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Coronavirus disease 2019 (COVID-19) was first recognised in December 2019. The subsequent pandemic has caused 4.3 million deaths and affected the lives of billions. It has increased psychosocial risk factors for mental illness including fear, social isolation and financial insecurity and is likely to lead to an economic recession. COVID-19 is associated with a high rate of neuropsychiatric sequelae. The long-term effects of the pandemic on mental health remain uncertain but could be marked, with some predicting an increased demand for psychiatric services for years to come. COVID-19 has turned a spotlight on mental health for politicians, policy makers and the public and provides an opportunity to make mental health a higher public health priority. We review longstanding reasons for prioritising mental health and the urgency brought by the COVID-19 pandemic, and highlight strategies to improve mental health and reduce the psychiatric fallout of the pandemic.
In-situ transmission electron microscopy (TEM) provides an avenue to explore time-dependent nanoscale material changes induced by a wide range of environmental conditions that govern material performance and degradation. The In-situ Ion Irradiation TEM (I3TEM) at Sandia National Laboratories is a JEOL 2100 microscope that has been highly modified with an array of hardware and software that makes it particularly well suited to explore fundamental mechanisms that arise from coupled extreme conditions. Examples pertaining to multibeam ion irradiation, rapid thermal cycling, and nanomechanical testing on the I3TEM are highlighted, along with prospective advancements in the field of in-situ microscopy.
This 86-year-old right-handed man with a 4-year history of Parkinson disease dementia (PDD) presented for follow-up with his wife, who reported a substantial decline. He was diagnosed with Parkinson disease (PD) five years prior and progressive cognitive impairment emerged three years later. At the visit, she described increasingly frequent episodes of unresponsiveness. These episodes would begin with the patient feeling tired, followed by a period of immobile unresponsiveness associated with glazed eyes lasting up to 10 minutes. The episodes occurred most commonly after eating breakfast. He was admitted to the hospital after one such event and his systolic blood pressure (BP) was reported to be as high as 250 mmHg, and was discharged on three new antihypertensive medications (lisinopril, hydralazine, and metoprolol). After this admission his episodes became more frequent. His wife noticed that having him lie down allowed him to recover promptly from episodes of unresponsiveness. No changes had been made to his levodopa regimen, which continued to be 200 mg three times a day.
This study investigates the use of ‘simple’ glasses, comprising six components, to represent the structure of complex LAW glasses proposed for Immobilized Low Activity Wastes from the Hanford site in the USA. The 18 elements present in ILAW glasses LAW A44, ORP LB2, and LAW A23 were represented by Al2O3, B2O3, CaO, Na2O, SiO2, and ZrO2 according to their coordination chemistry and their roles as network formers and modifiers. The dissolution behavior of each ‘simple’ glass was compared to its corresponding candidate “complex” LAW glass through PCT-B tests. Significant differences were observed; the durability of complex glasses was concluded to be LAW A44 > ORP LB2 ≥ LAW A23 whereas in their simplified versions the order was LAW A44 > LAW A23 > ORP LB2. These results are discussed in relation to compositional differences and highlight the importance of minor glass components in controlling glass durability. The implications of these results for the use of simplified glass compositions are discussed.
The emergence of methyl-ammonium lead halide (MAPbX3) perovskites motivates the identification of unique properties giving rise to exceptional bulk transport properties, and identifying future materials with similar properties. Here, we propose that this “defect tolerance” emerges from fundamental electronic-structure properties, including the orbital character of the conduction and valence band extrema, the charge-carrier effective masses, and the static dielectric constant. We use MaterialsProject.org searches and detailed electronic-structure calculations to demonstrate these properties in other materials than MAPbX3. This framework of materials discovery may be applied more broadly, to accelerate discovery of new semiconductors based on emerging understanding of recent successes.
Clostridium difficile infection (CDI) has been extensively described in healthcare settings; however, risk factors associated with community-acquired (CA) CDI remain uncertain. This study aimed to synthesize the current evidence for an association between commonly prescribed medications and comorbidities with CA-CDI.
A systematic search was conducted in 5 electronic databases for epidemiologic studies that examined the association between the presence of comorbidities and exposure to medications with the risk of CA-CDI. Pooled odds ratios were estimated using 3 meta-analytic methods. Subgroup analyses by location of studies and by life stages were conducted.
