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It remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.
Aims
To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.
Method
Randomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment–covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.
Results
IPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = −0.48 to −0.27). Effects could not be ascertained up to 24 months (s.m.d. = −0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27–2.79), reliable improvement (relative risk = 1.38–3.17), deterioration (relative risk = 0.67–0.54) and close-to-symptom-free status (relative risk = 1.41–2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (P > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = −0.33 for PHQ-9 = 5).
Conclusions
Psychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.
Tropical cyclones can significantly impact mangrove forests, with some recovering rapidly, whilst others may change permanently. Inconsistent approaches to quantifying these impacts limit the capacity to identify patterns of damage and recovery across landscapes and cyclone categories. Understanding these patterns is critical as the changing frequency and intensity of cyclones and compounding effects of climate change, particularly sea-level rise, threaten mangroves and their ecosystem services. Improvements in Earth observation data, particularly satellite-based sensors and datacube environments, have enhanced capacity to classify time-series data and advanced landscape monitoring. Using the Landsat archive within Digital Earth Australia to monitor annual changes in canopy cover and extent, this study aims to quantify and classify immediate and long-term impacts of category 3–5 cyclones for mangroves in Australia. Closed canopy mangrove forests experienced the greatest immediate impact (loss of canopy cover). Most immediate impacts were minor, implying limited immediate mortality. Impacts varied spatially, reflecting proximity to exposed coastlines, cyclone track and forest structure (height, density, condition and species). Recovery was evident across all cyclones, although some areas exhibited permanent damage. Understanding the impacts and characteristics of vulnerable and resilient forests is crucial for managers tasked with protecting mangroves and their services as the climate changes.
With persistent incidence, incomplete vaccination rates, confounding respiratory illnesses, and few therapeutic interventions available, COVID-19 continues to be a burden on the pediatric population. During a surge, it is difficult for hospitals to direct limited healthcare resources effectively. While the overwhelming majority of pediatric infections are mild, there have been life-threatening exceptions that illuminated the need to proactively identify pediatric patients at risk of severe COVID-19 and other respiratory infectious diseases. However, a nationwide capability for developing validated computational tools to identify pediatric patients at risk using real-world data does not exist.
Methods:
HHS ASPR BARDA sought, through the power of competition in a challenge, to create computational models to address two clinically important questions using the National COVID Cohort Collaborative: (1) Of pediatric patients who test positive for COVID-19 in an outpatient setting, who are at risk for hospitalization? (2) Of pediatric patients who test positive for COVID-19 and are hospitalized, who are at risk for needing mechanical ventilation or cardiovascular interventions?
Results:
This challenge was the first, multi-agency, coordinated computational challenge carried out by the federal government as a response to a public health emergency. Fifty-five computational models were evaluated across both tasks and two winners and three honorable mentions were selected.
Conclusion:
This challenge serves as a framework for how the government, research communities, and large data repositories can be brought together to source solutions when resources are strapped during a pandemic.
Childhood adversity and cannabis use are considered independent risk factors for psychosis, but whether different patterns of cannabis use may be acting as mediator between adversity and psychotic disorders has not yet been explored. The aim of this study is to examine whether cannabis use mediates the relationship between childhood adversity and psychosis.
Methods
Data were utilised on 881 first-episode psychosis patients and 1231 controls from the European network of national schizophrenia networks studying Gene–Environment Interactions (EU-GEI) study. Detailed history of cannabis use was collected with the Cannabis Experience Questionnaire. The Childhood Experience of Care and Abuse Questionnaire was used to assess exposure to household discord, sexual, physical or emotional abuse and bullying in two periods: early (0–11 years), and late (12–17 years). A path decomposition method was used to analyse whether the association between childhood adversity and psychosis was mediated by (1) lifetime cannabis use, (2) cannabis potency and (3) frequency of use.
Results
The association between household discord and psychosis was partially mediated by lifetime use of cannabis (indirect effect coef. 0.078, s.e. 0.022, 17%), its potency (indirect effect coef. 0.059, s.e. 0.018, 14%) and by frequency (indirect effect coef. 0.117, s.e. 0.038, 29%). Similar findings were obtained when analyses were restricted to early exposure to household discord.
Conclusions
Harmful patterns of cannabis use mediated the association between specific childhood adversities, like household discord, with later psychosis. Children exposed to particularly challenging environments in their household could benefit from psychosocial interventions aimed at preventing cannabis misuse.
