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Edited by
David Mabey, London School of Hygiene and Tropical Medicine,Martin W. Weber, World Health Organization,Moffat Nyirenda, London School of Hygiene and Tropical Medicine,Dorothy Yeboah-Manu, Noguchi Memorial Institute for Medical Research, University of Ghana,Jackson Orem, Uganda Cancer Institute, Kampala,Laura Benjamin, University College London,Michael Marks, London School of Hygiene and Tropical Medicine,Nicholas A. Feasey, Liverpool School of Tropical Medicine
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection (Singer et al. 2016). It manifests as a spectrum of disease characterized by a progression from sepsis to septic shock. Though it has been historically characterized as a severe condition resulting from Gram-negative bacteraemia, sepsis may be the final common pathway to death of many life-threatening infections. Causative pathogens include a wide range of bacteria, viruses, fungi and parasites, and epidemic-prone diseases such as meningococcal meningitis, Ebola Virus Disease (EVD) or COVID-19 can sometimes be detected as outbreaks of sepsis.
This article interrogates the ways in which two political books written by elites in the Constitutional Democratic Party of Japan (CDP) take different tacks to represent their party as trustworthy, responsible, and competent against the background of the liberal opposition's political difficulties since 2012. Focusing on two books published in the lead-up to the 2021 general election by former Prime Minister Kan Naoto and then-leader of the CDP Edano Yukio, it argues that the liberal opposition parties in Japan are, on top of the more commonly understood institutional pressures, constrained by demands that the narrative is a conventionally satisfying one when crafting claims about their viability as an alternative to government.
Sub-Sahara Africa (SSA) children are at high-risk neurodevelopmentally due to the prevalence of infectious disease, nutritional deficiencies and compromised caregiving. However, few mental health screening measures are readily available for general use. The Strengths and Difficulties Questionnaire (SDQ) has been used as a mental health screening measure in the SSA, but its psychometric properties are not well understood. Five hundred and sixty-six mothers completed the SDQ for their 6-year-old children in rural Benin north of Cotonou. These were mothers who had been part of a malarial and intestinal parasite treatment program and micronutrient fortification intervention program during pregnancy for these children. Their study children (N = 519) completed the computerized Tests of Variables of Attention (TOVA-visual) as a performance-based screening assessment of attention deficit and hyperactivity disorders. In evaluating the relationship between the SDQ and TOVA, we controlled for maternal risk factors such as depression, poor socioeconomic status and educational level, along with the child’s schooling status. TOVA measures of impulsivity were significantly related to SDQ emotional and hyperactivity/inattention difficulties. TOVA inattention was related to SDQ emotional difficulties. The triangulation of maternal risk factors (e.g., depression), the SDQ and the TOVA can provide effective screening for mental health issues in SSA children.
Magnetic reconnection leads to the formation of island-shaped magnetic structure(s). Due to disagreement between theoretical evaluations of the characteristic reconnection time and observations, it is commonly accepted that the collisionality (or resistivity) is too low to explain magnetic reconnection phenomena in fusion plasmas. Thus, magnetic reconnection still raises many open questions. The work presented here aims to improve the fundamental knowledge about ‘the life of a magnetic island’. Here, in the light of the many works of the last 70 years, a new paradigm for understanding magnetic reconnection in fusion plasmas is proposed. The life of a magnetic island (whatever its scale) follows three phases: the origin, the growth and the saturation. The possible physical mechanisms at play in these three phases will be investigated. First, for the island origin, typical time scales in link with magnetic reconnection will be evaluated for three tokamaks of different sizes (TCV, WEST and JET) to verify if magnetic reconnection is such an unexplained phenomenon in fusion plasmas. Second, for the island drive, the richness of possible mechanisms leading to ‘rapid’ magnetic island growth in fusion devices will be presented for small and large scales. Third comes the island saturation step. Results on the prediction of a large island width at saturation are presented and discussed.
