To send 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 sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.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 sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent 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.
Social cognitive deficits can have many negative consequences, spanning social withdrawal to psychopathology. Prior work has shown that child maltreatment may associate with poorer social cognitive skills in later life. However, no studies have examined this association from early childhood into adolescence. Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC; n = 4,438), we examined the association between maltreatment (caregiver physical or emotional abuse; sexual or physical abuse), assessed repeatedly (every 1–3 years) from birth to age 9, and social cognitive skills at ages 7.5, 10.5, and 14 years. We evaluated the role of both the developmental timing (defined by age at exposure) and accumulation of maltreatment (defined as the number of occasions exposed) using a least angle regression variable selection procedure, followed by structural equation modeling. Among females, accumulation of maltreatment explained the most variation in social cognitive skills. For males, no significant associations were found. These findings underscore the importance of early intervention to minimize the accumulation of maltreatment and showcase the importance of prospective studies to understand the development of social cognition over time.
This article provides an overview of selected ongoing international efforts that have been inspired by Edward Zigler's vision to improve programs and policies for young children and families in the United States. The efforts presented are in close alignment with three strategies articulated by Edward Zigler: (a) conduct research that will inform policy advocacy; (b) design, implement, and revise quality early childhood development (ECD) programs; and (c) invest in building the next generation of scholars and advocates in child development. The intergenerational legacy left by Edward Zigler has had an impact on young children not only in the United States, but also across the globe. More needs to be done. We need to work together with a full commitment to ensure the optimal development of each child.
This work compares dose-volume constraints (DVCs) and tumour control predictions based on the average intensity projection (AVIP) to those on each phase of the four-dimensional computed tomography.
Materials and methods:
In this prospective study plans generated on an AVIP for nine patients with locally advanced non-small-cell lung cancer were recalculated on each phase. Dose-volume histogram (DVH) metrics extracted and tumour control probabilities (TCP) were calculated. These were evaluated by Bland–Altman analysis and Pearson Correlation.
The largest difference between clinical target volume (CTV) on the individual phases and the internal CTV (iCTV) on the AVIP was seen for the smallest volume. For the planning target volume, the mean of each metric across all phases is well represented by the AVIP value. For most patients, TCPs from individual phases are representative of that on the AVIP. Organ at risk metrics from the AVIP are similar to those seen across all phases.
Utilising traditional DVH metrics on an AVIP is generally valid, however, additional investigation may be required for small target volumes in combination with large motion as the differences between the values on the AVIP and any given phase may be significant.
We reviewed stroke care delivery during the COVID-19 pandemic at our stroke center and provincial telestroke system. We counted referrals to our prevention clinic, code strokes, thrombolysis, endovascular thrombectomies, and activations of a provincial telestroke system from February to April of 2017–2020. In April 2020, there was 28% reduction in prevention clinic referrals, 32% reduction in code strokes, and 26% reduction in telestroke activations compared to prior years. Thrombolysis and endovascular thrombectomy rates remained constant. Fewer patients received stroke services across the spectrum from prevention, acute care to telestroke care in Ontario, Canada, during the COVID-19 pandemic.
The Tennessee Department of Health (TDH) investigated a hepatitis A virus (HAV) outbreak to identify risk factors for infection and make prevention recommendations.
Healthcare workers (HCWs) or patients with laboratory-confirmed acute HAV infection during October 1, 2018–January 10, 2019.
HCWs with suspected or confirmed hepatitis A infections were interviewed to assess their exposures and activities. Patient medical records and hospital administrative records were reviewed to identify common exposures. We conducted a site investigation to assess knowledge of infection control practices among HCWs. Serum specimens from ill persons were tested for HAV RNA by polymerase chain reaction (PCR) and genotyped.
We identified 6 HCWs and 2 patients with laboratory-confirmed HAV infection. All cases likely resulted from exposure to a homeless patient with a history of recreational substance use and undiagnosed HAV infection. Breaches in hand hygiene and use of standard precautions were identified. HAV RNA was detected in 7 serum specimens and all belonged to an identical strain of HAV genotype 1b.
A hepatitis A outbreak among hospital patients and HCWs resulted from exposure to a single patient with undiagnosed HAV infection. Breakdowns in infection control practices contributed to the outbreak. The likelihood of nosocomial transmission can be reduced with proper hand hygiene, standard precautions, and routine disinfection. During community outbreaks, medical providers can better prevent ongoing transmission by including hepatitis A in the differential diagnosis among patients with a history of recreational substance use and homelessness.
