Physostigmine should be used more readily for antimuscarinic toxicity: PRO

Physostigmine is the preferred treatment for antimuscarinic toxicity. Its use has a clear biological rationale and is supported by extensive clinical use which demonstrated effectiveness and safety.

Charge-Transfer in Panchromatic Porphyrin-Tetracyanobuta-1,3-Diene-Donor Conjugates: Switching the Role of Porphyrin in the Charge Separation Process

Using a combination of cycloaddition-retroelectrocyclization reaction, free-base and zinc porphyrins (H₂ P and ZnP) are decorated at their β-pyrrole positions with strong charge transfer complexes, viz., tetracyanobuta-1,3-diene (TCBD)-phenothiazine (3 and 4) or TCBD-aniline (7 and 8), novel class of push-pull systems. The physico-chemical properties of these compounds (MP-Donor and MP-TCBD-Donor) have been investigated using a range of electrochemical, spectroelectrochemical, DFT as well as steady-state and time-resolved spectroscopic techniques. Ground-state charge transfer interactions between the porphyrin and the electron-withdrawing TCBD directly attached to the porphyrin π-system extended the absorption features well into the near-infrared region. To visualize the photo-events, energy level diagrams with the help of free-energy calculations have been established. Switching the role of porphyrin from the initial electron acceptor to electron donor was possible to envision. Occurrence of photoinduced charge separation has been established by complementary transient absorption spectral studies followed by global and target data analyses. Better charge stabilization in H₂ P derived over ZnP derived conjugates, and in phenothiazine derived over aniline derived conjugates has been possible to establish. These findings highlight the importance of the nature of porphyrins and second electron donor in governing the ground and excited state charge transfer events in closely positioned donor-acceptor conjugates.

The Emerging Drugs Network of Australia: A toxicosurveillance system of illicit and emerging drugs in the emergency department

OBJECTIVE

The unprecedented rise in synthetic drugs, many containing unknown toxic agents, has made timely analytical diagnosis more difficult, and has reduced the confidence of clinicians providing ED management to this population of patients. This has also impacted the quality of evidence informing harm reduction responses. The Emerging Drugs Network of Australia (EDNA) brings together emergency physicians, toxicologists and forensic laboratories to establish a standardised ED toxicosurveillance system in Australia.

METHODS

Blood analysis of intoxicated patients will be conducted by forensic laboratories to enable precise identification of the substances causing acute toxicity. This will be linked with clinical data collected at the time of ED presentation to enable analysis of the clinical effects and outcomes associated with different illicit and emerging drugs. Toxicological and clinical data collected across sentinel sites will align with a nationally endorsed minimum dataset.

RESULTS

EDNA's collaborative network will establish a national system of surveillance and reporting of illicit and emerging drugs causing acute toxicity. Standardisation of data collection recorded in a national clinical registry will provide more robust data on epidemiology and associated harms. This will facilitate the translation of clinical and toxicological evidence into timely, appropriate harm reduction and policy.

CONCLUSION

Our work represents a collaborative response to calls for more sophisticated data on emerging drug trends in Australia. EDNA will improve coordination between clinicians and analytical services by way of its standardised approach to surveillance and reporting.

The achilles heel of democracy? A macro cross-national assessment of the correlates of state legitimacy

This study investigates the macro-level correlates of subjective state legitimacy using a cross-national panel dataset of 82 countries from 1989 to 2014. It conducts the first comprehensive multivariate assessment of the effect of democracy, while also evaluating the effects of the nationalist principle of ethnic self-rule and state endogeneity (i.e. colonialism), net of controls. The findings suggest that-contrary to certain theories and earlier empirical studies-democracy has a strong and negative association with legitimacy, which is robust across different measures of democracy and model specifications. The results also provide some evidence that adhering to the nationalist principle is related to subjective state legitimacy, while suggesting that state endogeneity is not. Moreover, democracy is the strongest correlate of subjective state legitimacy whose effect becomes stronger-rather than weaker, as some predict-in the presence of controls. Preliminary analyses provide some support to the claim that the freedom of expression contributes to the negative democracy/state legitimacy relationship.

