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Resting state functional magnetic resonance imaging studies have identified functional connectivity patterns associated with acute undernutrition in anorexia nervosa (AN), but few have investigated recovered patients. Thus, a trait connectivity profile characteristic of the disorder remains elusive. Using state-of-the-art graph–theoretic methods in acute AN, the authors previously found abnormal global brain network architecture, possibly driven by local network alterations. To disentangle trait from starvation effects, the present study examines network organization in recovered patients.
Graph–theoretic metrics were used to assess resting-state network properties in a large sample of female patients recovered from AN (recAN, n = 55) compared with pairwise age-matched healthy controls (HC, n = 55).
Indicative of an altered global network structure, recAN showed increased assortativity and reduced global clustering as well as small-worldness compared with HC, while no group differences at an intermediate or local network level were evident. However, using support-vector classifier on local metrics, recAN and HC could be separated with an accuracy of 70.4%.
This pattern of results suggests that long-term recovered patients have an aberrant global brain network configuration, similar to acutely underweight patients. While the finding of increased assortativity may represent a trait marker of AN, the remaining findings could be seen as a scar following prolonged undernutrition.
Gray matter (GM) ‘pseudoatrophy’ is well-documented in patients with anorexia nervosa (AN), but changes in white matter (WM) are less well understood. Here we investigated the dynamics of microstructural WM brain changes in AN patients during short-term weight restoration in a combined longitudinal and cross-sectional study design.
Diffusion-weighted images were acquired in young AN patients before (acAN-Tp1, n = 56) and after (acAN-Tp2, n = 44) short-term weight restoration as well as in age-matched healthy controls (HC, n = 60). Images were processed using Tract-Based-Spatial-Statistics to compare fractional anisotropy (FA) across groups and timepoints.
In the cross-sectional comparison, FA was significantly reduced in the callosal body in acAN-Tp1 compared with HC, while no differences were found between acAN-Tp2 and HC. In the longitudinal arm, FA increased with weight gain in acAN-Tp2 relative to acAN-Tp1 in large parts of the callosal body and the fornix, while it decreased in the right corticospinal tract.
Our findings reveal that dynamic, bidirectional changes in WM microstructure in young underweight patients with AN can be reversed with brief weight restoration therapy. These results parallel those previously observed in GM and suggest that alterations in WM in non-chronic AN are also state-dependent and rapidly reversible with successful intervention.
Bipolar disorder and schizophrenia are associated with increased mortality relative to the general population. There is an international emphasis on decreasing this excess mortality.
To determine whether the mortality gap between individuals with bipolar disorder and schizophrenia and the general population has decreased.
A nationally representative cohort study using primary care electronic health records from 2000 to 2014, comparing all patients diagnosed with bipolar disorder or schizophrenia and the general population. The primary outcome was all-cause mortality.
Individuals with bipolar disorder and schizophrenia had elevated mortality (adjusted hazard ratio (HR) = 1.79, 95% CI 1.67–1.88 and 2.08, 95% CI 1.98–2.19 respectively). Adjusted HRs for bipolar disorder increased by 0.14/year (95% CI 0.10–0.19) from 2006 to 2014. The adjusted HRs for schizophrenia increased gradually from 2004 to 2010 (0.11/year, 95% CI 0.04–0.17) and rapidly after 2010 (0.34/year, 95% CI 0.18–0.49).
The mortality gap between individuals with bipolar disorder and schizophrenia, and the general population is widening.
In the past 20 years, social change and expectations for both maternal and paternal responsibilities have highlighted the need for services for families to better understand the role of a father in family relationships. In Australia, as well as internationally, there have been many contested understandings about what constitutes ‘good fathering’ in research, social media and in the political sphere. More specifically, there has also been an emerging trend to understand the challenging task of recruiting and maintaining men's involvement in child and family services programmes, particularly those fathers who are deemed a risk to children and mothers, violent or have been separated from their children. That many child and family/welfare services have exercised dedicated effort to work with fathers is still a relatively recent phenomenon, and has only emerged following criticism that services have been too geared towards working only with mothers. Despite this increasing interest, there is still ongoing need for more research to be undertaken in Australia. An important area of focus is the views of professionals about their perception and engagement of fathers, particularly the views of fathers who are described as being absent from family-based services. The purpose of this article is to report briefly on a study undertaken to examine how child and family welfare workers engage fathers in their work. First, this paper will describe some of the social and health benefits to fathers and their children, focusing on the key role of attachment through play. Research into effective service delivery involving fathers will then be presented, concluding with key practice factors necessary for fathers to be involved in family life.
