Structure and Connectivity of Depressive Symptom Networks Corresponding to Early Treatment Response.

Background There are suggestions that denser network connectivity (i.e., the strength of associations between individual symptoms) may be a prognostic indicator of poor treatment response in depression. We sought to examine this aspect of depressive symptom networks in the context of early responses to treatment in adolescents. Methods Routine psychiatric data were obtained for child/adolescent service users who underwent at least three treatment sessions in publicly funded services in England between 2011 and 2015 (N = 3017, 78% female; mean age [SD] = 14.43 years [1.75]). Depressive symptoms were assessed using the Revised Children's Anxiety and Depression Scale at presentation, and again after three treatment sessions. Treatment response was determined using the Reliable Change Index. Network analysis was used to compare the depressive symptom structure and connectivity of sub-samples who, after three treatment sessions had: 1) positively responded (n = 566), 2) not reliably changed (n = 2277), and 3) reliably deteriorated (n = 174), using matched samples to control for baseline severity. Findings Overall connectivity (i.e., the summed total of weighted connections) was significantly weaker for the positive treatment response group at baseline (compared with unchanged and deteriorated groups), however, this group saw the largest increase in connectivity over the course of treatment. With regard to the overall importance of specific symptoms within the networks, fatigue was highest in strength for the unchanged and deteriorated groups, whereas low mood was highest in strength for the improved group. Interpretation This study demonstrates that adolescents who respond early to treatment for depression are characterised by symptom networks that are less densely connected initially, yet increase in connectivity over the course of treatment. This may be indicative of ‘positive spirals’ whereby improvement in one symptom triggers improvements in other symptoms, thereby increasing symptom–symptom associations even as severity decreases. Funding The study was supported by the Wellcome Trust grant 204366/Z/16/Z. The funders had no role in the study design, data collection, data analysis, interpretation, or writing of the report

L'educazione ambientale come patrimonio per le generazioni future

Fare la raccolta differenziata, consumare in modo più ragionevole, evitare gli sprechi di cibo ed energia, tutto questo non significa rinunciare ma accrescere il proprio livello di benessere e aiutare l’ambiente. Nelle pagine che seguono dopo aver illustrato per sommi capi i vari problemi che affliggono il nostro pianeta e come e perché è nata l’Educazione Ambientale, dedicherò ampio spazio ai contributi dati nel tempo, in particolar modo dalla psicologia sociale, a questa materia interdisciplinare. Alla base dei vari problemi ambientali o ecologici vi sono i comportamenti umani, i quali sono accompagnati e guidati dai relativi pensieri, sentimenti, atteggiamenti e valori. Per questo motivo, da più di trent’anni gli psicologi stanno dedicando attenzione alle questioni ecologiche attraverso numerose attività di ricerca in questo campo. Gran parte di tale ricerche sono state pubblicate su riviste internazionali e quindi poco note in Italia

Ross-kabbani operation in an infant with mitral valve dysplasia.

Background. Mitral valve replacement can be very difficult to obtain in infants because the valve annulus diameter can be smaller than the available prosthesis. Case Report. We describe the case of a 2-month-old female weighing 3.5 kg affected by mitral valve dysplasia leading to severe valve stenosis. Despite full medication, the clinical conditions were critical and surgery was undertaken. The mitral valve was unsuitable for repair and the orifice of mitral anulus was 12 mm, too small for a mechanical prosthesis. Therefore, a Ross-Kabbani operation was undertaken, replacing the mitral valve with the pulmonary autograft and reconstructing the right ventricular outflow tract with an etherograft. Results. The postoperative course was uneventful and the clinical conditions are good at 4-month follow-up. Conclusion. The Ross-Kabbani operation can be an interesting alternative to mitral valve replacement in infants when valve repair is not achievable and there is little space for an intra-annular mechanical prosthesis implant

Evaluation of reliable improvement rates in depression and anxiety at the end of treatment in adolescents

