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In the nearly a quarter of a century since the addition of the clinically significant distress/impairment criterion to the definition of PTSD in DSM-IV, little research has been done to examine the association of this criterion with symptom group criteria and with the numbing subgroup specifically. This study was conducted to examine these relationships in a large database of disaster survivors consistently studied across 12 different incidents of the full range of disaster typology.
Analysis was conducted on a merged database representing 1187 trauma-exposed survivors of 12 different disasters studied systematically. DSM-IV-TR criteria for disaster-related PTSD were assessed with the Diagnostic Interview Schedule.
PTSD Group C (avoidance/numbing) and numbing specifically were less common and more associated than other symptom groups with criterion F (distress/impairment). Consistently in multivariable models, group C and numbing were independently associated with criterion F. Group D (hyperarousal) was less strongly associated with criterion F. Neither group B (intrusion) nor avoidance were associated with criterion F.
In this and other studies, group C and numbing specifically have been shown to be associated with criterion F, which is consistent with the demonstration that group C and the numbing component specifically are central to the psychopathology of PTSD. The addition of the distress/impairment requirement broadly across the psychiatric diagnoses in DSM-IV added little value to PTSD symptom criteria. Future revisions of diagnostic criteria may benefit by carefully considering these findings to possibly re-include a prominent numbing symptom section.
Variety management is a cross-domain issue in product family design. In the real field, the relationships across the domains are so complex for most of the existing product families that they cannot be easily identified without proper reference architecture. This reference architecture should provide the cross- domain mapping mechanisms in an explicit manner and be able to identify the proper units for management. From this perspective of cross-domain framework, this paper introduces development architecture (DA) to describe the relationships between elements in market, design, and production domains and to give insights for the cross-domain variety management in the product development stage. DA has three parts: (1) the arrangement of elements in each domain, (2) the mapping between elements, and (3) the identification of management sets and key interfaces which are the proper units for variety management. The proposed development architecture framework is applied to the case of front chassis family of modules of an automobile.
India has the second largest number of people with type 2 diabetes (T2D) globally. Epidemiological evidence indicates that consumption of white rice is positively associated with T2D risk, while intake of brown rice is inversely associated. Thus, we explored the effect of substituting brown rice for white rice on T2D risk factors among adults in urban South India. A total of 166 overweight (BMI ≥ 23 kg/m2) adults aged 25–65 years were enrolled in a randomised cross-over trial in Chennai, India. Interventions were a parboiled brown rice or white rice regimen providing two ad libitum meals/d, 6 d/week for 3 months with a 2-week washout period. Primary outcomes were blood glucose, insulin, glycosylated Hb (HbA1c), insulin resistance (homeostasis model assessment of insulin resistance) and lipids. High-sensitivity C-reactive protein (hs-CRP) was a secondary outcome. We did not observe significant between-group differences for primary outcomes among all participants. However, a significant reduction in HbA1c was observed in the brown rice group among participants with the metabolic syndrome (−0·18 (se 0·08) %) relative to those without the metabolic syndrome (0·05 (se 0·05) %) (P-for-heterogeneity = 0·02). Improvements in HbA1c, total and LDL-cholesterol were observed in the brown rice group among participants with a BMI ≥ 25 kg/m2 compared with those with a BMI < 25 kg/m2 (P-for-heterogeneity < 0·05). We observed a smaller increase in hs-CRP in the brown (0·03 (sd 2·12) mg/l) compared with white rice group (0·63 (sd 2·35) mg/l) (P = 0·04). In conclusion, substituting brown rice for white rice showed a potential benefit on HbA1c among participants with the metabolic syndrome and an elevated BMI. A small benefit on inflammation was also observed.
Describe the epidemiological and molecular characteristics of an outbreak of Klebsiella pneumoniae carbapenemase (KPC)–producing organisms and the novel use of a cohorting unit for its control.
A 566-room academic teaching facility in Milwaukee, Wisconsin.
Solid-organ transplant recipients.
