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Like COVID-19, new infectious disease outbreaks emerge almost annually, and studies predict that this trend will continue due to a variety of factors, including an aging population, ease of travel, and globalization of the economy. In response to episodic public health crises, governments and organizations develop, implement, and enforce policies, procedures, protocols, and programs. The epidemiological triad is both a model of disease causation and fundamentally used to design and deploy such control measures. Here we adapt this model to the workplace setting and use the epidemiological triad to characterize the related ethical challenges in implementing the control measures employers face as a guide for a workplace intervention framework. Through this approach, our aim is to show how an integrated ethical framework, grounded in epidemiological principles, has important implications for how we categorize, understand, and resolve the difficult decisions that emerge in the workplace under pandemic conditions.
Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.
To examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.
Genome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.
Earlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.
AAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.
The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in improving surrogates’ mental health and patient outcomes.
Part 1 involved obtaining qualitative stakeholder feedback from 5 bereaved surrogates and 10 critical care and mental health clinicians. Stakeholders were provided with the manual and prompted for feedback on its content, format, and language. Feedback was organized and incorporated into the manual, which was then re-circulated until consensus. In Part 2, surrogates of critically ill patients admitted to an intensive care unit (ICU) reporting moderate anxiety or close attachment were enrolled in an open trial of EMPOWER. Surrogates completed six, 15–20 min modules, totaling 1.5–2 h. Surrogates were administered measures of peritraumatic distress, experiential avoidance, prolonged grief, distress tolerance, anxiety, and depression at pre-intervention, post-intervention, and at 1-month and 3-month follow-up assessments.
Part 1 resulted in changes to the EMPOWER manual, including reducing jargon, improving navigability, making EMPOWER applicable for a range of illness scenarios, rearranging the modules, and adding further instructions and psychoeducation. Part 2 findings suggested that EMPOWER is feasible, with 100% of participants completing all modules. The acceptability of EMPOWER appeared strong, with high ratings of effectiveness and helpfulness (M = 8/10). Results showed immediate post-intervention improvements in anxiety (d = −0.41), peritraumatic distress (d = −0.24), and experiential avoidance (d = −0.23). At the 3-month follow-up assessments, surrogates exhibited improvements in prolonged grief symptoms (d = −0.94), depression (d = −0.23), anxiety (d = −0.29), and experiential avoidance (d = −0.30).
Significance of results
Preliminary data suggest that EMPOWER is feasible, acceptable, and associated with notable improvements in psychological symptoms among surrogates. Future research should examine EMPOWER with a larger sample in a randomized controlled trial.
To evaluate the diagnostic accuracy of three types of antigenic preparations from Strongyloides venezuelensis infective larvae for detection of serum IgG anti-Strongyloides antibodies by enzyme-linked immunosorbent assay (ELISA). Soluble somatic fractions (SSF) and membrane somatic fractions (MSF) and excretory−secretory (E/S) products from S. venezuelensis infective larvae were evaluated against 71 sera from individuals with strongyloidiasis, 105 sera from healthy individuals, and 84 sera from individuals with other helminth infections. Using an ELISA cut-off for 100% sensitivity, E/S products were 97.88% specific followed by MSF (93.12%) and then by SSF (85.2%). The occurrence of cross-reactivity with other helminths was 4.76% (4/84) with E/S products, 8.33% (7/84) with MSF, and 17.86% (15/84) with SSF. For a cut-off for 100% specificity, E/S products showed a sensitivity of 88.73% whereas MSF and SSF showed sensitivities of 59.15% and 53.52%, respectively. In conclusion, E/S products were the best antigenic option for the serodiagnosis of human strongyloidiasis.
Substantial progress has been made in the standardization of nomenclature for paediatric and congenital cardiac care. In 1936, Maude Abbott published her Atlas of Congenital Cardiac Disease, which was the first formal attempt to classify congenital heart disease. The International Paediatric and Congenital Cardiac Code (IPCCC) is now utilized worldwide and has most recently become the paediatric and congenital cardiac component of the Eleventh Revision of the International Classification of Diseases (ICD-11). The most recent publication of the IPCCC was in 2017. This manuscript provides an updated 2021 version of the IPCCC.
