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Physical health checks in primary care for people with severe mental illness ((SMI) defined as schizophrenia, bipolar disorders and non-organic psychosis) aim to reduce health inequalities. Patients who decline or are deemed unsuitable for screening are removed from the denominator used to calculate incentivisation, termed exception reporting.
Aims
To describe the prevalence of, and patient characteristics associated with, exception reporting in patients with SMI.
Method
We identified adult patients with SMI from the UK Clinical Practice Research Datalink (CPRD), registered with a general practice between 2004 and 2018. We calculated the annual prevalence of exception reporting and investigated patient characteristics associated with exception reporting, using logistic regression.
Results
Of 193 850 patients with SMI, 27.7% were exception reported from physical health checks at least once. Exception reporting owing to non-response or declining screening increased over the study period. Patients of Asian or Black ethnicity (Asian: odds ratio 0.72, 95% CI 0.65–0.80; Black: odds ratio 0.86, 95% CI 0.76–0.97; compared with White) and women (odds ratio 0.90, 95% CI 0.88–0.92) had a reduced odds of being exception reported, whereas patients diagnosed with ‘other psychoses’ (odds ratio 1.19, 95% CI 1.15–1.23; compared with bipolar disorder) had increased odds. Younger patients and those diagnosed with schizophrenia were more likely to be exception reported owing to informed dissent.
Conclusions
Exception reporting was common in people with SMI. Interventions are required to improve accessibility and uptake of physical health checks to improve physical health in people with SMI.
Late-life affective disorders (LLADs) are common and are projected to increase by 2050. There have been several studies linking late-life depression to an increased risk of dementia, but it is unclear if bipolar affective disorder or anxiety disorders pose a similar risk.
Aims
We aimed to compare the risk of LLADs progressing to all-cause dementia, and the demographic and clinical variables mediating the risk.
Methods
We used the South London and Maudsley National Health Service Foundation Trust Clinical Records Interactive Search system to identify patients aged 60 years or older with a diagnosis of any affective disorder. Cox proportional hazard models were used to determine differences in dementia risk between late-life anxiety disorders versus late-life depression, and late-life bipolar disorder versus late-life depression. Demographic and clinical characteristics associated with the risk of dementia were investigated.
Results
Some 5695 patients were identified and included in the final analysis. Of these, 388 had a diagnosis of bipolar affective disorder, 1365 had a diagnosis of an anxiety disorder and 3942 had a diagnosis of a depressive disorder. Bipolar affective disorder was associated with a lower hazard of developing dementia compared to depression (adjusted model including demographics and baseline cognition, hazard ratio: 0.60; 95% CI: 0.41–0.87). Anxiety disorders had a similar hazard of developing dementia (adjusted hazard ratio: 1.05; 95% CI: 0.90–1.22). A prior history of a depressive disorder reduced the risk of late-life depression progressing to dementia – suggesting the new onset of a depressive disorder in later life is associated with higher risk – but a prior history of anxiety disorders or bipolar affective disorder did not alter risk.
Conclusions
LLADs have a differential risk of developing all-cause dementia, with demographic- and illness-related factors influencing the risk. Further prospective cohort studies are needed to explore the link between LLADs and dementia development, and mediators of the lower risk of dementia associated with late-life bipolar disorder compared to late-life depression.
Reliable and specific biomarkers that can distinguish autism spectrum disorders (ASDs) from commonly co-occurring attention-deficit/hyperactivity disorder (ADHD) are lacking, causing misses and delays in diagnosis, and reducing access to interventions and quality of life.
Aims
To examine whether an innovative, brief (1-min), videogame method called Computerised Assessment of Motor Imitation (CAMI), can identify ASD-specific imitation differences compared with neurotypical children and children with ADHD.
Method
This cross-sectional study used CAMI alongside standardised parent-report (Social Responsiveness Scale, Second Edition) and observational measures of autism (Autism Diagnostic Observation Schedule-Second Edition; ADOS-2), ADHD (Conners) and motor ability (Physical and Neurological Examination for Soft Signs). The sample comprised 183 children aged 7–13 years, with ADHD (without ASD), with ASD (with and without ADHD) and who were neurotypical.
