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SR is a 50-year-old, former professional golfer. Five years ago, he had a lower back injury, which required extensive physiotherapy. He never fully recovered and subsequently retired from the professional golfers’ tour. During this time, he had become increasingly worried about the future, about whether he could even play golf socially and became concerned about his financial security. S’s sleep became disrupted and his alcohol consumption increased, drinking bourbon (whisky) most evenings. Also, he was going through divorce proceedings initiated by his wife, following frequent arguments and a breakdown in their marriage.
The timing of the Neanderthal-associated Middle Palaeolithic demise and a possible overlap with anatomically modern humans (AMH) in some regions of Eurasia continues to be debated. The Iberian Peninsula is considered a possible refuge zone for the last Neanderthals, but the chronology of the later Middle Palaeolithic record has undergone revision and has increased the debate on the timing of Neanderthal extinction. Here we report on a study of the 5-m-thick archaeological stratigraphy of the Cardina-Salto do Boi, an open-air site located in inland Iberia, from which optically stimulated luminescence (OSL) ages were obtained for Middle and Upper Palaeolithic occupations preserved in overbank alluvial deposits. Geomorphology, archaeostratigraphy, stone-tool evolution, and OSL dating support the persistence of Neanderthals after 41 ka in central Iberia; the transition between the Middle Palaeolithic material culture and the AMH-associated Aurignacian blade and bladelet production is estimated to lie between 34.0 ± 2.0 ka and 38.4 ± 1.9 ka. Our results demonstrate that investigations focusing on different geomorphological situations are necessary to overcome the current limitations of the evidence and to establish more consistent models for Neanderthal disappearance and AMH expansion in the Iberian Peninsula.
Fossil material from the Maastrichtian part of the Scollard Formation is identified as belonging to an acanthomorph fish. An articulated specimen, preserved in part and counterpart, is a member of the paracanthopterygian order Percopsiformes, based on it having a full neural spine on the second preural centrum and two epurals in the caudal skeleton (both paracanthopterygian characters), as well as six branchiostegal rays and an anterodorsal excavated margin on the opercle (percopsiform characters). We name this as a new genus and species, Lindoeichthys albertensis. A phylogenetic analysis with no prior constraints recovered a single most-parsimonious tree with the new taxon placed as the sister group to a clade containing the Palaeocene Montana genus Mcconichthys + Percopsidae. However, this analysis did not recover the traditional percopsiforms (including Aphredoderidae and Amblyopsidae) as monophyletic. A second analysis, in which we constrained the traditional members of the Percopsiformes to be monophyletic, resulted in the new species being placed as the sister group to Percopsis. The articulated percopsiform specimen from the Pisces Point locality allows isolated dentaries from vertebrate microfossil localities to be identified as being from a member of that group. These isolated elements first appear in the late Campanian Judith River Group of Alberta and the Kaiparowits Formation of Utah, documenting that percopsiform fishes were present in the Western Interior of North America at least 75 Ma ago.
Translocation and rehabilitation programmes are critical tools for wildlife conservation. These methods achieve greater impact when integrated in a combined strategy for enhancing population or ecosystem restoration. During 2002–2016 we reared 37 orphaned southern sea otter Enhydra lutris nereis pups, using captive sea otters as surrogate mothers, then released them into a degraded coastal estuary. As a keystone species, observed increases in the local sea otter population unsurprisingly brought many ecosystem benefits. The role that surrogate-reared otters played in this success story, however, remained uncertain. To resolve this, we developed an individual-based model of the local population using surveyed individual fates (survival and reproduction) of surrogate-reared and wild-captured otters, and modelled estimates of immigration. Estimates derived from a decade of population monitoring indicated that surrogate-reared and wild sea otters had similar reproductive and survival rates. This was true for males and females, across all ages (1–13 years) and locations evaluated. The model simulations indicated that reconstructed counts of the wild population are best explained by surrogate-reared otters combined with low levels of unassisted immigration. In addition, the model shows that 55% of observed population growth over this period is attributable to surrogate-reared otters and their wild progeny. Together, our results indicate that the integration of surrogacy methods and reintroduction of juvenile sea otters helped establish a biologically successful population and restore a once-impaired ecosystem.
In this study, we investigate quartz-based luminescence optical dating of Iron Age deposits at the archaeological site of Tell Damiyah in the Jordan valley. Ten samples, taken from different occupation layers from two different excavation areas, proved to have good luminescence characteristics (fast-component dominated, dose recovery ratio 1.032 ± 0.010, n=24). The optical ages are completely consistent with both available 14C ages and ages based on stylistic elements; it appears that this material was fully reset at deposition, although it is recognised that the agreement with age control is somewhat dependent on the assumed field water content of the samples. Further comparison with different OSL signals from feldspar, or investigations based on dose distributions from individual grains would be desirable to independently confirm the resetting of this material. It is concluded that the sediments of Tell Damiyah are very suitable for luminescence dating. Despite the relatively large associated age uncertainties of between 5 and 10%, OSL at tell sites has the potential to provide ages for material very difficult to date by conventional methods, and to identify reworked mixtures of older artifacts in a younger depositional setting.
