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TwinsMX is a national twin registry in Mexico recently created with institutional support from the Universidad Nacional Autónoma de México. It aims to serve as a platform to advance epidemiological and genetic research in the country and to disentangle the genetic and environmental contributions to health and disease in the admixed Mexican population. Here, we describe our recruitment and data collection strategies and discuss both the progress to date and future directions. More information about the registry is available on our website: https://twinsmxofficial.unam.mx/ (content in Spanish).
Introduced species can have strong ecological, social and economic effects on their non-native environment. Introductions of megafaunal species are rare and may contribute to rewilding efforts, but they may also have pronounced socio-ecological effects because of their scale of influence. A recent introduction of the hippopotamus Hippopotamus amphibius into Colombia is a novel introduction of a megaherbivore onto a new continent, and raises questions about the future dynamics of the socio-ecological system into which it has been introduced. Here we synthesize current knowledge about the Colombian hippopotamus population, review the literature on the species to predict potential ecological and socio-economic effects of this introduction, and make recommendations for future study. Hippopotamuses can have high population growth rates (7–11%) and, on the current trajectory, we predict there could be 400–800 individuals in Colombia by 2050. The hippopotamus is an ecosystem engineer that can have profound effects on terrestrial and aquatic environments and could therefore affect the native biodiversity of the Magdalena River basin. Hippopotamuses are also aggressive and may pose a threat to the many inhabitants of the region who rely upon the Magdalena River for their livelihoods, although the species could provide economic benefits through tourism. Further research is needed to quantify the current and future size and distribution of this hippopotamus population and to predict the likely ecological, social and economic effects. This knowledge must be balanced with consideration of social and cultural concerns to develop appropriate management strategies for this novel introduction.
Describe and validate the CHROME (CHemical Restraints avOidance MEthodology) criteria.
Observational prospective longitudinal study.
Single nursing home in Las Palmas de Gran Canaria, Spain.
288 residents; mean age: 81.6 (SD 10.6). 77.4% had dementia.
Multicomponent training and consultancy program to eliminate physical and chemical restraints and promote overall quality care. Clinicians were trained in stringent diagnostic criteria of neuropsychiatric syndromes and adequate psychotropic prescription.
Psychotropic prescription (primary study target), neuropsychiatric syndromes, physical restraints, falls, and emergency room visits were semi-annually collected from December 2015 to December 2017. Results are presented for all residents and for those who had dementia and participated in the five study waves (completer analysis, n=107).
For the study completers, atypical neuroleptic prescription dropped from 42.7% to 18.7%, long half-life benzodiazepines dropped from 25.2% to 6.5%, and hypnotic medications from 47.7% to 12.1% (p<0.0005). Any kind of fall evolved from 67.3 to 32.7 (number of falls by 100 residents per year). Physicians’ diagnostic confidence increased, while the frequency of diagnoses of neuropsychiatric syndromes decreased (p<0.0005).
Implementing the CHROME criteria reduced the prescription of the most dangerous medications in institutionalized people with dementia. Two independent audits found no physical or chemical restraint and confirmed prescription quality of psychotropic drugs. Adequate diagnosis and independent audits appear to be the keys to help and motivate professionals to optimize and reduce the use of psychotropic medication. The CHROME criteria unify, in a single compendium, neuropsychiatric diagnostic criteria, prescription guidelines, independent audit methodology, and minimum legal standards. These criteria can be easily adapted to other countries.
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.
A number of European Union (EU) countries have undertaken thorough reforms in the renewable energy sector over the past years. The regulatory changes have triggered a wave of claims from low-carbon investors asserting that the reforms have diminished or exhausted the economic viability of their investments. Unlike local investors, who typically take legal action before domestic courts, foreign investors have filed arbitration claims in accordance with the Energy Charter Treaty, notably against Spain, Italy, Bulgaria, and the Czech Republic, resulting in several awards of damages. However, recent developments in EU state aid law seem to restrict the ability of investors to obtain compensation. This article argues that such developments may undermine renewable energy policy, because arbitration enhances the regulatory stability and predictability which low-carbon investments require only if arbitral awards can be enforced effectively. The article examines the different scenarios that may arise out of the interplay between EU law and investment arbitration in the EU and concludes that the European Commission's arguable redrawing of the boundaries of state aid rules to encompass investment arbitration, combined with the EU's general quest to replace investment arbitration with alternative mechanisms of adjudication, may jeopardize climate change mitigation policies.
