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Malignant plasma cell proliferations are characterised by specific clinical, immunophenotypic and genetic features. Multiparameter flow cytometry (MFC) is an essential component of the diagnosis of these diseases. Clonal proliferations can be identified through their aberrant cell-surface immunophenotype or, more precisely, by demonstrating monotypy, i.e. selective expression of the same light chain in the cytoplasm of plasma-cells. This chapter reviews these immunophenotypic features, the technical points of caution to observe for proper use of MFC at diagnosis and during therapy to assess measurable residual disease.
Internal and external rotation of the shoulder is often challenging to quantify in the clinic. Existing technologies, such as motion capture, can be expensive or require significant time to setup, collect data, and process and analyze the data. Other methods may rely on surveys or analog tools, which are subject to interpretation. The current study evaluates a novel, engineered, wearable sensor system for improved internal and external shoulder rotation monitoring, and applies it in healthy individuals. Using the design principles of the Japanese art of kirigami (folding and cutting of paper to design 3D shapes), the sensor platform conforms to the shape of the shoulder with four on-board strain gauges to measure movement. Our objective was to examine how well this kirigami-inspired shoulder patch could identify differences in shoulder kinematics between internal and external rotation as individuals moved their humerus through movement patterns defined by Codman’s paradox. Seventeen participants donned the sensor while the strain gauges measured skin deformation patterns during the participants’ movement. One-dimensional statistical parametric mapping explored differences in strain voltage between the rotations. The sensor detected distinct differences between the internal and external shoulder rotation movements. Three of the four strain gauges detected significant temporal differences between internal and external rotation (all p < .047), particularly for the strain gauges placed distal or posterior to the acromion. These results are clinically significant, as they suggest a new class of wearable sensors conforming to the shoulder can measure differences in skin surface deformation corresponding to the underlying humerus rotation.
Cardiometabolic disease risk factors are disproportionately prevalent in bipolar disorder (BD) and are associated with cognitive impairment. It is, however, unknown which health risk factors for cardiometabolic disease are relevant to cognition in BD. This study aimed to identify the cardiometabolic disease risk factors that are the most important correlates of cognitive impairment in BD; and to examine whether the nature of the relationships vary between mid and later life.
Methods
Data from the UK Biobank were available for 966 participants with BD, aged between 40 and 69 years. Individual cardiometabolic disease risk factors were initially regressed onto a global cognition score in separate models for the following risk factor domains; (1) health risk behaviors (physical activity, sedentary behavior, smoking, and sleep) and (2) physiological risk factors, stratified into (2a) anthropometric and clinical risk (handgrip strength, body composition, and blood pressure), and (2b) cardiometabolic disease risk biomarkers (CRP, lipid profile, and HbA1c). A final combined multivariate regression model for global cognition was then fitted, including only the predictor variables that were significantly associated with cognition in the previous models.
Results
In the final combined model, lower mentally active and higher passive sedentary behavior, higher levels of physical activity, inadequate sleep duration, higher systolic and lower diastolic blood pressure, and lower handgrip strength were associated with worse global cognition.
Conclusions
Health risk behaviors, as well as blood pressure and muscular strength, are associated with cognitive function in BD, whereas other traditional physiological cardiometabolic disease risk factors are not.
Symptoms and cognition are both utilized as indicators of recovery following pediatric concussion, yet their interrelationship is not well understood. This study aimed to investigate: 1) the association of post-concussion symptom burden and cognitive outcomes (processing speed and executive functioning [EF]) at 4 and 12 weeks after pediatric concussion, and 2) the moderating effect of sex on this association.
Methods:
This prospective, multicenter cohort study included participants aged 5.00–17.99 years with acute concussion presenting to four Emergency Departments of the Pediatric Emergency Research Canada network. Five processing speed and EF tasks and the Post-Concussion Symptom Inventory (PCSI; symptom burden, defined as the difference between post-injury and retrospective [pre-injury] scores) were administered at 4 and 12 weeks post-concussion. Generalized least squares models were conducted with task performances as dependent variables and PCSI and PCSI*sex interaction as the main predictors, with important pre-injury demographic and injury characteristics as covariates.
Results:
311 children (65.0% males; median age = 11.92 [IQR = 9.14–14.21 years]) were included in the analysis. After adjusting for covariates, higher symptom burden was associated with lower Backward Digit Span (χ2 = 9.85, p = .043) and Verbal Fluency scores (χ2 = 10.48, p = .033) across time points; these associations were not moderated by sex, ps ≥ .20. Symptom burden was not associated with performance on the Coding, Continuous Performance Test, and Color-Word Interference scores, ps ≥ .17.
Conclusions:
Higher symptom burden is associated with lower working memory and cognitive flexibility following pediatric concussion, yet these associations were not moderated by sex. Findings may inform concussion management by emphasizing the importance of multifaceted assessments of EF.
