bluuebunny/crossref_metadata_2025 huggingface dataset:
LO42: Is point-of-care ultrasound a reliable predictor of outcome during atraumatic, non-shockable cardiac arrest? A systematic review and meta-analysis
Authors: Lalande E. , Burwash-Brennan T. , Burns K. , Atkinson P. , Lambert M. , Jarman B. , Lamprecht H. , Banerjee A. , Woo M.
Published: May 2019

Introduction: Point-of-Care Ultrasound (PoCUS) is being increasingly utilized during cardiac arrests for prognosis. Following the publication of recent studies, the goal of this study was to systematically review and analyze the literature to evaluate the accuracy of PoCUS in predicting return of spontaneous circulation (ROSC), survival to hospital admission (SHA), and survival to hospital discharge (SHD) in adult patients with non-traumatic, non- shockable out- of-hospital or emergency department cardiac arrest. Methods: A systematic review and meta-analysis was completed. A search of Medline, EMBASE, Cochrane, CINAHL, ClinicalTrials.gov and the World Health Organization Registry was completed from 1974 until August 24th 2018. Adult randomized controlled trials and observational studies were included. The QUADAS-2 tool was applied by two independent reviewers. Data analysis was completed according to PRISMA guidelines and with a random effects model for the meta-analysis. Heterogeneity was assessed using I-squared statistics. Results: Ten studies (1,485 participants) were included. Cardiac activity on PoCUS had a pooled sensitivity of 59.9% (95% confidence interval 36.5%-79.4%) and specificity of 91.5% (80.8%-96.5%) for ROSC; 74.7% (58.3%-86.2%) and 80.5% (71.7%-87.4%) for SHA; and 69.4% (45.5%-86.0%) and 74.6% (59.8%-85.3%) for SHD. The sensitivity of cardiac activity on PoCUS for predicting ROSC was 24.7%(6.8%-59.4%) in the asystole subgroup compared with 77% (59.4%-88.5%) within the PEA subgroup. Cardiac activity on PoCUS, compared to an absence had an odd ratio of 15.9 (5.9-42.5) for ROSC, 9.8 (4.9-19.4) for SHA and 5.7 (2.1-15.6) for SHD. Positive likelihood ratio (LR) was 6.65 (3.16-14.0) and negative LR was 0.27 (0.12-0.61) for ROSC. Conclusion: Cardiac activity on PoCUS was associated with improved odds for ROSC, SHA, and SHD among adults with non-traumatic asystole and PEA. We report lower sensitivity and higher negative likelihood ratio, but with greater heterogeneity compared to previous systematic reviews. PoCUS may provide valuable information in the management of non-traumatic PEA or asystole, but should not be viewed as the sole predictor in determining outcomes in these patients.
LO44: Simulation in the continuing professional development of Canadian academic emergency physicians: a national survey
Authors: Forristal C. , Russell E. , McColl T. , Petrosoniak A. , Mastoras G. , Caners K. , Thoma B. , Szulewski A. , Huffman J. , Dakin C. , Chaplin T. , Woolfrey K. , Hall A.
Published: May 2019

Introduction: Capitalizing on the success of Simulation-Based Education (SBE) in residency-training programs, simulation has been gradually integrated into Continued Professional Development (CPD) programs for Emergency Physicians (EPs) in Canada. This study sought to characterize how Canadian academic emergency medicine (EM) departments have implemented SBE for CPD. Methods: We conducted two national surveys: 1) the National Faculty Simulation Status Assessment Survey, administered by telephone to the simulation directors (or equivalent) at 20 Canadian academic EM sites and 2) the Faculty Simulation Needs Assessment Survey administered online to all full-time EPs across 9 Canadian academic EM sites. Results: The response rates for the National Status and Needs Assessment Surveys were 100% (20/20), and 40% (252/635), respectively. The majority (60%) of Canadian academic EM sites reported utilizing SBE for CPD, though only 30% reported dedicated funding support. EPs reported participating in a median of 3 hours per year of SBE (IQR 1-6 hours). Reported incentivization offered in the form of continued medical education credits varied between simulation directors (67%) and EPs (44%). Simulation directors identified several significant barriers to SBE including a lack of faculty time, fear of peer judgment, and faculty inexperience. In contrast, EP-identified barriers included time commitments outside of shift, lack of opportunities, and lack of departmental. The three most common topics of interest for SBE by EPs were performance of rare procedures, pediatric resuscitation, and neonatal resuscitation. Interprofessional involvement in SBE CPD was valued by both simulation directors and EPs, with most EPs (79%) indicating it is useful. Conclusion: Most Canadian EPs and simulation directors recognize the value of SBE for CPD, yet it is only utilized, infrequently, by 67% of Canadian academic EM departments for this purpose. This may be explained, in part, by poor incentivization for participation. Simulation directors and EPs noted different barriers to SBE implementation for CPD suggesting the need for dialogue to improve utilization. As SBE for CPD is incorporated more frequently, and at more sites, content should be guided by local needs assessments with an emphasis on interprofessional participation.
LO47: Concussions in minor hockey players before and after implementation of a policy to limit body checking
Authors: Loewen N. , Gaudet L. , Franczak B. , Rowe B.
Published: May 2019

