Development of a composite drought indicator for operational drought monitoring in the MENA region

This paper presents the composite drought indicator (CDI) that Jordanian, Lebanese, Moroccan, and Tunisian government agencies now produce monthly to support operational drought management decision making, and it describes their iterative co-development processes. The CDI is primarily intended to monitor agricultural and ecological drought on a seasonal time scale. It uses remote sensing and modelled data inputs, and it reflects anomalies in precipitation, vegetation, soil moisture, and evapotranspiration. Following quantitative and qualitative validation assessments, engagements with policymakers, and consideration of agencies' technical and institutional capabilities and constraints, we made changes to CDI input data, modelling procedures, and integration to tailor the system for each national context. We summarize validation results, drought modelling challenges and how we overcame them through CDI improvements, and we describe the monthly CDI production process and outputs. Finally, we synthesize procedural and technical aspects of CDI development and reflect on the constraints we faced as well as trade-offs made to optimize the CDI for operational monitoring to support policy decision-making-including aspects of salience, credibility, and legitimacy-within each national context.

What Drove Program Participants to Initially Attend Congregate Meals? Socialization, Health, and Other Reasons

The Congregate Nutrition Services support efforts to keep older Americans independent and engaged in their communities. We examined participants' self-reported reasons for initially attending the congregate meals program and whether reasons differed by participant characteristics. Descriptive statistics and tests of differences were used to compare participants (n = 1,072). Individuals attended congregate meals for several reasons, with the top two being socialization (36.3%) and age- or health-related reasons (18.7%). Those attending for socialization were less likely to be lower income, have food insecurity, or live with 3+ ADL limitations while participants who first attended due to age or health-related reasons were more likely to be low income, food insecure, and from historically marginalized populations. Health and social service professionals and community organizations could expand data collection on older adults in their communities and partner with congregate meal providers to encourage participation for individuals with unmet nutritional, health, and socialization needs.

Health phenome of Parkinson's patients reveals prominent mood-sleep cluster

Background

Associations between phenotypic traits, environmental exposures, and Parkinson's disease have largely been evaluated one-by-one, piecemeal, and pre-selections. A comprehensive picture of comorbidities, phenotypes, exposures, and polypharmacy characterizing the complexity and heterogeneity of real-world patients presenting to academic movement disorders clinics in the US is missing.

Objectives

To portrait the complexity of features associated with patients with Parkinson's disease in a study of 933 cases and 291 controls enrolled in the Harvard Biomarkers Study.

Methods

The primary analysis evaluated 64 health features for associations with Parkinson's using logistic regression adjusting for age and sex. We adjusted for multiple testing using the false discovery rate (FDR) with £ 0.05 indicating statistical significance. Exploratory analyses examined feature correlation clusters and feature combinations.

Results

Depression (OR = 3.11, 95% CI 2.1 to 4.71), anxiety (OR = 3.31, 95% CI 2.01-5.75), sleep apnea (OR 2.58, 95% CI 1.47-4.92), and restless leg syndrome (RLS; OR 4.12, 95% CI 1.81-12.1) were significantly more common in patients with Parkinson's than in controls adjusting for age and sex with FDR £ 0.05. The prevalence of depression, anxiety, sleep apnea, and RLS were correlated, and these diseases formed part of a larger cluster of mood traits and sleep traits linked to PD. Exposures to pesticides (OR 1.87, 95% CI 1.37-2.6), head trauma (OR 2.33, 95% CI 1.51-3.73), and smoking (OR 0.57, 95% CI 0.43-0.75) were significantly associated with the disease consistent with previous studies. Vitamin supplementation with cholecalciferol (OR 2.18, 95% CI 1.4-3.45) and coenzyme Q10 (OR 2.98, 95% CI 1.89-4.92) was more commonly used by patients than controls. Cumulatively, 43% (398 of 933) of Parkinson's patients had at least one psychiatric or sleep disorder, compared to 21% (60 of 291) of healthy controls.

Conclusions

43% of Parkinson's patients seen at Harvard-affiliated teaching hospitals have depression, anxiety, and disordered sleep. This syndromic cluster of mood and sleep traits may be pathophysiologically linked and clinically important.

The reliability of a portable steam sauna pod for the whole-body passive heating of humans

INTRODUCTION

Passive heating is receiving increasing attention within human performance and health contexts. A low-cost, portable steam sauna pod may offer an additional tool for those seeking to manipulate physiological (cardiovascular, thermoregulatory and sudomotor) and perceptual responses for improving sporting or health profiles. This study aimed to 1) report the different levels of heat stress and determine the pods' inter-unit reliability, and 2) quantify the reliability of physiological and perceptual responses to passive heating.

METHOD

In part 1, five pods were assessed for temperature and relative humidity (RH) every 5 min across 70 min of heating for each of the 9 settings. In part 2, twelve males (age: 24 ± 4 years) completed two 60 min trials of passive heating (3 × 20 min at 44 °C/99% RH, separated by 1 week). Heart rate (HR), rectal (Trectal) and tympanic temperature (Ttympanic) were recorded every 5 min, thermal comfort (Tcomfort) and sensation (Tsensation) every 10 min, mean arterial pressure (MAP) at each break period and sweat rate (SR) after exiting the pod.

