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The 14C peak in AD 775 (M12) has been measured and confirmed globally in several studies since it was first measured in annual tree rings by Miyake et al. (2012). However, M12 data measurements in early- and latewood are limited. This paper presents the Δ14C values in early- and latewood from AD 762–776 Zelkova serrata tree rings from Bangu-dong, Ulsan, South Korea (35°33′N, 129°20′E). The results indicate no early rise in Δ14C values in the latewood of AD 774 in this sample located at mid-latitude. A comparison of the results of this and previous studies suggests latitude dependence (Büntgen et al. 2018); that is, the early rise of Δ14C in AD 774 was not observed at mid-latitudes in South Korea but was observed at high latitudes in Finland. The half-oxidation time of 14C was estimated from a detailed analysis of a small bomb peak in AD 1962. Based on the half-oxidation time, the Δ14C rise in the latewood, but not in the earlywood, of AD 774 in Finland, and the absence of a Δ14C rise in both the early- and latewood of AD 774 in South Korea, the 14C spike was estimated to have been produced from late April to mid-June in AD 774.
Mental health disorders and their treatments produce significant costs and benefits in both healthcare and non-healthcare sectors. The latter are often referred to as intersectoral costs and benefits (ICBs). Little is known about healthcare-related ICBs in the criminal justice sector and how to include these in health economics research.
The triple aim of this study is (i) to identify healthcare-related ICBs in the criminal justice sector, (ii) to validate the list of healthcare-related ICBs in the criminal justice sector on a European level by sector-specific experts, and (iii) to classify the identified ICBs.
A scientific literature search in PubMed and an additional grey literature search, carried out in six European countries, were used to retrieve ICBs. In order to validate the international applicability of the ICBs, a survey was conducted with an international group of experts from the criminal justice sector. The list of criminal justice ICBs was categorized according to the PECUNIA conceptual framework.
The full-text analysis of forty-five peer-reviewed journal articles and eleven grey literature sources resulted in a draft list of items. Input from the expert survey resulted in a final list of fourteen unique criminal justice ICBs, categorized according to the care atom.
This study laid further foundations for the inclusion of important societal costs of mental health-related interventions within the criminal justice sector. More research is needed to facilitate the further and increased inclusion of ICBs in health economics research.
Patulous Eustachian tube appears to be caused by a concave defect in the anterolateral wall of the tubal valve of the Eustachian tube. This study aimed to compare the clinical features of patulous Eustachian tube patients with or without a defect in the anterolateral wall of the tubal valve.
Sixty-six patients with a patulous Eustachian tube completed a questionnaire, which was evaluated alongside endoscopic findings of the tympanic membrane, nasal cavity and Eustachian tube orifice.
Females were more frequently diagnosed with a patulous Eustachian tube, but the valve defect was more common in males (p = 0.007). The ratio of patulous Eustachian tube patients with or without defects in the anterolateral wall of the tubal valve was 1.6:1. Weight loss in the previous six months and being refractory to conservative management were significantly associated with the defect (p = 0.035 and 0.037, respectively). Symptom severity was significantly higher in patients with the defect.
Patulous Eustachian tube patients without a defect in the anterolateral wall of the tubal valve can be non-surgically treated more often than those with the defect. Identification of the defect could assist in making treatment decisions for patulous Eustachian tube patients.
Mental health problems can lead to costs and benefits in other sectors (e.g. in the education sector) in addition to the healthcare sector. These related costs and benefits are known as intersectoral costs and benefits (ICBs). Although some ICBs within the education sector have been identified previously, little is known about their extensiveness and transferability, which is crucial for their inclusion in health economics research.
The aim of this study was to identify ICBs in the education sector, to validate the list of ICBs in a broader European context, and to categorize the ICBs using mental health as a case study.
Previously identified ICBs in the education sector were used as a basis for this study. Additional ICBs were extracted from peer-reviewed literature in PubMed and grey literature from six European countries. A comprehensive list of unique items was developed based on the identified ICBs. The list was validated by surveying an international group of educational experts. The survey results were used to finalize the list, which was categorized according to the care atom.
Additional ICBs in the education sector were retrieved from ninety-six sources. Fourteen experts from six European countries assessed the list for completeness, clarity, and relevance. The final list contained twenty-four ICBs categorized into input, throughput, and output.
By providing a comprehensive list of ICBs in the education sector, this study laid further foundations for the inclusion of important societal costs in health economics research in the broader European context.
Life events and accompanying psychological and behavioral reactions frequently have an impact upon people's daily lives and are believed to predispose them to disease. Psychological stressors impact many physiological and pathological disease outcomes, including mental illness. Positive social interactions have in turn been shown to exert powerful beneficial effects on health outcomes and longevity.
The Objective of this study was to analyze the relationships of Psychological Distress, Social Support, and Mental Fitness among patients of mental health services.
