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Eighty percent of all patients suffering from major depressive disorder (MDD) relapse at least once in their lifetime. Thus, understanding the neurobiological underpinnings of the course of MDD is of utmost importance. A detrimental course of illness in MDD was most consistently associated with superior longitudinal fasciculus (SLF) fiber integrity. As similar associations were, however, found between SLF fiber integrity and acute symptomatology, this study attempts to disentangle associations attributed to current depression from long-term course of illness.
A total of 531 patients suffering from acute (N = 250) or remitted (N = 281) MDD from the FOR2107-cohort were analyzed in this cross-sectional study using tract-based spatial statistics for diffusion tensor imaging. First, the effects of disease state (acute v. remitted), current symptom severity (BDI-score) and course of illness (number of hospitalizations) on fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity were analyzed separately. Second, disease state and BDI-scores were analyzed in conjunction with the number of hospitalizations to disentangle their effects.
Disease state (pFWE < 0.042) and number of hospitalizations (pFWE< 0.032) were associated with decreased FA and increased MD and RD in the bilateral SLF. A trend was found for the BDI-score (pFWE > 0.067). When analyzed simultaneously only the effect of course of illness remained significant (pFWE < 0.040) mapping to the right SLF.
Decreased FA and increased MD and RD values in the SLF are associated with more hospitalizations when controlling for current psychopathology. SLF fiber integrity could reflect cumulative illness burden at a neurobiological level and should be targeted in future longitudinal analyses.
Schizotypy is a putative risk phenotype for psychosis liability, but the overlap of its genetic architecture with schizophrenia is poorly understood.
We tested the hypothesis that dimensions of schizotypy (assessed with the SPQ-B) are associated with a polygenic risk score (PRS) for schizophrenia in a sample of 623 psychiatrically healthy, non-clinical subjects from the FOR2107 multi-centre study and a second sample of 1133 blood donors.
We did not find correlations of schizophrenia PRS with either overall SPQ or specific dimension scores, nor with adjusted schizotypy scores derived from the SPQ (addressing inter-scale variance). Also, PRS for affective disorders (bipolar disorder and major depression) were not significantly associated with schizotypy.
This important negative finding demonstrates that despite the hypothesised continuum of schizotypy and schizophrenia, schizotypy might share less genetic risk with schizophrenia than previously assumed (and possibly less compared to psychotic-like experiences).
The Ringing Up About Breastfeeding earlY (RUBY) randomised controlled trial (RCT) found that a telephone-based peer volunteer support intervention increased breast-feeding duration in a setting with high breast-feeding initiation. This sub-study of the RUBY RCT describes the motivation, preparation and experiences of volunteers who provided the peer support intervention.
An online survey was completed by 154 (67 %) volunteers after ceasing volunteering.
Volunteers provided peer support to primiparous women (n 574) who birthed at one of three public hospitals in Melbourne, Australia, between February 2013 and December 2015.
Volunteers (n 230) had themselves breastfed for at least 6 months and received 4 h of training for the role.
The median number of mothers supported was two (range 1–11), and two-thirds of respondents supported at least one mother for 6 months. Volunteers were motivated by a strong desire to support new mothers to establish and continue breast-feeding. Most (93 %) considered the training session adequate. The majority (60 %) reported following the call schedule ‘most of the time’, but many commented that ‘it depends on the mother’. Overall, 84 % of volunteers were satisfied with the role and reported that the experience was enjoyable (85 %) and worthwhile (90 %). Volunteers agreed that telephone support for breast-feeding was valued by women (88 %) and that the programme would be effective in helping women to breastfeed (93 %).
These findings are important for those developing similar peer support programmes in which recruiting volunteers and developing training requirements are an integral and recurrent part of volunteer management.
Subclinical psychotic-like experiences (PLE), resembling key symptoms of psychotic disorders, are common throughout the general population and possibly associated with psychosis risk. There is evidence that such symptoms are also associated with structural brain changes.
In 672 healthy individuals, we assessed PLE and associated distress with the symptom-checklist-90R (SCL-90R) scales ‘schizotypal signs’ (STS) and ‘schizophrenia nuclear symptoms’ (SNS) and analysed associations with voxel- and surfaced-based brain structural parameters derived from structural magnetic resonance imaging at 3 T with CAT12.
