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It is unclear whether olfactory deficits improve after remission in depressed patients. Therefore, we aimed to assess in drug-free patients the olfactory performance of patients with major depressive episodes (MDE) and its change after antidepressant treatment.
In the DEP-ARREST-CLIN study, 69 drug-free patients with a current MDE in the context of major depressive disorder (MDD) were assessed for their olfactory performances and depression severity, before and after 1 (M1) and 3 (M3) months of venlafaxine antidepressant treatment. They were compared to 32 age- and sex-matched healthy controls (HCs). Olfaction was assessed with a psychophysical test, the Sniffin’ Sticks test (Threshold: T score; Discrimination: D score; Identification: I score; total score: T + D + I = TDI score) and Pleasantness (pleasantness score: p score; neutral score: N score; unpleasantness score: U score).
As compared to HCs, depressed patients had lower TDI olfactory scores [mean (s.d.) 30.0(4.5) v. 33.3(4.2), p < 0.001], T scores [5.6(2.6) v. 7.4(2.6), p < 0.01], p scores [7.5(3.0) v. 9.8(2.8), p < 0.001)] and higher N scores [3.5(2.6) v. 2.1(1.8), p < 0.01]. T, p and N scores at baseline were independent from depression and anhedonia severity. After venlafaxine treatment, significant increases of T scores [M1: 7.0(2.6) and M3: 6.8(3.1), p < 0.01] and p scores [M1: 8.1(3.0) and M3: 8.4(3.3), p < 0.05] were evidenced, in remitters only (T: p < 0.01; P: p < 0.01). Olfaction improvement was mediated by depression improvement.
The olfactory signature of MDE is restored after venlafaxine treatment. This olfaction improvement is mediated by depression improvement.
Many institutions are attempting to implement patient-reported outcome (PRO) measures. Because PROs often change clinical workflows significantly for patients and providers, implementation choices can have major impact. While various implementation guides exist, a stepwise list of decision points covering the full implementation process and drawing explicitly on a sociotechnical conceptual framework does not exist.
To facilitate real-world implementation of PROs in electronic health records (EHRs) for use in clinical practice, members of the EHR Access to Seamless Integration of Patient-Reported Outcomes Measurement Information System (PROMIS) Consortium developed structured PRO implementation planning tools. Each institution pilot tested the tools. Joint meetings led to the identification of critical sociotechnical success factors.
Three tools were developed and tested: (1) a PRO Planning Guide summarizes the empirical knowledge and guidance about PRO implementation in routine clinical care; (2) a Decision Log allows decision tracking; and (3) an Implementation Plan Template simplifies creation of a sharable implementation plan. Seven lessons learned during implementation underscore the iterative nature of planning and the importance of the clinician champion, as well as the need to understand aims, manage implementation barriers, minimize disruption, provide ample discussion time, and continuously engage key stakeholders.
Highly structured planning tools, informed by a sociotechnical perspective, enabled the construction of clear, clinic-specific plans. By developing and testing three reusable tools (freely available for immediate use), our project addressed the need for consolidated guidance and created new materials for PRO implementation planning. We identified seven important lessons that, while common to technology implementation, are especially critical in PRO implementation.
During pregnancy, mothers-to-be should adapt their diet to meet increases in nutrient requirements. Pregnant women appear to be keener to adopt healthier diets, but are not always successful. The objective of the present study was to determine whether a guided, stepwise and tailored dietary counselling programme, designed using an optimisation algorithm, could improve the nutrient adequacy of the diet of pregnant women, beyond generic guidelines. Pregnant women (n 80) who attended Notre-Dame-de-Bon-Secours Maternity Clinic were randomly allocated to the control or intervention arm. Dietary data were obtained twice from an online 3-d dietary record. The nutrient adequacy of the diet was calculated using the PANDiet score, a 100-point diet quality index adapted to the specific nutrient requirements for pregnancy. Women were supplied with generic dietary guidelines in a reference booklet. In the intervention arm, they also received nine sets of tailored dietary advice identified by an optimisation algorithm as best improving their PANDiet score. Pregnant women (n 78) completed the 12-week dietary follow-up. Initial PANDiet scores were similar in the control and intervention arms (60·4 (sd 7·3) v. 60·3 (sd 7·3), P = 0·92). The PANDiet score increased in the intervention arm (+3·6 (sd 9·3), P = 0·02) but not in the control arm (−0·3 (sd 7·3), P = 0·77), and these changes differed between arms (P = 0·04). In the intervention arm, there were improvements in the probabilities of adequacy for α-linolenic acid, thiamin, folate and cholesterol intakes (P < 0·05). Tailored dietary counselling using a computer-based algorithm is more effective than generic dietary counselling alone in improving the nutrient adequacy of the diet of French women in mid-pregnancy.
