Enhancing the Utility of the Dexamethasone Suppression Test: A Chart Review and Application of Bayes\u27 Theorem

The dexamethasone suppression test (DST) is the most extensively studied biological test in psychiatry. Despite this, its role in the diagnostic assessment of psychiatric patients remains controversial. Shortcomings of the test include limited sensitivity (45%) and limited specificity (75-80%) (1). The DST has many proposed uses, including the differentiation of endogenous from non-endogenous depressions, helping to decide when maintenance medications may be withdrawn, and as a diagnostic test for major depression. This paper is concerned with the latter use only, that is, the ability of the DST to function as a useful diagnostic test for major depression. The significance of the low sensitivity and specificity of the DST have been discussed extensively in the psychiatric lite rature (2,3). When the DST is used as a diagnostic test for major depression its sensitivity represents the likelihood of a positive test given that the tested patient has a major depression. Specificity represents the likelihood of a negative test given that the tested patient does not have a major depression. Notably, both sensitivity and specificity represent probabilities conditional on the presence or absence of disease. However, in the usual clinical situation, the diagnosis is unknown at the time the diagnostic test is ordered. Indeed, if the diagnosis is known then the test should not be performed. Thus neither sensitivity nor specificity is directly relevant to the interpretation of the results of diagnostic tests in a clinical setting. Another parameter, the positive predictive value (+ PV), is of more clinical relevance

Report on estimating the size of dolphin schools, based on data obtained during a charter cruise of the M/V Gina Anne, October 11 -November 25, 1979

Estimates of dolphin school sizes made by observers and crew members aboard tuna seiners or by observers on ship or aerial surveys are important components of population estimates of dolphins which are involved in the yellowfin tuna fishery in the eastern Pacific. Differences in past estimates made from tuna seiners and research ships and aircraft have been noted by Brazier (1978). To compare various methods of estimating dolphin school sizes a research cruise was undertaken with the following major objectives: 1) compare estimates made by observers aboard a tuna seiner and in the ship's helicopter, from aerial photographs, and from counts made at the backdown channel, 2) compare estimates of observers who are told the count of the school size after making their estimate to the observer who is not aware of the count to determine if observers can learn to estimate more accurately, and 3) obtain movie and still photographs of dolphin schools of known size at various stages of chase, capture and release to be used for observer training. The secondary objectives of the cruise were to: 1) obtain life history specimens and data from any dolphins that were killed incidental to purse seining. These specimens and data were to be analyzed by the U.S. National Marine Fisheries Service ( NMFS ) , 2) record evasion tactics of dolphin schools by observing them from the helicopter while the seiner approached the school, 3) examine alternative methods for estimating the distance and bearing of schools where they were first sighted, 4) collect the Commission's standard cetacean sighting, set log and daily activity data and expendable bathythermograph data. (PDF contains 31 pages.

Chevalier Jackson, M.D. (1865-1958): Il ne se repose jamais.

In the final year of the American Civil War, 1865, Chevalier Jackson was born on the 4th of November just outside Pittsburgh, Pennsylvania. The eldest of three sons of a poor, livestock-raising family, Jackson was raised in a period of social and political unrest. He was perhaps an even more unrestful boy. The description of his childhood days from his father’s father—Il ne se repose jamais, ‘‘He never rests’’—would ultimately reflect the man, doctor, and evangelist Jackson would later become.1 Indeed, he never did rest, Jackson would tirelessly pave the way for modern bronchoscopy and endoscopy as a whole; bringing international renown not only to himself, but also to his specialty

The Minimally Invasive Management of Ureteropelvic Junction Obstruction in Horseshoe Kidneys

Purpose: Data regarding the treatment of ureteropelvic junction obstruction (UPJO) in horseshoe kidneys are limited. We performed a retrospective analysis of our experience with minimally invasive treatment of UPJO in patients with this anomaly. Methods: Between March of 1996 and March 2008, 9 patients with horseshoe kidneys were treated for UPJO at our institution. Of these patients, 6 were managed with retrograde endopyelotomy, 2 with laparoscopic pyeloplasty, and one by robotic pyeloplasty. Outcomes of these procedures were retrospectively reviewed. Results: A total of nine patients were available for analysis. Four of six patients who underwent endopyelotomy had available follow-up, with a mean of 56 months. The success rate for these patients was 75%. Two of three patients (67%) in the laparoscopic/robotic cohort were successfully treated with a mean follow-up of 21 months. Conclusions: UPJO in horseshoe kidneys can pose a therapeutic dilemma. The minimally invasive treatment of these patients is feasible with good success rates for both endopyelotomy and laparoscopic/robotic pyeloplast

Discrimination against Mixed-Status Families and its Health Impact on Latino Children

Background and Objective: Restrictive immigration policies and discrimination are associated with negative health outcomes for immigrant and Latino families. Mixed-status families represent a unique subpopulation of Latinos affected by restrictive immigration policies. This qualitative study explored discrimination against mixed-status families and its potential health impact on Latino children from the perspective of Latina mothers. Methods: In 2017, twenty in-depth interviews with Latina mothers of mixed-status families living in northwestern North Carolina were conducted, transcribed, and analyzed. Constant comparison, an approach to grounded theory development, was used. Results: Nine themes emerged that reflected experiences with discrimination and its negative impact on children. Themes included more frequent and severe discrimination during and after the 2016 US presidential election, determination to stay together and remain in the US, experiences of discrimination in multiple settings, the impact of discrimination on child health and well-being, the impact of fear and stress on meeting the needs of children, the burden on children serving as liaisons between families and services, the inability of citizenship to protect against the effects of discrimination, positive and hopeful responses to discrimination, and the potential role of education in building a foundation for reducing discrimination (and thus promoting the health and well-being of Latino children) in the future. Conclusions: Discrimination against mixed-status Latino families constitutes a critical threat to the health and well-being of Latino children. Further research should inform immigration policies that support (rather than threaten) the health, well-being, and health care practices that mitigate the stresses experienced by Latino children

