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Premenstrual dysphoric disorder (PMDD) is a new Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 diagnosis characterized by the cyclical emergence of emotional and physical symptoms in the luteal phase of the menstrual cycle, with symptom remission in the follicular phase. Converging evidence highlights the possibility of distinct subtypes of PMDD with unique pathophysiologies, but temporal subgroups have yet to be explored in a systematic way.
In the current work, we use group-based trajectory modeling to identify unique trajectory subgroups of core emotional and total PMDD symptoms across the perimenstrual frame (days −14 to +9, where day 0 is menstrual onset) in a sample of 74 individuals prospectively diagnosed with DSM-5 PMDD.
For the total daily symptom score, the best-fitting model was comprised of three groups: a group demonstrating moderate symptoms only in the premenstrual week (65%), a group demonstrating severe symptoms across the full 2 weeks of the luteal phase (17.5%), and a group demonstrating severe symptoms in the premenstrual week that were slow to resolve in the follicular phase (17.5%).
These trajectory groups are discussed in the context of the latest work on the pathophysiology of PMDD. Experimental work is needed to test for the presence of possible pathophysiologic differences in trajectory groups, and whether unique treatment approaches are needed.
New therapeutic strategies have been established in chronic wound healing procedures, such as the use of platelet-rich plasma (PRP). There is currently still uncertainty about the effectiveness, cost-effectiveness and real safety of PRP in promoting chronic wound healing and what specific types of chronic wounds can benefit most from its use.
We conducted a systematic review of available scientific literature on the effectiveness, safety and cost-effectiveness of PRP compared to placebo, standard care or alternative topical therapies for the treatment of chronic wounds in adults. Overall effect size was estimated through a meta-analysis. A cost-effectiveness analysis was conducted using a Markov model which simulates the costs and health outcomes of individuals for a 5-year horizon, from the perspective of the Spanish National Health Service (NHS) for the PRP versus standard treatment in patients with diabetic foot ulcers. The effectiveness measure was quality-adjusted life years (QALYs). We ran extensive sensitivity analyses, including a probabilistic sensitivity analysis.
Sixteen RCTs and four observational studies were included for the effectiveness and safety meta-analysis. The primary outcome was the proportion of chronic wounds completely healed: 143 patients out of 334 (42.8 percent) were cured in the standard treatment arm and 251 patients out of 375 (66.9 percent) in the PRP arm, relative risk (RR) 1.68 (95% CI: 1.22–2.31). It was unclear whether there was a difference in the risk of infection (RR 0.53, 95% CI: 0.10–2.71) or adverse events (RR 1.05, 95% CI: 0.29–3.88) between PRP and standard care. Three studies were considered for the cost-effectiveness analysis. In the base case analysis, PRP led to higher QALYs and healthcare costs with an estimated incremental cost-effectiveness ratio (ICER) of EUR 41,767 (USD 48,323)/QALY.
PRP treatment is more expensive and more effective than standard treatment. The estimated ICER is above the acceptability threshold in Spain.
No one seems yet to have appreciated that what is the earliest Latin verse of the New World is also its earliest extant verse by any visitor from the Old World. Furthermore, no one has paid any attention to the very poems themselves.
The poet was Alessandro Geraldini (ca. 1455-1524), Italian humanist, diplomat, and churchman. A native of Umbria, Geraldini went to school in Italy, but later left for Spain with his older brother, Antonio, the two bringing with them, like their famous contemporaries Peter Martyr and Marineus Siculus, the influence of the new learning of the Renaissance. At the age of twenty-one, Alessandro served under Ferdinand and Isabella as the Castilians defeated the Portuguese at Toro. He became cupbearer to Isabella, and traveled with Antonio, when the latter was secretary to John II of Aragon, on visits to Francis II, Duke of Brittany, and to Edward IV of England.
This study examines the impacts of two types of advertising content—healthy eating and anti-obesity advertising—on the demand for healthy and unhealthy food and beverage items. We show that differentiating consumers by weight is crucial in fully understanding the effects of advertising content on food and beverage demand. We find that among overweight individuals, anti-obesity advertisements are more effective than healthy eating advertisements at reducing the demand for unhealthy items and increasing the demand for healthy items. Furthermore, the magnitude of this effect increases with BMI. We discuss possible explanations and policy implications based on our results.
