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Cardiovascular diseases are among the main causes of death in Brazil and worldwide. The literature indicates the hypertriglyceridemic waist phenotype (HTWP) as an accessible alternative for the identification of cardiovascular and metabolic risk. The present study aimed to identify the prevalence and factors associated with HTWP in individuals diagnosed with arterial hypertension (AH) and/or diabetes mellitus type 2 (DM2). A cross-sectional study was conducted with individuals diagnosed with AH and/or DM2. The study data were collected through semi-structured interviews containing socio-demographic information, lifestyle, health care, in addition to anthropometric assessment, blood pressure measurement and biochemical blood tests. The prevalence of HTWP was estimated and bivariate and multivariate logistic regression was used to assess the factors associated with HTWP. Of the 788 individuals analysed, 21⋅5 % had the HTWP. In the adjusted model, the following variables remained associated with a greater chance of presenting HTWP: sex, age, body mass index (BMI) and very-low-density lipoprotein (VLDL). Being female increased the chance of HTWP by 7⋅7 times (OR 7⋅7; 95 % CI 3⋅9, 15⋅2). The one-year increase in age increased the chance of HTWP by 4 % (OR 1⋅04; 95 % CI 1⋅02, 1⋅06). The addition of 1 mg/dl of VLDL-c increased the chance of HTWP by 15 % (odds ratio (OR) 1⋅15; 95 % confidence interval (CI) 1⋅12, 1⋅18), as well as the increase of 1 kg/m2 in the BMI increased the chance of this condition by 20 % (OR 1⋅20; 95 % CI 1⋅15, 1⋅27). The prevalence of HTWP was associated with females, older age, higher BMI, higher VLDL-c and risk waist/height ratio.
To examine the mortality risk of current and life-time depressive as well as anxiety disorders, whether this risk is moderated by sex or age, and whether this risk can be explained by lifestyle and/or somatic health status.
A cohort study (Lifelines) including 141,377 participants (18–93 years) which were followed-up regarding mortality for 8.6 years (range 3.0–13.7). Baseline depressive and anxiety disorders according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria were assessed with the Mini International Neuropsychiatric Interview and lifetime diagnoses by self-report. All-cause mortality was retrieved from Statistics Netherlands. Cox-regression was applied to calculate proportional hazard ratios, adjusted for lifestyle (physical activity, alcohol use, smoking, and body mass index) and somatic health status (multimorbidity and frailty) in different models.
The mortality rate of depressive and anxiety disorders was conditional upon age but not on sex. Only in people below 60 years, current depressive and anxiety disorders were associated with mortality. Only depressive disorder and panic disorder independently predicted mortality when all mental disorders were included simultaneously in one overall model (hazard ratio [HR] = 2.18 [95% confidence intervals (CI): 1.56–3.05], p < 0.001 and HR = 2.39 [95% CI: 1.15–4.98], p = 0.020). Life-time depressive and anxiety disorders, however, were independent of each other associated with mortality. Associations hardly changed when adjusted for lifestyle characteristics but decreased substantially when adjusted for somatic health status (in particular physical frailty).
In particular, depressive disorder is associated with excess mortality in people below 60 years, independent of their lifestyle. This effect seems partly explained by multimorbidity and frailty, which suggest that chronic disease management of depression-associated somatic morbidity needs to be (further) improved.
Psilocybin is a naturally occurring plant alkaloid in mushrooms and a prodrug of psilocin. It is a serotonin receptor (5-HT2A) agonist and known psychedelic, with similar hallucinatory properties to lysergic acid diethylamide (LSD). It has been identified as a safe and effective option in treatment-resistant depression. Literature focus mainly on its use on depressive but its interest in other psychiatric disorders such as obsessive-compulsive disorder (OCD) has grown.
To review the clinical evidence for the use of hallucinogens such as psilocybin in OCD.
Non-systematic review of literature found on PubMed/MEDLINE, Web of Science and Google Scholar, using the keywords “obsessive-compulsive disorder”, “psilocybin” and “hallucinogens”. Articles may include clinical trials, case report or case series. Articles found were admitted according to their relevance for the topic in review; only articles in English were included. Ongoing research trials on this topic were checked on ClinicalTrials.gov.