Heavy metal content of vegetables irrigated with mixtures of wastewater and sewage sludge in Zimbabwe: Implications for human health

There is growing public concern in Zimbabwe over the illegal cultivation of vegetables on soils amended with sewage sludge or irrigated with admixtures of sewage and sewage sludge. Excessive accumulation of heavy metals in agricultural soils may not only result in environmental contamination, but lead to elevated heavy metal uptake by crops, which may affect food quality and safety. The work reported here studied heavy metal concentrations in crops irrigated with sewage sludge and sewage/sewage sludge admixtures at Firle Municipal Farm in Harare. The crops analysed in this study are heavily contaminated with the four regulated elements Cd, Cu, Pb and Zn. This contamination is at its highest in two of the staple dietary crops maize and tsunga. Tsunga leaves contained 3.68 mg kg-1 Cd, over 18 times the permissible level by the EU standards (0.2 mg kg-1); Cu concentrations were 111 mg kg-1, 5 times the EU Standard (20 mg kg-1); concentrations of Pb were 6.77 mg kg-1, over 22 times the permissible levels allowed by both EU standards and UK guidelines (0.3 mg kg-1); Zn concentrations were 221 mg kg-1, over 4 times the guideline value (50 mg kg-1). The other plants (beans, maize, peppers and sugarcane) also contained concentrations of heavy metals above the permissible levels. Furthermore the concentrations observed in this study were higher than those reported by other workers who have examined vegetation from other contaminated sites. This study highlights the potential risks involved in the cultivation and consumption of vegetables on plots irrigated with sewage sludge, a practice which may place at risk the health of the urban population who consume these vegetables

Electronic structure and ferroelectricity in SrBi2Ta2O9

The electronic structure of SrBi2Ta2O9 is investigated from first-principles, within the local density approximation, using the full-potential linearized augmented plane wave (LAPW) method. The results show that, besides the large Ta(5d)-O(2p) hybridization which is a common feature of the ferroelectric perovskites, there is an important hybridization between bismuth and oxygen states. The underlying static potential for the ferroelectric distortion and the primary source for ferroelectricity is investigated by a lattice-dynamics study using the Frozen Phonon approach.Comment: 17 pages, 7 figures. Phys. Rev. B, in pres

Electrospun Fibrinogen-Polydioxanone Composite Matrix: Potential for In Situ Urologic Tissue Engineering

Our objective is to demonstrate an electrospun fibrinogen-PDO (polydioxanone) composite scaffold will retain the superior cellular interaction of fibrinogen while producing a product with the functional strength needed for direct implantation. Fibrinogen-PDO composite scaffolds were electrospun with PDO ratios of 0% (pure fibrinogen), 10%, 20%, 30%, 40%, 50% and 100% (pure PDO) and disinfected using standard methods. Scaffolds were seeded with human BSM (bladder smooth muscle cells) and incubated with twice weekly media changes. Samples were removed at 7, 14 and 21 days for evaluation by collagen assay, scanning electron microscopy and histology. Cell seeding and culture demonstrated human BSM readily migrate throughout and remodel electrospun fibrinogen-PDO composite scaffolds with deposition of native collagen. Cell migration and collagen deposition increased with increasing fibrinogen concentration while scaffold integrity increased with increasing PDO concentration. Electrospun fibrinogen-PDO composite structures promote rapid cellular in-growth by human BSM while maintaining structural integrity. The fibrinogen to PDO ratio can be adjusted to achieve the desired properties required for a specific tissue engineering application. Our ultimate objective is to utilize this innovative biomaterial technology to produce an acellular, bioresorbable product that enables in situ tissue regeneration. While there is still much work to be done, these initial findings indicate fibrinogen-PDO composite scaffolds deserve further investigation

Preserving the palaeoenvironmental record in Drylands: Bioturbation and its significance for luminescence-derived chronologies

Luminescence (OSL) dating has revolutionised the understanding of Late Pleistocene dryland activity. However, one of the key assumptions for this sort of palaeoenvironmental work is that sedimentary sequences have been preserved intact, enabling their use as proxy indicators of past changes. This relies on stabilisation or burial soon after deposition and a mechanism to prevent any subsequent re-mobilisation. As well as a dating technique OSL, especially at the single grain level, can be used to gain an insight into post-depositional processes that may distort or invalidate the palaeoenvironmental record of geological sediment sequences. This paper explores the possible impact of bioturbation (the movement of sediment by flora and fauna) on luminescence derived chronologies from Quaternary sedimentary deposits in Texas and Florida (USA) which have both independent radiocarbon chronologies and archaeological evidence. These sites clearly illustrate the ability of bioturbation to rejuvenate ancient weathered sandy bedrock and/or to alter depositional stratigraphies through the processes of exhumation and sub-surface mixing of sediment. The use of multiple OSL replicate measurements is advocated as a strategy for checking for bioturbated sediment. Where significant OSL heterogeneity is found, caution should be taken with the derived OSL ages and further measurements at the single grain level are recommended. Observations from the linear dunes of the Kalahari show them to have no bedding structure and to have OSL heterogeneity similar to that shown from the bioturbated Texan and Florida sites. The Kalahari linear dunes could have therefore undergone hitherto undetected post-depositional sediment disturbance which would have implications for the established OSL chronology for the region