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Psychogenic nonepileptic seizures (PNES) are paroxysms of altered sensory, cognitive, and/or motor manifestations with or without alteration of consciousness that may resemble epileptic seizures, but do not originate from epileptiform brain activity. One framework conceives PNES as arising from a biopsychosocial, multifactorial etiologic model. An unexpectedly high co-occurrence rate of PNES and mild traumatic brain injury (mTBI) has been reported. A causal relationship may be possible in many cases. In applying the biopsychosocial framework, this review discusses how TBI may subserve contributing roles as Predisposing, Precipitating, and Perpetuating factors in the development of PNES.
The Rhynchonellida is a major group of brachiopods that survived the “big five” mass extinctions and flourished after the Permian/Triassic (P/Tr) crisis. However, phylogenetic and character evolution in the Rhynchonellida across the P/Tr transition is poorly understood. In view of the widespread homoplasy across this order, we employ a tip-dated Bayesian analysis to reconstruct phylogenetic relationships for late Permian–Triassic rhynchonellides. The same data were also analyzed using three other methods: undated Bayesian, equal-weighting, and implied-weighting parsimony. Compared with trees generated by other methods, those constructed by tip-dating best account for the homoplasy in this group and are closer to previous assumptions on the evolution of this order. Based on the analyses of multiple trees, the major increase in lineage richness occurred in the Early and early Middle Triassic. Also, richness in the Anisian almost reached the highest level seen in the Triassic. According to fossil records, a pronounced reduction in shell size and in the development of ornamentation occurred after the P/Tr extinction, which is largely due to the loss of large and highly sculptured genera and the diversification of small-sized and weakly ornamented genera. Ancestral-state estimation of shell size and development of ornamentation, coupled with comparisons of other characters, indicate that the Early–Middle Triassic mature “small-sized taxa” may have characters displayed by juveniles of their ancestors. This suggests that for these genera, paedomorphosis was possibly a strategy to survive and diversify in the harsh environment after the P/Tr extinction.
The degree to which suicide risk aggregates in US families is unknown. The authors aimed to determine the familial risk of suicide in Utah, and tested whether familial risk varies based on the characteristics of the suicides and their relatives.
A population-based sample of 12 160 suicides from 1904 to 2014 were identified from the Utah Population Database and matched 1:5 to controls based on sex and age using at-risk sampling. All first through third- and fifth-degree relatives of suicide probands and controls were identified (N = 13 480 122). The familial risk of suicide was estimated based on hazard ratios (HR) from an unsupervised Cox regression model in a unified framework. Moderation by sex of the proband or relative and age of the proband at time of suicide (<25 v. ⩾25 years) was examined.
Significantly elevated HRs were observed in first- (HR 3.45; 95% CI 3.12–3.82) through fifth-degree relatives (HR 1.07; 95% CI 1.02–1.12) of suicide probands. Among first-degree relatives of female suicide probands, the HR of suicide was 6.99 (95% CI 3.99–12.25) in mothers, 6.39 in sisters (95% CI 3.78–10.82), and 5.65 (95% CI 3.38–9.44) in daughters. The HR in first-degree relatives of suicide probands under 25 years at death was 4.29 (95% CI 3.49–5.26).
Elevated familial suicide risk in relatives of female and younger suicide probands suggests that there are unique risk groups to which prevention efforts should be directed – namely suicidal young adults and women with a strong family history of suicide.
The coronavirus disease 2019 (COVID-19) pandemic has resulted in shortages of personal protective equipment (PPE), underscoring the urgent need for simple, efficient, and inexpensive methods to decontaminate masks and respirators exposed to severe acute respiratory coronavirus virus 2 (SARS-CoV-2). We hypothesized that methylene blue (MB) photochemical treatment, which has various clinical applications, could decontaminate PPE contaminated with coronavirus.
The 2 arms of the study included (1) PPE inoculation with coronaviruses followed by MB with light (MBL) decontamination treatment and (2) PPE treatment with MBL for 5 cycles of decontamination to determine maintenance of PPE performance.
MBL treatment was used to inactivate coronaviruses on 3 N95 filtering facepiece respirator (FFR) and 2 medical mask models. We inoculated FFR and medical mask materials with 3 coronaviruses, including SARS-CoV-2, and we treated them with 10 µM MB and exposed them to 50,000 lux of white light or 12,500 lux of red light for 30 minutes. In parallel, integrity was assessed after 5 cycles of decontamination using multiple US and international test methods, and the process was compared with the FDA-authorized vaporized hydrogen peroxide plus ozone (VHP+O3) decontamination method.
Overall, MBL robustly and consistently inactivated all 3 coronaviruses with 99.8% to >99.9% virus inactivation across all FFRs and medical masks tested. FFR and medical mask integrity was maintained after 5 cycles of MBL treatment, whereas 1 FFR model failed after 5 cycles of VHP+O3.
