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Pulmonary hypertension is a complex and progressive condition that is either idiopathic or heritable, or associated with one or multiple health conditions, with or without congenital or acquired cardiovascular disease. Recent developments have tremendously increased the armamentarium of diagnostic and therapeutic approaches in children and young adults with pulmonary hypertension that is still associated with a high morbidity and mortality. These modalities include non-invasive imaging, pharmacotherapy, interventional and surgical procedures, and supportive measures. The optimal, tailored diagnostic and therapeutic strategies for pulmonary hypertension in the young are rapidly evolving but still face enormous challenges: Healthcare providers need to take the patient’s age, development, disease state, and family concerns into account when initiating advanced diagnostics and treatment. Therefore, there is a need for guidance on core and advanced medical training in paediatric pulmonary hypertension. The Association for European Paediatric and Congenital Cardiology working group “pulmonary hypertension, heart failure and transplantation” has produced this document as an expert consensus statement; however, all recommendations must be considered and applied in the context of the local and national infrastructure and legal regulations.
The origin of malnutrition in older age is multifactorial and risk factors may vary according to health and living situation. The present study aimed to identify setting-specific risk profiles of malnutrition in older adults and to investigate the association of the number of individual risk factors with malnutrition.
Data of four cross-sectional studies were harmonized and uniformly analysed. Malnutrition was defined as BMI < 20 kg/m2 and/or weight loss of >3 kg in the previous 3–6 months. Associations between factors of six domains (demographics, health, mental function, physical function, dietary intake-related problems, dietary behaviour), the number of individual risk factors and malnutrition were analysed using logistic regression.
Community (CD), geriatric day hospital (GDH), home care (HC), nursing home (NH).
CD older adults (n 1073), GDH patients (n 180), HC receivers (n 335) and NH residents (n 197), all ≥65 years.
Malnutrition prevalence was lower in CD (11 %) than in the other settings (16–19 %). In the CD sample, poor appetite, difficulties with eating, respiratory and gastrointestinal diseases were associated with malnutrition; in GDH patients, poor appetite and respiratory diseases; in HC receivers, younger age, poor appetite and nausea; and in NH residents, older age and mobility limitations. In all settings the likelihood of malnutrition increased with the number of potential individual risk factors.
The study indicates a varying relevance of certain risk factors of malnutrition in different settings. However, the relationship of the number of individual risk factors with malnutrition in all settings implies comprehensive approaches to identify persons at risk of malnutrition early.
The Hamilton Depression Rating Scale (HAMD) and the Beck Depression Inventory (BDI) are the most frequently used observer-rated and self-report scales of depression, respectively. It is important to know what a given total score or a change score from baseline on one scale means in relation to the other scale.
We obtained individual participant data from the randomised controlled trials of psychological and pharmacological treatments for major depressive disorders. We then identified corresponding scores of the HAMD and the BDI (369 patients from seven trials) or the BDI-II (683 patients from another seven trials) using the equipercentile linking method.
The HAMD total scores of 10, 20 and 30 corresponded approximately with the BDI scores of 10, 27 and 42 or with the BDI-II scores of 13, 32 and 50. The HAMD change scores of −20 and −10 with the BDI of −29 and −15 and with the BDI-II of −35 and −16.
The results can help clinicians interpret the HAMD or BDI scores of their patients in a more versatile manner and also help clinicians and researchers evaluate such scores reported in the literature or the database, when scores on only one of these scales are provided. We present a conversion table for future research.
We present first results from a coordinated multiwavelength study of the neutron star low-mass X-ray binary EXO 0748 676. Fast UV, X-ray, and optical data were obtained including both spectral and timing information. We discuss how this study allows us to probe the temperature distribution within the binary and hence the geometry and efficiency of X-ray irradiation.
