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Major lower extremity amputations (MLEAs) are understood to be well recorded in secondary care in England in the Hospital Episode Statistics (HES) database. It is unclear how well MLEAs are recorded in primary care databases.
This study compared MLEA event case ascertainment in Clinical Practice Research Datalink (CPRD) to that in HES.
MLEA events were ascertained in CPRD and in HES linkage between 1 January 2010 and 31 December 2019. The number of MLEA events and the number of patients with at least one MLEA in each database were recorded and compared. Individual events were matched between the databases using varying date-matching windows. Reasons for differences in case ascertainment were explored.
In total 23 262 patients had at least one MLEA record, 8716 (37.5%) had an MLEA record in HES only, 5393 (23.2%) in CPRD only and 9153 (39.4%) in both. Out of a total of 75 221 events, 13 071 (62.4%) were recorded in HES only and 44 151 (81.3%) in CPRD only. 7874 (37.6%) of HES events were recorded in CPRD and 10 125 (18.6%) of CPRD events were recorded in HES when using the maximum date matching window of 28 days plus the time between admission and procedure. The main reasons for differences in case ascertainment included, re-recordings and miscoding in CPRD.
Compared to HES, MLEAs are poorly recorded in CPRD predominantly due to re-recordings of events and miscoding procedures. CPRD data cannot solely be relied upon to ascertain cases of MLEA; however, HES linkage to CPRD may be useful to obtain medical history of diagnoses, medication and diagnostic tests.
Individuals with autism spectrum disorder (ASD) struggle accessing psychotherapy services for comorbidities, including anxiety-, depressive- and obsessive-compulsive disorders (OCD). Apart from cognitive behavioural therapy (CBT) for anxiety in children with ASD, it is unclear whether psychotherapy is effective for these comorbid disorders.
We therefore systematically reviewed any form of psychotherapy for co-occurring symptoms of anxiety, depression and OCD in individuals with ASD.
Database searches were conducted until February 2022 using EMBASE, PsycINFO and PubMed. Randomised controlled trials (RCT) were included investigating any form of psychotherapy for symptoms of anxiety, depression and OCD in individuals with ASD. Summary data were extracted, and random-effects meta-analyses were conducted.
For CBT 26 RCTs (n = 1251), and for social skills training (SST) 11 RCTs (n = 475) met criteria for inclusion. Pooled effect sizes indicated a moderate reduction of anxiety in children (g = −0.70) and a small reduction of depressive symptoms in adults (g = −0.39). For SST overall effect sizes were small for reduction of anxiety in children (g = −0.35) and adults (g = −0.34) and moderate for reduction of depressive symptoms in children (g = −0.50). Risk of bias was high in 18, moderate in 16 and low in 3 RCTs.
Our results provide new and age-specific evidence that: (1) CBT is effective for reducing anxiety in children and to a lesser extent for depressive symptoms in adults with ASD; and (2) social skills interventions are effective for reducing anxiety in children and adults and for depressive symptoms in children with ASD.
An interatrial communication is present in most neonates. The majority are considered the “normal” patency of the oval foramen, while a minority are abnormal atrial septal defects. Differentiation between the two with transthoracic echocardiography may be challenging, and no generally accepted method of classification is presently available. We aimed to develop and determine the reliability of a new classification of interatrial communications in newborns.
Methods and Results:
An algorithm was developed based on echocardiographic criteria from 495 newborns (median age 11[8;13] days, 51.5% females). The algorithm defines three main categories: patency of the oval foramen, atrial septal defect, and no interatrial communication as well as several subtypes. We found an interatrial communication in 414 (83.6%) newborns. Of these, 386 (93.2%) were categorised as patency of the oval foramen and 28 (6.8%) as atrial septal defects.
Echocardiograms from another 50 newborns (median age 11[8;13] days, 36.0% female), reviewed by eight experts in paediatric echocardiography, were used to assess the inter- and intraobserver variation of classification of interatrial communications into patency of the oval foramen and atrial septal defect, with and without the use of the algorithm. Review with the algorithm gave a substantial interobserver agreement (kappa = 0.66), and an almost perfect intraobserver agreement (kappa = 0.82). Without the use of the algorithm, the interobserver agreement between experienced paediatric cardiologists was low (kappa = 0.20).
