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Neuropsychological assessment of preschool children is essential for early detection of delays and referral for intervention prior to school entry. This is especially pertinent in low- and middle-income countries (LMICs), which are disproportionately impacted by micronutrient deficiencies and teratogenic exposures. The Grenada Learning and Memory Scale (GLAMS) was created for use in limited resource settings and includes a shopping list and face-name association test. Here, we present psychometric and normative data for the GLAMS in a Grenadian preschool sample.
Methods:
Typically developing children between 36 and 72 months of age, primarily English speaking, were recruited from public preschools in Grenada. Trained Early Childhood Assessors administered the GLAMS and NEPSY-II in schools, homes, and clinics. GLAMS score distributions, reliability, and convergent/divergent validity against NEPSY-II were evaluated.
Results:
The sample consisted of 400 children (190 males, 210 females). GLAMS internal consistency, inter-rater agreement, and test-retest reliability were acceptable. Principal components analysis revealed two latent factors, aligned with expected verbal/visual memory constructs. A female advantage was observed in verbal memory. Moderate age effects were observed on list learning/recall and small age effects on face-name learning/recall. All GLAMS subtests were correlated with NEPSY-II Sentence Repetition, supporting convergent validity with a measure of verbal working memory.
Conclusions:
The GLAMS is a psychometrically sound measure of learning and memory in Grenadian preschool children. Further adaptation and scale-up to global LMICs are recommended.
Young people with a first episode of psychosis can achieve full remission with prompt treatment. Throughout Canada, early psychosis intervention programs are implementing policies to ensure timely delivery of services. One of Canada’s first early intervention services, the Prevention and Early Intervention for Psychosis program, set the guideline that all youth referred should receive an appointment within 72 hours. The availability of early intervention programs has increased significantly but the standards these programs have adopted to ensure timely delivery of services remains unknown.
Objectives
This project aims to identify the policies and practices in early intervention programs that ensure timely delivery of services. Secondly, the project aims to understand the level of awareness of the 72-hour recommendation and the level of adoption of this recommendation. Thirdly, the project aims to identify the factors that facilitate and hinder a program’s ability to reach and maintain their benchmarks for timely delivery of services.
Methods
Participants included 17 service delivery providers from four early intervention programs located in socio-culturally distinct regions in Canada. Participants completed a survey about their program’s service delivery policies and practices. We led individual semi-structured interviews with seven service providers to identify the barriers and facilitators to delivering timely care. We conducted frequency analyses of the survey data and thematic analysis of the interviews to identify emerging themes.
Results
Forty-one percent of survey respondents indicated that their program implemented formal policies to minimize the delay to the first appointment, with benchmarks ranging from 72 hours to 12 weeks. The majority of program managers interviewed were aware of the 72-hour benchmark, voiced satisfaction with standards, and felt that establishing standards was helpful to delivering quality services. Average time between referral and first appointment ranged from 10 days to 12 weeks; however, more than half of survey respondents were unaware of the average delay in their program. Notable barriers to implementation included patient non-responsiveness, insufficient staffing, and missing patient contact information from referrals. The service providers reported engaged staff, flexible schedules, and team-based care as facilitators to meeting service delivery benchmarks.
Conclusions
Benchmarks such as the 72-hour recommendation are an excellent step in improving timeliness of delivery of early intervention services. Common barriers to meeting benchmarks, such as patient adherence and staff resources may be difficult to overcome; however, implementing standardized referral forms and processes, increasing staff engagement, providing flexible schedules, and encouraging team-based care could improve timely delivery of services.
International travel is thought to be a major risk factor for developing gastrointestinal (GI) illness for UK residents. Here, we present an analysis of routine laboratory and exposure surveillance data from North East (NE) England, describing the destination-specific contribution that international travel makes to the regional burden of GI infection.
Laboratory reports of common notifiable enteric infections were linked to exposure data for cases reported between 1 January 2013 and 31 December 2022. Demographic characteristics of cases were described, and rates per 100,000 visits were determined using published estimates of overseas visits from the Office for National Statistics (ONS) International Passenger Survey (IPS).
