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To improve early intervention and personalise treatment for individuals early on the psychosis continuum, a greater understanding of symptom dynamics is required. We address this by identifying and evaluating the movement between empirically derived attenuated psychotic symptomatic substates—clusters of symptoms that occur within individuals over time.
Methods
Data came from a 90-day daily diary study evaluating attenuated psychotic and affective symptoms. The sample included 96 individuals aged 18–35 on the psychosis continuum, divided into four subgroups of increasing severity based on their psychometric risk of psychosis, with the fourth meeting ultra-high risk (UHR) criteria. A multilevel hidden Markov modelling (HMM) approach was used to characterise and determine the probability of switching between symptomatic substates. Individual substate trajectories and time spent in each substate were subsequently assessed.
Results
Four substates of increasing psychopathological severity were identified: (1) low-grade affective symptoms with negligible psychotic symptoms; (2) low levels of nonbizarre ideas with moderate affective symptoms; (3) low levels of nonbizarre ideas and unusual thought content, with moderate affective symptoms; and (4) moderate levels of nonbizarre ideas, unusual thought content, and affective symptoms. Perceptual disturbances predominantly occurred within the third and fourth substates. UHR individuals had a reduced probability of switching out of the two most severe substates.
Conclusions
Findings suggest that individuals reporting unusual thought content, rather than nonbizarre ideas in isolation, may exhibit symptom dynamics with greater psychopathological severity. Individuals at a higher risk of psychosis exhibited persistently severe symptom dynamics, indicating a potential reduction in psychological flexibility.
Technological innovations in the online food delivery sector include the use of autonomous delivery vehicles. The aim of the present study was to investigate consumers’ intentions to use these services once they are widely available and their motivations for using them to access unhealthy food.
Design:
Online survey including a vignette describing a future world where autonomous food deliveries are in common use in both metropolitan and non-metropolitan areas.
Setting:
Australia.
Participants:
1078 Australians aged 18 years and older, nationally representative by sex, age and location (metropolitan v. non-metropolitan residence).
Results:
Around half of the sample reported intending to use an autonomous food delivery service at least once per week for fast food (53 %) and/or healthy pre-prepared food (50 %). Almost two-thirds (60 %) intended using autonomous vehicle deliveries to receive groceries. Around one in five (17 %) anticipated an increase in their fast-food intake as a result of access to autonomous delivery services compared with one in two (46 %) expecting others’ total fast-food intake to increase. The most common reason provided for using autonomous food deliveries was increased convenience. More frequent current fast-food ordering, higher socio-economic status, younger age and regional location were significantly associated with an anticipated increase in fast-food consumption.
Conclusions:
The emergence of autonomous food delivery systems may bring both benefits and adverse consequences that in combination are likely to constitute a substantial regulatory challenge. Proactive efforts will be required to avoid negative public health nutrition outcomes of this transport evolution.
Radiocarbon (14C) dating of sediment deposition around Antarctica is often challenging due to heterogeneity in sources and ages of organic carbon in the sediment. Chemical and thermochemical techniques have been used to separate organic carbon when microfossils are not present. These techniques generally improve on bulk sediment dates, but they necessitate assumptions about the age spectra of specific molecules or compound classes and about the chemical heterogeneity of thermochemical separations. To address this, the Rafter Radiocarbon Laboratory has established parallel ramped pyrolysis oxidation (RPO) and ramped pyrolysis-gas chromatography-mass spectrometry (Py-GC-MS) systems to thermochemically separate distinct carbon fractions, diagnose the chemical composition of each fraction, and target suitable RPO fractions for radiocarbon dating. Three case studies of sediment taken from locations around Antarctica are presented to demonstrate the implementation of combined RPO-AMS and Py-GC-MS to provide more robust age determination in detrital sediment stratigraphy. These three depositional environments are good examples of analytical and interpretive challenges related to oceanographic conditions, carbon sources, and other factors. Using parallel RPO-AMS and Py-GC-MS analyses, we reduce the number of radiocarbon measurements required, minimize run times, provide context for unexpected 14C ages, and better support interpretations of radiocarbon measurements in the context of environmental reconstruction.
