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We define a new ribbon group action on ribbon graphs that uses a semidirect product of a permutation group and the original ribbon group of Ellis-Monaghan and Moffatt to take (partial) twists and duals, or twuals, of ribbon graphs. A ribbon graph is a fixed point of this new ribbon group action if and only if it is isomorphic to one of its (partial) twuals. This extends the original ribbon group action, which only used the canonical identification of edges, to the more natural setting of self-twuality up to isomorphism. We then show that every ribbon graph has in its orbit an orientable embedded bouquet and prove that the (partial) twuality properties of these bouquets propagate through their orbits. Thus, we can determine (partial) twualities via these one vertex graphs, for which checking isomorphism reduces simply to checking dihedral group symmetries. Finally, we apply the new ribbon group action to generate all self-trial ribbon graphs on up to seven edges, in contrast with the few, large, very high-genus, self-trial regular maps found by Wilson, and by Jones and Poultin. We also show how the automorphism group of a ribbon graph yields self-dual, -petrial or –trial graphs in its orbit, and produce an infinite family of self-trial graphs that do not arise as covers or parallel connections of regular maps, thus answering a question of Jones and Poulton.
Maternal thyroid hormones facilitate optimal foetal neurodevelopment; however, the exact role of the thyroid hormones on specific cognitive outcomes is unknown. The present study aimed to investigate associations between maternal thyroid function and neurodevelopmental outcomes in the Seychelles Child Development Study (SCDS) Nutrition 2 cohort (n 1328). Maternal free thyroid hormones (fT3, fT4 and fTSH) were assessed at 28 weeks’ gestation with a range of child cognitive outcomes analysed at 20 months. Dietary iodine intake was analysed for a subset of women through a Food Frequency Questionnaire. Linear regression analysis was used to test associations between serum concentrations of maternal thyroid hormones and child neurodevelopment outcomes. Thyroid hormones were analysed as continuous data and categorised as quintiles. 95% of mothers had optimal thyroid function based on fTSH concentrations. Overall, the present study shows that maternal thyroid function is not associated with neurodevelopmental outcomes in this high fish-eating population. However, a positive association, using quintiles for fT3, was reported for the Mental Developmental Index, between Q3 v. Q4 (β 0⋅073; P 0⋅043) and for Q3 v. Q5 (β value 0⋅086; P 0⋅018). To conclude, mothers in our cohort, who largely have optimal thyroid function and iodine intakes, appear able to regulate thyroid function throughout pregnancy to meet neurodevelopmental needs. However, it is possible that minor imbalances of fT3, as indicated from our secondary analysis, may impact offspring neurodevelopment. Further investigation of the relationship between maternal thyroid function and infant neurodevelopment is warranted, particularly in populations with different dietary patterns and thereby iodine intakes.
Parasites are important components of biodiversity and contributors to ecosystem functioning, but are often neglected in ecological studies. Most studies examine model parasite systems or single taxa, thus our understanding of community composition is lacking. Here, the seasonal and annual dynamics of parasites was quantified using a 5-year metabarcoding time-series of freshwater plankton, collected weekly. We first identified parasites in the dataset using literature searches of the taxonomic match and using sequence metadata from the National Center for Biotechnology Information (NCBI) nucleotide database. In total, 441 amplicon sequence variants (belonging to 18 phyla/clades) were classified as parasites. The four phyla/clades with the highest relative read abundance and richness were Chytridiomycota, Dinoflagellata, Oomycota and Perkinsozoa. Relative read abundance of total parasite taxa, Dinoflagellata and Perkinsozoa significantly varied with season and was highest in summer. Parasite richness varied significantly with season and year, and was generally lowest in spring. Each season had distinct parasite communities, and the difference between summer and winter communities was most pronounced. Combining DNA metabarcoding with searches of the literature and NCBI metadata allowed us to characterize parasite diversity and community dynamics and revealed the extent to which parasites contribute to the diversity of freshwater plankton communities.
This study was designed to test the feasibility of running a trial to compare the effectiveness of a combined weight management and physical function programme for patients with knee osteoarthritis ARMED (Arthritis Rehabilitation through the Management of Exercise and Diet) with usual care ESCAPE pain (Enabling Self-management and Coping with Arthritic Pain using Exercise). The COVID-19 pandemic interruption allowed additional measurement of the qualitative ‘lived in’ experiences of this patient group during the pandemic and also their appetite for virtual health.
