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Diagnostic criteria for major depressive disorder allow for heterogeneous symptom profiles but genetic analysis of major depressive symptoms has the potential to identify clinical and etiological subtypes. There are several challenges to integrating symptom data from genetically informative cohorts, such as sample size differences between clinical and community cohorts and various patterns of missing data.
Methods
We conducted genome-wide association studies of major depressive symptoms in three cohorts that were enriched for participants with a diagnosis of depression (Psychiatric Genomics Consortium, Australian Genetics of Depression Study, Generation Scotland) and three community cohorts who were not recruited on the basis of diagnosis (Avon Longitudinal Study of Parents and Children, Estonian Biobank, and UK Biobank). We fit a series of confirmatory factor models with factors that accounted for how symptom data was sampled and then compared alternative models with different symptom factors.
Results
The best fitting model had a distinct factor for Appetite/Weight symptoms and an additional measurement factor that accounted for the skip-structure in community cohorts (use of Depression and Anhedonia as gating symptoms).
Conclusion
The results show the importance of assessing the directionality of symptoms (such as hypersomnia versus insomnia) and of accounting for study and measurement design when meta-analyzing genetic association data.
Advanced laryngeal cancers are clinically complex; there is a paucity of modern decision-making models to guide tumour-specific management. This pilot study aims to identify computed tomography-based radiomic features that may predict survival and enhance prognostication.
Methods
Pre-biopsy, contrast-enhanced computed tomography scans were assembled from a retrospective cohort (n = 72) with advanced laryngeal cancers (T3 and T4). The LIFEx software was used for radiomic feature extraction. Two features: shape compacity (irregularity of tumour volume) and grey-level zone length matrix – grey-level non-uniformity (tumour heterogeneity) were selected via least absolute shrinkage and selection operator-based Cox regression and explored for prognostic potential.
Results
A greater shape compacity (hazard ratio 2.89) and grey-level zone length matrix – grey-level non-uniformity (hazard ratio 1.64) were significantly associated with worse 5-year disease-specific survival (p < 0.05). Cox regression models yielded a superior C-index when incorporating radiomic features (0.759) versus clinicopathological variables alone (0.655).
Conclusions
Two radiomic features were identified as independent prognostic biomarkers. A multi-centre prospective study is necessary for further exploration. Integrated radiomic models may refine the treatment of advanced laryngeal cancers.
Recreational cannabis policies are being considered in many jurisdictions internationally. Given that cannabis use is more prevalent among people with depression, legalisation may lead to more adverse events in this population. Cannabis legalisation in Canada included the legalisation of flower and herbs (phase 1) in October 2018, and the deregulation of cannabis edibles one year later (phase 2). This study investigated disparities in cannabis-related emergency department (ED) visits in depressed and non-depressed individuals in each phase.
Methods
Using administrative data, we identified all adults diagnosed with depression 60 months prior to legalisation (n = 929 844). A non-depressed comparison group was identified using propensity score matching. We compared the pre–post policy differences in cannabis-related ED-visits in depressed individuals v. matched (and unmatched) non-depressed individuals.
Results
In the matched sample (i.e. comparison with non-depressed people similar to the depressed group), people with depression had approximately four times higher risk of cannabis-related ED-visits relative to the non-depressed over the entire period. Phases 1 and 2 were not associated with any changes in the matched depressed and non-depressed groups. In the unmatched sample (i.e. comparison with the non-depressed general population), the disparity between individuals with and without depression is greater. While phase 1 was associated with an immediate increase in ED-visits among the general population, phase 2 was not associated with any changes in the unmatched depressed and non-depressed groups.
Conclusions
Depression is a risk factor for cannabis-related ED-visits. Cannabis legalisation did not further elevate the risk among individuals diagnosed with depression.
