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‘Hey boss, we have a real challenging case tomorrow. She is a 94-year-old lady with carcinoma of the stomach needing a laparoscopic resection for recurrent bleeding. She could move around the house ok six months ago but has lost a lot of weight over the past few months. On a load of medications for hypertension, diabetes and has atrial fibrillation. Family said she took ages waking up from her last GA. The family reckon the last anaesthetist overdosed her but the doctor said he gave her the usual dose at one MAC. I guess you want to use TIVA… what should I read up on tonight?’
What is the role of Northeastern agricultural products in the US food system? This paper presents a typology that categorizes where agricultural production and distribution of a specific geographic area, in this case a multi-state region, fits within the US food system. The place of each food is defined based on its production volume, scope of distribution, market timing and agro-ecological niche. Six distinct roles that a region might play in supplying food are identified: (a) the region is a national production center, (b) the region is a seasonally important supplier, (c) regional production and distribution is the primary scale for supplying a food, (d) the product occupies an agro-ecological niche, (e) a product is a co-product of another industry in the region, and (f) the product is marketed explicitly for its geographic provenance as a local or regional product. Illustrative examples of each role are provided from the research of the Enhancing Food Security in the Northeast (EFSNE) regional food systems project. The examples draw from a variety of methodological approaches including regional self-reliance analysis, product case studies, supply chain models, and examination of spatial and temporal patterns in crop and livestock production and marketing. While presented in the context of the Northeast, the typology would likely be valuable for characterizing other regions of the country. We need such a typology to better understand and communicate the value of geographically dispersed agricultural production to creating a resilient food system, thereby improving our decisions of how to respond to future agricultural challenges
The dehesa agroforestry system is classified as one of the most singular ecosystems in the European Union. In the southwest of the Iberian Peninsula, it spreads over an area of approximately 6.7 million hectares, contributing major environmental, cultural, aesthetic and economic value to the region. The main agricultural activity that is developed in this ecosystem is the extensive farming of cattle, sheep and Iberian pigs with low stocking density and few inputs. Sustainable management of these ecosystems' existing production farms is essential in order to secure their continuity, as they face a difficult situation on account of their low profitability. One of the strategies that could be employed to attain a sustainable situation is the proposition of an organic production model. In order to explore this option, a participatory research process has been proposed and developed in the Spanish region called Extremadura (Spain). The aim of this process is to investigate the potential of extensive farming systems in moving toward a sustainable organic production model, identifying the main barriers preventing livestock farmers from converting to the organic model and seeking specific improvement measures that would reduce such barriers. For that purpose, four focus group sessions were run with a total of 33 participating stakeholders. For the analysis of these focus groups, Atlas.ti qualitative software was used to categorize and quantify the main ideas proposed during the sessions. The findings revealed that the main barriers can be classified into three groups: barriers that are inherent to the production processes and the structure of the specific sector, barriers associated with administration and management issues and lastly, barriers relating to education and training of the various actors involved. We consider this paper may contribute to policy makers' decisions to focus on specific actions for improvement that are customized for the socio-economic and environmental conditions of the region.
First-degree relatives of patients with psychotic disorder have higher levels of polygenic risk (PRS) for schizophrenia and higher levels of intermediate phenotypes.
We conducted, using two different samples for discovery (n = 336 controls and 649 siblings of patients with psychotic disorder) and replication (n = 1208 controls and 1106 siblings), an analysis of association between PRS on the one hand and psychopathological and cognitive intermediate phenotypes of schizophrenia on the other in a sample at average genetic risk (healthy controls) and a sample at higher than average risk (healthy siblings of patients). Two subthreshold psychosis phenotypes, as well as a standardised measure of cognitive ability, based on a short version of the WAIS-III short form, were used. In addition, a measure of jumping to conclusion bias (replication sample only) was tested for association with PRS.
In both discovery and replication sample, evidence for an association between PRS and subthreshold psychosis phenotypes was observed in the relatives of patients, whereas in the controls no association was observed. Jumping to conclusion bias was similarly only associated with PRS in the sibling group. Cognitive ability was weakly negatively and non-significantly associated with PRS in both the sibling and the control group.
