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We sought to examine, via Phosphorus-31 magnetic resonance spectroscopy (31P-MRS) in a case-control design, whether bioenergetic deficits in autism spectrum disorders extend to the brain and muscle. Six cases with autism spectrum disorder with suspected mitochondrial dysfunction (age 6-18 years) and 6 age/sex-matched controls underwent 31P magnetic resonance spectroscopy. The outcomes of focus were muscle resting phosphocreatine and intracellular pH as well as postexercise phosphocreatine recovery time constant and frontal brain phosphocreatine. Intracellular muscle pH was lower in each autism spectrum disorder case than their matched control (6/6, P = .03; P = .0048, paired t test). Muscle phosphocreatine (5/6), brain phosphocreatine (3/4), and muscle phosphocreatine recovery time constant (3/3) trends were in the predicted direction (not all participants completed each). This study introduces 31P magnetic resonance spectroscopy as a noninvasive tool for assessment of mitochondrial function in autism spectrum disorder enabling bioenergetic assessment in brain and provides preliminary evidence suggesting that bioenergetic defects in cases with autism spectrum disorder are present in muscle and may extend to brain.

Previous studies report professional athletes return to play following arthroscopic microfracture of the hip for chondral defects. Our hypothesis is that professional hockey players undergoing arthroscopic microfracture for chondral defects of the hip achieve the same performance they had pre-injury and compared to matched controls. Seventeen professional hockey players underwent arthroscopic microfracture for an Outerbridge grade IV chondral lesion. Concomitant procedures for labral pathology or FAI were included. Performance data for the full season preceding and following index procedure were analysed, in addition to two matched control players per subject. Data were collected at two points, 2 years apart. Eighty-two per cent (14/17) of players who underwent arthroscopic microfracture returned to play. The year prior to injury for the 14 players who returned was compared to the average of their individual controls. There was no statistical difference between the groups for age, number of seasons in the league, games played, time on ice, points, save percentage, and shots against goal. Post-operatively, there was no statistical difference between the treatment and control groups regarding performance measures. There was a trend towards a decrease in games played and points post-operatively compared with controls. The treatment group decreased 11 games played, while the controls decreased five games. The treatment group also decreased 14 points, while the controls decreased three points for the season. Professional hockey players with a discrete, full-thickness chondral defect of the hip are able to return to elite performance level following an arthroscopic microfracture procedure when compared to pre-injury outcomes and controls. III.

Administration of Isuprel/Adenosine After PulmonaryVein Antrum IsolationBackground Pulmonary vein antrum isolation (PVAI) remains associated with atrial fibrillation (AF) recurrence. We administered adenosine and isoproterenol (ISP) after PVAI to uncover non-PV atrial triggers and PV reconnection, potentially increasing ablation success rate. Methods One hundred and ninety-two consecutive patients with symptomatic AF presenting for PVAI were prospectively studied (group 1). Following PVAI, adenosine (18–24 mg) and ISP (20–30 mcg/min) were administered intravenously. Supplemental ablation was performed in patients with non-PV triggers that induced AF (group 1A). Other subgroups included patients with (group 1B) or without (group 1C) consistent non-PV atrial foci that did not induce AF. A cohort of 196 matched control patients undergoing PVAI without drug challenge was used for comparison (group 2). Results A total of 132 atrial non-PV foci were revealed (31 inducing AF). The majority of atrial foci were observed with ISP (113/132, 86%). Less than 5% of patients had persistent PV recovery during the drug challenge. During a mean follow-up of 22 ± 8 months, PVAI was successful in 110/192 (57%, group 1) versus 100/196 (52%, group 2), P = 0.038. Furthermore, the success rate was statistically different between group 1A (25/32, 78%), group 1B (28/83, 34%), and group 1C (57/74, 74%), P < 0.001. Conclusion After PVAI, ablation guided by the administration of adenosine and ISP to target non-PV triggers inducing AF increased AF ablation outcomes. Patients with non-PV foci that did not induce AF had no further ablation, with the lowest ablation success rate. This group may likely benefit from further ablation after PVAI.

Background This study aimed to compare the metabolic and insulin secretory responses to dexamethasone with the metabolic responses observed at 10 years in normoglycaemic relatives of type 2 diabetic and healthy control subjects. Methods Twenty relatives and 20 matched control subjects were studied twice at 0 year (pre- and post-dexamethasone) and at 10 years, employing a 75-g oral glucose tolerance test (OGTT), with serial measurements of glucose and insulin, for determination of glucose tolerance and calculations of acute insulin release (ΔI30/ΔG30; insulinogenic index) and insulin sensitivity (SIHOMA). Results Following dexamethasone, the relatives group developed varying degrees of glucose intolerance, associated with reduced insulin sensitivity and insulinogenic index. By 10 years, fasting glucose and 2-h OGTT glucose were raised in the relatives group, especially in the relatives most metabolically affected by dexamethasone, including a reduced insulinogenic index. Multiple regression analysis of the data in relatives demonstrated that the 2-h OGTT glucose and fasting glucose values at 10 years depended on the 0-year post-dexamethasone 2-h OGTT glucose, post-dexamethasone fasting glucose and post-dexamethasone insulin sensitivity, r2adj = 56% (p

AIMS: This study aimed at comparing head posture, symmetry of shoulder muscle strength, and posture among developing flutists, professional flutists, and a matched control group of singers. METHODS: Measurements of head and scapular posture and muscle strength were compared between flutists with ≤10 yrs of practice (developing flutists, n=9), flutists with >10 years of practice (professional flutists, n=9), and singers (n=9). Posture was measured with a goniometer and tape measure; strength was assessed with an isokinetic dynamometer. RESULTS: Significant differences were found between groups concerning forward head posture only; developing flutists showed a higher forward head posture compared to the other two groups (p

Objective:To investigate whether the cumulative number, duration and subtypes (severity and presence of psychotic features) of previous episodes of depression in patients with unipolar depressive disorder in a remitted state are associated with decreased global cognitive function.Methods:Via the Danish registers individuals between 40 and 80 years of age were identified: (1) patients with a diagnosis of unipolar disorder at their first discharge from a psychiatric hospital in the period 1994 to 2002, and (2) gender and age matched control individuals. The participants were assessed with the Cambridge Cognitive Examination (CAMCOG), which provides a composite measure of global cognitive function.Results:A total of 88 patients and 50 controls accepted our invitation to participate, fulfilled the selection criteria and were included in the study. The cumulative duration of depressive episodes was associated with a decreased CAMCOG score adjusted for age, gender, education, premorbid IQ and residual depressive symptoms (B = −0.14, 95% C.I. (−0.26, −0.02), R2adj = 0.31, P = .02). Significant associations were also found between CAMCOG score and the cumulative duration and total number of depressive episodes with psychotic features, respectively.Conclusion:Our findings suggest that cognitive dysfunction is associated with the cumulative duration of depressive episodes, and that, in particular, depressive episodes with psychotic features in the course of illness may be a significant predictor of future impairment of cognitive function.

