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Adolescence is a critical period for preventing substance use and mental health concerns, often targeted through separate school-based programs. However, co-occurrence is common and is related to worse outcomes. This study explores prevention effects of leading school-based prevention programs on co-occurring alcohol use and psychological distress.
Methods
Data from two Australian cluster randomized trials involving 8576 students in 97 schools were harmonized for analysis. Students received either health education (control) or one of five prevention programs (e.g. Climate Schools, PreVenture) with assessments at baseline and 6, 12, 24, and 30 or 36 months (from ages ~13–16). Multilevel multinomial regressions were used to predict the relative risk ratios (RRs) of students reporting co-occurring early alcohol use and psychological distress, alcohol use only, distress only, or neither (reference) across programs.
Results
The combined Climate Schools: Alcohol and Cannabis and Climate Schools: Mental Health courses (CSC) as well as the PreVenture program reduced the risk of adolescents reporting co-occurring alcohol use and psychological distress (36 months RRCSC = 0.37; RRPreVenture = 0.22). Other evaluated programs (excluding Climate Schools: Mental Health) only appeared effective for reducing the risk of alcohol use that occurred without distress.
Conclusions
Evidence-based programs exist that reduce the risk of early alcohol use with and without co-occurring psychological distress, though preventing psychological distress alone requires further exploration. Prevention programs appear to have different effects depending on whether alcohol use and distress present on their own or together, thus suggesting the need for tailored prevention strategies.
Singularly perturbed ordinary differential equations often exhibit Stokes’ phenomenon, which describes the appearance and disappearance of oscillating exponentially small terms across curves in the complex plane known as Stokes lines. These curves originate at singular points in the leading-order solution to the differential equation. In many important problems, it is impossible to obtain a closed-form expression for these leading-order solutions, and it is therefore challenging to locate these singular points. We present evidence that the analytic leading-order solution of a linear differential equation can be replaced with a numerical rational approximation using the adaptive Antoulas–Anderson (AAA) method. Despite such an approximation having completely different singularity types and locations, we show that the subsequent exponential asymptotic analysis accurately predicts the exponentially small behaviour present in the solution. For sufficiently small values of the asymptotic parameter, this approach breaks down; however, the range of validity may be extended by increasing the number of poles in the rational approximation. We present a related nonlinear problem and discuss the challenges that arise due to nonlinear effects. Overall, our approach allows for the study of exponentially small asymptotic effects without requiring an exact analytic form for the leading-order solution; this permits exponential asymptotic methods to be used in a much wider range of applications.
Boyer's formulation neglects that humans are embodied agents. It is a biological imperative to distinguish self from other. Ownership of ideas, bodies, objects, and locations is an inevitable extension of this. We argue that (1) the body's capability influences the inputs that guide future actions, and (2) bodies in action influence all of cognition, from perception to decision making.
Background: Our aim was to develop a National Quality Indicators Set for the Care of Adults Hospitalized for Neurological Problems, to serve as a foundation to build regional or national quality initiatives in Canadian neurology centres. Methods: We used a national eDelphi process to develop a suite of quality indicators and a parallel process of surveys and patient focus groups to identify patient priorities. Canadian content and methodology experts were invited to participate. To be included, >70% of participants had to rate items as critical and <15% had to rate it as not important. Two rounds of surveys and consensus meetings were used identify and rank indicators, followed by national consultation with members of the Canadian Neurological Society. Results: 38 neurologists and methodologists and 56 patients/caregivers participated in this project. An initial list of 91 possible quality indicators was narrowed to 40 indicators across multiple categories of neurological conditions. 21 patient priorities were identified. Conclusions: This quality indicators suite can be used regionally or nationally to drive improvement initiatives for inpatient neurology care. In addition, we identified multiple opportunities for further research where evidence was lacking or patient and provider priorities did not align.
