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The current study reports on first-trimester reference ranges of plasma mineral Se/Zn/Cu concentration in relation to free thyroxine (FT4), thyrotropin (TSH) and thyroid peroxidase antibodies (TPO-Ab), assessed at 12 weeks’ gestation in 2041 pregnant women, including 544 women not taking supplements containing Se/Zn/Cu. The reference range (2.5th – 97.5th percentiles) in these 544 women was 0.72 – 1.25 µmol/L for Se, 17.15 – 35.98 µmol/L for Cu, and 9.57 – 16.41 µmol/L for Zn. These women had significantly lower mean plasma Se concentration (0.94 µmol/L, SD 0.12) than those (N = 1479) taking Se/Zn/Cu supplements (1.03 µmol/L, SD, 0.14; P < 0.001) while the mean Cu (26.25 µmol/L) and Zn (12.55 µmol/L) concentrations were almost identical in these sub-groups. Women with hypothyroxinemia (FT4 below reference range with normal TSH) had significantly lower plasma Zn concentrations than euthyroid women. After adjusting for co-variates including supplement intake, plasma Se (negatively), Zn and Cu (positively) concentrations were significantly related to logFT4; Se and Cu (but not Zn) were positively and significantly related to logTSH. Women taking additional Se/Zn/Cu supplements were 1.46 (95% CI: 1.09 – 2.04) times less likely to have elevated titres of TPO-Ab at 12 weeks of gestation. We conclude that first-trimester Se reference ranges are influenced by Se-supplement intake while Cu and Zn ranges are not. Plasma mineral Se/Zn/Cu concentration are associated with thyroid FT4 and TSH concentrations. Se/Zn/Cu supplement intake affects TPO-Ab status. Future research should focus on the impact of trace-mineral status during gestation on thyroid function.
In colorectal surgery, the composition of the most effective bundle for prevention of surgical site infections (SSI) remains uncertain. We performed a meta-analysis to identify bundle interventions most associated with SSI reduction.
We systematically reviewed 4 databases for studies that assessed bundles with ≥3 elements recommended by clinical practice guidelines for adult colorectal surgery. The main outcome was 30-day postoperative SSI rate (overall, superficial, deep, and/or organ-space).
We included 40 studies in the qualitative review, and 35 studies (54,221 patients) in the quantitative review. Only 3 studies were randomized controlled trials. On meta-analyses, bundles were associated with overall SSI reductions of 44% (RR, 0.57; 95% CI, 0.48–0.65); superficial SSI reductions of 44% (RR, 0.56; 95% CI, 0.42–0.75); deep SSI reductions of 33% (RR, 0.67; 95% CI, 0.46–0.98); and organ-space SSI reductions of 37% (RR, 0.63; 95% CI, 0.50–0.81). Bundle composition was heterogeneous. In our meta-regression analysis, bundles containing ≥11 elements, consisting of both standard of care and new interventions, demonstrated the greatest SSI reduction. Separate instrument trays, gloves with and without gown change for wound closure, and standardized postoperative dressing change at 48 hours correlated with the highest reductions in superficial SSIs. Mechanical bowel preparation combined with oral antibiotics, and preoperative chlorhexidine showers correlated with highest organ-space SSI reductions.
Preventive bundles emphasizing guideline-recommended elements from both standard of care as well as new interventions were most effective for SSI reduction following colorectal surgery. High clinical-bundle heterogeneity and low quality for most observational studies significantly limit our conclusion.
The literature shows that fighting against stigma with actions on a less grandiose scale seems to be more effective. (Sartorius, 2002)An example is interventions directed at medical personnel including psychiatrists, who are often important sources of stigmatization. The general public and even health professionals tend to hold a stereotyped image of those with schizophrenia. Before starting an educational program anti-stigma we consider important to know which are the most frequent misconceptions of medical personnel.
This study want to assess the most frequent misconceptions associated with patients with schizophrenia between medical personnel.
Material and methods:
we applied a questionnaire to three groups: medical students before studying psychiatry, medical personnel working in psychiatric setting and health professionals in general hospital.
health professionals contribute to stigmatisation of mental illness, using inadequate terms in defining psychiatric affection and a inadequate attitude; the majority of third group don't understand mental illness and avoids contact with psychiatric patients.
The study underlines the presence of misconceptions associated with patients with schizophrenia between health professionals and the results could be used for a concrete plan for fighting against stigma of this psychiatric disease.
When the heart is in danger – as is true during a myocardial infarction (MI) – this is life-threatening and as such can provoke specific fear: so-called cardiac anxiety. Both general anxiety and depression are associated with cardiac prognosis in MI-patients. However, as most treatment studies have not shown beneficial effects on cardiac prognosis, the need to examine specific aspects of anxiety and depression post-MI has been advocated.
