We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The delivery of paediatric cardiac care across the world occurs in settings with significant variability in available resources. Irrespective of the resources locally available, we must always strive to improve the quality of care we provide to our patients and simultaneously deliver such care in the most efficient and cost-effective manner. The development of cardiac networks is used widely to achieve these aims.
Methods:
This paper reports three talks presented during the 56th meeting of the Association for European Paediatric and Congenital Cardiology held in Dublin in April 2023.
Results:
The three talks describe how centres of congenital cardiac excellence can be developed in low-income countries, middle-income countries, and well-resourced environments, and also reports how centres across different countries can come together to collaborate and deliver high-quality care. It is a fact that barriers to creating effective networks may arise from competition that may exist among programmes in unregulated and especially privatised health care environments. Nevertheless, reflecting on the creation of networks has important implications because collaboration between different centres can facilitate the maintenance of sustainable programmes of paediatric and congenital cardiac care.
Conclusion:
This article examines the delivery of paediatric and congenital cardiac care in resource limited environments, well-resourced environments, and within collaborative networks, with the hope that the lessons learned from these examples can be helpful to other institutions across the world. It is important to emphasise that irrespective of the differences in resources across different continents, the critical principles underlying provision of excellent care in different environments remain the same.
DSM-5 differentiates avoidant/restrictive food intake disorder (ARFID) from other eating disorders (EDs) by a lack of overvaluation of body weight/shape driving restrictive eating. However, clinical observations and research demonstrate ARFID and shape/weight motivations sometimes co-occur. To inform classification, we: (1) derived profiles underlying restriction motivation and examined their validity and (2) described diagnostic characterizations of individuals in each profile to explore whether findings support current diagnostic schemes. We expected, consistent with DSM-5, that profiles would comprise individuals endorsing solely ARFID or restraint (i.e. trying to eat less to control shape/weight) motivations.
Methods
We applied latent profile analysis to 202 treatment-seeking individuals (ages 10–79 years [M = 26, s.d. = 14], 76% female) with ARFID or a non-ARFID ED, using the Nine-Item ARFID Screen (Picky, Appetite, and Fear subscales) and the Eating Disorder Examination-Questionnaire Restraint subscale as indicators.
Results
A 5-profile solution emerged: Restraint/ARFID-Mixed (n = 24; 8% [n = 2] with ARFID diagnosis); ARFID-2 (with Picky/Appetite; n = 56; 82% ARFID); ARFID-3 (with Picky/Appetite/Fear; n = 40; 68% ARFID); Restraint (n = 45; 11% ARFID); and Non-Endorsers (n = 37; 2% ARFID). Two profiles comprised individuals endorsing solely ARFID motivations (ARFID-2, ARFID-3) and one comprising solely restraint motivations (Restraint), consistent with DSM-5. However, Restraint/ARFID-Mixed (92% non-ARFID ED diagnoses, comprising 18% of those with non-ARFID ED diagnoses in the full sample) endorsed ARFID and restraint motivations.
Conclusions
The heterogeneous profiles identified suggest ARFID and restraint motivations for dietary restriction may overlap somewhat and that individuals with non-ARFID EDs can also endorse high ARFID symptoms. Future research should clarify diagnostic boundaries between ARFID and non-ARFID EDs.
Knowledge graphs have become a common approach for knowledge representation. Yet, the application of graph methodology is elusive due to the sheer number and complexity of knowledge sources. In addition, semantic incompatibilities hinder efforts to harmonize and integrate across these diverse sources. As part of The Biomedical Translator Consortium, we have developed a knowledge graph–based question-answering system designed to augment human reasoning and accelerate translational scientific discovery: the Translator system. We have applied the Translator system to answer biomedical questions in the context of a broad array of diseases and syndromes, including Fanconi anemia, primary ciliary dyskinesia, multiple sclerosis, and others. A variety of collaborative approaches have been used to research and develop the Translator system. One recent approach involved the establishment of a monthly “Question-of-the-Month (QotM) Challenge” series. Herein, we describe the structure of the QotM Challenge; the six challenges that have been conducted to date on drug-induced liver injury, cannabidiol toxicity, coronavirus infection, diabetes, psoriatic arthritis, and ATP1A3-related phenotypes; the scientific insights that have been gleaned during the challenges; and the technical issues that were identified over the course of the challenges and that can now be addressed to foster further development of the prototype Translator system. We close with a discussion on Large Language Models such as ChatGPT and highlight differences between those models and the Translator system.
