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England's primary care service for psychological therapy (Improving Access to Psychological Therapies [IAPT]) treats anxiety and depression, with a target recovery rate of 50%. Identifying the characteristics of patients who achieve recovery may assist in optimizing future treatment. This naturalistic cohort study investigated pre-therapy characteristics as predictors of recovery and improvement after IAPT therapy.
Methods
In a cohort of patients attending an IAPT service in South London, we recruited 263 participants and conducted a baseline interview to gather extensive pre-therapy characteristics. Bayesian prediction models and variable selection were used to identify baseline variables prognostic of good clinical outcomes. Recovery (primary outcome) was defined using (IAPT) service-defined score thresholds for both depression (Patient Health Questionnaire [PHQ-9]) and anxiety (Generalized Anxiety Disorder [GAD-7]). Depression and anxiety outcomes were also evaluated as standalone (PHQ-9/GAD-7) scores after therapy. Prediction model performance metrics were estimated using cross-validation.
Results
Predictor variables explained 26% (recovery), 37% (depression), and 31% (anxiety) of the variance in outcomes, respectively. Variables prognostic of recovery were lower pre-treatment depression severity and not meeting criteria for obsessive compulsive disorder. Post-therapy depression and anxiety severity scores were predicted by lower symptom severity and higher ratings of health-related quality of life (EuroQol questionnaire [EQ5D]) at baseline.
Conclusion
Almost a third of the variance in clinical outcomes was explained by pre-treatment symptom severity scores. These constructs benefit from being rapidly accessible in healthcare services. If replicated in external samples, the early identification of patients who are less likely to recover may facilitate earlier triage to alternative interventions.
Identifying youths most at risk to COVID-19-related mental illness is essential for the development of effective targeted interventions.
Aims
To compare trajectories of mental health throughout the pandemic in youth with and without prior mental illness and identify those most at risk of COVID-19-related mental illness.
Method
Data were collected from individuals aged 18–26 years (N = 669) from two existing cohorts: IMAGEN, a population-based cohort; and ESTRA/STRATIFY, clinical cohorts of individuals with pre-existing diagnoses of mental disorders. Repeated COVID-19 surveys and standardised mental health assessments were used to compare trajectories of mental health symptoms from before the pandemic through to the second lockdown.
Results
Mental health trajectories differed significantly between cohorts. In the population cohort, depression and eating disorder symptoms increased by 33.9% (95% CI 31.78–36.57) and 15.6% (95% CI 15.39–15.68) during the pandemic, respectively. By contrast, these remained high over time in the clinical cohort. Conversely, trajectories of alcohol misuse were similar in both cohorts, decreasing continuously (a 15.2% decrease) during the pandemic. Pre-pandemic symptom severity predicted the observed mental health trajectories in the population cohort. Surprisingly, being relatively healthy predicted increases in depression and eating disorder symptoms and in body mass index. By contrast, those initially at higher risk for depression or eating disorders reported a lasting decrease.
Conclusions
Healthier young people may be at greater risk of developing depressive or eating disorder symptoms during the COVID-19 pandemic. Targeted mental health interventions considering prior diagnostic risk may be warranted to help young people cope with the challenges of psychosocial stress and reduce the associated healthcare burden.
The dynamics of interfaces in slow diffusion equations with strong absorption are studied. Asymptotic methods are used to give descriptions of the behaviour local to a comprehensive range of possible singular events that can occur in any evolution. These events are: when an interface changes its direction of propagation (reversing and anti-reversing), when an interface detaches from an absorbing obstacle (detaching), when two interfaces are formed by film rupture (touchdown) and when the solution undergoes extinction. Our account of extinction and self-similar reversing and anti-reversing is built upon previous work; results on non-self-similar reversing and anti-reversing and on the various types of detachment and touchdown are developed from scratch. In all cases, verification of the asymptotic results against numerical solutions to the full PDE is provided. Self-similar solutions, both of the full equation and of its asymptotic limits, play a central role in the analysis.
