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Sex-related differences in psychopathology are known phenomena, with externalizing and internalizing symptoms typically more common in boys and girls, respectively. However, the neural correlates of these sex-by-psychopathology interactions are underinvestigated, particularly in adolescence.
Participants were 14 years of age and part of the IMAGEN study, a large (N = 1526) community-based sample. To test for sex-by-psychopathology interactions in structural grey matter volume (GMV), we used whole-brain, voxel-wise neuroimaging analyses based on robust non-parametric methods. Psychopathological symptom data were derived from the Strengths and Difficulties Questionnaire (SDQ).
We found a sex-by-hyperactivity/inattention interaction in four brain clusters: right temporoparietal-opercular region (p < 0.01, Cohen's d = −0.24), bilateral anterior and mid-cingulum (p < 0.05, Cohen's d = −0.18), right cerebellum and fusiform (p < 0.05, Cohen's d = −0.20) and left frontal superior and middle gyri (p < 0.05, Cohen's d = −0.26). Higher symptoms of hyperactivity/inattention were associated with lower GMV in all four brain clusters in boys, and with higher GMV in the temporoparietal-opercular and cerebellar-fusiform clusters in girls.
Using a large, sex-balanced and community-based sample, our study lends support to the idea that externalizing symptoms of hyperactivity/inattention may be associated with different neural structures in male and female adolescents. The brain regions we report have been associated with a myriad of important cognitive functions, in particular, attention, cognitive and motor control, and timing, that are potentially relevant to understand the behavioural manifestations of hyperactive and inattentive symptoms. This study highlights the importance of considering sex in our efforts to uncover mechanisms underlying psychopathology during adolescence.
Introduction: Prehospital sepsis alerts assist paramedics in identifying patients with sepsis and in communicating this diagnosis to receiving facilities. Following the prospective implementation study of our regional systemic inflammatory response syndrome-based alert criteria (Alert), the purpose of this sub-study was to determine the cause of Alert false negatives (patients without an Alert that subsequently met sepsis criteria in the Emergency Department (ED)). Additionally, the sensitivity of the Alert for detecting sepsis was compared to the Quick Sequential Organ Failure Assessment (qSOFA) and Hamilton Early Warning Score (HEWS). Methods: This study was an additional analysis of the prospective Alert implementation study. Included patients were ≥ 18 years old, transported by a regional Emergency Medical Service and met severe sepsis or septic shock criteria (SS/SS, 2012 Surviving Sepsis Guidelines) in regional EDs in 2013. False negative patients were identified prospectively and reviewed by comparing paramedic determined Alert status to the retrospective application of the Alert criteria to Paramedic Call Report (PCR) data. The Alert sensitivity was first calculated from prospective data, then retrospective sensitivities of the Alert, qSOFA and HEWS were calculated by retrospectively applying these tools to PCRs, using ED diagnosis of SS/SS as reference standard. Results: In 2013, 229 patients met SS/SS criteria in the ED and had PCRs available; 115 (50.2%) were male and median age [interquartile range] was 76.0 [63.0-84.0]. Of 229, 149 (65.0%) arrived in the ED without an Alert (false negatives) and 46 (30.9%) of these met Alert criteria retrospectively and were therefore missed by paramedics. Sensitivity of the Alert was 34.9% when applied by paramedics and 41.5% when applied retrospectively to PCRs. The retrospective sensitivities of the qSOFA and HEWS were 37.6% and 67.7%, respectively. Conclusion: In ED patients diagnosed with SS/SS who arrived with no Alert, the majority (69.1%) were missed by the Alert criteria, rather than by paramedic application of the tool. The Alert had a sensitivity of 34.9%. When applied retrospectively and compared to the Alert, qSOFA had similar sensitivity and HEWS had increased sensitivity. Future research should focus on deriving improved alerts or implementing those with higher accuracy, such as HEWS.
Heart disease is the leading cause of death in schizophrenia. However, there has been little research directly examining cardiac function in schizophrenia.
To investigate cardiac structure and function in individuals with schizophrenia using cardiac magnetic resonance imaging (CMR) after excluding medical and metabolic comorbidity.
In total, 80 participants underwent CMR to determine biventricular volumes and function and measures of blood pressure, physical activity and glycated haemoglobin levels. Individuals with schizophrenia (‘patients’) and controls were matched for age, gender, ethnicity and body surface area.
Patients had significantly smaller indexed left ventricular (LV) end-diastolic volume (effect size d = −0.82, P = 0.001), LV end-systolic volume (d = −0.58, P = 0.02), LV stroke volume (d = −0.85, P = 0.001), right ventricular (RV) end-diastolic volume (d = −0.79, P = 0.002), RV end-systolic volume (d = −0.58, P = 0.02), and RV stroke volume (d = −0.87, P = 0.001) but unaltered ejection fractions relative to controls. LV concentricity (d = 0.73, P = 0.003) and septal thickness (d = 1.13, P < 0.001) were significantly larger in the patients. Mean concentricity in patients was above the reference range. The findings were largely unchanged after adjusting for smoking and/or exercise levels and were independent of medication dose and duration.
