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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.
Hunting, habitat loss and fragmentation have caused a rapid decline in the distribution and abundance of the clouded leopard Neofelis nebulosa across its range, and in several areas, including Taiwan, the species is now extirpated. Taiwan, a former stronghold for the species, is a candidate for its reintroduction, based on increasing prey abundance and high forest coverage. Such future reintroduction efforts, however, are hampered by a lack of analysis of potential clouded leopard habitat on the island. To address this, we explore habitat suitability for the species in Taiwan. We used a multi-scale, multivariate habitat selection model based on clouded leopard presence–absence data from extensive camera-trap surveys across its current range to predict suitable habitat in Taiwan. Our findings indicate that 38% of Taiwanese territory is potentially suitable habitat for the clouded leopard, of which 46% is under protection. This demonstrates the high potential of Taiwan's habitat for clouded leopard reintroduction.
To determine the association between blood markers of white matter injury (e.g., serum neurofilament light and phosphorylated neurofilament heavy) and a novel neuroimaging technique measuring microstructural white matter changes (e.g., diffusion kurtosis imaging) in regions (e.g., anterior thalamic radiation and uncinate fasciculus) known to be impacted in traumatic brain injury (TBI) and associated with symptoms common in those with chronic TBI (e.g., sleep disruption, cognitive and emotional disinhibition) in a heterogeneous sample of Veterans and non-Veterans with a history of remote TBI (i.e., >6 months).
Participants and Methods:
Participants with complete imaging and blood data (N=24) were sampled from a larger multisite study of chronic mild-moderate TBI. Participants ranged in age from young to middle-aged (mean age = 34.17, SD age = 10.96, range = 19-58) and primarily male (66.7%). The number of distinct TBIs ranged from 1-5 and the time since most recent TBI ranged from 0-30 years. Scores on a cognitive screener (MoCA) ranged from 22-30 (mean = 26.75). We performed bivariate correlations with mean kurtosis (MK) in the anterior thalamic radiation (ATR; left, right) uncinate fasciculus (UF; left, right), and serum neurofilament light (NFL), and phosphorylated neurofilament heavy (pNFH). Both were log transformed for non-normality. Significance threshold was set at p<0.05.
Results:
pNFH was significantly and negatively correlated to MK in the right (r=-0.446) and left (r=-0.599) UF and right (r=-0.531) and left (r=-0.469) ATR. NFL showed moderate associations with MK in the right (r=-0.345) and left (r=-0.361) UF and little to small association in the right (r=-0.063) and left (r=-0.215) ATR. In post-hoc analyses, MK in both the left (r=0.434) and right (r=0.514) UF was positively associated with performance on a frontally-mediated list-learning task (California Verbal Learning Test, 2nd Edition; Trials 1-5 total).
Conclusions:
Results suggest that serum pNFH may be a more sensitive blood marker of microstructural complexity in white matter regions frequently impacted by TBI in a chronic mild-moderate TBI sample. Further, it suggests that even years after a mild-moderate TBI, levels of pNFH may be informative regarding white matter integrity in regions related to executive functioning and emotional disinhibition, both of which are common presenting problems when these patients are seen in a clinical setting.
