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In response to advancing clinical practice guidelines regarding concussion management, service members, like athletes, complete a baseline assessment prior to participating in high-risk activities. While several studies have established test stability in athletes, no investigation to date has examined the stability of baseline assessment scores in military cadets. The objective of this study was to assess the test–retest reliability of a baseline concussion test battery in cadets at U.S. Service Academies.
All cadets participating in the Concussion Assessment, Research, and Education (CARE) Consortium investigation completed a standard baseline battery that included memory, balance, symptom, and neurocognitive assessments. Annual baseline testing was completed during the first 3 years of the study. A two-way mixed-model analysis of variance (intraclass correlation coefficent (ICC)3,1) and Kappa statistics were used to assess the stability of the metrics at 1-year and 2-year time intervals.
ICC values for the 1-year test interval ranged from 0.28 to 0.67 and from 0.15 to 0.57 for the 2-year interval. Kappa values ranged from 0.16 to 0.21 for the 1-year interval and from 0.29 to 0.31 for the 2-year test interval. Across all measures, the observed effects were small, ranging from 0.01 to 0.44.
This investigation noted less than optimal reliability for the most common concussion baseline assessments. While none of the assessments met or exceeded the accepted clinical threshold, the effect sizes were relatively small suggesting an overlap in performance from year-to-year. As such, baseline assessments beyond the initial evaluation in cadets are not essential but could aid concussion diagnosis.
Evidence from high-income countries suggests that childhood trauma is associated with schizophrenia. Studies of childhood trauma and schizophrenia in low and middle income (LMIC) countries are limited. This study examined the prevalence of childhood traumatic experiences among cases and controls and the relationship between specific and cumulative childhood traumatic experiences and schizophrenia in a sample in South Africa.
Data were from the Genomics of Schizophrenia in the South African Xhosa people study. Cases with schizophrenia and matched controls were recruited from provincial hospitals and clinics in the Western and Eastern Cape regions in South Africa. Childhood traumatic experiences were measured using the Childhood Trauma Questionnaire (CTQ). Adjusted logistic regression models estimated associations between individual and cumulative childhood traumatic experiences and schizophrenia.
Traumatic experiences were more prevalent among cases than controls. The odds of schizophrenia were 2.44 times higher among those who experienced any trauma than those who reported no traumatic experiences (95% CI 1.77–3.37). The odds of schizophrenia were elevated among those who experienced physical/emotional abuse (OR 1.59, CI 1.28–1.97), neglect (OR 1.39, CI 1.16–1.68), and sexual abuse (OR 1.22, CI 1.03–1.45) compared to those who did not. Cumulative physical/emotional abuse and neglect experiences increased the odds of schizophrenia as a dose–response relationship.
Childhood trauma is common in this population. Among many other benefits, interventions to prevent childhood trauma may contribute to a decreasing occurrence of schizophrenia.
Candida auris (CA) is an emerging multidrug-resistant pathogen associated with increased mortality. The environment may play a role, but transmission dynamics remain poorly understood. We sought to limit environmental and patient CA contamination following a sustained unsuspected exposure.
A 528-bed teaching hospital.
The index case patient and 17 collocated ward mates.
Immediately after confirmation of CA in the bloodstream and urine of a patient admitted 6 days previously, active surveillance, enhanced transmission-based precautions, environmental cleaning with peracetic acid-hydrogen peroxide and ultraviolet light, and patient relocation were undertaken. Pre-existing agreements and foundational relationships among internal multidisciplinary teams and external partners were leveraged to bolster detection and mitigation efforts and to provide genomic epidemiology.
Candida auris was isolated from 3 of 132 surface samples on days 8, 9, and 15 of ward occupancy, and from no patient samples (0 of 48). Environmental and patient isolates were genetically identical (4–8 single-nucleotide polymorphisms [SNPs]) and most closely related to the 2013 India CA-6684 strain (~200 SNPs), supporting the epidemiological hypothesis that the source of environmental contamination was the index case patient, who probably acquired the South Asian strain from another New York hospital. All isolates contained a mutation associated with azole resistance (K163R) found in the India 2105 VPCI strain but not in CA-6684. The index patient remained colonized until death. No surfaces were CA-positive 1 month later.
