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Patients with major depressive disorder (MDD) display cognitive deficits in acutely depressed and remitted states. Childhood maltreatment is associated with cognitive dysfunction in adults, but its impact on cognition and treatment related cognitive outcomes in adult MDD has received little consideration. We investigate whether, compared to patients without maltreatment and healthy participants, adult MDD patients with childhood maltreatment display greater cognitive deficits in acute depression, lower treatment-associated cognitive improvements, and lower cognitive performance in remission.
Healthy and acutely depressed MDD participants were enrolled in a multi-center MDD predictive marker discovery trial. MDD participants received 16 weeks of standardized antidepressant treatment. Maltreatment and cognition were assessed with the Childhood Experience of Care and Abuse interview and the CNS Vital Signs battery, respectively. Cognitive scores and change from baseline to week 16 were compared amongst MDD participants with (DM+, n = 93) and without maltreatment (DM−, n = 90), and healthy participants with (HM+, n = 22) and without maltreatment (HM−, n = 80). Separate analyses in MDD participants who remitted were conducted.
DM+ had lower baseline global cognition, processing speed, and memory v. HM−, with no significant baseline differences amongst DM−, HM+, and HM− groups. There were no significant between-group differences in cognitive change over 16 weeks. Post-treatment remitted DM+, but not remitted DM−, scored significantly lower than HM− in working memory and processing speed.
Childhood maltreatment was associated with cognitive deficits in depressed and remitted adults with MDD. Maltreatment may be a risk factor for more severe and persistent cognitive deficits in adult MDD.
In an effort to optimize patient outcomes, considerable attention is being devoted to identifying patient characteristics associated with major depressive disorder (MDD) and its responsiveness to treatment. In the current study, we extend this work by evaluating whether early change in these sensitivities is associated with response to antidepressant treatment for MDD.
Participants included 210 patients with MDD who were treated with 8 weeks of escitalopram and 112 healthy comparison participants. Of the original 210 patients, 90 non-responders received adjunctive aripiprazole for an additional 8 weeks. Symptoms of depression and anhedonia were assessed at the beginning of treatment and 8 weeks later in both samples. Reward and punishment sensitivity were assessed using the BIS/BAS scales measured at the initiation of treatment and 2 weeks later.
Individuals with MDD exhibited higher punishment sensitivity and lower reward sensitivity compared with healthy comparison participants. Change in reward sensitivity during the first 2 weeks of treatment was associated with improved depressive symptoms and anhedonia following 8 weeks of treatment with escitalopram. Similarly, improvement in reward responsiveness during the first 2 weeks of adjunctive therapy with aripiprazole was associated with fewer symptoms of depression at post-treatment.
Findings highlight the predictive utility of early change in reward sensitivity during antidepressant treatment for major depression. In a clinical setting, a lack of change in early reward processing may signal a need to modify a patient's treatment plan with alternative or augmented treatment approaches.
An updated compilation of published and new data of major-ion (Ca, Cl, K, Mg, Na, NO3, SO4) and methylsulfonate (MS) concentrations in snow from 520 Antarctic sites is provided by the national ITASE (International Trans-Antarctic Scientific Expedition) programmes of Australia, Brazil, China, Germany, Italy, Japan, Korea, New Zealand, Norway, the United Kingdom, the United States and the national Antarctic programme of Finland. The comparison shows that snow chemistry concentrations vary by up to four orders of magnitude across Antarctica and exhibit distinct geographical patterns. The Antarctic-wide comparison of glaciochemical records provides a unique opportunity to improve our understanding of the fundamental factors that ultimately control the chemistry of snow or ice samples. This paper aims to initiate data compilation and administration in order to provide a framework for facilitation of Antarctic-wide snow chemistry discussions across all ITASE nations and other contributing groups. The data are made available through the ITASE web page (http://www2.umaine.edu/itase/content/syngroups/snowchem.html) and will be updated with new data as they are provided. In addition, recommendations for future research efforts are summarized.
