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Childhood abuse is a risk factor for poorer illness course in bipolar disorder, but the reasons why are unclear. Trait-like features such as affective instability and impulsivity could be part of the explanation. We aimed to examine whether childhood abuse was associated with clinical features of bipolar disorder, and whether associations were mediated by affective instability or impulsivity.
We analysed data from 923 people with bipolar I disorder recruited by the Bipolar Disorder Research Network. Adjusted associations between childhood abuse, affective instability and impulsivity and eight clinical variables were analysed. A path analysis examined the direct and indirect links between childhood abuse and clinical features with affective instability and impulsivity as mediators.
Affective instability significantly mediated the association between childhood abuse and earlier age of onset [effect estimate (θ)/standard error (SE): 2.49], number of depressive (θ/SE: 2.08) and manic episodes/illness year (θ/SE: 1.32), anxiety disorders (θ/SE: 1.98) and rapid cycling (θ/SE: 2.25). Impulsivity significantly mediated the association between childhood abuse and manic episodes/illness year (θ/SE: 1.79), anxiety disorders (θ/SE: 1.59), rapid cycling (θ/SE: 1.809), suicidal behaviour (θ/SE: 2.12) and substance misuse (θ/SE: 3.09). Measures of path analysis fit indicated an excellent fit to the data.
Affective instability and impulsivity are likely part of the mechanism of why childhood abuse increases risk of poorer clinical course in bipolar disorder, with each showing some selectivity in pathways. They are potential novel targets for intervention to improve outcome in bipolar disorder.
Guidelines for palliative and spiritual care emphasize the importance of screening patients for spiritual suffering. The aim of this review was to synthesize the research evidence of the accuracy of measures used to screen adults for spiritual suffering.
A systematic review of the literature. We searched five scientific databases to identify relevant articles. Two independent reviewers screened, extracted data, and assessed study methodological quality.
We identified five articles that yielded information on 24 spiritual screening measures. Among all identified measures, the two-item Meaning/Joy & Self-Described Struggle has the highest sensitivity (82–87%), and the revised Rush protocol had the highest specificity (81–90%). The methodological quality of all included studies was low.
Significance of Results
While most of the identified spiritual screening measures are brief (comprised 1 to 12 items), few had sufficient accuracy to effectively screen patients for spiritual suffering. We advise clinicians to use their critical appraisal skills and clinical judgment when selecting and using any of the identified measures to screen for spiritual suffering.
The Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND) cohort study of the Canadian Consortium on Neurodegeneration in Aging (CCNA) is a national initiative to catalyze research on dementia, set up to support the research agendas of CCNA teams. This cross-country longitudinal cohort of 2310 deeply phenotyped subjects with various forms of dementia and mild memory loss or concerns, along with cognitively intact elderly subjects, will test hypotheses generated by these teams.
The COMPASS-ND protocol, initial grant proposal for funding, fifth semi-annual CCNA Progress Report submitted to the Canadian Institutes of Health Research December 2017, and other documents supplemented by modifications made and lessons learned after implementation were used by the authors to create the description of the study provided here.
The CCNA COMPASS-ND cohort includes participants from across Canada with various cognitive conditions associated with or at risk of neurodegenerative diseases. They will undergo a wide range of experimental, clinical, imaging, and genetic investigation to specifically address the causes, diagnosis, treatment, and prevention of these conditions in the aging population. Data derived from clinical and cognitive assessments, biospecimens, brain imaging, genetics, and brain donations will be used to test hypotheses generated by CCNA research teams and other Canadian researchers. The study is the most comprehensive and ambitious Canadian study of dementia. Initial data posting occurred in 2018, with the full cohort to be accrued by 2020.
Availability of data from the COMPASS-ND study will provide a major stimulus for dementia research in Canada in the coming years.
In this paper we review the design and development of a 100 J, 10 Hz nanosecond pulsed laser, codenamed DiPOLE100X, being built at the Central Laser Facility (CLF). This 1 kW average power diode-pumped solid-state laser (DPSSL) is based on a master oscillator power amplifier (MOPA) design, which includes two cryogenic gas cooled amplifier stages based on DiPOLE multi-slab ceramic Yb:YAG amplifier technology developed at the CLF. The laser will produce pulses between 2 and 15 ns in duration with precise, arbitrarily selectable shapes, at pulse repetition rates up to 10 Hz, allowing real-time shape optimization for compression experiments. Once completed, the laser will be delivered to the European X-ray Free Electron Laser (XFEL) facility in Germany as a UK-funded contribution in kind, where it will be used to study extreme states of matter at the High Energy Density (HED) instrument.
