The international standards organization (ISO) 9000 series: A competitive pressure for U.S. business

ISO 9000 is becoming an increasingly significant issue for U. S. companies engaged in international business activity. Certification is fast becoming a requirement for companies doing business in Europe and other parts of the worl

Enhanced relapse prevention for bipolar disorder – ERP trial. A cluster randomised controlled trial to assess the feasibility of training care coordinators to offer enhanced relapse prevention for bipolar disorder

BACKGROUND: Bipolar Disorder (BD) is a common and severe form of mental illness characterised by repeated relapses of mania or depression. Pharmacotherapy is the main treatment currently offered, but this has only limited effectiveness. A recent Cochrane review has reported that adding psycho-social interventions that train people to recognise and manage the early warning signs of their relapses is effective in increasing time to recurrence, improving social functioning and in reducing hospitalisations. However, the review also highlights the difficulties in offering these interventions within standard mental health services due to the need for highly trained therapists and extensive input of time. There is a need to explore the potential for developing Early Warning Sign (EWS) interventions in ways that will enhance dissemination. METHODS AND DESIGN: This article describes a cluster-randomised trial to assess the feasibility of training care coordinators (CCs) in community mental health teams (CMHTs) to offer Enhanced Relapse Prevention (ERP) to people with Bipolar Disorder. CMHTs in the North West of England are randomised to either receive training in ERP and to offer this to their clients, or to continue to offer treatment as usual (TAU). The main aims of the study are (1) to determine the acceptability of the intervention, training and outcome measures (2) to assess the feasibility of the design as measured by rates of recruitment, retention, attendance and direct feedback from participants (3) to estimate the design effect of clustering for key outcome variables (4) to estimate the effect size of the impact of the intervention on outcome. In this paper we provide a rationale for the study design, briefly outline the ERP intervention, and describe in detail the study protocol. DISCUSSION: This information will be useful to researchers attempting to carry out similar feasibility assessments of clinical effectiveness trials and in particular cluster randomised controlled trials

Soil fungal abundance and plant functional traits drive fertile island formation in global drylands

