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Elevated levels of pro-inflammatory cytokines are consistently reported in schizophrenia (SZ) and bipolar-I disorder (BD), as well as among individuals who have been exposed to childhood trauma. However, higher levels of inflammatory markers in these disorders are yet to be investigated with respect to levels of exposure to different types of childhood trauma.
Participants were 68 cases with a diagnosis of schizophrenia/schizoaffective disorder (SZ), 69 cases with a diagnosis of psychotic BD and 72 healthy controls (HC). Serum levels of interleukin 6 (IL-6), tumour necrosis factor-α (TNF-α) and C-reactive protein (CRP) were quantified, and childhood trauma exposure was assessed with the Childhood Trauma Questionnaire.
The SZ group had significantly higher levels of IL-6, TNF-α and CRP when compared with the HC group (all p < 0.05, d = 0.41–0.63), as well as higher levels of TNF-α when compared with the BD group (p = 0.014, d = 0.50); there were no differences between the BD and HC groups for any markers. Exposure to sexual abuse was positively associated (standardised β = 0.326, t = 2.459, p = 0.018) with levels of CRP in the SZ group, but there were no significant associations between any form of trauma exposure and cytokine levels in the HC or BD groups.
These results contribute to the evidence for a chronic state of inflammation in SZ but not BD cases. Differential associations between trauma exposure and levels of pro-inflammatory cytokines across the diagnostic categories suggest that trauma may impact biological (stress and immune) systems differently in these patient groups.
Significant ethnic and socio-economic disparities exist in infectious diseases (IDs) rates in New Zealand, so accurate measures of these characteristics are required. This study compared methods of ascribing ethnicity and socio-economic status. Children in the Growing Up in New Zealand longitudinal cohort were ascribed to self-prioritised, total response and single-combined ethnic groups. Socio-economic status was measured using household income, and both census-derived and survey-derived deprivation indices. Rates of ID hospitalisation were compared using linked administrative data. Self-prioritised ethnicity was simplest to use. Total response accounted for mixed ethnicity and allowed overlap between groups. Single-combined ethnicity required aggregation of small groups to maintain power but offered greater detail. Regardless of the method used, Māori and Pacific children, and children in the most socio-economically deprived households had a greater risk of ID hospitalisation. Risk differences between self-prioritised and total response methods were not significant for Māori and Pacific children but single-combined ethnicity revealed a diversity of risk within these groups. Household income was affected by non-random missing data. The census-derived deprivation index offered a high level of completeness with some risk of multicollinearity and concerns regarding the ecological fallacy. The survey-derived index required extra questions but was acceptable to participants and provided individualised data. Based on these results, the use of single-combined ethnicity and an individualised survey-derived index of deprivation are recommended where sample size and data structure allow it.
In Ireland, attention-deficit hyperactivity disorder (ADHD) is the most commonly diagnosed condition in Child and Adolescent Mental Health Services (CAMHS). However, little is known about the experiences of stakeholders affected by ADHD in their pathways through care, especially in Ireland.
The aim of this stakeholder voice study was to explore stress and coping among parents and Children and Young People (C/YP) affected by ADHD in an Irish context, in order to contribute to knowledge about what works and what needs to change in practice from a service user perspective.
In total, 15 C/YP (7–18 years) with ADHD and their parents participated in semi-structured interviews, which were triangulated using other sources (e.g. visual methods), to contribute to a highly contextualised understanding of lived experiences. Transcribed interviews were analysed using a deductive approach to Thematic Analysis informed by a theoretical framework of stress and coping theory and Bronfenbrenner’s bio-ecological model.
Some degree of difficulty in their pathway through care was identified by participants in all case studies. Findings identified barriers to diagnosis, including delays in diagnosis, such as scepticism, stigma, and label avoidance from gatekeepers; poor multiagency working; and misdiagnosis. Once received, diagnosis may serve as an access to empowerment, providing knowledge, understanding, and support. However, C/YP and their parents also reported distressing experiences and a sense of powerlessness within CAMHS and with treatment; such as tensions around medical management, stigma, and a lack of child- and family-centred practice.