The US National Center for Health Statistics (NCHS) defines fetal death as “death prior to the complete expulsion or extraction from the mother of a product of human conception, irrespective of the duration of pregnancy and which is not an induced termination of pregnancy.” This definition is subcategorized by the gestational age at which the demise occurred: embryonic death at ≤ 12+6 weeks, early fetal death at 13–19+6 weeks’ gestation, intermediate fetal death at 20–27+6 weeks’ gestation, and late fetal death at ≥28 weeks’ gestation. The NCHS recommends reporting fetal deaths at ≥ 20 weeks’ gestation or, should the gestational age be unknown, a fetal weight of ≥ 350 grams, which represents the 50th percentile of weight at 20 weeks. Excluded from the definition of fetal death and associated statistics are losses due to induction after previable premature rupture of membranes or terminations/inductions for lethal fetal anomalies.
Exposure to threat-related early life stress (ELS) has been related to vulnerability for stress-related disorders in adulthood, putatively via disrupted corticolimbic circuits involved in stress response and regulation. However, previous research on ELS has not examined both the intrinsic strength and flexibility of corticolimbic circuits, which may be particularly important for adaptive stress responding, or associations between these dimensions of corticolimbic dysfunction and acute stress response in adulthood.
Seventy unmedicated women varying in history of threat-related ELS completed a functional magnetic resonance imaging scan to evaluate voxelwise static (overall) and dynamic (variability over a series of sliding windows) resting-state functional connectivity (RSFC) of bilateral amygdala. In a separate session and subset of participants (n = 42), measures of salivary cortisol and affect were collected during a social-evaluative stress challenge.
Higher severity of threat-related ELS was related to more strongly negative static RSFC between amygdala and left dorsolateral prefrontal cortex (DLPFC), and elevated dynamic RSFC between amygdala and rostral anterior cingulate cortex (rACC). Static amygdala-DLPFC antagonism mediated the relationship between higher severity of threat-related ELS and blunted cortisol response to stress, but increased dynamic amygdala-rACC connectivity weakened this mediated effect and was related to more positive post-stress mood.
Threat-related ELS was associated with RSFC within lateral corticolimbic circuits, which in turn was related to blunted physiological response to acute stress. Notably, increased flexibility between the amygdala and rACC compensated for this static disruption, suggesting that more dynamic medial corticolimbic circuits might be key to restoring healthy stress response.
At the lowest radio frequencies (≤30 MHz), the Earth's ionosphere transmits poorly or not at all. This relatively unexplored region of the electromagnetic spectrum is thus an area where high resolution, high sensitivity observations can open a new window for astronomical investigations. Also, extending observations down to very low frequencies brings astronomy to a fundamental physical limit where the Milky Way becomes optically thick over relatively short path lengths due to diffuse free-free absorption.
Ashley Smith lived and died at a confluence of legal sanctions and correctional policy, norms, decisions, and indifference. This article approaches her incarceration primarily through a particular articulation of legal pluralism. Martha-Marie Kleinhans and Roderick A. Macdonald argue legal subjects should be understood as creating law in relationship with laws/norms. The Correctional Service of Canada (CSC) treated Smith as an excluded legal subject through practices of isolation, but the correctional norms evolving in relationship with her resultant distress simultaneously indicate CSC treated Smith as if she were effectively a law-producer, capable of changing policy. However, treating her as a source of norm-creation assumes equality/power Smith did not have. The story leading to Smith’s death in custody illustrates two primary themes regarding the production of law/norms. First, the legal subject within a critical legal pluralism should be widened to encompass those who act within/against (and are acted upon by) legal/normative systems characterized by extreme power disparities. Drawing on Martha Fineman’s vulnerability analysis, I argue such legal subjects should be understood/treated as vulnerable, implicating an enlarged role for institutions. Second, I follow the broad dictates of a critical legal pluralism to demonstrate how the reciprocally constitutive (though unequal) relationship between the legal subject and legal/normative orders manifested in Smith’s incarceration and attendant changes to correctional norms.