BACKGROUND: Literature has focused on effect sizes rather than individual-level improvement rates to determine how effectively services address burgeoning numbers of adolescents with anxiety and depression.AimsTo consider how many adolescents report reliable improvement in anxiety, depression and comorbid depression and anxiety by end of treatment. METHOD: The primary outcome was reliable improvement (i.e. change greater than likely the result of measurement error) in self-reported anxiety and depression for N = 4464 adolescents (mean age 14.5 years, s.d. = 1.9; 75% female; 61% White) seen in specialist mental health services in England. RESULTS: In total, 53% of those with anxiety, 44% with depression, and 35% with comorbid depression and anxiety showed reliable improvement. CONCLUSIONS: Improvement rates were higher than previously reported, but lower than generally used in advice to the public. There may be a need to set more realistic expectations, including with young people who seek help.Declaration of interestAll authors were involved in the programme of service transformation that this report draws on. M.W. led the outcomes and evaluation group that agreed the approach to measurement used in the initiative

The unprecedented optical outburst of the quasar 3C 454.3. The WEBT campaign of 2004-2005

The radio quasar 3C 454.3 underwent an exceptional optical outburst lasting more than 1 year and culminating in spring 2005. The maximum brightness detected was R = 12.0, which represents the most luminous quasar state thus far observed (M_B ~ -31.4). In order to follow the emission behaviour of the source in detail, a large multiwavelength campaign was organized by the Whole Earth Blazar Telescope (WEBT). Continuous optical, near-IR and radio monitoring was performed in several bands. ToO pointings by the Chandra and INTEGRAL satellites provided additional information at high energies in May 2005. The historical radio and optical light curves show different behaviours. Until about 2001.0 only moderate variability was present in the optical regime, while prominent and long-lasting radio outbursts were visible at the various radio frequencies, with higher-frequency variations preceding the lower-frequency ones. After that date, the optical activity increased and the radio flux is less variable. This suggests that the optical and radio emissions come from two separate and misaligned jet regions, with the inner optical one acquiring a smaller viewing angle during the 2004-2005 outburst. Moreover, the colour-index behaviour (generally redder-when-brighter) during the outburst suggests the presence of a luminous accretion disc. A huge mm outburst followed the optical one, peaking in June-July 2005. The high-frequency (37-43 GHz) radio flux started to increase in early 2005 and reached a maximum at the end of our observing period (end of September 2005). VLBA observations at 43 GHz during the summer confirm theComment: 7 pages, 4 figures, to be published in A&

VEGF-A regulated by progesterone governs uterine angiogenesis and vascular remodelling during pregnancy

Peer reviewe

The European Registry for Patients with Mechanical Circulatory Support (EUROMACS)

OBJECTIVES: A second paediatric report has been generated from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS). The purpose of EUROMACS, which is operated by the European Association for Cardio-Thoracic Surgery, is to gather data related to durable mechanical circulatory support for scientific purposes and to publish reports with respect to the course of mechanical circulatory support therapy. Since the first report issued, efforts to increase compliance and participation have been extended. Additionally, the data provided the opportunity to analyse patients of younger age and lower weight. METHODS: Participating hospitals contributed pre-, peri- and long-term postoperative data on mechanical circulatory support implants to the registry. Data for all implants in paediatric patients (≤19 years of age) performed from 1 January 2000 to 1 July 2019 were analysed. This report includes updates of patient characteristics, implant frequency, outcome (including mortality rates, transplants and recovery rates) as well as adverse events including neurological dysfunction, device malfunction, major infection and bleeding. RESULTS: Twenty-nine hospitals contributed 398 registered implants in 353 patients (150 female, 203 male) to the registry. The most frequent aetiology of heart failure was any form of cardiomyopathy (61%), followed by congenital heart disease and myocarditis (16.4% and 16.1%, respectively). Competing outcomes analysis revealed that a total of 80% survived to transplant or recovery or are ongoing; at the 2-year follow-up examination, 20% died while on support. At 12 months, 46.7% received transplants, 8.7% were weaned from their device and 18.5% died. The 3-month adverse events rate was 1.69 per patient-year for device malfunction including pump exchange, 0.48 for major bleeding, 0.64 for major infection and 0.78 for neurological events. CONCLUSIONS: The overall survival rate was 81.5% at 12 months following ventricular assist device implant. The comparison of survival rates of the early and later eras shows no significant difference. A focus on specific subgroups showed that survival was less in patients of younger age (<1 year of age) (P = 0.01) and lower weight (<20 kg) (P = 0.015). Transplant rates at 6 months contin

Predicting mental health improvement and deterioration in a large community sample of 11- to 13-year-olds

Multivariate analysis of psychological dat