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The 'third wave' of variation study, spearheaded by the sociolinguist Penelope Eckert, places its focus on social meaning, or the inferences that can be drawn about speakers based on how they talk. While social meaning has always been a concern of modern sociolinguistics, its aims and assumptions have not been explicitly spelled out until now. This pioneering book provides a comprehensive overview of the central tenets of variation study, examining several components of dialects, and considering language use in a wide variety of cultural and linguistic contexts. Each chapter, written by a leader in the field, posits a unique theoretical claim about social meaning and presents new empirical data to shed light on the topic at hand. The volume makes a case for why attending to social meaning is vital to the study of variation while also providing a foundation from which variationists can productively engage with social meaning.
This essay provides a holistic review of what girls and young women learned, and the settings in which they learned, in the Middle Ages in England between the Norman Conquest (1066) and the Dissolution of the Monasteries (late 1530s). Education of girls was carried out in households, elementary schools, and nunneries, as well as through employment and apprenticeship. Girls were taught a wide range of subjects, depending on their socioeconomic status, including practical skills, reading comprehension, and social accomplishments. This essay also provides a review to date of the scholarship on the topic.
In March 2018, the US Department of Defense (DOD) added the smallpox vaccination, using ACAM2000, to its routine immunizations, increasing the number of persons receiving the vaccine. The following month, Fort Hood reported a cluster of 5 myopericarditis cases. The Centers for Disease Control and Prevention and the DOD launched an investigation.
The investigation consisted of a review of medical records, establishment of case definitions, causality assessment, patient interviews, and active surveillance. A 2-sided exact rate ratio test was used to compare myopericarditis incidence rates.
This investigation identified 4 cases of probable myopericarditis and 1 case of suspected myopericarditis. No alternative etiology was identified as a cause. No additional cases were identified. There was no statistically significant difference in incidence rates between the observed cluster (5.23 per 1000 vaccinated individuals, 95% CI: 1.7–12.2) and the ACAM2000 clinical trial outcomes for symptomatic persons, which was 2.29 per 1000 vaccinated individuals (95% CI: 0.3–8.3).
Vaccination with ACAM2000 is the presumptive cause of this cluster. Caution should be exercised before considering vaccination campaigns for smallpox given the clinical morbidity and costs incurred by a case of myopericarditis. Risk of myopericarditis should be carefully weighed with risk of exposure to smallpox.
Cervids living in high latitudes have evolved to thrive in ecosystems that experience dramatic seasonal changes. Understanding these seasonal adaptations is important for reconstructing cervid life histories, ecosystem dynamics, and responses in the distant and not-so-distant past to changing seasonality caused by climate change. Cervid antlers provide a rare opportunity for insight into faunal seasonal ecology, as they are grown and shed each year. Stable isotopes of carbon and nitrogen measured directly from antlers have the potential to provide seasonal dietary data for individuals. If the isotopic signals in bone and antler are controlled by the same metabolic processes, then the stable carbon and nitrogen isotope compositions of collagen (δ13CColl and δ15NColl) from incrementally grown antler tissue provide time-constrained dietary signals from the spring and summer growth season. Bone, by comparison, provides an average signal over several years. The amino acid (glutamate and phenylalanine) δ15N in antlers from modern captive caribou showed similar trophic discrimination factors to earlier results for other collagenous tissues (bone, tooth dentin, and cementum). Hence, growth rate was not the primary control on the stable isotope composition of antler collagen. We applied this knowledge to assess seasonal shifts in Quaternary fossils of three Cervidae species: elk (Cervus elaphus), moose (Alces alces), and caribou (Rangifer tarandus). Paired antler–bone δ13CColl and δ15NColl from the same individual were used to identify differences between summer and annual diet and ecology. Intra-antler isotopic variability from serially sampled antlers was used to examine seasonal dietary shifts and specialization.
To compare antimicrobial prescribing practices in Australian hematology and oncology patients to noncancer acute inpatients and to identify targets for stewardship interventions.
Retrospective comparative analysis of a national prospectively collected database.