Long-term sequelae of severe acute respiratory coronavirus-2 (SARS-CoV-2) infection may include increased incidence of diabetes. Here we describe the temporal relationship between new type 2 diabetes and SARS-CoV-2 infection in a nationwide database. We found that while the proportion of newly diagnosed type 2 diabetes increased during the acute period of SARS-CoV-2 infection, the mean proportion of new diabetes cases in the 6 months post-infection was about 83% lower than the 6 months preinfection. These results underscore the need for further investigation to understand the timing of new diabetes after COVID-19, etiology, screening, and treatment strategies.
ALMA observations with angular resolution in the range ∼20–200 mas demonstrate that emission at 268.149 and 262.898 GHz in the (0,2,0) and (0,1,0) vibrationally excited states of water are widespread in the inner envelope of O-rich AGB stars and red supergiants. These transitions are either quasi-thermally excited, in which case they can be used to estimate the molecular column density, or show signs of maser emission with a brightness temperature of ∼103–107 K in a few stars. The highest spatial resolution observations probe the inner few stellar radii environment, up to ∼10–12 R* in general, while the mid resolution data probe more thermally excited gas at larger extents. In several stars, high velocity components are observed at 268.149 GHz which may be caused by the kinematic perturbations induced by a companion. Radiative transfer models of water are revisited to specify the physical conditions leading to 268.149 and 262.898 GHz maser excitation.
ABSTRACT IMPACT: Within three EDs in a regional health system in Connecticut, African American race, male gender, non-Hispanic ethnicity, lack of private insurance, and homelessness were associated with significant odds of being physically restrained during a visit. OBJECTIVES/GOALS: Agitated patient encounters in the Emergency Department (ED) are on the rise, and physical restraints are used to protect staff and prevent self-harm. However, these are associated with safety risks and potential stigmatization of vulnerable individuals. We aim to determine factors that are associated with odds of being restrained in the ED. METHODS/STUDY POPULATION: We conducted a retrospective cohort analysis of all patients (≥18 yo) placed in restraints during an ED visit to three hospitals within a large tertiary health system from Jan 2013-Aug 2018. We undertook descriptive analysis of the data and created a generalized linear mixed model with a binary logistic identity link to model restraint use and determine odds ratios for various clinically significant demographic factors. These include gender, race, ethnicity, insurance status, alcohol use, illicit drug use, and homelessness. Our model accounted for patients nested across the three EDs and also accounted for multiple patient visits. RESULTS/ANTICIPATED RESULTS: In 726,417 total ED visits, 7,090 (1%) had associated restraint orders. Restrained patients had an average age of 45, with 64% male, 54% Caucasian and 29% African American. 17% had private insurance, 36% endorsed illicit substances, 51.4% endorsed alcohol use and 2.3% were homeless. African Americans had statistically significant odds of being restrained compared to Caucasians with adjusted odds ratio (AOR) of 1.14 (1.08,1.21). Females (AOR 0.75 [0.71, 0.79] had lower odds of being restrained compared to males while patients with Medicaid (AOR 1.57 [1.46, 1.68]) and Medicare (AOR 1.70 [1.57, 1.85]) had increased odds compared to the privately insured. Illicit substance use (AOR 1.55 [1.46, 1.64]), alcohol use (AOR 1.13 [1.07, 1.20] and homelessness (AOR 1.35 [1.14, 1.16]) had increased odds of restraint use. DISCUSSION/SIGNIFICANCE OF FINDINGS: We showed statistically significant effects of patient demographics on odds of restraint use in the ED. The increased odds based on race, insurance status, and substance use highlight the potential effects of implicit bias on the decision to physically restrain patients and underscores the importance of objective assessments of these patients.
To evaluate 3 formulations of copper (Cu)-based self-sanitizing surfaces for antimicrobial efficacy and durability over 1 year in inpatient clinical areas and laboratories.
Design:
Randomized control trial.
Setting:
We assessed 3 copper formulations: (1) solid alloy 80% Cu–20% Ni (integral copper), (2) spray-on 80% Cu–20% Ni (spray-on) and (3) 16% composite copper-impregnated surface (CIS). In total, 480 coupons (1 cm2) of the 3 products and control surgical grade (AISI 316) stainless steel were inserted into gaskets and affixed to clinical carts used in patient care areas (including emergency and maternity units) and on microbiology laboratory bench work spaces (n = 240). The microbial burden and assessment of resistance to wear, corrosion, and material compatibility were determined every 3 months. Participants included 3 tertiary-care Canadian adult hospital and 1 pediatric-maternity hospital.
