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Psychiatric mother and baby units (MBUs) are recommended for severe perinatal mental illness, but effectiveness compared with other forms of acute care remains unknown.
We hypothesised that women admitted to MBUs would be less likely to be readmitted to acute care in the 12 months following discharge, compared with women admitted to non-MBU acute care (generic psychiatric wards or crisis resolution teams (CRTs)).
Quasi-experimental cohort study of women accessing acute psychiatric care up to 1 year postpartum in 42 healthcare organisations across England and Wales. Primary outcome was readmission within 12 months post-discharge. Propensity scores were used to account for systematic differences between MBU and non-MBU participants. Secondary outcomes included assessment of cost-effectiveness, experience of services, unmet needs, perceived bonding, observed mother–infant interaction quality and safeguarding outcome.
Of 279 women, 108 (39%) received MBU care, 62 (22%) generic ward care and 109 (39%) CRT care only. The MBU group (n = 105) had similar readmission rates to the non-MBU group (n = 158) (aOR = 0.95, 95% CI 0.86–1.04, P = 0.29; an absolute difference of −5%, 95% CI −14 to 4%). Service satisfaction was significantly higher among women accessing MBUs compared with non-MBUs; no significant differences were observed for any other secondary outcomes.
We found no significant differences in rates of readmission, but MBU advantage might have been masked by residual confounders; readmission will also depend on quality of care after discharge and type of illness. Future studies should attempt to identify the effective ingredients of specialist perinatal in-patient and community care to improve outcomes.
Anorexia nervosa (AN) is a psychiatric disorder with complex etiology, with a significant portion of disease risk imparted by genetics. Traditional genome-wide association studies (GWAS) produce principal evidence for the association of genetic variants with disease. Transcriptomic imputation (TI) allows for the translation of those variants into regulatory mechanisms, which can then be used to assess the functional outcome of genetically regulated gene expression (GReX) in a broader setting through the use of phenome-wide association studies (pheWASs) in large and diverse clinical biobank populations with electronic health record phenotypes.
Here, we applied TI using S-PrediXcan to translate the most recent PGC-ED AN GWAS findings into AN-GReX. For significant genes, we imputed AN-GReX in the Mount Sinai BioMe™ Biobank and performed pheWASs on over 2000 outcomes to test the clinical consequences of aberrant expression of these genes. We performed a secondary analysis to assess the impact of body mass index (BMI) and sex on AN-GReX clinical associations.
Our S-PrediXcan analysis identified 53 genes associated with AN, including what is, to our knowledge, the first-genetic association of AN with the major histocompatibility complex. AN-GReX was associated with autoimmune, metabolic, and gastrointestinal diagnoses in our biobank cohort, as well as measures of cholesterol, medications, substance use, and pain. Additionally, our analyses showed moderation of AN-GReX associations with measures of cholesterol and substance use by BMI, and moderation of AN-GReX associations with celiac disease by sex.
Our BMI-stratified results provide potential avenues of functional mechanism for AN-genes to investigate further.
Airway injuries are the second leading cause of potentially survivable battlefield death and often require airway management strategies. Airway suction, the act of using negative pressure in a patient’s upper airway, removes debris that can prevent respiration, decreases possible aspiration risks, and allows clearer viewing of the airway for intubation. The most important characteristics for a portable airway suction device for prehospital combat care are portability, strong suction, and ease of use.
This market review searched academic papers, military publications, Google searches, and Amazon to identify devices. The search included specific characteristics that would increase the likelihood that the devices would be suitable for battlefield use including weight, size, battery life, noise emission, canister size, tubing, and suction power.
Sixty portable airway suction devices were resulted, 31 of which met inclusion criteria – 11 manually powered devices and 20 battery-operated devices. One type of manual suction pump was a bag-like design with a squeezable suction pump that was extremely lightweight but had limited suction capabilities (vacuum pressure of 100mmHg). Another type of manual suction pump had a trigger-like design which is pulled back to create suction with a firm collection canister that had increased suction capabilities (vacuum pressures of 188-600mmHg), though still less than the battery operated, and was slightly heavier (0.23-0.458kg). Battery-operated devices had increased suction capabilities and were easier to use, but they were larger and weighed more (1.18-11.0kg).
