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Kounis syndrome is the concurrence of acute coronary syndrome or coronary vasospasm with conditions associated with the release of inflammatory cytokines through mast cell activation in the setting of allergic or anaphylactic reactions. Many identified triggers have been identified in paediatric patients including exposures, drugs, and immunisations; however, to our knowledge this is the first case report of Kounis syndrome linked to immunotherapy. We present a case of a 9-year-old with seasonal allergies presenting with clinical symptoms of Kounis syndrome following her weekly subcutaneous injection of allergens. Clinicians need a high index of suspicion for Kounis syndrome in patients who develop systemic signs of anaphylaxis with clinical, laboratory, electrocardiographic, and echocardiographic findings of acute coronary syndrome to help direct therapy and improve outcomes.
This paper introduces a formal definition of a Cyber-Physical System (CPS) in the spirit of the CPS Framework proposed by the National Institute of Standards and Technology (NIST). It shows that using this definition, various problems related to concerns in a CPS can be precisely formalized and implemented using Answer Set Programming (ASP). These include problems related to the dependency or conflicts between concerns, how to mitigate an issue, and what the most suitable mitigation strategy for a given issue would be. It then shows how ASP can be used to develop an implementation that addresses the aforementioned problems. The paper concludes with a discussion of the potentials of the proposed methodologies.
The career of Dora Sigerson (1866–1918), also known as Dora Sigerson Shorter, moves between the worlds of the nineteenth-century nationalist ballad and the Edwardian lyric. Born a year after W. B. Yeats, she established herself on the British literary scene, becoming a friend of Thomas Hardy and reviewed in the Times Literary Supplement by Virginia Woolf, but experienced the Easter Rising as a traumatic call to reconnect with Ireland. A vein of agnostic anxiety runs through her work, which engages with themes of depression, ghostly visitations, and suicide. The poems of her final period move between private and public dramas, aspiring to a monumental framework (Sigerson was also a sculptor) but exploring Anglo-Irish relations through the familiar prism of a strained marriage. Her final work tackles wider themes of imperial wrongs, including slavery, while teetering on the edge of breakdown. Moving as she does between contrasting modes, Sigerson is a poet who has arguably still to find her audience, but whose work has much to tell us about how Irish poetry has been read and received over the last century.
The Subglacial Antarctic Lakes Scientific Access (SALSA) Project accessed Mercer Subglacial Lake using environmentally clean hot-water drilling to examine interactions among ice, water, sediment, rock, microbes and carbon reservoirs within the lake water column and underlying sediments. A ~0.4 m diameter borehole was melted through 1087 m of ice and maintained over ~10 days, allowing observation of ice properties and collection of water and sediment with various tools. Over this period, SALSA collected: 60 L of lake water and 10 L of deep borehole water; microbes >0.2 μm in diameter from in situ filtration of ~100 L of lake water; 10 multicores 0.32–0.49 m long; 1.0 and 1.76 m long gravity cores; three conductivity–temperature–depth profiles of borehole and lake water; five discrete depth current meter measurements in the lake and images of ice, the lake water–ice interface and lake sediments. Temperature and conductivity data showed the hydrodynamic character of water mixing between the borehole and lake after entry. Models simulating melting of the ~6 m thick basal accreted ice layer imply that debris fall-out through the ~15 m water column to the lake sediments from borehole melting had little effect on the stratigraphy of surficial sediment cores.
Seamus Heaney’s poetry and criticism kept up a regular conversation with Romantic and post-Romantic poetics: from Wordsworth to Hopkins, Frost, Plath and more. He initially found in Frost’s relation to the natural, ‘a primal reach into the physical’. This he developed into a poetic which balanced the need for roots in an account of the formation of the poet’s self, and the need for an individual voice which found responsibility in ‘an unconceding pursuit of poetic insight and poetic knowledge’. The route was via watery places, and an approach to the autobiographical grounded in Wordsworth, which was figured through the making and unmaking of gender. If Heaney’s later poetry was to trade this rootedness in for a sort of transcendence – ‘walking on air’ – he still remained preoccupied with its forging in imitation, its duty to communicate, and its desire for its own autonomy.
This paper proposes a model for developmental psychopathology that is informed by recent research suggestive of a single model of mental health disorder (the p factor) and seeks to integrate the role of the wider social and cultural environment into our model, which has previously been more narrowly focused on the role of the immediate caregiving context. Informed by recently emerging thinking on the social and culturally driven nature of human cognitive development, the ways in which humans are primed to learn and communicate culture, and a mentalizing perspective on the highly intersubjective nature of our capacity for affect regulation and social functioning, we set out a cultural-developmental approach to psychopathology.
The COVID-19 pandemic and mitigation measures are likely to have a marked effect on mental health. It is important to use longitudinal data to improve inferences.
Aims
To quantify the prevalence of depression, anxiety and mental well-being before and during the COVID-19 pandemic. Also, to identify groups at risk of depression and/or anxiety during the pandemic.
Method
Data were from the Avon Longitudinal Study of Parents and Children (ALSPAC) index generation (n = 2850, mean age 28 years) and parent generation (n = 3720, mean age 59 years), and Generation Scotland (n = 4233, mean age 59 years). Depression was measured with the Short Mood and Feelings Questionnaire in ALSPAC and the Patient Health Questionnaire-9 in Generation Scotland. Anxiety and mental well-being were measured with the Generalised Anxiety Disorder Assessment-7 and the Short Warwick Edinburgh Mental Wellbeing Scale.
