Public Understanding on Rip Currents and Beach Safety at Teluk Cempedak Recreational Beach of Pahang, Malaysia

A cross-sectional study was conducted to examine the public understanding of rips currents at Teluk Cempedak Recreational Beach of Pahang, Malaysia, from November 2020 to March 2021 via a questionnaire survey. Convenient sampling was used to collect data from 300 respondents. The questionnaire consisted of 24 questions, encompassing five sections, i.e., the demographic background, frequency of visiting the beach, swimming ability, their knowledge of rip currents, and understanding of beach safety. Associations between the study variables and the knowledge of both rip currents and beach safety were evaluated using the independent sample t-test, Chi-square test, and multiple logistic regressions at the confidence level of 0.05. In general, only 86% of the respondent knew about the rip currents. For beach safety knowledge, 83% of the respondents on the lifeguard facilities, 44% for the yellow red-flag and 93.7% for the red flag. Variables such as gender (knowledge of rip currents: Adjusted Odds Ratio (AOR) = 0.647, 95% confidence interval (CI) = 0.487 - 0.60, p = 0.003; beach safety: AOR = 0.665, 95% CI = 1.14 - 5.02, p = 0.021), locality (knowledge of rip currents: AOR = 2.482, 95% CI = 1.407 - 4.380, p = 0.002, beach safety: AOR = 1.821, 95% CI = 1.022 - 3.245, p = 0.042), and respondents’ experience of having problems in water activities (knowledge of rip currents: AOR = 0.170, 95% CI = 0.635 - 6.379, p = 0.000) were significantly associated with the knowledge of both rip currents and beach safety. Further studies are essential to enhance public understanding of rip currents and hence the beach safety in Malaysia.

Immunological causes of obsessive-compulsive disorder: is it time for the concept of an “autoimmune OCD” subtype?

Obsessive-compulsive disorder (OCD) is a highly disabling mental illness that can be divided into frequent primary and rarer organic secondary forms. Its association with secondary autoimmune triggers was introduced through the discovery of Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infection (PANDAS) and Pediatric Acute onset Neuropsychiatric Syndrome (PANS). Autoimmune encephalitis and systemic autoimmune diseases or other autoimmune brain diseases, such as multiple sclerosis, have also been reported to sometimes present with obsessive-compulsive symptoms (OCS). Subgroups of patients with OCD show elevated proinflammatory cytokines and autoantibodies against targets that include the basal ganglia. In this conceptual review paper, the clinical manifestations, pathophysiological considerations, diagnostic investigations, and treatment approaches of immune-related secondary OCD are summarized. The novel concept of “autoimmune OCD” is proposed for a small subgroup of OCD patients, and clinical signs based on the PANDAS/PANS criteria and from recent experience with autoimmune encephalitis and autoimmune psychosis are suggested. Red flag signs for “autoimmune OCD” could include (sub)acute onset, unusual age of onset, atypical presentation of OCS with neuropsychiatric features (e.g., disproportionate cognitive deficits) or accompanying neurological symptoms (e.g., movement disorders), autonomic dysfunction, treatment resistance, associations of symptom onset with infections such as group A streptococcus, comorbid autoimmune diseases or malignancies. Clinical investigations may also reveal alterations such as increased levels of anti-basal ganglia or dopamine receptor antibodies or inflammatory changes in the basal ganglia in neuroimaging. Based on these red flag signs, the criteria for a possible, probable, and definite autoimmune OCD subtype are proposed.

Between the Great Leap Forward and the Cultural Revolution

Yuan-tsung returned to Beijing in November 1960, but she could not forget what she had seen in the Red Flag Commune, and so she planned to circumvent another, probably worse catastrophe. She discussed options with Jack. Both agreed to leave China for Hong Kong, where Jack’s brother Percy ran the Marco Polo Club, a sort of bridge between Western businessmen and China. Jack would work as a freelance journalist. They consulted their friend Comrade Xia. Xia arranged for Jack to meet the foreign minister, Chen Yi, who liked to wear a French Beret. Chen Yi thought it was a good idea that Jack continue his work in a less restrictive environment. But Yuan-tsung and Jack disagreed on when to depart. She preferred 1965 and he, 1966. She was afraid that anything might happen in that one year.

