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Prehospital intramuscular (IM) ketamine is increasingly used for chemical restraint of agitated patients. However, few studies have assessed emergency department (ED) follow-up of patients receiving prehospital ketamine for this indication, with previous reports suggesting a high rate of post-administration intubation. This study examines the rate of and reasons for intubation and other airway interventions in agitated patients who received ketamine by Emergency Medical Services (EMS).
This retrospective cohort study included patients who received prehospital ketamine for agitation and were transported to two community hospital EDs. Charts were reviewed for demographics, ketamine dose, and airway intervention by EMS or in the ED. Characteristics of patients who were intubated versus those who did not receive airway intervention were analyzed.
Over 28 months, 86 patients received ketamine for agitation. Fourteen (16.3%) underwent endotracheal intubation. Patients with a higher temperature and a lower Glasgow Coma Score (GCS) were more likely to require intubation. There was no age or dose-dependent association on intubation rate. Intubated patients averaged 39 years old versus 44 for patients not intubated (negative five-year difference; 95% CI, -16 to 6). The mean ketamine dose was 339.3mg in patients intubated versus 350.7mg in patients not (-11.4mg difference; 95% CI, -72.4 to 49.6). The mean weight-based ketamine dose was 4.44mg/kg in patients intubated versus 4.96mg/kg in patients not (-0.53mg/kg difference; 95% CI, -1.49 to 0.43).
The observed rate of intubation in patients receiving prehospital ketamine for agitation was 16.3%. Study data did not reveal an age or dose-dependent rate of intubation. Further research should be conducted to compare the airway intervention rate of agitated patients receiving ketamine versus other sedatives in a controlled fashion.
This work presents updates in the diagnostics systems, magnetohydrodynamics (MHD) calculations and simulations of microwave heating scenarios of the small modular Stellarator of Costa Rica 1 (SCR-1). Similarly, the design of a flexible bolometer and magnetic diagnostics (a set of Mirnov coils, Rogowski coils and two diamagnetic loops) are introduced. Furthermore, new MHD equilibrium calculations for the plasma of the SCR-1 device were performed using the VMEC code including the poloidal cross-section of the magnetic flux surfaces at different toroidal positions, profiles of the rotational transform, magnetic well, magnetic shear and total magnetic field norm. Charged particle orbits in vacuum magnetic field were computed by the magnetic field solver BS-SOLCTRA (Vargas et al. In 27th IAEA Fusion Energy Conference (FEC 2018), 2018. IAEA). A visualization framework was implemented using Paraview (Solano-Piedra et al. In 23rd IAEA Technical Meeting on the Research Using Small Fusion Devices (23rd TM RUSFD), 2017) and compared with magnetic mapping results (Coto-Vílchez et al. In 16th Latin American Workshop on Plasma Physics (LAWPP), 2017, pp. 43–46). Additionally, simulations of microwave heating scenarios were performed by the IPF-FDMC full-wave code. These simulations calculate the conversion of the ordinary waves to extraordinary waves and allow us to identify the location where the conversion takes place. Finally, the microwave heating scenarios for the
toroidal position are presented. The microwave heating scenarios showed that the O–X–B mode conversion is around 12–14 %. It was possible to identify the spatial zone where the conversion takes place (upper hybrid frequency).
To determine which factors are associated with compliance with outpatient follow-up plan of discharged patients from a psychiatric ward of a general hospital.
A sample of 120 patients consecutively admitted to a psychiatric general ward, and referred to an outpatient clinic after discharge formed the sample.
To explore the factors predicting whether patients attended or did not attend to the outpatient clinic, a logistic regression analysis was conducted.
After controlling for age, gender, and overall clinical case severity (assessed by the Severity Psychiatric Illness Scale), have been previously attended in the outpatient clinic was the only factor that predicted the compliance with post-discharge outpatient plan (as dichotomous variable: attended/not attended), Odds Ratio (OR) = 12.53, P=0.042. Overall clinical case severity did not predict attendance to the outpatient clinic after discharge, OR=0.937, P=0.452.
Patients who were attended in an outpatient clinic prior to admission had 12-fold more likely to adhere with post-discharge outpatient plan than patients who were not previously attended. This result highlights the importance of strengthening community-hospital liaison strategies.
