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The approach taken to support individuals during the coronavirus disease 2019 (COVID-19) pandemic needs to take into account the requirements of people with intellectual disabilities and/or autism, who represent a major vulnerable group, with higher rates of co-occurring health conditions and a greater risk of dying prematurely. To date, little evidence on COVID-related concerns have been produced and no report has provided structured feedback from the point of view of people with intellectual disabilities and/or autism or of their family/carers.
To provide systemised evidence-based information of the priority concerns for people with intellectual disabilities and/or autism regarding the COVID-19 pandemic.
Senior representatives of major UK-based professional and service-user representative organisations with a stake in the care of people with intellectual disabilities and/or autism were contacted to provide a list of concerns across three domains: ‘mental health and challenging behaviour’, ‘physical health and epilepsy’ and ‘social circumstances and support’. The feedback was developed into statements on frequently reported priorities. These statements were then rated independently by expert clinicians. A video-conference meeting to reconcile outliers and to generate a consensus statement list was held.
Thirty-two organisations were contacted, of which 26 (81%) replied. From the respondent's data, 30 draft consensus statements were generated. Following expert clinician review, there was initially strong consensus for seven statements (23%), increasing to 27 statements (90%) following video conferencing.
These recommendations highlight the expectations of people with intellectual disabilities and/or autism in the current pandemic. This could support policymakers and professionals’ deliver and evidence person-centred care.
There is evidence that environmental and genetic risk factors for schizophrenia spectrum disorders are transdiagnostic and mediated in part through a generic pathway of affective dysregulation.
We analysed to what degree the impact of schizophrenia polygenic risk (PRS-SZ) and childhood adversity (CA) on psychosis outcomes was contingent on co-presence of affective dysregulation, defined as significant depressive symptoms, in (i) NEMESIS-2 (n = 6646), a representative general population sample, interviewed four times over nine years and (ii) EUGEI (n = 4068) a sample of patients with schizophrenia spectrum disorder, the siblings of these patients and controls.
The impact of PRS-SZ on psychosis showed significant dependence on co-presence of affective dysregulation in NEMESIS-2 [relative excess risk due to interaction (RERI): 1.01, p = 0.037] and in EUGEI (RERI = 3.39, p = 0.048). This was particularly evident for delusional ideation (NEMESIS-2: RERI = 1.74, p = 0.003; EUGEI: RERI = 4.16, p = 0.019) and not for hallucinatory experiences (NEMESIS-2: RERI = 0.65, p = 0.284; EUGEI: −0.37, p = 0.547). A similar and stronger pattern of results was evident for CA (RERI delusions and hallucinations: NEMESIS-2: 3.02, p < 0.001; EUGEI: 6.44, p < 0.001; RERI delusional ideation: NEMESIS-2: 3.79, p < 0.001; EUGEI: 5.43, p = 0.001; RERI hallucinatory experiences: NEMESIS-2: 2.46, p < 0.001; EUGEI: 0.54, p = 0.465).
The results, and internal replication, suggest that the effects of known genetic and non-genetic risk factors for psychosis are mediated in part through an affective pathway, from which early states of delusional meaning may arise.
This study attempted to replicate whether a bias in probabilistic reasoning, or ‘jumping to conclusions’(JTC) bias is associated with being a sibling of a patient with schizophrenia spectrum disorder; and if so, whether this association is contingent on subthreshold delusional ideation.
Data were derived from the EUGEI project, a 25-centre, 15-country effort to study psychosis spectrum disorder. The current analyses included 1261 patients with schizophrenia spectrum disorder, 1282 siblings of patients and 1525 healthy comparison subjects, recruited in Spain (five centres), Turkey (three centres) and Serbia (one centre). The beads task was used to assess JTC bias. Lifetime experience of delusional ideation and hallucinatory experiences was assessed using the Community Assessment of Psychic Experiences. General cognitive abilities were taken into account in the analyses.
