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The psychiatric interview is an important tool in the field of psychiatry, allowing the clinician to connect with the patient and to gather information that will help determine a treatment plan. The skills for this crucial assessment are not necessarily “learned on the job,” but rather should be taught with dedicated time and attention to ensure that interviewers become both confident and effective. Continuous self-reflection is essential for improvement, and is important for both inexperienced trainees and experienced mental health clinicians alike.
Sustainability is becoming a major strategic driver within the aviation industry, which has moved from providing primarily economic benefits to delivering the ‘triple bottom line’, including social and environmental impact as well as financial performance. Sustainable aviation is also being tracked by the International Civil Aviation Organisation (ICAO) Global Collation for Sustainable Aviation. Operations and Infrastructure is an important near-term opportunity to deliver sustainability benefits. Digital Technologies, Integrated Vehicle Health Management (IVHM) and Maintenance Repair and Overhaul (MRO) play a prominent role in implementing these benefits, with a particular focus on operational efficiencies. As part of this, the sustainable smart hangar of the future is a concept that is becoming more and more important in forming the future of the aviation industry. The Hangar of the Future is an excellent opportunity for innovation, combining the progress in manufacturing, materials, robotics and artificial intelligence technologies. Succeeding in developing a hangar with these characteristics will provide us with potential benefits ranging from reduced downtime and costs to improved safety and environmental impact. This work explores some of the key features related to the sustainable smart hangar of the future by discussing research that takes place in DARTeC’s (Digital Aviation Research and Technology Centre) hangar led by the IVHM Centre in Cranfield. Additionally, the paper touches on some longer-term aspirations.
In December 2018, an outbreak of Salmonella Enteritidis infections was identified in Canada by whole-genome sequencing (WGS). An investigation was initiated to identify the source of the illnesses, which proved challenging and complex. Microbiological hypothesis generation methods included comparisons of Salmonella isolate sequence data to historical domestic outbreaks and international repositories. Epidemiological hypothesis generation methods included routine case interviews, open-ended centralized re-interviewing, thematic analysis of open-ended interview data, collection of purchase records, a grocery store site visit, analytic comparison to healthy control groups, and case–case analyses. Food safety hypothesis testing methods included food sample collection and analysis, and traceback investigations. Overall, 83 cases were identified across seven provinces, with onset dates from 6 November 2018 to 7 May 2019. Case ages ranged from 1 to 88 years; 60% (50/83) were female; 39% (22/56) were hospitalized; and three deaths were reported. Brand X profiteroles and eclairs imported from Thailand were identified as the source of the outbreak, and eggs from an unregistered facility were hypothesized as the likely cause of contamination. This study aims to describe the outbreak investigation and highlight the multiple hypothesis generation methods that were employed to identify the source.
An investigation into an outbreak of Salmonella Newport infections in Canada was initiated in July 2020. Cases were identified across several provinces through whole-genome sequencing (WGS). Exposure data were gathered through case interviews. Traceback investigations were conducted using receipts, invoices, import documentation, and menus. A total of 515 cases were identified in seven provinces, related by 0–6 whole-genome multi-locus sequence typing (wgMLST) allele differences. The median age of cases was 40 (range 1–100), 54% were female, 19% were hospitalized, and three deaths were reported. Forty-eight location-specific case sub-clusters were identified in restaurants, grocery stores, and congregate living facilities. Of the 414 cases with exposure information available, 71% (295) had reported eating onions the week prior to becoming ill, and 80% of those cases who reported eating onions, reported red onion specifically. The traceback investigation identified red onions from Grower A in California, USA, as the likely source of the outbreak, and the first of many food recall warnings was issued on 30 July 2020. Salmonella was not detected in any tested food or environmental samples. This paper summarizes the collaborative efforts undertaken to investigate and control the largest Salmonella outbreak in Canada in over 20 years.
0.5 molal iron(III) chloride solutions were hydrolysed at room temperature by base additions in the range OH/Fe mole ratio 0–2.75. After an ageing period the hydrolysed solutions were used to produce amorphous hydroxide gels from which crystalline products were grown at 65°C, at low pH or high pH. Examination of crystal composition and morphology and comparison with similarly treated nitrate solutions showed that the nucleation of hematite and goethite is inhibited in chloride containing solutions, which allow growth of small rod shaped β-FeOOH to predominate or occur exclusively in gels at pH 1–2. The addition of seed crystals of hematite and goethite allows competitive growth of all three minerals. The transformations β-FeOOH → α-Fe2O3 and β-FeOOH → α-FeOOH at pH 1–2 proceed by dissolution and reprecipitation and are promoted by adding seed crystals.