Future research should work to lighten and debulk battery-operated suction devices with high suction performance.
This study evaluated: (1) apolipoprotein E (APOE) ϵ4 prevalence among Black, Latino, and White older adults, (2) associations of APOE ϵ4 status with baseline level and change over time of cognitive outcomes across groups, and (3) combined impact of APOE ϵ4 prevalence and magnitude of effect on cognitive decline within each racial/ethnic group.
Participants included 297 White, 138 Latino, and 149 Black individuals from the longitudinal UC Davis Diversity Cohort who had APOE genotyping and ≥2 cognitive assessments. Magnitude of associations of ϵ4 with cognitive baseline and change across racial/ethnic groups was tested with multilevel parallel process longitudinal analyses and multiple group models.
ϵ4 prevalence in Black (46%) and White participants (46%) was almost double that of Latino participants (24%). ϵ4 was associated with poorer baseline episodic memory only in White participants (p = .001), but had a moderately strong association with episodic memory change across all racial/ethnic groups (Blacks= −.061 SD/year, Latinos = −.055,Whites= −.055). ϵ4 association with semantic memory change was strongest in White participants (−.071), intermediate in Latino participants (−.041), and weakest in Black participants (−.022).
Calculated cognitive trajectories across racial/ethnic groups were influenced in an additive manner by ϵ4 prevalence and strength of association with cognitive decline within the group. Group differences in ϵ4 prevalences and associations of ϵ4 with cognition may suggest different pathways from APOE to cognitive decline, and, AD possibly having less salient impact on cognitive decline in non-White participants. Differential effects of APOE on episodic memory and non-memory cognition have important implications for understanding how APOE influences late life cognitive decline.
Mental health crises are common in people with complex emotional needs (our preferred working term for people diagnosed with a 'personality disorder'), yet this population is often dissatisfied with the crisis care they receive. Exploring their experiences and views on what could be improved, and those of carers and healthcare staff, is key to developing better services.
We aimed to synthesise the relevant qualitative literature.
Five databases were searched. Eligible studies included service users with a diagnosis of personality disorder and their carers or relevant staff, focused on crisis responses and used a qualitative design. Data were analysed with thematic synthesis.
Eleven studies were included, most focusing on emergency departments. Four meta-themes emerged: (a) acceptance and rejection when presenting to crisis care: limited options and lack of involvement of carers; (b) interpersonal processes: importance of the therapeutic relationship and establishing a framework for treatment; (c) managing recovery from a crisis: clear recovery plan and negotiating collaboration; and (d) equipping and supporting staff: training and emotional support.
Our findings suggest that emergency departments have major limitations as settings to provide crisis care for people with complex emotional needs, but there is a lack of research exploring alternatives. The quality of the therapeutic relationship was central to how care was experienced, with collaborative and optimistic staff highly valued. Staff reported feeling poorly supported in responding to the needs of this population. Research looking at experiences of a range of care options and how to improve these is needed.
The Trial Innovation Network has established an infrastructure for single IRB review in response to federal policies. The Network’s single IRB (sIRBs) have successfully supported over 70 multisite studies via more than 800 reliance arrangements. This has generated several lessons learned that can benefit the national clinical research enterprise, as we work to improve the conduct of clinical trials. These lessons include distinguishing the roles of the single IRB from institutional Human Research Protections programs, establishing a consistent sIRB review model, standardizing collection of local context and supplemental, study-specific information, and educating and empowering lead study teams to support their sites.
As the feature size of crystalline materials gets smaller, the ability to correctly interpret geometrical sample information from electron backscatter diffraction (EBSD) data becomes more important. This paper uses the notion of transition curves, associated with line scans across grain boundaries (GBs), to correctly account for the finite size of the excitation volume (EV) in the determination of the geometry of the boundary. Various metrics arising from the EBSD data are compared to determine the best experimental proxy for actual numbers of backscattered electrons that are tracked in a Monte Carlo simulation. Consideration of the resultant curves provides an accurate method of determining GB position (at the sample surface) and indicates a significant potential for error in determining GB position using standard EBSD software. Subsequently, simple criteria for comparing experimental and simulated transition curves are derived. Finally, it is shown that the EV is too shallow for the curves to reveal subsurface geometry of the GB (i.e., GB inclination angle) for most values of GB inclination.
