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Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.
To examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.
Genome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.
Earlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.
AAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.
The implementation of mandatory influenza vaccination policies among healthcare personnel (HCP) is controversial. Thus, we examined the affect of mandatory influenza vaccination policies among HCP working in outpatient settings.
Four Veterans’ Affairs (VA) health systems and three non-VA medical centers.
We analyzed rates of influenza and other viral causes of respiratory infections among HCP working in outpatient sites at 4 VA health systems without mandatory influenza vaccination policies and 3 non-VA health systems with mandatory influenza vaccination policies.
Influenza vaccination was associated with a decreased risk of influenza (odds ratio, 0.17; 95% confidence interval [CI], 0.13–0.22) but an increased risk of other respiratory viral infections (incidence rate ratio, 1.26; 95% CI, 1.02–1.57).
Our fitted regression models suggest that if influenza vaccination rates in clinics where vaccination was not mandated had equalled those where vaccine was mandated, HCP influenza infections would have been reduced by 52.1% (95% CI, 51.3%–53.0%). These observations, their possible causes, and additional strategies to reduce influenza and other viral respiratory illnesses among HCP working in ambulatory clinics warrant further investigation.
Evaluation of QOL, stress and coping strategies of people with psychiatric disorders after a one-year training course for social and occupational reintegration.
The main elements of the study focused on the SVF 120 (Stress Processing Questionnaire) and PLC (Quality of Life with Chronic Disease questionnaire).
In total a number of 20 people were enrolled in the study. Mean age of the participants was 33.4 years. The reintegration programme showed a retention rate of 100%. The PLC questionnaire showed no statistically significant results (p>0.050). The SVF 120 showed a slightly better score after one year regarding social encapsulating (p= 0.056) and trivializing (p = 0.021). After the one-year training course 60% of the participants could be reintegrated in an occupational activity and 40% could achieve a better social status.
Our results showed that participant of the programme used stress coping strategies morte than before the course. Reintegration data make clear that training courses of people with psychiatric disorders can achieve valuable results.
A relatively small proportion of patients account for a disproportionate share of healthcare utilization and cost with, on average, 1% of patients responsible for 20-25% of cost, 5% of patients for 40% and 10% for two thirds. These “high-utilizers” frequently suffer from co-morbid medical and psychiatric illnesses, but they are not well characterized in terms of diagnoses, current treatment patterns, or long-term outcomes. We sought to characterize further such patients at a large inner city acute care hospital.
We applied a validated tool, Patients At Risk for Re-hospitalization, to the entire hospital population and then performed a mixed methods (quantitative/qualitative) study of 100 patients judged to be at high risk (>67%) of re-hospitalization during the ensuing year.
Of over 130,000 patients, 6,000 were identified. These individuals were overwhelmingly non-elderly adults (96% ages 18-64). Most common medical diagnoses were hypertension (49%), asthma (41%), diabetes (33%), and HIV/AIDS (32%). Schizophrenia, bipolar illness, or other psychosis was found in 48%. Over two-thirds had substance abuse diagnoses. Although 56% had made at least one emergency department visit in the past two years, only 37% had seen a primary care provider. Patient interviews revealed high rates of unstable housing, social isolation, and failure to appreciate the severity of health problems.
High utilizers of general health care have very high rates of serious mental illness and substance abuse. Interviews suggest need for improved medical/psychiatric coordination with community outreach. Although such interventions are resource intense, the economic and health benefits may be large.
To determine the effect of mandatory and nonmandatory influenza vaccination policies on vaccination rates and symptomatic absenteeism among healthcare personnel (HCP).
Retrospective observational cohort study.
This study took place at 3 university medical centers with mandatory influenza vaccination policies and 4 Veterans Affairs (VA) healthcare systems with nonmandatory influenza vaccination policies.
The study included 2,304 outpatient HCP at mandatory vaccination sites and 1,759 outpatient HCP at nonmandatory vaccination sites.
To determine the incidence and duration of absenteeism in outpatient settings, HCP participating in the Respiratory Protection Effectiveness Clinical Trial at both mandatory and nonmandatory vaccination sites over 3 viral respiratory illness (VRI) seasons (2012–2015) reported their influenza vaccination status and symptomatic days absent from work weekly throughout a 12-week period during the peak VRI season each year. The adjusted effects of vaccination and other modulating factors on absenteeism rates were estimated using multivariable regression models.
The proportion of participants who received influenza vaccination was lower each year at nonmandatory than at mandatory vaccination sites (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.07–0.11). Among HCP who reported at least 1 sick day, vaccinated HCP had lower symptomatic days absent compared to unvaccinated HCP (OR for 2012–2013 and 2013–2014, 0.82; 95% CI, 0.72–0.93; OR for 2014–2015, 0.81; 95% CI, 0.69–0.95).
