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The incidence of facial palsy has been rising worldwide, with recent evidence emerging of links to COVID-19 infection. To date, guidance on cost-effective treatments is limited to medication (prednisolone). In terms of physical therapy, neuromuscular retraining (NMR) to restore balanced facial function has been most widely evaluated, but not in terms of cost effectiveness. The added value of telerehabilitation is unknown.
Methods
A multistage technology assessment was conducted, which included the following:
• a national survey of current therapy pathways in the UK and patients’ and clinicians’ views on the benefits and challenges of telerehabilitation;
• a systematic review of clinical effectiveness trials evaluating facial NMR therapy;
• calculation of long-term morbidity costs (national economic burden) based on incidence, patient recovery profiles, health-related quality of life, and national facial palsy treatment costs (valuation of clinical improvements in monetary terms was provided by a national Delphi panel); and
• evaluation of the cost effectiveness of telerehabilitation (remote monitoring wearables) added to current face-to-face NMR delivery.
Results
Nationally, approximately five percent of patients with facial palsy (17% of unresolved cases) are referred for facial NMR. The long-term economic burden associated with unresolved cases is estimated to range from GBP351 (EUR417) to GBP584 (EUR692) million, indicating substantial savings if long-term recovery can be improved. Medical treatment costs are GBP86.34 (EUR102) million per annual cohort, and physical and psychological therapy costs are GBP643,292 (EUR762,561). Economic modeling showed that telerehabilitation was cost effective, producing a health gain and a cost-saving of GBP468 (EUR555) per patient. If scaled to the national level for all patients who do not recover fully, an annual saving of GBP3.075 (EUR3.65) million is possible.
Conclusions
Economic modeling indicates that NMR could improve patient outcomes and reduce costs. The national survey demonstrated that access to NMR therapy services is limited, so introduction of telerehabilitation could improve access for currently underserved populations. Future clinical trials need to incorporate economic evaluations to help inform decision-making.
This chapter reviews research on work–nonwork balance, starting with early research on the topic and discussing how the conceptualization and measurement of balance has changed over time. Drawing from social psychological research on attitudes and person-environment fit theory, balance is defined as a multi-dimensional construct with three facets: affective balance, effectiveness balance, and involvement balance. The measurement of both global balance and the facets of balance is discussed. The literature that examines the link between balance and employee well-being is reviewed. Finally, directions for future research on work–nonwork balance are discussed.
To analyse GxE interactions assess non-shared environmental (E) risk factors for the development of AN specific for sisters discordant for an ED, polymorphisms in the serotonin transporter (G),.
Methods:
We interviewed 128 sister pairs discordant for an eating disorder using the Oxford-RFI as part of the European "Healthy Eating" multicenter study at 3 university centres (Vienna, London, Barcelona) (AN-R: 58; AN-BP: 70; 128 sisters without ED). To examine association between AN, G and E, and G x E-interaction, conditional logistic regression was used with a Cox proportional hazards regression model using the exact method.
Results:
Genotype (GT) distributions did not differ between the sister groups. Significant main effects were found for disruptive events, interpersonal problems and family dieting behaviour. The risk for AN increased with higher levels in these variables independently of the genotype. Significant interactions were found for G x parental problems and G x burden by parental psychiatric disorder. The increase of risk for AN with increasing number of problems with parents is larger for the S/S genotype than for L/L. However, a higher burden by parental psychiatric illness (subjective E according to Turkheimer 2000) increased the risk for AN-this was larger for the L/L than for the S/S GT.
Conclusions:
This study suggests that there is an interaction between stress (problems with parents) and the ss GT which increases the risk of developing AN.
