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A Pilot Randomized Controlled Trial of Augmented Reality Just-in-Time Guidance for the Performance of Rugged Field Procedures
- Laurel O’Connor, Sepahrad Zamani, Xinyi Ding, Nicolette McGeorge, Susan Latiff, Cindy Liu, Jorge Acevedo Herman, Matthew LoConte, Andrew Milsten, Michael Weiner, Timothy Boardman, Martin Reznek, Michael Hall, John P. Broach
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- Prehospital and Disaster Medicine , First View
- Published online by Cambridge University Press:
- 07 May 2024, pp. 1-9
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Introduction:
Medical resuscitations in rugged prehospital settings require emergency personnel to perform high-risk procedures in low-resource conditions. Just-in-Time Guidance (JITG) utilizing augmented reality (AR) guidance may be a solution. There is little literature on the utility of AR-mediated JITG tools for facilitating the performance of emergent field care.
Study Objective:The objective of this study was to investigate the feasibility and efficacy of a novel AR-mediated JITG tool for emergency field procedures.
Methods:Emergency medical technician-basic (EMT-B) and paramedic cohorts were randomized to either video training (control) or JITG-AR guidance (intervention) groups for performing bag-valve-mask (BVM) ventilation, intraosseous (IO) line placement, and needle-decompression (Needle-d) in a medium-fidelity simulation environment. For the interventional condition, subjects used an AR technology platform to perform the tasks. The primary outcome was participant task performance; the secondary outcomes were participant-reported acceptability. Participant task score, task time, and acceptability ratings were reported descriptively and compared between the control and intervention groups using chi-square analysis for binary variables and unpaired t-testing for continuous variables.
Results:Sixty participants were enrolled (mean age 34.8 years; 72% male). In the EMT-B cohort, there was no difference in average task performance score between the control and JITG groups for the BVM and IO tasks; however, the control group had higher performance scores for the Needle-d task (mean score difference 22%; P = .01). In the paramedic cohort, there was no difference in performance scores between the control and JITG group for the BVM and Needle-d tasks, but the control group had higher task scores for the IO task (mean score difference 23%; P = .01). For all task and participant types, the control group performed tasks more quickly than in the JITG group. There was no difference in participant usability or usefulness ratings between the JITG or control conditions for any of the tasks, although paramedics reported they were less likely to use the JITG equipment again (mean difference 1.96 rating points; P = .02).
Conclusions:This study demonstrated preliminary evidence that AR-mediated guidance for emergency medical procedures is feasible and acceptable. These observations, coupled with AR’s promise for real-time interaction and on-going technological advancements, suggest the potential for this modality in training and practice that justifies future investigation.
GWAS of Dizygotic Twinning in an Enlarged Australian Sample of Mothers of DZ Twins
- Scott D. Gordon, David L. Duffy, David C. Whiteman, Catherine M. Olsen, Kerrie McAloney, Jessica M. Adsett, Natalie A. Garden, Simone M. Cross, Susan E. List-Armitage, Joy Brown, Jeffrey J. Beck, Hamdi Mbarek, Sarah E. Medland, Grant W. Montgomery, Nicholas G. Martin
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- Journal:
- Twin Research and Human Genetics / Volume 26 / Issue 6 / December 2023
- Published online by Cambridge University Press:
- 23 November 2023, pp. 327-338
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Female fertility is a complex trait with age-specific changes in spontaneous dizygotic (DZ) twinning and fertility. To elucidate factors regulating female fertility and infertility, we conducted a genome-wide association study (GWAS) on mothers of spontaneous DZ twins (MoDZT) versus controls (3273 cases, 24,009 controls). This is a follow-up study to the Australia/New Zealand (ANZ) component of that previously reported (Mbarek et al., 2016), with a sample size almost twice that of the entire discovery sample meta-analysed in the previous article (and five times the ANZ contribution to that), resulting from newly available additional genotyping and representing a significant increase in power. We compare analyses with and without male controls and show unequivocally that it is better to include male controls who have been screened for recent family history, than to use only female controls. Results from the SNP based GWAS identified four genomewide significant signals, including one novel region, ZFPM1 (Zinc Finger Protein, FOG Family Member 1), on chromosome 16. Previous signals near FSHB (Follicle Stimulating Hormone beta subunit) and SMAD3 (SMAD Family Member 3) were also replicated (Mbarek et al., 2016). We also ran the GWAS with a dominance model that identified a further locus ADRB2 on chr 5. These results have been contributed to the International Twinning Genetics Consortium for inclusion in the next GWAS meta-analysis (Mbarek et al., in press).
