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Background: After a transient ischemic attack (TIA) or minor stroke, the long-term risk of subsequent stroke is uncertain. Methods: Electronic databases were searched for observational studies reporting subsequent stroke during a minimum follow-up of 1 year in patients with TIA or minor stroke. Unpublished data on number of stroke events and exact person-time at risk contributed by all patients during discrete time intervals of follow-up were requested from the authors of included studies. This information was used to calculate the incidence of stroke in individual studies, and results across studies were pooled using random-effects meta-analysis. Results: Fifteen independent cohorts involving 129794 patients were included in the analysis. The pooled incidence rate of subsequent stroke per 100 person-years was 6.4 events in the first year and 2.0 events in the second through tenth years, with cumulative incidences of 14% at 5 years and 21% at 10 years. Based on 10 studies with information available on fatal stroke, the pooled case fatality rate of subsequent stroke was 9.5% (95% CI, 5.9 – 13.8). Conclusions: One in five patients is expected to experience a subsequent stroke within 10 years after a TIA or minor stroke, with every tenth patient expected to die from their subsequent stroke.
Background: Cerebral small vessel disease (CSVD) is associated with stroke, cognitive decline, and dementia. In this study, we examined how SVD is longitudinally related to cognitive performance in transient ischemic attack (TIA) patients compared to controls. Methods: We rated CSVD at baseline on MRI in TIA patients (n=197) and controls (n=113) for microbleeds (CMB), lacunes, white matter hyperintensities (WMH), and perivascular spaces (EPVS). Neuropsychological testing was administered across 5 years using the following assessments: BVMT, RAVLT, TMTA, TMTB, WAIS-R. Results: Periventricular WMH≥2 yielded slower performance on TMTB across all timepoints (adjusted difference 20.3 seconds, 95%CI [8.4,32.2]), as did deep WMH≥2 (20.1 sec, 95%CI [7.6,32.6]). Basal ganglia EPVS>20 performed slower on TMTA (10.1 sec, 95%CI [4.7,15.5]) and TMTB (21.2 sec, 95%CI [3.4,39.1]). Centrum semiovale EPVS>20 performed slower on TMTB (27.2 sec, 95%CI [10.6,43.8]) and worse on WAIS-R at 5-years (-18.6, 95%CI [-35.0,-2.2]). Lacunes≥3 performed slower on TMTA across all timepoints (4.0 sec, 95%CI [0.1,7.9]). Total CSVD≥2 performed slower on TMTA (3.7 sec, 95%CI [0.4,7.0]) and TMTB (13.9 sec, 95%CI [2.9,24.9]) across 5 years. When stratifying results, associations were generally found in TIA, not controls. Conclusions: Findings demonstrate that CSVD is associated with poorer cognitive performance longitudinally, and is more pronounced in TIA compared to control.
We show that a common method of predicting individuals’ race in administrative records, Bayesian Improved Surname Geocoding (BISG), produces misclassification errors that are strongly correlated with demographic and socioeconomic factors. In addition to the high error rates for some racial subgroups, the misclassification rates are correlated with the political and economic characteristics of a voter’s neighborhood. Racial and ethnic minorities who live in wealthy, highly educated, and politically active areas are most likely to be misclassified as white by BISG. Inferences about the relationship between sociodemographic factors and political outcomes, like voting, are likely to be biased in models using BISG to infer race. We develop an improved method in which the BISG estimates are incorporated into a machine learning model that accounts for class imbalance and incorporates individual and neighborhood characteristics. Our model decreases the misclassification rates among non-white individuals, in some cases by as much as 50%.
Vulture populations are in severe decline across Africa and prioritization of geographic areas for their conservation is urgently needed. To do so, we compiled three independent datasets on vulture occurrence from road-surveys, GPS-tracking, and citizen science (eBird), and used maximum entropy to build ensemble species distribution models (SDMs). We then identified spatial vulture conservation priorities in Ethiopia, a stronghold for vultures in Africa, while accounting for uncertainty in our predictions. We were able to build robust distribution models for five vulture species across the entirety of Ethiopia, including three Critically Endangered, one Endangered, and one Near Threatened species. We show that priorities occur in the highlands of Ethiopia, which provide particularly important habitat for Bearded Gypaetus barbatus, Hooded Necrosyrtes monachus, Rüppell’s Gyps rüppelli and White-backed Gyps africanus Vultures, as well as the lowlands of north-eastern Ethiopia, which are particularly valuable for the Egyptian Vulture Neophron percnopterus. One-third of the core distribution of the Egyptian Vulture was protected, followed by the White-backed Vulture at one-sixth, and all other species at one-tenth. Overall, only about one-fifth of vulture priority areas were protected. Given that there is limited protection of priority areas and that vultures range widely, we argue that measures of broad spatial and legislative scope will be necessary to address drivers of vulture declines, including poisoning, energy infrastructure, and climate change, while considering the local social context and aiding sustainable development.
