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The efficacy of antidepressant treatment is fair, but the efficacy is considerably lower in patients failing two or more trials underscoring the need for new treatment options. Our study evaluated the augmenting antidepressant effect of 8-weeks transcranial pulsed electromagnetic field (T-PEMF) therapy in patients with treatment-resistant depression.
A multicenter 8-week single-arm cohort study conducted by the Danish University Antidepressant Group.
In total, 58 participants (20 men and 38 women) with a moderate to severe depression as part of a depressive disorder according to ICD-10 who fulfilled criteria for treatment resistance were included, with 19 participants being nonresponders to electroconvulsive therapy during the current depressive episode. Fifty-two participants completed the study period. Scores on the Hamilton Depression Scale 17-items version (HAM-D17) decreased significantly from baseline (mean = 20.6, SD 4.0) to endpoint (mean = 12.6, SD 7.1; N = 58). At endpoint, utilizing a Last Observation Carried Forward analysis, 49 and 28% of those participants with, respectively, a nonchronic current episode (≤2 years; N = 33) and a chronic current episode (>2 years; N = 25) were responders, that is, achieved a reduction of 50% or more on the HAM-D17 scale. At endpoint, respectively, 30 and 16% obtained remission, defined as HAM-D17 ≤ 7. On the Hamilton Scale 6-item version (HAM-D6), respectively, 51 and 16% obtained remission, defined as HAM-D6 ≤ 4.
The findings indicate a potential beneficial role of T-PEMF therapy as an augmentation treatment to ongoing pharmacotherapy in treatment-resistant depression.
Environmental scientists and managers increasingly recognize that socio-cultural evaluations expand the understanding of human–nature relationships. Here, user groups’ perceptions of the benefits from and threats to nature were analysed in Tierra del Fuego National Park, Argentina. We hypothesized that the different relationships of users to this place would lead to significantly different valuations among local Ushuaia residents (n = 122), Argentine nationals (n = 147) and international tourists (n = 294). All users perceived a broad spectrum of benefits. The three groups assessed intrinsic and relational values more highly than instrumental benefits, and significant differences included a higher mean valuation of benefits by Argentine visitors. Overall, threats were less perceived than benefits, and significant differences included a higher mean threat assessment by Ushuaia residents. To explain these relationships, we found that mean valuations of benefits and threats were weakly related to increased biodiversity knowledge for residents and international tourists, but not for Argentine visitors. These findings can orient environmental management in Patagonia and elsewhere by identifying areas where information can improve user experiences and by contributing a more pluralistic understanding of nature from multiple stakeholders.
Studies of the association between pre-deployment cognitive ability and post-deployment post-traumatic stress disorder (PTSD) have shown mixed results.
To study the inflence of pre-deployment cognitive ability on PTSD symptoms 6–8 months post-deployment in a large population while controlling for pre-deployment education and deployment-related variables.
Study linking prospective pre-deployment conscription board data with post-deployment self-reported data in 9695 Danish Army personnel deployed to different war zones in 1997–2013. The association between pre-deployment cognitive ability and post-deployment PTSD was investigated using repeated-measure logistic regression models. Two models with cognitive ability score as the main exposure variable were created (model 1 and model 2). Model 1 was only adjusted for pre-deployment variables, while model 2 was adjusted for both pre-deployment and deployment-related variables.
When including only variables recorded pre-deployment (cognitive ability score and educational level) and gender (model 1), all variables predicted post-deployment PTSD. When deployment-related variables were added (model 2), this was no longer the case for cognitive ability score. However, when educational level was removed from the model adjusted for deployment-related variables, the association between cognitive ability and post-deployment PTSD became significant.
Pre-deployment lower cognitive ability did not predict post-deployment PTSD independently of educational level after adjustment for deployment-related variables.
Arterial hypertension is common in adults with repaired coarctation of the aorta, and is associated with several severe complications.
This study aimed to investigate the prevalence of poorly controlled (⩾140/90 mmHg) blood pressure among patients with diagnosed hypertension and to identify associated factors.
In the national register for CHD, adults with repaired coarctation of the aorta and diagnosed hypertension – defined as a registry diagnosis and/or use of anti-hypertensive prescription medication – were identified. Logistic regression analysis was used to identify variables associated with poorly controlled blood pressure.
