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Universities struggle to provide meaningful education and mentorship to Native American students, especially in STEM fields such as archaeology and geography. The Native American Summer Mentorship Program (NASMP) at Utah State University is designed to address Native student retention and representation, and it fosters collaboration between mentors and mentees. In spring 2020, as university instruction went online due to the COVID-19 pandemic, NASMP mentors were faced with adapting hands-on activities and face-to-face interaction to an online format. Using our Water Heritage Anthropological Project as a case study, we show how virtual archaeological, archival, spatial, and anthropological labs can be adapted for online delivery. This approach may be especially useful for reaching students in rural settings but also for engaging students in virtual or remote research in the field sciences.
Childhood adversity (CA) is commonly associated with an increased risk of subsequent psychopathology. It is important to identify potential mediators of this relationship which can allow for the development of interventions. In a large population-based cohort study we investigated the relationship between CA and late adolescent psychopathology and early adolescent candidate mediators of this relationship.
We used data from three waves (n = 6039) of Cohort 98′ of the Growing up in Ireland Study (age 9, 13 and 17). We used doubly robust counterfactual analyses to investigate the relationship between CA (reported at age-9) with psychopathology (internalizing and externalizing problems), measured using the Strengths and Difficulties Questionnaire at age-17. Counterfactual and traditional mediation was used to investigate the mediating effects of the parent-child relationship, peer relations, self-concept, computer usage and physical activity.
CA was associated with an increased risk of internalizing and externalizing problems at age-17. Parent-child conflict mediated 35 and 42% of the relationship between CA and late adolescent externalizing problems and internalizing problems, respectively. Self-concept and physical activity mediated an additional proportion of the relationship between CA and internalizing problems. These results were robust to unmeasured confounding.
Parent-child conflict explains more than a third of the relationship between CA and later psychopathology. Self-concept and physical activity explain the additional proportion of the relationship between CA and internalizing problems. This suggests that these factors may be good targets for intervention in young people who have experienced CA to prevent subsequent psychopathology.
Three species of lichenicolous Opegrapha s. lat. are newly described, all apparently host-specific at genus level. Opegrapha arthoniicola Coppins & S. Y. Kondr. is described from western Britain and Ireland, where it grows on the thallus of Arthonia radiata on Corylus bark; it has small clustered ascomata, asci that are usually 6-spored and rather small ascospores (10.5–)12.5–14.5 μm in length. Opegrapha sawyeriana Coppins occurs on the thallus of Coniocarpon cinnabarinum, also on Corylus bark, from oceanic western parts of Scotland, Ireland and southern England; in comparison to O. arthoniicola it has smaller, often scattered ascomata with a pigmented basal layer, 8-spored asci and slightly larger ascospores 13–14.5(–16) μm in length. Opegrapha hochstetteri Coppins has been found on thalli of Verrucaria hochstetteri and V. muralis on calcareous rocks and stonework in southern England and Luxembourg; collections were formerly identified as Opegrapha rupestris Pers. but it differs from this species by narrower ascomata with a persistent narrow slit, normally 6- rather than 8-spored asci and ascospores with pigmentation in the spore wall rather than the perispore. Lifted from synonymy is Opegrapha opaca Nyl., which inhabits the thallus of Verrucaria nigrescens and V. viridula on calcareous rocks and stonework, and is so far recorded from southern England, Luxembourg, France, northern Spain and Israel. The hosts of the European species of lichenicolous Opegrapha on Verrucaria s. lat. on calcareous rocks (O. hochstetteri, O. opaca and O. rupestris) belong to different phylogenetic lineages within the Verrucariaceae. A key is also provided to the lichenicolous species of Opegraphaceae currently known from Great Britain and Ireland.
Assessment of risks of illnesses has been an important part of medicine for decades. We now have hundreds of ‘risk calculators’ for illnesses, including brain disorders, and these calculators are continually improving as more diverse measures are collected on larger samples.
We first replicated an existing psychosis risk calculator and then used our own sample to develop a similar calculator for use in recruiting ‘psychosis risk’ enriched community samples. We assessed 632 participants age 8–21 (52% female; 48% Black) from a community sample with longitudinal data on neurocognitive, clinical, medical, and environmental variables. We used this information to predict psychosis spectrum (PS) status in the future. We selected variables based on lasso, random forest, and statistical inference relief; and predicted future PS using ridge regression, random forest, and support vector machines.
