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Clinical outcomes of repetitive transcranial magnetic stimulation (rTMS) for treatment of treatment-resistant depression (TRD) vary widely and there is no mood rating scale that is standard for assessing rTMS outcome. It remains unclear whether TMS is as efficacious in older adults with late-life depression (LLD) compared to younger adults with major depressive disorder (MDD). This study examined the effect of age on outcomes of rTMS treatment of adults with TRD. Self-report and observer mood ratings were measured weekly in 687 subjects ages 16–100 years undergoing rTMS treatment using the Inventory of Depressive Symptomatology 30-item Self-Report (IDS-SR), Patient Health Questionnaire 9-item (PHQ), Profile of Mood States 30-item, and Hamilton Depression Rating Scale 17-item (HDRS). All rating scales detected significant improvement with treatment; response and remission rates varied by scale but not by age (response/remission ≥ 60: 38%–57%/25%–33%; <60: 32%–49%/18%–25%). Proportional hazards models showed early improvement predicted later improvement across ages, though early improvements in PHQ and HDRS were more predictive of remission in those < 60 years (relative to those ≥ 60) and greater baseline IDS burden was more predictive of non-remission in those ≥ 60 years (relative to those < 60). These results indicate there is no significant effect of age on treatment outcomes in rTMS for TRD, though rating instruments may differ in assessment of symptom burden between younger and older adults during treatment.
Former professional American football players have a high relative risk for neurodegenerative diseases like chronic traumatic encephalopathy (CTE). Interpreting low cognitive test scores in this population occasionally is complicated by performance on validity testing. Neuroimaging biomarkers may help inform whether a neurodegenerative disease is present in these situations. We report three cases of retired professional American football players who completed comprehensive neuropsychological testing, but “failed” performance validity tests, and underwent multimodal neuroimaging (structural MRI, Aß-PET, and tau-PET).
Participants and Methods:
Three cases were identified from the Focused Neuroimaging for the Neurodegenerative Disease Chronic Traumatic Encephalopathy (FIND-CTE) study, an ongoing multimodal imaging study of retired National Football League players with complaints of progressive cognitive decline conducted at Boston University and the UCSF Memory and Aging Center. Participants were relatively young (age range 55-65), had 16 or more years of education, and two identified as Black/African American. Raw neuropsychological test scores were converted to demographically-adjusted z-scores. Testing included standalone (Test of Memory Malingering; TOMM) and embedded (reliable digit span, RDS) performance validity measures. Validity cutoffs were TOMM Trial 2 < 45 and RDS < 7. Structural MRIs were interpreted by trained neurologists. Aß-PET with Florbetapir was used to quantify cortical Aß deposition as global Centiloids (0 = mean cortical signal for a young, cognitively normal, Aß negative individual in their 20s, 100 = mean cortical signal for a patient with mild-to-moderate Alzheimer’s disease dementia). Tau-PET was performed with MK-6240 and first quantified as standardized uptake value ratio (SUVR) map. The SUVR map was then converted to a w-score map representing signal intensity relative to a sample of demographically-matched healthy controls.
Results:
All performed in the average range on a word reading-based estimate of premorbid intellect. Contribution of Alzheimer’s disease pathology was ruled out in each case based on Centiloids quantifications < 0. All cases scored below cutoff on TOMM Trial 2 (Case #1=43, Case #2=42, Case #3=19) and Case #3 also scored well below RDS cutoff (2). Each case had multiple cognitive scores below expectations (z < -2.0) most consistently in memory, executive function, processing speed domains. For Case #1, MRI revealed mild atrophy in dorsal fronto-parietal and medial temporal lobe (MTL) regions and mild periventricular white matter disease. Tau-PET showed MTL tau burden modestly elevated relative to controls (regional w-score=0.59, 72nd%ile). For Case #2, MRI revealed cortical atrophy, mild hippocampal atrophy, and a microhemorrhage, with no evidence of meaningful tau-PET signal. For Case #3, MRI showed cortical atrophy and severe white matter disease, and tau-PET revealed significantly elevated MTL tau burden relative to controls (w-score=1.90, 97th%ile) as well as focal high signal in the dorsal frontal lobe (overall frontal region w-score=0.64, 74th%ile).
Conclusions:
Low scores on performance validity tests complicate the interpretation of the severity of cognitive deficits, but do not negate the presence of true cognitive impairment or an underlying neurodegenerative disease. In the rapidly developing era of biomarkers, neuroimaging tools can supplement neuropsychological testing to help inform whether cognitive or behavioral changes are related to a neurodegenerative disease.
