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Manen et al. provide here a reply to the critical comment published by A. J. Ammerman regarding their article “The Neolithic Transition in the Western Mediterranean: a complex and non-linear diffusion process—the radiocarbon record revisited,” published in 2019 in Radiocarbon. They also use this occasion to reaffirm the need to elaborate novel interpretive frameworks that combine both geo-chronological and cultural data.
Agitation is a common symptom in schizophrenia and bipolar mania, causing marked distress and posing considerable risks for patients. Intramuscular formulations of psychotropic medication can provide a fast acting treatment of severe agitation in patients with acute episodes of schizophrenia or mania. As effective as these treatments are, particular antipsychotics can be associated with a heightened risk of dystonia and related Extrapyramidal Symptoms (EPS). Patients presenting to emergency care settings are also likely to have coexisting intoxications and medical conditions that may contribute to this risk.
The aim of this observational prospective study was to document the safety and effectiveness of all IM psychotropic drugs during the 24 hours following an initial injection in acutely agitated patients suffering from schizophrenia or bipolar disorder under naturalistic conditions.
Two-hundred-thirty-two (232) participating investigator sites (12 European countries) observed 1940 patients (mean age: 39 y, 42% female, 66% schizophrenia diagnosis). The primary endpoint was the occurrence of extrapyramidal symptoms (EPS), further endpoints were clinical severity measured by PANSS-EC and CGI-S. A total of 1311 (68%) patients received a monotherapy injection at baseline. Within 24 hours after the first injection, 190 (10%) of all 1940 patients experienced EPS. All intramuscular psychotropic drugs were shown to be effective in reducing measures of acute agitation.
This study provides favourable results on EPS related adverse events and effectiveness of intramuscular psychotropic medication for the management of acute agitation in patients within a naturalistic setting during the first 24 hours of treatment.
Maternal stress during pregnancy has been associated with schizophrenia in some settings with evidence suggesting that male and female offspring might be affected differently.
In an outbreak of violence in 1941, at least 180 Jews died in Baghdad; rapes, beatings and property damage injured hundreds more in other towns. We questioned whether this stress might be reflected in any change in schizophrenia incidence in people born in 1941.
We studied admissions to psychiatric hospitals in 39,606 men and 41,208 women, parents of the population-based Jerusalem cohort. We used proportional hazards models to estimate relative incidence of schizophrenia in various groups, over time. Subjects were followed from age in 1950 or immigration, till age at first hospital admission, death or 2004. Schizophrenia was defined by discharge diagnosis, ICD-10 = F20–F29 at any hospital event. Models controlled for secular and cyclic time trends.
For all years combined, the 3,679 male immigrants from Iraq showed a schizophrenia incidence similar to other men (relative risk RR = 0.92, 95% confidence limits 0.67–1.26). But for 141 men born in Iraq in 1941, RR = 4.12 (1.67–10.2, p = .0021 based on 6 cases), compared with men from Iraq born in all other years. Among other men, RR for 1941 births was 1.21 (0.78–1.88,). Women from Iraq showed no significant findings.
These findings enlarge on long-term consequences of ethnic violence. They raise intriguing questions about the relative resilience of the sexes, but should be interpreted cautiously, given that all subjects in this cohort had been able to reproduce.
This naturalistic, observational pan-European study assessed the safety and early effectiveness of intramuscular (IM) psychotropic treatments in patients with acute agitation suffering from schizophrenia or bipolar mania. One thousand nine hundred and forty of 1945 patients completed the 24-hour observation period after initial IM treatment. Patients from 12 European countries were included (mean age 39 years; 58% male, 66% schizophrenia). IM treatment was at the physician's discretion. The primary objective was to describe the acute tolerability of IM psychotropic therapies in clinical practice, with particular emphasis on EPS. At baseline, 68% of the patients received IM monotherapy, with IM olanzapine most commonly prescribed (36%). During the first 24hours, 190 (9.8%) patients experienced EPS. The occurrence of EPS was statistically significantly lower in patients treated with IM olanzapine compared to those treated with other IM psychotropic medications (mainly typical antipsychotics and benzodiazepines): acute dystonia: 1.1%, 95% CI 0.5–2.3 and 2.9%, CI 2.0–4.0; akathisia: 2.3%, CI 1.3–3.7 and 5.5%, CI 4.3–6.9; Parkinsonism: 2.9%, CI 1.8–4.4 and 7.8%, CI 6.4–9.4, respectively. Anticholinergic treatment was given to 12% IM olanzapine versus 31% non-olanzapine treated patients. Acute agitation after 24hours was reduced by 1.68 (95% CI 1.46–1.91) points on the Clinical Global Impression of Severity (CGI-S) in IM olanzapine patients and 1.51 (95% CI 1.30–1.73) points in non-olanzapine patients. Additional psychotropic medication was required for 90% of the patients during the first 24hours of treatment. Results provide naturalistic evidence for low EPS rates and improvement of agitation with IM psychotropic medications during acute states of patients suffering from acute mania or schizophrenia.
