The Electronic Explication

The explication de texte, or commentary, has a distinguished record in the history of French education. It originated in biblical exegesis; by the seventeenth century it became a fundamental component in classical training at the Port Royal where the practice was for a master to "marquer" the text with different signs representing ideas, sentences, words or phrases for comment. It was systematised by educational dogmatists who dominated the Académie Française in the first half of the twentieth century and it became a focus of the pre-68 intellectual crisis, when it was increasingly subject to suspicion and challenge. It remains one of the principal methods of studying the works of French authors and testing student competence in textual appreciation in Britain and France alike. With its requirement for different orders of commentary on context, culture, form and content, structure and lexis, meaning and mise-en-scène amongst other considerations, it is clear that this classic exercise may benefit from recent developments in electronic publishing, particularly those relating to the electronic critical edition such as XML, XSLT and the TEI Guidelines. Electronic editions of texts with associated materials are excellent aids to the preparation of the traditional explication de texte. The study of old texts requires easy access to associated materials so that as well as the literary, linguistic and dramatic aspects, the social and political changes are also understood. Much work is currently being carried out by scholars to collate the disparate data that is available so that new insights into the text can be gained. But how can computer-based tools be of benefit to the undergraduate who has yet to gain a basic background knowledge of the texts, especially texts which present linguistic barriers? Two different websites have been designed by the authors of this paper specifically with the explication in mind. One is Hypert(ex)te/plications which provides information relating to seventeenth-century theatre studies: it contains the base texts of several plays by Corneille, Molière and Racine with commentaries by staff and students on selected extracts, as well as associated background materials that the students can refer to in a user-centred hypertext fashion. The other site, MedFrench, a prototype xml version of a DOS program created at the University of Hull which contains eight medieval French poetry together with "pearls of wisdom" about the history, culture, and language. It contains detailed sentence structure analysis and every word is annotated with its part-of-speech data, its modern French equivalent and its old French stem. The web version has been designed specifically with the idea of guiding the reader through the materials in a linear way. Can the new methods of digitisation and electronic publishing allow for a new style of explication? Could the process if creating an electronic edition constitute a form of explication as well? The idea of students creating their own electronic editions is not new. Programs such as the Poetry Shell provided a friendly interface and easy to learn tools for the students to add their own textual and graphic materials. But these programs shielded the students from grappling with some important issues relating to encoding and the ontology of text. By marking up a text, the original practices of explication de texte as experienced by Racine himself at Port-Royal are revived. But now the student is empowered to guide the master rather than simply follow his example.Hosted by the Scholarly Text and Imaging Service (SETIS), the University of Sydney Library, and the Research Institute for Humanities and Social Sciences (RIHSS), the University of Sydney

IMPROVING PATIENT FLOW ON ADULT MENTAL HEALTH UNITS: A MULTIMODAL STUDY OF CANBERRA HOSPITAL’S ACUTE PSYCHIATRIC FACILITIES

Background: Due to increasing demands on limited resources in the health care system, many hospitals are working to improve patient flow, thereby increasing their effective capacity. Identifying barriers to patient flow provides the best available evidence to improve such flow in The Canberra Hospital’s acute psychiatric units. Methods: This audit uses a multi-method design (combining focus groups, audits of flow in mental health units and retrospective data analysis on a cross-section of patients) to investigate current patterns of patient flow and barriers to discharge through the Canberra Hospital Mental Health Assessment & Adult Mental Health Units, and factors associated with increased length of stay. Results: Mean LoS for MHAU and AMHU was 8.45 hours and 15 days respectively. Multiple factors were associated with an increased LoS including patient factors, certain hospital processes, and limited availability of community services. Conclusions: These findings inform recommendations on improving patient flow and future research to support increases in available funding, staffing and resources

IMPROVING PATIENT FLOW ON ADULT MENTAL HEALTH UNITS: A MULTIMODAL STUDY OF CANBERRA HOSPITAL’S ACUTE PSYCHIATRIC FACILITIES

