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Objective: To assess racial variation in depression risk factors and symptom trajectories among older women.Methods: Using Nurses' Health Study data, participants (29,483 non-Hispanic white and 288 black women) aged 60 years or older, free of depression in 2000, were followed until 2012. Data on race and risk factors, selected a priori, were obtained from biennial questionnaires. Incident depression was defined as depression diagnosis, antidepressant use, or presence of severe depressive symptoms. Group-based trajectories of depressive symptoms were determined using latent variable modeling approaches.Results: Black participants had lower risk (hazard ratio: 0.76; 95% confidence interval: 0.57-0.99) of incident late-life depression compared with whites. Although blacks had higher prevalence than whites of some risk factors at study baseline, distributions of major contributors to late-life depression risk (low exercise, sleep difficulty, physical/functional limitation, pain) were comparable. There was evidence of effect modification by race for relations of region of birth (Southern birthplace), smoking, and medical comorbidity to depression risk; however, wide confidence intervals occurred among blacks because of smaller sample size. Four trajectories were identified: minimal symptoms-stable (58.3%), mild symptoms-worsening (31.4%), subthreshold symptoms-worsening (4.8%), and subthreshold symptoms-improving (5.5%). Probabilities of trajectory types were similar for blacks and whites.Conclusion: Although overall trajectories of late-life depressive symptoms were comparable by race, there was racial variation in depression risk estimates associated with less-studied factors, such as U.S. region of birth. Future work may address unmeasured health and resilience determinants that may underlie observed findings and that could inform clinical assessment of late-life depression risk factors. [ABSTRACT FROM AUTHOR]

A 2011 randomized controlled trial compared the effectiveness of two brief motivation-enhancing therapy (MET) models among alcohol-positive adolescents in an urban emergency department: adolescent MET-only versus MET + Family Check-Up (FCU), a parent MET model. Results indicated that among the 97 adolescents completing the 3-month assessment, both conditions were associated with reduced drinking and MET+FCU was associated with lower rates of high volume drinking than adolescent MET-only. The goal of this study was to identify predictors and moderators of high volume drinking in the original trial. Seven candidate variables were evaluated as moderators across three domains: demographic characteristics, psychological factors, and socio-contextual factors. Analyses of covariance models identified one significant predictor and one significant moderator of outcome. Older adolescents had significantly worse drinking outcomes than younger adolescents regardless of MET condition. Adolescents whose parents screened positive for problematic alcohol use at baseline had significantly worse drinking outcomes in the MET+FCU condition than the MET-only condition. Results indicate that alcohol-positive adolescents presenting to the emergency department may respond better to MET models if they are under the age of 16. Involving parents who have problematic alcohol use in a parent-focused MET may have negative effects on adolescent high volume drinking. [ABSTRACT FROM AUTHOR]

Isotropic hyperelastic models have been used to determine the material properties of normal human cartilage, but there remains an incomplete understanding of how these properties may be altered by osteoarthritis. The aims of this study were to (1) measure the material constants of normal and osteoarthritic human knee cartilage using isotropic hyperelastic models; (2) determine whether the material constants correlate with histological measures of structure and/or cartilage tissue damage; and (3) quantify the abilities of two common isotropic hyperelastic material models, the neo-Hookean and Yeoh models, to describe articular cartilage contact force, area, and pressure. Small osteochondral specimens of normal and osteoarthritic condition were retrieved from human cadaveric knees and from the knees of patients undergoing total knee arthroplasty and tested in unconfined compression at loading rates and large strains representative of weight-bearing activity. Articular surface contact area and lateral deformation were measured concurrently and specimen-specific finite element models then were used to determine the hyperelastic material constants. Structural parameters were measured using histological techniques while the severity of cartilage damage was quantified using the OARSI grading scale. The hyperelastic material constants correlated significantly with OARSI grade, indicating that the mechanical properties of cartilage for large strains change with tissue damage. The measurements of contact area described anisotropy of the tissue constituting the superficial zone. The Yeoh model described contact force and pressure more accurately than the neo-Hookean model, whereas both models under-predicted contact area and poorly described the anisotropy of cartilage within the superficial zone. These results identify the limits by which isotropic hyperelastic material models may be used to describe cartilage contact variables. This study provides novel data for the mechanical properties of normal and osteoarthritic human articular cartilage and enhances our ability to model this tissue using simple isotropic hyperelastic materials. [ABSTRACT FROM AUTHOR]

