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The Spoon-billed Sandpiper Calidris pygmaea is a ‘Critically Endangered’ migratory shorebird. The species faces an array of threats in its non-breeding range, making conservation intervention essential. However, conservation efforts are reliant on identifying the species’ key stopover and wintering sites. Using Maximum Entropy models, we predicted Spoon-billed Sandpiper distribution across the non-breeding range, using data from recent field surveys and satellite tracking. Model outputs suggest only a limited number of stopover sites are suitable for migrating birds, with sites in the Yellow Sea and on the Jiangsu coast in China highlighted as particularly important. All the previously known core wintering sites were identified by the model including the Ganges-Brahmaputra Delta, Nan Thar Island and the Gulf of Mottama. In addition, the model highlighted sites subsequently found to be occupied, and pinpointed potential new sites meriting investigation, notably on Borneo and Sulawesi, and in parts of India and the Philippines. A comparison between the areas identified as most likely to be occupied and protected areas showed that very few locations are covered by conservation designations. Known sites must be managed for conservation as a priority, and potential new sites should be surveyed as soon as is feasible to assess occupancy status. Site protection should take place in concert with conservation interventions including habitat management, discouraging hunting, and fostering alternative livelihoods.
Coronavirus disease 2019 personal protective equipment has been reported to affect communication in healthcare settings. This study sought to identify those challenges experimentally.
Bamford–Kowal–Bench speech discrimination in noise performance of healthcare workers was tested under simulated background noise conditions from a variety of hospital environments. Candidates were assessed for ability to interpret speech with and without personal protective equipment, with both normal speech and raised voice.
There was a significant difference in speech discrimination scores between normal and personal protective equipment wearing subjects in operating theatre simulated background noise levels (70 dB).
Wearing personal protective equipment can impact communication in healthcare environments. Efforts should be made to remind staff about this burden and to seek alternative communication paradigms, particularly in operating theatre environments.
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.
Introduction: In 2018, Canadian postgraduate specialist Emergency Medicine (EM) programs began implementing a competency-based medical education (CBME) assessment system. To support improvement of this assessment program, we sought to evaluate its short-term educational outcomes nationally and within individual programs. Methods: Program-level data from the 2018 resident cohort were amalgamated and analyzed. The number of Entrustable Professional Activity (EPA) assessments (overall and for each EPA) and the timing of resident promotion through program stages was compared between programs and to the guidelines provided by the national EM specialty committee. Total EPA observations from each program were correlated with the number of EM and pediatric EM rotations. Results: Data from 15 of 17 (88.2%) EM programs containing 9,842 EPA observations from 68 of the 77 (88.3%) Canadian EM specialist residents in the 2018 cohort were analyzed. The average number of EPAs observed per resident in each program varied from 92.5 to 229.6 and correlated strongly with the number of blocks spent on EM and pediatric EM (r = 0.83, p < 0.001). Relative to the guidelines outlined by the specialty committee, residents were promoted later than expected and with fewer EPA observations than suggested. Conclusion: We present a new approach to the amalgamation of national and program-level assessment data. There was demonstrable variation in both EPA-based assessment numbers and promotion timelines between programs and with national guidelines. This evaluation data will inform the revision of local programs and national guidelines and serve as a starting point for further reaching outcome evaluation. This process could be replicated by other national assessment programs.
The primary aim of this chapter is to provide practical, evidence-based information pertinent to the specific detection of anti-sperm antibodies (ASA) in males and females and the assessment of ASA results and their place in fertility evaluation and management.
Atomoxetine, a highly selective noradrenaline reuptake inhibitor, shows efficacy in the treatment of ADHD. Despite evidence that atomoxetine improved inhibitory control in animals and healthy volunteers, studies had yet to explore short-term cognitive effects in patients with ADHD.
The cognitive effects of a single oral dose of atomoxetine (60mg) were evaluated in n=22 adults with DSM-IV ADHD, using a within-subject placebo-controlled double-blind design. Assessment included the stop-signal test and Rapid Visual Information Processing test from the Cambridge Neuropsychological Test Automated Battery (CANTAB). Cardiovascular responses were monitored. Normative cognitive data from 20 healthy volunteers were collected for comparison.
