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Rapid spread of coronavirus disease 2019 (COVID-19) has affected people with intellectual disability disproportionately. Existing data does not provide enough information to understand factors associated with increased deaths in those with intellectual disability. Establishing who is at high risk is important in developing prevention strategies, given risk factors or comorbidities in people with intellectual disability may be different to those in the general population.
To identify comorbidities, demographic and clinical factors of those individuals with intellectual disability who have died from COVID-19.
An observational descriptive case series looking at deaths because of COVID-19 in people with intellectual disability was conducted. Along with established risk factors observed in the general population, possible specific risk factors and comorbidities in people with intellectual disability for deaths related to COVID-19 were examined. Comparisons between mild and moderate-to-profound intellectual disability subcohorts were undertaken.
Data on 66 deaths in individuals with intellectual disability were analysed. This group was younger (mean age 64 years) compared with the age of death in the general population because of COVID-19. High rates of moderate-to-profound intellectual disability (n = 43), epilepsy (n = 29), mental illness (n = 29), dysphagia (n = 23), Down syndrome (n = 20) and dementia (n = 15) were observed.
This is the first study exploring associations between possible risk factors and comorbidities found in COVID-19 deaths in people with intellectual disability. Our data provides insight into possible factors for deaths in people with intellectual disability. Some of the factors varied between the mild and moderate-to-profound intellectual disability groups. This highlights an urgent need for further systemic inquiry and study of the possible cumulative impact of these factors and comorbidities given the possibility of COVID-19 resurgence.
Establishment of alfalfa by interseeding into corn planted for silage can enhance crop productivity but weed management is a challenge to adoption. Although a glyphosate-based herbicide program could be a simple and effective approach, concerns about herbicide resistance and limitations in available alfalfa varieties exist. Field experiments were conducted to compare the efficacy and selectivity of preemergence (PRE), postemergence (POST) and PRE followed by POST herbicide programs to a glyphosate only strategy when interseeding alfalfa into corn. Experiment 1 compared PRE applications of acetochlor, mesotrione, S-metalochlor, metribuzin, and flumetsulam, and found both rates of acetochlor and metribuzin, and S-metalochlor at 1.1 kg ha-1 were the most effective and selective PRE herbicides 4 weeks after treatment (WAT), but each resulted in greater overall weed cover than glyphosate by 8 WAT. Experiment 2 evaluated POST applications at early and late timings of bentazon, bromoxynil, 2,4-DB, and mesotrione. Several POST herbicides exhibited similar effectiveness and selectivity as glyphosate including early applications of bromoxynil (0.14 kg ha-1) and 2,4-DB (0.84 or 1.68 kg ha-1), as well as late applications of bromoxynil (0.42 kg ha-1), 2,4-DB (0.84 kg ha-1) and mesotrione (0.05 or 0.11 kg ha-1). A third experiment compared applications of acetochlor PRE, bromoxynil POST, and the combination of acetochlor PRE with bromoxynil POST. All treatments were effective and safe for use in this interseeded system, although interseeded alfalfa provided 65-70% weed suppression in corn planted for silage without any herbicide. Herbicide treatments had no observable impacts on corn and alfalfa yields so weed management was likely of limited economic importance. However, weed competitiveness can vary based on several different factors including weed species, density, and site-specific factors, and so further investigations under different environments and conditions are needed.
The inclusion of students with autism spectrum disorder (ASD) is increasing, but there have been no longitudinal studies of included students in Australia. Interview data reported in this study concern primary school children with ASD enrolled in mainstream classes in South Australia and New South Wales, Australia. In order to examine perceived facilitators and barriers to inclusion, parents, teachers, and principals were asked to comment on the facilitators and barriers to inclusion relevant to each child. Data are reported about 60 students, comprising a total of 305 parent interviews, 208 teacher interviews, and 227 principal interviews collected at 6-monthly intervals over 3.5 years. The most commonly mentioned facilitator was teacher practices. The most commonly mentioned barrier was intrinsic student factors. Other factors not directly controllable by school staff, such as resource limitations, were also commonly identified by principals and teachers. Parents were more likely to mention school- or teacher-related barriers. Many of the current findings were consistent with previous studies but some differences were noted, including limited reporting of sensory issues and bullying as barriers. There was little change in the pattern of facilitators and barriers identified by respondents over time. A number of implications for practice and directions for future research are discussed.