MBL treatment decontaminated respirators and masks by inactivating 3 tested coronaviruses without compromising integrity through 5 cycles of decontamination. MBL decontamination is effective, is low cost, and does not require specialized equipment, making it applicable in low- to high-resource settings.
The hyper-function of the striatal dopamine system has been suggested to underlie key pathophysiological mechanisms in schizophrenia. Moreover, patients have been observed to present a significant elevation of dopamine receptor availability compared to healthy controls. Although it is difficult to measure dopamine levels directly in humans, neurochemical imaging techniques such as single-photon emission computed tomography (SPECT) provide indirect indices of in vivo dopamine synthesis and release, and putative synaptic levels.
We focused on the role of dopamine postsynaptic regulation using [123I] iodobenzamide (IBZM) SPECT. We compared D2/3 receptor availability between 53 healthy controls and 21 medication-naive patients with recent-onset schizophrenia.
The mean specific striatal binding showed no significant difference between patients and controls (estimated difference = 0.001; 95% CI −0.11 to 0.11; F = 0.00, df = 1, 69; p = 0.99). There was a highly significant effect of age whereby IBZM binding declined with advancing age [estimated change per decade of age = −0.01(binding ratio); 95% CI −0.01 to −0.004; F = 11.5, df = 1, 69; p = 0.001]. No significant correlations were found between the mean specific striatal binding and psychopathological or cognitive rating scores.
Medication-naïve patients with recent-onset schizophrenia have similar D2/3 receptor availability to healthy controls. We suggest that, rather than focusing exclusively on postsynaptic receptors, future treatments should target the presynaptic control of dopamine synthesis and release.
With the future of liberal internationalism in question, how will China's growing power and influence reshape world politics? We argue that views of the Liberal International Order (LIO) as integrative and resilient have been too optimistic for two reasons. First, China's ability to profit from within the system has shaken the domestic consensus in the United States on preserving the existing LIO. Second, features of Chinese Communist Party rule chafe against many of the fundamental principles of the LIO, but could coexist with a return to Westphalian principles and markets that are embedded in domestic systems of control. How, then, do authoritarian states like China pick and choose how to engage with key institutions and norms within the LIO? We propose a framework that highlights two domestic variables—centrality and heterogeneity—and their implications for China's international behavior. We illustrate the framework with examples from China's approach to climate change, trade and exchange rates, Internet governance, territorial sovereignty, arms control, and humanitarian intervention. Finally, we conclude by considering what alternative versions of international order might emerge as China's influence grows.
The global dairy sector is facing the challenge of reducing greenhouse gas (GHG) emissions whilst increasing productivity to feed a growing population. Despite the importance of this challenge, many developing countries do not have the required resources, specifically funding, expertise and facilities, for quantifying GHG emissions from dairy production and research. This paper aims to address this challenge by discussing the magnitude of the issue, potential mitigation approaches and benefits in quantifying GHG emissions in a developing country context. Further, the paper explores the opportunities for developing country dairy scientists to leverage resources from developed countries, such as using existing relevant GHG emission estimation models. It is clear that further research is required to support developing countries to quantify and understand GHG emissions from dairy production, as it brings significant benefits including helping to identify and implement appropriate mitigation strategies for local production systems, trading carbon credits and achieving the nationally determined contribution obligations of the Paris Agreement.
Benzodiazepine (BZD) prescription rates have increased over the past decade in the United States. Available literature indicates that sociodemographic factors may influence diagnostic patterns and/or prescription behaviour. Herein, the aim of this study is to determine whether the gender of the prescriber and/or patient influences BZD prescription.
Cross-sectional study using data from the Florida Medicaid Managed Medical Assistance Program from January 1, 2018 to December 31, 2018. Eligible recipients ages 18 to 64, inclusive, enrolled in the Florida Medicaid plan for at least 1 day, and were dually eligible. Recipients either had a serious mental illness (SMI), or non-SMI and anxiety.
Total 125 463 cases were identified (i.e., received BZD or non-BZD prescription). Main effect of patient and prescriber gender was significant F(1, 125 459) = 0.105, P = 0 .745, partial η2 < 0.001. Relative risk (RR) of male prescribers prescribing a BZD compared to female prescribers was 1.540, 95% confidence intervals (CI) [1.513, 1.567], whereas the RR of male patients being prescribed a BZD compared to female patients was 1.16, 95% CI [1.14, 1.18]. Main effects of patient and prescriber gender were statistically significant F(1, 125 459) = 188.232, P < 0.001, partial η2 = 0.001 and F(1, 125 459) = 349.704, P < 0.001, partial η2 = 0.013, respectively.
Male prescribers are more likely to prescribe BZDs, and male patients are more likely to receive BZDs. Further studies are required to characterize factors that influence this gender-by-gender interaction.
