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The prevalence of antimicrobial resistance (AMR) varies significantly among different patient populations. We aimed to summarise AMR prevalence data from screening studies in different patient settings in Switzerland and to identify surveillance gaps. We performed a systematic review, searching Pubmed, MEDLINE, Embase (01/2000–05/2017) and conference proceedings for Swiss studies reporting on carbapenemase-producing Enterobacteriaceae (CPE), extended-spectrum beta-lactamases (ESBL), mobilised colistin-resistance, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) within different patient settings. We identified 2345 references and included 46 studies. For acute care patients, most screening data come from admission screenings, whereas AMR prevalence among hospitalised patients is largely unknown. Universal admission screenings showed ESBL-prevalences of 5–8% and MRSA-prevalences of 2–5%. For targeted screening, ESBL-prevalence ranged from 14–21%; MRSA-prevalence from 1–4%. For refugees, high ESBL (9–24%) and MRSA (16–24%) carriage rates were reported; returning travellers were frequently (68–80%) colonised with ESBL. Screening data for other pathogens, long-term care facility (LTCF) residents and pediatric populations were scarce. This review confirms high ESBL- and MRSA-carriage rates for risk populations in Switzerland. Emerging pathogens (CPE and VRE) and certain populations (inpatients, LTCF residents and children) are understudied. We encourage epidemiologists and public health authorities to consider these findings in the planning of future surveillance studies.
Immune system markers may predict affective disorder treatment response, but whether an overall immune system marker predicts bipolar disorder treatment effect is unclear.
Bipolar CHOICE (N = 482) and LiTMUS (N = 283) were similar comparative effectiveness trials treating patients with bipolar disorder for 24 weeks with four different treatment arms (standard-dose lithium, quetiapine, moderate-dose lithium plus optimised personalised treatment (OPT) and OPT without lithium). We performed secondary mixed effects linear regression analyses adjusted for age, gender, smoking and body mass index to investigate relationships between pre-treatment white blood cell (WBC) levels and clinical global impression scale (CGI) response.
Compared to participants with WBC counts of 4.5–10 × 109/l, participants with WBC < 4.5 or WBC ≥ 10 showed similar improvement within each specific treatment arm and in gender-stratified analyses.
An overall immune system marker did not predict differential treatment response to four different treatment approaches for bipolar disorder all lasting 24 weeks.
Evidence suggests that skin picking disorder (SPD) could be a prevalent condition associated with comorbidity and psychosocial dysfunction. However, just a few studies have assessed the prevalence and correlates of SPD in samples from low- and middle-income countries. In addition, the impact of SPD on quality of life (QoL) dimension after multivariable adjustment to potential confounders remains unclear.
Data were obtained from a Brazilian anonymous Web-based research platform. Participants provided sociodemographic data and completed the modified Skin Picking–Stanford questionnaire, the Hypomania Checklist (HCL-32), the Patient Health Questionnaire-9 (PHQ-9), the Fagerström Test for Nicotine Dependence, Alcohol Use Disorder Identification Test (AUDIT), Symptom Checklist-90-Revised inventory (SCL-90R), early trauma inventory self report–short form, and the World Health Organization quality of life abbreviated scale (WHOQOL-Bref). Associations were adjusted to potential confounders through multivariable models.
For our survey, 7639 participants took part (71.3% females; age: 27.2±7.9 years). The prevalence of SPD was 3.4% (95% CI: 3.0–3.8%), with a female preponderance (P<0.001). In addition, SPD was associated with a positive screen for a major depressive episode, nicotine dependence, and alcohol dependence, as well as suicidal ideation. Physical and psychological QoL was significantly more impaired in participants with SPD compared to those without SPD, even after adjustment for comorbidity.
In this large sample, SPD was a prevalent condition associated with co-occurring depression, nicotine, and alcohol dependence. In addition, SPD was independently associated with impaired physical and psychological QoL. Public health efforts toward the early recognition and treatment of SPD are warranted.
We evaluate the variability in basal friction for Kronebreen, Svalbard, a fast-flowing tidewater glacier. We invert 3 years (2013–15) of surface velocities at high temporal resolution (generally 11 days), to estimate the changing basal properties of the glacier. Our results suggest that sliding behaviour of Kronebreen within a year is primarily influenced by changes in water input patterns during the meltwater season and basal friction is highly variable from a year to another. At present, models usually employ parameterisations to encompass the complex physics of glacier sliding by mathematically simulate their net effect. For such ice masses with strong seasonal variations of surface melt, the spatio-temporal patterns of basal friction imply that it is neither possible nor appropriate to use a parameterisation for bed friction that is fixed in space and/or time, at least in a timescale of a few years. Basal sliding may not only be governed by local processes such as basal topography or summer melt, but also be mediated by factors that vary over a larger distance and over a longer time period such as subglacial hydrology organisation, ice-thickness changes or calving front geometry.
