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The behavioural development of 90 chimpanzees (Pan troglodytes) was followed. Of these, 65 had been separated from their mothers to prevent casualties or, at a later age, to increase breeding success. Some showed body rocking and others did not. To obtain insight into the causes of the onset and development of body rocking, chimpanzees raised with peers, with their mother, or in a semi-natural group were compared Rocking was never observed in the semi-natural group. It was occasionally seen when with the mother. Separation from the mother soon after birth induced anxiety and rocking developed after sitting upright had developed. Rocking levels of three per cent of the time were still present at seven to nine years of age.
The most probable causes of the development of rocking are frustrating social circumstances and the inability to cope with these. Merging groups, disturbances and the introduction of a fearful object increased rocking in the individuals that had developed the habit. However, rockers reacted less to those circumstances than non-rockers, showing smaller increase in body contact and less reduction of play. This finding suggests that rocking, instead of being a bizarre reaction to unsurmountable stress, could be a behaviour that helps an individual to cope with difficulties and stress. In terms of animal welfare, rocking in chimpanzees housed in laboratory conditions is an indication of a less optimal reaction pattern to frustrating circumstances. The development of rocking may be prevented if the babies are left with the mother and in their social group. Rocking after (late) separation may be prevented when transfer takes place together with familiar peers.
Recently, the existence of so-called granular bubbles and droplets has been demonstrated experimentally. Granular bubbles and droplets are clusters of particles that respectively rise and sink if submerged in an aerated and vibrated bed of another granular material of different size and/or density. However, currently, there is no model that explains the coherent motion of these clusters and predicts the transition between a rising and sinking motion. Here, we propose an analytical model predicting accurately the neutral buoyancy limit of a granular bubble/droplet. This model allows the compilation of a regime map identifying five distinct regimes of granular bubble/droplet motion.
This article is a clinical guide which discusses the “state-of-the-art” usage of the classic monoamine oxidase inhibitor (MAOI) antidepressants (phenelzine, tranylcypromine, and isocarboxazid) in modern psychiatric practice. The guide is for all clinicians, including those who may not be experienced MAOI prescribers. It discusses indications, drug-drug interactions, side-effect management, and the safety of various augmentation strategies. There is a clear and broad consensus (more than 70 international expert endorsers), based on 6 decades of experience, for the recommendations herein exposited. They are based on empirical evidence and expert opinion—this guide is presented as a new specialist-consensus standard. The guide provides practical clinical advice, and is the basis for the rational use of these drugs, particularly because it improves and updates knowledge, and corrects the various misconceptions that have hitherto been prominent in the literature, partly due to insufficient knowledge of pharmacology. The guide suggests that MAOIs should always be considered in cases of treatment-resistant depression (including those melancholic in nature), and prior to electroconvulsive therapy—while taking into account of patient preference. In selected cases, they may be considered earlier in the treatment algorithm than has previously been customary, and should not be regarded as drugs of last resort; they may prove decisively effective when many other treatments have failed. The guide clarifies key points on the concomitant use of incorrectly proscribed drugs such as methylphenidate and some tricyclic antidepressants. It also illustrates the straightforward “bridging” methods that may be used to transition simply and safely from other antidepressants to MAOIs.
This report describes a cluster of patients infected by Serratia marcescens in a metropolitan neonatal intensive care unit (NICU) and a package of infection control interventions that enabled rapid, effective termination of the outbreak.
Design:
Cross-sectional analytical study using whole-genome sequencing (WGS) for phylogenetic cluster analysis and identification of virulence and resistance genes.
Setting:
NICU in a metropolitan tertiary-care hospital in Sydney, Australia.
Patients:
All neonates admitted to the level 2 and level 3 neonatal unit.
Interventions:
Active inpatient and environmental screening for Serratia marcescens isolates with WGS analysis for identification of resistance genes as well as cluster relatedness between isolates. Planning and implementation of a targeted, multifaceted infection control intervention.
