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People with schizophrenia have shortened lives. This excess mortality seems to be related to physical health conditions that may be amenable to better primary and secondary prevention. Better continuity of care may enhance such interventions as well as help prevent death by self-injury.
We set out to examine the relationship between the continuity of care of patients with schizophrenia, their mortality and cause of death.
Pseudoanonymised community data from 5551 people with schizophrenia presenting over 11 years were examined for changes in continuity of care using the numbers of community teams caring for them and the Modified Modified Continuity Index. These and demographic variables were related to death certifications of physical illness from the Office of National Statistics and mortal self-injury from clinical data. Data were analysed using generalised estimating equations.
We found no independent relationship between levels of continuity of care and overall mortality. However, lower levels of relationship continuity were significantly and independently related to death by self-injury.
We found no evidence that continuity of care is important in the prevention of physical causes of death in schizophrenia. However, there is evidence that declining relationship continuity of care has an independent effect on deaths as a result of self-injury. We suggest that there should be more attention focused on the improvement of continuity of care for these patients.
Research indicates that congresswomen are more effective at moving bills through the lawmaking process than their male counterparts. To investigate why, we discuss what legislative entrepreneurship involves and explain why it can serve as the basis for problem-solving and effective lawmaking in the U.S. Congress. We also examine the entrepreneurial work that members of Congress did on behalf of bills that they sponsored from 1973 to 2008. Among other findings, we observe that congresswomen, especially those in the minority party, are more entrepreneurial than their male colleagues. This finding enhances our understanding of why female lawmakers are more effective lawmakers.
Catheter ablation is a safe and effective therapy for the treatment of supraventricular tachycardia in children. Current improvements in technology have allowed progressive reduction in radiation exposure associated with the procedure. To assess the impact of three-dimensional mapping, we compared acute procedural results collected from the Catheter Ablation with Reduction or Elimination of Fluoroscopy registry to published results from the Prospective Assessment after Pediatric Cardiac Ablation study.
Inclusion and exclusion criteria from the Prospective Assessment after Pediatric Cardiac Ablation study were used as guidelines to select patient data from the Catheter Ablation with Reduction or Elimination of Fluoroscopy registry to compare acute procedural outcomes between cohorts. Outcomes assessed include procedural and fluoroscopy exposure times, success rates of procedure, and complications.
In 786 ablation procedures, targeting 498 accessory pathways and 288 atrioventricular nodal reentrant tachycardia substrates, average procedural time (156.5 versus 206.7 minutes, p < 0.01), and fluoroscopy time (1.2 versus 38.3 minutes, p < 0.01) were significantly shorter in the study group. Success rates for the various substrates were similar except for manifest accessory pathways which had a significantly higher success rate in the study group (96.4% versus 93.0%, p < 0.01). Major complication rates were significantly lower in the study group (0.3% versus 1.6%, p < 0.01).
In a large, multicentre study, three-dimensional systems show favourable improvements in clinical outcomes in children undergoing catheter ablation of supraventricular tachycardia compared to the traditional fluoroscopic approach. Further improvements are anticipated as technology advances.
What is status? How does it work? What effects does it tend to have? A new wave of scholarship on status in international relations has converged on a central definition of status, several causal pathways, and the claim that the pursuit of status tends to produce conflict. The authors take stock of the status literature and argue that this convergence is not only a sign of progress, but also an obstacle to it. They find that the consensus definition conceals critical contradictions between standing and membership, that its causal pathways are promising but often in tension with each other, and that the literature may be overlooking the ways in which status can help states avoid conflict and promote cooperation under certain conditions.
Schizophrenia is a disorder characterized by pervasive deficits in cognitive functioning. However, few well-powered studies have examined the degree to which cognitive performance is impaired even among individuals with schizophrenia not currently on antipsychotic medications using a wide range of cognitive and reinforcement learning measures derived from cognitive neuroscience. Such research is particularly needed in the domain of reinforcement learning, given the central role of dopamine in reinforcement learning, and the potential impact of antipsychotic medications on dopamine function.
