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The COVID-19 pandemic has affected all our lives, not only through the infection itself but also through the measures taken to control the spread of the virus (e.g. lockdown).
Aims
Here, we investigated how the COVID-19 pandemic and unprecedented lockdown affected the mental health of young adults in England and Wales.
Method
We compared the mental health symptoms of up to 4773 twins in their mid-20s in 2018 prior to the COVID-19 pandemic (T1) and during four-wave longitudinal data collection during the pandemic in April, July and October 2020, and in March 2021 (T2–T5) using phenotypic and genetic longitudinal designs.
Results
The average changes in mental health were small to medium and mainly occurred from T1 to T2 (average Cohen d = 0.14). Despite the expectation of catastrophic effects of the pandemic on mental health, we did not observe trends in worsening mental health during the pandemic (T3–T5). Young people with pre-existing mental health problems were disproportionately affected at the beginning of the pandemic, but their increased problems largely subsided as the pandemic persisted. Twin analyses indicated that the aetiology of individual differences in mental health symptoms did not change during the lockdown (average heritability 33%); the average genetic correlation between T1 and T2–T5 was 0.95, indicating that genetic effects before the pandemic were substantially correlated with genetic effects up to a year later.
Conclusions
We conclude that on average the mental health of young adults in England and Wales has been remarkably resilient to the effects of the pandemic and associated lockdown.
Let
$\eta (G)$
be the number of conjugacy classes of maximal cyclic subgroups of G. We prove that if G is a p-group of order
$p^n$
and nilpotence class l, then
$\eta (G)$
is bounded below by a linear function in
$n/l$
.
Evidence suggests that cognitive subtypes exist in schizophrenia that may reflect different neurobiological trajectories. We aimed to identify whether IQ-derived cognitive subtypes are present in early-phase schizophrenia-spectrum disorder and examine their relationship with brain structure and markers of neuroinflammation.
Method
161 patients with recent-onset schizophrenia spectrum disorder (<5 years) were recruited. Estimated premorbid and current IQ were calculated using the Wechsler Test of Adult Reading and a 4-subtest WAIS-III. Cognitive subtypes were identified with k-means clustering. Freesurfer was used to analyse 3.0 T MRI. Blood samples were analysed for hs-CRP, IL-1RA, IL-6 and TNF-α.
Results
Three subtypes were identified indicating preserved (PIQ), deteriorated (DIQ) and compromised (CIQ) IQ. Absolute total brain volume was significantly smaller in CIQ compared to PIQ and DIQ, and intracranial volume was smaller in CIQ than PIQ (F(2, 124) = 6.407, p = 0.002) indicative of premorbid smaller brain size in the CIQ group. CIQ had higher levels of hs-CRP than PIQ (F(2, 131) = 5.01, p = 0.008). PIQ showed differentially impaired processing speed and verbal learning compared to IQ-matched healthy controls.
Conclusions
The findings add validity of a neurodevelopmental subtype of schizophrenia identified by comparing estimated premorbid and current IQ and characterised by smaller premorbid brain volume and higher measures of low-grade inflammation (CRP).
Relapse and recurrence of depression are common, contributing to the overall burden of depression globally. Accurate prediction of relapse or recurrence while patients are well would allow the identification of high-risk individuals and may effectively guide the allocation of interventions to prevent relapse and recurrence.
Aims
To review prognostic models developed to predict the risk of relapse, recurrence, sustained remission, or recovery in adults with remitted major depressive disorder.
Method
We searched the Cochrane Library (current issue); Ovid MEDLINE (1946 onwards); Ovid Embase (1980 onwards); Ovid PsycINFO (1806 onwards); and Web of Science (1900 onwards) up to May 2021. We included development and external validation studies of multivariable prognostic models. We assessed risk of bias of included studies using the Prediction model risk of bias assessment tool (PROBAST).
Results
We identified 12 eligible prognostic model studies (11 unique prognostic models): 8 model development-only studies, 3 model development and external validation studies and 1 external validation-only study. Multiple estimates of performance measures were not available and meta-analysis was therefore not necessary. Eleven out of the 12 included studies were assessed as being at high overall risk of bias and none examined clinical utility.
