Reimagining the General Health Questionnaire as a measure of emotional wellbeing: A study of postpartum women in Malta

Background: Postpartum health has been subject to a focus on psychological morbidity, despite positive associations between postpartum recovery and maternal emotional wellbeing. There are currently many validated tools to measure wellbeing and related concepts, including non-psychiatric morbidity. The General Health Questionnaire, 12 items (GHQ-12) is one such instrument, widely used and validated in several languages. Its use in postpartum settings has been documented with disagreement about the instrument's utility in this population, particularly in relation to scoring method and threshold. The GHQ-12 has never been translated into Maltese. This study explored the psychometric properties of the GHQ-12 in a Maltese postpartum population to consider if the use of a different scoring method (visual analogue scale) in the GHQ-12 can determine postpartum wellbeing. Methods: One hundred and twenty-four postpartum women recruited from one hospital in Malta completed the translated and adapted GHQ-12 as a wellbeing measure (GHQ-12(WB)) at four postpartum time points. The psychometric properties of the GHQ-12(WB) were explored using confirmatory factor analysis, discriminant and divergent validity and reliability analysis. Results: The GHQ-12(WB) demonstrated good divergent and known-groups validity and internal consistency. No models offered a good fit to the data. The overall consistent best-fit to the data was an eight item, two factor model (GHQ-8). Model fit improved across all models in terms of CFI at 13 weeks. Conclusion: Findings generally support the reliability and validity of the Maltese version of the GHQ-12(WB). Model fit changes over time reflect the dynamic nature of postpartum recovery. Further evaluation of the GHQ-8(WB) is recommended. © 2013 Australian College of Midwives

How linear features alter predator movement and the functional\ud response

In areas of oil and gas exploration, seismic lines have been reported to alter the movement patterns of wolves (Canis lupus). We developed a mechanistic first passage time model, based on an anisotropic elliptic partial differential equation, and used this to explore how wolf movement responses to seismic lines influence the encounter rate of the wolves with their prey. The model was parametrized using 5 min GPS location data. These data showed that wolves travelled faster on seismic lines and had a higher probability of staying on a seismic line once they were on it. We simulated wolf movement on a range of seismic line densities and drew implications for the rate of predator–prey interactions as described by the functional response. The functional response exhibited a more than linear increase with respect to prey density (type III) as well as interactions with seismic line density. Encounter rates were significantly higher in landscapes with high seismic line density and were most pronounced at low prey densities. This suggests that prey at low population densities are at higher risk in environments with a high seismic line density unless they learn to avoid them

Identifying quantitative imaging features of posterior fossa syndrome in longitudinal MRI

Up to 25% of children who undergo brain tumor resection surgery in the posterior fossa develop posterior fossa syndrome (PFS). This syndrome is characterized by mutism and disturbance in speech. Our hypothesis is that there is a correlation between PFS and the occurrence of hypertrophic olivary degeneration (HOD) in structures within the posterior fossa, known as the inferior olivary nuclei (ION). HOD is exhibited as an increase in size and intensity of the ION on an MR image. Longitudinal MRI datasets of 28 patients were acquired consisting of pre-, intra-, and postoperative scans. A semiautomated segmentation process was used to segment the ION on each MR image. A full set of imaging features describing the first- and second-order statistics and size of the ION were extracted for each image. Feature selection techniques were used to identify the most relevant features among the MRI features, demographics, and data based on neuroradiological assessment. A support vector machine was used to analyze the discriminative features selected by a generative k-nearest neighbor algorithm. The results indicate the presence of hyperintensity in the left ION as the most diagnostically relevant feature, providing a statistically significant improvement in the classification of patients (p=0.01) when using this feature alone

Fully-automated identification of imaging biomarkers for post-operative cerebellar mutism syndrome using longitudinal paediatric MRI

Post-operative cerebellar mutism syndrome (POPCMS) in children is a post- surgical complication which occurs following the resection of tumors within the brain stem and cerebellum. High resolution brain magnetic resonance (MR) images acquired at multiple time points across a patient’s treatment allow the quantification of localized changes caused by the progression of this syndrome. However, MR images are not necessarily acquired at regular intervals throughout treatment and are often not volumetric. This restricts the analysis to 2D space and causes difficulty in intra- and inter-subject comparison. To address these challenges, we have developed an automated image processing and analysis pipeline. Multi-slice 2D MR image slices are interpolated in space and time to produce a 4D volumetric MR image dataset providing a longitudinal representation of the cerebellum and brain stem at specific time points across treatment. The deformations within the brain over time are represented using a novel metric known as the Jacobian of deformations determinant. This metric, together with the changing grey-level intensity of areas within the brain over time, are analyzed using machine learning techniques in order to identify biomarkers that correspond with the development of POPCMS following tumor resection. This study makes use of a fully automated approach which is not hypothesis-driven. As a result, we were able to automatically detect six potential biomarkers that are related to the development of POPCMS following tumor resection in the posterior fossa

