Teaching SBIRT through simulation: Educational case studies from nursing, psychology, social work, and medical residency programs

The prevalence of substance use disorders remains high in the United States and healthcare professionals are largely ill-equipped to intervene with patients experiencing substance misuse or use disorders. To address this issue, substance abuse intervention curricula such as Screening, Brief Intervention, and Referral to Treatment (SBIRT) are being integrated into university healthcare programs through the use of simulation to provide healthcare students with the necessary skills to address patient substance use. Teaching SBIRT with simulation provides students with an authentic clinical environment in which to learn and refine clinical skills. Simulation also supports reflective practice by providing an opportunity for instructors and peers to directly observe and provide feedback on students' patient care. Additionally, students can review (through video recording) and reflect on their own performance within the simulation to build self-awareness and improve their skills and approach to clinical work. This paper describes how SBIRT simulation was integrated into nursing, psychology, and social work curricula at a medium-sized northwest university and a family medicine residency program in the same community. Satisfaction with SBIRT simulation as well as students’ perceived change in confidence in addressing substance use was recorded. Overall, instructors, students, and medical residents were highly satisfied with simulation experiences. Students and medical residents also reported increases in understanding of and confidence in executing SBIRT. Simulation implementation strategies and resources are provided and discussed.Ye

Identification of Pathway-Biased and Deleterious Melatonin Receptor Mutants in Autism Spectrum Disorders and in the General Population

Melatonin is a powerful antioxidant and a synchronizer of many physiological processes. Alteration of the melatonin pathway has been reported in circadian disorders, diabetes and autism spectrum disorders (ASD). However, very little is known about the genetic variability of melatonin receptors in humans. Here, we sequenced the melatonin receptor MTNR1A and MTNR1B, genes coding for MT1 and MT2 receptors, respectively, in a large panel of 941 individuals including 295 patients with ASD, 362 controls and 284 individuals from different ethnic backgrounds. We also sequenced GPR50, coding for the orphan melatonin-related receptor GPR50 in patients and controls. We identified six non-synonymous mutations for MTNR1A and ten for MTNR1B. The majority of these variations altered receptor function. Particularly interesting mutants are MT1-I49N, which is devoid of any melatonin binding and cell surface expression, and MT1-G166E and MT1-I212T, which showed severely impaired cell surface expression. Of note, several mutants possessed pathway-selective signaling properties, some preferentially inhibiting the adenylyl cyclase pathway, others preferentially activating the MAPK pathway. The prevalence of these deleterious mutations in cases and controls indicates that they do not represent major risk factor for ASD (MTNR1A case 3.6% vs controls 4.4%; MTNR1B case 4.7% vs 3% controls). Concerning GPR50, we detected a significant association between ASD and two variations, Δ502–505 and T532A, in affected males, but it did not hold up after Bonferonni correction for multiple testing. Our results represent the first functional ascertainment of melatonin receptors in humans and constitute a basis for future structure-function studies and for interpreting genetic data on the melatonin pathway in patients

Biogeochemical and ecological impacts of boundary currents in the Indian Ocean

Monsoon forcing and the unique geomorphology of the Indian Ocean basin result in complex boundary currents, which are unique in many respects. In the northern Indian Ocean, several boundary current systems reverse seasonally. For example, upwelling coincident with northward-flowing currents along the coast of Oman during the Southwest Monsoon gives rise to high productivity which also alters nutrient stoichiometry and therefore, the species composition of the resulting phytoplankton blooms. During the Northeast Monsoon most of the northern Indian Ocean boundary currents reverse and favor downwelling. Higher trophic level species have evolved behavioral responses to these seasonally changing conditions. Examples from the western Arabian Sea include vertical feeding migrations of a copepod (Calanoides carinatus) and the reproductive cycle of a large pelagic fish (Scomberomorus commerson). The impacts of these seasonal current reversals and changes in upwelling and downwelling circulations are also manifested in West Indian coastal waters, where they influence dissolved oxygen concentrations and have been implicated in massive fish kills. The winds and boundary currents reverse seasonally in the Bay of Bengal, though the associated changes in upwelling and productivity are less pronounced. Nonetheless, their effects are observed on the East Indian shelf as, for example, seasonal changes in copepod abundance and zooplankton community structure. In contrast, south of Sri Lanka seasonal reversals in the boundary currents are associated with dramatic changes in the intensity of coastal upwelling, chlorophyll concentration, and catch per unit effort of fishes. Off the coast of Java, monsoon-driven changes in the currents and upwelling strongly impact chlorophyll concentrations, seasonal vertical migrations of zooplankton, and sardine catch in Bali Strait. In the southern hemisphere the Leeuwin is a downwelling-favorable current that flows southward along western Australia, though local wind forcing can lead to transient near shore current reversals and localized coastal upwelling. The poleward direction of this eastern boundary current is unique. Due to its high kinetic energy the Leeuwin Current sheds anomalous, relatively high chlorophyll, warm-core, downwelling eddies that transport coastal diatom communities westward into open ocean waters. Variations in the Leeuwin transport and eddy generation impact many higher trophic level species including the recruitment and fate of rock lobster (Panulirus cygnus) larvae. In contrast, the transport of the Agulhas Current is very large, with sources derived from the Mozambique Channel, the East Madagascar Current and the southwest Indian Ocean sub-gyre. Dynamically, the Agulhas Current is upwelling favorable; however, the spatial distribution of prominent surface manifestations of upwelling is controlled by local wind and topographic forcing. Meanders and eddies in the Agulhas Current propagate alongshore and interact with seasonal changes in the winds and topographic features. These give rise to seasonally variable localized upwelling and downwelling circulations with commensurate changes in primary production and higher trophic level responses. Due to the strong influence of the Agulhas Current, many neritic fish species in southeast Africa coastal waters have evolved highly selective behaviors and reproductive patterns for successful retention of planktonic eggs and larvae. For example, part of the Southern African sardine (Sardinops sagax) stock undergoes a remarkable northward migration enhanced by transient cyclonic eddies in the shoreward boundary of the Agulhas Current. There is evidence from the paleoceanographic record that these currents and their biogeochemical and ecological impacts have changed significantly over glacial to interglacial timescales. These changes are explored as a means of providing insight into the potential impacts of climate change in the Indian Ocean

