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Recent changes to US research funding are having far-reaching consequences that imperil the integrity of science and the provision of care to vulnerable populations. Resisting these changes, the BJPsych Portfolio reaffirms its commitment to publishing mental science and advancing psychiatric knowledge that improves the mental health of one and all.
Although early health technology assessment (HTA) is increasingly being used to guide and inform decisions on product development, a consensus definition is currently lacking. A working group under the HTA International Society was established to develop a consensus-based definition of early HTA. The working group developed a definition using an iterative process that comprised five stages of work and included a two-round Delphi survey with 133 respondents in the first and 99 respondents in the second round of the survey, with various backgrounds and levels of expertise. Following this process, the working group reached the first consensus-based definition of early HTA, which is an HTA conducted to inform decisions about subsequent development, research, and/or investment by explicitly evaluating the potential value of a conceptual or actual health technology. In total, 86 (87 percent) of the 99 panelists who participated in the second round of the Delphi survey either strongly agreed or agreed with this definition. This consensus definition represents an important milestone in early HTA. It will enhance the uniformity of terminology, increasing the visibility of research and policy in this field. We also hope that it will act as a catalyst sparkling further research and developments in this discipline.
The primary objective of our study was to survey ENT surgeons who perform functional endoscopic sinus surgery in the UK regarding their post-sinus surgery practices.
Method
A 28-item questionnaire on post-functional endoscopic sinus surgery practices was distributed electronically to ENT UK members specialising in rhinology.
Results
Ninety (90 per cent) surgeons prescribe saline nasal irrigation post-functional endoscopic sinus surgery but administration timing and methods vary. Following functional endoscopic sinus surgery, 17.7 per cent (n = 17) of respondents routinely prescribe antibiotics, whilst about a quarter (26.0 per cent, n = 25) do not prescribe antibiotics at all. The rest of the respondents only prescribe antibiotics in specific cases. Thirty-three (34.7 per cent) respondents do not prescribe oral steroids whilst most clinicians (83.9 per cent, n = 78) prescribe intranasal corticosteroids post-operatively.
Conclusion
Our study highlights homogeneous, evidence-based practices post-functional endoscopic sinus surgery from UK-based specialists, specifically in the use of saline irrigation and intranasal corticosteroids. However, our cohort displayed significant heterogeneity regarding oral antibiotics, oral steroids, and other specific aspects of post-operative care.
The descriptions of two co-occurring cardioid crustaceans from the Ballagan Formation (Tournaisian, Lower Carboniferous) of Chirnside, Scottish Borders, help to resolve the taxonomy of the genus Tealliocaris. Tealliocaris robusta Peach, 1908 is assigned to Schramocaris to form S. robusta (Peach, 1908) comb. nov. on the basis of morphological characters such as the rugosity and position of the branchial carinae as well as the nature of the pleon, and becomes the earliest representative of this genus in Scotland. A new species of Tealliocaris is also recognised from this locality and is described as T. briggsi sp. nov., based on the smooth carapace, lack of pleonic grooves and the number of spines on the scaphocerite and lateral margin of the anterior carapace. The systematic position of the Pendleian specimens identified by Peach (1908) as ‘Tealliocaris robusta var.’ is finally resolved and described as T. weegie sp. nov.
To investigate the symptoms of SARS-CoV-2 infection, their dynamics and their discriminatory power for the disease using longitudinally, prospectively collected information reported at the time of their occurrence. We have analysed data from a large phase 3 clinical UK COVID-19 vaccine trial. The alpha variant was the predominant strain. Participants were assessed for SARS-CoV-2 infection via nasal/throat PCR at recruitment, vaccination appointments, and when symptomatic. Statistical techniques were implemented to infer estimates representative of the UK population, accounting for multiple symptomatic episodes associated with one individual. An optimal diagnostic model for SARS-CoV-2 infection was derived. The 4-month prevalence of SARS-CoV-2 was 2.1%; increasing to 19.4% (16.0%–22.7%) in participants reporting loss of appetite and 31.9% (27.1%–36.8%) in those with anosmia/ageusia. The model identified anosmia and/or ageusia, fever, congestion, and cough to be significantly associated with SARS-CoV-2 infection. Symptoms’ dynamics were vastly different in the two groups; after a slow start peaking later and lasting longer in PCR+ participants, whilst exhibiting a consistent decline in PCR- participants, with, on average, fewer than 3 days of symptoms reported. Anosmia/ageusia peaked late in confirmed SARS-CoV-2 infection (day 12), indicating a low discrimination power for early disease diagnosis.
