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The aims of this study were to evaluate changes in inflammatory and oxidative stress levels following treatment with N-acetylcysteine (NAC) or mitochondrial-enhancing agents (CT), and to assess the how these changes may predict and/or moderate clinical outcomes primarily the Montgomery-Åsberg Depression Rating Scale (MADRS).
This study involved secondary analysis of a placebo-controlled randomised trial (n=163). Serum samples were collected at baseline and week 16 of the clinical trial to determine changes in interleukin (IL)-6 and total antioxidant capacity (TAC) following adjunctive CT and/or NAC treatment, and to explore the predictability of the outcome or moderator effects of these markers.
In the NAC treated group, no difference was observed in serum IL-6 and TAC levels after 16 weeks of treatment with NAC or CT. However, results from a moderator analysis showed that in the CT group, lower IL-6 levels at baseline was a significant moderator of MADRS χ2 (df) = 4.90, p=0.027) and Clinical Global Impression-improvement (CGI-I, X2 (df)=6.28 p=0.012). In addition, IL-6 was a non-specific but significant predictor of functioning (based on the Social and Occupational Functioning Assessment Scale (SOFAS)), indicating that individuals with higher IL-6 levels at baseline had a greater improvement on SOFAS regardless of their treatment (p=0.023).
Participants with lower IL-6 levels at baseline had a better response to the adjunctive treatment with the mitochondrial-enhancing agents in terms of improvements in MADRS and CGI-I outcomes.
Previous research in clinical, community, and school settings has demonstrated positive outcomes for the Secret Agent Society (SAS) social skills training program. This is designed to help children on the autism spectrum become more aware of emotions in themselves and others and to ‘problem-solve’ complex social scenarios. Parents play a key role in the implementation of the SAS program, attending information and support sessions with other parents and providing supervision, rewards, and feedback as their children complete weekly ‘home mission’ assignments. Drawing on data from a school-based evaluation of the SAS program, we examined whether parents’ engagement with these elements of the intervention was linked to the quality of their children’s participation and performance. Sixty-eight 8–14-year-olds (M age = 10.7) with a diagnosis of autism participated in the program. The findings indicated that ratings of parental engagement were positively correlated with children’s competence in completing home missions and with the quality of their contribution during group teaching sessions. However, there was a less consistent relationship between parental engagement and measures of children’s social and emotional skill gains over the course of the program.
Annual monitoring of physical health of people with severe mental illness (SMI) in primary or secondary care is recommended in England.
The SMI Health Improvement Profile (HIP) was developed to target physical well-being in SMI through the role of the mental health nurse.
The primary aim was to investigate if health checks performed by community mental health nurses (CMHNs) trained to use the HIP improved the physical well-being of patients with SMI at 12 months.
A single blind, parallel group randomised controlled trial of training to use the HIP (clustered at the level of the nurse). Physical well-being was measured in study patients using the physical component score of the SF36v2 at baseline and at 12 months.
Sixty CMHNs (working with 173 patients) were assigned to the HIP programme (training to use the HIP) or treatment as usual. The HIP was completed with 38 (42%) patients at baseline and 22 (24%) at follow-up in the HIP programme group. No effect of the HIP programme on physical health-related quality of life of study patients was identified, a finding supported by per protocol analyses.
This study found no evidence that CMHN delivered health checks following training to use the HIP are effective at improving the physical well-being of SMI patients at one year. More attention to methods that aim to enable the delivery, receipt and enactment of evidence-based interventions to improve physical health outcomes in this population is urgently required.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The prevalence of many diseases in pigs displays seasonal distributions. Despite growing concerns about the impacts of climate change, we do not yet have a good understanding of the role that weather factors play in explaining such seasonal patterns. In this study, national and county-level aggregated abattoir inspection data were assessed for England and Wales during 2010–2015. Seasonally-adjusted relationships were characterised between weekly ambient maximum temperature and the prevalence of both respiratory conditions and tail biting detected at slaughter. The prevalence of respiratory conditions showed cyclical annual patterns with peaks in the summer months and troughs in the winter months each year. However, there were no obvious associations with either high or low temperatures. The prevalence of tail biting generally increased as temperatures decreased, but associations were not supported by statistical evidence: across all counties there was a relative risk of 1.028 (95% CI 0.776–1.363) for every 1 °C fall in temperature. Whilst the seasonal patterns observed in this study are similar to those reported in previous studies, the lack of statistical evidence for an explicit association with ambient temperature may possibly be explained by the lack of information on date of disease onset. There is also the possibility that other time-varying factors not investigated here may be driving some of the seasonal patterns.
