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Myocardial strain using cardiac magnetic resonance (CMR) is a sensitive marker for predicting adverse outcomes in many cardiac disease states, but the prognostic value in the general population has not been studied conclusively. The goal of this study was to assess the independent prognostic value of CMR feature tracking (FT)—derived LV global longitudinal (GLS), circumferential (GCS), and radial strain (GRS) metrics in predicting adverse outcomes (heart failure, myocardial infarction, stroke, and death). Participants from the UK Biobank population imaging study were included. Univariable and multivariable Cox models were used for each outcome and each strain marker (GLS, GCS, GRS) separately. The multivariable models were tested with adjustment for prognostically important clinical features and conventional global LV imaging markers relevant for each outcome. Overall, 45,700 participants were included in the study (average age 65 ± 8 years), with a median follow-up period of 3 years. All univariable and multivariable models demonstrated that lower absolute GLS, GCS, and GRS were associated with increased incidence of heart failure, myocardial infarction, stroke, and death. All strain markers were independent predictors (incrementally above some respective conventional LV imaging markers) for the morbidity outcomes, but only GLS predicted death independently: (HR: 1.18; 95% CI: 1.07-1.30). In the general population, LV strain metrics derived using CMR-FT in radial, circumferential, and longitudinal directions are strongly and independently predictive of heart failure, myocardial infarction, and stroke, but only GLS is independently predictive of death in an adult population cohort. [ABSTRACT FROM AUTHOR]

We used concept-mapping methods to gain insights into promising HIV prevention intervention strategies from the collective experience of heterosexual Black men (HBM) in four cities of Ontario. We engaged 60 HBM in online group concept-mapping sessions. First, we held a brainstorming session where the HBM generated 226 statements anonymously on strategies to reduce HIV vulnerabilities. The statements were condensed to 123. Second, the HBM (n = 45) sorted the 123 statements into self-created categories. Third, the HBM rated the strategy statements by importance (n = 45) and feasibility (n = 41). Finally, cluster analysis and multidimensional scaling were used to describe data patterns. The statements cluster tagged "family and individual level interventions" had the highest mean rating in importance (4.061) and feasibility (3.610). The policy interventions cluster solution was rated second highest in importance (IR = 4.058) and the sixth in feasibility (FR = 3.413). Other cluster solutions ratings were addressing racism (third highest in importance [IR = 4.030] and fourth highest in feasibility [FR = 3.514]); healthcare, research, and economic opportunities (fourth highest in importance [IR = 4.018] and third highest in feasibility [FR = 3.526]); sexual health awareness strategies (fifth highest in importance [IR = 3.993] and highest in feasibility [FR = 3.611]) and sex/HIV education (sixth highest in importance [IR = 3.975] and fifth highest in feasibility [FR = 3.442]); and individual and community empowerment (lowest in importance [IR = 3.846] and lowest in feasibility [FR = 3.375]). Intergenerational (family and individual), policy, and anti-racism interventions are the top three priority strategies for HIV prevention and care for HBM and communities in Ontario. [ABSTRACT FROM AUTHOR]

The article offers guidance to help primary care teams provide culturally appropriate care for diverse patients. It presents the case of a 42-year old African American who shows psychotic disorder symptoms. It discusses the effect of the patient's intersectionality on his experience of the health care system, the need for the primary care team to balance the ethical dilemma of providing care and personal safety, and sociocultural differences within interpersonal interactions.

Objective: Although there is evidence of effective stigma reduction by various psychological and educational interventions, the mechanisms of change remain unclear. In this article, we examine hypothesized processes that might have mediated reductions in stigma observed among Asian men who had received in mental health promotion interventions in Greater Toronto Area, Canada. Method: Our sample consisted of 495 Asian men, who received either acceptance and commitment therapy (ACT; n = 133), contact-based empowerment education (CEE; n = 149), combination of ACT and CEE (n = 152), or psychoeducation (n = 61). Group differences on intervention outcomes, including stigmatizing attitudes (Community Attitudes toward the Mentally Ill), internalized stigma (Internalized Stigma of Mental Illness), valued living (Valued Living Questionnaire), and attitudes to engage in social change (Social Justice Scale) were hypothesized to be due to the impact of the different interventions and mediated by changes in specific underlying psychological processes. These process-related changes were modelled using measures of mindfulness (Freiburg Mindfulness Inventory), psychological flexibility (Acceptance and Action Questionnaire version II), and empowerment (Empowerment Scale [ES]). Their pre- and post changes were analyzed with repeated measures analysis of variance, and mediational analyses were performed. Results: Findings from mediational analyses suggest that empowerment (ES) mediated a significant portion of the effects observed in reduction in stigmatizing attitudes and internalized stigma across intervention groups (t = 3.67 to 3.78 for CEE groups, and t = 4.32 to 4.56 for ACT groups). For the ACT groups, reduction in internalized stigma might also have been partly mediated by psychological flexibility, an intervention-specific psychological process. Conclusions: Results from the current study suggest that different stigma reduction interventions may be mediated by increased empowerment as a common mechanism of change, while intervention-specific mechanism of change, improved psychological flexibility through ACT, may also contribute to improvement in internalized stigma. [ABSTRACT FROM AUTHOR]

Stigma of mental illness contributes to silence, denial and delayed help seeking. Existing stigma reduction strategies seldom consider gender and cultural contexts. The Strengths in Unity study was a multi-site Canadian study that engaged Asian men in three stigma reduction interventions (ACT, CEE, psychoeducation) and mobilized them as Community Mental Health Ambassadors. Our participants included both men living with or affected by mental illness (LWA) as well as community leaders (CL). This paper will: (1) describe the baseline characteristics of the Toronto participants including their sociodemographic information, mental illness stigma (CAMI and ISMI), attitudes towards social change (SJS), and intervention-related process variables (AAQ-II, VLQ, FMI, Empowerment); (2) compare the differences among these variables between LWA and CL; and (3) explore factors that may correlate with socio-economic status and mental health stigma. A total of 609 Asian men were recruited in Toronto, Canada. Both CL and LWA had similar scores on measures of external and internalized stigma and social change attitudes, except that LWA had more positive views about the acceptance and integration of those with mental illness into the community on the CAMI, while CL had a higher level of perceived behavioral control on the SJS. Group differences were also observed between LWA and CL in some process-related variables. Exploratory analysis suggests that younger and more educated participants had lower stigma. Our findings underscore the importance of engaging both community leaders and people with lived experience as mental health advocates to address stigma. [ABSTRACT FROM AUTHOR]

Mental illness stigma has detrimental effects on health and wellbeing. Approaches to address stigma in racialized populations in Western nations need to emphasize inclusivity, social justice, and sociocultural intersectionality of determinants of health. The current paper evaluates three intervention approaches to reduce stigma of mental illness among Asian men in Toronto, Canada. Participants received one of four group interventions: psychoeducation, Acceptance and Commitment Therapy (ACT), Contact-based Empowerment Education (CEE), and a combination of ACT+CEE. Self-report measures on stigma (CAMI, ISMI) and social change (SJS) were administered before and after the intervention. A total of 535 Asian men completed the interventions. Overall analyses found that all intervention approaches were successful in reducing stigma and promoting social change. Subscale differences suggest that CEE may be more broadly effective in reducing mental illness stigmatizing attitudes while ACT may be more specifically effective in reducing internalized stigma. More work needs to be done to elucidate mechanisms that contribute to socioculturally-informed mental illness stigma interventions for racialized communities and traditionally marginalized populations. [ABSTRACT FROM AUTHOR]

This position paper has been substantially revised by the Canadian Psychiatric Association (CPA)'s Section on Transcultural Psychiatry and the Standing Committee on Education and approved for republication by the CPA's Board of Directors on February 8, 2019. The original position paper1 was first approved by the CPA Board on September 28, 2011. [ABSTRACT FROM AUTHOR]