The Australian SKA Pathfinder (ASKAP) has surveyed the sky at multiple frequencies as part of the Rapid ASKAP Continuum Survey (RACS). The first two RACS observing epochs, at 887.5 (RACS-low) and 1 367.5 (RACS-mid) MHz, have been released (McConnell, et al. 2020, PASA, 37, e048; Duchesne, et al. 2023, PASA, 40, e034). A catalogue of radio sources from RACS-low has also been released, covering the sky south of declination $+30^{\circ}$ (Hale, et al., 2021, PASA, 38, e058). With this paper, we describe and release the first set of catalogues from RACS-mid, covering the sky below declination $+49^{\circ}$. The catalogues are created in a similar manner to the RACS-low catalogue, and we discuss this process and highlight additional changes. The general purpose primary catalogue covering 36 200 deg$^2$ features a variable angular resolution to maximise sensitivity and sky coverage across the catalogued area, with a median angular resolution of $11.2^{\prime\prime} \times 9.3^{\prime\prime}$. The primary catalogue comprises 3 105 668 radio sources, including those in the Galactic Plane (2 861 923 excluding Galactic latitudes of $|b|<5^{\circ}$), and we estimate the catalogue to be 95% complete for sources above 2 mJy. With the primary catalogue, we also provide two auxiliary catalogues. The first is a fixed-resolution, 25-arcsec catalogue approximately matching the sky coverage of the RACS-low catalogue. This 25-arcsec catalogue is constructed identically to the primary catalogue, except images are convolved to a less-sensitive 25-arcsec angular resolution. The second auxiliary catalogue is designed for time-domain science and is the concatenation of source lists from the original RACS-mid images with no additional convolution, mosaicking, or de-duplication of source entries to avoid losing time-variable signals. All three RACS-mid catalogues, and all RACS data products, are available through the CSIRO ASKAP Science Data Archive (https://research.csiro.au/casda/).
We present a systematic search for radio counterparts of novae using the Australian Square Kilometer Array Pathfinder (ASKAP). Our search used the Rapid ASKAP Continuum Survey, which covered the entire sky south of declination $+41^{\circ}$ ($\sim$$34000$ square degrees) at a central frequency of 887.5 MHz, the Variables and Slow Transients Pilot Survey, which covered $\sim$$5000$ square degrees per epoch (887.5 MHz), and other ASKAP pilot surveys, which covered $\sim$200–2000 square degrees with 2–12 h integration times. We crossmatched radio sources found in these surveys over a two–year period, from 2019 April to 2021 August, with 440 previously identified optical novae, and found radio counterparts for four novae: V5668 Sgr, V1369 Cen, YZ Ret, and RR Tel. Follow-up observations with the Australian Telescope Compact Array confirm the ejecta thinning across all observed bands with spectral analysis indicative of synchrotron emission in V1369 Cen and YZ Ret. Our light-curve fit with the Hubble Flow model yields a value of $1.65\pm 0.17 \times 10^{-4} \rm \:M_\odot$ for the mass ejected in V1369 Cen. We also derive a peak surface brightness temperature of $250\pm80$ K for YZ Ret. Using Hubble Flow model simulated radio lightcurves for novae, we demonstrate that with a 5$\sigma$ sensitivity limit of 1.5 mJy in 15-min survey observations, we can detect radio emission up to a distance of 4 kpc if ejecta mass is in the range $10^{-3}\rm \:M_\odot$, and upto 1 kpc if ejecta mass is in the range $10^{-5}$–$10^{-3}\rm \:M_\odot$. Our study highlights ASKAP’s ability to contribute to future radio observations for novae within a distance of 1 kpc hosted on white dwarfs with masses $0.4$–$1.25\:\rm M_\odot$, and within a distance of 4 kpc hosted on white dwarfs with masses $0.4$–$1.0\:\rm M_\odot$.
This paper investigates the rational and emotional functions of symbols in organizational change and how collective sensemaking and acceptance of organizational changes are facilitated by the emotional functioning of executive symbolism. Evidence from archived data, news reports, reviews, and case studies are used to support our theoretical analysis. Our opinion is that the CEO can incorporate symbols into not only the rational calculation process to convey the benefits and losses of organizational changes but also the emotional identification process to create new emotional connections and reduce the resistance of the members to organizational changes. We describe why and when the implementation of symbolism will gain the acceptance of members toward organizational change and explain the scenarios that apply for the two functions.
Antibiotics are frequently prescribed in nursing homes; national data describing facility-level antibiotic use are lacking. The objective of this analysis was to describe variability in antibiotic use in nursing homes across the United States using electronic health record orders.
