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At a time when nationalism has reappeared in Europe, when COVID-19 is not yet quarantined and when compassion coexists with grief, there is a need to consider the impact of these societal changes on international collaboration, frequency and management of perinatal mental disorder – and new roles for psychiatrists and other health professionals in the digital and AI (artificial intelligence) post-COVID era.
We critically review potential involvement of trimethylamine N-oxide (TMAO) as a link between diet, the gut microbiota and CVD. Generated primarily from dietary choline and carnitine by gut bacteria and hepatic flavin-containing mono-oxygenase (FMO) activity, TMAO could promote cardiometabolic disease when chronically elevated. However, control of circulating TMAO is poorly understood, and diet, age, body mass, sex hormones, renal clearance, FMO3 expression and genetic background may explain as little as 25 % of TMAO variance. The basis of elevations with obesity, diabetes, atherosclerosis or CHD is similarly ill-defined, although gut microbiota profiles/remodelling appear critical. Elevated TMAO could promote CVD via inflammation, oxidative stress, scavenger receptor up-regulation, reverse cholesterol transport (RCT) inhibition, and cardiovascular dysfunction. However, concentrations influencing inflammation, scavenger receptors and RCT (≥100 µm) are only achieved in advanced heart failure or chronic kidney disease (CKD), and greatly exceed pathogenicity of <1–5 µm levels implied in some TMAO–CVD associations. There is also evidence that CVD risk is insensitive to TMAO variance beyond these levels in omnivores and vegetarians, and that major TMAO sources are cardioprotective. Assessing available evidence suggests that modest elevations in TMAO (≤10 µm) are a non-pathogenic consequence of diverse risk factors (ageing, obesity, dyslipidaemia, insulin resistance/diabetes, renal dysfunction), indirectly reflecting CVD risk without participating mechanistically. Nonetheless, TMAO may surpass a pathogenic threshold as a consequence of CVD/CKD, secondarily promoting disease progression. TMAO might thus reflect early CVD risk while providing a prognostic biomarker or secondary target in established disease, although mechanistic contributions to CVD await confirmation.
International multiprofessional teams in primary and secondary care have much to teach psychiatrists, researchers and service planners about the perinatal mental health field. This editorial introduces a new series of papers in BJPsych International on perinatal mental health around the world.
The Edinburgh Postnatal Depression Scale (EPDS) was published over 30 years ago as a ten-item self-report questionnaire to facilitate the detection of perinatal depression – and for use in research. It is widely used at the present time in many regions of the world and has been translated into over 60 languages. It is occasionally misused. In this editorial, updated recommendations for optimal use in primary and secondary care as well as research are provided. Future studies to evaluate its use and validity in naturalistic community populations are now required, and to determine the psychometric properties and practical usefulness of the EPDS when completed online.
Declaration of interest
J.C. has no financial interest in the use of, or reproduction of, the EPDS.
We prove a variation of Easton’s lemma for strongly proper forcings, and use it to prove that, unlike the stronger principle IGMP, GMP together with 2ω ≤ ω2 is consistent with the existence of an ω1-distributive nowhere c.c.c. forcing poset of size ω1. We introduce the idea of a weakly guessing model, and prove that many of the strong consequences of the principle GMP follow from the existence of stationarily many weakly guessing models. Using Namba forcing, we construct a model in which there are stationarily many indestructibly weakly guessing models which have a bounded countable subset not covered by any countable set in the model.
The Edinburgh Postnatal Depression Scale (EPDS) is a questionnaire and was designed as a simple means of screening for postnatal depression in health care settings. The scale is now in use around the world and this book is a practical guide to using the scale in clinical practice, its origins and development background. This second edition has been revised and contains much advice based on years of experience. All chapters and references have been updated and the chapters on screening and counselling have been considerably revised, the evidence base on interventions for perinatal depression is provided, plus details of innovative methods such as internet-based therapy. The scale can also be used by researchers seeking information on factors which influence the emotional well-being of new mothers and their families and guidance is also given on use of the scale in research settings. The book will be useful for psychologists, psychiatrists, health visitors, midwives, family doctors, obstetricians and community psychiatric nurses, plus researchers in perinatal health.