Multi-messenger observations of the transient sky to detect cosmic explosions and counterparts of gravitational wave mergers critically rely on orbiting wide-FoV telescopes to cover the wide range of wavelengths where atmospheric absorption and emission limit the use of ground facilities. Thanks to continuing technological improvements, miniaturised space instruments operating as distributed-aperture constellations are offering new capabilities for the study of high-energy transients to complement ageing existing satellites. In this paper we characterise the performance of the upcoming joint SpIRIT and HERMES-TP/SP constellation for the localisation of high-energy transients through triangulation of signal arrival times. SpIRIT is an Australian technology and science demonstrator satellite designed to operate in a low-Earth Sun-synchronous Polar orbit that will augment the science operations for the equatorial HERMES-TP/SP constellation. In this work we simulate the improvement to the localisation capabilities of the HERMES-TP/SP constellation when SpIRIT is included in an orbital plane nearly perpendicular (inclination = 97.6°) to the HERMES-TP/SP orbits. For the fraction of GRBs detected by three of the HERMES satellites plus SpIRIT, we find that the combined constellation is capable of localising 60% of long GRBs to within ${\sim}30\,\textrm{deg}^{2}$ on the sky, and 60% of short GRBs within ${\sim}1850\,\textrm{deg}^{2}$ ($1\sigma$ confidence regions), though it is beyond the scope of this work to characterise or rule out systematic uncertainty of the same order of magnitude. Based purely on statistical GRB localisation capabilities (i.e., excluding systematic uncertainties and sky coverage), these figures for long GRBs are comparable to those reported by the Fermi Gamma Burst Monitor instrument. These localisation statistics represents a reduction of the uncertainty for the burst localisation region for both long and short GRBs by a factor of ${\sim}5$ compared to the HERMES-TP/SP alone. Further improvements by an additional factor of 2 (or 4) can be achieved by launching an additional 4 (or 6) SpIRIT-like satellites into a Polar orbit, respectively, which would both increase the fraction of sky covered by multiple satellite elements, and also enable localisation of ${\geq} 60\%$ of long GRBs to within a radius of ${\sim}1.5^{\circ}$ (statistical uncertainty) on the sky, clearly demonstrating the value of a distributed all-sky high-energy transient monitor composed of nano-satellites.
The COVID-19 pandemic presented a challenge to established seed grant funding mechanisms aimed at fostering collaboration in child health research between investigators at the University of Minnesota (UMN) and Children’s Hospitals and Clinics of Minnesota (Children’s MN). We created a “rapid response,” small grant program to catalyze collaborations in child health COVID-19 research. In this paper, we describe the projects funded by this mechanism and metrics of their success.
Methods:
Using seed funds from the UMN Clinical and Translational Science Institute, the UMN Medical School Department of Pediatrics, and the Children’s Minnesota Research Institute, a rapid response request for applications (RFAs) was issued based on the stipulations that the proposal had to: 1) consist of a clear, synergistic partnership between co-PIs from the academic and community settings; and 2) that the proposal addressed an area of knowledge deficit relevant to child health engendered by the COVID-19 pandemic.
Results:
Grant applications submitted in response to this RFA segregated into three categories: family fragility and disruption exacerbated by COVID-19; knowledge gaps about COVID-19 disease in children; and optimizing pediatric care in the setting of COVID-19 pandemic restrictions. A series of virtual workshops presented research results to the pediatric community. Several manuscripts and extramural funding awards underscored the success of the program.
Conclusions:
A “rapid response” seed funding mechanism enabled nascent academic-community research partnerships during the COVID-19 pandemic. In the context of the rapidly evolving landscape of COVID-19, flexible seed grant programs can be useful in addressing unmet needs in pediatric health.
In this paper, we describe the system design and capabilities of the Australian Square Kilometre Array Pathfinder (ASKAP) radio telescope at the conclusion of its construction project and commencement of science operations. ASKAP is one of the first radio telescopes to deploy phased array feed (PAF) technology on a large scale, giving it an instantaneous field of view that covers $31\,\textrm{deg}^{2}$ at $800\,\textrm{MHz}$. As a two-dimensional array of 36$\times$12 m antennas, with baselines ranging from 22 m to 6 km, ASKAP also has excellent snapshot imaging capability and 10 arcsec resolution. This, combined with 288 MHz of instantaneous bandwidth and a unique third axis of rotation on each antenna, gives ASKAP the capability to create high dynamic range images of large sky areas very quickly. It is an excellent telescope for surveys between 700 and $1800\,\textrm{MHz}$ and is expected to facilitate great advances in our understanding of galaxy formation, cosmology, and radio transients while opening new parameter space for discovery of the unknown.
In this paper, we revisit our previous work in which we derive an effective macroscale description suitable to describe the growth of biological tissue within a porous tissue-engineering scaffold. The underlying tissue dynamics is described as a multiphase mixture, thereby naturally accommodating features such as interstitial growth and active cell motion. Via a linearization of the underlying multiphase model (whose nonlinearity poses a significant challenge for such analyses), we obtain, by means of multiple-scale homogenization, a simplified macroscale model that nevertheless retains explicit dependence on both the microscale scaffold structure and the tissue dynamics, via so-called unit-cell problems that provide permeability tensors to parameterize the macroscale description. In our previous work, the cell problems retain macroscale dependence, posing significant challenges for computational implementation of the eventual macroscopic model; here, we obtain a decoupled system whereby the quasi-steady cell problems may be solved separately from the macroscale description. Moreover, we indicate how the formulation is influenced by a set of alternative microscale boundary conditions.
