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We describe the incidence of suicidality (2007–2017) in people with depression treated by secondary mental healthcare services at South London and Maudsley NHS Trust (n = 26 412). We estimated yearly incidence of ‘suicidal ideation’ and ‘high risk of suicide’ from structured and free-text fields of the Clinical Record Interactive Search system. The incidence of suicidal ideation increased from 0.6 (2007) to 1 cases (2017) per 1000 population. The incidence of high risk of suicide, based on risk forms, varied between 0.06 and 0.50 cases per 1000 adult population (2008–2017). Electronic health records provide the opportunity to examine suicidality on a large scale, but the impact of service-related changes in the use of structured risk assessment should be considered.
Emerging from the warehouse of knowledge about terrestrial ecosystem functioning and the application of the systems ecology paradigm, exemplified by the power of simulation modeling, tremendous strides have been made linking the interactions of the land, atmosphere, and water locally to globally. Through integration of ecosystem, atmospheric, soil, and more recently social science interactions, plausible scenarios and even reasonable predictions are now possible about the outcomes of human activities. The applications of that knowledge to the effects of changing climates, human-caused nitrogen enrichment of ecosystems, and altered UV-B radiation represent challenges addressed in this chapter. The primary linkages addressed are through the C, N, S, and H2O cycles, and UV-B radiation. Carbon dioxide exchanges between land and the atmosphere, N additions and losses to and from lands and waters, early studies of SO2 in grassland ecosystem, and the effects of UV-B radiation on ecosystems have been mainstays of research described in this chapter. This research knowledge has been used in international and national climate assessments, for example the IPCC, US National Climate Assessment, and Paris Climate Accord. Likewise, the knowledge has been used to develop concepts and technologies related to sustainable agriculture, C sequestration, and food security.
To better understand coronavirus disease 2019 (COVID-19) transmission among healthcare workers (HCWs), we investigated occupational and nonoccupational risk factors associated with cumulative COVID-19 incidence among a Massachusetts HCW cohort.
Design, setting, and participants:
The retrospective cohort study included adult HCWs in a single healthcare system from March 9 to June 3, 2020.
The SARS-CoV-2 nasopharyngeal RT-PCR results and demographics of the study participants were deidentified and extracted from an established occupational health, COVID-19 database at the healthcare system. HCWs from each particular job grouping had been categorized into frontline or nonfrontline workers. Incidence rate ratios (IRRs) and odds ratios (ORs) were used to compare subgroups after excluding HCWs involved in early infection clusters before universal masking began. A sensitivity analysis was performed comparing jobs with the greatest potential occupational risks with others.
Of 5,177 HCWs, 152 (2.94%) were diagnosed with COVID-19. Affected HCWs resided in areas with higher community attack rates (median, 1,755.2 vs 1,412.4 cases per 100,000; P < .001; multivariate-adjusted IRR, 1.89; 95% CI, 1.03–3.44 comparing fifth to first quintile of community rates). After multivariate adjustment, African-American and Hispanic HCWs had higher incidence of COVID-19 than non-Hispanic white HCWs (IRR, 2.78; 95% CI, 1.78–4.33; and IRR, 2.41, 95% CI, 1.42–4.07, respectively). After adjusting for race and residential rates, frontline HCWs had a higher IRR (1.73, 95% CI, 1.16–2.54) than nonfrontline HCWs overall, but not within specific job categories nor when comparing the highest risk jobs to others.
After universal masking was instituted, the strongest risk factors associated with HCW COVID-19 infection were residential community infection rate and race.
SHEA endorses adhering to the recommendations by the CDC and ACIP for immunizations of all children and adults. All persons providing clinical care should be familiar with these recommendations and should routinely assess immunization compliance of their patients and strongly recommend all routine immunizations to patients. All healthcare personnel (HCP) should be immunized against vaccine-preventable diseases as recommended by the CDC/ACIP (unless immunity is demonstrated by another recommended method). SHEA endorses the policy that immunization should be a condition of employment or functioning (students, contract workers, volunteers, etc) at a healthcare facility. Only recognized medical contraindications should be accepted for not receiving recommended immunizations.
We present the current status of a scalable computing framework to address the need of the multidisciplinary effort to study chemical dynamics. Specifically, we are enabling scientists to process and store experimental data, run large-scale computationally expensive high-fidelity physical simulations, and analyze these results using state-of-the-art data analytics, machine learning, and uncertainty quantification methods using heterogeneous computing resources. We present the results of this framework on a single metadata-driven workflow to accelerate an additive manufacturing use-case.
