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Inflammation and metabolic dysregulation are age-related physiological changes and are associated with depressive disorder. We tried to identify subgroups of depressed older patients based on their metabolic-inflammatory profile and examined the course of depression for these subgroups.
This clinical cohort study was conducted in a sample of 364 depressed older (⩾60 years) patients according to DSM-IV criteria. Severity of depressive symptoms was monitored every 6 months and a formal diagnostic interview repeated at 2-year follow-up. Latent class analyses based on baseline metabolic and inflammatory biomarkers were performed. Adjusted for confounders, we compared remission of depression at 2-year follow-up between the metabolic-inflammatory subgroups with logistic regression and the course of depression severity over 2-years by linear mixed models.
We identified a ‘healthy’ subgroup (n = 181, 49.7%) and five subgroups characterized by different profiles of metabolic-inflammatory dysregulation. Compared to the healthy subgroup, patients in the subgroup with mild ‘metabolic and inflammatory dysregulation’ (n = 137, 37.6%) had higher depressive symptom scores, a lower rate of improvement in the first year, and were less likely to be remitted after 2-years [OR 0.49 (95% CI 0.26–0.91)]. The four smaller subgroups characterized by a more specific immune-inflammatory dysregulation profile did not differ from the two main subgroups regarding the course of depression.
Nearly half of the patients with late-life depressions suffer from metabolic-inflammatory dysregulation, which is also associated with more severe depression and a worse prognosis. Future studies should examine whether these depressed older patients benefit from a metabolic-inflammatory targeted treatment.
The association of atrioventricular septal defect and transposition of the great arteries is very rare. As a rule, these patients have unbalanced ventricles. However, there have been no studies describing the results of single-ventricle palliation in these children.
All children who underwent surgery with a diagnosis of atrioventricular septal defect and transposition of the great arteries were included in the study. Data were obtained from medical records.
A total of 38 patients with atrioventricular septal defect and transposition of the great arteries underwent single-ventricle palliation at the study institution between 1971 and 2016. The mean follow-up was 12.4 years (median: 14.6 years, range 2–43.3 years). Most children had unbalanced atrioventricular septal defect (94.7%, 36/38). Survival was 67.6% (95% confidence interval [CI]: 50.0–80.2%) at 10 years and 57.8% (95% CI: 38.0–73.4%) at 20 years. By 10 years, 58.6% (95% CI: 40.8–72.7%) had progressed to Fontan completion, while 32.5% (95% CI: 18.2–47.6%) had died. In patients achieving Fontan completion, 20-year event-free survival was 73.3% (95% CI: 34.8–91.3%), while 5.0% (95% CI: 0.4–20.5%) had undergone cardiac transplantation and 21.7% (95% CI: 3.2–50.8%) had undergone takedown of the Fontan circulation. Freedom from atrioventricular valve surgery was 57.0% (95% CI: 37.2–72.7%) at 10 and 20 years.
The association of atrioventricular septal defect and transposition of the great arteries is very rare, and most of these children have unbalanced ventricles. Single-ventricle palliation results in 25-year overall survival of 50%. However, in patients, who had Fontan completion, survival was 75% at 25 years after Fontan operation.
There is increasing evidence that smoking is a risk factor for severe mental illness, including bipolar disorder. Conversely, patients with bipolar disorder might smoke more (often) as a result of the psychiatric disorder.
We conducted a bidirectional Mendelian randomisation (MR) study to investigate the direction and evidence for a causal nature of the relationship between smoking and bipolar disorder.
We used publicly available summary statistics from genome-wide association studies on bipolar disorder, smoking initiation, smoking heaviness, smoking cessation and lifetime smoking (i.e. a compound measure of heaviness, duration and cessation). We applied analytical methods with different, orthogonal assumptions to triangulate results, including inverse-variance weighted (IVW), MR-Egger, MR-Egger SIMEX, weighted-median, weighted-mode and Steiger-filtered analyses.
