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Social outings can trigger influenza transmission, especially in children and elderly. In contrast, school closures are associated with reduced influenza incidence in school-aged children. While influenza surveillance modelling studies typically account for holidays and mass gatherings, age-specific effects of school breaks, sporting events and commonly celebrated observances are not fully explored. We examined the impact of school holidays, social events and religious observances for six age groups (all ages, ⩽4, 5–24, 25–44, 45–64, ⩾65 years) on four influenza outcomes (tests, positives, influenza A and influenza B) as reported by the City of Milwaukee Health Department Laboratory, Milwaukee, Wisconsin from 2004 to 2009. We characterised holiday effects by analysing average weekly counts in negative binomial regression models controlling for weather and seasonal incidence fluctuations. We estimated age-specific annual peak timing and compared influenza outcomes before, during and after school breaks. During the 118 university holiday weeks, average weekly tests were lower than in 140 school term weeks (5.93 vs. 11.99 cases/week, P < 0.005). The dampening of tests during Winter Break was evident in all ages and in those 5–24 years (RR = 0.31; 95% CI 0.22–0.41 vs. RR = 0.14; 95% CI 0.09–0.22, respectively). A significant increase in tests was observed during Spring Break in 45–64 years old adults (RR = 2.12; 95% CI 1.14–3.96). Milwaukee Public Schools holiday breaks showed similar amplification and dampening effects. Overall, calendar effects depend on the proximity and alignment of an individual holiday to age-specific and influenza outcome-specific peak timing. Better quantification of individual holiday effects, tailored to specific age groups, should improve influenza prevention measures.
Capacity building is essential in low- and middle-income countries (LMICs) to address the gap in skills to conduct and implement research. Capacity building must not only include scientific and technical knowledge, but also broader competencies, such as writing, disseminating research and achieving work–life balance. These skills are thought to promote long-term career success for researchers in high-income countries (HICs) but the availability of such training is limited in LMICs.
This paper presents the contextualisation and implementation of the Academic Competencies Series (ACES). ACES is an early-career researcher development programme adapted from a UK university. Through consultation between HIC and LMIC partners, an innovative series of 10 workshops was designed covering themes of self-development, engagement and writing skills. ACES formed part of the African Mental Health Research Initiative (AMARI), a multi-national LMIC-led consortium to recruit, train, support and network early-career mental health researchers from four sub-Saharan African countries.
Of the 10 ACES modules, three were HIC-LMIC co-led, four led by HIC facilitators with LMIC training experience and three led by external consultants from HICs. Six workshops were delivered face to face and four by webinar. Course attendance was over 90% and the delivery cost was approximately US$4500 per researcher trained. Challenges of adaptation, attendance and technical issues are described for the first round of workshops.
This paper indicates that a skills development series for early-career researchers can be contextualised and implemented in LMIC settings, and is feasible for co-delivery with local partners at relatively low cost.
The physiology of mesophotic Scleractinia varies with depth in response to environmental change. Previous research has documented trends in heterotrophy and photosynthesis with depth, but has not addressed between-site variation for a single species. Environmental differences between sites at a local scale and heterogeneous microhabitats, because of irradiance and food availability, are likely important factors when explaining the occurrence and physiology of Scleractinia. Here, 108 colonies of Agaricia lamarcki were sampled from two locations off the coast of Utila, Honduras, distributed evenly down the observed 50 m depth range of the species. We found that depth alone was not sufficient to fully explain physiological variation. Pulse Amplitude-Modulation fluorometry and stable isotope analyses revealed that trends in photochemical and heterotrophic activity with depth varied markedly between sites. Our isotope analyses do not support an obligate link between photosynthetic activity and heterotrophic subsidy with increasing depth. We found that A. lamarcki colonies at the bottom of the species depth range can be physiologically similar to those nearer the surface. As a potential explanation, we hypothesize sites with high topographical complexity, and therefore varied microhabitats, may provide more physiological niches distributed across a larger depth range. Varied microhabitats with depth may reduce the dominance of depth as a physiological determinant. Thus, A. lamarcki may ‘avoid’ changes in environment with depth, by instead existing in a subset of favourable niches. Our observations correlate with site-specific depth ranges, advocating for linking physiology and abiotic profiles when defining the distribution of mesophotic taxa.
