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Background Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness.
Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated.
Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated?
Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD.
Silicon carbide together with amorphous carbon are the main components of dust grains in the atmospheres of C-rich AGB stars. Small gaseous Si-C bearing molecules (such as SiC, SiCSi, and SiC2) are efficiently formed close to the stellar photosphere. They likely condense onto dust seeds owing to their highly refractory nature at the lower temperatures (i.e., below about 2500 K) in the dust growth zone which extends a few stellar radii from the photosphere. Beyond this region, the abundances of Si-C bearing molecules are expected to decrease until they are eventually reformed in the outer shells of the circumstellar envelope, owing to the interaction between the gas and the interstellar UV radiation field. Our goal is to understand the time-dependent chemical evolution of Si-C bond carriers probed by molecular spectral line emission in the circumstellar envelope of IRC+10216 at millimeter wavelengths.
Detecting gastrointestinal (GI) infection transmission among men who have sex with men (MSM) in England is complicated by a lack of routine sexual behavioural data. We investigated whether gender distributions might generate signals for increased transmission of GI pathogens among MSM. We examined the percentage male of laboratory-confirmed patient-episodes for patients with no known travel history for 10 GI infections of public health interest in England between 2003 and 2013, stratified by age and region. An adult male excess was observed for Shigella spp. (annual maximum 71% male); most pronounced for those aged 25–49 years and living in London, Brighton and Manchester. An adult male excess was observed every year for Entamoeba histolytica (range 59.8–76.1% male), Giardia (53.1–57.6%) and Campylobacter (52.1–53.5%) and for a minority of years for hepatitis A (max. 69.8%) and typhoidal salmonella (max. 65.7%). This approach generated a signal for excess male episodes for six GI pathogens, including a characterised outbreak of Shigella among MSM. Stratified analyses by geography and age group were consistent with MSM transmission for Shigella. Optimisation and routine application of this technique by public health authorities elsewhere might help identify potential GI infection outbreaks due to sexual transmission among MSM, for further investigation.
An unexpected increase in gastroenteritis cases was reported by healthcare workers on the KwaZulu-Natal Coast, South Africa, January 2017 with >600 cases seen over a 3-week period. A case–control study was conducted to identify the source and risk factors associated with the outbreak so as to recommend control and prevention measures. Record review identified cases and controls and structured-telephonic interviews were conducted to obtain exposure history. Stool specimens were collected from 20 cases along with environmental samples and both screened for enteric pathogens. A total of 126 cases and 62 controls were included in the analysis. The odds of developing gastroenteritis were 6.0 times greater among holiday makers than residents (95% confidence interval (CI) 2.0–17.7). Swimming in the lagoon increased the odds of developing gastroenteritis by 3.3 times (95% CI 1.06–10.38). Lagoon water samples tested positive for norovirus (NoV) GI.6, GII.3 and GII.6, astrovirus and rotavirus. Eleven (55%) stool specimens were positive for NoV with eight genotyped as GI.1 (n = 2), GI.5 (n = 3), GI.6 (n = 2), and GI.7 (n = 1). A reported sewage contamination event impacting the lagoon was the likely source with person-to-person spread perpetuating the outbreak. Restriction to swimming in the lagoon was apparently ineffective at preventing the outbreak, possibly due to inadequate enforcement, communication and signage strategies.
Established methods of recruiting population controls for case–control studies to investigate gastrointestinal disease outbreaks can be time consuming, resulting in delays in identifying the source or vehicle of infection. After an initial evaluation of using online market research panel members as controls in a case–control study to investigate a Salmonella outbreak in 2013, this method was applied in four further studies in the UK between 2014 and 2016. We used data from all five studies and interviews with members of each outbreak control team and market research panel provider to review operational issues, evaluate risk of bias in this approach and consider methods to reduce confounding and bias. The investigators of each outbreak reported likely time and cost savings from using market research controls. There were systematic differences between case and control groups in some studies but no evidence that conclusions on the likely source or vehicle of infection were incorrect. Potential selection biases introduced by using this sampling frame and the low response rate are unclear. Methods that might reduce confounding and some bias should be balanced with concerns for overmatching. Further evaluation of this approach using comparisons with traditional methods and population-based exposure survey data is recommended.
An outbreak of respiratory diphtheria occurred in two health districts in the province of KwaZulu-Natal in South Africa in 2015. A multidisciplinary outbreak response team was involved in the investigation and management of the outbreak. Fifteen cases of diphtheria were identified, with ages ranging from 4 to 41 years. Of the 12 cases that were under the age of 18 years, 9 (75%) were not fully immunized for diphtheria. The case fatality was 27%. Ninety-three household contacts, 981 school or work contacts and 595 healthcare worker contacts were identified and given prophylaxis against Corynebacterium diphtheriae infection. A targeted vaccination campaign for children aged 6–15 years was carried out at schools in the two districts. The outbreak highlighted the need to improve diphtheria vaccination coverage in the province and to investigate the feasibility of offering diphtheria vaccines to healthcare workers.