Across different methods of MR, consistent evidence was found for a positive effect of smoking on the odds of bipolar disorder (smoking initiation ORIVW = 1.46, 95% CI 1.28–1.66, P = 1.44 × 10−8, lifetime smoking ORIVW = 1.72, 95% CI 1.29–2.28, P = 1.8 × 10−4). The MR analyses of the effect of liability to bipolar disorder on smoking provided no clear evidence of a strong causal effect (smoking heaviness betaIVW = 0.028, 95% CI 0.003–0.053, P = 2.9 × 10−2).
These findings suggest that smoking initiation and lifetime smoking are likely to be a causal risk factor for developing bipolar disorder. We found some evidence that liability to bipolar disorder increased smoking heaviness. Given that smoking is a modifiable risk factor, these findings further support investment into smoking prevention and treatment in order to reduce mental health problems in future generations.
Paediatric heart transplantation in Australia is centralised at The Royal Children’s Hospital, Melbourne. Survival to adulthood is improving but the ongoing need for complex medical therapy, surveillance, and potential for late complications continues to impact on quality of life. Quality of life in adults who underwent heart transplantation in childhood in Australia has not been assessed.
Cross-sectional quality of life data were collected from paediatric heart transplant survivors >18 years of age using Rand 36-Item Health Survey. Self-reported raw scores were transformed to a 0–100 scale with higher scores indicating better quality of life. Mean scores were compared to National Health Survey Short Form-36 Population Norms data using the independent sample t-test.
A total of 64 patients (64/151) who underwent transplantation at The Royal Children’s Hospital between 1988 and 2016 survived to adulthood. In total 51 patients (51/64, 80%) were alive at the time of the study and 27 (53%) responded with a mean age of 25 ± 6 years, being a median of 11 years (interquartile range 7–19) post-transplantation. Most self-reported quality of life subscale scores were not significantly different from the Australian normative population data. However, self-reported ‘General Health’ was significantly worse than normative data (p = 0.02). Overall, 93% (25/27) reported their general health as being the same or better compared to 1-year ago.
Adult survivors after paediatric heart transplantation in Australia report good quality of life in multiple domains and demonstrate independence in activities of daily living and employment. However, lifelong medical treatment may affect perceptions of general health.
Identifying characteristics of individuals at greatest risk for prolonged grief disorder (PGD) can improve its detection and elucidate the etiology of the disorder. The Safe Passage Study, a study of women at high risk for sudden infant death syndrome (SIDS), prospectively examined the psychosocial functioning of women while monitoring their healthy pregnancies. Mothers whose infants died of SIDS were followed in bereavement.
Pre-loss data were collected from 12 000 pregnant mothers and analyzed for their associations with grief symptoms and PGD in 50 mothers whose infants died from SIDS, from 2 to 48 months after their infant's death, focusing on pre-loss risk factors of anxiety, depression, alcohol use, maternal age, the presence of other living children in the home, and previous child loss.
The presence of any four risk factors significantly predicted PGD for 24 months post-loss (p < 0.003); 2–3 risk factors predicted PGD for 12 months (p = 0.02). PGD rates increased in the second post-loss year, converging in all groups to approximately 40% by 3 years. Pre-loss depressive symptoms were significantly associated with PGD. Higher alcohol intake and older maternal age were consistently positively associated with PGD. Predicted risk scores showed good discrimination between PGD and no PGD 6–24 months after loss (C-statistic = 0.83).
A combination of personal risk factors predicted PGD in 2 years of bereavement. There is a convergence of risk groups to high rates at 2–3 years, marked by increased PGD rates in mothers at low risk. The risk factors showed different effects on PGD.
Programmatic learning goals serve as the foundation for an educational institution’s curriculum design and assurance of learning processes. The purpose of our study is to determine the relevance or alignment of undergraduate business school learning goals. We identify the learning goals of US undergraduate business programs accredited by the Association to Advance Collegiate Schools of Business-International (AACSB) and determine the extent to which the goals are aligned with (a) evidence-based competencies that are needed for managerial success (including the ‘Great Eight’ and the ‘hyperdimensional taxonomy’) and (b) content areas identified in AACSB’s Eligibility Procedures and Accreditation Standards for Business Accreditation. We found that learning goals conform to AACSB Standards and evidence-based managerial competencies, but goals are most closely aligned with AACSB Standards, followed by the Great Eight, and the hyperdimensional taxonomy, respectively. We discuss the implications of our findings with respect to business schools’ assurance of learning processes and provide recommendations for AACSB, business schools, the broader academy, and future research.
