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Background: Visual impairment can impact 70% of individuals who have experienced a stroke. Identification and remediation of visual impairments can improve overall function and perceived quality of life. Our project aimed to improve visual assessment and timely intervention for patients with post-stroke visual impairment (PSVI). Methods: We conducted a quality improvement initiative to create a standardized screening and referral process for patients with PSVI to access an orthoptist. Post-stroke visual impairment was identified using the Visual Screen Assessment (VISA) tool. Patients filled out a VFQ-25 questionnaire before and after orthoptic assessment, and differences between scores were evaluated. Results: Eighteen patients completed the VFQ-25 both before and after orthoptic assessment. Of the vision related constructs, there was a significant improvement in reported outcomes for general vision (M=56.9, SD=30.7; M=48.6, SD=16.0), p=0.002, peripheral vision (M=88.3, SD=16; M=75, SD=23.1), p= 0.027, ocular pain (M=97.2, SD=6.9; M=87.5, SD=21.4), p=0.022, near activities (M=82.4, SD=24.1; M=67.8, SD=25.6), p<0.001, social functioning (M=90.2, SD=19; M=78.5, SD=29.3), p=0.019, mental health (M=84.0, SD=25.9; M=70.5, SD=31.2), p=0.017, and role difficulties (M=84.7, SD=26.3; M=67.4, SD=37.9), p=0.005. Conclusions: Orthoptic assessments for those with PSVI significantly improved perceived quality of life in a numerous vision related constructs, suggesting it is a valuable part of a patient’s post-stroke recovery.
This chapter considers the legacy of respect for individual autonomy and ‘informed consent’ in health research. The primacy of informed consent as a safeguard has led to a systemic regulatory tendency to conceive of and protect privacy as an individual rather than a collective concern. This has limited any regulatory ability to grasp broader social concerns with the use and disclosure of data gathered and generated by health research. Any systemic failure to recognise collective interests in data, and the public interest in (non-personal) data protection, has profound implications for an information age. The chapter reflects on the value of re-negotiating the interests and expectations protected by health research regulation. It recognises the significance of Graeme Laurie’s preferred conception of privacy to enabling such negotiation, and the value of stewardship in establishing normative expectations free of historical encumbrance. Laurie’s conceptualisation of ‘privacy as separateness’, when placed alongside the idea of stewardship, may allow us to rebalance respect to encompass collective interests as fundamental to self-determination and mutual respect.
Studies were conducted in 2019 and 2020 in Lewiston, NC, to determine the crop response of 4-hydroxyphenylpyrivate dioxygenase (HPPD)-resistant cotton to isoxaflutole (IFT) and other cotton herbicides as part of a cotton weed management program that included herbicides applied preemergence, early postemergence (EPOST), and mid-postemergence (MPOST). IFT was applied PRE at 105 g ha−1 alone and in various combinations with acetochlor, diuron, fluometuron, fluridone, fomesafen, pendimethalin, and pyrithiobac. EPOST treatments included IFT at 53 or 105 g ha−1 alone or in combination with glyphosate or glufosinate, or dimethenamid-P + glufosinate. Glyphosate + glufosinate was applied MPOST to all treatments except the nontreated control. Cotton injury from IFT applied PRE was minimal (0% to 3%). Injury following EPOST application of dimethenamid-P + glufosinate ranged from 3% to 5% and 6% to 9% in 2019 and 2020, respectively. In both years, injury from IFT applied PRE followed by IFT applied EPOST never exceeded injury from IFT applied PRE followed by dimethenamid-P + glufosinate. Isoxaflutole applied PRE followed by IFT applied EPOST at 105 g ha−1 resulted in 0% to 2% cotton injury, indicating that IFT can be applied either PRE or EPOST with minimal risk to cotton. Late-season cotton height and cotton lint yield were not affected by any herbicide treatment. The experimental HPPD-resistant cotton cultivar was minimally injured by IFT applied PRE and EPOST, it tolerated standard cotton herbicides, and yield loss was not observed. Given these results, HPPD-resistant cotton and IFT may be integrated into cotton weed management systems with minimal risk for cotton injury and provide an additional effective mechanism of action for managing troublesome weeds in cotton.
