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Aetiologies, neuroradiological features, and risk factors for mortality and long-term neurosequelae of febrile coma in Malawian children:a prospective cohort study
Get PDFBACKGROUND: Children in febrile coma in Africa are frequently hospitalised, with poorer outcomes than those in high-income settings. Cerebral malaria is historically the most common cause of febrile coma. Due to limited diagnostic and radiological resources and a decrease in malaria prevalence, there might be under-recognition of non-malarial coma. However, prospective data are scarce. We aimed to determine causes, neuroradiological features, risk factors for mortality, and neurosequelae of children in febrile coma in Malawi.METHODS: In this prospective cohort study, we enrolled children in a coma (Blantyre Coma Scale score ≤2) who were aged between 3 months and 15 years at Queen Elizabeth Central Hospital, Blantyre, Malawi. We used pathogen-specific PCR analysis of blood and cerebrospinal fluid for 15 pathogens including Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Salmonella spp, non-typhoidal Salmonella, Salmonella enterica serotype Typhi (S Typhi), Klebsiella spp, Escherichia coli, Mycobacterium tuberculosis (also using GeneXpert), Streptococcus agalactiae, herpes simplex virus (types 1 and 2), varicella zoster virus, cytomegalovirus, enteroviruses, and SARS-CoV-2; microscopy for malaria; admission brain MRI to enhance the diagnosis of cause and identify brain injury, swelling, and any other complications; and electroencephalography tracings were used identify subclinical seizures or non-convulsive status epilepticus. Assessment of malarial retinopathy was performed by a trained ophthalmologist. We used regression models to estimate risk factors for (and the difference in) 30-day mortality and 180-day neurosequelae (outcome assessed in-person) between children with non-malarial coma and cerebral malaria.FINDINGS: Between Jan 31, 2018, and June 30, 2021, we recruited 352 children with febrile coma. Cerebral malaria was the most common cause (in 231 [66%] of 352 children). Pathogenic diagnosis was possible in 289 (82%) of 352 children. Co-infection was identified in 63 (27%) of 231 children with cerebral malaria, of which 49 (78%) were bacterial. The most common non-malarial causes of coma were meningitis (48 [14%] of 352 children) and encephalitis (24 [7%] of 352); 32 (9%) cases had an unknown cause. Compared with standard cultures, PCR significantly increased pathogen diagnosis (p<0·0001), with the highest yield in patients with meningitis (seven [15%] of 48 vs 30 [63%] of 48). S pneumoniae (n=44) and non-typhoidal salmonella or S Typhi (n=24) were the most frequently detected bacterial pathogens. Brain parenchymal abnormalities were identified on MRI in most children with febrile coma (165 [92%] of 178), and were significantly more common in children with non-malarial coma (68 [100%] of 68]) than cerebral malaria (98 [89%] of 110; p<0·0001). Overall, at 30 days after discharge, death (69 [21%] of 323) or any neurological impairment (163 [50%] of 323) were common, but poorer long-term outcomes were more frequent following non-malarial coma than cerebral malaria (death at 30 days: 32 [28%] of 114 vs 37 [18%] of 209, p=0·029; severe neurological impairment at 180 days: 19 [17%] of 114 vs 15 [7%] of 209, p=0·0079). Children who had cerebral malaria with CNS co-infection had higher mortality (ten [37%] of 27) than those with cerebral malaria alone (19 [12%] of 154, p=0·0033).INTERPRETATION: Despite malaria control efforts, cerebral malaria remains the most common cause of febrile coma in Malawi. However, non-malarial coma causes a greater disease burden (death and disability), and a higher case-fatality rate was observed in non-malarial coma and cerebral malaria with non-malarial co-infection than cerebral malaria alone. To adequately treat severe invasive bacterial infections, that are frequently not detected in routine clinical practice, commencing empirical antimicrobials in all children in febrile coma, including those with cerebral malaria, could and should be rapidly implemented across Africa and must be considered. The study highlights the value of molecular diagnostics and imaging to guide diagnosis. The frequent findings of brain abnormalities from imaging at admission emphasises the need for earlier escalation of children with febrile coma to specialist care. Further work is needed to develop feasible molecular and radiological diagnostics for their successful deployment across the continent. Implementation of these methods could improve diagnosis and outcomes for children with febrile coma in Africa.<p/
A numerical study on the significance of slab for the response of a prototype structure under travelling fires