Australian Aboriginal and Torres Strait Islander peoples are disproportionately affected by diet-related disease such as type 2 diabetes, the rate of which is 20 fold higher than that of non-Indigenous young Australians(1). Before colonisation, Gomeroi and other First Nations people harvested, threshed and ground native grass seeds with water into a paste before cooking(2). The introduction of white refined flour has meant that time-consuming grass seed processing has mainly ceased, and native grains are no longer eaten habitually. The aim of this study was to determine the effect of 10% incorporation of two native grain flours on postprandial blood glucose response and Glycemic Index (GI). Five male and five female subjects, with a mean age of 30 ± 0.9 and BMI of 21.6 ± 0.4 and normoglycemic, participated in GI testing of three flour + water pancake compositions matched for available carbohydrate: 100% wheat (Wheat) and 90% wheat:10% native grains (Native_a and Native_b). Effect on satiety was determined using subjective ratings of hunger/fullness over the time course of the GI testing. In comparison to the plain flour pancake, replacing 10% plain wheat flour with Native_b flour significantly reduced the GI by 28.8% from 73 ± 5 to 48 ± 5, having a profound effect on postprandial blood glucose levels in 9 of 10 subjects (p<0.05, paired t-test). The GI of 10% Native_a flour pancake was not different from 100% wheat flour pancake (75 ± 5). Satiety tended to be greater when native grains were incorporated but this study was not powered to detect effect on satiety. In conclusion, replacing only 10% of plain wheat flour with Native_b flour was sufficient to significantly reduce the blood glycemic response to the pancake. This replacement could be easily implemented for prevention and treatment of type 2 diabetes. For Aboriginal people with access to grain Country, the nutritional health benefits associated with eating native grains, as well as the cultural benefits of caring for Country, will have a direct transformational impact on local communities. Our vision is to revitalise Gomeroi grains and to guide a sustainable Indigenous-led industry to heal Country and people through co-designed research.
Unsupervised classification is becoming an increasingly common method to objectively identify coherent structures within both observed and modelled climate data. However, in most applications using this method, the user must choose the number of classes into which the data are to be sorted in advance. Typically, a combination of statistical methods and expertise is used to choose the appropriate number of classes for a given study; however, it may not be possible to identify a single “optimal” number of classes. In this work, we present a heuristic method, the ensemble difference criterion, for unambiguously determining the maximum number of classes supported by model data ensembles. This method requires robustness in the class definition between simulated ensembles of the system of interest. For demonstration, we apply this to the clustering of Southern Ocean potential temperatures in a CMIP6 climate model, and show that the data supports between four and seven classes of a Gaussian mixture model.
To evaluate the effects of handshake antimicrobial stewardship on medicine floors at a large tertiary care hospital.
Design:
Retrospective observational study.
Setting:
1,278-bed academic hospital.
Patients:
Adults admitted to non-ICU medicine services.
Interventions:
A handshake stewardship team consisting of an infectious diseases (ID) physician and pharmacist reviewed charts of patients receiving antimicrobials on medicine floors without a formal ID consult. Recommendations were communicated in-person to providers and acceptance rates were examined with descriptive statistics. Additional data regarding program perception among providers were obtained via surveys. Antibiotic usage trends were extracted from National Healthcare Safety Network Antimicrobial Use option data and evaluated using an interrupted time-series analysis pre- and post-intervention.
Results:
The overall acceptance rate of interventions was 80%, the majority being recommendations either to discontinue (37%) or de-escalate therapy (28%). Medical residents and hospitalists rated the intervention favorably with 90% reporting recommendations were helpful all or most of the time. There was a statistically significant decrease in vancomycin (78 vs 70 DOT/1,000 d present (DP), p = 0.002) and meropenem (24 vs 17 DOT/1,000 DP, p = 0.007) usage and a statistically significant increase in amoxicillin-clavulanate usage (11 vs 15 DOT/1,000 DP, p < 0.001). Overall antibiotic usage remained unchanged by the intervention, though pre-intervention there was a nonsignificant overall increasing trend while post-intervention there was a nonsignificant decreasing trend in overall usage. There was no change in in-hospital mortality.
Conclusion:
The addition of handshake stewardship with adult medicine services was favorably viewed by participants and led to shifts in antibiotic usage.
