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A considerable knowledge gap exists in relation to the presence and even existence of seagrass within Northern Ireland’s waters. Peer-reviewed publications on the historical ecology of seagrass are scarce and a collated timeline of references directly focusing on Northern Irish seagrasses does not exist. Recognising abiotic and biotic induced environmental change within key marine features such as seagrass is vital when attempting to measure the biodiversity and carbon sequestration services they provide. The research undertaken during this study identified three distinct periods within the archival records, which could be matched to the ecological history of seagrass in Northern Ireland. The first period (extensive and dense seagrass meadows from 1790 to 1880) was characterised by extensive seagrass meadows which were dense and healthy. The second period (degradation from 1880 to 1940) saw the beginnings of decline in seagrass from the 1790s, initially from anthropogenic influences and later from the seagrass wasting disease) and the final period (signs of recovery from 1940 to present day) showed small amounts of local regrowth of seagrass but at far reduced densities compared to the historical baseline described. These three defined periods all delivered varying degrees of anthropogenic stressors which determined the conservational health of seagrass in Northern Ireland. Seagrass habitats have become integral components in future-proofing the coastal marine environment against the effects of climate change and its associated impacts. Therefore, it is envisaged that the historical baseline that this manuscript provides will greatly benefit habitat managers in protecting, repairing, and restoring lost seagrass meadows.
Patient- and proxy-reported outcomes (PROs) are an important indicator of healthcare quality and can be used to inform treatment. Despite the widescale use of PROs in adult cardiology, they are underutilised in paediatric cardiac care. This study describes a six-center feasibility and pilot experience implementing PROs in the paediatric and young adult ventricular assist device population.
Methods:
The Advanced Cardiac Therapies Improving Outcomes Network (ACTION) is a collaborative learning network comprised of 55 centres focused on improving clinical outcomes and the patient/family experience for children with heart failure and those supported by ventricular assist devices. The development of ACTION’s PRO programme via engagement with patient and parent stakeholders is described. Pilot feasibility, patient/parent and clinician feedback, and initial PRO findings of patients and families receiving paediatric ventricular assist support across six centres are detailed.
Results:
Thirty of the thirty-five eligible patients (85.7%) were enrolled in the PRO programme during the pilot study period. Clinicians and participating patients/parents reported positive experiences with the PRO pilot programme. The most common symptoms reported by patients/parents in the first month post-implant period included limitations in activities, dressing change distress, and post-operative pain. Poor sleep, dressing change distress, sadness, and fatigue were the most common symptoms endorsed >30 days post-implant. Parental sadness and worry were notable throughout the entirety of the post-implant experience.
Conclusions:
This multi-center ACTION learning network-based PRO programme demonstrated initial success in this six-center pilot study experience and yields important next steps for larger-scale PRO collection, research, and clinical intervention.
Children with hearing loss are at increased risk of mental health conditions, including behavioural problems, but there is limited evidence about available mental health support.
Aims
We aimed to map the evidence on mental health support for children and adolescents with hearing loss.
Method
Medline, Embase, PsycINFO and grey literature databases were searched until April 2021. Articles of any study design were eligible if they described an intervention supporting the mental health of children with hearing loss. No restrictions were placed on geography or publication date. Four reviewers independently screened results by title, abstract and full text. Study characteristics and outcome data were extracted, with results narratively synthesised.
Results
From 5629 search results, 27 articles were included. A large majority of the studies (81%, n = 22) were from high-income settings, with two-thirds (67%, n = 18) conducted in the USA. Less than half (41%, n = 11) of the articles adopted experimental research designs, and the majority of studies included small samples. The interventions presented were diverse, with the majority either therapy based (30%, n = 8) or skills training (30%, n = 8). Interventions included ice-skating, parent–child interaction therapy and resilience training. When measured, interventions demonstrated at least some evidence of effectiveness, although this was not always assessed with gold-standard methodology.