A new algorithm for echocardiographic classification of interatrial communications in newborns produced almost perfect intraobserver and substantial interobserver agreement. The algorithm may prove useful in both research and clinical practice.
The internet has expanded opportunities for wildlife traders to conduct business globally, but monitoring this activity is often challenging. As monitoring techniques frequently employ language-based searches for particular words, it is important to understand the language traders use, particularly the nomenclature used to refer to traded species. We recorded advert data from four UK websites, focusing on reptiles, which constitute a large proportion of the international pet trade. We analysed whether the language types used by advertisers to refer to individual reptiles were associated with certain trader characteristics. We found English common names were the most frequent name type used to refer to species, regardless of the geographical location of the seller and the CITES Appendix listing of the species. However, scientific names were recorded in twice as many adverts for threatened and Near Threatened species as in adverts for non-threatened species, and only scientific names were used for three families: Anguidae, Pseudaspididae and Sphaerodactylidae. These findings could inform the creation of tailored keyword detection tools, which must account for the numerous language types in use within online wildlife trade communities. Future studies should examine the nuances of language used by other online wildlife trader communities in other contexts, such as different online platforms or different languages. The ultimate aim of these language detection tools will be to track in detail trends in the online reptile trade, offering a better understanding of potentially unsustainable trade patterns and helping authorities to enforce laws against illegal online reptile trade.
Since 2014, Chinese courts have placed tens of millions of court judgments online. We analyze the promise and pitfalls of using this new data source, highlighting takeaways for readers facing similar issues using other collections of legal texts. Drawing on 1,058,986 documents from Henan Province, we identify problems with missing data and call on scholars to treat variation in court disclosure rates as an urgent research question. We also outline strategies for learning from a corpus that is vast and incomplete. Using a topic model of administrative litigation in Henan, we complicate conventional wisdom that administrative lawsuits are an extension of contentious politics that give Chinese citizens an opportunity to challenge the state. Instead, we find a high prevalence of administrative cases that reflect an underlying dispute between two private parties, suggesting that administrative lawsuits are often an attempt to enlist help from the state in resolving an underlying civil dispute.
An increasing number of children, adolescents and adults with intellectual disabilities and/or autism are being admitted to general psychiatric wards and cared for by general psychiatrists.
The aim of this systematic review was to consider the likely effectiveness of in-patient treatment for this population, and compare and contrast differing models of in-patient care.
A systematic search was completed to identify papers where authors had reported data about the effectiveness of in-patient admissions with reference to one of three domains: treatment effect (e.g. length of stay, clinical outcome, readmission), patient safety (e.g. restrictive practices) and patient experience (e.g. patient or family satisfaction). Where possible, outcomes associated with admission were considered further within the context of differing models of in-patient care (e.g. specialist in-patient services versus general mental health in-patient services).
A total of 106 studies were included and there was evidence that improvements in mental health, social functioning, behaviour and forensic risk were associated with in-patient admission. There were two main models of in-patient psychiatric care described within the literature: admission to a specialist intellectual disability or general mental health in-patient service. Patients admitted to specialist intellectual disability in-patient services had greater complexity, but there were additional benefits, including fewer out-of-area discharges and lower seclusion rates.
There was evidence that admission to in-patient services was associated with improvements in mental health for this population. There was some evidence indicating better outcomes for those admitted to specialist services.
The infestation of the fall armyworm (FAW), Spodoptera frugiperda (J.E. Smith) (Lepidoptera: Noctuidae) in Africa since 2016 has been a major threat to maize production. Previous studies in Togo and Ghana from 2016 to 2018 did not correlate FAW infestation to yield losses. Thus, the aim of this study which assesses the impact of FAW infestation by inspecting 150 maize farms throughout the five Agro-Ecological Zones (AEZs) of Togo for FAW plant damage, and third instar larvae were used to infest 10-day-old maize plants in netted plots under controlled conditions at an experiment station (Station d'Expérimentations Agronomiques de Lomé) in 2019 and 2020. As control plots at the experiment station, plots were both netted and treated with emamectin benzoate, simply netted, or open to natural infestation. The number of larvae, egg masses, percent damaged plants, and damage proportions of leaves and ears were scored until harvest. Infestations and damages on maize plant throughout Togo were similar between the two years but were higher in the southern part of the county (AEZ5). At the experiment station, the yield losses were significantly considerable and increased from 25% infestation. The losses were 0.37 t ha−1 for 25% infestation, 0.34 t ha−1 for 30%, 0.59 t ha−1 for the open plots, 0.70 t ha−1 for simple netted and 50% infestation, 1.03 t ha−1 for 75%, and 1.27 t ha−1 for 100% infestation. This current study suggested thorough inspection on maize farms to set off management practices from 25% of infestation.
