Environmental drivers of increased ecosystem respiration in a warming tundra

Arctic and alpine tundra ecosystems are large reservoirs of organic carbon1,2. Climate warming may stimulate ecosystem respiration and release carbon into the atmosphere3,4. The magnitude and persistency of this stimulation and the environmental mechanisms that drive its variation remain uncertain5-7. This hampers the accuracy of global land carbon-climate feedback projections7,8. Here we synthesize 136 datasets from 56 open-top chamber in situ warming experiments located at 28 arctic and alpine tundra sites which have been running for less than 1 year up to 25 years. We show that a mean rise of 1.4 °C [confidence interval (CI) 0.9-2.0 °C] in air and 0.4 °C [CI 0.2-0.7 °C] in soil temperature results in an increase in growing season ecosystem respiration by 30% [CI 22-38%] (n = 136). Our findings indicate that the stimulation of ecosystem respiration was due to increases in both plant-related and microbial respiration (n = 9) and continued for at least 25 years (n = 136). The magnitude of the warming effects on respiration was driven by variation in warming-induced changes in local soil conditions, that is, changes in total nitrogen concentration and pH and by context-dependent spatial variation in these conditions, in particular total nitrogen concentration and the carbon:nitrogen ratio. Tundra sites with stronger nitrogen limitations and sites in which warming had stimulated plant and microbial nutrient turnover seemed particularly sensitive in their respiration response to warming. The results highlight the importance of local soil conditions and warming-induced changes therein for future climatic impacts on respiration.

Mental Health Over Time and Financial Concerns Predict Change in Online Gambling During COVID-19

This study examined online gambling behavior during COVID-19 land-based gambling restrictions and associations with changes in mental health, impacts on household income due to the pandemic, financially focused motivations, and symptoms of gambling problems. A repeated online survey was administered to adult gamblers in Ontario, Canada. Wave 1 was conducted at the beginning of the first COVID-19 lockdown (April 2020) and wave 2 in August 2020. Respondents (N = 940) completed validated self-report questionnaires related to depression and anxiety, financial motivation, financial impacts due to the pandemic, online gambling behaviors, and problem gambling symptomatology. A cluster analysis identified three subgroups: no online gambling (subgroup 1), engagement in a range of gambling games online and change in gambling involvement (i.e., some increased and some decreased gambling; subgroup 2), and predominantly online lottery play with no change in online gambling (subgroup 3). Respondents who reported increased anxiety and depression symptom severity between the two waves and those who experienced greater symptoms of problem gambling and negative impacts on household income due to COVID-19 were most likely to be found in subgroup 2. Greater financial focus was also noted in this group. Results indicate a link between change in online gambling involvement during COVID-19 and increased mental health problems, elevated problem gambling severity, negative impacts on household income, and a greater financially focused self-concept. These results may help generate novel research questions examining short and long-term effects of the pandemic on online behaviors that inform policy and practice.