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Change detection for update of topographic databases through multi-level region-based classification of VHR optical and SAR data

The geographic database producers need improved and faster updating methods for their topographic databases to fulfil the user's demand. In this context, change detection methods using remotely sensed data are interesting tools applicable on wide areas and are less demanding for human work. Indeed, database update is currently mainly realized through a tedious and laborious photogrammetric restitution. The objective of this study is to compare built-up and roads extracted with a hierarchical region-based classification method (Definiens) from VHR optical and SAR data to the ones of an old geographic database in order to pinpoint changes. Simulation of PLEIADES data on Toulouse at a resolution of 0.7m in the panchromatic band and 2.8m in the multispectral one are used together with a DSM derived from SAR Cosmo-Skymet data. The NGI-France Topo-Pays database is generalised to map 5 classes: building, road, vegetation, water and other. Their outline is used as a first level during the segmentation process; the objects of the database are then subdivided according to their spectral homogeneity. This procedure allows the use of the database as prior knowledge and avoids objects matching between detected and database objects to map changes. Data are classified with a hierarchical scheme into 5 classes using spectral thresholds and the nearest neighbour algorithm. The results show that the use of the DSM in the classification process allows a better accuracy in the change detection process.SCOPUS: cp.pinfo:eu-repo/semantics/publishe

Change detection for updates of vector databases through multi-level region- based classification of VHR data: CHADE, final report.

info:eu-repo/semantics/publishe

Urban development and population estimation in central Africa through remote sensing

info:eu-repo/semantics/publishe

Local authorities’ obligations about monitoring of urban and green areas: contribution of Very High Resolution images

Local authorities adapt regularly their land policy and land management tools, in order to control urban evolution or to integrate environment protection measures for example. To achieve the diagnostic of the situation and to follow up the effectiveness of the policies, an inventory of the current landuse/cover at local to regional scale is needed for both urban changes and green network management. Remote sensing methods using VHR imagery can help authorities to achieve this integrated multi-scale landuse coverage.info:eu-repo/semantics/publishe

Une macro-géographie du commerce de détail en Belgique

Cet article analyse une nouvelle source, issue d'un inventaire de terrain exhaustif. Il confirme que la Belgique est dotée d'un équipement commercial très dense par comparaison aux pays d'Europe du nord-ouest. Il présente les types de commerces les plus fréquents, ceux qui comptent le plus d'enseignes, les plus grands et les plus petits en surface moyenne. La densité commerciale par codes postaux est cartographiée et les variations spatiales de la structure commerciale sont analysées au moyen d'une analyse en composantes principales et d'une typologie. Les résultats sont comparés à la hiérarchie urbaine. Le rôle du pouvoir d'achat et du tourisme est mis en avant, comme le développement des centres commerciaux et zones d'activités commerciales.<br>Thisarticleanalyzesanew source, followingacomprehensivefield inventory. ItconfirmsthatBelgiumhasadensecommercial equipmentcomparedto the countries of northwestern Europe. Itpresentsthemostnumerous types ofretail, those with the mostbanners, the largestandthe smallestinaverage size. Thecommercial densitybypostal codeis mappedandthe spatial variationsofthe commercial structureareanalyzedusingaprincipal components analysisandatypology. Theresultsarecomparedwiththe urban hierarchy.Theroleofpurchasing powerandtourismishighlightedasthedevelopment ofshopping centersandretail areas