Background: Due to increasing demands on limited resources in the health care system, many hospitals are working to improve patient flow, thereby increasing their effective capacity. Identifying barriers to patient flow provides the best available evidence to improve such flow in The Canberra Hospital’s acute psychiatric units. Methods: This audit uses a multi-method design (combining focus groups, audits of flow in mental health units and retrospective data analysis on a cross-section of patients) to investigate current patterns of patient flow and barriers to discharge through the Canberra Hospital Mental Health Assessment & Adult Mental Health Units, and factors associated with increased length of stay. Results: Mean LoS for MHAU and AMHU was 8.45 hours and 15 days respectively. Multiple factors were associated with an increased LoS including patient factors, certain hospital processes, and limited availability of community services. Conclusions: These findings inform recommendations on improving patient flow and future research to support increases in available funding, staffing and resources

Psychosocial interventions for suicidal ideation, plans, and attempts: a database of randomised controlled trials

BACKGROUND Research in suicide prevention using psychosocial interventions is rapidly advancing. However, randomised controlled trials are published across a range of medical, psychological and sociology journals, and it can be difficult to locate a full set of research studies. In this paper, we present a database of randomised controlled outcome studies on psychosocial interventions targeting suicidal behaviour. The database is updated annually and can be accessed by contacting the corresponding author. DESCRIPTION A comprehensive literature search of the major bibliographical databases (PsycINFO; PubMed; Cochrane Central Register of Controlled Trials) was conducted for articles published between 1800 to July 30 2013, and examined reference lists of previous relevant reviews and included papers to locate additional references. Studies were included if they featured a randomised controlled design in which the effects of a psychosocial intervention were compared to a control condition (no intervention, attention placebo, wait-list, treatment-as-usual [TAU]), another psychosocial intervention or a pharmacological intervention. In total, 12,250 abstracts were identified. Of these, 131 studies met eligibility criteria and were included. Each paper was then coded into categories of participant characteristics (age, gender, formal diagnosis, primary reason for recruitment); details of the intervention (recruitment setting, content, intervention setting, administering individual, delivery type, delivery format, delivery frequency, delivery length); and study characteristics (control and experimental conditions, primary outcome/s, secondary outcome/s, follow-up period). One paper has been published from the database using studies collected and coded prior to 2012. CONCLUSION The database and listing of 131 studies is available for use by suicide prevention researchers. It provides a strong starting point for systematic reviews and meta-analyses of treatments and interventions. It will be updated yearly by researchers funded through the Australian National Health and Medical Research Council Centre for Research Excellence for Suicide Prevention (CRESP), located at the Black Dog Institute, Australia. This database adds to the evidence base of best-practice psychosocial interventions for suicidal behaviour and prevention.HC acknowledges the National Health and Medical Research Council (Centre For Research Excellence Grant 1042580) for research support

Suicide prevention in Psychotic Disorders: A systematic review

BACKGROUND: The incidence of suicide is high among patients with schizophrenia spectrum disorders and psychosis. A systematic review was performed to investigate the effectiveness of psychosocial interventions in reducing suicidal behaviour among patients with schizophrenia spectrum disorders and psychosis. METHODS: Cochrane, PubMed and PsycINFO databases were searched to January 2012. Additional materials were obtained from reference lists. Randomised Controlled Trials describing psychosocial interventions for psychotic disorders with attention placebo, treatment as usual (TAU), no intervention or waitlist control groups were included. RESULTS: In total, 11,521 abstracts were identified. Of those, 10 papers describing 11 trials targeting psychosocial interventions for reducing suicidal behaviour in patients with schizophrenia spectrum disorders and psychosic symptoms or disorders met the inclusion criteria. Odds Ratios describing the likelihood of a reduction in suicidal behaviour or ideation ranged from 0.09 to 1.72 at post-test and 0.13 to 1.48 at follow-up. CONCLUSIONS: Psychosocial interventions may be effective in reducing suicidal behaviour in patients with schizophrenia spectrum disorders and psychosis, although the additional benefit of these interventions above that contributed by a control condition or treatment-as-usual is not clear