Few studies have examined interventions or therapeutic processes that may help parents of children with Autism Spectrum Disorder (ASD) manage their stress. This study examines the impact of a brief Acceptance and Commitment Therapy (ACT) group intervention, led by parents, among a cohort of 33 mothers of children with ASD. Changes in ACT process measures (psychological flexibility, cognitive fusion, values) were evaluated at pre, post, and 3 months following the intervention. Mothers reported significant improvement post-intervention in psychological flexibility, cognitive fusion, and value-consistent activities in multiple life domains, including parenting, relationships, and self-care. These improvements were maintained at follow-up. The results provide preliminary evidence that improvements observed in depression and stress may be mediated by cognitive fusion and action-values consistency. [ABSTRACT FROM AUTHOR]

Background The available evidence on interventions addressing the stigma of mental illness is limited because of small samples, lack of diversity in study samples, and exclusion of people living with mental illness. To date, no published studies have evaluated anti-stigma interventions for Asian men in Canada. Aim This paper describes the protocol of a study to evaluate psychological and collective empowerment interventions (ACT, CEE, and ACT+CEE) in addressing self-stigma and social stigma in Asian communities in three urban settings in Canada: Toronto, Calgary and Vancouver. The study targets Asian men living with or affected by mental illness, and community leaders interested in stigma reduction and advocacy. Methods Guided by a population health promotion framework and an ecological approach to health, the study will use a repeated measure design with mixed methods for data collection. In total, 2160 participants will be enrolled to detect moderate-to-large effect sizes, while accounting for possible attrition. Participants will be randomly assigned to one of three interventions or a control group, using a randomization matrix. Established measures will be used to collect outcome data at pretest, post-test, and 3 and 6 months follow-up, along with focus group discussions and monthly activity logs. Mixed linear models will compare participants' stigma, psychological flexibility, valued life domains, mindfulness, and empowerment readiness within and between groups. Discussion The project will generate new knowledge on the applicability and effectiveness of evidence-based psychological and collective empowerment interventions (ACT, CEE, and ACT+CEE) in addressing stigma of mental illness and mobilizing community leadership. [ABSTRACT FROM AUTHOR]

Racialized diasporic communities in Canada experience disproportionate burden of HIV infection. Their increased vulnerabilities are associated with interlocking challenges, including barriers in accessing resources, migration and settlement stress, and systemic exclusion. Further, people living with HIV (PLHIV) in these diasporic communities face stigma and discrimination in both mainstream Canadian society as well as their own ethno-racial communities. HIV stigma negatively impacts all aspects of HIV care, from testing to disclosure to treatment and ongoing care. In response to these challenges, a Toronto based community organization developed and implemented the CHAMP project to engage people living with HIV/AIDS (PLHIV) and leaders from different service sectors from the African/Caribbean, Asian and Latino communities to explore challenges and strategies to reduce HIV stigma and build community resilience. The study engaged 66 PLHIV and ethno-racial leaders from faith, media and social justice sectors in two stigma-reduction training programs: Acceptance Commitment Therapy Training (ACT) and Social Justice Capacity Building (SJCB). Data collection included pre-and post- intervention surveys, focus groups and monthly activity logs. Participants were followed for a year and data on changes in the participants’ attitudes and behaviors as well as their actual engagement in HIV prevention, PLHIV support and stigma reduction activities were collected. CHAMP results showed that the interventions were effective in reducing HIV stigma and increasing participants’ readiness to take action towards positive social change. Participants’ activity logs over a period of 9 months after completing the training showed they had engaged in 1090 championship activities to advocate for HIV related health equity and social justice issues affecting racialized and newcomer PLHIV and communities. [ABSTRACT FROM AUTHOR]

A vast wealth of literature exists on the topic of rocket trajectory optimisation, particularly in the area of interplanetary trajectories due to its relevance today. Studies on optimising interstellar and intergalactic trajectories are usually performed in flat spacetime using an analytical approach, with very little focus on optimising interstellar trajectories in a general relativistic framework. This paper examines the use of low-acceleration rockets to reach galactic destinations in the least possible time, with a genetic algorithm being employed for the optimisation process. The fuel required for each journey was calculated for various types of propulsion systems to determine the viability of low-acceleration rockets to colonise the Milky Way. The results showed that to limit the amount of fuel carried on board, an antimatter propulsion system would likely be the minimum technological requirement to reach star systems tens of thousands of light years away. However, using a low-acceleration rocket would require several hundreds of thousands of years to reach these star systems, with minimal time dilation effects since maximum velocities only reached about 0.2 c . Such transit times are clearly impractical, and thus, any kind of colonisation using low acceleration rockets would be difficult. High accelerations, on the order of 1 g, are likely required to complete interstellar journeys within a reasonable time frame, though they may require prohibitively large amounts of fuel. So for now, it appears that humanity's ultimate goal of a galactic empire may only be possible at significantly higher accelerations, though the propulsion technology requirement for a journey that uses realistic amounts of fuel remains to be determined. [ABSTRACT FROM AUTHOR]

Acceptance and Commitment Therapy (ACT) is a psychological intervention that has wide clinical applications with emerging empirical support. It is based on Functional Contextualism and is derived as a clinical application of the Relational Frame Theory, a behavioral account of the development of human thought and cognition. The six core ACT therapeutic processes include: Acceptance, Defusion, Present Moment, Self-as-Context, Values, and Committed Action. In addition to its explicit use of the concept of mindfulness, the therapeutic techniques of ACT implicitly incorporate other aspects of Buddhism. This article describes the basic principles and processes of ACT, explores the similarities and differences between ACT processes and some of the common tenets in Buddhism such as the Four Noble Truths and No-Self, and reports on the experience of running a pilot intervention ACT group for the Cambodian community in Toronto in partnership with the community’s Buddhist Holy Monk. Based on this preliminary exploration in theory and the reflections of the group experience, ACT appears to be consistent with some of the core tenets of Buddhism in the approach towards alleviating suffering, with notable differences in scope reflecting their different aims and objectives. Further development of integrative therapies that can incorporate psychological and spiritual as well as diverse cultural perspectives may help the continued advancement and evolution of more effective psychotherapies that can benefit diverse populations. [ABSTRACT FROM AUTHOR]

Cultural competence is increasingly recognized as an essential component of effective mental health care delivery to address diversity and equity issues. Drawing from the literature and our experience in providing cultural competence consultation and training, the paper will discuss our perspective on the foundational concepts of cultural competence and how it applies to a health care organization, including its programs and services. Based on a recent consultation project, we present a methodology for assessing cultural competence in health care organizations, involving mixed quantitative and qualitative methods. Key findings and recommendations from the resulting cultural competence plan are discussed, including core principles, change strategies, and an Organizational Cultural Competence Framework, which may be applicable to other health care institutions seeking such changes. This framework, consisting of eight domains, can be used for organizational assessment and cultural competence planning, ultimately aiming at enhancing mental health care service to the diverse patients, families, and communities. [ABSTRACT FROM PUBLISHER]

The article offers guidelines for training in cultural psychiatry. Based on a review of literature and existing training programs, it addresses issues relevant to general psychiatry and specific populations including refugees and immigrants. A knowledge exchange centre is developed by the Section on Transcultural Psychiatry of the Canadian Psychiatric Association to share curriculum materials, interactional learning and self assessment tools of clinical practice and organizational change.