OBJECTIVE. This article describes a performance-based measure of executive function, the Multiple Errands Test–Revised (MET–R), and examines its ability to discriminate between people with mild cerebrovascular accident (mCVA) and control participants. METHOD. We compared the MET–R scores and measures of CVA outcome of 25 participants 6 mo post-mCVA and 21 matched control participants. RESULTS. Participants with mCVA showed no to minimal impairment on measures of executive function at hospital discharge but reported difficulty with community integration at 6 mo. The MET–R discriminated between participants with and without mCVA (p ≤ .002). CONCLUSION. The MET–R is a valid and reliable measure of executive functions appropriate for the evaluation of clients with mild executive function deficits who need occupational therapy to fully participate in community living.

Stanford University's Education Program for Gifted Youth (EPGY) conducted a randomized-treatment experiment during the 2006–2007 school year to test the efficacy, for Title I students, of the technological and individualized EPGY Kindergarten through Grade 5 Mathematics Course Sequence, modified for the Title I schools. Restricting attention to students who were in the top half of the distribution of correct first-exercise attempts (a measure of work and engagement), we found substantial and statistically significant improvements in the 2007 California Standard Math Tests (CST07) scores compared to those of matched control students. Gains in second grade were larger than those in Grades 3 to 5. Less able students, as measured by their 2006 CST mathematics scores, also had, on average, larger gains.

The long term aim with this study was to identify predictors or early indicators of tail biting outbreaks using registrations from electronic feeders. This study is based on information about daily frequency of feeder visits (DFV) and daily feed consumption (DFC) recorded in electronic feeders from 460 noncastrated boars in tail biting pens (TB pens, n = 21) and matched control pens (Con pens, n = 21) from 10 wk before to 10 wk after the first injured tail in the pen. The results showed lower average DFV among pigs in TB pens compared with pigs in Con pens 6 to 9 wk before the start of the tail biting outbreak (first treatment for tail damage due to tail biting; P ≤ 0.1, df = 487) but a greater DFV for tail biting victims 2 to 5 wk before the start of the tail biting outbreak compared both to other pigs in the TB pen and to pigs in the Con pen (P < 0.1, df = 6,500). Tail biting victims had decreased DFC during and after the tail biting outbreak (wk 0 to 2 after the tail biting outbreak (P < 0.1, df = 6,500)). In conclusion, information from electronic feeders can be used for surveillance of tail biting outbreaks in pigs. Due to common casual factors, low feeding frequencies observed on the group level can predict future tail biting in the pen as early as 9 wk before the first tail injuries. Moreover, increased feeding frequencies for individual pigs in potential tail biting pens may predict which pigs will be become the victims in the tail biting outbreak. The results further support previous findings that pigs with tail injuries due to tail biting consume decreased amounts of feed.

AimsThis study aimed to examine the relationship between rape and the subsequent psychiatric diagnosis of any anxiety or mood disorder.MethodData from the Danish Civil Registration System and the Danish Psychiatric Central Register were used to identify a sample of female victims who had visited a centre for rape victims during an index year and their subsequent psychiatric records were compared with a matched control group.ResultsWhile controlling for demographic variables and previous psychiatric disorders, the effect of sexual victimization increased the likelihood of a subsequent diagnosis of an anxiety disorder but not a mood disorder.ConclusionSexual victimization significantly increases the likelihood of experiencing an anxiety disorder, and therefore victims require post-assault information and support.

When comparing outcomes, such as survival, in two groups— say a focal group and a comparison group—a common question is whether an adjustment for certain baseline differences that separate these two groups actually matters for the difference in outcomes. Did the adjustment matter? If it did matter, to what quantitative extent did it matter? This question is quite distinct from whether the baseline variables predict the outcome: baseline variables may predict the outcome, yet explain no part of the difference in outcomes in two groups. The question is also distinct from whether a difference between the groups remains after adjustment: an adjustment may matter quite a bit, yet fail to explain a substantial part of the difference in outcomes, and, indeed, adjustment may increase the difference. Whether an adjustment for (x 1, x 2) matters over and above an adjustment for x 1 alone can be addressed by comparing outcomes in two control groups formed from the comparison group, one matched to the focal group for...

The immune system can be the target of many chemicals, with potentially severe adverse effects on the host's health. In Western countries pesticides, together with new and modified patterns of exposure to chemicals, have been implicated in the increasing prevalence of diseases associated with alterations of the immune response, such as hypersensitivity reactions, certain autoimmune diseases and cancers. Xenobiotics may initiate, facilitate or exacerbate pathological immune processes, resulting in immunotoxicity by induction of mutations in genes coding for immunoregulatory factors, modifying immune tolerance and activation pathways. The purpose of this article is to update the evidence of pesticide immunotoxicity. Even if experimental data as well as sporadic human studies indicate that some pesticides can affect the immune system, overall, existing epidemiological studies are inadequate to raise conclusions on the immunotoxic risk associated to pesticide exposure. The available studies on the effects of pesticides on human immune system have several limitations including poor indication on exposure levels, multiple chemical exposures, heterogeneity of the approach, and difficulty in giving a prognostic significance to the slight changes often observed. Further studies are necessary, and they should be preferably carried out through comparison of pre and post-exposure findings in the same group of subjects with a matched control group. Attempt should be made to define the prognostic significance of slight changes often observed. Animal and in vitro studies are also important and necessary to scientifically support epidemiological evidences on pesticide-induced immunotoxicity.

Proponents of the Conscious Capitalism (CC) movement claim that CC firms should demonstrate a lower gross margin, a higher profit margin, a lower SG&A, and a lower marketing expense than their non-CC comparable firms. Using a sample of industry-year-size matched control firms as the CC firms' benchmark, this article shows that empirical evidence largely disagrees with these conjectures. It further shows that in contrast to the implications of the CC movement, CC firms neither demonstrated superior stock performance relative to the S&P 500 in recent years, nor do they respond less to the pressures from the equity market.