Three-dimensional printing is increasingly utilised for congenital heart defect procedural planning. CT or MR datasets are typically used for printing, but similar datasets can be obtained from three-dimensional rotational angiography. We sought to assess the feasibility and accuracy of printing three-dimensional models of CHD from rotational angiography datasets.
Methods:
Retrospective review of CHD catheterisations using rotational angiography was performed, and patient and procedural details were collected. Imaging data from rotational angiography were segmented, cleaned, and printed with polylactic acid on a Dremel® 3D Idea Builder (Dremel, Mount Prospect, IL, USA). Printing time and materials’ costs were captured. CT scans of printed models were compared objectively to the original virtual models. Two independent, non-interventional paediatric cardiologists provided subjective ratings of the quality and accuracy of the printed models.
Results:
Rotational angiography data from 15 catheterisations on vascular structures were printed. Median print time was 3.83 hours, and material costs were $2.84. The CT scans of the printed models highly matched with the original digital models (root mean square for Hausdorff distance 0.013 ± 0.003 mesh units). Independent reviewers correctly described 80 and 87% of the models (p = 0.334) and reported high quality and accuracy (5 versus 5, p = NS; κ = 0.615).
Conclusion:
Imaging data from rotational angiography can be converted into accurate three-dimensional-printed models of CHD. The cost of printing the models was negligible, but the print time was prohibitive for real-time use. As the speed of three-dimensional printing technology increases, novel future applications may allow for printing patient-specific devices based on rotational angiography datasets.
After the commercialization of Aripiprazole in Spain, two observational studies were proposed, one was conducted when the drug was first launched, and the other when the starting dose of Aripiprazole was modified, in order to understand the switching strategies, the effectiveness, tolerability and adherence to treatment in standard use conditions.
Patients and Methods:
Two multicenter, retrospective, observational studies were carried out involving 200 psychiatrists throughout Spain with approximate 1000 patients treated with Aripiprazole during the previous four months in each one of the studies during 2005 and 2006 respectively.
Results:
Both groups of patients had a very similar demographic profile that matches with the general schizophrenic population. In the first study, the main reasons for switching medication were low efficacy (56% of cases) and intolerance (35%), and 44% and 43% respectively in the second study. Despite the poor response to previous treatment, clinical evaluation of effectiveness and tolerability with Aripiprazole was very positive: In the first study, 76% of patients had very good or good effectiveness and tolerability was very good or good in 90%. In the second study, these values were 75% and 93%, respectively. Patterns of change from the previous treatment were switching in 75% of cases in the first study and in 60% in the second study.
Conclusions:
Effectiveness of treatment with Aripiprazole is good in patients who had a poor response to their previous antipsychotic treatments. The most frequent and effective pattern for change patients to Aripiprazole treatments is switching.
This review aims to understand the scope of the literature regarding mental health-related microaggressions towards people affected by mental health problems.
Methods
A scoping review was conducted to explore this question. Four electronic health-oriented databases were searched alongside Google Scholar. As per scoping review principles, the inclusion criteria were developed iteratively. The results of included studies were synthesised using a basic narrative synthesis approach, utilising principles of thematic analysis and thematic synthesis where appropriate.
Results
A total of 1196 records were identified, of which 17 met inclusion criteria. Of these, 12 were peer-reviewed journal articles, three were research degree theses and two were book chapters. Six included empirical studies were qualitative, four were quantitative and two employed a mixed-methods design. Within these, five qualitative studies aimed to describe the nature of mental health microaggressions experienced by people with mental health problems. Themes identified in a thematic synthesis of these five studies included stereotypes about mental illness, invalidating peoples' experience and blaming people with mental illness for their condition. The included publications informed on the perpetration of mental health microaggressions by family, friends, health professionals and social workers. In addition, two studies created scales, which were then used in cross-sectional surveys of the general public and community members to assess characteristics, such as right-wing political views, associated with endorsement of mental health microaggressions. A consensus definition of microaggressions emerged from the included studies: microaggressions are brief, everyday slights, snubs or insults, that may be subtle or ambiguous, but communicate a negative message to a target person based on their membership of a marginalised group, in this case, people affected by mental illness.
