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The topic of patients recording healthcare consultations has been previously debated in the literature, but little consideration has been given to the risks and benefits of such recordings in the context of mental health assessments and treatment. This issue is of growing importance given the increasing use of technology in healthcare and the recent increase in online healthcare services, largely accelerated by the COVID-19 pandemic. We discuss the clinical, ethical and legal considerations relevant to audio or visual recordings of mental health consultations by patients, with reference to existing UK guidance and the inclusion of a patient's perspective.
Particle segregation is common in natural and industrial processes involving flowing granular materials. Complex, and seemingly contradictory, segregation phenomena have been observed for different boundary conditions and forcing. Using discrete element method simulations, we show that segregation of a single particle intruder can be described in a unified manner across different flow configurations. A scaling relation for the net segregation force is obtained by measuring forces on an intruder particle in controlled-velocity flows where gravity and flow kinematics are varied independently. The scaling law consists of two additive terms: a buoyancy-like gravity-induced pressure gradient term and a shear rate gradient term, both of which depend on the particle size ratio. The shear rate gradient term reflects a kinematics-driven mechanism whereby larger (smaller) intruders are pushed toward higher (lower) shear rate regions. The scaling is validated, without refitting, in wall-driven flows, inclined wall-driven flows, vertical silo flows, and free-surface flows down inclines. Comparing the segregation force with the intruder weight results in predictions of the segregation direction that match experimental and computational results for various flow configurations.
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.
To determine the utility of the Sofia SARS rapid antigen fluorescent immunoassay (FIA) to guide hospital-bed placement of patients being admitted through the emergency department (ED).
Cross-sectional analysis of a clinical quality improvement study.
This study was conducted in 2 community hospitals in Maryland from September 21, 2020, to December 3, 2020. In total, 2,887 patients simultaneously received the Sofia SARS rapid antigen FIA and SARS-CoV-2 RT-PCR assays on admission through the ED.
Rapid antigen results and symptom assessment guided initial patient placement while confirmatory RT-PCR was pending. The sensitivity, specificity, positive predictive values, and negative predictive values of the rapid antigen assay were calculated relative to RT-PCR, overall and separately for symptomatic and asymptomatic patients. Assay sensitivity was compared to RT-PCR cycle threshold (Ct) values. Assay turnaround times were compared. Clinical characteristics of RT-PCR–positive patients and potential exposures from false-negative antigen assays were evaluated.
For all patients, overall agreement was 97.9%; sensitivity was 76.6% (95% confidence interval [CI], 71%–82%), and specificity was 99.7% (95% CI, 99%–100%). We detected no differences in performance between asymptomatic and symptomatic individuals. As RT-PCR Ct increased, the sensitivity of the antigen assay decreased. The mean turnaround time for the antigen assay was 1.2 hours (95% CI, 1.0–1.3) and for RT-PCR it was 20.1 hours (95% CI, 18.9–40.3) (P < .001). No transmission from antigen-negative/RT-PCR–positive patients was identified.
Although not a replacement for RT-PCR for detection of all SARS-CoV-2 infections, the Sofia SARS antigen FIA has clinical utility for potential initial timely patient placement.
To identify the BOLD (blood oxygenation level dependent) correlates of bursts of beta frequency band electrophysiological activity, and to compare BOLD responses between healthy controls and patients with psychotic illness.
The post movement beta rebound (PMBR) is a transient increase in power in the beta frequency band (13-30 Hz), recorded with methods such as electroencephalography (EEG), following the completion of a movement. PMBR size is reduced in patients with schizophrenia and inversely correlated with severity of illness. PMBR size is inversely correlated with measures of schizotypy in non-clinical groups. Therefore, beta-band activity may reflect a fundamental neural process whose disruption plays an important role in the pathophysiology of schizophrenia. Recent work has found that changes in beta power reflect changes in the probability-of-occurrence of transient bursts of beta-frequency activity. Understanding the generators of beta bursts could help unravel the pathophysiology of psychotic illness and thus identify novel treatment targets.