Blood-based biomarkers represent a scalable and accessible approach for the detection and monitoring of Alzheimer’s disease (AD). Plasma phosphorylated tau (p-tau) and neurofilament light (NfL) are validated biomarkers for the detection of tau and neurodegenerative brain changes in AD, respectively. There is now emphasis to expand beyond these markers to detect and provide insight into the pathophysiological processes of AD. To this end, a reactive astrocytic marker, namely plasma glial fibrillary acidic protein (GFAP), has been of interest. Yet, little is known about the relationship between plasma GFAP and AD. Here, we examined the association between plasma GFAP, diagnostic status, and neuropsychological test performance. Diagnostic accuracy of plasma GFAP was compared with plasma measures of p-tau181 and NfL.
Participants and Methods:
This sample included 567 participants from the Boston University (BU) Alzheimer’s Disease Research Center (ADRC) Longitudinal Clinical Core Registry, including individuals with normal cognition (n=234), mild cognitive impairment (MCI) (n=180), and AD dementia (n=153). The sample included all participants who had a blood draw. Participants completed a comprehensive neuropsychological battery (sample sizes across tests varied due to missingness). Diagnoses were adjudicated during multidisciplinary diagnostic consensus conferences. Plasma samples were analyzed using the Simoa platform. Binary logistic regression analyses tested the association between GFAP levels and diagnostic status (i.e., cognitively impaired due to AD versus unimpaired), controlling for age, sex, race, education, and APOE e4 status. Area under the curve (AUC) statistics from receiver operating characteristics (ROC) using predicted probabilities from binary logistic regression examined the ability of plasma GFAP to discriminate diagnostic groups compared with plasma p-tau181 and NfL. Linear regression models tested the association between plasma GFAP and neuropsychological test performance, accounting for the above covariates.
Results:
The mean (SD) age of the sample was 74.34 (7.54), 319 (56.3%) were female, 75 (13.2%) were Black, and 223 (39.3%) were APOE e4 carriers. Higher GFAP concentrations were associated with increased odds for having cognitive impairment (GFAP z-score transformed: OR=2.233, 95% CI [1.609, 3.099], p<0.001; non-z-transformed: OR=1.004, 95% CI [1.002, 1.006], p<0.001). ROC analyses, comprising of GFAP and the above covariates, showed plasma GFAP discriminated the cognitively impaired from unimpaired (AUC=0.75) and was similar, but slightly superior, to plasma p-tau181 (AUC=0.74) and plasma NfL (AUC=0.74). A joint panel of the plasma markers had greatest discrimination accuracy (AUC=0.76). Linear regression analyses showed that higher GFAP levels were associated with worse performance on neuropsychological tests assessing global cognition, attention, executive functioning, episodic memory, and language abilities (ps<0.001) as well as higher CDR Sum of Boxes (p<0.001).
Conclusions:
Higher plasma GFAP levels differentiated participants with cognitive impairment from those with normal cognition and were associated with worse performance on all neuropsychological tests assessed. GFAP had similar accuracy in detecting those with cognitive impairment compared with p-tau181 and NfL, however, a panel of all three biomarkers was optimal. These results support the utility of plasma GFAP in AD detection and suggest the pathological processes it represents might play an integral role in the pathogenesis of AD.
In low-resource settings, valid mental health screening tools for non-specialists can be used to identify patients with psychiatric disorders in need of critical mental health care. The Mental Wellness Tool-13 (mwTool-13) is a 13-item screener for identifying adults at risk for common mental disorders (CMDs) alcohol-use disorders (AUDs), substance-use disorders (SUD), severe mental disorders (SMDs), and suicide risk (SR). The mwTool-13 is administered in two steps, specifically, only those who endorse any of the initial three questions receive the remaining ten questions. We evaluated the performance of mwTool-13 in South Africa against a diagnostic gold standard. We recruited a targeted, gender-balanced sample of adults, aged ≥18 years at primary and tertiary healthcare facilities in Eastern Cape Province. Of the 1885 participants, the prevalence of CMD, AUD, SMD, SR, and SUD was 24.4%, 9.5%, 8.1%, 6.0%, and 1.6%, respectively. The mwTool-13 yielded high sensitivities for CMD, SMD, and SR, but sub-optimal sensitivities for AUD and SUD (56.7% and 64.5%, respectively). Including a single AUD question in the initial question set improved the tool’s performance in identifying AUD and SUD (sensitivity > 70%), while maintaining brevity, face-validity, and simplicity in the South African setting.
