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Childhood adversities (CAs) predict heightened risks of posttraumatic stress disorder (PTSD) and major depressive episode (MDE) among people exposed to adult traumatic events. Identifying which CAs put individuals at greatest risk for these adverse posttraumatic neuropsychiatric sequelae (APNS) is important for targeting prevention interventions.
Data came from n = 999 patients ages 18–75 presenting to 29 U.S. emergency departments after a motor vehicle collision (MVC) and followed for 3 months, the amount of time traditionally used to define chronic PTSD, in the Advancing Understanding of Recovery After Trauma (AURORA) study. Six CA types were self-reported at baseline: physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect and bullying. Both dichotomous measures of ever experiencing each CA type and numeric measures of exposure frequency were included in the analysis. Risk ratios (RRs) of these CA measures as well as complex interactions among these measures were examined as predictors of APNS 3 months post-MVC. APNS was defined as meeting self-reported criteria for either PTSD based on the PTSD Checklist for DSM-5 and/or MDE based on the PROMIS Depression Short-Form 8b. We controlled for pre-MVC lifetime histories of PTSD and MDE. We also examined mediating effects through peritraumatic symptoms assessed in the emergency department and PTSD and MDE assessed in 2-week and 8-week follow-up surveys. Analyses were carried out with robust Poisson regression models.
Most participants (90.9%) reported at least rarely having experienced some CA. Ever experiencing each CA other than emotional neglect was univariably associated with 3-month APNS (RRs = 1.31–1.60). Each CA frequency was also univariably associated with 3-month APNS (RRs = 1.65–2.45). In multivariable models, joint associations of CAs with 3-month APNS were additive, with frequency of emotional abuse (RR = 2.03; 95% CI = 1.43–2.87) and bullying (RR = 1.44; 95% CI = 0.99–2.10) being the strongest predictors. Control variable analyses found that these associations were largely explained by pre-MVC histories of PTSD and MDE.
Although individuals who experience frequent emotional abuse and bullying in childhood have a heightened risk of experiencing APNS after an adult MVC, these associations are largely mediated by prior histories of PTSD and MDE.
The Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (‘P-POSSUM’) is a two-part scoring system that includes a physiological assessment and a measure of operative severity. This study sought to determine whether risk estimates for this scoring system could be used in major head and neck reconstructive surgery.
A retrospective review was performed of patients undergoing resection for a temporal bone malignancy in a single head and neck centre in Dublin, Ireland, from 2002 to 2021.
The mean ± standard deviation morbidity estimate calculated using the scoring system was 47.6 per cent ± 19.5 per cent. The actual rate of complications was 47 per cent. The optimal cut-off for the scoring system was calculated using the Youden index from the receiver operating characteristic curve, which was 40.5 per cent in this case.
The study indicates that the Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity is a useful tool for predicting morbidity risk in patients undergoing head and neck resection with reconstruction for temporal bone malignancies.
Racial and ethnic groups in the USA differ in the prevalence of posttraumatic stress disorder (PTSD). Recent research however has not observed consistent racial/ethnic differences in posttraumatic stress in the early aftermath of trauma, suggesting that such differences in chronic PTSD rates may be related to differences in recovery over time.
As part of the multisite, longitudinal AURORA study, we investigated racial/ethnic differences in PTSD and related outcomes within 3 months after trauma. Participants (n = 930) were recruited from emergency departments across the USA and provided periodic (2 weeks, 8 weeks, and 3 months after trauma) self-report assessments of PTSD, depression, dissociation, anxiety, and resilience. Linear models were completed to investigate racial/ethnic differences in posttraumatic dysfunction with subsequent follow-up models assessing potential effects of prior life stressors.
Racial/ethnic groups did not differ in symptoms over time; however, Black participants showed reduced posttraumatic depression and anxiety symptoms overall compared to Hispanic participants and White participants. Racial/ethnic differences were not attenuated after accounting for differences in sociodemographic factors. However, racial/ethnic differences in depression and anxiety were no longer significant after accounting for greater prior trauma exposure and childhood emotional abuse in White participants.
The present findings suggest prior differences in previous trauma exposure partially mediate the observed racial/ethnic differences in posttraumatic depression and anxiety symptoms following a recent trauma. Our findings further demonstrate that racial/ethnic groups show similar rates of symptom recovery over time. Future work utilizing longer time-scale data is needed to elucidate potential racial/ethnic differences in long-term symptom trajectories.
