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Major depressive disorder (MDD) is a leading cause of disability worldwide. One of the most efficacious treatments for treatment-resistant MDD is electroconvulsive therapy (ECT). Recently, magnetic seizure therapy (MST) was developed as an alternative to ECT due to its more favorable side effect profile. While these approaches have been very successful clinically, the neural mechanisms underlying their therapeutic effects are unknown. For example, clinical “slowing” of the electroencephalogram has been observed in both treatment modalities. A recent longitudinal study of a small cohort of ECT patients revealed that observed clinical slowing was better explained by increases in frontal aperiodic activity, an emerging EEG signal linked to neural inhibition. Here we investigate the role of aperiodic activity in a cohort of patients who received ECT and a cohort of patients who received MST treatment. We find that across treatments, frontal aperiodic activity better explains increases in delta band power associated with clinical slowing, compared to delta oscillations. Increased aperiodic activity is also linked to therapeutic efficacy, which is suggestive of a potential shared neural mechanism of action across ECT and MST: an increase in frontal inhibitory activity.

(1) Background: The COVID-19 pandemic has put essential workers at high risk for contracting the disease. This study documents situational compliance with public health recommendations such as masking and social distancing among rural and urban Latinx families, with the goal of understanding change over time in COVID-19 risk reduction behaviors. (2) Methods: Respondents for 67 rural families and 44 urban families responded to repeated telephone surveys at three time points in the first year of the pandemic, providing data on use of masks and social distancing by themselves and family members while interacting with others at home, work, and in the community. Cumulative logistic regression models were employed to compare changes in risk behaviors between rural and urban groups over time. (3) Results: While group descriptive results indicated behaviors that posed low risk at each time point, regression models revealed greater change between time points for rural than urban residents. Rural residents also had gendered patterns. (4) Conclusions: Patterns of change appear to reflect structural issues such as seasonal labor demand and gender roles more than pandemic fatigue or changing public health recommendations. The findings suggest that structural factors play a role in individuals complying with public health prevention measures for COVID-19.

Background Mental health among low-income Latinx women in the United States (US), including those in farmworker families, is a health equity concern. This analysis (1) describes the depressive symptoms among Latinx women in rural farmworker families and urban non-farmworker families and (2) delineates immigration and acculturation, family composition and disruption, and financial characteristics associated with depressive symptoms experienced by these women. Methods Data are from a 2019–2020 cross-sectional survey of 66 rural farmworker and 52 urban non-farmworker women with a child participating in a study of pesticide exposure and neurocognitive development. Depressive symptoms were measured with the CES-D Short Form. Results The median (25th–75th percentiles) depressive symptom score reported was 2.0 (1.0–4.0), with 10 (8.5%) women having depressive symptom scores of 10 or greater. In bivariate analysis, among immigration and acculturation characteristics, women born in the USA and who spoke English fluently had lower depressive symptom scores. Among family composition and disruption characteristics, married women, and those with two adults in the household had lower depressive symptom scores. No financial status characteristic had statistically significant associations with depressive symptom score. In multivariate analysis, rural farmworker women had an expected median score one point lower than did urban non-farmworker women. Conclusion Addressing mental health among immigrant women, particularly those in farmworker families, is a complex undertaking. Rural versus urban locality provides a context for mental health. Determining the proximal determinants of locality requires further analysis.

Electroconvulsive therapy (ECT) is one of the most efficacious interventions for treatment-resistant depression. Despite its efficacy, ECT’s neural mechanism of action remains unknown. Although ECT has been associated with “slowing” in the electroencephalogram (EEG), how this change relates to clinical improvement is unresolved. Until now, increases in slow-frequency power have been assumed to indicate increases in slow oscillations, without considering the contribution of aperiodic activity, a process with a different physiological mechanism. Here we show that aperiodic activity, indexed by the aperiodic exponent, increases with ECT treatment. This increase better explains EEG “slowing” when compared to power in oscillatory peaks in the delta (1-3 Hz) range, and is correlated to clinical improvement. In accordance with computational models of excitation-inhibition balance, these increases in aperiodic exponent are linked to increasing levels of inhibitory activity, indicating that ECT might ameliorate depressive symptoms by restoring healthy levels of inhibition in frontal cortices.

