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Personality traits (e.g. neuroticism) and the social environment predict risk for internalizing disorders and suicidal behavior. Studying these characteristics together and prospectively within a population confronted with high stressor exposure (e.g. U.S. Army soldiers) has not been done, yet could uncover unique and interactive predictive effects that may inform prevention and early intervention efforts.
Methods
Five broad personality traits and social network size were assessed via self-administered questionnaires among experienced soldiers preparing for deployment (N = 4645) and new soldiers reporting for basic training (N = 6216). Predictive models examined associations of baseline personality and social network variables with recent distress disorders or suicidal behaviors assessed 3- and 9-months post-deployment and approximately 5 years following enlistment.
Results
Among the personality traits, elevated neuroticism was consistently associated with increased mental health risk following deployment. Small social networks were also associated with increased mental health risk following deployment, beyond the variance accounted for by personality. Limited support was found for social network size moderating the association between personality and mental health outcomes. Small social networks also predicted distress disorders and suicidal behavior 5 years following enlistment, whereas unique effects of personality traits on these more distal outcomes were rare.
Conclusions
Heightened neuroticism and small social networks predict a greater risk for negative mental health sequelae, especially following deployment. Social ties may mitigate adverse impacts of personality traits on psychopathology in some contexts. Early identification and targeted intervention for these distinct, modifiable factors may decrease the risk of distress disorders and suicidal behavior.
The Ediacaran rangeomorph Fractofusus misrai is the most common and best-preserved of the E Surface fossil assemblage in the Mistaken Point Ecological Reserve of southeastern Newfoundland, Canada. Fractofusus has been interpreted as a fusiform epifaunal soft-sediment recliner, and like other rangeomorphs it has a self-similar, fractal-like branching morphology. The rangeomorph branching of Fractofusus has been considered to be identical on the upper and lower surfaces; however, study of specimens with complex biostratinomic histories suggests clear differences between the upper and lower surfaces. The first-order branches grew downwards into the sediment from a high point near the midline but grew above the sediment–water interface at their lateral and distal margins. Our new three-dimensional appreciation of rangeomorph branching in Fractofusus explains many of the taphomorphs of Fractofusus including straight, curved, kinked and tousled forms. The three-dimensional morphology, mode of life, taphonomy and palaeoenvironmental interactions of F. misrai are discussed along with a new three-dimensional reconstruction.
Among outpatients with coronavirus disease 2019 (COVID-19) due to the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) δ (delta) variant who did and did not receive 2 vaccine doses at 7 days after symptom onset, there was no difference in viral shedding (cycle threshold difference 0.59, 95% CI, −4.68 to 3.50; P = .77) with SARS-CoV-2 cultured from 2 (7%) of 28 and 1 (4%) of 26 outpatients, respectively.
Clozapine is the only drug licensed for treatment-resistant schizophrenia (TRS) but the real-world clinical and cost-effectiveness of community initiation of clozapine is unclear.
Aims
The aim was to assess the feasibility and cost-effectiveness of community initiation of clozapine.
Method
This was a naturalistic study of community patients recommended for clozapine treatment.
Results
Of 158 patients recommended for clozapine treatment, 88 (56%) patients agreed to clozapine initiation and, of these, 58 (66%) were successfully established on clozapine. The success rate for community initiation was 65.4%; which was not significantly different from that for in-patient initiation (58.82%, χ2(1,88) = 0.47, P = 0.49). Following clozapine initiation, there was a significant reduction in median out-patient visits over 1 year (from 24.00 (interquartile range (IQR) = 14.00–41.00) to 13.00 visits (IQR = 5.00–24.00), P < 0.001), and 2 years (from 47.50 visits (IQR = 24.75–71.00) to 22.00 (IQR = 11.00–42.00), P < 0.001), and a 74.71% decrease in psychiatric hospital bed days (z = −2.50, P = 0.01). Service-use costs decreased (1 year: –£963/patient (P < 0.001); 2 years: –£1598.10/patient (P < 0.001). Subanalyses for community-only initiation also showed significant cost reductions (1 year: –£827.40/patient (P < 0.001); 2 year: –£1668.50/patient (P < 0.001) relative to costs prior to starting clozapine. Relative to before initiation, symptom severity was improved in patients taking clozapine at discharge (median Positive and Negative Syndrome Scale total score: initial visit: 80 (IQR = 71.00–104.00); discharge visit 50.5 (IQR = 44.75–75.00), P < 0.001) and at 2 year follow-up (Health of Nation Outcome Scales total score median initial visit: 13.00 (IQR = 9.00–15.00); 2 year follow-up: 8.00 (IQR = 3.00–13.00), P = 0.023).