Cetaceans in the eastern South Atlantic Ocean are poorly studied. We present results from a 2 week ship-based survey from Cape Town to Vema Seamount (980 km to the west) during October–November 2019, including visual and towed-hydrophone observations from the vessel, and 10 days of acoustic monitoring on the seamount. Fifty-two hours of visual surveys resulted in 39 encounters of whale groups including seven of humpback, six of fin and one sei whale, as well as four unidentified baleen whales, 18 unidentified balaenopterid whales and four unidentified odontocetes. Two humpback whales at the seamount were engaged in possible feeding behaviour. A large aggregation of mostly fin whales was observed near the continental shelf edge (22 encounters over a 70 × 50 km2 area, six fin, one sei whale, 15 not confirmed to species), an historic whaling ground for both fin and sei whales. Towed-hydrophone data (78.7 h) detected five groups of sperm whales, 45 of delphinids, one beaked whale and no Kogiids. Acoustic data from the seamount detected calls from several baleen whale species including humpback whale non-song calls, Antarctic minke ‘bioduck’ calls, sei whale down-sweep calls and a likely Bryde's whale call. Two call types could not be assigned to species, including the most detected – a simple frequency-modulated call with peak power around 130 Hz. This study contributes to an improved understanding of cetacean occurrence in the eastern South Atlantic Ocean and highlights the need for more research to improve identification of cetacean vocalizations in the region.
Obesity is highly prevalent and disabling, especially in individuals with severe mental illness including bipolar disorders (BD). The brain is a target organ for both obesity and BD. Yet, we do not understand how cortical brain alterations in BD and obesity interact.
Methods:
We obtained body mass index (BMI) and MRI-derived regional cortical thickness, surface area from 1231 BD and 1601 control individuals from 13 countries within the ENIGMA-BD Working Group. We jointly modeled the statistical effects of BD and BMI on brain structure using mixed effects and tested for interaction and mediation. We also investigated the impact of medications on the BMI-related associations.
Results:
BMI and BD additively impacted the structure of many of the same brain regions. Both BMI and BD were negatively associated with cortical thickness, but not surface area. In most regions the number of jointly used psychiatric medication classes remained associated with lower cortical thickness when controlling for BMI. In a single region, fusiform gyrus, about a third of the negative association between number of jointly used psychiatric medications and cortical thickness was mediated by association between the number of medications and higher BMI.
Conclusions:
We confirmed consistent associations between higher BMI and lower cortical thickness, but not surface area, across the cerebral mantle, in regions which were also associated with BD. Higher BMI in people with BD indicated more pronounced brain alterations. BMI is important for understanding the neuroanatomical changes in BD and the effects of psychiatric medications on the brain.
A number of controversial aspects of the relationship between religion and the state are located in public space. Although burqa bans, the Swiss minaret ban, and duties to display crucifixes on public buildings are different in various ways, it is significant that they all take place in this particular type of location. However, when normative political theorists have addressed these issues, they have rarely paid sufficient attention to their spatial location, and, as a result, their analyses are lacking a vital dimension. This article shows what can go wrong when these normative analyses do not refer to an account of public space. It then indicates what part of a suitable account would look like by sketching four of its essential elements, referred to as the definition, distinctiveness, differentiation, and dynamism of public space. It is argued that normative political theorists should draw on aspects of such an account in order to achieve a more sophisticated understanding of issues concerning religion in public spaces, as well as to reach more securely grounded normative conclusions about them.
The coronavirus disease 2019 (COVID-19) pandemic has significantly increased depression rates, particularly in emerging adults. The aim of this study was to examine longitudinal changes in depression risk before and during COVID-19 in a cohort of emerging adults in the U.S. and to determine whether prior drinking or sleep habits could predict the severity of depressive symptoms during the pandemic.
