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The aim of this study was to assess unconsciousness in pigs during exposure to CO2 through changes in the middle latency auditory evoke potentials (MLAEP) of the central nervous system (CNS), blood parameters (pH, carbon dioxide partial pressure [pCO2], oxygen partial pressure [pO2], oxygen saturation [SatO2] and bicarbonate [HCO−3]), behaviour and the corneal reflex. The MLEAP did not decrease significantly until after 60 s exposure to CO2. The blood parameters (decreased pH, pO2 and SatO2 and increased pCO2 and HCO3) changed 53 s after the onset of immersion. The burst suppression index (BS%) and the A-line ARX index (AAI) from the MLEAP recovered basal levels at 136 and 249 s, respectively. The first blood parameter to return to basal levels was HCO−3 at 76 s of exposure, followed by SatO2 at 180 s, pH and pO2 at 210 s and pCO2 at 240 s. During exposure to the gas, pigs exhibited lateral head movements and sneezing (10.3 s), gasping (23.5 s) and vocalisation (26.1 s). Furthermore, all pigs demonstrated muscular excitation after between 19 and 39 s exposure, when the AAI and BS% values were not significantly different from basal values. It was suggested, therefore, that these excitatory movements represent conscious movement, indicative of aversion to the gas. According to our results, loss of consciousness began, on average, after 60 s inhalation of 90% CO2. During exposure to the gas, decreased brain activity was seen, immediately following the changes in blood parameters. Following exposure, the restoration of blood parameters to basal levels allows a return to normal brain activity.
The stability and uniformity of the following gas mixtures: 90% argon; 85% argon and 15% carbon dioxide (CO2); 70% argon and 30% CO2; 98% nitrogen (N2); 92% N2 and 8% CO2; 90% N2 and 10% CO2; 85% N2 and 15% CO2; 80% N2 and 20% CO2; 70% N2 and 30% CO2; and 90% CO2 by volume in atmospheric air were assessed in a commercial dip-lift stunning system when the cradle was either stationary or in motion. The gas mixtures of 90% argon, 85% argon and 15% CO2, 70% argon and 30% CO2, 85% N2 and 15% CO2, 80% N2 and 20% CO2, 70% N2 and 30% CO2 and 90% CO2 by volume in atmospheric air could be sustained in a commercial dip-lift stunning system. The stability of the gas mixtures 92% N2 and 8% CO2, and 90% N2 and 10% CO2 by volume in atmospheric air were lower than in the previous cases. On the other hand, an N2 concentration higher than 94% by volume in atmospheric air could not be sustained in the stunning system. In addition, gas mixtures of argon and CO2 showed a higher stability than gas mixtures of N2 and CO2. The uniformity at different levels inside the pit (defined as the capacity of the gas to maintain its concentration constant at different levels inside the pit) was higher in 90% argon, or argon and CO2 mixtures and N2 and CO2 mixtures than in 90% CO2. This fact ensures that for the whole time the animals are inside the pit, the same conditions are applied, which is not the case for 90% CO2.
In certain areas of South America, free-ranging, wild guanacos (Lama guanicoe) are exploited for fibre by local people. This activity includes the capture and handling of animals which can adversely affect their behaviour and physiology. This study investigated the behavioural and physiological responses of guanacos to shearing and handling activities in order to obtain a better picture of the welfare state of individuals. Parameters that were assessed consisted of: time enclosed; handling time; sex; age; and vital signs (heart beat frequency per minute, respiratory rate per minute, body temperature and body condition). Blood samples were also collected to measure serum cortisol levels and neutrophil/lymphocyte ratios. Frequencies of spitting, kicking, escape attempts and vocalisations were recorded as behaviours considered indicative of stress. Our results showed that stress behaviour frequencies were higher with increased handling time, whereas serum cortisol and N/L levels were higher when body condition scores were low. Handling time should be kept as short as possible to minimise individuals’ stress levels, particularly when body condition is low. Stress behaviour rates and serum cortisol levels were higher in juvenile compared to adult guanacos. Finally, both physiological measures of stress — serum cortisol concentrations and N/L ratios — were higher during the management activities of 2010 than in 2009, which may have been as a result of more inclement weather in 2010. When managing guanacos, it is important to consider both animal traits and previous environmental conditions and to avoid shearing juveniles and individuals with poor body condition scores if weather conditions are severe. These management recommendations are likely to improve animal welfare, facilitating sustainable management of this wild and emblematic species from the desert biomes of South America.