So far, only one open-label non-randomized study directly assessed the effects of psilocybin on OCD patients that found acute reductions of obsessive-compulsive symptoms. Case reports of patients improving with off-label use of psilocybin are reported. There are two ongoing phase I research trials, aiming to explore the effect of the substance on symptomatology, hypothesizing that psilocybin will normalize cerebral connectivity and thus correlate with clinical improvement.
More research to establish the usefulness of psilocybin in OCD patients is needed; the collected data is encouraging are there may be a role for its use on this disorder.
Catatonia is a neuropsychiatric syndrome characterized by an onset of a dysfunction in psychomotor activity and/or muscle tone, which may be associated with changes in consciousness, affect, and thinking. It is characterized by negativism, wax flexibility, catalepsy, mutism echolalia, ecopraxia, or stupor. It was first described in 1874 by Kahlbaum, who characterized it as specific motor disorder associated with different psychiatric disorders. Kraepelin and Bleuler restricted catatonia to a specific subtype of schizophrenia. However, the association between catatonia and other disorders, notably mood disorders, has been reinstated, including Bipolar Disorder. Its etiology is multiple and there are two severe forms: Neuroleptic Malignant Syndrome (NMS) and Malignant Catatonia (MC). These are syndromes that present high mortality, and the health professional should be aware of its etiology, signs, symptoms, evaluation and treatment.
The aim of this work is to present a clinical case of MC, who was sustained by literature included on scientific platforms.
It is essential to recognize the different clinical presentations of catatonia, taking into account that these are psychiatric alterations in which urgent intervention is justified. In the presented case, the use of antipsychotic medication has worsened the motor function and its suspension, associated with the introduction of lorazepam, resulted in a slight improvement. The electroconvulsive therapy was the last resort, fully succeeded.
The relationship between SMN and Catatonia/MC remains nuclear from a psychopathological and pathophysiological point of view. Nevertheless, there is general agreement that catatonia represents a very significant risk factor for NMS.
Childhood and adolescence sexual abuse (CSA) is a risk factor for psychological trauma and a strong predictor of lifetime psychopathology, including depression, anxiety, inappropriate sexual behavior, anger, guilt, shame and other emotional and relationship problems.
Describe a clinical case of a sexually abused adolescent admitted in a psychiatric unit for young adults and to correlate sexual abuse with trauma and sexual risk behaviors.
The data was collected through clinical and family interviews. The revision was made with the search terms “trauma”, “child and adolescence sexual abuse”, “sexual risk behaviors” in scientific databases.
16 year-old girl, high-school student, living with her nuclear family, was admitted in a psychiatric hospital with feelings of sadness and anxiety since the previous month, that lead to a voluntary medicine ingestion. She has been continuously sexually abused from the age of 12 to 16 by an older man, and once by her cousin and his friends. Since than, she refers feelings of anger, sadness, dissociative symptoms and intrusive images and nightmares related to the abuses, and continues to seek attention from older men. With medication and individual and family psychotherapeutic interventions, depressive, anxiety and dissociative symptoms have improved.
Literature concludes that there’s a strong correlation between CSA, trauma and sexual risk behaviors throughout adulthood. In fact, our patient met criteria for Pos-traumatic Stress Disorder and has sexual risk behaviors that must be worked through therapy. Due to it’s complexity, treatment of the adolescent and familial system after sexual abuse is multifaceted and requires a biopsychosocial approach.
Clozapine is a member of the dibenazepine class of antipsychotic drugs and has been designated an atypical antipsychotic drug. Clinical studies have shown that clozapine is effective in ameliorating the core symptoms, as well as the negative symptoms, in severe psychotic disorders and is therapeutically effective in treating about 30% of schizophrenic patients who are resistant to standard antipsychotic drugs.
The goal is to review pharmacology, efficacy, and clinical use of clozapine, such as its side effects, and the benefit-to-risk ratio of this antipsychotic drug.
Non-systematic literature review based on scientific databases such as PubMed, using key words such as “clozapine”, “efficacy”, “side effects” and “resistant schizophrenia”.
