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Endomyocardial biopsy remains the gold standard for cardiac cellular rejection surveillance after heart transplantation. We studied a novel non-invasive index of left ventricular relaxation to detect cardiac cellular rejection in paediatric heart transplant patients.
Methods:
This is a single-centre retrospective study of paediatric heart transplant patients who underwent endomyocardial biopsy from June 2014 to September 2021. Left ventricular relaxation index was calculated as the sum of diastolic tissue Doppler imaging velocities (E) of the left ventricular lateral, septal, and posterior walls divided by the percentage of the left ventricular posterior wall thinning by M-mode. Statistical analysis included t-tests and Mann-Whitney tests to compare means and medians between treatment and non-treatment groups. We used the cut-off with the maximum Youden index to compare the sensitivity and specificity of left ventricular relaxation index to detect rejection.
Results:
The study included 65 patients who underwent 246 cardiac catheterizations and endomyocardial biopsies. Out of 246, 192 procedures were included and 54 were excluded due to recent transplants or lack of echocardiographic data. A total of 114 demonstrated Grade 0R, 68 Grade 1R, 8 Grade 2R, and 2 Grade 3R allograft rejection. The difference in mean left ventricular relaxation index between treatment versus non-treatment groups (2R, 3R vs. 0R, 1R) was not statistically significant (p = 0.917). A left ventricular relaxation index cut-off of 0.73 had the highest Youden index with good sensitivity (100%) and poor specificity (23%) for detecting rejections with grades 2R and 3R.
Conclusion:
Left ventricular relaxation index, a novel index of left ventricular relaxation, was not a sensitive or specific predictor of cardiac cellular rejection in paediatric heart transplants.
Various studies have reported a positive relationship between child maltreatment and personality disorders (PDs). However, few studies included all DSM-IV PDs and even fewer adjusted for other forms of childhood adversity, e.g. bullying or family problems.
Method
We analyzed questionnaires completed by 512 participants of the ZInEP epidemiology survey, a comprehensive psychiatric survey of the general population in Zurich, Switzerland. Associations between childhood adversity and PDs were analyzed bivariately via simple regression analyses and multivariately via multiple path analysis.
Results
The bivariate analyses revealed that all PD dimensions were significantly related to various forms of family and school problems as well as child abuse. In contrast, according to the multivariate analysis only school problems and emotional abuse were associated with various PDs. Poverty was uniquely associated with schizotypal PD, conflicts with parents with obsessive-compulsive PD, physical abuse with antisocial PD, and physical neglect with narcissistic PD. Sexual abuse was statistically significantly associated with schizotypal and borderline PD, but corresponding effect sizes were small.
Conclusion
Childhood adversity has a serious impact on PDs. Bullying and violence in schools and emotional abuse appear to be more salient markers of general personality pathology than other forms of childhood adversity. Associations with sexual abuse were negligible when adjusted for other forms of adversity.
Iraq and Afghanistan Veterans with posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) history have high rates of performance validity test (PVT) failure. The study aimed to determine whether those with scores in the invalid versus valid range on PVTs show similar benefit from psychotherapy and if psychotherapy improves PVT performance.
Method:
Veterans (N = 100) with PTSD, mild-to-moderate TBI history, and cognitive complaints underwent neuropsychological testing at baseline, post-treatment, and 3-month post-treatment. Veterans were randomly assigned to cognitive processing therapy (CPT) or a novel hybrid intervention integrating CPT with TBI psychoeducation and cognitive rehabilitation strategies from Cognitive Symptom Management and Rehabilitation Therapy (CogSMART). Performance below standard cutoffs on any PVT trial across three different PVT measures was considered invalid (PVT-Fail), whereas performance above cutoffs on all measures was considered valid (PVT-Pass).
Results:
Although both PVT groups exhibited clinically significant improvement in PTSD symptoms, the PVT-Pass group demonstrated greater symptom reduction than the PVT-Fail group. Measures of post-concussive and depressive symptoms improved to a similar degree across groups. Treatment condition did not moderate these results. Rate of valid test performance increased from baseline to follow-up across conditions, with a stronger effect in the SMART-CPT compared to CPT condition.
