Remission and recovery from first-episode psychosis in adults: systematic review and meta-analysis of long-term outcome studies

Background: Remission and recovery rates for people with first-episode psychosis (FEP) remain uncertain. Aims: To assess pooled prevalence rates of remission and recovery in FEP and to investigate potential moderators. Method: We conducted a systematic review and meta-analysis to assess pooled prevalence rates of remission and recovery in FEP in longitudinal studies with more than 1 year of follow-up data, and conducted meta-regression analyses to investigate potential moderators. Results: Seventy-nine studies were included representing 19072 patients with FEP. The pooled rate of remission among 12301 individuals with FEP was 58% (60 studies, mean follow-up 5.5 years). Higher remission rates were moderated by studies from more recent years. The pooled prevalence of recovery among 9642 individuals with FEP was 38% (35 studies, mean follow-up 7.2 years). Recovery rates were higher in North America than in other regions. Conclusions: Remission and recovery rates in FEP may be more favourable than previously thought. We observed stability of recovery rates after the first 2 years, suggesting that a progressive deteriorating course of illness is not typical. Although remission rates have improved over time recovery rates have not, raising questions about the effectiveness of services in achieving improved recovery

In vitro functional correction of Hermansky-Pudlak Syndrome type-1 by lentiviral-mediated gene transfer.

Hermansky-Pudlak syndrome (HPS) is a genetic disorder characterized by oculocutaneous albinism, bleeding tendency and susceptibility to pulmonary fibrosis. No curative therapy is available. Genetic correction directed to the lungs, bone marrow and/or gastro-intestinal tract might provide alternative forms of treatment for the diseases multi-systemic complications. We demonstrate that lentiviral-mediated gene transfer corrects the expression and function of the HPS1 gene in patient dermal melanocytes, which opens the way to development of gene therapy for HPS

Audit and feedback using the Robson classification to reduce caesarean section rates: a systematic review

Background: In most regions worldwide, caesarean section (CS) rates are increasing. In these settings, new strategies are needed to reduce CS rates. Objectives: To identify, critically appraise and synthesise studies using the Robson classification as a system to categorise and analyse data in clinical audit cycles to reduce CS rates. Search strategy Medline, Embase, CINAHL and LILACS were searched from 2001 to 2016. Selection criteria Studies reporting use of the Robson classification to categorise and analyse data in clinical audit cycles to reduce CS rates. Data collection Data on study design, interventions used, CS rates, and perinatal outcomes were extracted. Results: Of 385 citations, 30 were assessed for full text review and six studies, conducted in Brazil, Chile, Italy and Sweden, were included. All studies measured initial CS rates, provided feedback and monitored performance using the Robson classification. In two studies, the audit cycle consisted exclusively of feedback using the Robson classification; the other four used audit and feedback as part of a multifaceted intervention. Baseline CS rates ranged from 20 to 36.8%; after the intervention, CS rates ranged from 3.1 to 21.2%. No studies were randomised or controlled and all had a high risk of bias. Conclusion: We identified six studies using the Robson classification within clinical audit cycles to reduce CS rates. All six report reductions in CS rates; however, results should be interpreted with caution because of limited methodological quality. Future trials are needed to evaluate the role of the Robson classification within audit cycles aimed at reducing CS rates. Tweetable abstract Use of the Robson classification in clinical audit cycles to reduce caesarean rates

Resolved SPLASH Chemodynamics in Andromeda's PHAT Stellar Halo and Disk: On the Nature of the Inner Halo Along the Major Axis