RESULTS

In part 1, setting 9 provided the highest temperature (44.3 ± 0.2 °C) and longest time RH remained stable at 99% (51±7 min). Inter-unit reliability data demonstrated agreement between pods for settings 5-9 (intra-class correlation [ICC] >0.9), but not for settings 1-4 (ICC <0.9). In part 2, between-visits, high correlations, and low typical error of measurement (TEM) and coefficient of variation (CV) were found for Trectal, HR, MAP, SR, and Tcomfort, but not for Ttympanic or Tsensation. A peak Trectal of 38.09 ± 0.30 °C, HR of 124 ± 15 b min-1 and a sweat loss of 0.73 ± 0.33 L were reported. No between-visit differences (p > 0.05) were observed for Trectal, Ttympanic, Tsensation or Tcomfort, however HR (+3 b.min-1) and MAP (+4 mmHg) were greater in visit 1 vs. 2 (p < 0.05).

CONCLUSION

Portable steam sauna pods generate reliable heat stress between-units. The highest setting (44 °C/99% RH) also provides reliable but modest adjustments in physiological and perceptual responses.

Evaluating the effect of child home safety training upon three family support practitioner groups: a mixed-methods study

AIMS

Unintentional injuries in the home contribute substantially to preschool child morbidity and mortality. Practitioners such as health visitors, family mentors and children's centre staff are well-positioned to facilitate child injury prevention by providing home safety advice to families, and training may enhance their ability to do so. We aimed to assess the impact of child home safety training for these practitioners.

METHODS

An explanatory mixed-methods design was used. Practitioners completed questionnaires before, and up to 7 months after, receiving child home safety training and took part in interviews. Seventy-eight health visitors, 72 family mentors and 11 children's centre staff members completed questionnaires. Items were used to calculate scores on home safety knowledge, confidence to provide home safety advice and belief that child home safety promotion is important. Thematic analysis of interviews with seven health visitors and nine family mentors, open-ended responses to the questionnaires and an additional evaluation form was conducted to explore attendees' perceptions of the training and its impact. In addition, seven health visitors and six children's centre staff who had received no training were interviewed.

RESULTS

Knowledge was greater post-training than pre-training across all participants (p < .001). When practitioner groups were analysed separately, there were significant increases in family mentors' knowledge (p < .001) and belief (p = .016), and health visitors' confidence (p = .0036). Qualitative findings indicated that most training session attendees valued the training, believed their practice relating to child home safety had improved as a result, and felt further similar training sessions would be beneficial. Those who had not attended the sessions described a need for more child home safety training.

CONCLUSIONS

Delivering training to practitioners providing child home safety promotion to families with preschool children can enhance injury prevention knowledge, beliefs and confidence and positively impact on home safety promotion by practitioners.

Magnetic resonance imaging-guided focused ultrasound thalamotomy for essential tremor: 5-year follow-up results

OBJECTIVE

The objective of this study was to evaluate, at 4 and 5 years posttreatment, the long-term safety and efficacy of unilateral MRI-guided focused ultrasound (MRgFUS) thalamotomy for medication-refractory essential tremor in a cohort of patients from a prospective, controlled, multicenter clinical trial.

METHODS

Outcomes per the Clinical Rating Scale for Tremor (CRST), including postural tremor scores (CRST Part A), combined hand tremor/motor scores (CRST Parts A and B), and functional disability scores (CRST Part C), were measured by a qualified neurologist. The Quality of Life in Essential Tremor Questionnaire (QUEST) was used to assess quality of life. CRST and QUEST scores at 48 and 60 months post-MRgFUS were compared to those at baseline to assess treatment efficacy and durability. All adverse events (AEs) were reported.

RESULTS

Forty-five and 40 patients completed the 4- and 5-year follow-ups, respectively. CRST scores for postural tremor (Part A) for the treated hand remained significantly improved by 73.3% and 73.1% from baseline at both 48 and 60 months posttreatment, respectively (both p < 0.0001). Combined hand tremor/motor scores (Parts A and B) also improved by 49.5% and 40.4% (p < 0.0001) at each respective time point. Functional disability scores (Part C) increased slightly over time but remained significantly improved through the 5 years (p < 0.0001). Similarly, QUEST scores remained significantly improved from baseline at year 4 (p < 0.0001) and year 5 (p < 0.0003). All previously reported AEs remained mild or moderate, and no new AEs were reported.

CONCLUSIONS

Unilateral MRgFUS thalamotomy demonstrates sustained and significant tremor improvement at 5 years with an overall improvement in quality-of-life measures and without any progressive or delayed complications. Clinical trial registration no.: NCT01827904 (ClinicalTrials.gov).