Lessons from an evaluation of an antimicrobial resistance laboratory capacity telementoring program in Ethiopia and Kenya
- Kieran Hartsough, Jacqueline Safstrom, Martin Evans, Manise Pierre, Edward Schroder, Carolyn Herzig, Ana Da Costa, Susan Githii, Rajiha Abubeker, Gebrie Alebachew, Surafel Fentaw Dinku, Abera Abdeta, Estifanos Tsige, Maritza Urrego
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue S2 / June 2023
- Published online by Cambridge University Press:
- 29 September 2023, p. s123
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Background: Antimicrobial resistance (AMR) presents a global health threat. Training laboratory technicians to accurately identify and report AMR is critical in low- and middle-income countries (LMICs) to control the spread of AMR. Ethiopia and Kenya implemented a telementoring program, ECHO AMR, via the Project ECHO learning platform to improve laboratory technician capacity to isolate, identify, and report AMR organisms; to perform antimicrobial susceptibility testing (AST); and to develop a community of learning. Between January 2018 and January 2022, biweekly 1-hour sessions were held for 8 and 22 laboratories averaging 19 or 43 participants per session in Ethiopia and Kenya, respectively. Each session included a lecture, a laboratory challenge case presentation, and discussion. An evaluation was conducted to assess perceived strengths and weaknesses of the program and its usefulness in improving bacteriology capacity. Methods: In July–August 2022, semistructured key informant interviews of purposively and randomly selected laboratorians were conducted to understand participant perspectives of ECHO AMR, including session structure and content, changes in laboratory performance, and the virtual learning platform. Eligible participants attended at least one-third of available sessions in Ethiopia (8 of 26 sessions) or Kenya (5 of 16 sessions) during 2021. Key informant interviews were transcribed and systematically reviewed to identify key themes. Results: In total, 22 laboratory technicians participated in the key informant interviews: 12 in Ethiopia and 10 in Kenya. Participants reported that the ECHO AMR session structure was well organized but recommended increasing session duration to allow more time for discussion. Technical content was presented at an appropriate level and was highly rated. However, participants suggested including more subject-matter experts to provide the lectures. All participants reported positive change in laboratory practice, including implementation of international standards for AST, better quality control, improved confidence and critical thinking, and increased AMR awareness and reporting. Participants learned well in the virtual environment, with the platform providing wide-ranging geographic interactions to share skills and knowledge among sites without travel. However, there were connectivity issues, competing work priorities during sessions, and a lack of dedicated space for team participation. Conclusions: Laboratory technicians reported that virtual laboratory training was well-received, efficient, and impactful. Participants benefited both individually and collectively, as a laboratory. Suggested improvements included increasing session duration, connectivity support, and including more subject-matter experts to broaden technical content. Further assessment is needed to evaluate the ECHO AMR’s impact on laboratory practices through observation and laboratory data. Virtual programs, requiring less time and resources than traditional in-country trainings, can be optimized and used to share and increase bacteriology knowledge in LMICs.
Disclosures: None
A causal roadmap for generating high-quality real-world evidence
- Lauren E. Dang, Susan Gruber, Hana Lee, Issa J. Dahabreh, Elizabeth A. Stuart, Brian D. Williamson, Richard Wyss, Iván Díaz, Debashis Ghosh, Emre Kıcıman, Demissie Alemayehu, Katherine L. Hoffman, Carla Y. Vossen, Raymond A. Huml, Henrik Ravn, Kajsa Kvist, Richard Pratley, Mei-Chiung Shih, Gene Pennello, David Martin, Salina P. Waddy, Charles E. Barr, Mouna Akacha, John B. Buse, Mark van der Laan, Maya Petersen
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- Journal:
- Journal of Clinical and Translational Science / Volume 7 / Issue 1 / 2023
- Published online by Cambridge University Press:
- 22 September 2023, e212
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Increasing emphasis on the use of real-world evidence (RWE) to support clinical policy and regulatory decision-making has led to a proliferation of guidance, advice, and frameworks from regulatory agencies, academia, professional societies, and industry. A broad spectrum of studies use real-world data (RWD) to produce RWE, ranging from randomized trials with outcomes assessed using RWD to fully observational studies. Yet, many proposals for generating RWE lack sufficient detail, and many analyses of RWD suffer from implausible assumptions, other methodological flaws, or inappropriate interpretations. The Causal Roadmap is an explicit, itemized, iterative process that guides investigators to prespecify study design and analysis plans; it addresses a wide range of guidance within a single framework. By supporting the transparent evaluation of causal assumptions and facilitating objective comparisons of design and analysis choices based on prespecified criteria, the Roadmap can help investigators to evaluate the quality of evidence that a given study is likely to produce, specify a study to generate high-quality RWE, and communicate effectively with regulatory agencies and other stakeholders. This paper aims to disseminate and extend the Causal Roadmap framework for use by clinical and translational researchers; three companion papers demonstrate applications of the Causal Roadmap for specific use cases.
Cost-effectiveness of mirtazapine for agitated behaviors in dementia: findings from a randomized controlled trial
- Catherine Henderson, Martin Knapp, Susan Stirling, Lee Shepstone, Juliet High, Clive Ballard, Peter Bentham, Alistair Burns, Nicolas Farina, Chris Fox, Julia Fountain, Paul Francis, Robert Howard, Iracema Leroi, Gill Livingston, Ramin Nilforooshan, Shirley Nurock, John T. O’Brien, Annabel Price, Ann Marie Swart, Naji Tabet, Tanya Telling, Alan J. Thomas, Sube Banerjee
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- Journal:
- International Psychogeriatrics / Volume 34 / Issue 10 / October 2022
- Published online by Cambridge University Press:
- 19 July 2022, pp. 905-917
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Objectives:
To examine the costs and cost-effectiveness of mirtazapine compared to placebo over 12-week follow-up.