Thirty-two patients with knee osteoarthritis were recruited from a combined primary/secondary care waiting list and were allocated to either a six-week intervention group (ARMED) or to the six-week usual care ESCAPE pain group (Enabling Self-management and Coping with Arthritic Pain using Exercise) group.
The intervention programme was interrupted after three weeks by COVID-19. Fifteen patients were reassessed after the first stage. The average attendance was 92% with 6 patients attending all sessions, 5 attending 5/6, 1 attending 4/6 and 2 attending 3/6. One subject dropped out and 15/16 patients completed all outcome measurements. All patients completed the KOOS knee score and the Short Warwick-Edinburgh Mental Well Being Scale to evaluate anxiety and depression. There was a statistically significant improvement in pain, activities of daily living, quality of life and mental health and well-being scores from time one to time 2. The mean weight, BMI and waist measurements were reduced also from time one to time 2, but these failed to reach significance. The semi-structured interviews provided rich information on enablers and barriers to coping in lockdown, benefits of the ARMED programme to increasing physical activity and weight management and enablers and barriers to redesigning the programme for online delivery.
Evaluation of preliminary data from this feasibility study supports the three-week intervention combining education, exercise and weight management in this patient group even during a pandemic. Based on the results of the qualitative interviews, we have now redesigned our programme to present it virtually. We hope to present the results of our virtual feasibility study later in 2021.
This chapter considers the UK’s assertion of sovereignty over the Chagos Archipelago in the wake of the Advisory Opinion of the International Court of Justice (ICJ) in Legal Consequences of the Separation of the Chagos Archipelago from Mauritius in 1965. It will be argued in this chapter that the UK’s assertion to sovereignty is tenuous as it rests on weak foundations which are increasingly undermined by the colonial context in which the then colony of Mauritius agreed to the detachment of the Chagos Archipelago. The UK’s sovereignty over the Chagos Archipelago is contested by Mauritius (and by the majority of countries that have given their support to the campaign to force the return of the territory). The Republic of Mauritius first challenged the UK’s sovereignty at the United Nations General Assembly (UNGA) in 1980, some twelve years after gaining its independence.1 The Court’s Advisory Opinion is a landmark in terms of how sovereignty over the Chagos Archipelago must now be approached.
Only studies in the UK on individuals dying from coronavirus disease 2019 (COVID-19) in hospital have been published, to date. Cremation law requires collection of clinical information that can improve understanding of deaths in both hospital and community settings. Age, sex, date and place of death, occupation, comorbidities and where infection acquired was recorded for all deaths from COVID-19, between 6 April and 30 May, for whom an application was made for cremation at a South Wales' crematorium. Of 752 cremations, 215 (28.6%) were COVID-19 (115 (53.5%) male and 100 (46.5%) female). Median age was 82 years (youngest patient 47 and the oldest 103 years). Over half the deaths (121/215: 56.3%) were over 80 years. Males' odds of dying in hospital, rather than the community were 1.96 times that of females (95% confidence intervals (CI) 1.03–3.74, P = 0.054) despite being of similar age and having a similar number of comorbidities. Only 21 (9.8%) of 215 patients had no comorbidities recorded. Patients dying in care homes were significantly older than those dying in hospital (median 88 years (interquartile (IQ) range 82–93 years) vs. 80 years (IQ range 71–87 years): P < 0.0001). Patients dying in hospital had significantly more comorbidities than those dying in care homes (median 2: IQ range 1–3 vs. 1: IQ range 1–2: P < 0.001). Sixty three (29.3%) of infections were hospital acquired and a further 55 (25.6%) acquired in care homes. In a series, of hospital and community deaths, persons over 80 with an average two comorbidities predominated. Men were more likely to die in hospital. Half the infections were acquired in hospitals or care homes with implications for management of the pandemic.
Traumatic brain injury is recognised as a significant and pervasive health issue among offender populations. Despite this, no qualitative research exists exploring the experiences and perceptions of offenders with TBI in prison.
Qualitative interviews were conducted with male and female offenders housed in a UK prison. Interviews examined what participants felt led them to offend, experiences of incarceration, and post-release plans. Presence of TBI was assessed via the Brain Injury Screening Index. Data were analysed by means of inductive content analysis.
Both male and female prisoners primarily attributed their incarceration to drugs and alcohol use, with males also referencing more issues with aggression, while mental illness and past abuse were more commonly mentioned among females. A lack of recognition for the possible role of TBI was noted, with several males describing themselves as ‘stupid’ or prone to making ‘poor lifestyle choices’. Both groups indicated a desire to return to education or work post-release.
