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Community advisory boards (CABs) are a promising approach for strengthening patient and partner voices in community health center (CHC) evidence-based decision-making. This paper aims to describe how CHCs used CABs during the COVID-19 pandemic to improve the reach of testing among populations experiencing health disparities and identify transferable lessons for future implementation.
Methods:
This mixed methods study integrates brief quantitative surveys of community engagement (N = 20) and one-on-one qualitative interviews (N = 13) of staff and community partners engaged in CHC CABs with a cost analysis and qualitative feedback from CHC staff participating in an online learning community (N = 17).
Results:
Community partners and staff engaged in the CHC CABs reported high ratings of engagement, with all mean ratings of community engagement principles above a 4 (“very good” or “often”) out of 5. Qualitative findings provided a more in-depth understanding of experiences serving on the CHC CAB and highlighted how engagement principles such as trust and mutual respect were reflected in CAB practices. We developed a CHC CAB toolkit with strategies for governance and prioritization, cost estimates to ensure sustainment, guidance on integrating quality improvement expertise, testimonies from community members on the benefits of joining, and template agendas and facilitator training to ensure meeting success.
Conclusion:
In alignment with the Translational Science Benefits Model, this study expands research impact through comprehensive mixed methods measurement of community engagement and by transforming findings into an action-orientated guide for CHCs to implement CABs to guide evidence-based decision-making for community and public health impact.
Limited data exist on training of European paediatric and adult congenital cardiologists.
Methods:
A structured and approved questionnaire was circulated to national delegates of Association for European Paediatric and Congenital Cardiology in 33 European countries.
Results:
Delegates from 30 countries (91%) responded. Paediatric cardiology was not recognised as a distinct speciality by the respective ministry of Health in seven countries (23%). Twenty countries (67%) have formally accredited paediatric cardiology training programmes, seven (23%) have substantial informal (not accredited or certified) training, and three (10%) have very limited or no programme. Twenty-two countries have a curriculum. Twelve countries have a national training director. There was one paediatric cardiology centre per 2.66 million population (range 0.87–9.64 million), one cardiac surgical centre per 4.73 million population (range 1.63–10.72 million), and one training centre per 4.29 million population (range 1.63–10.72 million population). The median number of paediatric cardiology fellows per training programme was 4 (range 1–17), and duration of training was 3 years (range 2–5 years). An exit examination in paediatric cardiology was conducted in 16 countries (53%) and certification provided by 20 countries (67%). Paediatric cardiologist number is affected by gross domestic product (R2 = 0.41).
Conclusion:
Training varies markedly across European countries. Although formal fellowship programmes exist in many countries, several countries have informal training or no training. Only a minority of countries provide both exit examination and certification. Harmonisation of training and standardisation of exit examination and certification could reduce variation in training thereby promoting high-quality care by European congenital cardiologists.
Spectral-broadening of the APOLLON PW-class laser pulses using a thin-film compression technique within the long-focal-area interaction chamber of the APOLLON laser facility is reported, demonstrating the delivery of the full energy pulse to the target interaction area. The laser pulse at 7 J passing through large aperture, thin glass wafers is spectrally broadened to a bandwidth that is compatible with a 15-fs pulse, indicating also the possibility to achieve sub-10-fs pulses using 14 J. Placing the post-compressor near the interaction makes for an economical method to produce the shortest pulses by limiting the need for high damage, broadband optics close to the final target rather than throughout the entire laser transport system.
Evidence suggests that pregnant women who test positive for COVID-19 may develop more severe illness than non-pregnant women and may be at greater risk for psychological distress. The relationship between COVID-19 status (positive, negative, never tested) and symptoms of depression was examined in a survey study (May to September 2020) of pregnant women (n = 869). Pregnant women who reported testing positive for COVID-19 were significantly more likely to report depressive symptoms compared with women who tested negative (P = 0.027) and women who were never tested (P = 0.005). Findings indicate that pregnant women who test positive for COVID-19 should be screened and monitored for depressive symptoms.
We reported that the non-specific 5HT agonist m-chlorophenylpiperazine (mCPP) and the SSRI fluoxetine (FLX) both cause acute persistence increases in the rewarded alternation (RA) model of OCD. Chronic pretreatment with either substance or their combined subclinical doses protects from this ‘pathogenic’ effect, so mCPP and fluoxetine exhibit cross-tolerance and synergy.
