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Over the past decade, the World Health Summit (WHS) has provided a global platform for policy-makers and decision-makers to interact with academics and practitioners on global health. Recently the WHS adopted health security into their agenda for transnational disease risks (eg, Ebola and antimicrobial resistance) that increasingly threaten multiple sectors. Global health engagement (GHE) focuses efforts across interdisciplinary and interorganizational lines to identify critical threats and provide rapid deployment of key resources at the right time for addressing health security risks. As a product of subject matter experts convening at the WHS, a special side-group has organically risen with leadership and coordination from the German Institute for Defense and Strategic Studies in support of GHE activities across governmental, academic, and industry partners. Through novel approaches and targeted methodology that maximize outcomes and streamline global health operational process, the Global Health Security Alliance (GloHSA) was born. This short conference report describes in more detail the GloHSA.
To determine the accuracy of 12 previously validated short versions of the Geriatric Depression Scale (GDS) to detect major depressive disorder (MDD) in a high-risk population with and without global cognitive impairment.
Five hospitals, Western Sweden.
Older adults (age ≥70 years, n = 60) assessed at a home visit 1 year after hospital care in connection with suicide attempt.
Depression symptoms were rated using the established 15-item GDS. Eleven short GDS versions identified by a recent systematic review were derived from this administered version. Receiver operating characteristic curves and area under the curve (AUC) for the identification of MDD diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, were obtained for each version. The Youden Index optimal criterion was used to determine the appropriate cutoffs. Analyses were repeated after stratification by cognitive status (Mini Mental State Examination score ≤24 and >24) for the best performing GDS short versions and the established 15-item GDS.
The 7-item GDS according to Broekman et al. (2011), with a cutoff 3, was the most accurate among the 12 short versions (AUC 0.90, 95% confidence interval 0.80–1.00), identifying MDD with sensitivity 88% and specificity 81%. The cutoff score remained consistent in the presence of global cognitive impairment, which was not the case for the standardized 15-item GDS.
The Broekman 7-item GDS had high accuracy to detect MDD in this prospective clinical cohort at high risk for MDD. Further testing of GDS short versions in diverse settings is required.
Focusing on a pocket-size edition of Whitman’s poems from the early twentieth century provides an opportunity for thinking about what happens to poems we think we know well when they’re read in different published contexts. Building on the central insight from book historical studies about the inextricability of publication form and literary content, this chapter also engages aspects of the history of sexuality that likewise take shape through the practices of reading and writing. The Little Blue Book edition at this chapter’s heart juxtaposes Whitman’s poems with the writings of another figure in the long US history of sexual liberation: feminist and birth-control advocate Margaret Sanger. Reading Whitman alongside Sanger as the edition urges us to do uncovers unexpected intersections, and sometimes contradictions, at the sites of gender normativity, progressive political reform, and socialism, as well as the backlash against the progressive reforms to which Whitman and Sanger dedicated themselves.
Comparisons of antipsychotics with placebo can be biased by unblinding due to side effects. Therefore, this meta-analysis compared the efficacy of antipsychotics for acute schizophrenia in trials using barbiturates or benzodiazepines as active placebos.
Randomized controlled trials (RCTs) in acute schizophrenia with at least 3 weeks duration and comparing any antipsychotic with barbiturates or benzodiazepines were eligible. ClinicalTrials.gov, CENTRAL, EMBASE, MEDLINE, PsycINFO, PubMed, WHO-ICTRP as well as previous reviews were searched up to 9 January 2018. Two separate meta-analyses, one for barbiturates and one for benzodiazepines, were conducted using random-effects models. The primary outcome was response to treatment, and mean values of schizophrenia rating scales and dropouts were analyzed as secondary outcomes. This study is registered with PROSPERO (CRD42018086263).