Cross-validated prediction diagnostics were obtained by building and testing models in randomly selected sub-samples of the data, resulting in a distribution of the diagnostics; we report the mean. The strongest predictors of later PS status were the Children's Global Assessment Scale; delusions of predicting the future or having one's thoughts/actions controlled; and the percent married in one's neighborhood. Random forest followed by ridge regression was most accurate, with a cross-validated area under the curve (AUC) of 0.67. Adjustment of the model including only six variables reached an AUC of 0.70.
Results support the potential application of risk calculators for screening and identification of at-risk community youth in prospective investigations of developmental trajectories of the PS.
Previous systematic reviews and meta-analyses of cross-sectional data assessing the effect of cannabis on cognitive functioning and intelligence show inconsistent results. We hypothesized that frequent and dependent cannabis use in youth would be associated with Intelligence Quotient (IQ) decline. This study is a systematic review and meta-analysis. We searched Embase, PubMed and PsychInfo from inception to 24 January 2020. We included studies with non-treatment seeking samples and pre- and post-exposure measures of IQ. We requested data from authors if summary data was not available from published work. We preregistered our review with PROSPERO (ID no. CRD42019125624). We found seven cohort studies including 808 cases and 5308 controls. We found a significant effect for the association between frequent or dependent cannabis use in youth and IQ change, Cohen's d = −0.132 (95% CI −0.198 to −0.066) p < 0.001. Statistical heterogeneity between studies was also low at I2 = 0.2%. Study quality was moderate to high. This translates to an average decline of approximately 2 IQ points following exposure to cannabis in youth. Future studies should have longer periods of follow up to assess the magnitude of developmental impact.
On-call and crisis psychiatry is a very challenging aspect of psychiatric training. This study aimed to describe the experiences of psychiatric trainees on-call in hospitals, emergency departments and psychiatric units in Ireland.
In total, 193 psychiatric trainees in Ireland were emailed a survey in 2017. The survey included questions regarding the duties expected of the trainee, frequency of on-call obligations, un-rostered hours worked, level of senior support, assessment facilities available and doctors’ satisfaction with the on-call experience.
Overall, 68 trainees responded to the survey. In total, 35% of respondents reported dissatisfaction with their experience of on-call and crisis psychiatry, 46% reported that they were not provided with training in risk assessment and 21% of respondents stated that there was not a suitable room available to perform their assessments.
This survey has raised important issues facing those on the frontline of psychiatric services in Ireland. Of particular concern are resource issues faced by trainees and the need for further training and support related to risk assessment when on-call. Remedying these issues may lead to a decreased rate of dropout as well as a safer and better environment for patients and doctors alike.
The mental health of third-level students is of major societal concern with the gap between the demand for services and supports offered at crisis level. In Ireland, similar to elsewhere, colleges have responded to this need in vastly differing ways, with student counselling services available to all institutions, and student health departments and sessional psychiatry in some of the larger institutions, with none operating as a single multidisciplinary service. There is an increasing recognition for a more systematised approach, with the establishment of International Networks, Charters and Frameworks. These advocate for a whole institutional approach to student mental health, in addition to the development of an integrated system of supports with effective pathways to appropriate care. This paper, by members of the Youth and Student Special Interest Group of the College of Psychiatrists of Ireland, contextualises student mental health currently and describes future directions for this emerging field. It is a call to action to develop a structure that supports the needs of students with mental health problems across the full range of the spectrum from mild to severe.
There is a high rate of psychiatric comorbidity in patients with epilepsy. However, the impact of surgical treatment of refractory epilepsy on psychopathology remains under investigation. We aimed to examine the impact of epilepsy surgery on psychopathology and quality of life at 1-year post-surgery in a population of patients with epilepsy refractory to medication.
This study initially assessed 48 patients with refractory epilepsy using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Hospital Anxiety and Depression Scale (HADS) and the Quality of Life in Epilepsy Inventory 89 (QOLIE-89) on admission to an Epilepsy Monitoring Unit (EMU) as part of their pre-surgical assessment. These patients were again assessed using the SCID-I, QOLIE-89 and HADS at 1-year follow-up post-surgery.
There was a significant reduction in psychopathology, particularly psychosis, following surgery at 1-year follow-up (p < 0.021). There were no new cases of de novo psychosis and surgery was also associated with a significant improvement in the quality of life scores (p < 0.001).