Stellar kinematics and metallicity are key to exploring formation scenarios for galactic disks and halos. In this work, we characterized the relationship between kinematics and photometric metallicity along the line-of-sight to M31's disk. We combined optical HST/ACS photometry from the Panchromatic Hubble Andromeda Treasury (PHAT) survey with Keck/DEIMOS spectra from the Spectroscopic and Photometric Landscape of Andromeda's Stellar Halo (SPLASH) survey. The resulting sample of 3536 individual red giant branch stars spans 4-19 projected kpc, making it a useful probe of both the disk and inner halo. We separated these stars into disk and halo populations by modeling the line-of-sight velocity distributions as a function of position across the disk region, where 70.9% stars have a high likelihood of belonging to the disk and 17.1% to the halo. Although stellar halos are typically thought to be metal-poor, the kinematically identified halo contains a significant population of stars (29.4%) with disk-like metallicity ([Fe/H]$_{\rm phot} \sim -0.10$). This metal-rich halo population lags the gaseous disk to a similar extent as the rest of the halo, indicating that it does not correspond to a canonical thick disk. Its properties are inconsistent with those of tidal debris originating from the Giant Stellar Stream merger event. Moreover, the halo is chemically distinct from the phase-mixed component previously identified along the minor axis (i.e., away from the disk), implying contributions from different formation channels. These metal-rich halo stars provide direct chemodynamical evidence in favor of the previously suggested "kicked-up'' disk population in M31's inner stellar halo.Comment: Submitted to AJ. Conclusions on page 20. 18 figures, 2 tables, 4 appendice

S5S^5: Probing the Milky Way and Magellanic Clouds potentials with the 6-D map of the Orphan-Chenab stream

We present a 6-D map of the Orphan-Chenab (OC) stream by combining the data from 5 years of Southern Stellar Stream Spectroscopic Survey $S^5$ observations with Gaia EDR3 data. We reconstruct the proper motion, radial velocity, distance and on-sky track of stream stars with spline models and extract the stellar density along the stream. The stream has a total luminosity of $M_V=-8.2$ and an average metallicity of $[Fe/H]=-1.9$, similar to classical MW satellites like Draco. The stream shows drastic changes in its physical width varying from 200 pc to 1 kpc, a constant line of sight velocity dispersion of 5 km/s, but an increase in the velocity dispersion along the stream near pericenter to $\sim$ 10 km/s. Despite the large apparent variation in the stellar number density along the stream, the flow rate of stars along the stream is remarkably constant. We model the 6-D stream track by a Lagrange-point stripping method with a flexible MW potential in the presence of a moving extended LMC potential. This allows us to constrain the mass profile of the MW within the distance range 15.6 < r < 55.5 kpc, with the best measured enclosed mass of $(2.85\pm 0.1)\times10^{11}\,M_\odot$ within 32.4 kpc. With the OC stream's closest approach distance to the LMC of $\sim 21$ kpc, our stream measurements are highly sensitive to the LMC mass profile with the most precise measurement of the LMC's enclosed mass being at 32.8 kpc with $M=(7.02\pm 0.9)\times10^{10}\, {M}_\odot$. We confidently detect that the LMC DM halo extends to at least 53 kpc. The fitting of the OC stream allows us to constrain the past LMC trajectory and the degree of dynamical friction it experienced. We demonstrate that the stars on the OC stream show large energy and angular momentum spreads caused by the LMC perturbation and revealing the limitations of orbital invariants for substructure identification in the MW halo.Comment: submitted to MNRAS; comments welcome; data released with the paper is available on Zenodo https://zenodo.org/record/722265

Signature of a massive rotating metal-poor star imprinted in the Phoenix stellar stream*