Atomoxetine was associated with shorter stop-signal reaction times (p<0.05) and lower numbers of commission errors (p<0.05) on the sustained attention task in the ADHD patients.
These findings suggest that atomoxetine exerts beneficial effects on aspects of inhibitory control in ADHD, which may belie the efficacy of this medication in the treatment of impulsive features of the disorder. These findings also have potential clinical implications for other impulse dysregulation disorders such as trichotillomania and Tourette's Syndrome.
Negative symptoms have been previously reported during the psychosis prodrome, however our understanding of their relationship with treatment-phase negative symptoms remains unclear.
We report the prevalence of psychosis prodrome onset negative symptoms (PONS) and ascertain whether these predict negative symptoms at first presentation for treatment.
Presence of expressivity or experiential negative symptom domains was established at first presentation for treatment using the Scale for Assessment of Negative Symptoms (SANS) in 373 individuals with a first episode psychosis. PONS were established using the Beiser Scale. The relationship between PONS and negative symptoms at first presentation was ascertained and regression analyses determined the relationship independent of confounding.
PONS prevalence was 50.3% in the schizophrenia spectrum group (n = 155) and 31.2% in the non-schizophrenia spectrum group (n = 218). In the schizophrenia spectrum group, PONS had a significant unadjusted (χ2 = 10.41, P < 0.001) and adjusted (OR = 2.40, 95% CI = 1.11–5.22, P = 0.027) association with first presentation experiential symptoms, however this relationship was not evident in the non-schizophrenia spectrum group. PONS did not predict expressivity symptoms in either diagnostic group.
PONS are common in schizophrenia spectrum diagnoses, and predict experiential symptoms at first presentation. Further prospective research is needed to examine whether negative symptoms commence during the psychosis prodrome.
Predicting transition from clinical high risk (CHR) to first episode psychosis has proven difficult. Assessment of oxidative stress biomarkers and the niacin skin flush response (NSFR) may improve prediction accuracy.
To predict transition to psychosis based on combined clinical and blood biomarker.
To analyse data from patients in placebo group of a 12-week trial of omega-3 fatty acid supplementation in CHR. Transition likelihood ratios (LRs) for baseline historical risks, clinical assessments (PANSS subscales and total, GAF), NSFR and blood markers (nervonic acid, superoxide dismutase, glutathione) were calculated. Variables with the highest positive and lowest negative LRs were included in an odds ratio form of Bayes’ rule transition prediction models. Model accuracy was calculated by area under the receiver operating curves (AUROC) of each model.
1-year transition to psychosis was 28% (n=40). Historical data showed no predictability (sensitivity 30%, specificity 100% (AUROC)=0.688, p=0.085). Clinical assessments alone produced a sensitivity of 30% at a specificity of 95% (AUROC=0.83, p<0.0001). The biomarker panel alone predicted transition with 40% sensitivity and 100% specificity (AUROC=0.73, p=0.03). Combining history and clinical assessment provided no improvement above clinical data alone (sensitivity = 30%, specificity = 100%, AUROC=0.85, p< 0.0001). The combination of history, clinical assessment and biomarkers identified transition with a sensitivity of 60% and specificity of 100% (AUROC=0.87, p< 0.0001).
Probabilistic models combining biomarkers and clinical data are able to target high-risk subgroups within CHR and may help to personalise treatment.
Impaired insight is commonly seen in psychosis and some studies have proposed that is a biologically based deficit. Support for this view comes from the excess of neurological soft signs (NSS) observed in patients with psychoses and their neural correlates which demonstrate a degree of overlap with the regions of interest implicated in neuroimaging studies of insight. The aim was to examine the relationship between NSS and insight in a sample of 241 first-episode psychosis patients.
Total scores and subscale scores from three insight measures and two NSS scales were correlated in addition to factors representing overall insight and NSS which we created using principal component analysis.