Conclusions
The evidence is lacking in breadth, study quality and geographical spread. That said, what is available indicates a range of effective approaches to support the mental health of children with hearing loss. Additional research is needed to improve the breadth of evidence on mental health support for this population.
This study presents the first documented observations of a brachyuran crab's proactive fishing behaviour in conjunction with mangrove pneumatophores which are employed as prey-localization devices. All ecological data were recorded in situ using simple behavioural observations, visual census and field experiments. Field experiments were based on stimulus-response and ecological surveys on random displacement. Assemblages of Metopograpsus messor were observed daily performing a foraging/predatory tide-related cyclic behaviour pattern in an arid mangrove ecosystem which experiences challenging environmental conditions. Prey-localizing behaviour was observed during the flood tide when pneumatophore-borne vibrations were used to identify potential prey. The prey simulation field experiment (where a single pneumatophore was stimulated by knocking) showed that in >93% of instances a crab approached the exact pneumatophore being stimulated. As water levels increased during the tidal cycle M. messor was observed climbing pneumatophores. The crabs anchored themselves to the pneumatophore just above the water level with their pereiopods. The chelipeds were positioned in a pincher-like trap, and remained in a ‘capture-position’ waiting for prey to move within striking range. This characteristic fishing behaviour was performed daily by a population of M. messor. Ecological observations suggest that both these predatory behaviours are associated with the fish Aphanius dispar dispar in a direct prey–predator relation. Evidence suggests that these fishing behaviours evolved due to characteristics within the M. messor phylogeny (foraging in intertidal zones; daily displacement following tidal levels; high sensitivity to vibrations; and an opportunist diet) and its associated environment (presence of pneumatophores and high availability of a fish resource).
OBJECTIVES/SPECIFIC AIMS: To create a composite index, referred to as the Pediatric Hydrocephalus Severity Index (PHSI), to classify the severity of disease at baseline and predict outcomes among children treated for hydrocephalus. METHODS/STUDY POPULATION: The Hydrocephalus Outcome Questionnaire will be administered in person or online to the parents of 150 patients between the ages of 5 and 18 years who are followed at the Neurosurgery Clinic at St. Louis Children’s Hospital for hydrocephalus. Patients must have been diagnosed and treated for hydrocephalus at least 6 months prior to the survey date. Potential participants are excluded if their health status changed during the 4 weeks prior to survey date, as determined by the child’s parents. Potential risk factors (see anticipated results) will be identified on retrospective medical record review. We will create a clinical prediction rule, called the PHSI, to stratify patients on likelihood of experiencing a poor long-term outcome after surgical treatment. Participants will be classified as “good” or “poor” outcome based on thresholds set for questionnaire results. We will use a combination of bivariate analysis and clinical reasoning to restrict the number of factors for further analysis, and multivariate logistic regression to build a predictive model for poor outcome. Creation of the PHSI will involve assigning integer values to adjusted odds ratios for significant risk factors at a 95% confidence level. RESULTS/ANTICIPATED RESULTS: Risk factors that we anticipate will be predictive of long-term clinical outcome include signs and symptoms at onset (bulging fontanel, splayed sutures, papilledema, up-gaze palsy, headache, vomiting, lethargy), head circumference above the 97th percentile, frontal-occipital horn ratio greater than 0.4, etiology of meningitis or neonatal intraventricular hemorrhage, central nervous system comorbidities (seizures, Chiari malformation, scoliosis, periventricular leukomalacia), preoperative infection or sepsis, and frequent shunt revisions or infections. We hypothesize that a PHSI will be a valuable tool for stratifying patients in future research studies, as well as aiding prognosis in clinical situations. DISCUSSION/SIGNIFICANCE OF IMPACT: A validated composite PHSI would be a major advance in clinical hydrocephalus research and practice. A PHSI would allow investigators to stratify patients based on initial presentation for clinical research studies, which may in turn lead to the establishment of more standardized treatment guidelines. It would also facilitate studies investigating differential utilization of healthcare resources based on disease severity. Clinically, a PHSI would better equip physicians to counsel parents on what to expect for their child or future healthcare resource requirements.