The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD), in collaboration with the World Health Organization (WHO), developed the paediatric and congenital cardiac nomenclature that is now within the eleventh version of the International Classification of Diseases (ICD-11). This unification of IPCCC and ICD-11 is the IPCCC ICD-11 Nomenclature and is the first time that the clinical nomenclature for paediatric and congenital cardiac care and the administrative nomenclature for paediatric and congenital cardiac care are harmonized. The resultant congenital cardiac component of ICD-11 was increased from 29 congenital cardiac codes in ICD-9 and 73 congenital cardiac codes in ICD-10 to 318 codes submitted by ISNPCHD through 2018 for incorporation into ICD-11. After these 318 terms were incorporated into ICD-11 in 2018, the WHO ICD-11 team added an additional 49 terms, some of which are acceptable legacy terms from ICD-10, while others provide greater granularity than the ISNPCHD thought was originally acceptable. Thus, the total number of paediatric and congenital cardiac terms in ICD-11 is 367. In this manuscript, we describe and review the terminology, hierarchy, and definitions of the IPCCC ICD-11 Nomenclature. This article, therefore, presents a global system of nomenclature for paediatric and congenital cardiac care that unifies clinical and administrative nomenclature.
The members of ISNPCHD realize that the nomenclature published in this manuscript will continue to evolve. The version of the IPCCC that was published in 2017 has evolved and changed, and it is now replaced by this 2021 version. In the future, ISNPCHD will again publish updated versions of IPCCC, as IPCCC continues to evolve.
Preclinical and clinical studies suggest that males and females may be differentially affected by cannabis use. This study evaluated the interaction of cannabis use and biological sex on cognition, and the association between observed cognitive deficits and features of cannabis use.
Cognitive measures were assessed in those with regular, ongoing, cannabis use (N = 40; 22 female) and non-using peers (N = 40; 23 female). Intelligence, psychomotor speed, and verbal working memory were measured with the Wechsler Abbreviated Scale of Intelligence, Digit Symbol Test, and Digit Span and Hopkins Verbal Learning Test, respectively. Associations between cognitive measures and cannabis use features (e.g., lifetime cannabis use, age of initiation, time since last use of cannabis, recent high-concentration tetrahydrocannabinoid exposure) were also evaluated.
No main effects of group were observed across measures. Significant interactions between group and biological sex were observed on measures of intelligence, psychomotor speed, and verbal learning, with greatest group differences observed between males with and without regular cannabis use. Psychomotor performance was negatively correlated with lifetime cannabis exposure. Female and male cannabis use groups did not differ in features of cannabis use.
Findings suggest that biological sex influences the relationship between cannabis and cognition, with males potentially being more vulnerable to the neurocognitive deficits related to cannabis use.
The measurement of the composition of ε-Ga2O3 and the quantification of Sn doping in ε-Ga2O3:Sn by laser-assisted atom probe tomography (APT) may be inaccurate depending on the experimental conditions. Both the role of the laser energy and surface electric field were investigated, and the results clearly indicate that deviations from stoichiometry are observed changing the electric field conditions during APT. The measured atomic fraction of Ga can change from 0.45 at low field to 0.38 at high field, to be compared with the expected 0.4. This was interpreted in terms of preferential evaporation of Ga at high field and deficit of O at low field, which was caused by the formation of neutrals. The quantification of Sn-doping is accurate at low-field conditions, with an overestimation of the detected Sn-metallic fraction at high field. This suggests that Sn has a higher evaporation field compared to Ga. Finally, multiple detection events were in-depth studied, revealing that three dissociation reactions occur during APT: GaO2+ → Ga+ + O+; Ga2O22+ → Ga+ + GaO2+; Ga3O22+ → Ga+ + Ga2O2+. Nevertheless, only 2% of the detected events are related to such dissociation reactions, too small a fraction to fully explain the observed deviation from the stoichiometric composition in ε-Ga2O3.
To explore the mental health of private flat owners in residential buildings with external combustible cladding, which require remediation following the 2017 Grenfell tower fire.
The speed at which the fire at Grenfell spread, killing 72 people, is largely attributed to external combustible cladding. It is increasingly suspected that there are ongoing profound effects on the mental health of people living in flats with external combustible cladding like Grenfell both in the UK and abroad. The issue has left flat owners facing severe financial hardship, the threat of bankruptcy and concerns about safety in their own homes.
An exploratory ‘Google Forms’ online mental health survey comprising multiple choice and free text questions over 47 sections was distributed to flat owners in affected buildings. The survey remained open for 6 weeks to allow response. 550 individual responses were studied.
550 individuals completed the survey, from 143 buildings across 45 UK councils.
As a direct result of external combustible cladding:
89.5% said their mental health had deteriorated,
22.5% reported having suicidal feelings or a desire to self-harm,
71.1% reported having difficulty sleeping,
93.8% said they were suffering from worry and anxiety,
59.6% used coping strategies to deal with their situation,
35.1% said that existing physical and mental health conditions had been exacerbated,
84.1% said they cannot move on with their lives and
57.9% of people had concerns about seeking help or treatment for mental/physical health problems caused by their situation during the pandemic.
