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A diversity of management and environmental factors influence weed seedbank community composition, yet the conditions under which each of these factors is an important driver of the weed seedbank are poorly understood. To investigate this relationship, we used a series of univariate and multivariate analyses to test associations between soil health, nematode community composition parameters, and the composition of the weed seedbank at 59 agricultural sites in the Prince Edward Island Soil Quality Monitoring (PEI SQM) Network spanning a range of land-use intensities and using potato (Solanum tuberosum L.) production systems as a case study. Land-use intensity is a nonstandard term that refers to increasing agricultural activity, including tillage and use of synthetic inputs to sustain high crop yield. Sites were classified into low, medium, and high land-use intensity categories based on frequency of potato cultivation in the past 10 yr. A total of 36 different weed species were found across all sites, and while neither seedbank density nor species richness was influenced by land-use intensity, community assemblage was. Seedbank communities at low land-use intensity sites were largely associated with grass weeds and other weakly competitive species, positively correlated with soil CO2 respiration and nematode community richness and diversity, and negatively correlated with the carbon to nitrogen ratio. In contrast, seedbank communities at medium and high land-use intensity sites were similar and composed of many highly competitive weedy species and correlated with the frequency of potato in the rotation and soil N and K, two commonly used soil fertility inputs. The absence of common agricultural weed species at low land-use intensity sites filtered by soil edaphic factors and abundance of neutral species despite past history of annual cropping suggest that these sites are not refuges for these species and may present a template for the design of weed seed–suppressive soils.
Recent changes to US research funding are having far-reaching consequences that imperil the integrity of science and the provision of care to vulnerable populations. Resisting these changes, the BJPsych Portfolio reaffirms its commitment to publishing mental science and advancing psychiatric knowledge that improves the mental health of one and all.
Posttraumatic stress disorder (PTSD) has been associated with advanced epigenetic age cross-sectionally, but the association between these variables over time is unclear. This study conducted meta-analyses to test whether new-onset PTSD diagnosis and changes in PTSD symptom severity over time were associated with changes in two metrics of epigenetic aging over two time points.
Methods
We conducted meta-analyses of the association between change in PTSD diagnosis and symptom severity and change in epigenetic age acceleration/deceleration (age-adjusted DNA methylation age residuals as per the Horvath and GrimAge metrics) using data from 7 military and civilian cohorts participating in the Psychiatric Genomics Consortium PTSD Epigenetics Workgroup (total N = 1,367).
Results
Meta-analysis revealed that the interaction between Time 1 (T1) Horvath age residuals and new-onset PTSD over time was significantly associated with Horvath age residuals at T2 (meta β = 0.16, meta p = 0.02, p-adj = 0.03). The interaction between T1 Horvath age residuals and changes in PTSD symptom severity over time was significantly related to Horvath age residuals at T2 (meta β = 0.24, meta p = 0.05). No associations were observed for GrimAge residuals.
Conclusions
Results indicated that individuals who developed new-onset PTSD or showed increased PTSD symptom severity over time evidenced greater epigenetic age acceleration at follow-up than would be expected based on baseline age acceleration. This suggests that PTSD may accelerate biological aging over time and highlights the need for intervention studies to determine if PTSD treatment has a beneficial effect on the aging methylome.
The rise in interest rates globally in 2022–23 led to improved scheme funding for many defined-benefit pension schemes. Many schemes in the UK now find themselves closer to, or at, a fully funded position on a low-risk basis (annuity buyout or self-sufficiency). Finishing the journey while managing the risk of losses on that journey is highly desirable, but may be difficult to achieve in practice.
However many schemes are not yet sufficiently funded to buy out liabilities in full with an insurer. Others may not wish to, and many who can afford to do so are not yet able to for investment reasons (such as holding illiquid assets) or operational reasons (such as the time needed to resolve member data issues). For schemes that instead look to adopt self-sufficient ongoing management with low dependency on the sponsoring employer, this may be difficult to maintain in practice. In short, there remains a risk that benefits will not be secured in full, which with hindsight could have been avoided.
The addition of capital to pension scheme assets has long been deployed to enhance the security of member benefits e.g., capital from insurers in the case of a buyout or capital from sponsors in the form of contingent assets.
More recently, providers have developed a diverse set of arrangements that draw on external capital to aid trustees and corporates to meet scheme funding ambitions. Capital Backed Funding Arrangements (“CBFA”) are in this context an additional tool in the trustee toolkit for delivering funding strategies.
This paper focusses on the UK-defined benefit market but the dynamics are applicable to other jurisdictions, with CBFAs being developed for wider markets (e.g., Ireland).