This is the first of three papers in which we give a moduli interpretation of the second flip in the log minimal model program for $\overline{M}_{g}$, replacing the locus of curves with a genus $2$ Weierstrass tail by a locus of curves with a ramphoid cusp. In this paper, for $\unicode[STIX]{x1D6FC}\in (2/3-\unicode[STIX]{x1D716},2/3+\unicode[STIX]{x1D716})$, we introduce new $\unicode[STIX]{x1D6FC}$-stability conditions for curves and prove that they are deformation open. This yields algebraic stacks $\overline{{\mathcal{M}}}_{g}(\unicode[STIX]{x1D6FC})$ related by open immersions $\overline{{\mathcal{M}}}_{g}(2/3+\unicode[STIX]{x1D716}){\hookrightarrow}\overline{{\mathcal{M}}}_{g}(2/3){\hookleftarrow}\overline{{\mathcal{M}}}_{g}(2/3-\unicode[STIX]{x1D716})$. We prove that around a curve $C$ corresponding to a closed point in $\overline{{\mathcal{M}}}_{g}(2/3)$, these open immersions are locally modeled by variation of geometric invariant theory for the action of $\text{Aut}(C)$ on the first-order deformation space of $C$.
We prove a general criterion for an algebraic stack to admit a good moduli space. This result may be considered as a generalization of the Keel–Mori theorem, which guarantees the existence of a coarse moduli space for a separated Deligne–Mumford stack. We apply this result to prove that the moduli stacks $\overline{{\mathcal{M}}}_{g,n}(\unicode[STIX]{x1D6FC})$ parameterizing $\unicode[STIX]{x1D6FC}$-stable curves introduced in [J. Alper et al., Second flip in the Hassett–Keel program: a local description, Compositio Math. 153 (2017), 1547–1583] admit good moduli spaces.
Climatic fluctuation is often cited as a major factor in the collapse of Maya civilisation during the Terminal Classic Period (e.g. Luzzadder-Beach et al.2016). Evidence of how people dealt or failed to deal with it has only recently become a more widespread focus for archaeologists. Investigations at Xcoch in the Puuc Hills show the various ways in which resident populations sought to manage water stores when faced with a climate prone to drought and other meteorological extremes. The study also presents results from the analysis of nearby speleothem laminae, which indicate that severe episodes of flooding and droughts may have contributed to a collapse in the population around AD 850.
We examined non-medical use (NMU) of olanzapine among adults on methadone treatment. Information was collected on patient demographics and NMU of olanzapine. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was administered to assess risk among current users of olanzapine.
Results
Ninety-two clients participated and 30% reported lifetime history of NMU of olanzapine. Nine people reported doses of 30 mg or higher on a typical day of use, with three typically using 100 mg. The most common reasons for use were to relieve anxiety and to aid sleep, but a quarter used it to ‘get stoned’. Eleven participants (12%) reported NMU of olanzapine in the preceding month. Eight completed the ASSIST with four scoring in the high-risk zone.
Clinical implications
Self-medication is the dominant motivator for NMU of olanzapine, but hedonic motivations also occur. A small minority show features of dependency. All doctors should be aware of the potential NMU of olanzapine, especially among patients with history of addiction.
A series of editorials in this Journal have argued that psychiatry is in the midst of a crisis. The various solutions proposed would all involve a strengthening of psychiatry's identity as essentially ‘applied neuroscience’. Although not discounting the importance of the brain sciences and psychopharmacology, we argue that psychiatry needs to move beyond the dominance of the current, technological paradigm. This would be more in keeping with the evidence about how positive outcomes are achieved and could also serve to foster more meaningful collaboration with the growing service user movement.
