Army Psychiatry: In and Out of Battle, Its Relationship to the Soldier and to the Service

1. Until the early years of the Great War of 1914-1918 Military Psychiatry as an entity had little place within the scheme of medical care of troops. Since then it has developed into a subject of increasing scope and importance. 2. The various types of Neurotic and Psychotic reaction that are found in medical practice among troops in wartime are discussed, but the organic reactions are not dealt with in this paper. The causative factors are studied and differences among various racial groupings receive comment. The symptomatology is briefly outlined. 3. Seventeen clinical cases are discussed in some detail. 4. The treatment of the various reactions is discussed, but it is detailed only in so far as it bears particularly on the Service aspects of the case. A few prognostic indications are touched upon. 5. Three statistical tables are included, it having been impossible to date to obtain complete statistical information. 6. A few suggestions and recommendations are made with regard to the future of military psychiatry, the examining and placing of recruits, the training of medical officers and one or two matters of general application. Cape Town, S.A., June, 1946

Near-Infrared Stellar Populations in the metal-poor, Dwarf irregular Galaxies Sextans A and Leo A

We present JHK$_{s}$ observations of the metal-poor ([Fe/H] $<$ -1.40) Dwarf-irregular galaxies, Leo A and Sextans A obtained with the WIYN High-Resolution Infrared Camera at Kitt Peak. Their near-IR stellar populations are characterized by using a combination of colour-magnitude diagrams and by identifying long-period variable stars. We detected red giant and asymptotic giant branch stars, consistent with membership of the galaxy's intermediate-age populations (2-8 Gyr old). Matching our data to broadband optical and mid-IR photometry we determine luminosities, temperatures and dust-production rates (DPR) for each star. We identify 32 stars in Leo A and 101 stars in Sextans A with a DPR $>10^{-11}$ $M_\odot \,{\rm yr}^{-1}$, confirming that metal-poor stars can form substantial amounts of dust. We also find tentative evidence for oxygen-rich dust formation at low metallicity, contradicting previous models that suggest oxygen-rich dust production is inhibited in metal-poor environments. The total rates of dust injection into the interstellar medium of Leo A and Sextans A are (8.2 $\pm$ 1.8) $\times 10^{-9}$ $M_\odot \,{\rm yr}^{-1}$ and (6.2 $\pm$ 0.2) $\times 10^{-7}$ $M_\odot \,{\rm yr}^{-1}$, respectively. The majority of this dust is produced by a few very dusty evolved stars, and does not vary strongly with metallicity.Comment: 21 pages, 11 figures, 10 tables; accepted for publication in Ap

Gedanken experiments with Casimir forces, vacuum energy, and gravity

Gedanken experiments are used to explore properties of quantum vacuum energy that are currently challenging to explore experimentally. A constant lateral Casimir force is predicted to exist between two overlapping finite parallel plates at 0 K, otherwise it would be possible to extract an arbitrary amount of energy from the quantum vacuum. A rigid unpowered object cannot be accelerated by the quantum vacuum because of the translational symmetry of space. By considering systems in which vacuum energy and other forms of energy are exchanged, we demonstrate that a change {\Delta}E in vacuum energy, whether positive or negative with respect to the free field, corresponds to an equivalent inertial mass and equivalent gravitational mass {\Delta}M={\Delta}E/c^2. We consider the possibility of a gravitational shield, and show that, if it exists, the energy to operate it would have to cancel the net energy extracted from the gravitational field, otherwise we could extract an arbitrary amount of energy from the field.Comment: 24 pages, 3 figure

International critical care nursing considerations and quality indicators for the 2017 surviving sepsis campaign guidelines

This letter is freely available via Open Access. Click on the Publisher URL to access

The validity of using ICD-9 codes and pharmacy records to identify patients with chronic obstructive pulmonary disease

