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Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.
To examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.
Genome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.
Earlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.
AAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.
Cardiac surgery for CHD was pioneered in Washington, DC by Charles Hufnagel and Edgar Davis working at Georgetown University and Children’s Hospital of the District of Columbia. Children’s Hospital, now Children’s National Hospital, had been established just 5 years after the end of the Civil War. In the 1950s, Davis and Hufnagel undertook many open-heart operations using the technique of surface cooling, hypothermia, and circulatory arrest. Hufnagel and Lewis Scott, who founded the cardiology department at Children’s, were trained in Boston by Gross and Nadas. Judson Randolph, also a trainee of Gross, introduced cardiac surgery using cardiopulmonary bypass and established the General Pediatric Surgery department at Children’s in the 1960s. The transition of hospital staffing from community-based private physicians to full-time hospital employees was often controversial but was complete by the turn of the millennium. The 21st century has seen continuing growth of the new Children’s National Heart Institute and consolidation of several congenital cardiac programmes in Washington, DC.
The concept of Design for Additive Manufacturing (DfAM) is gaining popularity along with AM, despite its scopes are not well established. In particular, in the last few years, DfAM methods have been intuitively subdivided into opportunistic and restrictive. This distinction is gaining traction despite a lack of formalization. In this context, the paper investigates experts' understanding of DfAM. In particular, the authors have targeted educators, as the perception of DfAM scopes in the future will likely depend on teachers' view. A bespoke survey has been launched, which has been answer by 100 worldwide-distributed respondents. The gathered data has undergone several analyses, markedly answers to open questions asking for individual definitions of DfAM, and evaluations of the pertinence of meanings and acceptations from the literature. The results show that the main DfAM aspects focused on by first standardization attempts have been targeted, especially products, processes, opportunities and constraints. Beyond opportunistic and restrictive nuances, DfAM different understandings are characterized by different extents of cognitive endeavor, convergence vs. divergence in the design process, theoretical vs. hands on approaches.
While childhood externalizing, internalizing and comorbid problems have been associated with suicidal risk, little is known about their specific associations with suicidal ideation and attempts. We examined associations between childhood externalizing, internalizing and comorbid problems and suicidal ideation (without attempts) and attempts by early adulthood, in males and females.
Participants were from the Quebec Longitudinal Study of Kindergarten Children, a population-based study of kindergarteners in Quebec from 1986 to 1988 and followed-up until 2005. We captured the co-development of teacher-rated externalizing and internalizing problems at age 6–12 using multitrajectories. Using the Diagnostic Interview Schedule administered at age 15 and 22, we identified individuals (1) who never experienced suicidal ideation/attempts, (2) experienced suicidal ideation but never attempted suicide and (3) attempted suicide.
The identified profiles were no/low problems (45%), externalizing (29%), internalizing (11%) and comorbid problems (13%). After adjusting for socioeconomic and familial characteristics, children with externalizing (OR 2.00, CI 1.39–2.88), internalizing (OR 2.34, CI 1.51–3.64) and comorbid (OR 3.29, CI 2.05–5.29) problems were at higher risk of attempting suicide (v. non-suicidal) by age 22 than those with low/no problems. Females with comorbid problems were at higher risk of attempting suicide than females with one problem. Childhood problems were not associated with suicidal ideation. Externalizing (OR 2.01, CI 1.29–3.12) and comorbid problems (OR 2.28, CI 1.29–4.03) distinguished individuals who attempted suicide from those who thought about suicide without attempting.
Childhood externalizing problems alone or combined with internalizing problems were associated with suicide attempts, but not ideation (without attempts), suggesting that these problems confer a specific risk for suicide attempts.
Procedure induced anxiety affects the majority of children undergoing medical intervention and has been directly linked to behaviour disturbances, psychological trauma, phobias and symptoms of PTSD. Despite this, there is currently no formal training relating to the management of procedure induced anxiety for medical personnel caring for children. A distillation of more than eighty years of research, this textbook examines the nature, prevalence and consequences of anxiety in children, alongside evidence-based strategies for its effective management. Designed as a training manual, it includes a comprehensive account of positive and negative aspects of behaviour that contribute to the successful management of anxious children. Chapters cover topics such as non-verbal and verbal communication, enhanced communication management strategies, support of children with autistic spectrum disorder, ADHD, learning difficulties, the use of premedication and the role that families play. Essential reading for anaesthetists and paediatricians and a valuable resource for any practitioner working with children.
Optimum care for anxious children mandates deployment of anxiety management strategies in advance of planned interventions. For this to be achieved, we must detect children who are more likely to experience anxiety by utilising an effective screening system. The advent of pre-assessment grants the perfect opportunity to implement such a system with a view to offering specialist psychological support and intervention to those who need it.
The hospital environment as a whole, or aspects of it, can trigger extreme anxiety in some children, particularly following repeated exposure associated with psychological trauma. Such a process represents negative conditioning and will require expert elective psychological support if the problem is to be resolved and positive reconditioning undertaken.
Verbal communication refers to all aspects of speech including linguistic and paralinguistic elements. Linguistic communication refers to the selection and integration of words into sentences and their literal or implied meaning. Paralinguistic communication encompasses all qualitative characteristics of speech. These qualitative elements often grant context and can exert a significant if not a dominant influence in dictating a recipient’s interpretation and response. Qualitative elements include the tone, volume, tonal quality and cadence of speech.
Non-verbal communication, often referred to as body language, refers to the myriad of cues and signals we send and receive each and every moment, every day of our lives. A three-month-old baby will reciprocate a smile as the process of communicating begins the moment we are born and our mastery of interpretation and composition grows exponentially over time. As such, we are all experts in communication. It is agreed that some of us are exquisitely sensitive, the majority are at very least aware and competent, while a minority, often due to specific impairments, can struggle. With this in mind, what follows in this section is an appraisal of non-verbal communication, the work that has been carried out to help us understand how we interact, and the signalling, interpretation and dynamic interaction that might help us in managing procedure-induced anxiety (PIA).
Some disorders of behaviour can impair a child’s sensitivity to, and interpretation of, others’ communication and behaviour. In addition, they may fail to appreciate and observe established socially acceptable patterns of interaction, struggle to effectively explain their own thoughts and feelings and at the same time, lack the capabilities that help most of us cope with adversity.
As has been defined in previous sections, the ability to manage PIA is dependent on coping strategies, the ability to deploy them and whether the situation is such that they are adequate or are overwhelmed.