While the burden of dementia is increasing in low- and middle-income countries, there is a low rate of diagnosis and paucity of research in these regions. A major challenge to study dementia is the limited availability of standardised diagnostic tools for use in populations with linguistic and educational diversity. The objectives of the study were to develop a standardised and comprehensive neurocognitive test battery to diagnose dementia and mild cognitive impairment (MCI) due to varied etiologies, across different languages and educational levels in India, to facilitate research efforts in diverse settings.
A multidisciplinary expert group formed by Indian Council of Medical Research (ICMR) collaborated towards adapting and validating a neurocognitive test battery, that is, the ICMR Neurocognitive Tool Box (ICMR-NCTB) in five Indian languages (Hindi, Bengali, Telugu, Kannada, and Malayalam), for illiterates and literates, to standardise diagnosis of dementia and MCI in India.
Following a review of existing international and national efforts at standardising dementia diagnosis, the ICMR-NCTB was developed and adapted to the Indian setting of sociolinguistic diversity. The battery consisted of tests of cognition, behaviour, and functional activities. A uniform protocol for diagnosis of normal cognition, MCI, and dementia due to neurodegenerative diseases and stroke was followed in six centres. A systematic plan for validating the ICMR-NCTB and establishing cut-off values in a diverse multicentric cohort was developed.
A key outcome was the development of a comprehensive diagnostic tool for diagnosis of dementia and MCI due to varied etiologies, in the diverse socio-demographic setting of India.
Treatment for hoarding disorder is typically performed by mental health professionals, potentially limiting access to care in underserved areas.
We aimed to conduct a non-inferiority trial of group peer-facilitated therapy (G-PFT) and group psychologist-led cognitive–behavioural therapy (G-CBT).
We randomised 323 adults with hording disorder 15 weeks of G-PFT or 16 weeks of G-CBT and assessed at baseline, post-treatment and longitudinally (≥3 months post-treatment: mean 14.4 months, range 3–25). Predictors of treatment response were examined.
G-PFT (effect size 1.20) was as effective as G-CBT (effect size 1.21; between-group difference 1.82 points, t = −1.71, d.f. = 245, P = 0.04). More homework completion and ongoing help from family and friends resulted in lower severity scores at longitudinal follow-up (t = 2.79, d.f. = 175, P = 0.006; t = 2.89, d.f. = 175, P = 0.004).
Peer-led groups were as effective as psychologist-led groups, providing a novel treatment avenue for individuals without access to mental health professionals.
Declaration of interest
C.A.M. has received grant funding from the National Institutes of Health (NIH) and travel reimbursement and speakers’ honoraria from the Tourette Association of America (TAA), as well as honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. K.D. receives research support from the NIH and honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. R.S.M. receives research support from the National Institute of Mental Health, National Institute of Aging, the Hillblom Foundation, Janssen Pharmaceuticals (research grant) and the Alzheimer's Association. R.S.M. has also received travel support from the National Institute of Mental Health for Workshop participation. J.Y.T. receives research support from the NIH, Patient-Centered Outcomes Research Institute and the California Tobacco Related Research Program, and honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. All other authors report no conflicts of interest.
Focussing on the psychosocial dimensions of poverty, the contention that shame lies at the ‘irreducible absolutist core’ of the idea of poverty is examined through qualitative research with adults and children experiencing poverty in diverse settings in seven countries: rural Uganda and India; urban China; Pakistan; South Korea and United Kingdom; and small town and urban Norway. Accounts of the lived experience of poverty were found to be very similar, despite massive disparities in material circumstances associated with locally defined poverty lines, suggesting that relative notions of poverty are an appropriate basis for international comparisons. Though socially and culturally nuanced, shame was found to be associated with poverty in each location, variably leading to pretence, withdrawal, self-loathing, ‘othering’, despair, depression, thoughts of suicide and generally to reductions in personal efficacy. While internally felt, poverty-related shame was equally imposed by the attitudes and behaviour of those not in poverty, framed by public discourse and influenced by the objectives and implementation of anti-poverty policy. The evidence appears to confirm the negative consequences of shame, implicates it as a factor in increasing the persistence of poverty and suggests important implications for the framing, design and delivery of anti-poverty policies.
Experiments are not models of cooperation; instead, they demonstrate the presence of the ethical and other-regarding predispositions that often motivate cooperation and the punishment of free-riders. Experimental behavior predicts subjects' cooperation in the field. Ethnographic studies in small-scale societies without formal coercive institutions demonstrate that disciplining defectors is both essential to cooperation and often costly to the punisher.
Major depressive disorder (MDD) and anxiety disorders (ANX) are debilitating and prevalent conditions that often co-occur in adolescence and young adulthood. The leading theoretical models of their co-morbidity include the direct causation model and the shared etiology model. The present study compared these etiological models of MDD–ANX co-morbidity in a large, prospective, non-clinical sample of adolescents tracked through age 30.
