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The special mental states such as hallucination and confusion in schizophrenia have been creating obstacles in research in spirituality in this population. Although primary treatment should focus on symptom management, psychosocial and spiritual care should not be neglected. This study aimed to understand spirituality from the perspectives of both the patients and the healthcare professionals and its role in different stages of disease and rehabilitation.
Schizophrenic patients (n=22) and healthcare professionals including psychiatric doctors, nurses, and social workers (n=19) were recruited from an out-patient clinic of a hospital and a mental health rehabilitation complex. Semi-structured interviews on the meaning and experiences of spirituality, and its role in rehabilitation were conducted, with follow-up interviews when further clarification was needed. Interviews were transcribed into verbatim and analyzed with the assistance of computer software based on Ground theory. Trustworthiness was assured through member checking and peer scrutiny.
Both patients and professionals regarded spirituality as an inherent part of the patients’ well-being. Spirituality could be a practice, a way of thinking, sense of peace and fulfillment, and connectedness towards oneself, others, and a higher power. Spiritual experiences were helpful in the rehabilitation phase. However, some patients considered spirituality as apparitional experiences, thus hindered their recovery.
This study demonstrated that the spirituality played a part in patients’ lives and rehabilitation. Findings suggest the importance of spiritual care in this population and provide insights and roadmap for developing spiritual assessments and holistic care in psychiatric context.
Non-tuberculous mycobacterium encephalitis is rare. Since 2013, a global outbreak of Mycobacterium chimaera infection has been attributed to point-source contamination of heater cooler units used in cardiac surgery. Disseminated M. chimaera infection has presented many unique challenges, including non-specific clinical presentations with delays in diagnosis, and a high mortality rate among predominantly immunocompetent adults. Here, we describe three patients with fatal disseminated Mycobacterium chimaera infection showing initially non-specific, progressively worsening neurocognitive decline, including confusion, delirium, depression and apathy. Autopsy revealed widespread granulomatous encephalitis of the cerebrum, brain stem and spinal cord, along with granulomatous chorioretinitis. Cerebral involvement and differentiation between mycobacterial granulomas and microangiopathic changes can be assessed best on MRI with contrast enhancement. The prognosis of M. chimaera encephalitis appears to be very poor, but might be improved by increased awareness of this new syndrome and timely antimicrobial treatment.
This presentation will enable the learner to:
1.Describe the clinical, radiological and neuropathological findings of Mycobacterium chimaera encephalitis
2.Be aware of this rare form of encephalitis, and explain its diagnosis, prognosis and management
Global inequity in access to and availability of essential mental health services is well recognized. The mental health treatment gap is approximately 50% in all countries, with up to 90% of people in the lowest-income countries lacking access to required mental health services. Increased investment in global mental health (GMH) has increased innovation in mental health service delivery in LMICs. Situational analyses in areas where mental health services and systems are poorly developed and resourced are essential when planning for research and implementation, however, little guidance is available to inform methodological approaches to conducting these types of studies. This scoping review provides an analysis of methodological approaches to situational analysis in GMH, including an assessment of the extent to which situational analyses include equity in study designs. It is intended as a resource that identifies current gaps and areas for future development in GMH. Formative research, including situational analysis, is an essential first step in conducting robust implementation research, an essential area of study in GMH that will help to promote improved availability of, access to and reach of mental health services for people living with mental illness in low- and middle-income countries (LMICs). While strong leadership in this field exists, there remain significant opportunities for enhanced research representing different LMICs and regions.