These data suggest that mandatory HCP influenza vaccination policies increase influenza vaccination rates and that HCP symptomatic absenteeism diminishes as rates of influenza vaccination increase. These findings should be considered in formulating HCP influenza vaccination policies.
Expensive and time-consuming preparation procedures for radiocarbon and stable isotope analyses can be conducted on archaeological bone samples even if no collagen is preserved. Such unsuccessful preparation can lead to the partial destruction of valuable archaeological material. Establishing a rapid prescreening method for evaluating the amount of bone collagen while minimizing the impact of sampling constitutes a challenge for the preservation of archaeological collections. This study proposes and discusses a new methodology to detect and quantify collagen content in archaeological bone samples by attenuated total reflection Fourier transform infrared (ATR-FTIR) spectroscopy. A total of 42 Pleistocene to modern bone samples were selected according to their nitrogen content measured using an elemental analyzer. Comparison of collagen content estimation using ATR-FTIR and mass spectrometry reveals that some of the studied samples are contaminated by a nitrogen source coming from the burial environment. Two different FTIR calibration approaches were tested on the uncontaminated samples: peak-to-peak ratio and multivariate regression (PLS). The two approaches yield similar results with a good correlation of ATR-FTIR analyses and N wt% from 0.7 to 4wt% (R²=0.97–0.99; standard error of estimation ±0.22 to 0.25wt%). While collagen content remains difficult to detect in poorly preserved bones (less than ~3wt%), ATR-FTIR analysis can be a fast alternative for sample screening to optimize the sampling strategy and avoid partial destruction of valuable samples that do not contain enough collagen for further analysis.
Two genera of tylosaurine mosasaurs, Tylosaurus and Hainosaurus, are recorded for the first time from Germany. Tylosaurus sp. is represented by two isolated tooth crowns, originally described as Mosasaurus? alseni (here considered a nomen dubium) from the latest Santonian–Early Campanian, which are very similar to T. ivoensis and T. gaudryi. The material of Hainosaurus sp. comprises a maxillary with associated postorbitofrontal, two pterygoid teeth and several indeterminate cranial fragments. The specimen from the Late Campanian is slightly less derived than H. bernardi from the Maastrichtian in retaining labiolingually less compressed anterior maxillary teeth and unserrated pterygoid teeth with only very weak carinae. Despite only minor skeletal differences, the genus Hainosaurus is considered to be distinct from Tylosaurus because of its significant modification of the dental apparatus compared to the plesiomorphic condition in the latter. This dental morphology suggests a phylogenetic trend from a generalised-piercing marginal dentition in Tylosaurus towards the increasingly labiolingually compressed, symmetrical, strongly bicarinate cutting marginal teeth in Hainosaurus spp. from the Early through Late Campanian and Maastrichtian. A similar trend is also present in pterygoid teeth with very indistinct unserrated carinae in the Campanian Hainosaurus sp. towards serrated ones in the Maastrichtian H. bernardi. A short review indicates the presence of Hainosaurus in northern, central and western Europe (Sweden to Spain) since the Early Campanian, and the occurrence of Tylosaurus spp. in the same area until the Late Campanian. Hainosaurus persisted until the end of the Maastrichtian; outside Europe it may have been present in the Late Campanian of the USA and the Maastrichtian of the Democratic Republic of Congo. Judging from a simple, uni- to bicarinate, stoutly conical tooth morphology in aigialosaurs and very basal mosasaurs as well as phylogenetic patterns, the development of blade-like cutting tooth crowns appears to have been convergent in several clades of large-bodied Campanian–Maastrichtian mosasaurids. These include both mosasaurines ('Leiodon' mosasauroides, Prognathodon? sectorius, Prognathodon? kianda, Eremiasaurus heterodontus) and tylosaurines (Hainosaurus spp.).
We studied methicillin-resistant Staphylococcus aureus (MRSA)-colonized children with multiple intensive care unit (ICU) admissions to assess the persistence of MRSA colonization. Our data found that children with more than 1 year between ICU admissions had a higher prevalence of MRSA colonization than the overall ICU population, which supports empirical contact precautions for children with previous MRSA colonization.
As evidenced by many of the chapters in this volume, robust research is emerging that explores the role of video games and virtual worlds in young people’s learning. However, far fewer studies have looked at the role of culture and community in relation to learning not only within these virtual spaces but also in the fan communities that surround them. Moreover, there are even fewer, if any, studies that explore these topics in the context of virtual worlds for very young children. This chapter addresses this gap through a focus on culture and community within and surrounding Webkinz World (WW), a virtual environment designed for children between the ages of six and thirteen.
