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Glaciers in the eastern Pamir have reportedly been gaining mass during recent decades, even though glaciers in most other regions in High Mountain Asia have been in recession. Questions still remain about whether the trend is strengthening or weakening, and how far the positive balances extend into the eastern Pamir. To address these gaps, we use three different digital elevation models to reconstruct glacier surface elevation changes over two periods (2000–09 and 2000–15/16). We characterize the eastern Pamir as a zone of transition from positive to negative mass balance with the boundary lying at the northern end of Kongur Tagh, and find that glaciers situated at higher elevations are those with the most positive balances. Most (67% of 55) glaciers displayed a net mass gain since the 21st century. This led to an increasing regional geodetic glacier mass balance from −0.06 ± 0.16 m w.e. a−1 in 2000–09 to 0.06 ± 0.04 m w.e. a−1 in 2000–15/16. Surge-type glaciers, which are prevalent in the eastern Pamir, showed fluctuations in mass balance on an individual scale during and after surges, but no statistical difference compared to non-surge-type glaciers when aggregated across the region.
Survivors of childhood brain tumors experience neurological sequelae that disrupt everyday adaptive functioning (AF) skills. The Neurological Predictor Scale (NPS), a cumulative measure of tumor treatments and sequelae, predicts cognitive outcomes, but findings on its relation to informant-reported executive dysfunction (ED) and AF are mixed. Given known effects of frontal-subcortical system disruptions on AF, this study assessed the NPS’ relationship with AF as mediated by frontal systems dysfunction, measured by the Frontal Systems Behavior Scale (FrSBe).
75 participants (Mage = 23.5, SDage = 4.5) were young adult survivors of childhood brain tumors at least 5 years past diagnosis. FrSBe and Scales of Independent Behavior-Revised (SIB-R), a measure of AF, were administered to informants. Parallel multiple mediator models included Apathy and ED as mediators, and age at diagnosis and time between diagnosis and assessment as covariates.
More complex treatment and sequelae were correlated with poorer functioning. Mediation models were significant for all subscales: Motor Skills (MS), p = .0001; Social Communication (SC), p = .002; Personal Living (PL), p = .004; Community Living (CL), p = .007. The indirect effect of ED on SC and CL was significant; the indirect effect of Apathy was not significant for any subscales.
More complex tumor treatment and sequelae were associated with poorer long-term AF via increased ED. Cognitive rehabilitation programs may focus on the role of executive function and initiation that contribute to AF, particularly SC and CL skills, to help survivors achieve comparable levels of independence in everyday function as their peers.
The thickness of glaciers in High-Mountain Asia (HMA) is critical in determining when the ice reserve will be lost as these glaciers thin but is remarkably poorly known because very few measurements have been made. Through a series of ground-based and airborne field tests, we have adapted a low-frequency ice-penetrating radar developed originally for Antarctic over-snow surveys, for deployment as a helicopter-borne system to increase the number of measurements. The manoeuvrability provided by helicopters and the ability of our system to detect glacier beds through thick, dirty, temperate ice makes it well suited to increase greatly the sample of measurements available for calibrating ice thickness models on the regional and global scale. The Bedmap Himalayas radar-survey system can reduce the uncertainty in present-day ice volumes and therefore in projections of when HMA's river catchments will lose this hydrological buffer against drought.
