213 results
Physiological and biochemical processes underlying the differential sucrose yield and biomass production in sugarcane varieties
- Tamires Da Silva Martins, José R. Magalhães Filho, Larissa Prado Cruz, Daniela F. S. P. Machado, Norma M. Erismann, Rose M. A. Gondim-Tomaz, Paulo E. R. Marchiori, André L. B. O. Silva, Eduardo Caruso Machado, Rafael Vasconcelos Ribeiro
-
- Journal:
- Experimental Agriculture / Volume 60 / 2024
- Published online by Cambridge University Press:
- 14 May 2024, e13
-
- Article
- Export citation
-
Sucrose yield in sugarcane is a complex process regulated by both environmental and endogenous factors. However, the metabolic balance driving vegetative growth and sucrose accumulation remains poorly understood. Herein, we carried out a comprehensive assessment of carbohydrate dynamics throughout the crop cycle in two sugarcane varieties varying in biomass production, evaluating the carbon metabolism in both leaves and stalks. Our data revealed that the decline in photosynthetic rates during sugarcane maturation is associated not only to accumulation of sugars in leaves but also due to stomatal and non-stomatal limitations. We found that metabolic processes in leaves and stalks were intrinsically linked. While IACSP94-2094 had higher stalk sucrose concentration than IACSP95-5000, this latter produced more biomass. Compared to IACSP95-5000, IACSP94-2094 showed higher sucrose phosphate synthase (SPS) activity in leaves and stalks, along with lower soluble acid invertase (SAI) activity in leaves during the maximum growth stage. Interestingly, IACSP94-2094 also exhibited higher stalk SPS activity and lower stalk SAI activity than IACSP95-5000 during maturation. High biomass production by IACSP95-5000 was associated with higher sucrose synthase (SuSy) and SAI activity in leaves and higher SuSy and soluble neutral invertase (SNI) activity in stalks when compared to IACSP94-2094 during the maximum growth. Despite the contrasting strategies, both varieties displayed similar total sucrose yield, a balance between sucrose concentration and biomass production. This phenomenon implies the presence of a compensatory mechanism in sugarcane, with high biomass production compensating low sucrose accumulation and vice versa.
Geographical Variation In Medication and Health Resource Use In Multiple Sclerosis
- Erin F. Balcom, Jennifer A. McCombe, Mahesh Kate, Khanh Vu, Karen J. B. Martins, Sylvia Aponte-Hao, Huong Luu, Lawrence Richer, Tyler Williamson, Scott W. Klarenbach, Penelope Smyth
-
- Journal:
- Canadian Journal of Neurological Sciences , First View
- Published online by Cambridge University Press:
- 11 April 2024, pp. 1-9
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Background:
Understanding disease-modifying therapy (DMT) use and healthcare resource utilization by different geographical areas among people living with multiple sclerosis (pwMS) may identify care gaps that can be used to inform policies and practice to ensure equitable care.
Methods:Administrative data was used to identify pwMS on April 1, 2017 (index date) in Alberta. DMT use and healthcare resource utilization were compared between those who resided in various geographical areas over a 2-year post-index period; simple logistic regression was applied.
Results:Among the cohort (n = 12,338), a higher proportion of pwMS who resided in urban areas (versus rural) received ≥ 1 DMT dispensation (32.3% versus 27.4%), had a neurologist (67.7% versus 63.9%), non-neurologist specialist (88.3% versus 82.9%), ambulatory care visit (87.4% versus 85.3%), and MS tertiary clinic visit (59.2% versus 51.7%), and a lower proportion had an emergency department (ED) visit (46.3% versus 62.4%), and hospitalization (20.4% versus 23.0%). Across the provincial health zones, there were variations in DMT selection, and a higher proportion of pwMS who resided in the Calgary health zone, where care is managed by MS tertiary clinic neurologists, had an outpatient visit to a neurologist or MS tertiary clinic versus those who resided in other zones where delivery of MS-related care is more varied.
Conclusions:Urban/rural inequalities in DMT use and healthcare resource utilization appear to exist among pwMS in Alberta. Findings suggest the exploration of barriers with consequent strategies to increase access to DMTs and provide timely outpatient MS care management, particularly for those pwMS residing in rural areas.
VaTEST III: Validation of eight potential super-earths from TESS data
- Priyashkumar Mistry, Aniket Prasad, Mousam Maity, Kamlesh Pathak, Sarvesh Gharat, Georgios Lekkas, Surendra Bhattarai, Dhruv Kumar, Jack J. Lissauer, Joseph D. Twicken, Abderahmane Soubkiou, Francisco J. Pozuelos, Jon Jenkins, Keith Horne, Steven Giacalone, Khalid Barkaoui, Mathilde Timmermans, Cristilyn N. Watkins, Ramotholo Sefako, Karen A. Collins, David R. Ciardi, Catherine A. Clark, Boris S. Safonov, Avi Shporer, Joshua E. Schlieder, Zouhair Benkhaldoun, Chris Stockdale, Carl Ziegler, Emily A. Gilbert, Jehin Emmanuël, Felipe Murgas, Ian J. M. Crossfield, Martin Paegert, Michael B. Lund, Norio Narita, Richard P. Schwarz, Robert F. Goeke, Sergio B. Fajardo-Acosta, Steve B. Howell, Thiam-Guan Tan, Thomas Barclay, Yugo Kawai
-
- Journal:
- Publications of the Astronomical Society of Australia / Volume 41 / 2024
- Published online by Cambridge University Press:
- 11 April 2024, e030
-
- Article
- Export citation
-
NASA’s all-sky survey mission, the Transiting Exoplanet Survey Satellite (TESS), is specifically engineered to detect exoplanets that transit bright stars. Thus far, TESS has successfully identified approximately 400 transiting exoplanets, in addition to roughly 6 000 candidate exoplanets pending confirmation. In this study, we present the results of our ongoing project, the Validation of Transiting Exoplanets using Statistical Tools (VaTEST). Our dedicated effort is focused on the confirmation and characterisation of new exoplanets through the application of statistical validation tools. Through a combination of ground-based telescope data, high-resolution imaging, and the utilisation of the statistical validation tool known as TRICERATOPS, we have successfully discovered eight potential super-Earths. These planets bear the designations: TOI-238b (1.61$^{+0.09} _{-0.10}$ R$_\oplus$), TOI-771b (1.42$^{+0.11} _{-0.09}$ R$_\oplus$), TOI-871b (1.66$^{+0.11} _{-0.11}$ R$_\oplus$), TOI-1467b (1.83$^{+0.16} _{-0.15}$ R$_\oplus$), TOI-1739b (1.69$^{+0.10} _{-0.08}$ R$_\oplus$), TOI-2068b (1.82$^{+0.16} _{-0.15}$ R$_\oplus$), TOI-4559b (1.42$^{+0.13} _{-0.11}$ R$_\oplus$), and TOI-5799b (1.62$^{+0.19} _{-0.13}$ R$_\oplus$). Among all these planets, six of them fall within the region known as ‘keystone planets’, which makes them particularly interesting for study. Based on the location of TOI-771b and TOI-4559b below the radius valley we characterised them as likely super-Earths, though radial velocity mass measurements for these planets will provide more details about their characterisation. It is noteworthy that planets within the size range investigated herein are absent from our own solar system, making their study crucial for gaining insights into the evolutionary stages between Earth and Neptune.
