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OBJECTIVES/GOALS: The objectives of this presentation are to discuss 1) the implementation of Consent to Contact at an Academic Medical Center; 2) the access to lists of potential participants by study teams; and 3) the challenges and adjustments made to the initial conceptualized process. METHODS/STUDY POPULATION: Participant recruitment is critical to the success of all research studies. It is particularly challenging when investigators do not have a patient population from which to recruit. Thus, the University of Miami launched the CTC initiative in 2016 to facilitate study recruitment. Study investigators can request access to a registry of participants who agreed to be contacted and meet the initial study eligibility criteria. A multidisciplinary Operational Committee provides oversight and regulates access to the CTC registry. RESULTS/ANTICIPATED RESULTS: The registry has over 110K patients who have agreed to be contacted for eligible research studies. The demographic distribution of the patients in the registry mirrors the diversity of the UHealth population. As of January 2018, when the registry became available to the research community, 25 study teams from different departments, including the All of Us Research Program, have requested potential participant lists. The process of requesting access to patient lists is adapted to studies’ needs, with particular reference to sensitive populations, such as HIV/AIDS, substance abuse, etc. Results on utilization and satisfaction of the CTC initiative are being collected and will be presented. DISCUSSION/SIGNIFICANCE OF IMPACT: The CTC initiative allows UHealth patients to opt-in to the registry for research studies. The Operational Committee continues to monitor the successful consent of patients to participate in individual research studies and improving the request process.
Introduction: Crowding is associated with poor patient outcomes in emergency departments (ED). Measures of crowding are often complex and resource-intensive to score and use in real-time. We evaluated single easily obtained variables to establish the presence of crowding compared to more complex crowding scores. Methods: Serial observations of patient flow were recorded in a tertiary Canadian ED. Single variables were evaluated including total number of patients in the ED (census), in beds, in the waiting room, in the treatment area waiting to be assessed, and total inpatient admissions. These were compared with Crowding scores (NEDOCS, EDWIN, ICMED, three regional hospital modifications of NEDOCS) as predictors of crowding. Predictive validity was compared to the reference standard of physician perception of crowding, using receiver operator curve analysis. Results: 144 of 169 potential events were recorded over 2 weeks. Crowding was present in 63.9% of the events. ED census (total number of patients in the ED) was strongly correlated with crowding (AUC = 0.82 with 95% CI = 0.76 - 0.89) and its performance was similar to that of NEDOCS (AUC = 0.80 with 95% CI = 0.76 - 0.90) and a more complex local modification of NEDOCS, the S-SAT (AUC = 0.83, 95% CI = 0.74 - 0.89). Conclusion: The single indicator, ED census was as predictive for the presence of crowding as more complex crowding scores. A two-stage approach to crowding intervention is proposed that first identifies crowding with a real-time ED census statistic followed by investigation of precipitating and modifiable factors. Real time signalling may permit more standardized and effective approaches to manage ED flow.
Positive symptoms are a useful predictor of aggression in schizophrenia. Although a similar pattern of abnormal brain structures related to both positive symptoms and aggression has been reported, this observation has not yet been confirmed in a single sample.
To study the association between positive symptoms and aggression in schizophrenia on a neurobiological level, a prospective meta-analytic approach was employed to analyze harmonized structural neuroimaging data from 10 research centers worldwide. We analyzed brain MRI scans from 902 individuals with a primary diagnosis of schizophrenia and 952 healthy controls.
The result identified a widespread cortical thickness reduction in schizophrenia compared to their controls. Two separate meta-regression analyses revealed that a common pattern of reduced cortical gray matter thickness within the left lateral temporal lobe and right midcingulate cortex was significantly associated with both positive symptoms and aggression.
These findings suggested that positive symptoms such as formal thought disorder and auditory misperception, combined with cognitive impairments reflecting difficulties in deploying an adaptive control toward perceived threats, could escalate the likelihood of aggression in schizophrenia.
