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Principles of Medicine in Africa combines clinical medicine with a rich understanding of the major environmental and cultural influences on health and disease, providing comprehensive guidance for anyone intending to practise medicine in Africa. Presenting disease in the context of family and culture, the effects of inequality and problems of limited resources are addressed. The authors have a wealth of experience in front line healthcare in Africa and provide practical, evidence-based management guidelines for all the common and less common conditions likely to be encountered. This fifth edition has been thoroughly updated to incorporate the latest research findings and management guidelines and there has been much greater involvement of African physicians in the writing and editorial process. The chapters on cancer and non-communicable diseases have been expanded and new chapters have been added on digital health, critical care in a resource-limited setting, antimicrobial resistance, COVID-19 and other emerging infectious diseases.
We present the Sydney Radio Star Catalogue, a new catalogue of stars detected at megahertz to gigahertz radio frequencies. It consists of 839 unique stars with 3 405 radio detections, more than doubling the previously known number of radio stars. We have included stars from large area searches for radio stars found using circular polarisation searches, cross-matching, variability searches, and proper motion searches as well as presenting hundreds of newly detected stars from our search of Australian SKA Pathfinder observations. The focus of this first version of the catalogue is on objects detected in surveys using SKA precursor and pathfinder instruments; however, we will expand this scope in future versions. The 839 objects in the Sydney Radio Star Catalogue are distributed across the whole sky and range from ultracool dwarfs to Wolf-Rayet stars. We demonstrate that the radio luminosities of cool dwarfs are lower than the radio luminosities of more evolved sub-giant and giant stars. We use X-ray detections of 530 radio stars by the eROSITA soft X-ray instrument onboard the Spectrum Roentgen Gamma spacecraft to show that almost all of the radio stars in the catalogue are over-luminous in the radio, indicating that the majority of stars at these radio frequencies are coherent radio emitters. The Sydney Radio Star Catalogue can be found in Vizier or at https://radiostars.org.
In order to study the structure and temperature distribution within high-mass star-forming clumps, we employed the Australia Telescope Compact Array to image the $\mathrm{NH}_3$ (J,K) = (1,1) through (6,6) and the (2,1) inversion transitions, the $\mathrm{H}_2\mathrm{O}$$6_{16}$-$5_{23}$ maser line at 22.23508 GHz, several $\mathrm{CH}_3\mathrm{OH}$ lines and hydrogen and helium recombination lines. In addition, 22- and 24-GHz radio continuum emission was also imaged.
The $\mathrm{NH}_3$ lines probe the optical depth and gas temperature of compact structures within the clumps. The $\mathrm{H}_2\mathrm{O}$ maser pinpoints the location of shocked gas associated with star formation. The recombination lines and the continuum emission trace the ionised gas associated with hot OB stars. The paper describes the data and presents sample images and spectra towards select clumps. The technique for estimating gas temperature from $\mathrm{NH}_3$ line ratios is described. The data show widespread hyperfine intensity anomalies in the $\mathrm{NH}_3$ (1,1) images, an indicator of non-LTE $\mathrm{NH}_3$ excitation. We also identify several new $\mathrm{NH}_3$ (3,3) masers associated with shocked gas. Towards AGAL328.809+00.632, the $\mathrm{H}_2\mathrm{O}$$6_{16}$-$5_{23}$ line, normally seen as a maser, is instead seen as a thermally excited absorption feature against a strong background continuum. The data products are described in detail.
Although the link between alcohol involvement and behavioral phenotypes (e.g. impulsivity, negative affect, executive function [EF]) is well-established, the directionality of these associations, specificity to stages of alcohol involvement, and extent of shared genetic liability remain unclear. We estimate longitudinal associations between transitions among alcohol milestones, behavioral phenotypes, and indices of genetic risk.
Methods
Data came from the Collaborative Study on the Genetics of Alcoholism (n = 3681; ages 11–36). Alcohol transitions (first: drink, intoxication, alcohol use disorder [AUD] symptom, AUD diagnosis), internalizing, and externalizing phenotypes came from the Semi-Structured Assessment for the Genetics of Alcoholism. EF was measured with the Tower of London and Visual Span Tasks. Polygenic scores (PGS) were computed for alcohol-related and behavioral phenotypes. Cox models estimated associations among PGS, behavior, and alcohol milestones.
