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Responding to increasing concerns regarding human-induced climate change and shared commitment as environmental educators to support climate action, we crafted this article as a composite piece — an emerging method of inquiry. We are eleven contributors: the Editorial Executive of the Australian Journal of Environmental Education and two colleagues who each respond to prompts concerning our experience of climate change and our practices of climate change education. The responses provide insights regarding how we strive to enact meaningful climate action, education, advocacy and agency. This article presents the reader with various ways environmental educators work through eco-anxiety and engage in active hope when supporting climate change education/agency/action. The following insights emerged, illustrating 1. the significance of embracing diverse perspectives and knowledge systems; 2. Emotions as catalysts for action and activism; 3. the value of fostering collaborative spaces/relationships/communities that empower people; 4. the importance of integrating ethical responses and critical climate literacy in climate change education/research; 5. learning from places and multi-species entanglements; 6. acknowledging tensions. We offer these six insights not as a solution but as a potentially generative heuristic for navigating the complexity and uncertainty of climate change education in contemporary times.
A clinical tool to estimate the risk of treatment-resistant schizophrenia (TRS) in people with first-episode psychosis (FEP) would inform early detection of TRS and overcome the delay of up to 5 years in starting TRS medication.
Aims
To develop and evaluate a model that could predict the risk of TRS in routine clinical practice.
Method
We used data from two UK-based FEP cohorts (GAP and AESOP-10) to develop and internally validate a prognostic model that supports identification of patients at high-risk of TRS soon after FEP diagnosis. Using sociodemographic and clinical predictors, a model for predicting risk of TRS was developed based on penalised logistic regression, with missing data handled using multiple imputation. Internal validation was undertaken via bootstrapping, obtaining optimism-adjusted estimates of the model's performance. Interviews and focus groups with clinicians were conducted to establish clinically relevant risk thresholds and understand the acceptability and perceived utility of the model.
Results
We included seven factors in the prediction model that are predominantly assessed in clinical practice in patients with FEP. The model predicted treatment resistance among the 1081 patients with reasonable accuracy; the model's C-statistic was 0.727 (95% CI 0.723–0.732) prior to shrinkage and 0.687 after adjustment for optimism. Calibration was good (expected/observed ratio: 0.999; calibration-in-the-large: 0.000584) after adjustment for optimism.
Conclusions
We developed and internally validated a prediction model with reasonably good predictive metrics. Clinicians, patients and carers were involved in the development process. External validation of the tool is needed followed by co-design methodology to support implementation in early intervention services.
Coronavirus disease 2019 (COVID-19) was first recognised in December 2019. The subsequent pandemic has caused 4.3 million deaths and affected the lives of billions. It has increased psychosocial risk factors for mental illness including fear, social isolation and financial insecurity and is likely to lead to an economic recession. COVID-19 is associated with a high rate of neuropsychiatric sequelae. The long-term effects of the pandemic on mental health remain uncertain but could be marked, with some predicting an increased demand for psychiatric services for years to come. COVID-19 has turned a spotlight on mental health for politicians, policy makers and the public and provides an opportunity to make mental health a higher public health priority. We review longstanding reasons for prioritising mental health and the urgency brought by the COVID-19 pandemic, and highlight strategies to improve mental health and reduce the psychiatric fallout of the pandemic.
This 86-year-old right-handed man with a 4-year history of Parkinson disease dementia (PDD) presented for follow-up with his wife, who reported a substantial decline. He was diagnosed with Parkinson disease (PD) five years prior and progressive cognitive impairment emerged three years later. At the visit, she described increasingly frequent episodes of unresponsiveness. These episodes would begin with the patient feeling tired, followed by a period of immobile unresponsiveness associated with glazed eyes lasting up to 10 minutes. The episodes occurred most commonly after eating breakfast. He was admitted to the hospital after one such event and his systolic blood pressure (BP) was reported to be as high as 250 mmHg, and was discharged on three new antihypertensive medications (lisinopril, hydralazine, and metoprolol). After this admission his episodes became more frequent. His wife noticed that having him lie down allowed him to recover promptly from episodes of unresponsiveness. No changes had been made to his levodopa regimen, which continued to be 200 mg three times a day.
Imazaquin and imazethapyr were applied postemergence to soybeans for control of 8- to 12-leaf rhizome johnsongrass and pitted morningglory in the field. At 8 weeks, johnsongrass control was 70% with 70 g ai/ha imazaquin plus 105 g ai/ha imazethapyr but was no more than 50% with a single application of either herbicide. Imazaquin at 70 g/ha plus imazethapyr at 35 g/ha interacted synergistically to provide 90% pitted morningglory control, while 140 g/ha imazaquin controlled 77%. Imazaquin at 70 g/ha with imazethapyr from 18 to 105 g/ha controlled both weed species equal to or better than that obtained with 140 g/ha imazaquin.
