Schizophrenia is associated with excess multiple physical-health comorbidities but low levels of recorded cardiovascular disease in primary care: cross-sectional study

<b>Objective</b> To assess the nature and extent of physical-health comorbidities in people with schizophrenia and related psychoses compared with controls. <p></p> <b>Design </b>Cross-sectional study. <p></p> <b>Setting </b>314 primary care practices in Scotland. <p></p> <b>Participants </b>9677 people with a primary care record of schizophrenia or a related psychosis and 1 414 701 controls. Main outcome measures Primary care records of 32 common chronic physical-health conditions and combinations of one, two and three or more physical-health comorbidities adjusted for age, gender and deprivation status. <p></p> <b>Results</b> Compared with controls, people with schizophrenia were significantly more likely to have one physical-health comorbidity (OR 1.21, 95% CI 1.16 to 1.27), two physical-health comorbidities (OR 1.37, 95% CI 1.29 to 1.44) and three or more physical-health comorbidities (OR 1.19, 95% CI 1.12 to 1.27). Rates were highest for viral hepatitis (OR 3.98, 95% CI 2.81 to 5.64), constipation (OR 3.24, 95% CI 3.00 to 4.49) and Parkinson's disease (OR 3.07, 95% CI 2.42 to 3.88) but people with schizophrenia had lower recorded rates of cardiovascular disease, including atrial fibrillation (OR 0.62, 95% CI 0.51 to 0.73), hypertension (OR 0.71, 95% CI 0.67 to 0.76), coronary heart disease (OR 0.75, 95% CI 0.61 to 0.71) and peripheral vascular disease (OR 0.83, 95% CI 0.71 to 0.97).<p></p> <b>Conclusions </b>People with schizophrenia have a wide range of comorbid and multiple physical-health conditions but are less likely than people without schizophrenia to have a primary care record of cardiovascular disease. This suggests a systematic under-recognition and undertreatment of cardiovascular disease in people with schizophrenia, which might contribute to substantial premature mortality observed within this patient group. <p></p&gt

Abdominal functional electrical stimulation to enhance mechanical insufflation-exsufflation

Context: Respiratory complications, attributed to the build-up of secretions in the airway, are a leading cause of rehospitalisation for the tetraplegic population. Previously, we observed that the application of Abdominal Functional Electrical Stimulation (AFES) improved cough function and increased demand for secretion removal, suggesting AFES may aid secretion clearance. Clinically, secretion clearance is commonly achieved by using Mechanical insufflation-exsufflation (MI-E) to simulate a cough. In this study the feasibility of combining AFES with MI-E is evaluated. Findings: AFES was successfully combined with MI-E at eight fortnightly assessment sessions conducted with one sub-acute participant with tetraplegia. By using the signal from a pressure sensor, integrated with the MI-E device, AFES was correctly applied in synchrony with MI-E with an accuracy of 96.7%. Acute increases in exhaled volume and peak flow were observed during AFES assisted MI-E, compared to MI-E alone, at six of eight assessment sessions. Conclusion: The successful integration of AFES with MI-E at eight assessment sessions demonstrates the feasibility of this technique. The acute increases in respiratory function observed at the majority of assessment sessions generate the hypothesis that AFES assisted MI-E may be more effective for secretion clearance than MI-E alone

Challenges and implications of routine depression screening for depression in chronic disease and multimorbidity: a cross sectional study

<b>Background</b> Depression screening in chronic disease is advocated but its impact on routine practice is uncertain. We examine the effects of a programme of incentivised depression screening in chronic disease within a UK primary care setting.<p></p> <b>Methods and Findings</b> Cross sectional analysis of anonymised, routinely collected data (for 2008-9) from family practices in Scotland serving a population of circa 1.8 million. Patients registered in primary care with at least one of three chronic diseases, coronary heart disease, diabetes and stroke, underwent incentivised depression screening using the Hospital Anxiety and Depression Score (HADS). <p></p> 125143 patients were identified with at least one chronic disease. 10670 (8.5%) were under treatment for depression and exempt from screening. Of the remaining, HADS were recorded for 35537 (31.1%) patients. 7080 (19.9% of screened) had raised HADS (≥8); the majority had indications of mild depression with a HADS between 8 and 10. Over 6 months, 572 (8%) of those with a raised HADS (≥8) were initiated on antidepressants, while 696 (2.4%) patients with a normal HADS (<8) were also initiated on antidepressants (relative risk of antidepressant initiation with raised HADS 3.3 (CI 2.97-3.67), p value <0.0001). Of those with multimorbidity who were screened, 24.3% had a raised HADS (≥8). A raised HADS was more likely in females, socioeconomically deprived, multimorbid or younger (18-44) individuals. Females and 45-64 years old were more likely to receive antidepressants.<p></p> <b>Limitations</b> – retrospective study of routinely collected data.<p></p> <b>Conclusions </b> Despite incentivisation, only minority of patients underwent depression screening, suggesting that systematic depression screening in chronic disease can be difficult to achieve in routine practice. Targeting those at greatest risk such as the multimorbid or using simpler screening methods may be more effective. Raised HADS was associated with a higher number of new antidepressant prescriptions which has significant resource implications. The clinical benefits of such screening remain uncertain and merit investigation

