Is there a gap between recommended and ‘real world’ practice in the management of depression in young people? : a medical file audit of practice

Background: Literature has shown that dissemination of guidelines alone is insufficient to ensure that guideline recommendations are incorporated into every day clinical practice. Methods: We aimed to investigate the gaps between guideline recommendations and clinical practice in the management of young people with depression by undertaking an audit of medical files in a catchment area public mental health service for 15 to 25 year olds in Melbourne, Australia. Results: The results showed that the assessment and recording of depression severity to ensure appropriate treatment planning was not systematic nor consistent; that the majority of young people (74.5%) were prescribed an antidepressant before an adequate trial of psychotherapy was undertaken and that less than 50% were monitored for depression symptom improvement and antidepressant treatment emergent suicide related behaviours (35% and 30% respectively). Encouragingly 92% of first line prescriptions for those aged 18 years or under who were previously antidepressant-naïve was for fluoxetine as recommended. Conclusions: This research has highlighted the need for targeted strategies to ensure effective implementation. These strategies might include practice system tools that allow for systematic monitoring of depression symptoms and adverse side effects, particularly suicide related behaviours. Additionally, youth specific psychotherapy that incorporates the most effective components for this age group, delivered in a youth friendly way would likely aid effective implementation of guideline recommendations for engagement in an adequate trial of psychotherapy before medication is initiated

Fermi Level Dependent Spin Pumping from a Magnetic Insulator into a Topological Insulator

Topological spintronics aims to exploit the spin-momentum locking in the helical surface states of topological insulators for spin-orbit torque devices. We address a fundamental question that still remains unresolved in this context: does the topological surface state alone produce the largest values of spin-charge conversion efficiency or can the strongly spin-orbit coupled bulk states also contribute significantly? By studying the Fermi level dependence of spin pumping in topological insulator/ferrimagnetic insulator bilayers, we show that the spin Hall conductivity is constant when the Fermi level is tuned across the bulk band gap, consistent with a full bulk band calculation. The results suggest a new perspective, wherein "bulk-surface correspondence" allows spin-charge conversion to be simultaneously viewed either as coming from the full bulk band, or from spin-momentum locking of the surface state

Correlation between pyocyanin production and hydrocarbonoclastic activity in nine strains of Pseudomonas aeruginosa

The more pyocyanin produced by the hydrocarbon degrading Pseudomonas aeruginosa strains, the more hydrocarbons would be assimilated and transformed. To evaluate this assumption,we asssed the potential use of nine wild types of pyocyanin-producing P. aeruginosain bioremediation. They exhibit concentrations of pyocyanin ranging from 0.08 to 28.68 μg/mL.Hydrocarbonoclastic activity in the presence of pyocyanin was determined by two protocols. First, ahigh correlation was found between the synthesis of pyocyanin and the emulsification index of lubricating oil. Second, two strains were tested for their ability to degrade anthracene and pyrene in soil by the concentration of pigment produced.Microcosms were filled with 250g of sterile sandy soil, supplemented with glycerin and then contaminated with a 20 mg/kg of mixture of the two compounds. The volume of the inoculum suspension (≈108 CFU/mL) was equivalent to 5% of the soil mass contained in the microcosms. Static incubation lasted 60 days at 25°C. A roughly 60-fold difference between the pigment concentrations produced by the two strains resulted in an increase of 65 and 45% in the pyrene and anthracene biodegradation, also indicating that the molecule served as a co-substrate of pyrene degradation

ESR1 Is Co-Expressed with Closely Adjacent Uncharacterised Genes Spanning a Breast Cancer Susceptibility Locus at 6q25.1

Approximately 80% of human breast carcinomas present as oestrogen receptor α-positive (ER+ve) disease, and ER status is a critical factor in treatment decision-making. Recently, single nucleotide polymorphisms (SNPs) in the region immediately upstream of the ER gene (ESR1) on 6q25.1 have been associated with breast cancer risk. Our investigation of factors associated with the level of expression of ESR1 in ER+ve tumours has revealed unexpected associations between genes in this region and ESR1 expression that are important to consider in studies of the genetic causes of breast cancer risk. RNA from tumour biopsies taken from 104 postmenopausal women before and after 2 weeks treatment with an aromatase (oestrogen synthase) inhibitor was analyzed on Illumina 48K microarrays. Multiple-testing corrected Spearman correlation revealed that three previously uncharacterized open reading frames (ORFs) located immediately upstream of ESR1, C6ORF96, C6ORF97, and C6ORF211 were highly correlated with ESR1 (Rs = 0.67, 0.64, and 0.55 respectively, FDR<1×10−7). Publicly available datasets confirmed this relationship in other groups of ER+ve tumours. DNA copy number changes did not account for the correlations. The correlations were maintained in cultured cells. An ERα antagonist did not affect the ORFs' expression or their correlation with ESR1, suggesting their transcriptional co-activation is not directly mediated by ERα. siRNA inhibition of C6ORF211 suppressed proliferation in MCF7 cells, and C6ORF211 positively correlated with a proliferation metagene in tumours. In contrast, C6ORF97 expression correlated negatively with the metagene and predicted for improved disease-free survival in a tamoxifen-treated published dataset, independently of ESR1. Our observations suggest that some of the biological effects previously attributed to ER could be mediated and/or modified by these co-expressed genes. The co-expression and function of these genes may be important influences on the recently identified relationship between SNPs in this region and breast cancer risk

