Two risk assessments: Evaluating the use of indicator HF183 Bacteroides versus pathogen measurements for modelling recreational illness risks in an urban watershed.

The purpose of this study was to evaluate the performance of HF183 Bacteroides for estimating pathogen exposures during recreational water activities. We compared the use of Bacteroides-based exposure assessment to exposure assessment that relied on pathogen measurements. We considered two types of recreational water sites: those impacted by combined sewer overflows (CSOs) and those not impacted by CSOs. Samples from CSO-impacted and non-CSO-impacted urban creeks were analysed by quantitative polymerase chain reaction (qPCR) for HF183 Bacteroides and eight human gastrointestinal pathogens. Exposure assessment was conducted two ways for each type of site (CSO-impacted vs. non-CSO impacted): 1) by estimating pathogen concentrations from HF183 Bacteroides concentrations using published ratios of HF183 to pathogens in sewage and 2) by estimating pathogen concentrations from qPCR measurements. QMRA (quantitative microbial risk assessment) was then conducted for swimming, wading, and fishing exposures. Overall, mean risk estimates varied from 0.27 to 53 illnesses per 1,000 recreators depending on exposure assessment, site, activity, and norovirus dose-response model. HF183-based exposure assessment identified CSO-impacted sites as higher risk, and the recommended HF183 risk-based threshold of 525 genomic copies per 100 mL was generally protective of public health at the CSO-impacted sites but was not as protective at the non-CSO-impacted sites. In the context of our urban watershed, HF183-based exposure assessment over- and under-estimated risk relative to exposure assessment based on pathogen measurements, and the etiology of predicted pathogen-specific illnesses differed significantly. Across all sites, the HF183 model overestimated risk for norovirus, adenovirus, and Campylobacter jejuni, and it underestimated risk for E. coli and Cryptosporidium. To our knowledge, this study is the first to directly compare health risk estimates using HF183 and empirical pathogen measurements from the same waterways. Our work highlights the importance of site-specific hazard identification and exposure assessment to decide whether HF183 is applicable for monitoring risk.

Use of crisis management interventions among suicidal patients: Results of a randomized controlled trial.

BACKGROUND: Previous research supports the efficacy of the crisis response plan (CRP) for the reduction of suicidal behaviors as compared to treatment as usual (TAU). Patient perspectives and use of the CRP, and their relationship to later suicidal thoughts, remain unknown. METHODS: A secondary analysis of a randomized clinical trial comparing a standard CRP (S-CRP), a CRP enhanced with reasons for living (E-CRP), and TAU in a sample of 97 active-duty U.S. Army personnel was conducted. Participants were asked about their use, perceptions, and recall of each intervention. Generalized estimating equations were used to test the conditional effects of intervention use, perceptions, and recall on severity of suicide ideation during follow-up. RESULTS: Across all treatment groups, over 80% of participants retained their written CRP up to 6 months later, but less than 25% had the written plan in their physical possession at the time of each assessment. Participants in S-CRP and E-CRP were more likely to recall self-management strategies and sources of social support. Participants in TAU were more likely to recall use of professional healthcare services and crisis management services. All three interventions were rated as highly useful. More frequent use of the E-CRP and recall of its components were associated with significantly reduced suicide ideation as compared to TAU. CONCLUSIONS: Both CRPs have high acceptability ratings. The effect of both CRPs on reduced suicide ideation is associated with patient recall of components. More frequent use of the E-CRP is associated with larger reductions in suicide ideation.

Associations of patient-rated emotional bond and vocally encoded emotional arousal among clinicians and acutely suicidal military personnel.

OBJECTIVE: To determine if synchrony in emotional arousal and affective regulation between patients and clinicians reflect emotional bonding during emergency behavioral health appointments. METHOD: Audio recordings of suicide risk assessment interviews and crisis intervention planning with 54 suicidal active duty soldiers presenting to an emergency department or behavioral health clinic were analyzed. Emotional arousal was assessed using mean fundamental frequency. Patient-rated emotional bond was assessed with the Working Alliance Inventory, Short Form (Hatcher & Gillaspy, 2014). Actor-partner interdependence modeling was used to identify moment-to-moment patterns of covariance among clinician and patient emotional arousal. RESULTS: Greater synchrony in clinician and patient emotional arousal was positively associated with higher emotional bond ratings during the crisis intervention but not the risk assessment interview. During the risk assessment interview, higher emotional bond was associated with a dysregulating effect of the clinician on the patient's emotional arousal (i.e., larger fluctuations in the patient's emotional arousal). The reverse pattern was seen during the intervention: Higher emotional bond was associated with a regulating effect of the clinician on the patient's emotional arousal (i.e., smaller fluctuations in the patient's emotional arousal). Emotional bond during the intervention was also positively associated with a regulating effect of the patient on the clinician's emotional arousal. CONCLUSION: Emotional bonding during emergency clinical encounters is associated with patient-clinician synchrony in emotional states. During crisis interventions, emotional bonding is also associated with mutual down-regulation of emotional arousal among patients and clinicians. (PsycINFO Database Record

An evidence-based oral health promotion programme: Lessons from Leicester.