EEG data were recorded simultaneously with BOLD data measured with 3T functional magnetic resonance imaging (fMRI), whilst participants performed an n-back working memory task. We included seventy-eight participants – 32 patients with schizophrenia, 16 with bipolar disorder and 30 healthy controls. Beta bursts were identified in the EEG data using a thresholding method and burst timings were used as markers in an event-related fMRI design convolved with a conventional haemodynamic response function. A region of interest analysis compared beta-event-related BOLD activity between patients and controls.
Beta bursts phasically activated brain regions implicated in coding task-relevant content (specifically, regions involved in the phonological representation of letter stimuli, as well as areas representing motor responses). Further, bursts were associated with suppression of tonically-active regions. In the EEG, PMBR was greater in controls than patients, and, in patients, PMBR size was positively correlated with Global Assessment of Functioning scores, and negatively correlated with persisting symptoms of disorganisation and performance on a digit symbol substition test. Despite this, patients showed greater, more extensive, burst-related BOLD activation than controls.
Our findings are consistent with a recent model in which beta bursts serve to reactivate latently-maintained, task-relevant, sensorimotor information. The increased BOLD response associated with bursts in patients, despite reduced PMBR, could reflect inefficiency of burst-mediated cortical synchrony, or it may suggest that the sensorimotor information reactivated by beta bursts is less precisely specified in psychosis. We propose that dysfunction of the mechanisms by which beta bursts reactivate task-relevant content can manifest as disorganisation and working memory deficits, and may contribute to persisting symptoms and impairment in psychosis.
Flowing granular materials segregate due to differences in particle size (driven by percolation) and density (driven by buoyancy). Modelling the segregation of mixtures of large/heavy particles and small/light particles is challenging due to the opposing effects of the two segregation mechanisms. Using discrete element method (DEM) simulations of combined size and density segregation we show that the segregation velocity is well described by a model that depends linearly on the local shear rate and quadratically on the species concentration for free surface flows. Concentration profiles predicted by incorporating this segregation velocity model into a continuum advection–diffusion–segregation transport model match DEM simulation results well for a wide range of particle size and density ratios. Most surprisingly, the DEM simulations and the segregation velocity model both show that the segregation direction for a range of size and density ratios depends on the local species concentration. This leads to a methodology to determine the combination of particle size ratio, density ratio and particle concentration for which a bidisperse mixture will not segregate.
We discuss whole-child development, learning, and thriving through a dynamic systems theory lens that focuses on the United States and includes an analysis of historical challenges in the American public education system, including inequitable resources, opportunities, and outcomes. To transform US education systems, developmental and learning scientists, educators, policymakers, parents, and communities must apply the knowledge they have today to 1. challenge the assumptions and goals that drove the design of the current US education system, 2. articulate a revised, comprehensive definition of whole-child development, learning, and thriving that accepts rather than simplifies how human beings develop, 3. create a profound paradigm shift in how the purpose of education is described in the context of social, cultural, and political forces, including the impacts of race, privilege, and bias and 4. describe a new dynamic 'language' for measurement of both the academic competencies and the full set of 21st century skills.
Although no drugs are licensed for the treatment of personality disorder, pharmacological treatment in clinical practice remains common.
This study aimed to estimate the prevalence of psychotropic drug use and associations with psychological service use among people with personality disorder.
Using data from a large, anonymised mental healthcare database, we identified all adult patients with a diagnosis of personality disorder and ascertained psychotropic medication use between 1 August 2015 and 1 February 2016. Multivariable logistic regression models were constructed, adjusting for sociodemographic, clinical and service use factors, to examine the association between psychological services use and psychotropic medication prescribing.
Of 3366 identified patients, 2029 (60.3%) were prescribed some form of psychotropic medication. Patients using psychological services were significantly less likely to be prescribed psychotropic medication (adjusted odds ratio 0.48, 95% CI 0.39–0.59, P<0.001) such as antipsychotics, benzodiazepines and antidepressants. This effect was maintained following several sensitivity analyses. We found no difference in the risk for mood stabiliser (adjusted odds ratio 0.79, 95% CI 0.57–1.10, P = 0.169) and multi-class psychotropic use (adjusted odds ratio 0.80, 95% CI 0.60–1.07, P = 0.133) between patients who did and did not use psychological services.