Conclusions
These findings indicate that community initiation of clozapine is feasible and is associated with significant reductions in costs, service use and symptom severity.
OBJECTIVES/GOALS: Our hypothesis is that microneedle array (MA) extraction of interstitial fluid (ISF) will enable minimally invasive quantitation of heavy metal (HM) exposure. We aim to establish analytical parameters for ICP-MS analysis of HMs, quantify baseline HM content in ISF vs other fluids, and characterize a mixed HM exposure model. METHODS/STUDY POPULATION: Ten healthy human volunteers were recruited into the study, approved by the UNM Human Research and Resource Committee Each subject had blood and urine collected. ISF was also collected using 3D-printed MAs inserted into the forearm. Additionally, twelve Sprague Dawley rats were unexposed (n=6) or exposed (n=6) to ad libitum water containing a mixture of uranium (U), cadmium (Cd), vanadium (V), and arsenic (As), each at 5X the maximum contaminant level (MCL) for drinking water under a protocol approved by the UNM animal care and use program. Human and animal fluids were analyzed, using ICP-MS, to quantify the levels of U, Cd, V, and As. RESULTS/ANTICIPATED RESULTS: Recent advances in ISF extraction and analysis suggest a minimally invasive method that can be adapted to monitor HM exposure and biological loads longitudinally in both localized and dispersed communities. ISF can be collected with MAs and is a rich source of disease and exposure biomarkers. However, determining biological loads remains challenging due to the need to collect blood or urine from a dispersed rural population over time. Our preliminary results suggest similar HM concentrations in ISF, compared with blood in small unexposed human and animal populations. All four metals can be successfully quantified in tandem using ICP-MS. DISCUSSION/SIGNIFICANCE: Chronic exposure to heavy metals (HM) is associated with detrimental health effects. Exposure to multiple HMs is suspected to have additive or synergistic harmful effects. We envision a wearable microneedle patch that could be mailed to individuals or distributed through community centers, worn for a few hours, and returned to a central laboratory.
The North American Waterfowl Management Plan highlights the importance of enhancing waterfowl habitat for productivity and resilience. Many forms of land management are conducted in wetlands to support the diverse communities of waterfowl and other species. Primary burrowing crayfish are also abundant and important in these environments, but little research is available assessing the effects of waterfowl land management on primary burrowers. We examined the response of the digger crayfish, Creaserinus fodiens, to the common vegetation management practices of mowing and disking at waterfowl conservation areas in south-eastern Missouri. Our results demonstrated that at a fine scale, crayfish density was affected by only canopy cover. We also highlighted distributional effects of landscape-level environmental variables and suggested that habitat generalists were tolerant of vegetation management, responding more to vegetation composition and broader landscape effects. We discuss wetlands conservation practices and suggest that burrowing crayfish management would integrate well with some current management strategies for waterfowl.
The rate of normal birth outcomes (i.e. full-term births without intervention) for women with severe mental illness (SMI – psychotic and bipolar disorders) is not known. We examined rates of birth without intervention (spontaneous labour onset, spontaneous vaginal delivery without instruments, no episiotomy and no indication of pre- or post-delivery anaesthesia) in women with SMI (584 pregnancies) compared with a control population (70 942 pregnancies). Outcome ratios were calculated standardising for age. Women with SMI were less likely to have a birth without intervention (29.5%) relative to the control population (36.8%) (standardised outcome ratio 0.74, 95% CI 0.63–0.87).