The rate of deforestation in the Amazon is increasing. Predictive models estimate that as a result of agricultural expansion 40% of these forests will be lost by 2050. As a consequence the habitat of forest-dwelling species such as the Endangered black-faced black spider monkey Ateles chamek is being lost, particularly along the arc of deforestation in the Brazilian Amazon. We used species distribution modelling to (1) define the distribution of this spider monkey, using environmental predictors, (2) calculate the area of this distribution covered by the protected area network, and (3) calculate the expected loss of the species’ habitat under future scenarios of deforestation. We found that the species occupies only c. 28% of its extent of occurrence. Only 32% of the species’ area of occupancy is legally protected, and the modelling suggests that 31–40% of the species’ habitat will be lost by 2050. We highlight three unprotected regions with extensive forest cover that are predicted to become severely deforested by 2050 as priority regions for expanding the protected area network. We also propose landscape management and restoration in three human-modified regions. Our study provides an example of how species distribution modelling can be applied to assess threats to species and support decision makers in implementing conservation actions.
Suicide has been recognised as one of the major causes of premature death in psychosis. However, predicting suicidal behaviour (SB) is still challenging in the clinical setting and the association of neurocognition with SB in psychosis remains poorly understood. This study aimed to investigate the role of neurocognitive performance as predictor of SB. Also, we sought to explore differences in the evolution of clinical and neurocognitive functioning between participants with/without history of suicide attempts (SA) over follow-up period.
The sample of the study is composed by 517 patients. Sociodemographic, clinical, functional and neurocognitive measures were evaluated at baseline as well as 1-year and 3 years after first episode of psychosis. Bivariate and multivariate analyses explored the influence of these variables as putative baseline predictors of SB. Repeated measures analyses of variance tested differences in clinical and neurocognitive outcomes at 1- and 3-year follow-up.
Global cognitive functioning (GCF) (OR = 1.83, 95% CI = 1.25–2.67) and severe depressive symptoms (OR = 1.17, 95% CI = 1.07–1.28) predicted SB. Longitudinal analyses revealed that patients with SB at follow-up presented with higher levels of remission in terms of positive psychotic symptoms and depression. In addition, those with a history of SB had worse GCF and visual memory than those without such antecedents.
GCF was found to be the most robust predictor of SB along with severe depressive symptomatology. Hence, poorer cognitive performance in FEP appears to emerge as a risk factor for suicidal behaviour from early stages of the illness and a comprehensive neurocognitive assessment may contribute to risk assessment.
Information deficit constrains our capacity to assess the status of threatened species in regional and global contexts. In this study of the endangered Worthen’s Sparrow Spizella wortheni, we first review its current and potential distribution using the species distribution software, Maxent. An initial basic model was constructed using historical records, and used to guide a subsequent search for additional populations in summer 2013. Using the information gathered from our survey, we built a second, breeding model, to update the current and potential species distribution. Population size was estimated using line transects of variable length to count singing males and calculate densities per 10 ha. We found 10 new small reproductive populations dispersed south of the established core area, increasing the extent of occurrence of the species from 25 km2 to almost 17,000 km2. Suitable habitat across the species’ range was more than threefold higher in the breeding compared with the basic model. We counted 316 males, with a mean density of four individuals per 10 ha. Our results demonstrate that conservation assessment based on limited records can exaggerate the vulnerability of species, and confirm that the Worthen’s Sparrow population and geographic distribution range are larger than previously determined, indicating that the Red List status of this species should be reconsidered. The use of niche models was successful in enhancing species information data quantity (e.g. range extensions) and quality (e.g. more precise habitat requirements), facilitating improved understanding of needs and conservation status in the wild.
In humans, maximum brain development occurs between the third trimester of gestation and 2 years of life. Nutrition during these critical windows of rapid brain development might be essential for later cognitive functioning and behaviour. In the last few years, trends on protein recommendations during infancy and childhood have tended to be lower than that in the past. It remains to be demonstrated that lower protein intakes among healthy infants, a part of being able to reduce obesity risk, is safe in terms of mental performance achievement. Secondary analyses of the EU CHOP, a clinical trial in which infants from five European countries were randomised to be fed a higher or a lower protein content formula during the 1st year of life. Children were assessed at the age of 8 years with a neuropsychological battery of tests that included assessments of memory (visual and verbal), attention (visual, selective, focused and sustained), visual-perceptual integration, processing speed, visual-motor coordination, verbal fluency and comprehension, impulsivity/inhibition, flexibility/shifting, working memory, reasoning, visual-spatial skills and decision making. Internalising, externalising and total behaviour problems were assessed using the Child Behaviour Checklist 4–18. Adjusted analyses considering factors that could influence neurodevelopment, such as parental education level, maternal smoking, child’s gestational age at birth and head circumference, showed no differences between feeding groups in any of the assessed neuropsychological domains and behaviour. In summary, herewith we report on the safety of lower protein content in infant formulae (closer to the content of human milk) according to long-term mental performance.