Herbicide resistance is ‘wicked’ in nature; therefore, results of the many educational efforts to encourage diversification of weed control practices in the United States have been mixed. It is clear that we do not sufficiently understand the totality of the grassroots obstacles, concerns, challenges, and specific solutions needed for varied crop production systems. Weed management issues and solutions vary with such variables as management styles, regions, cropping systems, and available or affordable technologies. Therefore, to help the weed science community better understand the needs and ideas of those directly dealing with herbicide resistance, seven half-day regional listening sessions were held across the United States between December 2016 and April 2017 with groups of diverse stakeholders on the issues and potential solutions for herbicide resistance management. The major goals of the sessions were to gain an understanding of stakeholders and their goals and concerns related to herbicide resistance management, to become familiar with regional differences, and to identify decision maker needs to address herbicide resistance. The messages shared by listening-session participants could be summarized by six themes: we need new herbicides; there is no need for more regulation; there is a need for more education, especially for others who were not present; diversity is hard; the agricultural economy makes it difficult to make changes; and we are aware of herbicide resistance but are managing it. The authors concluded that more work is needed to bring a community-wide, interdisciplinary approach to understanding the complexity of managing weeds within the context of the whole farm operation and for communicating the need to address herbicide resistance.
Seven half-day regional listening sessions were held between December 2016 and April 2017 with groups of diverse stakeholders on the issues and potential solutions for herbicide-resistance management. The objective of the listening sessions was to connect with stakeholders and hear their challenges and recommendations for addressing herbicide resistance. The coordinating team hired Strategic Conservation Solutions, LLC, to facilitate all the sessions. They and the coordinating team used in-person meetings, teleconferences, and email to communicate and coordinate the activities leading up to each regional listening session. The agenda was the same across all sessions and included small-group discussions followed by reporting to the full group for discussion. The planning process was the same across all the sessions, although the selection of venue, time of day, and stakeholder participants differed to accommodate the differences among regions. The listening-session format required a great deal of work and flexibility on the part of the coordinating team and regional coordinators. Overall, the participant evaluations from the sessions were positive, with participants expressing appreciation that they were asked for their thoughts on the subject of herbicide resistance. This paper details the methods and processes used to conduct these regional listening sessions and provides an assessment of the strengths and limitations of those processes.
We apply a novel one-dimensional glacier hydrology model that calculates hydraulic head to the tidewater-terminating Sermeq Avannarleq flowline of the Greenland ice sheet. Within a plausible parameter space, the model achieves a quasi-steady-state annual cycle in which hydraulic head oscillates close to flotation throughout the ablation zone. Flotation is briefly achieved during the summer melt season along a ∼17 km stretch of the ∼50 km of flowline within the ablation zone. Beneath the majority of the flowline, subglacial conduit storage ‘closes’ (i.e. obtains minimum radius) during the winter and ‘opens’ (i.e. obtains maximum radius) during the summer. Along certain stretches of the flowline, the model predicts that subglacial conduit storage remains open throughout the year. A calculated mean glacier water residence time of ∼2.2 years implies that significant amounts of water are stored in the glacier throughout the year. We interpret this residence time as being indicative of the timescale over which the glacier hydrologic system is capable of adjusting to external surface meltwater forcings. Based on in situ ice velocity observations, we suggest that the summer speed-up event generally corresponds to conditions of increasing hydraulic head during inefficient subglacial drainage. Conversely, the slowdown during fall generally corresponds to conditions of decreasing hydraulic head during efficient subglacial drainage.
Two observational programs which provide new information about particular LBVs through investigations of their immediate surroundings are described. (1) Digital spectral classification of OB supergiants in compact groups apparently associated with Radcliffe 127 and S Doradus has revealed several interesting objects and indicates which of them are likely to be generically related to the LBVs. (2) Velocity-resolved images of the Eta Carinae shell show qualitatively new features, which will contribute substantially to the interpretation of its complex spatial/kinematical structure.
In the spring of 1995 an extensive global positioning system (GPS) survey was carried out on the Amery Ice Shelf, East Antarctica, providing ground-truth ellipsoidal height measurements for the European remote-sensing satellite (ERS) radar altimeters. GPS- and altimeter-derived surface heights have been compared at the intersecting points of the ERS ground tracks and the GPS survey. The mean and rms height difference for all ERS-1 geodetic-phase tracks across the survey region is 0.0 + 0.1 m and 1.7 m, respectively. The spatial distribution of the height differences is highly correlated with surface topographic variations. Comparisons of GPS-derived surface-elevation profiles along ERS ground tracks show that the ERS altimeters can closely follow the GPS representation of the actual surface.
Twenty one samples of relatively pure tubular halloysites (HNTs) from localities in Australia, China, New Zealand, Scotland, Turkey and the USA have been investigated by X-ray diffraction (XRD), infrared spectroscopy (IR) and electron microscopy. The halloysites occur in cylindrical tubular forms with circular or elliptical cross sections and curved layers and also as prismatic tubular forms with polygonal cross sections and flat faces. Measurements of particle size indicate a range from 40 to 12,700 nm for tube lengths and from 20 to 600 nm for diameters. Size distributions are positively skewed with mean lengths ranging from 170 to 950 nm and mean diameters from 50 to 160 nm. Cylindrical tubes are systematically smaller than prismatic ones. Features related to order/ disorder in XRD patterns e.g. as measured by a ‘cylindrical/prismatic’ (CP) index and IR spectra as measured by an ‘OH-stretching band ratio’ are related to the proportions of cylindrical vs. prismatic tubes and correlated with other physical measurements such as specific surface area and cation exchange capacity. The relationships of size to geometric form, along with evidence for the existence of the prismatic form in the hydrated state and the same 2M1 stacking sequence irrespective of hydration state (i.e. 10 vs. 7 Å) or form, suggests that prismatic halloysites are the result of continued growth of cylindrical forms.