Conclusions
The study of mental health microaggressions is an emerging, heterogeneous field, embedded in the wider stigma and discrimination literature. It has been influenced by earlier work on racial microaggressions. Both can be ambiguous and contradictory, which creates difficulty defining the boundaries of the concept, but also underpins the key theoretical basis for the negative impact of microaggressions. Mental illness is a more concealable potential type of identity, so it follows that the reported perpetrators of microaggressions are largely friends, family and professionals. This has implications for intervening to reduce the impact of microaggressions. There are several challenges facing research in this area, and further work is needed to understand the impact of mental health microaggressions on people affected by mental health problems.
Field experiments were conducted in 2012 and 2013 across four locations for a total of 6 site-years in the midsouthern United States to determine the effect of growth stage at exposure on soybean sensitivity to sublethal rates of dicamba (8.8 g ae ha−1) and 2,4-D (140 g ae ha−1). Regression analysis revealed that soybean was most susceptible to injury from 2,4-D when exposed between 413 and 1,391 accumulated growing degree days (GDD) from planting, approximately between V1 and R2 growth stages. In terms of terminal plant height, soybean was most susceptible to 2,4-D between 448 and 1,719 GDD, or from V1 to R4. However, maximum susceptibility to 2,4-D was only between 624 and 1,001 GDD or from V3 to V5 for yield loss. As expected, soybean was sensitive to dicamba for longer spans of time, ranging from 0 to 1,162 GDD for visible injury or from emergence to R2. Likewise, soybean height was most affected when dicamba exposure occurred between 847 and 1,276 GDD or from V4 to R2. Regarding grain yield, soybean was most susceptible to dicamba between 820 and 1,339 GDD or from V4 to R2. Consequently, these data indicate that soybean response to 2,4-D and dicamba can be variable within vegetative or reproductive growth stages; therefore, specific growth stage at the time of exposure should be considered when evaluating injury from off-target movement. In addition, application of dicamba near susceptible soybean within the V4 to R2 growth stages should be avoided because this is the time of maximum susceptibility. Research regarding soybean sensitivity to 2,4-D and dicamba should focus on multiple exposure times and also avoid generalizing growth stages to vegetative or reproductive.
The hippocampus plays an important role in psychopathology and treatment outcome. While posterior hippocampus (PH) may be crucial for the learning process that exposure-based treatments require, affect-focused treatments might preferentially engage anterior hippocampus (AH). Previous studies have distinguished the different functions of these hippocampal sub-regions in memory, learning, and emotional processes, but not in treatment outcome. Examining two independent clinical trials, we hypothesized that anterior hippocampal volume would predict outcome of affect-focused treatment outcome [Interpersonal Psychotherapy (IPT); Panic-Focused Psychodynamic Psychotherapy (PFPP)], whereas posterior hippocampal volume would predict exposure-based treatment outcome [Prolonged Exposure (PE); Cognitive Behavioral Therapy (CBT); Applied Relaxation Training (ART)].
Methods
Thirty-five patients with posttraumatic stress disorder (PTSD) and 24 with panic disorder (PD) underwent structural magnetic resonance imaging (MRI) before randomization to affect-focused (IPT for PTSD; PFPP for PD) or exposure-based treatments (PE for PTSD; CBT or ART for PD). AH and PH volume were regressed with clinical outcome changes.
Results
Baseline whole hippocampal volume did not predict post-treatment clinical severity scores in any treatment. For affect-focused treatments, but not exposure-based treatments, anterior hippocampal volume predicted clinical improvement. Smaller AH correlated with greater affect-focused treatment improvement. Posterior hippocampal volume did not predict treatment outcome.
Conclusions
This is the first study to explore associations between hippocampal volume sub-regions and treatment outcome in PTSD and PD. Convergent results suggest that affect-focused treatment may influence the clinical outcome through the ‘limbic’ AH, whereas exposure-based treatments do not. These preliminary, theory-congruent, therapeutic findings require replication in a larger clinical trial.
