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Introduction: Optimizing naloxone dosing in the context of increasing fentanyl and ultra-potent opioid (UPO) prevalence is an important consideration for emergency health care providers. The goal of this systematic review was to evaluate the association between initial and cumulative naloxone doses on effective reversal and adverse events in undifferentiated and fentanyl/UPO overdoses. Methods: We searched Embase, MEDLINE, Cochrane Central Register of Controlled Trials, DARE, CINAHL, Science Citation Index, reference lists, toxicology websites, and conference proceedings from July to October 2018 and back to 1972. Our search included pertinent indexing terms for UPOs. We included interventional and observational studies reporting on naloxone administration for opioid toxicity reversal in people ≥12 years old. Additionally, we accessed non-traditional evidence sources (case reports and series) given this rapidly changing field. We conducted inclusion screens, data extraction and quality assessments in duplicate. We summarized study characteristics and where reported, analyzed number of patients with clinical response. Response was defined as not receiving further naloxone doses and remaining alive. Results: We included 174 studies (108 case reports and series, 55 observational, 9 interventional) with 26,660 subjects (median age 35.1; 74.2% male). We observed lower response among patients exposed to fentanyl/UPO versus heroin for initial naloxone doses ≤0.4mg (56.8% versus 80.2%) and > 0.4mg (27.0% versus 82.1%). Mean cumulative doses were higher for fentanyl/UPO (2.10 mg, SD 1.80 mg) versus heroin (1.48 mg, SD 1.68 mg) overdoses. In North American studies the median cumulative dose used was higher for fentanyl/UPO versus heroin overdoses. A dose-response curve for fentanyl/UPO studies showed marked variability in doses among responders, indicating heterogeneity. Adverse events reporting was inconsistent; 10% of subjects experienced withdrawal based on studies in which they were reported. Conclusion: This is the first systematic review to summarize proportion of patients with clinical response by naloxone dose provided. While variable reporting, study quality, heterogeneity, and our outcome definitions limit the conclusions we can draw, it appears that higher initial doses and in some cases, higher cumulative naloxone doses were used and may be necessary to reverse toxicity due to fentanyl/UPO compared to other opioids. High-quality prospective studies assessing effectiveness and safety are needed.
Despite the magnitude and protracted nature of the Rohingya refugee situation, there is limited information on the culture, mental health and psychosocial wellbeing of this group. This paper, drawing on a report commissioned by the United Nations High Commissioner for Refugees (UNHCR), aims to provide a comprehensive synthesis of the literature on mental health and psychosocial wellbeing of Rohingya refugees, including an examination of associated cultural factors. The ultimate objective is to assist humanitarian actors and agencies in providing culturally relevant Mental Health and Psychosocial Support (MHPSS) for Rohingya refugees displaced to Bangladesh and other neighbouring countries.
We conducted a systematic search across multiple sources of information with reference to the contextual, social, economic, cultural, mental health and health-related factors amongst Rohingya refugees living in the Asia-Pacific and other regions. The search covered online databases of diverse disciplines (e.g. medicine, psychology, anthropology), grey literature, as well as unpublished reports from non-profit organisations and United Nations agencies published until 2018.
The legacy of prolonged exposure to conflict and persecution compounded by protracted conditions of deprivations and displacement is likely to increase the refugees' vulnerability to wide array of mental health problems including posttraumatic stress disorder, anxiety, depression and suicidal ideation. High rates of sexual and gender-based violence, lack of privacy and safe spaces and limited access to integrated psychosocial and mental health support remain issues of concern within the emergency operation in Bangladesh. Another challenge is the limited understanding amongst the MHPSS personnel in Bangladesh and elsewhere of the language, culture and help-seeking behaviour of Rohingya refugees. While the Rohingya language has a considerable vocabulary for emotional and behavioural problems, there is limited correspondence between these Rohingya terms and western concepts of mental disorders. This hampers the provision of culturally sensitive and contextually relevant MHPSS services to these refugees.
The knowledge about the culture, context, migration history, idioms of distress, help-seeking behaviour and traditional healing methods, obtained from diverse sources can be applied in the design and delivery of culturally appropriate interventions. Attention to past exposure to traumatic events and losses need to be paired with attention for ongoing stressors and issues related to worries about the future. It is important to design MHPSS interventions in ways that mobilise the individual and collective strengths of Rohingya refugees and build on their resilience.