Results
Externalizing phenotypes (e.g. conduct disorder symptoms) were associated with future initiation and drinking problems (hazard ratio (HR)⩾1.16). Internalizing (e.g. social anxiety) was associated with hazards for progression from first drink to severe AUD (HR⩾1.55). Initiation and AUD were associated with increased hazards for later depressive symptoms and suicidal ideation (HR⩾1.38), and initiation was associated with increased hazards for future conduct symptoms (HR = 1.60). EF was not associated with alcohol transitions. Drinks per week PGS was linked with increased hazards for alcohol transitions (HR⩾1.06). Problematic alcohol use PGS increased hazards for suicidal ideation (HR = 1.20).
Conclusions
Behavioral markers of addiction vulnerability precede and follow alcohol transitions, highlighting dynamic, bidirectional relationships between behavior and emerging addiction.
Oxygen isotope analyses (δO18) of micas that were artificially depleted in K+ indicate little or no isotope exchange during the transformation. The oxidation of iron in K-depleted, iron-rich micas by H2O2 treatment resulted in 1.6 to 4.6% decrease in SO18 due to the fact that the equilibrium fractionation factor is less than the initial difference between the starting δO18 of the fluid and micas. The oxygen isotope ratio of a saponite formed by the weathering of phlogopite showed a 9.7% increase in δO18 due to authigenic recrystallization. These results suggest that oxygen isotope ratios can be used to determine the nature of chemical transformation during the weathering of mica to vermiculite and/or smectite.
Clinical outcomes of repetitive transcranial magnetic stimulation (rTMS) for treatment of treatment-resistant depression (TRD) vary widely and there is no mood rating scale that is standard for assessing rTMS outcome. It remains unclear whether TMS is as efficacious in older adults with late-life depression (LLD) compared to younger adults with major depressive disorder (MDD). This study examined the effect of age on outcomes of rTMS treatment of adults with TRD. Self-report and observer mood ratings were measured weekly in 687 subjects ages 16–100 years undergoing rTMS treatment using the Inventory of Depressive Symptomatology 30-item Self-Report (IDS-SR), Patient Health Questionnaire 9-item (PHQ), Profile of Mood States 30-item, and Hamilton Depression Rating Scale 17-item (HDRS). All rating scales detected significant improvement with treatment; response and remission rates varied by scale but not by age (response/remission ≥ 60: 38%–57%/25%–33%; <60: 32%–49%/18%–25%). Proportional hazards models showed early improvement predicted later improvement across ages, though early improvements in PHQ and HDRS were more predictive of remission in those < 60 years (relative to those ≥ 60) and greater baseline IDS burden was more predictive of non-remission in those ≥ 60 years (relative to those < 60). These results indicate there is no significant effect of age on treatment outcomes in rTMS for TRD, though rating instruments may differ in assessment of symptom burden between younger and older adults during treatment.
In the landmark case Daubert v. Merrell Dow Pharmaceuticals, Inc. (1993), the Supreme Court of the United States articulated the admissibility standard for expert evidence. In jurisdictions that have adopted the Daubert standard, trial court judges must make difficult decisions regarding the admissibility of proffered expert evidence. Although all federal courts and nearly all state courts use the Daubert standard, we know little about how judges fulfill their gatekeeping role when making admissibility decisions. This chapter reviews the empirical and theoretical considerations regarding how judges in Daubert jurisdictions determine which proffered expert evidence should be admitted. After reviewing the standards governing the admissibility of expert testimony, which includes a discussion of the Federal Rules of Evidence, Daubert, and related cases, the chapter provides a discussion of each Daubert criterion, including the available evidence relating to judges’ understanding of those criteria. It then discusses the heuristics and biases that affect judicial decision-making. The chapter concludes with a discussion of implications for practice and research.
Inequalities in terms of who participates in politics yield policy outcomes that fail to reflect the interests of the broader public. Because these processes fail to engage the full citizenry in political decision-making processes, they are also markers of an anemic civic culture. Advocates of participatory budgeting (PB) – a process implemented at the subnational level in thousands of cities in the United States and beyond that invites residents to participate directly in the process of allocating public resources for local projects – argue that it can alleviate these inequalities. They argue that features of the PB process make it ripe for engaging new participants in the political process and weaving a more inclusive social fabric. We examine the correlates of interest in participating in PB using a survey of Cook County residents. We also consider the extent to which the policy priorities of those who are interested in participating diverge from those who are less interested. Although we find evidence that the process is particularly appealing to younger respondents and those who identify as Latine or Black (as opposed to White), we also find that interest is higher among those with higher socioeconomic status and those who perceive conditions in their neighborhood to already be good. Our evidence also suggests that inequalities in who is interested in participating may not radically affect policy outcomes. However, those who decline to participate cannot reap the broader social and political benefits advocates hope the PB process can foster.