In 2016, the National Center for Advancing Translational Science launched the Trial Innovation Network (TIN) to address barriers to efficient and informative multicenter trials. The TIN provides a national platform, working in partnership with 60+ Clinical and Translational Science Award (CTSA) hubs across the country to support the design and conduct of successful multicenter trials. A dedicated Hub Liaison Team (HLT) was established within each CTSA to facilitate connection between the hubs and the newly launched Trial and Recruitment Innovation Centers. Each HLT serves as an expert intermediary, connecting CTSA Hub investigators with TIN support, and connecting TIN research teams with potential multicenter trial site investigators. The cross-consortium Liaison Team network was developed during the first TIN funding cycle, and it is now a mature national network at the cutting edge of team science in clinical and translational research. The CTSA-based HLT structures and the external network structure have been developed in collaborative and iterative ways, with methods for shared learning and continuous process improvement. In this paper, we review the structure, function, and development of the Liaison Team network, discuss lessons learned during the first TIN funding cycle, and outline a path toward further network maturity.
Experimental data on the effects of lifestyle interventions on fetal neurodevelopment in humans remain scarce. This study assessed the impact of a pregnancy nutrition+exercise intervention on offspring neurodevelopment at 12 months of age. The Be Healthy in Pregnancy (BHIP) randomized controlled trial (RCT) randomly assigned pregnant persons with stratification by site and body mass index (BMI) to bi-weekly nutrition counselling and high dairy protein diet, walking goal of 10,000 steps/day plus usual prenatal care (UPC; intervention group) or UPC alone (control group). This study examined a subset of these mothers (> 18 years, singleton pregnancy, BMI <40 kg/m2, and enrolled by ≤12 weeks gestation) and their infants (intervention = 42, control = 32), assessing cognition, language, motor, social-emotional, and adaptive functioning at 12 months using the Bayley Scales of Infant and Toddler Development third edition (BSID-III) as the outcome measure. We also examined if maternal factors (prepregnancy BMI, gestational weight gain (GWG)) moderated associations. Expressive language (MD = 9.62, 95% CI = (9.05–10.18), p = 0.03, ƞ2p = 0.07) and general adaptive composite (GAC) scores (MD = 103.97, 95% CI = (100.31–107.63), p = 0.04, ƞ2p = 0.06) were higher in infants of mothers in the intervention group. Effect sizes were medium. However, mean cognitive, receptive language, motor, and social-emotional scale scores did not differ between groups. A structured and monitored nutrition+exercise intervention during pregnancy led to improved expressive language and general adaptive behavior in 12-month-olds, but not cognitive, receptive language, motor, or socioemotional functioning. While these experimental data are promising, further research is needed to determine the clinical utility of nutrition+exercise interventions for optimizing infant neurodevelopment.
This paper describes a case example where initiatives from private assurance schemes, scientists, charities, government and egg companies have improved the welfare of UK cage-free laying hens. The RSPCA and Soil Association farm assurance schemes introduced formal welfare outcome assessment into their annual audits of laying-hen farms in 2011. Feather loss was assessed on 50 birds from each flock on a three-point scale for two body regions: Head and Neck (HN) and Back and Vent (BV). In support of the observations, assessors were trained in feedback techniques designed to encourage change in farmer behaviour to improve welfare. In addition, during Year 2 farmers were asked about changes they had made, and intended to make on their farms. During 2011-2013 there were also wider industry initiatives to improve feather cover. Data were analysed from 830 and 743 farms in Year 1 and Year 2, respectively. From Year 1 to Year 2 there was a significant reduction in the prevalence of feather loss from 31.8% (9.6% severe) to 20.8% (6% severe) for the HN region, and from 33.1% (12.6% severe) to 22.7% (8.3% severe) for BV. Fifty-nine percent of 662 farmers reported they had made changes on their farms during Year 1 to improve bird welfare. For such a substantial industry change, attributing causation to specific initiatives is difficult; however, this is the first study to demonstrate the value to animal welfare of certification schemes monitoring the effectiveness of their own and other industry-led interventions to guide future policy.
Understanding global variation in democratic outcomes is critical to efforts to promote and sustain democracy today. Here, we use data on the democratic status of 221 modern and historical nations stretching back up to 200 years to show that, particularly over the last 50 years, nations with shared linguistic and, more recently, religious ancestry have more similar democratic outcomes. We also find evidence that for most of the last 50 years the democratic trajectory of a nation can be predicted by the democratic status of its linguistic and, less clearly, religious relatives, years and even decades earlier. These results are broadly consistent across three democracy indicators (Polity 5, Vanhanen's Index of Democracy, and Freedom in the World) and are not explained by geographical proximity or current shared language or religion. Our findings suggest that deep cultural ancestry remains an important force shaping the fortunes of modern nations, at least in part because democratic norms, institutions, and the factors that support them are more likely to diffuse between close cultural relatives.
