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Mental ill-health has a major impact on young people, with pain often co-occurring. We estimated the prevalence and impact of pain in young people with mental ill-health.
Methods
Longitudinal data (baseline and three-month follow-up) of 1,107 Australian young people (aged 12–25 years) attending one of five youth mental health services. Multi-level linear mixed models estimated associations between pain characteristics (frequency, intensity, and limitations) and outcomes with false discovery rate (FDR) adjustment. Pain characteristics were baseline-centered to estimate if the baseline score (between-participant effect) and/or change from baseline (within-participant effect) was associated with outcomes.
Results
At baseline, 16% reported serious pain more than 3 days, 51% reported at least moderate pain, and 25% reported pain-related activity limitations in the last week. Between participants, higher serious pain frequency was associated with greater anxiety symptoms (β[95%CI]: 0.90 [0.45, 1.35], FDR-p=0.001), higher pain intensity was associated with greater symptoms of depression (1.50 [0.71, 2.28], FDR-p=0.001), anxiety (1.22 [0.56, 1.89], FDR-p=0.002), and suicidal ideation (3.47 [0.98, 5.96], FDR-p=0.020), and higher pain limitations were associated with greater depressive symptoms (1.13 [0.63, 1.63], FDR-p<0.001). Within participants, increases in pain intensity were associated with increases in tobacco use risk (1.09 [0.48, 1.70], FDR-p=0.002), and increases in pain limitations were associated with increases in depressive symptoms (0.99 [0.54, 1.43], FDR-p<0.001) and decreases in social and occupational functioning (−1.08 [−1.78, −0.38], FDR-p=0.009).
Conclusions
One-in-two young people seeking support for mental ill-health report pain. Youth mental health services should consider integrating pain management.
Attention-deficit hyperactivity disorder (ADHD) is commonly considered a neurodevelopmental disorder, with symptoms present before 12 years of age. Increasingly, adults who have no evidence of impairment in childhood are seeking treatment for ADHD. In this Editorial, we propose that psychiatry considers conceptual changes to better understand impairment and distress caused by inattention and disorganisation in adulthood.
Calyptosuchus wellesi is an aetosaur known from the upper Blue Mesa Member and lowermost Sonsela Member of the Chinle Formation in Arizona, and the Tecovas Formation of the Dockum Group of Texas. The taxon is considered biostratigraphically informative and aids in correlating Upper Triassic strata across the southwestern United States. Our anatomical understanding of Calyptosuchus was primarily based on the holotype specimen from Texas and referred specimens, including several disarticulated elements from the Placerias Quarry in northern Arizona. We provide a re-interpretation of the holotype specimen and describe two new specimens referrable to Calyptosuchus from northern Arizona. Together these specimens provide new information on the cranial anatomy, including dentition, and the positional and intraspecific variation within the carapace and vertebral column of the taxon. This new evidence suggests that the skull anatomy of Calyptosuchus is more similar to that of Neoaetosauroides and Stagonolepis than to other aetosaurs. The dentition of Calyptosuchus supports recent hypotheses suggesting that aetosaurs were more omnivorous/faunivorous. The associated carapace expands our anatomical understanding of characters that vary among trunk paramedian osteoderms. We identify variation in the vertebral column within the trunk region, including the prominence of the centrodiapophyseal lamina and anatomy of the neural spine. Additionally, we report the first documentation of co-ossified sacral vertebrae within Calyptosuchus, which is also the first observation of this state within the Aetosauria outside of the Desmatosuchini. This suggests that co-ossification of the sacral vertebrae may be more prevalent within the Aetosauria than previously recognized.