Using data from the 2014–2018 annual Australian point-prevalence surveys of antimicrobial prescribing in hospitalized patients (ie, Hospital National Antimicrobial Prescribing Survey called Hospital NAPS), the most frequently used antimicrobials, their appropriateness, and guideline concordance were compared among hematology/bone marrow transplant (hemBMT), oncology, and noncancer inpatients in the setting of treatment of neutropenic fever and antibacterial and antifungal prophylaxis.
In 454 facilities, 94,226 antibiotic prescriptions for 62,607 adult inpatients (2,230 hemBMT, 1,824 oncology, and 58,553 noncancer) were analyzed. Appropriateness was high for neutropenic fever management across groups (83.4%–90.4%); however, hemBMT patients had high rates of carbapenem use (111 of 746 prescriptions, 14.9%), and 20.2% of these prescriptions were deemed inappropriate. Logistic regression demonstrated that hemBMT patients were more likely to receive appropriate antifungal prophylaxis compared to oncology and noncancer patients (adjusted OR, 5.3; P < .001 for hemBMT compared to noncancer patients). Oncology had a low rate of antifungal prophylaxis guideline compliance (67.2%), and incorrect dosage and frequency were key factors. Compared to oncology patients, hemBMT patients were more likely to receive appropriate nonsurgical antibacterial prophylaxis (aOR, 8.4; 95% CI, 5.3–13.3; P < .001). HemBMT patients were also more likely to receive appropriate nonsurgical antibacterial prophylaxis compared to noncancer patients (OR, 3.1; 95% CI, 1.9–5.0; P < .001). However, in the Australian context, the hemBMT group had higher than expected use of fluoroquinolone prophylaxis (66 of 831 prescriptions, 8%).
This study demonstrates why separate analysis of hemBMT and oncology populations is necessary to identify specific opportunities for quality improvement in each patient group.
The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.
This study sought to assess the impact of simulation training in influencing trainees’ initial surgical participation as perceived by experienced surgeon trainers.
Twenty ENT surgeons assessed how much of a given procedure they would expect to allow a trainee to perform for their first time. Responses were provided for trainees who had undergone a relevant simulation course and those who had not, and scored according to the eLogbook levels of involvement in surgery. This was completed for simulated procedures with validated models, across four grades of junior doctors.
A total of 1120 judgements on the trainees’ intended level of involvement were made. The median involvement score was higher in the simulation group versus the non-simulation group (Mann–Whitney U, p = 0.0001), corresponding to a translation in surgical opportunity from a primarily assisting role to an active role.
Trainer perception of a relevant ENT simulation course appears to positively impact on the initial surgical opportunities afforded to the trainee.
This study aimed to analyse social, health and environmental factors associated with the development of chronic otitis media by age nine.
This was a prospective, longitudinal, birth cohort study of 6560 children, reviewed at age nine. Chronic otitis media defined as previous surgical history or video-otoscopic changes of tympanic membrane retraction, perforation or cholesteatoma. Non-affected children were used as the control group.
Univariate analysis demonstrated an association between chronic otitis media and otorrhoea, snoring, grommet insertion, adenoidectomy, tonsillectomy, hearing loss, abnormal tympanograms and preterm birth. Multivariate analysis suggests many of these factors may be interrelated.
The association between chronic otitis media and otorrhoea, abnormal tympanograms and grommets supports the role of the Eustachian tube and otitis media (with effusion or acute) in the pathogenesis of chronic otitis media. The role of snoring, adenoidectomy and tonsillectomy is unclear. Associations suggested by previous studies (sex, socioeconomic group, parental smoking, maternal education, childcare, crowding and siblings) were not found to be significant predictors in this analysis.