OBJECTIVES/GOALS: Patient online portal (POP) allows patients to access electronic health records (EHRs) and have efficient communication with their clinicians. We assessed disparities in access to POP by families with different SES and its impact on asthma research which is little known in the literature. METHODS/STUDY POPULATION: A randomized controlled trial testing the efficacy of an EHRs-based clinical decision support (CDS) system was conducted at a pediatric primary care setting of Mayo Clinic. Asthma Control Test (ACT) questionnaire was administered to parents every 3 months through phone or email for this study after consenting, and reminders were sent to unanswered subjects through the POP. SES was measured by HOUSES (in quartiles), a validated individual-level SES index based on housing features (the higher HOUSES, the higher SES).The association of HOUSES with availability of POP access and missing ACT score rate was assessed. RESULTS/ANTICIPATED RESULTS: The mean age of 184 participants was 9.0 years (57% male) and parents of 152 (83%) children had POP. Only 68% of children from lowest HOUSES (Q1) had access to POP (vs. 74% (Q2), 88% (Q3), and 92% (Q4; highest SES); p = .02). ACT score was completed by 144 (78%), 150 (82%), 171 (94%), and 164 (95%) at each intervention conducted every 3 months with a total of 61 (33%) missing at least once. Overall, children whose parents had access to POP had a lower missing rate in ACT score at all interventions during the study; 16% (those with access to POP) vs. 47% (those without), 13% vs. 44%, 3% vs. 16%, and 1% vs. 23% for 1st, 2nd, 3rd, and 4th intervention, respectively (p < .007 for all). DISCUSSION/SIGNIFICANCE OF IMPACT: There are significant disparities in access to POP by SES defined by HOUSES which impact availability of ACT score resulting in a systematic bias in asthma research and potentially widening disparities in asthma care. CONFLICT OF INTEREST DESCRIPTION: NA.
Although there is growing interest in mental health problems in university students there is limited understanding of the scope of need and determinants to inform intervention efforts.
To longitudinally examine the extent and persistence of mental health symptoms and the importance of psychosocial and lifestyle factors for student mental health and academic outcomes.
Undergraduates at a Canadian university were invited to complete electronic surveys at entry and completion of their first year. The baseline survey measured important distal and proximal risk factors and the follow-up assessed mental health and well-being. Surveys were linked to academic grades. Multivariable models of risk factors and mental health and academic outcomes were fit and adjusted for confounders.
In 1530 students surveyed at entry to university 28% and 33% screened positive for clinically significant depressive and anxiety symptoms respectively, which increased to 36% and 39% at the completion of first year. Over the academic year, 14% of students reported suicidal thoughts and 1.6% suicide attempts. Moreover, there was persistence and overlap in these mental health outcomes. Modifiable psychosocial and lifestyle factors at entry were associated with positive screens for mental health outcomes at completion of first year, while anxiety and depressive symptoms were associated with lower grades and university well-being.
Clinically significant mental health symptoms are common and persistent among first-year university students and have a negative impact on academic performance and well-being. A comprehensive mental health strategy that includes a whole university approach to prevention and targeted early-intervention measures and associated research is justified.
Introduction: Distal radial fractures (DRF) remain the most commonly encountered fracture in the Emergency Department (ED). The initial management of displaced DRFs by Emergency Physicians (EP) poses considerable resource allocation. We wished to determine the adequacy of reduction, both initially and at follow up. This data updates previously presented high level findings. Methods: We performed a mixed-methods study including patients who underwent procedural sedation and manipulation by an EP for a DRF. Radiological images performed at initial assessment, post-reduction, and clinic follow up were reviewed by a panel of orthopedic surgeons and radiologists blinded to outcomes, and assessed for evidence of displacement. Demographic data were pooled from patient records and included in statistical analysis. Results: Seventy patients were included and had follow-up completed. Initial reduction was deemed to be adequate in 37 patients (53%; 95% CI 41.32 to 64.10%). At clinic follow-up assessment, 26 reductions remained adequate; a slippage rate of 30% (95% CI of 17.37 to 45.90). Overall 7 patients (10%; 95% CI 4.65 to 19.51%) required revision of the initial reduction in the operating room. Agreement on adequacy of reduction on post-reduction radiographs between radiologists and orthopedic surgeons was 38.6% (95% CI -38.3 to -7.4, Kappa -0.229). The statistical strength of this agreement is worse than what would be expected by chance alone. There was no association found between age, sex, or of time of initial presentation and final outcomes. Conclusion: Although blinded review by specialists determined only half of initial EP DRF reductions to be radiographically adequate, only 10 percent actually required further intervention. Agreement between specialists on adequacy was poor. The majority of DRFs reduced by EPs do not require further surgical intervention.
Dysregulation of motivation and altered processing of reward represent important diagnostic criteria of bipolar disorder and have been proposed as a trait marker of the disorder. Until now, only few studies investigated the processing of reward and learning through reward and punishment in euthymic bipolar patients (BP).
Two studies were conducted to investigate mechanisms of reward learning and processing in euthymic BP and healthy individuals (HC).
