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Total Intravenous Anaesthesia (TIVA) is an innovative alternative to traditional inhalational anaesthesia. Often incorrectly perceived as overly complex, TIVA has numerous advantages over inhalational drugs, such as a lower risk of nausea, less pain and better cognitive recovery. Taking on TIVA is a practical, easy to read and engaging guide to TIVA. It demystifies this important technique and will empower the novice but also support more experienced practitioners. It is a clear step-by-step approach to treating everything from routine elective to paediatric, geriatric, obese and pregnant patients. Pharmacokinetic models, dosage calculations, and the use of TIVA in emergency medicine are also elucidated. Written by international experts in the field with many years of experience both conducting and teaching TIVA, this handbook is an essential resource for experienced and novice anaesthetists alike who want to improve their understanding and confidence with the technique.
Sleep disturbance is a symptom of and a well-known risk factor for depression. Further, atypical functioning of the HPA axis has been linked to the pathogenesis of depression. The purpose of this study was to examine the role of adolescent HPA axis functioning in the link between adolescent sleep problems and later depressive symptoms. Methods: A sample of 157 17–18 year old adolescents (61.8% female) completed the Pittsburgh Sleep Quality Inventory (PSQI) and provided salivary cortisol samples throughout the day for three consecutive days. Two years later, adolescents reported their depressive symptoms via the Center for Epidemiological Studies Depression Scale (CES-D). Results: Individuals (age 17–18) with greater sleep disturbance reported greater depressive symptoms two years later (age 19–20). This association occurred through the indirect effect of sleep disturbance on the cortisol awakening response (CAR) (indirect effect = 0.14, 95%CI [.02 -.39]). Conclusions: One pathway through which sleep problems may lead to depressive symptoms is by up-regulating components of the body’s physiological stress response system that can be measured through the cortisol awakening response. Behavioral interventions that target sleep disturbance in adolescents may mitigate this neurobiological pathway to depression during this high-risk developmental phase.
Objectives: People living with HIV (PLWH) are more likely to report sleep difficulties and cognitive deficits. While cognitive impairment associated with sleep problems have been found in healthy and medical populations, less is known about the effects of poor sleep health (SH) on cognition among PLWH. This study examined differences in cognitive performance among participants classified based upon their HIV status and reported SH. Methods: One hundred sixteen (N=116) adults recruited from the Greater Los Angeles community were administered a comprehensive cognitive test battery and completed a questionnaire about SH. Participants were classified into the following HIV/SH groups: [HIV+/good sleep health (SH+; n=34); HIV−/SH+ (n=32); HIV−/poor sleep health (SH−; n=18) and HIV+/SH− (n=32)]. Results: For both HIV+ and HIV− individuals, poor SH was associated with lower cognitive performance, with the domains of learning and memory driving the overall relationship. The HIV+/SH− group had poorer scores in domains of learning and memory compared to the SH+ groups. Additionally, the HIV−/SH− group demonstrated poorer learning compared to the HIV−/SH+ group. Conclusions: Our findings suggest that sleep problems within medical populations are relevant to cognitive functioning, highlighting the clinical and scientific importance of monitoring sleep health and cognition to help identify individuals at greatest risk of poor health outcomes. Longitudinal investigations using both objective and subjective measures of sleep are needed to determine the robustness of the current findings and the enduring effects of poor SH in the context of chronic disease. (JINS, 2018, 24, 1038–1046)
Psychosocial stress during childhood and adolescence is associated with alterations in the hypothalamic–pituitary–adrenal (HPA) axis and with heightened inflammation, both of which are implicated in poor health; however, factors that may protect against these effects relatively early in life are not well understood. Thus, we examined whether psychosocial resources protect against stress-related alterations in the HPA axis and heightened inflammation in a sample of 91 late adolescents. Participants completed measures of various stressors (major life events, daily interpersonal stress, early adversity), and psychosocial resources (mastery, optimism, self-esteem, and positive reappraisal). They also completed the Trier Social Stress Test and provided saliva and blood samples for the assessment of cortisol and interleukin-6 reactivity. Each of the stressors was associated with lower cortisol reactivity. Additionally, associations with major life events and daily stress were moderated by psychological resources, such that more life events and daily stress were associated with decreased HPA reactivity among adolescents with lower levels of psychological resources, but not among those with higher levels of psychological resources. This pattern of findings was observed only for cortisol reactivity and not for interleukin-6 reactivity. Findings suggest that psychological resources may counteract the effects of certain adversity-related decreases in cortisol reactivity.
