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Several social determinants of health (SDoH) have been associated with the onset of major depressive disorder (MDD). However, prior studies largely focused on individual SDoH and thus less is known about the relative importance (RI) of SDoH variables, especially in older adults. Given that risk factors for MDD may differ across the lifespan, we aimed to identify the SDoH that was most strongly related to newly diagnosed MDD in a cohort of older adults.
We used self-reported health-related survey data from 41 174 older adults (50–89 years, median age = 67 years) who participated in the Mayo Clinic Biobank, and linked ICD codes for MDD in the participants' electronic health records. Participants with a history of clinically documented or self-reported MDD prior to survey completion were excluded from analysis (N = 10 938, 27%). We used Cox proportional hazards models with a gradient boosting machine approach to quantify the RI of 30 pre-selected SDoH variables on the risk of future MDD diagnosis.
Following biobank enrollment, 2073 older participants were diagnosed with MDD during the follow-up period (median duration = 6.7 years). The most influential SDoH was perceived level of social activity (RI = 0.17). Lower level of social activity was associated with a higher risk of MDD [hazard ratio = 2.27 (95% CI 2.00–2.50) for highest v. lowest level].
Across a range of SDoH variables, perceived level of social activity is most strongly related to MDD in older adults. Monitoring changes in the level of social activity may help identify older adults at an increased risk of MDD.
Intrauterine preeclampsia exposure affects the lifelong cardiometabolic health of the child. Our study aimed to compare the growth (from birth to 6 months) of infants exposed to either a normotensive pregnancy or preeclampsia and explore the influence of being born small for gestational age (SGA). Participants were children of women participating in the Post-partum, Physiology, Psychology and Paediatric follow-up cohort study. Birth and 6-month weight and length z-scores were calculated for term and preterm (<37 weeks) babies, and change in weight z-score, rapid weight gain (≥0.67 increase in weight z-score) and conditional weight gain z-score were calculated. Compared with normotensive exposed infants (n = 298), preeclampsia exposed infants (n = 84) were more likely to be born SGA (7% versus 23%; P < 0.001), but weight gain from birth to 6 months, by any measure, did not differ between groups. Infants born SGA, irrespective of pregnancy exposure, were more likely to have rapid weight gain and had greater increases in weight z-score compared with those not born SGA. Preeclampsia exposed infants born SGA may benefit from interventions designed to prevent future cardiometabolic disease.
Charles Darwin never doubted the common ancestry of the human races. But he was open-minded about whether the races might nevertheless be so different from each other that they ought to be classified not as varieties of one species but as distinct species. He pondered this varieties-or-species question on and off for decades, from his time aboard the Beagle through to the publication of the Descent of Man. A constant throughout was his concern with something that he first learned on the Beagle voyage and that, on the face of it, seemed to favour the species ranking: the different races, he was told, play host to distinct species of lice. This paper reconstructs the long run of Darwin's reflections and interactions on race, lice and history, using his extended correspondence with Henry Denny – curator of the scientific collections of the Leeds Philosophical and Literary Society, and Britain's leading expert in the natural history of lice – as a window onto the social world whose imprint is everywhere in the pages of the Descent.
Assimilation of continuously streamed monitored data is an essential component of a digital twin; the assimilated data are used to ensure the digital twin represents the monitored system as accurately as possible. One way this is achieved is by calibration of simulation models, whether data-derived or physics-based, or a combination of both. Traditional manual calibration is not possible in this context; hence, new methods are required for continuous calibration. In this paper, a particle filter methodology for continuous calibration of the physics-based model element of a digital twin is presented and applied to an example of an underground farm. The methodology is applied to a synthetic problem with known calibration parameter values prior to being used in conjunction with monitored data. The proposed methodology is compared against static and sequential Bayesian calibration approaches and compares favourably in terms of determination of the distribution of parameter values and analysis run times, both essential requirements. The methodology is shown to be potentially useful as a means to ensure continuing model fidelity.
Fungal endocarditis classically involves dense heterogenous vegetations. However, several patients with fungal infections were noted to have myocardial changes ranging from focal brightening to nodular thickening of chordae or papillary muscles. This study evaluates whether these findings are associated with fungal infections.
In a retrospective case–control study, paediatric inpatients with fungal infections (positive blood, urine, or catheter tip culture) in a 5-year period were matched 1:1 to inpatients without positive fungal cultures. Echocardiograms were scored on a 5-point scale by two independent readers for presence of myocardial brightenings, nodular thickenings, and vegetations. Clinical data were compared.
