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Depression is a common, serious, but under-recognised problem in multiple sclerosis (MS). The primary objective of this study was to assess whether a rapid visual analogue screening tool for depression could operate as a quick and reliable screening method for depression, in patients with MS.
Patients attending a regional MS outpatient clinic completed the Emotional Thermometer 7 tool (ET7), the Hospital Anxiety and Depression Scale – Depression Subscale (HADS-D) and the Major Depression Inventory (MDI) to establish a Diagnostic and Statistical Manual, 4th edition (DSM-IV) diagnosis of Major Depression. Full ET7, briefer subset ET4 version and depression and distress thermometers alone were compared with HADS-D and MDI. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and receiver operating characteristic (ROC) curve were calculated to compare the performance of all the screening tools.
In total, 190 patients were included. ET4 performed well as a ‘rule-out’ screening step (sensitivity 0.91, specificity 0.72, NPV 0.98, PPV 0.32). ET4 performance was comparable to HADS-D (sensitivity 0.96, specificity 0.77, NPV 0.99, PPV 0.37) without need for clinician scoring. The briefer ET4 performed as well as the full ET7.
ET are quick, sensitive and useful screening tools for depression in this MS population, to be complemented by further questioning or more detailed psychiatric assessment where indicated. Given that ET4 and ET7 perform equally well, we recommend the use of ET4 as it is briefer. It has the potential to be widely implemented across busy neurology clinics to assist in depression screening in this under diagnosed group.
Understanding the relative risks of maintenance treatment versus discontinuation of antipsychotics following remission in first episode psychosis (FEP) is an important area of practice.
A systematic review and meta-analysis. Prospective experimental studies including a parallel control group were identified to compare maintenance antipsychotic treatment with total discontinuation or medication discontinuation strategies following remission in FEP.
Seven studies were included. Relapse rates were higher in the discontinuation group (53%; 95% CIs: 39%, 68%; N = 290) compared with maintenance treatment group (19%; 95% CIs: 0.05%, 37%; N = 230). In subgroup analyses, risk difference of relapse was lower in studies with a longer follow-up period, a targeted discontinuation strategy, a higher relapse threshold, a larger sample size, and samples with patients excluded for drug or alcohol dependency. Insufficient studies included psychosocial functioning outcomes for a meta-analysis.
There is a higher risk of relapse for those who undergo total or targeted discontinuation strategies compared with maintenance antipsychotics in FEP samples. The effect size is moderate and the risk difference is lower in trials of targeted discontinuation strategies.
Declaration of interest
A.T. has received honoraria and support from Janssen-Cilag and Otsuka Pharmaceuticals for meetings and has been has been an investigator on unrestricted investigator-initiated trials funded by AstraZeneca and Janssen-Cilag. He has also previously held a Pfizer Neurosciences Research Grant. S.M. has received sponsorship from Otsuka and Lundbeck to attend an academic congress and owns shares in GlaxoSmithKline and AstraZeneca. J.H. has attended meetings supported by Sunovion Pharmaceuticals.
Many studies have identified changes in the brain associated with obsessive–compulsive disorder (OCD), but few have examined the relationship between genetic determinants of OCD and brain variation.
We present the first genome-wide investigation of overlapping genetic risk for OCD and genetic influences on subcortical brain structures.
Using single nucleotide polymorphism effect concordance analysis, we measured genetic overlap between the first genome-wide association study (GWAS) of OCD (1465 participants with OCD, 5557 controls) and recent GWASs of eight subcortical brain volumes (13 171 participants).
We found evidence of significant positive concordance between OCD risk variants and variants associated with greater nucleus accumbens and putamen volumes. When conditioning OCD risk variants on brain volume, variants influencing putamen, amygdala and thalamus volumes were associated with risk for OCD.
These results are consistent with current OCD neurocircuitry models. Further evidence will clarify the relationship between putamen volume and OCD risk, and the roles of the detected variants in this disorder.
Declaration of interest
The authors have declared that no competing interests exist.
Children with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.
Materials and methods
We sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.
A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.
The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.
Eight million American children under the age of 5 attend daycare and more than another 50 million American children are in school or daycare settings. Emergency planning requirements for daycare licensing vary by state. Expert opinions were used to create a disaster preparedness video designed for daycare providers to cover a broad spectrum of scenarios.
Various stakeholders (17) devised the outline for an educational pre-disaster video for child daycare providers using the Delphi technique. Fleiss κ values were obtained for consensus data. A 20-minute video was created, addressing the physical, psychological, and legal needs of children during and after a disaster. Viewers completed an anonymous survey to evaluate topic comprehension.
A consensus was attempted on all topics, ranging from elements for inclusion to presentation format. The Fleiss κ value of 0.07 was obtained. Fifty-seven of the total 168 video viewers completed the 10-question survey, with comprehension scores ranging from 72% to 100%.