There were only four significant associations when we controlled for symptoms. “Softer” Condensed Neurological Evaluation (CNE) signs were associated with our overall insight factor (r = 0.19, P = 0.02), with total Birchwood (r = −0.24, P<0.01), and the Birchwood subscales; recognition of mental illness (r = −0.24, P<0.01) and need for treatment (r = −0.18, P = 0.02). Total Neurological Evaluation Scale (NES) and recognition of the achieved effects of medication were also weakly correlated (r = 0.14, P = 0.04).
This study does not support a direct link between neurological dysfunction and insight in psychosis. Our understanding of insight as a concept remains in its infancy.
Anorexia nervosa (AN) is the most severe in terms of morbidity psychiatric illness with the highest mortality rate increased by 23 fold. Treatments are limited effectiveness. AN has a strong genetic component with heritability at 70% but despite ∼ 200 studies no major gene was identified. Epigenetics, such as DNA methylation, is another component of heritability that could explain the high heritability. Methylation is poorly studied in AN from small samples, and is focused on few candidate genes among publications. Under publication, a first genome-wide methylation study investigated 10 restrictive type AN patients, 19 binging/purging type of AN patients and 15 normal eaters using DNAs from whole blood (Booij, 2015). Of the 480K CpG sites that can be methylated of Infinium Human Methylation450 BeadChip Kit, authors focused on 24,000 sites located close to genes and they identified candidate genes with a different profile of methylation between AN and controls.
Our work is to replicate the results of Booji and also to investigate the AN remitters.
Our goal is to identify epigenetic signatures of the AN disorder and the prognostic of remission.
Twenty-four AN patients, 24 AN remitters will be compared to 48 healthy control women for methylation using the Infinium Human Methylation450.
As Booji et al., we will compare methylation for 24,000 sites located close to genes for 24 AN, 24 remitters and 48 controls.
We expected to replicate the published results of Booji and to identify genes with a methylation signature specific of the AN remission.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
This paper provides an up-to-date review of the problems related to the generation, detection and mitigation of strong electromagnetic pulses created in the interaction of high-power, high-energy laser pulses with different types of solid targets. It includes new experimental data obtained independently at several international laboratories. The mechanisms of electromagnetic field generation are analyzed and considered as a function of the intensity and the spectral range of emissions they produce. The major emphasis is put on the GHz frequency domain, which is the most damaging for electronics and may have important applications. The physics of electromagnetic emissions in other spectral domains, in particular THz and MHz, is also discussed. The theoretical models and numerical simulations are compared with the results of experimental measurements, with special attention to the methodology of measurements and complementary diagnostics. Understanding the underlying physical processes is the basis for developing techniques to mitigate the electromagnetic threat and to harness electromagnetic emissions, which may have promising applications.
A developing application of laser-driven currents is the generation of magnetic fields of picosecond–nanosecond duration with magnitudes exceeding
. Single-loop and helical coil targets can direct laser-driven discharge currents along wires to generate spatially uniform, quasi-static magnetic fields on the millimetre scale. Here, we present proton deflectometry across two axes of a single-loop coil ranging from 1 to 2 mm in diameter. Comparison with proton tracking simulations shows that measured magnetic fields are the result of kiloampere currents in the coil and electric charges distributed around the coil target. Using this dual-axis platform for proton deflectometry, robust measurements can be made of the evolution of magnetic fields in a capacitor coil target.
Ices of various compositions and in various phases and combinations with one another are found on planetary surfaces through remote sensing techniques, of which optical spectroscopy is the most powerful and diagnostic. Ices also are found in combination with minerals and organic materials; some complex organic materials are the result of energetic processing of ices, while some may represent organic matter from other sources. Remote spectroscopic observations from Earth-based telescopes and planetary probes are usually interpreted with the aid of radiative transfer models that account for the compositions, particle properties, mixing configurations and other parameters relevant to the materials under consideration. This chapter reviews the spectroscopic character of planetary ices in pure states and in combinations with one another, and with minerals and organic solid materials found by remote sensing techniques and by the analysis of analog materials, both naturally occurring and synthesized in the laboratory and thus available for analytical studies.
