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Despite increased focus on ascertaining the status of elasmobranch fish, the stock units for many species are uncertain. Data from mark-recapture tagging studies undertaken from 1959–2017 were analysed for 13 batoid species. Data were most comprehensive for skates (Rajidae), with 22,374 released and 3342 (14.9%) returned. Most data related to thornback ray Raja clavata, blonde ray R. brachyura and spotted ray R. montagui. Tags were generally returned from areas less than 50 km from their release, and usually from the ICES Division in which they were released. However, straight-line distances travelled of up to 910 km (R. brachyura) and 772 km (R. clavata) were recorded, highlighting that individual skates are capable of longer-distance movements. The maximum time at liberty was 16.6 years (R. clavata). Whilst mark-recapture data indicated that the current stock units used by ICES are broadly appropriate, southward movements of several skate species tagged off Northern Ireland (Division 6.a) to the Irish Sea (Division 7.a) were observed. In contrast, skates tagged in the Irish Sea and Bristol Channel (Division 7.f) generally remained in that area, with only occasional recaptures from Division 6.a.
Although the efficacy of endovascular thrombectomy (EVT) for acute ischemic stroke caused by intracranial anterior circulation large vessel occlusion (LVO) is proven, demonstration of local effectiveness is critical for health system planning and resource allocation because of the complexity and cost of this treatment.
Using our prospective registry, we identified all patients who underwent EVT for out-of-hospital LVO stroke from February 1, 2013 through January 31, 2017 (n = 44), and matched them 1:1 in a hierarchical fashion with control patients not treated with EVT based on age (±5 years), prehospital functional status, stroke syndrome, severity, and thrombolysis administration. Demographics, in-hospital mortality, discharge disposition from acute care, length of hospitalization, and functional status at discharge from acute care and at follow-up were compared between cases and controls.
For EVT-treated patients (median age 66, 50% women), the median onset-to-recanalization interval was 247 min, and successful recanalization was achieved in 30/44 (91%). Alteplase was administered in 75% of cases and 57% of controls (p = 0.07). In-hospital mortality was 11% among the cases and 36% in the control group (p = 0.006); this survival benefit persisted during follow-up (p = 0.014). More EVT patients were discharged home from acute care (50% vs. 18%, p = 0.002). Among survivors, there were nonsignificant trends in favor of EVT for median length of hospitalization (14 vs. 41 days, p = 0.11) and functional independence at follow-up (51% vs. 32%, p = 0.079).
EVT improved survival and decreased disability. This demonstration of single-center effectiveness may help facilitate expansion of EVT services in similar health-care jurisdictions.
Endovascular thrombectomy (EVT) is efficacious for ischemic stroke caused by proximal intracranial large-vessel occlusion involving the anterior cerebral circulation. However, evidence of its cost-effectiveness, especially in a real-world setting, is limited. We assessed whether EVT ± tissue plasminogen activator (tPA) was cost-effective when compared with standard care ± tPA at our center.
We identified patients treated with EVT ± tPA after the Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing computed tomography to recanalization times trial from our prospective stroke registry from February 1, 2013 to January 31, 2017. Patients admitted before February 2013 and treated with standard care ± tPA constitute the controls. The sample size was 88. Cost-effectiveness was assessed using the net monetary benefit (NMB). Differences in average costs and quality-adjusted life years (QALYs) were estimated using the augmented inverse probability weighted estimator. We accounted for sampling and methodological uncertainty in sensitivity analyses.
Patients treated with EVT ± tPA had a net gain of 2.89 [95% confidence interval (CI): 0.93–4.99] QALYs at an additional cost of $22,200 (95% CI: −28,902–78,244) per patient compared with the standard care ± tPA group. The NMB was $122,300 (95% CI: −4777–253,133) with a 0.85 probability of being cost-effective. The expected savings to the healthcare system would amount to $321,334 per year.
EVT ± tPA had higher costs and higher QALYs compared with the control, and is likely to be cost-effective at a willingness-to-pay threshold of $50,000 per QALY.