Dryland vegetation is characterized by discrete plant patches that accumulate and capture soil resources under their canopies. These “fertile islands” are major drivers of dryland ecosystem structure and functioning, yet we lack an integrated understanding of the factors controlling their magnitude and variability at the global scale.EEA BarilocheFil: Ochoa-Hueso, Raúl. Universidad Autónoma de Madrid. Department of Ecology; EspañaFil: Eldridge, David J. University of New South Wales. School of Biological, Earth and Environmental Sciences; AustraliaFil: Delgado-Baquerizo, Manuel. University of Colorado. Cooperative Institute for Research in Environmental Sciences; Estados Unidos. Universidad Rey Juan Carlos. Escuela Superior de Ciencias Experimentales y Tecnología. Departamento de Biología y Geología, Física y Química Inorgánica; EspañaFil: Soliveres, Santiago. University of Bern. Institute of Plant Sciences; SuizaFil: Bowker, Matthew A. Northern Arizona University. School of Forestry; Estados UnidosFil: Gross, Nicolás. Universidad Rey Juan Carlos. Escuela Superior de Ciencias Experimentales y Tecnología. Departamento de Biología y Geología, Física y Química Inorgánica; España. Institut Nationale de la Recherche Agronomique; Francia. Université La Rochelle. Centre d’étude biologique de Chizé; FranciaFil: Le Bagousse-Pinguet, Yoann. Universidad Rey Juan Carlos. Escuela Superior de Ciencias Experimentales y Tecnología. Departamento de Biología y Geología, Física y Química Inorgánica; EspañaFil: Quero, José L. Universidad de Córdoba. Escuela Técnica Superior de Ingeniería Agronómica y de Montes. Departamento de Ingeniería Forestal: EspañaFil: García-Gómez, Miguel. Universidad Rey Juan Carlos. Escuela Superior de Ciencias Experimentales y Tecnología. Departamento de Biología y Geología, Física y Química Inorgánica; EspañaFil: Valencia, Enrique. Universidad Rey Juan Carlos. Escuela Superior de Ciencias Experimentales y Tecnología. Departamento de Biología y Geología, Física y Química Inorgánica; EspañaFil: Arredondo, Tulio. Instituto Potosino de Investigación Científica y Tecnológica. División de Ciencias Ambientales; MéxicoFil: Beinticinco, Laura. Universidad Nacional de La Pampa. Facultad de Agronomía; ArgentinaFil: Bran, Donaldo Eduardo. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Bariloche; ArgentinaFil: Cea, Alex. Universidad de La Serena. Departamento de Biología; ChileFil: Coaguila, Daniel. Instituto de Ensino Superior de Rio Verde; BrasilFil: Dougill, Andrew J. University of Leeds. School of Earth and Environment; Gran BretañaFil: Espinosa, Carlos I. Universidad Técnica Particular de Loja. Departamento de Ciencias Naturales; EcuadorFil: Gaitan, Juan Jose. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Suelos; ArgentinaFil: Guuroh, Reginald T. University of Cologne. Botanical Institute. Range Ecology and Range Management Group; Alemania. CSIR-Forestry Research Institute of Ghana; GhanaFil: Guzmán, Elizabeth. Universidad Técnica Particular de Loja. Departamento de Ciencias Naturales; EcuadorFil: Gutiérrez, Julio R.. Universidad de La Serena. Departamento de Biología; Chile. Centro de Estudios Avanzados en Zonas Áridas (CEAZA); Chile. Instituto de Ecología y Biodiversidad; ChileFil: Hernández, Rosa M. Universidad Experimental Simón Rodríguez. Centro de Agroecología Tropical. Laboratorio de Biogeoquímica; VenezuelaFil: Huber-Sannwald, Elisabeth. Instituto Potosino de Investigación Científica y Tecnológica. División de Ciencias Ambientales; MéxicoFil: Jeffries, Thomas. Western Sydney University. Hawkesbury Institute for the Environment; AustraliaFil: Linstädter, Anja. University of Cologne. Botanical Institute. Range Ecology and Range Management Group; AlemaniaFil: Mau, Rebecca L. Northern Arizona University. Center for Ecosystem Science and Society: Estados UnidosFil: Monerris, Jorge. Université du Québec à Montréal. Pavillon des Sciences Biologiques. Département des Sciences Biologiques; CanadáFil: Prina, Anibal. Universidad Nacional de La Pampa. Facultad de Agronomía; ArgentinaFil: Pucheta, Eduardo. Universidad Nacional de San Juan. Facultad de Ciencias Exactas, Físicas y Naturales. Departamento de Biología; ArgentinaFil: Stavi, Ilan. Dead Sea and Arava Science Center, IsraelFil: Thomas, Andrew. Aberystwyth University. Department of Geography and Earth Sciences; Gran BretañaFil: Zaady, Eli. Agricultural Research Organization. Gilat Research Center. Natural Resources; IsraelFil: Singh, Brajesh K. Western Sydney University. Hawkesbury Institute for the Environment; Australia. Western Sydney University. Global Centre for Land-Based Innovation; AustraliaFil: Maestre, Fernando T. Universidad Rey Juan Carlos. Escuela Superior de Ciencias Experimentales y Tecnología. Departamento de Biología y Geología, Física y Química Inorgánica; Españ

Soil fungal abundance and plant functional traits drive fertile island formation in global drylands

