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Causes of the comorbidity of substance misuse with anxiety-related and depressive disorders (anxiety/depression) remain poorly known. We estimated associations of substance misuse and anxiety/depression in the general population and tested them while accounting for genetic and shared environmental factors.
We studied individuals born in Sweden 1968–1997 (n = 2 996 398) with follow-up in nationwide register data for 1997–2013. To account for familial effects, stratified analyses were conducted within siblings and twin pairs. Substance misuse was defined as ICD-10 alcohol or drug use disorder or an alcohol/drug-related criminal conviction. Three dimensions of ICD-10 anxiety and depressive disorders and a substance misuse dimension were identified through exploratory factor analysis.
Substance misuse was associated with a 4.5-fold (95% CI 4.50–4.58) elevated risk of lifetime generalized anxiety/depression, 4.7-fold (95% CI 4.63–4.82) elevated risk of panic disorder and agora/social phobia, and 2.9-fold elevated risk of phobias/OCD (95% CI 2.82–3.02) as compared to those without substance misuse. The associations were attenuated in within-family analyses but we found elevated risks in monozygotic twin pairs discordant for substance misuse as well as significant non-shared environmental correlations. The association between anxiety/depression and substance misuse was mainly driven by generalized anxiety/depression, whereas other anxiety/depression dimensions had minor or no independent associations with substance misuse.
Substance misuse and anxiety/depression are associated at the population level, and these associations are partially explained by familial liabilities. Our findings indicate a common genetic etiology but are also compatible with a potential partially causal relationship between substance misuse and anxiety/depression.
The importance of overall diet in modifying circulating lipoprotein particles and fatty acids during pregnancy is unclear. We examined the relationships of diet quality as assessed by the validated Healthy Food Intake Index (HFII) with serum HDL, LDL and VLDL particle concentrations and sizes and proportions of serum fatty acids in pregnant women at high risk for gestational diabetes mellitus (GDM). Overall, 161 women with a BMI of ≥30 kg/m2 and/or a history of GDM were drawn from the Finnish Gestational Diabetes Prevention Study, which is a dietary and exercise intervention trial to prevent GDM. At baseline, the HFII score was inversely related to concentrations of HDL particles (P=0·010) and MUFA (P=0·010) and positively related to concentrations of n-3 (P<0·001) and n-6 (P=0·003) PUFA. The significance for MUFA disappeared after adjustments. An increase in the HFII score from the first to second trimester of pregnancy correlated with reduced VLDL particle size (r −0·16, 95 % CI −0·31, −0·01), decreased MUFA concentrations (r −0·17, 95 % CI −0·31, −0·01) and elevated n-6 PUFA concentrations (r 0·16, 95 % CI 0·01, 0·31). In the maximum-adjusted model, the results remained significant except for VLDL particle size. These findings suggest that higher diet quality as defined by the HFII is related to a more favourable serum fatty acid profile, whereas the relationship with serum lipoprotein profile is limited in pregnant women at increased GDM risk.
To evaluate the performances of two auditory brainstem response (ABR) profiling tests as potential biomarkers and diagnostic support for schizophrenia and adult attention-deficit hyperactivity disorder (ADHD), respectively, in an investigator-initiated blinded study design.
Male and female patients with schizophrenia (n=26) and adult ADHD (n=24) meeting Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM IV) diagnostic criteria and healthy controls (n=58) comprised the analysis set (n=108) of the total number of study participants (n=119). Coded sets of randomized ABR recordings were analysed by an independent party blinded to clinical diagnoses before a joint code-breaking session.
The ABR profiling test for schizophrenia identified schizophrenia patients versus controls with a sensitivity of 84.6% and a specificity of 93.1%. The ADHD test identified patients with adult ADHD versus controls with a sensitivity of 87.5% and a specificity of 91.4%.
The ABR profiling tests discriminated schizophrenia and ADHD versus healthy controls with high sensitivity and specificity. The methods deserve to be further explored in larger clinical studies including a broad range of psychiatric disorders to determine their utility as potential diagnostic biomarkers.