The complexity associated with the treatment planning and delivery of stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) volumetric modulated arc therapy (VMAT) plans which employs continuous dynamic modulation of dose rate, field aperture and gantry speed necessitates diligent pre-treatment patient-specific quality assurance (QA). Numerous techniques for pre-treatment VMAT treatment plans QA are currently available with the aid of several different devices including the electronic portal imager (EPID). Although several studies have provided recommendations for gamma criteria for VMAT pre-treatment QA, there are no specifics for SRS/SRT VMAT QA. Thus, we conducted a study to evaluate intracranial SRS/SRT VMAT QA to determine clinical action levels for gamma criteria based on the institutional estimated means and standard deviations.
Materials and methods:
We conducted a retrospective analysis of 118 EPID patient-specific pre-treatment QA dosimetric measurements of 47 brain SRS/SRT VMAT treatment plans using the integrated Varian solution (RapidArcTM planning, EPID and Portal dosimetry system) for planning, delivery and EPID QA analysis. We evaluated the maximum gamma (γmax), average gamma (γave) and percentage gamma passing rate (%GP) for different distance-to-agreement/dose difference (DTA/DD) criteria and low-dose thresholds.
The gamma index analysis shows that for patient-specific SRS/SRT VMAT QA with the portal dosimetry, the mean %GP is ≥98% for 2–3 mm/1–3% and Field+0%, +5% and +10% low-dose thresholds. When applying stricter spatial criteria of 1 mm, the mean %GP is >90% for DD of 2–3% and ≥88% for DD of 1%. The mean γmax ranges: 1·32 ± 1·33–2·63 ± 2·35 for 3 mm/1–3%, 1·57 ± 1·36–2·87 ± 2·29 for 2 mm/1–3% and 2·36 ± 1·83–3·58 ± 2·23 for 1 mm/1–3%. Similarly the mean γave ranges: 0·16 ± 0·06–0·19 ± 0·07 for 3 mm/1–3%, 0·21 ± 0·08–0·27 ± 0·10 for 2 mm/1–3% and 0·34 ± 0·14–0·49 ± 0·17 for 1 mm/1–3%. The mean γmax and mean γave increase with increased DTA and increased DD for all low-dose thresholds.
The establishment of gamma criteria local action levels for SRS/SRT VMAT pre-treatment QA based on institutional resources is imperative as a useful tool for standardising the evaluation of EPID-based patient-specific SRS/SRT VMAT QA. Our data suggest that for intracranial SRS/SRT VMAT QA measured with the EPID, a stricter gamma criterion of 1 mm/2% or 1 mm/3% with ≥90% %GP could be used while still maintaining an in-control QA process with no extra burden on resources and time constraints.
Background: Over the past decade, the CLSI has updated susceptibility break points for several antimicrobial agents. The purpose of this study was to evaluate the impact of these changes against gram-negative bacteria at our academic medical center. Methods: In this retrospective, IRB-approved study, we collected consecutive, nonduplicate clinical isolates of Enterobacter cloacae, Escherichia coli, Klebsiella aerogenes, K. oxytoca, K. pneumoniae, and Pseudomonas aeruginosa for the past decade (2010–2019) at our academic medical center and 3 adult ICUs. Susceptibility testing was performed using the BD Phoenix automated system. For these isolates, susceptibilities for 7 β-lactams (aztreonam, ceftriaxone, ceftazidime, cefepime, piperacillin/tazobactam, ertapenem, and meropenem) and 2 fluoroquinolones (levofloxacin, ciprofloxacin) were calculated based upon CLSI break points in 2010 and current CLSI break points in 2020. Any change >5% in susceptibility was deemed significant for this analysis. Results: In 17.5% of Enterobacteriales isolates tested, at least 1 antimicrobial demonstrated significant decline. Ertapenem was the most commonly affected antimicrobial (45% of the isolates) followed by ceftriaxone (35%) and cefepime (25%). Susceptibilities of aztreonam, ceftazidime, and meropenem were not affected for any of the Enterobacteriales. The most common organism demonstrating a significant impact on change in susceptibility among the Enterobacteriales was E. cloacae (41.7% of the time) followed by E. aerogenes (20.8%), K. oxytoca (12.5%), K. pneumoniae (8.3%) and E. coli (4.2%). Most of the impact was observed hospital-wide (33.3%), followed closely by the MICU (28.6%), the NSICU (23.8%) and the CVICU (14.3%). For P. aeruginosa, the impact of the antimicrobial break-point changes on susceptibility was more pronounced than the Enterobacteriales. Overall, 93.8% of the time there was a significant decline in antimicrobial susceptibility. Each antimicrobial (ciprofloxacin, levofloxacin, meropenem, and piperacillin/tazobactam) demonstrated a significant decline in susceptibility hospital-wide and in each ICU except for the susceptibility of meropenem in the NSICU. Conclusions: Changes in break points had a significant impact on the susceptibility of all antimicrobials for P. aeruginosa at our institution, both hospital-wide and in the adult ICUs. Although the impact was less for the Enterobacteriales, ertapenem, ceftriaxone, and cefepime demonstrated significant susceptibility changes, especially with E. cloacae. Understanding and evaluating the impact of the break-point changes may lead to changes in empiric therapy in other institutions.
