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Embedding climate resilient development principles in planning, urban design, and architecture means ensuring that transformation of the built environment helps achieve carbon neutrality, effective adaptation, and well-being for people and nature. Planners, urban designers, and architects are called to bridge the domains of research and practice and evolve their agency and capacity, developing methods and tools consistent across spatial scales to ensure the convergence of outcomes towards targets. Shaping change necessitates an innovative action-driven framework with multi-scale analysis of urban climate factors and co-mapping, co-design, and co-evaluation with city stakeholders and communities. This Element provides analysis on how urban climate factors, system efficiency, form and layout, building envelope and surface materials, and green/blue infrastructure affect key metrics and indicators related to complementary aspects like greenhouse gas emissions, impacts of extreme weather events, spatial and environmental justice, and human comfort. This title is also available as open access on Cambridge Core.
Students of the arts are empowered to explore new concepts, communicate confidently and grow into creative, critical thinkers. Teaching the Arts: Early Childhood and Primary Education emphasises the fundamental nature of the arts in learning and development. Arranged in three parts and focusing on the key areas of dance, drama, media arts, music and visual arts, this book encourages educators to connect to the 'why', 'what' and 'how' of arts education. This fourth edition continues to provide up-to-date and comprehensive coverage of arts education in Australia, with links to the updated Australian Curriculum and Early Years Learning Framework. The text supports further learning in each area of the Arts through teacher tips, spotlights on Arts education and teaching in the remote classroom. Teaching the Arts is an essential resource for all pre-service early childhood and primary teachers aiming to diversify and enhance their engagement with the Arts in early education environments.
In order to cast a satisfying vote, understand politics, or otherwise participate in political discourse or processes, voters must have some idea of what policies parties are pursuing and, more generally, 'who goes with whom.' This Element aims to both advance the study of how voters formulate and update their perceptions of party brands and persuade our colleagues to join us in studying these processes. To make this endeavor more enticing, but no less rigorous, the authors make three contributions to this emerging field of study: presenting a framework for building and interrogating theoretical arguments, aggregating a large, comprehensive data archive, and recommending a parsimonious strategy for statistical analysis. In the process, they provide a definition for voters' perceptions of party brands and an analytical schema to study them, attempt to contextualize and rationalize some competing findings in the existing literature, and derive and test several new hypotheses.
To identify changes in emergency department (ED) use in Houston, TX during the mid-summer Hurricane Beryl-induced power outage to inform future targeted public health interventions.
Methods
Syndromic surveillance system ED visit daily counts for total visits, heat-related illness, carbon monoxide poisoning, acute cardiac condition, stroke, dialysis, and medication refills post-hurricane were statistically compared to the 2 weeks prior and plotted alongside the percentage of the population with power outage.
Results
Daily ED visits post-storm were statistically higher (P< 0.05) than the 2 weeks prior for total visits and acute cardiac events (Day 1, 2); heat-related illness (Day 1-3); dialysis (Day 0-3); and carbon monoxide poisoning and medication refill (Day 1-9).
Conclusions
While 50% of the city experienced power outages from high winds, total ED visits, acute cardiac events, and heat-related illness were statistically higher in the first 3 days after Beryl than expected. Houston developed targeted messaging to mitigate these events in future disasters.
Ketamine exerts potent but transient antidepressant effects in treatment-resistant depression (TRD). Combinations of ketamine and psychotherapy have attracted interest, but no trial has investigated a psychedelic model of ketamine–psychotherapy for TRD to our knowledge.
Aims
This secondary analysis of a randomised clinical trial (RCT) explores the therapeutic effects and experiential mechanisms of the Montreal Model of ketamine–psychotherapy for TRD, with or without music.
Method
A two-centre, single-blinded, RCT conducted in Montreal, Canada, between January 2021 and August 2022 (NCT04701866). Participants received ketamine–psychotherapy for TRD – six subanaesthetic infusions over 4 weeks and psychological support – with either music or matched non-music support during ketamine doses, as per random group assignments. The primary therapeutic outcome was the Montgomery–Åsberg Depression Rating Scale, assessed by blinded raters. Psychedelic-like experiences, evaluated by the Mystical Experience Questionnaire and Emotional Breakthrough Inventory, and their session-by-session relationships with depression were explored with multilevel, time-lagged covariate models with autoregressive residuals.
