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Self-reported activity restriction is an established correlate of depression in dementia caregivers (dCGs). It is plausible that the daily distribution of objectively measured activity is also altered in dCGs with depression symptoms; if so, such activity characteristics could provide a passively measurable marker of depression or specific times to target preventive interventions. We therefore investigated how levels of activity throughout the day differed in dCGs with and without depression symptoms, then tested whether any such differences predicted changes in symptoms 6 months later.
Design, setting, participants, and measurements:
We examined 56 dCGs (mean age = 71, standard deviation (SD) = 6.7; 68% female) and used clustering to identify subgroups which had distinct depression symptom levels, leveraging baseline Center for Epidemiologic Studies of Depression Scale–Revised Edition and Patient Health Questionnaire-9 (PHQ-9) measures, as well as a PHQ-9 score from 6 months later. Using wrist activity (mean recording length = 12.9 days, minimum = 6 days), we calculated average hourly activity levels and then assessed when activity levels relate to depression symptoms and changes in symptoms 6 months later.
Clustering identified subgroups characterized by: (1) no/minimal symptoms (36%) and (2) depression symptoms (64%). After multiple comparison correction, the group of dCGs with depression symptoms was less active from 8 to 10 AM (Cohen’s d ≤ −0.9). These morning activity levels predicted the degree of symptom change on the PHQ-9 6 months later (per SD unit β = −0.8, 95% confidence interval: −1.6, −0.1, p = 0.03) independent of self-reported activity restriction and other key factors.
These novel findings suggest that morning activity may protect dCGs from depression symptoms. Future studies should test whether helping dCGs get active in the morning influences the other features of depression in this population (i.e. insomnia, intrusive thoughts, and perceived activity restriction).
Maternal mental health during pregnancy and postpartum predicts later emotional and behavioural problems in children. Even though most perinatal mental health problems begin before pregnancy, the consequences of preconception maternal mental health for children's early emotional development have not been prospectively studied.
We used data from two prospective Australian intergenerational cohorts, with 756 women assessed repeatedly for mental health problems before pregnancy between age 13 and 29 years, and during pregnancy and at 1 year postpartum for 1231 subsequent pregnancies. Offspring infant emotional reactivity, an early indicator of differential sensitivity denoting increased risk of emotional problems under adversity, was assessed at 1 year postpartum.
Thirty-seven percent of infants born to mothers with persistent preconception mental health problems were categorised as high in emotional reactivity, compared to 23% born to mothers without preconception history (adjusted OR 2.1, 95% CI 1.4–3.1). Ante- and postnatal maternal depressive symptoms were similarly associated with infant emotional reactivity, but these perinatal associations reduced somewhat after adjustment for prior exposure. Causal mediation analysis further showed that 88% of the preconception risk was a direct effect, not mediated by perinatal exposure.
Maternal preconception mental health problems predict infant emotional reactivity, independently of maternal perinatal mental health; while associations between perinatal depressive symptoms and infant reactivity are partially explained by prior exposure. Findings suggest that processes shaping early vulnerability for later mental disorders arise well before conception. There is an emerging case for expanding developmental theories and trialling preventive interventions in the years before pregnancy.
This paper examines some of the concerns regarding the development of an algorithm for the refinement of X-ray diffraction profiles. The object of the algorithm is to provide a time efficient method of refinement through the choice of a suitable profile function and optimization technique.
Seven profile models were tested using a least-squares error criterion for refinement. Profile parameters were refined using non-linear Gauss-Newton, Marquardt and Simplex algorithms. The profiles were refined on a pattern digitally collected from an NBS 640A silicon sample.
The results of this study indicate the repetitive function evaluations are not necessarily the time consuming step in the profile fitting process. As the number of parameters needed to evaluate the profile and the number of points in the profile increases, the time required to perform the mathematics in the Gauss-Newton and Marquardt algorithms increases. Although the Simplex was most memory and time efficient, our Gauss-Newton optimization algorithm provided a more consistent set of refined values which were not as dependent on the initial estimates of the parameters.
The most favorable results were obtained by using the split Pearson VII profile with the alpha 2 reflection fixed in position and intensity with respect to the alpha 1 reflsction. This method generated the lowest residual error and was found to avoid some problems resulting from the alpha 1, alpha 2 line overlap.
The development of unmanned systems (UMS) for naval combat poses a profound challenge to existing conventions regarding the treatment of the shipwrecked and wounded in war at sea. Article 18 of the 1949 Geneva Convention II states that warring parties are required to take “all possible measures” to search for and collect seamen left in the water after each engagement. The authors of the present paper analyze the ethical basis of this convention and argue that the international community should demand that UMS intended for roles in war at sea be provided with the capacity to make some contribution to search and rescue operations.
