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Despite knowing for many decades that depressive psychopathology is common in first-episode schizophrenia spectrum disorders (FES), there is limited knowledge regarding the extent and nature of such psychopathology (degree of comorbidity, caseness, severity) and its demographic, clinical, functional and treatment correlates. This study aimed to determine the pooled prevalence of depressive disorder and caseness, and the pooled mean severity of depressive symptoms, as well as the demographic, illness, functional and treatment correlates of depressive psychopathology in FES.
This systematic review, meta-analysis and meta-regression was prospectively registered (CRD42018084856) and conducted in accordance with PRISMA and MOOSE guidelines.
Forty studies comprising 4041 participants were included. The pooled prevalence of depressive disorder and caseness was 26.0% (seven samples, N = 855, 95% CI 22.1–30.3) and 43.9% (11 samples, N = 1312, 95% CI 30.3–58.4), respectively. The pooled mean percentage of maximum depressive symptom severity was 25.1 (38 samples, N = 3180, 95% CI 21.49–28.68). Correlates of depressive psychopathology were also found.
At least one-quarter of individuals with FES will experience, and therefore require treatment for, a full-threshold depressive disorder. Nearly half will experience levels of depressive symptoms that are severe enough to warrant diagnostic investigation and therefore clinical intervention – regardless of whether they actually fulfil diagnostic criteria for a depressive disorder. Depressive psychopathology is prominent in FES, manifesting not only as superimposed comorbidity, but also as an inextricable symptom domain.
Objectives: Research has shown that analyzing intrusion errors generated on verbal learning and memory measures is helpful for distinguishing between the memory disorders associated with Alzheimer’s disease (AD) and other neurological disorders, including Huntington’s disease (HD). Moreover, preliminary evidence suggests that certain clinical populations may be prone to exhibit different types of intrusion errors. Methods: We examined the prevalence of two new California Verbal Learning Test-3 (CVLT-3) intrusion subtypes – across-trial novel intrusions and across/within trial repeated intrusions – in individuals with AD or HD. We hypothesized that the encoding/storage impairment associated with medial-temporal involvement in AD would result in a greater number of novel intrusions on the delayed recall trials of the CVLT-3, whereas the executive dysfunction associated with subcortical-frontal involvement in HD would result in a greater number of repeated intrusions across trials. Results: The AD group generated significantly more across-trial novel intrusions than across/within trial repeated intrusions on the delayed cued-recall trials, whereas the HD group showed the opposite pattern on the delayed free-recall trials. Conclusions: These new intrusion subtypes, combined with traditional memory analyses (e.g., recall versus recognition performance), promise to enhance our ability to distinguish between the memory disorders associated with primarily medial-temporal versus subcortical-frontal involvement.
Unlike for many other respiratory infections, the seasonality of pertussis is not well understood. While evidence of seasonal fluctuations in pertussis incidence has been noted in some countries, there have been conflicting findings including in the context of Australia. We investigated this issue by analysing the seasonality of pertussis notifications in Australia using monthly data from January 1991 to December 2016. Data were made available for all states and territories in Australia except for the Australian Capital Territory and were stratified into age groups. Using a time-series decomposition approach, we formulated a generalised additive model where seasonality is expressed using cosinor terms to estimate the amplitude and peak timing of pertussis notifications in Australia. We also compared these characteristics across different jurisdictions and age groups. We found evidence that pertussis notifications exhibit seasonality, with peaks observed during the spring and summer months (November–January) in Australia and across different states and territories. During peak months, notifications are expected to increase by about 15% compared with the yearly average. Peak notifications for children <5 years occurred 1–2 months later than the general population, which provides support to the theory that older household members remain an important source of pertussis infection for younger children. In addition, our results provide a more comprehensive spatial picture of seasonality in Australia, a feature lacking in previous studies. Finally, our findings suggest that seasonal forcing may be useful to consider in future population transmission models of pertussis.