Infants and children born with CHD are at significant risk for neurodevelopmental delays and abnormalities. Individualised developmental care is widely recognised as best practice to support early neurodevelopment for medically fragile infants born premature or requiring surgical intervention after birth. However, wide variability in clinical practice is consistently demonstrated in units caring for infants with CHD. The Cardiac Newborn Neuroprotective Network, a Special Interest Group of the Cardiac Neurodevelopmental Outcome Collaborative, formed a working group of experts to create an evidence-based developmental care pathway to guide clinical practice in hospital settings caring for infants with CHD. The clinical pathway, “Developmental Care Pathway for Hospitalized Infants with Congenital Heart Disease,” includes recommendations for standardised developmental assessment, parent mental health screening, and the implementation of a daily developmental care bundle, which incorporates individualised assessments and interventions tailored to meet the needs of this unique infant population and their families. Hospitals caring for infants with CHD are encouraged to adopt this developmental care pathway and track metrics and outcomes using a quality improvement framework.
This chapter explores the intentions behind, progress made towards and practical barriers faced by the Australian government in its bid to help more people with disabilities gain meaningful employment. Insights into these issues along with some key recommendations are illustrated through a case study of Holy Cross Services in their adherence to new government policy. The chapter thereby provides insights into the general policy issues along with some specific recommendations.
Four key dimensions are explored, based on a continuous improvement approach to supporting people with different abilities in achieving their career goals. Firstly, we provide an overview of the Australian employment market for people with a disability and recent changes. Secondly, we present a case study reviewing the design and implementation of a supported employment (SE) service delivery model designed to empower people in achieving their career ambitions. Thirdly, we offer an introduction to the challenges encountered by people with different abilities as they progress through their career opportunities. Finally, we discuss the learnings and principles informed by these initiatives and case study to support future employment models for empowering the individual to achieve their career goals and enabling employers to employ more people with different abilities.
Australian disability employment policy
National Disability Insurance Scheme
The National Disability Insurance Scheme (NDIS) provides support for Australians with disability, their families and carers. The NDIS is designed to provide approximately 460,000 Australians under the age of 65 who have a permanent or a significant disability, reasonable and necessary support to live an ordinary life. As an insurance scheme, the NDIS takes a lifetime approach, investing in people with disability early to improve their outcomes later in life. The NDIS supports people with disability to build skills and capability so they can participate in the community and employment. Participants are provided with an NDIS package which allows them to receive support from service providers of their choice, and when they choose it, giving the participant ‘choice and control’ over where and what support they receive. This model of providing services to people with their own funding is referred to as individualized funding.
The Great Black-backed Gull Larus marinus is a generalist species that inhabits temperate and arctic coasts of the north Atlantic Ocean. In recent years, there has been growing concern about population declines at local and regional scales; however, there has been no attempt to robustly assess Great Black-backed Gull population trends across its global range. We obtained the most recent population counts across the species’ range and analysed population trends at a global, continental, and national scale over the most recent three-generation period (1985–2021) following IUCN Red List criteria. We found that, globally, the species has declined by 43%–48% over this period (1.2–1.3% per annum, respectively), from an estimated 291,000 breeding pairs to 152,000–165,000 breeding pairs under two different scenarios. North American populations declined more steeply than European ones (68% and 28%, respectively). We recommend that Great Black-backed Gull should be uplisted from ‘Least Concern’ to ‘Vulnerable’ on the IUCN Red List of Threatened Species under criterion A2 (an estimated reduction in population size >30% over three generations).
To examine differences in surgical practices between salaried and fee-for-service (FFS) surgeons for two common degenerative spine conditions. Surgeons may offer different treatments for similar conditions on the basis of their compensation mechanism.
Methods:
The study assessed the practices of 63 spine surgeons across eight Canadian provinces (39 FFS surgeons and 24 salaried) who performed surgery for two lumbar conditions: stable spinal stenosis and degenerative spondylolisthesis. The study included a multicenter, ambispective review of consecutive spine surgery patients enrolled in the Canadian Spine Outcomes and Research Network registry between October 2012 and July 2018. The primary outcome was the difference in type of procedures performed between the two groups. Secondary study variables included surgical characteristics, baseline patient factors, and patient-reported outcome.