Translational research needs to show value through impact on measures that matter to the public, including health and societal benefits. To this end, the Translational Science Benefits Model (TSBM) identified four categories of impact: Clinical, Community, Economic, and Policy. However, TSBM offers limited guidance on how these areas of impact relate to equity. Central to the structure of our Center for American Indian and Alaska Native Diabetes Translation Research are seven regional, independent Satellite Centers dedicated to community-engaged research. Drawing on our collective experience, we provide empirical evidence about how TSBM applies to equity-focused research that centers community partnerships and recognizes Indigenous knowledge. For this special issue – “Advancing Understanding and Use of Impact Measures in Implementation Science” – our objective is to describe and critically evaluate gaps in the fit of TSBM as an evaluation approach with sensitivity to health equity issues. Accordingly, we suggest refinements to the original TSBM Logic model to add: 1) community representation as an indicator of providing community partners “a seat at the table” across the research life cycle to generate solutions (innovations) that influence equity and to prioritize what to evaluate, and 2) assessments of the representativeness of the measured outcomes and benefits.
The trace element selenium is known to protect against oxidative damage which is known to contribute to cognitive impairment with ageing (1,2). The aim of this study was to explore the association between selenium status (serum selenium and selenoprotein P (SELENOP)) and global cognitive performance at baseline and after 5 years in 85-year-olds living in the Northeast of England.
Serum selenium and SELENOP concentrations were measured at baseline by total reflection X-ray fluorescence (TXRF) and enzyme-linked immunosorbent assay (ELISA), respectively, in 757 participants from the Newcastle 85+ study. Global cognitive performance was assessed using the Standardized Mini-Mental State Examination (SMMSE) where scores ≤25 out of 30 indicated cognitive impairment. Logistic regressions explored the associations between selenium status and global cognition at baseline. Linear mixed models explored associations between selenium status and global cognition prospectively after 5 years. Covariates included sex, body mass index, physical activity, high sensitivity C-reactive protein, alcohol intake, self-rated health, medications and smoking status.
At baseline, in fully adjusted models, there was no increase in odds of cognitive impairment with serum selenium (OR 1.004, 95% CI 0.993-1.015, p = 0.512) or between SELENOP (OR 1.006, 95% CI 0.881-1.149, p = 0.930). Likewise, over 5 years, in fully adjusted models there was no association between serum selenium and cognitive impairment (β 7.20E-4 ± 5.57E-4, p = 0.197), or between SELENOP and cognitive impairment (β 3.50E-3 ± 6.85E-3, p = 0.610).
In this UK cohort of very old adults, serum selenium or SELENOP was not associated with cognitive impairment at baseline and 5 years. This was an unexpected finding despite SELENOP’s key role in the brain and the observed associations in other studies. Further research is needed to explore the effect of selenium on global cognition in very old adults.
Children with pediatric brain tumors (PBT) are at increased risk of psychosocial challenges (e.g., emotional distress, social difficulties), which in turn can result in functional impairment, or problems engaging appropriately across settings. These concerns have been shown to be especially pronounced in patients with lower socioeconomic status (SES), which tends to be overrepresented among ethnic minorities, such as Latino populations. On the other hand, resilience (the ability to utilize resources to alleviate stress and overcome adversity) can act as a protective factor against functional impairment. While resilience has been found to be lower among Latino survivors of pediatric cancer, little is known about the potential role of resilience in mitigating functional impairment among Latino patients with PBT. The authors hypothesized poorer resilience and increased functional impairment among Latino patients with PBT compared to normative expectations, in an attempt to explore need for additional support within this population.
Participants and Methods:
42 Latino patients with PBT ages 2-20 (x=11.08 years, SD=5.24) completed neuropsychological evaluation between 2018 and 2022. The sample was split relatively equally in terms of sex (47.6% male, 52.4% female), tumor location (45.2% infratentorial, 54.8% supratentorial), and household language (47.6% predominantly English, 52.4% predominantly Spanish). Outcome variables included Resiliency and Functional Impairment content scales from the Behavior Assessment Scale for Children – Third Edition: Parent Rating Scales (BASC-3: PRS). Standardized T-scores (x=50; SD=10) were derived using age-appropriate normative data, with higher T-scores indicating better resiliency, yet poorer functional impairment. Median household income for specific neighborhoods was used as a proxy for SES.