Accurately dating when people first colonized new areas is vital for understanding the pace of past cultural and environmental changes, including questions of mobility, human impacts and human responses to climate change. Establishing effective chronologies of these events requires the synthesis of multiple radiocarbon (14C) dates. Various “chronometric hygiene” protocols have been used to refine 14C dating of island colonization, but they can discard up to 95% of available 14C dates leaving very small datasets for further analysis. Despite their foundation in sound theory, without independent tests we cannot know if these protocols are apt, too strict or too lax. In Iceland, an ice core-dated tephrochronology of the archaeology of first settlement enables us to evaluate the accuracy of 14C chronologies. This approach demonstrated that the inclusion of a wider range of 14C samples in Bayesian models improves the precision, but does not affect the model outcome. Therefore, based on our assessments, we advocate a new protocol that works with a much wider range of samples and where outlying 14C dates are systematically disqualified using Bayesian Outlier Models. We show that this approach can produce robust termini ante quos for colonization events and may be usefully applied elsewhere.
A point-prevalence study of antimicrobial use among inpatients at 5 public hospitals in Sri Lanka revealed that 54.6% were receiving antimicrobials: 43.1% in medical wards, 68.0% in surgical wards, and 97.6% in intensive care wards. Amoxicillin-clavulanate was most commonly used for major indications. Among patients receiving antimicrobials, 31.0% received potentially inappropriate therapy.
Hospital environmental surfaces are frequently contaminated by microorganisms. However, the causal mechanism of bacterial contamination of the environment as a source of transmission is still debated. This prospective study was performed to characterize the nature of multidrug-resistant organism (MDRO) transmission between the environment and patients using standard microbiological and molecular techniques.
Prospective cohort study at 2 academic medical centers.
A prospective multicenter study to characterize the nature of bacterial transfer events between patients and environmental surfaces in rooms that previously housed patients with 1 of 4 ‘marker’ MDROs: methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Clostridium difficile, and MDR Acinetobacter baumannii. Environmental and patient microbiological samples were obtained on admission into a freshly disinfected inpatient room. Repeat samples from room surfaces and patients were taken on days 3 and 7 and each week the patient stayed in the same room. The bacterial identity, antibiotic susceptibility, and molecular sequences were compared between organisms found in the environment samples and patient sources.
We enrolled 80 patient–room admissions; 9 of these patients (11.3%) were asymptomatically colonized with MDROs at study entry. Hospital room surfaces were contaminated with MDROs despite terminal disinfection in 44 cases (55%). Microbiological Bacterial Transfer events either to the patient, the environment, or both occurred in 12 patient encounters (18.5%) from the microbiologically evaluable cohort.
Microbiological Bacterial Transfer events between patients and the environment were observed in 18.5% of patient encounters and occurred early in the admission. This study suggests that research on prevention methods beyond the standard practice of room disinfection at the end of a patient’s stay is needed to better prevent acquisition of MDROs through the environment.
During the summer of 2016, the Hawaii Department of Health responded to the second-largest domestic foodborne hepatitis A virus (HAV) outbreak in the post-vaccine era. The epidemiological investigation included case finding and investigation, sequencing of RNA positive clinical specimens, product trace-back and virologic testing and sequencing of HAV RNA from the product. Additionally, an online survey open to all Hawaii residents was conducted to estimate baseline commercial food consumption. We identified 292 confirmed HAV cases, of whom 11 (4%) were possible secondary cases. Seventy-four (25%) were hospitalised and there were two deaths. Among all cases, 94% reported eating at Oahu or Kauai Island branches of Restaurant Chain A, with 86% of those cases reporting raw scallop consumption. In contrast, a food consumption survey conducted during the outbreak indicated 25% of Oahu residents patronised Restaurant Chain A in the 7 weeks before the survey. Product trace-back revealed a single distributor that supplied scallops imported from the Philippines to Restaurant Chain A. Recovery, amplification and sequence comparison of HAV recovered from scallops revealed viral sequences matching those from case-patients. Removal of product from implicated restaurants and vaccination of those potentially exposed led to the cessation of the outbreak. This outbreak further highlights the need for improved imported food safety.
