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Antenatal corticosteroids are given to pregnant people at risk of preterm birth to reduce newborn morbidity, including respiratory distress syndrome. However, there has been concern surrounding potential adverse effects on subsequent generations. Animal studies have demonstrated endocrine and metabolic changes in those exposed to corticosteroids in utero (F1) and in the second generation (F2). We aimed to assess the effects of parental antenatal corticosteroid exposure on health of the second generation (F2) of Auckland Steroid Trial (AST) participants. In the AST, women (F0) expected to birth between 24 and 36 weeks’ gestation were randomised to betamethasone or placebo. When their children (F1) were 50 years old, they and their children (F2) were followed up with a self-report questionnaire and data linkage. The primary outcome for this analysis was body mass index (BMI) z-score in the F2 generation. Secondary outcomes included respiratory, cardiovascular, neurodevelopmental, mental and general health, and social outcomes. Of the 213 F2 participants, 144 had BMI data available. There was no difference in BMI z-score between participants whose parent was exposed to betamethasone versus placebo (mean (SD) 0.63 (1.45), N = 77 vs 0.41 (1.28), N = 67, adjusted mean difference (95% confidence interval) = 0.16 (-0.37, 0.69)). There was no evidence of a difference in rates of overweight, diabetes, respiratory disease, cardiometabolic risk factors, neurodevelopmental difficulties, mental health difficulties and social outcomes between parental betamethasone versus placebo exposure groups, but confidence intervals were wide. These findings are reassuring regarding the intergenerational safety of antenatal corticosteroids.
In their rich history, community-based educational spaces (CBESs) have afforded communities room to build young people’s critical consciousness, to organize for social change, and to create learning environments that foster a political – and, in certain respects, a more meaningful – education. Broadly speaking, CBESs meet the specific needs of communities, such as providing access to food and opportunities for learning and identity exploration. In this chapter, the authors overview the scholarly literature related to CBESs and their power-building features that facilitate community power and psychological empowerment processes, as well as the tensions in CBESs that can hinder power-building. Amid this discussion, the authors highlight Urban Underground, a CBES in Milwaukee, Wisconsin, as an organization that exemplifies the humanizing education, youth empowerment, and power-building possible within CBESs. Through this chapter, the authors contend that CBESs have the power to bring about social change in their communities and spur transformative change for those they serve.
To determine whether poorer performance on the Boston Naming Test (BNT) in individuals with transactive response DNA-binding protein 43 pathology (TDP-43+) is due to greater loss of word knowledge compared to retrieval-based deficits.
Methods:
Retrospective clinical-pathologic study of 282 participants with Alzheimer’s disease neuropathologic changes (ADNC) and known TDP-43 status. We evaluated item-level performance on the 60-item BNT for first and last available assessment. We fit cross-sectional negative binomial count models that assessed total number of incorrect items, number correct of responses with phonemic cue (reflecting retrieval difficulties), and number of “I don’t know” (IDK) responses (suggestive of loss of word knowledge) at both assessments. Models included TDP-43 status and adjusted for sex, age, education, years from test to death, and ADNC severity. Models that evaluated the last assessment adjusted for number of prior BNT exposures.
Results:
43% were TDP-43+. The TDP-43+ group had worse performance on BNT total score at first (p = .01) and last assessments (p = .01). At first assessment, TDP-43+ individuals had an estimated 29% (CI: 7%–56%) higher mean number of incorrect items after adjusting for covariates, and a 51% (CI: 15%–98%) higher number of IDK responses compared to TDP-43−. At last assessment, compared to TDP-43−, the TDP-43+ group on average missed 31% (CI: 6%–62%; p = .01) more items and had 33% more IDK responses (CI: 1% fewer to 78% more; p = .06).
Conclusions:
An important component of poorer performance on the BNT in participants who are TDP-43+ is having loss of word knowledge versus retrieval difficulties.