Purpose: To report on the efficacy of the oral carbonic anhydrase inhibitor (CAI) acetazolamide in treating macular retinoschisis (RS) in the rare vitreoretinal dystrophy best known as the enhanced S-cone syndrome (ESCS). Design: Interventional case report. Methods: setting: University-based practice. patient: A 48-year old Jewish Italian male with clinically, functionally, and molecularly confirmed ESCS, attributable to homozygosity for the R311Q mutation in the NR2E3 gene, presented with sudden visual acuity (VA) loss (20/200) and metamorphopsia in the left eye resulting from acute, late-onset, asymmetric macular RS. intervention: Open-label, off-label treatment with the oral CAI acetazolamide. main outcome measure(s): Best-corrected VA, retinal thickness, and retinal microanatomy, assessed by Stratus optical coherence tomography (OCT) criteria. Results: Following treatment, instituted one month after the acute-onset VA loss, retinal thickness and microanatomic profile normalized in the affected eye, with restoration of 20/20 corrected VA. The fellow eye, which had remained asymptomatic at 20/16 vision, had experienced mild paracentral macular RS evident by OCT criteria, which also resolved completely following oral CAI treatment. The outcome was maintained throughout the follow-up period at a low maintenance dose. Conclusions: Taken together with other recent reported benefits of topical and oral CAIs in the treatment of macular RS in X-linked retinoschisis, this interventional case report shows that CAIs can be used to treat effectively macular RS in general, and also specifically in ESCS. [Copyright &y& Elsevier]

Background and aims: It has been recognized that Asian immigrants in North America have lower rates of mental health service utilization. From the perspective of cross-cultural psychiatry, one of the most important cultural factors may be differences in the explanatory model of illness. This article examines the relationship of causal beliefs, perceived service accessibility and attitudes towards seeking mental health care. Method: The sample consisted of 1000 immigrant and refugee women from five ethnic minority communities in Toronto, including three Chinese Canadian communities (Hong Kong, mainland China and Taiwan), Korean Canadians and Vietnamese Canadians. Data were acquired by a self-administered structured questionnaire. Quantitative data were analysed using MANOVA, ANOVA and stepwise multiple regression. Results: The five ethnic minority groups of women differed in their explanatory models about mental illness and distress. In the full model where other variables were controlled for, the most significant factor predicting attitudes towards seeking professional help was perceived access for all groups except the Hong Kong Chinese. In the last group, those subscribing more to a Western stress model of illness had a more positive attitude towards seeking professional help, while those subscribing more to supernatural beliefs had a more negative attitude. Age and education were not significant predictors. Conclusion: Perceived access is one of the main factors that influence attitudes toward seeking professional help. Explanatory models may predict help-seeking behaviours if perceived access to such services is available. [ABSTRACT FROM AUTHOR]

To provide effective psychotherapy for culturally different patients, therapists need to attain cultural competence, which can be divided broadly into the 2 intersecting dimensions of generic and specific cultural competencies. Generic cultural competence includes the knowledge and skill set necessary to work effectively in any cross-cultural therapeutic encounter. For each phase of psychotherapy--preengagement, engagement, assessment and feedback, treatment, and termination--we discuss clinically relevant generic cultural issues under the following headings: therapist, patient, family or group, and technique. Specific cultural competence enables therapists to work effectively with a specific ethnocultural community and also affects each phase of psychotherapy. A comprehensive assessment and treatment approach is required to consider the specific effects of culture on the patient. Cultural analysis (CA) elaborates the DSM-IV cultural formulation, tailoring it for psychotherapy; it is a clinical tool developed to help therapists systematically review and generate hypotheses regarding cultural influences on the patient's psychological world. CA examines issues under 3 domains: self, relations, and treatment. We present a case to illustrate the influence of culture on patient presentation, diagnosis, CA, and psychotherapeutic treatment. Successful therapy requires therapists to employ culturally appropriate treatment goals, process, and content. The case also demonstrates various techniques with reference to culture, including countercultural, cultural reinforcing, or culturally congruent strategies and the use of contradictory cultural beliefs. In summary, developing both generic and specific cultural competencies will enhance clinician effectiveness in psychotherapy, as well as in other cross-cultural therapeutic encounters. [ABSTRACT FROM AUTHOR]

Presents information on a study which used a Gaussian radial basis function neural network to preprocess raw evoked potential signals before serving as the reference input. Methodology; Results; Conclusion.

Arterial stiffness index (ASI) is a non-invasive measure of arterial stiffness using infra-red finger sensors (photoplethysmography). It is a well-suited measure for large populations as it is relatively inexpensive to perform, and data can be acquired within seconds. These features raise interest in using ASI as a tool to estimate cardiovascular disease risk as prior work demonstrates increased arterial stiffness is associated with elevated systolic blood pressure, and ASI is predictive of cardiovascular disease and mortality. We conducted genome-wide association studies (GWASs) for ASI in 127,121 UK Biobank participants of European-ancestry. Our primary analyses identified variants at four loci reaching genome-wide significance (P < 5 × 10−8): TEX41 (rs1006923; P = 5.3 × 10−12), FOXO1 (rs7331212; P = 2.2 × 10−11), C1orf21 (rs1930290, P = 1.1 × 10−8) and MRVI1 (rs10840457, P = 3.4 × 10−8). Gene-based testing revealed three significant genes, the most significant gene was COL4A2 (P = 1.41 × 10−8) encoding type IV collagen. Other candidate genes at associated loci were also involved in smooth muscle tone regulation. Our findings provide new information for understanding the development of arterial stiffness. [ABSTRACT FROM AUTHOR]

Emerging research shows that Acceptance and Commitment Therapy (ACT) may improve mental health for caregivers. Parents of autistic children, adolescents, and adults (N = 54) were randomly assigned to either complete a brief group-based ACT intervention or remain on the waitlist. Participants completed surveys immediately prior to randomization, and 3-, 7-, and 17-weeks post-randomization. The primary outcome was depression symptoms and secondary outcomes included stress, goal attainment, positive affect, ACT psychological processes, child mental health, and family functioning. Mixed effects linear models testing Group × Time interaction indicated the Treatment group (n = 27) demonstrated greater post-intervention improvements than the Waitlist group (n = 27) in parent depression (p =.03, d = −0.64) and family distress (p =.04, d = −0.57). Treatment group parents also reported greater short-term gains in positive affect (p =<.001, d = 0.77) and personal goal attainment (p =.007, d = 0.80), compared to the Waitlist group. Although there was no significant Group × Time interaction for other outcomes, stress (b = −2.58, p =.01), defusion (b = −3.78, p =.001), and experiential avoidance (b = −4.22, p =.01) showed improvement for the Treatment group, but not the Waitlist group, at post-intervention. All Treatment group improvements were maintained at follow-up. Results suggest that a brief ACT group intervention is efficacious for improving some aspects of mental health for parents of autistic children. Parents of autistic children commonly experience difficulties with their own mental health. This study looked at the effects of a brief group-based Acceptance and Commitment Therapy program, developed for parents of autistic children, youth, and adults. ACT focuses on increasing psychological flexibility, which is the ability to be mindful and accepting of difficult thoughts and experiences, shown to be important for mental wellness. Participants included 54 parents of autistic people, ages 3–34. Parents were randomly divided into two groups: a Treatment group that received the intervention right away, and a Waitlist group that completed the program after the Treatment group completed the trial. All parents filled out questionnaires right before the program began, and at 3, 7, and 17 weeks after randomization. Compared to the group that was waiting to participate in the program, parents in the Treatment group reported greater improvements in depression and family distress, and these improvements were still present 4 months later. Parents in the Treatment group also reported short-term improvements in their positive feelings and personal goals, compared to those waiting. Results showed that ACT may help improve some aspects of mental health for parents of autistic children, but further research is recommended. [ABSTRACT FROM AUTHOR]