Conclusions
Due to high risk of bias of the included studies, poor predictive performance and limited external validation of the models identified, presently available clinical prediction models for relapse and recurrence of depression are not yet sufficiently developed for deploying in clinical settings. There is a need for improved prognosis research in this clinical area and future studies should conform to best practice methodological and reporting guidelines.
Psychosis is a major mental illness with first onset in young adults. The prognosis is poor in around half of the people affected, and difficult to predict. The few tools available to predict prognosis have major weaknesses which limit their use in clinical practice. We aimed to develop and validate a risk prediction model of symptom non-remission in first-episode psychosis.
Method
Our development cohort consisted of 1027 patients with first-episode psychosis recruited between 2005 to 2010 from 14 early intervention services across the National Health Service in England. Our validation cohort consisted of 399 patients with first-episode psychosis recruited between 2006 to 2009 from a further 11 English early intervention services. The one-year non-remission rate was 52% and 54% in the development and validation cohorts, respectively. Multivariable logistic regression was used to develop a risk prediction model for non-remission, which was externally validated.
Result
The prediction model showed good discrimination (C-statistic of 0.74 (0.72, 0.76) and adequate calibration with intercept alpha of 0.13 (0.03, 0.23) and slope beta of 0.99 (0.87, 1.12). Our model improved the net-benefit by 16% at a risk threshold of 50%, equivalent to 16 more detected non-remitted first-episode psychosis individuals per 100 without incorrectly classifying remitted cases.
Conclusion
Once prospectively validated, our first episode psychosis prediction model could help identify patients at increased risk of non-remission at initial clinical contact.
Morgan and Parker proved that if G is a group with
${\textbf{Z}(G)} = 1$
, then the connected components of the commuting graph of G have diameter at most
$10$
. Parker proved that if, in addition, G is solvable, then the commuting graph of G is disconnected if and only if G is a Frobenius group or a
$2$
-Frobenius group, and if the commuting graph of G is connected, then its diameter is at most
$8$
. We prove that the hypothesis
$Z (G) = 1$
in these results can be replaced with
$G' \cap {\textbf{Z}(G)} = 1$
. We also prove that if G is solvable and
$G/{\textbf{Z}(G)}$
is either a Frobenius group or a
$2$
-Frobenius group, then the commuting graph of G is disconnected.
This chapter looks at the proliferation and pluralization of the subject of human rights, in terms of identity and difference, in the twentieth century, with its inclusion of previously elided constituencies – women, LGBTQ individuals, persons with disabilities, migrants, and so on. The authors test the limits of this plurality by studying its imbrication with heteronormative notions of reproductive futurism, transnormativity, ableism, and neoliberal agency. The texts in consideration are three documentary films – Growing up Coy, Born in the Wrong Body: My Transgender Kid and Kids on the Edge: the Gender Clinic. This chapter seeks to understand the potentialities and limitations of transformative identity-based legal categories, and the children whose personal lives are derecognized within the systems of these categories, and also to ‘queer’ or ‘crip’ established human rights discourses which have their roots in heterosexist notions of ownership of one's body.
Cognitive-behavioural therapy (CBT) is an effective treatment for depressed adults. CBT interventions are complex, as they include multiple content components and can be delivered in different ways. We compared the effectiveness of different types of therapy, different components and combinations of components and aspects of delivery used in CBT interventions for adult depression. We conducted a systematic review of randomised controlled trials in adults with a primary diagnosis of depression, which included a CBT intervention. Outcomes were pooled using a component-level network meta-analysis. Our primary analysis classified interventions according to the type of therapy and delivery mode. We also fitted more advanced models to examine the effectiveness of each content component or combination of components. We included 91 studies and found strong evidence that CBT interventions yielded a larger short-term decrease in depression scores compared to treatment-as-usual, with a standardised difference in mean change of −1.11 (95% credible interval −1.62 to −0.60) for face-to-face CBT, −1.06 (−2.05 to −0.08) for hybrid CBT, and −0.59 (−1.20 to 0.02) for multimedia CBT, whereas wait list control showed a detrimental effect of 0.72 (0.09 to 1.35). We found no evidence of specific effects of any content components or combinations of components. Technology is increasingly used in the context of CBT interventions for depression. Multimedia and hybrid CBT might be as effective as face-to-face CBT, although results need to be interpreted cautiously. The effectiveness of specific combinations of content components and delivery formats remain unclear. Wait list controls should be avoided if possible.
