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In May 2016, the National Academies of Sciences, Engineering, and Medicine (NASEM) released the report “Genetically Engineered Crops: Experiences and Prospects,” summarizing scientific consensus on genetically engineered crops and their implications. NASEM reports aim to give the public and policymakers information on socially relevant science issues. Their impact, however, is not well understood. This analysis combines national pre- and post-report survey data with a large-scale content analysis of Twitter discussion to examine the report’s effect on public perceptions of genetically modified organisms (GMOs). We find that the report’s release corresponded with reduced negativity in Twitter discourse and increased ambivalence in public risk and benefit perceptions of GMOs, mirroring the NASEM report’s conclusions. Surprisingly, this change was most likely for individuals least trusting of scientific studies or university scientists. Our findings indicate that NASEM consensus reports can help shape public discourse, even in, or perhaps because of, the complex information landscape of traditional and social media.
Treatment for hoarding disorder is typically performed by mental health professionals, potentially limiting access to care in underserved areas.
We aimed to conduct a non-inferiority trial of group peer-facilitated therapy (G-PFT) and group psychologist-led cognitive–behavioural therapy (G-CBT).
We randomised 323 adults with hording disorder 15 weeks of G-PFT or 16 weeks of G-CBT and assessed at baseline, post-treatment and longitudinally (≥3 months post-treatment: mean 14.4 months, range 3–25). Predictors of treatment response were examined.
G-PFT (effect size 1.20) was as effective as G-CBT (effect size 1.21; between-group difference 1.82 points, t = −1.71, d.f. = 245, P = 0.04). More homework completion and ongoing help from family and friends resulted in lower severity scores at longitudinal follow-up (t = 2.79, d.f. = 175, P = 0.006; t = 2.89, d.f. = 175, P = 0.004).
Peer-led groups were as effective as psychologist-led groups, providing a novel treatment avenue for individuals without access to mental health professionals.
Declaration of interest
C.A.M. has received grant funding from the National Institutes of Health (NIH) and travel reimbursement and speakers’ honoraria from the Tourette Association of America (TAA), as well as honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. K.D. receives research support from the NIH and honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. R.S.M. receives research support from the National Institute of Mental Health, National Institute of Aging, the Hillblom Foundation, Janssen Pharmaceuticals (research grant) and the Alzheimer's Association. R.S.M. has also received travel support from the National Institute of Mental Health for Workshop participation. J.Y.T. receives research support from the NIH, Patient-Centered Outcomes Research Institute and the California Tobacco Related Research Program, and honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. All other authors report no conflicts of interest.
Children with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.
Materials and methods
We sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.
A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.
The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.
Increased temporal and frontal slow-wave delta (1–4 Hz) and theta (4–7
Hz) activities are the most consistent resting-state neural abnormalities
reported in schizophrenia. The frontal lobe is associated with negative
symptoms and cognitive abilities such as attention, with negative
symptoms and impaired attention associated with poor functional
To establish whether frontal dysfunction, as indexed by slowing, would be
associated with functional impairments.
Eyes-closed magnetoencephalography data were collected in 41 participants
with schizophrenia and 37 healthy controls, and frequency-domain source
imaging localised delta and theta activity.
Elevated delta and theta activity in right frontal and right
temporoparietal regions was observed in the schizophrenia
v. control group. In schizophrenia, right-frontal
delta activity was uniquely associated with negative but not positive
symptoms. In the full sample, increased right-frontal delta activity
predicted poorer attention and functional capacity.
Our findings suggest that treatment-associated decreases in slow-wave
activity could be accompanied by improved functional outcome and thus
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format to assist acute care hospitals in implementing and prioritizing strategies to prevent ventilator-associated pneumonia (VAP) and other ventilator-associated events (VAEs) and to improve outcomes for mechanically ventilated adults, children, and neonates. This document updates “Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format to assist acute care hospitals in implementing and prioritizing strategies to prevent ventilator-associated pneumonia (VAP) and other ventilator-associated events (VAEs) and to improve outcomes for mechanically ventilated adults, children, and neonates. This document updates "Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals," published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
Recent Hα surveys such as SHS and IPHAS have improved the completeness of the Galactic planetary nebula (PN) census. We now know of ∼3000 PNe in the Galaxy, but this is far short of most estimates, typically ~25 000 or more for the total population. The size of the Galactic PN population is required to derive an accurate estimate of the chemical enrichment rates of nitrogen, carbon, and helium. In addition, a high PN count (>20 000) is strong evidence that most main-sequence stars of mass 1–8 M⊙ will go through a PN phase, while a low count (<10 000) argues that special conditions (e.g. close binary interactions) are required to form a PN. We describe a technique for finding hundreds more PNe using the existing data collections of the digital sky surveys, thereby improving the census of Galactic PNe.