Background: Administrative data is often used to identify patients with chronic obstructive pulmonary disease (COPD), yet the validity of this approach is unclear. We sought to develop a predictive model utilizing administrative data to accurately identify patients with COPD. Methods: Sequential logistic regression models were constructed using 9573 patients with postbronchodilator spirometry at two Veterans Affairs medical centers (2003-2007). COPD was defined as: 1) FEV1/FVC <0.70, and 2) FEV1/FVC < lower limits of normal. Model inputs included age, outpatient or inpatient COPD-related ICD-9 codes, and the number of metered does inhalers (MDI) prescribed over the one year prior to and one year post spirometry. Model performance was assessed using standard criteria. Results: 4564 of 9573 patients (47.7%) had an FEV1/FVC < 0.70. The presence of ≥1 outpatient COPD visit had a sensitivity of 76% and specificity of 67%; the AUC was 0.75 (95% CI 0.74-0.76). Adding the use of albuterol MDI increased the AUC of this model to 0.76 (95% CI 0.75-0.77) while the addition of ipratropium bromide MDI increased the AUC to 0.77 (95% CI 0.76-0.78). The best performing model included: ≥6 albuterol MDI, ≥3 ipratropium MDI, ≥1 outpatient ICD-9 code, ≥1 inpatient ICD-9 code, and age, achieving an AUC of 0.79 (95% CI 0.78-0.80). Conclusion: Commonly used definitions of COPD in observational studies misclassify the majority of patients as having COPD. Using multiple diagnostic codes in combination with pharmacy data improves the ability to accurately identify patients with COPD.Department of Veterans Affairs, Health Services Research and Development (DHA), American Lung Association (CI- 51755-N) awarded to DHA, the American Thoracic Society Fellow Career Development AwardPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/84155/1/Cooke - ICD9 validity in COPD.pd

The relationship between 18F-FDG-PETCT-derived tumour metabolic activity, nutritional risk, body composition, systemic inflammation and survival in patients with lung cancer

The aim of this study was to examine the relationship between PET-CT derived tumour glucose uptake as measured by maximum standard glucose uptake (SUVmax) and total lesion glycolysis (TLG), nutritional risk as measured by the malnutrition universal screening tool (MUST), CT derived body composition as measured by skeletal muscle index (SMI) and skeletal muscle radiodensity (SMD), the systemic inflammatory response as measured by the modified Glasgow prognostic score (mGPS) and the neutrophil to lymphocyte ratio (NLR) and survival in patients with lung cancer, treated with radiotherapy. In a retrospective cohort study, 119 patients were included in final analyses. The majority of patients were over 65 (86%), female (52%), had a performance status (ECOG-PS) of 0 or 1 (57%), were at nutritional risk (57%), were overweight (53%), had visceral obesity (62%), had a normal SMI (51%), had a low SMD (62%) and were systemically inflammed (mGPS 1/2, 51%). An elevated TLG was associated with sex (p &lt; 0.05), TNM stage (p &lt; 0.001), MUST (p &lt; 0.01) and mGPS (p &lt; 0.01). An elevated mGPS was associated with age (p &lt; 0.05), NLR (p &lt; 0.01), MUST (p &lt; 0.01), and TLG (p &lt; 0.01). On univariate survival analysis, TNM stage (p &lt; 0.01), mGPS (p &lt; 0.05), NLR (p &lt; 0.01), MUST (p ≤ 0.001), Low SMD (p &lt; 0.05), SUVmax (p ≤ 0.001) and TLG (p &lt; 0.001) were associated with overall survival. On multivariate survival analysis MUST (HR: 1.49 95%CI 1.12–01.98 p &lt; 0.01) and TLG (HR: 2.02 95%CI 1.34–3.04 p = 0.001) remained independently associated with survival. In conclusion, elevated tumour metabolic activity was associated with more advanced stage, greater nutritional risk, the systemic inflammatory response and poorer survival but not body composition analysis in patients with lung cancer. These results suggest that detrimental body composition is not directly determined by tumour metabolic activity but rather an ongoing systemic inflammatory response

Normal and Lateral Casimir Forces between Deformed Plates

The Casimir force between macroscopic bodies depends strongly on their shape and orientation. To study this geometry dependence in the case of two deformed metal plates, we use a path integral quantization of the electromagnetic field which properly treats the many-body nature of the interaction, going beyond the commonly used pairwise summation (PWS) of van der Waals forces. For arbitrary deformations we provide an analytical result for the deformation induced change in Casimir energy, which is exact to second order in the deformation amplitude. For the specific case of sinusoidally corrugated plates, we calculate both the normal and the lateral Casimir forces. The deformation induced change in the Casimir interaction of a flat and a corrugated plate shows an interesting crossover as a function of the ratio of the mean platedistance H to the corrugation length \lambda: For \lambda \ll H we find a slower decay \sim H^{-4}, compared to the H^{-5} behavior predicted by PWS which we show to be valid only for \lambda \gg H. The amplitude of the lateral force between two corrugated plates which are out of registry is shown to have a maximum at an optimal wavelength of \lambda \approx 2.5 H. With increasing H/\lambda \gtrsim 0.3 the PWS approach becomes a progressively worse description of the lateral force due to many-body effects. These results may be of relevance for the design and operation of novel microelectromechanical systems (MEMS) and other nanoscale devices.Comment: 20 pages, 5 figure

