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Accurate diagnosis of bipolar disorder (BPD) is difficult in clinical practice, with an average delay between symptom onset and diagnosis of about 7 years. A depressive episode often precedes the first manic episode, making it difficult to distinguish BPD from unipolar major depressive disorder (MDD).
Aims
We use genome-wide association analyses (GWAS) to identify differential genetic factors and to develop predictors based on polygenic risk scores (PRS) that may aid early differential diagnosis.
Method
Based on individual genotypes from case–control cohorts of BPD and MDD shared through the Psychiatric Genomics Consortium, we compile case–case–control cohorts, applying a careful quality control procedure. In a resulting cohort of 51 149 individuals (15 532 BPD patients, 12 920 MDD patients and 22 697 controls), we perform a variety of GWAS and PRS analyses.
Results
Although our GWAS is not well powered to identify genome-wide significant loci, we find significant chip heritability and demonstrate the ability of the resulting PRS to distinguish BPD from MDD, including BPD cases with depressive onset (BPD-D). We replicate our PRS findings in an independent Danish cohort (iPSYCH 2015, N = 25 966). We observe strong genetic correlation between our case–case GWAS and that of case–control BPD.
Conclusions
We find that MDD and BPD, including BPD-D are genetically distinct. Our findings support that controls, MDD and BPD patients primarily lie on a continuum of genetic risk. Future studies with larger and richer samples will likely yield a better understanding of these findings and enable the development of better genetic predictors distinguishing BPD and, importantly, BPD-D from MDD.
A 16-year-old male with newly diagnosed granulomatosis with polyangiitis presented to the emergency room with chest pain. He was found to have a myocardial infarction involving the right coronary artery and the left circumflex artery. He underwent mechanical thrombectomy and stent placement without significant sequelae. This is a rare complication associated with granulomatosis with polyangiitis.
Syncope is common among pediatric patients and is rarely pathologic. The mechanisms for symptoms during exercise are less well understood than the resting mechanisms. Additionally, inert gas rebreathing analysis, a non-invasive examination of haemodynamics including cardiac output, has not previously been studied in youth with neurocardiogenic syncope.
Methods:
This was a retrospective (2017–2023), single-center cohort study in pediatric patients ≤ 21 years with prior peri-exertional syncope evaluated with echocardiography and cardiopulmonary exercise testing with inert gas rebreathing analysis performed on the same day. Patients with and without symptoms during or immediately following exercise were noted.
Results:
Of the 101 patients (15.2 ± 2.3 years; 31% male), there were 22 patients with symptoms during exercise testing or recovery. Resting echocardiography stroke volume correlated with resting (r = 0.53, p < 0.0001) and peak stroke volume (r = 0.32, p = 0.009) by inert gas rebreathing and with peak oxygen pulse (r = 0.61, p < 0.0001). Patients with syncopal symptoms peri-exercise had lower left ventricular end-diastolic volume (Z-score –1.2 ± 1.3 vs. –0.36 ± 1.3, p = 0.01) and end-systolic volume (Z-score –1.0 ± 1.4 vs. −0.1 ± 1.1, p = 0.001) by echocardiography, lower percent predicted peak oxygen pulse during exercise (95.5 ± 14.0 vs. 104.6 ± 18.5%, p = 0.04), and slower post-exercise heart rate recovery (31.0 ± 12.7 vs. 37.8 ± 13.2 bpm, p = 0.03).
Discussion:
Among youth with a history of peri-exertional syncope, those who become syncopal with exercise testing have lower left ventricular volumes at rest, decreased peak oxygen pulse, and slower heart rate recovery after exercise than those who remain asymptomatic. Peak oxygen pulse and resting stroke volume on inert gas rebreathing are associated with stroke volume on echocardiogram.
Estimates of test size (probability of Type I error) were obtained for several specific repeated measures designs. Estimates were presented for configurations where the underlying covariance matrices exhibited varying degrees of heterogeneity. Conventional variance ratios were employed as basic statistics in order to produce estimates of size for a conventional test, an ∊-adjusted test, and ∊-adjusted test and a conservative test. Indices for empirical distributions of two estimators of ∊j, a measure of covariance heterogeneity, were also provided.