Of 67 fungal cases, positive culture sites included blood (n = 44), vascular catheter tip (n = 7), and urine (n = 29); several had multiple positive sites. “Positive” echo findings (score ≥ 2+) were more frequent in the Fungal Group (33 versus 18%, p = 0.04). Fungal Group patients with “positive” versus “negative” echo findings had similar proportion of bacterial infections. Among fungal cases, those with “positive” echo findings had longer hospital length of stay than cases with “negative” echos (median 58 versus 40 days, p = 0.03) but no difference in intensive care unit admission, extracorporeal membranous oxygenation support, or mortality.
Myocardial and papillary muscle brightening with nodular thickening on echocardiogram appear to be associated with fungal infections. There may be prognostic implications of these findings as patients with “positive” echo have longer length of stay. Further studies are needed to better understand the mechanism and temporal progression of these changes and determine the prognostic value of this scoring system.
This is the first report on the association between trauma exposure and depression from the Advancing Understanding of RecOvery afteR traumA(AURORA) multisite longitudinal study of adverse post-traumatic neuropsychiatric sequelae (APNS) among participants seeking emergency department (ED) treatment in the aftermath of a traumatic life experience.
We focus on participants presenting at EDs after a motor vehicle collision (MVC), which characterizes most AURORA participants, and examine associations of participant socio-demographics and MVC characteristics with 8-week depression as mediated through peritraumatic symptoms and 2-week depression.
Eight-week depression prevalence was relatively high (27.8%) and associated with several MVC characteristics (being passenger v. driver; injuries to other people). Peritraumatic distress was associated with 2-week but not 8-week depression. Most of these associations held when controlling for peritraumatic symptoms and, to a lesser degree, depressive symptoms at 2-weeks post-trauma.
These observations, coupled with substantial variation in the relative strength of the mediating pathways across predictors, raises the possibility of diverse and potentially complex underlying biological and psychological processes that remain to be elucidated in more in-depth analyses of the rich and evolving AURORA database to find new targets for intervention and new tools for risk-based stratification following trauma exposure.
Dinosaur body fossil material is rare in Scotland, previously known almost exclusively from the Great Estuarine Group on the Isle of Skye. We report the first unequivocal dinosaur fossil from the Isle of Eigg, belonging to a Bathonian (Middle Jurassic) taxon of uncertain affinity. The limb bone NMS G.2020.10.1 is incomplete, but through a combination of anatomical comparison and osteohistology, we determine it most likely represents a stegosaur fibula. The overall proportions and cross-sectional geometry are similar to the fibulae of thyreophorans. Examination of the bone microstructure reveals a high degree of remodelling and randomly distributed longitudinal canals in the remaining primary cortical bone. This contrasts with the histological signal expected of theropod or sauropod limb bones, but is consistent with previous studies of thyreophorans, specifically stegosaurs. Previous dinosaur material from Skye and broadly contemporaneous sites in England belongs to this group, including Loricatosaurus and Sarcolestes and a number of indeterminate stegosaur specimens. Theropods such as Megalosaurus and sauropods such as Cetiosaurus are also known from these localities. Although we find strong evidence for a stegosaur affinity, diagnostic features are not observed on NMS G.2020.10.1, preventing us from referring it to any known genera. The presence of this large-bodied stegosaur on Eigg adds a significant new datapoint for dinosaur distribution in the Middle Jurassic of Scotland.
In patients with β-lactam allergies, administration of non–β-lactam surgical prophylaxis is associated with increased risk of infection. Although many patients self-report β-lactam allergies, most are unconfirmed or mislabeled. A quality improvement process, utilizing a structured β-lactam allergy tool, was implemented to improve the utilization of preferred β-lactam surgical prophylaxis.
Analysis of human remains and a copper band found in the center of a Late Archaic (ca. 5000–3000 cal BP) shell ring demonstrate an exchange network between the Great Lakes and the coastal southeast United States. Similarities in mortuary practices suggest that the movement of objects between these two regions was more direct and unmediated than archaeologists previously assumed based on “down-the-line” models of exchange. These findings challenge prevalent notions that view preagricultural Native American communities as relatively isolated from one another and suggest instead that wide social networks spanned much of North America thousands of years before the advent of domestication.
Roles for pharmacists in general practice are developing in Australia. It is known that pharmacists can provide effective smoking cessation services in other settings but evidence in general practice is lacking.
To determine whether a pharmacist can provide effective smoking cessation services within general practice.
Data from smoking cessation consultations were obtained for 66 consecutive patients seen by one practice pharmacist. The pharmacist tailored interventions to the individual. Medication was offered in collaboration with community pharmacists and general practitioners. Quit coaching, based on motivational interviewing, was conducted. Smoking status was ascertained at least 6 months after the intended quit date and verified by a carbon monoxide breath test where possible.