This study demonstrates the impact of epilepsy surgery on psychopathology and quality of life in a patient population with refractory surgery. The presence of a psychiatric illness should not be a barrier to access surgical treatment.
The ongoing crisis created by the arrival of the COVID-19 virus (the Corona crisis as some have labelled it) has revealed and exacerbated pre-existing inequalities throughout the world in terms of income, gender and race. This is illustrated graphically in Latin America, considered by the World Health Organization (WHO) at the time of writing as an ‘intense zone’ for COVID-19 transmission (UN News, 2020). According to Sánchez-Ancochea (2020):
80% of individuals in the bottom quintile of the population work in the informal sector. Almost one fourth of all Latin Americans have no access to potable water, a third has no access to the internet, and many live in low quality housing – with dramatic consequences not only for their income opportunities but also for their health during the pandemic.
This graphic situation of inequality presents difficult choices for Latin American governments in their policy responses to the pandemic, particularly with regard to the most severe of these ‘lockdowns’ – that is, national shutdowns of all but essential economic and social activity combined with stay at home orders for most of the population. On the one hand, not imposing lockdowns can risk the rapid spread of the virus; on the other, the stark context of inequality alongside poorquality, sparse and badly equipped and funded health and public services make lockdowns difficult to implement in an effective manner, and may exacerbate poverty and inequality further. Additionally, their cost may add to existing state debt burdens already being repaid with great difficulty and at a high social cost. All these issues have contributed to the uneven outcomes of virus management efforts in the region.
This chapter will briefly examine these issues in the context of Latin America in the following order: the political, social and economic background preceding the emergence of COVID-19 in the region; the range of measures used to contain the virus, particularly lockdowns and any compensatory policy packages introduced to mitigate their negative socioeconomic impacts, assessing the impact and effectiveness of both; and, some policy responses being discussed for the medium to long term on how to address the inequalities made more urgent by the pandemic.
The COVID-19 pandemic is much more than a health crisis, as the diverse contributions to this timely book make abundantly clear. Dr Michael J Ryan, Director General of the World Health Organization (WHO) Emergency Programme, has observed that “Nobody on this planet is safe until everyone is safe”. An unprecedented spirit of global solidarity is required to overcome the multiple threats COVID-19 poses to our health, economies and societies, particularly in resource-poor settings.
In Ireland, we have a strong sense of community – meitheal – coming together to work collectively for a better future. This clear sense of global citizenship underpins Ireland's development cooperation, as outlined in our international development policy, A Better World. Ireland is playing its part in building and contributing to a coherent, effective and integrated global response to COVID-19. Our overarching priority is to reduce the incidence and mitigate the impact of the pandemic among vulnerable populations, in line with our commitment to reaching the furthest behind first.
As the contributors to this book outline from a range of different perspectives, these efforts are unfolding in a highly dynamic, interconnected and changing world. Pre-COVID-19, we were already facing unprecedented levels of humanitarian crises, with over 134 million people in need of assistance and protection. Protracted crises are becoming the new normal. New threats are emerging to peace, and geopolitics is becoming increasingly complex and volatile. To overcome these challenges and achieve the UN (United Nations) Sustainable Development Goals (SDGs), poverty needs to be addressed from a multidimensional perspective. This includes the way the international community approaches and applies research, evidence, knowledge and learning.
‘Research and Learning’ is identified as one of the five key criteria for action in A Better World, acknowledging the need to prioritize learning and to situate research and evidence centrally within Ireland's development cooperation programme. We recognize the intrinsic value of research as a global public good, but also its role in better understanding approaches that work most effectively to reduce poverty. Together with learning from experience, reviews and evaluations, research is the basis on which we build knowledge and evidence for our work in international development – and nowhere is this more important than when working in conflict and fragility, where the context can and does change rapidly.
