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Perfectionism is a transdiagnostic risk factor across psychopathology. The Clinical Perfectionism Questionnaire (CPQ) was developed to assess change in order to provide clinical utility, but currently the psychometric properties of the CPQ with adolescents is unknown.
To assess the factor structure and construct validity of the CPQ in female adolescents.
The CPQ was administered to 267 females aged 14–19 years of age. Confirmatory factor analysis (CFA) was used to examine the validity of the two-factor model and a second-order factor model. Pearson correlations were used to evaluate the relationships between the CPQ and a wide range of measures of perfectionism, psychopathology and personality traits.
The study demonstrated internal consistency, construct validity and incremental validity of the CPQ in a sample of female adolescents. The CFA in the present study confirmed the two-factor model of the CPQ with Factor 1 relating to perfectionistic strivings and Factor 2 representing perfectionistic concerns. The second-order two factor model indicated no deterioration in fit.
The two-factor model of the CPQ fits with the theoretical definition of clinical perfectionism where the over-dependence of self-worth on achievement and concern over mistakes are key elements. The CPQ is suitable for use with female adolescents in future research that seeks to better understand the role of perfectionism in the range of mental illnesses that impact youth.
We examine the changes in funerary rituals from the Early Agricultural period (2100 BC–AD 50) to the Early Preclassic period (AD 475–750) and how these changes concurrently reflect changes in social relationships between the dead, their families, and the community. The predominant mortuary ritual in the Early Agricultural period was inhumation, possibly emphasizing a variety of identity intersections of the dead and the mourners in the treatment of the body while creating collective memories and remembrances through shared ways of commemorating the dead. An innovation in funerary practices in the form of secondary cremation appeared in the Early Agricultural period and was slowly but broadly adopted, representing new social dynamics within the society. Thereafter, secondary cremation became the main funeral custom. During the Early Preclassic period, the variation in body position and the type and quantity of objects found with individuals decreased. It is possible that the vehicle for displaying different identity intersections changed and was not placed in the body, per se, as much as in previous periods. However, the transformation characteristics of these funeral rituals and the increase in community investment could have fostered the building or reinforcing of stronger social ties that highlighted a “collective identity.”
Background: There is growing concern about emergency physicians overuse of computed tomography (CT). In an attempt to ensure appropriate ordering many hospitals implement strict protocols for ordering of CT scans in the emergency department (ED) that include approval of all scans by a board-certified radiologist, and a reduced access to CT overnight. Aim Statement: The aim of this study is to review the impact of RAD ED – direct access to CT ordering by ED physicians, 24hr CT technologist and third-party reporting on CT scans overnight. Our objectives were to assess the effect on; 1) ED length of stay, 2) number of CT scans ordered and 3) admission rates. Measures & Design: We conducted a prospective pilot before & after study at a single tertiary-care emergency department between February 1st, 2018 and July 31st, 2018. Inclusion criteria were adult patients presenting to the emergency department and undergoing CT for any of the following: face, neck, spine, upper and lower extremities, chest, abdomen and pelvis. Exclusion criteria were those undergoing CT head for stroke or trauma. Evaluation/Results: A total of 924 patients met our criteria, 352 before and 568 after implementation. Comparison of the patient populations demonstrate very similar characteristics in both groups; (49% male, average age 56 years, CTAS 2(40%) and 3(47%). Results demonstrate that an additional 216 scans were performed in post-implementation group. This equates to an increase of 61%. ED length of stay averaged 5.6 hours pre-implementation and 4.7 hours post-implementation. This corresponds to a significant reduction in length of stay of approximately 0.9 hours (p < 0.01). Collection is currently ongoing for factors that we will adjust for a multivariate analysis, including admission rates. Discussion/Impact: RAD ED led to a significant increase in CT ordering and decrease in ED length of stay. We believe that this project provides important information to clinicians and patients with regards to overall CT utilization, ED wait times, follow up visits for CT scanning and admission rates. It is also important for administrators to help decide if these new rules are leading to improved efficiency, and to help estimate their financial impact.