About 34.9% of cases reported international travel during their incubation period between 2013 and 2022, although travel-associated cases were significantly reduced (>80%) during the COVID-19 pandemic. Between 2013 and 2019, half of Shigella spp. and non-typhoidal Salmonella infections and a third of Giardia sp., Cryptosporidium spp., and Shiga toxin-producing Escherichia coli (STEC) infections were reported following travel. Rates of illness were highest in travellers returning from Africa and Asia (107.8 and 61.1 per 100,000 visits), with high rates also associated with tourist resorts like Turkey, Egypt, and the Dominican Republic (386.4–147.9 per 100,000 visits).
International travel is a major risk factor for the development of GI infections. High rates of illness were reported following travel to both destinations, which are typically regarded as high-risk and common tourist resorts. This work highlights the need to better understand risks while travelling to support the implementation of guidance and control measures to reduce the burden of illness in returning travellers.
The Greenland Ice Sheet has become an increasingly larger contributor to sea level rise in the past two decades and is projected to continue to lose mass. Climate variability is expected to increase under future warming, but the effect of climate variability on the Greenland Ice Sheet volume is poorly understood and is adding to the uncertainty of the projected mass loss. Here we quantify the influence of inter-annual temperature variability on mass loss from the Greenland Ice Sheet using the PISM model. We construct an ensemble of temperature-forcing fields that accounts for inter-annual variability in temperature using reanalysis data from NOAA-CIRES over the period 1851–2014. We investigate the steady-state and transient response of the Greenland Ice Sheet. We find that the simulated steady-state ice-sheet volume decreases by 1.9 ± 0.4 cm of sea level equivalent when forced with a varying temperature forcing compared to a constant temperature forcing, and by 11.5 ± 1.4 cm when the variability is doubled. The northern basins are particularly sensitive with a change in volume of 0.9–1.1%. Our results emphasize the importance of including temperature variability in projections of future mass loss.
Precision Medicine is an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle. Autoimmune diseases are those in which the body’s natural defense system loses discriminating power between its own cells and foreign cells, causing the body to mistakenly attack healthy tissues. These conditions are very heterogeneous in their presentation and therefore difficult to diagnose and treat. Achieving precision medicine in autoimmune diseases has been challenging due to the complex etiologies of these conditions, involving an interplay between genetic, epigenetic, and environmental factors. However, recent technological and computational advances in molecular profiling have helped identify patient subtypes and molecular pathways which can be used to improve diagnostics and therapeutics. This review discusses the current understanding of the disease mechanisms, heterogeneity, and pathogenic autoantigens in autoimmune diseases gained from genomic and transcriptomic studies and highlights how these findings can be applied to better understand disease heterogeneity in the context of disease diagnostics and therapeutics.
The young open cluster NGC 6231 hosts a rich population of O-type binary stars. We study several of these eccentric short-period massive eclipsing binaries and assess their fundamental parameters. The properties of these systems make them interesting targets to study tidally induced apsidal motion. The analysis of apsidal motion offers a powerful means to obtain information about the internal structure of the stars. Indeed, since the rate of apsidal motion in a binary system is proportional to the internal structure constants of the stars composing it, its value gives direct insight into the internal structure and evolutionary state of these stars. Stellar evolution models are constructed based on the observationally-determined fundamental parameters and a theoretical rate of apsidal motion is inferred. The results are striking: Adopting standard stellar evolution models yields a theoretical rate of apsidal motion much larger than the observational value. This discrepancy results from the standard models predicting too low an efficiency of internal mixing and thus too homogenous stars in terms of density. By enforcing the theoretical rates of apsidal motion to match the observational values, enhanced mixing is required, through a large overshooting parameter and/or additional turbulent/rotational mixing. Our analysis leads to the conclusion that the chemically mixed cores in those massive stars must be more extended than anticipated from standard models.
To investigate associations between multimodal analgesia and post-operative pain among patients undergoing transoral robotic surgery for oropharyngeal squamous cell carcinoma.
Methods
Records of patients who underwent surgery from 5 September 2012 to 30 November 2016 were abstracted. Associations were assessed using multivariable analysis.