OBJECTIVES/SPECIFIC AIMS: The purpose of this study is to use the baboon as a novel animal model for breath research and to identify and characterize baboon breath metabolites that reflect cardiometabolic function to inform us in the development of a noninvasive, cost-effective, and repeatable point-of-care diagnostic breath test. METHODS/STUDY POPULATION: Blood and urine was collected from control and IUGR at the approximate age of 3.5 years. Both groups were then placed on a high fat, high sugar, high salt diet for 7 weeks, after which blood, urine, and breath were collected. The breath samples were then subjected to comprehensive, 2-dimensional gas chromatography coupled with time-of-flight mass spectrometry. Using ChromaTOF software, breath VOCs were identified with at least an 80% spectral match against the National Institute of Standards and Technology (NIST) chemical reference library. The raw data were then statistically analyzed using MetaboAnalyst. We then interrogated multiple online databases to characterize and identify the role of VOCs that were present in both control and IUGR groups. RESULTS/ANTICIPATED RESULTS: Preliminary analyses of the breath VOCs indicate differences in expression between sexes and in control Versus IUGR groups. These results indicate unique “breath signatures.” Further analysis of the breath VOCs reveals the presence of metabolites that are involved in β-oxidation and oxidative stress pathways. DISCUSSION/SIGNIFICANCE OF IMPACT: This breath study, a first of its kind, will develop the baboon as a superior animal model for breath biomarker research. Our observed unique “breath signatures” indicate changes in lipid metabolism and oxidative stress pathways, which we hypothesize are the early metabolic changes at the cellular level that are not yet reflected in clinical lab measures. Future directions include analyzing breath VOCs that did not meet 80% spectral match, validation using SPME technology and commercial standards, and initiating a human pilot study in clinically obese, at-risk children in collaboration with physicians at the Children’s Hospital of San Antonio to develop a noninvasive, cost-effective, rapid, and repeatable point-of-care diagnostic breath test.
Regulatory impact analyses (RIAs) weigh the benefits of regulations against the burdens they impose and are invaluable tools for informing decision makers. We offer 10 tips for nonspecialist policymakers and interested stakeholders who will be reading RIAs as consumers.
1. Core problem: Determine whether the RIA identifies the core problem (compelling public need) the regulation is intended to address.
2. Alternatives: Look for an objective, policy-neutral evaluation of the relative merits of reasonable alternatives.
3. Baseline: Check whether the RIA presents a reasonable “counterfactual” against which benefits and costs are measured.
4. Increments: Evaluate whether totals and averages obscure relevant distinctions and trade-offs.
5. Uncertainty: Recognize that all estimates involve uncertainty, and ask what effect key assumptions, data, and models have on those estimates.
6. Transparency: Look for transparency and objectivity of analytical inputs.
7. Benefits: Examine how projected benefits relate to stated objectives.
8. Costs: Understand what costs are included.
9. Distribution: Consider how benefits and costs are distributed.
10. Symmetrical treatment: Ensure that benefits and costs are presented symmetrically.
In today’s global business environment teams are fast becoming the norm. Collaboration is an essential factor in leveraging team effectiveness, and organizations are looking for strategies to increase collaboration among their teams. In this study, we administered an eSurvey to 308 professionals working in face-to-face and virtual teams to investigate emotional intelligence and strengths, opportunities, aspirations, and results as strategies to support the collaborative process. Results found the regression of collaboration on emotional intelligence (controlling for age, ethnicity, and education) was significant (p<.01). Results also found a significant indirect effect between emotional intelligence and collaboration as mediated by strengths, opportunities, aspirations, and results (β=0.110, Z=2.444). We focus on understanding the effect of emotional intelligence on team collaboration as mediated by strengths, opportunities, aspirations, and results. Recommendations are provided for increasing emotional intelligence and strengths, opportunities, aspirations, and results among team members. Our research has important implications for teams and their pervasive use in business.
Shakespeare's most innovative genre was the history play, because it has no precedent in either classical or medieval tradition. In contrast to the focused teleology of Christian medieval drama, Shakespeare's history plays manifest an implicit idea of history that was secular, political, and open-ended. They emphasize human action in a political arena, where the criterion for success is the ability to act in time, without regard to one's spiritual state. Time determines royal succession, which is the focus of all Shakespeare's history plays, as it was the focus of political concern in England in the 1590s, when the plays were written. His emphasis on time and royal succession distinguishes his implied political theory from the moralism and authoritarianism of official Tudor state doctrine on one hand and from the pragmatism of Machiavelli on the other.
Part of Robert T. Leiper's (1881–1969) lasting legacy in medical helminthology is grounded on his pioneering work on schistosomiasis (Bilharzia). Having undertaken many expeditions to the tropics, his fascination with parasite life cycles typically allowed him to devise simple preventive measures that curtailed transmission. Building on his formative work with others in Africa and Asia, and again in Egypt in 1915, he elucidated the life cycles of African schistosomes. His mandate, then commissioned by the British War Office, was to prevent and break transmission of this disease in British troops. This he did by raising standing orders based on simple water hygiene measures. Whilst feasible in military camp settings, today their routine implementation is sadly out of reach for millions of Africans living in poverty. Whilst we celebrate the centenary of Leiper's research we draw attention to some of his lesser known colleagues, then focus on schistosomiasis in Uganda discussing why expanded access to treatment with praziquantel is needed now. Looking to WHO 2020 targets for neglected tropical diseases, we introduce COUNTDOWN, an implementation research consortium funded by DFID, UK, which fosters the scale-up of interventions and confirm the current relevance of Leiper's original research.
We prove that a wide class of strongly proper forcing posets have quotients with strong properties. Specifically, we prove that quotients of forcing posets which have universal strongly generic conditions on a stationary set of models by certain nice regular suborders satisfy the ω1-approximation property. We prove that the existence of stationarily many ω1-guessing models in Pω2(H(θ)), for sufficiently large cardinals θ, is consistent with the continuum being arbitrarily large, solving a problem of Viale and Weiss .