Logistic regression was used to examine cross-sectional associations between ANX and MDD at Time 1 (T1). In prospective analyses, Cox proportional hazards models were used to examine T1 predictors of subsequent disorder onset, including risk factors specific to each disorder or common to both disorders. Prospective predictive effect of a lifetime history of one disorder (e.g. MDD) on the subsequent onset of the second disorder (e.g. ANX) was then examined. This step was repeated while controlling for common risk factors.
The findings supported relatively distinct profiles of risk between MDD and ANX depending on order of development. Whereas the shared etiology model best explained co-morbid cases in which MDD preceded ANX, direct causation was supported for co-morbid cases in which ANX preceded MDD.
Consistent with previous research, significant cross-sectional and prospective associations were found between MDD and ANX. The results of the present study suggest that different etiological models may characterize the co-morbidity between MDD and ANX based upon the temporal order of onset. Implications for classification and prevention efforts are discussed.
La Convention sur l'interdiction ou la limitation de l'emploi de certaines armes classiques qui peuvent être considérées comme produisant des effets traumatiques excessifs ou comme frappant sans discrimination (du 10 octobre 1980) a établi le cadre juridique pour non seulement interdire certaines armes particulièrement cruelles mais encore, et surtout, en limiter l'emploi. l'article retrace l'histoire de ce traité et rappelle l'évolution qu'il a connue depuis 1980 à travers, notamment, l'adoption d'un nouveau protocole sur les armes à laser aveuglantes et le renforcement du Protocole II (relatif aux mines terrestres). Toutefois, après l'interdiction complète des mines antipersonnel par le traité d'Ottawa en 1997, peut-on encore justifier l'approche choisie par la Convention de 1980, à savoir la limitation dans l'emploi ? L'auteur répond par l'affirmative.
We inoculated pasteurized whole milk with Escherichia coli strains GC4468 (intact marRAB locus), JHC1096 (Δ marRAB), or AG112 (Δ marR), and incubated each overnight at 37°C. All strains were then recovered from the milk cultures, and susceptibilities to antimicrobial agents were determined by the E-test strip method (CLSI). Cells of strain GC4468, prior to culturing in milk, were susceptible to trimethoprim, gatifloxacin, cefotaxime and tetracycline. After culturing GC4468 in pasteurized milk, however, the minimal inhibitory concentrations (MICs) increased 1·4-fold for trimethoprim (P⩽0·05), 1·5-fold for gatifloxacin (P⩽0·05), 2·0-fold for cefotaxime (P=0·008), and 1·4-fold for tetracycline (P⩾0·05). After culturing GC4468 on milk count agar the MICs were enhanced 3·4-fold for trimethoprim (P⩽0·05), 10-fold for gatifloxacin (P=0·001), 7·1-fold for cefotaxime (P=0·011), and 40·5-fold for tetracycline (P=0·074), but exhibiting tetracycline resistance with a mean MIC of 74·7±18·47 μg/ml (CLSI). The MICs of the antimicrobial agents for JHC1096 cells after culturing in pasteurized whole milk were indistinguishable (P⩾0·05) from baseline MICs measured before culturing in the same type of milk. Thus, Esch. coli cells harbouring the marRAB locus exhibit reduced susceptibilities to multiple antimicrobial agents after culturing in pasteurized whole milk.
We performed genome-wide chemical mutagenesis of C57BL/6J mice
using N-ethyl-N-nitrosourea (ENU). Electroretinographic
screening of the third generation offspring revealed two G3 individuals
from one G1 family with a normal a-wave but lacking the b-wave that we
named nob4. The mutation was transmitted with a recessive mode of
inheritance and mapped to chromosome 11 in a region containing the
Grm6 gene, which encodes a metabotropic glutamate receptor
protein, mGluR6. Sequencing confirmed a single nucleotide substitution
from T to C in the Grm6 gene. The mutation is predicted to result
in substitution of Pro for Ser at position 185 within the extracellular,
ligand-binding domain and oocytes expressing the homologous mutation in
mGluR6 did not display robust glutamate-induced currents. Retinal mRNA
levels for Grm6 were not significantly reduced, but no
immunoreactivity for mGluR6 protein was found. Histological and fundus
evaluations of nob4 showed normal retinal morphology. In
contrast, the mutation has severe consequences for visual function. In
nob4 mice, fewer retinal ganglion cells (RGCs) responded to the
onset (ON) of a bright full field stimulus. When ON responses could be
evoked, their onset was significantly delayed. Visual acuity and contrast
sensitivity, measured with optomotor responses, were reduced under both
photopic and scotopic conditions. This mutant will be useful because its
phenotype is similar to that of human patients with congenital stationary
night blindness and will provide a tool for understanding retinal
circuitry and the role of ganglion cell encoding of visual
The creation of metastable defects in the bulk of the intrinsic layers of a-Si:H p-i-n solar cells by recombination of photo-generated carriers as well as those injected under far forward bias has been investigated. The evolutions in the defects, created with volume-absorbed red light at open circuit voltage and constant far forward bias currents, were characterized with the Shockley-Reed-Hall recombination obtained from the dark currents under low forward bias voltages. This allowed the kinetics to be studied at different temperatures in the absence of isothermal annealing. It is found that the form of the kinetics obtained with the two methods are the same and a detailed study was carried out with currents from 1 to 100mA/cm2 with carrier injection during which the electron and hole concentrations remain essentially constant. This kinetics is similar to that reported for thin film results exhibiting stretched exponential behavior with a t1/3 relation over a limited regime before the onset of saturation. By separating the contributions of the metastable defects from the intrinsic defects, their evolution is found to have a t1/2 dependence over the entire range prior to the onset of saturation. Since these kinetics also exhibit an (intensity)2t dependence they point to a rate equation for the creation of metastable defects, Nms, dNms / dt ~ (intensity)2 / Nms, which is suggestive of new creation mechanisms for SWE defects.
