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Patients with posttraumatic stress disorder (PTSD) exhibit smaller regional brain volumes in commonly reported regions including the amygdala and hippocampus, regions associated with fear and memory processing. In the current study, we have conducted a voxel-based morphometry (VBM) meta-analysis using whole-brain statistical maps with neuroimaging data from the ENIGMA-PGC PTSD working group.
Methods
T1-weighted structural neuroimaging scans from 36 cohorts (PTSD n = 1309; controls n = 2198) were processed using a standardized VBM pipeline (ENIGMA-VBM tool). We meta-analyzed the resulting statistical maps for voxel-wise differences in gray matter (GM) and white matter (WM) volumes between PTSD patients and controls, performed subgroup analyses considering the trauma exposure of the controls, and examined associations between regional brain volumes and clinical variables including PTSD (CAPS-4/5, PCL-5) and depression severity (BDI-II, PHQ-9).
Results
PTSD patients exhibited smaller GM volumes across the frontal and temporal lobes, and cerebellum, with the most significant effect in the left cerebellum (Hedges’ g = 0.22, pcorrected = .001), and smaller cerebellar WM volume (peak Hedges’ g = 0.14, pcorrected = .008). We observed similar regional differences when comparing patients to trauma-exposed controls, suggesting these structural abnormalities may be specific to PTSD. Regression analyses revealed PTSD severity was negatively associated with GM volumes within the cerebellum (pcorrected = .003), while depression severity was negatively associated with GM volumes within the cerebellum and superior frontal gyrus in patients (pcorrected = .001).
Conclusions
PTSD patients exhibited widespread, regional differences in brain volumes where greater regional deficits appeared to reflect more severe symptoms. Our findings add to the growing literature implicating the cerebellum in PTSD psychopathology.
Cattle (Bos spp.) grazing on weed–mixed forage biomass may potentially spread weed seeds, leading to plant invasions across pasturelands. Understanding the possibility and intensity of this spread is crucial for developing effective weed control methods in grazed areas. This research undertook an in vitro experiment to evaluate the germination and survival of five dominant weed species in the southern United States [Palmer amaranth (Amaranthus palmeri S. Watson), yellow foxtail [Setaria pumila (Poir.) Roem. & Schult.], johnsongrass [Sorghum halepense (L.) Pers.], field bindweed (Convolvulus arvensis L.) and pitted morningglory (Ipomoea lacunosa L.)] upon incubation in rumen fluid for eight time periods (0, 4, 8, 12, 24, 24, 48, 72, and 96 h). For the 96-h treatment, a full Tilley and Terry procedure was applied after 48 h for stopping fermentation, followed by incubation for another 48 h simulating abomasum digestion. Seed germination, upon incubation, varied significantly among weed species, with I. lacunosa reaching zero germination after only 24 h of incubation, whereas A. palmeri and S. halepense retained up to 3% germination even after 96 h of incubation. The hard seed coats of A. palmeri and S. halepense likely made them highly resistant, whereas the I. lacunosa seed coat became easily permeable and ruptured under rumen fluid incubation. This suggests that cattle grazing can selectively affect seed distribution and invasiveness of weeds in grazed grasslands and rangelands, including the designated invasive and noxious weed species. As grazing is a significant component in animal husbandry, a major economic sector in the U.S. South, our research provides important insights into the potential role of grazing as a dispersal mechanism for some of the troublesome arable weeds in the United States. The results offer opportunities for devising customized feeding and grazing practices combined with timely removal of weeds in grazeable lands at the pre-flowering stage for effective containment of weeds.
Recent changes to US research funding are having far-reaching consequences that imperil the integrity of science and the provision of care to vulnerable populations. Resisting these changes, the BJPsych Portfolio reaffirms its commitment to publishing mental science and advancing psychiatric knowledge that improves the mental health of one and all.
