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We present the Evolutionary Map of the Universe (EMU) survey conducted with the Australian Square Kilometre Array Pathfinder (ASKAP). EMU aims to deliver the touchstone radio atlas of the southern hemisphere. We introduce EMU and review its science drivers and key science goals, updated and tailored to the current ASKAP five-year survey plan. The development of the survey strategy and planned sky coverage is presented, along with the operational aspects of the survey and associated data analysis, together with a selection of diagnostics demonstrating the imaging quality and data characteristics. We give a general description of the value-added data pipeline and data products before concluding with a discussion of links to other surveys and projects and an outline of EMU’s legacy value.
Common neuroanatomical regions are associated with both states of anorexia nervosa (AN) and autistic characteristics, but restoration of body mass index (BMI) has been associated with decreased presentation of autistic characteristics in some individuals with AN. This study aims to examine neuroanatomical correlates associated with autistic characteristics in those with acute anorexia nervosa (ac-AN) and those previously diagnosed with AN but whose weight has been restored (WR). In total, 183 individuals (healthy controls [HCs] = 67; n[ac-AN] = 68; n[WR] = 48) from the Brain imaging of Emotion And Cognition of adolescents with Anorexia Nervosa (BEACON) study were included, with autistic characteristics determined in both ac-AN and WR individuals (n = 116). To further examine BMI, ac-AN and WR group associations were compared. Random forest regression (RFR) models examined whether autistic characteristics and morphology of the anterior cingulate cortex (ACC), middle frontal gyrus (MFG), and orbitofrontal cortex (OFC) were able to predict future levels of social anhedonia and alexithymia. Group-wise differences were identified within the volume and surface area of the MFG and OFC, which were unrelated to BMI. Autistic characteristics were inversely associated with MFG and ACC volume, with differences in associations between ac-AN and WR groups seen in the surface area of the MFG. RFR models identified moderate-to-weak performance and found that autistic characteristics were not important predictive features in a priori and exploratory models. Findings suggest that the presence of autistic characteristics in those with ac-AN are associated with the volume of the MFG and are unrelated to BMI restoration.
Accurate diagnosis of bipolar disorder (BPD) is difficult in clinical practice, with an average delay between symptom onset and diagnosis of about 7 years. A depressive episode often precedes the first manic episode, making it difficult to distinguish BPD from unipolar major depressive disorder (MDD).
Aims
We use genome-wide association analyses (GWAS) to identify differential genetic factors and to develop predictors based on polygenic risk scores (PRS) that may aid early differential diagnosis.
Method
Based on individual genotypes from case–control cohorts of BPD and MDD shared through the Psychiatric Genomics Consortium, we compile case–case–control cohorts, applying a careful quality control procedure. In a resulting cohort of 51 149 individuals (15 532 BPD patients, 12 920 MDD patients and 22 697 controls), we perform a variety of GWAS and PRS analyses.
Results
Although our GWAS is not well powered to identify genome-wide significant loci, we find significant chip heritability and demonstrate the ability of the resulting PRS to distinguish BPD from MDD, including BPD cases with depressive onset (BPD-D). We replicate our PRS findings in an independent Danish cohort (iPSYCH 2015, N = 25 966). We observe strong genetic correlation between our case–case GWAS and that of case–control BPD.
Conclusions
We find that MDD and BPD, including BPD-D are genetically distinct. Our findings support that controls, MDD and BPD patients primarily lie on a continuum of genetic risk. Future studies with larger and richer samples will likely yield a better understanding of these findings and enable the development of better genetic predictors distinguishing BPD and, importantly, BPD-D from MDD.
Our diet and its impact on the human gut microbiota in terms of composition and function are key determinants of human health across the life-course(1). Fermented vegetables can have enhanced functional and nutritional properties through substrate transformation by microbes and production of biochemicals during the fermentation process(2). Kimchi is a traditional Korean vegetable ferment produced via spontaneous lactic acid bacteria fermentation. Plant nutrients and biochemicals, microbial metabolites and microbial cell components are present in kimchi(3). As live products, fermented vegetables present challenges to commercial producers who need shelf/ transport stability to deliver consistent products to consumers. We hypothesise that fermented vegetable health advantages will be preserved by freeze-drying, while enabling product stability, extended shelf and storage life, stable transportation and utility as food ingredients.
Utilising existing kimchi physiochemical data, we identified kimchi biochemicals (KBs) (benefit health but not essential to it) and kimchi nutrients (KNs) (essential to health). We quantified these components in 3-day old fresh kimchi (T3) and in 3-day old fresh kimchi that had been freeze-dried and powdered (T3 FDP). We sampled technical triplicates and calculated P values using an unpaired 2 tailed t-test.
