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The goals of the present study were to examine the associations between depressive symptoms, sleep problems and the risk of developing heart disease in a Canadian community sample.
Baseline data were from the CARTaGENE study, a community health survey of adults aged 40–69 years in Quebec, Canada. Incidence of heart disease was examined in N = 33 455 participants by linking survey data with administrative health insurance data. Incident heart disease was identified using the World Health Organization's International Classification of Diseases, 9th or 10th edition (ICD-9 and ICD-10) diagnostic codes for heart disease. Sleep problems were assessed with diagnostic codes for sleep disorders within the 2 years preceding the baseline assessment. Average sleep duration was assessed by self-report. Depressive symptoms were assessed with the nine-item Patient Health Questionnaire.
In total, 2448 (7.3%) participants developed heart disease over an average follow-up period of 4.6 years. Compared to those without depressive symptoms and with no sleep disorders, those with elevated depressive symptoms and a sleep disorder (HR = 2.60, 95% CI 1.83–3.69), those with depressive symptoms alone (HR = 1.40, 95% CI 1.25–1.57) and those with sleep disorders alone (HR = 1.33, 95% CI 1.03–1.73) were more likely to develop heart disease. Test of additive interaction suggested a synergistic interaction between depressive symptoms and sleep disorders (synergy index = 2.17 [95% CI 1.01–4.64]). When sleep duration was considered, those with long sleep duration and elevated depressive symptoms were more likely to develop heart disease than those with long sleep alone (HR = 1.77, 95% CI 1.37–2.28; and HR = 1.16, 95% CI 0.99–1.36, respectively).
Depression and diagnosed sleep disorders or long sleep duration are independent risk factors for heart disease and are associated with a stronger risk of heart disease when occurring together.
An x-ray source is described that can have high brilliance, monochromaticity and spatial coherence. This source filters, by successive diffraction, spontaneous x-ray radiation produced by electron impact in a Bonse-Hart monolithic crystal monochromater. A germanium single crystal was grooved to form a monolithic monochromater and subsequently was fitted with a filament. Field emitted electrons from the filament impact on the crystal side walls. Thus, the passive Bonse-Hart monochromater is converted into an active x-ray source. The detailed diffraction geometry within the cavity, in the limit of kinematic diffraction theory, is described and compared to the experimentally observed radiation pattern. Since this radiation source achieves its monochromaticity and spatial coherence by filtering it is highly inefficient. However, the diffraction process is highly efficient when the radiation is in the proper geometric direction to satisfy Bragg's law. Thus, the stationary radiation source can have a high brilliance although the input of electrical energy could be well in excess of a rotating anode x-ray tube.
The diffractograms of syn-gypsum and of fine gas desulfurization products indicate that CaSO4.2H2O is converted to other phase(s) when heated to 100°C. Syn-hannebachite (CaSO30.5H2O) is unaffected by similar thermal treatment.
Objectives: As the number of adolescents and young adults (AYAs) surviving congenital heart disease (CHD) grows, studies of long-term outcomes are needed. CHD research documents poor executive function (EF) and cerebellum (CB) abnormalities in children. We examined whether AYAs with CHD exhibit reduced EF and CB volumes. We hypothesized a double dissociation such that the posterior CB is related to EF while the anterior CB is related to motor function. We also investigated whether the CB contributes to EF above and beyond processing speed. Methods: Twenty-two AYAs with CHD and 22 matched healthy controls underwent magnetic resonance imaging and assessment of EF, processing speed, and motor function. Volumetric data were calculated using a cerebellar atlas (SUIT) developed for SPM. Group differences were compared with t tests, relationships were tested with Pearson’s correlations and Fisher’s r to z transformation, and hierarchical regression was used to test the CB’s unique contributions to EF. Results: CHD patients had reduced CB total, lobular, and white matter volume (d=.52–.99) and poorer EF (d=.79–1.01) compared to controls. Significant correlations between the posterior CB and EF (r=.29–.48) were identified but there were no relationships between the anterior CB and motor function nor EF. The posterior CB predicted EF above and beyond processing speed (ps<.001). Conclusions: This study identified a relationship between the posterior CB and EF, which appears to be particularly important for inhibitory processes and abstract reasoning. The unique CB contribution to EF above and beyond processing speed alone warrants further study. (JINS, 2018, 24, 939–948)
Previous studies have examined associations of cardiometabolic factors with depression and cognition separately.
To determine if depressive symptoms mediate the association between cardiometabolic factors and cognitive decline in two community studies.
Data for the analyses were drawn from the Rotterdam Study, the Netherlands (n = 2940) and the Whitehall II study, UK (n = 4469).
Mediation analyses suggested a direct association between cardiometabolic factors and cognitive decline and an indirect association through depression: poorer cardiometabolic status at time 1 was associated with a higher level of depressive symptoms at time 2 (standardised regression coefficient 0.07 and 0.06, respectively), which, in turn, was associated with greater cognitive decline between time 2 and time 3 (standardised regression coefficient of −0.15 and −0.41, respectively).
