Post-traumatic stress disorder in children and adolescents one year after a super-cyclone in Orissa, India: exploring cross-cultural validity and vulnerability factors

BACKGROUND: It has been asserted that psychological responses to disasters in children and adolescents vary widely across cultures, but this has rarely been investigated. The objectives of the study were to clinically evaluate the construct of traumatic stress symptoms and disorder in children and adolescents after a super-cyclone in Orissa, India; to find out the prevalence at one year; compare the effect in high and low exposure areas and study the factors associated with it. METHODS: Clinical examination of children and adolescents (n = 447) was done, supplemented by a symptoms checklist based on International Classification of Mental and Behavioural Disorders, Diagnostic Criteria for Research and a semi-structured questionnaire for disaster related experiences. RESULTS: A majority of children had post-traumatic symptoms. Post-traumatic stress disorder (PTSD) was present in 30.6% (95% confidence interval: 26.4 to 34.9), and an additional 13.6% had sub-syndromal PTSD. Parents or teachers reported mental health concerns in 7.2% subjects, who were a minor proportion (12.8%) of subjects with any syndromal diagnosis (n = 196). Significantly more (43.7%) children in high exposure areas had PTSD than that (11.2%) in low exposure areas (p < 0.001). Depression was significantly associated with PTSD. Binary logistic regression analysis indicated that high exposure, lower educational level and middle socioeconomic status significantly predicted the outcome of PTSD. Extreme fear and perceived threat to life during the disaster, death in family, damage to home, or staying in shelters were not significantly associated with PTSD. CONCLUSION: Following natural disaster PTSD is a valid clinical construct in children and adolescents in Indian set up; and though highly prevalent it may be missed without clinical screening. Its manifestation and associated factors resembled those in other cultures

How do family physicians communicate about cardiovascular risk? Frequencies and determinants of different communication formats

Background: Patients understand information about risk better if it is communicated in numerical or visual formats (e.g. graphs) compared to verbal qualifiers only. How frequently different communication formats are used in clinical primary care settings is unknown. Methods: We collected socioeconomic and patient understanding data using questionnaires and audio-recorded consultations about cardiovascular disease risk. The frequencies of the communication formats were calculated and multivariate regression analysis of associations between communication formats, patient and general practitioner characteristics, and patient subjective understanding was performed. Results: In 73% of 70 consultations, verbal qualifiers were used exclusively to communicate cardiovascular risk, compared to numerical (11%) and visual (16%) formats. Female GPs and female patient's gender were significantly associated with a higher use of verbal formats compared to visual formats (p = 0.001 and p = 0.039, respectively). Patient subjective understanding was significantly higher in visual counseling compared to verbal counseling (p = 0.001). Conclusions: Verbal qualifiers are the most often used communication format, though recommendations favor numerical and visual formats, with visual formats resulting in better understanding than others. Also, gender is associated with the choice of communication format. Barriers against numerical and visual communication formats among GPs and patients should be studied, including gender aspects. Adequate risk communication should be integrated into physicians' education

Vancomycin AUC/MIC ratio and 30-day mortality in patients with Staphylococcus aureus bacteremia

A ratio of the vancomycin area under the concentration-time curve to the MIC (AUC/MIC) of ≥ 400 has been associated with clinical success when treating Staphylococcus aureus pneumonia, and this target was recommended by recently published vancomycin therapeutic monitoring consensus guidelines for treating all serious S. aureus infections. Here, vancomycin serum trough levels and vancomycin AUC/MIC were evaluated in a "real-world" context by following a cohort of 182 patients with S. aureus bacteremia (SAB) and analyzing these parameters within the critical first 96 h of vancomycin therapy. The median vancomycin trough level at this time point was 19.5 mg/liter. There was a significant difference in vancomycin AUC/MIC when using broth microdilution (BMD) compared with Etest MIC (medians of 436.1 and 271.5, respectively; P373, derived using classification and regression tree analysis, was associated with reduced mortality (P=0.043) and remained significant in a multivariable model. This study demonstrated that we obtained vancomycin trough levels in the target therapeutic range early during the course of therapy and that obtaining a higher vancomycin AUC/MIC (in this case, >373) within 96 h was associated with reduced mortality. The MIC test method has a significant impact on vancomycin AUC/MIC estimation. Clinicians should be aware that the current target AUC/MIC of ≥400 was derived using the reference BMD method, so adjustments to this target need to be made when calculating AUC/MIC ratio using other MIC testing methods. Copyrigh

Unravelling the spirits’ message: a study of help-seeking steps and explanatory models among patients suffering from spirit possession in Uganda

As in many cultures, also in Uganda spirit possession is a common idiom of distress associated with traumatic experiences. In the DSM-IV and -5, possession trance disorders can be classified as dissociative disorders. Dissociation in Western countries is associated with complicated, time-consuming and costly therapies. Patients with spirit possession in SW Uganda, however, often report partial or full recovery after treatment by traditional healers. The aim of this study is to explore how the development of symptoms concomitant help-seeking steps, and explanatory models (EM) eventually contributed to healing of patients with spirit possession in SW Uganda. Illness narratives of 119 patients with spirit possession referred by traditional healers were analysed using a mixed-method approach. Treatments of two-thirds of the patients were unsuccessful when first seeking help in the medical sector. Their initially physical symptoms subsequently developed into dissociative possession symptoms. After an average of two help-seeking steps, patients reached a healing place where 99% of them found satisfactory EM and effective healing. During healing sessions, possessing agents were summoned to identify themselves and underlying problems were addressed. Often-mentioned explanations were the following: neglect of rituals and of responsibilities towards relatives and inheritance, the call to become a healer, witchcraft, grief, and land conflicts. The results demonstrate that traditional healing processes of spirit possession can play a role in restoring connections with the supra-, inter-, intra-, and extra-human worlds. It does not always seem necessary to address individual traumatic experiences per se, which is in line with other research in this field. The study leads to additional perspectives on treatment of trauma-related dissociation in Western countries and on developing effective mental health services in low -and middle-income countries