Results
A total of 216 patients (mean age of 59.1 years, 89.4 per cent male) underwent transoral robotic surgery (92.6 per cent were human papilloma virus positive, 87.5 per cent had stage T1–T2 tumours, and 82.9 per cent had stage N0–N1 nodes). Gabapentin (n = 86) was not associated with a reduction in severe pain. Ibuprofen (n = 72) was administered less often in patients with severe pain. Gabapentin was not associated with increased post-operative sedation (p = 0.624) and ibuprofen was not associated with increased bleeding (p = 0.221). Post-operative opioid usage was not associated with surgical duration, pharyngotomy, bilateral neck dissections, tumour stage, tumour size, subsite or gabapentin.
Conclusion
Scheduled low-dose gabapentin was not associated with improved pain control or increased respiratory depression. Ibuprofen was not associated with an increased risk of bleeding and may be under-utilised.
Given the current lack of experimental data for shock waves interacting with incoming transitional boundary layers, the goal of this study was to characterize the dynamics of such an interaction to better understand the fundamental fluid physics of these complex phenomena. Here, the mean flow field and time-dependent characteristics of a three-dimensional Mach 5 cylinder-induced shock-wave/boundary-layer interaction where the upstream boundary layer is transitional, have been studied experimentally. The interactions were generated with a right circular cylinder mounted on a flat plate. Streamwise–spanwise planar laser scattering from a condensed alcohol fog and schlieren imaging were used to characterize the mean and instantaneous structure of the interaction, and fast-response wall-pressure measurements on the centreline upstream of the cylinder enabled characterization of the unsteadiness. The pressure measurements show a mean pressure profile that resembles a composite of an upstream laminar profile and a downstream turbulent profile. The upstream influence location of the transitional interaction was approximately 8.5 diameters ($d$) upstream of the cylinder leading edge, which is between that of a laminar and a turbulent interaction, and is followed by a plateau region to approximately $4d$ upstream of the cylinder. The plateau region is a region with a thicker boundary layer and possible flow separation. The plateau pressure was within 7 % of the value predicted by Hill's correlation for free-interaction phenomena. Furthermore, a statistical analysis of the pressure histories suggests that the entire interaction stretches and contracts in concert. Power spectral densities of the pressure fluctuations showed unsteadiness throughout the interaction with energy content primarily centred between a region defined by a separation-length-based Strouhal number $St_{L} = 0.05\text {--}0.2$, comparing well with other related studies of cylinder-induced interactions. Cross-correlations and coherence functions in the interaction suggest that the unsteadiness in the laminar region may be due to the entire ‘laminar’ region oscillating in response to the ‘turbulent’ unsteadiness of the intermittent region.
L’Organisation mondiale de la santé (OMS) définit l’empowerment comme faisant « référence au niveau de choix, de décision, d’influence et de contrôle que les usagers des services de santé mentale peuvent exercer sur les événements de leur vie (…). La clé de l’empowerment se trouve dans la transformation des rapports de force et des relations de pouvoir entre les individus, les groupes, les services et les gouvernements » (Wallerstein, 2006). L’OMS mentionne également les aidants dans le Pacte européen pour la santé mentale et le bien-être (2004, 2007) : « L’empowerment des personnes avec un problème de santé mentale et des aidants sont des priorités pour la prochaine décennie ». Suite aux 4e rencontres internationales du centre collaborateur de l’OMS pour la recherche et la formation en santé mentale (CCOMS, Lille, France), 21 recommandations en faveur de l’empowerment des usagers des services de santé mentale et des aidants ont été définies (document disponibles : http://www.ccomssantementalelillefrance.org/?q=promotion-des-indicateurs-d%E2 %80 %99empowerment). Cette première étape est le fruit d’un travail conjoint entre usagers, aidants, élus et professionnels. Une seconde étape, en cours, consiste à associer des indicateurs d’empowerment permettant de dresser une cartographie de l’empowerment en santé mentale en Europe. Cette communication présentera le concept d’empowerment en santé mentale, la promotion de cette notion par l’OMS et les 21 recommandations. La discussion portera sur la question fondamentale suivante : comment promouvoir de manière concrète ces recommandations ?
