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Dissociative identity disorder (DID) is a severely debilitating disorder. Despite recognition in the current and past versions of the DSM, DID remains a controversial psychiatric disorder, which hampers its diagnosis and treatment. Neurobiological evidence regarding the aetiology of DID supports clinical observations that it is a severe form of post-traumatic stress disorder.
Childhood maltreatment (CM) plays an important role in the development of major depressive disorder (MDD). The aim of this study was to examine whether CM severity and type are associated with MDD-related brain alterations, and how they interact with sex and age.
Within the ENIGMA-MDD network, severity and subtypes of CM using the Childhood Trauma Questionnaire were assessed and structural magnetic resonance imaging data from patients with MDD and healthy controls were analyzed in a mega-analysis comprising a total of 3872 participants aged between 13 and 89 years. Cortical thickness and surface area were extracted at each site using FreeSurfer.
CM severity was associated with reduced cortical thickness in the banks of the superior temporal sulcus and supramarginal gyrus as well as with reduced surface area of the middle temporal lobe. Participants reporting both childhood neglect and abuse had a lower cortical thickness in the inferior parietal lobe, middle temporal lobe, and precuneus compared to participants not exposed to CM. In males only, regardless of diagnosis, CM severity was associated with higher cortical thickness of the rostral anterior cingulate cortex. Finally, a significant interaction between CM and age in predicting thickness was seen across several prefrontal, temporal, and temporo-parietal regions.
Severity and type of CM may impact cortical thickness and surface area. Importantly, CM may influence age-dependent brain maturation, particularly in regions related to the default mode network, perception, and theory of mind.
A diagnosis of dissociative identity disorder (DID) is controversial and prone to under- and misdiagnosis. From the moment of seeking treatment for symptoms to the time of an accurate diagnosis of DID individuals received an average of four prior other diagnoses and spent 7 years, with reports of up to 12 years, in mental health services.
To investigate whether data-driven pattern recognition methodologies applied to structural brain images can provide biomarkers to aid DID diagnosis.
Structural brain images of 75 participants were included: 32 female individuals with DID and 43 matched healthy controls. Individuals with DID were recruited from psychiatry and psychotherapy out-patient clinics. Probabilistic pattern classifiers were trained to discriminate cohorts based on measures of brain morphology.
The pattern classifiers were able to accurately discriminate between individuals with DID and healthy controls with high sensitivity (72%) and specificity (74%) on the basis of brain structure. These findings provide evidence for a biological basis for distinguishing between DID-affected and healthy individuals.
We propose a pattern of neuroimaging biomarkers that could be used to inform the identification of individuals with DID from healthy controls at the individual level. This is important and clinically relevant because the DID diagnosis is controversial and individuals with DID are often misdiagnosed. Ultimately, the application of pattern recognition methodologies could prevent unnecessary suffering of individuals with DID because of an earlier accurate diagnosis, which will facilitate faster and targeted interventions.
Declaration of interest
The authors declare no competing financial interests.
Introduction: Survival for victims of out-of-hospital cardiac arrest (OHCA) is typically between 8 and 12%. We sought to report the trends in survival in British Columbia (BC) over a 10-year period. Methods: The BC Resuscitation Outcomes Consortium prospectively collected detailed prehospital and hospital data on consecutive non-traumatic OHCAs from 2006 to 2016 within BC’s four metropolitan areas. We included EMS-treated adult patients without DNR orders. To describe baseline characteristics we organized patient characteristics in three time periods: 2006-09, 2010-13, and 2014-16 (first and last periods reported below). The primary and secondary endpoints were survival at hospital discharge and return of spontaneous circulation (ROSC). We tested the significance of year-by-year trends in baseline characteristics, and performed multivariable Poisson regression, using calendar year as an independent variable, to calculate risk-adjusted rates for survival. Results: Between January 1, 2006 and March 31, 2016 there were a total of 26 433 non-traumatic OHCAs, with 15 145 included in this study. There were significant decreases in the proportion with initial shockable cardiac rhythms (28% to 23%) and bystander witnessed arrests (42% to 39%), however significant increases in the proportion with bystander CPR (40% to 49%) and ALS treatment (86% to 97%), and the median chest compression fraction (0.81 to 0.87). There was a significant increase in the median time until termination of resuscitation in those who did not achieve ROSC (27 to 32 minutes), and a significant decrease in the proportion of patients who were transported in absence of ROSC (17% to 6.5%). There was a significant improvement in achieving ROSC (44% to 48%; adjusted rate ratio per year 1.02, 95% CI 1.01 to 1.02) and survival at hospital discharge (10% to 14%; adjusted rate ratio per year 1.05, 95% CI 1.04 to 1.06). Both subgroups of initial shockable (adjusted rate ratio per year 1.04, 95% CI 1.03 to 1.05) and non-shockable (adjusted rate ratio per year 1.08, 95% CI 1.06 to 1.12) cardiac rhythms demonstrated survival improvement. Conclusion: Despite a significant decrease in those with initial shockable rhythms, out-of-hospital cardiac arrest survival in BC’s metropolitan regions increased by approximately 40% over a 10-year period. During this time there were system changes and quality of care improvements as provided by bystanders and professionals.
