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Background: Non-pharmacological interventions that promote self-management are crucial for individuals with mild cognitive impairment (MCI.) Mindfulness training has shown promise but is often not tailored to MCI. Methods: In 2021, the Neil and Susan Manning Cognitive Health Initiative (CHI) - a collaboration between the Vancouver Island Health Authority, Universities of BC and Victoria, and the Victoria Hospitals Foundation - partnered with the BC Association for Living Mindfully (BCALM) to develop a specialized mindfulness program for MCI, based on Mindfulness-Based Stress Reduction (MBSR). This multi-phase initiative aimed to enhance self-management, address the lack of outpatient services for MCI in Victoria, and contribute to the evidence base for mindfulness interventions. Results: Phase 1 assessed the BCALM program’s suitability for MCI; feedback included suggestions to simplify content and meditations. Phase 2 piloted an adapted version, with an 8-week program consisting of weekly sessions. Participants, recruited from the Seniors Outpatient Clinic in Victoria, completed pre- and post-program surveys; results showed over 90% of participants reported improved memory and coping, and 80% managed memory-related challenges better. Conclusions: Now in Phase 3, the MCI program is being transitioned into regular BCALM curriculum, with plans for a clinical trial comparing it to traditional psychoeducational approaches.
Background: Neck vessel imaging is often performed in hyperacute stroke to allow neurointerventionalists to estimate access complexity. This study aimed to assess clinician agreement on catheterization strategies based on imaging in these scenarios. Methods: An electronic portfolio of 60 patients with acute ischemic stroke was sent to 53 clinicians. Respondents were asked: (1) the difficulty of catheterization through femoral access with a regular Vertebral catheter, (2) whether to use a Simmons or reverse-curve catheter initially, and (3) whether to consider an alternative access site. Agreement was assessed using Fleiss’ Kappa statistics. Results: Twenty-two respondents (7 neurologists, 15 neuroradiologists) completed the survey. Overall there was slight interrater agreement (κ=0.17, 95% CI: 0.10–0.25). Clinicians with >50 cases annually had better agreement (κ=0.22) for all questions than those with fewer cases (κ=0.07). Agreement did not significantly differ by imaging modality: CTA (κ=0.18) and MRA (κ=0.14). In 40/59 cases (67.80%), at least 25% of clinicians disagreed on whether to use a Simmons or reverse-curve catheter initially. Conclusions: Agreement on catheterization strategies remains fair at best. Our results suggest that visual assessment of pre-procedural vessels imaging is not reliable for the estimation of endovascular access complexity.
Globally, mental disorders account for almost 20% of disease burden and there is growing evidence that mental disorders are associated with various social determinants. Tackling the United Nations Sustainable Development Goals (UN SDGs), which address known social determinants of mental disorders, may be an effective way to reduce the global burden of mental disorders.
Objectives
To examine the evidence base for interventions that seek to improve mental health through targeting the social determinants of mental disorders.
Methods
We conducted a systematic review of reviews, using a five-domain conceptual framework which aligns with the UN SDGs (PROSPERO registration: CRD42022361534). PubMed, PsycInfo, and Scopus were searched from 01 January 2012 until 05 October 2022. Citation follow-up and expert consultation were used to identify additional studies. Systematic reviews including interventions seeking to change or improve a social determinant of mental disorders were eligible for inclusion. Study screening, selection, data extraction, and quality appraisal were conducted in accordance with PRISMA guidelines. The AMSTAR-2 was used to assess included reviews and results were narratively synthesised.
Results
Over 20,000 records were screened, and 101 eligible reviews were included. Most reviews were of low, or critically low, quality. Reviews included interventions which targeted sociocultural (n = 31), economic (n = 24), environmental (n = 19), demographic (n = 15), and neighbourhood (n = 8) determinants of mental disorders. Interventions demonstrating the greatest promise for improved mental health from high and moderate quality reviews (n = 37) included: digital and brief advocacy interventions for female survivors of intimate partner violence; cash transfers for people in low-middle-income countries; improved work schedules, parenting programs, and job clubs in the work environment; psychosocial support programs for vulnerable individuals following environmental events; and social and emotional learning programs for school students. Few effective neighbourhood-level interventions were identified.