Este trabajo busca conocer las estrategias tecnológicas, los rangos de acción y la conectividad en las estrategias humanas de ambientes marginales. Se discute, para el caso del sur de Mendoza, el modelo clásico de trashumancia cazadora recolectora entre tierras bajas y altas. El estudio se centra específicamente en El Payén y en el uso de la obsidiana andina Laguna del Maule. En El Payén, esta obsidiana ocupa el primer lugar entre las variedades conocidas y su uso se vinculó a circuitos de movilidad estacional que involucraban tierras bajas y altas. La obsidiana Laguna del Maule posee dos subtipos geoquímicos, el Subtipo 1 registrado en cordillera, y el Subtipo 2 localizado en depósitos fluviales distales. En este trabajo modelamos las estrategias de interacción de tierras altas con tierras bajas, enfocándonos en modelos propuestos para La Payunia, que ponen énfasis en la tecnología lítica y se articulan con análisis geoquímicos y geoarqueológicos. Los resultados sostienen que las poblaciones de El Payén obtenían este recurso mediante distintas estrategias tecnológicas: un aprovisionamiento serial del Subtipo 2, con circuitos de movilidad centrados en tierras bajas; diferente al Subtipo 1 de aprovisionamiento cíclico, que habría involucrado la interacción entre tierras altas y tierras bajas.
Within the multidisciplinary team, there can sometimes be lack of clarity as to the specific different contributions of each of the psycho-social-spiritual professionals: social workers, psychologist, and spiritual caregivers. This study examined the content of their end-of-life conversations with patients.
Methods
A total of 180 patients with terminal cancer received standard multidisciplinary care, including conversations with a social worker, psychologist, and spiritual caregiver. After each patient’s death, these professionals reported using a structured tool which content areas had arisen in their conversations with that patient.
Results
Across all content areas, there were significant differences between social work and spiritual care. The difference between social work and psychology was slightly smaller but still quite large. Psychology and spiritual care were the most similar, though they still significantly differed in half the content areas. The differences persisted even among patients who spoke with more than 1 kind of professional. The 6 content areas examined proved to subdivide into 2 linked groups, where patients speaking about 1 were more likely to speak about the others. One group, “reflective” topics (inner and transpersonal resources, interpersonal relationships, one’s past, and end of life), included all those topics which arose more often with spiritual caregivers or psychologists. The second group, “decision-making” topics (medical coping and life changes), was comprised of those topics which arose most commonly with social workers, bridging between the medical and personal aspects of care and helping patients navigate their new physical, psychological, and social worlds.
Significance of results
These findings help shed light on the differences, in practice, between patients’ conversations with social workers, psychologists, and spiritual caregivers and the roles these professionals are playing; can aid in formulating individualized care plans; and strengthen the working assumption that all 3 professions contribute in unique, complementary ways to improving patients’ and families’ well-being.
In eastern Africa, there are few long, high-quality records of environmental change at high altitudes, inhibiting a broader understanding of regional climate change. We investigated a Holocene lacustrine sediment archive from Lake Garba Guracha, Bale Mountains, Ethiopia, (3,950 m asl), and reconstructed high-altitude lake evaporation history using δ18O records derived from the analysis of compound-specific sugar biomarkers and diatoms. The δ18Odiatom and δ18Ofuc records are clearly correlated and reveal similar ranges (7.9‰ and 7.1‰, respectively). The lowest δ18O values occurred between 10–7 cal ka BP and were followed by a continuous shift towards more positive δ18O values. Due to the aquatic origin of the sugar biomarker and similar trends of δ18Odiatom, we suggest that our lacustrine δ18Ofuc record reflects δ18Olake water. Therefore, without completely excluding the influence of the ‘amount-effect’ and the ‘source-effect’, we interpret our record to reflect primarily the precipitation-to-evaporation ratio (P/E). We conclude that precipitation increased at the beginning of the Holocene, leading to an overflowing lake between ca. 10 and ca. 8 cal ka BP, indicated by low δ18Olake water values, which are interpreted as reduced evaporative enrichment. This is followed by a continuous trend towards drier conditions, indicating at least a seasonally closed lake system.
Let A and $\tilde A$ be unbounded linear operators on a Hilbert space. We consider the following problem. Let the spectrum of A lie in some horizontal strip. In which strip does the spectrum of $\tilde A$ lie, if A and $\tilde A$ are sufficiently ‘close’? We derive a sharp bound for the strip containing the spectrum of $\tilde A$, assuming that $\tilde A-A$ is a bounded operator and A has a bounded Hermitian component. We also discuss applications of our results to regular matrix differential operators.
The knowledge about the association of physical activity (PA) and sedentary behaviours (SB) with the most considered healthy dairy products consumption, as milk and yogurt, in childhood is scared.
Aim
To assess the longitudinal relationship between specific lifestyle behaviours (PA and SB) and combined dairy consumption (milk + yogurt) in a sample of European children.