Introduction: The opioid epidemic has been influenced by immense marketing campaigns produced by pharmaceutical companies. These campaigns include advertisements aimed at emergency medicine (EM) physicians, which may have influenced overprescription. This study is a part of a larger effort to systematically assess opioid ads published in major medical journals in North America. To our knowledge, this is the first study to systematically assess the volume, claims, and levels of evidence for opioid ads aimed at EM physicians. Methods: Up to two issues per year from 1996 to 2016 of ten major North American medical journals were hand-searched for opioid advertisements. Specifically, we assessed random samples of issues from five major North American emergency medicine journals, including Annals of Emergency Medicine, Emergency Medicine, Canadian Journal of Emergency Medicine, Emergency Medicine Journal, and American Journal of Emergency Medicine. Five generalist medical journals were assessed including Journal of the American Medical Association, New England Journal of Medicine, Canadian Medical Association Journal, American Family Physician, and Canadian Family Physician. The volume of advertisements, nature of the claims, and cited evidence were collected by independent reviewers. The referenced evidence was assessed using the Oxford Centre for Evidence-Based Medicine Levels of Evidence rubric. Results: Of the 269 issues across the ten journals, opioid ads compromised 95 of the 3392 pharmaceutical advertisements with 79 opioid ads available for analysis. When analysis was completed with two reviewers, inter-rater agreement was rated as 99.87 (Cohen's kappa of 0.976). 37/79 ads did not mention the addictive potential of opioids, with 60/79 not mentioning the possibility of death. The tamper potential of medications was mentioned in 27/79 ads. Positive claims included efficacy (47/79), fast-acting ability (16/79), patient preference (5/79), convenience (26/79) and reduced side effects (22/79). 26/79 cited references directly in their text. Citations were provided for a total of 19 available original studies, of which a majority (16/19) were Level 2 evidence. Upon examination of conflicts of interest, 100% (19/19) of the referenced studies were funded by a pharmaceutical company. Conclusion: A variety of claims were published in medical journals through opioid advertisements, which cite industry studies. Many ads did not mention key negative information, which may have influenced EM physician prescribing.
There is renewed interest in the inverse association between psychiatric hospital and prison places, with reciprocal time trends shown in more than one country. We hypothesised that the numbers of admissions to psychiatric hospitals and committals to prisons in Ireland would also correlate inversely over time (i.e. dynamic measures of admission and committal rather than static, cross-sectional numbers of places).
Publicly available activity statistics for psychiatric hospitals and prisons in Ireland were collated from 1986 to 2010.
There was a reciprocal association between psychiatric admissions and prison committals (Pearson r=−0.788, p<0.001), an increase of 91 prison committals for every 100 psychiatric hospital admissions foregone.
Penrose’s hypothesis applies to admissions to psychiatric hospitals and prisons in Ireland over time (dynamic measures), just as it does to the numbers of places in psychiatric hospitals and prisons in Ireland and elsewhere (static, cross-sectional measures). Although no causal connection can be definitively established yet, mentally disordered prisoners are usually known to community mental health services. Psychiatric services for prisons and the community should be linked to ensure that the needs of those currently accessing care through prisons can also be met in the community.
Accurate and reproducible patient positioning is a critical step in radiotherapy for breast cancer. This has seen the use of permanent skin markings becoming standard practice in many centres. Permanent skin markings may have a negative impact on long-term cosmetic outcome, which may in turn, have psychological implications in terms of body image. The aim of this study was to investigate the feasibility of using a semi-permanent tattooing device for the administration of skin marks for breast radiotherapy set-up.
Materials and methods
This was designed as a phase II double-blinded randomised-controlled study comparing our standard permanent tattoos with the Precision Plus Micropigmentation (PPMS) device method. Patients referred for radical breast radiotherapy were eligible for the study. Each study participant had three marks applied using a randomised combination of the standard permanent and PPMS methods and was blinded to the type of each mark. Follow up was at routine appointments until 24 months post radiotherapy. Participants and a blind assessor were invited to score the visibility of each tattoo at each follow-up using a Visual Analogue Scale. Tattoo scores at each time point and change in tattoo scores at 24 months were analysed by a general linear model using the patient as a fixed effect and the type of tattoo (standard or research) as covariate. A simple questionnaire was used to assess radiographer feedback on using the PPMS.
In total, 60 patients were recruited to the study, of which 55 were available for follow-up at 24 months. Semi-permanent tattoos were more visible at 24 months than the permanent tattoos. Semi-permanent tattoos demonstrated a greater degree of fade than the permanent tattoos at 24 months (final time point) post completion of radiotherapy. This was not statistically significant, although it was more apparent for the patient scores (p=0·071) than the blind assessor scores (p=0·27). No semi-permanent tattoos required re-marking before the end of radiotherapy and no adverse skin reactions were observed.
