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Background: People with serious mental illnesses (SMI) have higher levels of loneliness than the general population. Furthermore, people with SMI tend to be less satisfied with their housing and tend to move more frequently. Aim: This study aims to examine relationships between housing variables (whom they live with, duration of residence, and satisfaction) and loneliness among individuals with SMI. Methods: Data were collected from 188 adults with SMI in greater Philadelphia area. Classification and Regression Trees (CART) were used to examine whether whom they live with, duration of residence, and housing satisfaction were associated with loneliness. Results: Housing satisfaction was found to be the most prominent predictor of loneliness. Those who were unsatisfied with their overall housing conditions always had the highest level of loneliness, regardless of other factors. Even if they were satisfied with their housing conditions, their loneliness was higher if they had just moved to the new residence. Participants had lower loneliness the longer they lived in a residence and had the lowest loneliness levels after about three years. Conclusion: Housing is associated with loneliness among people with SMI. Psychiatric service providers should increase support to factors contributing to housing satisfaction and duration of residence, including active engagement in the community.

To describe angiotensin II (ANGII) use in patients on mechanical circulatory support (MCS). To evaluate the efficacy and safety of ANGII in patients with shock on MCS.Retrospective cohort study.A single-center, quaternary care academic medical center.The study comprised critically ill patients on MCS.None.Fourteen patients were included in this retrospective analysis. The median age was 54 years (44.8, 68.3) and 78.6% were men. Six patients were receiving venoarterial extracorporeal membrane oxygenation support, 4 patients were receiving venovenous extracorporeal membrane oxygenation support, and 4 patients were on left ventricular assist devices. Five patients (36%) achieved hemodynamic response to ANGII at 3 hours, defined as a mean arterial pressure (MAP) of ≥65 mmHg or a 10-mmHg increase in MAP with a decrease or no change in total vasopressor dose. Overall, the median MAP increased from 61 mmHg (51, 73) at baseline to 66 mmHg (58, 71) at 3 hours, and the median norepinephrine dose decreased from 0.45 µg/kg/min (0.28, 0.6) at baseline to 0.2 µg/kg/min (0.18, 0.32) at 3 hours. The in-hospital mortality rate was 78.6%. Two patients experienced severe adverse drug events and 1 patient had a sentinel thrombotic event.This study suggested that ANGII may provide a salvage treatment option in patients on MCS with refractory vasodilatory shock. There are several safety considerations with the use of ANGII in these patients. Prospective randomized controlled trials are needed to evaluate the safety and efficacy of ANGII in patients on MCS.

Background Asthma is one of the most frequent reasons children visit a general practitioner (GP). The diagnosis of childhood asthma is challenging, and a variety of diagnostic tests for asthma exist. GPs may refer to clinical practice guidelines when deciding which tests, if any, are appropriate, but the quality of these guidelines is unknown. Objectives To determine (i) the methodological quality and reporting of paediatric guidelines for the diagnosis of childhood asthma in primary care, and (ii) the strength of evidence supporting diagnostic test recommendations. Design Meta-epidemiological study of English-language guidelines from the United Kingdom and other high-income countries with comparable primary care systems including diagnostic testing recommendations for childhood asthma in primary care. The AGREE-II tool was used to assess the quality and reporting of the guidelines. The quality of the evidence was assessed using GRADE. Results Eleven guidelines met the eligibility criteria. The methodology and reporting quality varied across the AGREE II domains (median score 4.5 out of 7, range 2–6). The quality of evidence supporting diagnostic recommendations was generally of very low quality. All guidelines recommended the use of spirometry and reversibility testing for children aged ≥5 years, however, the recommended spirometry thresholds for diagnosis differed across guidelines. There were disagreements in testing recommendations for 3 of the 7 included tests. Conclusions The variable quality of guidelines, lack of good quality evidence, and inconsistent recommendations for diagnostic tests may contribute to poor clinician adherence to guidelines and variation in testing for diagnosing childhood asthma.

Background The objective of this study was to evaluate the behavioral determinants associated with exclusive use of arsenic-safe water in the community-led Strong Heart Water Study (SHWS) arsenic mitigation program. Methods The SHWS is a randomized controlled trial of a community-led arsenic mitigation program designed to reduce arsenic exposure among private well users in American Indian Great Plains communities. All households received point-of-use (POU) arsenic filters installed at baseline and were followed for 2 years. Behavioral determinants selected were those targeted during the development of the SHWS program, and were assessed at baseline and follow-up. Results Among participants, exclusive use of arsenic-safe water for drinking and cooking at follow-up was associated with higher self-efficacy for accessing local resources to learn about arsenic (OR: 5.19, 95% CI: 1.48–18.21) and higher self-efficacy to resolve challenges related to arsenic in water using local resources (OR: 3.11, 95% CI: 1.11–8.71). Higher commitment to use the POU arsenic filter faucet at baseline was also a significant predictor of exclusive arsenic-safe water use for drinking (OR: 32.57, 95% CI: 1.42–746.70) and cooking (OR: 15.90, 95% CI: 1.33–189.52) at follow-up. From baseline to follow-up, the SHWS program significantly increased perceived vulnerability to arsenic exposure, self-efficacy, descriptive norms, and injunctive norms. Changing one’s arsenic filter cartridge after installation was associated with higher self-efficacy to obtain arsenic-safe water for drinking (OR: 6.22, 95% CI: 1.33–29.07) and cooking (OR: 10.65, 95% CI: 2.48–45.68) and higher perceived vulnerability of personal health effects (OR: 7.79, 95% CI: 1.17–51.98) from drinking arsenic-unsafe water. Conclusions The community-led SHWS program conducted a theory-driven approach for intervention development and evaluation that allowed for behavioral determinants to be identified that were associated with the use of arsenic safe water and changing one’s arsenic filter cartridge. These results demonstrate that theory-driven, context-specific formative research can influence behavior change interventions to reduce water arsenic exposure. The SHWS can serve as a model for the design of theory-driven intervention approaches that engage communities to reduce arsenic exposure. Trial registration The SHWS is registered with ClinicalTrials.gov (Identifier: NCT03725592).