Gut microbiota data obtained by DNA sequencing are not only complex because of the number of taxa that may be detected within human cohorts, but also compositional because characteristics of the microbiota are described in relative terms (e.g., “relative abundance” of particular bacterial taxa expressed as a proportion of the total abundance of taxa). Nutrition researchers often use standard principal component analysis (PCA) to derive dietary patterns from complex food data, enabling each participant's diet to be described in terms of the extent to which it fits their cohort's dietary patterns. However, compositional PCA methods are not commonly used to describe patterns of microbiota in the way that dietary patterns are used to describe diets. This approach would be useful for identifying microbiota patterns that are associated with diet and body composition. The aim of this study is to use compositional PCA to describe gut microbiota profiles in 5 year old children and explore associations between microbiota profiles, diet, body mass index (BMI) z-score, and fat mass index (FMI) z-score. This study uses a cross-sectional data for 319 children who provided a faecal sample at 5 year of age. Their primary caregiver completed a 123-item quantitative food frequency questionnaire validated for foods of relevance to the gut microbiota. Body composition was determined using dual-energy x-ray absorptiometry, and BMI and FMI z-scores calculated. Compositional PCA identified and described gut microbiota profiles at the genus level, and profiles were examined in relation to diet and body size. Three gut microbiota profiles were found. Profile 1 (positive loadings on Blautia and Bifidobacterium; negative loadings on Bacteroides) was not related to diet or body size. Profile 2 (positive loadings on Bacteroides; negative loadings on uncultured Christensenellaceae and Ruminococcaceae) was associated with a lower BMI z-score (r = -0.16, P = 0.003). Profile 3 (positive loadings on Faecalibacterium, Eubacterium and Roseburia) was associated with higher intakes of fibre (r = 0.15, P = 0.007); total (r = 0.15, P = 0.009), and insoluble (r = 0.13, P = 0.021) non-starch polysaccharides; protein (r = 0.12, P = 0.036); meat (r = 0.15, P = 0.010); and nuts, seeds and legumes (r = 0.11, P = 0.047). Further regression analyses found that profile 2 and profile 3 were independently associated with BMI z-score and diet respectively. We encourage fellow researchers to use compositional PCA as a method for identifying further links between the gut, diet and obesity, and for developing the next generation of research in which the impact on body composition of dietary interventions that modify the gut microbiota is determined.
Although both obesity and ageing are risk factors for cognitive impairment, there is no evidence in Chile on how obesity levels are associated with cognitive function. Therefore, the aim of the present study was to investigate the association between adiposity levels and cognitive impairment in older Chilean adults. This cross-sectional study includes 1384 participants, over 60 years of age, from the Chilean National Health Survey 2009–2010. Cognitive impairment was evaluated using the Mini-Mental State Examination. BMI and waist circumference (WC) were used as measures of adiposity. Compared with people with a normal BMI, the odds of cognitive impairment were higher in participants who were underweight (OR 4·44; 95 % CI 2·43, 6·45; P < 0·0001), overweight (OR 1·86; 95 % CI 1·06, 2·66; P = 0·031) and obese (OR 2·26; 95 % CI 1·31, 3·21; P = 0·003). The associations were robust after adjustment for confounding variables. Similar results were observed for WC. Low and high levels of adiposity are associated with an increased likelihood of cognitive impairment in older adults in Chile.
Application timing and environmental factors reportedly influence the efficacy of auxinic herbicides. In resistance-prone weed species such as Palmer amaranth (Amaranthus palmeri S. Watson), efficacy of auxinic herbicides recently adopted for use in resistant crops is of utmost importance to reduce selection pressure for herbicide-resistance traits. Growth chamber experiments were conducted comparing the interaction of different environmental effects with application time to determine the influence of these factors on visible phytotoxicity and hydrogen peroxide (H2O2) formation in A. palmeri. Temperature displayed a high degree of influence on 2,4-D and dicamba efficacy in general, with applications at the low-temperature treatment (31/20 C day/night) resulting in an increase in phytotoxicity compared with high-temperature treatments (41/30 C day/night). Application time across temperature treatments significantly affected 2,4-D–induced phytotoxicity, resulting in a ≥30% increase across rates with treatments at 4:00 PM compared with 8:00 AM. Temperature differential had a significant influence on dicamba efficacy based on visible phytotoxicity data, with a ≥46% increase with a high (37/20 C day/night) compared with a low differential (41/30 C day/night). Concentration of H2O2 in herbicide-treated plants was 34% higher under a high temperature differential compared with the low differential. Humidity treatments and application time interactions displayed undetected or inconsistent effects on visible phytotoxicity and H2O2 production. Overall, temperature-related influences seem to have the largest environmental effect on auxinic herbicides within conditions evaluated in this study. Leaf concentration of H2O2 appears to be generally correlated with phytotoxicity, providing a potentially useful tool in determining efficacy of auxinic herbicides in field settings.