The role that vitamin D plays in pulmonary function remains uncertain. Epidemiological studies reported mixed findings for serum 25-hydroxyvitamin D (25(OH)D)–pulmonary function association. We conducted the largest cross-sectional meta-analysis of the 25(OH)D–pulmonary function association to date, based on nine European ancestry (EA) cohorts (n 22 838) and five African ancestry (AA) cohorts (n 4290) in the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium. Data were analysed using linear models by cohort and ancestry. Effect modification by smoking status (current/former/never) was tested. Results were combined using fixed-effects meta-analysis. Mean serum 25(OH)D was 68 (sd 29) nmol/l for EA and 49 (sd 21) nmol/l for AA. For each 1 nmol/l higher 25(OH)D, forced expiratory volume in the 1st second (FEV1) was higher by 1·1 ml in EA (95 % CI 0·9, 1·3; P<0·0001) and 1·8 ml (95 % CI 1·1, 2·5; P<0·0001) in AA (Prace difference=0·06), and forced vital capacity (FVC) was higher by 1·3 ml in EA (95 % CI 1·0, 1·6; P<0·0001) and 1·5 ml (95 % CI 0·8, 2·3; P=0·0001) in AA (Prace difference=0·56). Among EA, the 25(OH)D–FVC association was stronger in smokers: per 1 nmol/l higher 25(OH)D, FVC was higher by 1·7 ml (95 % CI 1·1, 2·3) for current smokers and 1·7 ml (95 % CI 1·2, 2·1) for former smokers, compared with 0·8 ml (95 % CI 0·4, 1·2) for never smokers. In summary, the 25(OH)D associations with FEV1 and FVC were positive in both ancestries. In EA, a stronger association was observed for smokers compared with never smokers, which supports the importance of vitamin D in vulnerable populations.
Psychosocial disability affects a number of individuals with psychosis and often begins years before the formal onset of disorder. This suggests that for many, their psychosocial disability is enduring, and targeted interventions are therefore needed earlier in their developmental trajectories to ensure that psychosocial disability does not become entrenched. Poor psychosocial functioning also affects individuals with a range of different emerging mental health problems, putting these young people at risk of long-term social marginalisation and economic disadvantage; all of which are known risk factors for the development of psychosis. Identification of the markers of poor psychosocial functioning will help to inform effective treatments. This editorial will discern the early trajectories and markers of poor psychosocial outcome in psychosis, and highlight which individuals are most at risk of having a poor outcome. This editorial will also discuss whether early interventions are currently being targeted appropriately and will propose how intervention and preventative strategies can be implemented, to restore psychosocial trajectories in a way that enables young people to maximise their life chances.
Objectives: The third edition of the California Verbal Learning Test (CVLT-3) includes a new index termed List A versus Novel/Unrelated recognition discriminability (RD) on the Yes/No Recognition trial. Whereas the Total RD index incorporates false positive (FP) errors associated with all distractors (including List B and semantically related items), the new List A versus Novel/Unrelated RD index incorporates only FP errors associated with novel, semantically unrelated distractors. Thus, in minimizing levels of source and semantic interference, the List A versus Novel/Unrelated RD index may yield purer assessments of yes/no recognition memory independent of vulnerability to source memory difficulties or semantic confusion, both of which are often seen in individuals with primarily frontal-system dysfunction (e.g., early Huntington’s disease [HD]). Methods: We compared the performance of individuals with Alzheimer’s disease (AD) and HD in mild and moderate stages of dementia on CVLT-3 indices of Total RD and List A versus Novel/Unrelated RD. Results: Although AD and HD subgroups exhibited deficits on both RD indices relative to healthy comparison groups, those with HD generally outperformed those with AD, and group differences were more robust on List A versus Novel/Unrelated RD than on Total RD. Conclusions: Our findings highlight the clinical utility of the new CVLT-3 List A versus Novel/Unrelated RD index, which (a) maximally assesses yes/no recognition memory independent of source and semantic interference; and (b) provides a greater differentiation between individuals whose memory disorder is primarily at the encoding/storage level (e.g., as in AD) versus at the retrieval level (e.g., as in early HD). (JINS, 2018, 24, 833–841)
Adolescence is a critical time point in the lifecourse. LifeLab is an educational intervention engaging adolescents in understanding Developmental Origins of Health and Disease (DOHaD) concepts and the impact of the early life environment on future health, benefitting both their long-term health and that of the next generation. We aimed to assess whether engaging adolescents with DOHaD concepts improves scientific literacy and whether engagement alone improves health behaviours.
Six schools were randomized, three to intervention and three to control. Outcome measures were changed in knowledge, and intended and actual behaviour in relation to diet and lifestyle. A total of 333 students completed baseline and follow-up questionnaires. At 12 months, intervention students showed greater understanding of DOHaD concepts. No sustained changes in behaviours were identified.