Earthquakes may lead to a reaction to severe stress and adjustment disorders (RSSAD). On September 7, 19, and 23, 2017, Mexico was struck by many severe earthquakes. The aim of this study was to examine whether there was an increase in the number of consultations and RSSAD in a psychiatric emergency department in Mexico City after these earthquakes.
We studied retrospectively the diagnosis and triage assessment from a Mexican psychiatric emergency department database from September 1 to November 30, 2017, and analyzed RSSAD and the number of consultations after the earthquakes.
A total of 1,811 psychiatric emergency consultations were registered from the period of study. A total of 141 consultations represented RSSAD. There was a significant increase of RSSAD after the September 23, 2017, earthquake. The triage assessment revealed that the urgency of the consultations was higher immediately after the earthquakes.
Natural disasters, such as earthquakes, may trigger diverse RSSAD leading to increased emergency consultations, especially when those disasters are repetitive. Mental health professionals should be adequately trained and sensitized for possible acute disaster victims. (Disaster Med Public Health Preparedness. 2019;13:686–690).
Current clinical practice is based on guidelines and local protocols that are informed by clinical evidence. This means that clinical variability is reduced, but can lead to inefficient clinical decision-making, and can increase medical errors, decreasing patient's safety. The aim of the EXCON project is to investigate the innovative concept of Intelligent Clinical History (ICH), and to develop functional prototypes of high added-value in healthcare services.
The innovative EXCON project will take advantage of recent advances in technologies for coding, structuring and semantizing medical information. Thanks to this new structuring, the EXCON platform will be developed. Final users will be health professionals and other decision-makers. Doctors, nurses, epidemiologists and information specialists will be involved in the development and subsequent validation of the platforms.
To develop the ICH platform clinical data on a highly prevalent symptom with high variability in clinical practice, such as non-traumatic chest pain in emergency services, has been collected from different electronic medical record databases. The extraction of clinical data to implement new techniques of artificial intelligence requires tasks that must be automated, which today is difficult and tedious (data is often not computerized). Through techniques applied in EXCON, such as natural language processing, relevant clinical data have been extracted and a Decision Support System has been developed and validated. This tool optimizes resources and improves clinical management, reducing errors and increasing patient's safety.
In coming decades, patient management will be impacted by the application of new advanced data analytics tools. This will allow for safer and more efficient clinical management, decrease variability in clinical practice, and improve equity. That is why the development and assessment of these technologies is necessary.
German palaeontologist Johannes Weigelt (1890–1948) was the first proponent of taphonomy – the study of the decay, burial and fossilization of plants, animals and other organisms across geological time. Thousands of his fossil specimens, many recovered from coal fields in central Germany, are stored within the Geiseltalmuseum – a palaeontological collection at the Martin Luther University Halle-Wittenberg, founded by Weigelt in 1934. A significant portion of Weigelt's papers and extensive photographic production related to his taphonomic research are also within the museum's holdings. Amidst these documents, museum curator Dr Meinholf Hellmund and I discovered over forty photo-collages attributable to Weigelt. This visual essay exposes the through-lines between Weigelt's unpublished collages and his academic activities on taphonomy, suggesting the museum archive as a site of ideological fault lines crossing concomitant artistic and scientific production.
The main aim of this study was to confirm the relationship between executive performance and salivary alpha-amylase (SAA) activity in a sample of 64 healthy children (39 boys), and compare it to the association of SAA output and salivary flow rate (SFR). Executive functioning was assessed via fluency, trail-making, rings and inhibition tasks from the Batería de Evaluación Neuropsicológica de la Función Ejecutiva en Niños [Battery of Neuropsychological Assessment for Executive Function in Children] (ENFEN), merged into an ENFEN total score. SAA activity, output, and SFR were measured at baseline, one minute before, and one minute after the end of a neuropsychological testing session. Our results confirmed a direct, linear and significant association between SAA activity and executive functioning, r(64) = .351, p < .05, and extended it to SAA output, r(64) =.431, p < .05. The mean level of SAA output was the best predictor of executive functioning (β = .431, p < .05) and explained 18.2 % of the variance in ENFEN total score. In sum, and compared to SAA activity, measuring SAA output may be a more precise and indirect marker to assess executive functioning in children.
Obesity and hyperglycaemia contribute to the atherosclerotic process in part through oxidative modifications to lipoprotein particles. The present study aimed to evaluate the effects of a lifestyle intervention on markers of oxidized lipoproteins in obese Latino adolescents with prediabetes.