For SNS, we found a positive correlation with the volume in the left superior parietal lobule and the precuneus, and a negative correlation with the volume in the right inferior temporal gyrus [p < 0.05 cluster-level Family Wise Error (FWE-corrected]. For STS, we found a negative correlation with the volume of the left and right precentral gyrus (p < 0.05 cluster-level FWE-corrected). Surface-based analyses did not detect any significant clusters with the chosen statistical threshold of p < 0.05. However, in exploratory analyses (p < 0.001, uncorrected), we found a positive correlation of SNS with gyrification in the left insula and rostral middle frontal gyrus and of STS with the left precuneus and insula, as well as a negative correlation of STS with gyrification in the left temporal pole.
Our results show that brain structures in areas implicated in schizophrenia are also related to PLE and its associated distress in healthy individuals. This pattern supports a dimensional model of the neural correlates of symptoms of the psychotic spectrum.
Introduction: An important challenge physicians face when treating acute heart failure (AHF) patients in the emergency department (ED) is deciding whether to admit or discharge, with or without early follow-up. The overall goal of our project was to improve care for AHF patients seen in the ED while avoiding unnecessary hospital admissions. The specific goal was to introduce hospital rapid referral clinics to ensure AHF patients were seen within 7 days of ED discharge. Methods: This prospective before-after study was conducted at two campuses of a large tertiary care hospital, including the EDs and specialty outpatient clinics. We enrolled AHF patients ≥50 years who presented to the ED with shortness of breath (<7 days). The 12-month before (control) period was separated from the 12-month after (intervention) period by a 3-month implementation period. Implementation included creation of rapid access AHF clinics staffed by cardiology and internal medicine, and development of referral procedures. There was extensive in-servicing of all ED staff. The primary outcome measure was hospital admission at the index visit or within 30 days. Secondary outcomes included mortality and actual access to rapid follow-up. We used segmented autoregression analysis of the monthly proportions to determine whether there was a change in admissions coinciding with the introduction of the intervention and estimated a sample size of 700 patients. Results: The patients in the before period (N = 355) and the after period (N = 374) were similar for age (77.8 vs. 78.1 years), arrival by ambulance (48.7% vs 51.1%), comorbidities, current medications, and need for non-invasive ventilation (10.4% vs. 6.7%). Comparing the before to the after periods, we observed a decrease in hospital admissions on index visit (from 57.7% to 42.0%; P <0.01), as well as all admissions within 30 days (from 65.1% to 53.5% (P < 0.01). The autoregression analysis, however, demonstrated a pre-existing trend to fewer admissions and could not attribute this to the intervention (P = 0.91). Attendance at a specialty clinic, amongst those discharged increased from 17.8% to 42.1% (P < 0.01) and the median days to clinic decreased from 13 to 6 days (P < 0.01). 30-day mortality did not change (4.5% vs. 4.0%; P = 0.76). Conclusion: Implementation of rapid-access dedicated AHF clinics led to considerably increased access to specialist care, much reduced follow-up times, and possible reduction in hospital admissions. Widespread use of this approach can improve AHF care in Canada.
Hypnosis may induce striking changes in consciousness and volition under the effect of particular suggestions. Popular theories often consider hypnosis as a state of consciousness where volition is abolished, while cognitive theories postulate that it involves inhibitory control processes mediated by frontal lobe areas. Moreover, since the time of Freud and Charcot, hypnotic effects have often been likened to the abnormal behaviour seen in some psychiatric disorders such as hysteria. However, the neural mechanisms of these different conditions and their putative relationships still remain unclear. By using functional neuroimaging methods in volunteers and patient, we can now identify specific changes in brain activity that underlie the behavioural and perceptual alterations observed during hypnosis and directly compare the latter with findings in hysteria conversion. Our recent results suggest both commonalities between these two conditions, as suggested by Freud and Charcot, but also clear differences that are consistent modern views on hysteria and brain functions. Moreover, hypnosis appears to reflect a state of heightened self-control and monitoring, in agreement with some cognitive theories. This research does not only provide novel insights on how the human mind can regulate itself, but also help better understand the neural underpinning of hysteria, a condition standing at the frontiers of psychiatry and neurology since more than a century.
Knowledge of drug prescription is essential for pharmacovigilance, i. e. for classifying adverse drug reactions (ADR) in clinical routine and for methods of their elimination and prevention.
