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The Expanded Program for Immunization Consortium – Human Immunology Project Consortium study aims to employ systems biology to identify and characterize vaccine-induced biomarkers that predict immunogenicity in newborns. Key to this effort is the establishment of the Data Management Core (DMC) to provide reliable data and bioinformatic infrastructure for centralized curation, storage, and analysis of multiple de-identified “omic” datasets. The DMC established a cloud-based architecture using Amazon Web Services to track, store, and share data according to National Institutes of Health standards. The DMC tracks biological samples during collection, shipping, and processing while capturing sample metadata and associated clinical data. Multi-omic datasets are stored in access-controlled Amazon Simple Storage Service (S3) for data security and file version control. All data undergo quality control processes at the generating site followed by DMC validation for quality assurance. The DMC maintains a controlled computing environment for data analysis and integration. Upon publication, the DMC deposits finalized datasets to public repositories. The DMC architecture provides resources and scientific expertise to accelerate translational discovery. Robust operations allow rapid sharing of results across the project team. Maintenance of data quality standards and public data deposition will further benefit the scientific community.
Partly as a consequence of an aging global population, radiology departments have seen an increase in imaging in patients older than 65 years of age . One department in the United Kingdom found a 51% increase in radiological studies performed in patients over 90 years of age over a recent 7-year period .
Bipolar disorder (BD) is a familial psychiatric disorder associated with frontotemporal and subcortical brain abnormalities. It is unclear whether such abnormalities are present in relatives without BD, and little is known about structural brain trajectories in those at risk.
Neuroimaging was conducted at baseline and at 2-year follow-up interval in 90 high-risk individuals with a first-degree BD relative (HR), and 56 participants with no family history of mental illness who could have non-BD diagnoses. All 146 subjects were aged 12–30 years at baseline. We examined longitudinal change in gray and white matter volume, cortical thickness, and surface area in the frontotemporal cortex and subcortical regions.
Compared to controls, HR participants showed accelerated cortical thinning and volume reduction in right lateralised frontal regions, including the inferior frontal gyrus, lateral orbitofrontal cortex, frontal pole and rostral middle frontal gyrus. Independent of time, the HR group had greater cortical thickness in the left caudal anterior cingulate cortex, larger volume in the right medial orbitofrontal cortex and greater area of right accumbens, compared to controls. This pattern was evident even in those without the new onset of psychopathology during the inter-scan interval.
This study suggests that differences previously observed in BD are developing prior to the onset of the disorder. The pattern of pathological acceleration of cortical thinning is likely consistent with a disturbance of molecular mechanisms responsible for normal cortical thinning. We also demonstrate that neuroanatomical differences in HR individuals may be progressive in some regions and stable in others.
Field studies were conducted to determine sweetpotato tolerance to and weed control from management systems that included linuron. Treatments included flumioxazin preplant (107 g ai ha−1) followed by (fb) S-metolachlor (800 g ai ha−1), oryzalin (840 g ai ha−1), or linuron (280, 420, 560, 700, and 840 g ai ha−1) alone or mixed with S-metolachlor or oryzalin applied 7 d after transplanting. Weeds did not emerge before the treatment applications. Two of the four field studies were maintained weed-free throughout the season to evaluate sweetpotato tolerance without weed interference. The herbicide program with the greatest sweetpotato yield was flumioxazin fb S-metolachlor. Mixing linuron with S-metolachlor did not improve Palmer amaranth management and decreased marketable yield by up to 28% compared with flumioxazin fb S-metolachlor. Thus, linuron should not be applied POST in sweetpotato if Palmer amaranth has not emerged at the time of application.
