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[What keeps the US and the world economy afloat at a time when US balance of payments and budgetd eficits have soared to unprecedented levels? As The Economist noted in its September 23, 1999 edition, “Never before in history have central banks wielded so much power.” That power has only increased, as central governments continue to withdraw from economic management by reducing redistributive taxes, transfers and regulations, thus leaving even more decisions to central banks, the market and lower levels of the state. As central bankers become more influential, it is reasonable to ask what lies behind their decisionmaking and how they might be held more accountable. The long series of asset bubbles over the past decade suggests that there is something fundamentally wrong in the governance of the financial side of the economy. This is the context for Richard Duncan's analysis of the strategy of Japanese and Chinese central banks in underwriting US deficits. Duncan takes no position on the larger debate over central bank governance, but instead offers a fascinating, speculative glimpse into their decisionmaking processes. Duncan asks whether it is possible that central bankers in Japan and America made a political decision to coordinate their policies. Duncan concludes that central bankers stopped a spiral into deflation. From another perspective, however, unelected officials propped up the fiscal irresponsibility of the Bush regime as well as poured more froth on the worsening bubble-trouble hangover from the 1990s. Japan Focus]
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.
Orbital driven climate control on sedimentation produces regional, stratigraphically repetitive characters and so cyclostratigraphic correlation can improve correlation and identify stratigraphic trends in borehole sections. This concept is commonly used to correlate marine and lacustrine strata. However, in the alluvial domain, its use is more challenging because internal, local dynamics controlling sedimentation may interfere with the expression of cyclic climate forcing. Intervals of low net-to-gross may be important for successful application in this domain as they tend to better document regional changes. This study applies climate-based stratigraphic correlation concepts to improve well correlations, characterise vertical sand distribution, and identify potential reservoir targets in a generally low net-to-gross interval. Coarsening upward sedimentary repetitions (cyclothems) are identified and correlated with high certainty in nineteen well sections in the upper Carboniferous Westoe and Cleaver formations of the Silverpit Basin. Local sedimentary dynamics provide variability in the character of the cyclothems and several types of cyclothem are classified. Correlation of sections using cyclothems recognised on wireline logs is done twice: once manually and once semi-automatically. The semi-automated correlation is based on calculation of deviation curves which depict stratigraphic changes that are less dependent on absolute wireline values and follow vertical trends more clearly. The correlations provide composite stratigraphies that are analysed using vertical proportions curves. Both approaches yield similar results in terms of stratigraphic trends. However, for detailed correlation of wells, the manual correlation is better at accounting for any local variability within the system. The same two zones of higher net-to-gross ratios are found using both correlation methods. These are linked to palaeoclimatic changes driven by long eccentricity and the proposed climate stratigraphic model has predictive value for identifying sandstone occurrence. The climate-based stratigraphic correlation improves the assessment reservoir distribution and properties on small (10–20 m thickness) and large (100–200 m thickness) stratigraphical scales.
The utilisation of massed therapy for treating posttraumatic stress disorder (PTSD) is gaining strength, especially prolonged exposure. However, it is unknown whether massed prolonged exposure (MPE) is non-inferior to standard prolonged exposure (SPE) protocols in the long term. The current study aimed to assess whether MPE was non-inferior to SPE at 12 months post-treatment, and to ascertain changes in secondary measure outcomes.
Methods
A multi-site non-inferiority randomised controlled trial (RCT) compared SPE with MPE in 12 clinics. The primary outcome was PTSD symptom severity (CAPS-5) at 12 months post-treatment commencement. Secondary outcome measures included symptoms of depression, anxiety, anger, disability, and quality of life at 12 weeks and 12 months post-treatment commencement. Outcome assessors were blinded to treatment allocation. The intention-to-treat sample included 138 Australian military members and veterans and data were analysed for 134 participants (SPE = 71, MPE = 63).
Results
Reductions in PTSD severity were maintained at 12 months and MPE remained non-inferior to SPE. Both treatment groups experienced a reduction in depression, anxiety, anger, and improvements in quality of life at 12 weeks and 12 months post-treatment commencement. Treatment effects for self-reported disability in the SPE group at 12 weeks were not maintained, with neither group registering significant effects at 12 months.
