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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.
Ice shelves play a critical role in modulating dynamic loss of ice from the grounded portion of the Antarctic Ice Sheet and its contribution to sea-level rise. Measurements of ice-shelf motion provide insights into processes modifying buttressing. Here we investigate the effect of seasonal variability of basal melting on ice flow of Ross Ice Shelf. Velocities were measured from November 2015 to December 2016 at 12 GPS stations deployed from the ice front to 430 km upstream. The flow-parallel velocity anomaly at each station, relative to the annual mean, was small during early austral summer (November–January), negative during February–April, and positive during austral winter (May–September). The maximum velocity anomaly reached several metres per year at most stations. We used a 2-D ice-sheet model of the RIS and its grounded tributaries to explore the seasonal response of the ice sheet to time-varying basal melt rates. We find that melt-rate response to changes in summer upper-ocean heating near the ice front will affect the future flow of RIS and its tributary glaciers. However, modelled seasonal flow variations from increased summer basal melting near the ice front are much smaller than observed, suggesting that other as-yet-unidentified seasonal processes are currently dominant.
Incumbent city councillors have an almost insurmountable advantage in Canadian municipal elections. This article aims to improve our understanding of the municipal incumbency advantage by considering the ability of electors to correctly identify the two most competitive candidates in one's ward and the factors associated with being able to do so. Using survey data from the Canadian Municipal Election Study (CMES), we consider the case of the 2018 elections in Mississauga, a city with typically high rates of incumbent re-election. Survey respondents were asked to identify the two most competitive candidates in their local ward races. We find that comparatively few electors are able to recognize which challenger serves as the strongest threat to a sitting councillor, a finding that suggests that coordination problems may help to contribute to high rates of incumbent success. We identify several individual-level and ward-level correlates of correctly identifying the first-place and second-place finishers. We do note, however, that there is a significant amount of variation among the thousands of municipalities in Canada, so findings from this case should be tested in other settings, including larger or smaller cities where levels of information might be different.
Anthocyanins and bromelain have gained significant attention due to their antioxidative and anti-inflammatory properties. Both have been shown to improve endothelial function, blood pressure (BP), and oxygen utility capacity in humans, however the combination of these two and the impacts on endothelial function, BP, total antioxidant capacity (TAC), and oxygen utility capacity have not been previously investigated. The purpose of this study was to investigate the impacts of a combined anthocyanins and bromelain supplement (BE) on endothelial function, BP, TAC, oxygen utility capacity, and fatigability in healthy adults. Healthy adults (n=18, age 24±4) received BE or placebo in a randomized crossover design. Brachial artery flow-mediated dilation (FMD), BP, TAC, resting heart rate, oxygen utility capacity, and fatigability were measured pre-and post-BE and placebo intake. The BE group showed significantly increased FMD, reduced systolic BP, and improved oxygen utility capacity compared placebo group (p<0.05). Tissue saturation and oxygenated hemoglobin significantly increased following BE intake while deoxygenated hemoglobin significantly decreased (p<0.05) during exercise. Additionally, TAC was significantly increased following BE intake (p<0.05). There were no significant differences for resting heart rate, diastolic BP, or fatigability index. These results suggest that BE intake is an effective nutritional therapy for improving endothelial function, BP TAC, and oxygen utility capacity, which may be beneficial to support vascular health in humans.
Electron diffraction is an essential characterization tool for materials scientists. When using the transmission electron microscope (TEM) to perform diffraction experiments, setting up the microscope for both calibration standards and unknown materials in a consistent method ensures that dependable results are obtained. Care must also be exercised to protect digital cameras from intense transmitted and diffracted beams to avoid damage. In Parts 1 and 2 of this series, procedures were presented for recording high-quality, well-calibrated, digital SAED patterns. In Part 3, aspects of diffraction analysis software packages and the reliability of data are discussed.
