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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.
We investigate the turbulence below a quasi-flat free surface, focusing on the energy transport in space and across scales. We leverage a large zero-mean-flow tank where homogeneous turbulence is generated by randomly actuated jets. A wide range of Reynolds number is spanned, reaching sufficient scale separation for the emergence of an inertial sub-range. Unlike previous studies, the forcing extends through the source layer, although the surface deformation remains millimetric. Particle image velocimetry along a surface-normal plane resolves from the dissipative to the integral scales. The contributions to turbulent kinetic energy from both vertical and horizontal components of velocity approach the prediction based on rapid distortion theory as the Reynolds number is increased, indicating that discrepancies among previous studies are likely due to differences in the forcing. At odds with the theory, however, the integral scale of the horizontal fluctuations grows as the surface is approached. This is rooted in the profound influence exerted by the surface on the inter-scale energy transfer: along horizontal separations, the direct cascade of energy in horizontal fluctuations is hindered, while an inverse cascade of that in vertical fluctuations is established. This is connected to the structure of upwellings and downwellings. The former, characterized by somewhat larger spatial extent and stronger intensity, are associated with extensional surface-parallel motions. They thus transfer energy to the larger horizontal scales, prevailing over downwellings which favour the compression (and concurrent vertical stretching) of the eddies. Both types of structures extend to depths between the integral scale and the Taylor microscale.
We present experiments on large air cavities spanning a wide range of sizes relative to the Hinze scale $d_{H}$, the scale at which turbulent stresses are balanced by surface tension, disintegrating in turbulence. For cavities with initial sizes $d_0$ much larger than $d_{H}$ (probing up to $d_0/d_{H} = 8.3$), the size distribution of bubbles smaller than $d_{H}$ follows $N(d) \propto d^{-3/2}$, with $d$ the bubble diameter. The capillary instability of ligaments involved in the deformation of the large bubbles is shown visually to be responsible for the creation of the small bubbles. Turning to dynamical, three-dimensional measurements of individual break-up events, we describe the break-up child size distribution and the number of child bubbles formed as a function of $d_0/d_{H}$. Then, to model the evolution of a population of bubbles produced by turbulent bubble break-up, we propose a population balance framework in which break-up involves two physical processes: an inertial deformation to the parent bubble that sets the size of large child bubbles, and a capillary instability that sets the size of small child bubbles. A Monte Carlo approach is used to construct the child size distribution, with simulated stochastic break-ups constrained by our experimental measurements and the understanding of the role of capillarity in small bubble production. This approach reproduces the experimental time evolution of the bubble size distribution during the disintegration of large air cavities in turbulence.
Limited data exist on training of European paediatric and adult congenital cardiologists.
Methods:
A structured and approved questionnaire was circulated to national delegates of Association for European Paediatric and Congenital Cardiology in 33 European countries.
Results:
Delegates from 30 countries (91%) responded. Paediatric cardiology was not recognised as a distinct speciality by the respective ministry of Health in seven countries (23%). Twenty countries (67%) have formally accredited paediatric cardiology training programmes, seven (23%) have substantial informal (not accredited or certified) training, and three (10%) have very limited or no programme. Twenty-two countries have a curriculum. Twelve countries have a national training director. There was one paediatric cardiology centre per 2.66 million population (range 0.87–9.64 million), one cardiac surgical centre per 4.73 million population (range 1.63–10.72 million), and one training centre per 4.29 million population (range 1.63–10.72 million population). The median number of paediatric cardiology fellows per training programme was 4 (range 1–17), and duration of training was 3 years (range 2–5 years). An exit examination in paediatric cardiology was conducted in 16 countries (53%) and certification provided by 20 countries (67%). Paediatric cardiologist number is affected by gross domestic product (R2 = 0.41).
Conclusion:
Training varies markedly across European countries. Although formal fellowship programmes exist in many countries, several countries have informal training or no training. Only a minority of countries provide both exit examination and certification. Harmonisation of training and standardisation of exit examination and certification could reduce variation in training thereby promoting high-quality care by European congenital cardiologists.
