Post-traumatic stress symptoms in pathological gambling: Potential evidence of anti-reward processes

Excessive gambling is considered to be a part of the addiction spectrum. Stress-like emotional states are a key feature both of pathological gambling (PG) and of substance addiction. In substance addiction, stress symptomatology has been attributed in part to “anti-reward” allostatic neuroadaptations, while a potential involvement of anti-reward processes in the course of PG has not yet been investigated. Methods To that end, individuals with PG (n = 22) and mentally healthy subjects (n = 13) were assessed for trauma exposure and post-traumatic stress symptomatology (PTSS) using the Life Events Checklist and the Civilian Mississippi Scale, respectively. Results In comparison with healthy subjects, individuals with PG had significantly greater PTSS scores including greater physiological arousal sub-scores. The number of traumatic events and their recency were not significantly different between the groups. In the PG group, greater gambling severity was associated with more PTSS, but neither with traumatic events exposure nor with their recency. Conclusions Our data replicate prior reports on the role of traumatic stress in the course of PG and extend those findings by suggesting that the link may be derived from the anti-reward-type neuroadaptation rather than from the traumatic stress exposure per se

Epidemiology of overweight and obesity in early childhood in the Gulf Cooperation Council countries:a systematic review and meta-analysis protocol

Introduction There has been a notable increase in the prevalence of overweight and obesity in school-aged children in many industrialised regions. The worldwide prevalence of childhood overweight and obesity increased from 4.2% in 1990 to 6.7% in 2010. Although many studies have been published, the epidemiological burden of overweight and obesity in the Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates) is unclear. There is a need to bring together and appraise relevant studies in order to estimate the epidemiological burden (including incidence, prevalence, risk factors, trend over time) of overweight and obesity in this region and thus help to inform national and regional policies. Methods and analysis We will conduct a systematic review and meta-analysis on the epidemiology of overweight and obesity in early childhood including incidence, prevalence, risk factors and trends over time in the GCC countries. We will search international electronic databases including MEDLINE, EMBASE, Cochrane Library, ISI Web of Science, CINAHL, Google Scholar, AMED, Psych INFO, CAB International and WHO Global Health Library for published, unpublished and in-progress epidemiological studies of interest published from inception to 2017. In addition, we will contact an international panel of experts on the topic. There will be no restriction on the language of publication of studies. We will use the Effective Public Health Practice Project (EPHPP) to appraise the methodological quality of included studies. Meta-analysis will be undertaken using random effects models. Ethics and dissemination Ethical approval is not required. The outcome of the review will be disseminated through conference presentations and peer-reviewed journal publication

Modified Mamdani-fuzzy inference system for predicting the cost overrun of construction projects

Cost overruns are a common worldwide problem in the construction industry; improved proactive risk management and cost control are much needed. Several models have been proposed, but all have weaknesses, particularly in data demands and the severity of critical risks or uncertainties associated with expert judgment. In response, this study develops a new 3-part model based on the Mamdani-type fuzzy inference system (FIS) to predict the cost overrun of construction projects. The first part assesses the weight of each expert, evaluating the severity of cost overrun factors. The second part contains a list of 40 in-built cost overrun factors and their degree of severity, while the third part establishes the relationships of every factor's occurrence probability and severity to predict the cost overrun of a specific project. The severity of each factor is assessed based on a survey of 31 randomly selected experts in the Saudi Arabian construction industry. The model is demonstrated on two completed projects in Saudi Arabia. For each project, this involves a group of project-based experts rating the probability of occurrence of each factor on that project and applying this to the factor severity list to obtain a predicted cost overrun (PCO) for the whole project. The model is validated for robustness by sensitivity analysis comparing the predicted and actual whole project cost overrun and shown to be of practical value in assessing critical risks and predicting the likely amount of cost overrun. The model is equally applicable in the early project stages.</p

A combination of surgery, theranostics, and liquid biopsy - a personalised oncologic approach to treatment of patients with advanced metastatic neuroendocrine neoplasms

Rationale: Neuroendocrine neoplasia (NEN) of small bowel (SBNEN) frequently present with metastatic disease. Theranostics (molecular imaging followed by targeting therapy) allow for personalised medicine. Liquid biopsies enable precise identification of residual disease and real-time monitoring of therapeutic response. Our aim was to determine the clinical utility of a combination of surgery, theranostics, and a multigene blood measurement in metastasised SBNEN. Methods: Inclusion criteria were SBNEN, G1/G2 NEN, initial tumour diagnosis, stage IV NEN, positivity on 68Ga somatostatin analogue PET/CT, eligible for surgery, and 177Lu peptide receptor radionuclide therapy (PRRT). Blood samples for NETest were collected longitudinally. Progression-free survival (PFS) and overall survival (OS) were calculated. NETest results were assessed prior to surgery and during clinical follow-up. Results: A surgical cohort of 39 SBNEN patients met eligibility criteria. Thirty-two patients underwent ileal resection and 7 right hemicolectomy. The mean number of 177Lu PRRT cycles was 4. Mortality was nil. Surgical morbidity was 10.3%. Transient grade 1/2 toxicity occurred in 41% (PRRT). NETest scores (n=9 patients) decreased in 100% following treatment and correlated with diminished tumour volume and disease stabilization following surgery and PRRT. Median follow-up: 78 months. Median PFS and OS: 42.7 and 110 months, respectively. Progression-free survival at 1-, 3-, and 5-years was 79.4%, 57.1% and 40.5%, respectively. Overall survival at 1-, 3-, and 5-years was 97.4%, 97.4%, and 94.1%, respectively. Conclusions: Surgery combined with 177Lu PRRT is safe and provides favourable PFS and OS in selected patients with advanced SBNEN. Liquid biopsy (NETest) has the potential to accurately delineate disease status

Limited sampling strategies for estimation of tacrolimus exposure in kidney transplant recipients receiving extended-release tacrolimus preparation.