Impaired olfaction may be a biomarker for early Lewy body disease, but its value in mild cognitive impairment with Lewy bodies (MCI-LB) is unknown. We compared olfaction in MCI-LB with MCI due to Alzheimer’s disease (MCI-AD) and healthy older adults. We hypothesized that olfactory function would be worse in probable MCI-LB than in both MCI-AD and healthy comparison subjects (HC).
Design:
Cross-sectional study assessing olfaction using Sniffin’ Sticks 16 (SS-16) in MCI-LB, MCI-AD, and HC with longitudinal follow-up. Differences were adjusted for age, and receiver operating characteristic (ROC) curves were used for discriminating MCI-LB from MCI-AD and HC.
Setting:
Participants were recruited from Memory Services in the North East of England.
Participants:
Thirty-eight probable MCI-LB, 33 MCI-AD, 19 possible MCI-LB, and 32HC.
Measurements:
Olfaction was assessed using SS-16 and a questionnaire.
Results:
Participants with probable MCI-LB had worse olfaction than both MCI-AD (age-adjusted mean difference (B) = 2.05, 95% CI: 0.62–3.49, p = 0.005) and HC (B = 3.96, 95% CI: 2.51–5.40, p < 0.001). The previously identified cutoff score for the SS-16 of ≤ 10 had 84% sensitivity for probable MCI-LB (95% CI: 69–94%), but 30% specificity versus MCI-AD. ROC analysis found a lower cutoff of ≤ 7 was better (63% sensitivity for MCI-LB, with 73% specificity vs MCI-AD and 97% vs HC). Asking about olfactory impairments was not useful in identifying them.
Conclusions:
MCI-LB had worse olfaction than MCI-AD and normal aging. A lower cutoff score of ≤ 7 is required when using SS-16 in such patients. Olfactory testing may have value in identifying early LB disease in memory services.
The present study aimed to clarify the neuropsychological profile of the emergent diagnostic category of Mild Cognitive Impairment with Lewy bodies (MCI-LB) and determine whether domain-specific impairments such as in memory were related to deficits in domain-general cognitive processes (executive function or processing speed).
Method:
Patients (n = 83) and healthy age- and sex-matched controls (n = 34) underwent clinical and imaging assessments. Probable MCI-LB (n = 44) and MCI-Alzheimer’s disease (AD) (n = 39) were diagnosed following National Institute on Aging-Alzheimer’s Association (NIA-AA) and dementia with Lewy bodies (DLB) consortium criteria. Neuropsychological measures included cognitive and psychomotor speed, executive function, working memory, and verbal and visuospatial recall.
Results:
MCI-LB scored significantly lower than MCI-AD on processing speed [Trail Making Test B: p = .03, g = .45; Digit Symbol Substitution Test (DSST): p = .04, g = .47; DSST Error Check: p < .001, g = .68] and executive function [Trail Making Test Ratio (A/B): p = .04, g = .52] tasks. MCI-AD performed worse than MCI-LB on memory tasks, specifically visuospatial (Modified Taylor Complex Figure: p = .01, g = .46) and verbal (Rey Auditory Verbal Learning Test: p = .04, g = .42) delayed recall measures. Stepwise discriminant analysis correctly classified the subtype in 65.1% of MCI patients (72.7% specificity, 56.4% sensitivity). Processing speed accounted for more group-associated variance in visuospatial and verbal memory in both MCI subtypes than executive function, while no significant relationships between measures were observed in controls (all ps > .05)
Conclusions:
MCI-LB was characterized by executive dysfunction and slowed processing speed but did not show the visuospatial dysfunction expected, while MCI-AD displayed an amnestic profile. However, there was considerable neuropsychological profile overlap and processing speed mediated performance in both MCI subtypes.
