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The current global crisis in mental health has seen psychiatry assume an increasingly integral role in healthcare. This comprehensive and accessible textbook provides an evidence-based foundation in psychiatry for medical students and serves as an excellent refresher for all mental health professionals. Written by medical school faculty and experts in the field, with comprehensive coverage from neurobiology to population health, this essential textbook is an invaluable guide to the evaluation, treatment and current understanding of the major disorders in psychiatry. The book introduces the basics of clinical assessment and all major modalities of evidence based treatment, along with topics often not covered adequately in textbooks such as gender and sexuality, and global mental health. Chapters are complemented by easy to navigate tables, self-assessment questions, and a short bibliography of recommended reading. An essential resource for medical students, trainees, and other medical professionals seeking a clear and comprehensive introduction to psychiatry.
This graduate text is indispensable for those wanting to see and understand the mechanics of extreme dynamic events. It describes in detail the mechanics and material models used in understanding impact and penetration events. Covers continuum mechanics, the Hugoniot jump conditions, plasticity theory, damage and failure theory, shock and wave propagation in both Eulerian and Lagrangian frameworks, and the high pressure and high-rate response of materials. Nonlinearity in response of materials and systems is a common theme, showing itself in interesting and surprising ways. Materials are studied through damage to failure, since in armor and protection applications materials are utilized all the way through failure. Continuum and constitutive modelling topics required for modern large-scale numerical simulation techniques are clearly described. Extensive exercises ensure comprehension and explore new topics. This text is appropriate for a variety of graduate courses, including Continuum Mechanics, Advanced Solid Mechanics, and Plasticity and Inelasticity Theory.
We study the pairwise interactions of drops in an applied uniform DC electric field within the framework of the leaky dielectric model. We develop three-dimensional numerical simulations using the boundary integral method and an analytical theory assuming small drop deformations. We apply the simulations and the theory to explore the electrohydrodynamic interactions between two identical drops with arbitrary orientation of their line of centres relative to the applied field direction. Our results show a complex dynamics depending on the conductivities and permittivities of the drops and suspending fluids, and the initial drop pair alignment with the applied electric field.
The adult population of repaired tetralogy of Fallot is increasing and at risk of pre-mature death and arrhythmia. This study evaluates risk factors for adverse outcome and the effect of pulmonary valve replacement within a national cohort.
Methods:
A retrospective cohort study of 341 adult repaired tetralogy of Fallot (16–72 years) managed through a single national service was undertaken incorporating over 1200 patient-years of follow-up. Demographics, cardiopulmonary exercise testing, cardiac magnetic resonance, reintervention (including pulmonary valve replacement), and clinical events were analysed. The influence of these parameters on a primary outcome (death or arrhythmia) was evaluated.
Results:
Compared with an age-/gender-matched population, patients experienced a reduced survival, particularly males over 55 years (standardised mortality ratio : 6.12, 95% CI: 1.64–15.66, p = 0.004). Cox proportional hazards modelling identified increased indexed right ventricle (RV) end-diastolic volume (hazard ratio (HR): 2.86, 95% CI: 1.4–5.85, p = 0.004) and female gender (HR (male): 0.37, 95% CI: 0.14–0.98, p = 0.045) to be predictors significantly associated with the primary outcome. Pulmonary valve replacement undertaken at indexed RV end-diastolic volume = 145 ml/m2 reduced RV volumes and QRS duration but did not improve cardiopulmonary exercise testing nor NYHA class. Pulmonary valve replacement during cohort period was associated with increased risk of primary outcome (HR: 2.82, 95% CI: 1.36–5.86, p = 0.005).
Conclusions:
Although the majority of adult tetralogy of Fallot were asymptomatic in NYHA 1, cardiopulmonary exercise testing revealed important deficits. Tetralogy of Fallot survival was reduced compared to the general population. Female gender and increasing RV end-diastolic volume predicted adverse events. Pulmonary valve replacement reduced RV volumes and QRS duration but did not improve primary outcome.