Maternal psychological stress during pregnancy has been associated with the risk for mood disorders in offspring, although there is no consensus about the influence of the timing of the stress on outcomes. We examined the relationship of prenatal stress at specific times in pregnancy to the incidence of mood disorders in offspring using data from a large birth cohort.
We linked data on 90,079 offspring born in Jerusalem in 1964–76 to Israel's psychiatric registry. We used proportional hazards models to evaluate the link between discharge diagnoses and gestational age during the Arab-Israeli war of June, 1967.
Those in their first trimester of fetal development during the war were significantly more likely to be admitted to hospitals for any mood disorders (RR = 3.01, 1.68–5.39, p = .0002), and the subgroups of bipolar disorder (2.44; 1.0–5.99; p = .054) and “other” mood disorders (3.61; 1.68–7.80; p = .001). Mood disorders were substantially increased in offspring whose mothers had been in the third month of pregnancy in June, 1967 (5.54, 2.73–11.24, p < .0001).
These findings suggest that acute maternal stress in early pregnancy may contribute to the etiology of mood disorders in offspring. They point to the third month of fetal development as a moment of special vulnerability.
Carbon-14 (radiocarbon, 14C) is a long-lived radionuclide (5730 yr) of interest regarding the safety for the management of intermediate level wastes (ILW). The present study gives an overview of the release of 14C from irradiated Zircaloy cladding in alkaline media. 14C is found either in the alloy part of Zircaloy cladding due to the neutron activation of 14N impurities by 14N(n,p)14C reaction, or in the oxide layer (ZrO2) formed at the metal surface by the neutron activation of 17O from UO2 or (U-Pu)O2 fuel and water from the primary circuit in the reactor by 17O(n,α)14C reaction. Various irradiated and unirradiated Zircaloys have been studied. The total 14C inventory has been determined both experimentally and by calculations. The results seem to be in good agreement. Leaching experiments were conducted in alkaline media for several time durations. 14C was mainly released as carboxylic acids. Further, corrosion measurements were performed by using both hydrogen measurements and electrochemical measurements. The corrosion rate (CR) ranges from a few nm/yr to 100 nm/yr depending on the surface conditions and the method used for measurement. From a safety assessment point of view, the instant release fraction (IRF) was determined on irradiated Zircaloy-2. The results showed that the 14C inventory in the oxide was significantly below the 20% commonly used in safety case assessments.
The Neolithic transition is a particularly favorable field of research for the study of the emergence and evolution of cultures and cultural phenomena. In this framework, high-precision chronologies are essential for decrypting the rhythms of emergence of new techno-economic traits. As part of a project exploring the conditions underlying the emergence and dynamics of the development of the first agro-pastoral societies in the Western Mediterranean, this paper proposes a new chronological modeling. Based on 45 new radiocarbon (14C) dates and on a Bayesian statistical framework, this work examines the rhythms and dispersal paths of the Neolithic economy both on coastal and continental areas. These new data highlight a complex and far less unidirectional dissemination process than that envisaged so far.
A study was carried out, from 2012 to 2015, in 10 French départements to estimate the serological prevalence of Q fever and the frequency of abortive episodes potentially related to Coxiella burnetii in a large sample of cattle, sheep and goat herds. The serological survey covered 731 cattle, 522 sheep and 349 goat herds, randomly sampled. The frequency of abortive episodes potentially related to C. burnetii was estimated by investigating series of abortions in 2695 cattle, 658 sheep and 105 goat herds using quantitative polymerase chain reaction analyses and complementary serological results when needed. The average between-herd seroprevalence was significantly lower for cattle (36·0%) than for sheep (55·7%) and goats (61·0%) and significantly higher for dairy herds (64·9% for cattle and 75·6% for sheep) than for meat herds (18·9% for cattle and 39·8% for sheep). Within-herd seroprevalence was also significantly higher for goats (41·5%) than for cattle (22·2%) and sheep (25·7%). During the study period, we estimated that 2·7% (n = 90), 6·2% (n = 48) and 16·7% (n = 19) of the abortive episodes investigated could be ‘potentially related to C. burnetii’in cattle, sheep and goat herds, respectively. Overall, strong variability was observed between départements and species, suggesting that risk factors such as herd density and farming practices play a role in disease transmission and maintenance.