The degree of endophenotypic expression of schizophrenia polygenic risk depends on having a sibling with psychotic disorder, suggestive of underlying gene–environment interaction. Cognitive biases may better index genetic risk of disorder than traditional measures of neurocognition, which instead may reflect the population distribution of cognitive ability impacting the prognosis of psychotic disorder.
It is crucial to identify people at risk for type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM) to implement preventive interventions in order to address these pandemics. A simple score exclusively based on dietary components, the Dietary-Based Diabetes-Risk Score (DDS) showed a strong inverse association with incident T2DM. The objective was to assess the association between DDS and the risk of GDM in a cohort of Spanish university graduates. The ‘Seguimiento Universidad de Navarra’ project is a prospective and dynamic cohort which included data of 3455 women who notified pregnancies between 1999 and 2012. The diagnosis of GDM is self-reported and further confirmed by physicians. A validated 136-item semi-quantitative FFQ was used to assess pre-gestational dietary habits. The development of the DDS was aimed to quantify the association between the adherence to this a priori dietary score and T2DM incidence. The score exclusively included dietary components (nine food groups with reported inverse associations with T2DM incidence and three food groups which reported direct associations with T2DM). Three categories of adherence to the DDS were assessed: low (11–24), intermediate (25–39) and high (40–60). The upper category showed an independent inverse association with the risk of incident GDM compared with the lowest category (multivariate-adjusted OR 0·48; 95 % CI 0·24, 0·99; P for linear trend: 0·01). Several sensitivity analyses supported the robustness of these results. These results reinforce the importance of pre-gestational dietary habits for reducing GDM and provide a brief tool to practically assess the relevant dietary habits in clinical practice.
How do parties protect themselves from electoral manipulation? To answer this question, we study the drivers of polling station party representatives’ presence and their impact on electoral outcomes in an environment where electoral irregularities are common. Using election data from the Mexican Chamber of Deputies, we find a robust positive correlation between the presence of party representatives and that party’s vote share. The evidence suggests that this correlation can be attributed to party representatives influencing the electoral results. We also formulate a game theoretic model of the levels of representation chosen by parties in a given precinct and structurally estimate its parameters. We find that parties send their representatives where they expect their opponents to send their own. The finding suggests representatives play a primarily protective role, even when they are often involved in irregularities themselves.
Objectives: Long-term neurological response to treatment after a severe traumatic brain injury (sTBI) is a dynamic process. Failure to capture individual heterogeneity in recovery may impact findings from single endpoint sTBI randomized controlled trials (RCT). The present study re-examined the efficacy of erythropoietin (Epo) and transfusion thresholds through longitudinal modeling of sTBI recovery as measured by the Disability Rating Scale (DRS). This study complements the report of primary outcomes in the Epo sTBI RCT, which failed to detect significant effects of acute treatment at 6 months post-injury. Methods: We implemented mixed effects models to characterize the recovery time-course and to examine treatment efficacy as a function of time post-injury and injury severity. Results: The inter-quartile range (25th–75th percentile) of DRS scores was 20–28 at week1; 8–24 at week 4; and 3–17 at 6 months. TBI severity group was found to significantly interact with Epo randomization group on mean DRS recovery curves. No significant differences in DRS recovery were found in transfusion threshold groups. Conclusions: This study demonstrated the value of taking a comprehensive view of recovery from sTBI in the Epo RCT as a temporally dynamic process that is shaped by both treatment and injury severity, and highlights the importance of the timing of primary outcome measurement. Effects of Epo treatment varied as a function of injury severity and time. Future studies are warranted to understand the possible moderating influence of injury severity on treatment effects pertaining to sTBI recovery. (JINS, 2019, 25, 293–301)
