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Objective: Cognitive dysfunction is one of the most frequently reported symptoms in post-acute sequelae of COVID-19 (PASC) and has become a common reason for neuropsychological referral. While data are emerging, we aimed to address possible cross-cultural patterns of neuropsychological outcomes that remain underexplored. Methods: In this cross-sectional, retrospective study, we characterize the cognitive performance, demographic makeup, and clinical characteristics of 84 PASC patients (Mage = 57 years) referred for neuropsychological evaluation to three USA sites and one in Germany. Neuropsychological data (mean demographically adjusted z-scores and frequencies of impairment) were examined across six cognitive domains. Independent t-tests compared performances of previously hospitalized and non-hospitalized patients. Results: Patients were assessed on average seven months post-COVID-19 infection. The majority were women and non-hospitalized. Mean cognitive performance was within the normative range, but high variability existed within and between sites. Deficits were generally mild and most frequent in processing speed (range across sites: 9–57% of patients), executive functioning (range across sites: 4–43% of patients) and attention/working memory (range across sites: 0–43% of patients). Hospitalized patients showed greater cognitive impairment than those not requiring hospitalization. Mood symptoms and fatigue/sleep disturbance were more frequent than objective cognitive impairments. At the time of assessment, most patients were unable to return to work. Conclusions: Cognitive performance in clinically referred PASC patients was, overall, within the normative range. Mild deficits were most frequent in time-based attentional/executive tasks. Other factors, such as affective symptoms and fatigue, were frequent and may significantly impact functioning, perhaps more than cognition. Further work with larger samples and longitudinal measures is needed to clarify the impact of COVID-19 on cognitive function and psychiatric distress.

Background Mental health issues are reaching epidemic proportions among our youth. Understanding factors associated with emotional and physical functioning are critical to developing effective interventions and preventive strategies. Despite evidence of the association of cognitive fusion and emotional and physical health among adults, little is known about how this is associated with emotional and physical well-being in emerging adulthood. The purpose of this study was to examine how cognitive fusion is associated with different domains of health after controlling for psychosocial variables. Methods A sample of 353 undergraduate students completed measures on sleep, stress (Perceived Stress Scale- 14), domains of health (Medical Outcomes Study Short Form Survey), the five facets of dispositional mindfulness (Five Facet Mindfulness Scale), social support (Lubben Social Network Scale), and cognitive fusion (Cognitive Fusion Questionnaire). Results Using step-wise hierarchal multiple regression, we examined the variance accounted for by health behaviors and psychosocial variables in various domains of health (emotional, physical, social, general health, fatigue/energy, pain and limitations from physical/emotional functioning). After controlling for psychosocial variables and sleep, cognitive fusion was a significant predictor of six out of eight domains of health. In the domains of physical functioning and general health, facets of mindfulness (nonjudging and awareness, respectively) emerged as significant factors. Conclusions This study suggests that cognitive fusion plays an important role in some areas of health for emerging adults, even more so than other established predictors. Among emerging adults, it appears that thoughts play a key role in well-being and cognitive defusion techniques may be useful to enhance health among this population.

Low-income populations are at a disproportionately high risk for various physical and emotional disorders. One factor that has received little attention in its link to health among low-income groups is dispositional mindfulness. Dispositional mindfulness has been associated with better health in college undergraduate and predominantly higher-income Caucasian samples. Understanding the relationship between dispositional mindfulness and health among low-income populations may be helpful for developing effective programs. Therefore, the purpose of the current study was to assess the relationship between the facets of mindfulness and various health domains in a low-income community sample. Participants were 256 community members (55.9% female) from a small town in Upstate New York, and 51.6% of the sample had a household income of less than $20,000 a year. After informed consent was obtained, participants completed the following questionnaires: The Medical Outcomes Study Short Form Survey, Perceived Stress Scale, Lubben Social Network Scale-Revised, Five Facet Mindfulness Questionnaire, and a demographic and health behavior questionnaire. After controlling for health and psychosocial variables, there was a significant effect of the non-judging and non-reactivity facets of mindfulness on emotional health. The acting with awareness facet of mindfulness was associated with social functioning. However, dispositional mindfulness was not associated with physical health. Dispositional mindfulness plays a significant role in emotional health and social functioning among low-income adults. Mindfulness-based programs may be beneficial for this demographic if focused on the enhancement of non-judgment, non-reactivity, and acting with awareness.