As a so-called non-null subject language, it has been proposed that in English, unexpressed subjects occur only in registers that have specific grammatical properties. We test this hypothesis through a comparison of the conditioning of subject expression for third-person singular human specific subjects in English conversation and narrative. Despite a stark difference in the rates of nonexpression (4% in conversation vs. 22% in narratives), there is no evidence of different grammars across the registers—in both, outside of coreferential clauses conjoined with a coordinating conjunction, unexpressed subjects only occur in prosodic initial position in main clause declaratives. Within the variable context, in both registers, expression is sensitive to accessibility, priming, and temporal sequentiality. A register effect is, however, evident in the contextual distribution, with a larger proportion of the narrative tokens occurring in contexts propitious to unexpressed subjects, and it is this that accounts for the higher rate of nonexpression in this register.
Abuse or unintended overdose (OD) of opiates and heroin may result in prehospital and emergency department (ED) care. Prehospital naloxone use has been suggested as a surrogate marker of community opiate ODs. The study objective was to verify externally whether prehospital naloxone use is a surrogate marker of community opiate ODs by comparing Emergency Medical Services (EMS) naloxone administration records to an independent database of ED visits for opiate and heroin ODs in the same community.
A retrospective chart review of prehospital and ED data from July 2009 through June 2013 was conducted. Prehospital naloxone administration data obtained from the electronic medical records (EMRs) of a large private EMS provider serving a metropolitan area were considered a surrogate marker for suspected opiate OD. Comparison data were obtained from the regional trauma/psychiatric ED that receives the majority of the OD patients. The ED maintains a de-identified database of narcotic-related visits for surveillance of narcotic use in the metropolitan area. The ED database was queried for ODs associated with opiates or heroin. Cross-correlation analysis was used to test if prehospital naloxone administration was independent of ED visits for opiate/heroin ODs.
Naloxone was administered during 1,812 prehospital patient encounters, and 1,294 ED visits for opiate/heroin ODs were identified. The distribution of patients in the prehospital and ED datasets did not differ by gender, but it did differ by race and age. The frequency of naloxone administration by prehospital providers varied directly with the frequency of ED visits for opiate/heroin ODs. A monthly increase of two ED visits for opiate-related ODs was associated with an increase in one prehospital naloxone administration (cross-correlation coefficient [CCF]=0.44; P=.0021). A monthly increase of 100 ED visits for heroin-related ODs was associated with an increase in 94 prehospital naloxone administrations (CCF=0.46; P=.0012).
Frequency of naloxone administration by EMS providers in the prehospital setting varied directly with frequency of opiate/heroin OD-related ED visits. The data correlated both for short-term frequency and longer term trends of use. However, there was a marked difference in demographic data suggesting neither data source alone should be relied upon to determine which populations are at risk within the community.
LindstromHA, ClemencyBM, SnyderR, ConsiglioJD, MayPR, MoscatiRM. Prehospital Naloxone Administration as a Public Health Surveillance Tool: A Retrospective Validation Study. Prehosp Disaster Med. 2015;30(4):1–5.
Needle thoracostomy is the prehospital treatment for tension pneumothorax. Sufficient catheter length is necessary for procedural success. The authors of this study determined minimum catheter length needed for procedural success on a percentile basis.
A meta-analysis of existing studies was conducted. A Medline search was performed using the search terms: needle decompression, needle thoracentesis, chest decompression, pneumothorax decompression, needle thoracostomy, and tension pneumothorax. Studies were included if they published a sample size, mean chest wall thickness, and a standard deviation or confidence interval. A PubMed search was performed in a similar fashion. Sample size, mean chest wall thickness, and standard deviation were found or calculated for each study. Data were combined to create a pooled dataset. Normal distribution of data was assumed. Procedural success was defined as catheter length being equal to or greater than the chest wall thickness.
The Medline and PubMed searches yielded 773 unique studies; all study abstracts were reviewed for possible inclusion. Eighteen papers were identified for full manuscript review. Thirteen studies met all inclusion criteria and were included in the analysis. Pooled sample statistics were: n=2,558; mean=4.19 cm; and SD=1.37 cm. Minimum catheter length needed for success at the 95th percentile for chest wall size was found to be 6.44 cm.