From the Magic Circle into the Great Famine

Yuan-tsung awaited her fate, sure that it would be the same as that of her immediate boss, Director Wang, who had been driven to suicide, but Jack came to her rescue. They reconciled and got married in 1958. She lived a privileged life in his “magic circle,” which, up to that time, was untouched by either purges or famines. But in that magic circle, she watched with terror and apathy as the disastrous Great Leap Forward and the ensuing Great Famine unfolded. Feeling it morally wrong that she did not suffer with the others, she volunteered in 1960, the worst famine year, to go to a famine-devastated rural area, the Red Flag People’s Commune. To survive, she had to hunt for food like the other villagers.

A VIP (Very Important Pig)

In addition to working in the fields, Yuan-tsung helped in the office of Red Flag Village’s Party secretary, Old Xu, who eventually took her into his confidence. He let her in on an almost comical attempt to smuggle a fat pig past starving peasants, so that the Party bigwigs could feast on it. It opened her eyes to the corruption and shenanigans of village politics, which mirrored the state of affairs nationwide. Meanwhile it brought her close to the victims and she became their friend. One of them, Lotus Boy, talented and gentle, would soon die of starvation and political persecution.

Prevalence and Prognosis of Fever Symptoms, Hypo-, and Hyperthermia in Unselected Emergency Patients

Assessments of history and body temperature are cornerstones of the diagnostic workup in all patients presenting to emergency departments (ED). Yet, the objective measurement of temperature and the subjective perception of fever can differ. This is a secondary exploratory analysis of a consecutive all-comer study, performed at an adult ED in Switzerland. Trained medical students interviewed all patients if fever was present. Altered temperature (>38.0 °C/<36.0 °C) measured at triage using an ear thermometer was used as the reference standard for diagnostic performance. In case of a disagreement between fever symptoms and altered temperature, discordance was noted. Outcome measures for case severity (acute morbidity, hospitalization, intensive care, and in-hospital mortality) were extracted from the electronic health records. Odds ratios (OR) for discordance between signs and symptoms and outcomes were calculated. Among 2183 patients, 325 patients reported fever symptoms. The sensitivity of fever symptoms as a test for altered temperature was 36.3%. Specificity was 91.5%. The negative predictive value was 84.1%, positive likelihood ratio was 4.2 and negative likelihood ratio was 0.7. The adjusted OR for discordance between fever symptoms and altered temperature was 1.71 (95% CI: 1.2–2.44) for acute morbidity, 1.56 (95% CI: 1.13–2.15) for hospitalization, and 1.12 (95% CI: 0.64–1.59) for intensive care. Unadjusted OR for mortality was 1.5 (95% CI: 0.69–3.25). Fever symptoms and altered temperature broadly overlap, but presentations can be stratified according to concordance between signs and symptoms. In case of discordance, the odds for acute morbidity and hospitalization are increased. Discordance may therefore be further investigated as a red flag for a serious outcome.

Deep Learning Based on Hierarchical Self-Attention for Finance Distress Prediction Incorporating Text

To detect comprehensive clues and provide more accurate forecasting in the early stage of financial distress, in addition to financial indicators, digitalization of lengthy but indispensable textual disclosure, such as Management Discussion and Analysis (MD&A), has been emphasized by researchers. However, most studies divide the long text into words and count words to treat the text as word count vectors, bringing massive invalid information but ignoring meaningful contexts. Aiming to efficiently represent the text of large size, an end-to-end neural networks model based on hierarchical self-attention is proposed in this study after the state-of-the-art pretrained model is introduced for text embedding including contexts. The proposed model has two notable characteristics. First, the hierarchical self-attention only affords the essential content with high weights in word-level and sentence-level and automatically neglects lots of information that has no business with risk prediction, which is suitable for extracting effective parts of the large-scale text. Second, after fine-tuning, the word embedding adapts the specific contexts of samples and conveys the original text expression more accurately without excessive manual operations. Experiments confirm that the addition of text improves the accuracy of financial distress forecasting and the proposed model outperforms benchmark models better at AUC and F2-score. For visualization, the elements in the weight matrix of hierarchical self-attention act as scalers to estimate the importance of each word and sentence. In this way, the “red-flag” statement that implies financial risk is figured out and highlighted in the original text, providing effective references for decision-makers.