Aims:
Using specific 5HT2A and 5HT2C receptor antagonists we investigated whether these receptors participate in a common mechanism of action mediating the acute mCPP/fluoxetine effect in our model.
Methods:
Naïve, male Wistars were used. Drugs used (intraperitoneally): FLX (10mg/kg), mCPP (2.5mg/kg), M100907 (5HT2A antagonist, 0.03mg/kg), SB242084 (5HT2C antagonist, 0.5mg/kg), vehicle. Experiments included a drug-free training/baseline phase in T-maze RA (group-matching for spontaneous persistence: SP).
Experiment 1: Effects of M100907, SB242084, vehicle were assessed on 3 matched low SP and 3 high SP groups.
Experiment 2: the acute effect of FLX, mCPP and saline were examined on RA in 3 SP-matched groups.
Experiment 3: Effects of Vehicle+FLX, M100900+FLX, SB242084+FLX and Vehicle were examined on RA, in 4 SP-matched groups.
Experiment 4: Correspondingly for mCPP.
Results:
Experiment 1: Neither M100907 nor SB242084 affected high or low SP.
Experiment 2 replicated the pathogenic effects of FLX/mCPP.
Experiment 3: Neither M100907 nor SB242084 affected the pathogenic effect of FLX.
Experiment 4: in contrast, SB242084 (but not M100907) significantly reduced the pathogenic mCPP effect.
Conclusions:
The acute pathogenic action of mCPP, but not of FLX, involves 5HT2C but not 5HT2A receptors. the similar acute action of mCPP and FLX on persistence cannot be attributed to 5HT2 mediation.
In the rewarded alternation model of obsessive compulsive disorder (OCD), the serotonin agonist m-chlorophenylpiperazine (mCPP) increases persistent behaviour, while chronic pretreatment with selective serotonin reuptake inhibitor (SSRI-fluoxetine) but not benzodiazepine or desipramine abolishes mCPP effects. However, we noted that acute SSRI administration also causes transient persistence increases, counteracted by mCPP pretreatment.
Objectives:
This study
a. further explores the apparent cross-tolerance between fluoxetine and mCPP and
b. extends the model by investigating its sensitivity to dopaminergic manipulations (D2,3 agonism - quinpirole).
Methods:
In both experiments, baseline and drug testing was carried out under daily T-maze alternation training.
Exp.1:
Matched group (n=8) pairs of rats received one of the following 20-day pretreatments (daily intraperitoneal administration):
1. saline,
2. low-dose fluoxetine (2.5mg/kg),
3. low-dose mCPP (0.5mg/kg) or
4. combined fluoxetine+mCPP.
One group per pretreatment then received a 4-day challenge with high-dose fluoxetine (10mg/kg), the other with high-dose mCPP (2.5mg/kg).
Exp.2:
One group (n=12) of rats received 20-day treatment with saline, another with quinpirole (0.5 mg/kg).
Results:
Exp.1:
Saline and low-dose mCPP- or fluoxetine-pretreated animals showed significant persistence increases under both challenges, while combined low-dose fluoxetine+mCPP pretreatment afforded full protection from either challenge.
Exp.2:
Quinpirole significantly increased directional persistence after 13 administration days.
Conclusions:
These results establish the sensitivity of the rewarded alternation OCD model to D2,3receptor activation, thereby extending its profile of pharmacological isomorphism with OCD. Furthermore, they suggest a common mechanism of action of an SSRI and a serotonin agonist in the control of directional persistence.
Schizophrenia and bipolar disorder are both associated with increased levels of serum lipids compared to healthy controls. However, it is not clear whether patients with schizophrenia differ from bipolar patients in terms of serum lipid concentrations and hyperlipidemia rates.
Methods:
The serum lipid levels of 160 patients with schizophrenia and 41 patients with bipolar disorder (manic episode), consecutively admitted in an acute psychiatric ward during a 2-year period, were assessed.
Results:
There was no significant difference in serum cholesterol, high-density lipoproteins, low-density lipoproteins or triglycerides levels between the two groups of patients, after controlling for age. A considerable rate of schizophrenia patients demonstrated high cholesterol levels (>200mg/dl; 45.6%), whereas 15.6% of them had elevated triglyceride levels (>150 mg/dl). In bipolar patients, the rates for both
hypercholesterolemia and hypertriglyceridemia were 29.3%. The above rates did not differ significantly between the two groups of patients.
