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A subset of Australia’s workforce are shift workers undertaking critical work for our community, who are at greater risk for obesity and related conditions, such as type 2 diabetes and cardiovascular disease(1,2,3). The lifestyle and circadian disruption experienced by night shift workers is currently not addressed in existing dietary guidance for obesity management. The Shifting Weight using Intermittent Fasting in night shift workers study (SWIFt) is a world-first, randomised controlled trial that compares three, 24-week weight-loss interventions for night shift workers: continuous energy restriction (CER) and two twice-per-week intermittent fasting (IF) interventions (fasting during a night shift or during the day). This qualitative study aimed to explore the experiences of participants while following the dietary interventions to understand how intervention features and associated behaviour change mechanisms influence engagement. Semi-structured interviews at baseline and 24-weeks were conducted and audio diaries were collected every two weeks from participants using a maximum variation sampling approach, and analysed using the five steps of framework analysis(4). Each coded text for intervention enablers was mapped to the following behaviour change frameworks: the COM-B model, the Theoretical Domains Framework (TDF), and the Behaviour Change Taxonomy (BCT). Of the 250 participants randomised to the SWIFt study, 47 interviews from n = 33 participants were conducted and n = 18 participants completed audio diaries. Three major themes were identified related to intervention factors influencing engagement: 1) Simplicity and ease are important for night shift workers; 2) Support and accountability are needed to change behaviour and to tackle fluctuating motivation; and 3) An individualised approach is sometimes needed. Ten enabler sub-themes were identified: ease and acceptability of provided foods, structured and straightforward approach, flexible approach, easier with time, simplicity and small changes, dietetic support, accountability, self-monitoring, increased nutrition knowledge, and focus on regular eating. The enabler sub-themes were predominantly related to the ‘motivation’ and ‘capability’ domains of the COM-B model and one sub-theme related to the ‘opportunity’ domain. Mapping to the ‘capability’ COM-B domain was more frequent for the CER intervention compared to the IF interventions. For the Theoretical Domains Framework (TDF), the following domains were the most frequently reported: ‘behavioural regulation’, ‘knowledge’, ‘goals’ and ‘environmental context and resources’. For the Behaviour Change Taxonomy (BCT), the following domains were the most frequently reported: ‘instruction on how to perform a behaviour’, ‘goal setting (behaviour)’, ‘self-monitoring of outcome(s) of behaviour’, and ‘adding objects to the environment’. This study provides important findings detailing the behaviour change mechanisms perceived to positively influence night shift worker engagement during the weight-loss interventions of the SWIFt study, which will help inform the translation of interventions into non-research settings.
Approximately 15% of Australia’s workforce are shift workers, who are at greater risk for obesity and related conditions, such as type 2 diabetes and cardiovascular disease.(1,2,3) While current guidelines for obesity management prioritise diet-induced weight loss as a treatment option, there are limited weight-loss studies involving night shift workers and no current exploration of the factors associated with engagement in weight-loss interventions. The Shifting Weight using Intermittent Fasting in night shift workers (SWIFt) study was a randomised controlled trial that compared three, 24-week weight-loss interventions: continuous energy restriction (CER), and 500-calorie intermittent fasting (IF) for 2-days per week; either during the day (IF:2D), or the night shift (IF:2N). This current study provided a convergent, mixed methods, experimental design to: 1) explore the relationship between participant characteristics, dietary intervention group and time to drop out for the SWIFt study (quantitative); and 2) understand why some participants are more likely to drop out of the intervention (qualitative). Participant characteristics included age, gender, ethnicity, occupation, shift schedule, number of night shifts per four weeks, number of years in shift work, weight at baseline, weight change at four weeks, and quality of life at baseline. A Cox regression model was used to specify time to drop out from the intervention as the dependent variable and purposive selection was used to determine predictors for the model. Semi-structured interviews at baseline and 24-weeks were conducted and audio diaries every two weeks were collected from participants using a maximum variation sampling approach, and analysed using the five steps of framework analysis.(4) A total of 250 participants were randomised to the study between October 2019 and February 2022. Two participants were excluded from analysis due to retrospective ineligibility. Twenty-nine percent (n = 71) of participants dropped out of the study over the 24-week intervention. Greater weight at baseline, fewer years working shift work, lower weight change at four weeks, and women compared to men were associated with a significant increased rate of drop out from the study (p < 0.05). Forty-seven interviews from 33 participants were conducted and 18 participants completed audio diaries. Lack of time, fatigue and emotional eating were barriers more frequently reported by women. Participants with a higher weight at baseline more frequently reported fatigue and emotional eating barriers, and limited guidance on non-fasting days as a barrier for the IF interventions. This study provides important considerations for refining shift-worker weight-loss interventions for future implementation in order to increase engagement and mitigate the adverse health risks experienced by this essential workforce.
It remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.
Aims
To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.
Method
Randomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment–covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.
Results
IPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = −0.48 to −0.27). Effects could not be ascertained up to 24 months (s.m.d. = −0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27–2.79), reliable improvement (relative risk = 1.38–3.17), deterioration (relative risk = 0.67–0.54) and close-to-symptom-free status (relative risk = 1.41–2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (P > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = −0.33 for PHQ-9 = 5).
Conclusions
Psychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.
From early on, infants show a preference for infant-directed speech (IDS) over adult-directed speech (ADS), and exposure to IDS has been correlated with language outcome measures such as vocabulary. The present multi-laboratory study explores this issue by investigating whether there is a link between early preference for IDS and later vocabulary size. Infants’ preference for IDS was tested as part of the ManyBabies 1 project, and follow-up CDI data were collected from a subsample of this dataset at 18 and 24 months. A total of 341 (18 months) and 327 (24 months) infants were tested across 21 laboratories. In neither preregistered analyses with North American and UK English, nor exploratory analyses with a larger sample did we find evidence for a relation between IDS preference and later vocabulary. We discuss implications of this finding in light of recent work suggesting that IDS preference measured in the laboratory has low test-retest reliability.
Understanding characteristics of healthcare personnel (HCP) with SARS-CoV-2 infection supports the development and prioritization of interventions to protect this important workforce. We report detailed characteristics of HCP who tested positive for SARS-CoV-2 from April 20, 2020 through December 31, 2021.
Methods:
CDC collaborated with Emerging Infections Program sites in 10 states to interview HCP with SARS-CoV-2 infection (case-HCP) about their demographics, underlying medical conditions, healthcare roles, exposures, personal protective equipment (PPE) use, and COVID-19 vaccination status. We grouped case-HCP by healthcare role. To describe residential social vulnerability, we merged geocoded HCP residential addresses with CDC/ATSDR Social Vulnerability Index (SVI) values at the census tract level. We defined highest and lowest SVI quartiles as high and low social vulnerability, respectively.
Results:
Our analysis included 7,531 case-HCP. Most case-HCP with roles as certified nursing assistant (CNA) (444, 61.3%), medical assistant (252, 65.3%), or home healthcare worker (HHW) (225, 59.5%) reported their race and ethnicity as either non-Hispanic Black or Hispanic. More than one third of HHWs (166, 45.2%), CNAs (283, 41.7%), and medical assistants (138, 37.9%) reported a residential address in the high social vulnerability category. The proportion of case-HCP who reported using recommended PPE at all times when caring for patients with COVID-19 was lowest among HHWs compared with other roles.
Conclusions:
To mitigate SARS-CoV-2 infection risk in healthcare settings, infection prevention, and control interventions should be specific to HCP roles and educational backgrounds. Additional interventions are needed to address high social vulnerability among HHWs, CNAs, and medical assistants.
Different fertilization strategies can be adopted to optimize the productive components of an integrated crop–livestock systems. The current research evaluated how the application of P and K to soybean (Glycine max (L.) Merr.) or Urochloa brizantha (Hochst. ex A. Rich.) R. D. Webster cv. BRS Piatã associated with nitrogen or without nitrogen in the pasture phase affects the accumulation and chemical composition of forage and animal productivity. The treatments were distributed in randomized blocks with three replications. Four fertilization strategies were tested: (1) conventional fertilization with P and K in the crop phase (CF–N); (2) conventional fertilization with nitrogen in the pasture phase (CF + N); (3) system fertilization with P and K in the pasture phase (SF–N); (4) system fertilization with nitrogen in the pasture phase (SF + N). System fertilization increased forage accumulation from 15 710 to 20 920 kg DM ha/year compared to conventional without nitrogen. Stocking rate (3.1 vs. 2.8 AU/ha; SEM = 0.12) and gain per area (458 vs. 413 kg BW/ha; SEM = 27.9) were higher in the SF–N than CF–N, although the average daily gain was lower (0.754 vs. 0.792 kg LW/day; SEM = 0.071). N application in the pasture phase, both, conventional and system fertilization resulted in higher crude protein, stocking rate and gain per area. Applying nitrogen and relocate P and K from crop to pasture phase increase animal productivity and improve forage chemical composition in integrated crop–livestock system.