Methods
Participants were 525 emerging adults from the National Consortium on Alcohol and NeuroDevelopment in Adolescence (NCANDA), a five-site community sample including moderate-to-heavy drinkers. Poisson mixed-effect models evaluated changes in the Center for Epidemiological Studies Depression Scale (CES-D-10) from before to during COVID-19, also testing for sex and age interactions. Additional analyses examined whether alcohol use frequency or sleep duration measured in the last pre-COVID assessment predicted pandemic-related increase in depressive symptoms.
Results
The prevalence of risk for clinical depression tripled due to a substantial and sustained increase in depressive symptoms during COVID-19 relative to pre-COVID years. Effects were strongest for younger women. Frequent alcohol use and short sleep duration during the closest pre-COVID visit predicted a greater increase in COVID-19 depressive symptoms.
Conclusions
The sharp increase in depression risk among emerging adults heralds a public health crisis with alarming implications for their social and emotional functioning as this generation matures. In addition to the heightened risk for younger women, the role of alcohol use and sleep behavior should be tracked through preventive care aiming to mitigate this looming mental health crisis.
The technology around generating efficient and sustainable energy is rapidly evolving; hydrogen and fuel cells are versatile examples within a portfolio of options. This article provides an overview of the early-stage materials R&D in hydrogen and fuel cells at the US Department of Energy (DOE) Fuel Cell Technologies Office within the Office of Energy Efficiency & Renewable Energy. The article highlights technology status and progress toward achieving DOE targets, discusses R&D needs and challenges, and provides specific examples where advanced materials research is relevant to addressing those challenges. For broader context, materials R&D advances are discussed in the context of DOE’s H2@Scale initiative, which is enabling innovations to generate cost-competitive hydrogen as an energy carrier, enabling renewables, as well as nuclear, fossil fuels, and the grid, to enhance the economics of both baseload power plants and intermittent solar and wind, enhancing resiliency and avoiding curtailment.
Mental health services in the UK National Health Service have evolved to include primary-care generalist, secondary-care generalist and secondary-care specialist services. We argue that there continues to be an important role for the secondary-care generalists as they minimise interfaces, can live with diagnostic uncertainty and support continuity of care. The lack of commissioning and clinical boundaries in secondary-care generalist services can undermine their feasibility, leading to difficulties recruiting and retaining staff. There is a risk of a polo-mint service, where the specialist services on the edge are well resourced, but the secondary-care generalist services taking the greatest burden struggle to recruit and retain clinicians. We need to establish equity in resources and expectations between generalist and specialist mental health services.
Background:ATP8A2 mutations have only recently been associated with human disease. We present the clinical features from the largest cohort of patients with this disorder reported to date. Methods: An observational study of 9 unreported and 2 previously reported patients with biallelic ATP8A2 mutations was carried out at multiple centres. Results: The mean age of the cohort was 9.4 years old (range: 2.5-28 yrs). All patients demonstrated developmental delay, severe hypotonia and movement disorders: chorea/choreoathetosis (100%), dystonia (27%) or facial dyskinesia (18%). Hypotonia was apparent at birth (70%) or before 6 months old (100%). Optic atrophy was observed in 75% of patients who had a funduscopic examination. MRI of the brain was normal for most patients with a small proportion showing mild cortical atrophy (30%), delayed myelination (20%) and/or hypoplastic optic nerves (20%). Epilepsy was seen in two older patients. Conclusions:ATP8A2 gene mutations have emerged as a cause of a novel phenotype characterized by developmental delay, severe hypotonia and hyperkinetic movement disorders. Optic atrophy is common and may only become apparent in the first few years of life, necessitating repeat ophthalmologic evaluation. Early recognition of the cardinal features of this condition will facilitate diagnosis of this disorder.
Children with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.
Materials and methods
We sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.
Results
A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.
Conclusions
The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.
