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Childhood maltreatment (CM) plays an important role in the development of major depressive disorder (MDD). The aim of this study was to examine whether CM severity and type are associated with MDD-related brain alterations, and how they interact with sex and age.
Within the ENIGMA-MDD network, severity and subtypes of CM using the Childhood Trauma Questionnaire were assessed and structural magnetic resonance imaging data from patients with MDD and healthy controls were analyzed in a mega-analysis comprising a total of 3872 participants aged between 13 and 89 years. Cortical thickness and surface area were extracted at each site using FreeSurfer.
CM severity was associated with reduced cortical thickness in the banks of the superior temporal sulcus and supramarginal gyrus as well as with reduced surface area of the middle temporal lobe. Participants reporting both childhood neglect and abuse had a lower cortical thickness in the inferior parietal lobe, middle temporal lobe, and precuneus compared to participants not exposed to CM. In males only, regardless of diagnosis, CM severity was associated with higher cortical thickness of the rostral anterior cingulate cortex. Finally, a significant interaction between CM and age in predicting thickness was seen across several prefrontal, temporal, and temporo-parietal regions.
Severity and type of CM may impact cortical thickness and surface area. Importantly, CM may influence age-dependent brain maturation, particularly in regions related to the default mode network, perception, and theory of mind.
OBJECTIVES/SPECIFIC AIMS: Reducing radiologic exams has been a focus of cost reduction in healthcare systems. The utility and justification of obtaining cross-sectional imaging (PPCSI) before surgical intervention continues to be evaluated. For peripheral artery disease (PAD) consensus guidelines regarding PPCSI do not exist and may be influenced by patient complexity, variation of disease presentation, and physician preference. The objective of this study was to determine the utility of PPCSI before percutaneous PAD intervention. METHODS/STUDY POPULATION: Patients receiving first-time endovascular revascularization procedure for PAD from 2013 to 2015 were evaluated for PPCSI done within 180 days prior to revascularization. Patient and physician demographics, perioperative characteristics, and disease distribution/severity were evaluated. The primary outcome was technical success defined as improving inflow and/or revascularization of the target outflow vessels to <50% stenosis. RESULTS/ANTICIPATED RESULTS: Of the 348 patients who underwent an attempted revascularization procedure 159 (45.7%) patients underwent PPCSI, including 151 CTA and 8 MRA. Of these, 48% were ordered by the referring provider (84% at an outside institution), and 52% were ordered by the treating physician. PPCSI was performed a median of 26 days (IQR 9-53) prior to procedure. Individual vascular surgeon practice identified PPCSI rates ranging from 31% to 70%. On multivariate analysis chronic kidney disease (OR=0.35; CI 0.17–0.73) had the strongest effect against of PPCSI, and Inpatient/ED evaluation (OR=3.20; CI 1.58–6.50), aorto-iliac (OR=2.78; CI 1.46–5.29) and femoral-popliteal occlusions (OR=2.51; CI 1.38–4.55) most strongly predicted PPCSI. After excluding 31 diagnostic procedures, technical success did not differ between endovascular procedures with PPSCI (91.3%) or without PPCSI (85.6%), p=0.11. When analyzing 89 femoral-popliteal occlusions, technical success was higher with PPCSI (88%) compared to procedures without PPSCI (69%), p=0.026. DISCUSSION/SIGNIFICANCE OF IMPACT: PPCSI use is influenced by inpatient status, chronic kidney disease, and anatomic consideration. PPCSI was not associated with overall technical success although it appeared beneficial for femoral-popliteal occlusions. Routine practices of ordering of PPCSI may not be warranted when considering technical success but may be important in treatment planning. Further studies are warranted to determine if radiation, cost, and contrast load justify PPCSI.