Objective: To develop and validate an Instrumental Activities of Daily Living Scale for elderly people (IADL-E) to use in conjunction with cognitive screening tests for dementia in an educationally and socioculturally heterogeneous population.
Method: Eleven IADL items were selected and weighted for major factors causing heterogeneity in the population – gender, education, social (rural/urban) setting and age. Each item was rated for its applicability (yes/no), degree of disability (scored from 0 to 2) and causative impairment (cognitive and/or physical). From this a composite index of cognitive (CDI) or physical (PDI) disability was derived. Validation was performed retrospectively on 240 subjects: 135 without and 105 with dementia by DSM-IV.
Results: The IADL-E had a high internal consistency (α=0.95). The area under the receiver operating characteristic (ROC) curve was 0.97 (CI=0.94−0.99). A cutoff score of 16 on CDI provided a sensitivity of 0.91, specificity 0.99 and positive predictive value 0.76 (at 5% base rate). IADL-E correlated highly with clinical (DSM-IV, κ=0.89), functional (CDR, 0.82) and cognitive (Mini-mental Status Examination, MMSE, 0.74) diagnoses. It showed good responsiveness, with the change on CDI over a median of 23 months correlating significantly with that on MMSE (coefficient=−0.382, CI=−0.667 to −0.098; p=0.009). Individual items had good interrater and test–retest reliability.
Conclusions: The IADL-E is a reliable, sensitive and responsive scale of functional abilities useful in dementia screening in a socioculturally heterogeneous population.
The 1980 Convention on Certain Conventional Weapons (CCW) was opened for signature on 10 October 1980 and entered into force on 2 December 1983 (six months after the deposit of the twentieth ratification). Following several years of virtual obscurity, interest in the CCW increased in the early 1990s, partly as a consequence of greater interest in the potential of the CCW in reducing the inhumane consequences of anti-personnel landmines (APLs). This led to the convening of the First Review Conference (Revcon) in 1995/6. One of the decisions taken by the first Revcon was that a second Revcon should be convened within five years to review the operation of the CCW. This indicated that for many states the CCW had come to assume a greater importance than they had accorded it during the preceding 15 years, as well as their acceptance that APLs and other weapons covered by the CCW warranted closer attention. In the lead-up to the second Revcon, which was convened in December 2001, major issues under consideration included the scope of the CCW and Explosive Remnants of War (ERW), including cluster bombs and other forms of unexploded ordnance not covered by existing international law, and strengthened provisions relating to antivehicle landmines (AVMs).
Myotonic dystrophy is caused by an expanded CTG
repeat in the 3′ untranslated region of the DM protein
kinase (DMPK) gene. The expanded repeat triggers the nuclear
retention of mutant DMPK transcripts, but the resulting
underexpression of DMPK probably does not fully account
for the severe phenotype. One proposed disease mechanism
is that nuclear accumulation of expanded CUG repeats may
interfere with nuclear function. Here we show by thermal
melting and nuclease digestion studies that CUG repeats
form highly stable hairpins. Furthermore, CUG repeats bind
to the dsRNA-binding domain of PKR, the dsRNA-activated
protein kinase. The threshold for binding to PKR is ∼15
CUG repeats, and the affinity increases with longer repeat
lengths. Finally, CUG repeats that are pathologically expanded
can activate PKR in vitro. These results raise the possibility
that the disease mechanism could be, in part, a gain of
function by mutant DMPK transcripts that involves sequestration
or activation of dsRNA binding proteins.