Blood-based biomarkers offer a more feasible alternative to Alzheimer’s disease (AD) detection, management, and study of disease mechanisms than current in vivo measures. Given their novelty, these plasma biomarkers must be assessed against postmortem neuropathological outcomes for validation. Research has shown utility in plasma markers of the proposed AT(N) framework, however recent studies have stressed the importance of expanding this framework to include other pathways. There is promising data supporting the usefulness of plasma glial fibrillary acidic protein (GFAP) in AD, but GFAP-to-autopsy studies are limited. Here, we tested the association between plasma GFAP and AD-related neuropathological outcomes in participants from the Boston University (BU) Alzheimer’s Disease Research Center (ADRC).
Participants and Methods:
This sample included 45 participants from the BU ADRC who had a plasma sample within 5 years of death and donated their brain for neuropathological examination. Most recent plasma samples were analyzed using the Simoa platform. Neuropathological examinations followed the National Alzheimer’s Coordinating Center procedures and diagnostic criteria. The NIA-Reagan Institute criteria were used for the neuropathological diagnosis of AD. Measures of GFAP were log-transformed. Binary logistic regression analyses tested the association between GFAP and autopsy-confirmed AD status, as well as with semi-quantitative ratings of regional atrophy (none/mild versus moderate/severe) using binary logistic regression. Ordinal logistic regression analyses tested the association between plasma GFAP and Braak stage and CERAD neuritic plaque score. Area under the curve (AUC) statistics from receiver operating characteristics (ROC) using predicted probabilities from binary logistic regression examined the ability of plasma GFAP to discriminate autopsy-confirmed AD status. All analyses controlled for sex, age at death, years between last blood draw and death, and APOE e4 status.
Results:
Of the 45 brain donors, 29 (64.4%) had autopsy-confirmed AD. The mean (SD) age of the sample at the time of blood draw was 80.76 (8.58) and there were 2.80 (1.16) years between the last blood draw and death. The sample included 20 (44.4%) females, 41 (91.1%) were White, and 20 (44.4%) were APOE e4 carriers. Higher GFAP concentrations were associated with increased odds for having autopsy-confirmed AD (OR=14.12, 95% CI [2.00, 99.88], p=0.008). ROC analysis showed plasma GFAP accurately discriminated those with and without autopsy-confirmed AD on its own (AUC=0.75) and strengthened as the above covariates were added to the model (AUC=0.81). Increases in GFAP levels corresponded to increases in Braak stage (OR=2.39, 95% CI [0.71-4.07], p=0.005), but not CERAD ratings (OR=1.24, 95% CI [0.004, 2.49], p=0.051). Higher GFAP levels were associated with greater temporal lobe atrophy (OR=10.27, 95% CI [1.53,69.15], p=0.017), but this was not observed with any other regions.
Conclusions:
The current results show that antemortem plasma GFAP is associated with non-specific AD neuropathological changes at autopsy. Plasma GFAP could be a useful and practical biomarker for assisting in the detection of AD-related changes, as well as for study of disease mechanisms.
Communication at the science-policy interface can be bewildering not only for early-career researchers, but also for many within the research community. In the context of Antarctica and the Southern Ocean, decision-makers operating within the Antarctic Treaty System (ATS) aspire to use the best available science as a basis for their decision-making. Therefore, to maximize the impact of Antarctic Treaty Parties' substantial investment in southern polar research, researchers wishing to contribute to policy and management must understand 1) how their work relates to and can potentially inform Antarctic and/or global policy and 2) the available mechanisms by which their research can be communicated to decision-makers. Recognizing these needs, we describe the main legal instruments relevant to Antarctic governance (primarily the ATS) and the associated meetings and stakeholders that contribute to policy development for the region. We highlight effective mechanisms by which Antarctic researchers may communicate their science into the policy realm, including through National Delegations or the Scientific Committee on Antarctic Research (SCAR), and we detail the key contemporary topics of interest to decision-makers, including those issues where further research is needed. Finally, we describe challenges at the Antarctic science-policy interface that may potentially slow or halt policy development.
