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We analyse United States presidential appointee positions subject to Senate confirmation without a confirmed appointee in office. These “vacant” positions are byproducts of American constitutional design, shaped by the interplay of institutional politics. Using a novel dataset, we analyse appointee vacancies across executive branch departments and single-headed agencies from 1989 to 2013. We develop a theoretical model that uncovers the dynamics of vacancy onset and length. We then specify an empirical model and report results highlighting both position and principal–agent relations as critical to the politics of appointee vacancies. Conditional on high status positions reducing the frequency and duration of vacancies, we find important principal–agent considerations from a separation of powers perspective. Appointee positions in agencies ideologically divergent from the relevant Senate committee chair are vacant for less time than in ideologically proximal agencies. Importantly, this relationship strengthens as agency ideology diverges away from the chair and towards the chair’s party extreme.
Wild radish (Raphanus raphanistrum L.) is a weed found globally in agricultural systems. The facultative winter annual nature of this plant and high genetic variability makes modeling its growth and phenology difficult. In the present study, R. raphanistrum natural seed banks exhibited a biphasic pattern of emergence, with emergence peaks occurring in both fall and spring. Traditional sigmoidal models were inadequate to fit this pattern, regardless of the predictive environmental variable, and a corresponding biphasic model (sigmoidal + Weibull) was used to describe emergence based on the best parameters. Each best-fit chronological, thermal, and hydrothermal model accounted for at least 85% of the variation of the validation data. Observations on phenology progression from four cohorts were used to create a common model that described all cohorts adequately. Different phenological stages were described using chronological, thermal, hydrothermal, day length dependent thermal time, and day length dependent hydrothermal time. Integrating day length and temperature into the models was important for predicting reproductive stages of R. raphanistrum.
Prolonged survival of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on environmental surfaces and personal protective equipment may lead to these surfaces transmitting this pathogen to others. We sought to determine the effectiveness of a pulsed-xenon ultraviolet (PX-UV) disinfection system in reducing the load of SARS-CoV-2 on hard surfaces and N95 respirators.
Chamber slides and N95 respirator material were directly inoculated with SARS-CoV-2 and were exposed to different durations of PX-UV.
For hard surfaces, disinfection for 1, 2, and 5 minutes resulted in 3.53 log10, >4.54 log10, and >4.12 log10 reductions in viral load, respectively. For N95 respirators, disinfection for 5 minutes resulted in >4.79 log10 reduction in viral load. PX-UV significantly reduced SARS-CoV-2 on hard surfaces and N95 respirators.
With the potential to rapidly disinfectant environmental surfaces and N95 respirators, PX-UV devices are a promising technology to reduce environmental and personal protective equipment bioburden and to enhance both healthcare worker and patient safety by reducing the risk of exposure to SARS-CoV-2.
The Clinical and Translational Science Award (CTSA) Program is a Consortium of nearly 60 academic medical research centers across the USA and a natural network for evaluating the spread and uptake of translational research innovation across the Consortium.
Dissemination of the Accrual to Clinical Trials (ACT) Network, a federated clinical informatics data network for population-based cohort discovery, began January 2018 across the Consortium. Diffusion of innovation theory guided dissemination design and evaluation. Mixed-methods assessed the spread and uptake across the Consortium through July 1, 2019 (n = 48 CTSAs). Methods included prospective time activity tracking (Kaplan–Meier curves), and survey and qualitative interviews.
Within 18 months, nearly 80% of CTSAs had joined the data network and two-thirds of CTSAs achieving technical readiness had initiated launch to local clinical investigators. Over 10,000 ACT Network queries are projected for 2019; and by 2020, nearly all CTSAs will have joined the network. Median time-from-technical-readiness-to-local-launch was 154 days (interquartile range: 87–225 days]. Quality improvement processes reduced time-to-launch by 35.2% (64 days, p = 0.0036). Lessons learned include: (1) conceptualize dissemination as two-stage adoption demonstrating value for both CTSA hub service providers and clinical investigators; (2) include institutional trial into dissemination strategies so CTSA hubs can refine internal workflows and gather local user feedback endorsement; (3) embrace designing-for-dissemination during technology development; and (4) sustain adaptive dissemination and customer relationship management to keep CTSA hubs and users engaged.
