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This study was designed to verify whether fluoxetine (FL), a serotonin (5-HT) re-uptake inhibitor, would interfere with nortriptyline (NT), a biphasic U-shaped curvilinear dose-response relationship recently described in our laboratory. We associated 10 mg/kg NT or vehicle to 0, 5, 10, 20 and 40 mg/kg FL, in one group, and 10 mg FL or vehicle to 0, 5, 10, 20 and 40 mg/kg NT, in another group, 30 min before the tail suspension test (TST) in mice. Although we were not able to confirm a synergistic effect between FL and NT, FL-NT association seems to require higher doses of NT to block its own anti-immobility effect at high doses, thus widening NT effective antidepressant-like dose range in mice submitted to TST.
Acute coronary syndromes (ACS) are a major cause of morbidity and mortality in western industrialized countries and account for disability and loss of productivity. Type D personality and depression are established psychosocial factors with a negative impact on prognosis following acute events.
We evaluated 65 patients admitted to a coronary unit with ACS regarding type D personality (DS-14), depression (BDI-II, HADS), anxiety (HADS), clinical depression (clinical interview following DSM-IV-TR criteria) and quality of life (SF-36). SPSS 12.0 was used for statistical analysis and significance considered for p< 0.05.
We found that 38.5% of patients had type D personality and divided the sample into two groups. No significant differences were found regarding social and demographic factors but differences were found regarding diagnosis on admission: type D patients had more AMI with ST elevation (p< 0.05). Type D patients had significantly higher scores in depression and anxiety scales of the HADS (p< 0.01) and worse quality of life in most SF-36 subscales (p< 0.01). There was a negative and significant correlation between the HADS and all the SF-36 subscales, strongest in the mental health subscale (p< 0.01).
Type D patients have higher indices of anxiety and depression and worse quality of life when compared with other patients, and constitute a high risk group of worse prognosis. Our results also suggest differences between groups regarding the type of acute event but these results require further confirmation.
The co-occurence of depression and congestive heart failure (CHF) represents a great challenge and opportunity for those interested in exploring the complex interactions between the brain and the heart. The cumulative effect of these medical conditions has an evident effect on quality of life.
The objective of this study was to evaluate the quality of life and symptoms of depression among a group of 103 adult patients with CHF recruited from an outpatient cardiology practice and determine the factors related to a poor outcome. The challenge was to identify the group of patients who are at risk of suffering from depression and poor quality of life as early as possible and try to provide them appropriate psychiatric treatment.
The results of this study lead us to suggest that an older female patient with a more severe illness (NYHA ≥ II) and renal impairment is at great risk of presenting simultaneously depressive sintomatology and poorer perception of quality of life, thus beeing a strong candidate to a very negative evolution of her cardiac condition.
These findings allow us to define a group of patients that would surely benefit from a closer psychiatric and cardiac management.
The high prevalence of depression, the complexity of managing it and the recent evidence demonstrating that depression is associated with increased morbidity and mortality suggests that is important the development of collaborative and integrative approaches combining the medical expertise and interest of psychiatrists, cardiologists and internists and the involvement of psychologists and social workers.
More than one in five women die from ischemic heart disease (IHD) and given their longer life expectancy, these numbers are expected to rise and so is the concomitant disability burden. Women are still under-represented in cardiovascular research with much of the knowledge from clinical trials conducted largely with men being applied to women, disregarding potential gender differences in both biomedical and psychosocial domains. Gender differences in both pathophysiology and biological risk factors may underlie distinct prevalence rates, symptom profiles and even medical outcomes. Not only do women have more persistent and atypical symptoms, but have more frequent hospitalizations, lower rates of general well-being and increased functional limitations in daily life activities. Gender related specificities regarding psychosocial risk factors might further explain this. The authors review the key issues on this topic and outline suggestions for future research. Ultimately, a better understanding of this matter will translate not only into improved clinical management of female patients but also genderspecific strategies in the prevention of CVD.
Women remain under-represented in cardiovascular clinical trials even though, in Europe, 55% of female deaths are caused by cardiovascular disease. Women have less extensive and less severe disease but poorer outcome compared to men. Gender related specificities in risk factors and adaptation to illness, or both, might further explain this.
As part of a larger study examining the impact of depression and type D personality in cardiac patients, a sample of 243 (148 females) highly educated controls (mean age = 41 ± 10 years) were evaluated on demographic, behavioral, psychosocial [BDI-II (Beck Depression Inventory, 2nd edition); HADS (Hamilton Anxiety and Depression Scale); DS-14 (Type D personality)] and clinical risk factors known to be implicated in cardiovascular disease.