Infection control bundles were used throughout the time of observation. All KPC cases were intermittently housed in a cohorting unit with dedicated nurses and nursing aids. The rooms used in the cohorting unit had anterooms where clean supplies and linens were placed. Spread of KPC-producing organisms was determined using rectal surveillance cultures on admission and weekly thereafter among all consecutive patients admitted to the involved units. KPC-positive strains underwent pulsed-field gel electrophoresis and whole-genome sequencing.
A total of 8 KPC cases (5 identified by surveillance) were identified from April 2016 to April 2017. After the index patient, 3 patients acquired KPC-producing organisms despite implementation of an infection control bundle. This prompted the use of a cohorting unit, which immediately halted transmission, and the single remaining KPC case was transferred out of the cohorting unit. However, additional KPC cases were identified within 2 months. Once the cohorting unit was reopened, no additional KPC cases occurred. The KPC-positive species identified during this outbreak included Klebsiella pneumoniae, Enterobacter cloacae complex, and Escherichia coli. blaKPC was identified on at least 2 plasmid backbones.
A complex KPC outbreak involving both clonal and plasmid-mediated dissemination was controlled using weekly surveillances and a cohorting unit.
Clozapine treatment increases the risk of agranulocytosis, but findings on the epidemiology of agranulocytosis have been inconsistent. This meta-analysis examined the prevalence of agranulocytosis and related death in clozapine-treated patients.
A literature search in the international (PubMed, PsycINFO, and EMBASE) and Chinese (WanFang, Chinese National Knowledge Infrastructure, and Sinomed) databases was conducted. Prevalence estimates of agranulocytosis and related death in clozapine-treated patients were synthesized with the Comprehensive Meta-Analysis program using the random-effects model.
Thirty-six studies with 260 948 clozapine-treated patients published between 1984 and 2018 were included in the meta-analysis. The overall prevalence of agranulocytosis and death caused by agranulocytosis were 0.4% (95% CI 0.3–0.6%) and 0.05% (95% CI 0.03–0.09%), respectively. The prevalence of agranulocytosis was moderated by sample size, study quality, year of publication, and that of data collection.
The prevalence of clozapine-associated agranulocytosis is low. Agranulocytosis-related death appears rare.
OBJECTIVES/SPECIFIC AIMS: Intensive lifestyle change (e.g., the Diabetes Prevention Program) and metformin reduce type 2 diabetes risk among patients with prediabetes. However, real-world uptake remains low. Shared decision-making (SDM) may increase awareness and help patients select and follow through with informed options for diabetes prevention that are aligned with their preferences.The objective was to test the effectiveness of a prediabetes SDM intervention. METHODS/STUDY POPULATION: This was a cluster-randomized controlled trial in 20 primary care clinics within a large regional health system. Participants were overweight/obese adults with prediabetes (BMI>24 kg/m2 and HbA1c 5.7-6.4%) were enrolled from 10 SDM intervention clinics. Propensity score matching was used to identify control patients from 10 usual care clinics.Intervention clinic patients were invited to participate in a face-to-face SDM visit with a pharmacist who used a decision aid (DA) to describe prediabetes and four possible options for diabetes prevention; DPP, DPP +/− metformin, metformin only, or usual care. RESULTS/ANTICIPATED RESULTS: Uptake of DPP and/or metformin was higher among SDM participants (n=351) than controls receiving usual care (n = 1,028; 38% vs. 2%, p<.001). At 12-months follow-up, adjusted weight loss (lbs.) was greater among SDM participants than controls (−5.3 vs. −0.2, p < .001). DISCUSSION/SIGNIFICANCE OF IMPACT: A prediabetes SDM intervention led by pharmacists increased patient engagement in evidence-based options for diabetes prevention and was associated with significantly greater uptake of DPP and/or metformin at 4-months and weight loss at 12-months. Prediabetes SDM may be a promising approach to enhance prevention efforts among patients at increased risk.