The Atlantic Forest of South America supports a rich terrestrial biodiversity but has been reduced to only a small extent of its original forest cover. It hosts a large number of endemic mammalian species but our knowledge of arboreal mammal ecology and conservation has been limited because of the challenges of observing arboreal species from ground level. Camera trapping has proven to be an effective tool in terrestrial mammal monitoring but the technique has rarely been used for arboreal species. For the first time in the Atlantic Forest, we obtained data on the arboreal mammal community using arboreal camera trapping, focusing on Caparaó National Park, Brazil. We placed 24 infrared camera traps in the forest canopy in seven areas within the Park, operating them continuously during January 2017–June 2019. During this period the camera traps accumulated 4,736 camera-days of footage and generated a total of 2,256 photographs and 30-s videos of vertebrates. The arboreal camera traps were able to detect arboreal mammals of a range of body sizes. The mammal assemblage comprised 15 identifiable species, including the Critically Endangered northern muriqui Brachyteles hypoxanthus and buffy-headed marmoset Callithrix flaviceps as well as other rare, nocturnal and inconspicuous species. We confirmed for the first time the occurrence of the thin-spined porcupine Chaetomys subspinosus in the Park. Species richness varied across survey areas and forest types. Our findings demonstrate the potential of arboreal camera trapping to inform conservation strategies.
Injury to quizalofop-resistant rice was reported in some fields following postemergence applications of quizalofop. Glyphosate-resistant (GR) corn, cotton, and soybean, and imidazolinone-resistant rice are grown near quizalofop-resistant rice. Herbicide drift from glyphosate and imazethapyr and the resulting crop injury and potential yield loss is a cause of concern for producers. Field experiments conducted near Colt, and Keiser, AR, in 2021 evaluated whether low rates of glyphosate or imazethapyr interact with sequential quizalofop applications to exacerbate injury to quizalofop-resistant rice compared to quizalofop applications alone. Herbicide treatments consisted of a low rate of glyphosate (90 g ae ha−1) or imazethapyr (10.7 g ai ha−1) applied 10, 7, 4, and 0 d before the 2-leaf growth stage of rice, and glyphosate or imazethapyr, at the same rate and timings, followed by quizalofop at 120 g ai ha−1 applied to 2-leaf rice. All plots treated with quizalofop received a subsequent application of the same herbicide and rate at the 5-leaf rice stage. At 28 d after final treatment (DAFT), glyphosate followed by quizalofop the same day to 2-leaf rice caused 77% injury compared with 58% when glyphosate was applied alone, regardless of location. Glyphosate followed by quizalofop the same day reduced rough rice grain yield by 67% compared with 33% when glyphosate was applied alone to 2-leaf rice at the Colt location. Application of imazethapyr followed by quizalofop the same day to 2-leaf rice caused more injury (63% and 19% injury at the Colt and Keiser locations, respectively) than imazethapyr alone (42% and 7% injury at the Colt and Keiser locations, respectively) at 35 DAFT. Overall, glyphosate and imazethapyr followed by quizalofop applications worsened injury compared to glyphosate, imazethapyr, and quizalofop applications alone. As the interval between exposure to a low rate of glyphosate or imazethapyr and quizalofop decreases, the detrimental effect of herbicide on rice likewise increases.
Congenital heart disease (CHD) encompasses a large collection of cardiac malformations discovered at or before birth. CHD has an incidence of 4 – 50/1000 live births annually. One quarter of these require surgery shortly after birth. Newborn heart surgery has substantially changed since the modern era began with the adaptation of adult cardiopulmonary bypass (CPB) circuitry for infants. After decades of progress, the center of focus has now shifted from survival to the quality of life following newborn heart surgery (NBHS). Indeed, neurodevelopmental disabilities are now considered the single most common sequela of NBHS. Clinical management in the peri-operative period has a significant impact on the infants’ long-term outcomes. Consequently, neurological monitoring in the congenital heart disease population is increasing worldwide. With so many infants undergoing NBHS, the field of neuromonitoring for these patients is wide. In this chapter, we first review the neurological effects of hypothermia and the actual conduct of newborn heart surgery. We then discuss the indications for neuromonitoring and summarize its findings and outcomes in this unique population.