Study of D-(*())(+)(sJ) mesons decaying to D*K-+(S)0 and D*K-0(+) final states

A search is performed for $D^{(*)+}_{sJ}$ mesons in the reactions $pp \to D^{*+} K^0_{\rm S} X$ and $pp \to D^{*0} K^+ X$ using data collected at centre-of-mass energies of 7 and 8 TeV with the LHCb detector. For the $D^{*+} K^0_{\rm S}$ final state, the decays $D^{*+} \to D^0 \pi^+$ with $D^0 \to K^- \pi^+$ and $D^0 \to K^- \pi^+ \pi^+ \pi^-$ are used. For $D^{*0} K^+$, the decay $D^{*0} \to D^0 \pi^0$ with $D^0 \to K^- \pi^+$ is used. A prominent $D_{s1}(2536)^+$ signal is observed in both $D^{*+} K^0_{\rm S}$ and $D^{*0} K^+$ final states. The resonances $D^*_{s1}(2700)^+$ and $D^*_{s3}(2860)^+$ are also observed, yielding information on their properties, including spin-parity assignments. The decay $D^*_{s2}(2573)^+ \to D^{*+} K^0_{\rm S}$ is observed for the first time, at a significance of 6.9 $\sigma$, and its branching fraction relative to the $D^*_{s2}(2573)^+ \to D^+ K^0_{\rm S}$ decay mode is measured

Search for Violations of Lorentz Invariance and CPT Symmetry in B-(s)(0) Mixing

Violations of CPT symmetry and Lorentz invariance are searched for by studying interference effects in B^{0} mixing and in B_{s}^{0} mixing. Samples of B^{0}→J/ψK_{S}^{0} and B_{s}^{0}→J/ψK^{+}K^{-} decays are recorded by the LHCb detector in proton-proton collisions at center-of-mass energies of 7 and 8 TeV, corresponding to an integrated luminosity of 3  fb^{-1}. No periodic variations of the particle-antiparticle mass differences are found, consistent with Lorentz invariance and CPT symmetry. Results are expressed in terms of the standard model extension parameter Δa_{μ} with precisions of O(10^{-15}) and O(10^{-14})  GeV for the B^{0} and B_{s}^{0} systems, respectively. With no assumption on Lorentz (non)invariance, the CPT-violating parameter z in the B_{s}^{0} system is measured for the first time and found to be Re(z)=-0.022±0.033±0.005 and Im(z)=0.004±0.011±0.002, where the first uncertainties are statistical and the second systematic

Measurement of the B-s(0) -> D-s(()*D-)+(s)(*()-) branching fractions

The branching fraction of the decay B-s(0) -> D-s(()*D-)+(s)(*()-) is measured using pp collision data corresponding to an integrated luminosity of 1.0 fb(-1), collected using the LHCb detector at a center-of-mass energy of 7 TeV. It is found to be B(B-s(0) -> D-s(()*D-)(s)(*()-)) = (3.05 +/- 0.10 +/- 0.20 +/- 0.34) where the uncertainties are statistical, systematic, and due to the normalization channel, respectively. The branching fractions of the individual decays corresponding to the presence of one or two D-s(*+/-) are also measured. The individual branching fractions are found to be B(B-s(0) -> D-s*D-+/-(s)-/+) = (1.35 +/- 0.06 +/- 0.09 +/- 0.15) B(B-s(0) -> D-s*D-+(s)*(-)) = (1.27 +/- 0.08 +/- 0.10 +/- 0.14)%. All three results are the most precise determinations to date

Observation of the B (s) (0) -> aEuro parts per thousand J/psi I center dot I center dot decay

The B (s) (0) -> aEuro parts per thousand J/psi I center dot I center dot decay is observed in pp collision data corresponding to an integrated luminosity of 3 fb(-1) recorded by the LHCb detector at centre-of-mass energies of 7 TeV and 8 TeV. This is the first observation of this decay channel, with a statistical significance of 15 standard deviations. The mass of the B (s) (0) meson is measured to be 5367.08 +/- 0.38 +/- 0.15 MeV/c(2). The branching fraction ratio a?not sign(B (s) (0) -> aEuro parts per thousand J/psi I center dot I center dot)/a?not sign(B (s) (0) -> aEuro parts per thousand J/psi I center dot) is measured to be 0.0115 +/- A 0.0012 (-aEuro parts per thousand 0.0009) (+ 0.0005) . In both cases, the first uncertainty is statistical and the second is systematic. No evidence for non-resonant B (s) (0) -> aEuro parts per thousand J/psi I center dot K (+) K (-) or B (s) (0) -> aEuro parts per thousand J/psi K (+) K (-) K (+) K (-) decays is found

First observation of the rare B+ -> D+K+pi(-) decay

The B+ -> D+K+pi(-) decay is observed in a data sample corresponding to 3.0 fb(-1) of pp collision data recorded by the LHCb experiment during 2011 and 2012. The signal significance is 8 sigma and the branching fraction is measured to be B(B+ -> D+K+pi(-)) = (5.31 +/- 0.90 +/- 0.48 +/- 0.35) x 10(-6), where the uncertainties are statistical, systematic and due to the normalization mode B+ -> D-K+pi(+), respectively. The Dalitz plot appears to be dominated by broad structures. Angular distributions are exploited to search for quasi-two-body contributions from B+ -> D*(2)(2460)K-0(+) and B+ -> (D+K*)(892)(0) decays. No significant signals are observed and upper limits are set on their branching fractions