Results:
The sample as a whole did not deviate from age expectations in terms of resiliency [t(41)=-.469, p=.642] or functional impairment [t(38)=.118, p=.907]. However, when separated by household language, participants from English speaking households demonstrated lower resiliency and increased functional impairment as compared to both normative expectations [t(19)=-2.748, p=.006; t(18)=1.882, p=.038, respectively] and participants from Spanish speaking households [t(40)=-3.327, p=.002; t(37)=2.717, p=.010, respectively]. In contrast, participants from Spanish speaking households performed similarly to same-aged peers in terms of both resiliency [t(21)=1.931, p=.067] and functional impairment [t(19)=-1.969, p=.064]. Furthermore, household language predicted both resiliency [F(2, 39)=8.639, p=.0008] and functional impairment [F(2, 36)=6.203, p=.005] above and beyond SES, explaining an additional 29.4% (p=.0002) and 24.3% (p=.002) of the variation in these variables, respectively.
Conclusions:
Latino patients with PBT from Spanish speaking households had better reported resiliency and lower functional impairment than their counterparts from English speaking households. Given the subjective nature of parent reported outcomes and the importance of appropriately supporting patients and families from underserved populations, the roles of culturally-ingrained protective factors and cultural/linguistic differences in perceiving or articulating distress need further exploration. Future research, including comparison of parent report with objective measurement of impairment, is needed to better understand relationships between home language and these important variables. Additionally, examination of diagnostic and treatment-related factors will be beneficial to determine the best approaches to interventions and resources within this population.
Single-ended and balanced 90–120 GHz microstrip power amplifier MMICs have been designed for cost-sensitive 5G and 6G backhaul in a commercial 6-inch, 0.1-µm GaAs process. At 108 GHz, measured output power is 20.4 and 22.5 dBm, respectively. At 120 GHz, measured output is 12.6 and 17.4 dBm, respectively. This is the highest reported for GaAs, among the highest reported to date for microstrip MMIC amplifiers at these frequencies and competitive with more expensive InP and GaN processes. Measurement is compared with simulation.
To determine whether lame broilers are in pain it is necessary to compare measures of lameness and mobility before and after analgesic treatment. Such measures should not be unduly affected by other bird characteristics. This study assessed the performance of lame (gait score, GS 3-4) and non-lame (GS 0-1) broilers using two mobility tests: (i) a novel test to assess broiler ability to access resources when housed in groups (Group Obstacle test); and (ii) a Latency-to-Lie (LTL) test. Outcome test measures included number of obstacle crossings, latency to cross an obstacle, and time taken to sit in shallow water. Associations between outcome test measures and other bird characteristics (established lameness risk-factors), including strain, sex, age, mass, contact dermatitis and pathology, were also investigated. The performance of high-GS and low-GS broilers differed in both mobility tests and no other bird characteristics were as consistent a predictor as lameness. This demonstrates that mobility impairments are closely related to lameness assessed using GS, and that there is a component of lameness that cannot be explained by other bird characteristics (eg being male and heavy). This component may represent pain or discomfort. Both mobility tests are suitable for further application with analgesic testing to classify lameness-associated pain in broilers.
Lame broiler chickens perform poorly in standardised mobility tests and have nociceptive thresholds that differ from those of nonlame birds, even when confounding factors such as differences in bodyweight are accounted for. This study investigated whether these altered responses could be due to pain, by comparing performance in a Group Obstacle test and a Latency to Lie (LTL) test of lame (Gait Score [GS] 2.5-4) and non-lame (GS 0-1) broilers administered analgesia or a saline control. We used exploratory subcutaneous doses of the non-steroidal anti-inflammatory drugs (NSAIDs), meloxicam (5 mg kg−1) or carprofen (35 mg kg−1) or the opioid butorphanol tartrate (4 mg kg−1). We included butorphanol to explore the possibility that NSAIDs could improve mobility by reducing inflammation without necessarily invoking an analgesic effect. Lameness was a significant predictor in all analyses. Neither the number of obstacle crossings nor latency to cross an obstacle was significantly changed by either NSAID, but LTL was longer in lame birds given carprofen and meloxicam than in lame birds given saline. LTL was associated with foot-pad dermatitis and ameliorated by both NSAIDs. Butorphanol did not affect LTL but appeared soporific in the obstacle test, increasing latency to cross and, in non-lame birds, reducing the number of crossings. Combined with data from other studies, the results suggest carprofen and meloxicam had some analgesic effect on lame birds, lending further support to concerns that lameness compromises broiler welfare. Further investigation of opioid treatments and lameness types is needed to disentangle effects on mobility and on pain.
