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Fungal endocarditis classically involves dense heterogenous vegetations. However, several patients with fungal infections were noted to have myocardial changes ranging from focal brightening to nodular thickening of chordae or papillary muscles. This study evaluates whether these findings are associated with fungal infections.
In a retrospective case–control study, paediatric inpatients with fungal infections (positive blood, urine, or catheter tip culture) in a 5-year period were matched 1:1 to inpatients without positive fungal cultures. Echocardiograms were scored on a 5-point scale by two independent readers for presence of myocardial brightenings, nodular thickenings, and vegetations. Clinical data were compared.
Of 67 fungal cases, positive culture sites included blood (n = 44), vascular catheter tip (n = 7), and urine (n = 29); several had multiple positive sites. “Positive” echo findings (score ≥ 2+) were more frequent in the Fungal Group (33 versus 18%, p = 0.04). Fungal Group patients with “positive” versus “negative” echo findings had similar proportion of bacterial infections. Among fungal cases, those with “positive” echo findings had longer hospital length of stay than cases with “negative” echos (median 58 versus 40 days, p = 0.03) but no difference in intensive care unit admission, extracorporeal membranous oxygenation support, or mortality.
Myocardial and papillary muscle brightening with nodular thickening on echocardiogram appear to be associated with fungal infections. There may be prognostic implications of these findings as patients with “positive” echo have longer length of stay. Further studies are needed to better understand the mechanism and temporal progression of these changes and determine the prognostic value of this scoring system.
Individuals with schizophrenia are at higher risk of physical illnesses, which are a major contributor to their 20-year reduced life expectancy. It is currently unknown what causes the increased risk of physical illness in schizophrenia.
To link genetic data from a clinically ascertained sample of individuals with schizophrenia to anonymised National Health Service (NHS) records. To assess (a) rates of physical illness in those with schizophrenia, and (b) whether physical illness in schizophrenia is associated with genetic liability.
We linked genetic data from a clinically ascertained sample of individuals with schizophrenia (Cardiff Cognition in Schizophrenia participants, n = 896) to anonymised NHS records held in the Secure Anonymised Information Linkage (SAIL) databank. Physical illnesses were defined from the General Practice Database and Patient Episode Database for Wales. Genetic liability for schizophrenia was indexed by (a) rare copy number variants (CNVs), and (b) polygenic risk scores.
Individuals with schizophrenia in SAIL had increased rates of epilepsy (standardised rate ratio (SRR) = 5.34), intellectual disability (SRR = 3.11), type 2 diabetes (SRR = 2.45), congenital disorders (SRR = 1.77), ischaemic heart disease (SRR = 1.57) and smoking (SRR = 1.44) in comparison with the general SAIL population. In those with schizophrenia, carrier status for schizophrenia-associated CNVs and neurodevelopmental disorder-associated CNVs was associated with height (P = 0.015–0.017), with carriers being 7.5–7.7 cm shorter than non-carriers. We did not find evidence that the increased rates of poor physical health outcomes in schizophrenia were associated with genetic liability for the disorder.
This study demonstrates the value of and potential for linking genetic data from clinically ascertained research studies to anonymised health records. The increased risk for physical illness in schizophrenia is not caused by genetic liability for the disorder.
As a result of the coronavirus-19 disease (COVID-19) pandemic, Australia adopted emergency measures on 22 March 2020. This study reports the effect of the COVID-19 lockdown on appetite and overeating in Australian adults during the first month of emergency measures.
This study reports analysis of data from the population-based, self-completed survey. The main outcome measure was an item from the Patient Health Questionnaire 9 asking: ‘Over the past 2 weeks, how often have you been bothered by poor appetite or overeating?’. Data on sociodemographic factors, symptoms of anxiety and depression, and the impact of COVID-19 and lockdown were also collected. Multivariable logistic regression was used to examine associations with poor appetite or overeating.
An anonymous online survey available from 3 April to 2 May 2020.
A total of 13 829 Australian residents aged 18 years or over.
The weighted prevalence of being bothered by poor appetite or overeating in the past 2 weeks was 53·6 %, with 11·6 % (95 % CI 10·6, 12·6) of the cohort reporting poor appetite or overeating nearly every day. High levels of anxiety, concern about contracting COVID-19, being in lockdown with children and reporting a severe impact of the lockdown were associated with increased odds of poor appetite or overeating.
Given the widespread prevalence of being bothered by poor appetite or overeating, universal public health interventions to address emotion-focused or situational eating during periods of lockdown may be appropriate.
