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Stroke is a major cause of lasting disability worldwide. Virtual reality (VR) training has been introduced as a means of increasing the effectiveness of rehabilitation by providing large doses of task-related training with many repetitions and different modes of feedback. As VR is increasingly used in neurorehabilitation, cost considerations are important.
A cost-analysis was conducted based on the Virtual Reality for Upper Extremity in Subacute stroke (VIRTUES) trial, a recent international randomized controlled observer-blind multicenter trial. Average therapist time required per therapy session may differ between VR and conventional training (CT), leading to potential cost savings due to a therapist being able to supervise more than one patient at a time. Exploratory cost analyses are presented to explore such assumptions.
Based on our calculations, VR incurs extra costs as compared with CT when the same amount of therapist contact is provided, as was the case in VIRTUES. However, the exploratory analyses demonstrated that these costs may be rapidly counterbalanced when time for therapist supervision can be reduced.
Extra costs for VR can be outweighed by reduced therapist time and decreasing VR system costs in the nearer future, and not least by increased patient motivation.
Review findings on the role of dietary patterns in preventing depression are inconsistent, possibly due to variation in assessment of dietary exposure and depression. We studied the association between dietary patterns and depressive symptoms in six population-based cohorts and meta-analysed the findings using a standardised approach that defined dietary exposure, depression assessment and covariates.
Included were cross-sectional data from 23 026 participants in six cohorts: InCHIANTI (Italy), LASA, NESDA, HELIUS (the Netherlands), ALSWH (Australia) and Whitehall II (UK). Analysis of incidence was based on three cohorts with repeated measures of depressive symptoms at 5–6 years of follow-up in 10 721 participants: Whitehall II, InCHIANTI, ALSWH. Three a priori dietary patterns, Mediterranean diet score (MDS), Alternative Healthy Eating Index (AHEI-2010), and the Dietary Approaches to Stop Hypertension (DASH) diet were investigated in relation to depressive symptoms. Analyses at the cohort-level adjusted for a fixed set of confounders, meta-analysis used a random-effects model.
Cross-sectional and prospective analyses showed statistically significant inverse associations of the three dietary patterns with depressive symptoms (continuous and dichotomous). In cross-sectional analysis, the association of diet with depressive symptoms using a cut-off yielded an adjusted OR of 0.87 (95% confidence interval 0.84–0.91) for MDS, 0.93 (0.88–0.98) for AHEI-2010, and 0.94 (0.87–1.01) for DASH. Similar associations were observed prospectively: 0.88 (0.80–0.96) for MDS; 0.95 (0.84–1.06) for AHEI-2010; 0.90 (0.84–0.97) for DASH.
Population-scale observational evidence indicates that adults following a healthy dietary pattern have fewer depressive symptoms and lower risk of developing depressive symptoms.
of this study was to examine the Twitter experiences and networks of six adults with cognitive-communication disability after a traumatic brain injury (TBI).
Using mixed methods, the study integrated: (a) quantitative analysis of Twitter networks using computational and manual coding of tweets; and (b) narrative analysis of in-depth interviews.
Diverse experiences were evident, with two experienced and four novice users of the platform. However, all reported feeling connected and included, and identified both positive and negative experiences in their use of Twitter. Developing a supportive network facilitated higher frequency of tweets and increased feelings of enjoyment and connectedness. All expressed a desire to continue using or learning to use Twitter but novices lacked support from rehabilitation professionals or experienced Twitter users, and relied instead on a “trial and error” approach.
Proactive integration of Twitter use during rehabilitation after TBI is warranted to support safe, enjoyable, and meaningful use.
Background: A previous clinical trial of training communication partners of people with traumatic brain injury (TBI) demonstrated positive outcomes [Togher, Power, McDonald, Tate, & Rietdijk (2009). Brain Impairment, 10(2), 188-204]. Adapting communication partner training for delivery via telehealth could improve access to this intervention.
Objectives: To compare outcomes across in-person communication partner training, telehealth communication partner training and a control group
Method: Protocol for a partially randomised controlled trial. People with moderate-severe TBI will be allocated to either an in-person or telehealth-based training program. Comparison data will be drawn from the original trial control group, which was recruited using the same eligibility criteria as this protocol. Outcomes after training will be compared between the in-person training group, the telehealth training group and the historical control group.
