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Both acute and chronic pain can disrupt reward processing. Moreover, prolonged prescription opioid use and depressed mood are common in chronic pain samples. Despite the prevalence of these risk factors for anhedonia, little is known about anhedonia in chronic pain populations.
We conducted a large-scale, systematic study of anhedonia in chronic pain, focusing on its relationship with opioid use/misuse, pain severity, and depression. Chronic pain patients across four distinct samples (N = 488) completed the Snaith–Hamilton Pleasure Scale (SHAPS), measures of opioid use, pain severity and depression, as well as the Current Opioid Misuse Measure (COMM). We used a meta-analytic approach to determine reference levels of anhedonia in healthy samples spanning a variety of countries and diverse age groups, extracting SHAPS scores from 58 published studies totaling 2664 psychiatrically healthy participants.
Compared to healthy samples, chronic pain patients showed higher levels of anhedonia, with ~25% of patients scoring above the standard anhedonia cut-off. This difference was not primarily driven by depression levels, which explained less than 25% of variance in anhedonia scores. Neither opioid use duration, dose, nor pain severity alone was significantly associated with anhedonia. Yet, there was a clear effect of opioid misuse, with opioid misusers (COMM ⩾13) reporting greater anhedonia than non-misusers. Opioid misuse remained a significant predictor of anhedonia even after controlling for pain severity, depression and opioid dose.
Study results suggest that both chronic pain and opioid misuse contribute to anhedonia, which may, in turn, drive further pain and misuse.
Objective: To conduct a formative evaluation of a transitional intervention for family caregivers, with assessment of feasibility, acceptability, appropriateness, and potential benefits. Methods: The intervention aimed to provide emotional support, information on community resources, and information and support for development of coping skills for the caregivers of patients aged 65 and older who were to be discharged home from an acute medical hospital admission. We used a one-group, pre- and three-month post-test study design. Results: Ninety-one patient-caregiver dyads were recruited. Of these, 63 caregivers (69%) received all five planned intervention sessions, while 60 (66%) completed the post-test. There were significant reductions in caregiver anxiety and depression following the intervention, and high rates of satisfaction. Discussion: This transitional intervention should be further evaluated, preferably with a control group, either as a stand-alone intervention or as one component of a comprehensive transitional intervention for older patients and their caregivers.
Mood disorders and adiposity are major public health challenges. Few studies have investigated the bidirectional association of weight and waist circumference (WC) change with psychological distress in middle age, while taking into account the potential U-shape of the association. The aim of this study was to examine the bidirectional association between psychological distress and categorical change in objectively measured weight and WC.
We analysed repeated measures (up to 17 522 person-observations in adjusted analyses) of psychological distress, weight and WC from the Whitehall II cohort. Participants were recruited at age 35–55 and 67% male. Psychological distress was assessed using the General Health Questionnaire. We used random-effects regressions to model the association between weight and WC changes and psychological distress, with and without a 5-year lag period.
Psychological distress was associated with weight and WC gain over the subsequent 5 years but not the second 5-year period. Weight gain and loss were associated with increased odds for incident psychological distress in models with and without time-lag [odds ratio (OR) for incident psychological distress after 5-year time-lag: loss 1.20, 95% confidence interval (CI) 1.00–1.43; gain>5% 1.20, 95% CI 1.02–1.40]. WC changes were only associated with psychological distress in models without time-lag (OR for incident psychological distress: loss 1.29, 95% CI 1.02–1.64; gain>5% 1.33, 95% CI 1.11–1.58).
Weight gain and loss increase the odds for psychological distress compared with stable weight over subsequent 10 years. In contrast, the association between psychological distress and subsequent weight and WC changes was limited to the first 5 years of follow-up.
Patients suffering from an out-of-hospital cardiac arrest (OHCA) associated with an initial shockable rhythm have a better prognosis than their counterparts. The implications of recurrent or refractory malignant arrhythmia in such context remain unclear. The objective of this study is to evaluate the association between the number of prehospital shocks delivered and survival to hospital discharge among patients in OHCA.
This cohort study included adult patients with an initial shockable rhythm over a 5-year period from a registry of OHCA in Montreal, Canada. The relationship between the number of prehospital shocks delivered and survival to discharge was described using dynamic probabilities. The association between the number of prehospital shocks delivered and survival to discharge was assessed using multivariable logistic regression.