Objectives: Children with acquired brain injury (ABI) can present with disruptive behavior, which is often a consequence of injury and parent factors. Parent factors are associated with child disruptive behavior. Furthermore, disinhibition in the child also leads to disruptive behavior. However, it is unclear how these factors interact. We investigated whether parental factors influence child disruptive behavior following ABI and how these factors interact. Methods: Parents of 77 children with ABI participated in the study. Parent factors (executive dysfunction, trait-anxiety), potential intervention targets (dysfunctional parenting practices, parental stress, child disinhibition), and child disruptive behavior were assessed. A hypothetical model based on the literature was tested using mediation and path analysis. Results: Mediation analysis revealed that child disinhibition and dysfunctional parenting practices mediated the association of parent factors and child disruptive behavior. Parents’ executive dysfunction mediated the association of dysfunctional parenting practices, parental stress and parent trait-anxiety. Parenting practices mediated the association of executive dysfunction and child disruptive behavior. Path analysis indices indicated good model adjustment. Comparative and Tucker-Lewis Index were >0.95, and the root mean square error of approximation was 0.059, with a chi-square of 0.25. Conclusions: A low level of parental trait-anxiety may be required to reduce dysfunctional parenting practices and child disinhibition. Impairments in child disinhibition can be exacerbated when parents present with high trait-anxiety. Child disinhibition is the major contributor of disruptive behavior reported by parents and teachers. The current study provides evidence of parent anxiety and child disinhibition as possible modifiable intervention targets for reducing child disruptive behavior. (JINS, 2019, 25, 237–248)
Public approval is a crucial source of executive power in presidential systems. Does the public support female and male presidents similarly? Combining insights from gender and politics research with psychological evidence, this study theorizes sex-based differentials in popularity based on more general expectations linking gender stereotypes to diverging performance evaluations. Using quarterly analyses of eighteen Latin American democracies, South Korea and the Philippines, the analyses compare the levels, dynamics, and policy performance of macro-approval for male and female presidents. As expected, female presidents are less popular, experience exaggerated approval dynamics and their approval is more responsive to security and corruption (though not economic) outcomes. These findings have clear implications for our understandings of mass politics, political accountability and presidentialism.
To examine timing of eating across ten European countries.
Cross-sectional analysis of the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study using standardized 24 h diet recalls collected during 1995–2000. Eleven predefined food consumption occasions were assessed during the recall interview. We present time of consumption of meals and snacks as well as the later:earlier energy intake ratio, with earlier and later intakes defined as 06.00–14.00 and 15.00–24.00 hours, respectively. Type III tests were used to examine associations of sociodemographic, lifestyle and health variables with timing of energy intake.
Ten Western European countries.
In total, 22 985 women and 13 035 men aged 35–74 years (n 36 020).
A south–north gradient was observed for timing of eating, with later consumption of meals and snacks in Mediterranean countries compared with Central and Northern European countries. However, the energy load was reversed, with the later:earlier energy intake ratio ranging from 0·68 (France) to 1·39 (Norway) among women, and from 0·71 (Greece) to 1·35 (the Netherlands) among men. Among women, country, age, education, marital status, smoking, day of recall and season were all independently associated with timing of energy intake (all P<0·05). Among men, the corresponding variables were country, age, education, smoking, physical activity, BMI and day of recall (all P<0·05).
We found pronounced differences in timing of eating across Europe, with later meal timetables but greater energy load earlier during the day in Mediterranean countries compared with Central and Northern European countries.
Understanding the consequences of environmental fluctuations for parasite dynamics requires a long-term view stretching over many transmission cycles. Here we studied the dynamics of three malaria parasites (Plasmodium azurophilum, P. leucocytica and P. floridense) infecting the lizard Anolis gundlachi, in the rainforest of Puerto Rico. In this malaria–anole system we evaluated temporal fluctuations in individual probability of infection, the environmental drivers of observed variation and consequences for host body condition and Plasmodium parasites assemblage. We conducted a total of 15 surveys including 10 from 1990 to 2002 and five from 2015 to 2017. During the early years, a lizard's probability of infection by all Plasmodium species appeared stable despite disturbances ranging from two hurricanes to short droughts. Over a longer timescale, probability of infection and overall prevalence varied significantly, following non-linear relationships with temperature and rainfall such that highest prevalence is expected at intermediate climate measures. A perplexing result was that host body condition was maximized at intermediate levels of rainfall and/or temperature (when risk of infection was highest), yet we found no significant decreases in body condition due to infection. Plasmodium parasite species composition varied through time with a reduction and near local extinction of P. floridense. Our results emphasize the need for long-term studies to reveal host–parasite dynamics, their drivers and consequences.
