The identification and psychological treatment of panic disorder in adolescents: a survey of CAMHS clinicians

Background Panic disorder is experienced by around 1% of adolescents, and has a significant impact on social and academic functioning. Preliminary evidence supports the effectiveness of panic disorder specific treatment in adolescents with panic disorder, however panic disorder may be overlooked in adolescents due to overlapping symptoms with other anxiety disorders and other difficulties being more noticeable to others. The aim of this study was to establish what training National Health Service (NHS) Child and Adolescent Mental Health Services (CAMHS) clinicians have received in psychological therapies and panic disorder and how they identify and treat panic disorder in adolescents. Method CAMHS clinicians from a range of professions (n = 427), who were delivering psychological treatments to children and adolescents with anxiety disorders, participated. They completed a cross-sectional, online survey, including a vignette describing an adolescent with panic disorder, and were asked to identify the main diagnosis or presenting problem. Results Less than half the clinicians (48.6%) identified panic disorder or panic symptoms as the main presenting problem from the vignette. The majority of clinicians suggested CBT would be their treatment approach. However, few identified an evidence-based treatment protocol for working with young people with panic disorder. Almost half the sample had received no training in cognitive behaviour therapy (CBT) and around a fifth had received no training in delivering psychological treatments. Conclusions Only half of CAMHS clinicians identified panic disorder from a vignette and although CBT treatments are widely offered, only a minority of adolescents with panic disorder are receiving treatments developed for, and evaluated with young people with panic disorder. There is a vital need for clinician training, the use of tools that aid identification and the implementation of evidence-based treatments within CAMHS

Melanoma in congenital melanocytic naevi

Congenital melanocytic naevi (CMN) are a known risk factor for melanoma, with the greatest risk currently thought to be in childhood. There has been controversy over the years about the incidence, and therefore over clinical management of CMN, due partly to the difficulties of histological diagnosis and partly to publishing bias towards cases of malignancy. Large cohort studies have demonstrated that risk in childhood is related to the severity of the congenital phenotype, not only cutaneous but neuroradiological. New understanding of the genetics of CMN offers the possibility of improvement in diagnosis of melanoma, identification of those at highest risk, and new treatment options. We review the world literature and our centre's experience over the last 25 years, including the molecular characteristics of melanoma in these patients and new melanoma incidence and outcome data from our prospective cohort. Management strategies are proposed for presentation of suspected melanoma of the skin and the CNS in patients with CMN, including use of oral MEK inhibitors in NRAS-mutated tumours. This article is protected by copyright. All rights reserved

Surveillance imaging of grade 1 astrocytomas in children: can duration and frequency of follow-up imaging and the use of contrast agents be reduced?

Purpose: The optimum strategy for the surveillance of low-grade gliomas in children has not been established, and there is concern about the use of gadolinium-based contrast agents (GBCAs), particularly in children, due to their deposition in the brain. The number of surveillance scans and the use of GBCAs in surveillance of low-risk tumours should ideally be limited. We aimed to investigate the consistency and utility of our surveillance imaging and also determine to what extent the use of GBCAs contributed to decisions to escalate treatment in children with grade 1 astrocytomas. / Methods: This was a retrospective single-centre study at a tertiary paediatric hospital. All children with a new diagnosis of a non-syndromic World Health Organization (WHO) grade 1 astrocytoma between 2007 and 2013 were included, with surveillance imaging up to December 2018 included in analysis. The intervals of surveillance imaging were recorded, and imaging and electronic health records were examined for decisions related to treatment escalation. / Results: Eighty-eight patients had 690 surveillance scans in the study period. Thirty-one patients had recurrence or progression leading to treatment escalation, 30 of whom were identified on surveillance imaging. The use of GBCAs did not appear to contribute to multidisciplinary team (MDT) decisions in the majority of cases. / Conclusion: Surveillance imaging could be reduced in number and duration for completely resected cerebellar tumours. MDT decisions were rarely made on the basis of post-contrast imaging, and GBCA administration could therefore potentially be restricted in the setting of surveillance of grade 1 astrocytomas in children

X-Rays from NGC 3256: High-Energy Emission in Starburst Galaxies and Their Contribution to the Cosmic X-Ray Background

