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Anxiety is a common comorbid feature of late-life depression (LLD) and is associated with poorer global cognitive functioning independent of depression severity. However, little is known about whether comorbid anxiety is associated with a domain-specific pattern of cognitive dysfunction. We therefore examined group differences (LLD with and without comorbid anxiety) in cognitive functioning performance across multiple domains.
Method:
Older adults with major depressive disorder (N = 228, ages 65–91) were evaluated for anxiety and depression severity, and cognitive functioning (learning, memory, language, processing speed, executive functioning, working memory, and visuospatial functioning). Ordinary least squares regression adjusting for age, sex, education, and concurrent depression severity examined anxiety group differences in performance on tests of cognitive functioning.
Results:
Significant group differences emerged for confrontation naming and visuospatial functioning, as well as for verbal fluency, working memory, and inhibition with lower performance for LLD with comorbid anxiety compared to LLD only, controlling for depression severity.
Conclusions:
Performance patterns identified among older adults with LLD and comorbid anxiety resemble neuropsychological profiles typically seen in neurodegenerative diseases of aging. These findings have potential implications for etiological considerations in the interpretation of neuropsychological profiles.
To identify if patients discharged from an older adult psychiatric ward were followed up in line with national recommended guidelines. Current National Institute for Clinical Excellence (NICE) guidelines recommend follow up and final discharge letters (FDLs) being available within 7 days of discharge.
Methods
A record search was conducted to identify all patients discharged from one ward during a one year period.
Each patient's notes were reviewed to identify what follow up they had in place and how long it took for this to be implemented. We also examined the time taken for a final discharge letter (FDL) to be made available to their General Practitioner (GP).
Results
We identified 99 patients who were discharged from the ward within the specified period.
The mean time taken for patients to be followed up after discharge was 9.72 days. In 63.16% of cases this follow up was provided by Community Psychiatric Nurses (CPNs), with 51.58% being reviewed in medical clinic. A further 9.47% had their initial follow up with an occupational therapist, 4.21% with a psychologist, 4.21% with the addictions team, 4.21% with care home liaison, 2.11% with social work, 2.11% with continuing care and 1.05% with rehab.
FDLs were sent to GPs, on average, 13.6 days after patients were discharged.
Conclusion
Within our data set a few outlier values markedly increased the mean for both outcomes. Using median figures, average follow up time fell to 6 days, meeting national guidelines, and FDL time fell to 8 days, exceeding recommendations by just 1 day.
Within our department, measures have since been put in place to ensure secretaries are reminding medical staff of the recommended time frames for final discharge letters and it should be noted that an immediate discharge letter (IDL) is routinely sent to GPs containing key clinical information prior to patients being discharged.
The results show that our current practice does fall somewhat short of matching national guidelines and further work should be done to investigate how we can improve standards.
We aimed to review various health outcomes for patients admitted to an older adult psychiatry ward specialising in functional illness, over a one year period.
In 2020 the Mental Welfare Commission for Scotland highlighted a concern about the lack of evidence and data surrounding admission to older people’s functional mental health wards. We aimed to review this for North Lanarkshire and provide a comprehensive overview of our in-patient population that will aid in service review and improve care.
Methods
We reviewed the electronic notes of all patients (total: 99) admitted to the ward over a one year period. Extracted data included demographics, medications, mental health act status, discharge destination and readmissions.
Results
We found the average age was 73 years old and the median length of stay was 33 days (mean 63). Patients were admitted with a wide range of diagnosis including (most common to least): mood disorders, psychotic disorders, dementia, substance misuse and ARBD, delirium and personality disorders. 30% of patients required detention under the mental health act during their admission, but this fell to only 7% on discharge. 51% of patients were discharged on an antipsychotic. The majority of patients were discharged home; within a year 34% were readmitted to psychiatry and 40% required a medical admission.
Conclusion
We found that our demographic information was broadly consistent with the mental welfare commission's findings. However there is a significant variation in length of stay shown by the difference in the mean and median, due to a small number of significantly longer admissions. Notably there were numerous admissions with a dementia as a primary diagnosis, on a functional ward. In this age group it was significant that a high proportion of patients were prescribed antipsychotics. Further work is required to better understand these findings.
Late-life depression (LLD) is common and frequently co-occurs with neurodegenerative diseases of aging. Little is known about how heterogeneity within LLD relates to factors typically associated with neurodegeneration. Varying levels of anxiety are one source of heterogeneity in LLD. We examined associations between anxiety symptom severity and factors associated with neurodegeneration, including regional brain volumes, amyloid beta (Aβ) deposition, white matter disease, cognitive dysfunction, and functional ability in LLD.
