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Evolutionary psychiatry attempts to explain and examine the development and prevalence of psychiatric disorders through the lens of evolutionary and adaptationist theories. In this edited volume, leading international evolutionary scholars present a variety of Darwinian perspectives that will encourage readers to consider 'why' as well as 'how' mental disorders arise. Using insights from comparative animal evolution, ethology, anthropology, culture, philosophy and other humanities, evolutionary thinking helps us to re-evaluate psychiatric epidemiology, genetics, biochemistry and psychology. It seeks explanations for persistent heritable traits shaped by selection and other evolutionary processes, and reviews traits and disorders using phylogenetic history and insights from the neurosciences as well as the effects of the modern environment. By bridging the gap between social and biological approaches to psychiatry, and encouraging bringing the evolutionary perspective into mainstream psychiatry, this book will help to inspire new avenues of research into the causation and treatment of mental disorders.
In addition to time and place, which are inseparable from sociolinguistic variation, language may vary according to age, social class, sex or (social) gender, ethnicity, medium, style, and register. Contact between speakers often leads to change, and different patterns result according to whether this contact involves first-language (L1) or second language (L2) acquisition. Thus, ‘family tree’ aspects of language change are largely accounted for by transmission (involving L1 acquisition), whilst ‘wave model’ changes can be explained in terms of diffusion (involving L2 acquisition). Languages with a high degree of L2 contact will tend to simplify, whilst stable bilingualism or isolation will often lead to complexification. Contact may be interlinguistic or intralinguistic, sometimes resulting in complex linguistic repertoires, with up to four different levels existing simultaneously (national standard, regional standard, interdialectal koiné, local dialect). Contact may also result in code-switching, the emergence of contact vernaculars, and ‘language death’. The receptiveness of a variety to contact influence depends on the extent to which its social networks are open or closed and on the social attitudes of its speakers. Standard languages emerge through a variety of conscious and unconscious processes, and attempts may be made to give non-standard speech varieties a distinct linguistic identity through codification and the creation of literature.
Electroanatomic mapping systems are increasingly used during ablations to decrease the need for fluoroscopy and therefore radiation exposure. For left-sided arrhythmias, transseptal puncture is a common procedure performed to gain access to the left side of the heart. We aimed to demonstrate the radiation exposure associated with transseptal puncture.
Data were retrospectively collected from the Catheter Ablation with Reduction or Elimination of Fluoroscopy registry. Patients with left-sided accessory pathway-mediated tachycardia, with a structurally normal heart, who had a transseptal puncture, and were under 22 years of age were included. Those with previous ablations, concurrent diagnostic or interventional catheterisation, and missing data for fluoroscopy use or procedural outcomes were excluded. Patients with a patent foramen ovale who did not have a transseptal puncture were selected as the control group using the same criteria. Procedural outcomes were compared between the two groups.
There were 284 patients in the transseptal puncture group and 70 in the patent foramen ovale group. The transseptal puncture group had a significantly higher mean procedure time (158.8 versus 131.4 minutes, p = 0.002), rate of fluoroscopy use (38% versus 7%, p < 0.001), and mean fluoroscopy time (2.4 versus 0.6 minutes, p < 0.001). The acute success and complication rates were similar.
Performing transseptal puncture remains a common reason to utilise fluoroscopy in the era of non-fluoroscopic ablation. Better tools are needed to make non-fluoroscopic transseptal puncture more feasible.
Fluting is a technological and morphological hallmark of some of the most iconic North American Paleoindian stone points. Through decades of detailed artifact analyses and replication experiments, archaeologists have spent considerable effort reconstructing how flute removals were achieved, and they have explored possible explanations of why fluting was such an important aspect of early point technologies. However, the end of fluting has been less thoroughly researched. In southern North America, fluting is recognized as a diagnostic characteristic of Clovis points dating to approximately 13,000 cal yr BP, the earliest widespread use of fluting. One thousand years later, fluting occurs more variably in Dalton and is no longer useful as a diagnostic indicator. How did fluting change, and why did point makers eventually abandon fluting? In this article, we use traditional 2D measurements, geometric morphometric (GM) analysis of 3D models, and 2D GM of flute cross sections to compare Clovis and Dalton point flute and basal morphologies. The significant differences observed show that fluting in Clovis was highly standardized, suggesting that fluting may have functioned to improve projectile durability. Because Dalton points were used increasingly as knives and other types of tools, maximizing projectile functionality became less important. We propose that fluting in Dalton is a vestigial technological trait retained beyond its original functional usefulness.