In this paper we present a microfabricated SiC based alternative to glass-fiber optogenetic stimulation. The glass fiber system currently used for stimulation has numerous drawbacks. First, the very presence of glass can evoke an immune response in cortical tissue that can impede the light-to-neuron optical interface. This glial scarring of brain tissue effectively lowers the spatial resolution and power output of the system. Second, the fragility of an implanted glass fiber is a problem that has yet to be fully addressed. Using SiC the proposed optical structure will address these problems by significantly lowering the amount glial scarring and astrocytic activity expressed as a result of the implant. In addition, single crystal SiC allows for a flexible device that can move with the surrounding tissue without fracturing. Finally, the current glass fibers tend be single channel devices with a single ended emitter. The proposed microfabricated device will allow for multiple channels, multiple wavelengths of stimulation, and electrical feedback on each channel improving upon the current standard.
The N95 respirator is one type that is recommended by the World Health Organization and the Centers for Disease Control and Prevention (CDC) to prevent inhalation of droplets that may act to transmit respiratory pathogens. However, the reliability of this respirator to prevent transmission is dependent on how well it is fitted to the wearer. For ill-fitting respirators, the average penetration by ambient aerosol was found to be 33%, compared with 4% for well-fitting respirators. Such penetration or leakage may be caused by the gap between the respirator and the wearer's face. Therefore, formal fit testing should be carried out prior to the use of N95 respirators. Quantitative fit testing measures “the adequacy of respirator fit by numerically measuring the amount of leakage into the respirator” using an electronic device.
The objective of this study was to estimate the burden of cancer in counties affected by Hurricane Katrina using population-based cancer registry data, and to discuss issues related to cancer patients who have been displaced by disasters.
The cancer burden was assessed in 75 counties in Louisiana, Alabama, and Mississippi that were designated by the Federal Emergency Management Agency as eligible for individual and public assistance. Data from the National Program of Cancer Registries were used to determine three-year average annual age-adjusted incidence rates and case counts during the diagnosis years 2000–2002 for Louisiana and Alabama. Expected rates and counts for the most-affected counties in Mississippi were estimated by direct, age-specific calculation using the 2000–2002 county level populations and the site-, sex-, race-, and age-specific cancer incidence rates for Louisiana.
An estimated 23,549 persons with a new diagnosis of cancer in the past year resided in the disaster-affected counties. Fifty-eight percent of the cases were cancers of the lung/bronchus, colon/rectum, female breast, and prostate. Eleven of the top 15 cancer sites by sex and black/white race in disaster counties had >50% of cases diagnosed at the regional or distant stage.
Sizable populations of persons with a recent cancer diagnosis were potentially displaced by Hurricane Katrina. Cancer patients required special attention to access records in order to confirm diagnosisand staging, minimize disruption in treatment, and ensure coverage of care. Cancer registry data can be used to provide disaster planners and clinicians with estimates of the number of cancer patients, many of whom maybe undergoing active treatment.
Maximum height was assessed for tree species from seven temperate deciduous forests, one subtropical forest and one tropical forest and combined with published tree heights for three other tropical forests. The temperate deciduous forests showed a strong concentration of canopy species and a dearth of subcanopy species. In contrast, the four tropical forests showed more uniform distributions of maximum heights, while the subtropical forest had an intermediate distribution. The tropical and subtropical sites had greater densities of small trees than did the temperate sites and most of these small trees were members of small-to medium-sized species. Sapling recruitment per unit stem basal area increased with declining maximum height in Panama, which is consistent with the criterion for coexistence of species of differing stature derived from Kohyama's forest architecture hypothesis. Greater penetration of light into gaps and favourable conditions for growth over most of the year may allow more smaller-statured species to coexist with canopy trees in tropical vs. temperate forests.
Background. Higher levels of religious involvement are modestly associated with better health, after taking account of other influences, such as age, sex and social support. However, little account is taken of spiritual beliefs that are not tied to personal or public religious practice. Our objective was to develop a standardized measure of spirituality for use in clinical research.
