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Although there is growing interest in mental health problems in university students there is limited understanding of the scope of need and determinants to inform intervention efforts.
To longitudinally examine the extent and persistence of mental health symptoms and the importance of psychosocial and lifestyle factors for student mental health and academic outcomes.
Undergraduates at a Canadian university were invited to complete electronic surveys at entry and completion of their first year. The baseline survey measured important distal and proximal risk factors and the follow-up assessed mental health and well-being. Surveys were linked to academic grades. Multivariable models of risk factors and mental health and academic outcomes were fit and adjusted for confounders.
In 1530 students surveyed at entry to university 28% and 33% screened positive for clinically significant depressive and anxiety symptoms respectively, which increased to 36% and 39% at the completion of first year. Over the academic year, 14% of students reported suicidal thoughts and 1.6% suicide attempts. Moreover, there was persistence and overlap in these mental health outcomes. Modifiable psychosocial and lifestyle factors at entry were associated with positive screens for mental health outcomes at completion of first year, while anxiety and depressive symptoms were associated with lower grades and university well-being.
Clinically significant mental health symptoms are common and persistent among first-year university students and have a negative impact on academic performance and well-being. A comprehensive mental health strategy that includes a whole university approach to prevention and targeted early-intervention measures and associated research is justified.
Disease surveillance in wildlife populations presents a logistical challenge, yet is critical in gaining a deeper understanding of the presence and impact of wildlife pathogens. Erinaceus coronavirus (EriCoV), a clade C Betacoronavirus, was first described in Western European hedgehogs (Erinaceus europaeus) in Germany. Here, our objective was to determine whether EriCoV is present, and if it is associated with disease, in Great Britain (GB). An EriCoV-specific BRYT-Green® real-time reverse transcription PCR assay was used to test 351 samples of faeces or distal large intestinal tract contents collected from casualty or dead hedgehogs from a wide area across GB. Viral RNA was detected in 10.8% (38) samples; however, the virus was not detected in any of the 61 samples tested from Scotland. The full genome sequence of the British EriCoV strain was determined using next generation sequencing; it shared 94% identity with a German EriCoV sequence. Multivariate statistical models using hedgehog case history data, faecal specimen descriptions and post-mortem examination findings found no significant associations indicative of disease associated with EriCoV in hedgehogs. These findings indicate that the Western European hedgehog is a reservoir host of EriCoV in the absence of apparent disease.
Although most hospitals report very high levels of hand hygiene compliance (HHC), the accuracy of these overtly observed rates is questionable due to the Hawthorne effect and other sources of bias. In the study, we aimed (1) to compare HHC rates estimated using the standard audit method of overt observation by a known observer and a new audit method that employed a rapid (<15 minutes) “secret shopper” method and (2) to pilot test a novel feedback tool.
Quality improvement project using a quasi-experimental stepped-wedge design.
This study was conducted in 5 acute-care hospitals (17 wards, 5 intensive care units) in the Midwestern United States.
Sites recruited a hand hygiene observer from outside the acute-care units to rapidly and covertly observe entry and exit HHC during the study period, October 2016–September 2017. After 3 months of observations, sites received a monthly feedback tool that communicated HHC information from the new audit method.
The absolute difference in HHC estimates between the standard and new audit methods was ~30%. No significant differences in HHC were detected between the baseline and feedback phases (OR, 0.92; 95% CI, 0.84–1.01), but the standard audit method had significantly higher estimates than the new audit method (OR, 9.83; 95% CI, 8.82–10.95).
HHC estimates obtained using the new audit method were substantially lower than estimates obtained using the standard audit method, suggesting that the rapid, secret-shopper method is less subject to bias. Providing feedback using HHC from the new audit method did not seem to impact HHC behaviors.
To evaluate whole-genome sequencing (WGS) as a molecular typing tool for MRSA outbreak investigation.
Investigation of MRSA colonization/infection in a neonatal intensive care unit (NICU) over 3 years (2014–2017).
Single-center level IV NICU.
NICU infants and healthcare workers (HCWs).