Compared to previous descriptions, CA dissemination was minimal. Immediate access to rapid CA diagnostics facilitates early containment strategies and outbreak investigations.
In this qualitative study, we explored the perspectives of 10 adolescents with a diagnosis of autism spectrum disorder (ASD) and their experiences of bullying. Through individual semistructured interviews, they were asked to describe their understandings and experiences of bullying. Details of their experiences are described as well as the perceived impact on the students and their schooling. Data analysis revealed a number of common experiences including high rates of traditional bullying and more specifically verbal bullying, with fewer incidents of cyberbullying reported. In support of literature in the area, the results of the study indicate that bullying can be a significant inhibitor, which may prevent students with ASD from taking full advantage of their schooling. Listening to and reflecting on the voices and personal stories of adolescent students with ASD is critically important for developing more supportive approaches to their education and needs. The reports of bullying by students on the autism spectrum emphasises the need for more effective interventions and management strategies to be implemented in a whole-school approach as well as targeted strategies to prevent bullying experiences for this particular population of students.
Interventions that prevent healthcare-associated infection should lead to fewer deaths and shorter hospital stays. Cleaning hands (with soap or alcohol) is an effective way to prevent the transmission of organisms, but rates of compliance with hand hygiene are sometimes disappointingly low. The National Hand Hygiene Initiative in Australia aimed to improve hand hygiene compliance among healthcare workers, with the goal of reducing rates of healthcare-associated infection.
We examined whether the introduction of the National Hand Hygiene Initiative was associated with a change in infection rates. Monthly infection rates for healthcare-associated Staphylococcus aureus bloodstream infections were examined in 38 Australian hospitals across 6 states. We used Poisson regression and examined 12 possible patterns of change, with the best fitting pattern chosen using the Akaike information criterion. Monthly bed-days were included to control for increased hospital use over time.
The National Hand Hygiene Initiative was associated with a reduction in infection rates in 4 of the 6 states studied. Two states showed an immediate reduction in rates of 17% and 28%, 2 states showed a linear decrease in rates of 8% and 11% per year, and 2 showed no change in infection rates.
The intervention was associated with reduced infection rates in most states. The failure in 2 states may have been because those states already had effective initiatives before the national initiative’s introduction or because infection rates were already low and could not be further reduced.
Patient registries represent an important method of organizing “real world” patient information for clinical and research purposes. Registries can facilitate clinical trial planning and recruitment and are particularly useful in this regard for uncommon and rare diseases. Neuromuscular diseases (NMDs) are individually rare but in aggregate have a significant prevalence. In Canada, information on NMDs is lacking. Barriers to performing Canadian multicentre NMD research exist which can be overcome by a comprehensive and collaborative NMD registry.
We describe the objectives, design, feasibility and initial recruitment results for the Canadian Neuromuscular Disease Registry (CNDR).
The CNDR is a clinic-based registry which launched nationally in June 2011, incorporates paediatric and adult neuromuscular clinics in British Columbia, Alberta, Ontario, Quebec, New Brunswick and Nova Scotia and, as of December 2012, has recruited 1161 patients from 12 provinces and territories. Complete medical datasets have been captured on 460 “index disease” patients. Another 618 “non-index” patients have been recruited with capture of physician-confirmed diagnosis and contact information. We have demonstrated the feasibility of blended clinic and central office-based recruitment. “Index disease” patients recruited at the time of writing include 253 with Duchenne and Becker muscular dystrophy, 161 with myotonic dystrophy, and 71 with ALS.