Results:
For stable spinal stenosis (n = 2234), salaried surgeons performed statistically fewer uninstrumented fusion (p < 0.05) than FFS surgeons. For degenerative spondylolisthesis (n = 1292), salaried surgeons performed significantly more instrumentation plus interbody fusions (p < 0.05). There were no statistical differences in patient-reported outcomes between the two groups.
Conclusions:
Surgeon compensation was associated with different approaches to stable lumbar spinal stenosis and degenerative lumbar spondylolisthesis. Salaried surgeons chose a more conservative approach to spinal stenosis and a more aggressive approach to degenerative spondylolisthesis, which highlights that remuneration is likely a minor determinant in the differences in practice of spinal surgery in Canada. Further research is needed to further elucidate which variables, other than patient demographics and financial incentives, influence surgical decision-making.
A few monasteries cannot easily be categorized because so little is known about them from fleeting references in documents. This brief chapter considers the limited evidence for these monasteries and evaluates what can be said about their likely affiliation and their place in the framework of Crusader States society.
Monasticism in the Christian tradition was a product of the Eastern Roman Empire, particularly the provinces of Egypt, Syria and Palestine. Monks and monasteries already existed in Syria and the Holy Land before the end of the fourth century and, despite the profound changes associated with the Arab and Seljuq conquests of the seventh and eleventh centuries, some were still functioning by the time of the First Crusade at the end of the eleventh century. The most distinctive feature of monasticism in the Holy Land was its close relationship, both institutional and spiritual, with the shrines and Holy Places that also exercised a magnetic attraction to pilgrims from all over Christendom.
The focus of this chapter is on Orthodox monasteries as spiritual centres. The nature of Orthodox monastic spirituality in the Holy Land is examined from hagiographical and theological writing. The theme of the chapter is the continuity of early monastic traditions and the adherence of the monasteries to ideals and practices that had their roots in the early Christian ‘golden age’ of monasticism.
A Latin monastic presence was part of the landscape of the Holy Land as early as the fourth century. Although the Latin presence waned after the Arab Conquest of the seventh century, interest and involvement in the monastic presence of the Holy Land continued, notably in the reign of Charlemagne in the early ninth century. The eleventh century saw increased knowledge of conditions for Christians in the Holy Land as pilgrimage from the West became more widespread. By the eve of the First Crusade in 1095, the Latin and Greek Orthodox Churches had drifted apart in observance of religious customs, but they remained in communion. The purpose of the Crusade was to revive and strengthen the Christian presence in the Holy Land.
One of the main features of western religious life in the twelfth century was the emergence of new monastic Orders inspired by the desire either to reform observance of the Rule of Benedict or to create alternative forms of monasticism. One such initiative following the latter approach was the Order of Prémontré founded in northern France in the 1120s. This chapter examines the foundations of the Order made in the Holy Land in the twelfth century and considers their appeal to lay patrons and their distinctive role in religious society.
The Carmelites were an unique religious Order: the only contemplative Order to owe their foundation entirely to the Crusader States. They were formed in the early thirteenth century from a group of solitaries and hermits who had gathered for safety on Mt Camel, near the new capital of the kingdom of Jerusalem at Acre, and absorbed into a new community by Albert, patriarch of Jerusalem. Their aim was the pursuit of a penitent life in a small regulated community in a fixed location without the burden of property ownership. By the middle of the thirteenth century, however, they had made the transition to being mendicants, and although Mt Carmel remained the spiritual heart of the Order, they had founded houses in the West as well. This chapter examines the origins of the community and the process of transition, situating the Carmelites alongside other models of reform in the Crusader States.
Although Francis of Assisi never set foot in person in the Holy Land, he was associated with the Crusader States through his presence in Egypt on the Fifth Crusade. The Franciscans established priories in the Holy Land, notably at Acre but also in other centres of population, and played a significant role in the pastoral life of the Latins in the thirteenth century, at a time when monasteries were struggling to maintain their landed properties and thus to minister to rural parishes. Franciscan spirituality manifested itself through care for prisoners and in the mission field.