Despite nematodes routinely being the most frequent soil- and bryophyte-associated animals in maritime Antarctica, there is a lack of clarity about the influence of warming on their populations in the region. Here, we report the results of a field experiment on Adelaide Island that tested the effects of warming with open-top chambers (OTCs) for 37 months on nematodes associated with the bryophytes Cephaloziella varians and Sanionia uncinata. Over the experiment's duration, OTCs increased the population density of the nematode Plectus belgicae in mats of both bryophytes by six-fold, with four- to seven-fold increases in the abundances of male, female and juvenile P. belgicae in warmed mats, and with the largest effects on the abundances of juveniles. Despite C. varians, which is black in colour, warming to a greater extent than S. uncinata during summer, no interactive effects of OTCs and bryophyte species were recorded on the population density of P. belgicae. Our results corroborate a previous study showing that warming increases Plectus population densities in maritime Antarctic soils, with implications for the region's terrestrial food webs.
The discussion and critical examination of poverty, child poverty and the impact of child poverty on school education in Scotland has intensified in recent years. This has been provoked by the increase in the level of poverty and a greater awareness of the effects of poverty and deprivation. The levels of child poverty have remained more stable but are still disturbingly high. Arguably, a more informed and nuanced understanding of the complexity of these issues has begun to emerge and influence public consciousness. There is now greater cognisance that children are dependents and are affected by the financial resource issues faced by their parents or carers. These challenges can include longterm unemployment or the cycle of ‘low pay, no pay’ (Thompson, 2015). There has been a rise in the level of working poverty in Scotland as the percentage of the workingage population in relative poverty has risen from 48% in 1996– 99 to 59% in 2014– 2017 (Scottish Government, 2019a). These challenges all lead to temporary or longerterm financial insecurity that impact on the lives of children and their readiness to participate in all social and academic aspects of school life.
There has also been an increased focus on research and the collation of information on child poverty and the impact of child poverty on school education. There are numerous ways to measure child poverty and deprivation and there is a substantial body of evidence on attainment and achievement (these will be discussed later in the chapter). There is also evidence that gender and disability are important factors that can be barriers to work and this has an effect on the household income (Congreve and McCormick, 2018). Around 40% of the children living in poverty are in a family with a disabled member, usually an adult. For half of these children, there is no adult working in the household. The children themselves may be the primary or sole carer for a disabled adult: there are approximately 44,000 young carers (young people under 18) in Scotland who care for a friend or a member of the family because of illness, disability, mental health or addiction (Scottish Government, 2018a).
The COVID-19 pandemic has greatly affected public health and wellbeing. In response to the pandemic threat of the coronavirus epidemic, several countries, including China, adopted lockdown and quarantine policies, which may cause psychological distress. This study aimed to explore the psychological impact of province-wide lockdown and personal quarantine during the COVID-19 outbreak in China as well as the corresponding risk factors and protective factors.
We examined the immediate (2-week) and delayed (2-month) impact of province-wide lockdown and personal quarantine on psychological distress in a national sample of 1390 Chinese residents.
No immediate impact of province-wide lockdown on psychological distress was observed, whereas personal quarantine increased individuals’ anxiety, fear, and anger. Despite the lack of initial association, psychological distress increased among those in province-wide lockdown. Self-stigma and personal control both significantly moderated the association between lockdown and psychological distress, but in different directions. Those with higher self-stigma and lower personal control were more impacted by the lockdown. Government support moderated the impact of quarantine on psychological distress, but not that of lockdown.
The delayed effects of lockdown and quarantine on psychological distress were observed, and self-stigma, social support, and perceived control moderate the relationships. This study is the first to demonstrate the psychological costs of province-wide lockdowns on individuals’ mental health, providing evidence of the need for mitigation strategies and timely public mental health preparedness in countries with recent outbreaks of COVID-19.
Schizotypy is a putative risk phenotype for psychosis liability, but the overlap of its genetic architecture with schizophrenia is poorly understood.
We tested the hypothesis that dimensions of schizotypy (assessed with the SPQ-B) are associated with a polygenic risk score (PRS) for schizophrenia in a sample of 623 psychiatrically healthy, non-clinical subjects from the FOR2107 multi-centre study and a second sample of 1133 blood donors.
We did not find correlations of schizophrenia PRS with either overall SPQ or specific dimension scores, nor with adjusted schizotypy scores derived from the SPQ (addressing inter-scale variance). Also, PRS for affective disorders (bipolar disorder and major depression) were not significantly associated with schizotypy.
