An Improved Average Atomic Number Calculation for Estimating Backscatter and Continuum Production in Compounds

It is often assumed that electron backscatter and continuum (bremsstrahlung) productions emitted from electron-solid interactions during X-ray microanalysis in compounds can be extrapolated from pure element observations by means of the assumption of average atomic number, or Z-bar (Z¯). For pure elements the average Z is equal to the atomic number, but this direct approach fails for compounds. The use of simple atomic fractions yields completely spurious results, and while the commonly used mass fraction Z averaging produces fairly reasonable results, we know from physical considerations that the mass of the neutron plays only a negligible role in such interactions below ∼1 MeV. Therefore, including the mass or atomic weight in such calculations can only introduce further errors in these models. We present an expression utilizing atomic fractions of the atomic numbers of the elements in the compound (Z fraction), with an exponent to account for the variation in nuclear screening as a function of the element Z value.

Detecting anomalous experiences in the community: The Transpersonal Experiences Questionnaire (TEQ)

OBJECTIVES

There is growing recognition of the value of researching anomalous experiences in the general population to aid our understanding of the psychosis continuum. There are key differences in aims, foci and epistemologies of existing measures, with varying utility for specific research designs. This study addresses gaps in the literature by developing a measure of anomalous experiences with utility for longitudinal (time-sensitive) research, and with particular reliability for people towards the upper (high scoring) end of the continuum.

METHODS

An online sample was recruited from the general population to provide questionnaire data for two study parts: (A) item selection and (B) psychometric evaluation. For Part A, both classical test theory and item response theory methods were used to select which items to be included from an initial pool of 57, generated from individuals with persistent anomalous experiences. For Part B, psychometric properties of the resulting measure were evaluated using exploratory and confirmatory factor analysis and tests of reliability and validity.

RESULTS

Scores were provided by 532 participants, from which a 19-item scale, the Transpersonal Experiences Questionnaire (TEQ), was developed. The TEQ was found to be a unidimensional scale, with satisfactory internal consistency (0.85), good test-retest reliability and convergent validity.

CONCLUSIONS

The TEQ can be used as a unidimensional scale to detect anomalous experiences in the general population, with particular reliability for people with higher incidence of these experiences.

Exploring the Hypothesis of a Schizophrenia and Bipolar Disorder Continuum: Biological, Genetic and Pharmacologic Data

Present time nosology has its roots in Kraepelin's demarcation of schizophrenia and bipolar disorder. However, accumulating evidence has shed light on several commonalities between the two disorders, and some authors have advocated for the consideration of a disease continuum. Here, we review previous genetic, biological and pharmacological findings that provide the basis for this conceptualization. There is a cross-disease heritability, and they share single-nucleotide polymorphisms in some common genes. EEG and imaging patterns have a number of similarities, namely reduced white matter integrity and abnormal connectivity. Dopamine, serotonin, GABA and glutamate systems have dysfunctional features, some of which are identical among the disorders. Finally, cellular calcium regulation and mitochondrial function are, also, impaired in the two.

Pain "chronification": what is the problem with this model?

OBJECTIVES

There appears to be an unwarranted focus on all chronic pain being a "chronification" of acute pain. Despite a plethora of studies on mechanisms to prevent this "chronification" following surgery, the positive effects have been minimal. An alternate model to explain chronic pain is presented.

METHODS

Research in PUBMED and accessing data from the HUNTpain examination study.

RESULTS

Data from the HUNT pain examination study reveal that less than 25% of individuals with chronic pain in a general population can relate the onset to an acute event. Another theory explaining the origin of chronic pain is that of priming and the accumulation of events that can be predictors along a continuum before chronic pain is apparent. This theory is presented to refocus for better prevention and treatment of chronic pain.

CONCLUSIONS

"Chronification" cannot explain all cases of chronic/persistent pain. The plastic changes in the pain processing system can be seen as a continuum where at some point where an acute pain event is only one of several possible tipping points on this continuum that changes potential pain to perceived pain.