To validate the two-factor structure (i.e., cognitive and somatic) of the Health and Behaviour Inventory (HBI), a widely used post-concussive symptom (PCS) rating scale, through factor analyses using bifactor and correlated factor models and by examining measurement invariance (MI).
Methods:
PCS ratings were obtained from children aged 8–16.99 years, who presented to the emergency department with concussion (n = 565) or orthopedic injury (OI) (n = 289), and their parents, at 10-days, 3-months, and 6-months post-injury. Item-level HBI ratings were analyzed separately for parents and children using exploratory and confirmatory factor analyses (CFAs). Bifactor and correlated models were compared using various fit indices and tested for MI across time post-injury, raters (parent vs. child), and groups (concussion vs. OI).
Results:
CFAs showed good fit for both a three-factor bifactor model, consisting of a general factor with two subfactors (i.e., cognitive and somatic), and a correlated two-factor model with cognitive and somatic factors, at all time points for both raters. Some results suggested the possibility of a third factor involving fatigue. All models demonstrated strict invariance across raters and time. Group comparisons showed at least strong or strict invariance.
Conclusions:
The findings support the two symptom dimensions measured by the HBI. The three-factor bifactor model showed the best fit, suggesting that ratings on the HBI also can be captured by a general factor. Both correlated and bifactor models showed substantial MI. The results provide further validation of the HBI, supporting its use in childhood concussion research and clinical practice.
A new fossil site in a previously unexplored part of western Madagascar (the Beanka Protected Area) has yielded remains of many recently extinct vertebrates, including giant lemurs (Babakotia radofilai, Palaeopropithecus kelyus, Pachylemur sp., and Archaeolemur edwardsi), carnivores (Cryptoprocta spelea), the aardvark-like Plesiorycteropus sp., and giant ground cuckoos (Coua). Many of these represent considerable range extensions. Extant species that were extirpated from the region (e.g., Prolemur simus) are also present. Calibrated radiocarbon ages for 10 bones from extinct primates span the last three millennia. The largely undisturbed taphonomy of bone deposits supports the interpretation that many specimens fell in from a rock ledge above the entrance. Some primates and other mammals may have been prey items of avian predators, but human predation is also evident. Strontium isotope ratios (87Sr/86Sr) suggest that fossils were local to the area. Pottery sherds and bones of extinct and extant vertebrates with cut and chop marks indicate human activity in previous centuries. Scarcity of charcoal and human artifacts suggests only occasional visitation to the site by humans. The fossil assemblage from this site is unusual in that, while it contains many sloth lemurs, it lacks ratites, hippopotami, and crocodiles typical of nearly all other Holocene subfossil sites on Madagascar.
Objective: Concussion in children and adolescents is a prevalent problem with implications for subsequent physical, cognitive, behavioral, and psychological functioning, as well as quality of life. While these consequences warrant attention, most concussed children recover well. This study aimed to determine what pre-injury, demographic, and injury-related factors are associated with optimal outcome (“wellness”) after pediatric concussion. Method: A total of 311 children 6–18 years of age with concussion participated in a longitudinal, prospective cohort study. Pre-morbid conditions and acute injury variables, including post-concussive symptoms (PCS) and cognitive screening (Standardized Assessment of Concussion, SAC), were collected in the emergency department, and a neuropsychological assessment was performed at 4 and 12 weeks post-injury. Wellness, defined by the absence of PCS and cognitive inefficiency and the presence of good quality of life, was the main outcome. Stepwise logistic regression was performed using 19 predictor variables. Results: 41.5% and 52.2% of participants were classified as being well at 4 and 12 weeks post-injury, respectively. The final model indicated that children who were younger, who sustained sports/recreational injuries (vs. other types), who did not have a history of developmental problems, and who had better acute working memory (SAC concentration score) were significantly more likely to be well. Conclusions: Determining the variables associated with wellness after pediatric concussion has the potential to clarify which children are likely to show optimal recovery. Future work focusing on wellness and concussion should include appropriate control groups and document more extensively pre-injury and injury-related factors that could additionally contribute to wellness. (JINS, 2019, 25, 375–389)
In this paper, we examine triad resonances in a rotating shallow water system when there are two free interfaces. This allows for an examination in a relatively simple model of the interplay between baroclinic and barotropic dynamics in a context where there is also a geostrophic mode. In contrast to the much-studied one-layer rotating shallow water system, we find that as well as the usual slow geostrophic mode, there are now two fast waves, a barotropic mode and a baroclinic mode. This feature permits triad resonances to occur between three fast waves, with a mixture of barotropic and baroclinic modes, an aspect that cannot occur in the one-layer system. There are now also two branches of the slow geostrophic mode, with a repeated branch of the dispersion relation. The consequences are explored in a derivation of the full set of triad interaction equations, using a multiscale asymptotic expansion based on a small-amplitude parameter. The derived nonlinear interaction coefficients are confirmed using energy and enstrophy conservation. These triad interaction equations are explored, with an emphasis on the parameter regime with small Rossby and Froude numbers.