Introduction: Concussions are one of the most common sports-related injuries presenting to emergency departments (EDs), and are particularly frequent among players of contact sports such as ice hockey (hockey). Studies of youth hockey players report increased concussion incidence when participating in levels of hockey that allow body-checking. In 2016, an Edmonton minor hockey organization implemented a policy to remove body checking from play for non-elite levels of Bantam (13-14 years) and Midget (15-17 years). This study aimed to evaluate the effect of this policy on occurrence of concussions in male minor hockey players. Methods: Alberta Health Services Sport and Recreation codes (SR = 54) were used to identify Bantam and Midget hockey players presenting to Edmonton Zone emergency departments (ED) during the 2013/2014 to 2016/2017 hockey seasons from the National Ambulatory Care Record System. Injured hockey players with a concussion were identified using International Classification of Diseases 10-CA diagnosis code S06.0. Odds ratios (OR) of concussions among total hockey injuries before (2013-2016) and after (2016-2017) the policy are reported with 95% confidence intervals (CIs). Differences were assessed using Pearson's χ2 test. Results: During the study period, 1978 minor hockey players presented to an Edmonton Zone ED with a hockey-related injury, including 272 players with a concussion (14%). Most of the injuries occurred to Midget players (n = 1274). The proportions of concussion were similar before and after the policy change for players of all ages (OR = 0.78; 95% CI: 0.37 to 0.92) and for injured Bantam players (OR = 0.97; 95% CI: 0.59 to 1.55); however, there was a significant reduction in concussions as a proportion of all injuries for Midget players before and after the policy change (OR = 0.61; 95% CI: 0.36 to 1.00). Conclusion: In the initial year of implementation, the policy to limit body-checking to elite levels of play had mixed results. While the policy change did not result in a significant reduction in concussions overall, or for Bantam players, Midget players did experience a significant reduction in concussions after the policy change. The reasons behind these age-related differences require further investigation. Moreover, further evaluation of the policy using additional years of post-policy data, as well as hockey registration numbers, is needed to evaluate the sustainability of its effect.
LO49: Can the HINTS exam rule out stroke in those with vertigo? A systematic review and meta-analysis
Authors: Ohle R. , Montpellier R. , Marchadier V. , Wharton A. , McIsaac S.
Published: May 2019

Introduction: Acute vestibular syndrome (AVS - vertigo, nystagmus, head motion intolerance, ataxia, and nausea/vomiting) is a subset of patients presenting with vertigo. They are most often due to benign vestibular neuritis but can be a sign of a vertebrobasilar stroke. The HINTS (head impulse test, nystagmus, positive test of skew) exam has been proposed as an extremely accurate bedside test to rule out stroke in those presenting with AVS. Is the HINTS exam compared to MRI sufficiently sensitive to rule out vertebrobasliar stroke in an adult population presenting to the emergency department with AVS. Methods: We searched in Pubmed, Medline, Embase, the Cochrane database, and relevant conference abstracts from 1968 to December 2018 and performed hand searches. No restrictions for language or study type were imposed. Relevant studies were reviewed and data was extracted by two independent reviewers. Gold standard in ruling out stroke was; Negative late acute (72 hrs–10d) cranial MRI with DWI OR Negative early acute (0–72hrs) cranial MRI plus negative follow-up cranial MRI or clinical follow-up for TIA/stroke of ≥3 months. Included studies were prospective or retrospective with patients presenting with acute vestibular syndrome. Studies combined if low clinical and statstitical heterogeonity. Study quality was assessed using the QUADAS tool. Random effects meta analysis using Revman 5 and SAS9.3 was performed. Results: 6 studies with 715 participants were included( QUADAS 12/14 SD 1.2). Average study length 5.3 years ( STD 3.3 years) . Prevalence of vertebrobasilar stroke ranged 9.3-76% (Mean 39.1% SD 17.1). The most common diagnosis were vertebrobasilar stroke (Mean 34.8% SD 17.1%), peripheral cause (Mean 30.9% SD 16%). Intra cerebral haemorrhage (Mean 2.2%, SD 0.5%). Neurologist/neuro ophthalmologist performed the exam in 5/6 studies. 1 study reported a kappa between emergency medicine physician and neurologist of 0.24-0.41. The HINTS exam had a sensitivity of 96% (CI 95% 0.92-0.98, I2-0%), Specificity 91.4% (CI 95% 64.5-98.4% I2 94%). Positive likelihood ratio 11.9 ( CI 95% 2.9-48.8) and a negative likelihood ratio of 0.04 ( CI 95% 0.01– 0.14). Conclusion: The HINTS exam has excellent diagnostic accuracy for ruling out stroke when performed by a neurologist. The lack of ER proven diagnostic accuracy and high prevalence of serious diagnosis in those presenting with acute vestibular syndrome suggests care should be taken in ruling out central cause of dizziness in this population.
LO53: The correlation of workplace-based assessments with periodic performance assessment of emergency medicine residents
Authors: Collings L. , Szulewski A. , Hopman W. , Hall A.
Published: May 2019