Inconsistent findings have been reported on the role of comorbid alcohol
use disorders as risk factors for a persistent course of depressive and
To determine whether the course of depressive and/or anxiety disorders is
conditional on the type (abuse or dependence) or severity of comorbid
alcohol use disorders.
In a large sample of participants with current depression and/or anxiety
(n = 1369) we examined whether the presence and
severity of DSM-IV alcohol abuse or alcohol dependence predicted the
2-year course of depressive and/or anxiety disorders.
The persistence of depressive and/or anxiety disorders at the 2-year
follow-up was significantly higher in those with remitted or current
alcohol dependence (persistence 62% and 67% respectively), but not in
those with remitted or current alcohol abuse (persistence 51% and 46%
respectively), compared with no lifetime alcohol use disorder
(persistence 53%). Severe (meeting six or seven diagnostic criteria) but
not moderate (meeting three to five criteria) current dependence was a
significant predictor as 95% of those in the former group still had a
depressive and/or anxiety disorder at follow-up. This association
remained significant after adjustment for severity of depression and
anxiety, psychosocial factors and treatment factors.
Alcohol dependence, especially severe current dependence, is a risk
factor for an unfavourable course of depressive and/or anxiety disorders,
whereas alcohol abuse is not.
One of the core behavioral features associated with obsessive compulsive symptomatology is the inability to inhibit thoughts and/or behaviors. Neuroimaging studies have indicated abnormalities in frontostriatal and dorsolateral prefrontal – anterior cingulate circuits during inhibitory control in patients with obsessive compulsive disorder compared with controls. In the present study, task performance and brain activation during Stroop color-word and Flanker interference were compared within monozygotic twin pairs discordant for obsessive compulsive symptoms and between groups of pairs scoring very low or very high on obsessive compulsive symptoms, in order to examine the differential impact of non-shared environmental versus genetic risk factors for obsessive compulsive symptomatology on inhibitory control related functional brain activation. Although performance was intact, brain activation during inhibition of distracting information differed between obsessive compulsive symptom high-scoring compared to low-scoring subjects. Regions affected in the discordant group (e.g., temporal and anterior cingulate gyrus) were partly different from those observed to be affected in the concordant groups (e.g., parietal gyrus and thalamus). A robust increase in dorsolateral prefrontal activity during response interference was observed in both the high-scoring twins of the discordant sample and the high-scoring twins of the concordant sample, marking this structure as a possible key region for disturbances in inhibitory control in obsessive compulsive disorder.
