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The Scaling-up Health-Arts Programme: Implementation and Effectiveness Research (SHAPER) project is the world's largest hybrid study on the impact of the arts on mental health embedded into a national healthcare system. This programme, funded by the Wellcome Trust, aims to study the impact and the scalability of the arts as an intervention for mental health. The programme will be delivered by a team of clinicians, research scientists, charities, artists, patients and healthcare professionals in the UK's National Health Service (NHS) and the community, spanning academia, the NHS and the charity sector. SHAPER consists of three studies – Melodies for Mums, Dance for Parkinson's, and Stroke Odysseys – which will recruit over 800 participants, deliver the interventions and draw conclusions on their clinical impact, implementation effectiveness and cost-effectiveness. We hope that this work will inspire organisations and commissioners in the NHS and around the world to expand the remit of social prescribing to include evidence-based arts interventions.
This essay describes the histories of the Middle English Dictionary (MED, completed in 2001) and the Dictionary of Old English (DOE, still in progress), their editorial procedures, and how each one has dealt with the problems facing it. For the MED, those problems included how to reconcile the fairly reliable dates of the manuscripts with the usually conjectural composition dates in the dating of illustrative quotations; how to distinguish the chronological dimension from the synchronic dimension and at the same time to distinguish the geographical/regional dimension from the chronological; and how to balance the original conception of a bilingual translation dictionary with the need to define as accurately as possible. For the DOE, those problems included how to develop a comprehensive electronic corpus of Old English texts, as well as to maintain and renew it; how to mark up the digital DOE to capture its deeply embedded information so that both Anglo-Saxon language and culture are accessible; how to connect outward to other relevant digital resources to enlarge DOE’s interpretative environment; and finally, how to balance the writing of definitions without claiming more knowledge than exists for this early material.
The linear stability of plane Couette flow is investigated when the plates are horizontal, and the fluid is stably stratified with a cubic basic density profile. The disturbances are treated as inviscid and diffusion of the density field is neglected. Previous studies have shown that this density profile can develop multiple neutral curves, despite the stable stratification, and the fact that plane Couette flow of homogeneous fluid is stable. It is shown that when the neutral curves are plotted with wave angle on one axis, and location of the density inflexion point on the other axis, they produce a self-similar fractal pattern. The repetition on smaller and smaller scales occurs in the limit when the waves are highly oblique, i.e. longitudinal vortices almost aligned with the flow; the corresponding limit for two-dimensional waves is that of strong buoyancy/weak flow. The fractal set of neutral curves also represents a fractal of bifurcation points at which nonlinear solutions can be continued from the trivial state, and these may be helpful for understanding turbulent states. This may be the first example of a fractal generated by a linear ordinary differential equation.
The Reinforcement Sensitivity Theory of Personality has as its main foundation a Behavioural Inhibition System (BIS), defined by anxiolytic drugs, in which high trait sensitivity should lead to internalising, anxiety, disorders. Conversely, it has been suggested that low BIS sensitivity would be a characteristic of externalising disorders. BIS output should lead to increased arousal and attention as well as behavioural inhibition. Here, therefore, we tested whether an externalising disorder, Attention Deficit Hyperactivity Disorder (ADHD), involves low BIS sensitivity. Goal-Conflict-Specific Rhythmicity (GCSR) in an auditory Stop Signal Task is a right frontal EEG biomarker of BIS function. We assessed children diagnosed with ADHD-I (inattentive) or ADHD-C (combined) and healthy control groups for GCSR in: a) an initial smaller study in Dunedin, New Zealand (population ~120,000: 15 control, 10 ADHD-I, 10 ADHD-C); and b) a main larger one in Tehran, Iran (population ~9 [city]-16 [metropolis] million: 27 control, 18 ADHD-I, 21 ADHD-C). GCSR was clear in controls (particularly at 6–7 Hz) and in ADHD-C (particularly at 8–9 Hz) but was reduced in ADHD-I. Reduced attention and arousal in ADHD-I could be due, in part, to BIS dysfunction. However, hyperactivity and impulsivity in ADHD-C are unlikely to reflect reduced BIS activity. Increased GCSR frequency in ADHD-C may be due to increased input to the BIS. BIS dysfunction may contribute to some aspects of ADHD (and potentially other externalising disorders) and to some differences between the ADHD subtypes but other prefrontal systems (and, e.g. dopamine) are also important.
Appendicitis is a common surgical condition that frequently requires diagnostic imaging. Abdominal computed tomography (CT) is the gold standard for diagnosing appendicitis. Ultrasound offers a radiation-free modality; however, its availability outside business hours is limited in many emergency departments (EDs). The purpose of this study is to evaluate the test characteristics of emergency physician-performed point-of-care ultrasound (POCUS) to diagnose appendicitis in a Canadian ED.
A health records review was performed on all ED patients who underwent POCUS to diagnose appendicitis from December 1, 2010 to December 4, 2015. The sensitivity, specificity, and likelihood ratios were calculated. The gold standard used for diagnosis was pathology, laparoscopy, CT scans, and a radiologist-performed ultrasound.
Ninety patients were included in the study, and 24 were diagnosed with appendicitis on POCUS. Ultimately, 18 were confirmed to have appendicitis through radiologist-performed imaging, laparoscopy, and pathology. The sensitivity and specificity of POCUS to diagnose appendicitis were 69.2% (95% CI, 48.1%-84.9%) and 90.6% (95% CI, 80.0%-96.1%), respectively.
POCUS has a high specificity for diagnosing acute appendicitis and has very similar characteristics to those of a radiologist-performed ultrasound. These findings are consistent with the current literature and have the potential to decrease patient morbidity, diagnostic delays, ED length of stay, and need for additional imaging.