This article aims to discuss the evidence supporting the mediating effect of social support between psychological stress and mental health.
This study was performed on patients who visited the mental health services in Daejeon from October to December 2011. In total, 395 patients were evaluated with Mental Fitness Scale, Kessler Psychological Distress Scale(KPDS), and Multidimensional Scale of Perceived Social Support(MSPSS).
Correlations among variables of psychological distress and social support on subordinate variable of mental fitness of patients were significant. The result of the regression analysis, psychological distress and social support have a positively significant influence on mental fitness of patients. social support showed mediating effects between psychological distress and mental fitness.
These results suggest that health care providers ought to seek social support for patients, in order to provide positive mental fitness of patients.
The defining features of Type D personality, that is, tendencies to experience negative emotions and inability to express emotions, are the known risk factors of somatization tendencies.
Many depressive patients express their mental distress through somatic symptoms. Therefore, it may be worthwhile to investigate the relationship between Type D personality and complaints of somatic symptoms in depressive patients.
The purpose of this study was to evaluate the relationship between type D personality and somatic symptom complaints in depressive patients.
Eighty-two individuals diagnosed with depressive disorder were included. Type D personality was measured with 14- item Type D personality Scale (DS14). Patient Health Questionnaire 9 and 15 were used to measure depression severity and somatization tendencies.
Two-thirds of the subjects were classified as Type D personality (63.4%). The mean PHQ-15 score of the Type D individuals was significantly higher than the remaining subjects (12.7 vs. 7.2, p=8.2E-6). The best regression model included age, PHQ-9 score and NA subscale score as predictor variables. Among these, only the coefficients of age (p=0.0015)and NA score (p=1.5E-7) was found to be statistically significant.
The result showed that Type D personality was one of the strong predictors of somatic complaints among depressive individuals. The finding that alexithymia was not shown to be a significant predictors also substantiated this discrepancy. However, it might be possible that the high correlation between NA and SI subscore (r=0.65) and between NA and TAS-20 score(r=0.44) hid the additional effects of social inhibition and alexithymia.
Both trauma-focused cognitive behaviour therapy and antidepressant medication are regarded as the first line treatments for post-traumatic stress disorder (PTSD). However, little is known about sequential or combined efficacy of these two different treatment options. This prospective study examined the add-on efficacy of eye movement desensitization and reprocessing (EMDR) therapy among adult civilians with PTSD who continued to be symptomatic after antidepressant treatment.
Adult patients with PTSD at a specialized trauma clinic who received treatment doses of antidepressants for more than 12 weeks were recruited; definition of symptomatic PTSD was a total score > 40 on the Clinician-administered PTSD Scale (CAPS). The CAPS and the global improvement from Clinical Global Impression (CGI) were rated prior to EMDR, after termination and six months follow-up.
A total of 15 patients underwent an average of six sessions of EMDR and 7 (47%) of 15 no longer met the criteria for PTSD and 10 (67%) were given status of very much or much improved. The CAPS scores and significantly decreased after EMDR therapy (paired t = 7.38, df = 14, P < 0.0001).
These results indicate that EMDR or trauma-focused CBT can be successfully added to those who failed to improve after initial pharmacotherapy for PTSD. Further studies are needed to explore the best sequence or components of therapies in the treatment of PTSD.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The international guideline for treating depression has been widely used.
The current study focused on the maintenance treatment section of the third revision of Korean Medication Algorithm for Depressive Disorder (KMAP-DD)
A 44-item questionnaire was used to obtain the consensus of experts regarding pharmacological treatment strategies for depressive disorder. Of the 144 committee members, 79 psychiatrists responded to the survey. Each treatment strategy or treatment option was evaluated with the nine-point scale.
Most clinicians answered to maintain both antidepressants (AD) and atypical antipsychotics (AAP) for psychotic depression in remission state. The duration of AD maintenance: from 19.8 weeks to 46.8 weeks for patients in remission of the first episode, from 34.8 weeks to 78.4 weeks for the second depressive episode, and long-term continuation for three or more depressive episodes. Aripiprazole was the most preferred AAP. The preferred doses of AD and AAP in maintenance treatment were about 75% and 50% of those in acute treatment The maintenance of AAP in the psychotic depression in remission was similar to the AD, although shorter and less.