Methods
Two measurements, with 2 years’ interval (T0 and T1), were conducted in 1 688 (50.8% boys) childrenfrom the IDEFICS study. Dietary information was parental-registered by a 24-hour dietary recall. At both time points, sedentary behaviour and objective estimation of PA was obtained by accelerometers. Different groups were defined according to the international children's PA and SB behaviours recommendations over time. The cut-offs for the SB and PA recommendations were established on 2hour/day of SB and 2 hour/day of moderate to vigorous PA. Multilevel ordinal logistic regression models were used to assess the group's association with the combined dairy consumption (milk + yogurt), adjusted for potential confounders (sex, body mass index zscore, intervention versus control region, parental education level, dietary quality index, energy intake and the consumption by each dairy group at T0).
Results
Nine groups of meeting or not both recommendations (SB and PA) were obtained. Those children who meeting both lifestyle recommendations at both measurement points, had higher probability to consume more milk and yogurt (p < 0.05), in comparison to the rest of combinations.Those children who did not meet any recommendations at both time points were less likely to consume milk + yogurt (OR: 0.47, 95%CI:0.26–0.83) than those who met both recommendations at both time points. Those children which improved one behaviours (PA or SB) between both measurement point were associated with low consumption of milk + yogurt (OR:0.41, 95%CI 0.22;0.74; OR:0.40, 95%CI 0.22,0.72), compared with those who meet both lifestyle recommendations at both periods (T0 and T1). Also, those which improved both behaviours (PA and SB) were less likely to consume milk + yogurt (OR:0.34, 95%CI 0.15–0.80) than those who were physically active and low sedentary at both time points.
Conclusions
These results suggest that European children with a healthy lifestyle regarding PA and SB over time, had the highest milk and yogurt consumption in comparison with other children.
Integrating spiritual care into multidisciplinary care teams has seen both successful thoughtful collaboration and challenges, including feelings of competition and poor cross-disciplinary understanding. In Israel, where the profession is new, we aimed to examine how spiritual care is perceived by other healthcare professionals learning to integrate spiritual caregivers into their teams.
Method
Semi-structured qualitative interviews of 19 professionals (seven physicians, six nurses, three social workers, two psychologists, and one medical secretary) working with spiritual caregivers in three Israeli hospitals, primarily in oncology/hematology. The interviews were transcribed and subjected to thematic analysis.
Results
Respondents’ overall experience with adding a spiritual caregiver was strongly positive. Beneficial outcomes described included calmer patients and improved patient–staff relationships. Respondents identified reasons for a referral not limited to the end of life. Respondents distinguished between the role of the spiritual caregiver and those of other professions and, in response to case studies, differentiated when and how each professional should be involved.
Conclusion
Despite its relative newness in Israel, spiritual care is well received by a wide variety of professionals at those sites where it has been integrated. Steps to improve collaboration should include improving multidisciplinary communication to broaden the range of situations in which spiritual caregivers and other professionals work together to provide the best possible holistic care.
When patients feel spiritually supported by staff, we find increased use of hospice and reduced use of aggressive treatments at end of life, yet substantial barriers to staff spiritual care provision still exist. We aimed to study these barriers in a new cultural context and analyzed a new subgroup with “unrealized potential” for improved spiritual care provision: those who are positively inclined toward spiritual care yet do not themselves provide it.
Method
We distributed the Religion and Spirituality in Cancer Care Study via the Middle East Cancer Consortium to physicians and nurses caring for advanced cancer patients. Survey items included how often spiritual care should be provided, how often respondents themselves provide it, and perceived barriers to spiritual care provision.
Result
We had 770 respondents (40% physicians, 60% nurses) from 14 Middle Eastern countries. The results showed that 82% of respondents think staff should provide spiritual care at least occasionally, but 44% provide spiritual care less often than they think they should. In multivariable analysis of respondents who valued spiritual care yet did not themselves provide it to their most recent patients, predictors included low personal sense of being spiritual (p < 0.001) and not having received training (p = 0.02; only 22% received training). How “developed” a country is negatively predicted spiritual care provision (p < 0.001). Self-perceived barriers were quite similar across cultures.
Significance of results
Despite relatively high levels of spiritual care provision, we see a gap between desirability and actual provision. Seeing oneself as not spiritual or only slightly spiritual is a key factor demonstrably associated with not providing spiritual care. Efforts to increase spiritual care provision should target those in favor of spiritual care provision, promoting training that helps participants consider their own spirituality and the role that it plays in their personal and professional lives.