Gambling and Gaming in an Ontario Sample of Youth and Parents

Despite the convergence of the gambling and gaming worlds, the majority of studies of gambling behaviour are void of gaming behaviour and vice versa. Further, many studies examine specific age ranges rather than covering the entire span of adolescence and young adulthood. The current study improves our knowledge of gambling and gaming behaviours, as well as their convergence, by examining young people aged 8 to 24 and parents of children 8 to 17 years in Ontario. Descriptive and bivariate analyses were performed on a survey of 2,651 Ontarians (678 adolescents, 973 young adults, and 1,000 parents who reported on themselves and their child). Young people and parents are engaging in games that combine gambling and gaming at substantial rates and frequencies, and playing these games is associated with a higher level of risk. In this sample, playing video games for money and social casino games were associated with a higher level of gambling problems among adolescents (p < .001, p =.001), young adults (p < .001, p < .001), and parents (p < .001, p < .001). Further, parent reports of their own and their child’s gambling (p < .001), social casino play (p < .001), and gambling concerns were linked (p < .001). In summary, we found that playing games that combine gambling and gaming was associated with increased risk across youth age groups. Parents who reported gambling, social casino play, and gambling concerns also tended to report these behaviours among and concerns for their children.Résumé Malgré la convergence entre les univers des jeux de hasard et des jeux vidéo, la majorité des études sur le comportement des joueurs excluent l’une ou l’autre activité. De plus, elles se limitent à une tranche d’âge précise plutôt que de couvrir la période entière de l’adolescence et de la jeune vie adulte. Notre enquête ajoute aux connaissances sur les habitudes en matière de jeux de hasard et de jeux vidéo et la convergence entre ces activités. Elle a été menée en Ontario auprès de jeunes âgés de huit à 24 ans et de parents d’enfants âgés de huit à 17 ans. 2651 Ontariens (678 adolescents, 973 jeunes adultes et 1000 parents répondant en leur propre nom et en celui de leur enfant) ont répondu à un questionnaire dont les résultats ont fait l’objet d’une analyse descriptive et bivariée. Un grand nombre de jeunes et de parents combinent fréquemment jeux de hasard et jeux vidéo, une activité liée à un niveau de risque élevé. Dans notre échantillon, la pratique des jeux vidéo pour de l’argent et des jeux de casino est associée à un risque élevé de problèmes de jeu chez l’adolescent (p < .001, p =.001), le jeune adulte (p < .001, p < .001) et les parents (p < .001, p < .001). De plus, un lien a été établi entre les habitudes de jeu déclarées par les parents à propos d’eux-mêmes et de leurs enfants (p < .001), les jeux de casino (p < .001) et les problèmes de jeu (p < .001). La pratique combinée des jeux de hasard et des jeux vidéo est associée à une augmentation du risque dans tous les groupes d’âge. Ainsi, les comportements et les problèmes de jeu observés chez les parents tendent à se refléter chez leurs enfants.

Parent problem gambling: A systematic review of prevention programs for children

Parent problem gambling (PG) has pervasive adverse effects on children. These children experience considerable losses such as loss of trust, loss of safety and stability, as well as financial and emotional losses. They are at greater risk for maltreatment and mental health disorders, and they are also at risk for intergenerational transmission of PG. These children are two to four times more likely to develop PG than children of non-PG parents. To date, there has been a dearth of research examining the impact of parent PG on children, and even less research focusing on reducing risks in children of PG parents. The goal of this systematic review was to identify PG prevention programs for children and examine the types of prevention used and whether these programs target specific subgroups. Our search retained 16 studies examining PG prevention programs for children. Results indicated that all of the PG prevention programs in the selected studies are universal and do not target children of PG parents or any other specific subgroups. A large gap is the absence of secondary and tertiary PG prevention programs for children. Another gap is the lack of family focused prevention strategies which the substance use literature has shown to be the most effective form of prevention. Further research is needed on parent PG and ways of reducing risks and increasing protective factors in children and families. A public health framework must be adopted to delay onset, reduce risks and minimize consequences in children of PG parents.

Protocol for the Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) study: a pragmatic, randomised clinical trial

INTRODUCTION

Postoperative delirium, arbitrarily defined as occurring within 5 days of surgery, affects up to 50% of patients older than 60 after a major operation. This geriatric syndrome is associated with longer intensive care unit and hospital stay, readmission, persistent cognitive deterioration and mortality. No effective preventive methods have been identified, but preliminary evidence suggests that EEG monitoring during general anaesthesia, by facilitating reduced anaesthetic exposure and EEG suppression, might decrease incident postoperative delirium. This study hypothesises that EEG-guidance of anaesthetic administration prevents postoperative delirium and downstream sequelae, including falls and decreased quality of life.

METHODS AND ANALYSIS

This is a 1232 patient, block-randomised, double-blinded, comparative effectiveness trial. Patients older than 60, undergoing volatile agent-based general anaesthesia for major surgery, are eligible. Patients are randomised to 1 of 2 anaesthetic approaches. One group receives general anaesthesia with clinicians blinded to EEG monitoring. The other group receives EEG-guidance of anaesthetic agent administration. The outcomes of postoperative delirium (≤5 days), falls at 1 and 12 months and health-related quality of life at 1 and 12 months will be compared between groups. Postoperative delirium is assessed with the confusion assessment method, falls with ProFaNE consensus questions and quality of life with the Veteran's RAND 12-item Health Survey. The intention-to-treat principle will be followed for all analyses. Differences between groups will be presented with 95% CIs and will be considered statistically significant at a two-sided p<0.05.