The occupational health of immigrant workers in the United States is a major concern. This analysis describes two domains, organization of work and work safety culture, important to the occupational health of Latinx women in farmworker families. Sixty-seven Latinx women in North Carolina farmworker families completed a baseline and five follow-up questionnaires in 2019 through 2021. Fifty-nine of the women were employed in the year prior to the Follow-Up 5 Questionnaire. These women experienced an abysmal organization of work and work safety culture. They experienced significant job churn, with most changing employment several times during the 18-month period. Most of their jobs were seasonal, paid less than $10.00 per hour, piece-rate, and almost all without benefits. The women’s jobs had little skill variety (mean 1.5) or decision latitude (mean 1.1), but had high psychological demands (mean 2.0). Work safety climate was very low (mean 13.7), with 76.3% of women noting that their supervisors were “only interested in doing the job fast and cheaply” rather than safely. Women employed as farmworkers versus those in other jobs had few differences. Further research and intervention are needed on the organization of work and work safety culture of Latinx women manual workers.

NEW FINDINGS What is the central question of this study? Vascular compliance importantly contributes to the regulation of cerebral perfusion and complex mechanisms are known to influence compliance of a vascular bed: while vasodilatation mediates changes in vascular resistance, does it also affect compliance, particularly in the cerebral vasculature? What is the main finding and its importance? Cerebral vasodilatation, elicited by hypercapnia and sodium nitroglycerin administration, reduced cerebrovascular compliance by approximately 26% from baseline. This study provides new insight into mechanisms mediating cerebrovascular compliance. ABSTRACT Changes in vascular resistance and vascular compliance contribute to the regulation of cerebral perfusion. While changes in vascular resistance are known to be mediated by vasodilatation, the mechanisms contributing to changes in vascular compliance are complex. In particular, whether vasodilatation affects compliance of the vasculature within the cranium remains unknown. Therefore, the present study examined the impact of two vasodilatation pathways on cerebrovascular compliance in humans. Fifteen young, healthy adults (26 ± 5 years, seven females) completed two protocols: (i) sublingual sodium nitroglycerin (SNG; 0.4 mg) and (ii) hypercapnia (5-6% carbon dioxide gas mixture for 4 min). Blood pressure waveforms (finger photoplethysmography) and middle cerebral artery blood velocity waveforms (transcranial Doppler ultrasound) were input into a modified Windkessel model and an index of cerebrovascular compliance (Ci) was calculated. During the SNG protocol, Ci decreased 24 ± 17% from baseline ((5.0 ± 2.3) × 10-4 cm s-1 mmHg-1 ) to minute 10 ((3.6 ± 1.2) × 10-4 cm s-1 mmHg-1 ; P = 0.009). During the hypercapnia protocol, Ci decreased 28 ± 9% from baseline ((4.4 ± 1.9) × 10-4 cm s-1 mmHg-1 ) to minute 4 ((3.1 ± 1.4) × 10-4 cm s-1 mmHg-1 ; P

Lithium is commonly used for the treatment of mood disorders and possesses a narrow therapeutic index. A medication utilization evaluation performed regarding its use at an academic medical center found that only 89.9% of patients received a lithium level within 24 hours of admission. This review prompted development of the evaluated protocol.To compare pharmacist- and provider-managed safety and biochemical monitoring outcomes in a medical and psychiatric hospital population.A retrospective chart review was conducted to identify hospitalized medical or psychiatric patients who received lithium therapy during a 6-month period. Patients were excluded if younger than 16 years or if lithium therapy was ordered but never administered. For cohort comparisons, descriptive statistics were used for baseline characteristics, and chi-square test or t test was used for outcomes.Pharmacists managed 67 patients versus 63 provider-managed patients. Pharmacist-managed patients were more likely to receive a lithium level within 24 hours of admission (100% vs. 89.1%, P = 0.012); receive a pregnancy test if indicated (90.5% vs. 41.7%, P 0.001); have an identified drug interaction affecting lithium levels (47.8% vs. 27%, P = 0.014); and receive pharmacy-provided education (71.6% vs. 34.9%, P0.001).Patients initiated or maintained on lithium therapy require a unique level of management within the inpatient realm. The addition of lithium management to existing pharmacy services creates the opportunity to deliver safer and more complete patient care while expanding practice offerings for clinical pharmacists.