Alcohol use disorder (AUD) and schizophrenia (SCZ) frequently co-occur, and large-scale genome-wide association studies (GWAS) have identified significant genetic correlations between these disorders.
We used the largest published GWAS for AUD (total cases = 77 822) and SCZ (total cases = 46 827) to identify genetic variants that influence both disorders (with either the same or opposite direction of effect) and those that are disorder specific.
We identified 55 independent genome-wide significant single nucleotide polymorphisms with the same direction of effect on AUD and SCZ, 8 with robust effects in opposite directions, and 98 with disorder-specific effects. We also found evidence for 12 genes whose pleiotropic associations with AUD and SCZ are consistent with mediation via gene expression in the prefrontal cortex. The genetic covariance between AUD and SCZ was concentrated in genomic regions functional in brain tissues (p = 0.001).
Our findings provide further evidence that SCZ shares meaningful genetic overlap with AUD.
There is now an established argument that public policy should focus on conditions necessary for people's wellbeing as well as those for economic growth (McGregor, 2007; Bache and Reardon, 2013). In 2009, the Commission on the Measurement of Economic Performance (Stiglitz et al, 2009) published an influential report which argued that to achieve sustainable and inclusive development necessitates a clear shift from measuring societal progress in terms of production and consumption, to measures of human wellbeing. The last decade has seen an explosion of initiatives to conceptualize and measure human wellbeing and to put it into practice in academia and policy (OECD, 2011; Helliwell et al, 2017; Bache, 2018). The concept of wellbeing now appears at the heart of many UK public policies from the 2014 Care Act, to the current 25-year plan for the Environment (DEFRA). The UK Office of National Statistics created its National Wellbeing Programme, which aims to ‘produce accepted and trusted measures of the well-being of the nation’ and has incorporated subjective wellbeing questions into the Annual Population Survey since April 2011. This is viewed, by some, as a long-term process of transformative change, which could lead to a refocusing of government policy and agenda across many public policy sectors (Kroll, 2011).
To realize the full potential of wellbeing-orientated policy, beyond just the measurement of wellbeing, will require greater understanding about how wellbeing can be creatively employed in policy and practice, and the difference it can actually make to people's lives. Very often wellbeing is used narrowly as an output following an intervention or is used as an indicator of social change over time. It can also be used more ambitiously as an ‘input’ – a framing concept in the design phase of policy and practice. We can use it to understand the different wellbeing strategies people deploy, and the values which underpin these, illuminating new forms of social policy interventions. In their review of wellbeing and public policy in the UK, Bache et al (2016) distinguish two aspects to the wellbeing agenda: ‘measurement’ and ‘policy application’ arguing that while the former is well advanced, the latter remains ‘somewhat embryonic’, illustrating a clear gap in understanding how wellbeing influences research, policy and practice.
This study compared the level of education and tests from multiple cognitive domains as proxies for cognitive reserve.
The participants were educationally, ethnically, and cognitively diverse older adults enrolled in a longitudinal aging study. We examined independent and interactive effects of education, baseline cognitive scores, and MRI measures of cortical gray matter change on longitudinal cognitive change.