Normal cardiac function is directly associated with the maintenance of cerebrovascular health. Whether the Mediterranean-Dietary Approach to Systolic Hypertension Intervention for Neurodegenerative Delay (MIND) diet, designed for the maintenance of neurocognitive health, is associated with cardiac remodeling is unknown. We evaluated 2512 Framingham Offspring Cohort participants who attended the 8th examination cycle and had available dietary and echocardiographic data (mean age 66 years; 55% women). Using multivariable regression, we related the cumulative MIND diet score (independent variable) to left ventricular (LV) ejection fraction, left atrial emptying fraction, LV mass (LVM), E/e’ ratio (dependent variables; primary), global longitudinal strain, global circumferential strain (GCS), mitral annular plane systolic excursion, longitudinal segmental synchrony, LV hypertrophy, and aortic root diameter (secondary). Adjusting for age, sex, and energy intake, higher cumulative MIND diet scores were associated with lower values of indices of LV diastolic (E/e’ ratio: logβ=-0.03) and systolic function (GCS: β=-0.04), and with higher values of LVM (logβ=0.02), all P≤0.01. We observed effect modification by age in the association between the cumulative MIND diet score and GCS. When we further adjusted for clinical risk factors, the associations of the cumulative MIND diet score with GCS in participants ≥66 years (β=-0.06, P=0.005) and LVM remained significant. In our community-based sample, relations between the cumulative MIND diet score and cardiac remodeling differ among indices of LV structure and function. Our results suggest that favorable associations between a higher cumulative MIND diet score and indices of LV function may be influenced by cardiometabolic and lifestyle risk factors.
Ladin (ISO 639-3: lld) is a Romance language spoken in the Italian Central-Eastern Alps by a community of about 30,000 speakers (Dell’Aquila 2010). The classification of Ladin within Western Romance has been the subject of a long-lasting scientific and at times ideological debate, particularly because at the end of the 19th century the region was contested between the new-born Italian state and the Habsburg empire. The varieties of Ladin share phonetic-phonological, morphological, syntactic and lexical features with the other languages spoken in the Central-Eastern Alps, such as Friulian and Romansh, thus leading to the identification of the Rhaeto-Romance group (Haiman & Benincà 1992). However, in Ladin there are still many linguistic phenomena that connect it to the Romance dialects of Northern Italy. Therefore, a clear assignment of Ladin to a group is by no means a simple and uncontroversial operation (Salvi 2016).
The remnant phase of a radio galaxy begins when the jets launched from an active galactic nucleus are switched off. To study the fraction of radio galaxies in a remnant phase, we take advantage of a $8.31$ deg$^2$ subregion of the GAMA 23 field which comprises of surveys covering the frequency range 0.1–9 GHz. We present a sample of 104 radio galaxies compiled from observations conducted by the Murchison Widefield Array (216 MHz), the Australia Square Kilometer Array Pathfinder (887 MHz), and the Australia Telescope Compact Array (5.5 GHz). We adopt an ‘absent radio core’ criterion to identify 10 radio galaxies showing no evidence for an active nucleus. We classify these as new candidate remnant radio galaxies. Seven of these objects still display compact emitting regions within the lobes at 5.5 GHz; at this frequency the emission is short-lived, implying a recent jet switch off. On the other hand, only three show evidence of aged lobe plasma by the presence of an ultra-steep-spectrum ($\alpha<-1.2$) and a diffuse, low surface brightness radio morphology. The predominant fraction of young remnants is consistent with a rapid fading during the remnant phase. Within our sample of radio galaxies, our observations constrain the remnant fraction to $4\%\lesssim f_{\mathrm{rem}} \lesssim 10\%$; the lower limit comes from the limiting case in which all remnant candidates with hotspots are simply active radio galaxies with faint, undetected radio cores. Finally, we model the synchrotron spectrum arising from a hotspot to show they can persist for 5–10 Myr at 5.5 GHz after the jets switch of—radio emission arising from such hotspots can therefore be expected in an appreciable fraction of genuine remnants.
Children's vocabulary ability at school entry is highly variable and predictive of later language and literacy outcomes. Sleep is potentially useful in understanding and explaining that variability, with sleep patterns being predictive of global trajectories of language acquisition. Here, we looked to replicate and extend these findings. Data from 354 children (without English as an additional language) in the Born in Bradford study were analysed, describing the mean intercepts and linear trends in parent-reported day-time and night-time sleep duration over five time points between 6 and 36 months-of-age. The mean difference between night-time and day-time sleep was predictive of receptive vocabulary at age five, with more night-time sleep relative to day-time sleep predicting better language. An exploratory analysis suggested that socioeconomic status was predictive of vocabulary outcomes, with sleep patterns partially mediating this relationship. We suggest that the consolidation of sleep patterns acts as a driver of early language development.
