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Neurocognitive impairments robustly predict functional outcome. However, heterogeneity in neurocognition is common within diagnostic groups, and data-driven analyses reveal homogeneous neurocognitive subgroups cutting across diagnostic boundaries.
To determine whether data-driven neurocognitive subgroups of young people with emerging mental disorders are associated with 3-year functional course.
Model-based cluster analysis was applied to neurocognitive test scores across nine domains from 629 young people accessing mental health clinics. Cluster groups were compared on demographic, clinical and substance-use measures. Mixed-effects models explored associations between cluster-group membership and socio-occupational functioning (using the Social and Occupational Functioning Assessment Scale) over 3 years, adjusted for gender, premorbid IQ, level of education, depressive, positive, negative and manic symptoms, and diagnosis of a primary psychotic disorder.
Cluster analysis of neurocognitive test scores derived three subgroups described as ‘normal range’ (n = 243, 38.6%), ‘intermediate impairment’ (n = 252, 40.1%), and ‘global impairment’ (n = 134, 21.3%). The major mental disorder categories (depressive, anxiety, bipolar, psychotic and other) were represented in each neurocognitive subgroup. The global impairment subgroup had lower functioning for 3 years of follow-up; however, neither the global impairment (B = 0.26, 95% CI −0.67 to 1.20; P = 0.581) or intermediate impairment (B = 0.46, 95% CI −0.26 to 1.19; P = 0.211) subgroups differed from the normal range subgroup in their rate of change in functioning over time.
Neurocognitive impairment may follow a continuum of severity across the major syndrome-based mental disorders, with data-driven neurocognitive subgroups predictive of functional course. Of note, the global impairment subgroup had longstanding functional impairment despite continuing engagement with clinical services.
Androphilia refers to sexual attraction and arousal to adult males, whereas gynephilia refers to sexual attraction and arousal to adult females. Male androphilia is considered one of the outstanding paradoxes of evolutionary biology because its very existence flouts our expectations concerning what constitutes an evolutionarily viable trait (Bailey & Zuk, 2009). In humans, male androphilia is heritable, as evinced by twin studies (Alanko et al., 2010; Bailey et al., 2000; Kendler et al., 2000; Långström et al., 2010), as well as research in the area of molecular genetics (Hamer et al., 1993; Mustanski et al.,2005; Sanders et al., 2015). Despite the heritability of this trait, androphilic males reproduce at far lower rates when compared to gynephilic males, if they reproduce at all, which, very often, they do not (e.g., Bell & Weinberg, 1978; King et al., 2005; Saghir & Robins, 1973; Schwartz et al., 2010).
This paper examines the determinants of financial industry actors’ regulatory preferences—examining why some financial industry actors prefer less stringent financial regulations while others prefer more stringent regulations. The determination of preferences, we argue, can be understood as mutually dependent. How an organization is connected to other organisations through network ties may help to explain its regulatory preferences. Our empirical point of focus is financial industry lobbying in the context of the European Union (EU). Using data from nearly nine hundred lobbying letters related to legislation on banking, insurance, and securities regulation, we map out a “socialization network” that models connections between financial industry firms, their associations, as well as a broad range of other organisations and actors that are auxiliary to this community of organizations. Using these data we find evidence that organizations’ preferences are informed by their location within this socialization network. Controlling for a range of other plausible factors, we find that 1) those connected via common associational ties, 2) those closer to one another in the network and 3) those more “embedded” in this network are all less likely to diverge in terms of their preferences from one another.
Duchenne muscular dystrophy is associated with progressive cardiorespiratory failure, including left ventricular dysfunction.
Methods and Results:
Males with probable or definite diagnosis of Duchenne muscular dystrophy, diagnosed between 1 January, 1982 and 31 December, 2011, were identified from the Muscular Dystrophy Surveillance Tracking and Research Network database. Two non-mutually exclusive groups were created: patients with ≥2 echocardiograms and non-invasive positive pressure ventilation-compliant patients with ≥1 recorded ejection fraction. Quantitative left ventricular dysfunction was defined as an ejection fraction <55%. Qualitative dysfunction was defined as mild, moderate, or severe. Progression of quantitative left ventricular dysfunction was modelled as a continuous time-varying outcome. Change in qualitative left ventricle function was assessed by the percentage of patients within each category at each age. Forty-one percent (n = 403) had ≥2 ejection fractions containing 998 qualitative assessments with a mean age at first echo of 10.8 ± 4.6 years, with an average first ejection fraction of 63.1 ± 12.6%. Mean age at first echo with an ejection fraction <55 was 15.2 ± 3.9 years. Thirty-five percent (140/403) were non-invasive positive pressure ventilation-compliant and had ejection fraction information. The estimated rate of decline in ejection fraction from first ejection fraction was 1.6% per year and initiation of non-invasive positive pressure ventilation did not change this rate.