We investigate how turbulence in liquid affects the rising speed of gas bubbles within the inertial range. Experimentally, we employ stereoscopic tracking of bubbles rising through water turbulence created by the convergence of turbulent jets and characterized with particle image velocimetry performed throughout the measurement volume. We use the spatially varying, time-averaged mean water velocity field to consider the physically relevant bubble slip velocity relative to the mean flow. Over a range of bubble sizes within the inertial range, we find that the bubble mean rise velocity $\left \langle v_z \right \rangle$ decreases with the intensity of the turbulence as characterized by its root-mean-square fluctuation velocity, $u'$. Non-dimensionalized by the quiescent rise velocity $v_{q}$, the average rise speed follows $\left \langle v_z \right \rangle /v_{q}\propto 1/{\textit {Fr}}$ at high ${\textit {Fr}}$, where ${\textit {Fr}}=u'/\sqrt {dg}$ is a Froude number comparing the intensity of the turbulence to the bubble buoyancy, with $d$ the bubble diameter and $g$ the acceleration due to gravity. We complement these results by performing numerical integration of the Maxey–Riley equation for a point bubble experiencing nonlinear drag in three-dimensional, homogeneous and isotropic turbulence. These simulations reproduce the slowdown observed experimentally, and show that the mean magnitude of the slip velocity is proportional to the large-scale fluctuations of the flow velocity. Combining the numerical estimate of the slip velocity magnitude with a simple theoretical model, we show that the scaling $\left \langle v_z \right \rangle /v_{q}\propto 1/{\textit {Fr}}$ originates from a combination of the nonlinear drag and the nearly isotropic behaviour of the slip velocity at large ${\textit {Fr}}$ that drastically reduces the mean rise speed.
Influenza vaccination remains the most effective primary prevention strategy for seasonal influenza. This research explores the percentage of emergency medical services (EMS) clinicians who received the seasonal flu vaccine in a given year, along with their reasons for vaccine acceptance and potential barriers.
Methods:
A survey was distributed to all EMS clinicians in Virginia during the 2018-2019 influenza season. The primary outcome was vaccination status. Secondary outcomes were attitudes and perceptions toward influenza vaccination, along with patient care behaviors when treating an influenza patient.
Results:
Ultimately, 2796 EMS clinicians throughout Virginia completed the survey sufficiently for analysis. Participants were mean 43.5 y old, 60.7% male, and included the full range of certifications. Overall, 79.4% of surveyed EMS clinicians received a seasonal flu vaccine, 74% had previously had the flu, and 18% subjectively reported previous side effects from the flu vaccine. Overall, 54% of respondents believed their agency has influenza or respiratory specific plans or procedures.
Conclusions:
In a large, state-wide survey of EMS clinicians, overall influenza vaccination coverage was 79.4%. Understanding the underlying beliefs of EMS clinicians remains a critical priority for protecting these frontline clinicians. Agencies should consider practical policies, such as on-duty vaccination, to increase uptake.
Clarifying the relationship between depression symptoms and cardiometabolic and related health could clarify risk factors and treatment targets. The objective of this study was to assess whether depression symptoms in midlife are associated with the subsequent onset of cardiometabolic health problems.
Methods
The study sample comprised 787 male twin veterans with polygenic risk score data who participated in the Harvard Twin Study of Substance Abuse (‘baseline’) and the longitudinal Vietnam Era Twin Study of Aging (‘follow-up’). Depression symptoms were assessed at baseline [mean age 41.42 years (s.d. = 2.34)] using the Diagnostic Interview Schedule, Version III, Revised. The onset of eight cardiometabolic conditions (atrial fibrillation, diabetes, erectile dysfunction, hypercholesterolemia, hypertension, myocardial infarction, sleep apnea, and stroke) was assessed via self-reported doctor diagnosis at follow-up [mean age 67.59 years (s.d. = 2.41)].
Results
Total depression symptoms were longitudinally associated with incident diabetes (OR 1.29, 95% CI 1.07–1.57), erectile dysfunction (OR 1.32, 95% CI 1.10–1.59), hypercholesterolemia (OR 1.26, 95% CI 1.04–1.53), and sleep apnea (OR 1.40, 95% CI 1.13–1.74) over 27 years after controlling for age, alcohol consumption, smoking, body mass index, C-reactive protein, and polygenic risk for specific health conditions. In sensitivity analyses that excluded somatic depression symptoms, only the association with sleep apnea remained significant (OR 1.32, 95% CI 1.09–1.60).
Conclusions
A history of depression symptoms by early midlife is associated with an elevated risk for subsequent development of several self-reported health conditions. When isolated, non-somatic depression symptoms are associated with incident self-reported sleep apnea. Depression symptom history may be a predictor or marker of cardiometabolic risk over decades.
Heavy alcohol consumption is associated with poorer cognitive function in older adults. Although understudied in middle-aged adults, the relationship between alcohol and cognition may also be influenced by genetics such as the apolipoprotein (ApoE) ε4 allele, a risk factor for Alzheimer’s disease. We examined the relationship between alcohol consumption, ApoE genotype, and cognition in middle-aged adults and hypothesized that light and/or moderate drinkers (≤2 drinks per day) would show better cognitive performance than heavy drinkers or non-drinkers. Additionally, we hypothesized that the association between alcohol use and cognitive function would differ by ApoE genotype (ε4+ vs. ε4−).
