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The weakening and/or removal of floating ice shelves in Antarctica can induce inland ice flow acceleration. Numerical modelling suggests these processes will play an important role in Antarctica's future sea-level contribution, but our understanding of the mechanisms that lead to ice tongue/shelf collapse is incomplete and largely based on observations from the Antarctic Peninsula and West Antarctica. Here, we use remote sensing of structural glaciology and ice velocity from 2001 to 2020 and analyse potential ocean-climate forcings to identify mechanisms that triggered the rapid disintegration of ~2445 km2 of ice mélange and part of the Voyeykov Ice Shelf in Wilkes Land, East Antarctica between 27 March and 28 May 2007. Results show disaggregation was pre-conditioned by weakening of the ice tongue's structural integrity and was triggered by mélange removal driven by a regional atmospheric circulation anomaly and a less extensive latent-heat polynya. Disaggregation did not induce inland ice flow acceleration, but our observations highlight an important mechanism through which floating termini can be removed, whereby the break-out of mélange and multiyear landfast sea ice triggers disaggregation of a structurally-weak ice shelf. These observations highlight the need for numerical ice-sheet models to account for interactions between sea-ice, mélange and ice shelves.
Much of our current understanding about novel coronavirus disease 2019 (COVID-19) comes from hospitalised patients. However, the spectrum of mild and subclinical disease has implications for population-level screening and control. Forty-nine participants were recruited from a group of 99 adults repatriated from a cruise ship with a high incidence of COVID-19. Respiratory and rectal swabs were tested by polymerase chain reaction (PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Sera were tested for anti-SARS-CoV-2 antibodies by enzyme-linked immunosorbent assay (ELISA) and microneutralisation assay. Symptoms, viral shedding and antibody response were examined. Forty-five participants (92%) were considered cases based on either positive PCR or positive ELISA for immunoglobulin G. Forty-two percent of cases were asymptomatic. Only 15% of symptomatic cases reported fever. Serial respiratory and rectal swabs were positive for 10% and 5% of participants respectively about 3 weeks after median symptom onset. Cycle threshold values were high (range 31–45). Attempts to isolate live virus were unsuccessful. The presence of symptoms was not associated with demographics, comorbidities or antibody response. In closed settings, incidence of COVID-19 could be almost double that suggested by symptom-based screening. Serology may be useful in diagnosis of mild disease and in aiding public health investigations.
The Rapid ASKAP Continuum Survey (RACS) is the first large-area survey to be conducted with the full 36-antenna Australian Square Kilometre Array Pathfinder (ASKAP) telescope. RACS will provide a shallow model of the ASKAP sky that will aid the calibration of future deep ASKAP surveys. RACS will cover the whole sky visible from the ASKAP site in Western Australia and will cover the full ASKAP band of 700–1800 MHz. The RACS images are generally deeper than the existing NRAO VLA Sky Survey and Sydney University Molonglo Sky Survey radio surveys and have better spatial resolution. All RACS survey products will be public, including radio images (with
15 arcsec resolution) and catalogues of about three million source components with spectral index and polarisation information. In this paper, we present a description of the RACS survey and the first data release of 903 images covering the sky south of declination
made over a 288-MHz band centred at 887.5 MHz.
This study aimed to assess the published literature on non-technical skills in otolaryngology surgery and examine the applicability of any research to others’ practice, and to explore how the published literature can identify areas for further development and guide future research.
A systematic review was conducted using the following key words: ‘otolaryngology’, ‘otorhinolaryngology’, ‘ENT’, ‘ENT surgery’, ‘ear, nose and throat surgery’, ‘head and neck surgery’, ‘thyroid surgery’, ‘parathyroid surgery’, ‘otology’, ‘rhinology’, ‘laryngology’ ‘skull base surgery’, ‘airway surgery’, ‘non-technical skills’, ‘non technical skills for surgeons’, ‘NOTSS’, ‘behavioural markers’ and ‘behavioural assessment tool’.
Three publications were included in the review – 1 randomised, controlled trial and 2 cohort studies – involving 78 participants. All were simulation-based studies involving training otolaryngology surgeons.
