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Prenatal alcohol exposure (PAE) is associated with cognitive, behavioural, and developmental impairments throughout the lifespan of affected individuals, but there is limited evidence on how early this impact can be identified through routinely collected childhood data. This paper explores the relationship between PAE and the Early Years Foundation Stage Profile (EYFSP), a statutory teacher-based summative assessment of early development in relation to learning goals. This analysis uses the Born in Bradford dataset, a UK based cohort (n = 13,959; full dataset), which collected self-reported PAE from 11,905 mothers, with 19.8% reporting drinking alcohol at some point during pregnancy. Coarsened exact matching was conducted to examine relationships between patterns of PAE and children achieving a ‘Good Level of Development’ on the EYFSP, a binary variable assessed at 4–5 years of age, controlling for known confounders, including deprivation, mother’s education, exposure to other teratogenic substances, and child’s age at assessment. Additionally, we examined EYFSP sub-scores to identify specific developmental deficits associated with PAE.
The key finding is a statistically significant association between PAE at a level of consuming 5 or more units of alcohol (equivalent to 50 ml or 40 g of pure alcohol) at least once per week from the 4th month of pregnancy onwards and lower EYFSP scores when accounting for established confounding variables. These findings highlight that the detrimental impact of alcohol during pregnancy can be identified using statutory educational assessments. This has implications internationally for prevention work, policy, and commissioning of support services for people impacted by PAE.
Traditional approaches for evaluating the impact of scientific research – mainly scholarship (i.e., publications, presentations) and grant funding – fail to capture the full extent of contributions that come from larger scientific initiatives. The Translational Science Benefits Model (TSBM) was developed to support more comprehensive evaluations of scientific endeavors, especially research designed to translate scientific discoveries into innovations in clinical or public health practice and policy-level changes. Here, we present the domains of the TSBM, including how it was expanded by researchers within the Implementation Science Centers in Cancer Control (ISC3) program supported by the National Cancer Institute. Next, we describe five studies supported by the Penn ISC3, each focused on testing implementation strategies informed by behavioral economics to reduce key practice gaps in the context of cancer care and identify how each study yields broader impacts consistent with TSBM domains. These indicators include Capacity Building, Methods Development (within the Implementation Field) and Rapid Cycle Approaches, implementing Software Technologies, and improving Health Care Delivery and Health Care Accessibility. The examples highlighted here can help guide other similar scientific initiatives to conceive and measure broader scientific impact to fully articulate the translation and effects of their work at the population level.
Milk production declines as dairy cows enter late lactation, resulting in reduced milk quality and negatively impacting milk processability, such as rennet coagulation time (RCT), milk pH and ethanol stability (ES), leading to seasonality issues for milk processors. Multispecies forages, containing grass, legume and herb species, require lower N inputs and are of interest to dairy farmers. However, little is known about the effect of grazing multispecies forages on milk processability characteristics in late lactation dairy cows. Forty-five autumn-calving dairy cows in late lactation were allocated to 1 of 3 grazing forages; perennial ryegrass (PRG; Lolium perenne), perennial ryegrass and white clover (Trifolium pratense) (PRGWC), and a 6 – species multispecies forage (MULTI) containing perennial ryegrass, timothy (Phleum pratense), white clover, red clover (Trifolium repens), chicory (Cichorium intybus) and plantain (Plantago lanceolata). Cows were allocated 12 kg DM grazed forage and supplemented with a grass – silage TMR and concentrate. Forage DMI was significantly lower for cows grazing PRG. Milk yield increased when cows grazed PRGWC (18.07 kg/d) and MULTI (17.84 kg/d) compared to PRG (16.08 kg/d). Milk RCT (mins) and ES (%) were unaffected by treatment. However, offering cows PRGWC and MULTI increased the concentration of C18:2 cis – 9, 12 and C18:3 cis – 9, 12, 15 in milk compared to PRG. Compared to PRG, grazing forages containing clover and herb species improved milk yield and beneficially altered milk fatty acid profile in late lactation dairy cows without negatively impacting milk processability.
The 2014 US National Strategy for Combating Antibiotic-Resistant Bacteria (CARB) aimed to reduce inappropriate inpatient antibiotic use by 20% for monitored conditions, such as community-acquired pneumonia (CAP), by 2020. We evaluated annual trends in length of therapy (LOT) in adults hospitalized with uncomplicated CAP from 2013 through 2020.
