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Edited by
David Mabey, London School of Hygiene and Tropical Medicine,Martin W. Weber, World Health Organization,Moffat Nyirenda, London School of Hygiene and Tropical Medicine,Dorothy Yeboah-Manu, Noguchi Memorial Institute for Medical Research, University of Ghana,Jackson Orem, Uganda Cancer Institute, Kampala,Laura Benjamin, University College London,Michael Marks, London School of Hygiene and Tropical Medicine,Nicholas A. Feasey, Liverpool School of Tropical Medicine
The mortality rate of children less than 5 years of age has decreased by 60% since 1990, with the Millennium Development Goals having been a powerful drive for improvement. However, the reduction has not been evenly distributed throughout the world (UN IGME 2020). Sub-Saharan Africa remains the region with the highest under-5 mortality rate in the world, where 1 child in every 13 dies before celebrating their 5th birthday (UN IGME 2020).
Impulsivity is a multidimensional trait associated with substance use disorders (SUDs), but the relationship between distinct impulsivity facets and stages of substance use involvement remains unclear.
Methods
We used genomic structural equation modeling and genome-wide association studies (N = 79,729–903,147) to examine the latent genetic architecture of nine impulsivity traits and seven substance use (SU) and SUD traits.
Results
We found that the SU and SUD factors were strongly genetically inter-correlated (rG=0.77) but their associations with impulsivity facets differed. Lack of premeditation, negative and positive urgency were equally positively genetically correlated with both the SU (rG=.0.30–0.50) and SUD (rG=0.38–0.46) factors; sensation seeking was more strongly genetically correlated with the SU factor (rG=0.27 versus rG=0.10); delay discounting was more strongly genetically correlated with the SUD factor (rG=0.31 versus rG=0.21); and lack of perseverance was only weakly genetically correlated with the SU factor (rG=0.10). After controlling for the genetic correlation between SU/SUD, we found that lack of premeditation was independently genetically associated with both the SU (β=0.42) and SUD factors (β=0.21); sensation seeking and positive urgency were independently genetically associated with the SU factor (β=0.48, β=0.33, respectively); and negative urgency and delay discounting were independently genetically associated with the SUD factor (β=0.33, β=0.36, respectively).
Conclusions
Our findings show that specific impulsivity facets confer risk for distinct stages of substance use involvement, with potential implications for SUDs prevention and treatment.
Clinical research professionals (CRPs) are integral to the academic medical center workforce, research operations, and daily clinical research tasks; however, due to inconsistent training, there is a shortage of qualified CRPs. The Joint Task Force for Clinical Trial Competency created a competency framework for CRPs, which has demonstrated positive results from various institutions, but training programs have been limited in standardization, replicability, and dissemination. To improve this, we designed the University of Texas Southwestern (UTSW) Medical Center Clinical Research Foundations (CRF) training program, which is a competency-based online self-paced CRP training curriculum hosted via the Collaborative Institutional Training Initiative (CITI) portal. We examined feasibility, acceptability, and uptake of the UTSW CRF training on an institutional scale and were pleased to find this curriculum is not only feasible but has high levels of acceptability. Furthermore, faculty, clinicians, and trainees voluntarily completed this training program indicating utility across diverse groups. The UTSW CRF combines the existing CITI training modules with UTSW-created material, providing an optimal balance between generalized clinical research education and institutionally tailored content. We believe the UTSW CRF curriculum could serve as a plug-and-play foundational model for other research centers to tailor according to their audience and institutional needs.
DSM-5 differentiates avoidant/restrictive food intake disorder (ARFID) from other eating disorders (EDs) by a lack of overvaluation of body weight/shape driving restrictive eating. However, clinical observations and research demonstrate ARFID and shape/weight motivations sometimes co-occur. To inform classification, we: (1) derived profiles underlying restriction motivation and examined their validity and (2) described diagnostic characterizations of individuals in each profile to explore whether findings support current diagnostic schemes. We expected, consistent with DSM-5, that profiles would comprise individuals endorsing solely ARFID or restraint (i.e. trying to eat less to control shape/weight) motivations.
Methods
We applied latent profile analysis to 202 treatment-seeking individuals (ages 10–79 years [M = 26, s.d. = 14], 76% female) with ARFID or a non-ARFID ED, using the Nine-Item ARFID Screen (Picky, Appetite, and Fear subscales) and the Eating Disorder Examination-Questionnaire Restraint subscale as indicators.