For some time, it has been clear that elevated glucose is detrimental to the organism. A plethora of medicines have been introduced to reduce the fasting and postprandial glucose levels (including insulin, glucagon-like peptide receptor 1 [GLP-1] agonists, and sodium-glucose co-transporter 2 [SGLT2] inhibitors, among others). Although these medications are useful to reduce tissue exposure to glucose, no single compound and no combination have been able to totally normalize the blood sugar. Thus, it was astonishing when it was reported that surgery of the gastrointestinal tract could not only reduce obesity but also normalize the blood sugar. These discoveries have transformed diabetes research. What is it about bariatric surgery that causes the remarkable amelioration of glucose homeostasis dysregulation? The answer to this million dollar question is a billion dollar answer. However, a new perspective could shed some light and help provide a clear path for investigation. Instead of asking what does bariatric surgery do to change the pathophysiology, we can ask what pathophysiology and risk factors confer a greater success with remission and improved disease state after surgery. Work from our laboratory and others can help to offer a physiologic basis for which mechanisms may be put into play when the anatomy is altered during surgery. Here, we do not offer an explanation of the mechanism of action of bariatric surgery, but rather provide a background on the regulation of blood glucose and how it is altered during both the diseased state and, as available, the remission state. [ABSTRACT FROM AUTHOR]

Summary Circulating levels of undercarboxylated and bioactive osteocalcin double during aerobic exercise at the time levels of insulin decrease. In contrast, circulating levels of osteocalcin plummet early during adulthood in mice, monkeys, and humans of both genders. Exploring these observations revealed that osteocalcin signaling in myofibers is necessary for adaptation to exercise by favoring uptake and catabolism of glucose and fatty acids, the main nutrients of myofibers. Osteocalcin signaling in myofibers also accounts for most of the exercise-induced release of interleukin-6, a myokine that promotes adaptation to exercise in part by driving the generation of bioactive osteocalcin. We further show that exogenous osteocalcin is sufficient to enhance the exercise capacity of young mice and to restore to 15-month-old mice the exercise capacity of 3-month-old mice. This study uncovers a bone-to-muscle feedforward endocrine axis that favors adaptation to exercise and can reverse the age-induced decline in exercise capacity. [ABSTRACT FROM AUTHOR]

Using a novel combination of in situ potentiometric experiments and quick-scanning XAS we present Fe K-edge XAS spectra (to k = 12 Å −1 ) during Fe III hydrolysis and precipitation in 0.33 M Fe(ClO 4 ) 3 , Fe(NO 3 ) 3 , FeCl 3 and Fe 2 (SO 4 ) 3 solutions up to pH 4.8. Edge-sharing Fe III polymers appeared almost immediately upon hydrolysis with strong evidence for a μ-oxo dimer species forming in the Fe(ClO 4 ) 3 , Fe(NO 3 ) 3 and FeCl 3 solutions. The effects of SO 4 on hydrolysis and polymerization pathways included inhibition of both the formation of the μ-oxo dimer and double corner Fe III bonding, ultimately resulting in the precipitation of schwertmannite. As such, under these experimental conditions, double corner Fe III bonding appears to be critical to the formation of ferrihydrite. The spectral trends indicated that the decomposition/transformation of the dimer was sudden and broadly coincident with shortening average Fe–O bond distances, increased Fe neighbors at ∼3.43 Å and a pre-edge energy transformation suggestive of decreased ligand field strength as well as increasing proportions of tetrahedral Fe III . This result suggests that the incorporation of tetrahedral Fe III into ferrihydrite occurs only at the latter stages of extended polymerization. [ABSTRACT FROM AUTHOR]

Processes leading to the development of coastal hypoxia are usually attributed to anthropogenic nutrient loading. We present new evidence documenting a natural process capable of producing large-scale water masses undersaturated with respect to dissolved oxygen, independent of human-caused nutrient loading and subsequent nutrient-enhanced productivity. Along the heavily developed coastline of Myrtle Beach, South Carolina, the offshore discharge of saline, anoxic groundwater generates undersaturated bottom water masses which can be advected into nearshore waters. Highly elevated radium isotope activities measured in low-oxygen bottom waters cannot be supported by any known terrestrial source. Rather, discharge of cold, anoxic, high-radium water from offshore carbonate aquifers is the likely source. Density stratification inhibits mixing of these discharged waters during inshore transport. During a low-oxygen event in August 2012, this restricted mixing is likely the mechanism for the observed oxygen deficit in bottom waters. This discovery suggests benthic layers undersaturated with respect to dissolved oxygen may be considerably more prevalent than currently recognized, particularly around the carbonate-platform of the US East Coast. [ABSTRACT FROM AUTHOR]