While negative affect reliably predicts binge eating, it is unknown how this association may decrease or ‘de-couple’ during treatment for binge eating disorder (BED), whether such change is greater in treatments targeting emotion regulation, or how such change predicts outcome. This study utilized multi-wave ecological momentary assessment (EMA) to assess changes in the momentary association between negative affect and subsequent binge-eating symptoms during Integrative Cognitive Affective Therapy (ICAT-BED) and Cognitive Behavior Therapy Guided Self-Help (CBTgsh). It was predicted that there would be stronger de-coupling effects in ICAT-BED compared to CBTgsh given the focus on emotion regulation skills in ICAT-BED and that greater de-coupling would predict outcomes.
Adults with BED were randomized to ICAT-BED or CBTgsh and completed 1-week EMA protocols and the Eating Disorder Examination (EDE) at pre-treatment, end-of-treatment, and 6-month follow-up (final N = 78). De-coupling was operationalized as a change in momentary associations between negative affect and binge-eating symptoms from pre-treatment to end-of-treatment.
There was a significant de-coupling effect at follow-up but not end-of-treatment, and de-coupling did not differ between ICAT-BED and CBTgsh. Less de-coupling was associated with higher end-of-treatment EDE global scores at end-of-treatment and higher binge frequency at follow-up.
Both ICAT-BED and CBTgsh were associated with de-coupling of momentary negative affect and binge-eating symptoms, which in turn relate to cognitive and behavioral treatment outcomes. Future research is warranted to identify differential mechanisms of change across ICAT-BED and CBTgsh. Results also highlight the importance of developing momentary interventions to more effectively de-couple negative affect and binge eating.
Background: Trauma care represents a complex patient journey, requiring multi-disciplinary coordinated care. Team members are human, and as such, how they feel about their colleagues and their work affects performance. The challenge for health service leaders is enabling culture that supports high levels of collaboration, cooperation and coordination across diverse groups. Aim Statement: We aimed to define and set the agenda for improvement of the relational aspects of trauma care at a large tertiary care hospital. Measures & Design: We conducted a mixed-methods collaborative ethnography using the Relational Coordination survey – an established tool to analyze the relational dimensions of multidisciplinary teamwork – participant observation, interviews, and narrative surveys. Findings were presented to clinicians in working groups for further interpretation and to facilitate co-creation of targeted interventions designed to improve team relationships and performance. Evaluation/Results: We engaged a complex multidisciplinary network of ~500 care providers dispersed across seven core interdependent clinical disciplines. Initial findings highlighted the importance of relationships in trauma care and opportunities to improve. Narrative survey and ethnographic findings further highlighted the centrality of a translational simulation program in contributing positively to team culture and relational ties. A range of 16 interventions – focusing on structural, process and relational dimensions – were co-created with participants and are now being implemented and evaluated by various trauma care providers. Discussion/Impact: Through engagement of clinicians spanning organizational boundaries, relational aspects of care can be measured and directly targeted in a collaborative quality improvement process. We encourage health care leaders to consider relationship-based quality improvement strategies, including translational simulation and relational coordination processes, in their efforts to improve care for patients with complex, interdependent journeys.
Electron diffraction is an essential tool for materials scientists to have in their characterization toolboxes. When using the transmission electron microscope (TEM) to perform diffraction experiments, setting up the microscope for both calibration standards and unknown materials in a consistent method will ensure that dependable results are obtained. Care must also be exercised to protect digital cameras from intense transmitted and diffracted beams to avoid damage. In Part 2 of this series a procedure is presented for the proper recording of SAED patterns.