Panarchy theory for convergence

Coping with surprise and uncertainty resulting from the emergence of undesired and unexpected novelty or the sudden reorganization of systems at multiple spatiotemporal scales requires both a scientific process that can incorporate diverse expertise and viewpoints, and a scientific framework that can account for the structure and dynamics of interacting social-ecological systems (SES) and the inherent uncertainty of what might emerge in the future. We argue that combining a convergence scientific process with a panarchy framework provides a pathway for improving our understanding of, and response to, emergence. Emergent phenomena are often unexpected (e.g., pandemics, regime shifts) and can be highly disruptive, so can pose a significant challenge to the development of sustainable and resilient SES. Convergence science is a new approach promoted by the U.S. National Science Foundation for tackling complex problems confronting humanity through the integration of multiple perspectives, expertise, methods, tools, and analytical approaches. Panarchy theory is a framework useful for studying emergence, because it characterizes complex systems of people and nature as dynamically organized and structured within and across scales of space and time. It accounts for the fundamental tenets of complex systems and explicitly grapples with emergence, including the emergence of novelty, and the emergent property of social-ecological resilience. We provide an overview of panarchy, convergence science, and emergence. We discuss the significant data and methodological challenges of using panarchy in a convergence approach to address emergent phenomena, as well as state-of-the-art methods for overcoming them. We present two examples that would benefit from such an approach: climate change and its impacts on social-ecological systems, and the relationships between infectious disease and social-ecological systems.

Motor cortical excitability and pre-supplementary motor area neurochemistry in healthy adults with substantia nigra hyperechogenicity

Substantia nigra (SN) hyperechogenicity, viewed with transcranial ultrasound, is a risk marker for Parkinson's disease. We hypothesized that SN hyperechogenicity in healthy adults aged 50-70 years is associated with reduced short-interval intracortical inhibition in primary motor cortex, and that the reduced intracortical inhibition is associated with neurochemical markers of activity in the pre-supplementary motor area (pre-SMA). Short-interval intracortical inhibition and intracortical facilitation in primary motor cortex was assessed with paired-pulse transcranial magnetic stimulation in 23 healthy adults with normal (n = 14; 61 ± 7 yrs) or abnormally enlarged (hyperechogenic; n = 9; 60 ± 6 yrs) area of SN echogenicity. Thirteen of these participants (7 SN- and 6 SN+) also underwent brain magnetic resonance spectroscopy to investigate pre-SMA neurochemistry. There was no relationship between area of SN echogenicity and short-interval intracortical inhibition in the ipsilateral primary motor cortex. There was a significant positive relationship, however, between area of echogenicity in the right SN and the magnitude of intracortical facilitation in the right (ipsilateral) primary motor cortex (p = .005; multivariate regression), evidenced by the amplitude of the conditioned motor evoked potential (MEP) at the 10-12 ms interstimulus interval. This relationship was not present on the left side. Pre-SMA glutamate did not predict primary motor cortex inhibition or facilitation. The results suggest that SN hyperechogenicity in healthy older adults may be associated with changes in excitability of motor cortical circuitry. The results advance understanding of brain changes in healthy older adults at risk of Parkinson's disease.

Quantitative Thermal Imaging

Quantitative thermal imaging, the measurement of temperature by use of thermal imaging devices, is reviewed here from a metrological perspective with a focus on measurement confidence and system application to fields such as condition monitoring and healthcare diagnostics. Thermal imaging has seen greatly increased application for the measurement of temperature following dramatic improvements in practicality and price. Selected thermal imaging systems are reviewed here by providing some example measurements outputs from devices, highlighting their outcomes on measurement confidence and impact on practical use, such as in condition monitoring and healthcare diagnostics.

REASONS OLDER ADULTS START ATTENDING CONGREGATE MEAL PROGRAMS AND WHO ATTENDS FOR SOCIALIZATION

The Older Americans Act Nutrition Services Program’s congregate meals support food security and nutrition, promote socialization, and improve quality of life. Understanding what drives people to first attend a congregate meal program may support efforts to increase involvement. This study used the 2019 National Survey of Older Americans Act Participants to analyze the open-ended survey responses of congregate meal participants (N=1,072) on why they started attending the program. The top three reasons were that they sought socialization (36.3%), had a medical or age-related need (18.7%), or accompanied or were referred by a friend or relative (12.3%). We conducted descriptive analyses on differences in the demographic, socioeconomic, and health characteristics of those attending for socialization compared to others. Results indicated a relationship between attending congregate meals for socialization and several characteristics: these individuals are more often non-Hispanic white (p&lt; 0.05), widowed (p&lt; 0.05), aged 75 to 84 (p&lt; 0.05), and have at least a high school education (p&lt; 0.01). People who attend for socialization are also less likely to be lower income (p&lt; 0.01), living in cities (p&lt; 0.001), have food insecurity (p&lt; 0.01), and living with three or more ADLs (p&lt; 0.01). Findings suggest two subpopulations of congregate meal attendees: those who have the choice to attend and do so for socialization, and those who attend because of unmet needs (e.g., food insecurity or disability). Identification of different categories of participants and what drives them to attend congregate meal sites has implications for improvements to advertising congregate meal services, targeting of certain populations, and ultimately to increasing participation.

Bleeding risk of oral anticoagulants in liver cirrhosis

AIM

The safety of dabigatran is poorly studied in patients with liver cirrhosis and has rarely been compared to warfarin in terms of bleeding risks.

METHOD

We undertook a retrospective cohort study across three tertiary centres in Auckland, New Zealand, between 2008 to 2020. Adults 18 years and over and those with a clinically confirmed diagnosis of cirrhosis were included. Data collected included demographic data and clinical characteristics, baseline medication and comorbidities. The primary outcome measure was the incidence of any bleeding event that resulted in hospital admission.