To investigate a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak event involving multiple healthcare facilities in Riyadh, Saudi Arabia; to characterize transmission; and to explore infection control implications.
Cases presented in 4 healthcare facilities in Riyadh, Saudi Arabia: a tertiary-care hospital, a specialty pulmonary hospital, an outpatient clinic, and an outpatient dialysis unit.
Contact tracing and testing were performed following reports of cases at 2 hospitals. Laboratory results were confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) and/or genome sequencing. We assessed exposures and determined seropositivity among available healthcare personnel (HCP) cases and HCP contacts of cases.
In total, 48 cases were identified, involving patients, HCP, and family members across 2 hospitals, an outpatient clinic, and a dialysis clinic. At each hospital, transmission was linked to a unique index case. Moreover, 4 cases were associated with superspreading events (any interaction where a case patient transmitted to ≥5 subsequent case patients). All 4 of these patients were severely ill, were initially not recognized as MERS-CoV cases, and subsequently died. Genomic sequences clustered separately, suggesting 2 distinct outbreaks. Overall, 4 (24%) of 17 HCP cases and 3 (3%) of 114 HCP contacts of cases were seropositive.
We describe 2 distinct healthcare-associated outbreaks, each initiated by a unique index case and characterized by multiple superspreading events. Delays in recognition and in subsequent implementation of control measures contributed to secondary transmission. Prompt contact tracing, repeated testing, HCP furloughing, and implementation of recommended transmission-based precautions for suspected cases ultimately halted transmission.
This paper presents a rare case of oculostapedial synkinesis.
After partial resolution of an idiopathic facial palsy, a male patient presented with persistent distortion of hearing when blinking and closing his eye. Audiometry findings were unremarkable, and cross-sectional imaging of the facial nerve revealed no abnormalities apart from an incidental contralateral meningioma. Initial conservative management, with referral to a specialist physiotherapist, failed to resolve the symptoms. The patient subsequently opted for surgical intervention, and underwent a transmeatal tympanotomy and transection of the stapedial tendon. Following this, he had complete resolution of symptoms.
Oculostapedial synkinesis is a rare complication of facial palsy, but is recognised in the literature. Given its unusual presentation, it can be overlooked, especially by more junior team members. This case highlights the need to pay careful attention to patients' symptoms and listen out for the description of hearing distortion on facial movement.
Zirconolite glass-ceramics are being developed as potential wasteforms for the disposition of Pu wastes in the UK. Previous studies utilised a variety of surrogates whilst this work uses both cold-press and sinter and hot isostatic press methods to validate the wasteform with PuO2. A cold press and sinter sample was fabricated as part of a validation study for plutonium incorporation in hot isostatically pressed (HIPed) wasteforms. The results confirmed the cold-press and sinter, achieved successful waste incorporation and a microstructure and phase assemblage that was in agreement with those expected of a HIPed equivalent. A HIP sample was fabricated of the same composition and characterised by SEM and XRD. Results were in agreement with the sintered sample and achieved complete waste incorporation into the glass-ceramic wasteform. These samples have demonstrated successful incorporation of PuO2 into glass-ceramic HIPed wasteforms proposed for processing Pu-based waste-streams in the UK.
We explore the transformation of a site into a place of remembrance by evaluating the life history of an urnfield at Cerro de Trincheras, Sonora, Mexico. Prehispanic inhabitants used this cemetery as a cremation burial ground ca. AD 1300–1450. Memory of the cemetery persisted into historical times among inhabitants of the area, but its use changed. We argue that critical and contextualized approaches to cemeteries are needed to understand the complexity of how burial spaces are used through time.
