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Vascular involvement in neurofibromatosis type 1 has been described, although coronary artery disease is rare. Data about clinical presentation and natural history are anecdotal. This is the first case of myocardial infarction due to coronary aneurysms in a 13-year-old boy with neurofibromatosis type 1. We discuss pathophysiology, diagnostic images, and therapeutic management of this rare association.
Little is know about COVID-19 outcome in specific populations such as Adult congenital heart disease (ACHD) patients. We report three cases of adult patients with similar underlying disease with completely different clinical severity at the time of COVID-19 infection. The patient with the most severe clinical course was obese and diabetic, suggesting that COVID-19 mortality and morbidity in Adult congenital heart disease patients might be independent of anatomic complexity.
We aim to assess the diagnostic role of QRS fragmentation in children with suspected acute myocarditis.
Diagnosis of myocarditis in the paediatric population is challenging. Clinical suspicion, electrocardiogram, and laboratory tests are the main diagnostic features at presentation. However, electrocardiogram in patients with myocarditis is usually considered aspecific. We have previously described QRS fragmentation in adult patients with acute myocarditis.
Patients aged less than 18 years, admitted between 2003 and 2019, and discharged with a diagnosis of acute myocarditis were included. Standard electrocardiogram, laboratory, and echocardiographic findings at admission and follow-up were reviewed. QRS fragmentation was defined by the presence of multiphasic R′ spikes. Cardiac magnetic resonance and biopsy were performed in selected patients.
Twenty-one patients were analysed, 16 males (76%), median age 9.5 (2.5–16) years. At presentation, 12 patients (57%) displayed QRS fragmentation. Median ejection fraction was 40% (27–60). Nine patients (43%) underwent cardiac magnetic resonance and displayed late gadolinium enhancement. One patient underwent biopsy that showed borderline findings. Electrocardiogram leads showing QRS fragmentation correlated with distribution of late gadolinium enhancement. Median follow-up was 600 (190–2343) days. All patients were alive at last follow-up. Six patients (33%) patients displayed persistence of QRS fragmentation. Median ejection fraction was 60% (60–65%). In three patients (14%), ejection fraction remained depressed, two of which showed persistence of QRS fragmentation.
In this cohort of children with suspected myocarditis, QRS fragmentation was confirmed as a new additional diagnostic finding to look for at admission and during follow-up.
There is a substantial proportion of patients who drop out of treatment before they receive minimally adequate care. They tend to have worse health outcomes than those who complete treatment. Our main goal is to describe the frequency and determinants of dropout from treatment for mental disorders in low-, middle-, and high-income countries.
Respondents from 13 low- or middle-income countries (N = 60 224) and 15 in high-income countries (N = 77 303) were screened for mental and substance use disorders. Cross-tabulations were used to examine the distribution of treatment and dropout rates for those who screened positive. The timing of dropout was examined using Kaplan–Meier curves. Predictors of dropout were examined with survival analysis using a logistic link function.
Dropout rates are high, both in high-income (30%) and low/middle-income (45%) countries. Dropout mostly occurs during the first two visits. It is higher in general medical rather than in specialist settings (nearly 60% v. 20% in lower income settings). It is also higher for mild and moderate than for severe presentations. The lack of financial protection for mental health services is associated with overall increased dropout from care.
Extending financial protection and coverage for mental disorders may reduce dropout. Efficiency can be improved by managing the milder clinical presentations at the entry point to the mental health system, providing adequate training, support and specialist supervision for non-specialists, and streamlining referral to psychiatrists for more severe cases.
The screen for cognitive impairment in psychiatry (SCIP) is a brief, accessible scale designed for detecting cognitive deficits in psychiatric disorders.
The objective of this study is to test the SCIP's validity as a cognitive test by comparison with standard neuropsychological scale using the Pearson's correlation.
Aims Test the convergent and discriminant validity of the SCIP within the Italian SCIP validation project.
Patients between 18 and 65 years who are in a stable phase of the disease, diagnosed with schizophrenia, schizoaffective disorder or bipolar I disorder were enrolled in this study, from the community mental health department of Ferrara.
The tests were administered to 110 patients (mean age: 45 ± 11,4) and to 86 controls (mean age: 35 ± 12,6) of both sex. SCIP presents high correlation with the R-BANS total score (P < 0.01) and the subscales (verbal learning test-immediate, working memory, verbal fluency test, verbal learning test-delayed, processing speed test, P < 0.01). There are significant differences (P < 0.01) in all SCIP dimensions between patient and control group (Table 1).