A higher incidence of psychotic disorders has been consistently reported among black and other minority ethnic groups, particularly in northern Europe. It is unclear whether these rates have changed over time.
We identified all individuals with a first episode psychosis who presented to adult mental health services between 1 May 2010 and 30 April 2012 and who were resident in London boroughs of Lambeth and Southwark. We estimated age-and-gender standardised incidence rates overall and by ethnic group, then compared our findings to those reported in the Aetiology and Ethnicity of Schizophrenia and Other Psychoses (ÆSOP) study that we carried out in the same catchment area around 10 years earlier.
From 9109 clinical records we identified 558 patients with first episode psychosis. Compared with ÆSOP, the overall incidence rates of psychotic disorder in southeast London have increased from 49.4 (95% confidence interval (CI) 43.6–55.3) to 63.1 (95% CI 57.3–69.0) per 100 000 person-years at risk. However, the overall incidence rate ratios (IRR) were reduced in some ethnic groups: for example, IRR (95% CI) for the black Caribbean group reduced from 6.7 (5.4–8.3) to 2.8 (2.1–3.6) and the ‘mixed’ group from 2.7 (1.8–4.2) to 1.4 (0.9–2.1). In the black African group, there was a negligible difference from 4.1 (3.2–5.3) to 3.5 (2.8–4.5).
We found that incidence rates of psychosis have increased over time, and the IRR varied by the ethnic group. Future studies are needed to investigate more changes over time and determinants of change.
Parasites inflict many costs on their hosts. Understanding host–parasite relationship eco-evolutionary dynamics needs appreciation of how parasites affect individual fitness, survival and reproductive potential, and how they combine to influence population demography, dynamics and viability; also, how these processes drive microevolutionary processes that define natural and sexual selection. We synthesise work on the relationship between the red grouse and its main parasite, a gastrointestinal nematode. At individual level, we show how parasites impose a physiological cost, measured by immunosuppression and increased oxidative stress, and how their impact varies depending on contexts. We describe how parasite infection constrains expression of sexually selected traits and summarise how relationships between parasite, host and environment shape host population demography and dynamics. Genetic analyses in red grouse suggest nematode burden is moderately heritable, underpinned by a potentially large array of genes involved in the immune system, energy balance and broader homeostatic processes. There is no clear association between allele frequencies among populations and differences in nematode burdens. Possibly, beneficial alleles for parasite resistance cannot spread through the population due to the strong diversifying e?ects of gene ?ow and genetic drift.
An ageing population leading to more chronic disease is straining healthcare systems. This paper makes two core contributions to healthcare systems design research: Firstly, a systemic techno-behavioural approach is presented to support intervention design with value-effective health outcomes. The systemic techno-behavioural perspective takes into consideration the interaction between three angles: The current healthcare system in place, the technological opportunities for addressing an issue and a broader and deeper understanding of the behaviour of those involved. The purpose of considering these three angels is to create interventions that are more robust. This will help inform healthcare systems design researchers and other stakeholders. Secondly, it is proposed that interventions should be grounded in behavioural theory, a collection of theories are presented to be incorporated in the design process of interventions. The systemic techno-behavioural approach is applied to dementia care highlighting the need to understand the dynamic relationship between the context of the current healthcare delivery system, technology, and behaviour to improve quality of care during the progression of the disease.