Scale-up and spread of the ACT Network provides lessons learned for others disseminating innovation across the CTSA Consortium. The Network is primed for embedded implementation research.
Results of in situ U–Pb dating of calcite spherulites, cone-in-cone (CIC) calcite and calcite fibres from a calcareous concretion of the upper Ediacaran of Finnmark, Arctic Norway, are reported. Calcite spherulites from the innermost layers of the concretion yielded a lower intercept age of 563 ± 70 Ma, which, although imprecise, is within uncertainty of the age of sedimentation based on fossil assemblages. Non-deformed CIC calcite from the bottom part of the concretion yielded an age of 475 ± 25 Ma, which is interpreted as the age of CIC calcite formation during a period of fluid overpressure induced during burial of the sediments. Deformed CIC calcite from the top part of the concretion yielded an age of 418 ± 23 Ma, which overlaps with a known Caledonian tectono-metamorphic event, and indicates a potential post-depositional overprint at this time. Calcite fibres that grew in small fissures along spherulite rims, which are interpreted as a recrystallization feature during deformation and formation of a cleavage, gave an imprecise age of 486 ± 161 Ma. Our results show that U–Pb dating of calcite can provide age constraints for ancient carbonates and syn- to post-depositional processes that operated during burial and metamorphic overprinting.
Right cerebellar-left frontal (RC-LF) white matter integrity (WMI) has been associated with working memory. However, prior studies have employed measures of working memory that include processing speed and attention. We examined the relationships between the RC-LF WMI and processing speed, attention, and working memory to clarify the relationship of RC-LF WMI with a specific cognitive function. Right superior longitudinal fasciculus II (SLF II) WMI and visual attention were included as a negative control tract and task to demonstrate a double dissociation.
Adult survivors of childhood brain tumors [n = 29, age: M = 22 years (SD = 5), 45% female] and demographically matched controls were recruited (n = 29). Tests of auditory attention span, working memory, and visual attention served as cognitive measures. Participants completed a 3-T MRI diffusion-weighted imaging scan. Fractional anisotropy (FA) and radial diffusivity (RD) served as WMI measures. Partial correlations between WMI and cognitive scores included controlling for type of treatment.
A correlational double dissociation was found. RC-LF WMI was associated with auditory attention (FA: r = .42, p = .03; RD: r = −.50, p = .01) and was not associated with visual attention (FA: r = −.11, p = .59; RD: r = −.11, p = .57). SLF II FA WMI was associated with visual attention (FA: r = .44, p = .02; RD: r = −.17, p = .40) and was not associated with auditory attention (FA: r = .24, p = .22; RD: r = −.10, p = .62).
The results show that RC-LF WMI is associated with auditory attention span rather than working memory per se and provides evidence for a specificity based on the correlational double dissociation.
Little is known about the experiences of people living alone with dementia in the community and their non-resident relatives and friends who support them. In this paper, we explore their respective attitudes and approaches to the future, particularly regarding the future care and living arrangements of those living with dementia. The study is based on a qualitative secondary analysis of interviews with 24 people living alone with early-stage dementia in North Wales, United Kingdom, and one of their relatives or friends who supported them. All but four of the dyads were interviewed twice over 12 months (a total of 88 interviews). In the analysis, it was observed that several people with dementia expressed the desire to continue living at home for ‘as long as possible’. A framework approach was used to investigate this theme in more depth, drawing on concepts from the existing studies of people living with dementia and across disciplines. Similarities and differences in the future outlook and temporal orientation of the participants were identified. The results support previous research suggesting that the future outlook of people living with early-stage dementia can be interpreted in part as a response to their situation and a way of coping with the threats that it is perceived to present, and not just an impaired view of time. Priorities for future research are highlighted in the discussion.