A one-pot three-component tandem reaction involving a key Pictet-Spengler-like annulation step has been developed, providing an efficient method for the synthesis of 3,4-dihydroquinazolines in moderate to good yields from amides, aldehydes, and amines. The multicomponent triflic anhydride mediated reaction tolerates the installation of numerous functional groups, affording extensive diversity about the heterocyclic scaffold.

Purpose: We have observed that students’ performance in our PreClerkship curriculum does not align well with their USMLE STEP1 scores. Students at-risk of failing or underperforming on STEP1 have often excelled in our institutional assessments. We sought to test the validity and reliability of our course-assessments in predicting STEP1 scores, and in the process generate and validate a more accurate prediction model for STEP1 performance.Methods: Student pre-matriculation and course assessment data of the Class of 2020 (n = 76) is used to generate a stepwise STEP1 prediction model, which is tested with the students of the Class of 2021 (n = 71). Predictions are generated for the end of each course in the programing language R. For the Class of 2021, predicted STEP1 score is correlated with their actual STEP1 scores and data-agreement is tested with means-difference plots. A similar model is generated and tested for the Class of 2022.Results: STEP1 predictions based pre-matriculation data are unreliable and fail to identify at-risk students (R2 = 0.02). STEP1 predictions for most year 1 courses (anatomy, biochemistry, physiology) correlate poorly with students’ actual STEP1 scores (R2 = 0.30). STEP1 predictions improve for year 2 courses (microbiology, pathology and pharmacology), but reliable predictions are based on truly integrated courses with customized NBMEs as comprehensive exams (0.66). Predictions based on these NBMEs and integrated courses are reproducible for the Class of 2022.Conclusion: MCAT and undergraduate GPA are poor predictors of students’ STEP1 scores. Partially integrated courses with biweekly assessments do not promote problem-solving skills and leave students’ at-risk of failing STEP1. Only truly integrated courses with comprehensive assessments are reliable indicators of students STEP1 preparation.

Postconcussion syndrome (PCS) remains one of the most challenging neuropsychiatric illnesses to evaluate and address clinically. Despite the fact that mild traumatic brain injury (or concussion) accounts for 75% of all head injuries, and that approximately 20% of patients will report a variety of symptoms lasting for months to years (sometimes indefinitely), our understanding of PCS is still evolving and there are few evidence-based treatment options for this condition. PCS involves a cluster of symptoms that are highly variable, not only in populations of patients with PCS, but also with regard to a person's presentation over time. Common symptoms include headache, dizziness, tinnitus, light and noise sensitivity, memory deficits, movement disorders, sleep disturbances, and cognitive impairment, as well as depression, anxiety, and other neuropsychiatric symptoms. This article reviews the latest understanding of the epidemiology, pathophysiology, and risk factors associated with PCS. Possible symptoms, potential short- and long-term comorbidities, PCS diagnostic criteria, and the evaluation of athletes suspected of concussive injury are also reviewed. [ Psychiatr Ann . 2017;47(2):77–82.]

Breath-hold divers (BHD) experience repeated bouts of severe hypoxia and hypercapnia with large increases in blood pressure. However, the impact of long-term breath-hold diving on cerebrovascular control remains poorly understood. The ability of cerebral blood vessels to respond rapidly to changes in blood pressure represents the property of dynamic autoregulation. The current investigation tested the hypothesis that breath-hold diving impairs dynamic autoregulation to a transient hypotensive stimulus. Seventeen BHD (3 women, 11 ± 9 yr of diving) and 15 healthy controls (2 women) completed two or three repeated sit-to-stand trials during spontaneous breathing and poikilocapnic conditions. Heart rate (HR), finger arterial blood pressure (BP), and cerebral blood flow velocity (BFV) from the right middle cerebral artery were measured continuously with three-lead electrocardiography, finger photoplethysmography, and transcranial Doppler ultrasonography, respectively. End-tidal carbon dioxide partial pressure was measured with a gas analyzer. Offline, an index of cerebrovascular resistance (CVRi) was calculated as the quotient of mean BP and BFV. The rate of the drop in CVRi relative to the change in BP provided the rate of regulation [RoR; (∆CVRi/∆T)/∆BP]. The BHD demonstrated slower RoR than controls ( P ≤ 0.001, d = 1.4). Underlying the reduced RoR in BHD was a longer time to reach nadir CVRi compared with controls ( P = 0.004, d = 1.1). In concert with the longer CVRi response, the time to reach peak BFV following standing was longer in BHD than controls ( P = 0.01, d = 0.9). The data suggest impaired dynamic autoregulatory mechanisms to hypotension in BHD. NEW & NOTEWORTHY Impairments in dynamic cerebral autoregulation to hypotension are associated with breath-hold diving. Although weakened autoregulation was observed acutely in this group during apneic stress, we are the first to report on chronic adaptations in cerebral autoregulation. Impaired vasomotor responses underlie the reduced rate of regulation, wherein breath-hold divers demonstrate a prolonged dilatory response to transient hypotension. The slower cerebral vasodilation produces a longer perturbation in cerebral blood flow velocity, increasing the risk of cerebral ischemia.