Little research has been undertaken on non-technical skills in otolaryngology. Training surgeons’ non-technical skill levels are similar across every tested aspect. The research already performed can guide further studies, particularly amongst non-training otolaryngology surgeons and in both emergency and elective non-simulated environments.
The ‘sick-quitter’ hypothesis states that mental disorders associated with alcohol abstinence are accounted for by people who stop consuming alcohol because of poor health.
We investigated the association between alcohol abstinence and symptoms of common mental disorder and personality disorder, distinguishing between lifelong abstinence and abstinence following previous consumption.
Analyses were based on the British National Survey of Psychiatric Morbidity 2000, which sampled 8580 residents aged 16 to 74 years. Heavy consumers of alcohol were excluded, using the Alcohol Use Disorders Identification Test Questionnaire. Symptoms of common mental disorder (depression/anxiety) were identified by the Clinical Interview Schedule. The screening questionnaire of the Structured Clinical Interview for Axis II Personality Disorders was used to identify potential personality disorder. Self-reported alcohol abstinence was divided into lifelong abstinence and previous consumption. Previous consumers were asked why they had stopped. Covariates included socioeconomic status, social activity and general health status.
After adjustment, alcohol abstinence was associated with both common mental disorder symptoms and any personality disorder, but only for previous consumers (respective odds ratios 1.70 (1.23-2.34) and 1.45 (1.09-1.94)). Associations were non-specific, being apparent for most individual mental disorder symptoms and personality disorder categories. More detailed analysis indicated that associations were limited to previous consumers who reported ceasing alcohol consumption for health reasons.
The results were consistent with the ‘sick-quitter’ hypothesis and should be taken into account when interpreting associations between moderate alcohol consumption and beneficial health outcomes.
Associations have been described between lower IQ and serious mental illness. Associations between common mental disorders (CMDs) and IQ have received little research. The objective of this study was to investigate the association between verbal IQ and CMD symptoms and diagnoses, and to investigate the role of potential mediating and confounding factors.
Data were analysed from a British national survey with an analysed sample of 8054 people aged 16–74 years. Associations between verbal IQ (NART) and mental symptoms/disorders (CIS-R) were analysed with covariates including education, social class, income, debt, problem drinking, life events, physical health and relationship quality.
CMD was associated with lower IQ. This association was stronger for depressive disorder/symptoms than for generalised anxiety disorder/symptoms. The most important covariates were education, social class, income and relationship quality.
The association between lower IQ and CMD is partly accounted for by adverse social/socioeconomic conditions. Stronger associations for depression than anxiety may indicate an effect of IQ on the way mental distress is communicated.
Lipids appear to mediate depressive vulnerability in the elderly, however, sex differences and genetic vulnerability have not been taken into account in previous prospective studies.
Depression was assessed in a population of 1040 women and 752 men aged 65 years and over at baseline and after 7-year follow-up. Clinical level of depression (DEP) was defined as having either a score of 16 and above on the Centre for Epidemiology Studies Depression scale or a diagnosis of current major depression on the Mini International Neuropsychiatric Interview. Lipid levels, apolipoprotein E and serotonin transporter linked promoter region (5-HTTLPR) genotypes were evaluated at baseline.
Multivariate analyses adjusted by socio-demographic and behavioral variables, measures of physical health including ischemic pathologies, and genetic vulnerability indicated gender-specific associations between dyslipidemia and DEP, independent of the use of lipid lowering agents or apolipoprotein E status. Men with low LDL-cholesterol levels had twice the risk of prevalent and incident DEP whereas in women low HDL-cholesterol levels were found to be significantly associated with increased prevalent DEP (OR = 1.5) only. A significant interaction was observed between low LDL-cholesterol and 5-HTTLPR genotype, men with s/s or s/l genotype being at increased risk of DEP (OR = 6.0 and 2.7, respectively). No significant gene-environment interaction was observed for women.