Background: The molecular and epidemiological landscape of C. difficile infection (CDI) has evolved markedly in the last decade; however, limited information is available contrasting differences between adult and pediatric populations. We describe a multicenter study evaluating healthcare-associated (HA) and community-associated (CA) adult and pediatric-CDI identified in the Canadian Nosocomial Infection Surveillance Program (CNISP) network from 2015 to 2022. Methods: Hospitalized patients with CDI were identified from up to 84 hospitals between 2015–2022 using standardized case definitions. Cases were confirmed by PCR, cultured, and further characterized using ribotyping and E-test. We used two-tailed tests for significance (p≤0.05). Results: Of 30,817 cases reported, 29,245 were adult cases [HA-CDI (73.2%), CA-CDI (26.8%)] and 1,572 were pediatric cases [HA-CDI (77.7%), CA-CDI (22.3%)]. From 2015 to 2022, HA-CDI rates decreased 19.7% (p=0.007) and 29.4% (p=0.004) in adult and pediatric populations, respectively (Figure 1). CA-CDI rates remained relatively stable in the adult population (p=0.797), while decreasing 60.7% in the pediatric population (p=0.013). Median ages of adult and pediatric patients were 70 (interquartile range (IQR), 58–80) and seven (IQR, 3–13) years, respectively. Thirty-day all-cause mortality was significantly higher among adult vs. Pediatric CDI patients (11.0% vs 1.4%, p < 0.0001). No significant differences in other severe outcomes were found. Ribotyping and susceptibility data were available for 4,620 samples: 3,558 adult (77.0%) and 1,062 pediatric (23.0%). The predominant adult and pediatric ribotypes (RT) were 106 (12.2/16.2%), 027 (11.4/3.2%), and 014 (8.8/8.2%). Overall, RT027 prevalence significantly decreased from 17.9% in 2015 to 3.2% in 2022 (p=0.003), while RT106 increased from 8.5% to 14.4%. Resistance rates among adult and pediatric isolates were similar for all antimicrobials tested except moxifloxacin (16.2% vs. 6.2%, p < 0.0001, respectively). Adult moxifloxacin resistance decreased from 30% to 6.3% from 2015 to 2022 (p=0.006). Adults with moxifloxacin-resistant CDI were older (median: 74 vs. 69 years, p < 0.001) and had higher thirty-day all-cause mortality (13% vs. 9.8%, p=0.041) and recurrence (10% vs. 5.7%, p < 0.001) compared to those with moxifloxacin non-resistant CDI, while these trends were not observed in pediatric patients. Among RT027 strains, moxifloxacin resistance decreased from 91.0% in 2015 to 7.1% in 2022. There was one metronidazole-resistant pediatric sample in 2018 and no resistance to vancomycin or tigecycline in either population. Conclusion: We have found differences in the epidemiological and molecular characteristics of adult and pediatric CDI, with higher thirty-day all-cause mortality among adults. Overall, RT106 has replaced RT027 as the predominant ribotype with a concomitant decrease in fluoroquinolone resistance.
The numerous testaments on papyrus provide a valuable basis for an investigation of legal language around διαθήκη in the Pauline letters. Of particular importance is the ancient practice of revoking wills, which I consider to be the legal frame of reference for the recipients of the Pauline letters to grasp expressions like καινὴ/παλαιὰ διαθήκη. In the Corinthian correspondence the conformity to the current legal practice is evident, but in Galatians Paul turns the whole procedure upside down, manipulating in the construction of his argument not only the practice of testamentary cancellation, but also the traditional connection of Abraham with circumcision. We are compelled to a text-internal solution of the problem in Gal 3.15–17 by the fact that the papyrological evidence shows clearly that no other type of document than the ordinary revocable διαθήκαι can be taken into consideration. This approach is not compilatory, as it is often the case when dealing with documentary papyri applied to New Testament texts, but heuristic, with the purpose of elaborating new exegetical insights in old controversies.