The PPMS presents a safe and feasible alternative to our permanent tattooing method. An extended period of follow-up is required to fully assess the extent of semi-permanent tattoo fade.
The Molonglo Observatory Synthesis Telescope (MOST) is an 18000 m2 radio telescope located 40 km from Canberra, Australia. Its operating band (820–851 MHz) is partly allocated to telecommunications, making radio astronomy challenging. We describe how the deployment of new digital receivers, Field Programmable Gate Array-based filterbanks, and server-class computers equipped with 43 Graphics Processing Units, has transformed the telescope into a versatile new instrument (UTMOST) for studying the radio sky on millisecond timescales. UTMOST has 10 times the bandwidth and double the field of view compared to the MOST, and voltage record and playback capability has facilitated rapid implementaton of many new observing modes, most of which operate commensally. UTMOST can simultaneously excise interference, make maps, coherently dedisperse pulsars, and perform real-time searches of coherent fan-beams for dispersed single pulses. UTMOST operates as a robotic facility, deciding how to efficiently target pulsars and how long to stay on source via real-time pulsar folding, while searching for single pulse events. Regular timing of over 300 pulsars has yielded seven pulsar glitches and three Fast Radio Bursts during commissioning. UTMOST demonstrates that if sufficient signal processing is applied to voltage streams, innovative science remains possible even in hostile radio frequency environments.
Research on post-traumatic stress disorder (PTSD) course finds a substantial proportion of cases remit within 6 months, a majority within 2 years, and a substantial minority persists for many years. Results are inconsistent about pre-trauma predictors.
The WHO World Mental Health surveys assessed lifetime DSM-IV PTSD presence-course after one randomly-selected trauma, allowing retrospective estimates of PTSD duration. Prior traumas, childhood adversities (CAs), and other lifetime DSM-IV mental disorders were examined as predictors using discrete-time person-month survival analysis among the 1575 respondents with lifetime PTSD.
20%, 27%, and 50% of cases recovered within 3, 6, and 24 months and 77% within 10 years (the longest duration allowing stable estimates). Time-related recall bias was found largely for recoveries after 24 months. Recovery was weakly related to most trauma types other than very low [odds-ratio (OR) 0.2–0.3] early-recovery (within 24 months) associated with purposefully injuring/torturing/killing and witnessing atrocities and very low later-recovery (25+ months) associated with being kidnapped. The significant ORs for prior traumas, CAs, and mental disorders were generally inconsistent between early- and later-recovery models. Cross-validated versions of final models nonetheless discriminated significantly between the 50% of respondents with highest and lowest predicted probabilities of both early-recovery (66–55% v. 43%) and later-recovery (75–68% v. 39%).
We found PTSD recovery trajectories similar to those in previous studies. The weak associations of pre-trauma factors with recovery, also consistent with previous studies, presumably are due to stronger influences of post-trauma factors.
The fungus Pleospora papaveracea is a potential biocontrol agent for opium poppy. The objective of this study was to characterize the growth and production of propagules of P. papaveracea on various substrates and determine their infectivity on opium poppy. Pleospora papaveracea was grown on agar media containing wheat bran, corn cobs, soy fiber, cottonseed meal, rice flour, cornstarch, pectin, dextrin, or molasses, all with the addition of brewer's yeast (BY). Maximum radial growth of P. papaveracea occurred on molasses, soy fiber, and wheat bran media. Pleospora papaveracea produced chlamydospores on dextrin–BY and cornstarch–BY only. Pleospora papaveracea growth in liquid media with 1% (wt/v) dextrin, cornstarch, soy fiber, or wheat bran resulted in the production of greater than 106 colony-forming units (cfu) ml−1 within 3 to 5 d of incubation. Pleospora papaveracea produced less than 105 chlamydospores ml−1 after 10 d of incubation in wheat bran–BY and soy fiber–BY liquid media compared with the production of greater than 105 chlamydospores ml−1 after 5 d of incubation in dextrin–BY or cornstarch–BY liquid media. Fewer cfu were produced by P. papaveracea in 0.25% dextrin or 0.25 and 0.50% soy fiber liquid media than with 1 or 2% substrate. Greater than 107 chlamydospores g−1 dry weight and 108 cfu g−1 dry weight of P. papaveracea were produced in dextrin–BY liquid media in a commercial bench-top fermentor. After air drying biomass for 6 d, propagules of P. papaveracea remained infective on opium poppy. Mycelia and chlamydospores of P. papaveracea grew and formed appressoria during the infection process. Air-dried biomass, when rehydrated in 0.001% Tween 20, caused necrosis within 48 h after application to detached opium poppy leaves. At least 94% of the propagules from air-dried biomass that germinated and infected detached opium poppy leaves were of mycelial origin.