Results
Thirty-two participants with severe and highly comorbid TRD, including high rates of personality disorder and suicidality, received 181 ketamine infusions. Therapeutic outcomes and psychedelic experiences did not differ between music (n = 15) and non-music (n = 17) interventions. Both groups experienced significant reductions in clinician-rated and self-reported depression (d = 1.2 and d = 0.87, respectively; p < 0.001), anxiety (d = 0.8, p < 0.001) and suicidality (d = 0.4, p < 0.05) at 4 weeks, fully maintained at 8-week follow-up. Ketamine experiences were highly emotional and mystical. Converging analyses supported mystical-like ketamine experiences as mechanisms of its antidepressant effects.
Conclusions
This trial found large and notably sustained benefits of ketamine–psychotherapy for severe TRD, with or without music, and psychedelic experiences of comparable intensity to those observed with psilocybin. Mystical-like experiences may particularly contribute to ketamine’s immediate and persistent psychiatric benefits.
The Paragaricocrinidae is an enigmatic late Paleozoic family of camerate crinoids that retained a robustly constructed calyx more typical of Devonian to Early Mississippian crinoids. The discovery of the oldest member of this family, Tuscumbiacrinus madisonensis n. gen. n. sp., initiated a phylogenetic investigation of the Paragaricocrinidae and consideration of its diversification and paleobiogeographic distribution. Phylogenetic analyses demonstrate the need to describe Tuscumbiacrinus n. gen and conduct revisions to preexisting taxa, resulting in the description of Palenciacrinus mudaensis n. gen. n. sp.; Pulcheracrinus n. gen.; Nipponicrinus hashimotoi n. gen. n. sp.; and Nipponicrinus akiyoshiensis n. gen. n. sp. Megaliocrinus exotericus Strimple is reassigned to Pulcheracrinus n. gen. In addition to having an anachronistic morphology, relatively few specimens are known through the ca. 76-million-year duration of this family. This pattern is unlikely to have resulted from low fossil sampling alone, and instead likely reflects low abundance and/or taxonomic richness of a long-lived waning clade. From its apparent origination in Laurussia during the Mississippian, the Paragaricocrinidae diversified into a cosmopolitan clade. Following a diversity drop during the Pennsylvanian, the Paragaricocrinidae persisted but exemplified characteristics of a dead clade walking until its eventual extinction during the middle Permian (Wordian).
Recent changes to US research funding are having far-reaching consequences that imperil the integrity of science and the provision of care to vulnerable populations. Resisting these changes, the BJPsych Portfolio reaffirms its commitment to publishing mental science and advancing psychiatric knowledge that improves the mental health of one and all.
SHEA, in partnership with ASGE, APIC, AAMI, AORN, HSPA, IDSA, SGNA, and The Joint Commission, developed this multisociety infection prevention guidance document for individuals and organizations that engage in sterilization or high-level disinfection (HLD). This document follows the CDC Guideline for Disinfection and Sterilization in Healthcare Facilities. This guidance is based on a synthesis of published scientific evidence, theoretical rationale, current practices, practical considerations, writing group consensus, and consideration of potential harm when applicable. The supplementary material includes a summary of recommendations. The guidance provides an overview of the Spaulding Classification and considerations around manufacturers’ instructions for use (MIFUs). Its recommendations address: point-of-use treatment prior to sterilization or HLD, preparation of reusable medical devices at the location of processing, sterilization, and immediate use steam sterilization (IUSS), HLD of lumened and non-lumened devices, processing of reusable medical devices used with lubricating or defoaming agents, monitoring for effectiveness of processing, handling of devices after HLD, augments and alternatives to HLD, processing of investigational devices, tracking of reusable medical devices, and approaches to implementation.