New technological methods, such as rapidly developing molecular approaches, often provide new tools for scientific advances. However, these new tools are often not utilized equally across different research areas, possibly leading to disparities in progress between these areas. Here, we use empirical evidence from the scientific literature to test for potential discrepancies in the use of genetic tools to study parasitic vs non-parasitic organisms across three distinguishable molecular periods, the allozyme, nucleotide and genomics periods. Publications on parasites constitute only a fraction (<5%) of the total research output across all molecular periods and are dominated by medically relevant parasites (especially protists), particularly during the early phase of each period. Our analysis suggests an increasing complexity of topics and research questions being addressed with the development of more sophisticated molecular tools, with the research focus between the periods shifting from predominantly species discovery to broader theory-focused questions. We conclude that both new and older molecular methods offer powerful tools for research on parasites, including their diverse roles in ecosystems and their relevance as human pathogens. While older methods, such as barcoding approaches, will continue to feature in the molecular toolbox of parasitologists for years to come, we encourage parasitologists to be more responsive to new approaches that provide the tools to address broader questions.
We report an abrupt change in the diffusive transport of inertial objects in wave-driven turbulence as a function of the object size. In these non-equilibrium two-dimensional flows, the turbulent diffusion coefficient
of finite-size objects undergoes a sharp change for values of the object size
close to the flow forcing scale
. For objects larger than the forcing scale (
), the diffusion coefficient is proportional to the flow energy
and inversely proportional to the size
. This behaviour,
, observed in a chaotic macroscopic system is reminiscent of a fluctuation–dissipation relation. In contrast, the diffusion coefficient of smaller objects (
. This result does not allow simple analogies to be drawn but instead it reflects strong coupling of the small objects with the fabric and memory of the out-of-equilibrium flow. In these turbulent flows, the flow structure is dominated by transient but long-living bundles of fluid particle trajectories executing random walk. The characteristic widths of the bundles are close to
. We propose a simple phenomenology in which large objects interact with many bundles. This interaction with many degrees of freedom is the source of the fluctuation–dissipation-like relation. In contrast, smaller objects are advected within coherent bundles, resulting in diffusion properties closely related to those of fluid tracers.
The identification of threats to migratory species of conservation concern and the relevance of protected areas for them is often biased towards breeding areas. The European Roller Coracias garrulus is a long-distance migrant experiencing a pronounced decline throughout its breeding range, which has been attributed to the degradation of open agricultural habitats. However, its conservation status in non-breeding areas in Africa remains unstudied. Land cover change is a major threat affecting migratory birds in their wintering grounds, therefore identifying important areas for their protection at this stage is a priority. Here we used occurrence data during the wintering season and ecological niche models to identify key land cover and areas used by Rollers in Africa. First, we used 33 filtered locations from six satellite-tracked birds breeding in Spain to describe suitable wintering areas for the Spanish population (westernmost part of the Eurasian breeding range). We also used 1,167 occurrence data in southern Africa from open-access databases and bird atlases to characterise the overall wintering range of the species. The Spanish population occupied a relatively small area in the north-western part of southern Africa, and a narrow range of land covers. Open grassland, less steep areas and those with sparse tree cover are correlated with suitability. In all, 18.06% of suitable wintering areas for the Spanish population overlapped with protected areas. The overall population of Rollers occupied a wider area and range of land cover. Tree cover was the most important variable affecting suitability, with areas without tree cover being the least suitable. We found that 9.58% of suitable wintering areas for the overall population overlapped with protected areas. Our results suggest that Rollers from different origins (breeding populations) use separate, but overlapping, wintering areas and may have different habitat requirements, and therefore, population-specific conservation strategies in these areas might be needed to fully protect the species.
Pallid breath-holding spells are common and dramatic forms of recurrent syncope in infancy. They are very stressful despite their harmless nature and sometimes require treatment.
The objective of this study was to evaluate the efficacy of belladonna in severe breath-holding spells.