Adolescents’ engagement with DOHaD concepts can be improved and maintained over 12 months. Such engagement does not itself translate into behaviour change. The intervention has consequently been revised to include additional components beyond engagement alone.
It has been suggested that cattle have a greater ability to digest fibrous feeds and a lower ability to digest non-fibrous feeds than sheep (Mc Donald et al., 1995). This statement applies mainly to forages and few direct comparisons have been conducted using concentrate ingredients. The digestibility of concentrate ingredients may be influenced by the level of consumption since an increase in intake of a complete diet resulted in a decrease in digestibility (El Khidir and Vestergaard Thomsen, 1983). The aims of this study were (a) to determine the effect of level of consumption by cattle and (b) to examine the effect of animal species (sheep and cattle) on the digestibility of concentrate ingredients.
Objectives: Agenesis of the corpus callosum (AgCC), characterized by developmental absence of the corpus callosum, is one of the most common congenital brain malformations. To date, there are limited data on the neuropsychological consequences of AgCC and factors that modulate different outcomes, especially in children. This study aimed to describe general intellectual, academic, executive, social and behavioral functioning in a cohort of school-aged children presenting for clinical services to a hospital and diagnosed with AgCC. The influences of age, social risk and neurological factors were examined. Methods: Twenty-eight school-aged children (8 to 17 years) diagnosed with AgCC completed tests of general intelligence (IQ) and academic functioning. Executive, social and behavioral functioning in daily life, and social risk, were estimated from parent and teacher rated questionnaires. MRI findings reviewed by a pediatric neurologist confirmed diagnosis and identified brain characteristics. Clinical details including the presence of epilepsy and diagnosed genetic condition were obtained from medical records. Results: In our cohort, ~50% of children experienced general intellectual, academic, executive, social and/or behavioral difficulties and ~20% were functioning at a level comparable to typically developing children. Social risk was important for understanding variability in neuropsychological outcomes. Brain anomalies and complete AgCC were associated with lower mathematics performance and poorer executive functioning. Conclusions: This is the first comprehensive report of general intellectual, academic, executive social and behavioral consequences of AgCC in school-aged children. The findings have important clinical implications, suggesting that support to families and targeted intervention could promote positive neuropsychological functioning in children with AgCC who come to clinical attention. (JINS, 2018, 24, 445–455)
The application of modern process control techniques to poultry production is outlined. Compact dynamic data-based models are proposed to describe and control the metabolic responses of broiler chickens to variations in the micro-environment. The dynamic response of heat production to step changes in air temperature and light intensity could be modelled with a , on average, of 0.83 and 0.93 respectively. Using recursive parameter estimation techniques, the time-variant response of animal growth to food supply could be predicted on-line with a prediction error of a maximum of 5%, three to seven days ahead depending on the type of feeding schedule. We argue that the potential conflicts between the environmental, financial and biological pressures on sustainable poultry production can be resolved through the development of integrated management systems using process control techniques.
This review considers the likely impact of changing consumer requirements, political pressure, economics and technological advances on the dairy production industry of the future. The vision is one of diverse strategies of production, the majority of milk being produced from cows managed technologically with much greater regard for welfare, with a number of ‘romantic’ strategies such as organic, extensive or dual-purpose production supplying niche markets. The important novel feature of the technological strategy will be an escape from the intensive twelve-month lactation cycle to extended lactations of, say, eighteen months, since this will reduce the number of times the cow is exposed to metabolic and other stresses associated with parturition, peak lactation and rebreeding.
Scientists have long known that certain pesticides, industrial chemicals and heavy metals have a detrimental impact on the reproductive health of a wide range of species (including humans) by disrupting the endocrine system. As exposure to, and the effects of, ‘endocrine disrupters’ are likely to be more pronounced in wild species with a short gestation period and life-cycle we have chosen to develop non-invasive tools based upon faecal steroid analysis to monitor the reproductive status of the short-tailed field vole (Microtus agrestis). This approach is hoped to eventually provide a sensitive means of detecting environmental disturbances that could adversely affect humans, livestock and wildlife by establishing the the field vole as a terrestrial biomarker. Faecal steroid hormone analysis has already been demonstrated as being a convenient and reliable means of diagnosing reproductive state in a large range of mammalian species (including gazelle, rhino, macaque and mice), however, as of yet little is known regarding the hormonal changes that occur during pregnancy in M. agrestis.