In this work, we present a methodology and a corresponding code-base for constructing mock integral field spectrograph (IFS) observations of simulated galaxies in a consistent and reproducible way. Such methods are necessary to improve the collaboration and comparison of observation and theory results, and accelerate our understanding of how the kinematics of galaxies evolve over time. This code, SimSpin, is an open-source package written in R, but also with an API interface such that the code can be interacted with in any coding language. Documentation and individual examples can be found at the open-source website connected to the online repository. SimSpin is already being utilised by international IFS collaborations, including SAMI and MAGPI, for generating comparable data sets from a diverse suite of cosmological hydrodynamical simulations.
To characterize residential social vulnerability among healthcare personnel (HCP) and evaluate its association with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection.
Design:
Case–control study.
Setting:
This study analyzed data collected in May–December 2020 through sentinel and population-based surveillance in healthcare facilities in Colorado, Minnesota, New Mexico, New York, and Oregon.
Participants:
Data from 2,168 HCP (1,571 cases and 597 controls from the same facilities) were analyzed.
Methods:
HCP residential addresses were linked to the social vulnerability index (SVI) at the census tract level, which represents a ranking of community vulnerability to emergencies based on 15 US Census variables. The primary outcome was SARS-CoV-2 infection, confirmed by positive antigen or real-time reverse-transcriptase– polymerase chain reaction (RT-PCR) test on nasopharyngeal swab. Significant differences by SVI in participant characteristics were assessed using the Fisher exact test. Adjusted odds ratios (aOR) with 95% confidence intervals (CIs) for associations between case status and SVI, controlling for HCP role and patient care activities, were estimated using logistic regression.
Results:
Significantly higher proportions of certified nursing assistants (48.0%) and medical assistants (44.1%) resided in high SVI census tracts, compared to registered nurses (15.9%) and physicians (11.6%). HCP cases were more likely than controls to live in high SVI census tracts (aOR, 1.76; 95% CI, 1.37–2.26).
Conclusions:
These findings suggest that residing in more socially vulnerable census tracts may be associated with SARS-CoV-2 infection risk among HCP and that residential vulnerability differs by HCP role. Efforts to safeguard the US healthcare workforce and advance health equity should address the social determinants that drive racial, ethnic, and socioeconomic health disparities.
Background: The Canadian Registry for Amyloidosis Research (CRAR) is a nationwide disease registry of transthyretin (ATTR) and light-chain (AL) amyloidosis. Recent advances in disease-modifying therapy have improved prognosis, however there is a critical need for real-world evidence to address knowledge gaps, particularly longer-term therapeutic outcomes and surveillance strategies. Methods: A multi-stakeholder process was undertaken to develop a consensus dataset for ATTR- and AL-amyloidosis. This process included surveys to rank the importance of potential data items, and a consensus meeting of the CRAR steering committee, (comprised of multidisciplinary clinical experts, and patient organization representatives). Patients and patient organizations supported the development and implementation of a patient-reported dataset. Results: Consensus data items include disease onset, progression, severity, treatments, and outcomes, as well as patient-reported outcomes. Both prospective and retrospective (including deceased) patient cohorts are included. Further baseline data will be presented on an initial cohort of patients. Conclusions: CRAR has been established to collect a longitudinal, multidisciplinary dataset that will evaluate amyloidosis care and outcomes. CRAR has launched at multiple specialty amyloidosis centers nationally and is continually expanding. The growth of this program will promote opportunities to assess real-world safety and efficacy and inform the cost-effectiveness of therapies while supporting patient recruitment for research.
OBJECTIVES/GOALS: NSF often requires cross-disciplinary team composition to be competitive for funding. To what extent do research teams have multidisciplinary authorships after they win an award, given that awards are not contracts? We examined the quantity and quality of multidisciplinary collaboration of NSF-funded teams before and after receiving their award. METHODS/STUDY POPULATION: Our sample was 150 PIs and Co-PIs (67% male) from 58 NSF-funded EAGER (EArly-concept Grants for Exploratory Research) grants between 2013 and 2019. Using publicly available information, we collected the number of conference papers, publications, and grants PIs/co-PIs produced with each other (all PIs and co-PIs in a team or a partial subset). Based on Ph.D. fields, we also cataloged whether the combination of PIs/co-PI authors on outputs represented unidisciplinary or multidisciplinary collaboration after their NSF award. Multidisciplinary collaboration consisted of multidivisional (Ph.D. disciplines across NSF divisions, e.g., political science and cognitive psychology) or multidirectorate (Ph.D. disciplines across NSF directorates, e.g., psychology and engineering) authorship. RESULTS/ANTICIPATED RESULTS: Of the 74% of PI and co-PI teams who collaborated after their EAGER award, almost 9 out of 10 chose to work with a collaborator from a different discipline, and almost 8 out of 10 chose to work with a researcher from an extremely diverse discipline from their own (e.g., computer science and psychology). Research on interdisciplinary teams largely emphasizes the challenges and problems they face but the current research demonstrated that 90% of the sample chose to continue working together across disciplines after EAGER awards. Therefore, future research should dedicate more attention to the nontangible benefits members receive in interdisciplinary teams. Moreover, quality measures revealed higher H-indices for multidisciplinary than unidisciplinary journals and conferences. DISCUSSION/SIGNIFICANCE: Our archival results revealed that NSF EAGER grants are having their intended effect of being a catalyst for 1) continued multidisciplinary (and especially multidirectorate) collaboration) and 2) high-quality multidisciplinary publication and conference output. These results have contributed to NSF policy changes to reinstate the EAGER grant.