The Cassini Visual Infrared Mapping Spectrometer (VIMS) spans a wavelength range of 0.34 to 5.2 µm. Executing numerous close targeted flybys of the major moons of Saturn, as well as serendipitous flybys of the smaller moons, VIMS gathered millions of spectra of these bodies during its 13-year mission, some at spatial resolutions of a few hundred meters. The surfaces of the inner moons are dominated by water ice, while Iapetus, Hyperion, and Titan have substantial amounts of dark materials, including hydrocarbons, on their surfaces. Phoebe is grayer in color in the visible than Saturn’s other low-albedo moons. The surfaces of the inner small moons are also dominated by water ice, and they share compositional similarities to the main rings. The optical properties of the main moons are affected by particles from Saturn’s rings: the inner moons are coated by the E-ring, which originates from cryoactivity on Enceladus, while Iapetus and Hyperion are coated by particles from the Phoebe ring. Cassini VIMS detected previously unknown volatiles and organics on these moons, including CO2, H2, organic molecules as complex as aromatic hydrocarbons, nano-iron, and nano-iron oxides.
Visible and near-infrared reflectance spectroscopy using reflected sunlight is an ideal tool for remote detection of many compounds. Surfaces can be measured in the field at close range (mm), or from a distance with aircraft or spacecraft. The technology works throughout the Solar System. Advancements have recently been made in sensor calibration and atmospheric correction, enabling faster and more accurate calibration to surface reflectance (or apparent surface reflectance). Parallel to these advancements have been advancements in radiative transfer models, including a better understanding of the scattering effects of submicrometer particles and the ability to model those effects. There has also been progress in spectral analysis, including methods to rapidly analyze imaging spectrometer data to identify and map hundreds of compounds. Finally, with the advancements in computer technology, both in compute speed and in storage, analysis of very large imaging spectrometer data sets is now feasible in a relatively short time. With some additional development, imaging spectroscopy could be used in real time or near real time applications, including exploration of resources to autonomous robots such as spacecraft rovers searching for resources or life on remote planets and satellites.
Positive symptoms are a useful predictor of aggression in schizophrenia. Although a similar pattern of abnormal brain structures related to both positive symptoms and aggression has been reported, this observation has not yet been confirmed in a single sample.
To study the association between positive symptoms and aggression in schizophrenia on a neurobiological level, a prospective meta-analytic approach was employed to analyze harmonized structural neuroimaging data from 10 research centers worldwide. We analyzed brain MRI scans from 902 individuals with a primary diagnosis of schizophrenia and 952 healthy controls.
The result identified a widespread cortical thickness reduction in schizophrenia compared to their controls. Two separate meta-regression analyses revealed that a common pattern of reduced cortical gray matter thickness within the left lateral temporal lobe and right midcingulate cortex was significantly associated with both positive symptoms and aggression.
These findings suggested that positive symptoms such as formal thought disorder and auditory misperception, combined with cognitive impairments reflecting difficulties in deploying an adaptive control toward perceived threats, could escalate the likelihood of aggression in schizophrenia.
The most frequently asked questions about Chlamydia trachomatis, commonly known as “chlamydia,” are (1) what is it? and (2) where did it come from? The capricious and cryptic nature of genital infections caused by C. trachomatis and the difficulties in isolating the pathogen have led to many misconceptions about its origins and how infection occurs. The first question is now easy to answer. There is no doubt: chlamydiae are not viruses, nor are they protozoan parasites; they are bacteria. However, they are not free-living bacteria and so cannot be cultivated on conventional media such as agar plates. Chlamydiae are highly specialized bacteria, which can be grown only within living cells; thus they are obligate intracellular pathogens.