To verify whether most compliant patients with outpatient postdischarge follow-up plan remain in the community longer before readmission than those who don't adhere to outpatient follow-up plan.
From a total of 120 consecutive admissions to a psychiatric general ward, 63 patients were consecutively readmitted along a 2 year period after their reference first admission.
Out of the 63 patients, 25 patients were attended in an Outpatient Unit (OU) previously to their re-admission (group A), whereas 38 patients had not been attended in the OU between reference admission and readmission (group B). Patient's socio-demographic data (age, gender, marital status, and years of education) were obtained and a case-mix scale (Severity Psychiatric Illness Scale) was administered. Length of survival in community of both groups was compared by means of Analysis of Covariance, controlled for gender, age, diagnosis, clinical severity and number of previous admissions.
Group A had a mean length of survival in the community of 47.7 days (SD=44.3). Group B had a mean length of survival in the community of 23.2 days (SD=37.9). This difference was statistically significant (F=4.74, df=6, 63, p=0.034).
Being attended by OU after the discharge of reference admission lengthen significantly survival in the community after controlling for gender, age, diagnosis, clinical severity and number of previous admissions. Further research will be conducted to determine the cause of the observed differences in patient attendance to post-discharge appointments.
Body- art is associated with an increased risk of self- harming behaviours and suicide attempts (SA) in adolescents, but there is no concluding evidence for adults yet.
We investigate the relationship between ‘body art’ (i.e. tattoos, piercings) and SA in adult patients.
All patients admitted to the Psychiatric Clinic of Genoa for a SA between October 2012 - January 2013 were enrolled. Age, gender, education, previous SA, psychiatric diagnosis were analyzed. The patients underwent first a clinical interview where the presence of body-art, type, number, location, time between its performance and previous or present SA were assessed along with its meaning for the patient, then SCID I & II.
44 patients were enrolled (24 females). Mean age 47 years. 26 had at least a tattoo, among them six females. Eight had at least one piercing, of whom six were females. 58,3% had a diagnosis of MDD, 41.6% of PD (BPD 72%;NPD 34%; OCPD 42%; PPD 23%). 75% of patients with more than one tattoo had a diagnosis in both axes and attempted suicide more than once. These results show that 40% of our sample has a tattoo and one third a piercing, which presence in the same-age American population is estimated to be 26%. However, these results have a limited statistical significance because of the small sample size.
These results suggest a particular mind-body bond which would correlate SA and body art in adult patients, while previous studies found such evidences only in the adolescent population.
'Body- Art” and dissociative episodes are associated with a higher risk for self harm and suicide attempts (SA) in adolescents. Evidence of these associations in adults are lacking.
we investigate the association between body-art, SA and dissociative episodes in a sample of adult psychiatric in-patients. AIMS: to investigate and further describe the relationship between these issues.
all subjects aged more than 18 hospitalized for a SA in the Psychiatric Clinic of Genova (February 2013- 2014) were recruited. For each of them an age- and sex- matched control hospitalized for reasons other than SA was enrolled. Each of them completed SCID I, II; ISS; DES. A semistructured interview about the body-art, the method used in the SA, the presence of family TS was conducted.
positive association between body-art, more previous SA and dissociative episodes. 75% of patients with more than one body-art had a diagnosis in both axis and repeated SA. No association between axis II diagnosis and dissociative episodes. Positive association between violent methods in SA and dissociative episodes, but not with body art.
our results support in adults evidence from previous literature concerning adolescents. The results can be understood in the light of recent epigenetic evidence and of the altered pain threshold in suicidal people.
The altered perception of the body mind bond could be an important target for prevention and treatment strategies of suicidal patients. Further studies are needed to better investigate these associations in adult population.
Physical illness has been recognized as a major risk factor for suicidal behaviours, especially among females. A higher number of physical comorbidities has been associated with higher suicide- risk, thus having a greater burden among the elderly.
investigate this evidence to be able to estimate the load of physical illness on suicidality among psychiatric females of different age.
Evaluate the association between suicidal ideation, age, depression and physical comorbidities in a sample of acute females psychiatric in-patients.