Results
Regardless of co-occurring ADHD, children with ASD showed poorer CAMI performance than neurotypical children (P < 0.0001; adjusted R2 = 0.28), whereas children with ADHD and neurotypical children showed similar CAMI performance. Receiver operating curve and support vector machine analyses showed that CAMI distinguishes ASD from both neurotypical children (80% true positive rate) and children with ADHD (70% true positive rate), with a high success rate significantly above chance. Among children with ASD, poor CAMI performance was associated with increased autism traits, particularly ADOS-2 measures of social affect and restricted and repetitive behaviours (adjusted R2 = 0.23), but not with ADHD traits or motor ability.
Conclusions
Four levels of analyses confirm that poor imitation measured by the low-cost and scalable CAMI method specifically distinguishes ASD not only from neurotypical development, but also from commonly co-occurring ADHD.
First-order stochastic dominance is a core principle in rational decision-making. If lottery A has a higher or equal chance of winning an amount $x $ or more compared to lottery B for all x, and a strictly higher chance for at least one $x $, then A should be preferred over B. Previous research suggests that violations of this principle may result from failures in recognizing coalescing equivalence. In Expected Utility Theory (EUT) and Cumulative Prospect Theory (CPT), gambles are represented as probability distributions, where probabilities of equivalent events can be combined, ensuring stochastic dominance. In contrast, the Transfer of Attention Exchange (TAX) model represents gambles as trees with branches for each probability and outcome, making it possible for coalescing and stochastic dominance violations to occur. We conducted two experiments designed to train participants in identifying dominance by splitting coalesced gambles. By toggling between displays of coalesced and split forms of the same choice problem, participants were instructed to recognize stochastic dominance. Despite this training, violations of stochastic dominance were only minimally reduced, as if people find it difficult—or even resist—shifting from a trees-with-branches representation (as in the TAX model) to a cognitive recognition of the equivalence among different representations of the same choice problem.
Reducing inequalities in preconception health and care is critical to improving the health and life chances of current and future generations. A hybrid workshop was held at the 2023 UK Preconception Early and Mid-Career Researchers (EMCR) Network conference to co-develop recommendations on ways to address inequalities in preconception health and care. The workshop engaged multi-disciplinary professionals across diverse career stages and people with lived experience (total n = 69). Interactive discussions explored barriers to achieving optimal preconception health, driving influences of inequalities and recommendations. The Socio-Ecological Model framed the identified themes, with recommendations structured at interpersonal (e.g. community engagement), institutional (e.g. integration of preconception care within existing services) and environmental/societal levels (e.g. education in schools). The co-developed recommendations provide a framework for addressing inequalities in preconception health, emphasising the importance of a whole-systems approach. Further research and evidence-based interventions are now needed to advance the advocacy and implementation of our recommendations.
To measure SARS-CoV-2 anti-nucleocapsid (anti-N) antibody seropositivity among healthcare personnel (HCP) without a history of COVID-19 and to identify HCP characteristics associated with seropositivity.
Design:
Prospective cohort study from September 22, 2020, to March 3, 2022.
Setting:
A tertiary care academic medical center.
Participants:
727 HCP without prior positive SARS-CoV-2 PCR testing were enrolled; 559 HCP successfully completed follow-up.
Methods:
At enrollment and follow-up 1–6 months later, HCP underwent SARS-CoV-2 anti-N testing and were surveyed on demographics, employment information, vaccination status, and COVID-19 symptoms and exposures.
Results:
Of 727 HCP enrolled, 27 (3.7%) had a positive SARS-CoV-2 anti-N test at enrollment. Seropositive HCPs were more likely to have a household exposure to COVID-19 in the past 30 days (OR 7.92, 95% CI 2.44–25.73), to have had an illness thought to be COVID-19 (4.31, 1.94–9.57), or to work with COVID-19 patients more than half the time (2.09, 0.94–4.77). Among 559 HCP who followed-up, 52 (9.3%) had a positive SARS-CoV-2 anti-N antibody test result. Seropositivity at follow-up was associated with community/household exposures to COVID-19 within the past 30 days (9.50, 5.02–17.96; 2.90, 1.31–6.44), having an illness thought to be COVID-19 (8.24, 4.44–15.29), and working with COVID-19 patients more than half the time (1.50, 0.80–2.78).