Results:
The cluster of 10 neonates colonized or infected with Serratia marcescens was identified in a metropolitan NICU. Two initial cases involved devastating intracranial infections with brain abscesses, highlighting the virulence of this organism. A targeted and comprehensive infection control intervention guided by WGS findings enabled termination of this outbreak within 15 days of onset. WGS examination demonstrated phylogenetic linkage across the cluster, and genomic unrelatedness of later strains identified in the neonatal unit and elsewhere.
Conclusions:
A comprehensive, multipronged, infection control package incorporating close stakeholder engagement, frequent microbiological patient screening, environmental screening, enhanced cleaning, optimization of hand hygiene and healthcare worker education was paramount to the prompt control of Serratia marcescens transmission in this neonatal outbreak. WGS was instrumental in establishing relatedness between isolates and identification of possible transmission pathways in an outbreak setting.
American Indian and Alaska Native peoples (AI/AN) have a disproportionately high rate of obesity, but little is known about the social determinants of obesity among older AI/AN. Thus, our study assessed social determinants of obesity in AI/AN aged ≥ 50 years.
Design:
We conducted a cross-sectional analysis using multivariate generalised linear mixed models to identify social determinants associated with the risk of being classified as obese (BMI ≥ 30·0 kg/m2). Analyses were conducted for the total study population and stratified by median county poverty level.
Setting:
Indian Health Service (IHS) data for AI/AN who used IHS services in FY2013.
Participants:
Totally, 27 696 AI/AN aged ≥ 50 years without diabetes.
Results:
Mean BMI was 29·8 ± 6·6 with 43 % classified as obese. Women were more likely to be obese than men, and younger ages were associated with higher obesity risk. While having Medicaid coverage was associated with lower odds of obesity, private health insurance was associated with higher odds. Living in areas with lower rates of educational attainment and longer drive times to primary care services were associated with higher odds of obesity. Those who lived in a county where a larger percentage of people had low access to a grocery store were significantly less likely to be obese.
Conclusions:
Our findings contribute to the understanding of social determinants of obesity among older AI/AN and highlight the need to investigate AI/AN obesity, including longitudinal studies with a life course perspective to further examine social determinants of obesity in older AI/AN.
Fluting is a technological and morphological hallmark of some of the most iconic North American Paleoindian stone points. Through decades of detailed artifact analyses and replication experiments, archaeologists have spent considerable effort reconstructing how flute removals were achieved, and they have explored possible explanations of why fluting was such an important aspect of early point technologies. However, the end of fluting has been less thoroughly researched. In southern North America, fluting is recognized as a diagnostic characteristic of Clovis points dating to approximately 13,000 cal yr BP, the earliest widespread use of fluting. One thousand years later, fluting occurs more variably in Dalton and is no longer useful as a diagnostic indicator. How did fluting change, and why did point makers eventually abandon fluting? In this article, we use traditional 2D measurements, geometric morphometric (GM) analysis of 3D models, and 2D GM of flute cross sections to compare Clovis and Dalton point flute and basal morphologies. The significant differences observed show that fluting in Clovis was highly standardized, suggesting that fluting may have functioned to improve projectile durability. Because Dalton points were used increasingly as knives and other types of tools, maximizing projectile functionality became less important. We propose that fluting in Dalton is a vestigial technological trait retained beyond its original functional usefulness.
Field studies were conducted in North Carolina in 2018 and 2019 to determine sweetpotato tolerance to indaziflam and its effectiveness in controlling Palmer amaranth in sweetpotato. Treatments included indaziflam pre-transplant; 7 d after transplanting (DATr) or 14 DATr at 29, 44, 58, or 73 g ai ha−1; and checks (weedy and weed-free). Indaziflam applied postemergence caused transient foliar injury to sweetpotato. Indaziflam pretransplant caused less injury to sweetpotato than other application timings regardless of rate. Palmer amaranth control was greatest when indaziflam was applied pretransplant or 7 DATr. In a weed-free environment, sweetpotato marketable yield decreased as indaziflam application was delayed. No differences in storage root length to width ratio were observed.