Gordonia phages BaxterFox, Kita, Nymphadora, and Yeezy are newly characterized phages of Gordonia terrae , isolated from soil samples in Pittsburgh, Pennsylvania. These phages have genome lengths between 50,346 and 53,717 bp, and encode on average 84 predicted proteins. All have G+C content of 66.6%.

Through a holistic health lens, the current study examines the effects of weight-related issues and stress on suicidality while controlling for depressive symptoms in college students.In total, 872 undergraduate and graduate students at DePaul University completed the American College Health Association-National College Health Assessment II Web-based survey in Spring 2010.Measures of suicidality, depression, weight-related issues, and life stressors were assessed, along with gender differences.Females reported experiencing more weight loss attempts and total stressors than males. Weight-related issues and stress both significantly predicted depressive symptoms in a path analysis; depressive symptoms, in turn, significantly predicted suicidality. Gender differences were found; depressive symptoms mediate the relation between stress and suicidal behavior for females but not for males.This investigation furthers previous research on suicidality in college students and suggests that all-inclusive interventions that address weight-related issues and stress may help reduce depressive symptoms, which then may reduce suicidal behavior.

Youth are faced with many stressful interpersonal, contextual, and identify development related challenges that contribute to the increased risk of negative outcomes during adolescence. The current study examined two important factors related to youth’s development and well-being: parent–child attachment and negative body image. Specifically, the current study examined body image as one mechanism responsible for the effect that mother and father attachment has on internalizing symptoms in a sample of low-income, ethnic minority youth. Additionally, differences across gender and ethnic/racial groups were examined. Participants included 140 (71 % female) ages 10–16 at baseline recruited from urban public schools in Chicago with high percentages of low-income students. The current sample was ethnically diverse (41 % African American, 30 % Latino, 16 % European American, 6 % Biracial, 6 % Asian, and 1 % other). Participants completed measures of their relationships with their mothers and fathers, negative body image, and internalizing symptoms across two periods of time separated by approximately 1 year. Results showed that body image mediated the relation between both mother and father attachment and internalizing symptoms. These results were further moderated by race/ethnicity, but not by sex. For African American participants, mother attachment was related to internalizing symptoms through negative body image while for Latinos, paternal attachment was related to internalizing symptoms through negative body image. Although maternal attachment had direct effects on internalizing symptoms for Latinos, negative body image did not mediate this relationship. These results support an integrative model in which interpersonal risk lays the foundation for the development of cognitive risk, which in turn leads to internalizing symptoms for urban youth.

The relation between light absorption rate and crop growth rate may be deduced from the kinetics of net photosynthesis showing that for a crop, such as winter wheat, growing from winter to summer this relation must be S-shaped. Altering the soil-solution nutrient level changes, in an opposite sense, the root:shoot ratio, thereby changing light interception. Destruction of live roots by soil organisms by increasing root growth enhances the long-life organic content of the soil. The relation between growth of the plant and the growth of seeds or tubers on the plant is determined by their relative competitive strengths for attracting nutrients.

