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This study aimed to examine the predictors of cognitive performance in patients with pediatric mild traumatic brain injury (pmTBI) and to determine whether group differences in cognitive performance on a computerized test battery could be observed between pmTBI patients and healthy controls (HC) in the sub-acute (SA) and the early chronic (EC) phases of injury.
203 pmTBI patients recruited from emergency settings and 159 age- and sex-matched HC aged 8–18 rated their ongoing post-concussive symptoms (PCS) on the Post-Concussion Symptom Inventory and completed the Cogstate brief battery in the SA (1–11 days) phase of injury. A subset (156 pmTBI patients; 144 HC) completed testing in the EC (∼4 months) phase.
Within the SA phase, a group difference was only observed for the visual learning task (One-Card Learning), with pmTBI patients being less accurate relative to HC. Follow-up analyses indicated higher ongoing PCS and higher 5P clinical risk scores were significant predictors of lower One-Card Learning accuracy within SA phase, while premorbid variables (estimates of intellectual functioning, parental education, and presence of learning disabilities or attention-deficit/hyperactivity disorder) were not.
The absence of group differences at EC phase is supportive of cognitive recovery by 4 months post-injury. While the severity of ongoing PCS and the 5P score were better overall predictors of cognitive performance on the Cogstate at SA relative to premorbid variables, the full regression model explained only 4.1% of the variance, highlighting the need for future work on predictors of cognitive outcomes.
The general public is familiar with weather forecasts and their utility, and the field of weather forecasting is well-established. Even the theoretical limit of the weather forecasting – two weeks – is known. In contrast, familiarity with climate prediction is low outside of the research field, the theoretical basis is not fully established, and we do not know the extent to which climate can be predicted. Variations in climate, however, can have large societal and economic consequences, as they can lead to droughts and floods, and spells of extreme hot and cold weather. Thus, improving our capabilities to predict climate is important and urgent, as it can enhance climate services and thereby contribute to the sustainable development of humans in this era of climate change.
Prototypes are a common feature of many product design and development endeavours. An ever widening range of prototyping options are available to designers and engineers. May particular options be superior to others, or more appropriate for particular endeavours? This paper reviews current literature on the nature of what constitutes a prototype and the benefits they offer to the discipline. They principally facilitate communication, aid learning, help gain and provide feedback, inform decision making and generally provide superior design outcomes. In order to determine if any particular manner of prototype is preferable for achieving these benefits a comparative study of some of the contemporary prototyping methods is subsequently conducted: A 3D printed prototype (physical prototype), a CAD prototype (represented using a computer monitor), an augmented reality prototype (represented using a tablet device) and a virtual reality prototype (represented using a stereo projector and polarised glasses). The results indicate that while all provide benefits, overall the physical prototype performs best and the augmented reality prototype performs most poorly.
This study profiles climate change as an emerging disaster risk in Oceania. The rationale for undertaking this study was to investigate climate change and disaster risk in Oceania. The role of this analysis is to examine what evidence exists to support decision-making and profile the nature, type, and potential human and economic impact of climate change and disaster risk in Oceania.
To evaluate perceptions of climate change and disaster risk in the Oceania region.
Thirty individual interviews with participants from 9 different countries were conducted. All of the participants were engaged in disaster management in the Oceania region as researchers, practitioners in emergency management, disaster health care and policy managers, or academics. Data collection was conducted between April and November 2017. Thematic analysis was conducted using narrative inquiry to gather first-hand insights on their perceptions of current and emerging threats and propose improvements in risk management practice to capture, monitor, and control disaster risk.
Interviewees who viewed climate change as a risk or hazard described a breadth of impacts. Hazards identified included climate variability and climate-related disasters, climate issues in island areas and loss of land mass, trans-nation migration, and increased transportation risk due to rising sea levels. These emerging risks are reflective of both the geographical location of countries in Oceania, where land mass due to rising oceans has been previously reported and climate change-driven migration of island populations.
Climate change was perceived as a significant contemporary and future risk, and as an influencing factor on other risks in the Oceania region.
The rationale for undertaking this study was to investigate how characteristics of population health relate to and impact disaster risk, resilience, vulnerability, impact, and recovery. The multi-disciplinary environment that contextualizes disaster practice can influence determinants of health. Robust health determinants, or lack thereof, may influence the outcomes of disaster events affecting an individual or a community.
To investigate how the social determinants of health inform community perceptions of disaster risk.