Glacial erosion creates diagnostic landscapes and vast amounts of sediment. Yet, knowledge about the rate by which glaciers erode and sculpt bedrock and the proportion of quarried (plucked) versus abraded material is limited. To address this, we quantify subglacial erosion rates and constrain the ratio of quarrying to abrasion during the 19th/20th century overriding of a bedrock surface fronting Jakobshavn Isbræ, Greenland, by combining 10Be analyses, a digital terrain model, and field observations. Cosmogenic 10Be measurements along a 1.2-m-tall quarried bedrock step reveal a triangular wedge of quarried rock. Using individual 10Be measurements from abraded surfaces across the study area, we derive an average abrasion rate of 0.13±0.08 mm yr-1. By applying this analysis across a ~1.33 km2 study area, we estimate that the Greenland Ice Sheet quarried 378±45 m3 and abraded 322±204 m3 of material at this site. These values result in an average total erosion rate of 0.26±0.16 mm yr-1 with abrasion and quarrying contributing in roughly equal proportions within uncertainty. Additional cosmogenic 10Be analysis and surface texture mapping indicate that many lee steps are relict from the prior glaciation and were not re-quarried during the recent overriding event. These new observations of glacier erosion in a recently exposed landscape provide one of the first direct measurements of quarrying rates and indicate that quarrying accounts for roughly half of total glacial erosion in representative continental shield lithologies.

Background Exposure to environmental tobacco smoke (ETS) has been associated with detectable levels of cotinine (a nicotine metabolite) in children’s saliva. However, tobacco smoke also contains toxic and essential trace metals, including chromium (Cr), copper (Cu), lead (Pb), manganese (Mn), nickel (Ni) and zinc (Zn). Objective The current study examines whether there is a relationship between ETS exposure, as gauged by salivary cotinine, and salivary levels of these metals in a subset (n = 238) of children from the Family Life Project. Methods Using inductively-coupled-plasma optical emission spectrophotometry, we measured levels of metals in saliva from children at ~90 months of age. Salivary cotinine was measured using a commercial immunoassay. Results We found that Cr, Cu, Mn, and Zn were detected in most samples (85–99%) with lower levels of detection for Pb and Ni (9.3% and 13.9% respectively). There were no significant differences in any of the metal concentrations between males and females, nor were levels associated with body mass index, although significant differences in salivary Cr and Mn by race, state and income-to-needs ratio were observed. Children with cotinine levels >1 ng/ml had higher levels of Zn (b = 0.401, 95% CI: 0.183 to 0.619; p = 0.0003) and Cu (b = 0.655, 95% CI: 0.206 to 1.104; p = 0.004) compared to children with levels 1 μg/L were more likely to have detectable levels of Pb in their saliva (b = 1.40, 95% CI: 0.424 to 2.459; p = 0.006) compared to children with cotinine levels Impact statement This is the first study to demonstrate significant associations between salivary cotinine and salivary levels of Cu, Zn and Pb, suggesting that environmental tobacco smoke exposure my be one source of increased children’s exposure to heavy metals. This study also demonstrates that saliva samples can be used to measure heavy metal exposure, and thus serve as a non-invasive tool for assessing a broader range of risk indicators.

Introduction: Patterns of physical activity (PA) and time in bed (TIB) across the 24-hr cycle have important implications for many health outcomes; therefore, wearable accelerometers are often implemented in behavioral research to measure free-living PA and TIB. Two accelerometers, the activPAL and Actiwatch, are common accelerometers for measuring PA (activPAL) and TIB (Actiwatch), respectively. Both accelerometers have the capacity to measure TIB, but the degree to which these accelerometers agree is not clear. Therefore, this study compared estimates of TIB between activPAL and the Actiwatch accelerometers. Methods: Participants (mean ± SDage = 39.8 ± 7.6 years) with overweight or obesity (N = 83) wore an activPAL and Actiwatch continuously for 7 days, 24 hr per day. TIB was assessed using manufacturer-specific algorithms. Repeated-measures mixed-effect models and Bland–Altman plots were used to compare the activPAL and Actiwatch TIB estimates. Results: Statistical differences between TIB assessed by activPAL versus Actiwatch (p p = .87). The difference in TIB between accelerometers ranged from −72.9 ± 15.7 min (Day 7) to −98.6 ± 14.5 min (Day 3), with the Actiwatch consistently estimating longer TIB compared with the activPAL. Conclusion: Data generated by the activPAL and Actiwatch accelerometers resulted in divergent estimates of TIB. Future studies should continue to explore the validity of activity monitoring accelerometers for estimating TIB.

The maximum extent and elevation of the Greenland Ice Sheet in southwestern Greenland during the Last Glacial Maximum (LGM, 26–19.5 ka) is poorly constrained. Yet, the size of the Greenland Ice Sheet during the LGM helps to inform estimates of past ice-sheet sensitivity to climate change and provides benchmarks for ice-sheet modeling. Reconstructions of LGM ice extents vary between an inner continental shelf minimum, a mid-shelf position, and a maximum extent at the shelf break. We use three approaches to resolve LGM ice extent in the Sisimiut sector of southwestern Greenland. First, we explore the likelihood of minimum versus maximum Greenland Ice Sheet reconstructions using existing relative sea-level data. We use an empirical relationship between marine limit elevation and distance to LGM terminus established from other Northern Hemisphere Pleistocene ice sheets as context for interpreting marine limit data in southwestern Greenland. Our analysis supports a maximum regional Greenland Ice Sheet extent to the shelf break during the LGM. Second, we apply a simple 1-D crustal rebound model to simulate relative sea-level curves for contrasting ice-sheet sizes and compare these simulated curves with existing relative sea-level data. The only realistic ice-sheet configuration resulting in relative sea-level model-data fit suggests that the Greenland Ice Sheet terminated at the shelf break during the LGM. Lastly, we constrain the LGM ice-sheet thickness using cosmogenic 10Be, 26Al, and 14C exposure dating from two summit areas, one at 381 m above sea level at the coast, and another at 798 m asl 32 km inland. Twenty-four cosmogenic radionuclide measurements, combined with results of our first two approaches, reveal that our targeted summits were likely ice-covered during the LGM and became deglaciated at ca. 11.6 ka. Inventories of in situ 14C in bedrock at one summit point to a small degree of inherited 14C and suggest that the Greenland Ice Sheet advanced to its maximum late Pleistocene extent at 17.1 ± 2.5 ka. Our results point to a configuration where the southwestern part of the Greenland Ice Sheet reached its maximum LGM extent at the continental shelf break.

