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Major depressive disorder (MDD) is the leading cause of disability worldwide. Patients with MDD have high rates of comorbidity with mental and physical conditions, one of which is chronic pain. Chronic pain conditions themselves are also associated with significant disability, and the large number of patients with MDD who have chronic pain drives high levels of disability and compounds healthcare burden. The management of depression in patients who also have chronic pain can be particularly challenging due to underlying mechanisms that are common to both conditions, and because many patients with these conditions are already taking multiple medications. For these reasons, healthcare providers may be reluctant to treat such patients. The Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines provide evidence-based recommendations for the management of MDD and comorbid psychiatric and medical conditions such as anxiety, substance use disorder, and cardiovascular disease; however, comorbid chronic pain is not addressed. In this article, we provide an overview of the pathophysiological and clinical overlap between depression and chronic pain and review evidence-based pharmacological recommendations in current treatment guidelines for MDD and for chronic pain. Based on clinical experience with MDD patients with comorbid pain, we recommend rapidly and aggressively treating depression according to CANMAT treatment guidelines, using antidepressant medications with analgesic properties, while addressing pain with first-line pharmacotherapy as treatment for depression is optimized. We review options for treating pain symptoms that remain after response to antidepressant treatment is achieved.
Substance use disorders are highly prevalent, affecting millions of Americans directly (social, occupational, and health problems) and indirectly (billions of dollars in health care costs and lost revenues due to disability). This section briefly introduces the chemical classification and neurobehavioral properties of the most commonly misused substances.
Substantial progress has been made in the standardization of nomenclature for paediatric and congenital cardiac care. In 1936, Maude Abbott published her Atlas of Congenital Cardiac Disease, which was the first formal attempt to classify congenital heart disease. The International Paediatric and Congenital Cardiac Code (IPCCC) is now utilized worldwide and has most recently become the paediatric and congenital cardiac component of the Eleventh Revision of the International Classification of Diseases (ICD-11). The most recent publication of the IPCCC was in 2017. This manuscript provides an updated 2021 version of the IPCCC.
The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD), in collaboration with the World Health Organization (WHO), developed the paediatric and congenital cardiac nomenclature that is now within the eleventh version of the International Classification of Diseases (ICD-11). This unification of IPCCC and ICD-11 is the IPCCC ICD-11 Nomenclature and is the first time that the clinical nomenclature for paediatric and congenital cardiac care and the administrative nomenclature for paediatric and congenital cardiac care are harmonized. The resultant congenital cardiac component of ICD-11 was increased from 29 congenital cardiac codes in ICD-9 and 73 congenital cardiac codes in ICD-10 to 318 codes submitted by ISNPCHD through 2018 for incorporation into ICD-11. After these 318 terms were incorporated into ICD-11 in 2018, the WHO ICD-11 team added an additional 49 terms, some of which are acceptable legacy terms from ICD-10, while others provide greater granularity than the ISNPCHD thought was originally acceptable. Thus, the total number of paediatric and congenital cardiac terms in ICD-11 is 367. In this manuscript, we describe and review the terminology, hierarchy, and definitions of the IPCCC ICD-11 Nomenclature. This article, therefore, presents a global system of nomenclature for paediatric and congenital cardiac care that unifies clinical and administrative nomenclature.
The members of ISNPCHD realize that the nomenclature published in this manuscript will continue to evolve. The version of the IPCCC that was published in 2017 has evolved and changed, and it is now replaced by this 2021 version. In the future, ISNPCHD will again publish updated versions of IPCCC, as IPCCC continues to evolve.
Although important treatment decisions are made in the Emergency Department (ED), conversations about patients’ goals and values and priorities often do not occur. There is a critical need to improve the frequency of these conversations, so that ED providers can align treatment plans with these goals, values, and priorities. The Serious Illness Conversation Guide has been used in other care settings and has been demonstrated to improve the frequency, quality, and timing of conversations, but it has not been used in the ED setting. Additionally, ED social workers, although integrated into hospital and home-based palliative care, have not been engaged in programs to advance serious illness conversations in the ED. We set out to adapt the Serious Illness Conversation Guide for use in the ED by social workers.
We undertook a four-phase process for the adaptation of the Serious Illness Conversation Guide for use in the ED by social workers. This included simulated testing exercises, pilot testing, and deployment with patients in the ED.
During each phase of the Guide's adaptation, changes were made to reflect both the environment of care (ED) and the clinicians (social workers) that would be using the Guide. A final guide is presented.
