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This chapter examines the intersection of regionalisms and queer studies with special attention to US literary studies. It asks what difference, if any, queer critical regionalism as an intellectual approach may make in analyses of literature of the imperial center. Attempting to answer this question, the chapter revisits a short story that depicts queer love – “The Queen’s Twin” (1899) – by Sarah Orne Jewett, a US regionalist writer who has figured prominently in both scholarship on US literary regionalism and queer studies. By analyzing this story, the chapter demonstrates the potential of queer critical regionalism as an approach that both encourages comparative and transnational queer studies research and enables reevaluation of texts like Jewett’s that have hitherto been understood as foundational to a queer Western literary canon.
To slow down the transmission of coronavirus disease 2019 (COVID-19), it is important to identify specific symptoms for effective screening. While anosmia/hyposmia and dysgeusia/ageusia have been identified as highly prevalent symptoms, there are wide geographic variations, necessitating the regional evaluation of the prevalence of the symptoms.
A cross-sectional study was performed to evaluate the self-reported symptoms among adults (over 18 years old) who underwent COVID-19 tests at an ambulatory assessment centre. We identified 1,345 patients (102 positive and 1,243 negative) who visited the assessment centre between March 16 and April 15, 2020. We randomly sampled negative patients in a 1:3 ratio. The primary outcome was the prevalence of self-reported anosmia/hyposmia and dysgeusia/ageusia. Logistic regression was performed to evaluate the association between COVID-19 positivity and loss of smell and taste.
Fifty-six of 102 (50%) positive patients and 72 of 306 (23.5%) negative patients completed the survey. Anosmia/hyposmia and dysgeusia/ageusia were more prevalent among COVID-19 positive patients (41.1% v. 4.2%, p < 0.001 for smell and 46.4% v. 5.6%, p < 0.001 for taste). Anosmia/hyposmia and dysgeusia/ageusia were independently highly associated with COVID-19 positivity (adjusted odds ratios 14.4 and 11.4 for smell and taste, respectively).
In this Canadian study, smell and taste loss may be key symptoms of COVID-19. This evidence can be helpful in the clinical diagnosis of COVID-19, particularly settings of limited testing capacity.
Background: In patients with acute hip fracture, a fascia iliaca compartment block (FICB) has been shown to provide effective non-opioid analgesia, reduce the incidence of pneumonia, and potentially decrease the rate of delirium . However, this procedure was infrequently used in the St. Michael's Hospital (SMH) emergency department (ED). Aim Statement: Our aim was to increase the proportion of patients with hip fracture receiving FICB in the ED to 50% in six months. Measures & Design: We completed two Plan-Do-Study-Act (PDSA) cycles, measuring rates of FICB before and after each cycle. The first was a departmental rounds presentation with information about the process and benefits of FICB, addressing barriers identified by surveying the group. The second cycle included a bundle of interventions comprising of an “instruction card” with the steps required to do the procedure, access to a video tutorial, and a list of experienced physicians willing to help less experienced providers perform FICB. Evaluation/Results: In the three months prior to the project, the rate of FICB in the ED was 12.5% (3/24). For the three months after the first PDSA cycle, the rate increased to 22.2% (8/36). Then, the second cycle was performed. In the following two months the rate further increased to 36.8% (7/19). Discussion/Impact: Despite the clear increase in FICB rate, these changes were not statistically significant (p = 0.063). Our methodology was shown to be safe and effective, and our model can be applied to other ED groups looking to increase their rates of FICB.
Introduction: A proportion of Emergency Department (ED) visits may be treated in out-of-hospital settings. The objective of this curriculum was to expand paramedic competencies to safely risk stratify patients and divert low risk, low acuity patients from EDs with and without physician oversight. Methods: We followed Kerns 6-step Curriculum Development Framework . (a) We identified a problem, and (b) completed a needs assessment by retrospectively reviewing the clinical pathways of 3000 patients were cared for and transported by paramedics and received care at an EDs. We used this data to identify competencies (e.g., diagnostics, interventions, reasoning needs) and targeted patient types that would result in the most significant advancements to paramedic services. These were translated to (c) goals and objectives. Results: Our (d) educational strategies involved a 14-week intensive patient-type and case-based curriculum. (e) Implementation involved 3 days/wk of clinical rotations supplemented with 2 days/wk of a mixed curriculum (i.e., fixed instruction using blended didactic small and large group sessions; flexible/individualized curriculum based on identified needs; formative assessments; self and peer-directed learning; simulations). (f) Assessment involved knowledge and application tests, clinical placement and simulation assessments; case development, assignments, and OSCE. Evaluation outcomes included student performance scores across 7-dimensions, clinical placement and student feedback. Thirteen Advanced Care Paramedics from York Region Paramedic Services completed the program. Challenges included provincial stakeholder consensus, and formally addressing clinical suspicion in a protocol based field within a limited time frame. Conclusion: A curriculum for expanded paramedic practice to risk stratify and divert targeted low risk patients from EDs resulted in new paramedic competencies and scope of practice. It received high evaluations from clinical staff and students. Successful candidates will undergo a 1-year study for validation and safety.