ABSTRACT IMPACT: Current practice guidelines offer a variety of treatment options for sternal reconstruction but complications and infections remain a serious surgical problem. This work seeks to provide a comprehensive picture of the com-morbidities and reconstructive methods that lead to success and improve patient outcomes. OBJECTIVES/GOALS: Patients that undergo cardiac surgery via the median sternotomy approach are at risk of wound complications that require repair. We seek to evaluate how outcomes of sternal reconstruction are influenced by patient comorbidities, flap usage and internal mammary artery grafts and methods of sternal closure. METHODS/STUDY POPULATION: We identified patients between 2005 and 2020 who underwent sternotomy followed by debridement and flap coverage at our institution. Comorbidities, method of reconstruction, demographic data, surgical history, and other factors pertaining to mortality and morbidity were collected. The data will then be analyzed to identify population characteristics using logistic regression variables to determine univariate and adjusted multivariable measures of association with mortality. We present the pre-liminary data analyzed using chi-square and one-way anova in R. RESULTS/ANTICIPATED RESULTS: In this study we present a preliminary characterization of one institution’s sternal reconstruction patient outcomes with a variety of reconstruction methods including pectoralis advancement flaps, omental flaps and latissumus dorsi flaps. Notable preoperative comorbidities include 50% of patients > age 60, 18% with diabetes mellitus, 18 % with diagnosed hypertension, 18% with COPD, and 9% with a smoking history DISCUSSION/SIGNIFICANCE OF FINDINGS: In an evolving cardiothoracic landscape, clinical characteristics of patients being treated for sternal reconstructive surgery present a moving target. Understanding current risk factors, preoperative management and timing for aggressive surgical treatment offers an opportunity to update treatment protocol and maximize successful outcomes.
It has been an underlying assumption in many studies that near-surface layers imaged by ground-penetrating radar (GPR) can be interpreted as depositional markers or isochrones. It has been shown that GPR layers can be approximately reproduced from the measured electrical properties of ice, but these material layers are generally narrower and more closely spaced than can be resolved by typical GPR systems operating in the range 50−400 MHz. Thus GPR layers should be interpreted as interference patterns produced from closely spaced and potentially discontinuous material layers, and should not be assumed to be interpretable as precise markers of isochrones. We present 100 MHz GPR data from Lyddan Ice Rise, Antarctica, in which near-surface (<50 m deep) layers are clearly imaged. The growth of the undulations in these layers with depth is approximately linear, implying that, rather than resulting from a pattern of vertical strain rate, they do correspond to some pattern of snowfall variation. Furthermore, comparison of the GPR layers with snow-stake measurements suggests that around 80% of the rms variability in mean annual accumulation is present in the GPR layers. The observations suggest that, at least in this case, the GPR layers do approximate isochrones, and that patterns of snow accumulation over Lyddan Ice Rise are dominated by extremely persistent spatial variations with only a small residual spatial variability. If this condition is shown to be widely applicable it may reduce the period required for measurements of surface elevation change to be taken as significant indications of mass imbalance.
Growth chamber studies and field trials were conducted to evaluate the toxicity of glyphosate [N-(phosphonomethyl)glycine] and certain other herbicides to wild garlic (Allium vineale L.). Toxicity to wild garlic increased with increasing rates up to 6 kg/ha. Glyphosate was more toxic to wild garlic when applied in spray volumes of 125 to 500 L/ha than in greater volumes. Addition of surfactant did not increase toxicity or absorption rates of 3 kg/ha of glyphosate, but did increase the advantage of 2 kg/ha of glyphosate over 2,4-D [(2,4-dichlorophenoxy)acetic acid]. When glyphosate was sprayed on wild garlic plants at 3 kg/ha, then washed off after 2, 4, 8, 16, and 32 h, absorption of a biologically significant amount of glyphosate required 8 h, and toxicity increased through the 32-h exposure. Injury, which increased as mowing was delayed up to 12 days after application, indicated that significant quantities of glyphosate were translocated between 3 to 12 days after treatment in a field test. Glyphosate; 2,4-D; 2,4-D + mecoprop {2-[(4-chloro-o-tolyl)oxy] propionic acid} + dicamba (3,6-dichloro-o-anisic acid); and VEL-4207 [N-phenyldiethanolamine-bis-(2-methoxy-3,6-dichlorobenzoate)], applied in a sequence of either spring-fall-spring or fall-spring, were compared for wild garlic control. All herbicides tested controlled wild garlic, but glyphosate was more effective than 2,4-D after spring-fall-spring applications. All spring-fall-spring treatments except 2,4-D + mecoprop + dicamba significantly reduced the number and weight of hardshell bulbs present 8 weeks after the last treatment. The initial treatment in the spring-fall-spring sequence was necessary to reduce hardshell bulb populations the second spring. One year after treatment wild garlic reinfested all plots.