Identifying Predictors of University Students' Wellbeing during the COVID-19 Pandemic-A Data-Driven Approach

BACKGROUND

The COVID-19 pandemic has posed risks to public mental health worldwide. University students, who are already recognised as a vulnerable population, are at elevated risk of mental health issues given COVID-19-related disruptions to higher education. To assist universities in effectively allocating resources to the launch of targeted, population-level interventions, the current study aimed to uncover predictors of university students' psychological wellbeing during the pandemic via a data-driven approach.

METHODS

Data were collected from 3973 Australian university students ((median age = 22, aged from 18 to 79); 70.6% female)) at five time points during 2020. Feature selection was conducted via least absolute shrinkage and selection operator (LASSO) to identify predictors from a comprehensive set of variables. Selected variables were then entered into an ordinary least squares (OLS) model to compare coefficients and assess statistical significance.

RESULTS

Six negative predictors of university students' psychological wellbeing emerged: White/European ethnicity, restriction stress, perceived worry on mental health, dietary changes, perceived sufficiency of distancing communication, and social isolation. Physical health status, emotional support, and resilience were positively associated with students' psychological wellbeing. Social isolation has the largest effect on students' psychological wellbeing. Notably, age, gender, international status, and educational level did not emerge as predictors of wellbeing.

CONCLUSION

To cost-effectively support student wellbeing through 2021 and beyond, universities should consider investing in internet- and tele- based interventions explicitly targeting perceived social isolation among students. Course-based online forums as well as internet- and tele-based logotherapy may be promising candidates for improving students' psychological wellbeing.

Evaluating spatiotemporal dynamics of snakebite in Sri Lanka: Monthly incidence mapping from a national representative survey sample

BACKGROUND

Snakebite incidence shows both spatial and temporal variation. However, no study has evaluated spatiotemporal patterns of snakebites across a country or region in detail. We used a nationally representative population sample to evaluate spatiotemporal patterns of snakebite in Sri Lanka.

METHODOLOGY

We conducted a community-based cross-sectional survey representing all nine provinces of Sri Lanka. We interviewed 165 665 people (0.8% of the national population), and snakebite events reported by the respondents were recorded. Sri Lanka is an agricultural country; its central, southern and western parts receive rain mainly from Southwest monsoon (May to September) and northern and eastern parts receive rain mainly from Northeast monsoon (November to February). We developed spatiotemporal models using multivariate Poisson process modelling to explain monthly snakebite and envenoming incidences in the country. These models were developed at the provincial level to explain local spatiotemporal patterns.

PRINCIPAL FINDINGS

Snakebites and envenomings showed clear spatiotemporal patterns. Snakebite hotspots were found in North-Central, North-West, South-West and Eastern Sri Lanka. They exhibited biannual seasonal patterns except in South-Western inlands, which showed triannual seasonality. Envenoming hotspots were confined to North-Central, East and South-West parts of the country. Hotspots in North-Central regions showed triannual seasonal patterns and South-West regions had annual patterns. Hotspots remained persistent throughout the year in Eastern regions. The overall monthly snakebite and envenoming incidences in Sri Lanka were 39 (95%CI: 38-40) and 19 (95%CI: 13-30) per 100 000, respectively, translating into 110 000 (95%CI: 107 500-112 500) snakebites and 45 000 (95%CI: 32 000-73 000) envenomings in a calendar year.

CONCLUSIONS/SIGNIFICANCE

This study provides information on community-based monthly incidence of snakebites and envenomings over the whole country. Thus, it provides useful insights into healthcare decision-making, such as, prioritizing locations to establish specialized centres for snakebite management and allocating resources based on risk assessments which take into account both location and season.

