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Why do stock and housing markets sometimes experience amazing booms followed by massive busts and why is this happening more and more frequently? In order to answer these questions, William Quinn and John D. Turner take us on a riveting ride through the history of financial bubbles, visiting, among other places, Paris and London in 1720, Latin America in the 1820s, Melbourne in the 1880s, New York in the 1920s, Tokyo in the 1980s, Silicon Valley in the 1990s and Shanghai in the 2000s. As they do so, they help us understand why bubbles happen, and why some have catastrophic economic, social and political consequences whilst others have actually benefited society. They reveal that bubbles start when investors and speculators react to new technology or political initiatives, showing that our ability to predict future bubbles will ultimately come down to being able to predict these sparks.
Flood and drought events cause significant freshwater inflow fluctuations in estuaries, potentially leading to physiological stress and altered abundances of pathogens such as Vibrio vulnificus and Perkinsus marinus in oysters. To assess the effects of freshwater pulses to oyster reefs in subtropical estuaries in Texas, this study accomplished two goals: 1) reconstructed a reef-specific history of freshwater pulses through shell stable isotope analysis, 2) quantified the abundance of V. vulnificus and P. marinus through culture-dependent and culture-independent microbiology analyses. Oysters from a natural and restored reef experienced similar fluctuations in shell isotopes, indicating similar ranges of past environmental conditions. V. vulnificus and P. marinus were detected throughout the study but the abundance of these microorganisms was not correlated with environmental parameters or one another. Importantly, the P. marinus infection intensity was always lower at the restored reef, which suggests that restored reefs may experience lower infection frequencies.
Workplace aggression is a significant and prevalent issue facing organizations. Almost all employees report experiencing workplace incivility: low-intensity deviant behavior with ambiguous intent to harm the target (Andersson & Pearson, 1999). More severe forms of workplace aggression happen at lower but still sizable rates. For example, data from the 2014 Canadian General Social Survey indicates that 27 percent of all physically violent incidents occur in the workplace (Perreault, 2015), with women more than twice as likely to be targets of workplace violence than men after adjusting for work hours (Lanthier, Bielecky, & Smith, 2018). These numbers are even more startling when one considers that employees often fail to report workplace aggression. For example, in the hospital environment – a context with elevated risks of aggression – 88 percent of employees who experienced a violent incident did not formally document the incident (Arnetz et al., 2015).
Approximately, 1.7 million individuals in the United States have been infected with SARS-CoV-2, the virus responsible for the novel coronavirus disease-2019 (COVID-19). This has disproportionately impacted adults, but many children have been infected and hospitalised as well. To date, there is not much information published addressing the cardiac workup and monitoring of children with COVID-19. Here, we share the approach to the cardiac workup and monitoring utilised at a large congenital heart centre in New York City, the epicentre of the COVID-19 pandemic in the United States.
The aims of this study were to evaluate changes in inflammatory and oxidative stress levels following treatment with N-acetylcysteine (NAC) or mitochondrial-enhancing agents (CT), and to assess the how these changes may predict and/or moderate clinical outcomes primarily the Montgomery-Åsberg Depression Rating Scale (MADRS).
This study involved secondary analysis of a placebo-controlled randomised trial (n=163). Serum samples were collected at baseline and week 16 of the clinical trial to determine changes in interleukin (IL)-6 and total antioxidant capacity (TAC) following adjunctive CT and/or NAC treatment, and to explore the predictability of the outcome or moderator effects of these markers.
In the NAC treated group, no difference was observed in serum IL-6 and TAC levels after 16 weeks of treatment with NAC or CT. However, results from a moderator analysis showed that in the CT group, lower IL-6 levels at baseline was a significant moderator of MADRS χ2 (df) = 4.90, p=0.027) and Clinical Global Impression-improvement (CGI-I, X2 (df)=6.28 p=0.012). In addition, IL-6 was a non-specific but significant predictor of functioning (based on the Social and Occupational Functioning Assessment Scale (SOFAS)), indicating that individuals with higher IL-6 levels at baseline had a greater improvement on SOFAS regardless of their treatment (p=0.023).
Participants with lower IL-6 levels at baseline had a better response to the adjunctive treatment with the mitochondrial-enhancing agents in terms of improvements in MADRS and CGI-I outcomes.