Twelve publications (n=56,776 patients) met inclusion criteria. Antimicrobial (odds ratio, 6.18; 95% CI, 3.80–10.04) and corticosteroid (1.81; 1.15–2.84) exposure were associated with increased risk of CA-CDI. Among the comorbidities, inflammatory bowel disease (odds ratio, 3.72; 95% CI, 1.52–9.12), renal failure (2.64; 1.23–5.68), hematologic cancer (1.75; 1.02–5.68), and diabetes mellitus (1.15; 1.05–1.27) were associated with CA-CDI. By location, antimicrobial exposure was associated with a higher risk of CA-CDI in the United States, whereas proton-pump inhibitor exposure was associated with a higher risk in Europe. By life stages, the risk of CA-CDI associated with antimicrobial exposure greatly increased in adults older than 65 years.
Antimicrobial exposure was the strongest risk factor associated with CA-CDI. Further studies are required to investigate the risk of CA-CDI associated with medications commonly prescribed in the community. Patients with diarrhea who have inflammatory bowel disease, renal failure, hematologic cancer, or diabetes are appropriate populations for interventional studies of screening.
We evaluated the behaviors of anesthesiologists during induction and maintenance of anesthesia. Contacts with surfaces occurred a mean (±standard error) of 154.8 ± 7.7 and 60 ± 3.1 times per hour during induction and maintenance, respectively (P < .0001). Hand hygiene events were 1.8 ± 0.27 per hour during induction versus 1.19 ± 0.27 during maintenance (P = .018).
Infect Control Hosp Epidemiol 2014;35(8):1056–1059
Our aim was to compare the return-to-work rates between individuals supported by their GP plus workplace health advisers (intervention group) and those supported by their GP alone.
Workplace sickness absence places a significant cost burden on individuals and the wider economy. Previous research shows better outcomes for individuals if they are supported while still in employment, or have been on sick leave for four weeks or less. Those helped back to work at an early stage are more likely to remain at work. A non-medicalised case-managed approach appears to have the best outcomes and can prevent or reduce the slide onto out-of-work benefits, but UK literature on its effectiveness is sparse.
The design was a feasibility-controlled trial in which participants were sickness absentees, or presentees in employment with work-related health problems. Individuals completed health status measures (SF-36; EQ-5D) and a Job Content Questionnaire at baseline and again at four-month follow-up.
In the intervention group, 29/60 participants completed both phases of the trial. GP practices referred two control patients, and, despite various attempts by the research team, GPs failed to engage with the trial. This finding is of concern, although not unique in primary care research. In earlier studies, GPs reported a lack of knowledge and confidence in dealing with workplace health issues. Despite this, we report interesting findings from the case-managed group, the majority of whom returned to work within a month. Age and length of sickness absence at recruitment were better predictors of return-to-work rates than the number of case-managed contacts. The traditional randomised controlled trial approach was unsuitable for this study. GPs showed low interest in workplace sickness absence, despite their pivotal role in the process. This study informed a larger Department for Work and Pensions study of case-managed support.
Background: With rapid aging, Singapore faces an increasing proportion of the population with age-related dementia. We used system dynamics methodology to estimate the number and proportion of people with mild, moderate, and severe dementia in future years and to examine the impact of changing family composition on their likely living arrangements.
Methods: A system dynamics model was constructed to estimate resident population, drawing birth and mortality rates from census data. We simulate future mild, moderate, and severe dementia prevalence matched with estimates of total dementia prevalence for the Asian region that includes Singapore. Then, integrating a submodel in which family size trends were projected based on fertility rates with tendencies for dependent elderly adults with dementia to live with family members, we estimate likely living arrangements of the future population of individuals with dementia.
Results: Though lower than other previous estimates, our simulation results indicate an increase in the number and proportion of people in Singapore with severe dementia. This and the concurrent decrease in family size point to an increasing number of individuals with dementia unlikely to live at home.
Conclusions: The momenta of demographic and illness trends portend a higher number of individuals with dementia less likely to be cared for at home by family members. Traditions of care for frail elderly found in the diverse cultures of Singapore will be increasingly difficult to sustain, and care options that accommodate these demographic shifts are urgently needed.