Get PDF“Travelling fires” discriminate a fire plume at the near-field and a hot smoke layer preheating the ceiling at the far-field, with the intent of ensuring the robustness of structural design for large compartments under realistic fires. Once the fire is “travelling”, the near-field has a leading edge representing the fire spread, and a trailing edge representing the burnout of the fuel. Despite the recognised effects of travelling fires, the mainstream of efforts into their effect on structural response has been limited to 2D models using the finite element method (FEM). This paper aims to identify the importance of slab inclusion with a 3D FEM structural model for steel-composite structures under travelling fires, assessed against the corresponding simplified 2D structural frame models (i.e., with and without effective slab in the 2D steel frame model). The first step is a comparative structural analysis of a prototype composite structure under various design fire scenarios, including standard fire, parametric fires and travelling fires. The role of the fire protection scheme for the simplified 2D models against the 3D model for the numerical predictions is also explored. It is found that the structural load path, and the potential structural failure mechanisms, could be fundamentally different between the 3D model and the simplified 2D models. Although the 2D frame model tends to predict larger deflections (i.e., more conservative) than the 3D model, it could also significantly underestimate the large internal forces from the beams, so that the connections' failure under travelling fires might be overlooked. Further, due to the simplification of the 2D models in omitting the significant stiffness contribution from the slab and the adjacent structural components, the effect of the fire protection is likely to be amplified. This may give misleading information on the performance-based structural fire design under different travelling fire scenarios. Hence, the 3D model can be considered as feasible but also necessary for structural fire analysis for travelling fires as a complement to the simplified 2D model approach
Changes in metazoan functional diversity across the Cambrian Radiation and the first Phanerozoic mass extinction: the Cambrian Sinsk Event
Get PDFThe Sinsk Event (approx. 513.5 million years ago, Ma) is the first Phanerozoic mass extinction, marking the end of the canonical Cambrian Radiation. We reconstruct taxonomic and functional diversity patterns of skeletal metazoans from the Siberian Platform during the Cambrian Radiation and across the Sinsk Event from approximately 529 Ma to 508 Ma, to investigate the changing occupation of functional space and the evolution of functional traits during the radiation, and the role of these in extinction selectivity at the Sinsk extinction and subsequent recovery. During the radiation, functional richness increased before taxonomic richness as new groups with novel traits emerged and diversified. Taxonomic richness declined sharply at the Sinsk, but thereafter increased rapidly while functional richness continued to decline until approx. 508 Ma, indicating a post-extinction decoupling. While there is limited evidence of extinction selectivity at the Sinsk, certain functional traits are associated with post-extinction recovery from approximately 511 Ma to 508 Ma. Groups with novel functional traits associated with motility, diversified feeding modes and broad water depth tolerances diversified rapidly, while sessile, inshore filtrators and heavily calcified taxa which had been dominant prior to the extinction either failed to recover or became extinct. The Sinsk Event therefore marks a significant transition in marine ecosystem function
Petrogenesis and metamorphism of mafic rocks, Atlantis Massif, IODP Expedition 357: implications of two episodes of magmatism
Get PDFThe petrogenesis and metamorphism of International Ocean Discovery Program (IODP) Expedition 357 (Atlantis Massif, Mid-Atlantic Ridge) mafic rocks is the focus of this paper. At least two phases of magmatism are identified. Later Phase I metamorphosed mafic intrusive rocks (MMIs) are moderately to extremely chloritized, recording loss on ignition (LOI) of 3.33–9.99 wt%, and latest Phase II basalts are exceptionally fresh, with LOI of 0.09–1.03 wt%. Phase I MMIs have Fe-chromite identical to Atlantis Massif serpentinites that have undergone melt-impregnation and Phase II basalt Cr-spinels are analogous to those of Atlantis Massif peridotites that have not undergone secondary melt-impregnation. Whole-rock Cr/Y relations of the Phase II basalt record melt fractions (F) of c. 16–25% and melt–liquid equilibria established for Phase II basalt olivine yield crystallization temperatures of 1173–1219°C similar to mid-ocean ridge basalt (c. 1125–1290°C). Trivariant plots of Na2O–CaO–MgO and XRD analysis confirm extreme chloritization of the Phase I MMIs. Phase I MMI spinel is predominantly Fe-chromite that formed under amphibolite-facies conditions (c. 500°C). Subsequent to peridotite exhumation, serpentinization and Phase I magmatism, an episode (or episodes) of asthenospheric upwelling resulted in contact metamorphism caused by Phase II magmatism
He Kept Me Safe:A play on intimate partner violence amongst gay and bisexual men
