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Research examining (MCI) criteria in diverse and/or health-disparate populations is limited. There is a critical need to investigate the predictive validity for incident dementia of widely used MCI definitions in diverse populations.
Method:
Eligible participants were non-Hispanic White or Black Bronx community residents, free of dementia at enrollment, with at least one annual follow-up visit after baseline. Participants completed annual neurological and neuropsychological evaluations to determine cognitive status. Dementia was defined based on DSM-IV criteria using case conferences. Cox proportional hazard models assessed predictive validity for incident dementia of four specific MCI definitions (Petersen, Jak/Bondi, number of impaired tests, Global Clinical Ratings) at baseline, controlling for age, sex, education, and race/ethnicity. Time-dependent sensitivity and specificity at 2–7 years for each definition, and Youden’s index were calculated as accuracy measures.
Results:
Participants (N = 1073) ranged in age from 70 to 100 (mean = 78.4 ± 5.3) years at baseline. The sample was 62.5% female, and educational achievement averaged 13.9 ± 3.5 years. Most participants identified as White (70.0%), though Black participants were well-represented (30.0%). In general, MCI definitions differed in sensitivity and specificity for incident dementia. However, there were no significant differences in Youden’s index for any definition, across all years of follow-up.
Conclusions:
This work provides an important step toward improving the generalizability of the MCI diagnosis to underrepresented/health-disparate populations. While our findings suggest the studied MCI classifications are comparable, researchers and clinicians may choose to consider one method over another depending on the rationale for evaluation or question of interest.
A clinical tool to estimate the risk of treatment-resistant schizophrenia (TRS) in people with first-episode psychosis (FEP) would inform early detection of TRS and overcome the delay of up to 5 years in starting TRS medication.
Aims
To develop and evaluate a model that could predict the risk of TRS in routine clinical practice.
Method
We used data from two UK-based FEP cohorts (GAP and AESOP-10) to develop and internally validate a prognostic model that supports identification of patients at high-risk of TRS soon after FEP diagnosis. Using sociodemographic and clinical predictors, a model for predicting risk of TRS was developed based on penalised logistic regression, with missing data handled using multiple imputation. Internal validation was undertaken via bootstrapping, obtaining optimism-adjusted estimates of the model's performance. Interviews and focus groups with clinicians were conducted to establish clinically relevant risk thresholds and understand the acceptability and perceived utility of the model.
Results
We included seven factors in the prediction model that are predominantly assessed in clinical practice in patients with FEP. The model predicted treatment resistance among the 1081 patients with reasonable accuracy; the model's C-statistic was 0.727 (95% CI 0.723–0.732) prior to shrinkage and 0.687 after adjustment for optimism. Calibration was good (expected/observed ratio: 0.999; calibration-in-the-large: 0.000584) after adjustment for optimism.
Conclusions
We developed and internally validated a prediction model with reasonably good predictive metrics. Clinicians, patients and carers were involved in the development process. External validation of the tool is needed followed by co-design methodology to support implementation in early intervention services.
Dickite and kaolinite are polymorphs of Al4(Si4O10)(OH)8. Dickite traditionally is regarded as hydrothermal, based on field and laboratory evidence. Dickite and kaolinite occur in cavities in phylloid algal limestones, in interstices of biocalcarenites and sandstones, and along joints, fractures, and stylolites, in Pennsylvanian rocks exposed throughout 9600 square miles of southeastern Kansas. The stratigraphic interval of approximately 1100 ft extends from the Fort Scott Limestone (Desmoinesian) through the Lecompton Limestone (Virgilian). The best crystallized dickites are found in porous algal limestones as pockets of glistening white powder composed of well developed pseudohexagonal plates up to 40 μ across. Very well crystallized kaolinites occur similarly, except the crystals are much smaller. Less well crystallized dickites and b-axis disordered kaolinites occur in less porous rocks. Variations in crystal size and morphological development are genetically significant.
Dickite-kaolinite distribution is related to: (1) stratigraphic alternation of limestones and impervious shales; (2) gentle, westward regional dip; (3) thick, mound-like buildups of highly porous algal limestones, miles in length and width; (4) igneous intrusions (early Tertiary?) in Woodson and Wilson counties. Dickite is confined to an elliptical area 125 miles long northeast-southwest, extending 60 miles eastward from the intrusions. Dickite is associated preferentially with porous algal mounds. Kaolinite occurs in less porous rocks within the dickite area, and also is abundant well beyond. Heated groundwaters, possibly mixed with magmatic waters, moved readily up-dip and along strike outward from the intrusions through the conduit-like algal mounds; dickite was deposited from such solutions. Where water movement was restricted or where water had travelled tens of miles from the intrusions, water temperature fell below the limit for dickite crystallization, and kaolinite precipitated instead. Kansas dickite, unlike most other reported dickites, formed in rocks that were neither deeply buried nor extensively altered hydrothermally.
