Verapamil in the treatment of reversible cerebral vasoconstriction syndrome: A systematic review.

INTRODUCTION: Extrapolating from efficacy in subarachnoid haemorrhage (SAH), nimodipine has been used as a treatment for reversible cerebral vasoconstriction syndrome (RCVS). However, 4-hourly dosing is a practical limitation and verapamil has been proposed as an alternative. The potential efficacy, adverse effects, preferred dosing and formulation of verapamil for RCVS have not been systematically reviewed previously. METHOD: A systematic review was conducted of the databases PubMed, EMBASE, and the Cochrane Library from inception to July 2022 for peer-reviewed articles describing the use of verapamil for RCVS. This systematic review adheres to the PRISMA guidelines and was registered on PROSPERO. RESULTS: There were 58 articles included in the review, which included 56 patients with RCVS treated with oral verapamil and 15 patients treated with intra-arterial verapamil. The most common oral verapamil dosing regimen was controlled release 120 mg once daily. There were 54/56 patients described to have improvement in headache following oral verapamil and one patient who died from worsening RCVS. Only 2/56 patients noted possible adverse effects with oral verapamil, with none requiring discontinuation. There was one case of hypotension from combined oral and intra-arterial verapamil. Vascular complications including ischaemic and haemorrhagic stroke were recorded in 33/56 patients. RCVS recurrence was described in 9 patients, with 2 cases upon weaning oral verapamil. CONCLUSIONS: While no randomised studies exist to support the use of verapamil in RCVS, observational data support a possible clinical benefit. Verapamil appears well tolerated in this setting and represents a reasonable treatment option. Randomised controlled trials including comparison with nimodipine are warranted.

Corpus linguistics and clinical psychology: Investigating personification in first-person accounts of voice-hearing.

Triangulating corpus linguistic approaches with other (linguistic and non-linguistic) approaches enhances "both the rigour of corpus linguistics and its incorporation into all kinds of research" (McEnery & Hardie, 2012:227). Our study investigates an important area of mental health research: the experiences of those who hear voices that others cannot hear, and particularly the ways in which those voices are described as person-like. We apply corpus methods to augment the findings of a qualitative approach to 40 interviews with voice-hearers, whereby each interview was coded as involving 'minimal' or 'complex' personification of voices. Our analysis provides linguistic evidence in support of the qualitative coding of the interviews, but also goes beyond a binary approach by revealing different types and degrees of personification of voices, based on how they are referred to and described by voice-hearers. We relate these findings to concepts that inform therapeutic interventions in clinical psychology.

The Icepack Test in the Diagnosis of Myasthenia Gravis with Ocular Features: A Systematic Review of Diagnostic Accuracy, Technique, and Economic Utility.

BACKGROUND: The diagnosis of myasthenia gravis (MG) may be challenging and require multiple specialised testing modalities. Accessing these investigations can involve significant waiting time and costs. The bedside icepack test (IPT) has been proposed to assist with the diagnosis of MG with ocular features, and may prove an economically viable; however, there have been there is heterogeneity in the literature evaluating the IPT. OBJECTIVES: A systematic review was performed examining the accuracy, described techniques, and economic implications of the IPT for the diagnosis of MG with ocular features. METHOD: The databases EMBASE, PubMed, and the Cochrane Library were searched from inception to July 2022. The systematic review adhered to PRISMA guidelines. Eligibility determination was undertaken with a standardised form using appropriate inclusion criteria. The Cochrane risk of bias assessment tool for diagnostic test accuracy was employed to evaluate studies that presented the diagnostic performance of the IPT. The Johanna Briggs Institute Critical Appraisal Checklist for Economic Evaluations was used for the assessment of studies presenting economic evaluations of the IPT. RESULTS: 20 articles met the specified criteria and included a total of 1264 participants. The IPT had a sensitivity ranging from 38.5% to 100%. Specificity was found to be > 95% in six studies. Excluding two outlier results of 25% and 31.3%, the lowest specificity recorded was 62.5%. The most commonly described method of evaluating the IPT involved applying ice to both eyelids and using a >2 mm change as a threshold for a positive test (evaluated with a ruler). There were no adverse effects described with the IPT. There were no studies that formally examined the economic implications of the IPT. CONCLUSIONS: The IPT is a well-tolerated and readily available diagnostic tool that has an important role in the evaluation of possible MG with ocular features in specific contexts. Despite limited economic evaluation of this test, it is likely the use of the IPT may result in significant financial and time savings.

Precision Monitoring of Honey Bee (Hymenoptera: Apidae) Activity and Pollen Diversity during Pollination to Evaluate Colony Health.