The maintenance strategies of KMAP-DD 2017 were similar to those of KMAP-DD 2012. Most clinicians preferred to maintain AD for substantial duration after achieving remission. The maintenance of AAP was also preferred, but the duration was shorter than AD.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Infectious diseases, such as Helicobacter pylori, which produce systemic inflammation may be one key factor in the onset of autoimmunity. The association between H. pylori and antinuclear antibodies (ANA), a marker of autoimmunity, has been understudied. Data from the 1999–2000 National Health and Nutrition Examination Survey were used to evaluate the cross-sectional association between H. pylori seroprevalence and ANA positivity in US adults aged ≥20 years. ANA was measured in a 1:80 dilution of sera by indirect immunofluorescence using HEp-2 cells (positive ⩾3). H. pylori immunoglobulin G enzyme-linked immunosorbent assays were used to categorise individuals as seropositive or seronegative. H. pylori seropositivity and ANA positivity were common in the adult US population, with estimated prevalences of 33.3% and 9.9%, respectively. Both were associated with increasing age. H. pylori seropositivity was associated with higher odds of ANA (prevalence odds ratio = 1.89, 95% confidence interval = 1.08–3.33), adjusted for age, sex, race/ethnicity, educational attainment and body mass index. H. pylori infection may be one key factor in the loss of self-tolerance, contributing to immune dysfunction.
The esophagus is approximately 25 cm in length and begins at the level of the C6 vertebra. The external landmark is the cricoid cartilage. It terminates 2–3 cm below the diaphragmatic hiatus, which corresponds to the T11 vertebra.
The esophagus is divided into three parts: cervical, thoracic, and intra-abdominal. The cervical esophagus begins approximately 15 cm from the upper incisors and is approximately 6 cm long. The thoracic esophagus begins approximately 23 cm from the incisors and is approximately 15 cm in length. The intra-abdominal esophagus begins approximately 38 cm from the incisors at the diaphragmatic hiatus and extends for 2–3 cm distally before becoming the gastric cardia.
The thoracic esophagus rests on the thoracic spine and the longus colli muscles. It passes posterior to the trachea, the tracheal bifurcation, the left main stem bronchus, and the left atrium. It descends to the right of the thoracic aorta and moves anterior to the aorta, just above the diaphragm (Figures 18.1a and 18.1b).
The azygos vein lies in front of the bodies of the lower thoracic vertebrae and to the right of the esophagus. At the level of the bifurcation of the trachea, it arches anteriorly to drain into the superior vena cava, just before it enters the pericardium.
The hemiazygos vein passes from the left side of the spine to the right, after crossing the spine and travelling behind the aorta, esophagus, and thoracic duct, to drain into the azygos vein.
The thoracic duct lies between the esophagus, the aorta, and the azygos vein before crossing over, just below the level of the tracheal bifurcation, to the left hemithorax, where it drains into the left subclavian vein.
The esophagus does not have a serosal layer. This increases the risk of anastomotic leaks.
The arterial and venous blood supply and drainage of the esophagus are segmental. The cervical esophagus is supplied by branches of the inferior thyroid artery. The upper thoracic esophagus is supplied by the inferior thyroid artery and an anterior esophagotracheal branch directly from the aorta. The middle and lower esophagus receives its arterial supply directly from the aorta via a bronchoesophageal branch. The lower esophagus and intra-abdominal esophagus portions are supplied by small branches from the left gastric artery and the left inferior phrenic artery.
The parasympathetic innervation of the esophagus is through the vagal nerves. The right and left recurrent laryngeal nerves ascend in the tracheoesophageal groove, giving off branches to both the trachea and the cervical and upper esophagus. The vagal nerves join with the fibers of the sympathetic chain to form the esophageal plexus. Together with the esophagus, the vagi pass through the diaphragm and continue along the lesser curvature of the stomach.
The sympathetic innervation comes from the cervical and thoracic sympathetic chains.
Light Detection and Ranging (LiDAR) is a primary sensor for autonomous vehicles to recognize surroundings. It detects near-infrared (NIR) light pulses, typically at 905nm, which is emitted and reflected by surrounding objects. Here, the fact of the matter is that conventional black or dark-tone cars with extremely low NIR reflection are hard to be detected by LiDAR and endanger the future highway. In this work, we propose to use platelet-shaped effect pigments with visible absorption and NIR reflectivity. Copper(Ⅱ) oxide and Silicon dioxide multilayer are theoretically investigated with different numbers of layers and thicknesses. The optimized structures appear various dark-tone colors with high NIR-reflectivity over 90%.
The Single Ventricle Reconstruction Trial randomised neonates with hypoplastic left heart syndrome to a shunt strategy but otherwise retained standard of care. We aimed to describe centre-level practice variation at Fontan completion.
Centre-level data are reported as median or median frequency across all centres and range of medians or frequencies across centres. Classification and regression tree analysis assessed the association of centre-level factors with length of stay and percentage of patients with prolonged pleural effusion (>7 days).