Diatoms are important primary producers in present day Antarctic waters but their relative significance in the past is less clear. In this study we used long-chain diols to reconstruct Proboscia diatom productivity in shelf waters of the western Antarctic Peninsula over the last 8500 yr. Biomarker lipid analysis revealed the presence of a suite of long-chain diols in the sediments, mainly comprising the C28 and C30 1,14-diol isomers derived from Proboscia diatoms and C28 and C30 1,13-diols derived from other unknown algae. The relative importance of Proboscia diatoms was assessed using the relative abundances of 1,14-diols versus 1,13-diols, which showed that Proboscia diatoms were relatively more abundant during the Late Holocene, suggesting that stronger upwelling of circumpolar waters occurred at that time. The variations in the diol index strongly correlate with melt events in the Siple Dome ice core, suggesting that the climatic processes responsible for changes in mean summer temperature, open marine influence and atmospheric cyclonic activity recorded at Siple Dome, also controlled the productivity of Proboscia diatoms on the western Antarctic Peninsula region.
Ticks are blood-feeding arthropods widely distributed in the world and vectors of several diseases. As haematophagy demands evasion strategies and repeatedly infested hosts develop protective immune responses, we investigated the mechanisms of the Rhipicephalus (Boophilus) microplus saliva anti-haemostatic activity and the possible relationship between the acquired natural anti-tick host resistance and anti-haemostatic action. For this purpose, we studied the effects of R. microplus saliva on different pathways of haemostasis and tested whether repeated infested bovine sera (RIBS) are able to abolish salivary anti-haemostatic activities. R. microplus saliva (i) displays inhibitory activity upon collagen-induced platelet aggregation; (ii) inhibits the induction of endothelial pro-coagulant state; and (iii) reduces thrombogenesis in vivo. RIBS were shown to be able to partially block the delay of coagulation and the anti-thrombotic effect of saliva, and to totally abolish the modulation of endothelium activation. Conversely, RIBS has no effect on the inhibition of platelet aggregation. These results show, for the first time, the neutralization ability of sera from acquired resistance hosts against tick anti-haemostatics. Moreover, this is the first report of a haematophagous parasite able to modulate endothelial cell pro-coagulant state, and addresses the presence of anti-platelet and anti-thrombotic activity in R. microplus saliva.
Objective: to establish the prevalence and associations of peer aggression as manifested in preschool children, in community-based populations and to study links with DSM-IV externalizing diagnoses. Method: Subjects were 1,104 children, 3-to-5-year-olds attending rural and urban pre-schools classes. Teachers completed the Peer Conflict Scale (PCS) to inform about direct physical and verbal aggression, object aggression and symbolic aggression and the questionnaire on psychopathology ECI-4. Results: 6.6% (n = 73) had at least one positive item on the PCS. This percentage dropped to 2.6% (n = 29) if we take into account a minimum of three positive items. Physical direct aggression was the more prevalent type of aggressive behavior, followed by verbal aggression, object aggression and symbolic aggression. Significant differences by gender and age were found. Peer aggression was associated with male gender from three years of age. Physical, object and verbal aggressive behavior was linked with externalizing disorders. This association was very strong with oppositional disorder. Conclusions: The present research with a Spanish population confirms the existence of peer aggression in preschoolers and the gender differences. Our chief contribution is about the age of emergence of sex differences and gender differences in different types of peer aggression.
To compare the effectiveness for prevention of central venous and arterial catheter colonization of 3 skin antisepsis with 1 of 3 antiseptic solutions: 10% aqueous povidone iodine (aqueous PI), 2% aqueous chlorhexidine gluconate (aqueous CG), and 0.5% alcoholic chlorhexidine gluconate (alcoholic CG).
Prospective, randomized controlled trial.
Intensive care unit in a teaching hospital.
Patients were randomly assigned to 1 of the 3 skin antisepsis groups. The distal tips of catheters were semiquantitatively cultured when the catheters were no longer necessary or if there was a suspicion of catheter-related infection. Rates of catheter colonization, catheter-related sepsis, and catheter-related bacteremia were compared among the 3 groups.