Due to cultural and systemic factors, Chinese-Canadians tend to use mental health services less or when mental health problems are more severe. Services need to be more culturally responsive in their treatment of mental illness. Around important life events, when there may be heightened vulnerability to mental illness, this is especially important. In this study, postpartum cultural practices were examined among recent immigrant, longer-term immigrant, and Canadian-born Chinese women. We conducted a longitudinal cohort study of 493 women in Toronto, Ontario, with livebirths in 2011–2014. Participants completed a demographic survey and Postpartum Rituals Questionnaire. Most women (82.2%) practiced at least one postpartum ritual. Younger age (OR 0.93; 95% CI 0.87–0.99) and greater participation in the heritage culture (OR 1.28; 95% CI 1.02–1.61) were associated with ritual practice. From among five types of postpartum rituals identified (i.e., avoidance of homeostatic disturbances, dietary practices, wind avoidance, organized support, and cold avoidance), dietary practices were most commonly undertaken and cold avoidance was least commonly undertaken. There were differences in postpartum ritual patterns by immigration status, with immigrant women being more likely to undertake a greater number of rituals, to attribute these rituals to Chinese culture, and to ascribe health benefits to these rituals and being less likely to feel forced into performing these rituals. Our findings underscore the importance of clinicians becoming more aware of Chinese postpartum rituals to provide women with culturally competent and patient-centered care. [ABSTRACT FROM AUTHOR]

Mental health literacy (MHL) is essential to mental health. Symptoms of depression and anxiety are significant antecedents and closely related to suicide among college students. Few studies have explored the mediating role of depressive and anxiety symptoms between MHL and suicidal ideation. 5578 college students were included in the analysis. The online Wenjuanxing platform was used to collect data from November 2020 to March 2021. The bootstrapping method was used to test the mediating role of depressive and anxiety symptoms in the links between MHL and suicidal ideation. Approximately 18.8 % of Chinese college students in our study reported having suicidal ideation. MHL exhibited a significant and negative correlation with depressive symptoms, anxiety symptoms, and suicidal ideation, whereas depressive and anxiety symptoms correlated significantly and positively with suicidal ideation. Compared with the lowest MHL quartile, the 3rd and 4th quartiles of MHL were associated with a significantly lower risk of suicidal ideation after adjusting for various confounding factors. Depressive and anxiety symptoms partially mediated the relationship between MHL and suicidal ideation, and the mediating effect of depressive symptoms was significantly greater than that of anxiety symptoms. This study was a cross-sectional survey. Future longitudinal studies on this relation are needed. Depressive and anxiety symptoms mediate the relationship between MHL and suicidal ideation. Comprehensive school-based specific psychological education programs are needed to improve college students' MHL and change their attitudes toward mental health services. • About 18.8% of college students have considered suicide in the past 12 months. • Mental health literacy exhibited a significant and negative correlation with depressive symptoms, anxiety symptoms, and suicidal ideation. • Depressive symptoms and anxiety symptoms partially mediated the relationship between MHL and suicidal ideation, and the mediating effect of depressive symptoms was significantly greater than that of anxiety symptoms. • Females may be more susceptible than males to the anxiety-induced suicide pathway. [ABSTRACT FROM AUTHOR]

The knowledge and experience of diverse psychiatrists is crucial to improving care for racialized patients and working toward broader change in health-care institutions and systems.[106],[163],[183] In the meantime, health-care institutions and professional organizations must stop current "colourblind" approaches that are common and continue to perpetuate discrimination against people of colour.[184] One important step would be for each academic department of psychiatry in Canada to identify an equity, diversity and inclusion (EDI) leader. In Canada, where Indigenous Peoples[116] and many other groups are under-represented in the health professions, funding and hiring strategies that lead to recruitment of minority medical students and residents can contribute to a long range shift within psychiatry toward greater diversity and inclusiveness in the mental health workforce and equitable representation of racialized groups.[181],[182] More than mere numerical representation, racialized psychiatrists and trainees need the mental health system to change to become actively anti-racist and welcoming of diversity. Bridging cultural psychiatry and global mental health: a resident-led initiative. Bridging cultural psychiatry and global mental health: a resident-led initiative. [Extracted from the article]

A position paper developed by the Canadian Psychiatric Association's Education Committee and approved by the CPA's Board of Directors on August 15, 2016. [ABSTRACT FROM AUTHOR]

An abstract of the article "Community mobilisation and empowerment for combating a pandemic" is presented.

We appreciate the response to the CPA Position Paper on Training in Cultural Psychiatry from Drs. Persad and Oyewumi.[1] We completely concur with their comments underscoring the importance of religion and spirituality in cultural psychiatry. [Extracted from the article]

Caregivers of autistic children and caregivers of children with fetal alcohol spectrum disorder (FASD) experience considerable stress. However, what is unique or similar across these groups remains understudied. This study explored how female caregivers of children with FASD who registered to participate in a caregiver focused mental health intervention differed from female caregivers of autistic children participating in a similar intervention. Prior to the intervention, caregivers of children with FASD (n = 21), and caregivers of autistic children (n = 22) were asked to complete an online baseline questionnaire. This questionnaire collected information pertaining to caregiver and child demographics, as well as clinical characteristics related to wellbeing, values, and what caregivers identified as rewarding and challenging about raising their child. Results identified similarities across caregiver groups in terms of wellbeing, values, and the challenges and rewards they identified with raising their children. Given the similarities in these two caregiver groups, and the shortage of research on families of people with FASD relative to families of autistic people, interventions for family caregivers in the autism community may also be applicable for FASD families, for whom fewer resources are available. [ABSTRACT FROM AUTHOR]

The current paper examines whether resilience-promoting interventions lead to increased self-reported resilience relative to a control group. The literature search was conducted using terms "resilience intervention" OR "promoting resilience" OR "promoting resiliency" OR "resilience-based intervention". A total of 83 studies were included in the meta-analysis and systematic review. The quality of studies was evaluated based on sample size, appropriateness of statistical analyses, and protocol for intervention adoption. Moderation models examined effects of study characteristics (study rigour), delivery characteristics (mode of intervention [e.g., self-guided], mode of delivery [e.g., in-person] and format [e.g., group-based]), and resilience characteristics (type of resilience [e.g., coping] and resilience process) on outcomes. Findings indicated that resilience-promoting interventions significantly improved resilience relative to controls, Hedges' g = 0.72 (SE = 0.07, 95% CI = [0.59, 0.85], Z = 10.61, p <.001). These effects were heterogeneous, Q(102) = 1232.57, p <.001. Mode of intervention, resilience type, and resilience process emerged as important moderators. Results of the current meta-analysis support the effectiveness of resilience interventions, while positing considerations for intervention design and implementation. Clinical and research implications are discussed. [ABSTRACT FROM AUTHOR]

Extended Gaussian image (EGI) and complex EGI (CEGI) have been widely used as the representation of 3D shapes for shape recognition and pose estimation. In this work, we extend the representations and present a new representation named enriched complex extended Gaussian image (EC-EGI). The representation follows the same framework of EGI and CEGI, which is to represent each surface patch of the target 3D shape as a weight at the associated spot on the surface of the Gaussian sphere. However, while the original CEGI uses a single complex number as the weight, the new representation uses three complex numbers, which are related to the centroid position of the surface patch in 3D. With the inclusion of more information in the new representation, not only could object pose be determined more accurately, but also some key ambiguities of shape representation that CEGI and EGI have also removed. The translation parameters in the pose estimation application could also be determined in a simpler and more accurate way. In addition, the Gaussian sphere partition problem of CEGI is no longer present. Experimental results on synthetic and real image data are shown to illustrate the performance of the proposed representation in pose estimation. [ABSTRACT FROM AUTHOR]

Objectives: In many cultures, postpartum rituals are observed because they are believed to have beneficial mental health effects. Our systematic review examines the research literature investigating the effects of postpartum rituals on postpartum depression (PPD) to determine if the rituals protect against PPD. Methods: MEDLINE, CINAHL, PsyclNFO, EMBASE, and the Cochrane Library were searched (from 1966 to October 31, 2008). Reference lists of relevant articles and links to related articles were also examined. Both qualitative and quantitative studies that focused on traditional practices and rituals in the postpartum period (that is, within the first year following childbirth) and their relation to PPD or mood were included. Results: Seventy-two studies were considered, with 12 meeting the inclusion criteria. The data were summarized according to the type of ritual including: organized support, diet, and other or multiple postpartum practices, and evidence for or against a protective effect on PPD. Although limited, not all studies suggested that the rituals prevent PPD. Overall, there is some evidence that postpartum rituals dictating appropriate and wanted social support may be of some protective value, depending on numerous contextual factors. Conclusions: This area needs more culturally sensitive and systematic research. Current studies suggest that the key protective element may be the presence of welcome support rather than the specific ritual. [ABSTRACT FROM AUTHOR]