We investigated intestinal trichomonads in western lowland gorillas, central chimpanzees and humans cohabiting the forest ecosystem of Dzanga-Sangha Protected Area in Central African Republic, using the internal transcribed spacer (ITS) region and SSU rRNA gene sequences. Trichomonads belonging to the genus Tetratrichomonas were detected in 23% of the faecal samples and in all host species. Different hosts were infected with different genotypes of Tetratrichomonas. In chimpanzees, we detected tetratrichomonads from ‘novel lineage 2’, which was previously reported mostly in captive and wild chimpanzees. In gorillas, we found two different genotypes of Tetratrichomonas. The ITS region sequences of the more frequent genotype were identical to the sequence found in a faecal sample of a wild western lowland gorilla from Cameroon. Sequences of the second genotype from gorillas were almost identical to sequences previously obtained from an anorexic French woman. We provide the first report of the presence of intestinal tetratrichomonads in asymptomatic, apparently healthy humans. Human tetratrichomonads belonged to the lineage 7, which was previously reported in domestic and wild pigs and a domestic horse. Our findings suggest that the ecology and spatial overlap among hominids in the tropical forest ecosystem has not resulted in exchange of intestinal trichomonads among these hosts.
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.
The likelihood that Palaeolithic artisans sometimes used natural objects as models for their image-making has long been suggested, yet well-contextualized and stratified examples have remained rare. This study examines a series of natural and fabricated items from the Natufian settlement of Wadi Hammeh 27 in Jordan (12,000–12,500 cal. bc) to propose that the site occupants collected a variety of found objects such as fossils, unusually shaped stones and animal bones, which they utilized as templates in the production of geometric art pieces. Natural and fabricated objects were woven into complex schemes of relation by Natufian artisans. Existing patterns were copied and applied to a variety of representational images. Found objects were sometimes subtly modified, whereas at other times they were transformed into finished artefacts. The scute pattern on the tortoise carapace, in particular, appears to have formed the basis of important ritual beliefs across the Natufian culture area. At Wadi Hammeh 27, it was evoked in various media and at various scales to form interrelating tableaux of representation.
Natural living conductive biofilms transport electrons between electrodes and cells, as well as among cells fixed within the film, catalyzing an array of reactions from acetate oxidation to CO2 reduction. Synthetic biology offers tools to modify or improve electron transport through biofilms, creating a new class of engineered living conductive materials. Engineered living conductive materials could be used in a range of applications for which traditional conducting polymers are not appropriate, including improved catalytic coatings for microbial fuel-cell electrodes, self-powered sensors for austere environments, and next-generation living components of bioelectronic devices that interact with the human microbiome.
Over recent decades, the number of outlet glaciers terminating in lakes in Iceland has increased in line with climate warming. The mass-balance changes of these lake-terminating outlet glaciers are sensitive to rising air temperatures, due to altered glacier dynamics and increased surface melt. This study aims to better understand the relationship between proglacial lake development, climate, glacier dynamics and glacier structure at Fjallsjökull, a large, lake-terminating outlet glacier in south-east Iceland. We used satellite imagery to map glacier terminus position and lake extent between 1973 and 2016, and a combination of aerial and satellite imagery to map the structural architecture of the glacier's terminus in 1982, 1994 and 2011. The temporal evolution of ice surface velocities between 1990 and 2018 was calculated using feature tracking. Statistically significant increases in the rate of terminus retreat and lake expansion were identified in 2001, 2009 and 2011. Our surface velocity and structural datasets revealed the development of localised flow ‘corridors’ over time, which conveyed relatively faster flow towards the glacier's terminus. We attribute the overall changes in dynamics and structural architecture at Fjallsjökull to rising air temperatures, but argue that the spatial complexities are driven by glacier specific factors, such as basal topography.
We test the antiquity of a dietary life history model on Tutuila, American Samoa. Stable carbon and nitrogen isotopes in serial, age-adjusted samples of first and third molars reveal isotopic biographies of 16 individuals from five late Holocene (200–1100 RCYBP) sites. Combining this with bone collagen from a larger sample of individuals, we document a patterned dietary life history on the island. Between ages zero and two years, infants show elevated δ15N values, consistent with a diet rich in breast milk. In early childhood (two–10 years), individuals shift to a diet with higher δ13C values, suggesting greater marine protein intake. Around age 10 years, males shift to a more terrestrially focused diet, while females retain a higher marine signature. After ~20 years of age, males and females are more similar in diet, with a greater contribution from terrestrial resources. We argue that these shifts reflect diet-marked social transitions in life histories, especially social status and eating order within households, as predicted from the ethnographic model. When contextualized with other archaeological data, such as mortuary patterns and social organization, the isotopic biographic approach facilitates examination of diet-linked social transitions of individuals as they aged within ancient societies.