Get PDFHe Kept Me Safe is a multi-actor theatre play shedding light on the experiences of intimate partner violence (IPV) amongst gay and bisexual men (GBM). The play is based on qualitative research conducted with 10 GBM survivors in Scotland using a narrative inquiry approach, allowing participants to authentically recount their IPV experiences. Subsequently, using narrative portraiture, the interview transcripts were transformed into a script featuring a mental health practitioner facilitating a group session with four male survivors. The play delves into various forms of abuse endured, the resulting trauma, and the journey toward healing and recovery
A new approach to retrofitting FHE campus buildings using a whole life carbon assessment
Get PDFExisting further and higher education (FHE) buildings urgently need effective retrofitstrategies to meet net-zero targets, despite limited historical data. This researchintegrates LCA, techno-economic assessments, and modelling to identify optimalinterventions balancing envelope improvements and low-carbon heating. It considersfactors like cost, user comfort, climate change, and evolving energy grids to achievesignificant carbon reductions. Considering the inherited occupant thermal comfortbenefits of the proposed building retrofit options, the study outlines results thatreduce not only operational carbon but also embodied carbon from retrofit work tothe end-of-life of the building (60 Years). A fast carbon reduction approach, such asconverting to heat pumps, can cut operational energy by 100-118% and GWP by97%, but increase operational energy costs by 80-101%. Although choosingbetween specifying synthetic over natural materials can impact project costs, thedifferences in whole-life carbon emissions provide a 27% and 31% reduction incarbon without considering a change in heating system (and fuel type). Over time,during replacements and maintenance periods, these can play a more relevant role.Switching to lower carbon heat pump refrigerants has shown marginal carbonreductions; however, it is hoped that this technology can find other improvements inlowering its embodied carbon footprint. This research has shown that implementingcombined retrofits by integrating heat pumps and envelope improvements, offeroptimal cost-effective, emission-cutting solutions for university buildings, enhancingcomfort and prioritising natural materials and optimised heating technology. Thestudy provides a detailed comparison of retrofit solutions to inform holisticdecarbonisation strategies replicable across different building archetypes.Highlights* This research combines life-cycle assessment (LCA) and techno-economicanalysis, utilising both static and dynamic modelling, to evaluate optimalretrofit strategies for FHE buildings.* The study demonstrates the benefits of a combined approach, integratingbuilding envelope improvements with low-carbon heating systems, to enhanceoccupant comfort and reduce emissions.* Recognising financial constraints, the research prioritises readily availablematerials and optimised heat pump sizing to deliver cost-effective retrofitsolutions.* A comparative analysis of natural and synthetic envelope materials highlightsthe long-term environmental benefits of natural materials, despite potentialreplacement needs
Social inference brain networks in autistic adults during movie-viewing:Functional specialization and heterogeneity
Get PDFBackground: Difficulty in social inferences is a core feature in autism spectrum disorders (ASD). On the behavioral level, it remains unclear whether reasoning about others’ mental states (Theory of Mind, ToM) and empathic responses to others’ physical states may be similarly or differentially affected in autism. On the neural level, these inferences typically engage distinct brain networks (ToM versus Pain networks), but their functional specialization remains not well understood in autism. This study aimed to investigate the functional specialization, heterogeneity, and brain-behavior relationships of the ToM and Pain networks in autistic compared to neurotypical (NT) participants. We hypothesized differential functional network specialization (i.e., functional connectivity), increased heterogeneity, and less typical network responses specifically in the ToM network, with relatively similar responses in the Pain network in ASD.Methods: Using functional magnetic resonance imaging (fMRI), we investigated neural responses in 107 adults (autistic: 34 (female = 11), NT: 73 (female = 23); matched for age, intellectual functioning, sex, motion) while they passively watched a short, animated movie including events that evoke reasoning about characters’ mental states and bodily sensations. Preregistered analyses included regression models to assess inter-region correlation of within- and across-network connectivity, inter-subject correlation to quantify similarity to the average neurotypical, as well as to within- and across-group timecourse responses, and brain-behavior relationships relevant