Objectives: We assessed trends in the incidence, prevalence, and post-diagnosis mortality of parkinsonism in Ontario, Canada over 18 years. We also explored the influence of a range of risk factors for brain health on the trend of incident parkinsonism. Methods: We established an open cohort by linking population-based health administrative databases from 1996 to 2014 in Ontario. The study population comprised residents aged 20–100 years with an incident diagnosis of parkinsonism ascertained using a validated algorithm. We calculated age- and sex-standardized incidence, prevalence, and mortality of parkinsonism, stratified by young onset (20–39 years) and mid/late onset (≥40 years). We assessed trends in incidence using Poisson regression, mortality using negative binomial regression, and prevalence of parkinsonism and pre-existing conditions (e.g., head injury) using the Cochran–Armitage trend test. To better understand trends in the incidence of mid/late-onset parkinsonism, we adjusted for various pre-existing conditions in the Poisson regression model. Results: From 1996 to 2014, we identified 73,129 incident cases of parkinsonism (source population of ∼10.5 million), of whom 56% were male, mean age at diagnosis was 72.6 years, and 99% had mid/late-onset parkinsonism. Over 18 years, the age- and sex-standardized incidence decreased by 13.0% for mid/late-onset parkinsonism but remained unchanged for young-onset parkinsonism. The age- and sex-standardized prevalence increased by 22.8%, while post-diagnosis mortality decreased by 5.5%. Adjustment for pre-existing conditions did not appreciably explain the declining incidence of mid/late-onset parkinsonism. Conclusion: Young-onset and mid/late-onset parkinsonism exhibited differing trends in incidence over 18 years in Ontario. Further research to identify other factors that may appreciably explain trends in incident parkinsonism is warranted.
Suicide attempt (SA), which is one of the strongest predictors of completed suicide, is common in major depressive disorder (MDD) but its prevalence across epidemiological studies has been mixed. The aim of this comprehensive meta-analysis was to examine the pooled prevalence of SA in individuals with MDD.
A systematic literature search was conducted in PubMed, Embase, PsycINFO, Web of Science and Cochrane Library from their commencement date until 27 December 2017. Original studies containing data on prevalence of SA in individuals with MDD were analyzed.
In all, 65 studies with a total of 27 340 individuals with MDD were included. Using the random effects model, the pooled lifetime prevalence of SA was 31% [95% confidence interval (CI) 27–34%], 1-year prevalence was 8% (95% CI 3–14%) and 1-month prevalence was 24% (95% CI 15–34%). Subgroup analyses revealed that the lifetime prevalence of SA was significantly associated with the patient setting, study region and income level, while the 1-month prevalence of SA was associated with only the patient setting.
This meta-analysis confirmed that SA was common in individuals with MDD across the world. Careful screening and appropriate interventions should be implemented for SA in the MDD population.
To investigate the effects of soybean isoflavone (SI) on immunity in infectious bursal disease virus (IBDV)-infected broilers, chicks were fed the same basal diet supplemented with 0 (non-infected control), 0 (infected control), 10, 20 or 40 mg/kg SI for 44 days. At 21 days old, chickens were inoculated with bursal infectious dose causing 50% morbidity of the IBDV BC 6/85 strain by the eye-drop and nasal route (except for non-infected controls). Results showed that, over 1–23 days post-infection (dpi), there was a significant interaction between SI supplementation level and time: high-level SI supplementation increased peripheral T lymphocyte proliferation, percentages of CD3+, CD4+ and CD8+ T lymphocytes, CD4+ to CD8+ ratio, serum concentrations of IgA, IgM and IgG, and IBDV antibody titres. Except for serum IgA and IgM, these variables increased over time with far higher values at 23 dpi than earlier. Compared with non-infected controls, IBDV inoculation decreased peripheral T lymphocyte proliferation at 3 dpi, percentages of CD3+, CD4+ and CD8+ T lymphocytes, and serum IgG, IgM concentration at 23 dpi, and increased IBDV antibody titres at 7, 15 and 23 dpi. Supplemental SI quadratically increased peripheral T lymphocyte proliferation, CD4+ to CD8+ ratio and serum IgA concentration at 3 dpi, percentages of CD3+, CD4+ and CD8+ T lymphocytes at 3 and 23 dpi, and serum IgM concentration and IBDV antibody titres at 23 dpi. These results indicate that dietary SI improved cellular and humoral immunity of IBDV-infected birds and may enhance resistance of Yellow-feathered broilers to infectious diseases.