It is not clear to what extent associations between schizophrenia, cannabis use and cigarette use are due to a shared genetic etiology. We, therefore, examined whether schizophrenia genetic risk associates with longitudinal patterns of cigarette and cannabis use in adolescence and mediating pathways for any association to inform potential reduction strategies.
Associations between schizophrenia polygenic scores and longitudinal latent classes of cigarette and cannabis use from ages 14 to 19 years were investigated in up to 3925 individuals in the Avon Longitudinal Study of Parents and Children. Mediation models were estimated to assess the potential mediating effects of a range of cognitive, emotional, and behavioral phenotypes.
The schizophrenia polygenic score, based on single nucleotide polymorphisms meeting a training-set p threshold of 0.05, was associated with late-onset cannabis use (OR = 1.23; 95% CI = 1.08,1.41), but not with cigarette or early-onset cannabis use classes. This association was not mediated through lower IQ, victimization, emotional difficulties, antisocial behavior, impulsivity, or poorer social relationships during childhood. Sensitivity analyses adjusting for genetic liability to cannabis or cigarette use, using polygenic scores excluding the CHRNA5-A3-B4 gene cluster, or basing scores on a 0.5 training-set p threshold, provided results consistent with our main analyses.
Our study provides evidence that genetic risk for schizophrenia is associated with patterns of cannabis use during adolescence. Investigation of pathways other than the cognitive, emotional, and behavioral phenotypes examined here is required to identify modifiable targets to reduce the public health burden of cannabis use in the population.
Objective. To identify clinically useful predictors of adherence to medication among persons with schizophrenia. Method. We evaluated levels of compliance with neuroleptic medication among 32 consecutive admissions with DSM-III-R schizophrenia from a geographically defined catchment area using a compliance interview. We also assessed symptomatology, insight, neurological status and memory. Results. Less than 25% of consecutive admissions reported being fully compliant. Drug attitudes were the best predictor of regular compliance, symptomatology the best predictor of noncompliance, and memory the best predictor of partial compliance with neuroleptic medication. Conclusions. These data emphasise the complexity of factors that influence whether a person adheres to his medication regimen. Furthermore, they suggest that these factors may vary within the same person over time.
There is limited published data from long-term pediatric bipolar clinical trials with which to guide appropriate treatment decisions. Long-term efficacy and safety of aripiprazole was investigated in this patient population.
296 youths, ages 10-17 year-old with a DSM-IV diagnosis of bipolar I disorder were randomized to receive either placebo or aripiprazole (10mg or 30mg) in a 4-week double-blind trial. Completers continued assigned treatments for an additional 26 weeks (double-blind). Efficacy endpoints included mean change from baseline to week 4 and week 30 on the Young Mania Rating Scale; Children's Global Assessment Scale, Clinical Global Impressions-Bipolar version severity scale, General Behavior Inventory, Attention Deficit Hyperactivity Disorders Rating Scale, and time to discontinuation. Tolerability/safety assessments included incidence and severity of AEs, blood chemistries and metabolic parameters.
Over the 30-week course of double-blind treatment, aripiprazole (10 mg and 30 mg) was superior to placebo as early as week 1 (p< 0.002) and at all scheduled visits from week 2 through week 30 on mean change from baseline in the Y-MRS total score (p<.0001; all visits). Significant improvements were observed on multiple endpoints including the CGAS, GBI, CGI-BP, ADHD-RS-IV total score, time to discontinuation, and response and remission rates. The 3 most common AEs were somnolence, extrapyramidal disorder, and fatigue. Mean change in body weight z-scores over 30 weeks was not clinically significant.
Over 30-weeks of treatment, both doses of aripiprazole were superior to placebo in the long term treatment of pediatric bipolar patients. Aripiprazole was generally well tolerated.
To describe the infection control preparedness measures undertaken for coronavirus disease (COVID-19) due to SARS-CoV-2 (previously known as 2019 novel coronavirus) in the first 42 days after announcement of a cluster of pneumonia in China, on December 31, 2019 (day 1) in Hong Kong.
A bundled approach of active and enhanced laboratory surveillance, early airborne infection isolation, rapid molecular diagnostic testing, and contact tracing for healthcare workers (HCWs) with unprotected exposure in the hospitals was implemented. Epidemiological characteristics of confirmed cases, environmental samples, and air samples were collected and analyzed.