Individual herbicides and all double combinations of imazaquin, imazethapyr, and imazapyr were applied alone and in combination to the foliage of pitted morningglory plants in order to evaluate potential influences on translocation. Unlabeled imazethapyr at 5.62 μg plant−1 stimulated basipetal translocation of both 14C-imazaquin and 14C–imazapyr. Unlabeled imazaquin at 7.49 μg plant−1 also increased basipetal translocation of 14C–imazethapyr but did not influence 14C–imazapyr translocation. No combination affected the amount of 14C herbicide remaining in treated leaves or moving into foliage above treated leaves. Unlabeled imazapyr at 0.11 μg plant−1 did not affect movement of either imazaquin or imazethapyr.
Field experiments were conducted to evaluate postemergence combinations of imazethapyr, imazquin, or chlorimuron with low rates of imazapyr for Johnsongrass and pitted morningglory control. Imazapyr applied alone at rates up to 4 g ai/ha gave little or no control of either weed species. However, the addition of imazapyr to various rates of imazethapyr or imazaquin synergistically increased both johnsongrass and pitted morningglory control 8 weeks after treatment. The rates of imazethapyr or imazaquin required for significant enhancement of johnsongrass control were higher than those required for pitted morningglory control. No synergistic increases in control of either weed species were noted with mixtures of imazapyr and chlorimuron. Although not synergistic in every case, the mixtures of imazapyr at 4 g/ha with imazethapyr, imazaquin, or chlorimuron gave johnsongrass and pitted morningglory control equal to or better than the next higher rate of these herbicides applied alone. Imazapyr did not increase soybean injury or decrease yield provided by chlorimuron, imazaquin, or imazethapyr.
This study investigates the use of ‘simple’ glasses, comprising six components, to represent the structure of complex LAW glasses proposed for Immobilized Low Activity Wastes from the Hanford site in the USA. The 18 elements present in ILAW glasses LAW A44, ORP LB2, and LAW A23 were represented by Al2O3, B2O3, CaO, Na2O, SiO2, and ZrO2 according to their coordination chemistry and their roles as network formers and modifiers. The dissolution behavior of each ‘simple’ glass was compared to its corresponding candidate “complex” LAW glass through PCT-B tests. Significant differences were observed; the durability of complex glasses was concluded to be LAW A44 > ORP LB2 ≥ LAW A23 whereas in their simplified versions the order was LAW A44 > LAW A23 > ORP LB2. These results are discussed in relation to compositional differences and highlight the importance of minor glass components in controlling glass durability. The implications of these results for the use of simplified glass compositions are discussed.
Although pain is not generally recognized as a symptom of tic disorders, we have seen a number of patients in whom this was a prominent feature, at times even the symptom of greatest concern. The commonest pain complaints are those arising from the actual performance of a tic. Most often this follows directly from the discomfort produced by sudden or repeated extreme exertion. Here the origin of the pain is usually musculoskeletal, though rare examples of neuropathic pain may occur. Pain also may arise from striking or being struck by a moving body part involved in large amplitude tics. Other related painful acts include deliberate self-injury and pain inflicted upon others. A second major category is represented by a smaller number of patients who complain of pain during voluntary efforts to suppress their tics. Finally, there are patients who obtain relief from tics while experiencing pain, to such an extent that they will deliberately provoke pain to obtain its benefit. We feel that pain should be recognized as a common complaint, and occasionally a source of significant disability, in patients with tics.
CQA 206-291, a new ergot derivative with a “biphasic” dopaminergic profile, was studied in 6 patients with longstanding Parkinson's disease suffering from pronounced fluctuations in hourly mobility. On alternate days, up to seven single doses, escalating from 0.2 to 20 mg, were given as replacement for the usual first morning dose of levodopa. At the most effective dosage, four of the six patients obtained as good a peak response to CQA (8-20 mg) as to L-dopa. Side effects were common and similar to other ergot derivatives, suggesting that the initial weak dopamine antagonist properties of the parent compound, documented in animals, may be of little clinical significance. However, comparative studies will be needed to confirm this suspicion. The addition of domperidone successfully reduced the incidence and severity of side effects. CQA 206-291 has potent anti-parkinsonian properties; further longer-term treatment trials are indicated.
The emergence of methyl-ammonium lead halide (MAPbX3) perovskites motivates the identification of unique properties giving rise to exceptional bulk transport properties, and identifying future materials with similar properties. Here, we propose that this “defect tolerance” emerges from fundamental electronic-structure properties, including the orbital character of the conduction and valence band extrema, the charge-carrier effective masses, and the static dielectric constant. We use MaterialsProject.org searches and detailed electronic-structure calculations to demonstrate these properties in other materials than MAPbX3. This framework of materials discovery may be applied more broadly, to accelerate discovery of new semiconductors based on emerging understanding of recent successes.