Psychotropic medication prescribing is common in patients with personality disorder, but significantly less likely in those who have used psychological services. This does not appear to be explained by differences in demographic, clinical and service use characteristics. There is a need to develop clear prescribing guidelines and conduct research in clinical settings to examine medication effectiveness for this population.
To investigate the presence, nature and direction of the daily temporal association between depressive symptoms, cognitive performance and sleep in older individuals.
Design, setting, participants:
Single-subject study design in eight older adults with cognitive impairments and depressive symptoms.
For 63 consecutive days, depressive symptoms, working memory performance and night-time sleep duration were daily assessed with an electronic diary and actigraphy. The temporal associations of depressive symptoms, working memory and total sleep time were evaluated for each participant separately with time-series analysis (vector autoregressive modeling).
For seven out of eight participants we found a temporal association between depressive symptoms and/or sleep and/or working memory performance. More depressive symptoms were preceded by longer sleep duration in one person (r = 0.39; p < .001), by longer or shorter sleep duration than usual in one other person (B = 0.49; p < .001), by worse working memory in one person (B = −0.45; p = .007), and by better working memory performance in one other person (B = 0.35; p = .009). Worse working memory performance was preceded by longer sleep duration (r = −.35; p = .005) in one person, by shorter or longer sleep duration in three other persons (B = −0.76; p = .005, B = −0.61; p < .001; B = −0.34; p = .002), and by more depressive symptoms in one person (B = −0.25; p = .009).
The presence, nature and direction of the temporal associations between depressive symptoms, cognitive performance and sleep differed between individuals. Knowledge of personal temporal associations may be valuable for the development of personalized intervention strategies in order to maintain their health, quality of life, functional outcomes and independence.
Demonization is a widespread aspect of political discourse. We are familiar with the demonization of Brussels bureaucrats as a tool for pursuing the British exit from the European Union, and we take stories about the compulsory straightening of bananas with a pinch of salt, however frustrating it might be that some disaffected voters choose to accept these canards as true. But somehow, stories about the demonic in Africa have been accorded much greater ontological respect, not only by colonial powers keen to boost their own legitimacy through claims to a civilizing mission, but also by anthropologists anxious to understand their informants’ imaginative concerns, perhaps without fully appreciating the political craft or guile with which these discourses are invested. In seeking to void the charge of delusion, an empathetic reading of demonization risks missing the strategic significance of mythic interventions intended to extract political advantage. This article examines an instance of mythic creativity in the politics of late nineteenth-century interior Sierra Leone as an example of the stagecraft sometimes implicit in African public authority. The case is that of the human leopard, an avatar of commercially compromised chieftaincy. The article asks whether the alleged activities of these leopards were the straight bananas of a certain form of anti-colonial political resistance. In a concluding discussion, some consequences for understanding current forms and practices of local public authority are inferred.
Insular species, particularly birds, experience high levels of speciation and endemism. Similarly, island birds experience extreme levels of extinction. Based on a 2012 taxonomic assessment, historically there were four reed-warbler species in the Mariana Islands, the Guam Reed-warbler Acrocephalus luscinia (Guam), the Nightingale Reed-warbler Acrocephalus hiwae (Saipan and Alamagan), the Aguijuan Reed-warbler A. nijoi (Aguiguan or Aguijuan), and the Pagan Reed-warbler A. yamashinae (Pagan). Between 2008 and 2010 we surveyed for three of these species on Alamagan, Aguiguan, and Pagan. Our results indicate that reed-warblers are extinct on Aguiguan, likely extinct on Pagan, and only the Nightingale Reed-warbler on Alamagan and Saipan remains. We estimated the global population at between 1,019 and 6,356 birds (95% CI; mean estimate 3,688), which has declined by more than 1,000 birds since the first quantitative surveys were conducted in 1982, i.e. a 24% decline in 28 years. Camp et al. (2009) describe the status of the Nightingale Reed-warbler on Saipan, which has also declined. We estimated the Alamagan population to be between 428 and 1,762 birds in 2010 (mean estimate 946). Thus, the Alamagan population is ~25 % of the global population, and it has declined slightly since 2000. This decline was not significant but is concerning, especially given a similar decline on Saipan. Restoration and protection of tall-stature native and secondary forest could benefit the Alamagan population, as would similar conservation on Saipan that includes wetland habitat. After suitable restoration of forest and wetland habitats on Aguiguan, Guam and Pagan, individuals from Alamagan and Saipan could serve as founder populations. Careful consideration of the extent and habitat preference of individuals translocated to Tinian, where an unknown reed-warbler species previously occurred, is warranted.