Of the 243 included patients, 27.2% were female, the mean age was 45.4±15.3 years, and 52.3% had poorly controlled blood pressure at the last registration. In a multivariable model, age (years) (OR 1.03, CI 1.01–1.06, p=0.008) was independently associated with poorly controlled blood pressure and so was systolic arm–leg blood pressure gradient in the ranges [10, 20] mmHg (OR 4.92, CI 1.76–13.79, p=0.002) to >20 mmHg (OR 9.93, CI 2.99–33.02, p<0.001), in comparison with the reference interval [0, 10] mmHg. Patients with poorly controlled blood pressure had, on average, more types of anti-hypertensive medication classes prescribed (1.9 versus 1.5, p=0.003).
Poorly controlled blood pressure is common among patients with repaired coarctation of the aorta and diagnosed hypertension, despite what seems to be more intensive treatment. A systolic arm–leg blood pressure gradient is associated with poorly controlled blood pressure, even at low levels usually not considered for intervention, and may be an indicator of hypertension that is difficult to treat.
Several studies have investigated the potential benefits of marine n-3 PUFA in CVD, generally suggesting a lower risk of CHD. However, recent trials have questioned these results. This study investigated the association of fish consumption with dietary intake of marine n-3 PUFA with incident myocardial infarction (MI). In a Danish cohort study, 57 053 subjects between 50 and 64 years of age were enrolled from 1993 to 1997. From national registries, we identified all cases of incident MI. Dietary fish consumption was assessed using a semi-quantitative food questionnaire, including twenty-six questions regarding fish intake. In addition, we calculated the intake of total and individual marine n-3 PUFA. During a median follow-up of 17·0 years, we identified 3089 cases of incident MI. For both men and women, a high intake of fatty fish was inversely related to incident MI. Thus, when comparing the highest and the lowest quintile of fatty fish intake, we found a 12 % lower relative risk of MI in men (hazard ratio (HR) 0·88; 95 % CI 0·77, 1·00) and a 22 % lower relative risk in women (HR 0·78; 95 % CI 0·63, 0·96) after adjustments. For women, similar associations were observed for individual and total marine n-3 PUFA. In contrast, intake of lean fish was not associated with MI. In conclusion, incident MI was inversely related to a high intake of fatty fish, but not lean fish. However, test for trends across quintiles was not statistically significant. In general, this study supports the view that consumption of fatty fish may protect against MI.
Malignant arrhythmias are a major cause of sudden cardiac death in adults with congenital heart disease. We developed a model to serially investigate electrophysiological properties in an animal model of right ventricular hypertrophy and failure.
We created models of compensated (cHF; n=11) and decompensated (dHF; n=11) right ventricular failure in Wistar rats by pulmonary trunk banding. Healthy controls underwent sham operation (Control; n=13). Surface electrocardiography was recorded from extremities, and inducibility of ventricular tachycardia was evaluated in vivo by programmed stimulation. Isolated right ventricular myocardium was analysed for mRNA expression of selected genes.
Banding caused an increased mRNA expression of both connexin 43 and the voltage-gated sodium channel 1.5, as well as a prolongation of PQ, QRS and QTc intervals. Ventricular tachycardia was induced in the majority of banded animals compared with none in the healthy control group. No differences were found between the two degrees of failure in neither the electrophysiological parameters nor inducibility.
The electrophysiological properties of rat hearts subjected to pulmonary trunk banding were significantly changed with increased susceptibility to ventricular tachycardia, but no differences were found between compensated and decompensated right ventricular failure. Furthermore, we demonstrate that in vivo electrophysiological evaluation is a sensitive method to characterise the cardiac electric phenotype in an experimental rat model.