Co-design is seen as crucial for designing solutions for resource-constrained people living in developing countries. To best understand their needs, user engagement and co-design strategies need to first be developed. In this Design Practice Brief, a process of co-design was created and used to understand ways telecommunication engineers could engage with rural communities in Uganda. It reports and reflects on (i) the experience of co-designing with nondesigners and (ii) creating a co-design structure and developing co-design methods of engaging with community members living in developing countries. In doing so, it offers a format and case study for future practitioners facilitating and conducting co-design with nondesigners and contributes to a knowledge gap in the reporting and reflection of co-design practice. This case study is unique as the co-design practice was achieved remotely (online), crossed disciplines (designers and telecommunication engineers) and cultural boundaries (European and African). It finds that in co-designing with nondesigners, preparation and structure are key, with acknowledgement and management of cultural and discipline differences.
Justice-involved youth (JIY) have high rates of behavioral health disorders, but few can access, much less complete, treatment in the community. Behavioral health treatment completion among JIY is poorly understood, even within treatment studies. Measurement, reporting, and rates of treatment completion vary across studies. This systematic review and meta-analysis synthesizes the literature on rates of treatment completion among JIY enrolled in research studies and identifies potential moderators. After systematically searching 6 electronic databases, data from 13 studies of 20 individual treatment groups were abstracted and coded. A meta-analysis examined individual prevalence estimates of treatment completion in research studies as well as moderator analyses. Prevalence effect sizes revealed high rates of treatment completion (pr = 82.6). However, analysis suggests a high likelihood that publication bias affected the results. Treatment groups that utilized family- or group-based treatment (pr = 87.8) were associated with higher rates of treatment completion compared to treatment groups utilizing individual treatment (pr = 61.1). Findings suggest that it is possible to achieve high rates of treatment completion for JIY, particularly within the context of family- and group-based interventions. However, these findings are limited by concerns about reporting of treatment completion and publication bias.
To examine cross-sectional associations between farmers’ market shopping behaviours and objectively measured and self-reported fruit and vegetable (FV) intake among rural North Carolina (NC) and New York City (NYC) shoppers.
Design:
Cross-sectional intercept surveys were used to assess self-reported FV intake and three measures of farmers’ market shopping behaviour: (1) frequency of purchasing FV; (2) variety of FV purchased and (3) dollars spent on FV. Skin carotenoids, a non-invasive biomarker for FV intake, were objectively measured using pressure-mediated reflection spectroscopy. Associations between farmers’ market shopping behaviours and FV intake were examined using regression models that controlled for demographic variables (e.g. age, sex, race, smoking status, education, income and state).
Setting:
Farmers’ markets (n 17 markets) in rural NC and NYC.
Participants:
A convenience sample of 645 farmers’ market shoppers.
Results:
Farmers’ market shoppers in NYC purchased a greater variety of FV and had higher skin carotenoid scores compared with shoppers in rural NC. Among all shoppers, there was a positive, statistically significant association between self-reported frequency of shopping at farmers’ markets and self-reported as well as objectively assessed FV intake. The variety of FV purchased and farmers’ market spending on FV also were positively associated with self-reported FV intake, but not skin carotenoids.
Conclusion:
Those who shop for FV more frequently at a farmers’ markets, purchase a greater variety of FV and spend more money on FV have higher self-reported, and in some cases higher objectively measured FV intake. Further research is needed to understand these associations and test causality.