Chlamydiae also have a complex developmental cycle. The name is derived from Chlamydozoa, which means “cloaked organisms,” because they develop within an inclusion membrane within the cytoplasm of the cell and initially in the infection process are not visible. These gram-negative bacteria have a unique development cycle that includes the repeated division of a replicating stage, called an RB, or reticulate body. RBs increase in number to a point where they can be seen under the microscope as moving specks within a defined membrane structure known as an inclusion in the host cell's cytoplasm. With time the inclusion ruptures out of the cell and releases the smaller nonreplicating infectious forms called “elementary bodies.”
The genus is also known as Chlamydia; it is a proper noun written in italics, with no plural. The genus Chlamydia currently contains nine species and no doubt, more will be added. The species C. trachomatis, the focus of our discussion, is made up of a number of serovars, differentiated by surface antigens that induce specific antibodies. It has four ocular serovars that cause blinding endemic trachoma, A, B, Ba, and C and at least eight serovars, D to K, which typically cause genital tract infections. There are additionally the three L serovars that cause the condition known as lymphogranuloma venerum. Closely related species are C. muridarum, which infects mice and hamsters, and C. suis, which is endemic in pigs.
We determined how pasture and grazing management practices affected the number of days hay was fed to cattle by season. Data were collected from a survey of Tennessee cattle producers. Days of cattle on hay varied across seasons because of variations in forage production and weather. The number of days hay was fed to cattle varied with pasture-animal management practices such as rotating pastures, forage mixtures, and weed management strategies. Having mixtures of cool- and warm-season grasses reduced the number of days on hay in the winter, spring, and summer months indicating benefits from diversified forages.
Introduction: Hypotension is known to be associated with increased mortality in severe traumatic brain injury (TBI) patients. Systolic blood pressure (SBP) of <90 mmHg is the threshold for hypotension in consensus TBI treatment guidelines; however, evidence suggests hypotension should be defined at higher levels for these patients. Our objective was to determine the influence of hypotension on mortality in TBI patients requiring ICU admission using different thresholds of SBP on arrival at the emergency department (ED). Methods: Retrospective cohort study of patients with severe TBI (Abbreviated Injury Scale Head score ≥3) admitted to ICU at the QEII Health Sciences Centre (Halifax, Canada) between 2002 and 2013. Patients were grouped by SBP on ED arrival ( <90 mmHg, <100 mmHg, <110 mmHg). We performed multiple logistic regression analysis with mortality as the dependent variable. Models were adjusted for confounders including age, gender, Injury Severity Score (ISS), injury mechanism, and trauma team activation (TTA). Results: A total of 1233 patients sustained a severe TBI and were admitted to the ICU during the study period. The mean age was 43.4 ± 23.9 years and most patients were male (919/1233; 74.5%). The most common mechanism of injury was motor vehicle collision (491/1233; 41.2%) followed by falls (427/1233; 35.8%). Mean length of stay in the ICU was 6.1 ± 6.4 days, and the overall mortality rate was 22.7%. SBP on arrival was available for 1182 patients. The <90 mmHg group had 4.6% (54/1182) of these patients; mean ISS was 20.6 ± 7.8 and mortality was 40.7% (22/54). The <100 mmHg had 9.3% (110/1182) of patients; mean ISS was 19.3 ± 7.9 and mortality was 34.5% (38/110). The <110 mmHg group had 16.8% (198/1182) of patients; mean ISS was 17.9 ± 8.0 and mortality was 28.8% (57/198). After adjusting for confounders, the association between hypotension and mortality was 2.22 (95% CI 1.19-4.16) using a <90 mmHg cutoff, 1.79 (95% CI 1.12-2.86) using a <100 mmHg cutoff, and 1.50 (95% CI 1.02-2.21) using a <110 mmHg cutoff. Conclusion: While we found that TBI patients with a SBP <90 mmHg were over 2 times more likely to die, patients with an SBP <110 mmHg on ED arrival were still 1.5 times more likely to die from their injuries compared to patients without hypotension. These results suggest that establishing a higher threshold for clinically meaningful hypotension in TBI patients is warranted.