Background: Localization of intramedullary spine tumors can be difficult. Various intraoperative aids have previously been described, but have limited use due to expense, complexity, and time. Intravenous fluorescein is an inexpensive and safe drug that may be useful in the localization of such tumors. We describe a technical description of the intra-operative use of fluorescein as an aid in the localization of a intramedullary spine tumour. Methods: In this technical report, the authors present a case example of a 56 year old man presenting with a intramedullary tumor at the level of C5/6. Intra-operatively intravenous Fluorescein was administered and the Pentero microscope BLUE™ 400 feature was used to accurately identify the lesion. Multiple biopsies of the fluorescent tissue were taken. Results: After 10 cardiac cycles the fluorescent coloring was isolated to what was thought to be the intramedullary lesion. Our myelotomy was made based on the uptake of this fluorescent coloring and multiple biopsies were taken. Final pathology confirmed this tissue was consistent with a high grade glioma. Conclusions: The use of intravenous fluorescein was a valuable aid in localizing the lesion and minimizing the size of our myelotomy. The use of intravenous fluorescein to localize high grade intramedullary spinal cord tumours appears to be safe, accurate, and inexpensive.
An updated compilation of published and new data of major-ion (Ca, Cl, K, Mg, Na, NO3, SO4) and methylsulfonate (MS) concentrations in snow from 520 Antarctic sites is provided by the national ITASE (International Trans-Antarctic Scientific Expedition) programmes of Australia, Brazil, China, Germany, Italy, Japan, Korea, New Zealand, Norway, the United Kingdom, the United States and the national Antarctic programme of Finland. The comparison shows that snow chemistry concentrations vary by up to four orders of magnitude across Antarctica and exhibit distinct geographical patterns. The Antarctic-wide comparison of glaciochemical records provides a unique opportunity to improve our understanding of the fundamental factors that ultimately control the chemistry of snow or ice samples. This paper aims to initiate data compilation and administration in order to provide a framework for facilitation of Antarctic-wide snow chemistry discussions across all ITASE nations and other contributing groups. The data are made available through the ITASE web page (http://www2.umaine.edu/itase/content/syngroups/snowchem.html) and will be updated with new data as they are provided. In addition, recommendations for future research efforts are summarized.
Objectives: Sleep quality affects memory and executive function in older adults, but little is known about its effects in midlife. If it affects cognition in midlife, it may be a modifiable factor for later-life functioning. Methods: We examined the association between sleep quality and cognition in 1220 middle-aged male twins (age 51–60 years) from the Vietnam Era Twin Study of Aging. We interviewed participants with the Pittsburgh Sleep Quality Index and tested them for episodic memory as well as executive functions of inhibitory and interference control, updating in working memory, and set shifting. Interference control was assessed during episodic memory, inhibitory control during working memory, and non-memory conditions and set shifting during working memory and non-memory conditions. Results: After adjusting for covariates and correcting for multiple comparisons, sleep quality was positively associated with updating in working memory, set shifting in the context of working memory, and better visual-spatial (but not verbal) episodic memory, and at trend level, with interference control in the context of episodic memory. Conclusions: Sleep quality was associated with visual-spatial recall and possible resistance to proactive/retroactive interference. It was also associated with updating in working memory and with set shifting, but only when working memory demands were relatively high. Thus, effects of sleep quality on midlife cognition appear to be at the intersection of executive function and memory processes. Subtle deficits in these age-susceptible cognitive functions may indicate increased risk for decline in cognitive abilities later in life that might be reduced by improved midlife sleep quality. (JINS, 2018, 24, 67–76)
Cultures obtained from pre-operative middle-ear swabs from patients with chronic otitis media have traditionally been used to guide antibiotic selection. This study investigated changes in the bacterial strains of the middle ear during chronic otitis media surgery.
Pre-operative bacterial cultures of otorrhoea, and peri-operative cultures of the granulation tissue in either the middle ear or mastoid cavity, were obtained. Post-operative cultures were selectively obtained when otorrhoea developed after surgery.
Bacterial growth was observed in 45.5 per cent of pre-operative cultures, 13.5 per cent of peri-operative cultures and 4.5 per cent of post-operative cultures. Methicillin-resistant Staphylococcus aureus was identified as the most common bacteria in all pre-operative (32.4 per cent), peri-operative (52.4 per cent) and post-operative (71.4 per cent) tests, and the percentage of Methicillin-resistant S aureus increased from the pre- to the post-operative period.