RESULTS

Overall, 100 patients were included in this study. A total of 52 patients took warfarin, and 48 took dabigatran. Baseline characteristics for both groups were generally similar. The incidence rate of bleeds for patients taking warfarin was 14.4 per 100 person-years (95% CI, 8.8-23.5) compared to 9.1 per 100 person-years (95% CI, 4.5-18.1) for patients taking dabigatran. The incidence rate ratio comparing dabigatran to warfarin was 0.63 (95% CI, 0.23-1.60), p=0.25.

CONCLUSION

Our study found that patients on dabigatran may have a lower bleeding risk than patients taking warfarin, but this was not statistically significant.

Training assessment of clinical knowledge and skills in the use of negative pressure wound dressings in cardiac patients

Funding Acknowledgements

Type of funding sources: None.

Objective

An assessment was conducted to analyse the level of improvement impact one can have on clinical knowledge and skills in the use of a novel negative pressure wound dressings in high-risk cardiac patients along with their years of experience following a training program conducted among our cardiac staff.

Methods

In a prospective study involving twenty cardiac nursing staff from December 2020 to June 2021 who voluntarily participated in the study. Their pre and post training assessment of clinical knowledge and skills were assessed using twenty questionnaires. The pre and post training educational knowledge and skills scores were analysed along with their years of clinical experience.

Results

In the six-month period n=20 (100 %) were compliant to the training despite the covid-19 pandemic.

The study group showed an average pre-training score of 10.5% (Knowledge 5.25% and Skills 5.25%)

The average post-training score of84.75% (Knowledge 42.25% and Skills 42.25%)

While comparing the years of clinical experience against the pre and post training scoresSeventeen (n=17/20, 85%) had five to ten years experience compared to three (n-3/20, 15%) with more than 20 years of experience.

Conclusion

Both clinical knowledge and skills can be augmented through regular training members with more than ten years of clinical experience might have an added benefit and their experience could be important to train younger staff members with less clinical experience.

Experimental characterization and automatic identification of stridulatory sounds inside wood

The propagation of animal vocalizations in water and in air is a well-studied phenomenon, but sound produced by bark and wood-boring insects, which feed and reproduce inside trees, is poorly understood. Often being confined to the dark and chemically saturated habitat of wood, many bark- and woodborers have developed stridulatory mechanisms to communicate acoustically. Despite their ecological and economic importance and the unusual medium used for acoustic communication, very little is known about sound production in these insects, or their acoustic interactions inside trees. Here, we use bark beetles (Scolytinae) as a model system to study the effects of wooden tissue on the propagation of insect stridulations and propose algorithms for their automatic identification. We characterize distance dependence of the spectral parameters of stridulatory sounds, propose data-based models for the power decay of the stridulations in both outer and inner bark, provide optimal spectral ranges for stridulation detectability and develop automatic methods for their detection and identification. We also discuss the acoustic discernibility of species cohabitating the same log. The species tested can be acoustically identified with 99% of accuracy at distances up to 20 cm and detected to the greatest extent in the 2-6 kHz frequency band. Phloem was a better medium for sound transmission than bark.

Neuromuscular fatigability during repeated sprints assessed with an innovative cycle ergometer

PURPOSE

Repeated sprint ability is an integral component of team sports. This study aimed to evaluate fatigability development and its aetiology during and immediately after a cycle repeated sprint exercise performed until a given fatigability threshold.

METHODS

On an innovative cycle ergometer, 16 healthy males completed an RSE (10-s sprint/28-s recovery) until task failure (TF): a 30% decrease in sprint mean power (Pmean). Isometric maximum voluntary contraction of the quadriceps (IMVC), central alterations [voluntary activation (VA)], and peripheral alterations [twitch (Pt)] were evaluated before (pre), immediately after each sprint (post), at TF and 3 min after. Sprints were expressed as a percentage of the total number of sprints to TF (TS_TF). Individual data were extrapolated at 20, 40, 60, and 80% TS_TF.

RESULTS

Participants completed 9.7 ± 4.2 sprints before reaching a 30% decrease in Pmean. Post-sprint IMVCs were decreased from pre to 60% TS_TF and then plateaued (pre: 345 ± 56 N, 60% 247 ± 55 N, TF: 233 ± 57 N, p < 0.001). Pt decreased from 20% and plateaued after 40% TS_TF (p < 0.001, pre-TF = - 45 ± 13%). VA was not significantly affected by repeated sprints until 60% TS_TF (pre-TF = - 6.5 ± 8.2%, p = 0.036). Unlike peripheral parameters, VA recovered within 3 min (p = 0.042).

CONCLUSION

During an RSE, Pmean and IMVC decreases were first concomitant to peripheral alterations up to 40% TS_TF and central alterations was only observed in the second part of the test, while peripheral alterations plateaued. The distinct recovery kinetics in central versus peripheral components of fatigability further confirm the necessity to reduce traditional delays in neuromuscular fatigue assessment post-exercise.