The invasive alien Scolytus schevyrewi Semenov (Coleoptera: Curculionidae: Scolytinae) was detected in Saskatchewan and Manitoba, Canada, in 2007. Because S. schevyrewi is a potential vector of the Dutch elm disease pathogen (Ophiostomanovo-ulmi Brasier; Fungi: Ophiostomataceae), the natural history of the beetle was studied from 2009 to 2012 in the two provinces, where the disease is managed to protect Ulmus americana Linnaeus (Ulmaceae). Typically, healthy trees become infected when their xylem is contacted during feeding by spore-bearing scolytine adults that have flown from a diseased tree; adults emerging from brood galleries in diseased trees frequently carry spores. We caught flying S. schevyrewi adults from May to October; adults were weakly attracted to healthy Ulmus Linnaeus but were strongly attracted to Ulmus pumila Linnaeus stressed by girdling. Scolytus schevrewi colonised and completed development in girdled trees and trap logs of U. pumila. In contrast to other studies, U. americana – the major source of pathogen spores in the area – was never colonised as a brood host. Our results suggest that S. schevyrewi will primarily use U. pumila, which, in Manitoba and Saskatchewan, seldom exhibits symptoms of Dutch elm disease. Thus, arrival of S. schevyrewi does not appear to require changes to Dutch elm disease management programmes.
UK Biobank is a well-characterised cohort of over 500 000 participants including genetics, environmental data and imaging. An online mental health questionnaire was designed for UK Biobank participants to expand its potential.
Aims
Describe the development, implementation and results of this questionnaire.
Method
An expert working group designed the questionnaire, using established measures where possible, and consulting a patient group. Operational criteria were agreed for defining likely disorder and risk states, including lifetime depression, mania/hypomania, generalised anxiety disorder, unusual experiences and self-harm, and current post-traumatic stress and hazardous/harmful alcohol use.
Results
A total of 157 366 completed online questionnaires were available by August 2017. Participants were aged 45–82 (53% were ≥65 years) and 57% women. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status. Lifetime depression was a common finding, with 24% (37 434) of participants meeting criteria and current hazardous/harmful alcohol use criteria were met by 21% (32 602), whereas other criteria were met by less than 8% of the participants. There was extensive comorbidity among the syndromes. Mental disorders were associated with a high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.
Conclusions
The UK Biobank questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed because of selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.
Tebufenozide (Mimic) kills Lepidoptera larvae that ingest it. Aerial applications of tebufenozide were made against spruce budworm (Choristoneura fumiferana (Clemens)) (Lepidoptera: Tortricidae) in boreal forest in Manitoba, Canada, in 1999 and 2000. In 2000 and 2001, moths in sprayed and unsprayed plots were sampled with light traps; trapping was supplemented by foliage sampling. Relative to unsprayed plots, catches of spruce budworm moths in plots sprayed in 1999 and 2000 were depressed in 2000, but not in 2001. Host tree defoliation was reduced in 2000 by 1999 and 2000 applications; the 2000 application reduced numbers of spruce budworm larvae in 2000 and 2001. Multivariate analysis revealed negative effects of tebufenozide application on two species of non-target moths in 2000 and no negative effects in 2001. Negatively affected species have larvae feeding in the tree canopy at the time of spray application. Higher catches of non-target species in sprayed treatments were observed for three species in 2000 and two species in 2001. We conclude that tebufenozide can depress the numbers of spruce budworm larvae and provide foliage protection during the year of application and the following year, and that negative effects on non-target species are detectable for about 15 months after application.