The loss of natural habitats is a major threat to biodiversity, and protected area designation is one of the standard responses to this threat. However, greater understanding of the drivers of habitat loss and of the circumstances under which protected areas succeed or fail is still needed. We use visual assessment of satellite images to quantify land-cover change over periods of up to 30 years in and around a matched sample of protected and unprotected Important Bird and Biodiversity Areas (IBAs) in Africa. We modelled the annual survival of forests and other natural land covers as a function of a range of environmental and anthropic predictors of plausible drivers. The best-supported model indicated that survival rates of natural land cover were highest in steeper areas, at higher altitudes, in areas with lower human population densities and in areas where the cover of natural habitats was already higher at the start of the period. Survival rates of natural land cover in protected areas were, on average, around twice those in unprotected areas, but the differences between them varied along different environmental gradients. The overall survival rates of both protected and unprotected forests were significantly lower than those of other natural land-cover types, but the net benefit of protection, in terms of the absolute difference in rates of loss between protected and unprotected sites, was higher in forests. Interaction terms indicated that as slope and altitude increased, the natural protection offered by topography increasingly nullified the additional benefits of legislative protection. Furthermore, protected area designation offered reduced additional benefits to the survival of natural land cover in areas where rates of conversion were higher at the start of the observation period. Variation in the impacts of protected area status along different environmental gradients indicates that targets to improve the world's protected area network, such as Aichi Target 11 of the Convention on Biological Diversity, need to look beyond simple area-based metrics. Our methods and results contribute to the development of a protocol for prioritizing places where protection is likely to have the greatest effect.
Depression is associated with the metabolic syndrome (MS). We examined whether metabolic dysregulation predicted the 2-year course of clinical depression.
A total of 285 older persons (⩾60 years) suffering from depressive disorder according to DSM-IV-TR criteria was followed up for 2 years. Severity of depression was assessed with the Inventory of Depressive Symptomatology (IDS) at 6-month intervals. Metabolic syndrome was defined according the National Cholesterol Education Programme (NCEP-ATP III). We applied logistic regression and linear mixed models adjusted for age, sex, years of education, smoking, alcohol use, physical activity, somatic co-morbidity, cognitive functioning and drug use (antidepressants, anti-inflammatory drugs) and severity of depression at baseline.
MS predicted non-remission at 2 years (odds ratioper component = 1.26, 95% confidence interval 1.00–1.58), p = 0.047), which was driven by the waist circumference and HDL cholesterol. MS was not associated with IDS sum score. Subsequent analyses on its subscales, however, identified an association with the somatic symptom subscale score over time (interaction time × somatic subscale, p = 0.005), driven by higher waist circumference and elevated fasting glucose level.
Metabolic dysregulation predicts a poor course of late-life depression. This finding supports the concept of ‘metabolic depression’, recently proposed on population-based findings of a protracted course of depressive symptoms in the presence of metabolic dysregulation. Our findings seem to be driven by abdominal obesity (as indicated by the waist circumference) and HDL cholesterol dysregulation.
Understanding stellar birth requires observations of the clouds in which they form. These clouds are dense and self-gravitating, and in all existing observations, they are molecular with H2 the dominant species and CO the best available. When the abundances of carbon and oxygen are low compared to hydrogen, and the opacity from dust is also low, as in primeval galaxies and local dwarf irregular galaxies CO forms slowly and is easily destroyed, so it cannot accumulate inside dense clouds. Then we lose our ability to trace the gas in regions of star formation and we lose critical information on the temperatures, densities, and velocities of the material that collapses. I will report on high resolution observations with ALMA of CO clouds in the local group dwarf irregular galaxy WLM, which has a metallicity that is 13% of the solar value and 50% lower than the previous CO detection threshold and the properties derived of very small dense CO clouds mapped..