Double-cropping winter rye cover crops (CC) with soybean in the North Central US could help with the global effort to sustainably intensify agriculture. Studies addressing the management of these systems are limited. Therefore, a field study was conducted from 2017 to 2019 in Central Iowa, US to evaluate winter rye CC biomass production, aboveground N accumulation, estimated economics, estimated within-field energy balance and estimated greenhouse gas (GHG) emissions under three N application rates (0, 60, 120 kg N ha−1) and three planting methods (pre- and post-harvest broadcast and post-harvest drilling). Averaged over N rates, all planting methods resulted in >5.0 Mg ha−1 year−1 rye aboveground biomass dry matter. Averaged over the 2-year study and compared with unfertilized treatments, applying 60 kg N ha−1 produced 1.1 Mg ha−1 more aboveground biomass (6.1 vs 5.0 Mg ha−1), accumulated 30 kg ha−1 more N in aboveground biomass (88 vs 58 kg N ha−1), and led to 20 GJ ha−1 more net energy. Biomass production was not significantly higher with 120 kg N ha−1 compared with the 60 kg N ha−1 rate. Even when accounting for an estimated 0.75 Mg ha−1 of above ground rye biomass left in the field after harvesting, more N was removed than applied at the 60 kg N ha−1 rate. The minimum rye prices over the 2-year study needed for double-cropping winter rye CC to be profitable (breakeven prices) averaged $117 and $104 Mg−1 for the 0 and 60 kg N ha−1 rates, which factors in estimated soybean yield reductions in 2019 compared with local averages but not off-site transportation. GHG emissions were estimated to increase approximately threefold between the unfertilized and 60 kg N ha−1 rates without considering bioenergy offsets. While environmental tradeoffs need further study, results suggest harvesting fertilized rye CC biomass before planting soybean is a promising practice for the North Central US to maximize total crop and net energy production.
Background. Cognitive impairment in schizophrneia is highly prevalent, the level of impairment range from moderate to severe. It has previously beed stated that cognitive impairment was stable through the course of illness, but newer finding from long-term studies indicate that some patient have improved cognitive function. Cognitive function is marginally reactive to antipsychotic medication, and it is highly predictive of poor social and vocational outcome. Also, it constitute a ‘glass ceiling’ for psychosocial and vocational rehabilitation. Several large batteries have been developed, and internationally, there is an attempt to agree on common measurements of core areas. There is a strong rationale for cognitive remediation, namly that it might improve the ability of patients to function in everyday life and that it has no side effects. Individuals at ultra-high risk (UHR) for psychosis have significant cognitive deficits that can impede functional recovery. Methods. In this randomised, clinical trial 146 individuals at UHR for psychosis were randomly assigned to treatment as usual (TAU) or TAU plus cognitive remediation. The CR targeted neurocognitive and social cognitive remediation. Results. A total of 73 UHR individuals were assigned to TAU and 73 assigned to TAU + cognitive remediation. Cognitive remediation did not result in significant improvement on the primary outcome; the Brief Assessment of Cognition in Schizophrenia composite score at 6-month follow-up (b=-0.125, 95%CI: -0.23 to 0.172, p=0.41). Conclusion. The 20-session treatment protocol was not well received in the UHR group. Possibly situations close to everyday life could be better received and be more motivating
Dicamba was labeled in dicamba-resistant cotton (Gossypium hirsutum L.) and soybean [Glycine max (L.) Merr.] in 2017, resulting in a record number of off-target complaints. To address off-target movement via volatilization, experiments were conducted to evaluate the effectiveness of potassium tetraborate tetrahydrate (KBo) as a volatility-reducing agent (VRA) with dicamba. Low-tunnel experiments examined: (1) whether KBo functions as a dicamba VRA, (2) the relationship between KBo concentration and dicamba volatilization, (3) the effectiveness of KBo compared with potassium acetate as a VRA, and (4) the impact of KBo on dicamba volatilization with and without glufosinate. In a large-scale trial (0.4-ha plots), the effectiveness of KBo in reducing dicamba volatilization was quantified relative to a commercial dicamba application labeled for use in 2020. The addition of KBo to dicamba reduced volatility over dicamba alone and a dicamba plus potassium acetate premix. As KBo concentration increased in the dicamba spray solution, volatilization was exponentially reduced. Dicamba volatilization with the addition of KBo at 0.01 M was comparable to dicamba plus potassium acetate at 0.05 M. Potassium tetraborate tetrahydrate was more effective than potassium acetate at reducing volatility of a dicamba plus glufosinate mixture. In large-scale experiments over a 30-h period, the addition of KBo to a diglycolamine plus glyphosate mixture lowered dicamba volatilization 82% to 89% over the herbicide mixture alone. Overall, the addition of KBo to dicamba appears promising as a VRA compared with what is commercially available.