Despite the influence of key figures like Henry Sigerist and the Rockefeller Foundation, social medicine achieved a formal presence at only a handful of medical schools in the US, partly reflecting the political context in which “social medicine” was often heard as “socialized medicine.” Work that might otherwise have been called social medicine had to pass under other names. Does “social medicine” in the US only include those who self-identified with social medicine or does it include people who worked in the spirit of social medicine? Beginning with the recognized work of Sigerist and the Rockefeller, we then examine several Black social theorists whose work can now be recognized as social medicine. The Cold War context challenged would-be proponents of social medicine but different threads endured. The first, clinically oriented, focused on community health. The second, based in academic departments, applied the interpretive social sciences to explore the interspace between the clinical and the social. These threads converged in the 1990s and 2000s in new forms of social medicine considered as healthcare committed to social justice and health equity.
The participants at the six-party talks should consider the full scope of activities needed to implement the South Korean scheme; that they should explore an alternative approach that would link the Russian and South Korean grids, thereby achieving the same outcome at lower cost and lesser political risk; and that the six parties should consider adopting a short-term, alternative package rather than resuming HFO deliveries to the DPRK because this approach would provide more energy services, faster, and at lower risk and cost to give immediate substance to statements of longer “term intention to supply assistance to the DPRK. We further suggest that these issues be explored with the North Koreans at the six-party talks at a subsequent technical working group before major commitments are made to proceeding with the South Korean proposal.
Despite advances in antiretroviral treatment (ART), human immunodeficiency virus (HIV) can detrimentally affect everyday functioning. Neurocognitive impairment (NCI) and current depression are common in people with HIV (PWH) and can contribute to poor functional outcomes, but potential synergies between the two conditions are less understood. Thus, the present study aimed to compare the independent and combined effects of NCI and depression on everyday functioning in PWH. We predicted worse functional outcomes with comorbid NCI and depression than either condition alone.
Methods:
PWH enrolled at the UCSD HIV Neurobehavioral Research Program were assessed for neuropsychological performance, depression severity (≤minimal, mild, moderate, or severe; Beck Depression Inventory-II), and self-reported everyday functioning.
Results:
Participants were 1,973 PWH (79% male; 66% racial/ethnic minority; Age: M = 48.6; Education: M = 13.0, 66% AIDS; 82% on ART; 42% with NCI; 35% BDI>13). ANCOVA models found effects of NCI and depression symptom severity on all functional outcomes (ps < .0001). With NCI and depression severity included in the same model, both remained significant (ps < .0001), although the effects of each were attenuated, and yielded better model fit parameters (i.e., lower AIC values) than models with only NCI or only depression.
Conclusions:
Consistent with prior literature, NCI and depression had independent effects on everyday functioning in PWH. There was also evidence for combined effects of NCI and depression, such that their comorbidity had a greater impact on functioning than either alone. Our results have implications for informing future interventions to target common, comorbid NCI and depressed mood in PWH and thus reduce HIV-related health disparities.
Archimedes screw generators are a small-scale, eco-friendly hydropower technology. Despite their promise as a sustainable energy technology, the design specifics of the technology are not well documented in the published literature. Existing performance prediction models often fail to accurately forecast power loss, particularly as it relates to the outlet of the screw generator. To address this, a comprehensive computational fluid dynamic model was developed and evaluated using both laboratory-scale experiments and real-world data. This yielded an extensive dataset that covered wide variations in design parameters. The dataset was then used to inform the development and evaluation of an outlet power loss prediction model. The resulting model significantly improved the accuracy of overall performance predictions, reducing average error to 13.68 % compared with nominal experimental data – a substantial improvement over previous models, which averaged around 42.55 % error for the same test cases. Notably, the new model achieved an absolute error of 5 % or less in over 26 % of comparison points, marking a remarkable advancement by predicting outlet power loss by more than 28.8 %.
To better understand clinicians’ rationale for ordering testing for C. difficile infection (CDI) for patients receiving laxatives and the impact of the implementation of a clinical decision support (CDS) intervention.
Design:
A mixed-methods, case series was performed from March 2, 2017 to December 31, 2018.
Setting:
Yale New Haven Hospital, a 1,541 bed tertiary academic medical center.
Participants:
Hospitalized patients ≥ 18 years old, and clinicians who were alerted by the CDS.
Intervention:
CDS was triggered in real-time when a clinician sought to order testing for CDI for a patient who received one or more doses of laxatives within the preceding 24 hours.