Discussion: This protocol uses specific design features with the aim of maximising the study’s power, including a partially randomised allocation process and a historical control group. The results will inform about the feasibility and effectiveness of delivering TBI rehabilitation via telehealth.
Trial registration: Australian and New Zealand Clinical Trials Registry: ACTRN12615001024538.
Early life maltreatment (ELM), borderline personality disorder (BPD), and major depressive disorder (MDD) have been associated with empathy deficits in different domains. Lack of maternal empathy has also been related to child behavioral problems. As ELM, BPD, and MDD often co-occur, we aimed to identify dissociable effects on empathy due to these three factors. In addition, we aimed to investigate their indirect effects via empathy on child psychopathology.
We included 251 mothers with and without MDD (in remission), BPD and ELM and their children, aged 5–12. We used the Interpersonal Reactivity Index as a measure of empathy on four different dimensions (personal distress, empathic concern, perspective taking, and fantasy) and the Child Behavior Checklist as a measure of child psychopathology.
Having included all three factors (ELM, MDD, BPD) in one analysis, we found elevated personal distress in MDD and BPD, and lower levels of perspective-taking in BPD, but no effects from ELM on any empathy subscales. Furthermore, we found indirect effects from maternal BPD and MDD on child psychopathology, via maternal personal distress.
The present study demonstrated the dissociable effects of maternal ELM, MDD, and BPD on empathy. Elevated personal distress in mothers with BPD and MDD may lead to higher levels of child psychopathology.
The dynamics of electron-plasma waves is described at arbitrary collisionality by considering the full Coulomb collision operator. The description is based on a Hermite–Laguerre decomposition of the velocity dependence of the electron distribution function. The damping rate, frequency and eigenmode spectrum of electron-plasma waves are found as functions of the collision frequency and wavelength. A comparison is made between the collisionless Landau damping limit, the Lenard–Bernstein and Dougherty collision operators and the electron–ion collision operator, finding large deviations in the damping rates and eigenmode spectra. A purely damped entropy mode, characteristic of a plasma where pitch-angle scattering effects are dominant with respect to collisionless effects, is shown to emerge numerically, and its dispersion relation is analytically derived. It is shown that such a mode is absent when simplified collision operators are used, and that like-particle collisions strongly influence the damping rate of the entropy mode.
Failure of the Fontan circulation is not a well-understood clinical phenomena.For some patients, a gradual increase in pulmonary vascular resistance (PVR) and structural changes in the pulmonary artery may be an important causative factor. To further investigate this issue, we employed optical coherence tomography (OCT) to evaluate structural changes within the pulmonary arteries of Fontan patients and compared to those with a normal pulmonary circulation.
Materials and Methods:
Pulmonary artery OCT was performed, without complications, in 12 Fontan and 11 control patients. Wall thickness and wall:vessel cross-sectional area (CSA) ratio were calculated after image acquisition, using digital planimetry.
There was no difference in wall thickness between both groups. Median wall thickness for Fontan patients was 0.12 mm (IQR, 0.10–0.14) and for controls was 0.11 mm (IQR, 0.10–0.12; p = 0.62). Wall:vessel CSA ratio for Fontan patients was 0.13 (IQR, 0.12–0.16) and for controls was 0.13 (IQR, 0.11–0.15) (p = 0.73). There was no association between wall thickness and ventricle morphology, age at catheterisation, age at Fontan, years since Fontan completion, pulmonary artery pressure, and PVR. The vessel media was more readily visualised in control patients.
OCT of the pulmonary arteries in Fontan patients is safe and feasible. Our OCT findings suggest that during childhood, pulmonary artery wall dimensions are normal in Fontan children with reassuring hemodynamics. Further evaluation of Fontan patients with abnormal hemodynamics and serial evaluation into adulthood are required to conclude on the utility of OCT for identifying early pulmonary artery structural changes.
Great. Well thank you to ASIL for inviting me, thank you to Joel and Paul for inviting me, and thanks for the chance to read the paper, which I really enjoyed. I thought it was really thought-provoking and it made me want to go through and read all the citations that were cited in the footnotes, which is always a good sign.