Conclusions
This review presents interventions with the strongest evidence base for the prevention of mental disorders and highlights synergies where addressing the UN SDGs can be beneficial for mental health. A range of issues across the literature were identified, including barriers to conducting randomised controlled trials and lack of follow-up limiting the ability to measure long-term mental health outcomes. Interdisciplinary and novel approaches to intervention design, implementation, and evaluation are required to improve the social circumstances and mental health experienced by individuals, communities, and populations.
Infrared spectra of 2-ethoxyethanol (ethylene glycol monoethyl ether, EGME) adsorbed on Camontmorillonite were obtained using diffuse-reflectance infrared-Fourier-transform (DRIFT) and attenuated total-reflectance (ATR) spectroscopy. The molecular conformation of adsorbed EGME shows predominantly a gauche configuration for the CH2-CH2 linkage as originally present in the liquid. The orientation of the adsorbed EGME molecule in the interlamellar region of the clay was deduced from measurements of the polarized ATR spectra. The planar zig-zag skeleton of the molecule appears to have its long axis tilted at an angle of 44° to the clay surface; the molecule is in van der Waals contact with both adjacent surfaces. Further, the plane of the skeleton of the molecule is tilted at an angle of 69° to the clay surface. This orientation leads to estimates of the d-value of the clay-EGME complex and of the surface area occupied by each molecule. These values are in excellent agreement with independent measurements of both parameters. The full surface coverage on montmorillonite is represented by a single layer of tilted EGME molecules shared by two adjacent clay sheets; each molecule occupies a total surface area consisting of one portion (25.4 Å2) on the lower surface of the interlayer plus another portion (14.8 Å2) on the upper surface. The implication of this model for materials such as kaolinite, where adsorption takes place on the external surface only, is that on these materials each EGME molecule occupies 20 Å2 at full surface coverage.
To determine whether poorer performance on the Boston Naming Test (BNT) in individuals with transactive response DNA-binding protein 43 pathology (TDP-43+) is due to greater loss of word knowledge compared to retrieval-based deficits.
Methods:
Retrospective clinical-pathologic study of 282 participants with Alzheimer’s disease neuropathologic changes (ADNC) and known TDP-43 status. We evaluated item-level performance on the 60-item BNT for first and last available assessment. We fit cross-sectional negative binomial count models that assessed total number of incorrect items, number correct of responses with phonemic cue (reflecting retrieval difficulties), and number of “I don’t know” (IDK) responses (suggestive of loss of word knowledge) at both assessments. Models included TDP-43 status and adjusted for sex, age, education, years from test to death, and ADNC severity. Models that evaluated the last assessment adjusted for number of prior BNT exposures.
Results:
43% were TDP-43+. The TDP-43+ group had worse performance on BNT total score at first (p = .01) and last assessments (p = .01). At first assessment, TDP-43+ individuals had an estimated 29% (CI: 7%–56%) higher mean number of incorrect items after adjusting for covariates, and a 51% (CI: 15%–98%) higher number of IDK responses compared to TDP-43−. At last assessment, compared to TDP-43−, the TDP-43+ group on average missed 31% (CI: 6%–62%; p = .01) more items and had 33% more IDK responses (CI: 1% fewer to 78% more; p = .06).
Conclusions:
An important component of poorer performance on the BNT in participants who are TDP-43+ is having loss of word knowledge versus retrieval difficulties.
Adverse factors in the psychosocial work environment are associated with the onset of depression among those without a personal history of depression. However, the evidence is sparse regarding whether adverse work factors can also play a role in depression recurrence. This study aimed to prospectively examine whether factors in the psychosocial work environment are associated with first-time and recurrent treatment for depression.
Methods
The study included 24,226 participants from the Danish Well-being in Hospital Employees study. We measured ten individual psychosocial work factors and three theoretical constructs (effort–reward imbalance, job strain and workplace social capital). We ascertained treatment for depression through registrations of hospital contacts for depression (International Statistical Classification of Diseases and Related Health Problems version 10 [ICD-10]: F32 and F33) and redeemed prescriptions of antidepressant medication (Anatomical Therapeutic Chemical [ATC]: N06A) in Danish national registries. We estimated the associations between work factors and treatment for depression for up to 2 years after baseline among those without (first-time treatment) and with (recurrent treatment) a personal history of treatment for depression before baseline. We excluded participants registered with treatment within 6 months before baseline. In supplementary analyses, we extended this washout period to up to 2 years. We applied logistic regression analyses with adjustment for confounding.