Non-tuberculous mycobacterium encephalitis is rare. Since 2013, a global outbreak of Mycobacterium chimaera infection has been attributed to point-source contamination of heater cooler units used in cardiac surgery. Disseminated M. chimaera infection has presented many unique challenges, including non-specific clinical presentations with delays in diagnosis, and a high mortality rate among predominantly immunocompetent adults. Here, we describe three patients with fatal disseminated Mycobacterium chimaera infection showing initially non-specific, progressively worsening neurocognitive decline, including confusion, delirium, depression and apathy. Autopsy revealed widespread granulomatous encephalitis of the cerebrum, brain stem and spinal cord, along with granulomatous chorioretinitis. Cerebral involvement and differentiation between mycobacterial granulomas and microangiopathic changes can be assessed best on MRI with contrast enhancement. The prognosis of M. chimaera encephalitis appears to be very poor, but might be improved by increased awareness of this new syndrome and timely antimicrobial treatment.
LEARNING OBJECTIVES
This presentation will enable the learner to:
1. Describe the clinical, radiological and neuropathological findings of Mycobacterium chimaera encephalitis
2. Be aware of this rare form of encephalitis, and explain its diagnosis, prognosis and management
Steady and unsteady linearised flow past a submerged source are studied in the small-surface-tension limit, in the absence of gravitational effects. The free-surface capillary waves generated are exponentially small in the surface tension, and are determined using the theory of exponential asymptotics. In the steady problem, capillary waves are found to extend upstream from the source, switching on across curves on the free surface known as Stokes lines. Asymptotic predictions are compared with computational solutions for the position of the free surface. In the unsteady problem, transient effects cause the solution to display more complicated asymptotic behaviour, such as higher-order Stokes lines. The theory of exponential asymptotics is applied to show how the capillary waves evolve over time, and eventually tend to the steady solution.
Impact craters are the dominant landform on Mercury and range from the largest basins to the smallest young craters. Peak-ring basins are especially prevalent on Mercury, although basins of all forms are far undersaturated, probably the result of the extensive volcanic emplacement of intercrater plains and younger smooth plains between about 4.1 and 3.5 Ga. This chapter describes the geology of the two largest well-preserved basins, Caloris and Rembrandt, and the three smaller Raditladi, Rachmaninoff, and Mozart basins. We describe analyses of crater size–frequency distributions and relate them to populations of asteroid impactors (Late Heavy Bombardment in early epochs and the near-Earth asteroid population observable today during most of Mercury’s history), to secondary cratering, and to exogenic and endogenic processes that degrade and erase craters. Secondary cratering is more important on Mercury than on other solar system bodies and shaped much of the surface on kilometer and smaller scales, compromising our ability to use craters for relative and absolute age-dating of smaller geological units. Failure to find “vulcanoids” and satellites of Mercury suggests that such bodies played a negligible role in cratering Mercury. We describe an absolute cratering chronology for Mercury’s geological evolution as well as its uncertainties.
Numerous experimental studies have documented that injecting low-salinity water into an oil reservoir can increase the amount of oil recovered. However, owing to the complexity of the chemical interactions involved in this process, there has been much debate over the dominant mechanism causing this effect. In order to further understand one proposed mechanism, multicomponent ionic exchange, we study the motion of an oil slug through a clay pore throat filled with saline water. The pore throat is modelled as a capillary tube connecting two bulk regions of water. We assume that the surfaces of the oil and the capillary are negatively charged and that, due to repulsion between these surfaces, the oil slug is separated from the capillary surface by a thin film of water. Ion interactions at the oil–water and clay–water interfaces are modelled using the law of mass action. By using lubrication theory to describe the thin-film flow in the water layer separating the oil from the clay surface, and the macroscopic flow through the capillary, we derive expressions for the thickness of the wetting film, and the velocity of the oil slug, given a pressure difference across the ends of the capillary. Numerical results show that the thickness of the water layer and the velocity of the oil slug increase as the salinity of the water is reduced, suggesting that this mechanism contributes to the low-salinity effect. An analytical solution is presented in the limit in which the applied pressure is small.