Method:
Participants were 1266 men from the Vietnam Era Twin Study of Aging (VETSA; M age = 56; range 51–60) who completed a neuropsychological battery assessing seven cognitive abilities: general cognitive ability (GCA), episodic memory, processing speed, executive function, abstract reasoning, verbal fluency, and visuospatial ability. Alcohol consumption was categorized into five groups: never, former, light, moderate, and heavy.
Results:
In fully adjusted models, there was no significant main effect of alcohol consumption on cognitive functions. However, there was a significant interaction between alcohol consumption and ApoE ε4 status for GCA and episodic memory, such that the relationship of alcohol consumption and cognition was stronger in ε4 carriers. The ε4+ heavy drinking subgroup had the poorest GCA and episodic memory.
Conclusions:
Presence of the ε4 allele may increase vulnerability to the deleterious effects of heavy alcohol consumption. Beneficial effects of light or moderate alcohol consumption were not observed.
Retinoblastoma is the most common primary intraocular tumor of childhood with >95% survival rates in the US. Traditional therapy for retinoblastoma often included enucleation (removal of the eye). While much is known about the visual, physical, and cognitive ramifications of enucleation, data are lacking about survivors' perception of how this treatment impacts overall quality of life.
Methods
Qualitative analysis of an open-ended response describing how much the removal of an eye had affected retinoblastoma survivors' lives and in what ways in free text, narrative form.
Results
Four hundred and four retinoblastoma survivors who had undergone enucleation (bilateral disease = 214; 52% female; mean age = 44, SD = 11) completed the survey. Survivors reported physical problems (n = 205, 50.7%), intrapersonal problems (n = 77, 19.1%), social and relational problems (n = 98, 24.3%), and affective problems (n = 34, 8.4%) at a mean of 42 years after diagnosis. Three key themes emerged from survivors' responses; specifically, they (1) continue to report physical and intrapersonal struggles with appearance and related self-consciousness due to appearance; (2) have multiple social and relational problems, with teasing and bullying being prominent problems; and (3) reported utilization of active coping strategies, including developing more acceptance and learning compensatory skills around activities of daily living.
Significance of results
This study suggests that adult retinoblastoma survivors treated with enucleation continue to struggle with a unique set of psychosocial problems. Future interventions can be designed to teach survivors more active coping skills (e.g., for appearance-related issues, vision-related issues, and teasing/bullying) to optimize survivors' long-term quality of life.
Studies involving clinically recruited samples show that genetic liability to schizophrenia overlaps with that for several psychiatric disorders including bipolar disorder, major depression and, in a population study, anxiety disorder and negative symptoms in adolescence.
Aims
We examined whether, at a population level, association between schizophrenia liability and anxiety disorders continues into adulthood, for specific anxiety disorders and as a group. We explored in an epidemiologically based cohort the nature of adult psychopathology sharing liability to schizophrenia.
Method
Schizophrenia polygenic risk scores (PRSs) were calculated for 590 European-descent individuals from the Christchurch Health and Development Study. Logistic regression was used to examine associations between schizophrenia PRS and four anxiety disorders (social phobia, specific phobia, panic disorder and generalised anxiety disorder), schizophrenia/schizophreniform disorder, manic/hypomanic episode, alcohol dependence, major depression, and – using linear regression – total number of anxiety disorders. A novel population-level association with hypomania was tested in a UK birth cohort (Avon Longitudinal Study of Parents and Children).
Results
Schizophrenia PRS was associated with total number of anxiety disorders and with generalised anxiety disorder and panic disorder. We show a novel population-level association between schizophrenia PRS and manic/hypomanic episode.
Conclusions
The relationship between schizophrenia liability and anxiety disorders is not restricted to psychopathology in adolescence but is present in adulthood and specifically linked to generalised anxiety disorder and panic disorder. We suggest that the association between schizophrenia liability and hypomanic/manic episodes found in clinical samples may not be due to bias.
We present a multiproxy study of land use by a pre-Columbian earth mounds culture in the Bolivian Amazon. The Monumental Mounds Region (MMR) is an archaeological sub-region characterized by hundreds of pre-Columbian habitation mounds associated with a complex network of canals and causeways, and situated in the forest–savanna mosaic of the Llanos de Moxos. Pollen, phytolith, and charcoal analyses were performed on a sediment core from a large lake (14 km2), Laguna San José (14°56.97′S, 64°29.70′W). We found evidence of high levels of anthropogenic burning from AD 400 to AD 1280, corroborating dated occupation layers in two nearby excavated habitation mounds. The charcoal decline pre-dates the arrival of Europeans by at least 100 yr, and challenges the notion that the mounds culture declined because of European colonization. We show that the surrounding savanna soils were sufficiently fertile to support crops, and the presence of maize throughout the record shows that the area was continuously cultivated despite land-use change at the end of the earth mounds culture. We suggest that burning was largely confined to the savannas, rather than forests, and that pre-Columbian deforestation was localized to the vicinity of individual habitation mounds, whereas the inter-mound areas remained largely forested.