Executive functions (EF) and psychomotor speed (PMS) has been widely studied in Huntington’s disease (HD). Most studies have focused on finding markers of disease progression by comparing group means at different disease stages. Our aim was to investigate performances on nine measures of EF and PMS in a group of premanifest and manifest HD-gene expansion carriers and to investigate which measures were most sensitive for assessment of individual patients by analyzing frequencies of impaired performances relative to healthy controls. We recruited HD gene-expansion carriers, 48 manifest and 50 premanifest and as controls 39 healthy gene-expansion negative individuals. All participants underwent neurological examination and neuropsychological testing with nine cognitive measures. The frequency of impairment was investigated using cutoff scores. In group comparisons the manifest HD gene-expansion carriers scored significantly worse than controls on all tests and in classification of individual scores the majority of scores were classified as probably impaired (10th percentile) or impaired (5th percentile) with Symbol Digit Modalities Test (SDMT) being the most frequently impaired. Group comparisons of premanifest HD gene-expansion carriers and healthy controls showed significant differences on SDMT and Alternating fluency tests. Nevertheless the frequencies of probably impaired and impaired scores on individual tests were markedly higher for Alternating and Lexical fluency tests than for SDMT. We found distinct group differences in frequency of impairment on measures of EF and PMS in manifest and premanifest HD gene-expansion carriers. Our results indicate to what degree these measures can be expected to be clinically impaired. (JINS, 2015, 21, 1–10)
A liquid chromatography–MS (LC-MS) metabolomics analysis of plasma from portal–arterial catheterised pigs fed breads prepared with whole-grain rye or wheat flour with added concentrated arabinoxylan (AX) or β-glucan (BG) was conducted. Comparison of the effects of concentrated fibres with whole grains has received little attention. Six female catheterised pigs were given two white wheat breads with wheat AX or oat BG, two rye breads with ground rye (GR) or intact rye kernels (RK), and a control white wheat bread (WF) on separate occasions in a randomised cross-over design. The amount of available carbohydrate was similar for the five breads but varied in the content of protein. Plasma was collected continuously for 4 h after feeding. Glucose levels in the portal vein were reduced postprandially in response to the AX, GR and RK breads that had high contents of AX compared with WF bread (P < 0·03). AX and RK breads further tended to decrease plasma levels of some lysophosphatidylcholine species (P ≤ 0·10). The abundance of amino acids in plasma correlated with the protein contents in the breads and leucine uptake significantly affected insulin secretion in the mesenteric artery. In conclusion, the present study revealed that concentrated AX in wheat bread had similar positive effects as whole-grain rye bread on glucose and lipid metabolism.
The limit behaviour in probability of realised quadratic variation is discussed under a relatively simple ambit process setting. The relation of this to the underlying volatility/intermittency field is in focus, especially as concerns the question of no volatility/intermittency memory.
In 2005 an airborne survey was carried out from a Twin Otter aircraft at Pâkitsup Akuliarusersua (Paakitsoq) near Ilulissat in West Greenland. The survey aimed to measure ice thickness with a 60 MHz coherent radar and surface elevation with a scanning laser altimeter. Positioning information came from multiple on-board differential GPS units and an inertial navigation system. The region surveyed covers >80km along the ice margin and has a total area of ~2700km2 with varying density of measurements: the between-track distance was ~1 km near the margin, increasing to ~3km away from the margin. Regional high-resolution maps of basal topography under the Greenland ice sheet are useful for resolving important glaciological and hydrological questions and for enhancing related process studies, such as the influence of basal meltwater on ice dynamics. The ice-sheet margin in this region is also currently under consideration for hydropower development and has a long and continuing history of glaciological investigations, lately with emphasis on the connection between surface meltwater formation and surface velocity of the ice sheet. Here we present a new regional map of the surface and basal topography of the ice-sheet margin and discuss some of the implications for reported observations at Swiss Camp.
The number of adults with congenitally malformed hearts is growing, and there is an increasing demand for their continuous follow-up. At present, different programmes have been established for adults with congenital cardiac disease, but there is a lack of knowledge regarding how education and psychosocial support should be given to achieve effects. Before developing educational programmes, it is necessary to be aware of the perspective of the patients. The aim of our study, therefore, was to describe how adults with congenitally malformed hearts experience their educational needs.
The study had a qualitative design. We interviewed 16 adults, aged from 19 to 55 years, with congenitally malformed hearts.
Two-way communication emerged as crucial to individualising education. Without good communication, those with congenitally malformed hearts, receiving information from providers of healthcare, are unable to transfer the information received. Thus, individualised education gives access to knowledge and the tools required to manage important areas in life, such as the congenital cardiac malformation, physical activity, the situation of life, treatment, and resources available for healthcare. The information given should provide easy access to knowledge through proper educational materials and methods, and be given with respect for the individual. This is facilitated if the education is tailored to the requirements of the individual in a holistic approach, and is provided through good communication.
Our investigation shows that a structured educational programme needs to start from the perspective of the individual patient, and that two-way communication needs to be taken into consideration to enhance knowledge.