The evaluation of healthcare pathways must be considered of fundamental importance. The quality of care provided to patients with severe mental disorders (SMD) does not correspond to the standards set by the recommendations. Therefore, measures such as the real coverage rate of psychiatric patients’ needs (contact coverage), by comparing epidemiological prevalence rates and the number of patients receiving adequate care, could be a valuable resource for implementing the transition to community mental health. However, simple assessment and reporting of rates of contact with mental healthcare potentially overestimate the full expected health benefits of services. Therefore, in addition to monitor the coverage rate achieved by the services, the evaluation of the effectiveness of the care provided (effective coverage) [De Silva et al. Int J Epidemiol 2014;43(2):341–53] is also of relevant importance.
Objectives
To measure the gap between contact and effective coverage of mental healthcare, i.e., the effectiveness of interventions provided by services for the treatment of SMD in preventing an exacerbation of psychiatric symptoms.
Methods
Data were retrieved from Healthcare Utilization databases of four Italian Regions (Lombardy, Emilia-Romagna, Lazio, Sicily). 45,761 newly taken-in-care cases of depression, schizophrenia, bipolar, and personality disorder were included. A variant of the self-controlled case series method was used to estimate the incidence rate ratio (IRR) for the relationship between exposure (use of different types of mental healthcare such as pharmacotherapy, generic contacts with the outpatient service, psychosocial interventions, and psychotherapies) and relapse episodes (mental illness emergency hospital admissions).
Results
11,500 relapses occurred. Relapse risk was reduced (Figure) during periods covered by (i) psychotherapy for patients with depression (IRR 0.67; 95% CI, 0.49 to 0.91) and bipolar disorder (0.64; 0.29 to 0.99); (ii) psychosocial interventions for those with depression (0.74; 0.56 to 0.98), schizophrenia (0.83; 0.68 to 0.99) and bipolar disorder (0.55; 0.36 to 0.84), (iii) pharmacotherapy for those with schizophrenia (0.58; 0.49 to 0.69), and bipolar disorder (0.59; 0.44 to 0.78). Coverage with generic mental healthcare, in the absence of psychosocial/psychotherapeutic interventions, did not affect the risk of relapse.
Image:
Conclusions
Psychosocial interventions, psychotherapies and specific pharmacotherapies can be considered particularly effective in treating patients with bipolar, depressive, and schizophrenic disorders. This study ascertained the gap between utilization of mental healthcare and effective coverage, showing that real-world data can represent a useful resource to monitor mental healthcare paths and to assess the effectiveness of a mental health system.
The 1978 Italian reform of psychiatric services initiated the closure of psychiatric hospitals encouraging the development of community mental health. However, there is wide variability across regions in the amount of resources devoted to community-based psychiatric care, and the range of services provided still is cause of concern.
Objectives
To evaluate the quality of mental health care delivered to patients with schizophrenia and related disorders taken-in-care by mental health services in four Italian regions (Lombardy, Emilia-Romagna, Lazio, Sicily).
Methods
Thirty-one clinical indicators concerning accessibility, appropriateness, continuity, and safety were defined and estimated using healthcare utilization (HCU) databases, containing data on mental health treatments, hospital admissions, outpatient interventions, lab tests and drug prescriptions.
Results
A total of 70,586 prevalent patients with schizophrenia treated in 2015 were identified, of whom 1,752 were newly taken-in-care. For most patients community care was accessible and moderately intensive. However, care pathways were not implemented based on a structured assessment and only half of the patients received psychosocial treatments. One patient out of ten had access to psychological interventions and psychoeducation. Activities specifically addressed to families involved a third of prevalent patients and less than half of new patients. One patient out of six was admitted to a community residential facility, and one out of ten to a general hospital psychiatric ward (GHPW); higher values were identified in new cases. In general hospitals, one-fifth of the admissions were followed by readmission within 30 days of discharge. For two- thirds of patients continuity of community care was met, and six times out of ten a discharge from a GHPW was followed by an outpatient contact within two weeks. For cases newly taken-in-care the continuity of community care was uncommon, while the readiness of outpatient contacts after discharge was slightly more frequent. Most of the patients received antipsychotic medication, but their adherence to long-term treatment was low. Antipsychotic polytherapy was frequent and the control of metabolic side effects was poor. The variability between regions was high and consistent.