DEP is associated with higher atherogenic risk in women (low HDL-cholesterol), whereas the reverse is observed in men (low LDL-cholesterol). Late-life depression may have a complex gender-specific etiology involving genetic vulnerability in men.
Depression is reported to be associated with increased mortality, but underlying mechanisms are uncertain. Associations between anxiety and mortality are also uncertain. In a large population study, we investigated associations between anxiety, depression and mortality over a 3-6 year period. We utilized a unique link between a large regional community survey and a comprehensive national mortality database.
Baseline information on mental and physical health was collected in a population-based health study (n=61,349) (the HUNT-2 study) of adults aged 20 years and over. Anxiety and depressive symptoms were ascertained using the Hospital Anxiety and Depression Scale (HADS). Records were linked with the Norwegian national mortality database.
Case-level depression was a risk-factor for mortality, but case-level anxiety was not (having adjusted for confounding factors). The association between anxiety symptoms and mortality was U-shaped, and anxiety comorbid with depression was associated with lower mortality compared to depression alone. Associations between depression and mortality were partly but not entirely explained by somatic symptoms and conditions, and also physical impairment, but not by smoking, obesity, cholesterol level or blood pressure.
Depression predicted general mortality after adjustment for multiple potential confounding factors. Associations between anxiety symptoms and mortality were U-shaped. Lower mortality was found in comorbid anxiety and depression than in depression alone.
Depression is reported to increase general mortality. For cause-specific mortality, there is evidence for the effect of depression on cardiac mortality and suicide. Less is known as to other mortality diagnoses. The literature on anxiety in relation to mortality is scarce and conflicting. This study investigates empirically the association between anxiety/depression and cause-specific mortality with particular attention to underlying mechanisms and causes of death.
Employing a historical cohort design we utilized a unique link between a large epidemiological cohort study and a comprehensive national mortality database. Baseline information on physical and mental health (HADS) was gathered from the population based health study (N=61349). Causes of death were registered with ICD-10 diagnoses during 4.4 year follow-up.
Case-level depression increased mortality for all major disease-related causes of death, whereas case-level anxiety and comorbid anxiety/depression did not. The effect of depression was equal in cardiac mortality compared to all other causes combined, and confounding factors were also markedly similar. Accidents and suicide was predicted by comorbid anxiety depression.
Depression is a risk factor for all major disease-related causes of death, and is not limited to cardiac mortality or suicide. Case-level anxiety imposes no increased disease-related mortality, but comorbid anxiety depression predicts external causes of death. As the association between depression and cardiac mortality was comparable to the other causes of death combined, and confounding and mediating factors are markedly similar, future investigation as to mechanisms underlying the effect of depression on mortality should not be limited to CVD mortality.
Mental health records are increasingly kept in fully electronic format. This offers potentially transformative research opportunities because of both the very large samples and the depth of the data contained. However, there are clearly substantial challenges in ensuring both adequate anonymity and robust governance for these sensitive data. In addition, the depth of information is often not exploited because most of this is contained in text rather than structured fields. Natural language processing (NLP) offers a potential solution to this, but NLP application in health records data is in its infancy. The Clinical Record Interactive Search (CRIS) application will be discussed, which was developed at the Maudsley Hospital in south London and which offers a robust and patient-led de-identification and governance model for records-based research. NLP applications have now been developed which comprehensively profile a range of symptoms, interventions and outcomes in routine mental healthcare, providing both breadth (250,000 cases) and depth of information, and supporting both novel research output and decision support for clinical services.
Autism Spectrum Disorders (ASDs) affect 1% of children and are associated with lifelong psychosocial impairments. The majority of children with ASD will experience co-occurring psychiatric disorders. In the UK, antipsychotics remain unlicensed for use in ASDs, however 10% of children with ASD receive antipsychotic treatment; the co-occurring disorders being targeted by these medications remains unclear.
To examine rates of antipsychotic medication use and identify associated co-occurring disorders among children with ASD receiving psychiatric care.
