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A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.
Mental disorders in children and adolescents have an impact on educational attainment.
To examine the temporal association between attainment in education and subsequent diagnosis of depression or self-harm in the teenage years.
General practitioner, hospital and education records of young people in Wales between 1999 and 2014 were linked and analysed using Cox regression.
Linked records were available for 652 903 young people and of these 33 498 (5.1%) developed depression and 15 946 (2.4%) self-harmed after the age of 12 but before the age of 20. Young people who developed depression over the study period were more likely to have achieved key stage 1 (age 7 years) but not key stage 2 (age 11) (hazard ratio (HR) = 0.79, 95% CI 0.74–0.84) milestones, indicating that they were declining in academic attainment during primary school. Conversely, those who self-harmed were achieving as well as those who did not self-harm in primary school, but showed a severe decline in their attainment during secondary school (HR = 0.72, 95% CI 0.68–0.78).
Long-term declining educational attainment in primary and secondary school was associated with development of depression in the teenage years. Self-harm was associated with declining educational attainment during secondary school only. Incorporating information on academic decline with other known risk factors for depression/self-harm (for example stressful life events, parental mental health problems) may improve risk profiling methods.
Benthic habitat composition is a key factor that structures assemblages of coral reef fishes. However, natural and anthropogenic induced disturbances impact this relationship. This study investigates the link between benthic habitat composition and fish functional groups in four countries in the Western Indian Ocean (WIO). Benthic composition of 32 sites was quantified visually from percentage cover of hard and soft corals, rubble, turf, fleshy and crustose coralline algae. At each site, abundance of 12 coral-associated fish functional groups in 50 × 5 m transects was determined. Cluster analysis characterized reefs based on benthic cover and revealed five habitat types (A, B, C, D and E) typified by decreasing cover of hard corals, increasing cover of turf and/or fleshy algae and differences in benthic diversity. Habitat type A was present in all four countries. Other habitats types showed geographic affiliations: notably Comoros sites clustered in either habitats B or E, northern Madagascar had B, C and D type habitats, whereas sites in central Tanzania and northern Mozambique had habitats D and E. Fish functional groups showed significant linkages with some habitat types. The abundances of corallivores, invertivores, detritivores and grazers were higher in habitat B, whereas planktivores and small excavators showed lower abundances in the same habitat. These linkages between benthic habitat types and fish functional groups are important in informing priority reefs that require conservation and management planning.
We present a Holocene radiocarbon chronology of hunter-gatherer occupation based on contemporaneous samples of charcoal and Mytilus californianus shell recovered from 7 archaeological sites near Bodega Bay, California, USA. A series of 127 14C ages reveals a chronological sequence that spans from 8940–110 cal BP (1 σ). This sequence serves as a foundation for the interpretation of behavioral change along the northern California coast over the last 9000 yr, including the adaptive strategies used by human foragers to colonize and inhabit coastal areas of this region. These 14C ages will also permit us to explore major dimensions of temporal change in Holocene ocean conditions (via marine reservoir corrections) and their potential effect on the resources available to ancient hunter-gatherers.
Prenatal maternal depression and a multilocus genetic profile of two susceptibility genes implicated in the stress response were examined in an interaction model predicting negative emotionality in the first 3 years. In 179 mother–infant dyads from the Maternal Adversity, Vulnerability, and Neurodevelopment cohort, prenatal depression (Center for Epidemiologic Studies Depressions Scale) was assessed at 24 to 36 weeks. The multilocus genetic profile score consisted of the number of susceptibility alleles from the serotonin transporter linked polymorphic region gene (5-HTTLPR): no long-rs25531(A) (LA: short/short, short/long-rs25531(G) [LG], or LG/LG] vs. any LA) and the dopamine receptor D4 gene (six to eight repeats vs. two to five repeats). Negative emotionality was extracted from the Infant Behaviour Questionnaire—Revised at 3 and 6 months and the Early Child Behavior Questionnaire at 18 and 36 months. Mixed and confirmatory regression analyses indicated that prenatal depression and the multilocus genetic profile interacted to predict negative emotionality from 3 to 36 months. The results were characterized by a differential susceptibility model at 3 and 6 months and by a diathesis–stress model at 36 months.
We aimed to determine the frequency of qacA/B chlorhexidine tolerance genes and high-level mupirocin resistance among MRSA isolates before and after the introduction of a chlorhexidine (CHG) daily bathing intervention in a surgical intensive care unit (SICU).
Retrospective cohort study (2005–2012)
A large tertiary-care center
Patients admitted to SICU who had MRSA surveillance cultures of the anterior nares
A random sample of banked MRSA anterior nares isolates recovered during (2005) and after (2006–2012) implementation of a daily CHG bathing protocol was examined for qacA/B genes and high-level mupirocin resistance. Staphylococcal cassette chromosome mec (SCCmec) typing was also performed.