The Phoenix stellar stream has a low intrinsic dispersion in velocity and metallicity that implies the progenitor was probably a low mass globular cluster. In this work we use Magellan/MIKE high-dispersion spectroscopy of eight Phoenix stream red giants to confirm this scenario. In particular, we find negligible intrinsic scatter in metallicity ($\sigma(\mathrm{[Fe~II/H]}) = 0.04^{+0.11}_{-0.03}$) and a large peak-to-peak range in [Na/Fe] and [Al/Fe] abundance ratios, consistent with the light element abundance patterns seen in the most metal-poor globular clusters. However, unlike any other globular cluster, we also find an intrinsic spread in [Sr II/Fe] spanning $\sim$1 dex, while [Ba II/Fe] shows nearly no intrinsic spread ($\sigma(\mathrm{[Ba~II/H]}) = {0.03}^{+0.10}_{-0.02}$). This abundance signature is best interpreted as slow neutron capture element production from a massive fast-rotating metal-poor star ($15-20 \mathrm{M}_\odot$, $v_\mathrm{ini}/v_\mathrm{crit} = 0.4$, $[\mathrm{Fe/H}] = -3.8$). The low inferred cluster mass suggests the system would have been unable to retain supernovae ejecta, implying that any massive fast-rotating metal-poor star that enriched the interstellar medium must have formed and evolved before the globular cluster formed. Neutron capture element production from asymptotic giant branch stars or magneto-rotational instabilities in core-collapse supernovae provide poor fits to the observations. We also report one Phoenix stream star to be a lithium-rich giant ($A(\mathrm{Li}) = 3.1 \pm 0.1$). At $[\mathrm{Fe/H}] = -2.93$ it is among the most metal-poor lithium-rich giants known.Comment: Accepted to ApJ 2021-07-0

Broken into Pieces::ATLAS and Aliqa Uma as One Single Stream

We present the first spectroscopic measurements of the ATLAS and Aliqa Uma streams from the Southern Stellar Stream Spectroscopic Survey ($S^5$), in combination with the photometric data from the Dark Energy Survey and astrometric data from $Gaia$. From the coherence of spectroscopic members in radial velocity and proper motion, we find out that these two systems are extremely likely to be one stream with discontinuity in morphology and density on the sky (the "kink" feature). We refer to this entire stream as the ATLAS-Aliqa Uma stream, or the AAU stream. We perform a comprehensive exploration of the effect of baryonic substructures and find that only an encounter with the Sagittarius dwarf $\sim 0.5$ Gyr ago can create a feature similar to the observed "kink". In addition, we also identify two gaps in the ATLAS component associated with the broadening in the stream width (the "broadening" feature). These gaps have likely been created by small mass perturbers, such as dark matter halos, as the AAU stream is the most distant cold stream known with severe variations in both the stream surface density and the stream track on the sky. With the stream track, stream distance and kinematic information, we determine the orbit of the AAU stream and find that it has been affected by the Large Magellanic Cloud, resulting in a misalignment between the proper motion and stream track. Together with the Orphan-Chenab Stream, AAU is the second stream pair that has been found to be a single stream separated into two segments by external perturbation.Comment: 33 pages, 22 figures (including 1 movie), 3 tables. Accepted for publication in Ap

Reliability and tolerance comparison in water supply networks

The final publication is available at Springer via http://dx.doi.org/10.1007/s11269-010-9753-2Urban water supply is a high priority service and so looped networks are extensively used in order to considerably reduce the number of consumers affected by a failure. Looped networks may be redundant in connectivity and capacity. The concept of reliability has been introduced in an attempt to quantitatively measure the possibility of maintaining an adequate service for a given period. Numerous researchers have considered reliability as a measure of redundancy. This concept is usually implicit, but some researchers have even stated it explicitly. This paper shows why reliability cannot be considered a measure of redundancy given that branched networks can achieve high values of reliability and this would deny the fact that a looped network is more reliable than a branched network with a similar layout and size. To this end the paper discusses two quantitative indices for measuring expected network behavior: reliability and tolerance. These indices are calculated and a comparison is made between looped, branched, and mixed networks. © 2011 Springer Science+Business Media B.V.The authors wish to acknowledge the support received from project IDAWAS, DPI2009-11591, of the Directorate-General of Research at the Spanish Ministry of Education, the grant PAID-02-09 for a stay at the Universidad Politecnica de Valencia by the first author, and a grant MAEC-AECI 0000202066 awarded to the second author by the Ministerio de Asuntos Exteriores y Cooperacion of Spain. The use of English in this paper was revised by John Rawlins; and the revision was funded by the Universidad Politecnica de Valencia, Spain.Martínez-Rodríguez, JB.; Montalvo Arango, I.; Izquierdo Sebastián, J.; Pérez García, R. (2011). Reliability and tolerance comparison in water supply networks. 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Defining sustainable transport in rural tourism: experiences from the New Forest