Method. We characterized the core components of spirituality using narrative data from a purposive sample of people, some of whom were near the end of their lives. These data were developed into statements in a scale to measure strength of spiritual beliefs and its reliability, validity and factor structure were evaluated in order to reach a final version.
Results. Thirty-nine people took part in the qualitative study to define the nature of spirituality in their lives. These data were used to construct a 47-item instrument that was evaluated in 372 people recruited in medical and non-medical settings. Analysis of these statements led to a 24-item version that was evaluated in a further sample of 284 people recruited in similar settings. The final 20-item questionnaire performed with high test–retest and internal reliability and measures spirituality across a broad religious and non-religious perspective.
Conclusions. A measure of spiritual belief that is not limited to religious thought, may contribute to research in psychiatry and medicine.
A 4Mb magnetoresistive random access memory (MRAM) with a novel magnetic free layer and toggle switching mode is presented. The new free layer uses a balanced synthetic-antiferromagnet trilayer structure and a novel write pulse sequence to provide robust switching performance with immunity from ½-select disturbs. This new mode greatly improves the switching performance of the MRAM as compared to conventional MRAM. The intrinsic reliability of the magnetoresistive tunnel junction (MTJ) and the metal interconnect system of MRAM are two other areas of great interest due to the new materials involved. Time dependent dielectric breakdown (TDDB) and resistance drift were the two main failure mechanisms identified for intrinsic memory bit reliability. Results indicated that a lifetime over 10 years is achievable under the operating conditions. Finally data retention is demonstrated over times that are orders of magnitude longer than 10 years.
In this work, we present for the first time, the fabrication of a fully biodegradable microfluidic device with features of micron-scale precision. This implantable MEMS device is a transition from poorly defined porous scaffolds to reproducible precision scaffolds with built-in convective conduits. First, conventional photolithography is used to create a master mold by bulk micromachining silicon. Next, polydimethylsiloxane (PDMS) silicone elastomer is replica molded to form a flexible inverse mold. The commonly used biodegradable polymer Poly-lactic-co-glycolic acid (PLGA 85:15) is then compression micromolded onto the PDMS to form micropatterned films of the biodegradable polymer. Finally, a thermal fusion bonding process is used to seal the biodegradable PLGA films, forming closed microfluidic channels at the capillary size-scale. Film thicknesses from 100μm-1mm are demonstrated with features having 2μm resolution and 0.2μm precision. Scanning electron micrographs of bonded biodegradable films reveal no observable bond interface and no significant pattern deformation. Bonded microfluidic channels are capable of supporting more than 30psi during flow studies, and we have used the processes to develop complex microfluidic networks for cell culture and implantation as well as simple channels to verify the fluid dynamics in the degradable microchannels. The processes described here are high resolution and fully biodegradable. In addition, they are fast, inexpensive, reproducible, and scalable, making them ideal for both rapid prototyping and manufacturing of tissue engineering scaffolds.
We propose a remedy for the discrepancy between the way political scientists analyze data with missing values and the recommendations of the statistics community. Methodologists and statisticians agree that “multiple imputation” is a superior approach to the problem of missing data scattered through one’s explanatory and dependent variables than the methods currently used in applied data analysis. The discrepancy occurs because the computational algorithms used to apply the best multiple imputation models have been slow, difficult to implement, impossible to run with existing commercial statistical packages, and have demanded considerable expertise. We adapt an algorithm and use it to implement a general-purpose, multiple imputation model for missing data. This algorithm is considerably faster and easier to use than the leading method recommended in the statistics literature. We also quantify the risks of current missing data practices, illustrate how to use the new procedure, and evaluate this alternative through simulated data as well as actual empirical examples. Finally, we offer easy-to-use software that implements all methods discussed.
Autism has been described in association with a variety of medical and genetic conditions. We previously reported on a patient whose clinical phenotype was compatible with both fetal valproate syndrome (FVS) and autism. Here we present five additional patients with FVS and autism. In all five of our patients, there was evidence of cognitive deficits, manifestations of autism, and typical phenotypic characteristics of FVS. The association between this known teratogen and autism has both clinical and research implications.