Since the frequency of ADR is correlated with age, multi-morbidity and polypharmacy, special attention should be given to the medication of elderly or chronically ill patients.
To determine the rate of all kinds of ADR inpatient data (number, gender, age, and psychiatric diagnoses), drug prescriptions and occurrences of ADR were surveyed.
Once in a week for a period of six weeks data from all inpatients of an open station of each of the departments social psychiatry and geriatric psychiatry of the kbo-Inn-Salzach-Klinikum gemeinnützigen GmbH were determined.
The 34 inpatients of geriatric psychiatry were on average 75 years old with on average eight prescribed drugs. Leading diagnosis was recurrent depression’ (17%); leading prescribed agent was sertraline (13%). In 55% of cases ADR occurred, mostly eliminated by medicinal counteractions (34%).
The 54 inpatients of social psychiatry were on average 41 years old with on average four prescribed drugs. Leading diagnosis was paranoid schizophrenia (24%); leading prescribed agent was risperidone (14%). In 36% of cases ADR occurred, mostly eliminated by stopping medication and medicinal counteractions (each 31%).
In general, new drugs were prescribed in a cautious dose-regime. Clozapine was still of high relevance. Drug prescriptions were age specific as was the occurrence of ADR. Although ADR occurrence was high (55% and 36%), severe cardiac and circulatory troubles were relatively rare.
Will Irwin worked as a reporter and muckraker for ten years before he wrote The American newspaper (1911). Published by Collier's magazine over fifteen issues, it was a pioneering study of ‘journalism in its relation to the public’, and it has been much cited by historians. Irwin argued that American newspapers in the early twentieth century had come to possess enormous power; indeed, ‘no other extrajudicial force, except religion, is half so powerful’. Newspapers had been significant influences on public opinion since the early nineteenth century and had become even more important and popular with the rise of ‘yellow journalism’ in the 1890s. But Irwin worried about conflicts between ‘the business attitude’, which insisted that newspapers were commercial products above all, and ‘the professional attitude’, which identified journalism with civic education and the public interest. He was especially anxious about ‘the advertising influence’, on which newspapers depended for economic survival, and which necessarily damaged their journalism. For when advertisers wanted stories spiked or editorials altered, they generally had their way. And when publishers courted businessmen over drinks and dinner, they grew fat and corrupt. So ‘the perplexity of free journalism’ was that ‘so long as our American capitalism retains its insolence and its ruthlessness of method, commercial publishers of million-dollar newspapers must recognize this [advertising] influence whether they like it or no. And many of them do like it.’ Irwin's sense that newspapers claimed to be the people's tribunes but often served their owner's interests made him think that ‘the system is dishonest to its marrow’. Thus his study raised some enduring questions for historians: why were newspapers so powerful? How important were their publishers? Is free journalism ever possible?
In much of Europe, the advent of low-input cereal farming regimes between c.ad 800 and 1200 enabled landowners—lords—to amass wealth by greatly expanding the amount of land under cultivation and exploiting the labour of others. Scientific analysis of plant remains and animal bones from archaeological contexts is generating the first direct evidence for the development of such low-input regimes. This article outlines the methods used by the FeedSax project to resolve key questions regarding the ‘cerealization’ of the medieval countryside and presents preliminary results using the town of Stafford as a worked example. These indicate an increase in the scale of cultivation in the Mid-Saxon period, while the Late Saxon period saw a shift to a low-input cultivation regime and probably an expansion onto heavier soils. Crop rotation appears to have been practised from at least the mid-tenth century.
Little is known about who would benefit from Internet-based personalised nutrition (PN) interventions. This study aimed to evaluate the characteristics of participants who achieved greatest improvements (i.e. benefit) in diet, adiposity and biomarkers following an Internet-based PN intervention. Adults (n 1607) from seven European countries were recruited into a 6-month, randomised controlled trial (Food4Me) and randomised to receive conventional dietary advice (control) or PN advice. Information on dietary intake, adiposity, physical activity (PA), blood biomarkers and participant characteristics was collected at baseline and month 6. Benefit from the intervention was defined as ≥5 % change in the primary outcome (Healthy Eating Index) and secondary outcomes (waist circumference and BMI, PA, sedentary time and plasma concentrations of cholesterol, carotenoids and omega-3 index) at month 6. For our primary outcome, benefit from the intervention was greater in older participants, women and participants with lower HEI scores at baseline. Benefit was greater for individuals reporting greater self-efficacy for ‘sticking to healthful foods’ and who ‘felt weird if [they] didn’t eat healthily’. Participants benefited more if they reported wanting to improve their health and well-being. The characteristics of individuals benefiting did not differ by other demographic, health-related, anthropometric or genotypic characteristics. Findings were similar for secondary outcomes. These findings have implications for the design of more effective future PN intervention studies and for tailored nutritional advice in public health and clinical settings.