Our analysis confirm the results of the English, French and Spanish version of the SCIP regarding convergent and discriminant validity. The SCIP represents a valid, simple and brief screening tool for the cognitive evaluation of patients with schizophrenia-spectrum disorders.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
This article presents a new (multivalued) semantics for classical propositional logic. We begin by maximally extending the space of sequent proofs so as to admit proofs for any logical formula; then, we extract the new semantics by focusing on the axiomatic structure of proofs. In particular, the interpretation of a formula is given by the ratio between the number of identity axioms out of the total number of axioms occurring in any of its proofs. The outcome is an informational refinement of traditional Boolean semantics, obtained by breaking the symmetry between tautologies and contradictions.
In this paper, we propose and explore a new approach to abstract machines and optimal reduction via streams, infinite sequences of elements. We first define a sequential abstract machine capable of performing directed virtual reduction (DVR) and then we extend it to its parallel version, whose equivalence is explained through the properties of DVR itself. The result is a formal definition of the λ-calculus interpreter called Parallel Environment for Lambda Calculus Reduction (PELCR), a software for λ-calculus reduction based on the Geometry of Interaction. In particular, we describe PELCR as a stream-processing abstract machine, which in principle can also be applied to infinite streams.
While many Latin teachers are successfully implementing Comprehensible Input-based practices1 in their classrooms, plenty of teachers are hesitant to do so - and for good reason. One need only follow the discussions on the various blogs and Facebook groups dedicated to CI-based practices to see a predictable arc that goes from enthusiastic implementation to giving up and falling back on previous practices. Teachers who are attracted to CI-based practices are often those who also are frustrated with the traditional textbooks and curricula, and so a change in methods is often accompanied by a loosening of a traditional unit structure, or even the daily and weekly structure of a traditional language classroom. To do this, however, is to confuse the content of classroom instruction with the practices that contain them, the latter being an important element of classroom management.
Reduction of body size is a common response of organisms to environmental stress. Studying the early Toarcian succession in the Lusitanian Basin of Portugal, we tested whether the shell size of benthic marine communities of bivalves and brachiopods changed at and before the global, warming–related Toarcian oceanic anoxic event (T-OAE). Statistical analyses of shell size over time show that the mean shell size of communities decreased significantly before the T-OAE. This trend is distinct in brachiopods and is caused by larger-sized species becoming less abundant over time, whereas it is not significant in bivalves, suggesting a decoupled response to environmental stress. Reductions in shell size precede the decline in standardized sample-level species richness associated with the early Toarcian extinction event. Such decreases in the shell size of marine invertebrates, well before the onset of biodiversity change, suggest that reductions in body size more generally may be a precursor of a subsequent loss of species and turnover at the community level caused by climate change. Sedimentological evidence is against hypoxia as a driver of extinction and the preceding size decrease in the brachiopod fauna in the studied succession, although low oxygen levels are widely held responsible for elevated early Toarcian extinction rates globally. Reduction of mean shell size in brachiopods but stasis in bivalves is difficult to explain with ocean acidification, because experimental work shows that brachiopods can be resilient to lowered pH, albeit long-term metabolic costs and potential evolutionary adaptations are unknown. Rising early Toarcian temperatures in the Lusitanian Basin seem to be a plausible factor in both diversity decline associated with the T-OAE and the preceding reductions in mean shell size, because thermal tolerances in modern bivalves are among the highest within marine invertebrates.
Until now there are only few data on the effects of thermal treatments on the nutritional and hygienic characteristics of donkey milk. This Research Communication aims to provide information on the effects of pasteurization (at +65 °C for 30 min) and prolonged storage at refrigeration and freezing temperatures (21 d at + 3 °C ± 2 °C and up to 90 d at −20 °C ± 5 °C) on some nutritional and hygienic characteristics of Amiata donkey milk. The milk was monitored by chemical and microbiological analysis. Pasteurization ensured compliance with EC Regulation No 1441/2007, as Enterobacteriaceae were never found in the milk, or during storage at refrigeration and freezing temperatures. Colony count at 30 °C in pasteurized milk never went beyond 1 log CFU/ml. The heat treatment and the storage did not result in any variations in the main constituents of the milk. Only a decrease in lactose and few variations in some fatty acids at 90 d of freezing were observed. In conclusion, pasteurization was able to achieve and maintain a high hygienic-sanitary quality over time; storage at refrigeration or freezing temperatures did not alter the nutritional quality of fat and the gross composition of the product. These findings are useful to improve knowledge on the milk shelf life in order to guarantee safety and nutritional quality for infants who need small quantities of daily milk.
Previous work has identified associations between psychotic experiences (PEs) and general medical conditions (GMCs), but their temporal direction remains unclear as does the extent to which they are independent of comorbid mental disorders.
In total, 28 002 adults in 16 countries from the WHO World Mental Health (WMH) Surveys were assessed for PEs, GMCs and 21 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders. Discrete-time survival analyses were used to estimate the associations between PEs and GMCs with various adjustments.
