Decision Making and Pediatric Bipolar Disorder Assessment/Diagnosis: A Phenomenographic Study

Prior to the 1990s, bipolar disorder, a behavioral disorder characterized by severe mood fluctuations, was not considered an suitable diagnosis for children. However, in recent decades, an increase in pediatric bipolar disorder (PBD) diagnosis has occurred in the U.S. The purpose of this study was to explore the perceptions and lived experiences of licensed mental health clinicians regarding their decision-making processes used during assessment and diagnosis of PBD. This phenomenographic study utilized individual, semi-structured interviews to explore the perceptions and lived experiences of 14 licensed clinicians in the Commonwealth of Massachusetts who assess and diagnose PBD. Data were collected with a 7-question face to face interview. Using NVivo 10 software several key phrases and words were identified, coded, and used to locate patterns, themes, and concepts. Data analysis revealed that significant issues related to PBD assessment and diagnosis may exist, including: inconsistencies in assessment/diagnostic processes; reticence to diagnose the disorder; failure to use available assessment instruments; a lack of attention to comorbidities; and trouble differentiating between PBD symptoms and other issues, such as trauma or dysfunctional family dynamics. Given the reluctance of these mental health professionals to diagnose PBD, implications for social change underscore the important role of education, training, and ongoing clinical supervision to help other mental health professionals accurately assess and diagnose PBD. Recommendations emanating from study findings suggest further research on PBD assessment and diagnosis to help professionals develop more effective diagnostic frameworks for clinical training and practice

Star-Forming Galaxies at z~2: An Emerging Picture of Galaxy Dynamics and Assembly

In these proceedings, we summarize recent results from our "SINS" VLT/SINFONI integral-field survey, focusing on the 52 detected UV/optically-selected star-forming galaxies at z~2. Our H-alpha emission-line imaging and kinematic data of these systems illustrates that a substantial fraction (> 1/3) of these galaxies are large, rotating disks and that these disks are clumpy, thick, and forming stars rapidly. We compare these systems to local disk scaling relations and find that the backbones of these relations are already in place at z~2. Detailed analysis of the large disks in our sample provides strong evidence that this population cannot result from a merger-dominated formation history and instead must be assembled by the smooth but rapid inflow of gas along filaments. These systems will then secularly evolve from clump-dominated disks to bulge-dominated disks on short timescales, a phenomenon that is observed in our SINS observations and is consistent with predictions from numerical simulations. These results provide new and exciting insights into the formation of bulge-dominated galaxies in the local Universe.Comment: 7 pages, to appear in the proceedings of "Galaxy Evolution: Emerging Insights and Future Challenges," Austin, TX, 11-14 Nov 200

Fatigue in inflammatory rheumatic diseases: Current knowledge and areas for future research

Fatigue is a complex phenomenon and an important health concern for many people with chronic inflammatory rheumatic diseases, such as rheumatoid arthritis, psoriatic arthritis, primary Sjögren syndrome and systemic lupus erythematosus. Although some clinical trials have shown the benefits of cognitive behavioural therapy in fatigue management, the effect of this approach is relatively modest, and no curative treatment has been identified. The pathogenesis of fatigue remains unclear. Despite many challenges and limitations, a growing body of research points to roles for the immune system, the central and autonomic nervous systems and the neuroendocrine system in the induction and maintenance of fatigue in chronic diseases. New insights indicate that sleep, genetic susceptibility, metabolic disturbances and other biological and physiological mechanisms contribute to fatigue. Furthermore, understanding of the relationships between psychosocial factors and fatigue is increasing. However, the interrelationships between these diverse mechanisms and fatigue remain poorly defined. In this Review, we outline various biological, physiological and psychosocial determinants of fatigue in inflammatory rheumatic diseases, and propose mechanistic and conceptual models of fatigue to summarize current understanding, stimulate debate and develop further research ideas

Mergers and Mass Accretion Rates in Galaxy Assembly: The Millennium Simulation Compared to Observations of z~2 Galaxies

Recent observations of UV-/optically selected, massive star forming galaxies at z~2 indicate that the baryonic mass assembly and star formation history is dominated by continuous rapid accretion of gas and internal secular evolution, rather than by major mergers. We use the Millennium Simulation to build new halo merger trees, and extract halo merger fractions and mass accretion rates. We find that even for halos not undergoing major mergers the mass accretion rates are plausibly sufficient to account for the high star formation rates observed in z~2 disks. On the other hand, the fraction of major mergers in the Millennium Simulation is sufficient to account for the number counts of submillimeter galaxies (SMGs), in support of observational evidence that these are major mergers. When following the fate of these two populations in the Millennium Simulation to z=0, we find that subsequent mergers are not frequent enough to convert all z~2 turbulent disks into elliptical galaxies at z=0. Similarly, mergers cannot transform the compact SMGs/red sequence galaxies at z~2 into observed massive cluster ellipticals at z=0. We argue therefore, that secular and internal evolution must play an important role in the evolution of a significant fraction of z~2 UV-/optically and submillimeter selected galaxy populations.Comment: 5 pages, 4 figures, Accepted for publication in Ap

