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To outline features of the neurologic examination that can be performed virtually through telemedicine platforms (the virtual neurological examination [VNE]), and provide guidance for rapidly pivoting in-person clinical assessments to virtual visits during the COVID-19 pandemic and beyond.
The full neurologic examination is described with attention to components that can be performed virtually.
A screening VNE is outlined that can be performed on a wide variety of patients, along with detailed descriptions of virtual examination maneuvers for specific scenarios (cognitive testing, neuromuscular and movement disorder examinations).
During the COVID-19 pandemic, rapid adoption of virtual medicine will be critical to provide ongoing and timely neurological care. Familiarity and mastery of a VNE will be critical for neurologists, and this article outlines a practical approach to implementation.
During pregnancy, changes occur to influence the maternal gut microbiome, and potentially the fetal microbiome. Diet has been shown to impact the gut microbiome. Little research has been conducted examining diet during pregnancy with respect to the gut microbiome. To meet inclusion criteria, dietary analyses must have been conducted as part of the primary aim. The primary outcome was the composition of the gut microbiome (infant or maternal), as assessed using culture-independent sequencing techniques. This review identified seven studies for inclusion, five examining the maternal gut microbiome and two examining the fetal gut microbiome. Microbial data were attained through analysis of stool samples by 16S rRNA gene-based microbiota assessment. Studies found an association between the maternal diet and gut microbiome. High-fat diets (% fat of total energy), fat-soluble vitamins (mg/day) and fibre (g/day) were the most significant nutrients associated with the gut microbiota composition of both neonates and mothers. High-fat diets were significantly associated with a reduction in microbial diversity. High-fat diets may reduce microbial diversity, while fibre intake may be positively associated with microbial diversity. The results of this review must be interpreted with caution. The number of studies was low, and the risk of observational bias and heterogeneity across the studies must be considered. However, these results show promise for dietary intervention and microbial manipulation in order to favour an increase of health-associated taxa in the gut of the mother and her offspring.
Structural fetal anomalies complicate up to 5% of pregnancies and an underlying chromosomal or genetic etiology underlies up to half of cases. Understanding the fetal genome is increasingly key in attempting to make a prenatal diagnosis and in delineating a prognosis for the baby. Over the past decades, the field of prenatal genomics has advanced exponentially, beginning with the conventional ‘full’ karyotype available in the 1960s and going up to the present day and beyond with the application of next-generation sequencing (NGS) (Figure 4.1). Current and potential future advances in prenatal diagnostics will allow couples to make more informed decisions prospectively about their pregnancies in addition to aiding decisions on and the development of fetal therapies . In the wake of advancing technologies and large prospective studies such as the United Kingdom’s ‘proof of principle’ 100 000 Genomes Project  and the Prenatal Assessment of Genomes and Exomes (PAGE) study , the degree of information obtained and turnaround time of results with the development of more sophisticated bioinformatic analytical pathways is likely to improve rapidly. Fetal medicine subspecialists, obstetricians, pediatricians, geneticists, genomic scientists and genetic counselors have a responsibility to stay up to date with this wealth of advances so that couples can be informed accordingly.
Stanford University's indirect cost rates for federally sponsored research dramatically increased from 58 percent in 1980 to 78 percent in 1991. Faculty frustration with increasing rates and scrutiny from a zealous government contracting officer culminated in a congressional inquiry into Stanford's indirect cost accounting practices in 1990 and 1991. The investigation revealed controversial luxury expenses charged to the government, including a yacht and antiques for the Stanford president's home, which attracted extensive public attention. Stanford president Donald Kennedy admitted some expenses were accounting errors but defended many expenses as permissible under government rules. Stanford's aggressive overhead recovery practices represent the institution's struggle to adapt to a changing economy for sponsored research in the twilight of the Cold War. The congressional response, which included a cap on administrative cost recovery for all universities, highlighted how shifting federal priorities—from defense research to deficit reduction—strained the relationship between the federal government and academic science.