We present soft X-ray photomosaic images of two supernova remnants, Puppis A and IC 443, constructed from a series of exposures by the Einstein imaging instruments. The complex morphologies displayed in these images reflect the interaction between “middle-aged” supernova remnants and various components of the interstellar medium. Surface brightness variations across Puppis A suggest that inhomogeneities on scales from 0.2 to 30 pc are present in the interstellar medium, while the structure of IC 443 is apparently dominated by the interaction between the remnant and a giant molecular cloud.
This paper summarizes results of magnetostratigraphic and rock magnetic investigations performed on fluvial sediments from the Ludwigshafen-Parkinsel drilling project (Upper Rhine Graben (URG) Germany). The drilling penetrated into Pleistocene gravel, sand, silt and clay, and unconsolidated Pliocene deposits. Its primary objective was the exploration of groundwater resources in the area of Ludwigshafen. Our rock magnetic investigations together with results of heavy mineral analyses (see Hagedorn & Boenigk, 2008) show a clearly structured sediment profile. It was possible to identify the change from mainly locally controlled sedimentation from the Graben margins to a more distinct Alpine controlled sedimentation at a depth of 177 m by magnetic data. Based on lithostratigraphic correlation with other sedimentary records from the URG and also based on palynological evidence, this event happened at the end of Late Pliocene during a time of normal polarity of the Earth's magnetic field (Gauss Chron?). The well-documented characteristic change in magneto-mineralogy from goethite to greigite almost at the same stratigraphic level, we interpret solely as a climatic signal which can be correlated with the global climate change at ∼2.5 Ma that is well documented in a wide range of sedimentary environments (e.g. deep-sea sediments, loess).
We present the first submillimetric line survey of extragalactic sources carried out by APEX. The surveys cover the 0.8 mm atmospheric window from 270 to 370GHz toward NGC253, NGC4945 and Arp220. We found in NGC 253, 150 transitions of 26 molecules. For NGC 4945, 136 transitions of 24 molecules, and 64 transitions of 17 molecules for Arp 220. Column densities and rotation temperatures have been determinate using the Local Thermodinamical Equilibrium(LTE) line profile simulation and fitting in the MADCUBA IJ software. The differences found in ratios between the Galactic Center and the starburst galaxies NGC 4945 and NGC 253 suggest that the gas is less processed in the latter than in the Galactic Center. The high 18O/17O ratios in the galaxies NGC 4945 and NGC 253 suggest also material less processed in the nuclei of these galaxies than in the Galactic Center. This is consistent with the claim that 17O is a more representative primary product than 18O in stellar nucleosynthesis (Wilson and Rood 1994); Also, we did a Multitransitions study of H3O+ at 307GHz, 364GHz, 388GHz and 396GHz. From our non-LTE analysis of H3O+ in NGC253 with RADEX we found that the collisional excitation can not explain the observed intensity of the ortho 396 GHz line. Excitation by radiation from the dust in the Far-IR can roughly explain the observations if the H2 densities are relatively low. From the derived H3O+ column densities we conclude that the chemistry of this molecule is dominated by ionization produce by the starburst in NGC253 (UV radiation from the O stars) and Arp 220 (cosmic rays from the supernovae) and likely from the AGN in NGC4549 (X-rays ); Finally, we report, for the first time, the tentative detection of the molecular ion HCNH+ (precursor of HCN and HNC) toward a galaxy, NGC4945, abundance explain the claimed enhancement of HCN abundance in the AGN, due to the enhancement of the ionization rate by X-rays. The abundance is much larger than the Galactic center of the Milky Way.