In this study, we isolate and analyse a new set of microsatellite loci for Cattleya walkeriana. Twenty-two primer pairs were screened for C. walkeriana (n = 32) and assessed for their transferability to Cattleya loddigesii (n = 12) and Cattleya nobilior (n = 06). All loci amplified for C. walkeriana; however, for C. loddigesii and C. nobilior, four and five primers, respectively, did not present amplification. The polymorphic loci presented between 2 and 13 alleles per locus for both C. walkeriana and C. loddigesii, with respective averages of 5.1 and 4.2. For C. nobilior, we found between two and five alleles per locus, with an average of 2.6. For C. walkeriana, observed heterozygosity varied from 0.100 to 0.966, whereas expected heterozygosity ranged from 0.097 to 0.900. The observed and expected heterozygosity for C. loddigesii and C. nobilior were also estimated. We found no significant linkage disequilibrium between any pair of loci, and evidence of null alleles at four loci (Cw16, Cw24, Cw30 and Cw31) for C. walkeriana. The combined power to exclude the first parent and combined non-exclusion probability of identity were 0.999 and 2.3 × 10−20, respectively. These new loci can be used in studies of germplasm resources, and assessments of genotypic and genetic diversity and population structure, thus improving the accuracy of such analyses and their applicability in the conservation and protection of these endangered species.
We present moderate to high signal-to-noise high-resolution (R ≈ 150,000–170,000) optical spectra toward ζ Oph. Gaussian fits to our data indicate a value of the line-width parameter b, of b = 1.4 ± 0.2 km s−1, along this line of sight. When CN is used as an indirect probe of the cosmic microwave background (CMB) temperature, the line profile is used to determine saturation corrections in the line. This affects column density calculations, which are reflected in the excitation temperature. Current measurements of the b-value along this line of sight range from 0.88 ± 0.02 km s−1 (Crane et al. 1986) to 1.3 ± 0.1 km s−1 (Hegyi, Traub, and Carleton 1972). The extreme range of these b-values yield saturation corrections to the CMB temperature that differ by 0.05 K, which is equal to the quoted precision of current measurements. Preliminary analysis of observations toward HD 29647 indicate that TCMB = 2.70 ± 0.14 K at 2.64 mm toward this line of sight.
Catheter-associated urinary tract infections (CAUTIs) are among the most common hospital-acquired infections (HAIs). Reducing CAUTI rates has become a major focus of attention due to increasing public health concerns and reimbursement implications.
To implement and describe a multifaceted intervention to decrease CAUTIs in our ICUs with an emphasis on indications for obtaining a urine culture.
A project team composed of all critical care disciplines was assembled to address an institutional goal of decreasing CAUTIs. Interventions implemented between year 1 and year 2 included protocols recommended by the Centers for Disease Control and Prevention for placement, maintenance, and removal of catheters. Leaders from all critical care disciplines agreed to align routine culturing practice with American College of Critical Care Medicine (ACCCM) and Infectious Disease Society of America (IDSA) guidelines for evaluating a fever in a critically ill patient. Surveillance data for CAUTI and hospital-acquired bloodstream infection (HABSI) were recorded prospectively according to National Healthcare Safety Network (NHSN) protocols. Device utilization ratios (DURs), rates of CAUTI, HABSI, and urine cultures were calculated and compared.
The CAUTI rate decreased from 3.0 per 1,000 catheter days in 2013 to 1.9 in 2014. The DUR was 0.7 in 2013 and 0.68 in 2014. The HABSI rates per 1,000 patient days decreased from 2.8 in 2013 to 2.4 in 2014.
Effectively reducing ICU CAUTI rates requires a multifaceted and collaborative approach; stewardship of culturing was a key and safe component of our successful reduction efforts.