Purpose: To assess methods used for glaucoma screening in the Student Sight Savers Program (SSSP), an initiative of the Friends of the Congressional Glaucoma Caucus Foundation that has screened individuals for glaucoma in the United States since 2001. Methods: This was a prospective, case-control, clinic-based study (total N = 70). Patients with primary open-angle glaucoma and age- and sex-matched controls with no evidence of glaucoma or other ocular disease were evaluated with the SSSP screening method. Primary outcome measures were sensitivity, specificity, and positive predictive power for both low- and high-prevalence populations. Results: Sensitivity and specificity values of the individual tests were 48.6% and 68.6% for family history of glaucoma, 22.1% and 78.6% for intraocular pressure (IOP), and 58.1% and 98.6% for frequency doubling technology (FDT) visual field (P = 0.03, chi-square). Specificity of FDT was significantly better than IOP (P < 0.001) and the questionnaire (P < 0.01) by z-test. When analyzing the overall screening criteria (positive screen was ≥ 1 positive in the three tests), the sensitivity increased to 88.6% with reduction in specificity to 57.1%. The positive predictive power (PPP) for high-prevalence population was low for the overall screening criteria (15.4%) and highest for FDT as an individual (34.0%) or combined (41.0% to 45.3%) test. The medical student education and community awareness aspects of the program were not assessed. Conclusions: Of different methods used in the SSSP, FDT was the best single screening test, demonstrating high specificity but only moderate sensitivity. Use of multiple screening criteria resulted in slightly increased sensitivity and PPP over FDT, but decreased specificity. [ABSTRACT FROM AUTHOR]

A position statement developed by the Canadian Psychiatric Association (CPA) on racism and social justice in mental health is presented. It calls for social change to address violence and inequities of systemic racism and discrimination around the world. It also calls for diversity in mental health professional training, the creation of inclusive and safe educational and clinical environment, and challenging biases and assumptions built into mental health theory and practice.

Background: Mitral valve (MV) and tricuspid valve (TV) apparatus geometry are essential to define mechanisms and etiologies of regurgitation and to inform surgical or transcatheter interventions. Given the increasing use of cardiovascular magnetic resonance (CMR) for the evaluation of valvular heart disease, we aimed to establish CMR-derived age- and sex-specific reference values for mitral annular (MA) and tricuspid annular (TA) dimensions and tethering indices derived from truly healthy Caucasian adults.Methods: 5065 consecutive UK Biobank participants underwent CMR using cine balanced steady-state free precession imaging at 1.5 T. Participants with non-Caucasian ethnicity, prevalent cardiovascular disease and other conditions known to affect cardiac chamber size and function were excluded. Absolute and indexed reference ranges for MA and TA diameters and tethering indices were stratified by gender and age (45–54, 55–64, 65–74 years).Results: Overall, 721 (14.2%) truly healthy participants aged 45–74 years (54% women) formed the reference cohort. Absolute MA and TA diameters, MV tenting length and MV tenting area, were significantly larger in men. Mean ± standard deviation (SD) end-diastolic and end-systolic MA diameters in the 3-chamber view (anteroposterior diameter) were 2.9 ± 0.4 cm (1.5 ± 0.2 cm/m2) and 3.3 ± 0.4 cm (1.7 ± 0.2 cm/m2) in men, and 2.6 ± 0.4 cm (1.6 ± 0.2 cm/m2) and 3.0 ± 0.4 cm (1.8 ± 0.2 cm/m2) in women, respectively. Mean ± SD end-diastolic and end-systolic TA diameters in the 4-chamber view were 3.2 ± 0.5 cm (1.6 ± 0.3 cm/m2) and 3.2 ± 0.5 cm (1.7 ± 0.3 cm/m2) in men, and 2.9 ± 0.4 cm (1.7 ± 0.2 cm/m2) and 2.8 ± 0.4 cm (1.7 ± 0.3 cm/m2) in women, respectively. With advancing age, end-diastolic TA diameter became larger and posterior MV leaflet angle smaller in both sexes. Reproducibility of measurements was good to excellent with an inter-rater intraclass correlation coefficient (ICC) between 0.92 and 0.98 and an intra-rater ICC between 0.90 and 0.97.Conclusions: We described age- and sex-specific reference ranges of MA and TA dimensions and tethering indices in the largest validated healthy Caucasian population. Reference ranges presented in this study may help to improve the distinction between normal and pathological states, prompting the identification of subjects that may benefit from advanced cardiac imaging for annular sizing and planning of valvular interventions. [ABSTRACT FROM AUTHOR]

The Youth Engagement Project (YEP) is a community-based pilot study in Toronto, Canada that we developed to better understand perspectives about and experiences of sexual health education among socioeconomically marginalized, racialized, and LGBTQ youth. We investigated: 1) what sex-related messages these young people received as they grew up, 2) how those messages affected their perspectives and sexual behaviour, and 3) their recommendations for sexual health education that meets their needs. Engaging youth whose voices are often overlooked due to their low socioeconomic status and their racial, sexual, and religious identities, and using a place-based method, we recruited a total of 47 young people, aged 16–24, and divided them into six groups based on gender and residential neighbourhood. The data was collected through a demographic and sexual practice survey, followed by a series of two focus groups. We conducted thematic analysis, guided by a socio-ecological approach and paying particular attention to participants' intrapersonal, interpersonal and environmental factors. Our results indicate that participants received inadequate and contradictory sexuality related information from multiple sources. These mixed messages contributed to confusion, misconceptions, distress, and sexual vulnerabilities. Youth expressed their need for more inclusive and relevant sexual health education starting from an early age, more support for parents and teachers to help them talk with children and youth about sexuality, and more youth-driven integrated health promotion programs to allow them to make informed choices. Their voices and perspectives are useful in informing inclusive and youth-centred sexual health education at home, in school and in the community. [ABSTRACT FROM AUTHOR]

Background: The genetic basis of left ventricular (LV) image-derived phenotypes, which play a vital role in the diagnosis, management, and risk stratification of cardiovascular diseases, is unclear at present.Methods: The LV parameters were measured from the cardiovascular magnetic resonance studies of the UK Biobank. Genotyping was done using Affymetrix arrays, augmented by imputation. We performed genome-wide association studies of 6 LV traits-LV end-diastolic volume, LV end-systolic volume, LV stroke volume, LV ejection fraction, LV mass, and LV mass to end-diastolic volume ratio. The replication analysis was performed in the MESA study (Multi-Ethnic Study of Atherosclerosis). We identified the candidate genes at genome-wide significant loci based on the evidence from extensive bioinformatic analyses. Polygenic risk scores were constructed from the summary statistics of LV genome-wide association studies to predict the heart failure events.Results: The study comprised 16 923 European UK Biobank participants (mean age 62.5 years; 45.8% men) without prevalent myocardial infarction or heart failure. We discovered 14 genome-wide significant loci (3 loci each for LV end-diastolic volume, LV end-systolic volume, and LV mass to end-diastolic volume ratio; 4 loci for LV ejection fraction, and 1 locus for LV mass) at a stringent P<1×10-8. Three loci were replicated at Bonferroni significance and 7 loci at nominal significance (P<0.05 with concordant direction of effect) in the MESA study (n=4383). Follow-up bioinformatic analyses identified 28 candidate genes that were enriched in the cardiac developmental pathways and regulation of the LV contractile mechanism. Eight genes (TTN, BAG3, GRK5, HSPB7, MTSS1, ALPK3, NMB, and MMP11) supported by at least 2 independent lines of in silico evidence were implicated in the cardiac morphogenesis and heart failure development. The polygenic risk scores of LV phenotypes were predictive of heart failure in a holdout UK Biobank sample of 3106 cases and 224 134 controls (odds ratio 1.41, 95% CI 1.26 - 1.58, for the top quintile versus the bottom quintile of the LV end-systolic volume risk score).Conclusions: We report 14 genetic loci and indicate several candidate genes that not only enhance our understanding of the genetic architecture of prognostically important LV phenotypes but also shed light on potential novel therapeutic targets for LV remodeling. [ABSTRACT FROM AUTHOR]