Of the 504 randomly selected isolates (63 per year), 36 (7.1%) were qacA/B positive (+) and 35 (6.9%) were mupirocin resistant. Of these, 184 (36.5%) isolates were SCCmec type IV. There was a significant trend for increasing qacA/B (P=.02; highest prevalence, 16.9% in 2009 and 2010) and SCCmec type IV (P<.001; highest prevalence, 52.4% in 2012) during the study period. qacA/B(+) MRSA isolates were more likely to be mupirocin resistant (9 of 36 [25%] qacA/B(+) vs 26 of 468 [5.6%] qacA/B(−); P=.003).
A long-term, daily CHG bathing protocol was associated with a change in the frequency of qacA/B genes in MRSA isolates recovered from the anterior nares over an 8-year period. This change in the frequency of qacA/B genes is most likely due to patients in those years being exposed in prior admissions. Future studies need to further evaluate the implications of universal CHG daily bathing on MRSA qacA/B genes among hospitalized patients.
Disorganized attachment is an important early risk factor for socioemotional problems throughout childhood and into adulthood. Prevailing models of the etiology of disorganized attachment emphasize the role of highly dysfunctional parenting, to the exclusion of complex models examining the interplay of child and parental factors. Decades of research have established that extreme child birth weight may have long-term effects on developmental processes. These effects are typically negative, but this is not always the case. Recent studies have also identified the dopamine D4 receptor (DRD4) as a moderator of childrearing effects on the development of disorganized attachment. However, there are inconsistent findings concerning which variant of the polymorphism (seven-repeat long-form allele or non–seven-repeat short-form allele) is most likely to interact with caregiving in predicting disorganized versus organized attachment. In this study, we examined possible two- and three-way interactions and child DRD4 polymorphisms and birth weight and maternal caregiving at age 6 months in longitudinally predicting attachment disorganization at 36 months. Our sample is from the Maternal Adversity, Vulnerability and Neurodevelopment project, a sample of 650 mother–child dyads. Birth weight was cross-referenced with normative data to calculate birth weight percentile. Infant DRD4 was obtained with buccal swabs and categorized according to the presence of the putative allele seven repeat. Macroanalytic and microanalytic measures of maternal behavior were extracted from a videotaped session of 20 min of nonfeeding interaction followed by a 10-min divided attention maternal task at 6 months. Attachment was assessed at 36 months using the Strange Situation procedure, and categorized into disorganized attachment and others. The results indicated that a main effect for DRD4 and a two-way interaction of birth weight and 6-month maternal attention (frequency of maternal looking away behavior) and sensitivity predicted disorganized attachment in robust logistic regression models adjusted for social demographic covariates. Specifically, children in the midrange of birth weight were more likely to develop a disorganized attachment when exposed to less attentive maternal care. However, the association reversed with extreme birth weight (low and high). The DRD4 seven-repeat allele was associated with less disorganized attachment (protective), while non–seven-repeat children were more likely to be classified as disorganized attachment. The implications for understanding inconsistencies in the literature about which DRD4 genotype is the risk direction are also considered. Suggestions for intervention with families with infants at different levels of biological risk and caregiving risk are also discussed.
While there is increasing recognition among archaeologists of the extent to which non-agricultural societies have managed their terrestrial ecosystems, the traditional management of marine ecosystems has largely been ignored. In this paper, we bring together Indigenous ecological knowledge, coastal geomorphological observations, and archaeological data to document how Northwest Coast First Nations cultivated clams to maintain and increase productivity. We focus on “clam gardens,” walled intertidal terraces constructed to increase bivalve habitat and productivity. Our survey and excavations of clam gardens in four locations in British Columbia provide insights into the ecological and social context, morphology, construction, and first reported ages of these features. These data demonstrate the extent of traditional maricultural systems among coastal First Nations and, coupled with previously collected information on terrestrial management, challenge us to broaden our definition of “forager” as applied to Northwest Coast peoples. This study also highlights the value of combining diverse kinds of knowledge, including archaeological data, to understand the social and ecological contexts of traditional management systems.
Global interest in food policy is emerging in parallel with mounting challenges to the food supply and the rising prevalence of diet-related chronic health conditions. Some of the foundational elements of food policies are agricultural practices, finite resources, as well as economic burdens associated with a growing and ageing population. At the intersection of these interests is the need for policy synchronisation and a better understanding of the dynamics within local, regional and national government decision-making that ultimately affect the wellness of the populous and the safety, quality, affordability and quantity of the food supply. Policies, synchronised or not, need to be implemented and, for the food industry, this has seen a myriad of approaches with respect to condensing complex nutritional information and health claims. These include front and/or back of pack labelling, traffic light systems, etc. but in general there is little uniformity at the more regional and global scales. This translation of the nutritional and health-beneficial messages accompanying specific products to the consumer will undoubtedly be an area of intense activity, and hopefully interaction with policy makers, as the food industry continues to become a more global industry.