The World of Berossos. Edited by Johannes Haubold; Giovanni B. LanfranchI; Robert Rollinger; and John Steele. Classica et Orientalia, vol. 5. Wiesbaden: Harrassowitz Verlag, 2013. Pp. 332. €58.

Ctesias’ World. Classica et Orientalia, vol. 1. Edited by Josef Wieshöfer; Robert Rollinger; and Giovanni Lanfranchi. Wiesbaden: Harrassowitz Verlag, 2011. Pp. 546, illus. €88.

Die Sicht auf die Welt zwischen Ost und West (750 v. Chr.–550 n. Chr.). Edited by Robert Rollinger. Classica et Orientalia, vol. 12. Wiesbaden: Harrassowitz Verlag, 2017. Pp. x + 231 + 119, map in pocket. €79.

This article traces the history of Greek and Roman views about Nubia from the end of the Bronze Age to Late Antiquity. Throughout this period, knowledge of Nubia was mediated through Egypt. As a result, it is clear that knowledge of the geography and ethnography of Nubia fluctuated with the extent of involvement in Egypt, expanding in the 5th century bce, again in the 3rd century bce and finally in the late 1st century bce, periods when contact between Nubia and Egypt were most intense. Although none of the ancient accounts of Nubia are extant in their original form except for the Histories of Herodotus, much of their content survives in the form of excurses in general histories and geographies and encyclopedias like those of Diodorus, Strabo, and Pliny the Elder that are important sources for the history of ancient Nubia and its peoples.

BackgroundThreshold and subthreshold forms of generalized anxiety disorder (GAD) are highly prevalent and impairing conditions among adults. However, there are few general population studies that have examined these conditions during the early life course. The primary objectives of this study were to: (1) examine the prevalence, and sociodemographic and clinical characteristics of threshold and subthreshold forms of GAD in a nationally representative sample of US youth; and (2) test differences in sociodemographic and clinical characteristics between threshold and subthreshold forms of the disorder.MethodThe National Comorbidity Survey-Adolescent Supplement is a nationally representative face-to-face survey of 10 123 adolescents 13 to 18 years of age in the continental USA.ResultsApproximately 3% of adolescents met criteria for threshold GAD. Reducing the required duration from 6 months to 3 months resulted in a 65.7% increase in prevalence (5.0%); further relaxing the uncontrollability criterion led to an additional 20.7% increase in prevalence (6.1%). Adolescents with all forms of GAD displayed a recurrent clinical course marked by substantial impairment and co-morbidity with other psychiatric disorders. There were few significant differences in sociodemographic and clinical characteristics between threshold and subthreshold cases of GAD. Results also revealed age-related differences in the associated symptoms and clinical course of GAD.ConclusionsFindings demonstrate the clinical significance of subthreshold forms of GAD among adolescent youth, highlighting the continuous nature of the GAD construct. Age-related differences in the associated symptoms and clinical course of GAD provide further support for criteria that capture variation in clinical features across development.