Community perception of disaster risk in reference to the social determinants of health was assessed in this study. Individual interviews with participants from a community were conducted, all of whom were permanent community residents. Thematic analysis was conducted using narrative inquiry to gather firsthand insights on their perceptions of how characteristics of population health relate to and impact an individual’s disaster risk.
Analysis demonstrated commonality between interviewees in perceptions of the influence of the social determinants of health on individual disaster risk by determinant type. Interviewees sensed a strong correlation between low community connection and disaster risk vulnerability. Specific populations thought to have low community connection were perceived to be socially isolated, resulting in low knowledge or awareness of the surrounding disaster risks, or how to prepare and respond to disasters. In addition, they had reduced access to communication and support in time of need.
The importance of a strong social community connection was a feature of this research. Further research on how health determinants can enable disaster risk awareness and disaster risk communication is warranted.
It is now well recognised that contractual purposes play an important role in the construction of contracts. The methods by which purposes are taken into account have not, however, been systematically explored. This paper considers three central issues in the purposive construction of contracts: first, the reasons contractual purposes are relevant to the interpretation of express terms and the identification of implied terms; secondly, the way in which contractual purposes are identified and distinguished from individual party interests; and, thirdly, the different ways in which contractual purposes inform the processes of interpretation and implication. It is argued that reference to contractual purposes can both raise and resolve interpretive choices, and that purposive construction plays a significant and under-recognised role in the identification of implied terms.
The emergence of callous unemotional (CU) traits, and associated externalizing behaviors, is believed to reflect underlying dysfunction in the amygdala. Studies of adults with CU traits or psychopathy have linked characteristic patterns of amygdala dysfunction to reduced amygdala volume, but studies in youths have not thus far found evidence of similar amygdala volume reductions. The current study examined the association between CU traits and amygdala volume by modeling CU traits and externalizing behavior as independent continuous variables, and explored the relative contributions of callous, uncaring, and unemotional traits.
CU traits and externalizing behavior problems were assessed in 148 youths using the Inventory of Callous Unemotional Traits (ICU) and the Child Behavior Checklist (CBCL). For a subset of participants (n = 93), high-resolution T1-weighted images were collected and volume estimates for the amygdala were extracted.
Analyses revealed that CU traits were associated with increased externalizing behaviors and decreased bilateral amygdala volume. These results were driven by the callous and uncaring sub-factors of CU traits, with unemotional traits unrelated to either externalizing behaviors or amygdala volume. Results persisted after accounting for covariation between CU traits and externalizing behaviors. Bootstrap mediation analyses indicated that CU traits mediated the relationship between reduced amygdala volume and externalizing severity.
These findings provide evidence that callous-uncaring traits account for reduced amygdala volume among youths with conduct problems. These findings provide a framework for further investigation of abnormal amygdala development as a key causal pathway for the development of callous-uncaring traits and conduct problems.
Tomato (Solanum lycopersicum) fruit quality and yield are highly dependent on adequate uptake of nutrients. Potassium, magnesium and calcium are essential elements that influence fruit quality traits such as colour, uniformity of ripening, hollow fruit, fruit shape, firmness and acidity. Sodium is not an essential element for tomato and can detrimentally compete with the absorption of potassium and calcium. Daily intakes of potassium, magnesium and calcium in human diets are typically below healthful levels, while sodium intake is often excessive. The objective of this study was to compare 52 diverse commercially important varieties of tomato for concentrations of potassium, magnesium, calcium and sodium in fruits. The tomatoes were produced in replicated plots in Geneva, NY in 2010 and 2011. Multiple fruits per plot were harvested vine-ripe, homogenized and assayed for cations. Analysis of variance showed significant differences among the 52 varieties for all four traits, i.e. cation concentrations (df = 51, P < 0.0001–0.0034) and no significant differences between years for any trait (df = 1, P = 0.3432–0.6770). Factor analysis showed a strong interrelationship between potassium and magnesium that was independent of calcium and sodium. Potassium and magnesium were highly significantly correlated with each other (r = 0.64, P < 0.0001). No other correlations between pairs of traits were observed. Results supported a genetic basis for potassium, magnesium, calcium and sodium concentrations that was consistent across environments (i.e. years). Results can contribute to the development of cultivars with favourable cation profiles in terms of human health and fruit quality.