Background: Poorly-defined cases (PDCs) of focal epilepsy are cases with no/subtle MRI abnormalities or have abnormalities extending beyond the lesion visible on MRI. Here, we evaluated the utility of Arterial Spin Labeling (ASL) MRI perfusion in PDCs of pediatric focal epilepsy. Methods: ASL MRI was obtained in 25 consecutive children presenting with poorly-defined focal epilepsy (20 MRI- positive, 5 MRI-negative). Qualitative visual inspection and quantitative analysis with asymmetry and Z-score maps were used to detect perfusion abnormalities. ASL results were compared to the hypothesized epileptogenic zone (EZ) derived from other clinical/imaging data and the resection zone in patients with Engel I/II outcome and >18 month follow-up. Results: Qualitative analysis revealed perfusion abnormalities in 17/25 total cases (68%), 17/20 MRI-positive cases (85%) and none of the MRI-negative cases. Quantitative analysis confirmed all cases with abnormalities on qualitative analysis, but found 1 additional true-positive and 4 false-positives. Concordance with the surgically-proven EZ was found in 10/11 cases qualitatively (sensitivity=91%, specificity=50%), and 11/11 cases quantitatively (sensitivity=100%, specificity=23%). Conclusions: ASL perfusion may support the hypothesized EZ, but has limited localization benefit in MRI-negative cases. Nevertheless, owing to its non-invasiveness and ease of acquisition, ASL could be a useful addition to the pre-surgical MRI evaluation of pediatric focal epilepsy.
Negative emotionality (NE) was evaluated as a candidate mechanism linking prenatal maternal affective symptoms and offspring internalizing problems during the preschool/early school age period. The participants were 335 mother–infant dyads from the Maternal Adversity, Vulnerability and Neurodevelopment project. A Confirmatory Bifactor Analysis (CFA) based on self-report measures of prenatal depression and pregnancy-specific anxiety generated a general factor representing overlapping symptoms of prenatal maternal psychopathology and four distinct symptom factors representing pregnancy-specific anxiety, negative affect, anhedonia and somatization. NE was rated by the mother at 18 and 36 months. CFA based on measures of father, mother, child-rated measures and a semistructured interview generated a general internalizing factor representing overlapping symptoms of child internalizing psychopathology accounting for the unique contribution of each informant. Path analyses revealed significant relationships among the general maternal affective psychopathology, the pregnancy- specific anxiety, and the child internalizing factors. Child NE mediated only the relationship between pregnancy-specific anxiety and the child internalizing factors. We highlighted the conditions in which prenatal maternal affective symptoms predicts child internalizing problems emerging early in development, including consideration of different mechanistic pathways for different maternal prenatal symptom presentations and child temperament.
Background: Poorly-defined cases (PDCs) of focal epilepsy are cases with no/subtle MRI abnormalities or have abnormalities extending beyond the lesion visible on MRI. Here, we evaluated the utility of Arterial Spin Labeling (ASL) MRI perfusion in PDCs of pediatric focal epilepsy. Methods: ASL MRI was obtained in 25 consecutive children presenting with poorly-defined focal epilepsy (20 MRI- positive, 5 MRI-negative). Qualitative visual inspection and quantitative analysis with asymmetry and Z-score maps were used to detect perfusion abnormalities. ASL results were compared to the hypothesized epileptogenic zone (EZ) derived from other clinical/imaging data and the resection zone in patients with Engel I/II outcome and >18 month follow-up. Results: Qualitative analysis revealed perfusion abnormalities in 17/25 total cases (68%), 17/20 MRI-positive cases (85%) and none of the MRI-negative cases. Quantitative analysis confirmed all cases with abnormalities on qualitative analysis, but found 1 additional true-positive and 4 false-positives. Concordance with the surgically-proven EZ was found in 10/11 cases qualitatively (sensitivity=91%, specificity=50%), and 11/11 cases quantitatively (sensitivity=100%, specificity=23%). Conclusions: ASL perfusion may support the hypothesized EZ, but has limited localization benefit in MRI-negative cases. Nevertheless, owing to its non-invasiveness and ease of acquisition, ASL could be a useful addition to the pre-surgical MRI evaluation of pediatric focal epilepsy.