Reward Deficiency Syndrome (RDS) is an umbrella term for all drug and nondrug addictive behaviors, due to a dopamine deficiency, “hypodopaminergia.” There is an opioid-overdose epidemic in the USA, which may result in or worsen RDS. A paradigm shift is needed to combat a system that is not working. This shift involves the recognition of dopamine homeostasis as the ultimate treatment of RDS via precision, genetically guided KB220 variants, called Precision Behavioral Management (PBM). Recognition of RDS as an endophenotype and an umbrella term in the future DSM 6, following the Research Domain Criteria (RDoC), would assist in shifting this paradigm.
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.
Each summer, surface melting of the margin of the Greenland Ice Sheet exposes a distinctive visible stratigraphy that is related to past variability in subaerial dust deposition across the accumulation zone and subsequent ice flow toward the margin. Here we map this surface stratigraphy along the northern margin of the ice sheet using mosaicked Sentinel-2 multispectral satellite imagery from the end of the 2019 melt season and finer-resolution WorldView-2/3 imagery for smaller regions of interest. We trace three distinct transitions in apparent dust concentration and the top of a darker basal layer. The three dust transitions have been identified previously as representing late-Pleistocene climatic transitions, allowing us to develop a coarse margin chronostratigraphy for northern Greenland. Substantial folding of late-Pleistocene stratigraphy is observed but uncommon. The oldest conformal surface-exposed ice in northern Greenland is likely located adjacent to Warming Land and may be up to ~55 thousand years old. Basal ice is commonly exposed hundreds of metres from the ice margin and may indicate a widespread frozen basal thermal state. We conclude that the ice margin across northern Greenland offers multiple opportunities to recover paleoclimatically distinct ice relative to previously studied regions in southwestern Greenland.
This chapter provides an overview of the use of affect-based interventions to change behavior. Affect is defined in terms of affect proper and affect processing; both of these terms are used regularly in research on affect interventions. The evidence of direct modification of these affect constructs is then reviewed. Based on this evidence, step-by-step guides to techniques focusing on changing two key aspects of affective processing are provided: changing affective attitudes and anticipated affect. The guides to these techniques include typical means of delivery, target audience, behaviors, enabling or inhibiting factors, training and skills required, intensiveness, typical materials needed, and typical examples of implementation. In addition, application of implementation intentions, fear appeals, evaluative conditioning, and exercise games as other ways to change affect as a means to changing behavior are reviewed. Finally, two additional intervention pathways that could have impact on behavior change are reviewed: direct modification of other sources of behavioral influence (e.g., traditional social cognitive factors) in order to overcompensate for the impact of affect and self-regulation of the intensity of the affect experience as a means of inhibiting its impact.
Hernando de Soto's expedition through the southeastern United States between 1539 and 1543 is often regarded as a watershed moment for the collapse of Indigenous societies across the region. Historical narratives have proposed that extreme depopulation as a result of early contact destabilized Indigenous economies, politics, networks, and traditions. Although processes of depopulation and transformation were certainly set in motion by this and earlier colonial encounters, the timing, temporality, and heterogeneous rhythms of postcontact Indigenous histories remain unclear. Through the integration of radiocarbon and archaeological data from the Mississippian earthen platform mound at Dyar (9GE5) in central Georgia, we present a case of Indigenous endurance and resilience in the Oconee Valley that has long been obfuscated by materially based chronologies and typologies. Bayesian chronological modeling suggests that Indigenous Mississippian traditions persisted for up to 130 years beyond contact with European colonizers. We argue that advances in modeling radiocarbon dates, along with meaningful consultation/collaboration with descendant communities, can contribute to efforts that move us beyond a reliance on materially based chronologies that can distort and erase Indigenous histories.