The degree to which prehispanic societies in the northern upland Southwest were hierarchical or egalitarian is still debated and seems likely to have changed through time. This paper examines the plausibility of village-spanning polities in the northern Southwest by simulating the coevolution of hierarchy and warfare using extensions to the Village Ecodynamics Project's agent-based model. We additionally compile empirical data on the population size distribution of habitations and ritual spaces (kivas) and the social groups that used them in three large regions of the Pueblo Southwest and analyze these through time. All lines of evidence refute an “autonomous village” model during the Pueblo II period (A.D. 890–1145); rather, they support the existence of village-spanning polities during the Pueblo II and probably into the Pueblo III period (A.D. 1145–1285) in some areas. One or more polities connecting the northern Southwest, with tribute flowing to an apex in Chaco Canyon, appears plausible during Pueblo II for the areas we examine. During Pueblo III, more local organizations likely held sway until depopulation in the late thirteenth century.
To date no comprehensive evaluation has appraised the likelihood of bias or the strength of the evidence of peripheral biomarkers for bipolar disorder (BD). Here we performed an umbrella review of meta-analyses of peripheral non-genetic biomarkers for BD.
The Pubmed/Medline, EMBASE and PsycInfo electronic databases were searched up to May 2015. Two independent authors conducted searches, examined references for eligibility, and extracted data. Meta-analyses in any language examining peripheral non-genetic biomarkers in participants with BD (across different mood states) compared to unaffected controls were included.
Six references, which examined 13 biomarkers across 20 meta-analyses (5474 BD cases and 4823 healthy controls) met inclusion criteria. Evidence for excess of significance bias (i.e. bias favoring publication of ‘positive’ nominally significant results) was observed in 11 meta-analyses. Heterogeneity was high for (I2 ⩾ 50%) 16 meta-analyses. Only two biomarkers met criteria for suggestive evidence namely the soluble IL-2 receptor and morning cortisol. The median power of included studies, using the effect size of the largest dataset as the plausible true effect size of each meta-analysis, was 15.3%.
Our findings suggest that there is an excess of statistically significant results in the literature of peripheral biomarkers for BD. Selective publication of ‘positive’ results and selective reporting of outcomes are possible mechanisms.
The consequences of climate change vary over space and time. Effective studies of human responses to climatically induced environmental change must therefore sample the environmental diversity experienced by specific societies. We reconstruct population histories from A.D. 600 to 1280 in six environmentally distinct portions of the central Mesa Verde region in southwestern Colorado, relating these to climate-driven changes in agricultural potential. In all but one subregion, increases in maize-niche size led to increases in population size. Maize-niche size is also positively correlated with regional estimates of birth rates. High birth rates continued to accompany high population levels even as productive conditions declined in the A.D. 1200s. We reconstruct prominent imbalances between the maize-niche size and population densities in two subregions from A.D. 1140 to 1180 and from A.D. 1225 to 1260. We propose that human responses in those subregions, beginning by the mid-A.D. 1200s, contributed to violence and social collapse across the entire society. Our findings are relevant to discussions of how climate change will affect contemporary societies.
Observations show that emission from the Unidentified Infrared (UIR) bands is strongly suppressed in H II regions. UIR bands are generally attributed to vibrational relaxation of FUV - excited Polycyclic Aromatic Hydrocarbon (PAH) molecules or hydrocarbon nanoparticles containing aromatic domains. If the strongly reduced UIR emission in H II regions is due to the suppression of the carriers, an efficient destruction mechanism is required to explain observations. The aim of this work is to clarify whether UV processing of PAHs and nanoparticles is indeed responsible for the observed lack of infrared emission. We present here our first results on the physical response to photo-processing of the proposed UIR-bands carriers.
The control of Johne's disease requires the identification of Mycobacterium avium ssp. paratuberculosis (MAP)-positive herds. Boot swabs and liquid manure samples have been suggested as an easy-to-use alternative to sampling individual animals in order to diagnose subclinical Johne's disease at the herd level, but there is a need to evaluate performance of this approach in the field. Using a logistic regression model, this study aimed to calculate the threshold level of the apparent within-herd prevalence as determined by individual faecal culture, thus allowing the detection of whether a herd is MAP positive. A total of 77 boot swabs and 75 liquid manure samples were taken from 19 certified negative and 58 positive dairy herds. Faecal culture, three different polymerase chain reaction (PCR) methods and the combination of faecal culture with PCR were applied in order to detect MAP. For 50% probability of detection, a within-herd prevalence threshold of 1·5% was calculated for testing both matrices simultaneously by faecal culture and PCR, with the threshold increased to 4·0% for 90% probability of detection. The results encourage the use of boot swabs or liquid manure samples, or a combination both, for identifying MAP-positive herds and, to a certain extent, for monitoring certified Johne's disease-negative cattle herds.