The present study aimed to determine the prevalence of adiposity-based chronic disease (ABCD) and its association with anthropometric indices in the Mexican population. A cross-sectional study was conducted in 514 adults seen at a clinical research unit. The American Association of Clinical Endocrinology/AACE/ACE criteria were used to diagnose ABCD by first identifying subjects with BMI ≥ 25 kg/m2 and those with BMI of 23–24·9 kg/m2 and waist circumference ≥ 80 cm in women or ≥ 90 cm in men. The presence of metabolic and clinical complications associated with adiposity, such as factors related to metabolic syndrome, prediabetes, type 2 diabetes, dyslipidaemia and arterial hypertension, were subsequently evaluated. Anthropometric indices related to cardiometabolic risk factors were then determined. The results showed the prevalence of ABCD was 87·4 % in total, 91·5 % in men and 86 % in women. The prevalence of ABCD stage 0 was 2·4 %, stage 1 was 33·7 % and stage 2 was 51·3 %. The prevalence of obesity according to BMI was 57·6 %. The waist/hip circumference index (prevalence ratio (PR) = 7·57; 95 % CI 1·52, 37·5) and the conicity index (PR = 3·46; 95 % CI 1·34, 8·93) were better predictors of ABCD, while appendicular skeletal mass % and skeletal muscle mass % decreased the risk of developing ABCD (PR = 0·93; 95 % CI 0·90, 0·96; and PR = 0·95; 95 % CI 0·93, 0·98). In conclusion, the prevalence of ABCD in our study was 87·4 %. This prevalence increased with age. It is important to emphasise that one out of two subjects had severe obesity-related complications (ABCD stage 2).
Identifying the optimal treatment for individuals with major depressive disorder (MDD) is often a long and complicated process. Functional magnetic resonance imaging (fMRI) studies have been used to help predict and explain differences in treatment response among individuals with MDD.
Objectives
We conducted a comprehensive meta-analysis of treatment prediction studies utilizing fMRI in patients with MDD to provide evidence that neural activity can be used to predict response to antidepressant treatment.
Methods
A multi-level kernel density analysis was applied to these primary fMRI studies, in which we analyzed brain activation patterns of depressed patients (N= 364) before receiving antidepressant treatment.
Results
The results of this analysis demonstrated that hyperactivity in six brain regions significantly predicted treatment response in patients with MDD: the right anterior cingulate, right cuneus, left fusiform gyrus, left middle frontal gyrus, right cingulate gyrus, and left superior frontal gyrus.
Conclusions
This study provides evidence that neural activity, as measured by standard fMRI paradigms, can be used to successfully predict response to antidepressant treatment. This may be used in the future clinically to improve decision-making processes and treatment outcomes for patients.
Since Kraepelin and Bleuler, schizotypy was understood as a mild expression of psychosis, a latent form with the same trajectory but different severity. They pointed characteristics such as being eccentric, unreasonable, supersticious or hipersensitive, interpersonal aversiveness (often related to suspiciousness and expectation of rejection), ambivalence, anhedonia,… and psychosis-like features that don’t usually lead to help-seeking.
Objectives
To do a case review
Methods
We report a case of a 17 years old boy with a childhood trauma history who started psychiatric consultations a year and a half ago because his “usual” (as his mother referred) strange behaviour got worse, which was perceived by his
ENT specialist. During the appointments, the patient showed suspiciousness, odd speech, inappropriate affect, tendency to social withdrawal, obsessive ruminations with sexual content and occasional perceptual experiences (such as depersonalization, derealization and auditory hallucinations).
Results
Psychosis and schizotypy are linked historically and phenomenologically, which is evidenced by their placement in non-affective psychosis in the ICD-10 and DSM-5, and it is known that the direct observation (by clinicians or family members) during the childhood and adolescence are key for a correct diagnosis. In fact, this construct reflects a phenotypic expression of vulnerability to schizophrenia, and during childhood or adolescence it may be understood as an early mental risk state.