The current generation of experiments aiming to detect the neutral hydrogen signal from the Epoch of Reionisation (EoR) is likely to be limited by systematic effects associated with removing foreground sources from target fields. In this paper, we develop a model for the compact foreground sources in one of the target fields of the MWA’s EoR key science experiment: the ‘EoR1’ field. The model is based on both the MWA’s GLEAM survey and GMRT 150 MHz data from the TGSS survey, the latter providing higher angular resolution and better astrometric accuracy for compact sources than is available from the MWA alone. The model contains 5 049 sources, some of which have complicated morphology in MWA data, Fornax A being the most complex. The higher resolution data show that 13% of sources that appear point-like to the MWA have complicated morphology such as double and quad structure, with a typical separation of 33 arcsec. We derive an analytic expression for the error introduced into the EoR two-dimensional power spectrum due to peeling close double sources as single point sources and show that for the measured source properties, the error in the power spectrum is confined to high k⊥ modes that do not affect the overall result for the large-scale cosmological signal of interest. The brightest 10 mis-modelled sources in the field contribute 90% of the power bias in the data, suggesting that it is most critical to improve the models of the brightest sources. With this hybrid model, we reprocess data from the EoR1 field and show a maximum of 8% improved calibration accuracy and a factor of two reduction in residual power in k-space from peeling these sources. Implications for future EoR experiments including the SKA are discussed in relation to the improvements obtained.
Impulsive solar energetic particle (SEP) events originate from the energy dissipation process in small solar flares. Anomalous abundances in impulsive SEP events provide an evidence on unique, yet unclear, acceleration mechanism. The pattern of heavy-ion enhancements indicates that the temperature of the source plasma that is accelerated is low and not flare-like. We examine the solar source of the 3He-rich SEP event of 2012 November 20 using Solar Dynamics Observatory (SDO)/ Atmospheric Imaging Assembly (AIA) images and investigate its thermal variation. The examined event is associated with recurrent coronal jets. The Differential Emission Measure (DEM) analysis is applied to study the temperature evolution/distribution of the source regions. Preliminary results show that the temperature of the associated solar source is ranged between 1.2-3.1 MK.
Early weak treatment response is one of the few trans-diagnostic, treatment-agnostic predictors of poor outcome following a full treatment course. We sought to improve the outcome of clients with weak initial response to guided self-help cognitive behavior therapy (GSH).
One hundred and nine women with binge-eating disorder (BED) or bulimia nervosa (BN) (DSM-IV-TR) received 4 weeks of GSH. Based on their response, they were grouped into: (1) early strong responders who continued GSH (cGSH), and early weak responders randomized to (2) dialectical behavior therapy (DBT), or (3) individual and additional group cognitive behavior therapy (CBT+).
Baseline objective binge-eating-day (OBD) frequency was similar between DBT, CBT+ and cGSH. During treatment, OBD frequency reduction was significantly slower in DBT and CBT+ relative to cGSH. Relative to cGSH, OBD frequency was significantly greater at the end of DBT (d = 0.27) and CBT+ (d = 0.31) although these effects were small and within-treatment effects from baseline were large (d = 1.41, 0.95, 1.11, respectively). OBD improvements significantly diminished in all groups during 12 months follow-up but were significantly better sustained in DBT relative to cGSH (d = −0.43). At 6- and 12-month follow-up assessments, DBT, CBT and cGSH did not differ in OBD.
Early weak response to GSH may be overcome by additional intensive treatment. Evidence was insufficient to support superiority of either DBT or CBT+ for early weak responders relative to early strong responders in cGSH; both were helpful. Future studies using adaptive designs are needed to assess the use of early response to efficiently deliver care to large heterogeneous client groups.
We examined two potentially interacting, connected pathways by which parental supportiveness during early adolescence (ages 1–13) may come to be associated with later African American young adult smoking. The first pathway is between parental supportiveness and young adult stress (age 19), with stress, in turn, predicting increased smoking at age 20. The second pathway is between supportive parenting and tumor necrosis factor (TNF) gene methylation (i.e., TNFm), a proinflammatory epitype, with low levels indicating greater inflammatory potential and forecasting increased risk for smoking in response to young adult stress. In a sample of 382 African American youth residing in rural Georgia, followed from early adolescence (age 10–11) to young adulthood (age 20), supportive parenting indirectly predicted smoking via associations with young adult stress, IE = –0.071, 95% confidence interval [–0.132, –0.010]. In addition, supportive parenting was associated with TNFm measured at age 20 (r = .177, p = .001). Further, lower TNFm was associated with a significantly steeper slope (b = 0.583, p = .003) of increased smoking in response to young adult stress compared to those with higher TNFm (b = 0.155, p = .291), indicating an indirect, amplifying role for supportive parenting via TNFm. The results suggest that supportive parenting in early adolescence may play a role in understanding the emergence of smoking in young adulthood.
