White coat hypertension is associated with increased small vessel disease in the brain

Objective: Small vessel disease, as measured by white matter hyperintensity (WMH) in the brain, is known to be associated with increased stroke risk and cognitive impairment. This study explored the relationship between WMH on computerised tomography (CT) and white coat hypertension/effect (WCH/E) in patients with recent transient ischaemic attack (TIA) or lacunar stroke (LS). Design and method: Ninety-six patients recruited for the ASIST trial (Arterial Stiffness in Lacunar Stroke and TIA) underwent measurement of clinic blood pressure (BP) and ambulatory BP monitoring (APBM) within two weeks of TIA or LS. Twenty-three patients had normotension (clinic BP / = 140/90mmHg and day-time ABPM < 135/85mmHg). Arterial stiffness was measured using carotid-femoral pulse wave velocity (PWV) (Complior®, ALAM Medical) and carotid-ankle vascular index (CAVI) (VaSera VS-1500N®, Fukuda Denshi). CT images were scored for WMH using the four-point Fazekas visual rating scale. Patients were grouped into no-mild WMH (scores 0–1) or moderate-severe (scores 2–3) groups. The relationship between BP, vascular stiffness and WMH was explored with t-tests, chi-square and logistic regression accounting for known cardiovascular risk factors. Results: Forty-four percent of patients with WCH/E had moderate-severe WMH compared to 17% of normotensives (p = 0.047). The regression model with WMH as the dependent factor, and WCH/E and cardiovascular risk factors as independent factors showed WCH/E and either CAVI or PWV to be the only independent significant factor contributing to WMH (CAVI:p = 0.038, PWV:p = 0.043)

Physiotherapy in upper abdominal surgery - what is current practice in Australia?

Background: Upper abdominal surgery (UAS) has the potential to cause post-operative pulmonary complications (PPCs). In the absence of high-quality research regarding post-operative physiotherapy management, consensus-based best practice guidelines formulated by Hanekom et al. (2012) are available to clinicians providing recommendations for post-UAS treatment. Such best practice guidelines have recommended that physiotherapists should be using early mobilisation and respiratory intervention to minimise risk of PPCs. However, recent evidence supports the implementation of mobilisation as a standalone treatment in PPC prevention, though the diversity in literature poses questions regarding ideal current practice. This project aimed to document and report the assessment measures and interventions physiotherapists are utilising following UAS, establishing whether current management is reflective of best practice guidelines and recent evidence. Results: An online survey was completed by 57 experienced Australian physiotherapists working with patients following UAS (35% survey response rate, 63% completion rate). On day one following UAS, when a patient’s condition is not medically limited, most physiotherapists routinely mobilise. Additionally, routine chest treatment continues to be implemented, with only 23% (n = 11/47) of physiotherapists mobilising patients without accompanying specific respiratory intervention. Variability of screening tools used to identify post-operative patients at high risk of PPC development was evident. Patient-dependent factors such as ‘fatigue’ and ‘non-compliance’ were among those identified as barriers to treatment, all influencing the commencement of treatment. Conclusions: Physiotherapists indicated that early mobilisation away from the bedside was the preferred post-operative treatment within the UAS patient population. Many continue to perform routine respiratory interventions despite recent literature suggesting it may provide no additional benefit to preventing PPCs. Current intervention choice is reflective of guidelines [1], however, recent literature has called this into question and more research needs to be done to establish if these recommendations are the most effective at reducing PPCs. Continued research is necessary to promote translation of knowledge to ensure physiotherapists are mobilising patients day one post-UAS. Likewise, future work should focus on identification of barriers, the strategies used to overcome limitations and the creation of a reliable and validated screening tool to ensure appropriate prioritisation and allocation of physiotherapy resources within the UAS patient population

The relation between psychological flexibility and mental health stigma in Acceptance and Commitment Therapy: A preliminary process investigation.

