Prospective, multicentre study of screening, investigation and management of hyponatraemia after subarachnoid haemorrhage in the UK and Ireland

Background: Hyponatraemia often occurs after subarachnoid haemorrhage (SAH). However, its clinical significance and optimal management are uncertain. We audited the screening, investigation and management of hyponatraemia after SAH. Methods: We prospectively identified consecutive patients with spontaneous SAH admitted to neurosurgical units in the United Kingdom or Ireland. We reviewed medical records daily from admission to discharge, 21 days or death and extracted all measurements of serum sodium to identify hyponatraemia (<135 mmol/L). Main outcomes were death/dependency at discharge or 21 days and admission duration >10 days. Associations of hyponatraemia with outcome were assessed using logistic regression with adjustment for predictors of outcome after SAH and admission duration. We assessed hyponatraemia-free survival using multivariable Cox regression. Results: 175/407 (43%) patients admitted to 24 neurosurgical units developed hyponatraemia. 5976 serum sodium measurements were made. Serum osmolality, urine osmolality and urine sodium were measured in 30/166 (18%) hyponatraemic patients with complete data. The most frequently target daily fluid intake was >3 L and this did not differ during hyponatraemic or non-hyponatraemic episodes. 26% (n/N=42/164) patients with hyponatraemia received sodium supplementation. 133 (35%) patients were dead or dependent within the study period and 240 (68%) patients had hospital admission for over 10 days. In the multivariable analyses, hyponatraemia was associated with less dependency (adjusted OR (aOR)=0.35 (95% CI 0.17 to 0.69)) but longer admissions (aOR=3.2 (1.8 to 5.7)). World Federation of Neurosurgical Societies grade I–III, modified Fisher 2–4 and posterior circulation aneurysms were associated with greater hazards of hyponatraemia. Conclusions: In this comprehensive multicentre prospective-adjusted analysis of patients with SAH, hyponatraemia was investigated inconsistently and, for most patients, was not associated with changes in management or clinical outcome. This work establishes a basis for the development of evidence-based SAH-specific guidance for targeted screening, investigation and management of high-risk patients to minimise the impact of hyponatraemia on admission duration and to improve consistency of patient care

Psychotic experiences in childhood are associated with increased structural integrity of the left arcuate fasciculus – A population-based case-control study

Around 1 in 5 children under 13 years old experience sub-clinical psychotic experiences (PEs) like hallucinations and delusions. While PEs in childhood are a significant risk factor for adult psychotic disorders, the majority of those experiencing childhood PEs do not develop a psychotic disorder. Individual differences in regional brain maturation rates may be responsible for this age-related and often transient emergence of PEs. Fronto-temporal association tracts undergo extensive maturation and myelination throughout childhood and adolescence, thus we focus on individual differences in one such tract, the arcuate fasciculus. A normative population-based sample of children (aged 11–13) attended a clinical interview and MRI (n = 100), 25 of whom were identified as reporting strong PEs. This group had reduced mean and radial diffusivity in the arcuate fasciculus compared with a group of matched controls (n = 25) who reported no PEs. The group difference was greater in the left hemisphere than the right. Mediation analyses showed that this group difference was driven predominantly by perceptual disturbances and an along-tract analysis showed that the group difference was greatest approximately halfway between the frontal and temporal termination points of the tract (adjacent to the left lateral ventricle). This study is the first to investigate links between arcuate fasciculus diffusivity and psychotic experiences in a population sample of children

Psychotic experiences in childhood are associated with increased structural integrity of the left arcuate fasciculus – a population-based case-control study