The patients’ median age was 43 years (range 19–74 years); 42 were females (64%). At baseline, the median (i) number of pack years smoked was 20 (range: 1–75); (ii) Fagerstrom Test of dependence score was 6 (1–10); and (iii) number of previous quit attempts was 3 (0–10). Follow-up after at least 6 months determined a self-reported point prevalence abstinence rate of 30% (20/66). Of all patients who reported to be abstinent, 65% (13/20) were tested for carbon monoxide breath levels and were all below 7 ppm. The biochemically verified smoking abstinence rate was therefore 20% overall (13/66). Successful quit attempts were associated with varenicline recommendation (69% v 25%), increased median number of practice pharmacist consultations (4 v 2 per patient) and mental health diagnosis (85% v 51%).
Our observed abstinence rate was comparable or better than those obtained by practice nurses, community pharmacists and outpatient pharmacists, indicating the general practice pharmacist provided an effective smoking cessation intervention. A larger randomised trial is warranted.
The outermost “crust” and an underlying, compositionally distinct, and denser layer, the “mantle,” constitute the silicate portion of a terrestrial planet. The “lithosphere” is the planet’s high-strength outer shell. The crust records the history of shallow magmatism, which along with temporal changes in lithospheric thickness, provides information on a planet’s thermal evolution. We focus on the basic structure and mechanics of Mercury’s crust and lithosphere as determined primarily from gravity and topography data acquired by the MESSENGER mission. We first describe these datasets: how they were acquired, how the data are represented on a sphere, and the limitations of the data imparted by MESSENGER’s highly eccentric orbit. We review different crustal thickness models obtained by parsing the observed gravity signal into contributions from topography, relief on the crust–mantle boundary, and density anomalies that drive viscous flow in the mantle. Estimates of lithospheric thickness from gravity–topography analyses are at odds with predictions from thermal models, thus challenging our understanding of Mercury’s geodynamics. We show that, like those of the Moon, Mercury's ellipsoidal shape and geoid are far from hydrostatic equilibrium, possibly the result of Mercury's peculiar surface temperature distribution and associated buoyancy anomalies and thermoelastic stresses in the interior.
As part of a multifactorial approach to address weak incentives for innovative antimicrobial drug development, market entry rewards (MERs) are an emerging solution. Recently, the Duke-Margolis Center for Health Policy released the Priority Antimicrobial Value and Entry (PAVE) Award proposal, which combines a MER with payment reforms, transitioning from volume-based to “value-based” payments for antimicrobials. Here, the PAVE Award and similar MERs are reviewed, focusing on further refinement and avenues for implementation.
Research has clearly established the important role of parents in preventing substance use among early adolescents. Much of this work has focused on deviance (e.g., antisocial behavior, delinquency, and oppositional behavior) as a central pathway linking parenting behaviors and early adolescent substance use. This study proposed an alternative pathway; using a four-wave longitudinal design, we examined whether nurturant-involved parenting (Fall sixth grade) was inversely associated with adolescent drunkenness, marijuana use, and cigarette use (eighth grade) through social anxiety symptoms (Spring sixth grade) and subsequent decreases in substance refusal efficacy (seventh grade). Nurturant-involved parenting is characterized by warmth, supportiveness, low hostility, and low rejection. Analyses were conducted with a sample of 687 two-parent families. Results indicated that adolescents who were in families where fathers exhibited lower levels of nurturant-involved parenting experienced subsequent increases in social anxiety symptoms and decreased efficacy to refuse substances, which in turn was related to more frequent drunkenness, cigarette use, and marijuana use. Indirect effects are discussed. Findings were not substantiated for mothers’ parenting. Adolescent gender did not moderate associations. The results highlight an additional pathway through which parenting influences youth substance use and links social anxiety symptoms to reduced substance refusal efficacy.
One of the major threats to tropical forests throughout the world is the frequency and intensity with which local people use forests for subsistence. Kakamega Forest in Kenya is one such forest, in which fuelwood harvest is a primary use. The Kenya Forest Service and Kenya Wildlife Service have tried to regulate subsistence harvesting in this forest. However, high human population density (c. 542 people per km2) and extreme poverty leave local people little choice but to use forest resources to survive. We investigated patterns of wood use by people across Kakamega Forest. Our results indicate that wood harvesters prefer indigenous as opposed to non-indigenous wood, as the former sells for a premium price. Harungana madagascariensis and Psidium guajava were the most harvested indigenous and non-indigenous woods, respectively. Our data suggest that because market economies seem to drive forest use, perhaps they can be used to incentivize forest conservation. Proper integration of economic forest conservation interventions, economic diversification, and effective forest management are needed to protect Kakamega Forest.