Background: Revision of the Task Force diagnostic criteria for arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) has increased their sensitivity for the diagnosis of early and familial forms of the disease. The epsilon wave is a major diagnostic criterion in the context of ARVC/D, which, however, remains not quantifiable and therefore may leave room for substantial subjective interpretation.Objective: The purpose of this study was to assess interobserver agreement in epsilon wave definition and epsilon wave importance for ARVC/D diagnosis.Methods: Electrocardiographic (ECG) tracings depicting leads V1, V2, and V3 collected from individuals evaluated for ARVC/D (n = 30) were given to panel members who were asked to respond to the question whether ECG patterns meet epsilon wave definition outlined by the Task Force diagnostic criteria. The prevalence and importance of epsilon waves for ARVC/D diagnosis were assessed in a pooled data set of patients with definite ARVC/D from European and American registries (n = 815).Results: The number of ECG patterns identified as epsilon waves varied from 5 to 18 per reviewer (median 13 per reviewer). A unanimous agreement was reached for only 10 cases (33%), 2 of which qualified as epsilon waves and 8 as non-epsilon waves by all panel members. From a pooled data set, 106 patients reportedly had epsilon waves (13%). In 105 of 106 patients with epsilon waves (99%), exclusion of epsilon waves from the diagnostic score would not affect the "definite" diagnostic category.Conclusion: Interobserver variability in the assessment of epsilon waves is high; however, the impact of epsilon waves on ARVC/D diagnosis is negligibly low. The results urge to exercise caution in the assessment of epsilon waves, especially in patients who would not otherwise meet diagnostic criteria. [ABSTRACT FROM AUTHOR]

Pulmonary hypertension is a hemodynamic condition, defined as a mean pulmonary artery pressure by right-sided heart catheterization of at least 25 mm Hg at rest. It is classified into 5 general groups based on the underlying cause, with left ventricular failure and chronic obstructive pulmonary disease being 2 of the most common causes in the United States. Although the specifics of the pathophysiology will vary with the cause, appreciating the risks of pulmonary hypertension and right ventricular failure is critical to appropriately evaluating and resuscitating pulmonary hypertension patients in the emergency department (ED). Patients may present to the ED with complaints related to pulmonary hypertension or unrelated ones, but this condition will affect all aspects of care. Exertional dyspnea is the most common symptom attributable to pulmonary hypertension, but the latter should be considered in any ED patient with unexplained dyspnea on exertion, syncope, or signs of right ventricular dysfunction. Patients with right ventricular failure are often volume overloaded, and careful volume management is imperative, especially in the setting of hypotension. Vasopressors and inotropes, rather than fluid boluses, are often required in shock to augment cardiac output and reduce the risk of exacerbating right ventricular ischemia. Intubation should be avoided if possible, although hypoxemia and hypercapnia may also worsen right-sided heart function. Emergency physicians should appreciate the role of pulmonary vasodilators in the treatment of pulmonary arterial hypertension and recognize that patients receiving these medications may rapidly develop right ventricular failure and even death without these therapies. Patients may require interventions not readily available in the ED, such as a pulmonary artery catheter, inhaled pulmonary vasodilators, and mechanical support with a right ventricular assist device or extracorporeal membrane oxygenation. Therefore, early consultation with a pulmonary hypertension specialist and transfer to a tertiary care center with invasive monitoring and mechanical support capabilities is advised. [ABSTRACT FROM AUTHOR]

We generalize the concept of the pointwise supremum of real-valued functions to the pointfree setting. The concept itself admits a direct and intuitive formulation which makes no mention of points. But our aim here is to investigate pointwise suprema of subsets of R L , the family of continuous real valued functions on a locale, or pointfree space. Thus our setting is the category W of archimedean lattice-ordered groups ( ℓ -groups) with designated weak order unit, with morphisms which preserve the group and lattice operations and take units to units. This is an appropriate context for this investigation because every W -object can be canonically represented as a subobject of some R L . We show that the suprema which are pointwise in the Madden representation can be characterized purely algebraically. They are precisely the suprema which are context-free, in the sense of being preserved by every W homomorphism out of G . We show that closure under such suprema characterizes the W -kernels among the convex ℓ -subgroups. Finally, we prove that all existing joins in a W -object G are pointwise iff its Madden frame L is boolean, and that all existing countable joins in G are pointwise if L is a P -frame, but not conversely. This leads up to the appropriate analog of the Nakano–Stone Theorem: a (completely regular) locale L has the feature that R L is conditionally pointwise complete ( σ -complete), i.e., every bounded (countable) family from R L has a pointwise supremum in R L , iff L is boolean (a P -locale). We adopt a maximally broad definition of unconditional pointwise completeness ( σ -completeness): a divisible W -object G is pointwise complete ( σ -complete) if it contains a pointwise supremum for every subset which has a supremum in any extension. We show that the pointwise complete ( σ -complete) W -objects are those of the form R L for L a boolean locale ( P -locale). Finally, we show that a W -object G is pointwise σ -complete iff it is epicomplete. [ABSTRACT FROM AUTHOR]