Ketamine has recently become an agent of interest as an acute treatment for severe depression and as the anaesthetic for electroconvulsive therapy (ECT). Subanaesthetic doses result in an acute reduction in depression severity while evidence is equivocal for this antidepressant effect with anaesthetic or adjuvant doses. Recent systematic reviews call for high-quality evidence from further randomised controlled trials (RCTs).
To establish if ketamine as the anaesthetic for ECT results in fewer ECT treatments, improvements in depression severity ratings and less memory impairment than the standard anaesthetic.
Double-blind, parallel-design, RCT of intravenous ketamine (up to 2 mg/kg) with an active comparator, intravenous propofol (up to 2.5 mg/kg), as the anaesthetic for ECT in patients receiving ECT for major depression on an informal basis. (Trial registration: European Clinical Trials Database (EudraCT): 2011-000396-14 and clinicalTrials.gov: NCT01306760.)
No significant differences were found on any outcome measure during, at the end of or 1 month following the ECT course.
Ketamine as an anaesthetic does not enhance the efficacy of ECT.
Bodily isomerism, also referred to as heterotaxy, involves predominantly the thoracic organs, although other organs are usually abnormally positioned. Previously assessed on the basis of splenic anatomy, it is now understood that isomerism is better segregated on the basis of atrial appendage morphology. This allows for anticipation of associated findings. We aimed to assess the accuracy of segregation based on the morphology of the atrial appendages and other structures more easily identified by echocardiography.
We reviewed postmortem specimens of hearts from the archives at four institutions categorised as obtained from patients with “heterotaxy”. The cardiac structures were analysed using sequential segmental analysis. Non-cardiac structures were also examined if available. Statistical analyses were performed to compare differences in the settings of right as opposed to left isomerism.
Specimens were available from 188 patients. Of these, 57 had left isomerism, and 131 had right isomerism. Atrial appendages were isomeric in all patients. A coronary sinus was found only in left isomerism, whereas a terminal crest, or a Eustachian valve, was found only in right isomerism. Interruption of the inferior caval vein was associated with left isomerism, whereas totally anomalous pulmonary venous connection was associated with right isomerism.
Isomerism is uniformly segregated on the basis of the morphology of the atrial appendages, itself defined by the extent of the pectinate muscles. Other features such as the presence of a coronary sinus and systemic venous return can further help with such segregation of isomerism.
Objectives: Good glycemic control is an important goal of diabetes management. Late adolescents with type 1 diabetes (T1D) are at risk for poor glycemic control as they move into young adulthood. For a subset of these patients, this dysregulation is extreme, placing them at risk for life-threatening health complications and permanent cognitive declines. The present study examined whether deficiency in emotional decision making (as measured by the Iowa Gambling Task; IGT) among teens with T1D may represent a neurocognitive risk factor for subsequent glycemic dysregulation. Methods: As part of a larger longitudinal study, a total of 241 high-school seniors (147 females, 94 males) diagnosed with T1D underwent baseline assessment that included the IGT. Glycated hemoglobin (HbA1c), which reflects glycemic control over the course of the past 2 to 3 months, was also assessed at baseline. Of the 241,189 (127 females, 62 males, mean age=17.76, mean HbA1c=8.11) completed HbA1c measurement 1 year later. Results: Baseline IGT performance in the impaired range (per norms) was associated with greater dysregulation in glycemic control 1 year later, as evidenced by an average increase in HbA1c of 2%. Those with normal IGT scores (per norms) exhibited a more moderate increase in glycemic control, with an HbA1c increase of 0.7%. Several IGT scoring approaches were compared, showing that the total scores collapsed across all trials was most sensitive to change in glycemic control. Conclusions: IGT assessment offers promise as a tool for identifying late adolescents at increased risk for glycemic dysregulation. (JINS, 2017, 23, 204–213)
The origin of red supergiant mass loss still remains to be unveiled. Characterising the formation loci and the dust distribution in the first stellar radii above the surface is key to understand the initiation of the mass loss phenomenon. Polarimetric interferometry observations in the near-infrared allowed us to detect an inner dust atmosphere located only 0.5 stellar radius above the photosphere of Betelgeuse. We modelled these observations and compare them with visible polarimetric measurements to discuss the dust distribution properties.