The IntCal04 and Marine04 radiocarbon calibration curves have been updated from 12 cal kBP (cal kBP is here defined as thousands of calibrated years before AD 1950), and extended to 50 cal kBP, utilizing newly available data sets that meet the IntCal Working Group criteria for pristine corals and other carbonates and for quantification of uncertainty in both the 14C and calendar timescales as established in 2002. No change was made to the curves from 0–12 cal kBP. The curves were constructed using a Markov chain Monte Carlo (MCMC) implementation of the random walk model used for IntCal04 and Marine04. The new curves were ratified at the 20th International Radiocarbon Conference in June 2009 and are available in the Supplemental Material at www.radiocarbon.org.
The ALFA mission is designed to map the entire sky at frequencies between approximately 0.3 and 30 MHz with angular resolution limited by interstellar and interplanetary scattering. Most of this region of the spectrum is inaccessible from the ground because of absorption and refraction by the Earth’s ionosphere. A wide range of astrophysical questions concerning solar system, galactic, and extragalactic objects could be answered with high resolution images at low frequencies, where absorption effects and coherent emission processes become important and the synchrotron lifetimes of electrons are comparable to the age of the universe.
The Caune de l'Arago Cave (southern France) has yielded one of the best preserved and best documented sedimentary successions of the European Middle Pleistocene (Oxygen Isotopic Stages 14 to 12). Herbivorous ungulates (horse, reindeer, red deer, fallow deer, bison, musk ox, argali, and tahr) are well represented in the three major stratigraphic units CM1, CM2, and CM3. CM1 and CM3 correspond to cold and dry climate and CM2 represents temperate and humid environmental conditions. Dental microwear and mesowear analyses were performed for the ungulates from CM1–3 to test whether these methods of dental wear evaluation were suitable for detecting climate-driven changes in the dietary resources of the Arago ungulate community. We found that both dental mesowear and microwear indicate dietary traits and their relationship to climatic conditions as reflected by vegetation cover and community structure. In all units, even if some species seem to share habitats or resources, it appears that the overlap in their feeding ecology is very low. The CM1 and CM3 units, where pollen analysis indicates that the climate was cold and dry, show the lowest diversity in dietary traits. The CM2, where climate is known to be more temperate and humid, the spectrum of dietary traits is large—grazers, browsers, and mixed feeders are present.
A new site with Lateglacial palaeosols covered by 0.8 - 2.4 m thick aeolian sands is presented. The buried soils were subjected to multidisciplinary analyses (pedology, micromorphology, geochronology, dendrology, palynology, macrofossils). The buried soil cover comprises a catena from relatively dry (’Nano’-Podzol, Arenosol) via moist (Histic Gleysol, Gleysol) to wet conditions (Histosol). Dry soils are similar to the so-called Usselo soil, as described from sites in NW Europe and central Poland. The buried soil surface covers ca. 3.4 km2. Pollen analyses date this surface into the late Allerød. Due to a possible contamination by younger carbon, radiocarbon dates are too young. OSL dates indicate that the covering by aeolian sands most probably occurred during the Younger Dryas. Botanical analyses enables the reconstruction of a vegetation pattern typical for the late Allerød. Large wooden remains of pine and birch were recorded.
High-quality data from appropriate archives are needed for the continuing improvement of radiocarbon calibration curves. We discuss here the basic assumptions behind 14C dating that necessitate calibration and the relative strengths and weaknesses of archives from which calibration data are obtained. We also highlight the procedures, problems, and uncertainties involved in determining atmospheric and surface ocean 14C/12C in these archives, including a discussion of the various methods used to derive an independent absolute timescale and uncertainty. The types of data required for the current IntCal database and calibration curve model are tabulated with examples.
The IntCal09 and Marine09 radiocarbon calibration curves have been revised utilizing newly available and updated data sets from 14C measurements on tree rings, plant macrofossils, speleothems, corals, and foraminifera. The calibration curves were derived from the data using the random walk model (RWM) used to generate IntCal09 and Marine09, which has been revised to account for additional uncertainties and error structures. The new curves were ratified at the 21st International Radiocarbon conference in July 2012 and are available as Supplemental Material at www.radiocarbon.org. The database can be accessed at http://intcal.qub.ac.uk/intcal13/.