Online interventions for people hospitalized for deliberate self-harm and problematic alcohol use: Lessons learned from the iiAIM trial

Deliberate self-harm and suicide affect all age groups, sexes, and regions, and their prevention is a global health priority. Acute alcohol misuse and chronic alcohol misuse are strong, modifiable risk factors, and Internet interventions aiming to reduce alcohol misuse and comorbid mental health problems (e.g., depression) are a promising and effective treatment modality. The research team aimed to evaluate the feasibility and effectiveness of an Internet-based comorbidity intervention primarily aiming to reduce alcohol consumption, and secondarily to reduce readmission for deliberate self-harm and improve psychological outcomes among people hospitalized for deliberate self-harm who also engage in problematic alcohol use. However, due to several barriers to recruitment, the trial could not be completed and was discontinued. The authors present a "Lessons Learned" discussion and describe the Internet Intervention for Alcohol Improvement (iiAIM) trial, discuss the key barriers experienced by the research team, and recommend potential solutions that may help future trials in this area.

841 The psychological impact of Foundation Interim Year 1 Placements on Final Year UK Medical Students Transitioning to Foundation Year One During the COVID Era

Introduction

During the COVID pandemic, the 2019-2020 cohort of final year students were invited to participate in Foundation interim Year 1 placements (FiY1). FiY1 aimed to ease transition to Foundation Year 1 doctor (FY1). We assessed the psychological impact of FiY1 on final year medical students.

Method

A cross-sectional survey was distributed to final year medical students in the UK between June 4th and July 4th, 2020. The survey contained the following domains: participant demographics, rationale for FiY1 participation, a checklist of the key safety principles for FiY1s, the Hospital Anxiety and Depression Scale and the Perceived Stress scale-4.

Results

107 final years responded to the survey. 72.0% (n = 77) of final year students surveyed were working as FiY1s. Final year students participating in FiY1 postings had reduced rates of anxiety (29.9% vs 43.4%, P = 0.186), depression (5.2% vs 20.0%, P = 0.018) and lower perceived stress levels (5.0 vs 7.2, P < 0.001). 19.5% (15/77) FiY1s reported working beyond their competency, 27.3% (22/77) felt unsupervised, but 94.8% (73/77) of FiY1s felt the post prepared them for FY1.

Conclusions

Students participating in FiY1 postings felt less stressed and depressed than those not participating in the scheme and the majority felt it was preparing them for FY1.

After-Discharge in the Upper Airway Muscle Genioglossus Following Brief Hypoxia

STUDY OBJECTIVES

Genioglossus after-discharge is thought to protect against pharyngeal collapse by minimising periods of low upper airway muscle activity. How genioglossus after-discharge occurs and which single motor units (SMUs) are responsible for the phenomenon are unknown. The aim of this study was to investigate genioglossal after-discharge.

METHODS

During wakefulness, after-discharge was elicited 8-12 times in healthy individuals with brief isocapnic hypoxia (45-60s of 10%O2 in N2) terminated by a single breath of 100% O2. Genioglossus SMUs were designated as firing solely, or at increased rate, during inspiration (Inspiratory phasic [IP] and inspiratory tonic [IT] respectively); solely, or at increased rate, during expiration (Expiratory phasic [EP] or expiratory tonic [ET] respectively) or firing constantly without respiratory modulation (Tonic). SMUs were quantified at baseline, the end of hypoxia, the hyperoxic breath and the following 8 normoxic breaths.

RESULTS

210 SMU's were identified in 17 participants. Genioglossus muscle activity was elevated above baseline for 7 breaths after hyperoxia (p<0.001), indicating a strong after-discharge effect. After-discharge occurred due to persistent firing of IP and IT units that were recruited during hypoxia, with minimal changes in ET, EP or Tonic SMUs. The firing frequency of units that were already active changed minimally during hypoxia or the afterdischarge period (P>0.05).

CONCLUSION

That genioglossal after-discharge is almost entirely due to persistent firing of previously silent inspiratory SMUs provides insight into the mechanisms responsible for the phenomenon and supports the hypothesis that the inspiratory and expiratory/tonic motor units within the muscle have idiosyncratic functions.