Discrete episodes of overconsumption may induce a positive energy balance and impair metabolic control. However, the effects of an ecologically relevant, single day of balanced macronutrient overfeeding are unknown. Twelve healthy men (of age 22 (sd 2) years, BMI 26·1 (sd 4·2) kg/m2) completed two 28 h, single-blind experimental trials. In a counterbalanced repeated measures design, participants either consumed their calculated daily energy requirements (energy balance trial (EB): 10 755 (sd 593) kJ) or were overfed by 50 % (overfeed trial (OF): 16 132 (sd 889) kJ) under laboratory supervision. Participants returned to the laboratory the next day, after an overnight fast, to complete a mixed-meal tolerance test (MTT). Appetite was not different between trials during day 1 (P>0·211) or during the MTT in the fasted or postprandial state (P>0·507). Accordingly, plasma acylated ghrelin, total glucagon-like peptide-1 and total peptide YY concentrations did not differ between trials during the MTT (all P>0·335). Ad libitum energy intake, assessed upon completion of the MTT, did not differ between trials (EB 6081 (sd 2260) kJ; OF 6182 (sd 1960) kJ; P=0·781). Plasma glucose and insulin concentrations were not different between trials (P>0·715). Fasted NEFA concentrations were lower in OF compared with EB (P=0·005), and TAG concentrations increased to a greater extent on OF than on EB during the MTT (P=0·009). The absence of compensatory changes in appetite-related variables after 1 d of mixed macronutrient overfeeding highlights the limited physiological response to defend against excess energy intake. This supports the concept that repeated discrete episodes of overconsumption may promote weight gain, while elevations in postprandial lipaemia may increase CVD risk.
UK Biobank is a well-characterised cohort of over 500 000 participants that offers unique opportunities to investigate multiple diseases and risk factors.
Aims
An online mental health questionnaire completed by UK Biobank participants was expected to expand the potential for research into mental disorders.
Method
An expert working group designed the questionnaire, using established measures where possible, and consulting with a patient group regarding acceptability. Case definitions were defined using operational criteria for lifetime depression, mania, anxiety disorder, psychotic-like experiences and self-harm, as well as current post-traumatic stress and alcohol use disorders.
Results
157 366 completed online questionnaires were available by August 2017. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status than the general population across a range of indicators. Thirty-five per cent (55 750) of participants had at least one defined syndrome, of which lifetime depression was the most common at 24% (37 434). There was extensive comorbidity among the syndromes. Mental disorders were associated with high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.
Conclusions
The questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed owing to selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.
Declaration of interest
G.B. received grants from the National Institute for Health Research during the study; and support from Illumina Ltd. and the European Commission outside the submitted work. B.C. received grants from the Scottish Executive Chief Scientist Office and from The Dr Mortimer and Theresa Sackler Foundation during the study. C.S. received grants from the Medical Research Council and Wellcome Trust during the study, and is the Chief Scientist for UK Biobank. M.H. received grants from the Innovative Medicines Initiative via the RADAR-CNS programme and personal fees as an expert witness outside the submitted work.
The Miami site, excavated in 1937, is in a small "playa" basin on the High Plains surface. The site is one of the earliest documented co-occurrences of Clovis points and mammoth. Reinvestigation of the site and related collections was undertaken to better understand the stratigraphy, geochronology, and archaeology. The basin, 23 m diameter × 1.6 m deep, filled with (1) dark gray silty clay, and (2) near the top of the section, a lens of well-sorted silt or loess. The basin started to fill ca. 13,700 yr B.P., the loess dates to ca. 11,400 yr B.P., and the bone bed probably dates to ca. 11,400-10,500 yr B.P. The loess may be the local manifestation of a "Clovis drought." The partial remains of five mammoths (three adults and two juveniles) were recovered in 1937; no other animal remains are known. The bone is heavily weathered and there are no clear indications of human modification. Artifacts found at the site include three Clovis points and a scraper found among the bones and two flakes and a scraper found on the surface near the playa. The origins of the bone and stone assemblage are uncertain but four scenarios are offered: a successful mammoth kill, an unsuccessful kill with wounded animals dying at the watering hole, opportunistic scavenging following natural deaths, or a palimpsest of multiple deaths following both natural and human causes.
The rate of progress in most technical fields, and propulsion is no exception, has increased so rapidly during the past 50 years that it is becoming difficult to predict the trend of development for more than a few years ahead. On the other hand, there are fundamental limits to progress in certain directions and it is within these limits that this paper is written. One must, of course, devote some thought to the validity of the limit. Not so long ago it was thought that the speed of sound would be a limiting speed for aircraft, for instance. One cannot go far wrong with the basic laws of physics and the intention, at least, of this paper is not to transgress such laws.