Invasive predators have decimated island biodiversity worldwide. Rats (Rattus spp.) are perhaps the greatest conservation threat to island fauna. The ground nesting Palau Micronesian Scrubfowl Megapodius laperouse senex (Megapodiidae) inhabits many of the islands of Palau’s Rock Island Southern Lagoon Conservation Area (RISL) in the western Pacific. These islands are also heavily visited by tourists and support populations of introduced rats, both of which may act as added stressors for the scrubfowl. Using passive chew-tag and call playback surveys on five tourist-visited and five tourist-free islands, we investigated if rats and tourists negatively affect scrubfowl, and if higher rat activity is associated with tourist presence. Rat detection probability and site occupancy were significantly higher on tourist visited (89% and 99%, respectively) compared to tourist-free islands (52% and 73%). Scrubfowl were detected at significantly more stations on tourist-free (93%) than tourist visited (47%) islands and their relative abundance was higher (2.66 and 1.58 birds per station, respectively), although not statistically significantly. While rat occupancy probability likewise had a non-significant negative effect on scrubfowl numbers across islands, our results show a negative relationship between tourist presence and scrubfowl in the RISL. Our findings also suggest that rat populations may be augmented by tourist visitation in the RISL. Although this situation may not seriously affect the scrubfowl, it may be highly detrimental to populations of other threatened island landbirds.
Apathy, defined as a lack of motivation, is common in neurodegenerative diseases. Specific scales are available for the evaluation of apathy but it lacks objective evaluation methods.
To evaluate the changes in reaction time task according to the presence or absence of reward stimulation and to assess the relation between these performances and apathy scales.
13 patients with Mild Cognitive Impairment, 15 patients with Alzheimer's disease and 91 elderly healthy subjects were enrolled. A computerized test using the experiment software E-prime® was designed to assess reaction times in different experimental conditions after a training trial (neutral, stimulation, stress, stimulation after stress, extinction) and relation between the performances to the test and the Apathy Inventory (AI) scores were observed.
Patients reaction times were significantly higher than control. Reactions times were lower in stimulation conditions and maximum during the stress condition. In the patients population, apathetic subjects (AI total score >2) had significantly higher reaction times than non apathetic subjects (p<0,05). We found significant positive correlation between AI dimensions lack of initiative and lack of interest, and reaction times in the following conditions: lack of interest and neutral condition (p<0,01), stimulation condition (p<0,05), lack of initiative and stress condition (p<0,05). Furthermore, AI total score was correlated with both stimulation and extinction conditions (p<0,05). There was no significant correlation with the emotional blunting.
the reaction time task may be a promising tool for an objective evaluation of the initiative and interest dimensions of apathy in neurodegenerative diseases.
The aim of this study was to determine whether schizophrenic patients' impairment in semantic verbal fluency tasks is due to difficulties in organizing their search or, in other words, in organizing output in terms of clusters of meaningfully related words. Consecutive association of words belonging to subcategories of the semantic task was defined as semantic clustering. A categorical verbal fluency task was first administered to 100 healthy subjects and then to 22 schizophrenic patients and 22 healthy subjects matched for sex, age and education. In the normal population, semantic clustering was found to be involved in word generation. A large number of semantic clusters indicated efficient organization of semantic knowledge and led to better word production. Schizophrenic patients showed impaired verbal fluency and generated a smaller number of semantic clusters than the control subjects. These findings point to a defect in self-initiation of semantic categorization in schizophrenia.
Neuropsychiatric symptoms, also referred to as ‘BPSD’ (Behavioural and Psychological Symptoms of Dementia), are now proposed as a major component of the dementia syndrome and are as clinically significant as disorders of cognition. Behavioural changes are not only important at a symptomatic level but could be a key feature for the future disease modifying therapies.
