Hoarding disorder: A new obsessive-compulsive related disorder in DSM-5

Obsessive-compulsive disorder (OCD) and related disorders have been the subject of significant revisions in the fifth edition of the Diagnostic and Statistical Manual (DSM-5). One of these major changes has been the removal of OCD from the \u2018Anxi- ety Disorders\u2019 section and its instalment in a new and distinct Obsessive-Compulsive and Related Disorders (OCRDs) chap- ter. However, it is the instatement of Hoarding Disorder (HD) as a new OCRD that marks the most significant change. Previously considered a symptom of OCPD, and subsequently linked to OCD, it is now acknowledged that hoarding can emerge inde- pendently from any alternative condition. The present paper provides an updated review of recent investigations supporting the status of HD as an independent nosological entity. Specifi- cally, we will present the new DSM-5 diagnostic criteria and examine the literature pertaining to the psychopathological and phenomenological aspects of the disorder, with particular atten- tion to practical strategies that can help clinicians to recognise and differentiate HD from OCD. Finally, the available assess- ment and treatment strategies for HD are summarised

Effects of maintenance lithium treatment on serum parathyroid hormone and calcium levels: a retrospective longitudinal naturalistic study

Objective: The aim of this retrospective longitudinal naturalistic study was to evaluate the effects of maintenance lithium treatment on parathyroid hormone (PTH) and calcium levels. Methods: A retrospective longitudinal naturalistic study design was used. Data were collected from the database of a tertiary psychiatric center covering the years 2010\u20132014. Included were bipolar patients who had never been exposed to lithium and had lithium started, and who had PTH, and total and ionized calcium levels available before and during lithium treatment. Paired t-tests were used to analyze changes in PTH and calcium levels. Linear regressions were per- formed, with mean lithium level and duration of lithium exposure as independent variables and change in PTH levels as dependent variable. Results: A total 31 patients were included. The mean duration of lithium treatment was 18.6\ub111.4 months. PTH levels significantly increased during lithium treatment (+13.55\ub114.20 pg/mL); the rate of hyperparathyroidism was 12.9%. Neither total nor ionized calcium increased from baseline to follow-up; none of our patients developed hypercalcemia. Linear regressions analyses did not show an effect of duration of lithium exposure or mean lithium level on PTH levels. Conclusion: Lithium-associated stimulation of parathyroid function is more common than assumed to date. Among parameters to be evaluated prior to lithium implementation, calcium and PTH should be added

Fourientations and the Tutte polynomial

A fourientation of a graph is a choice for each edge of the graph whether to orient that edge in either direction, leave it unoriented, or biorient it. Fixing a total order on the edges and a reference orientation of the graph, we investigate properties of cuts and cycles in fourientations which give trivariate generating functions that are generalized Tutte polynomial evaluations of the form (k + m)[superscript n−1](k + l)[superscript gT](αk + βl + m/k + m , γ k + l + δm/ k + l) for α, γ ∈ {0, 1, 2} and β, δ ∈ {0, 1}. We introduce an intersection lattice of 64 cut–cycle fourientation classes enumerated by generalized Tutte polynomial evaluations of this form. We prove these enumerations using a single deletion–contraction argument and classify axiomatically the set of fourientation classes to which our deletion–contraction argument applies. This work unifies and extends earlier results for fourientations due to Gessel and Sagan (Electron J Combin 3(2):Research Paper 9, 1996), results for partial orientations due to Backman (Adv Appl Math, forthcoming, 2014. arXiv:1408.3962), and Hopkins and Perkinson (Trans Am Math Soc 368(1):709–725, 2016), as well as results for total orientations due to Stanley (Discrete Math 5:171–178, 1973; Higher combinatorics (Proceedings of NATO Advanced Study Institute, Berlin, 1976). NATO Advanced Study Institute series, series C: mathematical and physical sciences, vol 31, Reidel, Dordrecht, pp 51–62, 1977), Las Vergnas (Progress in graph theory (Proceedings, Waterloo silver jubilee conference 1982), Academic Press, New York, pp 367–380, 1984), Greene and Zaslavsky (Trans Am Math Soc 280(1):97–126, 1983), and Gioan (Eur J Combin 28(4):1351–1366, 2007), which were previously unified by Gioan (2007), Bernardi (Electron J Combin 15(1):Research Paper 109, 2008), and Las Vergnas (Tutte polynomial of a morphism of matroids 6. A multi-faceted counting formula for hyperplane regions and acyclic orientations, 2012. arXiv:1205.5424). We conclude by describing how these classes of fourientations relate to geometric, combinatorial, and algebraic objects including bigraphical arrangements, cycle–cocycle reversal systems, graphic Lawrence ideals, Riemann–Roch theory for graphs, zonotopal algebra, and the reliability polynomial. Keywords: Partial graph orientations, Tutte polynomial, Deletion–contraction, Hyperplane arrangements, Cycle–cocycle reversal system, Chip-firing, G-parking functions, Abelian sandpile model, Riemann–Roch theory for graphs, Lawrence ideals, Zonotopal algebra, Reliability polynomialNational Science Foundation (U.S.) (Grant 1122374