The infrared-luminous galaxy NGC3256 is a classic example of a merger induced nuclear starburst system. We find here that it is the most X-ray luminous star-forming galaxy yet detected (~10^42 ergs/s). Long-slit optical spectroscopy and a deep, high-resolution ROSAT X-ray image show that the starburst is driving a "superwind" which accounts for ~20% of the observed soft (kT~0.3 keV) X-ray emission. Our model for the broadband X-ray emission of NGC3256 contains two additional components: a warm thermal plasma (kT~0.8 keV) associated with the central starburst, and a hard power-law component with an energy index of ~0.7. We find that the input of mechanical energy from the starburst is more than sufficient to sustain the observed level of emission. We also examine possible origins for the power-law component, concluding that neither a buried AGN nor the expected population of high-mass X-ray binaries can account for this emission. Inverse-Compton scattering, involving the galaxy's copious flux of infrared photons and the relativistic electrons produced by supernovae, is likely to make a substantial contribution to the hard X-ray flux. Such a model is consistent with the observed radio and IR fluxes and the radio and X-ray spectral indices. We explore the role of X-ray-luminous starbursts in the production of the cosmic X-ray background radiation. The number counts and spectral index distribution of the faint radio source population, thought to be dominated by star-forming galaxies, suggest that a significant fraction of the hard X-ray background could arise from starbursts at moderate redshift.Comment: 31 pages (tex, epsf), 8 figures (postscript files), accepted for publication in Part 1 of The Astrophysical Journa

The Electron Energy Distribution in the Hotspots of Cygnus A: Filling the Gap with the Spitzer Space Telescope

Here we present Spitzer Space Telescope imaging of Cyg A with the Infrared Array Camera, resulting in the detection of the high-energy tails or cut-offs in the synchrotron spectra for all four hotspots of this archetype radio galaxy. When combined with the other data collected from the literature, our observations allow for detailed modeling of the broad-band emission for the brightest spots A and D. We confirm that the X-ray flux detected previously from these features is consistent with the synchrotron self-Compton radiation for the magnetic field intensity 170 muG in spot A, and 270 muG in spot D. We also find that the energy density of the emitting electrons is most likely larger by a factor of a few than the energy density of the hotspots' magnetic field. We construct energy spectra of the radiating ultrarelativistic electrons. We find that for both hotspots A and D these spectra are consistent with a broken power-law extending from at least 100 MeV up to 100 GeV, and that the spectral break corresponds almost exactly to the proton rest energy of 1 GeV. We argue that the shape of the electron continuum reflects two different regimes of the electron acceleration process at mildly relativistic shocks, rather than resulting from radiative cooling and/or absorption effects. In this picture the protons' inertia defines the critical energy for the hotspot electrons above which Fermi-type acceleration processes may play a major role, but below which the operating acceleration mechanism has to be of a different type. At energies >100 GeV, the electron spectra cut-off/steepen again, most likely as a result of spectral aging due to radiative loss effects. We discuss several implications of the presented analysis for the physics of extragalactic jets.Comment: 29 pages, 8 figures and 2 tables included. Accepted for publication in Ap

Spectrum of neuroimaging findings post-proton beam therapy in a large pediatric cohort

PURPOSE: Proton beam therapy (PBT) is now well established for the treatment of certain pediatric brain tumors. The intrinsic properties of PBT are known to reduce long-term negative effects of photon radiotherapy (PRT). To better understand the intracranial effects of PBT, we analyzed the longitudinal imaging changes in a cohort of children with brain tumors treated by PBT with clinical and radiotherapy dose correlations. MATERIALS AND METHODS: Retrospective imaging review of 46 patients from our hospital with brain tumors treated by PBT. The imaging findings were correlated with clinical and dose parameters. RESULTS: Imaging changes were assessed by reviewing serial magnetic resonance imaging (MRI) scans following PBT over a follow-up period ranging from 1 month to 7 years. Imaging changes were observed in 23 patients undergoing PBT and categorized as pseudoprogression (10 patients, 43%), white matter changes (6 patients, 23%), parenchymal atrophy (6 patients, 23%), and cerebral large vessel arteriopathy (5 patients, 25%). Three patients had more than one type of imaging change. Clinical symptoms attributable to PBT were observed in 13 (28%) patients. CONCLUSION: In accordance with published literature, we found evidence of varied intracranial imaging changes in pediatric brain tumor patients treated with PBT. There was a higher incidence (10%) of large vessel cerebral arteriopathy in our cohort than previously described in the literature. Twenty-eight percent of patients had clinical sequelae as a result of these changes, particularly in the large vessel arteriopathy subgroup, arguing the need for angiographic and perfusion surveillance to pre-empt any morbidities and offer potential neuro-protection