Clostridium difficile infection (CDI) has been extensively described in healthcare settings; however, risk factors associated with community-acquired (CA) CDI remain uncertain. This study aimed to synthesize the current evidence for an association between commonly prescribed medications and comorbidities with CA-CDI.
Methods
A systematic search was conducted in 5 electronic databases for epidemiologic studies that examined the association between the presence of comorbidities and exposure to medications with the risk of CA-CDI. Pooled odds ratios were estimated using 3 meta-analytic methods. Subgroup analyses by location of studies and by life stages were conducted.
Results
Twelve publications (n=56,776 patients) met inclusion criteria. Antimicrobial (odds ratio, 6.18; 95% CI, 3.80–10.04) and corticosteroid (1.81; 1.15–2.84) exposure were associated with increased risk of CA-CDI. Among the comorbidities, inflammatory bowel disease (odds ratio, 3.72; 95% CI, 1.52–9.12), renal failure (2.64; 1.23–5.68), hematologic cancer (1.75; 1.02–5.68), and diabetes mellitus (1.15; 1.05–1.27) were associated with CA-CDI. By location, antimicrobial exposure was associated with a higher risk of CA-CDI in the United States, whereas proton-pump inhibitor exposure was associated with a higher risk in Europe. By life stages, the risk of CA-CDI associated with antimicrobial exposure greatly increased in adults older than 65 years.
Conclusions
Antimicrobial exposure was the strongest risk factor associated with CA-CDI. Further studies are required to investigate the risk of CA-CDI associated with medications commonly prescribed in the community. Patients with diarrhea who have inflammatory bowel disease, renal failure, hematologic cancer, or diabetes are appropriate populations for interventional studies of screening.
We evaluated the behaviors of anesthesiologists during induction and maintenance of anesthesia. Contacts with surfaces occurred a mean (±standard error) of 154.8 ± 7.7 and 60 ± 3.1 times per hour during induction and maintenance, respectively (P < .0001). Hand hygiene events were 1.8 ± 0.27 per hour during induction versus 1.19 ± 0.27 during maintenance (P = .018).
Infect Control Hosp Epidemiol 2014;35(8):1056–1059
Our aim was to compare the return-to-work rates between individuals supported by their GP plus workplace health advisers (intervention group) and those supported by their GP alone.
Background
Workplace sickness absence places a significant cost burden on individuals and the wider economy. Previous research shows better outcomes for individuals if they are supported while still in employment, or have been on sick leave for four weeks or less. Those helped back to work at an early stage are more likely to remain at work. A non-medicalised case-managed approach appears to have the best outcomes and can prevent or reduce the slide onto out-of-work benefits, but UK literature on its effectiveness is sparse.
Methods
The design was a feasibility-controlled trial in which participants were sickness absentees, or presentees in employment with work-related health problems. Individuals completed health status measures (SF-36; EQ-5D) and a Job Content Questionnaire at baseline and again at four-month follow-up.
Findings
In the intervention group, 29/60 participants completed both phases of the trial. GP practices referred two control patients, and, despite various attempts by the research team, GPs failed to engage with the trial. This finding is of concern, although not unique in primary care research. In earlier studies, GPs reported a lack of knowledge and confidence in dealing with workplace health issues. Despite this, we report interesting findings from the case-managed group, the majority of whom returned to work within a month. Age and length of sickness absence at recruitment were better predictors of return-to-work rates than the number of case-managed contacts. The traditional randomised controlled trial approach was unsuitable for this study. GPs showed low interest in workplace sickness absence, despite their pivotal role in the process. This study informed a larger Department for Work and Pensions study of case-managed support.
Background: With rapid aging, Singapore faces an increasing proportion of the population with age-related dementia. We used system dynamics methodology to estimate the number and proportion of people with mild, moderate, and severe dementia in future years and to examine the impact of changing family composition on their likely living arrangements.
Methods: A system dynamics model was constructed to estimate resident population, drawing birth and mortality rates from census data. We simulate future mild, moderate, and severe dementia prevalence matched with estimates of total dementia prevalence for the Asian region that includes Singapore. Then, integrating a submodel in which family size trends were projected based on fertility rates with tendencies for dependent elderly adults with dementia to live with family members, we estimate likely living arrangements of the future population of individuals with dementia.
Results: Though lower than other previous estimates, our simulation results indicate an increase in the number and proportion of people in Singapore with severe dementia. This and the concurrent decrease in family size point to an increasing number of individuals with dementia unlikely to live at home.
Conclusions: The momenta of demographic and illness trends portend a higher number of individuals with dementia less likely to be cared for at home by family members. Traditions of care for frail elderly found in the diverse cultures of Singapore will be increasingly difficult to sustain, and care options that accommodate these demographic shifts are urgently needed.