Design:Economic evaluation in a double-blind randomized controlled trial of mirtazapine vs. placebo.
Setting:Community settings and care homes in 26 UK centers.
Participants:People with probable or possible Alzheimer’s disease and agitation.
Measurements:Primary outcome included incremental cost of participants’ health and social care per 6-point difference in CMAI score at 12 weeks. Secondary cost-utility analyses examined participants’ and unpaid carers’ gain in quality-adjusted life years (derived from EQ-5D-5L, DEMQOL-Proxy-U, and DEMQOL-U) from the health and social care and societal perspectives.
Results:One hundred and two participants were allocated to each group; 81 mirtazapine and 90 placebo participants completed a 12-week assessment (87 and 95, respectively, completed a 6-week assessment). Mirtazapine and placebo groups did not differ on mean CMAI scores or health and social care costs over the study period, before or after adjustment for center and living arrangement (independent living/care home). On the primary outcome, neither mirtazapine nor placebo could be considered a cost-effective strategy with a high level of confidence. Groups did not differ in terms of participant self- or proxy-rated or carer self-rated quality of life scores, health and social care or societal costs, before or after adjustment.
Conclusions:On cost-effectiveness grounds, the use of mirtazapine cannot be recommended for agitated behaviors in people living with dementia. Effective and cost-effective medications for agitation in dementia remain to be identified in cases where non-pharmacological strategies for managing agitation have been unsuccessful.
Using polygenic scores and clinical data for bipolar disorder patient stratification and lithium response prediction: machine learning approach – CORRIGENDUM
- Micah Cearns, Azmeraw T. Amare, Klaus Oliver Schubert, Anbupalam Thalamuthu, Joseph Frank, Fabian Streit, Mazda Adli, Nirmala Akula, Kazufumi Akiyama, Raffaella Ardau, Bárbara Arias, JeanMichel Aubry, Lena Backlund, Abesh Kumar Bhattacharjee, Frank Bellivier, Antonio Benabarre, Susanne Bengesser, Joanna M. Biernacka, Armin Birner, Clara Brichant-Petitjean, Pablo Cervantes, HsiChung Chen, Caterina Chillotti, Sven Cichon, Cristiana Cruceanu, Piotr M. Czerski, Nina Dalkner, Alexandre Dayer, Franziska Degenhardt, Maria Del Zompo, J. Raymond DePaulo, Bruno Étain, Peter Falkai, Andreas J. Forstner, Louise Frisen, Mark A. Frye, Janice M. Fullerton, Sébastien Gard, Julie S. Garnham, Fernando S. Goes, Maria Grigoroiu-Serbanescu, Paul Grof, Ryota Hashimoto, Joanna Hauser, Urs Heilbronner, Stefan Herms, Per Hoffmann, Andrea Hofmann, Liping Hou, Yi-Hsiang Hsu, Stephane Jamain, Esther Jiménez, Jean-Pierre Kahn, Layla Kassem, Po-Hsiu Kuo, Tadafumi Kato, John Kelsoe, Sarah Kittel-Schneider, Sebastian Kliwicki, Barbara König, Ichiro Kusumi, Gonzalo Laje, Mikael Landén, Catharina Lavebratt, Marion Leboyer, Susan G. Leckband, Mario Maj, the Major Depressive Disorder Working Group of the Psychiatric Genomics Consortium, Mirko Manchia, Lina Martinsson, Michael J. McCarthy, Susan McElroy, Francesc Colom, Marina Mitjans, Francis M. Mondimore, Palmiero Monteleone, Caroline M. Nievergelt, Markus M. Nöthen, Tomas Novák, Claire O'Donovan, Norio Ozaki, Vincent Millischer, Sergi Papiol, Andrea Pfennig, Claudia Pisanu, James B. Potash, Andreas Reif, Eva Reininghaus, Guy A. Rouleau, Janusz K. Rybakowski, Martin Schalling, Peter R. Schofield, Barbara W. Schweizer, Giovanni Severino, Tatyana Shekhtman, Paul D. Shilling, Katzutaka Shimoda, Christian Simhandl, Claire M. Slaney, Alessio Squassina, Thomas Stamm, Pavla Stopkova, Fasil TekolaAyele, Alfonso Tortorella, Gustavo Turecki, Julia Veeh, Eduard Vieta, Stephanie H. Witt, Gloria Roberts, Peter P. Zandi, Martin Alda, Michael Bauer, Francis J. McMahon, Philip B. Mitchell, Thomas G. Schulze, Marcella Rietschel, Scott R. Clark, Bernhard T. Baune
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- Journal:
- The British Journal of Psychiatry / Volume 221 / Issue 2 / August 2022
- Published online by Cambridge University Press:
- 04 May 2022, p. 494
- Print publication:
- August 2022
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Using polygenic scores and clinical data for bipolar disorder patient stratification and lithium response prediction: machine learning approach