Conclusions
The emergence of massed protocols for PTSD is an important advancement. The current study provides RCT evidence for the longevity of MPE treatment gains at 12 months post-treatment commencement and demonstrated non-inferiority to SPE. Promisingly, both treatments also significantly reduced the severity of comorbid symptoms commonly occurring alongside PTSD.
The coronavirus disease 2019 (COVID-19) pandemic highlighted the lack of agreement regarding the definition of aerosol-generating procedures and potential risk to healthcare personnel. We convened a group of Massachusetts healthcare epidemiologists to develop consensus through expert opinion in an area where broader guidance was lacking at the time.
A short, effective therapy for posttraumatic stress disorder (PTSD) could decrease barriers to implementation and uptake, reduce dropout, and ameliorate distressing symptoms in military personnel and veterans. This non-inferiority RCT evaluated the efficacy of 2-week massed prolonged exposure (MPE) therapy compared to standard 10-week prolonged exposure (SPE), the current gold standard treatment, in reducing PTSD severity in both active serving and veterans in a real-world health service system.
Methods
This single-blinded multi-site non-inferiority RCT took place in 12 health clinics across Australia. The primary outcome was PTSD symptom severity measured by the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) at 12 weeks. 138 military personnel and veterans with PTSD were randomised. 71 participants were allocated to SPE, with 63 allocated to MPE.
Results
The intention-to-treat sample included 138 participants, data were analysed for 134 participants (88.1% male, M = 46 years). The difference between the mean MPE and SPE group PTSD scores from baseline to 12 weeks-post therapy was 0.94 [95% confidence interval (CI) −4.19 to +6.07]. The upper endpoint of the 95% CI was below +7, indicating MPE was non-inferior to SPE. Significant rates of loss of PTSD diagnosis were found for both groups (MPE 53.8%, SPE 54.1%). Dropout rates were 4.8% (MPE) and 16.9% (SPE).
Conclusions
MPE was non-inferior to SPE in significantly reducing symptoms of PTSD. Significant reductions in symptom severity, low dropout rates, and loss of diagnosis indicate MPE is a feasible, accessible, and effective treatment. Findings demonstrate novel methods to deliver gold-standard treatments for PTSD should be routinely considered.
The Altar Stone at Stonehenge in Wiltshire, UK, is enigmatic in that it differs markedly from the other bluestones. It is a grey–green, micaceous sandstone and has been considered to be derived from the Old Red Sandstone sequences of South Wales. Previous studies, however, have been based on presumed derived fragments (debitage) that have been identified visually as coming from the Altar Stone. Portable X-ray fluorescence (pXRF) analyses were conducted on these fragments (ex situ) as well as on the Altar Stone (in situ). Light elements (Z<37) in the Altar Stone analyses, performed after a night of heavy rain, were affected by surface and pore water that attenuate low energy X-rays, however the dry analyses of debitage fragments produced data for a full suite of elements. High Z elements, including Zr, Nb, Sr, Pb, Th and U, all occupy the same compositional space in the Altar Stone and debitage fragments, and are statistically indistinguishable, indicating the fragments are derived from the Altar Stone. Barium compares very closely between the debitage and Altar Stone, with differences being related to variable baryte distribution in the Altar Stone, limited accessibility of its surface for analysis, and probably to surface weathering.
A notable feature of the Altar Stone sandstone is the presence of baryte (up to 0.8 modal%), manifest as relatively high Ba in both the debitage and the Altar Stone. These high Ba contents are in marked contrast with those in a small set of Old Red Sandstone field samples, analysed alongside the Altar Stone and debitage fragments, raising the possibility that the Altar Stone may not have been sourced from the Old Red Sandstone sequences of Wales. This high Ba ‘fingerprint’, related to the presence of baryte, may provide a rapid test using pXRF in the search for the source of the Stonehenge Altar Stone.
The state of California, in the United States of America, has a population of nearly 40 million people and is the 5th largest economy in the world. During the coronavirus disease 2019 (COVID-19) pandemic in 2020-2021, the state experienced a medical surge that stressed its sophisticated health-care and public health system. During this period, ventilators, oxygen, and other equipment necessary for providing ventilatory support became a scarce resource in many health-care settings. When demand overwhelms supply, creative solutions are required at all levels of disaster management and health care. This study describes the disaster response by the state of California to mitigate the emergency demands for oxygen delivery resources.