Consumers now demand evidence of welfare assurance at all stages of animal production, marketing, transport and slaughter. In response, retailers have increasingly adopted preferred supply chain relationships which preclude sourcing animals via livestock auction markets. One of the criteria dictating this action is a perceived improvement in animal welfare resulting from direct transport from farm to abattoir.
A survey of complete journey structures of 18 393 slaughterweight lambs from farm to abattoir was conducted between April and July 1997. Journeys were characterized in terms of distances travelled, duration and the number of discrete components within a whole journey which comprised: transport; trans-shipping (when animals were transferred from one vehicle to another); multiple pickups from a number of farms; and holding at either assembly points, lairages or auction markets. The results identified that journeys in the livestock distribution system are diverse and range in complexity, irrespective of marketing channel. Journey complexity was found to be positively related to distance travelled.
The study demonstrates that discussions concerning welfare of livestock in transit should consider the journey structure and not just the marketing channel per se. Furthermore, it also shows that changes taking place in the infrastructure of the marketing and meat processing sectors may result in a reduction in animal welfare.
Extensive sheep farming systems make an important contribution to socio-economic well-being and the ‘ecosystem services’ that flow from large areas of the UK and elsewhere. They are therefore subject to much policy intervention. However, the animal welfare implications of such interventions and their economic drivers are rarely considered. Under Defra project AW1024 (a further study to assess the interaction between economics, husbandry and animal welfare in large, extensively managed sheep flocks) we therefore assessed the interaction between profit and animal welfare on extensive sheep farms. A detailed inventory of resources, resource deployment and technical performance was constructed for 20 commercial extensive sheep farms in Great Britain (equal numbers from the Scottish Highlands, Cumbria, Peak District and mid-Wales). Farms were drawn from focus groups in these regions where participative research with farmers added further information. These data were summarised and presented to a panel of 12 experts for welfare assessment. We used two welfare assessment methods one drawn from animal welfare science (‘needs’ based) the other from management science (Service Quality Modelling). The methods gave complementary results. The inventory data were also used to build a linear programme (LP) model of sheep, labour and feed-resource management month-by-month on each farm throughout the farming year. By setting the LP to adjust farm management to maximise gross margin under each farm's circumstances we had an objective way to explore resource allocations, their constraints and welfare implications under alternative policy response scenarios. Regression of indicators of extensification (labour per ewe, in-bye land per ewe, hill area per ewe and lambs weaned per ewe) on overall welfare score explained 0.66 of variation with labour and lambs weaned per ewe both positive coefficients. Neither gross margin nor flock size were correlated with welfare score. Gross margin was also uncorrelated with these indicators of extensification with the exception of labour/ewe, which was negatively correlated with flock size and hence with gross margin. These results suggest animal welfare is best served by reduced extensification while greater profits are found in flock expansion with reduced labour input per ewe and no increase in other inputs or in productivity. Such potential conflicts should be considered as policy adjusts to meet the requirements for sustainable land use in the hills and uplands.
While studies from the start of the COVID-19 pandemic have described initial negative effects on mental health and exacerbating mental health inequalities, longer-term studies are only now emerging.
Method
In total, 34 465 individuals in the UK completed online questionnaires and were re-contacted over the first 12 months of the pandemic. We used growth mixture modelling to identify trajectories of depression, anxiety and anhedonia symptoms using the 12-month data. We identified sociodemographic predictors of trajectory class membership using multinomial regression models.
Results
Most participants had consistently low symptoms of depression or anxiety over the year of assessments (60%, 69% respectively), and a minority had consistently high symptoms (10%, 15%). We also identified participants who appeared to show improvements in symptoms as the pandemic progressed, and others who showed the opposite pattern, marked symptom worsening, until the second national lockdown. Unexpectedly, most participants showed stable low positive affect, indicating anhedonia, throughout the 12-month period. From regression analyses, younger age, reporting a previous mental health diagnosis, non-binary, or self-defined gender, and an unemployed or a student status were significantly associated with membership of the stable high symptom groups for depression and anxiety.