We examined whether cardiac anxiety can be reliably assessed with the Cardiac Anxiety Questionnaire (CAQ) in 237 hospitalized MI-patients. Cross-sectional associations were explored, as well as possible trajectories of cardiac anxiety in the year post-MI (by latent class-analysis) and its association with quality of life. Finally, the prognostic association of cardiac anxiety with major adverse cardiac events (MACE) including all-cause mortality was examined with cox-regression-survival analysis.
The CAQ is a valid and reliable instrument in MI-patients and assessed fear, attention, avoidance of physical exercise, and safety-seeking behavior. Higher cardiac anxiety was associated with more psychological distress but lower severity in cardiac injury. In the year post-MI four cardiac anxiety trajectories were identified; higher cardiac anxiety was associated with worse quality of life. CAQ score significantly predicted MACE in a five-year-follow-up period, even after adjustment for age, cardiac disease severity and depressive symptoms (HRbaseline: 1.60 [95% CI: 1.05–2.45], P = 0.029; HR3-months: 1.71 [0.99–2.59]; P = 0.054).
Cardiac anxiety is an important and potentially modifiable factor in the treatment of MI-patients: it is prevalent and associated with quality of life and cardiac prognosis.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
We solve the inverse differential Galois problem over differential fields with a large field of constants of infinite transcendence degree over
. More generally, we show that over such a field, every split differential embedding problem can be solved. In particular, we solve the inverse differential Galois problem and all split differential embedding problems over
Alternatives to skin preparation with conventional preoperative antiseptics are required because of adverse reactions and the potential emergence of resistance. Here, we present 2 phase 2 studies of ZuraGard (ZG), a novel formulation of isopropyl alcohol and functional excipients developed for preoperative skin antisepsis.
Microbial skin flora on abdominal and inguinal sites in healthy volunteers were quantitatively assessed following application of ZG versus a negative control (ZV) and a chlorhexidine/alcohol preparation, Chloraprep (CP). In trial 1, ZG administered for both recommended and abbreviated application times was compared with CP and ZV via bacterial reductions at 10 minutes, and 6 hours, 12 hours, and 24 hours following application. In trial 2, the 10-minute postapplication responder rates (RRs) for ZG, participants with abdominal ≥2 log10 per cm2, and inguinal ≥3 log10 per cm2 reductions in colony-forming units (CFU) were compared to RRs of participants treated with CP.
In trial 1, ZG at the recommended application time reduced mean bacterial counts by ~3.18 log10 CFU/cm2 and ~2.98 log10 CFU/cm2 at abdominal and inguinal sites, respectively. Qualitatively similar reductions were observed for the abbreviated ZG application time and all CP applications. Application of ZV was ineffective. In trial 2, 10-minute RRs for ZG and CP exceeded 90% at abdominal sites. At inguinal sites, RRs were 83.3% for ZG and 86.7% for CP. No skin irritation or other adverse events were observed.
ZG matched CP efficacy under these experimental conditions with immediate and persistent microbial reductions, including abbreviated application times. Further clinical studies of this novel preoperative antiseptic are merited.
For a company it is necessary to know, which products can be configured using carry-over-parts or the same technology. This can become quite relevant in the context of automobile electrification, where complex mechatronic systems are used. Consisting of various mechanical components, these systems perform the required function while being actuated by electronically controlled motors. To solve this, a novel mechanism for data driven portfolio analysis based on product platforms using knowledge-based systems is proposed in this paper. Further, the mechanism is tested by applying it to an electrical motors' case study. Using this method, all possible combinations of a product platform are calculated and finally displayed in different product portfolios. Additionally, all the non-feasible motor designs are removed from the solutions portfolio using the acquired knowledge base and performing design checks. The latter are employed for penalising and eliminating from the pareto-front of the designs, which violate the thermal, mechanical and acoustic constraints. The generated product portfolio can be used further to expand the systems engineering collaboration and support decision-making.
In this invited talk, we discuss the physics of the lifecycle of dust in the context of galaxy formation simulations. After outlining the basic physical processes, we apply algorithms for the formation, growth, and destruction of dust in the ISM to a state-of-the-art cosmological simulation to develop a model for the evolution of the dust to gas and dust to metals ratios in galaxies. We show that while modern simulations are able to match the observed dust mass function at redshift z = 0, most models underpredict the observed mass function at high-redshift (z = 2). We then show the power of these techniques by expanding our model to include a spectrum of dust sizes, and make initial predictions for extinction laws in local galaxies.