The purpose of this study was to determine if estimated center of pressure (COP) from plantar force data collected using three-sensor loadsol insoles was comparable to the COP from plantar pressure data collected using pedar insoles during walking and running. Ten healthy adults walked and ran at self-selected speeds on a treadmill while wearing both a loadsol and pedar insole in their right shoe. Plantar force recorded from the loadsol was used to estimate COP along mediolateral (COPx) and anteroposterior (COPy) axes. The estimated COPx and COPy were compared with the COPx and COPy from pedar using limits of agreement and Spearman’s rank correlation. There were significant relationships and agreement within 5 mm in COPx and 20 mm in COPy between loadsol and pedar at 20–40% of stance during walking and running. However, loadsol demonstrated biases of 7 mm in COPx and 10 mm in COPy compared to pedar near initial contact and toe-off.
This paper introduces the concept of Natural Capital and explores the implications for actuarial work by way of case studies. It is part of a wider series of IFoA papers focussing on the risks from global biodiversity loss and how these risks can be mitigated.
Sabellidites cambriensis is a tubular non-mineralized metazoan that appears as compressed ribbon-shaped imprints with transverse wrinkling, thick walls and an even tube diameter of up to 3 mm. The distribution of Sabellidites is investigated in three Ediacaran–Cambrian sections on the Digermulen Peninsula in Arctic Norway, spanning the Manndrapselva Member of the Stáhpogieddi Formation and the lower member of the Breidvika Formation. Here, the Ediacaran–Cambrian boundary is located in the lower part of the upper parasequence (third cycle) of the Manndrapselva Member. Specimens of Sabellidites are rare but consistently present close to the lowest level of Treptichnus pedum and upsection, whereas the taxon is common and abundant in the lower part of the lower member of the Breidvika Formation, with an upper record at c. 55 m above the base. The range is comparable with that of the GSSP section in Newfoundland, Canada, establishing Sabellidites as an index fossil for the lowermost Cambrian. In the Manndrapselva Member, Sabellidites co-occurs with the acritarch Granomarginata, indicative of the lowermost Cambrian Granomarginata Zone, whereas in the Breidvika Formation it co-occurs with Asteridium. Sabellidites is widely distributed in Baltica, through the Rovnian and Lontovan regional stages but confined to the Fortunian global stage. In its lower range, Sabellidites is associated with a Treptichnus pedum trace fossil association and a depauperate leiosphaerid acritarch assemblage, followed by a Granomarginata assemblage. In its upper range, Sabellidites co-occurs with acritarchs of the Asteridium–Comasphaeridium Zone and the tubular foraminiferan Platysolenites. In Baltica, Sabellidites is a useful index fossil.
Both past and current research indicates that the creation of an imaginary companion is a common, normative, and healthy form of elaborated role-play that emerges in early childhood. Imaginary companions are often the invisible friends that children create for themselves, or the special stuffed animals or dolls that children imbue with personalities. Children often describe and experience their imaginary companions in ways that parallel real friendships with peers. Their emotional investment in these invented characters raises important questions about the broader roles they serve in their lives. Current research in this area has focused on the developmental significance of imaginary companions, and the extent to which they might have a real and meaningful impact on children’s development. This chapter reviews the extant literature on imaginary companions, with a particular focus on the relations between children’s imaginary companions, creativity, and coping with adversity.
To understand the transmission dynamics of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in a hospital outbreak to inform infection control actions.
Design:
Retrospective cohort study.
Setting:
General medical and elderly inpatient wards in a hospital in England.
Methods:
Coronavirus disease 2019 (COVID-19) patients were classified as community or healthcare associated by time from admission to onset or positivity using European Centre for Disease Prevention and Control definitions. COVID-19 symptoms were classified as asymptomatic, nonrespiratory, or respiratory. Infectiousness was calculated from 2 days prior to 14 days after symptom onset or positive test. Cases were defined as healthcare-associated COVID-19 when infection was acquired from the wards under investigation. COVID-19 exposures were calculated based on symptoms and bed proximity to an infectious patient. Risk ratios and adjusted odds ratios (aORs) were calculated from univariable and multivariable logistic regression.