Methods:
We conducted a retrospective cohort study among adults with a primary diagnosis of bacterial or unspecified pneumonia using International Classification of Diseases Ninth and Tenth Revision codes in MarketScan and the Centers for Medicare & Medicaid Services databases. We included patients with length of stay (LOS) of 2–10 days, discharged home with self-care, and not rehospitalized in the 3 days following discharge. We estimated inpatient LOT based on LOS from the PINC AI Healthcare Database. The total LOT was calculated by summing estimated inpatient LOT and actual postdischarge LOT. We examined trends from 2013 to 2020 in patients with total LOT >7 days, which was considered an indicator of likely excessive LOT.
Results:
There were 44,976 and 400,928 uncomplicated CAP hospitalizations among patients aged 18–64 years and ≥65 years, respectively. From 2013 to 2020, the proportion of patients with total LOT >7 days decreased by 25% (68% to 51%) among patients aged 18–64 years and by 27% (68%–50%) among patients aged ≥65 years.
Conclusions:
Although likely excessive LOT for uncomplicated CAP patients decreased since 2013, the proportion of patients treated with LOT >7 days still exceeded 50% in 2020. Antibiotic stewardship programs should continue to pursue interventions to reduce likely excessive LOT for common infections.
Diminished skeletal muscle strength and size, termed sarcopenia, contributes substantially to physical disability, falls, dependence and reduced quality of life among older people. Physical activity and nutrition are the cornerstones of sarcopenia prevention and treatment. The optimal daily protein intake required to preserve muscle mass and function among older adults is a topic of intense scientific debate. Older adults require protein intakes about 67 % higher than their younger counterparts to maximally stimulate postprandial muscle protein synthesis rates. In addition, evidence suggests a possible benefit of increasing protein intake above the population reference intake (0⋅83 g/kg/d) on lean mass and, when combined with exercise training, muscle strength. In addition to protein quantity, protein quality, the pattern of protein intake over the day and specific amino acids (i.e. leucine) represent key considerations. Long-chain n-3 PUFA (LC n-3 PUFA) supplementation has been shown to enhance muscle protein synthesis rates, increase muscle mass and function and augment adaptations to resistance training in older adults. Yet, these effects are not consistent across all studies. Emerging evidence indicates that an older person's dietary, phenotypic and behavioural characteristics may modulate the efficacy of protein and LC n-3 PUFA interventions for promoting improvements in muscle mass and function, highlighting the potential inadequacy of a ‘one-size-fits-all’ approach. The application of personalised or precision nutrition to sarcopenia represents an exciting and highly novel field of research with the potential to help resolve inconsistencies in the literature and improve the efficacy of dietary interventions for sarcopenia.
The coronavirus disease 2019 pandemic caused substantial changes to healthcare delivery and antibiotic prescribing beginning in March 2020. To assess pandemic impact on Clostridioides difficile infection (CDI) rates, we described patients and trends in facility-level incidence, testing rates, and percent positivity during 2019–2020 in a large cohort of US hospitals.
Methods:
We estimated and compared rates of community-onset CDI (CO-CDI) per 10,000 discharges, hospital-onset CDI (HO-CDI) per 10,000 patient days, and C. difficile testing rates per 10,000 discharges in 2019 and 2020. We calculated percent positivity as the number of inpatients diagnosed with CDI over the total number of discharges with a test for C. difficile. We used an interrupted time series (ITS) design with negative binomial and logistic regression models to describe level and trend changes in rates and percent positivity before and after March 2020.
Results:
In pairwise comparisons, overall CO-CDI rates decreased from 20.0 to 15.8 between 2019 and 2020 (P < .0001). HO-CDI rates did not change. Using ITS, we detected decreasing monthly trends in CO-CDI (−1% per month, P = .0036) and HO-CDI incidence (−1% per month, P < .0001) during the baseline period, prior to the COVID-19 pandemic declaration. We detected no change in monthly trends for CO-CDI or HO-CDI incidence or percent positivity after March 2020 compared with the baseline period.
Conclusions:
While there was a slight downward trajectory in CDI trends prior to March 2020, no significant change in CDI trends occurred during the COVID-19 pandemic despite changes in infection control practices, antibiotic use, and healthcare delivery.
Response to lithium in patients with bipolar disorder is associated with clinical and transdiagnostic genetic factors. The predictive combination of these variables might help clinicians better predict which patients will respond to lithium treatment.
Aims
To use a combination of transdiagnostic genetic and clinical factors to predict lithium response in patients with bipolar disorder.