Frontal ablation, the combination of submarine melting and iceberg calving, changes the geometry of a glacier's terminus, influencing glacier dynamics, the fate of upwelling plumes and the distribution of submarine meltwater input into the ocean. Directly observing frontal ablation and terminus morphology below the waterline is difficult, however, limiting our understanding of these coupled ice–ocean processes. To investigate the evolution of a tidewater glacier's submarine terminus, we combine 3-D multibeam point clouds of the subsurface ice face at LeConte Glacier, Alaska, with concurrent observations of environmental conditions during three field campaigns between 2016 and 2018. We observe terminus morphology that was predominately overcut (52% in August 2016, 63% in May 2017 and 74% in September 2018), accompanied by high multibeam sonar-derived melt rates (4.84 m d−1 in 2016, 1.13 m d−1 in 2017 and 1.85 m d−1 in 2018). We find that periods of high subglacial discharge lead to localized undercut discharge outlets, but adjacent to these outlets the terminus maintains significantly overcut geometry, with an ice ramp that protrudes 75 m into the fjord in 2017 and 125 m in 2018. Our data challenge the assumption that tidewater glacier termini are largely undercut during periods of high submarine melting.
Evidence suggests that well-funded, professional legislatures more effectively provide constituents with their preferred policies and may improve social welfare. Yet, legislative resources across state legislatures have stagnated or dwindled at least in part due to public antagonism toward increasing representatives’ salaries. We argue that one reason voters oppose legislative resources, like salary and staff, is that they are unaware of the potential benefits. Employing a pre-registered survey experiment with a pre–post design, we find that subjects respond positively to potential social welfare benefits of professionalization, increasing support for greater resources. We also find that individuals identifying with the legislative majority party respond positively to potential responsiveness benefits and that out-partisans do not respond negatively to potential responsiveness costs. In a separate survey of political elites, we find similar patterns. These results suggest that a key barrier to increasing legislative professionalism – anticipated public backlash – may not be insurmountable. The findings also highlight a challenge of institutional choice: beliefs that representatives are unresponsive or ineffective lead to governing institutions that may ensure these outcomes.
Dependencia theory is in vogue among social scientists throughout the world. Having originated in Latin America in the early 1960s, it was widely embraced both there and in parts of Europe and Africa by the end of the decade. In the 1970s, North Americans joined the flood of scholars attempting to grapple with the problems of underdevelopment in the so-called Third World from a perspective explicitly rejecting traditional theories of development. With this new stream of researchers came new tools and new approaches to the study of peripheral societies, tools and approaches intended to complement those previously used within the dependencia tradition.
Loneliness, a negative emotion stemming from the perception of unmet social needs, is a major public health concern. Current interventions often target social domains but produce small effects and are not as effective as established emotion regulation (ER)-based interventions for general psychological distress (i.e., depression/anxiety). Given that loneliness and distress are types of negative affect, we aimed to compare them within an ER framework by examining the amount of variance ER strategies accounted for in loneliness versus distress, and comparing the ER strategy profiles characterising them. Participants (N = 582, Mage = 22.31, 77.66% female) completed self-report measures of loneliness, distress, and use of 12 cognitive (e.g., cognitive reappraisal) or behavioural (e.g., expressive suppression) ER strategies. Regression analyses revealed that ER explained comparable variance in these constructs. Latent profile analysis identified seven profiles differing in ER patterns, with no distinct loneliness or distress profile identified. Rather, similar patterns of ER characterised these two constructs, involving the greater use of generally maladaptive strategies and the lesser use of generally adaptive strategies. However, loneliness was additionally characterised by less use of strategies involving social connection/expression. Overall, our study supports the utility of ER for understanding loneliness. Established ER-based frameworks/interventions for distress may have transdiagnostic utility in targeting loneliness.
Categorization – assimilating objects to psychological equivalence classes – is a crucial cognitive capacity that has always enhanced vertebrate fitness. This chapter reviews from a primate perspective the state of knowledge in comparative categorization’s subdomains: prototypes, exemplars, rules, and abstractions. Primate studies have made a profound contribution to the prototype-exemplar debate – essentially resolving it. They have illuminated the evolutionary emergence of a cognitive capacity for category rules, illuminating also the emergence of humans’ explicit-declarative cognition. In this area, primates appear as a pivotal transitional form. In the literature on abstract concepts (e.g., Same-Different), primate studies highlight the differences in cognitive capacities across vertebrate lines. The review will demonstrate the crucial role of a fitness/ecological perspective in understanding categorization as an adaptive, information-processing capability. It will raise important questions about the similarity structure of natural (and unnatural) kinds and categories. It will show strong continuities between human and animal cognition, but important discontinuities as well. In all the subdomains, the primates have been extraordinary behavioral ambassadors to the broader field of categorization.