Anti-retroviral therapy (ART) regimes for HIV are associated with raised levels of circulating triglycerides (TGs) in western populations. However, there are limited data on the impact of ART on cardiometabolic risk in sub-Saharan African (SSA) populations.
Pooled analyses of 14 studies comprising 21 023 individuals, on whom relevant cardiometabolic risk factors (including TG), HIV and ART status were assessed between 2003 and 2014, in SSA. The association between ART and raised TG (>2.3 mmol/L) was analysed using regression models.
Among 10 615 individuals, ART was associated with a two-fold higher probability of raised TG (RR 2.05, 95% CI 1.51–2.77, I2 = 45.2%). The associations between ART and raised blood pressure, glucose, HbA1c, and other lipids were inconsistent across studies.
Evidence from this study confirms the association of ART with raised TG in SSA populations. Given the possible causal effect of raised TG on cardiovascular disease (CVD), the evidence highlights the need for prospective studies to clarify the impact of long term ART on CVD outcomes in SSA.
In laboratory experiments, we investigated how media with varying ratio of peat:sand and two levels of compaction influence dispersal success of entomopathogenic nematode (EPN) species with different foraging strategies: Steinernema carpocapsae (ambusher), Heterorhabditis downesi (cruiser) and Steinernema feltiae (intermediate). Success was measured by the numbers of nematodes moving through a 4 cm column and invading a wax moth larva. We found that both compaction and increasing peat content generally decreased EPN infective juvenile (IJ) success for all three species. Of the three species, H. downesi was the least affected by peat content, and S. carpocapsae was the most adversely influenced by compaction. In addition, sex ratios of the invading IJs of the two Steinernema species were differentially influenced by peat content, and in the case of S. feltiae, sex ratio was also affected by compaction. This indicates that dispersal of male and female IJs is differentially affected by soil parameters and that this differentiation is species-specific. In conclusion, our study shows that organic matter: sand ratio and soil compaction have a marked influence on EPN foraging behaviour with implications for harnessing them as biological pest control agents.
The National Defense Education Act (NDEA) of 1958 was the first federal investment in low-interest student loans and became a precedent for expansion of student loans in the Higher Education Act of 1965. In its controversial loyalty provisions, the NDEA required loan recipients to affirm loyalty to the U.S. government. Between 1958 and 1962, thirty-two colleges and universities refused to participate or withdrew from the NDEA loan program, arguing that the loyalty provisions unfairly targeted students and violated principles of free inquiry. This essay argues that debate over the loyalty provisions fractured a partnership between progressives who favored general aid to education and conservatives who supported short-term investment for defense purposes. Although debates over the NDEA loyalty requirements seem specific to the Cold War, a close examination of the arguments illuminates their alignment with long-standing ideological conflicts over legitimacy of federal aid to higher education.
Cone-in-cone (CIC) and beef (BF) carbonate lenses ornament detachment zone faults underlying Triassic growth basins on Edgeøya. Field relationships place CIC and BF growth as during early diagenesis and a transition from hydroplastic to a later brittle-style of faulting that is marked by coarser calcite veining. Deformation is constrained to have occurred at <300 m depth. Multiple models exist for CIC formation. For the Edgeøya example, textural analysis of thin-sections suggests that small tensile fractures and carbonate shell fragments nucleated development of calcite aggregates with CIC and BF morphology within unconsolidated to poorly consolidated sediment to form asymmetric antitaxial tensile aggregates subparallel to bedding and fault surfaces. The conical forms result from differential growth on stepped, cleavage-parallel faces of fibres facing host sediment, with preferential inclusion incorporation at inner corners. The preferred directions of calcite growth are attributed to local stresses and seepage flow associated with pore pressure gradients. Substantial framboidal pyrite in the sediments represents an early phase of microbially driven sulphate reduction, which may have induced calcite mineralization. The transition to brittle-style faulting was marked by development of deformation twins in CIC/BF fibres, and a transition to coarse, blocky calcite growth in relay arrays of steeply oriented microveins. This indicates local fault-related stresses substantially changed during shallow diagenesis and lithification, an evolution attributed to changing pore pressures, seepage forces and material moduli. Calcite mineralizations at Edgeøya track the very significant changes in mechanical properties and stress states that occur during synlithification deformation at very shallow crustal levels.