Cognitive impulsivity may increase children's risk of developing delinquent behavior. However, the influence of cognitive impulsivity may depend on social environmental risk factors. This study examined the moderating effect of late childhood parenting behaviors and peer relations on the influence of children's cognitive impulsivity on delinquency development across adolescence and early adulthood, while taking possible interactions with intelligence also into account. Delinquent behavior of 412 boys from the Pittsburgh Youth Study was measured annually from ages 13 to 29 years with official arrest records. Cognitive impulsivity (neurocognitive test scores) and intelligence were assessed at age 12–13. Parenting behaviors (persistence of discipline, positive reinforcement, and parental knowledge), peer delinquency, and peer conventional activities were assessed between ages 10 and 13 years. Results showed that, while controlling for intelligence, the influence of youths' cognitive impulsivity on delinquency depended on their parents' behaviors. An interaction was found among cognitive impulsivity, intelligence, and peer delinquency, but instead of cognitive impulsivity, the effect of intelligence on delinquency was particularly moderated. Overall, findings suggest that when there was moderation, high cognitive impulsivity and low intelligence were associated with an increased probability for engaging in delinquency predominantly among boys in a good social environment, but not in a poor social environment.
In this paper, we present several dielectric waveguide (DWG) setups that enable the transition between radar front ends and antennas in challenging, industrial environments. Apart from good propagation behavior, DWG provide a nearly dispersion free transmission over large distances. Furthermore, they can be used as an electrical insulator in places with critical creep distances, in high temperature environments, and for applications with limited installation space. Fundamentals concerning the ideal propagation mode and adequate waveguide–fiber transitions are presented. Results of electromagnetic simulations as well as measurements on manufactured DWG are discussed in detail. The presented excellent propagation behavior proves the effectiveness of the proposed setup.
Background: Cognitive behavioural therapy for psychosis (CBTp) is currently a recommended form of psychosocial treatment for persons suffering from persistent psychotic symptoms. It has been argued that effect sizes from efficacy studies cannot be generalized to real clinical settings. Aims: Our aim was to evaluate whether the positive results from randomized controlled trials conducted by experts could be replicated in clinical setting with a heterogeneous sample of patients with psychotic disorder. Method: Patients referred to the study were either randomized to CBTp + TAU (the treatment group) or to a waiting-list group, only receiving TAU. The patients were assessed on different outcome measures such as the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment of Negative Symptoms (SANS), and the Psychotic Symptom Rating Scales (PSYRATS), at pretreatment, at posttreatment (6 months), and at 12 months follow-up. In total, 45 patients participated in the study. Results: The results showed that 20 sessions of CBTp performed significantly better than the waiting list controls with respect to the global score on the BPRS, the delusional scale on the PSYRATS, and the GAF symptom score at posttreatment. At 12 months follow-up only the GAF symptom score remained significantly changed for the total sample. Conclusions: The study revealed that CBTp delivered by non-experts in routine clinical settings can produce improvements in positive psychotic symptoms, and also that some of these improvements can be maintained at one year follow-up.
Very little is known on the impact of recurrent disasters on mental health.
The present study examines the immediate impact of a recurrent flood on mental health and functioning among an affected population in the rural district of Bahraich, Uttar Pradesh, India, compared with a population in the same region that is not affected by floods.
The study compared 318 affected respondents with 308 individuals who were not affected by floods. Symptoms of anxiety and depression were assessed by the Hopkins Symptom Checklist-25 (HSCL-25). Psychological and physical functioning was assessed by using the Short Form-12 (SF-12).
The affected group showed large to very large differences with the comparison group on symptoms of anxiety (D = .92) and depression (D = 1.22). The affected group scored significantly lower on psychological and physical functioning than the comparison group (respectively D = .33 and D = .80). However, hierarchical linear regressions showed no significant relationship between mental health and the domains of functioning in the affected group, whereas mental health and the domains of functioning were significantly related in the comparison group.
This study found a large negative impact of the recurrent floods on mental health outcomes and psychological and physical functioning. However, in a context with recurrent floods, disaster mental health status is not a relevant predictor of functioning. The findings suggest that the observed mental health status and impaired functioning in this context are also outcomes of another mechanism: Both outcomes are likely to be related to the erosion of the social and environmental and material context. As such, the findings refer to a need to implement psychosocial context-oriented interventions to address the erosion of the context rather than specific mental health interventions.