A total of 1,788 patients (78% male with a mean age of 64 years) were included in this analysis, of whom 536 (30%) received treatments from an advanced care paramedic. A third of the cohort (583 patients, 33%) survived to hospital discharge. The probability of survival was highest with the first shock (33% [95% confidence interval 30%-35%]), but decreased to 8% (95% confidence interval 4%-13%) following nine shocks. A higher number of prehospital shocks was independently associated with lower odds of survival (adjusted odds ratio=0.88 [95% confidence interval 0.85-0.92], p < 0.001).
Survival remains possible even after a high number of shocks for patients suffering from an OHCA with an initial shockable rhythm. However, requiring more shocks is independently associated with worse survival.
Although there is a growing interest for the effects of intermittent fasting on energy balance, this study aimed to compare appetite, energy intake and food reward responses with an energy depletion induced either by 24-h food restriction or an equivalent deficit with exercise in healthy males. In all, twelve healthy lean males (21·5 (sd 0·5) years old; BMI: 22·5 (sd 1·7) kg/m2) participated in this study. Body composition, aerobic capacity, food preferences and energy intake were assessed. They randomly completed three conditions: (i) no depletion (CON); (ii) full 24-h energy restrictions (Def-EI); and (iii) exercise condition (Def-EX). Ad libitum energy intake and food reward were assessed at the end of each session. Appetite feelings were assessed regularly. Ad libitum energy intake was higher on Def-EI (7330 (sd 2975) kJ (1752 (sd 711) kcal) compared with that on CON (5301 (sd 1205) kJ (1267 (sd 288) kcal)) (P<0·05), with no difference between CON and Def-EX (6238 (sd 1741) kJ (1491 (sd 416) kcal) (P=0·38) and between Def-EX and Def-EI (P=0·22). There was no difference in the percent energy ingested from macronutrients. Hunger was lower on CON and Def-EX compared with Def-EI (P<0·001). Satiety was higher on CON and Def-EI compared with that on Def-EX (P<0·001). There was a significant interaction condition × time for food choice fat bias (P=0·04), showing a greater preference for high-fat v. low-fat food during Def-EI and Def-EX. Although 24-h fasting leads to increased energy intake at the following test meal (without total daily energy intake difference), increased hunger profile and decreased post-meal food choice fat bias, such nutritional responses are not observed after a similar deficit induced by exercise.
The widespread replication of research findings in independent laboratories prior to publication is suggested as a complement to traditional replication approaches. The pre-publication independent replication approach further addresses three key concerns from replication skeptics by systematically taking context into account, reducing reputational costs for original authors and replicators, and increasing the theoretical value of failed replications.
In the past, ionic analyses of deep ice cores tended to consist of a few widely spaced measurements that indicated general trends in concentration. the ion-chromatographic methods widely used provide well-validated individual data, but are time-consuming. the development of continuous flow analysis (CFA) methods has allowed very rapid, high-resolution data to be collected in the field for a wide range of ions. In the European Project for Ice Coring in Antarctica (EPICA) deep ice-core drilling at Dome C, many ions have been measured at high resolution, and several have been analyzed by more than one method. the full range of ions has been measured in five different laboratories by ion chromatography (IC), at resolutions of 2.5–10 cm. In the field, CFA was used to measure the ions Na+, Ca2+, nitrate and ammonium. Additionally, a new semi-continuous in situ IC method, fast ion chromatography (FIC), was used to analyze sulphate, nitrate and chloride. Some data are now available to 788 m depth. In this paper we compare the data obtained by the three methods, and show that the rapid methods (CFA and FIC) give an excellent indication of trends in ionic data. Differences between the data from the different methods do occur, and in some cases these are genuine, being due to differences in speciation in the methods. We conclude that the best system for most deep ice-core analysis is a rapid system of CFA and FIC, along with in situ meltwater collection for analysis of other ions by IC, but that material should be kept aside for a regular check on analytical quality and for more detailed analysis of some sections.
A novel, alloy-agnostic, nanofunctionalization process has been utilized to produce metal matrix composites (MMCs) via additive manufacturing, providing new geometric freedom for MMC design. MMCs were produced with the addition of tungsten carbide nanoparticles to commercially available AlSi10Mg alloy powder. Tungsten carbide was chosen due to the potential for coherent crystallographic phases that were identified utilizing a lattice-matching approach to promote wetting and increase dislocation interactions. Structures were produced with evenly distributed strengthening phases leading to tensile strengths >385 MPa and a 50% decrease in wear rate over the commercially available AlSi10Mg alloy at only 1 vol% loading of tungsten carbide.
