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The number of clinical trials in body dysmorphic disorder (BDD) has steadily increased in recent years. As the number of studies grows, it is important to define the most empirically useful definitions for response and remission in order to enhance field-wide consistency and comparisons of treatment outcomes across studies. In this study, we aim to operationally define treatment response and remission in BDD.
We pooled data from three randomized controlled trials of cognitive-behavior therapy (CBT) for BDD (combined n = 153) conducted at four academic sites in Sweden, the USA, and England. Using signal detection methods, we examined the Yale-Brown Obsessive Compulsive Scale modified for BDD (BDD–YBOCS) score that most reliably identified patients who responded to CBT and those who achieved remission from BDD symptoms at the end of treatment.
A BDD–YBOCS reduction ⩾30% was most predictive of treatment response as defined by the Clinical Global Impression (CGI) – Improvement scale (sensitivity 0.89, specificity 0.91, 91% correctly classified). At post-treatment, a BDD–YBOCS score ⩽16 was the best predictor of full or partial symptom remission (sensitivity 0.85, specificity 0.99, 97% correctly classified), defined by the CGI – Severity scale.
Based on these results, we propose conceptual and operational definitions of response and full or partial remission in BDD. A consensus regarding these constructs will improve the interpretation and comparison of future clinical trials, as well as improve communication among researchers, clinicians, and patients. Further research is needed, especially regarding definitions of full remission, recovery, and relapse.
Hurricane Maria caused catastrophic damage in Puerto Rico, increasing the risk for morbidity and mortality in the post-impact period. We aimed to establish a syndromic surveillance system to describe the number and type of visits at 2 emergency health-care settings in the same hospital system in Ponce, Puerto Rico.
We implemented a hurricane surveillance system by interviewing patients with a short questionnaire about the reason for visit at a hospital emergency department and associated urgent care clinic in the 6 mo after Hurricane Maria. We then evaluated the system by comparing findings with data from the electronic medical record (EMR) system for the same time period.
The hurricane surveillance system captured information from 5116 participants across the 2 sites, representing 17% of all visits captured in the EMR for the same period. Most visits were associated with acute illness/symptoms (79%), followed by injury (11%). The hurricane surveillance and EMR data were similar, proportionally, by sex, age, and visit category.
The hurricane surveillance system provided timely and representative data about the number and type of visits at 2 sites. This system, or an adapted version using available electronic data, should be considered in future disaster settings.
In discourse comprehension, if all goes well, people tend to create a rich and coherent mental representation of the events described in the text. To do so, referential and relational coherence must be established in order to construct a connected discourse. The objective of this follow-up eye-tracking study (N = 72) is to explore the existence of an interaction effect between two factors: (a) the extension of the referent (short and long antecedent), and (b) the semantic relation (counter-argumentative a pesar de, and causal por), when processing the neuter pronoun ello in texts written in Spanish. No previous study has systematically compared the on-line processing of texts in which different extensions of the encapsulated anaphoric antecedent by the neuter pronoun ello (‘this’ or ‘it’ in English) are presented in diverse marked semantic relations (causal and counter-argumentative). Based on three eye-tracking measures, we found distinctive patterns of reading behavior when anaphoric neuter reference and semantic relations must be processed conjointly in order to construct a coherent mental representation. The main findings show that reading longer and more complex antecedents encapsulated by the neutral pronouns ello exerts more cognitive effort in late processing (Look Back measure), particularly when simultaneously and in the same discourse construction there is an explicitly marked counter-argumentative semantic relation. Implications for theories of referential and relational coherence are discussed.
The Bipolar Spectrum Diagnostic Scale (BSDS) is widely validated and used as a screening tool for bipolar disorder. However, there is no BSDS validated version for its use in Mexican population. The aim of the present study was to examine the BSDS diagnostic capacity, and to evaluate its criterion validity and internal consistency for its use in Mexican psychiatric patients. We recruited 200 patients who attended the psychiatric outpatient service of a Mental Health Specialized Hospital and were screened for bipolar disorder using BSDS. To determine the cut-off point, sensitivity and specificity, we used the SCID–I diagnosis as the gold standard in 100 participants with bipolar disorder and 100 with major depression. Internal consistency according to Cronbach’s coefficient alpha was .81. The area under ROC curve for the overall discriminability of BSDS against the criterion of SCID–I for bipolar disorder was .90. Finally, a cut-off value of 12 reached the most stable sensitivity and specificity, with predictive powers higher than .80. In conclusion, the properties of the scale including internal consistency, sensitivity and specificity, make of BSDS a valuable instrument for screening bipolar disorder in Mexican psychiatric population.