JTC bias was positively associated not only with patient status but also with sibling status [adjusted relative risk (aRR) ratio : 4.23 CI 95% 3.46–5.17 for siblings and aRR: 5.07 CI 95% 4.13–6.23 for patients]. The association between JTC bias and sibling status was stronger in those with higher levels of delusional ideation (aRR interaction in siblings: 3.77 CI 95% 1.67–8.51, and in patients: 2.15 CI 95% 0.94–4.92). The association between JTC bias and sibling status was not stronger in those with higher levels of hallucinatory experiences.
These findings replicate earlier findings that JTC bias is associated with familial liability for psychosis and that this is contingent on the degree of delusional ideation but not hallucinations.
The global community needs to be aware of the potential psychosocial consequences that may be experienced by health care workers who are actively managing patients with coronavirus disease (COVID-19). These health care workers are at increased risk for experiencing mood and trauma-related disorders, including posttraumatic stress disorder (PTSD). In this concept article, strategies are recommended for individual health care workers and hospital leadership to aid in mitigating the risk of PTSD, as well as to build resilience in light of a potential second surge of COVID-19.
The mitigation of CMAS (calcium–magnesium–aluminum–silicon oxide) infiltration is a major requirement for the stability of thermal barrier coatings. In this study, yttria-stabilized zirconia (YSZ)–Al2O3–SiC, YSZ–Al2O3–Ta2O5, and YSZ–Al2O3–Nb2O5 self-healing composites produced by uniaxially pressing powders were investigated as an alternative to YSZ. CMAS infiltration in these materials was tested at 1250 °C for 10 h. Comparing the depth of CMAS infiltration using scanning electron microscope (SEM) in tandem with electron-dispersive X-ray spectroscopy (EDS), all self-healing materials were found to perform better than the reference materials. While standard YSZ shows massive CMAS infiltration, SEM micrographs and EDS maps revealed a 33-fold improvement in CMAS resistance for the YSZ–Al2O3–Nb2O5 system, which exhibited the best performance among the selected self-repairing materials. X-ray diffraction and high-resolution SEM micrographs taken 10 μm below the surface revealed that CMAS only infiltrated pores in the topmost region of the samples. Both YSZ–Al2O3–Ta2O5 and YSZ–Al2O3–Nb2O5 systems showed no signs of chemical reaction with CMAS.
This study assesses the association between living in a food desert and cardiovascular health risk among young adults in the USA, as well as evaluates whether personal and area socioeconomic status moderates this relationship.
A cross-sectional analysis was performed using data from Wave I (1993–1994) and Wave IV (2008) from the National Longitudinal Study of Adolescent to Adult Health. Ordinary least squares regression models assessing the association between living in a food desert and cardiovascular health were performed. Mediation and moderation analyses assessed the degree to which this association was conditioned by area and personal socioeconomic status.
Sample of respondents living in urban census tracts in the USA in 2008.
Young adults (n 8896) aged 24–34 years.
Net of covariates living in a food desert had a statistically significant association with cardiovascular health risk (range 0–14) (β = 0·048, P < 0·01). This association was partially mediated by area and personal socioeconomic status. Further analyses demonstrate that the adverse association between living in a food desert and cardiovascular health is concentrated among low socioeconomic status respondents.
The findings from this study suggest a complex interplay between food deserts and economic conditions for the cardiovascular health of young adults. Developing interventions that aim to improve health behaviour among lower-income populations may yield benefits for preventing the development of cardiovascular health problems.
Colombia is the fourth largest country in South America. It is an upper middle-income country with an estimated population of 49.2 million people, and road traffic collisions (RTCs) are the second most common cause of traumatic death. The United Nations (UN) proclaimed 2011 to 2020 as the “Decade of Action for Road Safety.” In this context, the government of Colombia established the National Road Safety Plan (PNSV) for the period 2011-2021, aiming to reduce RTC-related deaths by 26%. Some road safety laws (RSLs) were implemented before the PNSV, but their impact on deaths and injuries is still not known.