An insect trap constructed using three-dimensional (3D) printing technology was tested in potato (Solanum tuberosum Linnaeus; Solanaceae) fields to determine whether it could substitute for the standard yellow sticky card used to monitor Bactericera cockerelli (Šulc) (Hemiptera: Psylloidea: Triozidae). Sticky cards have shortcomings that prompted search for a replacement: cards are messy, require weekly replacement, are expensive to purchase, and accumulate large numbers of nontarget insects. Bactericera cockerelli on sticky cards also deteriorate enough that specimens cannot be tested reliably for the presence of vectored plant pathogens. A prototype trap constructed using 3D printing technology for monitoring Diaphorina citri Kuwayama (Hemiptera: Psylloidea: Liviidae) was tested for monitoring B. cockerelli. The trap was designed to attract B. cockerelli visually to the trap and then funnel specimens into preservative-filled vials at the trap bottom. Prototype traps were paired against yellow sticky cards at multiple fields to compare the captures of B. cockerelli between cards and traps. The prototype trap was competitive with sticky cards early in the growing season when B. cockerelli numbers were low. We estimated that two or three prototype traps would collect as many B. cockerelli as one sticky card under these conditions. Efficacy of the prototype declined as B. cockerelli numbers increased seasonally. The prototype trap accumulated nontarget taxa that are common on sticky cards (especially Thysanoptera and Diptera), and was also found to capture taxa of possible interest in integrated pest management research, including predatory insects, parasitic Hymenoptera, and winged Aphididae (Hemiptera), suggesting that the traps could be useful outside of the purpose targeted here. We believe that 3D printing technology has substantial promise for developing monitoring tools that exploit behavioural traits of the targeted insect. Ongoing work includes the use of this technology to modify the prototype, with a focus on making it more effective at capturing psyllids and less susceptible to capture of nontarget species.
Auditory hallucinations (AH) are often considered a sign of a psychotic disorder. This is promoted by the DSM-5 category of Other Specified Schizophrenia Spectrum And Other Psychotic Disorder (OSSSOPD), the diagnostic criteria for which are fulfilled with the sole presence of persistent AH, in the absence of any other psychotic symptoms. And yet, persistent AH are not synonymous with having a psychotic disorder, and should therefore not be uncritically treated as such. Many people who seek treatment for persistent AH have no other psychotic symptoms, have preserved reality-testing capacities, and will never develop a schizophrenia spectrum disorder. Instead, hallucinations may be the result of many different causes, including borderline personality disorder, post-traumatic stress disorder (PTSD), hearing loss, sleep disorders or brain lesions, and they may even occur outside the context of any demonstrable pathology. In such cases, the usage of the DSM-5 diagnosis of OSSSOPD would be incorrect, and it may prompt unwarranted treatment with antipsychotic medication. We therefore argue that a DSM-5 diagnosis of Schizophrenia Spectrum Disorder (or any other type of psychotic disorder) characterized by AH should require at least one more symptom listed under the A-criterion (i.e. delusions, disorganized speech, disorganized or catatonic behavior or negative symptoms). Adhering to these more stringent criteria may help to distinguish between individuals with persistent AH which are part of a psychotic disorder, for whom antipsychotic medication may be helpful, and individuals with AH in the absence of such a disorder who may benefit from other approaches (e.g. different pharmacological interventions, improving coping style, trauma-related therapy).
The energy distribution of HR 2142 is studied in order to test the hypothesis that this star is an interacting binary with a cool Roche–lobe filling companion. We find that, for any reasonable choice of Teff, the companion should have been detected in the red part of the spectrum. We propose instead that the Be star is the outcome of a case B mass-transfer, which has pun it up. It is now surrounded by a mass-loss disc, rather than an accretion disc and is accompanied by either a helium star (resembling the Φ Per system) or by a white dwarf. If the binary was born spinning rapidly, alternatively the companion may be a solar-type, unevolved main sequence star. In case of a Helium star companion, there may be Helium lines visible (like in Φ Per), or the helium star may be detectable in the XUV, e.g. by the ROSAT XUV instrument. A white dwarf companion may be accreting material from the disc around the Be star and may show low luminosity X-ray emission. This emission may have been seen in the ROSAT PSPC X-Ray Survey.
Disorganized attachment is associated with a host of negative developmental outcomes, leading to a growing interest in preventative interventions targeting the attachment relationship in infancy. The objective of this meta-analysis was to assess the effectiveness of interventions that aimed to prevent or reduce rates of disorganization among children at risk. We performed a literature search using PsycINFO, MEDLINE, and ProQuest databases for studies published between January 1989 and August 2016. All 16 studies (N = 1,360) included a control condition and reported postintervention rates of organized and disorganized attachments assessed by the Strange Situation Procedure. Results showed that, overall, interventions were effective in increasing rates of organized attachment compared to control conditions (d = 0.35, 95% CI [0.10–0.61]). Moderator analyses demonstrated that interventions were more effective (a) in more recently published studies than in older studies, (b) for maltreated samples than nonmaltreated samples, and (c) as children increased in age. These results have important implications for future development, tailoring, and implementation of attachment-based intervention programs.
