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The first episode of psychosis is a critical period in the emergence of cardiometabolic risk.
We set out to explore the influence of individual and lifestyle factors on cardiometabolic outcomes in early psychosis.
This was a prospective cohort study of 293 UK adults presenting with first-episode psychosis investigating the influence of sociodemographics, lifestyle (physical activity, sedentary behaviour, nutrition, smoking, alcohol, substance use) and medication on cardiometabolic outcomes over the following 12 months.
Rates of obesity and glucose dysregulation rose from 17.8% and 12%, respectively, at baseline to 23.7% and 23.7% at 1 year. Little change was seen over time in the 76.8% tobacco smoking rate or the quarter who were sedentary for over 10 h daily. We found no association between lifestyle at baseline or type of antipsychotic medication prescribed with either baseline or 1-year cardiometabolic outcomes. Median haemoglobin A1c (HbA1c) rose by 3.3 mmol/mol in participants from Black and minority ethnic (BME) groups, with little change observed in their White counterparts. At 12 months, one-third of those with BME heritage exceeded the threshold for prediabetes (HbA1c >39 mmol/mol).
Unhealthy lifestyle choices are prevalent in early psychosis and cardiometabolic risk worsens over the next year, creating an important window for prevention. We found no evidence, however, that preventative strategies should be preferentially directed based on lifestyle habits. Further work is needed to determine whether clinical strategies should allow for differential patterns of emergence of cardiometabolic risk in people of different ethnicities.
This comprehensive review of the factors that affect the harvesting and preparation of oocytes and the management of embryos will allow practitioners to make evidence-based decisions for successful IVF. The book reviews and re-considers the value of strategies and outcomes in the management of fertility and conception rates, centred on the production of oocytes, and successful development of the embryo. Authored by leading experts in the field, chapters engage with treatments and strategies that affect the production of oocytes and embryos, optimizing outcomes in the management of female fertility, conception rates, and live births. This vital guide covers controlled ovarian hyperstimulation, the role of AMH in determining ovarian reserve, and primary stimulation agents and the use of adjuncts. Integral for all clinicians and embryologists working in reproductive medicine units, readers are provided with evidence-based, comprehensive advice and review of all factors affecting the management of oocytes and the embryo that are vital for successful IVF cycles.
Jumping to conclusions (JTC), which is the proneness to require less information before forming beliefs or making a decision, has been related to formation and maintenance of delusions. Using data from the National Institute of Health Research Biomedical Research Centre Genetics and Psychosis (GAP) case–control study of first-episode psychosis (FEP), we set out to test whether the presence of JTC would predict poor clinical outcome at 4 years.
One-hundred and twenty-three FEP patients were assessed with the Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF) and the probabilistic reasoning ‘Beads’ Task at the time of recruitment. The sample was split into two groups based on the presence of JTC bias. Follow-up data over an average of 4 years were obtained concerning clinical course and outcomes (remission, intervention of police, use of involuntary treatment – the Mental Health Act (MHA) – and inpatient days).
FEP who presented JTC at baseline were more likely during the follow-up period to be detained under the MHA [adjusted OR 15.62, 95% confidence interval (CI) 2.92–83.54, p = 0.001], require intervention by the police (adjusted OR 14.95, 95% CI 2.68–83.34, p = 0.002) and have longer admissions (adjusted IRR = 5.03, 95% CI 1.91–13.24, p = 0.001). These associations were not accounted for by socio-demographic variables, IQ and symptom dimensions.
JTC in FEP is associated with poorer outcome as indicated and defined by more compulsion police intervention and longer periods of admission. Our findings raise the question of whether the implementation of specific interventions to reduce JTC, such as Metacognition Training, may be a useful addition in early psychosis intervention programmes.
This article assesses the sociolinguistic impact and importance of the other articles in this special issue on Paris, considering three main themes that are evoked. First, the contribution of the articles here to the development of work on language variation and change on Hexagonal French within the variationist paradigm. Second, I address what I see as the important contribution made to our understanding of the ‘city’ as a sociolinguistic site. Finally, I focus on ethnicity as a social construct in recent variationist work in cities and consider what the articles here, and in comparison with cities elsewhere, add to our understanding of the impact of immigration on local manifestations of language variability. In each case, I attempt to show how these articles foreground or even problematize these three issues, and provide a prospectus for further research that can address unresolved questions.