OBJECTIVES: To provide an overview and draw lessons from the establishment of a local oral health promotion programme for preschool children in Leicester, England (2013-2017). The article provides information on the strategic approach taken in Leicester, one of the most ethnically diverse cities in England, and also one of the most deprived. Over a third of children aged 3 years, and half of those aged 5 years, have experience of obvious dental decay. METHODS: A description of the evolution and development of the programme is provided along with commentary by the authors. This includes the origins, design and evaluation of the programme. RESULTS: Progress so far has been promising. There has been a statistically significant 8% decrease in the proportion of 5-year-old children in Leicester with dental decay from 2011/2012 to 2014/2015. This will need to be sustained and further developed to deliver the 10% reduction required within the strategy. CONCLUSIONS: The successful implementation of a local oral health improvement programme in Leicester has required leadership to coordinate a multiagency partnership approach to embedding effective concepts and realising opportunities collaboratively. However, longer term sustainability remains a concern.

Effect of Crisis Response Planning on Patient Mood and Clinician Decision Making: A Clinical Trial With Suicidal U.S. Soldiers.

OBJECTIVE: The study examined the immediate effect of crisis interventions on the emotional state of acutely suicidal soldiers and clinician decision making. METHODS: Soldiers (N=97) presenting to a military emergency department or behavioral health clinic were randomly assigned to receive a contract for safety (N=32), standard crisis response plan (S-CRP; N=32), or enhanced crisis response plan (E-CRP; N=33). Soldiers completed self-report scales before and after the intervention. Clinicians blinded to treatment group assignment rated participants' suicide risk level and made a decision about inpatient psychiatric admission. RESULTS: Larger reductions in negative emotional states occurred in S-CRP and E-CRP. Larger increases in positive emotional states occurred in E-CRP. Clinician suicide risk ratings did not differ across treatment groups. Participants in E-CRP were less likely to be psychiatrically admitted. CONCLUSIONS: The CRP immediately reduces negative emotional states among acutely suicidal soldiers. Discussing a patient's reasons for living during a CRP also reduces the likelihood of inpatient psychiatric admission.

Effect of crisis response planning vs. contracts for safety on suicide risk in U.S. Army Soldiers: A randomized clinical trial.

OBJECTIVE: To evaluate the effectiveness of crisis response planning for the prevention of suicide attempts. METHOD: Randomized clinical trial of active duty Army Soldiers (N=97) at Fort Carson, Colorado, presenting for an emergency behavioral health appointment. Participants were randomly assigned to receive a contract for safety, a standard crisis response plan, or an enhanced crisis response plan. Incidence of suicide attempts during follow-up was assessed with the Suicide Attempt Self-Injury Interview. Inclusion criteria were the presence of suicidal ideation during the past week and/or a lifetime history of suicide attempt. Exclusion criteria were the presence of a medical condition that precluded informed consent (e.g., active psychosis, mania). Survival curve analyses were used to determine efficacy on time to first suicide attempt. Longitudinal mixed effects models were used to determine efficacy on severity of suicide ideation and follow-up mental health care utilization. RESULTS: From baseline to the 6-month follow-up, 3 participants receiving a crisis response plan (estimated proportion: 5%) and 5 participants receiving a contract for safety (estimated proportion: 19%) attempted suicide (log-rank χ2(1)=4.85, p=0.028; hazard ratio=0.24, 95% CI=0.06-0.96), suggesting a 76% reduction in suicide attempts. Crisis response planning was associated with significantly faster decline in suicide ideation (F(3,195)=18.64, p<0.001) and fewer inpatient hospitalization days (F(1,82)=7.41, p<0.001). There were no differences between the enhanced and standard crisis response plan conditions. CONCLUSION: Crisis response planning was more effective than a contract for safety in preventing suicide attempts, resolving suicide ideation, and reducing inpatient hospitalization among high-risk active duty Soldiers.

High-precision lattice QCD confronts experiment.

The recently developed Symanzik-improved staggered-quark discretization allows unquenched lattice-QCD simulations with much smaller (and more realistic) quark masses than previously possible. To test this formalism, we compare experiment with a variety of nonperturbative calculations in QCD drawn from a restricted set of "gold-plated" quantities. We find agreement to within statistical and systematic errors of 3% or less. We discuss the implications for phenomenology and, in particular, for heavy-quark physics.

[The study of unions in demography: from categories to process]. / L'etude des unions en demographie: des categories aux processus.