Conclusions
The Italian mental health system could be improved by increasing the accessibility to psychosocial interventions, improving the quality of care for newly taken-in-care patients, focusing on somatic health and mortality, and reducing regional variability. Clinical indicators demonstrate the strengths and weaknesses of the mental health system in these regions, and, as HCU databases, they could be useful tools in the routine assessment of mental healthcare quality at regional and national levels.
OBJECTIVES/GOALS: There is evidence that lesbian, gay, and bisexual (LGB) adults have poorer cardiovascular health than their heterosexual peers, but studies of the association between sexual orientation (SO) and diabetes mellitus (DM) have been few with mixed findings. To further investigate this association, large cohorts with objective data capture are needed. METHODS/STUDY POPULATION: We used data from the Veterans Healthcare Administration Lesbian, Gay, Bisexual, Transgender EHR cohort which includes veterans with at least 2 encounters October 1, 2009-September 30, 2019. The first clinic visit in this window was the index date with the baseline date one year later; the intervening year served as a baseline period for observation of prevalent disease and comorbidities. We did not include transgender veterans in this analysis in order to focus on SO rather than on the intersection of SO with gender identity. The SO of 1,108,990 veterans was identified using a natural language processing tool; 185,788 veterans were classified as LGB. We first examined sample characteristics by sex and SO and then used logistic regression to assess the association between SO and prevalent DM. RESULTS/ANTICIPATED RESULTS: DM was present among 193,330 veterans (32,986 LGB). Mean age was similar across SO in women (41) and men (53). Distribution of race was similar across groups, but LGB veterans were more likely to be Hispanic (11%, both sexes) than non-LGB men (6%) and women (8%). Current smoking was more prevalent among LGB (44% men, 39% women) than non-LGB veterans (40% men, 30% women). Adjusting for age, sex, race, Hispanic ethnicity, BMI, smoking status, health insurance, marital status, and enrollment priority, LGB veterans had 1.12 [1.10, 1.13] times the odds of DM vs. non-LGB veterans. Bisexual (0.87 [0.74, 1.01]) or lesbian (1.03 [0.97, 1.10]) women did not have significantly different DM odds than non-LGB women. Bisexual men had lower DM odds (0.86 [0.80, 0.93]) while gay men had higher odds (1.04 [1.01, 1.06]) than non-LGB men. DISCUSSION/SIGNIFICANCE: This is one of the first studies to report DM in a veteran cohort stratified by SO. Our findings highlight the importance of examining SO groups separately and jointly, as to further elucidate the association between SO, cardiovascular risk factors, and general cardiovascular health. Future work will examine the intersection of SO and gender identity.
The radiated tortoise and Aldabra giant tortoise were used as ecological replacements for the extinct Mauritian tortoise Cylindraspis inepta. Aldabra giant tortoises were better adapted as seed dispersers and grazers, and have become the species of choice. It is intended to remove the radiated tortoises from Round Island. It is suggested there was an open grazing climax plant community maintained by tortoises with heliophilous native plants that have adaptations to avoid being grazed or browsed and respond to grazing with prostrate growth form. The Aldabra giant tortoises fed on fallen fruits and spread the seeds of hardwood trees, screw-pines and palms in their droppings that subsequently demonstrated enhanced germination and growth rates. Preliminary work was done on Ile aux Aigrettes before the release on Round Island. The tortoises have established grazed areas colonised by the native tussock grass Chrysopogon argutus that the tortoises do not graze and is benefiting from reduced competition from the fast-growing non-native grasses.