Experimental stone tool replication is an important method for understanding the context and production of prehistoric technologies. Experimental control is valuable for restricting the influence of confounding variables. Researchers can exert control in studies related to cognition and behavior by standardizing the type, form, and size of raw materials. Although standardization measures are already part of archaeological practice, specific protocols—let alone comparisons between standardization techniques—are rarely openly reported. Consequently, independent laboratories often repeat the costly trial-and-error process for selecting usable raw material types or forms. Here, we investigated various techniques and raw materials (such as hand-knapped flint, machine-cut basalt, manufactured glass, and porcelain) and evaluated them for validity, reliability, and standardizability. We describe the tests we performed, providing information on the individual approaches, as well as comparisons between the techniques and materials according to validity and reliability, along with relative costs. We end by providing recommendations. This is intended as a serviceable guide on raw material standardization for knapping experiments, including existing strategies and ones so far undescribed in the experimental archaeology literature. The future of this field would benefit from developments in the relevant technologies and methodologies, especially for those that are not yet widely available or affordable.
Recent increases in homophobic and transphobic harassment, hate crimes, anti-lesbian, gay, bisexual, transgender, gender nonconforming, and queer (LGBTQ+) legislation, and discrimination in healthcare toward LGBTQ+ persons require urgent attention.
This study describes seriously ill LGBTQ+ patients’ and partners’ experiences of discriminatory care delivered by healthcare providers.
Methods
Qualitative data from a mixed-methods study using an online survey were analyzed using a grounded theory approach. Seriously ill LGBTQ+ persons, their spouses/partners and widows were recruited from a wide range of organizations serving the LGBTQ+ community. Respondents were asked to describe instances where they felt they received poor care from a healthcare provider because they were LGBTQ+.
Results
Six main themes emerged: (1) disrespectful care; (2) inadequate care; (3) abusive care; (4) discriminatory care toward persons who identify as transgender; (5) discriminatory behaviors toward partners; and (6) intersectional discrimination. The findings provide evidence that some LGBTQ+ patients receive poor care at a vulnerable time in their lives. Transgender patients experience unique forms of discrimination that disregard or belittle their identity.
Significance of Results
Professional associations, accrediting bodies, and healthcare organizations should set standards for nondiscriminatory, respectful, competent, safe and affirming care for LGBTQ+ patients. Healthcare organizations should implement mechanisms for identifying problems and ensuring nondiscrimination in services and employment; safety for patients and staff; strategies for outreach and marketing to the LGBTQ+ community, and ongoing staff training to ensure high quality care for LGBTQ+ patients, partners, families, and friends. Policy actions are needed to combat discrimination and disparities in healthcare, including passage of the Equality Act by Congress.
Objectives/Goals: To identify clinician and researcher barriers, facilitators and learning preferences for patient partner engagement in research. In addition, to describe the strategies, our Patient Partners Program has planned for building clinician and researcher capacity to engage patient partners in clinical research. Methods/Study Population: Our program to promote authentic patient–researcher partnerships to advance clinical and translational research is grounded in participatory approaches to maximize meaningful engagement. We utilized small group listening sessions with health care providers involved in clinical research at the University of Michigan, Michigan Medicine healthcare system. Insights from these sessions are informing the development of learning models and curriculum content. We used purposive sampling to recruit individuals (n = 12) with a wide array of patient engagement experiences across diverse clinical departments. The study materials and interview guide were co-created with a patient research partner who also participated in co-facilitating the listening sessions. Results/Anticipated Results: The interview guide included questions about the benefits, challenges, and supports to engagement and capacity building training programs for researchers. The listening sessions were recorded, transcribed, and analyzed for common themes. Preliminary findings have identified the following themes related to barriers: (1) identifying and onboarding patient partners, (2) communication challenges, and (3) institutional and structural challenges (e.g., time constraints and difficulty offering compensation) and facilitators: (1) institutional and administrative support, (2) flexibility, and (3) respect, trust, and partnership. Improved knowledge about how and when to engage patient partners was identified as a key component to build researcher capacity in patient partnered research. Discussion/Significance of Impact: Integrating patient partners into study teams accelerates innovation and translational science, increases the relevance of research findings, improves health outcomes and patient empowerment, and elevates the value of the patient perspective allowing researchers to gain a new point of view from an individual with lived experience.
Since cannabis was legalized in Canada in 2018, its use among older adults has increased. Although cannabis may exacerbate cognitive impairment, there are few studies on its use among older adults being evaluated for cognitive disorders.