Background: It is unclear as to the extent to which psychological interventions focusing specifically on depression and anxiety are helpful for people with physical health conditions, with respect to mood and condition management. Aims: To evaluate the effectiveness of a modified evidence-based psychological intervention focusing on depression and anxiety for people with type 2 diabetes mellitus (T2DM), compared with a control intervention. Method: Clients (n = 140) who experienced mild to moderate depression and/or anxiety and had a diagnosis of T2DM were allocated to either diabetes specific treatment condition (n = 52) or standard intervention (control condition, n = 63), which were run in parallel. Each condition received a group intervention offering evidence-based psychological interventions for people with depression and anxiety. Those running the diabetes specific treatment group received additional training and supervision on working with people with T2DM from a clinical health psychologist and a general practitioner. The diabetes specific treatment intervention helped patients to link mood with management of T2DM. Results: Both conditions demonstrated improvements in primary outcomes of mood and secondary outcome of adjustment [95% confidence interval (CI) between 0.25 and 5.06; p < 0.05 in all cases]. The diabetes specific treatment condition also demonstrated improvements in secondary outcomes of self-report management of T2DM for diet, checking blood and checking feet, compared with the control condition (95% CIs between 0.04 and 2.05; p < 0.05 in all cases) and in glycaemic control (95% CI: 0.67 to 8.22). The findings also suggested a non-significant reduction in NHS resources in the diabetes specific treatment condition. These changes appeared to be maintained in the diabetes specific treatment condition. Conclusions: It is concluded that a modified intervention, with input from specialist services, may offer additional benefits in terms of improved diabetic self-management and tighter glycaemic control.
Halkieriids are known largely from isolated sclerites, although it is understood that originally they formed the scleritomes of slug-like animals in Lower Cambrian benthic environments. The Yurtus Formation (?Tommotian–Atdabanian equivalent) of the Aksu-Wushi area, west Xinjiang, China, has yielded abundant sclerites. These are secondarily phosphatized, but show considerable detail. The sclerites can be divided into three classes: cultrates, long palmates, and short palmates; definite siculates have not been recognized. In some samples elongate to semicircular shells co-occur with the sclerites; these may derive from the same halkieriid scleritome. The external surface of the shells may bear a subdued ornamentation. The concave interior, however, is remarkable on account of a unique structure consisting of a group of nodular-like units. These may be arranged in a low cone or dispersed in a small circle. In addition to the sclerites of halkieriids and their possibly associated shells, rarer material is attributable to the related group of siphogonuchitids.
III Zw 35 is a pair of galaxies characterised by intense OH maser emission, and powerful far-infrared and radio continuum. We have made a detailed study of the galaxy pair based on optical, infrared and radio observations. The brighter northern component is identified as a LINER or Seyfert galaxy and contains an active nuclear region from which radio continuum, OH maser and thermal dust emission are detected. We propose that the northern component has a compact active nucleus deeply embedded in an obscured region of diameter ~ 210 pc within which enhanced star-formation occurs. The lower luminosity, southern component is of low mass and is undergoing starburst activity over an extended region of diameter ~ 5.5 kpc. The origin of the starburst and non-thermal activity appears to be an interaction between the two components.
JET experiments have compared the efficacy of low- and high-field side ion cyclotron resonance heating (ICRH) as an actuator to deliberately minimise the sawtooth period. It is found that low-field side ICRH with low minority concentration is optimal for sawtooth control for two main reasons. Firstly, low-field side heating means that any toroidal phasing of the ICRH ($-90^{\circ }$, $+90^{\circ }$ or dipole) has a destabilising effect on the sawteeth, meaning that dipole phasing can be employed, since this is preferable due to less plasma wall interaction from Resonant Frequency (RF) sheaths. Secondly, the resonance position of the low-field side ICRH does not have to be very accurately placed to achieve sawtooth control, relaxing the requirement for real-time control of the RF frequency. These empirical observations have been confirmed by hybrid kinetic–magnetohydrodynamic modelling, and suggest that the ICRH antenna design for ITER is well positioned to provide a control actuator capable of having a significant effect on the sawtooth behaviour.
Background: For adolescents with epilepsy, there is often a poor system in place to meet their individualized transition needs. Our objectives were 1) to develop epilepsy-specific transition care management plans (TCMPs) to ensure access, and attachment to adult healthcare providers, and 2) to identify strategies for providing support during the transition period, including through the development of physician and patient (or caregiver) navigated web-based tools, resources and recommendations for health system improvements. Methods: Physicians and nurses with expertise in areas including adult and pediatric epilepsy, family medicine, psychiatry, and varied allied health professionals were engaged to generate epilepsy-related TCMPs. Results: Through an iterative process spanning the course of over a year, TCMPs were developed to cover areas including: treatment responsive and resistant epilepsy, ketogenic diet, epilepsy surgery, women’s issues, mental health, and psychosocial aspects of epilepsy. The TCMPs referenced established guidelines and best practices in the literature wherever possible. Caregiver roles and responsibilities were outlined, remaining cognoscent of available provincial resources. Conclusions: Epilepsy specific TCMPs can be developed through a collaborative approach between pediatric and adult healthcare providers, easing the patient experience, creating educated accountability, and providing a forum to identify and address gaps of care in adolescents with epilepsy.