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The COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) project is a large international collaborative effort to analyze individual-level phenotype data from twins in multiple cohorts from different environments. The main objective is to study factors that modify genetic and environmental variation of height, body mass index (BMI, kg/m2) and size at birth, and additionally to address other research questions such as long-term consequences of birth size. The project started in 2013 and is open to all twin projects in the world having height and weight measures on twins with information on zygosity. Thus far, 54 twin projects from 24 countries have provided individual-level data. The CODATwins database includes 489,981 twin individuals (228,635 complete twin pairs). Since many twin cohorts have collected longitudinal data, there is a total of 1,049,785 height and weight observations. For many cohorts, we also have information on birth weight and length, own smoking behavior and own or parental education. We found that the heritability estimates of height and BMI systematically changed from infancy to old age. Remarkably, only minor differences in the heritability estimates were found across cultural–geographic regions, measurement time and birth cohort for height and BMI. In addition to genetic epidemiological studies, we looked at associations of height and BMI with education, birth weight and smoking status. Within-family analyses examined differences within same-sex and opposite-sex dizygotic twins in birth size and later development. The CODATwins project demonstrates the feasibility and value of international collaboration to address gene-by-exposure interactions that require large sample sizes and address the effects of different exposures across time, geographical regions and socioeconomic status.
Ecosystem services typically benefit multiple groups of people. However, natural resource management decisions aiming to secure ecosystem services for one beneficiary group rarely consider potential consequences for others. Here, we examine records of moose hunting in Vermont, USA, a recreational ecosystem service with at least two beneficiary groups: hunters, who benefit from recreational experiences and moose meat, and residents, who live in hunting areas and benefit from hunters’ expenditures. We ask how the allocation of hunting permits has affected (1) the total number of hunters and therefore the benefits enjoyed by this group, (2) the benefits residents received, and (3) the spatial distribution of benefits for each group. We found that changes in the allocation of permits had heterogeneous effects on the beneficiaries. For example, increasing the number of hunting permits increased the total number of hunters, but not necessarily the number of residents who potentially benefit. Also, a more balanced distribution of permits across Vermont increased the total number of potentially benefiting residents, but not those from lower socio-economic groups. Understanding these differences and interactions between beneficiary groups is necessary to distribute benefits equitably amongst them.
Background: Cervical sponylotic myelopathy (CSM) may present with neck and arm pain. This study investiagtes the change in neck/arm pain post-operatively in CSM. Methods: This ambispective study llocated 402 patients through the Canadian Spine Outcomes and Research Network. Outcome measures were the visual analogue scales for neck and arm pain (VAS-NP and VAS-AP) and the neck disability index (NDI). The thresholds for minimum clinically important differences (MCIDs) for VAS-NP and VAS-AP were determined to be 2.6 and 4.1. Results: VAS-NP improved from mean of 5.6±2.9 to 3.8±2.7 at 12 months (P<0.001). VAS-AP improved from 5.8±2.9 to 3.5±3.0 at 12 months (P<0.001). The MCIDs for VAS-NP and VAS-AP were also reached at 12 months. Based on the NDI, patients were grouped into those with mild pain/no pain (33%) versus moderate/severe pain (67%). At 3 months, a significantly high proportion of patients with moderate/severe pain (45.8%) demonstrated an improvement into mild/no pain, whereas 27.2% with mild/no pain demonstrated worsening into moderate/severe pain (P <0.001). At 12 months, 17.4% with mild/no pain experienced worsening of their NDI (P<0.001). Conclusions: This study suggests that neck and arm pain responds to surgical decompression in patients with CSM and reaches the MCIDs for VAS-AP and VAS-NP at 12 months.
