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Several questions still exist in the literature on the relationship between cumulative exposure to work-related incidents and posttraumatic stress disorder (PTSD) in First Responders (FR).
To address three unanswered questions in the field.
(1) Are different cumulative exposure scoring algorithms similarly related to PTSD?
(2) Is PTSD associated only with incidents rated as severe and traumatic?
(3) Can we identify cut-off scores of cumulative exposure that maximize sensitivity and specificity to predict PTSD?
To better characterize the relationship between cumulative exposure and PTSD in FR.
The association between exposure and PTSD was examined with logistic and linear regression and with receiver operating characteristic analysis in 349 FR.
(1) The strength of the association between PTSD and total cumulative exposure indexes varied across different scoring algorithms.
(2) Compared to total cumulative exposure indexes and to sub-scores of exposure to non-traumatic and/or less severe incidents, sub-scores indexing exposure to severe traumatic events only were more strongly and significantly associated with PTSD.
(3) The use of two cut-off scores maximizes sensitivity and specificity to predict PTSD.
(1) The relationship between current PTSD and cumulative exposure is partially dependent on the approach used to quantify exposure.
(2) Focusing on the assessment of cumulative exposure to severe traumatic events is sufficient to predict PTSD, and might be more useful and effective in research and clinical decision-making.
(3) Sensitivity and specificity of exposure scores might help improve secondary prevention (early detection and effective intervention) of individuals at risk.
Introduction: Low acuity patients have been controversially tagged as a source of emergency department (ED) misuse. Authorities for many Canadian health regions have set up policies so these patients preferably present to walk-in clinics (WIC). We compared the cost and quality of the care given to low acuity patients in an academic ED and a WIC of Québec City during fiscal year 2015-16. Methods: We conducted an ambidirectional (prospective and retrospective) cohort study using a time-driven activity-based costing method. This method uses duration of care processes (e.g., triage) to allocate to patient care all direct costs (e.g., personnel, consumables), overheads (e.g., building maintenance) and physician charges. We included consecutive adult patients, ambulatory at all time and discharged from the ED or WIC with a diagnosis of upper respiratory tract infection (URTI), urinary tract infection (UTI) or low back pain. Mean cost [95%CI] per patient per condition was compared between settings after risk-adjustment for age, sex, vital signs, number of regular medications and co-morbidities using generalized log-gamma regression models. Proportions [95%CI] of antibiotic prescription and chest X-Ray use in URTI, compliance with provincial guidelines on use of antibiotics in UTI, and column X-Ray use in low back pain were compared between settings using a Pearson Chi-Square test. Results: A total of 409 patients were included. ED and WIC groups were similar in terms of age, sex and vital signs on presentation, but ED patients had a greater burden of comorbidities. Adjusted mean cost (2016 CAN$) of care was significantly higher in the ED than in the WIC (p < 0.0001) for URTI (78.42[64.85-94.82] vs. 59.43[50.43-70.06]), UTI (78.88[69.53-89.48] vs. 53.29[43.68-65.03]), and low back pain (87.97[68.30-113.32] vs. 61.71[47.90-79.51]). For URTI, antibiotics were more frequently prescribed in the WIC (44.1%[34.3-54.3] vs. 5.8%[1.2-16.0]; p < 0.0001) and chest X-Rays, more frequently used in the ED (26.9%[15.6-41.0] vs. 13.7%[7.7-22.0]; p = 0.05). No significant differences were observed in the compliance with guidelines on use of antibiotics in UTI and in the use of column X-Ray in low back pain. Conclusion: Total cost of care for low acuity patients is lower in walk-in clinics than in EDs. However, our results suggest that quality-of-care issues should be considered in determining the best alternate setting for treating ambulatory emergency patients.
There has recently been an increased interest in mental health indicators for the monitoring of population wellbeing, which is among the targets of Sustainable Development Goals adopted by the United Nations. Levels of subjective wellbeing and suicide rates have been proposed as indicators of population mental health, but prior research is limited.
Data on individual happiness and life satisfaction were sourced from a population-based survey in Hong Kong (2011). Suicide data were extracted from Coroner's Court files (2005–2013). Area characteristic variables included local poverty rate and four factors derived from a factor analysis of 21 variables extracted from the 2011 census. The associations between mean happiness and life satisfaction scores and suicide rates were assessed using Pearson correlation coefficient at two area levels: 18 districts and 30 quantiles of large street blocks (LSBs; n = 1620). LSB is a small area unit with a higher level of within-unit homogeneity compared with districts. Partial correlations were used to control for area characteristics.
