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To examine the association of posttraumatic headache (PTH) type with postconcussive symptoms (PCS), pain intensity, and fluid cognitive function across recovery after pediatric concussion.
Methods:
This prospective, longitudinal study recruited children (aged 8–16.99 years) within 24 hours of sustaining a concussion or mild orthopedic injury (OI) from two pediatric hospital emergency departments. Based on parent-proxy ratings of pre- and postinjury headache, children were classified as concussion with no PTH (n = 18), new PTH (n = 43), worse PTH (n = 58), or non-worsening chronic PTH (n = 19), and children with OI with no PTH (n = 58). Children and parents rated PCS and children rated pain intensity weekly up to 6 months. Children completed computerized testing of fluid cognition 10 days, 3 months, and 6- months postinjury. Mixed effects models compared groups across time on PCS, pain intensity, and cognition, controlling for preinjury scores and covariates.
Results:
Group differences in PCS decreased over time. Cognitive and somatic PCS were higher in new, chronic, and worse PTH relative to no PTH (up to 8 weeks postinjury; d = 0.34 to 0.87 when significant) and OI (up to 5 weeks postinjury; d = 0.30 to 1.28 when significant). Pain intensity did not differ by group but declined with time postinjury. Fluid cognition was lower across time in chronic PTH versus no PTH (d = −0.76) and OI (d = −0.61) and in new PTH versus no PTH (d = −0.51).
Conclusions:
Onset of PTH was associated with worse PCS up to 8 weeks after pediatric concussion. Chronic PTH and new PTH were associated with moderately poorer fluid cognitive functioning up to 6 months postinjury. Pain declined over time regardless of PTH type.
Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.
Aims
To examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.
Method
Genome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.
Results
Earlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.
Conclusions
AAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.
Hitler's Machtergreifung, or seizure of power, on January 30, 1933, marked the end of the Weimar Republic and the beginning of the Third Reich, and German film scholarship has generally accepted this date as the break between Weimar and Nazi-era film as well. This collection of essays interrogates the continuities and discontinuities in German cinema before and after January 1933 and theirrelationship to the various crises of the years 1928 to 1936 in seven areas: politics, the economy, concepts of race and ethnicity, the making of cinema stars, genre cinema, film technologies and aesthetics, and German-international film relations. Focusing both on canonical and lesser-known works, the essays analyze a representative sample of films and genres from the period. This book will be ofinterest to scholars and students of Weimar and Third Reich cinema and of the sociopolitical, economic, racial, artistic, and technological spheres in both late Weimar and the early Third Reich, as well as to film scholars in general.
Contributors: Paul Flaig, Margrit Frölich, Barbara Hales, Anjeana Hans, Bastian Heinsohn, Brook Henkel, Kevin B. Johnson, Owen Lyons, Richard W. McCormick, Kalani Michell, Mihaela Petrescu, Christian Rogowski, Valerie Weinstein, Wilfried Wilms.
Barbara Hales is Associate Professor of History at the University of Houston-Clear Lake. MihaelaPetrescu is Visiting Lecturer at the University of Pittsburgh. Valerie Weinstein is Assistant Professor of Women's, Gender, and Sexuality Studies and German Studies at the University of Cincinnati.
While organs had been built in the United States since the eighteenth century, until the middle of the nineteenth century what passed as an ‘organ concert’ consisted of a mélange of transcriptions from choral music and simple improvisations, interspersed with choral music and vocal solos. As larger organs began to appear by the middle of the nineteenth century, solo organ recitals by players such as George W. Morgan were occasionally performed. In the 1850s Americans such as Dudley Buck and John K. Paine travelled to Germany to study organ performance and composition, and others followed. The opening of a large organ in Boston's Music Hall in 1863 and the building of large churches in the post-war period gave impetus to public organ recitals, which along with compositions by Bach, Mendelssohn, Rinck and Batiste etc. usually included transcriptions from operas and orchestral works, and compositions by the performers. At first, the emphasis was on Germanic music, but as the second half of the century progressed and more organists were studying abroad, works by British and French composers began to appear. By the end of the century the emphasis had become strongly French, particularly after the concert tours of Parisian virtuoso Alexandre Guilmant, and America's first true concert organist, Clarence Eddy, began making tours to European countries. By this time many large organs had been built for concert halls, cathedrals, colleges, and urban churches, providing excellent venues for solo organ recitals as the twentieth century opened.
Emergency department (ED) patients with symptoms of cardiac ischemia often require a second cardiac troponin (cTn) measurement to rule out non–ST elevation myocardial infarction. We measured the total turnaround time and the component event times following the ordering of the second cTn level to ED discharge to identify root causes of delays.
Methods:
We reviewed a random sample of ED discharges following a second normal cTn measurement and recorded associated event times. The central tendency of time intervals is reported as median and mean number of minutes with interquartile ranges (IQRs) and 95% confidence intervals, respectively.
Results:
From 9,656 eligible cases, we randomly selected 226 for data collection. The median number of minutes for each event are as follows: from ordering the second cTn measurement to the time of ED discharge was 90 minutes (IQR 65–120); for blood collection from the time the collection was ordered for was 0 minutes (IQR 212–0); from blood collection to the time the blood was transported to the laboratory was 9 minutes (IQR 2–19); laboratory process duration was 44 minutes (IQR 39–52); from when the results were available to the time the patient was discharged was 30 minutes (IQR 15–52).
Conclusions:
For ED patients discharged following two normal cTn levels, the laboratory processing time and time from the result being available to the time of ED discharge represent the longest modifiable time periods to reduce ED length of stay.