Around 1 in 5 children under 13 years old experience sub-clinical psychotic experiences (PEs) like hallucinations and delusions. While PEs in childhood are a significant risk factor for adult psychotic disorders, the majority of those experiencing childhood PEs do not develop a psychotic disorder. Individual differences in regional brain maturation rates may be responsible for this age-related and often transient emergence of PEs. Fronto-temporal association tracts undergo extensive maturation and myelination throughout childhood and adolescence, thus we focus on individual differences in one such tract, the arcuate fasciculus. A normative population-based sample of children (aged 11–13) attended a clinical interview and MRI (n = 100), 25 of whom were identified as reporting strong PEs. This group had reduced mean and radial diffusivity in the arcuate fasciculus compared with a group of matched controls (n = 25) who reported no PEs. The group difference was greater in the left hemisphere than the right. Mediation analyses showed that this group difference was driven predominantly by perceptual disturbances and an along-tract analysis showed that the group difference was greatest approximately halfway between the frontal and temporal termination points of the tract (adjacent to the left lateral ventricle). This study is the first to investigate links between arcuate fasciculus diffusivity and psychotic experiences in a population sample of children

Neuroanatomical markers of psychotic experiences in adolescents: a machine-learning approach in a longitudinal population-based sample

It is important to identify accurate markers of psychiatric illness to aid early prediction of disease course. Subclinical psychotic experiences (PEs) are important risk factors for later mental ill-health and suicidal behaviour. This study used machine learning to investigate neuroanatomical markers of PEs in early and later stages of adolescence. Machine learning using logistic regression using Elastic Net regularization was applied to T1-weighted and diffusion MRI data to classify adolescents with subclinical psychotic experiences vs. controls across 3 timepoints (Time 1:11–13 years, n = 77; Time 2:14–16 years, n = 56; Time 3:18–20 years, n = 40). Neuroimaging data classified adolescents aged 11–13 years with current PEs vs. controls returning an AROC of 0.62, significantly better than a null model, p = 1.73e-29. Neuroimaging data also classified those with PEs at 18–20 years (AROC = 0.59;P = 7.19e-10) but performance was at chance level at 14–16 years (AROC = 0.50). Left hemisphere frontal regions were top discriminant classifiers for 11–13 years-old adolescents with PEs, particularly pars opercularis. Those with future PEs at 18–20 years-old were best distinguished from controls based on left frontal regions, right-hemisphere medial lemniscus, cingulum bundle, precuneus and genu of the corpus callosum (CC). Deviations from normal adolescent brain development in young people with PEs included an acceleration in the typical pattern of reduction in left frontal thickness and right parietal curvature, and accelerated progression of microstructural changes in right white matter and corpus callosum. These results emphasise the importance of multi-modal analysis for understanding adolescent PEs and provide important new insights into early phenotypes for psychotic experiences

Directional effect of climate change.

<p>Colors represent expected negative (red), neutral (tan), and positive (green) effects. Certainty in score is denoted by text font and text color: very high certainty (>95%, black, bold font), high certainty (90–95%, black, italic font), moderate certainty (66–90%, white or gray, bold font), low certainty (<66%, white or gray, italic font).</p

Climate exposure factors.

<p>Average climate exposure scores across all species (A) and results of sensitivity analysis for the effect of individual exposure factors on overall climate vulnerability (B).</p

Map of Northeast U.S. Continental Shelf Large Marine Ecosystem.

<p>Map of Northeast U.S. Continental Shelf Large Marine Ecosystem.</p

Logic rule for calculating overall species’ climate exposure and biological sensitivity.

<p>The scoring rubric is based on a logic model where a certain number of individual scores above a certain threshold are used to determine the overall climate exposure and overall biological sensitivity.</p

Overall climate vulnerability score.

<p>For species names and functional groups see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0146756#pone.0146756.t001" target="_blank">Table 1</a>. Overall climate vulnerability is denoted by color: low (green), moderate (yellow), high (orange), and very high (red). Certainty in score is denoted by text font and text color: very high certainty (>95%, black, bold font), high certainty (90–95%, black, italic font), moderate certainty (66–90%, white or gray, bold font), low certainty (<66%, white or gray, italic font).</p

Potential for a change in species distribution.

<p>Potential was calculated using a subset of sensitivity attributes. Colors represent low (green), moderate (yellow), high (orange) and very high (red) potential for a change in distribution. Certainty in score is denoted by text font and text color: very high certainty (>95%, black, bold font), high certainty (90–95%, black, italic font), moderate certainty (66–90%, white or gray, bold font), low certainty (<66%, white or gray, italic font).</p