Results:
Copper formulations used on inpatient units statistically significantly reduced bacterial bioburden compared to stainless steel at months 3 and 6. Only the integral copper product had significantly less bacteria than stainless steel at month 12. No statistically significant differences were detected in microbial burden between copper formulations and stainless-steel coupons on microbiology laboratory benches where bacterial counts were low overall. All mass changes and corrosion rates of the formulations were acceptable by engineering standards.
Conclusions:
Copper surfaces vary in their antimicrobial efficacy after 1 year of hospital use. Frequency of cleaning and disinfection influence the impact of copper; the greatest reduction in microbial bioburden occurred in clinical areas compared to the microbiology laboratory where cleaning and disinfection were performed multiple times daily.
The Murchison Widefield Array (MWA) has observed the entire southern sky (Declination, $\delta< 30^{\circ}$) at low radio frequencies, over the range 72–231MHz. These observations constitute the GaLactic and Extragalactic All-sky MWA (GLEAM) Survey, and we use the extragalactic catalogue (EGC) (Galactic latitude, $|b| >10^{\circ}$) to define the GLEAM 4-Jy (G4Jy) Sample. This is a complete sample of the ‘brightest’ radio sources ($S_{\textrm{151\,MHz}}>4\,\text{Jy}$), the majority of which are active galactic nuclei with powerful radio jets. Crucially, low-frequency observations allow the selection of such sources in an orientation-independent way (i.e. minimising the bias caused by Doppler boosting, inherent in high-frequency surveys). We then use higher-resolution radio images, and information at other wavelengths, to morphologically classify the brightest components in GLEAM. We also conduct cross-checks against the literature and perform internal matching, in order to improve sample completeness (which is estimated to be $>95.5$%). This results in a catalogue of 1863 sources, making the G4Jy Sample over 10 times larger than that of the revised Third Cambridge Catalogue of Radio Sources (3CRR; $S_{\textrm{178\,MHz}}>10.9\,\text{Jy}$). Of these G4Jy sources, 78 are resolved by the MWA (Phase-I) synthesised beam ($\sim2$ arcmin at 200MHz), and we label 67% of the sample as ‘single’, 26% as ‘double’, 4% as ‘triple’, and 3% as having ‘complex’ morphology at $\sim1\,\text{GHz}$ (45 arcsec resolution). We characterise the spectral behaviour of these objects in the radio and find that the median spectral index is $\alpha=-0.740 \pm 0.012$ between 151 and 843MHz, and $\alpha=-0.786 \pm 0.006$ between 151MHz and 1400MHz (assuming a power-law description, $S_{\nu} \propto \nu^{\alpha}$), compared to $\alpha=-0.829 \pm 0.006$ within the GLEAM band. Alongside this, our value-added catalogue provides mid-infrared source associations (subject to 6” resolution at 3.4$\mu$m) for the radio emission, as identified through visual inspection and thorough checks against the literature. As such, the G4Jy Sample can be used as a reliable training set for cross-identification via machine-learning algorithms. We also estimate the angular size of the sources, based on their associated components at $\sim1\,\text{GHz}$, and perform a flux density comparison for 67 G4Jy sources that overlap with 3CRR. Analysis of multi-wavelength data, and spectral curvature between 72MHz and 20GHz, will be presented in subsequent papers, and details for accessing all G4Jy overlays are provided at https://github.com/svw26/G4Jy.
The entire southern sky (Declination, $\delta< 30^{\circ}$) has been observed using the Murchison Widefield Array (MWA), which provides radio imaging of $\sim$2 arcmin resolution at low frequencies (72–231 MHz). This is the GaLactic and Extragalactic All-sky MWA (GLEAM) Survey, and we have previously used a combination of visual inspection, cross-checks against the literature, and internal matching to identify the ‘brightest’ radio-sources ($S_{\mathrm{151\,MHz}}>4$ Jy) in the extragalactic catalogue (Galactic latitude, $|b| >10^{\circ}$). We refer to these 1 863 sources as the GLEAM 4-Jy (G4Jy) Sample, and use radio images (of ${\leq}45$ arcsec resolution), and multi-wavelength information, to assess their morphology and identify the galaxy that is hosting the radio emission (where appropriate). Details of how to access all of the overlays used for this work are available at https://github.com/svw26/G4Jy. Alongside this we conduct further checks against the literature, which we document here for individual sources. Whilst the vast majority of the G4Jy Sample are active galactic nuclei with powerful radio-jets, we highlight that it also contains a nebula, two nearby, star-forming galaxies, a cluster relic, and a cluster halo. There are also three extended sources for which we are unable to infer the mechanism that gives rise to the low-frequency emission. In the G4Jy catalogue we provide mid-infrared identifications for 86% of the sources, and flag the remainder as: having an uncertain identification (129 sources), having a faint/uncharacterised mid-infrared host (126 sources), or it being inappropriate to specify a host (2 sources). For the subset of 129 sources, there is ambiguity concerning candidate host-galaxies, and this includes four sources (B0424–728, B0703–451, 3C 198, and 3C 403.1) where we question the existing identification.
