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Drift analysis is one of the state-of-the-art techniques for the runtime analysis of randomized search heuristics (RSHs) such as evolutionary algorithms (EAs), simulated annealing, etc. The vast majority of existing drift theorems yield bounds on the expected value of the hitting time for a target state, for example the set of optimal solutions, without making additional statements on the distribution of this time. We address this lack by providing a general drift theorem that includes bounds on the upper and lower tail of the hitting time distribution. The new tail bounds are applied to prove very precise sharp-concentration results on the running time of a simple EA on standard benchmark problems, including the class of general linear functions. On all these problems, the probability of deviating by an r-factor in lower-order terms of the expected time decreases exponentially with r. The usefulness of the theorem outside the theory of RSHs is demonstrated by deriving tail bounds on the number of cycles in random permutations. All these results handle a position-dependent (variable) drift that was not covered by previous drift theorems with tail bounds. Finally, user-friendly specializations of the general drift theorem are given.
Deposits of at least three glaciations are present in New Jersey and the New York City area. The oldest deposits are magnetically reversed. Pollen and stratigraphic relations suggest that they are from the earliest Laurentide advance at ~2.4 Ma. Deposits of a second advance are overlain by peat dated to 41 ka and so are pre-Marine Isotope Stage (pre-MIS) 2. Their relation to marine deposits indicates that they predate MIS 5 but postdate MIS 11 and may postdate MIS 7 or 9, suggesting an MIS 6 age. The most recent deposits are of MIS 2 (last glacial maximum [LGM]) age. Radiocarbon dates and varve counts tied to glacial-lake events indicate that LGM ice arrived at its terminus at 25 ka, stood at the terminus until ~24 ka, retreated at a rate of 80 m/yr until 23.5 ka, and then retreated at a rate of 12 m/yr to 18 ka. At 18 ka the retreat record connects to the base of the North American Varve Chronology at Newburgh, New York. The 25–24 ka age for the LGM is slightly younger than, but within the uncertainty of, cosmogenic ages; it is significantly older than the oldest dated macrofossils in postglacial deposits in the region.
Pathological gambling is a behavioural addiction with negative economic, social, and psychological consequences. Identification of contributing genes and pathways may improve understanding of aetiology and facilitate therapy and prevention. Here, we report the first genome-wide association study of pathological gambling. Our aims were to identify pathways involved in pathological gambling, and examine whether there is a genetic overlap between pathological gambling and alcohol dependence.
Four hundred and forty-five individuals with a diagnosis of pathological gambling according to the Diagnostic and Statistical Manual of Mental Disorders were recruited in Germany, and 986 controls were drawn from a German general population sample. A genome-wide association study of pathological gambling comprising single marker, gene-based, and pathway analyses, was performed. Polygenic risk scores were generated using data from a German genome-wide association study of alcohol dependence.
No genome-wide significant association with pathological gambling was found for single markers or genes. Pathways for Huntington's disease (P-value = 6.63 × 10−3); 5′-adenosine monophosphate-activated protein kinase signalling (P-value = 9.57 × 10−3); and apoptosis (P-value = 1.75 × 10−2) were significant. Polygenic risk score analysis of the alcohol dependence dataset yielded a one-sided nominal significant P-value in subjects with pathological gambling, irrespective of comorbid alcohol dependence status.
The present results accord with previous quantitative formal genetic studies which showed genetic overlap between non-substance- and substance-related addictions. Furthermore, pathway analysis suggests shared pathology between Huntington's disease and pathological gambling. This finding is consistent with previous imaging studies.
To develop and evaluate a program to presvent hospital-acquired pneumonia (HAP).
Prospective, observational, surveillance program to identify HAP before and after 7 interventions. An order set automatically triggered in programmatically identified high-risk patients.
All 21 hospitals of an integrated healthcare system with 4.4 million members.
All hospitalized patients.
Interventions for high-risk patients included mobilization, upright feeding, swallowing evaluation, sedation restrictions, elevated head of bed, oral care and tube care.