for social inferences.Results: Functional specialization of ToM and Pain networks were overall intact, with distinct network responses in both groups. The autistic group showed differential ToM network responses and reduced similarity to the average typical response for both networks. Network responses were more idiosyncratic and heterogenous in the autistic group. Brain-behavior relationships differed between groups for ToM behavior only.Limitations: Effects between groups were overall small. Samples were acquired across two sites, yet the sample size restricts subgroup analyses that may further inform autistic heterogeneity and limits generalizability.Conclusions: We found weak evidence for greater differential responses in brain networks underlying ToM inferences than those involved in empathic responses in autism, consistent with a prior empathy imbalance hypothesis. We outline suggestions for replicating, generalizing and extending these results in future research
Social rights and the origins of the social constitution:From collective natural rights to the social state
Get PDFThis Foreword revisits the commonly understood origin story of social rights and the social constitution. It challenges the predominant thesis that social rights were a conceptual by-product of the rise of the welfare state. Instead, it argues that, in the nineteenth century, social rights - which have longer and deeper historical lineages than previously recognized - became a compelling register through which a new imaginary of a social state was constructed. It argues that social rights ideas emerged as "collective natural rights"and were used to articulate a concept of the state as a public power that represented the interests of the whole of society, not just the propertied, and to assert the state's purpose in upholding the equal right of all to a fair share of the wealth produced by the social whole. For this reason, social rights played a distinctive role in the articulation of the transformative ambitions of revolutionary movements and post-colonial states. This Foreword concludes that recovering this historical understanding of social rights and the social constitution is valuable, and potentially useful, in an epoch of galloping inequality, intensifying concentrations of private wealth and power, and downward social mobility for many
Cyberbullying by Chinese adolescents after being cyber-victimized:How does moral disengagement affect this process?
Get PDFCyberbullying among adolescents is a serious concern, warranting the attention of both researchers and practitioners. While cyber-victimization is considered one of the most important factors leading to cyberbullying perpetration, more investigation is needed on the underlying mediating mechanisms, especially from a developmental perspective. Based on the social information processing model, this study investigated the direction of the relationship between cyber-victimization and cyberbullying perpetration as well as the underlying developmental mechanisms of moral disengagement. Parallel process latent growth curve modeling was used to jointly model the developmental trajectories of cyber-victimization and cyberbullying perpetration and to investigate the mediating role of moral disengagement. Three-wave longitudinal data—with a 1-year time interval between consecutive waves—were obtained from a sample of Chinese adolescents (N = 1,422; 50.9% girls; mean age = 13.56) and analyzed. All participants completed self-report questionnaires on cyber-victimization, cyberbullying perpetration, and moral disengagement. Results showed that both the initial level and change in cyber-victimization predicted an increase in cyberbullying perpetration over time. Changes in moral disengagement mediated the relationship between initial levels of cyber-victimization and changes in cyber-victimization, and also changes in cyberbullying perpetration. Initial levels of cyber-victimization also indirectly influenced initial levels of cyberbullying perpetration through initial levels of moral disengagement. Furthermore, gender was significantly associated with cyber-victimization, with girls showing a lower likelihood of being cyberbullying victims than boys. By investigating the development of both cyberbullying victimization and perpetration among adolescents, this study provides valuable insights for future research and intervention programs aimed at protecting adolescents in the cyber world
The use of smoking cessation applications:A realist evaluation
Get PDFThe worldwide tobacco epidemic continues to present significant public health challenges, necessitating persistent smoking cessation efforts. Mobile applications have shown potential as effective tools to aid individuals in quitting smoking, yet there is limited understanding of how it works. This study utilised a realist evaluation approach to establish programme theories that explain how smoking cessation applications help Chinese smokers stop smoking
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