Conclusions:
Acutely hospitalized patients with schizophrenia and bipolar disorder did not differ in serum lipid concentrations and hyperlipidemia rates.
Suicide seasonality with a peak incidence in spring or early summer has been consistently reported. Although a quite robust finding this spring peak of suicides is poorly understood. The effect of climate parameters such as sunlight, temperature, humidity etc. on hormones and neurotransmitters such as serotonin has been hypothesized to explain the seasonal variation in suicide.
Objective
To examine the amplitude of suicide seasonality in relation to sunlight duration and serotonergic medication.
Methods
By using Swedish Registers we gathered information including forensic data on antidepressive medication for 11,845 suicides during 1992 to 2003. Moreover, data for sunlight duration for the same period for all Swedish counties was obtained from the Swedish Meteorological and Hydrological Institute. The presence of suicide seasonality was estimated with a Poisson regression variant, in three groups, as defined by tertiles of sunlight duration.
Results
In regions with low sunlight duration no statistically significant seasonality pattern was found for men independently of medication. In regions with middle or high sunlight duration an increased amplitude of seasonality was observed among men treated with SSRIs in a dose dependent pattern. Such a pattern was not observed among suicide victims on other antidepressant medication or those without an antidepressant. Women on the other hand showed a seasonal variation in suicide only in regions with low sunlight duration.
Conclusions
Suicide seasonality amplitude increases with higher sunlight duration especially in men treated with SSRIs. In women, the highest suicide seasonality was observed in regions with the lowest sunshine duration.
Several investigations have shown the influence of environmental factors, i.e. seismic activity on human health. However, no studies have focused on the effect of earthquakes on mental health. Crete is located within a rectangular region at the boundaries of Eurasian and African tectonic plates with high seismicity.
Objectives
To investigate the effect of seismic activity on mental health.
Aim
To explore possible association between seismic activity and rates of hospital admissions of psychotic patients.
Methods
We compared the seismic activity (EQs with magnitude M>2) in a geographical area of Crete, and admissions to the Psychiatric Inpatient Unit/ University General Hospital of Heraklion, Crete during the years 2008–2010.
Results
Our analysis showed (1) a very low rate of admissions of psychotic patients suffering from acute psychotic disorders, during the period with several great (M>6.4) and middle (4.5< M< 6.4) magnitude period earthquakes (EQs), (2) an increasing trend of admissions of acute psychotic disorders during a period with increasing number of relatively small EQs(r=0.667; p< 0.001), (3) a correlation between the number of total monthly admissions and the number of M>2 EQs.
Conclusions
It appears that strong EQs have a protective effect on the relapse of major psychiatric disorders, whereas small EQs are associated with an increasing number of relapses. We hypothesized that the beneficial/adverse effects are related to anomalous electric fields/Extra Low Frequency (ELF)-Ultra Low Frequency (ULF) emissions.
In the 2015 review paper ‘Petawatt Class Lasers Worldwide’ a comprehensive overview of the current status of high-power facilities of ${>}200~\text{TW}$ was presented. This was largely based on facility specifications, with some description of their uses, for instance in fundamental ultra-high-intensity interactions, secondary source generation, and inertial confinement fusion (ICF). With the 2018 Nobel Prize in Physics being awarded to Professors Donna Strickland and Gerard Mourou for the development of the technique of chirped pulse amplification (CPA), which made these lasers possible, we celebrate by providing a comprehensive update of the current status of ultra-high-power lasers and demonstrate how the technology has developed. We are now in the era of multi-petawatt facilities coming online, with 100 PW lasers being proposed and even under construction. In addition to this there is a pull towards development of industrial and multi-disciplinary applications, which demands much higher repetition rates, delivering high-average powers with higher efficiencies and the use of alternative wavelengths: mid-IR facilities. So apart from a comprehensive update of the current global status, we want to look at what technologies are to be deployed to get to these new regimes, and some of the critical issues facing their development.