Few studies have described clinical characteristics of patients subject to an involuntary detention in an Irish context. The Irish Mental Health Act 2001 makes provision under Section 23(1), whereby a person who has voluntary admission status can be detained.
This study aimed to describe all involuntary admissions to St Patrick’s University Hospital (SPUH) (2011–2013) and to evaluate clinical characteristics of voluntary patients who underwent Mental Health Act assessment during 2011 to determine differences in those who had involuntary admission orders completed and those who did not.
All uses of Mental Health Act 2001 within SPUH 2011–2013 were identified. All uses of Section 23(1) during 2011 were reviewed and relevant documents/case-notes examined using a pro forma covering clinical data, factors recognized to influence involuntary admissions and validated scales were used to determine diagnoses, insight, suicide and violence risk.
Over 2011–2013, 2.5–3.8% of all admissions were involuntary with more detained after use of Section 23(1) than Section 14(2). The majority of initiations of Section 23(1) did not result in an involuntary admission (72%), occurred out of hours (52%) and many occurred early after admission (<1 week, 43%). Initiation of Section 23(1) by a consultant psychiatrist (p=0.001), suicide risk (p=0.03) and lack of patient insight into treatment (p=0.007) predicted conversion to involuntary admission.
This study predicts a role for patient insight, suicide risk and consultant psychiatrist decision making in the initiation of Mental Health Act assessment of voluntary patients. Further data describing the involuntary admissions process in an Irish setting are needed.
One common dogma in ecology is based on the competitive exclusion principle. Hence, competition is often considered to be one of the primary determinants of the structure and functioning of ecosystems. In this paper, we investigate how the native Vespa crabro and the recently introduced Vespa velutina show some degree of niche differentiation that potentially minimizes their interspecific competition, the two dimensions investigated here being seasonal activity patterns and preferences for food. These two species share common characteristics: they are closely related, live in the same areas, belong to the same guild (predators), exploit the same kind of food sources, and exhibit a similar annual life cycle. Considering all these similarities, interspecific competition may occur if the two species exhibit identical seasonal phenologies. Our data show that their seasonal phenologies overlap to some extent probably due to biological constraints common to Vespinae. The shifts in time observed here allow the hornet species to not directly compete for food sources at the same time. It does not however exclude indirect competition, especially in a ‘first-come, first-served’ fashion.
This paper describes the system architecture of a newly constructed radio telescope – the Boolardy engineering test array, which is a prototype of the Australian square kilometre array pathfinder telescope. Phased array feed technology is used to form multiple simultaneous beams per antenna, providing astronomers with unprecedented survey speed. The test array described here is a six-antenna interferometer, fitted with prototype signal processing hardware capable of forming at least nine dual-polarisation beams simultaneously, allowing several square degrees to be imaged in a single pointed observation. The main purpose of the test array is to develop beamforming and wide-field calibration methods for use with the full telescope, but it will also be capable of limited early science demonstrations.
