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To examine the relationship between childhood traumatic experiences and early and late-onset suicidal behavior among depressed older adults.
Design:
Cross-sectional study.
Setting:
Inpatient and outpatient psychiatric services in Pennsylvania.
Participants:
Our sample included 224 adults aged 50+ (M ± SD = 62.5 ± 7.4) recruited into three depressed groups: (1) 84 suicide attempters, (2) 44 suicide ideators, and (3) 58 non-suicidal comparisons, and a non-psychiatric healthy comparison group (N = 38).
Measurements:
The Childhood Trauma Questionnaire measured experiences of childhood trauma such as emotional abuse, physical abuse, emotional neglect, physical neglect, and sexual abuse.
Results:
Attempters were separated into early- and late-onset based on age of first attempt using a statistical algorithm that identified a cutoff age of 30 years old. Overall, we found group differences in emotional and physical abuse and neglect in both genders and sexual abuse in females, but not in males. Early-onset attempters experienced more childhood emotional abuse and neglect than late-onset attempters and were more likely to have experienced multiple forms of abuse. They also experienced more emotional abuse and neglect than all comparison groups. Consistently, early-onset attempters more often met criteria for current or lifetime PTSD relative to late-onset attempters and most comparison groups. Late-onset attempters had similar levels of childhood trauma as other depressed groups.
Conclusions:
Our study reaffirms that there are distinct pathways to suicidal behavior in older adults based on their age of first suicide attempt and that trauma experienced in childhood has long-lasting emotional and behavioral consequences, even into late life.
N-3 long-chain PUFA (LC-PUFA) and probiotics are generally considered to induce health benefits. The objective was to investigate (1) the impact of fish oil and/or probiotics on serum fatty acids (sFA), (2) the interaction of sFA with low-grade inflammation and (3) the relation of sFA to the onset of gestational diabetes mellitus (GDM). Pregnant women with overweight/obesity were allocated into intervention groups with fish oil + placebo, probiotics + placebo, fish oil + probiotics or placebo + placebo in early pregnancy (fish oil: 1·9 g DHA and 0·22 g EPA, probiotics: Lacticaseibacillus rhamnosus HN001 and Bifidobacterium animalis ssp. lactis 420, 1010 CFU, each daily). Blood samples were collected in early (n 431) and late pregnancy (n 361) for analysis of fatty acids in serum phosphatidylcholine (PC), cholesteryl esters (CE), TAG and NEFA with GC and high-sensitivity C-reactive protein and GlycA by immunoassay and NMR spectroscopy, respectively. GDM was diagnosed according to 2 h 75 g oral glucose tolerance test. EPA in PC, CE and TAG and DHA in PC, CE, TAG and NEFA were higher in fish oil and fish oil + probiotics groups compared with placebo. EPA in serum NEFA was lower in women receiving probiotics compared with women not receiving. Low-grade inflammation was inversely associated with n-3 LC-PUFA, which were related to an increased risk of GDM. Fish oil and fish oil + probiotics consumption increase serum n-3 LC-PUFA in pregnant women with overweight/obesity. Although these fatty acids were inversely related to inflammatory markers, n-3 LC-PUFA were linked with an increased risk for GDM.
This article challenges the orthodox view of international law, according to which states have no legal duty to cooperate. It argues for this legal duty in the context of COVID-19, based on the ethical principles of solidarity, stewardship, and subsidiarity. More specifically, the article argues that states have a legal duty to cooperate during a pandemic (as solidarity requires); and while this duty entails an extraterritorial responsibility to care for and assist other nations (as stewardship requires), the legal duty to cooperate still allows states to attend first to the basic needs of those under their own jurisdiction—namely, fellow nationals and residents (as subsidiarity requires). The article provides a definition and philosophical justifications for this legal duty that are lacking in the literature by examining its application to a current COVID-19 controversy: namely, states’ responsibility to assist other countries in greater need by, inter alia, exporting at a discount or donating scarce COVID-19 treatments (including vaccines). In providing a principled tripartite account of pandemic governance, this conceptual and normative article offers a new lens for debating the potential international treaty for pandemic prevention, preparedness, and response that has now been drafted and is under negotiation at the World Health Assembly, by responding to the recent backlash against multilateralism by substantiating global co-responsibilities in times of pandemics and beyond.