Although sheep are known to be seasonal breeders and give birth in winter, not all of them follow this trend. A few breeds can be mated and give birth all year round, meaning that mothers and neonates will have to face contrasting climatic conditions. The aim of this study was to test whether lambing season affects maternal and neonatal behaviors in D’man sheep. During four different lambing seasons (winter, autumn, summer and spring), periparturient ewes (n = 111) and their lambs (n = 213) were kept under 24-h-video surveillance in order to record postpartum behaviors. Mother-young preference was tested around 48 h after parturition. Lamb vigor was studied by the determination of birth weight, early postnatal behavior and rectal temperature at birth and 48 h later. Litter expulsion time was not affected by lambing season, but birth weight was biased against summer and winter born lambs. Ewes provided a higher intensity of care to their offspring in winter: latency for grooming was shorter and time spent grooming was longer compared to lambing in spring and summer (P = 0.01 in all cases). On the other hand, lambs were the most active in spring as they were faster to extend their hind legs (P = 0.01), stand up (P = 0.04) and reach the udder (P = 0.04). Rectal temperature at 48 h was affected by season of birth (P < 0.001) with higher values observed in summer. Glycemia variation between birth and 48 h was the lowest in spring born lambs and plasma levels increased less in spring born lambs than in winter (P < 0.0001), autumn (P < 0.0001) and summer born lambs (P < 0.0001). In the choice test, mothers clearly preferred their own young and no season effect was detected except that in the first minute of the test they spent less time near their own young in winter than in the other seasons (P = 0.04). Lambs also chose their mother successfully without any major effect of the season however, but winter born lambs were the least vocal (P = 0.01). Overall, this study show that maternal care, lamb behavior and vigor vary lightly according to seasons, albeit not in a consistent manner. In conclusion, a season is no more detrimental than another for the onset of mother-young relationships.
OBJECTIVES/GOALS: In 2016, more than 3,100 children died, and an estimated 17,000 children had non-fatal injuries, from firearms in the United States. In this study, we used hospital charges as a proxy for medical resource utilization, and compared differences in charges by intent of firearm injury among children. METHODS/STUDY POPULATION: In this cross-sectional study of the 2016 Nationwide Emergency Department Sample, we identified firearm injury cases among children aged 19 years or younger using ICD-10-CM external cause of morbidity codes. Injury intent was characterized as unintentional, assault, self-inflicted, undetermined, or due to legal intervention. We included patients treated and released from the emergency department (ED) or admitted alive to the hospital, and excluded those who were transferred or died in the ED. We used linear regressions with survey weighting to compare differences in mean healthcare charges by firearm injury intent, with and without adjustment for ED disposition. RESULTS/ANTICIPATED RESULTS: Among 12,469 cases in the weighted sample, mean age was 16.5 years, a majority were male (88.2%) and Medicaid-insured (57.8%), and 64% were discharged from the ED and 36% admitted. Injuries were 49.0% unintentional, 45.1% assault-related, and 1.8% self-inflicted. Compared to children with self-inflicted injuries (charges $115,224), children with assault-related injuries (charges $55,052; p<0.007) and unintentional injuries (charges $38,643; p<0.001) had lower mean charges per visit. Differences in charges were no longer significant after adjusting for ED disposition, as 85.8% of self-inflicted injuries were admitted, compared to 46.5% of assault-related and 24.3% of unintentional injuries. DISCUSSION/SIGNIFICANCE OF IMPACT: Although the majority of pediatric firearm-related injuries resulting in emergency department care are unintentional or assault-related, self-inflicted injuries result in greater per visit hospital charges, attributable to higher hospitalization rates, and likely due to more severe injuries.
Évaluer l’efficience du palmitate de palipéridone (PP) par rapport aux antipsychotiques les plus communément utilisés en France.
Un modèle médico-économique a été développé afin de simuler la progression d’une cohorte de patients atteints de schizophrénie à travers quatre états de santé (« Stable-traité », « Stable-non-traité », « En-rechute », « Décédé »). PP a été comparé à rispéridone injectable à libération prolongée (ILP), aripiprazole ILP, olanzapine ILP, halopéridol décanoate et olanzapine orale (OO). Les coûts, les années de vie pondérées par la qualité de vie (« Quality-adjusted-life-year » ; QALY) et le nombre de rechutes ont été estimés sur cinq ans selon une perspective tous payeurs. Supposés stabilisés suite à une décompensation clinique, les patients initiaient un antipsychotique et passaient en phase de prévention de la rechute en cas de succès après trois mois. Ils/elles pouvaient arrêter leur traitement après une rechute, un manque de tolérance ou par choix, et passer sur la ligne de traitement suivante jusqu’à la troisième ligne (c.-à.-d. clozapine). Afin de prendre en compte l’observance, les probabilités de rechute en phase de prévention ont été calculées à partir de taux d’hospitalisation sur des données françaises en vie réelle. Les données de tolérance et d’utilité ont été dérivées d’études internationales, et les coûts de sources françaises. La robustesse des résultats a été testée via des analyses de sensibilité.