We investigated the course of decline in multiple cognitive domains in non-demented subjects from a memory clinic setting, and compared pattern, onset and magnitude of decline between subjects who progressed to Alzheimer's disease (AD) dementia at follow-up and subjects who did not progress.
In this retrospective cohort study 819 consecutive non-demented patients who visited the memory clinics in Maastricht or Amsterdam between 1987 and 2010 were followed until they became demented or for a maximum of 10 years (range 0.5–10 years). Differences in trajectories of episodic memory, executive functioning, verbal fluency, and information processing speed/attention between converters to AD dementia and subjects remaining non-demented were compared by means of random effects modelling.
The cognitive performance of converters and non-converters could already be differentiated seven (episodic memory) to three (verbal fluency and executive functioning) years prior to dementia diagnosis. Converters declined in these three domains, while non-converters remained stable on episodic memory and executive functioning and showed modest decline in verbal fluency. There was no evidence of decline in information processing speed/attention in either group.
Differences in cognitive performance between converters to AD dementia and subjects remaining non-demented could be established 7 years prior to diagnosis for episodic memory, with verbal fluency and executive functioning following several years later. Therefore, in addition to early episodic memory decline, decline in executive functions may also flag incident AD dementia. By contrast, change in information processing speed/attention seems less informative.
Recovery Ice Stream has multiple branches reaching far into the East Antarctic ice sheet. We use new airborne and ground-based geophysics to give the first comprehensive overview of the upper catchment and, by constraining the physical setting, to advance our understanding of the controlling mechanisms for the onset of fast flow. The 400 km wide ice stream extends towards the Recovery Subglacial Lakes, a region characterized by a crustal boundary, a change in bed roughness, a bedrock topographic step and four topographic basins (A–D), three of which (A–C) contain subglacial water. All these characteristics are considered potential causal mechanisms that contribute to the onset of fast flow. In Lakes B and C the subglacial water is located in basins with sharp downstream ridges, in contrast to the gently sloping ridge on the downstream margin of Lake A. The fastest-flowing branch of the ice stream emanates from Lake A. The presence of multiple causal mechanisms along the four Recovery Lakes allows us to identify basal water as a dominant factor for the onset of fast flow, but only if it is stored in a shallow-sided basin where it can lubricate the flow downstream. Relatively minor topographic barriers appear to inhibit streaming.
This article represents a systematic effort to answer the question, What are archaeology’s most important scientific challenges? Starting with a crowd-sourced query directed broadly to the professional community of archaeologists, the authors augmented, prioritized, and refined the responses during a two-day workshop focused specifically on this question. The resulting 25 “grand challenges” focus on dynamic cultural processes and the operation of coupled human and natural systems. We organize these challenges into five topics: (1) emergence, communities, and complexity; (2) resilience, persistence, transformation, and collapse; (3) movement, mobility, and migration; (4) cognition, behavior, and identity; and (5) human-environment interactions. A discussion and a brief list of references accompany each question. An important goal in identifying these challenges is to inform decisions on infrastructure investments for archaeology. Our premise is that the highest priority investments should enable us to address the most important questions. Addressing many of these challenges will require both sophisticated modeling and large-scale synthetic research that are only now becoming possible. Although new archaeological fieldwork will be essential, the greatest pay off will derive from investments that provide sophisticated research access to the explosion in systematically collected archaeological data that has occurred over the last several decades.
Chromosome 22q11.2 deletion syndrome (22q11DS) is a common genetic disorder with high rates of psychosis and other psychopathologies, but few studies discuss treatment. Our aim was to characterize the prevalence and treatment of major psychiatric illnesses in a well-characterized sample of individuals with 22q11DS.
This was a cross-sectional study of 112 individuals aged 8 to 45 years with a confirmed diagnosis of 22q11DS. Each participant was administered a modified Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) and the Structured Interview for Prodromal Syndromes (SIPS). Phenotypes assessed were threshold and subthreshold psychosis, depression, mania, generalized and separation anxiety, obsessions/compulsions, inattention/hyperactivity and substance use. Histories of mental health care and current psychotropic treatment were obtained.
Psychopathology was common, with 79% of individuals meeting diagnostic criteria for a disorder at the time of assessment. Diagnoses of psychosis were made in 11% of cases, attenuated positive symptom syndrome (APS) in 21%, and 47% experienced significant subthreshold symptoms. Peak occurrence of psychosis risk was during adolescence (62% of those aged 12–17 years). Criteria for a mood disorder were met by 14%, for anxiety disorder 34% and for attention deficit hyperactivity disorder (ADHD) 31%. Mental health care had been received by 63% of individuals in their lifetime, but only 40% continued therapy and 39% used psychotropics. Antipsychotics were used by 42% of participants with psychosis and none of the participants with APS. Half of those at risk for psychosis were receiving no mental health care.