Evidence of Late Triassic large tetrapods from the UK is rare. Here, we describe a track-bearing surface located on the shoreline near Penarth, south Wales, United Kingdom. The total exposed surface is c. 50 m long and c. 2 m wide, and is split into northern and southern sections by a small fault. We interpret these impressions as tracks, rather than abiogenic sedimentary structures, because of the possession of marked displacement rims and their relationship to each other with regularly spaced impressions forming putative trackways. The impressions are large (up to c. 50 cm in length), but poorly preserved, and retain little information about track-maker anatomy. We discuss alternative, plausible, abiotic mechanisms that might have been responsible for the formation of these features, but reject them in favour of these impressions being tetrapod tracks. We propose that the site is an additional occurrence of the ichnotaxon Eosauropus, representing a sauropodomorph trackmaker, thereby adding a useful new datum to their sparse Late Triassic record in the UK. We also used historical photogrammetry to digitally map the extent of site erosion during 2009–2020. More than 1 m of the surface exposure has been lost over this 11-year period, and the few tracks present in both models show significant smoothing, breakage and loss of detail. These tracks are an important datapoint for Late Triassic palaeontology in the UK, even if they cannot be confidently assigned to a specific trackmaker. The documented loss of the bedding surface highlights the transient and vulnerable nature of our fossil resources, particularly in coastal settings, and the need to gather data as quickly and effectively as possible.
Early intervention in psychosis (EIP) services target the early manifestation of psychosis and provide multidisciplinary care. They demonstrate effectiveness and cost-effectiveness. Implementation of EIP services is inconsistent and piecemeal. This systematic review and narrative synthesis aims to identify barriers and facilitators to EIP service implementation.
Methods
We conducted an electronic search of databases (EMBASE, Medline, Web of Science, and PsychINFO) to detect papers reporting EIP service implementation findings and associated barriers and facilitators. The search occurred between June to August 2020, and again in January 2021. Articles meeting inclusion criteria were extracted and narratively synthesized. A quality assessment was conducted using the Mixed Methods Appraisal Tool.
Results
Twenty-three studies were selected. The most common study design was descriptive accounts of implementation. Patient age ranged varied from 14 to 35 years. We identified three barrier and facilitator domains: (a) system; (b) services; and (c) staff, and a range of subdomains. The most frequent subdomains were “funding” and “strength of collaboration and communication between EIP and outside groups and services”. Associations between domains and subdomains were evident, particularly between systems and services.
Conclusions
A range of barriers and facilitators to EIP implementation exist. Some of these are generic factors germane across health systems and services, while others are specific to EIP services. A thorough prior understanding of these challenges and enablers are necessary before implementation is attempted. Accounting for these issues within local and national contexts may help predict and increase the likelihood of services’ success, stability, and longevity.
What is the rule of law, and under what conditions does it become a self-reinforcing, stable order? Missing from the various literatures that have attempted an answer is a coherent attempt to create a satisfying account of the microfoundations of the behaviors that generate and sustain a distinctively legal order. Whether philosophical or applied, existing approaches to the rule of law have neglected the question of what, exactly, is distinct about law’s rule. We do not yet know enough about what sets legal ordering apart from other strategies of ordering, be they economic, political, or violent.1 This chapter responds to this lacuna. In so doing it gives an account of the kinds of things required for a positive theory of the rule of law.
Case identification is an ongoing issue for the COVID-19 epidemic, in particular for outpatient care where physicians must decide which patients to prioritise for further testing. This paper reports tools to classify patients based on symptom profiles based on 236 severe acute respiratory syndrome coronavirus 2 positive cases and 564 controls, accounting for the time course of illness using generalised multivariate logistic regression. Significant symptoms included abdominal pain, cough, diarrhoea, fever, headache, muscle ache, runny nose, sore throat, temperature between 37.5 and 37.9 °C and temperature above 38 °C, but their importance varied by day of illness at assessment. With a high percentile threshold for specificity at 0.95, the baseline model had reasonable sensitivity at 0.67. To further evaluate accuracy of model predictions, leave-one-out cross-validation confirmed high classification accuracy with an area under the receiver operating characteristic curve of 0.92. For the baseline model, sensitivity decreased to 0.56. External validation datasets reported similar result. Our study provides a tool to discern COVID-19 patients from controls using symptoms and day from illness onset with good predictive performance. It could be considered as a framework to complement laboratory testing in order to differentiate COVID-19 from other patients presenting with acute symptoms in outpatient care.