Infants were screened for MRSA using a swab of the anterior nares, axilla, and groin, initially by targeted (ring) screening, and later by universal weekly screening. Clinical cultures were collected as indicated. HCWs were screened once using swabs of the anterior nares. MRSA isolates were typed using WGS with core-genome multilocus sequence typing (cgMLST) analysis and by pulsed-field gel electrophoresis (PFGE). Colonized and infected infants and HCWs were decolonized. Control strategies included reinforcement of hand hygiene, use of contact precautions, cohorting, enhanced environmental cleaning, and remodeling of the NICU.
We identified 64 MRSA-positive infants: 53 (83%) by screening and 11 (17%) by clinical cultures. Of 85 screened HCWs, 5 (6%) were MRSA positive. WGS of MRSA isolates identified 2 large clusters (WGS groups 1 and 2), 1 small cluster (WGS group 3), and 8 unrelated isolates. PFGE failed to distinguish WGS group 2 and 3 isolates. WGS groups 1 and 2 were codistributed over time. HCW MRSA isolates were primarily in WGS group 1. New infant MRSA cases declined after implementation of the control interventions.
We identified 2 contemporaneous MRSA outbreaks alongside sporadic cases in a NICU. WGS was used to determine strain relatedness at a higher resolution than PFGE and was useful in guiding efforts to control MRSA transmission.
In Cameroon, there is a national programme engaged in the control of schistosomiasis and soil-transmitted helminthiasis. In certain locations, the programme is transitioning from morbidity control towards local interruption of parasite transmission. The volcanic crater lake villages of Barombi Mbo and Barombi Kotto are well-known transmission foci and are excellent context-specific locations to assess appropriate disease control interventions. Most recently they have served as exemplars of expanded access to deworming medications and increased environmental surveillance. In this paper, we review infection dynamics through time, beginning with data from 1953, and comment on the short- and long-term success of disease control. We show how intensification of local control is needed to push towards elimination and that further environmental surveillance, with targeted snail control, is needed to consolidate gains in preventive chemotherapy as well as empower local communities to take ownership of interventions.
With the push towards control and elimination of soil-transmitted helminthiasis and schistosomiasis in low- and middle-income countries, there is a need to develop alternative diagnostic assays that complement the current in-country resources, preferably at a lower cost. Here, we describe a novel high-resolution melt (HRM) curve assay with six PCR primer pairs, designed to sub-regions of the nuclear ribosomal locus. Used within a single reaction and dye detection channel, they are able to discriminate Ancylostoma duodenale, Necator americanus, Strongyloides stercoralis, Ascaris lumbricoides, Trichuris trichiuria and Schistosoma spp. by HRM curve analysis. Here we describe the primers and the results of a pilot assessment whereby the HRM assay was tested against a selection of archived fecal samples from Ghanaian children as characterized by Kato–Katz and real-time PCR analysis with species-specific TaqMan hydrolysis probes. The resulting sensitivity and specificity of the HRM was 80 and 98.6% respectively. We judge the assay to be appropriate in modestly equipped and resourced laboratories. This method provides a potentially cheaper alternative to the TaqMan method for laboratories in lower resource settings. However, the assay requires a more extensive assessment as the samples used were not representative of all target organisms.
The discovery of the ubiquity of filaments in the interstellar medium in the last two decades has begged the question: “What role do filaments play in star formation?” Here we describe how our automated filament finding algorithms can combine with both magnetic field measurements and high-resolution observations of dense cores in these filaments, to provide a statistically large sample to investigate the effect of filaments on star formation. We find that filaments are likely actively accreting mass from the interstellar medium, explaining why some 60% of stars, and all massive stars, form “on-filament”.
Structured, empirically supported psychological interventions are lacking for patients who require organ transplantation. This stage IA psychotherapy development project developed and tested the feasibility, acceptability, tolerability, and preliminary efficacy of an 8-week group cognitive behavioral stress management intervention adapted for patients with end-stage liver disease awaiting liver transplantation.
Twenty-nine English-speaking United Network for Organ Sharing–registered patients with end-stage liver disease from a single transplantation center enrolled in 8-week, group cognitive-behavioral liver stress management and relaxation training intervention adapted for patients with end-stage liver disease. Patients completed pre- and postintervention surveys that included the Beck Depression Inventory II and the Beck Anxiety Inventory. Feasibility, acceptability, tolerability, and preliminary efficacy were assessed.