Discovery of strongly-lensed gravitational wave (GW) sources will unveil binary compact objects at higher redshifts and lower intrinsic luminosities than is possible without lensing. Such systems will yield unprecedented constraints on the mass distribution in galaxy clusters, measurements of the polarization of GWs, tests of General Relativity, and constraints on the Hubble parameter. Excited by these prospects, and intrigued by the presence of so-called “heavy black holes” in the early detections by LIGO-Virgo, we commenced a search for strongly-lensed GWs and possible electromagnetic counterparts in the latter stages of the second LIGO observing run (O2). Here, we summarise our calculation of the detection rate of strongly-lensed GWs, describe our review of BBH detections from O1, outline our observing strategy in O2, summarize our follow-up observations of GW170814, and discuss the future prospects of detection.
Callous–unemotional (CU) traits characterize a subgroup of youths with conduct problems who exhibit low empathy, fearlessness, and elevated externalizing behaviors. The current study examines the role of aberrant amygdala activity and functional connectivity during a socioemotional judgment task in youths with CU traits, and links these deficits to externalizing behaviors. Functional magnetic resonance imaging was used to compare neural responses in 18 healthy youths and 30 youths with conduct problems and varying levels of CU traits as they evaluated the acceptability of causing another person to experience each of several emotions, including fear. Neuroimaging analyses examined blood oxygenation level dependent responses and task-dependent functional connectivity. High-CU youths exhibited left amygdala hypoactivation relative to healthy controls and low-CU youths primarily during evaluations of causing others fear. CU traits moderated the relationship between externalizing behavior and both amygdala activity and patterns of functional connectivity. The present data suggest that CU youths' aberrant amygdala activity and connectivity affect how they make judgments about the acceptability of causing others emotional distress, and that these aberrations represent risk factors for externalizing behaviors like rule breaking and aggression. These findings suggest that reducing externalizing behaviors in high-CU youths may require interventions that influence affective sensitivity.
Specific knowledge and skills are required, especially in the first 72 hours post-disaster, to bridge the time gap until essential services are restored and Emergency Medical Services (EMS) can focus on individuals’ needs. This study explores disaster knowledge and preparedness in the first 72 hours as a function of the individual’s engagement in discussions about disasters, and several other factors (both at personal and community/country level), as well as the entities/organizations perceived by the individual as being responsible for disaster risk reduction (DRR) education.
A prospective, cross-sectional survey of 3,829 final-year high-school students was conducted in nine countries with different levels of disaster risk and economic development. Regression analyses examined the relationship between a 72-hour disaster preparedness composite outcome (ability to make water safe for drinking, knowledge of water potability, home evacuation skill, and improvising a safe room) and a series of independent predictors.
Respondents from countries with lower economic development were significantly better prepared for the first 72 hours post-disaster than those from developed countries (OR=767.45; CI=13.75-48,822.94; P=.001). While several independent predictors showed a significant main effect, combined disaster risk education (DRE) efforts, as a partnership between school and local government, had the best predictive value (OR=3.52; CI=1.48-8.41; P=.005).
Disaster preparedness in final-year high-school students is significantly better in developing countries. Further improvement requires a convergent effort in aligning the most effective educational policies and actions to best address the individual’s and the community needs.
CodreanuTA, NgoH, RobertsonA, CelenzaA. Challenging Assumptions: What Do We Need to Address in Our Disaster Risk Reduction Efforts?Prehosp Disaster Med. 2017;32(2):134–147.
In December 2014, the United States government expanded the Priority Review Voucher (“PRV” or “voucher”) program to include Ebola and other related Filoviruses. By doing so, lawmakers provided a potentially powerful incentive for drug companies to invest time and money in the development of novel medicines for terrifying diseases. This expansion is one of several additions made to the PRV programs since 2012. Many companies rely on voucher resale to recoup research and development (“R&D”) costs; however, it is unclear whether the PRV program could be overextended, thereby diluting the value of the incentives. In this paper, I use historical approval data from the Food and Drug Administration (“FDA”) and United States drug revenue data to better understand the secondary market value of a PRV. The data suggests that that purchase prices of a PRV could continue to climb; despite this, the market size for these vouchers is limited. The implications of these findings are discussed further.
The law of civil remedies is a fascinating subject. More than any other field of study in the core curriculum, it lays bare fundamental questions as to the nature and purpose of the law of obligations. The law of remedies defines what it means to have particular private law rights and to owe particular private law duties. Difficult issues concerning remedies necessarily direct attention to questions as to what precisely is to be remedied, why particular obligations are imposed, and the nature of the interests protected by different private law causes of action. The law of remedies is also an immensely practical subject. Remedies are, after all, the ends of civil litigation. The principles that govern their application are in many cases simple to state in the abstract but give rise to great difficulty in their application to particular fact situations. The finer points of the law of remedies are therefore not only matters of great theoretical interest and intense academic debate, but also of great day-to-day importance for legal practitioners.