Workplace Intimacy

Amidst massive economic damage tension between the needs to save lives and save jobs has become the basis of a key political fault-line and a matter of daily on-the-ground management during the COVID-19 pandemic. In this article we consider four especially salient changes to work-life wrought by the pandemic: (1) new workplace praxes pertaining to matters of touch; (2) erosion and degrading of the quality of erstwhile intimate relations in certain workplaces; (3) changes to senses of belonging and homeliness in workplaces; (4) and, reflecting on the particular type of work that we do, how the pandemic (and pandemic lockdown especially) is impacting our pedagogical and research practices. Throughout we reveal how the intimacies experienced within workplaces are being transformed – not always eroded or degraded, but also sometimes adapted, sustained in new ways (especially via new communications technologies), and even enhanced.

Aboriginal community controlled health organisations address health equity through action on the social determinants of health of Aboriginal and Torres Strait Islander peoples in Australia

BACKGROUND

Indigenous populations globally are continually striving for better health and wellbeing due to experiencing significant health and social inequities. The social determinants of health are important contributors to health outcomes. Comprehensive primary health care that is governed and delivered by Indigenous people extends beyond the biomedical model of care to address the social determinants of health. Aboriginal Community Controlled Health Organisations (ACCHOs) are known to provide culturally informed, holistic health services that directly and indirectly address the social determinants of health. The range and extent of their activities in addressing the social determinants of health, however, is not well documented.

METHODS

The most recent ACCHO annual reports were retrieved online or by direct correspondence. For coding consistency, a dictionary informed by the World Health Organization's Conceptual Framework for Action on the Social Determinants of Health was developed. A document and textual analysis of reports coded ACCHO activities and the determinants of health they addressed, including intermediary determinants, socio-economic position and/or socio-political context. Summary statistics were reported. Representative quotes illustrating the unique nature of ACCHO service provision in addressing the social determinants of health were used to contextualise the quantitative findings.

RESULTS

Sixty-seven annual reports were collected between 2017 and 2018. Programs were delivered to population groups across the life span. Fifty three percent of reports identified programs that included work at the socio-political level and all annual reports described working to improve socioeconomic position and intermediary determinants of health through their activities. Culture had a strong presence in program delivery and building social cohesion and social capital emerged as themes.

CONCLUSIONS

This study provides evidence of the considerable efforts of the ACCHO sector, as a primary health care provider, in addressing the social determinants of health and health inequity experienced by Indigenous communities. For the Aboriginal and Torres Strait Islander population, ACCHOs not only have an essential role in addressing immediate healthcare needs but also invest in driving change in the more entrenched structural determinants of health. These are important actions that are likely to have an accumulative positive effect in closing the gap towards health equity.

COVID-19 and the Transformation of Intimate Inter- and Intra-National Relations

Based conceptually on Michael Herzfeld’s ideas of cultural intimacy and disemia, and empirically on lockdown auto-ethnography, this article considers how erstwhile intimate inter-and intra-national relations have been transformed by COVID-19. Its particular ethnographic focus is Australian–British post-colonial relations and the personal emergence of a hybrid Br-Australian consciousness.

Social Intimacy

In this article, we highlight how COVID-19 has transformed, is transforming and may transform into the future human intimacies at several different social levels: between couples, within and between families, between citizens and states, among nations, and between people and their deities. We conclude by highlighting an uncertain future for intimacies that may entail the radical transformation of societies characterised by conversely new and liberating forms of socio-economic organisation or enslavement, especially to new spatio-temporal configurations engendered by the pandemic.

Understanding Stabilization in Nanoporous Intermetallic Alloy Anodes for Li-Ion Batteries Using Operando Transmission X-ray Microscopy

Tin-based alloying anodes are exciting due to their high energy density. Unfortunately, these materials pulverize after repetitive cycling due to the large volume expansion during lithiation and delithiation; both nanostructuring and intermetallic formation can help alleviate this structural damage. Here, these ideas are combined in nanoporous antimony-tin (NP-SbSn) powders, synthesized by a simple and scalable selective-etching method. The NP-SbSn exhibits bimodal porosity that facilitates electrolyte diffusion; those void spaces, combined with the presence of two metals that alloy with lithium at different potentials, further provide a buffer against volume change. This stabilizes the structure to give NP-SbSn good cycle life (595 mAh/g after 100 cycles with 93% capacity retention). Operando transmission X-ray microscopy (TXM) showed that during cycling NP-SbSn expands by only 60% in area and then contracts back nearly to its original size with no physical disintegration. The pores shrink during lithiation as the pore walls expand into the pore space and then relax back to their initial size during delithiation with almost no degradation. Importantly, the pores remained open even in the fully lithiated state, and structures are in good physical condition after the 36th cycle. The results of this work should thus be useful for designing nanoscale structures in alloying anodes.