The sample consisted of 2844 children aged 2 to 17 with a NHS clinician recorded ICD-10 diagnoses for ASD between 2008–2013. Clinical variables extracted from their anonymised electronic patient records included disorder severity, medication use, co-occurring ICD-10 diagnoses, family characteristics, demographics and antipsychotic use.
Of the 2844 children (79% male), the majority (57%) had co-occurring psychiatric diagnoses. 313 (11%) received antipsychotic medication. The proportion of children aged 13 to 17 years and 6 to 12 years prescribed antipsychotics was 19% and 7% respectively. After controlling for socio-demographic factors, disorder severity, specialist treatment, inpatient duration, risk of self harm, violence to others, self injurious behaviour, maltreatment history, parental mental illness, caregiver anxiety, and neighbourhood deprivation, multivariate regression analysis revealed only hyperactivity disorders (O.R 1.94, 95%C.I. 1.32–2.86), psychotic disorders (O.R 5.12 95% C.I. 2.6–10.1), mood disorders (O.R 2.02, 95%C.I. 1.04–3.92) and intellectual disability (O.R 2.89 95% C.I. 1.89–4.71) were associated with anti-psychotic use.
The prescription of antipsychotic medications in this UK ASD clinical sample is strongly associated with specific co-occurring psychiatric disorders and intellectual disability.
A relative decline in systolic blood pressure has been found to occur prior to and around the clinical onset of dementia but the reasons for this remain unclear.
Aims and objectives
In a large series of surveys carried out using identical methodology in populations with relatively low mean blood pressures we investigated the consistency of the association between dementia, dementia severity and resting blood pressure.
The analysed sample comprised 15,022 participants from eleven cross-sectional surveys carried out in seven low and middle income countries (Cuba, Dominican Republic, Peru, Venezuela, Mexico, China and India). Associations between dementia status (ascertained through a detailed assessment with extensive cross-cultural validation) and resting blood pressure were described for each sample and then compared in meta-analyses.
In age- and sex-adjusted linear regression analyses, there was a high level of between-site heterogeneity in these associations (I-squared 60.2% for dementia and SBP). The only site with significant and consistent associations was Cuba (n=2944), the sample with highest mean systolic blood pressure, where dementia was associated with 7.9mmHg lower systolic blood pressure (95% CI 4.7-11.1) and 2.6mmHg lower diastolic blood pressure (95% CI 0.9-4.2). In general, associations between dementia and lower blood pressure were weak or absent in these surveys.
The association between dementia and low blood pressure, generally observed in Western settings was not observed in these populations with lower hypertension prevalence. These findings do not support a hypothesis that lower blood pressure in dementia is purely secondary to underlying neurodegeneration.
Whereas depression as a risk factor for the incidence of activity limitations in the elderly has been confirmed, little attention has been paid to anxiety, despite its high prevalence, with or without comorbid depression.
In a community-dwelling cohort of 1581 participants aged 65 years and over, the association between trait anxiety symptoms (Spielberger State-Trait Anxiety Inventory, third highest tercile) and current DSM-IV anxiety disorder (GAD, PTSD, OCD, panic disorder, agoraphobia or social phobia) at baseline and 7-year incident activity limitations was determined using mixed logistic regression models. Repeated measures of activity limitations included by increased severity level: social restriction (neighbourhood and house confined), mobility (Rosow and Breslau scale) and limitations in instrumental activities of daily living (IADL).
Of the sample, 42% were male and 14.2% had an anxiety disorder at baseline. Adjusting for socio-demographic and health variables, past and present depression and anxiolytic drugs, trait anxiety symptomatology was associated with increased incidence of social restriction (OR (95% CI): 2.46 (1.45–4.16), p = 0.0008) and current anxiety disorder with an increased risk of incident IADL limitation (OR (95% CI): 1.86 (1.01–3.41), p = 0.046). Associations remained significant in participants free of depressive symptoms at baseline (OR (95% CI): 2.92 (1.41–6.05), p = 0.004; OR (95% CI): 3.21 (1.31–7.89), p = 0.011, respectively).