Evolution of sub-ice-shelf channels reveals changes in ocean-driven melt in West Antarctica
- Karen E. Alley, Richard B. Alley, Alex D. Crawford, Naomi Ochwat, Christian T. Wild, Juliana Marson, Tasha Snow, Atsuhiro Muto, Erin C. Pettit, Sarah F. Child, Martin Truffer, Gabriela Collao-Barrios, Ted A. Scambos
-
- Journal:
- Journal of Glaciology , First View
- Published online by Cambridge University Press:
- 19 March 2024, pp. 1-15
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Basal channels, which are troughs carved into the undersides of ice shelves by buoyant plumes of water, are modulators of ice-shelf basal melt and structural stability. In this study, we track the evolution of 12 large basal channels beneath ice shelves of the Amundsen and Bellingshausen seas region in West Antarctica using the Landsat record since its start in the 1970s through 2020. We observe examples of channel growth, interactions with ice-shelf features, and systematic changes in sinuosity that give insight into the life cycles of basal channels. We use the last two decades of the record, combined with contemporary ice-flow velocity datasets, to separate channel-path evolution into components related to advection by ice flow and those controlled by other forcings, such as ocean melt or surface accumulation. Our results show that ice-flow-independent lateral channel migration is overwhelmingly to the left when viewed down-flow, suggesting that it is dominated by Coriolis-influenced ocean melt. By applying a model of channel-path evolution dominantly controlled by ice flow and ocean melt, we show that the majority of channels surveyed exhibit non-steady behavior that serves as a novel proxy for increased ocean forcing in West Antarctica starting at least in the early 1970s.
Clay-Sized Minerals in Permafrost-Affected Soils (Cryosols) From King George Island, Antarctica
- Felipe N. B. Simas, Carlos Ernesto G. R. Schaefer, Vander F. Melo, Marcelo B. B. Guerra, Martin Saunders, Robert J. Gilkes
-
- Journal:
- Clays and Clay Minerals / Volume 54 / Issue 6 / December 2006
- Published online by Cambridge University Press:
- 01 January 2024, pp. 721-736
-
- Article
- Export citation
-
Cryosols from Maritime Antarctica have been less studied than soils from continental areas of Antarctica. In this work X-ray diffraction, difference X-ray diffraction, differential thermal analysis, thermogravimetry, transmission electron microscopy/energy dispersive spectroscopy and selective chemical dissolution were used to characterize the clay fraction of basaltic, acid sulfate and ornithogenic Cryosols from ice-free areas of Admiralty Bay, King George Island. Non-crystalline phases are important soil components and reach >75% of the clay fraction for some ornithogenic soils. Randomly interstratified smectite-hydroxy-Al-interlayered smectite is the main clay mineral of basaltic soils. Kaolinite, chlorite and regularly interstratified illite-smectite predominate in acid sulfate soils. Jarosite is also an important component of the clay fraction in these soils. Crystalline Al and Fe phosphates occur in the clay at sites directly affected by penguin activity and the chemical characteristics of these ornithogenic sites are controlled by highly reactive, non-crystalline Al, Si, Fe and P phases. Chemical weathering is an active process in Cryosols in Maritime Antarctica and is enhanced by the presence of sulfides for some parent materials, and faunal activity.
5 Cognitive Rehabilitation Using Teleneuropsychology. A Cohort Study in South America
- Carlos Martinez Canyazo, Rodrigo S Fernandez, Maria B Helou, Micaela Arruabarrena, Nicolas Corvalan, Agostina Carello, Paula Harris, Monica Feldman, Ismael Luis Calandri, Maria E Martin, Ricardo F Allegri, Lucia Crivelli
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, p. 209
-
- Article
-
- You have access Access
- Export citation
-
Objective:
The COVID-19 pandemic has affected the continuity of cognitive rehabilitation (CR) worldwide. However, the use of teleneuropsychology (TNP) to provide CR has contributed significantly to the continuity of treatment. The objective of this study was to measure the effects of CR via the TNP on cognition, neuropsychiatric symptoms, and memory strategies in a cohort of patients with Mild Cognitive Impairment (MCI).
Participants and Methods:A sample of 60 patients (60% female; age: 72.4±6.96) with MCI according to Petersen criteria was randomly divided into two groups: 30 cases (treatment group) and 30 controls (waiting list group). Subjects were matched for age, sex, and MMSE or MoCA.
The treatment group received ten weekly CR sessions of 45 minutes weekly. Pre-treatment (week 0) and post-treatment (week 10) measures were assessed for both groups. Different Linear Mixed Models were estimated to test treatment effect (CR vs. Controls) on each outcome of interest over Time (Pre/Post), controlling for Diagnosis, Age, Sex, and MMSE/MoCA performance.