Lower and middle income countries (LMICs) are home to >80% of the global population, but mental health researchers and LMIC investigator led publications are concentrated in 10% of LMICs. Increasing research and research outputs, such as in the form of peer reviewed publications, require increased capacity building (CB) opportunities in LMICs. The National Institute of Mental Health (NIMH) initiative, Collaborative Hubs for International Research on Mental Health reaches across five regional ‘hubs’ established in LMICs, to provide training and support for emerging researchers through hub-specific CB activities. This paper describes the range of CB activities, the process of monitoring, and the early outcomes of CB activities conducted by the five research hubs.
The indicators used to describe the nature, the monitoring, and the early outcomes of CB activities were developed collectively by the members of an inter-hub CB workgroup representing all five hubs. These indicators included but were not limited to courses, publications, and grants.
Results for all indicators demonstrate a wide range of feasible CB activities. The five hubs were successful in providing at least one and the majority several courses; 13 CB recipient-led articles were accepted for publication; and nine grant applications were successful.
The hubs were successful in providing CB recipients with a wide range of CB activities. The challenge remains to ensure ongoing CB of mental health researchers in LMICs, and in particular, to sustain the CB efforts of the five hubs after the termination of NIMH funding.
We show that there exists a simple geometric picture for the geometries of protoplanetary disks around Herbig Ae/Be stars that explains the two main kinds of spectral energy distributions found for these objects, and that makes predictions that are qualitatively in agreement with currently available spatially resolved images and/or interferometric measurements. Also it qualitatively explains the phenomenon of UX Orionis variability.
Using published data and new data from mm observations, we calculate spectral indices α(12μ-25μ), α(25μ-1.1mm) and α(1.1mm-2cm) for Be stars. The index α(25μ-1.1mm), obtained for 8 stars, shows two characteristics: 1) for “normal” Be stars the index decreases from earlier types towards later types, i.e., later type Be stars tend to have shallower spectra in the IR-radio region than earlier types; 2) the index for shell stars appears to have smaller values than that for normal Be stars with same spectral types.
We surveyed 0.5 square degrees in the Bar of the LMC with ISOCAM at 4.5 and 12 μm, and with DENIS in the I, J, and Ks bands. Our goal was to build a complete sample of Thermally-Pulsing AGB stars. Here we present the first analysis of 0.14 square degrees. In total we find about 300 TP-AGB stars. Among these TP-AGB stars, 9% are obscured AGB stars (high mass-loss rates); 9 of them were detected by IRAS, and only 1 was previously identified. Their luminosities range from 2 500 to 14 000 L⊙, with a distribution very similar to the one of optical TP-AGB stars (i.e. those with low mass-loss rates). Such a luminosity distribution, as well as the percentage of obscured stars among TP-AGB stars, is in very good agreement with the evolutionary models of Vassiliadis & Wood (1993) if most of the TP-AGB stars that we find have initial masses smaller than 1.5 to 2 M⊙.
We have performed a parameter study of the spectral evolution of a typical post-AGB star with particular emphasis on the evolution of the IRAS colours. The models are based on the latest evolutionary tracks by Blöcker (1995, A&A 297, 727 and A&A 299, 755), which are used to define the evolutionary rate and the mass loss history of the central star. The resulting model for the post-AGB star is then used to calculate the spectral evolution with the photo-ionization code CLOUDY (Ferland 1993, Univ. of Kentucky, Int. Report), which includes dust in the radiative transfer.
In his studies of the temperature fluctuation in the solar photosphere P. R. Wilson came to the conclusion that, in order to explain Edmond’s r.m.s. intensity fluctuation distribution against heliocentric angle, one is led, using two dimensional solutions for the equation of radiative transfer, to the existence of a sharp temperature fluctuation of about 660 K r.m.s. at a depth of 250 km below τ5000 = 0.03 and that this temperature fluctuation decreases sharply in the next 70 km. There also seems to be an indication that there exists a second temperature fluctuation maximum at a depth of approximately 100 km below the first one.
In a previous paper it was shown how one could improve upon the Böhm-Vitense model of the solar convection zone by the inclusion of four different length scales and by the determination of these length scales with the use of the quasi-Vitense model as developed by Unno. In this way the vertical wave number kz, associated with a characteristic eddy, can be determined by the integration of a second order differential equation. The integrations have to be started at a suitable depth and all model calculations depend critically on the assumed structure of the top layer.