Conclusions
In contrast to models of psychosis that mainly rely on positive features and assume a progression of them, the positive traits of schizotypy seem to be beneficial and related to a “benign or happy schizotypy” according to the articles we reviewed.
Inflammation and neural plasticity play a significant role in major depressive disorder (MDD) pathogenesis and cognitive dysfunction. The olfactory neuroepithelium (ON), closely related to the central nervous system (CNS), allows a non-invasive, low-cost study of neuropsychiatric disorders. However, few studies have used ON cells to ascertain them as biomarkers for MDD.
Objectives
Determine the relationship between inflammatory/neural plasticity markers and cognitive functioning in MDD patients and healthy controls.
Methods
Sample: 9 MDD patients and 7 healthy controls. Exclusion criteria: other Axis I mental disorders (patients) or any mental disorder (controls) and any inflammatory, autoimmune, or CNS diseases. Assessment: sociodemographic, clinical, and cognitive variables (CANTAB) were recorded. mRNA was isolated from ON cells and MAPK14, IL6, TNF-α, Mecp2, BDNF, GSK3, GRIA2, and FosB gene expression levels were quantified using quantitative polymerase chain reaction.
Results
MDD patients showed decreased levels of BDNF (p=0.022), GSK3 (p=0.027), and working memory (p=0.024) compared with healthy controls. In healthy controls, planning was positively correlated with NRF2, BDNF, and MAPK14 gene expression. In MDD patients no correlation between cognitive parameters and inflammation/neural plasticity biomarkers was found.
Conclusions
These results reveal that: (1) Plasticity biomarkers such as BDNF and GSK3 could be useful diagnostic tools for MDD (2) MDD is associated with working memory deficits; (3) no association could be determined between planning and NRF2, BDNF, and MAPK14 gene expression in MDD and (4) the ON is a promising model in the study of neuropsychiatric disorders.
A 21-year-old woman diagnosed with bipolar disorder was hospitalized in the Mental Health Day Hospital of Salamanca during the Covid pandemic. The patient engaged with 4 different jobs and a master’s degree, beginning with verbose speech, dysphoria, global insomnia, grandiose delusions, extremely high energy and thinking she has the vaccine. She works the following objectives:illness insight, risk factors, psychopathological stabilization, social skills, slowing down of activities and taking responsibilities.
Objectives
The objective is do a follow-up of the patient during her hospitalization in the Mental Health Day Hospital and to carry out a structured search in PubMed and Up-to-Date about psychotherapy and bipolar disorder.
Methods
3-month follow-up of a 21-year-old woman diagnosed with bipolar disorder during her hospitalization in the Mental Health Day Hospital in Salamanca and a structured search in PubMed and Up-to-Date in April 2021 in English, French and Spanish, including the last 10 years with the keywords “psychotherapy”, “psychotherapies” and “bipolar disorder “.77 studies were analyzed: 12 included, 65 excluded.
Results
Several randomized trials highlight the efficacy of group psychoeducation and cognitive-behavioural therapy in relapse prevention, improving illness insight, medical adherence and less hospitalizations. Therapeutic alliance plays a significant role in the process. Our patient improved her knowledge of her illness and treatment, her social skills and reconnected with her relatives and slowed down her activity. She then was referred to her community mental heath center psychiatrist.
Conclusions
The insight in bipolar disorder plays an important role in medical adherence and prevention of relapses. Therapeutic alliance improves their insight, their functionality in their daily life and enables close monitoring. Medical treatment should be accompanied by psychotherapy for a complete approach of the treatment.
Levetirazetam is an antiepileptic drug with psychiatric adverse reactions. It includes psychosis, paranoia or hallucinations. The frequency is less than 1%.
Objectives
To describe a case of Psychosis produced by Levetirazetam
Methods
Retrospective review of clinical records and complementary test, including psychiatry, electrophysiology and neurology. Diagnosis schales such as Salamanca Questionnaire were used as suport.