Results:A significant Group (Control/Treatment) x Time (pre/post) interaction revealed that the treatment group at 10 weeks had better scores in cognitive variables: memory (RAVLT learning trials p=0.030; RAVLT delayed recall p=0.029), phonological fluency(p=0.001), activities of daily living (FAQ p=0.001), satisfaction with memory performance (MMQ Satisfaction p=0.004) and use of memory strategies (MMQ Strategy p=0.00), and a significant reduction of affective symptomatology: depression (GDS p=0.00), neuropsychiatric symptoms (NPIQ p=0.045), Forgetfulness (EDO-10 p=0.00), Stress (DAS Stress p=0.00).
Conclusions:This is the first study to test CR using teleNP in South America. Our results suggest that CR through teleNP is an effective intervention to improve performance on cognitive variables and reduce neuropsychiatric symptomatology compared to patients with MCI. These results have great significance in the context of the COVID-19 pandemic in South America, where teleNP is proving to be a valuable tool.
Ten new insights in climate science 2023
- Mercedes Bustamante, Joyashree Roy, Daniel Ospina, Ploy Achakulwisut, Anubha Aggarwal, Ana Bastos, Wendy Broadgate, Josep G. Canadell, Edward R. Carr, Deliang Chen, Helen A. Cleugh, Kristie L. Ebi, Clea Edwards, Carol Farbotko, Marcos Fernández-Martínez, Thomas L. Frölicher, Sabine Fuss, Oliver Geden, Nicolas Gruber, Luke J. Harrington, Judith Hauck, Zeke Hausfather, Sophie Hebden, Aniek Hebinck, Saleemul Huq, Matthias Huss, M. Laurice P. Jamero, Sirkku Juhola, Nilushi Kumarasinghe, Shuaib Lwasa, Bishawjit Mallick, Maria Martin, Steven McGreevy, Paula Mirazo, Aditi Mukherji, Greg Muttitt, Gregory F. Nemet, David Obura, Chukwumerije Okereke, Tom Oliver, Ben Orlove, Nadia S. Ouedraogo, Prabir K. Patra, Mark Pelling, Laura M. Pereira, Åsa Persson, Julia Pongratz, Anjal Prakash, Anja Rammig, Colin Raymond, Aaron Redman, Cristobal Reveco, Johan Rockström, Regina Rodrigues, David R. Rounce, E. Lisa F. Schipper, Peter Schlosser, Odirilwe Selomane, Gregor Semieniuk, Yunne-Jai Shin, Tasneem A. Siddiqui, Vartika Singh, Giles B. Sioen, Youba Sokona, Detlef Stammer, Norman J. Steinert, Sunhee Suk, Rowan Sutton, Lisa Thalheimer, Vikki Thompson, Gregory Trencher, Kees van der Geest, Saskia E. Werners, Thea Wübbelmann, Nico Wunderling, Jiabo Yin, Kirsten Zickfeld, Jakob Zscheischler
-
- Journal:
- Global Sustainability / Volume 7 / 2024
- Published online by Cambridge University Press:
- 01 December 2023, e19
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Non-technical summary
We identify a set of essential recent advances in climate change research with high policy relevance, across natural and social sciences: (1) looming inevitability and implications of overshooting the 1.5°C warming limit, (2) urgent need for a rapid and managed fossil fuel phase-out, (3) challenges for scaling carbon dioxide removal, (4) uncertainties regarding the future contribution of natural carbon sinks, (5) intertwinedness of the crises of biodiversity loss and climate change, (6) compound events, (7) mountain glacier loss, (8) human immobility in the face of climate risks, (9) adaptation justice, and (10) just transitions in food systems.
Technical summaryThe Intergovernmental Panel on Climate Change Assessment Reports provides the scientific foundation for international climate negotiations and constitutes an unmatched resource for researchers. However, the assessment cycles take multiple years. As a contribution to cross- and interdisciplinary understanding of climate change across diverse research communities, we have streamlined an annual process to identify and synthesize significant research advances. We collected input from experts on various fields using an online questionnaire and prioritized a set of 10 key research insights with high policy relevance. This year, we focus on: (1) the looming overshoot of the 1.5°C warming limit, (2) the urgency of fossil fuel phase-out, (3) challenges to scale-up carbon dioxide removal, (4) uncertainties regarding future natural carbon sinks, (5) the need for joint governance of biodiversity loss and climate change, (6) advances in understanding compound events, (7) accelerated mountain glacier loss, (8) human immobility amidst climate risks, (9) adaptation justice, and (10) just transitions in food systems. We present a succinct account of these insights, reflect on their policy implications, and offer an integrated set of policy-relevant messages. This science synthesis and science communication effort is also the basis for a policy report contributing to elevate climate science every year in time for the United Nations Climate Change Conference.
Social media summaryWe highlight recent and policy-relevant advances in climate change research – with input from more than 200 experts.
Associations of free, bioavailable and total 25-hydroxyvitamin D with neonatal birth anthropometry and calcium homoeostasis in mother–child pairs in a sunny Mediterranean region
- Hana M. A. Fakhoury, Tarek Ziad Arabi, Hani Tamim, Rene F. Chun, William B. Grant, Martin Hewison, Fatme AlAnouti, Stefan Pilz, Cedric Annweiler, Georgios Tzimagiorgis, Costas Haitoglou, Spyridon N. Karras
-
- Journal:
- British Journal of Nutrition / Volume 131 / Issue 5 / 14 March 2024
- Published online by Cambridge University Press:
- 26 October 2023, pp. 801-808
- Print publication:
- 14 March 2024
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Sufficient vitamin D status is crucial for successful pregnancy and fetal development. The assessment of 25-hydroxyvitamin D (25(OH)D) concentrations is commonly used to evaluate vitamin D status. Our objective was to examine the interrelated biodynamics of maternal and neonatal total, free and bioavailable 25(OH)D in maternal–neonatal dyads at birth and their associations with homeostasis and neonatal birth anthropometry. We analysed a cohort of seventy full-term mother–child pairs. We found positive associations between all neonatal measures of vitamin D status. Maternal forms exhibited a similar pattern of association, except for the bioavailable maternal form. In multivariate analysis, both total and free maternal 25(OH)D concentrations were correlated with all neonatal forms (neonatal total 25(OH)D: 1·29 (95 % CI, 1·12, 1·46) for maternal total 25(OH)D, 10·89 (8·16, 13·63) for maternal free 25(OH)D), (neonatal free 25(OH)D: 0·15 for maternal total 25(OH)D, 1·28 (95 % CI, 0·89, 1·68) for maternal free 25(OH)D) and (0·13 (95 % CI, 0·10, 0·16), 1·06 (95 % CI, 0·68, 1·43) for maternal free 25(OH)D), respectively, with the exclusion of the bioavailable maternal form. We observed no significant interactions within or between groups regarding maternal and neonatal vitamin D parameters and maternal calcium and parathyroid hormone concentrations, and neonatal birth anthropometry. Our study indicates that bioavailable maternal and neonatal 25(OH)D have no significant effects on vitamin D equilibrium, Ca homeostasis and neonatal anthropometry at birth. However, we observed an interaction between maternal and neonatal total and free 25(OH)D concentrations at the maternal–neonatal interface, with no associations observed with other calciotropic or anthropometric outcomes.