Previous studies by Electron Spin Resonance (ESR) have established the substitution of Fe3+ and Mg2+ in the kaolinite structure. It is shown that Fe2+ can substitute in kaolinite and stabilize defects which are detectable by ESR in a manner identical to Mg2+. The development of methods of preparing a synthetic kaolinite doped with Fe2+ is described in detail. It is shown that the main ESR signals, which occur at g = 2.0 in natural kaolinites and which previously have been interpreted in terms of iron and magnesium, can be attributed to iron alone.
Aortopathy in Turner syndrome is associated with aortic dilation, and the risk of dissection is increased when the aortic size index is ≥ 2–2.5 cm/m2. We evaluated the aortic biophysical properties in paediatric Turner syndrome using cardiac MRI to determine their relationship to aortic size index.
Methods:
Turner syndrome patients underwent cardiac MRI to evaluate ventricular function, aortic dimensions, and biophysical properties (aortic stiffness index, compliance, distensibility, pulse wave velocity, and aortic and left ventricular elastance). Spearman correlation examined correlations between these properties and aortic size index. Data was compared to 10 controls.
Results:
Of 25 Turner syndrome patients, median age 14.7 years (interquartile range: 11.0–16.8), height z score −2.7 (interquartile range: −2.92 – −1.54), 24% had a bicuspid aortic valve. Turner syndrome had increased diastolic blood pressure (p < 0.001) and decreased left ventricular end-diastolic (p < 0.001) and end-systolic (p = 0.002) volumes compared to controls. Median aortic size index was 1.81 cm/m2 (interquartile range: 1.45–2.1) and 7 had an aortic size index > 2 cm/m2. Aortic and left ventricular elastance were greater in Turner syndrome compared to controls (both p < 0.001). Increased aortic size index correlated with increased aortic elastance (r = 0.5, p = 0.01) and left ventricular elastance (r = 0.59, p = 0.002) but not aortic compliance. Higher ascending aortic areas were associated with increased aortic compliance (r = 0.44, p = 0.03) and left ventricular elastance (r = 0.49, p = 0.01).
Conclusion:
Paediatric Turner syndrome with similar aortic size index to controls showed MRI evidence of abnormal aortic biophysical properties. These findings point to an underlying aortopathy and provide additional parameters that may aid in determining risk factors for aortic dissection.
NASA’s all-sky survey mission, the Transiting Exoplanet Survey Satellite (TESS), is specifically engineered to detect exoplanets that transit bright stars. Thus far, TESS has successfully identified approximately 400 transiting exoplanets, in addition to roughly 6 000 candidate exoplanets pending confirmation. In this study, we present the results of our ongoing project, the Validation of Transiting Exoplanets using Statistical Tools (VaTEST). Our dedicated effort is focused on the confirmation and characterisation of new exoplanets through the application of statistical validation tools. Through a combination of ground-based telescope data, high-resolution imaging, and the utilisation of the statistical validation tool known as TRICERATOPS, we have successfully discovered eight potential super-Earths. These planets bear the designations: TOI-238b (1.61$^{+0.09} _{-0.10}$ R$_\oplus$), TOI-771b (1.42$^{+0.11} _{-0.09}$ R$_\oplus$), TOI-871b (1.66$^{+0.11} _{-0.11}$ R$_\oplus$), TOI-1467b (1.83$^{+0.16} _{-0.15}$ R$_\oplus$), TOI-1739b (1.69$^{+0.10} _{-0.08}$ R$_\oplus$), TOI-2068b (1.82$^{+0.16} _{-0.15}$ R$_\oplus$), TOI-4559b (1.42$^{+0.13} _{-0.11}$ R$_\oplus$), and TOI-5799b (1.62$^{+0.19} _{-0.13}$ R$_\oplus$). Among all these planets, six of them fall within the region known as ‘keystone planets’, which makes them particularly interesting for study. Based on the location of TOI-771b and TOI-4559b below the radius valley we characterised them as likely super-Earths, though radial velocity mass measurements for these planets will provide more details about their characterisation. It is noteworthy that planets within the size range investigated herein are absent from our own solar system, making their study crucial for gaining insights into the evolutionary stages between Earth and Neptune.