In addition, free text responses reflected feelings of anxiety and low mood attributed to the constant fear of fire, and an inability to plan families and future homes. One person said, “I have been left utterly broken by this. My mental and physical health has worsened, I have severe anxiety, depression and PTSD. I struggle each day to keep myself alive.”
Safe housing is a basic human right. The results show the current situation is having a detrimental impact on flat owners’ mental health and makes a strong case for the provision of specific services offering support - particularly given it is 3.5 years since Grenfell and a viable solution for all is yet to be found.
Patients with psychiatric disorders are exposed to high risk of COVID-19 and increased mortality. In this study, we set out to assess the clinical features and outcomes of patients with current psychiatric disorders exposed to COVID-19.
This multi-center prospective study was conducted in 22 psychiatric wards dedicated to COVID-19 inpatients between 28 February and 30 May 2020. The main outcomes were the number of patients transferred to somatic care units, the number of deaths, and the number of patients developing a confusional state. The risk factors of confusional state and transfer to somatic care units were assessed by a multivariate logistic model. The risk of death was analyzed by a univariate analysis.
In total, 350 patients were included in the study. Overall, 24 (7%) were transferred to medicine units, 7 (2%) died, and 51 (15%) patients presented a confusional state. Severe respiratory symptoms predicted the transfer to a medicine unit [odds ratio (OR) 17.1; confidence interval (CI) 4.9–59.3]. Older age, an organic mental disorder, a confusional state, and severe respiratory symptoms predicted mortality in univariate analysis. Age >55 (OR 4.9; CI 2.1–11.4), an affective disorder (OR 4.1; CI 1.6–10.9), and severe respiratory symptoms (OR 4.6; CI 2.2–9.7) predicted a higher risk, whereas smoking (OR 0.3; CI 0.1–0.9) predicted a lower risk of a confusional state.
COVID-19 patients with severe psychiatric disorders have multiple somatic comorbidities and have a risk of developing a confusional state. These data underline the need for extreme caution given the risks of COVID-19 in patients hospitalized for psychiatric disorders.
Indigenous literature suggests Māori businesses are distinct within Aotearoa New Zealand, due to facing unique challenges and having different operating preferences. It could also be argued that Māori and non-Māori enterprises in the private, public and not-for-profit sectors are identical as a function of operating in similar markets. However, there is a paucity of empirical evidence, and the present article rectifies this with a study of 230 Aotearoa enterprises, including 24 Māori. We test differences and find Māori enterprises report higher cultural capital, which relates to employees' knowledge and skills towards working with and respecting cultural values. However, we find no differences across human capital, relational capital, entrepreneurial culture, and organisational performance. The findings suggest that apart from a culturally specific factor, Māori and non-Māori enterprises appear to be similarly enabled, which provides a useful benchmark for understanding Māori business. We discuss the implications for research.
This chapter looks at the production of data visualizations (dataviz) in newsrooms and audiences’ everyday engagements with them.
Keywords: data visualization, audience engagement, newsrooms, dataviz, storytelling, data publics
This chapter looks at both the production of data visualizations (henceforth “dataviz”) in newsrooms and audiences’ everyday engagements with dataviz, drawing on two separate research projects. The first is Seeing Data, which explored how people make sense of data visualizations, and the second is INDVIL, which explored dataviz as a semiotic, aesthetic and discursive resource in society. The chapter starts by summarizing the main findings of an INDVIL sub-project focusing on dataviz in the news, in which we found that dataviz are perceived in diverse ways and deployed for diverse purposes. It then summarizes our main findings from Seeing Data, where we also found great diversity, this time in how audiences make sense of dataviz. This diversity is important for the future work of both dataviz researchers and practitioners.
Data Visualization in Newsrooms: Trends and Challenges
How is data visualization being embedded into newsroom practice? What trends are emerging, and what challenges are arising? To answer these questions, in 2016 and 2017 we undertook 60 interviews in 26 newsrooms across six European countries: Norway (NO), Sweden (SE), Denmark (DK), Germany (DE), Switzerland (CH) and the United Kingdom (UK). Interviewees in mainstream, online news media organizations included editorial leaders, leaders of specialist data visualization teams, data journalists, visual journalists, graphic/data visualization designers and developers (although some didn't have job titles, a sign in itself that this is a rapidly emerging field). We present some highlights from our research here.
