'The risks of playing it safe': a prospective longitudinal study of response to reward in the adolescent offspring of depressed parents

BACKGROUND Alterations in reward processing may represent an early vulnerability factor for the development of depressive disorder. Depression in adults is associated with reward hyposensitivity and diminished reward seeking may also be a feature of depression in children and adolescents. We examined the role of reward responding in predicting depressive symptoms, functional impairment and new-onset depressive disorder over time in the adolescent offspring of depressed parents. In addition, we examined group differences in reward responding between currently depressed adolescents, psychiatric and healthy controls, and also cross-sectional associations between reward responding and measures of positive social/environmental functioning. Method We conducted a 1-year longitudinal study of adolescents at familial risk for depression (n = 197; age range 10-18 years). Reward responding and self-reported social/environmental functioning were assessed at baseline. Clinical interviews determined diagnostic status at baseline and at follow-up. Reports of depressive symptoms and functional impairment were also obtained. RESULTS Low reward seeking predicted depressive symptoms and new-onset depressive disorder at the 1-year follow-up in individuals free from depressive disorder at baseline, independently of baseline depressive symptoms. Reduced reward seeking also predicted functional impairment. Adolescents with current depressive disorder were less reward seeking (i.e. bet less at favourable odds) than adolescents free from psychopathology and those with externalizing disorders. Reward seeking showed positive associations with social and environmental functioning (extra-curricular activities, humour, friendships) and was negatively associated with anhedonia. There were no group differences in impulsivity, decision making or psychomotor slowing. CONCLUSIONS Reward seeking predicts depression severity and onset in adolescents at elevated risk of depression. Adaptive reward responses may be amenable to change through modification of existing preventive psychological interventions

Intracranial Hemorrhage Due to Secondary Hypertension from Intracranial Large Vessel Occlusion

Simultaneous hemorrhagic and ischemic strokes have been previously reported in the literature. Typically, these occur in patients secondary to dialysis, cerebral amyloid angiopathy, or thrombotic thrombocytopenic purpura.1,2,3 However, this is the unique case of a 62-year-old Asian female who presented with a hemorrhagic stroke suspected to be secondary to refractory hypertension from intracranial large vessel atherosclerotic flow limiting stenosis, with rapid subsequent large vessel occlusion and ischemic stroke. Questions arise such as ideal blood pressure parameters for dual management, timeliness of computed tomography angiography imaging in the emergency department for detection of large vessel occlusion during intracranial hemorrhage, and subsequent selection of treatment plan in the dual-lesion patient population

Air conditioning, comfort and energy in india's commercial building sector

Before India's building sector can fulfil its CO2 abatement potential, it is imperative for new build projects, especially those which provide for commercial and public functions, to eschew the energy-intensive designs that characterized western commercial buildings of the 20th century. In the absence of an adaptive thermal comfort standard specifically for India's climatic and cultural context, the current trend is simply to design airconditioned buildings to meet the stringent ASHRAE and ISO "Class A" comfort specifications. This paper proposes a holistic Post Occupancy Evaluation (POE) study of a cross section of Indian office buildings purposively stratified across a range of energy intensities with diverse environmental control systems and design approach in different climatic zones to develop an adaptive thermal comfort standard. By climatically adapting indoor design temperatures, the standard will offer India a low-carbon development pathway for its commercial building sector without compromising overall comfort or productivity

School environment assessment tools to address behavioural risk factors of non-communicable diseases: A scoping review

We aimed to identify, describe and analyse school environment assessment (SEA) tools that address behavioural risk factors (unhealthy diet, physical inactivity, tobacco and alcohol consumption) for non-communicable diseases (NCD). We searched in MEDLINE and Web of Science, hand-searched reference lists and contacted experts. Basic characteristics, measures assessed and measurement properties (validity, reliability, usability) of identified tools were extracted. We narratively synthesized the data and used content analysis to develop a list of measures used in the SEA tools. Twenty-four SEA tools were identified, mostly from developed countries. Out of these, 15 were questionnaire based, 8 were checklists or observation based tools and one tool used a combined checklist/observation based and telephonic questionnaire approach. Only 1 SEA tool had components related to all the four NCD risk factors, 2 SEA tools has assessed three NCD risk factors (diet/nutrition, physical activity, tobacco), 10 SEA tools has assessed two NCD risk factors (diet/nutrition and physical activity) and 11 SEA tools has assessed only one of the NCD risk factor. Several measures were used in the tools to assess the four NCD risk factors, but tobacco and alcohol was sparingly included. Measurement properties were reported for 14 tools. The review provides a comprehensive list of measures used in SEA tools which could be a valuable resource to guide future development of such tools. A valid and reliable SEA tool which could simultaneously evaluate all NCD risk factors, that has been tested in different settings with varying resource availability is needed