Conclusions:
Among HCP without prior positive SARS-CoV-2 testing, SARS-CoV-2 anti-N seropositivity was comparable to that of the general population and was associated with COVID-19 symptomatology and both occupational and non-occupational exposures to COVID-19.
Well-crystallized laumontite has been found for the first time precipitating naturally at the earth's surface at temperatures of 89° to 43°C as a component of gray to white coatings and efflorescences on exterior surface and as precipitates on interior fractures of stones and blocks lining Hot Springs Creek immediately downstream from Sespe Hot Springs, Ventura County, California. X-ray powder diffraction, scanning electron microscope (SEM), and electron microprobe analyses show thenardite to be the dominant phase in the exterior coatings, in association with minor microcrystalline (<50 μm) laumontite and gypsum. Macrocrystalline (>1 mm) laumontite is the dominant phase in interior fracture coatings and is associated with quartz, potassium feldspar, and gypsum. Trace amounts of smectite(?), halite, a mercury sulfide, an iron sulfide, an iron-bearing mineral (possibly an oxide or carbonate), and a copper mineral are also present. Zeolites other than laumontite have not been seen, and carbonate minerals are either entirely or nearly absent. SEM textures indicate nonreactive intergrowths of laumontite, quartz, potassium feldspar, and gypsum. Unbroken laumontite crystals are generally euhedral or have skeletal growth characteristics and exhibit sharp, fresh, non-corroded faces, edges, and corners.
The water issuing from the hottest and largest spring is 89°C, has a pH of 7.74, 1200 mg/liter total dissolved solids, and contains Na+, Cl−, SO42-, and H4SiO4 as the dominant dissolved species. Computations indicate that the water is supersaturated with respect to laumontite, quartz, chlorite, and prehnite and is slightly undersaturated with respect to calcite and noncrystalline silica. Water-dominated water-rock interaction is indicated by isotopic analyses. The δO18 composition expectable on the basis of the −81‰ δD composition is −11.38‰ instead of the −9.5‰ actually found (all referred to SMOW). The water chemistry suggests that the subsurface water source may have a temperature of 125°–135°C. This temperature range, together with the regionally low geothermal gradient, implies that the source is probably 3550 to 3900 m beneath the springs in fractured and permeable Mesozoic and older plutonites and gneisses.
The discovery of laumontite crystallizing at atmospheric pressure and 43°C (or lower) provides important insight into the processes responsible for burial diagenetic laumontite and a valuable perspective on the zeolite metamorphic facies.
To describe changes in home food availability during early childhood, including modified, developmentally sensitive obesogenic scores, and to determine whether home food availability is associated with food and nutrient intakes of children concurrently, over time.
Design:
Data were drawn from the STRONG Kids 2 longitudinal, birth cohort to achieve the study objectives. Home food availability was assessed with the Home Food Inventory (HFI) and included fifteen food groups (e.g. fruit and vegetables) and three obesogenic scores (one original and two modified). Food and nutrient intakes were measured using the Block FFQ and included twenty-seven food groups and eighteen nutrients (e.g. vitamins A and C, protein). HFI and FFQ were completed by trained researchers or mothers, respectively, at 24, 36 and 48 months. Repeated-measures ANOVA and Spearman’s correlations were used to achieve the study objectives.
Setting:
Central Illinois, USA.
Participants:
Participants were 468 children at 24, 36 and 48 months of age.
Results:
Availability of less nutritious foods and obesogenic foods and beverages increased as children aged, and availability of both nutritious and less nutritious foods were associated with child food and nutrient intake. The three obesogenic scores demonstrated similar, positive associations with the intake of energy, saturated fat, added sugars and kilocalories from sweets.