Introduction: Competency-based medical education (CBME) relies on pragmatic assessment to inform trainee progression decisions. It is unclear whether face-to-face workplace-based assessment (WBA) scoring by faculty reflects their true perception of trainee competence, as many factors influence individual assessments. To better defend competence committee decisions, it is critical to understand how accurately WBAs reflect the faculty's honest perception of resident competence and entrustment. Methods: To best capture faculty perception of trainee competence, we created a periodic performance assessment (PPA) tool for anonymous faculty assessment of residents after repeated clinical interactions. PPA surveys were distributed to full-time EM faculty at a single Canadian FRCPC-EM training site. Faculty were asked to score residents on entrustable professional activities (EPAs) based on encounters over the previous 6-months, and were advised that all data would be anonymized. All WBA scores for FRCPC-EM residents (N = 21) were collected from the 6-months preceding PPA completion. Analysis compared paired WBA and PPA entrustment scores for an individual resident, faculty, and EPA using Wilcoxon Signed Ranks tests and Spearman correlations. Data were analyzed across faculty, EPAs, and both faculty and EPA. Results: About half (17/33) of all invited full-time EM faculty participated. Overall, anonymous PPAs had a significantly lower mean score compared to face-to-face WBAs (3.61-3.69 vs. 3.92-4.06, p < 0.001 for all) across all groupings. Individual WBAs had a low-moderate correlation with individual PPAs (rho = 0.44). When scores were averaged across 1) faculty or 2) EPA, there was an increase in correlation, but it remained moderate (rho = 0.53 and 0.54, respectively). When scores were averaged for an individual resident across 3) faculty and EPA, there was a strong correlation between WBA and PPA (rho = 0.86). Conclusion: There is only moderate correlation between an individual faculty's WBAs and their anonymous longitudinal entrustment for a given resident on a specific EPA. These results may signal caution when interpreting WBA scores in the context of high stakes decisions. Aggregated scores from multiple faculty and/or multiple EPAs substantially increased the correlation between WBA and PPA. These findings highlight the importance of using aggregated WBA scores across multiple assessors and EPA for high-stakes resident progression decisions, to minimize the noise and bias in individual assessment.
LO55: Signal & noise – do professionalism concerns impact decision-making of competence committees?
Authors: Odorizzi S. , Cheung W. , Sherbino J. , Lee A. , Thurgur L. , Frank J.
Published: May 2019

Introduction: Competence committees (CCs) struggle with incorporating professionalism issues into resident progression decisions. This study examined how professionalism concerns influence individual faculty decisions about resident progression using simulated CC reviews. Methods: In 2017, the investigators conducted a survey of 25 program directors of Royal College emergency medicine residency training programs in Canada and those faculty members who are members of the CCs (or equivalent) at their home institution. The survey contained twelve resident portfolios, each containing formative and summative information available to a CC for making progression decisions. Six portfolios outlined residents progressing as expected and six were not progressing as expected. Further, a professionalism variable (PV) was added to six portfolios, evenly split between those residents progressing as expected and not. Participants were asked to make progression decisions based on each portfolio. Results: Raters were able to consistently identify a resident needing an educational intervention versus those who did not. When a PV was added, the consistency among raters decreased by 34.2% in those residents progressing as expected, versus increasing by 3.8% in those not progressing as expected (p = 0.01). Conclusion: When using an unstructured review of a simulated resident portfolio, individual reviewers can better discriminate between trainees progressing as expected when professionalism concerns are added. Considering this, educators using a competence committee in a CBME program must have a system to acquire and document professionalism issues to make appropriate progress decisions.
Comparison of ventilation during exercise in horses wearing half- and full-face masks
Authors: Marlin D.J. , Adams V. , Greenwood A. , Case E. , Roberts M. , Deaton C.M.
Published: May 2019

Several studies have shown that the placement of a face mask on a horse can have effects on ventilation, gas exchange and the cardiovascular system during exercise. The aim of the present study was to determine if airflow and ventilation measured with the same ultrasonic flowmeters were different during exercise between horses wearing half- (HM) and full-face (FM) masks. Five clinically healthy Thoroughbred horses with no history of respiratory disease were studied in an unbalanced crossover design. They were exercised on a treadmill at speeds between 1.7 and 11ms−1on a 3° incline wearing both masks. The following variables were recorded: peak inspired (PIF) and peak expired flow rates (PEF), inspiratory tidal volume (VT), respiratory rate (fR), inspiratory minute ventilation (VE), inspiratory time, (TI), expiratory time (TE), total breath time (TT), end tidal oxygen (ETO2), end tidal carbon dioxide (ETCO2) and heart rate (HR). A mask by speed of exercise interaction term was not significant for any of the models. The PEF (mean difference 12.91s−1; lower and upper 95% CI 7.6 and 18.21s−1, respectively;P<0.0001) and ETO2(mean difference 0.77%; lower and upper 95% CI 0.48 and 1.00%, respectively;P<0.0001) were significantly greater and ETCO2was significantly lower (mean difference −1.3%; lower and upper 95% CI −2.0 and 0.7%, respectively;P<0.0001) with the FM compared with the HM. There was also a trend for inspiredVEto be higher with the FM compared with the HM (mean difference 1021min−1; lower and upper 95% CI 26 and 1781 min−1, respectively; non-significant). We conclude that the HM may impair ventilation in the horse during exercise compared with the FM, despite the latter having a greater deadspace.
High-extraction-efficiency, nanosecond bidirectional ring amplifier with twin pulses
Authors: Yu Tiancheng , Guo Jiangtao , Xia Gang , Zhang Xiang , Gao Fan , Wang Jiangfeng , Fan Wei , Yuan Xiao
Published: May 2019