From day 1 to day 42, 42 of 1,275 patients (3.3%) fulfilling active (n = 29) and enhanced laboratory surveillance (n = 13) were confirmed to have the SARS-CoV-2 infection. The number of locally acquired case significantly increased from 1 of 13 confirmed cases (7.7%, day 22 to day 32) to 27 of 29 confirmed cases (93.1%, day 33 to day 42; P < .001). Among them, 28 patients (66.6%) came from 8 family clusters. Of 413 HCWs caring for these confirmed cases, 11 (2.7%) had unprotected exposure requiring quarantine for 14 days. None of these was infected, and nosocomial transmission of SARS-CoV-2 was not observed. Environmental surveillance was performed in the room of a patient with viral load of 3.3 × 106 copies/mL (pooled nasopharyngeal and throat swabs) and 5.9 × 106 copies/mL (saliva), respectively. SARS-CoV-2 was identified in 1 of 13 environmental samples (7.7%) but not in 8 air samples collected at a distance of 10 cm from the patient’s chin with or without wearing a surgical mask.
Appropriate hospital infection control measures was able to prevent nosocomial transmission of SARS-CoV-2.
Knowing individuals is important. It is hard to think of a more open-ended truism with which to start a chapter on knowing individual bears, but for behavioural ecologists, it is not only important, it is essential. As Barrie Gilbert notes in the foreword to this volume, the consequences of ‘not knowing’ individual bears and/or ‘their place’ can be serious. Whether that knowledge of individuals is applied in the academic pursuit of ethology (the study of behaviour in wild animals), as a naturalist guide within the ecotourism industry or to improve husbandry in an agricultural setting, including bear farming for bile across China and southeast Asia (see Chapter 8, this volume), it draws on a deep history and heritage. In this chapter, we outline the history and trajectory of bear identification and in doing so reflect on antecedents of human/other animal relations that span millennia.
Our behavioural research with brown bears in Glendale Cove on Knight Inlet in British Columbia began in 1996 and has continued over a period of more than 20 years in partnership with Knight Inlet Lodge (KIL), a commercial bear viewing lodge based in the cove. While not unique, this long-term commitment to research by a commercial partner offers a model by which generational scale studies can be conducted beyond the boundaries of parks and protected areas, which, after all, is where most wildlife resides. As Western (2015) notes, globally most biodiversity lives outside of protected areas, though it is undoubtedly richer within protected areas (Gray et al 2016). This has profound implications for how we interact with wildlife, and in particular how people relate to charismatic megafauna.
Ethological studies at KIL have included investigation of the impact of viewing activities on the foraging energetics of bears (Nevin 2003; Nevin and Gilbert 2005b, 2005c); temporal-spatial refuging (Nevin 2003; Nevin and Gilbert 2005b, 2005c); breeding behaviour (Nevin and Gilbert 2005a); and the selection and use of mark trees in olfactory communication (Clapham 2012; Clapham et al 2012, 2013, 2014). In parallel, GPS telemetry and genetic sampling have addressed spatial movement, habitat use, connectivity, dispersal and relatedness, while social science research has explored the relationship between people and bears, and their cultural meanings (Nevin et al 2012, 2014). Much of the detailed behavioural study on the site is facilitated by the maintenance of a register of individually identifiable bears of known age-sex class.
Olfactory communication has been defined as: ‘The process whereby a chemical signal is generated by a presumptive sender and transmitted (generally through the air) to a presumptive receiver who by means of adequate receptors can identify, integrate and respond (either behaviourally or physiologically) to the signal’ (Eisenberg and Kleiman 1972, 1).
Brown bears (Ursus arctos) have been reported in literature to mark and rub on trees (Tschanz et al 1970; Green and Mattson 2003; Puchkovskiy 2009). This has been linked to olfactory communication among brown bears, though until recently no clear function had been attributed. In this chapter we present an overview of research conducted to explore the biological significance of chemical signalling in brown bears (from Clapham 2012; Clapham et al 2012, 2013, 2014). This was conducted by assessing scent marking site selection, understanding who are the signallers and receivers, and studying the postures and stereotypithy of marking behaviour. To establish why these behaviours have evolved, the significance of observed signalling behaviours can be evaluated in terms of their potential fitness benefits. Assessing the function of scent marking in brown bears provides an opportunity to establish its influence on the social behaviour of the species, thus demonstrating the importance of behavioural studies conducted in situ. Collectively, knowledge of this form of social behaviour provides a unique insight into the social complexity of this species.