Prescription opioid use disorder and heroin use among 12-34 year-olds in the United States from 2002 to 2014

Trend analyses of prescription opioids in the U.S. indicate use, especially use of prescription opioids stronger than morphine, has more than doubled among adults since the early 1990's (Frenk, Porter, & Paulozzi, 2015). Prescription opioids, like Oxycontin®, are effective pharmacological treatments for acute and chronic pain (Fitzcharles and Shir, 2009 ; Gallagher and Rosenthal, 2008). When used as indicated, these medications can be an important component of pain management. However, their high abuse potential presents concerns regarding their nonmedical use, which can be defined as ‘use of a prescription opioid that was not prescribed, or taken for the experience or feeling it caused’ (SAMHSA, 2014). In the United States, nonmedical use of prescription opioids (NMPO) is increasingly recognized as a serious public health problem among adults (Blanco et al., 2007; Han et al., 2015 ; Huang et al., 2006). Nonmedical prescription drug use, specifically nonmedical use of prescription opioids, is also a growing problem in other countries such as Canada (Fischer et al., 2014 ; Fischer et al., 2013) and Australia (Degenhardt et al., 2006 ; Rintoul et al., 2011)

Mood and anxiety disorders and their association with non-medical prescription opioid use and prescription opioid-use disorder

Background: Non-medical use of prescription opioids represents a national public health concern of growing importance. Mood and anxiety disorders are highly associated with non-medical prescription opioid use. The authors examined longitudinal associations between non-medical prescription opioid use and opioid disorder due to non-medical opioid use and mood/anxiety disorders in a national sample, examining evidence for precipitation, self-medication and general shared vulnerability as pathways between disorders. Method: Data were drawn from face-to-face surveys of 34 653 adult participants in waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic regression models explored the temporal sequence and evidence for the hypothesized pathways. Results: Baseline lifetime non-medical prescription opioid use was associated with incidence of any mood disorder, major depressive disorder (MDD), bipolar disorder, any anxiety disorder and generalized anxiety disorder (GAD in wave 2, adjusted for baseline demographics, other substance use, and co-morbid mood/anxiety disorders). Lifetime opioid disorder was not associated with any incident mood/anxiety disorders. All baseline lifetime mood disorders and GAD were associated with incident non-medical prescription opioid use at follow-up, adjusted for demographics, co-morbid mood/anxiety disorders, and other substance use. Baseline lifetime mood disorders, MDD, dysthymia and panic disorder were associated with incident opioid disorder due to non-medical prescription opioid use at follow-up, adjusted for the same covariates. Conclusions: These results suggest that precipitation, self-medication as well as shared vulnerability are all viable pathways between non-medical prescription opioid use and opioid disorder due to non-medical opioid use and mood/anxiety disorders

Inequalities in the Management of Diabetic Kidney Disease in UK Primary Care: :A Cross‐Sectional Analysis of A Large Primary Care Database