The present study sought to fill this gap by examining healthy controls (N = 75), unmedicated (N = 48) and medicated (N = 148) individuals with schizophrenia. Participants were recruited across five sites as part of the CNTRaCS Consortium to complete tasks assessing processing speed, cognitive control, working memory, verbal learning, relational encoding and retrieval, visual integration and reinforcement learning.
Individuals with schizophrenia who were not taking antipsychotic medications, as well as those taking antipsychotic medications, showed pervasive deficits across cognitive domains including reinforcement learning, processing speed, cognitive control, working memory, verbal learning and relational encoding and retrieval. Further, we found that chlorpromazine equivalency rates were significantly related to processing speed and working memory, while there were no significant relationships between anticholinergic load and performance on other tasks.
These findings add to a body of literature suggesting that cognitive deficits are an enduring aspect of schizophrenia, present in those off antipsychotic medications as well as those taking antipsychotic medications.
Passive acoustic monitoring is rapidly gaining recognition as a practical, affordable and robust tool for measuring gun hunting levels within protected areas, and consequently for its potential to evaluate anti-poaching patrols’ effectiveness based on outcome (i.e., change in hunting pressure) rather than effort (e.g., kilometres patrolled) or output (e.g., arrests). However, there has been no report to date of a protected area successfully using an acoustic grid to explore baseline levels of gun hunting activity, adapting its patrols in response to the evidence extracted from the acoustic data and then evaluating the effectiveness of the new patrol strategy. We report here such a case in Cameroon’s Korup National Park, where anti-poaching patrol effort was markedly increased in the 2015–2016 Christmas/New Year holiday season to curb the annual peak in gunshots recorded by a 12-sensor acoustic grid in the same period during the previous 2 years. Despite a three- to five-fold increase in patrol days, distance and area covered, the desired outcome – lower gun hunting activity – was not achieved under the new patrol scheme. The findings emphasize the need for adaptive wildlife law enforcement and how passive acoustic monitoring can help attain this goal, and they warn about the risks of using effort-based metrics of anti-poaching strategies as a surrogate for desired outcomes. We propose ways of increasing protected areas’ capacity to adopt acoustic grids as a law enforcement monitoring tool.
While solar photovoltaics are projected to grow, major financial barriers exist that impede installation. Soft costs (human-driven costs) can account for over half of total project costs and are often simplified in typical models. We use the National Renewable Energy Laboratory's “Cost of Renewable Energy Spreadsheet Tool” to quantify uncertainty of three soft cost inputs and their influence on the output cost of energy using variance-based sensitivity indices. We then suggest how the development process and model can be redesigned to represent the complexities of this socio-technical system.
Generalization of conditioned-fear, a core feature of post-traumatic stress disorder (PTSD), has been the focus of several recent neuroimaging studies. A striking outcome of these studies is the frequency with which neural correlates of generalization fall within hubs of well-established functional networks including salience (SN), central executive (CEN), and default networks (DN). Neural substrates of generalization found to date may thus reflect traces of large-scale brain networks that form more expansive neural representations of generalization. The present study includes the first network-based analysis of generalization and PTSD-related abnormalities therein.
fMRI responses in established intrinsic connectivity networks (ICNs) representing SN, CEN, and DN were assessed during a generalized conditioned-fear task in male combat veterans (N = 58) with wide-ranging PTSD symptom severity. The task included five rings of graded size. Extreme sizes served as conditioned danger-cues (CS+: paired with shock) and safety-cues (CS−), and the three intermediate sizes served as generalization stimuli (GSs) forming a continuum-of-size between CS+ and CS–. Generalization-gradients were assessed as behavioral and ICN response slopes from CS+, through GSs, to CS–. Increasing PTSD symptomatology was predicted to relate to less-steep slopes indicative of stronger generalization.
SN, CEN, and DN responses fell along generalization-gradients with levels of generalization within and between SN and CEN scaling with PTSD symptom severity.
Neural substrates of generalized conditioned-fear include large-scale networks that adhere to the functional organization of the brain. Current findings implicate levels of generalization in SN and CEN as promising neural markers of PTSD.
