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The descriptions of two co-occurring cardioid crustaceans from the Ballagan Formation (Tournaisian, Lower Carboniferous) of Chirnside, Scottish Borders, help to resolve the taxonomy of the genus Tealliocaris. Tealliocaris robusta Peach, 1908 is assigned to Schramocaris to form S. robusta (Peach, 1908) comb. nov. on the basis of morphological characters such as the rugosity and position of the branchial carinae as well as the nature of the pleon, and becomes the earliest representative of this genus in Scotland. A new species of Tealliocaris is also recognised from this locality and is described as T. briggsi sp. nov., based on the smooth carapace, lack of pleonic grooves and the number of spines on the scaphocerite and lateral margin of the anterior carapace. The systematic position of the Pendleian specimens identified by Peach (1908) as ‘Tealliocaris robusta var.’ is finally resolved and described as T. weegie sp. nov.
To determine if the intention to perform an exercise at speed leads to beneficial alterations in kinematic and kinetic components of the movement in people with post-stroke hemiplegia.
Design:
Comparative study.
Setting:
Subacute metropolitan rehabilitation hospital.
Participants:
Convenience sample of patients admitted as an inpatient or outpatient with a diagnosis of stroke with lower limb weakness, functional ambulation category score ≥3, and ability to walk ≥14metres.
Methods:
Participants performed a single leg squat exercise on their paretic and nonparetic legs on a leg sled under three conditions: 1) self-selected speed (SS), 2) fast speed (FS), 3) jump squat (JS). Measures of displacement, flight time, peak concentric velocity, and muscle excitation (via electromyography) were compared between legs and conditions.
Results:
Eleven participants (age: 56 ± 17 years; median time since stroke onset: 3.3 [IQR 3,41] months) were tested. All participants achieved a jump during the JS, as measured by displacement and flight time respectively, on both their paretic (0.25 ± 0.16 m and 0.42 ± 0.18 s) and nonparetic (0.49 ± 0.36 m and 0.73 ± 0.28 s) legs; however it was significantly lower on the non-paretic leg (p < 0.05). Peak concentric velocity increased concordantly with intended movement speed (JS-FS paretic: 0.96 m/s, non-paretic: 0.54 m/s; FS-SS paretic 0.69 m/s, nonparetic 0.38 m/s; JS-SS paretic 1.66 m/s, non-paretic 0.92 m/s). Similarly, muscle excitation increased significantly (p < 0.05) with faster speed for the paretic and nonparetic vastus lateralis. For gastrocnemius, the only significant difference was an increase during nonparetic JS vs. SS and FS.
Conclusions:
Speed affects the kinematic and kinetic components of the movement. Performing exercises ballistically may improve training outcomes for people post-stroke.
Many studies have reported associations between prenatal stress and the development of psychotic, anxiety and depressive disorders; however, to date no studies have investigated potential associations with personality disorders.
Aims
This study investigated potential associations between exposure to prenatal stress and personality disorder in offspring.
Method
In a subsample (N = 3626) of a large Finnish birth cohort, we used logistic regression models to examine associations between self-reported maternal stress during pregnancy, collected monthly during antenatal clinic appointments, and personality disorder in offspring. Familial and outcome information were obtained by linking data from the Finnish Hospital Discharge Register and the Finnish Population Register.
Results
Compared with those unexposed, children exposed to any maternal stress during gestation had three times the odds of developing a personality disorder (odds ratio 2.76, 95% CI 1.59–4.80, P = 0.000). Those exposed to moderate stress had three times the odds (odds ratio 3.13, 95% CI 1.42–6.88, P = 0.005) and those exposed to severe stress had seven times the odds (odds ratio 7.06, 95% CI 2.10–23.81, P = 0.002) of developing a personality disorder. These associations remained after adjusting for parental psychiatric history, comorbid psychiatric diagnoses, prenatal smoking and antenatal depression.*
Conclusions
Exposure to stress during gestation increases the odds of personality disorder in offspring, independent of other psychiatric disorders. These results suggest the assessment of maternal stress and well-being during pregnancy may be useful in identifying those at greatest risk of developing personality disorder, and highlight the importance of prenatal care for good maternal mental health during pregnancy.