Results
A 42-year-old woman diagnosed with tuberous sclerosis and undergoing treatment with levetirazetam acudes to the emergency department for behavioral disorders. She has presented an episode of aggression against a relative threatening him with a kitchen knife. The family reports that since the change in antiepilepticus 1 month ago, the patient has presented strange behaviors. Te Patient is conscious, uncooperative. Barely Approachable. Suspicious of her surroundings, with psychomotor restlessness, self-reference ideas and sparse speech. Auditory hallucinations seem to be present, as well as depressed and irritable mood. Psychic and somatic anxiety is found.
Levetirazetam is discontinued, being replaced by valproic acid. Risperidone is started at a 3 mg dose. Treatment is well tolerated, and clinical stability is achived. Cluster A personality traits are found. Complementary test Blood and Urine simples, Imaging tests (CT and MRI), electroencephalogram and Electrocardiogram show no alterations
Conclusions
Levetirazetam can cause psychiatric adverse effects. it is important to make a proper diagnosis before a first psychotic outbreak in later life. Drugs that can produce psychiatric side effects should be identified and patients should be inform.
It’s well known the challenge of differential diagnosis between Obssesive compulsive disorder and autism since their symptoms (intrusive, recurrent thoughts and repetitive behaviours) often overlap.
Objectives
We report a case of a 14 years old boy diagnosed of ASD who was hospitalized for the first time due to difficult management of repetitive behaviours that made him incapable of doing basic activities without help. To interrupt them led to anxiety, aggressive responses and to insistence on sameness behaviours. Only with this information and with the literature research we made, anyone could tell the problem was probably an ASD symptom. However, during his evolution it was difficult to know whether this behaviour was due to ASD or OCD: after adjusting the medication, and when he started trusting his therapists, he told us about a theory he believed so he could explain the uncomfortable ideas that crossed his mind more than often, so he used those behaviours as an anxiety-reduction technique. This new situation was the fuel to make the present review.
Methods
To report a case.
Results
The results are included in the “conclusions” section.
Conclusions
Although there is an ongoing debate concerning the nature of the symptoms in ASD versus those observed in OCD, there are commonly used criteria to differentiate them according to the articles we reviewed:
Over the last 25 years, radiowave detection of neutrino-generated signals, using cold polar ice as the neutrino target, has emerged as perhaps the most promising technique for detection of extragalactic ultra-high energy neutrinos (corresponding to neutrino energies in excess of 0.01 Joules, or 1017 electron volts). During the summer of 2021 and in tandem with the initial deployment of the Radio Neutrino Observatory in Greenland (RNO-G), we conducted radioglaciological measurements at Summit Station, Greenland to refine our understanding of the ice target. We report the result of one such measurement, the radio-frequency electric field attenuation length $L_\alpha$. We find an approximately linear dependence of $L_\alpha$ on frequency with the best fit of the average field attenuation for the upper 1500 m of ice: $\langle L_\alpha \rangle = ( ( 1154 \pm 121) - ( 0.81 \pm 0.14) \, ( \nu /{\rm MHz}) ) \,{\rm m}$ for frequencies ν ∈ [145 − 350] MHz.
The current study aimed to evaluate the effects of cactus pear as a moistening additive on fermentative and microbiological characteristics, aerobic stability (AS), chemical composition and in situ rumen degradability of corn grain silage at different opening times. A completely randomized experimental design was adopted in a 4 × 3 factorial scheme with four levels of dry matter (DM) (50; 60; 70 and 80% of DM) and three opening times (30; 60 and 120 days after ensiling), with four replications. There was an effect of interaction (P < 0.05) between the DM levels and opening times on silage yeast population, effluent losses, gas losses, dry matter recovery (DMR), AS of the silage and on lactic acid bacteria, mould and yeast populations after AS trial. The 60% DM level presented DMR values above 930 g/kg of DM. However, the lowest AS time (96.52 h) was observed in silages with 60% DM at 60 days after ensiling, although all silages have shown high AS. The DM in situ degradability of the ensiled mass increased after the ensiling process at all DM levels and opening times, with the 60% DM content showing the best result. When using cactus pear as a corn grain moistening additive, the 60% DM level is recommended when the opening time is up 120 days.