Participants were enrolled into a 12-week lifestyle intervention. Measurements pre- and post-intervention included anthropometrics and body composition, lipid panel, oxidized LDL (oxLDL), oxidized HDL (oxHDL), intake of fresh fruits and vegetables, and cardiorespiratory fitness.
Thirty-five obese Latino adolescents (seventeen females, eighteen males; mean age 15·5 (sd 1·0) years; mean BMI percentile 98·5 (sd 1·2)) with prediabetes.
Intervention participation resulted in significant reductions in weight (−1·2 %, P = 0·042), BMI and BMI percentile (−2·0 and −0·4 %, respectively, P < 0·001), body fat (−7·0 %, P = 0·025), TAG (−11·8 %, P = 0·032), total cholesterol (−5·0 %, P = 0·002), VLDL-cholesterol (−12·5 %, P = 0·029), and non-HDL-cholesterol (−6·7 %, P = 0·007). Additionally, fitness (6·4 %, P < 0·001) and intake of fruits and vegetables (42·4 %, P = 0·025) increased significantly. OxLDL decreased significantly after the intervention (51·0 (sd 14·0) v. 48·7 (sd 12·8) U/l, P = 0·022), while oxHDL trended towards a significant increase (395·2 (sd 94·6) v. 416·1 (sd 98·4) ng/ml, P = 0·056).
These data support the utility of lifestyle intervention to improve the atherogenic phenotype of Latino adolescents who are at high risk for developing premature CVD and type 2 diabetes.
Bipolar disorder (BD) and schizophrenia (SZ) are characterized by neurocognitive and functional deficits with marked heterogeneity. It has been suggested that BD with a history of psychotic symptoms (BD-P) could constitute a phenotypically homogeneous subtype characterized by greater neurocognitive and functional impairments, or by a distinct trajectory of such deficits. The aim of this study was to compare the neurocognitive and functional course of euthymic BD-P, euthymic BD patients without a history of psychosis (BD-NP), stabilized patients with schizophrenia and healthy subjects, during a five-year follow-up.
Neurocognitive and psychosocial function was examined in 100 euthymic patients with BD (50 BD-P, 50 BD-NP), 50 stabilized patients with schizophrenia (SZ), and 51 healthy controls (HC) at baseline (T1), and after a 5-year follow-up (T2).
The course of both neurocognitive performance and functional outcome of patients with SZ and BD (BD-P and BD-NP) is stable. The profile of neurocognitive impairment of patients with SZ or BD (BD-P and BD-NP), is similar, with only quantitative differences circumscribed to certain domains, such as working memory. The subgroup of patients with BD-NP does not show functional deterioration.
We have not found evidence of progression in the neurocognitive or psychosocial impairment in any of the three groups of patients, although it cannot be dismissed the possibility of a subset of patients with a progressive course. Other longitudinal studies with larger samples and longer duration are necessary to confirm these findings.
To study zooplankton–phytoplankton relationships in the diatom-dominated plankton communities of the northern Adriatic we performed feeding experiments with diatoms and zoea I larvae of the brachyuran Xantho poressa. We found that zoea I of X. poressa feed on diatoms of different forms (centric, pennate, colony forming, single celled, with or without setae) and size classes. In a laboratory setup, we presented the zoeas with a mix of diatom species similar to communities observed during blooms regularly found in the northern Adriatic. We report that the grazing activity resulted in a decrease of the relative abundance of the toxic diatom Pseudo-nitzschia calliantha. For the colonial, bloom-forming diatom Skeletonema marinoi our results show a chain length reduction in the presence of zoea I. Of particular interest is the observation that the presence of larvae also resulted in an increased growth rate and abundance of S. marinoi, which resembles bloom induction by grazer presence.
The neurocognitive trajectory in bipolar disorder (BD) is variable, with controversial findings, and most evidence come from cross-sectional studies. We aimed to examine the course of neurocognitive functioning in a sample of euthymic BD patients in comparison with a control group during a 5-year follow-up.
Ninety-nine euthymic bipolar patients and 40 healthy controls were assessed using a comprehensive neurocognitive battery (six neurocognitive domains) at baseline (T1) and then at 5-year follow-up (T2) in a longitudinal study.
No evidence of a progression in neurocognitive dysfunction was found either in cognitive composite index or in any of the neurocognitive domains for the whole cohort. However, there was a negative correlation between number of manic episodes and hospitalisations due to manic episodes and change in neurocognitive composite index (NCI) during the follow-up. Moreover, patients with higher number of manic and hypomanic episodes have a greater decrease in NCI, working memory and visual memory. History of psychotic symptoms was not related to the trajectory of neurocognitive impairment.