The increase in natural and man-made disasters occurring worldwide places Emergency Medicine (EM) physicians at the forefront of responding to these crises. Despite the growing interest in Disaster Medicine, it is unclear if resident training has been able to include these educational goals.
This study surveys EM residencies in the United States to assess the level of education in Disaster Medicine, to identify competencies least and most addressed, and to highlight effective educational models already in place.
The authors distributed an online survey of multiple-choice and free-response questions to EM residency Program Directors in the United States between February 7 and September 24, 2014. Questions assessed residency background and details on specific Disaster Medicine competencies addressed during training.
Out of 183 programs, 75 (41%) responded to the survey and completed all required questions. Almost all programs reported having some level of Disaster Medicine training in their residency. The most common Disaster Medicine educational competencies taught were patient triage and decontamination. The least commonly taught competencies were volunteer management, working with response teams, and special needs populations. The most commonly identified methods to teach Disaster Medicine were drills and lectures/seminars.
There are a variety of educational tools used to teach Disaster Medicine in EM residencies today, with a larger focus on the use of lectures and hospital drills. There is no indication of a uniform educational approach across all residencies. The results of this survey demonstrate an opportunity for the creation of a standardized model for resident education in Disaster Medicine.
SarinRR, CattamanchiS, AlqahtaniA, AljohaniM, KeimM, CiottoneGR. Disaster Education: A Survey Study to Analyze Disaster Medicine Training in Emergency Medicine Residency Programs in the United States. Prehosp Disaster Med. 2017;32(4):368–373.
The purpose of this study is to assess the effectiveness of diabetes self-management education (DSME) in a rural agricultural town.
In this prospective, education-intervention trial, 85 adults with type 2 diabetes mellitus from villages randomly assigned to DSME and 70 from villages assigned to standard care participated. The DSME group underwent a curriculum delivered by peer educators; those in the standard group received usual advice. Outcome measures were anthropometric, biochemical, health behaviors, and medication use data taken at baseline then after three and six months.
DSME group had a lower median A1C after three and six months. After six months, there was a 0.5% median A1C reduction in DSME group and a 0.25% increase in the standard group. There were more participants in DSME group with A1C ⩽7.0% after three and six months. By the third month, there were more participants in DSME group performing foot examination.
DSME in this rural agricultural town improved glycemic control and promoted foot examination.
Catharism was neither a Balkan heresy, a construct of the persecuting society, or, for that matter, even a medieval phenomenon, as it has never existed, except as an enduring invention of late nineteenth-century scholars of religion and history. The historical and epistemological paradigm shaping and guiding research on Catharism for more than a century is moribund. Great (if misguided) scholarship was achieved within this paradigm, including some of the methods and insights now leading to its obsolescence. What distinguishes historians who persist in accepting (and defending) the reality of Catharism is, as Thomas Kuhn argued about scientists wedded to conventional wisdom, ‘how little they aim to produce major novelties, conceptual or phenomenal’. This blinkered competence, where the achievements of older scholars are solemnly replicated, and all new research is wilfully ignored, consistently misunderstood, or vehemently rejected (and, every so often, a curious mix of all three), encourages either a studious treading of intellectual waters, hoping against hope that the tide is not turning, or a learned backstroke to around 1970, although, depending on the current, it is, more often than not, 1870. It is this retreat by many (really, too many) historians recently into earlier academic accomplishments and assumptions, along with a debating style closer to soapbox moralism than scholarly analysis, that, more than anything else, reveals how profound and threatening is the ongoing paradigm shift – for that is what it is – of a Middle Ages without Catharism.
The old paradigm of Catharism was, and still is, shaped by two seemingly incompatible methodological approaches to the past. The first and dominant approach views the study of religion and heresy as an exercise in intellectual history. This intellectualist bias presumes that what defines heresies are coherent theologies and doctrines compiled and disseminated in canonical texts by heretical leaders. Although this bias was implicit in most scholarly research into religion before the late nineteenth century, it was only after 1870 that this idealist inclination was explicitly codified as a method, especially by German academics practising the new Religionsgeschichte.
We summarize work on the central parsec of the Galactic center based on imaging and spectroscopic observations at the Keck and Gemini telescopes. These observations include stellar positions in two dimension and the velocity in three dimensions. Spectroscopic observations also enables measurements of the physical properties of individual stars, such as the spectral type and in some cases the effective temperature, metallicity, and surface gravity. These observations show a complex stellar population with a young (4-6 Myr) compact star cluster in the central 0.5 pc embedded in in an older and much more massive nuclear star cluster. Surprisingly, the old late-type giants do not show a cusp profile as long been expected from theoretical work. The majority of the stars have higher than solar metallicity, with only about 6% of the stars having [M/Fe] < −0.5, which is consistent with an origin from the MW disk.