Deriving glacier outlines from satellite data has become increasingly popular in the past decade. In particular when glacier outlines are used as a base for change assessment, it is important to know how accurate they are. Calculating the accuracy correctly is challenging, as appropriate reference data (e.g. from higher-resolution sensors) are seldom available. Moreover, after the required manual correction of the raw outlines (e.g. for debris cover), such a comparison would only reveal the accuracy of the analyst rather than of the algorithm applied. Here we compare outlines for clean and debris-covered glaciers, as derived from single and multiple digitizing by different or the same analysts on very high- (1 m) and medium-resolution (30 m) remote-sensing data, against each other and to glacier outlines derived from automated classification of Landsat Thematic Mapper data. Results show a high variability in the interpretation of debris-covered glacier parts, largely independent of the spatial resolution (area differences were up to 30%), and an overall good agreement for clean ice with sufficient contrast to the surrounding terrain (differences ∼5%). The differences of the automatically derived outlines from a reference value are as small as the standard deviation of the manual digitizations from several analysts. Based on these results, we conclude that automated mapping of clean ice is preferable to manual digitization and recommend using the latter method only for required corrections of incorrectly mapped glacier parts (e.g. debris cover, shadow).
An analysis of snow-cover variability over Northern Hemisphere land masses reveals a continuation of the subnormal coverage that began in the late 1980s (relative to the 1972–present interval). While the 1994 snow year (September 1993–August 1994) exhibited a return to near-normal hemispheric extent, only three months during this period had above-normal coverage. Only 11 of the past 88 months (through October 1994) have been above the norm. Deficits have been most common in spring, over both the Eurasian and North American continents. This is a hemisphere-wide situation; positive correlations are identified between hemispheric and regional snow extents in spring, as well as in fall and winter. A number of significant associations are also recognized between regions during these three seasons; however, it is uncommon to see more than 50% of the variance in one region explained by another. These correlations are most common between adjacent regions, but some are found between regions on different continents. Only in spring are significant positive relationships between non-adjacent regions on the same continent observed.
Skin and soft tissue infections (SSTIs) due to Staphylococcus aureus have become increasingly common in the outpatient setting; however, risk factors for differentiating methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) SSTIs are needed to better inform antibiotic treatment decisions. We performed a case-case-control study within 14 primary-care clinics in South Texas from 2007 to 2015. Overall, 325 patients [S. aureus SSTI cases (case group 1, n = 175); MRSA SSTI cases (case group 2, n = 115); MSSA SSTI cases (case group 3, n = 60); uninfected control group (control, n = 150)] were evaluated. Each case group was compared to the control group, and then qualitatively contrasted to identify unique risk factors associated with S. aureus, MRSA, and MSSA SSTIs. Overall, prior SSTIs [adjusted odds ratio (aOR) 7·60, 95% confidence interval (CI) 3·31–17·45], male gender (aOR 1·74, 95% CI 1·06–2·85), and absence of healthcare occupation status (aOR 0·14, 95% CI 0·03–0·68) were independently associated with S. aureus SSTIs. The only unique risk factor for community-associated (CA)-MRSA SSTIs was a high body weight (⩾110 kg) (aOR 2·03, 95% CI 1·01–4·09).
We report on new measurements extending the spectral range of our earlier photometry (Frey et al. 1974) to the near ultraviolet. The residual extinction caused by atmospheric ozone was found to be 0.m25 ± 0.m13 (2950 Å) and 0m36 ± 0m13 (2150 Å) at 41.5 km float altitude. Within the errors of 10-30% arising from calibration and the reduction procedure our measurements at 5000, 3450, and 2950 Å are compatible to a colour of the zodiacal light not different from that of the sun. Our result obtained at 2150 Å is an upper limit, since no reduction of airglow and integrated starlight has been done yet at that wavelength. This upper limit is 30% above a solar-like spectrum. This result is not in contradiction to the 0A0-2 measurements (Lillie 1972). The strong intensity increase he found occurs at wavelengths below 2150 Å.
Recent work in the Upper Cretaceous of northeastern Mexico has produced a diversity of vertebrate remains. For specimens referable to Squamata, both old and new, an annotated catalogue is here provided, wherein are summarised the geological context and morphological features of each specimen. All specimens appear to represent marine squamates, including an aigialosaur-like reptile preserving integumentary structures, several vertebrae possibly representing mosasauroids, the first Mexican mosasaur known from significant cranial material, an isolated mosasaur mandibular fragment, and the holotype of Amphekepubis johnsoni (considered to belong to Mosasaurus). These discoveries are auspicious and should deepen our understanding of palaeobiogeographic and evolutionary patterns
Clostridium difficile infection (CDI) in hospitalized patients is generally attributed to the current stay, but recent studies reveal high C. difficile colonization rates on admission.
To determine the rate of colonization with toxigenic C. difficile among intensive care unit patients upon admission as well as acquired during hospitalization, and the risk of subsequent CDI.