Rates of common mental health problems (depression/anxiety) rise sharply in adolescence and peak in young adulthood, often coinciding with the transition to parenthood. Little is known regarding the persistence of common mental health problems from adolescence to the perinatal period in both mothers and fathers.
A total of 393 mothers (686 pregnancies) and 257 fathers (357 pregnancies) from the intergenerational Australian Temperament Project Generation 3 Study completed self-report assessments of depression and anxiety in adolescence (ages 13–14, 15–16, 17–18 years) and young adulthood (ages 19–20, 23–24, 27–28 years). The Edinburgh Postnatal Depression Scale was used to assess depressive symptoms at 32 weeks pregnancy and 12 months postpartum in mothers, and at 12 months postpartum in fathers.
Most pregnancies (81%) in which mothers reported perinatal depression were preceded by a history of mental health problems in adolescence or young adulthood. Similarly, most pregnancies (83%) in which fathers reported postnatal depression were preceded by a preconception history of mental health problems. After adjustment for potential confounders, the odds of self-reporting perinatal depression in both women and men were consistently higher in those with a history of persistent mental health problems across adolescence and young adulthood than those without (ORwomen 5.7, 95% CI 2.9–10.9; ORmen 5.5, 95% CI 1.03–29.70).
Perinatal depression, for the majority of parents, is a continuation of mental health problems with onsets well before pregnancy. Strategies to promote good perinatal mental health should start before parenthood and include both men and women.
The gregariousness of the Scotch, - ‘Highlanders! shoulder to shoulder’, - the abstract coherency of the people as a nation, - their peculiar pride in the history of their country, - their strong exhilarating associations with battlefields on which the conflict terminated more than six hundred years ago, - their enthusiastic regard for the memory of heroes many centuries departed, who fought and bled in the national behalf, - are all well-known manifestations of a prominent national trait.
Hugh Miller, First Impressions of England and its People (Edinburgh, 1870)
Since 1707, in the absence of independent statehood, the ‘abstract coherency’ of the Scottish people as a ‘nation’ has frequently been predicated on stylised readings of Scotland's past and complementary inferences regarding native sensibilities. As has been highlighted elsewhere, ‘the historic sense’ is often more vivid ‘in the dispossessed than in those who are themselves the visible guardians of tradition’. And indeed, in a very real sense, ‘Scotland’ has survived the Union and the subsequent emigrant diaspora as a set of shared values evoked by its history and personified in its heroes.
Significantly, this association of principle and precedent has encouraged the conflation of the discourses of radicalism and patriotism at various stages in Scotland's political evolution. Most particularly, the historicism of the Scottish Labour movement perpetuated this vision in the twentieth century. In 1924 James Maxton considered that Scotland was ‘a nation which, above all, has the democratic spirit’, and in her biography of Ramsay MacDonald, Margaret Agnes Hamilton considered that to the Scot, ‘a sense of the dignity and equality of man is native’. In arriving at such and similar conclusions, the influence of history was profound. William Haddow recounted that
From the days of Wallace there has always been a
Revolutionary Movement in Scotland, fighting at one time for
religious Liberty, at another for political Equality, and for the
past thirty years or so, for economic and industrial Freedom
Previous studies on the acquisition of semantics in the aspectual domain have suggested that a difficult case for achieving a targetlike representation in a second language arises when learners need to preempt a first language (L1) option (Gabriele, 2009). This study investigates this issue by focusing on a learning scenario where predicate-level variability exists in the L1 input. We investigate whether Japanese learners of English can learn to invalidate event cancellation readings (Tsujimura, 2003) in English and how such knowledge develops with increasing English proficiency. We address these questions by examining how Japanese learners of English interpret accomplishment predicates that allow an event cancellation reading in Japanese but not in English. A truth-value judgment task was administered to 60 beginner, 96 intermediate, and 40 advanced Japanese learners of English as well as 20 L1 English and 20 L1 Japanese speakers. Our results showed that Japanese learners of English progressed toward a targetlike representation of aspectual entailment. We argue that such progress follows two parallel routes: a grammatical route rooted in the learners’ growing awareness of the English determiner and number morphology combined with a statistical route rooted in the learners’ inferences based on missing data.