Neurophysiological measurements of the response to pre-pulse and startle stimuli have been suggested to represent an important endophenotype for both substance dependence and other select psychiatric disorders. We have previously shown, in young adult Mexican Americans (MA), that presentation of a short delay acoustic pre-pulse, prior to the startle stimuli can elicit a late negative component at about 400 msec (N4S), in the event-related potential (ERP), recorded from frontal cortical areas. In the present study, we investigated whether genetic factors associated with this endophenotype could be identified. The study included 420 (age 18–30 years) MA men (n = 170), and women (n = 250). DNA was genotyped using an Affymetrix Axiom Exome1A chip. An association analysis revealed that the CCKAR and CCKBR (cholecystokinin A and B receptor) genes each had a nearby variant that showed suggestive significance with the amplitude of the N4S component to pre-pulse stimuli. The neurotransmitter cholecystokinin (CCK), along with its receptors, CCKAR and CCKBR, have been previously associated with psychiatric disorders, suggesting that variants near these genes may play a role in the pre-pulse/startle response in this cohort.
Jacqueline E. A. K. Bamfo, Subspeciality Trainee in Maternal FetalMedicine, Fetal Medicine Unit, St Mary's Hospital, Manchester, UK,
Matthew D. Phillips, Manchester Royal Infirmary, Manchester, UK,
M. Kingston, Consultant Physician in Genitourinang Medicine, Manchester Royal Infirmary, Manchester, UK,
K. Chan, Consultant Obstetrician, Department of Obstetrics and Fetal Medicine Unit, St Mary's Hospital, Manchester, UK,
Ian Clegg, Consultant Anaesthetist, East Lancashire Hospitals NHS Trust, UK
Human immunodeficiency virus (HIV) is a retrovirus acquired by direct inoculation of infected bodily fluids. This is most often during sexual intimacy, but may also result from contaminated needles or iatrogenic interventions, such as blood transfusion or surgical procedures with contaminated products. The infection is lifelong and if untreated significant morbidity and mortality arise from HIV-associated infections and malignancies; this is termed the acquired immune deficiency syndrome (AIDS). During infection, HIV enters cells presenting CD4 receptors, the most common being the CD4+ T lymphocyte. Within the hosting cell, HIV replication, virion release and eventual cell death occur. The main measurable and prognostic parameters widely used are quantification of peripheral CD4 cells (the CD4 count), and the level of viraemia (HIV viral load). The likelihood of AIDS-defining illness developing increases with progressive CD4+ cell depletion, which occurs steadily over time from infection and more rapidly in individuals with a higher HIV viral load.
The advent of highly active antiretroviral therapy (HAART) in the late 1990s transformed the management of HIV-positive patients, and the infection is now generally treatable with a good prognosis, particularly when detected early. In addition to this, effective HAART together with appropriate obstetric management, infant antiretroviral prophylaxis and avoidance of breastfeeding has reduced rates of mother-to-child transmission (MTCT) of HIV significantly. Universal screening for HIV in UK antenatal clinics from 1999 onwards, followed by appropriate management of mothers and their babies, has resulted in MTCT rates falling from between 20–30%, depending on maternal viral load in the mid-1990s to less than 1% in 2010. Worldwide, of the 34 million people living with HIV, 69% reside in sub-Saharan Africa, with other high-prevalence areas including Asia, the Caribbean and Eastern Europe. Many HIV-positive parturients receiving their antenatal care in the UK have acquired HIV whilst residing in one of the pandemic areas. The estimated UK prevalence in 2009 was 2.2 per 1000 women giving birth; most of these live in urban areas, with London having the highest rates.
Effect of HIV on pregnancy
HIV infection itself does not cause sub-fertility, although HIV-positive women may have decreased fertility due to associated conditions such as concurrent infections or illnesses, opiate use and low weight. HAART itself, particularly protease inhibitors, has been associated with preterm delivery in some studies, but not in others.
Mass casualty triage is the process of prioritizing multiple victims when resources are not sufficient to treat everyone immediately. No national guideline for mass casualty triage exists in the United States. The lack of a national guideline has resulted in variability in triage processes, tags, and nomenclature. This variability has the potential to inject confusion and miscommunication into the disaster incident, particularly when multiple jurisdictions are involved. The Model Uniform Core Criteria for Mass Casualty Triage were developed to be a national guideline for mass casualty triage to ensure interoperability and standardization when responding to a mass casualty incident. The Core Criteria consist of 4 categories: general considerations, global sorting, lifesaving interventions, and individual assessment of triage category. The criteria within each of these categories were developed by a workgroup of experts representing national stakeholder organizations who used the best available science and, when necessary, consensus opinion. This article describes how the Model Uniform Core Criteria for Mass Casualty Triage were developed.
(Disaster Med Public Health Preparedness. 2011;5:129-137)