Compliance with college emergency notifications can minimize injury; however, time is often wasted in alert verification. Building on prior research, this study assesses using health-behavior theory to predict rapid compliance to emergency notifications across a range of scenarios and within a diverse college population.
Cross-sectional, student data were collected in 2017-2018 (n = 1529). The Theory of Planned Behavior and Protection Motivation Theory were used to explain intention to comply with emergency notifications in scenarios: robbery, shooter, fire, chemical spill, protest, health emergency, and air quality. Regression models assessed associations between constructs and intention to rapidly comply with each notification.
The most consistent predictors of rapid compliance were attitudes and subjective norms (adjusted odds ratio [AOR]: 1.057-1.118; 95% CI: 1.009-1.168). Scenarios prone to rapid developments such as robbery, shooter, and fire were associated with increased perceived threat and response efficacy (AOR: 1.024-1.082; 95% CI: 1.003-1.132) Slower developing situations such as air quality and health hazards were associated with increased perceived control (AOR: 1.027-1.073; 95% CI: 1.031-1.117).
This study identified attitude and subjective norms as consistent predictors of rapid compliance and improves understanding of additional constructs across scenarios. Campuses may benefit from leveraging concepts from health-behavior theory to provide targeted intervention focusing on factors associated with rapid compliance.
The bio-synthesis of pyoverdine (PVD) in Pseudomonas aeruginosa involves multiple enzymatic steps including the action of non-ribosomal peptide synthetases (NRPSs). One hallmark of NRPS is their ability to make usage of non-proteinogenic amino-acids synthesized by co-expressed accessory enzymes. It is generally proposed that different enzymes of a secondary metabolic pathway assemble into large supra-molecular complexes. However, evidence for the assembly of sequential enzymes in the cellular context is sparse. Here, we used in cellulo single-molecule tracking and Förster resonance energy transfer measured by fluorescence lifetime microscopy (FRET-FLIM) to explore the spatial partitioning of the ornithine hydroxylase PvdA and its interactions with NRPS. We found PvdA was mostly diffusing bound to large complexes in the cytoplasm with a small exchangeable trapped fraction. FRET-FLIM clearly showed that PvdA is physically interacting with PvdJ, PvdI, PvdL, and PvdD, the four NRPS involved in the PVD pathway in Pseudomonas aeruginosa PAO1. The binding modes of PvdA were strikingly different according to the NRPS it is interacting with, suggesting that PvdA binding sites have co-evolved with the enzymatic active sites of NRPS. Our data provide evidence for strongly organized multi-enzymatic complexes responsible for the bio-synthesis of PVD and illustrate how binding sites have evolved to finely control the co-localization of sequential enzymes and promote metabolic pathway efficiency.
Following the Paris Commune of 1871, around 3,500 Communard refugees and their families arrived in Britain, with the majority settling in the capital. This article is an exploration of these exiled Communards within the geography of London. The spatial configurations of London's radical and exile communities, and the ways in which Communards interacted with those they crossed paths with, is vital in understanding how some of the ideas that came out of the Commune permeated London's radical scene. Too often British political movements, particularly British socialism, have been presented as being wilfully impervious to developments on the continent. Instead, this article argues that in order to find these often more affective and ancillary foreign influences, it is important to think spatially and trace how the exile map of London corresponded with, extended, and redrew parts of the existing radical mapping of the city. In carving out spaces for intellectual exchange, Communard refugees moved within and across various communities and physical places. The social and spatial context in which British sympathizers absorbed and appropriated ideas from the Commune is key to understanding how the exiles of the Paris Commune left their mark on the landscape, and mindscape, of London.
The concept of Geist – mind or spirit – plays a central, indeed dominant, role in Hegel’s philosophy. But the concept seems to me to be very different in both its origin and its character than it is commonly taken to be. So I would like here to try to shed some light on both of these aspects.