Paediatric obsessive-compulsive disorder and depressive symptoms: clinical correlates and CBT treatment outcomes.

Depression frequently co-occurs with paediatric obsessive-compulsive disorder (OCD), yet the clinical correlates and impact of depression on CBT outcomes remain unclear. The prevalence and clinical correlates of depression were examined in a paediatric specialist OCD-clinic sample (N = 295; Mean = 15 [7 - 18] years, 42 % female), using both dimensional (Beck Depression Inventory-youth; n = 261) and diagnostic (Development and Wellbeing Assessment; n = 127) measures of depression. The impact of depressive symptoms and suspected disorders on post-treatment OCD severity was examined in a sub-sample who received CBT, with or without SSRI medication (N = 100). Fifty-one per-cent of patients reported moderately or extremely elevated depressive symptoms and 26 % (95 % CI: 18 - 34) met criteria for a suspected depressive disorder. Depressive symptoms and depressive disorders were associated with worse OCD symptom severity and global functioning prior to CBT. Individuals with depression were more likely to be female, have had a psychiatric inpatient admission and less likely to be attending school (ps < 0.01). OCD and depressive symptom severity significantly decreased after CBT. Depressive symptoms and depressive disorders predicted worse post-treatment OCD severity (βs = 0.19 and 0.26, ps < 0.05) but became non-significant when controlling for pre-treatment OCD severity (βs = 0.05 and 0.13, ns). Depression is common in paediatric OCD and is associated with more severe OCD and poorer functioning. However, depression severity decreases over the course of CBT for OCD and is not independently associated with worse outcomes, supporting the recommendation for treatment as usual in the presence of depressive symptoms

On a class of generalised Schmidt groups

In this paper families of non-nilpotent subgroups covering the non-nilpotent part of a finite group are considered. An $A_5$-free group possessing one of these families is soluble, and soluble groups with this property have Fitting length at most three. A bound on the number of primes dividing the order of the group is also obtained

Laboratory observations of double-diffusive convection using high-frequency broadband acoustics

Author Posting. © The Author(s), 2008. This is the author's version of the work. It is posted here by permission of Springer for personal use, not for redistribution. The definitive version was published in Experiments in Fluids 46 (2009): 355-364, doi:10.1007/s00348-008-0570-9.High-frequency broadband (200-300 kHz) acoustic scattering techniques have been used to observe the diffusive regime of double-diffusive convection in the laboratory. Pulse compression signal processing techniques allow 1) centimetre-scale interface thickness to be rapidly, remotely, and continuously measured, 2) the evolution, and ultimate merging, of multiple interfaces to be observed at high-resolution, and 3) convection cells within the surrounding mixed layers to be observed. The acoustically measured interface thickness, combined with knowledge of the slowly-varying temperatures within the surrounding layers, in turn allows the direct estimation of double-diffusive heat and buoyancy fluxes. The acoustically derived interface thickness, interfacial fluxes and migration rates are shown to support established theory. Acoustic techniques complement traditional laboratory sampling methods and provide enhanced capabilities for observing the diffusive regime of double-diffusion in the ocean.Funding for this project was provided by the Ocean Acoustics program at the Office of Naval Research, and by the WHOI Cecil and Ida Greene Technology Award

The impact of emotional well-being on long-term recovery and survival in physical illness: a meta-analysis

This meta-analysis synthesized studies on emotional well-being as predictor of the prognosis of physical illness, while in addition evaluating the impact of putative moderators, namely constructs of well-being, health-related outcome, year of publication, follow-up time and methodological quality of the included studies. The search in reference lists and electronic databases (Medline and PsycInfo) identified 17 eligible studies examining the impact of general well-being, positive affect and life satisfaction on recovery and survival in physically ill patients. Meta-analytically combining these studies revealed a Likelihood Ratio of 1.14, indicating a small but significant effect. Higher levels of emotional well-being are beneficial for recovery and survival in physically ill patients. The findings show that emotional well-being predicts long-term prognosis of physical illness. This suggests that enhancement of emotional well-being may improve the prognosis of physical illness, which should be investigated by future research