For the quantitative analysis of a 65 Cu-30 Ni-S Fe alloy, a 96 Cu-3 Si-1 Mn alloy, and a 78 Cu-20 Zn-2 Al alloy, the Ziebold empirical method of correcting electron-microbeam-probe data was used. Four binary standards, of single-phase Cu-Ni, Ni-Fe, Cu-Mn, and Cu-Zn alloys, were cast and the a correction factor found for each element in each binary by Ziebold's relationship (1 – K)/K – α (1 – C)/C, where K – I/I0 found in the probe and C is the weight fraction found by wet chemistry. The ARL EMX probe was used at 30 kV with a 25-μ beam diameter to negate inhomogeneities. Experience with these binaries indicated that in the presence of secondary fluorescence, the experimental α values agreed poorly with theoretically calculated K values; however, where secondary fluorescence was negligible, agreement between the experimental and theoretical α values was good. The α values for Cu–Si, Cu–Al, Al-Zn, and Mn–Si alioys, were therefore calculated from the theoretical equations. The α values for Cu–Fe alloys were also calculated from theoretical considerations because single-phase binaries over the composition range of interest could not be made for this system. All these α values were used in Ziebold's ternary equations to correct probe data (again using a 25-μ beam) from specimens of Cu–Ni-Fe, Cu–Si–Mn, and Cu-Zn–Al. These results were compared to wet-chemistry analyses for the same specimens with quite good correlation between the two sets of data. Calibration curves for the binary systems Cu-Ni, Cu-Fe, Ni-Fe, Cu-Mn, Cu-Si, Mn-Si, Cu-Al, Cu-Zn, and Al-Zn were made and are reproduced.
As depression has a recurrent course, relapse and recurrence prevention is essential.
In our randomised controlled trial (registered with the Nederlands trial register, identifier: NTR1907), we found that adding preventive cognitive therapy (PCT) to maintenance antidepressants (PCT+AD) yielded substantial protective effects versus antidepressants only in individuals with recurrent depression. Antidepressants were not superior to PCT while tapering antidepressants (PCT/−AD). To inform decision-makers on treatment allocation, we present the corresponding cost-effectiveness, cost-utility and budget impact.
Data were analysed (n = 289) using a societal perspective with 24-months of follow-up, with depression-free days and quality-adjusted life years (QALYs) as health outcomes. Incremental cost-effectiveness ratios were calculated and cost-effectiveness planes and cost-effectiveness acceptability curves were derived to provide information about cost-effectiveness. The budget impact was examined with a health economic simulation model.
Mean total costs over 24 months were €6814, €10 264 and €13 282 for AD+PCT, antidepressants only and PCT/−AD, respectively. Compared with antidepressants only, PCT+AD resulted in significant improvements in depression-free days but not QALYs. Health gains did not significantly favour antidepressants only versus PCT/−AD. High probabilities were found that PCT+AD versus antidepressants only and antidepressants only versus PCT/−AD were dominant with low willingness-to-pay thresholds. The budget impact analysis showed decreased societal costs for PCT+AD versus antidepressants only and for antidepressants only versus PCT/−AD.
Adding PCT to antidepressants is cost-effective over 24 months and PCT with guided tapering of antidepressants in long-term users might result in extra costs. Future studies examining costs and effects of antidepressants versus psychological interventions over a longer period may identify a break-even point where PCT/−AD will become cost-effective.
Declaration of interest
C.L.H.B. is co-editor of PLOS One and receives no honorarium for this role. She is also co-developer of the Dutch multidisciplinary clinical guideline for anxiety and depression, for which she receives no remuneration. She is a member of the scientific advisory board of the National Insure Institute, for which she receives an honorarium, although this role has no direct relation to this study. C.L.H.B. has presented keynote addresses at conferences, such as the European Psychiatry Association and the European Conference Association, for which she sometimes receives an honorarium. She has presented clinical training workshops, some including a fee. She receives royalties from her books and co-edited books and she developed preventive cognitive therapy on the basis of the cognitive model of A. T. Beck. W.A.N. has received grants from the Netherlands Organisation for Health Research and Development and the European Union and honoraria and speakers' fees from Lundbeck and Aristo Pharma, and has served as a consultant for Daleco Pharma.