Results
Among 21,156 (87%) participants without a history of treatment for depression, 350 (1.7%) had first-time treatment during follow-up. Among the 3070 (13%) participants with treatment history, 353 (11%) had recurrent treatment during follow-up. Those with a history of depression generally reported a more adverse work environment than those without such a history. Baseline exposure to bullying (odds ratio [OR] = 1.72, 95% confidence interval [95% CI]: 1.30–2.32), and to some extent also low influence on work schedule (OR = 1.27, 95% CI: 0.97–1.66) and job strain (OR = 1.24, 95% CI: 0.97–1.57), was associated with first-time treatment for depression during follow-up. Baseline exposure to bullying (OR = 1.40, 95% CI: 1.04–1.88), lack of collaboration (OR = 1.31, 95% CI: 1.03–1.67) and low job control (OR = 1.27, 95% CI: 1.00–1.62) were associated with recurrent treatment for depression during follow-up. However, most work factors were not associated with treatment for depression. Using a 2-year washout period resulted in similar or stronger associations.
Conclusions
Depression constitutes a substantial morbidity burden in the working-age population. Specific adverse working conditions were associated with first-time and recurrent treatment for depression and improving these may contribute to reducing the onset and recurrence of depression.
This research paper aimed to locate protein modifications caused by treatment of milk and determine if the modification locations were consistent. The majority of milk for consumption is homogenised using pressure and heat, and this causes changes in the location of proteins in the milk as well as protein modifications. To investigate these proteomic changes, raw milk was pasteurised (72°C, 15 s), then, to separate the treatment for homogenisation, heated at these different pressures and temperatures: 45°C without no pressure applied, 45°C with 35 MPa, 80°C without pressure applied and 80°C, with 35 MPa. Proteomic analysis was done after separating the milk into three fractions: whey, casein and cream. Protein modifications in each fraction were examined and we found Maillard products as well as oxidation to be of interest. The proteins were also further identified and characterised to compare protein modification sites and differences in proteins present in the cream resulting from homogenisation and/or pasteurisation. This experiment showed that both heat and pressure during homogenisation can cause increases in protein modifications as a result of oxidation or the Maillard reaction. Total cysteine oxidation and total proline oxidation differed between treatments although this was only significantly different for cysteine. It was observed that protein modifications occurred in the same location in the protein sequence rather than in random locations which we highlighted by examining α-S1-casein, lactadherin and β-lactoglobulin.
Declines in mental health among youth in the COVID-19 pandemic have been observed, yet longitudinal studies on how housing may impact these declines are lacking.
Objectives
Our aim was to determine whether changes in mental health among Danish youth were dependent on their housing conditions.
Methods
Young participants from the Danish National Birth Cohort, who had responded to an online questionnaire at 18 years of age, and later during the initial national Danish lockdown, were included. Associations between housing conditions (direct access to outdoor spaces, urbanicity, household density, and household composition) and changes in mental health (mental well-being, quality of life (QoL) and loneliness) were examined in multivariate linear and logistic regression analyses.
Results
We included 7455 participants. Greater decreases in mental well-being were observed for youth with no access to direct outdoor spaces and those living in denser households (mean difference -0.83 [95 % CI -1.19, -0.48], -0.30 [-0.43, -0.18], respectively). Onset of low mental well-being was associated with no access and living alone (odds ratios (OR) 1.68 [1.15, 2.47] and OR 1.47 [1.05, 2.07], respectively). Household density was negatively associated with QoL (mean difference -0.21 [-0.30, -0.12]). Youth living alone experienced more loneliness (OR 2.12 [95 % CI 1.59, 2.82]).
Conclusions
How youth’s mental health changed from before to during lockdown was associated with housing conditions. Among the Danish youth in our study, greater decreases in mental health during lockdown were observed among youth without access to outdoor spaces, living alone, or living in denser households.