Women had significantly less alcohol consumption (p< .001) and exercise (p< .05), but had higher cholesterol and triglycerides (p < .05) than men. Past psychiatric complaints (p< .05), current depression (p< .05), moderate levels of anxiety (p< .05), and negative affectivity (p< .05) were all significantly more common among women. Age-adjusted multivariate analyses confirmed that lack of exercise together with dietary concerns and increased levels of mental distress (depression, anxiety and negative affectivity) tend to cluster in women. Importantly, no gender differences were detected in traditional cardiovascular risk factors such as hypertension and diabetes, or Type D personality prevalence.
In a highly educated sample, women presented with increased behavioral and psychosocial difficulties than men. These vulnerabilities may augment the impact of putative pathophysiological risk factors for cardiac disease.
Most reactions to grief are adaptive. However, there is the possibility that some individuals present a complicated grief disorder, where there is a pathological intensification of symptoms lasting more than 6 months, deserving special treatment.
Evaluate the effectiveness of two types of intervention in complicated grief: group intervention (GI) and cognitive-narrative (CN) therapy.
Patients in a complicated grief process were selected (n = 70), and distributed in three groups: cognitive–narrative therapy group (CNTG), group intervention group (GIG) and a control group (CG). Inclusion criteria: adults, with a reference to mourning situation, with personal meaning, for over six months and results in ICG ≥30points (cutoff). The Inventory of Complicated Grief (ICG), the Center for epidemiologic studies depression scale (CES-D) and the trauma questionnaire (ICD-11) were used. Follow-up was performed 3 months after the end of each intervention. Data analysis was performed using the statistical package from social sciences (SPSS 20).
With respect to complicated grief symptoms (CGx) and depression symptoms (Dx) there were statistically significant differences between the CNTG and the CG, but not with the GIG. There was no statistically significant effect in post-traumatic symptoms (PTx), even though both interventions had a slight decrease. When the CNTG and the GIG were directly compared, there was only a statistically significant difference between PTx.
In our single center cohort, CNTG was a more effective intervention in complicated grief patients for CGx and Dx reduction. For PTx, no intervention was superior. Larger multi-center studies are needed to validate these results.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Disgust propensity (DP) and disgust sensitivity (DS) contribute to individual differences in the experience of disgust. Studies have shown that DP and DS are predictive of some anxiety (e.g., spider phobia and blood-injection-injury phobia) and obsessive-compulsive and related disorders.
The aim of this study was to develop and validate a Portuguese version of the Disgust Propensity and Sensitivity Scale-Revised (DPSS-R; van Overveld= et al., 2006) for use in Portuguese-speaking populations.
Two hundred and six participants (162 females), with ages between 18 and 47 (M = 25.92; SD = 8.75), filled in the DPSS-R, which was first translated and adapted into Portuguese language by individuals highly proficient in English and then back-translated by a bilingual with no prior knowledge of the scale. Finally, the DPSS-R was subjected to a think-aloud procedure.
The results showed good internal consistency (Cronbach's alfa = .833) for a DPSS-R. The two subscales displayed an adequate internal consistency (DPCronbach'salfa = .776; DSCronbach'salfa = .790). Test-retest analysis documented good intraclass correlation coefficient for the two subscales (ICCPropensity = .889; ICC Sensitivity = .900). We also confirmed the bifactorial structure using a confirmatory factor analysis, since we obtained appropriate values in all goodness of fit indices (χ2df = 1,906; CFI = .94; PCFI = .736; GFI = .93; PGFI = .607; RMSEA = .067).
DPSS-R obtained good psychometric properties and may therefore be proposed as a valid instrument to assess DS and DP in the Portuguese population. This instrument may provide an important contribute to study the development and maintenance of psychopathology associated with disgust.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Traumatising experiences have been shown to be important in suicide ideation and attempt. A prolonged and continuous exposure to stressing interpersonal events can have more complex consequences. Therefore, the concept of Complex Post-Traumatic Stress Disorder (C-PTSD) has been emerging.
Our goal is to relate the symptoms of C-PTSD with suicide attempt and to evaluate the differences between C-PTSD and PTSD on those patients. Moreover, we compared our findings with a control population without prior suicide attempts.
Fifty patients that had been hospitalised in the Psychiatry ward following a suicide attempt were evaluated one week after the event with the ICD-11 Trauma Questionnaire (PTSD and C-PTSD). The same evaluation was performed on a control population without known suicide attempts.