Lcapy: symbolic linear circuit analysis with Python

Lcapy is an open-source Python package for solving linear circuits symbolically. It uses a superposition of DC analysis, AC (phasor) analysis, transient (Laplace) analysis, and noise analysis. Expressions are evaluated using the computer algebra system SymPy. Lcapy can model circuits comprised of combinations of one-port and two-port networks or circuits specified using a netlist with a Spice-like notation. Lcapy can present the system of equations produced from nodal analysis, modified nodal analysis, loop analysis, and state-space analysis. Expressions can be formatted into many representations, parameterized, and transformed to other domains. Dimensional analysis is performed to reduce user errors and to present results with units. Both continuous and discrete signals are supported. Lcapy produces high-quality output. Textbook quality schematics in a number of different formats can be generated from netlists and customized for different conventions. Expressions can be formatted into LaTeX format for inclusion into a document or numerically evaluated and plotted. An overview of the features and capabilities of Lcapy is presented, along with implementation details and performance considerations.

Implementation of a remote rapid access chest pain service during the COVID-19 pandemic

Background

Rapid Access Chest Pain Clinic (RACPC) is a vital service in many hospitals in the UK, providing early specialist input for patients with suspected coronary artery disease referred via the Emergency Department (ED) or primary care (1). When the COVID-19 pandemic forced hospitals to refine their outpatient systems (2), our Trust continued the RACPC service remotely via telephone consultations.

Purpose

To examine the long-term viability of this service, we designed a study to compare the outcomes of patients seen remotely during the pandemic to patients seen face to face.

Methods

We performed a retrospective cohort study. The remote group (n=217) were patients seen over 4 weeks in April 2020, all having telephone consultations. The control group (n=368) were patients assessed face to face in the same 4-week period in 2019. Outcomes being analysed included: mode of investigation; interventions performed; and a 12 month combined safety endpoint of ED attendance with chest pain, re-referral to cardiology and hospitalisation for cardiac issue. Subgroup analysis was performed based on typicality of symptoms defined by NICE (3).

Results

Baseline characteristics were similar between groups. In both 2019 and 2020, the largest subgroup of patients were those with non-anginal chest pain (64%, 71%). There were significant differences in investigation and management between the two cohorts (Figure 1). In 2020, a higher proportion of patients were discharged with no investigation (57% vs 23%, p<0.0001). This was driven primarily by changes in management of patients with non-anginal chest pain. There were significantly higher rates of investigation of this subgroup in 2019 by either CT Coronary Angiography (25% versus 4.5%, p<0.001) or functional testing (25% versus 6.5%, p<0.001), with a much higher rate of reassurance and discharge in 2020 (81% versus 36%, p<0.0001). More patients received coronary intervention in 2019 than in 2020 (2.4% vs 0%, p=0.02). In 2020, higher proportions of patients were commenced on medical therapy without further investigation when presenting with atypical (28% versus 1%, p<0.0001) or typical angina (63% versus 11.4%, p<0.0001) (Figure 2). There was no significant difference in the 12 month combined safety endpoint (1.3% in 2019 versus 2.3% in 2020, p=0.39), and no reported cardiac deaths.

Conclusions

During the pandemic, as expected, fewer patients were investigated for coronary artery disease, with the preference being to commence medical therapy initially. This did not have a significant effect on safety endpoints. Importantly, clinicians felt comfortable with assessing and discharging patients with non-anginal chest pain remotely in 2020. This is key to the viability of a remote RACPC model, as this subgroup forms the majority of the referrals. We suggest that RACPC is appropriate for a remote model in the long term, in view of the relatively low-risk population and clear management guidelines.

Funding Acknowledgement

Type of funding sources: None.

Mapping Heat Vulnerability Index Based on Different Urbanization Levels in Nebraska, USA

Heatwaves cause excess mortality and physiological impacts on humans throughout the world, and climate change will intensify and increase the frequency of heat events. Many adaptation and mitigation studies use spatial distribution of highly vulnerable local populations to inform heat reduction and response plans. However, most available heat vulnerability studies focus on urban areas with high heat intensification by Urban Heat Islands (UHIs). Rural areas encompass different environmental and socioeconomic issues that require alternate analyses of vulnerability. We categorized Nebraska census tracts into four urbanization levels, then conducted factor analyses on each group and captured different patterns of socioeconomic vulnerabilities among resultant Heat Vulnerability Indices (HVIs). While disability is the major component of HVI in two urbanized classes, lower education, and races other than white have higher contributions in HVI for the two rural classes. To account for environmental vulnerability of HVI, we considered different land type combinations for each urban class based on their percentage areas and their differences in heat intensifications. Our results demonstrate different combinations of initial variables in heat vulnerability among urban classes of Nebraska and clustering of high and low heat vulnerable areas within the highest urbanized sections. Less urbanized areas show no spatial clustering of HVI. More studies with separation on urbanization level of residence can give insights into different socioeconomic vulnerability patterns in rural and urban areas, while also identifying changes in environmental variables that better capture heat intensification in rural settings.

The elderly's physiological and perceptual responses to cooling during simulated activities of daily living in UK summer climatic conditions

OBJECTIVES

The elderly are the most at-risk population for heat-related illness and mortality during the periods of hot weather. However, evidence-based elderly-specific cooling strategies to prevent heat-illness are limited. The aim of this investigation was to quantify the elderly's physiological and perceptual responses to cooling through cold water ingestion (COLD) or an L-menthol mouth rinse (MENT) during simulated activities of daily living in UK summer climatic conditions.