Determining infectious cross-transmission events in healthcare settings involves manual surveillance of case clusters by infection control personnel, followed by strain typing of clinical/environmental isolates suspected in said clusters. Recent advances in genomic sequencing and cloud computing now allow for the rapid molecular typing of infecting isolates.
Objective:
To facilitate rapid recognition of transmission clusters, we aimed to assess infection control surveillance using whole-genome sequencing (WGS) of microbial pathogens to identify cross-transmission events for epidemiologic review.
Methods:
Clinical isolates of Staphylococcus aureus, Enterococcus faecium, Pseudomonas aeruginosa, and Klebsiella pneumoniae were obtained prospectively at an academic medical center, from September 1, 2016, to September 30, 2017. Isolate genomes were sequenced, followed by single-nucleotide variant analysis; a cloud-computing platform was used for whole-genome sequence analysis and cluster identification.
Results:
Most strains of the 4 studied pathogens were unrelated, and 34 potential transmission clusters were present. The characteristics of the potential clusters were complex and likely not identifiable by traditional surveillance alone. Notably, only 1 cluster had been suspected by routine manual surveillance.
Conclusions:
Our work supports the assertion that integration of genomic and clinical epidemiologic data can augment infection control surveillance for both the identification of cross-transmission events and the inclusion of missed and exclusion of misidentified outbreaks (ie, false alarms). The integration of clinical data is essential to prioritize suspect clusters for investigation, and for existing infections, a timely review of both the clinical and WGS results can hold promise to reduce HAIs. A richer understanding of cross-transmission events within healthcare settings will require the expansion of current surveillance approaches.
To examine relationships between frequency of adolescents eating alone (dependent variable) and diet, weight status and perceived food-related parenting practices (independent variables).
Design
Analyses of publicly available, cross-sectional, web-based survey data from adolescents.
Setting
Online consumer opinion panel.
Subjects
A US nationwide sample of adolescents (12–17 years) completed Family Life, Activity, Sun, Health, and Eating (FLASHE) Study surveys to report demographic and family meal characteristics, weight, dietary intake, home food availability and perceptions of parenting practices. Parents provided information about demographic characteristics. Logistic regression analyses were used to test for associations between variables.
Results
About 20 % of adolescents reported often eating alone (n 343) v. not often eating alone (n 1309). Adjusted odds of adolescents often eating alone were significantly higher for non-Hispanic Black compared with non-Hispanic White adolescents (OR=1·7) and for overweight or obese compared with normal- or underweight adolescents (OR=1·6). Adjusted odds of adolescents eating alone were significantly lower for those who reported that fruits and vegetables were often/always available in the home (OR=0·65), for those who perceived that parents had expectations about fruit and vegetable intake (OR=0·71) and for those who agreed with parental authority to make rules about intake of junk food/sugary drinks (OR=0·71). Junk food and sugary drink daily intake frequency was positively associated with often eating alone.
Conclusions
Often eating alone was related to being overweight/obese, having less healthy dietary intake and perceptions of less supportive food-related parenting practices.
A 15-month-old child underwent percutaneous expansion of a Melody transcatheter pulmonary valve in the mitral position to accommodate growth after initial surgical implantation during infancy, but transiently decompensated after valvuloplasty owing to stent malformation. The Melody valve in the mitral position of small patients can be further expanded by percutaneous dilation, but there are a number of potential complications and technical improvements to consider.
Informal (unpaid) care-givers of older people with dementia experience stress and isolation, causing physical and psychiatric morbidity. Comprehensive geriatric assessment clinics represent an important geriatrician-led model of dementia care. Our qualitative study examined the educational and support needs of care-givers of people diagnosed with dementia at a geriatric assessment clinic, resources used to address those needs and challenges experienced in doing so. We conducted structured thematic analysis of interviews with 18 informal care-givers. Participants’ narratives reflected four themes. First, care-givers sought information from varied sources, including the Alzheimer Society, the internet and clinic staff. Responsive behaviours, the expected progression of dementia and system navigation were topics of particular interest. Second, care-givers obtained assistance from public, for-profit and voluntary sources. Third, care-givers received little assistance. Two-thirds received fewer than four hours of help weekly from all sources combined, and none more than 15. Several received no assistance whatsoever. Publicly funded support workers’ tasks, and their timing, were often unhelpful. Finally, while numerous care-givers felt physical and emotional strain, and worried about how poor health impaired their care-giving, many hesitated to seek help. The needs of this unique population of informal care-givers can be met by improved home-care service flexibility, and access to trustworthy information about the expected progression of dementia and skills for managing behavioural and psychological symptoms.