Results:
A total of 3,376 CDS alerts were triggered during the 21-month study period from 2,567 unique clinician interactions. Clinicians bypassed the CDS alert 74.5% of the time, more frequent among residents (48.3% bypass vs. 39.9% accept) and advanced practice providers (APPs) (34.9% bypass vs. 30.6% accept) than attendings (11.3% bypass vs. 22.5% accept). Ordering clinicians noted increased stool frequency/output (48%), current antibiotic exposure (34%), and instructions by an attending physician to test (28%) were among the most common reasons for overriding the alert and proceeding with testing for CDI.
Conclusions:
Testing for CDI despite patient laxative use was associated with an increased clinician concern for CDI, patient risk for CDI, and attending physician instruction for testing. Attendings frequently accepted CDS guidance while residents and APPs often reinstated CDI test orders, suggesting a need for greater empowerment and discretion when ordering tests.
To improve early intervention and personalise treatment for individuals early on the psychosis continuum, a greater understanding of symptom dynamics is required. We address this by identifying and evaluating the movement between empirically derived attenuated psychotic symptomatic substates—clusters of symptoms that occur within individuals over time.
Methods
Data came from a 90-day daily diary study evaluating attenuated psychotic and affective symptoms. The sample included 96 individuals aged 18–35 on the psychosis continuum, divided into four subgroups of increasing severity based on their psychometric risk of psychosis, with the fourth meeting ultra-high risk (UHR) criteria. A multilevel hidden Markov modelling (HMM) approach was used to characterise and determine the probability of switching between symptomatic substates. Individual substate trajectories and time spent in each substate were subsequently assessed.
Results
Four substates of increasing psychopathological severity were identified: (1) low-grade affective symptoms with negligible psychotic symptoms; (2) low levels of nonbizarre ideas with moderate affective symptoms; (3) low levels of nonbizarre ideas and unusual thought content, with moderate affective symptoms; and (4) moderate levels of nonbizarre ideas, unusual thought content, and affective symptoms. Perceptual disturbances predominantly occurred within the third and fourth substates. UHR individuals had a reduced probability of switching out of the two most severe substates.
Conclusions
Findings suggest that individuals reporting unusual thought content, rather than nonbizarre ideas in isolation, may exhibit symptom dynamics with greater psychopathological severity. Individuals at a higher risk of psychosis exhibited persistently severe symptom dynamics, indicating a potential reduction in psychological flexibility.
This wide-ranging, historically grounded exploration of motion picture remakes produced in East Asia brings together original contributions from experts in Chinese, Hong Kong, Japanese, South Korean, and Taiwanese cinemas and puts forth new ways of thinking about the remaking process as both a critically underappreciated form of artistic expression and an economically motivated industrial practice. Exploring everything from ethnic Korean filmmaker Lee Sang-il's 'Unforgiven' (2013), a Japanese remake of Clint Eastwood's Western of the same title, to Stephen Chow's 'The Mermaid' (2016), a Chinese slapstick reimagining of Walt Disney's 'The Little Mermaid' (1989) and Hans Christian Andersen's 1837 fairy tale, East Asian Film Remakes contributes to a better understanding of cinematic remaking across the region and offers vital alternatives to the Eurocentric and Hollywood-focused approaches that have thus far dominated the field.
Duchenne muscular dystrophy is a devastating neuromuscular disorder characterized by the loss of dystrophin, inevitably leading to cardiomyopathy. Despite publications on prophylaxis and treatment with cardiac medications to mitigate cardiomyopathy progression, gaps remain in the specifics of medication initiation and optimization.
Method:
This document is an expert opinion statement, addressing a critical gap in cardiac care for Duchenne muscular dystrophy. It provides thorough recommendations for the initiation and titration of cardiac medications based on disease progression and patient response. Recommendations are derived from the expertise of the Advance Cardiac Therapies Improving Outcomes Network and are informed by established guidelines from the American Heart Association, American College of Cardiology, and Duchenne Muscular Dystrophy Care Considerations. These expert-derived recommendations aim to navigate the complexities of Duchenne muscular dystrophy-related cardiac care.
Results:
Comprehensive recommendations for initiation, titration, and optimization of critical cardiac medications are provided to address Duchenne muscular dystrophy-associated cardiomyopathy.