Radio frequency (RF) waves are routinely used in tokamak fusion plasmas for plasma heating, current control, as well as in diagnostics. These waves are excited by antenna structures placed near the tokamak’s wall and they have to propagate through a turbulent layer known as the scrape-off layer, before reaching the core plasma (which is their target). This layer exhibits coherent density fluctuations in the form of filaments and blobs. The scattering processes of RF plane waves by a single filament is studied with the assumption that the filament has a cylindrical shape and infinite length. Furthermore, besides the major toroidal component of the externally imposed magnetic field, there is also a small poloidal magnetic field component. Considering also that the cylindrical filament’s axis is not necessarily aligned with the toroidal direction, the total magnetic field is in general neither aligned with the axis of the cylinder nor with the toroidal direction. The investigation concerns the case of electron cyclotron (EC) waves (of frequency $f_{0}=170~\text{GHz}$) for tokamak applications. The study covers a variety of density contrasts between the filament and the ambient plasma, different magnetic field inclinations with respect to the cylinder axis (for the same magnitude of magnetic induction $B=4.5T$) and a wide range of filament radii.
Introduction: Resource allocation planning (RAP) for emergency medical services (EMS) systems determines optimal resources for patient needs in order to minimize morbidity and mortality. The British Columbia Emergency Health Services developed a new RAP using an evidenced informed methodology, statistical analysis of outcomes and with further clinical input from EMS physicians, paramedics and allied EMS providers. The revised RAP was implemented on a pan provincial basis in fall of 2013. It is unknown how the modifications will affect outcomes of EMS cases. Population-based analysis was used to determine the effect of a comprehensive RAP changes by comparing 24-hour mortality before and after province-wide implementation of the revised RAP. Methods: The primary outcome, 24-hour mortality, was obtained through linked provincial health administrative data. All adult cases with evaluable outcome data were included in the analysis. A pre and post methodology was used to evaluate the effect of post-RAP revision (post-RAP-revision) on 24-hour mortality compared to pre-RAP revision (pre-RAP-revision). Multivariable logistic regression was used to adjust for variations in other significant factors associated with 24-hour mortality. The interrupted time series (ITS) estimated any immediate changes in the level or trend of outcome after the start of the revised RAP implementation (fall of 2013), while simultaneously controlling for pre-existing trends. Results: The cohort is comprised of 562,546 cases (April 2012 March 2015). In the multivariate model, adjusted for age, sex, urban/metro region, season, day hour, and MPDS determinant, the probability of dying within 24 hours of EMS call was 7% lower in the post-RAP-revision cohort (OR=0.936; 95% CI: 0.886 - 0.989; P=0.018). A sub-group analysis of immediately life-threatening cases demonstrated similar effect (OR=0.890; 95% CI: 0.808 - 0.981; P=0.019) Conclusion: Our results demonstrate that a comprehensive, evidence informed reconstruction of a provincial EMS RAP is feasible. Despite considerable change in crew level response and resource allocation, there was significant decrease in 24 hour mortality in a large pan-provincial population based patient cohort.
Our current knowledge of star formation and accretion luminosity at high redshift (z > 3–4), as well as the possible connections between them, relies mostly on observations in the rest-frame ultraviolet, which are strongly affected by dust obscuration. Due to the lack of sensitivity of past and current infrared instrumentation, so far it has not been possible to get a glimpse into the early phases of the dust-obscured Universe. Among the next generation of infrared observatories, SPICA, observing in the 12–350 µm range, will be the only facility that can enable us to trace the evolution of the obscured star-formation rate and black-hole accretion rate densities over cosmic time, from the peak of their activity back to the reionisation epoch (i.e., 3 < z ≲ 6–7), where its predecessors had severe limitations. Here, we discuss the potential of photometric surveys performed with the SPICA mid-infrared instrument, enabled by the very low level of impact of dust obscuration in a band centred at 34 µm. These unique unbiased photometric surveys that SPICA will perform will fully characterise the evolution of AGNs and star-forming galaxies after reionisation.
The objective of the Apollon 10 PW project is the generation of 10 PW peak power pulses of 15 fs at $1~\text{shot}~\text{min}^{-1}$. In this paper a brief update on the current status of the Apollon project is presented, followed by a more detailed presentation of our experimental and theoretical investigations of the temporal characteristics of the laser. More specifically the design considerations as well as the technological and physical limitations to achieve the intended pulse duration and contrast are discussed.
