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Paleodemographic mortality profiles are flawed due in part to well-understood methodological problems with individual age-at-death estimates. Cementochronology combined with probability density analysis potentially provides a solution. In this chapter we apply cementochronology as a single age indicator to reconstruct the mortality profile and life table of an archaeological sample of deciduous and permanent teeth from 119 individuals in France. Our results are consistent with the parish register data and demonstrate that cementochronology is effective in estimating the mortality of those under the age of 35. However, the method appears to underestimate the age-at-death for elderly individuals. This research points to the need for additional testing in elderly subjects. In addition, to improve the representativeness of archaeological samples, expanding this approach to other types of teeth for adults and subadults remains a major issue.
The aim of the post hoc analysis was to better understand the efficacy and safety of cariprazine in patients with schizophrenia for less than 5 years (early stage) and for more than 15 years (late stage).
Data from three phase II/III randomized, double-blind, placebo-controlled trials with similar design in patients with acute exacerbation of schizophrenia were pooled and patients with early and late stage of schizophrenia were determined. A mixed-effects model for repeated measures approach was applied and least square (LS) mean changes from baseline to week 6 on the Positive and Negative Syndrome Scale (PANSS) total and factor scores were reported. Descriptive statistics were used for safety analyses including treatment emergent adverse events (TEAEs) and discontinuation rates.
Overall, 460 patients were identified as being in the early and 414 in the late stage of schizophrenia. The pooled analysis evaluating mean change from baseline to week 6 in the PANSS total score indicated statistically significant difference between cariprazine and placebo in favor of cariprazine in both the early (LS mean difference [LSMD] −7.5 P < .001) and late stage (LSMD −6.7, P < .01) subpopulation. Early stage patients experienced similar amount of TEAEs (CAR 67.3%, PBO 54.1%) as patients in the late stage (CAR 69.6%, PBO 65.6%).
In conclusion, cariprazine, a potent D3-D2 partial agonist has been found to be safe and effective in the treatment of early and late stage schizophrenia.
We interpret the degrees which arise in Tevelev’s study of scattering amplitudes in terms of moduli spaces of Hurwitz covers. Via excess intersection theory, the boundary geometry of the Hurwitz moduli space yields a simple recursion for the Tevelev degrees (together with their natural two parameter generalisation). We find exact solutions which specialise to Tevelev’s formula in his cases and connect to the projective geometry of lines and Castelnuovo’s classical count of
’s in other cases. For almost all values, the calculation of the two parameter generalisation of the Tevelev degree is new. A related count of refined Dyck paths is solved along the way.
We prove that a formula for the ‘pluricanonical’ double ramification cycle proposed by Janda, Pandharipande, Pixton, Zvonkine, and the second-named author is in fact the class of a cycle constructed geometrically by the first-named author. Our proof proceeds by a detailed explicit analysis of the deformation theory of the double ramification cycle, both to first and to higher order.
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.
Additive manufacturing offers several potentials such as the freedom of design, part consolidation, function integration, or time and cost-savings. These potentials make AM interesting for industries such as aerospace, automotive and medical implants, and are also seen as enables for the creation of entirely new business models. Additive manufacturing has the potential to change the current manufacturing landscape substantially and has attracted much attention of industry and academia over the last decades.
However, these developments require improvements concerning the technology itself and its successful implementation into the value creation chain. Driven by the promising market opportunities and upcoming technological developments, many research activities started.
This paper presents a literature review of publications from the last 20 years. Based on this analysis, the evolution of the AM research landscape is portrayed. The research landscape is organised into four areas: machine and process, material, digital process chain and methodology. The paper summarises developments in each of these areas and concludes by presenting current and discussing future research topics.
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.
Two prominent risk factors for major depressive disorder (MDD) are childhood maltreatment (CM) and familial risk for MDD. Despite having these risk factors, there are individuals who maintain mental health, i.e. are resilient, whereas others develop MDD. It is unclear which brain morphological alterations are associated with this kind of resilience. Interaction analyses of risk and diagnosis status are needed that can account for complex adaptation processes, to identify neural correlates of resilience.