Levetirazetam is an antiepileptic drug with psychiatric adverse reactions. It includes psychosis, paranoia or hallucinations. The frequency is less than 1%.
Objectives
To describe and study a case of Psychosis produced by Levetirazetam
Methods
Retrospective review of clinical records and complementary test, including psychiatry, electrophysiology and neurology. Diagnosis schales such as Salamanca Questionnaire were used as suport.
Results
A 42-year-old woman diagnosed with tuberous sclerosis and undergoing treatment with levetirazetam acudes to the emergency department for behavioral disorders. She has presented an episode of aggression against a relative threatening him with a kitchen knife. The family reports that since the change in antiepilepticus 1 month ago, the patient has presented strange behaviors. Te Patient is conscious, uncooperative. Barely Approachable. Suspicious of her surroundings, with psychomotor restlessness, self-reference ideas and sparse speech. Auditory hallucinations seem to be present, as well as depressed and irritable mood. Psychic and somatic anxiety is found. Levetirazetam is discontinued, being replaced by valproic acid. Risperidone is started at a 3 mg dose. Treatment is well tolerated, and clinical stability is achived. Cluster A personality traits are found. Complementary test Blood and Urine simples, Imaging tests (CT and MRI), electroencephalogram and Electrocardiogram show no alterations
Conclusions
Levetirazetam can cause psychiatric adverse effects. it is important to make a proper diagnosis before a first psychotic outbreak in later life. Drugs that can produce psychiatric side effects should be identified and patients should be inform.
Multiple neuroendocrine disorders can present themselves through diverse psychiatric symptoms. In the case of hypothyroidism it can manifest itself through mood disorders that will require a comprehensive differential diagnosis.
Objectives
We present a case report and a review of the relevant literature about the relation between mood disorders and hypothyroidism.
Methods
We present the case of a 56-year-old man with no prior psychiatric record who concurring with a grieving process, developed a depressed mood, fatigue, decreased daily activity, and home isolation for months of evolution. He was diagnosed of hypothyroidism and treated with levotiroxine. It was necessary to boost hormonal treatment with antidepressant drugs due to the persistence of the symptoms after the resolution of the hormonal deficit.
Results
The relationship of depression in patients with overt hypothyroidism is widely recognized. Common alterations to both disorders that could make their diagnosis difficult have been observed: existence of psychomotor slowing, attentional and executive disturbance, anxiety, asthenia, weight gain, depressed mood or bradypsychia among others. In the case of subclinical hypothyroidism, certain neuropsychiatric disorders have been linked without having conclusive evidence.
Conclusions
An early screening of thyroid function at the onset of psychiatric symptoms in individuals without prior psychiatric record is essential in the provision of adequate treatment. Clinical improvement has been seen with hormone replacement therapy alone. However, in up to 10% of patients it becomes insufficient, being necessary to complete it with antidepressant drugs for the complete resolution of the condition.
In the early phase of the coronavirus disease 2019 (COVID-19) pandemic, United States Emergency Medical Services (EMS) experienced a decrease in calls, and at the same time, an increase in out-of-hospital deaths. This finding led to a concern for the implications of potential delays in care for the obstetric population.
Hypothesis/Problem:
This study examines the impact of the pandemic on prehospital care amongst pregnant women.
Methods:
A retrospective observational study was conducted comparing obstetric-related EMS activations in Maryland (USA) during the pandemic (March 10-July 20, 2020) to a pre-pandemic period (March 10-July 20, 2019). Comparative analysis was used to analyze the difference in frequency and acuity of calls between the two periods.
Results:
There were fewer obstetric-related EMS encounters during the pandemic compared to the year prior (daily average during the pandemic 12.5 [SD = 3.8] versus 14.6 [SD = 4.1] pre-pandemic; P <.001), although the percent of total female encounters remained unchanged (1.6% in 2020 versus 1.5% in 2019; P = .091). Key indicators of maternal status were not significantly different between the two periods. African-American women represented a disproportionately high percentage of obstetric-related activations (36.2% in 2019 and 34.8% in 2020).