Evidence from two independent cohort studies suggest an association between cardiometabolic dysregulation and cognitive decline and that depressive symptoms tend to precede this decline.
The aim of this study was to evaluate the dynamic association between depressive symptoms and glycated hemoglobin A1c (HbA1c) levels using data from the English Longitudinal Study of Ageing (ELSA).
The sample was comprised of 2886 participants aged ⩾50 years who participated in three clinical assessments over an 8-year period (21% with prediabetes and 7% with diabetes at baseline). Structural equation models were used to address reciprocal associations between depressive symptoms and HbA1c levels and to evaluate the mediating effects of lifestyle-related behaviors and cardiometabolic factors.
We found a reciprocal association between depressive symptoms and HbA1c levels: depressive symptoms at one assessment point predicted HbA1c levels at the next assessment point (standardized β = 0.052) which in turn predicted depressive symptoms at the following assessment point (standardized β = 0.051). Mediation analysis suggested that both lifestyle-related behaviors and cardiometabolic factors might mediate the association between depressive symptoms and HbA1c levels: depressive symptoms at baseline predicted lifestyle-related behaviors and cardiometabolic factors at the next assessment, which in turn predicted HbA1c levels 4 years later. A similar association was observed for the other direction: HbA1c levels at baseline predicted lifestyle-related behaviors and cardiometabolic factors at the next assessment, which in turn predicted depressive symptoms 4 years later.
Our results suggest a dynamic relationship between depressive symptoms and HbA1c which might be mediated by both lifestyle and cardiometabolic factors. This has important implications for investigating the pathways which could link depressive symptoms and increased risk of diabetes.
Depression and anxiety in Parkinson's disease are common and frequently co-morbid, with significant impact on health outcome. Nevertheless, management is complex and often suboptimal. The existence of clinical subtypes would support stratified approaches in both research and treatment.
Five hundred and thirteen patients with Parkinson's disease were assessed annually for up to 4 years. Latent transition analysis (LTA) was used to identify classes that may conform to clinically meaningful subgroups, transitions between those classes over time, and baseline clinical and demographic features that predict common trajectories.
In total, 64.1% of the sample remained in the study at year 4. LTA identified four classes, a ‘Psychologically healthy’ class (approximately 50%), and three classes associated with psychological distress: one with moderate anxiety alone (approximately 20%), and two with moderate levels of depression plus moderate or severe anxiety. Class membership tended to be stable across years, with only about 15% of individuals transitioning between the healthy class and one of the distress classes. Stable distress was predicted by higher baseline depression and psychiatric history and younger age of onset of Parkinson's disease. Those with younger age of onset were also more likely to become distressed over the course of the study.
Psychopathology was characterized by relatively stable anxiety or anxious-depression over the 4-year period. Anxiety, with or without depression, appears to be the prominent psychopathological phenotype in Parkinson's disease suggesting a pressing need to understanding its mechanisms and improve management.
There is limited evidence on the acceptability, feasibility and cost-effectiveness of task-sharing interventions to narrow the treatment gap for mental disorders in sub-Saharan Africa. The purpose of this article is to describe the rationale, aims and methods of the Africa Focus on Intervention Research for Mental health (AFFIRM) collaborative research hub. AFFIRM is investigating strategies for narrowing the treatment gap for mental disorders in sub-Saharan Africa in four areas. First, it is assessing the feasibility, acceptability and cost-effectiveness of task-sharing interventions by conducting randomised controlled trials in Ethiopia and South Africa. The AFFIRM Task-sharing for the Care of Severe mental disorders (TaSCS) trial in Ethiopia aims to determine the acceptability, affordability, effectiveness and sustainability of mental health care for people with severe mental disorder delivered by trained and supervised non-specialist, primary health care workers compared with an existing psychiatric nurse-led service. The AFFIRM trial in South Africa aims to determine the cost-effectiveness of a task-sharing counselling intervention for maternal depression, delivered by non-specialist community health workers, and to examine factors influencing the implementation of the intervention and future scale up. Second, AFFIRM is building individual and institutional capacity for intervention research in sub-Saharan Africa by providing fellowship and mentorship programmes for candidates in Ethiopia, Ghana, Malawi, Uganda and Zimbabwe. Each year five Fellowships are awarded (one to each country) to attend the MPhil in Public Mental Health, a joint postgraduate programme at the University of Cape Town and Stellenbosch University. AFFIRM also offers short courses in intervention research, and supports PhD students attached to the trials in Ethiopia and South Africa. Third, AFFIRM is collaborating with other regional National Institute of Mental Health funded hubs in Latin America, sub-Saharan Africa and south Asia, by designing and executing shared research projects related to task-sharing and narrowing the treatment gap. Finally, it is establishing a network of collaboration between researchers, non-governmental organisations and government agencies that facilitates the translation of research knowledge into policy and practice. This article describes the developmental process of this multi-site approach, and provides a narrative of challenges and opportunities that have arisen during the early phases. Crucial to the long-term sustainability of this work is the nurturing and sustaining of partnerships between African mental health researchers, policy makers, practitioners and international collaborators.