Over the last decade, substantial progress has been made in understanding the topology of quasi-two-dimensional (2-D) non-equilibrium fluid flows driven by ATP-powered microtubules and microorganisms. By contrast, the topology of three-dimensional (3-D) active fluid flows still poses interesting open questions. Here, we study the topology of a spherically confined active flow using 3-D direct numerical simulations of generalized Navier–Stokes (GNS) equations at the scale of typical microfluidic experiments. Consistent with earlier results for unbounded periodic domains, our simulations confirm the formation of Beltrami-like bulk flows with spontaneously broken chiral symmetry in this model. Furthermore, by leveraging fast methods to compute linking numbers, we explicitly connect this chiral symmetry breaking to the entanglement statistics of vortex lines. We observe that the mean of linking number distribution converges to the global helicity, consistent with the asymptotic result by Arnold [In Vladimir I. Arnold – Collected Works (ed. A.B. Givental, B.A. Khesin, A.N. Varchenko, V.A. Vassiliev & O.Y. Viro), pp. 357–375. Springer]. Additionally, we characterize the rate of convergence of this measure with respect to the number and length of observed vortex lines, and examine higher moments of the distribution. We find that the full distribution is well described by a k-Gamma distribution, in agreement with an entropic argument. Beyond active suspensions, the tools for the topological characterization of 3-D vector fields developed here are applicable to any solenoidal field whose curl is tangent to or cancels at the boundaries of a simply connected domain.
X-ray photoelectron spectroscopy (XPS) has been used to characterize the bonding state of Cu2+, Si4+, Al3+, and O2− ions in structural (octahedral and interlamellar) or adsorbed position in phyllosilicates. Five smectites, 5 kaolinites, and 1 chrysocolla with Cu(II) in known positions (octahedral, interlamellar, or surface adsorbed) have been investigated. Their spectra were compared with those of pure Cu metal and of pure Cu(I) and Cu(II) oxides.
The line for Cu 2p3/2 (binding energy of 935.4 eV) and well-defined shake-up lines (binding energy of about 943 eV) observed after 1 hr of X-ray irradiation are characteristic of Cu(II) in phyllosilicate octahedral sites. But due to the photoreduction effect, they show Cu(I) oxidation states (Cu 2p3/2, binding energy of 933.2 eV and near absence of shake-up lines) for the phyllosilicates with adsorbed Cu or in interlamellar positions. The kinetics of photoreduction distinguishes octahedral from interlamellar positions, and the latter from a surface adsorbed position. The enlargement of the FWHM (full width at half maximum) of XPS lines has been used to describe crystallochemical parameters linked to local ordering around the probe cations. Crystallization produces decreasing O 1 s and Cu 2p (octahedral cation) line widths but has no effect on the Si 2p (tetrahedral cation) line width. The enlargement of FWHM for all ion lines of the lattice is linked to the nature (Cu > Mg > Al) and the number and amount of structural cations in the phyllosilicates.
Two clay minerals, a dioctahedral, Na-montmorillonite from Wyoming and a trioctahedral, synthetic Na-laponite, were exchanged by cupric (Cu(II)) ions and subsequently heated at 100 °C intervals up to 500 °C. The resulting materials were analyzed by chemical analysis, X-ray diffraction (XRD), cation exchange capacity (CEC) measurements, combined thermogravimetric and differential thermal analysis (TGA-DTA), infrared (IR) spectroscopy, electron paramagnetic resonance (EPR) and X-ray photoelectron spectroscopy (XPS). Montmorillonite exhibits a well-known Hoffmann-Klemen effect in that, when heated, cupric (Cu) ions migrate into the lacunae of the octahedral sheet, where they compensate the negative charge deficit of the clay layer. In the case of laponite, CEC measurements and spectroscopic measurements reveal that Cu ions migrate into the octahedral sheet where they replace Li and Mg ions. After heating at 200 °C, approximately half the interlayer Cu ions are exchanged. The exchange appears to be 1 Cu for 1 Li, resulting in a slight decrease of the negative charge of the layer. After heating at 300 °C, the remaining Cu ions are exchanged by either 1 Mg or 2 Li, which does not result in any further charge reduction. At 400 °C, some of the extracted Mg remigrates into the structure and exchanges some Li (1 Mg for 2 Li). The final product at 400 or 500 °C is then a Li-laponite with Cu(II) in the octahedral sheet.