The Universe is permeated by hot, turbulent, magnetized plasmas. Turbulent plasma is a major constituent of active galactic nuclei, supernova remnants, the intergalactic and interstellar medium, the solar corona, the solar wind and the Earth’s magnetosphere, just to mention a few examples. Energy dissipation of turbulent fluctuations plays a key role in plasma heating and energization, yet we still do not understand the underlying physical mechanisms involved. THOR is a mission designed to answer the questions of how turbulent plasma is heated and particles accelerated, how the dissipated energy is partitioned and how dissipation operates in different regimes of turbulence. THOR is a single-spacecraft mission with an orbit tuned to maximize data return from regions in near-Earth space – magnetosheath, shock, foreshock and pristine solar wind – featuring different kinds of turbulence. Here we summarize the THOR proposal submitted on 15 January 2015 to the ‘Call for a Medium-size mission opportunity in ESAs Science Programme for a launch in 2025 (M4)’. THOR has been selected by European Space Agency (ESA) for the study phase.
An outbreak of acute hepatitis recently occurred in a nursing home in Zhejiang Province, China. The objectives of this study were to confirm the outbreak and identify the aetiology, source and transmission patterns. All residents and staff in or near the nursing home during the period from 1 October 2014 to 21 May 2015 were investigated regarding hygiene and for epidemiological information including water and food (eating meat especially pork products). Serum and stool specimens were collected for detection of hepatitis E virus (HEV) antibodies using ELISA and RNA using RT–PCR. Samples that were RNA positive were genotyped. Of 185 senior residents and 24 staff in the nursing home, there were 37 laboratory-confirmed cases during the outbreak. Of these cases, 12 patients (three deaths) were symptomatic with jaundice, a common clinical symptom for hepatitis E infection. HEV strains were isolated from three cases and they formed a single cluster within genotype 4d. A case-control study was conducted to investigate potential risk factors for the outbreak and the results revealed that cases more often washed their dishes and rinsed their mouths using tap water than the controls (P < 0·05). Based on hygiene investigation and meteorological information, it is likely that HEV-infected sewage and faeces contaminated the water network on rainy days. Collectively, these results suggest that the outbreak of HEV genotype 4 infection was most likely caused by contaminated tap water rather than food.
Metsulfuron is used for POST control of spotted spurge in many warm-season
turfgrasses. A suspected resistant (R) biotype of spotted spurge was
collected from turfgrass in Georgia with a history of exclusive metsulfuron
use. Research was conducted to evaluate the resistance level of this biotype
to metsulfuron, efficacy of other mechanisms of action for control, and the
molecular basis for resistance. Compared with a susceptible (S) biotype, the
R biotype required >90 and >135 times greater metsulfuron rates to
reach 50% injury and reduce biomass 50% from the nontreated, respectively.
The R biotype was also resistant to trifloxysulfuron but was injured
equivalent to the S biotype from dicamba, glyphosate, and triclopyr. Gene
sequencing of the R biotype revealed a Trp574 to Leu substitution
that has conferred resistance to acetolactate synthase (ALS) inhibitors in
previous research. This is the first report of ALS resistance in spotted
spurge. More importantly, this is the first report of a herbicide-resistant
broadleaf weed from a turfgrass system in the United States.
Plasma loops are the dominant structures, in the higher levels of the Sun’s atmosphere above active regions. Much of our knowledge of their properties has come from space observations made over the past decade or so in the EUV and X-ray regions of the spectrum and, more recently, from high-resolution, two-dimensional images of microwave sources obtained with the Very Large Array radio interferometer (VLA). On the other hand, the spatial resolution of rocket and satellite observations has so far generally failed to match that of ground-level optical observations made in Hα and other strong chromospheric lines. The latter permit one to study in much greater detail the morphology of individual loops, as illustrated for example in the recent work of Loughhead, Wang and Blows (1983). These authors addressed themselves to the task of determining the true geometrical shapes of individual loops, a problem which had hitherto received little attention.