Bermudagrass is a major forage species throughout Georgia and the Southeast. An essential part of achieving high-yielding, top-quality forages is proper weed control. Indaziflam is a residual herbicide that controls many broadleaf and grass species by inhibiting cellulose biosynthesis. Research conducted in Tift and Colquitt counties in Georgia determined optimal PRE rates for indaziflam for bermudagrass forage production. Treatments applied at spring greenup of established ‘Alicia’ bermudagrass included indaziflam at 47, 77, 155, or 234 g ai ha−1 PRE, pendimethalin at 4,480 g ha−1 PRE, a split application of indaziflam at 47 g ha−1 PRE followed by the same rate applied POST after the first cutting, and a nontreated control (seven treatments in all). Forages were machine harvested three times each year for each location beginning at least 47 d after treatment (DAT), with final cuttings up to 168 DAT. For all treatments, fresh- and dry-weight yields at each harvest and totals for the season did not differ from the nontreated control. Indaziflam at 155 and 234 g ha−1 did cause minor stunting at 44 DAT, but this was transient and not observed at the second harvest. Indaziflam applied PRE has the potential to provide residual control of troublesome weeds in bermudagrass forage and hay production, with ephemeral stunting at the recommended application rates.
This paper discusses the need for consistency in mass-gathering research and evaluation from an environmental reporting perspective.
Mass gatherings occur frequently throughout the world. Having an understanding of the complexities of mass gatherings is important to inform health services about the possible required health resources. Factors within the environmental, psychosocial, and biomedical domains influence the usage of health services at mass gatherings. A minimum data set (MDS) has been proposed to standardize collection of biomedical data across various mass gatherings, and there is a need for an environmental component. The environmental domain includes factors such as the nature of the event, availability of drugs or alcohol, venue characteristics, and meteorological factors.
This research used an integrative literature review design. Manuscripts were collected using keyword searches from databases and journal content pages from 2003 through 2018. Data were analyzed and categorized using the existing MDS as a framework.
In total, 39 manuscripts were identified that met the inclusion criteria.
In collecting environmental data from mass gatherings, there must be an agreed-upon MDS. A set of variables can be used to collect de-identified environmental variables for the purpose of making comparisons across societies for mass-gathering events (MGEs).
Background: Massive transfusion protocols (MTP) are widely used to rapidly deliver blood products to bleeding trauma patients. Every minute delay in blood product administration in bleeding trauma patients is associated with a 5% increased odds of death. In-situ simulation (ISS) is simulation that takes place in the actual clinical work environment. We used ISS as a novel, prospective and iterative quality improvement (QI) approach to identify and improve MTP steps that impact time to blood delivery (TTBD) during actual trauma resuscitations. Aim Statement: To reduce the TTBD for bleeding trauma patients by 20% over a 12-month ISS-based QI initiative. Measures & Design: We conducted twelve high-fidelity, interprofessional ISS sessions at a Level-1 trauma center in Toronto, Canada. We used clinician video review as well as extensive stakeholder involvement, including with nurses, porters, blood bank and human factors experts, to develop Plan-Do-Study-Act (PDSA) cycles for MTP improvement. Our three major PDSA cycles revolved around: 1) decreasing MTP activation time; 2) reducing the unpredictable and inefficient transport times for the blood itself; and 3) improving the notification of blood product arrival in the trauma bay. Each PDSA cycle was iteratively tested with ISS prior to implementation into clinical care. Outcome measure was the mean TTBD for trauma patients requiring MTP (in minutes, standard deviation [SD]). Process measures included time to MTP activation and porter transport times. Balancing measures included stakeholder satisfaction. Evaluation/Results: Our baseline TTBD for MTP patients was 11.58min (n = 41, SD 6.8). There were 54 trauma patients that had MTP during the ISS-based QI initiative, and their mean TTBD was 10.44min (SD 6.1). The TTBD after the QI initiative was 9.12min, sustained over 1 year (n = 50, SD 5.3; 21.2% relative reduction, p < 0.05). A run chart did not show special cause variation chronologically related to our interventions. Patients in each group were similar in demographic data, trauma characteristics and injury severity score. Discussion/Impact: We achieved a 21.2% reduction in TTBD for trauma patients requiring MTP with an ISS-based QI initiative. ISS represents a novel approach to the identification and iterative testing of process improvements within trauma care. This methodology can and should be included in QI projects in order to safely test and improve processes of care before they impact real patients.
Depression in older people is likely to become a growing global health problem with aging populations. Significant cultural variation exists in beliefs about depression (terminology, symptomatology, and treatments) but data from sub-Saharan Africa are minimal. Low-resource interventions for depression have been effective in low-income settings but cannot be utilized without accurate diagnosis. This study aimed to achieve a shared understanding of depression in Tanzania in older people.