Depression can impair the immunogenicity of vaccine administration in adults. Whereas many vaccinations are administered in childhood, it is not known whether adolescent or adult onset depression is associated with impairments in the maintenance of protection of childhood vaccines. This study tested the hypothesis that individuals with adolescent or adult onset mood disorders would display compromised immunity to measles, a target of childhood vaccination.
IgG antibodies to measles were quantified using a solid phase immunoassay in volunteers with bipolar disorder (BD, n = 64, mean age of onset = 16.6 ± 5.6), currently depressed individuals with major depressive disorder (cMDD, n = 85, mean age of onset = 17.9 ± 7.0), remitted individuals with a history of MDD (rMDD, n = 82, mean age of onset = 19.2 ± 8.6), and non-depressed comparison controls (HC, n = 202), all born after the introduction of the measles vaccine in the USA in 1963.
Relative to HC, both the cMDD group (p = 0.021, adjusted odds ratios (OR) = 0.47, confidence interval (CI) = 0.24–0.90), and the rMDD group (p = 0.038, adjusted OR = 0.50, CI = 0.26–0.97) were less likely to test seropositive for measles. Compared with unmedicated MDD participants, currently medicated MDD participants had a longer lifetime duration of illness and were less likely to test seropositive for measles.
Individuals with adolescent or adult onset MDD are less likely to test seropositive for measles. Because lower IgG titers are associated with increased risk of measles infection, MDD may increase the risk and severity of infection possibly because of impaired maintenance of vaccine-related protection from measles.
The Sextans dwarf Spheroidal (dSph) galaxy was discovered recently by Irwin, et al. (1990, M. N. R. A. S., 244, 16p). We report results concerning a number of the global properties of the stellar population of this system. Based on deep CCD photometry obtained with the prime-focus CCD camera on the CTIO 4m telescope, we find that the galaxy is dominated by an old stellar population, similar to that observed in the Draco, Sculptor, and Ursa Minor dwarfs. Some blue stragglers are also present; if these are associated with an intermediate age component, they indicate that only a tiny fraction of the stellar population of Sextans is younger than about 10 Gyr. Based on the apparent magnitude of the predominately red horizontal branch, we conclude that the true distance modulus of Sextans is 19.7 ± 0.3, and the total luminosity of the galaxy is 5.2 × 105L⊙. A complete description of these results is given in Mateo, et al. (1991, A. J., 101, 892).
VLBI observations show that the center of the nearby (~ 3.3 Mpc distant) spiral galaxy, M81, consists of a single elongated radio core, of dimensions 1000 × 4000 AU, with the major axis aligned, in projection, within 3° (<1σ) of the galaxy's rotation axis. This morphology can be interpreted in terms of an active galactic nucleus (AGN) with either a core-jet structure residing in M81's center or an accretion disk filling out the broadline region of this center. In contrast, the radio structure in the companion galaxy, M82, is very complex. VLBI observations of M82 yield the diameters and spectral index distribution of the hot spots, and the morphology and expansion velocity of the brightest hot spot, 41.9+58. Our results argue against the hot spots being core and jet condensations, or young supernovae (SNe), or typical supernova remnants (SNRs). We suggest that the hot spots in M82 are the remnants of stellar events that yielded some combination of SNRs and “exotic” objects.