Increasing emphasis on the use of real-world evidence (RWE) to support clinical policy and regulatory decision-making has led to a proliferation of guidance, advice, and frameworks from regulatory agencies, academia, professional societies, and industry. A broad spectrum of studies use real-world data (RWD) to produce RWE, ranging from randomized trials with outcomes assessed using RWD to fully observational studies. Yet, many proposals for generating RWE lack sufficient detail, and many analyses of RWD suffer from implausible assumptions, other methodological flaws, or inappropriate interpretations. The Causal Roadmap is an explicit, itemized, iterative process that guides investigators to prespecify study design and analysis plans; it addresses a wide range of guidance within a single framework. By supporting the transparent evaluation of causal assumptions and facilitating objective comparisons of design and analysis choices based on prespecified criteria, the Roadmap can help investigators to evaluate the quality of evidence that a given study is likely to produce, specify a study to generate high-quality RWE, and communicate effectively with regulatory agencies and other stakeholders. This paper aims to disseminate and extend the Causal Roadmap framework for use by clinical and translational researchers; three companion papers demonstrate applications of the Causal Roadmap for specific use cases.
The Covid 19 pandemic has worsened mental health of teenagers and young adults in particular and highlighted the lack of data for children aged 3 -11 years living in France. To fill this gap, Santé publique France, the national public health agency set up the first nationwide study, Enabee, in 2022.
Objectives
Enabee (National study on Children wellbeing) aims at monitoring wellbeing and most frequent mental health disorders of children and at understanding associated factors, gathering information from children, parents and teachers. First analyses will be focused on children’ and teachers’ point of view.
Methods
Enabee is a nationwide cross sectional study. Elementary and nursery schools were randomly selected in Metropolitan France. Then a maximum of four classes were randomly selected in each school. Elementary school children (from 6 to 11 years old) gave their own assessment of wellbeing and mental health using the following self-administrated questionnaires on tablets: the Kindl and the Dominique Interactive. To get a comprehensive evaluation, parents and teachers also filled the web-administrated Strengths and Difficulties Questionnaire for each child. The parents’ questionnaire also included questions on child’s life habits and global health, parenting attitudes, parent’s mental health, covid 19, major life events and household social situation. A pilot study was launched in January to assess the feasibility and the acceptance before implementing the study at a nationwide level. Key stakeholders of education, family and health participated at the setting up of the study.
Results
706 schools were selected and 399 participated (participation rate 57%). Data were collected from May 2nd to July 31st 2022. In those schools, 1357 classes participated, representing 29 414 children. We collected 15 206 questionnaires filled by children of elementary schools and 21 016 questionnaires filled by teachers for children in nursery and elementary schools. Analysis are ongoing. By March 2023, we will produce weighted estimates of prevalence of children internal and externals disorders based on the children self-assessment and the teachers’ assessment respectively and different dimensions of wellbeing. Prevalences will be presented by sex, age and school levels.
Conclusions
Enabee will provide a representative picture of French children wellbeing and mental health and protective and risks factors. This milestone is essential to guide national policies and build dedicated actions for children in order to promote and improve their wellbeing and mental health. Beyond this edition, Enabee is the first step of a long term monitoring system that will provide regularly updated data and will be completed by ancillary and ad hoc studies.
Relatedness within groups is influenced by the mating patterns of founders: the more parents that contribute to a group, the lower the relatedness of their offspring. Xylocopa virginica (Hymenoptera: Apidae) is a facultatively social bee in which low relatedness is influenced by sequential maternity. We investigated whether multiple paternity, which would occur if egg-laying females mate multiple times, might also contribute to low relatedness among female nestmates. We used two approaches to investigate how frequently females mate polyandrously. First, we used visual observations of mating behaviour to estimate mating frequencies and to evaluate evidence for temporal variation in female receptivity to mates. Second, we used a data set of microsatellite genotypes to evaluate evidence for multiple paternity based on inferred proportions of full and half sisters. Based on visual observations, we inferred a female mating frequency of 1.1 (harmonic mean). Females were more receptive early in their first nestmate provisioning phase and less receptive in their second brood provisioning phase. Based on microsatellite genotypes analysed with COLONY software, we inferred that 5–44% of female sibships included maternal half sisters, implying female mating frequencies between 1.13 and 1.41 (harmonic means). Thus, multiple mating contributes to the low group relatedness found in Xylocopa virginica.