Background: As many as 40% of infants aged ≤12 months and 10%–28% of children aged 13–24 months are colonized by Clostridioides difficile. The IDSA and the SHEA recommend that testing should never be routinely recommended for infants ≤12 months of age and should not be routinely performed for children 1–2 years of age unless other causes are excluded. We report implementation of C. difficile diagnostic stewardship at 2 children’s hospitals. Methods: We implemented age-based restrictions for C. difficile testing at hospital A (∼200-bed, free-standing, children’s hospital) and hospital B (∼100-bed children’s hospital within a larger hospital). Both sites are part of the same multicampus institution, and both used nucleic acid amplification testing to detect C. difficile throughout the study. In May 2018, we implemented an electronic order set for C. difficile that provided alerts to avoid testing young infants and patients with recent use of laxatives, stool softeners, or enemas, but providers could order C. difficile testing at their discretion. In October 2018, we implemented a more restrictive diagnostic stewardship algorithm for C. difficile. No testing was allowed for infants aged ≤12 months. Approval pediatric infectious diseases staff was required to test children aged 13–24 months. Pathology resident approval was required to test children aged ≥24 months who had received laxatives, stool softeners, or enemas within ≤24 hours. Clinical microbiology laboratory supervisors reinforced rejection of nondiarrheal stool specimens for testing. Providers at both campuses were informed about the new testing guidelines by e-mail. We compared the number of tests sent and positive cases of healthcare facility-onset C. difficile (HO-CDI) by age strata before and after the implementation of the restrictive testing algorithm. Results: After the intervention, the number of tests in infants significantly declined; 2 infants aged ≤12 months and 4 infants aged 13–24 months were tested for C. difficile (Table). After the intervention, the number of tests per month declined at hospital A, as did the number of HO-CDI cases at both hospitals. Rejections of nondiarrheal stools significantly increased after the intervention (P < .001). Conclusions:C. difficile diagnostic stewardship for children was successfully implemented using a rule-based alert system in the electronic health record. This intervention was associated with a reduced number of tests sent and cases of HO-CDI. This strategy was cost-saving and prevented misdiagnosis, unnecessary antibiotic therapy, and overestimation of HO-CDI rates.
To determine if the initial COVID-19 societal restrictions, introduced in Ireland in March 2020, impacted on the number and nature of psychiatry presentations to the emergency department (ED) of a large academic teaching hospital.
We examined anonymised clinical data of psychiatry presentations to the ED during the initial 8-week period of COVID-19 restrictions. Data from corresponding 8-week periods in 2018 and 2019 were also extracted for comparison.
Psychiatry presentations to ED reduced by 21% during the COVID-19 restrictions, from 24/week to 19/week when compared with corresponding periods in 2018/2019 (Poisson’s Rate Test estimate of difference −5.2/week, 95% CI 1.3–9.1, p = 0.012). Numbers attending for out-of-hours assessment remained unchanged (81 v. 80), but numbers seeking assessment during normal hours decreased (71 v. 114). We observed increased presentations from the <18 age group, but decreased presentations from the 18 to 29 age group (Pearson’s Chi-Square 20.363, df = 6, p = 0.002). We recorded an increase in anxiety disorders during the initial COVID-19 restrictions (31 v. 23), and a reduction in alcohol disorders (28 v. 52). The proportion of presentations with suicidal ideation (SI) or self-harm as factors remained unchanged.
Rates of emergency presentation with mental illness reduced during the initial COVID-19 restrictions. This may represent an unmet burden of mental health needs. Younger people may be experiencing greater distress and mental illness during the current crisis. More people sought help for anxiety disorders during the COVID-19 restrictions compared with corresponding data from 2018 and 2019.
Youth mental health is a rapidly developing field with a focus on prevention, early identification, treatment innovation and service development. In this perspective piece, we discuss the effects of COVID-19 on young people’s mental health. The psychosocial effects of COVID-19 disproportionately affect young people. Both immediate and longer-term factors through which young people are affected include social isolation, changes to the delivery of therapeutic services and almost complete loss of all structured occupations (school, work and training) within this population group. Longer-term mechanisms include the effects of the predicted recession on young people’s mental health. Opportunities within this crisis exist for service providers to scale up telehealth and digital services that may benefit service provision for young people’s mental health in the future.
Abnormal body mass index (BMI) has been associated with development of psychopathology. This association in children is well documented, for both overweight and underweight children. However, the association between change in BMI and the development of psychopathology has been less investigated.
To investigate the association between change in BMI between childhood and adolescence and psychopathology in adolescence.
Data from the Growing Up in Ireland cohort were used. We investigated the ’98 cohort (also known as the child cohort) at age 9/13. BMI, defined using internationally recognised definitions as underweight, healthy or overweight, was used as the exposure, and abnormal Strength and Difficulties Questionnaire scores were used as the outcome. Logistic regression was undertaken for the analysis. All analyses were adjusted for confounders.