To examine temporal trends and determinants of discretionary salt use in the USA.
Multiple logistic regression was used to assess temporal trends in discretionary salt use at the table and during home cooking/preparation, adjusting for demographic characteristics, using data from the National Health and Nutrition Examination Survey 2003–2012. Prevalence and determinants of discretionary salt use in 2009–2012 were also examined.
Participants answered salt use questions after completing a 24 h dietary recall in a mobile examination centre.
Nationally representative sample of non-institutionalized US children and adults, aged ≥2 years.
From 2003 to 2012, the proportion of the population who reported using salt ‘very often’ declined; from 18 % to 12 % for use at the table (P<0·01) and from 42 % to 37 % during home cooking (P<0·02). While one-third of the population reported never adding salt at the table, most used it during home cooking/preparation (93 %). Use of discretionary salt was least commonly reported among young children and older adults and demographic and health subgroups at risk of CVD.
While most people reported using salt during home cooking/preparation, a minority reported use at the table. Reported ‘very often’ discretionary salt use has declined. That discretionary salt use is less common among those at risk of CVD suggests awareness of messages to limit Na intake.
To examine the association between overweight and obesity and serum ferritin among women of reproductive age (15–49 years) in Nicaragua, considering the effect of α1-acid glycoprotein (AGP), a marker of inflammation.
We analysed data from the 2004–05 Nicaraguan Integrated Surveillance System for Nutrition Interventions. Three logistic regression models were analysed with low serum ferritin (<15 μg/l) as the dependent variable: (i) overweight or obese status and covariates; (ii) model 1 plus AGP; and (iii) model 1 restricted to only women with normal AGP levels (≤1·0 g/l).
Included in this analysis were 832 non-pregnant mother/caregivers (15–49 years) surveyed in 2004–2005.
In the sample, prevalence of overweight and obesity was 31·8 % and 19·2 %, respectively, and 27·6 % had low serum ferritin. In model 1, the adjusted OR of low serum ferritin was 0·74 (95 % CI 0·52, 1·05) for overweight women and 0·42 (95 % CI 0·26, 0·65) for obese women. In model 2, AGP was significantly independently associated with low serum ferritin (adjusted OR=0·56, 95 % CI 0·34, 0·92) while the adjusted OR for overweight and obesity were largely unchanged. Excluding women with elevated AGP did not appreciably affect the relationship between overweight or obesity and low serum ferritin (model 3).
Overall, in this population of reproductive-age women, obese women were less likely to have low serum ferritin levels, and this was independent of inflammation as measured by AGP.
Electroconvulsive therapy (ECT) is an effective treatment for depression but the extent and persistence of cognitive side-effects remain uncertain. It has been reported that there is little evidence that impairments last longer than up to 15 days post-ECT. However, relatively few studies have followed patients for even as long as 1 month post-ECT. Here we report results from a brief cognitive battery given prior to ECT and repeated five times up to 6 months post-ECT.
In a retrospective case-note study of routinely collected clinical data 126 patients treated with ECT completed two neuropsychological tests [Cambridge Neuropsychological Test Automated Battery (CANTAB) spatial recognition memory (SRM) and Mini Mental State Examination (MMSE)] and two subjective reports of memory function, prior to ECT. Patients were reassessed following ECT and at 1, 3 and 6 months post-ECT although not all patients completed all assessments.
Performance relative to pre-ECT baseline was significantly poorer at each post-ECT assessment up to 3 months post-ECT using the CANTAB SRM, but was improved at 6 months. Conversely, MMSE score showed improvements relative to baseline from 1 month post-ECT. Mood and subjective memory scores improved following ECT and were correlated with one another, but not with either neuropsychological measure.
The CANTAB SRM task revealed reversible cognitive deficiencies relative to a pre-ECT baseline for at least 3 months following ECT, while MMSE score and patients' subjective reports showed only improvement. Visuospatial memory scores eventually exceeded baseline 6 months post-ECT.
We present detailed models of the edge-on protoplanetary disk ESO Hα 569 (SSTgbs J111110.7-764157) from resolved scattered light images from HST and a complete spectral energy distribution. Data was obtained as part of an HST campaign to catalogue edge-on disks around young stars in nearby star forming regions (HST program 12514, PI: Karl Stapelfeldt). We confirm that this object is an optically thick edge-on disk around a young star with an outer radius of 125 AU. Using full radiative transfer models, we probe the distribution of dust grains and overall shape of the disk (inclination, scale height, dust mass, maximum particle size, inner radius, flaring exponent and surface/volume density exponent).