To audit compliance of mental health assessment rooms in Irish adult emergency departments (EDs) which are open 24 hours on 7 days a week with standards identified by the Psychiatric Liaison Accreditation Network (PLAN).
Methods
A self-audit tool was sent via email to Clinical Nurse Specialists and Consultant Psychiatrists in Ireland’s 26 Adult EDs that are open 24 hours on seven days a week. Results were collated and are presented ensuring anonymity.
Results
A response rate of 100% was achieved. Full or substantial compliance with PLAN standards was recorded in 73% of services. In seven services, the rooms used for mental health assessments were unsuitable when measured against the PLAN standards. A number of services identified the presence of ligature points within the rooms.
Conclusion
The Health Service Executive (HSE) National Clinical Programme for the Assessment and Management of patients presenting to the ED following self-harm is committed to achieving 100% compliance with PLAN standards in all services. Recommendations include introducing formal ligature risk assessments and risk assessments of the use of the assessment rooms. The Chief Executive Officers of all hospital groups were informed of the results of the audits and advised on recommendations for each hospital ED.
Critical shortages of personal protective equipment, especially N95 respirators, during the coronavirus disease 2019 (COVID-19) pandemic continues to be a source of concern. Novel methods of N95 filtering face-piece respirator decontamination that can be scaled-up for in-hospital use can help address this concern and keep healthcare workers (HCWs) safe.
Methods:
A multidisciplinary pragmatic study was conducted to evaluate the use of an ultrasonic room high-level disinfection system (HLDS) that generates aerosolized peracetic acid (PAA) and hydrogen peroxide for decontamination of large numbers of N95 respirators. A cycle duration that consistently achieved disinfection of N95 respirators (defined as ≥6 log10 reductions in bacteriophage MS2 and Geobacillus stearothermophilus spores inoculated onto respirators) was identified. The treated masks were assessed for changes to their hydrophobicity, material structure, strap elasticity, and filtration efficiency. PAA and hydrogen peroxide off-gassing from treated masks were also assessed.
Results:
The PAA room HLDS was effective for disinfection of bacteriophage MS2 and G. stearothermophilus spores on respirators in a 2,447 cubic-foot (69.6 cubic-meter) room with an aerosol deployment time of 16 minutes and a dwell time of 32 minutes. The total cycle time was 1 hour and 16 minutes. After 5 treatment cycles, no adverse effects were detected on filtration efficiency, structural integrity, or strap elasticity. There was no detectable off-gassing of PAA and hydrogen peroxide from the treated masks at 20 and 60 minutes after the disinfection cycle, respectively.
Conclusion:
The PAA room disinfection system provides a rapidly scalable solution for in-hospital decontamination of large numbers of N95 respirators during the COVID-19 pandemic.
Casein glycomacropeptide (CGMP) is a bioactive milk-derived peptide with potential anti-inflammatory effects. Animal studies suggest that CGMP may work by altering gut microbiota composition and enhancing butyrate production. Its effects on intestinal homoeostasis, microbiota and metabolites in humans are unknown. The aim of the present study was to assess both the intestinal and systemic immunomodulatory effects of orally ingested CGMP. We hypothesised that daily oral CGMP intake would reduce high-sensitive C-reactive protein (hsCRP) in healthy adults. In a single-centre limited but randomised, double-blinded, reference-controlled study, we compared the effects of a 4-week intervention of either 25 g of oral powder-based chocolate-flavoured CGMP or a reference drink. We included twenty-four healthy adults who all completed the study. CGMP had no systemic or intestinal immunomodulatory effects compared with a reference drink, with regard to either hsCRP or faecal calprotectin level, faecal microbiota composition or faecal SCFA content. CGMP ingestion did not affect satiety or body weight, and it caused no severe adverse events. The palatability of CGMP was acceptable, and adherence was high. CGMP did not induce or change gastrointestinal symptoms. In conclusion, we found no immunomodulatory effects of CGMP in healthy adults. In a minor group of healthy adults, oral ingestion of 25 g of CGMP during 4 weeks was safe, well tolerated, had acceptable palatability and was without any effects on body weight.