Reconstructions of long-term solar variability underpin our understanding of the solar dynamo, potential tropospheric climate implications and future space weather scenarios. Prior to direct spacecraft measurements of the heliospheric magnetic field (HMF) and solar wind, accurate annual reconstructions are possible using geomagnetic and sunspot records. On longer timescales, information about the HMF can be extracted from cosmogenic radionuclide records, particularly 14C in ancient trees and 10Be in ice sheets. These proxies, and what they reveal about the HMF and solar wind, are briefly reviewed here.
Vitamin E and selenium have been reported to improve immune function across a range of species. Ewes lambing on poor-quality dry pasture in autumn in Western Australia are at risk of being deficient in vitamin E and selenium at lambing thus predisposing their lambs to deficiencies and increasing the risk of infection and disease. This study tested the hypotheses that (i) supplementation of autumn-lambing ewes with vitamin E plus selenium in late gestation will increase the concentrations of vitamin E and selenium in plasma in the ewe and lamb and (ii) that the increased concentrations of vitamin E and selenium in plasma in the lambs will improve their innate and adaptive immune responses and thus survival. Pregnant Merino ewes were divided into a control group (n=58) which received no supplementation or a group supplemented with vitamin E plus selenium (n=55). On days 111, 125 and 140 of pregnancy ewes in the vitamin E plus selenium group were given 4 g all-rac-α-tocopherol acetate orally. On day 111 the ewes were also given 60 mg of selenium as barium selenate by subcutaneous injection. The concentrations of α-tocopherol and selenium were measured in ewes and/or lambs from day 111 of pregnancy to 14 weeks of age±10 days (weaning). Immune function of the lamb was assessed by analysing the numbers and phagocytic capacities of monocytes and polymorphonuclear leucocytes and plasma IgG and anti-tetanus toxoid antibody concentrations between birth and 14 weeks of age±10 days. Maternal supplementation with vitamin E plus selenium increased the concentration of α-tocopherol in plasma (1.13 v. 0.67 mg/l; P<0.001) and selenium in whole blood (0.12 v. 0.07 mg/l; P<0.01) of the ewes at lambing compared with controls. Supplementation also increased the concentration of α-tocopherol (0.14 v. 0.08 mg/l; P<0.001) and selenium (0.08 v. 0.05 mg/l; P<0.01) in lambs at birth compared with controls. There was no significant effect of supplementation on immune function or survival in the lambs.
To assess the impact of Matrix-Assisted Laser Desorption/Ionization Time-of-Flight (MALDI-TOF) mass spectrometry for rapid pathogen identification directly from early-positive blood cultures coupled with an antimicrobial stewardship program (ASP) in two community hospitals. Process measures and outcomes prior and after implementation of MALDI-TOF/ASP were evaluated.
Multicenter retrospective study.
Two community hospitals in a system setting, Houston Methodist (HM) Sugar Land Hospital (235 beds) or HM Willowbrook Hospital (241 beds).
Patients ≥18 years of age with culture-proven Gram-negative bacteremia.
Blood cultures from both hospitals were sent to and processed at our central microbiology laboratory. Clinical pharmacists at respective hospitals were notified of pathogen ID and susceptibility results.
We evaluated 572 patients for possible inclusion. After pre-defined exclusion criteria, 151 patients were included in the pre-intervention group and 242 were included in the intervention group. After MALDI-TOF/ASP implementation, the mean identification time after culture positivity was significantly reduced from 32 hours (±16 hours) to 6.5 hours (±5.4 hours) (P<.001); mean time to susceptibility results was significantly reduced from 48 (±22) hours to 23 (±14) hours (P<.001); and time to therapy adjustment was significantly reduced from 75 (±59) hours to 30 (±30) hours (P<.001). Mean hospital costs per patient were $3,411 less in the intervention group compared with the pre-intervention group ($18,645 vs $15,234; P=.04).