A few studies examine the time evolution of delirium in long-term care (LTC) settings. In this work, we analyze the multivariate Delirium Index (DI) time evolution in LTC settings.
The multivariate DI was measured weekly for six months in seven LTC facilities, located in Montreal and Quebec City. Data were analyzed using a hidden Markov chain/latent class model (HMC/LC).
The analysis sample included 276 LTC residents. Four ordered latent classes were identified: fairly healthy (low “disorientation” and “memory impairment,” negligible other DI symptoms), moderately ill (low “inattention” and “disorientation,” medium “memory impairment”), clearly sick (low “disorganized thinking” and “altered level of consciousness,” medium “inattention,” “disorientation,” “memory impairment” and “hypoactivity”), and very sick (low “hypoactivity,” medium “altered level of consciousness,” high “inattention,” “disorganized thinking,” “disorientation” and “memory impairment”). Four course types were also identified: stable, improvement, worsening, and non-monotone. Class order was associated with increasing cognitive impairment, frequency of both prevalent/incident delirium and dementia, mortality rate, and decreasing performance in ADL.
Four ordered latent classes and four course types were found in LTC residents. These results are similar to those reported previously in acute care (AC); however, the proportion of very sick residents at enrolment was larger in LTC residents than in AC patients. In clinical settings, these findings could help identify participants with a chronic clinical disorder. Our HMC/LC approach may help understand coexistent disorders, e.g. delirium and dementia.
Sea surface reservoir ages (R) are reported from radiocarbon (14C) measurements of the annual growth bands of coral Siderastrea siderea collected on the Atlantic coast off Martinique Island, in the Lesser Antilles volcanic arc. Mean values of R are similar between 1835 and 1845 during pre-anthropogenic times at 385±30 yr and between 1895 and 1905 at 382±20 yr when there was a huge eruption from the Montagne Pelée volcano in 1902–1903. Limited 14C aging of sea surface (~40 yr) may be due to enhanced volcanic activity. Variability of R is slightly greater during 1835–1845 than during 1895–1905. It is linked to a moderate increase of ∆14C of 5‰, strengthened by a clear increase of δ18O of 0.4‰. This is attributed to a decrease of the northward advection of the South Atlantic Waters into the western tropical North Atlantic and Caribbean Sea and relative enhanced westward flux of the tropical North Atlantic surface waters, the southern waters having lower values of 14C and δ18O than the North Atlantic ones. From 1835 to 1845, the fraction of the South Atlantic Waters transported up to Martinique Island was reduced from 25% to 15%.
How do epidemics, pandemics, and outbreaks become recognized as social problems? In this chapter, we suggest that the constructionist perspective focuses on the perception of these phenomena as social problems, often neglecting their materiality. A complementary approach, organized by the concept of medicalization, directs attention to the processes of authority and social control that both produce and regulate epidemics, pandemics, and outbreaks as social problems. In our view, these approaches, while important for the study of medicalized social problems more generally, are somewhat ill-suited to the study of epidemics, pandemics, and outbreaks. Accordingly, we turn to Michel Foucault's conceptualization of governmentality, refracted through the lens of Actor-Network Theory (ANT), as an alternative approach. This yields a perspective on epidemics, pandemics, and outbreaks that arcs back to materiality and also brings attention to the actor-networks, processes, and practices that (imperfectly) translate these phenomena into social problems. As we argue, this method of analysis should consider, at a minimum, (1) cultural understandings about bodily vulnerability; (2) social processes of stigmatization and marginalization; (3) structural inequalities and structural violence; and (4) public health efforts to detect and preempt disease spread.
Zirconolite glass-ceramics are being developed as potential wasteforms for the disposition of Pu wastes in the UK. Previous studies utilised a variety of surrogates whilst this work uses both cold-press and sinter and hot isostatic press methods to validate the wasteform with PuO2. A cold press and sinter sample was fabricated as part of a validation study for plutonium incorporation in hot isostatically pressed (HIPed) wasteforms. The results confirmed the cold-press and sinter, achieved successful waste incorporation and a microstructure and phase assemblage that was in agreement with those expected of a HIPed equivalent. A HIP sample was fabricated of the same composition and characterised by SEM and XRD. Results were in agreement with the sintered sample and achieved complete waste incorporation into the glass-ceramic wasteform. These samples have demonstrated successful incorporation of PuO2 into glass-ceramic HIPed wasteforms proposed for processing Pu-based waste-streams in the UK.