In our cohort, we observed that left ventricle function in patients with Duchenne muscular dystrophy declined over time, independent of non-invasive positive pressure ventilation use. Future studies are needed to examine the impact of respiratory support on cardiac function.
The United States has the highest incarceration rate in the world. With a substantial number of inmates diagnosed with mental illness, substance use, or both, various diversion strategies have been developed to help decrease and avoid criminalization of individuals with mental illness. This article focuses primarily on the first three Sequential Intercept Model intercept points as related to jail diversion and reviews types of diversion programs, research outcomes for diversion programs, and important components that contribute to successful diversion.
For life insurers in the United Kingdom (UK), the risk margin is one of the most controversial aspects of the Solvency II regime which came into force in 2016.
The risk margin is the difference between the technical provisions and the best estimate liabilities. The technical provisions are intended to be market-consistent, and so are defined as the amount required to be paid to transfer the business to another undertaking. In practice, the technical provisions cannot be directly calculated, and so the risk margin must be determined using a proxy method; the method chosen for Solvency II is known as the cost-of-capital method.
Following the implementation of Solvency II, the risk margin came under considerable criticism for being too large and too sensitive to interest rate movements. These criticisms are particularly valid for annuity business in the UK – such business is of great significance to the system for retirement provision. A further criticism is that mitigation of the impact of the risk margin has led to an increase in reinsurance of longevity risks, particularly to overseas reinsurers.
This criticism has led to political interest, and the risk margin was a major element of the Treasury Committee inquiry into EU Insurance Regulation.
The working party was set up in response to this criticism. Our brief is to consider both the overall purpose of the risk margin for life insurers and solutions to the current problems, having regard to the possibility of post-Brexit flexibility.
We have concluded that a risk margin in some form is necessary, although its size depends on the level of security desired, and so is primarily a political question.
We have reviewed possible alternatives to the current risk margin, both within the existing cost-of-capital methodology and considering a wide range of alternatives.
We believe that requirements for the risk margin will depend on future circumstances, in particular relating to Brexit, and we have identified a number of possible changes to methodology which should be considered, depending on circumstances.
Clostridioides difficile infection (CDI) can be prevented through infection prevention practices and antibiotic stewardship. Diagnostic stewardship (ie, strategies to improve use of microbiological testing) can also improve antibiotic use. However, little is known about the use of such practices in US hospitals, especially after multidisciplinary stewardship programs became a requirement for US hospital accreditation in 2017. Thus, we surveyed US hospitals to assess antibiotic stewardship program composition, practices related to CDI, and diagnostic stewardship.
Surveys were mailed to infection preventionists at 900 randomly sampled US hospitals between May and October 2017. Hospitals were surveyed on antibiotic stewardship programs; CDI prevention, treatment, and testing practices; and diagnostic stewardship strategies. Responses were compared by hospital bed size using weighted logistic regression.
Overall, 528 surveys were completed (59% response rate). Almost all (95%) responding hospitals had an antibiotic stewardship program. Smaller hospitals were less likely to have stewardship team members with infectious diseases (ID) training, and only 41% of hospitals met The Joint Commission accreditation standards for multidisciplinary teams. Guideline-recommended CDI prevention practices were common. Smaller hospitals were less likely to use high-tech disinfection devices, fecal microbiota transplantation, or diagnostic stewardship strategies.
Following changes in accreditation standards, nearly all US hospitals now have an antibiotic stewardship program. However, many hospitals, especially smaller hospitals, appear to struggle with access to ID expertise and with deploying diagnostic stewardship strategies. CDI prevention could be enhanced through diagnostic stewardship and by emphasizing the role of non–ID-trained pharmacists and clinicians in antibiotic stewardship.