The output performances of a bidirectional ring amplifier with twin pulses are demonstrated. Compared to the extraction efficiency of 32% for single-pulse injection, the extraction efficiency of stored energy for twin-pulse injection with bidirectional propagation is increased to 60%. The maximum output energies of the twin pulses are 347 mJ and 351 mJ, and the output energy of a single pulse is only 373 mJ under the same amplifier operating conditions. The experimental results show that the bidirectional ring amplifier with twin pulses can achieve a higher extraction efficiency of stored energy at a lower operating fluence, and has potential applications in high-power and high-energy laser facilities.
Running a mentalization-based treatment (MBT) programme within a public community adult mental health service setting: a feasibility study
Authors: Beattie D. , Murphy S. , Jamieson S. , Lee A.
Published: May 2019

Objectives:

This article aimed to address the feasibility of mentalization-based treatment (MBT) for patients with personality disorder in a non-specialist setting. The development and implementation of an MBT Programme is described.

Methods:

A multidisciplinary Consult Group met to plan the implementation of the programme. Participants attended a psychoeducation group (MBT Introductory Group), then weekly individual and group therapy. Fourteen participants started the full programme with eight completing at least 9 months, complete data are available for five participants who completed 27 months (first cohort) and 21 months (second cohort). Data include quantitative measures and qualitative questionnaires/interviews. All had a diagnosis of personality dysfunction with co-morbid disorder including anxiety/depressive disorder, post-traumatic stress disorder and eating disorder.

Results:

Data on five participants revealed reductions in global level of distress, improvements in psychological well-being, less interpersonal difficulties and better work and social functioning. Qualitative data from feedback questionnaires (n = 18) and in-depth interview (n = 2) are discussed under the themes of mentalizing, treatment feedback/outcomes and group factors. Therapist reflections on the process identify the challenges involved in implementing a specialist psychotherapy programme within a general service and learning points from this are discussed.

Conclusions:

MBT is an acceptable treatment for patients with personality dysfunction. Prior to the implementation of a programme, factors at the therapist, team and organizational level, as well as the wider context, need to be examined. This is to ensure that conditions are in place for proper adherence to the model to achieve the positive outcomes demonstrated in the RCT studies.
Helicoidal particles in turbulent flows with multi-scale helical injection
Authors: Biferale L. , Gustavsson K. , Scatamacchia R.
Published: May 2019

We present numerical and theoretical results concerning the properties of turbulent flows with strong multi-scale helical injection. We perform direct numerical simulations of the Navier–Stokes equations under a random helical stirring with power-law spectrum and with different intensities of energy and helicity injections. We show that there exists three different regimes where the forward energy and helicity inertial transfers are: (i) both leading with respect to the external injections, (ii) energy transfer is leading and helicity transfer is sub-leading and (iii) both are sub-leading and helicity is maximal at all scales. As a result, the cases (ii)–(iii) give flows with Kolmogorov-like inertial energy cascade and tuneable helicity transfers/contents. We further explore regime (iii) by studying its effect on the kinetics of point-like isotropic helicoids, particles whose dynamics is isotropic but breaks parity invariance. We investigate small-scale fractal clustering and preferential sampling of intense helical flow structures. Depending on their structural parameters, the isotropic helicoids either preferentially sample co-chiral or anti-chiral flow structures. We explain these findings in limiting cases in terms of what is known for spherical particles of different densities and degrees of inertia. Furthermore, we present theoretical and numerical results for a stochastic model where dynamical properties can be calculated using analytical perturbation theory. Our study shows that a suitable tuning of the stirring mechanism can strongly modify the small-scale turbulent helical properties and demonstrates that isotropic helicoids are the simplest particles able to preferentially sense helical properties in turbulence.
The Amendment of the War Crimes Act
Authors: Matheson Michael J.
Published: May 2019

There are many important aspects to the 2006 Military Commissions Act, most of which are covered in the contributions of others to this Agora. I will focus on the amendments made by the Act to the earlier War Crimes Act, which set forth criminal sanctions for various violations of international humanitarian law. These amendments, which were ostensibly designed to remove ambiguities in the existing law, have the effect of raising questions about United States implementation of the 1949 Geneva Conventions that need to be resolved by the executive branch or, if necessary, by further action of Congress.
International Criminal Tribunal for Rwanda—genocide—conspiracy to commit genocide—complicity in genocide—mens rea—judicial notice
Authors: Bodansky Daniel , Heller Kevin Jon
Published: May 2019

Prosecutor v. Karemera, Ngirumpatse, & Nzirorera. Case No. ICTR-98-44-AR73(C). Decision on Prosecutor's Interlocutory Appeal of Decision on Judicial Notice. At .

International Criminal Tribunal for Rwanda, Appeals Chamber, June 16, 2006.