This study aimed to investigate the characteristics and prognosis of patients with alcoholic Marchiafava–Bignami disease (MBD), a rare neurological disorder commonly associated with chronic alcoholism, in Chongqing, China.
Methods:
We conducted a retrospective analysis of clinical data from 21 alcoholic MBD patients treated at the First Affiliated Hospital of Chongqing University between 2012 and 2022.
Results:
The study included 21 patients with alcoholic MBD who had a mean age of 59 ± 9.86 years and an average drinking history of 35.48 ± 8.65 years. Acute onset was observed in 14 (66.7%) patients. The primary clinical signs observed were psychiatric disorders (66.7%), altered consciousness (61.9%), cognitive disorders (61.9%), and seizures (42.9%). Magnetic resonance imaging revealed long T1 and long T2 signal changes in the corpus callosum, with lesions predominantly found in the genu (76.2%) and splenium (71.4%) of the corpus callosum. The poor prognosis group demonstrated an increased incidence of altered consciousness (100% vs 50%, P = 0.044), pyramidal signs (80% vs 18.8%, P = 0.011), and pneumonia (100% vs 31.3%, P = 0.007). Patients with a longer drinking history (45.0 ± 10.0 years vs 32.69 ± 5.99 years, p = 0.008) and a lower thiamine dose (p = 0.035) had a poorer prognosis at 1 year.
Conclusions:
This study identified altered consciousness, pyramidal signs, and pneumonia as predictors of a poor prognosis in patients with alcoholic MBD. A longer duration of alcohol consumption and inadequate thiamine supplementation were associated with a poorer prognosis.
Over the past decade, reform efforts in the area of collateral consequences of conviction have succeeded in emancipating themselves from standard discourses and dynamics in the US criminal legal reform space. This article draws on concepts and insights from the literature on penal transformation to explore the unique interplay of goals and values that have led to recent collateral consequences reforms. It identifies three major drivers of change that have had a significant impact, particularly, on softening occupational licensing restrictions for individuals with a criminal history and passing criminal record clearance legislation. First, advocates of the economic libertarian agenda joined forces with civil libertarian groups to reduce occupational licensing hurdles for criminal record holders. Second, an attitude promoting redemption and second chances through criminal record clearance reform has been championed, in particular, by the Christian right. Third, economic concerns by employers seeking to hire individuals with a criminal record have become more pronounced in tight labor markets, both pre- and post-pandemic. The analysis concludes that, although much remains to be done, ongoing reforms represent a significant reshaping of the collateral consequences landscape. A logic of unworthiness toward individuals with criminal records, however, remains hard to eradicate and can easily resurface in the current unstable phase of penal transition.
We present novel numerical simulations investigating the bag breakup of liquid droplets. We first examine the viscous effect on the early-time drop deformation, comparing with theory and experiment. Next, a bag film forms at late time and is susceptible to spurious mesh-induced breakup in numerical simulations, which has prevented previous studies from reaching grid convergence of fragment statistics. We therefore adopt the manifold death (MD) algorithm which artificially perforates thin films once they reach a prescribed critical thickness independent of the grid size, controlled by a numerical parameter $L_{sig}$. We show grid convergence of fragment statistics when utilising the MD algorithm, and analyse the fragment behaviour and bag film disintegration mechanisms including ligament breakup, node detachment and rim destabilisation. Our choice of the critical thickness parameter $L_{sig}$ is limited by numerical constraints and thus has not been matched to experiment or theory; consequently, the current simulations yield critical bag film perforation thicknesses larger than experimentally observed. The influence of the MD algorithm configuration on the bag breakup phenomena and statistics will be investigated in future work. We also study the effects of moderate liquid Ohnesorge number ($0.005 \leqslant Oh \leqslant 0.05$) on the bag breakup process and fragment statistics, where a non-monotonic dependency of the average diameter of bag film fragments on $Oh$ is found. These results highlight the utility of the MD algorithm in multiphase simulations involving topological changes, and pave the way for physics-based numerical investigations into spume generation at the air–sea interface.