Baseline episodic memory was related to cognitive decline independent of brain and demographic variables and moderated (weakened) the impact of gray matter change. Education moderated (strengthened) the gray matter change effect. Non-memory cognitive measures did not incrementally explain cognitive decline or moderate gray matter change effects.
Episodic memory showed strong construct validity as a measure of cognitive reserve. Education effects on cognitive decline were dependent upon the rate of atrophy, indicating education effectively measures cognitive reserve only when atrophy rate is low. Results indicate that episodic memory has clinical utility as a predictor of future cognitive decline and better represents the neural basis of cognitive reserve than other cognitive abilities or static proxies like education.
This essay explores the legacy and afterlife of François Macandal, a man who escaped enslavement on an eighteenth-century plantation in the French colony of Saint-Domingue. His fame as a poisoner and immortal rebel persist over time and space, reflecting transcaribbean associations of fetish making with spiritual and physical resistance on the plantation. Stories of Macandal and the fetish objects he crafted, also called macandals, continued to circulate in nineteenth-century Louisiana as one of many narratives of slave uprising and Revolution in the Americas. One example of the reach of Macandal’s story is the 1892 novel, Le Macandal: Épisode de l’Insurrection des Noirs à St. Domingue, published in New Orleans, Louisiana, by Marie-Joséphine Augustin. This work is part of a larger archive of how Macandal and his macandals shaped the literary realm. His story moves across genres arguing that Macandal is simultaneously the man, the fetish object, and the story in its many forms.
In recent years, a variety of efforts have been made in political science to enable, encourage, or require scholars to be more open and explicit about the bases of their empirical claims and, in turn, make those claims more readily evaluable by others. While qualitative scholars have long taken an interest in making their research open, reflexive, and systematic, the recent push for overarching transparency norms and requirements has provoked serious concern within qualitative research communities and raised fundamental questions about the meaning, value, costs, and intellectual relevance of transparency for qualitative inquiry. In this Perspectives Reflection, we crystallize the central findings of a three-year deliberative process—the Qualitative Transparency Deliberations (QTD)—involving hundreds of political scientists in a broad discussion of these issues. Following an overview of the process and the key insights that emerged, we present summaries of the QTD Working Groups’ final reports. Drawing on a series of public, online conversations that unfolded at www.qualtd.net, the reports unpack transparency’s promise, practicalities, risks, and limitations in relation to different qualitative methodologies, forms of evidence, and research contexts. Taken as a whole, these reports—the full versions of which can be found in the Supplementary Materials—offer practical guidance to scholars designing and implementing qualitative research, and to editors, reviewers, and funders seeking to develop criteria of evaluation that are appropriate—as understood by relevant research communities—to the forms of inquiry being assessed. We dedicate this Reflection to the memory of our coauthor and QTD working group leader Kendra Koivu.1
Studies in countries where assisted dying is legal show that bereaved people express concern over the potential for social disapproval and social stigma because of the manner of death. There are indications that voluntary assisted dying is judged as less acceptable if the deceased is younger. A vignette-based experiment was used to determine whether public stigma (i.e., negative emotional reactions and desired social distance) and expected grief symptoms are higher for conjugally bereaved people through voluntary assisted dying (vs. long-term illness), when the deceased is a young adult (vs. older adult).
A 2 × 2 randomized factorial design was conducted with 164 Australian adults (130 women, 34 men, Mage = 37.69 years). Each participant was randomized online to read one of four vignettes and completed measures of anger, fear, prosocial emotions, desire for social distance, and expectations of grief symptomatology.
A multivariate analysis of variance (MANOVA) was conducted. Death at a young age (28 years) was significantly associated with stronger negative emotional reactions of fear ($\eta _p^2 = 0.04$, P = 0.048) and anger ($\eta _p^2 = 0.06$, P = 0.010). There were no differences in outcomes associated with the mode of death, nor was there an interaction between mode of death and age group.
Significance of results
Concerns that voluntary assisted dying elicits public stigma appear unfounded. The fact that participants reported significantly higher anger and fear in response to bereaved people experiencing loss at a younger (vs. older) age, irrespective of cause of death, indicates that young people who lose their spouse might benefit from additional support.