Personalized medicine has exposed wearable sensors as new sources of biomedical data which are expected to accrue annual data storage costs of approximately $7.2 trillion by 2020 (>2000 exabytes). To improve the usability of wearable devices in healthcare, it is necessary to determine the minimum amount of data needed for accurate health assessment.
Here, we present a generalizable optimization framework for determining the minimum necessary sampling rate for wearable sensors and apply our method to determine optimal optical blood volume pulse sampling rate. We implement t-tests, Bland–Altman analysis, and regression-based visualizations to identify optimal sampling rates of wrist-worn optical sensors.
We determine the optimal sampling rate of wrist-worn optical sensors for heart rate and heart rate variability monitoring to be 21–64 Hz, depending on the metric.
Determining the optimal sampling rate allows us to compress biomedical data and reduce storage needs and financial costs. We have used optical heart rate sensors as a case study for the connection between data volumes and resource requirements to develop methodology for determining the optimal sampling rate for clinical relevance that minimizes resource utilization. This methodology is extensible to other wearable sensors.
The evidence base for stigma in mental health largely originates from high-income countries.
This study from Pakistan aimed to address the gap in literature on stigma from low- and middle-income countries.
This cross-sectional study surveyed 1470 adults from Karachi, Pakistan. Participants from three groups (healthcare professionals, healthcare students and the general public) completed the adapted Bogardus Social Distance Scale (SDS) as a measure of stigma.
All three groups reported higher scores of stigma toward mental disorders compared with physical disorders. SDS scores for mental illness in the general public were significantly higher than in healthcare students (mean difference (MD) 6.93, 95% CI 5.45–8.45, P < 0.001) and healthcare professionals (MD 6.93, 95% CI 5.48–8.38, P < 0.001). However, SDS scores between healthcare students and healthcare professionals were not significantly different (MD 0.003, 95% CI −1.14–1.14, P > 0.99). Being female was associated with lower stigma scores and being over the age of 30 years was associated with higher stigma scores.
Stigma campaigns in Pakistan need to target the general population. However, evidence of negative attitudes toward mental illness in healthcare students and healthcare professionals supports the need for stronger emphasis on psychiatric education within undergraduate and postgraduate training in Pakistan.
UK clinical guidelines recommend treatment of attention-deficit hyperactivity disorder (ADHD) in adults by suitably qualified clinical teams. However, young people with ADHD attempting the transition from children's to adults’ services experience considerable difficulties in accessing care.
To map the mental health services in the UK for adults who have ADHD and compare the reports of key stakeholders (people with ADHD and their carers, health workers, service commissioners).
A survey about the existence and extent of service provision for adults with ADHD was distributed online and via national organisations (e.g. Royal College of Psychiatrists, the ADHD Foundation). Freedom of information requests were sent to commissioners. Descriptive analysis was used to compare reports from the different stakeholders.
A total of 294 unique services were identified by 2686 respondents. Of these, 44 (15%) were dedicated adult ADHD services and 99 (34%) were generic adult mental health services. Only 12 dedicated services (27%) provided the full range of treatments recommended by the National Institute for Health and Care Excellence. Only half of the dedicated services (55%) and a minority of other services (7%) were reported by all stakeholder groups (P < 0.001, Fisher's exact test).
There is geographical variation in the provision of NHS services for adults with ADHD across the UK, as well as limited availability of treatments in the available services. Differences between stakeholder reports raise questions about equitable access. With increasing numbers of young people with ADHD graduating from children's services, developing evidence-based accessible models of care for adults with ADHD remains an urgent policy and commissioning priority.
Dunn identifies two foundational types of motivating experiences in earliest Christianity: postmortem appearances of Jesus and the first disciples’ Pentecost experiences. He regards the experiences of the apostle Paul as particularly illustrative of early Christianity, featuring the liberating power of the Spirit and of being “in Christ,” experiencing the Spirit of God as the Spirit of Jesus, and the shared experience of believers as members of the body of Christ.
