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Psychiatric disorders commonly emerge during the first year following traumatic brain injury (TBI). However, it is not clear whether these disorders soon remit or persist for long periods post-injury. This study aimed to examine, prospectively: (1) the frequency, (2) patterns of co-morbidity, (3) trajectory, and (4) risk factors for psychiatric disorders during the first 5 years following TBI.
Participants were 161 individuals (78.3% male) with moderate (31.2%) or severe (68.8%) TBI. Psychiatric disorders were diagnosed using the Structured Clinical Interview for DSM-IV, administered soon after injury and 3, 6 and 12 months, and 2, 3, 4 and 5 years post-injury. Disorder frequencies and generalized estimating equations were used to identify temporal relationships and risk factors.
In the first 5 years post-injury, 75.2% received a psychiatric diagnosis, commonly emerging within the first year (77.7%). Anxiety, mood and substance-use disorders were the most common diagnostic classes, often presenting co-morbidly. Many (56.5%) experienced a novel diagnostic class not present prior to injury. Disorder frequency ranged between 61.8 and 35.6% over time, decreasing by 27% [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.65–0.83] with each year post-injury. Anxiety disorders declined significantly over time (OR 0.73, 95% CI 0.63–0.84), whilst mood and substance-use disorder rates remained stable. The strongest predictors of post-injury disorder were pre-injury disorder (OR 2.44, 95% CI 1.41–4.25) and accident-related limb injury (OR 1.78, 95% CI 1.03–3.07).
Findings suggest the first year post-injury is a critical period for the emergence of psychiatric disorders. Disorder frequency declines thereafter, with anxiety disorders showing greater resolution than mood and substance-use disorders.
The mechanism behind the beneficial effects of enteral nutrition (EN) for patients with acute pancreatitis (AP) is largely unknown. Adipokines, as mediators of metabolism and inflammation, may be a possible mechanism. The study aimed to investigate the effect of EN on adipokines early in the course of AP. Patients with AP were randomised to EN or nil-by-mouth (NBM). Blood samples were taken on the first 4 d of admission and adipokine concentrations for adiponectin, leptin, omentin, resistin and visfatin were determined by ELISA assays. A linear mixed model analysis was run to determine differences in adipokine concentrations between the two study groups. A total of thirty-two patients were included in the study. Omentin concentrations were significantly higher in patients who received EN compared with NBM across the first 4 d of admission (mean difference: 11·6 (95 % CI 1·0, 22·3) ng/ml; P = 0·033). Leptin concentrations were significantly higher in patients who received EN compared with NBM after adjusting for age, sex and BMI (mean difference: 2·3 (95 % CI 0·1, 4·5) ng/ml; P = 0·037). No significant difference in adiponectin, resistin or visfatin concentrations were observed between the two study groups. EN significantly increases omentin and leptin concentrations in AP. Future research should be directed towards understanding whether these adipokines are responsible for the therapeutic benefits of EN.
Clostridium difficile infection (CDI) has been extensively described in healthcare settings; however, risk factors associated with community-acquired (CA) CDI remain uncertain. This study aimed to synthesize the current evidence for an association between commonly prescribed medications and comorbidities with CA-CDI.
A systematic search was conducted in 5 electronic databases for epidemiologic studies that examined the association between the presence of comorbidities and exposure to medications with the risk of CA-CDI. Pooled odds ratios were estimated using 3 meta-analytic methods. Subgroup analyses by location of studies and by life stages were conducted.
Twelve publications (n=56,776 patients) met inclusion criteria. Antimicrobial (odds ratio, 6.18; 95% CI, 3.80–10.04) and corticosteroid (1.81; 1.15–2.84) exposure were associated with increased risk of CA-CDI. Among the comorbidities, inflammatory bowel disease (odds ratio, 3.72; 95% CI, 1.52–9.12), renal failure (2.64; 1.23–5.68), hematologic cancer (1.75; 1.02–5.68), and diabetes mellitus (1.15; 1.05–1.27) were associated with CA-CDI. By location, antimicrobial exposure was associated with a higher risk of CA-CDI in the United States, whereas proton-pump inhibitor exposure was associated with a higher risk in Europe. By life stages, the risk of CA-CDI associated with antimicrobial exposure greatly increased in adults older than 65 years.
Antimicrobial exposure was the strongest risk factor associated with CA-CDI. Further studies are required to investigate the risk of CA-CDI associated with medications commonly prescribed in the community. Patients with diarrhea who have inflammatory bowel disease, renal failure, hematologic cancer, or diabetes are appropriate populations for interventional studies of screening.