The New York Bight is undergoing rapid anthropogenic change amidst an apparent increase in baleen whale sightings. Though survey efforts have increased in recent years, the lack of published knowledge on baleen whale occurrence prior to these efforts impedes effective assessments of distributional or behavioural shifts due to increasing human activities. Here we synthesize opportunistic sightings of baleen whales from 1998–2017, which represent the majority of sightings data prior to recent survey efforts, and which are largely unpublished. Humpback and fin whales were the most commonly sighted species, followed by North Atlantic right whales and North Atlantic minke whales. Important behaviours such as feeding and nursing were observed, and most species (including North Atlantic right whales) were seen during all seasons. Baleen whales overlapped with multiple anthropogenic use areas, and all species, but of particular importance North Atlantic right whales, were sighted outside the spatial and temporal bounds of the Seasonal Management Areas for North Atlantic right whales. These opportunistic data are vital for providing a baseline and context of baleen whales in the New York Bight prior to broad-scale efforts and facilitate interpretation of current and future observations and trends, which can more accurately inform effective management and mitigation efforts.
Mental health was only modestly affected in adults during the early months of the COVID-19 pandemic on the group level, but interpersonal variation was large.
We aim to investigate potential predictors of the differences in changes in mental health.
Data were aggregated from three Dutch ongoing prospective cohorts with similar methodology for data collection. We included participants with pre-pandemic data gathered during 2006–2016, and who completed online questionnaires at least once during lockdown in The Netherlands between 1 April and 15 May 2020. Sociodemographic, clinical (number of mental health disorders and personality factors) and COVID-19-related variables were analysed as predictors of relative changes in four mental health outcomes (depressive symptoms, anxiety and worry symptoms, and loneliness), using multivariate linear regression analyses.
We included 1517 participants with (n = 1181) and without (n = 336) mental health disorders. Mean age was 56.1 years (s.d. 13.2), and 64.3% were women. Higher neuroticism predicted increases in all four mental health outcomes, especially for worry (β = 0.172, P = 0.003). Living alone and female gender predicted increases in depressive symptoms and loneliness (β = 0.05–0.08), whereas quarantine and strict adherence with COVID-19 restrictions predicted increases in anxiety and worry symptoms (β = 0.07–0.11).Teleworking predicted a decrease in anxiety symptoms (β = −0.07) and higher age predicted a decrease in anxiety (β = −0.08) and worry symptoms (β = −0.10).
Our study showed neuroticism as a robust predictor of adverse changes in mental health, and identified additional sociodemographic and COVID-19-related predictors that explain longitudinal variability in mental health during the COVID-19 pandemic.
Pleistocene periglacial activity in eastern Australia was widespread and has been predicted to have extended along much of the east coast. This paper describes block deposits in the New England Tablelands, Australia, as far north as 30°S. These deposits are characterized by openwork blocks on slopes below the angle of repose. The deposits are positioned where frost cracking was significant and range in area up to 8 ha. Surface exposure dating using the cosmogenic nuclide 36Cl from four block deposits indicate all sites were active late during the last glacial cycle, with a concentration of activity between 15–30 ka. Modern temperature measurements from block deposits highlight the importance of local topography for promoting freezing. Periglacial deposits are likely to have been more extensive than previously recognized at these northern limits, and mean annual temperature more than 8°C colder than today.