Psychiatry and Cardiac Transplantation

This paper explores the role of psychiatry in the field of cardiac transplantation by way of a literature review. The various stages of cardiac transplantation are discussed with respect to their time frame within the transplantation process, the cognitive and emotional reactions of patients within a given stage, and the dynamics of staff, patient, and family interactions. Research and clinical experience in the field suggest psychiatric assessment, follow-up, and, when necessary, intervention are valuable and important in promoting successful psychological adjustment as patients face their adaptive tasks in the various stages of the transplantation process

Adverse Cerebral Outcomes after Coronary Bypass Surgery

ABSTRACT Background Acute changes in cerebral function after elective coronary bypass surgery are a difficult clinical problem. We carried out a multicenter study to determine the incidence and predictors of — and the use of resources associated with — perioperative adverse neurologic events, including cerebral injury. Methods In a prospective study, we evaluated 2108 patients from 24 U.S. institutions for two general categories of neurologic outcome: type I (focal injury, or stupor or coma at discharge) and type II (deterioration in intellectual function, memory deficit, or seizures). Results Adverse cerebral outcomes occurred in 129 patients (6.1 percent). A total of 3.1 percent had type I neurologic outcomes (8 died of cerebral injury, 55 had nonfatal strokes, 2 had transient ischemic attacks, and 1 had stupor), and 3.0 percent had type II outcomes (55 had deterioration of intellectual function and 8 had seizures). Patients with adverse cerebral outcomes had higher in-hospital mortality (21 percent of patients with type I outcomes died, vs. 10 percent of those with type II and 2 percent of those with no adverse cerebral outcome; P0.001 for all comparisons), longer hospitalization (25 days with type I outcomes, 21 days with type II, and 10 days with no adverse outcome; P0.001), and a higher rate of discharge to facilities for intermediate- or long-term care (47 percent, 30 percent, and 8 percent; P0.001). Predictors of type I outcomes were proximal aortic atherosclerosis, a history of neurologic disease, and older age; predictors of type II outcomes were older age, systolic hypertension on admission, pulmonary disease, and excessive consumption of alcohol. Conclusions Adverse cerebral outcomes after coronary bypass surgery are relatively common and serious; they are associated with substantial increases in mortality, length of hospitalization, and use of intermediate- or long-term care facilities. New diagnostic and therapeutic strategies must be developed to lessen such injury. (N Engl J Med 1996;335:1857-63.)

Low-threshold organic laser based on an oligofluorene truxene with low optical losses

A blue-emitting distributed feedback laser based on a star-shaped oligofluorene truxene molecule is presented. The gain, loss, refractive index, and (lack of) anisotropy are measured by amplified spontaneous emission and variable-angle ellipsometry. The waveguide losses are very low for an organic semiconductor gain medium, particularly for a neat film. The results suggest that truxenes are promising for reducing loss, a key parameter in the operation of organic semiconductor lasers. Distributed feedback lasers fabricated from solution by spin-coating show a low lasing threshold of 270 W/cm(2) and broad tunability across 25 nm in the blue part of the spectrum

Inequalities in the dental health needs and access to dental services among looked after children in Scotland: a population data linkage study

Background: There is limited evidence on the health needs and service access among children and young people who are looked after by the state. The aim of this study was to compare dental treatment needs and access to dental services (as an exemplar of wider health and well-being concerns) among children and young people who are looked after with the general child population. Methods: Population data linkage study utilising national datasets of social work referrals for ‘looked after’ placements, the Scottish census of children in local authority schools, and national health service’s dental health and service datasets. Results: 633 204 children in publicly funded schools in Scotland during the academic year 2011/2012, of whom 10 927 (1.7%) were known to be looked after during that or a previous year (from 2007–2008). The children in the looked after children (LAC) group were more likely to have urgent dental treatment need at 5 years of age: 23%vs10% (n=209/16533), adjusted (for age, sex and area socioeconomic deprivation) OR 2.65 (95% CI 2.30 to 3.05); were less likely to attend a dentist regularly: 51%vs63% (n=5519/388934), 0.55 (0.53 to 0.58) and more likely to have teeth extracted under general anaesthesia: 9%vs5% (n=967/30253), 1.91 (1.78 to 2.04). Conclusions: LAC are more likely to have dental treatment needs and less likely to access dental services even when accounting for sociodemographic factors. Greater efforts are required to integrate child social and healthcare for LAC and to develop preventive care pathways on entering and throughout their time in the care system

Predicting seawater intrusion in coastal groundwater boreholes using self-potential data

Many coastal groundwater abstraction wells are under threat from seawater intrusion: this is exacerbated in summer by low water tables and increased abstraction. Existing hydrochemistry or geophysical techniques often fail to predict the timing of intrusion events. We investigate whether the presence and transport of seawater can influence self-potentials (SPs) measured within groundwater boreholes, with the aim of using SP monitoring to provide early warning of saline intrusion. SP data collection: SP data were collected from a coastal groundwater borehole and an inland borehole (> 60 km from the coast) in the Seaford Chalk of southern England. The SP gradient in the inland borehole was approximately 0.05 mV/m, while that in the coastal borehole varied from 0.16-0.26 mV/m throughout the monitoring period. Spectral analysis showed that semi-diurnal fluctuations in the SP gradient were several orders of magnitude higher at the coast than inland, indicating a strong influence from oceanic tides. A characteristic decrease in the gradient, or precursor, was observed in the coastal borehole several days prior to seawater intrusion. Modelling results: Hydrodynamic transport and geoelectric modelling suggest that observed pressure changes (associated with the streaming potential) are insufficient to explain either the magnitude of the coastal SP gradient or the semi-diurnal SP fluctuations. By contrast, a model of the exclusion-diffusion potential closely matches these observations and produces a precursor similar to that observed in the field. Sensitivity analysis suggests that both a sharp saline front and spatial variations in the exclusion efficiency arising from aquifer heterogeneities are necessary to explain the SP gradient observed in the coastal borehole. The presence of the precursor in the model depends also on the presence and depth of fractures near the base of the borehole. Conclusions: Our results indicate that SP monitoring, combined with hydrodynamic transport and geoelectric modelling, holds considerable promise as an early warning device for seawater intrusion. We now aim to refine our understanding of the technique by applying it to a range of aquifer types