… when [the army] was mistaken enough to come down into the arena and to play politics instead of controlling them, it began a descent which ended in its abject defeat – militarily, politically, spiritually. (Wheeler-Bennett 2005 [1953], p. xxxii)
To whom or what does an army—as the primary force of the sole legitimate yielder of violence on behalf of a community with its own internationally recognized territory, the state—owe its loyalty? To representations of the state—the constitution, the head of state, the nation, a noble ideal, its own professional éclat? Or to the government—the president or prime minister, the legislature, the ruling party of the day? This dilemma is at the heart of all discussions of civil-military relations. Those who believe that armies are not faced with this dilemma live in fantasyland. The army, as a central pillar of the modern state, is inevitably a political institution, and the answer to the opening question above is quintessentially a political one. The answers given to this question at various times have determined the role of the armies of Thailand and Myanmar, and of most of the other countries in Southeast Asia if not the world, since the formation of the modern, professional militaries of independent states. Both of those armies, since 1911 in the case of Thailand and since 1948 in the case of Myanmar, have been deeply involved in politics, but to different degrees at different times. The devil, as always, is in the detail, as the contributions to this volume make amply clear.
The extensive theoretical literature on the political role of the military has provided a variety of taxonomies for the degree of military involvement in politics during the course of the past century and more. For example, Samuel Finer, in his classic The Man on Horseback, set out six levels of involvement—from normal constitutional mechanisms through to intimidation and threats, and to failure to protect or outright violence against civilian authorities (Finer 2005, p. 140). Like Finer, other analysts lay out various continua of degrees to which the military directly involves itself in politics, up to and including direct military rule such as that in Myanmar between 1988 and 2011 and in Thailand between—most recently—2015 and 2019.
Electroencephalographic (EEG) abnormalities are greater in mild cognitive impairment (MCI) with Lewy bodies (MCI-LB) than in MCI due to Alzheimer’s disease (MCI-AD) and may anticipate the onset of dementia. We aimed to assess whether quantitative EEG (qEEG) slowing would predict a higher annual hazard of dementia in MCI across these etiologies. MCI patients (n = 92) and healthy comparators (n = 31) provided qEEG recording and underwent longitudinal clinical and cognitive follow-up. Associations between qEEG slowing, measured by increased theta/alpha ratio, and clinical progression from MCI to dementia were estimated with a multistate transition model to account for death as a competing risk, while controlling for age, cognitive function, and etiology classified by an expert consensus panel.
Over a mean follow-up of 1.5 years (SD = 0.5), 14 cases of incident dementia and 5 deaths were observed. Increased theta/alpha ratio on qEEG was associated with increased annual hazard of dementia (hazard ratio = 1.84, 95% CI: 1.01–3.35). This extends previous findings that MCI-LB features early functional changes, showing that qEEG slowing may anticipate the onset of dementia in prospectively identified MCI.
How do actors undertake institutional design in complex systems? Scholars recognize that many international regimes are becoming increasingly complex. Yet relatively little is known about how actors design or redesign institutions amid this complexity. As participant-observers in the UN negotiations on investment treaty reform, we have watched state officials and other participants grapple with this question for several years. To help explain what we have observed, we conceptualize these participants as complex designers—actors who seek to design and redesign institutions within complex adaptive systems. We then formulate three emergent design principles that seem to guide their approach as they aim to create: flexible structures, balanced content, and adaptive management processes. In a dynamic era marked by unpredictability, division, and complex transnational challenges, we believe these concepts may prove to be increasingly relevant in global governance.
Across Eurasia, horse transport transformed ancient societies. Although evidence for chariotry is well dated, the origins of horse riding are less clear. Techniques to distinguish chariotry from riding in archaeological samples rely on elements not typically recovered from many steppe contexts. Here, the authors examine horse remains of Mongolia's Deer Stone-Khirigsuur (DSK) Complex, comparing them with ancient and modern East Asian horses used for both types of transport. DSK horses demonstrate unique dentition damage that could result from steppe chariotry, but may also indicate riding with a shallow rein angle at a fast gait. A key role for chariots in Late Bronze Age Mongolia helps explain the trajectory of horse use in early East Asia.
Chefs have the potential to influence diet quality and food systems sustainability through their work. We aimed to assess the attitudes and perceptions of culinary students about nutrition and sustainability as part of their roles, responsibilities and future work as chefs.
Design:
We surveyed students attending the Culinary Institute of America (CIA) in the fall of 2019 (n 546). Descriptive statistics compared food priority rankings and Likert-scale distributions of nutrition and sustainability attitudes and beliefs. Adjusted generalised linear models were used to evaluate whether there were differences in attitudes and beliefs across demographic groups.