Changing Journalistic Storytelling
The growing use of data visualization within journalism means that there is a shift from writing as the main semiotic mode to data and visualization as central elements in journalistic storytelling. Many interviewees stated that data visualization is the driving force of a story, even when it is a simple graphic or diagram.
The reader stats tell us that when we insert a simple data visualization in a story, readers stay on the page a little longer. (SE)
A thorough characterization of the shear layer that exists in large eddy simulation data of three separated, compression ramp-generated shock/turbulent boundary layer interactions is presented. Free stream Mach numbers ahead of the separation shock are 2.9, 7.2 and 9.1. The shear layers produced by the separation in these flows have convective Mach numbers of 1.0, 1.9 and 2.0, respectively. It is found that the separation shear layers share many properties associated with canonical compressible mixing layers. A region of approximate similarity is found in each where it is possible to collapse the mean flow profiles into nearly a single similarity profile. Large mixing-layer-like vortical rollers are found in the shear layers and these are shown to become increasingly three-dimensional with increasing convective Mach number. The relation between the peak turbulence stress and the spreading rate was found to be consistent with mixing layer data and mixing layer theory derived from dimensional analysis. Turbulent kinetic energy and Reynolds stress budget analysis revealed that, although the streamwise turbulence production is greater than the canonical mixing layer, the transfer of turbulence energy by the pressure–strain terms and the energy drain by viscosity terms both show similar behaviour to mixing layer data at matching convective Mach number. As a result, the spreading rate and turbulence anisotropy decrease with increasing $M_c$. These conclusions are aided by an accurate and direct measurement of the vortex convection velocity determined from enhanced two-point correlations in the shear flow. The usefulness of studying the shock/turbulent boundary layer flow in this manner is emphasized.
Recently, artificial intelligence-powered devices have been put forward as potentially powerful tools for the improvement of mental healthcare. An important question is how these devices impact the physician-patient interaction.
Aifred is an artificial intelligence-powered clinical decision support system (CDSS) for the treatment of major depression. Here, we explore the use of a simulation centre environment in evaluating the usability of Aifred, particularly its impact on the physician–patient interaction.
Twenty psychiatry and family medicine attending staff and residents were recruited to complete a 2.5-h study at a clinical interaction simulation centre with standardised patients. Each physician had the option of using the CDSS to inform their treatment choice in three 10-min clinical scenarios with standardised patients portraying mild, moderate and severe episodes of major depression. Feasibility and acceptability data were collected through self-report questionnaires, scenario observations, interviews and standardised patient feedback.
All 20 participants completed the study. Initial results indicate that the tool was acceptable to clinicians and feasible for use during clinical encounters. Clinicians indicated a willingness to use the tool in real clinical practice, a significant degree of trust in the system's predictions to assist with treatment selection, and reported that the tool helped increase patient understanding of and trust in treatment. The simulation environment allowed for the evaluation of the tool's impact on the physician–patient interaction.
The simulation centre allowed for direct observations of clinician use and impact of the tool on the clinician–patient interaction before clinical studies. It may therefore offer a useful and important environment in the early testing of new technological tools. The present results will inform further tool development and clinician training materials.
The 2020 COVID-19 pandemic has had a profound impact on the clinical research enterprises at the 60 Clinical and Translational Science Award (CTSA) Hubs throughout the nation. There was simultaneously a need to expand research to obtain crucial data about disease prognosis and therapy and enormous limitations on conducting research as localities and institutions limited travel and person-to-person contact. These imperatives resulted in major changes in the way research was conducted, including expediting Institutional Review Board review, shifting to remote interactions with participants, centralizing decision-making in prioritizing research protocols, establishing biobanks, adopting novel informatics platforms, and distributing study drugs in unconventional ways. National CTSA Steering Committee meetings provided an opportunity to share best practices and develop the idea of capturing the CTSA program experiences in a series of papers. Here we bring together the recommendations from those papers in a list of specific actions that research sites can take to strengthen operations and prepare for similar future public health emergencies. Most importantly, creative innovations developed in response to the COVID-19 pandemic deserve serious consideration for adoption as new standards, thus converting the painful trauma of the pandemic into “post-traumatic growth” that makes the clinical research enterprise stronger, more resilient, and more effective.
The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.