We report apparent robust doping of ZnO and MgxZn1-xO (x ∼20%) nanoparticle films by annealing in hydrogen gas. The annealing was done at sequentially higher temperatures from about 20 °C to 140 °C. The effect of the annealing was determined by comparing current-voltage measurements of the samples at room-temperature and in vacuum after each annealing cycle.The nanoparticles were grown using an aqueous solution and heating process that created thinfilms of ZnO or MgZnO nanoparticles with diameters of about 30 nm. When exposed to hydrogen gas at room-temperature or after annealing at temperatures up to about 100 °C, no measureable changes to the room-temperature vacuum conductivity of the films was observed. However, when the samples were annealed at temperatures above 100 °C, an appreciable robust increase in the room-temperature conductance in vacuum occurred. Annealing at the maximum temperature (∼135-140 °C) resulted in about a factor of about twenty increase in the conductivity. Furthermore, the ratio of the conductance of the ZnO and MgZnO nanoparticle films while being annealed to their conductance at room-temperature were found to increase and then decrease for increasing annealing temperatures. Maximum changes of about five-fold and seven-fold for the MgZnO and ZnO samples, respectively, were found to occur at temperatures just below the annealing temperature threshold for the onset of the robust hydrogen gas doping. Comparisons of these results to other work on bulk ZnO and MgZnO films and reasons for this behavior will be discussed.
Clinically ascertained reports suggest that boys and girls with attention deficit hyperactivity disorder (ADHD) may differ from each other in their vulnerability to substance use problems.
A total of 1545 Finnish adolescents were assessed for DSM-IV-based ADHD symptoms by their parents and classroom teachers using standardized rating scales at age 11–12 years. At age 14, substance use disorders and psychiatric co-morbidity were assessed with the Semi-Structured Assessment for the Genetics of Alcoholism, providing DSM-III-R/DSM-IV diagnoses for Axis I disorders. At age 17.5, substance use was assessed by multi-item questionnaire.
Although baseline ADHD symptoms were less common among females, they were more predictive of adverse substance use outcomes once conduct disorder and previous substance use were controlled for. Only in females were baseline ADHD symptoms significant predictors of alcohol abuse and dependence and illicit drug use at age 14. At the age of 17.5, parents' reports of inattentiveness and hyperactivity were significant predictors for frequent alcohol use in both sexes, but they were more predictive of frequent alcohol and illicit drug use in girls. Impulsivity in teachers' ratings predicted frequent alcohol use and illicit drug use in boys. Parental reports of inattentiveness in their 11-/12-year-old daughters were a consistent predictor for illicit drug use across adolescence.
Inattentiveness and hyperactivity may be more predictive of alcohol use disorders and maladaptive patterns of alcohol and illicit drug use among girls than boys. The importance of these behavioural symptoms should be assessed further in the community, as they could jeopardize adolescents' successful transitioning into adult roles.
The efficiency of a diphtheria, tetanus, poliomyelitis vaccine in inducing a serological response after a three-dose primary course of immunization was tested in thirty-nine children aged 5 and 6 years and found to be satisfactory. This vaccine had previously been shown to be suitable for use as a single dose reinforcing vaccine for children of this age who had been immunized in infancy. It is suggested that all children might receive one dose of the vaccine at the time they enter school, and then those who have not been immunized before should receive a further two suitably spaced doses to complete their course of primary immunization.
Reactions to the pertussis component of the original commercial batches of quadruple vaccine against poliomyelitis, diphtheria, tetanus and pertussis (Quadrilin, Glaxo Laboratories) gave some cause for concern. Severe reactions were found to be more common in infants under 6 months of age than in older infants.
A modified quadruple vaccine, which has been used in N. Ireland since October 1964, was found to give rise to significantly fewer and milder reactions. This vaccine when given in three doses separated by intervals of 6–9 weeks and 6 months to fifty-eight infants most of whom were 6–7 months of age at the start of immunization was found to give a satisfactory immunological response.