Population imaging studies generate data for developing and implementing personalised health strategies to prevent, or more effectively treat disease. Large prospective epidemiological studies acquire imaging for pre-symptomatic populations. These studies enable the early discovery of alterations due to impending disease, and enable early identification of individuals at risk. Such studies pose new challenges requiring automatic image analysis. To date, few large-scale population-level cardiac imaging studies have been conducted. One such study stands out for its sheer size, careful implementation, and availability of top quality expert annotation; the UK Biobank (UKB). The resulting massive imaging datasets (targeting ca. 100,000 subjects) has put published approaches for cardiac image quantification to the test. In this paper, we present and evaluate a cardiac magnetic resonance (CMR) image analysis pipeline that properly scales up and can provide a fully automatic analysis of the UKB CMR study. Without manual user interactions, our pipeline performs end-to-end image analytics from multi-view cine CMR images all the way to anatomical and functional bi-ventricular quantification. All this, while maintaining relevant quality controls of the CMR input images, and resulting image segmentations. To the best of our knowledge, this is the first published attempt to fully automate the extraction of global and regional reference ranges of all key functional cardiovascular indexes, from both left and right cardiac ventricles, for a population of 20,000 subjects imaged at 50 time frames per subject, for a total of one million CMR volumes. In addition, our pipeline provides 3D anatomical bi-ventricular models of the heart. These models enable the extraction of detailed information of the morphodynamics of the two ventricles for subsequent association to genetic, omics, lifestyle habits, exposure information, and other information provided in population imaging studies. We validated our proposed CMR analytics pipeline against manual expert readings on a reference cohort of 4620 subjects with contour delineations and corresponding clinical indexes. Our results show broad significant agreement between the manually obtained reference indexes, and those automatically computed via our framework. 80.67% of subjects were processed with mean contour distance of less than 1 pixel, and 17.50% with mean contour distance between 1 and 2 pixels. Finally, we compare our pipeline with a recently published approach reporting on UKB data, and based on deep learning. Our comparison shows similar performance in terms of segmentation accuracy with respect to human experts. [ABSTRACT FROM AUTHOR]

Introduction: Aortic distensibility can be calculated using semi-automated methods to segment the aortic lumen on cine CMR (Cardiovascular Magnetic Resonance) images. However, these methods require visual quality control and manual localization of the region of interest (ROI) of ascending (AA) and proximal descending (PDA) aorta, which limit the analysis in large-scale population-based studies. Using 5100 scans from UK Biobank, this study sought to develop and validate a fully automated method to 1) detect and locate the ROIs of AA and PDA, and 2) provide a quality control mechanism. Methods: The automated AA and PDA detection-localization algorithm followed these steps: 1) foreground segmentation; 2) detection of candidate ROIs by Circular Hough Transform (CHT); 3) spatial, histogram and shape feature extraction for candidate ROIs; 4) AA and PDA detection using Random Forest (RF); 5) quality control based on RF detection probability. To provide the ground truth, overall image quality (IQ = 0–3 from poor to good) and aortic locations were visually assessed by 13 observers. The automated algorithm was trained on 1200 scans and Dice Similarity Coefficient (DSC) was used to calculate the agreement between ground truth and automatically detected ROIs. Results: The automated algorithm was tested on 3900 scans. Detection accuracy was 99.4% for AA and 99.8% for PDA. Aorta localization showed excellent agreement with the ground truth, with DSC ≥ 0.9 in 94.8% of AA (DSC = 0.97 ± 0.04) and 99.5% of PDA cases (DSC = 0.98 ± 0.03). AA×PDA detection probabilities could discriminate scans with IQ ≥ 1 from those severely corrupted by artefacts (AUC = 90.6%). If scans with detection probability < 0.75 were excluded (350 scans), the algorithm was able to correctly detect and localize AA and PDA in all the remaining 3550 scans (100% accuracy). Conclusion: The proposed method for automated AA and PDA localization was extremely accurate and the automatically derived detection probabilities provided a robust mechanism to detect low quality scans for further human review. Applying the proposed localization and quality control techniques promises at least a ten-fold reduction in human involvement without sacrificing any accuracy. [ABSTRACT FROM AUTHOR]

Background: Exposure to ambient air pollution is strongly associated with increased cardiovascular morbidity and mortality. Little is known about the influence of air pollutants on cardiac structure and function. We aim to investigate the relationship between chronic past exposure to traffic-related pollutants and the cardiac chamber volume, ejection fraction, and left ventricular remodeling patterns after accounting for potential confounders.Methods: Exposure to ambient air pollutants including particulate matter and nitrogen dioxide was estimated from the Land Use Regression models for the years between 2005 and 2010. Cardiac parameters were measured from cardiovascular magnetic resonance imaging studies of 3920 individuals free from pre-existing cardiovascular disease in the UK Biobank population study. The median (interquartile range) duration between the year of exposure estimate and the imaging visit was 5.2 (0.6) years. We fitted multivariable linear regression models to investigate the relationship between cardiac parameters and traffic-related pollutants after adjusting for various confounders.Results: The studied cohort was 62±7 years old, and 46% were men. In fully adjusted models, particulate matter with an aerodynamic diameter <2.5 μm concentration was significantly associated with larger left ventricular end-diastolic volume and end-systolic volume (effect size = 0.82%, 95% CI, 0.09-1.55%, P=0.027; and effect size = 1.28%, 95% CI, 0.15-2.43%, P=0.027, respectively, per interquartile range increment in particulate matter with an aerodynamic diameter <2.5 μm) and right ventricular end-diastolic volume (effect size = 0.85%, 95% CI, 0.12-1.58%, P=0.023, per interquartile range increment in particulate matter with an aerodynamic diameter <2.5 μm). Likewise, higher nitrogen dioxide concentration was associated with larger biventricular volume. Distance from the major roads was the only metric associated with lower left ventricular mass (effect size = -0.74%, 95% CI, -1.3% to -0.18%, P=0.01, per interquartile range increment). Neither left and right atrial phenotypes nor left ventricular geometric remodeling patterns were influenced by the ambient pollutants.Conclusions: In a large asymptomatic population with no prevalent cardiovascular disease, higher past exposure to particulate matter with an aerodynamic diameter <2.5 μm and nitrogen dioxide was associated with cardiac ventricular dilatation, a marker of adverse remodeling that often precedes heart failure development. [ABSTRACT FROM AUTHOR]

Background: We explored understanding and experiences of health advocacy among psychiatry and family medicine residents and faculty and the implications for clinical care and teaching through the lens of relationship-centred care. Methods: This qualitative study was conducted in the psychiatry and family medicine departments at a large urban university. We interviewed 19 faculty members and conducted two focus groups with 18 residents. Semi-structured questions explored the relational meaning of health advocacy, how residents and faculty learned about the role and ethical considerations involved in incorporating advocacy work into clinical practice within a relationship-centred care framework. Results: Four themes emerged from the interviews and focus groups: 1) health advocacy as an extension of the relationship to self; 2) health advocacy and professional boundaries in the physician–patient relationship; 3) health advocacy within a team-based approach; and 4) health advocacy and the physician–community/organization relationship. Participants described implications for practice of the challenges of health advocacy, including perceived institutional risks, professional boundaries and the appropriation of patient voice. Conclusions: Our study provides insights into the relational complexities of the health advocate role in residency curriculum and clinical practice. All participants described health advocacy as a broad spectrum of actions that are guided by relationships among patients, health care professionals and communities. Our analysis revealed that some challenges that participants identified with a health advocacy role could be addressed by anchoring the role within a specific theoretical framework. This would better enable us to create a culture of advocacy in the training and development of physicians. [ABSTRACT FROM AUTHOR]