Landforms and sediments on the palaeo–ice stream beds of central Alberta record glacitectonic raft production and subsequent progressive disaggregation and moulding, associated substrate ploughing, and grooving. We identify a subglacial temporal or developmental hierarchy that begins with incipient rafts, including en échelon hill-hole complexes, hill-hole pairs, and strike-slip raft complexes, all of which display patterns typical of transcurrent fault activation and pull apart. Many display jigsaw puzzle–style fragmentation, indicative of substrate displacement along shallow décollement zones and potentially related to patchy ice stream freeze-on. Their gradual fragmentation and smoothing produces ice flow-transverse ridges (ribbed moraine), hill-groove pairs, and paraxial ridge and groove associations. Initiator scarp and megafluting associations are indicative of raft dislodgement and groove ploughing, leading to the formation of murdlins, crag-and-tails, stoss-and-lee type flutings and drumlins, and Type 1 hogsback flutings. Downflow modification of rafts creates linear block trains (rubble stripes), stoss-and-lee type megaflutings, horned crag-and-tails, rubble drumlinoids, and murdlins, diagnostic of an immature palaeo–ice stream footprint. Lateral ice stream margin migration ingests disaggregated thrust masses to form ridged spindles, ladder-type morphologies, and narrow zones of ribbed terrain and Type 2 hogsback flutings, an assemblage diagnostic of ice stream shear margin moraine formation.
Background: Negative body image predicts many adverse outcomes. The current study prospectively examined patterns of body esteem development in early adolescence and identified predictors of developmental subtypes. Methods: 328 girls and 429 boys reported annually across a 4-year period (Mage at baseline = 11.14, SD = 0.35) on body esteem, appearance ideal internalization, perceived sociocultural pressures, appearance comparisons, appearance-related teasing, self-esteem, positive and negative affect, and dietary restraint. We performed latent class growth analyses to identify the most common trajectories of body esteem development and examine risk and protective factors for body image development. Results: Three developmental subgroups were identified: (a) high body esteem (39.1%); (b) moderate body esteem (46.1%); and (c) low body esteem (14.8%). Body esteem was stable within the low trajectory and there were minor fluctuations in the high and moderate trajectories. Greater appearance-related teasing, lower self-esteem, less positive affect, and higher dietary restraint predicted the low trajectory, whereas higher self-esteem and lower dietary restraint best predicted the high trajectory. Conclusions: Low body esteem appears to be largely stable from age 11 years. Prevention programming may be enhanced by incorporating components to address transdiagnostic resilience factors such as self-esteem and positive affect.
Introduction: The New Brunswick Trauma Registry is a database of injury admissions from eight hospitals throughout the province. Data tracks individuals in-hospital. By linking this information with vital statistics, we are able to observe outcomes post-discharge and can model health outcomes for participants. We want to know how outcomes for trauma patients compare with the general population post discharge. Methods: Using data from 2014-15, we followed over 2100 trauma registry observations for one year and tracked mortality rate per 1,000 people by age-group. We also compared the outcomes of this group to all Discharge Abstract Database (DAD) entries in the province (circa. 7500 total). We tracked mortality in-hospital, at six months, and one year after discharge. We truncated age into groups aged 40-64, 65-84, and 85 or older. Results: In-hospital mortality among those in the trauma registry is approximately 20 per 1,000 people for those age 40-64, 50 per 1,000 people for those aged 65-84, and 150 per 1,000 people aged 85 or older. For the oldest age group this is in line with the expected population mortality rate, for the younger two groups these estimates are approximately 2-4 times higher than expected mortality. The mortality at six-month follow-up for both of the younger groups remains higher than expected. At one-year follow-up, the mortality for the 65-84 age group returns to the expected population baseline, but is higher for those age 40-64. Causes of death for those who die in hospital are injury for nearly 50% of observations. After discharge, neoplasms and heart disease are the most common causes of death. Trends from the DAD are similar, with lower mortality overall. Of note, cardiac causes of death account for nearly as many deaths in the 6 months after the injury in the 40 -64 age group as the injury itself. Conclusion: Mortality rates remain high upon discharge for up to a year later for some age groups. Causes of death are not injury-related. Some evidence suggests that the injury could have been related to the eventual cause of death (e.g., dementia), but questions remain about the possibility for trauma-mitigating care increasing the risk of mortality from comorbidities. For example, cardiac death, which is largely preventable, is a significant cause of death in the 40-64 age group after discharge. Including an assessment of Framingham risk factors as part of the patients rehabilitation prescription may reduce mortality.