After adjustment for comorbid mental disorders, temporally prior PEs were significantly associated with subsequent onset of 8/12 GMCs (arthritis, back or neck pain, frequent or severe headache, other chronic pain, heart disease, high blood pressure, diabetes and peptic ulcer) with odds ratios (ORs) ranging from 1.3 [95% confidence interval (CI) 1.1–1.5] to 1.9 (95% CI 1.4–2.4). In contrast, only three GMCs (frequent or severe headache, other chronic pain and asthma) were significantly associated with subsequent onset of PEs after adjustment for comorbid GMCs and mental disorders, with ORs ranging from 1.5 (95% CI 1.2–1.9) to 1.7 (95% CI 1.2–2.4).
PEs were associated with the subsequent onset of a wide range of GMCs, independent of comorbid mental disorders. There were also associations between some medical conditions (particularly those involving chronic pain) and subsequent PEs. Although these findings will need to be confirmed in prospective studies, clinicians should be aware that psychotic symptoms may be risk markers for a wide range of adverse health outcomes. Whether PEs are causal risk factors will require further research.
The patterns of comorbidity among mental disorders have led researchers to model the underlying structure of psychopathology. While studies have suggested a structure including internalizing and externalizing disorders, less is known with regard to the cross-national stability of this model. Moreover, little data are available on the placement of eating disorders, bipolar disorder and psychotic experiences (PEs) in this structure.
We evaluated the structure of mental disorders with data from the World Health Organization Composite International Diagnostic Interview, including 15 lifetime mental disorders and six PEs. Respondents (n = 5478–15 499) were included from 10 high-, middle- and lower middle-income countries across the world aged 18 years or older. Confirmatory factor analyses (CFAs) were used to evaluate and compare the fit of different factor structures to the lifetime disorder data. Measurement invariance was evaluated with multigroup CFA (MG-CFA).
A second-order model with internalizing and externalizing factors and fear and distress subfactors best described the structure of common mental disorders. MG-CFA showed that this model was stable across countries. Of the uncommon disorders, bipolar disorder and eating disorder were best grouped with the internalizing factor, and PEs with a separate factor.
These results indicate that cross-national patterns of lifetime common mental-disorder comorbidity can be explained with a second-order underlying structure that is stable across countries and can be extended to also cover less common mental disorders.
Although childhood adversities are known to predict increased risk of post-traumatic stress disorder (PTSD) after traumatic experiences, it is unclear whether this association varies by childhood adversity or traumatic experience types or by age.
To examine variation in associations of childhood adversities with PTSD according to childhood adversity types, traumatic experience types and life-course stage.
Epidemiological data were analysed from the World Mental Health Surveys (n = 27017).
Four childhood adversities (physical and sexual abuse, neglect, parent psychopathology) were associated with similarly increased odds of PTSD following traumatic experiences (odds ratio (OR)=1.8), whereas the other eight childhood adversities assessed did not predict PTSD. Childhood adversity–PTSD associations did not vary across traumatic experience types, but were stronger in childhood-adolescence and early-middle adulthood than later adulthood.
Childhood adversities are differentially associated with PTSD, with the strongest associations in childhood-adolescence and early-middle adulthood. Consistency of associations across traumatic experience types suggests that childhood adversities are associated with generalised vulnerability to PTSD following traumatic experiences.
Research on post-traumatic stress disorder (PTSD) course finds a substantial proportion of cases remit within 6 months, a majority within 2 years, and a substantial minority persists for many years. Results are inconsistent about pre-trauma predictors.
The WHO World Mental Health surveys assessed lifetime DSM-IV PTSD presence-course after one randomly-selected trauma, allowing retrospective estimates of PTSD duration. Prior traumas, childhood adversities (CAs), and other lifetime DSM-IV mental disorders were examined as predictors using discrete-time person-month survival analysis among the 1575 respondents with lifetime PTSD.
20%, 27%, and 50% of cases recovered within 3, 6, and 24 months and 77% within 10 years (the longest duration allowing stable estimates). Time-related recall bias was found largely for recoveries after 24 months. Recovery was weakly related to most trauma types other than very low [odds-ratio (OR) 0.2–0.3] early-recovery (within 24 months) associated with purposefully injuring/torturing/killing and witnessing atrocities and very low later-recovery (25+ months) associated with being kidnapped. The significant ORs for prior traumas, CAs, and mental disorders were generally inconsistent between early- and later-recovery models. Cross-validated versions of final models nonetheless discriminated significantly between the 50% of respondents with highest and lowest predicted probabilities of both early-recovery (66–55% v. 43%) and later-recovery (75–68% v. 39%).
We found PTSD recovery trajectories similar to those in previous studies. The weak associations of pre-trauma factors with recovery, also consistent with previous studies, presumably are due to stronger influences of post-trauma factors.