The objective of this cohort study was to examine the prevalence of acute respiratory illness among children under 5 years of age and to identify water, sanitation, and hygiene (WASH) and nutritional risk factors. This prospective cohort study was conducted in Walungu Territory, South Kivu, Democratic Republic of the Congo (DRC) and enrolled 512 participants. Spot checks of the household environment were conducted at baseline. Baseline minimum dietary diversity (MDD) was defined by consumption of five or more of the following food groups: 1) breast milk; 2) grains, roots, and tubers; 3) legumes and nuts; 4) dairy products; 5) flesh foods; 6) eggs; 7) vitamin A rich fruits and vegetables; and 8) other fruits and vegetables. Acute respiratory illness was defined as caregiver-reported rapid breathing, difficulty breathing, lower chest wall in-drawing, or coughing in the previous 2 weeks obtained at a 6-month follow-up. A total of 58% of children had acute respiratory illness, 19% had soap present in the household cooking area, and 4% in the defecation area, and 21% of children met MDD. A decreased odds of acute respiratory illness was associated with soap being present in the household cooking area (odds ratio [OR]: 0.49, 95% confidence interval [CI]: 0.38–0.88) and children with MDD (OR: 0.62, 95% CI: 0.38–1.00). These findings highlight the need for interventions targeting hygiene and improved dietary diversity among rural DRC households to reduce the rate of respiratory illnesses in children under 5 years.

Diarrhea is one of the leading causes of childhood illness and a major cause of infant and child mortality globally. In the Reducing Enteropathy, Undernutrition, and Contamination in the Environment (REDUCE) prospective cohort study, we investigated the association between diarrheal disease awareness and handwashing with soap among caregivers of children under 5 years of age. A total of 259 caregivers of children under 5 years of age in Walungu Territory, South Kivu, Democratic Republic of the Congo (DRC), were administered an open-ended questionnaire assessing awareness of diarrheal disease transmission and prevention, and key times to wash hands with soap. An overall diarrhea awareness score was developed based on the responses to these items. Five-hour structured observation of handwashing behaviors was conducted at the 6-month follow-up. Diarrheal disease awareness among caregivers was low. Only 32% of caregivers were able to correctly identify a method of diarrhea prevention. The median diarrhea awareness score was 3 out of 10 (SD: 1.7, range: 0–9). During structured observation, 9% of caregivers washed their hands with soap at a food-related event and 9% washed their hands with soap at a stool-related event. Higher diarrheal disease awareness was associated with an increased odds of handwashing with soap at food-related events (odds ratio: 1.40, 95% confidence interval: 1.03, 1.90). Our findings emphasize the need for targeted water, sanitation, and hygiene interventions to increase diarrhea awareness and facilitate handwashing with soap among caregivers of children under 5 years in rural DRC.

Combat-exposed veterans risk encountering events that disrupt beliefs. To facilitate reduced discrepancy between prior beliefs and current trauma appraisals, veterans may engage in a process of meaning-making. Meaning-making can lead to positive outcomes, such as integrating the traumatic event into one's life narrative or adapting global meaning (meaning made) or elicit distress. Given these potentially different outcomes, this study examined potential correlates of posttraumatic stress symptom (PTSS) severity and meaning made, including relationship attachment dimensions of anxiety and avoidance, and difficulties with emotion regulation, while controlling for combat exposure.Veterans receiving mental health services at a Veterans Affairs (VA) Medical Center and a VA community-based outpatient clinic (N = 130) completed measures through a paper-and-pencil survey. Almost all participants (92%) were male, with a mean age of 55.92 years.In terms of meaning made, lower levels of attachment anxiety and emotional clarity (an aspect of emotion regulation) predicted higher meaning made. In terms of PTSS severity, higher attachment avoidance, attachment anxiety, and difficulties engaging in goal-directed behavior (an aspect of emotion regulation) significantly predicted higher PTSS severity.Aspects of both attachment style and emotion regulation difficulties affect meaning made and PTSS severity. These constructs may be especially relevant for clinicians working with veterans to help PTSS and support meaning made postcombat.

Community participation in occupational, social, recreational, and other domains is critically important during young adulthood. Coordinated Specialty Care (CSC) programs provide developmentally tailored care to young adults experiencing early psychosis within the United States, but little is known about the breadth of efforts to promote community participation. This study aimed to develop and evaluate indicators of these efforts based on the perspectives of a national multi-stakeholder group.Seventeen stakeholders (i.e., young adults with early psychosis, family members, experts by profession) participated in a modified e-Delphi study, conducted in two rounds. The purpose of round one was to generate a comprehensive list of community participation-promoting indicators. During round two, stakeholders rated the importance and feasibility of the implementation of each indicator. Descriptive statistics and percentage of agreement regarding round two ratings were assessed.During round one, 186 indicators of activities and/or practices designed to promote community participation were identified; this list was reduced to 44 by eliminating redundancies or indicators not related to community participation. In round two, we found broad agreement regarding the importance, but significant variation in perceived feasibility of indicators. The highest-rated indicators in both categories pertained to staff knowledge (regarding barriers and supports to participation and the importance of participation to health) and strategies for addressing participation barriers.This study is expected to facilitate the identification and development of promising CSC activities and practices designed to promote community participation among young adults while potentially also enhancing engagement in services and improving clinical outcomes.