Despite high comorbidity between depressive and anxiety symptoms, both trait symptomatology and anxiety disorder are independently associated with increased incident dependency with a gradient of severity: trait anxiety symptoms associated with incident social restriction and anxiety disorder with incidence of IADL limitations.
Higher all-cause mortality and shorter life expectancies for people with severe mental illness (SMI, including schizophrenia, schizoaffective disorder, and bipolar disorder) have been frequently reported. Cancer contributes a substantial proportion of mortality (20 to 30%) as the second or third leading cause of death among people with SMI. Outcomes of cancer incidence studies in SMI were considerably heterogeneous, varying by cancer types and mental disorders.
To compare the incidence of overall and each type of cancer between people with SMI in southeast London and general population in UK.
Using the anonymised linkage between a regional monopoly secondary mental health service provider covering four southeast London boroughs and a population-based cancer register, we carried out the comparisons of cancer incidences between people with SMI and general population by age- and gender-standardisation in 2011.
Among SMI subjects with cancer (N=105), the most common cancer types were lung and colorectal cancer followed by breast cancer for women and prostate cancer for men in this area. Standardised incidence ratios (SIRs) for all cancers in SMI were 1.19 (95% CI: 0.97-1.44) overall, 2.43 (95% CI: 1.98-2.94) in men (n=61), and 0.98 (95% CI: 0.71-1.31) in women (n=44). Based on relatively small case numbers, raised SIRs were found for lung cancer in men (SIR=7.57, 95% CI: 3.04-15.6) and women (SIR=7.61, 95% CI: 2.79-16.6), and in women for colorectal (SIR=7.85, 95%CI: 2.55-18.32) and breast cancer (SIR=7.86, 95% CI: 4.58-12.59).
Specific pattern of elevated risks of cancer incidence were found for people with SMI.
Compared to the general population, people with schizophrenia have a substantially higher risk of premature mortality which translates into a 10–15 year reduction in life expectancy. The aim of this investigation was to determine if symptoms (including aggression, hallucinations or delusions, and depression) or the environmental and functional status of people with schizophrenia contribute to the high mortality risk observed in this patient group.
We identified cases of schizophrenia, aged ≥15 years in a large secondary mental healthcare case register linked to national mortality tracing. We modelled the effect of specific symptoms, activities of daily living (ADLs), living conditions, occupational and recreational activities (Health of the Nation Outcome Scale [HoNOS] subscales) on all-cause mortality over a 4-year observation period (2007-10) using Cox regression.
We identified 4270 schizophrenia cases (170 deaths) in the observation period. After controlling for a broad range of covariates, mortality was not significantly associated with hallucinations and delusions or overactive-aggressive behaviour, but was associated with subclinical depression (adjusted HR 1.5; 95% CI 1.1-2.2) and ADL impairment (adjusted HR 1.8; 95% CI 1.2-2.9).
Severity of symptoms, such as delusions and hallucinations, was less important in predicting mortality than subclinical depression and difficulties carrying out activities of daily living. The overall picture appears to be one where the highest all-cause mortality risk is in service users who are least visible to clinical teams.
Longitudinal cognitive change before and after acetyl cholinesterase inhibitor (AChEI) treatment initiation in Alzheimer's disease has never been described previously in a representative clinical population.
To model longitudinal changes in cognitive function for before and after AChEI prescription.
To further investigate differences in response by cognitive function at treatment initiation.
A retrospective longitudinal analysis was carried out of all 1843 patients from the South London and Maudsley NHS Foundation Trust (a large mental health provider to a catchment population of approximately 1.2 m) who were prescribed AChEIs between 2003–10 and had a minimum of one MMSE score within 1 year before treatment initiation and one MMSE score within 3 years after this. Manually extracted MMSE scores were analyzed over this period using three-piece linear mixed models.
Rates of MMSE change were −1.9 (95% CI −2.3,−1.4) in the year before treatment initiation, +1.3 (0.9,1.7) in the 6 months after treatment initiation, and −2.4 (−2.6,−2.3) from 6 months to 3 years. The difference between pre-treatment and 6-month-post-treatment slopes was −0.6 (−1.8,0.6) at baseline (treatment initiation) MMSE of 25 or over, +2.7 (1.7,3.7) at MMSE 21–24, and +4.6 (3.6,5.7) at MMSE 10–20.
