Koori voices: Self-harm, suicide attempts, arrests and substance use among Aboriginal and Torres Strait Islander adolescents following residential treatment

Background: Complex interacting social, economic and historical factors influence the availability and uptake of alcohol and drugs, including among Indigenous communities. Self-harm and suicide as well as homelessness and incarceration, can both precede and result from drug and alcohol use. Rates of self-harm, suicide and incarceration among Aboriginal and Torres Strait Islander people in Australia are among the highest in the world and drug and alcohol treatment programs need to address these underlying complexities. This study examines whether an 'holistic' residential drug and alcohol treatment program for adolescents, with over 30% of clients identifying as Aboriginal and Torres Strait Islander, can improve outcomes post-discharge, including reducing self-harm, suicide attempts, arrests and alcohol and drug use. The program addresses substance use, mental health, employment, accommodation, social/community and family life. Program admission and 3 months' post-discharge data from 2007 to 2016 were analysed. Results: From 2007 to 2016, 619 Aboriginal and Torres Strait Islander young people were admitted to the program; 247 stayed in the program for 30 days or more; 89 were successfully followed up three months post-discharge to determine whether there was a significant improvement from baseline using the McNemar's Test and the Wilcoxon Signed Ranks Test. On admission, 18 people (20%) of the study population reported attempting suicide in the last 3 months and 23 people (30%) reported self-harm. Most had been engaged in the criminal justice system, with 67 people (75%) having been to court and 62 people (70%) arrested one or more times in the past 3 months, with 35 people (41%) in unstable housing, reporting having lived in three or more places in the previous 6 months. At 3 months post-treatment, all (n = 18) who reported suicide attempts in the 3 months prior to admission reported no attempts in the prior 3 months at follow-up. There was also a significant reduction in self-harm with 23 young people out of the 27 who reported self-harm at baseline not reporting self-harm at follow up (85%) and in the proportion of adolescents who reported using cannabis, amphetamines and alcohol, as well as a reduction in the proportion who reported being arrested. Conclusions: The findings provide support for an 'holistic' residential treatment program as an approach to improve health and related outcomes for Aboriginal and Torres Strait Islander young people. In addition to a focus on multiple aspects of a young person's life in treatment, culturally relevant modes of treatment and support should be a future focus to further strengthen programs when Aboriginal and Torres Strait Islander young people are over-represented in the client group

Mortality among young people seeking residential treatment for problematic drug and alcohol use: A data linkage study.

Background Young people with problematic alcohol and other drug (AOD) use are often referred to residential treatment. Subsequent mortality rates among this high-risk group is not known. This study estimates mortality rates and determines causes of death amongst young people referred to residential treatment in Sydney, Australia. Design Retrospective data linkage study. Data of young people (13–18 years) referred to a residential treatment service 2001–2015 (n = 3256) linked with Australian death registration data, and followed up to 16 years (2001–2016). Methods Mortality rates (CMRs) and standardised mortality ratios (SMRs, age-, gender-, calendar-year-adjusted) calculated using population mortality rates. Causes of death were analysed using ICD-10 codes for AOD-induced, AOD as contributory and non-AOD related causes. Results During follow-up of the cohort (28,838 person-years), 63 people died (71.4 % males; 48 % Indigenous; median age at death = 21.9 years; median follow-up = 5.1years), with 76 % dying before aged 25 years. Overall mortality (SMR = 4.91, 95 % CI: 3.8−6.2; CMR = 2.18/1000 person-years, 95 % CI: 1.7−2.8) was significantly higher than age-gender-matched general population, particularly in females (SMR = 9.55; males: SMR = 4.11; RR: 2.3, 95 % CI: 1.3–4.1). SMRs were not significantly different between treatment groups (SMRs>5.5) and non-attend group (SMR = 3.7) (p = 0.359). Two-thirds of deaths involved AOD, with AOD-induced deaths comprising 42 % and AOD as contributory for 22 % deaths. Overdose, mainly opioids (including opiates), suicide, and transport accidents were major causes of deaths. Conclusion Very high mortality rates, particularly among females, and the high incidence of overdose and suicide emphasise early screening for those at high-risk, targeted and culturally appropriate interventions, and maximised continuing after-care accessible to young people

Landscape Features Affecting Northern Bobwhite Predator-Specific Nest Failures in Southeastern USA