Richard Jeffrey’s “Conditioning, Kinematics, and Exchangeability” is one of the foundational documents of probability kinematics. However, the section entitled “Successive Updating” contains a subtle error regarding the applicability of updating by so-called relevance quotients in order to ensure the commutativity of successive probability kinematical revisions. Upon becoming aware of this error, Jeffrey formulated the appropriate remedy, but he never discussed the issue in print. To head off any confusion, it seems worthwhile to alert readers of Jeffrey’s “Conditioning, Kinematics, and Exchangeability” to the aforementioned error and to document his remedy, placing it in the context of both earlier and subsequent work on commuting probability kinematical revisions.1
Research indicates that sexual harassment and assault commonly occur during archaeological field research, and students, trainees, and early career professionals are more frequently subjected to harassing behaviors compared to mid-career and senior scientists. Specific to archaeological education, the undergraduate educational requirement of a field school puts students and trainees in situations where harassment historically has been unchecked. We present the results of a systematic content analysis of 24 sets of field school documents. We analyzed these documents with attention to how field school policies, procedures, and language may impact students’ perceptions of their expected behaviors, logistics and means of reporting, and stated policies surrounding sexual harassment and assault. Coding was conducted using an a priori coding scheme to identify practices that should lead to a safe and supportive field learning environment. Our coding scheme resulted in 11 primary codes that we summarized as three primary themes: (1) field school organization and expected student behavior, (2) logistics of the course, and (3) stated policies surrounding sexual harassment and assault. Based on these themes, we provide recommendations to modify field school documents and practices to create a field school that provides safe opportunities for students to learn.
Hypoactive sexual desire disorder (HSDD) is a common female sexual dysfunction and is estimated to affect approximately 10% of women in the United States. It has been suggested that HSDD is associated with an imbalance of hormone and neurotransmitter levels in the brain, resulting in decreased excitation, increased inhibition, or a combination of both. Evidence suggests neurotransmitters, including dopamine (DA), norepinephrine, and serotonin, as well as hormones such as estradiol and testosterone, contribute to female sexual desire and response. Current treatments for HSDD include psychotherapy, and two US Food and Drug Administration-approved medications for premenopausal women: flibanserin, a serotonin mixed agonist and antagonist, and bremelanotide, a melanocortin receptor (MCR) agonist. Melanocortins are endogenous neuropeptides associated with the excitatory pathway of the female sexual response system. MCRs are found throughout the body, including the brain. Bremelanotide is an MCR agonist that nonselectively activates several of the receptor subtypes, of which subtype 4 (MC4R) is the most relevant at therapeutic doses. MC4R is predominantly expressed in the medial preoptic area (mPOA) of the hypothalamus in the brain, and is important for female sexual function. Animal studies suggest that bremelanotide may affect female sexual desire by activating presynaptic MC4Rs on neurons in the mPOA of the hypothalamus, leading to increased release of DA, an excitatory neurotransmitter that increases sexual desire. This review presents what is known about the mechanism of action of bremelanotide in the context of treating HSDD.
Libraries have historically engaged computing technologies to advance two primary goals: to enhance user experience, and to improve the efficiency and accuracy of library work. The first decade and a half of the computerisation of libraries, which began in earnest in the early 1950s, was devoted almost exclusively to the first of these primary goals – to providing enhanced user search, discovery and access to materials (Kilgour, 1970). Attention to the latter goal of improving library efficiency was a secondary movement brought on by an economic imperative towards efficiency that ‘must be an ultimate goal if libraries are to be economically viable in the future’ (Kilgour, 1970, 219).
As Kilgour suggested, our present library landscape is heavily influenced by a pervasive economic pressure towards efficiency of operations. The two factors of shrinking budgets and an always increasing number of items that must be managed have required that, as a community, we focus on seeking ways to do more with less. Thus most of our attention and external funding in the area of linked data has focused on understanding the impact of linked data adoption on library operations. While migrating data to a format that would improve discovery may have stimulated the initial impulse to pursue linked data, this pursuit was quickly subsumed by a desire to leverage its capabilities to advance efficiency and lower the costs of library operations.
The Library of Congress report On the Record (Boehr et al., 2008) is a good exemplar of the tension between the two impulses of service and efficiency. The report is divided into the following titled sections:
‘Increase the efficiency of bibliographic production and maintenance’
‘Enhance access to rare, unique, and other special hidden materials’
‘Position our technology for the future’
‘Position our community for the future’
‘Strengthen the library and information science profession’.