Conclusions
While most participants showed little change in their depression and anxiety symptoms across the first year of the pandemic, we highlight the divergent responses of subgroups of participants, who fared both better and worse around national lockdowns. We confirm that previously identified predictors of negative outcomes in the first months of the pandemic also predict negative outcomes over a 12-month period.
As part of surveillance of snail-borne trematodiasis in Knowsley Safari (KS), Prescot, United Kingdom, a collection was made in July 2021 of various planorbid (n = 173) and lymnaeid (n = 218) snails. These were taken from 15 purposely selected freshwater habitats. In the laboratory emergent trematode cercariae, often from single snails, were identified by morphology with a sub-set, of those most accessible, later characterized by cytochrome oxidase subunit 1 (cox1) DNA barcoding. Two schistosomatid cercariae were of special note in the context of human cercarial dermatitis (HCD), Bilharziella polonica emergent from Planorbarius corneus and Trichobilharzia spp. emergent from Ampullacaena balthica. The former schistosomatid was last reported in the United Kingdom over 50 years ago. From cox1 analyses, the latter likely consisted of two taxa, Trichobilharzia anseri, a first report in the United Kingdom, and a hitherto unnamed genetic lineage having some affiliation with Trichobilharzia longicauda. The chronobiology of emergent cercariae from P. corneus was assessed, with the vertical swimming rate of B. polonica measured. We provide a brief risk appraisal of HCD for public activities typically undertaken within KS educational and recreational programmes.
The coronavirus disease 2019 (COVID-19) pandemic has placed significant burden on healthcare systems. We compared Clostridioides difficile infection (CDI) epidemiology before and during the pandemic across 71 hospitals participating in the Canadian Nosocomial Infection Surveillance Program. Using an interrupted time series analysis, we showed that CDI rates significantly increased during the COVID-19 pandemic.
The impact of the coronavirus disease 2019 (COVID-19) pandemic on mental health is still being unravelled. It is important to identify which individuals are at greatest risk of worsening symptoms. This study aimed to examine changes in depression, anxiety and post-traumatic stress disorder (PTSD) symptoms using prospective and retrospective symptom change assessments, and to find and examine the effect of key risk factors.
Method
Online questionnaires were administered to 34 465 individuals (aged 16 years or above) in April/May 2020 in the UK, recruited from existing cohorts or via social media. Around one-third (n = 12 718) of included participants had prior diagnoses of depression or anxiety and had completed pre-pandemic mental health assessments (between September 2018 and February 2020), allowing prospective investigation of symptom change.
Results
Prospective symptom analyses showed small decreases in depression (PHQ-9: −0.43 points) and anxiety [generalised anxiety disorder scale – 7 items (GAD)-7: −0.33 points] and increases in PTSD (PCL-6: 0.22 points). Conversely, retrospective symptom analyses demonstrated significant large increases (PHQ-9: 2.40; GAD-7 = 1.97), with 55% reported worsening mental health since the beginning of the pandemic on a global change rating. Across both prospective and retrospective measures of symptom change, worsening depression, anxiety and PTSD symptoms were associated with prior mental health diagnoses, female gender, young age and unemployed/student status.
Conclusions
We highlight the effect of prior mental health diagnoses on worsening mental health during the pandemic and confirm previously reported sociodemographic risk factors. Discrepancies between prospective and retrospective measures of changes in mental health may be related to recall bias-related underestimation of prior symptom severity.
Decumulation Pathways are proposed to help achieve better retirement outcomes for those with Defined Contribution (DC) pensions. The DC fund is split into two parts, in proportions of the consumer’s choice. Most is allocated to the Pension Fund to provide a lifetime income, while the rest is placed in the Flexible Fund for flexible access and/or to leave as a legacy. The Flexible Fund is invested in flexi-access drawdown. The Pension Fund is invested in a guaranteed annuity, Collective Defined Contribution, or a Pooled Pension Fund which maintains individual DC funds but pools longevity risk between participants. An illustrative standard Decumulation Pathway is intended as a default solution, or can be tailored by the consumer. It uses the Pooled Pension Fund, an automated withdrawal strategy which ensures a lifetime income is provided and one that aims to increase in line with inflation, and a moderate risk investment strategy. The standard approach is evaluated using various metrics, indicating that it has as a strong chance of providing a higher income than could be obtained from an annuity or drawdown, with limited downside risk.