Attendance rate was 69.40%. The intervention was rated as “good” to “excellent” by 100% of participants who completed the postintervention survey in teaching them new skills to relax and to cope with stress, and by 94.12% of participants in helping them feel supported while waiting for a liver transplant. No adverse events were recorded over the course of treatment. Attrition was 13.79%. Anxious and depressive symptoms were not statistically different after the intervention.
Significance of results
The liver stress management and relaxation training intervention is feasible, acceptable, and tolerable to end-stage liver disease patients within a transplant clinic setting. Anxious and depressive symptoms remained stable postintervention. Randomized controlled trials are needed to study the intervention's effectiveness in this population.
Routine symptom monitoring and feedback improves out-patient outcomes, but the feasibility of its use to inform decisions about discharge from in-patient care has not been explored.
To examine the potential value to clinical decision-making of monitoring symptoms during psychiatric in-patient hospitalisation.
A total of 1102 in-patients in a private psychiatric hospital, primarily with affective and neurotic disorders, rated daily distress levels throughout their hospital stay. The trajectories of patients who had, and had not, met a criterion of clinically significant improvement were examined.
Two-thirds of patients (n=604) met the clinically significant improvement criterion at discharge, and three-quarters (n=867) met the criterion earlier during their hospital stay. After meeting the criterion, the majority (73.2%) showed stable symptoms across the remainder of their hospital stay, and both classes showed substantially lower symptoms than at admission.
Monitoring of progress towards this criterion provides additional information regarding significant treatment response that could inform clinical decisions around discharge readiness.
To determine the scope, source, and mode of transmission of a multifacility outbreak of extensively drug-resistant (XDR) Acinetobacter baumannii.
SETTING AND PARTICIPANTS
Residents and patients in skilled nursing facilities, long-term acute-care hospital, and acute-care hospitals.
A case was defined as the incident isolate from clinical or surveillance cultures of XDR Acinetobacter baumannii resistant to imipenem or meropenem and nonsusceptible to all but 1 or 2 antibiotic classes in a patient in an Oregon healthcare facility during January 2012–December 2014. We queried clinical laboratories, reviewed medical records, oversaw patient and environmental surveillance surveys at 2 facilities, and recommended interventions. Pulsed-field gel electrophoresis (PFGE) and molecular analysis were performed.
We identified 21 cases, highly related by PFGE or healthcare facility exposure. Overall, 17 patients (81%) were admitted to either long-term acute-care hospital A (n=8), or skilled nursing facility A (n=8), or both (n=1) prior to XDR A. baumannii isolation. Interfacility communication of patient or resident XDR status was not performed during transfer between facilities. The rare plasmid-encoded carbapenemase gene blaOXA-237 was present in 16 outbreak isolates. Contact precautions, chlorhexidine baths, enhanced environmental cleaning, and interfacility communication were implemented for cases to halt transmission.
Interfacility transmission of XDR A. baumannii carrying the rare blaOXA-237 was facilitated by transfer of affected patients without communication to receiving facilities.
Planets form in disks around young stars. The planet formation process may start when the protostar and disk are still deeply embedded within their infalling envelope. However, unlike more evolved protoplanetary disks, the physical and chemical structure of these young embedded disks are still poorly constrained. We have analyzed ALMA data for 13CO, C18O and N2D+ to constrain the temperature structure, one of the critical unknowns, in the disk around L1527. The spatial distribution of 13CO and C18O, together with the kinetic temperature derived from the optically thick 13CO emission and the non-detection of N2D+, suggest that this disk is warm enough (≳ 20 K) to prevent CO freeze-out.