While video games such as World of Warcraft and virtual worlds such as Second Life that target adolescents and adults have been popular for years, online environments aimed at preteen populations (between the ages of six and twelve) are a relatively new phenomenon. Recently, there has been a marked increase in the development of such spaces, with Webkinz World (www.webkinz.com), Club Penguin (www.clubpenguin.com), Neopets (www.neopets.com), and Barbie Girls (www.barbiegirls.com) among the most popular. These sites garner a significant number of monthly visitors, with Webkinz World attracting approximately twenty-eight million monthly visits in June 2009, Club Penguin and Neopets boasting approximately ten and ten and a half million, respectively, and Barbie Girls attracting nearly eight hundred and fifty thousand (Compete, Inc., 2009). Despite the rampant popularity of such sites, we know very little about children’s activities in these spaces at present.
It is clinically important to understand the factors that increase the likelihood of the frequent and recurrent suicide attempts seen in those with borderline personality disorder (BPD). Although several studies have examined this subject in a cross-sectional manner, the aim of this study was to determine the most clinically relevant baseline and time-varying predictors of suicide attempts over 16 years of prospective follow-up among patients with BPD.
Two-hundred and ninety in-patients meeting Revised Diagnostic Interview for Borderlines (DIB-R) and DSM-III-R criteria for BPD were assessed during their index admission using a series of semistructured interviews and self-report measures. These subjects were then reassessed using the same instruments every 2 years. The generalized estimating equations (GEE) approach was used to model the odds of suicide attempts in longitudinal analyses, controlling for assessment period, yielding an odds ratio (OR) and 95% confidence interval (CI) for each predictor.
Nineteen variables were found to be significant bivariate predictors of suicide attempts. Eight of these, seven of which were time-varying, remained significant in multivariate analyses: diagnosis of major depressive disorder (MDD), substance use disorder (SUD), post-traumatic stress disorder (PTSD), presence of self-harm, adult sexual assault, having a caretaker who has completed suicide, affective instability, and more severe dissociation.
The results of this study suggest that prediction of suicide attempts among borderline patients is complex, involving co-occurring disorders, co-occurring symptoms of BPD (self-harm, affective reactivity and dissociation), adult adversity, and a family history of completed suicide.
Foot-and-mouth disease (FMD) is one of the most serious transboundary, contagious viral diseases of cloven-hoofed livestock, because it can spread rapidly with high morbidity rates when introduced into disease-free herds or areas. Epidemiological simulation modeling can be developed to study the hypothetical spread of FMD and to evaluate potential disease control strategies that can be implemented to decrease the impact of an outbreak or to eradicate the virus from an area. Spatial analysis, a study of the distributions of events in space, can be applied to an area to investigate the spread of animal disease. Hypothetical FMD outbreaks can be spatially analyzed to evaluate the effect of the event under different control strategies. The main objective of this paper is to review FMD-related articles on FMD epidemiology, epidemiological simulation modeling and spatial analysis with the focus on disease control. This review will contribute to the development of models used to simulate FMD outbreaks under various control strategies, and to the application of spatial analysis to assess the outcome of FMD spread and its control.
Show how detailed incubation period estimates can be used to identify and investigate potential healthcare-associated infections and dangerous diseases.
We used the incubation period of 9 respiratory viruses to derive decision rules for distinguishing between community- and hospital-acquired infection. We developed a method, implemented in a simple spreadsheet, that can be used to investigate the exposure history of an individual patient and more specifically to identify the probable time and location of infection. Illustrative examples are used to explain and evaluate this technique.
If the risks of hospital and community infection are equal, 95% of patients who develop symptoms of adenovirus infection within 5 days of hospital admission will have been infected in the community, as will 95% of patients who develop symptoms within 3 days for human-coronavirus infection, 2.5 days for severe acute respiratory syndrome, 1 day for influenza A, 0.5 day for influenza B, 12 days for measles, 2 days for parainfluenza, 4 days for respiratory syncytial virus infection, and 1.5 days for rhinovirus infection. Sources of infection suggested by analysis of the symptom onset times of individual patients are consistent with those from detailed investigations.
This work shows how a detailed understanding of the incubation period can be an effective tool for identifying the source of infection, ultimately ensuring patient safety.
The electrochemical reaction behavior of a commercial Li-ion battery (LiFePO4-based cathode, graphite-based anode) has been measured via in situ neutron diffraction. A multivariate analysis was successfully applied to the neutron diffraction data set facilitating in the determination of Li bearing phases participating in the electrochemical reaction in both the anode and cathode as a function of state-of-charge (SOC). The analysis resulted in quantified phase fraction values for LiFePO4 and FePO4 cathode compounds as well as the identification of staging behavior of Li6, Li12, Li24, and graphite phases in the anode. An additional Li-graphite phase has also been tentatively identified during electrochemical cycling as LiC48 at conditions of ∼5% to 15% SOC.