Antineuronal antibodies are associated with psychosis, although their clinical significance in first episode of psychosis (FEP) is undetermined.
Aims
To examine all patients admitted for treatment of FEP for antineuronal antibodies and describe clinical presentations and treatment outcomes in those who were antibody positive.
Method
Individuals admitted for FEP to six mental health units in Queensland, Australia, were prospectively tested for serum antineuronal antibodies. Antibody-positive patients were referred for neurological and immunological assessment and therapy.
Results
Of 113 consenting participants, six had antineuronal antibodies (anti-N-methyl-D-aspartate receptor antibodies [n = 4], voltage-gated potassium channel antibodies [n = 1] and antibodies against uncharacterised antigen [n = 1]). Five received immunotherapy, which prompted resolution of psychosis in four.
Conclusions
A small subgroup of patients admitted to hospital with FEP have antineuronal antibodies detectable in serum and are responsive to immunotherapy. Early diagnosis and treatment is critical to optimise recovery.
On 1 December 2011 the West Antarctic Ice Sheet (WAIS) Divide ice-core project reached its final depth of 3405 m. The WAIS Divide ice core is not only the longest US ice core to date, but is also the highest-quality deep ice core, including ice from the brittle ice zone, that the US has ever recovered. The methods used at WAIS Divide to handle and log the drilled ice, the procedures used to safely retrograde the ice back to the US National Ice Core Laboratory (NICL) and the methods used to process and sample the ice at the NICL are described and discussed.
from
Part II
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TOOLS, TECHNIQUES, MODELS AND ANALYSES TO RESOLVE COMPLEX WATER PROBLEMS
By
Melanie Wong Turlington, Arcadis, San Francisco, California, USA,
Richard de Neufville, Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA,
Margaret Garcia, Department of Civil & Environmental Engineering, Tufts University, Medford, Massachusetts, USA
Future water needs and sources of supply are often highly uncertain. This is especially the case in the many areas under stress from climate change and rapid, variable urban development. Innovations in water treatment technologies, and price volatility in energy and other resources combine to aggravate the uncertainties concerning the risks and opportunities associated with planning investments in water infrastructure systems. The problem is that conventional techniques for the planning and design of water supply systems do not adequately deal with these important uncertainties. This chapter presents “Flexible Design” as an approach to deal with the situation, and demonstrates its effectiveness in a case study, inspired by Singapore, of a long- term design of the water supply system for a major city. The results show that Flexible Design can significantly increase overall performance compared to conventional design methods— a 15 percent increase in expected present monetary value, while decreasing downside risk and increasing upside opportunities. Flexible Design achieves these improvements by carefully analyzing possible futures using Monte Carlo simulation and designing the system with modules that managers can implement as and when needed. Flexible Design is shown to be an effective tool and is increasingly used in infrastructure development.
Introduction
The future is uncertain. Technologies, needs, policies, economies, and environments change frequently. Some changes are quantifiable, and we attempt to make best estimates of what will happen, but we will always encounter game- changing events and unanticipated new technologies.
When decision-makers consider needs for future water infrastructure, they often use a conventional, deterministic approach. They assume that current conditions will not change and that we can safely rely on a forecast of long- term requirements. However, the water supply and demand system is complex. Natural, societal, and political forces interact to drive changes in both supply and demand over time. Our ability to predict future conditions is low when dealing with such complexity, leading to forecasts that are rarely accurate.
For projects in transboundary watersheds or other multi- stakeholder water systems, reaching consensus among stakeholders on highly uncertain future conditions is a key challenge; there is a tendency to downplay uncertainty to make the problem more tractable and to advocate for a vision of the future convenient to dominant interests (Lempert and Kalra 2011).
This essay uses as its case study the reconstruction of an East German Vietnamese socialist folk dance Spring in Vietnam (1969) to reflect on Randy Martin's 1998 conviction that Dance Studies has the potential to embody and materialize solutions to intellectual and political issues that have been left out of other academic disciplines. Written as a play script, the essays performs a remobilization of Dance Studies and its potential to reflect on its disciplinary authority.