Analysis of direct segregated boundary-domain integral equations for variable-coefficient mixed bvps in exterior domains

This is the post-print version of the Article. The official published version can be accessed from the link below - Copyright @ 2013 World Scientific Publishing.Direct segregated systems of boundary-domain integral equations are formulated for the mixed (Dirichlet–Neumann) boundary value problems for a scalar second-order divergent elliptic partial differential equation with a variable coefficient in an exterior three-dimensional domain. The boundary-domain integral equation system equivalence to the original boundary value problems and the Fredholm properties and invertibility of the corresponding boundary-domain integral operators are analyzed in weighted Sobolev spaces suitable for infinite domains. This analysis is based on the corresponding properties of the BVPs in weighted Sobolev spaces that are proved as well.The work was supported by the grant EP/H020497/1 \Mathematical analysis of localised boundary-domain integral equations for BVPs with variable coefficients" of the EPSRC, UK

Close pairs of galaxies with different activity levels

We selected and studied 180 pairs with dV < 800 km/s and Dp < 60 kpc containing Markarian (MRK) galaxies to investigate the dependence of galaxies' integral parameters, star-formation (SF) and active galactic nuclei (AGN) properties on kinematics of pairs, their structure and large-scale environments. Projected radial separation Dp and perturbation level P are better measures of interaction strength than dV. The latter correlates with the density of large-scale environment and with the morphologies of galaxies. Both galaxies in a pair are of the same nature, the only difference is that MRK galaxies are usually righter than their neighbors. Specific star formation rates (SSFR) of galaxies in pairs with smaller Dp or dV is in average 0.5 dex higher than that of galaxies in pairs with larger Dp or dV. Closeness of a neighbor with the same and later morphological type increases the SSFR, while earlier-type neighbors do not increase SSFR. Major interactions/mergers trigger SF and AGN more effectively than minor ones. The fraction of AGNs is higher in more perturbed pairs and pairs with smaller Dp. AGNs typically are in stronger interacting systems than star-forming and passive galaxies. There are correlations of both SSFRs and spectral properties of nuclei between pair members.Comment: 4 pages, 3 figures. arXiv admin note: substantial text overlap with arXiv:1310.024

Abdominal functional electrical stimulation to assist ventilator weaning in acute tetraplegia: a cohort study

Background Severe impairment of the major respiratory muscles resulting from tetraplegia reduces respiratory function, causing many people with tetraplegia to require mechanical ventilation during the acute stage of injury. Abdominal Functional Electrical Stimulation (AFES) can improve respiratory function in non-ventilated patients with sub-acute and chronic tetraplegia. The aim of this study was to investigate the clinical feasibility of using an AFES training program to improve respiratory function and assist ventilator weaning in acute tetraplegia.&lt;p&gt;&lt;/p&gt; Methods AFES was applied for between 20 and 40 minutes per day, five times per week on four alternate weeks, with 10 acute ventilator dependent tetraplegic participants. Each participant was matched retrospectively with a ventilator dependent tetraplegic control, based on injury level, age and sex. Tidal Volume (VT) and Vital Capacity (VC) were measured weekly, with weaning progress compared to the controls.&lt;p&gt;&lt;/p&gt; Results Compliance to training sessions was 96.7%. Stimulated VT was significantly greater than unstimulated VT. VT and VC increased throughout the study, with mean VC increasing significantly (VT: 6.2 mL/kg to 7.8 mL/kg VC: 12.6 mL/kg to 18.7 mL/kg). Intervention participants weaned from mechanical ventilation on average 11 (sd: ± 23) days faster than their matched controls.&lt;p&gt;&lt;/p&gt; Conclusion The results of this study indicate that AFES is a clinically feasible technique for acute ventilator dependent tetraplegic patients and that this intervention may improve respiratory function and enable faster weaning from mechanical ventilation.&lt;p&gt;&lt;/p&gt