George J. Brewer, Department of Human Genetics, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA,
Fred Askari, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA,
Matthew T. Lorincz, Department of Neurology, University of Michigan, Ann Arbor, MI, USA,
Martha Carlson, Department of Pediatrics-Neurology, University of Michigan, Ann Arbor, MI, USA,
Michael Schilsky, Department of Internal Medicine, Cornell University, New York, NY, USA,
Karen J. Kluin, Department of Neurology, Department of Speech Pathology, University of Michigan, Ann Arbor, MI, USA,
Peter Hedera, Department of Neurology, Vanderbilt University, Nashville, TN, USA,
Paolo Moretti, Departments of Neurology and Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA,
John K. Fink, Department of Neurology, University of Michigan, Ann Arbor, MI, USA,
Roberta Tankanow, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA,
Robert B. Dick, Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA,
Julia Sitterly, Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
Background: The initial treatment of the neurologic presentation of Wilson's disease is problematic. Penicillamine, used for years on most patients, causes neurologic worsening in up to half of such patients, and half of those who worsen never recover. Zinc, ideal for maintenance therapy, is too slow for these acutely ill patients. We have developed tetrathiomolybdate (TM) for this type of patient, and it has worked well in open label studies. Trientine, another anticopper drug on the market approved for penicillamine intolerant patients, had not been tried in this type of patient. Here, we report on a double blind trial of TM versus trientine in the neurologically presenting Wilson's disease patient. Design and Methods: The study was a double blind design in which patients received either TM plus zinc, or trientine plus zinc, for 8 weeks. Patients were accepted if they presented with neurologic symptoms from Wilson's disease, if they had not been treated longer than 4 weeks with penicillamine or trientine. Patients were followed in the hospital for the 8 weeks of treatment with weekly semiquantitative neurologic and speech examinations, to evaluate possible neurologic worsening. They also had blood and urine studies done weekly. At discharge from hospital they were continued on zinc maintenance therapy, and returned at yearly intervals for 3 years for further evaluation. Results: Twenty-three patients were entered into the trientine arm and 6 reached criteria for neurologic deterioration, while 25 patients were entered into the TM arm and only 1 deteriorated (p < 0.05).
Background: The initial treatment of the neurologic presentation of Wilson's disease is problematic. Penicillamine, used for years on most patients, causes neurologic worsening in up to half of such patients, and half of those who worsen never recover. Zinc, ideal for maintenance therapy, is too slow for these acutely ill patients. We have developed tetrathiomolybdate (TM) for this type of patient, and it has worked well in open label studies. Trientine, another anticopper drug on the market approved for penicillamine intolerant patients, had not been tried in this type of patient. Here, we report on a double blind trial of TM versus trientine in the neurologically presenting Wilson's disease patient. Design and Methods: The study was a double blind design in which patients received either TM plus zinc, or trientine plus zinc, for 8 weeksThis study was originally published in reference 1. Patients were accepted if they presented with neurologic symptoms from Wilson's disease, if they had not been treated longer than 4 weeks with penicillamine or trientine. Patients were followed in the hospital for the 8 weeks of treatment with weekly semiquantitative neurologic and speech examinations, to evaluate possible neurologic worsening. They also had blood and urine studies done weekly. At discharge from hospital they were continued on zinc maintenance therapy, and returned at yearly intervals for 3 years for further evaluation. Results: Twenty-three patients were entered into the trientine arm and 6 reached criteria for neurologic deterioration, while 25 patients were entered into the TM arm and only 1 deteriorated (p < 0.05). One patient on trientine had an adverse event while 7 on TM had adverse events. All adverse events were mild. Four patients in the trientine arm died during follow-up, 3 having shown initial neurologic deterioration, 2 patients in the TM arm died. In those patients who did not deteriorate or die, neurologic and speech recovery over 3 years was good. Interpretation: TM is a superior choice to trientine for the initial therapy of neurologic Wilson's disease.
The definition of UTC was implemented in 1972, principally to accommodate celestial navigation and follows recommendation 460 of the International Radio Consultative Committee (CCIR) in 1970. Since 1972 the use of electronic means to navigate has overtaken celestial navigation. This fact along with increasing public dissatisfaction with the possible disruption to modern electronic communications and navigation systems caused by the insertion of a leap second has called into question the current definition of UTC. An extensive review of the background and issues relating to the leap second can be found in Nelson, et al (2001).
The microsporidian parasite, Pleistophora mulleri, infects the abdominal muscle of the freshwater amphipod Gammarus duebeni celticus. We recently showed that P. mulleri infection was associated with G. d. celticus hosts being more vulnerable to predation by the invasive amphipod Gammarus pulex. Parasitized G. d. celticus also had a reduced ability to prey upon other co-occurring amphipods. We suggested the parasite may have pervasive influences on host ecology and behaviour. Here, we examine the association between P. mulleri parasitism and parameters influencing individual host fitness, behaviour and interspecific interactions. We also investigate the relationship between parasite prevalence and host population structure in the field. In our G. d. celticus study population, P. mulleri prevalence was strongly seasonal, ranging from 8·5% in summer to 44·9% in winter. The relative abundance of hosts with the heaviest parasite burden increased during summer, which coincided with high host mortality, suggesting that parasitism may regulate host abundance to some degree. Females were more likely to be parasitized than males and parasitized males were paired with smaller females than unparasitized males. Parasitism was associated with reduction in the host's activity level and reduced both its predation on the isopod Asellus aquaticus and aggression towards precopula pairs of the invasive G. pulex. We discuss the pervasive influence of this parasite on the ecology of its host.