In this paper we:
survey the current scheme funding landscape and consider the need in this environment for arrangements to support scheme funding journeys to deliver benefits in full
summarise the key features of arrangements in the market that may support these objectives
set out considerations for trustees and sponsoring companies when assessing these arrangements.
The aim of this paper is educational – to increase awareness of the key issues and potential solutions. Professional advice will always be required prior to any transaction. We welcome feedback from readers on further material that would be beneficial to support consideration of these arrangements.
Engineering machines are becoming increasingly complex and possess more control variables, increasing the complexity and versatility of the control systems. Different configurations of the control system, named a policy, can result in similar output behavior but with different resource or component life usage. There is therefore an opportunity to find optimal policies with respect to economic decisions. While many solutions have been proposed to find such economic policy decisions at the asset level, we consider this problem at the fleet level. In this case, the optimal operation of each asset is affected by the state of all other assets in the fleet. Challenges introduced by considering multiple assets include the construction of economic multi-objective optimization criteria, handling rare events such as failures, application of fleet-level constraints, and scalability. The proposed solution presents a framework for economic fleet optimization. The framework is demonstrated for economic criteria relating to resource usage, component lifing, and maintenance scheduling, but is generically extensible. Direct optimization of lifetime distributions is considered in order to avoid the computational burden of discrete event simulation of rare events. Results are provided for a real-world case study targeting the optimal economic operation of a fleet of aerospace gas turbine engines.
The articles in this volume celebrate the work of Steven Burns. Versions of the articles were presented originally at two sessions organized in Burns's honour at the 2022 meeting of the Atlantic Regional Philosophers’ Association (ARPA), held at Dalhousie University in Halifax. This introduction presents a brief academic biography and summarizes each of the contributions. The articles, by Michael Hymers, Robbie Moser and Darren Bifford, Alice MacLachlan, Jason Holt, and Warren Heiti, address perennial themes in philosophy, such as self-knowledge, attention, friendship, interpretation, and judgement. The collection concludes with some last words by Burns himself.
Chemsex occurs primarily among gay, bisexual and other men who have sex with men (GBMSM), and there is evidence of a subgroup of users who carry out chemsex-related criminal offences and experience harm. Challenges with chemsex can present to various settings; there are concerns that harm is increasing, including at interfaces between health, social care and criminal justice systems. The UK response to date has lacked a coordinated approach. An expert reference group was convened to share chemsex knowledge, articulate priorities for research and pathway development, and foster collaborative working between agencies. It made three key recommendations: develop and increase training and awareness across all services; implement a coordinated research programme with the development of a common data-set and assessment tool to fully characterise population-level needs; develop a professional network to share information, provide professional support and act as a knowledge hub. There was support for a unified multi-agency strategy incorporating the priorities identified as overarching principles.
In September 2023, the UK Health Security Agency identified cases of Salmonella Saintpaul distributed across England, Scotland, and Wales, all with very low genetic diversity. Additional cases were identified in Portugal following an alert raised by the United Kingdom. Ninety-eight cases with a similar genetic sequence were identified, 93 in the United Kingdom and 5 in Portugal, of which 46% were aged under 10 years. Cases formed a phylogenetic cluster with a maximum distance of six single nucleotide polymorphisms (SNPs) and average of less than one SNP between isolates. An outbreak investigation was undertaken, including a case–control study. Among the 25 UK cases included in this study, 13 reported blood in stool and 5 were hospitalized. One hundred controls were recruited via a market research panel using frequency matching for age. Multivariable logistic regression analysis of food exposures in cases and controls identified a strong association with cantaloupe consumption (adjusted odds ratio: 14.22; 95% confidence interval: 2.83–71.43; p-value: 0.001). This outbreak, together with other recent national and international incidents, points to an increase in identifications of large outbreaks of Salmonella linked to melon consumption. We recommend detailed questioning and triangulation of information sources to delineate consumption of specific fruit varieties during Salmonella outbreaks.
