Changes in daily mental health service use and mortality at the commencement and lifting of COVID-19 'lockdown' policy in 10 UK sites: a regression discontinuity in time design.

OBJECTIVES: To investigate changes in daily mental health (MH) service use and mortality in response to the introduction and the lifting of the COVID-19 'lockdown' policy in Spring 2020. DESIGN: A regression discontinuity in time (RDiT) analysis of daily service-level activity. SETTING AND PARTICIPANTS: Mental healthcare data were extracted from 10 UK providers. OUTCOME MEASURES: Daily (weekly for one site) deaths from all causes, referrals and discharges, inpatient care (admissions, discharges, caseloads) and community services (face-to-face (f2f)/non-f2f contacts, caseloads): Adult, older adult and child/adolescent mental health; early intervention in psychosis; home treatment teams and liaison/Accident and Emergency (A&E). Data were extracted from 1 Jan 2019 to 31 May 2020 for all sites, supplemented to 31 July 2020 for four sites. Changes around the commencement and lifting of COVID-19 'lockdown' policy (23 March and 10 May, respectively) were estimated using a RDiT design with a difference-in-difference approach generating incidence rate ratios (IRRs), meta-analysed across sites. RESULTS: Pooled estimates for the lockdown transition showed increased daily deaths (IRR 2.31, 95% CI 1.86 to 2.87), reduced referrals (IRR 0.62, 95% CI 0.55 to 0.70) and reduced inpatient admissions (IRR 0.75, 95% CI 0.67 to 0.83) and caseloads (IRR 0.85, 95% CI 0.79 to 0.91) compared with the pre lockdown period. All community services saw shifts from f2f to non-f2f contacts, but varied in caseload changes. Lift of lockdown was associated with reduced deaths (IRR 0.42, 95% CI 0.27 to 0.66), increased referrals (IRR 1.36, 95% CI 1.15 to 1.60) and increased inpatient admissions (IRR 1.21, 95% CI 1.04 to 1.42) and caseloads (IRR 1.06, 95% CI 1.00 to 1.12) compared with the lockdown period. Site-wide activity, inpatient care and community services did not return to pre lockdown levels after lift of lockdown, while number of deaths did. Between-site heterogeneity most often indicated variation in size rather than direction of effect. CONCLUSIONS: MH service delivery underwent sizeable changes during the first national lockdown, with as-yet unknown and unevaluated consequences

Is speed of healing a good predictor of eventual healing of pyoderma gangrenosum?

Background: Pyoderma gangrenosum is a rare inflammatory skin condition. The STOPGAP studies compared treatments for pyoderma gangrenosum using a primary outcome of healing speed at 6 weeks. Objective: Using data from both studies we assessed the predictive value of three early predictors for healing at 6 months - speed of healing, Investigator Global Assessment and resolution of inflammation, recorded at 2 and 6 weeks. Methods: Logistic regression models were applied and the effectiveness of the three measures was assessed through estimating the positive (PPV) and negative predictive values (NPV) and the area under the receiver operating characteristic curve (AUC). Results: The PPV and NPV at 6 weeks were 63.5% (95% CI:52.4%, 73.7%) and 74.6% (95% CI:62.5%, 84.5%) respectively for speed of healing; 80% (95% CI:68.7%, 88.6%) and 74.2% (95% CI:64.1%, 2.7%) for IGA; and 72.1% (95% CI:59.9%, 82.3%) and 68.1% (95% CI:57.7%, 77.3%) for resolution of inflammation. Investigator Global Assessment had the best combined PPV, NPV and AUC at 2 and 6 weeks. Limitations: We were limited by data available from the STOP GAP trial and cohort study. Conclusion: Speed of healing, Investigator Global Assessment and resolution of inflammation were all shown to be good predictors of eventual healing

“We Used to Say Rats Fell from the Sky After a Flood:” Temporary Recovery of Muskrat Following Ice Jams in the Peace-Athabasca Delta