Methods:
We analyzed data from 238 patients who attended a cognitive clinic between 2019 and 2023 and provided data on cannabis use. Health professionals collected information using a standardized case report form.
Results:
Cannabis use was reported by 23 out of 238 patients (9.7%): 12 took cannabis for recreation, 8 for medicinal purposes and 3 for both purposes. Compared to non-users, cannabis users were younger (mean ± SD 62.0 ± 7.5 vs 68.9 ± 9.5 years; p = 0.001), more likely to have a mood disorder (p < 0.05) and be current or former cigarette smokers (p < 0.05). There were no significant differences in sex, race or education. The proportion with dementia compared with pre-dementia cognitive states did not differ significantly in users compared with non-users. Cognitive test scores were similar in users compared with non-users (Montreal Cognitive Assessment: 20.4 ± 5.0 vs 20.7 ± 4.5, p = 0.81; Folstein Mini-Mental Status Exam: 24.5 ± 5.1 vs 26.0 ± 3.6, p = 0.25). The prevalence of insomnia, obstructive sleep apnea, anxiety disorders, alcohol use or psychotic disorders did not differ significantly.
Conclusion:
The prevalence of cannabis use among patients with cognitive concerns in this study was similar to the general Canadian population aged 65 and older. Further research is necessary to investigate patients’ motivations for use and explore the relationship between cannabis use and mood disorders and cognitive decline.
Vascular rings represent a heterogeneous set of aberrant great vessel anatomic configurations which can cause respiratory symptoms or dysphagia due to tracheal or oesophageal compression. These symptoms can be subtle and may present at varied ages. More recently, many have been identified in patients without symptoms, including fetal echocardiogram, resulting in a conundrum for practitioners when attempting to determine who will benefit from surgical correction. Here, we provide a review of vascular rings and a guide to the practitioner on when to consider additional imaging or referral. Additionally, we discuss the changing landscape regarding asymptomatic patients and fetal echocardiogram.
Archimedes screw generators are a small-scale, eco-friendly hydropower technology. Despite their promise as a sustainable energy technology, the design specifics of the technology are not well documented in the published literature. Existing performance prediction models often fail to accurately forecast power loss, particularly as it relates to the outlet of the screw generator. To address this, a comprehensive computational fluid dynamic model was developed and evaluated using both laboratory-scale experiments and real-world data. This yielded an extensive dataset that covered wide variations in design parameters. The dataset was then used to inform the development and evaluation of an outlet power loss prediction model. The resulting model significantly improved the accuracy of overall performance predictions, reducing average error to 13.68 % compared with nominal experimental data – a substantial improvement over previous models, which averaged around 42.55 % error for the same test cases. Notably, the new model achieved an absolute error of 5 % or less in over 26 % of comparison points, marking a remarkable advancement by predicting outlet power loss by more than 28.8 %.
Behind the black boxes of algorithms promoting or adding friction to posts, technical design decisions made to affect behavior, and institutions stood up to make decisions about content online, it can be easy to lose track of the heteromation involved, the humans spreading disinformation and, on the other side, moderating or choosing not to moderate it. This can be aptly shown in the case of the spread of misinformation on WhatsApp during Brazil’s 2018 general elections. Since WhatsApp runs on a peer-to-peer architecture, there was no algorithm curating content according to the characteristics or demographics of the users, which is how filter bubbles work on Facebook. Instead, a human infrastructure was assembled to create a pro-Bolsonaro environment on WhatsApp and spread misinformation to bolster his candidacy. In this paper, we articulate the labor executed by the human infrastructure of misinformation as hetoromation.
On the upper reaches of the Tigris and Euphrates, archaeologists encounter evidence that challenges conventional understandings of early state formation as a transition from ‘small-scale, egalitarian’ to ‘large-scale, stratified’ societies. One such location is the Early Bronze Age cemetery of Başur Höyük, which presents evidence of grand funerary rituals—including ‘retainer burials’ and spectacular deposits of metallic wealth—in an otherwise small-scale, egalitarian setting. A further, puzzling feature of this cemetery is the preponderance of teenagers in the richest tombs. Here we describe the combined results of archaeological and anthropological analysis at Başur Höyük, including ancient DNA, and consider the challenges they pose to traditional accounts of early state formation.