Individuals with schizophrenia show evidence of concentric cardiac remodelling compared with healthy controls of a similar age, gender, ethnicity, body surface area and blood pressure, and independent of smoking and activity levels. This could be contributing to the excess cardiovascular mortality observed in schizophrenia. Future studies should investigate the contribution of antipsychotic medication to these changes.
Maternal stress has been linked to low birth weight in newborns. One potential pathway involves epigenetic changes at candidate genes that may mediate the effects of prenatal maternal stress on birth weight. This relationship has been documented in stress-related genes, such as NR3C1. There is less literature exploring the effect of stress on growth-related genes. IGF1 and IGF2 have been implicated in fetal growth and development, though via different mechanisms as IGF2 is under imprinting control. In this study, we tested for associations between prenatal stress, methylation of IGF1 and IGF2, and birth weight. A total of 24 mother–newborn dyads in the Democratic Republic of Congo were enrolled. Ethnographic interviews were conducted with mothers at delivery to gather culturally relevant war-related and chronic stressors. DNA methylation data were generated from maternal venous, cord blood and placental tissue samples. Multivariate regressions were used to test for associations between stress measures, DNA methylation and birth weight in each of the three tissue types. We found an association between IGF2 methylation in maternal blood and birth weight. Previous literature on the relationship between IGF2 methylation and birth weight has focused on methylation at known differentially methylated regions in cord blood or placental samples. Our findings indicate there may be links between the maternal epigenome and low birth weight that rely on mechanisms outside known imprinting pathways. It thus may be important to consider the effect of maternal exposures and epigenetic profiles on birth weight even in the setting of maternally imprinted genes such as IGF2.
We assessed the appropriateness of initiating antibiotics in 49 nursing home (NH) residents receiving antibiotics for urinary tract infection (UTI) using 3 published algorithms. Overall, 16 residents (32%) received prophylaxis, and among the 33 receiving treatment, the percentage of appropriate use ranged from 15% to 45%. Opportunities exist for improving UTI antibiotic prescribing in NH.
To facilitate surveillance and describe the burden of healthcare-associated infection (HAI) in nursing homes (NHs), we compared the quality of resident-level data collected by NH personnel and external staff.
A 1-day point-prevalence survey
SETTING AND PARTICIPANTS
Overall, 9 nursing homes among 4 Centers for Disease Control and Prevention (CDC) Emerging Infection Program (EIP) sites were included in this study.
NH personnel collected data on resident characteristics, clinical risk factors for HAIs, and the presence of 3 HAI screening criteria on the day of the survey. Trained EIP surveillance officers collected the same data elements via retrospective medical chart review for comparison; surveillance officers also collected available data to identify HAIs (using revised McGeer definitions). Overall agreement was calculated among residents identified by both teams with selected risk factors and HAI screening criteria. The impact of using NH personnel to collect screening criteria on HAI prevalence was assessed.
The overall prevalence of clinical risk factors among the 1,272 residents was similar between NH personnel and surveillance officers, but the level of positive agreement (residents with factors identified by both teams) varied between 39% and 87%. Surveillance officers identified 253 residents (20%) with ≥1 HAI screening criterion, resulting in 67 residents with an HAI (5.3 per 100 residents). The NH personnel identified 152 (12%) residents with ≥1 HAI screening criterion; 42 residents had an HAI (3.5 per 100 residents).
We identified discrepancies in resident-level data collection between surveillance officers and NH personnel, resulting in varied estimates of the HAI prevalence. These findings have important implications for the design and implementation of future HAI prevalence surveys.
We have integrated the motion of the four Jovian planets on Myr timescales in fictitious solar systems in which the orbits differ from those of the real solar system. A change of ≲1% in the major axis of any one of the planets from its real value can lead to chaotic motion with a Lyapunov exponent larger than 10-5 yr−1. A survey of fifty solar systems with initial conditions chosen at random from a reasonable probability distribution shows the majority of them to be chaotic.
Drift mobilities, drift mobility-lifetime products and minority carrier diffusion lengths perpendicular to the planes of a-Si:H, F/a-Si0.35,Ge0.65:H, F superlattices have been measured over a range of well sublayer widths. The transport data suggest a transition from scattering dominated transport in states at the top of the barriers for short superlattice periods to recombination dominated transport at the bottom of the wells for large periods. The characteristic period for this transition is ˜3 nm.
Morning and evening plasma cortisol levels were checked in 123 consecutively newly admitted psychiatric patients with a variety of diagnoses. Questions asked were whether there were differences among groups with more severe illness, type of depression, alcohol abuse, or particular symptoms. Morning cortisol elevation was found in 33% of patients and was not associated with any particular diagnostic category. Evening cortisol elevation occurred in 85% of the subjects. It was significantly higher in those with unipolar depression and organic brain syndrome, also in those patients who abused alcohol regardless of diagnosis. Evening cortisol elevation was twice as common in patients with diagnoses of more severe psychiatric illness than in those with minor disorders. Further study is suggested to see if these patterns of cortisol elevation are sustained beyond the stress-of-admission period.
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