This paper develops an efficient Stein-like shrinkage estimator for estimating slope parameters under structural breaks in seemingly unrelated regression models, which is then used for forecasting. The proposed method is a weighted average of two estimators: a restricted estimator that estimates the parameters under the restriction of no break in the coefficients, and an unrestricted estimator that considers break points and estimates the parameters using the observations within each regime. It is established that the asymptotic risk of the Stein-like shrinkage estimator is smaller than that of the unrestricted estimator, which is the method typically used to estimate the slope coefficients under structural breaks. Furthermore, this paper proposes an averaging minimal mean squared error estimator in which the averaging weight is derived by minimizing its asymptotic risk. Insights from the theoretical analysis are demonstrated in Monte Carlo simulations and through an empirical example of forecasting output growth of G7 countries.
For multiply recurrent glioma, options are few and choices are very limited. Etoposide in combination with carboplatin and/or bevacizumab has been evaluated in recurrent glioma with modest efficacy. This retrospective study describes the efficacy of etoposide monotherapy in adults with multiply recurrent diffuse glioma.
Methods:
In this single center retrospective series, all adult patients with radiographically proven multiply recurrent diffuse glioma (WHO grade 2–4) treated with etoposide between 2016 and 2020 were evaluated. Progression-free survival (PFS) and overall survival (OS) after initiating etoposide were calculated for the total group and for different histologic tumor types. In addition, treatment-related toxicity was recorded.
Results:
Totally, 48 patients with a median age 43 years-old (range 24–78) were included. Etoposide was given as 3rd line of treatment in 18 patients (37.5%) and as 4th or 5th line of treatment in 30 patients (62.5%). The majority were diagnosed with a glioblastoma, WHO grade 4 (27, 56.3%). The median PFS was 8.6 weeks (95% confidence interval [CI]: 8.3–8.9). The median OS of the total population was 4.0 months (95% CI: 2.4–5.6). Patients with an oligodendroglioma had the best OS (median 13 months), compared to astrocytoma and glioblastoma, but the difference was not statistically significant (p = 0.15). Etoposide was stopped due to progression in the majority of the patients (81.3%). Only 1 patient had a grade 3 toxicity.
Conclusion:
Etoposide is a well-tolerated chemotherapy in heavily pretreated patients with multiply recurrent glioma and could be considered when other options are not available. OS was 4 months after initiating etoposide.
In its early decades, Antiquity regularly featured the subject of linear earthworks that criss-cross the British landscape. Subsequently, however, discussion has been largely relegated to period-specific and local journals. As a result, interpretations of these imposing but often poorly dated earthworks have been drawn in the contrasting research traditions of later prehistory and the early medieval period. Here, the authors propose a comparative dialogue as a means for reinterpreting these landscape features, and as a lens through which to explore social complexity. Combined with advances in archaeometrical dating, this new approach promises to reinvigorate the study of some of Britain's largest archaeological monuments.
Given the central place organisms occupy in Kant’s account of living nature, it might seem unlikely that his claims about biological wholes could be relevant to current debates over the problem of biological individuality. These debates acknowledge the multiple realizability of biological individuality in vastly different forms, including parts of organisms and complex groups of organisms at various levels of the biological hierarchy, sparking much controversy in attempts to characterize a biological individual. I argue that, far from being irrelevant to this controversy, Kant’s account provides a key insight for addressing the multiple realizability problem. I show how the reciprocal causality between a self-organizing whole and its parts, which Kant thinks characterizes a natural end, is not limited to organisms but is exhibited by numerous types of beings in living nature. Self-organizing wholes of various kinds, and at various biological levels, may count as biological individuals, depending on the degree to which their functionally integrated parts are represented by reflective judgement as a natural end.