Evidence suggests that the anterior cingulate cortex (ACC) plays a key role in the development of posttraumatic stress disorder (PTSD). Owing to the region’s highly variable patterns, three different studies of PTSD have yielded inconsistent volume reductions. Accordingly, in order to measure the correct borders and volumes, the different patterns of the ACC must be considered separately. We examined 15 victims with chronic symptoms of PTSD, all traumatized at the same accident in 1988, comparing them to 15 matched control subjects. After categorizing the ACC according to single, single segmented, double or double segmented cingulate sulcus (CS), we measured the area with a semi-automated procedure using Brain2 software. Fifty-three percent of our PTSD subjects had single segmented CS compared to 23 % in control subjects and 25 % in the literature. Furthermore, the four patterns showed differences in mean volume over all subjects of up to 13 %. We detected no differences in absolute ACC volumes when differentiating between the patterns or in correlation with brain volumes or clinical parameters. This is the first study to differentiate ACC structure into different patterns in PTSD. We found that one pattern was overrepresented which, in turn, could signal vulnerability to develop PTSD. Because of the remarkable volume differences between patterns, future studies should categorize this highly variable region into different patterns for volumetric measurements. However, future investigations in larger samples should confirm our findings and assess to which extend alterations of ACC patterns may influence the incidence of PTSD.

Purpose – The purpose of this paper is to investigate the extent to which introduction of ETFs reduces short‐sale constraints in their constituent stocks.Design/methodology/approach – First, the introduction of ETFs increases short interest for stocks that they hold. Second, the increase in short interest is highest for the stocks that were most short‐sale constrained. Third, subsequent additions of a stock to an ETF will have a lesser impact on short interest than the first time additions. Finally, using matched control sample and regression analysis approaches, the authors make sure that their results are robust to determinants of short‐selling activity which extant research has found to be relevant.Findings – When a stock is included in an ETF for the first time, the paper finds that the average monthly short‐selling activity of the stock in the six months following ETF‐inclusion is, on average, 33 percent higher than that in six months prior to the inclusion. This effect is the strongest for stocks th...

The empty and full can arm positions are used as diagnostic tests and in therapeutic exercise programs for patients with subacromial impingement syndrome. The adverse effects of these arm positions on the rotator cuff have not been fully described. The purpose of this investigation was to compare the acromio-humeral distance, three-dimensional scapular position, and shoulder pain during maximum isometric contractions in the empty and full can arm positions.Subjects with subacromial impingement syndrome (n=28) and a matched control group without shoulder pain (n=28) participated. Acromio-humeral distance, scapular/clavicular positions and shoulder pain were measured during maximal isometric contractions in each position.No difference was found in acromio-humeral distance (P=0.314) between the arm positions or between the groups (P=0.598). The empty can position resulted in greater scapular upward rotation (P0.001, difference=4.9°), clavicular elevation (P0.001, difference=2.7°), clavicular protraction (P=0.001, difference=2.5°) and less posterior tilt (P0.001, difference=3.8°) than the full can position. No differences in the scapular positions were found between the groups. Positive correlations were seen between the scapular positions in the control and not in the subacromial impingement group.Our results did not show a difference in acromio-humeral distance between the arm positions or groups, indicating that the kinematic differences between the positions are not associated with altered acromio-humeral distance. The increased pain in the EC position might be due to the lack of an association amongst the scapular positions rather than the deficiency of a single scapular motion.

Introduction: Vomiting in the emergency department after trauma occurs frequently and might lead to aspiration of gastric content. An orogastric tube (OGT) is a way to prevent emesis. However, this is an inconvenient procedure and may actually trigger vomiting. Therefore, a change in policy was applied from preferably an OGT to the administration of anti-emetics in a selected population. The aim of this study was to analyse the prevention of vomiting in trauma patients after OGT or anti-emetics. Materials and methods: Retrospective cohort study. Data of all trauma patients presented at the crash room of the emergency department between July 1st 2013 and July 1st 2014 were collected from the local trauma registry and electronic patient documentation system and comprising 6 months preceding and 6 months after change of policy. Vomiting and nausea after trauma were recorded. Furthermore, complications such as aspiration and cardiac arrhythmias were documented. Results: A total of 1446 patients were presented after trauma. 230 patients were promptly intubated. An additional 763 patients were fully responsive and did not complain of nausea. The remaining 453 patients were further analysed. 44 patients received OGT placement procedure and 409 patients received antiemetics. Significant difference was found in patients vomiting after OGT placement or anti-emetics (20.5% vs. 2.7%; P

Disease modification is a primary therapeutic aim when developing treatments for most chronic progressive diseases. The best treatments do not simply affect disease symptoms but fundamentally improve disease course by slowing, halting, or reversing disease progression. One of many challenges for establishing disease modification relates to the identification of adequate analytic tools to show differences in a disease course following intervention. Traditional approaches rely on the comparisons of slopes or noninferiority margins. However, it has proven difficult to conclusively demonstrate disease modification using such approaches. To address these challenges, we propose a novel adaptation of the delayed start study design that incorporates posterior probabilities identified by hierarchical Bayesian inference approaches to establish evidence for disease modification. Our models compare the size of treatment differences at the end of the delayed start period with those at the end of the early start period. Simulations that compare several models are provided. These include general linear models, repeated measures models, spline models, and model averaging. Our work supports the superiority of model averaging for accurately characterizing complex data that arise in real world applications. This novel approach has been applied to the design of an ongoing, doubly randomized, matched control study that aims to show disease modification in young persons with schizophrenia (the Disease Recovery Evaluation and Modification (DREaM) study). The application of this Bayesian methodology to the DREaM study highlights the value of this approach and demonstrates many practical challenges that must be addressed when implementing this methodology in a real world trial.