Methods:
A retrospective cohort study of antibiotic orders for 309,884 residents in 1,664 US nursing homes in 2016 were included in the analysis. Antibiotic use rates were calculated as antibiotic days of therapy (DOT) per 1,000 resident days and were compared by type of stay (short stay ≤100 days vs long stay >100 days). Prescribing indications and the duration of nursing home-initiated antibiotic orders were described. Facility-level correlations of antibiotic use, adjusting for resident health and facility characteristics, were assessed using multivariate linear regression models.
Results:
In 2016, 54% of residents received at least 1 systemic antibiotic. The overall rate of antibiotic use was 88 DOT per 1,000 resident days. The 3 most common antibiotic classes prescribed were fluoroquinolones (18%), cephalosporins (18%), and urinary anti-infectives (9%). Antibiotics were most frequently prescribed for urinary tract infections, and the median duration of an antibiotic course was 7 days (interquartile range, 5–10). Higher facility antibiotic use rates correlated positively with higher proportions of short-stay residents, for-profit ownership, residents with low cognitive performance, and having at least 1 resident on a ventilator. Available facility-level characteristics only predicted a small proportion of variability observed (Model R2 version 0.24 software).
Conclusions:
Using electronic health record orders, variability was found among US nursing-home antibiotic prescribing practices, highlighting potential opportunities for targeted improvement of prescribing practices.
The Variables and Slow Transients Survey (VAST) on the Australian Square Kilometre Array Pathfinder (ASKAP) is designed to detect highly variable and transient radio sources on timescales from 5 s to $\sim\!5$ yr. In this paper, we present the survey description, observation strategy and initial results from the VAST Phase I Pilot Survey. This pilot survey consists of $\sim\!162$ h of observations conducted at a central frequency of 888 MHz between 2019 August and 2020 August, with a typical rms sensitivity of $0.24\ \mathrm{mJy\ beam}^{-1}$ and angular resolution of $12-20$ arcseconds. There are 113 fields, each of which was observed for 12 min integration time, with between 5 and 13 repeats, with cadences between 1 day and 8 months. The total area of the pilot survey footprint is 5 131 square degrees, covering six distinct regions of the sky. An initial search of two of these regions, totalling 1 646 square degrees, revealed 28 highly variable and/or transient sources. Seven of these are known pulsars, including the millisecond pulsar J2039–5617. Another seven are stars, four of which have no previously reported radio detection (SCR J0533–4257, LEHPM 2-783, UCAC3 89–412162 and 2MASS J22414436–6119311). Of the remaining 14 sources, two are active galactic nuclei, six are associated with galaxies and the other six have no multi-wavelength counterparts and are yet to be identified.
Approximately 60 000 people in England have coexisting type 2 diabetes mellitus (T2DM) and severe mental illness (SMI). They are more likely to have poorer health outcomes and require more complex care pathways compared with those with T2DM alone. Despite increasing prevalence, little is known about the healthcare resource use and costs for people with both conditions.
Aims
To assess the impact of SMI on healthcare resource use and service costs for adults with T2DM, and explore the predictors of healthcare costs and lifetime costs for people with both conditions.
Method
This was a matched-cohort study using data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics for 1620 people with comorbid SMI and T2DM and 4763 people with T2DM alone. Generalised linear models and the Bang and Tsiatis method were used to explore cost predictors and mean lifetime costs respectively.
Results
There were higher average annual costs for people with T2DM and SMI (£1930 higher) than people with T2DM alone, driven primarily by mental health and non-mental health-related hospital admissions. Key predictors of higher total costs were older age, comorbid hypertension, use of antidepressants, use of first-generation antipsychotics, and increased duration of living with both conditions. Expected lifetime costs were approximately £35 000 per person with both SMI and T2DM. Extrapolating nationally, this would generate total annual costs to the National Health Service of around £250 m per year.
Conclusions
Our estimates of resource use and costs for people with both T2DM and SMI will aid policymakers and commissioners in service planning and resource allocation.