In the first study, 23 euthymic BP, 15 remitted patients with Major depression (MD) and 16 HC participated in an associative learning task, assessing the efficiency of contingency learning as well as the preference to learn through positive or negative feedback. In the second study, a probabilistic reversal learning task was conducted during functional magnetic resonance imaging. Here, the neural correlates of reward and punishment were assessed in 22 euthymic BP and 21 HC.
We observed no group differences for the efficiency of contingency learning. However, euthymic BP with a manic episode prior to remission learned better from positive feedback whereas euthymic BP with a depressed episode prior to remission and remitted MD patients learned better from negative feedback. HC did not show such preferences in learning. In addition, bipolar patients exhibited increased orbitofrontal and parahippocampal activity in response to reward but no differences in response to punishment.
Interestingly, the last episode seems to differentially affect emotional and learning processes during euthymia. On a neural level, euthymic BP seem to be more sensitive to reward than healthy individuals.
This study frames anomalous functional brain organization among persons with Schizophrenia (SCZ) within an evolutionary model of brain development, the Dual Trends Theory (DTT). The DTT argues that neural architecture develops along two separate pathways: the dorsal’archicortical’ trend and the ventral’paleocortical’ trend. The DTT dovetails with visual system organization, which is also comprised of two independent pathways: a visuomotor dedicated dorsal stream and a perceptual dedicated ventral stream.
The present study examined the integrity of these pathways using a size-contrast visual illusion. Prior research has shown that, normally, perceptual estimations of object size are susceptible to visual illusions, whereas goal-directed actions are resistant. We hypothesized that, unlike control participants, SCZ patients’ goal-directed actions would be susceptible to the illusion, reflecting selective dorsal stream dysfunction.
Here, 42 SCZ patients and 42 healthy control participants grasped and estimated the size of target blocks in both control and illusion conditions. Movement kinematics were measured using a magnetic motion trracking system (Flock of Birds). During estimation, both groups were equally perturbed by the illusion; however, grasping movements of patients alone were influenced by the illusion.
These results suggest disrupted dorsal brain circuitry in SCZ but relatively intact ventral brain circuitry.
With one in ten young people being affected by ill mental health and stigma regularly cited as a factor affecting access to early intervention services, focussing resources on school based stigma reduction strategies seems prudent. ‘Headucate’, a student society, designed a 50 minute workshop which aims to increase mental health literacy and decrease stigma.
Repeated, cross sectional surveys were carried out at three time points; 1) immediately before (n=77), 2) Immediately after (n=81) and 3) three months post workshop (n=73). The surveys were paper based versions of the Reported Intended Behaviours Score (RIBS) and Mental Health Knowledge Scale (MAKS) utilising a social distance scale.
Four year 10 classed (pupils aged 14-15) were recruited. Post hoc t-tests were carried out when one-way ANOVAS were significant.
Disorder knowledge (from MAKS) and intended contact (from RIBS) significantly increased between time points one and two (p<0.01 and <0.004 respectively) but then decreased.
Analysis of the question pertaining to knowing where to access help showed a statistically significant increase (p<0.001) between time points one and two and then a decrease at time three, albeit to a higher value than at time point one (3.45 compared to 3.13, P=0.088).
Headucate workshops offer a low resource option which is well accepted by students. Like other school based stigma reduction strategies, a dramatic increase was seen between immediately before and after indicating that the workshop resonates with the pupils, but there was little sustained change in attitudes.
where the constant
cannot be replaced by
. In addition to being interesting and important in their own right, inequalities such as these have applications in additive combinatorics. We show that for
to be extremal for this inequality, we must have
Our central technique for deriving this result is local perturbation of
to increase the value of the autocorrelation, while leaving
unchanged. These perturbation methods can be extended to examine a more general notion of autocorrelation. Let
matrix with real entries and columns
$1\leq i\leq n$
be a constant. For a broad class of matrices
, we prove necessary conditions for
to extremise autocorrelation inequalities of the form
Family caregivers of people with dementia can experience loss and grief before death. We hypothesized that modifiable factors indicating preparation for end of life are associated with lower pre-death grief in caregivers.