Background: Endovascular thrombectomy (EVT) has shown efficacy in acute ischemic stroke (AIS) patients with infective endocarditis (IE). The possibility to undertake advanced histopathological clot analysis following EVT offers a new avenue to establish the etiological basis of the stroke – which is often labelled “cryptogenic.” In this paper, we present our findings from four consecutive patients with IE who underwent EVT following an AIS at our tertiary referral comprehensive stroke centre. Methods: Comprehensive histopathological analysis of clot retrieved after EVT, including morphology, was undertaken. Results: The consistent observation was the presence of dense paucicellular fibrinoid material mixed/interspersed with clusters of bacterial cocci. This clot morphology may be specific to septic embolus due to IE unlike incidental bacteraemia and could possibly explain the refractoriness of such clots to systemic thrombolysis. Conclusion: Detailed morphological and histopathological analysis of EVT-retrieved clots including Gram staining can assist in etiological classification of the clot. Understanding the composition of the clot may be of clinical value in early diagnostics and mapping treatment planning in IE.
Objectives: We assessed trends in the incidence, prevalence, and post-diagnosis mortality of parkinsonism in Ontario, Canada over 18 years. We also explored the influence of a range of risk factors for brain health on the trend of incident parkinsonism. Methods: We established an open cohort by linking population-based health administrative databases from 1996 to 2014 in Ontario. The study population comprised residents aged 20–100 years with an incident diagnosis of parkinsonism ascertained using a validated algorithm. We calculated age- and sex-standardized incidence, prevalence, and mortality of parkinsonism, stratified by young onset (20–39 years) and mid/late onset (≥40 years). We assessed trends in incidence using Poisson regression, mortality using negative binomial regression, and prevalence of parkinsonism and pre-existing conditions (e.g., head injury) using the Cochran–Armitage trend test. To better understand trends in the incidence of mid/late-onset parkinsonism, we adjusted for various pre-existing conditions in the Poisson regression model. Results: From 1996 to 2014, we identified 73,129 incident cases of parkinsonism (source population of ∼10.5 million), of whom 56% were male, mean age at diagnosis was 72.6 years, and 99% had mid/late-onset parkinsonism. Over 18 years, the age- and sex-standardized incidence decreased by 13.0% for mid/late-onset parkinsonism but remained unchanged for young-onset parkinsonism. The age- and sex-standardized prevalence increased by 22.8%, while post-diagnosis mortality decreased by 5.5%. Adjustment for pre-existing conditions did not appreciably explain the declining incidence of mid/late-onset parkinsonism. Conclusion: Young-onset and mid/late-onset parkinsonism exhibited differing trends in incidence over 18 years in Ontario. Further research to identify other factors that may appreciably explain trends in incident parkinsonism is warranted.
There is increasing evidence for shared genetic susceptibility between schizophrenia and bipolar disorder. Although genetic variants only convey subtle increases in risk individually, their combination into a polygenic risk score constitutes a strong disease predictor.
To investigate whether schizophrenia and bipolar disorder polygenic risk scores can distinguish people with broadly defined psychosis and their unaffected relatives from controls.
Using the latest Psychiatric Genomics Consortium data, we calculated schizophrenia and bipolar disorder polygenic risk scores for 1168 people with psychosis, 552 unaffected relatives and 1472 controls.
Patients with broadly defined psychosis had dramatic increases in schizophrenia and bipolar polygenic risk scores, as did their relatives, albeit to a lesser degree. However, the accuracy of predictive models was modest.
Although polygenic risk scores are not ready for clinical use, it is hoped that as they are refined they could help towards risk reduction advice and early interventions for psychosis.
Declaration of interest
R.M.M. has received honoraria for lectures from Janssen, Lundbeck, Lilly, Otsuka and Sunovian.
There is no consensus as to whether magnetic resonance imaging (MRI) should be used as part of the initial clinical evaluation of patients with first-episode psychosis (FEP).
(a) To assess the logistical feasibility of routine MRI; (b) to define the clinical significance of radiological abnormalities in patients with FEP.
Radiological reports from MRI scans of two FEP samples were reviewed; one comprised 108 patients and 98 healthy controls recruited to a research study and the other comprised 241 patients scanned at initial clinical presentation plus 66 healthy controls.
In the great majority of patients, MRI was logistically feasible. Radiological abnormalities were reported in 6% of the research sample and in 15% of the clinical sample (odds ratio (OR) = 3.1, 95% CI 1.26–7.57, χ2(1) = 6.63, P = 0.01). None of the findings necessitated a change in clinical management.
Rates of neuroradiological abnormalities in FEP are likely to be underestimated in research samples that often exclude patients with organic abnormalities. However, the majority of findings do not require intervention.