STUDY DESIGN

Randomised, controlled repeated measures research design.

METHODS

A total of ten participants (men n = 7, women n = 3: age; 69 ± 3 yrs, height; 168 ± 10 cm, body mass; 68.88 ± 13.72 kg) completed one preliminary and three experimental trials; control (CON), COLD and MENT. Experimental trials consisted of 40 min rest followed by 30 min of cycling exercise at 6 metabolic equivalents and a 6-min walk test (6MWT), within a 35 °C, 50% relative humidity environment. Experimental interventions (every 10 min); cold water (4 °C) ingestion (total of 1.5L) or menthol (5 ml mouth swill for 5 s, menthol concentration of 0.01%).

RESULTS

Peak rectal temperature (T_re) was significantly (P < 0.05) lower in COLD compared with CON (-0.34 ± 0.16 °C) and MENT (-0.36 ± 0.20 °C). End exercise heart rate (HR) decreased in COLD compared with CON (-7 ± 9 b min^-1) and MENT (-6 ± 7 b min^-1). There was no difference in end exercise thermal sensation (TS) (CON; 6.1 ± 0.4, COLD; 6.0 ± 0.4, MENT; 6.4 ± 0.6) or thermal comfort (TC) (CON; 4 ± 1, COLD; 4 ± 1, MENT; 4 ± 1) between trials. The participants walked significantly further during the COLD 6MWT compared with CON (40 m ± 40 m) and MENT (40 m ± 30 m). There was reduced physiological strain in the COLD 6MWT compared with CON (T_re; -0.21 ± 0.24 °C, HR; -7 ± 8 b min^-1) and MENT (T_re; -0.23 ± 0.24 °C, HR; -4 ± 7 b min^-1).

CONCLUSION

The elderly have reduced physiological strain (T_re and HR) during activities of daily living and a 6MWT in hot UK climatic conditions, when they drink cold water. Furthermore, the elderly's perception (TS and TC) of the hot environment did not differ from CON at the end of exercise with COLD or MENT interventions. Menthol provided neither perceptual benefit to exercise in the heat nor functional gain. The TS data indicate that elderly may be at increased risk of heat illness, due to not feeling hot and uncomfortable enough to implement physiological strain reducing strategies such as cold-water ingestion.

Group-led creative writing and behavioural health in cancer: a randomised clinical trial

BACKGROUND

Cancer diagnosis can adversely affect mental well-being and overall clinical outcome. We evaluated the efficacy of a group-led creative writing workshop (CWW) on mood in patients with cancer prospectively.

METHODS

We conducted a single-institution phase II study. Sixty adult patients with cancer (any type or stage) were randomised 2:1 to CWW (4×CWW sessions, bimonthly over 8 weeks) versus active control (AC) (independent writing at home with the help of a book, four sessions, bimonthly over 8 weeks). The total study duration was 6 months with a follow-up of up to 3 months.

PRIMARY OBJECTIVE

changes in overall mood, depression and anxiety symptoms before and after intervention in both arms. Emotional Thermometer Scale (ETS) was used to assess changes in patients' mood. Additionally, the Patient Health Questionnaire (PHQ)-9 and General Anxiety Disorder Scale (GAD)-7 were used to evaluate depression and anxiety symptoms.

RESULTS

Of 50 evaluable patients (CWW 34, AC 17), 26 patients in the CWW arm attended at least one class and 19 attended at least four classes. Patients in CWW had significant immediate improvement in the overall ETS (post vs preclass scores; p<0.0001, 95% CI -4.31 to -2.47). Four of the five subscale ETS scores were significantly lower for the CWW arm: distress (p=0.0346, 95% CI -2.6 to -0.1), anxiety (p=0.0366, 95% CI -4.1 to -0.2), depression (p=0.0441, 95% CI -3.9 to -0.1) and anger (p=0.0494, 95% CI -3.3 to 0). No significant differences were seen in the AC arm. No significant differences were observed in the PHQ-9 or the GAD-7 scores.

CONCLUSION

CWW had a positive effect on mood based on ETS scores, suggesting a potential therapeutic benefit among patients with cancer.

A revealed preference analysis to develop composite scores approximating lung allocation policy in the U.S

BACKGROUND

The patient ranking process for donor lung allocation in the United States is carried out by a classification-based, computerized algorithm, known as the match system. Experts have suggested that a continuous, points-based allocation framework would better serve waiting list candidates by removing hard boundaries and increasing transparency into the relative importance of factors used to prioritize candidates. We applied discrete choice modeling to match run data to determine the feasibility of approximating current lung allocation policy by one or more composite scores. Our study aimed to demystify the points-based approach to organ allocation policy; quantify the relative importance of factors used in current policy; and provide a viable policy option that adapts the current, classification-based system to the continuous allocation framework.

METHODS

Rank ordered logistic regression models were estimated using 6466 match runs for 5913 adult donors and 534 match runs for 488 pediatric donors from 2018. Four primary attributes are used to rank candidates and were included in the models: (1) medical priority, (2) candidate age, (3) candidate's transplant center proximity to the donor hospital, and (4) blood type compatibility with the donor.