Conclusion:
These findings offer novel insight into changes in home food availability and associations with food and nutrient intake during early childhood. Additional attention is needed examining antecedents (e.g. built environments, purchasing behaviours) and consequences (e.g. child diet quality and weight) of home food availability.
Sensory differences and anxiety disorders are highly prevalent in autistic individuals with and without ADHD. Studies have shown that sensory differences and anxiety are associated and that intolerance of uncertainty (IU) plays an important role in this relationship. However, it is unclear as to how different levels of the sensory processing pathway (i.e., perceptual, affective, or behavioral) contribute. Here, we used psychophysics to assess how alterations in tactile perception contribute to questionnaire measures of sensory reactivity, IU, and anxiety. Thirty-eight autistic children (aged 8-12 years; 27 with co-occurring ADHD) were included. Consistent with previous findings, mediation analyses showed that child-reported IU fully mediated an association between parent-reported sensory reactivity and parent-reported anxiety and that anxiety partially mediated an association between sensory reactivity and IU. Of the vibrotactile thresholds, only simultaneous frequency discrimination (SFD) thresholds correlated with sensory reactivity. Interestingly, we found that sensory reactivity fully mediated an association between SFD threshold and anxiety, and between SFD threshold and IU. Taken together, those findings suggest a mechanistic pathway whereby tactile perceptual alterations contribute to sensory reactivity at the affective level, leading in turn to increased IU and anxiety. This stepwise association can inform potential interventions for IU and anxiety in autism.
Russian thistle (Salsola tragus L.) is among the most troublesome weeds in cropland and ruderal semiarid areas of the Pacific Northwest (PNW). Predicting S. tragus emergence timing plays a critical role in scheduling weed management measures. The objective of this research was to develop and validate a predictive model of the seedling emergence pattern of S. tragus under field conditions in the PNW to increase the efficacy of control measures targeting this species. The relationship between cumulative seedling emergence and cumulative hydrothermal time under field conditions was modeled using the Weibull function. This model is the first to use hydrothermal time units (HTT) to predict S. tragus emergence and showed a very good fit to the experimental data. According to this model, seedling emergence starts at 5 HTT, and 50% and 90% emergence is completed at 56 HTT and 177 HTT, respectively. For model validation, independent field experiments were carried out. Cumulative seedling emergence was accurately predicted by the model, supporting the idea that this model is robust enough to be used as a predictive tool for S. tragus seedling emergence. Our model can serve as the basis for the development of decision support systems, helping farmers make the best decisions to control S. tragus populations in no-till fallow and spring wheat systems.
Delay discounting—the extent to which individuals show a preference for smaller immediate rewards over larger delayed rewards—has been proposed as a transdiagnostic neurocognitive process across mental health conditions, but its examination in relation to posttraumatic stress disorder (PTSD) is comparatively recent. To assess the aggregated evidence for elevated delay discounting in relation to posttraumatic stress, we conducted a meta-analysis on existing empirical literature. Bibliographic searches identified 209 candidate articles, of which 13 articles with 14 independent effect sizes were eligible for meta-analysis, reflecting a combined sample size of N = 6897. Individual study designs included case-control (e.g. examination of differences in delay discounting between individuals with and without PTSD) and continuous association studies (e.g. relationship between posttraumatic stress symptom severity and delay discounting). In a combined analysis of all studies, the overall relationship was a small but statistically significant positive association between posttraumatic stress and delay discounting (r = .135, p < .0001). The same relationship was statistically significant for continuous association studies (r = .092, p = .027) and case-control designs (r = .179, p < .001). Evidence of publication bias was minimal. The included studies were limited in that many did not concurrently incorporate other psychiatric conditions in the analyses, leaving the specificity of the relationship to posttraumatic stress less clear. Nonetheless, these findings are broadly consistent with previous meta-analyses of delayed reward discounting in relation to other mental health conditions and provide further evidence for the transdiagnostic utility of this construct.
To determine the prevalence of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) IgG nucleocapsid (N) antibodies among healthcare personnel (HCP) with no prior history of COVID-19 and to identify factors associated with seropositivity.
Design:
Prospective cohort study.