Results:
Of 153 patients, 65 were COVID-19 patients and 45 of these were healthcare-associated cases. Exposure to a COVID-19 patient with respiratory symptoms was associated with healthcare-associated infection irrespective of proximity (aOR, 3.81; 95% CI, 1.6.3–8.87). Nonrespiratory exposure was only significant within 2.5 m (aOR, 5.21; 95% CI, 1.15–23.48). A small increase in risk ratio was observed for exposure to a respiratory patient for >1 day compared to 1 day from 2.04 (95% CI, 0.99–4.22) to 2.36 (95% CI, 1.44–3.88).
Conclusions:
Respiratory exposure anywhere within a 4-bed bay was a risk, whereas nonrespiratory exposure required bed distance ≤2.5 m. Standard infection control measures required beds to be >2 m apart. Our findings suggest that this may be insufficient to stop SARS-CoV-2 transmission. We recommend improving cohorting and further studies into bed distance and transmission factors.
New occurrences of flask-shaped and envelope-bearing microfossils, including the predominantly Cambrian taxon Granomarginata, are reported from new localities, as well as from earlier in time (Ediacaran) than previously known. The stratigraphic range of Granomarginata extends into the Cambrian System, where it had a cosmopolitan distribution. This newly reported Ediacaran record includes areas from Norway (Baltica), Newfoundland (Avalonia) and Namibia (adjacent to the Kalahari Craton), and puts the oldest global occurrence of Granomarginata in the Indreelva Member (< 563 Ma) of the Stáhpogieddi Formation on the Digermulen Peninsula, Arctic Norway. Although Granomarginata is rare within the assemblage, these new occurrences together with previously reported occurrences from India and Poland, suggest a potentially widespread palaeogeographic distribution of Granomarginata through the middle–late Ediacaran interval. A new flask-shaped microfossil Lagoenaforma collaris gen. et sp. nov. is also reported in horizons containing Granomarginata from the Stáhpogieddi Formation in Norway and the Dabis Formation in Namibia, and flask-shaped fossils are also found in the Gibbett Hill Formation in Newfoundland. The Granomarginata–Lagoenaforma association, in addition to a low-diversity organic-walled microfossil assemblage, occurs in the strata postdating the Shuram carbon isotope excursion, and may eventually be of use in terminal Ediacaran biostratigraphy. These older occurrences of Granomarginata add to a growing record of body fossil taxa spanning the Ediacaran–Cambrian boundary.
Background: Visual impairment exists for an estimated 70% of individuals who have experienced a stroke. Identification and remediation of visual impairments can improve overall function and perceived quality of life. Our project aims to improve visual assessment and timely intervention for patients with post-stroke visual impairment (PSVI). Methods: We conducted a quality improvement initiative to create a standardized screening and referral process for patients with PSVI to access an orthoptist. Post-stroke visual impairment was assessed by way of the Visual Screen Assessment (VISA) tool, administered by an occupational therapist. Patients filled out a VFQ-25 questionnaire before and after orthoptic assessment and intervention. The VFQ-25 is a validated post-stroke survey assessing a patient’s perceived quality of life. Differences between pre- and post-orthoptic assessment scores will be evaluated. Results: Data collection currently ongoing.The benefits of a standardized screen for PSVI, standardized referral to, and experience with an orthoptist assessment will be determined. Learnings gained will also inform how we can expand the program to benefit a wider demographic of patients. Conclusions: The data gathered and the subsequent analysis will be instrumental in guiding ongoing improvement initiatives for patients with PSVI.
The mechanics underlying ice–skate friction remain uncertain despite over a century of study. In the 1930s, the theory of self-lubrication from frictional heat supplanted an earlier hypothesis that pressure melting governed skate friction. More recently, researchers have suggested that a layer of abraded wear particles or the presence of quasi-liquid molecular layers on the surface of ice could account for its slipperiness. Here, we assess the dominant hypotheses proposed to govern ice–skate friction and describe experiments conducted in an indoor skating rink aimed to provide observations to test these hypotheses. Our results indicate that the brittle failure of ice under rapid compression plays a strong role. Our observations did not confirm the presence of full-contact water films and are more consistent with the presence of lubricating ice-rich slurries at discontinuous high-pressure zones (HPZs). The presence of ice-rich slurries supporting skates through HPZs merges pressure-melting, abrasion and lubricating films as a unified hypothesis for why skates are so slippery across broad ranges of speeds, temperatures and normal loads. We suggest tribometer experiments to overcome the difficulties of investigating these processes during actual skating trials.