Describing the monthly variability of hospital-onset Clostridioides difficile during early coronavirus disease 2019 (COVID-19) using electronic health record data
- Kaiting Lang, T. J. Atchison, Priti Singh, David M. Kline, James B. Odei, Jennifer L. Martin, Justin F. Smyer, Shandra R. Day, Courtney L. Hebert
-
- Journal:
- Infection Control & Hospital Epidemiology / Volume 45 / Issue 3 / March 2024
- Published online by Cambridge University Press:
- 09 October 2023, pp. 329-334
- Print publication:
- March 2024
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Objective:
To assess the relative risk of hospital-onset Clostridioides difficile (HO-CDI) during each month of the early coronavirus disease 2019 (COVID-19) pandemic and to compare it with historical expectation based on patient characteristics.
Design:This study used a retrospective cohort design. We collected secondary data from the institution’s electronic health record (EHR).
Setting:The Ohio State University Wexner Medical Center, Ohio, a large tertiary healthcare system in the Midwest.
Patients or participants:All adult patients admitted to the inpatient setting between January 2018 and May 2021 were eligible for the study. Prisoners, children, individuals presenting with Clostridioides difficile on admission, and patients with <4 days of inpatient stay were excluded from the study.
Results:After controlling for patient characteristics, the observed numbers of HO-CDI cases were not significantly different than expected. However, during 3 months of the pandemic period, the observed numbers of cases were significantly different from what would be expected based on patient characteristics. Of these 3 months, 2 months had more cases than expected and 1 month had fewer.
Conclusions:Variations in HO-CDI incidence seemed to trend with COVID-19 incidence but were not fully explained by our case mix. Other factors contributing to the variability in HO-CDI incidence beyond listed patient characteristics need to be explored.
Agricultural Research Service Weed Science Research: Past, Present, and Future
- Stephen L. Young, James V. Anderson, Scott R. Baerson, Joanna Bajsa-Hirschel, Dana M. Blumenthal, Chad S. Boyd, Clyde D. Boyette, Eric B. Brennan, Charles L. Cantrell, Wun S. Chao, Joanne C. Chee-Sanford, Charlie D. Clements, F. Allen Dray, Stephen O. Duke, Kayla M. Eason, Reginald S. Fletcher, Michael R. Fulcher, John F. Gaskin, Brenda J. Grewell, Erik P. Hamerlynck, Robert E. Hoagland, David P. Horvath, Eugene P. Law, John D. Madsen, Daniel E. Martin, Clint Mattox, Steven B. Mirsky, William T. Molin, Patrick J. Moran, Rebecca C. Mueller, Vijay K. Nandula, Beth A. Newingham, Zhiqiang Pan, Lauren M. Porensky, Paul D. Pratt, Andrew J. Price, Brian G. Rector, Krishna N. Reddy, Roger L. Sheley, Lincoln Smith, Melissa C. Smith, Keirith A. Snyder, Matthew A. Tancos, Natalie M. West, Gregory S. Wheeler, Martin M. Williams, Julie Wolf, Carissa L. Wonkka, Alice A. Wright, Jing Xi, Lew H. Ziska
-
- Journal:
- Weed Science / Volume 71 / Issue 4 / July 2023
- Published online by Cambridge University Press:
- 16 August 2023, pp. 312-327
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
The U.S. Department of Agriculture–Agricultural Research Service (USDA-ARS) has been a leader in weed science research covering topics ranging from the development and use of integrated weed management (IWM) tactics to basic mechanistic studies, including biotic resistance of desirable plant communities and herbicide resistance. ARS weed scientists have worked in agricultural and natural ecosystems, including agronomic and horticultural crops, pastures, forests, wild lands, aquatic habitats, wetlands, and riparian areas. Through strong partnerships with academia, state agencies, private industry, and numerous federal programs, ARS weed scientists have made contributions to discoveries in the newest fields of robotics and genetics, as well as the traditional and fundamental subjects of weed–crop competition and physiology and integration of weed control tactics and practices. Weed science at ARS is often overshadowed by other research topics; thus, few are aware of the long history of ARS weed science and its important contributions. This review is the result of a symposium held at the Weed Science Society of America’s 62nd Annual Meeting in 2022 that included 10 separate presentations in a virtual Weed Science Webinar Series. The overarching themes of management tactics (IWM, biological control, and automation), basic mechanisms (competition, invasive plant genetics, and herbicide resistance), and ecosystem impacts (invasive plant spread, climate change, conservation, and restoration) represent core ARS weed science research that is dynamic and efficacious and has been a significant component of the agency’s national and international efforts. This review highlights current studies and future directions that exemplify the science and collaborative relationships both within and outside ARS. Given the constraints of weeds and invasive plants on all aspects of food, feed, and fiber systems, there is an acknowledged need to face new challenges, including agriculture and natural resources sustainability, economic resilience and reliability, and societal health and well-being.
Moria or Mania? Manic symptoms as the clinical manifestation of glioblastoma recurrence: a case report
- F. Mayor Sanabria, M. E. Expósito Durán, M. Fernández Fariña, C. E. Regueiro Martín-Albo, M. Paz Otero, I. Alberdi Páramo, B. Rodado León
-
- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S520
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
Up to 50% of patients with brain tumors experience psychiatric symptoms, and rates up to 80% have been reported in malignant neoplasms such as glioblastoma multiforme (GBM). Still, clinical presentation as mania-like syndromes is a rare phenomenon, mainly occurring when frontal structures are compromised.