Organisationally, we see immediately that increasing the efficiency of library work gets top bill in the discussion and, when we get to discovery in the second section, we are presented with a limited view of discovery, which sees the conversion as presenting a moment of possibility for combining new disparate library data stores – something which could be accomplished just as easily using any number of non-linked data formats. The lower level organisation of the report reflects a similar bias.
Iodine intake affects the occurrence of thyroid disorders. However, the association of iodine intake with longevity remains to be described. This led us to perform a 20 years’ follow-up on participants from the Randers–Skagen (RaSk) study. Residents in Randers born in 1920 (n 210) and Skagen born in 1918–1923 (n 218) were included in a clinical study in 1997–1998. Mean iodine content in drinking water was 2 µg/l in Randers and 139 µg/l in Skagen. We collected baseline data through questionnaires, performed physical examinations and measured iodine concentrations in spot urine samples. Income data were retrieved from Danish registries. We performed follow-up on mortality until 31 December 2017 using Danish registries. Complete follow-up data were available on 428 out of 430 of participants (99·5 %). At baseline, the median urinary iodine concentration was 55 µg/l in Randers and 160 µg/l in Skagen residents. Participants were long-term residents with 72·8 and 92·7 % residing for more than 25 years in Randers and Skagen, respectively. Cox regression showed that living in Skagen compared with Randers was associated with a lower hazard ratio (HR) of death in both age- and sex-adjusted analyses (HR 0·60, 95 % CI 0·41, 0·87, P = 0·006), but also after adjustment for age, sex, number of drugs, Charlson co-morbidity index, smoking, alcohol and income (HR 0·60, 95 % CI 0·41, 0·87, P = 0·008). Residing in iodine-replete Skagen was associated with increased longevity. This indicates that long-term residency in an iodine-replete environment may be associated with increased longevity compared with residency in an iodine-deficient environment.
Given the hierarchical nature and structure of field schools, enrolled students are particularly susceptible to harassment and assault. In 2018, the National Academies of Sciences, Engineering, and Medicine (NASEM) released recommendations to help prevent sexual harassment and assault of women in academia. Although these recommendations are specific to higher education and exclusive to women, some can be modified and applied to the context of archaeological field schools. We review the NASEM's recommendations, with particular attention to those applicable to the field school setting, and provide suggestions for making field schools safer and more inclusive learning environments for all students. Although we present recommendations for practices that can be implemented at field schools, additional research is needed to understand how sexual harassment occurs at field schools and how the implementation of these recommendations can make learning safer.
Integrins are large heterodimeric type 1 membrane proteins expressed in all nucleated mammalian cells. Eighteen α-chains and eight β-chains can combine to form 24 different integrins. They are cell adhesion proteins, which bind to a large variety of cellular and extracellular ligands. Integrins are required for cell migration, hemostasis, translocation of cells out from the blood stream and further movement into tissues, but also for the immune response and tissue morphogenesis. Importantly, integrins are not usually active as such, but need activation to become adhesive. Integrins are activated by outside-in activation through integrin ligand binding, or by inside-out activation through intracellular signaling. An important question is how integrin activity is regulated, and this topic has recently drawn much attention. Changes in integrin affinity for ligand binding are due to allosteric structural alterations, but equally important are avidity changes due to integrin clustering in the plane of the plasma membrane. Recent studies have partially solved how integrin cell surface structures change during activation. The integrin cytoplasmic domains are relatively short, but by interacting with a variety of cytoplasmic proteins in a regulated manner, the integrins acquire a number of properties important not only for cell adhesion and movement, but also for cellular signaling. Recent work has shown that specific integrin phosphorylations play pivotal roles in the regulation of integrin activity. Our purpose in this review is to integrate the present knowledge to enable an understanding of how cell adhesion is dynamically regulated.
Edited by
Lara J. Farrell, Griffith University, Queensland,Thomas H. Ollendick, Virginia Polytechnic Institute and State University,Peter Muris, Universiteit Maastricht, Netherlands