In an interlocutory appeal in Prosecutor v. Karemera, the appeals chamber of the International Criminal Tribunal for Rwanda (ICTR) held that the commission of genocide against the Tutsis in 1994 is a “fact of common knowledge” of which trial chambers must take judicial notice (Appeals Decision, paras. 35, 38). The decision represents a significant reversal in ICTR practice: although some trial chambers have been willing to take notice of “widespread and systematic attacks” against Tutsis in Rwanda, they have uniformly insisted that the question of whether the attacks amounted to genocide is so fundamental that formal proof is required.

As noted in the indictment, Edouard Karemera and Jospeh Nzirorera were minister-level officials in the Rwanda’ interim government (Indictment, paras. 1, 3) and served, along with Mathieu Ngirumpatse, as the national executive leadership of the National Republican Movement for Democracy and Development (MRND) (id., para. 9). They are charged with, inter alia, conspiracy to commit genocide, direct and public incitement to commit genocide, genocide, and—alternatively—complicity in genocide (id.). The prosecution alleges that they created, recruited, and organized the Interahamwe, the vicious youth wing of the MRND; provided members of the Interahamwe with weapons and military training; and helped formulate and implement policies of the interim government of April 8, 1994, that were intended to incite, encourage, and abet killings of Tutsis (id., para. 14).
Aguas del Tunari, S.A. v. Republic of Bolivia. ICSID Case no. ARB/02/3. Jurisdiction. 20 ICSID
Authors: Bodansky Daniel , Vandevelde Kenneth J.
Published: May 2019

Aguas Del Tunari, S.A. v. Republic of Bolivia, ICSID Case No. ARB/02/3. Jurisdiction. 20 ICSID Review: Foreign Investment Law Journal 450 (2005).

International Centre for Settlement of Investment Disputes, October 21, 2005.

In Aguas del Tunari v. Republic of Bolivia, an International Centre for Settlement of Investment Disputes (ICSID) tribunal held that it had jurisdiction under the Netherlands-Bolivia bilateral investment treaty (BIT) over a claim against Bolivia brought by a Bolivian company owned primarily by two companies— one American and one Spanish—through Dutch intermediaries. The tribunal found that the Dutch intermediaries “controlled” the Bolivian company and that jurisdiction existed notwithstanding that the dispute related to a concession agreement with a choice-of-forum clause designating Bolivian courts.

The origin of the dispute lay in Bolivia's attempt in the late 1990s to privatize the water service in Cochabamba, its third largest city. In September 1999, Bolivia awarded a forty-year concession agreement to a Bolivian company, Aguas del Tunari, S.A. (AdT), for the exclusive provision of water services in the city.
Congress Enacts Increased Protections for Sunken Military Craft
Authors: Bederman David J.
Published: May 2019

The domestic and international legal status of warships and military aircraft submerged in United States waters or in international waters has been quite contentious of late. It has resulted in some notable litigation in U.S. courts, a presidential statement on U.S. policy, official lodgings of positions by foreign governments with the United States, a proposed international convention drafted by the United Nations Educational, Scientific and Cultural Organization (UNESCO), and other developments that have previously received notice in the pages of this Journal. In a somewhat surprising turn, Congress, in October 2004, adopted as part of the National Defense Authorization Act for Fiscal Year 2005 a set of provisions known as the Sunken Military Craft Act (SMCA). This essay briefly traces the trajectory of developments in this sector of international law, analyzes the provisions of the SMCA, and offers a critique of the underlying policy and legal assumptions of that statute in light of those developments.
1898: the Beginning of the End for Chinese Religion?
Authors: Goossaert Vincent
Published: May 2019

On July 10, 1898, the reformist leader Kang Youwei 康有為 (1858–1927) memorialized the throne proposing that all academies and temples in China, with the exception of those included in registers of state sacrifices (sidian祀典), be turned into schools. The Guangxu emperor was so pleased with the proposal that he promulgated an edict (shangyu上諭) the same day taking over Kang’s phrasing. On three occasions in the following weeks, the editorial in the famous Shanghai dailyShenbao申報 discussed the edict not as a piece of legislation aiming at facilitating the creationex nihiloof a nationwide network of public schools, but as the declaration of a religious reform, that is, a change in religious policy that would rid China of temple cults and their specialists, Buddhists, Taoists, and spirit-mediums. This it was, indeed, although both Chinese and Western historiography have so far usually neglected to appreciate the importance of the religious element in the so-called Wuxu reforms (June 11–September 21, 1898) and later modernist policies. This importance, as we will see, can be gauged both in the writings of some of the reformist leaders, and among the populations concerned by the practical consequences.
Passive Trust or Active Application: Changes in the Management of Difficult Childbirth and the Edinburgh Royal Maternity Hospital, 1850–1890
Authors: Nuttall Alison
Published: May 2019