The neuro-endoscopy is a surgical technique that allows the neurosurgeon to maintain a visual contact while operating inside the brain of a patient. A special instrument called the neuro-endoscope is inserted in the brain until the neurosurgeon reaches his/her target. Its manipulation requires a high level of training for neurosurgeons. To enforce both quality and safety of neuro-endoscopy, we propose a robotic manipulator based on a Spherical Decoupled Mechanism. This mechanical architecture has been modified from a 5-Bar Spherical Linkages and adapted to this medical application. It is able to generate a Remote Center of Motion of 2 Degrees of Freedom. It merges the advantages of parallel mechanisms with the kinematic and control simplicity of decoupled mechanisms, while having a very simple architecture. Motion capture experiments using a brain simulation model have been performed with a team of neurosurgeons to obtain the kinematic data of the neuro-endoscope during brain exploration. Based on the identified workspace, the mechanism has been optimized using kinematic performance and architectural compactness as criteria. An optimum mechanism has been selected, showing better kinematic performances than the original 5-bar spherical linkage mechanism.
Increasing weed control costs and limited herbicide options threaten vegetable crop profitability. Traditional interrow mechanical cultivation is very effective at removing weeds between crop rows. However, weed control within the crop rows is necessary to establish the crop and prevent yield loss. Currently, many vegetable crops require hand weeding to remove weeds within the row that remain after traditional cultivation and herbicide use. Intelligent cultivators have come into commercial use to remove intrarow weeds and reduce cost of hand weeding. Intelligent cultivators currently on the market such as the Robovator, use pattern recognition to detect the crop row. These cultivators do not differentiate crops and weeds and do not work well among high weed populations. One approach to differentiate weeds is to place a machine-detectable mark or signal on the crop (i.e., the crop has the mark and the weed does not), thereby facilitating weed/crop differentiation. Lettuce and tomato plants were marked with labels and topical markers, then cultivated with an intelligent cultivator programmed to identify the markers. Results from field trials in marked tomato and lettuce found that the intelligent cultivator removed 90% more weeds from tomato and 66% more weeds from lettuce than standard cultivators without reducing yields. Accurate crop and weed differentiation described here resulted in a 45% to 48% reduction in hand-weeding time per hectare.
In Canada, recreational use of cannabis was legalized in October 2018. This policy change along with recent publications evaluating the efficacy of cannabis for the medical treatment of epilepsy and media awareness about its use have increased the public interest about this agent. The Canadian League Against Epilepsy Medical Therapeutics Committee, along with a multidisciplinary group of experts and Canadian Epilepsy Alliance representatives, has developed a position statement about the use of medical cannabis for epilepsy. This article addresses the current Canadian legal framework, recent publications about its efficacy and safety profile, and our understanding of the clinical issues that should be considered when contemplating cannabis use for medical purposes.
Prenatal sex steroid exposure plays an important role in determining child development. Yet, measurement of prenatal hormonal exposure has been limited by the paucity of newborn/infant data and the invasiveness of fetal hormonal sampling. Here we provide descriptive data from the MIREC-ID study (n=173 girls; 162 boys) on a range of minimally invasive physical indices thought to reflect prenatal exposure to androgens [anogenital distances (AGDs); penile length/width, scrotal/vulvar pigmentation], to estrogens [vaginal maturation index (VMI) – the degree of maturation of vaginal wall cells] or to both androgens/estrogens [2nd-to-4th digit ratio (2D:4D); areolar pigmentation, triceps/sub-scapular skinfold thickness, arm circumference]. VMI was found to be associated with triceps skinfold thickness (β=0.265, P=0.005), suggesting that this marker may be sensitive to estrogen levels produced by adipose tissue in girls. Both estrogenic and androgenic markers (VMI: β=0.338, P=0.031; 2D:4D – right: β=−0.207, P=0.040; left: β=−0.276, P=0.006; AGD-fourchette − β=0.253, P=0.036) were associated with areolar pigmentation in girls, supporting a role for the latter as an index of both androgen and estrogen exposure. We also found AGD-penis (distance from the anus to the penis) to be associated with scrotal pigmentation (β=0.290, P=0.048), as well as right arm circumference (β=0.462, P<0.0001), supporting the notion that these indices may be used together as markers of androgen exposure in boys. In sum, these findings support the use of several physical indices at birth to convey a more comprehensive picture of prenatal exposure to sex hormones.
To characterise subjective symptoms in patients undergoing surgical repair of superior semicircular canal dehiscence.