A change to overweight from healthy BMI was significantly associated with increased risk of psychopathology (adjusted OR 1.66; 95% CI 1.19–2.32). Both change from underweight to healthy (adjusted OR 0.12; 95% CI 0.03–0.43) or from overweight to healthy (adjusted OR 0.47; 95% CI 0.79–0.8) was associated with a significantly reduced risk of developing psychopathology.
As a child’s BMI returns to within the healthy range, their risk of adolescent psychopathology is reduced. Interventions to restore healthy BMI, in both underweight and overweight, children may reduce their risk of adolescent psychopathology.
Often referred to as psychotic experiences, unusual perceptual experiences, thoughts and beliefs (UPTBs) are not uncommon in youth populations. Phenomenological studies of these experiences are lacking. This study aimed to (1) describe the phenomenological characteristics of UPTBs in a sample of young adolescents and (2) explore how young people made sense of those experiences.
Participants were 53 young people aged 11–13 years from a population-based study of mental health. All met criteria for UPTBs following clinical interviews as part of the study. Documentary data on UPTBs in the form of transcribed notes, recorded during clinical interviews, were analysed using content analysis. Data on UPTBs were coded, organised into categorical themes and quantified using descriptive statistics. Qualitative themes on how participants made sense of their experiences were identified.
Participants reported UPTBs across four domains: auditory verbal, auditory non-verbal, non-auditory perceptual experiences and unusual thoughts and beliefs. UPTBs were phenomenologically rich and diverse. Young people sought to make sense of their experiences in multiple ways: normalising them, externalising them by attributing them to paranormal entities and distancing them from psychiatric explanations. Uncertainty about the source of UPTBs was identified as a superordinate theme.
Findings from this study offer new insights into the phenomenological qualities and characteristics of UPTBs in young adolescents. They also reveal that early adolescents may not make sense of their experiences within a psychiatric framework. These findings highlight the need to develop a more phenomenologically sensitive and nuanced approach to studying UPTBs in young people.
In 1928, Noel Morss was shown “irrigation ditches” along Pleasant Creek on the Dixie National Forest near Capitol Reef National Park, Utah, by a local guide who contended they were ancient. We relocated the site and mapped the route of an unusual mountain irrigation canal. We conducted excavations and employed OSL and AMS 14C showing historic irrigation, and an earlier event between AD 1460 and 1636. Geomorphic evidence indicates that the canal existed prior to this time, but we cannot date its original construction. The canal is 7.2 km long, originating at 2,450 m asl and terminating at 2,170 m asl. Less than half of the system was hand constructed. We cannot ascribe the prehistoric use-event to an archaeological culture, language, or ethnic group, but the 100+ sites nearby are largely Fremont in cultural affiliation. We also report the results of experimental modeling of the capital and maintenance costs of the system, which holds implications for irrigation north of the Colorado River and farming during the Little Ice Age. The age of the prehistoric canal is consistent with a fragmentary abandonment of farming and continuity between ancient and modern tribes in Utah.
Individuals who report psychotic-type experiences are at increased risk of future clinical psychotic disorder. They constitute a ‘at-high risk’ group for studying the trajectory to schizophrenia and related illnesses. Psychotic disorders are a significant risk factor for suicide, especially young people. Previous research has used screening instruments to identify this high risk group but few studies have followed up by an in-depth clinical interview to assess the relationship between psychotic symptoms and suicidality or other psychopathology.
As part of a community study, a 50-minute self -reported screening questionnaire which included one item designed to assess psychotic symptoms (auditory hallucinations) was administered to 900 adolescents aged 14 years in community schools, in Cork, Ireland. The following question (“Have you ever heard voices or sounds that no one else can hear?”) was used as it has been shown previously to have best predictive power (Kelleher., 2009). Other screening questions assessed suicidality and other psychopathology. Detailed clinical interviews by experienced child and adolescent psychiatrists were subsequently carried out with some of these adolescents who endorsed a positive answer to screening questions.
We plan to calculate the sensitivity and specificity and positive predictive value for the specific screening symptom on auditory hallucinations and its relationship to psychopathology as verified on clinical interview.
Our results will be of value to those engaged in treating children and adolescents with psychiatric disorder and will inform on the clinical significance of a positive answer to a screening question on auditory hallucinations in adolescence.