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biBackground:/i/bEach health provider/agency in Southland, New Zealand, previously had its own forms and processes to document and communicate the planned scope of treatment; this project attempted to consolidate and streamline these variable processes into one actionable medical order that is valid in all settings.biAim:/i/bThe hypothesis was that the intervention would reduce unnecessary hospitalizations in the final year of life.biDesign:/i/bThe Clinical Order Articulating Scope of Treatment (COAST) form was a single-page medical order designed to document and communicate the resuscitation status and scope of medical treatment for adult patients believed to be in the final year of life, as evidenced by a "no" response to the Surprise Question. This three-phase initiative piloted the use of the COAST form in Southland from May 2019 to January 2020.biResults:/i/bOne hundred eighty-three patients with COAST forms consented to study participation. Sixty-one percent had a malignant primary diagnosis. The average number of emergency department (ED) presentations in the 12 months before COAST form implementation was 1.5 per person, and the average number of hospital admissions per person was 2.2. This was reduced to 0.5 and 0.5, respectively, in the 12 months following COAST implementation (ip/i = 0.00). Three patients had no ED presentations/hospital admissions in the 12 months before COAST implementation, compared with 29 following COAST implementation, and 66.7% of patients died between May 2019 and February 2021.biConclusions:/i/bPatients with a COAST form had significantly fewer ED presentations and hospital admissions in the 12 months following implementation.

BACKGROUND Healthcare and educational workforces are under a great deal of stress, especially since the Covid-19 pandemic. Synchronous Health offers tele-mental health services plus interventions via an integrated Digital Mental Health Platform bot named Karla® that connects with participants between sessions. OBJECTIVE In analyzing outcome variables for this retrospective study, we ascertained whether participants improved from their baseline assessments in resilience, anxiety, and depression. METHODS Outcome variables for this retrospective study are resilience, anxiety, and depression. Clinicians administered these assessments at baseline and at approximately every 4 sessions to participants who are primarily employees of a large health system and a large public school system, offered as part of their employee benefit programs. Eleven other healthcare organizations also contributed a few participants. A total of 833 participants completed 2 sets of assessments and 394 of these people completed a third set as well. RESULTS Based on changes in categories of outcomes and on a Repeated Measures ANOVA (p CONCLUSIONS This study demonstrates the ability of clinicians to combine tele-mental health with an integrated Digital Mental Health Platform [Karla]bot between sessions to improve resilience, anxiety, and depression for people from 2 different types of workforces, healthcare and education. CLINICALTRIAL N/A

The study of the role of retroviruses in amyotrophic lateral sclerosis (ALS) dates back to the 1960s shortly after transposable elements themselves were first discovered. It was quickly realized that in wild mice both horizontal and vertical transmissions of retroviral elements were key to the development of an ALS-like syndrome leading to the postulate that endogenous retroviruses (ERVs) contribute significantly to the pathogenicity of this disease. Subsequent studies identified retroviral reverse transcriptase activity in brains of individuals with ALS from Guam. However, except for a single study from the former Soviet Union, ALS could not be transmitted to rhesus macaques. The discovery of an ALS-like syndrome in human immunodeficiency virus (HIV) and human T cell leukemia virus infected individuals led to renewed interest in the field and reverse transcriptase activity was found in the blood and cerebrospinal fluid of individuals with sporadic ALS. However, exogenous retroviruses could not be found in individuals with ALS which further reinforced the possibility of involvement of a human ERV (HERV). The first demonstration of the involvement of a HERV was the discovery of the activation of human endogenous retrovirus-K subtype HML-2 in the brains of individuals with ALS. The envelope protein of HML-2 is neurotoxic and transgenic animals expressing the envelope protein develop an ALS-like syndrome. Activation of HML-2 occurs in the context of generalized transposable element activation and is not specific for ALS. Individuals with HIV-associated ALS show a remarkable response to antiretroviral therapy; however, antiretroviral trials in ALS down-regulate HML-2 without ameliorating the disease. This highlights the need for specific drugs to be developed against HML-2 as a novel therapeutic target for ALS. Other approaches might include antisense oligonucleotides, shRNA targeted against the envelope gene or antibodies that can target the extracellular envelope protein. Future clinical trials in ALS should consider combination therapies to control these ERVs.