The present study examined the relation between changes in psychological flexibility and changes in mental health stigma in the context of a 2.5-hour long Acceptance and Commitment Therapy group workshop for reducing mental health stigma. Of 27 college undergraduates who attended the workshop, 22 completed one-month follow-up assessments, and their data were used for analyses. Results revealed that mental health stigma reduced significantly at post-treatment, and these reductions were maintained at one-month follow-up. The degree of improvement in psychological flexibility from pre to follow-up was found to be significantly correlated with the degree of reduction in mental health stigma from pre to follow-up. Limitations of the current study and directions for future research are discussed

Uniqueness and non-uniqueness of static vacuum black holes in higher dimensions

We prove the uniqueness theorem for asymptotically flat static vacuum black hole solutions in higher dimensional space-times. We also construct infinitely many non-asymptotically flat regular static black holes on the same spacetime manifold with the same spherical topology.Comment: to appear in Progress of Theoretical Physics Supplement No. 14

Patterns of Suicidal Ideation and Behavior in Northern Ireland and Associations with Conflict Related Trauma

In this study, data from the World Mental Health Survey's Northern Ireland (NI) Study of Health and Stress (NISHS) was used to assess the associations between conflict- and non-conflict-related traumatic events and suicidal behaviour, controlling for age and gender and the effects of mental disorders in NI. DSM mental disorders and suicidal ideation, plans and attempts were assessed using the Composite International Diagnostic Interview (CIDI) in a multi-stage, clustered area probability household sample (N = 4,340, response rate 68.4%). The traumatic event categories were based on event types listed in the PTSD section of the CIDI. Suicidal ideation and attempts were more common in women than men, however, rates of suicide plans were similar for both genders. People with mood, anxiety and substance disorders were significantly more likely than those without to endorse suicidal ideation, plan or attempt. The highest odds ratios for all suicidal behaviors were for people with any mental disorder. However, the odds of seriously considering suicide were significantly higher for people with conflict and non-conflict-related traumatic events compared with people who had not experienced a traumatic event. The odds of having a suicide plan remain significantly higher for people with conflict-related traumatic events compared to those with only non-conflict-related events and no traumatic events. Finally, the odds of suicide attempt were significantly higher for people who have only non-conflict-related traumatic events compared with the other two categories. The results suggest that traumatic events associated with the NI conflict may be associated with suicidal ideation and plans, and this effect appears to be in addition to that explained by the presence of mental disorders. The reduced rates of suicide attempts among people who have had a conflict-related traumatic event may reflect a higher rate of single, fatal suicide attempts in this population

Uniqueness Theorem for Static Black Hole Solutions of sigma-models in Higher Dimensions

We prove the uniqueness theorem for self-gravitating non-linear sigma-models in higher dimensional spacetime. Applying the positive mass theorem we show that Schwarzschild-Tagherlini spacetime is the only maximally extended, static asymptotically flat solution with non-rotating regular event horizon with a constant mapping.Comment: 5 peges, Revtex, to be published in Class.Quantum Gra

The impact of Acceptance and Commitment Therapy versus education on stigma toward people with psychological disorders

Acceptance and Commitment Therapy (ACT) has previously been shown to alter stigmatizing attitudes and to be relatively useful for psychologically inflexible participants. The present study is the first to bring those two findings together by comparing ACT to an education intervention for reducing stigma toward people with psychological disorders, and examining whether results differ for psychologically inflexible versus flexible individuals. A sample of college students (N = 95) was randomly assigned to a 2 ½ hour ACT or educational workshop. Measures were taken before and after the workshop and at a one-month follow-up. ACT reduced mental health stigma significantly regardless of participants’ pre-treatment levels of psychological flexibility, but education reduced stigma only among participants who were relatively flexible and non-avoidant to begin with. Acceptance could be an important avenue of exploration for stigma researcher

THE UNIQUENESS THEOREM FOR ROTATING BLACK HOLE SOLUTIONS OF SELF-GRAVITATING HARMONIC MAPPINGS

We consider rotating black hole configurations of self-gravitating maps from spacetime into arbitrary Riemannian manifolds. We first establish the integrability conditions for the Killing fields generating the stationary and the axisymmetric isometry (circularity theorem). Restricting ourselves to mappings with harmonic action, we subsequently prove that the only stationary and axisymmetric, asymptotically flat black hole solution with regular event horizon is the Kerr metric. Together with the uniqueness result for non-rotating configurations and the strong rigidity theorem, this establishes the uniqueness of the Kerr family amongst all stationary black hole solutions of self-gravitating harmonic mappings.Comment: 18 pages, latex, no figure