Magnetic grain-size variations have been used as sensitive paleoclimate proxies to investigate the evolution of the East Asian summer monsoon, but their relationship with temperature and precipitation is not entirely clear. Here we find that two magnetic grain-size proxy records (χARM/χLF and χARM/SIRM, where χARM, χLF and SIRM are anhysteretic remanent magnetization susceptibility, magnetic susceptibility measured at 470 Hz and saturation isothermal remanent magnetization, respectively) of Chinese loess and red-clay sediments co-vary during the last 6 Ma, except between ~ 4.5 and 2.6 Ma, when these two records had opposite trends. We attribute this disparate behavior to the different responses of χARM/χLF and χARM/SIRM to temperature and precipitation during ~ 4.5–2.6 Ma, when temperature and precipitation on the Chinese Loess Plateau were decoupled. A comparison of the loess and red-clay χARM/χLF and χARM/SIRM records with the global ice-volume proxy records reveals that χARM/χLF is more sensitive to temperature variations than χARM/SIRM. The results suggest that temperature on the Chinese Loess Plateau had a cooling trend from ~ 4.5 to ~ 2.6 Ma, whereas rainfall tended to increase. Our studies demonstrate that joint analysis of loess χARM/χLF and χARM/SIRM records can reveal paleoclimatic information that cannot be revealed by a single parameter.
A high-resolution rock magnetic investigation was performed on the Chaona Quaternary loess/paleosol sequences in the Central Chinese Loess Plateau. Based on a newly developed independent unturned time scale and magnetic records, we reconstructed the history of the East Asia monsoons during the last 3 Ma and explored the middle Pleistocene climate transition (MPT). Rock magnetic results show that the loess layers are characterized by relatively high coercivity and remanent coercivity, lower magnetic susceptibility (MS), and that the paleosol layers are characterized by relatively high MS, saturation magnetization and remanent saturation magnetization. Spectrum analyses indicate that there are various periods in addition to orbital periodicities. According to the onset and stable appearance of 100 kyr period, we consider that the MPT recorded in this section began at ~ 1.26 Ma and was completed by ~ 0.53 Ma, which differs from previous investigations based on orbitally tuned time scales. The forcing mechanism for the MPT was more complicated than just the orbital forcing. We conclude that the rapid uplift of the Tibetan Plateau may have played an important role in the shift of periodicities during the middle Pleistocene.
This work presents a detailed, orbitally tuned biogenic silica record of continental paleoclimate change during the Brunhes chron. The Brunhes/Matuyama boundary lies within the warm isotopic stage 19 in Baikal, and the boundaries between eight lithological cycles correspond to terminations in the marine oxygen isotope record. The high amplitude and resolution of climatically driven changes in BioSi content in Lake Baikal sediments permits tuning of almost every precessional cycle during the Brunhes and reveals the structure of interglacial stages. For example, the last three interglacial stages (MIS 5, 7, and 9) clearly consist of five substages (a, b, c, d, e) corresponding to precessional insolation peaks. Abrupt and intense regional glaciations in Siberia during substages 5d and 7d were driven by extreme insolation minima. During substage 9d cooling was more gradual in response to more moderate forcing. The impact of strong glaciation is also observed in the middle of stage 15, where full glacial conditions appear to have lasted for over 30,000 yr during substages 15d, 15c, and 15b. Marine oxygen isotopic stage 11 appears to be the warmest period during the Brunhes in the Lake Baikal record, with at least three substages.
A new hypothesis is presented regarding the response of the Lake Baikal BioSi record to insolation forcing. Based on the mechanism controlling modern diatom blooms, biogenic silica production is hypothesized to be dependent on changes in the heat balance of the lake and consequently on changes in the thermal structure of the water column. This mechanism is also sensitive to short-term sub-Milankovich cooling events, such as the mid-Eemian cooling, the Montaigu event during substage 5c, and a cooling which appears to be analogous to the Montaigu event during substage 9c. The continuity of the Lake Baikal paleoclimate record, its sensitivity to orbital forcing, and its high resolution make it an excellent candidate for a new “paleoclimatic stratotype” section for continental Asia.