Heavy alcohol consumption is associated with poorer cognitive function in older adults. Although understudied in middle-aged adults, the relationship between alcohol and cognition may also be influenced by genetics such as the apolipoprotein (ApoE) ε4 allele, a risk factor for Alzheimer’s disease. We examined the relationship between alcohol consumption, ApoE genotype, and cognition in middle-aged adults and hypothesized that light and/or moderate drinkers (≤2 drinks per day) would show better cognitive performance than heavy drinkers or non-drinkers. Additionally, we hypothesized that the association between alcohol use and cognitive function would differ by ApoE genotype (ε4+ vs. ε4−).
Participants were 1266 men from the Vietnam Era Twin Study of Aging (VETSA; M age = 56; range 51–60) who completed a neuropsychological battery assessing seven cognitive abilities: general cognitive ability (GCA), episodic memory, processing speed, executive function, abstract reasoning, verbal fluency, and visuospatial ability. Alcohol consumption was categorized into five groups: never, former, light, moderate, and heavy.
In fully adjusted models, there was no significant main effect of alcohol consumption on cognitive functions. However, there was a significant interaction between alcohol consumption and ApoE ε4 status for GCA and episodic memory, such that the relationship of alcohol consumption and cognition was stronger in ε4 carriers. The ε4+ heavy drinking subgroup had the poorest GCA and episodic memory.
Presence of the ε4 allele may increase vulnerability to the deleterious effects of heavy alcohol consumption. Beneficial effects of light or moderate alcohol consumption were not observed.
Intensified cover-cropping practices are increasingly viewed as a herbicide-resistance management tool but clear distinction between reactive and proactive resistance management performance targets is needed. We evaluated two proactive performance targets for integrating cover-cropping tactics, including (1) facilitation of reduced herbicide inputs and (2) reduced herbicide selection pressure. We conducted corn (Zea mays L.) and soybean [Glycine max (L.) Merr.] field experiments in Pennsylvania and Delaware using synthetic weed seedbanks of horseweed [Conyza canadensis (L.) Cronquist] and smooth pigweed (Amaranthus hybridus L.) to assess winter and summer annual population dynamics, respectively. The effect of alternative cover crops was evaluated across a range of herbicide inputs. Cover crop biomass production ranged from 2,000 to 8,500 kg ha−1 in corn and 3,000 to 5,500 kg ha−1 in soybean. Experimental results demonstrated that herbicide-based tactics were the primary drivers of total weed biomass production, with cover-cropping tactics providing an additive weed-suppression benefit. Substitution of cover crops for PRE or POST herbicide programs did not reduce total weed control levels or cash crop yields but did result in lower net returns due to higher input costs. Cover-cropping tactics significantly reduced C. canadensis populations in three of four cover crop treatments and decreased the number of large rosettes (>7.6-cm diameter) at the time of preplant herbicide exposure. Substitution of cover crops for PRE herbicides resulted in increased selection pressure on POST herbicides, but reduced the number of large individuals (>10 cm) at POST applications. Collectively, our findings suggest that cover crops can reduce the intensity of selection pressure on POST herbicides, but the magnitude of the effect varies based on weed life-history traits. Additional work is needed to describe proactive resistance management concepts and performance targets for integrating cover crops so producers can apply these concepts in site-specific, within-field management practices.