HAP rates decreased between 2012 and 2018: from 5.92 to 1.79 per 1,000 admissions (P = .0031) and from 24.57 to 6.49 per 100,000 members (P = .0014). HAP mortality decreased from 1.05 to 0.34 per 1,000 admissions and from 4.37 to 1.24 per 100,000 members. Concomitant antibiotic utilization demonstrated reductions of broad-spectrum antibiotics. Antibiotic therapy per 100,000 members was measured as follows: carbapenem days (694 to 463; P = .0020), aminoglycoside days (154 to 61; P = .0165), vancomycin days (2,087 to 1,783; P = .002), and quinolone days (2,162 to 1,287; P < .0001). Only cephalosporin use increased, driven by ceftriaxone days (264 to 460; P = .0009). Benzodiazepine use decreased between 2014 to 2016: 10.4% to 8.8% of inpatient days. Mortality for patients with HAP was 18% in 2012% and 19% in 2016 (P = .439).
HAP rates, mortality, and broad-spectrum antibiotic use were all reduced significantly following these interventions, despite the absence of strong supportive literature for guidance. Most interventions augmented basic nursing care. None had risks of adverse consequences. These results support the need to examine practices to improve care despite limited literature and the need to further study these difficult areas of care.
The association between schizophrenia and decreased vitamin D levels is well documented. Low maternal and postnatal vitamin D levels suggest a possible etiological mechanism. Alternatively, vitamin D deficiency in patients with schizophrenia is presumably (also) the result of disease-related factors or demographic risk factors such as urbanicity.
In a study population of 347 patients with psychotic disorder and 282 controls, group differences in vitamin D concentration were examined. Within the patient group, associations between vitamin D, symptom levels and clinical variables were analyzed. Group × urbanicity interactions in the model of vitamin D concentration were examined. Both current urbanicity and urbanicity at birth were assessed.
Vitamin D concentrations were significantly lower in patients (B = −8.05; 95% confidence interval (CI) −13.68 to −2.42; p = 0.005). In patients, higher vitamin D concentration was associated with lower positive (B = −0.02; 95% CI −0.04 to 0.00; p = 0.049) and negative symptom levels (B = −0.03; 95% CI −0.05 to −0.01; p = 0.008). Group differences were moderated by urbanicity at birth (χ2 = 6.76 and p = 0.001), but not by current urbanicity (χ2 = 1.50 and p = 0.224). Urbanicity at birth was negatively associated with vitamin D concentration in patients (B = −5.11; 95% CI −9.41 to −0.81; p = 0.020), but not in controls (B = 0.72; 95% CI −4.02 to 5.46; p = 0.765).
Lower vitamin D levels in patients with psychotic disorder may in part reflect the effect of psychosis risk mediated by early environmental adversity. The data also suggest that lower vitamin D and psychopathology may be related through direct or indirect mechanisms.
Introduction: Formal ultrasound imaging, with use of ultrasound technicians and radiologists, provides a valuable diagnostic component to patient care in the Emergency Department (ED). Outside of regular weekday hours, ordering formal ultrasounds can produce logistical difficulties. EDs have developed protocols for next-day ultrasounds, where the patient returns the following day for imaging and reassessment by an ED physician. This creates additional stress on ED resources – personnel, bed space, finances – that are already strained. There is a dearth of literature regarding the use of next-day ultrasounds or guidelines to direct efficient use. This study sought to accumulate data on the use of ED next-day ultrasounds and patient oriented clinical outcomes. Methods: This study was a retrospective chart review of 150 patients, 75 from each of two different tertiary care hospitals in Saskatoon, Saskatchewan. After a predetermined start date, convenience samples were collected of all patients who had undergone a next-day ultrasound ordered from the ED until the quota was satisfied. Patients were identified by an electronic medical record search for specific triage note phrases indicating use of next-day ultrasounds. Different demographic, clinical, and administrative parameters were collected and analyzed. Results: Of the 150 patients, the mean age was 35.9 years and 75.3% were female. Median length of stay for the first visit was 4.1 hours, and 2.2 hours for the return visit. Most common ultrasound scans performed were abdomen and pelvis/gyne (34.7%), complete abdomen (30.0%), duplex extremity venous (10.0%). Most common indications on the ultrasound requisition were nonspecific abdominal pain (18.7%), vaginal bleeding with or without pregnancy (17.3%), and hepatobiliary pathology (15.3%). Ultrasounds results reported a relevant finding 56% of the time, and 34% were completely normal. After the next-day ultrasound 5.3% of patients had a CT scan, 10.7% had specialist consultation, 8.2% were admitted, and 7.3% underwent surgery. Conclusion: Information was gathered to close gaps in knowledge about the use of next-day ultrasounds from the ED. A large proportion of patients are discharged home without further interventions. Additional research and the development of next-day ultrasound guidelines or outpatient pathways may improve patient care and ED resource utilization.