Happiness and life satisfaction demonstrated weak inverse associations with suicide rate at the district level (r = −0.32 and −0.36, respectively) but very strong associations at the LSB quantile level (r = −0.83 and −0.84, respectively). There were generally very weak or weak negative correlations across sex/age groups at the district level but generally moderate to strong correlations at the LSB quantile level. The associations were markedly attenuated or became null after controlling for area characteristics.
Subjective wellbeing is strongly associated with suicide at a small area level; socioeconomic factors can largely explain this association. Socioeconomic factors could play an important role in determining the wellbeing of the population, and this could inform policies aimed at enhancing population wellbeing.
Hand, foot and mouth disease (HFMD) is generally a benign febrile exanthematous childhood disease caused by human enteroviruses. The route of transmission is postulated to be faeco-oral in developing areas but attributed more to respiratory droplet in developed areas. Transmission is facilitated by the prolonged environmental survival of these viruses and their greater resistance to biocides. Serious outbreaks with neurological and cardiopulmonary complications caused by human enterovirus 71 (HEV-71) seem to be commoner in the Asian Pacific region than elsewhere in the world. This geographical predilection is unexplained but could be related to the frequency of intra- and inter-typic genetic recombinations of the virus, the host populations' genetic predisposition, environmental hygiene, and standard of healthcare. Vaccine development could be hampered by the general mildness of the illness and rapid genetic evolution of the virus. Antivirals are not readily available; the role of intravenous immunoglobulin in the treatment of serious complications should be investigated. Monitoring of this disease and its epidemiology in the densely populated Asia Pacific epicentre is important for the detection of emerging epidemics due to enteroviruses.
Infectious diseases establish in a population of wildlife hosts when the number of secondary infections is greater than or equal to one. To estimate whether establishment will occur requires extensive experience or a mathematical model of disease dynamics and estimates of the parameters of the disease model. The latter approach is explored here. Methods for estimating key model parameters, the transmission coefficient (β) and the basic reproductive rate (RDRS), are described using classical swine fever (hog cholera) in wild pigs as an example. The tentative results indicate that an acute infection of classical swine fever will establish in a small population of wild pigs. Data required for estimation of disease transmission rates are reviewed and sources of bias and alternative methods discussed. A comprehensive evaluation of the biases and efficiencies of the methods is needed.
Patients with major depressive disorder are found to show selective attention biases towards mood-congruent information. Although previous studies have identified various structural changes in the brains of these patients, it remains unclear whether the structural abnormalities are associated with these attention biases. In this study, we used voxel-based morphometry (VBM) to explore the structural correlates of attention biases towards depression-related stimuli.
Seventeen female patients with major depressive disorder and 17 female healthy controls, matched on age and intelligence, underwent magnetic resonance imaging (MRI). They also performed positive-priming (PP) and negative-priming (NP) tasks involving neutral and negative words that assessed selective attention biases. The reaction time (RT) to a target word that had been attended to or ignored in a preceding trial was measured on the PP and NP tasks respectively. The structural differences between the two groups were correlated with the indexes of attention biases towards the negative words.
The enhanced facilitation of attention to stimuli in the PP task by the negative valence was only found in the depressed patients, not in the healthy controls. Such attention biases towards negative stimuli were found to be associated with reduced gray-matter concentration (GMC) in the right superior frontal gyrus, the right anterior cingulate gyrus and the right fusiform gyrus. No differential effect in inhibition of attention towards negative stimuli in the NP task was found between the depressed patients and the healthy controls.
Specific structural abnormalities in depression are associated with their attention biases towards mood-congruent information.
Diffusion tensor imaging (DTI) can be used to investigate cerebral structural connectivity in never-medicated individuals with first-episode schizophrenia.
Subjects with first-episode schizophrenia according to DSM-IV-R who had never been exposed to antipsychotic medication (n=25) and healthy controls (n=26) were recruited. Groups were matched for age, gender, best parental socio-economic status and ethnicity. All subjects underwent DTI and structural magnetic resonance imaging (MRI) scans. Voxel-based analysis was performed to investigate brain regions where fractional anisotropy (FA) values differed significantly between groups. A confirmatory region-of-interest (ROI) analysis of FA scores was performed in which regions were placed blind to group membership.