Consciousness consists of two components: arousal and awareness of the environment and self. Arousal refers to the behavioral continuum that occurs between sleep and wakefulness, while awareness to the content of consciousness (Laureys, 2014). In normal physiological states, with the exception of REM sleep, the level of arousal is positively correlated with awareness (Laureys, 2014) such that arousal is graded and measured by the degree to which it is diminished. This conceptualization appears to have led experts, including the DSM-5, to consider delirium as a condition to not associated with impairments in arousal (Schiff and Plum, 2000, American Psychiatric Association, 2013). However, arousal can be both diminished and heightened, not unlike the performance of an old-fashioned incandescent bulb at different voltages, giving barely sufficient light at low voltages and brightening up unbearably at high voltages (MacIsaac et al., 1999). Delirium is associated with both hypo-arousal and hyper-arousal (Han et al., 2017). A small but significant proportion of delirious older patients (10%; n = 155) in the emergency department in this study had normal arousal at the time of the short arousal assessment (Han et al., 2014).
Despite a growing body of literature on integrated land–sea management (ILSM), very little critical assessment has been conducted in order to evaluate ILSM in practice on island systems. Here we develop indicators for assessing 10 integrated island management principles and evaluate the performance of planning and implementation in four island ILSM projects from the tropical Pacific across different governance structures. We find that where customary governance is still strongly respected and enabled through national legislation, ILSM in practice can be very effective at restricting access and use according to fluctuations in resource availability. However, decision-making under customary governance systems may be vulnerable to mismanagement. Government-led ILSM processes have the potential to design management actions that address the spatial scale of ecosystem processes and threats within the context of national policy and legislation, but may not fully capture broad stakeholder interests, and implementation may be poorly coordinated across highly dispersed island archipelagos. Private sector partnerships offer unique opportunities for resourcing island ILSM, although these are highly likely to be geared towards private sector interests that may change in the future and no longer align with community and/or national objectives. We identify consistent challenges that arise during island ILSM planning and implementation and offer recommendations for improvement.
This call to revolution in theories of visual search does not go far enough. Treating fixations as uniform is an oversimplification that obscures the critical role of the mind. We remind readers that what happens during a fixation depends on mindset, as shown in studies of search strategy and of humans' ability to rapidly resume search following an interruption.
A self-adjoint first-order system with Hermitian π-periodic potential Q(z), integrable on compact sets, is considered. It is shown that all zeros of are double zeros if and only if this self-adjoint system is unitarily equivalent to one in which Q(z) is π/2-periodic. Furthermore, the zeros of are all double zeros if and only if the associated self-adjoint system is unitarily equivalent to one in which Q(z) = σ2Q(z)σ2. Here, Δ denotes the discriminant of the system and σ0, σ2 are Pauli matrices. Finally, it is shown that all instability intervals vanish if and only if Q = rσ0 + qσ2, for some real-valued π-periodic functions r and q integrable on compact sets.
Perfectionism is a risk and maintaining factor across psychopathology and has been proposed to be a transdiagnostic process. The aim of this study was to examine the reliability and validity of the Clinical Perfectionism Questionnaire (CPQ) in 32 adults (75% female, M age = 35.54 years, SD = 9.71) with a range of psychological disorders, presenting for treatment of clinical perfectionism. There was evidence that the CPQ was correlated with established measures of perfectionism and theoretically related constructs including self-criticism and dichotomous thinking. The CPQ was also able to predict treatment outcome. The internal consistency was not adequate in the current study; however, the sample size was small. Future studies should examine the psychometric properties of the CPQ in a larger sample of individuals with a range of psychological disorders.
When children have marked problems with motor coordination, they often have problems with attention and impulse control. Here, we map the neuroanatomic substrate of motor coordination in childhood and ask whether this substrate differs in the presence of concurrent symptoms of attention-deficit/hyperactivity disorder (ADHD).
Participants were 226 children. All completed Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5)-based assessment of ADHD symptoms and standardized tests of motor coordination skills assessing aiming/catching, manual dexterity and balance. Symptoms of developmental coordination disorder (DCD) were determined using parental questionnaires. Using 3 Tesla magnetic resonance data, four latent neuroanatomic variables (for the cerebral cortex, cerebellum, basal ganglia and thalamus) were extracted and mapped onto each motor coordination skill using partial least squares pathway modeling.