Children's and adolescents' rising animal-source food intakes in 1990-2018 were impacted by age, region, parental education and urbanicity

Animal-source foods (ASF) provide nutrition for children and adolescents physical and cognitive development. Here, we use data from the Global Dietary Database and Bayesian hierarchical models to quantify global, regional and national ASF intakes between 1990 and 2018 by age group across 185 countries, representing 93% of the worlds child population. Mean ASF intake was 1.9 servings per day, representing 16% of children consuming at least three daily servings. Intake was similar between boys and girls, but higher among urban children with educated parents. Consumption varied by age from 0.6 at <1 year to 2.5 servings per day at 1519 years. Between 1990 and 2018, mean ASF intake increased by 0.5 servings per week, with increases in all regions except sub-Saharan Africa. In 2018, total ASF consumption was highest in Russia, Brazil, Mexico and Turkey, and lowest in Uganda, India, Kenya and Bangladesh. These findings can inform policy to address malnutrition through targeted ASF consumption programmes. (c) 2023, The Author(s)

Incident type 2 diabetes attributable to suboptimal diet in 184 countries

The global burden of diet-attributable type 2 diabetes (T2D) is not well established. This risk assessment model estimated T2D incidence among adults attributable to direct and body weight-mediated effects of 11 dietary factors in 184 countries in 1990 and 2018. In 2018, suboptimal intake of these dietary factors was estimated to be attributable to 14.1 million (95% uncertainty interval (UI), 13.814.4 million) incident T2D cases, representing 70.3% (68.871.8%) of new cases globally. Largest T2D burdens were attributable to insufficient whole-grain intake (26.1% (25.027.1%)), excess refined rice and wheat intake (24.6% (22.327.2%)) and excess processed meat intake (20.3% (18.323.5%)). Across regions, highest proportional burdens were in central and eastern Europe and central Asia (85.6% (83.487.7%)) and Latin America and the Caribbean (81.8% (80.183.4%)); and lowest proportional burdens were in South Asia (55.4% (52.160.7%)). Proportions of diet-attributable T2D were generally larger in men than in women and were inversely correlated with age. Diet-attributable T2D was generally larger among urban versus rural residents and higher versus lower educated individuals, except in high-income countries, central and eastern Europe and central Asia, where burdens were larger in rural residents and in lower educated individuals. Compared with 1990, global diet-attributable T2D increased by 2.6 absolute percentage points (8.6 million more cases) in 2018, with variation in these trends by world region and dietary factor. These findings inform nutritional priorities and clinical and public health planning to improve dietary quality and reduce T2D globally. (c) 2023, The Author(s)

Rivaroxaban Compared with Standard Anticoagulants for the Treatment of Acute Venous Thromboembolism in Children: a Randomised, Controlled, Phase 3 Trial

Background: Treatment of venous thromboembolism in children is based on data obtained in adults with little direct documentation of its efficacy and safety in children. The aim of our study was to compare the efficacy and safety of rivaroxaban versus standard anticoagulants in children with venous thromboembolism. Methods: In a multicentre, parallel-group, open-label, randomised study, children (aged 0–17 years) attending 107 paediatric hospitals in 28 countries with documented acute venous thromboembolism who had started heparinisation were assigned (2:1) to bodyweight-adjusted rivaroxaban (tablets or suspension) in a 20-mg equivalent dose or standard anticoagulants (heparin or switched to vitamin K antagonist). Randomisation was stratified by age and venous thromboembolism site. The main treatment period was 3 months (1 month in children <2 years of age with catheter-related venous thromboembolism). The primary efficacy outcome, symptomatic recurrent venous thromboembolism (assessed by intention-to-treat), and the principal safety outcome, major or clinically relevant non-major bleeding (assessed in participants who received ≥1 dose), were centrally assessed by investigators who were unaware of treatment assignment. Repeat imaging was obtained at the end of the main treatment period and compared with baseline imaging tests. This trial is registered with ClinicalTrials.gov, number NCT02234843 and has been completed. Findings: From Nov 14, 2014, to Sept 28, 2018, 500 (96%) of the 520 children screened for eligibility were enrolled. After a median follow-up of 91 days (IQR 87–95) in children who had a study treatment period of 3 months (n=463) and 31 days (IQR 29–35) in children who had a study treatment period of 1 month (n=37), symptomatic recurrent venous thromboembolism occurred in four (1%) of 335 children receiving rivaroxaban and five (3%) of 165 receiving standard anticoagulants (hazard ratio [HR] 0·40, 95% CI 0·11–1·41). Repeat imaging showed an improved effect of rivaroxaban on thrombotic burden as compared with standard anticoagulants (p=0·012). Major or clinically relevant non-major bleeding in participants who received ≥1 dose occurred in ten (3%) of 329 children (all non-major) receiving rivaroxaban and in three (2%) of 162 children (two major and one non-major) receiving standard anticoagulants (HR 1·58, 95% CI 0·51–6·27). Absolute and relative efficacy and safety estimates of rivaroxaban versus standard anticoagulation estimates were similar to those in rivaroxaban studies in adults. There were no treatment-related deaths. Interpretation: In children with acute venous thromboembolism, treatment with rivaroxaban resulted in a similarly low recurrence risk and reduced thrombotic burden without increased bleeding, as compared with standard anticoagulants. Funding: Bayer AG and Janssen Research & Development. © 2020 Elsevier Ltd