The aim of this study was to evaluate whether these RSLs have had a long-term effect on road safety in the country.
Data on RTC casualties, deaths, and injuries from January 1, 2001 through December 31, 2017 were collated from official Colombian governmental publications. Three different periods were considered for analysis: 2001-2010 to evaluate the Transit Code; 2011-2017 to evaluate the PNSV; and 2001-2017 to evaluate a composite of the full study period. Analyses of trends in deaths and injuries were related to dates of new RSLs.
A total of 102,723 deaths (12.7%) and 707,778 injuries (87.3%) were reported from 2001 through 2017. The Transit Code period (2001-2010) showed a 10.1% decline in deaths, 16.6% decline in injuries, and rates per 100,000 inhabitants and per 10,000 registered vehicles also declined. During the period of the PNSV (2011-2017), there was an increase in the number of deaths by 16.6%, injuries decreased by 1.7%, and death rates per 100,000 inhabitants also increased. During the total study period, a 12.4% reduction in the total number of casualties was achieved, and death and injury rates per 100,000 inhabitants decreased by 12.4% and 27.5%, respectively.
Despite the introduction of the PNSV, RTCs remain the second most common cause of preventable death in Colombia. Overall, while the absolute number of RTCs and deaths has been increasing, the rate of RTCs per 10,000 registered vehicles has been decreasing. This suggests that although the goals of the PNSV may not be realized, some of the laws emanating from it may be having a beneficial effect. Further study is required over a protracted period to determine the longer-term impact of these initiatives.
OBJECTIVES/GOALS: Vaginal delivery is typically avoided in extremely preterm breech fetuses due to the concern for head entrapment by the cervix. Development of a device to prevent head entrapment would be best addressed by a multidisciplinary approach incorporating engineering principles with clinical obstetrics. METHODS/STUDY POPULATION: Construction of a collaborative multidisciplinary team to address the clinical challenge of preventing head entrapment was initiated through a unique course at the Massachusetts Institute of Technology (Course 2.75, Medical Device Design). The course would provide a structured means by which students (senior undergraduate and graduate students in Mechanical Engineering) would be paired with a clinical advisor and faculty in their department. Weekly team meetings were scheduled to review the clinical context pertinent to the problem and review engineering principles needed to develop a solution. The course also provided a small monetary budget ($4K) for the students to purchase supplies. RESULTS/ANTICIPATED RESULTS: During the semester long course, several iterations of a prototype were designed. Each subsequent rendition was evaluated from both an engineering and manufacturing perspective, as well as clinical appropriateness. The weekly meetings allowed for rapid re-design and assured that all necessary parameters were considered by the entire team. Students also had access to lab facilities and additional mentorship that allowed for supplementary input beyond that generated by core team members. These interactions, along with those of their classmates working on other projects, provided a strong base for exploring subsequent device development. DISCUSSION/SIGNIFICANCE OF IMPACT: Successful medical device development requires a collaborative process and students can be ideal members of these teams as they reside in an environment that is conducive to exploration and novel idea generation. Course-based student led team science platforms can provide an excellent foundation for solving uniquely challenging medical problems.
In this cross-sectional study we compared alcohol-dependent smokers and non-alcohol-dependent smokers with respect to intensity of nicotine dependence, craving conditions, sleep disturbances, comorbidity with major depression, reasons for smoking, accompanying somatic diseases and patients' prolonged abstinence from smoking during the 3 years preceding the study.
Subjects and methods
Fifty-one alcohol-dependent smokers and 327 non-alcohol-dependent smokers diagnosed as ICD-10 and DSM-IV-nicotine dependent, were investigated by means of the Fagerström Test for Nicotine Dependence, the Lübeck Craving-Recurrence Risk Questionnaire and the Lesch Alcohol Dependence Typology (both adapted to smoking).