Orbital-free density functional theory (OFDFT) is both grounded in quantum physics and suitable for direct simulation of thousands of atoms. This article describes the application of OFDFT for materials research over roughly the past two decades, highlighting computational studies that would have been impractical (or impossible) to perform with other techniques. In particular, we review the growing body of simulations of solids and liquids that have been conducted with planewave-pseudopotential (or related) techniques. We also provide an updated account of the fundamentals of OFDFT, emphasizing aspects—such as nonlocal density functionals for computing the kinetic energy of noninteracting electrons—that enabled much of the application work. The article concludes with a discussion of the OFDFT frontier, which contains brief descriptions of other topics at the forefront of OFDFT research.
Children and adolescents are a vulnerable group to develop post-traumatic stress symptoms after natural or man-made disasters. In the light of increasing numbers of refugees under the age of 18 years worldwide, there is a significant need for effective treatments. This meta-analytic review investigates specific psychosocial treatments for children and adolescents after man-made and natural disasters. In a systematic literature search using MEDLINE, EMBASE and PsycINFO, as well as hand-searching existing reviews and contacting professional associations, 36 studies were identified. Random- and mixed-effects models were applied to test for average effect sizes and moderating variables. Overall, treatments showed high effect sizes in pre–post comparisons (Hedges' g = 1.34) and medium effect sizes as compared with control conditions (Hedges' g = 0.43). Treatments investigated by at least two studies were cognitive–behavioural therapy (CBT), eye movement desensitization and reprocessing (EMDR), narrative exposure therapy for children (KIDNET) and classroom-based interventions, which showed similar effect sizes. However, studies were very heterogenic with regard to their outcomes. Effects were moderated by type of profession (higher level of training leading to higher effect sizes). A number of effective psychosocial treatments for child and adolescent survivors of disasters exist. CBT, EMDR, KIDNET and classroom-based interventions can be equally recommended. Although disasters require immediate reactions and improvisation, future studies with larger sample sizes and rigorous methodology are needed.
The aim of this study was to assess the efficacy of meaning-centered group psychotherapy for cancer survivors (MCGP-CS) to improve personal meaning, compared with supportive group psychotherapy (SGP) and care as usual (CAU).
A total of 170 cancer survivors were randomly assigned to one of the three study arms: MCGP-CS (n = 57); SGP (n = 56); CAU (n = 57). The primary outcome measure was the Personal Meaning Profile (PMP; total score). Secondary outcome measures were subscales of the PMP, psychological well-being (Scales of Psychological Well-being; SPWB), post-traumatic growth (Posttraumatic Growth Inventory), Mental Adjustment to Cancer (MAC), optimism (Life Orientation Test-Revised), hopelessness (Beck's Hopelessness Scale), psychological distress (anxiety and depression, Hospital Anxiety and Depression Scale; HADS) and quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire; EORTC QLQ-C30). Outcome measures were assessed before randomization, post-intervention, and after 3 and 6 months of follow-up (FU).