For clinical trials, the following points have been suggested by members of BPSD European Alzheimer Disease Consortium (EADC):
- to limit the use of BNPI total score
- to use NPI sub syndrome or single item score
- to use in combination with the NPI specific behavioural domains scale
For clinical practice, results from the cohort such as the REAL.Fr study help to stress
the importance neuropsychiatric symptoms in AD patients. 686 AD patients included
A majority of patients at any stage of the disease presented with one or several behavioral and psychological disturbances. Apathy concerned 43% of patients and, with or without depression, was associated with more pronounced deficits in global cognition, everyday life and instrumental abilities, nutritional status and with a higher burden level. A high level of psychotropic prescription, especially with antidepressant, was observed in patients with apathy. In a multivariate analysis taking into account the cognitive and functional variables of AD, apathy and depression were the only significant predictors of psychotropic prescription.
Other results coming from the 4 year follow up assessment will also be presented.
There is wide acknowledgement that apathy is an important behavioural syndrome in Alzheimer’s disease and in various neuropsychiatric disorders. In light of recent research and the renewed interest in the correlates and impacts of apathy, and in its treatments, it is important to develop criteria for apathy that will be widely accepted, have clear operational steps, and that will be easily applied in practice and research settings. Meeting these needs is the focus of the task force work reported here.
The task force includes members of the Association Française de Psychiatrie Biologique, the European Psychiatric Association, the European Alzheimer’s Disease Consortium and experts from Europe, Australia and North America. An advanced draft was discussed at the consensus meeting (during the EPA conference in April 7th 2008) and a final agreement reached concerning operational definitions and hierarchy of the criteria.
Apathy is defined as a disorder of motivation that persists over time and should meet the following requirements. Firstly, the core feature of apathy, diminished motivation, must be present for at least four weeks; secondly two of the three dimensions of apathy (reduced goal-directed behaviour, goal-directed cognitive activity, and emotions) must also be present; thirdly there should be identifiable functional impairments attributable to the apathy. Finally, exclusion criteria are specified to exclude symptoms and states that mimic apathy.
Deficits in emotional processes are often observed by clinicians in anorexia nervosa and may have an impact on social functioning. Recognition of emotion was mostly investigated using visual stimuli as faces of emotional scenes. Only one study (Kucharska-Pietura et al., 2004) demonstrated impairments in emotional prosody using positive and negative valenced stimuli. However, this study did not provide a highlight for the identification of emotional bias (for example, to recognize an intense fear in a friendly voice). The aim of this study is to better understand the recognition of emotional prosody in anorexia nervosa using a wide range of positive, negative and neutral stimuli (Belin et al., 2008). In order to test emotion recognition biases in emotional prosody, we exposed 15 patients with anorexia nervosa and 15 healthy controls (HCs) to emotional vocal tasks asking them to rate emotional intensity on visual analog scales. In addition, we assessed clinical symptomatology and cognitive functioning for all participants. We showed that patients with anorexia nervosa provided higher intensity ratings on the non-target scales (e.g., surprise scale for fear stimuli) than HCs for sadness, fear and neutral voices. Furthermore, with the exception of neutral vocal stimuli, they provided the same intensity ratings on the target scales as the HCs. These findings suggested a bias in the processing of emotional prosody and may impact the social functioning of patients with anorexia nervosa. The bias may result from a sensorial deficit or a high-order cognitive dysfunction and have to be investigated in future studies.
This commentary is an author response to Lu and Wang, regarding the manuscript entitled ‘Cardiovascular risk factors in offspring exposed to gestational diabetes mellitus in utero: Systematic review and meta-analysis’. We address their concern regarding duplication of studies in the meta-analysis and the quality of included studies.
Deficits in emotional processes are often observed by clinicians in anorexia nervosa and may have an impact on social functioning. Recognition of emotion was mostly investigated using visual stimuli as faces of emotional scenes. Only one study (Kucharska-Pietura et al., 2004) demonstrated impairments in emotional prosody using positive and negative valenced stimuli. However, this study did not provide a highlight for the identification of emotional bias (for example, to recognize an intense fear in a friendly voice). The aim of this study is to better understand the recognition of emotional prosody in anorexia nervosa using a wide range of positive, negative and neutral stimuli (Belin et al., 2008).