In the current paper, we review existing tools for solving variable selection problems in psychology. Modern regularization methods such as lasso regression have recently been introduced in the field and are incorporated into popular methodologies, such as network analysis. However, several recognized limitations of lasso regularization may limit its suitability for psychological research. In this paper, we compare the properties of lasso approaches used for variable selection to Bayesian variable selection approaches. In particular we highlight advantages of stochastic search variable selection (SSVS), that make it well suited for variable selection applications in psychology. We demonstrate these advantages and contrast SSVS with lasso type penalization in an application to predict depression symptoms in a large sample and an accompanying simulation study. We investigate the effects of sample size, effect size, and patterns of correlation among predictors on rates of correct and false inclusion and bias in the estimates. SSVS as investigated here is reasonably computationally efficient and powerful to detect moderate effects in small sample sizes (or small effects in moderate sample sizes), while protecting against false inclusion and without over-penalizing true effects. We recommend SSVS as a flexible framework that is well-suited for the field, discuss limitations, and suggest directions for future development.
To understand healthcare workers’ (HCWs) beliefs and practices toward blood culture (BCx) use.
Design:
Cross-sectional electronic survey and semi-structured interviews.
Setting:
Academic hospitals in the United States.
Participants:
HCWs involved in BCx ordering and collection in adult intensive care units (ICU) and wards.
Methods:
We administered an anonymous electronic survey to HCWs and conducted semi-structured interviews with unit staff and quality improvement (QI) leaders in these institutions to understand their perspectives regarding BCx stewardship between February and November 2023.
Results:
Of 314 HCWs who responded to the survey, most (67.4%) were physicians and were involved in BCx ordering (82.3%). Most survey respondents reported that clinicians had a low threshold to culture patients for fever (84.4%) and agreed they could safely reduce the number of BCx obtained in their units (65%). However, only half of them believed BCx was overused. Although most made BCx decisions as a team (74.1%), a minority reported these team discussions occurred daily (42.4%). A third of respondents reported not usually collecting the correct volume per BCx bottle, half were unaware of the improved sensitivity of 2 BCx sets, and most were unsure of the nationally recommended BCx contamination threshold (87.5%). Knowledge regarding the utility of BCx for common infections was limited.
Conclusions:
HCWs’ understanding of best collection practices and yield of BCx was limited.
Furrow-irrigated rice (Oryza sativa L.) hectares are increasing in the Midsouth. The lack of sustained flooding creates a favorable environment for weed emergence and persistence, which makes Palmer amaranth (Amaranthus palmeri S. Watson) difficult to control throughout the growing season. The negative yield impacts associated with season-long A. palmeri interference in corn, cotton, and soybean have been evaluated. However, there is limited knowledge of the weed’s ability to influence rice grain yield. Research was initiated in 2022 and 2023 to determine the effect of A. palmeri time of emergence relative to rice on weed seed production and grain yield. Cotyledon stage A. palmeri plants were marked every seven days, beginning one week before rice emergence through four weeks after rice emergence. Amaranthus palmeri seed production decreased exponentially as emergence timing was delayed relative to rice, and seed production increased by 447 seed plant-1 for every one-gram increase in weed biomass. Without rice competition and from the earliest emergence timing, A.palmeri produced 540,000 seeds plant-1. Amaranthus palmeri that emerged one week before the crop had the greatest spatial influence on rice, with grain yield loss of 5% and 50% at a distance of 1.4 m and 0.40 m from the weed, respectively. As A. palmeri emergence was delayed, the area of influence decreased. However, A. palmeri plants emerging 3.5 weeks after rice emergence still negatively affected grain yield and produce sufficient seed to replenish the soil seedbank, potentially impacting long-term crop management decisions. These results show that the time of A. palmeri emergence is a crucial factor influencing rice grain yield and weed seed production, which can be used to determine the consequences of escapes in rice.
Social impact has been widely discussed by the engineering community, but studies show that there is currently little systematic consideration of the social impact of products in both academia and in industry beyond social impacts on health and safety. While Failure Mode and Effect Analysis (FMEA) is useful for evaluating health and safety risks, new developments are needed to create an FMEA-style evaluation that can be applied to a wide range of social impacts for engineered products. The authors describe necessary modifications to traditional FMEA that transform it into a tool for social impact analysis. The modification of FMEA involves the introduction of positive and negative impacts, the inclusion of discrete and continuous impacts, the consideration of various stakeholder types, and the inclusion of uncertainty in place of detectability. This modified FMEA is referred to in this paper as Social Impact Effects Analysis (SIEA). The paper describes how SIEA is performed and articulates the potential benefits of SIEA.
We examine whether the “privileged coordinates” of a geometric space encode its “amount of structure.” In doing so, we compare this coordinate approach to comparing amounts of structure to the more familiar automorphism approach. We first show that on a natural understanding of the former, it faces one of the same well-known problems as the latter. We then capture a precise sense in which the two approaches are closely related to one another, and we conclude by discussing whether they might still prove useful in cases of philosophical interest, despite their shortcomings.