The aim of this analysis was to test if changes in insomnia symptoms and global sleep quality are associated with coinciding changes in depressed mood among older adults. We report on results yielded from secondary analysis of longitudinal data from a clinical trial of older adults (N = 49) aged 55 to 80 years who reported at least moderate levels of sleep problems. All measures were collected at baseline and after the trial ten weeks later. We computed change scores for two separate measures of disturbed sleep, the Athens Insomnia Scale (AIS) and the Pittsburgh Sleep Quality Index (PSQI), and tested their association with change in depressed mood (Beck Depression Inventory-II; BDI-II) in two separate linear regression models adjusted for biological covariates related to sleep (sex, age, body mass index, and NF-κB as a biological marker previously correlated with insomnia and depression). Change in AIS scores was associated with change in BDI-II scores (β = 0.38, p < 0.01). Change in PSQI scores was not significantly associated with change in BDI-II scores (β = 0.17, p = 0.26). Our findings suggest that improvements over ten weeks in insomnia symptoms rather than global sleep quality coincide with improvement in depressed mood among older adults.
For decades, star counts and HR diagrams extending below the main sequence turnoff in globular clusters meant the work of Sandage (1957). The advent of large CCD's at the foci of large telescopes has changed this (McClure et al. 1985, Harris & Hesser 1985, Christian & Heasley 1986, Heasley et al. 1986, Penny & Dickens 1986, Richer & Fahlman 1986, Smith et al. 1986) and made clear that clusters differ in the shapes of their luminosity functions and in the morphology of their HR diagrams. We return here to photographic methods, which can capture an order of magnitude more images and so possibly reveal new details.
Coordinates are listed for 26 carbon stars which are radial velocity members of the Sagittarius Dwarf Galaxy (SDG). Their near-infrared properties indicate that most are on an extended Asymptotic Giant Branch (AGB), and the total number of such stars in the SDG is estimated at about 100. At least one-third of the C stars studied are large amplitude, i.e. Mira, variables; these are the first Miras to be found in a dSph galaxy. Surprisingly, the most luminous C star is not a Mira, but a low amplitude variable.
A comparison of the properties of C stars in the Bulge and in the SDG indicates that the two groups cannot be drawn from the same population. It is therefore highly unlikely that the Bulge C stars are, contrary to previous suggestions, related in any way to the SDG.
We are using the UK Schmidt telescope (UKST) to carry out a new objective prism survey, covering 2000-3000 square degrees of high galactic latitude sky in the equatorial region. The survey is targeted at discovering both bright (R < 18) quasars in general and bright high redshift (2 < z < 4) quasars in particular, which will be valuable for high resolution spectroscopic follow-up studies. We are using a mixture of ultra-violet excess (XJVX) and a new template matching technique to identify all the bright quasars. Details of the project are discussed and some preliminary results of the survey are presented.
We have measured proper motions for fast, oxygen-rich knots in Puppis A, which we demonstrate are probably uncontaminated ejecta from the progenitor star’s core. Typical fast knots show motions of 0.1-0.2 arcsec yr-1 diverging from a point 4’ northeast of the center of the radio shell. A model assuming constant expansion fits the data well and gives an age of 3700 ± 300 yr for Puppis A. We also present new spectra which indicate the presence of neon along with oxygen in the fast knots.
This study assessed disaster medicine knowledge and competence and perceived self-efficacy and motivation for disaster response among medical, nursing, and dental students.
Survey methodology was used to evaluate knowledge, comfort, perceived competency, and motivation. Also, a nonresponder survey was used to control for responder bias.
A total of 136 responses were received across all 3 schools. A nonresponder survey showed no statistical differences with regard to age, gender, previous presence at a disaster, and previous emergency response training. In spite of good performance on many knowledge items, respondent confidence was low in knowledge and in comfort to perform in disaster situations. Knowledge was strong in areas of infection control, decontamination, and biological and chemical terrorism but weak in areas of general emergency management, role of government agencies, and radiologic events. Variations in knowledge among the different health professions were slight, but overall the students believed that they required additional education. Finally, students were motivated not only to acquire more knowledge but to respond to disaster situations.