Flexible piezoelectric generators (PEGs) present a unique opportunity for renewable and sustainable energy harvesting. Here, we present a low-temperature and low-energy deposition method using solvent evaporation-assisted three-dimensional printing to deposit electroactive poly(vinylidene fluoride) (PVDF)-trifluoroethylene (TrFE) up to 19 structured layers. Visible-wavelength transmittance was above 92%, while ATR-FTIR spectroscopy showed little change in the electroactive phase fraction between layer depositions. Electroactivity from the fabricated PVDF-TrFE PEGs showed that a single structured layer gave the greatest output at 289.3 mV peak-to-peak voltage. This was proposed to be due to shear-induced polarization affording the alignment of the fluoropolymer dipoles without an electric field or high temperature.
Formation of a low barrier back contact plays a critical role in improving the photoconversion efficiency of the CdTe solar cells. Incorporating a buffer layer to minimize the band bending at the back of the CdTe device can significantly lower the barrier for the hole current, improving open circuit voltage (VOC) and the fill factor. Over the past years, researchers have incorporated the both ZnTe and Te as buffer layers to improve CdTe device performance. Here we compare device performance using these two materials as buffer layers at the back of CdTe devices. We show that using Te in contact to CdTe results in higher performance than using ZnTe in contact to the CdTe. Low temperature current density-voltage measurements show that Te results is a lower barrier with CdTe than ZnTe, indicating that Te has better band alignment, resulting in less downward bending in the CdTe at the back interface, than ZnTe does.
The preconception, pregnancy and immediate postpartum and newborn periods are times for mothers and their offspring when they are especially vulnerable to major stressors – those that are sudden and unexpected and those that are chronic. Their adverse effects can transcend generations. Stressors can include natural disasters or political stressors such as conflict and/or migration. Considerable evidence has accumulated demonstrating the adverse effects of natural disasters on pregnancy outcomes and developmental trajectories. However, beyond tracking outcomes, the time has arrived for gathering more information related to identifying mechanisms, predicting risk and developing stress-reducing and resilience-building interventions to improve outcomes. Further, we need to learn how to encapsulate both the quantitative and qualitative information available and share it with communities and authorities to mitigate the adverse developmental effects of future disasters, conflicts and migrations. This article briefly reviews prenatal maternal stress and identifies three contemporary situations (wildfire in Fort McMurray, Alberta, Canada; hurricane Harvey in Houston, USA and transgenerational and migrant stress in Pforzheim, Germany) where current studies are being established by Canadian investigators to test an intervention. The experiences from these efforts are related along with attempts to involve communities in the studies and share the new knowledge to plan for future disasters or tragedies.
The aim of this study was to describe patient level costing methods and develop a database of healthcare resource use and cost in patients with AHF receiving ventricular assist device (VAD) therapy.
Patient level micro-costing was used to identify documented activity in the years preceding and following VAD implantation, and preceding heart transplant for a cohort of seventy-seven consecutive patients listed for heart transplantation (2009–12). Clinician interviews verified activity, established time resource required for each activity, and added additional undocumented activities. Costs were sourced from the general ledger, salary, stock price, pharmacy formulary data, and from national medical benefits and prostheses lists. Linked administrative data analyses of activity external to the implanting institution, used National Weighted Activity Units (NWAU), 2014 efficient price, and admission complexity cost weights and were compared with micro-costed data for the implanting admission.
The database produced includes patient level activity and costs associated with the seventy-seven patients across thirteen resource areas including hospital activity external to the implanting center. The median cost of the implanting admission using linked administrative data was $246,839 (interquartile range [IQR] $246,839–$271,743), versus $270,716 (IQR $211,740–$378,482) for the institutional micro-costing (p = .08).
Linked administrative data provides a useful alternative for imputing costs external to the implanting center, and combined with institutional data can illuminate both the pathways to transplant referral and the hospital activity generated by patients experiencing the terminal phases of heart failure in the year before transplant, cf-VAD implant, or death.