The Diene Report of 2005 represents an instance in which an international organization investigated Japanese official treatment of minority communities in Japan in relation to international standards, and their findings strongly supported the Ainu activists. The United Nations sent Doudou Diene, their Special Rapporteur, to Japan to look into discrimination and racism. Diene's report harshly criticized the racism that exists in Japan and suggested that improved measures are necessary to protect the Ainu and other minorities there. This article is a response to his report by five Japanese individuals who have long been committed to countering discrimination and racism in the country. Four of the five contributors agree with the overall content of the Diene report and provide further information. They see the report as a small but positive impetus that will help the 21st century activism that further counters discrimination and racism in Japan. On the other hand, William Wetherall criticizes the report as seriously flawed, because he thinks it misunderstands the main aspects of the issue.
Williams v Commonwealth of Australia is a landmark decision of the High Court on the scope of federal executive power in s 61 of the Constitution. The decision is also important for the interpretive methodology adopted by the Court. Notably, each judge based their understanding of s 61 upon federal readings of the Constitution. This methodology raises fresh questions about how the Constitution is to be interpreted, and whether Williams marks a break from orthodox understandings of that task. This article assesses the significance of Williams for constitutional interpretation in Australia, and whether it lays the foundation for a more robust protection of state interests by the High Court.
Confidence intervals are ubiquitous in the presentation of social science models, data, and effects. When several intervals are plotted together, one natural inclination is to ask whether the estimates represented by those intervals are significantly different from each other. Unfortunately, there is no general rule or procedure that would allow us to answer this question from the confidence intervals alone. It is well known that using the overlaps in 95% confidence intervals to perform significance tests at the 0.05 level does not work. Recent scholarship has developed and refined a set of tools for inferential confidence intervals that permit inference on confidence intervals with the appropriate type I error rate in many different bivariate contexts. These are all based on the same underlying idea of identifying the multiple of the standard error (i.e., a new confidence level) such that the overlap in confidence intervals matches the desired type I error rate. These procedures remain stymied by multiple simultaneous comparisons. We propose an entirely new procedure for developing inferential confidence intervals that decouples the testing and visualization that can overcome many of these problems in any visual testing scenario. We provide software in R and Stata to accomplish this goal.
Pharmacogenetic testing is becoming more common, especially to provide guidance for psychiatric medications. Over 17 psychotropic medications currently have a Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline. Several clinical trials have described PGx testing in specific patient populations, but various exclusion criteria create cohorts that may not represent real-world populations. Given the overall undefined characteristics of a real-world population utilizing commercial PGx testing, the clinical presentation of 15,198 patients that used a commercial PGx laboratory (Genomind) from October 15, 2018 through April 11, 2023 was assessed. These 15,198 patients include those whose provider conducted a clinical consultation with a Genomind psychopharmacologist, regardless of ICD diagnosis on the requisition form. Data were extracted from de-identified consult notes entered by the psychopharmacologist. Consultants made a total symptom severity assessment based on CGI-S (Clinician Global Impression Severity) criteria. Most patients were described as mildly (15%), moderately (59%), or markedly ill (21%). The most common presenting symptoms identified in the cohort were “Anxious” (61.6%), “Depressed” (61.1%), “Inattentive” (37.8%) and “Hyperactive” (11.4%). The most common co-occurring symptoms in patients with a depressive presentation were “Anxious” (68.1%), “Inattentive” (16.0%), “Manic/Hypomanic” (11.1%), “Insomnia” (9.8%) and “Irritable/Angry” (7.4%). The most common co-occurring symptoms in patients presenting with anxiety were “Depressed” (67.6%), “Inattentive” (20.9%), “Panic” (11.5%), “Worry/Rumination” (11.2%) and “Hyperactive” (11.1%). This analysis suggests that PGx testing is commonly being utilized in patients with symptoms of anxiety, mood lability and inattentiveness. Future PGx research should prioritize the selection of patients with these symptoms to generate evidence that matches the real-world users of commercial PGx services.