Psychotic experiences (PEs) are common in childhood and adolescence and their association with mental disorders is well-established. We aim to conduct a quantitative synthesis the literature on the relationship between childhood and adolescent PEs and (i) any mental disorder; and (ii) specific categories of mental disorder, while stratifying by study design.
Method
Three electronic databases (PUBMED, PsycINFO and EMBASE) were searched from inception to August 2017 for all the published literature on childhood and adolescent PEs and mental disorder (outcome) in non-help-seeking community samples. Study quality was assessed using a recognised quality assessment tool for observational studies. Two authors conducted independent data extraction. Pooled odds ratios were calculated for mental disorders using random-effects models. Additional analyses were conducted investigating different categories of mental disorder while stratifying by study design.
Results
Fourteen studies from 13 community samples (n = 29 517) were identified with 9.8% of participants reporting PEs. PEs were associated with a three-fold increased risk of any mental disorder [odds ratio (OR) 3.08, confidence interval (CI) 2.26–4.21, k = 12]. PEs were associated with four-fold increase risk of psychotic disorder (OR 3.96, CI 2.03–7.73, population-attributable-fraction: 23.2%, k = 5). In addition, PEs were associated with an increased risk of affective disorders, anxiety disorders, behavioural disorders and substance-use disorders. Few longitudinal studies have investigated childhood and adolescent PEs and subsequent non-psychotic disorders which limited a meaningful synthesis and interpretation of these results.
Conclusion
This meta-analysis confirms that PEs are prevalent in childhood and adolescent community samples and are associated with a variety of mental disorders beyond psychotic disorders. Further longitudinal research is necessary to fully determine the longitudinal relationship between PEs and non-psychotic disorders.
Breast milk is the only source of the essential amino acid tryptophan (TRP) in breast-fed infants. Low levels of TRP could have implications for infant neurodevelopment. The objectives of the present study were to compare the relationship of TRP and its neuroactive pathway metabolites kynurenine (Kyn) and kynurenic acid (KynA) in preterm and term expressed breast milk (EBM) in the first 14 d following birth, and the relationship of TRP metabolism to maternal stress and immune status. A total of twenty-four mothers were recruited from Cork University Maternity Hospital: twelve term (>38 weeks) and twelve preterm (<35 weeks). EBM samples were collected on days 7 and 14. Free TRP, Kyn and KynA were measured using HPLC, total TRP using MS, cytokines using the Meso Scale Discovery (MSD) assay system, and cortisol using a cortisol ELISA kit. Although total TRP was higher in preterm EBM in comparison with term EBM (P < 0·05), free TRP levels were lower (P < 0·05). Kyn, KynA and the Kyn:TRP ratio increased significantly in term EBM from day 7 to day 14 (P < 0·05), but not in preterm EBM. TNF-α, IL-6 and IL-8 were higher in day 7 preterm and term EBM in comparison with day 14. There were no significant differences between term and preterm EBM cortisol levels. Increased availability of total TRP, lower levels of free TRP and alterations in the temporal dynamics of TRP metabolism in preterm compared with term EBM, coupled with higher EBM inflammatory markers on day 7, may have implications for the neurological development of exclusively breast-fed preterm infants.
Traditionally health statistics are derived from civil and/or vital registration. Civil registration in low- to middle-income countries varies from partial coverage to essentially nothing at all. Consequently the state of the art for public health information in low- to middle-income countries is efforts to combine or triangulate data from different sources to produce a more complete picture across both time and space – data amalgamation. Data sources amenable to this approach include sample surveys, sample registration systems, health and demographic surveillance systems, administrative records, census records, health facility records and others. We propose a new statistical framework for gathering health and population data – Hyak – that leverages the benefits of sampling and longitudinal, prospective surveillance to create a cheap, accurate, sustainable monitoring platform. Hyak has three fundamental components:
•Data amalgamation: A sampling and surveillance component that organizes two or more data collection systems to work together: (1) data from HDSS with frequent, intense, linked, prospective follow-up and (2) data from sample surveys conducted in large areas surrounding the Health and Demographic Surveillance System (HDSS) sites using informed sampling so as to capture as many events as possible;
•Cause of death: Verbal autopsy to characterize the distribution of deaths by cause at the population level; and
•Socioeconomic status (SES): Measurement of SES in order to characterize poverty and wealth.