OBJECTIVE Spirituality is part of recovery for many people with lived experience of mental health issues, including those who become peer specialists and utilize their own recovery experiences to facilitate the recovery of others. This research explores how peer specialists view spirituality in their work with their peers and the factors that impact conversations in this area. METHOD Eleven peer specialists participated in individual qualitative interviews. Inquiries were made about their own experiences of spirituality and how these were used to support others. Additional questions probed factors that facilitated or served as barriers to their ability to engage in such conversations. Data were subjected to thematic analysis. RESULTS Peer specialists experienced well-being, hope, and self-acceptance through spirituality. Use of spirituality in peer support was influenced by their personal spiritual journey, specifically because they understood its value to recovery. Barriers to use included fear of rejection and lack of formal support. The number one facilitator was their personal experience, but they suggested the need for training and guidelines as important future facilitators. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Results indicate that at least some peer specialists are thinking about the role of spirituality in their work but express some struggles with such activities. There appears a need for guidelines on how to use spirituality in peer support, better definitions of the competencies peer specialists need, and more attention to training and supervision in this area-possibly to maximize the benefit of the lived experience that many peer specialists bring to their work. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Here we present a case study for using visual stratigraphy to date a shallow firn core from coastal West Antarctica. The Mount Siple ice core has the potential to reconstruct climate in this data-sparse region over recent decades. Line scanned images of the 24 m firn core were used to generate a grey-scale, which displays variability consistent with annual cycles. The resulting Mount Siple age scale spans from 1998 ± 1 to 2017 CE. This study demonstrates that the seasonal changes in the grey-scale record provide an independent method of dating firn cores. However, the presence of melt layers at this site has introduced an error of ±1 year. Visual line stratigraphy has the unique advantage over traditional annual layer counting, based on chemical or isotopic species, of being non-destructive and relatively inexpensive. Visual line stratigraphy has proved to be an effective dating method for this site.

IntroductionBrain fog (i.e., memory complaints and concentration difficulties) is frequently reported during the menopausal transition. There is lack of standardized scales available to measure brain fog across the menopause transition. This study aimed to evaluate the factor structure of the Everyday Memory Questionnaire-Revised (EMQ-R) and to determine the most commonly reported everyday cognitive symptoms in a menopausal population.Methods417 females, including 107 pre-menopausal, 149 peri-menopausal, and 161 early post-menopausal, met criteria and were included in the analyses. Memory and attention related symptoms were measured using the EMQ-R. Confirmatory factor analysis (CFA) was conducted to test the model fit of the bifactor structure (attentional and retrieval) of the EMQ-R in menopausal populations and evaluated by Cronbach’s alpha test. One way ANOVA and MANCOVA were used to investigate the group differences of individual items and two subscales.ResultsCFA indicated that the bifactor model (retrievalandattentional) of the EMQ-R has a good fit in all three groups. A significant difference (with the highest mean score observed in peri-menopausal group) was identified in the retrieval subscale score (F=3.17,p=0.043) but not in the attentional subscale or total scores amongst the three groups. Items (1, 3, 5) related to daily information retrieval problems were significantly reported in the peri-menopausal group.DiscussionThe EMQ-R serves as an instrument to measure memory and attention symptoms, referred to as ‘brain fog’ in menopause. Increased memory retrieval complaints reported by peri-menopausal group suggests a transition-related memory retrieval dysfunction during menopausal transition.

Arsenic is a naturally occurring toxicant in groundwater, which increases cancer and cardiovascular disease risk. American Indian populations are disproportionately exposed to arsenic in drinking water. The Strong Heart Water Study (SHWS), through a community-centered approach for intervention development and implementation, delivered an arsenic mitigation program for private well users in American Indian communities. The SHWS program comprised community-led water arsenic testing, point-of-use arsenic filter installation, and a mobile health program to promote sustained filter use and maintenance (i.e., changing the filter cartridge). Half of enrolled households received additional in-person behavior change communication and videos. Our objectives for this study were to assess successes, barriers, and facilitators in the implementation, use, and maintenance of the program among implementers and recipients. We conducted 45 semi-structured interviews with implementers and SHWS program recipients. We analyzed barriers and facilitators using the Consolidated Framework for Implementation Research and the Risks, Attitudes, Norms, Abilities, and Self-regulation model. At the implementer level, facilitators included building rapport and trust between implementers and participating households. Barriers included the remoteness of households, coordinating with community plumbers for arsenic filter installation, and difficulty securing a local supplier for replacement filter cartridges. At the recipient level, facilitators included knowledge of the arsenic health risks, perceived effectiveness of the filter, and visual cues to promote habit formation. Barriers included attitudes towards water taste and temperature and inability to procure or install replacement filter cartridges. This study offers insights into the successes and challenges of implementing an arsenic mitigation program tailored to American Indian households, which can inform future programs in partnership with these and potentially similar affected communities. Our study suggests that building credibility and trust between implementers and participants is important for the success of arsenic mitigation programs.

OBJECTIVE: Shared decision making (SDM) is a health communication model that may be particularly appealing to service users with serious mental illnesses, who often want to be more involved in making decisions about their mental healthcare. The purpose of this systematic review was to describe and evaluate participant, intervention, methodological, and outcome characteristics of SDM intervention studies conducted within this population. METHODS: Systematic searches of the literature through April 2020 were conducted and supplemented by hand-searching of reference lists. Fifty-three independent studies of SDM interventions that were conducted with service users with serious mental illnesses and included a quantitative or qualitative measure of the intervention were included in the review. Data were independently extracted by at least two reviewers. RESULTS: Most studies were conducted with middle-aged, male, white individuals from western countries. Interventions fell into the following categories: decision support tools only, multi-component interventions involving decision support tools, multi-component interventions not involving decision support tools, and shared care planning/preference elicitation interventions. Most studies were randomized controlled trials of sufficient sample size. Outcomes assessed were diverse, spanning decision-making, clinical, functional, treatment engagement/adherence, and other constructs. CONCLUSIONS: This review suggests important future directions for research, including the need to evaluate the impact of SDM within special populations (e.g., young adults, racial/ethnic minorities), to expand interventions to a broader array of decisions, users, and contexts, and to establish consensus measures to assess intervention effectiveness.