Using a qualitative design, focus groups were conducted with participants aged 60 and over. Participants from rural villages of Kilimanjaro, Tanzania, were selected via randomized sampling using census data. Topic guides were developed including locally developed case vignettes. Transcripts were translated into English from Swahili and thematic analysis conducted.
Ten focus groups were held with 81 participants. Three main themes were developed: a) conceptualization of depression by older people and differentiation from other related conditions (“too many thoughts,” cognitive symptoms, affective and biological symptoms, wish to die, somatic symptoms, and its difference to other concepts); b) the causes of depression (inability to work, loss of physical strength and independence, lack of resources, family difficulties, chronic disease); c) management of depression (love and comfort, advice, spiritual support, providing help, medical help).
This research expands our understanding of how depression presents in older Tanzanians and provides information about lay beliefs regarding causes and management options. This may allow development of culturally specific screening tools for depression that, in turn, increase diagnosis rates, support accurate diagnosis, improve service use, and reduce stigma.
The spatial-intensity profile of light reflected during the interaction of an intense laser pulse with a microstructured target is investigated experimentally and the potential to apply this as a diagnostic of the interaction physics is explored numerically. Diffraction and speckle patterns are measured in the specularly reflected light in the cases of targets with regular groove and needle-like structures, respectively, highlighting the potential to use this as a diagnostic of the evolving plasma surface. It is shown, via ray-tracing and numerical modelling, that for a laser focal spot diameter smaller than the periodicity of the target structure, the reflected light patterns can potentially be used to diagnose the degree of plasma expansion, and by extension the local plasma temperature, at the focus of the intense laser light. The reflected patterns could also be used to diagnose the size of the laser focal spot during a high-intensity interaction when using a regular structure with known spacing.
Sugarbeet, grown for biofuel, is being considered as an alternate cool-season crop in the southeastern United States. Previous research identified ethofumesate PRE and phenmedipham + desmedipham POST as herbicides that controlled troublesome cool-season weeds in the region, specifically cutleaf evening-primrose. Research trials were conducted from 2014 through 2016 to evaluate an integrated system of sweep cultivation and reduced rates of ethofumesate PRE and/or phenmedipham+desmedipham POST for weed control in sugarbeet grown for biofuel. There were no interactions between the main effects of cultivation and herbicides for control of cutleaf evening-primrose and other cool-season species in two out of three years. Cultivation improved control of cool-season weeds, but the effect was largely independent of control provided by herbicides. Of the herbicide combinations evaluated, the best overall cool-season weed control was from systems that included either a 1/2X or 1X rate of phenmedipham+desmedipham POST. Either rate of ethofumesate PRE was less effective than phenmedipham+desmedipham POST. Despite improved cool-season weed control, sugarbeet yield was not affected by cultivation each year of the study. Sugarbeet yields were greater when treated with any herbicide combination that included either a 1/2X or 1X rate of phenmedipham+desmedipham POST compared with either rate of ethofumesate PRE alone or the nontreated control. These results indicate that cultivation has a very limited role in sugarbeet grown for biofuel. The premise of effective weed control based on an integration of cultivation and reduced herbicide rates does not appear to be viable for sugarbeet grown for biofuel.
Energy-filtered transmission electron microscopy provides an opportunity to map the nanoscale elemental composition in polymeric systems. Nevertheless, it presents its own set of unique challenges in its application to soft materials. Here, we outline an optimized protocol for elemental mapping in soft materials using sulfur mapping of polymer/fullerene mixtures as an example. Three factors are crucial: (1) focusing at zero-loss, (2) using an objective aperture, and (3) maximizing signal-to-noise and counts for the chosen imaging conditions. Analyzing the corresponding source images, bright field images, and thickness maps can ensure optimum conditions are achieved for elemental mapping of polymers.
The earliest generations of stars were produced in galaxies at high redshift. The physical conditions in which these stars formed, produced heavy elements and dust, and subsequently ended their life cycles, however, are vastly different from those in the Milky Way. Nearby low metal-abundance galaxies provide critical laboratories within which it is possible to observe conditions similar to those at high redshift, shedding light on the lifecycle of dust and metals in the early Universe. Does the process of star formation change at low metallicity? How did galaxies in the early Universe produce significant amounts of dust without the elapsed time necessary for stars to evolve to the asymptotic giant branch (AGB) phase and contribute via mass loss? Here we present work cataloging dust-producing sources in the nearby metal-poor galaxy NGC 6822 and outline forthcoming GTO observations of this system and the blue compact dwarf I Zw 18 with JWST.