We present the case of a 42-year-old woman who was admitted to our hospital due to manic symptoms coinciding with a recurrence of a bifrontal GBM, for which she underwent surgery 5 months prior.
Objectives1) To describe the clinical particularities of this case, focusing on the differential diagnosis.
2) To review the association between manic symptoms and frontal dysfunction caused by brain tumors, with special interest on GBM.
MethodsA review of the patient’s clinical history and complementary tests performed was carried out. Likewise, we reviewed the available literature in relation to manic symptoms related to brain tumors.
ResultsThe patient’s GBM recurrence presented with late onset symptoms of mania, including euphoric mood, increased spending, ideas of grandiosity and hyper-religiosity. She had no previous psychiatric history but, interestingly, she had an extensive affective burden in her family, with 4 consummated suicides. However, she also presented other clinical signs, such as disorientation, perseveration, mild memory impairment and stereotyped motor behaviors, that pointed to relevant frontal lobe dysfunction, suggesting Moria as a possible contribution for the symptoms described.
Manic symptoms in the context of brain tumors appear in 7-15% of patients with psychiatric symptoms, usually associated with right frontal dysfunction (75% of cases). Bifrontal affectation, such as this patient, is only described in 6% of cases. Although fast growing, malignant tumors have been associated with higher rates of psychiatric symptoms, no correlation has been described between these and brain tumor histology.
Conclusions- The presence of atypical manic symptoms, such as those presented in this case, should raise clinical concern for secondary mania.
- Moria shares similarities with mania, including mood elevation, tendency to hilarity or hyper-sexuality, that may hinder diagnosis of patients with frontal dysfunction.
- This case outlines the difficulties in making a differential diagnosis in patient with both manic and neurological signs, and highlights the implication of frontal structures in the development of manic symptoms.
Disclosure of InterestNone Declared
Mindfulness, Attention, and Impulsivity in Bipolar Disorder
- N. E. Fares-Otero, B. Solé, S. Martin-Parra, F. Piazza, J. Sanchez-Moreno, E. Vieta, A. Martinez-Aran
-
- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S84-S85
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
Bipolar disorder (BD) is a chronic mental disorder characterized by mood instability1. BD is further related to neurocognitive and functional disruptions that remain remarkably stable even when patients are euthymic, leading to poor well-being and quality of life. Mindfulness means paying attention on purpose, in the present moment, and involves different facets such as observing, describing, acting with awareness, non-judging and non-reacting of inner experience. It remains unclear whether mindfulness and its specific facets are differentially associated with different aspects of attention and trait impulsivity in individuals with BD.
ObjectivesTo examine associations between different mindfulness facets, and different aspects of attention and trait impulsivity in BD.
MethodsThis study was approved by the Hospital Clínic Ethics and Research Board (HCB/2017/0432). After informed consent, 94 outpatients, M age = 45.57, SD = 9.8, range 19-61 years, 41.5% Male, 63.8% BD-I according to DSM-5 criteria, in partial or total remission based on Young Mania Rating Scale (YMRS; M = 1.81, SD = 2.11) and Hamilton Depression Rating Scale (HDRS; M = 5.46, SD = 3.71) were enrolled in this study. Participants were evaluated using the Five Facet Mindfulness Questionnaire (FFMQ) to assess Mindfulness, the Trail Making Test (TMT-A) and the Conner’s Continuous Performance test (CPT-II) to assess Attention, and the Barratt Impulsiveness Scale (BIS-11) to assess Impulsivity. Pearson correlations were performed, and statistical significance was evaluated two-sided at the 5% threshold.
ResultsMindfulness-Describing was negatively associated with Cognitive and Non-Planning Impulsivity (r = -.43 and -.28, p < .001), Mindfulness-Acting with Awareness was negatively associated with Cognitive, Motor and Non-Planning Impulsivity (r = -.27 to -.45, p < .001), Mindfulness Non-Judging (r = -.33 and -.34, p < .001) and Non-Reacting (r = -.30 and -.46, p < .001) of inner experience were negatively associated with Cognitive and Motor Impulsivity. No associations were found between neither Mindfulness nor Impulsivity with any aspects of Attention.
ConclusionsPreliminary findings suggest that better performance in specific facets of mindfulness (describing, acting with awareness, non-judging or reacting of inner experience) may be related to a decrease in different aspects of trait impulsivity. Further longitudinal and interventional research is needed on underlying mechanisms. Nonetheless, our study suggests the need for including mindfulness-based approaches to improve behavioral and functional outcomes for those with BD.
FundingThis work was supported by the European Union Horizon 2020 research and innovation program (EU.3.1.3. Treating and managing disease: Grant 945151), CIBERSAM, FIS PI17/00941 ISCIII, European Regional Development Fund.