In recent years, there has been increased use of dicamba due to the introduction of dicamba-resistant cotton and soybean in the United States. Therefore, there is a potential increase in off-target movement of dicamba and injury to sensitive crops. Flue-cured tobacco is extremely sensitive to auxin herbicides, particularly dicamba. In addition to yield loss, residue from drift or equipment contamination can have severe repercussions for the marketability of the crop. Studies were conducted in 2016, 2017, and 2018 in North Carolina to evaluate spray-tank cleanout efficiency of dicamba using various cleaning procedures. No difference in dicamba recovery was observed regardless of dicamba formulation and cleaning agent. Dicamba residue decreased with the number of rinses. There was no difference in dicamba residue recovered from the third rinse compared with residue from the tank after being refilled for subsequent tank use. Recovery ranged from 2% to 19% of the original concentration rate among the three rinses. Field studies were also conducted in 2018 to evaluate flue-cured tobacco response to reduced rates of dicamba ranging, from 1/5 to 1/10,000 of a labeled rate. Injury and yield reductions varied by environment and application timing. When exposed to 1/500 of a labeled rate at 7 and 11 wk after transplanting, tobacco injury ranged from 39% to 53% and 10% to 16% 24 days after application, respectively. The maximum yield reduction was 62%, with a 55% reduction in value when exposed to 112 g ha−1 of dicamba. Correlations showed significant relationships between crop injury assessment and yield and value reductions, with Pearson values ranging from 0.24 to 0.63. These data can provide guidance to growers and stakeholders and emphasize the need for diligent stewardship when using dicamba technology.
The number of refugees is at its highest since the Second World War and on the rise. Many refugees suffer from anxiety, depression and post-traumatic stress disorder (PTSD), but exact and up-to-date prevalence estimates are not available.
Aims
To report the pooled prevalence of anxiety and mood disorders and PTSD in general refugee populations residing in high-income countries and to detect sources of heterogeneity therein.
Method
Systematic review with meta-analyses and meta-regression.
Results
Systematic searches (final search date 3 August 2019) yielded 66 eligible publications that reported 150 prevalence estimates (total sample N = 14 882). Prevalence rates were 13 and 42% (95% CI 8–52%) for diagnosed and self-reported anxiety, 30 and 40% (95% CI 23–48%) for diagnosed and self-reported depression, and 29 and 37% (95% CI 22–45%) for diagnosed and self-reported PTSD. These estimates are substantially higher relative to those reported in non-refugee populations over the globe and to populations living in conflict or war settings, both for child/adolescent and adult refugees. Estimates were similar over different home and resettlement areas and independent of length of residence.
Conclusions
Our data indicate a challenging and persisting disease burden in refugees due to anxiety, mood disorders and PTSD. Knowing this is relevant for the development of public health policies of host countries. Scalable interventions, tailored for refugees, should become more readily available.