Background: Buprenorphine/naloxone (bup/nal) is a partial opioid agonist/antagonist and recommended first line treatment for opioid use disorder (OUD). Emergency departments (EDs) are a key point of contact with the healthcare system for patients living with OUD. Aim Statement: We implemented a multi-disciplinary quality improvement project to screen patients for OUD, initiate bup/nal for eligible individuals, and provide rapid next business day walk-in referrals to addiction clinics in the community. Measures & Design: From May to September 2018, our team worked with three ED sites and three addiction clinics to pilot the program. Implementation involved alignment with regulatory requirements, physician education, coordination with pharmacy to ensure in-ED medication access, and nurse education. The project is supported by a full-time project manager, data analyst, operations leaders, physician champions, provincial pharmacy, and the Emergency Strategic Clinical Network leadership team. For our pilot, our evaluation objective was to determine the degree to which our initiation and referral pathway was being utilized. We used administrative data to track the number of patients given bup/nal in ED, their demographics and whether they continued to fill bup/nal prescriptions 30 days after their ED visit. Addiction clinics reported both the number of patients referred to them and the number of patients attending their referral. Evaluation/Results: Administrative data shows 568 opioid-related visits to ED pilot sites during the pilot phase. Bup/nal was given to 60 unique patients in the ED during 66 unique visits. There were 32 (53%) male patients and 28 (47%) female patients. Median patient age was 34 (range: 21 to 79). ED visits where bup/nal was given had a median length of stay of 6 hours 57 minutes (IQR: 6 hours 20 minutes) and Canadian Triage Acuity Scores as follows: Level 1 – 1 (2%), Level 2 – 21 (32%), Level 3 – 32 (48%), Level 4 – 11 (17%), Level 5 – 1 (2%). 51 (77%) of these visits led to discharge. 24 (47%) discharged patients given bup/nal in ED continued to fill bup/nal prescriptions 30 days after their index ED visit. EDs also referred 37 patients with OUD to the 3 community clinics, and 16 of those individuals (43%) attended their first follow-up appointment. Discussion/Impact: Our pilot project demonstrates that with dedicated resources and broad institutional support, ED patients with OUD can be appropriately initiated on bup/nal and referred to community care.
Distinguishing a disorder of persistent and impairing grief from normative grief allows clinicians to identify this often undetected and disabling condition. As four diagnostic criteria sets for a grief disorder have been proposed, their similarities and differences need to be elucidated.
Participants were family members bereaved by US military service death (N = 1732). We conducted analyses to assess the accuracy of each criteria set in identifying threshold cases (participants who endorsed baseline Inventory of Complicated Grief ⩾30 and Work and Social Adjustment Scale ⩾20) and excluding those below this threshold. We also calculated agreement among criteria sets by varying numbers of required associated symptoms.
All four criteria sets accurately excluded participants below our identified clinical threshold (i.e. correctly excluding 86–96% of those subthreshold), but they varied in identification of threshold cases (i.e. correctly identifying 47–82%). When the number of associated symptoms was held constant, criteria sets performed similarly. Accurate case identification was optimized when one or two associated symptoms were required. When employing optimized symptom numbers, pairwise agreements among criteria became correspondingly ‘very good’ (κ = 0.86–0.96).
The four proposed criteria sets describe a similar condition of persistent and impairing grief, but differ primarily in criteria restrictiveness. Diagnostic guidance for prolonged grief disorder in International Classification of Diseases, 11th Edition (ICD-11) functions well, whereas the criteria put forth in Section III of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) are unnecessarily restrictive.
The last 12 years have seen the evolution of a new funding regime under the supervision of the Pensions Regulator. Over this period, there has been significant turbulence in financial markets, including record low interest rates. This paper takes a critical look at the development of funding approaches and methodologies over this period. It analyses the Pensions Regulator guidance and how scheme specific actuarial methods have emerged since the move away from the Minimum Funding Requirement in 2001 and the introduction of the Scheme Specific Funding Requirements in 2005. It asks whether these new methodologies have been successful from the perspective of members, trustees, employers and shareholders. At a time when actuarial valuation methodologies have faced considerable criticism, this paper aims to propose a pension funding methodology which is fit for purpose and also reflects the latest guidance from the Pensions Regulator on integrated risk management.