Costanza and Finkelstein (2015) question whether there really are generational differences in the workplace. They argue that the generation construct is not properly operationalized (often confounding age, period, and cohort factors) and that generational research is atheoretical and plagued by methodological problems. We agree that generational research is largely guilty as charged. We also share their concern regarding the generationally based interventions that are being sold to, and adopted by, managers—interventions that are often little more than fads based on popular myths and folklore. We are also in full agreement with the potential significant harm that can be associated with stereotyping groups of individuals.
The purpose of this research is to examine the undergraduate learning goals of business programs and determine if these goals are skewed in the directions posed by critics of undergraduate business education. The underlying theme of many critiques is that nonlinear-thinking processes are underrepresented in undergraduate business curricula, whereas linear-thinking processes are overrepresented. The learning goals of 208 Association to Advance Collegiate Schools of Business International-accredited business programs were coded into two goal categories: linear thinking and nonlinear thinking. The results support the contention that nonlinear-thinking processes have a lesser presence in the typical undergraduate business program’s curriculum. These findings are consistent across research and teaching universities.
Impulsive decision making is a hallmark of frequently occurring addiction disorders including alcohol dependence (AD). Therefore, ameliorating impulsive decision making is a promising target for the treatment of AD. Previous studies have shown that modafinil enhances cognitive control functions in various psychiatric disorders. However, the effects of modafinil on delay discounting and its underlying neural correlates have not been investigated as yet. The aim of the current study was to investigate the effects of modafinil on neural correlates of impulsive decision making in abstinent AD patients and healthy control (HC) subjects.
A randomized, double-blind, placebo-controlled, within-subjects cross-over study using functional magnetic resonance imaging (fMRI) was conducted in 14 AD patients and 16 HC subjects. All subjects participated in two fMRI sessions in which they either received a single dose of placebo or 200 mg of modafinil 2 h before the session. During fMRI, subjects completed a delay-discounting task to measure impulsive decision making.
Modafinil improved impulsive decision making in AD pateints, which was accompanied by enhanced recruitment of frontoparietal regions and reduced activation of the ventromedial prefrontal cortex. Moreover, modafinil-induced enhancement of functional connectivity between the superior frontal gyrus and ventral striatum was specifically associated with improvement in impulsive decision making.
These findings indicate that modafinil can improve impulsive decision making in AD patients through an enhanced coupling of prefrontal control regions and brain regions coding the subjective value of rewards. Therefore, the current study supports the implementation of modafinil in future clinical trials for AD.
Cross-sectional and longitudinal studies have shown a positive association between attention deficit hyperactivity disorder (ADHD) and problematic alcohol use in adults. To what extent this association is explained by genetic and environmental factors is largely unknown.
Data on ADHD and alcohol consumption were collected by self-report in 6024 adult Dutch twins. ADHD symptoms were assessed by three subscales of the Conners' Adult ADHD Rating Scales – Self-Report: Screening Version (CAARS–S:SV): inattentiveness, hyperactivity and the ADHD index (ADHD-I). Problem drinking was defined as at least two self-reported alcohol-related problems on the CAGE questionnaire. Structural equation modelling was applied to the bivariate twin data to estimate genetic and environmental influences.
Heritability of ADHD symptoms ranged between 32% and 40% and heritability of problem drinking was 50%. The positive correlation between ADHD symptoms and problem drinking was confirmed in this general population sample, with phenotypic correlations between 0.20 and 0.28 and genetic correlations between 0.39 and 0.50. Phenotypic correlations are primarily (61–100%) explained by genetic influences with non-shared environmental influences explaining the remaining covariance. No significant quantitative or qualitative gender differences in covariance structure were found.
This study convincingly shows that ADHD symptoms and problem drinking are moderately but significantly correlated in adults and that genetic correlations are primarily underlying this association. This suggests that early interventions are required to prevent adolescents with ADHD from developing problematic levels of alcohol use. Furthermore, clinicians who treat alcohol-dependent patients should be aware that the patient may have a co-morbid condition of ADHD; integrated interventions are required.