Digital health is rapidly expanding due to surging healthcare costs, deteriorating health outcomes, and the growing prevalence and accessibility of mobile health (mHealth) and wearable technology. Data from Biometric Monitoring Technologies (BioMeTs), including mHealth and wearables, can be transformed into digital biomarkers that act as indicators of health outcomes and can be used to diagnose and monitor a number of chronic diseases and conditions. There are many challenges faced by digital biomarker development, including a lack of regulatory oversight, limited funding opportunities, general mistrust of sharing personal data, and a shortage of open-source data and code. Further, the process of transforming data into digital biomarkers is computationally expensive, and standards and validation methods in digital biomarker research are lacking.
In order to provide a collaborative, standardized space for digital biomarker research and validation, we present the first comprehensive, open-source software platform for end-to-end digital biomarker development: The Digital Biomarker Discovery Pipeline (DBDP).
Here, we detail the general DBDP framework as well as three robust modules within the DBDP that have been developed for specific digital biomarker discovery use cases.
The clear need for such a platform will accelerate the DBDP’s adoption as the industry standard for digital biomarker development and will support its role as the epicenter of digital biomarker collaboration and exploration.
Dementia is a clinical syndrome that is estimated to affect 46 million people worldwide. This number is estimated to increase to 131.5 million by 2050 (Prince et al., 2015). Dementia has a huge impact on people with the condition, their families and on health and social services. In the UK alone, it affects some 850 000 people with an estimated annual cost of £26 billion. It is a progressive neuropsychiatric condition leading to a significant strain on individuals, their families and the wider society. The risk increases with age and the burden of disease is set to rise in the coming years (Prince et al., 2015). While symptomatic treatments for the commonest cause of dementia, Alzheimer’s disease, are available, no disease-modifying therapy has emerged and the majority of trials in this space have been negative although there is room for optimism (Aisen, 2017).
OBJECTIVES/GOALS: Juvenile idiopathic arthritis (JIA) is the most common childhood rheumatologic disease childhood and a cause of pain and potential disability. JIA has a strong genetic component and no known cure. The goal of this study is to evaluate allele-dependent effects of a novel JIA risk variant at 1q24.3. METHODS/STUDY POPULATION: JIA patients meeting criteria for the two most common disease subtypes (oligoarticular and RF neg polyarthritis) were genotyped using the Immunochip, an Illumina array with dense coverage of the HLA region and 186 other loci previously reported in autoimmune diseases. Phase I association findings (Hinks, 2013) and Phase II analysis (unpublished) of an expanded cohort (4,271 JIA and 14,390 controls) identified new risk loci, including rs78037977 at 1q24.3. We prioritized rs78037977 and predicted possible impacted mechanisms based on Bayesian predictions of attributable risk, the surrounding chromatin landscape, and transcription factor binding data. A luciferase reporter assay was used to assess allele-dependent enhancer activity. RESULTS/ANTICIPATED RESULTS: rs78037977 is located between FASLG and TNFSF18 at chromosome 1q24.3 is associated with JIA (p = 6.3x10−09), and explains 94% of the posterior probability at this locus; no other SNPs in linkage disequilibrium (r2>0.6). The chromatin landscape around rs78037977 contains H3K4Me1 and H3K27Ac marks, which are indicative of enhancer activity. Further, >160 transcription factors have chromatin immunoprecipitation followed by sequencing (ChIP-seq) peaks overlapping rs78037977 in various cellular contexts. In luciferase reporter assays, the region around rs78037977 containing the reference A allele had ~2-fold increased enhancer activity compared to the non-reference allele. DISCUSSION/SIGNIFICANCE OF IMPACT: This work provides in vitro evidence to support allele-dependent enhancer activity of a novel JIA-risk variant at 1q24.3. Our ongoing work investigates the effect of the DNA-containing region of rs78037977 on gene expression and differential transcription factor binding at rs78037977.
OBJECTIVES/GOALS: The Stanford CTSA Program has started to create Clinical Research Units (CRUs) with the goal to establish CRUs in all clinical departments by the end of 2020. CRUs will be responsible for managing the portfolio of projects proposed and conducted by faculty within departments. CRUs will be responsible for reviewing all clinical research studies. METHODS/STUDY POPULATION: CRUs will be an integral part of the Stanford’s research infrastructure, tasked with 5 key functions to ensure clinical research conducted by Stanford investigators: scientific merit, feasibility, funding, compliance, progress. Each CRU will review all clinical research projects proposed by investigators within the department prior to moving forward with IRB review. Studies will be evaluated annually to ensure compliance with the protocol, applicable laws and regulations, and recruitment goals. The Stanford CTSA will provide guidelines, SOPs and personnel to assist CRUs. In fall 2019, a landscape analysis of SoM clinical departments was conducted to identify:
1) similar existing CRU-like systems,
2) unique needs of departments/divisions for developing CRUs and
3) barriers to implementation.