The bacterial culture results for post-operative otorrhoea showed low agreement with those for pre-operative or peri-operative culture, and strain re-identification was required.
Total-dissolvable iron has been measured in sections of three ice cores from Law Dome, East Antarctica, and the results used to calculate atmospheric iron deposition over this region during the late Holocene and to provide a preliminary estimate of aerosol iron deposition during the Last Glaciol Maximum I LGM). Ice-core sections dating from 56-2730 BP (late Holocene) and ~18000 BP (LGM) were decontaminated using trace-metal clean techniques, and total-dissolvable iron was determined in the acidified meltwatcrs by flow-injection analysis. Our results suggest that the atmospheric iron flux onto the Law Dome region has varied significantly over time-scales ranging from seasonal to Glaciol-interglaciol. The iron concentrations in ice-core sections from the past century suggest (1) a 2 4-fold variation in the atmospheric iron flux over a single annual cycle, with the highest flux occurring during the spring and summer, and (2) a nearly 7-fold variation in the annual maximum atmospheric iron flux over a 14 year period. The average estimated atmospheric iron flux calculated from our late-Holocene samples is 0.056-0.14 mg m a−1, which agrees well with Holocene flux estimates derived from aluminium measurements in inland Antarctic ice cores and a recent order-of-magnitude estimate of present-day atmospheric iron deposition over the Southern Ocean. The iron concentration of an ice-corc section dating from the LGM was more than 50 times higher than in the late-Holocene ice samples. Using a snow-accumulation rate estimate of 130 kg m −2 a−1 for this period, we calculate 0.87 mgm −2 a−1 as a preliminary estimate of atmospheric iron deposition during the LGM, which is 6-16 times greater than our average late-Holocene iron flux. Our data are consistent with the suggestion that there was a significantly greater flux of atmospheric iron onto the Southern Ocean during the LGM than during then Holocene.
Relativistic collisionless shock charged particle acceleration is considered as a possible origin of high-energy cosmic rays. However, it is hard to explore the nature of relativistic collisionless shock due to its low occurring frequency and remote detecting distance. Recently, there are some works attempt to solve this problem by generating relativistic collisionless shock in laboratory conditions. In laboratory, the scheme of generation of relativistic collisionless shock is that two electron–positron pair plasmas knock each other. However, in laboratory, the appropriate pair plasmas have been not generated. The 10 PW laser pulse maybe generates the pair plasmas that satisfy the formation condition of relativistic collisionless shock due to its ultrahigh intensity and energy. In this paper, we study the positron production by ultraintense laser high Z target interaction using numerical simulations, which consider quantum electrodynamics effect. The simulation results show that the forward positron beam up to 1013/kJ can be generated by 10 PW laser pulse interacting with lead target. The estimation of relativistic collisionless shock formation shows that the positron yield satisfies formation condition and the positron divergence needs to be controlled. Our results indicate that the generation of relativistic collisionless shock by 10 PW laser facilities in laboratory is possible.
The isotopic composition of Pb and the concentrations of Pb, Ba and Bi wert- measured in selected ice-core samples from Law Dome, East Antarctica, to a depth of 1196 m. The range of concentrat ions found in decontaminated ice was 0.03-1.5 pgg−1 for Pb, 0.9-6.1 pgg−1 for Ba and 0.4 17 fgg −1 for Bi, excluding the deepest sample which contained ~1 pjpm of rock dust. The abundances of all four stable lead isotopes were measured and gave 206Pb/207Pb ratios up to ~1.23. Avalue of 208Pb/207Pb= 2.78 was measured in the deepest sample and is consistent with reported Pb isotope ratios of Antarctic gran-ulites. Although the element concentrations in some samples were lower than have been reported elsewhere, geochemkal and isotopic evidence indicated that a number of samples were contaminated with Pb not present in the original ice. However, it appears that the technical skills now available are approaching the level where careful sample selection, decontamination and analysis can yield accurate results for the concentration and isotopic composition of Pb in Earth's purest naturally occurring ice.