After their oceanic migration, juvenile European eels Anguilla anguilla enter estuaries as glass eels, develop into pigmented elvers and migrate into fresh water. Fisheries often transfer such eels abruptly between salinities, principally glass eels and elvers from estuarine to fresh water. It is usually assumed that survival rates are high, but this required systematic investigation. Survival was found to be 100% over 21 days of glass eels and semi-pigmented elvers transferred abruptly from estuary conditions into fresh water, 50% sea water and full sea water. Fully pigmented elvers, however, showed significantly reduced survival when transferred into sea water. Salinity preference experiments with juvenile eels have historically been inconclusive. Here, in a choice chamber design, a clear developmental shift in salinity preference was found, with glass eels preferring 100% sea water, semi-pigmented elvers showing no clear preference and fully pigmented elvers preferring fresh water. We conclude that eel fisheries enhancement by abrupt transfer of juveniles among salinities is largely vindicated. In addition, developmental shifts in salinity preference have been clarified and this aids in the interpretation of eel migration patterns.
The amphipod Gammarus pulex is an intermediate host to the acanthocephalan fish parasite Echinorhynchus truttae. Gammarus pulex has a wide trophic repertoire, feeding as a herbivore, detritivore and predator. In this study an examination was made of the effects of E. truttae parasitism on components of the G. pulex diet: stream-conditioned leaves, dead chironomids and live juvenile isopods Asellus aquaticus. Over 21 days, parasitism had no effect on daily feeding rates or wet weights of G. pulex fed on leaves or chironomids. Parasitism had a significant effect on the number of A. aquaticus killed by G. pulex, with parasitized individuals killing significantly fewer than their unparasitized counterparts. In addition, unparasitized amphipods killed all size classes of A. aquaticus indiscriminately, whereas parasitized animals tended to kill the smaller size classes. The impacts of the parasitism of G. pulex throughout the wider freshwater community are discussed.
Recent experimental work has demonstrated that unique high porosity thin films may be ob- tained in physical deposition systems by combining glancing angle deposition with in situ sub-strate motion control [1-7]. The microstructure of these films consists of isolated columns engineered into shapes such as helices, posts, or chevrons. Due to the isolated nature of the columns, the films present a unique opportunity to study fundamental thin film growth behaviour and, in particular, the influence of the self shadowing mechanism in three dimensions. Apart from this academic motivation, there is the need to characterize the physical constraints imposed on the engineering of these films. In particular, this study will have implications for the realization of isolated, periodically arranged nanostructures envisioned for certain applications. Preliminary results from an ongoing study of growth dynamics, morphology, porosity, and scaling behaviour, and the dependence of these features on deposition parameters are presented below.
The membership of the Commission, as of its 50th anniversary in 1998, stands at 146 members and 19 consultants. In order to increase communications, during the report period the President issued six Newsletters to Commission members, consultants, and IAU officers. In a further attempt to increase communications, Commission 41 also instituted a web site (http://www.astro.uni-bonn.de/~pbrosche/iaucomm41/) in early 1998. This was largely due to the efforts of C41 Organizing Committee member Wolfgang Dick and the kindness of Professor Peter Brosche in supplying space. The site not only contains the Newsletters, meeting notices, and a list of members, but also the Bibliography on History of Astronomy, compiled by Ruth Preitag of the Library of Congress in Washington, D.C. The site also links to the history of astronomy site maintained for several years by the History of Astronomy Working Group of the Astronomische Gesellschaft, and now also maintained on behalf of Commission 41. These sites serve not only for better communication among Commission members, but also the broader history of astronomy community.