This important negative finding demonstrates that despite the hypothesised continuum of schizotypy and schizophrenia, schizotypy might share less genetic risk with schizophrenia than previously assumed (and possibly less compared to psychotic-like experiences).
A number of genomic conditions caused by copy number variants (CNVs) are associated with a high risk of neurodevelopmental and psychiatric disorders (ND-CNVs). Although these patients also tend to have cognitive impairments, few studies have investigated the range of emotion and behaviour problems in young people with ND-CNVs using measures that are suitable for those with learning difficulties.
A total of 322 young people with 13 ND-CNVs across eight loci (mean age: 9.79 years, range: 6.02–17.91, 66.5% male) took part in the study. Primary carers completed the Developmental Behaviour Checklist (DBC).
Of the total, 69% of individuals with an ND-CNV screened positive for clinically significant difficulties. Young people from families with higher incomes (OR = 0.71, CI = 0.55–0.91, p = .008) were less likely to screen positive. The rate of difficulties differed depending on ND-CNV genotype (χ2 = 39.99, p < 0.001), with the lowest rate in young people with 22q11.2 deletion (45.7%) and the highest in those with 1q21.1 deletion (93.8%). Specific patterns of strengths and weaknesses were found for different ND-CNV genotypes. However, ND-CNV genotype explained no more than 9–16% of the variance, depending on DBC subdomain.
Emotion and behaviour problems are common in young people with ND-CNVs. The ND-CNV specific patterns we find can provide a basis for more tailored support. More research is needed to better understand the variation in emotion and behaviour problems not accounted for by genotype.
Coronavirus disease 2019, a highly transmissible respiratory infection, has created a public health crisis of global magnitude. The mainstay of diagnostic testing for coronavirus disease 2019 is molecular polymerase chain reaction testing of a respiratory specimen, obtained with a viral swab. As the incidence of new cases of coronavirus disease 2019 increases exponentially, the use of viral swabs to collect nasopharyngeal specimens is anticipated to increase drastically.
This paper draws attention to a complication of viral swab testing in the nasopharynx and describes the premature engagement of a viral swab breakpoint, resulting in impaction in the nasal cavity.
This case highlights a possible design flaw of the viral swab when used to collect nasopharyngeal specimens, which then requires an aerosol-generating procedure in a high-risk patient to be performed. The paper outlines a safe technique of nasal foreign body removal in a suspected coronavirus disease 2019 patient and suggests alternative testing materials.
Feeding cattle with on-pasture supplementation or feedlot diets can increase animal efficiency and system profitability while minimizing environmental impacts. However, cattle system profit margins are relatively small and nutrient supply accounts for most of the costs. This paper introduces a nonlinear profit-maximizing diet formulation problem for beef cattle based on well-established predictive equations. Nonlinearity in predictive equations for nutrient requirements poses methodological challenges in the application of optimization techniques. In contrast to other widely used diet formulation methods, we develop a mathematical model that guarantees an exact solution for maximum profit diet formulations. Our method can efficiently solve an often-impractical nonlinear problem by solving a finite number of linear problems, that is, linear time complexity is achieved through parametric linear programming. Results show the impacts of choosing different objective functions (minimizing cost, maximizing profit and maximizing profit per daily weight gain) and how this may lead to different optimal solutions. In targeting improved ration formulation on feedlot systems, this paper demonstrates how profitability and nutritional constraints can be met as an important part of a sustainable intensification production strategy.
