The long-term relationship between cannabis and heroin use:An 18-20-year follow-up of the Australian Treatment Outcome Study (ATOS)

Objective: Cannabis use is common among those with opioid use disorders (OUD), but it remains unclear whether cannabis use is associated with an increase or reduction in illicit opioid use. To extend upon previous longitudinal studies with limited follow-ups, the current study examined a within-person reciprocal relationship between cannabis and heroin use at several follow-ups over 18-20-years. Methods: The Australian Treatment Outcome Study (ATOS) recruited 615 people with heroin dependence in 2001-2002 and reinterviewed at 3-, 12-, 24-, 36-months, 11 and 18-20-years post-baseline. Heroin and cannabis use were assessed at each time point using the Opiate Treatment Index (OTI). A random intercept cross-lagged panel model (RI-CLPM) was conducted to identify within-person relationships between cannabis use and heroin use at subsequent follow-ups. Results: After accounting for a range of demographic, other substance use, mental and physical health measures, an increase in cannabis use at 24-months was associated with an increase in heroin use at 36months (Estimate = 0.21, SE = 0.10, p = 0.03). Additionally, an increase in heroin use at 3-months and 24-months post-baseline was associated with a decrease in cannabis use at 12-months (Estimate = -0.27, SE = 0.09, p <0.01) and 36-months post-baseline (Estimate = -0.22, SE = 0.08, p <0.01). All other cross-lagged associations were not significant. Conclusions: Although there was some evidence of a significant relationship between cannabis and heroin use at earlier follow-ups, this was sparse, and inconsistent across time-points. Overall, there was insufficient evidence to suggest a unidirectional or bidirectional relationship between the use of these substances

Do primate action plans work?

John Oates authored the first primate conservation Action Plan in 1986, which assessed the status of and proposed conservation actions for all mainland African primate species. A revised version of the continent-wide plan was published in 1996, but since then, action plans have generally evolved into prioritizing actions for specific species, often within defined landscapes. We will review and evaluate the content and success of conservation action plans for the nine currently recognized taxa of chimpanzees and gorillas in Africa. Since 2003, six detailed action plans and one population viability analysis have been published, covering priority actions and landscapes for seven of the nine great ape taxa in Africa. Two further action plans (for gorillas and chimpanzees in Eastern DRC and for bonobos) are in the final stages of review and may also be included in the analysis. Assessments for western chimpanzees, Cross River gorillas, western lowland gorillas and central chimpanzees have been peer reviewed, and we will consider their recommendations and the challenges of quantitatively evaluating the success of primate conservation action plans

The DRESS trial: a feasibility randomized controlled trial of a neuropsychological approach to dressing therapy for stroke inpatients

Objective: To investigate two approaches to treating patients with persistent dressing problems and cognitive difficulties following stroke. Design: Pilot randomized controlled trial. Setting: Inpatient stroke rehabilitation service. Subjects: Seventy consecutive stroke patients with persistent dressing problems and accompanying cognitive difficulties at two weeks after their stroke. Interventions: Patients were randomly allocated to six weeks of either a systematic neuropsychological approach, based on analysis of dressing problems and further cognitive testing, or to the control group who received conventional (functional) dressing practice. Both groups received treatment three times a week in accordance with two separately prepared manuals. Main measures: Nottingham Stroke Dressing Assessment (NSDA), Line Cancellation, 10-hole peg transfer test, Object Decision, Gesture Imitation. Patients were assessed at six weeks after randomization by an independent assessor masked to group allocation. Results: Both neuropsychological and functional groups improved performance on the NSDA over the treatment period (31% and 22%, respectively) but there was no significant difference between groups at six weeks. However, the neuropsychological group showed a significantly greater improvement on a line cancellation test of visual neglect (t(62) = 2.1, P < 0.05) and a planned subanalysis for those with right hemisphere damage showed a trend towards better dressing outcome (P = 0.07, one-tailed). Conclusions: Results demonstrate the potential benefits of a systematic neuropsychological approach to dressing therapy, particularly for patients with right hemisphere damage. This study suggests the need for a phase III study evaluating the efficacy of a systematic neuropsychological approach in treating dressing difficulties, targeting patients with right hemisphere stroke and visuospatial impairments

Women, wellbeing and Wildlife Management Areas in Tanzania

Community-based wildlife management claims pro-poor, gender-sensitive outcomes. However, intersectional political ecology predicts adverse impacts on marginalised people. Our large-scale quantitative approach draws out common patterns and differentiated ways women are affected by Tanzania’s Wildlife Management Areas (WMAs). This first large-scale, rigorous evaluation studies WMA impacts on livelihoods and wellbeing of 937 married women in 42 villages across six WMAs and matched controls in Northern and Southern Tanzania. While WMAs bring community infrastructure benefits, most women have limited political participation, and experience resource use restrictions and fear of wildlife attacks. Wealth and region are important determinants, with the poorest worst impacted

Regional Action Plan for the Conservation of the Nigeria–Cameroon Chimpanzee (Pan troglodytes ellioti)

First paragraph: This document represents the consensus of views from forestry and wildlife conservation agencies in Nigeria and Cameroon, local and international nongovernmental conservation organizations, and university-based researchers who met at a series of workshops in Cameroon and Nigeria to formulate a set of actions that, if implemented, will increase the longterm survival prospects of the Nigeria-Cameroon chimpanzee, Pan troglodytes ellioti. The Nigeria-Cameroon chimpanzee is the most endangered of all currently recognized chimpanzee subspecies, with a total remaining population of between 3,500 and 9,000 living in forested habitat to the north of the Sanaga River in Cameroon, the eastern edge of Nigeria, and in forest fragments in the Niger Delta and southwestern Nigeri

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Les progrès dans la réalisation de la classification quantitative de la psychopathologie

Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad "spectrum level'' dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the "problem of comorbidity'' by explicitly modeling patterns of co-occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach. (C) 2020 Published by Elsevier Masson SAS

Para-infectious brain injury in COVID-19 persists at follow-up despite attenuated cytokine and autoantibody responses

To understand neurological complications of COVID-19 better both acutely and for recovery, we measured markers of brain injury, inflammatory mediators, and autoantibodies in 203 hospitalised participants; 111 with acute sera (1–11 days post-admission) and 92 convalescent sera (56 with COVID-19-associated neurological diagnoses). Here we show that compared to 60 uninfected controls, tTau, GFAP, NfL, and UCH-L1 are increased with COVID-19 infection at acute timepoints and NfL and GFAP are significantly higher in participants with neurological complications. Inflammatory mediators (IL-6, IL-12p40, HGF, M-CSF, CCL2, and IL-1RA) are associated with both altered consciousness and markers of brain injury. Autoantibodies are more common in COVID-19 than controls and some (including against MYL7, UCH-L1, and GRIN3B) are more frequent with altered consciousness. Additionally, convalescent participants with neurological complications show elevated GFAP and NfL, unrelated to attenuated systemic inflammatory mediators and to autoantibody responses. Overall, neurological complications of COVID-19 are associated with evidence of neuroglial injury in both acute and late disease and these correlate with dysregulated innate and adaptive immune responses acutely