The history of the medical and nursing care given to parturient women has been approached in a number of ways. Early studies largely equated it with the development of obstetric technology that occurred from the early eighteenth century onwards, focusing on its potential to save maternal and foetal life, but without examining closely the frequency and significance of its actual use. Thereafter, feminist historians re-interpreted similar evidence to stress what they regarded as the degrading and invasive aspects of such technology, especially as it related to the increasing use of chloroform anaesthesia in the latter half of the nineteenth century. Interest then moved from the technology itself, to its effects on other aspects of care in childbirth, particularly on the eighteenth-century decline of the traditional midwife and the concomitant rise of the man-midwife.
Blame and Vindication in the Early Modern Birthing Chamber
Authors: McTavish Lianne
Published: May 2019

Who was to blame when a labouring woman or her unborn child died during the early modern period? How was responsibility assessed, and who was charged with assessing it? To answer such questions, this article draws on French obstetrical treatises produced by male surgeons and female midwives between 1550 and 1730, focusing on descriptions of difficult deliveries. Sometimes the poor outcome of a labour was blamed on the pregnant woman herself, but more often a particular medical practitioner was implicated. Authors of obstetrical treatises were careful to assign fault when injuries or deaths occurred in cases concerning them. Chirurgiens accoucheurs (surgeon men-midwives) regularly accused female midwives of incompetence, yet also attacked fellow surgeons as well as those male physicians officially superior to them in the medical hierarchy. Female midwives similarly condemned the actions of male practitioners, without hesitating to censure other women when their mismanagement of deliveries had tragic consequences. Part of authors' eagerness to blame others stemmed from the fear of being held accountable for mistakes preceding practitioners had made. Ascribing responsibility usually went hand-in-hand with defensive claims of innocence, or boastful declarations of having saved a suffering woman from the bungling attempts of less skilled birth attendants.
Ancient Messiah Discourse and Paul's Expression ἄχρις οὗ ἔλθῃ τὸ σπέρμα in Galatians 3.19
Authors: Hewitt J. Thomas
Published: May 2019

In Gal 3.16 Paul asserts that Abraham's seed is the messiah. While some have suggested that the rationale for this assertion is Paul's identification of Abraham's seed with David's seed, few have identified evidence for this rationale in the immediate context of Galatians 3, and none have genuinely argued for it. Noting that the reappropriation of scriptural idioms is a common feature of ancient messiah discourse, I demonstrate that Gal 3.19 entails a reappropriation of the wording of Gen 49.10, an oracle often interpreted as Davidic-messianic, and thereby I elucidate the scriptural reasoning undergirding Gal 3.16.
How ‘Democratic’ Was the PaulineEkklēsia? An Assessment with Special Reference to the Christ Groups of Roman Corinth
Authors: Welborn L. L.
Published: May 2019

Several recent studies have argued for the importance of democratic practices and ideology for a proper understanding of the issues and debates reflected in Paul's Corinthian correspondence. This new perspective stands in tension with older scholarship which emphasised the role of patronage in the structure and dynamics of the house churches that made up theekklēsiaof Christ-believers at Corinth. This essay draws upon new research into the political sociology of Greek cities in the early Empire, which highlights evidence of the continuing vitality of democratic assemblies (ekklēsiai) in the first and second centuries, despite the limitations imposed upon local autonomy by Roman rule. Special attention is devoted to the epigraphic evidence of first-century Corinth, whose political institutions and social relations were those of a Roman colony. The essay seeks to ascertain whether the politics of the Christ groups mimicked those of the city in which they were located or represented an alternative.
Imaging the Divine: Idolatry and God's Body in the Book of Acts
Authors: Wilson Brittany E.
Published: May 2019

This article problematises the widespread assumption that the God of early Christianity is an invisible God. This assumption is found in both popular and academic discourse and often appeals to biblical critiques of divine images to make its case. Yet while Hebrew Bible scholars have recently questioned this axiomatic belief, New Testament scholars have yet to do the same. To address this oversight, this article first looks at divine images and idol polemic in the ancient world and then turns to Luke's depiction of divine images in the book of Acts as a test case. Here I demonstrate how Acts depicts God as a visible – and even embodied – being, while at the same time critiquing visual representations of the divine. With Acts, we find that not all Christians ‘imaged’ God as invisible.
Autonomous Stairwell Ascent
Authors: Ilhan B. Deniz , Johnson Aaron M. , Koditschek D. E.
Published: May 2019

This paper documents autonomous multi-floor stairwell ascent by a legged robot. This is made possible through empirically deployed sequential composition of several reactive controllers, with perceptually triggered transitions. This composition relies on simplified assumptions regarding the robot’s sensory capabilities, its level of mobility, and the environment it operates in. The discrepancies between these assumptions and the physical reality are capably handled by the intrinsic motor competence of the robot. This behavior is implemented on the legged RHex platform and experiments spanning 10 different stairwells with various challenges are conducted.
Investigation on GEO satellite orbit determination based on CEI measurements of short baselines
Authors: Liu Zejun , Du Lan , Zhu Yongxing , Qian Zhihan , Wang Jinqing , Liang Shiguang
Published: May 2019