Potato producers in Canada’s Atlantic provinces of Prince Edward Island (PE) and New Brunswick rely on photosystem II (PSII)-inhibiting herbicides to provide season-long weed control. Despite this fact, a high proportion of common lambsquarters populations in the region have been identified as resistant to this class of herbicides. Crop-topping is a late-season weed management practice that exploits the height differential between weeds and a developing crop canopy. Two field experiments were conducted in Harrington, PE, in 2020 and 2021, one each to evaluate the efficacy of a different crop-topping strategy, above-canopy mowing or wick-applied glyphosate, at two potato phenological stages, on common lambsquarters viable seed production and potato yield and quality. Mowing common lambsquarters postflowering decreased viable seed production (72% to 91%) in 2020 but increased seed production (78% to 278%) in 2021. Mowing had minimal impact on potato marketable yield across cultivars in both years. In contrast, treating common lambsquarters with wick-applied glyphosate had variable impacts on seed output in 2020 but dramatically reduced seed production (up to 95%) in 2021 when treatments were applied preflowering. Glyphosate damage to potato tubers was not influenced by timing and resulted in a 14% to 15% increase in culled tubers due to black spotting and rot. Our results highlight the importance of potato and common lambsquarters phenology when selecting a crop-topping strategy and demonstrate that above-canopy mowing and wick-applied glyphosate can be utilized for seedbank management of herbicide-resistant common lambsquarters in potato production systems.
With the aim of producing a 3D representation of tumors, imaging and molecular annotation of xenografts and tumors (IMAXT) uses a large variety of modalities in order to acquire tumor samples and produce a map of every cell in the tumor and its host environment. With the large volume and variety of data produced in the project, we developed automatic data workflows and analysis pipelines. We introduce a research methodology where scientists connect to a cloud environment to perform analysis close to where data are located, instead of bringing data to their local computers. Here, we present the data and analysis infrastructure, discuss the unique computational challenges and describe the analysis chains developed and deployed to generate molecularly annotated tumor models. Registration is achieved by use of a novel technique involving spherical fiducial marks that are visible in all imaging modalities used within IMAXT. The automatic pipelines are highly optimized and allow to obtain processed datasets several times quicker than current solutions narrowing the gap between data acquisition and scientific exploitation.
The argument that there exist a causal link between national savings and current account deficits is often simplistically formulated in terms of national income accounting identities. However the validity of formulating national saving-argmenting policies to target current account deficits is open to much debate when the possible theoretical linkages between these aggregates are investigated more closely. In particular; if the adjustment mechanism to external balance is expenditure driven rather than relying on exchange rate induced relative price changes, the alternative case of interventionist policy to promote net exports is strengthened. Theoretical arguments opposing the use of interventionist trade policies are often derived form inappropriately constructed, or simplistically interpreted, economic models.
Antarctic and Southern Ocean environments are facing increasing pressure from multiple threats. The Antarctic Treaty System regularly looks to the Scientific Committee on Antarctic Research (SCAR) for the provision of independent and objective advice based on the best available science to support decision-making, policy development and effective environmental management. The recently approved SCAR Scientific Research Programme Ant-ICON - ‘Integrated Science to Inform Antarctic and Southern Ocean Conservation‘ - facilitates and coordinates high-quality transdisciplinary research to inform the conservation and management of Antarctica, the Southern Ocean and the sub-Antarctic in the context of current and future impacts. The work of Ant-ICON focuses on three research themes examining 1) the current state and future projections of Antarctic systems, species and functions, 2) human impacts and sustainability and 3) socio-ecological approaches to Antarctic and Southern Ocean conservation, and one synthesis theme that seeks to facilitate the provision of timely scientific advice to support effective Antarctic conservation. Research outputs will address the most pressing environmental challenges facing Antarctica and offer high-quality science to policy and advisory bodies including the Antarctic Treaty Consultative Meeting, the Committee for Environmental Protection and the Scientific Committee of the Commission for the Conservation of Antarctic Marine Living Resources.
Theorists acknowledge that conspiracy beliefs represent an established psychological construct. The study of conspiracy beliefs is important because allied ideation potentially influences everyday attitudes and behaviors across a range of domains (i.e., cognitive, social, cross-cultural, and political psychology). In this article, we analyze the internal structure and construct validity of the Spanish adaptation of the Generic Conspiracist Beliefs Scale (GCBS). Correlational and confirmatory factor analyses using an international sample of 732 Spanish-speakers revealed a five-factor structure equivalent to the original instrument. Convergent validity was demonstrated using educational level, political orientation, need for uniqueness, and four social axioms (social cynicism, religiosity, reward for application, and fate control). In comparison to two English samples (N = 794 and N = 421), the adaptation demonstrated satisfactory, although restricted, levels of invariance. Accordingly, findings support the use of this translated form of the GCBS with Spanish speakers.