Airway dimensions in COPD:relationships with clinical variables

SummaryBackgroundCOPD patients have varying degrees of airways disease and emphysema. CT scanning can differentiate these pathological subtypes. We evaluated airway dimensions and emphysema severity with low dose CT scanning in COPD patients to determine relationships with clinical features of the disease.MethodsFifty six patients with COPD had a low dose thoracic CT scan. Airways were analysed using novel software as either proximal (1st and 2nd generation) or distal (3rd to 6th generation); the extent of emphysema was assessed as the percentage of pixels less than −950 Hounsfield units. CT measures were related to clinical features of COPD.ResultsThicker walls in the proximal airways were associated with clinical features that may represent a bronchitic phenotype (MRC Bronchitis Score; β = 0.20, p = 0.003, Frequent Exacerbations; β = 0.14, p = 0.017, Total St George’s Score; β = 0.50, p = 0.001 and body mass index [BMI]; β = 0.26, p = 0.049); these associations were independent of emphysema. BMI was negatively correlated with the degree of emphysema (β = −0.41, p = 0.001). Airway wall thickness was negatively correlated with CT measured emphysema for both proximal and more distal airways (r = −0.30, p = 0.025 and r = −0.32, p = 0.015).ConclusionsCT measured airway dimensions are associated with several clinical measures of COPD; these are related to a bronchitic phenotype and the effect is independent of emphysema

The Role of Circulating Serotonin in the Development of Chronic Obstructive Pulmonary Disease

BACKGROUND: Cigarette smoking is a major risk factor in the development of age-related chronic obstructive pulmonary disease (COPD). The serotonin transporter (SERT) gene polymorphism has been reported to be associated with COPD, and the degree of cigarette smoking has been shown to be a significant mediator in this relationship. The interrelation between circulating serotonin (5-hydroxytyptamine, 5-HT), cigarette smoking and COPD is however largely unknown. The current study aimed at investigating the mediation effects of plasma 5-HT on cigarette smoking-induced COPD and the relation between plasma 5-HT levels and age. METHODS: The association between plasma 5-HT, age and COPD was analyzed in a total of 62 COPD patients (ever-smokers) and 117 control subjects (healthy non-smokers and ever-smokers). Plasma 5-HT levels were measured by enzyme-linked immuno assay (EIA). RESULTS: The elevated plasma 5-HT levels were significantly associated with increased odds for COPD (OR = 1.221, 95% CI = 1.123 to 1.319, p<0.0001). The effect remained significant after being adjusted for age and pack-years smoked (OR = 1.271, 95% CI = 1.134 to 1.408, p = 0.0003). Furthermore, plasma 5-HT was found to mediate the relation between pack-years smoked and COPD. A positive correlation (r = 0.303, p = 0.017) was found between plasma 5-HT levels and age in COPD, but not in the control subjects (r = -0.149, p = 0.108). CONCLUSION: Our results suggest that cigarette smoke-induced COPD is partially mediated by the plasma levels of 5-HT, and that these become elevated with increased age in COPD. The elevated plasma 5-HT levels in COPD might contribute to the pathogenesis of this disease.published_or_final_versio

Filled pauses in Hungarian: Their phonetic form and function

Filled pauses are natural occurrences in spontaneous speech and they may turn up at any level of the speech planning process and in a number of functions. The aim of this paper is to find out whether the diverse functions of filled pauses correlate with diverse articulations resulting in diverse acoustic structures. Spontaneous narratives are used as research material. The duration of the filled pauses and the frequency values of their first two formants are analyzed. The most frequent form, schwa, shows function-dependent realizations as confirmed by the durational values and by the second formant values of these vowel-like sounds