Resonant response of water waves in a narrow gap, with the interaction of multiple highly resonant modes, is an interesting hydrodynamic phenomenon with practical applications. Gap resonances between two identical fixed rectangular boxes are experimentally investigated for unidirectional waves with broadside incidence. We show that gap resonances can be driven through both linear wave excitation and nonlinear processes, i.e. frequency doubling, tripling and quadrupling – apparently new observations. It is striking that the time histories of the gap resonances excited through different nonlinear interactions are remarkably similar to each other. It seems likely that the nonlinear sum-frequency transfer functions for gap resonances depend strongly on the output frequency sum of the interacting linear components, but only weakly on the frequency difference. In terms of their structure in multiple frequency space (at second order the bi-frequency plane for two components), these transfer functions must then have a near-flat form in the direction(s) perpendicular to the leading diagonal. This is supported by our potential flow calculations of the quadratic transfer functions (QTFs). It is therefore convenient to approximate the QTF matrix as ‘flat’ in the direction perpendicular to the leading diagonal. This approximation is justified through experimental data that includes viscous damping. It is too complex, if not impossible, to calculate the full cubic or quartic transfer functions as direct evidence. However, the experimental analysis does provide some support for the near-flat structure being applicable to transfer functions above second order. The flat form approximation greatly reduces lengthy calculations of the high-order transfer functions.
We examined the association between potato consumption in two different age periods during adolescence and risk of obesity and cardiometabolic dysfunction in White and Black girls. We used data from the biracial prospective National Growth and Health Study. Average potato consumption was derived from multiple 3-d food records in two age periods, 9–11 and 9–17 years, and included white and sweet potatoes from all sources. Multivariable logistic regression models were used to estimate OR for becoming overweight, developing prehypertension, elevated TAG levels or impaired fasting glucose (IFG) at 18–20 years of age according to the category of daily potato intake. We also stratified by cooking method (fried/non-fried) and race. ANCOVA was also used to estimate adjusted mean levels of BMI, systolic blood pressure, diastolic blood pressure, log-transformed TAG, the TAG:HDL ratio and fasting glucose levels associated with potato intake category. Higher potato consumption was associated with higher fruit and non-starchy vegetable intakes and higher Healthy Eating Index scores in Black girls. There were no statistically significant associations overall between moderate or higher (v. lower) intakes of potatoes and risks of overweight, prehypertension, elevated fasting TAG, high TAG:HDL ratio or IFG. Also, no adverse associations were found between fried or non-fried potato intake and cardiometabolic outcomes. Potato consumption has been the subject of much controversy in recent years. This study adds evidence that potato consumption among healthy girls during the critical period of adolescence was not associated with cardiometabolic risk.
The objective of the current study was to determine if patients of a large health care system in Detroit who self-identify as food insecure live further away from healthy grocery stores compared with food secure patients. Second, we explored whether food insecurity and distance to healthy grocery stores are related to ecological measures of vehicle availability in the area of residence.
Design:
A secondary data analysis that uses baseline data from a pilot intervention/feasibility study.
Setting:
Detroit, Michigan, USA.
Participants:
Patients of Henry Ford Health System were screened for food insecurity to determine eligibility for a pilot intervention/feasibility study (i.e. Henry’s Groceries for Health), conducted through a collaboration with Gleaners Community Foodbank of Southeastern Michigan. Only patients residing in Detroit city limits (including Highland Park and Hamtramck) were included in the secondary analysis. Of the 1,100 patients included in the analysis, 336 (31 %) were food insecure.
Results:
After accounting for socio-demographic factors associated with food insecurity, we did not find evidence that food insecure patients lived further away from healthier grocery stores, nor was this modified by ecological measures of vehicle access. However, some neighbourhoods were identified as having a significantly higher risk of food insecurity.
Conclusions:
Food insecure patients in Detroit are perhaps limited by social and political determinants and not their immediate neighbourhood geography or physical access to healthy grocery stores. Future research should explore the complexity in linkages between household socio-economic factors, socio-cultural dynamics and the neighbourhood food environment.