Lichens of the Ramalina siliquosa complex dominate seashore cliffs in Europe and South-East Asia, but their taxonomy has been vigorously debated for over a century. On many cliffs, they exhibit a bewildering zonation of chemotypes that resembles the classic zonation of organisms that occupy the littoral zone below. Do the chemotypes represent separate species, or infraspecific variation? To better understand the systematics of this group, sequences from four genetic loci (ITS, IGS, RPB1 and RPB2) were obtained for 59 samples from Denmark, France, Iceland, Norway, UK, Japan and Korea, including all major chemotypes. Maximum likelihood analysis of these sequences, together with sequences from 36 other Ramalina species, reveals that the complex comprises two distinct phylogenetic lineages, each including multiple chemotypes. These two putative species-level lineages correspond to the currently accepted taxa R. cuspidata and R. siliquosa. There is no evidence that these two taxa are phylogenetic sister species. Consequently, the explanation of this chemotype complex as an example of ‘sibling speciation’ is rejected. Specimens traditionally called ‘R. siliquosa’ from South-East Asia form a third clade, identified here as R. semicuspidata, with an additional, divaricatic acid chemotype. Other results include a robustly supported clade of Ramalina species that produce medullary depsides and depsidones; this clade includes another well-supported clade of south-eastern United States coastal plain and tropical Ramalina species. By contrast, large, strap-shaped Ramalina species that lack medullary depsides and depsidones occur in separate lineages. In addition, close relationships between the following groups of species are indicated: R. farinacea with R. subfarinacea; R. fraxinea with R. leptocarpha, R. menziesii and R. subleptocarpha; R. sinensis with R. unifolia. Furthermore, a new, variolaric acid-only chemotype is reported for R. farinacea, and a new, acid-deficient chemotype is reported for a more broadly circumscribed R. culbersoniorum.
Amazon's Mechanical Turk is widely used for data collection; however, data quality may be declining due to the use of virtual private servers to fraudulently gain access to studies. Unfortunately, we know little about the scale and consequence of this fraud, and tools for social scientists to detect and prevent this fraud are underdeveloped. We first analyze 38 studies and show that this fraud is not new, but has increased recently. We then show that these fraudulent respondents provide particularly low-quality data and can weaken treatment effects. Finally, we provide two solutions: an easy-to-use application for identifying fraud in the existing datasets and a method for blocking fraudulent respondents in Qualtrics surveys.
Before October 2012 there was no service level agreement for psychiatry cover in Whiston Hospital, an acute trust in the UK. The Crisis team would visit on goodwill to assess patients. This changed when a Liaison Psychiatry (LP) service was commissioned to provide 24 hour cover, Monday to Sunday for the Emergency Department (ED) for adults.
To quantify waiting times to be assessed by psychiatry, comparing the new LP Service (intervention group) to its predecessor (control). The null hypothesis being that the waiting time for the control and intervention group are the same.
The authors prospectively collected data on all referrals received by the LP service in the first three months of operation n=305 and retrospectively collected data on a random sample of 50 patients referred from ED in the same months 2011 (control).
The median time from referral to the time of psychiatric assessment in the control group was 162.5 minutes [IQR 130–330], the mean time was 246.16 [95% CI 180 to 312]. The median time from referral to the time of psychiatric assessment following the introduction of the LP service was 30 minutes [IQR 15-90], the mean time was 79.63 [95% CI 65 to 93]. When the two samples were compared using an independent t test they were significantly different p<0.002.
The new LP service has decreased the median wait for a psychiatry assessment by 132 minutes. The team currently seeS 82% of referrals within 60 minutes. This improves patient safety and encourages appropriate and timely discharge.
The Department of Health in the UK wants the National Health Service to make £20 Billion worth of efficiency savings by 2015 to reinvest.
In the UK the General Hospitals use paper records which are then scanned to create electronic records while Psychiatric Hospitals require that information to be typed on to their electronic records and these electronic records are not available to each other.
Therefore liaison psychiatry assessments require a written entry to be made in the Medical notes and a second entry typed on to the psychiatric electronic patient record which requires a full psychiatric history.
This duplication in typing information was consuming a considerable amount of this Teams time and resources which could have instead been spent with patients.
To identify how much time is spent by Staff typing information on to the psychiatric electronic patient records.