In 2019, a 42-year-old African man who works as an Ebola virus disease (EVD) researcher traveled from the Democratic Republic of Congo (DRC), near an ongoing EVD epidemic, to Philadelphia and presented to the Hospital of the University of Pennsylvania Emergency Department with altered mental status, vomiting, diarrhea, and fever. He was classified as a “wet” person under investigation for EVD, and his arrival activated our hospital emergency management command center and bioresponse teams. He was found to be in septic shock with multisystem organ dysfunction, including circulatory dysfunction, encephalopathy, metabolic lactic acidosis, acute kidney injury, acute liver injury, and diffuse intravascular coagulation. Critical care was delivered within high-risk pathogen isolation in the ED and in our Special Treatment Unit until a diagnosis of severe cerebral malaria was confirmed and EVD was definitively excluded.
This report discusses our experience activating a longitudinal preparedness program designed for rare, resource-intensive events at hospitals physically remote from any active epidemic but serving a high-volume international air travel port-of-entry.
A combination of olanzapine and samidorphan (OLZ/SAM) is in development for schizophrenia to provide the efficacy of olanzapine while mitigating olanzapine-associated weight gain. The objective of this phase 1 exploratory study was to assess metabolic treatment effects of OLZ/SAM.
Healthy, non-obese adults (18–40 years) were randomized 2:2:1 to once-daily OLZ/SAM, olanzapine, or placebo for 21 days. Assessments included oral glucose tolerance test (OGTT), hyperinsulinemic-euglycemic clamp, weight gain, and adverse event (AE) monitoring. Treatment effects were estimated with analysis of covariance.
Sixty subjects were randomized (OLZ/SAM, n=24; olanzapine, n=24; placebo, n=12); 19 (79.2%), 22 (91.7%), and 11 (91.7%), respectively, completed the study. In the OGTT, olanzapine led to significant hyperinsulinemia (P<0.0001) and significantly reduced insulin sensitivity (2-hour Matsuda index) at day 19 vs baseline (P=0.0012), changes not observed with OLZ/SAM. No significant between-group differences were observed for change from baseline in clamp-derived insulin sensitivity index at day 21. Least squares mean weight change from baseline was similar with OLZ/SAM (3.16 kg) and olanzapine (2.87 kg); both were significantly higher than placebo (0.57 kg; both P<0.01). Caloric intake significantly decreased from baseline to day 22 with OLZ/SAM (P=0.015) but not with olanzapine or placebo. Forty-nine subjects (81.7%) experienced ≥1 AE (OLZ/SAM, 87.5%; olanzapine, 79.2%; placebo, 75.0%).
In this exploratory study, hyperinsulinemia and decreased insulin sensitivity were observed in the OGTT with olanzapine but not with OLZ/SAM or placebo. Clamp-derived insulin sensitivity index and weight changes were similar with OLZ/SAM and olanzapine in healthy subjects during the 3-week study.
UK Biobank is a well-characterised cohort of over 500 000 participants including genetics, environmental data and imaging. An online mental health questionnaire was designed for UK Biobank participants to expand its potential.
Describe the development, implementation and results of this questionnaire.
An expert working group designed the questionnaire, using established measures where possible, and consulting a patient group. Operational criteria were agreed for defining likely disorder and risk states, including lifetime depression, mania/hypomania, generalised anxiety disorder, unusual experiences and self-harm, and current post-traumatic stress and hazardous/harmful alcohol use.
A total of 157 366 completed online questionnaires were available by August 2017. Participants were aged 45–82 (53% were ≥65 years) and 57% women. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status. Lifetime depression was a common finding, with 24% (37 434) of participants meeting criteria and current hazardous/harmful alcohol use criteria were met by 21% (32 602), whereas other criteria were met by less than 8% of the participants. There was extensive comorbidity among the syndromes. Mental disorders were associated with a high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.
The UK Biobank questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed because of selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.
A case study of hard disk drives (HDDs) and rare-earth magnets is presented to show the use of decision support tools to identify and assess the barriers and opportunities for circular business models. Pilot demonstration projects, which showcased HDD circular recovery strategies, were useful as a low-risk opportunity for business model experimentation and to build trust among key supply chain actors.