The horticultural industry is an important source of invasive ornamental plant species, which is part of the motivation for an increased emphasis on using native alternatives. We were interested in the possibility that plants marketed in the midwestern United States as the native Celastrus scandens, or American bittersweet, were actually the difficult-to-distinguish invasive Celastrus orbiculatus (oriental bittersweet) or hybrids of the two species. We used nuclear microsatellite DNA loci to compare the genetic identities of 34 plants from 11 vendors with reference plants from wild populations of known species identity. We found that 18 samples (53%) were mislabeled, and 7 of the 11 vendors sold mislabeled plants. Mislabeled plants were more likely to be purchased through Internet or phone order shipments and were significantly less expensive than accurately labeled plants. Vendors marketed mislabeled plants under five different cultivar names, as well as unnamed strains. Additionally, the most common native cultivar, ‘Autumn Revolution,’ displays reproductive characteristics that diverge from the typical C. scandens, which could be of some concern. The lower price and abundance of mislabeled invasive plants introduces incentives for consumers to unknowingly contribute to the spread of C. orbiculatus. Revealing the potential sources of C. orbiculatus is critical for controlling further spread of the invasive vine and limiting its impact on C. scandens populations.
An unprecedented outbreak of Ebola virus diseases (EVD) occurred in West Africa from March 2014 to January 2016. The French Institute for Public Health implemented strengthened surveillance to early identify any imported case and avoid secondary cases.
Methods
Febrile travellers returning from an affected country had to report to the national emergency healthcare hotline. Patients reporting at-risk exposures and fever during the 21st following day from the last at-risk exposure were defined as possible cases, hospitalised in isolation and tested by real-time polymerase chain reaction. Asymptomatic travellers reporting at-risk exposures were considered as contact and included in a follow-up protocol until the 21st day after the last at-risk exposure.
Results
From March 2014 to January 2016, 1087 patients were notified: 1053 were immediately excluded because they did not match the notification criteria or did not have at-risk exposures; 34 possible cases were tested and excluded following a reliable negative result. Two confirmed cases diagnosed in West Africa were evacuated to France under stringent isolation conditions. Patients returning from Guinea (n = 531; 49%) and Mali (n = 113; 10%) accounted for the highest number of notifications.
Conclusion
No imported case of EVD was detected in France. We are confident that our surveillance system was able to classify patients properly during the outbreak period.
Three-dimensionally phosphatized, spherical fossils, interpreted as metazoan eggs and embryos on the basis of taphonomic features and cleavage patterns, are reported for the first time from the Cambrian of North America. These microfossils occur with a phosphatized biota of skeletonized fossils, including specimens indicative of the earliest Cambrian Anabarites–Protohertzina Zone in the Wernecke Mountains of eastern Yukon Territory, northwestern Canada. They range in size from 0.25 mm to more than 1.0 mm in diameter and can be referred to two genera, Olivooides Qian, 1977 and Archaeooides Qian, 1977. The North American discovery extends the biogeographic range of earliest Cambrian eggs and embryos from coeval successions in China and Siberia, suggesting a wide geographic distribution of these taxa, and emphasizes the crucial role of local environmental and taphonomic conditions in preserving this phosphatic window into the record of early animal evolution. In addition to previously reported taxa, the phosphatized biota also include indeterminate spheroids, fused clusters of Protohertzina siciformis Missarzhevsky, 1973, the enigmatic rodlike fossil Zhejiangorhabdion comptum Yue and Zhao, 1993, phosphatized fossils, including Paradoxiconus typicalis Qian et al., 2001, protoconularid Carinachites sp., and phosphatic tubes assigned to Hyolithellus cf. H. isiticus Missarzhevsky, 1969, cf. Pseudorthotheca sp., and ?Rugatotheca sp.
The traces of macroboring organisms are known throughout the Phanerozoic, with diversification and exploitation of the macroboring niche paralleling variations in the development of skeletal metazoa. The oldest macroboring biota is an abundant yet low diversity fauna in hardgrounds and reefs of Lower Cambrian age. Following the extinction of archaeocyathids at the end of the Lower Cambrian (and thus the demise of skeletal reefs until the Middle Ordovician), boring organisms appear to be restricted to submarine hardgrounds. With the development of skeletal reefs in the Middle Ordovician the macroboring fauna shows a rapid speciation and a dramatic increase in diversity. This same pattern occurs again in the Devonian. This record appears to represent refuge of the fauna in low stress, hardground environments when skeletal reefs were not present and radiation in the high stress environment of the reef when large skeletal metazoa were abundant and diverse.