- Micah Cearns, Azmeraw T. Amare, Klaus Oliver Schubert, Anbupalam Thalamuthu, Joseph Frank, Fabian Streit, Mazda Adli, Nirmala Akula, Kazufumi Akiyama, Raffaella Ardau, Bárbara Arias, Jean-Michel Aubry, Lena Backlund, Abesh Kumar Bhattacharjee, Frank Bellivier, Antonio Benabarre, Susanne Bengesser, Joanna M. Biernacka, Armin Birner, Clara Brichant-Petitjean, Pablo Cervantes, Hsi-Chung Chen, Caterina Chillotti, Sven Cichon, Cristiana Cruceanu, Piotr M. Czerski, Nina Dalkner, Alexandre Dayer, Franziska Degenhardt, Maria Del Zompo, J. Raymond DePaulo, Bruno Étain, Peter Falkai, Andreas J. Forstner, Louise Frisen, Mark A. Frye, Janice M. Fullerton, Sébastien Gard, Julie S. Garnham, Fernando S. Goes, Maria Grigoroiu-Serbanescu, Paul Grof, Ryota Hashimoto, Joanna Hauser, Urs Heilbronner, Stefan Herms, Per Hoffmann, Andrea Hofmann, Liping Hou, Yi-Hsiang Hsu, Stephane Jamain, Esther Jiménez, Jean-Pierre Kahn, Layla Kassem, Po-Hsiu Kuo, Tadafumi Kato, John Kelsoe, Sarah Kittel-Schneider, Sebastian Kliwicki, Barbara König, Ichiro Kusumi, Gonzalo Laje, Mikael Landén, Catharina Lavebratt, Marion Leboyer, Susan G. Leckband, Mario Maj, the Major Depressive Disorder Working Group of the Psychiatric Genomics Consortium, Mirko Manchia, Lina Martinsson, Michael J. McCarthy, Susan McElroy, Francesc Colom, Marina Mitjans, Francis M. Mondimore, Palmiero Monteleone, Caroline M. Nievergelt, Markus M. Nöthen, Tomas Novák, Claire O'Donovan, Norio Ozaki, Vincent Millischer, Sergi Papiol, Andrea Pfennig, Claudia Pisanu, James B. Potash, Andreas Reif, Eva Reininghaus, Guy A. Rouleau, Janusz K. Rybakowski, Martin Schalling, Peter R. Schofield, Barbara W. Schweizer, Giovanni Severino, Tatyana Shekhtman, Paul D. Shilling, Katzutaka Shimoda, Christian Simhandl, Claire M. Slaney, Alessio Squassina, Thomas Stamm, Pavla Stopkova, Fasil Tekola-Ayele, Alfonso Tortorella, Gustavo Turecki, Julia Veeh, Eduard Vieta, Stephanie H. Witt, Gloria Roberts, Peter P. Zandi, Martin Alda, Michael Bauer, Francis J. McMahon, Philip B. Mitchell, Thomas G. Schulze, Marcella Rietschel, Scott R. Clark, Bernhard T. Baune
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- Journal:
- The British Journal of Psychiatry / Volume 220 / Issue 4 / April 2022
- Published online by Cambridge University Press:
- 28 February 2022, pp. 219-228
- Print publication:
- April 2022
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Background
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.
AimsTo use a combination of transdiagnostic genetic and clinical factors to predict lithium response in patients with bipolar disorder.
MethodThis 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.
ResultsThe 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.
ConclusionsUsing 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.
9 - Reflections on inspiring conversations in social work education: the voices of Scottish experts by experience and Italian students
- Edited by Kristel Driessens, Karel de Grote Hogeschool Antwerpen, Belgium, Vicky Lyssens-Danneboom, Karel de Grote Hogeschool Antwerpen, Belgium
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- Book:
- Involving Service Users in Social Work Education, Research and Policy
- Published by:
- Bristol University Press
- Published online:
- 13 May 2022
- Print publication:
- 06 December 2021, pp 97-108
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Summary
Introduction
There is an increasing literature setting out models and good practice in service-user involvement in social work education (Skilton, 2011; Robinson and Webber, 2013; Tanner et al, 2015; Askheim et al, 2017; Duffy et al, 2017; Cabiati and Levy, 2020). Pedagogically this work is framed by approaches to integrating the voices, lived experiences and experiential knowledge of service users and carers into social work education. While these voices are becoming less marginal within social work education, the contribution of service users and carers as co-authors in this literature is less visible (McPhail, 2007; Fox, 2016; Bell et al, 2020; Levy et al, 2016, 2020). This chapter contributes to addressing this lacuna by being co-authored with three Scottish service users and/or carers, also called experts by experience. All three have written reflectively on their experiences of involvement in social work education and their perceptions of the impact of their involvement on students’ learning, social work practice and on them personally. The chapter also includes reflective accounts written by Italian social work students as part of their course work. The EBE and students all used the concept of ‘inspiring conversations’ (Cabiati and Levy, 2020) as a starting point to explore and reflect on their experiences of user involvement in social work education.