Most techniques for pollen-based quantitative climate reconstruction use modern assemblages as a reference data set. We examine the implication of methodological choices in the selection and treatment of the reference data set for climate reconstructions using Weighted Averaging Partial Least Squares (WA-PLS) regression and records of the last glacial period from Europe. We show that the training data set used is important because it determines the climate space sampled. The range and continuity of sampling along the climate gradient is more important than sampling density. Reconstruction uncertainties are generally reduced when more taxa are included, but combining related taxa that are poorly sampled in the data set to a higher taxonomic level provides more stable reconstructions. Excluding taxa that are climatically insensitive, or systematically overrepresented in fossil pollen assemblages because of known biases in pollen production or transport, makes no significant difference to the reconstructions. However, the exclusion of taxa overrepresented because of preservation issues does produce an improvement. These findings are relevant not only for WA-PLS reconstructions but also for similar approaches using modern assemblage reference data. There is no universal solution to these issues, but we propose a number of checks to evaluate the robustness of pollen-based reconstructions.
Ultraviolet C (UV-C) light reduces contamination on high-touch clinical surfaces. We assessed the efficacy of 2 UV-C devices at eradicating important clinical pathogens in hyperbaric chambers. Both devices were similarly efficacious against MRSA but differed significantly against C. difficile. Additionally, direct UV-C exposure was more efficacious against both species than indirect exposure.
London, Ontario is a mid-sized Canadian city which appears to be experiencing a syndemic predominately amongst its marginalized populations. Since 2014, rates of HIV, hepatitis A (HAV), hepatitis C (HCV), and invasive group A streptococcal disease have climbed well above provincial rates amid increasing use of injection drugs. Rates of infective endocarditis have also been on the rise. Extensive public health and community-based efforts were taken in response to these concurrent outbreaks. These efforts included establishing improved client care pathways, creating specialized teams to engage underhoused clients, providing mass immunization, and developing new health promotion campaigns. Rates of HIV and HAV were subsequently controlled locally while rates of HCV, iGAS and infective endocarditis remain high within the community and throughout the province.
OBJECTIVES/GOALS: This study uses diffusion kurtosis imaging (DKI) to investigate the structural profiles of basal ganglia (BG) motor circuitry in Vascular Parkinsonism (VP), Parkinson’s disease (PD), and healthy aging controls (HC). VP is a clinical diagnosis of lower body predominant parkinsonism without significant benefit from levodopa. VP is distinct from PD, yet the concept of VP remains debated due to the inability of prior studies to identify specific causative changes. One reason for this may be limitations in measuring intricate BG connectivity in vivo. Given the predominant lower body parkinsonism symptoms in VP, we hypothesized that VP would be associated with decreased connectivity specifically within the BG motor loop. METHODS/STUDY POPULATION: We obtained DKI brain imaging in subjects with VP (N = 7), PD (N = 21), and HCs (N = 58), the latter of which had cardiovascular risk factors but no neurological symptoms. The VP and PD groups were evaluated by a parkinsonism-focused motor exam and brief cognitive testing. We compared BG motor loop connectivity between groups and investigated for correlation between connectivity and clinical scores. To account for differences in fiber counts due to the different imaging scanners and protocols between cohorts, we used a BG motor loop proportion, which was the ratio of the BG motor loop fiber count over a control loop, the visual processing pathway. We used Kruskal-Wallis rank sum test with post-hoc Dunn tests to assess imaging findings between subject groups, and Pearson’s correlation to look for correlation between clinical scores and fiber counts. RESULTS/ANTICIPATED RESULTS: The whole brain connectome showed the fewest number of fibers in VP, followed by PD, and then HC (p<0.0001). The BG motor loop proportion fiber count of the BG motor loop was lower in the VP group, compared to the PD and HC cohorts (p = 0.031). In the VP group, the whole brain connectome fiber count correlated with a gait and balance subscore of the Movement Disorders Society - Unified Parkinson Disease Rating Scale (R = −0.87, p = 0.01). DISCUSSION/SIGNIFICANCE OF IMPACT: This study indicates that VP is associated with decreased structural connectivity, with a disproportionate degree of loss in the BG motor circuitry. While the etiology for this susceptibility to injury and preferential damage to BG remains to be defined, these findings can provide an important starting point for a biological understanding of VP, and a potential future marker for diagnosis and tracking disease progression.