The intensity of nicotine dependence was more enhanced in alcohol-dependent smokers compared to non-alcohol-dependent smokers. Several variables of all factors of craving (“depressive mood”, “stimulation”, “relaxation”, “socially triggered tension”) were significantly increased in alcohol-dependent patients (P < 0.05). Alcohol-dependent smokers showed depressive symptoms and sleep disturbances, whilst non-alcohol-dependent individuals mainly smoked for stress release and weight control.
Our study demonstrates that the intensity of nicotine dependence, several conditions of craving for nicotine, sleep disturbances and symptoms of depression appear to be enhanced in alcohol-dependent smokers compared with non-alcohol-dependent smokers.
It is hoped that the factors of craving and reasons for smoking identified in this study will contribute to a better understanding of smoking temptation in alcohol-dependent smokers and non-alcohol-dependent smokers in future.
High-resolution analysis of the ice core from Colle Gnifetti, Switzerland, allows yearly and sub-annual measurement of pollution for the period of highest lead production in the European Middle Ages, c. AD 1170–1220. Here, the authors use atmospheric circulation analysis and other geoarchaeological records to establish that Britain was the principal source of that lead pollution. The comparison of annual lead deposition at Colle Gnifetti displays a strong similarity to trends in lead production documented in the English historical accounts. This research provides unique new insight into the yearly political economy and environmental impact of the Angevin Empire of Kings Henry II, Richard the Lionheart and John.
Experiments were performed to further investigate a quadratic interaction between stationary and travelling cross-flow modes that was revealed in the previous experiment by Corke et al. (J. Fluid Mech., vol. 856, 2018, pp. 822–849) in the boundary layer on a sharp right-circular cone at an angle of attack at Mach 6.0. As with the previous experiment, passive discrete roughness was applied near the cone tip, just upstream of Branch I of the linear stability neutral curve for stationary cross-flow modes. The passive roughness consisted of indentations (dimples) that were evenly spaced azimuthally to excite a specific azimuthal wavenumber. A plasma actuator was located just downstream of the discrete roughness array. This was designed to produce an azimuthally uniform unsteady disturbance with a frequency that was at the centre of the band of most amplified travelling cross-flow modes. Measurements consisted of off-wall azimuthal profiles of mean and fluctuating total pressure at different axial locations. Spectra of total-pressure fluctuations verified the receptivity of the boundary layer to the unsteady excitation. This affected the azimuthal and streamwise development of the stationary cross-flow modes, with a general effect to move the transition location upstream by approximately 16 %. The quadratic interaction between the stationary and travelling cross-flow modes was further enhanced by the excitation of the travelling cross-flow mode. This was particularly evident by an enlarged band of azimuthal wavenumbers over which a significant triple phase locking existed. The significantly enlarged range of wavenumber sum and difference interactions offered a mechanism for rapid spectral broadening that could account for the hastened transition by the addition of unsteady disturbances.
We agree that the emergence of cumulative technological culture was tied to nonsocial cognitive skills, namely, technical-reasoning skills, which allowed humans to constantly acquire and improve information. Our concern is with a reading of the history of cumulative technological culture that is based largely on modern experiments in simulated settings and less on phenomena crucial to the long-term dynamics of cultural evolution.