Glyphosate-resistant populations of Conyza canadensis have been spreading at a rapid rate in Ontario, Canada, since first being documented in 2010. Determining the genetic relationship among existing Ontario populations is necessary to understand the spread and selection of the resistant biotypes. The objectives of this study were to: (1) characterize the genetic variation of C. canadensis accessions from the province of Ontario using simple sequence repeat (SSR) markers and (2) investigate the molecular mechanism (s) conferring resistance in these accessions. Ninety-eight C. canadensis accessions were genotyped using 8 SSR markers. Germinable accessions were challenged with glyphosate to determine their dose response, and the sequences of 5-enolpyruvylshikimate-3-phosphate synthase genes 1 and 2 were obtained. Results indicate that a majority of glyphosate-resistant accessions from Ontario possessed a proline to serine substitution at position 106, which has previously been reported to confer glyphosate resistance in other crop and weed species. Accessions possessing this substitution demonstrated notably higher levels of resistance than non–target site resistant (NTSR) accessions from within or outside the growing region and were observed to form a subpopulation genetically distinct from geographically proximate glyphosate-susceptible and NTSR accessions. Although it is unclear whether other non–target site resistance mechanisms are contributing to the levels of resistance observed in target-site resistant accessions, these results indicate that, at a minimum, selection for Pro-106-Ser has occurred in addition to selection for non–target site resistance and has significantly enhanced the levels of resistance to glyphosate in C. canadensis accessions from Ontario.
Whether monozygotic (MZ) and dizygotic (DZ) twins differ from each other in a variety of phenotypes is important for genetic twin modeling and for inferences made from twin studies in general. We analyzed whether there were differences in individual, maternal and paternal education between MZ and DZ twins in a large pooled dataset. Information was gathered on individual education for 218,362 adult twins from 27 twin cohorts (53% females; 39% MZ twins), and on maternal and paternal education for 147,315 and 143,056 twins respectively, from 28 twin cohorts (52% females; 38% MZ twins). Together, we had information on individual or parental education from 42 twin cohorts representing 19 countries. The original education classifications were transformed to education years and analyzed using linear regression models. Overall, MZ males had 0.26 (95% CI [0.21, 0.31]) years and MZ females 0.17 (95% CI [0.12, 0.21]) years longer education than DZ twins. The zygosity difference became smaller in more recent birth cohorts for both males and females. Parental education was somewhat longer for fathers of DZ twins in cohorts born in 1990–1999 (0.16 years, 95% CI [0.08, 0.25]) and 2000 or later (0.11 years, 95% CI [0.00, 0.22]), compared with fathers of MZ twins. The results show that the years of both individual and parental education are largely similar in MZ and DZ twins. We suggest that the socio-economic differences between MZ and DZ twins are so small that inferences based upon genetic modeling of twin data are not affected.
Many snow models have been developed for various applications such as hydrology, global atmospheric circulation models and avalanche forecasting. The degree of complexity of these models is highly variable, ranging from simple index methods to multi-layer models that simulate snow-cover stratigraphy and texture. In the framework of the Snow Model Intercomparison Project (SnowMIP), 23 models were compared using observed meteorological parameters from two mountainous alpine sites. The analysis here focuses on validation of snow energy-budget simulations. Albedo and snow surface temperature observations allow identification of the more realistic simulations and quantification of errors for two components of the energy budget: the net short- and longwave radiation. In particular, the different albedo parameterizations are evaluated for different snowpack states (in winter and spring). Analysis of results during the melting period allows an investigation of the different ways of partitioning the energy fluxes and reveals the complex feedbacks which occur when simulating the snow energy budget. Particular attention is paid to the impact of model complexity on the energy-budget components. The model complexity has a major role for the net longwave radiation calculation, whereas the albedo parameterization is the most significant factor explaining the accuracy of the net shortwave radiation simulation.
The SAFRAN/Crocus/MÉPRA software is used to assess the climatology of the avalanche hazard and its sensitivity to climate change. A natural avalanche-hazard index based on MEPRA analysis is defined and validated against natural avalanche observations (triggered avalanches are not taken into account). A 15 year climatology then allows a comparison of avalanche hazard in the different French massifs. Finally a simple climate scenario (with a general increase of precipitation and temperature) shows that avalanche hazard may decrease slightly in winter (mainly February) and more significantly in May/June. The relative proportion of wet-snow avalanches increases.