Care of people with serious mental illness in prayer camps in low-income countries generates human rights concerns and ethical challenges for outcome researchers.
To ethically evaluate joining traditional faith healing with psychiatric care including medications (Clinical trials.gov identifier NCT02593734).
Residents of a Ghana prayer camp were randomly assigned to receive either indicated medication for schizophrenia or mood disorders along with usual prayer camp activities (prayers, chain restraints and fasting) (n = 71); or the prayer camp activities alone (n = 68). Masked psychologists assessed Brief Psychiatric Rating Scale (BPRS) outcomes at 2, 4 and 6 weeks. Researchers discouraged use of chaining, but chaining decisions remained under the control of prayer camp staff.
Total BPRS symptoms were significantly lower in the experimental group (P = 0.003, effect size –0.48). There was no significant difference in days in chains.
Joining psychiatric and prayer camp care brought symptom benefits but, in the short-run, did not significantly reduce days spent in chains.
Whether monozygotic (MZ) and dizygotic (DZ) twins differ from each other in a variety of phenotypes is important for genetic twin modeling and for inferences made from twin studies in general. We analyzed whether there were differences in individual, maternal and paternal education between MZ and DZ twins in a large pooled dataset. Information was gathered on individual education for 218,362 adult twins from 27 twin cohorts (53% females; 39% MZ twins), and on maternal and paternal education for 147,315 and 143,056 twins respectively, from 28 twin cohorts (52% females; 38% MZ twins). Together, we had information on individual or parental education from 42 twin cohorts representing 19 countries. The original education classifications were transformed to education years and analyzed using linear regression models. Overall, MZ males had 0.26 (95% CI [0.21, 0.31]) years and MZ females 0.17 (95% CI [0.12, 0.21]) years longer education than DZ twins. The zygosity difference became smaller in more recent birth cohorts for both males and females. Parental education was somewhat longer for fathers of DZ twins in cohorts born in 1990–1999 (0.16 years, 95% CI [0.08, 0.25]) and 2000 or later (0.11 years, 95% CI [0.00, 0.22]), compared with fathers of MZ twins. The results show that the years of both individual and parental education are largely similar in MZ and DZ twins. We suggest that the socio-economic differences between MZ and DZ twins are so small that inferences based upon genetic modeling of twin data are not affected.
We derive mass changes of the Greenland ice sheet (GIS) for 2003–07 from ICESat laser altimetry and compare them with results for 1992–2002 from ERS radar and airborne laser altimetry. The GIS continued to grow inland and thin at the margins during 2003–07, but surface melting and accelerated flow significantly increased the marginal thinning compared with the 1990s. The net balance changed from a small loss of 7 ± 3 Gt a−1 in the 1990s to 171 ± 4 Gt a−1 for 2003–07, contributing 0.5 mm a−1 to recent global sea-level rise. We divide the derived mass changes into two components: (1) from changes in melting and ice dynamics and (2) from changes in precipitation and accumulation rate. We use our firn compaction model to calculate the elevation changes driven by changes in both temperature and accumulation rate and to calculate the appropriate density to convert the accumulation-driven changes to mass changes. Increased losses from melting and ice dynamics (17–206 Gt a−1) are over seven times larger than increased gains from precipitation (10–35 Gt a−1) during a warming period of ∼2 K (10 a)−1 over the GIS. Above 2000 m elevation, the rate of gain decreased from 44 to 28 Gt a−1, while below 2000 m the rate of loss increased from 51 to 198 Gt a−1. Enhanced thinning below the equilibrium line on outlet glaciers indicates that increased melting has a significant impact on outlet glaciers, as well as accelerating ice flow. Increased thinning at higher elevations appears to be induced by dynamic coupling to thinning at the margins on decadal timescales.