A catheter of at least 6.44 cm in length would be required to ensure that 95% of the patients in this pooled sample would have penetration of the pleural space at the site of needle decompression, and therefore, a successful procedure. These findings represent Level III evidence.
ClemencyBM, TanskiCT, RosenbergM, MayPR, ConsiglioJD, LindstromHA. Sufficient Catheter Length for Pneumothorax Needle Decompression: A Meta-Analysis. Prehosp Disaster Med. 2015;30(3):15
The electronic structure of defects produced by 2.5-MeV electron irradiation and their effect on optical properties of GaN are investigated using photoluminescence (PL) and optically detected magnetic resonance (ODMR) techniques. The electron irradiation is shown to produce, in particular, a deep PL band with a no-phonon line at around 0.88 eV followed by a phonon-assisted sideband. We suggest that this emission is caused by an internal transition between excited and ground state of a deep defect. The excited state is a multiple-level state, as revealed from temperature dependent PL and level anti-crossing experiments. The electronic structure of the 0.88 eV defect is shown to be sensitive to the internal strain in the GaN epilayers. The ODMR studies reveal that the principal axis of the defect coincides with the c-axis of the host lattice and should therefore be either an on-site point defect or an axial complex defect along the c-axis.
Specialized knowledge and a scientific body of literature are the foundation of the recognition of Emergency Medical Services (EMS) as a subspecialty within emergency medicine (EM). Emergency Medical Services research often is presented at national meetings and published in abstract form, but full publication occurs less frequently.
The primary goal of the study was to determine the rate at which EMS-related research presented at selected conferences went on to manuscript publication. A secondary goal was the determination of the time to manuscript publication.
A cross-sectional study of published abstracts from the 2003-2005 national meetings of the American College of Emergency Physicians (ACEP), Society for Academic Emergency Medicine (SAEM), National Association of EMS Physicians (NAEMSP), Association of Air Medical Services (AAMS), and the National Association of EMS Educators (NAEMSE) was conducted to identify EMS-related abstracts. PubMed (National Center for Biotechnology Information, Bethesda, Maryland USA) was searched using abstract title keywords and authors’ names to determine if the study had been published in a PubMed-indexed journal in the time since presentation and abstract publication.
Abstracts for the five conferences were reviewed for 2003-2005. Six hundred and thirty-five EMS-related abstracts met the inclusion criteria. The total number of EMS abstracts presented and the percent subsequently published as a manuscript were: SAEM 135, 53.3%; ACEP 128, 48.4%; NAEMSP 282, 42.9%; AAMS 66, 33.3%; and NAEMSE 24, 16.7%. The overall rate of publication was 44.3%. The average time to publication was 22.2 months (SD = 16.5 months, range = 0-94 months).
Less than half of EMS abstracts go on to manuscript publication. This may represent missed opportunities for the growth of EMS as a subspecialty.
ClemencyBM, ThompsonJJ, LindstromHA, GurienS, JaisonBA, Grates-SciarrinoAA. Frequency of Manuscript Publication Following Presentation of EMS Abstracts at National Meetings. Prehosp Disaster Med. 2014;29(3):1-5.
High-dose intravenous nitroglycerin is a common in-hospital treatment for respiratory distress due to congestive heart failure (CHF) with hypertension. Intravenous (IV) nitroglycerin administration is impractical in the prehospital setting. In 2011, a new regional Emergency Medical Services (EMS) protocol was introduced allowing advanced providers to treat CHF with high-dose oral nitroglycerin. The protocol calls for patients to be treated with two sublingual tabs (0.8 mg) when systolic blood pressure (SBP) was >160 mm Hg, or three sublingual tabs (1.2 mg) when SBP was >200 mm Hg, every five minutes as needed.
To assess the protocol's safety, the incidence of hypotension following prehospital administration of multiple simultaneous nitroglycerin (MSN) tabs by EMS providers was studied.