Pompe disease results from lysosomal acid α-glucosidase deficiency, which leads to cardiomyopathy in all infantile-onset and occasional late-onset patients. Cardiac assessment is important for its diagnosis and management. This article presents unpublished cardiac findings, concomitant medications, and cardiac efficacy and safety outcomes from the ADVANCE study; trajectories of patients with abnormal left ventricular mass z score at enrolment; and post hoc analyses of on-treatment left ventricular mass and systolic blood pressure z scores by disease phenotype, GAA genotype, and “fraction of life” (defined as the fraction of life on pre-study 160 L production-scale alglucosidase alfa). ADVANCE evaluated 52 weeks’ treatment with 4000 L production-scale alglucosidase alfa in ≥1-year-old United States of America patients with Pompe disease previously receiving 160 L production-scale alglucosidase alfa. M-mode echocardiography and 12-lead electrocardiography were performed at enrolment and Week 52. Sixty-seven patients had complete left ventricular mass z scores, decreasing at Week 52 (infantile-onset patients, change −0.8 ± 1.83; 95% confidence interval −1.3 to −0.2; all patients, change −0.5 ± 1.71; 95% confidence interval −1.0 to −0.1). Patients with “fraction of life” <0.79 had left ventricular mass z score decreasing (enrolment: +0.1 ± 3.0; Week 52: −1.1 ± 2.0); those with “fraction of life” ≥0.79 remained stable (enrolment: −0.9 ± 1.5; Week 52: −0.9 ± 1.4). Systolic blood pressure z scores were stable from enrolment to Week 52, and no cohort developed systemic hypertension. Eight patients had Wolff–Parkinson–White syndrome. Cardiac hypertrophy and dysrhythmia in ADVANCE patients at or before enrolment were typical of Pompe disease. Four-thousand L alglucosidase alfa therapy maintained fractional shortening, left ventricular posterior and septal end-diastolic thicknesses, and improved left ventricular mass z score.
Social Media Statement: Post hoc analyses of the ADVANCE study cohort of 113 children support ongoing cardiac monitoring and concomitant management of children with Pompe disease on long-term alglucosidase alfa to functionally improve cardiomyopathy and/or dysrhythmia.
We discuss observational strategies to detect prompt bursts associated with gravitational wave (GW) events using the Australian Square Kilometre Array Pathfinder (ASKAP). Many theoretical models of binary neutron stars mergers predict that bright, prompt radio emission would accompany the merger. The detection of such prompt emission would greatly improve our knowledge of the physical conditions, environment, and location of the merger. However, searches for prompt emission are complicated by the relatively poor localisation for GW events, with the 90% credible region reaching hundreds or even thousands of square degrees. Operating in fly’s eye mode, the ASKAP field of view can reach $\sim1\,000$ deg$^2$ at $\sim$$888\,{\rm MHz}$. This potentially allows observers to cover most of the 90% credible region quickly enough to detect prompt emission. We use skymaps for GW170817 and GW190814 from LIGO/Virgo’s third observing run to simulate the probability of detecting prompt emission for GW events in the upcoming fourth observing run. With only alerts released after merger, we find it difficult to slew the telescope sufficiently quickly as to capture any prompt emission. However, with the addition of alerts released before merger by negative-latency pipelines, we find that it should be possible to search for nearby, bright prompt fast radio burst-like emission from GW events. Nonetheless, the rates are low: we would expect to observe $\sim$0.012 events during the fourth observing run, assuming that the prompt emission is emitted microseconds around the merger.