Little is known about the effect of stimulant use (amphetamines, cocaine, ecstasy) on cognitive functioning in schizophrenia patients. The current study examined (1) whether recency and frequency of stimulant use is associated with cognitive functioning and (2) whether these associations differ between psychotic patients, their unaffected siblings and controls.
Participants completed a comprehensive cognitive test battery. Stimulant use was assessed by urinalysis and by the Composite International Diagnostic Interview (CIDI). Using random effects regression models, the main effects of Stimulant Use and the interaction with Diagnostic Status on cognitive functioning were assessed.
The interaction term between Stimulant Use and Diagnostic Status was not significant for any of the cognitive outcome variables, indicating similar effects of stimulant use in all three groups. Recent stimulant users showed more errors deficit in verbal learning in comparison to never users (Cohen's d = −0.60, p < 0.005). Lifetime frequent stimulant use was significantly associated with worse immediate and delayed verbal recall, working memory and acquired knowledge (Cohen's d = −0.22 to −0.29, p < 0.005). Lifetime infrequent stimulant use was not associated with significant cognitive alterations in comparison to never use.
The presence of cognitive deficits associated with lifetime stimulant use is dependent on the frequency of use, with no observed deficits in infrequent users and modest negative effects in frequent users.
Merging systems at low redshift provide the unique opportunity to study the processes related to star formation in a variety of environments that presumably resemble those seen at higher redshifts. Previous studies of distant starbursting galaxies suggest that stars are born in turbulent gas, with a higher efficiency than in MW-like spirals. We have investigated in detail the turbulent-driven regime of star-formation in nearby colliding galaxies combining high resolution VLA B array Hi maps and UV GALEX observations. With these data, we could check predictions of our state-of-the-art simulations of mergers, such as the global sharp increase of the fraction of dense gas, as traced by the SFR, with respect to the diffuse gas traced by Hi during the merging stage, following the increased velocity dispersion of the gas. We present here initial results obtained studying the SFR-Hi relation at 4.5 kpc resolution. We determined SFR/Hi mass ratios that are higher in the external regions of mergers than in the outskirts of isolated spirals, though both environments are Hi dominated. SFR/Hi increases towards the central regions following the decrease of the atomic gas fraction and possibly the increased star–formation efficiency. These results need to be checked with a larger sample of systems and on smaller spatial scales. This is the goal of the on-going Chaotic THINGS project that ultimately will allow us to determine why starbursting galaxies deviate from the Kennicutt-Schmidt relation between SFR density and gas surface density.
We investigate the radial column density distribution in a sample of 9 galaxies taken from the THINGS survey. The HI data have been used to probe the extent of the neutral (atomic) gas disks down to column densities of less than 0.1 ℳ⊙ pc−2. The size of the disks might be set simply by the amount of available gas that has contributed to the formation of the galaxy or truncated by ionisation by the extragalactic radiation field once the HI column density has dropped below a certain threshold.
Indirect evidence from detailed chemical evolution studies shows that infall of low metallicity gas appears to have proceeded at a rather constant rate during the lifetime of the Galactic disk. We explore two possible implications: (a) the effect of an infalling high velocity cloud (HVC) on interstellar cloud stability leading to enhanced star formation, and (b) the presence of these HVC’s around neighbouring galaxies, which would generalize this aspect of the evolution of galaxies in groups. (a) Using a simple analytical model we show how the overpressure produced in the galactic plane by HVC infall reduces the effective Jeans mass of the existing clouds, thus tending to enhance the SFR. (b) Using HI data from the THINGS survey we detect HI “fluff” around 4 galaxies of a total sample of 32 observed. Projecting some of the largest Galactic HVC’s to the distances of the THINGS galaxies we produce a useful estimate of the fraction of the HVC masses that we can detect at these distances, finding a value of order 10%, and go on to make tentative estimates about infall rates for nearby galaxies.