A ‘sleep debt’ is widely reported among adolescents. Addressing this is of societal importance given that sleep deprivation has been linked to a range of cognitive and affective disturbances. Initial evidence suggests that modest gains in total sleep time over a week or less can improve attention and mood in adolescents; however, extant studies have methodological caveats and findings have been inconsistent. The present proof-of-concept study tests a protocol for extending sleep duration in teens. We also explored whether this has benefits for daytime sleepiness, mood, attention and word learning. Thirty-nine 13-15-year-olds who were sleeping less than the recommended 9 hours per night completed one week of baseline sleep monitoring before being randomly allocated to a control (business as usual) group or a four-night sleep extension group where individuals’ bedtimes were gradually brought forward. The extension protocol successfully increased total sleep time by ~50 minutes on average but did not alter sleep efficiency or time spent in different sleep stages. Decreases in subjective sleepiness were associated with increases in sleep duration. There were no observed benefits for mood or cognitive abilities. These data suggest that adolescent sleep can be modified over a short time span, and call for further research into how to optimize sleep to bolster cognitive and affective performance in adolescence.

Gynaecological cancers are malignancies involving the female genital tract, of which there are five types: ovarian, uterine, cervical, vaginal and vulval cancer. Every year in the UK, more than 21 000 women are diagnosed with a gynaecological cancer and there are 8000 deaths. The NHS is aiming for earlier diagnosis, and campaigns from various UK cancer groups are hoping to increase awareness among women. This article will discuss the epidemiology, risk factors and clinical features of gynaecological cancers and provide a summary of investigation and management in primary and secondary care.

The ability to extract patterns from sensory input across time and space is thought to underlie the development and acquisition of language and literacy skills, particularly the subdomains marked by the learning of probabilistic knowledge. Thus, impairments to the procedural learning mechanisms are hypothesised by the procedural deficit hypothesis to underlie neurodevelopmental disorders such as dyslexia and developmental language disorder. In the present meta-analysis, comprising 2396 participants from 39 independent studies, the relationship between language, literacy, and procedural memory on the Serial Reaction Time task (SRTT) was assessed across children and adults with typical development, dyslexia and DLD. Based on the procedural/declarative model a positive relationship was expected between procedural memory and language and literacy measures for the typically developing group; however, no such relationship was observed. This was also the case for the disordered groups (ps < .05). Also counter to the procedural deficit hypothesis, the magnitude of the relationship between procedural learning and grammar and phonology did not differ between TD and DLD (ps < .05), nor between the TD and dyslexic group on reading, spelling, and phonology (ps < .05). Whilst lending little support to the procedural/declarative model and the procedural deficit hypothesis, we consider that these results may be the consequence of poor psychometric properties of the SRTT as a measure of procedural learning.

This essay departs from a stand-up performance by comic and critic Hannah Gadsby to think through divestments of whiteness alongside investments in indigeneity, multi-modality, and a “politics of possibility” for the future of media studies.

