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Adverse childhood experiences (ACEs) are a measure of childhood adversity and are associated with life-long morbidity. The impacts of ACEs on peripartum health including preeclampsia, a common and dangerous hypertensive disorder of pregnancy, remain unclear, however. Therefore, we aimed to determine ACE association with peripartum psychiatric health and prevalence of preeclampsia using a case–control design.
Methods:
Clinical data were aggregated and validated using a large, intergenerational knowledgebase developed at our institution. Depression symptoms were measured by standard clinical screeners: the Patient Health Questionnaire-9 (PHQ-9) and the Edinburgh Postnatal Depression Scale (EPDS). ACEs were assessed via survey. Scores were compared between participants with (N = 32) and without (N = 46) prior preeclampsia.
Results:
Participants with ACE scores ≥4 had significantly greater odds of preeclampsia than those with scores ≤ 3 (adjusted odds ratio = 6.71, 95% confidence interval:1.13–40.00; p = 0.037). Subsequent speculative analyses revealed that increased odds of preeclampsia may be driven by increased childhood abuse and neglect dimensions of the ACE score. PHQ-9 scores (3.73 vs. 1.86, p = 0.03), EPDS scores (6.38 vs. 3.71, p = 0.01), and the incidence of depression (37.5% vs. 23.9%, p = 0.05) were significantly higher in participants with a history of preeclampsia versus controls.
Conclusions:
Childhood sets the stage for life-long health. Our findings suggest that ACEs may be a risk factor for preeclampsia and depression, uniting the developmental origins of psychiatric and obstetric risk.
Migraine refers to recurrent, unilateral headache attacks, lasting 4-72 hours, that have a pulsating quality and can occur with or without aura. Aura is a symptom, usually preceding the onset of a migraine, where there is an experience of gradually spreading focal neurological symptoms which typically last less than one hour. A meta-analysis was conducted which quantitatively synthesized literature documenting performance on clinical measures of processing speed (PS) in individuals with migraine with (MwA) and without aura (MwoA).
Participants and Methods:
Data for this study came from a larger study that compared overall neuropsychological functioning in primary headache disorders (PHD) and healthy controls (HC). We searched OneSearch and PubMed using a uniform search-strategy to locate original research comparing cognition between PHD and HC. Analyses were modeled under random effects. Hedge’s g was used as a bias-corrected estimate of effect size. We assessed between-study heterogeneity using Cochran’s Q and I2. Egger’s regression test was used to assess publication bias (i.e., the association between standard error and effect size). High heterogeneity in effects was analyzed for possible moderating variables using metaregression and sub-group analyses.
Results:
The initial search interval spanned inception-May 2021 and yielded 6692 results. Twelve studies met inclusion criteria, included clinical measures of PS, and included PHD subgroups with MwA and/or MwoA (MwA n = 279, MwoA n = 655, HC n = 2159). MwA demonstrated moderately worse performance in PS overall when compared to HC (k = 7, g = -0.41, p = 0.028). MwoA also demonstrated worse performance in PS overall when compared to HC but the effect size was small (k = 12, g = -0.21, p = 0.006). Heterogeneity of MwoA studies was low (Q = 15.12, I2 = 21.19) while heterogeneity of MwA studies was high (Q = 21.91, I2 = 72.61). Meta-regressions of MwA studies indicated clinical age and disease duration to be related to effect sizes such that studies with older clinical participants and longer disease durations yielded greater (negative) differences. Egger’s regression intercept noted a possible association effect size and standard error for MwA articles (t = 3.60, p = 0.02) and MwoA articles (t = 5.21, p < 0.005). Trim-and-fill procedure estimated 0 MwA studies to be missing due to publication bias (adjusted g = -0.41, p = 0.028) while 7 MwoA studies were estimated to be missing due to publication bias (adjusted g = -0.03, Q = 34.79).
Conclusions:
Individuals with migraine demonstrated worse performances on tests of PS compared to controls. Effect sizes were generally moderate in strength for MwA while effect sizes were generally small in strength for MwoA. This quantitative summary confirmed that individuals with migraine experience slowed processing speed in general and this effect is magnified when aura is a presenting symptom.
Primary headache disorder is characterized by recurrent headaches which lack underlying causative pathology or trauma. Primary headache disorder is common and encompasses several subtypes including migraine. Vestibular migraine (VM) is a subtype of migraine that causes vestibular symptoms such as vertigo, difficulties with balance, nausea, and vomiting. Literature indicates subjective and performance-based cognitive problems (executive dysfunction) among migraineurs. This study compared the magnitude of the total effect size across neuropsychological domains to determine if there is a reliable difference in effect sizes between individuals with VM and healthy controls (HC). An additional aim was to meta-analyze neuropsychological outcomes in migraine subtypes (other than VM) in reference to healthy controls.