The North Carolina Legislature appropriated funds in 2016–2019 for the Healthy Food Small Retailer Program (HFSRP), providing small retailers located in food deserts with equipment to stock nutrient-dense foods and beverages. The study aimed to: (1) examine factors facilitating and constraining implementation of, and participation in, the HFSRP from the perspective of storeowners and (2) measure and evaluate the impact and effectiveness of investment in the HFSRP.
Design:
The current analysis uses both qualitative and quantitative assessments of storeowner perceptions and store outcomes, as well as two innovative measures of policy investment effectiveness. Qualitative semi-structured interviews and descriptive quantitative approaches, including monthly financial reports and activity forms, and end-of-programme evaluations were collected from participating HFSRP storeowners.
Setting:
Eight corner stores in North Carolina that participated in the two cohorts (2016–2018; 2017–2019) of the HFSRP.
Participants:
Owners of corner stores participating in the HFSRP.
Results:
All storeowners reported that the HFSRP benefitted their stores. In addition, the HFSRP had a positive impact on sales across each category of healthy food products. Storeowners reported that benefits would be enhanced with adjustments to programme administration and support. Specific suggestions included additional information regarding which healthy foods and beverages to stock; inventory management; handling of perishable produce; product display; modified reporting requirements and a more efficient process of delivering and maintaining equipment.
Conclusions:
All storeowners reported several benefits of the HFSRP and would recommend that other storeowners participate. The barriers and challenges they reported inform potential approaches to ensuring success and sustainability of the HFSRP and similar initiatives underway in other jurisdictions.
The Expanded Program for Immunization Consortium – Human Immunology Project Consortium study aims to employ systems biology to identify and characterize vaccine-induced biomarkers that predict immunogenicity in newborns. Key to this effort is the establishment of the Data Management Core (DMC) to provide reliable data and bioinformatic infrastructure for centralized curation, storage, and analysis of multiple de-identified “omic” datasets. The DMC established a cloud-based architecture using Amazon Web Services to track, store, and share data according to National Institutes of Health standards. The DMC tracks biological samples during collection, shipping, and processing while capturing sample metadata and associated clinical data. Multi-omic datasets are stored in access-controlled Amazon Simple Storage Service (S3) for data security and file version control. All data undergo quality control processes at the generating site followed by DMC validation for quality assurance. The DMC maintains a controlled computing environment for data analysis and integration. Upon publication, the DMC deposits finalized datasets to public repositories. The DMC architecture provides resources and scientific expertise to accelerate translational discovery. Robust operations allow rapid sharing of results across the project team. Maintenance of data quality standards and public data deposition will further benefit the scientific community.
OBJECTIVES/GOALS: We aim to identify and characterize anti-Sox2-specific CD8+ T cell responses in stable MUGS patients expressing HLA class I alleles-A*02:01 and /or -B*07:02. METHODS/STUDY POPULATION: Cross sectional study of patients with stable MGUS defined as stable serum paraprotein for ≥ 12 months from the MM Research Clinic at the Abramson Cancer Institute. Sox2 T cell reactivity will be assessed by IFN-γ ELISPOT assays. Rested PBMC will be pulsed with candidate Sox2-derived peptides predicted to display high affinity to HLA class I alleles and known to be processed and presented as determined by “targeted MS/MS” (mass spectrometry). The presence of anti-Sox2-specific CD8+ T cells will be confirmed in peptide/HLA multimer assays using flow cytometry. Anti-Sox2-specific CD8+ T cells will be characterized for HLA restriction and TCR αβ composition. RESULTS/ANTICIPATED RESULTS: Our work is still in progress. From Aug to Dec 2019, 22 MGUS subjects have been analyzed, 11 of which were found to have the HLA of interest. Positive Sox-2 reactivity by ELISpot was found in 3 subjects. DISCUSSION/SIGNIFICANCE OF IMPACT: Anti-Sox2 immune responses may maintain MGUS in a clinical indolent state by eliminating Sox2-expressing clonogenic MM cells. A detailed characterization of anti-Sox2 T cells followed by in-vivo assessment of their anti-myeloma activity could provide the foundation for a Sox2 based immunotherapy approach in MM.