The role that vitamin D plays in pulmonary function remains uncertain. Epidemiological studies reported mixed findings for serum 25-hydroxyvitamin D (25(OH)D)–pulmonary function association. We conducted the largest cross-sectional meta-analysis of the 25(OH)D–pulmonary function association to date, based on nine European ancestry (EA) cohorts (n 22 838) and five African ancestry (AA) cohorts (n 4290) in the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium. Data were analysed using linear models by cohort and ancestry. Effect modification by smoking status (current/former/never) was tested. Results were combined using fixed-effects meta-analysis. Mean serum 25(OH)D was 68 (sd 29) nmol/l for EA and 49 (sd 21) nmol/l for AA. For each 1 nmol/l higher 25(OH)D, forced expiratory volume in the 1st second (FEV1) was higher by 1·1 ml in EA (95 % CI 0·9, 1·3; P<0·0001) and 1·8 ml (95 % CI 1·1, 2·5; P<0·0001) in AA (Prace difference=0·06), and forced vital capacity (FVC) was higher by 1·3 ml in EA (95 % CI 1·0, 1·6; P<0·0001) and 1·5 ml (95 % CI 0·8, 2·3; P=0·0001) in AA (Prace difference=0·56). Among EA, the 25(OH)D–FVC association was stronger in smokers: per 1 nmol/l higher 25(OH)D, FVC was higher by 1·7 ml (95 % CI 1·1, 2·3) for current smokers and 1·7 ml (95 % CI 1·2, 2·1) for former smokers, compared with 0·8 ml (95 % CI 0·4, 1·2) for never smokers. In summary, the 25(OH)D associations with FEV1 and FVC were positive in both ancestries. In EA, a stronger association was observed for smokers compared with never smokers, which supports the importance of vitamin D in vulnerable populations.
Medication overuse headache (MOH) is defined as headache occurring on 15 or more days per month developing as a consequence of regular overuse of acute or symptomatic headache medication (on 10 or more, or 15 or more days per month, depending on the medication) for more than three months. Triptans, NSAIDs, acetaminophen, ergotamine, barbiturates, and opioids can all cause MOH. Although the optimal treatment strategy for MOH is debated, treatments include discontinuing the overused medications and treating with preventive migraine medications. In the ED, it is important to recognize patients who have MOH to provide appropriate treatment recommendations for MOH and to avoid perpetuating the patient’s medication overuse. In general, ED treatment of the patient with frequent headaches should not include narcotics or butalbital-containing medications as they are associated with the highest risk of developing MOH as well as the potential to create drug-seeking behavior. Proper follow-up should be arranged prior to discharge from the ED.
High order total variation (TV2) and ℓ1 based (TV2L1) model has its advantage over the TVL1 for its ability in avoiding the staircase; and a constrained model has the advantage over its unconstrained counterpart for simplicity in estimating the parameters. In this paper, we consider solving the TV2L1 based magnetic resonance imaging (MRI) signal reconstruction problem by an efficient alternating direction method of multipliers. By sufficiently utilizing the problem's special structure, we manage to make all subproblems either possess closed-form solutions or can be solved via Fast Fourier Transforms, which makes the cost per iteration very low. Experimental results for MRI reconstruction are presented to illustrate the effectiveness of the new model and algorithm. Comparisons with its recent unconstrained counterpart are also reported.
Information linking seed movement, along with changes in seed viability, is critical for understanding weed seed dynamics. Studies were conducted to examine the use of passive integrated transponder (PIT) tags placed in nylon mesh packets in combination with GPS (Global Positioning System) technology to track weed seed movement after tillage. Cylindrical PIT tags 11.5, 12, 20, and 23 mm long by 2 mm wide were evaluated in water and soil. Detection improved as tag size increased because of greater signal strength. Tags with the main axis oriented vertically were recovered at greater depths than when placed horizontally. Average detection depths for 12-mm PIT tags were 29.5 cm in water, 18.2 cm in sand, 24 cm in artificial soil, and 21.2 cm in sandy loam soil. Tests also showed that PIT tags and nylon mesh packets were resilient to intense tillage with a rototiller. No significant differences in displacement because of tillage were observed between free PIT tags and PIT-tagged packets. PIT tag performance was further tested in a 2-yr field experiment conducted between September 2003 and October 2005 at six sites in Nebraska and Wyoming. Tilled and no-till blocks were established at each site. PIT-tagged packets in the tilled block and untagged packets in the no-till block were used. Sample burial depths were 0, 2.5, 7.5, and 15 cm. Sample recovery rate did not differ between tilled and no-till blocks. Time of recovery was the main factor affecting recovery of packets buried at 0 and 2.5 cm in both blocks. Seed predation by small rodents and movement of samples beyond the area of study by tillage implements were the main sources of packet loss. Nevertheless, 2 yr after initiation of the study, more than 85% of the samples were recovered. Future development of PIT tag technology will lead to an enhanced ability to monitor seed movement.