ETHICS AND DISSEMINATION

Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) is approved by the ethics board at Washington University. Recruitment began in January 2015. Dissemination plans include presentations at scientific conferences, scientific publications, internet-based educational materials and mass media.

TRIAL REGISTRATION NUMBER

NCT02241655; Pre-results.

Fiber chirped pulse amplifier at 2.08 μm emitting 383-fs pulses at 10 nJ and 7 MHz

An all-polarization maintaining (PM) fiber chirped pulse amplifier system at 2.08 μm based on thulium:holmium codoped gain fibers is reported. An inhouse built oscillator emits pulses at a repetition rate of 7 MHz with a spectral full width at half-maximum (FWHM) bandwidth of 23.5 nm at 2.8 mW average output power. The pulses are temporally stretched and subsequently amplified in a double-stage amplifier setup. The stretched pulses are compressed to 383 fs by use of a Martinez-style setup at an output pulse energy of 10.2 nJ. By neglecting temporal stretching, high peak powers in a single amplifier stage led to Raman soliton formation at 2.3 μm.

Plasma-beam traps and radiofrequency quadrupole beam coolers

Two linear trap devices for particle beam manipulation (including emittance reduction, cooling, control of instabilities, dust dynamics, and non-neutral plasmas) are here presented, namely, a radiofrequency quadrupole (RFQ) beam cooler and a compact Penning trap with a dust injector. Both beam dynamics studies by means of dedicated codes including the interaction of the ions with a buffer gas (up to 3 Pa pressure), and the electromagnetic design of the RFQ beam cooler are reported. The compact multipurpose Penning trap is aimed to the study of multispecies charged particle samples, primarily electron beams interacting with a background gas and/or a micrometric dust contaminant. Using a 0.9 T solenoid and an electrode stack where both static and RF electric fields can be applied, both beam transport and confinement operations will be available. The design of the apparatus is presented.

Beyond description: Understanding gender differences in problem gambling

Background and aims Though women make up roughly one third of all problem gamblers, research has typically focused on male problem gamblers. Recent research has started to shift its attention toward the importance of gender. However, studies rarely attempt to understand gender differences in problem gambling or subject these differences to thorough multivariate analyses. To address some of the gaps in our knowledge of gender differences, we examine whether patterns of gambling behavior and psychological factors mediate the relationship between gender and problem gambling. Methods We use logistic multiple regression to analyze two large Canadian datasets - the 2005 Ontario Prevalence Survey and the 2007 Canadian Community Health Survey. Results Variables found to mediate the relationship between gender and problem gambling are the type(s) of game(s) played (in the 2005 Ontario Prevalence Survey) and the number of games played (in the 2007 Canadian Community Health Survey). Conclusions Men are more likely to be problem gamblers than women, and this gender difference is understandable in terms of differences in patterns of gambling behavior. We conclude that men experience problems because they play riskier games and women experience problems because they prefer chance-based games, which are associated with significantly higher odds of problem gambling. We specify the three main ways that women's reasons for gambling - to escape or for empowerment - translate into chance-based games.

Efficacy and safety of two different antifungal pastes in infants with diaper dermatitis: a randomized, controlled study

BACKGROUND

Diaper dermatitis (DD) is the most common type of irritative dermatitis in infancy. It is frequently complicated by Candida superinfection.

OBJECTIVE

Comparison of efficacy and safety of two antifungal pastes (Imazol = 1% clotrimazole; Multilind = 100,000 IU nystatin/g + 20% zinc oxide) in infants with DD.