RESULTS

Two composite scores were developed, one for adult and one for pediatric donor allocation. Candidate rankings based on the composite scores were highly correlated with current policy rankings (Kendall's Tau ~ 0.80, Spearman correlation > 90%), indicating both scores strongly reflect current policy. In both models, candidates are ranked higher if they have higher medical priority, are registered at a transplant center closer to the donor hospital, or have an identical blood type to the donor. Proximity was the most important attribute. Under a points-based scoring system, candidates in further away zones are sometimes ranked higher than more proximal candidates compared to current policy.

CONCLUSIONS

Revealed preference analysis of lung allocation match runs produced composite scores that capture the essence of current policy while removing rigid boundaries of the current classification-based system. A carefully crafted, continuous version of lung allocation policy has the potential to make better use of the limited supply of donor lungs in a manner consistent with the priorities of the transplant community.

Brown marmorated stink bug overwintering aggregations are not regulated through vibrational signals during autumn dispersal

The brown marmorated stink bug, Halyomorpha halys (Heteroptera: Pentatomidae), is regarded as one of the world's most pernicious invasive pest species, as it feeds on a wide range of economically important crops. During the autumn dispersal period, H. halys ultimately moves to potential overwintering sites, such as human-made structures or trees where it will alight and seek out a final overwintering location, often aggregating with other adults. The cues used during this process are unknown, but may involve vibrational signals. We evaluated whether vibrational signals regulate cluster aggregation in H. halys in overwintering site selection. We collected acoustic data for six weeks during the autumn dispersal period and used it to quantify movement and detect vibrational communication of individuals colonizing overwintering shelters. Both movement and vibrational signal production increased after the second week, reaching their maxima in week four, before decaying again. We found that only males produced vibrations in this context, yet there was no correlation between movement and vibrational signals, which was confirmed through playback experiments. The cues regulating the formation of aggregations remain largely unknown, but vibrations may indicate group size.

Characterization of a novel enzyme from Photobacterium phosphoreum with histidine decarboxylase activity

Histamine or scombrotoxin fish poisoning is caused by ingestion of bacterially produced histamine in fish. Histamine-producing bacteria generally contain the histidine decarboxylase gene (hdc). However, some strains of Photobacterium phosphoreum are known to produce significant levels of histamine, although the hdc gene in these strains has not been recognized. The objective of this study was to investigate a previously unidentified mechanism of histamine production by P. phosphoreum. We identified a protein with histidine decarboxylase (HDC) activity comparable to activity of the pyridoxal-5-phosphate (PLP) dependent HDC from P. kishitanii and M. morganii. The newly identified protein (HDC2) in P. phosphoreum and P. kishitanii strains, was approximately 2× longer than the HDC protein from other Gram-negative bacteria and had 12% similarity to previously identified HDCs. In addition, the hdc2 gene cluster in P. phosphoreum was identical to the hdc gene cluster in P. kishitanii. HDC2 had optimal activity at 20-35 °C, at pH 4, and was not affected by 0-8% NaCl concentrations. Compared to the hdc gene from P. kishitanii, expression of the hdc2 gene was constitutive and not affected by pH or excess histidine. This newly identified protein explains possible mechanisms of histamine production in P. phosphoreum. Characterization of this protein will help in designing control measures to prevent or reduce histamine production in fish.

1146 Interaction Of Mild Cognitive Impairment And Late-life Depression In Actigraphy And Self Report Of Sleep Problems

Introduction

Late-life depression has been proposed as a precursor to amnestic Mild Cognitive Impairment (aMCI), the prodrome of Alzheimer’s disease. Both conditions are associated with sleep and cognitive problems. We hypothesized that MCI and current depressive symptoms would co-occur more frequently, but express distinct sleep phenotypes.

Methods

Independently living older adults (N=80), age 62-90 (M=71.78, SD=5.98), were recruited from a geriatric psychiatry clinic and the community for a home sleep study. A clinical decision board and neurocognitive battery were used to determine MCI status. Participants completed the CES-D and depression history interview where endorsement of current depression was considered positive. Sleep was examined with wrist actigraphy for 7 days. Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Stanford Sleepiness Scale (SSS) provided subjective sleep quality.

Results

Based on these criteria, 41.2% of the sample were determined to be MCI (n=33); the remainder were deemed normative for age (NC; n=47). Chi-square analyses showed a higher frequency of MCI were positive for current depression than expected (14.2%; p=0.017). Repeated-measures MANOVA, using current depression symptoms and MCI as factors, revealed MCI was associated with longer sleep latency (p=0.035) and wake bout time (p=0.039); whereas, current depression was associated with longer sleep latency, more fragmentation/WASO, and lower sleep efficiency (p’s&lt;0.05), self-report of poorer daytime dysfunction (p=0.005), and greater daytime sleepiness (p=0.001). MCI x current depression interactions were found for sleep latency (p=0.029); and PSQI sleep disturbances (p=0.005) and sleep medication (p=0.025).

Conclusion

Despite distinct sleep disordered phenotypes, the interaction of MCI and current depression is associated with delayed sleep onset, use sleep medication and report of sleep disturbances.