OBJECTIVES/GOALS: Antibiotic treatment sets the stage for intestinal domination by Candida albicanswhich is necessary for development of invasive disease, but the resources driving this bloom remain poorly defined. We sought to determine these factors in order to design novel prophylaxis strategies for reducing gastrointestinal (GI) colonization. METHODS/STUDY POPULATION: We initially developed a generalizable framework, termed metabolic footprinting to determine the metabolites C. albicanspreferentially uses in the mouse GI tract. After identifying the metabolites C. albicansutilizes, we usedin vitro growth assays in the presence and absence of oxygen to validate out metabolomics findings. We next determined if a probiotic E. coli that utilizes oxygen would reduce C. albicanscolonization compared to a mutant E. coli that could not respire oxygen. Finding that oxygen was a necessary resource, we utilized germ-free mice to determine if Clostridiaspp. known to reduce GI oxygen would prevent C. albicanscolonization. Lastly, we sought to see if 5-aminosalicylic acid (5-ASA) could prevent C. albicanscolonization. RESULTS/ANTICIPATED RESULTS: We found that C. albicans preferentially utilizes simple carbohydrates including fructo-oligosaccharides (e.g., 1-kestose), disaccharides (e.g., β-gentiobiose), and alcoholic sugars (e.g., sorbitol) and is able to grow in vitro on minimal media supplemented with either of these nutrients. However, in the hypoxic environment that is found in the “healthy” colon, C. albicans cannot utilize these nutrients. We next found that pre-colonization in a mouse model with a probiotic E. coli significantly reduced C. albicanscolonization, but the mutant E. coli had no effect on colonization. We next showed that Clostridia supplementation restored GI hypoxia and reduced C. albicanscolonization. Remarkably, we found that 5-ASA significantly reduced GI colonization of C. albicans. DISCUSSION/SIGNIFICANCE: We have shown that C. albicans requires oxygen to colonize the GI tract. Importantly, we found that 5-ASA can prevent an antibiotic mediated bloom of C. albicans by restoring GI hypoxia, which warrants additional studies to determine if 5-ASA can be used as an adjunctive prophylactic treatment in high risk patients.
Three authigenic muscovite morphologies are associated with Norphlet Formation stylolitization observed in the Texaco Mobile Area Block 872 #1 well: l)large crystals of 1M muscovite, which grew in the stylolites with their c-axes parallel to the plane of maximum compressive stress; 2) fine-grained bundles of muscovite that occur as pore-fillings near stylolites; and 3) pods of fine-grained muscovite that exist within stylolite insoluble residue and that were precipitated as pore-filling muscovite before the host sandstone pressolved.
The population of large crystals of 1M muscovite grew at 51 ± 9 Ma, pore-filling muscovites precipitated at 77 ± 22 Ma, and muscovite pods have ages of 86 ± 16 Ma, as indicated by 40Ar/39Ar laser fusion. Apparent ages indicate that stylolitization was coincident with the beginning of organic maturation Zone 5 and could be the product of reservoir fluid pressure fluctuations induced by gas leakage. The lower Smackover Formation source/seal rock, acting as a pressure relief valve, could have been compromised by microfractures occurring during hydrocarbon generation and expulsion. Decreases in reservoir fluid pressure would have acted upon the sandstone framework by increasing the effective overburden pressure, thus making the rock more susceptible to pressure solution.
Stylolite frequency and quartz cement volume increase in the finer grained portion of the conventional core. Quartz cement volume correlates inversely to percent sandstone porosity. Apparent muscovite ages indicate that stylolitization occurred after hydrocarbon migration. Silica mobility was limited because pressure solution mineral products were precipitated from within grain films of irreducible water within the sandstone.
Stylolitization of quartz grains accounts for a minimum of 34% of the quartz cement in the upper cored section of the Norphlet Formation and minimum of 17% of the quartz cement in the lower cored Norphlet Formation. Quartz cement volumes are based on stylolite insoluble residue thickness and weight measurements of pyrobitumen within and nearby the insoluble residue seams. Stylolitization of K-feldspar and precipitation of muscovite can release additional silica which may have precipitated as quartz cement.
Using a life tables approach with 2011–2017 claims data, we calculated lifetime risks of Clostridioides difficile infection (CDI) beginning at age 18 years. The lifetime CDI risk rates were 32% in female patients insured by Medicaid, 10% in commercially insured male patients, and almost 40% in females with end-stage renal disease.
Adult vaccination with 13-valent pneumococcal conjugate vaccine is currently recommended in the UK only for very high-risk individuals, with 23-valent pneumococcal polysaccharide vaccine (PPV23) being recommended to all adults 65 years or older and those 18 years or older with specified risk conditions. A 20-valent pneumococcal conjugate vaccine (PCV20) has recently become available for use in adults with potential to address a substantial proportion of the current adult pneumococcal disease burden in the UK. We evaluated the cost-effectiveness of PCV20 vaccination compared with PPV23 in adults in England currently eligible for pneumococcal vaccination.
Methods
A probabilistic model with a Markov-type process was used to depict lifetime risks and costs of pneumococcal disease among a cohort of English adults. Epidemiologic parameters, serotype coverage, costs, vaccine effectiveness and coverage were based on published literature or publicly available data. The National Health Service perspective was adopted, health effects were expressed in quality-adjusted life years (QALYs), and future costs and QALYs were discounted at 3.5 percent.