In our rejoinder to the excellent commentaries provided by Macfie, Noose, and Gorrondona (This Volume) and Davies and Thompson (This Volume), we discuss three key directions for research and clinical work that emerge from our chapter on environmental and sociocultural influences on personality disorders. First, it is critical to recognize the importance of early caregiving environments and family processes in the etiology of personality pathology. Second, identifying transactional models that integrate biological, psychological and sociocultural influences may move the field towards a more holistic and multifaceted understanding of the underpinnings of personality pathology. Third and finally, expanding the use of dimensional models of personality pathology may contextualize these transactional relationships and facilitate more rapid advances in our understanding and conceptualizations of (mal)adaptive expressions of personality traits. Dimensional models may further facilitate consideration of socioeconomic, cultural and geopolitical influences in evaluating and defining the maladaptiveness of specific traits and behaviors. Increasing our focus on contextual, environmental, and sociocultural influences in research design, assessment, and case conceptualization will improve personality research and clinical care.
The authors offer their appreciation of the astute commentaries by Scott and Pilkonis and Niedtfeld, Paret, and Schmahl regarding their chapter on borderline personality disorder. Scott and Pilkonis address some very important big picture themes regarding the conceptualization, etiology, and treatment of BPD, and Niedtfeld et al. more specifically comment on innovative research highlighting the interplay of neuroscience and psychotherapy. In this rejoinder, the authors comment on these and other issues and suggest that a developmental psychopathology framework for theory and research has promise for illuminating the nature and etiology of BPD and highlighting important directions for prevention and treatment.
Characterized by a combination of interpersonal, emotional, behavioral, and cognitive instability, borderline personality disorder (BPD) is a serious and often misunderstood condition. The prevalence of BPD is approximately 1.4 to 6%, with substantially higher estimates among psychiatric outpatients and inpatients. Beyond the personal costs of BPD in terms of suffering, BPD is strongly associated with functional impairment and high societal costs for mental healthcare. Clinical descriptions of BPD first appeared before the mid-twentieth century and have evolved to the present conceptualization of an overarching BPD construct represented by the key domains of emotion dysregulation, impulsivity, and interpersonal disturbance. BPD has a varying course, with many individuals achieving remission or recovery, but emotional and interpersonal vulnerabilities and functional impairments often persist for many years, even after structured treatment. The success of treatment for BPD over the past few decades, however, has countered common clinical lore that BPD patients are recalcitrant. Further, novel developments in research on the putative core vulnerabilities underlying BPD, as well as evidence that these vulnerabilities can be addressed in treatment, illuminate important future directions and hope for patients and loved ones affected by this disorder.
In addition to identifying important biological and psychosocial correlates of personality disorders, recent research has illuminated environmental and sociocultural factors that influence the development, expression, and maintenance of personality disorders. In particular, cross-national and cross-cultural comparisons indicate that the expression, meaning, and impact of specific personality traits and behaviors differ across gender roles, historical periods, and cultural and socioeconomic groups. Moreover, whereas interpersonal and attachment theories have historically underscored the importance of parent-child relationships, emotional attunement, and early childhood adversity in the formation and continuation of personality pathology, recent behavioral genetic studies suggest that unique, non-shared environmental influences account for as much or more variance in personality disorders as shared influences among family members. Additional sources of sociocultural and environmental influence on personality disorders include peer and romantic relationships. Increasingly, integrative theories highlight the importance of considering interactions and transactions across biological, psychological, and sociocultural systems in understanding the etiology of personality disorders. These theoretical and empirical advances have important implications for personality disorder research and clinical practice, and point to the potential utility of considering cross-cultural diagnostic validity when evaluating dimensional or categorical diagnostic models.
Introduction: Acute pain represents one of the most common reasons for emergency department (ED) visits. In the opioid epidemic that North America faces, there is a significant demand for novel pain control modalities that are both safe and effective. Regional anesthesia techniques have revolutionized perioperative pain management, and they are currently thought to be indicated for acute pain relief in the ED. The erector spinae plane block (ESPB) is a novel regional block that has the ability to block multidermatomal sensation, including cervical, thoracic and lumbar regions, depending on the vertebral level at which the anesthetic is injected along the erector spinae muscle. Under ultrasound guidance, the landmarks involved are easy to identify, and there are no vital structures in the immediate vicinity of the site of injection. By reviewing the literature on ESPB, this review aims to summarize all its indications and efficacy for acute pain management in the ED. Methods: In April 2019, PUBMED, EMBASE, MEDLINE as well as CINAHL databases were systematically searched for articles discussing the use of ESPB in the ED. In compliance with the PRISMA guidelines, the search results were selected against inclusion and exclusion criteria. Due to the novelty of the block, all types of articles were included. Results: Ten studies on 7 different indications have been published on the use of ESPB in the ED. It is currently most commonly used for rib and spine fractures. Other indications include, mechanical back pain, burn injuries, herpes zoster, renal colic, and acute pancreatitis. ESPB was administered at the vertebral level of region of most pain, unilaterally or bilaterally for complete dermatomal block. It was injected as a single or continuous block - in the seated, lateral, or prone position. All of the studies demonstrate a significant reduction in pain. Furthermore, it has been reported to improve respiratory function, and it has not been associated with any complications following administration. Conclusion: This review shows initial data on the promising effect of ESPB in acute pain management in the ED. Current evidence shows its effectiveness and safety for the most common presenting cases of pain, such as rib and spine fracture, mechanical back pain, burn injuries, herpes zoster, renal colic, as well as acute pancreatitis. ESPB is flexible in administration and relatively easy to perform under ultrasound guidance.