WindTR, JoshiPC, KleberRJ, KomproeIH. The Impact of Recurrent Disasters on Mental Health: A Study on Seasonal Floods in Northern India. Prehosp Disaster Med. 2013;28(3):1-7.
In the wake of the recent terrorist attacks, such as the 2008 Mumbai hotel explosion or the December 25th 2009 “underwear bomber”, our group has developed a technique (US patent #7368292) to apply differential reflective spectroscopy to the problem of detecting explosives in order to detect terrorist threats. Briefly, light (200-500 nm) is shone on a surface such as a piece of luggage at an airport or a parcel at a courier distribution center. Upon reflection, the light is collected with a spectrometer combined with a camera. A computer processes the data and produces in turn a differential reflection spectrum taken between two adjacent areas of the surface. This differential technique is highly sensitive and provides spectroscopic data of explosives. As an example, 2,4,6, trinitrotoluene (TNT) displays strong and distinct features in differential reflectograms near 420 nm. Similar, but distinctly different features are observed for other explosives such as RDX, PETN or ANFO. Our detection system uses a two dimension detector (CCD camera) which provide spatial and spectroscopic information in each of the two dimensions. By scanning (involving fixed optical equipment and scanning moving bags or parcels on a conveyor belt), the surface to be surveyed the system provide the spatial location of the potential threat. We present in this paper how our detector works and how it is applied to the problem of explosive screening for explosives at airports and mail sorting centers. Additionally, we will present the effect of the explosives morphology on the detection response. In particular we will evaluate the implication on the limit of detection of the instrument as well as discuss the sample morphology with respect to a realistic threat scenario.
A brief history of research into the unusual laminated and spherulitic East Kirkton Limestone (Brigantian, Viséan) is given. It documents the paucity of fossil finds until 1984, when S. P. Wood discovered a previously unsuspected terrestrial biota. Some early finds, such as stromatolites, have since been overlooked, while others were misinterpreted, e.g. a ‘fish-bone’ collected before 1870 proves to be amphibian. A formal lithostratigraphic description is given of the three beds that comprise the c. 15 m sequence in East Kirkton Quarry: the East Kirkton Limestone, overlain by Little Cliff Shale and Geikie Tuff, the latter two being here formally named. Lithological descriptions and a unit-by-unit distribution of major elements of the biota are provided for a measured section comprising 88 units. This is based on bed-by-bed excavations carried out 1985-92, supplemented by nine boreholes. Two 3 m-thick massive limestones lenses are recorded from the quarry and a probable third was proved in a borehole. Brief reports are given on the ‘stromatolites’ (by M. R. Walter), bivalve molluscs (R. M. C. Eagar and R. B. Wilson), ostracods (J. Pollard) and gypsum pseudomorphs.
Abstract:Thick section copper canisters are planned to be used as a corrosion protection of nuclear waste disposal containers for long term underground deposal in Sweden. The copper canisters will have the top and possibly the bottom lid welded to the canister walls using electron beam or friction stir welding. Due to the high external hydrostatic pressure and the relatively high temperature of the waste during the first one hundred years the copper will creep. The creep process will close the manufacturing gap between the cast iron container and the copper canister. The creep ductility must be sufficient to avoid cracking of the weld.
Specimens cut from the friction stir welds and the electron beam welds have been creep tested at temperatures ranging from 75 to 175 °C. Cross-weld specimens were used for both friction stir and electron beam welds. Weld metal, heat affected zone and base metal were also studied for friction stir welds. The results for the electron beam welds show that the main creep deformation is concentrated to the weld metal where the failure takes place. Weld metal and most cross-weld tests of friction stir weld material show similar creep lives and ductility as base metal tests. Ductility at rupture was found to exceed 30% for friction stir weld specimens, and the Norton power law exponent was determined to be between 30 and 50.