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Cognitive behavior therapy (CBT) is effective for most patients with a social anxiety disorder (SAD) but a substantial proportion fails to remit. Experimental and clinical research suggests that enhancing CBT using imagery-based techniques could improve outcomes. It was hypothesized that imagery-enhanced CBT (IE-CBT) would be superior to verbally-based CBT (VB-CBT) on pre-registered outcomes.
A randomized controlled trial of IE-CBT v. VB-CBT for social anxiety was completed in a community mental health clinic setting. Participants were randomized to IE (n = 53) or VB (n = 54) CBT, with 1-month (primary end point) and 6-month follow-up assessments. Participants completed 12, 2-hour, weekly sessions of IE-CBT or VB-CBT plus 1-month follow-up.
Intention to treat analyses showed very large within-treatment effect sizes on the social interaction anxiety at all time points (ds = 2.09–2.62), with no between-treatment differences on this outcome or clinician-rated severity [1-month OR = 1.45 (0.45, 4.62), p = 0.53; 6-month OR = 1.31 (0.42, 4.08), p = 0.65], SAD remission (1-month: IE = 61.04%, VB = 55.09%, p = 0.59); 6-month: IE = 58.73%, VB = 61.89%, p = 0.77), or secondary outcomes. Three adverse events were noted (substance abuse, n = 1 in IE-CBT; temporary increase in suicide risk, n = 1 in each condition, with one being withdrawn at 1-month follow-up).
Group IE-CBT and VB-CBT were safe and there were no significant differences in outcomes. Both treatments were associated with very large within-group effect sizes and the majority of patients remitted following treatment.
The false codling moth (FCM), Thaumatotibia leucotreta (Lepidoptera: Tortricidae) is an insect pest which represents an important threat to the production and marketing of a wide range of agricultural crops in the African-Caribbean-Pacific (ACP) countries. The FCM reduces not only the yield and quality of the crop but also as a quarantine insect pest, restricts the trade of susceptible agricultural produce on the international market. In addition, little research has been conducted in the ACP countries on the bio-ecology and sustainable management of this pest, especially on vegetables for export. Thus, action-oriented research aimed at understanding the bio-ecology of this important pest is essential to achieve effective management. Various management interventions against this pest have been used in some parts of the world, especially in South Africa on citrus. Currently, farm sanitation is regarded as the key management strategy. Exploring and improving on other interventions such as Sterile Insect Technique, monitoring and mass trapping of male moths, augmentative biological control, use of bio-pesticides, protected cultivation and cold treatment may help to mitigate the expansion of FCM into other countries, especially in the European and Mediterranean Plant Protection Organization region where it has become a regulated insect pest since 2014. This review discussed the bio-ecology of FCM and highlighted some of the challenges and opportunities for its effective management and its implication for international trade, especially the export of chillies from the ACP countries into the European Union market which requires strict phytosanitary regulations.
Sierra Leone is the country with highest maternal mortality and infections are the underlying cause in 11% of maternal deaths, but the real burden remains unknown. This study aims to determine the incidence and risk factors of surgical site infection (SSI) post-caesarean section (CS) in women admitted to Princess Christian Maternity Hospital (PCMH) in Freetown, Sierra Leone. A prospective case–control (1:3 ratio) study was implemented from 1 May 2018 to 30 April 2019 and 11 women presenting with suspected or confirmed infection post-CS were screened for inclusion as a case. For each case, three patients undergoing CS on the same day and admitted to the same ward, but not presenting with SSI, were selected as controls. The post-CS infection rate was 10.9%. Two hundred and fifty-four clinically confirmed cases were enrolled and matched with 762 control patients. By multivariable analysis, the risk factors for SSI were: being single (odds ratio (OR) 1.48, 95% confidence interval (CI) 1.36–1.66), low education level (OR 1.68, 95% CI 1.55–1.84), previous CS (OR 1.27, 95% CI 1.10–1.52), presenting with premature membranes rupture (OR 1.49, 95% CI 1.18–1.88), a long decision–incision time (OR 2.08, 95% CI 1.74–2.24) and a high missing post-CS antibiotic doses rate (OR 2.52, 95% CI 2.10–2.85).
Determining infectious cross-transmission events in healthcare settings involves manual surveillance of case clusters by infection control personnel, followed by strain typing of clinical/environmental isolates suspected in said clusters. Recent advances in genomic sequencing and cloud computing now allow for the rapid molecular typing of infecting isolates.
To facilitate rapid recognition of transmission clusters, we aimed to assess infection control surveillance using whole-genome sequencing (WGS) of microbial pathogens to identify cross-transmission events for epidemiologic review.