A fourth season of work was carried out in the Spring of 1984. The centrepiece of the programme was the investigation of the well-preserved farm in the Wadi el-Amud (Lamout). The main farm buildings were excavated, faunal and botanical samples were collected systematically from within and between them, the field systems and sluices were examined in detail and investigations begun on the geomorphological and hydrological context. This report presents the basic description of the archaeological data resulting from excavation and survey; a second report will present the results of the various laboratory studies which were generated by the field work.
The most salient fact about the Gothic migrations is that they forcefully underscore how old theories never die. They linger to play upon the intellect for generations until they seem to constitute facts themselves. The study of the migrations tempts the unwary with marvelous sagas and apparently straightforward accounts of trusted ancient authors. Even if we follow Odysseus' lead, and with our ears carefully plugged with scientific beeswax, rivet our eyes to the narrow channels of fact, the old theories still beckon; after all, Roman history is in part a series of thrusts and counterthrusts along the northern peripheries of the Greco-Roman world, in need of explanation then as now. The origins of the migrants and invaders of the Roman frontiers was a question appropriate to Tacitus in the late first century A.D. and to countless others across the centuries. All too often the questioners were far removed from the contact zones and looked down upon a simple battlefield of “we and they.” Such self-proclaimed Valkyries chose sides for their own reasons, usually preconditioned and often totally unrelated to the struggles below. This essay traces the evolution of the theoretical and factual elements of the early Gothic migrations and concludes with a personal sketch drawn in light of recent studies of the Roman frontier and insights from other areas, especially comparative anthropology.
The historiography of the early Gothic migrations is a classic example of the impact of contemporary attitudes, problems, and methodologies on the study of the past. So meager is the evidence that is likens to a broken kaleidoscope in which the few remaining pieces can be jostled easily from place to place.
This article is an executive summary of a report from the Centers for Disease Control and Prevention Ventilator-Associated Pneumonia Surveillance Definition Working Group, entitled “Developing a new, national approach to surveillance for ventilator-associated events” and published in Critical Care Medicine. The full report provides a comprehensive description of the Working Group process and outcome.
In September 2011, the Centers for Disease Control and Prevention (CDC) convened a Ventilator-Associated Pneumonia (VAP) Surveillance Definition Working Group to organize a formal process for leaders and experts of key stakeholder organizations to discuss the challenges of VAP surveillance definitions and to propose new approaches to VAP surveillance in adult patients (Table 1).
Using Burgers’ equation with mixed Neumann–Dirichlet boundary conditions, we highlight a
problem that can arise in the numerical approximation of nonlinear dynamical systems on
computers with a finite precision floating point number system. We describe the dynamical
system generated by Burgers’ equation with mixed boundary conditions, summarize some of
its properties and analyze the equilibrium states for finite dimensional dynamical systems
that are generated by numerical approximations of this system. It is important to note
that there are two fundamental differences between Burgers’ equation with mixed
Neumann–Dirichlet boundary conditions and Burgers’ equation with both Dirichlet boundary
conditions. First, Burgers’ equation with homogenous mixed boundary conditions on a finite
interval cannot be linearized by the Cole–Hopf transformation. Thus, on finite intervals
Burgers’ equation with a homogenous Neumann boundary condition is truly nonlinear. Second,
the nonlinear term in Burgers’ equation with a homogenous Neumann boundary condition is
not conservative. This structure plays a key role in understanding the complex dynamics
generated by Burgers’ equation with a Neumann boundary condition and how this structure
impacts numerical approximations. The key point is that, regardless of the particular
numerical scheme, finite precision arithmetic will always lead to numerically generated
equilibrium states that do not correspond to equilibrium states of the Burgers’ equation.
In this paper we establish the existence and stability properties of these numerical
stationary solutions and employ a bifurcation analysis to provide a detailed mathematical
explanation of why numerical schemes fail to capture the correct asymptotic dynamics. We
extend the results in [E. Allen, J.A. Burns, D.S. Gilliam, J. Hill and V.I. Shubov,
Math. Comput. Modelling 35 (2002) 1165–1195] and prove
that the effect of finite precision arithmetic persists in generating a nonzero numerical
false solution to the stationary Burgers’ problem. Thus, we show that the results obtained
in [E. Allen, J.A. Burns, D.S. Gilliam, J. Hill and V.I. Shubov, Math. Comput.
Modelling 35 (2002) 1165–1195] are not dependent on a specific
time marching scheme, but are generic to all convergent numerical approximations of