Clozapine was developed as the first atypical antipsychotic with activity for both the negative and positive symptoms of schizophrenia. The primary indications for clozapine are treatment-resistant psychotic disorder, defined as persistent moderate to severe delusions or hallucinations despite two or more clinical trials with other antipsychotic drugs, and patients who are at high risk for suicide. Concerns over a number of safety considerations are responsible for much of the underutilization of clozapine, such as agranulocytosis, metabolic side effects and myocarditis. These side effects can be detected, prevented, minimized and treated, but there will be a very small number of fatalities.
Awareness of the benefits and risks of clozapine is essential for increasing the use of this lifesaving agent.
Gender identity is each person’s internal and individual experience of gender. Gender expression is how a person publicly expresses their gender. Gender incongruence (GI) is defined as a condition in which a person has a marked incongruence between the expressed or experienced gender and the biological sex at birth. Adolescence is a crucial period for the persistence or development of GI, due hormonal changes, peer relations and first romantic experiences.
To make a revision of the literature about GI along childhood throughout adolescence.
Research in the literature with the words “gender identity”, “gender incongruence”, “gender dysphoria”, “childhood” and “adolescence” in scientific databases.
GI is present in a small percentage of children, often provoking psychopathological distress. There is a high prevalence of autism spectrum disorders in these children, compared with the general population. In most cases the dysphoria does not persist until adolescence. There has been an increasing number of adolescents seeking for treatment at gender identity services. The studies show that after the onset of puberty, the probability of persistent GI is high and that adolescents submitted to hormonal suppression tend to continue the medical treatment.
Epidemiological formal studies about gender incongruence in children and adolescents are very few. Studies of prevalence in these populations are community studies and don’t reflect the true prevalence of GI, so it would be necessary to investigate its prevalence and persistence in different world populations. It’s also necessary to make more prospective studies about the long-term effects of the medical treatment of GI.
Lithium has been one of the oldest substances used in psychiatric treatments and remains the first-line treatment for prevention of manic and depressive episodes of bipolar disorder (BD), but it has also a wide spectrum of side-effects.
The goal is to review efficacy, and clinical use of lithium, such as its side effects, and its benefit-to-risk ratio.
Non-systematic literature review based on scientific databases such as PubMed.
The first modern use of lithium was for the treatment of mania. Lithium has also proven useful in major depression, particularly for augmentation of antidepressants, for aggressive behavior and it has a specific antisuicide effect. Lithium’s prophylactic and antisuicidal effects are most unique. However, the use of lithium became problematic due to the serious toxicity since lithium also a narrow therapeutic index, with therapeutic levels between 0.6 and 1.5 mEq/L.
Awareness of the benefits and risks of lithium is essential for the use of this lifesaving agent. Lithium levels must be carefully monitored and lithium dosage adjusted as necessary.
Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention and/or hyperactivity-impulsivity resulting from the interaction of genetic and environmental risk factors. Family studies shows that persistent ADHD is very familial.
We aim to review the literature on this condition and its heritability and describe the implications that a possible misdiagnosis can have during life.
Bibliography review was performed using the databases PubMed and Cochrane, using the following keywords: “ADHD”; “Adults”; “Heretability”; “Family” and “Rater effect”.
Childhood ADHD persists into adolescence and adulthood substantially, identified in some studies, as going up to 78%. The prevalence of ADHD in children and adults is between 2.5% and 5% worldwide. Family studies have shown that children of adults with ADHD are at higher risk of having ADHD. Some large-scale twin studies of adult ADHD, used self-report assessments of ADHD symptoms and estimated the heritability of this condition to be between 30 to 40%, which differs from other studies that analyse parents and teachers responses and estimates heritability to be between 60 and 90%.
Since there is a direct influence of the evaluators in estimating the extent of ADHD heritability, future studies need to clarify and describe in detail all the related characteristics of the raters. Although ADHD is widely studied, there is still a lot to learn about its etiology. The diagnosis of ADHD is clinical and complex and must be considered both in childhood and adolescence and in adulthood, with special emphasis on the family antecedents.