Linear mixed model analyses (intention-to-treat) showed significant differences between MCGP-CS, SGP and CAU on the total PMP score, and on (sub)scales of the PMP, SPWB, MAC and HADS. Post-hoc analyses showed significantly stronger treatment effects of MCGP-CS compared with CAU on personal meaning (d = 0.81), goal-orientedness (d = 1.07), positive relations (d = 0.59), purpose in life (d = 0.69); fighting spirit (d = 0.61) (post-intervention) and helpless/hopeless (d = −0.87) (3 months FU); and distress (d = −0.6) and depression (d = −0.38) (6 months FU). Significantly stronger effects of MCGP-CS compared with SGP were found on personal growth (d = 0.57) (3 months FU) and environmental mastery (d = 0.66) (6 months FU).
MCGP-CS is an effective intervention for cancer survivors to improve personal meaning, psychological well-being and mental adjustment to cancer in the short term, and to reduce psychological distress in the long run.
Parasites of the genera Plasmodium and Haemoproteus (Apicomplexa: Haemosporida) are a diverse group of pathogens that infect birds nearly worldwide. Despite their ubiquity, the ecological and evolutionary factors that shape the diversity and distribution of these protozoan parasites among avian communities and geographic regions are poorly understood. Based on a survey throughout the Neotropics of the haemosporidian parasites infecting manakins (Pipridae), a family of Passerine birds endemic to this region, we asked whether host relatedness, ecological similarity and geographic proximity structure parasite turnover between manakin species and local manakin assemblages. We used molecular methods to screen 1343 individuals of 30 manakin species for the presence of parasites. We found no significant correlations between manakin parasite lineage turnover and both manakin species turnover and geographic distance. Climate differences, species turnover in the larger bird community and parasite lineage turnover in non-manakin hosts did not correlate with manakin parasite lineage turnover. We also found no evidence that manakin parasite lineage turnover among host species correlates with range overlap and genetic divergence among hosts. Our analyses indicate that host switching (turnover among host species) and dispersal (turnover among locations) of haemosporidian parasites in manakins are not constrained at this scale.
Well-resolved measurements of the small-scale dissipation statistics within turbulent channel flow are reported for a range of Reynolds numbers from
to 4000. In this flow, the local large-scale Reynolds number based on the longitudinal integral length scale is found to poorly describe the Reynolds number dependence of the small-scale statistics. When a length scale based on Townsend’s attached-eddy hypothesis is used to define the local large-scale Reynolds number, the Reynolds number scaling behaviour was found to be more consistent with that observed in homogeneous, isotropic turbulence. The Reynolds number scaling of the dissipation moments up to the sixth moment was examined and the results were found to be in good agreement with predicted scaling behaviour (Schumacher et al., Proc. Natl Acad. Sci. USA, vol. 111, 2014, pp. 10961–10965). The probability density functions of the local dissipation scales (Yakhot, Physica D, vol. 215 (2), 2006, pp. 166–174) were also determined and, when the revised local large-scale Reynolds number is used for normalization, provide support for the existence of a universal distribution which scales differently for inner and outer regions.
Clinical and ethical implications of personality and mood changes in Parkinson's disease (PD) patients treated with subthalamic deep brain stimulation (STN-DBS) are under debate. Although subjectively perceived personality changes are often mentioned by patients and caregivers, few empirical studies concerning these changes exist. Therefore, we analysed subjectively perceived personality and mood changes in STN-DBS PD patients.
In this prospective study of the ELSA-DBS group, 27 PD patients were assessed preoperatively and 1 year after STN-DBS surgery. Two categories, personality and mood changes, were analysed with semi-structured interviews. Patients were grouped into personality change yes/no, as well as positive/negative mood change groups. Caregivers were additionally interviewed about patients’ personality changes. Characteristics of each group were assessed with standard neurological and psychiatric measurements. Predictors for changes were analysed.
Personality changes were perceived by six of 27 (22%) patients and by 10 of 23 caregivers (44%). The preoperative hypomania trait was a significant predictor for personality change perceived by patients. Of 21 patients, 12 (57%) perceived mood as positively changed. Higher apathy and anxiety ratings were found in the negative change group.
Our results show that a high proportion of PD patients and caregivers perceived personality changes under STN-DBS, emphasizing the relevance of this topic. Mood changed in positive and negative directions. Standard measurement scales failed to adequately reflect personality or mood changes subjectively perceived by patients. A more individualized preoperative screening and preparation for patients and caregivers, as well as postoperative support, could therefore be useful.