Background: Depression and anxiety are the two most frequently studied emotional outcomes of stroke. However, few previous studies have been carried out at a population level or beyond 6 months post stroke. The aim of this study was to describe depression and anxiety across the first year following incident ischemic stroke (IS), and identify predictive factors in a population-based study.
Method: The Hospital Anxiety Depression Scale (HADS) was administered at baseline (within 2 weeks of onset), and again at 1-month, 6-months and 12-months after IS in a sample (N = 365) drawn from a population-based study.
Results: Over 75% of those assessed experienced depression or anxiety symptoms below cut-offs for probable disorder across the year post stroke. Moderate to severe symptoms for anxiety were approximately twice as likely (range 4.1%–10.6%) as compared to depression (range 2.5%–5.0%) at each assessment. The greatest improvement in anxiety occurred within the first month post stroke. In contrast, the greatest reduction in depression occurred between 1- to 6-months post stroke.
Conclusions: Anxiety symptoms in the moderate to severe range were twice as common as depression, and improved over the first month post stroke, whilst depression symptoms persisted for up to 6 months, indicating a need to target these two issues at different points in the recovery process.
Adolescence is a period of heightened risk-taking. Therefore it is important to investigate positive settings that can facilitate healthy adolescent development and reduce risk-taking behaviour. This study investigated the relations between non-sporting extracurricular activity participation intensity and risky behaviour. Adolescents’ coping efficacy was tested as a moderator between extracurricular activity participation and risk-taking among adolescents at different levels of contextual risk. Adolescents (N = 1,599) across Western Australia were surveyed. Results for moderately at-risk youth indicated a significant interaction, such that greater activity intensity was associated with less risk-taking for adolescents with higher coping efficacy. However, higher intensity activity participation predicted more risk-taking for adolescents with low coping efficacy.
Pachyonychia congenita is a rare keratinising disorder, which typically presents during the first three years of life and usually affects the nails and palmoplantar surfaces. It can involve the larynx and potentially result in life-threatening airway obstruction.
Methods:
A case report is presented and the findings of a literature review are reported. The review involved a PubMed search using the keywords ‘pachyonychia congenita’ together with ‘larynx’, ‘laryngeal involvement’, ‘laryngeal obstruction’, ‘airway obstruction’, ‘hoarseness’ and/or ‘stridor’.
Results:
A five-year-old boy, with confirmed pachyonychia congenita, presented with complications of laryngeal involvement over a four-year period. He required three intubations and a tracheostomy for acute airway obstruction. Treatment with potassium titanyl phosphate laser laryngoscopy stabilised the progression of laryngeal disease.
Conclusion:
Patients with pachyonychia congenita and laryngeal involvement can have a varied presentation, ranging from hoarseness to acute airway obstruction. Management can be a challenge, requiring early evaluation, regular surveillance and aggressive treatment. This paper reports our experience in managing and treating the laryngeal complications of a child with pachyonychia congenita.
Background: Neuropsychological deficits occur in over half of the stroke survivors and are associated with the reduced functioning and a decline in quality of life. However, the trajectory of recovery and predictors of neuropsychological outcomes over the first year post stroke are poorly understood.
Method: Neuropsychological performance, assessed using the CNS-Vital signs, was examined at 1 month, 6 months and 12 months after ischaemic stroke (IS) in a sample drawn from a population-based study (N = 198).
Results: While mean scores across neuropsychological domains at each time-point fell in the average range, one in five individuals produced very low-range scores for verbal memory, attention and psychomotor speed. Significant improvements were seen for executive functioning, psychomotor speed and cognitive flexibility within 6 months post stroke, but no gains were noted from 6 to 12 months. Stroke-related neurological deficits and depression at baseline significantly contributed to the prediction of neuropsychological function at 12 month follow-up.
Conclusions: In a significant minority of IS survivors, focal deficits are evident in psychomotor speed, verbal memory, executive functions and attention. Significant improvements in these domains were only evident in the first 6 months post stroke. Initial stroke-related neurological deficits and concurrent depression may be the best predictors of later cognitive functioning.
Counter-rotating vortices form from the opposite edges of lifting surfaces, and gradually move laterally and dissipate as they travel downstream (as seen in a wing-fixed reference frame). Under ground effect conditions, the vortex from a lifting wing – such as that used in an aircraft application – moves laterally outboard from the wingtip as it progresses downstream; for a downforce wing in ground effect – such as that used in an automotive application – the vortex moves laterally inboard. An interesting case is the situation where the inboard moving vortices become in close proximity to each other. The objective of the present study was to investigate counter-rotating vortices produced from a low aspect ratio downforce wing operating in ground effect. The pair of vortices move towards each other and mutually induce an upwards directed motion which in turn reduces the inboard movement driven by the ground effect. Experimental data gained from three-dimensional Laser Doppler Anemometry in a moving ground wind-tunnel was used to validate a Large Eddy Simulation computational result.