This study aimed to analyse the geographical distribution of coronavirus disease 2019 (COVID-19) and to identify high-risk areas in space and time for the occurrence of cases and deaths in the indigenous population of Brazil. This is an ecological study carried out between 24 March and 26 October 2020 whose units of analysis were the Special Indigenous Sanitary Districts. The Getis-Ord General G and Getis-Ord Gi* techniques were used to verify the spatial association of the phenomena and a retrospective space–time scan was performed. There were 32 041 confirmed cases of COVID-19 and 471 deaths. The non-randomness of cases (z score = 5.40; P < 0.001) and deaths (z score = 3.83; P < 0.001) were confirmed. Hotspots were identified for cases and deaths in the north and midwest regions of Brazil. Sixteen high-risk space–time clusters were identified for the occurrence of cases with a higher RR = 21.23 (P < 0.001) and four risk clusters for deaths with a higher RR = 80.33 (P < 0.001). These clusters were identified from 22 May and were active until 10 October 2020. The results indicate critical areas in the indigenous territories of Brazil and contribute to better directing the actions of control of COVID-19 in this population.
There is growing interest in conceptualizing and diagnosing frailty. Less is understood, however, about older adults’ perceptions of the term “frail”, and the implications of being classified as “frail”. The purpose of this scoping review was to map the breadth of primary studies; and describe the meaning, perceptions, and perceived implications of frailty language amongst community-dwelling older adults. Eight studies were included in the review and three core themes were identified: (1) understanding frailty as inevitable age-related decline in multiple domains, (2) perceiving frailty as a generalizing label, and (3) perceiving impacts of language on health and health care utilization. Clinical practice recommendations for health care professionals working with individuals with frailty include: (1) maintaining a holistic view of frailty that extends beyond physical function to include psychosocial and environmental constructs, (2) using person-first language, and (3) using a strengths-based approach to discuss aspects of frailty.
It is widely assumed that people with obesity have several common eating patterns, including breakfast-skipping (1), eating during the night (2) and high fast-food consumption (3). However, differences in individual meal and dietary patterns may be crucial to optimizing obesity treatment. Therefore, we investigated the inter-individual variation in eating patterns, hypothesizing that individuals with obesity show different dietary and meal patterns, and that these associate with self-reported energy intake (rEI) and/or anthropometric measures.
Cross-sectional data from 192 participants (aged 20–55 years) with obesity, including 6 days of weighed food records, were analyzed. Meal patterns and dietary patterns were derived using exploratory hierarchical cluster analysis and k-means cluster analysis, respectively.
Five clear meal patterns were found based on the time-of-day with the highest mean rEI. The daily rEI (mean ± SD kcal) was highest among “midnight-eaters” (2550 ± 550), and significantly (p < 0.05) higher than “dinner-eaters” (2060 ± 550), “lunch-eaters” (2080 ± 520), and “supper-eaters” (2100 ± 460), but not “regular-eaters” (2330 ± 650). Despite differences of up to 490 kcal between meal patterns, there were no significant differences in anthropometric measures or physical activity level (PAL). Four dietary patterns were also found with significant differences in intake of specific food groups, but without significant differences in anthropometry, PAL, or rEI. Our data highlight meal timing as a determinant of individual energy intake in people with obesity. The study supports the importance of considering a person’s specific meal pattern, with possible implications for more person-focused guidelines and targeted advice.
To evaluate the potential impact of sugar-sweetened beverage (SSB) taxes on overweight and obesity prevalence in countries of different income classifications.
Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO number CRD42020161612). Five databases (Cochrane Library, Embase, LILACS (via Virtual Health Library) and MEDLINE (via PubMed), and Web of Science were searched, from January 2009 to December 2019. Articles that reported changes in purchases, sales, intake, body weight, BMI, overweight and/or obesity prevalence due to a tax on or price change in SSB were included.
Studies conducted in countries of different income classifications.
The search yielded 8349 articles of which 21 met inclusion criteria.