We have found a class of circular radio objects in the Evolutionary Map of the Universe Pilot Survey, using the Australian Square Kilometre Array Pathfinder telescope. The objects appear in radio images as circular edge-brightened discs, about one arcmin diameter, that are unlike other objects previously reported in the literature. We explore several possible mechanisms that might cause these objects, but none seems to be a compelling explanation.
Using novel weekly mortality data for London spanning 1866-1965, we analyze the changing relationship between temperature and mortality as the city developed. Our main results show that warm weeks led to elevated mortality in the late nineteenth century, mainly due to infant deaths from digestive diseases. However, this pattern largely disappeared after WWI as infant digestive diseases became less prevalent. The resulting change in the temperature-mortality relationship meant that thousands of heat-related deaths—equal to 0.9-1.4 percent of all deaths— were averted. These findings show that improving the disease environment can dramatically alter the impact of high temperature on mortality.
Identify risk factors that could increase progression to severe disease and mortality in hospitalized SARS-CoV-2 patients in the Southeast US.
Design, Setting, and Participants
Multicenter, retrospective cohort including 502 adults hospitalized with laboratory-confirmed COVID-19 between March 1, 2020 and May 8, 2020 within one of 15 participating hospitals in 5 health systems across 5 states in the Southeast US.
Methods
The study objectives were to identify risk factors that could increase progression to hospital mortality and severe disease (defined as a composite of intensive care unit admission or requirement of mechanical ventilation) in hospitalized SARS-CoV-2 patients in the Southeast US.
Results
A total of 502 patients were included, and the majority (476/502, 95%) had clinically evaluable outcomes. Hospital mortality was 16% (76/476), while 35% (177/502) required ICU admission, and 18% (91/502) required mechanical ventilation. By both univariate and adjusted multivariate analysis, hospital mortality was independently associated with age (adjusted odds ratio [aOR] 2.03 for each decade increase, 95% CI 1.56-2.69), male sex (aOR 2.44, 95% CI: 1.34-4.59), and cardiovascular disease (aOR 2.16, 95% CI: 1.15-4.09). As with mortality, risk of severe disease was independently associated with age (aOR 1.17 for each decade increase, 95% CI: 1.00-1.37), male sex (aOR 2.34, 95% CI 1.54-3.60), and cardiovascular disease (aOR 1.77, 95% CI 1.09-2.85).
Conclusions
In an adjusted multivariate analysis, advanced age, male sex, and cardiovascular disease increased risk of severe disease and mortality in patients with COVID-19 in the Southeast US. In-hospital mortality risk doubled with each subsequent decade of life.
Common mental disorders (CMDs), particularly depression, are major contributors to the global mental health burden. South Asia, while diverse, has cultural, social, and economic challenges, which are common across the region, not least an aging population. This creates an imperative to better understand how CMD affects older people in this context, which relies on valid and culturally appropriate screening and research tools. This review aims to scope the availability of CMD screening tools for older people in South Asia. As a secondary aim, this review will summarize the use of these tools in epidemiology, and the extent to which they have been validated or adapted for this population.
Design:
A scoping review was performed, following PRISMA guidelines. The search strategy was developed iteratively in Medline and translated to Embase, PsychInfo, Scopus, and Web of Science. Data were extracted from papers in which a tool was used to identify CMD in a South Asian older population (50+), including validation, adaptation, and use in epidemiology. Validation studies meeting the criteria were critically appraised using the Quality Assessment of Diagnostic Accuracy Studies – version 2 (QUADAS-2) tool.
Results:
Of the 4694 papers identified, 176 met the selection criteria at full-text screening as relevant examples of diagnostic or screening tool use. There were 15 tool validation studies, which were critically appraised. Of these, 10 were appropriate to evaluate as diagnostic tests. All of these tools assessed for depression. Geriatric Depression Scale (GDS)-based tools were predominant with variable diagnostic accuracy across different settings. Methodological issues were substantial based on the QUADAS-2 criteria. In the epidemiological studies identified (n = 160), depression alone was assessed for 82% of the studies. Tools lacking cultural validation were commonly used (43%).