Elders and Indigenous land users in the Peace-Athabasca Delta (PAD) have observed a dramatic decline in the relative abundance of muskrat in recent decades (~1935–2014). The main explanation for the decline has been reduction in suitable habitat as a result of decades with reduced frequency of ice-jam flooding on the Peace River. Under favourable conditions, ice jams can cause flooding of perched basins within the PAD that would otherwise receive no recharge from floodwaters. To examine whether abundance of muskrat in the PAD is driven by flooding, we tested the predictions that the density of muskrat (estimated by winter counts of houses) (1) was inversely related to the number of years since major ice jam floods and (2) increased with water depth. An ongoing collaborative monitoring program initiated in 2011, combined with analysis of data from past surveys (1973–2015), allowed Indigenous land users and scientists to document a 10 to 100-fold increase in the density of muskrat houses in 24 basins, over the two years following ice-jam flood events in the PAD. During 1973–2015, in the periods between major floods, density of houses dropped by approximately 79% for every year after a significant flood. In 27 basins surveyed from 2011 to 2015, density of muskrat houses increased by two orders of magnitude in the two years following a flood in the spring of 2014. Density of muskrat houses had a non-linear relationship with estimated depth of water at the time of fall freeze-up; the highest densities of muskrat houses were in basins with about 60 – 250 cm of water at the time of freeze-up. The depth of snow at the time of surveys did not have a strong relationship with the density of muskrat houses. However, few houses were counted in basins with more than 20 cm of snow, likely because deeper snow made it more difficult to conduct surveys and spot houses. Factors other than an increase in the depth of water at fall freeze-up may provide the mechanisms by which flooding affects muskrat. Density of muskrat houses is clearly tied to ice-jam flooding in the PAD. However, the local mechanisms by which floods affect muskrat are best understood by Indigenous land users and remain poorly understood by Western science. Indigenous peoples continue to regard muskrat as an indicator of ecological and cultural health of the PAD. This study highlights the value of consistent ecological monitoring that includes Indigenous knowledge.Les aînés et les utilisateurs des terres autochtones du delta des rivières de la Paix et Athabasca ont observé une baisse draconienne de l’abondance du rat musqué au cours des dernières décennies (~1935-2014). La principale explication du déclin est la diminution d’abris convenables, et ce, en raison de plusieurs décennies marquées par la fréquence réduite d’inondations causées par des embâcles dans la rivière de la Paix. Dans des conditions favorables, les embâcles peuvent causer l’inondation des bassins perchés au sein du delta des rivières de la Paix et Athabasca qui autrement ne recevraient pas de recharge des eaux de crue. Afin d’examiner si l’abondance du rat musqué dans le delta des rivières de la Paix et Athabasca est favorisée par les inondations, nous avons testé des prévisions selon lesquelles la densité du rat musqué (estimée par le nombre d’abris en hiver) 1) était inversement liée au nombre d’années depuis les dernières importantes inondations causées par des embâcles et 2) augmentait avec la profondeur de l’eau. Un programme collaboratif de suivi continu lancé en 2011, combiné à l’analyse de données des relevés antérieurs (1973-2015), a permis aux utilisateurs des terres autochtones et aux scientifiques de multiplier de 10 à 100 fois la densité d’abris du rat musqué dans 24 bassins, au cours des deux années suivant des événementsd’inondation causés par des embâcles dans le delta des rivières de la Paix et Athabasca. Entre 1973 et 2015, durant les périodes se situant entre les inondations importantes, la densité d’abris a diminué d’environ 79 % chaque année suivant une inondation importante. Dans 27 bassins sondés entre 2011 et 2015, la densité d’abris du rat musqué a augmenté de deux ordres de grandeur au cours des deux années ayant suivi une inondation survenue au printemps de 2014. La densité d’abris du rat musqué avait une relation non linéaire avec la profondeur de l’eau estimée au moment de la prise des glaces en automne; les plus fortes densités d’abris du rat musqué se trouvaient dans les bassins ayant de 60 à 250 cm d’eau au moment de la prise des glaces. La profondeur de la neige au moment des relevés n’avait pas de relation solide avec la densité d’abris du rat musqué. Cependant, nous avons compté peu d’abris dans les bassins comptant plus de 20 cm de neige, probablement parce qu’il était plus difficile d’effectuer des relevés et de trouver les abris dans la neige plus épaisse. Des facteurs autres que l’augmentation de la profondeur de l’eau au moment de la prise des glaces en automne pourraient fournir les mécanismes par lesquels les inondations se répercutent sur les rats musqués. La densité d’abris du rat musqué est manifestement liée aux inondations causées par des embâcles dans le delta des rivières de la Paix et Athabasca. Toutefois, les utilisateurs des terres autochtones comprennent mieux les mécanismes locaux par lesquels les inondations se répercutent sur les rats musqués, tandis qu’ils demeurent mal compris par la science occidentale. Les peuples autochtones continuent de considérer le rat musqué comme un indicateur de la santé écologique et culturelle du delta des rivières de la Paix et Athabasca. Cette étude fait ressortir la valeur d’un suivi écologique constant qui tient compte des connaissances autochtones