Livestock producers are encouraged to reduce the use of antibiotics belonging to classes of medical importance to humans. We conducted a scoping review on non-antibiotic interventions in the form of products or management practices that could potentially reduce the need for antibiotics in beef and veal animals living under intensive production conditions. Our objectives were to systematically describe the research on this broad topic, identify specific topics that could feasibly support systematic reviews, and identify knowledge gaps. Multiple databases were searched. Two reviewers independently screened and charted the data. From the 13,598 articles screened, 722 relevant articles were charted. The number of relevant articles increased steadily from 1990. The Western European research was dominated by veal production studies whereas the North American research was dominated by beef production studies. The interventions and outcomes measured were diverse. The four most frequent interventions included non-antibiotic feed additives, vaccinations, breed type, and feed type. The four most frequent outcomes were indices of immunity, non-specific morbidity, respiratory disease, and mortality. There were seven topic areas evaluated in clinical trials that may share enough commonality to support systemic reviews. There was a dearth of studies in which interventions were compared to antibiotic comparison groups.
This chapter reviews key findings from analyses of spectral reflectance measurements of Mercury taken by the MESSENGER mission. Mercury’s crust lacks the 1-µm crystal field absorption due to ferrous iron that is common on other silicate bodies, yet is unusually low in reflectance. The most likely darkening phase is carbon as graphite. Variations in reflectance and color reveal that volcanic plains averaging >5 km in thickness overlie graphite-rich low-reflectance material, which may have originated as a graphite flotation crust from a magma ocean. The one unambiguous absorption due to an oxidized transition metal, an ultraviolet oxygen–metal charge transfer band in bright, pyroclastic deposits, may originate by oxidation of carbon and sulfides, reducing 0.3–1 wt.% ferrous iron in silicates to a metallic state, unsaturating the very strong oxygen–metal charge transfer band.
Visible to short-wave infrared (VSWIR, 0.4–5.0 µm) reflectance spectroscopy is a powerful tool to identify and map mineral groups on the martian surface. The Mars Express/OMEGA and Mars Reconnaissance Orbiter/CRISM instruments have characterized more than 30 mineral groups, revolutionizing previous understanding of martian crustal composition and the role of water in altering it. Analyses of these spectral images revealed the primary structure of the crust to be dominated by basalt, over a deep layer of segregated pyroxene- and olivine-rich plutons, with sparse feldspar-rich, differentiated intrusions. Martian volatile-bearing environments have evolved through four phases: the pre-Noachian to early Noachian period when alteration by liquid water occurred near the surface and deep in the subsurface, in chemically neutral to alkaline environments that formed hydrous silicates and carbonates; the middle to late Noachian period when liquid water was widely present at the surface forming valley networks, lacustrine deposits, and clay-rich pedogenic horizons; the early Hesperian to early Amazonian period during which water became increasingly acidic and saline, forming deposits rich in sulfate salts, chlorides, and hydrated silica; and the Amazonian period when surface water has existed predominantly as ice, with only localized reaction with regolith and briny flow on the surface.
The opioid crisis in the USA requires immediate action through clinical and translational research. Already built network infrastructure through funding by the National Institute on Drug Abuse (NIDA) and National Center for Advancing Translational Sciences (NCATS) provides a major advantage to implement opioid-focused research which together could address this crisis. NIDA supports training grants and clinical trial networks; NCATS funds the Clinical and Translational Science Award (CTSA) Program with over 50 NCATS academic research hubs for regional clinical and translational research. Together, there is unique capacity for clinical research, bioinformatics, data science, community engagement, regulatory science, institutional partnerships, training and career development, and other key translational elements. The CTSA hubs provide unprecedented and timely response to local, regional, and national health crises to address research gaps [Clinical and Translational Science Awards Program, Center for Leading Innovation and Collaboration, Synergy paper request for applications]. This paper describes opportunities for collaborative opioid research at CTSA hubs and NIDA–NCATS opportunities that build capacity for best practices as this crisis evolves. Results of a Landscape Survey (among 63 hubs) are provided with descriptions of best practices and ideas for collaborations, with research conducted by hubs also involved in premier NIDA initiatives. Such collaborations could provide a rapid response to the opioid epidemic while advancing science in multiple disciplinary areas.
Viral pneumonia is an important cause of death and morbidity among infants worldwide. Transmission of non-influenza respiratory viruses in households can inform preventative interventions and has not been well-characterised in South Asia. From April 2011 to April 2012, household members of pregnant women enrolled in a randomised trial of influenza vaccine in rural Nepal were surveyed weekly for respiratory illness until 180 days after birth. Nasal swabs were tested by polymerase chain reaction for respiratory viruses in symptomatic individuals. A transmission event was defined as a secondary case of the same virus within 14 days of initial infection within a household. From 555 households, 825 initial viral illness episodes occurred, resulting in 79 transmission events. The overall incidence of transmission was 1.14 events per 100 person-weeks. Risk of transmission incidence was associated with an index case age 1–4 years (incidence rate ratio (IRR) 2.35; 95% confidence interval (CI) 1.40–3.96), coinfection as initial infection (IRR 1.94; 95% CI 1.05–3.61) and no electricity in household (IRR 2.70; 95% CI 1.41–5.00). Preventive interventions targeting preschool-age children in households in resource-limited settings may decrease the risk of transmission to vulnerable household members, such as young infants.