Biological considerations are often a major focus in conservation translocations: they include the physiological, behavioural, demographic, and ecological considerations relevant to management decisions about translocation planning, implementation, and evaluation. The vast array of biological, and other, considerations that managers must wrestle with render conservation translocations exceedingly complex, and a framework that supports thinking through this complexity to inform decisions in a transparent and deliberative fashion is indispensable. Structured decision-making (SDM) is a framework that is well suited to help managers deal with the complexity of their decisions, and SDM facilitates the integration of science (biological knowledge) to inform decisions. Scientists supporting conservation translocations have many tools at their disposal to help them provide predictions of management outcomes that are as accurate as possible, recognising that various sources of data are valid, and there is substantial guidance available on the appropriate methods to obtain, analyse, and interpret available data. Decisions will represent a mix of objective scientific prediction and subjective attitudes regarding trade-offs between objectives and regarding the uncertainty surrounding predictions. All conservation translocation decisions can be informed using SDM irrespective of their focus being biological, non-biological, and perhaps most realistically a mix across these concerns.
Quaternary environments on the Arabian Peninsula shifted between pronounced arid conditions and phases of increased rainfall, which had a profound impact on Earth surface processes. However, while aeolian sediment dynamics are reasonably well understood, there is a lack of knowledge with regard to variability in the fluvial systems. Presented here are the findings from several locations within wadi drainage systems to the west of the Hajar Mountains (United Arab Emirates). The performance of optically stimulated luminescence dating using a customized standardized growth curve approach is investigated, showing that this approach allows reliable determination of ages by reducing the machine time required. Three main periods of fluvial activity occurred at 160–135, 43–34, and ca. 20 ka. Additional ages fall into the latest Pleistocene and Late Holocene. None of the ages coincides with major wet periods in SE Arabia that have been identified in stalagmites and by the deposition of lake sediments. It is shown that fluvial activity was partly contemporaneous (within the given time resolution) with phases of aeolian deposition and was almost continuous, but likely sporadic, during the Middle to Late Pleistocene. This highlights the need for regionally defined paleoenvironmental records to fully understand the response of dryland systems to long-term climatic change.
Consumption of unpasteurised milk in the United States has presented a public health challenge for decades because of the increased risk of pathogen transmission causing illness outbreaks. We analysed Foodborne Disease Outbreak Surveillance System data to characterise unpasteurised milk outbreaks. Using Poisson and negative binomial regression, we compared the number of outbreaks and outbreak-associated illnesses between jurisdictions grouped by legal status of unpasteurised milk sale based on a May 2019 survey of state laws. During 2013–2018, 75 outbreaks with 675 illnesses occurred that were linked to unpasteurised milk; of these, 325 illnesses (48%) were among people aged 0–19 years. Of 74 single-state outbreaks, 58 (78%) occurred in states where the sale of unpasteurised milk was expressly allowed. Compared with jurisdictions where retail sales were prohibited (n = 24), those where sales were expressly allowed (n = 27) were estimated to have 3.2 (95% CI 1.4–7.6) times greater number of outbreaks; of these, jurisdictions where sale was allowed in retail stores (n = 14) had 3.6 (95% CI 1.3–9.6) times greater number of outbreaks compared with those where sale was allowed on-farm only (n = 13). This study supports findings of previously published reports indicating that state laws resulting in increased availability of unpasteurised milk are associated with more outbreak-associated illnesses and outbreaks.