Fontan survivors have depressed cardiac index that worsens over time. Serum biomarker measurement is minimally invasive, rapid, widely available, and may be useful for serial monitoring. The purpose of this study was to identify biomarkers that correlate with lower cardiac index in Fontan patients.
Methods and results
This study was a multi-centre case series assessing the correlations between biomarkers and cardiac magnetic resonance-derived cardiac index in Fontan patients ⩾6 years of age with biochemical and haematopoietic biomarkers obtained ±12 months from cardiac magnetic resonance. Medical history and biomarker values were obtained by chart review. Spearman’s Rank correlation assessed associations between biomarker z-scores and cardiac index. Biomarkers with significant correlations had receiver operating characteristic curves and area under the curve estimated. In total, 97 cardiac magnetic resonances in 87 patients met inclusion criteria: median age at cardiac magnetic resonance was 15 (6–33) years. Significant correlations were found between cardiac index and total alkaline phosphatase (−0.26, p=0.04), estimated creatinine clearance (0.26, p=0.02), and mean corpuscular volume (−0.32, p<0.01). Area under the curve for the three individual biomarkers was 0.63–0.69. Area under the curve for the three-biomarker panel was 0.75. Comparison of cardiac index above and below the receiver operating characteristic curve-identified cut-off points revealed significant differences for each biomarker (p<0.01) and for the composite panel [median cardiac index for higher-risk group=2.17 L/minute/m2 versus lower-risk group=2.96 L/minute/m2, (p<0.01)].
Conclusions
Higher total alkaline phosphatase and mean corpuscular volume as well as lower estimated creatinine clearance identify Fontan patients with lower cardiac index. Using biomarkers to monitor haemodynamics and organ-specific effects warrants prospective investigation.
Effective preparedness, response, and recovery from disasters require a well-planned, integrated effort with experienced professionals who can apply specialized knowledge and skills in critical situations. While some professionals are trained for this, others may lack the critical knowledge and experience needed to effectively perform under stressful disaster conditions. A set of clear, concise, and precise training standards that may be used to ensure workforce competency in such situations has been developed. The competency set has been defined by a broad and diverse set of leaders in the field and like-minded professionals through a series of Web-based surveys and expert working group meetings. The results may provide a useful starting point for delineating expected competency levels of health professionals in disaster medicine and public health.
(Disaster Med Public Health Preparedness. 2012;6:44–52)
The Golden-cheeked Warbler Dendroica chrysoparia is a federally endangered Neotropical migrant that inhabits montane pine-oak forests in Mexico and northern Central America during the non-breeding season. Although it is known that Golden-cheeked Warblers are closely associated with ‘encino’ oaks (evergreen or holm oak) such as Quercus sapotifolia, Q. eliptica and Q. elongata, which have shiny, narrow, elliptical, or oblong leaves, quantitative habitat targets are useful for effectively incorporating this information into conservation planning and forest management practices. We analysed data on wintering Golden-cheeked Warblers collected during the non-breeding season in Honduras from 1996 to 1998 to identify quantitative targets for habitat conditions for this species. Data on warbler abundance were collected using line transect surveys located in montane pine-oak forests in a stratified-random fashion. Habitat data were collected at five 0.04 ha plots on these same transects and the averaged values used as predictors of Golden-cheeked Warbler abundance. We found that Golden-cheeked Warblers were strongly associated with the basal area of encino oaks and density of ‘roble’ oaks, such as Q. segoviensis, Q. purulhana and Q. rugosa, which have large, lobed leaves. Density of Golden-cheeked Warblers peaked at ≈ 5.6 m2 ha–1 basal area of encino and ≈7 roble oaks ha–1. These values can be used to identify quantitative habitat targets that can be directly incorporated into forest management practices to ensure that these activities maintain habitat conditions necessary for their use by Golden-cheeked Warblers.
Edited by
Alex S. Evers, Washington University School of Medicine, St Louis,Mervyn Maze, University of California, San Francisco,Evan D. Kharasch, Washington University School of Medicine, St Louis