Health benefits, costs, and cost-effectiveness of earlier eligibility for adult antiretroviral therapy and expanded treatment coverage: a combined analysis of 12 mathematical models.

BACKGROUND: New WHO guidelines recommend ART initiation for HIV-positive persons with CD4 cell counts ≤500 cells/µL, a higher threshold than was previously recommended. Country decision makers must consider whether to further expand ART eligibility accordingly. METHODS: We used multiple independent mathematical models in four settings-South Africa, Zambia, India, and Vietnam-to evaluate the potential health impact, costs, and cost-effectiveness of different adult ART eligibility criteria under scenarios of current and expanded treatment coverage, with results projected over 20 years. Analyses considered extending eligibility to include individuals with CD4 ≤500 cells/µL or all HIV-positive adults, compared to the previous recommendation of initiation with CD4 ≤350 cells/µL. We assessed costs from a health system perspective, and calculated the incremental cost per DALY averted ($/DALY) to compare competing strategies. Strategies were considered 'very cost-effective' if the$/DALY was less than the country's per capita gross domestic product (GDP; South Africa: $8040, Zambia:$1425, India: $1489, Vietnam:$1407) and 'cost-effective' if $/DALY was less than three times per capita GDP. FINDINGS: In South Africa, the cost per DALY averted of extending ART eligibility to CD4 ≤500 cells/µL ranged from$237 to $1691/DALY compared to 2010 guidelines; in Zambia, expanded eligibility ranged from improving health outcomes while reducing costs (i.e. dominating current guidelines) to$749/DALY. Results were similar in scenarios with substantially expanded treatment access and for expanding eligibility to all HIV-positive adults. Expanding treatment coverage in the general population was therefore found to be cost-effective. In India, eligibility for all HIV-positive persons ranged from $131 to$241/DALY and in Vietnam eligibility for CD4 ≤500 cells/µL cost $290/DALY. In concentrated epidemics, expanded access among key populations was also cost-effective. INTERPRETATION: Earlier ART eligibility is estimated to be very cost-effective in low- and middle-income settings, although these questions should be revisited as further information becomes available. Scaling-up ART should be considered among other high-priority health interventions competing for health budgets. FUNDING: The Bill and Melinda Gates Foundation and World Health Organization

Oral abstracts 1: SpondyloarthropathiesO1. Detecting axial spondyloarthritis amongst primary care back pain referrals