Background Half the US population uses drugs with anticholinergic properties. Their potential harms may outweigh their benefits. Amitriptyline is among the most frequently prescribed anticholinergic medicinal products, is used for multiple indications, and rated as strongly anticholinergic. Our objective was to explore and quantify (anticholinergic) adverse drug reactions (ADRs) in patients taking amitriptyline vs. placebo in randomized controlled trials (RCTs) involving adults and healthy individuals. Methods We searched electronic databases from their inception until 09/2022, and clinical trial registries from their inception until 09/2022. We also performed manual reference searches. Two independent reviewers selected RCTs with ≥100 participants of ≥18 years, that compared amitriptyline (taken orally) versus placebo for all indications. No language restrictions were applied. One reviewer extracted study data, ADRs, and assessed study quality, which two others verified. The primary outcome was frequency of anticholinergic ADRs as a binary outcome (absolute number of patients with/without anticholinergic ADRs) in amitriptyline vs. placebo groups. Results Twenty-three RCTs (mean dosage 5mg to 300mg amitriptyline/day) and 4217 patients (mean age 40.3 years) were included. The most frequently reported anticholinergic ADRs were dry mouth, drowsiness, somnolence, sedation, fatigue, constitutional, and unspecific anticholinergic ADRs. Random-effects meta-analyses showed anticholinergic ADRs had a higher odd’s ratio for amitriptyline versus placebo (OR = 7.41; [95% CI, 4.54 to 12.12]). Non-anticholinergic ADRs were as frequent for amitriptyline as placebo. Meta-regression analysis showed anticholinergic ADRs were not dose-dependent. Discussion The large OR in our analysis shows that ADRs indicative of anticholinergic activities can be attributed to amitriptyline. The low average age of participants in our study may limit the generalizability of the frequency of anticholinergic ADRs in older patients. A lack of dose-dependency may reflect limited reporting of the daily dosage when the ADRs occurred. The exclusion of small studies ( Registration PROSPERO: CRD42020111970.

SummaryDiagnostic tests play an essential role in children’s health. Previous work has shown variation in the use of diagnostic tests for adults. However, comparatively little is known about the use of tests in children. We aimed to analyze temporal trends in laboratory testing for children aged 0 to 15 from 2005 to 2019 in Oxfordshire, United Kingdom.MethodsFor this retrospective analysis, we used data from the Oxfordshire University Hospital NHS Trust laboratories. Using joinpoint regression models, we estimated annual percentage changes (APC) in test use. Temporal changes in age-adjusted rates in test use were calculated overall and stratified by healthcare setting, sex and age.FindingsBetween 2005 and 2019, overall test use increased in children (APC 1.6%, 95 confidence interval -0.8% to 4.1%). Increases were highest in females, in those aged 11-15 years and the outpatient setting. The most frequently requested tests were full blood count, urea and electrolytes, liver function test, C-reactive protein and calcium magnesium phosphate. The test with the greatest increase in use was Vitamin D, which increased on average by 27% per year. Other tests that showed a significant temporal increase included parathyroid hormone, iron studies, folate, vitamin B12 levels, glucose, HbA1c, IgA, coeliac, creatine kinase, thyroid function tests and IgG/IgM. Test changes were not uniformly distributed across all settings and age groups.InterpretationThe increase in test use may be the result of a combination of factors, including changes to the health service resulting in an increased volume of presentations and referrals, shifts in workforce composition towards less experienced clinicians, increased parental anxiety and expectation of tests and/or increased awareness and changing prevalence of disease. Further research is needed to quantify whether test use is warranted and to compare trends in Oxfordshire with other settings.FundingNo funding was obtained for this study.Research in contextEvidence before this studyWe searched PubMed using the terms “diagnostic test” “child” and “variation” from inception until 7 November 2022 to identify studies related to diagnostic test use in children. Previous studies have demonstrated substantial variation in the use of diagnostic tests across primary and secondary care in the UK. However, most of the literature on diagnostic testing focused on adults. Population-based studies of UK primary care identified that test use had increased by 9% annually from 2000 to 2015. Tests with the highest increase were knee MRIs which increased by 69% per year, followed by vitamin D tests and brain MRI. Tests subject to the greatest practice variation included drug monitoring, urine microalbumin and pelvic CTs. However, these studies did not specifically analyse data on test use in children. A few studies on children examined variation in the use of tests for specific conditions, such as community-acquired pneumonia, orbital cellulitis, fever or diabetes. No studies have quantified test use across all settings or examined temporal trends in test use in children.Added value of this studyTo our knowledge, this is the first population-based study to estimate long-term trends in childhood test use. We collected data on laboratory tests that were analysed at the Oxfordshire University Hospital NHS Trust laboratories for children aged below 16 between 2005 and 2019 and evaluated average annual percentage change and annual percentage change in test use using joinpoint regression. We found that test use increased by 2% per year overall, with the highest increases in the outpatient setting and for females aged 11-15. Vitamin D tests experienced the greatest overall increase during the study period.Implications of all the available evidenceChanges in test use may suggest potentially inappropriate testing, especially for Vitamin D and C reactive protein. It also suggests an increase in disease awareness and prevalence as well as changes in the healthcare workforce and service provision. A comparison between testing rates and the corresponding test results must be made to better understand whether increased test use is warranted. The observed trends in this study should also be compared with other settings to determine their generalisability. We encourage clinicians to become aware of their test-ordering practices and consider the individual and systemic implications of testing in children.

Changes in sea ice conditions and atmospheric circulation over the Southern Ocean play an important role in modulating Antarctic climate. However, observations of both sea ice and wind conditions are limited in Antarctica and the Southern Ocean, both temporally and spatially. Ice core chemistry data can be used to reconstruct changes over annual, decadal, and millennial timescales. To facilitate sea ice and wind reconstructions, the CLIVASH2k working group has compiled a database of two species, sodium [Na+] and sulphate [SO42-], commonly measured ionic species. The database contains records from 105 Antarctic ice cores, containing records with a maximum age duration of 2000 years. An initial filter has been applied, based on evaluation against climate observations, to identify sites suitable for reconstructing past sea ice conditions, wind strength, or atmospheric circulation.