Introduction: Patients with Heart failure (HF) experience frequent decompensation necessitating multiple emergency department (ED) visits and hospitalizations. If patients are able to receive timely interventions and optimize self-management, recurrent ED visits may be reduced. In this feasibility study, we piloted the application of home telemonitoring to support the discharge of HF patients from hospital to home. We hypothesized that TEC4Home would decrease ED revisits and hospital admissions and improve patient health outcomes. Methods: Upon discharge from the ED or hospital, patients with HF received a blood pressure cuff, weight scale, pulse oximeter, and a touchscreen tablet. Participants submitted measurements and answered questions on the tablet about their HF symptoms daily for 60 days. Data were reviewed by a monitoring nurse. From November 2016 to July 2017, 69 participants were recruited from Vancouver General Hospital (VGH), St. Pauls Hospital (SPH) and Kelowna General Hospital (KGH). Participants completed pre-surveys at enrollement and post-surveys 30 days after monitoring finished. Administrative data related to ED visits and hospital admissions were reviewed. Interviews were conducted with the monitoring nurses to assess the impact of monitoring on patient health outcomes. Results: A preliminary analysis was conducted on a subsample of participants (n=22) enrolled across all 3 sites by March 31, 2017. At VGH and SPH (n=14), 25% fewer patients required an ED visit in the post-survey reporting compared to pre-survey. During the monitoring period, the monitoring nurse observed seven likely avoided ED admissions due to early intervention. In total, admissions were reduced by 20% and total hospital length of stay reduced by 69%. At KGH (n=8), 43% fewer patients required an ED visit in the post-survey reporting compared to the pre-survey. Hospital admissions were reduced by 20% and total hospital length of stay reduced by 50%. Overall, TEC4Home participants from all sites showed a significant improvement in health-related quality of life and in self-care behaviour pre- to 90 days post-monitoring. A full analysis of the 69 patients will be complete in February 2018. Conclusion: Preliminary findings indicate that home telemonitoring for HF patients can decrease ED revisits and improve patient experience. The length of stay data may also suggest the potential for early discharge of ED patients with home telemonitoring to avoid or reduce hospitalization. A stepped-wedge randomized controlled trial of TEC4Home in 22 BC communities will be conducted in 2018 to generate evidence and scale up the service in urban, regional and rural communities. This work is submitted on behalf of the TEC4Home Healthcare Innovation Community.
The young stellar object SVS 13 has been proposed as the powering source of the HH 7-11 objects. Recent observations have revealed that in the radio continuum (3.6-cm) the source is a binary separated by about 0.3 in the east-west direction. We present Very Large Array observations, made in the highest angular resolution A configuration, of H2O maser emission toward this source. Our data show that the H2O spots appear to be segregated in two velocity groups: a group with radial velocity similar to that of the ambient cloud (VLSR ⋍ 8 km s−1) that is associated with the western radio source, and a blueshifted (by ∼20 km s−1) velocity group that is associated with the eastern radio source. We discuss the possible implications of this observation.
We report the temperature dependence of Er optical centers in GaN epilayers prepared by metal-organic chemical vapor deposition under the resonant excitation (4I15/2 → 4I9/2) excitation using a Ti:Sapphire laser (λexc = 809 nm). High resolution infrared spectroscopy and temperature dependence measurements of photoluminescence intensity from Er ions in GaN have been performed to identify the crystal filed splitting of the first excited state, 4I13/2. Here, we have employed a simple approach to determine activation energies which are related to the thermal population of electrons from the lowest level to the higher level of the crystal field splitting of the first excited state.
Experiments on the National Ignition Facility show that multi-dimensional effects currently dominate the implosion performance. Low mode implosion symmetry and hydrodynamic instabilities seeded by capsule mounting features appear to be two key limiting factors for implosion performance. One reason these factors have a large impact on the performance of inertial confinement fusion implosions is the high convergence required to achieve high fusion gains. To tackle these problems, a predictable implosion platform is needed meaning experiments must trade-off high gain for performance. LANL has adopted three main approaches to develop a one-dimensional (1D) implosion platform where 1D means measured yield over the 1D clean calculation. A high adiabat, low convergence platform is being developed using beryllium capsules enabling larger case-to-capsule ratios to improve symmetry. The second approach is liquid fuel layers using wetted foam targets. With liquid fuel layers, the implosion convergence can be controlled via the initial vapor pressure set by the target fielding temperature. The last method is double shell targets. For double shells, the smaller inner shell houses the DT fuel and the convergence of this cavity is relatively small compared to hot spot ignition. However, double shell targets have a different set of trade-off versus advantages. Details for each of these approaches are described.