To investigate the effect of uterine space on timing of embryonic mortality, multiparous sows were left intact (CTR; n=42) or subjected to unilateral oviduct ligation (LIG; n=23), after their first post wean oestrus. Intact sows were killed at day 9 (n=10), day 21 (n=15), or day 35 (n=17), and LIG sows were killed at day 21 (n=11) or day 35 (n=12) of gestation. At day 9, 92% of ovulations were represented by an embryo. At day 21, embryonic mortality was 24% and was not altered by increasing uterine space. At day 35, space per embryo was twice as large in LIG sows (30±3 v. 16±0.8 cm), and implantation length tended to be larger (19.0±1.2 v. 15.5±1.3 cm). Between day 21 and day 35, CTR sows lost another 8% to 14% of their embryos, whereas LIG sows lost none. Embryos tended to be heavier (4.9±0.2 v. 4.3±0.3 g) in LIG sows. In conclusion, embryonic loss in multiparous sows is 24% by day 21 and is not related to space, whereas after day 21 limited space causes additional 8% to 14% embryonic mortality in intact sows only.
Bipolar disorder is a highly heritable polygenic disorder. Recent
enrichment analyses suggest that there may be true risk variants for
bipolar disorder in the expression quantitative trait loci (eQTL) in the
We sought to assess the impact of eQTL variants on bipolar disorder risk
by combining data from both bipolar disorder genome-wide association
studies (GWAS) and brain eQTL.
To detect single nucleotide polymorphisms (SNPs) that influence
expression levels of genes associated with bipolar disorder, we jointly
analysed data from a bipolar disorder GWAS (7481 cases and 9250 controls)
and a genome-wide brain (cortical) eQTL (193 healthy controls) using a
Bayesian statistical method, with independent follow-up replications. The
identified risk SNP was then further tested for association with
hippocampal volume (n = 5775) and cognitive performance
(n = 342) among healthy individuals.
Integrative analysis revealed a significant association between a brain
eQTL rs6088662 on chromosome 20q11.22 and bipolar disorder (log Bayes
factor = 5.48; bipolar disorder P =
5.85×10–5). Follow-up studies across multiple independent
samples confirmed the association of the risk SNP (rs6088662) with gene
expression and bipolar disorder susceptibility (P =
3.54×10–8). Further exploratory analysis revealed that
rs6088662 is also associated with hippocampal volume and cognitive
performance in healthy individuals.
Our findings suggest that 20q11.22 is likely a risk region for bipolar
disorder; they also highlight the informative value of integrating
functional annotation of genetic variants for gene expression in
advancing our understanding of the biological basis underlying complex
disorders, such as bipolar disorder.
Lead halide perovskites have proven their great power conversion efficiency (PCE) in the last few years and attracted more and more attentions. Evaporation is an important method to get high quality perovskite films, especially for surface and interface investigation, which is important for the solar cell performance. In this paper, we present our investigations on growing PbI2 and CH3NH3I films by evaporation, and then CH3NH3PbI3 films by co-evaporation. X-ray photoemisson spectroscopy (XPS) was used to characterize the films. The results showed that CH3NH3I film was not stable in vacuum. Both N and I decreased in vacuum with time elapsing. PbI2 and CH3NH3PbI3 films are quite stable. The atomic ratio of CH3NH3PbI3 films (C: N: Pb: I =1.29:1.07:1.00:2.94) is very close to the ideal CH3NH3PbI3, which indicates that evaporation is a good method to get high quality perovskite films with accurate atomic ratio.
The CuInSe2 and CuSbSe2 ternary compounds and alloys of the (CuSbSe2)1-x·(CuInSe2)x system with the mole fraction of CuInSe2 (x) equal to 0.05, 0.15, 0.25, 0.375, 0.50, 0.625, 0.75, 0.85, and 0.95 were prepared and the phase relations in this system were investigated by X-ray powder diffraction, optical microscopy, and scanning electron microscopy. It was shown that the alloys of the CuSbSe2-CuInSe2 system are biphasic at room temperature in the whole range of compositions, and the limits of solubility for CuSbSe2 in CuInSe2 and for CuInSe2 in CuSbSe2 do not exceed 0.001 mole fraction.