Our results suggest that, although the progression of cognitive decline is not a general rule in BD, BD patients who have a greater number of manic or hypomanic episodes may constitute a subgroup characterised by the progression of neurocognitive impairment. Prevention of manic and hypomanic episodes could have a positive impact on the trajectory of cognitive function.
Cognitive deficits are a core feature of early stages in schizophrenia. However, the extent to which antipsychotic (AP) have a deleterious effect on cognitive performance remains under debate. We aim to investigate whether anticholinergic loadings and dose of AP drugs in first episode of psychosis (FEP) in advanced phase of remission are associated with cognitive impairment and the differences between premorbid intellectual quotient (IQ) subgroups.
Two hundred and sixty-six patients participated. The primary outcomes were cognitive dimensions, dopaminergic/anticholinergic load of AP [in chlorpromazine equivalents (Eq-CPZ) and the Anticholinergic Risk Scale (ARS), respectively].
Impairments in processing speed, verbal memory and global cognition were significantly associated with high Eq-CPZ and verbal impairment with high ARS score. Moreover, this effect was higher in the low IQ subgroup.
Clinicians should be aware of the potential cognitive impairment associated with AP in advanced remission FEP, particularly in lower premorbid IQ patients.
Stereo-electroencephalography (SEEG) has been shown to be a valuable tool for the anatomo-electroclinic definition of the epileptogenic zone (EZ) in some patients with medically refractory epilepsy considered for surgery. In Spain, many of those patients are not offered this diagnostic procedure. The objective of our health technology assessment (HTA) report was to evaluate the effectiveness, safety and cost-effectiveness of SEEG to define the EZ in patients with refractory epilepsy considered for surgery compared to no SEEG intervention (i.e. remaining with further antiepileptic drugs).
We undertook a systematic review with meta-analyses on the effectiveness and safety of SEEG. A cost-effectiveness analysis was conducted using a Markov model which simulates the costs and health outcomes of individuals for a lifetime horizon from the perspective of the Spanish National Health Service (NHS). The effectiveness measure was quality-adjusted life years (QALYs). We ran extensive sensitivity analyses, including a probabilistic sensitivity analysis.
The EZ was found in 92 percent of patients who underwent SEEG, 72 percent were eligible for epilepsy surgery and 33 percent were free of seizures after surgery (47 percent of those who received surgery). Any complications related to insertion and monitoring of SEEG and the subsequent intervention occurred in 1.3 percent of patients. In the base case analysis, SEEG led to higher QALYs and healthcare costs with an estimated incremental cost-effectiveness ratio of EUR 10,368 (USD 12,217) per QALY. The sensitivity analyses showed that the results of the study were robust.
SEEG is a cost-effective technology in patients with refractory epilepsy considered for surgery when compared to no SEEG intervention.
The Bipolar Spectrum Diagnostic Scale (BSDS) is widely validated and used as a screening tool for bipolar disorder. However, there is no BSDS validated version for its use in Mexican population. The aim of the present study was to examine the BSDS diagnostic capacity, and to evaluate its criterion validity and internal consistency for its use in Mexican psychiatric patients. We recruited 200 patients who attended the psychiatric outpatient service of a Mental Health Specialized Hospital and were screened for bipolar disorder using BSDS. To determine the cut-off point, sensitivity and specificity, we used the SCID–I diagnosis as the gold standard in 100 participants with bipolar disorder and 100 with major depression. Internal consistency according to Cronbach’s coefficient alpha was .81. The area under ROC curve for the overall discriminability of BSDS against the criterion of SCID–I for bipolar disorder was .90. Finally, a cut-off value of 12 reached the most stable sensitivity and specificity, with predictive powers higher than .80. In conclusion, the properties of the scale including internal consistency, sensitivity and specificity, make of BSDS a valuable instrument for screening bipolar disorder in Mexican psychiatric population.
The work shows the preparation and characterization of composite materials using a polymer as a matrix (ABS) and carbon black or a graphenic material (graphene or graphene foam). The materials were individually mixed with the polymer and the process parameters were established in an extruder with capacity for temperature control starting at laboratory conditions and up to 600 °C. The process parameters were adjusted to form filaments that were subsequently used in a 3D printer. The parameters of the printing process were adjusted to achieve the production of flat prototypes. These prototypes were characterized by Digital Optical Microscopy. The degree of homogeneity of the prototypes and the working ranges for the graphene material concentrations were determined. Even though the characterizations were done in flat samples, 3D printing allows obtaining a great diversity of structure that broadens the diversity of applications for such kind of composite materials.