Management options are needed to limit sweetpotato yield loss due to weeds. Greenhouse studies were conducted in 2018 in Greensboro, NC, and in the field from 2016 to 2018 in Clinton, NC, to evaluate the effect of bicyclopyrone on sweetpotato and Palmer amaranth (field only). In greenhouse studies, Covington and NC04-531 clones were treated with bicyclopyrone (0, 25, 50, 100, or 150 g ai ha−1) either preplant (PP; i.e., immediately before transplanting) or post-transplant (PT; i.e., on the same day after transplanting). Sweetpotato plant injury and stunting increased, and vine length and shoot dry weight decreased with increasing rate of bicyclopyrone regardless of clone or application timing. In field studies, Beauregard (2016) or Covington (2017 and 2018) sweetpotato clones were treated with bicyclopyrone at 50 g ha−1 PP, flumioxazin at 107 g ai ha−1 PP, bicyclopyrone at 50 or 100 g ha−1 PP followed by (fb) S-metolachlor at 800 g ai ha−1 PT, flumioxazin at 107 g ha−1 PP fb S-metolachlor at 800 g ha−1 PT, flumioxazin at 107 g ha−1 PP fb S-metolachlor at 800 g ha−1 PT fb bicyclopyrone at 50 g ha−1 PT-directed, and clomazone at 420 g ai ha−1 PP fb S-metolachlor at 800 g ha−1 PT. Bicyclopyrone PP at 100 g ha−1 fb S-metolachlor PT caused 33% or greater crop stunting and 44% or greater marketable yield reduction compared with the weed-free check in 2016 (Beauregard) and 2017 (Covington). Bicyclopyrone PP at 50 g ha−1 alone or fb S-metolachlor PT resulted in 12% or less injury and similar no. 1 and jumbo yields as the weed-free check in 2 of 3 yr. Injury to Covington from bicyclopyrone PT-directed was 4% or less at 4 or 5 wk after transplanting and marketable yield was similar to that of the weed-free check in 2017 and 2018.
Children with complex CHD are at risk for psychopathology such as severe attention-deficit/hyperactivity disorder symptoms after congenital heart surgery.
Objective:
The aim of this study was to investigate if children with Ventricular Septal Defect, Transposition of Great Arteries, or Tetralogy of Fallot have an increased occurrence of attention-deficit/hyperactivity disorder symptoms compared with the background population and to investigate differences between the three CHDs in terms of occurrence and appearance of attention-deficit/hyperactivity disorder symptoms.
Method:
A national register-based survey was conducted, including children aged 10–16 years with surgically corrected CHDs without genetic abnormalities and syndromes. The Attention-Deficit/Hyperactivity Disorder-Rating Scale questionnaires were filled in by parents and school teachers.
Results:
In total, 159 out of 283 questionnaires were completed among children with CHDs and compared with age- and sex-matched controls. Children with CHDs had significantly increased inattention scores (p = 0.009) and total attention-deficit/hyperactivity disorder scores (p = 0.008) compared with controls. Post hoc analyses revealed that children with Tetralogy of Fallot had significantly higher inattention scores compared with children both with Ventricular Septal Defect (p = 0.043) and controls (p = 0.004).
Conclusion:
Attention-deficit/hyperactivity disorder symptoms and inattention symptoms were significantly more frequent among children aged 10–16 years with CHDs, in particular in children with corrected Tetralogy of Fallot.
Palmer amaranth is the most common and troublesome weed in North Carolina sweetpotato. Field studies were conducted in Clinton, NC, in 2016 and 2017 to determine the critical timing of Palmer amaranth removal in ‘Covington’ sweetpotato. Palmer amaranth was grown with sweetpotato from transplanting to 2, 3, 4, 5, 6, 7, 8, and 9 wk after transplanting (WAP) and maintained weed-free for the remainder of the season. Palmer amaranth height and shoot dry biomass increased as Palmer amaranth removal was delayed. Season-long competition by Palmer amaranth interference reduced marketable yields by 85% and 95% in 2016 and 2017, respectively. Sweetpotato yield loss displayed a strong inverse linear relationship with Palmer amaranth height. A 0.6% and 0.4% decrease in yield was observed for every centimeter of Palmer amaranth growth in 2016 and 2017, respectively. The critical timing for Palmer amaranth removal, based on 5% loss of marketable yield, was determined by fitting a log-logistic model to the relative yield data and was determined to be 2 WAP. These results show that Palmer amaranth is highly competitive with sweetpotato and should be managed as early as possible in the season. The requirement of an early critical timing of weed removal to prevent yield loss emphasizes the importance of early-season scouting and Palmer amaranth removal in sweetpotato fields. Any delay in removal can result in substantial yield reductions and fewer premium quality roots.