Results
A 5-profile solution emerged: Restraint/ARFID-Mixed (n = 24; 8% [n = 2] with ARFID diagnosis); ARFID-2 (with Picky/Appetite; n = 56; 82% ARFID); ARFID-3 (with Picky/Appetite/Fear; n = 40; 68% ARFID); Restraint (n = 45; 11% ARFID); and Non-Endorsers (n = 37; 2% ARFID). Two profiles comprised individuals endorsing solely ARFID motivations (ARFID-2, ARFID-3) and one comprising solely restraint motivations (Restraint), consistent with DSM-5. However, Restraint/ARFID-Mixed (92% non-ARFID ED diagnoses, comprising 18% of those with non-ARFID ED diagnoses in the full sample) endorsed ARFID and restraint motivations.
Conclusions
The heterogeneous profiles identified suggest ARFID and restraint motivations for dietary restriction may overlap somewhat and that individuals with non-ARFID EDs can also endorse high ARFID symptoms. Future research should clarify diagnostic boundaries between ARFID and non-ARFID EDs.
To implement and evaluate a point-of-care (POC) molecular testing platform for respiratory viruses in congregate living settings (CLS).
Design:
Prospective quality improvement study.
Setting:
Seven CLS, including three nursing homes and four independent-living facilities.
Participants:
Residents of CLS.
Methods:
A POC platform for COVID-19, influenza A and B, and respiratory syncytial virus was implemented at participating CLS from December 1, 2022 to April 15, 2023. Residents with respiratory symptoms underwent paired testing, with respiratory specimens tested first with the POC platform and then delivered to an off-site laboratory for multiplex respiratory virus panel (MRVP) polymerase chain reaction (PCR) as per standard protocol. Turn-around time and diagnostic accuracy of the POC platform were compared against MRVP PCR. In an exploratory analysis, time to outbreak declaration among participating CLS was compared against a convenience sample of 19 CLS that did not use the POC platform.
Results:
A total of 290 specimens that underwent paired testing were included. Turn-around time to result was significantly shorter with the POC platform compared to MRVP PCR, with median difference of 36.2 hours (interquartile range 21.8–46.4 hours). The POC platform had excellent diagnostic accuracy compared to MRVP PCR, with area under the curve statistic of .96. Time to outbreak declaration was shorter in CLS that used the POC platform compared to CLS that did not.
Conclusion:
Rapid POC testing platforms for respiratory viruses can be implemented in CLS, with high diagnostic accuracy, expedited turn-around times, and shorter time to outbreak declaration.
Deployment of law enforcement operational canines (OpK9s) risks injuries to the animals. This study’s aim was to assess the current status of states’ OpK9 (veterinary Emergency Medical Services [VEMS]) laws and care protocols within the United States.
Methods:
Cross-sectional standardized review of state laws/regulations and OpK9 VEMS treatment protocols was undertaken. For each state and for the District of Columbia (DC), the presence of OpK9 legislation and/or care protocols was ascertained. Information was obtained through governmental records and from stakeholders (eg, state EMS medical directors and state veterinary boards).
The main endpoints were proportions of states with OpK9 laws and/or treatment protocols. Proportions are reported with 95% confidence intervals (CIs). Fisher’s exact test (P <.05) assessed whether presence of an OpK9 law in a given jurisdiction was associated with presence of an OpK9 care protocol, and whether there was geographic variation (based on United States Census Bureau regions) in presence of OpK9 laws or protocols.
Results:
Of 51 jurisdictions, 20 (39.2%) had OpK9 legislation and 23 (45.1%) had state-wide protocols for EMS treatment of OpK9s. There was no association (P = .991) between presence of legislation and presence of protocols. There was no association (P = .144) between presence of legislation and region: Northeast 66.7% (95% CI, 29.9-92.5%), Midwest 50.0% (95% CI, 21.1-78.9%), South 29.4% (95% CI, 10.3-56.0%), and West 23.1% (95% CI, 5.0-53.8%). There was significant (P = .001) regional variation in presence of state-wide OpK9 treatment protocols: Northeast 100.0% (95% CI, 66.4-100.0%), Midwest 16.7% (95% CI, 2.1-48.4%), South 47.1% (95% CI, 23.0-72.2%), and West 30.8% (95% CI, 9.1-61.4%).