BackgroundDeaths from opioids have increased in England and Wales, despite recognition of their harms. Coroners’ Prevention of Future Death reports (PFDs) provide important insights that may enable safer use and avert harms, yet these reports involving opioids have not been synthesised. We therefore aimed to identify opioid-related PFDs and explore concerns expressed by coroners to prevent future deaths.MethodsIn this systematic case series, we screened 3897 coronial PFDs dated between 01 July 2013 and 23 February 2022. These were obtained by web scraping the UK’s Courts and Tribunals Judiciary website to create an openly available database:https://preventabledeathstracker.net/. PFDs were included when an opioid was implicated in the death. Included PFDs were descriptively analysed, and content analysis was used to assess concerns reported by coroners and responses to such concerns.FindingsOpioids were involved in 219 deaths reported by coroners in PFDs (5·6% of all PFDs), equating to 4418 years of life lost (median 33 years/person). Morphine (29%), methadone (23%), and diamorphine (16%) were the most common implicated opioids. Coroners most frequently raised concerns regarding systems and protocols (52%) or safety issues (15%). These concerns were most often addressed to NHS organisations (51%), but response rates were low overall (47%).InterpretationOpioids could be used more safely and appropriately if coroners’ concerns in PFDs were addressed by national organisations such as NHS bodies, government agencies, and policymakers, as well as individual prescribing clinicians.FundingNo funding was obtained for this study. The National Institute for Health Research (NIHR) School for Primary Care Research (SCPR) provided funding to establish the Preventable Deaths Tracker website:https://preventabledeathstracker.net/Research in contextEvidence before this studyWe conducted a systematic search of PubMed and Google Scholar to identify studies of deaths involving opioids in England and Wales and analyses of coroners’ Prevention of Future Death reports (PFDs). We found that deaths from opioids had increased in England and Wales. We also identified studies that have used PFDs to assess preventable deaths during the COVID-19 pandemic and deaths involving anticoagulants, medicines purchased online, medication errors and adverse drug reactions. However, no study to date has examined opioid-related PFDs.Added value of this studyWe analysed coroners’ concerns in opioid-related deaths for which they issued PFDs and found that on average three decades of life are lost per individual. We found that most opioid-related PFDs involved males (64%) and were caused by prescribed opioids (52%). Deaths involving illicit opioids (24%) were more likely to occur in younger males than deaths from prescribed opioids. Failures in systems and processes were most commonly found to have contributed to preventable opioid-related deaths, but more than half of such concerns remain unaddressed.Implications of all the available evidenceCoroners’ PFDs offer important real-world insights into opioid-related deaths and can inform public health strategies that aim to improve the safe use of opioids. Future work should focus on disseminating these findings more widely and engaging with key stakeholders such as NHS organisations and government agencies, so that findings from PFDs can inform guidelines and be implemented in clinical practice.

Here we examine the water stable-isotope data from the Roosevelt Island Climate Evolution (RICE) ice core. Roosevelt Island is an independent ice rise located at the northeastern margin of the Ross Ice Shelf. In this study, we use empirical orthogonal function (EOF) analysis to investigate the relationship between RICE ice-core oxygen-18 isotopes (δ18O) and Southern Hemisphere atmospheric circulation during the extended austral winter (April–November). The RICE δ18O record is correlated with Southern Annular Mode (SAM) and Pacific–South American pattern 1 (PSA1), which both project onto the Amundsen–Bellingshausen Sea (ABS) geopotential height field. Pacific sector Southern Ocean, eastern Ross Sea, and West Antarctic’s atmospheric circulation, sea ice, and surface air temperature (SAT) anomalies, as well as RICE δ18O, are strongest when El Niño–Southern Oscillation (ENSO) and SAM are “in-phase”. That is when the SAM−/PSA1+ (El Niño) and SAM+/PSA1− (La Niña) phasing prevails. When in-phase, the δ18O correlation with the 500-hPa geopotential height (Z500) is strong in regions (e.g., the Amundsen Sea) where their anomalies associated with SAM and PSA1 show the same sign. SAM−/PSA1+ (El Niño) and SAM+/PSA1− (La Niña) is associated with positive and negative δ18O anomalies, respectively. RICE δ18O can aid in establishing past natural variability of the strength of the SH high-latitude Pacific sector ENSO-SAM connection and associated atmospheric circulation, SIC, and SAT extremes.

Introduction: Theta burst pattern repetitive transcranial magnetic stimulation (TBS) is increasingly applied to treat depression. TBS's brevity is well-suited to application in accelerated schedules. Sizeable trials of accelerated TBS are lacking; and optimal TBS parameters such as stimulation intensity are not established. Methods: We conducted a three arm, single blind, randomised, controlled, multi-site trial comparing accelerated bilateral TBS applied at 80 % or 120 % of the resting motor threshold and left unilateral 10 Hz rTMS. 300 patients with treatment-resistant depression (TRD) were recruited. TBS arms applied 20 bilateral prefrontal TBS sessions over 10 days, while the rTMS arm applied 20 daily sessions of 10 Hz rTMS to the left prefrontal cortex over 4 weeks. Primary outcome was depression treatment response at week 4. Results: The overall treatment response rate was 43.7 % and the remission rate was 28.2 %. There were no significant differences for response (p = 0.180) or remission (p = 0.316) across the three groups. Response rates between accelerated bilateral TBS applied at sub- and supra-threshold intensities were not significantly different (p = 0.319). Linear mixed model analysis showed a significant effect of time (p

Occupational therapy plays an important role in fostering community participation in areas such as education, employment, leisure, and social relationships, yet its added value within early intervention in psychosis services, especially in the United States, remains poorly understood. The purpose of this research was to conduct a national survey of early intervention in psychosis programs to: (1) understand the role and unique contributions of occupational therapists to early intervention teams, and (2) identify barriers and supports to the implementation of occupational therapy services within these programs.Fifty-one senior leaders from U.S.-based early intervention in psychosis programs participated in the national survey. The survey consisted of a series of closed and open-ended questions related to program staffing, the presence of specific services that fall within the occupational therapy scope of practice, and implementation barriers and supports.Despite there being strong interest in employing occupational therapists, a small proportion of programs (31%) reported having them on staff. Occupational therapists supported clients across multiple life areas and were significantly more likely than other team members to promote daily living activities (e.g., cooking) and to address sensory processing needs and challenges. Implementation was influenced by environmental/organizational and staff factors; the primary barrier was funding.Findings support the role occupational therapists may play in facilitating the community participation of clients of early intervention services, but significant barriers to implementation of occupational therapy services remain. Additional research is needed to further identify the impact of occupational therapy services within the early intervention model.