Kevin Howells, Emeritus Professor, School of Community Health Sciences, University of Nottingham, Nottingham, UK,
Gopi Krishnan, Consultant Forensic Psychiatrist and Associate Clinical Director, Rampton Hospital, Retford, UK,
Michael Daffern, Associate Professor, School of Psychology and Psychiatry, Monash University, Melbourne, Australia; Principal Consultant, Forensicare, Victoria, Australia; Special Lecturer, Division of Psychiatry, Nottingham University, Nottingham, UK
Summary Dangerous and severe personality disorder (DSPD) services have a relatively short history, are currently under review and may be reconfigured in the next few years. Despite such uncertainties, implementation of therapeutic programmes for patients and prisoners in this category is likely to remain a high priority. We describe the background to the DSPD initiative in England and consider issues that arose in planning and delivering treatment services. Two bodies of evidence are particularly relevant: previous research into personality disorder and its treatment, which we suggest is, as yet, of limited value, and research into the outcomes of offender treatment programmes. The latter is clearly relevant but greater consideration of adapting programmes for the patient population and of breadth of treatment is required in the DSPD setting. The important task is to integrate components for the treatment of personality disorder and offending behaviour in a holistic manner. We describe further challenges in delivering treatment and suggest that ongoing evaluation of treatments is critical in this area of practice, given the impoverished knowledge base.
In the past, personality disorder has been the Cinderella of Cinderella health services. Many psychiatrists have considered personality disorder to be untreatable, some doubting the legitimacy of treating it within the health system. The issue of how to treat and manage (predominantly) men with severe personality or psychopathic disorder who also pose a risk to the public has been even more contentious. This latter group was traditionally managed within the criminal justice system, but the problem of defining which agencies should be responsible for them was brought into sharp focus during the acrimonious public debate following the conviction of Michael Stone for the murder of a mother and child in 1998. Although Stone was considered to have a personality disorder, psychiatrists dealing with him did not consider the disorder treatable and hence he could not be detained under the Mental Health Act 1983. In February 1999, the UK Government announced proposals to introduce the Dangerous and Severe Personality Disorder (DSPD) pilot programme, the legal provision for which would be embedded within a new legislative framework.
This chapter discusses the case of a 17-year-old girl who was admitted for the evaluation of excessive daytime sleepiness (EDS). It presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on the patient. She suffered developmental delay, and was later diagnosed with mild mental retardation. Nocturnal polysomnography (PSG) and a multiple sleep latency test (MSLT) were carried out. The diagnosis was childhood-onset narcolepsy with cataplexy. The parents declined CSF testing for hypocretin. The onset of narcolepsy may occur with any of the four cardinal symptoms (excessive sleepiness, sleep paralysis, hypnagogic hallucinations and cataplexy), the most frequent being EDS. Childhood onset of narcolepsy is uncommon, but has been reported. The usual age of onset is mid- to late teens up to mid-20s. Occasionally patients may become ill after the age of 40.
A log-coffin excavated in the early nineteenth century proved to be well enough preserved in the early twenty-first century for the full armoury of modern scientific investigation to give its occupants and contents new identity, new origins and a new date. In many ways the interpretation is much the same as before: a local big man buried looking out to sea. Modern analytical techniques can create a person more real, more human and more securely anchored in history. This research team shows how.
Ab initio calculations for scytonemin, an important ultraviolet (UV)-radiation protective biomolecule synthesized by extremophilic cyanobacteria in stressed terrestrial environments, are reported for the first time. Vibrational spectroscopic assignments for the previously studied Raman spectra assist in the identification of the major features in the observed data. Calculations of the electronic absorption spectra confirm the capability of this molecule to absorb in all three regions of the UV, UVA, UVB and UVC, and also illustrate the need for a dimeric species in this respect. The presence of significant steric hindrance between the two halves of the dimeric molecule about the C—C bridging bond in scytonemin forces the molecule significantly out of planarity, contrary to assumptions made in the literature; however, it appears that the monomer is capable of absorbing to only a limited extent in the UVB and UVC regions only, so conferring a special emphasis upon the need for the dimerization to remove the lower-energy UV radiation whilst still affording protection for the chlorophyll with transmission of the visible radiation required for photosynthesis. The observation of vibrational band wavenumber coincidences for the first time between the infrared and Raman spectra confirm the non-planar structural prediction from the calculations. The results of this study provide information about the protective chemical strategies of terrestrial extremophilic cyanobacteria and provide a basis for the search for molecules of this type in the astrobiological exploration of Mars.