In order to test emotion recognition biases in emotional prosody, we exposed 15 patients with anorexia nervosa and 15 healthy controls (HCs) to emotional vocal tasks asking them to rate emotional intensity on visual analog scales. In addition, we assessed clinical symptomatology and cognitive functioning for all participants.
We showed that patients with anorexia nervosa provided higher intensity ratings on the non-target scales (e.g., surprise scale for fear stimuli) than HCs for sadness, fear and neutral voices. Furthermore, with the exception of neutral vocal stimuli, they provided the same intensity ratings on the target scales as the HCs.
These findings suggested a bias in the processing of emotional prosody and may impact the social functioning of patients with anorexia nervosa. The bias may result from a sensorial deficit or a high-order cognitive dysfunction and have to be investigated in future studies.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The fit note, introduced in England, Wales and Scotland in 2010, was designed to radically change the sickness certification process from advising on individuals’ inability to work to what they could do if adjustments were made available. Our review aimed to evaluate: (1) the percentage of fit notes utilizing the new “may be fit for work” option or advising on work adjustments, (2) the impact of the fit note on sickness absence and return to work, (3) demographic variation in fit note use.
We systematically searched in Embase, Cochrane CENTRAL, Pub Med, Worldcat, Ovid and PsychInfo from 1 Jan 2010–30 Nov 2016 for studies on working aged adults which included the search terms “fit note” or “fitnote”. Relevant abstracts were extracted and we assessed the quality of the papers and assessed bias using the modified Newcastle Ottawa Scale.
Nine papers met the inclusion criteria, four of which were based on the same cohort. Maybe fit notes made up just 6.6% of all fit notes. Work adjustments were most often recommended for patients who were less deprived, female and patients with physical health problems. Fit note advice for patients with physical health problems increased over time, but the opposite was seen for patients with mental health problems.
Further research needed to evaluate the use, impact and potential of the fit note, especially for patients with mental illness.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The national implementation of competency-based medical education (CBME) has prompted an increased interest in identifying and tracking clinical and educational outcomes for emergency medicine training programs. For the 2019 Canadian Association of Emergency Physicians (CAEP) Academic Symposium, we developed recommendations for measuring outcomes in emergency medicine training in the context of CBME to assist educational leaders and systems designers in program evaluation.
We conducted a three-phase study to generate educational and clinical outcomes for emergency medicine (EM) education in Canada. First, we elicited expert and community perspectives on the best educational and clinical outcomes through a structured consultation process using a targeted online survey. We then qualitatively analyzed these responses to generate a list of suggested outcomes. Last, we presented these outcomes to a diverse assembly of educators, trainees, and clinicians at the CAEP Academic Symposium for feedback and endorsement through a voting process.
Academic Symposium attendees endorsed the measurement and linkage of CBME educational and clinical outcomes. Twenty-five outcomes (15 educational, 10 clinical) were derived from the qualitative analysis of the survey results and the most important short- and long-term outcomes (both educational and clinical) were identified. These outcomes can be used to help measure the impact of CBME on the practice of Emergency Medicine in Canada to ensure that it meets both trainee and patient needs.
Addressing rural health disparities has unique challenges that require cross-sector collaborations to address social determinants of health and help those in need to get connected to care continuum. We brought the Clinical and Translational Science Award, Institutional Development Award Program Infrastructure for Clinical and Translational Research, and Cooperative Extension System Programs together for a one-day semi-structured meeting to discuss collaborative opportunities to address rural health disparities. Session notes and event materials were analyzed for themes to facilitate collaboration such as defining rural, critical issues, and organizational strengths in support of collaboration. Across 16 sessions, there were 26 broad topics of discussion. The most frequent topics included “barriers and challenges,” “strategies and opportunities,” and “defining rural.” There is a growing understanding of the opportunity that collaboration between these large programs provides in addressing rural health disparities.