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Patients with posttraumatic stress disorder (PTSD) exhibit smaller regional brain volumes in commonly reported regions including the amygdala and hippocampus, regions associated with fear and memory processing. In the current study, we have conducted a voxel-based morphometry (VBM) meta-analysis using whole-brain statistical maps with neuroimaging data from the ENIGMA-PGC PTSD working group.
Methods
T1-weighted structural neuroimaging scans from 36 cohorts (PTSD n = 1309; controls n = 2198) were processed using a standardized VBM pipeline (ENIGMA-VBM tool). We meta-analyzed the resulting statistical maps for voxel-wise differences in gray matter (GM) and white matter (WM) volumes between PTSD patients and controls, performed subgroup analyses considering the trauma exposure of the controls, and examined associations between regional brain volumes and clinical variables including PTSD (CAPS-4/5, PCL-5) and depression severity (BDI-II, PHQ-9).
Results
PTSD patients exhibited smaller GM volumes across the frontal and temporal lobes, and cerebellum, with the most significant effect in the left cerebellum (Hedges’ g = 0.22, pcorrected = .001), and smaller cerebellar WM volume (peak Hedges’ g = 0.14, pcorrected = .008). We observed similar regional differences when comparing patients to trauma-exposed controls, suggesting these structural abnormalities may be specific to PTSD. Regression analyses revealed PTSD severity was negatively associated with GM volumes within the cerebellum (pcorrected = .003), while depression severity was negatively associated with GM volumes within the cerebellum and superior frontal gyrus in patients (pcorrected = .001).
Conclusions
PTSD patients exhibited widespread, regional differences in brain volumes where greater regional deficits appeared to reflect more severe symptoms. Our findings add to the growing literature implicating the cerebellum in PTSD psychopathology.
Preterm birth has been associated with insulin resistance and beta-cell dysfunction, a hallmark characteristic of type 2 diabetes. However, studies investigating the relationship between a personal history of being born preterm and type 2 diabetes are sparse. We sought to investigate the potential association between a personal history of being born preterm and risk for type 2 diabetes in a racially and ethnically diverse population. Baseline and incident data (>16 years of follow-up) from the Women’s Health Initiative (n = 85,356) were used to examine the association between personal history of being born preterm (born 1910–1940s) and prevalent (baseline enrollment; cross-sectional) or incident (prospective cohort) cases of type 2 diabetes. Logistic and Cox proportional hazards regression models were used to estimate odds and hazards ratios. Being born preterm was significantly, positively associated with odds for prevalent type 2 diabetes at enrollment (adjOR = 1.79, 95% CI 1.43–2.24; P < 0.0001). Stratified regression models suggested the positive associations at baseline were consistent across race and ethnicity groups. However, being born preterm was not significantly associated with risk for incident type 2 diabetes. Regression models stratified by age at enrollment suggest the relationship between being born preterm and type 2 diabetes persists only among younger age groups. Preterm birth was associated with higher risk of type 2 diabetes but only in those diagnosed with type 2 diabetes prior to study enrollment, suggesting the association between preterm birth and type 2 diabetes may exist at earlier age of diagnosis but wane over time.
Clinical trials are constantly evolving in the context of increasingly complex research questions and potentially limited resources. In this review article, we discuss the emergence of “adaptive” clinical trials that allow for the preplanned modification of an ongoing clinical trial based on the accumulating evidence with application across translational research. These modifications may include terminating a trial before completion due to futility or efficacy, re-estimating the needed sample size to ensure adequate power, enriching the target population enrolled in the study, selecting across multiple treatment arms, revising allocation ratios used for randomization, or selecting the most appropriate endpoint. Emerging topics related to borrowing information from historic or supplemental data sources, sequential multiple assignment randomized trials (SMART), master protocol and seamless designs, and phase I dose-finding studies are also presented. Each design element includes a brief overview with an accompanying case study to illustrate the design method in practice. We close with brief discussions relating to the statistical considerations for these contemporary designs.
The aim of this study was to develop and evaluate a pre-deployment sequestration (PDS) protocol to prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases on board the USS Ronald Reagan (CVN-76).
Methods:
The USS Ronald Reagan includes a crew of approximately 3000 Sailors and an embarked Air Wing of 2000 personnel. The PDS was conducted in 3 waves of 14-day strict quarantines during the months of April and May 2020. Sailors were cleared to board the ship with 2 negative reverse transcriptase polymerase chain reaction (rtPCR) tests at days 14 and 16. The ship was sanitized before Wave 1 boarding.
Results:
From March 1, 2020, through May 31, 2020, a total of 51 SARS-CoV-2 positive cases were detected. During the 3 waves of PDS, 28 Sailors were found to be positive on exit testing (14, 11, and 3, respectively); no cases were found among the Air Wing. During the first 90 days at sea, no SARS-CoV-2 cases were detected among any of the embarked personnel.
Conclusions:
Although resource-intensive, the PDS protocol implemented for USS Ronald Reagan resulted in a coronavirus disease 2019 (COVID-19)-free ship during a global pandemic with unprecedented scope. Elements of this pandemic PDS protocol may be useful in other highly risk-averse environments with no tolerance for COVID-19 infections.