81 psychiatric female in-patients were evaluated during their first day of hospitalization through MADRS, SSI and the presence of organic comorbidity has been collected together with demographic data. All the evaluations were carried out at the Psychiatric Clinic, University of Genova, Italy.
Mean age 48 (age–range value: 74, high variability). Pearson's Chi-squared test showed: significant association between SSI and MADRS (P = 0,027; α = 0,05); no association between SSI and age (P = 0,194; α=0,05); no association between SSI and presence medical illness (P = 0,132; α = 0,05); no association between SSI and number of medical illness (P = 0,186; α = 0,05).
Our results show that the levels of suicidal ideation in psychiatric females are independent from age, presence and number of physical comorbidities. Suicidal ideation appears to be associated only with levels of depression. Our results challenge evidence from a large number of current studies and, if confirmed by further research, would lead to reconsider major suicide risk factors. Further research to investigate these associations on larger samples is needed.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
People seeking information and news regarding suicide are likely to use the Internet. There is contrasting evidence about the relationship between the cyclicity of suicide-related search volumes and national suicide-rates in different countries.
The objectives were to investigate first the cyclicity of Italian suicides and online suicide-related searches carried out by the Italian population in the same time frame (2008–2012) and analyze the correlation between the two cyclicities.
The study aimed to gain further insights on suicide-related internet use and its relationships to completed suicides.
Italian mortality database provided monthly national data concerning suicides (2008–2012). Google trends provided data of online monthly search-volumes of the term “suicide”; “commit suicide”; “how to commit suicide” in Google search (2008–2014).
Seasonal AR model suits the trend of Italian suicides with a periodic 1-year cycle. No specific cyclicity for Google search volumes for “how to commit suicide” and “to commit suicide” was found (ARIMA [0,1,1] and ARIMA [1,0,1] respectively). Google search time series for “suicide” performed with ARIMA (1,1,1) and the cross correlation analysis showed that it lags national suicides of three months (ρ = 0.482, P-value < 0.001).
Online searches for suicide-related terms in Italy are more linked to factors other than suicidality such as personal interest and bereavement. To our knowledge, no previous study reported a lag of three months between online searches for “suicide” and national suicides. This may shed further light on the grieving process being of help in organizing effective supportive strategies for the survivors.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Suicidal adolescents have a severely damaged body/mind relationship where issues pertaining to adolescence and psychache are tightly intertwined causing dissociation, hallucinations and concreteness. In this conundrum, the suffering mind swings from being identified and split from the body favouring self-harm and bodily together with visual hallucinations.
Investigating and working through suicidal concreteness together with the role and meaning of hallucinations in adolescents with a story of multiple suicide attempts.
Achieving a first integration and appropriation of the emotional experience with the establishment of the boundaries between mind/body, inside/outside giving up hallucinations.
Prolonged intensive psychodynamic work focusing on self-representation, the working through of persecutory internal objects causing rage, hostility and attacks on the affective links with the environment allowed a gradual process of integration of the self with the decrease of suicidiality.
The working through and containment of persecutory internal objects led to the possibility to unconsciously give up hallucinations and integrate the emotional experience in the mind together with the development of first effective boundaries between inside/outside.
An intense work of containment and working through of persecution and rage in the early stages of the psychotherapeutic treatment of adolescent multiple attempters can significantly favour the relinquishment of hallucinatory mechanisms and self-harm as a way to cope with intolerable anguish and psychache. This favours the process of in dwelling of the psyche in the soma as described by Winnicott.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Vaccination coverage (VC) against pertussis can increase when management practices and policies at primary care centres (PCCs) are reinforced. From 2011 to 2015, we performed a case–control study to evaluate VC among pertussis patients treated at PCCs in Barcelona, Spain. We recorded pertussis in patients from 8- to 16-year-olds at 52 PCCs. Pertussis cases had laboratory diagnostic and controls were healthy outpatients visiting the same facility for reasons other than cough. DTaP/dTap VC was recorded as either proper vaccination status (five doses recorded) or improper vaccination status (<5 doses recorded). We used a logistic regression model to estimate OR and 95% CI. We included 229 cases and 576 controls. VC was higher in cases (mean 5.01, s.e.: 0.57) than in controls (4.89, s.e.: 0.73). Around 69% of the cases had received DTaP primary immunisation after 2–5 years and 31.4% of cases had the dTap booster immunisation after 7–10 years. The 87% of children 5–9 years were properly vaccinated. We found no protection from becoming ill among properly vaccinated children (OR 1.87; 95% CI 1.22–2.85). The highest VC was observed in patients with confirmed pertussis, which was likely due to a more exhaustive follow-up of the VC in these patients. Being properly vaccinated against pertussis will probably not increase VC.