Psychopathology is common in 22q11DS but is not adequately treated or clinically followed. Particular attention should be paid to subthreshold psychotic symptoms, especially in adolescents.
This systematic review and collaborative recalculation was set up to recalculate schizophrenia incidence rates from previously published studies by age and sex.
PubMed, EMBASE and PsycINFO databases were searched (January 1950 to December 2009) for schizophrenia incidence studies. Numerator and population data were extracted by age, sex and, if possible, study period. Original data were requested from the authors to calculate age- and sex-specific incidence rates. Incidence rate ratios (IRRs) with their 95% confidence intervals (CIs) were computed by age and sex from negative binomial regression models.
Forty-three independent samples met inclusion criteria, yielding 133 693 incident cases of schizophrenia for analysis. Men had a 1.15-fold (95% CI 1.00–1.31) greater risk of schizophrenia than women. In men, incidence peaked at age 20–29 years (median rate 4.15/10 000 person-years, IRR 2.61, 95% CI 1.74–3.92). In women, incidence peaked at age 20–29 (median rate 1.71/10 000 person-years, IRR 2.34, 95% CI 1.66–3.28) and 30–39 years (median rate 1.24/10 000 person-years, IRR 2.25, 95% CI 1.55–3.28). This peak was followed by an age–incidence decline up to age 60 years that was stronger in men than in women (χ2 = 57.90, p < 0.001). The relative risk of schizophrenia was greater in men up to age 39 years and this reversed to a greater relative risk in women over the age groups 50–70 years. No evidence for a second incidence peak in middle-aged women was found.
Robust sex differences exist in the distribution of schizophrenia risk across the age span, suggesting differential susceptibility to schizophrenia for men and women at different stages of life.
Studies in hypertensive populations to date suggest that nondipping during the night, heightened blood pressure variability during the night, and nocturnal hypertension all predict future risk for cardiovascular morbidity and mortality, and are better prognostic factors than daytime hypertension. This chapter discusses the effects of sleep apnea treatment on hypertension. Although the prevalence of obstructive sleep apnea (OSA) increases with age, younger patients with OSA may be more prone to having cardiovascular consequences, including hypertension. Several studies suggest that the association between OSA and hypertension is more robust in the non-elderly. Different screening questionnaires have been developed and tested in attempts to identify patients at high risk for OSA. More studies are necessary to further elucidate pathogenetic mechanisms by which OSA causes hypertension and to determine the magnitude of the effect of OSA and its treatments on blood pressure.
The purpose of RethinkHIV is to identify and highlight the most cost-effective responses to HIV/AIDS in sub-Saharan Africa (SSA) with economic analyses of the benefits and costs of specific interventions in six categories of responses to HIV/AIDS. This is the assessment paper on the first of the six topics: prevention of sexual transmission of HIV.
As is well-known, sexual infections are a major source of the spread of HIV/AIDS generally (UNAIDS 2010), and are thought to be by far the most important source of the spread of HIV/AIDS in SSA, though there also are other sources of spread of the disease, such as maternal-child infection and the use of contaminated blood or needles. Sexual interactions may directly result in the transmission of HIV, and they also may increase the vulnerability to the HIV virus through transmitting other sexually transmitted diseases. Interventions to reduce sexual infections broadly speaking can work through reducing the frequency of such interactions or through reducing the risks of sexual infection per sexual encounter. Selection of partners, including with respect to age and risk behavior of the partner, condom use or other risk reduction strategies with a specific partner, and biomedical interventions that affect HIV transmission can all affect HIV infection risks. Interventions have been proposed to work through both of these channels, though with greater emphasis probably on the latter.
Psychotic symptoms, also termed psychotic-like experiences (PLEs) in the absence of psychotic disorder, are common in adolescents and are associated with increased risk of schizophrenia-spectrum illness in adulthood. At the same time, schizophrenia is associated with deficits in social cognition, with deficits particularly documented in facial emotion recognition (FER). However, little is known about the relationship between PLEs and FER abilities, with only one previous prospective study examining the association between these abilities in childhood and reported PLEs in adolescence. The current study was a cross-sectional investigation of the association between PLEs and FER in a sample of Irish adolescents.
The Adolescent Psychotic-Like Symptom Screener (APSS), a self-report measure of PLEs, and the Penn Emotion Recognition-40 Test (Penn ER-40), a measure of facial emotion recognition, were completed by 793 children aged 10–13 years.
Children who reported PLEs performed significantly more poorly on FER (β=−0.03, p=0.035). Recognition of sad faces was the major driver of effects, with children performing particularly poorly when identifying this expression (β=−0.08, p=0.032).
The current findings show that PLEs are associated with poorer FER. Further work is needed to elucidate causal relationships with implications for the design of future interventions for those at risk of developing psychosis.