METHODS

A total of 96 infants were included in this multi-centre, controlled, randomized, evaluator-blinded phase IV trial and treated with pastes containing either clotrimazole (n = 45) or nystatin (n = 46) twice daily for 14 days. In all, 91 children (age 12.1 +/- 5.3 months; 48 females) with DD were evaluable. Total symptom score after 7 days (TSS7) was assessed as primary parameter. Secondary efficacy parameters were TSS at 14 days (TSS14), clinical and microbiological cure rates and global assessment (GA) of clinical response.

RESULTS

TSS improved markedly with both pastes. Decreases in symptom score were 4.5 +/- 2.1 (day 7) and 6.1 +/- 1.9 (day 14) with clotrimazole compared with 4.2 +/- 2.3 and 5.4 +/- 2.4 with nystatin (P < 0.0001). With respect to TSS14, clotrimazole was superior to nystatin (P = 0.0434). Clinical cure rate was higher with clotrimazole [36.2% (day 7) and 68.1% (day 14)] compared with 28.6% and 46.9% (nystatin). GA was very good in 26 (55.3%) clotrimazole-treated children (nystatin: 16 [32.7%], P = 0.0257). Frequency of adverse events was comparable in both treatment groups.

CONCLUSION

Clotrimazole was superior to nystatin with respect to reduction in symptom score and GA. Microbiological cure rate was 100% for both agents. Both treatments were safe and well-tolerated.

[Complementary system of health care in cooperation with migrant communities--requirements for successful integration in health care]

National and ethnic diversities among and within groups of migrants present great challenges to health care, not only in Germany. Access to regular health care, in particular for relatively small migrant groups and new immigrants is sometimes difficult. In addition, specific cultural aspects and legal implications--such as the residence status--must be taken into account when setting up a complementary system of health care. Methods and arrangements should make use of already existing resources of the health care system as well as proceed to direct cooperation with migrant communities. The public health service with its wide range of technical and organisational efficiency can play a key role here, especially in the municipal sector, both for an effective medical care for those who have difficulties in gaining access to the system, as well as for developing municipal networks, cooperating with a maximum number of medical service providers, organisations, and regarding specific migrant lifestyles. Social and ethic aspects of medical care for people living in precarious conditions ought to be supplemented by practice models which render a flexible and economic organisation of a complementary system of health care, the only way to a sustainable medical care for small migrant groups or not optimally integrated immigrant populations.

Impact of BRCA mutation status on the clinical phenotype and survival of hereditary breast cancer

Abstract #3091

Background : In a multidisciplinary program supported by the German Cancer Aid in 1996-2006 a total of 3.408 women with a family history for breast and/or ovarian cancer were genetically counselled and tested for BRCA-1 and BRCA-2 mutations.&#x2028; Methods: The mutations were detected using DHPLC and direct sequencing. The family history of breast and/or ovarian cancer was proven by collecting medical reports of family members. The statistical analysis was done using standard procedures (Kaplan-Meier-analysis, t-test, chi-square-test).&#x2028; Results: Among the women with breast cancer 566 showed a deleterious BRCA1 and 313 a BRCA2 mutation. Four women were found to have mutations in both genes and 2.525 were BRCA-1/2 negative. In accordance with the literature we found the phenotype “hormone receptor negative and grade 3” as well as the medullary subtype significantly more often in BRCA1 associated breast cancers (74% vs. 24%, 63% vs. 42% and 10% vs. 5%). The median age of onset was significantly lower in BRCA1 mutation carriers (38 yrs) compared to BRCA2 mutation carriers (45 yrs) and women tested negative for BRCA1 and BRCA2 mutations (46 yrs) as well as sporadic breast cancer cases within these families (52 yrs). The median age of the 4 women with mutations in both genes was even lower (median age 33.5 yrs). Although BRCA2 associated breast carcinomas presented in more advanced stages (N+ in 44%[118/257] compared to BRCA-1 positive in 31%[166/519], p&lt;0.01) there was no difference in overall survival between BRCA1 and BRCA2 mutation carriers. However, BRCA1 and BRCA2 negative cases showed a significantly better survival rate compared to the women with mutations (p&lt;0.0001). Women from families with early onset breast cancer (&lt;35 yrs) or bilateral breast cancer (&lt;40 yrs) had a significantly better survival (p&lt;0.0001) than women from families with a later age of onset.&#x2028; Conclusions: The BRCA mutation status has a significant impact on the clinical phenotype of hereditary breast cancer which is important for the clinical management, counselling and prevention.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3091.