Setting:
The CIA, a private, not-for-profit college and culinary school with US campuses in New York, California and Texas.
Participants:
Students >18 years old currently enrolled in any of the school’s associate’s or bachelor’s degree programs.
Results:
Students agreed that chefs should be knowledgeable about nutrition (96·0 %) and the environmental impact of their ingredients (90·8 %) but fewer considered healthfulness (57·8 %) and environmental impact (60·2 %) of their food to be primary considerations in their career as a chef. Taste was the primary factor influencing culinary students’ food choices but food priorities differed by race/ethnicity.
Conclusions:
Culinary students believe nutrition and sustainability are important. Opportunities exist to empower them with knowledge and skills for promoting public health and sustainable food systems in their future work as chefs.
The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in improving surrogates’ mental health and patient outcomes.
Method
Part 1 involved obtaining qualitative stakeholder feedback from 5 bereaved surrogates and 10 critical care and mental health clinicians. Stakeholders were provided with the manual and prompted for feedback on its content, format, and language. Feedback was organized and incorporated into the manual, which was then re-circulated until consensus. In Part 2, surrogates of critically ill patients admitted to an intensive care unit (ICU) reporting moderate anxiety or close attachment were enrolled in an open trial of EMPOWER. Surrogates completed six, 15–20 min modules, totaling 1.5–2 h. Surrogates were administered measures of peritraumatic distress, experiential avoidance, prolonged grief, distress tolerance, anxiety, and depression at pre-intervention, post-intervention, and at 1-month and 3-month follow-up assessments.
Results
Part 1 resulted in changes to the EMPOWER manual, including reducing jargon, improving navigability, making EMPOWER applicable for a range of illness scenarios, rearranging the modules, and adding further instructions and psychoeducation. Part 2 findings suggested that EMPOWER is feasible, with 100% of participants completing all modules. The acceptability of EMPOWER appeared strong, with high ratings of effectiveness and helpfulness (M = 8/10). Results showed immediate post-intervention improvements in anxiety (d = −0.41), peritraumatic distress (d = −0.24), and experiential avoidance (d = −0.23). At the 3-month follow-up assessments, surrogates exhibited improvements in prolonged grief symptoms (d = −0.94), depression (d = −0.23), anxiety (d = −0.29), and experiential avoidance (d = −0.30).
Significance of results
Preliminary data suggest that EMPOWER is feasible, acceptable, and associated with notable improvements in psychological symptoms among surrogates. Future research should examine EMPOWER with a larger sample in a randomized controlled trial.
Supraglacial ponds and ice cliffs can dramatically enhance ablation rates on debris-covered glaciers. Supraglacial ponds can also coalesce, forming moraine-dammed lakes at risk of glacial lake outburst flood (GLOF). Given Bhutanese glaciers have some of the highest ice loss rates in the Himalaya and GLOF vulnerability is high, we seek to advance our understanding of the spatial distribution and evolution of supraglacial ponds and ice cliffs. Here, we use high-resolution (3 m) Planet Labs satellite imagery to provide the first short-term, high-resolution dataset of supraglacial pond and ice cliff evolution for three glaciers along the Bhutan–Tibet border from 2016 to 2018. A total of 5754 ponds and 2088 ice cliffs were identified. Large intra-annual changes were observed, with ponded area changes and drainage events coinciding with the seasonality of the Indian Summer Monsoon. On average, ~19% of the total number of ponds had a coincident ice cliff. Pond spatial distribution was driven by ice-surface velocities, with higher numbers of ponds found in areas of low velocity (<8 m a−1). Our study provides the first detailed, quantitative investigation of supraglacial ponds and ice cliffs in Bhutan, providing a framework for further monitoring in this understudied, yet important, region of the Himalaya.
To conduct a meta-analysis of the effect of ketamine on psychopathology in healthy volunteers and patients with schizophrenia, and the experimental factors affecting this.
Background
Ketamine is increasingly used to treat depression and other psychiatric disorders but can induce schizophrenia-like symptoms. Despite this, the consistency and magnitude of symptoms induced by ketamine, or what factors influence the effects of ketamine on these remain unknown.