OBJECTIVES/SPECIFIC AIMS: To use a systematic and iterative process to develop and refine toolkits to support dissemination and implementation (D&I) research. METHODS/STUDY POPULATION: Participants included research staff from the Dissemination and Implementation Research Core (DIRC), a research methods core from the Institute of Clinical and Translational Science at Washington University in St. Louis, other D&I experts from the University, and national experts from the D&I field. This project used education design research methodology and a systematic and iterative process involving several phases. The first phase (preliminary research and initial development) consisted of analysis of the educational problem and its context, and led to the development of toolkit prototypes and plans for their implementation. In the second phase (development and formative evaluation), toolkits were iteratively evaluated with emphasis on content validity and consistency and effectiveness as perceived by the users. Finally, in the summative evaluation, the toolkits were evaluated based on their use as intended. RESULTS/ANTICIPATED RESULTS: Our team identified the target audience as DIRC customers and investigators from disciplines across the University, and found that resources for beginners to D&I were lacking. The team developed 8 toolkits: (1) Introduction to D&I; (2) How to develop D&I Aims; (3) D&I Designs; (4) Implementation Outcomes; (5) Implementation Organizational Measures; (6) Assessing Barriers and Facilitators; (7) D&I Designs; and (8) Guideline research. These prototypes were iteratively revised for content validity and consistency. Finally, each toolkit was evaluated by two national experts in D&I science, and further refined. DISCUSSION/SIGNIFICANCE OF IMPACT: This systematic and cyclical process led to the development of 8 toolkits to support researchers in D&I science, which are now available on the DIRC Web site. This set the stage for development of new toolkits as additional needs are identified.
To determine whether antimicrobial-impregnated textiles decrease the acquisition of pathogens by healthcare provider (HCP) clothing.
DESIGN
We completed a 3-arm randomized controlled trial to test the efficacy of 2 types of antimicrobial-impregnated clothing compared to standard HCP clothing. Cultures were obtained from each nurse participant, the healthcare environment, and patients during each shift. The primary outcome was the change in total contamination on nurse scrubs, measured as the sum of colony-forming units (CFU) of bacteria.
PARTICIPANTS AND SETTING
Nurses working in medical and surgical ICUs in a 936-bed tertiary-care hospital.
INTERVENTION
Nurse subjects wore standard cotton-polyester surgical scrubs (control), scrubs that contained a complex element compound with a silver-alloy embedded in its fibers (Scrub 1), or scrubs impregnated with an organosilane-based quaternary ammonium and a hydrophobic fluoroacrylate copolymer emulsion (Scrub 2). Nurse participants were blinded to scrub type and randomly participated in all 3 arms during 3 consecutive 12-hour shifts in the intensive care unit.
RESULTS
In total, 40 nurses were enrolled and completed 3 shifts. Analyses of 2,919 cultures from the environment and 2,185 from HCP clothing showed that scrub type was not associated with a change in HCP clothing contamination (P=.70). Mean difference estimates were 0.118 for the Scrub 1 arm (95% confidence interval [CI], −0.206 to 0.441; P=.48) and 0.009 for the Scrub 2 rm (95% CI, −0.323 to 0.342; P=.96) compared to the control. HCP became newly contaminated with important pathogens during 19 of the 120 shifts (16%).
CONCLUSIONS
Antimicrobial-impregnated scrubs were not effective at reducing HCP contamination. However, the environment is an important source of HCP clothing contamination.
In this study photo-identification data were used to better understand movements, population structure and abundance of common bottlenose dolphin (Tursiops truncatus) in south-west England and surrounding waters, to inform conservation efforts. A catalogue of 485 photographic sightings of 113 individuals was compiled from ~150 common bottlenose dolphin encounters made on 87 dates between March 2007 and January 2014. From these and other data, three likely sub-populations were identified in the western English Channel, demarcated by bathymetry and distance to land: (1) south-west England – inshore Cornwall to Devon, (2) offshore English/French waters and (3) inshore France from Brittany to Normandy. Maximum abundance estimates for south-west England coastal waters, using two methods, ranged between 102 and 113 (range 87–142, 95% CL) over the period 2008–2013, likely qualifying the region as nationally important, whilst the yearly maximum was 58 in 2013. The population was centred on Cornwall, where 19 well-marked animals were considered ‘probable’ residents. There were no ‘probable’ resident well-marked individuals found to be restricted to either Devon or Dorset, with animals moving freely within coastal areas across the three counties. Movements were also detected within offshore English waters and French waters (from other studies) of the western English Channel, but no interchange has as yet been detected between the three regions, highlighting the possible separation of the populations, though sample sizes are insufficient to confirm this. Given the findings, south-west England waters should be considered as a separate management unit requiring targeted conservation efforts.