Although adherence to guidelines recommendations is assumed to be more difficult for nonacademic community hospitals, patterns of adherence have not been evaluated by hospital type. We sought to identify hospital characteristics associated with high levels of adherence in order to gain insight into successful processes of care.From January 2001 through March 2004, we analyzed data from 86,042 patients in the CRUSADE Initiative with high-risk non-ST-segment elevation acute coronary syndromes (NSTE ACS) defined by positive cardiac markers or ischemic ST-segment changes. Academic sites were defined by Council of Teaching Hospital affiliation in the American Hospital Association database. Adherence was determined for each hospital based on guidelines recommendations for the use of 4 acute (24 hrs) and 5 discharge therapies in patients without contraindications. Multivariable modeling was used to standardize hospital estimates for patient characteristics and control for clustering within centers.A total of 60,285 patients were admitted to nonacademic hospitals (n=355), and 25,757 were admitted to academic hospitals (n=125). Academic hospitals were larger (median 500 vs 268 beds, P.001) and more often had bypass services (88% vs 60%, P.001). Composite adherence to recommended therapies was slightly higher at academic vs. nonacademic hospitals (median 77.8% vs 73.7%, P0.01), and variance in individual hospital performance was greater among nonacademic sites. Nonacademic hospitals accounted for 15 of the 20 highest performing sites and 19 of the 20 lowest performing sites. In-hospital clinical outcomes, including cardiogenic shock, stroke, and death were similar for patients admitted to both types of hospital.Adherence to American College of Cardiology and American Heart Association (ACC/AHA) guidelines for NSTE ACS care at academic hospitals is slightly higher than at nonacademic hospitals; however there is significant room for improvement within both systems. The larger performance variation in care among nonacademic hospitals highlights the need for continued emphasis on consistent care processes.

The most elementary form of a switch network consists of a single square switch, where connection can be made between any one inlet and any one outlet by connecting the associated horizontal and vertical circuits at the point where they cross (i.e., the “crosspoint”). However, to provide a switching system capable of serving say 10,000 subscribers, it would not be economical either to construct a single large switch or to simply gang a large number of smaller switches to form a square matrix of 10,000 × 10,000 crosspoints. A more practical arrangement is to connect the switches in two or more stages.

The adrenals of heat stressed ducks exposed to a constant temperature of 29.4 C for 45 to 46 days showed an increase in relative weight and cholesterol concentration, but the corticosterone concentration remained at control levels.

Summary Hypomobility of the temporomandibular joint has a variety of causes. Two patients are presented in whom restricted jaw movement was the only clinical manifestation of serious underlying disease. The importance of submitting all tissues removed from patients for histopathological diagnosis is stressed.

A case of chronic osteomyelitis with proliferative periostitis of the mandible is reported. This is a unique form of osteomyelitis characterized radiographically by localized thickening of the periosteum and deposition of laminated subperiosteal bone.

A case report of a patient with faciocervical emphysema following an undisplaced fractured zygoma is presented. The aetiology, consequences and radiographic appearance are discussed.

Publisher Summary High metal content catalysts—such as steam reforming, water gas shift, and methanation—are frequently prepared by using precipitation from aqueous solution as a key stage in forming a high area well dispersed metal plus support structure. This chapter presents an analysis of the most important factors that determine this structure with particular reference to the copper, nickel, and iron-based catalysts used in substitute natural gas (SNG) and ammonia production. The chief feature of good industrial catalysts in this field is not so much that they catalyze the correct reactions with adequate degree of selectivity but rather that they have high activity and long life. The chapter discusses the essential quantitative effects of the various stages in catalyst preparation on the metal surface area and strength of the catalyst in use. In addition to high stabilized metal surface area and mechanical strength, the reduced catalyst must have adequate porosity to enable diffusional access for the reagents and egress for the products.

The calcifying odontogenic cyst is unusual in that it is frequently found in conjunction with the histologic features of a variety of other odontogenic conditions. Two cases are reported, one of which contained areas histologically similar to the ameloblastic fibro-odontome and also showed condensations of cells in the stroma beneath epithelial strands proliferating from the cyst lining. In both cases the “ghost cells” stained strongly for disulphide groups but only occasional areas were positive for sulphydryl groups. No amyloid or “amyloid-like” material was detected. As no part of the current name is specific to this lesion it is suggested that the nomenclature should be changed – perhaps to “ghost cell cyst”.

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