The European Commission is an increasingly important source of funding for international research projects and is due to announce its Framework 5 program early in 1999. The Outcomes of Depression International Network (ODIN), funded from the current EC Biomed 2 program, is a case study in European academic co-operation. Its organization has three key elements. First, engaging the principal investigators: this has involved identifying potential partners, ensuring reciprocity of interests, effective co-ordination, `dividing the spoils' in advance, and setting up good personal and electronic communication systems. Second, an esprit de corps has been created amongst the researchers, maintaining contact and consistency, and promoting higher degrees. Third, ongoing problems including difficulties in negotiations with the EC, divergence of detailed study methods, and isolation and demoralization amongst researchers, have been addressed. ODIN may provide a useful model for researchers wishing to set up international collaborative groups.
In 2004, there were 11,092 presentations to Irish hospitals with deliberate self-harm, including 7,933 cases of drug overdose, of which 31% involved paracetamol. Limiting the availability of paracetamol reduces morbidity and mortality associated with paracetamol overdose. The present study aimed to determine the level of compliance with statutory regulations governing the sale of paracetamol in Ireland.
Methods:
Researchers visited pharmacy and non-pharmacy outlets (newsagents, mini-markets and supermarkets) in Dublin city and attempted to purchase amounts of paracetamol that exceeded the statutory limits for a single transaction. All paracetamol tablets purchased in non-pharmacy outlets were in blister-packs and all non-pharmacy outlets sold packs with 12 tablets or fewer per pack.
Results:
Amounts of paracetamol in excess of statutory limits for a single transaction were purchased in
50.0% of pharmacies
81.8% of newsagents/mini-markets
20.0% of supermarkets.
Conclusions:
We recommend that
(a) the sale of paracetamol in newsagents/mini-markets should be discontinued
(b) the sale of paracetamol in supermarkets should continue, but automated check-out tills should be programmed to prevent the sales that exceed statutory limits
(c) there should be greater efforts to ensure compliance with statutory regulations in pharmacies.
This study investigated the attitudes of medical students towards psychiatry, both as a subject on the medical curriculum and as a career choice. Three separate questionnaires previously validated on medical student populations were administered prior to and immediately following an 8-week clinical training programme. The results indicate that the perception of psychiatry was positive prior to clerkship and became even more so on completion of training. On completion of the clerkship, there was a rise in the proportion of students who indicated that they might choose a career in psychiatry. Attitudes toward psychiatry correlated positively with the psychiatry examination results. Those that intended to specialise in psychiatry achieved significantly higher examination scores in the psychiatry examination.
Despite being commonly used in research and clinical practice, the evidence regarding the factor structure of the Beck Depression Inventory-II (BDI-II) remains equivocal and this has implications on how the scale scores should be aggregated. Researchers continue to debate whether the BDI-II is best viewed as a unidimensional scale, or whether specific subscales have utility. The present study sought to test a comprehensive range of competing factor analytic models of the BDI-II, including traditional non-hierarchical multidimensional models and confirmatory bifactor models.
Method
Participants (n=370) were clinical outpatients diagnosed with either depressive episode or adjustment disorder. Confirmatory factor analysis and confirmatory bifactor modelling were used to test 15 competing models. The unidimensionality of the best fitting model was assessed using three strength indices (explained common variance, percentage of uncontaminated correlations and ω hierarchical).
Results
Overall, bifactor solutions provided superior fit than both unidimensional and non-hierarchical multidimensional models. The best fitting model consisted of a general depression factor and three specific factors: cognitive, somatic and affective. High factor loadings and strength indices for the general depression factor supported the view that the BDI-II measures a single latent construct.
Conclusions
The BDI-II should primarily be viewed as a unidimensional scale, and should be scored as such. Although it is not recommended that scores on individual subscales are used in isolation, they may prove useful in clinical assessment and/or treatment planning if used in conjunction with total scores.