What do older people learn from young people? : Intergenerational learning in ‘day centre’ community settings in Malta

This study analyses what motivates older people to attend ‘day centres’ in Malta and what they believe that they derive from young people who carry out their placements at these day ‘centres’ These young people, who are aged 16–17, attend a vocational college in Malta and are studying health and social care. The study is based on a qualitative approach and employs the usage of focus groups. The main findings are that the elderly see the students as helping them on an emotional level by giving them encouragement, and on a practical level, by offering them insights that help them in modern-day life

Salt forms of sulfadiazine with alkali metal and organic cations

The structures of four salt forms of sulfadiazine (SDH) with alkali metal cations are presented. Three contain the deprotonated SD anion. These are the discrete complex [Li(SD)(OH2)2], (I), and the coordination polymers [Na(SD)]n, (II), and [K(SD)(OH2)2]n, (III). The Na complex (II) is a three-dimensional coordination polymer whilst the K complex (III) has two crystallographically independent [K(SD)(OH2)2] units per asymmetric unit, Z′ = 2, and gives a two dimensional coordination polymer whose layers propagate parallel to the crystallographic ab plane. The different bonding modes of the SD anion in these three complexes is discussed. Structure (IV) contains protonated SDH2 cations and the Orange G (OG), C16H10N2O7S2, dianion in a structure with formula [SDH2]2[Na(OG)(OH2)4]2·3H2O. The [Na(OG)(OH2)4]2 dimers have antiparallel naphthol ring structures joined through two Na centres that bond to the hydrazone anions through the O atoms of the ketone and sulfonate substituents. The structures of the salts formed on reaction of SDH with 2-aminopyridine and ethanolamine are also presented as [C5H7N2][SD], (V), and [HOCH2CH2NH3][SD]·H2O, (VI), respectively. Structure (V) features a heterodimeric R2 2(8) hydrogen bond motif between the cation and the anion whilst structure (VI) has a tetrameric core of two cations linked by a central R2 2(10) hydrogen bonded motif which supports two anions linked to this core by R3 3(8) motifs

{VOXEL}: {C}ross-Layer Optimization for Video Streaming with Imperfect Transmission

Delivering videos under less-than-ideal network conditions without compromising end-users' quality of experiences is a hard problem. Virtually all prior work follow a piecemeal approach - -either "tweaking"the fully reliable transport layer or making the client "smarter."We propose VOXEL, a cross-layer optimization system for video streaming. We use VOXEL to demonstrate how to combine application-provided "insights"with a partially reliable protocol for optimizing video streaming. To this end, we present a novel ABR algorithm that explicitly trades off losses for improving end-users' video-watching experiences. VOXEL is fully compatible with DASH, and backward-compatible with VOXEL-unaware servers and clients. In our experiments emulating a wide range of network conditions, VOXEL outperforms the state-of-the-art: We stream videos in the 90th-percentile with up to 97% less rebuffering than the state-of-the-art without sacrificing visual fidelity. We also demonstrate the benefits of VOXEL for small-buffer regimes like the emerging use case of low-latency and live streaming. In a survey of 54 real users, 84% of the participants indicated that they prefer videos streamed using VOXEL compared to the state-of-the-art

Post-operative pediatric cerebellar mutism syndrome and its association with hypertrophic olivary degeneration

Background: The dentato-thalamo-cortical (DTC) pathway is recognized as the anatomical substrate for postoperative pediatric cerebellar mutism (POPCMS), a well-recognized complication affecting up to 31% of children undergoing posterior fossa brain tumour resection. The proximal structures of the DTC pathway also form a segment of the Guillain and Mollaret triangle, a neural network which when disrupted causes hypertrophic olivary degeneration (HOD) of the inferior olivary nucleus (ION). We hypothesize that there is an association between the occurrence of POPCMS and HOD and aim to evaluate this on MR imaging using qualitative and quantitative analysis of the ION in children with and without POPCMS. Methods: In this retrospective study we qualitatively analysed the follow up MR imaging in 48 children who underwent posterior fossa tumour resection for presence of HOD. Quantitative analysis of the ION was possible in 28 children and was performed using semi-automated segmentation followed by feature extraction and feature selection techniques and relevance of the features to POPCMS were evaluated. The diagnosis of POPCMS was made independently based on clinical and nursing assessment notes. Results: There was significant association between POPCMS and bilateral HOD (P=0.002) but not unilateral HOD. Quantitative analysis showed that hyperintensity in the left ION was the most relevant feature in children with POPCMS. Conclusions: Bilateral HOD can serve as a reliable radiological indicator in establishing the diagnosis of POPCMS particularly in equivocal cases. The strong association of signal change due to HOD in the left ION suggests that injury to the right proximal efferent cerebellar pathway plays an important role in the causation of POPCMS. Keywords: Cerebellar mutism syndrome (CMS); hypertrophic olivary degeneration; posterior fossa syndrome (PFS); postoperative pediatric cerebellar mutism syndrom