‘Experts by experience’ (EBE), rather than ‘service users’, is used in this chapter as a term that more coherently conveys the essence of experiential and tacit knowledge; that is, knowledge acquired through living with a disability, being a family carer and/or receiving social services. The term EBE locates experiential, tacit knowledge in the experiences of service users, but is also inclusive of people who, for a variety of reasons, do not receive services (McLaughlin, 2009). More broadly, the term engages with the struggles, emotions and muted voices from the margins, and with people living precarious lives.
We start the chapter by discussing the concept of inspiring conversations; second, we contextualise the involvement of EBE in social work education at the University of Dundee, Scotland, and the Catholic University of Milan, Italy. We then present reflections from the three co-authors, Dow, Dowson and Swankie, and from student social workers.
Aleutian Tern Onychoprion aleuticus abundance estimates at four globally significant colonies
- HEATHER RENNER, MARTIN RENNER, DON LYONS, VLADIMIR ZYKOV, ZOYA REVYAKINA, SUSAN OEHLERS
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- Journal:
- Bird Conservation International / Volume 33 / 2023
- Published online by Cambridge University Press:
- 03 December 2021, e4
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Aleutian Tern Onychoprion aleuticus numbers have been in steep decline at known Alaskan breeding colonies in recent decades (IUCN recently uplisted to ‘Vulnerable’). Available data suggest that most of the species may currently breed in Russia. Efforts to document global abundance and trends have been hampered by remoteness of colonies, lack of a formal monitoring programme, and the absence of reproducible population estimates with quantifiable errors, especially for large colonies. We surveyed four historically large colonies in Russia (2018) and Alaska (2019), which together may comprise 30–50% of the global breeding population. At each colony we obtained high resolution aerial photographs using a small Unmanned Aircraft System (sUAS). The large size of the colonies and the minimum altitude required to identify terns made it impractical to collect imagery of the entire colony. Instead, we employed a sampling approach, with sample locations selected based on spatially balanced acceptance sampling. Statistically sampled, low altitude sUAS images provided a fast, reproducible, and rigorous count of abundance for geographically large colonies, with low disturbance, and were generally consistent with concurrent ground-based observations. Concurrence among observers in photo counts indicated high precision in counts of attending birds and unattended nests, although species attribution in mixed tern colonies remains a source of significant uncertainty. Our results indicate that the four colonies surveyed here together supported <2,500 pairs of Aleutian Terns in the survey years. None of the colonies approached their peak size reported previously, likely due to recent predation, long-term decline, cold early season weather, or other factors. If these reduced colony sizes are representative of the current conditions, the implications for the global population would be dire.
Superior colliculus projections to target populations in the supraoculomotor area of the macaque monkey
- Paul J. May, Martin O. Bohlen, Eddie Perkins, Niping Wang, Susan Warren
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- Journal:
- Visual Neuroscience / Volume 38 / 2021
- Published online by Cambridge University Press:
- 11 November 2021, E017
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A projection by the superior colliculus to the supraoculomotor area (SOA) located dorsal to the oculomotor complex was first described in 1978. This projection’s targets have yet to be identified, although the initial study suggested that vertical gaze motoneuron dendrites might receive this input. Defining the tectal targets is complicated by the fact the SOA contains a number of different cell populations. In the present study, we used anterograde tracers to characterize collicular axonal arbors and retrograde tracers to label prospective SOA target populations in macaque monkeys. Close associations were not found with either superior or medial rectus motoneurons whose axons supply singly innervated muscle fibers. S-group motoneurons, which supply superior rectus multiply innervated muscle fibers, appeared to receive a very minor input, but C-group motoneurons, which supply medial rectus multiply innervated muscle fibers, received no input. A number of labeled boutons were observed in close association with SOA neurons projecting to the spinal cord, or the reticular formation in the pons and medulla. These descending output neurons are presumed to be peptidergic cells within the centrally projecting Edinger–Westphal population. It is possible the collicular input provides a signaling function for neurons in this population that serve roles in either stress responses, or in eating and drinking behavior. Finally, a number of close associations were observed between tectal terminals and levator palpebrae superioris motoneurons, suggesting the possibility that the superior colliculus provides a modest direct input for raising the eyelids during upward saccades.