Clinical isolates of Staphylococcus aureus, Enterococcus faecium, Pseudomonas aeruginosa, and Klebsiella pneumoniae were obtained prospectively at an academic medical center, from September 1, 2016, to September 30, 2017. Isolate genomes were sequenced, followed by single-nucleotide variant analysis; a cloud-computing platform was used for whole-genome sequence analysis and cluster identification.
Most strains of the 4 studied pathogens were unrelated, and 34 potential transmission clusters were present. The characteristics of the potential clusters were complex and likely not identifiable by traditional surveillance alone. Notably, only 1 cluster had been suspected by routine manual surveillance.
Our work supports the assertion that integration of genomic and clinical epidemiologic data can augment infection control surveillance for both the identification of cross-transmission events and the inclusion of missed and exclusion of misidentified outbreaks (ie, false alarms). The integration of clinical data is essential to prioritize suspect clusters for investigation, and for existing infections, a timely review of both the clinical and WGS results can hold promise to reduce HAIs. A richer understanding of cross-transmission events within healthcare settings will require the expansion of current surveillance approaches.
Ferroelectric single-crystal-architecture-in-glass is a new class of metamaterials that would enable active integrated optics if the ferroelectric behavior is preserved within the confines of glass. We demonstrate using lithium niobate crystals fabricated in lithium niobosilicate glass by femtosecond laser irradiation that not only such behavior is preserved, the ferroelectric domains can be engineered with a DC bias. A piezoresponse force microscope is used to characterize the piezoelectric and ferroelectric behavior. The piezoresponse correlates with the orientation of the crystal lattice as expected for unconfined crystal, and a complex micro- and nano-scale ferroelectric domain structure of the as-grown crystals is revealed.
The role that vitamin D plays in pulmonary function remains uncertain. Epidemiological studies reported mixed findings for serum 25-hydroxyvitamin D (25(OH)D)–pulmonary function association. We conducted the largest cross-sectional meta-analysis of the 25(OH)D–pulmonary function association to date, based on nine European ancestry (EA) cohorts (n 22 838) and five African ancestry (AA) cohorts (n 4290) in the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium. Data were analysed using linear models by cohort and ancestry. Effect modification by smoking status (current/former/never) was tested. Results were combined using fixed-effects meta-analysis. Mean serum 25(OH)D was 68 (sd 29) nmol/l for EA and 49 (sd 21) nmol/l for AA. For each 1 nmol/l higher 25(OH)D, forced expiratory volume in the 1st second (FEV1) was higher by 1·1 ml in EA (95 % CI 0·9, 1·3; P<0·0001) and 1·8 ml (95 % CI 1·1, 2·5; P<0·0001) in AA (Prace difference=0·06), and forced vital capacity (FVC) was higher by 1·3 ml in EA (95 % CI 1·0, 1·6; P<0·0001) and 1·5 ml (95 % CI 0·8, 2·3; P=0·0001) in AA (Prace difference=0·56). Among EA, the 25(OH)D–FVC association was stronger in smokers: per 1 nmol/l higher 25(OH)D, FVC was higher by 1·7 ml (95 % CI 1·1, 2·3) for current smokers and 1·7 ml (95 % CI 1·2, 2·1) for former smokers, compared with 0·8 ml (95 % CI 0·4, 1·2) for never smokers. In summary, the 25(OH)D associations with FEV1 and FVC were positive in both ancestries. In EA, a stronger association was observed for smokers compared with never smokers, which supports the importance of vitamin D in vulnerable populations.
High-resolution spectra for all bright ( mag) and cooler than F5 spectral class dwarf stars were observed in two fields with radii of 20 degrees (centered at (2000) = 161.03º and (2000) = 86.60º and at (2000) = 265.08º and (2000) = 39.58º) towards the northern ecliptic pole. They coincide with two of the preliminary ESA PLATO fields which also will be targeted by the NASA TESS mission. We use high-resolution spectra obtained with the VUES spectrograph mounted on the 1.65 m telescope at the Moletai Astronomical Observatory of the Institute of Theoretical Physics and Astronomy, Vilnius University. In total we observed 405 stars. Spectroscopic atmospheric parameters and abundances of 23 neutral and ionised atomic species were determined for 261 slowly rotating stars (up to 15 kms-1). 73% of stars were analysed spectroscopically for the first time. We also derived stellar ages and orbital parameters to draw a chemical picture of the Solar vicinity.
We compared the number of lunar craters with diameters greater than 15 km with age less than 1.1 Gyr in the region of the Oceanus Procellarum with the estimates of the number of craters made based on the number of near-Earth objects and on the characteristic times elapsed before collisions of near-Earth objects with the Moon. Our estimates allow the increase of the number of near-Earth objects after a recent catastrophic disruption of a large main-belt asteroid. However, destruction of some old craters and variations in orbital distribution of near-Earth objects with time could allow that the mean number of near-Earth objects during the last billion years could be close to the present value.