Evaluation of caregivers that viewed our video supports understanding of video contents. Ultimately, the technique used to create and disseminate the resources may serve as a template for others providing pre-disaster planning education. (Disaster Med Public Health Preparedness. 2019;13:123–127)
Moraine dams can be inherently unstable, but effective assessment strategies remain poorly identified. We integrate electrical resistivity tomography (ERT) with electrical self-potential (SP) and lake-level measurements to investigate the structure of, and hydrological processes within, a moraine-dam complex adjacent to Miage glacier, Italy. This complex separates two meltwater lakes characterized by an efficient subterranean hydraulic connection. Our ERT data reveal a continuous free surface within the complex, whose morphology reflects the topography of the moraine complex akin to unconfined groundwater aquifers. SP data were corrected for spatial changes in the thickness of the upper unsaturated layer using principles of electrography. The residual streaming-potential map is consistent with Darcian flow of lake waters through the moraine complex, characterized by a negative-to-positive potential change from <-30 mV to >+70 mV. These electrical signatures are consistent with those generated by water seepage through earth dams in various non-glacial settings. Integrated electrical geophysical methods thus provided an inexpensive and unobtrusive evaluation of the hydrological properties of and processes within the moraine complex. Since spatio-temporal patterns of subsurface water flow critically affect the strengths of moraine sediments, such methods promise to be powerful in assessing the long-term stability of moraine-dammed glacial lakes.
The Coronal Solar Magnetism Observatory (CoSMO) is a proposed new facility led by the High Altitude Observatory and a consortium of partners to measure magnetic field and plasma properties in a large (one degree) field of view extending down to the inner parts of the solar corona. CoSMO is intended as a research facility that will advance the understanding and prediction of space weather. The instrumentation elements of CoSMO are: a white-light coronagraph (KCor), already operational at the Mauna Loa Solar Observatory (MLSO); the Chromosphere and Prominence Magnetometer (ChroMag), due for deployment to MLSO next year; and the CoSMO Large Coronagraph (LC) which has completed Preliminary Design Review.
The ablation areas of debris-covered glaciers typically consist of a complex mosaic of surface features with contrasting processes and rates of mass loss. This greatly complicates glacier response to climate change, and increases the uncertainty of predictive models. In this paper we present a series of high-resolution DEMs and repeat lake bathymetric surveys on Ngozumpa Glacier, Nepal, to study processes and patterns of mass loss on a Himalayan debris-covered glacier in unprecedented detail. Most mass loss occurs by melt below supraglacial debris, and melt and calving of ice cliffs (backwasting). Although ice cliffs cover only ~5% of the area of the lower tongue, they account for 40% of the ablation. The surface debris layer is subject to frequent re-distribution by slope processes, resulting in large spatial and temporal differences in debris-layer thickness, enhancing or inhibiting local ablation rates and encouraging continuous topographic inversion. A moraine-dammed lake on the lower glacier tongue (Spillway Lake) underwent a period of rapid expansion from 2001 to 2009, but later experienced a reduction of area and volume as a result of lake level lowering and sediment redistribution. Rapid lake growth will likely resume in the near future, and may eventually become up to 7 km long.
Compare the severity of illnesses associated with influenza and noninfluenza acute respiratory illness (ARI) in healthcare personnel (HCP).
Prospective observational cohort.
HCP at 2 healthcare organizations with direct patient contact were enrolled prior to the 2010–2011 influenza season.
HCP who were fewer than 8 days from the start of fever/feverishness/chills and cough were eligible for real-time reverse-transcription polymerase chain reaction influenza virus testing of respiratory specimen. Illness severity was assessed by the sum of self-rated severity (0, absent; 3, severe) of 12 illness symptoms, subjective health (0, best health; 9, worst health), activities of daily living impairment (0, able to perform; 9, unable to perform), missed work, and duration of illness.
Of 1,701 HCP enrolled, 267 were tested for influenza, and 58 (22%) of these tested positive. Influenza compared with noninfluenza illnesses was associated with higher summed 12-symptom severity score (mean [standard deviation], 17.9 [5.4] vs 14.6 [4.8]; P < .001), worse subjective health (4.5 [1.8] vs 4.0 [1.8]; P < .05), greater impairment of activities of daily living (4.9 [2.5] vs 3.8 [2.5]; P < .01), and more missed work (12.1 [10.5] vs 7.8 [10.5] hours; P < .01). Differences in symptom severity, activities of daily living, and missed work remained significant after adjusting for illness and participant characteristics.
Influenza had a greater negative impact on HCP than noninfluenza ARIs, indicated by higher symptom severity scores, less ability to perform activities of daily living, and more missed work. These results highlight the importance of efforts to prevent influenza infection in HCP.
The purpose of this study was to evaluate the impact of a dog safety program on the protective behaviour knowledge of children in the first year of school. This mixed methods study utilised pre- and post-testing (N = 121), observation of six sessions and individual interviews with a sub-group of children (N = 49). These interviews utilised a co-constructed narrative strategy where children were invited to assist an imaginary alien to safely navigate hypothetical safety scenarios. All schools improved their knowledge of safe dog interactions, with an overall increase in knowledge of 18%. Most children were able to apply abstract knowledge to hypothetical scenarios involving accompanied and unaccompanied dogs. Of concern, 24% of children still believed that dogs liked being patted on their heads and 16% of children had not overcome their intuitive reaction to run from a threatening dog. Whilst the program has made significant improvements to children's knowledge of safe dog-interactions, more gains can be made. We identify important opportunities for improving dog safety programs in general. We comment on the need to consider the impact of different models of child–dog relations in terms of either similitude or difference.