Although lignin has been negatively correlated with neutral-detergent fibre (NDF) digestibility (NDFD) in ruminants and used to predict potential extent of NDF digestion of forages, selection of an analysis, Klason lignin (KL) or acid-detergent lignin (ADL), to describe that the nutritionally relevant lignin has not been resolved. Dismissed as an artifact is the difference between KL and ADL (ΔL). A question is whether ΔL influences NDFD. We evaluated the relationships of ΔL, KL and ADL with NDFD in order to determine the nutritionally homogeneous or heterogeneous nature of KL. Data sets from two laboratories (DS1 and DS2) were used that included ADL, KL and in vitro NDFD at 48 h (NDFD48). DS1 contained seven C3 grasses, seventeen C4 maize forages and nineteen alfalfas, and DS2 had fifteen C3 grasses, eight C4 forages and six alfalfas. Mean ΔL was greater than ADL in C3 and C4 samples and less in alfalfas. Within forage type and laboratory, ΔL was not correlated with NDFD48 (r −0·34–0·49; all P > 0·17). ADL was more consistently correlated with NDFD48 (r −0·47–−0·95; P < 0·01–0·21) than with KL (r 0·03–−0·91; P < 0·01–0·94). ΔL as a proportion of KL was correlated with NDFD48 in C3 and C4 samples (r 0·44–0·76; P < 0·01–0·08). The differing behaviours of ΔL and ADL relative to NDFD48 indicate that KL is a nutritionally heterogeneous fraction, the behaviour of which may vary by forage type and ratios of ADL and ΔL present.
Innovation Concept: EM Sim Cases is an innovative, open-access website that was created in 2015 to publish medical simulation resources including standardized, peer-reviewed simulation cases. Herein we describe our interim analysis. Methods: We performed a massive online needs assessment using a methodology previously described by Chan et. al. to determine how we can shape EM Sim Cases to meet the needs of learners and educators who use it. We engaged with simulation experts from the Emergency Medicine Simulation Education Research Collaborative to design a Google Forms survey using best practices in survey design. We distributed the survey to our target community of practice via Twitter, email, and a blog post published on emsimcases.com. Curriculum, Tool, or Material: We received 81 responses from simulation educators representing 8 medical specialties and 13 countries. Most survey respondents identified themselves as staff physicians (n = 44) and specialized in emergency medicine (n = 39). They had 0-21+ years of experience. 37% of respondents (n = 30) stated that material from EM Sim Cases makes up 25% or more of their simulation curriculum. Several respondents noted that using this content made them feel more confident and more current. Respondents praised EM Sim Cases for a well-organized case format, the proper level of detail, consistency between case designs, and the wide variety of cases. Suggested improvements included an opportunity to directly comment on cases and more cases in pediatric, rural, and advanced airway management situations. Suggestions were made to improve the navigability of the website. Respondents wanted to see additional blog content on debriefing strategies and self-made task/skill trainers. Conclusion: EM Sim Cases is a novel, free open-access simulation resource. Using a massive online needs assessment we were able to determine future directions including case topics, website reorganization, and educational material. We were also able to capture how impactful a resource like this can be to clinical and educational practice outside of the simulation setting.
Introduction: A critical component for successful implementation of any innovation is an organization's readiness for change. Competence by Design (CBD) is the Royal College's major change initiative to reform the training of medical specialists in Canada. The purpose of this study was to measure readiness to implement CBD among the 2019 launch disciplines. Methods: An online survey was distributed to program directors of the 2019 CBD launch disciplines one month prior to implementation. Questions were developed based on the R = MC2 framework for organizational readiness. They addressed program motivation to implement CBD, general capacity for change, and innovation-specific capacity. Questions related to motivation and general capacity were scored using a 5-point scale of agreement. Innovation-specific capacity was measured by asking participants whether they had completed 33 key pre-implementation tasks (yes/no) in preparation for CBD. Bivariate correlations were conducted to examine the relationship between motivation, general capacity and innovation specific capacity. Results: Survey response rate was 42% (n = 79). A positive correlation was found between all three domains of readiness (motivation and general capacity, r = 0.73, p < 0.01; motivation and innovation specific capacity, r = 0.52, p < 0.01; general capacity and innovation specific capacity, r = 0.47, p < 0.01). Most respondents agreed that successful launch of CBD was a priority (74%). Fewer felt that CBD was a move in the right direction (58%) and that implementation was a manageable change (53%). While most programs indicated that their leadership (94%) and faculty and residents (87%) were supportive of change, 42% did not have experience implementing large-scale innovation and 43% indicated concerns about adequate support staff. Programs had completed an average of 72% of pre-implementation tasks. No difference was found between disciplines (p = 0.11). Activities related to curriculum mapping, competence committees and programmatic assessment had been completed by >90% of programs, while <50% of programs had engaged off-service rotations. Conclusion: Measuring readiness for change aids in the identification of factors that promote or inhibit successful implementation. These results highlight several areas where programs struggle in preparation for CBD launch. Emergency medicine training programs can use this data to target additional implementation support and ongoing faculty development initiatives.