BEARS AND TREE MARKING
Brown bears claw, bite, urinate and rub various parts of the body against trees, each being suggested as a method of chemical communication (Tschanz et al 1970; Lloyd 1979; Green and Mattson 2003; Puchkovskiy 2009). Brown bears are reported to use a diverse range of tree species for their marking activities; these are often referred to as ‘bear trees’ or ‘rub trees’ (Tschanz et al 1970; Puchkovskiy 2009). The use of ‘traditionally rubbed trees’ by brown bears is highlighted by Green and Mattson (2003). These are trees that are repeatedly used for marking by bears over successive years, and their non-random selection is said to indicate their importance within intraspecific communication (Tschanz et al 1970; Green and Mattson 2003; Clapham 2012; Clapham et al 2013), rather than an individual response to external stimuli as suggested by Meyer-Holzapfel (1968, in Burst and Pelton 1983).
Bears are iconic animals; they are totemic of the non-human world, symbols of multiple human-cultural manifestations of nature. In human culture, bears have played a number of roles; gods, monsters, kings, fools, brothers, lovers, dancers, medicine, food and pest. They are seen as protectors of the forest; symbols of masculinity; the strength of a fighter, football team or army; a comfort for our children; political bargaining chips; an economic indicator; the first casualty/poster boy of global warming; symbols for conservation; worthy adversaries for a hunter's rifle; prize photography subjects for nature tourists or the last bastion of wilderness. Bears offer a unique insight into a multiplicity of paradigms that explore human-non-human animal relationships. Bear totems reinforce and maintain our connection to the natural world.
Bears and humans have shared a similar geographic journey; as we colonised the world from Africa, bears did so from Europe (albeit a few thousand years earlier), with the brown bear being found most frequently where our species also found hospitable conditions. The ecology of (early) Homo sapiens and Ursus arctos (brown bear) are matched closely: dietary requirements, habitat choice and environmental tolerances. There are many stories that permeate from the past describing our ancestral eaves-dropping on bear foods (and medicines). There are stories of cultures that gathered berries in the same fields as bears and fished on the same rivers: a time when bears and people respected one another's personal space. This is true of some cultures to the present day.
Myths, legends and folklore have informed generations of our and bears’ place in the world. Oral histories passed through generations and through ever-changing norms of communication. From imagined fireside tales to blue-chip documentaries in the 21st century, bears have always been good for us to reflect upon; to ponder our lives in relation to their world, to define our own world, one seemingly at odds to the lives of the other. Bears interweave with many of our cultures.
Cave paintings, sculptures, stories of half-men and monsters, how we perceive bear species can have a huge impact on their survival. Our attitudes towards animals, people and places will shape the face of our planet, our climate and our survival.
Bears and other large carnivores excite pubic interest and as such might seem like natural candidates for citizen science projects. In reality, however, these charismatic carnivores often live in remote, rugged, difficult terrain; they are often widely dispersed, living at low densities and are cryptic in their habits. Even though public interest in this species is high, the logistics of citizen science projects sometimes render programmes ineffective or too challenging to manage. With thoughtful planning, however, citizen science projects focusing on grizzly bear research can be a positive experience for participants and increase the scope of research databases. As a recent example of this, a 2018 project developed by the Cornell University-based New York Cooperative Fish and Wildlife Research Unit is using data collected by citizen scientists to better understand New York's black bear population size and distribution, and how that distribution relates to forest, agricultural, and urban/suburban landscapes and communities (https://iseemammals. org/). In this chapter, we report on an earlier ‘bear citizen science’ project – Grizzly Research in the Rockies (Elmeligi 2016) – and another more established citizen science programme hosted by Alberta Parks, but first we consider the growth of citizen science.
Put simply, citizen science is the involvement of the public in scientific research; recentlywith smartphones and apps, but amateur naturalists have always played an important role in developing our understanding of nature. Before the emergence of the professional scientist it was provincial naturalists, men such as Gilbert White, who made enormous contributions to natural history (1993). White's 1789 book The Natural History and Antiquities of Selborne was a pioneering work of natural history and place, and remains one of the most frequently published titles in the English language (see also David Allen's The Naturalist in Britain (1976) for an excellent account of the evolution of natural history from the 17th to the early 20th century). Today, the term ‘citizen science’ is increasingly used to describe the involvement of ‘non-expert/non-professional’ scientists in research-related activities. Citizen science is a form of research collaboration where data acquisition is performed by ‘non-expert’ individuals who are often members of the public (Catlin-Groves 2012). Typically, this approach is used for large scale scientific studies (Hart et al 2012) and projects that encourage the public to participate by acting as voluntary field assistants, gathering information to greatly increase datasets (Fowler et al 2013).