We analyzed brain structural data (3T magnetic resonance imaging) by means of voxel-based morphometry (CAT12 toolbox), using a 2 × 2 design, comparing four groups (N = 804) that differed in diagnosis (healthy v. MDD) and risk profiles (low-risk, i.e. absence of CM and familial risk v. high-risk, i.e. presence of both CM and familial risk). Using regions of interest (ROIs) from the literature, we conducted an interaction analysis of risk and diagnosis status.
Volume in the left middle frontal gyrus (MFG), part of the dorsolateral prefrontal cortex (DLPFC), was significantly higher in healthy high-risk individuals. There were no significant results for the bilateral superior frontal gyri, frontal poles, pars orbitalis of the inferior frontal gyri, and the right MFG.
The healthy high-risk group had significantly higher volumes in the left DLPFC compared to all other groups. The DLPFC is implicated in cognitive and emotional processes, and higher volume in this area might aid high-risk individuals in adaptive coping in order to maintain mental health. This increased volume might therefore constitute a neural correlate of resilience to MDD in high risk.
The fifteenth century was decisive for establishing Venetian rule along the Eastern coast of the Adriatic. For decades, historiography on the topic has been rather fragmented between national historiographies that barely examined the region as a whole and a few scattered attempts at international Mediterranean studies. This essay seeks to reflect recent discussions on Venetian statehood and current research in Croatian and Albanian historiography.
MRI-derived cortical folding measures are an indicator of largely genetically driven early developmental processes. However, the effects of genetic risk for major mental disorders on early brain development are not well understood.
We extracted cortical complexity values from structural MRI data of 580 healthy participants using the CAT12 toolbox. Polygenic risk scores (PRS) for schizophrenia, bipolar disorder, major depression, and cross-disorder (incorporating cumulative genetic risk for depression, schizophrenia, bipolar disorder, autism spectrum disorder, and attention-deficit hyperactivity disorder) were computed and used in separate general linear models with cortical complexity as the regressand. In brain regions that showed a significant association between polygenic risk for mental disorders and cortical complexity, volume of interest (VOI)/region of interest (ROI) analyses were conducted to investigate additional changes in their volume and cortical thickness.
The PRS for depression was associated with cortical complexity in the right orbitofrontal cortex (right hemisphere: p = 0.006). A subsequent VOI/ROI analysis showed no association between polygenic risk for depression and either grey matter volume or cortical thickness. We found no associations between cortical complexity and polygenic risk for either schizophrenia, bipolar disorder or psychiatric cross-disorder when correcting for multiple testing.
Changes in cortical complexity associated with polygenic risk for depression might facilitate well-established volume changes in orbitofrontal cortices in depression. Despite the absence of psychopathology, changed cortical complexity that parallels polygenic risk for depression might also change reward systems, which are also structurally affected in patients with depressive syndrome.
How do experiments help us understand the role of gender in electoral decisions and outcomes? In this chapter, we begin by reviewing some of the key questions that gender scholars have addressed through experimental work, looking at gender among office-holders, electoral candidates, and voters. We then address important considerations that experimental scholars must keep in mind when designing their studies. In so doing, we provide guidance for how to overcome the unique challenges of employing experiments to study gender and elections. We conclude by highlighting what we see as particularly pressing areas for future work.