We describe a novel dietary assessment strategy to estimate usual food intake in the ongoing large-scale multi-center German National Cohort (GNC). The dietary assessment is based on three 24 h food lists (24h-FL) and a food frequency questionnaire (FFQ) enriched by information from the representative German National Nutrition Survey II (NVS II). The novelty of this dietary assessment strategy is based on separating the probability of food intake from daily consumption amounts. The probability of consumption is estimated from 24h-FLs used in the GNC. To estimate daily consumption amounts, the already collected data of the NVS II are used. The 24h-FL simplifies the question on food consumption for all foods asked to consumption or not and so the questionnaire can be completed in about 10 minutes, reducing the burden on study participants. As proof of concept, we applied the assessment strategy to pretest data collected in 2012 to 2013 to assess the feasibility of the instruments. In brief, the novel dietary assessment strategy comprises three steps. First, the individuals’ consumption probability is estimated by three 24h-FLs and one FFQ applying a logistic linear mixed model adjusted for characteristics of the participants. Second, person-specific daily consumption amounts are estimated from the NVS II applying a linear mixed model taking the characteristics of the participants into account. Third, usual food intake is estimated by the consumption probability multiplied by person-specific daily amounts. Usual intake of 41 food groups in 318 men and 377 women were estimated. Of those participants who completed the first 24h-FL, 84.4, and 68.5% completed the second and third 24h-FL, respectively. No associations were observed between probability to participate and lifestyle factors. The estimated usual food intake distributions were in a plausible range as shown by comparing the estimated energy intake to the energy needs approximated by estimated total energy expenditure. Total energy was estimated to be 2,707 kcal/day for men and 2,103 kcal/day for women. With a few exceptions, the estimated food-based consumption probabilities did not differ considerably between men and women. The differences in energy intake between men and women were mainly due to their differences in the estimated person-specific daily amounts. As a conclusion, plausible but not validated values for usual food intake were derived in the pretest study, so that the combination of three repeated 24h-FLs, an FFQ and person-specific daily amounts from an external source is a feasible strategy for dietary assessment.
To examine the impact of determinants of incident dementia in three different old age groups (75–79, 80–84, 85+years) in Germany.
Multicenter prospective AgeCoDe/AgeQualiDe cohort study with baseline and nine follow-up assessments at 1.5-year intervals.
Primary care medical record registry sample.
General practitioners’ (GPs) patients aged 75+years at baseline.
Conduction of standardized interviews including neuropsychological assessment and collection of GP information at each assessment wave. We used age-stratified competing risk regression models (accounting for the competing event of mortality) to assess determinants of incident dementia and age-stratified ordinary least square regressions to quantify the impact of identified determinants on the age at dementia onset.
Among 3027 dementia-free GP patients, n = 704 (23.3%) developed dementia during the 13-year study period. Worse cognitive performance and subjective memory decline with related worries at baseline, and the APOE ε4 allele were associated independently with increased dementia risk in all three old age groups. Worse cognitive performance at baseline was also associated with younger age at dementia onset in all three age groups. Other well-known determinants were associated with dementia risk and age at dementia onset only in some or in none of the three old age groups.
This study provides further evidence for the age-specific importance of determinants of incident dementia in old age. Such specifics have to be considered more strongly particularly with regard to potential approaches of early detection and prevention of dementia.
First-degree relatives of patients with psychotic disorder have higher levels of polygenic risk (PRS) for schizophrenia and higher levels of intermediate phenotypes.
We conducted, using two different samples for discovery (n = 336 controls and 649 siblings of patients with psychotic disorder) and replication (n = 1208 controls and 1106 siblings), an analysis of association between PRS on the one hand and psychopathological and cognitive intermediate phenotypes of schizophrenia on the other in a sample at average genetic risk (healthy controls) and a sample at higher than average risk (healthy siblings of patients). Two subthreshold psychosis phenotypes, as well as a standardised measure of cognitive ability, based on a short version of the WAIS-III short form, were used. In addition, a measure of jumping to conclusion bias (replication sample only) was tested for association with PRS.
In both discovery and replication sample, evidence for an association between PRS and subthreshold psychosis phenotypes was observed in the relatives of patients, whereas in the controls no association was observed. Jumping to conclusion bias was similarly only associated with PRS in the sibling group. Cognitive ability was weakly negatively and non-significantly associated with PRS in both the sibling and the control group.
The degree of endophenotypic expression of schizophrenia polygenic risk depends on having a sibling with psychotic disorder, suggestive of underlying gene–environment interaction. Cognitive biases may better index genetic risk of disorder than traditional measures of neurocognition, which instead may reflect the population distribution of cognitive ability impacting the prognosis of psychotic disorder.