Atheisms and the purification of faith

Philosophers of religion have distinguished between ‘negative’ and ‘positive’ atheism. This article considers further conceptions of atheism, especially the idea that atheism can facilitate a faith in God purified of idolatrous assumptions. After introducing Bultmann’s contention that a ‘conscious atheist’ can find something transcendent in the world, this contention is interpreted through reflection on Ricoeur’s claim that the atheisms of Nietzsche and Freud serve to mediate a transition to a purified faith – a faith involving heightened receptivity to agapeic love. The troubling question of what differentiates atheism from belief in God is then discussed in the light of Simone Weil’s meditations on God’s secret presence

Trait Conscientiousness and the Personality Meta-Trait Stability are Associated with Regional White Matter Microstructure

Establishing the neural bases of individual differences in personality has been an enduring topic of interest. However, while a growing literature has sought to characterize grey matter correlates of personality traits, little attention to date has been focused on regional white matter correlates of personality, especially for the personality traits agreeableness, conscientiousness and openness. To rectify this gap in knowledge we used a large sample (n > 550) of older adults who provided data on both personality (International Personality Item Pool) and white matter tract-specific fractional anisotropy (FA) from diffusion tensor MRI. Results indicated that conscientiousness was associated with greater FA in the left uncinate fasciculus (β = 0.17, P < 0.001). We also examined links between FA and the personality meta-trait ‘stability’, which is defined as the common variance underlying agreeableness, conscientiousness, and neuroticism/emotional stability. We observed an association between left uncinate fasciculus FA and stability (β = 0.27, P < 0.001), which fully accounted for the link between left uncinate fasciculus FA and conscientiousness. In sum, these results provide novel evidence for links between regional white matter microstructure and key traits of human personality, specifically conscientiousness and the meta-trait, stability. Future research is recommended to replicate and address the causal directions of these associations

The genomes of two key bumblebee species with primitive eusocial organization

Background: The shift from solitary to social behavior is one of the major evolutionary transitions. Primitively eusocial bumblebees are uniquely placed to illuminate the evolution of highly eusocial insect societies. Bumblebees are also invaluable natural and agricultural pollinators, and there is widespread concern over recent population declines in some species. High-quality genomic data will inform key aspects of bumblebee biology, including susceptibility to implicated population viability threats. Results: We report the high quality draft genome sequences of Bombus terrestris and Bombus impatiens, two ecologically dominant bumblebees and widely utilized study species. Comparing these new genomes to those of the highly eusocial honeybee Apis mellifera and other Hymenoptera, we identify deeply conserved similarities, as well as novelties key to the biology of these organisms. Some honeybee genome features thought to underpin advanced eusociality are also present in bumblebees, indicating an earlier evolution in the bee lineage. Xenobiotic detoxification and immune genes are similarly depauperate in bumblebees and honeybees, and multiple categories of genes linked to social organization, including development and behavior, show high conservation. Key differences identified include a bias in bumblebee chemoreception towards gustation from olfaction, and striking differences in microRNAs, potentially responsible for gene regulation underlying social and other traits. Conclusions: These two bumblebee genomes provide a foundation for post-genomic research on these key pollinators and insect societies. Overall, gene repertoires suggest that the route to advanced eusociality in bees was mediated by many small changes in many genes and processes, and not by notable expansion or depauperation