The aetiology of nausea and vomiting during pregnancy (NVP) is multifactorial, but the relative contribution of biological and psychological determinants is insufficiently understood. We examined the association of human chorionic gonadotropin (hCG), thyroid hormones (thyroid-stimulating hormone and thyroxin) and psychological factors with NVP.
Blood chemistry and psychological measures were obtained in 1682 pregnant women participating in the Holistic Approach to Pregnancy and the first Postpartum Year (HAPPY) study between 12 and 14 weeks of gestation. The presence of NVP was measured using the Pregnancy-Unique Quantification of Emesis scale. Depressive symptoms were assessed using the Edinburgh Depression Scale. Multivariable logistic regression analyses were used to investigate the independent role of hCG, thyroid hormones and depression as related to NVP, adjusting for age, body mass index, education, parity, smoking status, unplanned pregnancy and history of depression.
Elevated levels of NVP were observed in 318 (18.9%) participants. High hCG levels [odds ratio (OR) = 1.47, 95% confidence interval (CI) = 1.11–1.95], elevated depressive symptoms in the first trimester (OR = 1.67, 95% CI = 1.15–2.43) and a history of depression (OR = 1.53, 95% CI = 1.11–2.11) were independently related to high NVP. Multiparity (OR = 1.47, 95% CI = 1.12–1.92) and younger age (OR = 0.91, 95% CI = 0.87–0.94) were also associated with high NVP, whereas (sub)clinical hyperthyroidism was not related to high NVP.
The current study is the first to demonstrate that a combination of hCG hormone and psychological factors are independently related to nausea and vomiting during early pregnancy.
Current practice guidelines recommend cefazolin, cefoxitin, cefotetan, or ampicillin-sulbactam as first-line antibiotic prophylaxis in hysterectomy. We undertook this systematic review and meta-analysis of randomized controlled trials (RCTs) to determine whether cefazolin, with limited antianaerobic spectrum, is as effective in preventing surgical site-infection (SSI) as the other first-choice antimicrobials that have more extensive antianaerobic activity.
We searched PubMed, Scopus, Web of Science, Cochrane Central, and EMBASE for relevant randomized controlled trials (RCT) in any language up to January 23, 2018. We only included trials that measured SSI (our primary outcome) defined as superficial, deep, or organ space. We excluded trials of β-lactams no longer in clinical use.
In terms of SSI incidence, cefazolin use was not inferior to its comparator in 12 of 13 individual RCTs included in the analysis. The meta-analysis summary estimate showed a significantly higher SSI risk with cefazolin versus cefoxitin or cefotetan (risk ratio, 1.7; 95% CI, 1.04–2.77; P = .03). However, most studies included nonstandardized dosing and duration of antimicrobial prophylaxis, had indeterminate or high risk of bias, did not include patients with gynecological malignancies, and/or were older RCTs not reflective of current clinical practices.
Due to inherent limitations associated with old RCTs with limited relevance to contemporary surgery, an RCT of cefazolin versus regimens with significant antianaerobic spectrum is needed to establish the optimal choice for SSI prevention in hysterectomy.
Second-century CE (common era) household pottery sherds found in the city of Napoca (present day Cluj-Napoca, Romania) in Roman Dacia were investigated by polarized light optical microscopy, X-ray powder diffraction, Fourier-transform infrared spectroscopy and cold field emission scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy to obtain information on technology, raw materials and site of production. Compositionally, all samples are similar with comparable fine and semi-fine microstructures and oriented microtextures. Optically, there is a gradual transition from microcrystalline to an amorphous illitic-muscovitic matrix. The small aplastic inclusions are mostly quartz and feldspar. Fine-grained carbonate aggregates are distributed inhomogeneously in the ceramic body. Well-preserved Middle Miocene foraminifera tests are characteristic of the ceramics. The gradual thermal changes of the matrix and the newly formed phases upon firing, such as ‘ceramic melilite’, Fe-gehlenite, clinopyroxene, glass, hematite and some maghemite support inferences regarding the technological constraints in producing the pottery. The firing took place in a mostly oxidizing atmosphere and the temperature extended from at least 850°C to >900°C. The Middle Miocene marly clay from the area surrounding the site shows similar mineralogical and micropalaeontological contents to those of the ceramic specimens and is the best candidate for the raw material used for local production of the Roman pottery.