The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.
In this paper we consider the following problem: let Xk, be a Banach space with a normalised basis (e(k, j))j, whose biorthogonals are denoted by
be their l∞-sum, and let
be a bounded linear operator with a large diagonal, i.e.,
To conduct a pilot study implementing combined genomic and epidemiologic surveillance for hospital-acquired multidrug-resistant organisms (MDROs) to predict transmission between patients and to estimate the local burden of MDRO transmission.
Pilot prospective multicenter surveillance study.
The study was conducted in 8 university hospitals (2,800 beds total) in Melbourne, Australia (population 4.8 million), including 4 acute-care, 1 specialist cancer care, and 3 subacute-care hospitals.
All clinical and screening isolates from hospital inpatients (April 24 to June 18, 2017) were collected for 6 MDROs: vanA VRE, MRSA, ESBL Escherichia coli (ESBL-Ec) and Klebsiella pneumoniae (ESBL-Kp), and carbapenem-resistant Pseudomonas aeruginosa (CRPa) and Acinetobacter baumannii (CRAb). Isolates were analyzed and reported as routine by hospital laboratories, underwent whole-genome sequencing at the central laboratory, and were analyzed using open-source bioinformatic tools. MDRO burden and transmission were assessed using combined genomic and epidemiologic data.
In total, 408 isolates were collected from 358 patients; 47.5% were screening isolates. ESBL-Ec was most common (52.5%), then MRSA (21.6%), vanA VRE (15.7%), and ESBL-Kp (7.6%). Most MDROs (88.3%) were isolated from patients with recent healthcare exposure.
Combining genomics and epidemiology identified that at least 27.1% of MDROs were likely acquired in a hospital; most of these transmission events would not have been detected without genomics. The highest proportion of transmission occurred with vanA VRE (88.4% of patients).
Genomic and epidemiologic data from multiple institutions can feasibly be combined prospectively, providing substantial insights into the burden and distribution of MDROs, including in-hospital transmission. This analysis enables infection control teams to target interventions more effectively.
The Late Triassic fauna of the Lossiemouth Sandstone Formation (LSF) from the Elgin area, Scotland, has been pivotal in expanding our understanding of Triassic terrestrial tetrapods. Frustratingly, due to their odd preservation, interpretations of the Elgin Triassic specimens have relied on destructive moulding techniques, which only provide incomplete, and potentially distorted, information. Here, we show that micro-computed tomography (μCT) could revitalise the study of this important assemblage. We describe a long-neglected specimen that was originally identified as a pseudosuchian archosaur, Ornithosuchus woodwardi. μCT scans revealed dozens of bones belonging to at least two taxa: a small-bodied pseudosuchian and a specimen of the procolophonid Leptopleuron lacertinum. The pseudosuchian skeleton possesses a combination of characters that are unique to the clade Erpetosuchidae. As a basis for investigating the phylogenetic relationships of this new specimen, we reviewed the anatomy, taxonomy and systematics of other erpetosuchid specimens from the LSF (all previously referred to Erpetosuchus). Unfortunately, due to the differing representation of the skeleton in the available Erpetosuchus specimens, we cannot determine whether the erpetosuchid specimen we describe here belongs to Erpetosuchus granti (to which we show it is closely related) or if it represents a distinct new taxon. Nevertheless, our results shed light on rarely preserved details of erpetosuchid anatomy. Finally, the unanticipated new information extracted from both previously studied and neglected specimens suggests that fossil remains may be much more widely distributed in the Elgin quarries than previously recognised, and that the richness of the LSF might have been underestimated.