Certain crops depend upon pollination services for fruit set, and, of these, almonds are of high value for Australia. Stressors, such as diseases, parasites, pesticides, and nutrition, can contribute to honey bee Apis mellifera L. colony decline, thereby reducing bee activity and pollination efficiency. In Australia, field studies are required to monitor honey bee health and to ascertain whether factors associated with colony decline are impacting hives. We monitored honey bee colonies during and after pollination services of almond. Video surveillance technology was used to quantify bee activity, and bee-collected pollen was periodically tested for pesticide residues. Plant species diversity was also assessed using DNA metabarcoding of the pollen. Results showed that bee activity increased in almond but not in bushland. Residues detected included four fungicides, although the quantities were of low risk of oral toxicity to bees. Floral diversity was lower in the pollen collected by bees from almonds compared to bushland. However, diversity was higher at the onset and conclusion of the almond bloom, suggesting that bees foraged more widely when availability was low. Our findings suggest that commercial almond orchards may sustain healthier bee colonies compared to bushland in early spring, although the magnitude of the benefit is likely landscape-dependent.

'Doing Questioning' in the Emergency Department (ED).

Eliciting information from patients is fundamental to medical professionals' capacity to deliver good healthcare outcomes in Emergency Departments (EDs). There are different kinds of utterances that "do questioning", and health professionals can variously attend to the medical agenda and the interpersonal aspects of their interactions with those attending the ED in the way that they construct these utterances. We investigate a corpus of ED interactions to determine the prevalence and range of utterances produced by doctors and directed at patients that "do questioning." We developed a questioning utterance typology, informed by previous research on the formulation of such utterances and extended according to observations of our data. We subsequently manually coded 4,355 questioning utterances and report the variety of forms that such utterances can take, considering how these are distributed across doctors at different levels of seniority. We found that doctors at different seniority levels favored similar questioning utterance types and the most frequently used appeared to restrict the contributions of patients. We conclude that our extended typology of questioning utterances has value for understanding the ways in which doctors may encourage patients to provide more extensive responses.

Limits to post-fire vegetation recovery under climate change.

Record-breaking fire seasons in many regions across the globe raise important questions about plant community responses to shifting fire regimes (i.e., changing fire frequency, severity and seasonality). Here, we examine the impacts of climate-driven shifts in fire regimes on vegetation communities, and likely responses to fire coinciding with severe drought, heatwaves and/or insect outbreaks. We present scenario-based conceptual models on how overlapping disturbance events and shifting fire regimes interact differently to limit post-fire resprouting and recruitment capacity. We demonstrate that, although many communities will remain resilient to changing fire regimes in the short-term, longer-term changes to vegetation structure, demography and species composition are likely, with a range of subsequent effects on ecosystem function. Resprouting species are likely to be most resilient to changing fire regimes. However, even these species are susceptible if exposed to repeated short-interval fire in combination with other stressors. Post-fire recruitment is highly vulnerable to increased fire frequency, particularly as climatic limitations on propagule availability intensify. Prediction of community responses to fire under climate change will be greatly improved by addressing knowledge gaps on how overlapping disturbances and climate change-induced shifts in fire regime affect post-fire resprouting, recruitment, growth rates, and species-level adaptation capacity.

Person-ness of voices in lived experience accounts of psychosis: combining literary linguistics and clinical psychology.

In this paper, we use concepts and insights from the literary linguistic study of story-world characters to shed new light on the nature of voices as social agents in the context of lived experience accounts of voice-hearing. We demonstrate a considerable overlap between approaches to voices as social agents in clinical psychology and the perception of characters in the linguistic study of fiction, but argue that the literary linguistic approach facilitates a much more nuanced account of the different degrees of person-ness voices might be perceived to possess. We propose a scalar Characterisation Model of Voices and demonstrate its explanatory potential by comparing two lived experience descriptions of voices in interviews with voice-hearers in a psychosis intervention. The new insights into the phenomenology of voice-hearing achieved by applying the model are relevant to the understanding of voice-hearing as well as to therapeutic interventions.

A linguistic approach to the psychosis continuum: (dis)similarities and (dis)continuities in how clinical and non-clinical voice-hearers talk about their voices.