To explore if better diet quality scores as a measure of adherence to the Australian Dietary Guidelines (ADG) and the Mediterranean diet (MedDiet) are associated with a lower incidence of hypertension and non-fatal CVD.
Prospective analysis of the 1946–1951 cohort of the Australian Longitudinal Study on Women’s Health (ALSWH). The Australian Recommended Foods Score (ARFS) was calculated as an indicator of adherence to the ADG; the Mediterranean Diet Score (MDS) measured adherence to the MedDiet. Outcomes included hypertension and non-fatal CVD. Generalised estimating equations estimated OR and 95 % CI across quartiles of diet quality scores.
1946–1951 cohort of the ALSWH (n 5324), without CVD, hypertension and diabetes at baseline (2001), with complete FFQ data.
There were 1342 new cases of hypertension and 629 new cases of non-fatal CVD over 15 years of follow-up. Multivariate analysis indicated that women reporting better adherence to the ARFS (≥38/74) had 15 % (95 % CI 1, 28 %; P = 0·05) lower odds of hypertension and 46 % (95 % CI 6, 66 %; P = 0·1) lower odds of non-fatal CVD. Women reporting better adherence to the MDS (≥8/17) had 27 % (95 % CI 15, 47 %; P = 0·0006) lower odds of hypertension and 30 % (95 % CI 2, 50 %; P = 0·03) lower odds of non-fatal CVD.
Better adherence to diet quality scores is associated with lower risk of hypertension and non-fatal CVD. These results support the need for updated evidenced based on the ADG as well as public health nutrition policies in Australia.
Field studies were conducted on organic soils in Belle Glade, FL, in 2016 to 2017 to evaluate sugarcane tolerance and fall panicum control with topramezone applied alone or in combination with triazine herbicides (atrazine, metribuzin, ametryn). Treatments included topramezone (25 and 50 g ai ha−1) applied alone or in combination with atrazine (2,240 g ai ha−1), metribuzin (2,240 g ai ha−1), and ametryn (440 g ha−1) on four plant cane varieties to evaluate tolerance, and on second ratoon fields to determine efficacy on fall panicum control. Topramezone applied alone had no effect on sugarcane chlorophyll fluorescence (i.e., the ratio of variable fluorescence to maximum fluorescence), total chlorophyll, and carotenoid 7 to 28 d after treatment (DAT), suggesting sugarcane tolerance. Significant reduction of these parameters occured 7 to 14 DAT when topramezone (50 g ai ha−1) was applied with ametryn or metribuzin; however, reductions were not detected thereafter, indicating recovery. Sugarcane yield was not affected by topramezone applied alone or in combination with the triazine herbicides. Topramezone (50 g ai ha−1) plus metribuzin resulted in acceptable control of fall panicum (84%) with limited to no regrowth of meristematic tissue at sugarcane canopy closure, equivalent to 56 to 70 DAT. These results indicate that when sequential applications of topramezone, applied alone or in combination with these triazine herbicides, are required for efficacious weed control, topramezone applications alone can be made after 7 d, whereas the combinations can be made after 14 or 21 d, depending on sugarcane sensitivity.