Among the sixteen studies selected, only two did not show that consumption, sales and purchase decreased as the price of SSB increased. In eight of the thirteen studies selected, a positive effect of an SSB tax on decreasing overweight and obesity prevalence was expected. It is estimated that a 20 % taxation on SSB would result in a greater decrease in the prevalence of overweight and obesity compared to a 10 % rate. Studies with no significant effect of taxing on sales, purchases, consumption and prevalence of obesity were from high-income countries, while significant effects of taxing on reducing purchase, consumption and/or obesity prevalence were found in studies from upper-middle- and middle-income countries.
A high SSB tax might be an effective fiscal policy to decrease purchase and consumption of SSB and reduce overweight/obesity prevalence, especially if the tax were specific for beverage volume.
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.
Assess the accumulation of protein and biofilm on the inner surfaces of new flexible gastroscope (FG) channels after 30 and 60 days of patient use and full reprocessing.
Clinical use study of biofilm accumulation in FG channels.
Endoscopy service of a public hospital.
First, we tested an FG in clinical use before the implementation of a revised reprocessing protocol (phase 1 baseline; n = 1). After replacement of the channels by new ones and the implementation of the protocol, 3 FGs were tested after 30 days of clinical use (phase 2; n = 3) and 3 FGs were tested after 60 days of clinical use (phase 3; n = 3), and the same FGs were tested in phase 2 and 3. Their biopsy, air, water, and air/water junction channels were removed and subjected to protein testing (n = 21), bacteriological culture (n = 21), and scanning electron microscopy (SEM) (n = 28). Air–water junction channels fragments were subjected to SEM only.
For the FGs, the average number of uses and reprocessing cycles was 60 times. Extensive biofilm was detected in air, water, and air–water junction channels (n = 18 of 28). All channels (28 of 28) showed residual matter, and structural damage was identified in most of them (20 of 28). Residual protein was detected in the air and water channels of all FG evaluated (phases 1–3), except for 1 air channel from phase 2. Bacteria were recovered from 8 of 21 channels, most air or water channels.
The short time before damage and biofilm accumulation in the channels was evident and suggests that improving the endoscope design is necessary. Better reprocessing methods and channel maintenance are needed.
This chapter covers topics including: (1) timing of sperm retrieval, particularly whether or not it should be performed in conjunction with oocyte retrieval from the female partner; (2) processing of surgically retrieved sperm for intracytoplasmic sperm injection (ICSI) –which are the most appropriate types of sperm preparation techniques in cases of epidydimal- or testicular-retrieved spermatozoa, and low or high numbers of retrieved spermatozoa; (3) selection of surgically retrieved sperm for ICSI, including methods for the selection of immotile spermatozoa, if needed, such as mechanical touch technique, hypoosmotic swelling test, chemical motility enhancers (e.g., pentoxifylline and theophylline), laser-assisted immotile sperm selection, and birefringence–polarization microscopy; (4) artificial oocyte activation, which may be useful in those selected patients who might have low fertilization potential, as well as the potential benefits of mechanical activation, electrical stimulation, and chemical activation on ICSI outcomes.
Young adults with heart disease constitute a growing group with the risk of cognitive and physical impairment. The knowledge of their academic performance and mental and physical health is, however, scant. This study aimed to compare young adults with CHDs or arrhythmia with their peers.
Information on physical health (Somatic Symptom Scale-8), mental health problems (Hopkins Symptoms Checklist-25), quality of life (Satisfaction With Life Scale), physical activity, and academic performance was collected online in a national cross-sectional survey in Norway among students in higher education (the SHoT2018 study).
Among 50,054 students, 172 (0.34%) reported CHD and 132 (0.26%) arrhythmias. Students reporting arrhythmias scored significantly higher than the control group on somatic symptoms (OR = 2.3 (95% CI: 1.62–3.27)), anxiety (OR = 1.60 (1.08–2.37)), depression (OR = 1.49 (1.05–2.11)), self-harm, and suicide attempt (OR = 2.72 (1.56–4.75)), and lower quality of life (OR 1.64 (1.16–2.32)) and more loneliness (OR = 1.99 (1.28–3.10)) compared to participants without heart disease. Participants with CHD reported an increased somatic symptom burden (OR = 1.58 (1.16–2.16)). Despite a tendency to a higher score, this group did not differ significantly from the control group on anxiety or depression, quality of life, or loneliness. However, the risk of self-harm thoughts and suicidality was significantly increased (OR for suicide attempt 2.22 (1.3–3.77)). There was no difference between the groups on academic performance.