Despite significant rates of injury, there is a clear lack of understanding and consideration of the role of TBI in the behaviour and presentation of offenders. There is need for improved identification and education around TBI early in the criminal justice process.
“Flipped learning” has become increasingly popular in medical education as a means of developing independent learning skills in students. The article by Zheng at al. (2020) highlights the potential utility of this approach in disaster triage training. However, the article also highlights to us some concerns regarding how “flipped learning” may favor certain learners over others in the provision of disaster triage education. Specifically, the article demonstrates the necessity for increased preclassroom preparation when a “flipped classroom” model is used, which inevitably privileges those with a higher ability to engage with self-directed learning. Although such a skill is important to develop in medical education, we fear it may lead to polarized student attainment rather than ensuring a maximum number of students achieve the requisite standard required. More research is consequently needed to inform the most efficacious means of facilitating disaster triage training that supports all students sufficiently, while also helping to nurture their independent learning skills.
Life course research embraces the complexity of health and disease development, tackling the extensive interactions between genetics and environment. This interdisciplinary blueprint, or theoretical framework, offers a structure for research ideas and specifies relationships between related factors. Traditionally, methodological approaches attempt to reduce the complexity of these dynamic interactions and decompose health into component parts, ignoring the complex reciprocal interaction of factors that shape health over time. New methods that match the epistemological foundation of the life course framework are needed to fully explore adaptive, multilevel, and reciprocal interactions between individuals and their environment. The focus of this article is to (1) delineate the differences between lifespan and life course research, (2) articulate the importance of complex systems science as a methodological framework in the life course research toolbox to guide our research questions, (3) raise key questions that can be asked within the clinical and translational science domain utilizing this framework, and (4) provide recommendations for life course research implementation, charting the way forward. Recent advances in computational analytics, computer science, and data collection could be used to approximate, measure, and analyze the intertwining and dynamic nature of genetic and environmental factors involved in health development.
Regional patient and physician density patterns pose problems to accessing care for people with Parkinson’s disease, though telehealth may improve access. We surveyed and conducted a focus group for people with Parkinson’s disease in Interior British Columbia regarding barriers to neurological care. Eighteen individuals completed the survey and seven parties joined the focus group. Perceived barriers include cost and difficulty of travel, wait times, and lack of specialized services outside large cities. 80% of participants (95% CI 64–96) would likely use telehealth for follow-up neurologist appointments. This sample of people with Parkinson’s disease reports willingness to use telehealth to reduce travel and improve access to specialty care.
Background: People with Parkinson disease (PD) face progressive mobility loss, but medical treatment is dependent on clinical assessment and examination. Regional patient and physician density patterns pose further problems to accessing care. Telehealth may improve access particularly among rural populations, but an approach to this problem should consider patient perspectives. Methods: We surveyed and conducted a focus group for people with PD and their caregivers. Questions assessed perceptions of barriers to neurological care and use of telehealth for PD management. Thematic analysis was performed to classify qualitative data. Results: 18 individuals completed the survey and 7 parties joined the focus group. 52% of participants travel >50km for neurologist appointments (range = 59 to 842km). Perceived barriers include cost and difficulty of travel, wait times, lack of interdisciplinary healthcare and deep brain stimulation outside large cities. 80% of participants (95% C.I. 64-96%) would likely or very likely use telehealth for follow-up neurologist appointments if proven as good as in-office visits. Participants associated telehealth with improved quality of care, improved access to care, and cost savings. Conclusions: This sample of people with PD and their caregivers report willingness to access care via telehealth to reduce perceived cost and travel for specialty care.
The sound of words has been shown to relate to the meaning that the words denote, an effect that extends beyond morphological properties of the word. Studies of these sound-symbolic relations have described this iconicity in terms of individual phonemes, or alternatively due to acoustic properties (expressed in phonological features) relating to meaning. In this study, we investigated whether individual phonemes or phoneme features best accounted for iconicity effects. We tested 92 participants’ judgements about the appropriateness of 320 nonwords presented in written form, relating to 8 different semantic attributes. For all 8 attributes, individual phonemes fitted participants’ responses better than general phoneme features. These results challenge claims that sound-symbolic effects for visually presented words can access broad, cross-modal associations between sound and meaning, instead the results indicate the operation of individual phoneme to meaning relations. Whether similar effects are found for nonwords presented auditorially remains an open question.