In patients, FA values significantly lower than those in healthy controls were located in the left fronto-occipital fasciculus, left inferior longitudinal fasciculus, white matter adjacent to right precuneus, splenium of corpus callosum, right posterior limb of internal capsule, white matter adjacent to right substantia nigra, and left cerebral peduncle. ROI analysis of the corpus callosum confirmed that the patient group had significantly lower mean FA values than the controls in the splenium but not in the genu. The intra-class correlation coefficient (ICC) for independent ROI measurements was 0.90 (genu) and 0.90 (splenium). There were no regions where FA values were significantly higher in the patients than in the healthy controls.
Widespread structural dysconnectivity, including the subcortical region, is already present in neuroleptic-naive patients in their first episode of illness.
This study presents the mechanical and electrical properties (including elastic modulus, yield strength and electrical resistance) of PDMS/CNTs nanocomposites. The elastic modulus and yield strength were determined from tensile tests. In addition, a high resistance meter was used to measure the electrical resistances of the PDMS/CNTs nanocomposites. The test specimens of nanocomposites were manufactured using the thermoforming method. There were two recipes used during the thermoforming process: 100 °C for 1 hour, and 150 °C for 15 minutes. The mixtures of PDMS and CNTs were stirred by ultrasonic instrument to prevent polymerization. A feeler gap was used to define the thickness of the specimens. Therefore, the thickness could be controlled within the range of ∼100 μm. Four different kinds of specimens were investigated, including pure PDMS, 1.0 wt%, 2.0 wt% and 4.0 wt% CNTs polymeric composites. As for the l00°C recipe, the elastic modulus of pure PDMS, 1.0 wt%, 2.0 wt%, and 4.0 wt% CNTs were 1.05MPa, 1.17MPa, 1.10MPa and 1.35MPa, respectively. A for the l50°C recipe, the elastic modulus of pure PDMS, 1.0 wt%, 2.0 wt% and 4.0 wt% CNTs were 1.32MPa, 1.42MPa, 1.43MPa, and 1.54MPa. The differences of electrical resistance of PDMS/CNTs nanocomposites at two different conditions and the microstructures composed of the mixtures are also described in this article.
A white cast iron of composition Fe81C14Si5 can be cast into a nanostructure with network morphology by a fluxing technique. The conventional morphology of white cast iron, which is brittle, is eutectic. The mechanical behavior of network white cast iron is attractive. Hardness tests indicate that its average hardness value is ∼770 HV. The indentations made during hardness tests have no cracks. A stylus surface profiler was employed to study the surface profile at and near the indentations. The studies indicate that there are severe plastic flows, but without cracks.
We find evidence for dust in the intervening QSO absorbers from the spectra of QSOs in the Sloan Digital Sky Survey Data Release 1. No evidence is found for the 2175 Å feature which is present in the Milky Way dust extinction curve.
Charcoal-burning, a new suicide method, emerged in Hong Kong during the latest economic recession. With-in 2 months charcoal-burning had become the third most common suicide method.
To examine the characteristics of suicides by charcoal-burning, and to delineate the pathways linking macro-level economic and social changes with the subjective experiences of those surviving a charcoal-burning suicide attempt.
Both quantitative and qualitative methods were used. In the coroner's records study, the first 160 cases of suicide by charcoal-burning were compared with a control group. In the ethnographic enquiry, we interviewed 25 consecutive informants who had survived serious suicide attempt using charcoal-burning.
People who completed suicide by the charcoal-burning method were more likely to have been economically active and physically healthy, and were less likely to have had pre-existing mental illness. Charcoal-burning suicide was associated with overindebtedness. Media reports were pivotal in linking overindebtedness and financial troubles with charcoal-burning.
The political economy of suicide by charcoal-burning illustrated how historical, socio-economic and cultural forces shaped the lived experience that preceded suicide.