In this chapter we review the status of human–robot interaction (HRI) including current research directions within robotics that may impact issues of law, policy, and regulations. While the focus of this book is on HRI experienced in social contexts, to provide a broad review of the legal and policy issues impacted by HRI, we discuss different areas of robotics that require various levels of human interaction and supervisory control of robots. We note that robots have evolved from continuous human-controlled master–slave servomechanisms for handling nuclear waste to a broad range of robots incorporating artificial intelligence (AI), which are under human supervisory control but becoming more autonomous. Further, we note that research on human interaction with robots is a rapidly evolving field and specialized robots under human teleoperation have proven successful in hazardous environments and for medical and other applications. There is also a noticeable trend for more humanoid-appearing and AI-enabled robots interacting with humans in social contexts, and for this class of robots we discuss emerging issues of law, regulations, and policy.
In response to the COVID-19 pandemic, we rapidly implemented a plasma coordination center, within two months, to support transfusion for two outpatient randomized controlled trials. The center design was based on an investigational drug services model and a Food and Drug Administration-compliant database to manage blood product inventory and trial safety.
Methods:
A core investigational team adapted a cloud-based platform to randomize patient assignments and track inventory distribution of control plasma and high-titer COVID-19 convalescent plasma of different blood groups from 29 donor collection centers directly to blood banks serving 26 transfusion sites.
Results:
We performed 1,351 transfusions in 16 months. The transparency of the digital inventory at each site was critical to facilitate qualification, randomization, and overnight shipments of blood group-compatible plasma for transfusions into trial participants. While inventory challenges were heightened with COVID-19 convalescent plasma, the cloud-based system, and the flexible approach of the plasma coordination center staff across the blood bank network enabled decentralized procurement and distribution of investigational products to maintain inventory thresholds and overcome local supply chain restraints at the sites.
Conclusion:
The rapid creation of a plasma coordination center for outpatient transfusions is infrequent in the academic setting. Distributing more than 3,100 plasma units to blood banks charged with managing investigational inventory across the U.S. in a decentralized manner posed operational and regulatory challenges while providing opportunities for the plasma coordination center to contribute to research of global importance. This program can serve as a template in subsequent public health emergencies.
Ask most oncologists (especially radiation oncologists), and you may be hard pressed to find one who professes ignorance of Madame Curie and her historic contributions to medicine. Innumerable publications and media over the past century have correctly memorialised Madame Curie as one of the most brilliant minds in world history. However, do any of us really know the woman and the true extent of her sphere of influence? How, as well, does she fit into modern life and contemporary scientific advancement? Let us try to understand and learn from this complex scientist as more than just one of the most brilliant minds in human history.
Herbicides that persist in the forest litter and soil following their use for managing invasive plant species may negatively affect restoration efforts as well as minimize reinvasion via their residual phytotoxic activity. This study determined the impact of an herbicide mixture comprising triclopyr, dicamba, picloram, and aminopyralid (TDPA) for the control of dense infestations of a woody invader, Pinus contorta Douglas ex Loudon, on the germination of reinvading P. contorta and three New Zealand native species (Chionochloa rubra Zotov, Nothofagus cliffortiodes (Hook. f.) Oerst., and Leptospermum scoparium J.R. Forst. & G. Forst.) used in restoration. Given the essential role of ectomycorrhizal fungi in facilitating conifer reinvasion, the impact of residual herbicides present in mineral soil on the ectomycorrhizal infection of P. contorta seedling roots was also examined. Germination trials were conducted using intact forest litter–soil cores collected at 27, 112 and 480 d (after herbicide spraying) from sprayed and adjacent unsprayed dense P. contorta infestations. At the same time, mineral soil was also collected for the ectomycorrhizal infection study. Post-spray herbicide residue bound in the litter significantly decreased survival, germination rate, root and shoot growth, and also caused malformation of P. contorta seedlings. Similar results were recorded for native species’ germination; however, overall viability of native seed was poor, resulting in low germination rates. There was no difference in levels of ectomycorrhizal infection rates of P. contorta between treatments. Results indicate residual levels of TDPA herbicide in forest floor litter negatively affect P. contorta reinvasion, native recruitment, and active restoration management. Ectomycorrhizal fungi, however, are unaffected by this herbicide mixture and therefore remain a risk to facilitating reinvasion as residual herbicide declines.
The Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) Cross-Trial Statistics Group gathered lessons learned from statisticians responsible for the design and analysis of the 11 ACTIV therapeutic master protocols to inform contemporary trial design as well as preparation for a future pandemic. The ACTIV master protocols were designed to rapidly assess what treatments might save lives, keep people out of the hospital, and help them feel better faster. Study teams initially worked without knowledge of the natural history of disease and thus without key information for design decisions. Moreover, the science of platform trial design was in its infancy. Here, we discuss the statistical design choices made and the adaptations forced by the changing pandemic context. Lessons around critical aspects of trial design are summarized, and recommendations are made for the organization of master protocols in the future.