To investigate the relative contributions of cerebral cortex and basal ganglia to movement stopping, we tested the optimum combination Stop Signal Reaction Time (ocSSRT) and median visual reaction time (RT) in patients with Alzheimer’s disease (AD) and Parkinson’s disease (PD) and compared values with data from healthy controls.
Methods:
Thirty-five PD patients, 22 AD patients, and 29 healthy controls were recruited to this study. RT and ocSSRT were measured using a hand-held battery-operated electronic box through a stop signal paradigm.
Result:
The mean ocSSRT was found to be 309 ms, 368 ms, and 265 ms in AD, PD, and healthy controls, respectively, and significantly prolonged in PD compared to healthy controls (p = 0.001). The ocSSRT but not RT could separate AD from PD patients (p = 0.022).
Conclusion:
Our data suggest that subcortical networks encompassing dopaminergic pathways in the basal ganglia play a more important role than cortical networks in movement-stopping. Combining ocSSRT with other putative indices or biomarkers of AD (and other dementias) could increase the accuracy of early diagnosis.
We present an overview of the Middle Ages Galaxy Properties with Integral Field Spectroscopy (MAGPI) survey, a Large Program on the European Southern Observatory Very Large Telescope. MAGPI is designed to study the physical drivers of galaxy transformation at a lookback time of 3–4 Gyr, during which the dynamical, morphological, and chemical properties of galaxies are predicted to evolve significantly. The survey uses new medium-deep adaptive optics aided Multi-Unit Spectroscopic Explorer (MUSE) observations of fields selected from the Galaxy and Mass Assembly (GAMA) survey, providing a wealth of publicly available ancillary multi-wavelength data. With these data, MAGPI will map the kinematic and chemical properties of stars and ionised gas for a sample of 60 massive (
${>}7 \times 10^{10} {\mathrm{M}}_\odot$
) central galaxies at
$0.25 < z <0.35$
in a representative range of environments (isolated, groups and clusters). The spatial resolution delivered by MUSE with Ground Layer Adaptive Optics (
$0.6-0.8$
arcsec FWHM) will facilitate a direct comparison with Integral Field Spectroscopy surveys of the nearby Universe, such as SAMI and MaNGA, and at higher redshifts using adaptive optics, for example, SINS. In addition to the primary (central) galaxy sample, MAGPI will deliver resolved and unresolved spectra for as many as 150 satellite galaxies at
$0.25 < z <0.35$
, as well as hundreds of emission-line sources at
$z < 6$
. This paper outlines the science goals, survey design, and observing strategy of MAGPI. We also present a first look at the MAGPI data, and the theoretical framework to which MAGPI data will be compared using the current generation of cosmological hydrodynamical simulations including EAGLE, Magneticum, HORIZON-AGN, and Illustris-TNG. Our results show that cosmological hydrodynamical simulations make discrepant predictions in the spatially resolved properties of galaxies at
$z\approx 0.3$
. MAGPI observations will place new constraints and allow for tangible improvements in galaxy formation theory.
The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in improving surrogates’ mental health and patient outcomes.
Method
Part 1 involved obtaining qualitative stakeholder feedback from 5 bereaved surrogates and 10 critical care and mental health clinicians. Stakeholders were provided with the manual and prompted for feedback on its content, format, and language. Feedback was organized and incorporated into the manual, which was then re-circulated until consensus. In Part 2, surrogates of critically ill patients admitted to an intensive care unit (ICU) reporting moderate anxiety or close attachment were enrolled in an open trial of EMPOWER. Surrogates completed six, 15–20 min modules, totaling 1.5–2 h. Surrogates were administered measures of peritraumatic distress, experiential avoidance, prolonged grief, distress tolerance, anxiety, and depression at pre-intervention, post-intervention, and at 1-month and 3-month follow-up assessments.
