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This study explored the social policy context for international students in the UK and its implications for social exclusion (an inability to fully participate in society). Within a rapid review policy literature addressing international student experience, forty-two articles from the Web of Science and Social Science Research Network (SSRN) were selected through multiple screenings. Migration and education were the most explored policy areas, followed by inequalities, work, health and wellbeing, security, and housing. Results demonstrated that policy both creates barriers to inclusion (e.g. hostile environment migration/bordering practices) and supports inclusion/adaption to social exclusion-related challenges (e.g. sanctuary scholarships for forced migrants, Graduate visas). All international students to some degree lack equitable participation in wellbeing-relevant provision. Overall, policies are constructed so the state and universities can extract value from internationals without fully including them in British society. Policies abdicate responsibility for students’ inclusion, making it expensive and complicated to build a life there.
All his life, Hopkins was either student or teacher of the Classics. School, university, teaching posts, and finally a professorship in Dublin meant that he was engaged professionally with Latin and Greek almost without intermission. There are subjects, topics, or words in his writings which obviously derive directly from those studies, and there are approaches which were plainly learned from his experience. Specific examples of influence are betrayed by words and ideas, but the influence is perhaps more general; in word order, for example, or in the idea of poetry as speech, which connects with his discovery and use of Sprung Rhythm. His understanding of rhythm is the most important thing which his classical studies nurtured. In his university training and in his own teaching rhythm was a central concern. The Classics gave him models to follow, but they also freed him from some conventions of English poetry, which allowed him to write in an original style.
Background: Shared decision-making (SDM) is a dynamic, patient-engaged approach to collaborative medical care. Limited SDM tools exist in pregnancy. We aimed to examine the need and usability of a novel SDM tool for pharmaco-therapeutic treatment of neurological conditions in pregnancy. Methods: This is an exploratory mixed-methods study. Non-pregnant women of any age were recruited using convenience, purposive sampling from an academic neurology clinic in Toronto. Participants reported the user friendliness of the SDM by completing the systems usability (SUS) questionnaire and participated in a focus group to further elaborate on their experience. Results: Eleven participants completed the survey 45% each between age 31-40, and 51-60. Median time spent on the tool was 17.2 minutes, and median SUS score 70 (<68 being not usable). Thematic data analysis from 2 focus groups, identified technical and content improvements: use of inclusive language, simplified design, and importance of patient engagement in SDM. Conclusions: Based on our preliminary results, a SDM web-tool for medication-related concerns of pregnant patients with neurological conditions is needed and usable. With integration of patients’ lived experiences, this novel tool may serve as an anchor point for future work in this field.
We investigated the impact of workflow times on the outcomes of patients treated with endovascular thrombectomy (EVT) in the late time window.
Methods:
Individual patients’ data who underwent EVT in the late time window (onset to imaging >6 hours) were pooled from seven registries and randomized clinical trials. Multiple time intervals were analyzed. Mixed-effects logistic regression was used to estimate the likelihood of functional independence at 90 days (modified Rankin Scale 0–2). Mixed-effects negative binomial regression was used to evaluate the relationship between patient characteristics and workflow time intervals.
Results:
608 patients were included. The median age was 70 years (IQR: 58–71), 307 (50.5%) were female, and 310 (53.2%) had wake-up strokes. Successful reperfusion was achieved in 493 (81.2%) patients, and 262 (44.9%) achieved 90-day mRS 0–2. The estimated odds of functional independence decreased by 13% for every 30 minute delay from emergency department (ED) arrival to imaging time and by 7% from ED arrival to the end of EVT in the entire cohort. Also, the estimated odds of functional independence decreased by 33% for every 30 minute delay in the interval from arterial puncture to end of EVT, 16% in the interval from arrival in ED to end of EVT and 6% in the interval from stroke onset to end of EVT among patients who had a wake-up stroke.
Conclusion:
Faster workflow from ED arrival to end of EVT is associated with improved functional independence among stroke patients treated in the late window.
A newly discovered Spanish description of Kongo increases our knowledge of the country, joining Filippo Pigafetta’s famous account to expand our knowledge of Kongo in this early period. This research shows that the MS was written in 1587 or 1588 and was written by Carmelite Diego de la Encarnación. It adds details on the history of the country, daily life culture, and links to other Carmelite works, including an unpublished chapter of an account by Diego de Santissimo Santo and shows the author could have written a longer but well-known account in the Vatican Library. It includes extensive quotations from the new text.
Public and patient expectations of treatment influence health behaviours and decision-making.
Aims
We aimed to understand how the media has portrayed the therapeutic use of ketamine in psychiatry.
Method
We systematically searched electronic databases for print and online news articles about ketamine for psychiatric disorders. The top ten UK, USA, Canadian and Australian newspapers by circulation and any trade and consumer magazines indexed in the databases were searched from 2015 to 2020. Article content was quantitatively coded with a framework encompassing treatment indication, descriptions of prior use, references to research, benefits and harms, treatment access and process, patient and professional testimony, tone and factual basis.