Conclusion:
Both PVT groups experienced improved psychological symptoms following treatment. Veterans who failed PVTs at baseline demonstrated better test engagement following treatment, resulting in higher rates of valid PVTs at follow-up. Veterans with invalid PVTs should be enrolled in trauma-focused treatment and may benefit from neuropsychological assessment after, rather than before, treatment.
Summary: In this paper we build on work investigating the feasibility of human immunodeficiency virus (HIV) testing in emergency departments (EDs), estimating the prevalence of hepatitis B, C and HIV infections among persons attending two inner-London EDs, identifying factors associated with testing positive in an ED. We also undertook molecular characterisation to look at the diversity of the viruses circulating in these individuals, and the presence of clinically significant mutations which impact on treatment and control.
Blood-borne virus (BBV) testing in non-traditional settings is feasible, with emergency departments (ED) potentially effective at reaching vulnerable and underserved populations. We investigated the feasibility of BBV testing within two inner-London EDs. Residual samples from biochemistry for adults (⩾18 years) attending The Royal Free London Hospital (RFLH) or the University College London Hospital (UCLH) ED between January and June 2015 were tested for human immunodeficiency virus (HIV)Ag/Ab, anti-hepatitis C (HCV) and HBsAg. PCR and sequence analysis were conducted on reactive samples. Sero-prevalence among persons attending RFH and UCLH with residual samples (1287 and 1546), respectively, were 1.1% and 1.0% for HBsAg, 1.6% and 2.3% for anti-HCV, 0.9% and 1.6% for HCV RNA, and 1.3% and 2.2% for HIV. For RFH, HBsAg positivity was more likely among persons of black vs. white ethnicity (odds ratio 9.08; 95% confidence interval 2.72–30), with anti-HCV positivity less likely among females (0.15, 95% CI 0.04–0.50). For UCLH, HBsAg positivity was more likely among non-white ethnicity (13.34, 95% CI 2.20–80.86 (Asian); 8.03, 95% CI 1.12–57.61 (black); and 8.11, 95% CI 1.13–58.18 (other/mixed)). Anti-HCV positivity was more likely among 36–55 year olds vs. ⩾56 years (7.69, 95% CI 2.24–26.41), and less likely among females (0.24, 95% CI 0.09–0.65). Persons positive for HIV-markers were more likely to be of black vs. white ethnicity (4.51, 95% CI 1.63–12.45), and less likely to have one ED attendance (0.39, 95% CI 0.17–0.88), or female (0.12, 95% CI 0.04–0.42). These results indicate that BBV-testing in EDs is feasible, providing a basis for further studies to explore provider and patient acceptability, referral into care and cost-effectiveness.
Lithostratigraphical studies coupled with the development of new dating methods has led to significant progress in understanding the Late Pleistocene terrestrial record in Scotland. Systematic analysis and re-evaluation of key localities have provided new insights into the complexity of the event stratigraphy in some regions and the timing of Late Pleistocene environmental changes, but few additional critical sites have been described in the past 25 years. The terrestrial stratigraphic record remains important for understanding the timing, sequence and patterns of glaciation and deglaciation during the last glacial/interglacial cycle. Former interpretations of ice-free areas in peripheral areas during the Last Glacial Maximum (LGM) are inconsistent with current stratigraphic and dating evidence. Significant challenges remain to determine events and patterns of glaciation during the Early and Middle Devensian, particularly in the context of offshore evidence and ice sheet modelling that indicate significant build-up of ice throughout much of the period. The terrestrial evidence broadly supports recent reconstructions of a highly dynamic and climate-sensitive British–Irish Ice Sheet (BIIS), which apparently reached its greatest thickness in Scotland between 30 and 27ka, before the global LGM. A thick (relative to topography) integrated ice sheet reaching the shelf edge with a simple ice-divide structure was replaced after the LGM by a much thinner one comprising multiple dispersion centres and a more complex flow structure.