In this chapter, we address distributed learning algorithms for statistical latent variable models, with a focus on topic models. Many high-dimensional datasets, such as text corpora and image databases, are too large to allow one to learn topic models on a single computer. Moreover, a growing number of applications require that inference be fast or in real time, motivating the exploration of parallel and distributed learning algorithms.
We begin by reviewing topic models such as Latent Dirichlet Allocation and Hierarchical Dirichlet Processes. We discuss parallel and distributed algorithms for learning these models and show that these algorithms can achieve substantial speedups without sacrificing model quality. Next we discuss practical guidelines for running our algorithms within various parallel computing frameworks and highlight complementary speedup techniques. Finally, we generalize our distributed approach to handle Bayesian networks.
Several of the results in this chapter have appeared in previous papers in the specific context of topic modeling. The goal of this chapter is to present a comprehensive overview of distributed inference algorithms and to extend the general ideas to a broader class of Bayesian networks.
Latent Variable Models
Latent variable models are a class of statistical models that explain observed data with latent (or hidden) variables. Topic models and hidden Markov models are two examples of such models, where the latent variables are the topic assignment variables and the hidden states, respectively. Given observed data, the goal is to perform Bayesian inference over the latent variables and use the learned model to make inferences or predictions.
We prove that the moduli spaces of n-pointed m-stable curves introduced in our previous paper have projective coarse moduli. We use the resulting spaces to run an analogue of Hassett’s log minimal model program for .
We introduce a sequence of isolated curve singularities, the elliptic m-fold points, and an associated sequence of stability conditions, generalizing the usual definition of Deligne–Mumford stability. For every pair of integers 1≤m<n, we prove that the moduli problem of n-pointed m-stable curves of arithmetic genus one is representable by a proper irreducible Deligne–Mumford stack . We also consider weighted variants of these stability conditions, and construct the corresponding moduli stacks . In forthcoming work, we will prove that these stacks have projective coarse moduli and use the resulting spaces to give a complete description of the log minimal model program for .
(1) To determine whether rapid screening with polymerase chain reaction (PCR) assays leads to the earlier isolation of patients at risk for methicillin-resistant Staphylococcus aureus (MRSA) colonization, (2) to assess compliance with routine MRSA screening protocols, (3) to confirm the diagnostic accuracy of the Xpert MRSA real-time PCR assay (Cepheid) by comparison with culture, and (4) to compare turnaround times for PCR assay results with those for culture results.
Design.
Before-and-after study conducted in a 700-bed acute tertiary care referral hospital. Study periods were (1) a 5-week period before PCR testing began, (2) a 10-week period when the PCR assay was used, and (3) a 5-week period after PCR testing was discontinued.
Results.
Among 489 at-risk patients, MRSA was isolated from 20 (33%) of 60 patients during period 1, 77 (22%) of 349 patients during period 2, and 18 (23%) of 80 patients during period 3. Twenty-two (27%) of 82 at-risk patients were not screened during period 1, compared with 40 (10%) of 389 at-risk patients not screened during period 2 (P < .001). More MRSA-positive patients were preemptively isolated during periods 1 and 3 compared with period 2 (34 [24%] of 140 vs 28 [8%] of 389; P < .001); however, more MRSA-positive patients were isolated after notification of MRSA-positive results during period 2 (47 [13%] of 349) compared with periods 1 and 3 (2 [1%] of 140; P < .001). The sensitivity, specificity, positive predictive value, and negative predictive value of the PCR assay were 95%, 97%, 82%, and 99%, respectively. The mean turnaround time from receipt of specimens in the laboratory to PCR assay result was 2.6 hours.
Conclusions.
Rapid screening with the Xpert MRSA PCR assay facilitated compliance with screening policies and the earlier isolation of MRSA-positive Patients. Discrepant results confirm that PCR testing should be used as a screening tool rather than as a diagnostic tool.