The Eat Smart Study: A randomised controlled trial of a reduced carbohydrate versus a low fat diet for weight loss in obese adolescents

Background Despite the recognition of obesity in young people as a key health issue, there is limited evidence to inform health professionals regarding the most appropriate treatment options. The Eat Smart study aims to contribute to the knowledge base of effective dietary strategies for the clinical management of the obese adolescent and examine the cardiometablic effects of a reduced carbohydrate diet versus a low fat diet. Methods and design Eat Smart is a randomised controlled trial and aims to recruit 100 adolescents over a 2½ year period. Families will be invited to participate following referral by their health professional who has recommended weight management. Participants will be overweight as defined by a body mass index (BMI) greater than the 90th percentile, using CDC 2000 growth charts. An accredited 6-week psychological life skills program ‘FRIENDS for Life’, which is designed to provide behaviour change and coping skills will be undertaken prior to volunteers being randomised to group. The intervention arms include a structured reduced carbohydrate or a structured low fat dietary program based on an individualised energy prescription. The intervention will involve a series of dietetic appointments over 24 weeks. The control group will commence the dietary program of their choice after a 12 week period. Outcome measures will be assessed at baseline, week 12 and week 24. The primary outcome measure will be change in BMI z-score. A range of secondary outcome measures including body composition, lipid fractions, inflammatory markers, social and psychological measures will be measured. Discussion The chronic and difficult nature of treating the obese adolescent is increasingly recognised by clinicians and has highlighted the need for research aimed at providing effective intervention strategies, particularly for use in the tertiary setting. A structured reduced carbohydrate approach may provide a dietary pattern that some families will find more sustainable and effective than the conventional low fat dietary approach currently advocated. This study aims to investigate the acceptability and effectiveness of a structured reduced dietary carbohydrate intervention and will compare the outcomes of this approach with a structured low fat eating plan. Trial Registration: The protocol for this study is registered with the International Clinical Trials Registry (ISRCTN49438757)

Redirecting research efforts on the diversification-performance linkage: The search for synergy

We review the literature on the diversification-performance (D-P) relationship to a) propose that the time is ripe for a renewed attack on understanding the relationship between diversification and firm performance, and b) outline a new approach to attacking the question. Our paper makes four main contributions. First, through a review of the literature we establish the inherent complexities in the D-P relationship and the methodological challenges confronted by the literature in reaching its current conclusion of a non-linear relationship between diversification and performance. Second, we argue that to better guide managers the literature needs to develop along a complementary path – whereas past research has often focused on answering the big question of does diversification affect firm performance, this second path would focus more on identifying the precise micro-mechanisms through which diversification adds or subtracts value. Third, we outline a new approach to the investigation of this topic, based on (a) identifying the precise underlying mechanisms through which diversification affects performance; (b) identifying performance outcomes that are “proximate” to the mechanism that the researcher is studying, and (c) identifying an appropriate research design that can enable a causal claim. Finally, we outline a set of directions for future research

Can understanding reward help illuminate anhedonia?

Purpose of review: The goal of this paper is to examine how reward processing might help us understand the symptom of anhedonia. Recent findings: There are extensive reviews exploring the relationship between responses to rewarding stimuli and depression. These often include a discussion on anhedonia and how this might be underpinned in particular by dysfunctional reward processing. However, there is no specific consensus on whether studies to date have adequately examined the various sub-components of reward processing or how these might relate in turn to various aspects of anhedonia symptoms. Summary: The approach to understanding the symptom of anhedonia should be to examine all the sub-components of reward processing at the subjective and objective behavioural and neural level, with well validated tasks that can be replicated. Investigating real life experiences of anhedonia and how theses might be predicted by objective lab measures is also needed in future research