Rough sleeping is a chronic experience faced by some of the most disadvantaged people in modern society. This paper describes work carried out in partnership with Homeless Link (HL), a UK-based charity, in developing a data-driven approach to better connect people sleeping rough on the streets with outreach service providers. HL's platform has grown exponentially in recent years, leading to thousands of alerts per day during extreme weather events; this overwhelms the volunteer-based system they currently rely upon for the processing of alerts. In order to solve this problem, we propose a human-centered machine learning system to augment the volunteers' efforts by prioritizing alerts based on the likelihood of making a successful connection with a rough sleeper. This addresses capacity and resource limitations whilst allowing HL to quickly, effectively, and equitably process all of the alerts that they receive. Initial evaluation using historical data shows that our approach increases the rate at which rough sleepers are found following a referral by at least 15% based on labeled data, implying a greater overall increase when the alerts with unknown outcomes are considered, and suggesting the benefit in a trial taking place over a longer period to assess the models in practice. The discussion and modeling process is done with careful considerations of ethics, transparency, and explainability due to the sensitive nature of the data involved and the vulnerability of the people that are affected.
Background: Catheter-associated urinary tract infection (CAUTI) is considered a preventable healthcare-associated infection. Many local and national interventions using multimodal prevention measures have targeted CAUTI incidence as the primary outcome. Other undesirable events related to urinary catheters and infections such as overuse of urine culturing and antimicrobial prescribing for asymptomatic bacteriuria, are not captured by CAUTI surveillance, and may not be the targets of such interventions. The aim of this study was to assess the impact of expanded national surveillance targeting various aspects of urinary tract infections, culturing and treatment practices, and catheter use in internal medicine wards. Methods: The Israeli National Center for Infection Control (NCIC) issued CAUTI prevention guidelines and initiated in 2016 a urinary tract event surveillance system that targets the incidence of CAUTI, urinary catheter utilization ratio, and the proportion of urine cultures sent and patients treated in the absence of symptoms. The surveillance is conducted for 1 month 3 times per year. Hospitals are required to report all positive urine cultures (>100,000 CFU) collected in internal medicine wards, along with the following data: admission date, symptoms of infection, dates of urinary catheter use, and antibiotic treatment. These data enable the NCIC to validate hospital classifications of each event. In addition, during each surveillance month, hospitals conduct point-prevalence surveys of compliance with CAUTI prevention measures. An electronic data collection form with built-in algorithms supports the local teams during the surveillance process. Results: Between 2016 and 2019, a total of 3,028 positive urine cultures not present on admission were reported by internal medicine wards in 30 hospitals. A significant decrease was observed in the incidence of CAUTI (from 4.7 to 2.9; P < .001) and in the proportion of asymptomatic bacteriuria treated with antibiotics (from 31% to 20%; P = .02) (Table 1). The catheter utilization ratio decreased from 0.25 to 0.23 (P < .001). The rate of cultures sent from asymptomatic patients decreased from 1.5 to 1.1 (P < .01). Point-prevalence surveys in internal medicine wards detected a significant increase in the use of closed urinary drainage systems (from 79% to 97% in 2018, P < .001) and documentation of a daily nurse assessment of the need for a catheter (from 74% to 81%, P < .001). Conclusions: National surveillance of undesirable urinary tract events resulted in a significant reduction in CAUTI, antibiotic treatment for ASB, and the rate of cultures sent from asymptomatic patients. A small decrease was observed in catheter utilization ratio. CAUTI surveillance programs should include other undesirable urinary tract events.
The Order Spiriferinida spanning the latest Ordovician to Early Jurassic is a small group of brachiopods overshadowed by other taxon-rich clades during the Paleozoic. It diversified significantly after the end-Permian extinction and became one of the four major clades of Triassic brachiopods. However, the phylogeny and recovery dynamics of this clade during the Triassic still remain unknown. Here, we present a higher-level parsimony-based phylogenetic analysis of Mesozoic spiriferinids to reveal their evolutionary relationships. Ecologically related characters are analyzed to indicate the variances in ecomorphospace occupation and disparity of spiriferinids through the Permian–Triassic (P-Tr) transition. For comparison with potential competitors of the spiriferinids, the pre-extinction spiriferids are also included in the analysis. Phylogenetic trees demonstrate that about half of the Mesozoic families appeared during the Anisian, indicating the greatest phylogenetic diversification at that time. Triassic spiriferinids reoccupied a large part of the ecomorphospace released by its competitor spiriferids during the end-Permian extinction; they also fully exploited the cyrtiniform region and developed novel lifestyles. Ecomorphologic disparity of the spiriferinids dropped greatly in the Early Triassic, but it rebounded rapidly and reached the level attained by the pre-extinction spiriferids in the Late Triassic. The replacement in ecomorphospace occupation between spiriferids and spiriferinids during the P-Tr transition clearly indicates that the empty ecomorphospace released by the extinction of Permian spiriferids was one of the important drivers for the diversification of the Triassic spiriferinids. The Spiriferinida took over the empty ecomorphospace and had the opportunity to flourish.