Although mental disorders are significant predictors of educational attainment throughout the entire educational career, most research on mental disorders among students has focused on the primary and secondary school years.
The World Health Organization World Mental Health Surveys were used to examine the associations of mental disorders with college entry and attrition by comparing college students (n = 1572) and non-students in the same age range (18–22 years; n = 4178), including non-students who recently left college without graduating (n = 702) based on surveys in 21 countries (four low/lower-middle income, five upper-middle-income, one lower-middle or upper-middle at the times of two different surveys, and 11 high income). Lifetime and 12-month prevalence and age-of-onset of DSM-IV anxiety, mood, behavioral and substance disorders were assessed with the Composite International Diagnostic Interview (CIDI).
One-fifth (20.3%) of college students had 12-month DSM-IV/CIDI disorders; 83.1% of these cases had pre-matriculation onsets. Disorders with pre-matriculation onsets were more important than those with post-matriculation onsets in predicting subsequent college attrition, with substance disorders and, among women, major depression the most important such disorders. Only 16.4% of students with 12-month disorders received any 12-month healthcare treatment for their mental disorders.
Mental disorders are common among college students, have onsets that mostly occur prior to college entry, in the case of pre-matriculation disorders are associated with college attrition, and are typically untreated. Detection and effective treatment of these disorders early in the college career might reduce attrition and improve educational and psychosocial functioning.
The prediction of grass dry matter intake (GDMI) and milk yield (MY) are important to aid sward and grazing management decision making. Previous evaluations of the GrazeIn model identified weaknesses in the prediction of GDMI and MY for grazing dairy cows. To increase the accuracy of GDMI and MY prediction, GrazeIn was adapted, and then re-evaluated, using a data set of 3960 individual cow measurements. The adaptation process was completed in four additive steps with different components of the model reparameterised or altered. These components were: (1) intake capacity (IC) that was increased by 5% to reduce a general GDMI underprediction. This resulted in a correction of the GDMI mean and a lower relative prediction error (RPE) for the total data set, and at all stages of lactation, compared with the original model; (2) body fat reserve (BFR) deposition from 84 days in milk to next calving that was included in the model. This partitioned some energy to BFR deposition after body condition score nadir had been reached. This reduced total energy available for milk production, reducing the overprediction of MY and reducing RPE for MY in mid and late lactation, compared with the previous step. There was no effect on predicted GDMI; (3) The potential milk curve was reparameterised by optimising the rate of decrease in the theoretical hormone related to secretory cell differentiation and the basal rate of secretory cell death to achieve the lowest possible mean prediction error (MPE) for MY. This resulted in a reduction in the RPE for MY and an increase in the RPE for GDMI in all stages of lactation compared with the previous step; and (4) finally, IC was optimised, for GDMI, to achieve the lowest possible MPE. This resulted in an IC correction coefficient of 1.11. This increased the RPE for MY but decreased the RPE for GDMI compared with the previous step. Compared with the original model, modifying this combination of four model components improved the prediction accuracy of MY, particularly in late lactation with a decrease in RPE from 27.8% in the original model to 22.1% in the adapted model. However, testing of the adapted model using an independent data set would be beneficial and necessary to make definitive conclusions on improved predictions.
The World Mental Health Survey Initiative (WMHSI) has advanced our understanding of mental disorders by providing data suitable for analysis across many countries. However, these data have not yet been fully explored from a cross-national lifespan perspective. In particular, there is a shortage of research on the relationship between mood and anxiety disorders and age across countries. In this study we used multigroup methods to model the distribution of 12-month DSM-IV/CIDI mood and anxiety disorders across the adult lifespan in relation to determinants of mental health in 10 European Union (EU) countries.
Logistic regression was used to model the odds of any mood or any anxiety disorder as a function of age, gender, marital status, urbanicity and employment using a multigroup approach (n = 35500). This allowed for the testing of specific lifespan hypotheses across participating countries.
No simple geographical pattern exists with which to describe the relationship between 12-month prevalence of mood and anxiety disorders and age. Of the adults sampled, very few aged ⩾80 years met DSM-IV diagnostic criteria for these disorders. The associations between these disorders and key sociodemographic variables were relatively homogeneous across countries after adjusting for age.
Further research is required to confirm that there are indeed stages in the lifespan where the reported prevalence of mental disorders is low, such as among younger adults in the East and older adults in the West. This project illustrates the difficulties in conducting research among different age groups simultaneously.