This paper presents a new approach to vectoring jet thrust using a miniature fluidic actuator that provided spatially distributed mass addition. The fluidic actuators used had no moving parts and produced oscillatory flow with a square wave form at frequencies up to 1·6kHz. A subsonic jet with an exit diameter of 3·81cm was controlled using single and dual fluidic actuators, each with an equivalent circular diameter of 1·06mm. The fluidic nozzle was operated at pressures between 20·68 and 165·47kPa. The objectives of the present work included documentation of the actuation characteristics of fluidic devices, assessment of the effectiveness of fluidic devices for jet thrust vectoring, and evaluation of mass flow requirements for vectoring under various conditions. Measurements were made in the flow field using a pitot probe for the vectored and unvectored cases. Some acoustic measurements were made using microphones in the near-field and for selected cases particle image velocimetry (PIV) measurements were made. Thrust vectoring was obtained in low speed jets by momentum effects with fluidic device mass flow rates of only 2 × 10–4kg/sec (0·6% of main jet mass flow per fluidic oscillator). Although a single fluidic device produced vectoring of the primary jet, the dual fluidic device configuration (with two fluidic devices on either side of the jet exit) produced mass flux enhancement of 28% with no vectoring. Our results indicate that fluidic actuators have the potential for use in thrust vectoring, flow mixing and industrial flow deflection applications.
The objective of the Apollon project is the generation of 10 PW peak power pulses of 15 fs at 1 shot/minute. In this paper the Apollon facility design, the technological challenges and the current progress of the project will be presented.
We have numerically investigated the development of strong Langmuir turbulence (SLT) and associated electron acceleration at different angles of incidence of ordinary (O) mode pump waves. For angles of incidence within the Spitze cone, the turbulence initially develops within the first maximum of the Airy pattern near the plasma resonance altitude. After a few milliseconds, the turbulent layer shifts downwards by about 1 km. For injections outside the Spitze region, the turning point of the pump wave is at lower altitudes. Yet, an Airy-like pattern forms here, and the turbulence development is quite similar to that for injections within the Spitze. SLT leads to the acceleration of 10–20 eV electrons that ionize the neutral gas thereby creating artificial ionospheric layers. Our numerical modeling shows that most efficient electron acceleration and ionization occur at angles between the magnetic and geographic zenith, where SLT dominates over weak turbulence. Possible effects of the focusing of the electromagnetic beam on magnetic field-aligned density irregularities and the finite heating beam width at the magnetic zenith are also discussed. The results have relevance to ionospheric heating experiments using ground-based, high-power radio transmitters to heat the overhead plasma, where recent observations of artificial ionization layers have been made.
Control of rigid–flexible multi-body systems in space, during cooperative manipulation tasks, is studied in this paper. During such tasks, flexible members such as solar panels may vibrate. These vibrations in turn can lead to oscillatory disturbing forces on other subsystems, and consequently may produce significant errors in the position of operating end-effectors of cooperative arms. Therefore, to design and implement efficient model-based controllers for such complicated nonlinear systems, deriving an accurate dynamics model is required. On the other hand, due to practical limitations and real-time implementation, such models should demand fairly low computational complexity. In this paper, a precise dynamics model is derived by virtually partitioning the system into two rigid and flexible portions. These two portions will be assembled together to generate a proper model for controller design. Then, an adaptive hybrid suppression control (AHSC) algorithm is developed based on an appropriate variation rule of a virtual damping parameter. Finally, as a practical case study a space free-flying robot (SFFR) with flexible appendages is considered to move an object along a desired path through accurate force exertion by several cooperative end-effectors. This system includes a main rigid body equipped with thrusters, two solar panels, and two cooperative manipulators. The system also includes a third and fourth arm that act as a communication antenna and a photo capturing camera, respectively. The maneuver is deliberately planned such that flexible modes of solar panels get stimulated due to arms motion, while obtained results reveal the merits of proposed controller as will be discussed.
We study the action of the elements of the mapping class group of a surface of finite type on the Teichmüller space of that surface equipped with Thurston's asymmetric metric. We classify such actions as elliptic, parabolic, hyperbolic and pseudo-hyperbolic, depending on whether the translation distance of such an element is zero or positive and whether the value of this translation distance is attained or not, and we relate these four types to Thurston's classification of mapping class elements. The study is parallel to the one made by Bers in the setting of Teichmüller space equipped with Teichmüller's metric, and to the one made by Daskalopoulos and Wentworth in the setting of Teichmüller space equipped with the Weil–Petersson metric.