Although Norwegian students with heart disease reported more somatic symptoms, their academic progress was not reduced compared to students without heart disease. Students with CHD or arrhythmias showed an increased risk of self-harm thoughts and suicidality.
Among integrated crop–livestock systems, forage succession is an advantageous strategy for the use of pasture to feed cattle in periods of low rainfall, as well as for the generation of biomass for the no-till system for the next crop. Different species have different abilities to accumulate nutrients in their biomass, which are then released into the soil through the decomposition of crop residues. This study aimed to evaluate soybean yield in an integrated crop–livestock system in comparison to soybean–maize succession system through the production, decomposition and nutrient accumulation in the biomass. The experiment had a randomized block design with four replicates. The treatments were three cropping systems: integrated crop–livestock with Paiaguas palisadegrass (Brachiaria brizantha cv. BRS Paiaguas), integrated crop–livestock with Tamani guinea grass (Panicum maximum cv. BRS Tamani) and maize grown in succession to soybean. The results showed that the use of the integrated crop–livestock system in the form of forage succession provided greater soil cover and nutrient cycling as a result of the better utilization of the animal's excreta, than the cropping of maize in succession and resulted in higher soybean productivity, thus contributing to agricultural sustainability. Paiaguas palisadegrass and Tamani guinea grass showed a C:N ratio greater than 30:1, indicating slow decomposition of plant residues. The forages accumulated amounts of nutrients in their biomass that met the soybean demand, resulting in higher grain yield.
Estuaries in Brazil are highly threatened environments and habitat loss is the main influential factor for the increase in the number of strandings of Antillean manatee (Trichechus manatus) calves in the north-eastern region of the country. The aim of the present study was to analyse and quantify the spatiotemporal dynamics of mangroves in the state of Paraíba and the association with manatee calf stranding events. The study area encompassed 10 remaining mangroves along the coast of the state, four of which were located within protected areas. Information on the mangrove forests was obtained from satellite images from the last four decades. Data on stranded Antillean manatee calves were obtained from a databank with records from 1980 to 2019. The data were analysed using geoprocessing techniques and statistical analyses. The results demonstrated changes in the mangrove forest over time, with larger areas existing during the 1980s, reductions in the following periods but a slight increase in the last decade. The number of stranded Antillean manatee calves increased over the years, with stranding events concentrated mainly on the northern coast of the state. The smallest number of stranding events occurred in the 1980s, when the mangrove forests were larger. Our findings confirm that the integrity of mangroves is of extreme importance to the maintenance and sustainability of Antillean manatee populations.
Imagine you are a journalist in the not so distant future. You are working on a story, and in order to get the insight you are looking for, you ask your conversational agent (who you affectionately call Twiki) to stitch together over 15 anonymized databases. Given the magnitude and complexity of the fused data sets, visualization software is too rudimentary to isolate the anomalies you are searching for. So, using your brain implant, you plug into the system and easily navigate the abstraction of the data sets. Although, individually, each redacted data set is effective in protecting the identity and the personal data of the people listed, when combined, you are able to infer the identity of some top-profile individuals and put into context their personal data. Realizing the potential legal implications of revealing the names and the data attached to them, you ask Twiki to run a neural network to determine whether disclosing this information has ethical or legal implications. The network runs a “n+” number of simulations of virtual journalists making decisions based on a number of codes of ethics and regulatory frameworks. Whilst this runs in the background, you manage to isolate a few outliers and identify a couple of interesting trends. Since you want to make sure the anomalies have something to add to the story, and are not simply errors, you ask Twiki to check through archival historic records to see if the outliers coincide with any major historical event. In addition, you ask Twiki to run a predictive model to calculate the likelihood that the identified trends will persist for the foreseeable future, thus triggering worrying implications.
This brief, fictional introduction is based on a fascinating conversation I had with former Times data journalist Nicola Hughes a few years ago. Although the scene it describes could well have come out of Philip K. Dick's “The Minority Report,” it actually refers to a range of tools and techniques that are either already available and widely used, or in rapid development.