International audience1.Dryland vegetation is characterised by discrete plant patches that accumulate and capture soil resources under their canopies. These “fertile islands” are major drivers of dryland ecosystem structure and functioning, yet we lack an integrated understanding of the factors controlling their magnitude and variability at the global scale.2.We conducted a standardized field survey across two hundred and thirty-six drylands from five continents. At each site, we measured the composition, diversity and cover of perennial plants. Fertile island effects were estimated at each site by comparing composite soil samples obtained under the canopy of the dominant plants and in open areas devoid of perennial vegetation. For each sample, we measured fifteen soil variables (functions) associated with carbon, nitrogen and phosphorus cycling and used the Relative Interaction Index to quantify the magnitude of the fertile island effect for each function. In eighty sites, we also measured fungal and bacterial abundance (quantitative PCR) and diversity (Illumina MiSeq).3.The most fertile islands, i.e. those where a higher number of functions were simultaneously enhanced, were found at lower-elevation sites with greater soil pH values and sand content under semiarid climates, particularly at locations where the presence of tall woody species with a low specific leaf area increased fungal abundance beneath plant canopies, the main direct biotic controller of the fertile island effect in the drylands studied. Positive effects of fungal abundance were particularly associated with greater nutrient contents and microbial activity (soil extracellular enzymes) under plant canopies.4.Synthesis. Our results show that the formation of fertile islands in global drylands largely depends on: (i) local climatic, topographic and edaphic characteristics, (ii) the structure and traits of local plant communities and (iii) soil microbial communities. Our study also has broad implications for the management and restoration of dryland ecosystems worldwide, where woody plants are commonly used as nurse plants to enhance the establishment and survival of beneficiary species. Finally, our results suggest that forecasted increases in aridity may enhance the formation of fertile islands in drylands worldwide

Enhanced detection of circulating tumor DNA by fragment size analysis.

Existing methods to improve detection of circulating tumor DNA (ctDNA) have focused on genomic alterations but have rarely considered the biological properties of plasma cell-free DNA (cfDNA). We hypothesized that differences in fragment lengths of circulating DNA could be exploited to enhance sensitivity for detecting the presence of ctDNA and for noninvasive genomic analysis of cancer. We surveyed ctDNA fragment sizes in 344 plasma samples from 200 patients with cancer using low-pass whole-genome sequencing (0.4×). To establish the size distribution of mutant ctDNA, tumor-guided personalized deep sequencing was performed in 19 patients. We detected enrichment of ctDNA in fragment sizes between 90 and 150 bp and developed methods for in vitro and in silico size selection of these fragments. Selecting fragments between 90 and 150 bp improved detection of tumor DNA, with more than twofold median enrichment in >95% of cases and more than fourfold enrichment in >10% of cases. Analysis of size-selected cfDNA identified clinically actionable mutations and copy number alterations that were otherwise not detected. Identification of plasma samples from patients with advanced cancer was improved by predictive models integrating fragment length and copy number analysis of cfDNA, with area under the curve (AUC) >0.99 compared to AUC 0.91 compared to AUC < 0.5 without fragmentation features. Fragment size analysis and selective sequencing of specific fragment sizes can boost ctDNA detection and could complement or provide an alternative to deeper sequencing of cfDNA.We would like to acknowledge the support of The University of Cambridge, Cancer Research UK and the EPSRC (CRUK grant numbers A11906 (NR), A20240 (NR), A22905 (JDB), A15601 (JDB), A25177 (CRUK Cancer Centre Cambridge), A17242 (KMB), A16465 (CRUK-EPSRC Imaging Centre in Cambridge and Manchester)). The research leading to these results has received funding from the European Research Council under the European Union's Seventh Framework Programme (FP/2007-2013) / ERC Grant Agreement n. 337905. The research was supported by the National Institute for Health Research Cambridge, National Cancer Research Network, Cambridge Experimental Cancer Medicine Centre and Hutchison Whampoa Limited. This research is also supported by Target Ovarian Cancer and the Medical Research Council through their Joint Clinical Research Training Fellowship for Dr Moore. The CALIBRATE study was supported by funding from AstraZeneca

Design of a randomized controlled trial for multiple cancer risk behaviors among Spanish-speaking Mexican-origin smokers

Background: Smoking, poor diet, and physical inactivity account for as much as 60% of cancer risk. Latinos experience profound disparities in health behaviors, as well as the cancers associated with them. Currently, there is a dearth of controlled trials addressing these health behaviors among Latinos. Further, to the best of our knowledge, no studies address all three behaviors simultaneously, are culturally sensitive, and are guided by formative work with the target population. Latinos represent 14% of the U. S. population and are the fastest growing minority group in the country. Efforts to intervene on these important lifestyle factors among Latinos may accelerate the elimination of cancer-related health disparities