This paper reviews the changing environments, developing landforms and terrestrial stratigraphy during the Early and Middle Pleistocene stages in Scotland. Cold stages after 2.7 Ma brought mountain ice caps and lowland permafrost, but larger ice sheets were short-lived. The late Early and Middle Pleistocene sedimentary record found offshore indicates more than 10 advances of ice sheets from Scotland into the North Sea but only 4–5 advances have been identified from the terrestrial stratigraphy. Two primary modes of glaciation, mountain ice cap and full ice sheet modes, can be recognised. Different zones of glacial erosion in Scotland reflect this bimodal glaciation and the spatially and temporally variable dynamics at glacier beds. Depths of glacial erosion vary from almost zero in Buchan to hundreds of metres in glens in the western Highlands and in basins both onshore and offshore. The presence of tors and blockfields indicates repeated development of patches of cold-based, non-erosive glacier ice on summits and plateaux. In lowlands, chemical weathering continued to operate during interglacials, but gruss-type saprolites are mainly of Pliocene to Early Pleistocene age. The Middle Pleistocene terrestrial stratigraphic record in Scotland, whilst fragmentary and poorly dated, provides important and accessible evidence of changing glacial, periglacial and interglacial environments over at least three stadial–interstadial–interglacial cycles. The distributions of blockfields and tors and the erratic contents of glacial sediments indicate that the configuration, thermal regime and pattern of ice flow during MIS 6 were broadly comparable to those of the last ice sheet. Improved control over the ages of Early and Middle Pleistocene sediments, soils and saprolites and on long-term rates of weathering and erosion, combined with information on palaeoenvironments, ice extent and sea level, will in future allow development and testing of new models of Pleistocene tectonics, isostasy, sea-level change and ice sheet dynamics in Scotland.
Aguilarite, Ag4SeS, occurs in a hydrothermal vein deposit associated with sphalerite, chalcopyrite, galena, and native silver. Physical and chemical data agree with descriptions from Guanajuato (type locality). Differential thermal analysis of synthetic material indicates an inversion temperature of 122±1 °C. The mineral crystallized late in the paragenetic sequence, probably slightly above 200 °C.
Silica sinter masses in the southern portion of the Pliocene Puhipuhi geothermal field of Northland, New Zealand, have recrystallized to microcrystalline quartz and moganite but many primary depositional fabrics of the sinters can still be recognized. Finely disseminated cinnabar, acicular stibnite, pyrite framboids and minor livingstonite are distributed through both massive sinter and stromatolitic fabrics with sulphide mineralization extending from fractured rocks about former spring vents into less disturbed sinter layers. The deposition of sulphides in the sinters is part of a continuum of mineralization resulting from the former hydrothermal regime and which extends to depth in the extinct geothermal system. Periodic changes in the hydrology, such as repeated fracturing following fracture sealing facilitated episodic sulphide deposition. Mercury is considered to have travelled in the liquid phase with antimony and precipitated directly as cinnabar. Remobilization of the sulphides, along with the recrystallization of the sinter masses, have produced complex textural relations. The multifaceted paragenesis of the sulphides is reflected in the range of their minor and trace element compositions revealed by electron microprobe analyses.
Laser Raman spectroscopy is particularly well suited for routine characterization of the crystalline and the better ordered paracrystalline silica phases occurring in silica sinters: opal-C, quartz and moganite. The non-crystalline and poorly ordered paracrystalline silica phases (opal-CT and opal-A) are identified with difficulty, partly as a result of the high level of fluorescence exhibited by the younger sinters that are dominated by these phases, and partly as a result of the ill-defined nature of the broad phonon scattering bands produced by them. Nonetheless, given the limited number of phases present and the high level of phonon scattering from the better ordered phases, judicious use of a Raman microprobe enables the character of most siliceous microtextural sinter components to be determined readily. Microprobe examination of a series of New Zealand sinters, ranging from Late Quaternary to Pliocene in age shows that a silica phase inhomogeneity that exists in some outcrops reflects an underlying phase heterogeneity obtaining in the microstructure of the sinter; it is a consequence of the phase transformation process. In the older sinters, quartz, moganite and opaline cristobalite may be present in a single fabric element but in quite different proportions to their abundance in adjacent elements. Identification of opaline lepispheres partially pseudomorphed by quartz+moganite and the association of quartz+moganite in microcrystals exhibiting common quartz forms, cautions against the use of morphology as a means of identifying silica phases at the microstructural level.