Although repeatedly associated with white matter microstructural alterations, bipolar disorder (BD) has been relatively unexplored using complex network analysis. This method combines structural and diffusion magnetic resonance imaging (MRI) to model the brain as a network and evaluate its topological properties. A group of highly interconnected high-density structures, termed the ‘rich-club’, represents an important network for integration of brain functioning. This study aimed to assess structural and rich-club connectivity properties in BD through graph theory analyses.
We obtained structural and diffusion MRI scans from 42 euthymic patients with BD type I and 43 age- and gender-matched healthy volunteers. Weighted fractional anisotropy connections mapped between cortical and subcortical structures defined the neuroanatomical networks. Next, we examined between-group differences in features of graph properties and sub-networks.
Patients exhibited significantly reduced clustering coefficient and global efficiency, compared with controls globally and regionally in frontal and occipital regions. Additionally, patients displayed weaker sub-network connectivity in distributed regions. Rich-club analysis revealed subtly reduced density in patients, which did not withstand multiple comparison correction. However, hub identification in most participants indicated differentially affected rich-club membership in the BD group, with two hubs absent when compared with controls, namely the superior frontal gyrus and thalamus.
This graph theory analysis presents a thorough investigation of topological features of connectivity in euthymic BD. Abnormalities of global and local measures and network components provide further neuroanatomically specific evidence for distributed dysconnectivity as a trait feature of BD.
Declining availability of prey is potentially a major factor limiting snow leopard Panthera uncia populations in Tajikistan and neighbouring states. Conservation initiatives to develop community-based trophy hunting programmes for ibex Capra sibirica and argali Ovis ammon polii aim to provide financial incentives for communities to limit poaching of wild ungulates. Such programmes could help to reverse local declines in ibex and argali populations, and consequently snow leopard populations, while simultaneously improving the economic status of local people. However, in practice the desired effect may not materialize. To investigate the premise, we estimated the population density of the snow leopard, using a spatial capture–recapture model based on camera trapping in two study areas (each c. 1,000 km2) in the Tajik Pamirs: a well-managed trophy hunting concession and an otherwise similar area where grazing and poaching are unmanaged. We used distance-truncated counts to assess relative densities of wild and domestic ungulates between sites, and faecal analyses to compare the dietary habits of snow leopards. Our data were limited in scope but suggested that the density of snow leopards and the relative density of wild and domestic ungulates may have been greater in the hunting concession, where wild ungulates accounted for a greater proportion of prey items. Our results provide preliminary evidence that trophy hunting of ungulates may be a viable tool for achieving snow leopard conservation goals; however, we conclude that further investigation is necessary to adequately address the question.
The burden and aetiology of type 2 diabetes (T2D) and its microvascular complications may be influenced by varying behavioural and lifestyle environments as well as by genetic susceptibility. These aspects of the epidemiology of T2D have not been reliably clarified in sub-Saharan Africa (SSA), highlighting the need for context-specific epidemiological studies with the statistical resolution to inform potential preventative and therapeutic strategies. Therefore, as part of the Human Heredity and Health in Africa (H3Africa) initiative, we designed a multi-site study comprising case collections and population-based surveys at 11 sites in eight countries across SSA. The goal is to recruit up to 6000 T2D participants and 6000 control participants. We will collect questionnaire data, biophysical measurements and biological samples for chronic disease traits, risk factors and genetic data on all study participants. Through integrating epidemiological and genomic techniques, the study provides a framework for assessing the burden, spectrum and environmental and genetic risk factors for T2D and its complications across SSA. With established mechanisms for fieldwork, data and sample collection and management, data-sharing and consent for re-approaching participants, the study will be a resource for future research studies, including longitudinal studies, prospective case ascertainment of incident disease and interventional studies.