This chapter explores whether and how genomic resources can be protected by the communities from, or countries in which they are accessed. Specifically, it asks whether the Nagoya Protocol on Access and Benefit-Sharing can be an effective mechanism to reassure communities about the sharing of gene sequencing data. These questions are of particular importance to Indigenous peoples and local communities, as many have troubling historical experiences with colonization and associated natural resource exploitation. Many Indigenous and local communities (ILCs) live in developing countries, which are particularly sensitive to access and benefit-sharing (ABS) issues. Different but equally serious challenges exist for Indigenous peoples in developed countries like Canada, Australia, New Zealand and elsewhere. Until outcomes of implementation of the Nagoya Protocol are captured, Indigenous peoples and Local Communities (IPLCs) remain in a quandary as to how to protect digitized genetic resources within their territories or under their jurisdiction. To advance our understanding of legal and regulatory options, this chapter integrates normative and positive perspectives on the mechanisms for access and benefit-sharing in the age of digital biology.
Research on the causes of sheep death in sea voyages from Australia to the Middle East is limited, in particular little is known about the influence of climatic factors. Mortality data from 417 shipments of sheep exported over an 11-year period (November 2004 to June 2015) were modelled retrospectively to determine associated climatic factors. The statistical analysis were performed for both the full data set with 417 voyages based on actual and estimated departure and arrival dates and a restricted data set with 71 voyages based on actual dates. The results of the full data set demonstrated a seasonal mortality pattern, with more deaths occurring on sea voyages leaving Australia in the southern hemisphere winter or spring than those departing in Australian summer or autumn. Heat stress and inadequate fat mobilisation for energy supply when sheep are inappetant on shipments may explain this seasonality. Based on these two models, the voyage and weather factors associated with sheep mortalities included departure year, autumn departure in the southern hemisphere, voyage duration, single or multiple loading port(s), weekly mean dry bulb temperature and wind speed at departure ports, and humidity at destination ports. Significant correlations were observed between weather variables at the departure ports in the Australian winter and a high sheep mortality rate during voyages. This, together with the anticipated increased heat stress risk as a result of climate change, suggests that there could be review of the trade from Australia in the southern hemisphere winter. The influence of weather at the departure ports should be considered in sheep mortality prediction models, especially Australia’s heat stress risk assessment model.
Maternal insufficiency during fetal development can have long-lasting effects on the offspring, most notably on nephron endowment. In polycystic kidney disease (PKD), variability in severity of disease is observed and maternal environment may be a modifying factor. In this study, we first established that in a rodent model of PKD, the Lewis polycystic kidney (LPK) rat’s nephron numbers are 25% lower compared with wildtype animals. We then investigated the effects of prenatal and postnatal maternal environment on phenotype and nephron number. LPK pups born from and raised by homozygous LPK dams (control) were compared with LPK pups cross-fostered onto heterozygous LPK dams to improve postnatal environment; with LPK pups born from and raised by heterozygous LPK dams to improve both prenatal and postnatal environment and with LPK pups born from and raised by Wistar Kyoto-LPK heterozygous dams to improve both prenatal and postnatal environment on a different genetic background. Improvement in both prenatal and postnatal environment improved postnatal growth, renal function and reduced blood pressure, most notably in animals with different genetic background. Animals with improved postnatal environment only showed improved growth and blood pressure, but to a lesser extent. All intervention groups showed increased nephron number compared with control LPK. In summary, prenatal and postnatal environment had significant effect in delaying progression and reducing severity of PKD, including nephron endowment.
Indigenous women and children experience some of the most profound health disparities globally. These disparities are grounded in historical and contemporary trauma secondary to colonial atrocities perpetuated by settler society. The health disparities that exist for chronic diseases may have their origins in early-life exposures that Indigenous women and children face. Mechanistically, there is evidence that these adverse exposures epigenetically modify genes associated with cardiometabolic disease risk. Interventions designed to support a resilient pregnancy and first 1000 days of life should abrogate disparities in early-life socioeconomic status. Breastfeeding, prenatal care and early child education are key targets for governments and health care providers to start addressing current health disparities in cardiometabolic diseases among Indigenous youth. Programmes grounded in cultural safety and co-developed with communities have successfully reduced health disparities. More works of this kind are needed to reduce inequities in cardiometabolic diseases among Indigenous women and children worldwide.