In this study, we used the stable water isotope record (δ18O) from an ice core drilled in Palmer Land, southern Antarctic Peninsula (AP). Utilizing δ18O we identified two climate regimes during the satellite era. During the 1979–1998 positive interdecadal Pacific oscillation (IPO) phase, a low-pressure system north of the Weddell Sea drove southeasterly winds that are associated with an increase in warm air mass intrusion onto the Larsen shelves, which melted and a decreased sea ice concentration in the Weddell Sea/increase in the Bellingshausen Sea. This climate setting is associated with anomaly low δ18O values (compared with the latter IPO period). There is significantly more melt along the northern AP ice shelf margins and on the Larsen D and southern Larsen C during the 1979–1998 IPO positive phase. The IPO positive climatic setting was coincidental with the Larsen A ice shelf collapse. In contrast, during the IPO negative phase (1999–2011), northerly winds caused a reduction in sea ice in the Bellingshausen Sea/Drake Passage region. Moreover, a Southern Ocean north of the Weddell Sea high-pressure system caused low-latitude warm humid air over the tip and east of the AP, a setting that is associated with increased northern AP snowfall, a high δ18O anomaly, and less prone to Larsen ice shelf melt.

IntroductionMeasuring Huntingtin (Htt) protein in peripheral cells represents an essential step in biomarker discovery for Huntington’s Disease (HD), however to date, investigations into the salivary expression of Htt has been lacking.MethodIn the current study, we quantified total Htt (tHtt) and mutant Htt (mHtt) protein in matched blood and saliva samples using single molecule counting (SMC) immunoassays: 2B7-D7F7 (tHtt) and 2B7-MW1 (mHtt). Matched samples, and clinical data, were collected from 95 subjects: n=19 manifest HD, n=34 premanifest HD (PM), and n=42 normal controls (NC). ResultsTotal Htt and mHtt levels were not correlated in blood and saliva. Plasma tHtt was significantly associated with age, and participant sex; whereas salivary mHtt was significantly correlated with age, CAG repeat length and CAP score. Plasma and salivary tHtt did not differ across cohorts. Salivary and plasma mHtt were significantly increased in PM compared to NC; salivary mHtt was also significantly increased in HD compared to NC. Only salivary tHtt and mHtt were significantly correlated with clinical measures.Conclusions Salivary Htt is uniquely associated with clinical measures of HD and offers significant promise as a relevant, non-invasive HD biomarker. Its use could be immediately implemented into both translational and clinical research applications.

A new dataset of meteorological records from Antarctic automatic weather stations (here called AntAWS dataset) at 3-hourly, daily and monthly resolutions is constructed with quality control. This dataset compiles the measurements of air temperature, air pressure, relative humidity, and wind speed and direction from 216 AWSs available during 1980–2021. Their spatial distribution remains heterogeneous, with a majority of instrumented sites located on the coastal areas, and less at the inland East Antarctic Plateau. Among the 216 AWSs, 55 of them have the records spanning more than 20 years, and 25 of them spanning more than 30 years. Among the five meteorological parameters, the air temperature measurement data have the best continuity and the highest data integrity. The comprehensive compilation of AWS observations has the main aim to make them easy and time-saving to be used for local, regional and continental studies, which can be accessed at https://doi.org/10.48567/key7-ch19 (Wang et al., 2022). This dataset will be valuable for better characterizing surface climatology throughout the continent of Antarctica, improving our understanding of Antarctic surface snow-atmosphere interactions, and estimating regional climate models or meteorological reanalysis products.

The rate and magnitude of the Antarctic Ice Sheet (AIS) contribution to global sea-level rise beyond 2100 CE remains highly uncertain. Past changes of the AIS, however, offer opportunities to understand contemporary and future ice sheet behaviour. In this Review, we outline how the AIS evolved through the pre-Industrial Holocene, 11,700 years ago to 1850 CE. Three main phases of ice sheet behaviour are identified: a period of rapid ice volume loss across all sectors in the Early and Mid Holocene; a retreat inland of the present-day ice sheet margin in some sectors, followed by readvance; and continued ice volume loss in several sectors during the past few millennia, and in some areas up to and into the Industrial era. Global sea levels rose by 2.4–12 m owing to the period of rapid Antarctic ice loss, and possibly fell by 0.35–1.2 m owing to subsequent readvance. Changes in the AIS during the Holocene were likely driven by similar processes to those acting today and predicted for the future, which are associated with oceanic and atmospheric conditions as well as bed topography. Further work is required to better understand these processes, and to quantify Antarctica’s contribution to past sea-level change.

Objective The COVID-19 pandemic has resulted in significant changes to daily life and many health-related behaviors. The objective of this study was to examine the how stay-at-home/safer-at-home mandates issued in Colorado (March 2020 ? May 2020) impacted lifestyle behaviors and mental health among individuals with overweight or obesity participating in two separate behavioral weight loss trials (n = 82). Methods Questionnaires were used to collect qualitative and quantitative data on challenges to weight loss presented by the COVID-19 pandemic, including changes in dietary intake, physical activity, sedentary behavior, mental health during the stay-at-home/safer-at-home mandates. Results Using a convergent mixed method approach integrating qualitative and quantitative data, the greatest challenge experienced by participants was increased stress and anxiety, which led to more unhealthy behaviors. The majority perceived it to be harder to adhere to the prescribed diet (81%) and recommended physical activity (68%);however, self-reported exercise on weekdays increased significantly and 92% of participants lost weight or maintained weight within ±1% 5-6 weeks following the stay-at-home mandate. Conclusion Study results suggest that obesity treatment programs should consider and attempt to address the burden of stress and anxiety stemming from the COVID-19 pandemic and potential negative effects they may have on weight management behaviors. This article is protected by copyright. All rights reserved.