À 5 ans, PP est le moins coûteux des ILP et est associé à un surcoût de 249 € par rapport à OO. Rispéridone ILP et PP sont associés aux plus grands nombres de QALY. PP domine tous les autres ILP en termes de rechute évitée hormis olanzapine ILP.
PP est le moins coûteux des antipsychotiques ILP en France. OO est l’antipsychotique le moins coûteux, mais est associée à un nombre plus faible de QALY gagnées et de rechutes évitées comparé aux antipsychotiques ILP.
In recent years the courts have become more involved in the psychiatric services in Israel. Data reveal a gradual increase in the rate of court ordered hospitalizations according to Section 15 of the Law for the Treatment of the Mentally Ill. This paper examines the implications of this trend while focusing on the issues of security and safety in psychiatric hospitals. The work presents highlights from extensive British experience with this issue, while focusing on the implications on forensic psychiatry in Israel. The development of the hierarchy of security in the British psychiatric services beginning with the early 1970's, with the establishment of the Butler Committee that determined a hierarchy of three levels of security for the treatment of patients and culminating with the establishment of principles for the operation of medium security units in Britain (Read Committee, 1991) is reviewed. Forensic psychiatric services in Britain are based on these developments.
We examine the current status of mental health facilities in Israel, and the relevance of the British experience to the Israeli situation. In our opinion, a safe appropriate environment is a necessary condition for an appropriate treatment setting. As is in several European countries we are suggesting the establishment of medium security forensic psychiatry departments within a mental health facility that will enable concentration and classification of court ordered admissions as well as systemic flexibility and capacity for better treatment, commensurate with patient needs.
Neuropsychiatric symptoms and behavioral disturbances in dementia (BPSD) are key symptoms of AD, adds to cognitive decline and causes an increased caregivers burden. Antipsychotics provide a limited treatment option and acetylcholineesterase inhibitors (AchEI) also show beneficial effects in treatment of BPSD.
To compare treatment effects between AchEI (galantamine, GAL) and antipsychotics (risperidone, RIS) in patients with BPSD.
Open randomized trial in 100 patients (mean 78.7years, 67% females) using the NeuroPsychiatric Inventory score (NPI)>10 on patients (73% mild to moderate AD and 27% other dementias, treated with GAL (n=50) or RIS (n=50) for 12 weeks. Neuropsychiatric symptoms (NPI, CMAI, FAST), caregivers stress (PGWB), cognition (MMSE) and severity (CIBIC) were assessed at baseline and 12 weeks.
91 patients completed the trial. Safety and tolerability were good. 58% were APOEɛ4 carriers. At baseline MMSE was 20.1±4.6, and NPI 51.0±25.8. After 12 weeks NPI total scores had improved significantly (GAL: 16.6±16.1, RIS: 16.2±16.2).
In both groups there were statistically significant improvements after 12 weeks. In several of the NPI-domains galantamine and risperidone were equally effective. RIS showed a significant treatment advantage in the NPI-domains irritation (p=0.02), agitation (p=0.02) and a trend in aberrant motor behaviour (p=0.08). GAL showed a ppositive trend in apathy/indifference (p=0.09), night time behaviour (p=0.07) and appetite (p=0.06). GAL improved MMSE scores with 2.8 p (p< 0.001) and RIS with 1 p (p< 0.07).
This indicates that GAL could be beneficial in the treatment of neuropsychiatric and behavioural symptoms underlying AD unless aggressive symptoms are prominent.