Non-archosaur archosauromorphs are a paraphyletic group of diapsid reptiles that were important members of global Middle and Late Triassic continental ecosystems. Included in this group are the azendohsaurids, a clade of allokotosaurians (kuehneosaurids and Azendohsauridae + Trilophosauridae) that retain the plesiomorphic archosauromorph postcranial body plan but evolved disparate cranial features that converge on later dinosaurian anatomy, including sauropodomorph-like marginal dentition and ceratopsian-like postorbital horns. Here we describe a new malerisaurine azendohsaurid from two monodominant bonebeds in the Blue Mesa Member, Chinle Formation (Late Triassic, ca. 218–220 Ma); the first occurs at Petrified Forest National Park and preserves a minimum of eight individuals of varying sizes, and the second occurs near St. Johns, Arizona. Puercosuchus traverorum n. gen. n. sp. is a carnivorous malerisaurine that is closely related to Malerisaurus robinsonae from the Maleri Formation of India and to Malerisaurus langstoni from the Dockum Group of western Texas. Dentigerous elements from Puercosuchus traverorum n. gen. n. sp. confirm that some Late Triassic tooth morphotypes thought to represent early dinosaurs cannot be differentiated from, and likely pertain to, Puercosuchus-like malerisaurine taxa. These bonebeds from northern Arizona support the hypothesis that non-archosauriform archosauromorphs were locally diverse near the middle Norian and experienced an extinction event prior to the end-Triassic mass extinction coincidental with the Adamanian-Revueltian boundary recognized at Petrified Forest National Park. The relatively late age of this early-diverging taxon (Norian) suggests that the diversity of azendohsaurids is underrepresented in Middle and Late Triassic fossil records around the world.
The utility of quality of life (QoL) as an outcome measure in youth-specific primary mental health care settings has yet to be determined. We aimed to determine: (i) whether heterogeneity on individual items of a QoL measure could be used to identify distinct groups of help-seeking young people; and (ii) the validity of these groups based on having clinically meaningful differences in demographic and clinical characteristics.
Methods
Young people, at their first presentation to one of five primary mental health services, completed a range of questionnaires, including the Assessment of Quality of Life–6 dimensions adolescent version (AQoL-6D). Latent class analysis (LCA) and multivariate multinomial logistic regression were used to define classes based on AQoL-6D and determine demographic and clinical characteristics associated with class membership.
Results
1107 young people (12–25 years) participated. Four groups were identified: (i) no-to-mild impairment in QoL; (ii) moderate impairment across dimensions but especially mental health and coping; (iii) moderate impairment across dimensions but especially on the pain dimension; and (iv) poor QoL across all dimensions along with a greater likelihood of complex and severe clinical presentations. Differences between groups were observed with respect to demographic and clinical features.
Conclusions
Adding multi-attribute utility instruments such as the AQoL-6D to routine data collection in mental health services might generate insights into the care needs of young people beyond reducing psychological distress and promoting symptom recovery. In young people with impairments across all QoL dimensions, the need for a holistic and personalised approach to treatment and recovery is heightened.
This article is a clinical guide which discusses the “state-of-the-art” usage of the classic monoamine oxidase inhibitor (MAOI) antidepressants (phenelzine, tranylcypromine, and isocarboxazid) in modern psychiatric practice. The guide is for all clinicians, including those who may not be experienced MAOI prescribers. It discusses indications, drug-drug interactions, side-effect management, and the safety of various augmentation strategies. There is a clear and broad consensus (more than 70 international expert endorsers), based on 6 decades of experience, for the recommendations herein exposited. They are based on empirical evidence and expert opinion—this guide is presented as a new specialist-consensus standard. The guide provides practical clinical advice, and is the basis for the rational use of these drugs, particularly because it improves and updates knowledge, and corrects the various misconceptions that have hitherto been prominent in the literature, partly due to insufficient knowledge of pharmacology. The guide suggests that MAOIs should always be considered in cases of treatment-resistant depression (including those melancholic in nature), and prior to electroconvulsive therapy—while taking into account of patient preference. In selected cases, they may be considered earlier in the treatment algorithm than has previously been customary, and should not be regarded as drugs of last resort; they may prove decisively effective when many other treatments have failed. The guide clarifies key points on the concomitant use of incorrectly proscribed drugs such as methylphenidate and some tricyclic antidepressants. It also illustrates the straightforward “bridging” methods that may be used to transition simply and safely from other antidepressants to MAOIs.