This study is the first to analyze the impact of MALDI-TOF coupled with an ASP in a community hospital setting. Time to results significantly differed with the use of MALDI-TOF, and time to appropriate therapy was significantly improved with the addition of ASP.
Infect. Control Hosp. Epidemiol. 2016;37(4):425–432
A number of thin silicon films are prepared through ultra-high-vacuum evaporation on optical quality fused quartz substrates with different growth temperatures. Through an analysis of grazing incidence X-ray diffraction results, a phase transition, from amorphous-to-crystalline, is found corresponding to increases in the growth temperature. The corresponding Raman spectra are also observed to change their form as the films go through this phase transition. Using a Raman peak decomposition process, this phase transition is then quantitatively characterized through the determination of the amount of intermediate-range order and the crystalline volume fraction for the various growth temperatures considered in this analysis. The possible device consequences of these results are then commented upon.
Despite the abundance and diversity of Venericardia bivalves on the U.S. Coastal Plain during the Paleogene, the evolutionary relationships within the genus remain unresolved. The primary objectives of this study were to reconstruct a phylogeny of Venericardia species, identify major clades within the genus, and determine whether groupings within traditional venericard classifications constitute monophyletic taxa. Fifty-one conchological characters were applied to 18 venericard and two outgroup species. Parsimony analysis produced three equally parsimonious trees and robustness was assessed through Bremer support and bootstrap values. The resultant trees indicate that the smooth-ribbed planicostate venericards are monophyletic, whereas the sharp-ribbed alticostate venericards are paraphyletic. Additionally, the original planicostate subtaxon, Venericor, is monophyletic whereas the original alticostate subtaxa, Claibornicardia, Glyptoactis, and Rotundicardia, are nonmonophyletic.
Invasive species are an increasing presence in coastal marine ecosystems, and their ecological and economic impacts have been sometimes severe (Rilov & Crooks, 2009). Such impacts have stirred academic interest as well as directed policy and management actions designed to ameliorate or forestall further negative consequences (Ruiz et al., 2000). We review two key pieces of invasion ecology that dictate how we study the impact of coastal marine invaders, and we set available empirical evidence generated from research on marine invaders in this context. We show that significant gaps remain in our knowledge of the impacts of coastal marine invaders. These gaps include bias in the taxonomic groups and coastal habitats studied, incomplete documentation of ecological impacts, and scientific uncertainty in when negative impacts are likely to occur and how long they may persist. These gaps combine to inhibit comprehensive regulatory actions that are aimed at reducing the inflow of non-native species into coastal waters and executing effective eradication or control measures for those species that impose negative impacts.
The invasion process
One of the consistent themes across chapters in this volume is that invasive species can cause major changes to coastal ecosystems (e.g. Chapters 4 and 5). As is true across a variety of other ecosystems, coastal marine invaders can impose significant stress on co-occurring native species exacerbating what is already a precarious existence for many species (Rilov & Crooks, 2009; see also Chapter 7). Despite their occasionally large impacts, coastal marine invaders are only a small subset of all the non-native species established in coastal ecosystems, and a yet smaller subset of all the non-native species that were transported into these ecosystems and released there (Ruiz et al., 2000; Miller & Ruiz, 2009). In other words, of all the coastal marine species which have been entrained in a transport process (e.g. via ballast water, aquaria trade), only a fraction of them will go on to garner attention as having become widespread and imposing negative impacts on native species and ecosystems, or having become “invasive.” There is much general debate about what that invasive fraction may be, but it can be as low as 10% and as high as 50% depending on the taxa considered and the habitat into which non-natives are released (Ricciardi et al., 2013). Even the highest estimated fraction of 50% indicates that there are as many non-native species in an ecosystem that do not have recorded impacts as there are those that do.
Children with conduct problems (CP) are a heterogeneous group. Those with high levels of callous–unemotional traits (CP/HCU) appear emotionally under-reactive at behavioural and neural levels whereas those with low levels of CU traits (CP/LCU) appear emotionally over-reactive, compared with typically developing (TD) controls. Investigating the degree to which these patterns of emotional reactivity are malleable may have important translational implications. Instructing participants with CP/HCU to focus on the eyes of fearful faces (i.e. the most salient feature) can ameliorate their fear-recognition deficits, but it is unknown whether this is mediated by amygdala response. It is also unknown whether focusing on fearful eyes is associated with increased amygdala reactivity in CP/LCU.