Discussion:
The management of Duchenne muscular dystrophy requires a multidisciplinary approach. However, the diversity of healthcare providers involved in Duchenne muscular dystrophy can result in variations in cardiac care, complicating treatment standardization and patient outcomes. The aim of this report is to provide a roadmap for managing Duchenne muscular dystrophy-associated cardiomyopathy, by elucidating timing and dosage nuances crucial for optimal therapeutic efficacy, ultimately improving cardiac outcomes, and improving the quality of life for individuals with Duchenne muscular dystrophy.
Conclusion:
This document seeks to establish a standardized framework for cardiac care in Duchenne muscular dystrophy, aiming to improve cardiac prognosis.
This paper describes a semantics for pure Prolog programs with negation that provides meaning to metaprograms. Metaprograms are programs that construct and use data structures as programs. In Prolog a primary mataprogramming construct is the use of a variable as a literal in the body of a clause. The traditional Prolog 3-line metainterpreter is another example of a metaprogram. The account given here also supplies a meaning for clauses that have a variable as head, even though most Prolog systems do not support such clauses. This semantics naturally includes such programs, giving them their intuitive meaning. Ideas from Denecker and his colleagues form the basis of this approach. The key idea is to notice that if we give meanings to all propositional programs and treat Prolog rules with variables as the set of their ground instances, then we can give meanings to all programs. We must treat Prolog rules (which may be metarules) as templates for generating ground propositional rules, and not as first-order formulas, which they may not be. We use parameterized inductive definitions to give propositional models to Prolog programs, in which the propositions are expressions. Then the set of expressions of a propositional model determine a first-order Herbrand Model, providing a first-order logical semantics for all (pure) Prolog programs, including metaprograms. We give examples to show the applicability of this theory. We also demonstrate how this theory makes proofs of some important properties of metaprograms very straightforward.
Examine the relationship between patients’ race and prescriber antibiotic choice while accounting for differences in underlying illness and infection severity.
Design:
Retrospective cohort analysis.
Setting:
Acute care facilities within an academic healthcare system.
Patients:
Adult inpatients from January 2019 through June 2022 discharged from the Hospital Medicine Service with an ICD-10 Code for Pneumonia.
Methods:
We describe variability in days of therapy of antimicrobials with activity against Pseudomonas aeruginosa (anti-Pseudomonas agents) or against MRSA (anti-MRSA agents), by patient’s race and ethnicity. We estimated the likelihood of receipt of any anti-Pseudomonas agents by race and modeled the effect of race on rate of use, adjusting for age, severity, and indication.
Results:
5,820 patients with 6,700 encounters were included. After adjusting for broad indication, severity, underlying illness, and age, use of anti-Pseudomonas agents were less likely among non-Hispanic Black patients than other race groups, although this effect was limited to younger patients (adjusted odds ratio [aOR] 0.45, 95% confidence interval [CI] 0.29, 0.70), and not older ones (aOR 0.98; 95% CI 0.85, 1.13); use of anti-MRSA agents were similar between groups. Among patients receiving any anti-Pseudomonas agents, Black patients received them for relatively lower proportion of their inpatient stay (incidence rate ratio 0.91; 95% CI 0.87, 0.96).
Conclusions:
We found difference in use of anti-Pseudomonas agents between non-Hispanic Black patients and other patients that could not be easily explained by indications or underlying illness, suggesting unmeasured factors may be playing a role in treatment decisions.
Research on nutraceutical and dietary interventions in psychiatry has grown substantially, but progress is hindered by methodological inconsistencies and limited reporting standards. To address this, the International Society for Nutritional Psychiatry Research presents the first guidelines on clinical trial design, conduct, and reporting for future clinical trials in this area. Recommendations were developed using a Delphi process including eighteen researchers with considerable clinical trial expertise and experience in either methodology, nutraceutical, or dietary interventions in psychiatry. These guidelines provide forty-nine recommendations for clinical trial design and outcomes, five for trial reporting, and seven for future research priorities. The recommendations included in these guidelines are designed to inform both nutraceutical and dietary clinical trial interventions in Nutritional Psychiatry. Common themes include an emphasis on the importance of a multidisciplinary research team and integration of co-design processes into the conduct and design of clinical research, methods to improve transparency and replicability of trial outcomes, and measures to address common biases in nutrition trials. Furthermore, we provide recommendations for future research including examining a greater variety of nutraceutical and dietary interventions, scalable delivery models, effectiveness and implementation studies, and the need to investigate these interventions in the prevention and management of less studied psychiatric conditions (e.g. schizophrenia and bipolar disorder). Recommendations included within these guidelines are intended to improve the rigor and clinical relevance of ongoing and future clinical trials in Nutritional Psychiatry.