SANEPIC: A Map-Making Method for Timestream Data From Large Arrays

We describe a map-making method which we have developed for the Balloon-borne Large Aperture Submillimeter Telescope (BLAST) experiment, but which should have general application to data from other submillimeter arrays. Our method uses a Maximum Likelihood based approach, with several approximations, which allows images to be constructed using large amounts of data with fairly modest computer memory and processing requirements. This new approach, Signal And Noise Estimation Procedure Including Correlations (SANEPIC), builds upon several previous methods, but focuses specifically on the regime where there is a large number of detectors sampling the same map of the sky, and explicitly allowing for the the possibility of strong correlations between the detector timestreams. We provide real and simulated examples of how well this method performs compared with more simplistic map-makers based on filtering. We discuss two separate implementations of SANEPIC: a brute-force approach, in which the inverse pixel-pixel covariance matrix is computed; and an iterative approach, which is much more efficient for large maps. SANEPIC has been successfully used to produce maps using data from the 2005 BLAST flight.Comment: 27 Pages, 15 figures; Submitted to the Astrophysical Journal; related results available at http://blastexperiment.info/ [the BLAST Webpage

Classification of paediatric brain tumours by diffusion weighted imaging and machine learning

To determine if apparent diffusion coefficients (ADC) can discriminate between posterior fossa brain tumours on a multicentre basis. A total of 124 paediatric patients with posterior fossa tumours (including 55 Medulloblastomas, 36 Pilocytic Astrocytomas and 26 Ependymomas) were scanned using diffusion weighted imaging across 12 different hospitals using a total of 18 different scanners. Apparent diffusion coefficient maps were produced and histogram data was extracted from tumour regions of interest. Total histograms and histogram metrics (mean, variance, skew, kurtosis and 10th, 20th and 50th quantiles) were used as data input for classifiers with accuracy determined by tenfold cross validation. Mean ADC values from the tumour regions of interest differed between tumour types, (ANOVA P < 0.001). A cut off value for mean ADC between Ependymomas and Medulloblastomas was found to be of 0.984 × 10-3 mm2 s-1 with sensitivity 80.8% and specificity 80.0%. Overall classification for the ADC histogram metrics were 85% using Naïve Bayes and 84% for Random Forest classifiers. The most commonly occurring posterior fossa paediatric brain tumours can be classified using Apparent Diffusion Coefficient histogram values to a high accuracy on a multicentre basis

Wide-field global VLBI and MERLIN combined monitoring of supernova remnants in M82

From a combination of MERLIN (Multi-Element Radio-Linked Interferometer Network) and global VLBI (Very Long Baseline Interferometry) observations of the starburst galaxy M82, images of 36 discrete sources at resolutions ranging from ~3 to ~80 mas at 1.7 GHz are presented. Of these 36 sources, 32 are identified as supernova remnants, 2 are HII regions, and 3 remain unclassified. Sizes, flux densities and radio brightnesses are given for all of the detected sources. Additionally, global VLBI only data from this project are used to image four of the most compact radio sources. These data provide a fifth epoch of VLBI observations of these sources, covering a 19-yr time-line. In particular, the continued expansion of one of the youngest supernova remnants, 43.31+59.3 is discussed. The deceleration parameter is a power-law index used to represent the time evolution of the size of a supernova remnant. For the source 43.31+59.3, a lower limit to the deceleration parameter is calculated to be 0.53+/-0.06, based on a lower limit of the age of this source.Comment: 31 pages, 12 figures, 7 table