Core-accretion theory predicts that the formation of giant planets predominantly occurs at the dense mid-plane of the inner ∼50 AU of protoplanetary disks. However, due to observational limitation, this critical region remains to be the least charted area in protoplanetary disks. With its great sensitivity, ALMA recently started to image optically thin line emissions arisen from the mid-plane of the inner 50AU in nearby disks, which unlocks an exciting new path to directly constrain the physical properties of the giant planet formation zone through gas tracers. Here we present the first spatially resolved observations of the 13C18O J=3-2 line emission in the TW Hya disk. We show that this emission is optically thin even inside the CO mid-plane snowline. Combining it with the C18O J=3-2 images and the previously detected HD J=1-0 flux, we directly constrain the mid-plane temperature and optical depths of the CO gas and dust. We report a mid-plane CO snowline at 20.5 ± 1.3 AU, a mid-plane temperature distribution of 27+4−3×(R/20.5AU)-0.47+0.06−0.07 K, and a gas mass distribution of 13+8−5×(R/20.5AU)-0.9+0.4−0.3 g cm−2 between 5-20.5 AU in the TW Hya protoplanetary disk. We find a total gas/mm-sized dust mass ratio of 140 ± 40 in this region, suggesting that ∼2.4 earth mass of dust aggregates have grown to > cm sizes (and perhaps much larger).
Determining the locations of the major snowlines in protostellar environments is crucial to fully understand the planet formation process and its outcome. Despite being located far enough from the central star to be spatially resolved with ALMA, the CO snowline remains difficult to detect directly in protoplanetary disks. Instead, its location can be derived from N2H+ emission, when chemical effects like photodissociation of CO and N2 are taken into account. The water snowline is even harder to observe than that for CO, because in disks it is located only a few AU from the protostar, and from the ground only the less abundant isotopologue H218O can be observed. Therefore, using an indirect chemical tracer, as done for CO, may be the best way to locate the water snowline. A good candidate tracer is HCO+, which is expected to be particularly abundant when its main destructor, H2O, is frozen out. Comparison of H218O and H13CO+ emission toward the envelope of the Class 0 protostar IRAS2A shows that the emission from both molecules is spatially anticorrelated, providing a proof of concept that H13CO+ can indeed be used to trace the water snowline in systems where it cannot be imaged directly.
The formation of molecules in the interstellar medium is significantly driven by grain chemistry, ranging from simple (e.g. H2) to relatively complex (e.g. CH3OH) products. The movement of atoms and molecules on amorphous ice surfaces is not well constrained, and this is a quintessential component of surface chemistry. We show that ice structure created by utilizing an off-lattice Monte Carlo kinetics model is highly dependent on deposition parameters (i.e. angle, rate, and temperature). The model, thus far, successfully predicts the densities of deposition rate- and temperature-dependent laboratory experiments. The simulations indicate, when angle and deposition rate increase, the density decreases. On the other hand, temperature has the opposite effect and will increase the density. We can make ices with desired densities and monitor how molecules, like CO, percolate through H2O ice pores. The strength of this model lies in the ability to replicate TPD-like experiments by monitoring molecules diffusing on and desorbing from user-defined surfaces.
We present first results of a new heterodyne spectrometer dedicated to high-resolution spectroscopy of molecules of astrophysical importance. The spectrometer, based on a room-temperature heterodyne receiver, is sensitive to frequencies between 75 and 110 GHz with an instantaneous bandwidth of currently 2.5 GHz in a single sideband. The system performance, in particular the sensitivity and stability, is evaluated. Proof of concept of this spectrometer is demonstrated by recording the emission spectrum of methyl cyanide, CH3CN. Compared to state-of-the-art radio telescope receivers the instrument is less sensitive by about one order of magnitude. Nevertheless, the capability for absolute intensity measurements can be exploited in various experiments, in particular for the interpretation of the ever richer spectra in the ALMA era. The ease of operation at room-temperature allows for long time integration, the fast response time for integration in chirped pulse instruments or for recording time dependent signals. Future prospects as well as limitations of the receiver for the spectroscopy of complex organic molecules (COMs) are discussed.
Back-diffusion is the phenomenon by which random walkers revisit binding sites on a lattice. This phenomenon must occur on interstellar dust particles, slowing down dust-grain reactions, but it is not accounted for by standard rate-equation models. Microscopic kinetic Monte Carlo models have been used to investigate the effect of back-diffusion on reaction rates on interstellar dust grains. Grain morphology, size, and grain-surface coverage were varied and the effects of these variations on the magnitude of the back-diffusion effect were studied for the simple H+H reaction system. This back-diffusion effect is seen to reduce reaction rates by a maximum factor of ∼5 for the canonical grain of 106 binding sites. The resulting data were fit to logarithmic functions that can be used to reproduce the effects of back-diffusion in rate-equation models.