Seven barbiturate-RCTs (number of participants n = 1736), and two benzodiazepine-RCTs (n = 76) were included in the analysis. The studies were published between 1960 and 1968 and involved mainly chronically ill patients. More patients on antipsychotics in comparison to barbiturates achieved a ‘good’ response (36.2% v. 16.8%; RR 2.15; 95% CI 1.36–3.41; I2 = 48.9) and ‘any’ response (57.4% v. 27.8%; RR 2.07; 95% CI 1.35–3.18; I2 = 68.2). In a single small trial (n = 60), there was no difference between antipsychotics and benzodiazepines on ‘any’ response (74.7% v. 65%; RR 1.15; 95% CI 0.82–1.62).
Antipsychotic drugs were more efficacious than barbiturates, based on a large sample size. Response ratios were similar to those observed in placebo-controlled trials. The results on benzodiazepines were inconclusive due to the small number of studies and participants.
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.
Identical and fraternal twin pairs reared together have been key to understanding the genetic and environmental etiology of dyslexia and of individual differences in reading. In this chapter, we begin with a brief overview of the methods of twin research, and the historical development and application of these methods to understanding the etiology of individual differences and deficits in reading and related skills. Then we examine results from predominantly English-language twin research on dyslexia. The next section on twin studies of individual differences in reading ability introduces a broader cross-language perspective that includes comparisons of findings from studies in the United States, the United Kingdom, Australia, Norway, Sweden, the Netherlands, and China. Then we expand the reading phenotype beyond word recognition to reading comprehension, the ultimate goal of reading.
Across psychopathologies, trauma-exposed individuals suffer from difficulties in inhibiting emotions and regulating attention. In trauma-exposed individuals without psychopathology, only subtle alterations of neural activity involved in regulating emotions have been reported. It remains unclear how these neural systems react to demanding environments, when acute (non-traumatic but ordinary) stress serves to perturbate the system. Moreover, associations with subthreshold clinical symptoms are poorly understood.
The present fMRI study investigated response inhibition of emotional faces before and after psychosocial stress situations. Specifically, it compared 25 women (mean age 31.5 ± 9.7 years) who had suffered severe early life trauma but who did not have a history of or current psychiatric disorder, with 25 age- and education-matched trauma-naïve women.
Under stress, response inhibition related to fearful faces was reduced in both groups. Compared to controls, trauma-exposed women showed decreased left inferior frontal gyrus (IFG) activation under stress when inhibiting responses to fearful faces, while activation of the right anterior insula was slightly increased. Also, groups differed in brain–behaviour correlations. Whereas stress-induced false alarm rates on fearful stimuli negatively correlated with stress-induced IFG signal in controls, in trauma-exposed participants, they positively correlated with stress-induced insula activation.
Neural facilitation of emotion inhibition during stress appears to be altered in trauma-exposed women, even without a history of or current psychopathology. Decreased activation of the IFG in concert with heightened bottom-up salience of fear related cues may increase vulnerability to stress-related diseases.
Species identification in the tropical lichen genus Phyllopsora is generally challenging and is based on ascospore morphology, vegetative dispersal units, thallus structure and secondary chemistry. As several type specimens are in poor condition and difficult to interpret, it is often unclear how these old names fit with the currently used taxonomy. In the present study, we aim to identify species boundaries in Phyllopsora s. str. supported by an integrative approach using multiple sources of evidence. We investigated a substantial amount of herbarium as well as freshly collected material and generated mtSSU and ITS sequence data from most of the described species, including several types. Species delimitation analyses are applied on the gene trees using mPTP and we construct a species tree of both markers with *BEAST, facilitating discussion of species delimitation and sister-relationships. Comparing morphology, chemistry and molecular data, we found that the mPTP analyses split established species repeatedly. Based on our integrative results, we exclude nine species from the genus, resurrect one (P. melanoglauca Zahlbr.), reduce two into synonymy with other Phyllopsora species and describe five as new to science: Phyllopsora amazonica Kistenich & Timdal (which shares the secondary chemistry (atranorin and terpenoid pattern) with P. halei chemotype 1, but differs, e.g., in having smaller areolae that are attached to a thinner, white prothallus, and in having more persistently marginate and less convex apothecia), Phyllopsora concinna Kistenich & Timdal (which shares the secondary chemistry (atranorin and parvifoliellin) with P. parvifoliella and P. rappiana, but differs from both in forming larger isidia, having a white prothallus, apothecial margin paler than the disc, and longer and broader ascospores), Phyllopsora furfurella Kistenich & Timdal (which is here segregated from P. furfuracea based on having a white prothallus and in containing skyrin in the hypothecium (K+ red)), Phyllopsora isidosa Kistenich & Timdal (which differs from P. byssiseda in forming a more crustose thallus with more delicate isidia, and from P. isidiotyla in forming somewhat coarser, less branched isidia) and Phyllopsora neotinica Kistenich & Timdal (a neotropical species here segregated from the now exclusively paleotropical P. chodatinica, differing in containing an unknown xanthone (not chodatin)). Lectotypes are designated for Biatora pyrrhomelaena Tuck., Lecidea leucophyllina Nyl., L. pertexta Nyl., and P. brachyspora Müll. Arg. In total, we accept 54 species in the genus Phyllopsora.