Data were extracted from the case records of UK patients admitted with laboratory-confirmed influenza A(H1N1)pdm09. White and non-White patients were characterized by age, sex, socioeconomic status, pandemic wave and indicators of pre-morbid health status. Logistic regression examined differences by ethnicity in patient characteristics, care pathway and clinical outcomes; multivariable models controlled for potential confounders. Whites (n = 630) and non-Whites (n = 510) differed by age, socioeconomic status, pandemic wave of admission, pregnancy, recorded obesity, previous and current smoking, and presence of chronic obstructive pulmonary disease. After adjustment for a priori confounders non-Whites were less likely to have received pre-admission antibiotics [adjusted odds ratio (aOR) 0·43, 95% confidence interval (CI) 0·28–0·68, P < 0·001) but more likely to receive antiviral drugs as in-patients (aOR 1·53, 95% CI 1·08–2·18, P = 0·018). However, there were no significant differences by ethnicity in delayed admission, severity at presentation for admission, or likelihood of severe outcome.
Small scale explosively driven fragmentation experiments have been performed on Aluminum (Al)-Tungsten (W) granular composite rings processed using cold isostatic compression of Al and W powders with a particle size of 4-30 microns. Fragments collected from the experiments had a maximum size of the order of a few hundred micrometers. This is a dramatic reduction in the fragment size when compared to the 1-10 mm typical for a homogeneous material such as solid aluminum under similar loading conditions. Numerical simulations of the experiment were performed to elucidate the mechanisms of fragmentation that were responsible for this shift in fragmentation size scales. Simulations were performed with a significantly stronger explosive driver to examine how the mechanisms of fragmentation change when the detonation pressure increases.
This paper examines how the relationships between the factors (predisposing, enabling and illness) of the 1973 Andersen framework and service use are influenced by changes in the caring role in older women of the 1921–26 cohort of the Australian Longitudinal Study on Women's Health. Outcome variables were the use of three formal community support services: (a) nursing or community health services, (b) home-making services and (c) home maintenance services. Predictor variables were survey wave and the following carer characteristics: level of education, country of birth, age, area of residence, ability to manage on income, need for care, sleep difficulty and changes in caring role. Carer changes were a significant predictor of formal service use. Their inclusion did not attenuate the relationship between the Andersen framework factors and service use, but instead provided a more complete representation of carers' situations. Women were more likely to have used support services if they had changed into or out of co-resident caring or continued to provide co-resident care for a frail, ill or disabled person, needed care themselves, and reported sleep difficulties compared with women who did not provide care. These findings are important because they indicate that support services are particularly relevant to women who are changing their caring role and who are themselves in need of care.
Since the cytocompatibility of carbon nanofibers with respect to neural applications remains largely uninvestigated, the objective of the present in vitro study was to determine cytocompatibility properties of formulations containing carbon nanofibers. Carbon fiber substrates were prepared from four different types of carbon fibers, two with nanoscale diameters (nanophase, or less than or equal to 100 nm) and two with conventional diameters (or greater than 200 nm). Within these two categories, both a high and a low surface energy fiber were investigated and tested. Astrocytes (glial scar tissue-forming cells) and pheochromocytoma cells (PC-12; neuronal-like cells) were seeded separately onto the substrates. Results provided the first evidence that astrocytes preferentially adhered on the carbon fiber that had the largest diameter and the lowest surface energy. PC-12 cells exhibited the most neurites on the carbon fiber with nanodimensions and low surface energy. These results may indicate that PC-12 cells prefer nanoscale carbon fibers while astrocytes prefer conventional scale fibers. A composite was formed from poly-carbonate urethane and the 60 nm carbon fiber. Composite substrates were thus formed using different weight percentages of this fiber in the polymer matrix. Increased astrocyte adherence and PC-12 neurite density corresponded to decreasing amounts of the carbon nanofibers in the poly-carbonate urethane matrices. Controlling carbon fiber diameter may be an approach for increasing implant contact with neurons and decreasing scar tissue formation.
Carbon nanofibers possess excellent conductivity properties, which may be beneficial in the design of more effective neural prostheses, however, limited evidence on their cytocompatibility properties exists. The objective of the present in vitro study was to determine cytocompatibility and material properties of formulations containing carbon nanofibers to predict the gliotic scar tissue response. Poly-carbonate urethane was combined with carbon nanofibers in varying weight percentages to provide a supportive matrix with beneficial bulk electrical and mechanical properties. The substrates were tested for mechanical properties and conductivity. Astrocytes (glial scar tissue-forming cells) were seeded onto the substrates for adhesion. Results provided the first evidence that astrocytes preferentially adhered to the composite material that contained the lowest weight percentage of carbon nanofibers. Positive interactions with neurons, and, at the same time, limited astrocyte functions leading to decreased gliotic scar tissue formation are essential for increased neuronal implant efficacy.