Despite the professionals and the systematic supports available, stakeholders did not feel that they were fully understood, listened to, or participants in accessing diagnosis and care planning.
While preparing to write a vision of pig production in the UK, the fragility of crystal ball gazing became apparent, when in February 2001, the nightmare scenario of Foot and Mouth disease broke. The problem appears to have started on a pig farm using swill feed in Northumberland and within weeks, primarily associated with the farmer's failure to report a problem and legal but uncontrolled sheep movement, Foot and Mouth Disease spread throughout the West of England, Wales and the South West of Scotland as well as closing a major slaughterhouse for adult pigs. The disease then spread into continental Europe, causing instant havoc to export markets for the UK and then over the whole of the European Union. Had the problem prevented Denmark from exporting globally for any period, this would have resulted in severe price depression in pig production in Europe. And all this in the year following East Anglia's savaging with Classical Swine Fever.
The Foot and Mouth epidemic in the UK is likely to have a long term impact on the country's export capabilities; already there are threats of five year bans from countries like the United States of America. Much will depend on whether natural wildlife, such as deer, have become infected and how effective we are at finding carrier animals.
Industrial-organizational (I-O) psychology has begun to shed its reputation as a handmaiden to corporate and managerial interests, in part, through its engagement with humanitarian concerns. However, as highlighted by recent commentary, I-O psychology still has a decidedly POSH perspective on the world; that is, it has focused on Professionals who hold Official jobs in a formal economy and who enjoy relative Safety from discrimination while also living in High-income countries. This POSH perspective reflects an underlying bias away from people living in multidimensional poverty. We empirically illustrate some of the connections between a POSH perspective and poverty by reviewing 100 years of research in I-O psychology, and then we make a case for why a neglect of people living in poverty undermines the discipline's science, its practice, and its humanist charge. As moral justification for greater engagement with humanitarian concerns and as a guide to navigate the difficult ethical quandaries involved in doing so, we suggest that I-O psychologists should consider the capability approach. We discuss the concept of human capabilities, relate it to I-O psychology, and demonstrate its utility in the form of three hypothetical scenarios. Perhaps our most controversial claim is that there is a moral imperative for I-O psychology to overrepresent people living in the deepest forms of poverty in both its science and practice.
Taylor Glacier hosts an active englacial hydrologic system that feeds Blood Falls, a supraglacial outflow of iron-rich subglacial brine at the terminus, despite mean annual air temperatures of −17°C and limited surface melt. Taylor Glacier is an outlet glacier of the East Antarctic ice sheet that terminates in Lake Bonney, McMurdo Dry Valleys. To image and map the brine feeding Blood Falls, we used radio echo sounding to delineate a subhorizontal zone of englacial brine upstream from Blood Falls and elongated in the ice flow direction. We estimate volumetric brine content in excess of 13% within 2 m of the central axis of this zone, and likely much higher at its center. Brine content decreases, but remains detectable, up to 45 m away along some transects. Hence, we infer a network of subparallel basal crevasses allowing injection of pressurized subglacial brine into the ice. Subglacial brine is routed towards Blood Falls by hydraulic potential gradients associated with deeply incised supraglacial valleys. The brine remains liquid within the subglacial and englacial environments through latent heat of freezing coupled with elevated salt content. Our findings suggest that cold glaciers could support freshwater hydrologic systems through localized warming by latent heat alone.
Adulthood psychological health predicts labour force activity but few studies have examined childhood psychological health. We hypothesized that childhood psychological ill-health would be associated with labour force exit at 55 years.
Data were from the 55-year follow-up of the National Child Development Study (n = 9137). Labour force participation and exit (unemployment, retirement, permanent sickness, homemaking/other) were self-reported at 55 years. Internalizing and externalizing problems in childhood (7, 11 and 16 years) and malaise in adulthood (23, 33, 42, 50 years) were assessed. Education, social class, periods of unemployment, partnership separations, number of children, and homemaking activity were measured throughout adulthood.