The motor coordination skill of aiming/catching was significantly linked to latent variables for both the cerebral cortex (t = 4.31, p < 0.0001) and the cerebellum (t = 2.31, p = 0.02). This effect was driven by the premotor/motor cortical regions and the superior cerebellar lobules. These links were not moderated by the severity of symptoms of inattention, hyperactivity and impulsivity. In categorical analyses, the DCD group showed atypical reduction in the volumes of these regions. However, the group with DCD alone did not differ significantly from those with DCD and co-morbid ADHD.
The superior cerebellar lobules and the premotor/motor cortex emerged as pivotal neural substrates of motor coordination in children. The dimensions of these motor coordination regions did not differ significantly between those who had DCD, with or without co-morbid ADHD.
Introduction: In Canada, major trauma is a healthcare priority and in 2014 was responsible for over 15866 deaths, with a total economic burden of 26.8 billion dollars. Numerous factors influence the likelihood of occurrence and outcome from major trauma, including incident factors, host, EMS response, emergency, surgical and critical care. Traditionally trauma registers contained information that mainly concerning hospital treatment and host factors. This collaborative analysis uses matched data from a Provincial Trauma Research Register and records from a Provincial Ambulance Service. Methods: A retrospective observational (registry) study comparing rural and urban adult and pediatric major trauma patients (Injury Severity Score >15) who were injured in a motor vehicle crash (ICD V20-V99) and presented to a level 1 or level 2 trauma centre by EMS by primary or secondary transfer, between April 2011 and March 2013 in a selected province in Canada. Comparisons of the process care times, and patient disposition, were made in an inclusive trauma system. Results: 108 cases meet the inclusion criteria with 78 considered rural and 30 urban using published definitions. The median response times were 16.2 minutes for rural (95% CI: 13.2 -19.8) and 7.8 minutes for urban (95% CI: 7.2 - 10.5) with 60% and 61% meeting response targets respectively. A greater proportion of urban patients are taken initially to level 3-5 centers and require secondary transfer (45% urban vs 24% rural p=<0.01). Median times intervals to surgical care were double for the urban patients (14 rural vs 32 hrs urban p=<0.01). Conclusion: The majority of serious road traffic collisions occur in rural areas. Although rural patients wait longer for an initial EMS response, more rural patients are taken directly to a level 1 or 2 trauma center. Unexpectedly then rural patients have much shorter times to surgical care. The benefits of an inclusive trauma system should be weighed against the benefits of bypass processes in urban environments where the nearest Emergency Department is not a Level 1 or 2 Trauma Center.
Among the most important stimuli for developing the FLAIR multi-object spectroscopy system on the 1.2-m UK Schmidt Telescope was its potential for carrying out large-scale redshift surveys of galaxies of intermediate magnitude (B <~ 17). During FLAIR’s lengthy development period, these objects provided the yardstick by which the system’s performance was measured, and a number of limited-area redshift surveys were carried out. We are now following these with a 1-in-3 survey over the 60 fields of the ROE/Durham Galaxy Catalogue to produce a redshift map of some 4000 galaxies out to a distance of ~ 300h−1 Mpc (where the parameter h is the Hubble constant expressed as a fraction of 100 kms−1 Mpc−1). In this paper we summarise the results from our redshift surveys to highlight the capabilities of FLAIR. We present a status report on the current large-scale survey, and show that the recently-introduced FLAIR II system will speed its progress considerably.
The object EX Hya is a dwarf nova with a binary period of 98.3 min (Mumford 1964, 1967). Warner (1972, 1973a) has observed two complete cycles of this star with a photoelectric time resolution of 5 sec. These observations suggested that EX Hya can be understood in terms of the model proposed by Warner and Nather (1971) in their discussion of U Gem. In this model, a white dwarf primary of a semi-detached binary system is surrounded by a disk of gas formed from matter transfered from the secondary, which is a cool dwarf star filling its Roche lobe.