Characterisation of age and polarity at onset in bipolar disorder
- Janos L. Kalman, Loes M. Olde Loohuis, Annabel Vreeker, Andrew McQuillin, Eli A. Stahl, Douglas Ruderfer, Maria Grigoroiu-Serbanescu, Georgia Panagiotaropoulou, Stephan Ripke, Tim B. Bigdeli, Frederike Stein, Tina Meller, Susanne Meinert, Helena Pelin, Fabian Streit, Sergi Papiol, Mark J. Adams, Rolf Adolfsson, Kristina Adorjan, Ingrid Agartz, Sofie R. Aminoff, Heike Anderson-Schmidt, Ole A. Andreassen, Raffaella Ardau, Jean-Michel Aubry, Ceylan Balaban, Nicholas Bass, Bernhard T. Baune, Frank Bellivier, Antoni Benabarre, Susanne Bengesser, Wade H Berrettini, Marco P. Boks, Evelyn J. Bromet, Katharina Brosch, Monika Budde, William Byerley, Pablo Cervantes, Catina Chillotti, Sven Cichon, Scott R. Clark, Ashley L. Comes, Aiden Corvin, William Coryell, Nick Craddock, David W. Craig, Paul E. Croarkin, Cristiana Cruceanu, Piotr M. Czerski, Nina Dalkner, Udo Dannlowski, Franziska Degenhardt, Maria Del Zompo, J. Raymond DePaulo, Srdjan Djurovic, Howard J. Edenberg, Mariam Al Eissa, Torbjørn Elvsåshagen, Bruno Etain, Ayman H. Fanous, Frederike Fellendorf, Alessia Fiorentino, Andreas J. Forstner, Mark A. Frye, Janice M. Fullerton, Katrin Gade, Julie Garnham, Elliot Gershon, Michael Gill, Fernando S. Goes, Katherine Gordon-Smith, Paul Grof, Jose Guzman-Parra, Tim Hahn, Roland Hasler, Maria Heilbronner, Urs Heilbronner, Stephane Jamain, Esther Jimenez, Ian Jones, Lisa Jones, Lina Jonsson, Rene S. Kahn, John R. Kelsoe, James L. Kennedy, Tilo Kircher, George Kirov, Sarah Kittel-Schneider, Farah Klöhn-Saghatolislam, James A. Knowles, Thorsten M. Kranz, Trine Vik Lagerberg, Mikael Landen, William B. Lawson, Marion Leboyer, Qingqin S. Li, Mario Maj, Dolores Malaspina, Mirko Manchia, Fermin Mayoral, Susan L. McElroy, Melvin G. McInnis, Andrew M. McIntosh, Helena Medeiros, Ingrid Melle, Vihra Milanova, Philip B. Mitchell, Palmiero Monteleone, Alessio Maria Monteleone, Markus M. Nöthen, Tomas Novak, John I. Nurnberger, Niamh O'Brien, Kevin S. O'Connell, Claire O'Donovan, Michael C. O'Donovan, Nils Opel, Abigail Ortiz, Michael J. Owen, Erik Pålsson, Carlos Pato, Michele T. Pato, Joanna Pawlak, Julia-Katharina Pfarr, Claudia Pisanu, James B. Potash, Mark H Rapaport, Daniela Reich-Erkelenz, Andreas Reif, Eva Reininghaus, Jonathan Repple, Hélène Richard-Lepouriel, Marcella Rietschel, Kai Ringwald, Gloria Roberts, Guy Rouleau, Sabrina Schaupp, William A Scheftner, Simon Schmitt, Peter R. Schofield, K. Oliver Schubert, Eva C. Schulte, Barbara Schweizer, Fanny Senner, Giovanni Severino, Sally Sharp, Claire Slaney, Olav B. Smeland, Janet L. Sobell, Alessio Squassina, Pavla Stopkova, John Strauss, Alfonso Tortorella, Gustavo Turecki, Joanna Twarowska-Hauser, Marin Veldic, Eduard Vieta, John B. Vincent, Wei Xu, Clement C. Zai, Peter P. Zandi, Psychiatric Genomics Consortium (PGC) Bipolar Disorder Working Group, International Consortium on Lithium Genetics (ConLiGen), Colombia-US Cross Disorder Collaboration in Psychiatric Genetics, Arianna Di Florio, Jordan W. Smoller, Joanna M. Biernacka, Francis J. McMahon, Martin Alda, Bertram Müller-Myhsok, Nikolaos Koutsouleris, Peter Falkai, Nelson B. Freimer, Till F.M. Andlauer, Thomas G. Schulze, Roel A. Ophoff
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- Journal:
- The British Journal of Psychiatry / Volume 219 / Issue 6 / December 2021
- Published online by Cambridge University Press:
- 25 August 2021, pp. 659-669
- Print publication:
- December 2021
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Background
Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.
AimsTo examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.
MethodGenome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.
ResultsEarlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.
ConclusionsAAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.
Development and preliminary evaluation of EMPOWER for surrogate decision-makers of critically ill patients
- Wendy G. Lichtenthal, Martin Viola, Madeline Rogers, Kailey E. Roberts, Lindsay Lief, Christopher E. Cox, Chris R. Brewin, Jiehui Cici Xu, Paul K. Maciejewski, Cynthia X. Pan, Taylor Coats, Daniel J. Ouyang, Shayna Rabin, Susan C. Vaughan, William Breitbart, Marjorie E. Marenberg, Holly G. Prigerson
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- Journal:
- Palliative & Supportive Care / Volume 20 / Issue 2 / April 2022
- Published online by Cambridge University Press:
- 08 July 2021, pp. 167-177
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Objective
The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in improving surrogates’ mental health and patient outcomes.
MethodPart 1 involved obtaining qualitative stakeholder feedback from 5 bereaved surrogates and 10 critical care and mental health clinicians. Stakeholders were provided with the manual and prompted for feedback on its content, format, and language. Feedback was organized and incorporated into the manual, which was then re-circulated until consensus. In Part 2, surrogates of critically ill patients admitted to an intensive care unit (ICU) reporting moderate anxiety or close attachment were enrolled in an open trial of EMPOWER. Surrogates completed six, 15–20 min modules, totaling 1.5–2 h. Surrogates were administered measures of peritraumatic distress, experiential avoidance, prolonged grief, distress tolerance, anxiety, and depression at pre-intervention, post-intervention, and at 1-month and 3-month follow-up assessments.