The forward rate of dissolution of the International Simple Glass (ISG) was determined under alkaline conditions at 40 °C using the Single Pass Flow Through (SPFT) method. Forward rates were consistent with those obtained in the literature for this glass composition. The formation of altered gel layers and surface pits was observed on the surface of glass particles, especially at the very highest pH values, despite the application of high flow rates to prevent the build-up of solubility limiting phases. These features could be attributed to preferential localized dissolution at sites with a higher alkali concentration or from a separate, less durable, vitreous phase. These results may indicate that surface pit and altered gel formation occurs under the forward rate of dissolution as imposed by the SPFT method, particularly for simplified borosilicate glass materials.
We analyzed intestinal contents of two late-glacial mastodons preserved in lake sediments in Ohio (Burning Tree mastodon) and Michigan (Heisler mastodon). A multi-proxy suite of macrofossils and microfossils provided unique insights into what these individuals had eaten just before they died and added significantly to knowledge of mastodon diets. We reconstructed the mastodons’ habitats with similar multi-proxy analyses of the embedding lake sediments. Non-pollen palynomorphs, especially spores of coprophilous fungi differentiated intestinal and environmental samples. The Burning Tree mastodon gut sample originates from the small intestine. The Heisler mastodon sample is part of the large intestine to which humans had added clastic material to anchor parts of the carcass under water to cache the meat. Both carcasses had been dismembered, suggesting that the mastodons had been hunted or scavenged, in line with other contemporaneous mastodon finds and the timing of early human incursion into the Midwest. Both mastodons lived in mixed coniferous-deciduous late-glacial forests. They browsed tree leaves and twigs, especially Picea. They also ate sedge-swamp plants and drank the lake water. Our multi-proxy estimates for a spring/summer season of death contrast with autumn estimates derived from prior tusk analyses. We document the recovered fossil remains with photographs.
Given the history of the International Criminal Court in Africa, the relationship between African states and the Court is particularly significant to its legitimacy. If the power of the Court is grounded in international political support and the perception that it transcends international and national politics to deny impunity for ‘atrocity’ crimes, the Court's perceived legitimacy and normative legitimacy are so intertwined that charges of illegitimacy from significant regional stakeholders hold particular weight. More importantly, criticisms voiced by African actors point to a valid challenge to the Court's legitimate moral standing as an arbiter of global justice: the international power imbalance that seems to be becoming more entrenched and apparent in the Court's work. Tactics adopted by some African leaders of prioritising the issue of heads-of-state immunity, however, minimise the broader issue of power differentials and reduce the chance that African states will find allies in their cause to challenge the Court's operations.
The intent of this study was to determine whether there are differences in disaster preparedness between urban and rural community hospitals across New York State.
Descriptive and analytical cross-sectional survey study of 207 community hospitals; thirty-five questions evaluated 6 disaster preparedness elements: disaster plan development, on-site surge capacity, available materials and resources, disaster education and training, disaster preparedness funding levels, and perception of disaster preparedness.
Completed surveys were received from 48 urban hospitals and 32 rural hospitals.There were differences in disaster preparedness between urban and rural hospitals with respect to disaster plan development, on-site surge capacity, available materials and resources, disaster education and training, and perception of disaster preparedness. No difference was identified between these hospitals with respect to disaster preparedness funding levels.
The results of this study provide an assessment of the current state of disaster preparedness in urban and rural community hospitals in New York. Differences in preparedness between the two settings may reflect differing priorities with respect to perceived threats, as well as opportunities for improvement that may require additional advocacy and legislation. (Disaster Med Public Health Preparedness. 2019;13:424-428)
Children of parents with major mood and psychotic disorders are at increased risk of psychopathology, including psychotic symptoms. It has been suggested that the risk of psychosis may be more often transmitted from parent to opposite-sex offspring (e.g., from father to daughter) than to same-sex offspring (e.g., from father to son). To test whether sex-specific transmission extends to early manifestations of psychosis, we examined sex-specific contributions to psychotic symptoms among offspring of mothers and fathers with depression, bipolar disorder and schizophrenia. We assessed psychotic symptoms in 309 offspring (160 daughters and 149 sons) aged 8–24 years (mean=13.1, s.d.=4.3), of whom 113 had a mother with schizophrenia, bipolar disorder or major depression and 43 had a father with schizophrenia, bipolar disorder or major depression. In semi-structured interviews, 130 (42%) offspring had definite psychotic symptoms established and confirmed by psychiatrists on one or more assessments. We tested the effects of mental illness in parents on same-sex and opposite-sex offspring psychotic symptoms in mixed-effect logistic regression models. Psychotic symptoms were more prevalent among daughters of affected fathers and sons of affected mothers than among offspring of the same sex as their affected parent. Mental illness in the opposite-sex parent increased the odds of psychotic symptoms (odds ratio (OR)=2.65, 95% confidence interval (CI) 1.43–4.91, P=0.002), but mental illness in the same-sex parent did not have a significant effect on psychotic symptoms in offspring (OR=1.13, 95% CI 0.61–2.07, P=0.697). The opposite-sex-specific parent-of-origin effects may suggest X chromosome-linked genetic transmission or inherited chromosomal modifications in the etiology of psychotic symptoms.