The clinical toxicity of imidacloprid self-poisoning following the introduction of newer formulations

BACKGROUND

Self-poisoning with imidacloprid has been previously shown to have low toxicity in humans. Since 2007 newer formulations of Imidacloprid with unknown solvents have been introduced and the potential clinical consequences of these products have not been described.

METHODS

Clinical and demographic data were prospectively collected from admissions following oral ingestion of imidacloprid from seven hospitals in Sri Lanka. Data was collected from 2002 to 2007 in an already published study. We compared this data on poisonings collected from 2010 to 2016 following the introduction of new formulations of imidacloprid.

RESULTS

From 2002-2007, there were 56 patients with ingestion to imidacloprid compared to 67 patients post 2010 The median time to presentation prior to 2007 was 4 h (IQR 2.3-6.0 hrs) and post 2010 was only 2.0 hr (IQR 1.5 to 3.1 hrs). The median amount ingested was 15 ml (IQR 10.0-50.0mls) prior to 2007 and 27.5mls (IQR 5.0-71.8mls) post 2010. In both studies most patients developed non-specific symptoms including nausea, vomiting, epigastric pain and headache. However, prior to 2007 only 1.9% of the cohort required mechanical ventilation due to respiratory failure and there were no reported deaths. In contrast, post 2010; deaths occurred in 3.0% of the cohort and 6.0% required mechanical ventilation for respiratory failure. The cause of mortality was due to one case of cardiorespiratory failure and the other due to a prolonged admission complicated with lobar pneumonia leading to decompensated liver failure on the background of undiagnosed liver cirrhosis.

CONCLUSION

Although acute exposure to imidacloprid is usually associated with mild non-specific symptoms, since the introduction of new formulations of imidacloprid, the toxic profile has changed with reported cases of death as well as an increase in cases requiring mechanical ventilation. The change in toxicity could be due to the solvents used in the newer formulations but also due to higher dose of imidacloprid described in our latter cohort. Further research into these solvents needs to be done and continued toxicovigilance is required.

Foreign aid and the rule of law: Institutional diffusion versus legal reach

This paper examines the role of bilateral foreign aid in supporting the diffusion and enactment of common models and institutions of the rule of law among aid-recipient low- and middle-income countries. We ask whether aid targeted at security-sector reform and the rule of law influences the adoption of constitutional and legal reforms over time (institutional diffusion), and whether aid also supports more effective implementation of the rule of law, writ large (legal reach). We use event history and fixed-effects panel regression models to examine a sample of 154 countries between 1995 and 2013 to answer these questions. Our findings suggest that aid does increase the likelihood of adopting several rule of law reforms, but its effect on increasing the depth or quality of rule of law over time within countries is much less substantial. These findings suggest that though aid may play a role in supporting the diffusion of models contributing to state isomorphism among countries, it is less effective at increasing the pervasiveness and quality of such model's implementation. This discrepancy between the effectiveness of bilateral aid in promoting law on the books versus law in action in aid recipient countries calls into question the current approach to rule of law reforms.

Experiential Knowledge Affects the Visual Search Behaviors of Sprint Coaches and Sport Biomechanists

It is common for applied sport biomechanists and high-performance coaches to work closely together. A feature of this relationship is that both bring unique experiences and knowledge to the common goal of improving an athlete's performance. For sprint running, coaches and biomechanists place importance on different aspects of technique. The purpose of this paper was to determine if these differences in experiential knowledge impact coaches and biomechanists visual perception of sprinting technique. Sport biomechanists (n = 12) and, expert (n = 11) and developing (n = 11) coaches watched video of athletes sprinting at two different speeds while wearing eye tracking glasses and, retrospectively, reported on the technique features observed. Mixed methods ANOVAs were used to determine visual search strategies and efficiency and used to indicate the relationship between visual search and verbal commentary data. The speed of video playback was the main determinant of visual search behavior, significantly impacting the visual search rate and relative fixation duration at a number of areas of interest. The use of a visual pivot indicated all participants' visual search strategies were efficiency driven. Overall, the verbal commentary did not completely align with the eye tracking data and there were varying degrees of agreement with the identified technique related areas of interest for coaches and biomechanists. However, differences in visual search strategy and verbal commentary suggest that experiential knowledge impacts participants' observation and perception of sprinting technique.