ResultsPart 1 resulted in changes to the EMPOWER manual, including reducing jargon, improving navigability, making EMPOWER applicable for a range of illness scenarios, rearranging the modules, and adding further instructions and psychoeducation. Part 2 findings suggested that EMPOWER is feasible, with 100% of participants completing all modules. The acceptability of EMPOWER appeared strong, with high ratings of effectiveness and helpfulness (M = 8/10). Results showed immediate post-intervention improvements in anxiety (d = −0.41), peritraumatic distress (d = −0.24), and experiential avoidance (d = −0.23). At the 3-month follow-up assessments, surrogates exhibited improvements in prolonged grief symptoms (d = −0.94), depression (d = −0.23), anxiety (d = −0.29), and experiential avoidance (d = −0.30).
Significance of resultsPreliminary data suggest that EMPOWER is feasible, acceptable, and associated with notable improvements in psychological symptoms among surrogates. Future research should examine EMPOWER with a larger sample in a randomized controlled trial.
A comparison of the remote food photography method and the automated self-administered 24-h dietary assessment tool for measuring full-day dietary intake among school-age children
- Traci A. Bekelman, Corby K. Martin, Susan L. Johnson, Deborah H. Glueck, Katherine A. Sauder, Kylie K. Harrall, Rachel I. Steinberg, Daniel S. Hsia, Dana Dabelea
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- Journal:
- British Journal of Nutrition / Volume 127 / Issue 8 / 28 April 2022
- Published online by Cambridge University Press:
- 04 June 2021, pp. 1269-1278
- Print publication:
- 28 April 2022
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The limitations of self-report measures of dietary intake are well-known. Novel, technology-based measures of dietary intake may provide a more accurate, less burdensome alternative to existing tools. The first objective of this study was to compare participant burden for two technology-based measures of dietary intake among school-age children: the Automated-Self-Administered 24-hour Dietary Assessment Tool-2018 (ASA24-2018) and the Remote Food Photography Method (RFPM). The second objective was to compare reported energy intake for each method to the Estimated Energy Requirement for each child, as a benchmark for actual intake. Forty parent–child dyads participated in two, 3-d dietary assessments: a parent proxy-reported version of the ASA24 and the RFPM. A parent survey was subsequently administered to compare satisfaction, ease of use and burden with each method. A linear mixed model examined differences in total daily energy intake between assessments, and between each assessment method and the Estimated Energy Requirement (EER). Reported energy intake was 379 kcal higher with the ASA24 than the RFPM (P = 0·0002). Reported energy intake with the ASA24 was 231 kcal higher than the EER (P = 0·008). Reported energy intake with the RFPM did not differ significantly from the EER (difference in predicted means = −148 kcal, P = 0·09). Median satisfaction and ease of use scores were five out of six for both methods. A higher proportion of parents reported that the ASA24 was more time-consuming than the RFPM (74·4 % v. 25·6 %, P = 0·002). Utilisation of both methods is warranted given their high satisfaction among parents.
Cerebellar projections to the macaque midbrain tegmentum: Possible near response connections
- Martin O. Bohlen, Paul D. Gamlin, Susan Warren, Paul J. May
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- Journal:
- Visual Neuroscience / Volume 38 / 2021
- Published online by Cambridge University Press:
- 12 May 2021, E007
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Since most gaze shifts are to targets that lie at a different distance from the viewer than the current target, gaze changes commonly require a change in the angle between the eyes. As part of this response, lens curvature must also be adjusted with respect to target distance by the ciliary muscle. It has been suggested that projections by the cerebellar fastigial and posterior interposed nuclei to the supraoculomotor area (SOA), which lies immediately dorsal to the oculomotor nucleus and contains near response neurons, support this behavior. However, the SOA also contains motoneurons that supply multiply innervated muscle fibers (MIFs) and the dendrites of levator palpebrae superioris motoneurons. To better determine the targets of the fastigial nucleus in the SOA, we placed an anterograde tracer into this cerebellar nucleus in Macaca fascicularis monkeys and a retrograde tracer into their contralateral medial rectus, superior rectus, and levator palpebrae muscles. We only observed close associations between anterogradely labeled boutons and the dendrites of medial rectus MIF and levator palpebrae motoneurons. However, relatively few of these associations were present, suggesting these are not the main cerebellar targets. In contrast, labeled boutons in SOA, and in the adjacent central mesencephalic reticular formation (cMRF), densely innervated a subpopulation of neurons. Based on their location, these cells may represent premotor near response neurons that supply medial rectus and preganglionic Edinger–Westphal motoneurons. We also identified lens accommodation-related cerebellar afferent neurons via retrograde trans-synaptic transport of the N2c rabies virus from the ciliary muscle. They were found bilaterally in the fastigial and posterior interposed nuclei, in a distribution which mirrored that of neurons retrogradely labeled from the SOA and cMRF. Our results suggest these cerebellar neurons coordinate elements of the near response during symmetric vergence and disjunctive saccades by targeting cMRF and SOA premotor neurons.