Background Long-term outcome after bifurcation stenting with drug-eluting stents (DES) for obstructive coronary artery disease is poorly understood. In this study, we report 6–9-month angiographic follow-up and long-term clinical outcomes after implantation of drug-eluting stents by crush and kissing stent technique for coronary bifurcation lesions. Methods Consecutive patients undergoing bifurcation stenting with DES by crush or kissing stent technique were enrolled in a prospective registry. Angiographic follow-up was obtained at 6–9 months and clinical follow-up completed for a median of 38 months. Results A total of 86 patients participated in the study. Bifurcation stenting by crush technique was performed in 73 (85%) and by kissing stent in 13 (15%) patients. Stenting of left main bifurcation was applied in 24 (28%) patients. Angiographic follow-up was completed in 75 (87%) patients and showed restenosis in the main for 8 (11%) and side branch for 20 (27%) patients. Clinical follow-up was available for a median duration of 38 months. During follow-up, 2 (2%) patients died, 4 (5%) experienced myocardial infarction (MI), and 11 (13%) underwent target vessel revascularization (TVR) with an overall major adverse cardiac event (MACE) rate of 16%. In left main cohort, angiographic restenosis occurred in 9 (37%) patients, and 3 (12%) patients required TVR. There were no deaths or stent thrombosis. A comparison of crush and kissing stent technique showed significantly higher angiographic restenosis with crush (26% vs 13% in kissing stent patients, P = 0.046) and 95% of restenosis in crush group involved ostium of the side branch. There was no difference in clinical outcomes between the crush and kissing stent groups. Final kissing balloon dilatation (FKB) was successful in 65 (89%) patients in the crush group and associated with a significant reduction in MACE (8% in FKB successful vs 37% in FKB unsuccessful, P = 0.04) during follow-up. Conclusion Bifurcation stenting with crush or kissing stent technique is safe and associated with a low rate of TLR and MACE on long-term follow-up. Crush stenting is associated with a significantly higher rate of side branch restenosis compared to kissing stent technique. FKB is associated with significant reduction in MACE during follow-up. (J Interven Cardiol 2013;26:145–152)

Stanley M. Burstein and Caleb E. Finch reveal how a work by classical physician Galen pioneered the idea of the ‘healthspan’. Stanley M. Burstein and Caleb E. Finch reveal how a work by classical physician Galen pioneered the idea of the ‘healthspan’.

The Nubian encounter with Greek language began in the third century b.c.e. and lasted until the fi fteenth century c.e. During the Hellenistic and Roman periods, Nubian interest in Greek was pragmatic, since the Greek language was used primarily as a diplomatic tool for dealing with Greco-Roman Egypt. During the Middle Ages, however, Greek became integral to Nubian culture as the language of government and Nubian Christianity. This article traces the history of Greek language in Nubia and analyzes its changing function in ancient and medieval Nubian culture.

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For almost two hundred years Nubian Studies was treated as a sub-discipline of Egyptology. Not surpisingingly, histories of Kush written in this tradition were strongly Egyptocentric in their emphases. During the last quarter of a century, however, Nubian Studies has emerged as a distinct discipline in its own right. The three books reviewed in this article reflect this transformation.

The radial artery is commonly used as a conduit in coronary artery bypass grafting. No data exist on the effects of radial sheath insertion on radial artery function. Because many patients considered for coronary artery bypass grafting have had previous radial procedures, it is important to understand any effects radial sheath insertion may have on radial artery function. Twenty-two patients who underwent elective coronary angiography or angioplasty with a 6Fr sheath through the right radial artery were studied. Radial artery function was assessed using ultrasound to measure flow-mediated dilation (FMD). Reactive hyperemia was produced by 5-minute cuff inflation on the arm to suprasystolic pressures. Radial artery diameter was measured at rest and 1 minute after cuff deflation. FMD was expressed as percent change in radial diameter compared with at rest. In all cases, the left radial artery was studied as a control. Patients were studied before sheath insertion, immediately after sheath insertion, and 6 weeks after sheath insertion. The FMD of the cannulated arm was 13.2% before sheath insertion versus 3.6% immediately after sheath insertion (p

According to Procopius, Roman rule in Lower Nubia ended in 298 AD when Diocletian redeployed the Roman garrisons in the region to Philae. Recent scholarship, however, increasingly maintains that effective Roman audiority in the Dodecaschoenus ended in the third quarter of the third century AD and that Diocletian was only officially recognizing this reality. CIL 3.141483 indicates that Procopius’ account is correct.