Let ${\mathcal{H}}=\mathbb{C}^{n}\otimes {\mathcal{E}}$ be the tensor product of a Euclidean space $\mathbb{C}^{n}$ and a separable Hilbert space ${\mathcal{E}}$. Our main object is the operator $G=I_{n}\otimes S+A\otimes I_{{\mathcal{E}}}$, where $S$ is a normal operator in ${\mathcal{E}}$, $A$ is an $n\times n$ matrix, and $I_{n},I_{{\mathcal{E}}}$ are the unit operators in $\mathbb{C}^{n}$ and ${\mathcal{E}}$, respectively. Numerous differential operators with constant matrix coefficients are examples of operator $G$. In the present paper we show that $G$ is similar to an operator $M=I_{n}\otimes S+\hat{D}\times I_{{\mathcal{E}}}$ where $\hat{D}$ is a block matrix, each block of which has a unique eigenvalue. We also obtain a bound for the condition number. That bound enables us to establish norm estimates for functions of $G$, nonregular on the closed convex hull $\operatorname{co}(G)$ of the spectrum of $G$. The functions $G^{-\unicode[STIX]{x1D6FC}}\;(\unicode[STIX]{x1D6FC}>0)$ and $(\ln G)^{-1}$ are examples of such functions. In addition, in the appropriate situations we improve the previously published estimates for the resolvent and functions of $G$ regular on $\operatorname{co}(G)$. Since differential operators with variable coefficients often can be considered as perturbations of operators with constant coefficients, the results mentioned above give us estimates for functions and bounds for the spectra of differential operators with variable coefficients.
A controversy at the 2016 IUCN World Conservation Congress on the topic of closing domestic ivory markets (the 007, or so-called James Bond, motion) has given rise to a debate on IUCN's value proposition. A cross-section of authors who are engaged in IUCN but not employed by the organization, and with diverse perspectives and opinions, here argue for the importance of safeguarding and strengthening the unique technical and convening roles of IUCN, providing examples of what has and has not worked. Recommendations for protecting and enhancing IUCN's contribution to global conservation debates and policy formulation are given.
Let $\def \xmlpi #1{}\def \mathsfbi #1{\boldsymbol {\mathsf {#1}}}\let \le =\leqslant \let \leq =\leqslant \let \ge =\geqslant \let \geq =\geqslant \def \Pr {\mathit {Pr}}\def \Fr {\mathit {Fr}}\def \Rey {\mathit {Re}}H$ be a linear unbounded operator in a Hilbert space. It is assumed that the resolvent of $H$ is a compact operator and $H-H^*$ is a Hilbert–Schmidt operator. Various integro-differential operators satisfy these conditions. It is shown that $H$ is similar to a normal operator and a sharp bound for the condition number is suggested. We also discuss applications of that bound to spectrum perturbations and operator functions.
In our previous studies [1-3], four kinds of stacking faults in 4H-SiC bulk crystal have been distinguished based on their contrast behavior differences in synchrotron white beam x-ray topography images. These faults are Shockley faults, Frank faults, Shockley plus c/2 Frank faults, and Shockley plus c/4 Frank faults. Our proposed formation mechanisms for these stacking faults involve the overgrowth of the surface outcrop associated with threading screw dislocations (TSDs) or threading mixed dislocations (TMDs) with Burgers vector of c+a by macrosteps and the consequent deflection of TSDs or TMDs onto the basal plane. Previous synchrotron x-ray topography observations were made in offcut basal wafers using transmission geometry. In this paper, further evidence is reported to confirm the proposed stacking fault formation mechanism. Observations are made in axially cut slices with surface plane {11-20}. Several kinds of stacking faults are recognized and their contrast behavior agrees with the four kinds previously reported. Direct observation is obtained of a Shockley plus c/4 Frank stacking fault nucleating from a TMD deflected onto the basal plane. The contrast from stacking faults on the basal plane in the axial slices is enhanced by recording images after rotating the crystal about the active -1010 reflection vector enabling a broader projection of the basal plane.
Synchrotron X-ray topography (SXRT) of various geometries has been successfully utilized to image c+a dislocations in 4H-SiC crystals. Although molten potassium hydroxide(KOH) can be used to reveal the location of such dislocations, it is not possible to determine their senses or their Burgers vector magnitude. A simple, non-destructive method has been proposed to determine the Burgers vector of these c+a dislocations called the ray tracing simulation, which has been successfully implemented previously in revealing the dislocation sense and magnitude of micropipes, closed-core threading screw dislocations (TSDs) and threading edge dislocations (TEDs) in 4H-SiC. In this paper, grazing incidence topography is performed using the monochromatic beam for the horizontally cut wafers to record pyramidal reflections of 11-28 type. Ray tracing simulation has been successfully implemented to correlate the simulated images with experimental images which are discussed in the paper.
The paper deals with periodic systems of ordinary differential equations (ODEs). A new approach to the investigation of variations of multipliers under perturbations is suggested. It enables us to establish explicit conditions for the stability and instability of perturbed systems.
The “freezing” method for ordinary differential equations is extended to multivariable retarded systems with distributed delays and slowly varying coefficients. Explicit stability conditions are derived. The main tool of the paper is a combined usage of the generalized Bohl-Perron principle and norm estimates for the fundamental solutions of the considered equations.