Childhood internalizing and externalizing problems were associated with unemployment, permanent sickness and homemaking/other at 55 years, after adjustment for adulthood psychological health and education: one or two reports of internalizing was associated with increased risk for unemployment [relative risk (RR) 1.59, 95% confidence interval (CI) 1.12–2.25; RR 2.37, 95% CI 1.48–3.79] and permanent sickness (RR 1.32, 95% CI 1.00–1.74; RR, 1.48, 95% CI 1.00–2.17); three reports of externalizing was associated with increased risk for unemployment (RR 2.26, 95% CI 1.01–5.04), permanent sickness (RR 2.63, 95% CI 1.46–4.73) and homemaking/other (RR 1.95, 95% CI 1.00–3.78).
Psychological ill-health across the lifecourse, including during childhood, reduces the likelihood of working in older age. Support for those with mental health problems at different life stages and for those with limited connections to the labour market, including homemakers, is an essential dimension of attempts to extend working lives.
This study proposes a sampling method for ground-truthing LiDAR-derived data that will allow researchers to verify or predict the accuracy of results over a large area. Our case study is focused on a 24 km2 area centered on the site of Yaxnohcah in the Yucatan Peninsula. This area is characterized by a variety of dense tropical rainforest and wetland vegetation zones with limited road and trail access. Twenty-one 100 x 100 m blocks were selected for study, which included examples of several different vegetation zones. A pedestrian survey of transects through the blocks was conducted, recording two types of errors. Type 1 errors consist of cultural features that are identified in the field, but are not seen in the digital elevation model (DEM) or digital surface model (DSM). Type 2 errors consist of features that appear to be cultural when viewed on the DEM or DSM, but are caused by different vegetative features. Concurrently, we conducted an extensive vegetation survey of each block, identifying major species present and heights of stories. The results demonstrate that the lidar survey data are extremely reliable and a sample can be used to assess data accuracy, fidelity, and confidence over a larger area.
Clozapine is the most effective medication for treatment refractory schizophrenia. However, descriptions of the mental health and comorbidity profile and care experiences of people on clozapine in routine clinical settings are scarce. Using data from the 2010 Australian Survey of High Impact Psychosis, we aimed to examine the proportion of people using clozapine, and to compare clozapine users with other antipsychotic users on demographic, mental health, adverse drug reaction, polypharmacy and treatment satisfaction variables.
Data describing 1049 people with a diagnosis of schizophrenia or schizoaffective disorder, who reported taking any antipsychotic medication in the previous 4 weeks, were drawn from a representative Australian survey of people with psychotic disorders in contact with mental health services in the previous 12 months. We compared participants taking clozapine (n = 257, 22.4%) with those taking other antipsychotic medications, on a range of demographic, clinical and treatment-related indicators.
One quarter of participants were on clozapine. Of participants with a chronic course of illness, only one third were on clozapine. After adjusting for diagnosis and illness chronicity, participants taking clozapine had significantly lower odds of current alcohol, cannabis and other drug use despite similar lifetime odds. Metabolic syndrome and diabetes were more common among people taking clozapine; chronic pain was less common. Psychotropic polypharmacy did not differ between groups.
Consistent with international evidence of clozapine underutilisation, a large number of participants with chronic illness and high symptom burden were not taking clozapine. The lower probabilities of current substance use and chronic pain among clozapine users warrant further study.
The disk of the Milky Way galaxy shows evidence for gas-phase abundances which increase with decreasing radius (Simpson et al. 1995; Afflerbach et al. 1997). Sustained star formation in the center of the Milky Way Galaxy may be fueled by inflow of inner disk gas (Serabyn & Morris 1996), suggesting that Galactic Center (GC) stars may be metal-rich. Measurements of stellar abundances in the GC allow us to explore the chemical evolution of our Galaxy's nucleus and to infer its star formation history.