In this naturalistic sample, a clear cognitive response to AChEI treatment was observed over the first six months followed by an unchanged decline. Response was substantially higher for patients with lower MMSE scores at treatment initiation.
Tardive dyskinesia (TD) is a persistent and potentially disabling movement disorder associated with prolonged exposure to antipsychotics and other dopamine receptor blocking agents. Valbenazine is a highly selective vesicular monoamine transporter 2 (VMAT2) inhibitor approved for the treatment of TD in adults. Using data from a long-term study (KINECT 3; NCT02274558), the effects of once-daily valbenazine (40 mg, 80 mg) on TD were assessed using the Abnormal Involuntary Movement Scale (AIMS) in participants who were early responders based on subjective measures, including patient self-report (Patient Global Impression of Change [PGIC]) or clinician judgment (Clinical Impression of Change-Tardive Dyskinesia [CGI-TD]).
Data from KINECT 3 (6-week double-blind, placebo-controlled [DBPC] period; 42-week double-blind extension) were analyzed post hoc. Long-term outcomes included mean change from baseline to Week 48 in AIMS total score (sum of items 1-7) and AIMS response (≥50% total score improvement from baseline) at Week 48. These AIMS outcomes were assessed in participants who achieved early improvement, defined as a PGIC or CGI-TD score of ≤3 (“minimally improved” or better) at Week 2 (first post-baseline visit of the DBPC period). Participants who initially received placebo were not included in the analyses.
In participants who received only valbenazine (40 or 80 mg) during KINECT 3 and had available Week 2 assessment, 50% (72/143) had early PGIC improvement (score ≤3) and 43% (61/142) had early CGI-TD improvement (score ≤3). Baseline characteristics were generally similar between participants who achieved early PGIC or CGI-TD improvement and those who did not. Based on available assessments at Week 48, mean AIMS total score change from baseline in participants with early PGIC improvement was similar to those who did not reach the early PGIC improvement threshold (-4.1 [n=35] vs -3.5 [n=41]). Mean AIMS total score change from baseline in participants with early CGI-TD improvement was similar to those who did not achieve early CGI-TD improvement (-4.2 [n=31] vs -3.5 [n=45]). AIMS response at Week 48 was also similar in those who achieved early PGIC and CGI-TD improvement (40% and 42%, respectively) compared to those who did not achieve early PGIC and CGI-TD improvement (39% and 38%, respectively).
Results from this long-term valbenazine trial indicate that many participants achieved at least minimal patient- and clinician-reported improvement at Week 2. AIMS outcomes at Week 48 demonstrated long-term reductions in TD severity regardless of early response. More research is needed to understand the association between early improvement and long-term treatment effects, but early non-improvement based on subjective measures may not be predictive of long-term treatment failure.
International Congress of Parkinson’s Disease and Movement Disorders; September 22-26, 2019; Nice, France.
This study was sponsored by Neurocrine Biosciences, Inc.
Previous research in clinical, community, and school settings has demonstrated positive outcomes for the Secret Agent Society (SAS) social skills training program. This is designed to help children on the autism spectrum become more aware of emotions in themselves and others and to ‘problem-solve’ complex social scenarios. Parents play a key role in the implementation of the SAS program, attending information and support sessions with other parents and providing supervision, rewards, and feedback as their children complete weekly ‘home mission’ assignments. Drawing on data from a school-based evaluation of the SAS program, we examined whether parents’ engagement with these elements of the intervention was linked to the quality of their children’s participation and performance. Sixty-eight 8–14-year-olds (M age = 10.7) with a diagnosis of autism participated in the program. The findings indicated that ratings of parental engagement were positively correlated with children’s competence in completing home missions and with the quality of their contribution during group teaching sessions. However, there was a less consistent relationship between parental engagement and measures of children’s social and emotional skill gains over the course of the program.