OBJECTIVES/SPECIFIC AIMS: Knowing how to deliver culturally responsive care is of increasing importance as the nation’s patient population diversifies. However, unless cultural competence is taught with an emphasis on self-awareness (Wear, 2007) and critical consciousness (Kumagai and Lypson, 2009) learners find this education ineffective (Beagan, 2003). This study examines how physicians perceive their own social identities (eg, race, socio-economic status, gender, sexual orientation, religion, years of experience) and how these self-perceptions influence physician’s understandings of how to practice culturally responsive care. METHODS/STUDY POPULATION: This exploratory study took place at a university in the Intermountain West. We employed a qualitative case study method to investigate how academic physicians think about their identities and approaches to clinical care and research through interviews and observations. In total, 25 participants were enrolled in our study, with efforts to recruit a diverse sample with respect to gender and race as well as years of experience and specialty. Transcriptions of interviews and observations were coded using grounded theory. One major code that emerged was defining experiences: instances where physicians reflected on both personal and professional life encounters that have influenced how they think about themselves, how they understand an aspect of their identity, or why this identity matters. RESULTS/ANTICIPATED RESULTS: Two main themes emerged from an analysis of the codes that show how physicians think about their identities and their approaches to practice. (1) Physicians with nondominant identities (women, non-White) could more easily explain what these identities mean to them than those with dominant identities (men, White). For example, women in medicine had much to say about being a woman in medicine, but men had barely anything to say about being a man in medicine. (2) There was a positive trend between the number of defining experiences a physician encountered in life and the number of connections they made between their identities and the manner in which they practiced, both clinically and academically. It appeared that physicians who have few defining experiences made few connections between identity and practice, those with a moderate number of experiences made a moderate number of connections, and those with many experiences made many connections. Physicians who mentioned having many defining experiences were more likely to be able to articulate how those experiences were incorporated into their approaches to patient care. DISCUSSION/SIGNIFICANCE OF IMPACT: (1) According to literature in multicultural education, those with dominant identities do not think about their identities because they do not have to (Johnson, 2001). One privilege of being part of the majority is not having to think about life from a minority perspective. This helps to explain why women and non-White physicians in this study had more anecdotes to share about these identities—because they have had defining experiences that prompt reflection on these identities. (2) We propose that struggles and conflict are what compel physicians to reflect on their practice (Eva et al., 2012). Our findings suggest that physicians are more prepared to apply what they have learned from their own identity struggles in delivering culturally responsive care when they have had more opportunities to reflect on these identities and situations. Findings from this study have implications for transforming approaches to medical education. We suggest that medical education should provide learners with the opportunity to reflect on their life experience, and that providers may need explicit instruction on how to make connections between their experiences and their practice.
Depression and obesity are highly prevalent, and major impacts on public health frequently co-occur. Recently, we reported that having depression moderates the effect of the FTO gene, suggesting its implication in the association between depression and obesity.
To confirm these findings by investigating the FTO polymorphism rs9939609 in new cohorts, and subsequently in a meta-analysis.
The sample consists of 6902 individuals with depression and 6799 controls from three replication cohorts and two original discovery cohorts. Linear regression models were performed to test for association between rs9939609 and body mass index (BMI), and for the interaction between rs9939609 and depression status for an effect on BMI. Fixed and random effects meta-analyses were performed using METASOFT.
In the replication cohorts, we observed a significant interaction between FTO, BMI and depression with fixed effects meta-analysis (β=0.12, P = 2.7 × 10−4) and with the Han/Eskin random effects method (P = 1.4 × 10−7) but not with traditional random effects (β = 0.1, P = 0.35). When combined with the discovery cohorts, random effects meta-analysis also supports the interaction (β = 0.12, P = 0.027) being highly significant based on the Han/Eskin model (P = 6.9 × 10−8). On average, carriers of the risk allele who have depression have a 2.2% higher BMI for each risk allele, over and above the main effect of FTO.
This meta-analysis provides additional support for a significant interaction between FTO, depression and BMI, indicating that depression increases the effect of FTO on BMI. The findings provide a useful starting point in understanding the biological mechanism involved in the association between obesity and depression.