Significance of results
This report presents an adapted Serious Illness Conversation Guide for use in the ED by social workers. This Guide may provide a tool that can be used to increase the frequency and quality of serious illness conversations in the ED.
Palmer amaranth–a fast-growing, challenging-to-control noxious weed that significantly reduces crop yields—was first found in Minnesota in September 2016 in conservation plantings sown with Palmer amaranth contaminated seed mixes. Minnesota Department of Agriculture (MDA) designated Palmer amaranth as a Prohibited Noxious Weed in 2015 and listed it as a Noxious Weed Seed in 2016 by emergency order. A genetic test to identify Palmer amaranth was simultaneously developed by multiple laboratories, providing a tool to limit its spread as a contaminant in seed. Seed companies adopted genetic testing methods for labeling seed for sale, thus reducing introductions via the seed pathway. Additionally, MDA determined that manure spread on crop fields from contaminated screenings fed to livestock resulted in new infestations. Limiting spread via these and other potential pathways was critical to successfully reducing the impact of Palmer amaranth. MDA, University of Minnesota (UMN) Extension, Conservation Corps Minnesota and Iowa (CCMI), farmers, and other partners are working to eradicate these infestations before they can spread. In 2016, 35 sites were sown with Palmer amaranth–contaminated seed mixes. Palmer amaranth was found at eight (23%) of these sites. Management with intensive scouting, torching, prescribed burning, and herbicide application was implemented in 2016 and 2017. By 2018, no Palmer amaranth was found at any of these sites. Similar success to newer infestations in 2018, 2019, and 2020 was achieved using the same methods. MDA recorded management activities and documented a comprehensive timeline of Palmer amaranth in Minnesota. This timeline provides a story of success and challenges in combating and eradicating Palmer amaranth.
To examine the association between long-term intake of total and the six classes of dietary flavonoids and decline in cognitive function over a follow-up period of up to 15 years.
In this longitudinal study, we evaluated change in eight cognitive domain scores (verbal and visual memory, verbal learning, attention and concentration, abstract reasoning, language, visuoperceptual organisation and the global function) based on three neuropsychological exams and characterised the annualised change between consecutive exams. Long-term intakes of total and six flavonoid classes were assessed up to four times by a validated FFQ. Repeated-measures regression models were used to examine the longitudinal association between total and six flavonoid classes and annualised change in the eight cognitive domains.
The Framingham Heart Study (FHS), a prospective cohort study.
One thousand seven hundred and seventy-nine subjects who were free of dementia, aged ≥45 years and had attended at least two of the last three FHS Offspring cohort study exams.
Over a median follow-up of 11·8 years with 1779 participants, nominally significant trends towards a slower decline in cognitive function were observed among those with higher flavanol and flavan-3-ol intakes for global function, verbal and visual memory; higher total flavonoids and flavonoid polymers for visual memory; and higher flavanols for verbal learning.
In spite of modest nominal trends, overall, our findings do not support a clear association between higher long-term flavonoid intake and slowing age-related cognitive decline.
The first Laser-Induced Breakdown Spectroscopy (LIBS) instrument for extraterrestrial applications is part of the ChemCam instrument suite onboard the Curiosity Mars rover. ChemCam may be used in a number of operational modes depending on the science questions of interest, including active (with laser) and passive (spectrometers only) modes, and there is important synergy between ChemCam and other payload instruments. Notable discoveries made with ChemCam LIBS data include the characterization of hydrogen in rocks and soils, discovery of boron on Mars, and characterization of other trace elements (Li, F, Rb, Sr, Ba) that were previously never or rarely quantified on Mars, depth-dependent chemical trends on rock surfaces, and a much broader range of bulk-rock chemical compositions than was previously recognized, including highly evolved igneous rocks. In addition to ChemCam, another LIBS instrument is slated to fly to Mars on the Mars 2020 rover mission as part of the combined Raman-LIBS SuperCam instrument.
We present and analyze three powerful long-term historical trends in the electrification of energy by free-fuel sources. These trends point toward a future in which energy is affordable, abundant, and efficiently deployed; with major economic, geo-political, and environmental benefits to humanity.