Understanding abundance and distribution of weed species within the landscape of an agroecosystem is an important goal for weed science. Abundance is a measure of the number or frequency of individuals in an area. Distribution is a measure of the geographical range of a weed species. The study of weed population's abundance and distribution is helpful in determining how a population changes over time in response to selective pressures applied by our agronomic practices. Accurate estimates, however, of these two key variables are very important if we are to manage agricultural land both for productivity and for biodiversity.
The gist of what I want to say by way of introduction was suggested to me during my recent visit to Hong Kong and China. Reading about the events which led up to the establishment of the British presence on the South China coast in the 1830s and 1840s, I was struck, once again, by two things. The first is the way in which the 1838 Anglo-Turkish Convention was so obviously part of a world-wide movement of European self-assertion, spearheaded by a coalition of merchants, military men and politicians. The second concerns the essentially dramatic nature of the confrontation between European might and the declining power of the states and empires whose commercial practices it sought to control—the kind of drama which doesn't always get properly represented in history textbooks, let alone works of political economy.
This chapter begins with an account for the presence of a revolutionary situation that needed only a ‘spark’ to ignite it in Tunisia and Egypt. It then goes on to examine the post-revolutionary timetable of elections in these two countries leading to the establishment of a constitutional assembly obligated to create an entirely new structure for the practice of a representative and plural politics. It underlines not only the somewhat different paths taken in Egypt and Tunisia as they progress towards the same general goal, but also the passage of lessons and political experience of both, including what appear to be obvious mistakes. While the Arab world in general made use of examples taken from a global and historical repertoire of revolutionary change going back to the influence of both the American and French revolutions of the late eighteenth century, the mutual influences exercised in the Egyptian-Tunisian case remains something extra special in their intensity and effect.
Central to the diagnosis of myeloma is the demonstration of bone marrow infiltration by monoclonal plasma cells. The extent of infiltration typically exceeds 10% although it is well recognized that marrow disease can be patchy and a minority of patients with symptomatic myeloma will have <10% bone marrow plasma cells (BMPC)[1]. The 10% threshold chosen to distinguish myeloma from MGUS is somewhat arbitrary as both disorders form a continuous spectrum and it is therefore essential that the extent of marrow infiltration is correlated with the clinical features before a definitive diagnosis is made. It is recommended that a trephine biopsy be obtained in most patients as it provides a better assessment of the extent of marrow infiltration than even the best quality aspirate smears[2]. It is well recognized that bone marrow aspirate plasma cell counts consistently underestimate the overall level of infiltration[3–6]. An adequate trephine also ensures that a diagnosis can be made when the bone marrow aspirate specimen is of poor quality. Plasma cell cytomorphology varies considerably from patient to patient and a number of groups have proposed classification schema and have also demonstrated that cases with so-called blastic cytology have an inferior outcome[7–9]. However, such morphological classification schemes are poorly reproducible and have been largely superseded as prognostic tools by cytogenetic abnormalities and clinical parameters such as the International Staging System (ISS).
The Arab world has experienced a large number of military presidencies since General Bakr Sidki's brief rule in Iraq in 1936. The phenomenon became of great significance beginning with Colonel Jamal ʿAbd al-Nasir's presidency in Egypt in the early 1950s, which established a model for similar regimes in Sudan, Syria, Iraq, Yemen, and, at least initially, Libya under the self-promoted Colonel Muʿammar al-Qadhafi. The president who exchanged his uniform for a suit; an authoritarian style of political management in the name of a revolution against an old, foreign-dominated order; and the legitimacy obtained from laudable achievements in the international and economic sphere: these were all part of al-Nasir's influence and legacy.
Background: Cognitive Behavioural Therapy (CBT) is not primarily conceptualized as operating via affective processes. However, there is growing recognition that emotional processing plays an important role during the course of therapy. Aims: The Emotional Processing Scale was developed as a clinical and research tool to measure emotional processing deficits and the process of emotional change during therapy. Method: Fifty-five patients receiving CBT were given measures of emotional functioning (Toronto Alexithymia Scale [TAS-20]; Emotional Processing Scale [EPS-38]) and psychological symptoms (Brief Symptom Inventory [BSI]) pre- and post-therapy. In addition, the EPS-38 was administered to a sample of 173 healthy individuals. Results: Initially, the patient group exhibited elevated emotional processing scores compared to the healthy group, but after therapy, these scores decreased and approached those of the healthy group. Conclusions: This suggests that therapy ostensibly designed to reduce psychiatric symptoms via cognitive processes may also facilitate emotional processing. The Emotional Processing Scale demonstrated sensitivity to changes in alexithymia and psychiatric symptom severity, and may provide a valid and reliable means of assessing change during therapy.