A pilot study of change in fracture risk in patients with acute respiratory distress syndrome

INTRODUCTION: Acute skeletal muscle wasting is a major contributor to post critical illness physical impairment. However, the bone response remains uncharacterized. We prospectively investigated the early changes in bone mineral density (BMD) and fracture risk in critical illness. METHODS: Patients were prospectively recruited ≤ 24 hours following intensive care unit (ICU) admission to a University Teaching and a Community Hospital (August 2009 to April 2011).All were aged >18 years and expected to be intubated for >48 hours, spend >7 days in critical care and survive ICU admission. Forty-six patients were studied (55.3% male) with an age of 54.4 years (95% Confidence Interval (CI) 49.1-59.6)years and APACHE II score 23.9 (95%CI 22.4-25.5).Calcaneal Dual X-ray Absorptiometry (DXA) assessment of BMD was performed on day 1 and 10. Increase in fracture risk was calculated from the change in T-score. RESULTS: BMD did not change between day 1 and 10 in the cohort overall (0.434 (95%CI 0.405-0.463) vs. 0.425 g/cm(2) (95%CI 0.399-0.450), p = 0.58).Multivariable logistical regression revealed admission corrected calcium (OR 1.980 (95%CI 1.089-3.609), p = 0.026) and admission PaO2 to FiO2 ratio (OR 0.916 (95%CI 0.833-0.998), p = 0.044)to be associated with >2% loss of BMD. Patients with Acute Respiratory Distress Syndrome had a greater loss in BMD than those without (-2.81 (95%CI -5.73-0.118)%, n = 34 vs. 2.40 (95%CI 0.204-4.586)%,n = 12, p = 0.029). In the 34 patients with Acute Respiratory Distress Syndrome, fracture risk increased by 19.4% (95%CI 13.9-25.0%). CONCLUSIONS: Patients with acute respiratory distress syndrome demonstrated early and rapid bone demineralisation with associated increase in fracture risk

18 Nov 2013 In situ detection of electrified aerosols in the upper troposphere and stratosphere

Electrified aerosols have been observed in the lower troposphere and in the mesosphere, but have never been detected in the stratosphere and upper troposphere. We present measurements of aerosols obtained during a balloon flight to an altitude of 24 km. The measurements were per- formed with an improved version of the Stratospheric and Tropospheric Aerosol Counter (STAC) aerosol counter dedi- cated to the search for charged aerosols. It is found that most of the aerosols are charged in the upper troposphere for altitudes below 10 km and in the stratosphere for altitudes above 20 km. Conversely, the aerosols seem to be uncharged between 10 km and 20 km. Model calculations are used to quantify the electrification of the aerosols with a stratospheric aerosol–ion model. The percentages of charged aerosols obtained with model calculations are in excellent agreement with the observations below 10 km and above 20 km. However, the model cannot reproduce the absence of electrification found in the lower stratosphere, as the processes leading to neutralisation in this altitude range are unknown. The presence of sporadic transient layers of electrified aerosol in the upper troposphere and in the stratosphere could have significant implications for sprite formatio

Synthesis and characterization of ionic block copolymer templated calcium phosphate nanocomposites