There is a statistically significant relationship (P < 0.001) between the symptoms of C-PTSD and PTSD and suicide attempt, which effect is higher for C-PTSD. These symptoms are almost absent in the control group.
C-PTSD seams to be a more relevant risk factor for suicidal attempts. This aspect is important to define preventive and treatment programs and for suicidal attempts follow-up. The importance of traumatic events and of traumatic stress symptoms as moderator factors should be considered in future research.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Dirofilariosis caused by Dirofilaria immitis (heartworm) is a zoonosis, considered an endemic disease of dogs and cats in several countries of Western Europe, including Portugal. This study assesses the levels of D. immitis exposure in humans from Northern Portugal, to which end, 668 inhabitants of several districts belonging to two different climate areas (Csa: Bragança, Vila Real and Csb: Aveiro, Braga, Porto, Viseu) were tested for anti-D. immitis and anti-Wolbachia surface proteins (WSP) antibodies. The overall prevalence of seropositivity to both anti-D. immitis and WSP antibodies was 6.1%, which demonstrated the risk of infection with D. immitis in humans living in Northern Portugal. This study, carried out in a Western European country, contributes to the characterisation of the risk of infection with D. immitis among human population in this region of the continent. From a One Health point of view, the results of the current work also support the close relationship between dogs and people as a risk factor for human infection
Dense granular flows can spontaneously self-channelise by forming a pair of parallel-sided static levees on either side of a central flowing channel. This process prevents lateral spreading and maintains the flow thickness, and hence mobility, enabling the grains to run out considerably further than a spreading flow on shallow slopes. Since levees commonly form in hazardous geophysical mass flows, such as snow avalanches, debris flows, lahars and pyroclastic flows, this has important implications for risk management in mountainous and volcanic regions. In this paper an avalanche model that incorporates frictional hysteresis, as well as depth-averaged viscous terms derived from the
-rheology, is used to quantitatively model self-channelisation and levee formation. The viscous terms are crucial for determining a smoothly varying steady-state velocity profile across the flowing channel, which has the important property that it does not exert any shear stresses at the levee–channel interfaces. For a fixed mass flux, the resulting boundary value problem for the velocity profile also uniquely determines the width and height of the channel, and the predictions are in very good agreement with existing experimental data for both spherical and angular particles. It is also shown that in the absence of viscous (second-order gradient) terms, the problem degenerates, to produce plug flow in the channel with two frictionless contact discontinuities at the levee–channel margins. Such solutions are not observed in experiments. Moreover, the steady-state inviscid problem lacks a thickness or width selection mechanism and consequently there is no unique solution. The viscous theory is therefore a significant step forward. Fully time-dependent numerical simulations to the viscous model are able to quantitatively capture the process in which the flow self-channelises and show how the levees are initially emplaced behind the flow head. Both experiments and numerical simulations show that the height and width of the channel are not necessarily fixed by these initial values, but respond to changes in the supplied mass flux, allowing narrowing and widening of the channel long after the initial front has passed by. In addition, below a critical mass flux the steady-state solutions become unstable and time-dependent numerical simulations are able to capture the transition to periodic erosion–deposition waves observed in experiments.
Ceramic–metal composites are an important group of materials that have gained interest recently because of their peculiar properties. There have been numerous studies on the reinforcement of alumina through the incorporation of various ductile metals in it. However, these studies have been limited to determining the effect of the addition of metals on the mechanical properties of ceramics, without determining the effect of these metal additions on other physical properties of the resulting composite. In this way, in agreement with the obtained results, we have that because of the conductive nature of metals, there is a considerable decrease in the electrical resistivity of alumina, mainly when copper is added to it. However, in terms of optical performance, alumina matrix composites showed significant changes in absorbance in the visible spectra. The addition of iron, titanium, and yttrium enhanced the absorbance of alumina, whereas manganese addition significantly decreased the optical absorption.
Few personalised medicine investigations have been conducted for mental health. We aimed to generate and validate a risk tool that predicts adult attention-deficit/hyperactivity disorder (ADHD).
Using logistic regression models, we generated a risk tool in a representative population cohort (ALSPAC – UK, 5113 participants, followed from birth to age 17) using childhood clinical and sociodemographic data with internal validation. Predictors included sex, socioeconomic status, single-parent family, ADHD symptoms, comorbid disruptive disorders, childhood maltreatment, ADHD symptoms, depressive symptoms, mother's depression and intelligence quotient. The outcome was defined as a categorical diagnosis of ADHD in young adulthood without requiring age at onset criteria. We also tested Machine Learning approaches for developing the risk models: Random Forest, Stochastic Gradient Boosting and Artificial Neural Network. The risk tool was externally validated in the E-Risk cohort (UK, 2040 participants, birth to age 18), the 1993 Pelotas Birth Cohort (Brazil, 3911 participants, birth to age 18) and the MTA clinical sample (USA, 476 children with ADHD and 241 controls followed for 16 years from a minimum of 8 and a maximum of 26 years old).