PIP: For centuries, illegitimate children, those born outside of civil marriage or a marriage conducted within the church, were systematically accorded second-class status by both the law and religion. This attitude toward such children frustrates efforts to change legislation, social structure, and our understanding of new types of union outside of marriage. In Canada, no common term even exists in the two official languages to designate the cohabitation of an unmarried couple. Such unions simply fall through the net of classical demography. Even the more dynamic approaches, such as those seen in multistate models, follow only the movements of individuals in traditional categories. One must understand that the formation of couples is a multidimensional process and that a multidimensional approach to such unions could lead to the creation of a new group of nonethnocentric categories applicable to a number of different societies. The authors also consider the notion of process, in which marriage and cohabitation are merely two states in a range of possible states through which an individual will move during the course of his or her life. Cohabiting situations vary in importance depending upon one¿s states. Better demographic analyses can lead to greater understanding of the human couple and its sexual and reproductive behaviors.^ieng

Early life transitions of Canadian women: a cohort analysis of timing, sequences, and variations.

PIP: "This paper looks into the timing and sequences of early life transitions of Canadian women using data from the 1995 General Social Survey of Family. Six events occurring in early adulthood are examined: school completion, first job, home-leaving, first cohabitation, first marriage, and first birth. Our analysis of birth cohorts spanning 60 years shows that the biggest changes in timing occurred in school completion and start of work; that the trajectories involving work before marriage have gained popularity among later cohorts; and that education appreciably delays early life transitions." (EXCERPT)^ieng

Site-directed mutagenesis of ubiquitin. Differential roles for arginine in the interaction with ubiquitin-activating enzyme.

The strict evolutionary conservation of ubiquitin suggests an essential role for each residue in the folding, stability, or function of the protein but precludes identification of such contributions through interspecies comparison of ubiquitin sequences. However, site-directed mutagenesis potentially allows assignment of specific function(s) for each residue. The four arginines present on ubiquitin at positions 42, 54, 72, and 74 were independently mutated to leucine and their effects on the interaction of the resulting polypeptides with ubiquitin-activating enzyme (E1) were characterized. All of the mutants except UbR54L exhibited altered kinetics for E1-catalyzed ATP:PPi exchange compared to wild-type ubiquitin. In addition, the UbR72L mutant altered the mechanism of E1 from strictly order addition of substrates to random addition with respect to ATP and ubiquitin. Values for the intrinsic Kd of ubiquitin binding were determined by coupling the net forward reaction of E1 to the E232K-catalyzed conjugation of histone H2B. Only R54 and R72 residues participate in the initial binding of free ubiquitin, resulting in a 6- or 58-fold increase in Kd for UbR54L or UbR72L, respectively, compared to wild type. More significant effects of the UbR42L and UbR72L mutants were observed for binding of their respective ubiquitin adenylate intermediates within the E1 active site. Wild-type ubiquitin adenylate binds to E1 with an estimated Kd < or = 8 x 10(-12) M while intermediates formed with UbR42L or UbR72L each bind with ca. 10(3)-fold lower affinity, representing a destabilization of > or = 7 kcal/mol.(ABSTRACT TRUNCATED AT 250 WORDS)

Remarriage of older Canadians: description and interpretation.

The remarriage experience of Canadian men and women aged 55 and over at time of survey are described using data from the Canadian Family History Survey, carried out in 1984 by Statistics Canada. Data pertain to approximately 1,300 women and 1,100 men. Remarriage is put in the context of total life cycle experience by means of a simple decomposition of the lifetime probability of remarriage. The analysis highlights the greater exposure of women to remarriage (due to high rates of widowhood) but their lower remarriage rates compared to men. The sex differential in remarriage remains when age at dissolution is controlled. A major regional differential is found in remarriage patterns in Canada, with residents of Quebec showing appreciably lower remarriage rates following divorce than the rest of the country. An interpretation of the observed patterns suggests the need for more attention to motivation in the study of remarriage behavior.

Sex-role homogeneity, female status and demographic change.

"This study attempts to investigate the nature of the relationships governing child-bearing models and family formation by measuring the status and role of women in society....[The author] proposes that inductive analysis should be adopted using the difference in life-expectancy among males and females at birth as a measurement of women's status to define the distinction between the roles of the two sexes. This is carried out by analysing the interrelationships between the variables of development, religion, area, fertility and women's relative status in a group of 120 countries. The study concludes that the analysis of the downward slope at the international level may explain the effect of the roles of the two sexes and women's status on demographic change on the one hand, and the effect of cultural factors such as region and religion on women's role and status on the other."

[Effects and consequences of orphanhood in past populations: North America]. / Efectos y consecuencias de la orfandad en poblaciones del pasado: America del Norte.