Method
This study utilised genetic and clinical data (n = 1034) collected as part of the International Consortium on Lithium Genetics (ConLi+Gen) project. Polygenic risk scores (PRS) were computed for schizophrenia and major depressive disorder, and then combined with clinical variables using a cross-validated machine-learning regression approach. Unimodal, multimodal and genetically stratified models were trained and validated using ridge, elastic net and random forest regression on 692 patients with bipolar disorder from ten study sites using leave-site-out cross-validation. All models were then tested on an independent test set of 342 patients. The best performing models were then tested in a classification framework.
Results
The best performing linear model explained 5.1% (P = 0.0001) of variance in lithium response and was composed of clinical variables, PRS variables and interaction terms between them. The best performing non-linear model used only clinical variables and explained 8.1% (P = 0.0001) of variance in lithium response. A priori genomic stratification improved non-linear model performance to 13.7% (P = 0.0001) and improved the binary classification of lithium response. This model stratified patients based on their meta-polygenic loadings for major depressive disorder and schizophrenia and was then trained using clinical data.
Conclusions
Using PRS to first stratify patients genetically and then train machine-learning models with clinical predictors led to large improvements in lithium response prediction. When used with other PRS and biological markers in the future this approach may help inform which patients are most likely to respond to lithium treatment.
We present continuous estimates of snow and firn density, layer depth and accumulation from a multi-channel, multi-offset, ground-penetrating radar traverse. Our method uses the electromagnetic velocity, estimated from waveform travel-times measured at common-midpoints between sources and receivers. Previously, common-midpoint radar experiments on ice sheets have been limited to point observations. We completed radar velocity analysis in the upper ~2 m to estimate the surface and average snow density of the Greenland Ice Sheet. We parameterized the Herron and Langway (1980) firn density and age model using the radar-derived snow density, radar-derived surface mass balance (2015–2017) and reanalysis-derived temperature data. We applied structure-oriented filtering to the radar image along constant age horizons and increased the depth at which horizons could be reliably interpreted. We reconstructed the historical instantaneous surface mass balance, which we averaged into annual and multidecadal products along a 78 km traverse for the period 1984–2017. We found good agreement between our physically constrained parameterization and a firn core collected from the dry snow accumulation zone, and gained insights into the spatial correlation of surface snow density.
The thickness of glaciers in High-Mountain Asia (HMA) is critical in determining when the ice reserve will be lost as these glaciers thin but is remarkably poorly known because very few measurements have been made. Through a series of ground-based and airborne field tests, we have adapted a low-frequency ice-penetrating radar developed originally for Antarctic over-snow surveys, for deployment as a helicopter-borne system to increase the number of measurements. The manoeuvrability provided by helicopters and the ability of our system to detect glacier beds through thick, dirty, temperate ice makes it well suited to increase greatly the sample of measurements available for calibrating ice thickness models on the regional and global scale. The Bedmap Himalayas radar-survey system can reduce the uncertainty in present-day ice volumes and therefore in projections of when HMA's river catchments will lose this hydrological buffer against drought.
Environment early in life may have a long-lasting impact on mental health through epigenetic mechanisms. We studied the effect of early life adversity (ELA) on high risk subjects for Depression (MDD). 20 unaffected first degree relatives (FHP) and 20 controls (FHN) underwent high resolution MRI. We used CTQ questionnaire to assess ELA. Manual tracing of hippocampal subregions and voxel-based morphometry (VBM) analysis were used. We concluded that FHP individuals had reduced volume of those brain areas of emotional processing, in particular if they had a history of ELA. This suggests that ELA might influence brain structure via epigenetic mechanisms and structural changes may precede MDD.
We determined how the brain-derived neurotrphic factor (BDNF) Val66Met polymorphism and ELA affect volumetric measures of hippocampus. 62 MDD patients and 71 healthy controls underwent high-resolution MRI. We manually teaced hippocampi, assessed childhood adversity with CTQ and genotyped Val66Met BDNF. Met-allele carriers showed significantly smaller hippocampal volumes when they had a history of ELA, both in patients and controls. Our results highlight how relevant stress-gene interactions are for hippocampal volume reductions.
Another 37 patients with MDD and 42 healthy participants underwent Diffussion Tensor Imaging (DTI). Deterministic tractography was applied and Val66Met BDNF polymorphism genotyped. Patients carrying the BDNF met-allele had smaller FA in Uncinate Fasciculus (UF) compared to homozygous for val-allele and controls. The met allele of the BDNF polymorphism seems to render subjects more vulnerable for dysfunctions associated with the UF, a brain region which is very closely related to emotional and cognitive function.
Identify the training/ learning needs perceived by Trainees using an online questionnaire developed for the task.
Methods
• Literature review.
• Ethical Approval.
• Questionnaire developed, piloted.