Predicting the grass dry matter intake (GDMI), milk yield (MY) or milk fat and protein yield (milk solids yield (MSY)) of the grazing dairy herd is difficult. Decisions with regard to grazing management are based on guesstimates of the GDMI of the herd, yet GDMI is a critical factor influencing MY and MSY. A data set containing animal, sward, grazing management and concentrate supplementation variables recorded during weeks of GDMI measurement was used to develop multiple regression equations to predict GDMI, MY and MSY. The data set contained data from 245 grazing herds from 10 published studies conducted at Teagasc, Moorepark. A forward stepwise multiple regression technique was used to develop the multiple regression equations for each of the dependent variables (GDMI, MY, MSY) for three periods during the grazing season: spring (SP; 5 March to 30 April), summer (SU; 1 May to 31 July) and autumn (AU; 1 August to 31 October). The equations generated highlighted the importance of different variables associated with GDMI, MY and MSY during the grazing season. Peak MY was associated with an increase in GDMI, MY and MSY during the grazing season with the exception of GDMI in SU when BW accounted for more of the variation. A higher body condition score (BCS) at calving was associated with a lower GDMI in SP and SU and a lower MY and MSY in all periods. A higher BCS was associated with a higher GDMI in SP and SU, a higher MY in SU and AU and a higher MSY in all periods. The pre-grazing herbage mass of the sward (PGHM) above 4 cm was associated with a quadratic effect on GDMI in SP, on MY in SP and SU and on MSY in SU. An increase in daily herbage allowance (DHA) above 4 cm was associated with an increase in GDMI in AU, an increase in MY in SU and AU and MSY in AU. Supplementing grazing dairy cows with concentrate reduced GDMI and increased MY and MSY in all periods. The equations generated can be used by the Irish dairy industry during the grazing season to predict the GDMI, MY and MSY of grazing dairy herds.
Adaptation, speciation and extinction
A. Donnelly, Trinity College Dublin, Ireland,
A. Caffarra, Istituto Agrario San Michele all'Adige, Italy,
E. Diskin, Trinity College Dublin, Ireland,
C. T. Kelleher, National Botanic Gardens, Glasnevin, Dublin, Ireland,
A. Pletsers, Trinity College Dublin, Ireland,
H. Proctor, Trinity College Dublin, Ireland,
R. Stirnemann, Trinity College Dublin, Ireland,
M. B. Jones, Trinity College Dublin, Ireland,
J. O'Halloran, University College Cork, Ireland,
B. F. O'Neill, Trinity College Dublin, Ireland,
J. Peñuelas, Campus Universitat Autònoma de Barcelona, Spain,
T. Sparks, Technische Universität München, Germany and Institute of Zoology, Poznań University of Life Sciences, University of Cambridge, UK
The impact of climate change, in particular increasing spring temperatures, on life-cycle events of plants and animals has gained scientific attention in recent years. Leafing of trees, appearance and abundance of insects, and migration of birds, across a range of species and countries, have been cited as phenotrends that are advancing in response to warmer spring temperatures. The ability of organisms to acclimate to variations in environmental conditions is known as phenotypic plasticity. Plasticity allows organisms to time developmental stages to coincide with optimum availability of environmental resources. There may, however, come a time when the limit of this plasticity is reached and the species needs to adapt genetically to survive. Here we discuss evidence of the impact of climate warming on plant, insect and bird phenology through examination of: (1) phenotypic plasticity in (a) bud burst in trees, (b) appearance of insects and (c) migration of birds; and (2) genetic adaptation in (a) gene expression during bud burst in trees, (b) the timing of occurrence of phenological events in insects and (c) arrival and breeding times of migratory birds. Finally, we summarise the potential consequences of future climatic changes for plant, insect and bird phenology.
The recent resurgence of interest in phenology (the timing of recurring life-cycle events in plants and animals) has stemmed from research on the impact of climate change, in particular, global warming.
There is considerable debate within the literature about the significance of human papilloma virus in head and neck squamous cell carcinoma, and its potential influence on the prevention, diagnosis, grading, treatment and prognosis of these cancers. Cigarette smoking and alcohol consumption have traditionally been cited as the main risk factors for head and neck cancers. However, human papilloma virus, normally associated with cervical and other genital carcinomas, has emerged as a possible key aetiological factor in head and neck squamous cell carcinoma, especially oropharyngeal cancers. These cancers pose a significant financial burden on health resources and are increasing in incidence. The recent introduction of vaccines targeted against human papilloma virus types 16 and 18, to prevent cervical cancer, has highlighted the need for ongoing research into the importance of human papilloma virus in head and neck squamous cell carcinoma.