Transport policy agendas have long sought to bring about more sustainable transport at tourism destinations. While there are examples of successes, it remains unclear what inroads have been made towards creating a sustainable transport future. Policy directions have evolved over a number of years and in many tourism destination contexts it is far from clear what a desirable transport future looks like. When translated to implementation, the aims of initiatives can be unclear and baseline measures inconsistent, making success difficult to judge. This paper analyses how sustainable travel has been implemented in practice at a destination level. The focus is rural tourism and data are derived from a specific case, the New Forest National Park, UK, where a wide range of transport initiatives have been implemented since the Park’s designation in 2005. The study adopts a social practice theory perspective. Data are derived from a visitor survey, interviews and observations. It finds there is scope to improve sustainable transport provision at destinations through understanding visitor practices, but limited scope to influence meanings associated with visitor travel and travel skills. Policy meets the needs of some visitors more than others

Ghrelin as a novel locally produced relaxing peptide of the iris sphincter and dilator muscles

Ghrelin is a recently described acylated peptide, which works as a somatosecretagogue and has described effects on the smooth, skeletal and cardiac muscle. We examined the production and effects of ghrelin on relaxation of the iris muscles. Contractile effects of 1-5 human ghrelin (frGhr, 10(-9)-6 x 10(-5)M) and 1-5 human des-octanoyl-ghrelin (d-frGhr; 10(-9)-6 x 10(-5)M) were tested on iris rabbit sphincter (n=11 frGhr; n=7 d-frGhr), dilator (n=6 frGhr; n=6 d-frGhr) and rat sphincter (n=6 frGhr; n=8 d-frGhr) precontracted muscles. On rabbit sphincter the effect of frGhr was also tested in presence of: i) L-NA (10(-5)M; n=7); ii) indomethacin (10(-5)M; n=7); iii) DLys(3)GHRP6 (10(-4)M; n=6); and iv) apamin+carybdotoxin (10(-6)M; n=6). Furthermore, on rabbit dilator the effect of frGhr was tested in presence of DLys(3)GHRP6 (10(-4)M; n=7). Finally, ghrelin mRNA production was assessed by "in situ" hybridization in Wistar rat eyes (n=8). In all muscles, frGhr promoted a concentration-dependent relaxation, maximal at 6 x 10(-5)M, 1.5-3 min after its addition, decreasing tension by 34.1+/-12.1%, 25.8+/-4.8% and 52.1+/-10.3% in the rabbit sphincter, dilator and rat sphincter, respectively. In the rabbit sphincter the relaxing effects of frGhr were: (i) enhanced in presence of DLys(3)GHRP6 (118.1+/-21.1%); (ii) blunted by indomethacin; and (iii) not altered by apamin+carybdotoxin (36.4+/-14.4%) or L-NA (52.4+/-11.4%). Relaxing effects of d-frGhr in rabbit (43.3+/-5.2%) and rat (77.1+/-15.3%) sphincter muscles were similar to those of frGhr. In rabbit dilator muscle, d-frGhr did not significantly alter active tension and the relaxing effect of frGhr was blunted by GHSR-1a blockage. Ghrelin mRNA was identified in iris posterior epithelium. In conclusion, ghrelin is a novel, locally produced, relaxing agent of iris dilator and sphincter muscles, an effect that is mediated by GHSR-1a in the former, but not in the latter. Furthermore, in the sphincter it seems to be mediated by prostaglandins, but not by NO or K(Ca) channels.Portuguese Foundation for Science and Technology (nr. POCI/SAU-FCF/60803/2004) through Cardiovascular R&D Unit (FCT nr. 51/94). Authors are sincerely grateful to RS. Moura (SFRH/BPD/15408/2005), Development Unit, Health and Life Sciences Institute, School of Health Sciences, University of Minho, Braga, Portugal for her excellent contribution in the in-situ hybridization techniques