Innovation Concept: A major barrier to the development of a national simulation case repository and multi-site simulation research is the lack of a standardized national case template. This issue was recently identified as a priority research topic for Canadian simulation based education (SBE) research in emergency medicine (EM). We partnered with the EM Simulation Education Researchers Collaborative (EM-SERC) to develop a national simulation template. Methods: The EM Sim Cases template was chosen as a starting point for the consensus process. We generated feedback on the template using a three-phase modified nominal group technique. Members of the EM-SERC mailing list were consulted, which included 20 EM simulation educators from every Canadian medical school except Northern Ontario School of Medicine and Memorial University. When comments conflicted, the sentiment with more comments in favour was incorporated. Curriculum, Tool or Material: In phase one we sought free-text feedback on the EM Sim Cases template via email. We received 65 comments from 11 respondents. An inductive thematic analysis identified four major themes (formatting, objectives, debriefing, and assessment tools). In phase two we sought free-text feedback on the revised template via email. A second thematic analysis on 40 comments from 12 respondents identified three broad themes (formatting, objectives, and debriefing). In phase three we sought feedback on the penultimate template via focus groups with simulation educators and technologists at multiple Canadian universities. This phase generated 98 specific comments which were grouped according to the section of the template being discussed and used to develop the final template (posted on emsimcases.com). Conclusion: We describe a national consensus-building process which resulted in a simulation case template endorsed by simulation educators from across Canada. This template has the potential to: 1. Reduce the replication of effort across sites by facilitating the sharing of simulation cases. 2. Enable national collaboration on the development of both simulation cases and curricula. 3. Facilitate multi centre simulation-based research by removing confounders related to the local adoption of an unfamiliar case template. This could improve the rigour and validity of these studies by reducing inter-site variability. 4. Increase the validity of any simulation scenarios developed for use in national high-stakes assessment.
The anchoritic life was first attested among women in England in the early twelfth century and became an increasingly popular choice that continued up to the Reformation. In the thirteenth century, the time period under consideration here, the anchoritic life was flourishing, particularly for aristocratic women. The Ancrene Wisse, or Ancrene Riwle as it is alternatively known, was written in the West Midlands of England in the early thirteenth century as a handbook for such solitary women who sought physical enclosure, away from the world, in order to pursue a higher spiritual calling. The AW author's autograph text does not survive, but the unrevised version does, at one or two removes from the original, in the Nero manuscript (London, British Library, Cotton MS Nero A.xiv, henceforth “Nero”), dedicated to three aristocratic sisters who took up the anchoritic life and for whom the text was composed. The text was revised, possibly by the author himself, for a wider group of anchoresses, and this revised version is preserved in the Corpus, Cleopatra, Titus, Vitellius, and Vernon manuscripts. These, with the exception of Vitellius, make up the early manuscripts of the AW.
Particularly in the past thirty years, though studies of the readership of the AW have grown, few have probed more than superficially the relationship between the text and its thirteenth-century women readers. Even these studies typically consider English and French devotional literacy; questions of Latin literacy among this readership are often dealt with briefly and then set aside on the grounds that Latin literacy among thirteenth-century laywomen readers was exceptional, and the Latin that appears in the AW was not in the main directed at the women readers but at their supervisors. The predominant language of literacy was shifting; this shift is highlighted by the composition of the AW in English rather than in the Latin of Aelred of Rievaulx's anchoritic guidebook De institutione inclusarum only sixty or so years earlier. Also, the remarkable texts of the contemporary Katherine Group (KG) and the Wooing Group (WG) have often been taken as evidence that vernacular literacy among their women readers was supreme.