Breast milk iodine concentration (BMIC) is a promising indicator of iodine status in lactating women. However, there are limited data on its usefulness to reflect maternal iodine deficiency. Therefore, the aim of our study was to assess iodine concentration in breast milk and urine samples in exclusively breast-feeding women. Eligible pregnant women undergoing routine antenatal care in a large hospital in Shaanxi Province, China, were followed up from the third trimester of pregnancy until the first week of lactation. Urine samples (20 ml) were collected during pregnancy and lactation. Iodine concentration in samples was measured based on Sandell–Kolthoff reaction. Breast milk samples (5 ml) were provided during lactation. A receiver operating curve (ROC) was constructed to determine the diagnostic performance of BMIC. An iodine-specific FFQ was completed twice during pregnancy and lactation. A total of 200 women completed the study. The overall median BMIC was 89 μg/l, indicating iodine sufficiency (i.e. BMIC reference range between 60 and 465 μg/l). Women reported similar median urinary iodine concentration (UIC) during pregnancy and lactation (112 and 113 μg/l, respectively), but their iodine status differed – mild-to-moderate iodine deficiency during pregnancy and iodine sufficiency during lactation. The ROC for BMIC using UIC as a reference standard was 0·755 (95 % CI: 0·644, 0·866). In conclusion, this study demonstrated that women were iodine sufficient in the first week of lactation as assessed by UIC, which was consistent with BMIC. These findings suggested that BMIC is a useful biomarker to assess iodine status in lactating women.
This essay contends that the ethics around the use of spy technology to gather intelligence (TECHINT) during espionage and counterintelligence operations is ambiguous. To build this argument, the essay critically scrutinizes Cécile Fabre's recent and excellent book Spying through a Glass Darkly, which argues that there are no ethical differences between the use of human intelligence (HUMINT) obtained from or by human assets and TECHINT in these operations. As the essay explains, Fabre arrives at this position by treating TECHINT as a like-for-like replacement for HUMINT. The essay argues instead that TECHINT is unlikely to act as a like-for-like replacement for HUMINT. As such, TECHINT might transform existing practices of espionage and counterintelligence, giving rise to new ethical challenges not captured in Fabre's analysis. To illustrate the point, the essay builds an analogy between TECHINT and recent armed conflicts in which precision weapons have been deployed. Although precision weapons seem ethically desirable, their availability has created new practices of waging war that are ethically problematic. By analogy, TECHINT, though not intrinsically undesirable, has the capacity to generate new practices of intelligence gathering that are ethically problematic—potentially more than HUMINT. Ultimately, recent negative experiences with the use of precision weaponry should caution against an overly positive assessment of TECHINT's ethical desirability.
The discovery of a major archaeological complex at Faughan Hill, County Meath, was first reported on in the Proceedings of the Prehistoric Society in 2015. Comprising a series of large hilltop enclosures, probable burial sites, and associated features, the character and scale of the complex marked this out as an important focal centre in a region populated with some of Ireland’s largest and most spectacular monument ensembles, not least at the Hill of Tara, 15 km to the south-east. A more complete picture of the site has since been revealed through further geophysical survey followed by test excavations by the Discovery Programme’s Tara Research Project. Two trenches excavated across the hilltop enclosures in 2017 yielded evidence of four discrete phases of activity spanning some 3000 years, from the mid-4th to mid-1st millennia bc. During the Middle Neolithic the hilltop was encircled by a fenced enclosure (3635–3380 cal bc) possibly associated with the production of stone tools. At 250 m in projected diameter it is one of the largest enclosures of the 4th millennium known in Ireland. This was superseded in the Late Bronze Age by a far more substantial, 400 m diameter multivallate enclosure (1280–920 cal bc) representing the only excavated hillfort of its type in Meath. The hill was the focus of renewed activity during the Early Iron Age (800–520 cal bc) and later became central to the political ambitions of aspiring, early Uí Néill kings of Tara, achieving particular reknown as the burial place of their eponymous ancestor, Niall of the Nine Hostages. Developments at Faughan are illuminated further by a wealth of prehistoric settlement and ritual sites in the surrounding area, as well as early documentary sources, and, collectively, speak to a regional centre and gathering place with long-lived social, symbolic, and political significance.
Limited data exist on how trainees in paediatric cardiology are assessed among countries affiliated with the Association of European Paediatric and Congenital Cardiology.
Methods:
A structured and approved questionnaire was circulated to educationalists/trainers in 95 Association for European Paediatric and Congenital Cardiology training centres.