Comparisons of self-reported and register data on sickness absence among public employees in Sweden

AIM

Self-reported assessments of sickness absence are often performed in epidemiological studies. The objective of this study was to compare the number of sick-leave days according to self-reported data over 12 months with data from the employer's register for the same period. An additional aim was to ascertain whether the self-reported information and the recorded data would show equivalent associations with self-reported general health.

METHODS

The study was based on a cohort of 4869 municipal employees in Sweden, about 80% women, who answered a questionnaire in 2001-2. The responses provided by the employees included information on number of sick-leave days and self-rated health. Data on sick-leave days, occupation and age were derived from the employers' computerised registers. The questionnaire information on sick-leave days was compared with the corresponding information retrieved from the employer register by means of calculating sensitivity and specificity, using the employers' data as the "gold standard".

RESULTS

The annual number of sick-leave days was lower according to the self-reported information than to the register data. For women the agreement between the two sickness absence measures for no sick-leave days, 1-7 days and >/=28 days were 74%, 72% and 67%, respectively. The sensitivity of questionnaire versus register information regarding any self-reported sick-leave day was 91% and the specificity was 74%. Sensitivity and specificity for sickness absence >/=28 days were 67% and 98%, respectively. The results for men were similar to those for women. Self-reported and recorded sickness absence were both associated with self-rated health. The odds ratios were 7.27 and 8.25, for subjects with >/=28 recorded and self-reported number of sick-leave days respectively, compared to subjects with no sickness absence.

CONCLUSIONS

Good agreement was found between self-reported and register information on sickness absence. Self-reported data on sickness absence may be useful in common epidemiological applications.

Reisemedizinische Beratungen und Impfungen als infektionspräventive Aufgabe

Infection prevention is one of the main tasks of the Public Health authorities. Because of hundreds of travel associated infections imported by travellers every year and considering increasing travel activities to tropical countries, travel medicine and consultation on the correct prevention measures including vaccination is becoming more and more important. Hence the data of the special consultation hours of the public health department of Frankfurt am Main are reported and discussed with regard to possible improvements.

MATERIAL AND METHODS

The public health department of Frankfurt am Main has been offering special consultation hours for travel medicine for many years. Here, data derived from the anamneses of the clients from 2002 - 2004 are reported: personal data such as age, sex, travel destination as well as medical data such as vaccination and malaria prevention.

RESULTS

2002 - 2004, more than 14,000 persons were seen in the consultation hours, more than 66% of them asked for travel health advice, about 25% of them asked for standard vaccination (such as influenza), some others asked for attestation or certification. More than 20,000 doses of vaccines were given, the most important vaccination against hepatitis A (n = 5791), hepatitis B (n = 4064), typhoid fever (n = 2718) and yellow fever (n = 2473). 2814 were informed with regard to malaria prevention, including recipes. 7814 persons with complete data on their reason for travel were subjected to more detailed analysis: 75% of them were holiday tourists, 18% travelled as "hikers", 7% were business travellers and less than 1% of them planned a round-the-world tour. The most frequent travel destinations were: Asian or African countries about 33% each, 25% Middle or South America. Thailand, South Africa with Namibia, Brazil and India were the most important countries. The time from health consultation to the beginning of the journey was too short for full vaccine protection against typhoid fever and meningococcal disease in 10% and against rabies in 44% of the consultants. There were no significant differences between holiday tourists, business and "hikers" travellers.

CONCLUSION

According to many studies, only one-third of the travellers going abroad, especially to developing countries, obtain travel health information. Hence, the clients of our consultation hours are a positive selection. Nevertheless, great need for improvement could be seen as well. In many of the clients the time from getting health information and vaccination was too short for obtaining complete vaccination protection. People travelling to countries where most hepatitis A infections are obtained and re-imported home, such as Turkey and Tunisia and other Mediterranean countries almost never came for health advice and vaccination. Therefore, public health authorities should improve and increase their publicity campaigns for travel health and vaccination in order to prevent travel-associated infections and re-importation of such diseases.