We present and analyze three powerful long-term historical trends in energy, particularly electrical energy, as well as the opportunities and challenges associated with these trends. The first trend is from a world containing a diversity of energy currencies to one whose predominant currency is electricity, driven by electricity’s transportability, exchangeability, and steadily decreasing cost. The second trend is from electricity generated from a diversity of sources to electricity generated predominantly by free-fuel sources, driven by their steadily decreasing cost and long-term abundance. These trends necessitate a just-emerging third trend: from a grid in which electricity is transported unidirectionally, traded at near-static prices, and consumed under direct human control; to a grid in which electricity is transported bidirectionally, traded at dynamic prices, and consumed under human-tailored artificial agential control. These trends point toward a future in which energy is not costly, scarce, or inefficiently deployed but instead is affordable, abundant, and efficiently deployed; with major economic, geo-political, and environmental benefits to humanity.
Accurate weed emergence models are valuable tools for scheduling planting, cultivation, and herbicide applications. Multiple models predicting giant ragweed emergence have been developed, but none have been validated in diverse crop rotation and tillage systems, which have the potential to influence weed emergence patterns. This study evaluated the performance of published giant ragweed emergence models across various crop rotations and spring tillage dates in southern Minnesota. Across experiments, the most robust model was a mixed-effects Weibull (flexible sigmoidal function) model predicting emergence in relation to hydrothermal time accumulation with a base temperature of 4.4 C, a base soil matric potential of −2.5 MPa, and two random effects determined by overwinter growing degree days (GDD) (10 C) and precipitation accumulated during seedling recruitment. The deviations in emergence between individual plots and the fixed-effects model were distinguished by the positive association between the lower horizontal asymptote (Drop) and maximum daily soil temperature during seedling recruitment. This finding indicates that crops and management practices that increase soil temperature will have a shorter lag phase at the start of giant ragweed emergence compared with practices promoting cool soil temperatures. Thus, crops with early-season crop canopies such as perennial crops and crops planted in early spring and in narrow rows will likely have a slower progression of giant ragweed emergence. This research provides a valuable assessment of published giant ragweed emergence models and illustrates that accurate emergence models can be used to time field operations and improve giant ragweed control across diverse cropping systems.
Health nudge interventions to steer people into healthier lifestyles are increasingly applied by governments worldwide, and it is natural to look to such approaches to improve health by altering what people choose to eat. However, to produce policy recommendations that are likely to be effective, we need to be able to make valid predictions about the consequences of proposed interventions, and for this, we need a better understanding of the determinants of food choice. These determinants include dietary components (e.g. highly palatable foods and alcohol), but also diverse cultural and social pressures, cognitive-affective factors (perceived stress, health attitude, anxiety and depression), and familial, genetic and epigenetic influences on personality characteristics. In addition, our choices are influenced by an array of physiological mechanisms, including signals to the brain from the gastrointestinal tract and adipose tissue, which affect not only our hunger and satiety but also our motivation to eat particular nutrients, and the reward we experience from eating. Thus, to develop the evidence base necessary for effective policies, we need to build bridges across different levels of knowledge and understanding. This requires experimental models that can fill in the gaps in our understanding that are needed to inform policy, translational models that connect mechanistic understanding from laboratory studies to the real life human condition, and formal models that encapsulate scientific knowledge from diverse disciplines, and which embed understanding in a way that enables policy-relevant predictions to be made. Here we review recent developments in these areas.
In the midwestern United States, biotypes of giant ragweed resistant to multiple herbicide biochemical sites of action have been identified. Weeds with resistance to multiple herbicides reduce the utility of existing herbicides and necessitate the development of alternative weed control strategies. In two experiments in southeastern Minnesota, we determined the effect of six 3 yr crop-rotation systems containing corn, soybean, wheat, and alfalfa on giant ragweed seedbank depletion and emergence patterns. The six crop-rotation systems included continuous corn, soybean–corn–corn, corn–soybean–corn, soybean–wheat–corn, soybean–alfalfa–corn, and alfalfa–alfalfa–corn. The crop-rotation system had no effect on the amount of seedbank depletion when a zero-weed threshold was maintained, with an average of 96% of the giant ragweed seedbank being depleted within 2 yr. Seedbank depletion occurred primarily through seedling emergence in all crop-rotation systems. However, seedling emergence tended to account for more of the seedbank depletion in rotations containing only corn or soybean compared with rotations with wheat or alfalfa. Giant ragweed emerged early across all treatments, with on average 90% emergence occurring by June 4. Duration of emergence was slightly longer in established alfalfa compared with other cropping systems. These results indicate that corn and soybean rotations are more conducive to giant ragweed emergence than rotations including wheat and alfalfa, and that adopting a zero-weed threshold is a viable approach to depleting the weed seedbank in all crop-rotation systems.