Aims: To determine differences in the management of diabetic kidney disease (DKD) relevant to patient sex, ethnicity and socio-economic group in UK primary care. Methods: A cross-sectional analysis as of January 1, 2019 was undertaken using the IQVIA Medical Research Data dataset, to determine the proportion of people with DKD managed in accordance with national guidelines, stratified by demographics. Robust Poisson regression models were used to calculate adjusted risk ratios (aRR) adjusting for age, sex, ethnicity and social deprivation. Results: Of the 2.3 million participants, 161,278 had type 1 or 2 diabetes, of which 32,905 had DKD. Of people with DKD, 60% had albumin creatinine ratio (ACR) measured, 64% achieved blood pressure (BP, <140/90 mmHg) target, 58% achieved glycosylated haemoglobin (HbA1c, <58 mmol/mol) target, 68% prescribed renin–angiotensin–aldosterone system (RAAS) inhibitor in the previous year. Compared to men, women were less likely to have creatinine: aRR 0.99 (95% CI 0.98–0.99), ACR: aRR 0.94 (0.92–0.96), BP: aRR 0.98 (0.97–0.99), HbA 1c: aRR 0.99 (0.98–0.99) and serum cholesterol: aRR 0.97 (0.96–0.98) measured; achieve BP: aRR 0.95 (0.94–0.98) or total cholesterol (<5 mmol/L) targets: aRR 0.86 (0.84–0.87); or be prescribed RAAS inhibitors: aRR 0.92 (0.90–0.94) or statins: aRR 0.94 (0.92–0.95). Compared to the least deprived areas, people from the most deprived areas were less likely to have BP measurements: aRR 0.98 (0.96–0.99); achieve BP: aRR 0.91 (0.8–0.95) or HbA 1c: aRR 0.88 (0.85–0.92) targets, or be prescribed RAAS inhibitors: aRR 0.91 (0.87–0.95). Compared to people of white ethnicity; those of black ethnicity were less likely to be prescribed statins aRR 0.91 (0.85–0.97). Conclusions: There are unmet needs and inequalities in the management of DKD in the UK. Addressing these could reduce the increasing human and societal cost of managing DKD

Combinatorial hydrogel library enables identification of materials that mitigate the foreign body response in primates

The foreign body response is an immune-mediated reaction that can lead to the failure of implanted medical devices and discomfort for the recipient. There is a critical need for biomaterials that overcome this key challenge in the development of medical devices. Here we use a combinatorial approach for covalent chemical modification to generate a large library of variants of one of the most widely used hydrogel biomaterials, alginate. We evaluated the materials in vivo and identified three triazole-containing analogs that substantially reduce foreign body reactions in both rodents and, for at least 6 months, in non-human primates. The distribution of the triazole modification creates a unique hydrogel surface that inhibits recognition by macrophages and fibrous deposition. In addition to the utility of the compounds reported here, our approach may enable the discovery of other materials that mitigate the foreign body response.Leona M. and Harry B. Helmsley Charitable Trust (3-SRA-2014-285-M-R)United States. National Institutes of Health (EB000244)United States. National Institutes of Health (EB000351)United States. National Institutes of Health (DE013023)United States. National Institutes of Health (CA151884)United States. National Institutes of Health (P41EB015871-27)National Cancer Institute (U.S.) (P30-CA14051

Distinguishing the Impacts of Inadequate Prey and Vessel Traffic on an Endangered Killer Whale (Orcinus orca) Population

Managing endangered species often involves evaluating the relative impacts of multiple anthropogenic and ecological pressures. This challenge is particularly formidable for cetaceans, which spend the majority of their time underwater. Noninvasive physiological approaches can be especially informative in this regard. We used a combination of fecal thyroid (T3) and glucocorticoid (GC) hormone measures to assess two threats influencing the endangered southern resident killer whales (SRKW; Orcinus orca) that frequent the inland waters of British Columbia, Canada and Washington, U.S.A. Glucocorticoids increase in response to nutritional and psychological stress, whereas thyroid hormone declines in response to nutritional stress but is unaffected by psychological stress. The inadequate prey hypothesis argues that the killer whales have become prey limited due to reductions of their dominant prey, Chinook salmon (Oncorhynchus tshawytscha). The vessel impact hypothesis argues that high numbers of vessels in close proximity to the whales cause disturbance via psychological stress and/or impaired foraging ability. The GC and T3 measures supported the inadequate prey hypothesis. In particular, GC concentrations were negatively correlated with short-term changes in prey availability. Whereas, T3 concentrations varied by date and year in a manner that corresponded with more long-term prey availability. Physiological correlations with prey overshadowed any impacts of vessels since GCs were lowest during the peak in vessel abundance, which also coincided with the peak in salmon availability. Our results suggest that identification and recovery of strategic salmon populations in the SRKW diet are important to effectively promote SRKW recovery