Nest predation is a critical component in avian productivity and typically is the leading cause of nest failure for most birds. Several landscape features are thought to drive the behavioral interaction between northern bobwhite (Colinus virginianus; e.g., nest placement) and their predators (e.g., search methods for food acquisition). In order to understand habitat characteristics influencing predation, we studied bobwhite nests using 24-hour near-infrared video cameras. We monitored 675 bobwhite nests with cameras on 3 properties in northern Florida and southern Georgia, USA, during 2000–2006. To test the association between nest failures and specific failure causes with landscape structure, we calculated a suite of landscape metrics and examined these at 3 spatial scales (3.1 ha, 19.6 ha, and 50.3 ha). We found increased probability of nest success with greater proportions of, and proximity to, fallow and annually disked fields at larger scales (50.3 ha), but we found no landscape metrics to be important predictors of bobwhite nest failures at small scales (,20 ha). Fallow and disked fields may provide alternative prey items (e.g., rodents) important in buffering nest predation. Relative to meso-mammal predation, we observed increases in proportion of the landscape in field to be related to lower incidental nest failures at the smallest scale (3.1 ha). Nests closer to feed lines were more likely depredated by meso-mammals than ants at the 2 larger spatial scales. Interestingly, the fate of a nest was independent of the fate of neighboring nests, suggesting bobwhite nest predation may be primarily incidental

Landscape Features Affecting Northern Bobwhite Predator-Specific Nest Failures in Southeastern USA

Nest predation is a critical component in avian productivity and typically is the leading cause of nest failure for most birds. Several landscape features are thought to drive the behavioral interaction between northern bobwhite (Colinus virginianus; e.g., nest placement) and their predators (e.g., search methods for food acquisition). In order to understand habitat characteristics influencing predation, we studied bobwhite nests using 24-hour near-infrared video cameras. We monitored 675 bobwhite nests with cameras on 3 properties in northern Florida and southern Georgia, USA, during 2000–2006. To test the association between nest failures and specific failure causes with landscape structure, we calculated a suite of landscape metrics and examined these at 3 spatial scales (3.1 ha, 19.6 ha, and 50.3 ha). We found increased probability of nest success with greater proportions of, and proximity to, fallow and annually disked fields at larger scales (50.3 ha), but we found no landscape metrics to be important predictors of bobwhite nest failures at small scales (\u3c20 \u3eha). Fallow and disked fields may provide alternative prey items (e.g., rodents) important in buffering nest predation. Relative to meso-mammal predation, we observed increases in proportion of the landscape in field to be related to lower incidental nest failures at the smallest scale (3.1 ha). Nests closer to feed lines were more likely depredated by meso-mammals than ants at the 2 larger spatial scales. Interestingly, the fate of a nest was independent of the fate of neighboring nests, suggesting bobwhite nest predation may be primarily incidental

Comprehensive Dissection of PDGF-PDGFR Signaling Pathways in PDGFR Genetically Defined Cells

Despite the growing understanding of PDGF signaling, studies of PDGF function have encountered two major obstacles: the functional redundancy of PDGFRα and PDGFRβ in vitro and their distinct roles in vivo. Here we used wild-type mouse embryonic fibroblasts (MEF), MEF null for either PDGFRα, β, or both to dissect PDGF-PDGFR signaling pathways. These four PDGFR genetically defined cells provided us a platform to study the relative contributions of the pathways triggered by the two PDGF receptors. They were treated with PDGF-BB and analyzed for differential gene expression, in vitro proliferation and differential response to pharmacological effects. No genes were differentially expressed in the double null cells, suggesting minimal receptor-independent signaling. Protean differentiation and proliferation pathways are commonly regulated by PDGFRα, PDGFRβ and PDGFRα/β while each receptor is also responsible for regulating unique signaling pathways. Furthermore, some signaling is solely modulated through heterodimeric PDGFRα/β

Next-Generation Sequencing of Crown and Rhizome Transcriptome from an Upland, Tetraploid Switchgrass

The crown and rhizome transcriptome of an upland tetraploid switchgrass cultivar cv Summer well adapted to the upper Midwest was investigated using the Roche 454-FLX pyrosequencing platform. Overall, approximately one million reads consisting of 216 million bases were assembled into 27,687 contigs and 43,094 singletons. Analyses of these sequences revealed minor contamination with non-plant sequences (\u3c 0.5%), indicating that a majority were for transcripts coded by the switchgrass genome. Blast2Gos comparisons resulted in the annotation of ~65% of the contig sequences and ~40% of the singleton sequences. Contig sequences were mostly homologous to other plant sequences, dominated by matches to Sorghum bicolor genome. Singleton sequences, while displaying significant matches to S. bicolor, also contained sequences matching non-plant species. Comparisons of the 454 dataset to existing EST collections resulted in the identification of 30,177 new sequences. These new sequences coded for a number of different proteins and a selective analysis of two categories, namely, peroxidases and transcription factors, resulted in the identification of specific peroxidases and a number of low-abundance transcription factors expected to be involved in chromatin remodeling. KEGG maps for glycolysis and sugar metabolism showed high levels of transcript coding for enzymes involved in primary metabolism. The assembly provided significant insights into the status of these tissues and broadly indicated that there was active metabolism taking place in the crown and rhizomes at post-anthesis, the seed maturation stage of plant development

Early Detection of Poor Adherers to Statins: Applying Individualized Surveillance to Pay for Performance