As herbicide-resistant weed populations become increasingly problematic in crop production, alternative strategies of weed control are necessary. Giant ragweed, one of the most competitive agricultural weeds in row crops, has evolved resistance to multiple herbicide biochemical sites of action within the plant, necessitating the development of new and integrated methods of weed control. This study assessed the quantity and duration of seed retention of giant ragweed grown in soybean fields and adjacent field margins. Seed retention of giant ragweed was monitored weekly during the 2012 to 2014 harvest seasons using seed collection traps. Giant ragweed plants produced an average of 1,818 seeds per plant, with 66% being potentially viable. Giant ragweed on average began shattering hard (potentially viable) and soft (nonviable) seeds September 12 and continued through October at an average rate of 0.75 and 0.44% of total seeds per day during September and October, respectively. Giant ragweed seeds remained on the plants well into the Minnesota soybean harvest season, with an average of 80% of the total seeds being retained on October 11, when Minnesota soybean harvest was approximately 75% completed in the years of the study. These results suggest that there is a sufficient amount of time to remove escaped giant ragweed from production fields and field margins before the seeds shatter by managing weed seed dispersal before or at crop harvest. Controlling weed seed dispersal has potential to manage herbicide-resistant giant ragweed by limiting replenishment of the weed seed bank.
Two broad aims drive weed science research: improved management and improved
understanding of weed biology and ecology. In recent years, agricultural
weed research addressing these two aims has effectively split into separate
subdisciplines despite repeated calls for greater integration. Although some
excellent work is being done, agricultural weed research has developed a
very high level of repetitiveness, a preponderance of purely descriptive
studies, and has failed to clearly articulate novel hypotheses linked to
established bodies of ecological and evolutionary theory. In contrast,
invasive plant research attracts a diverse cadre of nonweed scientists using
invasions to explore broader and more integrated biological questions
grounded in theory. We propose that although studies focused on weed
management remain vitally important, agricultural weed research would
benefit from deeper theoretical justification, a broader vision, and
increased collaboration across diverse disciplines. To initiate change in
this direction, we call for more emphasis on interdisciplinary training for
weed scientists, and for focused workshops and working groups to develop
specific areas of research and promote interactions among weed scientists
and with the wider scientific community.
To examine the use of vitamin D supplements during infancy among the participants in an international infant feeding trial.
Information about vitamin D supplementation was collected through a validated FFQ at the age of 2 weeks and monthly between the ages of 1 month and 6 months.
Infants (n 2159) with a biological family member affected by type 1 diabetes and with increased human leucocyte antigen-conferred susceptibility to type 1 diabetes from twelve European countries, the USA, Canada and Australia.
Daily use of vitamin D supplements was common during the first 6 months of life in Northern and Central Europe (>80 % of the infants), with somewhat lower rates observed in Southern Europe (>60 %). In Canada, vitamin D supplementation was more common among exclusively breast-fed than other infants (e.g. 71 % v. 44 % at 6 months of age). Less than 2 % of infants in the USA and Australia received any vitamin D supplementation. Higher gestational age, older maternal age and longer maternal education were study-wide associated with greater use of vitamin D supplements.
Most of the infants received vitamin D supplements during the first 6 months of life in the European countries, whereas in Canada only half and in the USA and Australia very few were given supplementation.
During our first research in Jhakri, an exclusively Muslim village in Bijnor district (north-western Uttar Pradesh), the sterilization drive associated with the Emergency of 1975–77 was a recent memory. Our field-notes, then and subsequently, have repeatedly registered the conviction that using contraceptive techniques, especially sterilization [nasbandī or ‘tube closing’], is contrary to Islam. Recent surveys elsewhere in India indicate that 9 per cent of currently-married Muslim women—but only 1 per cent of Hindu and Christian women—say that their main reason for not intending to use contraception is because it is ‘against their religion’. For Bhat and Zavier (2005: 400), these figures reflect Muslims' slavish obedience to ignorant mullahs and account for most of the differences in contraceptive use between members of the three communities. Islamic doctrines are widely presumed to be central to Muslims' everyday lives. Superficially, Jhakri residents might seem to endorse this rarely examined or substantiated assumption, but leaving matters there would fall far short of adequately accounting for their fertility behaviour.
First we outline how several aspects of Muslim reformers' agendas might seem consistent with fertility limitation, yet the historical record provides no clear impression of their views on contraception. Further, the idea that Muslims slavishly follow a monolithic ‘Islamic doctrine’ ignores the contested and shifting understandings of contraception yielded by the same authoritative Islamic sources.