This study was a retrospective cohort study of patients from a single commercial EMS agency over a 6-month period. Records from patients with at least one administration of MSN were reviewed. For each administration, the first documented vital signs pre- and post-administration were compared. Administrations were excluded if pre- or post-administration vital signs were missing.
One hundred case-patients had at least one MSN administration by an advanced provider during the study period. Twenty-five case-patients were excluded due to incomplete vital signs. Seventy-five case-patients with 95 individual MSN administrations were included for analysis. There were 65 administrations of two tabs, 29 administrations of three tabs, and one administration of four tabs. The mean change in SBP following MSN was -14.7 mm Hg (SD = 30.7; range, +59 to -132). Three administrations had documented systolic hypotension in the post-administration vital signs (97/71, 78/50 and 66/47). All three patients were over 65 years old, were administered two tabs, had documented improved respiratory status, and had repeat SBP of at least 100. The incidence of hypotension following MSN administration was 3.2%.
High-dose oral nitroglycerin administration is a practical alternative to IV nitroglycerin in the prehospital setting when administered by advanced providers. The prehospital protocol for high dose oral nitroglycerin was demonstrated to be safe in the cohort of patients studied. Limitations of the study include the relatively small sample size and the inability to identify hypotension that may have occurred following the cessation of data collection in the field.
Hypotension was rare and self-limited in prehospital patients receiving MSN.
To examine the use of vitamin D supplements during infancy among the participants in an international infant feeding trial.
Information about vitamin D supplementation was collected through a validated FFQ at the age of 2 weeks and monthly between the ages of 1 month and 6 months.
Infants (n 2159) with a biological family member affected by type 1 diabetes and with increased human leucocyte antigen-conferred susceptibility to type 1 diabetes from twelve European countries, the USA, Canada and Australia.
Daily use of vitamin D supplements was common during the first 6 months of life in Northern and Central Europe (>80 % of the infants), with somewhat lower rates observed in Southern Europe (>60 %). In Canada, vitamin D supplementation was more common among exclusively breast-fed than other infants (e.g. 71 % v. 44 % at 6 months of age). Less than 2 % of infants in the USA and Australia received any vitamin D supplementation. Higher gestational age, older maternal age and longer maternal education were study-wide associated with greater use of vitamin D supplements.
Most of the infants received vitamin D supplements during the first 6 months of life in the European countries, whereas in Canada only half and in the USA and Australia very few were given supplementation.
In Finland in April 2010, a 3-month old baby was diagnosed with type A infant botulism. He excreted botulinum neurotoxin and/or Clostridium botulinum in his faeces until November 2010. Five months of excretion was after clinical recovery and discharge from hospital. C. botulinum isolates recovered from the household dust in the patient's home were genetically identical to those found in the infant's stool samples. Long-term faecal excretion of C. botulinum may pose a possible health risk for the parents and others in close contact with the infant.
Growing evidence supports the involvement of EF in academic performance and, consequently, EdF in learning disorders (commonly known as learning disabilities or LD). Often, the first indicator of LD is low academic achievement in areas of reading, math, or writing. The terminology used to describe different LD conditions varies by field and includes dyslexia and reading disorder/disability, dyscalculia and mathematics disorder/disability, and disorder of written expression/writing disability. Comorbidity among these learning disorders is common, as is the co-occurrence of LD with ADHD.
Recent US data indicate that almost 2.5 million public school students received special education and related services for LD in 2008, and 43% of all public school students receiving special education and related services were identified as having a specific learning disability. Federal guidelines used in educational settings indicate that a child may have a specific LD if, in the absence of any other disability or limiting condition and despite appropriate instruction and experiences, the child does not adequately achieve for age or state standards in one of the following eight academic areas: oral expression, listening comprehension, written expression, basic reading skills, reading fluency skills, reading comprehension, mathematics calculation, or mathematics problem solving. The DSM-IV-TR indicates diagnosis of specific disorders of reading, math, and written expression based on lower than expected performance on standardized tests “given the person’s chronological age, measured intelligence, and age-appropriate education.” The proposed changes for DSM-5 include defining these disorders based on low performance on standardized measures without requiring a significant discrepancy between measured intelligence and achievement.