Conclusions:
This review identifies a number of current research gaps including a need for culturally relevant validation studies, and attention to other CMDs such as anxiety.
During the past two decades, several reports have documented substantial support from clinicians, policy-makers, and the general public for the use of advance directives, yet studies continue to find that only a minority of individuals (10 to 25 percent) have completed these legal documents. Advance directives are written instructions, such as living wills or durable powers of attorney for health care, which describe an individual's medical treatment wishes in the event that individual becomes incapacitated in the future. The completion and use of advance directives is one of several components of the broader activity of advance care planning, that is, the overall planning and communication of personal wishes concerning future medical care.
In December 1991, the federal Patient Self-Determination Act (PSDA) became effective. Promoted as a federal initiative to enhance an individual's control over medical treatment decision making and, therefore, patient autonomy and self-determination, PSDA placed several new requirements on health care organizations receiving Medicare or Medicaid payments.
Winfried Siemerling’s The Black Atlantic Reconsidered: Black Canadian Writing, Cultural History, and the Presence of the Historical Past, to put it mildly, is an impressive piece of scholarship that will stand as one of the definitive works on the histories of Black writing in Canada for the foreseeable future. In his preface, Siemerling states that he embarked upon this undertaking when he learned, to his surprise (one is reminded here, incidentally, of Katherine McKittrick’s injunction that Black Canadian Studies is always constituted as a “surprise”), that there had been little written about Black contemporary writing aside from a few of the comprehensive and encyclopedic works that George Elliot Clarke published in the early to mid-1990s. It is this pioneering work upon which Siemerling builds. He starts with a discussion of “Modernity and Canadian Time-Spaces of the Black Atlantic” in his first chapter and introduction, where he lays out the analytical and conceptual approach of the work. Part 1, “Early Testimony and the Black Canadian Nineteenth Century,” includes chapters titled “Slavery and Early Black Canadian Writing” and “The Black Canadian Nineteenth Century.” Part 2, “The Presence of the Past,” highlights chapters that expand on the themes of “Slavery, the Black Canadian Nineteenth Century, and Caribbean Contexts in Contemporary Black Canadian Writing” and move into a discussion of what he calls “Other Black Canadas” and “Coda: Other Canadas, Other Americas, the Black Atlantic Reconsidered.”
To assess the contribution of different food groups to total salt purchases and to evaluate the estimated reduction in salt purchases if mandatory maximum salt limits in South African legislation were being complied with.
Design:
This study conducted a cross-sectional analysis of purchasing data from Discovery Vitality members. Data were linked to the South African FoodSwitch database to determine the salt content of each food product purchased. Food category and total annual salt purchases were determined by summing salt content (kg) per each unit purchased across a whole year. Reductions in annual salt purchases were estimated by applying legislated maximum limits to product salt content.
Setting:
South Africa.
Participants:
The study utilised purchasing data from 344 161 households, members of Discovery Vitality, collected for a whole year between January and December 2018.
Results:
Vitality members purchased R12·8 billion worth of food products in 2018, representing 9562 products from which 264 583 kg of salt was purchased. The main contributors to salt purchases were bread and bakery products (23·3 %); meat and meat products (19 %); dairy (12·2 %); sauces, dressings, spreads and dips (11·8 %); and convenience foods (8·7 %). The projected total quantity of salt that would be purchased after implementation of the salt legislation was 250 346 kg, a reduction of 5·4 % from 2018 levels.
Conclusions:
A projected reduction in salt purchases of 5·4 % from 2018 levels suggests that meeting the mandatory maximum salt limits in South Africa will make a meaningful contribution to reducing salt purchases.
The rise of multi-party processes in which people with quite different ties to a region, natural resource-related industry, or environmental issue work collaboratively to hammer out mutually acceptable agreements is arguably one of the biggest shifts in environmental management over the past twenty-five years. This chapter engages in some sensemaking around this diverse and evolving phenomenon in two ways. First, an approach to designing collaborative natural resource-related discourse with a particularly strong theoretical foundation (Collaborative Learning) is presented to illustrate how theory is manifest in practice. Second a recent best practices/common features list is examined through the perspectives of four social science theorists: Max Weber, Pierre Bourdieu, Niklas Luhmann, and Muzafer Sherif. The practical recommendations that emerge from this list is largely consistent with the larger social and communicative dynamics articulated by these theorists.