A case study of hard disk drives and rare-earth magnets is presented to show the use of decision support tools (DSTs) to assess the complex interaction of variables that must be considered when demonstrating the viability of circular business models (CBMs). A mix of quantitative and qualitative DSTs such as life cycle assessment, techno-economic assessment, Ostrom's Framework for social-ecological systems, decision trees, and others were implemented by the iNEMI Value Recovery Project team to overcome many of the identified barriers to circular economy. The DSTs were used to guide stakeholder coordination, create and share environmental, logistical and financial data, and generate decision-making flowcharts which promote circular economic strategies. Demonstration projects were used as a low-risk opportunity for business model experimentation and to build trust among key supply chain actors. The tools highlighted by this case study could be useful for establishing or expanding CBMs for other electronic products or components, especially components containing critical materials.
Colorectal cancer (CRC) is the fourth most common cancer in the UK; 95% of CRCs develop from colorectal adenomas. Adults in England aged 60–74 years are screened for colorectal cancer through the national Bowel Cancer Screening Programme (BCSP) which aims to detect colorectal cancer early, and also remove colorectal adenomas. However, adenoma recurrence is common. The World Cancer Research Fund (WCRF) estimates that around 45% of CRC cases could be prevented by a healthy lifestyle. There are no specific dietary guidelines to protect against adenoma recurrence and patients do not receive dietary advice in the care pathway. Nonetheless understanding the dietary intake of people with adenoma who are at high-risk of developing CRC and their subsequent dietary behaviour post-diagnosis may design future intervention strategies.
This study aims to describe the diet of colorectal adenoma patients and evaluate whether there were elective changes in diet following diagnosis.
The data used in this study were obtained from colorectal adenoma patients at high risk of recurrence, recruited to the seAFOod polyp prevention trial through the English BCSP. Dietary intake was assessed using the EPIC Food Frequency Questionnaire at two time points: during the 12 months before and during the 12 months after adenoma diagnosis. FETA dietary analysis software was used to extract data. Paired Sample-T-Tests and Wilcoxon Signed-Rank Test were used to assess change in intake using SPSS version 25.
Of the 709 patients recruited to the main study, 526 completed the FFQ on both occasions, of whom 81.7% were males. The mean age was 65 years (SD 4.8), 83.4% were overweight or obese with mean BMI = 29.5 kg/m2 (SD 5.7). The majority of nutrient intakes met UK DRVs, with the exception of low intake of fibre, vitamin D and selenium. Following diagnosis, a significant reduction was detected in daily intake of energy (from 7.7 to 7.5 MJ, p < 0.05) meat and meat products (from 124 to 111 g, p < 0.005), non-alcoholic beverages (from 939 to 898 g, p < 0.05) and nuts (from 5.5 to 4.3 g, p < 0.05). Subgroup analysis revealed that dietary changes were confined to men where the reduction in energy was by 293 kj/day and in meat by 1.5 portions per week.
Patients do modify diet following a diagnosis of adenoma and changes correspond to WCRF healthy diet guidelines. Whether detected difference between males and females was due to the sample size or due to actual difference in behavior is not clear.
The chapter examines racist and colonialist assumptions in Bergson’s philosophy and outlines what is at stake in the various approaches to these assumptions that recent interpreters have taken. Focusing on two readers of Bergson, Léopold Sédar Senghor and Messay Kebede, the chapter shows how the Négritude movement deployed a Bergsonian epistemology to challenge the dominance and domination of a European conception of rationality, mobilizing instead what Senghor calls an “embracing reason.” Critically assessing recent identifications of racism, the racialization of bodies, and whiteness as a transcendental norm in Bergson’s philosophy, the author concludes that Bergson cannot altogether escape the charges, given that his central distinction between open and closed in Two Sources relies on a notion of “primitives” as an indispensable foil for the achievements of the mystics. The question then becomes to what extent Bergson’s thought can be mobilized to remedy the evils it cannot wholly be extricated from. In conclusion, the essay surveys contemporary appropriations of the conception of the open society and suggests that Senghor’s rearticulation of Bergson’s intuition as sympathetic "embracing reason" offers theoretical and practical ways to address racist and colonial discourses.