Methods
Questionnaires assessing symptom severity and impact on function and quality of life were administered to patients before superior semicircular canal dehiscence surgery, between June 2011 and March 2016. Questionnaire sections included general quality of life, internal amplified sounds, dizziness and tinnitus, with scores of 0–100 points.
Results
Twenty-three patients completed the questionnaire before surgery. Section scores (mean±standard deviation) were: 38.2 ± 25.2 for general quality of life, 52.5 ± 23.9 for internal amplified sounds, 35.1 ± 28.8 for dizziness, 33.3 ± 30.7 for tinnitus, and 39.8 ± 22.2 for the composite score. Cronbach's α statistic averaged 0.93 (range, 0.84–0.97) across section scores, and 0.83 for the composite score.
Conclusion
The Gopen–Yang Superior Semicircular Canal Dehiscence Questionnaire provides a holistic, patient-centred characterisation of superior semicircular canal dehiscence symptoms. Internal consistency analysis validated the questionnaire and provided a quantitative framework for further optimisation in the clinical setting.
Lithium-ion batteries featuring electrodes of silicon nanoparticles, conductive carbon, and polymer binders were constructed with electrolyte containing 1.2 M LiPF6 in ethylene carbonate and diethyl carbonate (1:1, w/w). Material binders used include polyvinylidene difluoride (PVdF), polyacrylic acid (PAA), sodium carboxymethyl cellulose (CMC), and a mixture of equal masses of CMC and PAA (CMCPAA). Hard X-ray photoelectron spectroscopy (HAXPES) was performed on the electrodes when fresh, cycled at reduced potential, and cycled one full time to study how substrate material binders affect the early formation of the solid electrolyte interphase (SEI) layer. Electrodes cycled 5, 10, and 20 times were also analyzed to discern what changes to the SEI occur after initial formation. We also present estimates of the SEI thickness by cycle count, indicating that PAA develops the thinnest SEI, followed by CMCPAA, CMC, and PVdF in order of increasing layer thickness.
A cluster of Salmonella Paratyphi B variant L(+) tartrate(+) infections with indistinguishable pulsed-field gel electrophoresis patterns was detected in October 2015. Interviews initially identified nut butters, kale, kombucha, chia seeds and nutrition bars as common exposures. Epidemiologic, environmental and traceback investigations were conducted. Thirteen ill people infected with the outbreak strain were identified in 10 states with illness onset during 18 July–22 November 2015. Eight of 10 (80%) ill people reported eating Brand A raw sprouted nut butters. Brand A conducted a voluntary recall. Raw sprouted nut butters are a novel outbreak vehicle, though contaminated raw nuts, nut butters and sprouted seeds have all caused outbreaks previously. Firms producing raw sprouted products, including nut butters, should consider a kill step to reduce the risk of contamination. People at greater risk for foodborne illness may wish to consider avoiding raw products containing raw sprouted ingredients.
Prenatal adversity shapes child neurodevelopment and risk for later mental health problems. The quality of the early care environment can buffer some of the negative effects of prenatal adversity on child development. Retrospective studies, in adult samples, highlight epigenetic modifications as sentinel markers of the quality of the early care environment; however, comparable data from pediatric cohorts are lacking. Participants were drawn from the Maternal Adversity Vulnerability and Neurodevelopment (MAVAN) study, a longitudinal cohort with measures of infant attachment, infant development, and child mental health. Children provided buccal epithelial samples (mean age = 6.99, SD = 1.33 years, n = 226), which were used for analyses of genome-wide DNA methylation and genetic variation. We used a series of linear models to describe the association between infant attachment and (a) measures of child outcome and (b) DNA methylation across the genome. Paired genetic data was used to determine the genetic contribution to DNA methylation at attachment-associated sites. Infant attachment style was associated with infant cognitive development (Mental Development Index) and behavior (Behavior Rating Scale) assessed with the Bayley Scales of Infant Development at 36 months. Infant attachment style moderated the effects of prenatal adversity on Behavior Rating Scale scores at 36 months. Infant attachment was also significantly associated with a principal component that accounted for 11.9% of the variation in genome-wide DNA methylation. These effects were most apparent when comparing children with a secure versus a disorganized attachment style and most pronounced in females. The availability of paired genetic data revealed that DNA methylation at approximately half of all infant attachment-associated sites was best explained by considering both infant attachment and child genetic variation. This study provides further evidence that infant attachment can buffer some of the negative effects of early adversity on measures of infant behavior. We also highlight the interplay between infant attachment and child genotype in shaping variation in DNA methylation. Such findings provide preliminary evidence for a molecular signature of infant attachment and may help inform attachment-focused early intervention programs.