There is a broad consensus that state capacity is central to economic and institutional development. But while the concept originated as a tool for macro-historical and comparative analysis, its success has led the term ‘capacity’ to become a default metaphor for discussing the quality of government bureaucracies. This paper discusses the limitations to conceiving of narrower questions of bureaucratic performance and policy implementation through the lens of the broad, aggregate concept of capacity. Whereas capacity refers to bureaucracies' hypothetical potential, this usually differs from their actual actions due to internal information and incentive problems created by bureaucracies' collective nature, and the constraints and uncertainty imposed by their multiple political principals. Capacity is a convenient shorthand term and is appropriate for some purposes, but it achieves this convenience by abstracting away from the mechanisms that determine bureaucratic performance and policy implementation. To advance the study of bureaucratic quality, researchers should seek to understand the implications of bureaucracies' collective nature, engage with contextual specificity and contingency in policy implementation, and focus measurement and reform efforts more towards actual performance than hypothetical capacity.
The inclusion of students with autism spectrum disorder (ASD) is increasing, but there have been no longitudinal studies of included students in Australia. Interview data reported in this study concern primary school children with ASD enrolled in mainstream classes in South Australia and New South Wales, Australia. In order to examine perceived facilitators and barriers to inclusion, parents, teachers, and principals were asked to comment on the facilitators and barriers to inclusion relevant to each child. Data are reported about 60 students, comprising a total of 305 parent interviews, 208 teacher interviews, and 227 principal interviews collected at 6-monthly intervals over 3.5 years. The most commonly mentioned facilitator was teacher practices. The most commonly mentioned barrier was intrinsic student factors. Other factors not directly controllable by school staff, such as resource limitations, were also commonly identified by principals and teachers. Parents were more likely to mention school- or teacher-related barriers. Many of the current findings were consistent with previous studies but some differences were noted, including limited reporting of sensory issues and bullying as barriers. There was little change in the pattern of facilitators and barriers identified by respondents over time. A number of implications for practice and directions for future research are discussed.
Antarctica's ice shelves modulate the grounded ice flow, and weakening of ice shelves due to climate forcing will decrease their ‘buttressing’ effect, causing a response in the grounded ice. While the processes governing ice-shelf weakening are complex, uncertainties in the response of the grounded ice sheet are also difficult to assess. The Antarctic BUttressing Model Intercomparison Project (ABUMIP) compares ice-sheet model responses to decrease in buttressing by investigating the ‘end-member’ scenario of total and sustained loss of ice shelves. Although unrealistic, this scenario enables gauging the sensitivity of an ensemble of 15 ice-sheet models to a total loss of buttressing, hence exhibiting the full potential of marine ice-sheet instability. All models predict that this scenario leads to multi-metre (1–12 m) sea-level rise over 500 years from present day. West Antarctic ice sheet collapse alone leads to a 1.91–5.08 m sea-level rise due to the marine ice-sheet instability. Mass loss rates are a strong function of the sliding/friction law, with plastic laws cause a further destabilization of the Aurora and Wilkes Subglacial Basins, East Antarctica. Improvements to marine ice-sheet models have greatly reduced variability between modelled ice-sheet responses to extreme ice-shelf loss, e.g. compared to the SeaRISE assessments.
The principal aim of this study was to optimize the diagnosis of canine neuroangiostrongyliasis (NA). In total, 92 cases were seen between 2010 and 2020. Dogs were aged from 7 weeks to 14 years (median 5 months), with 73/90 (81%) less than 6 months and 1.7 times as many males as females. The disease became more common over the study period. Most cases (86%) were seen between March and July. Cerebrospinal fluid (CSF) was obtained from the cisterna magna in 77 dogs, the lumbar cistern in f5, and both sites in 3. Nucleated cell counts for 84 specimens ranged from 1 to 146 150 cells μL−1 (median 4500). Percentage eosinophils varied from 0 to 98% (median 83%). When both cisternal and lumbar CSF were collected, inflammation was more severe caudally. Seventy-three CSF specimens were subjected to enzyme-linked immunosorbent assay (ELISA) testing for antibodies against A. cantonensis; 61 (84%) tested positive, titres ranging from <100 to ⩾12 800 (median 1600). Sixty-one CSF specimens were subjected to real-time quantitative polymerase chain reaction (qPCR) testing using a new protocol targeting a bioinformatically-informed repetitive genetic target; 53/61 samples (87%) tested positive, CT values ranging from 23.4 to 39.5 (median 30.0). For 57 dogs, it was possible to compare CSF ELISA serology and qPCR. ELISA and qPCR were both positive in 40 dogs, in 5 dogs the ELISA was positive while the qPCR was negative, in 9 dogs the qPCR was positive but the ELISA was negative, while in 3 dogs both the ELISA and qPCR were negative. NA is an emerging infectious disease of dogs in Sydney, Australia.