The hypothesis that KBs and KNs in T3 FDP are preserved at levels not statistically significantly different to those in (T3) (P > 0.005) was disproved. Components of kimchi were affected differently by the FDP process, with decreases in some and increases in others. As a result, the overall profile of KBs and KNs in T3 FDP was different to T3. Based on a daily portion of fresh kimchi being ∼50 g, there was 2.64 g KBs and KNs in 50 g T3 and 2.28 g KBs and KNs in equivalent portion T3 FDP (7.5 g), a reduction of 13.64% after FDP in KBs and KNs combined. Unexpectedly, soluble fibre and iron were significantly lower in equivalent sample T3 FDP compared to T3 (P=0.003 and P < 0.0001 respectively) and vitamin B9 was significantly higher in T3 FDP compared to T3 (P < 0.0001). For KBs, acetic acid and lactic acid were significantly lower in T3 FDP (P=0.020 and P=0.046 respectively), but propionic acid was undetectable in T3 and the equivalent sample T3 FDP contained 1.44 g. Capsaicinoids were not detectable in T3, but were notably present in T3 FDP.
This study represents a critical first step in understanding the extent to which the functionality of fresh kimchi is preserved in its freeze dried and powdered form (termed a FermentceuticalTM). Improving health through fermented foods is a critical concept for consumers, food manufacturers and healthcare professionals, alike.
In this chapter, we discuss the relationship of individual personal thriving to fairness and worthiness by exploring the concept of epistemic injustice. Epistemic injustice refers to the rejection of people’s capacity as knowers, such that these individuals are treated as being less knowledgeable and less believable than other people, frequently on the basis of their social identities. In the first half of the chapter, we will explain how epistemic injustices take place and how they interrupt human thriving. In the second half of the chapter, we will profile the ways that psychologists and others can work to prevent epistemic injustice.
EDAC (Eating Disorders and Autism Collaborative) is an innovative project aiming to increase research capacity by supporting collaboration in the fields of eating disorders and autism. EDAC comprises four integrated workstreams to co-produce interdisciplinary research, directed by Autistic individuals with lived experience of eating disorders. Workstream 1 will outline best collaborative practices, informing the research network. Workstream 2 will use arts-based methodologies to set research priorities, with emphasis on the perspectives of underrepresented groups. Workstream 3 will support interdisciplinary collaborations to develop innovative research. Finally, workstream 4 will maximise knowledge mobilisation with the aim of reducing barriers to rapid incorporation of research into policy and clinical practice. A core aim of EDAC is to embed a neurodiversity-affirming culture within eating disorder research and to support the development of a new generation of researchers conducting innovative and meaningful research with the potential to improve clinical outcomes.
A gap in the literature exists pertaining to a global research nurse/research midwife resources and communication skill set necessary to engage with participants of diverse populations and geographic regions in the community or home-based conduct of decentralized clinical trials.
Aims:
An embedded mixed methods study was conducted to examine research nurse/research midwife knowledge base, experiences, and communication skill sets pertaining to decentralized trials across global regions engaged in remote research: the USA, Republic of Ireland, United Kingdom, and Australia.
Methods:
An online survey was deployed across international research nurse/research midwife stakeholder groups, collecting demographics, decentralized trial experience, barriers and facilitators to optimal trial conduct, and the self-perceived communication competence (SPCC) and interpersonal communication competence (IPCC) instruments.
Results:
86 research nurses and research midwives completed the survey across all countries: The SPCC and IPCC results indicated increased clinical research experience significantly correlated with increased SPCC score (p < 0.05). Qualitative content analysis revealed five themes: (1) Implications for Role, (2) Safety and Wellbeing, (3) Training and Education, (4) Implications for Participants, and (5) Barriers and Facilitators.
Conclusions:
Common trends and observations across the global sample can inform decentralized trial resource allocation and policy pertaining to the research nurse/research midwife workforce. This study demonstrates shared cultural norms of research nursing and midwifery across varied regional clinical trial ecosystems.
Women with bipolar disorder have a high recurrence rate in the perinatal period. However, the use of prophylactic medication can be a concern during pregnancy and breastfeeding. There are few studies looking at the impact of prophylactic medication on the risk of recurrence.The aims of this study are to describe the use of medication in women with bipolar disorder in the perinatal period and the impact of that prophylactic medication on the rate of postnatal recurrence.
Methods
The BDRN (Bipolar Disorder Research Network Study) is the largest individual network of individuals with bipolar disorder and related mood disorders in the world. The BDRN pregnancy study is a prospective observational study which took place in the UK. We collected sociodemographic, clinical and medication data from pregnant women with a diagnosis of bipolar disorder and who were euthymic entering the postpartum period. The clinical data were collected via interviews during pregnancy and the postpartum and access to clinical records where those were available.
Data were analysed for association using χ2 tests and logistic regression.
Results
Our total sample for this analysis comprised of 103 women who met the criteria.
We found that 71 (70%) were taking medication at delivery: 43 (43%) antipsychotics, 9 (9%) antidepressants, 10 (10%) mood stabilisers, (6 lithium, 4 anticonvulsants and 9 multiple medication classes).
Of the total sample, 44 (43%) experienced a postpartum recurrence: 21 (20%) had an episode of postpartum psychosis, 15 (15%) of non-psychotic depression and 8 (8%) of hypomania. Of the postpartum psychotic episodes 11 were of mania with psychosis, 8 of mania without psychosis and 2 of psychotic depression.