Participants and Measurements:
Older adults with major depression (N = 121, Ages 65–91) were evaluated for anxiety severity and the following: brain volume (orbitofrontal cortex [OFC], insula), cortical Aβ standardized uptake value ratio (SUVR), white matter hyperintensity (WMH) volume, global cognition, and functional ability. Separate linear regression analyses adjusting for age, sex, and concurrent depression severity were conducted to examine associations between anxiety and each of these factors. A global regression analysis was then conducted to examine the relative associations of these variables with anxiety severity.
Results:
Greater anxiety severity was associated with lower OFC volume (β = −68.25, t = −2.18, p = .031) and greater cognitive dysfunction (β = 0.23, t = 2.46, p = .016). Anxiety severity was not associated with insula volume, Aβ SUVR, WMH, or functional ability. When examining the relative associations of cognitive functioning and OFC volume with anxiety in a global model, cognitive dysfunction (β = 0.24, t = 2.62, p = .010), but not OFC volume, remained significantly associated with anxiety.
Conclusions:
Among multiple factors typically associated with neurodegeneration, cognitive dysfunction stands out as a key factor associated with anxiety severity in LLD which has implications for cognitive and psychiatric interventions.
Many people who experience opioid use disorder rely on Medicaid. The high penetration of managed care systems into Medicaid raises the importance of understanding states’ expectations regarding coverage, access to care, and health system performance and effectively elevates agreements between states and plans into blueprints for coverage and care. Federal law broadly regulates these structured agreements while leaving a high degree of discretion to states and plans. In this study, researchers reviewed the provisions of 15 state Medicaid managed care contract related to substance use disorder (SUD) treatment to identify whether certain elements of SUD treatment were a stated expectation and the extent to which the details of those expectations varied across states in ways that ultimately could affect evaluation of performance and health outcomes. We found that while all states include SUD treatment as a stated contract expectation, discussions around coverage of specific services and nationally recognized guidelines varied. These variations reflect key state choices regarding how much deference to afford their plans in coverage design and plan administration and reveal important differences in purchasing expectations that could carry implications for efforts to examine similarities and differences in access, quality, and health outcomes within managed care across the states.
To assess the training and the future workforce needs of paediatric cardiac critical care faculty.
Design:
REDCap surveys were sent May−August 2019 to medical directors and faculty at the 120 US centres participating in the Society of Thoracic Surgeons Congenital Heart Surgery Database. Faculty and directors were asked about personal training pathway and planned employment changes. Directors were additionally asked for current faculty numbers, expected job openings, presence of training programmes, and numbers of trainees. Predictive modelling of the workforce was performed using respondents’ data. Patient volume was projected from US Census data and compared to projected provider availability.
Measurements and main results:
Sixty-six per cent (79/120) of directors and 62% (294/477) of contacted faculty responded. Most respondents had training that incorporated critical care medicine with the majority completing training beyond categorical fellowship. Younger respondents and those in dedicated cardiac ICUs were more significantly likely to have advanced training or dual fellowships in cardiology and critical care medicine. An estimated 49–63 faculty enter the workforce annually from various training pathways. Based on modelling, these faculty will likely fill current and projected open positions over the next 5 years.
Conclusions:
Paediatric cardiac critical care training has evolved, such that the majority of faculty now have dual fellowship or advanced training. The projected number of incoming faculty will likely fill open positions within the next 5 years. Institutions with existing or anticipated training programmes should be cognisant of these data and prepare graduates for an increasingly competitive market.
Previous genetic association studies have failed to identify loci robustly associated with sepsis, and there have been no published genetic association studies or polygenic risk score analyses of patients with septic shock, despite evidence suggesting genetic factors may be involved. We systematically collected genotype and clinical outcome data in the context of a randomized controlled trial from patients with septic shock to enrich the presence of disease-associated genetic variants. We performed genomewide association studies of susceptibility and mortality in septic shock using 493 patients with septic shock and 2442 population controls, and polygenic risk score analysis to assess genetic overlap between septic shock risk/mortality with clinically relevant traits. One variant, rs9489328, located in AL589740.1 noncoding RNA, was significantly associated with septic shock (p = 1.05 × 10–10); however, it is likely a false-positive. We were unable to replicate variants previously reported to be associated (p < 1.00 × 10–6 in previous scans) with susceptibility to and mortality from sepsis. Polygenic risk scores for hematocrit and granulocyte count were negatively associated with 28-day mortality (p = 3.04 × 10–3; p = 2.29 × 10–3), and scores for C-reactive protein levels were positively associated with susceptibility to septic shock (p = 1.44 × 10–3). Results suggest that common variants of large effect do not influence septic shock susceptibility, mortality and resolution; however, genetic predispositions to clinically relevant traits are significantly associated with increased susceptibility and mortality in septic individuals.