The objectives were to examine clinical characteristics, length of recovery, and the prevalence of delayed physician-documented recovery, compare clinical outcomes among those with sport-related concussion (SRC) and non-sport-related concussion (nSRC), and identify risk factors for delayed recovery.
Methods:
Included patients (8–18 years) were assessed ≤14 days post-injury at a multidisciplinary concussion program and diagnosed with an acute SRC or nSRC. Physician-documented clinical recovery was defined as returning to pre-injury symptom status, attending full-time school without symptoms, completing Return-to-Sport strategy as needed, and normal physical examination. Delayed physician-documented recovery was defined as >28 days post-injury.
Results:
Four hundred and fifteen patients were included (77.8% SRC). There was no difference in loss of consciousness (SRC: 9.9% vs nSRC: 13.0%, p = 0.39) or post-traumatic amnesia (SRC: 24.1% vs SRC: 31.5%, p = 0.15) at the time of injury or any differences in median Post-Concussion Symptom Scale scores (SRC: 20 vs nSRC: 23, p = 0.15) at initial assessment. Among those with complete clinical follow-up, the median physician-documented clinical recovery was 20 days (SRC: 19 vs nSRC: 23; p = 0.37). There was no difference in the proportion of patients who developed delayed physician-documented recovery (SRC: 27.7% vs nSRC: 36.1%; p = 0.19). Higher initial symptom score increased the risk of delayed physician-documented recovery (IRR: 1.39; 95% CI: 1.29, 1.49). Greater material deprivation and social deprivation were associated with an increased risk of delayed physician-documented recovery.
Conclusions:
Most pediatric concussion patients who undergo early medical assessment and complete follow-up appear to make a complete clinical recovery within 4 weeks, regardless of mechanism.
Selenium is an essential micronutrient with biochemical and cellular effects through activities of 25 selenocysteine-containing selenoproteins. Selenoproteins are anti-inflammatory and have antioxidant properties. Severe selenium deficiency causes muscle weakness and atrophy in humans however the effects of moderate selenium deficiency are unclear. The aims of this study are twofold: 1) to determine dietary selenium intakes and contributing food sources in very old adults and; 2) to determine whether dietary selenium intakes are associated with 5-year trajectories of muscle function: hand-grip strength (HGS) and Timed-Up-and-Go (TUG).
Cross-sectional (baseline) and prospective (1.5, 3 and 5-year follow-up) analyses of 845 participants aged 85 years from the Newcastle 85 + study were assessed for HGS and TUG performance using standardized protocols (Antoneta et al. 2016). Baseline dietary intakes were assessed using 24-hour multiple pass recall methods on two separate days (Mendonça et al. 2016). The top selenium food contributors (~90%) and the adequacy of intakes were determined i.e. those with intakes < LRNI, between the LRNI and RNI and > RNI. Linear mixed models explored the associations between selenium intake categories and time on the prospective, 5-year change in HGS and TUG in all participants, males and females.
Median intakes of selenium were 39, 48 and 35μg for all participants, males and females, respectively. Selenium intakes were below the LRNI in 51% of participants (median 27μg) whilst 15% had intakes ≥ the RNI (median 85μg). Only 13.3% of females and 16.9 % of males met the RNI. The top selenium contributors were cereals (46%), meat (22%), fish (10%), milk (6%), eggs (4%) and potatoes (3%) making up 91% of selenium intakes. Those with the lowest intakes had 2.72 kg lower HGS and 2.36s slower TUG compared to those with higher intakes (P < 0.005). There was no association between selenium intake in HGS or TUG, but time had a significant effect on the rate of change over 5-years in both parameters (P < 0.001).
Overall these results show that poor dietary selenium intakes are common in very old adults and that cereal and cereal products are major sources of selenium in this population. Whilst low selenium intakes are associated with worse HGS and TUG performance in the cross-sectional analysis, no significant associations were observed in the prospective analyses.
Complex challenges may arise when patients present to emergency services with an advance decision to refuse life-saving treatment following suicidal behaviour.
Aims
To investigate the use of advance decisions to refuse treatment in the context of suicidal behaviour from the perspective of clinicians and people with lived experience of self-harm and/or psychiatric services.