Livestock systems are comprised of sets of complex interconnected processes each with their own outputs eg growth, yield, animal health, welfare and environmental emissions. Livestock management decisions are currently based almost entirely on the judgement and experience of the stockman who has to estimate or guess the likely effects of any control action.
An integrated management system for a livestock production enterprise would be one which controlled all relevant processes. For example if the purpose of the system was to regulate nutritional input in order to control animal growth and pollutant emissions, the controller would calculate input values which would enable growth and emissions criteria to be satisfied simultaneously.
The essential components of an integrated management system are sensors and models. Developments in sensor technology will make available increasing amounts of information relevant to monitoring animals and their environment. Model-based control systems are particularly appropriate for accommodating the variability of most livestock production processes. Models exist for most of the economically important and scientifically interesting processes in livestock production. However the requirements of a process model that is to be incorporated into a controller are different from those of a model which is aimed at demonstrating understanding of the process. Areas where process models are lacking include those involving interactions between production and environmental factors.
The pre-requisites for nutritional management of dairy cows are information about how much feed is being consumed as well as the nutrients that are being derived from that feed. Studies of feed intake and nutrient supply have been limited by difficult experimental techniques, particularly with grazing animals. The models derived from much earlier work are of only general applicability and there is a need for more site-specific information in order to benefit further from conceptual advances.
We have adopted a different approach to studying herbage intake and nutrient supply, using less-invasive approaches as well as techniques that monitor more accessible aspects of these processes, such as jaw movements. These techniques have a major advantage, in addition to their value as research tools, because they could translate directly into commercial applications in on-farm monitoring. The use of diagnostics and behavioural recording is well explored in relation to health monitoring; here we argue for its potential to advance the application of knowledge about grazing and nutrition. We will illustrate this approach using our experiences in measuring grazing behaviour, using IGER behaviour recorders and assessing rumen function, using a series of non-invasive techniques.
The IGER grazing behaviour recorder allows us to record jaw movements and hence grazing and ruminating time and bite dynamics. It also allows the recording of steps and is now being developed to incorporate non-invasive rumen state sensors. It has made a major contribution to our understanding of the foraging strategies of grazing animals and their effect on herbage intake. This technology has the potential to be developed for on-farm monitoring of foraging behaviour providing valuable inputs to the prediction of herbage intake, in decision support systems for grazing.
The introduction of concept of protein degradation and microbial synthesis in the rumen are significant advances in protein rationing schemes. However, real progress has been limited because the lack of consistent experimental results means that models have little relevance to specific farm situations. We foresee considerable opportunities to monitor products of rumen degradation and synthesis that appear in milk (e.g. odd-chain fatty acids) or breath (e.g. sulphides).
Taken together these technologies open the possibilities of an entirely new approach to nutritional management of dairy cows, with site-specific recommendations based on information gathered using new sensors that are incorporated into computerised feeding equipment and milking parlours.
Current commercial poultry production in the UK faces many challenges which make it difficult to confidently predict the future. Changing legislation, responding largely to welfare pressures, is one such challenge. Additionally, consumer demands are widening. Eggs and meat from stock which is organically produced, or fed on rations containing no genetically modified ingredients, or free range produced, or corn fed are some of the assurances sought by the purchaser and consumer. Although the market place already offers such produce it is difficult to predict the extent to which they will penetrate a market which developed largely through the use of intensive production systems. The alternatives to intensively produced eggs and meat are more expensive to produce and therefore purchase and consequently are susceptible to changes in standards of living and the affluence of the consumer.
This paper briefly describes current commercial practices and some of the specific challenges arising from new legislation.
A description of some specific requirements of birds highlights areas where improvements, in terms of performance, production efficiency, and welfare might be gained. Since the overwhelming majority of eggs and meat is produced in intensive, highly automated systems, there is an obvious need for an integrated approach featuring engineers and the poultry industry to refine and further develop technology which better serves the birds, and ultimately, the consumer.
It is concluded that the UK cannot compete in production costs with some other areas of the world and as retailers increasingly source their goods worldwide, the UK poultry producer may have to resort to the production of products which satisfy niche demands.