Background: Reduced lung function is common and associated with increased cardiovascular morbidity and mortality, even in asymptomatic individuals without diagnosed respiratory disease. Previous studies have identified relationships between lung function and cardiovascular structure in individuals with pulmonary disease, but the relationships in those free from diagnosed cardiorespiratory disease have not been fully explored. Methods: UK Biobank is a prospective cohort study of community participants in the United Kingdom. Individuals self-reported demographics and co-morbidities, and a subset underwent cardiovascular magnetic resonance (CMR) imaging and spirometry. CMR images were analysed to derive ventricular volumes and mass. The relationships between CMR-derived measures and spirometry and age were modelled with multivariable linear regression, taking account of the effects of possible confounders. Results: Data were available for 4,975 individuals, and after exclusion of those with pre-existing cardiorespiratory disease and unacceptable spirometry, 1,406 were included in the analyses. In fully-adjusted multivariable linear models lower FEV1 and FVC were associated with smaller left ventricular end-diastolic (−5.21ml per standard deviation (SD) change in FEV1, −5.69ml per SD change in FVC), end-systolic (−2.34ml, −2.56ml) and stroke volumes (−2.85ml, −3.11ml); right ventricular end-diastolic (−5.62ml, −5.84ml), end-systolic (−2.47ml, −2.46ml) and stroke volumes (−3.13ml, −3.36ml); and with lower left ventricular mass (−2.29g, −2.46g). Changes of comparable magnitude and direction were observed per decade increase in age. Conclusions: This study shows that reduced FEV1 and FVC are associated with smaller ventricular volumes and reduced ventricular mass. The changes seen per standard deviation change in FEV1 and FVC are comparable to one decade of ageing. [ABSTRACT FROM AUTHOR]

Background: Handgrip strength, a measure of muscular fitness, is associated with cardiovascular (CV) events and CV mortality but its association with cardiac structure and function is unknown. The goal of this study was to determine if handgrip strength is associated with changes in cardiac structure and function in UK adults. Methods and results: Left ventricular (LV) ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), mass (M), and mass-to-volume ratio (MVR) were measured in a sample of 4,654 participants of the UK Biobank Study 6.3 ± 1 years after baseline using cardiovascular magnetic resonance (CMR). Handgrip strength was measured at baseline and at the imaging follow-up examination. We determined the association between handgrip strength at baseline as well as its change over time and each of the cardiac outcome parameters. After adjustment, higher level of handgrip strength at baseline was associated with higher LVEDV (difference per SD increase in handgrip strength: 1.3ml, 95% CI 0.1–2.4; p = 0.034), higher LVSV (1.0ml, 0.3–1.8; p = 0.006), lower LVM (-1.0g, -1.8 –-0.3; p = 0.007), and lower LVMVR (-0.013g/ml, -0.018 –-0.007; p<0.001). The association between handgrip strength and LVEDV and LVSV was strongest among younger individuals, while the association with LVM and LVMVR was strongest among older individuals. Conclusions: Better handgrip strength was associated with cardiac structure and function in a pattern indicative of less cardiac hypertrophy and remodeling. These characteristics are known to be associated with a lower risk of cardiovascular events. [ABSTRACT FROM AUTHOR]

Background: The effect of menopausal hormone therapy (MHT)–previously known as hormone replacement therapy–on cardiovascular health remains unclear and controversial. This cross-sectional study examined the impact of MHT on left ventricular (LV) and left atrial (LA) structure and function, alterations in which are markers of subclinical cardiovascular disease, in a population-based cohort. Methods: Post-menopausal women who had never used MHT and those who had used MHT ≥3 years participating in the UK Biobank who had undergone cardiovascular magnetic resonance (CMR) imaging and free of known cardiovascular disease were included. Multivariable linear regression was performed to examine the relationship between cardiac parameters and MHT use ≥3 years. To explore whether MHT use on each of the cardiac outcomes differed by age, multivariable regression models were constructed with a cross-product of age and MHT fitted as an interaction term. Results: Of 1604 post-menopausal women, 513 (32%) had used MHT ≥3 years. In the MHT cohort, median age at menopause was 50 (IQR: 45–52) and median duration of MHT was 8 years. In the non-MHT cohort, median age at menopause was 51 (IQR: 48–53). MHT use was associated with significantly lower LV end-diastolic volume (122.8 ml vs 119.8 ml, effect size = -2.4%, 95% CI: -4.2% to -0.5%; p = 0.013) and LA maximal volume (60.2 ml vs 57.5 ml, effect size = -4.5%, 95% CI: -7.8% to -1.0%; p = 0.012). There was no significant difference in LV mass. MHT use significantly modified the effect between age and CMR parameters; MHT users had greater decrements in LV end-diastolic volume, LV end-systolic volume and LA maximal volume with advancing age. Conclusions: MHT use was not associated with adverse, subclinical changes in cardiac structure and function. Indeed, significantly smaller LV and LA chamber volumes were observed which have been linked to favourable cardiovascular outcomes. These findings represent a novel approach to examining MHT’s effect on the cardiovascular system. [ABSTRACT FROM AUTHOR]

Background: Women with comorbid depression and anxiety in the postpartum period experience more complex and severe symptoms than women with depression or anxiety alone; however, little is known about what influences these symptoms, especially among women from specific ethnic backgrounds. The objective of this study was to identify determinants of comorbid depression and anxiety symptomatology by 24 weeks postpartum in a cohort of Chinese-Canadian women.Methods: A longitudinal cohort study was completed where 549 Chinese immigrant and Canadian-born women in Toronto were followed to 24 weeks postpartum. Questionnaires included risk factors measured at 4 weeks. Logistic regression was used to develop a model of comorbidity (Edinburgh Postnatal Depression Scale score > 9; State-Trait Anxiety Inventory score > 40) up to and including 24 weeks.Results: Previous history of postpartum (AOR 2.42, 95% CI 1.42-4.14) and non-postpartum (AOR 4.20, 95% CI 2.21-7.98) depression, maternal age < 26 years (AOR 1.83, 95% CI 1.04-3.22), perception of support (AOR 0.97, 95% CI 0.94-1.00), acculturative stress (AOR 1.03, 95% CI 1.01-1.04), maternal fatigue (AOR 1.12, 95% CI 1.07-1.17), and perceived infant sleep problems (AOR 2.06, 95% CI 1.27-3.43) were significantly associated with comorbid depression and anxiety in the first 24 weeks postpartum.Limitations: Our sample consisted of Chinese-Canadian women; this study should be replicated in other ethnic groups to see if and how risk factors of postpartum comorbidity differ.Conclusion: The factors identified herein offer insight into groups of Chinese-Canadian women who might benefit most from early identification and treatment and suggest targets for prevention. [ABSTRACT FROM AUTHOR]