There is a growing awareness that diversity, health equity, and inclusion play a significant role in improving patient outcomes and advancing knowledge. The Pediatric Heart Network launched an initiative to incorporate diversity, health equity, and inclusion into its 2021 Scholar Award Funding Opportunity Announcement. This manuscript describes the process of incorporating diversity, health equity, and inclusion into the Pediatric Heart Network Scholar Award and the lessons learned. Recommendations for future Pediatric Heart Network grant application cycles are made which could be replicated by other funding agencies.
Responding to increasing concerns regarding human-induced climate change and shared commitment as environmental educators to support climate action, we crafted this article as a composite piece — an emerging method of inquiry. We are eleven contributors: the Editorial Executive of the Australian Journal of Environmental Education and two colleagues who each respond to prompts concerning our experience of climate change and our practices of climate change education. The responses provide insights regarding how we strive to enact meaningful climate action, education, advocacy and agency. This article presents the reader with various ways environmental educators work through eco-anxiety and engage in active hope when supporting climate change education/agency/action. The following insights emerged, illustrating 1. the significance of embracing diverse perspectives and knowledge systems; 2. Emotions as catalysts for action and activism; 3. the value of fostering collaborative spaces/relationships/communities that empower people; 4. the importance of integrating ethical responses and critical climate literacy in climate change education/research; 5. learning from places and multi-species entanglements; 6. acknowledging tensions. We offer these six insights not as a solution but as a potentially generative heuristic for navigating the complexity and uncertainty of climate change education in contemporary times.
Identifying persons with HIV (PWH) at increased risk for Alzheimer’s disease (AD) is complicated because memory deficits are common in HIV-associated neurocognitive disorders (HAND) and a defining feature of amnestic mild cognitive impairment (aMCI; a precursor to AD). Recognition memory deficits may be useful in differentiating these etiologies. Therefore, neuroimaging correlates of different memory deficits (i.e., recall, recognition) and their longitudinal trajectories in PWH were examined.
Design:
We examined 92 PWH from the CHARTER Program, ages 45–68, without severe comorbid conditions, who received baseline structural MRI and baseline and longitudinal neuropsychological testing. Linear and logistic regression examined neuroanatomical correlates (i.e., cortical thickness and volumes of regions associated with HAND and/or AD) of memory performance at baseline and multilevel modeling examined neuroanatomical correlates of memory decline (average follow-up = 6.5 years).
Results:
At baseline, thinner pars opercularis cortex was associated with impaired recognition (p = 0.012; p = 0.060 after correcting for multiple comparisons). Worse delayed recall was associated with thinner pars opercularis (p = 0.001) and thinner rostral middle frontal cortex (p = 0.006) cross sectionally even after correcting for multiple comparisons. Delayed recall and recognition were not associated with medial temporal lobe (MTL), basal ganglia, or other prefrontal structures. Recognition impairment was variable over time, and there was little decline in delayed recall. Baseline MTL and prefrontal structures were not associated with delayed recall.
Conclusions:
Episodic memory was associated with prefrontal structures, and MTL and prefrontal structures did not predict memory decline. There was relative stability in memory over time. Findings suggest that episodic memory is more related to frontal structures, rather than encroaching AD pathology, in middle-aged PWH. Additional research should clarify if recognition is useful clinically to differentiate aMCI and HAND.