References1. Carvalho AF, Firth J, Vieta E. Bipolar Disorder. N Engl J Med. 2020;383(1):58-66. doi:10.1056/NEJMra1906193
Disclosure of InterestNone Declared
THE RELATIONSHIP BETWEEN RESIDUAL MOOD SYMPTOMS, DISPOSITIONAL MINDFULNESS, AND QUALITY OF LIFE IN BIPOLAR DISORDER
- F. P. Piazza, B. Solé, S. Martín-Parra, A. Martínez-Arán, N. E. Fares-Otero
-
- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S698
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
Bipolar disorder (BD) is a chronic and recurrent mental condition characterized by mood fluctuations between hypomania or mania and depression, with high level of burden and mortality rates (Hayes et al., 2015). Subsyndromal mood symptoms, including residual depression, mania and/or anxiety, are major risk factors for episodic relapses after mood stabilisation (Samalin et al., 2016). A psychological protective mechanism against the occurrence of these maladaptative mood symptoms is dispositional mindfulness (DM). DM refers to paying purposeful attention to present moment experiences with a curious, non-judgmental and accepting attitude (Radford et al., 2014). DM has been barely assessed in BD and there is very little evidence on the relationship between DM, residual mood symptoms and quality of life
ObjectivesTo explore associations between DM, residual mood symptoms and quality of life in individuals with BD
MethodsAfter informed consent, a total of 94 adults (Mean age= 45.57 years, 41.50% Male) with diagnosis of BD according to DSM-5 criteria, in full or partial remission,were recruited from the Bipolar and Depressive Disorders Unit at the Hospital Clinic of Barcelona. The ethical committee approved this study. Dispositional mindfulness was assessed using the Mindfulness Attention Awareness Scale (MAAS).The presence of residual depressive symptoms was assessed with the Hamilton Depression Rating Scale (HDRS), residual mania symptoms were assessed with the Young Mania Rating Scale(YMRS), and anxiety symptoms were assessed with the Hamilton Anxiety Rating Scale (HAM-A). The subjective quality of life was assessed with the Quality of Life in Bipolar Disorder Questionnaire (QoL-BD). Pearson correlations were carried out and the level of significance was set at p<0.05
ResultsDM was negatively related to residual depressive symptoms (r= -0.283; p=0.009) and to anxiety symptoms (r=-0.345; p<0.001), and positively related to quality of life (r=0.433; p<0.001), but not related to residual manic symptoms in BD
ConclusionsOur preliminary data suggest that BD patients with higher levels of DM may experience less depressive and anxiety subsyndromal symptoms and perceived higher quality of life. No associations were detected regarding mania symptoms. These findings support the use of mindfulness training as an adjunct therapy to pharmacotherapy to reduce residual mood symptoms and improve quality of life in patients with BD
Disclosure of InterestNone Declared
Efficacy and safety of a 4-week course of repeated subcutaneous ketamine injections for treatment-resistant depression (KADS study): randomised double-blind active-controlled trial
- Colleen Loo, Nick Glozier, David Barton, Bernhard T. Baune, Natalie T. Mills, Paul Fitzgerald, Paul Glue, Shanthi Sarma, Veronica Galvez-Ortiz, Dusan Hadzi-Pavlovic, Angelo Alonzo, Vanessa Dong, Donel Martin, Stevan Nikolin, Philip B. Mitchell, Michael Berk, Gregory Carter, Maree Hackett, John Leyden, Sean Hood, Andrew A. Somogyi, Kyle Lapidus, Elizabeth Stratton, Kirsten Gainsford, Deepak Garg, Nicollette L. R. Thornton, Célia Fourrier, Karyn Richardson, Demi Rozakis, Anish Scaria, Cathrine Mihalopoulos, Mary Lou Chatterton, William M. McDonald, Philip Boyce, Paul E. Holtzheimer, F. Andrew Kozel, Patricio Riva-Posse, Anthony Rodgers
-
- Journal:
- The British Journal of Psychiatry / Volume 223 / Issue 6 / December 2023
- Published online by Cambridge University Press:
- 14 July 2023, pp. 533-541
- Print publication:
- December 2023
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Background
Prior trials suggest that intravenous racemic ketamine is a highly effective for treatment-resistant depression (TRD), but phase 3 trials of racemic ketamine are needed.
AimsTo assess the acute efficacy and safety of a 4-week course of subcutaneous racemic ketamine in participants with TRD. Trial registration: ACTRN12616001096448 at www.anzctr.org.au.
MethodThis phase 3, double-blind, randomised, active-controlled multicentre trial was conducted at seven mood disorders centres in Australia and New Zealand. Participants received twice-weekly subcutaneous racemic ketamine or midazolam for 4 weeks. Initially, the trial tested fixed-dose ketamine 0.5 mg/kg versus midazolam 0.025 mg/kg (cohort 1). Dosing was revised, after a Data Safety Monitoring Board recommendation, to flexible-dose ketamine 0.5–0.9 mg/kg or midazolam 0.025–0.045 mg/kg, with response-guided dosing increments (cohort 2). The primary outcome was remission (Montgomery-Åsberg Rating Scale for Depression score ≤10) at the end of week 4.
ResultsThe final analysis (those who received at least one treatment) comprised 68 in cohort 1 (fixed-dose), 106 in cohort 2 (flexible-dose). Ketamine was more efficacious than midazolam in cohort 2 (remission rate 19.6% v. 2.0%; OR = 12.1, 95% CI 2.1–69.2, P = 0.005), but not different in cohort 1 (remission rate 6.3% v. 8.8%; OR = 1.3, 95% CI 0.2–8.2, P = 0.76). Ketamine was well tolerated. Acute adverse effects (psychotomimetic, blood pressure increases) resolved within 2 h.
ConclusionsAdequately dosed subcutaneous racemic ketamine was efficacious and safe in treating TRD over a 4-week treatment period. The subcutaneous route is practical and feasible.
Mega-analysis of association between obesity and cortical morphology in bipolar disorders: ENIGMA study in 2832 participants
- Sean R. McWhinney, Christoph Abé, Martin Alda, Francesco Benedetti, Erlend Bøen, Caterina del Mar Bonnin, Tiana Borgers, Katharina Brosch, Erick J. Canales-Rodríguez, Dara M. Cannon, Udo Dannlowski, Ana M. Diaz-Zuluaga, Lorielle M.F. Dietze, Torbjørn Elvsåshagen, Lisa T. Eyler, Janice M. Fullerton, Jose M. Goikolea, Janik Goltermann, Dominik Grotegerd, Bartholomeus C. M. Haarman, Tim Hahn, Fleur M. Howells, Martin Ingvar, Neda Jahanshad, Tilo T. J. Kircher, Axel Krug, Rayus T. Kuplicki, Mikael Landén, Hannah Lemke, Benny Liberg, Carlos Lopez-Jaramillo, Ulrik F. Malt, Fiona M. Martyn, Elena Mazza, Colm McDonald, Genevieve McPhilemy, Sandra Meier, Susanne Meinert, Tina Meller, Elisa M. T. Melloni, Philip B. Mitchell, Leila Nabulsi, Igor Nenadic, Nils Opel, Roel A. Ophoff, Bronwyn J. Overs, Julia-Katharina Pfarr, Julian A. Pineda-Zapata, Edith Pomarol-Clotet, Joaquim Raduà, Jonathan Repple, Maike Richter, Kai G. Ringwald, Gloria Roberts, Alex Ross, Raymond Salvador, Jonathan Savitz, Simon Schmitt, Peter R. Schofield, Kang Sim, Dan J. Stein, Frederike Stein, Henk S. Temmingh, Katharina Thiel, Sophia I. Thomopoulos, Neeltje E. M. van Haren, Cristian Vargas, Eduard Vieta, Annabel Vreeker, Lena Waltemate, Lakshmi N. Yatham, Christopher R. K. Ching, Ole A. Andreassen, Paul M. Thompson, Tomas Hajek, for the ENIGMA Bipolar Disorder Working Group
-
- Journal:
- Psychological Medicine / Volume 53 / Issue 14 / October 2023
- Published online by Cambridge University Press:
- 27 February 2023, pp. 6743-6753
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Background:
Obesity is highly prevalent and disabling, especially in individuals with severe mental illness including bipolar disorders (BD). The brain is a target organ for both obesity and BD. Yet, we do not understand how cortical brain alterations in BD and obesity interact.