For all of these reasons, the publication of this substantial new book on the Australian law of civil remedies is an exciting event. It is the more so since Remedies in Australian Private Law has been written by two up-and-coming remedies scholars who have recently published monographs offering insightful analyses of particular aspects of the field. Sirko Harder is the author of Measuring Damages in the Law of Obligations: The Search for Harmonised Principles (Hart Publishing, 2010), and Katy Barnett is the author of Accounting for Profit for Breach of Contract: Theory and Practice (Hart Publishing, 2012). Readers of their new jointly authored book are offered new perspectives on the nature of the subject and new ways of approaching the many thorny issues that make it so challenging.
This paper seeks to develop a deeper understanding of the role of policy-based reasoning in the determination of duty of care questions. In order to do this, the first part explores the distinction between considerations of interpersonal justice and considerations of community welfare in the determination of duty questions. While imperfect, the distinction illuminates the nature of the factors taken into account by courts in determining duty of care questions and has practical as well as theoretical implications. The second part of the paper analyses the respective roles of interpersonal justice considerations and community welfare considerations in a sample of first instance and intermediate appellate cases from England and Canada. That study suggests that community welfare considerations play a far less significant role in determining duty cases at the first instance and intermediate appellate level than at the ultimate appellate level. Analysis of the cases also reveals significant differences between the English and Canadian courts in their approaches to the interpersonal justice and community welfare aspects of duty of care questions.
An analysis was undertaken to measure age-specific vaccine effectiveness (VE) of 2010/11 trivalent seasonal influenza vaccine (TIV) and monovalent 2009 pandemic influenza vaccine (PIV) administered in 2009/2010. The test-negative case-control study design was employed based on patients consulting primary care. Overall TIV effectiveness, adjusted for age and month, against confirmed influenza A(H1N1)pdm 2009 infection was 56% (95% CI 42–66); age-specific adjusted VE was 87% (95% CI 45–97) in <5-year-olds and 84% (95% CI 27–97) in 5- to 14-year-olds. Adjusted VE for PIV was only 28% (95% CI −6 to 51) overall and 72% (95% CI 15–91) in <5-year-olds. For confirmed influenza B infection, TIV effectiveness was 57% (95% CI 42–68) and in 5- to 14-year-olds 75% (95% CI 32–91). TIV provided moderate protection against the main circulating strains in 2010/2011, with higher protection in children. PIV administered during the previous season provided residual protection after 1 year, particularly in the <5 years age group.
It is likely that calls for disaster medical assistance teams (DMATs) will continue in response to international disasters.
As part of a national survey, the present study was designed to evaluate leadership issues and use of standards in Australian DMATs.
Data was collected via an anonymous mailed survey distributed via State and Territory representatives on the Australian Health Protection Committee, who identified team members associated with Australian DMAT deployments from the 2004 Asian Tsunami disaster.
The response rate for this survey was estimated to be approximately 50% (59/118). Most of the personnel had deployed to the Asian Tsunami affected areas. The DMAT members were quite experienced, with 53% (31/59) of personnel in the 45-55 years of age group. Seventy-five percent (44/59) of the respondents were male. Fifty-eight percent (34/59) of the survey participants had significant experience in international disasters, although few felt they had previous experience in disaster management (5%, 3/59). There was unanimous support for a clear command structure (100%, 59/59), with strong support for leadership training for DMAT commanders (85%, 50/59). However only 34% (20/59) felt that their roles were clearly defined pre-deployment, and 59% (35/59) felt that team members could be identified easily. Leadership was identified by two team members as one of the biggest personal hardships faced during their deployment. While no respondents disagreed with the need for meaningful, evidence-based standards to be developed, only 51% (30/59) stated that indicators of effectiveness were used for the deployment.
In this study of Australian DMAT members, there was unanimous support for a clear command structure in future deployments, with clearly defined team roles and reporting structures. This should be supported by clear identification of team leaders to assist inter-agency coordination, and by leadership training for DMAT commanders. Members of Australian DMATs would also support the development and implementation of meaningful, evidence-based standards. More work is needed to identify or develop actual standards and the measures of effectiveness to be used, as well as the contents and nature of leadership training.
Aitken P, Leggat PA, Robertson AG, Harley H, Speare R, Leclercq MG. Leadership and use of standards by Australian disaster medical assistance teams: results of a national survey of team members. Prehosp Disaster Med. 2012;27(2):1-6.