Objective: Our objectives were to examine the prevalence and incidence of postpartum depressive, anxiety, and comorbid symptoms over the first postpartum year; the persistence of these symptoms; and the prevalence stratified by immigration status.Method: We conducted a longitudinal cohort study in Ontario, Canada. Participants were 571 Chinese recent immigrant, nonrecent immigrant, and Canadian-born women with live births in 2011 to 2014. Participants were assessed at 4, 12, and 52 weeks postpartum for the presence of possible and high depressive symptomatology (Edinburgh Postnatal Depression Scale [EPDS] >9 and >12, respectively), anxiety symptomatology (State-Trait Anxiety Inventory [STAI] >40), and comorbid symptomatology (EPDS >9 and STAI >40). Prevalence and incidence with 95% confidence intervals were calculated.Results: Prevalence rates were highest at 4 weeks and decreased across time, with possible depressive symptomatology most prevalent at most time points. Incidence rates at 12 and 52 weeks were generally similar. Of those with possible symptomatology at 4 weeks, 42.0% or less continued to have symptomatology at 12 weeks and 17.4% or less at 52 weeks. There were no differences in prevalence of any type of symptomatology between immigrant and Canadian-born Chinese women at 4 weeks, but at 12 and 52 weeks, most types of symptomatology were more common among recent and nonrecent immigrants.Conclusion: Our findings suggest that Chinese immigrant women are a high-risk group for postpartum depressive and anxiety symptomatology. Future research should identify cultural and psychosocial factors associated with immigration that could be addressed in the system of care for postpartum immigrant women. [ABSTRACT FROM AUTHOR]

Aims: The UK Biobank is a large-scale population-based study utilising cardiovascular magnetic resonance (CMR) to generate measurements of atrial and ventricular structure and function. This study aimed to quantify the association between modifiable cardiovascular risk factors and cardiac morphology and function in individuals without known cardiovascular disease. Methods: Age, sex, ethnicity (non-modifiable) and systolic blood pressure, diastolic blood pressure, smoking status, exercise, body mass index (BMI), high cholesterol, diabetes, alcohol intake (modifiable) were considered important cardiovascular risk factors. Multivariable regression models were built to ascertain the association of risk factors on left ventricular (LV), right ventricular (RV), left atrial (LA) and right atrial (RA) CMR parameters. Results: 4,651 participants were included in the analysis. All modifiable risk factors had significant effects on differing atrial and ventricular parameters. BMI was the modifiable risk factor most consistently associated with subclinical changes to CMR parameters, particularly in relation to higher LV mass (+8.3% per SD [4.3 kg/m2], 95% CI: 7.6 to 8.9%), LV (EDV: +4.8% per SD, 95% CI: 4.2 to 5.4%); ESV: +4.4% per SD, 95% CI: 3.5 to 5.3%), RV (EDV: +5.3% per SD, 95% CI: 4.7 to 5.9%; ESV: +5.4% per SD, 95% CI: 4.5 to 6.4%) and LA maximal (+8.6% per SD, 95% CI: 7.4 to 9.7%) volumes. Increases in SBP were associated with higher LV mass (+6.8% per SD, 95% CI: 5.9 to 7.7%), LV (EDV: +4.5% per SD, 95% CI: 3.6 to 5.4%; ESV: +2.0% per SD, 95% CI: 0.8 to 3.3%) volumes. The presence of diabetes or high cholesterol resulted in smaller volumes and lower ejection fractions. Conclusions: Modifiable risk factors are associated with subclinical alterations in structure and function in all four cardiac chambers. BMI and systolic blood pressure are the most important modifiable risk factors affecting CMR parameters known to be linked to adverse outcomes. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular magnetic resonance (CMR) is the gold standard method for the assessment of cardiac structure and function. Reference ranges permit differentiation between normal and pathological states. To date, this study is the largest to provide CMR specific reference ranges for left ventricular, right ventricular, left atrial and right atrial structure and function derived from truly healthy Caucasian adults aged 45-74. Methods: Five thousand sixty-five UK Biobank participants underwent CMR using steady-state free precession imaging at 1.5 Tesla. Manual analysis was performed for all four cardiac chambers. Participants with non-Caucasian ethnicity, known cardiovascular disease and other conditions known to affect cardiac chamber size and function were excluded. Remaining participants formed the healthy reference cohort; reference ranges were calculated and were stratified by gender and age (45-54, 55-64, 65-74). Results: After applying exclusion criteria, 804 (16.²%) participants were available for analysis. Left ventricular (LV) volumes were larger in males compared to females for absolute and indexed values. With advancing age, LV volumes were mostly smaller in both sexes. LV ejection fraction was significantly greater in females compared to males (mean ± standard deviation [SD] of 61 ± 5% vs 58 ± 5%) and remained static with age for both genders. In older age groups, LV mass was lower in men, but remained virtually unchanged in women. LV mass was significantly higher in males compared to females (mean ± SD of 53 ± 9 g/m² vs 4² ± 7 g/m²). Right ventricular (RV) volumes were significantly larger in males compared to females for absolute and indexed values and were smaller with advancing age. RV ejection fraction was higher with increasing age in females only. Left atrial (LA) maximal volume and stroke volume were significantly larger in males compared to females for absolute values but not for indexed values. LA ejection fraction was similar for both sexes. Right atrial (RA) maximal volume was significantly larger in males for both absolute and indexed values, while RA ejection fraction was significantly higher in females. Conclusions: We describe age- and sex-specific reference ranges for the left ventricle, right ventricle and atria in the largest validated normal Caucasian population. [ABSTRACT FROM AUTHOR]

Noncontact optical imaging is frequently used in the inspection and metrology of stationary objects, including in particular the reconstruction of the 3-D surface profile. A technique, known as phase-measuring profilometry, involves projecting a sinusoidal pattern and then inferring the height of various points on the object by measuring the resulting phase changes at the respective locations. However, this method cannot be directly applied to systems involving moving objects, as the translation and the perspective geometry effect manifest as errors in the height calculations. In this paper, we report on an imaging and numerical surface profilometry with error compensation technology (INSPECT) measurement system that is tailored for moving objects. We model the imaging system that considers the nonlinear perspective geometry effect, and simplify to a first-order equation using Taylor series expansion. With this, we generalize the conventional phase shift algorithm, and develop the optimization procedures that can compute the height information effectively. We apply this technology to the INSPECT measurement system in semiconductor manufacturing and show significant improvement in accuracy and robustness. [ABSTRACT FROM PUBLISHER]

Advances in electronic technology have made integrated circuits (ICs) the fundamental components in all electronic devices. To increase their production yield by catching defects as early as possible, we need to perform quality assurance on the semiconductor dies during the assembly and packaging processes. A common approach is to employ machine vision to compare a test die with a "known good die". However, difficulties in ensuring identical imaging conditions (such as illumination) are limitations to this die-to-die comparison approach. Instead, in this work we develop a novel reference-free defect detection algorithm for an IC die by analyzing its image. By identifying intrinsic and extrinsic features of various segments in the image, we implement a classification scheme to identify whether the die is defective or not. We rely on the fact that normal ICs contain regular patterns, and the abnormal and irregular regions are classified as potential areas of defects. Experimental results show that the proposed reference-free defect detection algorithm can detect most of the defects from different types of IC dies, and can also correctly classify normal IC dies as non-defective. These results demonstrate the feasibility of the reference-free defect detection approach. [ABSTRACT FROM AUTHOR]

Coded structured light is an active approach that obtains the shape of object. In our previous work, we proposed a new binary projection mechanism for inspecting semiconductor products. The mechanism consists of only a single light source in combination with a binary grating for projecting binary pattern. By shifting the binary grating in space and in every shifting taking a separate image of the illuminated surface, each position on the illuminated surface is attached with a unique binary string for correspondence. In the mechanism the inspection speed is governed by the number of needed images which also equals to the number of shiftings of the grating. To reduce image number, we propose that two neighbor bits are combined together to produce unique codeword, which is referred to as bit-pairing mechanism. This paper addresses how the spatial shifting of bit-pairing mechanism can be designed optimally for minimizing this number for faster inspection speed. An optimal solution to shifting strategy optimization is proposed that is applicable to any given binary patterns. Theoretical analysis and real image experiments are presented to illustrate the workability of the solutions. [ABSTRACT FROM AUTHOR]