The relative weighting on traits within breeding goals are generally determined by bio-economic models or profit functions. While such methods have generally delivered profitability gains to producers, and are being expanded to consider non-market values, current approaches generally do not consider the numerous and diverse stakeholders that affect, or are affected, by such tools. Based on principles of respondent anonymity, iteration, controlled feedback and statistical aggregation of feedback, a Delphi study was undertaken to gauge stakeholder opinion of the importance of detailed milk quality traits within an overall dairy breeding goal for profit, with the aim of assessing its suitability as a complementary, participatory approach to defining breeding goals. The questionnaires used over two survey rounds asked stakeholders: (a) their opinion on incorporating an explicit sub-index for milk quality into a national breeding goal; (b) the importance they would assign to a pre-determined list of milk quality traits and (c) the (relative) weighting they would give such a milk quality sub-index. Results from the survey highlighted a good degree of consensus among stakeholders on the issues raised. Similarly, revelation of the underlying assumptions and knowledge used by stakeholders to make their judgements illustrated their ability to consider a range of perspectives when evaluating traits, and to reconsider their answers based on the responses and rationales given by others, which demonstrated social learning. Finally, while the relative importance assigned by stakeholders in the Delphi survey (4% to 10%) and the results of calculations based on selection index theory of the relative emphasis that should be placed on milk quality to halt any deterioration (16%) are broadly in line, the difference indicates the benefit of considering more than one approach to determining breeding goals. This study thus illustrates the role of the Delphi technique, as a complementary approach to traditional approaches, to defining breeding goals. This has implications for how breeding goals will be defined and in determining who should be involved in the decision-making process.
Genetic selection for milking speed is feasible. The existence of a correlation structure between milking speed and milk yield, however, necessitates a selection strategy to increase milking speed with no repercussion on genetic merit for milk yield. Residual milking duration (RMD) and residual milking duration including somatic cell score (RMDS), defined as the residuals from a regression model of milking duration on milk yield or milk yield plus somatic cell score (SCS) have been advocated. The objective of this study was to undertake a first ever genetic analysis of these novel traits. Data on electronically recorded milking duration and other milking characteristics from 235 005 test-day records on 74 608 cows in 1075 Irish dairy herds were available. Variance components for the milking characteristic traits were estimated using animal linear mixed models and covariances with other performance traits, including udder-related type traits, were estimated using sire models. The heritability of milking duration, RMD and RMDS was 0.20, 0.22 and 0.18, respectively. There were little differences in the heritability of RMD or RMDS when defined using genetic regression. The genetic standard deviation of RMDS defined on the phenotypic or genetic level was 36.8 s and 37.6 s, respectively, clearly indicating considerable exploitable genetic variation in milking duration independent of both milk yield and SCS. The genetic correlation between phenotypically derived RMDS and milk yield was favourable (−0.43), but RMDS was unfavourably genetically correlated with SCS (−0.30); the genetic correlations with both traits when RMDS was defined at a genetic level were zero. RMDS defined at the phenotypic level was negatively (i.e. unfavourable) genetically correlated (−0.35; s.e. = 0.15) with mastitis; however, when defined using genetic regression, shorter RMDS was not associated with greater expected incidence of mastitis. RMDS, defined at the genetic level, is a useful heritable trait with ample genetic variation for inclusion in a national breeding strategy without influencing genetic gain in either milk yield or udder health.
We present preliminary results from two parallel programs to search for new substellar companions to nearby, young M-stars and to characterize the atmospheres of known planetary mass and temperature substellar companions. For the M-star survey, we are analyzing high angular resolution archival data on systems within 15pc, complementing a subset with well-determined young ages based on measurements of several age indicators. The results include stellar and substellar companion candidates, which we are currently pursuing with follow-up second epoch images. The characterization component of the project involves using LBT LMIRCam and MMT ARIES direct imaging and spectroscopy data to investigate the atmospheres of known young substellar companions with masses overlapping the planetary regime. These atmospheric studies will represent an analogous comparison to the atmospheres of young imaged planets, and provide a means to fundamentally test evolutionary models, enhancing our understanding of the overall substellar population.
In most developed countries, motor vehicle accidents are a leading cause of death among young people, and a large proportion of motor vehicle accidents are alcohol-related. In Spain there are no currently available instruments for assessing positive expectancies related to drinking and driving behavior. Attempting to modify these expectancies may be an effective prevention approach, so there is a need for a valid and reliable scale to measure the construct. The aims of the present study were to translate, culturally adapt, and examine the psychometric properties of a Spanish-language version of the Positive Expectancies for Drinking and Driving for Youth (PEDD-Y) in a sample of Spanish young adults. A total of 352 college students with drivers licenses were recruited at a university in southeast Spain. We examined the factor structure, psychometric properties (reliability and validity) and temporal stability of the Spanish version of the PEDD-Y among Spanish young adult drivers. Findings indicated that the Spanish version of the PEDD-Y demonstrated satisfactory psychometric properties and was shown to significantly predict lifetime prevalence and future intentions to drink and drive as well as riding with a drunk driver. The Convenience factor performed with the most consistent reliability and predictive validity. Limitations and future research questions are discussed.