The ligamentum teres (LT) is perceived to contribute to hip stability and proprioception. LT incompetence can lead to pain and instability, which may play a role in chondral damage. Hip arthroscopy plays a role in diagnosing and treating LT tears. Reconstruction of the LT is feasible, but careful attention needs to be paid to tunnel positioning, graft material, graft length, and fixation methods. An anatomic femoral tunnel should exit at the fovea capitis on the femoral side, whereas the location for safe placement of the acetabular attachment is thought to be in the posteroinferior part of the cotyloid fossa. On the basis of a recent study, optimization of the acetabular tunnel can potentially be achieved by drilling from the femoral tunnel aided by 15° of abduction and 15° of internal rotation. The femoral neck-shaft angle and femoral anteversion must be factored in while planning the entry point of the femoral tunnel, and this may vary based on the amount of femoral head distraction during hip arthroscopy. [ABSTRACT FROM AUTHOR]

In operational engineering maintenance situations, limitations on time, resource or the information available often inhibit rigorous analysis on complex decision problems. Decision-makers who are compelled to act in such circumstances, may be informed by some level of analysis if available, or else may have to rely on their unsupported judgement. This paper presents three engineering risk decision-making case studies across a 20 year span from the rail, aerospace, and military aviation contexts, highlighting the fallibilities of using unsupported judgements in an unstructured manner. To help situate this type of decision situation, we provide a descriptive model of the decision space which extends an existing description from the discipline of decision analysis. Furthermore, to help make and describe the distinction between unsupported and supported thinking, we provide another descriptive model, this time drawing parallels with the distinction made between Type 1 and Type 2 reasoning. This model is an extension of the default-interventionist model from cognitive psychology. The paper concludes that there is a pressing need to provide some form of support to engineering decision-makers facing operational decisions under severe time pressure. While the ultimate aim must be to improve the quality of decision-making, improved transparency is an important additional benefit. Increased emphasis on decision justification and self-awareness are suggested as potential ways of improving this situation. A further contribution of this paper is to identify and strengthen linkages between safety science and two other relevant disciplines, decision analysis and psychology. Such linkages make it easier to communicate across traditional disciplinary boundaries and may provide opportunities for interdisciplinary learning or suggest future directions for collaborative research. • Three engineering case studies highlight operational constraints on decisions. • Attention is focused on unsupported operational decision-making. • Extended decision space model provides a linkage with decision analysis. • Extended default-interventionist model provides a linkage with psychology. • Organisational risk systems are unable to cater adequately for unsupported judgement. [ABSTRACT FROM AUTHOR]

Objective: To determine whether apolipoprotein E (ApoE) is associated with postoperative delirium incidence, severity, and duration in older patients free of dementia at baseline.Methods: The authors examined 557 nondemented patients aged 70 years or older undergoing major noncardiac surgery enrolled in the Successful Aging after Elective Surgery Study. Three ApoE measures were considered: ε2, ε4 carriers versus noncarriers, and a three-category ApoE measure. Delirium was determined using the Confusion Assessment Method (CAM) and chart review. We used generalized linear models to estimate the association between ApoE and delirium incidence, severity (peak CAM Severity [CAM-S] score), and days.Results: ApoE ε2 and ε4 was present in 15% and 19%, respectively, and postoperative delirium occurred in 24%. Among patients with delirium, the mean peak CAM-S score was 8.0 (standard deviation: 4), with most patients experiencing 1 or 2 delirium days (51% or 28%, respectively). After adjusting for age, sex, surgical procedure, and preoperative cognitive function, ApoE ε4 and ε2 carrier status were not associated with postoperative delirium: RR for ε4=1.0, 95% CI: 0.7-1.5 and RR for ε2=0.9, 95% CI: 0.6-1.4. No association between ApoE and delirium severity or number of delirium days was observed.Conclusion: In older surgery patients free of dementia, our findings do not support the hypothesis that the ApoE genotype does not confer either risk or protection in postoperative delirium incidence, severity, or duration. Thus, an important genetic risk factor for Alzheimer disease does not affect risk of delirium. [ABSTRACT FROM AUTHOR]