Introduction: "Continuum" approaches to psychosis have generated reports of similarities and differences in voice-hearing in clinical and non-clinical populations at the cohort level, but not typically examined overlap or degrees of difference between groups. Methods: We used a computer-aided linguistic approach to explore reports of voice-hearing by a clinical group (Early Intervention in Psychosis service-users; N = 40) and a non-clinical group (spiritualists; N = 27). We identify semantic categories of terms statistically overused by one group compared with the other, and by each group compared to a control sample of non-voice-hearing interview data (log likelihood (LL) value 6.63+=p < .01; effect size measure: log ratio 1.0+). We consider whether individual values support a continuum model. Results: Notwithstanding significant cohort-level differences, there was considerable continuity in language use. Reports of negative affect were prominent in both groups (p < .01, log ratio: 1.12+). Challenges of cognitive control were also evident in both cohorts, with references to "disengagement" accentuated in service-users (p < .01, log ratio: 1.14+). Conclusion: A corpus linguistic approach to voice-hearing provides new evidence of differences between clinical and non-clinical groups. Variability at the individual level provides substantial evidence of continuity with implications for cognitive mechanisms underlying voice-hearing.

The fate of carbon in a mature forest under carbon dioxide enrichment.

Atmospheric carbon dioxide enrichment (eCO2) can enhance plant carbon uptake and growth1-5, thereby providing an important negative feedback to climate change by slowing the rate of increase of the atmospheric CO2 concentration6. Although evidence gathered from young aggrading forests has generally indicated a strong CO2 fertilization effect on biomass growth3-5, it is unclear whether mature forests respond to eCO2 in a similar way. In mature trees and forest stands7-10, photosynthetic uptake has been found to increase under eCO2 without any apparent accompanying growth response, leaving the fate of additional carbon fixed under eCO2 unclear4,5,7-11. Here using data from the first ecosystem-scale Free-Air CO2 Enrichment (FACE) experiment in a mature forest, we constructed a comprehensive ecosystem carbon budget to track the fate of carbon as the forest responded to four years of eCO2 exposure. We show that, although the eCO2 treatment of +150 parts per million (+38 per cent) above ambient levels induced a 12 per cent (+247 grams of carbon per square metre per year) increase in carbon uptake through gross primary production, this additional carbon uptake did not lead to increased carbon sequestration at the ecosystem level. Instead, the majority of the extra carbon was emitted back into the atmosphere via several respiratory fluxes, with increased soil respiration alone accounting for half of the total uptake surplus. Our results call into question the predominant thinking that the capacity of forests to act as carbon sinks will be generally enhanced under eCO2, and challenge the efficacy of climate mitigation strategies that rely on ubiquitous CO2 fertilization as a driver of increased carbon sinks in global forests.

Prognostic Differences in ISUP Grade Group 4: a Systematic Review and Meta-Analysis.

The ISUP (Internal Society of Urologic Pathology) recently adopted a five-tiered prognostication system. There is evidence to suggest that the ISUP grade group 4 is a heterogeneous entity regarding prognosis. Our aim was to systematically examine the existing evidence to determine if outcome differences exist within the ISUP grade group 4. A systematic search of the literature for all studies examining the heterogeneity of the ISUP grade group 4 was conducted. Available studies were combined with meta-analysis to evaluate prognostic differences within the ISUP grade group 4 measured by all-cause mortality (ACM) and the prostate cancer-specific mortality (PCSM). Eight studies were identified and utilised a variety of outcome measures to answer the question of heterogeneity within the ISUP grade group 4. Four of these studies examined prognosis using both ACM and PCSM. These were combined into a meta-analysis. The combined group of 5 + 3/3 + 5 had statistically significant higher ACM (hazard ratio [HR] 1.23, 95% confidence internal [Cl] 1.08-1.41) when compared to the 4 + 4 group. There was no difference in the PCSM between the two groups (HR 1.34, 95% CI 0.89-2.01). However, heterogeneity was high for this analysis secondary to a range of methodological differences. Our meta-analysis showed that Gleason grade 3 + 5/5 + 3 had higher ACM than Gleason grade group 4 + 4. Measures of PCSM were statistically insignificant, although heterogeneity was high. Evidence suggests that heterogeneity is likely, although inconclusive. Further studies with consistent methodologies are required to answer this question.

The influence of planting size and configuration on landscape fire risk.

Revegetating cleared land with native trees and shrubs is increasingly used as a means of addressing loss of biodiversity, degraded soil and water resources and sequestration of carbon. However, revegetation also brings a potential to alter fire risk due to changing fuel types across the landscape. Previous research has found that increasing the area of revegetation does not increase the risk of fire at a landscape scale, but it remains unclear whether the design of revegetation can be optimised to minimise risk. We evaluated if size and arrangement of revegetation affects fire size and intensity within an agricultural setting using a simulation modelling approach. Three revegetation planting designs were assessed, including small (3.2 ha) dispersed plantings, small (3.2 ha) plantings clustered into one third of the landscape, and large (29.2 ha) dispersed plantings, all resulting in the same overall percentage of revegetation (approximately 10% of the landscape). We simulated fires using Phoenix Rapidfire under varying planting design, weather, surrounding pasture conditions, and fire suppression. Planting design had little effect on fire sizes across the landscape, with larger plantings resulting in slightly larger fire sizes. Fires were smaller in landscapes with all planting designs compared with current landscape patterns. There was no significant influence of planting design on fire intensity. Weather and suppression had the strongest influence on both fire size and intensity, with larger and more intense fires under extreme weather conditions, with higher adjacent pasture loads and with no simulated suppression. Management of fuel loads in the pasture surrounding revegetation, weather and suppression are far greater risk factors for fire in these landscapes than planting design.