The Science of Team Science (SciTS) has generated a substantial body of work detailing characteristics of effective teams. However, that knowledge has not been widely translated into accessible, active, actionable, evidence-based interventions to help translational teams enhance their team functioning and outcomes. Over the past decade, the field of Implementation Science has rapidly developed methods and approaches to increase the translation of biomedical research findings into clinical care, providing a roadmap for mitigating the challenges of developing interventions while maximizing feasibility and utility. Here, we propose an approach to intervention development using constructs from two Implementation Science frameworks, Consolidated Framework for Implementation Research, and Reach, Effectiveness, Adoption, Implementation, and Maintenance, to extend the Wisconsin Interventions for Team Science framework described in Rolland et al. 2021. These Implementation Science constructs can help SciTS researchers design, build, test, and disseminate interventions that meet the needs of both adopters, the institutional leadership that decides whether to adopt an intervention, and implementers, those actually using the intervention. Systematically considering the impact of design decisions on feasibility and usability may lead to the design of interventions that can quickly move from prototype to pilot test to pragmatic trials to assess their impact.
Achieving the clinical, public health, economic, and policy benefits of translational science requires the integration and application of findings across biomedical, clinical, and behavioral science and health policy, and thus, collaboration across experts in these areas. To do so, translational teams need the skills, knowledge, and attitudes to mitigate challenges and build on strengths of cross-disciplinary collaboration. Though these competencies are not innate to teams, they can be built through the implementation of effective strategies and interventions. The Science of Team Science (SciTS) has contributed robust theories and evidence of empirically-informed strategies and best practices to enhance collaboration. Yet the field lacks methodological approaches to rigorously translate those strategies into evidence-based interventions to improve collaborative translational research. Here, we apply lessons from Implementation Science and Human-Centered Design & Engineering to describe the Wisconsin Interventions in Team Science (WITS) framework, a process for translating established team science strategies into evidence-based interventions to bolster translational team effectiveness. To illustrate our use of WITS, we describe how University of Wisconsin’s Institute for Clinical and Translational Research translated the existing Collaboration Planning framework into a robust, scalable, replicable intervention. We conclude with recommendations for future SciTS research to refine and test the framework.
The ability to effectively lead an interdisciplinary translational team is a crucial component of team science success. Most KL2 Clinical Scholars have been members of scientific teams, but few have been team science leaders. There is a dearth of literature and outcome measures of effective Team Science Leadership in clinical and translational research. We focused our curriculum to emphasize Team Science Leadership, developed a list of Team Science Leadership competencies for translational investigators using a modified Delphi method, and incorporated the competencies into a quantitative evaluation survey. The survey is completed on entry and annually thereafter by the Scholar; the Scholar’s primary mentor and senior staff who educate and interact with the Scholar rate the Scholar at the end of each year. The program leaders and mentor review the results with each Scholar. The survey scales had high internal consistency and good factor structure. Overall ratings by mentors and senior staff were generally high, but ratings by Scholars tended to be lower, offering opportunities for discussion and career planning. Scholars rated the process favorably. A Team Science Leadership curriculum and periodic survey of attained competencies can inform individual career development and guide team science curriculum development.
To explore the perceptions of adolescents and their caregivers on drivers of diet and physical activity in rural India in the context of ongoing economic, social and nutrition transition.
A qualitative study comprising eight focus group discussions (FGD) on factors affecting eating and physical activity patterns, perceptions of health and decision-making on food preparation.
Villages approximately 40–60 km from the city of Pune in the state of Maharashtra, India.
Two FGD with adolescents aged 10–12 years (n 20), two with 15- to 17- year-olds (n 18) and four with their mothers (n 38).
Dietary behaviour and physical activity of adolescents were perceived to be influenced by individual and interpersonal factors including adolescent autonomy, parental influence and negotiations between adolescents and caregivers. The home food environment, street food availability, household food security and exposure to television and digital media were described as influencing behaviour. The lack of facilities and infrastructure was regarded as barriers to physical activity as were insufficient resources for public transport, safe routes for walking and need for cycles, particularly for girls. It was suggested that schools take a lead role in providing healthy foods and that governments invest in facilities for physical activity.
In this transitioning environment, that is representative of many parts of India and other Lower Middle Income Countries (LMIC), people perceive a need for interventions to improve adolescent diet and physical activity. Caregivers clearly felt that they had a stake in adolescent health, and so we would recommend the involvement of both adolescents and caregivers in intervention design.