Participants and Methods:
This study was a part of a larger study examining neuropsychological functioning and impairment in individuals with primary headache disorder and HCs. Standardized search terms were applied in OneSearch and PubMed. The search interval covered articles published from 1986 to May 2021. Analyses were random-effects models. Hedge’s g was used as a bias-corrected estimate of effect size. Between-study heterogeneity was assessed using Cochran’s Q and I2. Publication bias was assessed with Duval and Tweedie’s Trim-and-Fill method to identify evidence of missing studies.
Results:
The initial omnibus literature search yielded 6692 studies. Three studies (n=151 VM and 150 HC) met our inclusion criteria of having a VM group and reported neuropsychological performance. VM demonstrated significantly worse performance overall when compared to HCs (k=3, g=-0.99, p<0.001; Q=4.41, I2=54.66) with a large effect size. Within-domain effects of VM were: Executive Functioning=-0.99 (Q=0.62, I2=0), Screener=-1.15 (Q=3.29, I2=69.59), and Visuospatial/Construction=-1.47 (Q=0.001, I2=0.00). Compared to chronic migraine (k=3, g=-0.59, p<0.001; Q=0.68, I2=0.00) and migraine without aura (k=23, g=-0.39, p<0.001; Q=109.70, I2=79.95), VM was the only migraine subgroup to display a large effect size. Trim-and-fill procedure estimated zero VM studies to be missing due to publication bias (adjusted g=-0.99, Q=4.41).
Conclusions:
This initial attempt at a meta-analysis of cognitive deficits in VM was hampered by a lack of studies in this area. Based on our initial findings, individuals with VM demonstrated overall worse performances on neuropsychological tests compared to HCs with the greatest level of impairment seen in visuospatial/construction. Additionally, VM resulted in a large effect size while other migraine subtypes yielded small to moderate effect sizes. Despite the small sample of studies, the overall effect across neuropsychological performance was generally stable (i.e., low between-study heterogeneity). Given than VM accounts for 7% of patients seen in vertigo clinics and 9% of all migraine patients, our results suggest that neuropsychological impairment in VM deserves significantly more study.
During military operations, soldiers are required to successfully complete numerous physical and cognitive tasks concurrently. Understanding the typical variance in research tools that may be used to provide insight into the interrelationship between physical and cognitive performance is therefore highly important. This study assessed the inter-day variability of two military-specific cognitive assessments: a Military-Specific Auditory N-Back Task (MSANT) and a Shoot-/Don’t-Shoot Task (SDST) in 28 participants. Limits of agreement ±95% confidence intervals, standard error of the mean, and smallest detectable change were calculated to quantify the typical variance in task performance. All parameters within the MSANT and SDST demonstrated no mean difference for trial visit in either the seated or walking condition, with equivalency demonstrated for the majority of comparisons. Collectively, these data provided an indication of the typical variance in MSANT and SDST performance, while demonstrating that both assessments can be used during seated and walking conditions.
Low-mass stars form from the gravitational collapse of dense molecular cloud cores. While a general consensus picture of this collapse process has emerged, many details on how mass is transferred from cores to stars remain poorly understood. MASSES (Mass Assembly of Stellar Systems and their Evolution with the SMA), an SMA large project, has just finished surveying all 74 Class 0 and Class I protostars in the nearby Perseus molecular cloud to reveal the interplay between fragmentation, angular momentum, and outflows in regulating accretion and setting the final masses of stars. Scientific highlights are presented in this proceedings, covering the topics of episodic accretion, hierarchical thermal Jeans fragmentation, angular momentum transfer, envelope grain sizes, and disk evolution.
The ‘Digital Index of North American Archaeology’ (DINAA) project demonstrates how the aggregation and publication of government-held archaeological data can help to document human activity over millennia and at a continental scale. These data can provide a valuable link between specific categories of information available from publications, museum collections and online databases. Integration improves the discovery and retrieval of records of archaeological research currently held by multiple institutions within different information systems. It also aids in the preservation of those data and makes efforts to archive these research results more resilient to political turmoil. While DINAA focuses on North America, its methods have global applicability.