To examine differences in surgical practices between salaried and fee-for-service (FFS) surgeons for two common degenerative spine conditions. Surgeons may offer different treatments for similar conditions on the basis of their compensation mechanism.
Methods:
The study assessed the practices of 63 spine surgeons across eight Canadian provinces (39 FFS surgeons and 24 salaried) who performed surgery for two lumbar conditions: stable spinal stenosis and degenerative spondylolisthesis. The study included a multicenter, ambispective review of consecutive spine surgery patients enrolled in the Canadian Spine Outcomes and Research Network registry between October 2012 and July 2018. The primary outcome was the difference in type of procedures performed between the two groups. Secondary study variables included surgical characteristics, baseline patient factors, and patient-reported outcome.
Results:
For stable spinal stenosis (n = 2234), salaried surgeons performed statistically fewer uninstrumented fusion (p < 0.05) than FFS surgeons. For degenerative spondylolisthesis (n = 1292), salaried surgeons performed significantly more instrumentation plus interbody fusions (p < 0.05). There were no statistical differences in patient-reported outcomes between the two groups.
Conclusions:
Surgeon compensation was associated with different approaches to stable lumbar spinal stenosis and degenerative lumbar spondylolisthesis. Salaried surgeons chose a more conservative approach to spinal stenosis and a more aggressive approach to degenerative spondylolisthesis, which highlights that remuneration is likely a minor determinant in the differences in practice of spinal surgery in Canada. Further research is needed to further elucidate which variables, other than patient demographics and financial incentives, influence surgical decision-making.
Health technology assessment conducted to inform decisions during technology development (development-focused or DF-HTA) has a number of distinct features compared with HTA conducted to inform reimbursement and usage decisions. In particular, there are a broad range of decisions to be informed related to the development of a technology; multiple markets and decision makers to be considered; a limited (and developing) evidence base; and constrained resources for analysis. These features impact upon methods adopted by analysts. In this paper, we (i) set out methods of DF-HTA against a timeline of technology development; (ii) provide examples of the methods’ use; and (iii) explain how they have been adapted as a result of the features of DF-HTA. We present a toolkit of methods for analysts working with developers of medical technologies. Three categories of methods are described: literature review, stakeholder consultation, and decision analytic modeling. Literature review and stakeholder consultation are often used to fill evidence gaps. Decision analytic modeling is used to synthesize available evidence alongside plausible assumptions to inform developers about price or performance requirements. Methods increase in formality and complexity as the development and evidence base progresses and more resources are available for assessment. We hope this toolkit will be used in conjunction with the framework of features of DF-HTA presented in our earlier article in order to improve the clarity and appropriateness of methods of HTA used in DF-HTA. We also seek to contribute to a continuing dialogue about the nature of, and the best approach to, DF-HTA.
Perinatal light exposure predisposes towards health and behaviour in adulthood. Season of birth is associated with psychiatric, allergic, cardiovascular and metabolic problems. It has been proposed that early-life environmental light disrupts the development of biological rhythms which, in turn, influence later-life health. However, the mechanisms linking perinatal seasonal light to later-life biological rhythm and health in humans are unknown. In this study, we investigated the association between season of birth and epigenome-wide DNA methylation of two postmortem human brain regions (16 hypothalamus, 14 temporal cortex). We did not find statistically significant differences at the whole epigenome level, either because we lacked statistical power or that no association exists. However, when we examined 24 CpG sites that had the highest significance or differential methylation, we identified regions which may be associated with circadian rhythm entrainment, cholinergic neurotransmission and neural development. Amongst methylation of the core clock genes, we identified that hypothalamus Neuronal PAS Domain Protein 2 (NPAS2) gene has hypermethylated regions in long photoperiod-born individuals. In addition, we found nominal associations between season of birth and genes linked to chronotype and narcolepsy. Season of birth-related brain DNA methylation profile was different than a previously reported blood methylation profile, suggesting a tissue-specific mechanism of perinatal light programming. Overall, we are the first to analyse the relationship between season of birth and human brain DNA methylation. Further studies with larger sample sizes are required to confirm an imprinting effect of perinatal light on the circadian clock.