Little is known about potential harmful effects as a consequence of self-guided internet-based cognitive behaviour therapy (iCBT), such as symptom deterioration rates. Thus, safety concerns remain and hamper the implementation of self-guided iCBT into clinical practice. We aimed to conduct an individual participant data (IPD) meta-analysis to determine the prevalence of clinically significant deterioration (symptom worsening) in adults with depressive symptoms who received self-guided iCBT compared with control conditions. Several socio-demographic, clinical and study-level variables were tested as potential moderators of deterioration.
Randomised controlled trials that reported results of self-guided iCBT compared with control conditions in adults with symptoms of depression were selected. Mixed effects models with participants nested within studies were used to examine possible clinically significant deterioration rates.
Thirteen out of 16 eligible trials were included in the present IPD meta-analysis. Of the 3805 participants analysed, 7.2% showed clinically significant deterioration (5.8% and 9.1% of participants in the intervention and control groups, respectively). Participants in self-guided iCBT were less likely to deteriorate (OR 0.62, p < 0.001) compared with control conditions. None of the examined participant- and study-level moderators were significantly associated with deterioration rates.
Self-guided iCBT has a lower rate of negative outcomes on symptoms than control conditions and could be a first step treatment approach for adult depression as well as an alternative to watchful waiting in general practice.
Difficult asthma is a severe subgroup of asthma in which the main feature is uncontrollability of symptoms. Psychopathology is suggested to be prominent in patients with difficult asthma and considered important in its treatment; however, the evidence is scarce.
To describe psychopathology in difficult asthma, both major mental and personality disorders, based on diagnostic interviews.
This study was conducted in a specialised asthma care centre. A total of 51 patients with difficult asthma were diagnosed at the start of the treatment programme using two structured clinical interviews for both major mental (SCID-I) and personality disorders (SCID-II) according to DSM-IV-TR.
About 55% of the patients with difficult asthma had a psychiatric disorder of which 89% was undiagnosed and untreated before being interviewed. About 49% had a minimum of one major mental disorder of which the cluster of anxiety disorders was the most common cluster of major mental disorders, followed by somatoform disorders. About 20% were diagnosed with a personality disorder. Of the 10 patients with a personality disorder, 9 had an obsessive-compulsive personality disorder.
This study demonstrates that more than half of patients with difficult asthma had a psychiatric disorder of which 89% was unrecognised. This study highlights the importance of offering patients with difficult asthma a psychiatric diagnostic interview and/or a psychiatric consultation as part of their routine medical examination and provision of appropriate psychiatric treatment. Moreover, it highlights the urgency of further research into the role of psychopathology in the development of difficult asthma.
The postpartum period is well-known risk period for the first onset of autoimmune thyroid disorders (AITDs) as well as first onset of psychiatric disorders. These two disorders are some of the most prevalent medical conditions postpartum, often misdiagnosed and disabling if left untreated. Our study was designed to explore the possible bidirectional association between AITDs and psychiatric disorders during the postpartum period.
A population-based cohort study through linkage of Danish national registers, which comprised 312 779 women who gave birth to their first child during 1997–2010. We conducted Poisson regression analysis to estimate the incidence rate ratio (IRR) of psychiatric disorders among women with first-onset AITDs, the IRR of AITDs among women with first-onset psychiatric disorders as well as the overlap between these disorders using a comorbidity index.
Women with first-onset AITDs postpartum were more likely to have first-onset psychiatric disorders than women who did not have postpartum AITDs (IRR = 1.88, 95% confidence interval (CI): 1.25–2.81). Women with first-onset postpartum psychiatric disorders had a higher risk of AITDs than women with no psychiatric disorders (IRR = 2.16, 95% CI: 1.45–3.20). The comorbidity index 2 years after delivery was 2.26 (95% CI: 1.61–2.90), indicating a comorbidity between first-onset AITDs and psychiatric disorders.
First-onset AITDs and psychiatric disorders co-occur in the postpartum period, which has relevance to further studies on the etiologies of these disorders and why childbirth in particular triggers the onset.
The process of initial ice formation in brine is a highly complex problem. In this paper, we propose a mathematical model that captures the dynamics of nucleation and development of ice inclusions in brine. The primary emphasis is on the interaction between ice growth and salt diffusion, subject to external forcing provided by temperature. Within this setting two freezing regimes are identified, depending on the rate of change of the temperature: a slow freezing regime where a continuous ice domain is formed; and a fast freezing regime where recurrent nucleation appears within the fluid domain. The second regime is of primary interest, as it leads to fractal-like ice structures. We analyse the critical threshold between the slow and fast regimes by identifying the explicit rates of external temperature control that lead to self-similar salt-concentration profiles in the fluid domains. Subsequent heuristic analysis provides estimates of the characteristic length scales of the fluid domains depending on the time-variation of the temperature. The analysis is confirmed by numerical simulations.