Self-assembling thermo-reversibly gelling anionic and zwitterionic pentablock copolymers were used as templates for precipitation of calcium phosphate nanostructures, controlling their size and ordered structural arrangement. Calcium and phosphate ions were dissolved in a block-copolymer micellar dispersion at low temperatures. Aging at ambient temperature produced inorganic nanoparticles, presumably nucleated by ionic interactions. The self-assembled nanocomposites were characterized by small-angle X-ray and neutron scattering (SAXS/SANS), nuclear magnetic resonance (NMR), thermogravimetric analysis (TGA), and transmission electron microscopy (TEM). 1H-31P NMR with 1H spin diffusion from polymer to phosphate proved the formation of nanocomposites, with inorganic particle sizes from ∼2 nm, characterized by 1H-31P dipolar couplings, to \u3e 100 nm. TEM analysis showed polymer micelles surrounded by calcium phosphate. SAXS attested that a significant fraction of the calcium phosphate was templated by the polymer micelles. SANS data indicated that the order of the polymer was enhanced by the inorganic phase. The nanocomposite gels exhibited higher moduli than the neat polymer gels. The calcium phosphate was characterized by TGA, X-ray diffraction, high-resolution TEM, and various NMR techniques. An unusual crystalline phase with \u3e2 chemically and \u3e3 magnetically inequivalent HPO4 2- ions was observed with the zwitterionic copolymer, highlighting the influence of the polymer on the calcium phosphate crystallization. The inorganic fraction of the nanocomposite was around 30 wt % of the dried hydrogel. Thus, a significant fraction of calcium phosphate has been templated by the tailored self-assembling ionic block copolymers, providing a bottom-up approach to nanocomposite synthesis

Evaluation of etoricoxib in patients undergoing total knee replacement surgery in a double-blind, randomized controlled trial.

BACKGROUND: Optimal postoperative pain management is important to ensure patient comfort and early mobilization. METHODS: In this double-blind, placebo- and active-controlled, randomized clinical trial, we evaluated postoperative pain following knee replacement in patients receiving placebo, etoricoxib (90 or 120 mg), or ibuprofen 1800 mg daily for 7 days. Patients \u3e=18 years of age who had pain at rest \u3e=5 (0--10 Numerical Rating Scale [NRS]) after unilateral total knee replacement were randomly assigned to placebo (N = 98), etoricoxib 90 mg (N = 224), etoricoxib 120 mg (N = 230), or ibuprofen 1800 mg (N = 224) postoperatively. Co-primary endpoints included Average Pain Intensity Difference at Rest over Days 1--3 (0- to 10-point NRS) and Average Total Daily Dose of Morphine over Days 1--3. Pain upon movement was evaluated using Average Pain Intensity Difference upon Knee Flexion (0- to 10-point NRS). The primary objective was to demonstrate analgesic superiority for the etoricoxib doses vs. placebo; the secondary objective was to demonstrate that the analgesic effect of the etoricoxib doses was non-inferior to ibuprofen. Adverse experiences (AEs) including opioid-related AEs were evaluated. RESULTS: The least squares (LS) mean (95% CI) differences from placebo for Pain Intensity Difference at Rest over Days 1--3 were -0.54 (-0.95, -0.14); -0.49 (-0.89, -0.08); and -0.45 (-0.85, -0.04) for etoricoxib 90 mg, etoricoxib 120 mg, and ibuprofen, respectively (p \u3c 0.05 for etoricoxib vs. placebo). Differences in LS Geometric Mean Ratio morphine use over Days 1--3 from placebo were 0.66 (0.54, 0.82); 0.69 (0.56, 0.85); and 0.66 (0.53, 0.81) for etoricoxib 90 mg, etoricoxib 120 mg, and ibuprofen, respectively (p \u3c 0.001 for etoricoxib vs. placebo). Differences in LS Mean Pain Intensity upon Knee Flexion were -0.37 (-0.85, 0.11); -0.46 (-0.94, 0.01); and -0.42 (-0.90, 0.06) for etoricoxib 90 mg, etoricoxib 120 mg, and ibuprofen, respectively. Opioid-related AEs occurred in 41.8%, 34.7%, 36.5%, and 36.3% of patients on placebo, etoricoxib 90 mg, etoricoxib 120 mg, and ibuprofen, respectively. CONCLUSIONS: Postoperative use of etoricoxib 90 and 120 mg in patients undergoing total knee replacement is both superior to placebo and non-inferior to ibuprofen in reducing pain at rest and also reduces opioid (morphine) consumption.Clinical trial registration: NCT00820027