The Bristol Radiocarbon Accelerator Mass Spectrometry (BRAMS) Facility was established at the University of Bristol after the commissioning of our dedicated sample preparation laboratories and the installation and acceptance of the BrisMICADAS AMS in 2016. Routine measurements commenced in mid-2016, once validation was completed for each sample type. Herein, we give an overview of the standard pretreatment methods currently employed in the Facility and the results of radiocarbon (14C) determinations on a wide range of standards, blank materials, and intercomparison samples which have been measured during our extensive pretreatment method validation program and during our routine 14C analyses.
Geophysical survey and excavations from 2010–2016 at Lawrenz Gun Club (11CS4), a late pre-Columbian village located in the central Illinois River valley in Illinois, identified 10 mounds, a central plaza, and dozens of structures enclosed within a stout 10 hectare bastioned palisade. Nineteen radiocarbon (14C) measurements were taken from single entities of wood charcoal, short-lived plants, and animal bones. A site chronology has been constructed using a Bayesian approach that considers the stratigraphic contexts and feature formation processes. The village was host to hundreds of years of continuous human activity during the Mississippi Period. Mississippian activity at the site is estimated to have begun in cal AD 990–1165 (95% probability), ended in cal AD 1295–1450 (95% probability), and lasted 150–420 yr (95% probability) in the primary Bayesian model with similar results obtained in two alternative models. The palisade is estimated to have been constructed in cal AD 1150–1230 (95% probability) and was continuously repaired and rebuilt for 15–125 yr (95% probability), probably for 40–85 yr (68% probability). Comparison to other studies demonstrates that the bastioned palisade at Lawrenz was one of the earliest constructed in the midcontinental United States.
This paper draws on insider accounts from UK Department for Work and Pensions (DWP) officials to analyse the relationship between evidence and policy making at a time of rapid policy development relating to Universal Credit (UC). The paper argues, firstly, that evidence selection within the DWP was constrained by the overarching austerity paradigm, which constituted a Zeitgeist and had a significant bearing on the evidence selection and translation process, sharpening the focus of policy officials and analysts on the primacy of quantitative evidence when advising Ministers. Secondly, while methodological preferences (or an ‘evidence hierarchy’) impacted on evidence selection, this was not as significant as practitioners’ perceived capabilities to handle and develop evidence for policy. These capabilities were linked to departmental structures and constrained by political feasibility. Together, these dimensions constituted a significant filtration mechanism determining the kinds of evidence that were selected for policy development and those omitted, particularly in relation to UC. The paper contributes to debates about the contemporary role of evidence in policymaking and the potential of the relationship between future evidence production and use.
On August 25, 2017, Hurricane Harvey made landfall near Corpus Christi, Texas. The ensuing unprecedented flooding throughout the Texas coastal region affected millions of individuals.1 The statewide response in Texas included the sheltering of thousands of individuals at considerable distances from their homes. The Dallas area established large-scale general population sheltering as the number of evacuees to the area began to amass. Historically, the Dallas area is one familiar with “mega-sheltering,” beginning with the response to Hurricane Katrina in 2005.2 Through continued efforts and development, the Dallas area had been readying a plan for the largest general population shelter in Texas. (Disaster Med Public Health Preparedness. 2019;13:33–37)
A pilot study was designed to evaluate the potential of zircon geochronology as a provenance indicator of till from the Lake Michigan, Saginaw, and Huron-Erie Lobes of the Laurentide Ice Sheet. Based on existing ice flow-path models, we hypothesized that till from each lobe would have different zircon age population distributions because the lobes originated from regions of the Canadian Shield with different bedrock ages. After correcting for zircon fertility, the majority of grains in all till samples are 1600–950 Ma, with ~30 % of ages >2500 Ma. This similarity means that till from the three lobes cannot be clearly differentiated based on their zircon populations. The dominant ages found and the homogeneity of distributions in the till indicates a non-Shield source and, instead, reflect an origin from some combination of underlying till and sedimentary bedrock in the Great Lakes region. Even though the datasets are small, the tills have similarities to zircon distributions in Michigan Basin rocks. This implies that a substantial fraction of zircon in till was not transported long distances from the Canadian Shield. Although zircon ages are not distinct between tills, the method provides a novel application to understand Laurentide Ice Sheet glacial erosion and transport.