We welcome Kline's attempt to develop an overarching framework to allow much needed collaboration between fields in the study of teaching. While we see much utility in this enterprise, we are concerned that there is too much focus on the behavior of the teacher, without examining results or costs, and the categories within the framework are not sufficiently distinct.
Edited by
P.H. Cullum, Head of History at the University of Huddersfield,Katherine J. Lewis, Senior Lecturer in History at the University of Huddersfield
The complex relationship between masculinity and religion, as experienced in both the secular and ecclesiastical worlds, forms the focus for this volume, whose range encompasses the rabbis of the Babylonian and Palestinian Talmud, and moves via Carolingian and Norman France, Siena, Antioch, and high and late medieval England to the eve of the Reformation. Chapters investigate the creation and reconstitution of different expressions of masculine identity, from the clerical enthusiasts for marriage to the lay practitioners of chastity, from crusading bishops to holy kings. They also consider the extent to which lay and clerical understandings of masculinity existed in an unstable dialectical relationship, at times sharing similar features, at others pointedly different, co-opting and rejecting features of the other; the articles show this interplay to be more far more complicated than a simple linear narrative of either increasing divergence, or of clerical colonization of lay masculinity. They also challenge conventional historiographies of the adoption of clerical celibacy, of the decline of monasticism and the gendered nature of piety. Patricia Cullum is Head of History at the University of Huddersfield; Katherine J. Lewis is Senior Lecturer in History at the University of Huddersfield. Contributors: James G. Clark, P.H. Cullum, Kirsten A. Fenton, Joanna Huntington, Katherine J. Lewis, Matthew Mesley, Catherine Sanok, Michael L. Satlow, Rachel Stone, Jennifer D. Thibodeaux, Marita von Weissenberg
Edited by
P.H. Cullum, Head of History at the University of Huddersfield,Katherine J. Lewis, Senior Lecturer in History at the University of Huddersfield
Edited by
P.H. Cullum, Head of History at the University of Huddersfield,Katherine J. Lewis, Senior Lecturer in History at the University of Huddersfield
Edited by
P.H. Cullum, Head of History at the University of Huddersfield,Katherine J. Lewis, Senior Lecturer in History at the University of Huddersfield
Edited by
P.H. Cullum, Head of History at the University of Huddersfield,Katherine J. Lewis, Senior Lecturer in History at the University of Huddersfield
Edited by
P.H. Cullum, Head of History at the University of Huddersfield,Katherine J. Lewis, Senior Lecturer in History at the University of Huddersfield
Patients undergoing orthopedic surgery are susceptible to methicillin-resistant Staphylococcus aureus (MRSA) infections, which can result in increased morbidity, hospital lengths of stay, and medical costs. We sought to estimate the economic value of routine preoperative MRSA screening and decolonization of orthopedic surgery patients.
Methods.
A stochastic decision-analytic computer simulation model was used to evaluate the economic value of implementing this strategy (compared with no preoperative screening or decolonization) among orthopedic surgery patients from both the third-party payer and hospital perspectives. Sensitivity analyses explored the effects of varying MRSA colonization prevalence, the cost of screening and decolonization, and the probability of decolonization success.
Results.
Preoperative MRSA screening and decolonization was strongly cost-effective (incremental cost-effectiveness ratio less than $6,000 per quality-adjusted life year) from the third-party payer perspective even when MRSA prevalence was as low as 1%, decolonization success was as low as 25%, and decolonization costs were as high as $300 per patient. In most scenarios this strategy was economically dominant (ie, less costly and more effective than no screening). From the hospital perspective, preoperative MRSA screening and decolonization was the economically dominant strategy for all scenarios explored.
Conclusions.
Routine preoperative screening and decolonization of orthopedic surgery patients may under many circumstances save hospitals and third-party payers money while providing health benefits.