Richard Wagner wrote in 1852 that in settling on the theme of the phantom ship he had entered ‘upon a new path, that of Revolution against our modern Public Art’, that is, grand opéra. Wagner’s revolution has often been described in light of the poetics of return and homecoming that contributed a new sense of identity to (German) opera. The present article is written against the grain of this conviction, and highlights the cosmopolitan career of the phantom ship and of the vernacular art forms – the nautical theatre and the phantasmagoria – that maintained the seafaring image at the forefront of the liberal imagination, first in Britain, and then in Paris, where Wagner arguably seized on it. Specifically, it explores the significance of ‘apparitional images’ to mid-nineteenth-century opera and Wagner’s turn to a regime of modern spectacle, inspired by the art of phantasmagoria, in Der fliegende Holländer.
The island of Aguiguan is part of the Mariana archipelago and currently supports populations of four endemic species, including one endemic genus, Cleptornis. Bird population trends since 1982 were recently assessed on the neighbouring islands of Saipan, Tinian, and Rota indicating declines in some native species. Point-transect surveys were conducted in 2008 by the U.S. Fish and Wildlife Service to assess population densities and trends on Aguiguan. Densities for six of the nine native birds—White-throated Ground-dove Gallicolumba xanthonura, Collared Kingfisher Todiramphus chloris, Rufous Fantail Rhipidura rufifrons, Golden White-eye Cleptornis marchei, Bridled White-eye Zosterops conspicillatus and Micronesian Starling Aplonis opaca—and the non-native bird—Island Collared-dove Streptopelia bitorquata—were significantly greater in 2008 than in 1982. No differences in densities were detected among the surveys for Mariana Fruit-dove Ptilinopus roseicapilla, and Micronesian Myzomela Myzomela rubratra. Three federally and locally listed endangered birds—Nightingale Reed-warbler Acrocephalus luscinius, Mariana Swiftlet Collocalia bartschi, and Micronesian Megapode Megapodius laperous)—were either not detected during the point-transect counts, the surveys were not appropriate for the species, or the numbers of birds detected were too small to estimate densities. The factors behind the increasing trends for some species are unknown but may be related to increased forest cover on the island since 1982. With declining trends for some native species on neighbouring islands, the increasing and stable trends on Aguiguan is good news for forest bird populations in the region, as Aguiguan populations can help support conservation efforts on other islands in the archipelago.
To evaluate the association between weight gain in the first two years of life and the occurrence of wheezing, asthma, serum IgE, skin reactivity and pulmonary function.
The metropolitan region of Salvador, Bahia, Brazil.
The association was studied between 1997 and 2005 in 669 children up to 11 years of age. Data were collected on asthma and risk factors, both current factors and those present in the first years of life. Weight gain was considered fast when the Z-score was >0·67. Poisson regression was used in the multivariate statistical analysis.
Wheezing was reported in 25·6 % of the children. Weight gain was considered fast (Z-score >0·67) in 29·6 % of the children and slow (Z-score <−0·67) in 13·9 %. Children in the slow weight gain group had 36 % fewer symptoms of asthma (prevalence ratio = 0·65; 95 % CI 0·42, 0·99).
Slower weight gain in the early years of life may constitute a protective factor against symptoms of asthma. The relevance of this finding for public health is not yet certain, since it is known that children with slow and fast weight gain may be more likely to develop adverse health consequences related to both these situations.
Opal particles, with diameter ca. 80 nm, were synthesized by the Stöber method. Samples were exposed to 100 Gy of beta particle irradiation and its thermoluminescence (TL) emission was recorded. TL response presents good reproducibility, standard deviation 1 %. The glow curve displays two TL peaks 86 and 400 °C and the afterglow (AG) phenomenon is observed immediately after irradiation (< 150°C). The synthetic opal-C exhibits a linear dependence of AG response as function of dose from 0.25 to 8 Gy. This dose range is of interest for personal and clinical dosimetry. Moreover, a previous study indicates that cytotoxic and genotoxic effects caused by opal nanoparticles, did not induce unrepairable DNA damage neither a cellular harm. Therefore, our results show synthetic opal-C is a material useful for in vivo radiation dosimetry.