This research communication describes (1) the comparison of acute-phase protein (APP) concentrations in transition dairy cows on different farms using both pooled and individual blood samples, and (2) the association among different APP and clinical health parameters. The first hypothesis was that early postpartum dairy cows from different farms differ in the level of inflammation, which might be determined using APP assays in both pooled and individual blood samples. The second hypothesis was that the APP haptoglobin (Hp) might be the most sensitive parameter to detect cows at risk of excessive postpartum inflammation concomitant with systemic disease. Serum concentrations of Hp, serum amyloid-A (SAA), total protein (TP), albumin (Alb), coeruloplasmin (Cp) and C-reactive protein (CRP) in 100 fresh lactating cows (within 0–8 d postpartum) from 10 farms were compared and associated to clinical health parameters (rectal body temperature, vaginal discharge (Metricheck™ score), rumen fill, vulvovaginal laceration) using both pooled and individual blood samples. Mean serum concentrations of Hp, SAA and TP revealed significant differences among farms. Pooled serum samples of farms showed high correlations with the mean of individual samples. Only Hp was significantly positively correlated to both body temperature and Metricheck™ score. In conclusion, Hp differentiates dairy farms regarding the inflammatory state of transition cows using individual and pooled serum samples within the first week postpartum. It also mirrors the individual degree of inflammation, thus proving to be a diagnostic parameter of high interest during the periparturient period.
In 2010, we proposed a personal factor classification which was published in this journal. Since then, the International Classification of Functioning, Disability and Health (ICF) of the World Health Organization (WHO) and the biopsychosocial model were increasingly incorporated into the German Social Law Code for participation and rehabilitation, implying that personal factors are indispensable for individual assessments. For the present study, we aimed to come up with an updated version of the personal factors classification based on current research. To achieve this goal, we employed a qualitative approach to re-examine the basic structure, consistency, and selection of categories in the classification from our 2010 study, to amend and supplement the categories to reflect best practice personal factor classifications. Our findings indicate that the basic structure remained largely unchanged, with relatively minor changes, including the deletion of 5 categories from our 2010 classification, 10 categories revised in format or content, and 13 new categories. We believe our revised classification to be useful for supporting users in systematically, comprehensively, and transparently reporting influences on specific aspects of individuals’ life and living background on their functioning and participation, thus facilitating an equitable allocation of disability benefits.
Background: Antimicrobial resistance is a global public health threat. Integrated actions are necessary to reduce multidrug-resistant organisms (MDROs) in healthcare settings, including antimicrobial stewardship, infection prevention measures, and optimal environmental hygiene. We developed a project to improve hospital hygiene that involves 3 phases: (1) diagnostic, compounded by assessment of cleanliness and identification of barriers and facilitators for environment cleanliness improvement; (2) intervention, based on review of structure and processes followed by a training program focused on major weaknesses identified; and (3) evaluation, impact of the intervention assessment. Objectives: We performed group interviews to identify barriers and facilitators for improving environment cleanliness. Methods: The project was performed by the infection control team and the housekeeping manager in a 350-bed, private hospital located in the city of São Paulo (Brazil). Two group interviews were conducted, one involving supervisors and the other involving housekeeping cleaners. All professionals were invited to participate. A semistructured questionnaire was used to guide the discussion, which was compounded by the following topics: working process, availability of human and material resources, training on institutional norms and routines, perception regarding work conditions, and quality of cleanliness. Results: In total, 33 professionals attended the interviews: 12 were supervisors and 21 were housekeeping cleaners. The main facilitator identified was a good perception by the housekeeping team regarding the project. We identified several sets of barriers: (1) human resources, such as supervisor executing the cleaning, inadequate sizing of human resources in shifts, reduced scale on Sunday and holiday shifts, and lack of professional replacement for sick leave and vacation; (2) supplies and equipment, such as torn bed linen, insufficient mops, centralized and inadequate dilution of sanitizers causing delays and impacting quality of hygiene; (3) education, such as lack of training program perceived by supervisors (management) and housekeeping cleaners (basic procedures for cleaning) and knowledge regarding who cleans what; (4) motivation and relationships, such as supervisor perceptions that housekeeping cleaners are unmotivated, and this causes absenteeism. The team feels that they are disregarded by doctors, and they have relationship problems with nursing and hospital engineering staff. Also, they are afraid of being physically assaulted by coworkers. Finally, professionals reported the perception that the hospital is not clean enough and that this is related to the short time goals imposed on the staff. Conclusions: The main barriers identified were related to education strategies and management of human and material resources. The results will support the intervention phase.