In order to further define the molecular content of planetary nebulae (PNe), we have conducted searches for HCN, HCO+, HNC, and CCH at millimeter wavelengths in a sample of seventeen PNe using the new 12 m and Sub-Millimeter Telescopes of the Arizona Radio Observatory (ARO). HCN and HCO+ were identified in 75% of the PNe, with corresponding fractional abundances of f(HCN/H2) ~ 0.1-9.1 × 10−7 and f(HCO+/H2) ~ 0.04-7.4 × 10−7. HNC was subsequently identified in twelve PNe with f(HNC/H2) ~ 0.02-2.2 × 10−7. The [HCN]/[HNC] ratio was found to be ~1-8 in nebulae observed. CCH was also detected in eight PNe. The abundances for all molecules were found to remain relatively constant with nebular age across 10,000 years, in contrast to model predictions. They are also 10-100 greater than those observed in diffuse clouds, and suggest that molecular material from PNe seed the diffuse ISM.
Far-UV photons (FUV, E < 13.6 eV) from hot massive stars regulate, or at least influence, the heating, ionization, and chemistry of most of the neutral interstellar medium (H i and H2 clouds). Investigating the interaction between FUV radiation and interstellar matter (molecules, atoms and grains) thus plays an important role in astrochemistry.
The Orion Bar, an interface region between the Orion A molecular cloud and the H ii region around the Trapezium cluster, is a textbook example of a strongly illuminated dense PDR (photodissociation region). The Bar is illuminated by a FUV field of a few 104 times the mean interstellar radiation field. Because of its proximity and nearly edge-on orientation, it provides a very good template to investigate the chemical content, structure, and dynamics of a strongly irradiated molecular cloud edge. We have used ALMA to mosaic a small field of the Bar where the critical transition from atomic to molecular gas takes place. These observations provide an unprecedented sharp view of this transition layer (≲ 1″ resolution or ≲ 414 AU). The resulting images (so far in the rotational emission of CO, HCO+, H13CO+, SO+, SO, and reactive ions SH+ and HOC+) show the small-scale structure in gas density and temperature, and the steep abundance gradients. The images reveal a pattern of high-density substructures, photo-ablative gas flows and instabilities at the edge of the molecular cloud. These first ALMA images thus show a more complex morphology than the classical clump/interclump static model of a PDR.
In order to quantify the chemical content in strongly FUV-irradiated gas, we have also used the IRAM-30 m telescope to carry out a complete line-survey of the illuminated edge of the Bar in the millimeter domain. Our observations reveal the presence of complex organic molecules (and precursors) that were not expected in such a harsh environment. In particular, we have reported the first detection of the unstable cis conformer of formic acid (HCOOH) in the ISM. The energy barrier to internal rotation (the conversion from trans to cis) is approximately 4827 cm−1 (≈7000 K). Hence, this detection is surprising. The low inferred trans-to-cis abundance ratio of 2.8±1.0 supports a photoswitching mechanism: a given conformer absorbs a FUV stellar photon that radiatively excites the molecule to electronic states above the interconversion barrier. Subsequent fluorescent decay leaves the molecule in a different conformer form. This mechanism, which we have specifically studied with ab initio quantum calculations, was not considered so far in astrochemistry although it can affect the structure of a variety of molecules in PDRs.
The element boron belongs, together with lithium and beryllium, to a known trio of important elements for the study of evolutionary processes in low mass stars. Because B is the least fragile of this trio to be destroyed in the stellar interiors, it can be used to test if the Li enrichment is of planetary origin. Here, for the first time, boron lines are examined in the UV for four giants with different degrees of large Li enrichment by means of observations with the Hubble telescope. Two main results are found in our study. One is that to first approximation B abundances appear not to be in excess, invalidating the planet engulfment mechanism. The second one is that the two stars with very large Li abundances present emission lines indicating that quite strong active chromospheres are acting in these very Li-rich giants. These new results obtained from the UV complement our recent studies in the mid-IR (de la Reza et al. 2015) where strong emission-line features of organic material were found in the spectra of some Li-rich stars.