Whole-grain cereal breakfast consumption has been associated with beneficial effects on glucose and insulin metabolism as well as satiety. Pearl millet is a popular ancient grain variety that can be grown in hot, dry regions. However, little is known about its health effects. The present study investigated the effect of a pearl millet porridge (PMP) compared with a well-known Scottish oats porridge (SOP) on glycaemic, gastrointestinal, hormonal and appetitive responses. In a randomised, two-way crossover trial, twenty-six healthy participants consumed two isoenergetic/isovolumetric PMP or SOP breakfast meals, served with a drink of water. Blood samples for glucose, insulin, glucagon-like peptide 1, glucose-dependent insulinotropic polypeptide (GIP), peptide YY, gastric volumes and appetite ratings were collected 2 h postprandially, followed by an ad libitum meal and food intake records for the remainder of the day. The incremental AUC (iAUC2h) for blood glucose was not significantly different between the porridges (P > 0·05). The iAUC2h for gastric volume was larger for PMP compared with SOP (P = 0·045). The iAUC2h for GIP concentration was significantly lower for PMP compared with SOP (P = 0·001). Other hormones and appetite responses were similar between meals. In conclusion, the present study reports, for the first time, data on glycaemic and physiological responses to a pearl millet breakfast, showing that this ancient grain could represent a sustainable alternative with health-promoting characteristics comparable with oats. GIP is an incretin hormone linked to TAG absorption in adipose tissue; therefore, the lower GIP response for PMP may be an added health benefit.
Background: Gross total resection of pediatric posterior fossa tumors is paramount towards improving progression-free survival.
Fluorescein accumulates in tumoral tissue, where the blood-brain barrier is disrupted. It can therefore potentially aid in differentiating tumoral versus normal tissue. We aimed to evaluate the efficacy of fluorescent-guidance (using fluorescein) towards the resection of a pediatric cerebellar tumor, as the index case at our institution using this technique. Methods: 5 mg/kg of IV fluorescein sodium was injected upon induction of general anesthesia. During tumor resection, a yellow 560-nm filter (Kinevo microscope, Zeiss) was employed for fluorescent-guidance. The extent of resection was assessed via post-operative MRI. Results: There were no adverse side effects experienced by the patient. Tumoral material was clearly visualized under the yellow 560-nm filter, allowing for satisfactory gross total resection of the lesion (confirmed on post-operative MRI). Preliminary pathology was consistent with medulloblastoma. Conclusions: Fluorescent-guided resection of pediatric posterior fossa tumors appears to be a safe and useful adjunct for gross total resection of these lesions. To the best of our knowledge, this is the first reported case in Canada wherein IV fluorescein was used under a yellow 560-nm filter for resection of a posterior fossa medulloblastoma in a child.
Conservation planning, with its emphasis on nature reserves, provides a basis for the development of spatial plans, usually at regional scale, that explicitly state objectives and then provide options for achieving them, despite limited financial resources. Conservation planning, however, is still an imperfect science that places more importance on ecological considerations than on social ones. Complementing social considerations with an integrated understanding of the ecology of a region, and obtaining enough social data in a cost-effective manner, are recurrent challenges. Here, we address the potential of systematic planning to improve human–wildlife interactions. Mapping risks and opportunities with behavioural, social and economic data, e.g., would greatly facilitate management decisions. While data collection through conventional field methods is a constraint at large spatial scales, the huge and fast-growing amount of social data in the 'big data' space remains largely unexplored. We describe new, promising approaches for big data visualization and analysis that could be used to inform wildlife managers through easy-to-interpret, data-intensive approaches.
Introduction: The number of seniors presenting to emergency departments after a fall is increasing. Head injury concerns in this population often leads to a head CT scan. The CT rate among physicians is variable and the reasons for this are unknown. This study examined the role of patient characteristics and country of practice in the decision to order a CT. Methods: This study used a case-based survey of physicians across multiple countries. Each survey included 9 cases pertaining to an 82-year old man who falls. Each case varied in one aspect compared to a base case (aspirin, warfarin, or rivaroxaban use, occipital hematoma, amnesia, dementia, and fall with no head trauma). For each case, participants indicated how “likely” they were to order a head CT scan, measured on a 100-point scale. A response of 80 or more was defined a priori as ‘likely to order a CT scan’. The survey was piloted among emergency residents for feedback on design and comprehension, and was published in French and English. Recruitment was through the Canadian Association of Emergency Physicians, Twitter and CanadiEM. For each case we compared the proportion of physicians who were ‘likely to scan’ with relative to the base case. We also compared the proportion of participants who were ‘likely to scan’ each case in the USA, UK and Australia, relative to Canada. Results: Data was collected from 484 respondents (Canada-308, USA-64, UK-67, Australia-27, and 18 from other countries). Social media distribution limited our ability to estimate of the response rate. Physicians were most likely to scan in the anticoagulation cases (90% likely to order a scan compared to 36% for the base case (p = <0.001)). Other features associated with increased scans were occipital hematoma (48%), multiple falls (68%), and amnesia (68%) (all p < 0.005). Compared to Canada, US physicians were more likely to order CT scans for all cases (p = <0.05). Compared to Canada, UK physicians were significantly less likely to order CT for patients in every case except in the patient with amnesia. Finally, Australian physicians differed from Canada only for the occipital hematoma case where they were significantly more likely to order CT scan. Conclusion: Anticoagulation, amnesia and a history of multiple falls appear to drive the ordering a head CT scan in elderly patients who had fallen. We observed variations in practice between countries. Future clinical decision rules will likely have variable impact on head CT scan rates depending on baseline practice variation.