Conclusions:
In this state-wide analysis of EMS calls in Maryland early in the pandemic, no significant differences existed in the utilization of EMS by pregnant women. Prehospital EMS activations amongst pregnant women in Maryland only decreased slightly without an increase in acuity. Of note, over-representation by African-American women compared to population statistics raises concern for broader systemic differences in access to obstetric care.
We present 63 new multi-site radial velocity (RV) measurements of the K1III giant HD 76920, which was recently reported to host the most eccentric planet known to orbit an evolved star. We focused our observational efforts on the time around the predicted periastron passage and achieved near-continuous phase coverage of the corresponding RV peak. By combining our RV measurements from four different instruments with previously published ones, we confirm the highly eccentric nature of the system and find an even higher eccentricity of
$e=0.8782 \pm 0.0025$
, an orbital period of
$415.891^{+0.043}_{-0.039}\,\textrm{d}$
, and a minimum mass of
$3.13^{+0.41}_{-0.43}\,\textrm{M}_{\textrm{J}}$
for the planet. The uncertainties in the orbital elements are greatly reduced, especially for the period and eccentricity. We also performed a detailed spectroscopic analysis to derive atmospheric stellar parameters, and thus the fundamental stellar parameters (
$M_*, R_*, L_*$
), taking into account the parallax from Gaia DR2, and independently determined the stellar mass and radius using asteroseismology. Intriguingly, at periastron, the planet comes to within 2.4 stellar radii of its host star’s surface. However, we find that the planet is not currently experiencing any significant orbital decay and will not be engulfed by the stellar envelope for at least another 50–80 Myr. Finally, while we calculate a relatively high transit probability of 16%, we did not detect a transit in the TESS photometry.
ABSTRACT IMPACT: Current practice guidelines offer a variety of treatment options for sternal reconstruction but complications and infections remain a serious surgical problem. This work seeks to provide a comprehensive picture of the com-morbidities and reconstructive methods that lead to success and improve patient outcomes. OBJECTIVES/GOALS: Patients that undergo cardiac surgery via the median sternotomy approach are at risk of wound complications that require repair. We seek to evaluate how outcomes of sternal reconstruction are influenced by patient comorbidities, flap usage and internal mammary artery grafts and methods of sternal closure. METHODS/STUDY POPULATION: We identified patients between 2005 and 2020 who underwent sternotomy followed by debridement and flap coverage at our institution. Comorbidities, method of reconstruction, demographic data, surgical history, and other factors pertaining to mortality and morbidity were collected. The data will then be analyzed to identify population characteristics using logistic regression variables to determine univariate and adjusted multivariable measures of association with mortality. We present the pre-liminary data analyzed using chi-square and one-way anova in R. RESULTS/ANTICIPATED RESULTS: In this study we present a preliminary characterization of one institution’s sternal reconstruction patient outcomes with a variety of reconstruction methods including pectoralis advancement flaps, omental flaps and latissumus dorsi flaps. Notable preoperative comorbidities include 50% of patients > age 60, 18% with diabetes mellitus, 18 % with diagnosed hypertension, 18% with COPD, and 9% with a smoking history DISCUSSION/SIGNIFICANCE OF FINDINGS: In an evolving cardiothoracic landscape, clinical characteristics of patients being treated for sternal reconstructive surgery present a moving target. Understanding current risk factors, preoperative management and timing for aggressive surgical treatment offers an opportunity to update treatment protocol and maximize successful outcomes.
Manuscripts pertaining to paediatric cardiology and CHD have been published in a variety of different journals. Some of these journals are journals dedicated to paediatric cardiology, while others are focused on adult cardiology. Historically, it has been considered that manuscripts published in journals devoted to adult cardiology have greater citation potential. Our objective was to compare citation performance between manuscripts related to paediatric cardiology and CHD published in paediatric as opposed to adult cardiology journals.
Methods:
We identified manuscripts related to paediatric cardiology and CHD published in five journals of interest during 2014. Of these journals, two were primarily concerned with adult cardiology, while the other three focused on paediatric cardiology. The number of citations for these identified manuscripts was gathered from Google Scholar. We compared the number of citations (median, mean, and 25th, 75th, 90th, and 95th percentiles), the potential for citation, and the h-index for the identified manuscripts.