Defects in crystalline solids control the properties of engineered and natural materials, and their characterization focuses our strategies to optimize performance. Electron microscopy has served as the backbone of our understanding of defect structure and their interactions, owing to beneficial spatial resolution and contrast mechanisms that enable direct imaging of defects. These defects reside in complex microstructures and chemical environments, demanding a combination of experimental approaches for full defect characterization. In this article, we describe recent progress and trends in methods for examining defects using scanning electron microscopy platforms. Several emerging approaches offer attractive benefits, for instance, in correlative microscopy across length scales and in in situ studies of defect dynamics.
The Royal College of Physicians and Surgeons of Canada (RCPSC) emergency medicine (EM) programs transitioned to the Competence by Design training framework in July 2018. Prior to this transition, a nation-wide survey was conducted to gain a better understanding of EM faculty and senior resident attitudes towards the implementation of this new program of assessment.
A multi-site, cross-sectional needs assessment survey was conducted. We aimed to document perceptions about competency-based medical education, attitudes towards implementation, perceived/prompted/unperceived faculty development needs. EM faculty and senior residents were nominated by program directors across RCPSC EM programs. Simple descriptive statistics were used to analyse the data.
Between February and April 2018, 47 participants completed the survey (58.8% response rate). Most respondents (89.4%) thought learners should receive feedback during every shift; 55.3% felt that they provided adequate feedback. Many respondents (78.7%) felt that the ED would allow for direct observation, and most (91.5%) participants were confident that they could incorporate workplace-based assessments (WBAs). Although a fair number of respondents (44.7%) felt that Competence by Design would not impact patient care, some (17.0%) were worried that it may negatively impact it. Perceived faculty development priorities included feedback delivery, completing WBAs, and resident promotion decisions.
RCPSC EM faculty have positive attitudes towards competency-based medical education-relevant concepts such as feedback and opportunities for direct observation via WBAs. Perceived threats to Competence by Design implementation included concerns that patient care and trainee education might be negatively impacted. Faculty development should concentrate on further developing supervisors’ teaching skills, focusing on feedback using WBAs.
In many optimization problems arising from scientific, engineering and artificial intelligence applications, objective and constraint functions are available only as the output of a black-box or simulation oracle that does not provide derivative information. Such settings necessitate the use of methods for derivative-free, or zeroth-order, optimization. We provide a review and perspectives on developments in these methods, with an emphasis on highlighting recent developments and on unifying treatment of such problems in the non-linear optimization and machine learning literature. We categorize methods based on assumed properties of the black-box functions, as well as features of the methods. We first overview the primary setting of deterministic methods applied to unconstrained, non-convex optimization problems where the objective function is defined by a deterministic black-box oracle. We then discuss developments in randomized methods, methods that assume some additional structure about the objective (including convexity, separability and general non-smooth compositions), methods for problems where the output of the black-box oracle is stochastic, and methods for handling different types of constraints.