Healthcare facilities are a well-known high-risk environment for transmission of M. tuberculosis, the etiologic agent of tuberculosis (TB) disease. However, the link between M. tuberculosis transmission in healthcare facilities and its role in the general TB epidemic is unknown. We estimated the proportion of overall TB transmission in the general population attributable to healthcare facilities.
We combined data from a prospective, population-based molecular epidemiologic study with a universal electronic medical record (EMR) covering all healthcare facilities in Botswana to identify biologically plausible transmission events occurring at the healthcare facility. Patients with M. tuberculosis isolates of the same genotype visiting the same facility concurrently were considered an overlapping event. We then used TB diagnosis and treatment data to categorize overlapping events into biologically plausible definitions. We calculated the proportion of overall TB cases in the cohort that could be attributable to healthcare facilities.
In total, 1,881 participants had TB genotypic and EMR data suitable for analysis, resulting in 46,853 clinical encounters at 338 healthcare facilities. We identified 326 unique overlapping events involving 370 individual patients; 91 (5%) had biologic plausibility for transmission occurring at a healthcare facility. A sensitivity analysis estimated that 3%–8% of transmission may be attributable to healthcare facilities.
Although effective interventions are critical in reducing individual risk for healthcare workers and patients at healthcare facilities, our findings suggest that development of targeted interventions aimed at community transmission may have a larger impact in reducing TB.
Records of abnormal fossil arthropods present important insight into how extinct forms responded to traumatic damage and developmental complications. Trilobites, bearing biomineralized dorsal exoskeletons, have arguably the most well-documented record of abnormalities spanning the Cambrian through the end-Permian. As such, new records of malformed, often injured, trilobites are occasionally identified. To further expand the documentation of abnormal specimens, we describe malformed specimens of Lyriaspis sigillum Whitehouse, 1939, Zacanthoides sp. indet., Asaphiscus wheeleri Meek, 1873, Elrathia kingii (Meek, 1870), and Ogygiocarella debuchii (Brongniart, 1822) from lower Paleozoic deposits. In considering these forms, we propose that they illustrate examples of injuries, and that the majority of these injuries reflect failed predation. We also considered the origin of injuries impacting singular segments, suggesting that these could reflect predation, self-induced damage, or intraspecific interactions during soft-shelled stages. Continued examination of lower Paleozoic trilobite injuries will further the understanding of how trilobites functioned as prey and elucidate how disparate trilobite groups recovered from failed attacks.
The Global Alzheimer’s Platform Foundation® (GAP) is a patient-centric, non-profit organization founded in 2015. GAP is dedicated to speeding the delivery of innovative therapies to persons with Alzheimer’s disease (AD) or Parkinson’s disease (PD) by reducing the duration and cost while improving the effectiveness of AD and PD clinical trials. GAP’s growing network of high-performing AD and PD sites (GAP-Net) allows sponsors to complete clinical trials on a single, optimized trial site platform. GAP-Net sites activate 30% faster than non-GAP sites by leveraging trial services including a central institutional review board. GAP-Net sites experience up to a 24% faster screening rate, higher randomization rates, and fewer low/no randomizations per site compared with sites without the support of GAP Participant Services (GPS). GAP also sponsors the Bio-Hermes trial , designed to evaluate digital and blood-based biomarkers that are projected to accelerate enrollment and lower screen fail costs in clinical trials. Finally, GAP is extending its network globally as part of its mission to accelerate and improve the effectiveness of AD and PD clinical trials.
In 2018 unpublished archaeological evidence was discovered recording a doorway and passageway concealed inside the Romanesque wall of Westminster Hall, near the south-east corner. Although commemorated by a bronze plaque in situ, their existence had largely been forgotten. Further investigations revealed an access panel in the 1951 cloakroom fittings in adjoining St Stephen’s cloister: this was located, and the space accessed, seemingly for the first time since c 1952. The many features of interest found within included the doorcase and soffits of a great doorway and iron pintles for the doors; Purbeck flagstones on the floor; complex masonry and plaster from several different eras; graffiti by masons from the nineteenth and twentieth centuries; a still-functional Osram lightbulb dating from the early 1950s; and wooden joists supporting the masonry of the ceiling. Isotope dating of the timbers produced a date of 1659, and works accounts showed that the doorway and passageway were created in 1660–1, to form a ceremonial route for the coronation of Charles ii. Further archaeological and historical investigations have enabled the authors to establish a full chronology for the changing fabric and uses of the doorway and passageway from the seventeenth to the twenty-first century, and to trace the masons who walled in the space in 1851. They have also established why the brass plaque in Westminster Hall marking the space erroneously ascribes it with Tudor origins: that ‘fake history’ was created by an over-enthusiastic late-nineteenth century Clerk of the House of Commons.