The neural organization of cognitive processes, particularly hemispheric lateralization, changes throughout childhood and adolescence. Differences in the neural basis of relational memory between children and adults are not well characterized. In this study we used magnetoencephalography to observe the lateralization differences of hippocampal activation in children and adults during performance of a relational memory task, transverse patterning (TP). The TP task was paired with an elemental control task, which does not depend upon the hippocampus. We contrasted two hypotheses; the compensation hypothesis would suggest that more bilateral activation in children would lead to better TP performance, whereas the maturation hypothesis would predict that a more adult-like right-lateralized pattern of hippocampal activation would lead to better performance. Mean-centered partial least squares analysis was used to determine unique patterns of brain activation specific to each task per group, while diminishing activation that is consistent across tasks. Our findings support the maturation hypothesis that a more adult-like pattern of increased right hippocampal lateralization in children leads to superior performance on the TP task. We also found dynamic changes of lateralization throughout the time course for all three groups, suggesting that caution is needed when interpreting conclusions about brain lateralization. (JINS, 2013, 19, 1–11)
We present an update on the performance of our 2 mm bolometer camera GISMO (the Goddard IRAM 2 Millimeter Observer), which is used for astronomical observations at the IRAM 30 m Telescope. The camera is optimized to efficiently observe dusty high-redshift galaxies. GISMO uses a monolithic 8 by 16 Backshort Under Grid (BUG) array with superconducting Transition Edge Sensors (TES). It serves as a testbed for our close-packed superconducting bolometer technologies and guides us in optimizing the design of future fast, low background bolometer cameras. Illustrated by astronomical observations we obtained recently, we demonstrate the scientific potential of the camera, highlighted by the detection of two high redshift galaxies.
The assumption that the transmission of social behaviors and political preferences is purely cultural has been challenged repeatedly over the last 40 years by the combined evidence of large studies of adult twins and their relatives, adoption studies, and twins reared apart. Variance components and path modeling analyses using data from extended families quantified the overall genetic influence on political attitudes, but few studies have attempted to localize the parts of the genome which accounted for the heritability estimates found for political preferences. Here, we present the first genome-wide analysis of Conservative-Liberal attitudes from a sample of 13,000 respondents whose DNA was collected in conjunction with a 50-item sociopolitical attitude questionnaire. Several significant linkage peaks were identified and potential candidate genes discussed.
The Carboniferous Billefjorden rift basin is a well-known example of a suite of Carboniferous basins on the Barents Shelf and NE Greenland. The basin has a clastic, carbonate and evaporite fill with complex and disputed stratigraphic relationships, especially regarding the Ebbadalen and Minkinfjellet formations. Geometrically, the basin is considered a simple half-graben. A N–S-trending fault and monocline structure within the northern portion of the basin, the Løvehovden fault, has lithological and thickness differences across it within the Minkinfjellet and possibly Ebbadalen formations. The fault shows W-side-down movement, defining a sub-basin within the larger half-graben. Significant along-strike changes occur. Down-throw to the west is at least 150 metres and possibly 400 metres, as shown by across-fault thickness differences of Ebbadalen and/or Minkinfjellet formations. To the east of the fault, the contact between the Ebbadalen and Minkinfjellet formations is a disconformity with significant local relief, and is interpreted to represent exposure from footwall uplift, and associated near- or at-surface solution, producing basal stratiform breccias. A similar contact is not exposed west of the fault. Monoclinal deformation and thickening of the younger Wordiekammen Formation above and across the monocline constrain a later movement component. Kinematic data and the structural style clearly indicate the Løvehovden fault is a normal fault with associated tri-shear zone development, consistent with the regional Carboniferous rift setting. Earlier interpretations describe the Løvehovden fault and monocline as Tertiary contractional features. In contrast, our work advocates that they are an important architectural basin element, defining a sub-basin within the Billeforden Trough during Minkinfjellet Formation deposition, with insignificant, if any, Tertiary reactivation. The Løvehovden fault is aligned with and represents the southern termination of the Lemströmfjellet fault to the north. Thus, the Billefjorden basin changes from a narrow graben to a broader half-graben to the south. These along-strike changes have important implications for the stratigraphic architecture of the basin, and for palaeogeographic reconstructions. These results and application of 3-D models for extension related tri-shear zones may help inform interpretation of other Carboniferous basins on the Barents Shelf.
Cognitive-behavioral therapy (CBT) consisting of exposure and response prevention (EX/RP) is efficacious as a treatment for obsessive–compulsive disorder (OCD). However, about half of patients have a partial or poor response to EX/RP treatment. This study examined potential predictors and moderators of CBT augmentation of pharmacotherapy, to identify variables associated with a poorer response to OCD treatment.