Non-communicable diseases are projected to become the most common causes of death in Africa by 2030. The impact on health of epidemiological and nutritional transitions in sub-Saharan Africa remains unclear. To assess the trends of dietary fatty acids over time in Uganda, we examined fatty acids in serum collected from individuals in rural south-west Uganda, at three time points over two decades. Independent cross-sectional samples of 915 adults and children were selected from the general population cohort in 1990 (n 281), 2000 (n 283) and 2008 (n 351). Serum phospholipid fatty acids were measured by GC. Multivariate regression analyses were performed to compare the geometric means of fatty acids by time period. Serum fatty acid profiling showed high proportions of SFA, cis-MUFA and industrial trans-fatty acids (iTFA), likely to be biomarkers of high consumption of palm oil and hydrogenated fats. In contrast, proportions of n-6 and n-3 PUFA from vegetable oils and fish were low. From 1990 to 2008, serum phospholipids showed increases in absolute amounts of SFA (17·3 % increase in adults and 26·4 % in children), MUFA (16·7 % increase in adults and 16·8 % in children) and n-6:n-3 PUFA (40·1 % increase in adults and 39·8 % in children). The amount of elaidic acid, iTFA from hydrogenated fats, increased in children (60·1 % increase). In this rural Ugandan population, we show evidence of unfavourable trends over time of dietary fatty acids.
The procedure for deriving interatomic potentials for molecular ionic materials, using empirical fitting procedures, is described. Potentials are obtained for carbonates, phosphates and perchlorates, and used to calculate crystal and lattice properties which are compared with available experimental data.
The CANGAROO project incorporates two Čerenkov imaging telescopes at Woomera to obtain stereo images of very high-energy gamma-ray (and cosmic-ray) showers. The first stereo observations, with one imaging system, were made in March 1992, and preliminary stereo imaging observations began in July 1992. This paper describes the stereo imaging technique, the sources under investigation, and the indications from the first data sets.
In this paper the Very High Energy (VHE) gamma-ray astronomy program at the University of Adelaide is described. VHE gamma rays with energies above ~5 × 1011eV are observed using the atmospheric Cerenkov technique. Results from the first three years observations at Woomera and the current upgrading of the telecope are described. The CANGAROO project, a collaboration between the University of Adelaide and a number of Japanese institutions, is also introduced.
Sir William Wilde (1815–76), surgeon and father of Oscar Wilde, was an Irish patriot and antiquarian with a keen interest in the history of his country. This life of Gabriel Beranger (1729–1817), published in 1880, describes the activities of an Irish antiquarian in the eighteenth century. Born in Rotterdam, the Huguenot Beranger moved to Dublin in 1750 and opened a print shop. Historical pursuits were becoming popular in Dublin society at the time, and Beranger's sketches of ruins and monuments found great popularity. He went on several tours of Ireland, keeping a journal of his observations and the people he encountered, while making plans and drawings of antiquities with a view to later publication. Wilde's work, drawn from Beranger's journal and from the memories of people who had known him in his old age, offers an engaging insight into early antiquarian practice in Ireland.
Monoclinic Cu2SnS3 was made by solution based processing of the precursor metals after which the samples are annealed in a sulphur environment. XRD and Raman spectra shows that the monoclinic phase was synthesised. One sample was further etched in KCN and HCl to remove possible secondary phases. Transmission spectra show that the material has two optical transitions and in conjunction with reflection data absorption spectra were calculated. The two optical transitions are determined to be 0.91 and 0.98 for the unetched sample and 0.90 and 0.95 eV for the etched sample. The values of the optical transitions are within the error the same and thus etching does not affect the values of these optical transitions. Photoluminescence spectra map show only one luminescence peak with a maximum at 0.95 eV, which is consistent with the values found by absorption spectra. This in combination with the Raman spectra and XRD indicates that the sample contains only one polymorph of Cu2SnS3, which is monoclinic. Therefore the two optical transitions are intrinsic to monoclinic Cu2SnS3.
Edited by
Alex S. Evers, Washington University School of Medicine, St Louis,Mervyn Maze, University of California, San Francisco,Evan D. Kharasch, Washington University School of Medicine, St Louis
Both antidepressants and psychological treatments are effective in the management of late-life depression. Nevertheless, there remains a considerable challenge to improve the prognosis for depression in older people. Endlessly increasing the range of antidepressants does not seem to be the answer, so attention is turning to new combinations of treatments and new ways of delivering care and improving treatment uptake. Collaboration between specialist and primary care, case management and multifaceted interventions are currently the most exciting prospects. There is good evidence for the role of both medication and psychological treatment in keeping the patient well after recovery.
Metabolic abnormalities in patients with PCO syndrome demand that we change our clinical approach to PCO syndrome. No longer should the approach be short-term and driven by symptoms, rather it must recognize that PCO syndrome is a chronic disorder. Associated metabolic abnormalities may have long-term sequelae and their recognition influences not only how we evaluate patients, but also how we implement prevention. Observational, interventional, epidemiological and now mechanistic studies need to focus on interactive issues. Outcome study results are awaited to determine the likelihood of sequelae and to optimize preventive strategies. The PCO paradigm is a complex biological experiment on nature that offers a superb opportunity to begin to understand the many ways in which hormones affect atherogenesis. It is important to understand the clinical syndromes encompassed in this paradigm. Atherogenic consequences are still responsible for the majority of deaths in the industrialized world!