Mood disorders and adiposity are major public health challenges. Few studies have investigated the bidirectional association of weight and waist circumference (WC) change with psychological distress in middle age, while taking into account the potential U-shape of the association. The aim of this study was to examine the bidirectional association between psychological distress and categorical change in objectively measured weight and WC.
We analysed repeated measures (up to 17 522 person-observations in adjusted analyses) of psychological distress, weight and WC from the Whitehall II cohort. Participants were recruited at age 35–55 and 67% male. Psychological distress was assessed using the General Health Questionnaire. We used random-effects regressions to model the association between weight and WC changes and psychological distress, with and without a 5-year lag period.
Psychological distress was associated with weight and WC gain over the subsequent 5 years but not the second 5-year period. Weight gain and loss were associated with increased odds for incident psychological distress in models with and without time-lag [odds ratio (OR) for incident psychological distress after 5-year time-lag: loss 1.20, 95% confidence interval (CI) 1.00–1.43; gain>5% 1.20, 95% CI 1.02–1.40]. WC changes were only associated with psychological distress in models without time-lag (OR for incident psychological distress: loss 1.29, 95% CI 1.02–1.64; gain>5% 1.33, 95% CI 1.11–1.58).
Weight gain and loss increase the odds for psychological distress compared with stable weight over subsequent 10 years. In contrast, the association between psychological distress and subsequent weight and WC changes was limited to the first 5 years of follow-up.
To estimate the cost-effectiveness of price subsidies on fortified packaged complementary foods (FPCF) in reducing iodine deficiency, iron-deficiency anaemia and vitamin A deficiency in Pakistani children.
The study proceeded in three steps: (i) we determined the current lifetime costs of the three micronutrient deficiencies with a health economic model; (ii) we assessed the price sensitivity of demand for FPCF with a market survey in two Pakistani districts; (iii) we combined the findings of the first two steps with the results of a systematic review on the effectiveness of FPCF in reducing micronutrient deficiencies. The cost-effectiveness was estimated by comparing the net social cost of price subsidies with the disability-adjusted life years (DALY) averted.
Districts of Faisalabad and Hyderabad in Pakistan.
Households with 6–23-month-old children stratified by socio-economic strata.
The lifetime social costs of iodine deficiency, iron-deficiency anaemia and vitamin A deficiency in 6–23-month-old children amounted to production losses of $US 209 million and 175 000 DALY. Poor households incurred the highest costs, yet even wealthier households suffered substantial losses. Wealthier households were more likely to buy FPCF. The net cost per DALY of the interventions ranged from a return per DALY averted of $US 783 to $US 65. Interventions targeted at poorer households were most cost-effective.
Price subsidies on FPCF might be a cost-effective way to reduce the societal costs of micronutrient deficiencies in 6–23-month-old children in Pakistan. Interventions targeting poorer households are especially cost-effective.
Early life maltreatment (ELM), borderline personality disorder (BPD) and major depressive disorder (MDD) have been shown to increase the potential of abuse. Emotion regulation is an identified mediator for the association of ELM and BPD with abuse potential. Until now, there has been no study to account for the co-occurrence of these risk factors in one analysis, although BPD and MDD are known as common sequelae of ELM. This is paired with a lack of studies investigating the effects of abuse potential on child well-being.
Our study aims at (a) disentangling the effects of maternal ELM, MDD and BPD on abuse potential; (b) exploring the role of emotion regulation as a mediator; and (c) testing for intergenerational effects of abuse potential on child psychopathology.
The research design included 114 mothers with/without ELM, BPD and MDD in remission and their children, all of which were between 5 and 12 years of age. A path analysis was conducted to investigate the multiple associations between our variables.
ELM, MDD and BPD were all associated with abuse potential, with emotion regulation acting as a mediator for BPD and MDD. Furthermore, an elevated abuse potential was related to higher psychopathology in the child.
History of ELM as well as the common sequelae, BPD and MDD, pose risks for child abuse. Our findings suggest improvement of emotion regulation as a potential target for intervention programs. These programs should also aim at non-substantiated cases because even an elevated abuse potential affected child mental health.
The present study investigates whether the reversal of the social gradient in obesity, defined as a cross-over to higher obesity prevalence among groups with lower education level, has occurred among men and women in urban and rural areas of Mexico.