Deriving glacier outlines from satellite data has become increasingly popular in the past decade. In particular when glacier outlines are used as a base for change assessment, it is important to know how accurate they are. Calculating the accuracy correctly is challenging, as appropriate reference data (e.g. from higher-resolution sensors) are seldom available. Moreover, after the required manual correction of the raw outlines (e.g. for debris cover), such a comparison would only reveal the accuracy of the analyst rather than of the algorithm applied. Here we compare outlines for clean and debris-covered glaciers, as derived from single and multiple digitizing by different or the same analysts on very high- (1 m) and medium-resolution (30 m) remote-sensing data, against each other and to glacier outlines derived from automated classification of Landsat Thematic Mapper data. Results show a high variability in the interpretation of debris-covered glacier parts, largely independent of the spatial resolution (area differences were up to 30%), and an overall good agreement for clean ice with sufficient contrast to the surrounding terrain (differences ∼5%). The differences of the automatically derived outlines from a reference value are as small as the standard deviation of the manual digitizations from several analysts. Based on these results, we conclude that automated mapping of clean ice is preferable to manual digitization and recommend using the latter method only for required corrections of incorrectly mapped glacier parts (e.g. debris cover, shadow).
It has become our mantra at NIMH that mental disorders can be addressed as disorders of brain circuits.
—Thomas Insel, director, National Institute of Mental Health, 2010
The guideline of the institute, to quote the law, is “to provide support of research on the etiology, diagnosis, treatment, prevention, and control of mental illness and the promotion of mental health.” This broad mandate contains no restrictions on approaches or disciplines.
—Article encouraging submissions by anthropologists to the National Institute of Mental Health, 1963
Since its founding in 1949, the National Institute of Mental Health (NIMH) has been a major force in shaping America's understanding of mental illness, ushering the shift back toward a biological perspective. This move was not simply the logical outcome of scientific progress, but rather an admission of failure to meet the nation's growing mental health problems and a hope for salvation through reductionism. To facilitate this shift, NIMH modeled, underwrote, and broadcast the new biological revolution in psychiatry. Fulfilling its mission to disseminate mental health information, starting in the 1950s NIMH disseminated press releases, radio spots, television programs, and most recently websites and podcasts to broadcast the message that mental illnesses are fundamentally physical ailments whose cure depends on scientific medicine. The messages NIMH conveyed about how mental illness should be approached had a dramatic disciplinary de facto effect; such messages helped steer psychiatry away from psychosocial and psychodynamic explanations and toward a neurological picture of the mind and mental disturbances.
At the outset, it is prudent to bear in mind Daniel Breslau's cautionary words: “The dramatic reversal of the relationship between the declining psychodynamic orientation and the ascendant biological and nosological approach is inexplicable with reference only to the rhetoric of science.” Although this claim is undoubtedly true, it is the argument of this chapter that rhetorical strategies nevertheless did significantly help advance the cause of biological psychiatry. Ostensibly just reporting the latest research, NIMH's messages increasingly suggested that brain science will solve the problem of mental illness.
A few studies have examined the association between vitamin D and telomere length, and fewer still have examined the relationship in black or male populations. We investigated the cross-sectional association between the vitamin D metabolite 25-hydroxyvitamin D (25(OH)D) concentration in plasma and relative leucocyte telomere length (LTL) in 1154 US radiologic technologists who were 48–93 years old (373 white females, 278 white males, 338 black females, 165 black males). Plasma 25(OH)D concentration was measured by the chemiluminescence immunoassay, and relative LTL was measured by quantitative PCR. Logistic regression was used to obtain OR and 95 % CI for long v. short (based on median) LTL in relation to continuous 25(OH)D, quartiles of 25(OH)D and 25(OH)D deficiency. We found no significant association between continuous 25(OH)D and long LTL in all participants (Ptrend=0·440), nor in white females (Ptrend=0·845), white males (Ptrend=0·636), black females (Ptrend=0·967) or black males (Ptrend=0·484). Vitamin D deficiency (defined as 25(OH)D<30 nmol/l), however, was significantly associated with short LTL in whites (P=0·024), but not in other groups. In this population, we found little evidence to support associations between 25(OH)D and long LTL over the entire range of 25(OH)D in the overall study population or by sex and race.