Children who receive cochlear implants develop spoken language on a protracted timescale. The home environment facilitates speech-language development, yet it is relatively unknown how the environment differs between children with cochlear implants and typical hearing. We matched eighteen preschoolers with implants (31-65 months) to two groups of children with typical hearing: by chronological age and hearing age. Each child completed a long-form, naturalistic audio recording of their home environment (appx. 16 hours/child; >730 hours of observation) to measure adult speech input, child vocal productivity, and caregiver-child interaction. Results showed that children with cochlear implants and typical hearing were exposed to and engaged in similar amounts of spoken language with caregivers. However, the home environment did not reflect developmental stages as closely for children with implants, or predict their speech outcomes as strongly. Home-based speech-language interventions should focus on the unique input-outcome relationships for this group of children with hearing loss.
Dental and mucosal injuries from laryngoscopy in the peri-operative period are common medico-legal complaints. This study investigated lawsuits arising from laryngoscopy.
Methods
Westlaw, a legal database containing trial records from across the USA, was retrospectively reviewed. Plaintiff and/or defendant characteristics, claimed injuries, legal outcomes and awards were extracted.
Results
Of all laryngoscopy-related dental or mucosal injuries brought before a state or federal court, none (0 per cent) resulted in a defence verdict against the provider or monetary gain for the patient. Rulings in the patient's favour were observed only when laryngoscopy was found to be the proximate cause of multiple compounding complications that culminated in severe medical outcomes such as exsanguination, septic shock or cardiopulmonary arrest.
Conclusion
Proper laryngoscopy technique and a robust informed-consent process that accurately sets patients' expectations reduces litigation risk. Future litigation pursuits should consider the low likelihood of malpractice allegation success at trial.
The current study aimed to investigate the cardiovascular effects of epicatechin, a flavonoid found in green tea and cocoa, in attenuating complications associated with metabolic syndrome in diet-induced obese rats. Male Wistar-Kyoto (WKY) rats aged 16 weeks were fed either standard rat chow or given a high-fat-high-carbohydrate (HFHC) diet for 20 weeks. Epicatechin treatment (5 mg/kg/d) was administered to a subset of WKY rats commencing at week 8 of the 20 week HFHC feeding period. Body weights, food, water and energy intakes, blood pressure, heart rate and glucose tolerance were measured throughout the treatment period. Oxidative stress and inflammatory markers, lipid levels, cardiac collagen deposition, cardiac electrical function, aortic and mesenteric vessel reactivity were examined after the treatment. Twenty weeks of HFHC feeding in WKY rats resulted in the development of metabolic syndrome indicated by the presence of abdominal obesity, dyslipidaemia, glucose intolerance and increased blood pressure. Epicatechin treatment was found to enhance the oxidative stress status in HFHC groups through an increase in serum nitric oxide levels and a decrease in 8-isoprostane concentrations. Furthermore, WKY-HFHC rats displayed a decrease in IL-6 levels. The lipid profiles in HFHC groups showed improvement, with a decrease in LDL-cholesterol and TAG and an increase in HDL-cholesterol levels observed in WKY-HFHC rats. However, epicatechin was not effective in preventing weight gain, glucose intolerance or hypertension in HFHC fed rats. Overall, the results of this study suggest that epicatechin has the potential to improve the underlying mechanisms associated with metabolic syndrome in obese rats.
This is the first comprehensive publication of the Knaresborough 1864 hoard of copper-alloy vessels and tools. A consideration of the circumstances of the hoard’s discovery, along with a biographical account of Thomas Gott (the man who deposited the hoard in the Yorkshire Museum), for the first time enables a case to be made for a findspot. A consideration of the vessels and other objects establishes the hoard as one of the most unusual assemblages of its kind from late Roman Britain. pXRF analysis of the vessels sheds light on their composition. Finally, a discussion of the hoard places it within the international context of late Roman deposition practices.