Treatment of schizophrenia with antipsychotic drugs is frequently sub-optimal. One reason for this may be heterogeneity between patients with schizophrenia. The objectives of this study were to identify patient, disease and treatment attributes that are important for physicians in choosing an antipsychotic drug, and to identify empirically subgroups of patients who may respond differentially to antipsychotic drugs. The survey was conducted by structured interview of 744 randomly-selected psychiatrists in four European countries who recruited 3996 patients with schizophrenia. Information on 39 variables was collected. Multiple component analysis was used to identify dimensions that explained the variance between patients. Three axes, accounting for 99% of the variance, were associated with disease severity (64%), socioeconomic status (27%) and patient autonomy (8%). These dimensions discriminated between six discrete patient subgroups, identified using ascending hierarchical classification analysis. The six subgroups differed regarding educational level, illness severity, autonomy, symptom presentation, addictive behaviors, comorbidities and cardiometabolic risk factors. Subgroup 1 patients had moderately severe physician-rated disease and addictive behaviours (23.2%); Subgroup 2 patients were well-integrated and autonomous with mild to moderate disease (6.7%); Subgroup 3 patients were less well-integrated with mild to moderate disease, living alone (11.2%); Subgroup 4 patients were women with low education levels (5.4%), Subgroup 5 patients were young men with severe disease (36.8%); and Subgroup 6 patients were poorly-integrated with moderately severe disease, needing caregiver support (16.7%). The presence of these subgroups, which require confirmation and extension regarding potentially identifiable biological markers, may help individualizing treatment in patients with schizophrenia.
Patients with schizophrenia display significant working memory and executive deficits. In patients with obsessive-compulsive disorder (OCD), several studies suggest that working memory dysfunction may be one of the causes of compulsive checking behaviors. Hence, this study aimed at assessing whether patients with schizophrenia were impaired on an image comparison task used to measure checking behaviors, and whether the origin and profile of impairment on this task was different between schizophrenia and OCD.
Eye movement recordings were used to assess the checking behavior of 24 patients with schizophrenia and 24 control participants who had to decide whether two images were different or identical. The verbal and visuo-spatial components of participants’ working memory were measured using the reading span and backward location span tests.
Compared to controls, patients with schizophrenia had reduced working memory spans and showed excessive checking behavior when comparing the two images. However, the intensity of their checking behavior was not significantly related to their working memory deficits.
Several recent studies demonstrated that the excessive checking behaviors displayed by patients with OCD were related to working memory dysfunction. The absence of a relationship between the excessive checking behavior of patients with schizophrenia and their working memory deficits suggests that checking behaviors do not have the same origin in the two disorders.
Suicide and attempted suicide are a major public health issue throughout the world, one particularly affecting youth. Its prevalence rates over the past decade have varied from remarkably stable to rising. To understand this phenomenon, researchers turned toward qualitative research, which is more suitable to elicit what links participants' attitudes toward health, individual characteristics and their environment, and what are the facilitators and barriers in the care. The present work is a qualitative metasynthesis of qualitative studies on youth suicide.
A systematic review of 5 web databases (Medline, PsycInfo, Embase, CINAHL, and Social Science Citation Index) retrieve 44 studies from 16 different countries. Thematic synthesis was used to develop categories inductively from the themes identified in the studies.
Three themes organised the results: individual experience, describe the individual burden and suffering related to suicide; relational experience relates the importance of relationships with others; and social and cultural experience, which describes acceptation and rejection from the group.
The violence of the suicidal act and of its message and the fears associated with the representation of death and with the fascination that it might present prevent communication around the suicidal act between the youth, their families, and their healthcare providers, and lead to incomprehension. The physician must play a role as a mediator between young suicide attempters and their families and enable the circulation of representations.
Epidemiological data about surgeons’ mental health and wellbeing are alarming: burnout was reported in about 40% of surgeons, 19% met criteria for alcohol abuse, and 6% had suicidal ideation. Factors related to the surgical culture may have an influence and impede helpseeking (stigma, shame, and fear for career repercussion).
To explore surgeons’ account of their practice.