Non-invasive prenatal testing (NIPT) for the detection of foetal aneuploidy through analysis of cell-free DNA (cfDNA) in maternal blood is offered routinely by many healthcare providers across the developed world. This testing has recently been recommended for evaluative implementation in the UK National Health Service (NHS) foetal anomaly screening pathway as a contingent screen following an increased risk of trisomy 21, 18 or 13. In preparation for delivering a national service, we have implemented cfDNA-based NIPT in our Regional Genetics Laboratory. Here, we describe our validation and verification processes and initial experiences of the technology prior to rollout of a national screening service.
Data are presented from more than 1000 patients (215 retrospective and 840 prospective) from ‘high- and low-risk pregnancies’ with outcome data following birth or confirmatory invasive prenatal sampling. NIPT was by the Illumina Verifi® test.
Our data confirm a high-fidelity service with a failure rate of ~0.24% and a high sensitivity and specificity for the detection of foetal trisomy 13, 18 and 21. Secondly, the data show that a significant proportion of patients continue their pregnancies without prenatal invasive testing or intervention after receiving a high-risk cfDNA-based result. A total of 46.5% of patients referred to date were referred for reasons other than high screen risk. Ten percent (76/840 clinical service referrals) of patients were referred with ultrasonographic finding of a foetal structural anomaly, and data analysis indicates high- and low-risk scan indications for NIPT.
NIPT can be successfully implemented into NHS regional genetics laboratories to provide high-quality services. NHS provision of NIPT in patients with high-risk screen results will allow for a reduction of invasive testing and partially improve equality of access to cfDNA-based NIPT in the pregnant population. Patients at low risk for a classic trisomy or with other clinical indications are likely to continue to access cfDNA-based NIPT as a private test.
Multispectral imaging – the acquisition of spatially contiguous imaging data in a modest number (~3–16) of spectral bandpasses – has proven to be a powerful technique for augmenting panchromatic imaging observations on Mars focused on geologic and/or atmospheric context. Specifically, multispectral imaging using modern digital CCD photodetectors and narrowband filters in the 400–1100 nm wavelength region on the Mars Pathfinder, Mars Exploration Rover, Phoenix, and Mars Science Laboratory missions has provided new information on the composition and mineralogy of fine-grained regolith components (dust, soils, sand, spherules, coatings), rocky surface regions (cobbles, pebbles, boulders, outcrops, and fracture-filling veins), meteorites, and airborne dust and other aerosols. Here we review recent scientific results from Mars surface-based multispectral imaging investigations, including the ways that these observations have been used in concert with other kinds of measurements to enhance the overall scientific return from Mars surface missions.
Three new Llandovery (early Silurian) crinoids from Estonia provide an improved understanding of the paleogeographic aspects of the crinoid diversification following the end-Ordovician extinctions. The new taxa are Euspirocrinus hintsae new species (Rhuddanian eucladid), Oepikicrinus perensae new genus new species (Aeronian camerate), and Rozhnovicrinus isakarae new genus new species (Aeronian eucladid). This brings the total of described Llandovery crinoids in Estonia to eight nominal species and a further three taxa in open nomenclature. The Rhuddanian radiation in Baltica mirrored that on Laurentia and Avalonia and was dominated by Ordovician clades that continued to diversify during the Silurian. Known Aeronian crinoids from Estonia continue these clades, whereas new clades diversified on Laurentia and Avalonia. However, by the Wenlock, a largely cosmopolitan fauna existed on Laurentia, Avalonia, and Baltica.