The vulnerability-stress-inflammation model is a well-known psychopathological model in patients with psychosis. It implies an imbalance of the microglia activation (M1/M2 pathways’ homeostasis) leading to an over-expression of pro-inflammatory cytokines. However, despite a higher prevalence of cannabis (THC) consumption in patients with psychosis, few studies have investigated the impact of this use on inflammatory markers.
Objectives
The objective of this study was to investigate the impact of cannabis use and its withdrawal on inflammatory markers in patients with psychosis and to explore the link between these inflammatory markers and clinical symptoms.
Methods
A retrospective study was performed including 102 patients with psychosis. White blood cell, hsCRP and fibrinogen levels were measured at baseline and after 4 weeks of cannabis cessation. Urinary THC was also measured at baseline and after 4 weeks of cannabis cessation. Comparisons, adjusted on age, gender, body mass index, smoking status and diagnosis, were performed between cannabis users (THC+) and cannabis nonusers (THC-). To assess the association between inflammatory markers and sociodemographic or PANSS scores, Spearman or Pearson correlations were computed.
Results
After cannabis cessation, a greater increase of leucocyte levels (p < 0.01), monocyte levels (p = 0.05) and a statistical trend to a higher increase of lymphocyte levels (p = 0.06) were found in the consumer group compared to the nonuser group. After 4 weeks of cannabis cessation, higher leucocyte (p = 0.03), lymphocyte (p = 0.04) and monocyte (p < 0.01) counts were found in the THC+ group whereas at baseline no difference was found. A positive correlation was found between monocyte count at 4 weeks and baseline PANSS negative subscore (p = 0.045) and between the variation of monocyte count between baseline and 4 weeks and the PANSS total score at 4 weeks (p = 0.05).
Conclusions
This study shows that cannabis cessation is associated with an increased inflammation depicted by an elevation of white blood cell, lymphocyte, and monocyte levels, which correlates with symptomatology of patients with psychosis. Studying the link between cannabis and inflammation could lead to a better understanding of the pathophysiology of psychosis.
Disclosure of Interest
B. Romeo: None Declared, V. Lestra: None Declared, C. Martelli: None Declared, A. Amirouche: None Declared, A. Benyamina Consultant of: Lundbeck, Mylan, Merck-Serono and Bristol-Myers Squibb , Speakers bureau of: member of board Indivior, N. Hamdani: None Declared
Intensive support teams (ISTs) are recommended for individuals with intellectual disabilities who display behaviours that challenge. However, there is currently little evidence about the clinical and cost-effectiveness of IST models operating in England.
Aims
To investigate the clinical and cost-effectiveness of IST models.
Method
We carried out a cohort study to evaluate the clinical and cost-effectiveness of two previously identified IST models (independent and enhanced) in England. Adult participants (n = 226) from 21 ISTs (ten independent and 11 enhanced) were enrolled. The primary outcome was change in challenging behaviour between baseline and 9 months as measured by the Aberrant Behaviour Checklist-Community version 2.
Results
We found no statistically significant differences between models for the primary outcome (adjusted β = 4.27; 95% CI −6.34 to 14.87; P = 0.430) or any secondary outcomes. Quality-adjusted life-years (0.0158; 95% CI: −0.0088 to 0.0508) and costs (£3409.95; 95% CI −£9957.92 to £4039.89) of the two models were comparable.
Conclusions
The study provides evidence that both models were associated with clinical improvement for similar costs at follow-up. We recommend that the choice of service model should rest with local services. Further research should investigate the critical components of IST care to inform the development of fidelity criteria, and policy makers should consider whether roll out of such teams should be mandated.
A dysbalance of the immune system in psychotic disorders has been well investigated. However, despite a higher prevalence of cannabis (THC) consumption in patients with psychosis, few studies have investigated the impact of this use on inflammatory markers.
Methods:
One hundred and two inpatients were included in this retrospective study. Leukocytic formula, hsCRP, fibrinogen levels and urinary THC were measured, and comparisons were performed at baseline and after 4 weeks of cannabis cessation between cannabis users (THC+) and non-users (THC−).