This study treats radionuclide transport calculations for a canister defect scenario in the safety assessment SR 97, which concerns a deep repository for spent nuclear fuel of the KBS-3 type in Sweden. The aims of the calculations are to:
Quantitatively describe the radionuclide transport.
Show the impact of uncertainty in input data and show which parameters govern the calculated release rates.
Compare three different real sites in Sweden (Aberg, Beberg and Ceberg) with each other and with dose limits given in Swedish regulations (none of the sites is considered in the on-going localization process). Only briefly described in this paper.
Illustrate the impact of the different barriers in the system.
Deterministic calculations illustrate the radionuclide transport for reasonable conditions. Uncertainty cases show the influence of the uncertainty for data related to different parts of the repository system by systematically giving them pessimistic values while all others are reasonable. Simplified probabilistic calculations have also been performed.
The analysis shows that the most important parameters in the near field are the number of defective canisters and the instant release fraction. In the far field the most important uncertainties affecting release and retention are connected to permeability and connectivity of the fractures in the rock. The dose rate in the biosphere is essentially controlled by the possibilities of dilution.
The calculated maximum doses for the hypothetical repositories are well below the dose limits, and hence they meet the acceptance criteria for a deep repository for spent fuel.
In an attempt to decide the question whether enhanced oxygen diffusion is important for heat-treatments of silicon at ∼450ºC where thermal donors are formed we have conducted two types of experiments aimed at providing a measure of the “effective” oxygen diffusivity. First, we have extensively measured the temperature dependence of the thermal donor introduction rate for very short heat treatment times (20min). This measurement provides the thermal activation energy of TD formation. Since effects of long range diffusion and formation of large oxygen clusters are negligible for suchtimes and temperatures and, presumably, thermal donor formation at the lowest heat treatment temperatures is oxygen diffusion limited, it should be possible to interprete the obtained activation energy in terms of oxygen diffusivity. The change of the interstitialoxygen content is immeasureable for 20min heat treatment times. Therefore, the decay of the interstitial oxygen content was measured for longer heat treatments at 450ºC (up to 500hours). The two experiments are complementary in several ways: In one experiment the oxygen diffusion activation energy is extracted, while the other measurement provides the value of the diffusion coefficient at a given temperature. In one case thermal donors are monitored for short heat treatment times while in the other experiment the interstitial oxygen content is measured for long heat treatment times. The present measurements are different from other diffusion experiments in this temperature range where theatomic jump of isolated oxygen is monitored . Here we attempt to extract an effective oxygen diffusivity under conditions of thermal donor formation since the thermal donor formation process itself might be the cause of an enhanced oxygen diffusivity.
We summarize the recent results in hydrogen passivation in silicon, including presenting comprehensive diffusion profiles, i.e., profiles in floating zone n-type and p-type silicon vs resistivity. Domination of hydrogen diffusion by impurity trapping is clearly indicated for part of the profile in low resistivity p-type Si. Also mentioned are the current models of hydrogen passivation of dangling bonds, shallow acceptors, shallow donors, and hyper-deep defects.
The effect of ion-implantation followed by a rapid thermal annealing was investigated in borondoped silicon using photoluminescence (PL) spectroscopy. The radiation induced defects giving rise to the G, W and C PL lines are completely passivated by a hydrogen plasma treatment. However this hydrogen exposure also introduces broad and deep luminescence structure as well as new sharp PL lines very near the silicon band gap. Up to twelve new lines are observed at low temperature (< 20K). One of them exhibits a very low exciton localisation energy (≈ 2 meV) compared to the value measured for classical shallow donors or acceptors, and is observed only at very low temperature (≈4K). A broad deep PL band with a halfwidth of 30 meV is observed at around 925 meV. The excitation power dependence and the temperature dependence of the PL intensity of these sharp lines and the broad band are presented. Tentative correlations with the data currently available in the literature are presented for the understanding of the formation of the defects associated to the broad band as well as the sharp near band gap PL lines.