Little is known about the neural substrates of suicide risk in mood disorders. Improving the identification of biomarkers of suicide risk, as indicated by a history of suicide-related behavior (SB), could lead to more targeted treatments to reduce risk.
Participants were 18 young adults with a mood disorder with a history of SB (as indicated by endorsing a past suicide attempt), 60 with a mood disorder with a history of suicidal ideation (SI) but not SB, 52 with a mood disorder with no history of SI or SB (MD), and 82 healthy comparison participants (HC). Resting-state functional connectivity within and between intrinsic neural networks, including cognitive control network (CCN), salience and emotion network (SEN), and default mode network (DMN), was compared between groups.
Several fronto-parietal regions (k > 57, p < 0.005) were identified in which individuals with SB demonstrated distinct patterns of connectivity within (in the CCN) and across networks (CCN-SEN and CCN-DMN). Connectivity with some of these same regions also distinguished the SB group when participants were re-scanned after 1–4 months. Extracted data defined SB group membership with good accuracy, sensitivity, and specificity (79–88%).
These results suggest that individuals with a history of SB in the context of mood disorders may show reliably distinct patterns of intrinsic network connectivity, even when compared to those with mood disorders without SB. Resting-state fMRI is a promising tool for identifying subtypes of patients with mood disorders who may be at risk for suicidal behavior.
Research participants want to receive results from studies in which they participate. However, health researchers rarely share the results of their studies beyond scientific publication. Little is known about the barriers researchers face in returning study results to participants.
Using a mixed-methods design, health researchers (N = 414) from more than 40 US universities were asked about barriers to providing results to participants. Respondents were recruited from universities with Clinical and Translational Science Award programs and Prevention Research Centers.
Respondents reported the percent of their research where they experienced each of the four barriers to disseminating results to participants: logistical/methodological, financial, systems, and regulatory. A fifth barrier, investigator capacity, emerged from data analysis. Training for research faculty and staff, promotion and tenure incentives, and funding agencies supporting dissemination of results to participants were solutions offered to overcoming barriers.
Study findings add to literature on research dissemination by documenting health researchers’ perceived barriers to sharing study results with participants. Implications for policy and practice suggest that additional resources and training could help reduce dissemination barriers and increase the return of results to participants.
Total vegetation control (TVC) is an essential management practice to eliminate all vegetation for the purpose of protecting infrastructure, people, or natural resources on sites where vegetation poses major fire, visibility, and infrastructure risks. TVC is implemented on sites such as railroads, power substations, airports, roadsides, and oil and gas facilities. Current research has identified that tank-mixing two effective mechanisms of action is a superior resistance management strategy compared to rotating mechanisms of action; however, effective tank mixes for TVC have not been thoroughly evaluated. A field experiment was conducted from 2013 to 2014 at five sites in Colorado to compare 32 treatment combinations to two industry standards for TVC. Research objectives were (1) to identify herbicide tank-mix combinations for TVC with multiple effective mechanisms of action for resistance management, (2) to evaluate lower use rate alternatives to minimize nontarget impacts, and (3) to determine the efficacy of fall versus spring application timings. Seven treatments were identified as top-ranking treatments, averaging 96% bare-ground (BG) across five sites and two application timings. Four out of the seven top-ranked treatments included aminocyclopyrachlor, chlorsulfuron, and indaziflam. The industry standard diuron plus imazapyr was in the top ranking, whereas the other industry standard bromacil plus diuron performed inconsistently across sites. Probability modeling was used to predict the probability of achieving 97% or 100% BG with various treatment combinations. The combination of aminocyclopyrachlor, chlorsulfuron, indaziflam, and imazapyr had the highest predicted BG probability, with 88% predicted probability of achieving 100% BG, compared to 67% and 52% predicted probabilities for the industry standards diuron plus imazapyr and bromacil plus diuron, respectively. In three of the five sites, fall applications outperformed the same treatments applied in the spring. Several top-ranking treatments represent newer, lower use rate herbicide combinations that provide multiple mechanisms of action to manage herbicide-resistant weeds and minimize nontarget impacts.