PIP: The authors examine how North American societies have historically handled the problem of orphanhood. A preference for adoption by individual families over the institutionalization of orphans by the state is noted. The development of the family solution to orphanhood over the course of the nineteenth century and the extension of the system to deal with orphans brought in from the United Kingdom are discussed. The development of an institutional system for orphans in the late nineteenth century is also described. (SUMMARY IN ENG)^ieng

Viscosity of subretinal fluid and its clinical correlations.

The viscosity of subretinal fluid is an important factor in transmitting force created by subretinal fluid motion to the retina. The variation of viscosity of subretinal fluid can explain variations in the effect of subretinal fluid motion on the retina. Pseudoplastic variation of subretinal fluid viscosity was confirmed using a cone-plate microviscometer. To explain the variability in viscosity between subretinal fluid specimens, 14 clinical variables associated with each of 46 specimens were examined. The strongest statistical relationship was between aphakia and lower viscosity.

GM allotypes in Native Americans: evidence for three distinct migrations across the Bering land bridge.

We report the results of typings, for immunoglobulin G allotypes, of 5392 Native Americans from ten samples, the typings having been performed over the last 20 years. Four cultural groups are represented: the Pimans-Pima and Papago; the Puebloans-Zuni and Hopi; the Pai-Walapai; and the Athabascans-Apache and Navajo. The haplotype Gm1;21 has the highest frequency in each population while Gm1,2;21 is polymorphic in all except the Hopi. The Mongoloid marker Gm1;11,13 is found primarily in the Athabascans. The Caucasian haplotype Gm3;5,11,13 is found at polymorphic frequencies in several of the populations but its frequency is very low or absent among nonadmixed individuals. Although Nei's standard genetic distance analysis demonstrates genetic similarity at the Gm and Km loci, the heterogeneity that does exist is consistent both with what is known about the prehistory of Native Americans and traditional cultural categories. When the current Gm distributions are analyzed with respect to the three-migration hypothesis, there are three distinct Gm distributions for the postulated migrants: Gm1;21 and Gm1,2;21 for the Paleo-Indians 16,000 to 40,000 years ago; Gm1;21, Gm1,2;21, and Gm1;11,13 for the second wave of Na-Dene hunters 12,000 to 14,000 years ago; and Gm1;21 and Gm1;11,13 for the Eskimo-Aleut migration 9,000 years ago. The Pimans, Puebloans, and the Pai are descendents of the Paleo-Indians while the Apache and Navajo are the contemporary populations related to the Na-Dene. Finally, the Gm distribution in Amerindians is found to be consistent with a hypothesis of one migration of Paleo-Indians to South American, while the most likely homeland for the three ancestral populations is found to be in northeastern Asia.

Frequency of reproductive dysfunction in Hawaii by race and judicial district 1968-1982.

PIP: The frequency of births with congenital defects, infants with very low birth weight, late fetal loss, and neonatal deaths is contrasted with pesticide/herbicide usage in Hawaii, using the variables percent of agricultural workers, type of agriculture, race of mother, and judicial district of mother's residence for the 5 year periods around 1970, 1975, and 1980. Rates per 1000 live births are calculated for each geographic group, for each of the time periods, and for the total combined time period; similar rates for Caucasian, Chinese, Filipino, Hawaiian, Part Hawaiian, Japanese, and Negro mothers are calculated for the entire 15 year period. Results show that: 1) there were more birth defects in 1968-1972 than in 1978-1982 in the state as a whole; 2) there was no correlation between the total and per capita use of pesticides by county and the frequency of reproductive dysfunctions; 3) there was a negative correlation between the ranks for neonatal deaths and percent of agricultural workers when they were ranked from lowest to highest; and 4) the correlation between the ranks of birth defects, low birth weight infants, and late fetal deaths, and the ranks of percent of agricultural workers, were not significant. This study shows that there has been considerable variation between birth defects, low birth weight infants, late fetal loss, and neonatal mortality from one judicial district to another. However, it is not possible to evaluate the correlation between the districts with high rates of a reporductive dysfunction and possible exposure to known environmental toxins.^ieng

Viscous corneal protection by sodium hyaluronate, chondroitin sulfate, and methylcellulose.

The authors' study of the viscosities of various concentrations of sodium hyaluronate, chondroitin sulfate, and methylcellulose revealed that sodium hyaluronate and methylcellulose are pseudoplastic fluids in contrast to chondroitin sulfate, which is a Newtonian fluid. Pseudoplastic fluids are ideal for maintaining the anterior chamber, since they are more viscous at rest. Intermediate viscosity preparations of these three agents used as a thin endothelial coating gave excellent protection from intraocular lens abrasion. A highly viscous agent, eg, sodium hyaluronate 1%, in a thin layer produced extensive endothelial cell damage because it transmitted excessive shear force to the endothelium. A highly viscous agent, sodium hyaluronate 1% in a thick layer produced a physical barrier to compression with little endothelial damage. A low-viscosity agent, balanced salt solution provided insufficient protection against intraocular lens abrasion.