Results:
Trainers from 46 centres responded with complete data in 41 centres. Instructional design included bedside teaching (41/41), didactic teaching (38/41), problem-based learning (28/41), cardiac catheterisation calculations (34/41), journal club (31/41), fellows presenting in the multidisciplinary meeting (41/41), fellows reporting on echocardiograms (34/41), clinical simulation (17/41), echocardiography simulation (10/41), and catheterisation simulation (3/41). Assessment included case-based discussion (n = 27), mini-clinical evaluation exercise (mini-CEX) (n = 12), directly observed procedures (n = 12), oral examination (n = 16), long cases (n = 11), written essay questions (n = 6), multiple choice questions (n = 5), and objective structured clinical examination (n = 2). Entrustable professional activities were utilised in 10 (24%) centres. Feedback was summative only in 17/41 (41%) centres, formative only in 12/41 (29%) centres and a combination of formative and summative feedback in 10/41 (24%) centres. Written feedback was provided in 10/41 (24%) centres. Verbal feedback was most common in 37/41 (90 %) centres.
Conclusion:
There is a marked variation in instructional design and assessment across European paediatric cardiac centres. A wide mix of assessment tools are used. Feedback is provided by the majority of centres, mostly verbal summative feedback. Adopting a programmatic assessment focusing on competency/capability using multiple assessment tools with regular formative multisource feedback may promote assessment for learning of paediatric cardiology trainees.
To examine predictors of suicidal behavior (SB) in adults aged 75 years and above with dementia.
Design:
Longitudinal national register-based study.
Participants and setting:
Swedish residents aged ≥75 years with dementia identified in the Swedish Dementia Registry (SveDem) between 1 January 2007 and 31 December 2017 (N = 59 042) and followed until 31 December 2018. Data were linked with numerous national registers using personal identity numbers.
Measurements:
Outcomes were nonfatal self-harm and suicide. Fine and Gray regression models were used to investigate demographics, comorbidities, and psychoactive medications associated with fatal and nonfatal SB.
Results:
Suicidal behavior was observed in 160 persons after dementia diagnosis; 29 of these died by suicide. Adjusted sub-hazard ratio (aSHRs) for SB was increased in those who had a previous episode of self-harm (aSHR = 14.42; 95% confidence interval [CI] = 7.06–29.46), those with serious depression (aSHR = 4.33, 95%CI = 2.94–6.4), and in those born outside Sweden (aSHR = 1.53; 95% CI = 1.03–2.27). Use of hypnotics or anxiolytics was also associated with a higher risk of SB; use of antidepressants was not. Milder dementia and higher frailty score also increased risk of SB. Risk was decreased in those who received home care (aSHR = 0.52; 95%CI = 0.38–0.71) and in the oldest group (aSHR = 0.35; 95%CI = 0.25–0.49).
Conclusion:
In addition to established targets for suicidal behavior prevention (improved identification and treatment of depression and previous self-harm), several new risk factors were suggested. There is a need for innovative public health strategies to meet the needs of older dementia patients with a foreign background. Home care may have a potential positive effect to prevent SB in people with dementia, but this needs to be further explored.
This essay starts by accepting Cécile Fabre's argument in her book Spying through a Glass Darkly that intelligence work, including using incentives and pressures to encourage betrayal and treason, can be morally justified based on the criteria of necessity, effectiveness, and proportionality. However, while assessments of spying tend to be based on Cold War notions, I explore it here in the messier reality of counterinsurgency, counterterrorism, and “new wars.” In addition, I suggest a methodological expansion: adding a sociological perspective to the ethical discussion by exploring the wider effects on society, over longer periods, of the operation of informers. Based on these shifts in perspective and context, I identify additional social harms generated by espionage that should lead to a more restrictive view of ethical espionage than the one emerging from Fabre's work. I argue that many of these social harms are created by the mass recruitment of informers, in asymmetrical conflicts where governments have leverage over suspected communities, and given the (often mistaken) belief that everyone recruited to act as informer is an “asset,” primarily providing advantages. I argue, therefore, that the decisive issue is one of scale: many of the ethical problems created by espionage in these contexts result from the widespread systematic recruitment of informers, while small-scale, targeted, ad-hoc recruitment can more easily avoid such problems.