Introduction Parks are important settings for increasing population-level physical activity (PA). The objective of this study was to evaluate Park Hop, an incentivized scavenger-hunt-style intervention designed to influence park usage, discovery, park-based PA, and perceptions of parks among children and adolescents in Greenville County, South Carolina. Methods We used 2 data collection methods: matched preintervention and postintervention parent-completed surveys and in-park observations during 4 days near the midpoint of the intervention. We used paired-samples t tests and logistic regression to analyze changes in park visitation, perceptions, and PA. Results Children and adolescents visited an average of 12.1 (of 19) Park Hop parks, and discovered an average of 4.6 venues. In a subset of participants, from preintervention to postintervention, the mean number of park visits increased from 5.0 visits to 6.1 visits, the proportion of time engaged in PA during the most recent park visit increased from 77% to 87%, and parents reported more positive perceptions of the quality of park amenities. We observed more children and adolescents (n = 586) in the 2 intervention parks than in the 2 matched control parks (n = 305). However, the likelihood of children and adolescents engaging in moderate-to-vigorous PA was significantly greater in the control parks (74.3%) than in Park Hop parks (64.2%). Conclusion Park Hop facilitated community-collaboration between park agencies and positively influenced park usage, park discovery, time engaged in PA during park visits, and perceptions of parks. This low-cost, replicable, and scalable model can be implemented across communities to facilitate youth and family-focused PA through parks.

OBJECTIVEA population-based genealogical resource with linked medical data was used to define the observed familial clustering of Chiari malformation Type I (CM-I).METHODSAll patients with CM-I were identified from the 2 largest health care providers in Utah; those patients with linked genealogical data were used to test hypotheses regarding familial clustering. Relative risks (RRs) in first-, second-, and third-degree relatives were estimated using internal cohort-specific CM-I rates; the Genealogical Index of Familiality (GIF) test was used to test for an excess of relationships between all patients with CM-I compared with the expected distribution of relationships for matched control sets randomly selected from the resource. Pedigrees with significantly more patients with CM-I than expected (p < 0.05) based on internal rates were identified.RESULTSA total of 2871 patients with CM-I with at least 3 generations of genealogical data were identified. Significantly increased RRs were observed for first- and third-degree relatives (RR 4.54, p < 0.001, and RR 1.36, p < 0.001, respectively); the RR for second-degree relatives was elevated, but not significantly (RR 1.20, p = 0.13). Significant excess pairwise relatedness was observed among the patients with CM-I (p < 0.001), and borderline significant excess pairwise relatedness was observed when all relationships closer than first cousins were ignored (p = 0.051). Multiple extended high-risk CM-I pedigrees with closely and distantly related members were identified.CONCLUSIONSThis population-based description of the familial clustering of 2871 patients with CM-I provided strong evidence for a genetic contribution to a predisposition to CM-I.

This study aims at examining the attachment states of mind in 50 female outpatients with eating disorders compared with 50 matched control participants using the Adult Attachment Interview. Moreover, the differences in attachment states of mind among eating-disordered women with and without borderline personality disorders’ diagnosis were explored. The results showed an over-representation of insecure-dismissing and unresolved states of mind in clinical group compared to controls. Patients with both diagnosis showed higher scores on involving anger and unresolved loss compared with those with only eating disorder. Implications for further research and clinical practice are discussed.

Patent enforcement and its wide consequences have long been debated among scholars and practitioners. This study examines the causal impact of patent enforcement strength on firms’ technology trade and patenting strategies. Exploiting a precedential U.S. Supreme Court decision (eBay vs. MercExchange, 2006) that reduced patent enforcement strength, we investigate its impact by comparing U.S. firms to a matched control group of European firms. We find that U.S. firms significantly decrease their patenting and out-licensing activities due to lower patent enforcement strength. The decline in out-licensing activities is specifically driven by small and medium-sized firms, and software companies. Our study contributes to the innovation and markets for technology literatures by depicting the causal impact of patent enforcement strength, and discussing its implications.

Author(s): Tan, Teck Meng Junior Samuel | Advisor(s): Dechow, Patricia M | Abstract: Using a landmark Supreme Court decision as a natural experiment, I examine the impact of a fundamental requirement in securities litigation, the ex post loss rule, on income-decreasing accounting choices. Dura Pharmaceuticals v. Broudo (2005) established that plaintiffs must show that the alleged misrepresentations caused an actual economic loss. The case resolved a circuit split, allowing me to identify a treatment jurisdiction affected by Dura, and control jurisdictions in which the rule was already the prevailing legal standard. Motivated by legal analyses suggesting that Dura incentivizes firms to delay negative corrections, I hypothesize and find that treatment firms in high-litigation industries became more likely to delay write-downs and income-decreasing accrual error reversals at the firm level after Dura, relative to matched control firms. This dissertation sheds light on the relationship between securities law and accounting practices, and informs policy makers on the accounting impact of a key feature of the legal environment.

Main symptom of mucopolysaccharidosis type IVa (MPS IVa) is progressive systemic skeletal dysplasia. This is routinely monitored by cerebral and spinal MRI. The vascular system is generally not in the primary focus of interest. In our population of MPS IVa patients we observed vessel shape alterations of the vertebrobasilar arteries, which has not been described before.MRI-datasets of 26 patients with MPS IVa acquired between 2008 and 2015 were eligible for retrospective analysis of the vertebrobasilar arteries. The vessel length and angle of the basilar artery (BA) and both vertebral arteries (VA) were analyzed. A deflection angle between 90° and 130° in the vessel course was defined as tortuosity, less than 90° as kinking. The results were compared to a matched control group of 23 patients not suffering from MPS.The deflection angle [°] of the VA and BA was significantly decreased in the majority (85%) of MPS IVa patients compared to the control group: BA 132±24 vs. 177±6, BA/VA transition 113±21 vs. 152±13, right VA 108±23 vs. 156±13, left VA 110± 22 vs. 157±14 (all p0.005). Likewise, vessels of MPS IVa patients were significantly longer compared to the control group: BA 27±4 vs. 21±2, right VA 20±6 vs. 10±1, left VA 18±5 vs. 11±2 (all p0.005).MPS IVa is associated with significantly increased tortuosity of vertebrobasilar arteries. Therefore the vascular system of MPS IVa patients should be monitored on routinely basis, as vessel shape alterations had been associated with dissections, leading to a higher risk of cerebrovascular events.