Setting:
An academic, tertiary-care hospital in St. Louis, Missouri.
Participants:
The study included 400 HCP aged ≥18 years who potentially worked with coronavirus disease 2019 (COVID-19) patients and had no known history of COVID-19; 309 of these HCP also completed a follow-up visit 70–160 days after enrollment. Enrollment visits took place between September and December 2020. Follow-up visits took place between December 2020 and April 2021.
Methods:
At each study visit, participants underwent SARS-CoV-2 IgG N-antibody testing using the Abbott SARS-CoV-2 IgG assay and completed a survey providing information about demographics, job characteristics, comorbidities, symptoms, and potential SARS-CoV-2 exposures.
Results:
Participants were predominately women (64%) and white (79%), with median age of 34.5 years (interquartile range [IQR], 30–45). Among the 400 HCP, 18 (4.5%) were seropositive for IgG N-antibodies at enrollment. Also, 34 (11.0%) of 309 were seropositive at follow-up. HCP who reported having a household contact with COVID-19 had greater likelihood of seropositivity at both enrollment and at follow-up.
Conclusions:
In this cohort of HCP during the first wave of the COVID-19 pandemic, ∼1 in 20 had serological evidence of prior, undocumented SARS-CoV-2 infection at enrollment. Having a household contact with COVID-19 was associated with seropositivity.
We present the Cosmological Double Radio Active Galactic Nuclei (CosmoDRAGoN) project: a large suite of simulated AGN jets in cosmological environments. These environments sample the intra-cluster media of galaxy clusters that form in cosmological smooth particle hydrodynamics (SPH) simulations, which we then use as inputs for grid-based hydrodynamic simulations of radio jets. Initially conical jets are injected with a range of jet powers, speeds (both relativistic and non-relativistic), and opening angles; we follow their collimation and propagation on scales of tens to hundreds of kiloparsecs, and calculate spatially resolved synthetic radio spectra in post-processing. In this paper, we present a technical overview of the project, and key early science results from six representative simulations which produce radio sources with both core- (Fanaroff-Riley Type I) and edge-brightened (Fanaroff-Riley Type II) radio morphologies. Our simulations highlight the importance of accurate representation of both jets and environments for radio morphology, radio spectra, and feedback the jets provide to their surroundings.
Dental healthcare personnel (DHCP) are at high risk of exposure to coronavirus disease 2019 (COVID-19). We sought to identify how DHCP changed their use of personal protective equipment (PPE) as a result of the COVID-19 pandemic, and to pilot an educational video designed to improve knowledge of proper PPE use.
Design:
The study comprised 2 sets of semistructured qualitative interviews.
Setting:
The study was conducted in 8 dental clinics in a Midwestern metropolitan area.
Participants:
In total, 70 DHCP participated in the first set of interviews; 63 DHCP participated in the second set of interviews.
Methods:
In September–November 2020 and March–October 2021, we conducted 2 sets of semistructured interviews: (1) PPE use in the dental community during COVID-19, and (2) feedback on the utility of an educational donning and doffing video.
Results:
Overall, 86% of DHCP reported having prior training. DHCP increased the use of PPE during COVID-19, specifically N95 respirators and face shields. DHCP reported real-world challenges to applying infection control methods, often resulting in PPE modification and reuse. DHCP reported double masking and sterilization methods to extend N95 respirator use. Additional challenges to PPE included shortages, comfort or discomfort, and compatibility with specialty dental equipment. DHCP found the educational video helpful and relevant to clinical practice. Fewer than half of DHCP reported exposure to a similar video.
Conclusions:
DHCP experienced significant challenges related to PPE access and routine use in dental clinics during the COVID-19 pandemic. An educational video improved awareness and uptake of appropriate PPE use among DHCP.
Management of total anomalous pulmonary venous connections has been extensively studied to further improve outcomes. Our institution previously reported factors associated with mortality, recurrent obstruction, and reintervention. The study purpose was to revisit the cohort of patients and evaluate factors associated with reintervention, and mortality in early and late follow-up.