Results
Results suggest that under reasonable assumptions concerning disease burden, vaccine, effectiveness, and vaccine cost, PCV20 implementation of an age-and risk-based strategy targeting all adults aged 65 years or older and younger risk group adults aged 18 to 64 years would reduce a large number of pneumococcal disease hospitalizations and pneumococcal-related deaths compared to currently recommended PPV23.
The incremental cost-effectiveness ratio was well below the current willingness-to-pay range of GBP20,000-GBP30,000 per QALY gained, with PCV20 being cost saving compared with PPV23 in base case and most sensitivity analyses. Probabilistic sensitivity analysis suggests high certainty in recommending PCV20 for vaccination of adults aged 18 to 64 years in risk groups and all aged 65 years or older instead of PPV23.
Conclusions
Our findings support replacing PPV23 with PCV20 to directly protect adults against pneumococcal disease, reducing hospitalizations and saving lives in the UK.
Chemsex refers to the use of specific drugs before or during sex to sustain, enhance, disinhibit, or facilitate the sexual experience, primarily amongst gay, bisexual and other men who have sex with men. The main drugs associated with Chemsex are crystal methamphetamine, gamma-hydroxybutyrate/gamma-butyrolactone, mephedrone and ketamine. There are complex biological, psychological, and social factors that influence why someone may choose to engage in Chemsex that are yet to be fully elucidated. However, there are global concerns that such harm is increasing both in prevalence and complexity, including interfaces between the health, social care and criminal justice systems. Chemsex has been identified as a priority for the UK Home Office Drug Strategy since 2017; however, the response to date has lacked a coordinated approach between the multiple services and agencies where Chemsex can present.
Methods
West London NHS Trust hosted a day-long meeting of the Chemsex Expert Reference Group (ERG) on 27th July 2022 at the London School of Hygiene and Tropical Medicine. This comprised of a group of clinicians and academics across the NHS, criminal justice system and third sector, with the meeting focused on three main clinical questions: what do we need to know about working with this complex and vulnerable group of people?; What is the research needed to improve this?; What are the aspiration clinical pathways that should be developed?
Results
The ERG identified several gaps in our knowledge including a paucity of epidemiological data, the importance of cultural competency around the health needs of LGBTQ+ people, inconsistencies in the knowledge of healthcare professionals on how to manage emergency presentations such as methamphetamine-induced psychosis, GHB withdrawal and GHB overdose and risk assessment and risk management for those who may also be a victim and/or a perpetrator of a criminal offence in the Chemsex context. The group's core values for service and pathway development were identified as to be authentic, competent, non-judgemental and that lived experience should be at the centre of service development, as well as being evidence-based and supported by national clinical guidelines.
Conclusion
What was apparent was the ambition and interest from across so many clinical specialities, and some incredibly positive work that is already ongoing. It is hoped that the outcomes of this ERG can help progress this to a more cohesive set of responses, and the development of an evidence-based, multi-agency approach to assessment and treatment for this complex group.
True absence of a branch pulmonary artery is rare. We identified a patient initially diagnosed with an absent left pulmonary artery at a previous hospital. Due to disagreement in the initial diagnosis, she had a diagnostic catheterisation, which revealed an isolated left pulmonary artery off the left innominate artery via a ductus. The ductus was recanalised with serial stenting and balloon dilatation followed by reanastomosis to the main pulmonary artery. In a patient who initially is diagnosed with an absent pulmonary artery, an alternative diagnosis, such as this case report, should be considered.
A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.
Although measles incidence has reached historic lows in many parts of the world, the disease still causes substantial morbidity globally. Even where control programs have succeeded in driving measles locally extinct, unless vaccination coverage is maintained at extremely high levels, susceptible numbers may increase sufficiently to spark large outbreaks. Human mobility will drive potentially infectious contacts and interact with the landscape of susceptibility to determine the pattern of measles outbreaks. These interactions have proved difficult to characterise empirically. We explore the degree to which new sources of data combined with existing public health data can be used to evaluate the landscape of immunity and the role of spatial movement for measles introductions by retrospectively evaluating our ability to predict measles outbreaks in vaccinated populations. Using inferred spatial patterns of accumulation of susceptible individuals and travel data, we predicted the timing of epidemics in each district of Pakistan during a large measles outbreak in 2012–2013 with over 30 000 reported cases. We combined these data with mobility data extracted from over 40 million mobile phone subscribers during the same time frame in the country to quantify the role of connectivity in the spread of measles. We investigate how different approaches could contribute to targeting vaccination efforts to reach districts before outbreaks started. While some prediction was possible, accuracy was low and we discuss key uncertainties linked to existing data streams that impede such inference and detail what data might be necessary to robustly infer timing of epidemics.