There was no significant association between taking medication at delivery and postpartum recurrence χ2 (1)=0.116, p=0.73.
In a multivariable analysis there continued to be no association when adjusted for age, ethnicity, parity, severity (previous admissions, age at impairment, bipolar subtype) and previous psychotic symptoms aOR 1.35 95%CI [0.45; 4.00], p=0.59.
Conclusion
A high number of bipolar women are taking medication at delivery and in the majority, antipsychotics are prescribed. The postnatal recurrence rate in both medicated and unmedicated women is high.
Our findings align with recent electronic health records and observational studies, but differ from older clinical cohort and higher Lithium-prescribing sample studies. Limitations include the study design and confounding by indication. Further research in larger populations is necessary to inform clinical decision-making for women and their healthcare providers.
Infants and children born with CHD are at significant risk for neurodevelopmental delays and abnormalities. Individualised developmental care is widely recognised as best practice to support early neurodevelopment for medically fragile infants born premature or requiring surgical intervention after birth. However, wide variability in clinical practice is consistently demonstrated in units caring for infants with CHD. The Cardiac Newborn Neuroprotective Network, a Special Interest Group of the Cardiac Neurodevelopmental Outcome Collaborative, formed a working group of experts to create an evidence-based developmental care pathway to guide clinical practice in hospital settings caring for infants with CHD. The clinical pathway, “Developmental Care Pathway for Hospitalized Infants with Congenital Heart Disease,” includes recommendations for standardised developmental assessment, parent mental health screening, and the implementation of a daily developmental care bundle, which incorporates individualised assessments and interventions tailored to meet the needs of this unique infant population and their families. Hospitals caring for infants with CHD are encouraged to adopt this developmental care pathway and track metrics and outcomes using a quality improvement framework.
Translational research should examine racism and bias and improve health equity. We designed and implemented a course for the Master of Science in Clinical Investigation program of the Northwestern University Clinical and Translational Sciences Institute. We describe curriculum development, content, outcomes, and revisions involving 36 students in 2 years of “Anti-Racist Strategies for Clinical and Translational Science.” Ninety-six percent of students reported they would recommend the course. Many reported changes in research approaches based on course content. A course designed to teach anti-racist research design is feasible and has a positive short-term impact on learners.
Bipolar disorder is a chronic and severe mental health disorder. Early stratification of individuals into subgroups based on age at onset (AAO) has the potential to inform diagnosis and early intervention. Yet, the psychosocial predictors associated with AAO are unknown.
Aims
We aim to identify psychosocial factors associated with bipolar disorder AAO.
Method
Using data from the Bipolar Disorder Research Network UK, we employed least absolute shrinkage and selection operator regression to identify psychosocial factors associated with bipolar disorder AAO. Twenty-eight factors were entered into our model, with AAO as our outcome measure.
Results
We included 1022 participants with bipolar disorder (μ = 23.0, s.d. ± 9.86) in our model. Six variables predicted an earlier AAO: childhood abuse (β = −0.2855), regular cannabis use in the year before onset (β = −0.2765), death of a close family friend or relative in the 6 months before onset (β = −0.2435), family history of suicide (β = −0.1385), schizotypal personality traits (β = −0.1055) and irritable temperament (β = −0.0685). Five predicted a later AAO: the average number of alcohol units consumed per week in the year before onset (β = 0.1385); birth of a child in the 6 months before onset (β = 0.2755); death of parent, partner, child or sibling in the 6 months before onset (β = 0.3125); seeking work without success for 1 month or more in the 6 months before onset (β = 0.3505) and a major financial crisis in the 6 months before onset (β = 0.4575).
Conclusions
The identified predictor variables have the potential to help stratify high-risk individuals into likely AAO groups, to inform treatment provision and early intervention.
This report presents critical new evidence on the size of the widening health gap. New geographical data are presented and displayed in striking graphical form. The Widening Gap should be read alongside Inequalities in Health: The Evidence Presented to the Independent Inquiry into Inequalities in Health (The Policy Press, 1999).
Entrepreneurial action is the central idea that motivates the study of law and entrepreneurship.1 Promoting entrepreneurial action is a fundamental goal of the US legal system.2 Although existing definitions of entrepreneurial action are legion,3 these definitions have been difficult to operationalize in a legal context because the application of legal rules does not turn on whether someone is acting as an entrepreneur.4 In this chapter, therefore, we offer a new conception of entrepreneurship that is consistent with understandings of entrepreneurship in other disciplines while being accessible and meaningful to legal scholars. We assert, in simplest terms, that the core function of entrepreneurs is to challenge incumbency.
The conference that prompted the publication of this volume was motivated by a simple idea, that the core function of entrepreneurs is to challenge incumbency. The novelty inherent in entrepreneurial action implies uncertainty, and hence experimentation, learning, and selection. We invited conference participants to explore issues such as: the incentive effect of legal rules on startup activity; the role of private ordering in facilitating or impeding entrepreneurial action; the influence of legal rules and practices on the creation of entrepreneurial opportunities; the role of law in promoting or foreclosing market entry; or the effect of entrepreneurial action on legal doctrine. This volume is the result of that invitation.