Expert range maps of global mammal distributions harmonised to three taxonomic authorities

AimComprehensive, global information on species' occurrences is an essential biodiversity variable and central to a range of applications in ecology, evolution, biogeography and conservation. Expert range maps often represent a species' only available distributional information and play an increasing role in conservation assessments and macroecology. We provide global range maps for the native ranges of all extant mammal species harmonised to the taxonomy of the Mammal Diversity Database (MDD) mobilised from two sources, the Handbook of the Mammals of the World (HMW) and the Illustrated Checklist of the Mammals of the World (CMW).LocationGlobal.TaxonAll extant mammal species.MethodsRange maps were digitally interpreted, georeferenced, error-checked and subsequently taxonomically aligned between the HMW (6253 species), the CMW (6431 species) and the MDD taxonomies (6362 species).ResultsRange maps can be evaluated and visualised in an online map browser at Map of Life (mol.org) and accessed for individual or batch download for non-commercial use.Main conclusionExpert maps of species' global distributions are limited in their spatial detail and temporal specificity, but form a useful basis for broad-scale characterizations and model-based integration with other data. We provide georeferenced range maps for the native ranges of all extant mammal species as shapefiles, with species-level metadata and source information packaged together in geodatabase format. Across the three taxonomic sources our maps entail, there are 1784 taxonomic name differences compared to the maps currently available on the IUCN Red List website. The expert maps provided here are harmonised to the MDD taxonomic authority and linked to a community of online tools that will enable transparent future updates and version control

Identification of a BRCA2-Specific modifier locus at 6p24 related to breast cancer risk

Common genetic variants contribute to the observed variation in breast cancer risk for BRCA2 mutation carriers; those known to date have all been found through population-based genome-wide association studies (GWAS). To comprehensively identify breast cancer risk modifying loci for BRCA2 mutation carriers, we conducted a deep replication of an ongoing GWAS discovery study. Using the ranked P-values of the breast cancer associations with the imputed genotype of 1.4 M SNPs, 19,029 SNPs were selected and designed for inclusion on a custom Illumina array that included a total of 211,155 SNPs as part of a multi-consortial project. DNA samples from 3,881 breast cancer affected and 4,330 unaffected BRCA2 mutation carriers from 47 studies belonging to the Consortium of Investigators of Modifiers of BRCA1/2 were genotyped and available for analysis. We replicated previously reported breast cancer susceptibility alleles in these BRCA2 mutation carriers and for several regions (including FGFR2, MAP3K1, CDKN2A/B, and PTHLH) identified SNPs that have stronger evidence of association than those previously published. We also identified a novel susceptibility allele at 6p24 that was inversely associated with risk in BRCA2 mutation carriers (rs9348512; per allele HR = 0.85, 95% CI 0.80-0.90, P = 3.9×10−8). This SNP was not associated with breast cancer risk either in the general population or in BRCA1 mutation carriers. The locus lies within a region containing TFAP2A, which encodes a transcriptional activation protein that interacts with several tumor suppressor genes. This report identifies the first breast cancer risk locus specific to a BRCA2 mutation background. This comprehensive update of novel and previously reported breast cancer susceptibility loci contributes to the establishment of a panel of SNPs that modify breast cancer risk in BRCA2 mutation carriers. This panel may have clinical utility for women with BRCA2 mutations weighing options for medical prevention of breast cancer

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 world’s 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 15–19 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.publishedVersio

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), 13.8–14.4 million) incident T2D cases, representing 70.3% (68.8–71.8%) of new cases globally. Largest T2D burdens were attributable to insufficient whole-grain intake (26.1% (25.0–27.1%)), excess refined rice and wheat intake (24.6% (22.3–27.2%)) and excess processed meat intake (20.3% (18.3–23.5%)). Across regions, highest proportional burdens were in central and eastern Europe and central Asia (85.6% (83.4–87.7%)) and Latin America and the Caribbean (81.8% (80.1–83.4%)); and lowest proportional burdens were in South Asia (55.4% (52.1–60.7%)). 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.publishedVersio