Methods:
A retrospective review at our institution identified 81 patients undergoing total anomalous pulmonary venous connection repair from January 2002 to January 2018. Demographic and operative variables were evaluated. Anastomotic reintervention (interventional or surgical) and/or mortality were primary endpoints.
Results:
Eighty-one patients met the study criteria. Follow-up ranged from 0 to 6,291 days (17.2 years), a mean of 1263 days (3.5 years). Surgical mortality was 16.1% and reintervention rates were 19.8%. In re-interventions performed, 80% occurred within 1.2 years, while 94% of mortalities were within 4.1 months. Increasing cardiopulmonary bypass times (p = 0.0001) and the presence of obstruction at the time of surgery (p = 0.025) were predictors of mortality, while intracardiac total anomalous pulmonary venous connection type (p = 0.033) was protective. Risk of reintervention was higher with increasing cardiopulmonary bypass times (p = 0.015), single ventricle anatomy (p = 0.02), and a post-repair gradient >2 mmHg on transesophageal echocardiogram (p = 0.009).
Conclusions:
Evaluation of a larger cohort with longer follow-up demonstrated the relationship of anatomic complexity and symptoms at presentation to increased mortality risk after total anomalous pulmonary venous connection repair. The presence of a single ventricle or a post-operative confluence gradient >2 mmHg were risk factors for reintervention. These findings support those found in our initial study.
Transitivity is the assumption that if a person prefers A to B and B to C, then that person should prefer A to C. This article explores a paradigm in which Birnbaum, Patton and Lott (1999) thought people might be systematically intransitive. Many undergraduates choose C = ($96, .85; $90, .05; $12, .10) over A = ($96, .9; $14, .05; $12, .05), violating dominance. Perhaps people would detect dominance in simpler choices, such as A versus B = ($96, .9; $12, .10) and B versus C, and yet continue to violate it in the choice between A and C, which would violate transitivity. In this study we apply a true and error model to test intransitive preferences predicted by a partially effective editing mechanism. The results replicated previous findings quite well; however, the true and error model indicated that very few, if any, participants exhibited true intransitive preferences. In addition, violations of stochastic dominance showed a strong and systematic decrease in prevalence over time and violated response independence, thus violating key assumptions of standard random preference models for analysis of transitivity.
Racially and ethnically minoritized populations have been historically excluded and underrepresented in research. This paper will describe best practices in multicultural and multilingual awareness-raising strategies used by the Recruitment Innovation Center to increase minoritized enrollment into clinical trials. The Passive Immunity Trial for Our Nation will be used as a primary example to highlight real-world application of these methods to raise awareness, engage community partners, and recruit diverse study participants.
Non-technical summary. As we consider a transition to a low-carbon future, there is a need to examine the mineral needs for this transformation at a scale reminiscent of the Green Revolution. The efficiency gains of the agrarian transition came at ecological and social costs that should provide important lessons about future metal sourcing. We present three options for a Mineral Revolution: status quo, incremental adaption and revolutionary change. We argue that a sustainable Mineral Revolution requires a paradigm shift that considers wellbeing as a purpose and focuses on preserving natural capital.
Technical summary. As we consider a transition to a low-carbon future, there is a need to examine the mineral needs for this transformation at a scale reminiscent of the Green Revolution. The efficiency gains of the agrarian transition came at ecological and social costs that can also provide important lessons about the Mineral Revolution. We lay out some of the key ways in which such a mineral revolution can be delineated over temporal scales in a paradigm shift that considers wellbeing as a purpose and focuses on preserving natural capital. These prospects are conceptually presented as three pathways that consider the status quo, incremental adaption and revolutionary change as a means of planning more effectively for a low-carbon transition.
Social media summary. Sourcing metals sustainably will require to consider wellbeing as a purpose and to preserve natural capital.
In this prospective, longitudinal study, we examined the risk factors for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection among a cohort of chronic hemodialysis (HD) patients and healthcare personnel (HCPs) over a 6-month period. The risk of SARS-CoV-2 infection among HD patients and HCPs was consistently associated with a household member having SARS-CoV-2 infection.