6 - Building a Nation
- Susan F. Martin, Georgetown University, Washington DC
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- A Nation of Immigrants
- Published online:
- 05 March 2021
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- 25 March 2021, pp 90-110
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Summary
Between 1820, when the federal government began to count arrivals, and 1860, almost five million European immigrants arrived in the United States. Although the number declined during the first years of the Civil War, it began building again by 1863. During the course of the 1860s, about two million immigrants came, with another 2.7 million entering in the 1870s. Never before had the country needed to absorb so large a number of newcomers in so short a time. The range of countries from which immigration took place also increased, with fewer people coming from Britain and more from Ireland, Germany, and the Scandinavian countries. In addition, under the Treaty of Guadalupe Hidalgo, the United States gained control over large areas of what had been Mexico. Although they were not, strictly speaking, immigrants because they had already been living in what became US territory, under the treaty Spanish speakers found themselves under American rule. Their numbers were relatively small, however. The 1850 census, for example, counted only 13,000 Mexican nationals living in the United States.
12 - The Pennsylvania Model at Risk
- Susan F. Martin, Georgetown University, Washington DC
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- A Nation of Immigrants
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- 05 March 2021
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- 25 March 2021, pp 263-299
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Summary
Within a few short years of the 1990 changes in immigration and refugee policy, the country was turning away from the Pennsylvania model of immigration. This chapter begins with a discussion of the renewed growth in unauthorized migration after the IRCA legalization and the failure of the United States to address it. In many respects, the high level of tolerance for unauthorized migration represents a return to the Virginia model of disposable workers with few rights. But that tolerance came at a price when numbers increased. Unauthorized migration became a divisive issue in the 1994 elections when California adopted Proposition 187, which would have restricted the access of unauthorized migrants, including children, to basic emergency services and education.
10 - “A Nation of Immigrants”
- Susan F. Martin, Georgetown University, Washington DC
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- A Nation of Immigrants
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- 05 March 2021
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- 25 March 2021, pp 192-230
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Summary
In 1958, Senator John F. Kennedy published a slim volume, A Nation of Immigrants, which set out the case for reforming US immigration policies. He argued that the national origins quotas “violated the spirit expressed in the Declaration of Independence that ‘all men are created equal’” (Kennedy 1964). Kennedy did not live to see legislation enacted, but, in the spirit of the civil rights movement, the 1965 Amendments to the Immigration and Nationality Act tried to revive the Pennsylvania model of immigration, attempting to put in place a universalistic vision of immigration.
7 - The Golden Door
- Susan F. Martin, Georgetown University, Washington DC
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- A Nation of Immigrants
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- 05 March 2021
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- 25 March 2021, pp 111-138
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Summary
The 1880s ushered in a new era of immigration, with growth in both numbers and diversity of origins of the immigrants. With the advancing industrial revolution, demand for labor grew and so did immigration. From 1860 to 1880, about 2.5 million immigrants entered the United States each decade; during the 1880s, the number more than doubled to 5.2 million. In the first decade of the new century, 8.8 million entered the country, with a record of 1.285 million entering in 1907 alone. Only the decade of the 1890s saw a reduction over the previous decade’s levels, largely because of the economic depression that affected much of the US economy.
2 - “Gentlemen, Tradesmen, Serving-men, Libertines”
- Susan F. Martin, Georgetown University, Washington DC
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- A Nation of Immigrants
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- 05 March 2021
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- 25 March 2021, pp 13-29
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Summary
The title of this chapter comes from a passage in John Smith‘s General History of Virginia in which he rues the paucity of laborers among the early colonizers in Jamestown. The expense of migrating, as well as the conditions found in the colony, restricted movements to the colonies. Within a few decades, as the tobacco economy developed, Virginia had identified several sources of foreign labor. The first was indentured servants. The employer paid the migrant’s passage in exchange for indentured labor, which was usually for a term of from four to seven years. On release from the indenture, the worker was to be provided with tools, clothing, and land or other means of self-support, although these terms were by no means always upheld. There were prominent cases in which released servants experienced upward mobility, including landownership and political participation; but in many cases, the freed worker remained dependent on the former employer for continued employment.
11 - A Nation of Refuge
- Susan F. Martin, Georgetown University, Washington DC
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- A Nation of Immigrants
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- 05 March 2021
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- 25 March 2021, pp 231-262
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Summary
Just as the civil rights movement affected attitudes toward immigration, notions about the universalism of human rights eventually affected refugee policy, with the adoption of the international definition of the term “refugee” in the Refugee Act of 1980. The Cold War definition, in contrast, had been related specifically to those fleeing Communist or Communist-dominated countries. As early as 1948, the United States had subscribed to the idea that all people, regardless of where in the world they lived, had certain inalienable rights. Eleanor Roosevelt chaired the United Nations conference that drafted the Universal Declaration of Human Rights and lent her considerable prestige to the endeavor. During the height of the Cold War, however, US leadership in the field of human rights diminished as US foreign policy increasingly relied on realpolitik, which included support for authoritarian regimes as long as they allied themselves with the West against the Communist threat.