Persistence of the soil seed bank requires both dormancy and resistance to seed decay organisms. However, there is little or no information evaluating biochemical responses of dormant weed seeds to pathogens. Wild oat caryopses were incubated with four pathogenic fungal isolates to evaluate the response of the pathogen defense enzyme, polyphenol oxidase (PPO). Caryopsis PPO activity was induced by three Fusarium spp. isolates previously obtained from whole seeds incubated in the field whereas caryopsis PPO activity was decreased by a Pythium isolate. Fusarium avenaceum isolate F.a.1 caused the greatest PPO induction and was studied in more detail. When whole wild oat seeds were incubated on F.a.1, PPO activity was induced in seeds, hulls (lemma and palea), and caryopses. Incubation of whole seeds on F.a.1 gradually induced caryopsis PPO activity over an 8-d period, whereas incubation of caryopses on F.a.1 over a 4-d period caused a greater and more rapid induction of PPO activity. Very little PPO activity could be leached from untreated caryopses, but nearly all of the induced PPO activity in F.a.1-treated caryopses was readily leached when incubated in buffer. In Western blots, both untreated and F.a.1-treated leachates contained a ∼57-kilodalton (kD) protein, putatively the mature and relatively inactive form of PPO. However, lower molecular weight antigenic proteins between ∼52 and ∼25 kD were strongly induced in F.a.1-treated caryopses, with this induction being correlated with the increase in PPO activity. We hypothesize that dormant weed seeds possess biochemical defenses against pathogens and, more specifically, that proteolysis in the presence of fungal pathogens may release an activated form of PPO from the surface of wild oat caryopses and hulls.
Clinical supervision is of growing importance professionally, but instruments to measure its effectiveness are scarce. Based on the observational instrument Teachers' PETS, two complementary levels of outcome measurement were used to analyse supervisory effectiveness, namely momentary time sampling (i.e. a micro-analysis of frequencies) and the more molar “change episodes”. Ten audio-taped sessions of routine (baseline; N = 5) and CBT supervision (N = 5; i.e. the intervention phase) were coded with both measures, to assess their relative sensitivity to this manipulation. Improved supervisee learning was detected during the intervention phase by both measures. However, a retrospective comparison between the data within these change episodes and the accompanying non-episode data indicated that the micro level of analysis provided a more sensitive measure of supervisory effectiveness. Technical and conceptual issues arise.
The study objective was to explore the way in which the expert patients programme (EPP) has been implemented by primary care trusts (PCTs) and to identify key barriers and facilitators to the implementation of this initiative in the National Health Service (NHS). The study forms the first part of a process evaluation to record the development of the EPP in the NHS and to identify the patterns of development which impact on NHS organizations and local community partnerships and networks. This preliminary survey consisted of telephone interviews with the key personnel working in primary care sites where EPP was initially piloted. Forty-six PCT leads (74% of those eligible) and 19 EPP trainers were interviewed (68% of those eligible). Secondary sources of data (such as PCT websites and literature promoting the EPP courses) were also examined. The PCTs’ ability to recruit to EPP courses was considered a key marker of early success which in turn related to wider issues concerning EPP’s position in the PCT’s priorities and the degree to which it was seen or made to link with other agendas and goals. A quarter of the sample had good rates of recruitment, the characteristics associated with these sites included: location in urban areas; early access to voluntary tutors; delegation of administrative responsibilities; networking and sharing resources with other PCTs; use of local newspapers to publicize courses; and active support from health professionals. Problems with recruitment were associated with a reliance on a paper-based strategy; poorly developed links to the broader community and health professionals. The evaluation shows that initial success of a lay-led self-care support programme in the NHS depends on commitment at the level of the PCT boards as well as those directly charged with organizing and delivering pilot training courses. Helping key health professionals understand and engage with the principles and benefits of training in self-care for people with long-term health conditions is likely to impact on the success and future of this programme within the NHS.
To describe the control of multidrug-resistant Acinetobacter baumannii-calcoaceticus (MDRABC) colonization and infection in an intensive care unit (ICU).
An 18-bed ICU in a large tertiary care teaching hospital in London.
After recognition of the outbreak, a range of infection control measures were introduced over several months that were primarily aimed at reducing environmental contamination with the outbreak strain. Strategies included use of a closed tracheal suction system for all patients receiving mechanical ventilation, use of nebulized colistin for patients with evidence of mild to moderate ventilator-associated pneumonia, improved availability of alcohol for hand decontamination, and clearer designation of responsibilities and strategies for cleaning equipment and the environment in the proximity of patients colonized or infected with MDRABC.
The outbreak lasted from June 2001 through November 2002 and involved 136 new cases of MDRABC infection or colonization. The number of newly diagnosed cases per month reached a maximum of 15 in February 2002, and the number of new cases slowly decreased over the next 9 months.
This outbreak was controlled by emphasizing the control of environmental reservoirs and did not require recourse to ward closure or placement of affected patients in isolation.