The current Ebola virus disease (EVD) epidemic in West Africa is unprecedented in scale, and Sierra Leone is the most severely affected country. The case fatality risk (CFR) and hospitalization fatality risk (HFR) were used to characterize the severity of infections in confirmed and probable EVD cases in Sierra Leone. Proportional hazards regression models were used to investigate factors associated with the risk of death in EVD cases. In total, there were 17 318 EVD cases reported in Sierra Leone from 23 May 2014 to 31 January 2015. Of the probable and confirmed EVD cases with a reported final outcome, a total of 2536 deaths and 886 recoveries were reported. CFR and HFR estimates were 74·2% [95% credibility interval (CrI) 72·6–75·5] and 68·9% (95% CrI 66·2–71·6), respectively. Risks of death were higher in the youngest (0–4 years) and oldest (⩾60 years) age groups, and in the calendar month of October 2014. Sex and occupational status did not significantly affect the mortality of EVD. The CFR and HFR estimates of EVD were very high in Sierra Leone.
Magnetic resonance imaging studies of maltreated children with posttraumatic stress disorder (PTSD) suggest that maltreatment-related PTSD is associated with adverse brain development. Maltreated youth resilient to chronic PTSD were not previously investigated and may elucidate neuromechanisms of the stress diathesis that leads to resilience to chronic PTSD. In this cross-sectional study, anatomical volumetric and corpus callosum diffusion tensor imaging measures were examined using magnetic resonance imaging in maltreated youth with chronic PTSD (N = 38), without PTSD (N = 35), and nonmaltreated participants (n = 59). Groups were sociodemographically similar. Participants underwent assessments for strict inclusion/exclusion criteria and psychopathology. Maltreated youth with PTSD were psychobiologically different from maltreated youth without PTSD and nonmaltreated controls. Maltreated youth with PTSD had smaller posterior cerebral and cerebellar gray matter volumes than did maltreated youth without PTSD and nonmaltreated participants. Cerebral and cerebellar gray matter volumes inversely correlated with PTSD symptoms. Posterior corpus callosum microstructure in pediatric maltreatment-related PTSD differed compared to maltreated youth without PTSD and controls. The group differences remained significant when controlling for psychopathology, numbers of Axis I disorders, and trauma load. Alterations of these posterior brain structures may result from a shared trauma-related mechanism or an inherent vulnerability that mediates the pathway from chronic PTSD to comorbidity.
This study aimed to evaluate the incidence of cardiac disorders among children with mid-exertional syncope evaluated by a paediatric cardiologist, determine how often a diagnosis was not established, and define potential predictors to differentiate cardiac from non-cardiac causes.
We carried out a single-centre, retrospective review of children who presented for cardiac evaluation due to a history of exertional syncope between 1999 and 2012. Inclusion criteria included the following: (1) age ⩽18 years; (2) mid-exertional syncope; (3) electrocardiogram, echocardiogram and an exercise stress test, electrophysiology study, or tilt test, with exception of long QT, which did not require additional testing; and (4) evaluation by a paediatric cardiologist. Mid-exertional syncope was defined as loss of consciousness in the midst of active physical activity. Patients with peri-exertional syncope immediately surrounding but not during active physical exertion were excluded.
A total of 60 patients met the criteria for mid-exertional syncope; 32 (53%) were diagnosed with cardiac syncope and 28 with non-cardiac syncope. A majority of cardiac patients were diagnosed with an electrical myopathy, the most common being Long QT syndrome. In nearly half of the patients, a diagnosis could not be established or syncope was felt to be vasovagal in nature. Neither the type of exertional activity nor the symptoms or lack of symptoms occurring before, immediately preceding, and after the syncopal event differentiated those with or without a cardiac diagnosis.
Children with mid-exertional syncope are at risk for cardiac disease and warrant evaluation. Reported symptoms may not differentiate benign causes from life-threatening disease.