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To investigate the symptoms of SARS-CoV-2 infection, their dynamics and their discriminatory power for the disease using longitudinally, prospectively collected information reported at the time of their occurrence. We have analysed data from a large phase 3 clinical UK COVID-19 vaccine trial. The alpha variant was the predominant strain. Participants were assessed for SARS-CoV-2 infection via nasal/throat PCR at recruitment, vaccination appointments, and when symptomatic. Statistical techniques were implemented to infer estimates representative of the UK population, accounting for multiple symptomatic episodes associated with one individual. An optimal diagnostic model for SARS-CoV-2 infection was derived. The 4-month prevalence of SARS-CoV-2 was 2.1%; increasing to 19.4% (16.0%–22.7%) in participants reporting loss of appetite and 31.9% (27.1%–36.8%) in those with anosmia/ageusia. The model identified anosmia and/or ageusia, fever, congestion, and cough to be significantly associated with SARS-CoV-2 infection. Symptoms’ dynamics were vastly different in the two groups; after a slow start peaking later and lasting longer in PCR+ participants, whilst exhibiting a consistent decline in PCR- participants, with, on average, fewer than 3 days of symptoms reported. Anosmia/ageusia peaked late in confirmed SARS-CoV-2 infection (day 12), indicating a low discrimination power for early disease diagnosis.
Little is known about Se intakes and status in very young New Zealand children. However, Se intakes below recommendations and lower Se status compared with international studies have been reported in New Zealand (particularly South Island) adults. The Baby-Led Introduction to SolidS (BLISS) randomised controlled trial compared a modified version of baby-led weaning (infants feed themselves rather than being spoon-fed), with traditional spoon-feeding (Control). Weighed 3-d diet records were collected and plasma Se concentration measured using inductively coupled plasma mass spectrometry (ICP-MS). In total, 101 (BLISS n 50, Control n 51) 12-month-old toddlers provided complete data. The OR of Se intakes below the estimated average requirement (EAR) was no different between BLISS and Control (OR: 0·89; 95 % CI 0·39, 2·03), and there was no difference in mean plasma Se concentration between groups (0·04 μmol/l; 95 % CI −0·03, 0·11). In an adjusted model, consuming breast milk was associated with lower plasma Se concentrations (–0·12 μmol/l; 95 % CI −0·19, −0·04). Of the food groups other than infant milk (breast milk or infant formula), ‘breads and cereals’ contributed the most to Se intakes (12 % of intake). In conclusion, Se intakes and plasma Se concentrations of 12-month-old New Zealand toddlers were no different between those who had followed a baby-led approach to complementary feeding and those who followed traditional spoon-feeding. However, more than half of toddlers had Se intakes below the EAR.
Clinicians report training deficits in advance care planning (ACP), including limits to their understanding of cultural/spiritual influences on patient decision-making and skills in interdisciplinary teamwork. This study describes Advance Directives-Live Action Simulation Training (AD-LAST), an interdisciplinary experiential and didactic training program for discussing ACP and end-of-life (EOL) care. AD-LAST highlights cultural/spiritual variations in medical decision-making.
Methods
Prospective educational cohort study with pre-post intervention survey. AD-LAST incorporated standard curricular tools for didactic and experiential training in ACP/EOL communication. Study conducted in an urban community teaching hospital in Queens, NY, one of the most diverse counties in the USA. Participants included physicians, house staff, nurses, therapists, and other disciplines. AD-LAST format was a one-day workshop. The morning focused on didactic teaching using widely available curricular tools. The afternoon involved experiential practice with standardized patient-actors. Pre-post intervention questionnaires assessed ACP operational knowledge and self-efficacy (i.e., self-confidence in skills) in ACP and EOL communication. Repeated measure ANOVAs evaluated changes from pretest to posttest in knowledge and self-efficacy.
Results
A total of 163 clinical staff participated in 21 AD-LAST training sessions between August 2015 and January 2019. Participants displayed a significant increase from pretest to posttest in total knowledge (p < 0.001), ACP procedural knowledge (p < 0.001), ACP communication/relationships knowledge (p < 0.001), and self-efficacy (p < 0.001). Knowledge and self-efficacy were not correlated and represented independent outcomes. Postprogram evaluations showed greater than 96% of participants were highly satisfied with AD-LAST, especially the opportunity to practice skills in real-time and receive feedback from members of other professional groups.
Significance of results
AD-LAST, a multifaceted training program deployed in an interdisciplinary setting, is effective for increasing ACP knowledge and self-efficacy, including the capacity to address cultural/spiritual concerns. The use of standard tools facilitates dissemination. The use of case simulations reinforces learning.
The present volume brings scholarly perspectives from a variety of disciplines to bear on a specific medieval object: a beautifully produced parchment manuscript, now in Bern, Switzerland, containing over 500 songs. The first stanza of each song is carefully copied beneath staves for their melodies, but the planned musical notation was never entered. Despite the intriguing poignancy of the empty staves for musicologists, their muteness has led to the relative neglect of Bern, Burgerbibliothek, Cod. 389, known to scholars of trouvère song by Schwan's siglum C. After all, what can a musicologist say about a song when only the text survives?The lack of notation is the first of several factors that has led to the relative scholarly neglect of C, including its provenance on the easternmost border of the Francophone region, its choice not to organise by author corpora, its comparatively high numbers of unica, and the absence of illuminations.
C has thus been perceived as distant from a ‘central’ trouvère tradition embodied by the surviving authorially organised and richly illuminated manuscripts that hail largely from the Artois and Champagne; the supposedly problematic aspects of C have combined in various ways to cause C's neglect not just in musicology, but also in other academic disciplines that study trouvère song. Although literary scholars have considered C more deeply than their musicological colleagues, they have typically done so in conjunction with the creation of editions of the texts of specific authors or edited collections of predominantly anonymous secondary genres, like the pastourelle. C's eastern provenance has meant that the variants that it presents for those songs with concordances in other, more ‘central’ sources have been noted in the apparatus of critical editions, but largely relegated to a secondary status: indeed, some of the authorial songs in C have themselves been treated as of secondary authenticity within their respective author corpora. The high number of unica in C – over 20% of its contents – have all now been edited, but not yet thoroughly integrated into literary scholarship; that so many of C's songs are not also found in other sources has reinforced the impression of C as a peripheral source.
Trouvère songbooks are designated in bold type by their sigla as given in Raynaud/Spanke. Troubadour songbooks have sigla, in bold type, according to Pillet/Carstens and are preceded by the prefix ‘troub’, for example, troubD. Motet sources are represented by the sigla in Ludwig's Repertorium and, where it is necessary to distinguish a motet source from a trouvère source, are preceded by the prefix ‘motet’, for example, motetF. A full list of sigla is provided in the list of abbreviations. Where a manuscript has both a trouvère and a troubadour siglum, only the trouvère siglum is used (with the exception of Chapter 6, where the Occitan content is discussed specifically). trouvère songs are identified by an RS number according to Raynaud/Spanke; troubadour songs are similarly identified by a PC number according to Pillet/Carstens, and conducti by the identifier given in Anderson's collected edition. Songs are referred to in italics with the spelling given in Raynaud/Spanke. Quotations from manuscripts (including the incipit of a song in the orthography in which it appears in a specific chansonnier) are given in single quotation marks and Roman type. Where a song has two numbers in Raynaud/Spanke, only the corrected number is given. Where it is necessary to indicate the state of copying of a song's music notation, designates that music notation has been entered, ≡ designates empty staves, and ⬜ designates space left in the manuscript for staves which were never entered. When lines of poetry are quoted within the text, a forward slash (/) is used to separate poetic lines.