A total of 631 catheters were included in the study (194 from the aqueous PI group, 211 from the aqueous CG group, and 226 from the alcoholic CG group). The incidence of catheter colonization was significantly lower in the alcoholic CG than in the aqueous PI group (14.2% vs 24.7%; relative risk, 0.5 [95% confidence interval, 0.3-0.8; P < .01]); it was also significantly lower in the aqueous CG group than in the aqueous PI group (16.1 % vs 24.7%; relative risk, 0.6 [95% confidence interval, 0.4-0.9; P = .03]). There were no significant differences between the aqueous CG and the alcoholic CG groups. Incidences of catheter-related bacteremia were similar for all 3 groups. The aqueous and alcoholic CG solutions were superior to the aqueous PI solution in preventing catheter colonization due to gram-positive bacteria.
The aqueous and alcoholic CG solutions for cutaneous antisepsis were similarly effective in preventing colonization of central venous catheters and arterial catheters. Both had significantly lower incidences of colonization than did the aqueous PI solution; this effect seems to be related to the CG solutions' more efficacious prevention of colonization with gram-positive bacteria.
Ticks are important ectoparasites of domestic and wild animals, and tick infestations economically impact cattle production worldwide. Control of cattle tick infestations has been primarily by application of acaricides which has resulted in selection of resistant ticks and environmental pollution. Herein we discuss data from tick vaccine application in Australia, Cuba, Mexico and other Latin American countries. Commercial tick vaccines for cattle based on the Boophilus microplus Bm86 gut antigen have proven to be a feasible tick control method that offers a cost-effective, environmentally friendly alternative to the use of acaricides. Commercial tick vaccines reduced tick infestations on cattle and the intensity of acaricide usage, as well as increasing animal production and reducing transmission of some tick-borne pathogens. Although commercialization of tick vaccines has been difficult owing to previous constraints of antigen discovery, the expense of testing vaccines in cattle, and company restructuring, the success of these vaccines over the past decade has clearly demonstrated their potential as an improved method of tick control for cattle. Development of improved vaccines in the future will be greatly enhanced by new and efficient molecular technologies for antigen discovery and the urgent need for a tick control method to reduce or replace the use of acaricides, especially in regions where extensive tick resistance has occurred.
The aim of the study was to estimate the prevalence and risk factors associated with infection by high-risk human papillomavirus (HR-HPV) in cervix and squamous intra-epithelial lesions (SIL) in imprisoned women. This was done by a cross-sectional study of imprisoned women attending the gynaecological clinic in Foncalent prison in Alicante, Spain. The study period was from May 2003 to December 2005. HR-HPV infection was determined through Digene HPV Test, Hybrid Capture II (HC-II). HPV typing was determined by multiplex nested PCR assay combining degenerate E6/E7 consensus primers. Multiple logistic regression modelling was used for the analysis of associations between variables where some were considered possible confounders after checking for interactions. A total of 219 women were studied. HR-HPV prevalence was 27·4% and prevalence of SIL was 13·3%. HIV prevalence was 18%, higher in Spaniards than in migrant women (24·6% vs. 14·3%, P<0·05). In multivariate analyses, risk factors for HPV infection were younger age (P for trend=0·001) and tobacco use (OR 2·62, 95% CI 1·01–6·73). HPV infection (OR 4·8, 95% CI 1·7–13·8) and HIV infection were associated with SIL (OR 4·8, 95% CI 1·6–14·1). The commonest HPV types were HPV16 (29·4%), HPV18 (17·6%), HPV39 (17·6%) and HPV68 (17·6%). The prevalence of both HR-HPV infection and SIL in imprisoned women found in this study is high. Determinants for each of the outcomes studied were different. HPV infection is the most important determinant for SIL. A strong effect of HIV co-infection on the prevalence of SIL has been detected. Our findings reinforce the need to support gynaecological clinics in the prison setting.
Norovirus belongs to the Caliciviridae family and causes outbreaks of infectious enteritis by fecal-oral transmission. In Spain, there have been few outbreaks reported due to this virus. We describe an outbreak on a long-term-care hospital ward.
Cases were classified as probable, confirmed, and secondary. Stool cultures were performed. Polymerase chain reaction detection of norovirus was also performed.
The outbreak occurred from December 7 to 28, 2001, involving 60 cases (32 patients, 19 staff members, 8 patients' relatives, and 1 relative of a staff member). Most (82%) of the cases were female. The most frequently involved ages were 20 to 39 years for staff members and 70 to 89 years for patients. The incubation period of secondary cases in patients' families had a median of 48 hours (range, 1 to 7 days). Clinical symptoms included diarrhea (85%), vomiting (75%), fever (37%), nausea (23%), and abdominal pain (12%). Median duration of the disease was 48 hours (range, 1 to 7 days). All cases resolved and the outbreak halted with additional hygienic measures. Stool cultures were all negative for enteropathogenic bacteria and rotaviruses. In 16 of 23 cases, the norovirus genotype 2 antigen was detected.