Accurate estimates of body mass in fossil taxa are fundamental to paleobiological reconstruction. Predictive equations derived from correlation with craniodental and body mass data in extant taxa are the most commonly used, but they can be unreliable for species whose morphology departs widely from that of living relatives. Estimates based on proximal limb-bone circumference data are more accurate but are inapplicable where postcranial remains are unknown. In this study we assess the efficacy of predicting body mass in Australian fossil marsupials by using an alternative correlate, endocranial volume. Body mass estimates for a species with highly unusual craniodental anatomy, the Pleistocene marsupial lion (Thylacoleo carnifex), fall within the range determined on the basis of proximal limb-bone circumference data, whereas estimates based on dental data are highly dubious. For all marsupial taxa considered, allometric relationships have small confidence intervals, and percent prediction errors are comparable to those of the best predictors using craniodental data. Although application is limited in some respects, this method may provide a useful means of estimating body mass for species with atypical craniodental or postcranial morphologies and taxa unrepresented by postcranial remains. A trend toward increased encephalization may constrain the method's predictive power with respect to many, but not all, placental clades.
To analyze antipsychotic prescribing patterns in a UK high security hospital (HSH) that treats seriously violent men with either schizophrenia or personality disorder and examine how different groups consented to treatment and prescribing for metabolic conditions. We hypothesized that there would be high prevalence of antipsychotic polypharmacy, and high-dose antipsychotic and clozapine prescribing.
Background
HSHs treat seriously violent, mentally disordered offenders, and the extant literature on prescribing patterns in forensic settings is sparse.
Methods
Prescribing and clinical data on all 189 patients in a UK HSH were collected from the hospital’s databases. Data were analyzed using SPSS.
Results
The population was split into the following groups: schizophrenia spectrum disorder (SSD-only), personality disorder (PD-only), and comorbid schizophrenia spectrum disorder and PD. The majority (93.7%) of all patients were prescribed at least one antipsychotic, and (27.5%) were on clozapine. Polypharmacy was prevalent in 22.2% and high-dose antipsychotic in 27.5%. Patients on clozapine were more likely to be prescribed antidiabetic, statins, or antihypertensive medication. Patients in the PD-only group were more likely to be deemed to have the capacity to consent to treatment and be prescribed clozapine in contrast to the SSD-only group.
Conclusions
Rates of clozapine and high-dose antipsychotic prescribing were higher than in other psychiatric settings, while polypharmacy prescribing rates were lower. Higher clozapine prescribing rates may be a function of a treatment-resistant and aggressive population. A higher proportion of PD-only patients consented to treatment and received clozapine compared with in-house SSD-only as well as other psychiatric settings. Implications of the findings are discussed.
Developing and implementing effective strategies to increase influenza vaccination rates among health care personnel is an ongoing challenge, especially during a pandemic. We used participatory action research (PAR) methodology to identify targeted vaccination interventions that could potentially improve vaccine uptake in a medical center.
Methods
Front-line medical center personnel were recruited to participate in 2 PAR teams (clinical and nonclinical staff). Data from a recent medical center survey on barriers and facilitators to influenza (seasonal, pandemic, and combination) vaccine uptake were reviewed, and strategies to increase vaccination rates among medical center personnel were identified.
Results
Feasible, creative, and low-cost interventions were identified, including organizational strategies that differed from investigator-identified interventions. The recommended strategies also differed by team. The nonclinical team suggested programs focused on dispelling vaccination-related myths, and the clinical team suggested campaigns emphasizing the importance of vaccination to protect patients.
Conclusions
PAR methodology was useful to identify innovative and targeted recommendations for increasing vaccine uptake. By involving representative front-line workers, PAR may help medical centers improve influenza vaccination rates across all work groups. (Disaster Med Public Health Preparedness. 2013;0:1–7)
We examined learning outcomes, practice impacts and implementation processes for a training intervention in diagnostic skills delivered to multidisciplinary child and adolescent mental health service practitioners (n = 63).
Results
Training was viewed positively by most participants and associated with significant increases in practitioner self-efficacy, with the effect sustained at 8-month follow-up. A comparative audit before and after training indicated that clinicians were significantly more likely to assign an Axis I diagnosis following the training intervention. However, absolute rates of Axis I classification remained relatively low (< 40%) both before and after training. Practitioners were moderately successful at following through on personal plans for implementing new learning; inconsistent support for implementation was provided within teams.
Clinical implications
A brief training workshop may have limited effects in changing practitioners' behaviour so that diagnoses are made more promptly and appropriately recorded. Future workforce development initiatives should consider more comprehensive and diversified strategies, including targeted post-training support, if increased self-efficacy following training is to be translated into sustained changes in diagnostic practice.