To assess the impact of an emergency intensive care unit (EICU) established concomitantly with a freestanding emergency department (ED) during the aftermath of Hurricane Sandy.
Methods
We retrospectively reviewed records of all patients in Bellevue’s EICU from freestanding ED opening (December 10, 2012) until hospital inpatient reopening (February 7, 2013). Temporal and clinical data, and disposition upon EICU arrival, and ultimate disposition were evaluated.
Results
Two hundred twenty-seven patients utilized the EICU, representing approximately 1.8% of freestanding ED patients. Ambulance arrival occurred in 31.6% of all EICU patients. Median length of stay was 11.55 hours; this was significantly longer for patients requiring airborne isolation (25.60 versus 11.37 hours, P<0.0001 by Wilcoxon rank sum test). After stabilization and treatment, 39% of EICU patients had an improvement in their disposition status (P<0.0001 by Wilcoxon signed rank test); upon interhospital transfer, the absolute proportion of patients requiring ICU and SDU resources decreased from 37.8% to 27.1% and from 22.2% to 2.7%, respectively.
Conclusions
An EICU attached to a freestanding ED achieved significant reductions in resource-intensive medical care. Flexible, adaptable care systems should be explored for implementation in disaster response. (Disaster Med Public Health Preparedness. 2016;10:496–502)
We aimed to evaluate emergency medical services (EMS) data as disaster metrics and to assess stress in surrounding hospitals and a municipal network after the closure of Bellevue Hospital during Hurricane Sandy in 2012.
Methods
We retrospectively reviewed EMS activity and call types within New York City’s 911 computer-assisted dispatch database from January 1, 2011, to December 31, 2013. We evaluated EMS ambulance transports to individual hospitals during Bellevue’s closure and incremental recovery from urgent care capacity, to freestanding emergency department (ED) capability, freestanding ED with 911-receiving designation, and return of inpatient services.
Results
A total of 2,877,087 patient transports were available for analysis; a total of 707,593 involved Manhattan hospitals. The 911 ambulance transports disproportionately increased at the 3 closest hospitals by 63.6%, 60.7%, and 37.2%. When Bellevue closed, transports to specific hospitals increased by 45% or more for the following call types: blunt traumatic injury, drugs and alcohol, cardiac conditions, difficulty breathing, “pedestrian struck,” unconsciousness, altered mental status, and emotionally disturbed persons.
Conclusions
EMS data identified hospitals with disproportionately increased patient loads after Hurricane Sandy. Loss of Bellevue, a public, safety net medical center, produced statistically significant increases in specific types of medical and trauma transports at surrounding hospitals. Focused redeployment of human, economic, and social capital across hospital systems may be required to expedite regional health care systems recovery. (Disaster Med Public Health Preparedness. 2016;10:333–343)
Parkinson's disease (PD) has been proposed to result from the interaction of aging and environment in susceptible individuals. Defective metabolism of debrisoquine, inherited as an autosomal recessive, has been associated with this susceptibility. In 35 PD patients and 19 age-matched controls, no significant differences in debrisoquine metabolism were found, although a trend to impaired metabolism was noted in patients with disease onset ≤40. Foci of PD patients were associated with rural living and well water drinking, or rural living coupled with market gardening or wood pulp mills. In a questionnaire survey, patients with PD onset ≤age 47 were significantly more likely to have lived in rural areas and to have drunk well water than those with onset ≥age 54 (p≤0.01). Because of population mobility in North America, a case-control study designed to test environmental, occupational, dietary and other proposed risk factors for PD was conducted in China, where the population is more stationary and the environment more stable. No significant differences in incidences of head trauma, smoking or childhood measles were found between patients and controls.