Subthreshold/attenuated syndromes are established precursors of full-threshold mood and psychotic disorders. Less is known about the individual symptoms that may precede the development of subthreshold syndromes and associated social/functional outcomes among emerging adults.
Methods
We modeled two dynamic Bayesian networks (DBN) to investigate associations among self-rated phenomenology and personal/lifestyle factors (role impairment, low social support, and alcohol and substance use) across the 19Up and 25Up waves of the Brisbane Longitudinal Twin Study. We examined whether symptoms and personal/lifestyle factors at 19Up were associated with (a) themselves or different items at 25Up, and (b) onset of a depression-like, hypo-manic-like, or psychotic-like subthreshold syndrome (STS) at 25Up.
Results
The first DBN identified 11 items that when endorsed at 19Up were more likely to be reendorsed at 25Up (e.g., hypersomnia, impaired concentration, impaired sleep quality) and seven items that when endorsed at 19Up were associated with different items being endorsed at 25Up (e.g., earlier fatigue and later role impairment; earlier anergia and later somatic pain). In the second DBN, no arcs met our a priori threshold for inclusion. In an exploratory model with no threshold, >20 items at 19Up were associated with progression to an STS at 25Up (with lower statistical confidence); the top five arcs were: feeling threatened by others and a later psychotic-like STS; increased activity and a later hypo-manic-like STS; and anergia, impaired sleep quality, and/or hypersomnia and a later depression-like STS.
Conclusions
These probabilistic models identify symptoms and personal/lifestyle factors that might prove useful targets for indicated preventative strategies.
Edited by
Kenneth Ross, Zomba Theological College, Malawi and University of Pretoria,Ana Maria Bidegain, Florida International University,Todd M. Johnson, Gordon-Conwell Theological Seminary, Massachusetts and Boston University
During the twenty-first century, Christianity in Chile has been shaped by the social and religious transformations in the country. These are characterised by an advancing democratising process within the framework of a crisis of socio-political representation and a crisis of the current neoliberal development model. Likewise, in the religious field, a crisis is observed in the churches, especially the Catholic Church. Greater Evangelical presence and a growth in the number of non-believers has effected much change in the religious adherence of Chileans. These trends were already evident in the twentieth century, particularly due to the links of Christian movements with social and political processes, as well as the missionary activity of the Evangelical churches in Chilean society. A characteristic note of the evolution of Christianity in Chile in the twenty-first century is the change in religious adherence and the decline of trust in religious institutions in the face of secularising trends. However, a culture of Christian identity persists that in various quarters inspires a deep-rooted spirituality.
The contemporary religious culture of Chileans is mostly related to Western Christian traditions. In the 2012 national census, in which a religion question was asked, 66.7% declared themselves Catholic, 16.4% Evangelical or Protestant and 0.04% Orthodox. Jehovah's Witnesses reached 0.98% and the Church of Jesus Christ of Latter-day Saints 0.77%. On the other hand, 11.5% declared ‘no religion’ and 2.2% ignored the religion question. Finally, non-Christian religious adherents were few in number: Judaism (0.13%), Indigenous religions (0.1%), Buddhism (0.09%) and Islam (0.025%). The Institute of Statistics estimated a population of 19 million inhabitants in 2019.
The main phenomenon that manifests itself in the change of religious adherence has to do with the ostensible decline of Catholicism: from 81% in the 1970 national census to 67% in 2012. On the other hand, surveys by the Center for Public Studies (CEP) show no significant variation in the number of people who consider themselves Evangelical: 17% in 2008 and 16% in 2018. However, the trust in and prestige of churches and religious organisations have plummeted. In a 2018 international survey conducted by the International Social Survey Programme (ISSP), 28% of Chilean respondents declared a high level of trust and 39.1% little or no trust in religious organisations.
The process of generating FMEA following document-centric approach is tedious and susceptible to human error. This paper presents preliminary methodology for robotic manufacturing process modelling in MBSE environment with a scope of automating multiple steps of the modelling process using ontology. This is followed by the reasoning towards automatic generation of process FMEA from the MBSE model. The proposed methodology allows to establish robust and self-synchronising links between process-relevant information, reduce the likelihood of human error, and scale down time expenses.