Recent advances in molecular genetics and genomics have been embraced by many in natural resource conservation. Today, several major conservation and management journals are now using 'genetics' editors to deal solely with the influx of manuscripts that employ molecular data. The editors have attempted to synthesize some of the major uses of molecular markers in natural resource management in a book targeted not only at scientists but also at individuals actively making conservation and management decisions. To that end, the text features contributors who are major figures in molecular ecology and evolution - many having published books of their own. The aim is to direct and distil the thoughts of these outstanding scientists by compiling compelling case histories in molecular ecology as they apply to natural resource management.
Mangroves are an imperilled biome whose protection and restoration through payments for ecosystem services (PES) can contribute to improved livelihoods, climate mitigation and adaptation. Interviews with resource users in three Solomon Islands villages suggest a strong reliance upon mangrove goods for subsistence and cash, particularly for firewood, food and building materials. Village-derived economic data indicates a minimum annual subsistence value from mangroves of US$ 345–1501 per household. Fish and nursery habitat and storm protection were widely recognized and highly valued mangrove ecosystem services. All villagers agreed that mangroves were under threat, with firewood overharvesting considered the primary cause. Multivariate analyses revealed village affiliation and religious denomination as the most important factors determining the use and importance of mangrove goods. These factors, together with gender, affected users’ awareness of ecosystem services. The importance placed on mangrove services did not differ significantly by village, religious denomination, gender, age, income, education or occupation. Mangrove ecosystem surveys are useful as tools for raising community awareness and input prior to design of PES systems. Land tenure and marine property rights, and how this complexity may both complicate and facilitate potential carbon credit programmes in the Pacific, are discussed.
The Val158Met polymorphism of the catechol-O-methyltransferase (COMT) gene may be related to individual differences in cognition, likely via modulation of prefrontal dopamine catabolism. However, the available studies have yielded mixed results, possibly in part because they do not consistently account for other genes that affect cognition. We hypothesized that COMT Met allele homozygosity, which is associated with higher levels of prefrontal dopamine, would predict better executive function as measured using standard neuropsychological testing, and that other candidate genes might interact with COMT to modulate this effect. Participants were 95 healthy, right-handed adults who underwent genotyping and cognitive testing. COMT genotype predicted executive ability as measured by the Trail-Making Test, even after covarying for demographics and Apolipoprotein E (APOE), brain-derived neurotrophic factor (BDNF), and ankyrin repeat and kinase domain containing 1 (ANKK1) genotype. There was a COMT-ANKK1 interaction in which individuals having both the COMT Val allele and the ANKK1 T allele showed the poorest performance. This study suggests the heterogeneity in COMT effects reported in the literature may be due in part to gene–gene interactions that influence central dopaminergic systems. (JINS, 2011, 17, 1–7)
The world would be a wonderful place if our natural resources (e.g., forests, fish, and wildlife) needed no management and conservation was not a concern. In a world with a global human population approaching 7 billion and where most developed nations overconsume these resources, however, conservation is a concern and management is necessary for sustainable use. Historically, natural resource management strategies were determined by the collection and interpretation of basic field data. Today, as challenges to the sustainability and conservation of our natural resources arise, managers often need data that cannot be acquired using conventional methods. For example, a natural resource manager might want to know the number of successful breeders in a population or if genetic variation was being depleted because of a management practice. Traditional field craft alone cannot directly address such questions, but the answers can be determined with some precision if the field work is coupled with modern molecular genetic techniques.
Molecules can enlighten us about biological attributes that are virtually impossible to observe in the field (Avise 2004). Parentage analysis is one such arena in which genetic data can inform management practices (DeWoody 2005), but there are a host of others. For example, molecular data have revealed deep evolutionary splits in stocks at one time thought to be homogeneous. This finding has concomitant management implications (Hoffman et al. 2006). Similarly, molecules can enlighten us about biologies that are virtually impossible to observe in the field, such as pollen flow (Hamrick, this volume) or the physiology of migration (Nichols et al. 2008).