Support

This project was sponsored by: NASA, Maine Space Consortium; AG 056176, AG 053164 Vice President for Research, U. Maine; Maine Technology Institute; DoD Phase I SBIR and R44AG059536-01 SBIR Phase II Award.

The ABCF gene family facilitates disaggregation during animal development

Protein aggregation, once believed to be a harbinger and/or consequence of stress, age, and pathological conditions, is emerging as a novel concept in cellular regulation. Normal versus pathological aggregation may be distinguished by the capacity of cells to regulate the formation, modification, and dissolution of aggregates. We find that Caenorhabditis elegans aggregates are observed in large cells/blastomeres (oocytes, embryos) and in smaller, further differentiated cells (primordial germ cells), and their analysis using cell biological and genetic tools is straightforward. These observations are consistent with the hypothesis that aggregates are involved in normal development. Using cross-platform analysis in Saccharomyces cerevisiae, C. elegans, and Xenopus laevis, we present studies identifying a novel disaggregase family encoded by animal genomes and expressed embryonically. Our initial analysis of yeast Arb1/Abcf2 in disaggregation and animal ABCF proteins in embryogenesis is consistent with the possibility that members of the ABCF gene family may encode disaggregases needed for aggregate processing during the earliest stages of animal development.

Erratum: Delayed Onset of Nonthermal Melting in Single-Crystal Silicon Pumped with Hard X Rays [Phys. Rev. Lett. 120, 265701 (2018)]

This corrects the article DOI: 10.1103/PhysRevLett.120.265701.

Direct 24-Hour Presumptive Enumeration of Escherichia coli 0157:H7 in Foods Using Hydrophobic Grid Membrane Filter Followed by Serological Confirmation: Collaborative Study

Fifteen laboratories took part in a collaborative study to validate a method for enumerating Escherichia coli 0157:H7. The method is based on use of a hydrophobic grid membrane filter and consists of 24 h presumptive enumeration on SD-39 Agar and serological confirmation to yield a confirmed E. coli 0157:H7 count. Six food products were analyzed: pasteurized apple cider, pasteurized 2% milk, cottage cheese, cooked ground pork, raw ground beef, and frozen whole egg. The test method produced significantly higher confirmed count results than did the reference method for milk, pork, and beef. Test method results were numerically higher than but statistically equivalent to reference method results for cheese, cider, and egg. The test method produced lower repeatability and reproducibility values than did the reference method for most food/inoculation level combinations and values very similar to those of the reference method for the remaining combinations. Overall, 94% of presumptive positive isolates from the test method were confirmed serologically as E. coli 0157:H7, and 98% of these were also biochemically typical of E. coli 0157:H7 (completed test). Corresponding rates for the reference method were 69 and 98%, respectively. On the basis of the results of this collaborative study and the precollaborative study that preceded it, it is recommended that this method be adopted official first action for enumeration of E. coli 0157:H7 in meats, poultry, dairy foods, infant formula, liquid eggs, mayonnaise, and apple cider

Mental health of parents of children with a developmental disability in British Columbia, Canada

Background

There is evidence in the literature that parents of children who have a developmental disability experience an increased risk of mental health problems.

Methods

This study used population-level administrative data from the Ministry of Health, British Columbia, Canada, to assess the mental health of parents of children who have a developmental disability compared with the mental health of parents of children who do not have a developmental disability. Population-level and individual explanatory variables available in the data were included in the models.

Results

At a population level, the study found strong evidence that parents of children who have a developmental disability experience higher odds of depression or other mental health diagnoses compared with parents of children who do not have a developmental disability. Age of the parent at birth of the child, income and location of healthcare services were all associated with outcomes.

Conclusion

Parents of children who have a developmental disability may be in need of programmes and services that support their mental health.

Whole genome sequencing for the genetic diagnosis of heterogenous dystonia phenotypes

INTRODUCTION

Dystonia is a clinically and genetically heterogeneous disorder and a genetic cause is often difficult to elucidate. This is the first study to use whole genome sequencing (WGS) to investigate dystonia in a large sample of affected individuals.

METHODS

WGS was performed on 111 probands with heterogenous dystonia phenotypes. We performed analysis for coding and non-coding variants, copy number variants (CNVs), and structural variants (SVs). We assessed for an association between dystonia and 10 known dystonia risk variants.

RESULTS

A genetic diagnosis was obtained for 11.7% (13/111) of individuals. We found that a genetic diagnosis was more likely in those with an earlier age at onset, younger age at testing, and a combined dystonia phenotype. We identified pathogenic/likely-pathogenic variants in ADCY5 (n = 1), ATM (n = 1), GNAL (n = 2), GLB1 (n = 1), KMT2B (n = 2), PRKN (n = 2), PRRT2 (n = 1), SGCE (n = 2), and THAP1 (n = 1). CNVs were detected in 3 individuals. We found an association between the known risk variant ARSG rs11655081 and dystonia (p = 0.003).

CONCLUSION

A genetic diagnosis was found in 11.7% of individuals with dystonia. The diagnostic yield was higher in those with an earlier age of onset, younger age at testing, and a combined dystonia phenotype. WGS may be particularly relevant for dystonia given that it allows for the detection of CNVs, which accounted for 23% of the genetically diagnosed cases.