Close neighbors of Markarian galaxies. II. Statistics and discussions

According to the database from the first paper, we select 180 pairs with dV < 800 km/s and Dp < 60 kpc containing Markarian (MRK) galaxies. We study the dependence of galaxies integral parameters, star-formation (SF) and active galactic nuclei (AGN) properties on kinematics of pairs, their structure and large-scale environments. Following main results were obtained: projected radial separation Dp between galaxies correlates with the perturbation level P of the pairs. Both parameters do not correlate with line-of-sight velocity difference dV of galaxies. Dp and P are better measures of interaction strength than dV. The latter correlates with the density of large-scale environment and with the morphologies of galaxies. Both galaxies in a pair are of the same nature, the only difference is that MRK galaxies are usually brighter than their neighbors in average by 0.9 mag. Specific star formation rates (SSFR) of galaxies in pairs with smaller Dp or dV is in average 0.5 dex higher than that of galaxies in pairs with larger Dp or dV. Closeness of a neighbor with the same and later morphological type increases the SSFR, while earlier-type neighbors do not increase SSFR. Major interactions/mergers trigger SF and AGN more effectively than minor ones. The fraction of AGNs is higher in more perturbed pairs and pairs with smaller Dp. AGNs typically are in stronger interacting systems than star-forming and passive galaxies. There are correlations of both SSFRs and spectral properties of nuclei between pair members.Comment: 13 pages, 8 figures, 2 table

Regional cerebral relaxation times measured by magnetic resonance imaging at 3.0 Tesla

Brain tissue T1 and T2 relaxation times were measured at 3.0 T from a total of 8 (M/F = 5/3) healthy volunteers, selecting 9 regions of interest (ROIs) in the prefrontal, frontal, parietal, occipitoparietal and hippocampal regions. Apart from the prefrontal region, the other four ROIs were selected within the left and right brain hemispheres. The selected ROIs contained either grey matter (GM) or white matter (WM) or both. The T1 measurements were done using the saturation recovery imaging method at 8 different repetition times (TRs) whereas the T2 measurements were carried out using the multiple spin-echo imaging method at 12 different echo times (TEs). The average T1 values (mean ± SE, ms) from 4 (M/F = 2/2) volunteers were: 1942 ± 29 (prefrontal GM), 1203 ± 40 (frontal WM), 1217 ± 21 (parietal WM), 1425 ± 29 (occipitoparietal GM/WM), and 1435 ± 62 (hippocampi). The average T2 estimates (mean ± SE, ms) from another group of 4 (M/F = 3/1) volunteers were: 147 ± 9 (prefrontal GM), 121 ± 3 (frontal WM), 131 ± 4 (parietal WM), 127 ± 1 (occipitoparietal GM/WM), and 142 ± 8 (hippocampi). Neither T1 nor T2 relaxation times differed significantly between the two brain hemispheres by paired t-tests (p &gt; 0.05). However, regional T1 was found to vary significantly (p &lt; 0.01) while regional T2 did not vary significantly (p = 0.07) by one-way ANOVA. These findings are consistent with theory and published data for the ROIs studied. The results could thus serve as a reference data set for brain MRI pulse sequence optimisation at 3.0 T and could as well be useful in multicentre data set comparisons aimed at developing a database of in vivo brain relaxation times.Keywords: MRI, brain, saturation recovery, spin echo, relaxation tim

An alternative synthesis of cycloalkyl-substituted CPA catalysts and application in asymmetric protonation reactions

LAM thanks the EPSRC (grant number EP/S027165/1) for postdoctoral funding.An alternative synthesis of cycloalkyl-substituted CPA catalysts is reported. A Negishi coupling offers improved yields and purity of the necessary 1,3,5-tri(cycloalkyl)benzenes. Limitations in the use of commercial organozinc reagents have been identified and a robust procedure for the preparation of these reagents is detailed. Similarly, a robust procedure for the key Kumada coupling is also provided. The route is demonstrated by preparation of three different tri(cycloalkyl)aryl-substituted CPAs and the utility of these catalysts in asymmetric protonation reactions is shown.Publisher PDFPeer reviewe