Background: The role of aggressive surgical manipulation with clot evacuation, arachnoid dissection, and papaverine-guided adventitial dissection of large vessels during ruptured aneurysm surgery in reducing vasospasm is controversial. Here we describe a single-institution experience in aneurysm surgery outcomes with and without aggressive surgery. Methods: We performed retrospective analysis of all patients >18 years of age with subarachnoid hemorrhage (SAH) from anterior circulation aneurysms between 2008 and 2013 at the University of New Mexico Hospital. Vasospasm was characterized on days 3 through 14 after SAH based on: (1) angiography, (2) vasospasm requiring angiographic intervention, (3) development of delayed ischemic neurologic deficit (DIND), and (4) radiological appearance of new strokes. Results: Of 159 patients, 114 (71.6%) had “aggressive” and 45 (28.3%) had standard microsurgery. More than 60% of patients presented with a Hunt and Hess score of ≥3 and a Fisher grade (FG) of 4. Compared with standard surgery, there was a statistically significant decrease in the incidence of DIND in patients undergoing aggressive surgery (18.4% vs 37.8%, p=0.01). Moreover, there was a reduction in the number of new strokes by 30% in the aggressive surgery group with moderate or higher degrees of vasospasm (46.0% vs 76.5%, p=0.06). In the same group with FG 4 SAH, however, this difference was more than 50% (30% vs 64.7%, p=0.02). Conclusions: We conclude that aggressive surgical manipulation during aneurysm surgery results in lower incidence of DIND and new strokes. This effect is most pronounced in patients with FG 4 SAH.
We present a study based on four inland eolian locations in Eastern, Central and Southeastern Lithuania belonging to the northeastern part of the ‘European Sand Belt’ (ESB). Although there have been several previous studies of the ESB, this north-eastern extension has not been investigated before in any detail. The sedimentary structural–textural features are investigated and a chronology was derived using optically stimulated luminescence on both quartz and feldspar. The sedimentary structures and the rounding and surface characteristics of the quartz grains argue for a predominance of eolian transport. Additionally, some structural alternations and a significant contribution of non-eolian grains are interpreted as inherited local glacial/glaciofluvial-bearing lithologies.
Three main (glaciolacustrine–) eolian phases are distinguished based on the position in the landscape and the luminescence ages: (1) An older eolian series around 15 to 16 ka, possibly correlated with the cold GS-2a event according to the GRIP stratigraphy, and (2) a younger eolian series around 14.0 ka, possibly representing the GI-1d and 1c events. The older eolian series is underlain by (3) a glaciolacustrine–eolian series for which the period of deposition remains uncertain due to the significant discrepancy between the ages based on quartz and feldspar.
Current guidelines for image-guided cervical cancer brachytherapy planning recommend both computed tomography (CT) and magnetic resonance imaging (MRI) for adequate visualisation of the applicator and soft tissues, respectively. MRI-only planning would be ideal as it would save time within the patient pathway and avoid the concomitant CT exposures. However, applicator visualisation on MRI is usually achieved using fluid-filled fiducial marker tubes, which can be awkward to use and suffer from unwanted air bubble artefacts. Therefore, a new fiducial-free imaging technique was developed.
A dual echo time (TE) turbo spin echo sequence was used, at 1·5 T, to provide both T2-weighted images (100 ms TE) for tissue visualisation and strongly proton density-weighted images (17 ms TE) for improved applicator visualisation. In-house software was used to automatically segment the applicator in the short TE images (using Otsu's method) and transfer the information to the long TE images to provide a single fused dataset.
The method was evaluated successfully using titanium applicators in three patient cases and using a plastic applicator in a tissue-equivalent gel phantom.
The dual-echo technique provides a simple and efficient method for improving the visualisation of brachytherapy applicators in cervical cancer MRI images without the need for marker tubes.
Some data suggest that older adults with anxiety disorders do not respond as well to treatment as do younger adults.
We examined age differences in outcomes from the Coordinated Anxiety Learning and Management (CALM) study, an effectiveness trial comparing usual care to a computer-assisted collaborative care intervention for primary care patients with panic disorder, generalised anxiety disorder, post-traumatic stress disorder (PTSD), and/or social anxiety disorder. This is the first study to examine the efficacy of a collaborative care intervention in a sample that included both younger and older adults with anxiety disorders. We hypothesised that older adults would show a poorer response to the intervention than younger adults.
We examined findings for the overall sample, as well as within each diagnostic category (clinicaltrials.gov identifier: NCT00347269).
The CALM intervention was more effective than usual care among younger adults overall and for those with generalised anxiety disorder, panic disorder and social anxiety disorder. Among older adults, the intervention was effective overall and for those with social anxiety disorder and PTSD but not for those with panic disorder or generalised anxiety disorder. The effects of the intervention also appeared to erode by the 18-month follow-up, and there were no significant effects on remission among the older adults.
These results are consistent with the findings of other investigators suggesting that medications and psychotherapy for anxiety disorders may not be as effective for older individuals as they are for younger people.