Contains fulltext : 176032.pdf (Publisher’s version ) (Open Access) Objective: Since the publication of the WAIS-IV in the U.S. in 2008, efforts have been made to explore the structural validity by applying factor analysis to various samples. This study aims to achieve a more fine-grained understanding of the structure of the Dutch language version of the WAIS-IV (WAIS-IV-NL) by applying an alternative analysis based on causal modeling in addition to confirmatory factor analysis (CFA). The Bayesian Constraint-based Causal Discovery (BCCD) algorithm learns underlying network structures directly from data and assesses more complex structures than is possible with factor analysis. Method: WAIS-IV-NL profiles of two clinical samples of 202 patients (i.e. patients with temporal lobe epilepsy and a mixed psychiatric outpatient group) were analyzed and contrasted with a matched control group (N = 202) selected from the Dutch standardization sample of the WAIS-IV-NL to investigate internal structure by means of CFA and BCCD. Results: With CFA, the four-factor structure as proposed by Wechsler demonstrates acceptable fit in all three subsamples. However, BCCD revealed three consistent clusters (verbal comprehension, visual processing, and processing speed) in all three subsamples. The combination of Arithmetic and Digit Span as a coherent working memory factor could not be verified, and Matrix Reasoning appeared to be isolated. Conclusions: With BCCD, some discrepancies from the proposed four-factor structure are exemplified. Furthermore, these results fit CHC theory of intelligence more clearly. Consistent clustering patterns indicate these results are robust. The structural causal discovery approach may be helpful in better interpreting existing tests, the development of new tests, and aid in diagnostic instruments. 14 p.

Background Various factors contribute to instability of total hip arthroplasty (THA), with implant orientation being a major contributor. We performed a case-control study with computed tomography (CT) data to determine whether: 1) orientation contributes to THA instability and 2) a safer target zone for stability than Lewinnek's classic safe zone can be defined. Material and methods We included prospectively 363 cases of THA dislocation that occurred during the calendar 2013 year in 24 participating hospitals. Of the 128 dislocations that occurred in patients who underwent THA at these centers, 56 (24 anterior, 32 posterior) had CT scans, thus were included in the analysis. The control group was matched 4:1 based on implant type, year of implantation, age, sex, bearing types and THA indication. Of the 428 matched control THA cases, 93 had CT scans. In all, the CT scans from 149 cases (56 unstable, 93 stable) were analyzed to determine the acetabular cup's inclination and anteversion, and the femoral stem's anteversion. Results In the unstable THA group, cup inclination was 46.9° ± 7.4°, cup anteversion was 20.4° ± 10.8° and stem anteversion was 14.2° ± 9.9°. In the stable THA group, cup inclination was 44.9° ± 5.3° (P = 0.057), cup anteversion was 22.1° ± 5.1° (P = 0.009) and stem anteversion was 13.4° ± 4.4° (P = 0.362). The optimal total anteversion (cup + stem) of 40–60° was achieved in 16.5% of unstable THA cases and 13.9% of stable THA cases, thus this parameter does not predict stability (odds ratio [OR] of 0.40, P = 0.144). The cup was positioned in Lewinnek's safe zone in 44.6% of patients in the unstable group and 68.2% of those in the stable group (OR 3.74, P = 0.003). A target zone defined as 40–50° inclination and 15–30° anteversion was better able to distinguish between unstable cases (23.2%) and stable cases (71.6%) resulting in an OR of 13.91 (P Discussion Implant positioning was the only risk factor for instability found in this study. Moreover, our findings reinforce the theory put forward by other authors that Lewinnek's safe zone is not specific enough to differentiate between stable and unstable THA implantations. The target zone for acetabular cups proposed here (40–50° inclination and 15°–30° anteversion) is related to a lower risk of instability. This orientation can be used as a guide, but must be combined with other technical elements to optimize stability. By balancing stability and biomechanics, the 40–50° inclination and 15°–30° anteversion target zone redefines the optimal positioning window. Level of evidence III case-control study.

The U.S. teen birth rate remains high relative to other industrialized countries. Despite extensive literature on teen mothers and their children, almost no research has examined the rest of the mother’s family. I address this gap, finding that teen birth negatively affects the mother’s younger siblings. To estimate this effect, I use several matched control methods, all of which compare siblings of teen mothers to similar students in other families. I show that it is important to control for pre-existing downward trajectories in these families, both for estimating sibling spillovers and for estimating the effect on the mother herself.

To evaluate potential calming effects of alpha-casozepine on horses, we blindly compared behavior and training efficiency of adult semi-feral ponies treated with either alphacasozepine or control supplement during transition to domestic management and handling. Six ponies (three matched pairs) aged 2 to 8 years that had been reared and kept since birth under semi-feral social and environmental conditions were given either alpha-casozepine (1000 mg orally once daily for ponies weighing 160 to 205 kg) or control supplement, beginning 5 days before being moved to a domestic facility for a 2-week introduction to stabling, haltering, leading, tethering, social separation, stall confinement, grooming, simulated girthing, lifting feet, health care treatments, and transportation. Objective quantitative behavior measures (latencies to complete tasks, avoidance responses, and nervous defecations) were derived from video-recorded handling sessions. For each of the 14 sessions, ponies were ranked 1 (best) to 6 (poorest) for calm, compliance, and acclimation/skill progress. All humaneanimal interactions, video analyses, and rankings were done blindly to supplement assignments. For most daily sessions across the 2-week training period, each of the three alpha-casozepinetreated ponies performed better than their matched control counterparts, and they also had the top three sums of daily session ranks, with a mean of 35.2 compared with 62.8 for control ponies (P < .05, dependent t-test). At 6 weeks after the 2-week training period, the alpha-casozepine-treated ponies retained the best three sum of ranks for the seven specific skills re-assessed at that time. These results provide evidence of the benefit of alpha-casozepine supplementation to horses undergoing potentially stressful situations inherent to domestic management.

Maintaining burn patients' body temperature during surgery is a significant challenge. Although increasing the ambient operating room (OR) temperature and other passive rewarming methods help, such measures have limited effectiveness and prove taxing on OR personnel. Initial studies indicate that an intravascular warming catheter may improve and sustain burn patient body temperatures. The authors hypothesize that the warming catheter is similarly effective at maintaining normothermia despite a lower OR temperature than in a cohort of matched control burn patients. This is a retrospective case-control study involving patients with major burns treated between January 2006 and June 2011. Cases received an intravascular warming catheter, whereas controls receive traditional temperature conserving interventions. As the catheters maintained body temperature, the room temperature was gradually lowered to normal. Twenty-three patients were involved in 31 cases using the catheter, compared with 39 controls in 62 surgeries. The mean temperature deviation for each catheter group was -0.76 ± 1°C and -0.80 ± 0.9°C for the control group. Given 20-minute intervals throughout the operations, the mean patient temperature for cases and controls never deviated by more than 1°C. OR staff satisfaction has improved with decreased room temperatures. An intravenous warming catheter reliably maintained patient core body temperature during surgery. To date, this is the largest cohort study of such a catheter among burn patients. This system may be more effective than current warming techniques, with the potential to decrease the total number of procedures and the time to complete wound closure.