Introduction: Despite recent advances in resuscitation, some patients remain in ventricular fibrillation (VF) after multiple defibrillation attempts during out-of-hospital cardiac arrest (OHCA). Vector change defibrillation (VC) and double sequential external defibrillation (DSED) have been proposed as alternate therapeutic strategies for OHCA patients with refractory VF. The primary objective was to determine the feasibility, safety and sample size required for a future cluster randomized controlled trial (RCT) with crossover comparing VC or DSED to standard defibrillation for patients experiencing refractory VF. Secondary objectives were to evaluate the intervention effect on VF termination and return of spontaneous circulation (ROSC). Methods: We conducted a pilot cluster RCT with crossover in four Canadian paramedic services and included all treated adult OHCA patients who presented in VF and received a minimum of three defibrillation attempts. In addition to standard cardiac arrest care, each EMS service was randomly assigned to provide continued standard defibrillation (control), VC or DSED. Services crossed over to an alternate defibrillation strategy after six months. Prior to the launch of the trial, 2,500 paramedics received in-person training for VC and DSED defibrillation using a combination of didactic, video and simulated scenarios. Results: Between March 2018 and September 2019, 152 patients were enrolled. Monthly enrollment varied from 1.4 to 6.1 cases per service. With respect to feasibility, 89.5% of cases received the defibrillation strategy they were randomly allocated to, and 93.1% of cases received a VC or DSED shock prior to the sixth defibrillation attempt. There were no reported cases of defibrillator malfunction, skin burns, difficulty with pad placement or concerns expressed by paramedics, patients, families, or ED staff about the trial. In the standard defibrillation group, 66.6% of cases resulted in VF termination, compared to 82.0% in VC and 76.3% of cases in the DSED group. ROSC was achieved in 25.0%, 39.3% and 40.0% of standard, VC and DSED groups, respectively. Conclusion: Findings from our pilot RCT suggest the DOSE VF protocol is feasible and safe. VF termination and ROSC were higher with VC and DSED compared to standard defibrillation. The results of this pilot trial will allow us to inform a multicenter cluster RCT with crossover to determine if alternate defibrillation strategies for refractory VF may impact patient-centered, clinical outcomes
The purpose of the study was to examine the association between dietary lutein and zeaxanthin (L + Z) intake and immediate word recall (IWR) and delayed word recall (DWR), and to identify the major contributors to dietary L + Z intake in a recent and representative sample of the older US population.
In this cross-sectional analysis, multivariate path analytic models estimated the association between L + Z consumption and cognitive performance while adjusting for covariates.
Observations were drawn from the 2014 Health and Retirement Study, a nationally representative panel study of older US adults, and the 2013 Health Care and Nutrition Study, which assessed dietary intake via FFQ in a subsample of respondents.
The analytic sample included 6390 respondents aged ≥50 years.
L + Z intake was 2·44 ± 2·32 mg/d on average, and L + Z intake differed significantly across quartiles (P < 0·001). For example, average L + Z intake in Q1 was 0·74 ± 0·23 mg/d and in Q4 was 5·46 ± 2·88 mg/d. In covariate adjusted models, older adults in the highest quartiles of L + Z intake had significantly greater IWR and DWR scores than those in the lowest quartile. Leafy vegetables, cruciferous vegetables, dark yellow vegetables, fish and seafood, legumes, eggs and fruit were significant and meaningful predictors of dietary L + Z intake.
A high consumption of vegetables, fish and seafood, legumes, eggs and fruit is associated with a higher intake of L + Z and greater word recall among older adults.