Intercropping is the simultaneous cultivation of more than one crop species on the same piece of land and is regarded as the practical application of basic ecological principles such as diversity, competition and facilitation. Field experiments were carried out on a sandy loam soil and a sandy soil in Denmark over three consecutive cropping seasons including dual grain legume (pea, faba bean and lupin)–barley intercropping as compared to the respective sole crops (SC). Yield stability of intercrops (IC) was not greater than that of grain legume SC, with the exception of the IC containing faba bean. Faba bean and lupin had lower yield stability than pea and fertilized barley. However, the different IC used environmental resources for plant growth up to 50% (LER=0.91–1.51) more effectively as compared to the respective SC, but with considerable variation over location, years and crops. The SC performance supported the interspecific interactions within the IC stand. On the sandy loam 13% greater grain yield of pea cv. Agadir (520 g m−2) was observed as compared to cv. Bohatyr. Faba bean and lupin yielded similarly (340 g m−2) in the sandy loam soil, with decreasing yields on the sandy soil (320–270 g m−2). Nitrogen fixation was very constant in grain legume SC over species and location, varying from 13.2 to 15.8 g N m−2, being lowest in peas and highest in faba bean and lupin. The intercropped grain legumes increased the proportion of plant N derived from N2-fixation by on average 10–15% compared to the corresponding SC. However, especially lupin was suppressed when intercropping, with a reduced N2-fixation from 15 to 5–6 g N m−2. The IC were particularly effective at suppressing weeds, capturing a greater share of available resources than SC. Weed infestation in the different crops was comparable; however, it tended to be the highest in sole cropped faba bean, lupin and unfertilized barley, where the application of urea to barley reduced the weed infestation by around 50%. Reduction in disease was observed in all IC systems compared to the corresponding SC, with a general disease reduction in the range of 20–40%. For one disease in particular (brown spot on lupin) disease reduction was almost 80% in the IC. Intercropping practices offer many advantages but improved understanding of the ecological mechanisms associated with planned spatial diversity, including additional benefits with associated diversity, is needed to enhance the benefits achieved.
In this paper we provide an asymptotic analysis of generalized bipower
measures of the variation of price processes in financial economics. These
measures encompass the usual quadratic variation, power variation, and
bipower variations that have been highlighted in recent years in financial
econometrics. The analysis is carried out under some rather general
Brownian semimartingale assumptions, which allow for standard leverage
effects.Ole E. Barndorff-Nielsen's
work is supported by the Centre for Analytical Finance (CAF), which is
funded by the Danish Social Science Research Council. Neil Shephard's
research is supported by the UK's ESRC through the grant “High
frequency financial econometrics based upon power variation.” We
thank the editor, Peter Phillips, and the referees for their stimulating
comments on an earlier version.
Contraction-induced glucose uptake in skeletal muscle is mediated by an insulin-independent mechanism that leads to translocation of the GLUT4 glucose transporter to the muscle surface membrane from an intracellular storage site. Although the signalling events that increase glucose transport in response to muscle contraction are not fully elucidated, the aim of the present review is to briefly present the current understanding of the molecular signalling mechanisms involved. Glucose uptake may be regulated by Ca2+-sensitive contraction-related mechanisms, possibly involving Ca2+/calmodulin-dependent protein kinase II and some isoforms of protein kinase C. In addition, glucose transport may be regulated by mechanisms that reflect the metabolic status of the muscle, probably involving the 5′AMP-activated protein kinase. Furthermore, the p38 mitogen-activated protein kinase may be involved in activating the GLUT4 translocated to the surface membrane. Nevertheless, the picture is incomplete, and fibre type differences also seem to be involved.
In this paper we review some recent work on limit results on realised power variation, that is, sums of powers of absolute increments of various semimartingales. A special case of this analysis is realised variance and its probability limit, quadratic variation. Such quantities often appear in financial econometrics in the analysis of volatility. The paper also provides some new results and discusses open issues.
A record of estimated annual (prior August to current July) precipitation derived from a regional bur oak (Quercus macrocarpa Michx.) tree-ring chronology indicates that southern Manitoba's hydroclimate has been relatively stable over the last 200 yr. Although this stability was interrupted briefly by pronounced wet intervals in the late A.D. 1820s and 1850s, hydroclimatic conditions since permanent Euro-Canadian settlement were much less variable and persistent than those prior to A.D. 1790. The reconstruction indicates that the Red River basin experienced extremely dry conditions between A.D. 1670 and 1775, with below-normal precipitation occurring approximately 2 years out of 3. Annual precipitation was estimated at more than two standard deviations below the mean during A.D. 1477, 1485, 1556, 1595, 1612, 1644, 1661, 1743, 1900, and 1980. Comparisons with limnological records from North Dakota and Minnesota suggest that multidecadal fluctuations in regional hydroclimate have been remarkably coherent across the northeastern Great Plains during the last 600 yr. However, individual dry years in the Red River basin were usually associated with larger scale drought across much of the North American interior.