The CNDR is a new nationwide registry of patients with NMDs that represents an important advance in Canadian neuromuscular disease research capacity. It provides an innovative platform for organizing patient information to facilitate clinical research and to expedite translation of recent laboratory findings into human studies.
Imprinting control regions (ICRs) play a fundamental role in establishing and maintaining the non-random monoallelic expression of certain genes, via common regulatory elements such as non-coding RNAs and differentially methylated regions (DMRs) of DNA. We recently surveyed DNA methylation levels within four ICRs (H19-ICR, IGF2-DMR, KvDMR, and NESPAS-ICR) in whole-blood genomic DNA from 128 monozygotic (MZ) and 128 dizygotic (DZ) human twin pairs. Our analyses revealed high individual variation and intra-domain covariation in methylation levels across CpGs and emphasized the interaction between epigenetic variation and the underlying genetic sequence in a parent-of-origin fashion. Here, we extend our analysis to conduct two genome-wide screenings of single nucleotide polymorphisms (SNPs) underlying either intra-domain covariation or parent-of-origin-dependent association with methylation status at individual CpG sites located within ICRs. Although genome-wide significance was not surpassed due to sample size limitations, the most significantly associated SNPs found through multiple-trait genome-wide association (MQFAM) included the previously described rs10732516, which is located in the vicinity of the H19-ICR. Similarly, we identified an association between rs965808 and methylation status within the NESPAS-ICR. This SNP is positioned within an intronic region of the overlapping genes GNAS and GNAS-AS1, which are imprinted genes regulated by the NESPAS-ICR. Sixteen other SNPs located in regions apart from the analyzed regions displayed suggestive association with intra-domain methylation. Additionally, we identified 13 SNPs displaying parent-of-origin association with individual methylation sites through family-based association testing. In this exploratory study, we show the value and feasibility of using alternative GWAS approaches in the study of the interaction between epigenetic state and genetic sequence within imprinting regulatory domains. Despite the relatively small sample size, we identified a number of SNPs displaying suggestive association either in a domain-wide or in a parent-of-origin fashion. Nevertheless, these associations will require future experimental validation or replication in larger and independent samples.
In this study, we are reporting the time- and temperature-dependence of the electrical resistivity and temperature-dependence of the Hall voltage in neodymium nickelate thin films. The films were deposited on a lanthanum aluminate substrate [LaAlO3 (001)] by a pulsed laser deposition technique, with thicknesses ranging from 0.6 to 120 nm. Time-dependent electrical transport measurements indicated the formation of a kinetically stable metallic glassy phase rather than a stable insulating phase on cooling below the transition temperature, TM-I. Comparisons of the low-temperature behavior with that of common insulators further supported this claim. Hall effect measurements on the 1.2-nm sample showed a local maximum in the carrier concentration just below the TM-I on both the heating and cooling cycles. This again confirmed the proposed low-temperature structure, in that, for the 1.2-nm sample, there was a minimal degree of supercooling before transitioning to a kinetically stable glassy phase.
Electrical transport properties in ultrathin NdNiO3 films grown on single crystal LaAlO3(001) substrate were characterized. Films with thicknesses ranging from 0.6 nm to 12 nm were grown using a pulsed laser technique. Four probe resistivity as a function of temperature measurements indicated a strong dissipation of strain effects from 0.6 nm to 6 nm as well as the presence of defects in the 12 nm sample. A proposed mechanism of kinetically stable glassy phase formation explains the time dependence of the resistivity in both cooling and heating cycles.