Understanding the cellular and molecular events that regulate the formation of enamel is a major driving force in efforts to characterize critical events during amelogenesis. It is anticipated that through such an understanding, improvements in prevention, diagnosis and treatment-intervention into heritable and acquired diseases of enamel could be achieved. While knowledge of the precise role of an enamel-specific protein in directing the formation of inorganic crystallites remains refractory, progress has been made with other aspects of amelogenesis that can be brought to bear on the subject. One such area of progress has been with the identification of an ameloblast-lineage specific amelogenin gene promoter. This promoter can be used to direct the expression of enamel-specific proteins, as well as the expression of proteins foreign to amelogenesis, into the enamel extracellular matrix where their effect on biomineralization can be ascertained in a prospective manner. The resulting enamel from such animals can be examined by morphologic and biochemical modalities in order to identify the effect of the transgene protein on enamel crystallite formation and subsequent biomineralization. This manuscript outlines such a strategy with the potential for enhancing our understanding of amelogenesis.

Certain cutaneous lesions serve as both precursors of skin cancer and markers for increased risk. The solar or actinic keratosis serves such a role for the nonmelanoma (NMSC) forms of skin cancer (basal cell carcinoma and squamous cell carcinoma). Clinically, these keratoses manifest as rough, scaly, erythematous patches on chronically sun-exposed surfaces. Conversion to squamous cell carcinoma in an individual lesion is uncommon and has been estimated at 1 per 1000 per year. Individuals with actinic keratoses have had sufficient chronic photodamage to produce skin cancer, and regular surveillance is recommended. The second precursor for invasive NMSC is Bowen's disease (squamous cell carcinoma in situ). Invasion of the dermis results in frank squamous cell carcinoma. Some types of viral warts may develop into squamous cell carcinoma. The most important precursor/marker for melanoma is the clinically atypical mole (CAM) or dysplastic nevus. CAMs occur in 5-10% of the U.S. population. CAMs, under photographic follow-up, have been observed to evolve into cutaneous melanoma. The frequency of conversion to melanoma of any single CAM is quite low; however, in melanoma-prone families, prospectively diagnosed melanomas arise in association with a histopathologically observed dysplastic nevus in more than 80% of the cases. Giant congenital melanocytic nevi have an approximately 6% lifetime risk of melanoma development. The risk associated with small congenital nevi is uncertain. Lentigo maligna develop into invasive melanoma with a frequency reported in the literature ranging from 5-50%.

The purpose of this review is to enhance the clinical awareness of the association between membranous glomerulonephritis and neoplasia. Controversy has persisted that has tended to minimize this association, therefore, we report our experience to shed some light on this controversy as well as to make diagnostic recommendations. One hundred seven adult patients with biopsy-proven membranous glomerulonephritis were selected for review. Twenty of these patients had a known secondary cause of membranous glomerulonephritis other than malignancy. Data were collected retrospectively on all these patients and nine were found who had or developed malignancy associated with membranous glomerulonephritis. Clinical data were analyzed to ascertain the onset of renal disease in relation to the malignancy as well as to determine the ultimate patient and renal outcome after treatment of the neoplasm. Of the 87 patients with presumed idiopathic membranous glomerulonephritis, nine (10.3%) had or developed a malignancy associated with their renal disease. The membranous glomerulonephritis was seen in patients with various solid tumors as well as hematologic malignancies. All patients presented with nephrotic-range proteinuria. Proteinuria manifested itself prior to or concomitantly with the diagnosis of the neoplasm in approximately 80% of cases. Follow-up data were available on seven patients: complete remission of proteinuria was seen in two patients associated with treatment of their tumors, one patient developed end-stage renal disease, and the remaining four patients had persistent proteinuria associated with tumor recurrence or metastasis. There appears to be a clear association between membranous glomerulonephritis and neoplasia. We feel that the practicing internist and nephrologist should be cognizant of this relationship and that a search for malignancy is warranted in all adult patients presenting with membranous glomerulonephritis.