A 2018 workshop on the White Mountain Apache Tribe lands in Arizona examined ways to enhance investigations into cultural property crime (CPC) through applications of rapidly evolving methods from archaeological science. CPC (also looting, graverobbing) refers to unauthorized damage, removal, or trafficking in materials possessing blends of communal, aesthetic, and scientific values. The Fort Apache workshop integrated four generally partitioned domains of CPC expertise: (1) theories of perpetrators’ motivations and methods; (2) recommended practice in sustaining public and community opposition to CPC; (3) tactics and strategies for documenting, investigating, and prosecuting CPC; and (4) forensic sedimentology—uses of biophysical sciences to link sediments from implicated persons and objects to crime scenes. Forensic sedimentology served as the touchstone for dialogues among experts in criminology, archaeological sciences, law enforcement, and heritage stewardship. Field visits to CPC crime scenes and workshop deliberations identified pathways toward integrating CPC theory and practice with forensic sedimentology’s potent battery of analytic methods.
Introduction: Although acute gastroenteritis is an extremely common childhood illness, there is a paucity of literature characterizing the associated pain and its management. Our primary objective was to quantify the pain experienced by children with acute gastroenteritis in the 24-hours prior to emergency department (ED) presentation. Secondary objectives included describing maximum pain, analgesic use, discharge recommendations, and factors that influenced analgesic use in the ED. Methods: Study participants were recruited into this prospective cohort study by the Alberta Provincial Pediatric EnTeric Infection TEam between January 2014 and September 2017. This study was conducted at two Canadian pediatric EDs; the Alberta Children's Hospital (Calgary) and the Stollery Children's Hospital (Edmonton). Eligibility criteria included < 18 years of age, acute gastroenteritis (□ 3 episodes of diarrhea or vomiting in the previous 24 hours), and symptom duration □ 7 days. The primary study outcome, caregiver-reported maximum pain in the 24-hours prior to presentation, was assessed using the 11-point Verbal Numerical Rating Scale. Results: We recruited 2136 patients, median age 20.8 months (IQR 10.4, 47.4); 45.8% (979/2136) female. In the 24-hours prior to enrolment, 28.6% (610/2136) of caregivers reported that their child experienced moderate (4-6) and 46.2% (986/2136) severe (7-10) pain in the preceding 24-hours. During the emergency visit, 31.1% (664/2136) described pain as moderate and 26.7% (571/2136) as severe. In the ED, analgesia was provided to 21.2% (452/2131) of children. The most commonly administered analgesics in the ED were ibuprofen (68.1%, 308/452) and acetaminophen (43.4%, 196/452); at home, acetaminophen was most commonly administered (77.7%, 700/901), followed by ibuprofen (37.5%, 338/901). Factors associated with analgesia use in the ED were greater pain scores during the visit, having a primary-care physician, shorter illness duration, fewer diarrheal episodes, presence of fever and hospitalization. Conclusion: Although children presenting to the ED with acute gastroenteritis experience moderate to severe pain, both prior to and during their emergency visit, analgesic use is limited. Future research should focus on appropriate pain management through the development of effective and safe pain treatment plans.