A rapid mechanism to remobilize and homogenize highly crystalline magma bodies

International audienceThe largest products of magmatic activity on Earth, the great bodies of granite and their corresponding large eruptions, have a dual nature: homogeneity at the large scale and spatial and temporal heterogeneity at the small scale1-4. This duality calls for amechanism that selectively removes the large-scale heterogeneities associated with the incremental assembly4 of these magmatic systems and yet occurs rapidly despite crystal-rich, viscous conditions seemingly resistant to mixing2,5. Here we show that a simple dynamic template can unify a wide range of apparently contradictory observations from both large plutonic bodies and volcanic systems by a mechanism of rapid remobilization (unzipping) of highly viscous crystalrich mushes. We demonstrate that this remobilization can lead to rapid overturn and produce the observed juxtaposition ofmagmatic materials with very disparate ages and complex chemical zoning. What distinguishes our model is the recognition that the process has two stages. Initially, a stiff mushy magma is reheated from below, producing a reduction in crystallinity that leads to the growth of a subjacent buoyant mobile layer. When the thickening mobile layer becomes sufficiently buoyant, it penetrates the overlying viscous mushy magma. This second stage rapidly exports homogenized material from the lower mobile layer to the top of the system, and leads to partial overturn within the viscous mush itself as an additional mechanism of mixing. Model outputs illustrate that unzipping can rapidly produce large amounts of mobile magma available for eruption. The agreement between calculated and observed unzipping rates for historical eruptions at Pinatubo and at Montserrat demonstrates the general applicability of the model. This mechanism furthers our understanding of both the formation of periodically homogenized plutons (crust building) and of ignimbrites by large eruptions

Evidence-Based Assessment of Child Obsessive Compulsive Disorder: Recommendations for Clinical Practice and Treatment Research

Obsessive-compulsive disorder (OCD) presents heterogeneously and can be difficult to assess in youth. This review focuses on research-supported assessment approaches for OCD in childhood. Content areas include pre-visit screening, diagnostic establishment, differential diagnosis, assessment of comorbid psychiatric conditions, tracking symptom severity, determining psychosocial functioning, and evaluating clinical improvement. Throughout this review, similarities and differences between assessment approaches geared towards clinical and research settings are discussed

Worries about being judged versus being harmed: Disentangling the association of social anxiety and paranoia with schizotypy

Paranoia is a dimension of clinical and subclinical experiences in which others are believed to have harmful intentions. Mild paranoid concerns are relatively common in the general population, and more clinically severe paranoia shares features with social anxiety and is a key characteristic of schizotypy. Given that subclinical manifestations of schizotypy and paranoia may predict the occurrence of more severe symptoms, disentangling the associations of these related constructs may advance our understanding of their etiology; however no known studies to date have comprehensively evaluated how paranoia relates to social anxiety and schizotypy. The current research sought to examine the association of paranoia, assessed across a broad continuum of severity, with 1) the positive and negative schizotypy dimensions and 2) social anxiety. Specifically, the study tested a series of six competing, a priori models using confirmatory factor analysis in a sample of 862 young adults. As hypothesized, the data supported a four-factor model including positive schizotypy, negative schizotypy, social anxiety, and paranoia factors, suggesting that these are distinct constructs with differing patterns of interrelationships. Paranoia had a strong association with positive schizotypy, a moderate association with social anxiety, and a minimal association with negative schizotypy. The results are consistent with paranoia being part of a multidimensional model of schizotypy and schizophrenia. Prior studies treating schizotypy and schizophrenia as homogenous constructs often produce equivocal or non-replicable results because these dimensions are associated with distinct etiologies, presentations, and treatment responses; thus, the present conceptualization of paranoia within a multidimensional schizotypy framework should advance our understanding of these constructs. © 2014 Horton et al

Mycoplasma genitalium: An Emerging Cause of Sexually Transmitted Disease in Women