Method
Forty-one participants aged 18 or over from hospital services (emergency departments, liaison psychiatry and ambulance services) and groups of individuals with experience of psychiatric services and/or self-harm were recruited to six focus groups in a multisite study in England. Data were collected in 2016 using a structured topic guide and included a fictional vignette. They were analysed using thematic framework analysis.
Results
Advance decisions to refuse treatment for suicidal behaviour were contentious across groups. Three main themes emerged from the data: (a) they may enhance patient autonomy and aid clarity in acute emergencies, but also create legal and ethical uncertainty over treatment following self-harm; (b) they are anxiety provoking for clinicians; and (c) in practice, there are challenges in validation (for example, validating the patient’s mental capacity at the time of writing), time constraints and significant legal/ethical complexities.
Conclusions
The potential for patients to refuse life-saving treatment following suicidal behaviour in a legal document was challenging and anxiety provoking for participants. Clinicians should act with caution given the potential for recovery and fluctuations in suicidal ideation. Currently, advance decisions to refuse treatment have questionable use in the context of suicidal behaviour given the challenges in validation. Discussion and further patient research are needed in this area.
Declaration of interest
D.G., K.H. and N.K. are members of the Department of Health's (England) National Suicide Prevention Advisory Group. N.K. chaired the National Institute for Health and Care Excellence (NICE) guideline development group for the longer-term management of self-harm and the NICE Topic Expert Group (which developed the quality standards for self-harm services). He is currently chair of the updated NICE guideline for Depression. K.H. and D.G. are NIHR Senior Investigators. K.H. is also supported by the Oxford Health NHS Foundation Trust and N.K. by the Greater Manchester Mental Health NHS Foundation Trust.
Functional gastrointestinal disorders including constipation affect up to 14 % of the world's population. Treatment is difficult and challenging resulting in a need for alternative safe and effective therapies. The present study investigated whether daily consumption of three gold-fleshed kiwifruit could alleviate constipation and improve gastrointestinal discomfort in mildly constipated individuals with and without pain. A total of thirty-two participants were enrolled in a 16-week randomised, single-blind, crossover study. Participants received either three ‘Zesy002’ kiwifruit or 14·75 g Metamucil® (5 g dietary fibre/d (a positive control)) for 4 weeks each with a 4-week washout between treatments. A 2-week washout period was included at the beginning and end of the study. Daily bowel habit diaries were kept throughout the study. The primary outcome measure was differences in the number of complete spontaneous bowel movements (CSBM). Secondary outcome measures were bowel movement frequency and stool form as well as digestive symptoms and comfort. The number of CSBM per week was significantly greater during daily consumption of three kiwifruit compared with the baseline (6·3 v. 3·3; P < 0·05) and the Metamucil® treatment (6·3 v. 4·5; P < 0·05). Stool consistency was also improved, with kiwifruit producing softer stools and less straining (P < 0·05). Gastrointestinal discomfort was also improved compared with baseline for abdominal pain, constipation and indigestion (P < 0·05) during the kiwifruit intervention and constipation during the Metamucil® intervention (P < 0·05). This randomised controlled trial demonstrates that daily consumption of three gold-fleshed kiwifruit is associated with a significant increase of two CSBM per week and reduction in gastrointestinal discomfort in mildly constipated adults.
Geologists and archaeologists have long known that the bluestones of Stonehenge came from the Preseli Hills of west Wales, 230km away, but only recently have some of their exact geological sources been identified. Two of these quarries—Carn Goedog and Craig Rhos-y-felin—have now been excavated to reveal evidence of megalith quarrying around 3000 BC—the same period as the first stage of the construction of Stonehenge. The authors present evidence for the extraction of the stone pillars and consider how they were transported, including the possibility that they were erected in a temporary monument close to the quarries, before completing their journey to Stonehenge.