The ABO blood group is the most important blood group system in transfusion medicine. Since the ABO gene was cloned and the molecular basis of the three major alleles delineated about 10 years ago, the gene has increasingly been examined by a variety of DNA-based genotyping methods and analysed in detail by DNA sequencing. A few coherent observations emerge from these studies. First, there is extensive sequence heterogeneity underlying the major ABO alleles that produce normal blood groups A, B, AB and O when in correct combination with other alleles. Second, there is also extensive heterogeneity underlying the molecular basis of various alleles producing ABO subgroups such as A2, Ax and B3. There are over 70 ABO alleles reported to date and these alleles highlight the extensive sequence variation in the coding region of the gene. A unifying system of nomenclature is proposed to name these alleles. Third, extensive sequence variation is also found in the non-coding region of the gene, including variation in minisatellite repeats in the 5′ untranslated region (UTR), 21 single nucleotide polymorphisms (SNPs) in intron 6 and one SNP in the 3′ UTR. The haplotypes of these variations reveal a specific relationship with the major ABO alleles. Fourth, excluding the common alleles, about half of the remaining alleles are due to new mutations and the other half can better be explained by intragenic recombination (both crossover and gene conversion) between common alleles. In particular, the recombination sites in hybrid alleles can be quite precisely defined through haplotype analysis of the SNPs in intron 6. This indicates that recombination is equally as important as point mutations in generating the genetic diversity of the ABO locus. Finally, a large number of ABO genotyping methods are available and are based on restriction analysis, allele specific amplification, mutation screening techniques or their combinations.
We used spoligotyping to study 500 randomly selected pretreatment Mycobacterium tuberculosis (MTB) strains isolated in Hong Kong during the 2 year period 1998–9. It was found that amongst all MTB strains studied, the ‘Beijing’ genotype strains were highly prevalent in our geographic area, representing about 70% of the isolates. Unlike previous observations in Vietnam, no significant associations were found either between ‘Beijing’ genotype strains and all other anti-tuberculosis drug resistance phenotypes, or with particular patients' age groups, except for a weak association with isoniazid susceptibility. Eighteen of these strains exhibited spoligotype patterns that were similar but not identical to the ‘Beijing’ specific pattern. This is the first geographical area where genetic diversity among ‘Beijing’ genotype of MTB strains has been observed on this scale.
We have reconstructed the three-dimensional quaternary structure of the complete 480 kDa insulin receptor (IR), complexed with Nanogold - labeled insulin, and the 290 kDa Xanthine Dehydrogenase (XDH). Both molecules were imaged by low-dose, low-temperature dark field scanning transmission electron microscopy (STEM). XDH and IR were both freeze-plunged in liquid ethane, and transferred to the STEM (VG HB 601) where they were freeze dried at -130°C. Reconstruction was carried out using the method of quaternion-assisted angular reconstruction (IQAD) as described previously. XDH was further refined by an iterative process in which the IQAD produced volume was used as a reference for further refinements. Separate reconstructions of two sets of half the images indicated an inter-reconstruction resolution of 20 Å and 9 Å by phase residual criteria for the IR and XDH reconstructions, respectively.
For over 25 years a major effort in electron microscopy of macromolecules has been the determination of the three dimensional structure from the two-dimensional electron micrographs of such specimens. Great success has been realized when the macromolecule or complex takes the form of an array such as a 2D crystal (1,2), a helical structure (3,4) or one with icosahedral symmetry (5,6). However, for molecules which do not form such arrays, and in the limit only exist as single particles, a number of challenges have had to be addressed. No easy averaging of noisy low dose images is possible due to the lack of lateral and rotational symmetry. Random unknown orientations of the particles have to be determined, a process exacerbated by noise if low dose images are used as input. Alternatively, higher dose images result in radiation-induced structural alterations of the macromolecule.
Acute lung injury is defined as a syndrome of inflammation resulting in increased capillary-alveolar permeability that is associated with a constellation of clinical, radiological and physiological abnormalities. Adult respiratory distress syndrome (ARDS), relatively common in the intensive care, is a more specific, severe form of ALI, with diverse causes. Diffuse alveolar damage is the pathognomonic feature of the syndrome. Under the pathophysiologic conditions of increasing capillary membrane permeability, large macromolecules can gain access to the interstitium, resulting in pulmonary interstitial edema, and from there enter the alveolar space in severe cases. Detecting the distribution of macromolecules in lung tissue, therefore, constitutes evidence of the injury. Traditional pathologic examination of biopsy/autopsy materials is the only route to provide pathologic evidence of the capillary-alveolar membrane damage induced lung injury. Although morphometric analyses are more laborious, they provide qualitative assessment of morphological changes that is an important aspect of acute lung injury, see Fig.l.