This is a multicentric, retrospective series involving 84 children with severe pallid breath-holding spells. Inclusion criteria were >1 pallid breath-holding spell with loss of consciousness, paediatric cardiology evaluation, and follow-up >6 months. In total, 45 patients received belladonna and 39 patients did not receive treatment, according to physician preference.
Mean age was 11 months, ranging from 4 to 18 months, with 54% of males. Mean spell duration was 30 seconds (interquartile range 15, 60), and the frequency was four episodes per month (interquartile range 0.5, 6.5). Comparison of baseline characteristics between groups showed similar demographics, with the single difference in the severity of the spells, being more severe in the treated group. When comparing the treated and non-treated groups at 3 months, only two (5%) patients had a complete remission in the first group, whereas 20 (44%) had remission in the belladonna group (p<0.01). When considering the characteristics of the spells before and after the initiation of treatment with belladonna, 75% of the patients presented a positive response, with 44% of the patients presenting with complete resolution of the spells (p<0.01). No major adverse reaction was reported, with only 5% minor adverse events.
Belladonna is highly effective to alleviate severe breath-holding spells in young children, without any major adverse effects.
To make pragmatic recommendations on best practices for the engagement of patients in emergency medicine (EM) research.
We created a panel of expert Canadian EM researchers, physicians, and a patient partner to develop our recommendations. We used mixed methods consisting of 1) a literature review; 2) a survey of Canadian EM researchers; 3) qualitative interviews with key informants; and 4) feedback during the 2017 Canadian Association of Emergency Physicians (CAEP) Academic Symposium.
We synthesized our literature review into categories including identification and engagement, patients’ roles, perceived benefits, harms, and barriers to patient engagement; 40/75 (53% response rate) invited researchers completed our survey. Among respondents, 58% had engaged patients in research, and 83% intended to engage patients in future research. However, 95% stated that they need further guidance to engage patients. Our qualitative interviews revealed barriers to patient engagement, including the need for training and patient partner recruitment.
Our panel recommends 1) an overarching positive recommendation to support patient engagement in EM research; 2) seven policy-level recommendations for CAEP to support the creation of a national patient council, to develop, adopt and adapt training material, guidelines, and tools for patient engagement, and to support increased patient engagement in EM research; and 3) nine pragmatic recommendations about engaging patients in the preparatory, execution, and translational phases of EM research.
Patient engagement can improve EM research by helping researchers select meaningful outcomes, increase social acceptability of studies, and design knowledge translation strategies that target patients’ needs.
Glyphosate-resistant populations of Conyza canadensis have been spreading at a rapid rate in Ontario, Canada, since first being documented in 2010. Determining the genetic relationship among existing Ontario populations is necessary to understand the spread and selection of the resistant biotypes. The objectives of this study were to: (1) characterize the genetic variation of C. canadensis accessions from the province of Ontario using simple sequence repeat (SSR) markers and (2) investigate the molecular mechanism (s) conferring resistance in these accessions. Ninety-eight C. canadensis accessions were genotyped using 8 SSR markers. Germinable accessions were challenged with glyphosate to determine their dose response, and the sequences of 5-enolpyruvylshikimate-3-phosphate synthase genes 1 and 2 were obtained. Results indicate that a majority of glyphosate-resistant accessions from Ontario possessed a proline to serine substitution at position 106, which has previously been reported to confer glyphosate resistance in other crop and weed species. Accessions possessing this substitution demonstrated notably higher levels of resistance than non–target site resistant (NTSR) accessions from within or outside the growing region and were observed to form a subpopulation genetically distinct from geographically proximate glyphosate-susceptible and NTSR accessions. Although it is unclear whether other non–target site resistance mechanisms are contributing to the levels of resistance observed in target-site resistant accessions, these results indicate that, at a minimum, selection for Pro-106-Ser has occurred in addition to selection for non–target site resistance and has significantly enhanced the levels of resistance to glyphosate in C. canadensis accessions from Ontario.