Mycoplasma genitalium is an emerging sexually transmitted pathogen implicated in urethritis in men and several inflammatory reproductive tract syndromes in women including cervicitis, pelvic inflammatory disease (PID), and infertility. This comprehensive review critically examines epidemiologic studies of M. genitalium infections in women with the goal of assessing the associations with reproductive tract disease and enhancing awareness of this emerging pathogen. Over 27,000 women from 48 published reports have been screened for M. genitalium urogenital infection in high- or low-risk populations worldwide with an overall prevalence of 7.3% and 2.0%, respectively. M. genitalium was present in the general population at rates between those of Chlamydia trachomatis and Neisseria gonorrhoeae. Considering more than 20 studies of lower tract inflammation, M. genitalium has been positively associated with urethritis, vaginal discharge, and microscopic signs of cervicitis and/or mucopurulent cervical discharge in seven of 14 studies. A consistent case definition of cervicitis is lacking and will be required for comprehensive understanding of these associations. Importantly, evidence for M. genitalium PID and infertility are quite convincing and indicate that a significant proportion of upper tract inflammation may be attributed to this elusive pathogen. Collectively, M. genitalium is highly prevalent in high- and low-risk populations, and should be considered an etiologic agent of select reproductive tract disease syndromes in women

Mixing of rhyolite, trachyte and basalt magma erupted from a vertically and laterally zoned reservoir, composite flow P1, Gran Canaria

The 14.1 Ma composite welded ignimbrite P1 (45 km3 DRE) on Gran Canaria is compositionally zoned from a felsic lower part to a basaltic top. It is composed of four component magmas mixed in vertically varying proportions: (1) Na-rhyolite (10 km3) zoned from crystal-poor to highly phyric; (2) a continuously zoned, evolved trachyte to sodic trachyandesite magma group (6 km3); (3) a minor fraction of Na-poor trachyandesite (<1 km3); and (4) nearly aphyric basalt (26 km3) zoned from 4.3 to 5.2 wt% MgO. We distinguish three sites and phases of mixing: (a) Mutual mineral inclusions show that mixing between trachytic and rhyolitic magmas occurred during early stages of their intratelluric crystallization, providing evidence for long-term residence in a common reservoir prior to eruption. This first phase of mixing was retarded by increasing viscosity of the rhyolite magma upon massive anorthoclase precipitation and accumulation. (b) All component magmas probably erupted through a ring-fissure from a common upper-crustal reservoir into which the basalt intruded during eruption. The second phase of mixing occurred during simultaneous withdrawal of magmas from the chamber and ascent through the conduit. The overall withdrawal and mixing pattern evolved in response to pre-eruptive chamber zonation and density and viscosity relationships among the magmas. Minor sectorial variations around the caldera reflect both varying configurations at the conduit entrance and unsteady discharge. (c) During each eruptive pulse, fragmentation and particulate transport in the vent and as pyroclastic flows caused additional mixing by reducing the length scale of heterogeneities. Based on considerations of magma density changes during crystallization, magma temperature constraints, and the pattern of withdrawal during eruption, we propose that eruption tapped the P1 magma chamber during a transient state of concentric zonation, which had resulted from destruction of a formerly layered zonation in order to maintain gravitational equilibrium. Our model of magma chamber zonation at the time of eruption envisages a basal high-density Na-poor trachyandesite layer that was overlain by a central mass of highly phyric rhyolite magma mantled by a sheath of vertically zoned trachyte-trachyandesite magma along the chamber walls. A conventional model of vertically stacked horizontal layers cannot account for the deduced density relationships nor for the withdrawal pattern

The appropriateness of gatekeeping in the provision of reproductive health care for adolescents in Lithuania:the general practice perspective

BACKGROUND: Adolescents' consultation of primary health care services remains problematic despite their accessibility. The reproductive health service seeking behavior of adolescents is the object of much research but little is known about how this behavior is influenced by the gatekeeping system. This study aimed to explore general practitioners' perceptions of the appropriateness of gatekeeping in adolescent reproductive health care. METHODS: Twenty in-depth interviews regarding factors affecting adolescent reproductive health care were carried out on a diverse sample of general practitioners and analyzed using grounded theory. RESULTS: The analysis identified several factors that shaped GPs' negative attitude to gatekeeping in adolescent reproductive health care. Its appropriateness in this field was questionable due to a lack of willingness on the part of GPs to provide reproductive health services for teenagers, their insufficient training, inadequately equipped surgeries and low perceived support for reproductive health service provision. CONCLUSION: Since factors for improving adolescent reproductive health concern not only physicians but also the health system and policy levels, complex measures should be designed to overcome these barriers. Discussion of a flexible model of gatekeeping, encompassing both co-ordination of care provided by GPs and the possibility of patients' self-referral, should be included in the political agenda. Adolescents tend to under-use rather than over-use reproductive health services and every effort should be made to facilitate the accessibility of such services