Despite the high prevalence of domestic violence and abuse (DVA) among patients with psychiatric conditions, detection rates are low. Limited knowledge and skills on DVA in mental healthcare (MHC) professionals might contribute to poor identification.
To assess the level of, and factors associated with, DVA knowledge and skills among MHC professionals.
A total of 278 professionals in Dutch MHC institutions completed a survey assessing factual knowledge, perceived knowledge, perceived skills and attitudes about DVA.
On average, low scores were reported for perceived skills and knowledge. MHC professionals in primary care scored higher than those working with individuals with severe mental illness (P<0.005). Levels of factual knowledge were higher; levels of attitudes moderate. Previous training was positively associated with skills (odds ratios (OR) = 3.0) and attitudes (OR = 2.7). Years of work was negatively associated with factual knowledge (OR = 0.97). Larger case-loads predicted higher scores on skills (OR = 2.1).
Training is needed, particularly for clinicians working with patients with severe mental illness.
The accelerator mass spectrometry (AMS) center at Horia Hulubei National Institute for R&D in Physics and Nuclear Engineering, Bucharest, is based on the latest-generation 1 MV Tandetron® accelerator, produced by High Voltage Engineering Europa (HVEE), The Netherlands. The AMS center became fully functional at the start of 2013, and at the end of 2015 the laboratory established the RoAMS international code and it was added to the list of AMS laboratories maintained by Radiocarbon journal. An important aspect in the establishment of a new AMS laboratory is the declaration and documentation of the adopted protocols and to demonstrate the reliability and reproducibility of the measurements in comparison to internationally recognized reference materials. In this paper, we present the dating results on the Sixth International Radiocarbon Intercomparison (SIRI) samples that were pretreated, graphitized, and measured in our laboratory. The newly developed sample preparation laboratory can handle sample materials as (1) organic materials, (2) wood, (3) bones, and (4) carbonates. The results of our measurements are in very good agreement with the SIRI consensus values and confirm the reliability of our sample preparation laboratory and also the good performance of the HVEE AMS system. The blank levels for the SIRI materials are 0.277±0.045/0.333±0.046 percent modern carbon (pMC) for wood samples, 0.441±0.038 pMC for bone collagen, and 0.239±0.030 pMC for carbonate materials, considering an average mass of 1 mg sample graphite.
Diagnosing delirium superimposed on dementia (DSD) remains challenging because of a lack of specific tools, though motor dysfunction in delirium has been relatively under-explored. This study aimed to use dysfunction in balance and mobility (with the Hierarchical Assessment of Balance And Mobility: HABAM) to identify DSD. This is a cross-sectional multicenter study, recruiting consecutive patients ≥70 years admitted to five acute or rehabilitation hospitals in Ireland, Italy, Portugal, and Switzerland. Delirium was diagnosed using DSM-5 criteria; dementia was determined by the Mini-Mental State Examination and the Questionnaire of Cognitive Decline in the Elderly. HABAM score was recorded at admission. Out of 114 patients (mean age ± SD = 82 ± 7; 54% female), dementia alone was present in 24.6% (n = 28), delirium alone in 18.4% (n = 21) and DSD in 27.2% (n = 31). Patients with DSD had a mean HABAM score 7 points greater than those with dementia alone (19.8 ± 8.7 vs 12.5 ± 9.5; p < 0.001); 70% of participants with DSD were correctly identified using the HABAM at a cut off of 22 (sensitivity 61%, specificity 79%, AUC = 0.76). Individuals with delirium have worse motor function than those without delirium, even in the context of comorbid dementia. Measuring motor function using the HABAM in older people at admission may help to diagnose DSD.
