The Hospital Anxiety and Depression Scale: low sensitivity for depression screening in demented and non-demented hospitalized elderly

Background: We currently use the depression subscale (HADD) of the Hospital Anxiety and Depression Scale (HADS) for depression screening in elderly inpatients. Given recent concerns about the performance of the HADD in this age group, we performed a quality-control study retrospectively comparing HADD with the diagnosis of depression by a psychiatrist. We also studied the effect of dementia on the scale's performance. Methods: HADS produces two 7-item subscales assessing depression or anxiety. The HADD was administered by a neuropsychologist. As "gold standard” we considered the psychiatrist's diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Patients older than 65 years, assessed by both the HADD and the psychiatrist, with a clinical dementia rating (CDR) score lower than 3, were included. The effect of dementia was assessed by forming three groups according to the CDR score (CDR0-0.5, CDR1, and CDR2). Simple and multiple logistic regression models were applied to predict the psychiatrist's depression diagnosis from HADD scores. Areas under the receiver operating characteristics curve (AUC) were plotted and compared by χ2 tests. Results: On both univariate and multiple analyses, HADD predicted depression diagnosis but performed poorly (univariate: p = 0.009, AUC = 0.60 (95% confidence interval (CI) = 0.53-0.66); multiple: p = 0.007, AUC = 0.65 (95% CI = 0.58-0.71)), regardless of cognitive status. Because mood could have changed between the two assessments (they occurred at different points of the hospital stay), the multiple analyses were repeated after limiting time interval at 28, 21, and 14 days. No major improvements were noted. Conclusion: The HADD performed poorly in elderly inpatients regardless of cognitive status. It cannot be recommended in this population for depression screening without further stud

Coupled wave-2D hydrodynamics modeling at the Reno River mouth (Italy) under climate change scenarios

This work presents the results of the numerical study implemented for the natural area of Lido di Spina, a touristic site along the Italian coast of the North Adriatic Sea, close to the mouth of River Reno. High-resolution simulations of nearshore dynamics are carried out under climate change conditions estimated for the site. The adopted modeling chain is based on the implementation of multiple-nested, open-source numerical models. More specifically, the coupled wave-2D hydrodynamics runs, using the open-source TELEMAC suite, are forced at the offshore boundary by waves resulting from the wave model (SWAN) simulations for the Adriatic Sea, and sea levels computed following a joint probability analysis approach. The system simulates presentday scenarios, as well as conditions reflecting the high IPCC greenhouse concentration trajectory named RCP8.5 under predicted climate changes. Selection of sea storms directed from SE (Sirocco events) and E-NE (Bora events) is performed together with Gumbel analysis, in order to define ordinary and extreme sea conditions. The numerical results are here presented in terms of local parameters such as wave breaking position, alongshore currents intensity and direction and flooded area, aiming to provide insights on how climate changes may impact hydrodynamics at a site scale. Although the wave energy intensity predicted for Sirocco events is expected to increase only slightly, modifications of the wave dynamics, current patterns, and inland flooding induced by climate changes are expected to be significant for extreme conditions, especially during Sirocco winds, with an increase in the maximum alongshore currents and in the inundated area compared to past conditions. \ua9 2018 by the authors

Management of amiodarone-induced thyrotoxicosis at a cardiac transplantation centre