A soil climate monitoring network, consisting of seven automated weather stations, was established between 1999 and 2003, ranging from Minna Bluff to Granite Harbour and from near sea level to about 1700 m on the edge of the polar plateau. Active layer depth was calculated for each site for eight successive summers from 1999/2000 to 2006/2007. The active layer depth varied from year to year and was deepest in the warm summer of 2001–02 at all recording sites. No trends of overall increase or decrease in active layer depth were evident across the up-to-eight years of data investigated. Average active layer depth decreased with increasing latitude from Granite Harbour (77°S, active layer depth of > 90 cm) to Minna Bluff (78.5°S, active layer depth of 22 ± 0.4 cm), and decreased with increasing altitude from Marble Point (50 m altitude, active layer depth of 49 ± 9 cm) through to Mount Fleming (1700 m altitude, active layer depth of 6 ± 2 cm). When all data from the sites were grouped together and used to predict active layer depth the mean summer air temperature, mean winter air temperature, total summer solar radiation and mean summer wind speed explained 73% of the variation (R2 = 0.73).
Current ultrasound techniques can accurately determine the chorionicity of twins, but not zygosity. We previously proposed that the zygosity of spontaneously conceived twins can be determined at early ultrasound, where 2 corpora lutea infers dizygosity, and 1 implies monozygosity. Here we did a case series, comparing zygosity predicted using this method with definitive DNA genotyping of twins after birth. We retrospectively identified 14 ultrasound reports of spontaneous twin pregnancies at 6(+0 days) to 13+6 weeks' gestation, where both ovaries were seen and the number of corpora lutea documented. We visited all twin pairs, obtained buccal smears, and determined zygosity by genotyping 9 independent microsatellite markers. All 8 cases where 2 corpora lutea were seen were dizygotic pregnancies. One further case where 3 corpora lutea were seen was also dizygotic. All 3 sets of monozygotic twins had 1 corpus luteum. There were 2 cases incorrectly assigned, where 1 corpus luteum was seen in dizygotic pregnancies. We conclude if 2 corpora lutea are seen at a first trimester ultrasound of spontaneously conceived dichorionic twins, they appear to be almost certainly dizygotic. However, if 1 corpus luteum is seen in dichorionic twins, zygosity cannot be determined with certainty since it is either monozygotic, or dizygotic where a second corpus luteum has been missed.
The aim of our study was to examine psychosocial changes associated with participation in a camp for children with cardiac defects. We enrolled 29 children with cardiac defects aged from 8 to 18 years, along with their parents. Both the parents and the children completed measures of expectations for the camp and anxiety. Analyses of repeated measures indicated that levels of anxiety amongst the children decreased significantly at the end of camp when compared to its beginning. Levels of anxiety amongst the children were not statistically different at follow-up. Anxiety amongst the parents concerning the separation from their children also decreased at follow-up when compared to before the camp. Higher levels of anxiety reported by the children prior to the camp were associated with greater anxiety amongst the parents concerning the anticipated separation, more negative parental expectations of the camp, fewer experiences of separation from their children, and lower expectations by the children for the camping experience. Reductions in anxiety amongst the children following the camp were associated with negative parental expectations about the camping experience. The camping environment can provide a naturalistic exposure to new experiences for the child, and a successful separation for the parent, thereby promoting confidence amongst the parents in the ability of their children to function independently.
Seabee Hook is a low lying gravel spit adjacent to Cape Hallett, northern Victoria Land, in the Ross Sea region of Antarctica and hosts an Adélie penguin (Pygoscelis adeliae) rookery. Dipwells were inserted to monitor changes in depth to, and volume of, groundwater and tracer tests were conducted to estimate aquifer hydraulic conductivity and groundwater velocity. During summer (November–February), meltwater forms a shallow, unconfined, aquifer perched on impermeable ice cemented soil. Groundwater extent and volume depends on the amount of snowfall as meltwater is primarily sourced from melting snow drifts. Groundwater velocity through the permeable gravel and sand was up to 7.8 m day−1, and hydraulic conductivities of 4.7 × 10−4 m s−1 to 3.7 × 10−5 m s−1 were measured. The presence of the penguin rookery, and the proximity of the sea, affects groundwater chemistry with elevated concentrations of salts (1205 mg L−1 sodium, 332 mg L−1 potassium) and nutrients (193 mg L−1 nitrate, 833 mg L−1 ammonia, 10 mg L−1 total phosphorus) compared with groundwater sourced away from the rookery, and with other terrestrial waters in Antarctica.