Preparing and responding to the needs of children during public health emergencies continues to be challenging. The purpose of this study was to assess the usefulness of a tabletop exercise in initiating pediatric preparedness strategies and assessing the impact of the exercise on participants’ understanding of and confidence in their roles during pediatric public health emergencies.
A tabletop exercise was developed to simulate a public health emergency scenario involving smallpox in a child, with subsequent spread to multiple states. During the exercise, participants discussed and developed communication, collaboration, and medical countermeasure strategies to enhance pediatric public health preparedness. Exercise evaluation was designed to assess participants’ knowledge gained and level of confidence surrounding pediatric public health emergencies.
In total, 22 participants identified over 100 communication and collaboration strategies to promote pediatric public health preparedness during the exercise and found that the most beneficial aspect during the exercise was the partnership between pediatricians and public health officials. Participants’ knowledge and level of confidence surrounding a pediatric public health emergency increased after the exercise.
The tabletop exercise was effective in identifying strategies to improve pediatric public health preparedness as well as enhancing participants’ knowledge and confidence surrounding a potential pediatric public health emergency. (Disaster Med Public Health Preparedness. 2018;12:582–586)
We present a high-resolution Gravity Recovery and Climate Experiment (GRACE) mascon solution for Gulf of Alaska (GOA) glaciers and compare this with in situ glaciological, climate and other remote-sensing observations. Our GRACE solution yields a GOA glacier mass balance of −65 ± 11 Gt a−1 for the period December 2003 to December 2010, with summer balances driving the interannual variability. Between October/November 2003 and October 2009 we obtain a mass balance of −61 ± 11 Gt a−1 from GRACE, which compares well with −65 ± 12 Gt a−1 from ICESat based on hypsometric extrapolation of glacier elevation changes. We find that mean summer (June–August) air temperatures derived from both ground and lower-troposphere temperature records were good predictors of GRACE-derived summer mass balances, capturing 59% and 72% of the summer balance variability respectively. Large mass losses during 2009 were likely due to low early melt season surface albedos, measured by the Moderate Resolution Imaging Spectroradiometer (MODIS) and likely associated with the 31 March 2009 eruption of Mount Redoubt, southwestern Alaska. GRACE data compared well with in situ measurements at Wolverine Glacier (maritime Alaska), but poorly with those at Gulkana Glacier (interior Alaska). We conclude that, although GOA mass estimates from GRACE are robust over the entire domain, further constraints on subregional and seasonal estimates are necessary to improve fidelity to ground observations.
It has been suggested that offspring of parents with bipolar disorder are at increased risk for disruptive mood dysregulation disorder (DMDD), but the specificity of this association has not been established.
We examined the specificity of DMDD to family history by comparing offspring of parents with (a) bipolar disorder, (b) major depressive disorder and (c) a control group with no mood disorders.
We established lifetime diagnosis of DMDD using the Schedule for Affective Disorders and Schizophrenia for School Aged Children for DSM-5 in 180 youth aged 6–18 years, including 58 offspring of parents with bipolar disorder, 82 offspring of parents with major depressive disorder and 40 control offspring.
Diagnostic criteria for DMDD were met in none of the offspring of parents with bipolar disorder, 6 of the offspring of parents with major depressive disorder and none of the control offspring. DMDD diagnosis was significantly associated with family history of major depressive disorder.
Our results suggest that DMDD is not specifically associated with a family history of bipolar disorder and may be associated with parental depression.
Extensive marine terraces along the North Canterbury coast of the South Island of New Zealand record uplift in this tectonically active area. Although the terraces have been studied previously, applications of Quaternary geochronological techniques to the region have been limited. We use infrared-stimulated luminescence (IRSL), amino acid racemization (AAR), and radiocarbon to determine ages of terraces at three locations—Glenafric, Motunau Beach, and Haumuri Bluff. We develop an AAR calibration curve for the mollusk species Tawera spissa from sites of known age, including the sedimentary sequence of the Whanganui Basin. Bayesian model averaging of the results is used to estimate ages of marine shells from the North Canterbury terraces. By using both IRSL and AAR, we are able to confirm ages using two independent dating methods and to identify one IRSL result that is likely in error. We develop new age estimates for the marine terraces of North Canterbury and propose correlations between sites. This terrace chronology differs significantly from most previous studies, highlighting the importance of numerical dating. The most extensive terraces are from marine isotope stages (MISs) 5a and 5c, with partial reoccupation of one terrace during MIS 3, whereas MIS 5e terraces are notably lacking among those dated.