Results
Part 1 resulted in changes to the EMPOWER manual, including reducing jargon, improving navigability, making EMPOWER applicable for a range of illness scenarios, rearranging the modules, and adding further instructions and psychoeducation. Part 2 findings suggested that EMPOWER is feasible, with 100% of participants completing all modules. The acceptability of EMPOWER appeared strong, with high ratings of effectiveness and helpfulness (M = 8/10). Results showed immediate post-intervention improvements in anxiety (d = −0.41), peritraumatic distress (d = −0.24), and experiential avoidance (d = −0.23). At the 3-month follow-up assessments, surrogates exhibited improvements in prolonged grief symptoms (d = −0.94), depression (d = −0.23), anxiety (d = −0.29), and experiential avoidance (d = −0.30).
Significance of results
Preliminary data suggest that EMPOWER is feasible, acceptable, and associated with notable improvements in psychological symptoms among surrogates. Future research should examine EMPOWER with a larger sample in a randomized controlled trial.
Motivated by observations of turbulence in the strongly stratified ocean thermocline, we use direct numerical simulations to investigate the interaction of a sinusoidal shear flow and a large-amplitude internal gravity wave. Despite strong nonlinearities in the flow and a lack of scale separation, we find that linear ray-tracing theory is qualitatively useful in describing the early development of the flow as the wave is refracted by the shear. Consistent with the linear theory, the energy of the wave accumulates in regions of negative mean shear where we observe evidence of convective and shear instabilities. Streamwise-aligned convective rolls emerge the fastest, but their contribution to irreversible mixing is dwarfed by shear-driven billow structures that develop later. Although the wave strongly distorts the buoyancy field on which these billows develop, the mixing efficiency of the subsequent turbulence is similar to that arising from Kelvin–Helmholtz instability in a stratified shear layer. We run simulations at Reynolds numbers Re of 5000 and 8000, and vary the initial amplitude of the internal gravity wave. For high values of initial wave amplitude, the results are qualitatively independent of $Re$. Smaller initial wave amplitudes delay the onset of the instabilities, and allow for significant laminar diffusion of the internal wave, leading to reduced turbulent activity. We discuss the complex interaction between the mean flow, internal gravity wave and turbulence, and its implications for internal wave-driven mixing in the ocean.
An adequate intake of PUFA plays a vital role in human health. Therefore, it is important to assess PUFA intakes in different populations and validate them with biomarkers, but only a few small studies are in paediatric populations. We calculated the dietary intake of PUFA and their main food sources in children and assessed associations between PUFA intakes and plasma proportions. Dietary intakes of 7-year-old children (n 8242) enrolled in the Avon Longitudinal Study of Parents and Children were calculated from the parental-completed FFQ. Plasma PUFA were measured in 5571 children 8 months later, and 4380 children had complete dietary and plasma data. The association between dietary and plasma PUFA proportions was estimated using Spearman’s correlation coefficients, quintile cross-classification and Cohen’s κ coefficients. Mean total PUFA intake was 13·2 g/d (sd 4·2), contributing 6·5 % of total energy intake; n-6 PUFA contributed 5·2 % and n-3 PUFA 0·7 %. The n-6:n-3 ratio was 7·9:1. Mean intakes of EPA and DHA were 35·7 mg/d and 49·7 mg/d, respectively. Most n-3 and n-6 PUFA intakes were weakly correlated with their respective plasma lipids (0·07 ≤ r ≤ 0·16, P < 0·001). The correlation between dietary and plasma DHA was stronger though (r = 0·34, P < 0·001), supported by a modest level of agreement between quintiles (k = 0·32). The results indicate that the FFQ was able to reasonably rank the long-chain (LC) PUFA, DHA, in this paediatric population. Public health initiatives need to address the suboptimal ratio of n-6:n-3 PUFA and very low n-3 LC-PUFA intakes in school-age children in the UK.
This report describes the official photographic archives of Idi Amin’s government held by the Uganda Broadcasting Corporation (UBC). During his reign from 1971 to 1979, Idi Amin embraced visual media as a tool for archiving the achievements of populist military rule as his government sought to reorient Ugandans’ relationship with the state. Only a handful of the resulting images were ever printed or seen, reflecting the regime’s archival impulse undergirded by paranoia of unauthorized ways of seeing. The UBC’s newly opened collection of over 60,000 negatives from Amin’s photographers, alongside files at the Uganda National Archives, offers the first comprehensive opportunity to study the Ugandan state under Amin’s dictatorship through the lens of its own documentarians.