The goal of this study was to assess the utility of serial electrocardiograms in routine follow-up of paediatric Marfan patients.
Methods
Children ⩽18 years who met the revised Ghent criteria for Marfan syndrome and received a 12-lead electrocardiogram and echocardiogram within a 3-month period were included. Controls were matched by age, body surface area, gender, race, and ethnicity, and consisted of patients assessed in clinic with a normal cardiac evaluation. Demographic, clinical, echocardiographic, and electrocardiographic data were collected.
Results
A total of 45 Marfan patients (10.8 [2.4–17.1] years) and 37 controls (12.8 [1.3–17.1] years) were included. Left atrial enlargement and left ventricular hypertrophy were more frequently present on 12-lead electrocardiogram of Marfan patients compared with controls (12 (27%) versus 0 (0%), p<0.001; and 8 (18%) versus 0 (0%), p=0.008, respectively); however, only two patients with left atrial enlargement on 12-lead electrocardiogram were confirmed to have left atrial enlargement by echocardiogram, and one patient had mild left ventricular hypertrophy by echocardiogram, not appreciated on 12-lead electrocardiogram. QTc interval was longer in Marfan patients compared with controls (427±16 versus 417±22 ms, p=0.03), with four Marfan patients demonstrating borderline prolonged QTc intervals for gender.
Conclusions
While Marfan patients exhibited a higher frequency of left atrial enlargement and left ventricular hypertrophy on 12-lead electrocardiograms compared with controls, these findings were not supported by echocardiography. Serial 12-lead electrocardiograms in routine follow-up of asymptomatic paediatric Marfan patients may be more appropriate for a subgroup of Marfan patients only, specifically those with prolonged QTc interval at their baseline visit.
Introduction: Intra-articular steroid injection (IASI) is commonly used in the emergency department for management of osteoarthritis (OA) symptoms. Hip IASI carries risks, such as avascular necrosis, and there is currently no reliable way to predict long-term response of a patient’s OA to IASI. Ultrasound (US) conveniently assesses for active arthropathy by detecting effusion-synovitis, and x-ray (XR) is useful for visualizing bone-related changes. We investigated the extent that a response to hip IASI could be predicted from baseline OA patient clinical and physical features alongside US and XR imaging features. Methods: 97 consenting patients with symptomatic hip OA presenting for hip IASI were evaluated at baseline (XR and US) and again 8-weeks after IASI (US only). Self-reported pain (WOMAC), hip range of motion (ROM) were measured at baseline and follow up. On US images we quantified joint effusion and synovial thickening, i.e., “effusion-synovitis”, by the bone-capsule distance (BCD) at the apex of the femoral head from outer femoral cortex to outer synovium. On XR, we measured minimum joint space width (cm) and Kellgren-Lawrence (K-L) Grade for osteophytes and sclerotic changes. Results: In our 97 patients (43 female) aged 28-87 years (mean 59+/-13 years, K-L grades averaged 2.5+/-1.5, and US BCD averaged 5.9+/-2.0 mm. We performed multiple linear regression using age, sex, BMI, ROM of hip flexion, US BCD, radiographic joint space width and K-L grade against the dependent variable, change in WOMAC pain subscore (R=0.587, P=0.002). We compared the response predicted by this model to the actual change in WOMAC pain. At a threshold value of -20% for minimal clinically important difference, 35/97 patients were responders, and a 2x2 table gave 67% overall model predictive accuracy, 61% sensitivity, and 71% specificity. Likelihood ratio for a positive response (LR+) was 2.13. Conclusion: Combining radiographic information on structural damage, US information on active arthropathy, and demographics correctly predicted about two-thirds of the patients that would benefit from IASI after 8 weeks. A patient with hip OA that met our model criteria was more than twice as likely to respond to IASI. With further model refinement, effective, personalized evidence-based management of symptomatic hip OA is possible using XR and hip US, which could both be performed during an ER visit.