Elevated concentrations of fasting and non-fasting triacylglycerol-rich lipoproteins (TRL) as well as oxidative changes of lipoproteins may increase the risk of ischaemic heart disease. To compare the effects of different diets rich in unsaturated fatty acids on the concentrations and in vitro oxidation of fasting and postprandial lipoproteins eighteen males consumed diets enriched with rapeseed oil (RO), olive oil (OO), or sunflower-seed oil (SO) in randomised order for periods of 3 weeks followed by a RO test meal. In the postprandial state the concentrations of cholesterol and triacylglycerol (TAG) in TRL were higher after consumption of OO compared with RO and SO (P<0·04), possibly related to differences in the fasting state. The propagation rates for VLDL and LDL oxidation were higher in the postprandial compared with the fasting state irrespective of diet. In the fasting state, the propagation rates were highest after SO (P<0·001), and in the postprandial state, SO gave rise to a shorter VLDL lag time (P=0·03) and a higher propagation rate than OO consumption (P=0·04). Overall, the SO diet resulted in a higher postprandial propagation rate of LDL (P<0·001) compared with RO and OO, while there was no effect of diet on LDL oxidation lag time. Our results suggest that RO and SO diets lower the postprandial cholesterol and TAG concentrations compared with OO, while RO and OO diets result in similar and lower in vitro susceptibility to oxidation of lipoproteins than SO.
This study was performed to examine the postprandial effects of meals containing dietary fats, with their natural fatty acid composition and tocopherol content, on the plasma triacylglycerols (TG) and tocopherols and on the resistance of VLDL and LDL to oxidation. On six separate days eighteen healthy male subjects were given low-fat meals (LF) or the LF meals enriched with sunflower oil (SO), rapeseed oil (RO), olive oil (OO), palm oil (PO), or butter (B) in a crossover design. The fat-rich meals all resulted in similar postprandial TG responses while the LF test meal did not increase plasma TG level. The postprandial plasma fatty acid profile changed to resemble the fatty acid composition of the ingested test fat. The α-tocopherol:γ-tocopherol ratios in postprandial plasma and VLDL samples were greater than in the test fats. We found that the resistance of VLDL particles to oxidation in the postprandial state as assessed from lag time was increased after the PO-rich meal as compared with the SO-rich meal (P=0·018), and the propagation rate was greater after the SO- and RO-rich meals compared with the others (P<0·001). The resistance of LDL particles to oxidation was unaffected by the meals. In postprandial VLDL samples, the content of α-tocopherol was greater after the OO- and SO-rich meals compared with the meal rich in PO (P=0·034 and 0·042 respectively). The γ-tocopherol content of VLDL was highest after RO-meal as compared with all other test meals (P=0·0019), and higher after SO as compared with B (P=0·0148). Large individual differences were noted. In conclusion, meals enriched with different fats lead to the formation of VLDL particles with varying resistance to oxidation.
During chill storage, cholesterol oxidation in feta cheese produced from bovine butteroil bleached at high temperature was compared with cholesterol oxidation in feta cheese produced from non-bleached butteroil. The bleaching was performed at two different temperatures, 265 and 280 °C, and the oil was bleached for 2·4, 3·8 or 4·3 min; a reference feta cheese was produced without bleaching. All cheeses were stored in brine at 4 °C, and cholesterol oxidation was measured during a storage period of 5 months. For the first 11 weeks of storage, the concentration of cholesterol oxides was comparable for the bleached feta cheeses, but on longer storage the concentration of oxysterols was highest in feta cheeses produced from the butteroil bleached at 280 °C. The bleaching temperature rather than the bleaching time affected cholesterol oxidation, which was minimal in the non-bleached reference cheese throughout the storage period compared with the bleached feta cheeses. 7-Ketocholesterol was found to be the dominant oxysterol in the feta cheeses at the end of the storage, comprising ∼ 50% of the total cholesterol oxides. In feta cheeses based on butteroil bleached at 265 °C, the concentration of 7-ketocholesterol ranged from 3·7 to 4·9 µg/g lipid at the end of the storage period, and in feta cheese based on butteroil bleached at 280 °C the concentration was 10·4–13·1 µg/g lipid. In the reference feta cheese the concentration of 7-ketocholesterol was 1·2 /µg/g lipid. There was no difference in yellowness, measured by tristimulus colorimetry as the Hunter b characteristic, of the feta cheeses bleached at 265 and 280 °C, and a small scale bleaching experiment with butteroil showed that it was possible to secure complete bleaching at temperatures down to 220 °C. We suggest that bleaching of butteroil for feta production should be performed at temperatures as low as possible in order to prevent cholesterol oxidation.