We use Gaia (DR1, DR2) stellar proper motions to study the kinematics of OB-associations. The average one-dimensional velocity dispersion inside 18 OB-associations with more than 10 Gaia DR1 stars is σv = 3.9 km s−1. The median virial and stellar masses of OB-associations are equal to 7×105 and 9 × 103 solar masses, respectively. The median star-formation efficiency is ε = 2.1%. We have found the expansion in several OB-associations. Models of the Galaxy with a two-component outer ring R1R2 can reproduce the average residual velocities of OB-associations in the Perseus, Sagittarius and Local System complexes.
Formation of resonant multi-lane patterns in circumbinary young debris disks with planets is considered in a set of representative massively simulated models. We find that the long term-stable resonant patterns are generically formed, shepherded by embedded planets. The patterns are multi-lane, i.e., they consist of several concentric rings. Statistical dependences of their parameters on the planetary parameters are recovered. Relevant additional massive simulations of planetesimal disks in systems with parameters of Kepler-16, 34, and 35 are accomplished and described. We find that co-orbital patterns generically form in systems with moderate orbital eccentricities of the binary’s and planetary orbits (like in Kepler-16 and 35 cases).
A constraint on Solar System formation is the high 26Al/27Al abundance ratio, 17 times higher than the average Galactic ratio, while the 60Fe/56Fe value was lower than the Galactic value. This challenges the assumption that a nearby supernova was responsible for the injection of these short-lived radionuclides into the early Solar System. We suggest that the Solar System was formed by triggered star formation at the edge of a Wolf-Rayet (W-R) bubble. We discuss the details of various processes within the model using numerical simulations, and analytic and semi-analytic calculations, and conclude that it is a viable model that can explain the initial abundances of 26Al and 60Fe. We estimate that 1%-16% of all Sun-like stars could have formed in such a setting.
Recent theories on the formation of the Solar System turned the attention to the study of low mass cloud cores in massive star forming regions. The Rosette Molecular Cloud is a well-known star forming area having highly filamentary structure with dense cores covering a wide range of masses. These pre- and protostellar cores were observed by Herschel and key core properties were derived from its data. With the Effelsberg 100m telescope a sample of these cores with masses ranging between 3-40 M⊙ were observed in ammonia inversion lines. In this work we are examining the correlations between these two datasets with the aim of gaining insight of the processes behind the star formation of the region.
Discovered periodic sublimation activity on four main-belt primitive asteroids led us to conclusions about possible origin of those and similar bodies (or their parent bodies) near or beyond the snow line in the early Solar System making incorporated in them a considerable water ice stock. Water differentiation of the bodies owing to 26A1 decay and their internal thermal evolution might have created conditions for water soluble organics and prebiotic compounds formation. Subsequent longtime periodic changing temperature and other physico-chemical parameters (due to spinning and moving around the Sun) in the near-surface layers of primitive asteroids have led probably to formation of more complex organic compounds of astrobiological significance.
New data obtained by space missions to various objects in the Solar system and observations of the outer Solar system and exoplanets by space and ground-based telescopes allowed us to conclude that the atmospheric escape plays an important role in the evolution of the terrestrial planets in the Solar system. We present the recent results of application of the kinetic approach to the problem of neutral escape from planetary atmospheres. As an example, the recent measurements by Mars Express and MAVEN spacecraft are compared with the calculations of neutral escape with the aim to understand the atmospheric loss at Mars. Also the recent calculations of the mass-loss rates of the hot Neptune and Jupiter atmospheres are presented.
The Planck all-sky submillimetre observations have made it possible to study Galactic cold clumps in diverse environments, to probe dust properties and to examine the earliest stages of star formation. The TOP-SCOPE joint survey program aims to statistically study the evolution of molecular clouds and the initial conditions of star formation in a wide variety of environments. In this work we carry out an investigation of the 200 brightest compact sources detected by Planck.
The Working Party has produced this report in order to prompt readers to engage at an early stage in InsurTech projects, through considering (i) the full range of risks associated with InsurTech developments, (ii) the lifecycle of an InsurTech venture and how any risk considerations may vary over this lifecycle and (iii) the extent to which InsurTech ventures align with risk strategy and risk appetite.
The report contains practical guidance for actuaries, risk professionals, insurance companies and their Boards on these considerations, and can be used to facilitate appropriate questioning, to help ensure that InsurTech-related business decisions are fully cognisant of the risk management issues and to help ensure the success of projects.
The Working Party developed this guidance having carried out an industry survey on a number of risk management topics relating to InsurTech, as well as having carried out interviews with a number of relevant senior stakeholders across the insurance industry, in order to better understand current sentiment and how risk management plays a part when considering opportunities in InsurTech. The Working Party views on the findings from these activities are summarised in the report.