Animal and cross-sectional epidemiological studies suggest that prenatal lead exposure is related to delayed menarche, but this has not been confirmed in longitudinal studies. We analyzed this association among 200 girls from Mexico City who were followed since the first trimester of gestation. Maternal blood lead levels were analyzed once during each trimester of pregnancy, and daughters were asked about their first menstrual cycle at a visit between the ages of 9.8 and 18.1 years. We estimated hazard ratios (HRs) and 95% confidence intervals (CI) for probability of menarche over the follow-up period using interval-censored Cox models, comparing those with prenatal blood lead level ⩾5 µg/dl to those with prenatal blood lead <5 µg/dl. We also estimated HRs and 95% CI with conventional Cox regression models, which utilized the self-reported age at menarche. In adjusted analyses, we accounted for maternal age, maternal parity, maternal education, and prenatal calcium treatment status. Across trimesters, 36−47% of mothers had blood lead levels ⩾5 µg/dl. Using interval-censored models, we found that during the second trimester only, girls with ⩾5 µg/dl prenatal blood lead had a later age at menarche compared with girls with prenatal blood lead levels <5 µg/dl (confounder-adjusted HR=0.59, 95% CI 0.28–0.90; P=0.05). Associations were in a similar direction, although not statistically significant, in the conventional Cox regression models, potentially indicating measurement error in the self-recalled age at menarche. In summary, higher prenatal lead exposure during the second trimester could be related to later onset of sexual maturation.
This study investigates relations of maternal N-3 and N-6 polyunsaturated fatty acids (PUFA) intake during pregnancy with offspring body mass index (BMI), height z-score and metabolic risk (fasting glucose, C-peptide, leptin, lipid profile) during peripuberty (8–14 years) among 236 mother–child pairs in Mexico. We used food frequency questionnaire data to quantify trimester-specific intake of N-3 alpha-linolenic acid, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA); N-6 linoleic acid and arachidonic acid (AA); and N-6:N-3 (AA:EPA+DHA), which accounts for the fact that the two PUFA families have opposing effects on physiology. Next, we used multivariable linear regression models that accounted for maternal education and parity, and child’s age, sex and pubertal status, to examine associations of PUFA intake with the offspring outcomes. In models where BMI z-score was the outcome, we also adjusted for height z-score. We found that higher second trimester intake of EPA, DHA and AA were associated with lower offspring BMI and height z-score. For example, each 1-s.d. increment in second trimester EPA intake corresponded with 0.25 (95% CI: 0.03, 0.47) z-scores lower BMI and 0.20 (0.05, 0.36) z-scores lower height. Accounting for height z-score in models where BMI z-score was the outcome attenuated estimates [e.g., EPA: −0.16 (−0.37, 0.05)], suggesting that this relationship was driven by slower linear growth rather than excess adiposity. Maternal PUFA intake was not associated with the offspring metabolic biomarkers. Our findings suggest that higher PUFA intake during mid-pregnancy is associated with lower attained height in offspring during peripuberty. Additional research is needed to elucidate mechanisms and to confirm findings in other populations.
Suicide is a complex phenomenon determined by the interplay of an articulated network of factors including socio-economic factors which have a decisive role. This paper investigates the development of the modern conceptualization of suicide in Europe, its sociological understandings and its intertwinement with economic cycles throughout time.
MEDLINE, SCHOLAR, EMBASE using the keywords ‘socioeconomic factors AND suicide’; ‘economic cycles AND suicide’; ‘history AND suicide’ without timeframe limitations. Moreover, journal-by-journal search in journals of related areas was performed.