Wildfire refugia in forests: Severe fire weather and drought mute the influence of topography and fuel age.

Wildfire refugia (unburnt patches within large wildfires) are important for the persistence of fire-sensitive species across forested landscapes globally. A key challenge is to identify the factors that determine the distribution of fire refugia across space and time. In particular, determining the relative influence of climatic and landscape factors is important in order to understand likely changes in the distribution of wildfire refugia under future climates. Here, we examine the relative effect of weather (i.e. fire weather, drought severity) and landscape features (i.e. topography, fuel age, vegetation type) on the occurrence of fire refugia across 26 large wildfires in south-eastern Australia. Fire weather and drought severity were the primary drivers of the occurrence of fire refugia, moderating the effect of landscape attributes. Unburnt patches rarely occurred under 'severe' fire weather, irrespective of drought severity, topography, fuels or vegetation community. The influence of drought severity and landscape factors played out most strongly under 'moderate' fire weather. In mesic forests, fire refugia were linked to variables that affect fuel moisture, whereby the occurrence of unburnt patches decreased with increasing drought conditions and were associated with more mesic topographic locations (i.e. gullies, pole-facing aspects) and vegetation communities (i.e. closed-forest). In dry forest, the occurrence of refugia was responsive to fuel age, being associated with recently burnt areas (<5 years since fire). Overall, these results show that increased severity of fire weather and increased drought conditions, both predicted under future climate scenarios, are likely to lead to a reduction of wildfire refugia across forests of southern Australia. Protection of topographic areas able to provide long-term fire refugia will be an important step towards maintaining the ecological integrity of forests under future climate change.

Aboveground forest carbon shows different responses to fire frequency in harvested and unharvested forests.

Sequestration of carbon in forest ecosystems has been identified as an effective strategy to help mitigate the effects of global climate change. Prescribed burning and timber harvesting are two common, co-occurring, forest management practices that may alter forest carbon pools. Prescribed burning for forest management, such as wildfire risk reduction, may shorten inter-fire intervals and potentially reduce carbon stocks. Timber harvesting may further increase the susceptibility of forest carbon to losses in response to frequent burning regimes by redistributing carbon stocks from the live pools into the dead pools, causing mechanical damage to retained trees and shifting the demography of tree communities. We used a 27-yr experiment in a temperate eucalypt forest to examine the effect of prescribed burning frequency and timber harvesting on aboveground carbon (AGC). Total AGC was reduced by ~23% on harvested plots when fire frequency increased from zero to seven fires, but was not affected by fire frequency on unharvested plots. The reduction in total AGC associated with increasing fire frequency on harvested plots was driven by declines in large coarse woody debris (≥10 cm diameter) and large trees (≥20 cm diameter). Small tree (<20 cm DBH) AGC increased with fire frequency on harvested plots, but decreased on unharvested plots. Carbon in dead standing trees decreased with increasing fire frequency on unharvested plots, but was unaffected on harvested plots. Small coarse woody debris (<10 cm diameter) was largely unaffected by fire frequency and harvesting. Total AGC on harvested plots was between 67% and 82% of that on unharvested plots, depending on burning treatment. Our results suggest that AGC in historically harvested forests may be susceptible to declines in response to increases in prescribed burning frequency. Consideration of historic harvesting will be important in understanding the effect of prescribed burning programs on forest carbon budgets.

Aboveground carbon sequestration in dry temperate forests varies with climate not fire regime.