Results
Depression during the pandemic was similar to pre-pandemic levels in the ALSPAC index generation, but those experiencing anxiety had almost doubled, at 24% (95% CI 23–26%) compared with a pre-pandemic level of 13% (95% CI 12–14%). In both studies, anxiety and depression during the pandemic was greater in younger members, women, those with pre-existing mental/physical health conditions and individuals in socioeconomic adversity, even when controlling for pre-pandemic anxiety and depression.
Conclusions
These results provide evidence for increased anxiety in young people that is coincident with the pandemic. Specific groups are at elevated risk of depression and anxiety during the COVID-19 pandemic. This is important for planning current mental health provisions and for long-term impact beyond this pandemic.
Psychosocial factors have been implicated as both a cause and consequence of hypertension in the general population but are less understood in relation to hypertensive disorders of pregnancy (HDP). The aims of this review were to (1) synthesize the existing literature examining associations between depression and/or anxiety in pregnancy and HDP and (2) assess if depression and/or anxiety in early pregnancy was a risk factor for HDP.
Methods
A comprehensive search of Medline, Embase, CINAHL, and PsycINFO was conducted from inception to March 2020 using terms related to ‘pregnancy’, ‘anxiety’, ‘depression’, and ‘hypertensive disorders’. English-language cohort and case-control studies were included if they reported: (a) the presence or absence of clinically significant symptoms of depression/anxiety, or a medical record diagnosis of depression or an anxiety disorder in pregnancy; (b) diagnosis of HDP; and/or (c) data comparing the depressed/anxious group to the non-depressed/anxious group on HDP. Data related to depression/anxiety, HDP, study characteristics, and aspects related to study quality were extracted independently by two reviewers. Random-effects meta-analyses of estimated pooled relative risks (RRs) were conducted for depression/anxiety in pregnancy and HDP.
Results
In total, 6291 citations were retrieved, and 44 studies were included across 61.2 million pregnancies. Depression and/or anxiety were associated with HDP [RR = 1.39; 95% confidence interval (CI) 1.25–1.54].
Conclusions
When measurement of anxiety or depression preceded diagnosis of hypertension, the association remained (RR = 1.27; 95% CI 1.07–1.50). Women experiencing depression or anxiety in pregnancy have an increased prevalence of HDP compared to their non-depressed or non-anxious counterparts.
Cognitive behavior therapy (CBT) is effective for most patients with a social anxiety disorder (SAD) but a substantial proportion fails to remit. Experimental and clinical research suggests that enhancing CBT using imagery-based techniques could improve outcomes. It was hypothesized that imagery-enhanced CBT (IE-CBT) would be superior to verbally-based CBT (VB-CBT) on pre-registered outcomes.
Methods
A randomized controlled trial of IE-CBT v. VB-CBT for social anxiety was completed in a community mental health clinic setting. Participants were randomized to IE (n = 53) or VB (n = 54) CBT, with 1-month (primary end point) and 6-month follow-up assessments. Participants completed 12, 2-hour, weekly sessions of IE-CBT or VB-CBT plus 1-month follow-up.
Results
Intention to treat analyses showed very large within-treatment effect sizes on the social interaction anxiety at all time points (ds = 2.09–2.62), with no between-treatment differences on this outcome or clinician-rated severity [1-month OR = 1.45 (0.45, 4.62), p = 0.53; 6-month OR = 1.31 (0.42, 4.08), p = 0.65], SAD remission (1-month: IE = 61.04%, VB = 55.09%, p = 0.59); 6-month: IE = 58.73%, VB = 61.89%, p = 0.77), or secondary outcomes. Three adverse events were noted (substance abuse, n = 1 in IE-CBT; temporary increase in suicide risk, n = 1 in each condition, with one being withdrawn at 1-month follow-up).
Conclusions
Group IE-CBT and VB-CBT were safe and there were no significant differences in outcomes. Both treatments were associated with very large within-group effect sizes and the majority of patients remitted following treatment.
It is a point of some controversy whether we can call the Ireland of the nineteenth-century ‘Victorian’, for all that Victoria was its head of state within the United Kingdom. While not a state in itself, Ireland was certainly going through what William Carleton called in 1842 a ‘transition state’. There is much that is preliminary, provisional or even experimental about the writing of nineteenth-century Ireland, caught between Romanticism and Revival and never fully accounted for in the mainstream of Victorian literary history. The writing, too, was not located solely in Ireland: famine and mass emigration meant that the Irish found themselves in the United States, Australia or India, both as participants in decolonising movements or as servants of Empire. This chapter surveys the twin location of Irish literature, nationalist and diasporic. It focuses on the work of Carleton and Jane Elgee (Speranza) while also introducing many of the themes and authors which are the subject matter of the pages that follow.
The Irish poetry of the romantic age is dominated by its best-known figure, Thomas Moore. While Moore claimed that his songs were responsible for saving the national literary and musical culture, there were, of course, many other writers producing poetry in differing modes, languages, and registers. This chapter begins and ends with Moore’s considerable achievements, but it also deals with three issues that preoccupied Irish poetic and cultural debate in the period and after: translation, authenticity, and quality. The debate gains its first focus in the work of Charlotte Brooke, but continues through Moore’s contact with music in the collections of Edward Bunting. This period was also one of considerable historical moment, and the chapter also addresses poetry written out of the contact with French revolutionary ideas, the United Irishmen, 1798, and Union. Among poets considered are also William Drennan, Mary Tighe, James Orr, and Thomas Dermody, writing in English and Ulster Scots as well as in contact with the Irish-language tradition, mock-epic, and the oriental.