Results:
After cannabis cessation, we found a greater increase in leucocyte level (p < 0.01), monocyte level (p = 0.05) and a statistical trend to a highest increase of lymphocyte level (p = 0.06) between baseline and 4 weeks in the THC+ group as compared to the THC− group. At 4 weeks, highest leucocyte (p = 0.03), lymphocyte (p = 0.04) and monocyte (p < 0.01) counts were found in the THC+ group, whereas at baseline no difference was found. A positive correlation was found between monocyte count at 4 weeks and baseline Positive and Negative Syndrome Scale (PANSS) negative subscore (p = 0.045) and between the variation of monocyte count between baseline and 4 weeks and the PANSS total score at 4 weeks (p = 0.05).
Conclusion:
THC cessation is associated with an increase in inflammatory markers, including white blood cell, lymphocyte and monocyte levels, which correlates with symptomatology of patients with psychosis.
Edited by
Aris Ananta, Universitas Indonesia and Universiti Brunei Darussalam,Chang-Yau Hoon, Universiti Brunei Darussalam and University of Western Australia, Perth,Mahani Hamdan, Universiti Brunei Darussalam
Being situated in the northwest coast of the island of Borneo with flat coastal plains and having an equatorial climate, Brunei is vulnerable to extreme weather events and rising sea levels. Since the 1970s, Brunei’s annual mean temperature has been observed to increase by 0.25°C per decade; annual rainfall intensity has increased by 100 mm per decade, and; around 40 per cent of wildlife biodiversity were lost due to forest degradation (BCCS 2020). Coral bleaching was also observed in some shoals near Brunei-Muara district, and climate changes were expected to lengthen the transmission seasons of vector-borne diseases such as dengue, malaria and Zika (BCCS 2020).
In response to climate change threats, Brunei commits to international treaties and cooperation arrangements that address global climate change issues. The country acceded to the United Nations Framework Convention on Climate Change (UNFCCC) in 2007 and to the Kyoto Protocol in 2009. The country ratified the Doha Amendment to the Kyoto Protocol in 2014 and the Paris Agreement in 2016.
Brunei’s climate change policy, launched in July 2020, would be the basis for developing a response framework for the requirement imposed on Parties of the Paris Agreement. This international agreement aims to strengthen global response to climate change threat and limit the global temperature rise to below 2°C above pre-industrial levels. Signatories to the Paris Agreement are required to submit a “nationally determined contribution” which specifies each country’s efforts to reduce greenhouse gas emissions and adapt to impacts of climate change (UNFCCC 2015). A global stocktake will be undertaken every five years to monitor the progress in achieving the collective target.
Addressing climate change in Brunei requires a prudent approach to balance the interaction between key economic and environmental parameters. The country faces various economic and technical challenges in achieving a balanced mix of measures that satisfies various developmental concerns. While the new climate change policy appears to be skilfully designed to address the above concerns, its implementation, however, faces various challenges. In addition, the policy document states that the government pursues a whole-of-nation approach to policy governance, but the document does not present how the whole-of-nation approach was carried out to achieve these policy outcomes.
The chapter intends to contribute to studies on material constitutionalism by applying Costantino Mortati’s concept of material constitution to discuss theories of constitutional change. In particular, it focusses on ‘constitutional maintenance’ doctrines elaborated in continental Europe to explain cases of limited and/or substantively guided constitutional changes, generally eluding the formal amending procedures. It argues that while constitutional maintenance doctrines catch one of the functions of the theory of the material constitution, namely, to guide constitutional changes, they fall into a logical contradiction by: (a) observing constitutional changes on the basis of mismatches between constitutional practice and the master-text constitution; and (b) supporting the need to minimise those mismatches. The argument is preceded by an analysis of doctrinal debates on constitutional change in selected jurisdictions. It is then developed by unpacking the material constitution theory in two logical steps. In particular, it will focus on the problem of the identification of the constitution and on the related need to reduce the substantive distance between the formal and the material constitution. Eventually, the chapter offers conclusions on how material constitutionalism can contribute to studies on constitutional change.