The occurrence of herbicide tank contamination with dicamba or 2,4-D will likely increase with the recent commercialization of dicamba- and 2,4-D-resistant soybean. High-value sensitive crops, including dry bean, will be at higher risks for exposure. In 2017 and 2018, two separate field experiments were conducted in Michigan to understand how multiple factors may influence dry bean response to dicamba and 2,4-D herbicides, including 1) the interaction between herbicides applied POST to dry bean and dicamba or 2,4-D, and 2) the impact of low rates of glyphosate with dicamba or 2,4-D. Dry bean injury was 20% and 2% from POST applications of dicamba (5.6 h ae ha−1) and 2,4-D (11.2 g ae ha−1), respectively, 14 days after treatment (DAT). The addition of glyphosate (8.4 g ae ha−1) did not increase dry bean injury from dicamba or 2,4-D. Over 2 site-years the addition of dry bean herbicides to dicamba or dicamba + glyphosate (8.4 g ae ha−1) increased dry bean injury and reduced yield by 6% to 10% more than when dicamba or dicamba + glyphosate was applied alone. The interaction between 2,4-D (11.2 g ae ha−1) and dry bean herbicides was determined to be synergistic. However, 2,4-D (11.2 g ae ha−1) had little effect on dry bean with or without the addition of a dry bean herbicide program. These studies document that synergy also occurs between dicamba and dicamba + glyphosate and both common dry bean herbicide programs tested: 1) imazamox (35 g ha−1) + bentazon (560 g ha−1), and 2) fomesafen (280 g ha−1). The synergy between dry bean herbicide and dicamba and dicamba + glyphosate can increase plant injury, delay maturity, and reduce yield to a greater extent than dicamba or dicamba + glyphosate alone. This work emphasizes the need to properly clean out sprayers after applications of dicamba to reduce the risk of exposure to other crops.
Dicamba and 2,4-D exposure to sensitive crops, such as dry bean, is of great concern with the recent registrations of dicamba- and 2,4-D–resistant soybean. In 2017 and 2018, field experiments were conducted at two Michigan locations to understand how multiple factors, including dry bean market class, herbicide rate, and application timing, influence dry bean response to dicamba and 2,4-D. Dicamba and 2,4-D at rates of 0.1%, 1%, and 10% of the field use rate for dicamba and 2,4-D choline were applied to V2 and V8 black and navy bean. Field-use rates for dicamba and 2,4-D choline were 560 and 1,120 g ae ha−1, respectively. There were few differences between market classes or application timings when dry bean was exposed to dicamba or 2,4-D. Estimated rates to cause 20% dry bean injury 14 d after treatment were 4.5 and 107.5 g ae ha−1 for dicamba and 2,4-D, respectively. When dicamba was applied at 56 g ae ha−1, light interception was reduced up to 51% and maturity was delayed up to 16 d. Although both herbicides caused high levels of injury to dry bean, yield reductions were not consistently observed. At four site-years, 2,4-D did not reduce dry bean yield or seed weight with any rate tested. However, when averaged over site-years, dicamba rates of 3.7, 9.8 and 17.9 g ae ha−1 were estimated to cause 5%, 10%, and 15% yield loss, respectively. Dicamba also reduced seed weight by 10% when 56 g ae ha−1 was applied. However, the germination of harvested seed was not affected by dicamba or 2,4-D. Long delays in dry bean maturity from dicamba injury can also indirectly increase losses in yield and quality due to harvestability issues. This work further stresses the need for caution when using dicamba or 2,4-D herbicides near sensitive crops.
Weeds can cause significant yield loss in watermelon production systems. Commercially acceptable weed control is difficult to achieve, even with heavy reliance on herbicides. A study was conducted to evaluate a spring-seeded cereal rye cover crop with different herbicide application timings for weed management between row middles in watermelon production systems. Common lambsquarters and pigweed species (namely, Palmer amaranth and smooth pigweed) densities and biomasses were often lower with cereal rye compared with no cereal rye, regardless of herbicide treatment. The presence of cereal rye did not negatively influence the number of marketable watermelon fruit, but average marketable fruit weight in cereal rye versus no cereal rye treatments varied by location. These results demonstrate that a spring-seeded cereal rye cover crop can help reduce weed density and weed biomass, and potentially enhance overall weed control. Cereal rye alone did not provide full-season weed control, so additional research is needed to determine the best methods to integrate spring cover cropping with other weed management tactics in watermelon for effective, full-season control.