The storage of carbon in plant tissues and debris has been proposed as a method to offset anthropogenic increases in atmospheric [CO2 ]. Temperate forests represent significant above-ground carbon (AGC) "sinks" because their relatively fast growth and slow decay rates optimise carbon assimilation. Fire is a common disturbance event in temperate forests globally that should strongly influence AGC because: discrete fires consume above-ground biomass releasing carbon to the atmosphere, and the long-term application of different fire-regimes select for specific plant communities that sequester carbon at different rates. We investigated the latter process by quantifying AGC storage at 104 sites in the Sydney Basin Bioregion, Australia, relative to differences in components of the fire regime: frequency, severity and interfire interval. To predict the potential impacts of future climate change on fire/AGC interactions, we stratified our field sites across gradients of mean annual temperature and precipitation and quantified within- and between-factor interactions between the fire and climate variables. In agreement with previous studies, large trees were the primary AGC sink, accounting for ~70% of carbon at sites. Generalised additive models showed that mean annual temperature was the strongest predictor of AGC storage, with a 54% near-linear decrease predicted across the 6.1°C temperature range experienced at sites. Mean annual precipitation, fire frequency, fire severity and interfire interval were consistently poor predictors of total above-ground storage, although there were some significant relationships with component stocks. Our results show resilience of AGC to frequent and severe wildfire and suggest temperature mediated decreases in forest carbon storage under future climate change predictions.

Understorey productivity in temperate grassy woodland responds to soil water availability but not to elevated [CO2 ].

Rising atmospheric [CO2 ] and associated climate change are expected to modify primary productivity across a range of ecosystems globally. Increasing aridity is predicted to reduce grassland productivity, although rising [CO2 ] and associated increases in plant water use efficiency may partially offset the effect of drying on growth. Difficulties arise in predicting the direction and magnitude of future changes in ecosystem productivity, due to limited field experimentation investigating climate and CO2 interactions. We use repeat near-surface digital photography to quantify the effects of water availability and experimentally manipulated elevated [CO2 ] (eCO2 ) on understorey live foliage cover and biomass over three growing seasons in a temperate grassy woodland in south-eastern Australia. We hypothesised that (i) understorey herbaceous productivity is dependent upon soil water availability, and (ii) that eCO2 will increase productivity, with greatest stimulation occurring under conditions of low water availability. Soil volumetric water content (VWC) determined foliage cover and growth rates over the length of the growing season (August to March), with low VWC (<0.1 m3  m-3 ) reducing productivity. However, eCO2 did not increase herbaceous cover and biomass over the duration of the experiment, or mitigate the effects of low water availability on understorey growth rates and cover. Our findings suggest that projected increases in aridity in temperate woodlands are likely to lead to reduced understorey productivity, with little scope for eCO2 to offset these changes.

Who or what has agency in the discussion of antimicrobial resistance in UK news media (2010-2015)? A transitivity analysis.

The increase in infections resistant to the existing antimicrobial medicines has become a topic of concern for health professionals, policy makers and publics across the globe; however, among the public there is a sense that this is an issue beyond their control. Research has shown that the news media can have a significant role to play in the public's understanding of science and medicine. In this article, we respond to a call by research councils in the United Kingdom to study antibiotic or antimicrobial resistance as a social phenomenon by providing a linguistic analysis of reporting on this issue in the UK press. We combine transitivity analysis with a social representations framework to determine who and what the social actors are in discussions of antimicrobial resistance in the UK press (2010-2015), as well as which of those social actors are characterised as having agency in the processes around antimicrobial resistance. Findings show that antibiotics and the infections they are designed to treat are instilled with agency, that there is a tension between allocating responsibility to either doctors-as-prescribers or patients-as-users and collectivisation of the general public as an unspecified 'we': marginalising livestock farming and pharmaceutical industry responsibilities.

Participants' use of enacted scenes in research interviews: A method for reflexive analysis in health and social care.

In our study of a workforce intervention within a health and social care context we found that participants who took part in longitudinal research interviews were commonly enacting scenes from their work during one-to-one interviews. Scenes were defined as portions of the interviews in which participants directly quoted the speech of at least two actors. Our analysis in this paper focuses on these enacted scenes, and compares the content of them before and after the intervention. We found that, whilst the tensions between consistency and change, and change management, were common topics for scene enactment in both pre and post-intervention data, following the intervention participants were much more likely to present themselves as active agents in that change. Post-intervention enacted scenes also showed participants' reports of taking a service user perspective, and a focus on their interactions with service users that had been absent from pre-intervention data. In addition, descriptions of positive feeling and emotions were present in the post-intervention enacted scenes. We suggest that this analysis confirms the importance of enacted scenes as an analytic resource, and that this importance goes beyond their utility in identifying the impact of this specific intervention. Given the congruence between the themes prominent in enacted scenes, and those which emerged from a more extensive qualitative analysis of these data, we argue that enacted scenes may also be of wider methodological importance. The possibility of using scene enactment as an approach to the validation of inductive analysis in health and social care settings could provide a useful methodological resource in settings where longitudinal ethnographic observation of frontline care staff is impossible or impractical.