‘Big data’ in mental health research:current status and emerging possibilities

PURPOSE: ‘Big data’ are accumulating in a multitude of domains and offer novel opportunities for research. The role of these resources in mental health investigations remains relatively unexplored, although a number of datasets are in use and supporting a range of projects. We sought to review big data resources and their use in mental health research to characterise applications to date and consider directions for innovation in future. METHODS: A narrative review. RESULTS: Clear disparities were evident in geographic regions covered and in the disorders and interventions receiving most attention. DISCUSSION: We discuss the strengths and weaknesses of the use of different types of data and the challenges of big data in general. Current research output from big data is still predominantly determined by the information and resources available and there is a need to reverse the situation so that big data platforms are more driven by the needs of clinical services and service users

Integration of biophysical connectivity in the spatial optimization of coastal ecosystem services

Ecological connectivity in coastal oceanic waters is mediated by dispersion of the early life stages of marine organisms and conditions the structure of biological communities and the provision of ecosystem services. Integrated management strategies aimed at ensuring long-term service provision to society do not currently consider the importance of dispersal and larval connectivity. A spatial optimization model is introduced to maximise the potential provision of ecosystem services in coastal areas by accounting for the role of dispersal and larval connectivity. The approach combines a validated coastal circulation model that reproduces realistic patterns of larval transport along the coast, which ultimately conditions the biological connectivity and productivity of an area, with additional spatial layers describing potential ecosystem services. The spatial optimization exercise was tested along the coast of Central Chile, a highly productive area dominated by the Humboldt Current. Results show it is unnecessary to relocate existing management areas, as increasing no-take areas by 10% could maximise ecosystem service provision, while improving the spatial representativeness of protected areas and minimizing social conflicts. The location of protected areas was underrepresented in some sections of the study domain, principally due to the restriction of the model to rocky subtidal habitats. Future model developments should encompass the diversity of coastal ecosystems and human activities to inform integrative spatial management. Nevertheless, the spatial optimization model is innovative not only for its integrated ecosystem perspective, but also because it demonstrates that it is possible to incorporate time-varying biophysical connectivity within the optimization problem, thereby linking the dynamics of exploited populations produced by the spatial management regime.Comment: 30 pages, 5 figures, 2 tables; 1 graphical abstract. In this version: numbering of figures corrected, updated figure 2, typos corrected and references fixe

Marginalized Beauty, Struggle, and Present Reality

The three essential objectives of my current artwork all surround notions of beauty, struggle, the mundane present, reality, and marginalization. The first objective is to record and celebrate the juxtaposition of a person's sense of struggle, oddity, and difference with the beauty and strength of that struggle. The second is to illuminate the present and the mundane rather than hide the truth by romanticizing the past and future. The third objective is to avoid further categorizing and exoticizing of marginalized people in the process of celebrating that difference. I achieve these goals by using mundane materials, forms, and content and in the process remain authentic to my cultures, to my generation, and to myself I simultaneously reject contemporary artistic notions of "worthiness" and "exoticness" and embrace the everyday rhythms of life as the primary means through which we construct and reconstruct ourselves and our relationships with others.</p

Aspirin in people with dementia, long-term benefits and harms:A systematic review

Purpose: People with dementia may have indications for aspirin prescription and clinicians are asked to balance the potential risks against benefits. This review examines the evidence for risk and benefit of long-term aspirin use in people with dementia aged over 65 years, including randomised controlled trials and observational studies.Methods: We searched three databases for research published between 2007 to 2019. Each eligible article was assessed for risk of bias, and confidence in findings was rated using Grading of Recommendations Assessment, Development and Evaluation (GRADE).Results: Four papers met inclusion criteria, one randomised controlled trial, two cohort study, and one with pooled data. All looked only at dementia of the Alzheimer's type, and none addressed myocardial or cerebral infarction as outcomes. Dementia progression was reported by two studies, with conflicting results. The trial found no significant effect of aspirin on mortality (odds ratio aspirin vs no aspirin 1.07, 95% confidence interval 0.58-1.97) but found more events of severe bleeding with aspirin (OR aspirin vs no aspirin 6.9, 1.5-31.2). An excess in intracranial haemorrhage in the aspirin group was judged plausible based on two non-randomised studies.Conclusions: The review findings are limited because studies include only people with Alzheimer's type dementia and lack confirmatory studies, although an increased risk of bleeding events is recognised. Further research that addresses the benefits and risks of aspirin in more representative groups of people with dementia is needed to guide prescribing decisions