Results
We found 119 articles, peaking in March 2019 when the United States Food and Drug Administration approved esketamine. Ketamine treatment was portrayed in an extremely positive light (n = 82, 68.9%), with significant contributions of positive testimony from key opinion leaders (e.g. clinicians). Positive research results and ketamine's rapid antidepressant effect (n = 87, 73.1%) were frequently emphasised, with little reference to longer-term safety and efficacy. Side-effects were frequently reported (n = 96, 80.7%), predominantly ketamine's acute psychotomimetic effects and the potential for addiction and misuse, and rarely cardiovascular and bladder effects. Not infrequently, key opinion leaders were quoted as being overly optimistic compared with the existing evidence base.
Conclusions
Information pertinent to patient help-seeking and treatment expectations is being communicated through the media and supported by key opinion leaders, although some quotes go well beyond the evidence base. Clinicians should be aware of this and may need to address their patients’ beliefs directly.
Understanding the quality of seed dispersal effectiveness of frugivorous species can elucidate how endozoochory structures tropical forests. Large seeds, containing more resources for growth, and gut passage by frugivores, which remove seed pulp, both typically enhance the speed and probability of germination of tropical seeds. However, the interaction of seed size and gut passage has not been well studied. We assessed the role of two species of toucans (Ramphastos spp.) in seed germination of the tropical tree Eugenia uniflora, which produces seeds that vary considerably in size (3.7–14.3 mm), using 151 control and 137 regurgitated seeds in germination trials. We found that toucan regurgitation did not increase germination success, although 93.4% germinated compared to 76.8% of control seeds; however, larger seeds germinated more often at faster rates. Although only marginally significant, germination rates were 3.6× faster when seeds were both large and regurgitated by toucans, demonstrating that toucan regurgitation can disproportionally benefit larger E. uniflora seeds. As tropical forests are increasingly disturbed and fragmented by human activities, the ability of toucans to continue providing seed dispersal services to degraded habitats may be vital to the persistence of many tropical plants that contain larger seeds and depend on larger dispersers.
Research conducted into the demography of the Kingdom of Kongo some forty years ago, employing baptismal statistics left by missionaries, has been in need of revision thanks to challenges by more recent scholarship. This article revises the estimated population of Kongo by addressing these challenges, drawing on newly discovered documentary sources. Using this new evidence, the estimate for the kingdom's population in the mid-seventeenth century has been elevated from 509,000 to around 790,000. The original article's claims about levels of fertility and mortality have been retained. The article also addresses questions concerning the validity of missionary statistics and the impact of the slave trade, which was small before 1700 but then increasingly large thereafter, reaching very high levels by the early nineteenth century. While a quantitative estimate of the later population is not possible given the limitations of sources for this period, it is likely that the population of the kingdom fell as slave exports peaked.
HIV-associated neurocognitive disorders (HANDs) are prevalent in older people living with HIV (PLWH) worldwide. HAND prevalence and incidence studies of the newly emergent population of combination antiretroviral therapy (cART)-treated older PLWH in sub-Saharan Africa are currently lacking. We aimed to estimate HAND prevalence and incidence using robust measures in stable, cART-treated older adults under long-term follow-up in Tanzania and report cognitive comorbidities.
Design:
Longitudinal study
Participants:
A systematic sample of consenting HIV-positive adults aged ≥50 years attending routine clinical care at an HIV Care and Treatment Centre during March–May 2016 and followed up March–May 2017.
Measurements:
HAND by consensus panel Frascati criteria based on detailed locally normed low-literacy neuropsychological battery, structured neuropsychiatric clinical assessment, and collateral history. Demographic and etiological factors by self-report and clinical records.
Results:
In this cohort (n = 253, 72.3% female, median age 57), HAND prevalence was 47.0% (95% CI 40.9–53.2, n = 119) despite well-managed HIV disease (Mn CD4 516 (98-1719), 95.5% on cART). Of these, 64 (25.3%) were asymptomatic neurocognitive impairment, 46 (18.2%) mild neurocognitive disorder, and 9 (3.6%) HIV-associated dementia. One-year incidence was high (37.2%, 95% CI 25.9 to 51.8), but some reversibility (17.6%, 95% CI 10.0–28.6 n = 16) was observed.
Conclusions:
HAND appear highly prevalent in older PLWH in this setting, where demographic profile differs markedly to high-income cohorts, and comorbidities are frequent. Incidence and reversibility also appear high. Future studies should focus on etiologies and potentially reversible factors in this setting.
During the Randomized Assessment of Rapid Endovascular Treatment (EVT) of Ischemic Stroke (ESCAPE) trial, patient-level micro-costing data were collected. We report a cost-effectiveness analysis of EVT, using ESCAPE trial data and Markov simulation, from a universal, single-payer system using a societal perspective over a patient’s lifetime.