It can be shown that cepheids pulsating in the first harmonic when evolving through the instability zone at constant bolometric luminosity and mass, are at a given period 0.09 magnitudes bluer than stars pulsating in the fundamental mode. Bell and Rodgers have shown that effective temperatures of cepheids can be obtained by comparison of observed and computed profiles of the wings of the Hα line. Hα cores of cepheids are affected by strongly doppler broadened chromospheric emission and absorption. Using a modified Oke effective temperature-intrinsic colour relation, observations of the Hα line of the Eggen C cepheids β Dor and S Mus have been made at Mt. Stromlo and intrinsic colours obtained for these stars.
A low-cost differential image motion monitor (DIMM), consisting of an 11-inch Celestron, an SBIG ST-4 autoguiding CCD camera and a PC, is described. Two such systems were used during June–July and November–December 1993 to make near-simultaneous seeing measurements at Freeling Heights in the Northern Flinders Ranges and at Siding Spring Observatory. The results of these campaigns show that the seeing-distribution is generally similar at both sites, with the most common seeing value being ~l·2″. Siding Spring does, however, have slightly more bad seeing (>2″) than Freeling Heights. Weather records from Arkaroola Resort (15 km south of Freeling Heights) indicate that there is ~15% less cloud cover at Freeling Heights than at Siding Spring. Episodes of rapid seeing deterioration at Siding Spring in winter are shown to coincide with warm air masses crossing the mountain.
Whether the public stigma associated with mental illness negatively affects an individual, largely depends on whether the person has been labelled ‘mentally ill’. For labelled individuals concealing mental illness is a common strategy to cope with mental illness stigma, despite secrecy's potential negative consequences. In addition, initial evidence points to a link between stigma and suicidality, but quantitative data from community samples are lacking.
Methods.
Based on previous literature about mental illness stigma and suicidality, as well as about the potential influence of labelling processes and secrecy, a theory-driven model linking perceived mental illness stigma and suicidal ideation by a mediation of secrecy and hopelessness was established. This model was tested separately among labelled and unlabelled persons using data derived from a Swiss cross-sectional population-based study. A large community sample of people with elevated psychiatric symptoms was examined by interviews and self-report, collecting information on perceived stigma, secrecy, hopelessness and suicidal ideation. Participants who had ever used mental health services were considered as labelled ‘mentally ill’. A descriptive analysis, stratified logistic regression models and a path analysis testing a three-path mediation effect were conducted.
Results.
While no significant differences between labelled and unlabelled participants were observed regarding perceived stigma and secrecy, labelled individuals reported significantly higher frequencies of suicidal ideation and feelings of hopelessness. More perceived stigma was associated with suicidal ideation among labelled, but not among unlabelled individuals. In the path analysis, this link was mediated by increased secrecy and hopelessness.
Conclusions.
Results from this study indicate that among persons labelled ‘mentally ill’, mental illness stigma is a contributor to suicidal ideation. One explanation for this association is the relation perceived stigma has with secrecy, which introduces negative emotional consequences. If our findings are replicated, they would suggest that programmes empowering people in treatment for mental illness to cope with anticipated and experienced discrimination as well as interventions to reduce public stigma within society could improve suicide prevention.
Dr. Russell (2013) provocatively critiqued turnover research, expressing a sentiment that we share—namely, the lamentable modest predictability of turnover. All the same, we disagree with certain criticisms of turnover theory, methodology, and practicality. We organize our reactions into sections: predictive validity for the standard turnover criterion; other criteria for model evaluation; incremental validity controlling quit intentions; Russell's proposed methodology, the potential biases of the Russell and Van Sell (2012) test; and an alternate approach by Hom, Mitchell, Lee, and Griffeth (2012).
Prevalence and covariates of subclinical psychosis have gained increased interest in the context of early identification and treatment of persons at risk for psychosis.
Methods.