C reactive protein is sensitive physiological biomarkers of sub clinical inflammation associated with hyperglycemia. The aim of this study is to determine the fasting serum C reactive protein level in type 2 diabetes mellitus patients attending diabetic clinic in Benin City, Nigeria. The population sample consists of 142 subjects. 71 patients were known type 2 diabetes mellitus, while the other 71 were age matched control subjects. Fasting glucose and C reactive protein were estimated using glucose oxidase method and ELISA method respectively. The age group that has the highest number of type 2 diabetes mellitus was 41 - 50 (64% of males and 36% of the females). Our finding revealed that C reactive protein and serum glucose level of type 2 Diabetes mellitus in both females and males show a statistically significant increase as compared with age matched Control subjects, (P

Defense mechanism is a key concept in the psychoanalytic psychopathology of borderline personality disorder (BPD). Theoretical and empirical elaborations on this question are briefly reviewed and discussed with respect to process assessment of defense mechanisms; we put forward observer-rater methodology as an accurate means of assessing unconscious in-session processes. A sample of 25 patients presenting with BPD were interviewed, as were subjects from a matched control group without psychiatric symptoms (n = 25), using a psychodynamic interview paradigm. These interviews were transcribed and rated using the Defense Mechanisms Rating Scales. The results indicate that, compared to controls, patients with BPD used higher percentages of a action, borderline, disavowal, narcissistic, and hysteric defenses, along with lower levels of mature and obsessional defenses. Overall defensive functioning was significantly lower in the patients with BPD, compared to controls. Narcissistic defenses were related with symptom level. These results are discussed in light of previous studies on defensive functioning of BPD and the literature on psychoanalytic psychopathology. These results have several important clinical implications.

We examined whether normal aging spares or compromises cue-driven spontaneous retrieval processes that support prospective remembering. In Experiment 1, young and older adults performed prospective-memory tasks that required either strategic monitoring processes for retrieval (nonfocal) or for which participants relied on spontaneous retrieval processes (focal). We found age differences for nonfocal, but not focal, prospective-memory performance. Experiments 2 and 3 used an intention-interference paradigm in which participants were asked to perform a prospective-memory task (e.g., press "Q" when the word money appears) in the context of an image-rating task and were then told to suspend their prospective-memory intention until after completing an intervening lexical-decision task. During the lexical-decision task, we presented the exact prospective-memory cue (e.g., money; Experiments 2 and 3) or a semantically related lure (e.g., wallet; Experiment 3), and we inferred spontaneous retrieval from slowed lexical-decision responses to these items relative to matched control items. Young and older adults showed significant slowing when the exact prospective-memory cue was presented. Only young adults, however, showed significant slowing to the semantically related lure items. Collectively, these results partially support the multiprocess theory prediction that aging spares spontaneous retrieval processes. Spontaneous retrieval processes may become less sensitive with aging, such that older adults are less likely to respond to cues that do not exactly match their encoded targets.

PurposeTo evaluate cellular activity in milled versus unmilled surface of the femoral head in 21 patients who underwent robot-assisted total hip arthroplasty (THA).MethodsThe femoral head of 21 consecutive patients who underwent robot-assisted THA for osteonecrosis was used. 10 cc of trabecular bone from the entire milled surface was obtained using a curette. The same amount of trabecular bone was obtained at least 1 cm away from the milled surface and served as a matched control. Cell morphology, viability, osteocalcin activity, and alkaline phosphatase activity in milled versus unmilled surface were assessed.ResultsCell morphology of the milled or unmilled surface was comparable; cells were smaller in the milled surface. Cell viability was a mean of 40% higher in the milled surface (107.4% vs. 67.2%, pConclusionThe milled and unmilled surfaces of the femoral head were comparable in terms of cell morphology, viability, osteocalcin activity, and alkaline phosphatase activity.

The aim of this study was to investigate the relationship between the optic nerve sheath diameter (ONSD) measured on non-contrast head computed tomography (CT) and the diagnosis and prognosis of spontaneous subarachnoid hemorrhage (SAH) on emergency department (ED) patients.We used a matched control group of patients with the same age and gender who were diagnosed in the ED with spontaneous SAH and who admitted to the ED with headache. Four emergency medicine attending physicians made the ONSD measurements. For measurements, the 3-mm posterior location where the optic nerve enters the eyeball was used.This study was done with 61 spontaneous SAHs with an equal number of control patients. The median ONSD for control and spontaneous SAH groups was 5.76 [interquartile range (IQR): 0.96] mm and 6.72 (IQR: 1.42) mm, respectively (p0.001). The area under the receiver operating characteristic curve was determined as 0.791 (confidence interval 95% 0.710-0.872). At an ONSD threshold value of 6.1 mm, the sensitivity and specificity of SAH was 72%. There was no significant relationship between ONSD and in-hospital mortality in spontaneous SAH patients (p0.05). The intra-class correlation coefficients for inter and intra-rater reliability were 0.84 and 0.95, respectively.In patients with spontaneous SAH, the ONSD measured in the orbital sections of a head CT is strongly correlated with a SAH diagnosis. Assessment of ONSD in head CTs taken with spontaneous SAH suspicion may contribute to the diagnoses of spontaneous SAH.

BACKGROUND: Obesity is a leading cause of mortality and morbidity in Prader-Willi syndrome (PWS). OBJECTIVES: To study weight loss and growth after laparoscopic sleeve gastrectomy (LSG) in pediatric patients with PWS compared with those without the syndrome. SETTING: Academic center with a standardized care pathway for pediatric bariatric surgery as a part of a prospective clinical outcome study on children and adolescents undergoing weight loss surgery. METHODS: Clinical data of all PWS patients who underwent LSG were abstracted from our prospective database, which included all pediatric patients who underwent bariatric surgery. These data were then compared with a 1:3 non-PWS group matched for age, gender, and body mass index (BMI). Data for up to 5 years follow-up were analyzed. RESULTS: The 24 PWS patients (mean age 10.7; 6 < 8 yr old, range 4.9–18) had a preoperative BMI of 46.2 ± 12.2 kg/m(2). All PWS patients had obstructive sleep apnea (OSA), 62% had dyslipidemia, 43% had hypertension, and 29% had diabetes mellitus. BMI change at the first, second, third, fourth, and fifth annual visits was −14.7 (n = 22 patients), −15.0 (n = 18), 12.2 (n = 13), −12.7 (n = 11), and −10.7 (n = 7), respectively, in the PWS group, whereas the non-PWS group had a BMI change of −15.9 (n = 67), −18.0 (n = 50), −18.4 (n = 47), −18.9 (n = 26), and −19.0 (n = 20), respectively. No significant difference was observed in postoperative BMI change (P = .2–.7) or growth (postoperative height z-score P value at each annual visit = .2–.8); 95% of co-morbidities in both groups were in remission or improved, with no significant difference in the rate of co-morbidity resolution after surgery (P = .73). One PWS patient was readmitted 5 years after surgery with recurrence of OSA and heart failure. No other readmissions occurred, and there were no reoperations, postoperative leaks, or other complications. No mortality or major morbidity was observed during the 5 years of follow-up. Among the PWS patients who reached their follow-up visit time points the total follow-up rate was 94.1%, whereas in the non-PWS group it was 97%. All patients who missed a follow-up visit were subsequently seen in future follow-ups, and no patient was lost to follow-up in either group. CONCLUSIONS: PWS children and adolescents underwent effective weight loss and resolution of co-morbidities after LSG, without mortality, significant morbidity, or slowing of growth. LSG should be offered to obese PWS patients with heightened mortality particularly because no other effective alternative therapy is available.