To obtain an international consistent description of surgeons’ experience, addressing the problem of their wellbeing.
Medline, CINAHL, EMBASE, PsycINFO, and SSCI have been accessed to identify relevant international qualitative research exploring how surgeons talk about their practice. Meta-ethnography (a systematic review and analysis of qualitative literature that compensates for the potential lack of generalizability of the primary studies and provides new insights by their conjoint interpretation and comparison) have been used to identify key themes and synthesize them.
51 papers have been identified. The six emerging themes have been clustered in two axes. First, patient-surgeon relationship: strong emotions come from this relation due to the extent of personal involvement in decision-making, responsibility and uncertainty. Second, group relations and culture: it shows the influence of the surgical hidden curriculum on behaviours, coping attitudes and help-seeking.
Strong emotional components overwhelm surgical practice, which potentially expose surgeons to vulnerability and isolation. They appeared unprepared for and had difficulties coping with these issues. Our findings suggest that taking into account the relational and emotional dimensions of surgical practice (both with patients and within the institution) might improve surgeons’ wellbeing and mental health.
Cranioencephalic trauma and resulting traumatic brain injury are sometimes associated with hard to manage psychiatric symptoms, requiring interpretation from an integrated neuropsychiatric perspective.
We present the case of a 49-year-old man with no known psychiatric history who attempted suicide by gunshot to the head resulting in severe cranioencephalic trauma (GCS=7) and subsequent admission to our hospital's Neurosurgery ward. Brain-CT showed two intracranial projectiles, in left temporal and right occipital topography, as well as multiple haemorragic foci. He was transferred to our Psychiatry ward, as there was no neurosurgical indication and he repeatedly attempted suicide. At admission, he presented with level of consciousness fluctuations, temporospatial disorientation, anosognosia and difficult to assess depressive symptoms. Brief neuropsychological evaluation showed deficits on visual-perceptive abilities, executive functions, logical reasoning, and immediate verbal memory, with a MoCA (Montreal Cognitive Assessment) total score under the normative values. Some language capacities (i.e. naming and repetition) were found to be preserved. Neuroophthalmological evaluation evidenced damage to the anterior left optic tract and a right campimetric defect. The EEG revealed no epileptic activity. At the 34th day of hospitalization, after accidental choking, he began to exhibit delirium with accompanying psychotic symptoms. Presently, two-and-a-half months after admission, we observe remission of delirium, coherent and organized speech, an alexithymic pattern of response, ideative perseverance and no suicidal ideation.
The noteworthiness of this case resides on the scarcity of published reports and on the difficulty it presents in terms of therapeutic and post-discharge management, originating from the hard-to-interpret symptoms and uncertain prognosis.
Depression is one of the main causes of disability in the Western countries. This evidence presents new challenges for somatic medicine, such as surgery.
To determine the influence of patients’ depression on (i) length of hospital stay (LOS, which is a proxy of recovery) after major surgery, and (ii) LOS anticipated by surgeon preoperatively.
To explore the influence of depression on recovery after major surgery, and whether and how surgeons take into account patients’ emotional and psychological status in the care of their patients.
Prospective multicentre observational study. Depression was assessed with HADS (HADS > 8 showing the presence of significant depression). Two cox PH models were fitted to evaluate the influence of depression on patients’ LOS (first model) and anticipated LOS (second model). Adjustment variables were (i) preoperative (age, sex, anxiety, diagnosis, BMI, biology), (ii) intraoperative (blood transfusion, length of intervention), (iii) postoperative (morbidity).
Of 372 recruited patients (which had undergone major liver surgery), 69 (18,5%) had HADS>8. After adjustment, depression was a risk factor for a prolonged LOS (HR 1.96, 95%CI 1.44–2.63). However, depression was unrelated to the anticipated LOS (HR 1.26, 95%CI 0.90–1.66).
1 in 5 patients presented a significant level of depression. Depression was independently associated to longer LOS (ie. longer recovery time after surgery). However this data was not taken into account by surgeons, which failed to integrate that in their previsions. A psychiatric culture and education need to be developed in surgery, as well as more collaboration.