Data were drawn from a large randomized controlled trial that compared the augmenting effects of EX/RP to stress management training (SMT; an active CBT control) among 108 participants receiving a therapeutic dose of a serotonin reuptake inhibitor (SRI). Stepwise regression was used to determine the model specification.
Pretreatment OCD severity and gender were significant moderators of outcome: severity affected SMT (but not EX/RP) outcome; and gender affected EX/RP (but not SMT) outcome. Adjusting for treatment type and pretreatment severity, significant predictors included greater co-morbidity, number of past SRI trials, and lower quality of life (QoL). Significant moderators, including their main-effects, and predictors accounted for 37.2% of the total variance in outcome, comparable to the impact of treatment type alone (R2=30.5%). These findings were replicated in the subgroup analysis of EX/RP alone (R2=55.2%).
This is the first randomized controlled study to examine moderators and predictors of CBT augmentation of SRI pharmacotherapy. Although effect sizes for individual predictors tended to be small, their combined effect was comparable to that of treatment. Thus, future research should examine whether monitoring for a combination of these risk factors and targeting them with multi-modular strategies can improve EX/RP outcome.
Two patients (G01, J02) with chronic nonfluent aphasia and sentence
production deficits received syntactic mapping treatment to improve
sentence production. The patients had dramatically different outcomes in
that improved syntax production generalized to nontreatment tasks for G01,
but not for JO2. To learn how treatment influenced the neural substrates
for syntax production, both patients underwent pre- and posttreatment
functional magnetic resonance imaging (fMRI) of sentence generation. G01
showed more robust activity posttreatment than pretreatment in
Broca's area; ventral temporal activity decreased slightly from pre-
to posttreatment. Comparison of J02's pretreatment and posttreatment
images revealed little change, although activity was more diffuse pre-
than posttreatment. Findings suggest that for G01, rehabilitation led to
engagement of an area (Broca's area) used minimally during the
pretreatment scan, whereas for J02, rehabilitation may have led to more
efficient use of areas already involved in sentence generation during the
pretreatment scan. fMRI findings are discussed in the context of
sentence-production outcome and generalization. (JINS, 2006,
A two-choice bioassay was developed to evaluate the role of host-plant berry compounds on the oviposition site acceptance of the generalist moth Lobesia botrana (Denis & Shiffermüller). A key feature was the lining of the bioassay arena with felt which focused oviposition on the test substrates. Initial experiments comparing substrates with different physical features indicated that smooth textures and spherical shapes with interstices favour oviposition. Artificial oviposition substrates were thus constructed with glass spheres in order to test the behavioural activity of grapevine berry extracts. Only polar extracts obtained by soaking berries in methanol or water stimulated oviposition (more eggs were laid on the extract-treated substrate than on the control substrate), whereas more apolar ones obtained with chloroform or hexane had no significant effect. The prior removal of epicuticular waxes from grape berries before extraction did not enhance the stimulatory activity of the methanol extract. The oviposition response to this extract was dose-dependent. It is concluded that polar compounds present on grape berries act as oviposition stimulants for L. botrana.
The continued reduction in the size of critical features in integrated circuits has resulted in the need to develop rapid, site-specific, sectioning techniques to enable efficient physical characterization of the structures of interest. We have implemented a mechanical polishing approach to achieve this objective with the additional goals of maximizing the number of targeted sites in a sample that can be analyzed, and minimizing physically destructive procedures, such as ion beam exposure. Precision sample preparation approaches have been under investigation for both transmission electron microscopy and scanning electron microscopy.
The mechanical specimen preparation approach used in this work is a variant of the well-known wedge polishing technique. Here we use a polishing tool that does not contact the grinding surface, thus allowing precise control of the wedge angle. Prior to sample preparation, the polishing tool head was precision aligned parallel to the platen.