Vulnerability of satellite-based navigation signals to intentional and unintentional interference calls for a high-level overview of Global Navigation Satellite System (GNSS) threats occurring globally to understand the magnitude and evolution of the problem. Therefore, a mechanism needs to be developed whereby disparate monitoring systems will be capable of contributing to a common entity of basic information about the threat scenarios they experience. This paper begins with a literature survey of 37 state-of-the-art GNSS threat monitoring systems, which have been analysed based on their respective operational features - constellations monitored and whether they possess the capability to perform interference-type classification, spoofing detection, and interference localisation. Also described is a comparative analysis of four GNSS threat reporting formats in use today. Based on these studies, the paper describes the Horizon2020 Standardisation of GNSS Threat Reporting and Receiver Testing through International Knowledge Exchange, Experimentation and Exploitation (STRIKE3) proposed integrated threat monitoring demonstration system and related standardised threat reporting message, to enable a high-level overview of the prevailing international GNSS threat scenarios and its evolution over time.
West Antarctic climate and surface mass balance (SMB) records are sparse. To fill this gap, regional atmospheric climate modelling is useful, providing that such models are employed at sufficiently high horizontal resolution and coupled with a snow model. Here we present the results of a high-resolution (5.5 km) regional atmospheric climate model (RACMO2) simulation of coastal West Antarctica for the period 1979–2015. We evaluate the results with available in situ weather observations, remote-sensing estimates of surface melt, and SMB estimates derived from radar and firn cores. Moreover, results are compared with those from a lower-resolution version, to assess the added value of the resolution. The high-resolution model resolves small-scale climate variability invoked by topography, such as the relatively warm conditions over ice-shelf grounding zones, and local wind speed accelerations. Surface melt and SMB are well reproduced by RACMO2. This dataset will prove useful for picking ice core locations, converting elevation changes to mass changes, for driving ocean, ice-sheet and coupled models, and for attributing changes in the West Antarctic Ice Sheet and shelves to changes in atmospheric forcing.
The killing of Cecil the Lion in July 2015 generated considerable media attention worldwide. We measured public interest in Cecil's death to examine the degree to which this high-profile incident represented the type of focusing event that public policy scholars often emphasize as being important for triggering policy change. Finding that public interest in lion conservation spiked in the weeks immediately following the incident, we then analysed whether this focusing event led to policy changes to restrict trophy hunting in eight countries (USA, Spain, France, Russia, Canada, South Africa, Germany and Mexico) that most frequently import lion Panthera leo trophies. The surge in public attention seems to have had only a limited impact on the adoption of significant new policy, although it may have hastened changes in some countries.
Prodiamine is a dinitroaniline herbicide labeled for PRE control of goosegrass in warm- and cool-season turfgrass. In 2013, several golf course roughs in Maryville, TN reported poor goosegrass control (< 20%) following prodiamine treatment at 1,120 g ai ha-1. We harvested suspected prodiamine-resistant (PR) and prodiamine-susceptible (S) goosegrass phenotypes from the field and exposed them to a range of increasing prodiamine concentrations in hydroponic culture. Exposure to prodiamine at 0.001 mM reduced root growth of the S phenotype to 11% of the non-treated check. By comparison, exposure to 0.001 mM prodiamine had minimal effect on the PR phenotype, as root growth was 94% of the non-treated check. Molecular analyses revealed that PR plants contained a threonine (Thr) to isoleucine (Ile) substitution at position 239 on the α-tubulin 1 (TUA1) protein. The substitution, found in all PR plants, is the mechanism of prodiamine resistance in this phenotype. In field studies, topramezone controlled PR goosegrass 72% to 89% by 50 d after treatment (DAT) compared to only 22% to 23% for foramsulfuron. Topramezone treatment injured bermudagrass 34% to 60% from 7 to 14 DAT; however, injury was≤6% 28 DAT and 0% by the end of the study. Our results indicate that POST applications of topramezone can control dinitroaniline-resistant goosegrass. In addition, we established an easy-to-use genotyping assay to quickly screen goosegrass phenotypes for a target-site mutation (Thr-239-Ile) on TUA1 associated with resistance to dinitroaniline herbicides such as prodiamine. Future research should work to expand this assay for use with other weed species and herbicidal modes of action.