The so-called ejector nozzle has received a large amount of experimental study as a means for achieving efficient supersonic expansion of the main jet without the difficulties of a mechanically variable convergentdivergent nozzle. No satisfactory theory for the calculation of its performance has yet been put forward and it is the object of this paper partly to remedy this defect.
The effects of specialization on subsequent morphological evolution are poorly understood. Specialization has been implicated in both adaptive radiations that result from key innovations and evolutionary “dead ends,” where specialized characteristics appear to limit subsequent evolutionary options. Despite much theoretical debate, however, empirical studies remain infrequent. In this paper, we use sister-group comparisons to evaluate the effect of morphological specialization to a particular ecological niche, hypercarnivory, on subsequent taxonomic and morphological diversity. Six sets of sister groups are identified in which one clade exhibits hypercarnivorous characteristics and the sister clade does not. Comparison results are summed across the categories “hypercarnivore” and “sister group.” We also evaluate whether increasing degrees of specialization are correlated with decreasing phenotypic variation. Results presented here indicate that specialization to hypercarnivory has no effect on taxonomic diversity, but a strong effect on subsequent morphological diversity related to the jaws and dentition, and that increasing specialization does not correlate with morphological diversity except in the most specialized sabertoothed taxa, which exhibit higher variance than less specialized morphs, possibly due to selection on other characteristics.
In Manitoba, Canada, commercial soybeans and two types of field beans, navy and pinto, were sampled for plant bugs. At the centre and margins of 36 fields, sweep net and tap tray samples were taken weekly. In all three crops, Lygus lineolaris (Palisot de Beauvois) (Hemiptera: Miridae) comprised >78% and Adelphocoris lineolatus (Goeze) (Hemiptera: Miridae) <10% of adult mirids. Species composition varied among years but not among crops. For Lygus Hahn, nymphs were 46% of the catch in trays and 23% in sweeps, but total Lygus catch in trays was >2% of that in sweeps. Catch/sample effort was similar at field centres and margins for both Lygus adults and nymphs. Lygus lineolaris reproduced and developed in all three crops. In field beans, Lygus adults were first collected in late vegetative and early pod set stages and late instar nymphs and adults were present from pod elongation until maturity – results consistent with immigration of first summer generation reproductive adults and development of the second generation in the crops. There was evidence of late season immigration of Lygus into all crops. There was no loss of seed quantity attributable to mirids in any of the crops; in field beans there was no evidence that mirids reduced seed quality.
Clovis sites occur throughout the southwestern United States and northwestern Mexico, but are poorly documented in the central Rio Grande rift region. Here, we present data from two relatively unknown Clovis projectile point assemblages from this region: the first is from the Mockingbird Gap Clovis site and the second is from a survey of the surrounding region. Our goals are to reconstruct general features of the paleoecological adaptation of Clovis populations in the region using raw material sourcing and then to compare the point technology in the region to other Clovis assemblages in the Southwest and across the continent. Our results show that both assemblages were manufactured from similar suites of raw materials that come almost exclusively from the central Rio Grande rift region and the adjacent mountains of New Mexico. Additionally, we show that Clovis projectile points in the study region are significantly smaller than the continental average. Our results suggest that Clovis populations in this region operated within a large, well-known, and relatively high-elevation territory encompassing much of northern and western New Mexico.
Laboratory studies of the food preferences of several adult carabids showed that Amara aenea DeG., Anisodactylus sanctaecrucis F., Harpalus affinis Schr., and Stenolophus comma F. were polyphagous and readily fed on the seeds of several weeds as well as on young codling moth larvae and apple maggot pupae. H. affinis also attacked 4th and 5th instar codling moth larvae and pupae more readily than the other species. Pterostichus melanarius III. showed a strong preference for the larger prey such as 5th instar codling moth larvae, earthworms, and scarabaeid larvae. The potential of these species as predators of the codling moth and the apple maggot is discussed.