As we have noted before, the WG-IR was created following a Joint Commission Meeting at the IAU General Assembly in Baltimore in 1988, a meeting that provided both diagnosis and prescription for the perceived ailments of infrared photometry at the time. The results were summarized in Milone (1989). The challenges involve how to explain the failure to systematically achieve the milli-magnitude precision expected of infrared photometry and an apparent 3% limit on system transformability. The proposed solution was to re-define the broadband Johnson system, the passbands of which had proven so unsatisfactory that over time effectively different systems proliferated although bearing the same JHKLMNQ designations; the new system needed to be better positioned and centered in the atmospheric windows of the Earth's atmosphere, and the variable water vapour content of the atmosphere needed to be measured in real time to better correct for atmospheric extinction.
Dangerous and severe personality disorder (DSPD) services have a relatively short history but are increasingly involved in the implementation of therapeutic programmes. We describe the background to the DSPD initiative in England and consider issues that arise in planning and delivering treatment services. Two bodies of evidence are particularly relevant: previous research into personality disorder and its treatment, which we suggest is as yet of limited value, and research into the outcomes of offender treatment programmes. The latter is clearly relevant but greater consideration of adapting programmes for the patient population and of breadth of treatment is required in the DSPD setting. The important task is to integrate components for the treatment of personality disorder and offending behaviour in a holistic manner. We describe three further challenges in delivering treatment and suggest that ongoing evaluation of treatments is critical in this area of practice, given the impoverished knowledge base.
Analysis of nearly 200 prehispanic upland farming locations around Casas Grandes in northwestern Chihuahua indicates that land modification was widespread and involved a range of farming strategies depending on microtopographic setting. Most significantly, some cultivation seems to have been organized or controlled by the leaders of the Casas Grandes polity. Unusually large fields associate with small sites that likely served special administrative and/or ritual roles and that are in sparsely occupied locations.
John G. Nackel, Executive Vice President US Technology Resources, Aliso Viejo, California, USA,
Douglas S. Wakefield, Professor and Head of the Department Health Management and Policy in the College of Public Health at the University of Iowa,
Michael G. Kienzle, Special Assistant to the Dean and Director Economic and Business Development in the College of Medicine at the University of Iowa,
R. Edward Howell, Vice President and Chief Executive Officer University of Virginia Medical Center,
Robert P. Kelch, Executive Vice President Medical Affairs at the University of Michigan,
Edward D. Miller, Chief Executive Officer Johns Hopkins Medicine; Dean of the Medical Faculty Johns Hopkins University,
Steven Lipstein, President and Chief Executive Officer BJC Health Care
Leaders of academic health centers (AHCs) have always experienced a wide range of formidable challenges during their tenure. AHCs are complex organizations to lead because of their multiple missions, substantial size, highly specialized products and services, diverse internal and external constituencies, and culture marked by autonomy of faculty and departments. They operate as academic, business, and (in many cases) public organizations simultaneously, in an industry that is in the midst of evolving its production modes (i.e., from cottage to manufacturing to knowledge-based). Across AHCs, financial threats abound as a result of reduced government support and declining clinical revenues.
In many cases, governance structures are being or need to be modified because governing boards do not always facilitate needed change and internal decision-making processes are not always efficient. Moreover, the career path of AHC leaders is often antithetical to the development of skills necessary for effective leadership. Further, a coherent strategy to build future leaders is lacking in most AHCs. Planning for future leadership is often equivalent to establishing a search committee when a key position becomes vacant.
An array of societal, economic, and technological forces is creating a new and as yet uncharted terrain for AHCs. Academic health center leaders must address demographic shifts, new capabilities arising from information and communications technology, and growing consumer expectations for speed and customized products and services. These changes require that organizations assume new roles, acquire new capabilities, develop new business models, and interact with both customers and staff in new ways.