It is a traditional hope of comparative psychology that animal minds might be unitary, parsimonious, associative. In contrast, cognitive researchers acknowledge multiple learning systems, including humans’ capacity for explicit hypothesis testing and rule learning. The authors describe new paradigms that may dissociate the explicit from the associative and demonstrate animals’ explicit capabilities. These paradigms include matched tasks that foster explicit or associative category learning, and paradigms that disable crucial components of associative learning. Given this disabling, animals may adopt instead an alternative, more explicit learning system. The authors review this area, including research on humans, monkeys, rats, and pigeons. They also consider the evolutionary and fitness factors that might favor the development of complementary associative and explicit learning systems.
Background: Incidence of methicillin-sensitive Staphylococcus aureus (MSSA) bloodstream infections (BSIs) in the United States during 2012–2017 has been reported to have been stable for hospital-onset BSIs and to have increased 3.9% per year for community-onset BSIs. We sought to determine whether these trends continued in more recent years and whether there were further differences within subgroups of community-onset BSIs. Methods: We analyzed CDC Emerging Infections Program active, population- and laboratory-based surveillance data during 2016–2019 for MSSA BSIs from 8 counties in 5 states. BSI cases were defined as isolation of MSSA from blood in a surveillance area resident. Cases were considered hospital onset (HO) if culture was obtained >3 days after hospital admission and healthcare-associated community-onset (HACO) if culture was obtained on or after day 3 of hospitalization and was associated with dialysis, hospitalization, surgery, or long-term care facility residence within 1 year prior or if a central venous catheter was present ≤2 days prior. Cases were otherwise considered community-associated (CA). Annual rates per 100,000 census population were calculated for each epidemiologic classification; rates of HACO cases among chronic dialysis patients per 100,000 dialysis patients were calculated using US Renal Data System data. Annual increases were modeled using negative binomial or Poisson regression and accounting for changes in the overall population age group, and sex. Descriptive analyses were performed. Results: Overall, 8,344 MSSA BSI cases were reported. From 2016–2019 total MSSA BSI rates increased from 23.9 per 100,000 to 28.5 per 100,000 (6.6% per year; P < .01). MSSA BSI rates also increased significantly among all epidemiologic classes. HO cases increased from 2.5 per 100,000 to 3.2 per 100,000 (7.9% per year; P = .01). HACO cases increased from 12.7 per 100,000 to 14.7 per 100,000 (7.0% per year; P = .01). CA cases increased from 8.4 per 100,000 to 10.4 per 100,000 (6.7% per year; P < .01) (Fig. 1). Significant increases in MSSA BSI rates were also observed for nondialysis HACO cases (9.3 per 100,000 to 11.1 per 100,000; 7.8% per year; P < .01) but not dialysis HACO cases (1,823.2 per 100,000 to 1,857.4 per 100,000; 1.4% per year; P = .59). Healthcare risk factors for HACO cases were hospitalization in the previous year (82%), surgery (31%), dialysis (27%), and long-term care facility residence (19%). Conclusions: MSSA BSI rates increased from 2016–2019 overall, among all epidemiologic classes, and among nondialysis HACO cases. Efforts to prevent MSSA BSIs among individuals with healthcare risk factors, particularly those related to hospitalization, might have an impact on MSSA BSI rates.
OBJECTIVES/GOALS: Time restricted feeding (TRF) in diet induced obesity (DIO) has several health benefits, including improved metabolic rhythms and inflammation. Our lab has shown that TRF in DIO significantly reduces renal and aortic damage. The main goal of our research is to understand how TRF impacts aortic function, organ damage, and T cell activation in DIO. METHODS/STUDY POPULATION: We will use a 20-week DIO model, where mice will be on 20 weeks of normal fat diet (ND) or high fat diet (HFD). During weeks 18-20, mice will go through TRF intervention
where food is restricted to the 12-hour active period or continue ad libitum feeding. At the end of the 2-week TRF intervention or continued ad libitum feeding, aortic stiffness will be measured via pulse wave velocity measurements. We will also collect kidney, aorta, and small intestine at the end of the 20-week protocol for flow cytometric analysis of tissue T cell activation as well as histological assessments. This will allow us to determine the relationship with organ damage, organ function, and the T cell response. We will also analyze tissue and circulating levels of inflammatory T cell-derived cytokines such as interleukin-17A (IL-17A) via ELISA. RESULTS/ANTICIPATED RESULTS: DIO mice showed significantly increased aortic stiffness (measured by pulse wave velocity) compared to mice on ND. Interestingly, TRF intervention in DIO mice reduced aortic stiffness compared to DIO ad libitum. Histological assessments also showed that TRF abolished aortic and kidney fibrosis suggesting a role for the timing of feeding in regulating aortic function and organ damage from chronic HFD. We have several ongoing experiments to determine the T cell response with TRF in DIO mice. We predict that TRF in DIO mice will significantly decrease inflammatory T cells and reduce cytokine abundance in target organs. DISCUSSION/SIGNIFICANCE: Our lab has shown that TRF reduces aortic thickness and aortic and kidney fibrosis, but the driving mechanisms are unknown. We propose that TRF reduces T cell activation in DIO mice leading to reduced organ damage. Our work will provide insight on how TRF in DIO regulates the T cell response and may improve inflammation in the kidney and aorta.