Tacrolimus is the key component of most contemporary immunosuppressive drug regimens for the prevention of transplant rejection. Area under the concentration time curve over 24 h (AUC0-24 ) predicts efficacy, but predose (trough) tacrolimus blood concentration (C0 ) is currently used to guide dosing. In clinical or research situations where an estimate of AUC is required, collection of a full 24 h pharmacokinetic (PK) profile is cumbersome. Limited sampling strategies (LSSs) have been developed for some tacrolimus preparations but not for the new, extended-release, once-daily formulation of tacrolimus, ENVARSUS XR. Twenty-four kidney transplant recipients were enrolled in this study. Twenty-four tacrolimus PK profiles were obtained over 24 h. Multiple linear regression was used to generate LSSs with the best subset selection for accurate estimation of tacrolimus AUC0-24 . The predictive performance of each model was assessed in the evaluation group. The correlation between actual and predicted AUC0-24 was evaluated and mean percentage prediction error (MPE%), mean absolute percentage prediction error (MAE%), and root mean squared error (RMSE) were calculated for each prediction model to assess bias and precision. The selected LSSs were highly correlated to AUC0-24 compared with the correlation between C0 and AUC0-24 . Two and three sampling points limited sampling strategies: C0 , C2 , and C10 provide the most reliable and effective LSS for estimation of tacrolimus AUC0-24 in routine clinic use. These limited sampling models can be applied in therapeutic drug monitoring schemes to personalize tacrolimus dosing for kidney transplant recipients on treatment with extended-release tacrolimus

Patterns and predictors of smoking by race and medical diagnosis during hospital admission: A latent class analysis

Hospital-based tobacco treatment programs provide tobacco cessation for a diverse array of admitted patients. Person-centered approaches to classifying subgroups of individuals within large datasets are useful for evaluating the characteristics of the sample. This study categorized patients who received tobacco treatment while hospitalized and determined whether demographics and smoking-related health conditions were associated with group membership. Chart review data was obtained from 4854 patients admitted to a large hospital in South Carolina, USA, from July 2014 through December 2019 who completed a tobacco treatment visit. Smoking characteristics obtained from the visit interview were dichotomized, and then latent class analysis (LCA) was conducted to categorize patients based on smoking history and interest in stopping smoking. Finally, logistic regressions were used to evaluate demographics and smoking-related health conditions as predictors of class membership. LCA generated 5 classes of patients, differentiated by heaviness of smoking and motivation to quit. Patients who were black/African American were more likely to be lighter smokers compared to white patients. Hospitalized patients with a history of hypertension, diabetes, and congestive heart failure were more likely to be motivated to quit and also were more likely to be lighter smokers at the time of hospitalization. Hospitalized patients who smoke and receive tobacco treatment are heterogeneous in terms of their smoking histories and motivation to quit. Understanding latent categories of patients provides insight for tailoring interventions and potentially improving tobacco treatment outcomes

EXAFS Structural Determination of the Pt2(P2O5H2)44– Anion in Solution

We present the first structural determination of the Pt2(P2O5H2)44– anion in solution by analyzing the extended X-ray absorption fine structure (EXAFS) spectrum of the Pt LIII edge. The data could be fit with a simple model involving single and multiple scattering paths to near and far P-atoms, bridging O-atoms, and the other Pt-atom in the binuclear complex. A Pt–Pt distance of 2.876(28) Å and a Pt–P bond length of 2.32(4) Å are obtained. These values are in line with distances found in previous X-ray diffraction studies. The assignment of the EXAFS spectrum of the Pt2(P2O5H2)44– anion in its ground state is required for future time-resolved X-ray absorption measurements with the goal of determining the structure and dynamics of the complex in the 1,3A2u excited states

Physical activity levels across adult life and grip strength in early old age: updating findings from a British birth cohort.

Introduction: observational studies do not always find positive associations between physical activity and muscle strength despite intervention studies consistently showing that exercise improves strength in older adults. In previous analyses of the MRC National Survey of Health and Development (NSHD), the 1946 British birth cohort, there was no evidence of an association between leisure time physical activity (LTPA) across adulthood and grip strength at age 53. This study tested the hypothesis that cumulative benefits of LTPA across mid-life on grip strength will have emerged by age 60–64. Methods: data from the MRC NSHD were used to investigate the associations between LTPA at ages 36, 43, 53 and 60–64 and grip strength at 60–64. Linear regression models were constructed to examine the effect of activity at each age separately and as a cumulative score, including adjustment for potential confounders and testing of life course hypotheses. Results: there were complete longitudinal data available for 1,645 participants. There was evidence of a cumulative effect of LTPA across mid-life on grip strength at 60–64. Compared with the third of participants who reported the least LTPA participation across the four time points, those in the top third had on average 2.11 kg (95% CI: 0.88, 3.35) stronger grip after adjustments. Conclusions: increased levels of LTPA across mid-life were associated with stronger grip at age 60–64, in both men and women. As these associations have emerged since age 53, it suggests that LTPA across adulthood may prevent decline in grip strength in early old age