Changes in ice mass are estimated from elevation changes derived from 10.5 years (Greenland) and 9 years (Antarctica) of satellite radar altimetry data from the European Remote-sensing Satellites ERS-1 and -2. For the first time, the dH/dt values are adjusted for changes in surface elevation resulting from temperature-driven variations in the rate of firn compaction. The Greenland ice sheet is thinning at the margins (–42 ± 2Gta¯1 below the equilibrium-line altitude (ELA)) and growing inland (+53 ± 2Gta-1 above the ELA) with a small overall mass gain (+11 ± 3Gta–1; –0.03 mma–1 SLE (sea-level equivalent)). The ice sheet in West Antarctica (WA) is losing mass (–47 ± 4Gta–1) and the ice sheet in East Antarctica (EA) shows a small mass gain (+16 ± 11 Gta–1) for a combined net change of –31 ± 12 Gta–1 (+0.08mma–1 SLE). The contribution of the three ice sheets to sea level is +0.05±0.03mma–1. The Antarctic ice shelves show corresponding mass changes of –95 ± 11 Gta–1 in WA and +142 ± 10Gta–1 in EA. Thinning at the margins of the Greenland ice sheet and growth at higher elevations is an expected response to increasing temperatures and precipitation in a warming climate. The marked thinnings in the Pine Island and Thwaites Glacier basins of WA and the Totten Glacier basin in EA are probably ice- dynamic responses to long-term climate change and perhaps past removal of their adjacent ice shelves. The ice growth in the southern Antarctic Peninsula and parts of EA may be due to increasing precipitation during the last century.
Insights from the Developmental Origins of Health and Disease paradigm and epigenetics are elucidating the biological pathways through which social and environmental signals affect human health. These insights prompt a serious debate about how the structure of society affects health and what the responsibility of society is to counteract health inequalities. Unfortunately, oversimplified interpretations of insights from Developmental Origins of Health and Disease and epigenetics may be (mis)used to focus on the importance of individual responsibility for health rather than the social responsibility for health. In order to advance the debate on responsibility for health, we present an ethical framework to determine the social responsibility to counteract health inequalities. This is particularly important in a time where individual responsibility often justifies a passive response from policymakers.
Both active and passive human interactions with reef fish communities are increasingly recognized to cause fish behavioural changes. However, few studies have considered how these behavioural adaptations impact standard reef survey techniques, particularly across natural gradients of interest to ecologists and reef managers. Here we measure fish abundance, biomass and minimum approach distance using stereo-video surveys to compare the effects of bubble-producing open-circuit scuba vs near-silent closed-circuit rebreathers. Surveys extended across a shallow to upper-mesophotic gradient on the fringing reefs of Utila, Honduras, to explore how the effects of diver gear choice vary with depth. For most fish families we recorded similar abundances and biomass with the two diving techniques, suggesting that open-circuit transects are generally appropriate for surveying western Atlantic reefs similar to Utila with regular tourist diving but no spearfishing. Despite no overall significant difference in fish abundance or biomass, we identified several fish families (Labridae, Pomacentridae, Scaridae) that allowed closed-circuit rebreather divers to approach more closely than open-circuit divers. In addition, smaller fish generally allowed divers to approach more closely than larger fish, and in most cases divers could approach fish more closely on mesophotic than shallow reefs. Despite these significant differences in approach distances, their magnitude suggest they are unlikely to affect reef fish detectability during normal fish surveys for most families. Our findings highlight the importance of considering variation in fish behavioural adaptations along natural gradients such as depth, which otherwise has the potential to cause biases when surveying by traditional monitoring programmes.
Mass changes of the Antarctic ice sheet impact sea-level rise as climate changes, but recent rates have been uncertain. Ice, Cloud and land Elevation Satellite (ICESat) data (2003–08) show mass gains from snow accumulation exceeded discharge losses by 82 ± 25 Gt a−1, reducing global sea-level rise by 0.23 mm a−1. European Remote-sensing Satellite (ERS) data (1992–2001) give a similar gain of 112 61 Gt a−1. Gains of 136 Gt a−1 in East Antarctica (EA) and 72 Gt a−1 in four drainage systems (WA2) in West Antarctic (WA) exceed losses of 97 Gt a−1 from three coastal drainage systems (WA1) and 29 Gt a−1 from the Antarctic Peninsula (AP). EA dynamic thickening of 147 Gt a−1 is a continuing response to increased accumulation (>50%) since the early Holocene. Recent accumulation loss of 11 Gt a−1 in EA indicates thickening is not from contemporaneous snowfall increases. Similarly, the WA2 gain is mainly (60 Gt a−1) dynamic thickening. In WA1 and the AP, increased losses of 66 ± 16 Gt a−1 from increased dynamic thinning from accelerating glaciers are 50% offset by greater WA snowfall. The decadal increase in dynamic thinning in WA1 and the AP is approximately one-third of the long-term dynamic thickening in EA and WA2, which should buffer additional dynamic thinning for decades.