The overall prevalence of adult ADHD ranged from 8.1 to 12% in the population-based samples, and was 28.6% in the clinical sample. The internal performance of the model in the generating sample was good, with an area under the curve (AUC) for predicting adult ADHD of 0.82 (95% confidence interval (CI) 0.79–0.83). Calibration plots showed good agreement between predicted and observed event frequencies from 0 to 60% probability. In the UK birth cohort test sample, the AUC was 0.75 (95% CI 0.71–0.78). In the Brazilian birth cohort test sample, the AUC was significantly lower –0.57 (95% CI 0.54–0.60). In the clinical trial test sample, the AUC was 0.76 (95% CI 0.73–0.80). The risk model did not predict adult anxiety or major depressive disorder. Machine Learning approaches did not outperform logistic regression models. An open-source and free risk calculator was generated for clinical use and is available online at https://ufrgs.br/prodah/adhd-calculator/.
The risk tool based on childhood characteristics specifically predicts adult ADHD in European and North-American population-based and clinical samples with comparable discrimination to commonly used clinical tools in internal medicine and higher than most previous attempts for mental and neurological disorders. However, its use in middle-income settings requires caution.
When a layer of static grains on a sufficiently steep slope is disturbed, an upslope-propagating erosion wave, or retrogressive failure, may form that separates the initially static material from a downslope region of flowing grains. This paper shows that a relatively simple depth-averaged avalanche model with frictional hysteresis is sufficient to capture a planar retrogressive failure that is independent of the cross-slope coordinate. The hysteresis is modelled with a non-monotonic effective basal friction law that has static, intermediate (velocity decreasing) and dynamic (velocity increasing) regimes. Both experiments and time-dependent numerical simulations show that steadily travelling retrogressive waves rapidly form in this system and a travelling wave ansatz is therefore used to derive a one-dimensional depth-averaged exact solution. The speed of the wave is determined by a critical point in the ordinary differential equation for the thickness. The critical point lies in the intermediate frictional regime, at the point where the friction exactly balances the downslope component of gravity. The retrogressive wave is therefore a sensitive test of the functional form of the friction law in this regime, where steady uniform flows are unstable and so cannot be used to determine the friction law directly. Upper and lower bounds for the existence of retrogressive waves in terms of the initial layer depth and the slope inclination are found and shown to be in good agreement with the experimentally determined phase diagram. For the friction law proposed by Edwards et al. (J. Fluid. Mech., vol. 823, 2017, pp. 278–315, J. Fluid. Mech., 2019, (submitted)) the magnitude of the wave speed is slightly under-predicted, but, for a given initial layer thickness, the exact solution accurately predicts an increase in the wave speed with higher inclinations. The model also captures the finite wave speed at the onset of retrogressive failure observed in experiments.
Differences in forage nutritive value between morning and afternoon are related to patterns of dehydration and carbohydrate accumulation throughout the day. In this way, management strategies that maximize grazing time during the afternoon could increase forage nutritive value and consequently nutrient intake. The aim of the current experiment was to evaluate the effect of the time of day (06.00 h [designated AM] or 15.00 h [PM]) that cattle are moved to a new paddock on forage nutritive value, grazing behaviour and animal performance of beef cattle on rotationally stocked Marandu palisadegrass (Brachiaria brizantha cv. Marandu Syn. Urochloa brizantha cv. Marandu) pastures. A spring and summer study was conducted in Pirassununga, SP, Brazil from October 2012 to March 2013 (182 days). Treatments were distributed in a randomized complete block design with three replications. Herbage mass, morphological composition, herbage allowance and stocking rates were similar between treatments during spring and summer. Moving animals to a new paddock, regardless of the time of day – 06.00 h (AM) or 15.00 h (PM) – stimulated grazing, modifying the distribution of meals throughout the day. However, compensatory mechanisms among grazing time, bite rate and forage nutritive value throughout the day operated in order to generate similar performance between animals offered a new paddock in the morning or in the afternoon.