VLA observations in the (J, K)=(3,3) line of ammonia reveal new structures in the Galactic center region. An approximate ring of emission is centered on the central ionized streamers. This ring, seen previously in millimeter-wave interferometer maps, is very clumpy in the ammonia emission, with size scales ≲10″ (0.4 pc). The clumps show good spatial and velocity agreement with the ionized gas, and are warm with brightness temperatures exceeding 30 K. A comparison of the (3,3) to (1,1) ratio indicates considerably higher gas temperatures. This circumnuclear ring may not be the dominant feature in the mass distribution of the circumnuclear gas. A streamer, immediately to the south of the Galactic center, connects the gas complex at lII= −4′ (~10 pc) directly to the Galactic center. This streamer may define the path for gas flow into the nuclear region.
A 3′ × 6′ field centered ~4′ south of the Galactic center and a ~2′ × 4′ field east of the Galactic center have been mapped using the 4–1 → 30 E line (36.169 GHz) of methanol (CH3OH). Line profiles typically consist of broad (~10–20 km s−1) components, as well as narrow (~1 km s−1), spike-like components. The narrow features are bright and unresolved with 60″ resolution, and are probably due to maser activity. We found maser activity immediately adjacent to the non-thermal “wisp” (SgrA-E) ~4′ south of SgrA-West, the secondary knot at SgrA-F, and the eastern edge of SgrA-East. Position-velocity diagrams suggest that the molecular material has been shocked to a higher velocity in the same vicinities. We propose that the maser activity, and the shift in velocity south of the Galactic center, heretofore interpreted as an increasingly steep velocity gradient toward the Galactic center, may be due to the impact of a SNR and the resulting shock of the ambient molecular material. The dynamical effects on the molecular gas of such a shock may have implications on gas feeding toward the nucleus.
We report VLA observations of H76α emission from the H II region in M–0.13–0.08, the Sgr A “15 km s−1 cloud.” The line to continuum flux ratio implies an electron temperature Te ~ 7500 K, slightly lower than measurements of Te in Sgr B2. The deduced number of early stars and the infrared luminosity are consistent with a normal IMF in this cloud.
The inner few hundred parsecs of the Milky Way, the Central Molecular Zone (CMZ), is our closest laboratory for understanding star formation in the extreme environments (hot, dense, turbulent gas) that once dominated the universe. We present an update on the first large-area survey to expose the sites of star formation across the CMZ at high-resolution in submillimeter wavelengths: the CMZoom survey with the Submillimeter Array (SMA). We identify the locations of dense cores and search for signatures of embedded star formation. CMZoom is a three-year survey in its final year and is mapping out the highest column density regions of the CMZ in dust continuum and a variety of spectral lines around 1.3 mm. CMZoom combines SMA compact and subcompact configurations with single-dish data from BGPS and the APEX telescope, achieving an angular resolution of about 4″ (0.2 pc) and good image fidelity up to large spatial scales.
With the VLA in the D configuration we have mapped the (J,K) = (1,1) and (2,2) NH3 lines toward a molecular cloud core in NGC 2024. This region, which contains one of the most highly collimated molecular outflows (Richer et al. 1992), has been studied extensively using a variety of techniques, including dust continuum in the far-infrared (FIR) wavelengths (Mezger et al. 1988, 1992), and molecular lines (see Barnes & Crutcher 1992 and references therein). We find that the molecular condensations associated with FIR 5, 6, and 7 (Mezger et al. 1988, 1992) have kinetic temperatures TK ≃ 40 K. We also find a perturbation of the molecular gas near FIR 6 and FIR 7 in terms of broadening of the ammonia lines. These results suggest that these condensations may not be protostars heated by gravitational energy released during collapse, but that they have an internal heating source. A flattened structure of ammonia emission is found extending parallel to the unipolar CO outflow structure, but displaced systematically to the east. The location of the high velocity outflow along the surface of the NH3 structure suggests that a wind is sweeping material from the surface of this elongated cloud core. Figure 1 is an overlay of the VLA ammonia emission (dotted area) on top of the C18O emission (thick contours) and the CO outflow (thin contours).