Background: Inflammatory back pain (IBP) is an early feature of ankylosing spondylitis (AS) and its detection offers the prospect of early diagnosis of AS. However, since back pain is very common but only a very small minority of back pain sufferers have ASpA or AS, screening of back pain sufferers for AS is problematic. In early disease radiographs are often normal so that fulfilment of diagnostic criteria for AS is impossible though a diagnosis of axial SpA can be made if MRI evidence of sacroiliitis is present. This pilot study was designed to indicate whether a cost-effective pick up rate for ASpA/early AS could be achieved by identifying adults with IBP stratified on the basis of age. Methods: Patients aged between 18 and 45 years who were referred to a hospital physiotherapy service with back pain of more than 3 months duration were assessed for IBP. All were asked to complete a questionnaire based on the Berlin IBP criteria. Those who fulfilled IBP criteria were also asked to complete a second short questionnaire enquiring about SpA comorbidities, to have a blood test for HLA-B27 and CRP level and to undergo an MRI scan of the sacroiliac joints. This was a limited scan, using STIR, diffusion-weighted, T1 and T2 sequences of the sacroiliac joints to minimize time in the scanner and cost. The study was funded by a research grant from Abbott Laboratories Ltd. Results: 50 sequential patients agreed to participate in the study and completed the IBP questionnaire. Of these 27 (54%) fulfilled criteria for IBP. Of these, 2 patients reported a history of an SpA comorbidity - 1 psoriasis; 1 ulcerative colitis - and 3 reported a family history of an SpA comorbidity - 2 psoriasis; 1 Crohn's disease. 4 were HLA-B27 positive, though results were not available for 7. Two patients had marginally raised CRP levels (6, 10 -NR ≤ 5). 19 agreed to undergo MRI scanning of the sacroiliac joints and lumbar spine; 4 scans were abnormal, showing evidence of bilateral sacroiliitis on STIR sequences. In all cases the changes met ASAS criteria but were limited. Of these 4 patients 3 were HLA-B27 positive but none gave a personal or family history of an SpA-associated comorbidity and all had normal CRP levels. Conclusions: This was a pilot study yielding only limited conclusions. However, it is clear that: Screening of patients referred for physiotherapy for IBP is straightforward, inexpensive and quick. It appears that IBP is more prevalent in young adults than overall population data suggest so that targeting this population may be efficient. IBP questionnaires could be administered routinely during a physiotherapy assessment. HLA-B27 testing in this group of patients with IBP is a suitable screening tool. The sacroiliac joint changes identified were mild and their prognostic significance is not yet clear so that the value of early screening needs further evaluation. Disclosure statement: C.H. received research funding for this study from Abbott. A.K. received research funding for this study, and speaker and consultancy fees, from Abbott. All other authors have declared no conflicts of interes

Characterising within-hospital SARS-CoV-2 transmission events using epidemiological and viral genomic data across two pandemic waves

Hospital outbreaks of COVID19 result in considerable mortality and disruption to healthcare services and yet little is known about transmission within this setting. We characterise within hospital transmission by combining viral genomic and epidemiological data using Bayesian modelling amongst 2181 patients and healthcare workers from a large UK NHS Trust. Transmission events were compared between Wave 1 (1st March to 25th July 2020) and Wave 2 (30th November 2020 to 24th January 2021). We show that staff-to-staff transmissions reduced from 31.6% to 12.9% of all infections. Patient-to-patient transmissions increased from 27.1% to 52.1%. 40%-50% of hospital-onset patient cases resulted in onward transmission compared to 4% of community-acquired cases. Control measures introduced during the pandemic likely reduced transmissions between healthcare workers but were insufficient to prevent increasing numbers of patient-to-patient transmissions. As hospital-acquired cases drive most onward transmission, earlier identification of nosocomial cases will be required to break hospital transmission chains

Establishment and cryptic transmission of Zika virus in Brazil and the Americas

Transmission of Zika virus (ZIKV) in the Americas was first confirmed in May 2015 in northeast Brazil1. Brazil has had the highest number of reported ZIKV cases worldwide (more than 200,000 by 24 December 20162) and the most cases associated with microcephaly and other birth defects (2,366 confirmed by 31 December 20162). Since the initial detection of ZIKV in Brazil, more than 45 countries in the Americas have reported local ZIKV transmission, with 24 of these reporting severe ZIKV-associated disease3. However, the origin and epidemic history of ZIKV in Brazil and the Americas remain poorly understood, despite the value of this information for interpreting observed trends in reported microcephaly. Here we address this issue by generating 54 complete or partial ZIKV genomes, mostly from Brazil, and reporting data generated by a mobile genomics laboratory that travelled across northeast Brazil in 2016. One sequence represents the earliest confirmed ZIKV infection in Brazil. Analyses of viral genomes with ecological and epidemiological data yield an estimate that ZIKV was present in northeast Brazil by February 2014 and is likely to have disseminated from there, nationally and internationally, before the first detection of ZIKV in the Americas. Estimated dates for the international spread of ZIKV from Brazil indicate the duration of pre-detection cryptic transmission in recipient regions. The role of northeast Brazil in the establishment of ZIKV in the Americas is further supported by geographic analysis of ZIKV transmission potential and by estimates of the basic reproduction number of the virus

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