Increased cardiac troponin I (cTnI) concentration has been reported in dogs with atrioventricular (AV) block before and shortly following pacemaker implantation. The role of AV dyssynchrony, age, or concurrent cardiac disease on cTnI concentration remains unknown.To investigate change in cTnI concentration following dual-chamber pacemaker implantation on short- and long-term follow-up and to compare cTnI values to a case-matched control group.Thirty-eight client-owned dogs with permanent AV block and 38 matched control dogs.Retrospective review of medical records. Pacemaker group consisted of dogs with AV block and dual-chamber pacing. Control group matched the study population in age and cardiac disease. cTnI was compared between pacemaker and control group on short- and long-term follow-up. Different lead types and influence of arrhythmia on cTnI were tested.cTnI was high at presentation (median 0.66 ng/ml; range 0.03-18.6) and showed a significant reduction over time after pacemaker implantation (p 0.0001). Median cTnI values were significantly different between pacemaker and control group on short-term (p = 0.0004; 0.11 ng/ml, range 0.03-1.36 versus 0.06 ng/ml, range 0.03-0.46), but not on long-term follow-up (p = 0.0547; 0.14 ng/ml, range 0.03-0.73 versus 0.07 ng/ml, range 0.03-0.46). Lead type and severity of arrhythmia did not show a significant correlation to cTnI concentration.On long-term follow-up, cTnI remained mildly elevated in some of the pacemaker dogs but was not significantly different to the matched control group.

To evaluate the effects of a chronic occupational exposure to toluene on color vision. Color vision was tested in 51 workers exposed to pure toluene and in 51 matched control subjects. Current exposure was determined by biological monitoring. Blood samples were taken at the end of a Friday shift. Color vision ability was assessed using the Ishihara plates (to screen for congenital dyschromatopsia), the Farnsworth panel D-15 test, the Lanthony panel D-15 desaturated test, the Velhagen plates, and the Standard Pseudoisochromatic Plates Part 2. Median toluene concentration was 1.59 mg/l (quartiles 0.78 and 2.65). The whole group of workers did not perform worse than the controls. The same applies to 20 printers, who regularly assessed hues. Assessed with the most sensitive Lanthony panel D-15 desaturated test, color vision of 24 permanently exposed assistants was impaired (median color confusion index of the 1st eyes 1.08 vs. 1.02, p

Background: Primary schools are increasingly used as arenas for public health initiatives. The aim of this study was to assess a primary school-based food intervention. Methods: The intervention comprised timetabled kitchen classroom sessions (90 min, fortnightly). Pupils prepared and cooked food, which they then ate together. Children's relationship with food, including food enjoyment, experience and food neophobia, were addressed at the intervention school (baseline n = 154; follow-up n = 164) and at a matched control school (baseline n = 171; follow-up n = 174). Results: Pupils at the intervention school scored significantly higher (M = 3.90, SD = 1.81) for scores on Kitchen Equipment, compared to the control school (M = 3.06, SD = 2.12); and again scored significantly higher (M = 9.34, SD = 3.79) for the overall Cooking Experience Score compared to the control school (M = 7.98, SD = 4.57). Shifts accompanying the intervention in three outcome measures for pupils (taste description, liking for cooking and helping with cooking at home) were also revealed. No main intervention effect for food neophobia and fussiness was found; a close to significant time by intervention interaction (P = 0.053) was evident. Conclusions: The study indicates limited but encouraging changes, and contributes to the growing literature regarding school-based food initiatives.

The aim of the current study was to examine the effectiveness of a school-centered multicomponent PA intervention, called ‘Active Living’, on children's daily PA levels. A quasi-experimental design was used including 9 intervention schools and 9 matched control schools located in the Netherlands. The baseline measurement took place between March–June 2013, and follow-up measurements were conducted 12 months afterwards. Accelerometer (ActiGraph, GT3X +) data of 520 children aged 8–11 years were collected and supplemented with demographics and weather conditions data. Implementation magnitude of the interventions was measured by keeping logbooks on the number of implemented physical environmental interventions (PEIs) and social environmental interventions (SEIs). Multilevel multivariate linear regression analyses were used to study changes in sedentary behavior (SB), light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) between baseline and follow-up. Finally, effect sizes (ESs) were calculated using Cohen's d. No pooled effects on PA and SB were found between children exposed and not exposed to Active Living after 12 months. However, children attending Active Living schools that implemented larger numbers of both PEIs and SEIs engaged in 15 more minutes of LPA per weekday at follow-up than children in the control condition (ES = 0.41; p < .05). Moreover, children attending these schools spent less time in SB at follow-up (ES = 0.33), although this effect was non-significant. No significant effects were found on MVPA. A school-centered multicomponent PA intervention holds the potential to activate children, but a comprehensive set of intervention elements with a sufficient magnitude is necessary to achieve at least moderate effect sizes.