We conduct a simulation study of the informed sampling component of Hyak based on the Agincourt HDSS site in South Africa. Compared with traditional cluster sampling, Hyak's informed sampling captures more deaths, and when combined with an estimation model that includes spatial smoothing, produces estimates of both mortality counts and mortality rates that have lower variance and small bias.
A diverse millipede (diplopod) fauna has been recovered from the earliest Carboniferous (Tournaisian) Ballagan Formation of the Scottish Borders, discovered by the late Stan Wood. The material is generally fragmentary; however, six different taxa are present based on seven specimens. Only one displays enough characters for formal description and is named Woodesmus sheari Ross, Edgecombe & Clark gen. & sp. nov. The absence of paranota justifies the erection of Woodesmidae fam. nov. within the Archipolypoda. The diverse fauna supports the theory that an apparent lack of terrestrial animal fossils from ‘Romer's Gap' was due to a lack of collecting and suitable deposits, rather than to low oxygen levels as previously suggested.
Two new species of Schramocaris from the Viséan, Lower Carboniferous of Scotland and eastern Canada extend the range and distribution of this crustacean along the northwestern coast of the Rheic Ocean. New species from Glencartholm, southern Scotland and Upperton, New Brunswick, Canada represents the first recognised occurrence of this genus in Scotland and Canada. The Scottish species is here named S. clarksoni; it lacks the rugosity of the carinae of Schramocaris gilljonesorum, but has the same relative position of the carinae, as well as similar characteristics of the pleon, such as the relative lengths of the somites and the shape of the telson. The Canadian species is named Schramocaris matthewi on the basis of the papillations on the cuticle and robust second carinae of the carapace. The deposits at both these localities are that of a shallow marine argillaceous environment, although the Glencartholm deposit contains more lime. Schramocaris has previously only been known from the Avon Group (Hastarian) of the Forest of Dean, England.
Objectives: (1) Evaluate the features of purpose-built apartment living on access, environmental control, and home and community mobility of people living with neurotrauma and (2) Examine tenant perceptions of those features.
Research design: Observational case series pilot study. Setting: Three apartments within a residential development in Melbourne, Australia. Participants: Three males (aged 30–55 years) with traumatic brain and/or spinal cord injury living in the three separate apartments.
Method and procedures: Measures: Two-published measures of user experience of built and technology environments, coupled with customised interdisciplinary post-occupancy evaluation (POE) methods and GPS-enabled mobility tracking. Analysis: Measures completed per manual guidelines and data reported descriptively. Customised measured drawings produced to represent tenants’ physical access and mobility. GPS community mobility data plotted on Google Earth.
Results: Built design features which enabled access and mobility included linear paths of travel, well-located furnishings, and joinery design that allowed approach from either side using a wheelchair. Personal home furnishing choices posed barriers to physical access. Home automation technologies positively influenced participants’ sense of control and independence, but posed learning challenges. Close proximity of housing to accessible public transport and services enabled community travel options.
Conclusion: Findings from this pilot study indicate the combination of housing location, design and technologies used, together with availability of local community services, provides an acceptable level of environmental control, access, mobility and tenant experience. Further research is required to determine validity of the novel measures used, and deliver rigorous research design to evaluate those features most important in achieving optimal outcomes.
Stroke is a leading cause of disability worldwide, with approximately one third of people left with permanent deficits impacting on their function. This may contribute to a physically inactive lifestyle and further associated health issues. Current research suggests that people after stroke are not meeting the recommended levels of physical activity, and are less active than people with other chronic illnesses. Thus, it is important to understand how to support people after stroke to uptake and maintain physical activity. Wearable sensors and mobile health (mHealth) technologies are a potential platform to measure and promote physical activity. Some of these technologies may incorporate behaviour change techniques such as real-time feedback. Although wearable activity trackers and smartphone technology are widely available, the feasibility and applicability of these technologies for people after stroke is unclear. This article reviews the devices available for assessment of physical activity in stroke and discusses the potential for advances in technology to promote physical activity in this population.