We analysed 9829 adults representative of the general population within the canton of Zurich, Switzerland. Two psychosis syndromes, derived from the SCL-90-R, were applied: ‘schizotypal signs’ and ‘schizophrenia nuclear symptoms’.
Results.
Only a few subjects (13.2%) reported no schizotypal signs. While 33.2% of subjects indicated mild signs, only a small proportion (3.7%) reported severe signs. A very common outcome was no ‘schizophrenia nuclear symptoms’ (70.6%). Although 13.5% of the participants reported mild symptoms, severe nuclear symptoms were very rare (0.5%). Because these two syndromes were only moderately correlated (r = 0.43), we were able to establish sufficiently distinct symptom clusters. Schizotypal signs were more closely connected to distress than was schizophrenia nuclear symptoms, even though their distribution types were similar. Both syndromes were associated with several covariates, such as alcohol and tobacco use, being unmarried, low education level, psychopathological distress and low subjective well-being.
Conclusions.
Subclinical psychosis symptoms are quite frequent in the general population but, for the most part, are not very pronounced. In particular, our data support the notion of a continuous Wald distribution of psychotic symptoms in the general population. Our findings have enabled us to confirm the usefulness of these syndromes as previously assessed in other independent community samples. Both can appropriately be associated with well-known risk factors of schizophrenia.
To examine stigma- and knowledge-related barriers to help-seeking among members of the general population.
Methods.
In a representative survey of young to middle-aged Swiss adults (n = 8875), shame about a potential own mental illness, perceived knowledge about and satisfaction with one's mental health, psychiatric symptoms and attitudes towards help-seeking were assessed.
Results.
A latent profile analysis of all participants yielded two groups with different attitudes towards help-seeking. Relative to the majority, a one-in-four subgroup endorsed more negative attitudes towards seeking professional help, including psychiatric medication, and was characterized by more shame, less perceived knowledge, higher satisfaction with their mental health, younger age, male gender and lower education. Among participants with high symptom levels (n = 855), a third subgroup was reluctant to seek help in their private environment and characterized by high symptoms as well as low satisfaction with their mental health.
Conclusions.
Shame as an emotional proxy of self-stigma as well as poor subjective mental health literacy may be independent barriers to help-seeking. Interventions to increase mental health service use could focus on both variables and on those individuals with more negative views about professional help, in the general public as well as among people with a current mental illness.
In this work, we take advantage of injection molding as a high volume and repeatable method to create surface areas for the growth of human mesenchymal stem cells (hMSCs). Ultraviolet lithography, combined with deep reactive ion etching, was used to generate micro-features over a relatively large surface area of a silicon wafer. The micro-featured silicon wafer was used as a mold insert for the micro-injection molding process to create polystyrene and low density polyethylene surfaces. Micro-geometry was used to alter the effective surface stiffness of the polymer substrate. Created samples were characterized via scanning electron microscopy and tensile testing. hMSCs were seeded onto samples for initial studies. Actin and vinculin were visualized through ICC to compare cytoskeletal elements. Changes in cell morphology were examined using ICC. Results indicate that injection molding of microfeatured substrates is a viable technique to produce surfaces amenable to stem cell growth.
The Gemini Observatories primarily operate a multi-instrument queue, with observers selecting observations that are best suited to weather and seeing conditions. The Target of Opportunity (ToO) observing mode is intended to allow observation of targets that cannot be specified in advance but which have a well defined external trigger such as distant supernovae or Gamma Ray bursts. In addition, the instrument and configuration best suited to observe the ToO may depend on properties of the event, such as brightness and redshift which again are impossible to know in advance. Queue observing naturally lends itself to Target of Opportunity (ToO) support since the time required to switch between programs and instruments is very short, and the staff observer is trained to operate all the available instruments and modes. Gemini Observatory has supported pre-approved ToO programs since beginning queue operations, and has implemented a rapid (less than 15 minutes response time) ToO mode since 2005. ToOs comprise a significant fraction of the queue (20–25% of the highest ranking band) nowadays. We discuss the ToO procedures, the statistics of rapid ToOs observing at Gemini North Observatory, the science related to GRBs and supernovae that this important mode has enabled.