Clumps and filamentary structures have previously been observed in the extended molecular ridge of OMC-1 (see below). The region is affected by multiple outflow components, shock emission that extends 0.5 pc from the BN/KL core, and a foreground HII region expanding into the cloud. The region also displays a complex kinematical character, with a large scale shift in radial velocity along the ridge, multiple cloud velocity components (Womack et al. 1993), and fast gradients across constituent cores (Harris et al. 1983, Wiseman and Ho 1993).
To clarify the structure and kinematics of the region, we have used the VLA to observe with high (0.3 km s−1) velocity resolution and high (8”) angular resolution the NH3 (1,1) and (2,2) rotation-inversion lines over 20 adjacent fields covering a 3’ by 8’ region encompassing the KL region.
During the early stage of an epidemic, timely and reliable estimation of the severity of infections are important for predicting the impact that the influenza viruses will have in the population. We obtained age-specific deaths and hospitalizations for patients with laboratory-confirmed H1N1pdm09 infections from June 2009 to December 2009 in Hong Kong. We retrospectively obtained the real-time estimates of the hospitalization fatality risk (HFR), using crude estimation or allowing for right-censoring for final status in some patients. Models accounting for right-censoring performed better than models without adjustments. The risk of deaths in hospitalized patients with confirmed H1N1pdm09 increased with age. Reliable estimates of the HFR could be obtained before the peak of the first wave of H1N1pdm09 in young and middle-aged adults but after the peak in the elderly. In the next influenza pandemic, timely estimation of the HFR will contribute to risk assessment and disease control.
Our previous observations established the small angular size and high brightness temperature of emission from the v=1, J=1-0 transition of SiO from the circumstellar envelopes of the supergiant VX Sgr and the Mira variable R Cas. We performed a second VLBI experiment on the SiO masers in several late type stars on 31 Oct.-2 Nov. 1978 to compare the physical characteristics of the SiO masers in the v=1 and v=2 states. With an energy separation of 1258 cm-1 (an equivalent temperature of 1753 K) between the two vibrational states, differences in excitation and pumping of the maser states may lead to different maser properties.
Transparent films of platinum nanoparticles on graphene nanohybrids were synthesized in a two-step process. Reduction of homogeneously dispersed Pt precursor and graphene in water and solution coating/annealing afforded thin films with high catalytic performance as counter electrodes in dye-sensitized solar cells (DSSC). The requisite dispersant consisting of poly(oxyethylene)-(POE) segments and cyclic imide functionalities allowed the in-situ reduction of dihydrogen hexachloroplatinate by ethanol and the formation of nanohybrids of graphene-supported Pt nanoparticles at 4.0 nm diameter. Characterizations of polymeric dispersants by Fourier-transform infrared spectroscopy, thermogravimetric analysis, and nanohybrids by transmission electron microscope were performed. After screening various compositions of Pt/graphene, the nanohybrid film at the specific ratio of 5/1 by weight was fabricated into a counter electrode (CE) for DSSC by the solution casting method. The evaluation of cell performance demonstrated the most improved power conversion efficiency of 8.00%. This is significant achievement in comparison with 7.14% for the DSSC with the conventional platinum sputtered CE. Furthermore, the solution casting method allows the preparation of transparent CE films that are suitable for using as rear-illuminated DSSC. The approach was proven to be feasible by measuring the cell efficiency under rear light illumination. The power efficiency up to 7.01%, comparable to 8.00% by a normally front illumination, has been accomplished. In contrast, the rear illumination at merely 2.36% efficiency was obtained for the DSSC with sputtered platinum CE. Analyses of cyclic voltammetry, electrochemical impedance spectra were well correlated to the high efficiency of the performance caused by this nanohybrid film.
A retrospective case–case control study was conducted, including 60 cases with daptomycin-nonsusceptible vancomycin-resistant enterococci (DNS-VRE) matched to cases with daptomycin-susceptible VRE and to uninfected controls (1:1:3 ratio). Immunosuppression, presence of comorbid conditions, and prior exposure to antimicrobials were independent predictors of DNS-VRE, although prior daptomycin exposure occurred rarely. In summary, a case–case control study identified independent risk factors for the isolation of DNS-VRE: immunosuppression, multiple comorbid conditions, and prior exposures to cephalosporines and metronidazole.