Prospective cohort study from April 15 through July 8, 2013. Adults admitted to an intensive care unit within 48 hours of admission to the Johns Hopkins Hospital, Baltimore, Maryland, were screened for colonization with toxigenic C. difficile. The primary outcome was risk of developing CDI.
Among 542 patients, 17 (3.1%) were colonized with toxigenic C. difficile on admission and an additional 3 patients were found to be colonized during hospitalization. Both colonization with toxigenic C. difficile on admission and colonization during hospitalization were associated with an increased risk for development of CDI (relative risk, 10.29 [95% CI, 2.24–47.40], P=.003; and 15.66 [4.01–61.08], P<.001, respectively). Using multivariable analysis, colonization on admission and colonization during hospitalization were independent predictors of CDI (relative risk, 8.62 [95% CI, 1.48–50.25], P=.017; and 10.93 [1.49–80.20], P=.019, respectively), while adjusting for potential confounders.
In intensive care unit patients, colonization with toxigenic C. difficile is an independent risk factor for development of subsequent CDI. Further studies are needed to identify populations with higher toxigenic C. difficile colonization rates possibly benefiting from screening or avoidance of agents known to promote CDI.
Infect. Control Hosp. Epidemiol. 2015;36(11):1324–1329
Currently, limited studies have quantified the risk of methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTIs) for MRSA-colonized patients on discharge from hospital. Our retrospective, case-control study identified independent risk factors for the development of MRSA SSTIs among such patients detected by active MRSA nasal screening in an acute care hospital by PCR on admission, and bacteriological cultures on discharge. Cases were MRSA-colonized patients aged ⩾18 years who developed a MRSA SSTI post-discharge and controls were those who did not develop a MRSA SSTI post-discharge. Controls were matched to cases by length of follow-up (±10 days) for up to 18 months. Potential demographic and clinical risk factors for MRSA infection were identified using electronic queries and manual chart abstraction; data were compared by standard statistical tests and variables with P values ⩽0·05 in bivariable analysis were entered into a logistic regression model. Multivariable analysis demonstrated prior hospital admission within 12 months (P = 0·02), prior MRSA infection (P = 0·05), and previous myocardial infarction (P = 0·01) were independently predictive of a MRSA SSTI post-discharge. Identification of MRSA colonization upon admission and recognition of risk factors could help identify a high-risk population that could benefit from MRSA SSTI prevention strategies.
Background: Older adults with mental health disorders underutilize mental health services more than other adults. While there are well known general barriers to help seeking across the population, specific barriers for older adults include difficulties with transportation, beliefs that it is normal to be anxious and depressed in old age, and beliefs by referrers that psychological therapy is less likely to be effective. This study examined barriers related to identifying the need for help, seeking help and participating in therapy in a clinical population of older adults.
Method: Sixty older adults (aged 60–79 years) with comorbid anxiety and unipolar mood disorders completed barriers to treatment questionnaires before and after psychological group treatment, as well as measures of cognitive ability, anxiety, depression, and quality of life at baseline.
Results: The greatest barriers to help seeking related to difficulties identifying the need for help, with 50% of the sample reporting their belief that their symptoms were normal as a major barrier. Other major barriers identified were related to: self-reliance, cost of treatment, and fear of medication replicating previous findings. The main barriers reported for difficulties in continuing therapy included not finding therapy helpful, cost of treatment, and thinking that the therapist did not understand their issues.
Conclusions: The main barriers identified related to issues with identifying the need to seek help. More attention is needed to educate older adults and professionals about the need for, and effectiveness of, psychological therapies for older adults with anxiety and depression to reduce this barrier to help seeking.
The jet phenomenon is a trademark of active galactic nuclei (AGN). In most general terms, the current understanding of this phenomenon explains the jet appearance by effects of relativistic plasma physics. The fundamental source of energy that feeds the plasma flow is believed to be the gravitational field of a central supermassive black hole. While the mechanism of energy transfer and a multitude of effects controlling the plasma flow are yet to be understood, major properties of jets are strikingly similar in a broad range of scales from stellar to galactic. They are supposed to be controlled by a limited number of physical parameters, such as the mass of a central black hole and its spin, magnetic field induction and accretion rate. In a very simplified sense, these parameters define the formation of a typical core–jet structure observed at radio wavelengths in the region of the innermost central tens of parsecs in AGN. These core–jet structures are studied in the radio domain by Very Long Baseline Interferometry (VLBI) with milli- and sub-milliarcsecond angular resolution. Such structures are detectable at a broad range of redshifts. If observed at a fixed wavelength, a typical core–jet AGN morphology would appear as having a steep-spectrum jet fading away with the increasing redshift while a flat-spectrum core becoming more dominant. If core–jet AGN constitute the same population of objects throughout the redshift space, the apparent “prominence” of jets at higher redshifts must decrease (Gurvits 1999): well pronounced jets at high z must appear less frequent than at low z.