This outbreak of gastroenteritis due to norovirus genotype 2 affected patients, staff members, and their relatives in a long-term-care facility and was controlled in 21 days.
Mega-scale glacial lineations (MSGLs) are longitudinally aligned corrugations (ridge–groove structures 6–100 km long) in sediment produced subglacially. They are indicators of fast flow and a common signature of ice-stream beds. We develop a qualitative theory that accounts for their formation, and use numerical modelling, and observations of ice-stream beds to provide supporting evidence. Ice in contact with a rough (scale of 10–103 m) bedrock surface will mimic the form of the bed. Because of flow acceleration and convergence in ice-stream onset zones, the ice-base roughness elements experience transverse strain, transforming them from irregular bumps into longitudinally aligned keels of ice protruding downwards. Where such keels slide across a soft sedimentary bed, they plough through the sediments, carving elongate grooves, and deforming material up into intervening ridges. This explains MSGLs and has important implications for ice-stream mechanics. Groove ploughing provides the means to acquire new lubricating sediment and to transport large volumes of it downstream. Keels may provide basal drag in the force budget of ice streams, thereby playing a role in flow regulation and stability. We speculate that groove ploughing permits significant ice-stream widening, thus facilitating high-magnitude ice discharge.
Perovskite titanates with nominal stoichiometry ABO3+Δ are frequently reported in SOFC literature as having O3 stoichiometry. Such phases often exhibit quite interesting properties, but are not stoichiometric and the structural characterisation is usually not rigorous. Here we demonstrate how oxygen excess can be incorporated in a titanate perovskite-based lattice as crystallographic oxygen shears giving rise to the homologous series La4Srn−4TinO3n+2. The layered structure is lost for the n=12 member (La4Sr8Ti12O38−Δ), although the oxygen excess is accommodated within the perovskite framework in randomly distributed short-range linear defects. This compound was studied as potential fuel electrode due to its high total conductivity and stability in the most reducing conditions.
Two gravity cores, Gebra-1 and Gebra-2 from the central and eastern basins of Bransfield Strait, West Antarctica, consist mainly of hemipelagic, laminated muds with black layers rich in sand-sized volcanic ash. Micropalaeontological (diatoms and radiolarians) and geochemical (organic and inorganic) analyses, together with radiometric dating (U/Th, 14C and 210Pb) have been performed on both cores. AMS analyses on Total Organic Carbon yielded a 14C-age older than expected, 2810 yr BP for the core top of Gebra-1 and 2596 yr BP for Gebra-2. The downcore pattern of ages indicates a sedimentation rate of 130 cm kyr1 for Gebra-1 and 160 cm kyr1 for Gebra-2 210Pb anomalies suggest the core top of Gebra-1 is present-day sediment. The diatom and radiolarian assemblages are related to the sequence of neoglacial events over the last three millennia. The recent significant reduction in Chaetoceros resting spores is interpreted as a reduction in palaeoproductivity. The progressive increase in sea-ice taxa for the last three millennia may indicate a cooling trend. Greater sea-ice coverage during the coldest neoglacial events in the Bransfield Basin, as well as in the Weddell Sea and Bellingshausen Sea, is documented by increases in sea-ice taxa and reductions in Thalassiosira antarctica/ T. scotia resting spores, Fragilariopsis kerguelensis, the Lithomelissa group and the “circumpolar” group of radiolarians. For these periods, we postulate a restricted communication between the Weddell Sea, Bellingshausen Sea and Bransfield basin. The millenial-scale changes are overprinted by a high frequency cyclicity at about 200–300 yrs, which might be related to the 200–yrs solar cycle.
High-resolution Bottom Parametric Source profiles have revealed details of the sedimentary structure of the upper 150 ms of the sediment drifts off the Pacific margin of Graham Land, Antarctic Peninsula. These profiles show that the dominant process is hemipelagic sedimentation, although instability processes are also important, as shown by the widespread presence of transparent, chaotic and semi-transparent acoustic facies. These new data are relevant to the evaluation of the palaeoenvironmental potential of the sediment drifts and show that the amount of remobilised sediment is significant in some of the drifts.