Results:
We identified a total of 828 manuscripts related to paediatric cardiology and congenital heart as published in the 5 journals during 2014. Of these, 783 (95%) were published in journals focused on paediatric cardiology, and the remaining 45 (5%) were published in journals focused on adult cardiology. The median number of citations was 41 in the manuscripts published in the journals focused on adult cardiology, as opposed to 7 in journals focused on paediatric cardiology (p < 0.001). The h-index, however, was greater for the journals dedicated to paediatric cardiology (36 versus 27).
Conclusion:
Approximately one-twentieth of the work relating to paediatric cardiology and CHD is published in journals that focus predominantly on adult cardiology. The median number of citations is greater when manuscripts concerning paediatric cardiology and CHD are published in these journals focused on adult cardiology. The h-index, however, is higher when the manuscripts are published in journals dedicated to paediatric cardiology. While such publications in journals that focus on adult cardiology tend to generate a greater number of citations than those achieved for works published in specialised paediatric cardiology journals, the potential for citation is no different between the journals. Due to the drastically lower number of manuscripts published in journals dedicated to adult cardiology, however, median performance is different.
We summarize some of the past year's most important findings within climate change-related research. New research has improved our understanding of Earth's sensitivity to carbon dioxide, finds that permafrost thaw could release more carbon emissions than expected and that the uptake of carbon in tropical ecosystems is weakening. Adverse impacts on human society include increasing water shortages and impacts on mental health. Options for solutions emerge from rethinking economic models, rights-based litigation, strengthened governance systems and a new social contract. The disruption caused by COVID-19 could be seized as an opportunity for positive change, directing economic stimulus towards sustainable investments.
Technical summary
A synthesis is made of ten fields within climate science where there have been significant advances since mid-2019, through an expert elicitation process with broad disciplinary scope. Findings include: (1) a better understanding of equilibrium climate sensitivity; (2) abrupt thaw as an accelerator of carbon release from permafrost; (3) changes to global and regional land carbon sinks; (4) impacts of climate change on water crises, including equity perspectives; (5) adverse effects on mental health from climate change; (6) immediate effects on climate of the COVID-19 pandemic and requirements for recovery packages to deliver on the Paris Agreement; (7) suggested long-term changes to governance and a social contract to address climate change, learning from the current pandemic, (8) updated positive cost–benefit ratio and new perspectives on the potential for green growth in the short- and long-term perspective; (9) urban electrification as a strategy to move towards low-carbon energy systems and (10) rights-based litigation as an increasingly important method to address climate change, with recent clarifications on the legal standing and representation of future generations.
Social media summary
Stronger permafrost thaw, COVID-19 effects and growing mental health impacts among highlights of latest climate science.
Epidemiological studies indicate that individuals with one type of mental disorder have an increased risk of subsequently developing other types of mental disorders. This study aimed to undertake a comprehensive analysis of pair-wise lifetime comorbidity across a range of common mental disorders based on a diverse range of population-based surveys.
Methods
The WHO World Mental Health (WMH) surveys assessed 145 990 adult respondents from 27 countries. Based on retrospectively-reported age-of-onset for 24 DSM-IV mental disorders, associations were examined between all 548 logically possible temporally-ordered disorder pairs. Overall and time-dependent hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. Absolute risks were estimated using the product-limit method. Estimates were generated separately for men and women.
Results
Each prior lifetime mental disorder was associated with an increased risk of subsequent first onset of each other disorder. The median HR was 12.1 (mean = 14.4; range 5.2–110.8, interquartile range = 6.0–19.4). The HRs were most prominent between closely-related mental disorder types and in the first 1–2 years after the onset of the prior disorder. Although HRs declined with time since prior disorder, significantly elevated risk of subsequent comorbidity persisted for at least 15 years. Appreciable absolute risks of secondary disorders were found over time for many pairs.
Conclusions
Survey data from a range of sites confirms that comorbidity between mental disorders is common. Understanding the risks of temporally secondary disorders may help design practical programs for primary prevention of secondary disorders.