Conclusion:
There is substantial disparity with regard to presence of OpK9 legal and/or clinical guidance. National collaborative guidelines development is advisable to optimize and standardize care of OpK9s. Additional attention should be paid to educational and training programs to best utilize the limited available training budgets.
Due to the importance of clay minerals in metal sorption, many studies have attempted to derive mechanistic models that describe adsorption processes. These models often include several different types of adsorption sites, including permanent charge sites and silanol and aluminol functional groups on the edges of clay minerals. To provide a basis for development of adsorption models it is critical that molecular-level studies be done to characterize sorption processes. In this study we conducted X-ray absorption fine structure (XAFS) and electron paramagnetic resonance (EPR) spectroscopic experiments on copper (II) sorbed on smectite clays using suspension pH and ionic strength as variables. At low ionic strength, results suggest that Cu is sorbing in the interlayers and maintains its hydration sphere. At high ionic strength, Cu atoms are excluded from the interlayer and sorb primarily on the silanol and aluminol functional groups of the montmorillonite or beidellite structures. Interpretation of the XAFS and EPR spectroscopy results provides evidence that multinuclear complexes are forming. Fitting of extended X-ray absorption fine structure spectra revealed that the Cu-Cu atoms in the multinuclear complexes are 2.65 Å apart, and have coordination numbers near one. This structural information suggests that small Cu dimers are sorbing on the surface. These complexes are consistent with observed sorption on mica and amorphous silicon dioxide, yet are inconsistent with previous spectroscopic results for Cu sorption on montmorillonite. The results reported in this paper provide mechanistic data that will be valuable for modeling surface interactions of Cu with clay minerals, and predicting the geochemical cycling of Cu in the environment.
Outer main-belt asteroids are predominantly of the C-type (carbonaceous), suggesting that they are likely parent bodies of carbonaceous chondrites. Abundant phyllosilicates in some classes of carbonaceous chondrites have chemical compositions, mineral associations, and textures that preserve direct evidence of the processes by which carbonaceous chondrites and their parent asteroids originated and evolved to their present state. Serpentine is the dominant hydroxyl-bearing mineral in the most abundant (CM) group of carbonaceous chondrites. Serpentine may have formed as a direct nebular condensate during cooling of the solar nebula, or by aqueous alteration of anhydrous Mg,Fe-silicate precursors. Such alteration of anhydrous precursors may have occurred in the solar nebula prior to assembly of the meteorites’ parent bodies or on the parent bodies. The relative proportions of Fe and Mg in fine-grained CM2 serpentines have been used to compare the degree of aqueous alteration of different CM2 chondrites with one another. The Mg content of serpentine increases with increasing overall degree of aqueous alteration, so CM2 chondrites with Mg-rich serpentines experienced a more advanced degree of aqueous alteration than CM2 chondrites with Fe-rich serpentines. Attempts to quantify aqueous alteration of CM chondrites by interpreting electron microprobe analyses in terms of charge-balance and site-occupancy constraints from serpentine stoichiometry have met with mixed success. Despite its imperfections, one widely used alteration index based on serpentine stoichiometry is strongly correlated with the elapsed time since the fall and recovery of witnessed CM chondrite falls. Additionally, volatile organic contaminants introduced during sample processing in the laboratory are associated with serpentine and other matrix phyllosilicates. Together, these post-recovery changes in scientifically important sample attributes imply that oxidation-reduction and other types of weathering and contamination affect these meteorites even during curatorial storage and laboratory processing. The same phyllosilicates that make their carbonaceous-chondritic host rocks scientifically important research targets also render those same rocks extraordinarily vulnerable to terrestrial contamination of some of their most scientifically important attributes. This has possible implications for reconstructing pre-terrestrial (parent body) aqueous alteration phenomena from carbonaceous chondritic meteorites and eventually from samples returned by future missions to asteroids with spectral reflectance properties similar to carbonaceous chondrites.