The Roosevelt–Rondon Expedition marmoset Mico marcai was first collected in 1914 and all information on this primate previously came from three skins brought back by this expedition. As a result, M. marcai is categorized as Data Deficient on the IUCN Red List. As the presumed range of M. marcai lies on the path of the advancing arc of deforestation in Brazil, the collection of relevant data to assess the conservation status of this Amazonian species is of some urgency. Here we present the first field data on the distribution and population size of, and threats to, M. marcai, to reassess the species’ conservation status. During 2012–2015 we surveyed the species in the Marmelos–Aripuanã interfluve, and estimated its density using distance sampling. We also used spatial predictive modelling to estimate forest loss within the species range under two deforestation scenarios. We found the marmoset in 13 localities and estimated its extent of occurrence to be 31,073 km2. We estimated the species’ density to be 8.31 individuals/km2 and extrapolated this to estimate a total population of 258,218 individuals (CI 150,705–441,860). Under a business-as-usual deforestation scenario, c. 10,000 km2 of forest, comprising 33% of the species’ range, would be lost in three marmoset generations (c. 18 years), and we, therefore, recommend that M. marcai be categorized as Vulnerable on the IUCN Red List based on criterion A3c. Other Amazonian marmosets require similar reassessment as their ranges also fall in the path of the arc of deforestation.
It has been nearly 70 years since the discovery that strict adherence to a diet low in phenylalanine prevents severe neurological sequelae in patients with phenylalanine hydroxylase deficiency (phenylketonuria; PKU). Today, dietary treatment with restricted phenylalanine intake supplemented with non-phenylalanine amino acids to support growth and maintain a healthy body composition remains the mainstay of therapy. However, a better understanding is needed of the factors that influence N balance in the context of amino acid supplementation. The aim of the present paper is to summarise considerations for improving N balance in patients with PKU, with a focus on gaining greater understanding of amino acid absorption, disposition and utilisation. In addition, the impact of phenylalanine-free amino acids on 24 h blood phenylalanine/tyrosine circadian rhythm is evaluated. We compare the effects of administering intact protein v. free amino acid on protein metabolism and discuss the possibility of improving outcomes by administering amino acid mixtures so that their absorption profile mimics that of intact protein. Protein substitutes with the ability to delay absorption of phenylalanine and tyrosine, mimicking physiological absorption kinetics, are expected to improve the rate of assimilation into protein and minimise fluctuations in quantitative plasma amino acid levels. They may also help maintain normal glycaemia and satiety sensation. This is likely to play an important role in improving the management of patients with PKU.
The outer stellar halo is home to a number of substructures that are remnants of former interactions of the Galaxy with its dwarf satellites. Triangulum-Andromeda (TriAnd) is one of these halo substructures, found as a debris cloud by Rocha-Pinto et al., (2004) using 2MASS M giants. Would be these structures related to dwarf galaxies or to the galactic disk? To uncover the nature of these stars we performed a high-resolution spectroscopic study (R = 40,000) along with a kinematic analysis using Gaia data. We determined the atmospheric parameters and chemical abundances of Ca and Mg for the 13 TriAnd candidate stars along with their respective orbits. Our results indicate that the TriAnd stars analyzed have a galactic nature but that these stars are not from the local thin disk.
Small perturbations to a steady uniform granular chute flow can grow as the material moves downslope and develop into a series of surface waves that travel faster than the bulk flow. This roll wave instability has important implications for the mitigation of hazards due to geophysical mass flows, such as snow avalanches, debris flows and landslides, because the resulting waves tend to merge and become much deeper and more destructive than the uniform flow from which they form. Natural flows are usually highly polydisperse and their dynamics is significantly complicated by the particle size segregation that occurs within them. This study investigates the kinematics of such flows theoretically and through small-scale experiments that use a mixture of large and small glass spheres. It is shown that large particles, which segregate to the surface of the flow, are always concentrated near the crests of roll waves. There are different mechanisms for this depending on the relative speed of the waves, compared to the speed of particles at the free surface, as well as on the particle concentration. If all particles at the surface travel more slowly than the waves, the large particles become concentrated as the shock-like wavefronts pass them. This is due to a concertina-like effect in the frame of the moving wave, in which large particles move slowly backwards through the crest, but travel quickly in the troughs between the crests. If, instead, some particles on the surface travel more quickly than the wave and some move slower, then, at low concentrations, large particles can move towards the wave crest from both the forward and rearward sides. This results in isolated regions of large particles that are trapped at the crest of each wave, separated by regions where the flow is thinner and free of large particles. There is also a third regime arising when all surface particles travel faster than the waves, which has large particles present everywhere but with a sharp increase in their concentration towards the wave fronts. In all cases, the significantly enhanced large particle concentration at wave crests means that such flows in nature can be especially destructive and thus particularly hazardous.