Increased dietary Na intake and decreased dietary K intake are associated with higher blood pressure. It is not known whether the dietary Na:K ratio is associated with all-cause mortality or stroke incidence and whether this relationship varies according to race. Between 2003 and 2007, the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort enrolled 30 239 black and white Americans aged 45 years or older. Diet was assessed using the Block 98 FFQ and was available on 21 374 participants. The Na:K ratio was modelled in race- and sex-specific quintiles for all analyses, with the lowest quintile (Q1) as the reference group. Data on other covariates were collected using both an in-home assessment and telephone interviews. We identified 1779 deaths and 363 strokes over a mean of 4·9 years. We used Cox proportional hazards models to obtain multivariable-adjusted hazard ratios (HR). In the highest quintile (Q5), a high Na:K ratio was associated with all-cause mortality (Q5 v. Q1 for whites: HR 1·22; 95 % CI 1·00, 1·47, P for trend = 0·084; for blacks: HR 1·36; 95 % CI 1·04, 1·77, P for trend = 0·028). A high Na:K ratio was not significantly associated with stroke in whites (HR 1·29; 95 % CI 0·88, 1·90) or blacks (HR 1·39; 95 % CI 0·78, 2·48), partly because of the low number of stroke events. In the REGARDS study, a high Na:K ratio was associated with all-cause mortality and there was a suggestive association between the Na:K ratio and stroke. These data support the policies targeted at reduction of Na from the food supply and recommendations to increase K intake.
Offspring of mothers with depression are at heightened risk of psychiatric disorder. Many mothers with depression have comorbid psychopathology. How these co-occurring problems affect child outcomes has rarely been considered.
Aims
To consider whether the overall burden of co-occurring psychopathology in mothers with recurrent depression predicts new-onset psychopathology in offspring.
Method
Mothers with recurrent depression and their adolescent offspring (9–17 years at baseline) were assessed in 2007 and on two further occasions up to 2011. Mothers completed questionnaires assessing depression severity, anxiety, alcohol problems and antisocial behaviour. Psychiatric disorder in offspring was assessed using the Child and Adolescent Psychiatric Assessment.
Results
The number of co-occurring problems in mothers (0, 1 or 2+) predicted new-onset offspring disorder (odds ratio (OR) = 1.80, 95% CI 1.17–2.77, P = 0.007). Rates varied from 15.7 to 34.8% depending on the number of co-occurring clinical problems. This remained significant after controlling for maternal depression severity (OR = 1.73, 95% CI 1.03–2.89, P = 0.040).
Conclusions
The burden of co-occurring psychopathology among mothers with recurrent depression indexes increased risk of future onset of psychiatric disorder for offspring. This knowledge can be used in targeting preventive measures in children at high risk of psychiatric disorder.
We document patterns of distribution and relative abundance of marine megavertebrate fauna around Cornwall and the Isles of Scilly from a combination of aerial and boat-based surveying. Between January 2006 and November 2007, 20 aerial surveys were undertaken, comprising over 40 hours of on-effort flying time. In April to October of these years, 27 effort-corrected ferry surveys were also conducted from a passenger ferry travelling between Cornwall and the Isles of Scilly. Opportunistic sightings were also logged by the crew members of the ferry and another vessel travelling regularly along the same route on 155 days. Ten megavertebrate species were sighted: basking sharks Cetorhinus maximus, sunfish Mola mola, common dolphins Delphinus delphis, harbour porpoise Phocoena phocoena, grey seals Halichoerus grypus, Risso's dolphins Grampus griseus, bottlenose dolphins Tursiops truncatus, minke whales Balaenoptera acutorostrata, long-finned pilot whales Globicephala melas and killer whale Orcinus orca. During aerial surveys, 206 sighting events of seven species were made, compared with 145 sighting events of eight species during ferry surveys and 293 sighting events of 10 species from opportunistic ship-board data collection efforts. Seasonal and spatial patterns in species occurrence were evident. Basking sharks were the most commonly-sighted species in the region and were relatively abundant throughout the estimated 5 km-wide strip of coastal waters covered by the aerial surveys, during spring and summer. Ferry surveys and opportunistic vessel-based sightings data confirmed that the distribution of surface-feeding aggregations of this species was largely around the coasts. Despite the limited scope of this study, it has provided valuable baseline data, and possible insights into the marine biodiversity of the region.