To evaluate the association between overweight and the occurrence of asthma and atopy in a cohort of children of 4–12 years of age living in the city of Salvador in 2005.
Cross-sectional study nested in a cohort.
The metropolitan region of Salvador, Bahia, Brazil.
The study included 1129 children of 4–12 years age who presented complete information on the variables used here. Skin tests for allergy, spirometry, faecal parasitology, serum IgE and anthropometric surveys were conducted. Poisson's multivariate regression was adopted.
Wheezing was found in 29·1% and asthma in 22·8% of children, both conditions being more common in those under 6 years of age and 34% more common in overweight children (prevalence ratio (PR) = 1·34; 95% CI 1·07, 1·67) following adjustment. The ratio between forced expiratory volume in 1s and forced vital capacity was associated with overweight (PR = 1·35; 95% CI 1·11, 1·61). No statistically significant association was found between overweight and allergen-specific IgE or with wheezing.
These results are in agreement with the hypothesis that overweight is associated with asthma and pulmonary function, even following adjustment for intervening variables known to be associated with the pathogeny of asthma.
The present study examined the psychobiological Temperament and Character model of personality on obsessive-compulsive disorder (OCD) patients, as well as the relation of temperament and/or character dimensions on the severity of obsessive-compubive symptoms.
Fifty-four subjects diagnosed with OCD, were assessed with the Temperament and Character Inventory, the Yale-Brown Obsessive-Compulsive scale and the Hamilton Rating Scales for depression and anxiety.
Compared with controls, OCD subjects displayed increased harm avoidance and lower self-directedness and cooperativeness. Low self-directedness and high Hamilton depression scores were associated with increased severity of obsessive-compulsive symptoms.
The Temperament and Character profile of OCD patients characterized in the present stud personality model and can be linked to some of their behavioral features. Furthermore, our data provides support of the influence that some personality traits may have on the severity of OCD symptoms.
Living morphogenetic studies show that each definitive ventricle is constructed from different primitive cardiac segments, and each has its specific anatomical features. These ventricular segments are the atrioventricular junction; the primitive inlet segment, part of the primary heart tube, which initially provides the inlets of each ventricle; the primitive outlet segment, which gives rise to both ventricular outlets; and the apical trabeculated regions of the right and left ventricles which grow from the primary heart tube, respectively. In this review, we describe regional pathology based on the relationship of these primitive ventricular components. We propose that the abnormal morphogenesis of one of these segments gives origin to regional ventricular pathology. For example, abnormal embryogenesis of the atrioventricular canal produces malformations of the atrioventricular junctions, such as double inlet ventricle, absence of one atrioventricular connection, and straddling and overriding atrioventricular valves. Similarly, abnormal morphogenesis of the primitive outlet segment gives rise to malformations of the subarterial region of each ventricle, along with the valves guarding these vessels. The principal anatomical features of these malformations of the ventricular inlets and outlets are described, and their possible morphogenesis is discussed. Due to the fact that the apical trabeculated region of each ventricle arises from a separate primitive segment, each ventricle can be identified according to the pattern of its apical trabeculations. This feature is crucial in the elucidation of complex congenital pathology, such as discordant atrioventricular connections.
In his classic account of migration to the USA, Oscar Handlin (1951) depicts the tensions between the acceptance of the immigrant and the growth of restrictionist sentiment among recent arrivals. Americans, he says, ‘cannot push away the heritage of having been all once strangers in the land’; nor can they ‘forget the experience of having all been rootless, adrift’. However, the ‘tiredness of the transient’ produces a counter-reaction: ‘The ideals of the nest, remembered even at the height of the flight, have triumphed. Men weary of a century or more of struggle, impatient of the constant newness, more eagerly than ever hunger for the security of belonging. Restriction becomes a part of their lives – and perhaps it must be so’ (p. 306).
One can well imagine a less flattering description of the ‘nesting’, exclusionist attitudes Handlin describes. In his still widely cited account, John Higham (1955) considered such views as examples of ‘American nativism’; others have used vaguer or cruder labels like ‘nationalism’, ‘isolationism’ or ‘racism’. One can be more or less understanding, or more or less forgiving of those who pull the ladder up after their own ascent. However, it is clear that the contradiction between implicitly or explicitly encouraging new entrants, on the one hand, and excluding, deporting or repelling them, on the other, lies at the heart of the post-war immigration history of the USA.
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