The objective of this study was to explore salivary metabolite biomarkers by profiling both saliva and tumor tissue samples for oral cancer screening. Paired tumor and control tissues were obtained from oral cancer patients and whole unstimulated saliva samples were collected from patients and healthy controls. The comprehensive metabolomic analysis for profiling hydrophilic metabolites was conducted using capillary electrophoresis time-of-flight mass spectrometry. In total, 85 and 45 metabolites showed significant differences between tumor and matched control samples and between salivary samples from oral cancer and controls, respectively (P P

This study analyses, retrospectively, an established data set to measure the effect of the circulation change in European Resuscitation Council Guidelines. This prospective matched control study examined the extent to which Year 6 (10-11 years) children retained and were able to demonstrate the sequencing and assessment skills of Basic Life Support (BLS) techniques 5 months after BLS training through the Injury Minimization Programme for Schools (I.M.P.S.). A total of 1292 children were enrolled at the beginning of the study: 657 in the intervention group received BLS through I.M.P.S., 635 children in the control group received no planned intervention. Children in both groups were tested 5 months after intervention using small portable manikins. Chi-square analysis of individual variables indicated that the intervention group was better (P

To assess heart rate variability (HRV) in athletes with concussion across three phases of recovery.A prospective matched control group design included the collection of HRV and symptoms measured by the Rivermead Post-Concussion Questionnaire. These measures were taken at 3 phases of recovery [(1) symptomatic; (2). asymptomatic; and (3) one-week after return-to-play (RTP)]. The same protocol was completed by noninjured athletes.Interuniversity sports teams at a single institution.11 athletes, across 7 sports, diagnosed with concussion, and 11 matched-athlete controls volunteered for the study.Physician diagnosed concussion and a sitting to standing protocol for HRV monitoring.The frequency, time, and nonlinear domains of HRV were assessed along with the absolute difference between sitting and standing for each.A 2 x 3 (group x phase) repeated-measures analysis of variance revealed significant interactions for sitting High Frequency (HF) norm, sitting Low Frequency (LF) norm, the difference between sitting and standing HF norm, and difference between sitting and standing LF norm. Acutely, athletes with concussion displayed increased LF norm and decreased HF norm while sitting and a decreased change in their HF and LF norm measures between sitting and standing. A significant group effect for sample entropy when standing was detected, with the concussed group displaying decreased values compared with the matched controls.Athletes with concussion displayed autonomic dysfunction in some measures of HRV that persisted beyond RTP and were related to a previous history of concussion.

We have analyzed the frequency and properties of the nuclear activity in a sample of galaxies with circumnuclear rings and spirals (CNRs). This sample was compared with a control sample of galaxies with very similar global properties but without circumnuclear rings. We discuss the relevance of the results in regard to the AGN feeding processes and present the following results: (i) bright companion galaxies seem not to be important for the appearance of CNRs, which appear to be more related to intrinsic properties of the host galaxies or to minor merger processes; (ii) the proportion of strong bars in galaxies with an AGN and a CNR is somewhat higher than the expected ratio of strongly barred AGN galaxies from the results of Ho and co-workers; (iii) the incidence of Seyfert activity coeval with CNRs is clearly larger than the rate expected from the morphological distribution of the host galaxies; (iv) the rate of Sy 2 to Sy 1 type galaxies with CNRs is about three times larger than the expected ratio for galaxies without CNRs and is opposite to that predicted by the geometric paradigm of the classical unified model for AGNs, although it does support the hy-pothesis that Sy 2 activity is linked to circumnuclear star formation. The possible selection effects of the sample are discussed, and we conclude that the detected trends are strong enough to justify high quality observations of as large as possible sets of galaxies with circumnuclear rings and their matched control samples., Submitted to International Journal of Astronomy and Astrophysics

To compare our experience with salvage laparoscopic pyeloplasty, using a matched control set of primary laparoscopic pyeloplasty patients. We retrospectively reviewed patients who underwent laparoscopic pyeloplasty from 1996 to 2014 by a single surgeon. At least 12 months of follow-up was required. Salvage patients were matched 1:3 with primary patients. Matching was based on age ±5 years, body mass index (BMI) ±5, and type of pyeloplasty (dismembered vs. non-dismembered). Primary outcome was failure as defined as re-intervention following laparoscopic pyeloplasty (does not include temporary stenting without definitive retreatment). Of 128 laparoscopic pyeloplasty procedures, ten were salvage. These patients were matched to 26 patients who underwent a primary laparoscopic pyeloplasty in a 1:3 manner. One salvage pyeloplasty failed to match due to BMI, and the closest matches were made. Four salvage patients had one overlapping match, reducing the primary group to 26 patients. There were no differences in pre-, intra-, and postoperative variables between groups, except for operative time (salvage 247 min, primary 175 min, p = 0.03). With similar duration of radiologic and symptomatic follow-up, there was no significant difference in the rate of freedom from intervention. When matching for factors that could affect success, salvage laparoscopic pyeloplasty performed as well as primary pyeloplasty except for a longer operative time. In experienced hands, salvage laparoscopic pyeloplasty for ureteropelvic junction obstruction recurrence after prior pyeloplasty is a safe and effective procedure, and should be considered an excellent alternative to the more commonly recommended endopyelotomy.

This paper provides experimental evidence that visual representation of strategy and related concepts increases the probability of updating the cognitive frames of small entrepreneurs. An original strategy mapping technique and Osterwalder and Pigneur’s (2010) business model canvas were used to help 42 small entrepreneurs to critically review their current strategies and choices. A questionnaire about perceptions of the external environment and internal structure was submitted to the participants before and after the experiment. The same questionnaire was submitted twice to a matched control group of 50 SME entrepreneurs who were not involved in any activity. The results show that involvement in the visualization experiment significantly increased the probability of the participant changing perceptions on strategic issues, with a stronger impact for strategy mapping. The results are interpreted as indicative of a positive contribution of visual representation in strategy renewal.

Objectives This study examined patterns of professional and nontraditional help-seeking in a national sample of veterans from 57 colleges/universities and demographically matched students from the same institutions who had not served in the US Armed Forces. Methods In total, 945 veterans and 2835 demographically matched nonveteran students from the same 4-year institutions completed assessments of help-seeking intentions and behaviors from professional, religious and informal sources in the Healthy Minds Study between 2011 and 2015. Results Drawing on bivariate and multivariate logistic regression models, equal ratios of these samples (2:1) did not endorse professional help-seeking intentions or behaviors. When compared to nonveteran students, veterans had greater intentions for religious help-seeking but were less likely to seek help from family/friends. Nearly half of depressed veterans who had not utilized services had also not sought help from any religious or informal sources. Conclusions Unmet mental health needs might interfere with the success of a sizeable contingent of veterans pursuing new vocational goals. Community-based programs that can educate and/or equip nontraditional sources of support in veterans' naturally occurring relationships might offset these concerns.