A dense Ecklonia radiata (Laminariales) kelp forest extending at least 35 km has been found between 45 and 60 m depth range within the mesophotic zone inside the iSimangaliso marine-protected area (MPA) at the iSimangaliso Wetland park World Heritage Site on the east coast of South Africa. This is the first visual confirmation of the occurrence of E. radiata beds in subtropical South Africa, in an area situated between the tropical and subtropical bioregions, in an area that spans the Natal and Delagoa bioregions of the south-western Indian Ocean, more than 350 km north of its previously documented South African range. The kelp was found to be present across the length of the MPA, but dense beds were present only in the southern Natal bioregion, with sparse occurrences observed elsewhere on soft-coral and sponge-dominated reefs in the upper mesophotic zone. The footage was collected in November 2020, May 2021 and November 2022 during remotely operated vehicle and drop camera surveys of the mesophotic zone inside the MPA. This discovery adds to the body of knowledge on the global distribution of Laminariales populations in deep tropical and subtropical settings and the diversity of habitats within South Africa's largest coastal MPA.
Although offspring of women exposed to childhood trauma exhibit elevated rates of psychopathology, many children demonstrate resilience to these intergenerational impacts. Among the variety of factors that likely contribute to resilience, epigenetic processes have been suggested to play an important role. The current study used a prospective design to test the novel hypothesis that offspring epigenetic aging – a measure of methylation differences that are associated with infant health outcomes – moderates the relationship between maternal exposure to childhood adversity and offspring symptomatology. Maternal childhood adversity was self-reported during pregnancy via the ACEs survey and the CTQ, which assessed total childhood trauma as well as maltreatment subtypes (i.e., emotional, physical, and sexual abuse). Offspring blood samples were collected at or shortly after birth and assayed on a DNA methylation microarray, and offspring symptomatology was assessed with the CBCL/1.5–5 when offspring were 2–4 years old. Results indicated that maternal childhood trauma, particularly sexual abuse, was predictive of offspring symptoms (ps = 0.003–0.03). However, the associations between maternal sexual abuse and offspring symptomatology were significantly attenuated in offspring with accelerated epigenetic aging. These findings further our understanding of how epigenetic processes may contribute to and attenuate the intergenerational link between stress and psychopathology.
Gestational trophoblastic disease (GTD) incorporates a spectrum of placental related disorders, with both benign and malignant (Gestational trophoblastic neoplasia (GTN)) subtypes. Upon initial presentation, one should establish diagnosis (GTD versus GTN), the requirement for chemotherapy and whether monitoring has been concluded by a specialist trophoblastic centre. Women with a prior history of GTD or GTN that have completed monitoring, or early pregnant GTD patients, do not require specialist pregnancy management. Dissimilarly, early pregnant GTN patients, particularly those treated for high-risk disease, or women with a twin pregnancy involving a complete hydatidiform mole and viable co-existent foetus should receive detailed antenatal counselling and be managed under consultant-led care. Patients with a twin mole and viable co-existent foetus have a high risk of antenatal, intrapartum and post-partum complications. Fortunately, in women with a prior history of trophoblastic disease, live birth rates equal the general population, with no increased risk of disease relapse.
Preventing psychiatric admissions holds benefits for patients as well as healthcare systems. The Clinical Global Impression-Severity (CGI-S) scale is a 7-point measurement of symptom severity, independent of diagnosis, which has shown capability of predicting risk of hospitalisation in schizophrenia. Due to its routine use in clinical practice and ease of administration, it may have potential as a transdiagnostic predictor of hospitalisation.
Objectives
To investigate whether early trajectories of CGI-S scores predict risk of hospitalisation over a 6 month-follow-up period.
Methods
A retrospective cohort study was conducted, analysing Electronic Health Record (EHR) data from the NeuroBlu Database (Patel et al. BMJ Open 2022;12:e057227). Patients were included if they had a psychiatric diagnosis and at least 5 recorded CGI-S scores within a 2-month period, defined as the ‘index’ period. The relationship between early CGI-S trajectories and risk of hospitalisation was investigated using Cox regression. The analysis was adjusted for age, gender, race, number of years in education, and psychiatric diagnosis. Early CGI-S trajectories were estimated as clinical severity (defined as the mean CGI-S score during the index period) and clinical instability (defined as a generalised Root Mean Squared Subsequent Differences of all CGI-S scores recorded during the index period). The primary outcome was time to psychiatric hospitalisation up to 6 months following the index period. Patients who had been hospitalised before or within the index period were excluded.