Rapid technological innovation is leading to new health technologies and interventions becoming available to healthcare markets at increasing speed; these often cost more than current alternatives and significantly affect the cost of healthcare services and delivery (1). Identifying future technologies supports service preparedness, long-term planning, and strategic decision making. The aim of this study was to describe and classify health technologies predicted in fifteen forecasting studies according to their type, purpose and clinical use, and relate these to the original purpose and timing of the forecasting studies.
METHODS:
This was a descriptive study of predicted healthcare technologies identified in fifteen forecasting studies included in a previously published systematic review (2). Outcomes related to (i) each forecast study including country, year, intent and forecasting methods used, and (ii) the predicted technology type, purpose, targeted clinical area and forecast timeframe.
RESULTS:
We identified 896 predicted health-related topics, of which 685 were health technologies. Of these, 19.1 percent were diagnostic or imaging tests and 14.3 percent devices or biomaterials; 38.1 percent were intended to treat or manage disease and 21.6 percent to diagnose or monitor disease. The most frequent targeted clinical areas were infectious diseases followed by cancer, circulatory and nervous system disorders. The mean timeframe for technology forecast was 11.6 years (Standard Deviation, SD = 6.6). The forecasting timeframe significantly differed by technology type (p = .002), the intent of the forecasting group (p < .0001), and the methods used (p < .0001).
CONCLUSIONS:
Our description and classification of predicted health-related technologies from prior forecasting studies provides an overview of the technological and clinical frontiers of innovation in health and healthcare provision.
Cryoconite holes are water-filled holes in the surface of a glacier caused by enhanced ice melt around trapped sediment. Measurements on the ablation zones of four glaciers in Taylor Valley, Antarctica, show that cryoconite holes cover about 4–6% of the ice surface. They typically vary in diameter from 5 to 145 cm, with depths ranging from 4 to 56 cm. In some cases, huge holes form with 5 m depths and 30 m diameters. Unlike cryoconite holes elsewhere, these have ice lids up to 36 cm thick and melt from within each spring. About one-half of the holes are connected to the near-surface hydrologic system and the remainder are isolated. The duration of isolation, estimated from the chloride accumulation in hole waters, commonly shows ages of several years, with one hole of 10 years. The cryoconite holes in the McMurdo Dry Valleys create a near-surface hydrologic system tens of cm below the ice surface. The glacier surface itself is generally frozen and dry. Comparison of water levels between holes a few meters apart shows independent cycles of water storage and release. Most likely, local freeze–thaw effects control water passage and therefore temporary storage. Rough calculations indicate that the holes generate at least 13% of the observed runoff on the one glacier measured. This hydrologic system represents the transition between a melting ice cover with supraglacial streams and one entirely frozen and absent of water.
Lacustrine sediments from southeastern Arabia reveal variations in lake level corresponding to changes in the strength and duration of Indian Ocean Monsoon (IOM) summer rainfall and winter cyclonic rainfall. The late glacial/Holocene transition of the region was characterised by the development of mega-linear dunes. These dunes became stabilised and vegetated during the early Holocene and interdunal lakes formed in response to the incursion of the IOM at approximately 8500 cal yr BP with the development of C3 dominated savanna grasslands. The IOM weakened ca. 6000 cal yr BP with the onset of regional aridity, aeolian sedimentation and dune reactivation and accretion. Despite this reduction in precipitation, the lake was maintained by winter dominated rainfall. There was a shift to drier adapted C4 grasslands across the dune field. Lake sediment geochemical analyses record precipitation minima at 8200, 5000 and 4200 cal yr BP that coincide with Bond events in the North Atlantic. A number of these events correspond with changes in cultural periods, suggesting that climate was a key mechanism affecting human occupation and exploitation of this region.
Artificial Roman ponds present in various guises, but they are relatively rarely found in the service of rural agriculture. This article focuses on a possible example of this type from Worcestershire, where extensive excavation has been carried out. The results demonstrate the potential of a pond for the reconstruction of wider landscape usage, while the considerable quantity of associated finds potentially sheds some light on social practice. A review of similar sites across Roman Britain suggests there may be practical (in essence curatorial) issues about the fuller investigation of such features once identified, in order that a similarly high level of data can be achieved more regularly, and suggests a need for prospection/mapping for the better management of this resource, especially employing newly available LiDAR data.