In the past several decades, increasing evidence supports the efficacy of psychotherapies for depression. The vast majority of findings from meta-analyses, randomized clinical trials (RCTs) and naturalistic studies have demonstrated that well-established psychotherapies (behavioural activation, problem-solving therapy, psychodynamic therapy, cognitive-behavioural therapy, interpersonal therapy and emotion-focused therapy) are superior to no-treatment and control conditions, and are in most cases equally effective in treating depression. However, despite this abundant support for psychotherapies, studies have also consistently shown high drop-out rates, high percentages of non-respondent patients who experience treatment failures, and mixed findings regarding the enduring effects of psychotherapy. Thus, there is a need to develop more personalised treatment models tailored to patients’ needs. A new integrative sequential stepwise approach to the treatment of depression is suggested.
Electronystagmographic recordings were made of oculomotor and vestibular function in II patients with autósomat recessive spastic ataxia of Charlevoix-Saguenay. All had horizontal gaze nystagmus, marked impairment of smooth ocular pursuit and optokinetic nystagmus, and defective fixation suppression of caloric nystagmus. Many had saccadic dysmetria. but saccade velocity was probably unaffected. Abnormallies pointing to brainstem disturbance were sparse. The findings are thought to indicate mainly diffuse cerebellar disease, with particular involvement of vermis and vestibulo-cerebellum.
Four cases are described illustrating the clinical features of positional vertigo and nystagmus due to posterior fossa tumors and a case of obstructive hydrocephalus. In these cases positional vertigo was the first and only presenting symptom of central nervous system disease. One case of subependymoma of the fourth ventricle and one with hydrocephalus had characteristic symptoms of benign positional vertigo; each showed positional nystagmus of the benign paroxysmal type.
The Coral Triangle is the world's most biologically diverse marine environment, and the origins of this diversity have been the subject of debate for decades. Biogeographic studies have alternatively argued that this region is a center of (1) origin, (2) overlap, (3) accumulation, or (4) survival. Genetic studies focused on the pattern, distribution, and age of lineage divergence across a broad array of marine fishes and other groups show alternating support for all of these hypotheses, indicating pluralistic origins for the Coral Triangle biodiversity hotspot. While acknowledging multiple causations, the relative contribution of each model is still uncertain. Given the social and economic importance of marine fishes in the Coral Triangle combined with sharp declines in populations and coral reef habitat in this region, understanding the ecological and evolutionary processes shaping biodiversity in the Coral Triangle is more important now than ever. New genomic tools as well as standardized sampling methodologies hold great promise for refining our understanding of the processes driving lineage divergence in the Coral Triangle, providing information essential for effective conservation planning in this region.
THE CORAL TRIANGLE, FROM PATTERN TO PROCESS
Although the name and geographic scope of the Coral Triangle has changed greatly over the past 60 years [1141], it is unquestionably the most diverse marine region on the planet. Defined by the presence of >500 hard coral species [2566] and spanning six Southeast Asian nations, species diversity in a broad range of marine taxa reaches a global maximum in the Coral Triangle with steep declines in diversity moving away from this biodiversity hotspot [200,205,747,1141,2123,2415]. In reef fishes, diversity peaks in the Birds Head region of West Papua, Indonesia [41], with 1511 species in 451 genera and 111 families, 26 species, and 14 families being restricted to this region. Species diversity in fishes can be one to two orders of magnitude higher in the Coral Triangle than peripheral reefs of the Pacific or the Caribbean.
Live cultures believed to be aphids of Aphis fabae Scopoli from New Brunswick, Manitoba, and British Columbia were compared by several methods. Cultures from British Columbia lived on faba bean, Vicia faba L., but not on garden nasturtium Tropaeolum majus L. Cultures from Manitoba lived on nasturtium but not on faba bean. Some of the aphids from New Brunswick lived on nasturtium only, and some on faba bean only. The aphids which live on faba bean are believed to be Aphis fabae, and those which will not live on faba bean are considered to be a distinct species.