The use of botulinum toxin type-B in the treatment of patients who have become unresponsive to botulinum toxin type-A -- initial experiences

The increasing use of botulinum toxin type-A, especially for focal dystonia and spasticity has highlighted the issue of secondary non-responsiveness. Within the last few years botulinum toxin type-B (Myobloc/Neurobloc) has become commercially available as an alternative to type-A. This paper discusses our initial experience of botulinum toxin type-B in a total of 63 individuals who attended our botulinum clinic. Thirty-six patients had cervical dystonia and a secondary non-response to type-A toxin. Thirteen of these patients (36%) had a reasonable clinical response to Neurobloc and continue to have injections. The other 23 patients either had no response, or a poor response, or had unacceptable side effects and ceased treatment. A small number of people with blepharospasm, hemifacial spasm and foot dystonia also had a disappointing response to injection. Twenty patients with spasticity were also type-A resistant. Seven of these show some continuing response to type-B, without unacceptable side effects. These findings demonstrate that botulinum toxin type-B has a place in the management of patients who have become non-responsive to type-A, but overall the responses to type-B toxin were disappointing.

Rolle der Gesundheitsbehörden der Länder bei der Verhütung und Bekämpfung von Infektionskrankheiten

The goal is to describe the structure of administration for the control of infectious diseases in the German states. Internationally there is an increasing risk of potentially global transmission of infectious diseases and therefore increasing need for improved control mechanisms which are viable locally, regionally and internationally. The international public health community must ensure that responses to infectious disease with a potential impact on more than one county entail concerted action, clear communication and decision making by diverse administration agencies. Given Germany's federal structure, the 16 states have differing protocols delineating responsibilities for infection control systems. This paper provides an overview, going into detail only with regard to the administration structure in Hesse. In 2001, the German law governing infectious disease control was amended and significantly expanded. With regard to protection of humans from infectious disease, each state must define its schedule of responsibilities on the resulting scope of duties. Each state in Germany has entrusted the local public health service at the county level with the responsibility for infection prevention and control. As a rule, at the state level both an expert agency and one or more district administration agencies have been installed; these work directly with the Ministry of Health at the state level. In addition to this, Hesse has established a "centre of competence for highly contagious diseases." In the event of an infectious emergency, this network provides special treatment of highly infectious patients and expertise for public health services and the Ministry of Health on a 24-h shift basis. In times of ongoing structural transformation, it is important to emphasize that expertise at the state level is not an alternative to maintaining enough specialised personnel in the public health services themselves. Specialized practitioners are needed to ensure professional and fast-acting responses, both for the prevention and control of infectious diseases.

Service users, metaphors and teamworking in mental health

Despite the United Kingdom's recent governmental mental health policy directives aimed at strengthening professional collaboration and increasing service user involvement, the prevailing mental health care culture remains steeped in a discourse of treatment and care, control and compliance and professional expertise. Drawing upon the data collected during the two phases of a 2-year national evaluation undertaken for the English National Board for Nursing, Midwifery and Health Visiting, the perceptions of a group of mental health service users in relation to their experiences and contact with the multi-professional team are explored. A series of metaphorical descriptions were developed with these service users drawn from their experience. These begin to illuminate a realistic way of thinking about how teams are set up, how and why they carry out their various roles, and the need to think in non-professional terms about the relationships that are developed with service users. A hierarchy of power was noted that was congruent with the outcomes of other studies. However, there was also a concurrent acknowledgement of the 'usefulness'(to the individual service user) of each of the professional group members. This appeared to have been constructed alongside the power hierarchy and serves to illustrate how individual service users sought to find an accommodation within the social system they were placed in. This paper argues however, that the use of metaphors, as a form of shared communication, can be an effective first step in working towards this objective. Working in the way described here can allow for a greater shared understanding of what each group is experiencing and help ensure that future service development reflects a broader view of the mental health care world.