The first century-and-a-half of Quaker existence is presented through such metaphors as ‘the Lamb’s War’. This represented at first both a personal experience leading to overcoming evil within oneself and a corporate confrontation against evil in the larger world. By 1800, after a tumultuous series of revolutions and wars in the North Atlantic world, the Quaker Lamb’s War had changed to highly organized sectarianism distinct from mainstream society, and, among some notable Quakers, implied a humanitarianism impelled by ongoing commitment to the Inward Light. The Inward Light, revelation, spiritual equality, Quaker witness (also called ethics or ‘testimonies’), and group governance through discernment persisted through all three periods, and remain common to Friends today
Dysbiotic gut microbiota have been implicated in human disease. Diet-based therapeutic strategies have been used to manipulate the gut microbiota towards a more favourable profile. However, it has been demonstrated that large inter-individual variability exists in gut microbiota response to a dietary intervention. The primary objective of this study was to investigate whether habitually low dietary fibre (LDF) v. high dietary fibre (HDF) intakes influence gut microbiota response to an inulin-type fructan prebiotic. In this randomised, double-blind, placebo-controlled, cross-over study, thirty-four healthy participants were classified as LDF or HDF consumers. Gut microbiota composition (16S rRNA bacterial gene sequencing) and SCFA concentrations were assessed following 3 weeks of daily prebiotic supplementation (Orafti® Synergy 1; 16 g/d) or placebo (Glucidex® 29 Premium; 16 g/d), as well as after 3 weeks of the alternative intervention, following a 3-week washout period. In the LDF group, the prebiotic intervention led to an increase in Bifidobacterium (P=0·001). In the HDF group, the prebiotic intervention led to an increase in Bifidobacterium (P<0·001) and Faecalibacterium (P=0·010) and decreases in Coprococcus (P=0·010), Dorea (P=0·043) and Ruminococcus (Lachnospiraceae family) (P=0·032). This study demonstrates that those with HDF intakes have a greater gut microbiota response and are therefore more likely to benefit from an inulin-type fructan prebiotic than those with LDF intakes. Future studies aiming to modulate the gut microbiota and improve host health, using an inulin-type fructan prebiotic, should take habitual dietary fibre intake into account.
Historians and social scientists have relied on contemporaneous textual accounts to document African American mobility in the immediate aftermath of emancipation after the Civil War, but they have interpreted them in widely varying ways. Some emphasize large-scale migration across the South, while others suggest that most movements were local and limited. This research tracks the early or “first wave” of African American migrants between 1865 and 1867 within and out of the South in an attempt to map the motion taking place after the war and to document the scale, direction, and intensity of African American mobility in the period between 1865 and 1867. The Freedmen's Bureau records indicate certain kinds of movements within the South, while our census methodology shows that there was more movement out of the South than accounted for in the Freedmen's Bureau labor records or previously accounted for in the historiography. Further, we observe two types of movement: short-term migration based on one-year contracts, perhaps returning to the point of origin, and another movement not always mediated through the Freedmen's Bureau that was more long term, but also subject to the freedperson's return to the point of origin. We seek to chart the process of emancipation over time and across space, detecting spatial patterns on an otherwise highly variable individual experience. No study has used the Freedmen's Bureau labor contracts to trace African American labor movements, and no study has deployed the 1880 individual census data to examine African American migration based on birthplace cohorts.
Introduction: Atrial fibrillation (AF) is the most common sustained arrhythmia affecting 1-2% of the population. Oral anticoagulation (OAC) reduces stroke risk by 60-80% in AF patients, but only 50% of indicated patients receive OAC. Many patients present to the ED with AF due to arrhythmia symptoms, however; lack of OAC prescription in the ED has been identified as a significant gap in the care of AF patients. Methods: This was a multi-center, pragmatic, three-phase before-after study, in three Canadian sites. Patients who presented to the ED with electrocardiographically (ECG) documented, nonvalvular AF and were discharged home were included. Phase 1 was a retrospective chart review to determine OAC prescription of AF patients in each ED; Phase 2 was a low-intensity knowledge translation intervention where a simple OAC-prescription tool for ED physicians with subsequent short-term OAC prescription was used, as well as an AF patient education package and a letter to family physicians; phase 3 incorporated Phase 2 interventions, but added immediate follow-up in a community AF clinic. The primary outcome of the study was the rate of new OAC prescriptions at ED discharge in AF patients who were OAC eligible and were not on OAC at presentation. Results: A total of 632 patients were included from June, 2015-November, 2016. ED census ranged from 30000-68000 annual visits. Mean age was 71±15, 67±12, 67±13 years, respectively. 47.5% were women, most responsible ED diagnosis was AF in 75.8%. The mean CHA2DS2-VASc score was 2.6±1.8, with no difference amongst groups. There were 266 patients eligible for OAC and were not on this at presentation. In this group, the prescription of new OAC was 15.8% in Phase 1 as compared to 54% and 47%, in Phases 2 and 3, respectively. After adjustment for center, components of the CHA2DS2-VASc score, prior risk of bleeding and most responsible ED diagnosis, the odds ratio for new OAC prescription was 8.0 (95%CI (3.5,18.3) p<0.001) for Phase 3 vs 1, and 10.0 (95%CI (4.4,22.9) p<0.001), for Phase 2 vs 1). No difference in OAC prescription was seen between Phases 2 and 3. Conclusion: Use of a simple OAC-prescription tool was associated with an increase in new OAC prescription in the ED for eligible patients with AF. Further testing in a rigorous study design to assess the effect of this practice on stroke prevention in the AF patients who present to the ED is indicated.