The adult CHD population is increasing and ageing and remains at high risk for morbidity and mortality. In a retrospective single-centre study, we conducted a comprehensive review of non-elective hospitalisations of adults with CHD and explored factors associated with length of stay.
We identified adults (⩾18 years) with CHD admitted during a 12-month period and managed by the adult CHD service. Data regarding demographics, cardiac history, hospital admission, resource utilisation, and length of stay were extracted.
There were 103 admissions of 91 patients (age 37±10 years; 52% female). Of 91 patients, 96% had moderate or complex defects. Of 103 admissions, 45% were through the emergency department. The most common reasons for admission were arrhythmia (37%) and heart failure (28%); 29% of admissions included a stay in the ICU. The mean number of consultations by other services was 2.0. Electrophysiology and anaesthesiology departments were most frequently consulted. After removing outliers, the mean length of stay was 7.9±7.4 days (median=5 days). The length of stay was longer for patients admitted for heart failure (12.2±10.3 days; p=0.001) and admitted directly to the ward (9.6±8.9 days; p=0.009).
Among non-electively hospitalised adults with CHD in a tertiary-care centre, management often entails an interdisciplinary approach, and the length of stay is longest for patients admitted with heart failure. The healthcare system must ensure optimal resources to maintain high-quality care for this expanding patient population.
Loneliness is highly prevalent among older people, has serious health consequences and is an important predictor of mortality. Loneliness and depression may unfavourably interact with each other over time but data on this topic are scarce.
To determine whether loneliness is associated with excess mortality after 19 years of follow-up and whether the joint effect with depression confers further excess mortality.
Different aspects of loneliness were measured with the De Jong Gierveld scale and depression with the Centre for Epidemiologic Studies Depression Scale in a cohort of 2878 people aged 55–85 with 19 years of follow-up. Excess mortality hypotheses were tested with Kaplan–Meier and Cox proportional hazard analyses controlling for potential confounders.
At follow-up loneliness and depression were associated with excess mortality in older men and women in bivariate analysis but not in multivariate analysis. In multivariate analysis, severe depression was associated with excess mortality in men who were lonely but not in women.
Loneliness and depression are important predictors of early death in older adults. Severe depression has a strong association with excess mortality in older men who were lonely, indicating a lethal combination in this group.
We describe a long term project to find faint, heavily-reddened, cool supergiants and carbon stars and to classify IRAS Point Sources within 6° of the southern galactic plane. Many new supergiants and carbon stars have been found, and thousands of IRAS Point Sources have had their spectral types determined.
We analyzed birth order differences in means and variances of height and body mass index (BMI) in monozygotic (MZ) and dizygotic (DZ) twins from infancy to old age. The data were derived from the international CODATwins database. The total number of height and BMI measures from 0.5 to 79.5 years of age was 397,466. As expected, first-born twins had greater birth weight than second-born twins. With respect to height, first-born twins were slightly taller than second-born twins in childhood. After adjusting the results for birth weight, the birth order differences decreased and were no longer statistically significant. First-born twins had greater BMI than the second-born twins over childhood and adolescence. After adjusting the results for birth weight, birth order was still associated with BMI until 12 years of age. No interaction effect between birth order and zygosity was found. Only limited evidence was found that birth order influenced variances of height or BMI. The results were similar among boys and girls and also in MZ and DZ twins. Overall, the differences in height and BMI between first- and second-born twins were modest even in early childhood, while adjustment for birth weight reduced the birth order differences but did not remove them for BMI.