The soils of the Seabee Hook area of Cape Hallett in northern Victoria Land, Antarctica, were mapped and characterized. Seabee Hook is a low-lying gravel spit of beach deposits built up by coastal currents carrying basalt material from nearby cliffs. Seabee Hook is the location of an Adélie penguin (Pygoscelis adeliae) colony which influences the soils with additions of guano, dead birds, eggshells and feathers. A soil-landscape model was developed and a soil association was identified between the soils formed on mounds (relict beach ridges) favoured by penguins for nests (Typic Haplorthel) and the soils in the areas between the mounds (Typic Haplorthel/Typic Aquorthel). Soils formed on the mounds inhabited by penguins contained guano in the upper 50 cm, overlying sub-rounded beach-deposited gravel and sand. Soils between mounds had a thin veneer (< 5 cm) of guano overlying basaltic gravelly sand similar to that in the lower parts of the mound soils. The soils had high concentrations of nitrogen, organic carbon, phosphorus, cadmium, zinc, copper, and increased electrical conductivity, within horizons influenced by penguin guano. Five buried penguin bones were collected from the base of soil profiles and radiocarbon dated. The dates indicate that Seabee Hook has been colonized by penguins for at least 1000 years.
High density single nucleotide polymorphism (SNP) genotyping panels provide an alternative to microsatellite markers for genome scans. However, genotype errors have a major impact on power to detect linkage or association and are difficult to detect for SNPs. We estimated error rates with the Affymetrix GeneChip® SNP platform in samples from a family with a mixed set of monozygotic (MZ) and dizygotic (DZ) triplets using lymphocyte, buccal DNA and samples from whole genome amplification using the multiple displacement amplification (MDA) technique. The average call rate from 58,960 SNPs for five genomic samples was 99.48%. Comparison of results for the MZ twins showed only three discordant genotypes (concordance rate 99.995%). The mean concordance rate for comparisons of samples from lymphocyte and buccal DNA was 99.97%. Mendelian inconsistencies were identified in 46 SNPs with errors in one or more family members, a rate of 0.022%. Observed genotype concordance rates between parents, between parents and children, and among siblings were consistent with previously reported allele frequencies and Hardy–Weinberg equilibrium. Using the MDA technique, results for two samples had equivalent high accuracy to results with genomic samples. However, the SNP call rate for the remaining seven samples varied from 72.5% to 99.5%, with an average of 86.11%. Quality of the DNA sample following the MDA reaction appears to be the critical factor in SNP call rate for MDA samples. Our results demonstrate highly accurate and reproducible genotyping for the Affymetrix GeneChip® Human Mapping Set in lymphocyte and buccal DNA samples.
Hydrocarbon spills have occurred on Antarctic soils where fuel oils are utilized, moved or stored.
We investigated the effects of hydrocarbon spills on soil temperature and moisture regimes by comparing the
properties of existing oil contaminated sites with those of nearby, uncontaminated, control sites at Scott
Base, the old Marble Point camp, and Bull Pass in the Wright Valley. Hydrocarbon levels were elevated in
fuel-contaminated samples. Climate stations were installed at all three locations in both contaminated and
control sites. In summer at Scott Base and Marble Point the mean weekly maximum near surface (2 cm and
5 cm depth) soil temperatures were warmer (P<0.05), sometimes by more than 10°C, at the contaminated
site than the control sites. At Bull Pass there were no statistically significant differences in near-surface soil
temperatures between contaminated and control soils. At the Scott Base and Marble Point sites soil albedo
was lower, and hydrophobicity was higher, in the contaminated soils than the controls. The higher
temperatures at the Scott Base and Marble Point hydrocarbon contaminated sites are attributed to the
decreased surface albedo due to soil surface darkening by hydrocarbons. There were no noteworthy
differences in moisture retention between contaminated and control sites.
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