Results
A total of 36,914 patients were included (mean [SD] age: 29.7 [17.5] years; 57.3% female). Clinical instability (hazard ratio: 1.09, 95% CI 1.07-1.10, p<0.001) and severity (hazard ratio: 1.11, 95% CI 1.09-1.12, p<0.001) independently predicted risk of hospitalisation. These associations were consistent across all psychiatric diagnoses. Patients in the top 50% of severity and/or instability were at a 45% increased risk of hospitalisation compared to those in the bottom 50% (Figure 1).
Image:
Conclusions
Early CGI-S trajectories reflecting clinical severity and instability independently predict risk of hospitalisation across diagnoses. This risk was compounded when instability and severity were present together. These results have translation potential in predicting individuals who are at high risk of hospitalisation and could benefit from preventative strategies to mitigate this risk.
Disclosure of Interest
E. Palmer Employee of: Holmusk, M. Taquet Consultant of: Holmusk, K. Griffiths Employee of: Holmusk, S. Ker Employee of: Holmusk, C. Liman Employee of: Holmusk, S. N. Wee Employee of: Holmusk, S. Kollins Employee of: Holmusk, R. Patel Grant / Research support from: National Institute of Health Research (NIHR301690); Medical Research Council (MR/S003118/1); Academy of Medical Sciences (SGL015/1020); Janssen, Employee of: Holmusk
In the Ab Urbe Condita, Livy reports that in 363 BC a dictator was appointed to revive the ancient ritual of the Capitoline nail in the midst of a plague (Livy 7.3.1–9). While recounting this historic episode, Livy provides a detailed description of an inscribed law marking this ritual that was located in the temple of Jupiter Optimus Maximus on the Capitoline.
Tree-ring series offer considerable potential for the development of environment-sensitive proxy records. However, with traditional increment cores, only small amounts of wood are often available from annual tree-ring sequences. For this reason, it is important to understand the reliability (and reproducibility) of radiocarbon measurements obtained from small-sized samples. Here we report the F14C results from the Chronos 14Carbon-Cycle Facility of modern tropical Australian tree samples over a range of four graphite target sizes from the same rings. Our study shows that similar precision can be obtained from full-sized, half-sized, as well as small-sized graphite targets using standard pretreatment and analysis procedures. However, with a decline in sample size, there was an increase seen in the associated variance of the ages and the smallest target weights started showing a systematic bias. Wiggle-matching accuracy tests, comparing the Southern Hemisphere post-bomb atmospheric calibration curve to the different sample weight sequences, were all significant except for the 200 μgC graphite targets. Our results indicate that samples smaller than 350 μgC have limited accuracy and precision. Overall, reliable measurements of F14C sequences from tree-ring records across a range of sample sizes, with best results found using graphitized samples >350 μgC.
Sea-level science has seen many recent developments in observations and modelling of the different contributions and the total mean sea-level change. In this overview, we discuss (1) the evolution of the Intergovernmental Panel on Climate Change (IPCC) projections, (2) how the projections compare to observations and (3) the outlook for further improving projections. We start by discussing how the model projections of 21st century sea-level change have changed from the IPCC AR5 report (2013) to SROCC (2019) and AR6 (2021), highlighting similarities and differences in the methodologies and comparing the global mean and regional projections. This shows that there is good agreement in the median values, but also highlights some differences. In addition, we discuss how the different reports included high-end projections. We then show how the AR5 projections (from 2007 onwards) compare against the observations and find that they are highly consistent with each other. Finally, we discuss how to further improve sea-level projections using high-resolution ocean modelling and recent vertical land motion estimates.
We examined markers of completeness in healthcare-associated infection (HAI) data reported by California hospitals to the National Healthcare Safety Network for each half of 2020 compared with 2019. There were indications of decreased data completeness for both halves of 2020. California 2020 HAI data should be interpreted with caution.
This Element reviews literature on the physiological influences of music during perception and action. It outlines how acoustic features of music influence physiological responses during passive listening, with an emphasis on comparisons of analytical approaches. It then considers specific behavioural contexts in which physiological responses to music impact perception and performance. First, it describes physiological responses to music that evoke an emotional reaction in listeners. Second, it delineates how music influences physiology during music performance and exercise. Finally, it discusses the role of music perception in pain, focusing on medical procedures and laboratory-induced pain with infants and adults.