This paper explores the role of a designer's sense of engagement in early stage design. In the field of virtual reality, presence and immersion are standard measures of an individual's sense of engagement and involvement in an activity. High levels of presence might indicate that the designer is highly focused on the work. The central research question is the following: do designers who are more engaged in design activity, as measured by presence and immersive tendency questionnaires, produce better designs? An experiment was conducted to assess presence and immersive tendencies within the context of a hands-on, open-ended design-and-build activity. The results indicated that the designers' sense of immersion and presence ranged widely as well as their sense of frustration and calmness while performing the design activity. It was found that higher levels of presence correlated with either high design performance or low design performance. Lower levels of presence correlated with average design performance. No correlations were found between immersive tendency and design performance. This study suggests that some level of presence can be linked with better design, and it implies that level of presence might serve as an indicator of performance and learning in similar design-and-build activities.
The current situation of volatile milk prices and rising costs of, e.g. grain and labour, suggests that it is worth studying productivity and efficiency in dairy farming. The objective of the current whole-system study, carried out in lowland Central Switzerland from 2007 to 2010, was to compare the performance, efficiency, land productivity and profitability of indoor-feeding (IF) dairy production with that of pasture-based feeding (PF) dairy production. An IF herd consisting of 11 Holstein–Friesian (HF) and 13 Brown Swiss (BS) cows was kept in a free-stall barn and fed a part-mixed ration (PMR) of maize silage, grass silage and protein concentrate. The cows were allocated 15·8 ha of agricultural land (AL). In the PMR, an average per lactation of 443 kg protein concentrate and 651 kg compound feed was fed by a concentrate dispenser according to the requirements of each cow. The PF herd comprised 14 Swiss Fleckvieh (SF) and 14 BS cows, which were kept in a free-stall barn throughout the winter; barn-ventilated hay was offered ad libitum during the lactation period. This herd was allocated 15·7 ha of AL. After calving in spring, the PF cows grazed on semi-continuous pastures; they consumed an average of 285 kg of concentrate per lactation. The IF cows of the BS breed produced significantly more energy-corrected milk (ECM) per standard lactation compared with PF cows (8750 v. 5610 kg), more milk fat (350 v. 213 kg) and more milk protein (306 v. 203 kg). However, the milk of PF cows had higher levels of conjugated linoleic acid (CLA) (1·9 v. 0·6 g/100 g fat) and ω−3 fatty acids (1·7 v. 0·9 g/100 g fat) than the milk of the IF cows. The calving interval (378 v. 405 days) and the empty time (87 v. 118 days) of the BS breed were significantly shorter in the PF in comparison with that of the IF production system. The IF herd yielded significantly higher ECM/ha AL and year (12 716 v. 10 307 kg), and showed a higher feed efficiency (1·3 v. 1·1 kg ECM/kg of total dry matter intake (DMI)). The productivity per hour was roughly similar in the two systems (IF: 76 v. PF: 73 kg milk/h). The PF system resulted in higher labour income compared with the IF system (20·7 v. 13·4 €/h), but the difference was not significant. In conclusion, land productivity and efficiency were higher with the IF herd than the PF herd due to the higher energy intake per kg feed. However, within the given conditions, the more interesting case, economically, might be the reduced costs and improved milk quality of the PF system rather than the increased milk yield of the IF cows.
The genetic contribution to many neuropsychiatric disorders is disclosed by obtaining a family history. Patients with dissociative and conversion disorders often present to subspecialists in Behavioral Neurology & Neuropsychiatry (BN&NP). BN&NP remains a bastion of bedside medicine in an increasingly technological medical world. The clinician should screen for other symptoms when a dissociative or conversion disorder diagnosis is under consideration. Clinicians should routinely ask about nocturnal sleep timing and duration, sleep quality, and excessive daytime sleepiness. Many patients presenting with psychiatric symptoms have a remote history of traumatic brain injury (TBI), and a screening question about TBI should be routine in the psychiatric evaluation. Patients with many cerebral diseases, including incipient degenerative disease, cerebrovascular disease, multiple sclerosis, and past mild TBI, experience cognitive problems that are distressing and noticeable to others but not of a severity sufficient to warrant a diagnosis of dementia.