Microbial Intimacy

In this article, we highlight how COVID-19 has transformed, is transforming and may transform into the future human intimacies. This, we argue, is an appropriate focus for anthropological investigation particularly. We posit a scaler approach to the anthropological study of the transformation of intimacy in COVID-19, embracing multiple levels from human relations with microbes through to human relations with deities. Furthermore, we offer examples of the overlaps between the ways in which intimate relationships at small and large scales are conceptualised, especially metaphorically.

Toxicological analysis of serious drug-related harm among electronic dance music festival attendees in New South Wales, Australia: A consecutive case series

BACKGROUND

A substantial increase in drug-related harm was observed during the 2018-2019 music festival season in New South Wales, Australia, including the deaths of five young people. As part of a rapid public health response, the New South Wales Ministry of Health referred samples from patients with suspected severe drug-related illness for forensic toxicological testing to identify the type and concentration of substances associated with the presentations.

METHODS

Cases were identified through a variety of active and passive surveillance systems, and selected consecutively based on indicators of clinical severity. Comprehensive toxicology testing of blood and urine samples was expedited for all cases. Demographic and clinical characteristics were collated, together with quantitative toxicology results. Results were analysed using descriptive statistics.

RESULTS

Forty cases from eleven different music festivals were included. The majority of cases (80.0%) were aged 25 years and under. There were five fatalities, and 62.5% of cases were admitted to intensive care units. MDMA was the most frequent substance, detected in 87.5% of cases. In 82.9% of cases with MDMA, blood concentrations were above thresholds that have been associated with toxicity. Multiple substances were detected in 60.0% of cases. Novel psychoactive substances were not detected.

CONCLUSIONS

Our findings strongly suggest that MDMA-related toxicity was a major factor in the severity of the clinical presentations among these cases. Other substances may have enhanced MDMA toxicity but appear unlikely to have caused severe toxicity in isolation. These findings have important implications for harm reduction strategies targeted to music festival settings.

Does Nasal Obstruction Induce Obstructive Sleep Apnea in Healthy Women?

PURPOSE

Obstructive sleep apnea (OSA) is less prevalent among women and is associated with different symptoms and consequences to OSA in men. The reasons for these differences are unknown and difficult to tease apart in clinical populations. If OSA could be temporarily induced in healthy men and women, the causes of some of these differences could be investigated. Nasal blocking has been used to induce OSA in healthy men but its effect in women has not been reported.

PATIENTS AND METHODS

A total of 14 healthy individuals (10 women) underwent in-laboratory diagnostic sleep studies on two occasions separated by a week. On one occasion, the nasal passages were blocked, whereas on the other occasion, participants slept naturally. In both conditions, a full-face mask was used to monitor respiratory events. Participants' self-reported sleepiness, mood and performance on a motor learning task were assessed in the evening and morning of both sleep studies. Furthermore, endothelial function and self-reported sleep quality were assessed in the morning following each study.

RESULTS

Nasal blockage induced OSA in healthy young (age=22±3 years) and slim (BMI=22.2±3.2 kg/m²) women (control AHI=2.0±2.6, blocked AHI=33.1±36.7 events/hr, p=0.02). One night of OSA was associated with poorer self-reported sleep quality (p<0.001) and increased self-reported snoring (p<0.04), choking and gasping during sleep (p<0.001) but was not associated with alterations in mood, neurocognitive or endothelial function on the following morning.

CONCLUSION

Nasal blockage induces OSA in healthy, young, and normal weight women. However, whether the induced OSA is representative of naturally occurring OSA and the technique useful for future studies is unclear.