Is there a gap between recommended and ‘real world’ practice in the management of depression in young people? A medical file audit of practice

Background Literature has shown that dissemination of guidelines alone is insufficient to ensure that guideline recommendations are incorporated into every day clinical practice. Methods We aimed to investigate the gaps between guideline recommendations and clinical practice in the management of young people with depression by undertaking an audit of medical files in a catchment area public mental health service for 15 to 25 year olds in Melbourne, Australia. Results The results showed that the assessment and recording of depression severity to ensure appropriate treatment planning was not systematic nor consistent; that the majority of young people (74.5%) were prescribed an antidepressant before an adequate trial of psychotherapy was undertaken and that less than 50% were monitored for depression symptom improvement and antidepressant treatment emergent suicide related behaviours (35% and 30% respectively). Encouragingly 92% of first line prescriptions for those aged 18 years or under who were previously antidepressant-naïve was for fluoxetine as recommended. Conclusions This research has highlighted the need for targeted strategies to ensure effective implementation. These strategies might include practice system tools that allow for systematic monitoring of depression symptoms and adverse side effects, particularly suicide related behaviours. Additionally, youth specific psychotherapy that incorporates the most effective components for this age group, delivered in a youth friendly way would likely aid effective implementation of guideline recommendations for engagement in an adequate trial of psychotherapy before medication is initiated

Plant diversity effects on soil food webs are stronger than those of elevated CO2 and N deposition in a long-term grassland experiment

Recent metaanalyses suggest biodiversity loss affects the functioning of ecosystems to a similar extent as other global environmental change agents. However, the abundance and functioning of soil organisms have been hypothesized to be much less responsive to such changes, particularly in plant diversity, than aboveground variables, although tests of this hypothesis are extremely rare. We examined the responses of soil food webs (soil microorganisms, nematodes, microarthropods) to 13-y manipulation of multiple environmental factors that are changing at global scales-specifically plant species richness, atmospheric CO2, and N deposition-in a grassland experiment in Minnesota. Plant diversity was a strong driver of the structure and functioning of soil food webs through several bottom-up (resource control) effects, whereas CO2 and N only had modest effects. We found few interactions between plant diversity and CO2 and N, likely because of weak interactive effects of those factors on resource availability (e.g., root bio-mass). Plant diversity effects likely were large because high plant diversity promoted the accumulation of soil organic matter in the site's sandy, organic matter-poor soils. Plant diversity effects were not explained by the presence of certain plant functional groups. Our results underline the prime importance of plant diversity loss cascading to soil food webs (density and diversity of soil organisms) and functions. Because the present results suggest prevailing plant diversity effects and few interactions with other global change drivers, protecting plant diversity may be of high priority to maintain the biodiversity and functioning of soils in a changing world

Synergistic effects of four climate change drivers on terrestrial carbon cycling

Disentangling impacts of multiple global changes on terrestrial carbon cycling is important, both in its own right and because such impacts can dampen or accelerate increases in atmospheric CO2 concentration. Here we report on an eight-year grassland experiment, TeRaCON, in Minnesota, United States, that factorially manipulated four drivers: temperature, rainfall, CO2 and nitrogen deposition. Net primary production increased under warming, elevated CO2 and nitrogen deposition, and decreased under diminished summer rainfall. Treatment combinations that increased net primary production also increased soil CO2 emissions, but less so, and hence ecosystem carbon storage increased overall. Productivity, soil carbon emissions and plant carbon stock responses to each individual factor were influenced by levels of the other drivers, in both amplifying and dampening ways. Percentage increases in productivity, soil carbon emissions and plant carbon stocks in response to two, three or four global changes experienced jointly were generally much greater than those expected based on the effects of each individual driver alone. Multiple global change drivers had a profound combined influence on observed outcomes that would have been poorly predicted by knowledge of each driver alone. If such interacting impacts of multiple global change drivers on carbon cycling occur widely among ecosystems, accurately projecting biosphere responses to multifactorial global changes will remain a major challenge in the decades ahead