The use of underground geological repositories, such as in radioactive waste disposal (RWD) and in carbon capture (widely known as Carbon Capture and Storage; CCS), constitutes a key environmental priority for the 21st century. Based on the identification of key scientific questions relating to the geophysics, geochemistry and geobiology of geodisposal of wastes, this paper describes the possibility of technology transfer from high-technology areas of the space exploration sector, including astrobiology, planetary sciences, astronomy, and also particle and nuclear physics, into geodisposal. Synergies exist between high technology used in the space sector and in the characterization of underground environments such as repositories, because of common objectives with respect to instrument miniaturization, low power requirements, durability under extreme conditions (in temperature and mechanical loads) and operation in remote or otherwise difficult to access environments.
There are roughly 25 very metal-poor (VMP; [Fe/H] < -2.0), highly r-process-enhanced (‘r-II’; [Eu/Fe] > + 1.0) stars currently known, discovered over the past 20+ years. These stars provide nearly pure signatures of r-process events early in the Galactic history. We are conducting a high-resolution follow-up survey of RAVE and other bright targets to identify a total of > 100 r-II stars. Our pilot runs on the du Pont 2.5-m at Las Campanas Observatory and the ARC 3.5-m at Apache Point Observatory have already identified up to fourteen new r-II stars. We are continuing our high-resolution follow-up efforts to constrain the astrophysical site(s) and nature of the r-process.
The study of manuscripts is one of the most active areas of current research in medieval studies: manuscripts are the basic primary material evidence for literary scholars, historians and art-historians alike, and there has been an explosion of interest over the past twenty years. Manuscript study has developed enormously: codices are no longer treated as inert witnesses to a culture whose character has already been determined by the modern scholar, but are active participants in a process of exploration and discovery. The articles collected here discuss the future of this process and vital questions about manuscript study for tomorrow's explorers. They deal with codicology and book production, with textual criticism, with the material structure of the medieval book, with the relation of manuscripts to literary culture, to social history and to the medieval theatre, and with the importance to manuscript study of the emerging technology of computerised digitisation and hypertext display. The essays provide an end-of-millennium perspective on the most vigorous developments in a rapidly expanding field of study. Contributors: A.I. Doyle, C. David Benson, Martha W. Driver, J.P. Gumbert, Kathryn Kerby-Fulton, Linne R. Mooney, Eckehard Simon, Alison Stones, John Thompson. DEREK PEARSALL is former Professor and Co-Director of the Centre for Medieval Studies, York, and Professor of English at Harvard University.
Edited by
Carol M. Meale, Senior Research Fellow at the University of Bristol,Derek Pearsall, Professor Emeritus at Harvard University and Honorary Research Professor at the University of York
We must begin with names. ‘Tony Edwards’ is the person to whom this volume is dedicated, but it is not a name that everyone will immediately recognize, particularly those who know him only from his published work, for he has made himself known in public, from the first, as A. S. G. Edwards. When he began his career, this was the manner in which most scholars, most men at least, named themselves. Fashions have changed, and given names, one, two, or more, are now almost universal. But Tony has held on tenaciously to his initials, perhaps because he has three of them. We do not believe that he did so in any spirit of emulation of or desire to align himself with ‘Edwards A. S. G.’, the Edwards Active Strain Gauge well known to Google, an advanced form of technical engineering equipment which guarantees the vacuum conditions needed for the manufacture of certain precision instruments, such as aircraft engine turbine blades. It seems strangely apt as an analogous form of ‘A. S. G.’, whether one thinks of the ‘active strain’ involved as what he exerts upon himself or upon other people. The analogy fails, of course, when one comes to the creation of vacuum, where it works back to front, for Tony's work has essentially been to fill the vacuum that once existed in the study of manuscript history.
Edited by
Carol M. Meale, Senior Research Fellow at the University of Bristol,Derek Pearsall, Professor Emeritus at Harvard University and Honorary Research Professor at the University of York
Edited by
Carol M. Meale, Senior Research Fellow at the University of Bristol,Derek Pearsall, Professor Emeritus at Harvard University and Honorary Research Professor at the University of York