Human fascioliasis is a worldwide, pathogenic food-borne trematodiasis. Impressive clinical pictures comprising puzzling polymorphisms, manifestation multifocality, disease evolution changes, sequelae and mortality, have been reported in patients presenting with neurological, meningeal, neuropsychic and ocular disorders caused at distance by flukes infecting the liver. Proteomic and mass spectrometry analyses of the Fasciola hepatica excretome/secretome identified numerous, several new, plasminogen-binding proteins enhancing plasmin generation. This may underlie blood-brain barrier leakage whether by many simultaneously migrating, small-sized juvenile flukes in the acute phase, or by breakage of encapsulating formations triggered by single worm tracks in the chronic phase. Blood-brain barrier leakages may subsequently occur due to a fibrinolytic system-dependent mechanism involving plasmin-dependent generation of the proinflammatory peptide bradykinin and activation of bradykinin B2 receptors, after different plasminogen-binding protein agglomeration waves. Interactions between diverse parasitic situations and non-imbalancing fibrinolysis system alterations are for the first time proposed that explain the complexity, heterogeneity and timely variations of neurological disorders. Additionally, inflammation and dilation of blood vessels may be due to contact system–dependent generation bradykinin. This baseline allows for search of indicators to detect neurological risk in fascioliasis patients and experimental work on antifibrinolytic treatments or B2 receptor antagonists for preventing blood-brain barrier leakage.
Direct polycondensation of L-lactic acid with a comonomer allows tailoring the properties of the product from the very first step. The viscous L-lactic acid co-oligomers with star-shaped architectures obtained were modified with three different acrylate monomers. Regardless the functionalization agent, UV curing was fast and all materials were cell compatible and promoted cell adhesion. The physical properties of the three star-shaped films exhibited a consistent trend as swelling capacity, hydrolytic instability, and gel content decreased simultaneously. A higher network density increased crosslinking degree and gel content among the films with an isocyanate group. The methacrylic end group functionalized material, lowest molecular weight, consistently exhibited the higher hydrolytic instability. Comparison of physical properties of these films with the corresponding linear materials reported previously confirmed the influence of precursor molecular architecture on the final material. The methodology developed herein is prone to scale-up and lead to the industrial production of new bioadhesives.
Previous work has identified associations between psychotic experiences (PEs) and general medical conditions (GMCs), but their temporal direction remains unclear as does the extent to which they are independent of comorbid mental disorders.
In total, 28 002 adults in 16 countries from the WHO World Mental Health (WMH) Surveys were assessed for PEs, GMCs and 21 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders. Discrete-time survival analyses were used to estimate the associations between PEs and GMCs with various adjustments.
After adjustment for comorbid mental disorders, temporally prior PEs were significantly associated with subsequent onset of 8/12 GMCs (arthritis, back or neck pain, frequent or severe headache, other chronic pain, heart disease, high blood pressure, diabetes and peptic ulcer) with odds ratios (ORs) ranging from 1.3 [95% confidence interval (CI) 1.1–1.5] to 1.9 (95% CI 1.4–2.4). In contrast, only three GMCs (frequent or severe headache, other chronic pain and asthma) were significantly associated with subsequent onset of PEs after adjustment for comorbid GMCs and mental disorders, with ORs ranging from 1.5 (95% CI 1.2–1.9) to 1.7 (95% CI 1.2–2.4).
PEs were associated with the subsequent onset of a wide range of GMCs, independent of comorbid mental disorders. There were also associations between some medical conditions (particularly those involving chronic pain) and subsequent PEs. Although these findings will need to be confirmed in prospective studies, clinicians should be aware that psychotic symptoms may be risk markers for a wide range of adverse health outcomes. Whether PEs are causal risk factors will require further research.
Cognitive deficits are a core feature of early stages in schizophrenia. However, the extent to which antipsychotic (AP) have a deleterious effect on cognitive performance remains under debate. We aim to investigate whether anticholinergic loadings and dose of AP drugs in first episode of psychosis (FEP) in advanced phase of remission are associated with cognitive impairment and the differences between premorbid intellectual quotient (IQ) subgroups.
Two hundred and sixty-six patients participated. The primary outcomes were cognitive dimensions, dopaminergic/anticholinergic load of AP [in chlorpromazine equivalents (Eq-CPZ) and the Anticholinergic Risk Scale (ARS), respectively].
Impairments in processing speed, verbal memory and global cognition were significantly associated with high Eq-CPZ and verbal impairment with high ARS score. Moreover, this effect was higher in the low IQ subgroup.
Clinicians should be aware of the potential cognitive impairment associated with AP in advanced remission FEP, particularly in lower premorbid IQ patients.