Though the US civilian trauma care system plays a critical role in disaster response, there is currently no systems-based strategy that enables hospital emergency management and local and regional emergency planners to quantify, and potentially prepare for, surges in trauma care demand that accompany mass-casualty disasters.
A proof-of-concept model that estimates the geographic distributions of patients, trauma center resource usage, and mortality rates for varying disaster sizes, in and around the 25 largest US cities, is presented. The model was designed to be scalable, and its inputs can be modified depending on the planning assumptions of different locales and for different types of mass-casualty events.
To demonstrate the model’s potential application to real-life planning scenarios, sample disaster responses for 25 major US cities were investigated using a hybrid of geographic information systems and dynamic simulation-optimization. In each city, a simulated, fast-onset disaster epicenter, such as might occur with a bombing, was located randomly within one mile of its population center. Patients then were assigned and transported, in simulation, via the new model to Level 1, 2, and 3 trauma centers, in and around each city, over a 48-hour period for disaster scenario sizes of 100, 500, 5000, and 10,000 casualties.
Across all 25 cities, total mean mortality rates ranged from 26.3% in the smallest disaster scenario to 41.9% in the largest. Out-of-hospital mortality rates increased (from 21.3% to 38.5%) while in-hospital mortality rates decreased (from 5.0% to 3.4%) as disaster scenario sizes increased. The mean number of trauma centers involved ranged from 3.0 in the smallest disaster scenario to 63.4 in the largest. Cities that were less geographically isolated with more concentrated trauma centers in their surrounding regions had lower total and out-of-hospital mortality rates. The nine US cities listed as being the most likely targets of terrorist attacks involved, on average, more trauma centers and had lower mortality rates compared with the remaining 16 cities.
The disaster response simulation model discussed here may offer insights to emergency planners and health systems in more realistically planning for mass-casualty events. Longer wait and transport times needed to distribute high numbers of patients to distant trauma centers in fast-onset disasters may create predictable increases in mortality and trauma center resource consumption. The results of the modeled scenarios indicate the need for a systems-based approach to trauma care management during disasters, since the local trauma center network was often too small to provide adequate care for the projected patient surge. Simulation of out-of-hospital resources that might be called upon during disasters, as well as guidance in the appropriate execution of mutual aid agreements and prevention of over-response, could be of value to preparedness planners and emergency response leaders. Study assumptions and limitations are discussed.
A Geographic Simulation Model for the Treatment of Trauma Patients in Disasters. Prehosp Disaster Med.2016;31(4):413–421.
We aimed to characterize the geographic distribution of post-Hurricane Sandy emergency department use in administrative flood evacuation zones of New York City.
Using emergency claims data, we identified significant deviations in emergency department use after Hurricane Sandy. Using time-series analysis, we analyzed the frequency of visits for specific conditions and comorbidities to identify medically vulnerable populations who developed acute postdisaster medical needs.
We found statistically significant decreases in overall post-Sandy emergency department use in New York City but increased utilization in the most vulnerable evacuation zone. In addition to dialysis- and ventilator-dependent patients, we identified that patients who were elderly or homeless or who had diabetes, dementia, cardiac conditions, limitations in mobility, or drug dependence were more likely to visit emergency departments after Hurricane Sandy. Furthermore, patients were more likely to develop drug-resistant infections, require isolation, and present for hypothermia, environmental exposures, or administrative reasons.