Rabies virus (RABV) is a deadly zoonosis that circulates in wild carnivore populations in North America. Intensive management within the USA and Canada has been conducted to control the spread of the raccoon (Procyon lotor) variant of RABV and work towards elimination. We examined RABV occurrence across the northeastern USA and southeastern Québec, Canada during 2008–2018 using a multi-method, dynamic occupancy model. Using a 10 km × 10 km grid overlaid on the landscape, we examined the probability that a grid cell was occupied with RABV and relationships with management activities (oral rabies vaccination (ORV) and trap-vaccinate-release efforts), habitat, neighbour effects and temporal trends. We compared raccoon RABV detection probabilities between different surveillance samples (e.g. animals that are strange acting, road-kill, public health samples). The management of RABV through ORV was found to be the greatest driver in reducing the occurrence of rabies on the landscape. Additionally, RABV occupancy declined further with increasing duration of ORV baiting programmes. Grid cells north of ORV management were at or near elimination ($\hat{\psi }_{{\rm north}}$ = 0.00, s.e. = 0.15), managed areas had low RABV occupancy ($\hat{\psi }_{{\rm managed}}$ = 0.20, s.e. = 0.29) and enzootic areas had the highest level of RABV occupancy ($\hat{\psi }_{{\rm south}}$ = 0.83, s.e. = 0.06). These results provide evidence that past management actions have been being successful at the goals of reducing and controlling the raccoon variant of RABV. At a finer scale we also found that vaccine bait type and bait density impacted RABV occupancy. Detection probabilities varied; samples from strange acting animals and public health had the highest detection rates. Our results support the movement of the ORV zone south within the USA due to high elimination probabilities along the US border with Québec. Additional enhanced rabies surveillance is still needed to ensure elimination is maintained.
Risk of suicide-related behaviors is elevated among military personnel transitioning to civilian life. An earlier report showed that high-risk U.S. Army soldiers could be identified shortly before this transition with a machine learning model that included predictors from administrative systems, self-report surveys, and geospatial data. Based on this result, a Veterans Affairs and Army initiative was launched to evaluate a suicide-prevention intervention for high-risk transitioning soldiers. To make targeting practical, though, a streamlined model and risk calculator were needed that used only a short series of self-report survey questions.
Methods
We revised the original model in a sample of n = 8335 observations from the Study to Assess Risk and Resilience in Servicemembers-Longitudinal Study (STARRS-LS) who participated in one of three Army STARRS 2011–2014 baseline surveys while in service and in one or more subsequent panel surveys (LS1: 2016–2018, LS2: 2018–2019) after leaving service. We trained ensemble machine learning models with constrained numbers of item-level survey predictors in a 70% training sample. The outcome was self-reported post-transition suicide attempts (SA). The models were validated in the 30% test sample.
Results
Twelve-month post-transition SA prevalence was 1.0% (s.e. = 0.1). The best constrained model, with only 17 predictors, had a test sample ROC-AUC of 0.85 (s.e. = 0.03). The 10–30% of respondents with the highest predicted risk included 44.9–92.5% of 12-month SAs.
Conclusions
An accurate SA risk calculator based on a short self-report survey can target transitioning soldiers shortly before leaving service for intervention to prevent post-transition SA.
Long-term sequelae of severe acute respiratory coronavirus-2 (SARS-CoV-2) infection may include increased incidence of diabetes. Here we describe the temporal relationship between new type 2 diabetes and SARS-CoV-2 infection in a nationwide database. We found that while the proportion of newly diagnosed type 2 diabetes increased during the acute period of SARS-CoV-2 infection, the mean proportion of new diabetes cases in the 6 months post-infection was about 83% lower than the 6 months preinfection. These results underscore the need for further investigation to understand the timing of new diabetes after COVID-19, etiology, screening, and treatment strategies.
The coronavirus disease 2019 (COVID-19) pandemic highlighted the lack of agreement regarding the definition of aerosol-generating procedures and potential risk to healthcare personnel. We convened a group of Massachusetts healthcare epidemiologists to develop consensus through expert opinion in an area where broader guidance was lacking at the time.
Current psychiatric diagnoses, although heritable, have not been clearly mapped onto distinct underlying pathogenic processes. The same symptoms often occur in multiple disorders, and a substantial proportion of both genetic and environmental risk factors are shared across disorders. However, the relationship between shared symptoms and shared genetic liability is still poorly understood.
Aims
Well-characterised, cross-disorder samples are needed to investigate this matter, but few currently exist. Our aim is to develop procedures to purposely curate and aggregate genotypic and phenotypic data in psychiatric research.
Method
As part of the Cardiff MRC Mental Health Data Pathfinder initiative, we have curated and harmonised phenotypic and genetic information from 15 studies to create a new data repository, DRAGON-Data. To date, DRAGON-Data includes over 45 000 individuals: adults and children with neurodevelopmental or psychiatric diagnoses, affected probands within collected families and individuals who carry a known neurodevelopmental risk copy number variant.