Background: Medication nonadherence costs $300 billion annually in the US. Medicare Advantage plans have a financial incentive to increase medication adherence among members because the Centers for Medicare and Medicaid Services (CMS) now awards substantive bonus payments to such plans, based in part on population adherence to chronic medications. We sought to build an individualized surveillance model that detects early which beneficiaries will fall below the CMS adherence threshold. Methods: This was a retrospective study of over 210,000 beneficiaries initiating statins, in a database of private insurance claims, from 2008-2011. A logistic regression model was constructed to use statin adherence from initiation to day 90 to predict beneficiaries who would not meet the CMS measure of proportion of days covered 0.8 or above, from day 91 to 365. The model controlled for 15 additional characteristics. In a sensitivity analysis, we varied the number of days of adherence data used for prediction. Results: Lower adherence in the first 90 days was the strongest predictor of one-year nonadherence, with an odds ratio of 25.0 (95% confidence interval 23.7-26.5) for poor adherence at one year. The model had an area under the receiver operating characteristic curve of 0.80. Sensitivity analysis revealed that predictions of comparable accuracy could be made only 40 days after statin initiation. When members with 30-day supplies for their first statin fill had predictions made at 40 days, and members with 90-day supplies for their first fill had predictions made at 100 days, poor adherence could be predicted with 86% positive predictive value. Conclusions: To preserve their Medicare Star ratings, plan managers should identify or develop effective programs to improve adherence. An individualized surveillance approach can be used to target members who would most benefit, recognizing the tradeoff between improved model performance over time and the advantage of earlier detection

Paediatric radiology seen from Africa. Part I: providing diagnostic imaging to a young population

Article approval pendingPaediatric radiology requires dedicated equipment, specific precautions related to ionising radiation, and specialist knowledge. Developing countries face difficulties in providing adequate imaging services for children. In many African countries, children represent an increasing proportion of the population, and additional challenges follow from extreme living conditions, poverty, lack of parental care, and exposure to tuberculosis, HIV, pneumonia, diarrhoea and violent trauma. Imaging plays a critical role in the treatment of these children, but is expensive and difficult to provide. The World Health Organisation initiatives, of which the World Health Imaging System for Radiography (WHIS-RAD) unit is one result, needs to expand into other areas such as the provision of maintenance servicing. New initiatives by groups such as Rotary and the World Health Imaging Alliance to install WHIS-RAD units in developing countries and provide digital solutions, need support. Paediatric radiologists are needed to offer their services for reporting, consultation and quality assurance for free by way of teleradiology. Societies for paediatric radiology are needed to focus on providing a volunteer teleradiology reporting group, information on child safety for basic imaging, guidelines for investigations specific to the disease spectrum, and solutions for optimising imaging in children

Multi-PheWAS intersection approach to identify sex differences across comorbidities in 59 140 pediatric patients with autism spectrum disorder

[EN] Objective: To identify differences related to sex and define autism spectrum disorder (ASD) comorbidities female-enriched through a comprehensive multi-PheWAS intersection approach on big, real-world data. Although sex difference is a consistent and recognized feature of ASD, additional clinical correlates could help to identify potential disease subgroups, based on sex and age. Materials and Methods: We performed a systematic comorbidity analysis on 1860 groups of comorbidities exploring all spectrum of known disease, in 59 140 individuals (11 440 females) with ASD from 4 age groups. We explored ASD sex differences in 2 independent real-world datasets, across all potential comorbidities by comparing (1) females with ASD vs males with ASD and (2) females with ASD vs females without ASD. Results: We identified 27 different comorbidities that appeared significantly more frequently in females with ASD. The comorbidities were mostly neurological (eg, epilepsy, odds ratio [OR]>1.8, 3-18 years of age), congenital (eg, chromosomal anomalies, OR>2, 3-18 years of age), and mental disorders (eg, intellectual disability, OR>1.7, 6-18 years of age). Novel comorbidities included endocrine metabolic diseases (eg, failure to thrive, OR=2.5, ages 0-2), digestive disorders (gastroesophageal reflux disease: OR=1.7, 6-11 years of age; and constipation: OR>1.6, 3-11 years of age), and sense organs (strabismus: OR>1.8, 3-18 years of age). Discussion: A multi-PheWAS intersection approach on real-world data as presented in this study uniquely contributes to the growing body of research regarding sex-based comorbidity analysis in ASD population. Conclusions: Our findings provide insights into female-enriched ASD comorbidities that are potentially important in diagnosis, as well as the identification of distinct comorbidity patterns influencing anticipatory treatment or referrals.This work has been supported by the National Institutes of Health BD2K grant U54HG007963. JMZ received grants from Stichting de Drie Lichten and Stichting Sophia Kinderziekenhuis Fonds for a research internship at Harvard Medical School.Gutiérrez-Sacristán, A.; Sáez Silvestre, C.; De Niz, C.; Jalali, N.; Desain, TN.; Kumar, R.; Zachariasse, JM.... (2021). Multi-PheWAS intersection approach to identify sex differences across comorbidities in 59 140 pediatric patients with autism spectrum disorder. Journal of the American Medical Informatics Association. 29(2):230-238. https://doi.org/10.1093/jamia/ocab14423023829