Association of anthropometric measures with kidney disease progression and mortality: a retrospective cohort study of pre-dialysis chronic kidney disease patients referred to a specialist renal service

Background: Although elevated body mass index (BMI) is a predictor of better clinical outcomes in dialysis patients, the evidence in pre-dialysis chronic kidney disease (CKD) is conflicting. Clinical measures of central obesity may be better prognostic indicators, although investigation has been limited. The aim of this study was to assess the predictive value of anthropometric measures for kidney failure progression and mortality in stage 3-4 CKD. Methods: The study included newly referred stage 3-4 CKD patients at a single centre between 1/1/2008 and 31/12/2010. The associations between clinical measures of obesity (BMI, waist circumference [WC] and conicity index [ConI]) and time to a composite primary outcome of doubling of serum creatinine, commencement of renal replacement therapy or mortality were evaluated using the Kaplan-Meier method and multivariable Cox regression models. Results: Over a median follow-up period of 3.3 years, 229 (25.4 %) patients of a total population of 903 experienced the composite primary renal outcome. When compared to normal BMI (18.5-24.9 kg/m2, n = 174), the risk of the composite primary outcome was significantly lower in both the overweight (BMI 25-29.9 kg/m2, n = 293; adjusted hazard ratio [HR] 0.50, 95 % CI 0.33-0.75) and obese class I/II groups (BMI 30-39.9 kg/m2, n = 288; HR 0.62, 95 % CI 0.41-0.93), but not in the obese class III group (BMI ≥40 kg/m2, n = 72; HR 0.94, 95 % CI 0.52-1.69). All-cause mortality was also lower in the overweight group (HR 0.50, 95 % CI 0.30-0.83). WC and ConI were not associated with either the composite primary outcome or mortality. Conclusion: BMI in the overweight range is associated with reduced risks of kidney disease progression and all-cause mortality in stage 3-4 CKD. WC and ConI were not independent predictors of these outcomes in this population

The Evaluation and Followup of Children Referred to Pediatric Endocrinologists for Short Stature

Objective. To characterize the pediatric endocrinologists' evaluation and followup of short-statured patients. Study Design. Observational study of 21,548 short-statured children (April 1996 to December 1999). Baseline demographics, laboratory testing, height standard deviation score (SDS), target height, and height relative to target height were analyzed at initial and return visits with the specialist. Patients were scheduled for at least one return visit and no recombinant human growth hormone therapy was administered. Results. Mean patient age was 8.6 years with a mean height SDS of −2.1. Patients were predominantly male (69%), prepubertal (73%), and white (76%). Few screening tests were obtained during initial evaluation. Nearly 40% of children did not return for their second scheduled visit. The follow-up rate was unrelated to demographics or degree of short stature. Conclusions. Low return rates limit specialists' ability to monitor growth or obtain laboratory testing over time. Further studies are needed to determine which tests should be obtained at the initial clinic visit as well as the basis for the low return rate in this group of children

Attitudes of US Obstetricians Toward a Combined Tetanus-Diphtheria-Acellular Pertussis Vaccine for Adults

Objective. To describe obstetricians' perspectives related to tetanus-diphtheria-acellular pertussis (Tdap) vaccination of mothers and other adults in close contact with infants. Methods. Mail survey of national random sample of 400 obstetricians . Results. Response rate was 54%. Most respondents would likely recommend Tdap for women during the postpartum hospital stay (78%) or during pregnancy (69%) if a national recommendation was issued. Expected barriers were knowing the date of patients' most recent Td booster (74%) and patient resistance (46%). Most felt that obstetricians have a role in promoting and administering Tdap vaccine to adults other than mothers likely to come in close contact with infants. Conclusion. Obstetricians are likely to agree with the recent provisional US recommendation to administer Tdap to postpartum mothers and other adults expected to come in close contact with infants. Obstetricians would also be likely to support a potential recommendation to administer Tdap during pregnancy. Barriers to adoption of new Tdap vaccine recommendations should be monitored