Objective The majority of scales to measure family member distress in dementia are designed for community settings and do not capture the unique burdens of the nursing home (NH) environment. We report the psychometric properties of a new Family Distress in Advanced Dementia Scale for use in the NH setting. Design, Setting, Participants Cross-sectional questionnaire of 130 family member health care proxies of NH residents with advanced dementia in 31 Boston-area NHs. Methods Thirty-one initial items were evaluated, measuring the frequency over the past 3 months of sources of distress. Exploratory factor analysis identified domains of distress; Cronbach's alpha was computed for each domain. Associations between the domains and other measures were evaluated using Pearson correlation coefficients, including measures of depression (PHQ-9), satisfaction with care (Satisfaction with Care at the End-of-Life in Dementia [SWC-EOLD]), and caregiver burden (Zarit Burden Interview short version). Results Factor analysis suggested 3 domains: emotional distress (9 items), dementia preparedness (5 items), and NH relations (7 items). Cronbach's alpha coefficients were 0.82, 0.75, and 0.83 respectively. The PHQ-9 correlated most strongly with the emotional distress factor (r = 0.34), the SWC-EOWD correlated most strongly with the NH relations factor (r = 0.35), as did the Zarit Burden Scale (r = 0.50). Conclusions The Family Distress in Advanced Dementia Scale encompasses 3 domains of distress. This scale represents a much needed tool to assess distress among family members of NH residents with advanced dementia and provides a metric to evaluate interventions in the population. [ABSTRACT FROM AUTHOR]

Various forms of chronic renal disease as well as congestive heart failure progress irrespective of currently available supportive care. Clinical evidence indicates that blockade of the renin–angiotensin system and/or mineralocorticoid inhibition are partially effective. Recently, it was suggested that the initiation of feed–forward intracrine loops such as renin–angiotensin system up–regulation can explain the progression of disease in the face of the control of initiating factors such as high glucose or hypertension. Here, these notions are expanded to include a potential interaction of mineralocorticoid activity with intracrine renin–angiotensin system up–regulation. In addition to suggesting therapeutic interventions, these observations lead to an expanded view of intracrine physiology. [ABSTRACT FROM AUTHOR]

Objective Central administration of ligands for fibroblast growth factor receptors (FGFRs) such as fibroblast growth factor-19 (FGF19) and FGF21 exert glucose-lowering effects in rodent models of obesity and type 2 diabetes (T2D). Conversely, intracerebroventricular (icv) administration of the non-selective FGFR inhibitor (FGFRi) PD173074 causes glucose intolerance, implying a physiological role for neuronal FGFR signaling in glucose homeostasis. The current studies were undertaken to identify neuroendocrine mechanisms underlying the glucose intolerance induced by pharmacological blockade of central FGFRs. Methods Overnight fasted, lean, male, Long-Evans rats received icv injections of either PD173074 or vehicle (Veh) followed 30 min later by performance of a frequently sampled intravenous glucose tolerance test (FSIGT). Minimal model analysis of glucose and insulin data from the FSIGT was performed to estimate insulin-dependent and insulin-independent components of glucose disposal. Plasma levels of lactate, glucagon, corticosterone, non-esterified free fatty acids (NEFA) and catecholamines were measured before and after intravenous (iv) glucose injection. Results Within 20 min of icv PD173074 injection (prior to the FSIGT), plasma levels of lactate, norepinephrine and epinephrine increased markedly, and each returned to baseline rapidly (within 8 min) following the iv glucose bolus. In contrast, plasma glucagon levels were not altered by icv FGFRi at either time point. Consistent with a previous report, glucose tolerance was impaired following icv PD173074 compared to Veh injection and, based on minimal model analysis of FSIGT data, this effect was attributable to reductions of both insulin secretion and the basal insulin effect (BIE), consistent with the inhibitory effect of catecholamines on pancreatic β-cell secretion. By comparison, there were no changes in glucose effectiveness at zero insulin (GEZI) or the insulin sensitivity index (S I ). To determine if iv glucose (given during the FSIGT) contributed to the rapid resolution of the sympathoadrenal response induced by icv FGFRi, we performed an additional study comparing groups that received iv saline or iv glucose 30 min after icv FGFRi. Our finding that elevated plasma catecholamine levels returned rapidly to baseline irrespective of whether rats subsequently received an iv bolus of saline or glucose indicates that the rapid reversal of sympathoadrenal activation following icv FGFRi was unrelated to the subsequent glucose bolus. Conclusions The effect of acute inhibition of central FGFR signaling to impair glucose tolerance likely involves a stress response associated with pronounced, but transient, sympathoadrenal activation and an associated reduction of insulin secretion. Whether this effect is a true consequence of FGFR blockade or involves an off-target effect of the FGFR inhibitor requires additional study. [ABSTRACT FROM AUTHOR]

Total knee arthroplasty (TKA) systems permit a degree of femoro-tibial component size mismatch. The effect of mismatched components on revision rates has not been evaluated in a large study. We reviewed 21,906 fixed-bearing PFC Sigma primary TKAs using the Australian Orthopaedic Association National Joint Replacement Registry, dividing patients into three groups: no femoro-tibial size mismatch, tibial component size > femoral component size, and femoral component > tibial component. Revision rates were higher when the femoral size was greater than the tibia, compared to both equal size (HR = 1.20 (1.00, 1.45), P = 0.047) and to tibial size greater than femoral (HR = 1.60 (1.08, 2.37), P = 0.019). Potential mechanisms to explain these findings include edge loading of polyethylene and increased tibial component stresses. [ABSTRACT FROM AUTHOR]

Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is an inherited cardiomyopathy characterized by fibro-fatty replacement of predominantly the right ventricle (Rv), which predisposes patients to life-threatening ventricular arrhythmias and usually slowly progressive ventricular dysfunction. The disease is inherited as an autosomal dominant trait with incomplete penetrance and variable expressivity. Increased appreciation of ARVD/C as a "disease of the desmosome" has fueled research into possible disease mechanisms, and insights into ARVD/C pathogenesis are rapidly advancing. Although ARVD/C is known to preferentially affect the RV, early and/or predominant left ventricular involvement is increasingly recognized. Diagnosis is made by combining multiple sources of diagnostic information as prescribed by the consensus-based Task Force criteria. Affected individuals typically present in the third to fifth decade of life with palpitations, lightheadedness, or syncope due to frequent ventricular ectopy or arrhythmias originating from the RV. However, disease expression is highly variable, even among subjects from the same family or those carrying the same mutation. since sudden cardiac death can be the first manifestation of the disease, optimizing the approach to early detection and risk stratification of ARVD/C is of utmost importance. This review will discuss the changing spectrum of ARVD/C based on recent advances in diagnosis, genetics, and improved understanding of disease pathophysiology. [ABSTRACT FROM AUTHOR]

A microscale combustion calorimeter (MCC) was modified to study gas phase combustion of polymers and flame-retardant plastics by adding carbon monoxide (CO) and carbon dioxide (CO 2 ) analyzers to the standard oxygen (O 2 ) analyzer. Experiments were conducted on 22 hydrocarbon, heteroatom and halogen-containing polymers of known composition over a wide range of combustion temperatures and oxygen concentrations. At high temperatures and excess oxygen when combustion was complete, the oxygen consumed (ΔO 2 ) and CO 2 produced by combustion of the pyrolysis gases were in quantitative agreement with theoretical values for all of these charring and non-charring polymers. At lower combustor temperatures, halogen-containing polymers exhibited significantly reduced fuel oxidation rates, as evidenced by a shift in maximum ΔO 2 , CO and CO 2 yields to much higher temperatures. [ABSTRACT FROM AUTHOR]

Cores MAR02-45 and MAR05-03 were raised from 68–69 m water depth on the SW Black Sea shelf and indicate transgression and submergence beneath several tens of metres of water before 11.0 cal ka. Those who postulate a Black Sea lowstand below − 100 m until the approximately 9.1 cal ka reconnection with the world ocean have suggested that sites like MAR02-45 and MAR05-03 must have been located in perched lakes on what is now the modern shelf. However, the silt- and clay-fraction mineralogy of samples from MAR02-45 provides no evidence for a shift in provenance at 9.1 cal ka, with earlier input from local rivers and later input from a broader region. Sedimentary abundances of Sc, Fe, Co, Ce, La, Th and Y also show no significant downcore trends. These elements likely reside in aluminosilicate mineral grains shed from terrestrial sources, so negligible downcore variation suggests long-term continuity in the composition of the detrital supply. More critically, the volume of pre-9.1 cal ka sediment around the MAR02-45 and MAR05-03 sites is > 25 times the expected yield from local rivers over a 5000 year period, so other more substantial sources are required. The predominant silt size of the recovered sediments, the configuration of late Holocene currents in the western Black Sea, and analogies with dispersal systems elsewhere suggest that the bulk of the fine-grained muds at these sites likely came from the Danube and Kamchiya drainage basins where thick deposits of unconsolidated Pleistocene loess have been strongly dissected. To reach core sites on the SW Black Sea shelf, this material must have been advected from the Danube and Kamchiya deltas by unobstructed marine currents. Only thin event beds (tempestites) of fine sand and silt in the lower part of cores MAR02-45 and MAR05-03 are interpreted to have a local source in the Strandja Mountains of Thrace. Comparison of the palynology of surface samples from the Danube Delta and its associated coastal lagoons with the pre-9.1 cal ka sediments of core MAR02-45 confirms that the hypothesis of deposition in a perched ancient lake is untenable. [ABSTRACT FROM AUTHOR]