Results
We have processed the available phenotype information to derive core variables that can be reliably analysed across groups. In addition, all data-sets with genotype information have undergone rigorous quality control, imputation, copy number variant calling and polygenic score generation.
Conclusions
DRAGON-Data combines genetic and non-genetic information, and is available as a resource for research across traditional psychiatric diagnostic categories. Algorithms and pipelines used for data harmonisation are currently publicly available for the scientific community, and an appropriate data-sharing protocol will be developed as part of ongoing projects (DATAMIND) in partnership with Health Data Research UK.
Excavated over two centuries ago, the Upton Lovell G2a ‘Wessex Culture’ burial has held a prominent place in research on Bronze Age Britain. In particular, was it the grave of a ‘shaman’ or a metalworker? We take a new approach to the grave goods, employing microwear analysis and scanning electron microscopy to map a history of interactions between people and materials, identifying evidence for the presence of Bronze Age gold on five artefacts, four for the first time. Advancing a new materialist approach, we identify a goldworking toolkit, linking gold, stone and copper objects within a chaîne opératoire, concluding that modern categorisations of these materials miss much of their complexity.
Metabolic dysfunction and excess accumulation of adipose tissue are detrimental side effects from breast cancer treatment. Diet and physical activity are important treatments for metabolic abnormalities, yet patient compliance can be challenging during chemotherapy treatment. Time-restricted eating (TRE) is a feasible dietary pattern where eating is restricted to 8 h/d with water-only fasting for the remaining 16 h. The purpose of this study is to evaluate the effect of a multimodal intervention consisting of TRE, healthy eating, and reduced sedentary time during chemotherapy treatment for early-stage (I–III) breast cancer on accumulation of visceral fat (primary outcome), other fat deposition locations, metabolic syndrome and cardiovascular disease risk (secondary outcomes) compared with usual care. The study will be a two-site, two-arm, parallel-group superiority randomised control trial enrolling 130 women scheduled for chemotherapy for early-stage breast cancer. The intervention will be delivered by telephone, including 30–60-minute calls with a registered dietitian who will provide instructions on TRE, education and counselling on healthy eating, and goal setting for reducing sedentary time. The comparison group will receive usual cancer and supportive care including a single group-based nutrition class and healthy eating and physical activity guidelines. MRI, blood draws and assessment of blood pressure will be performed at baseline, after chemotherapy (primary end point), and 2-year follow-up. If our intervention is successful in attenuating the effect of chemotherapy on visceral fat accumulation and cardiometabolic dysfunction, it has the potential to reduce risk of cardiometabolic disease and related mortality among breast cancer survivors.
We briefly consider the history of maser variability, and of flaring variability specifically. We consider six proposed flare generation mechanisms, and model them computationally with codes that include saturation and 3-D structure (the last mechanism is modelled in 1-D). Fits to observational light curves have been made for some sources, and we suggest that a small number of observational parameters can diagnose the flare mechanism in many cases. The strongest flares arise from mechanisms that can increase the number density of inverted molecules in addition to by geometrical effects, and in events where unsaturated quiescent masers become saturated during the flare.
We compare detailed observations of multiple H2O maser transitions around the red supergiant star VY CMa with models to constrain the physical conditions in the complex outflows. The temperature profile is consistent with a variable mass loss rate but the masers are mostly concentrated in dense clumps. High-excitation lines trace localised outflows near the star.
Food insecurity on college campuses is a major public health problem and has been documented for the last decade. Sufficient food access is a crucial social determinant of health, thus campuses across the country have implemented various programmes, systems and policies to enhance access to food which have included food pantries, campus gardens, farmers’ markets, meal share or voucher programmes, mobile food applications, campus food gleaning, food recovery efforts, meal deliveries and task force/working groups. However, little is understood about how to best address food insecurity and support students who are struggling with basic needs. The impact of food insecurity on students’ academic and social success, in addition to their overall well-being, should be investigated and prioritised at each higher education institution. This is especially true for marginalised students, such as minority or first-generation students, who are at heightened risk for food insecurity. In order to create a culture of health equity, in which most at-risk students are provided resources and opportunities to achieve optimal well-being, higher education institutions must prioritise mitigating food insecurity on the college campus. Higher education institutions could benefit from adopting comprehensive and individualised approaches to promoting food security for marginalised students in order to facilitate equal opportunity for optimal scholastic achievement among students of all socio-demographic backgrounds.