Methods:We obtained body mass index (BMI) and MRI-derived regional cortical thickness, surface area from 1231 BD and 1601 control individuals from 13 countries within the ENIGMA-BD Working Group. We jointly modeled the statistical effects of BD and BMI on brain structure using mixed effects and tested for interaction and mediation. We also investigated the impact of medications on the BMI-related associations.
Results:BMI and BD additively impacted the structure of many of the same brain regions. Both BMI and BD were negatively associated with cortical thickness, but not surface area. In most regions the number of jointly used psychiatric medication classes remained associated with lower cortical thickness when controlling for BMI. In a single region, fusiform gyrus, about a third of the negative association between number of jointly used psychiatric medications and cortical thickness was mediated by association between the number of medications and higher BMI.
Conclusions:We confirmed consistent associations between higher BMI and lower cortical thickness, but not surface area, across the cerebral mantle, in regions which were also associated with BD. Higher BMI in people with BD indicated more pronounced brain alterations. BMI is important for understanding the neuroanatomical changes in BD and the effects of psychiatric medications on the brain.
DRAGON-Data: a platform and protocol for integrating genomic and phenotypic data across large psychiatric cohorts
- Amy J. Lynham, Sarah Knott, Jack F. G. Underwood, Leon Hubbard, Sharifah S. Agha, Jonathan I. Bisson, Marianne B. M. van den Bree, Samuel J. R. A. Chawner, Nicholas Craddock, Michael O'Donovan, Ian R. Jones, George Kirov, Kate Langley, Joanna Martin, Frances Rice, Neil P. Roberts, Anita Thapar, Richard Anney, Michael J. Owen, Jeremy Hall, Antonio F. Pardiñas, James T. R. Walters
-
- Journal:
- BJPsych Open / Volume 9 / Issue 2 / March 2023
- Published online by Cambridge University Press:
- 08 February 2023, e32
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Background
Current psychiatric diagnoses, although heritable, have not been clearly mapped onto distinct underlying pathogenic processes. The same symptoms often occur in multiple disorders, and a substantial proportion of both genetic and environmental risk factors are shared across disorders. However, the relationship between shared symptoms and shared genetic liability is still poorly understood.
AimsWell-characterised, cross-disorder samples are needed to investigate this matter, but few currently exist. Our aim is to develop procedures to purposely curate and aggregate genotypic and phenotypic data in psychiatric research.
MethodAs part of the Cardiff MRC Mental Health Data Pathfinder initiative, we have curated and harmonised phenotypic and genetic information from 15 studies to create a new data repository, DRAGON-Data. To date, DRAGON-Data includes over 45 000 individuals: adults and children with neurodevelopmental or psychiatric diagnoses, affected probands within collected families and individuals who carry a known neurodevelopmental risk copy number variant.
ResultsWe have processed the available phenotype information to derive core variables that can be reliably analysed across groups. In addition, all data-sets with genotype information have undergone rigorous quality control, imputation, copy number variant calling and polygenic score generation.
ConclusionsDRAGON-Data combines genetic and non-genetic information, and is available as a resource for research across traditional psychiatric diagnostic categories. Algorithms and pipelines used for data harmonisation are currently publicly available for the scientific community, and an appropriate data-sharing protocol will be developed as part of ongoing projects (DATAMIND) in partnership with Health Data Research UK.
Ten new insights in climate science 2022
- Maria A. Martin, Emmanuel A. Boakye, Emily Boyd, Wendy Broadgate, Mercedes Bustamante, Josep G. Canadell, Edward R. Carr, Eric K. Chu, Helen Cleugh, Szilvia Csevár, Marwa Daoudy, Ariane de Bremond, Meghnath Dhimal, Kristie L. Ebi, Clea Edwards, Sabine Fuss, Martin P. Girardin, Bruce Glavovic, Sophie Hebden, Marina Hirota, Huang-Hsiung Hsu, Saleemul Huq, Karin Ingold, Ola M. Johannessen, Yasuko Kameyama, Nilushi Kumarasinghe, Gaby S. Langendijk, Tabea Lissner, Shuaib Lwasa, Catherine Machalaba, Aaron Maltais, Manu V. Mathai, Cheikh Mbow, Karen E. McNamara, Aditi Mukherji, Virginia Murray, Jaroslav Mysiak, Chukwumerije Okereke, Daniel Ospina, Friederike Otto, Anjal Prakash, Juan M. Pulhin, Emmanuel Raju, Aaron Redman, Kanta K. Rigaud, Johan Rockström, Joyashree Roy, E. Lisa F. Schipper, Peter Schlosser, Karsten A. Schulz, Kim Schumacher, Luana Schwarz, Murray Scown, Barbora Šedová, Tasneem A. Siddiqui, Chandni Singh, Giles B. Sioen, Detlef Stammer, Norman J. Steinert, Sunhee Suk, Rowan Sutton, Lisa Thalheimer, Maarten van Aalst, Kees van der Geest, Zhirong Jerry Zhao
-
- Journal:
- Global Sustainability / Volume 5 / 2022
- Published online by Cambridge University Press:
- 10 November 2022, e20
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Non-technical summary
We summarize what we assess as the past year's most important findings within climate change research: limits to adaptation, vulnerability hotspots, new threats coming from the climate–health nexus, climate (im)mobility and security, sustainable practices for land use and finance, losses and damages, inclusive societal climate decisions and ways to overcome structural barriers to accelerate mitigation and limit global warming to below 2°C.