Black Hole and Neutron Star Transients in Quiescence

We consider the X-ray luminosity difference between neutron star and black hole soft X-ray transients (NS and BH SXTs) in quiescence. The current observational data suggest that BH SXTs are significantly fainter than NS SXTs. The luminosities of quiescent BH SXTs are consistent with the predictions of binary evolution models for the mass transfer rate if (1) accretion occurs via an ADAF in these systems and (2) the accreting compact objects have event horizons. The luminosities of quiescent NS SXTs are not consistent with the predictions of ADAF models when combined with binary evolution models, unless most of the mass accreted in the ADAF is prevented from reaching the neutron star surface. We consider the possibility that mass accretion is reduced in quiescent NS SXTs because of an efficient propeller and develop a model of the propeller effect that accounts for the observed luminosities. We argue that modest winds from ADAFs are consistent with the observations while strong winds are probably not.Comment: LateX, 37 pages, 7 figures; Accepted for publication in The Astrophysical Journa

The SINS Survey: Broad Emission Lines in High-Redshift Star-Forming Galaxies

High signal-to-noise, representative spectra of star-forming galaxies at z~2, obtained via stacking, reveal a high-velocity component underneath the narrow H-alpha and [NII] emission lines. When modeled as a single Gaussian, this broad component has FWHM > 1500 km/s; when modeled as broad wings on the H-alpha and [NII] features, it has FWHM > 500 km/s. This feature is preferentially found in the more massive and more rapidly star-forming systems, which also tend to be older and larger galaxies. We interpret this emission as evidence of either powerful starburst-driven galactic winds or active supermassive black holes. If galactic winds are responsible for the broad emission, the observed luminosity and velocity of this gas imply mass outflow rates comparable to the star formation rate. On the other hand, if the broad line regions of active black holes account for the broad feature, the corresponding black holes masses are estimated to be an order of magnitude lower than those predicted by local scaling relations, suggesting a delayed assembly of supermassive black holes with respect to their host bulges.Comment: 11 pages, 5 figures. Accepted version, incorporating referee comments, including changes to title, abstract, figures, and discussion sectio

Evidence for a dominant-negative effect in ACTA1 nemaline myopathy caused by abnormal folding, aggregation and altered polymerization of mutant actin isoforms

We have studied a cohort of nemaline myopathy (NM) patients with mutations in the muscle α-skeletal actin gene (ACTA1). Immunoblot analysis of patient muscle demonstrates increased γ-filamin, myotilin, desmin and α-actinin in many NM patients, consistent with accumulation of Z line-derived nemaline bodies. We demonstrate that nebulin can appear abnormal secondary to a primary defect in actin, and show by isoelectric focusing that mutant actin isoforms are present within insoluble actin filaments isolated from muscle from two ACTA1 NM patients. Transfection of C2C12 myoblasts with mutant actinEGFP constructs resulted in abnormal cytoplasmic and intranuclear actin aggregates. Intranuclear aggregates were observed with V163L-, V163M- and R183G-actinEGFP constructs, and modeling shows these residues to be adjacent to the nuclear export signal of actin. V163L and V163M actin mutants are known to cause intranuclear rod myopathy, however, intranuclear bodies were not reported in patient R183G. Transfection studies in C2C12 myoblasts showed significant alterations in the ability of V136L and R183G actin mutants to polymerize and contribute to insoluble actin filaments. Thus, we provide direct evidence for a dominant-negative effect of mutant actin in NM. In vitro studies suggest that abnormal folding, altered polymerization and aggregation of mutant actin isoforms are common properties of NM ACTA1 mutants. Some of these effects are mutation-specific, and likely result in variations in the severity of muscle weakness seen in individual patients. A combination of these effects contributes to the common pathological hallmarks of NM, namely intranuclear and cytoplasmic rod formation, accumulation of thin filaments and myofibrillar disorganizatio

What Does Weight Have to Do with It? Parent Perceptions of Weight and Pain in a Pediatric Chronic Pain Population

Tailored pain management strategies are urgently needed for youth with co-occurring chronic pain and obesity; however, prior to developing such strategies, we need to understand parent perspectives on weight in the context of pediatric chronic pain. Participants in this study included 233 parents of patients presenting to a multidisciplinary pediatric chronic pain clinic. Parents completed a brief survey prior to their child\u27s initial appointment; questions addressed parents\u27 perceptions of their child\u27s weight, and their perceptions of multiple aspects of the relationship between their child\u27s weight and chronic pain. The majority (64%) of parents of youth with obesity accurately rated their child\u27s weight; this group of parents was also more concerned (p \u3c 0.05) about their child\u27s weight than parents of youth with a healthy weight. However, the majority of parents of youth with obesity did not think their child\u27s weight contributed to his/her pain, or that weight was relevant to their child\u27s pain or pain treatment. Overall, only half of all parents saw discussions of weight, nutrition, and physical activity as important to treating their child\u27s pain. Results support the need for addressing parents\u27 perceptions of their child\u27s weight status, and educating parents about the relationship between excessive weight and chronic pain