Some supplementary results and interpretations on the theory of Hall MHD solitons (McKenzie and Doyle 2002 Phys. Plasmas9, 55) are presented. It is shown that the Hall MHD soliton reduces, in the appropriate limit, to an electrostatic ion–cyclotron soliton. It is also shown how the dynamical equations governing the Hall MHD soliton can be obtained from a Hamiltonian H. Soliton solutions correspond to H = 0, periodic solutions to H < 0 and rotation-type solutions to H >0. Possible applications are discussed. A non-canonical Hamiltonian picture is developed and compared to the well-known example of a free rigid body.
The Canadian spring wheat (Triticum aestivum L.; Poaceae) cultivar ‘Superb’ was less susceptible to damage by Hessian fly, Mayetiola destructor (Say), than the spring wheat cultivars ‘AC Barrie’, ‘AC Foremost’, ‘McKenzie’, ‘AC Domain’, and ‘Glenlea’ in Manitoba. The partial resistance of ‘Superb’ was similar, at the seedling stage, to that of ‘Guard’, which possesses the resistance gene H18. Females laid eggs readily on all cultivars, providing no evidence for antixenosis, but few larvae developed on seedlings of ‘Superb’ and ‘Guard’, showing that antibiosis against larvae is the mechanism of resistance in these seedlings. In the field, where infestation of spring wheat takes place about 4 weeks after the seedling stage, ‘Guard’ continued to show high levels of resistance, but ‘Superb’ was less resistant, although still more resistant than highly susceptible cultivars. Infested stems of ‘Superb’ and ‘Nordic’ were less likely to break than infested stems of other cultivars, showing that these two cultivars are partially tolerant to infestation. Infested stems of ‘Guard’ and other cultivars showed high levels of stem breakage and are intolerant. Yield losses due to infestation by Hessian fly were mostly caused by the breakage and falling over of infested stems, which prevented the seeds on these stems from being harvested. Infested stems of all susceptible cultivars that remained standing at harvest had lower seed masses and fewer seeds per spike than uninfested stems, which contributed to yield loss. ‘Grandin’, a parent of ‘Superb’, is the probable source of resistance in ‘Superb’, but the pedigree of ‘Grandin’ provides no clue as to the gene(s) involved. The partial antibiosis and tolerance expressed by ‘Superb’ is sufficient to reduce losses to Hessian fly by 65% in comparison with a susceptible cultivar such as ‘AC Barrie’. ‘Superb’ is the first Canadian spring wheat cultivar identified to have an agronomically useful level of resistance to Hessian fly.
Background. Although diurnal variation of mood is a widely recognized symptom of depression, the clinical, neurobiological and psychopharmacological significance of this symptom has not previously been reported.
Method. A total of 195 depressed out-patients underwent a detailed clinical and neurobiological assessment, and were then randomized to treatment with either fluoxetine or nortriptyline.
Results. Of the 195 depressed patients, 62 had a pattern of reversed diurnal variation (i.e. worse in the evening). Those with reversed diurnal variation had a poorer response to a serotonergic antidepressant, were less likely to have bipolar II disorder, had a higher tryptophan:large neutral amino acid ratio and had different allele frequencies of the polymorphisms in the promoter region of the serotonin transporter.
Conclusions. These findings raise the possibility of serotonergic influence on diurnal variation, and that the symptom of reversed diurnal variation is of relevance to antidepressant prescribing.
Background. Elevated rates of psychological morbidity and symptomatology have been widely reported in 1991 Gulf War veterans. The present study used brief self-report instruments to compare the psychological health of Australian Gulf War veterans with that of a randomly sampled military comparison group.
Method. The 12-item Short Form Health Survey (SF-12), 12-item General Health Questionnaire (GHQ-12), Posttraumatic Stress Disorder Checklist – Specific (PCL-S) and Military Service Experience (MSE) questionnaire were administered to 1424 male Australian Gulf War veterans and 1548 male Australian Defence Force members who were operational at the time of the Gulf War conflict, but were not deployed there.
Results. The Gulf War veterans exhibited poorer psychological health, as measured by the above three instruments, than the comparison group members. For Gulf War veterans, the number of stressful experiences, as measured by the MSE questionnaire, was correlated with scores on the three instruments. SF-12 mental health component summary scores and PCL-S caseness, but not GHQ-12 caseness, differed significantly between Gulf War veterans and comparison group members who had been on at least one active deployment.