The Canadian Nosocomial Infection Surveillance Program conducted point-prevalence surveys in acute-care hospitals in 2002, 2009, and 2017 to identify trends in antimicrobial use.
Eligible inpatients were identified from a 24-hour period in February of each survey year. Patients were eligible (1) if they were admitted for ≥48 hours or (2) if they had been admitted to the hospital within a month. Chart reviews were conducted. We calculated the prevalence of antimicrobial use as follows: patients receiving ≥1 antimicrobial during survey period per number of patients surveyed × 100%.
In each survey, 28−47 hospitals participated. In 2002, 2,460 (36.5%; 95% CI, 35.3%−37.6%) of 6,747 surveyed patients received ≥1 antimicrobial. In 2009, 3,566 (40.1%, 95% CI, 39.0%−41.1%) of 8,902 patients received ≥1 antimicrobial. In 2017, 3,936 (39.6%, 95% CI, 38.7%−40.6%) of 9,929 patients received ≥1 antimicrobial. Among patients who received ≥1 antimicrobial, penicillin use increased 36.8% between 2002 and 2017, and third-generation cephalosporin use increased from 13.9% to 18.1% (P < .0001). Between 2002 and 2017, fluoroquinolone use decreased from 25.7% to 16.3% (P < .0001) and clindamycin use decreased from 25.7% to 16.3% (P < .0001) among patients who received ≥1 antimicrobial. Aminoglycoside use decreased from 8.8% to 2.4% (P < .0001) and metronidazole use decreased from 18.1% to 9.4% (P < .0001). Carbapenem use increased from 3.9% in 2002 to 6.1% in 2009 (P < .0001) and increased by 4.8% between 2009 and 2017 (P = .60).
The prevalence of antimicrobial use increased between 2002 and 2009 and then stabilized between 2009 and 2017. These data provide important information for antimicrobial stewardship programs.
Monitoring population trends is important for evaluating the effectiveness of conservation interventions. An annual aerial census of three crane species, the Grey Crowned Crane Balearica regulorum, Blue Crane Anthropoides paradiseus and Wattled Crane Bugeranus carunculatus, was performed in KwaZulu-Natal province, South Africa over the past 23 years. These crane species are listed as ‘Endangered’, ‘Vulnerable’, and ‘Vulnerable’, respectively, on the IUCN Red List. KwaZulu-Natal was chosen as a key site for monitoring as it covers an important region for cranes that has received concerted conservation effort since the 1980s. These annual surveys are conducted by Ezemvelo KwaZulu-Natal Wildlife, a provincial conservation agency, and the Endangered Wildlife Trust, a conservation non-profit organisation. We estimated crane population trends from data collected by means of standardised surveys conducted between 2003 and 2019. Results from the surveys show a steady and significant increase in the population size of all three crane species. Interventions including power line collision mitigation and engagement with landowners have been implemented in formal conservation programs to protect these cranes. Results from the annual census suggest that conservation interventions have been effective.
Monoclonal antibody therapeutics to treat coronavirus disease (COVID-19) have been authorized by the US Food and Drug Administration under Emergency Use Authorization (EUA). Many barriers exist when deploying a novel therapeutic during an ongoing pandemic, and it is critical to assess the needs of incorporating monoclonal antibody infusions into pandemic response activities. We examined the monoclonal antibody infusion site process during the COVID-19 pandemic and conducted a descriptive analysis using data from 3 sites at medical centers in the United States supported by the National Disaster Medical System. Monoclonal antibody implementation success factors included engagement with local medical providers, therapy batch preparation, placing the infusion center in proximity to emergency services, and creating procedures resilient to EUA changes. Infusion process challenges included confirming patient severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity, strained staff, scheduling, and pharmacy coordination. Infusion sites are effective when integrated into pre-existing pandemic response ecosystems and can be implemented with limited staff and physical resources.
Patients with CHD can be exposed to high levels of cumulative ionising radiation. Utilisation of electroanatomic mapping during catheter ablation leads to reduced radiation exposure in the general population but has not been well studied in patients with CHD. This study evaluated the radiation sparing benefit of using three-dimensional mapping in patients with CHD.