The crucial question in the analysis of social unrest is why it occurs at a particular moment in history. Whether one refers to the new militant movements in the United States (“Black Power,” “Red Power,” “Ethnic Power”), Ukrainian nationalism in the Soviet Ukraine, Great Russian revitalization, or the recent World Slovak Congress held in New York; it is clear that traditional systems of social stratification in the United States and Soviet-dominated Eastern Europe are now being severely strained. As Shibutani and Kwan have emphasized, in stable stratified societies the inequality of prerogatives goes unquestioned, even by the subjugated who willingly support it. Only in periods of instability is the differential access to opportunity questioned. And dissatisfaction arises only when alternatives to the status quo are perceived. This insight is the core of the “theory of relative deprivation.”
Potentially modifiable risk factors for developing dementia have been identified. However, risk factors for increased mortality in patients with diagnosed dementia are not well understood. Identifying factors that influence prognosis would help clinicians plan care and address unmet needs.
To investigate diagnosed depression and sociodemographic factors as predictors of mortality in patients with dementia in UK secondary clinical care services.
We conducted a cohort study of patients with a dementia diagnosis in an electronic health records database in a UK National Health Service mental health trust.
In 3374 patients with 10 856 person-years of follow-up, comorbid depression was not associated with mortality (adjusted hazard ratio 0.94; 95% CI 0.71–1.24). Single patients had higher mortality than those who were married (adjusted hazard ratio 1.25; 95% CI 1.03–1.50). Patients of Asian ethnicity had lower mortality rates than White British patients (adjusted hazard ratio 0.50; 95% CI 0.34–0.73).
Clinically diagnosed depression does not increase mortality in patients with dementia. Patients who are single are a potential high-mortality risk group. Lower mortality rates in Asian patients with dementia that have been reported in the USA also apply in the UK.
UK Biobank is a well-characterised cohort of over 500 000 participants that offers unique opportunities to investigate multiple diseases and risk factors.
An online mental health questionnaire completed by UK Biobank participants was expected to expand the potential for research into mental disorders.
An expert working group designed the questionnaire, using established measures where possible, and consulting with a patient group regarding acceptability. Case definitions were defined using operational criteria for lifetime depression, mania, anxiety disorder, psychotic-like experiences and self-harm, as well as current post-traumatic stress and alcohol use disorders.
157 366 completed online questionnaires were available by August 2017. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status than the general population across a range of indicators. Thirty-five per cent (55 750) of participants had at least one defined syndrome, of which lifetime depression was the most common at 24% (37 434). There was extensive comorbidity among the syndromes. Mental disorders were associated with high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.
The questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed owing to selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.
Declaration of interest
G.B. received grants from the National Institute for Health Research during the study; and support from Illumina Ltd. and the European Commission outside the submitted work. B.C. received grants from the Scottish Executive Chief Scientist Office and from The Dr Mortimer and Theresa Sackler Foundation during the study. C.S. received grants from the Medical Research Council and Wellcome Trust during the study, and is the Chief Scientist for UK Biobank. M.H. received grants from the Innovative Medicines Initiative via the RADAR-CNS programme and personal fees as an expert witness outside the submitted work.
Hippocampal neurogenesis continues throughout adult life and potentially plays a crucial role in mood and cognitive disorders. We summarise the preclinical insights and potential translational steps that could be taken to investigate the role and importance of this phenomenon in disease and health in humans.
Cognitive improvement has been reported in patients receiving centrally acting angiotensin-converting enzyme inhibitors (C-ACEIs).
To compare cognitive decline and survival after diagnosis of Alzheimer's disease between people receiving C-ACEIs, non-centrally acting angiotensin-converting enzyme inhibitors (NC-ACEIs), and neither.
Routine Mini-Mental State Examination (MMSE) scores were extracted in 5260 patients receiving acetylcholinesterase inhibitors and analysed against C-/NC-ACEI exposure at the time of Alzheimer's disease diagnosis.
In the 9 months after Alzheimer's disease diagnosis, MMSE scores significantly increased by 0.72 and 0.19 points per year in patients on C-ACEIs and neither respectively, but deteriorated by 0.61 points per year in those on NC-ACEIs. There were no significant group differences in score trajectories from 9 to 36 months and no differences in survival.
In people with Alzheimer's disease receiving acetylcholinesterase inhibitors, those also taking C-ACEIs had stronger initial improvement in cognitive function, but there was no evidence of longer-lasting influence on dementia progression.