In total, 51 historical studies focusing on the subjects in European countries were included. Three main areas arose: (a) development of the conceptualization of suicide over time; (b) sociological understandings of suicide according to the structure of society and its economy of power; (c) economic theories explaining the intertwinement of economic cycles and suicides.
Suicide is a deeply human phenomenon inescapably linked to and grounded in society and economic cycles. Understandings from the past show the importance of accurate analysis of socio-economic contexts that shape societies together with man’s own sense of self in order to organize multi-layered tangible and intangible support strategies to better understand and prevent suicide in this day and age.
Despite the higher proportion of foreclosures and home evictions executed in Spain, compared to other countries, and the known link between social exclusion and mental health problems, studies exploring this association in Spain remain scarce. This study investigated the link between the process of home eviction and the appearance of symptomatology of post-traumatic stress disorder (PTSD), anxiety, depression, and perceived stress. Two hundred and five people affected by the process of home eviction were assessed using a structured interview that included three validated assessment instruments for PTSD, perceived stress, anxiety and depression. Analysis involved comparison with the normative groups that formed the validation studies together with regression analysis to determine the major psychological and socio-demographic predictors of perceived stress. Of the participants, 95.1% reported that they were experiencing the process of home eviction with fear, helplessness, or horror. In PTSD symptomatology, they scored higher than the normative PTSD group in symptoms of avoidance (t = 5.01; p < .05), activation (t = 5.48; p < .01), and total score (t = 4.15; p < .05). Of this subgroup, 72.5% fulfilled the DSM-IV symptom criteria for PTSD. The major predictor of perceived stress was PTSD symptomatology (B = .09; p < .001). The process of home eviction in Spain is having an alarming impact on mental health of affected people calling for effective measures to provide psychological and social support.
The aim of this work was to test the performance of a shrimp-tomato culture system (STCS) in an arid-semiarid region (Sonora, Mexico) and to evaluate the water quality variables and phytoplankton variation of shrimp effluent and that water returning from the tomato module culture. The field study was conducted using groundwater and consisted of three circular tanks that were used for shrimp (Litopenaeus vannamei) farming and were coupled to one culture module of tomato plants (Lycopersicon esculentum). The shrimp effluent was used to irrigate the tomato plants. The yield was 11.1±0.2 kg shrimp per tank (3.9±2.0 ton ha−1) and 33.3 kg tomatoes per 45 plants (36.1±2.3 ton ha−1). During the culture, the concentrations of nutrients were (mg L−1): total N-ammonia, <0.001–0.848; N-nitrite, <0.001–1.45; N-nitrate, 5.2–172.2; dissolved reactive-P, <0.005–0.343. A total of 35 taxa belonging to three different algal classes were observed: Chlorophyta (87 to 98%), Bacilliariophyta (2 to 9%) and Cyanophyta (0–3%). This STCS allowed us to harvest the equivalent of 3.9 ton ha−1 of shrimp and 36.3 ton ha−1 of tomatoes, with a water consumption of 2.1 m3 per kg harvested of both products.
The ferroic phase transition in LaEr(MoO4)3 has been analyzed for the first time. It has been confirmed that this compound undergoes a phase transition from a tetragonal system (paraelectric-paraelastic phase), with space group P-421m [β-Gd2(MoO4)3 averaged phase] to an orthorhombic system (ferroelectric-ferroelastic phase), with space group Pba2 [β'-Gd2(MoO4)3 phase] in a reversible process. This phenomenon, together with the observed demixing at high temperature has been studied using different techniques. LaEr(MoO4)3 samples have been obtained by the conventional solid-state synthesis. The thermal dependence of the crystal structure was studied by powder X-ray and neutron diffraction, following a new refining procedure in which the symmetry modes of atomic displacements from the paraelectric-paraelastic structure were analyzed. Dielectric spectroscopy measurements have confirmed the structural results, showing a very smooth phase transition. Finally, calculations within the framework of Density Functional Theory show a behavior of the lattice parameters similar to that observed in our experiments.