Caregivers of people with dementia living at home or in a care home.
In total, 150 caregivers, 77% female, mean age 63.0 (SD = 12.1). Participants cared for people with mild (25%), moderate (43%), or severe dementia (32%).
Primary outcome: Marwit-Meuser Caregiver Grief Inventory Short Form (MMCGI-SF). We included five factors reflecting preparation for end of life: (1) knowledge of dementia, (2) social support, (3) feeling supported by healthcare providers, (4) formalized end of life documents, and (5) end-of-life discussions with the person with dementia. We used multiple regression to assess associations between pre-death grief and preparation for end of life while controlling for confounders. We repeated this analysis with MMCGI-SF subscales (“personal sacrifice burden”; “heartfelt sadness”; “worry and felt isolation”).
Only one hypothesized factor (reduced social support) was strongly associated with higher grief intensity along with the confounders of female gender, spouse, or adult child relationship type and reduced relationship closeness. In exploratory analyses of MMCGI-SF subscales, one additional hypothesized factor was statistically significant; higher dementia knowledge was associated with lower “heartfelt sadness.”
We found limited support for our hypothesis. Future research may benefit from exploring strategies for enhancing caregivers’ social support and networks as well as the effectiveness of educational interventions about the progression of dementia (ClinicalTrials.gov ID: NCT03332979).
Prior studies indicate greater disease burden for obesity among rural compared with urban residents but no differences for mood disorder based on geographic location. Recent attention has focused on the need to examine regional rural–urban disparities in disease burden. We focused on mood disorders and obesity prevalence within three southeastern Minnesota counties served by the Mayo Clinic Center for Translational Science Award, in Rochester, Minnesota, as these were top priorities identified in community health needs assessments.
Cross-sectional study to assess the association of rural–urban locality on 5-year (2009–2014) prevalence of mood disorder and obesity obtained using the Rochester Epidemiological Project medical records linkage system, among subjects residing in three mixed rural–urban counties on April 1, 2014. Multivariable analyses adjusted for demographics, socioeconomic status using an individual housing-based measure, and counties.
The study cohort (percent rural location) included 91,202 (15%) for Olmsted, 10,197 (51%) in Dodge, and 10,184 (57%) in Wabasha counties. On multivariate analysis, 5-year prevalence of mood disorders and obesity was significantly greater for urban compared with rural residents, after adjusting for confounders; odds ratios (95% confidence intervals): 1.21 (1.17–1.26), P < 0.001, and 1.05 (1.01–1.10), P = 0.016, respectively. Observed effects were not modified in additional models adjusted for health care utilization (HCU; ≥1 general medical examination visit and flu vaccination).
Rural–urban health disparities for burden of mood disorders and obesity are independent of socioeconomic status and HCU in a Midwestern community. It is important to assess potential regional heterogeneity of rural–urban disparities on health outcomes.
Chapter 5 focuses on broken nation-states during the Arab Spring – Iraq, Syria, and the Islamic State –the human suffering broken states cause (even if they “broke” during efforts to implement and sustain democratic politics) and how elites have tried to put the states back together again.
Chapter 1 describes how Tunisia’s unique success has been based on comparative strength in national unity and state capacities along with an apolitical military, and Islamist and secular political parties exceptionally willing to work together to sustain a democratic bargain. Latent threats to Tunisia’s democracy remain in a security sector fighting reform, socioeconomic struggles, and the resurgence to power of pre–Arab Spring political and economic elites.
In Chapter 2, Egypt enters the Arab Spring with relative strength in national unity and state capacities. However, during the country’s democratic transition, its military took advantage of conflicts between Islamists and secularists in order to stage a coup and reassert its historical dominance of Egypt’s political economy. Both Islamist and secular-oriented political parties were at fault in failing to forge the “twin tolerations” necessary for a political pact or democratic bargain in Egypt. Witnessing the victory of Islamists in transitional elections, secularists turned to the streets and the military to overturn electoral outcomes. For their part, after winning Egypt’s post-Mubarak founding elections, President Morsi and the Muslim Brotherhood made decisions and appointments that raised questions about their commitment to democracy and their willingness to share power at the most delicate point of a democratic transition, the period that includes constitution writing.