A substantial subset of people with psychotic disorders are first diagnosed in old age, yet little is known about the epidemiology of very late-onset schizophrenia-like psychosis. We investigated the incidence of affective and non-affective psychotic disorders in those aged 65 and above, and examined variation related to potential risk factors via systematic literature review. We searched PubMed, PsychInfo, Web of Science and bibliographies and directly contacted authors to obtain citations published between 1960 and 2016 containing (derivable) incidence data. Cases were those diagnosed with non-organic psychotic disorders after age 65. Findings were presented narratively, and random-effects meta-analyses were used to obtain pooled incidence rates. From 5687 citations, 41 met inclusion criteria. The pooled incidence of: affective psychoses was 30.9 per 100 000 person-years at risk (100 kpy) [95% confidence interval (CI) 11.5–83.4; I2 = 0.99], and schizophrenia was 7.5 per 100 kpy (95% CI 6.2–9.1; I2 = 0.99), with some evidence of higher schizophrenia rates in women [odds ratio (OR) = 1.6; 95% CI 1.0–2.5, p = 0.05]. We found narrative evidence of increasing incidence rates of non-affective psychoses with age, and higher rates amongst migrants than baseline populations, but no evidence that incidence varied by study quality or case ascertainment period (quality OR = 1.04; 95% CI 0.74–1.48; time period OR = 1.00; 95% CI 0.95–1.05). Substantial heterogeneity in the incidence of very late-onset schizophrenia-like psychoses was observed. No identified studies examined possible risk factors which may account for such variation, including socio-economic status, sensory impairment, traumatic life events, or social isolation.
Recent observations of increased discharge through fast-flowing outlet glaciers and ice streams motivate questions concerning the inland migration of regions of fast flow, which could increase drawdown of the ice-sheet interior. To investigate one process that could lead to inland migration we conduct experiments with a two-dimensional, full-stress, transient ice-flow model. An initial steady state is perturbed by initiating a jump in sliding speed over a fraction of the model domain. As a result, longitudinal-stress gradients increase frictional melting upstream from the slow-to-fast sliding transition, and a positive feedback between longitudinal-stress gradients, basal meltwater production and basal sliding causes the sliding transition to migrate upstream over time. The distance and speed of migration depend on the magnitude of the perturbation and on the degree of non-linearity assumed in the link between basal stress and basal sliding: larger perturbations and/or higher degrees of non-linearity lead to farther and faster upstream migration. Migration of the sliding transition causes the ice sheet to thin over time and this change in geometry limits the effects of the positive feedback, ultimately serving to impede continued upstream migration.
Several parameters of the solar rotation show variations which appear to relate to the phase of the solar activity cycle. The latitude gradient of the differential rotation, as seen in the coefficients of the sin2 and sin4 terms in the latitude expansion, shows marked variations with the cycle. One of these variations may be described as a one-cycle-per-hemisphere torsional oscillation with a period of 11 years, where the high latitudes rotate faster at solar activity maximum and slower at minimum, and the low latitudes rotate faster at solar activity minimum and slower at maximum. Another variation is a periodic oscillation of the fractional difference in the low-latitude rotation between north and south hemispheres. The possibility of a variation in the absolute rotational velocity of the sun in phase with the solar cycle remains an open question. The two-cycle-per-hemisphere torsional waves in the solar rotation also represent an aspect of the rotation which varies with the cycle. We show that the amplitude of the fast flowing zone rises a year before the rise to activity maximum. The fast zone seems to be physically the more significant of the two zones.
A psychiatrist who cannot show that he or she has been involved in audit is going to be in difficulties. Short-listing panels for the appointment of trainees at CT1 or ST4 as well as those for the appointment of consultants already look for evidence of involvement in audit before ticking important boxes and the emerging criteria for revalidation of all doctors include completion of a number of audits during each 5-year revalidation cycle. We cannot avoid audit. Yet one of the biggest current contributors to wasted trainee and consultant time in psychiatry that I can think of is the conduct of audit projects that have been poorly thought through. These often mercifully stall. But even if they stutter on, those involved suffer frustration and pain before they are able only to deliver a product that nobody really wants to hear about. Conduct of a successful and satisfying audit requires expertise – in terms of both knowledge and experience – as well as energy. Expertise in the planning and conduct of audits may be hard to access in many of the settings within which we work. In such circumstances, how useful it would be to have access to a series of recipes for audit projects that have been successfully completed by experts and whose results have been useful and interesting. This is the exact purpose of the book you are now reading. The expertise and experiences of our colleagues in all branches of psychiatry who have carried out audit projects that have worked and usefully informed practice and service design are encapsulated in a comprehensive range of easy-to- follow recipes suitable for all, from the absolute beginner to the cordon bleu auditiste. I congratulate the editors for their vision and energy in putting this book together and thank all the contributors who supplied them with their audits. Psychiatrists will be happy and grateful to have this book to help them through the requirements of appointment panels and revalidation. But maybe, also, once helped to identify interesting and deliverable projects, psychiatrists will no longer feel they are wasting time on audit and will get some value and satisfaction out of the process.
A review is given of the observational and theoretical background of global-scale velocity fields on the solar surface. A newly-developed method of reduction of the Mount Wilson velocity data is described, and the results from this new method are compared with the results of the old method. A preliminary analysis is made of the new results over a short time interval. Small-scale latitude irregularities in the differential rotation are shown to exist. Variations in time which occur in the rotation rate are broadly distributed in latitude and longitude. Although a non-solar (instrumental) cause cannot be found for these variations, such a cause cannot be ruled out at this time. Global-scale non-axisymmetric velocity field patterns intermediate between solar diameter and super-granular scale are shown to exist on the solar surface as predicted by theory.