Conclusions. More than a decade after the 1991 Gulf War, Australian Gulf War veterans are exhibiting higher levels of current (past month) psychological ill-health, as measured using the GHQ-12 and PCL-S, as well as lower mental health status, as measured by the SF-12, than the comparison group. Although not a replacement for formal psychiatric diagnosis, instruments such as those above may aid in the assessment of veterans' psychological health.
Questions remain about the long-term health impacts of the 1991 Gulf War on its veterans.
To measure psychological disorders in Australian Gulf War veterans and a military comparison group and to explore any association with exposure to Gulf War-related psychological stressors.
Prevalences of DSM–IV psychological disorders were measured using the Composite International Diagnostic Interview. Gulf War-related psychological stressors were measured using a service experience questionnaire.
A total of 31% of male Gulf War veterans and 21% of the comparison group met criteria for a DSM–IVdisorder first present in the post-Gulf War period. The veterans were at greater risk of developing post-Gulf War anxiety disorders including post-traumatic stress disorder, affective disorders and substance use disorders. The prevalence of such disorders remained elevated a decade after deployment. The findings can be explained partly as a ‘war-deployment effect‘. There was a strong dose–response relationship between psychological disorders and number of reported Gulf War-related psychological stressors.
Service in the 1991 Gulf War is associated with increased risk of psychological disorders and these are related to stressful experiences.
This paper was written at the request of the Life Research Committee of the United Kingdom Actuarial Profession's Life Board. It concerns the valuation of U.K. with-profits business, with particular attention to the market-consistent ‘realistic reporting’ basis currently being used in the U.K. by the regulator, the Financial Services Authority (FSA). The paper surveys recent regulatory activity concerning the development and introduction of the new valuation approach, and puts it into the context of a survey of alternative methodologies, both deterministic and stochastic. The particular issues arising when considering prudential solvency are discussed, and various approaches are reviewed and compared with market consistent methods. Numerical examples are given, which demonstrate potential issues (regarding comparability and consistency) with the FSA's proposed approach — in particular the sensitivity of results to model calibration. The authors support the FSA's move to a stochastically-based framework for solvency measurement, but highlight some issues which need to be taken into account.
The mechanical properties of a range of tribological mitigating and biocompatible films deposited on a titanium alloy substrate have been investigated using nanoindentation. For a range of carbon films investigated, the ratio of hardness to modulus was almost constant at around 0.1. The onset of film–substrate interactions of a coated system upon progressive loading could be determined as the depth of penetration at which the slope of the force versus depth curve deviated from that of an analytically derived “bulk film” system that incorporated the indenter tip effect on the contact area. For the carbon-coated systems investigated, the corresponding force, or the critical load-carrying capacity of a localized contact event by a sharp indenter, appears to scale with the elastic modulus mismatch between film and substrate.
The bed-forming brittlestars Ophiothrix fragilis, Ophiocomina nigra and Amphiura chiajei from Oban Bay, Scotland were studied using methods previously employed to study chemoautotrophic symbioses. Ophiothrix fragilis and A. chiajei both contain symbiotic bacteria (SCB) while Ophiocomina nigra is non-symbiotic. Samples were taken of Ophiothrix fragilis at approximately two-week intervals for one year. Symbiotic bacteria numbers were determined by direct counting of homogenates of the arms of 50 individual brittlestars. Water samples were analysed for chlorophyll content. Stable isotope ratios for carbon and nitrogen were determined for each homogenate sample. Regular SCB counts were made on the infaunal brittlestar A. chiajei. Homogenate samples of Ophiothrix fragilis, A. chiajei and the non-symbiotic Ophiocomina nigra were analysed to produce fatty acid profiles for each species. Symbiotic bacteria count varied by up to one order of magnitude in both Ophiothrix fragilis and A. chiajei with no evidence of seasonality in this variation. Symbiotic bacteria number was inversely correlated with δ15N but no relationship was established with δ13C. 16:1ω7 and 18:1.ω7 fatty acids were used as putative bacterial markers. Both symbiotic species had higher percentages of 16:1ω7 than the non-symbiotic Ophiocomina nigra. However, only Ophiothrix fragilis appeared to receive appreciable quantities of 18:1ω7 from its SCB. The SCB are heterotrophic and may contribute to the nitrogen budget of the host. The two symbiotic species studied here derive the bulk of their nutrition from conventional feeding but SCB make significant, additional contributions.