Ectothermic species are fundamentally affected by environmental temperatures, which largely dictate their metabolic rate. In marine turtles, foraging behavior, migratory patterns, and ultimately breeding success may be modulated by the environment and influenced by climate change. This has the potential to have both positive and negative effects. The seven species of marine turtles broadly occupy three foraging niches (planktivory, herbivory, and omnivory) and occur in almost every non-polar ocean basin in the world, from shallow coastal seas to open ocean habitats. The effects of climate change to marine turtles likely will be wide ranging and of direct relevance to other marine animals in these varied habitats. Marine turtles are a fascinating “canary in the coal mine” with which to study the effects of climate change in marine habitats, and there has been an exponential increase in interest in the effects of climate change on them in the last decade (Poloczanska et al., 2009; Hamann et al., 2010; Hawkes et al., 2010). Marine turtles are also generally considered charismatic, making them ideal subjects with which to raise awareness of climate change effects to biodiversity and to increase support for effective management and conservation of marine environments.
There is growing awareness that small-scale fisheries may have large impacts on threatened marine fauna. Bycatch of small cetaceans by the Peruvian small-scale driftnet fleet results in the deaths of thousands of animals annually. We sought to assess the effectiveness of acoustic alarms (pingers) for reducing the incidental capture of dolphins and porpoises by this fleet. Forty-three experimental trips (156 fishing sets) and 47 control trips (195 fishing sets) out of Salaverry Port, northern Peru, were observed from April 2009 to August 2011. Twenty-two percent of control sets captured small cetaceans (67 individuals) and 16% of experimental sets had captures of small cetaceans (33 individuals). The bycatch rate of experimental sets was 0.50 individuals km−2h−1, whereas for control sets the rate was 0.80 individuals km−2h−1. This 37% reduction in bycatch rate suggests that pingers may be effective in reducing the bycatch of small cetaceans in this fishery. Catch rates of the fishery's target shark and ray species were unchanged. Given the vast size of this fishery and its current levels of bycatch of small cetaceans (> 10,000 individuals annually), even the modest declines in bycatch we observed could result in reductions in mortality of hundreds or thousands of small cetaceans per annum. Challenges, including increased costs, to large-scale utilization of pingers have yet to be overcome. The harpooning of dolphins for use as bait will also need to be addressed for further reductions in dolphin and porpoise bycatch and mortality to be achievable.
We document patterns of distribution and relative abundance of marine megavertebrate fauna around Cornwall and the Isles of Scilly from a combination of aerial and boat-based surveying. Between January 2006 and November 2007, 20 aerial surveys were undertaken, comprising over 40 hours of on-effort flying time. In April to October of these years, 27 effort-corrected ferry surveys were also conducted from a passenger ferry travelling between Cornwall and the Isles of Scilly. Opportunistic sightings were also logged by the crew members of the ferry and another vessel travelling regularly along the same route on 155 days. Ten megavertebrate species were sighted: basking sharks Cetorhinus maximus, sunfish Mola mola, common dolphins Delphinus delphis, harbour porpoise Phocoena phocoena, grey seals Halichoerus grypus, Risso's dolphins Grampus griseus, bottlenose dolphins Tursiops truncatus, minke whales Balaenoptera acutorostrata, long-finned pilot whales Globicephala melas and killer whale Orcinus orca. During aerial surveys, 206 sighting events of seven species were made, compared with 145 sighting events of eight species during ferry surveys and 293 sighting events of 10 species from opportunistic ship-board data collection efforts. Seasonal and spatial patterns in species occurrence were evident. Basking sharks were the most commonly-sighted species in the region and were relatively abundant throughout the estimated 5 km-wide strip of coastal waters covered by the aerial surveys, during spring and summer. Ferry surveys and opportunistic vessel-based sightings data confirmed that the distribution of surface-feeding aggregations of this species was largely around the coasts. Despite the limited scope of this study, it has provided valuable baseline data, and possible insights into the marine biodiversity of the region.