The clinical course of major depressive disorder (MDD) is heterogeneous, and early-onset MDD often has a more severe and complex clinical course. Our goal was to determine whether polygenic scores (PGSs) for psychiatric disorders are associated with treatment trajectories in early-onset MDD treated in secondary care.
Methods
Data were drawn from the iPSYCH2015 sample, which includes all individuals born in Denmark between 1981 and 2008 who were treated in secondary care for depression between 1995 and 2015. We selected unrelated individuals of European ancestry with an MDD diagnosis between ages 10–25 (N = 10577). Seven-year trajectories of hospital contacts for depression were modeled using Latent Class Growth Analysis. Associations between PGS for MDD, bipolar disorder, schizophrenia, ADHD, and anorexia and trajectories of MDD contacts were modeled using multinomial logistic regressions.
Results
We identified four trajectory patterns: brief contact (65%), prolonged initial contact (20%), later re-entry (8%), and persistent contact (7%). Relative to the brief contact trajectory, higher PGS for ADHD was associated with a decreased odds of membership in the prolonged initial contact (odds ratio = 1.06, 95% confidence interval = 1.01–1.11) and persistent contact (1.12, 1.03–1.21) trajectories, while PGS-AN was associated with increased odds of membership in the persistent contact trajectory (1.12, 1.03–1.21).
Conclusions
We found significant associations between polygenic liabilities for psychiatric disorders and treatment trajectories in patients with secondary-treated early-onset MDD. These findings help elucidate the relationship between a patient's genetics and their clinical course; however, the effect sizes are small and therefore unlikely to have predictive value in clinical settings.
Caribbean health research has overwhelmingly employed measures developed elsewhere and rarely includes evaluation of psychometric properties. Established measures are important for research and practice. Particularly, measures of stress and coping are needed. Stressors experienced by Caribbean people are multifactorial, as emerging climate threats interact with existing complex and vulnerable socioeconomic environments. In the early COVID-19 pandemic, our team developed an online survey to assess the well-being of health professions students across university campuses in four Caribbean countries. This survey included the Perceived Stress Scale, 10-item version (PSS-10) and the Brief Resilient Coping Scale (BRCS). The participants were 1,519 health professions students (1,144 females, 372 males). We evaluated the psychometric qualities of the measures, including internal consistency, concurrent validity by correlating both measures, and configural invariance using confirmatory factor analysis (CFA). Both scales had good internal consistency, with omega values of 0.91 for the PSS-10 and 0.81 for the BRCS. CFA suggested a two-factor structure of the PSS-10 and unidimensional structure of the BRCS. These findings support further use of these measures in Caribbean populations. However, the sampling strategy limits generalizability. Further research evaluating these and other measures in the Caribbean is desirable.
Tetralogy of Fallot patients face an elevated risk of developing chylothorax and pleural effusions post-surgery. This patient group exhibits risk factors known to compromise the lymphatic system, such as elevated central venous pressure, pulmonary flow changes, and hypoxia. This study investigates the morphology and function of the lymphatic system in tetralogy of Fallot patients through lymphatic magnetic resonance imaging and near-infrared fluorescence imaging, respectively.
Methods:
Post-repair tetralogy of Fallot patients aged 6–18 years were recruited, along with age and gender-matched controls. Magnetic resonance imaging was used to assess the morphology of the thoracic lymphatic vessels and the thoracic, while near-infrared fluorescence imaging was used to assess lymphatic activity utilising lymph rate, velocity, and pressure.
Results:
Nine patients and 10 controls were included. Echocardiography revealed that 2/3 of the patients had moderate-severe pulmonary regurgitation, while none displayed signs of elevated central venous pressure. Magnetic resonance imaging identified three patients with type 3 (out of 4 types) lymphatic abnormalities, while controls had none. The thoracic ducts showed severe (one patient) and moderate (one patient) tortuosity. Mean thoracic duct diameters were 3.3 mm ±1.1 in patients and 3.0 mm ± 0.8 in controls (p-value = 0.53). Near-infrared fluorescence imaging revealed no anomalous patterns.
Conclusion:
Despite no presence of clinical lymphatic disease, 3/9 of the repaired tetralogy of Fallot patients exhibited lymphatic morphological abnormalities. The significance of these anomalies remains uncertain currently. Further research is needed to determine whether these lymphatic alterations in this patient cohort are a result of congenital malformations, haemodynamic shifts, or prenatal and early-life saturation levels.