Obstetric anaesthesia poses a convergence of all the ethical and consensual dilemmas only encountered infrequently in other areas of anaesthetic practice. The patient population typically ranges from teenagers upwards, with varying degrees of capacity to consent, a varying level of understanding and information provision, but a universally high degree of expectation. Patients can present in a time-critical manner and the treatment of the mother or the baby may cause risk to one to save the other. The anaesthetist, however, is well placed to provide a unifying voice of reason in this difficult arena. Therefore it is incumbent on us to have a good grasp of all the pertinent issues. This chapter will cover the issues of consent in the obstetric population, the legal background which underpins our current situation, and finally the ethical controversy that surrounds pregnancy testing in the under-16s.
Consent
We perform consent for a number of reasons: ethical, legal and regulatory body requirements.
Ethical considerations
Ethically there are a couple of underlying principles which govern our actions in this area. The Select Committee of Medical Ethics ruled in their report in 1994 that:
Alongside the principle that human life is of special value, the principle is widely held that an individual should have some measure of autonomy to make choices about his or her life … As the law stands medical treatment may be given to competent adult patients only with their informed consent, except in an emergency.
Making your own decisions, whether this involves consenting or withholding consent, of itself promotes welfare. Seeking consent helps to establish trust between the doctor and patient, and actively involves the patient in their own care. The requirement of consent therefore promotes individual autonomy and encourages rational decision-making. These derive from the basic principle of the right to self-determination, complemented by the principle of respect for persons.
Legal considerations
The Department of Health has released the Reference Guide to Consent for Examination or Treatment (2009), which provides a guide to the legal framework that all health professionals need to take account of in obtaining valid consent for any examination, treatment or care that they propose to undertake. It stems from the case law that exists within English law and from Court of Appeal judgements, as well as the European Court of Human Rights.
Trauma is a leading cause of morbidity and mortality worldwide, with the majority occurring in low- and middle-income countries (LMICs). Allied health workers are often on the front lines of caring for trauma patients; this is the case in South Sudan, where a system of community health workers (CHWs) and clinical officers (COs) form an essential part of the health care structure. However, curricula for these workers vary, and it is unclear how much these training programs include trauma education.
Hypothesis/Methods
The CHW training curriculum in South Sudan was reviewed to evaluate the degree to which it incorporates trauma education, according to established guidelines from the World Health Organization (WHO). To the authors’ knowledge, this is the first formal comparison of a CHW curriculum with established WHO trauma guidelines.
Results
The curriculum incorporated a number of essential components of the WHO guidelines; however, the concepts taught were limited in scope. The curriculum only covered about 50% of the content required for basic providers, with major deficiencies being in the management of head and spinal injuries, safety protocols for health care personnel, and in the management of pediatric patients.
Discussion/Conclusion
The CHW training curriculum lacks the requisite content to provide adequately a basic level of trauma care and requires amending to ensure that all South Sudan citizens receive appropriate treatment. It is recommended that other LMICs review their existing training curricula in order to improve their ability to provide adequate trauma care and to ensure they meet the basic WHO guidelines.
OgunniyiA, ClarkM, DonaldsonR. Analysis of Trauma Care Education in the South Sudan Community Health Worker Training Curriculum. Prehosp Disaster Med. 2015; 30(2): 18
This village level study in Senegal seeks to improve the understanding of peasant behavior in developing countries. Policy makers designing programs for and interventions in the agricultural sector should benefit from an enhanced understanding of the workings of rural grain transactions. The study attempts (1) to provide a summary of principal producer grain transactions and (2) to discuss in greater detail millet marketing in rural Senegal. The methodology presented and conclusions advanced should encourage other researchers and Third World governments to recognize that evaluations of market process are vital to design effective agricultural policies.
For example, many West African countries have chosen to rely on national marketing organizations instead of using the private trader to commercialize food grains. Such reliance stems from their belief that the private market is noncompetitive and that public sector intervention will lead to efficiency gains. The conclusions of this study show that policy makers should first test the assumption of noncompetitive behavior before assuming that intervention will provide greater efficiency.
The first section of this paper provides some background information on Senegal agriculture. Next comes a summary of producer transactions. An analysis of the millet marketing process appears in the third section, while the last section indicates some policy implications.