RESULTS/ANTICIPATED RESULTS: Challenges the pilot CRU has faced include communication and concerns regarding additional obstacles to conducting research. However, as study teams moved through the initial CRU formation, the feedback was overwhelmingly positive. Study teams were appreciative of the constructive feedback and the support for setting up studies. Results from the landscape analysis identified CRU-like systems in 5 departments and highlighted concerns regarding resources needed to implement CRUs. Based on feedback from the landscape analysis, a faculty and operational lead was identified in each clinical department to oversee CRU implementation. Facilitated by CTSA personnel, CRU leads have met quarterly since April 2019. Meetings consist of discussing expectations, sharing ideas and identifying potential roadblocks. DISCUSSION/SIGNIFICANCE OF IMPACT: CRUs will constitute a new organizational structure that consists of teams of investigators and staff to promote high quality, efficient clinical research and enhance collaborative opportunities. The CRU leadership will champion new initiatives in CTR and create pathways for investigators to access research infrastructure and resources. CONFLICT OF INTEREST DESCRIPTION: NA.
To compare the nutritional quality of children’s combination meals offered at large US chain restaurants characterised by three versions – default (advertised), minimum (lower-energy) and maximum (higher-energy).
We identified default children’s meals (n 92) from online restaurant menus, then constructed minimum and maximum versions using realistic additions, substitutions and/or portion size changes for existing menu items. Nutrition data were obtained from the MenuStat database. Bootstrapped linear models assessed nutrition differences between meal versions and the extent to which meal components (main dish, side dish, beverage) drove differences across versions. For each version, we examined the proportion of meals meeting the Guidelines for Responsible Food Marketing to Children.
Twenty-six fast-food and fast-casual restaurants, in 2017.
Nutrient values differed significantly across meal versions for energy content (default 2443 kJ (584 kcal), minimum 1674 kJ (400 kcal), maximum 3314 kJ (792 kcal)), total fat (23, 17, 33 g), saturated fat (8, 6, 11 g), Na (1046, 915, 1287 mg) and sugar (35, 14, 51 g). The substitution of lower-energy beverages resulted in the greatest reduction in energy content (default to minimum, −418 kJ (−100 kcal)) and sugar (−20 g); choosing lower-energy side dishes resulted in the greatest reduction in total fat (default to minimum, −4 g), saturated fat (−1·1 g) and Na (−69 mg). Only 3 % of meals met guidelines for all nutrients.
Realistic modifications to children’s combination meals using existing menu options can significantly alter a meal’s nutrient composition. Promoting lower-energy items as the default option, especially for beverages and side dishes, has a potential to reduce fat, saturated fat and/or sugar in children’s meals.
Psychological resilience – positive psychological adaptation in the context of adversity – is defined and measured in multiple ways across disciplines. However, little is known about whether definitions capture the same underlying construct and/or share similar correlates. This study examined the congruence of different resilience measures and associations with sociodemographic factors and body mass index (BMI), a key health indicator.
In a cross-sectional sample of 1429 African American adults exposed to child maltreatment, we derived four resilience measures: a self-report scale assessing resiliency (perceived trait resilience); a binary variable defining resilience as low depression and posttraumatic stress (absence of distress); a binary variable defining resilience as low distress and high positive affect (absence of distress plus positive functioning); and a continuous variable reflecting individuals' deviation from distress levels predicted by maltreatment severity (relative resilience). Associations between resilience measures, sociodemographic factors, and BMI were assessed using correlations and regressions.
Resilience measures were weakly-to-moderately correlated (0.27–0.69), though similarly patterned across sociodemographic factors. Women showed higher relative resilience, but lower perceived trait resilience than men. Only measures incorporating positive affect or resiliency perceptions were associated with BMI: individuals classified as resilient by absence of distress plus positive functioning had lower BMI than non-resilient (β = −2.10, p = 0.026), as did those with higher perceived trait resilience (β = −0.63, p = 0.046).
Relatively low congruence between resilience measures suggests studies will yield divergent findings about predictors, prevalence, and consequences of resilience. Efforts to clearly define resilience are needed to better understand resilience and inform intervention and prevention efforts.