Characterizing the Self‐Potential Response to Concentration Gradients in Heterogeneous Subsurface Environments

DJM was supported by NERC CASE studentship NE/I018417/1. Additional support was provided by NERC to MG under the Science and Solutions for a Changing Planet Doctoral Training Partnership, run by the Grantham Institute for Climate Change at Imperial College London. Two anonymous reviewers are thanked for their comments, which greatly helped to improve the manuscript. The authors would also like to thank Southern Water for access to the borehole at Saltdean. Atkins Global and Southern Water are thanked for some additional funding under the NERC CASE studentship. The laboratory components of this work were carried out with support from TOTAL who we gratefully acknowledged. All data supporting the conclusions of this work are available in the supporting information.Peer reviewedPublisher PD

Environment-induced dynamical chaos

We examine the interplay of nonlinearity of a dynamical system and thermal fluctuation of its environment in the ``physical limit'' of small damping and slow diffusion in a semiclassical context and show that the trajectories of c-number variables exhibit dynamical chaos due to the thermal fluctuations of the bath.Comment: Revtex, 4 pages and 4 figure

Fast computation of Bernoulli, Tangent and Secant numbers

We consider the computation of Bernoulli, Tangent (zag), and Secant (zig or Euler) numbers. In particular, we give asymptotically fast algorithms for computing the first n such numbers in O(n^2.(log n)^(2+o(1))) bit-operations. We also give very short in-place algorithms for computing the first n Tangent or Secant numbers in O(n^2) integer operations. These algorithms are extremely simple, and fast for moderate values of n. They are faster and use less space than the algorithms of Atkinson (for Tangent and Secant numbers) and Akiyama and Tanigawa (for Bernoulli numbers).Comment: 16 pages. To appear in Computational and Analytical Mathematics (associated with the May 2011 workshop in honour of Jonathan Borwein's 60th birthday). For further information, see http://maths.anu.edu.au/~brent/pub/pub242.htm

Maternal Cortisol Concentrations During Pregnancy and Sex-Specific Associations With Neonatal Amygdala Connectivity and Emerging Internalizing Behaviors

Background: Maternal cortisol during pregnancy has the potential to influence rapidly developing fetal brain systems that are commonly altered in neurodevelopmental and psychiatric disorders. Research examining maternal cortisol concentrations across pregnancy and offspring neurodevelopment proximal to birth is needed to advance understanding in this area and lead to insight into the etiology of these disorders. Methods: Participants were 70 adult women recruited during early pregnancy and their infants born after 34 weeks gestation. Maternal cortisol concentrations were assessed serially over 4 days in early, mid, and late gestation. Resting state functional connectivity magnetic resonance imaging of the neonatal amygdala was examined. Mothers reported on children's internalizing behavior problems at 24 months of age. Results: Maternal cortisol concentrations during pregnancy were significantly associated with neonatal amygdala connectivity in a sex-specific manner. Elevated maternal cortisol was associated with stronger amygdala connectivity to brain regions involved in sensory processing and integration, as well as the default mode network in girls, and with weaker connectivity to these brain regions in boys. Elevated maternal cortisol was associated with higher internalizing symptoms in girls only, and this association was mediated by stronger neonatal amygdala connectivity. Conclusions: Normative variation in maternal cortisol during pregnancy is associated with the coordinated functioning of the amygdala soon after birth in a sex-specific manner. The identified pathway from maternal cortisol to higher internalizing symptoms in girls via alterations in neonatal amygdala connectivity may be relevant for the etiology of sex differences in internalizing psychiatric disorders, which are more prevalent in women

Maternal Systemic Interleukin-6 During Pregnancy Is Associated With Newborn Amygdala Phenotypes and Subsequent Behavior at 2 Years of Age

Background Maternal inflammation during pregnancy increases the risk for offspring psychiatric disorders and other adverse long-term health outcomes. The influence of inflammation on the developing fetal brain is hypothesized as one potential mechanism but has not been examined in humans. Methods Participants were adult women (N = 86) who were recruited during early pregnancy and whose offspring were born after 34 weeks’ gestation. A biological indicator of maternal inflammation (interleukin-6) that has been shown to influence fetal brain development in animal models was quantified serially in early, mid-, and late pregnancy. Structural and functional brain magnetic resonance imaging scans were acquired in neonates shortly after birth. Infants’ amygdalae were individually segmented for measures of volume and as seeds for resting state functional connectivity. At 24 months of age, children completed a snack delay task to assess impulse control. Results Higher average maternal interleukin-6 concentration during pregnancy was prospectively associated with larger right amygdala volume and stronger bilateral amygdala connectivity to brain regions involved in sensory processing and integration (fusiform, somatosensory cortex, and thalamus), salience detection (anterior insula), and learning and memory (caudate and parahippocampal gyrus). Larger newborn right amygdala volume and stronger left amygdala connectivity were in turn associated with lower impulse control at 24 months of age, and mediated the association between higher maternal interleukin-6 concentrations and lower impulse control. Conclusions These findings provide new evidence in humans linking maternal inflammation during pregnancy with newborn brain and emerging behavioral phenotypes relevant for psychiatric disorders. A better understanding of intrauterine conditions that influence offspring disease susceptibility is warranted to inform targeted early intervention and prevention efforts