Connected-Element Interferometry (CEI) is a technique for measuring the phase delay of difference of Time Of Arrival (TOA) of a downlink radio signal to two antennae on a short baseline. This technique can use an atomic clock for time-frequency transmission and achieve intermediate accuracy angular tracking. Owing to the relatively short length of the baseline, the passive reception mode, and near real-time operation, CEI can be used to continuously monitor the orbit variations of both cooperative and non-cooperative satellites. In this paper, a small-scale CEI system of two orthogonal baselines (75 m × 35 m) is investigated to track a Geostationary Earth Orbit (GEO) Television (TV) satellite at 110·5°E. The phases are extracted from correlation results. The results show that the Root Mean Square (RMS) of the phase fitting residuals, if not calibrated, is within 2° at night and up to 10° in the daytime. After applying the calibration signal, the RMS of the phase fitting residuals in the daytime decreases to the same level at night. Comparing the phase delay with the a priori phase delay using Two-Line-Element (TLE) data, the integer ambiguity is successfully resolved. Finally, a batch algorithm is used to estimate the orbit of the GEO satellite, and the orbit determination accuracy is evaluated using the precise orbits provided by the China National Time Service Centre (NTSC). The results show that the accuracies in the radial direction and the cross-track direction are less than 1 km, and the Three-Dimensional (3D) position accuracy reaches the 2 km order of magnitude.
L'enfant à naître et l'« héritier sien »
Authors: Thomas Yan
Published: May 2019

La jurisprudence romaine des droits de l’enfant à naître ne s’appuyait pas sur des considérations d’ordre génétique, ni sur telle ou telle conception de la vie embryonnaire. Les juristes anciens ne s’interrogeaient pas sur le substrat physique de l’existence humaine, ni sur les seuils de son développement, à la manière des physiciens et des médecins, ou plus tard des théologiens. Pour penser l’enfant à naître comme sujet de droit, ils avaient à se poser de tout autres questions. Bien des conclusions générales peuvent en être tirées, à condition d’en saisir les contours. Le problème était soulevé exclusivement à propos de la vocation successorale des enfants nés après la mort de leur père. Plus précisément, la discussion se nouait autour de la figure civile de l’« héritier sien », qui succédait à son ascendant mâle à condition d’avoir été assujetti à sa puissance au moment même où il mourait(potestas morientis). Conférer les droits d’un « héritier sien » à un posthume, cela contraignait dès lors à prolonger l’existence juridique du mort jusqu’à la naissance de l’enfant. Par cet ajustement, le droit suppléait aux interruptions et aux vacances du pouvoir, assurant la continuité des relais de la puissance. L’examen d’un cas-limite invite ainsi à soulever un coin du voile et à découvrir, bien au-delà des mécanismes de la filiation et du droit successoral, une véritable architecture juridique de la vie. La succession aux biens n’opérait pas en raison d’une transmission génétique, mais par la grâce d’un pouvoir qui doublait la vie et lui était d’une certaine manière substitué. C’est la raison pour laquelle le droit civil romain eut aussi à découper, dans un temps généalogique commun aux vivants et aux morts, des segments de durée propres à un pouvoir qui ne lie que des vivants contemporains les uns des autres – quitte à prolonger dans certains cas l’existence fictive des morts. Tel est précisément l’enjeu du droit des posthumes, dont les opérations intéressent les conditions élémentaires du pouvoir, plutôt que les données génétiques et physiques de la vie.
On the role of different age groups during pertussis epidemics in California, 2010 and 2014
Authors: Mahmud A. S. , Lipsitch M. , Goldstein E.
Published: May 2019

There is limited information on the roles of different age groups in propagating pertussis outbreaks, and the temporal changes in those roles since the introduction of acellular pertussis vaccines. The relative roles of different age groups in propagating the 2010 and the 2014 pertussis epidemics in California were evaluated using the relative risk (RR) statistic that measures the change in the group's proportion among all detected cases beforevs. after the epidemic peak. For the 2010–11 epidemic, evidence for a predominant transmission age group was weak, with the largest RR estimates being 1.26 (95% CI 1.08–1.46) (aged 11–13 years); 1.19 (1.01–1.4) (aged 9–10 years); 1.17 (0.86–1.59) (aged 14–15 years); 1.12 (0.86–1.46) (aged 16–19 years) and 1.1 (0.89–1.36) (aged 7–8 years). The 2014 epidemic showed a strong signal of the role of older adolescents, with the highest RR estimate being in those aged 14–15 years (RR = 1.83, 1.61–2.07), followed by adolescents aged 16–19 years (RR = 1.41, 1.24–1.61) and 11–13 years (RR = 1.26, 1.12–1.41), with lower RR estimates in other age groups. As the time following introduction of acellular pertussis vaccines in California progressed, older adolescents played an increasing role in transmission during the major pertussis outbreaks. Booster pertussis vaccination for older adolescents with vaccines effective against pertussis transmission should be considered with the aim of mitigating future pertussis epidemics in the community.
Using the Tolerance Principle to predict phonological change
Authors: Sneller Betsy , Fruehwald Josef , Yang Charles
Published: May 2019