In response to epidemic methicillin-resistant Staphylococcus aureus (MRSA) in the community, the Illinois General Assembly mandated that all patients admitted to intensive care units statewide be screened for MRSA. Screening was instituted at our neonatal intensive care unit (NICU) in September 2007 by a polymerase chain reaction (PCR)-based strategy. The law created an opportunity to determine the rate of MRSA colonization among neonates, to gather information about subsequent MRSA infections, and to evaluate risk factors for MRSA colonization on admission to the NICU.
The electron channeling contrast imaging (ECCI) technique was utilized to investigate atomic step morphologies and dislocation densities in 3C-SiC films grown by chemical vapor deposition (CVD) on Si (001) substrates. ECCI in this study was performed inside a commercial scanning electron microscope using an electron backscatter diffraction (EBSD) system equipped with forescatter diode detectors. This approach allowed simultaneous imaging of atomic steps, verified by atomic force microscopy, and dislocations at the film surface. EBSD analysis verified the orientation and monocrystalline quality of the 3C-SiC films. Dislocation densities in 3C-SiC films were measured locally using ECCI, with qualitative verification by x-ray diffraction. Differences in the dislocation density across a 50 mm diameter 3C-SiC film could be attributed to subtle variations during the carbonization process across the substrate surface.
Two high resolution crystal structures of Escherichia
coli alkaline phosphatase (AP) in the presence of
phosphonate inhibitors are reported. The phosphonate compounds,
phosphonoacetic acid (PAA) and mercaptomethylphosphonic
acid (MMP), bind competitively to AP with dissociation
constants of 5.5 and 0.6 mM, respectively. The structures
of the complexes of AP with PAA and MMP were refined at
high resolution to crystallographic R-values of
19.0 and 17.5%, respectively. Refinement of the AP-inhibitor
complexes was carried out using X-PLOR. The final round
of refinement was done using SHELXL-97. Crystallographic
analyses of the inhibitor complexes reveal different binding
modes for the two phosphonate compounds. The significant
difference in binding constants can be attributed to these
alternative binding modes observed in the high resolution
X-ray structures. The phosphinyl group of PAA coordinates
to the active site zinc ions in a manner similar to the
competitive inhibitor and product inorganic phosphate.
In contrast, MMP binds with its phosphonate moiety directed
toward solvent. Both enzyme-inhibitor complexes exhibit
close contacts, one of which has the chemical and geometrical
potential to be considered an unconventional hydrogen bond
of the type C-H···X.
Thin film ferroelectric structures are being investigated for use as storage capacitors for Non-volatile Random-Access Memories. To integrate ferroelectrics with standard silicon semiconductor processing, a great deal of effort must be spent identifying compatible materials. These materials must be able to withstand both ferroelectric and silicon processing steps involving different temperatures and environments.
In this paper we have used Rutherford backscattering spectrometry (RBS) to study the diffusion of ferroelectric Pb(Zr.5Ti.5)O3 elements into thin films of TiOx, TiNx, ZrNx and ZrOx deposited onto thermally grown SiO2. The sample matrix was annealed at various temperatures in argon ambient and analyzed using 2 MeV He+. Diffusion profiles (concentration vs. depth profiles) of the ferroelectric constituents were determined for the different barrier films. Results indicated that ZrN is the most promising barrier layer so far, having shown the least interdiffusion at 700°C.
Optimal foraging theory (OFT) is one of the few areas of study in behavior and ecology in which mathematical models derived from first principles have been seriously tested in the laboratory and field. The balance between theory and data has remained good, unlike, for example, the field of community ecology in the 1960s and 1970s, where arcane models of baroque complexity were generally matched only with qualitative and unconvincing tests. Part of the success of OFT lies in the fact that although ecological in origin, the models have been tested with both ecological methods and the methods developed by ethologists and comparative psychologists (Pyke et al. 1977; Krebs 1978, Staddon 1980; Hughes and Townsend 1981; Kamil and Yoerg 1982). In 1966, the first two papers published on OFT (MacArthur and Pianka 1966; Emlen 1966) amounted to 0.5% of the articles in American Naturalist, Ecology, Journal of Animal Ecology, and Animal Behavior. The proportion of papers on OFT in just these journals had quadrupled to 2% by 1974 and to 8% in 1981.
In this chapter, we will start with a brief general comment on optimal foraging theory, then we review the evidence relating to “classical” foraging models. This is followed by two more detailed discussions; the first considers the relationship between classical models and two more recent developments, models of “rules of thumb” and stochastic models, and the second looks at some implications of the traditional models for population interactions of predators and prey.
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