Purpose The present study examined the relative contributions of perceptions of social support from parents, close friends, and school on current suicidal ideation (SI) and suicide attempt (SA) history in a clinical sample of adolescents. Methods Participants were 143 adolescents (64% female; 81% white; range, 12–18 years; M = 15.38; standard deviation = 1.43) admitted to a partial hospitalization program. Data were collected with well-validated assessments and a structured clinical interview. Main and interactive effects of perceptions of social support on SI were tested with linear regression. Main and interactive effects of social support on the odds of SA were tested with logistic regression. Results Results from the linear regression analysis revealed that perceptions of lower school support independently predicted greater severity of SI, accounting for parent and close friend support. Further, the relationship between lower perceived school support and SI was the strongest among those who perceived lower versus higher parental support. Results from the logistic regression analysis revealed that perceptions of lower parental support independently predicted SA history, accounting for school and close friend support. Further, those who perceived lower support from school and close friends reported the greatest odds of an SA history. Conclusions Results address a significant gap in the social support and suicide literature by demonstrating that perceptions of parent and school support are relatively more important than peer support in understanding suicidal thoughts and history of suicidal behavior. Results suggest that improving social support across these domains may be important in suicide prevention efforts. [ABSTRACT FROM AUTHOR]

Insulin injected directly into skeletal muscle diffuses rapidly through the interstitial space to cause glucose uptake, but this is blocked in insulin resistance. As glucotoxicity is associated with endothelial dysfunction, the observed hyperglycemia in diet-induced obese dogs may inhibit insulin access to muscle cells, and exacerbate insulin resistance. Here we asked whether interstitial insulin diffusion is reduced in modest hyperglycemia, similar to that induced by a high fat diet. Methods During normoglycemic (100 mg/dl) and moderately hyperglycemic (120 mg/dl) clamps in anesthetized canines, sequential doses of insulin were injected into the vastus medialis of one hindlimb; the contra-lateral limb served as a control. Plasma samples were collected and analyzed for insulin content. Lymph vessels of the hind leg were also catheterized, and lymph samples were analyzed as an indicator of interstitial insulin concentration. Results Insulin injection increased lymph insulin in normoglycemic animals, but not in hyperglycemic animals. Muscle glucose uptake was elevated in response to hyperglycemia, however the insulin-mediated glucose uptake in normoglycemic controls was not observed in hyperglycemia. Modest hyperglycemia prevented intra-muscularly injected insulin from diffusing through the interstitial space reduced insulin-mediated glucose uptake. Conclusion Hyperglycemia prevents the appearance of injected insulin in the interstitial space, thus reducing insulin action on skeletal muscle cells. [ABSTRACT FROM AUTHOR]

Chronic neurologic diseases such as Alzheimer's disease, Parkinson's disease, and amyotrophic lateral sclerosis, as well as various forms of chronic renal disease and systolic congestive heart failure, are among the most common progressive degenerative disorders encountered in medicine. Each disease follows a nearly relentless course, albeit at varying rates, driven by progressive cell dysfunction and drop–out. The neurologic diseases are characterized by the progressive spread of disease–causing proteins (prion–like proteins) from cell to cell. Recent evidence indicates that cell autonomous renin angiotensin systems operate in heart and kidney, and it is known that functional intracrine proteins can also spread between cells. This then suggests that certain progressive degenerative cardiovascular disorders such as forms of chronic renal insufficiency and systolic congestive heart failure result from dysfunctional renin angiotensin system intracrine action spreading in kidney or myocardium. [ABSTRACT FROM AUTHOR]

This is the second of three articles on the topic of truncation as an operation on divisible abelian lattice-ordered groups, or simply ℓ -groups. This article uses the notation and terminology of the first article and assumes its results. In particular, we refer to an ℓ -group with truncation as a truncated ℓ -group, or simply a trunc, and denote the category of truncs with truncation homomorphisms by AT . Here we develop the analog for AT of Madden's pointfree representation for W , the category of archimedean ℓ -groups with designated order unit. More explicitly, for every archimedean trunc A there is a regular Lindelöf frame L equipped with a designated point ⁎ : L → 2 , a subtrunc A ˆ of R 0 L , the trunc of pointed frame maps O 0 R → L , and a trunc isomorphism A → A ˆ . A pointed frame map is just a frame map between frames which commutes with their designated points, and O 0 R stands for the pointed frame which is the topology O R of the real numbers equipped with the frame map of the insertion 0 → R . ( L , ⁎ ) is unique up to pointed frame isomorphism with respect to its properties. Finally, we reprove an important result from the first article, namely that W is a non-full monoreflective subcategory of AT . [ABSTRACT FROM AUTHOR]