Methods:
Primary data collection alongside the ESCAPE trial provided a 3-month trial-specific, non-model, based cost per quality-adjusted life year (QALY). A Markov model utilizing ongoing lifetime costs and life expectancy from the literature was built to simulate the cost per QALY adopting a lifetime horizon. Health states were defined using the modified Rankin Scale (mRS) scores. Uncertainty was explored using scenario analysis and probabilistic sensitivity analysis.
Results:
The 3-month trial-based analysis resulted in a cost per QALY of $201,243 of EVT compared to the best standard of care. In the model-based analysis, using a societal perspective and a lifetime horizon, EVT dominated the standard of care; EVT was both more effective and less costly than the standard of care (−$91). When the time horizon was shortened to 1 year, EVT remains cost savings compared to standard of care (∼$15,376 per QALY gained with EVT). However, if the estimate of clinical effectiveness is 4% less than that demonstrated in ESCAPE, EVT is no longer cost savings compared to standard of care.
Conclusions:
Results support the adoption of EVT as a treatment option for acute ischemic stroke, as the increase in costs associated with caring for EVT patients was recouped within the first year of stroke, and continued to provide cost savings over a patient’s lifetime.
La pandémie de la COVID-19 et l’état d’urgence publique qui en a découlé ont eu des répercussions significatives sur les personnes âgées au Canada et à travers le monde. Il est impératif que le domaine de la gérontologie réponde efficacement à cette situation. Dans la présente déclaration, les membres du conseil d’administration de l’Association canadienne de gérontologie/Canadian Association on Gerontology (ACG/CAG) et ceux du comité de rédaction de La Revue canadienne du vieillissement/Canadian Journal on Aging (RCV/CJA) reconnaissent la contribution des membres de l’ACG/CAG et des lecteurs de la RCV/CJA. Les auteurs exposent les voies complexes par lesquelles la COVID-19 affecte les personnes âgées, allant du niveau individuel au niveau populationnel. Ils préconisent une approche impliquant des équipes collaboratives pluridisciplinaires, regroupant divers champs de compétences, et différentes perspectives et méthodes d’évaluation de l’impact de la COVID-19.
The COVID-19 pandemic and subsequent state of public emergency have significantly affected older adults in Canada and worldwide. It is imperative that the gerontological response be efficient and effective. In this statement, the board members of the Canadian Association on Gerontology/L’Association canadienne de gérontologie (CAG/ACG) and the Canadian Journal on Aging/La revue canadienne du vieillissement (CJA/RCV) acknowledge the contributions of CAG/ACG members and CJA/RCV readers. We also profile the complex ways that COVID-19 is affecting older adults, from individual to population levels, and advocate for the adoption of multidisciplinary collaborative teams to bring together different perspectives, areas of expertise, and methods of evaluation in the COVID-19 response.
The otoliths (ear stones) of fishes are commonly used to describe the age and growth of marine and freshwater fishes. These non-skeletal structures are fortuitous in their utility by being composed of mostly inorganic carbonate that is inert through the life of the fish. This conserved record functions like an environmental chronometer and bomb-produced radiocarbon (14C)—a 14C signal created by atmospheric testing of thermonuclear devices—can be used as a time-specific marker in validating fish age. However, complications from the hydrogeology of nearshore marine environments can complicate 14C levels, as was the case with gray snapper (Lutjanus griseus) along the Gulf of Mexico coast of Florida. Radiocarbon of these nearshore waters is influenced by freshwater input from the karst topography of the Upper Floridan Aquifer—estuarine waters that are 14C-depleted from surface and groundwater inputs. Some gray snapper likely recruited to this kind of environment where 14C levels were depleted in the earliest otolith growth, although age was validated for individuals that were not exposed to 14C-depleted waters to an age of at least 25 years with support for a 30-year lifespan.
For the purposes of this study I am defining West Central Africa largely by the watershed of the Congo River. If the region has a hydrographic center, it is the Lunda Plateau in eastern Angola, a relatively flat region at roughly 1,000 meters elevation, origin of many of the largest effluents of the Congo. This highland continues eastward until it reaches the great range of mountains that define the Rift Valley, and separate it from the Nile system. Because human geography is not always identical to natural geography, there are additions to this defined space.
An important addition is the rivers that drain from the low mountains that define the western end of the Congo watershed that flow westward into the Atlantic Ocean which are included in the study because many political units had borders that straddled the two, such as the Kingdoms of Ndongo and Kasanje, which were regularly engaged on both sides of the Kwango watershed, or the Luyana Kingdom, which lay squarely in the Zambezi River watershed but was in substantial communication with the Lunda Empire.
The Lunda empire reaches its height, while Kongo collapses in anarchy, Viye and Mbailundu become important regional powers and Portugal tries to reform Angola