In this review we present the ISO imaging of nebulae around Luminous Blue Variables. Three LBVs have been imaged with ISO: HR Car, AG Car and the LBV candidate G79.29+0.46. The ISOCAM instrument did not resolve the nebula around HR Car. However some nebular emission lines are seen in the spectral energy distribution of this source. A proper deconvolution of the images may resolve the nebula. For AG Car and G79.29+0.46 the nebula is clearly resolved. The structure and intensity distribution of the nebular emission is dependent on the wavelength, indicating a separation between the ionised matter and the dust in the nebulae. Some model calculations are presented for the G79.29+0.46 nebula.
GK Per, a classical nova system that erupted in 1901, is one of the more unusual examples of its type. It has the longest known orbital period for a classical nova (1.997d; Crampton, Cowley & Fisher 1986); and it contains a white dwarf primary with an evolved K2 sub-giant secondary. Most remarkably, the IRAS Sky Survey (1991) reveals that GK Per exhibits far-IR dust emission extending ~ 17′ to the NW and SE of the nova (Bode et al. 1987; Seaquist et al. 1989). We have re-analysed the IRAS data using maximum entropy reconstruction (Bontekoe et al. 1991; Bontekoe, Koper & Kester 1994) to resolve structures at a spatial resolution approaching the diffraction limit of IRAS, which is 1′ at 60 μm and 1.7′ at 100/μm.
We present spectra obtained with the Infared Space Observatory (ISO) of the dust shells surrounding several Luminous Blue Variables (LBVs), both in our galaxy and in the LMC. The 20-45 μm spectra of R71, AG Car and Wra 751 show prominent emission features from crystalline silicates. The composition of the crystalline silicates in LBV dust shells is compared to that found in other types of objects, such as (post)-AGB stars and red supergiants (RSG). Both Wra 751 and AG Car have a high ratio of pyroxenes to olivines. This suggests that the grains in both stars experienced very similar processing, but that this processing has lead to a higher abundance of pyroxenes compared to RSG. The dust composition of the three LBVs discussed here suggests dust formation in a cool outflow not unlike those of RSG.
A rationalized lithostratigraphy for the Great Scar Limestone Group of the southeast Askrigg Block is established. The basal Chapel House Limestone Formation, assessed from boreholes, comprises shallow-marine to supratidal carbonates that thin rapidly northwards across the Craven Fault System, onlapping a palaeotopographical high of Lower Palaeozoic strata. The formation is of late Arundian age in the Silverdale Borehole, its northernmost development. The overlying Kilnsey Formation represents a southward-thickening and upward-shoaling carbonate development on a S-facing carbonate ramp. Foraminiferal/algal assemblages suggest a late Holkerian and early Asbian age, respectively, for the uppermost parts of the lower Scaleber Force Limestone and upper Scaleber Quarry Limestone members, significantly younger than previously interpreted. The succeeding Malham Formation comprises the lower Cove Limestone and upper Gordale Limestone members. Foraminiferal/algal assemblages indicate a late Asbian age for the formation, contrasting with the Holkerian age previously attributed to the Cove Limestone. The members reflect a change from a partially shallow-water lagoon (Cove Limestone) to more open-marine shelf (Gordale Limestone), coincident with the onset of marked sea-level fluctuations and formation of palaeokarstic surfaces with palaeosoils in the latter. Facies variations along the southern flank of the Askrigg Block, including an absence of fenestral lime-mudstone in the upper part of the Cove Limestone and presence of dark grey cherty grainstone/packstone in the upper part the Gordale Limestone are related to enhanced subsidence during late Asbian movement on the Craven Fault System. This accounts for the marked thickening of both members towards the Greenhow Inlier.
Fell's Cave lies near the Magellan Straits of South America's Southern Cone. This was the first site to provide evidence of a late Pleistocene occupation of South America, and it is the site where the Fishtail projectile point type was defined. Previous radiocarbon ages from Fell's Cave on charcoal samples from three hearths in the late Pleistocene artifact-bearing levels yielded dates ranging from ca. 11,000 to 10,100 radiocarbon years before present. New radiocarbon dates on curated charcoal samples from these same hearths yield revised ages of ca. 10,800 to 10,400 radiocarbon years before present. These new dates from Fell's Cave agree well with ages from other South American sites in the Southern Cone with Fishtail points and show that the Fishtail projectile point was made from ca. 10,850 to 10,300 radiocarbon years before present or ca. 12,800 to 12,100 calibrated years before present.
In this paper we calculate and compare diagnosis and net premium rates for critical illness insurance using different models for the claim delay distribution (CDD). The choice of CDD affects the diagnosis rates and hence the net premium rates in two ways: through the estimation of missing dates of diagnosis and through the adjustment of the exposure to allow for claims diagnosed but not settled in the observation period. We consider two CDDs: a three-parameter Burr distribution and a lognormal distribution. Our conclusion, based on a single, but extensive, data set, is that net premium rates are not significantly affected by the choice of CDD.