For nearly ten years – indeed more if we include his period of influence under Mandela’s presidency – Thabo Mbeki bestrode South Africa’s political stage. Despite attempts by some in the new ANC leadership to airbrush out his role, there can be little doubt that Mbeki was a seminal figure in South Africa’s new democracy, one who left a huge mark in many fields, perhaps most controversially in state and party management, economic policy, public health intervention, foreign affairs and race relations. If we wish to understand the character and fate of post-1994 South Africa, we must therefore ask: What kind of political system, economy and society has the former President bequeathed to the government of Jacob Zuma and to the citizens of South Africa generally? This question is addressed head-on here by a diverse range of analysts, commentators and participants in the political process. Amongst the specific questions they seek to answer: What is Mbeki’s legacy for patterns of inclusion and exclusion based on race, class and gender? How, if at all, did his presidency reshape relations within the state, between the state and the ruling party and between the state and society? How did he reposition South Africa on the continent and in the world? This book will be of interest to anyone wishing to understand the current political landscape in South Africa, and Mbeki’s role in shaping it.
Whether monozygotic (MZ) and dizygotic (DZ) twins differ from each other in a variety of phenotypes is important for genetic twin modeling and for inferences made from twin studies in general. We analyzed whether there were differences in individual, maternal and paternal education between MZ and DZ twins in a large pooled dataset. Information was gathered on individual education for 218,362 adult twins from 27 twin cohorts (53% females; 39% MZ twins), and on maternal and paternal education for 147,315 and 143,056 twins respectively, from 28 twin cohorts (52% females; 38% MZ twins). Together, we had information on individual or parental education from 42 twin cohorts representing 19 countries. The original education classifications were transformed to education years and analyzed using linear regression models. Overall, MZ males had 0.26 (95% CI [0.21, 0.31]) years and MZ females 0.17 (95% CI [0.12, 0.21]) years longer education than DZ twins. The zygosity difference became smaller in more recent birth cohorts for both males and females. Parental education was somewhat longer for fathers of DZ twins in cohorts born in 1990–1999 (0.16 years, 95% CI [0.08, 0.25]) and 2000 or later (0.11 years, 95% CI [0.00, 0.22]), compared with fathers of MZ twins. The results show that the years of both individual and parental education are largely similar in MZ and DZ twins. We suggest that the socio-economic differences between MZ and DZ twins are so small that inferences based upon genetic modeling of twin data are not affected.
CryoSat is currently being prepared for a 2005 launch as the first European Space Agency Earth Explorer Opportunity mission. It is a dedicated cryospheric mission equipped with a Ku-band SIRAL (SAR/Interferometric Radar ALtimeter), whose primary objectives are to measure the variability and trends in the mass of the Arctic sea-ice cover and large terrestrial ice sheets. In this paper, an overview is provided of the mission and of the measurement characteristics of the new SIRAL instrument. Examples of data acquired on recent preparatory campaigns are presented, illustrating the operating characteristics of the key SIRAL modes. Preparatory plans for calibration and validation of CryoSat data are described.
Extinctions have altered island ecosystems throughout the late Quaternary. Here, we review the main historic drivers of extinctions on islands, patterns in extinction chronologies between islands, and the potential for restoring ecosystems through reintroducing extirpated species. While some extinctions have been caused by climatic and environmental change, most have been caused by anthropogenic impacts. We propose a general model to describe patterns in these anthropogenic island extinctions. Hunting, habitat loss and the introduction of invasive predators accompanied prehistoric settlement and caused declines of endemic island species. Later settlement by European colonists brought further land development, a different suite of predators and new drivers, leading to more extinctions. Extinctions alter ecological networks, causing ripple effects for islands through the loss of ecosystem processes, functions and interactions between species. Reintroduction of extirpated species can help restore ecosystem function and processes, and can be guided by palaeoecology. However, reintroduction projects must also consider the cultural, social and economic needs of humans now inhabiting the islands and ensure resilience against future environmental and climate change.
The Protoplanetary Discussions conference—held in Edinburgh, UK, from 2016 March 7th–11th—included several open sessions led by participants. This paper reports on the discussions collectively concerned with the multi-physics modelling of protoplanetary discs, including the self-consistent calculation of gas and dust dynamics, radiative transfer, and chemistry. After a short introduction to each of these disciplines in isolation, we identify a series of burning questions and grand challenges associated with their continuing development and integration. We then discuss potential pathways towards solving these challenges, grouped by strategical, technical, and collaborative developments. This paper is not intended to be a review, but rather to motivate and direct future research and collaboration across typically distinct fields based on community-driven input, to encourage further progress in our understanding of circumstellar and protoplanetary discs.