Method
MEDLINE, EMBASE and PsychINFO databases were searched for within-subject placebo controlled studies reporting symptoms using the Brief Psychiatric Rating Scale (BPRS) or Positive and Negative Syndrome Scale (PANSS) in response to an acute ketamine challenge in healthy participants or people with schizophrenia. Two independent investigators extracted study-level data for a random-effects meta-analysis. Total, positive and negative BPRS and PANSS scores were extracted. Sub-group analyses were conducted examining the effect of: blinding status, ketamine preparation, infusion method and time between ketamine and placebo condition. Standardized mean change scores were used as effect sizes for individual studies. Standardized mean changes between ketamine and placebo for total, positive and negative BPRS and PANSS were calculated.
Result
Of 7819 citations retrieved, 36 studies involving healthy participants were included. The overall sample included 725 healthy volunteers exposed to both the ketamine and placebo condition. Ketamine induced a significant increase in transient psychopathology in healthy participants, for total (Standardized mean change (SMC) = 1.50 (95% CI = 1.23 to 1.77), p < 0.0001), positive (SMC = 1.55 (95% CI = 1.29 to 1.81), p < 0.0001) and negative (SMC = 1.16, (95% CI = 0.96 to 1.35), p < 0.0001) symptom ratings, relative to the placebo condition. This effect was significantly greater for positive symptoms than negative symptoms (p = 0.004). Bolus followed by constant infusion increased ketamine's effect on positive symptoms relative to infusion alone (p = 0.006). Single-day study design increased ketamine's effect on total symptoms (p = 0.007), but age and gender did not moderate effects. There were insufficient studies for meta-analysis of studies in schizophrenia. Of these studies, two found a significant increase in symptoms with ketamine administration in total and positive symptoms. Only one study found an increase in negative symptom severity with ketamine.
Conclusion
These findings show that acute ketamine administration induces schizophrenia-like symptomatology with large effect sizes but there is a greater increase in positive than negative symptoms, and when a bolus is used. These findings suggest bolus doses should be avoided in its therapeutic use to minimize the risk of inducing transient positive psychotic symptoms.
Like the rest of the region, Myanmar was under partial lockdown in 2020 as a measure designed to stop the spread of COVID-19. However, it was also an election year in a country that was experiencing continuing (and in some cases expanding) armed conflict, reeling from the aftermath of a mass migration of Muslim Rohingya from the northern Rakhine State and burdened with an economy that displayed few signs of growth. The lockdown of Yangon since 20 September 2020 has disrupted both the economic centre of the country as well as campaigning for the election. Conditions were far from ideal to conduct the third ever general election to be held under the army-drafted constitution of 2008, but the National League for Democracy (NLD) government insisted that the hustings proceed as scheduled despite calls for a postponement by several opposition parties.
The 2020 Election Campaign
The general election was contested by ninety-three political parties, which accounted for 6,742 candidates collectively. This was rounded up by a further 281 candidates who ran as independents in the election. With the usual campaign rallies and parades cancelled because of lockdown measures, Facebook became a central source of information for many voters during the run-up to polling day on 8 November. Both the NLD and the Union Solidarity and Development Party (USDP), which was formerly the ruling party and now the leading opposition party, relied heavily on Facebook, while other political parties, such as the People's Pioneer Party (PPP) (led by former NLD leader Daw Thet Thet Khine) and the Union Betterment Party (UBP) (led by former general Thura U Shwe Mann, who was the third-most senior in the junta), invested sums of money on their Facebook information campaigns.
The election was surrounded by controversy as many claimed that “democracy” under the NLD and its leader, Daw Aung San Suu Kyi (who wields real power as State Counsellor, a position she was anointed to after being constitutionally disqualified from holding the presidency), were becoming increasingly authoritarian since their electoral victory in 2015. Certainly, there were grounds for complaint, including the disenfranchisement of persons who are of the so-called Rohingya ethnicity. Some 730,000 of the Rohingyas had fled to neighbouring Bangladesh in 2017 following military reprisals after the Arakan Rohingya Salvation Army (ARSA) had attacked police stations in the northern Rakhine State.