Infants in the neonatal intensive care unit (NICU) are at increased risk for methicillin-resistant Staphylococcus aureus (MRSA) acquisition. Outbreaks may be difficult to identify due in part to limitations in current molecular genotyping available in clinical practice. Comparison of genome-wide single nucleotide polymorphisms (SNPs) may identify epidemiologically distinct isolates among a population sample that appears homogenous when evaluated using conventional typing methods.
OBJECTIVE
To investigate a putative MRSA outbreak in a NICU utilizing whole-genome sequencing and phylogenetic analysis to identify recent transmission events.
DESIGN
Clinical and surveillance specimens collected during clinical care and outbreak investigation.
PATIENTS
A total of 17 neonates hospitalized in a 43-bed level III NICU in northeastern Florida from December 2010 to October 2011 were included in this study.
METHODS
We assessed epidemiological data in conjunction with 4 typing methods: antibiograms, PFGE, spa types, and phylogenetic analysis of genome-wide SNPs.
RESULTS
Among the 17 type USA300 isolates, 4 different spa types were identified using pulsed-field gel electrophoresis. Phylogenetic analysis identified 5 infants as belonging to 2 clusters of epidemiologically linked cases and excluded 10 unlinked cases from putative transmission events. The availability of these results during the initial investigation would have improved infection control interventions.
CONCLUSION
Whole-genome sequencing and phylogenetic analysis are invaluable tools for epidemic investigation; they identify transmission events and exclude cases mistakenly implicated by traditional typing methods. When routinely applied to surveillance and investigation in the clinical setting, this approach may provide actionable intelligence for measured, appropriate, and effective interventions.
Infect. Control Hosp. Epidemiol. 2015;36(7):777–785
Transmission electron microscopy (TEM) based orientation mapping has been used to measure the length fraction of coherent and incoherent Σ3 grain boundaries in a series of six nanocrystalline Cu thin films with thicknesses in the range of 26–111 nm and grain sizes from 51 to 315 nm. The films were annealed at the same temperature (600 °C) for the same length of time (30 min), have random texture, and vary only in grain size and film thickness. A strong grain size dependence of Σ3 (coherent and incoherent) and coherent Σ3 boundary fraction was observed. The experimental results are quantitatively compared with three physical models for the formation of annealing twins developed for microscale materials. The experimental results for the nanoscale Cu films are found to be in good agreement with the two microscale models that explain twin formation as a growth accident process.
We compare forests dominated by Gilbertiodendron dewevrei at the Dja Biosphere Reserve (Cameroon) with adjacent high-diversity mixed forests in terms of tree-species composition and stand structure, in order to understand the co-occurrence of mixed forest tree species in the monodominant forest. A total of 18 1-ha permanent plots were established in the two forest types. In each plot, all trees with dbh ≥10 cm were identified as were those <10 cm dbh within a subsample of 300 m2. Species richness was significantly different between the two forest types. Mixed forest had an average of 109 species ha−1 for trees ≥10 cm dbh and 137 species for trees <10 cm dbh. By contrast, G. dewevrei-dominated forest had an average of 47 species ha−1 (≥10 cm dbh) and 92 species (<10 cm dbh). There was no significant difference in terms of stem density of the trees with dbh <10 cm between the two forests (mixed: 3.7 stems m−2; monodominant: 3.1 stems m−2). As G. dewevrei is a shade-tolerant species that can regenerate under its own shade, its higher stem density and basal area can reduce species richness of an area.
Although playing a key role in the understanding of the supernova phenomenon, the evolution of massive stars still suffers from uncertainties in their structure, even during their “quiet” main sequence phase and later on during their subgiant and helium burning phases. What is the extent of the mixed central region? In the local mixing length theory (LMLT) frame, are there structural differences using Schwarzschild or Ledoux convection criterion? Where are located the convective zone boundaries? Are there intermediate convection zones during MS and post-MS phase, and what is their extent and location? We discuss these points and show how asteroseismology could bring some light on these questions.