We electronically checked for the preceding three months the amount of time spent typing information on to the electronic records after every liaison psychiatry assessment.
We were then able to obtain the average for every week.
On average about 36 to 40 hours were spent every week typing information on to the electronic records.
Liaison Psychiatry should dispense with the requirement for information to be duplicated on to the electronic patient records and should instead scan the written entry made in the Medical notes.
This should lead to a saving of about £50,000, enough to employ an additional member of Staff every week.
There is a continual need for invasive plant science to develop approaches for cost-effectively benefiting native over nonnative species in dynamic management and biophysical contexts, including within predominantly nonnative plant landscapes containing only small patches of native plants. Our objective was to test the effectiveness of a minimal-input strategy for enlarging native species patches within a nonnative plant matrix. In Pecos National Historical Park, New Mexico, USA, we identified 40 native perennial grass patches within a matrix of the nonnative annual forb kochia [Bassia scoparia (L.) A.J. Scott]. We mechanically cut B. scoparia in a 2-m-wide ring surrounding the perimeters of half the native grass patches (with the other half as uncut controls) and measured change in native grass patch size (relative to pretreatment) for 3 yr. Native grass patches around which B. scoparia was cut grew quickly the first posttreatment year and by the third year had increased in size four times more than control patches. Treated native grass patches expanded by an average of 25 m2, from 4 m2 in October 2015 before treatment to 29 m2 in October 2018. The experiment occurred during a dry period, conditions that should favor B. scoparia and contraction of the native grasses, suggesting that the observed increase in native grasses occurred despite suboptimal climatic conditions. Strategically treating around native patches to enlarge them over time showed promise as a minimal-input technique for increasing the proportion of the landscape dominated by native plants.
Role functioning is key to optimal health and inoculates against life-long inequality. Depression is a leading cause of functional disability. In most cases, improved symptomatology corresponds with improved functioning; however, functioning does not always return to “normal”, despite symptom remission. Furthermore, the relationship between symptom remission and the likelihood of being Not in Employment, Education or Training (NEET) is unknown.
Objectives and aim
To examine the temporal associations between depression course, functioning, and NEET status in young adults with mental health problems.
A prospective and multisite clinical cohort study of young people aged 15–25 years seeking help from a primary mental health service (n = 448). Participants completed a clinical interview (incl. QIDS-C16) and self-report battery (incl. WHODAS 2.0, employment, education) at baseline which was repeated at 12-month follow-up whilst continuing treatment as usual.
Remitted depression was significantly associated with improved functioning; however, 12 month functioning was still lower than the normative ranges for age-matched peers. Remittance of depression did not change the likelihood of being NEET. Only 10% of those who were NEET had received vocational support during the study.
Remittance of depression was associated with improved functioning but it did not reduce the likelihood of being NEET. This may be explained by economic influences or alternatively, a time lag may exist where improvements in functioning do not immediately correspond with reduced NEET rates. Lastly, there may be a scarring effect of depression such that change in NEET status requires an additional intervention to depression treatment.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Successful conservation depends on human attitudes, values, and support. Increasingly scientists and managers analyse not only species status and needs, but also the long-term cost, risk, and effectiveness of activities. Socioeconomic costs and benefits are integral to these analyses. Gorongosa National Park in Mozambique provides a case study of conservation integrated with local community needs. Endangered Delta smelt in California exemplify conflicts around water apportionment. Case studies demonstrating the importance of socioeconomic considerations are provided by management of gray wolves and grizzly bears in the United States. The story of sage grouse illustrates how a regional agreement that resulted from many years of collaboration among stakeholders can be nullified by political changes at the national level. The cultural and socioeconomic values and rights of indigenous people play a prominent role in salmon management that can run counter to the interests of hydroelectric companies and other water users. Case studies illustrate how habitat management can be facilitated by participation by non-governmental organizations. Socioeconomic and political consideration also underlie the question of who can take responsibility for managing conservation-reliant species.