There is clear evidence that the mother's stress, anxiety, or depression during pregnancy can alter the development of her fetus and her child, with an increased risk for later psychopathology. We are starting to understand some of the underlying mechanisms including the role of the placenta, gene–environment interactions, epigenetics, and specific systems including the hypothalamic–pituitary–adrenal axis and cytokines. In this review we also consider how these effects may be different, and potentially exacerbated, in different parts of the world. There can be many reasons for elevated prenatal stress, as in communities at war. There may be raised pregnancy-specific anxiety with high levels of maternal and infant death. There can be raised interpersonal violence (in Afghanistan 90.2% of women thought that “wife beating” was justified compared with 2.0% in Argentina). There may be interactions with nutritional deficiencies or with extremes of temperature. Prenatal stress alters the microbiome, and this can differ in different countries. Genetic differences in different ethnic groups may make some more vulnerable or more resilient to the effects of prenatal stress on child neurodevelopment. Most research on these questions has been in predominantly Caucasian samples from high-income countries. It is now time to understand more about prenatal stress and psychopathology, and the role of both social and biological differences, in the rest of the world.
The experiences of and reflections on interpersonal violence and victimisation among adolescents living in low- and middle-income countries are poorly understood. The aim was to describe Vietnamese adolescents’ reflections on their experiences of victimisation.
A self-completed, cross-sectional survey investigating exposure to violence among high school students in Hanoi, Vietnam was conducted during 2013–2014. The last section invited participants to write about any of the matters covered in the questionnaire. Thematic analysis was conducted on these free-text comments.
A total of 73/76 eligible students participated in the pilot and 1616/1745 in the main survey. Of these, a total of 239 records with free-text comments were analysed. Students described experiences of violence occurring at home, at school and in the community. Experiences of violence led to sadness, loneliness, having extremely negative thoughts about the value of life, and suicidal ideas. Adolescents’ experiences occurred in the context of poor parent–adolescent and teacher–student relationships, particularly concerning dissatisfaction with academic performance. Adolescents wanted to be trusted, to be given more autonomy, and to improve their relationships with parents and teachers.
Vietnamese adolescents experience various forms of victimisation, which are detrimental to their health and wellbeing. Understanding of their experiences of and perceptions of violence and its impact on their health and wellbeing is important in the prevention of violence against young people in Vietnam.
This paper specifies term structure dynamics by a recursive cascade of heterogeneously persistent factors. The cascade naturally orders economic shocks by their adjustment speeds, and generates smooth interest-rate curves in closed form. For a class of specifications, the number of parameters is invariant to the size of the state space, and the term structure converges to a stochastic limit as the state dimension goes to infinity. High-dimensional specifications fit observed term structure almost perfectly, match the observed low correlation between movements in different maturities, and produce stable interest-rate forecasts that outperform lower-dimensional specifications.
We revise the data fitting in our original paper [The dissolution rates of simulated UK Magnox - ThORP blend nuclear waste glass as a function of pH, temperature and waste loading, Miner. Mag.79 (2015) 1529–1542]. The intrinsic rate constant data were calculated incorrectly, the corrected data are presented herein. To support the corrected analysis we have also taken the opportunity to report some additional 90°C data. The conclusions of the original paper remain sound.