There is considerable interest in the role of neuroimmune processes in neuropsychiatric presentations among young people seeking mental health, neurological, paediatric and rheumatological services. The increasing availability of new immunotherapies, particularly monoclonal antibodies, introduces challenges in effectively and appropriately selecting candidates for immunotherapies. Neuroimmune-mediated neuropsychiatric syndromes (NIMNPS) typically include two broad types: i) ‘autoimmune encephalitis’, characterised by acute or subacute onset, neurological signs such as seizures, delirium or motor features and severe psychotic or major mood phenomena. Anti-N-methyl-D-aspartate receptor encephalitis was a pioneering clinical example, but various other autoantibodies have since been associated with this phenotype; and ii) atypical mood or psychotic syndromes with sub-acute or insidious onset, moderately severe atypical mood or psychotic symptoms, autonomic dysregulation, narcolepsy-like features, poor response to conventional treatments and adverse (notably motor) effects from psychotropic medications. Diagnosis of NIMNPS requires clinical or laboratory evidence of direct brain involvement, though autoantibodies are not always detectable. Given the broad and controversial diagnostic criteria for NIMNPS, we propose standardised clinical criteria for identifying ‘possible cases’, followed by laboratory, neuropsychological and brain imaging tests to confirm ‘probable’ cases suitable for immunotherapy. We emphasise rapid clinical and informed co-decision-making with young people and their families and loved ones. While immunotherapy holds promise for symptom alleviation, highly-personalised approaches and long-term management are essential. Future research should validate our proposed criteria, establish optimal, standardised yet personalised immunotherapy strategies that balance between clinical benefit and risks, and identify predictive markers of treatment response.
Yellow and knotroot foxtail are two common weed species infesting turfgrass and pastures in the southeastern region of the United States. Yellow and knotroot foxtail share morphological similarities and are frequently misidentified by weed managers, thus leading to confusion in herbicide selection. Greenhouse research was conducted to evaluate the response of yellow and knotroot foxtail to several turfgrass herbicides: pinoxaden (35 and 70 g ai ha−1), sethoxydim (316 and 520 g ai ha−1), thiencarbazone + dicamba + iodosulfuron (230 g ai ha−1), nicosulfuron + rimsulfuron (562.8 g ai ha−1), metribuzin (395 g ha−1), sulfentrazone (330 g ai ha−1), sulfentrazone + imazethapyr (504 g ai ha−1), and imazaquin (550 g ai ha−1). All treatments controlled yellow foxtail >87% with more than 90% reduction of the biomass. By comparison, only sulfentrazone alone controlled knotroot foxtail 90% and completely reduced aboveground biomass. Sethoxydim (520 g ai ha−1), metribuzin, and imazaquin controlled knotroot foxtail >70% at 28 d after application. In a rate response evaluation, nonlinear regression showed that yellow foxtail was approximately 8 times more susceptible to pinoxaden and 2 times more susceptible to sethoxydim than knotroot foxtail based on log (WR50) values, which were 50% reduction in fresh weight. Our research indicates that knotroot foxtail is more difficult to control across a range of herbicides, making differentiation of these two species important before herbicides are applied.
In order to study the structure and temperature distribution within high-mass star-forming clumps, we employed the Australia Telescope Compact Array to image the $\mathrm{NH}_3$ (J,K) = (1,1) through (6,6) and the (2,1) inversion transitions, the $\mathrm{H}_2\mathrm{O}$$6_{16}$-$5_{23}$ maser line at 22.23508 GHz, several $\mathrm{CH}_3\mathrm{OH}$ lines and hydrogen and helium recombination lines. In addition, 22- and 24-GHz radio continuum emission was also imaged.
The $\mathrm{NH}_3$ lines probe the optical depth and gas temperature of compact structures within the clumps. The $\mathrm{H}_2\mathrm{O}$ maser pinpoints the location of shocked gas associated with star formation. The recombination lines and the continuum emission trace the ionised gas associated with hot OB stars. The paper describes the data and presents sample images and spectra towards select clumps. The technique for estimating gas temperature from $\mathrm{NH}_3$ line ratios is described. The data show widespread hyperfine intensity anomalies in the $\mathrm{NH}_3$ (1,1) images, an indicator of non-LTE $\mathrm{NH}_3$ excitation. We also identify several new $\mathrm{NH}_3$ (3,3) masers associated with shocked gas. Towards AGAL328.809+00.632, the $\mathrm{H}_2\mathrm{O}$$6_{16}$-$5_{23}$ line, normally seen as a maser, is instead seen as a thermally excited absorption feature against a strong background continuum. The data products are described in detail.