Language acquisition is a well-established avenue for language change (Labov, 2007). Given the theoretical importance of language acquisition to language change, it is all the more important to formulate clear theories of transmission-based change. In this paper, we provide a simulation method designed to test the plausibility of different possible transmission-based changes, using the Tolerance Principle (Yang, 2016) to determine precise points at which different possible changes may become plausible for children acquiring language. We apply this method to a case study of a complex change currently in progress: the allophonic restructuring of /æ/ in Philadelphia English. Using this model, we are able to evaluate several competing explanations of the ongoing change and determine that the allophonic restructuring of /æ/ in Philadelphia English is mostly likely the result of children acquiring language from mixed dialect input, consisting of approximately 40% input from speakers with a nasal /æ/ split. We show that applying our simulation to a phonological change allows us to make precise quantitative predications about the progress of this change. Moreover, it forces us to reassess intuitively plausible hypotheses about language change, such as grammatical simplification, in a quantitative and independently motivated framework of acquisition.
Effect of Fluctuating Extreme Temperatures on Tranexamic Acid
Authors: Loner Carly , Estephan Michael , Davis Hillary , Cushman Jeremy T. , Acquisto Nicole M.
Published: May 2019

Introduction:

Tranexamic acid (TXA) is an antifibrinolytic agent shown to reduce morbidity and mortality in hemorrhagic shock. It has potential use in prehospital and wilderness medicine; however, in these environments, TXA is likely to be exposed to fluctuating and extreme temperatures. If TXA degrades under these conditions, this may reduce antifibrinolytic effects.

Problem:

This study sought to determine if repetitive temperature derangement causes degradation of TXA.

Methods:

Experimental samples underwent either seven days of freeze/thaw or heating cycles and then were analyzed via mass spectrometry for degradation of TXA. An internal standard was used for comparison between experimental samples and controls. These samples were compared to room temperature controls to determine if fluctuating extreme temperatures cause degradation of TXA.

Results:

The coefficient of variability of ratios of TXA to internal standard within each group (room temperature, freeze, and heated) was less than five percent. An independent t-test was performed on freeze/thaw versus control samples (t = 2.77; P = .17) and heated versus control samples (t = 2.77; P = .722) demonstrating no difference between the groups.

Conclusion:

These results suggest that TXA remains stable despite repeated exposure to extreme temperatures and does not significantly degrade. These findings support the stability of TXA and its use in extreme environments.
Cognitive behaviour therapy for psychosis
Authors: Kuipers Elizabeth , Bebbington Paul
Published: May 2019

Aims– It used to be thought that the problems of psychosis were qualitatively difference from those of other disorders and therefore unamenable to psychological interventions. However more recent evidence will be summarised which suggests otherwise.Methods– A cognitive model of the positive symptoms of psychosis (Garety et al, 2001; Kuipers et al.,2006) is described which builds on work on the dimensions of symptoms of psychosis, the continuum between non-clinical and clinical populations, and the contribution of emotional processes, cognitive reasoning biases and social factors.Results– Evidence from both epidemiological and empirical studies from our research group and others, support some of the pathways of symptom formation and maintenance proposed by the model. Specifically there is evidence for the role of trauma, social adversity and stress. These may trigger emotional responses and unusual experiences and together with reasoning biases lead to appraisals that can be defined as positive symptoms such as delusions and hallucinations. Similar processes interact to maintain symptoms.Conclusions– Cognitive models of psychosis have led to the development of cognitive behavioural treatments for delusions and hallucinations, which show some evidence of efficacy. Such treatments need to be refined in the light of recent research.

Declaration of Interest: none
Identification and management of depression in primary care settings. A meta-review of evidence
Authors: Barbui Corrado , Tansella Michele
Published: May 2019

Aim– The purpose of this review is to summarize the evidence base on the effectiveness of (a) screening for depression in primary care; (b) managing depression in primary care employing specific management strategies; (c) treating primary care depressive patients with antidepressants.Methods– Meta-review of all available reviews of the evidence.Results– Screening alone does not improve the recognition, management and outcome of depression in primary care settings. Management strategies, including (a) training primary care staff, (b) consultation-liaison, (c) collaborative care, (d) replacement/referral are supported by insufficient evidence to provide a definite answer as to the clinical effectiveness of individual models. Robust evidence exists to encourage physicians to prescribe effective doses of antidepressants in patients with moderate to severe depression who seek treatment in primary care settings.Conclusion– Population-level screening campaigns have a negative ratio of costs to benefits. However, at an individual-level of care increasing the ability of primary care physicians in recognising depression remains a relevant factor. Primary care physicians should consider whether depression is mild, moderate or severe. This patient categorisation help develop appropriate management and therapeutic strategies.

Declaration of Interest: none
Socio-economic status and geographies of psychiatric inpatient service use. Places, provision, power and wellbeing
Authors: Curtis Sarah
Published: May 2019

This editorial briefly summarises some aspects of research on socio-economic status and use of mental health services that have particular relevance for the theme of this issue of Epidemiologia e Psichiatria Sociale. This discussion takes a view from the perspective of health geography, which examines how the relationships between individuals and their social and physical environment result in variations in health and health care use. Three particular issues are considered here. First, the geographical distribution and organisation of psychiatric services may interact with social and economic factors in ways that are important for service use. Second, increasingly sophisticated ecological modelling strategies have elucidated the associations between socio-economic factors and service use at the population level. Third, more intensive, qualitative research complements these statistical analyses and encouraged reflection on the socio-economic processes, within psychiatric care settings, as well as in wider society, which influence service use.