Health care students must be adequately educated to assume roles in disasters that are a required part of their professions. This education also is necessary for further disaster medicine education in either postgraduate or occupational education. As students’ performance on knowledge items was better than their perceived knowledge, it appears that a majority of this education can be achieved with the use of existing curricula, with minor modification, and the addition of a few focused subjects, which may be delivered through novel educational approaches. (Disaster Med Public Health Preparedness. 2013;7:499-506)
The success of natural resource management depends on monitoring, assessment and enforcement. In support of these efforts, reference points (RPs) are often viewed as critical values of management-relevant indicators. This paper considers RPs from the standpoint of objective-driven decision making in dynamic resource systems, guided by principles of structured decision making (SDM) and adaptive resource management (AM). During the development of natural resource policy, RPs have been variously treated as either ‘targets’ or ‘triggers’. Under a SDM/AM paradigm, target RPs correspond approximately to value-based objectives, which may in turn be either of fundamental interest to stakeholders or intermediaries to other central objectives. By contrast, trigger RPs correspond to decision rules that are presumed to lead to desirable outcomes (such as the programme targets). Casting RPs as triggers or targets within a SDM framework is helpful towards clarifying why (or whether) a particular metric is appropriate. Further, the benefits of a SDM/AM process include elucidation of underlying untested assumptions that may reveal alternative metrics for use as RPs. Likewise, a structured decision-analytic framework may also reveal that failure to achieve management goals is not because the metrics are wrong, but because the decision-making process in which they are embedded is insufficiently robust to uncertainty, is not efficiently directed at producing a resource objective, or is incapable of adaptation to new knowledge.
Psychological distress, defined as symptoms of depression and anxiety, is an increasingly important public health issue in developing countries. Little is known about the extent to which adverse dietary factors are associated with psychological distress in South Asians. Our aim was to compare the associations of diet and psychological distress in men and women in Goa, India.
Cross-sectional study of consecutive attendees in nine urban and rural general practices in Goa, India in 2004–2005. All participants completed an FFQ on their dietary intake in a typical week. Psychological distress was measured using the Kessler Psychological Distress Scale (K10), a WHO-validated screening instrument.
Consecutive attendees (n 1512; 601 men and 911 women) aged 30 to 75 years participated. Moderate and high scores of psychological distress were detected in significantly more women than men (eighty-eight men v. 264 women, unadjusted OR = 0·39; 95 % CI 0·29, 0·52). Those who ate one or more portions of fish weekly had nearly half the prevalence of distress in both sexes (women, OR = 0·52; 95 % CI 0·29, 0·91; men, OR = 0·50; 95 % CI 0·25, 0·99) and this was independent of age, marital status, education, income, religion and living alone.
Psychological distress is significantly lower with fish intake in both sexes. Further longitudinal work is needed to establish temporal relationships. Addressing psychological distress is becoming an increasingly significant public health priority in both high- and low-income countries.
AAT/WFI optical images of a candidate extragalactic HI cloud, HIPASS J1712–64, are presented. The g and r band CCD mosaic camera frames were processed using a new data pipeline recently installed at the AAO. The resultant stacked images reach significantly deeper levels than those of previous published optical imaging of this candidate, providing a detection limit Mg ˜ −7 at a distance of 3 Mpc, the inferred distance to HIPASS J1712–64. However, detailed analysis of the images fails to uncover any stellar population associated with the HI emission. If this system is a member of the Local Group then it is pathologically different to other members. Hence, our observations reinforce earlier suggestions that this HI cloud is most likely Galactic in origin and not a Local Volume dwarf galaxy.
Recent observational evidence suggests that the Sagittarius dwarf galaxy represents the only major ongoing accretion event in the Galactic halo, accounting for the majority of stellar debris identified there. This paper summarises the recent discovery of another potential Milky Way accretion event, the Canis Major dwarf galaxy. This dwarf satellite galaxy is found to lie just below the Galactic plane and appears to be on an equatorial orbit. Unlike Sagittarius, which is contributing to the Galactic halo, the location and eventual demise of Canis Major suggests that it represents a building block of the thick disk.