Cross-sectional series of nationally representative surveys (1988, 1999, 2006, 2012 and 2016). The association between education and obesity was investigated over the period 1988–2016. Effect modification of the education–obesity association by household wealth was tested.
Women (n 54 816) and men (n 20 589) aged 20–49 years.
In both urban and rural areas, the association between education and obesity in women varied by level of household wealth in the earlier surveys (1988, 1999 and 2006; interaction P<0·001). In urban areas in 1988, one level lower education was associated (prevalence ratio; 95 % CI) with 45 % higher obesity prevalence among the richest women (1·45; 1·24, 1·69), whereas among the poorest the same education difference was protective (0·84; 0·72, 0·99). In the latest surveys (2012, 2016), higher education was protective across all wealth groups. Among men, education level was not associated with obesity in urban areas; there was a direct association in rural areas. Wealth did not modify the association between education and obesity.
The reversal of the educational gradient in obesity among women occurred once a threshold level of household wealth was reached. Among men, there was no evidence of a reversal of the gradient. Policies must not lose sight of the populations most vulnerable to the obesogenic environment.
Diatoms are unicellular, eukaryotic microalgae inhabiting nearly all aquatic habitats. They are famous for their micro- and nanopatterned silica-based cell walls, which are envisioned for various technologic purposes. Within this review article, we summarize recent in vivo modifications of diatom biosilica with respect to the following questions: (i) Which metals are taken up by diatoms and eventually processed into nanoparticles (NPs)? (ii) Are these NPs toxic for the diatoms and––if so––what factors influence toxicity? (iii) What is the mechanism underlying NP synthesis and subsequent metabolism? (iv) How can the obtained materials be useful for materials science?
Many women experience both vasomotor menopausal symptoms (VMS) and depressed mood at midlife, but little is known regarding the prospective bi-directional relationships between VMS and depressed mood and the role of sleep difficulties in both directions.
A pooled analysis was conducted using data from 21 312 women (median: 50 years, interquartile range 49−51) in eight studies from the InterLACE consortium. The degree of VMS, sleep difficulties, and depressed mood was self-reported and categorised as never, rarely, sometimes, and often (if reporting frequency) or never, mild, moderate, and severe (if reporting severity). Multivariable logistic regression models were used to examine the bi-directional associations adjusted for within-study correlation.
At baseline, the prevalence of VMS (40%, range 13–62%) and depressed mood (26%, 8–41%) varied substantially across studies, and a strong dose-dependent association between VMS and likelihood of depressed mood was found. Over 3 years of follow-up, women with often/severe VMS at baseline were more likely to have subsequent depressed mood compared with those without VMS (odds ratios (OR) 1.56, 1.27–1.92). Women with often/severe depressed mood at baseline were also more likely to have subsequent VMS than those without depressed mood (OR 1.89, 1.47–2.44). With further adjustment for the degree of sleep difficulties at baseline, the OR of having a subsequent depressed mood associated with often/severe VMS was attenuated and no longer significant (OR 1.13, 0.90–1.40). Conversely, often/severe depressed mood remained significantly associated with subsequent VMS (OR 1.80, 1.38–2.34).
Difficulty in sleeping largely explained the relationship between VMS and subsequent depressed mood, but it had little impact on the relationship between depressed mood and subsequent VMS.
Migration has been reported to be associated with higher prevalence of mental disorders and suicidal behaviour.
To examine the prevalence of emotional and behavioural difficulties, suicidal ideation and suicide attempts among migrant adolescents and their non-migrant peers.
A school-based survey was completed by 11 057 European adolescents as part of the Saving and Empowering Young Lives in Europe (SEYLE) study.
A previous suicide attempt was reported by 386 (3.6%) adolescents. Compared with non-migrants, first-generation migrants had an elevated prevalence of suicide attempts (odds ratio (OR) 2.08; 95% CI 1.32–3.26; P=0.001 for European migrants and OR 1.86; 95% CI 1.06–3.27; P=0.031 for non-European migrants) and significantly higher levels of peer difficulties. Highest levels of conduct and hyperactivity problems were found among migrants of non-European origin.
Appropriate mental health services and school-based supports are required to meet the complex needs of migrant adolescents.