Breast-fed infants are susceptible to vitamin D deficiency rickets. The current vitamin D ‘adequate intake’ (AI) for 0–6-month-old infants is 10 µg/d, corresponding with a human milk antirachitic activity (ARA) of 513 IU/l. We were particularly interested to see whether milk ARA of mothers with lifetime abundant sunlight exposure reaches the AI. We measured milk ARA of lactating mothers with different cultural backgrounds, living at different latitudes. Mature milk was derived from 181 lactating women in the Netherlands, Curaçao, Vietnam, Malaysia and Tanzania. Milk ARA and plasma 25-hydroxyvitamin D (25(OH)D) were analysed by liquid-chromatography-MS/MS; milk fatty acids were analysed by GC-flame ionisation detector (FID). None of the mothers reached the milk vitamin D AI. Milk ARA (n; median; range) were as follows: Netherlands (n 9; 46 IU/l; 3–51), Curaçao (n 10; 31 IU/l; 5–113), Vietnam: Halong Bay (n 20; 58 IU/l; 23–110), Phu Tho (n 22; 28 IU/l; 1–62), Tien Giang (n 20; 63 IU/l; 26–247), Ho-Chi-Minh-City (n 18; 49 IU/l; 24–116), Hanoi (n 21; 37 IU/l; 11–118), Malaysia–Kuala Lumpur (n 20; 14 IU/l; 1–46) and Tanzania-Ukerewe (n 21; 77 IU/l; 12–232) and Maasai (n 20; 88 IU/l; 43–189). We collected blood samples of these lactating women in Curaçao, Vietnam and from Tanzania–Ukerewe, and found that 33·3 % had plasma 25(OH)D levels between 80 and 249·9 nmol/l, 47·3 % between 50 and 79·9 nmol/l and 19·4 % between 25 and 49·9 nmol/l. Milk ARA correlated positively with maternal plasma 25(OH)D (range 27–132 nmol/l, r 0·40) and milk EPA+DHA (0·1–3·1 g%, r 0·20), and negatively with latitude (2°S-53°N, r −0·21). Milk ARA of mothers with lifetime abundant sunlight exposure is not even close to the vitamin D AI for 0–6-month-old infants. Our data may point at the importance of adequate fetal vitamin D stores.
Placebo responses raise significant challenges for the design of clinical trials. We report changes in agitation outcomes in the placebo arm of a recent trial of citalopram for agitation in Alzheimer's disease (CitAD).
In the CitAD study, all participants and caregivers received a psychosocial intervention and 92 were assigned to placebo for nine weeks. Outcomes included Neurobehavioral Rating Scale agitation subscale (NBRS-A), modified AD Cooperative Study-Clinical Global Impression of Change (CGIC), Cohen-Mansfield Agitation Inventory (CMAI), the Neuropsychiatric Inventory (NPI) Agitation/Aggression domain (NPI A/A) and Total (NPI-Total) and ADLs. Continuous outcomes were analyzed with mixed-effects modeling and dichotomous outcomes with logistic regression.
Agitation outcomes improved over nine weeks: NBRS-A mean (SD) decreased from 7.8 (3.0) at baseline to 5.4 (3.2), CMAI from 28.7 (6.7) to 26.7 (7.4), NPI A/A from 8.0 (2.4) to 4.9 (3.8), and NPI-Total from 37.3 (17.7) to 28.4 (22.1). The proportion of CGI-C agitation responders ranged from 21 to 29% and was significantly different from zero. MMSE improved from 14.4 (6.9) to 15.7 (7.2) and ADLs similarly improved. Most of the improvement was observed by three weeks and was sustained through nine weeks. The major predictor of improvement in each agitation measure was a higher baseline score in that measure.
We observed significant placebo response which may be due to regression to the mean, response to a psychosocial intervention, natural course of symptoms, or nonspecific benefits of participation in a trial.
Helicobacter pylori infection is a major cause of peptic ulcer and is also associated with chronic gastritis, mucosa-associated lymphoid tissue (MALT) lymphoma, and adenocarcinoma of the stomach. Guidelines have been developed in the United States and Europe (areas with low prevalence) for the diagnosis and management of this infection, including the recommendation to ‘test and treat’ those with dyspepsia. A group of international experts performed a targeted literature review and formulated an expert opinion for evidenced-based benefits and harms for screening and treatment of H. pylori in high-prevalence countries. They concluded that in Arctic countries where H. pylori prevalence exceeds 60%, treatment of persons with H. pylori infection should be limited only to instances where there is strong evidence of direct benefit in reduction of morbidity and mortality, associated peptic ulcer disease and MALT lymphoma and that the test-and-treat strategy may not be beneficial for those with dyspepsia.