In order to investigate further the interest of using the Chilean gene pool in potato breeding programmes, the genetic diversity and population structure of a collection of Solanum tuberosum L. genotypes including 350 worldwide varieties or breeders' lines (referred to as the modern group) and 30 Chiloé Island landraces were examined using simple sequence repeat markers. The close genetic proximity of the Chiloé Island landraces to the modern group was confirmed using several structure analysis methods: principal coordinate analysis; hierarchical clustering analysis; analysis of molecular variance; Bayesian model-based clustering analysis. The latter analysis, in particular, revealed no clear genetic structure between the modern group and the Chiloé Island landraces. The Chiloé Island germplasm appears to represent an interesting gene pool that could be exploited in potato breeding programmes using an association mapping approach.
The dye-sensitized solar cells (DSSC) are a technological and economical alternative to conventional p-n junction solar cells. The DSSC is composed of a transparent conducting electrode (SnO2:F) coated by a porous, nanocrystalline film of n-ZnO to which dye molecules are attached, an organic electrolyte containing a reduction-oxidation couple, and finally a counter-electrode (glass/SnO2:F) coated by a thin film of platinum. The most efficient dyes for DSSCs are based on Ruthenium polypyridyl complexes, related to the high absorption coefficient in the entire visible range and the efficient injection of electrons into the conduction band of ZnO. However, the ruthenium polypyridyl complex contains a heavy metal of relatively high cost, and synthetic routes are complicated with low yields. Moreover, natural dyes in addition to their availability, are cost-effective, non-toxic and biodegradable materials, and can be extracted by simple procedures. In this paper we report the extraction of natural dyes from the stems of mangrove (D1) and tinto (D2) trees as well as from walnut (D3) shell. First, it was necessary to dehydrate the materials, after which extraction was performed using ethanol, water and sodium hydroxide solution. The dyes were characterized using UV-visible and infrared spectroscopy. The analysis of the infrared spectra shows an intense and broad band related to OH bond stretching vibration at 3393, 3442 and 3390 cm-1 for the mangrove tree, tinto tree and walnut shell, respectively. At 1051, 1123 and 1050 cm-1, there was a very strong absorption due to the stretching vibration of CO group, for the mangrove tree, tinto tree and walnut shell, respectively. These results indicate that the functional group for bonding to the ZnO is -OH for these dyes. The results of the U-Vis spectroscopy show that the strongest absorption in the visible region is provided by dyes of the tinto and mangrove trees. The current - voltage curve of a preliminary ZnO-DSSC sensitized with the natural dye of the mangrove tree bark is presented.
Atherosclerosis is the underlying cause of cardiovascular disease and stroke. Endothelial cell dysfunctions are early events in atherosclerosis, resulting in the recruitment of circulating monocytes. The immune system can elicit an inflammatory response toward the atherosclerotic lesion, thereby accelerating lesion growth. Risk factors for atherosclerosis include hypertension, smoking, stress perception or low birth weight. As prenatal stress challenge decreases the birth weight and affects the offspring's postnatal immune response, we aimed to investigate whether prenatal stress contributes to the development of atherosclerosis in mice. Syngenic pregnant apolipoprotein E-deficient (apoE−/−) dams were exposed to sound stress on gestation days 12.5 and 14.5. The presence and size of atherosclerotic plaques in the offspring at the age of 15 weeks was evaluated by histomorphology, accompanied by flow cytometric analysis of the frequency and phenotype of monocytes/macrophages and regulatory T (Treg) cells in the blood. Further, cytokine secretion of peripheral blood lymphocytes was analyzed. In response to prenatal stress challenge, an increased frequency of large atherosclerotic plaques was detectable in apoE−/− offspring, which was particularly profound in females. Prenatal stress also resulted in alterations of the offspring's immune response, such as a decreased frequency of Treg cells in blood, alterations of macrophage populations in blood and an increased secretion of inflammatory cytokines. We provide novel evidence that prenatally stressed adult offspring show an increased severity of atherosclerosis. As Treg cells are key players in dampening inflammation, the observed increase in atherosclerosis may be due to the lack of Treg cell frequency. Future interdisciplinary research is urgently required to understand the developmental origin of prenatal stress-induced atherosclerosis. The availability of our model may facilitate and foster such research endeavors.