Shared storybook reading is a key aid to vocabulary acquisition in childhood. However, word learning research has tended to use unnaturalistic (explicit) training regimes. Utilising a storybook paradigm, we examine whether children (particularly those with weaker vocabulary) are more likely to retain new words if they learn them closer to sleep. Parents read their child (5-7ys, n=237) an alien adventure story that contained 12 novel words with illustrations, at one of two training times: at bedtime or 3-5hrs before bedtime. Using on-line tasks, parents tested their child’s ability to recall the new words (production) and associate them with pictures (comprehension), immediately after hearing the story and again the following morning. As hypothesized, we replicated two findings: children showed overnight improvements in their ability to produce and comprehend new words when tested again the next day, and children with better existing vocabulary knowledge showed larger overnight gains in new word comprehension. Counter to expectations, overnight gains in comprehension were larger if the story was read 3-5 hours before, than at, bedtime. These ecologically valid findings are consistent with theories that characterise word learning as a prolonged process supported by mechanisms such as consolidation and retrieval practice, with existing vocabulary knowledge acting as an important source of variability in retention. The findings provide preliminary evidence that encountering new words in stories later in the day (but not too close to sleep) may help to harness vocabulary growth and may be more beneficial than leaving shared storybook reading just for bedtime.

This chapter focuses on Justify My Love and its reception in the mainstream and gay press to consider Madonna's resonance in lesbian and gay culture, particularly her privileged, if ambivalent, position in gay sexual politics. Wearing a loosely sashed black coat over lace lingerie, Madonna enters a hotel corridor, her high blond hair barely contrasting the stark walls. Tony Ward, former gay porn model and Madonna's lover on camera and off when the video was shot, joins her from the end of the corridor. Madonna remains the essential female spectacle, made up and laced up to denote her unambiguous feminity and thus her appeal to heterosexual male fantasy. In Justify My Love, Madonna's bad-girl repertoire includes her declaratively sexual persona and her acknowledgment of power relations in sexual fantasy and practice. In the mainstream and gay press alike, much is made of Madonna's perpetual transformations.

This chapter examines three critical points at which relations of marginality are articulated: between students and teachers, between film school and film industry, and between film as a popular medium and the cultural precinct of "art." The marginal relationship of school to industry may change, moreover, if an increasing number of successful, school-trained producers and directors reinvest in their alma maters. If a film school can continue to produce successful filmmakers, it hardly matters whether there is consensus about its curriculum or any established route from film school to film industry. In the commercial marketplace of popular cinema, film schools are only as good as their most recent famous graduates. The marginal relationship of school to industry may change, moreover, if an increasing number of successful, school-trained producers and directors reinvest in their alma maters.

Background Human blood pressure salt sensitivity is associated with changes in urinary metabolites related to fumarase (Fh) and nitric oxide (NO) metabolism, and fumarase promotes NO production thr...

BackgroundMeasurement of the medial olivocochlear (MOC) reflex provides useful clinical information for understanding the function of the auditory system. Although transient evoked otoacoustic emission (TEOAE) suppression has been demonstrated to be an indicator of MOC activity, its full role and fine details of TEOAE suppression spectra are still not clear. The aim of this study was to investigate details of ipsilateral suppression of TEOAEs in normally hearing adults.Material and MethodsExactly 29 adults (13 males, 16 females, mean age 26.5 years, range 18–42 years), who passed a battery of tests including otoscopy, pure tone audiometry, immittance, and TEOAE tests, participated in the study. Suppression was evaluated by comparing TEOAEs obtained with and without an ipsilateral suppressor in a forward-masking paradigm.ResultsIn general, suppression was small – less than 1.4 dB at all frequencies studied. The spectrum of mean TEOAE suppression showed suppression was greatest between 586 and 3711 Hz (0.6–1.4 dB) but less than 0.6 dB between 3906 and 4883 Hz. Mean suppression increased with post-stimulus time from 0.1 dB in the 2–4 ms time window to a maximum of 2.26 dB in the 16–18 ms window; the mean suppression between 8 and 18 ms after noise stimulation was 1.32 dB (range=0.22–3.23 dB). There were no significant gender or ear-laterality effects. Noise levels as measured in the ear canal were found to have a significant effect on calculated suppression at some frequencies.ConclusionsThe present study provides evidence of small ipsilateral TEOAE suppression by forward-masking noise in normally hearing adults. However, care is needed in interpreting the findings as noise in the ear canal can be a confounding factor during measurement of TEOAE suppression.