Background Interpretation of genetic screening results in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) often is difficult. Pathogenicity of variants with uncertain clinical significance may be predicted by software algorithms. However, functional assessment can unambiguously demonstrate the effect of such variants. Objective The purpose of this study was to perform functional analysis of potential splice site variants in ARVD/C patients. Methods Nine variants in desmosomal ( PKP2 , JUP , DSG2 , DSC2 ) genes with potential RNA splicing effect were analyzed. The variants were found in patients who fulfilled 2010 ARVD/C Task Force Criteria (n = 7) or had suspected ARVD/C (n = 2). Total RNA was isolated from fresh blood samples and subjected to reverse transcriptase polymerase chain reaction. Results An effect on splicing was predicted by software algorithms for all variants. Of the 9 variants, 5 were intronic and 4 exonic. RNA analysis showed a functional effect on mRNA splicing by exon skipping, generation of new splice sites, or activation of cryptic sites in 6 variants. All 5 intronic variants tested severely impaired splicing. Only 1 of 4 exonic potential splice site variants was shown to have a deleterious effect on splicing. The remaining 3 exonic variants had no detectable effect on splicing, and heterozygous presence in mRNA confirmed biallelic expression. Conclusion Six variants of uncertain clinical significance in the PKP2 , JUP , and DSG2 genes showed a deleterious effect on mRNA splicing, indicating these are ARVD/C–related pathogenic splice site mutations. These results highlight the importance of functional assessment of potential splice site variants to improve patient care and facilitate cascade screening. [ABSTRACT FROM AUTHOR]

Background: Previous human studies reported inconsistent effects of dietary protein and branched-chain amino acids (BCAAs) on insulin action and glucose metabolism. Similarly, it is unclear whether saturated fat (SF) intake influences these metabolic variables. Objective: The objective of this study was to test the effects of high [30% of energy (%E)] vs. moderate (20% E) intakes of protein (primarily whey) on insulin action and lipid and lipoprotein concentrations in the context of both high (15%E) and low (7%E) SF diets. Methods: The study was conducted as a randomized controlled trial in 158 overweight and obese men and women. After a 4-wk baseline diet [55%E carbohydrate, 15%E protein, 30%E fat (7%E SF)], participants were randomly assigned to 4 wk of either the baseline diet or 1 of 4 test diets containing 35%E carbohydrate and either 20%E or 30%E protein and either 7%E or 15%E SF. Frequently sampled i.v. glucose tolerance tests were administered after each dietary period. Results: Other than significantly higher fasting glucose concentrations for high vs. moderate protein intakes with a low-fat diet (difference ±SE:0 .4 7 ± 0.14 mmol/L; P= 0.001), there were no significant effects of dietary protein or SF on glucose metabolism, plasma insulin, or concentrations of lipids and lipoproteins. Changes in plasma BCAAs across all diets were negatively correlated with changes in the metabolic clearance rate of insulin (p = -0.18, P= 0.03) and positively correlated with changes in the acute insulin response to glucose (p = 0.15, P= 0.05). Conclusions: These findings suggest that short-term intake of BCAAs can influence insulin dynamics. However, in this group of overweight and obese individuals, neither high protein nor SF intake affected insulin sensitivity or plasma concentrations of lipids and lipoproteins. This trial was registered at clinicaltrials.gov as NCT00508937. [ABSTRACT FROM AUTHOR]

This study tested the hypothesis that black females have an increase in skeletal muscle and bone mineral mass compared with white females matched for age (±5 y), weight (±2 kg), height (±3 cm), and menstrual status. Conventional [underwater weighing, whole body 40K counting (WBC), ³H2O dilution] and newly developed (dual-photon absorptiometry) techniques were used to provide ethnicity-independent estimates of body composition in 28 pairs of matched subjects. Black females had greater appendicular skeletal muscle (P < 0.001), bone mineral (P < 0.001), and total body potassium (TBK) (P = 0.05) compared with white females. Two classic coefficients used in body composition research [density of fat-free mass (FFM) for underwater weighing and TBK/FFM for WBC] differed significantly (P < 0.05) between black and white females; currently applied coefficients underestimated fat in black females. This study confirms that black and white females differ in body composition and that errors in fat estimates occur when ethnicity is not accounted for in body composition models. [ABSTRACT FROM AUTHOR]

Family-based cognitive behavioral therapy (CBT) is an effective treatment for obsessive compulsive disorder (OCD), but not all children respond. Children with early-onset OCD may exhibit poorer outcomes, possibly due to developmental factors that affect treatment engagement and distress tolerance, which may ultimately affect treatment dose. Homework adherence between sessions can increase treatment dose and predict improved outcome. However, no studies have specifically examined the effect of homework adherence on treatment outcome for early-onset OCD. This study examined homework adherence during family-based CBT for young children (N = 63) with early-onset OCD. Caregiver and child homework adherence were rated weekly by clinicians and symptom change was assessed at multiple timepoints across treatment. Caregivers and children were both rated as highly adherent with homework, although caregivers were rated as more adherent than children. Structural equation modeling indicated that early homework adherence predicted later homework adherence, which predicted improved treatment outcome. • This study examined homework adherence during family-based CBT for early-onset OCD. • Caregivers and children were highly homework adherent across treatment course. • Early homework adherence predicted later homework adherence. • Homework adherence at the end of treatment predicted improved OCD treatment outcome. [ABSTRACT FROM AUTHOR]