The history of agricultural terraces remains poorly understood due to problems in dating their construction and use. This has hampered broader research on their significance, limiting knowledge of past agricultural practices and the long-term investment choices of rural communities. The authors apply OSL profiling and dating to the sediments associated with agricultural terraces across the Mediterranean region to date their construction and use. Results from five widely dispersed case studies reveal that although many terraces were used in the first millennium AD, the most intensive episodes of terrace-building occurred during the later Middle Ages (c. AD 1100–1600). This innovative approach provides the first large-scale evidence for both the longevity and medieval intensification of Mediterranean terraces.
People with CHD are at increased risk for executive functioning deficits. Meta-analyses of these measures in CHD patients compared to healthy controls have not been reported.
Objective:
To examine differences in executive functions in individuals with CHD compared to healthy controls.
Data sources:
We performed a systematic review of publications from 1 January, 1986 to 15 June, 2020 indexed in PubMed, CINAHL, EMBASE, PsycInfo, Web of Science, and the Cochrane Library.
Study selection:
Inclusion criteria were (1) studies containing at least one executive function measure; (2) participants were over the age of three.
Data extraction:
Data extraction and quality assessment were performed independently by two authors. We used a shifting unit-of-analysis approach and pooled data using a random effects model.
Results:
The search yielded 61,217 results. Twenty-eight studies met criteria. A total of 7789 people with CHD were compared with 8187 healthy controls. We found the following standardised mean differences: −0.628 (−0.726, −0.531) for cognitive flexibility and set shifting, −0.469 (−0.606, −0.333) for inhibition, −0.369 (−0.466, −0.273) for working memory, −0.334 (−0.546, −0.121) for planning/problem solving, −0.361 (−0.576, −0.147) for summary measures, and −0.444 (−0.614, −0.274) for reporter-based measures (p < 0.001).
Limitations:
Our analysis consisted of cross-sectional and observational studies. We could not quantify the effect of collinearity.
Conclusions:
Individuals with CHD appear to have at least moderate deficits in executive functions. Given the growing population of people with CHD, more attention should be devoted to identifying executive dysfunction in this vulnerable group.
To evaluate age-related differences in the independent/combined association of added sugar intake from soda and body adiposity with hyperuricaemia in gender-stratified US adults.
Design:
Consumption of added sugar from soda was calculated from 24-h dietary interviews and categorised into none, regular and excessive consumption. Hyperuricaemia was defined as serum uric acid levels >417 mmol/l in men and >357 mmol/l in women. Multiple regression models with interaction terms and logistic models adjusted for covariates were conducted under survey-data modules.
Setting:
National Health and Nutrition Examination Survey during 2007–2016.
Participants:
15 338 adults without gout, failing kidneys, an estimated glomerular filtration rate < 30 or diabetes were selected.
Results:
The age-stratified prevalence rate of hyperuricaemia was 18·8–20·4 % in males and 6·8–17·3 % in females. Hyperuricaemia prevalence of approximately 50 % was observed in young and middle age males who consumed excessive added sugar from soda. Excessive added sugar intake was observed to be associated with 1·5- to 2·0-fold and 2·0- to 2·3-fold increased risk of the probability of hyperuricaemia in young and middle age males and middle age females, respectively. Study participants, regardless of age or gender, who were obese and consumed excessive added sugar from soda had the highest risk of having hyperuricaemia.
Conclusions:
Our study revealed that the association between hyperuricaemia and consumption of excessive added sugar from soda may vary by age and gender. Obese adults who consumed excessive added sugar from soda had the highest risk of hyperuricaemia, a finding that was found across all age-specific groups for both genders.