Background: Amiodarone-induced thyrotoxicosis (AIT) is associated with significant morbidity and mortality, particularly in patients with cardiac failure. The aim of the study was to evaluate the management of AIT at a tertiary hospital specialising in cardiac failure and transplantation. Methods: Retrospective audit of 66 patients treated for AIT by Endocrinology (2007–2016), classified as type 1 (T1) or type 2 (T2) based on radiological criteria. Main outcome measurements were response rate to initial treatment, time to euthyroidism, and frequency/safety of thyroidectomy. Results: Mean age was 60 ± 2 years; 80% were male. Sixty-four patients commenced medical treatment: thionamides (THIO) in 23, glucocorticoids (GC) in 17 and combination (COMB) in 24. Median thyroxine (fT4) was 35.1 (31.2–46.7) in THIO, 43.1 (30.4 –60.7) in GC, and 60.0 (39.0 –\u3e99.9) pmol/L in COMB (p = 0.01). Initial therapy induced euthyroidism in 52%: 70% THIO, 53% GC, and 33% COMB (p = 0.045) by 100 (49–167), 47 (35–61), and 53 (45–99) days, respectively (p = 0.02). A further 11% became euthyroid after transitioning from monotherapy to COMB. Thyroidectomy was undertaken in 33%. Patients who underwent thyroidectomy were younger (54 ± 3 vs. 63 ± 2 years; p = 0.03), with higher prevalence of severely impaired left ventricular function prior to diagnosis of AIT (38 vs. 18%; p = 0.08). Despite median American Society of Anaesthesiologists classification 4, no thyroidectomy patient experienced cardiorespiratory complications/death. Conclusions: Patients with AIT had limited response to medical treatment. The poorest response was observed in COMB group, likely related to greater hyperthyroidism severity. Thyroidectomy is safe in patients with severe cardiac failure if performed in a centre with cardiac anaesthetic expertise. There should be low threshold for proceeding to thyroidectomy in patients with severe AIT and/or cardiac failure

Kek, Cucks, and God Emperor Trump: A Measurement Study of 4chan's Politically Incorrect Forum and its Effects on the Web

The discussion-board site 4chan has been part of the Internet's dark underbelly since its inception, and recent political events have put it increasingly in the spotlight. In particular, /pol/, the “Politically Incorrect'” board, has been a central figure in the outlandish 2016 US election season, as it has often been linked to the alt-right movement and its rhetoric of hate and racism. However, 4chan remains relatively unstudied by the scientific community: little is known about its user base, the content it generates, and how it affects other parts of the Web. In this paper, we start addressing this gap by analyzing /pol/ along several axes, using a dataset of over 8M posts we collected over two and a half months. First, we perform a general characterization, showing that /pol/ users are well distributed around the world and that 4chan's unique features encourage fresh discussions. We also analyze content, finding, for instance, that YouTube links and hate speech are predominant on /pol/. Overall, our analysis not only provides the first measurement study of /pol/, but also insight into online harassment and hate speech trends in social media

Risk-adapted FDG-PET/CT-based follow-up in patients with diffuse large B-cell lymphoma after first-line therapy

Background: The purpose of this study was to evaluate the impact of 2-[fluorine-18]fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) during follow-up of patients with diffuse large B-cell lymphoma (DLBCL) being in complete remission or unconfirmed complete remission after first-line therapy. Patients and methods: DLBCL patients receiving FDG-PET/CT during follow-up were analyzed retrospectively. Confirmatory biopsy was mandatory in cases of suspected disease recurrence. Results: Seventy-five patients were analyzed and 23 (30%) had disease recurrence. The positive predictive value (PPV) of FDG-PET/CT was 0.85. Patients >60 years [P = 0.036, hazard ratio (HR) = 3.82, 95% confidence interval (CI) 1.02-7.77] and patients with symptoms indicative of a relapse (P = 0.015; HR = 4.1; 95% CI 1.20-14.03) had a significantly higher risk for relapse. A risk score on the basis of signs of relapse, age >60 years, or a combination of these factors identified patients at high risk for recurrence (P = 0.041). Conclusions: FDG-PET/CT detects recurrent DLBCL after first-line therapy with high PPV. However, it should not be used routinely and if only in selected high-risk patients to reduce radiation burden and costs. On the basis of our retrospective data, FDG-PET/CT during follow-up is indicated for patients 60 years with and without clinical signs of relaps

The effect of rosiglitazone on PPARg expression in human adipose tissue Is limited by continued exposure to thymidine NRTI

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