Our study identified high-risk populations who developed acute medical and social needs in specific geographic areas after Hurricane Sandy. Our findings can inform coherent and targeted responses to disasters. Early identification of medically vulnerable populations can help to map “hot spots” requiring additional medical and social attention and prioritize resources for areas most impacted by disasters. (Disaster Med Public Health Preparedness. 2016;10:351–361)
Intrauterine growth restriction (IUGR) and postnatal catch-up growth confer an increased risk of adult-onset disease. Overnourishment of adolescent ewes generates IUGR in ∼50% of lambs, which subsequently exhibit increased fractional growth rates. We investigated putative epigenetic changes underlying this early postnatal phenotype by quantifying gene-specific methylation at cytosine:guanine (CpG) dinucleotides. Hepatic DNA/RNA was extracted from IUGR [eight male (M)/nine female (F)] and normal birth weight (12 M/9 F) lambs. Polymerase chain reaction was performed using primers targeting CpG islands in 10 genes: insulin, growth hormone, insulin-like growth factor (IGF)1, IGF2, H19, insulin receptor, growth hormone receptor, IGF receptors 1 and 2, and the glucocorticoid receptor. Using pyrosequencing, methylation status was determined by quantifying cytosine:thymine ratios at 57 CpG sites. Messenger RNA (mRNA) expression of IGF system genes and plasma IGF1/insulin were determined. DNA methylation was independent of IUGR status but sexual dimorphism in IGF1 methylation was evident (M<F, P=0.008). IGF1 mRNA:18S and plasma IGF1 were M>F (both P<0.001). IGF1 mRNA expression correlated negatively with IGF1 methylation (r=−0.507, P=0.002) and positively with plasma IGF1 (r=0.884, P<0.001). Carcass and empty body weights were greater in males (P=0.002–0.014) and this gender difference in early body conformation was mirrored by sexual dimorphism in hepatic IGF1 DNA methylation, mRNA expression and plasma IGF1 concentrations.
The effectiveness of practice bundles on reducing ventilator-associated pneumonia (VAP) has been questioned.
To implement a comprehensive program that included a real-time bundle compliance dashboard to improve compliance and reduce ventilator-associated complications.
Before-and-after quasi-experimental study with interrupted time-series analysis.
Academic medical center.
In 2007 a comprehensive institutional ventilator bundle program was developed. To assess bundle compliance and stimulate instant course correction of noncompliant parameters, a real-time computerized dashboard was developed. Program impact in 6 adult intensive care units (ICUs) was assessed. Bundle compliance was noted as an overall cumulative bundle adherence assessment, reflecting the percentage of time all elements were concurrently in compliance for all patients.
The VAP rate in all ICUs combined decreased from 19.5 to 9.2 VAPs per 1,000 ventilator-days following program implementation (P<.001). Bundle compliance significantly increased (Z100 score of 23% in August 2007 to 83% in June 2011 [P<.001]). The implementation resulted in a significant monthly decrease in the overall ICU VAP rate of 3.28/1,000 ventilator-days (95% CI, 2.64–3.92/1,000 ventilator-days). Following the intervention, the VAP rate decreased significantly at a rate of 0.20/1,000 ventilator-days per month (95% CI, 0.14–0.30/1,000 ventilator-days per month). Among all adult ICUs combined, improved bundle compliance was moderately correlated with monthly VAP rate reductions (Pearson correlation coefficient, −0.32).
A prevention program using a real-time bundle adherence dashboard was associated with significant sustained decreases in VAP rates and an increase in bundle compliance among adult ICU patients.
Infect. Control Hosp. Epidemiol. 2015;36(11):1261–1267
Unlike their television counterparts, website fund-raising advertisements designed by international aid agencies do not have to be compressed into short grabs and bites. This means that website technology might be used to convey relatively abstract, situational attributions for poverty, which are known to increase charitable donations. Seventy undergraduates from Australia's Northern Territory University viewed a simulated aid agency website containing varying degrees of textual and visual information about these situational causes of poverty; completed the situational attributions-focused Causes of Third World Poverty Questionnaire (CTWPQ); and reported their intentions to donate money to the simulated aid organisation's poverty relief projects. Consistent with attribution theory, both situational attributions made about poverty and charitable donation intentions were optimised when the website contained an optimal amount of (textual and visual) information on the situational causes of poverty. These preliminary findings suggest how Internet technology can be applied to raise dollar donations, as well as increasing tolerance within diverse regions like the South Pacific.