Technical summaryWe synthesize 10 topics within climate research where there have been significant advances or emerging scientific consensus since January 2021. The selection of these insights was based on input from an international open call with broad disciplinary scope. Findings concern: (1) new aspects of soft and hard limits to adaptation; (2) the emergence of regional vulnerability hotspots from climate impacts and human vulnerability; (3) new threats on the climate–health horizon – some involving plants and animals; (4) climate (im)mobility and the need for anticipatory action; (5) security and climate; (6) sustainable land management as a prerequisite to land-based solutions; (7) sustainable finance practices in the private sector and the need for political guidance; (8) the urgent planetary imperative for addressing losses and damages; (9) inclusive societal choices for climate-resilient development and (10) how to overcome barriers to accelerate mitigation and limit global warming to below 2°C.
Social media summaryScience has evidence on barriers to mitigation and how to overcome them to avoid limits to adaptation across multiple fields.
The relation between Complex PTSD and Borderline Personality Disorder – a review of the literature
- B. Ramos, F. Santos Martins, A. Elias De Sousa, I. Soares Da Costa, F. Andrade
-
- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S669
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
Adults diagnosed with Borderline Personality Disorder (BPD) likely have a history of psychological trauma. There has been research about the connection between Complex Post-Traumatic Stress Disorder (c-PTSD) and BPD.
ObjectivesThis paper provides a review of the relationship between complex trauma and key features of BPD.
MethodsReview of the literature from 2015 to present, using search engines such as Pubmed and Google Shoolar, using the following keywords: borderline personality disorder, complex post-traumatic stress disorder, trauma
ResultsTraumatic victimisation and compromised primary caregiving relationships have been hypothesized to be key aetiological factors in the subsequent development of BPD. c-PTSD was defined as a syndrome with symptoms of emotional dysregulation, dissociation somatisation and poor self-esteem, with distorted cognition about relationships, following traumatic interpersonal abuse. It was proposed as an alternative for understanding and treating people who had suffered prolonged and severe interpersonal trauma, many of whom were diagnosed with BPD. Although, the boundaries between c-PTSD and BPD remain vague. Currently, the main difference is the assumption that symptoms of c-PTSD are sequelae of exposure to traumatic stress, which is not inherent in the current DSM-5 definition of BPD. Furthermore, to date, the neurochemistry and neurostructural changes seen in c-PTSD, BPD and PTSD do not clearly differentiate the three conditions.
ConclusionsBPD and PTSD are relatively distinct with regard to the precise qualitative definitions of their diagnostic features, but nevertheless have substantial potential overlap in their symptom criteria.
DisclosureNo significant relationships.
Finding meanings in Late onset Post Traumatic Stress Disorder – a review of the literature
- B. Ramos, I. Soares Da Costa, A. Elias De Sousa, F. Andrade, F. Santos Martins
-
- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, pp. S675-S676
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
About a decade ago, the idea of a Late-Onset Post Traumatic Stress Disorder (LO-PTSD) emerged, in order to characterize the later-life emergence of symptoms related to early-life warzone trauma among aging combat Veterans.
ObjectivesThis paper provides a review of the changes happened during the onset of a late form of PTSD and how can mental health professionals intervene.
MethodsReview of the literature from 2015 to present, using search engines such as Pubmed and Google Schoolar, using the following keywords: Late-Onset Post Traumatic Stress Disorder, triggers, prevention, intervention
ResultsAt first, there was hypothesized that aging-related challenges (role transition and loss, death of family members and friends, physical and cognitive decline) might lead to increased reminiscence, and possibly distress, among Veterans who had previously dealt successfully with earlier traumatic events. However, recent studies have proposed that in later life many combat Veterans confront and rework their wartime memories in an effort to find meaning and build coherence. Through reminiscence, life review, and wrestling with issues such as integrity versus despair, they intentionally reengage with experiences they avoided or managed successfully earlier in life, perhaps without resolution or integration. This process can lead positively to personal growth or negatively to increased symptomatology.
ConclusionsTherefore the role of preventive intervention in enhancing positive outcomes for Veterans who reengage with their wartime memories in later life should be reconsidered.
DisclosureNo significant relationships.
Transmission visualizations of healthcare infection clusters: A scoping review
- Mya B. Brady, Helena M. VonVille, Joseph F. White, Elise M. Martin, Nathan J. Raabe, Julie M. Slaughter, Graham M. Snyder
-
- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 2 / Issue 1 / 2022
- Published online by Cambridge University Press:
- 15 June 2022, e92
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Objective:
To evaluate infectious pathogen transmission data visualizations in outbreak publications.
Design:Scoping review.
Methods:Medline was searched for outbreak investigations of infectious diseases within healthcare facilities that included ≥1 data visualization of transmission using data observable by an infection preventionist showing temporal and/or spatial relationships. Abstracted data included the nature of the cluster(s) (pathogen, scope of transmission, and individuals involved) and data visualization characteristics including visualization type, transmission elements, and software.
Results:From 1,957 articles retrieved, we analyzed 30 articles including 37 data visualizations. The median cluster size was 20.5 individuals (range, 7–1,963) and lasted a median of 214 days (range, 12–5,204). Among the data visualization types, 10 (27%) were floor-plan transmission maps, 6 (16%) were timelines, 11 (30%) were transmission networks, 3 (8%) were Gantt charts, 4 (11%) were cluster map, and 4 (11%) were other types. In addition, 26 data visualizations (70%) contained spatial elements, 26 (70%) included person type, and 19 (51%) contained time elements. None of the data visualizations contained contagious periods and only 2 (5%) contained symptom-onset date.
Conclusions:The data visualizations of healthcare-associated infectious disease outbreaks in the systematic review were diverse in type and visualization elements, though no data visualization contained all elements important to deriving hypotheses about transmission pathways. These findings aid in understanding the visualizing transmission pathways by describing essential elements of the data visualization and will inform the creation of a standardized mapping tool to aid in earlier initiation of interventions to prevent transmission.