As the United States faces the repercussions of the current opioid epidemic, it is important for social workers to be able to identify risks for poor birth outcomes in infants with neonatal abstinence syndrome (NAS). Although some studies have identified single risk factors, no studies have tested associations between total amount of risk (that is, cumulative risk) and birth outcomes in infants with NAS. Authors examined 318 mothers who used opioids during pregnancy and their infants’ birthweight, length, head circumference, and Apgar scores (which measure overall infant health after birth). All infants were admitted to a neonatal intensive care unit in Appalachia and were diagnosed with NAS. Authors found that high cumulative risk during pregnancy was associated with lower birthweight and Apgar scores one and five minutes after birth as well as shorter length and smaller head circumference at birth. Social workers are encouraged to assess for the quantity of prenatal adversity experienced by the mothers they serve and to consider multicomponent, comprehensive community-based interventions to reduce cumulative risk.

METHODS Adults seeking behavioral health or medical treatment (N = 158) were recruited from a community healthcare agency and a residential support program in the southeastern United States. RESULTS Individuals who reported interpersonal trauma had significantly higher total PTS severity and symptom clusters. No significant difference was found in perceived PTG based on trauma type. No significant curvilinear relationship between PTS and perceived PTG was found. A significant negative linear relationship was observed between PTS and perceived PTG for non-interpersonal trauma, but not interpersonal trauma. CONCLUSION Trauma type may influence the PTS and perceived PTG relationship and, while associated with PTS, seems less important to reporting of perceived PTG.

ObjectiveTo investigate whether plasma NfL levels correlate with clinical symptom severity in premanifest (PM) and manifest HD (HD) individuals, and whether a NfL cut-point could distinguish PM from HD patients with reasonable accuracy.Method98 participants (33 control, 26 PM, 39 HD), underwent blood sample collection and clinical assessment, using both UHDRS and non-UHDRS measures, at one academic HD Center. Years to onset (YTO), probability of disease onset in 5 years, and predicted years until 60% onset probability were also calculated. NfL levels were measured using a Meso Scale Discovery assay.ResultsCohorts differed by age. NfL levels differed significantly across diagnostic groups and were significantly correlated with age. Age-adjusted NfL levels were not correlated with clinical measures in either HD or PM cohorts, but were correlated when cohorts were combined. In PM subjects, NfL levels correlated with YTO, probability of onset in 5 years, and years until 60% onset probability. Using ROC analysis, a NfL cut-point of

Psychosocial difficulties are defined as impairments in mental and body functions, activity limitations and participation restrictions, experienced in common across brain disorders. This cross-sectional study compared the psychosocial difficulties among people with Parkinson's disease (n = 61), schizophrenia (n = 84) and stroke (n = 70). The extent of difficulties was found to be similar across the three disorders in most of the domains studied. Psychosocial difficulties were also found to be associated with sociodemographic and illness related factors. The results challenge the brain disorder-specific approach to psychosocial difficulties commonly carried out in neurological and psychiatric research. Implications to occupational therapy are presented.

Household members of diarrhea patients are at higher risk of developing diarrheal diseases (>100 times for cholera) than the general population during the 7 days after the diarrhea patient is admitted at a health facility. There is growing evidence demonstrating that theory-driven water, sanitation, and hygiene (WASH) interventions are likely to yield greater behavior change than those based on health education alone. The Cholera Hospital-Based Intervention for 7-Days (CHoBI7) mobile health (mHealth) program is a theory-driven WASH intervention initially delivered to a diarrhea patient by a health promoter during a health facility visit and reinforced through weekly voice and text messages. In the recent randomized controlled trial (RCT) of the CHoBI7-mHealth program in Bangladesh, this intervention significantly reduced diarrheal disease and stunting, and increased handwashing with soap and stored drinking water quality over the 12-month program period. The aim of this study was to assess the underlying mechanism of change of this intervention. Handwashing with soap was measured by 5-hour structured observation. Stored drinking water quality was assessed by the presence of Escherichia coli during unannounced spot checks. Psychosocial factors were measured among 1,468 participants in the CHoBI7-mHealth RCT. Perceived susceptibility, response efficacy, self-efficacy, dirt reactivity, and diarrhea knowledge were mediators of the CHoBI7-mHealth program’s effect on stored drinking water quality at the 1-week follow-up. Self-efficacy, response efficacy, and diarrhea knowledge were mediators of the intervention’s effect on handwashing with soap habit maintenance and stored drinking water quality at the 12-month follow-up. This study demonstrates how theory-driven approaches for intervention design can facilitate WASH behavior change.

This paper contributes to diversifying and situating understandings of occupational injustices through presenting findings from the knowledge generation phase of a participatory action research (PA...

Inflammatory responses play key roles in the development and progression of many pathological conditions, including neurodegenerative conditions. Accurate quantification of inflammatory factors in saliva would be highly advantageous, given its convenience and non-invasive nature, enabling use as biomarkers for disease processes especially in older adults. However, few studies have attempted to validate salivary assays by directly comparing cytokine levels in blood and saliva samples the same individuals. In this study, we measured levels of 10 cytokines, interferon gamma (IFNg), interleukin (IL)-1 beta (IL-1b), IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13 and tumor necrosis factor alpha (TNFa), as well as the inflammatory glycoprotein, YKL-40, in blood and saliva samples from a cohort of nondemented older adults (n = 71; 62% female; mean age 70.3 +/- 6.4 yrs; ) using sensitive electrochemiluminescence-based immunoassays. We found that the mean levels of all cytokines were higher in saliva compared to plasma, and specifically that levels of IL-1b, IL-2, IL-4, IL-12p70 and IL-13 in plasma were below the instrument detection limit for more than 50% of the subjects. We found strong sex differences in both saliva and plasma cytokines, with levels of several salivary cytokines, as well as YKL-40, showing higher concentrations in males compared to females. Comparing each cytokine between the two biofluids, we found that levels of IFNg, IL-6 and TNFa in blood were significantly correlated with their respective levels in saliva. We further observed that levels of these cytokines in blood were significantly correlated with additional cytokines in saliva, including IL-1b, IL-10, IL-8, IL12p70 and IL-13. These findings show that inflammatory markers in saliva are associated with those found in circulation, suggesting that inflammatory mechanisms between these two fluids are, at least to some extent, related. Consistent with prior work, several salivary markers were more likely to surpass the detection threshold than plasma markers, suggesting that salivary assays may, at least in some cases, be more useful for detecting physiological changes. Further our findings of robust sex differences in several salivary cytokines could have important implications for their potential use as health or disease biomarkers.