Functional magnetic resonance imaging (fMRI) was used to measure neural responses to fearful and calm faces in children with CP/HCU, CP/LCU and TD controls (n = 17 per group). On half of trials participants looked for a blue dot anywhere within target faces; on the other half, participants were directed to focus on the eye region.
Reaction time (RT) data showed that CP/LCU were selectively slowed in the fear/eyes condition. For the same condition, CP/LCU also showed increased amygdala and subgenual anterior cingulate cortex (sgACC)/orbitofrontal cortex (OFC) responses compared with TD controls. RT and amygdala response to fear/eyes were correlated in CP/LCU only. No effects of focusing on the eye region were observed in CP/HCU.
These data extend the evidence base suggesting that CU traits index meaningful heterogeneity in conduct problems. Focusing on regulating reactive emotional responses may be a fruitful strategy for children with CP/LCU.
Leprosy is a chronic disease predominantly affecting skin and nerves, which may result in deformity, disability and social stigma, creating problems for patients and their families. Africa is the third most affected region world-wide after Asia and South America (WHO, 2009). In 2009, eight African countries still reported more than one new leprosy case per 10 000 population.
In many countries leprosy work is being integrated into general health services, so all medical professionals need to be aware of the symptoms and signs of leprosy. Since new patients may have nerve function impairment at diagnosis, every health professional should know how to assess and manage nerve impairment caused by leprosy (Rijk et al., 1994).
Leprosy is caused by Mycobacterium leprae, an acid-fast intracellular organism not yet cultivated in vitro. The organism was first identified in the nodules of lepromatous leprosy patients by Hansen in 1873. M. leprae parasitizes skin macrophages and peripheral nerve Schwann cells.
M. leprae can be grown in the mouse footpad, but growth is slow. The nine-banded armadillo is susceptible to M. leprae infection, and develops disease with widespread bacterial multiplication. The armadillo and mouse models of M. leprae infection have been useful for producing M. leprae for biological studies and studying drug sensitivity patterns.
We present comprehensive quantitative analysis of Raman spectra in two-(Si/SiGe superlattices) and three-(Si/SiGe cluster multilayers) dimensional nanostructures. We find that the Raman spectra baseline is due to the sample surface imperfection and instrumental response associated with the stray light. The Raman signal intensity is analyzed, and Ge composition is calculated and compared with the experimental data. The local sample temperature and thermal conductivity are calculated, and the spectrum of longitudinal acoustic phonons is explained.
We report the degradation of low temperature photoluminescence (PL) from Si/SiGe three-dimensional cluster morphology nanostructures under continuous photoexcitation. The PL intensity initially decreases slowly for about 15 minutes, and then decreases rapidly, until only ∼ 10% of the original PL intensity remains. A complete recovery of the PL requires restoring the sample temperature to ∼ 300K. We propose that a slow accumulation of charge in SiGe clusters enhances the rate of Auger recombination and results in the observed PL degradation.
Nanotribology, the study of friction, wear and lubrication at the nanoscale is an important area of research; however in practice due to the size scale, requires specifically designed tools to characterize nanoscale contacts. We have developed a TEM triboprobe incorporating an advanced nano-positioner with 3D programmable motion inside a transmission electron microscope (TEM) which allows us to selectively apply multiple reciprocating wear cycles to a nanoscale surface, and observe in real-time dynamical changes and the evolution of wear around a sliding nano-contact.
Nanoscale cyclic rubbing of an automotive aluminum-silicon alloy processed by focused ion beam (FIB) reveals dynamical surface fragmentation and the generation of nanoscale debris particles. The nanoparticles undergo complex motion as they interact with the sliding nano-contact. Over hundreds of reciprocating cycles, frictional heating leads to a phase separation of the Ga+ ions implanted by FIB forming liquid Ga nano-droplets and liquid bridges. The addition of nanoscale debris particles and liquid droplets dramatically changes the wear dynamics and transforms a 2-body sliding contact into a complex 4-body solid–liquid system exhibiting time-dependent, non-equilibrium kinetic behavior.
TEM nanotribology opens up new possibilities for the real-time quantification of cyclic friction, wear and dynamic solid–liquid nano-mechanics, which will have widespread applications in many areas of nano-science and nanotechnology.