A new optimized quasi-helically symmetric configuration is described that has the desirable properties of improved energetic particle confinement, reduced turbulent transport by three-dimensional shaping and non-resonant divertor capabilities. The configuration presented in this paper is explicitly optimized for quasi-helical symmetry, energetic particle confinement, neoclassical confinement and stability near the axis. Post optimization, the configuration was evaluated for its performance with regard to energetic particle transport, ideal magnetohydrodynamic stability at various values of plasma pressure and ion temperature gradient instability induced turbulent transport. The effects of discrete coils on various confinement figures of merit, including energetic particle confinement, are determined by generating single-filament coils for the configuration. Preliminary divertor analysis shows that coils can be created that do not interfere with expansion of the vessel volume near the regions of outgoing heat flux, thus demonstrating the possibility of operating a non-resonant divertor.
Background: Although guidelines recommend the use of chlorhexidine gluconate (CHG) for hand hygiene (HH), the impact of its routine use on antimicrobial resistance is not clear. Objective: To analyze the impact on the CHG susceptibility among isolates obtained from hands of HCW during its routine use for HH. Methods: We conducted a crossover study at 4 medical-surgical wards of a tertiary-care hospital in São Paulo, Brazil. In 2 units (intervention group), we established routine use of CHG for HH. For the other 2 units (control group), regular soap was provided. The availability of alcohol formulation for HH was not changed during the study. Every 4 months we swapped the units, ie, those using CHG changed for regular soap and vice versa. At baseline, we cultured the hands of HCWs. Only nursing staff hands were investigated. For hand culturing, HCWs placed their hands inside a sterile bag containing a solution of phosphate-buffered saline, Tween 80, and sodium thiosulfate. After the solution incubated overnight, it was inoculated onto brain-heart infusion. Next, it was plated on McConkey and Mannitol agar. MALDI-TOF was used for identification. Agar dilution was performed for Staphylococcus spp. We selected all Staphylococcus spp with MIC ≥ 8 and performed inhibition of efflux pump test. For isolates that showed a decrease of 2 dilutions, we searched the gene qacA/B by polymerase chain reaction. Results: We obtained 262 samples from HCW hands yielding 428 isolates. The most frequent genera were Staphylococcus spp (58%), Acinetobacter spp (8%), Enterobacter spp (8%), Stenotrophomonas spp (5%), Klebsiella spp (4%), Pseudomonas spp (3%), and others (14%). Staphylococcus spp were less frequent in the intervention compared to control group (43% vs 61%; OR, 0.48; 95% CI, 0.29–0.69; P = .005). Among all Staphylococcus spp, the proportion of chlorhexidine resistance (RCHG; MIC ≥ 8) was 12%. All resistant isolates recovered susceptibility after inoculation with pump-efflux inhibitor. For pump-inhibited isolates, 53% had the gene qacA/B amplified by PCR. We did not investigate RCHG among gram-negative isolates. There was a nonsignificant increase in Staphylococcus spp RCHG in the intervention group (4% to 6%; P = .90). Healthcare-acquired infection rates did not change significantly during the intervention. The consumption of CHG increased from 7.3 to 13.9 mL per patient day. Conclusions: We did not detect a significant difference in RCHG during the routine use of CHG for HH, although we observed increasing resistance. Further investigation is needed to clarify other reasons for increasing MIC to CHG.
School-based transition planning is legally mandated for all students with disabilities. Much of the existing school psychology literature discusses procedures to construct a transition plan, with little attention given to evaluating the effectiveness of the plan. In this chapter, we argue that school-to-work transition planning should occur within a problem-solving framework as it is rare that a transition plan will be entirely successful as originally written. As such, transition-planning steps should include (a) identification of transition-plan goals, (b) analysis of transition needs and strengths, (c) transition-plan implementation and monitoring, and (d) transition-plan evaluation and adjustment. We also extend the school psychology literature by applying the person–environment–occupation (PEO) model (Law et al., 1996) to transition problem solving. Implications for the roles of school psychologists engaged in transition planning are discussed throughout.