The median Fontan age (14 centres, 320 patients) was 3.1 years (range from 1.7 to 3.9), and the weight-for-age z-score was −0.56 (−1.35 + 0.44). Extra-cardiac Fontans were performed in 79% (4–100%) of patients at the 13 centres performing this procedure; lateral tunnels were performed in 32% (3–100%) at the 11 centres performing it. Deep hypothermic circulatory arrest (nine centres) ranged from 6 to 100%. Major complications occurred in 17% (7–33%). The length of stay was 9.5 days (9–12); 15% (6–33%) had prolonged pleural effusion. Centres with fewer patients (<6%) with prolonged pleural effusion and fewer (<41%) complications had a shorter length of stay (<10 days; sensitivity 1.0; specificity 0.71; area under the curve 0.96). Avoiding deep hypothermic circulatory arrest and higher weight-for-age z-score were associated with a lower percentage of patients with prolonged effusions (<9.5%; sensitivity 1.0; specificity = 0.86; area under the curve 0.98).
Fontan perioperative practices varied widely among study centres. Strategies to decrease the duration of pleural effusion and minimise complications may decrease the length of stay. Further research regarding deep hypothermic circulatory arrest is needed to understand its association with prolonged pleural effusion.
On 24 May 1847, Sir John Franklin’s third expedition reported “All well”, but less than a year later, on 22 April 1848, the 129 sailors who had set out from Britain on Erebus and Terror had been reduced to 105 survivors departing their frozen ships in a desperate attempt to escape the Arctic. At least 24 were so unhealthy that they would perish after having travelled little more than 100 km from the ships. By contrast, the small mortality rates on other contemporary Arctic expeditions, some of which stayed in the Arctic considerably longer, were consistent with the mortality rates in the Royal Navy worldwide. This paper explores the question of what difference caused so many of Franklin’s crew to die during their final months on-board the ships and in the initial stages of the escape attempt. From the perspective of cultural ecology, the most significant difference, and the ultimate cause of the catastrophe as it unfolded, was wintering in the ice pack. This distinguished the Franklin expedition from all of the other comparable overwintering expeditions, and precluded the Erebus and Terror crews from hunting or fishing. That in turn led to nutritional deficiencies due to much greater reliance on stored provisions than other expeditions.
We construct links of arbitrarily many components each component of which is slice and yet are not concordant to any link with even one unknotted component. The only tool we use comes from the Alexander modules.
The COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) project is a large international collaborative effort to analyze individual-level phenotype data from twins in multiple cohorts from different environments. The main objective is to study factors that modify genetic and environmental variation of height, body mass index (BMI, kg/m2) and size at birth, and additionally to address other research questions such as long-term consequences of birth size. The project started in 2013 and is open to all twin projects in the world having height and weight measures on twins with information on zygosity. Thus far, 54 twin projects from 24 countries have provided individual-level data. The CODATwins database includes 489,981 twin individuals (228,635 complete twin pairs). Since many twin cohorts have collected longitudinal data, there is a total of 1,049,785 height and weight observations. For many cohorts, we also have information on birth weight and length, own smoking behavior and own or parental education. We found that the heritability estimates of height and BMI systematically changed from infancy to old age. Remarkably, only minor differences in the heritability estimates were found across cultural–geographic regions, measurement time and birth cohort for height and BMI. In addition to genetic epidemiological studies, we looked at associations of height and BMI with education, birth weight and smoking status. Within-family analyses examined differences within same-sex and opposite-sex dizygotic twins in birth size and later development. The CODATwins project demonstrates the feasibility and value of international collaboration to address gene-by-exposure interactions that require large sample sizes and address the effects of different exposures across time, geographical regions and socioeconomic status.
Introduction: Geriatric patients commonly present to the emergency department (ED) after a fall. Unfortunately, recent evidence suggests that ED physicians are poorly adherent to published ED-specific geriatric falls guidelines. This study applied a theoretical domains framework (TDF)-driven approach to systematically investigate barriers and enablers in the provision of guideline-based care to older patients presenting to the ED with a fall. Methods: From June to September 2017, semi-structured interviews of staff ED physicians practicing in Ontario, Canada were conducted and analyzed. An interview guide based on the TDF was used to capture 14 domains that may influence provision of guideline-based care. Interview transcripts were analyzed, and specific beliefs were generated by grouping similar responses. Relevant domains were identified based on frequencies of beliefs, existence of conflicting beliefs, and evidence of strong beliefs that would influence provision of guideline-based care. Results: Eleven interviews were conducted with practicing ED physicians. Thirty specific belief statements across 13 different TDF domains (all except Optimism) were identified as relevant. Overall, Ontario ED physicians are supportive of providing guideline-based care and believe it would lead to better outcomes for geriatric falls patients. Important barriers include knowledge, skills, time and workload constraints, and inconsistent allied health support. Conclusion: This study identified important barriers and enablers to provision of guideline-based care in geriatric ED falls patients. These results will help guide implementation of guidelines nationally and internationally, with a focus on improved knowledge dissemination, implementation of training interventions, and improvements in allied health coverage and supports.