• Dissemination- of the survey to all trainees with email addresses registered with the College of Psychiatry of Ireland. Anonymised and encrypted survey,
• 2009 survey- essentially functioned as pilot for 2010. Trainees were re-surveyed and the second national conference was held. Survey results analysed using surveymonkey tools, Excel and SPSS.
The provision of support for people with autism spectrum disorder (ASD) within the community is improving as a consequence of policy and legislative changes. However, specialist services are not currently provided in prisons.
Objectives
This aim of the study was to determine the extent of ASD and co-occurring mental health problems among prisoners. We tested the hypothesis that ASD traits would be unrecognised by prison staff and would be significantly associated with increased rates of anxiety, depression and suicidality.
Methods
ASD traits were measured among 240 prisoners in a resettlement prison in London, UK using the 20-item Autism Quotient (AQ-20). Anxiety, depression and suicidality were assessed using the Mini International Neuropsychiatric Interview (MINI).
Results
There were 39 participants (16%) with an AQ-20 score ≥10; indicating significant autistic traits. Mental health data were available for 37 ‘high autistic trait’ participants and another 101 prisoners with no/low ASD traits. There was a significant positive association between AQ-20 and suicidality scores (r=.29, p=0.001). Participants with ASD traits had significantly higher suicidality scores (means=15.1 vs. 5, p= 0.001) and chi-square analysis showed that they were more likely to have a high suicidality rating (27% vs. 8%, p=0.003) than those without ASD traits. Moreover, those with ASD were significantly more likely to be experiencing a current episode of depression (30% vs. 6%, p<0.001) or Generalised Anxiety Disorder (GAD) (27% vs. 11% p=0.019).
Conclusion
Our initial data suggests that severity of ASD traits is a risk factor for suicidality and common mental health problems among prisoners.
Background Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness.
Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated.
Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated?
Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD.
Silicon carbide together with amorphous carbon are the main components of dust grains in the atmospheres of C-rich AGB stars. Small gaseous Si-C bearing molecules (such as SiC, SiCSi, and SiC2) are efficiently formed close to the stellar photosphere. They likely condense onto dust seeds owing to their highly refractory nature at the lower temperatures (i.e., below about 2500 K) in the dust growth zone which extends a few stellar radii from the photosphere. Beyond this region, the abundances of Si-C bearing molecules are expected to decrease until they are eventually reformed in the outer shells of the circumstellar envelope, owing to the interaction between the gas and the interstellar UV radiation field. Our goal is to understand the time-dependent chemical evolution of Si-C bond carriers probed by molecular spectral line emission in the circumstellar envelope of IRC+10216 at millimeter wavelengths.
Cores dating back to deglaciation were taken from three lakes in Atlantic Canada and analyzed for arcellaceans and pollen. Paleotemperatures and paleo-precipitation were calculated from the pollen data using transfer functions. A sudden warming is recorded by the pollen around 10,000 years B.P., followed by a general warming to the mid Holocene Hypsithermal, then by a decrease in temperature and increase in effective precipitation to the present. The three lakes, two in western Newfoundland and one in eastern Nova Scotia, contain similar late glacial (13-10 ka), early Holocene (10-8 ka), mid Holocene (8-4 ka), and late Holocene (4-0 ka) arcellacean assemblages. Immediately following retreat of the ice sheets, Centropyxis aculeata, Centropyxis constricta, Difflugia oblonga, Difflugia urceolata, and Difflugia corona were common. The latter part of the late glacial is characterized by sparse assemblages dominated by C. aculeata. The arcellacean record thus suggests a climatic reversal in Atlantic Canada between 11,500 and 10,000 years B.P., analogous to the Younger Dryas, although this is not recorded by the pollen. Species diversity increased sharply at the beginning of the Holocene, and D. oblonga is the dominant taxon in early Holocene sediments. Difflugia oblonga remained common through the mid Holocene, but percentages of C. aculeata were very low, and Pontigulasia compressa and Difflugia bacillifera peaked in abundance during the Hypsithermal. The late Holocene is characterized by a resurgence in C. aculeata at the expense of other taxa. The increase in Heleopera sphagni and Nebella collaris since 5,000 years B.P. at the two sites in southwestern Newfoundland reflects paludification in response to increased precipitation since the Hypsithermal. Because the changes in arcellacean assemblages are regionally synchronous in all three lakes and coincide with climatically driven vegetational successions indicated by the pollen record, arcellaceans appear to respond to climatic change, and thus may be useful paleoecological and paleolimnological indicators. With their quicker generation time, these protists may be better suited than pollen to recording short-lived phenomena, like the mid-Holocene Hypsithermal and the Younger Dryas reversal.