Data were retrospectively collected from the Catheter Ablation with Reduction or Elimination of Fluoroscopy multi-institutional registry. Patients with CHD were selected. Those with previous ablations, concurrent diagnostic or interventional catheterisation and unknown arrhythmogenic foci were excluded. The control cohort was matched for operating physician, arrhythmia mechanism, arrhythmia location, weight and age. The procedure time, rate of fluoroscopy use, fluoroscopy time, procedural success, complications, and distribution of procedures per year were compared between the two groups.
Fifty-six patients with congenital heart disease and 56 matched patients without CHD were included. The mean total procedure time was significantly higher in patients with CHD (212.6 versus 169.5 minutes, p = 0.003). Their median total fluoroscopy time was 4.4 minutes (compared to 1.8 minutes), and their rate of fluoroscopy use was 23% (compared to 13%). The acute success and minor complication rates were similar and no major complications occurred.
With the use of electroanatomic mapping during catheter ablation, fluoroscopy use can be reduced in patients with CHD. The majority of patients with CHD received zero fluoroscopy.
To describe outcomes of acute coronavirus disease 2019 in paediatric and young adult patients with underlying cardiac disease and evaluate the association between cardiac risk factors and hospitalisation.
We conducted a retrospective single-institution review of patients with known cardiac disease and positive severe acute respiratory syndrome coronavirus 2 RT-PCR from 1 March, 2020 to 30 November, 2020. Extracardiac comorbidities and cardiac risk factors were compared between those admitted for coronavirus disease 2019 illness and the rest of the cohort using univariate analysis.
Forty-two patients with a mean age of 7.7 ± 6.7 years were identified. Six were 18 years of age or more with the oldest being 22 years of age. Seventy-six percent were Hispanic. The most common cardiac diagnoses were repaired cyanotic (n = 7, 16.6%) and palliated single ventricle (n = 7, 16.6%) congenital heart disease. Fourteen patients (33.3%) had underlying syndromes or chromosomal anomalies, nine (21%) had chronic pulmonary disease and eight (19%) were immunosuppressed. Nineteen patients (47.6%) reported no symptoms. Sixteen (38.1%) reported only mild symptoms. Six patients (14.3%) were admitted to the hospital for acute coronavirus disease 2019 illness. Noncardiac comorbidities were associated with an increased risk of hospitalisation (p = 0.02), particularly chronic pulmonary disease (p = 0.01) and baseline supplemental oxygen requirement (p = 0.007). None of the single ventricle patients who tested positive required admission.
Hospitalisations for coronavirus disease 2019 were rare among children and young adults with underlying cardiac disease. Extracardiac comorbidities like pulmonary disease were associated with increased risk of hospitalisation while cardiac risk factors were not.
The effects of overdispersion and zero inflation (e.g., poor model fits) can result in misinterpretation in studies using count data. These effects have not been evaluated in paleoecological studies of predation and are further complicated by preservational bias and time averaging. We develop a hierarchical Bayesian framework to account for uncertainty from overdispersion and zero inflation in estimates of specimen and predation trace counts. We demonstrate its application using published data on drilling predators and their prey in time-averaged death assemblages from the Great Barrier Reef, Australia.
Our results indicate that estimates of predation frequencies are underestimated when zero inflation is not considered, and this effect is likely compounded by removal of individuals and predation traces via preservational bias. Time averaging likely reduces zero inflation via accumulation of rare taxa and events; however, it increases the uncertainty in comparisons between assemblages by introducing variability in sampling effort. That is, there is an analytical cost with time-averaged count data, manifesting as broader confidence regions. Ecological inferences in paleoecology can be strengthened by accounting for the uncertainty inherent to paleoecological count data and the sampling processes by which they are generated.
Public representations of long-term residential care (LTRC) facilities have received limited focus in Canada, although literature from other countries indicates that public perceptions of LTRC tend to be negative, particularly in contexts that prioritize aging and dying in place. Using Manitoba as the study context, we investigate a question of broad relevance to the Canadian perspective; specifically, what are current public perceptions of the role and function of long-term care in the context of a changing health care system? Through critical discourse analysis, we identify four overarching discourses dominating public perceptions of LTRC: the problem of public aging, LTRC as an imperfect solution to the problem, LTRC as ambiguous social spaces, and LTRC as a last resort option. Building on prior theoretical work, we suggest that public perceptions of LTRC are informed by neoliberal discourses that privilege individual responsibility and problematize public care.