Functional and structural features of L2/3 pyramidal cells continuously covary with pial depth in mouse visual cortex

Pyramidal cells of neocortical layer 2/3 (L2/3 PyrCs) integrate signals from numerous brain areas and project throughout the neocortex. These PyrCs show pial depth-dependent functional and structural specializations, indicating participation in different functional microcircuits. However, whether these depth-dependent differences result from separable PyrC subtypes or whether their features display a continuum correlated with pial depth is unknown. Here, we assessed the stimulus selectivity, electrophysiological properties, dendritic morphology, and excitatory and inhibitory connectivity across the depth of L2/3 in the binocular visual cortex of mice. We find that the apical, but not the basal dendritic tree structure, varies with pial depth, which is accompanied by variation in subthreshold electrophysiological properties. Lower L2/3 PyrCs receive increased input from L4, while upper L2/3 PyrCs receive a larger proportion of intralaminar input. In vivo calcium imaging revealed a systematic change in visual responsiveness, with deeper PyrCs showing more robust responses than superficial PyrCs. Furthermore, deeper PyrCs are more driven by contralateral than ipsilateral eye stimulation. Importantly, the property value transitions are gradual, and L2/3 PyrCs do not display discrete subtypes based on these parameters. Therefore, L2/3 PyrCs' multiple functional and structural properties systematically correlate with their depth, forming a continuum rather than discrete subtypes.

The AT(N) system for describing biological changes in Alzheimer's disease: a plain language summary

WHAT IS THIS SUMMARY ABOUT?

This is a plain language summary of an article published in Nature Reviews Neurology. It explains how Alzheimer's disease is diagnosed. It also looks at whether a newer way to assess people with Alzheimer's disease could help improve how the condition is diagnosed, monitored, and treated.

WHY IS THIS IMPORTANT?

Alzheimer's disease is a long-term progressive brain disease that leads to difficulties with thinking and memory. It is a progressive condition, which means it gets worse over time. Biological changes occur in the brain of people with Alzheimer's disease. This includes a build-up of toxic protein clusters called amyloid plaques and tau tangles, gradual damage to the brain cells (neurodegeneration), and brain shrinkage due to loss of neurons. It is often due to multiple factors and doctors usually diagnose Alzheimer's disease by looking at a person's symptoms and ruling out other causes of dementia. However, research shows that people diagnosed in this way do not always have the biological changes in the brain that are related to Alzheimer's disease. This means that some people may be misdiagnosed. Additionally, there may be a delay in the appearance of Alzheimer's symptoms, by which point changes in the brain may be severe. For example, people with Alzheimer's disease show biological changes in the brain, years before symptoms appear.

WHAT ARE THE KEY TAKEAWAYS?

An assessment of biological changes in the brain, by measuring substances that indicate disease progress (biomarkers), may offer a fuller picture of a person's Alzheimer's disease, how advanced it is, and which treatments are likely to work best. A recently developed classification scheme known as the AT(N) system provides a way to assess and describe the biological changes in amyloid (A), tau (T), and neurodegeneration (N) that occur in people with Alzheimer's disease. The goal is to include biomarker testing in clinical practice to help physicians and practitioners diagnose, monitor, and treat people with Alzheimer's disease more effectively. The AT(N) system is being used for various purposes in clinical studies, and has the potential to assist physicians and practitioners in early detection, accurate diagnosis, staging, and treatment selection for people with Alzheimer's disease.

Model of Drug Delivery to Populations Composed of Two Cell Types

The rate of drug delivery to cells and the subsequent rate of drug metabolism are dependent on the cell membrane permeability to the drug. In some cases, tissue may be composed of different types of cells that exhibit order of magnitude differences in their membrane permeabilities. This paper presents a brief review of the components of the tissue scale three-compartment pharmacokinetic model of drug delivery to single-cell-type populations. The existing model is extended to consider tissue composed of two different cell types. A case study is presented of infusion mediated delivery of doxorubicin to a tumor that is composed a drug reactive cell type and of a drug resistive cell type. The membrane permeabilities of the two cell types differ by an order of magnitude. A parametric investigation of the population composition is conducted and it is shown that the drug metabolism of the low permeability cells are negatively influenced by the fraction of the tissue composed of the permeable drug reactive cells. This is because when the population is composed mostly of drug permeable cells, the extracellular space is rapidly depleted of the drug. This has two compounding effects: (i) locally there is simply less drug available to the neighboring drug resistant cells, and (ii) the depletion of the drug from the extracellular space near the vessel-tissue interface leaves less drug to be transported to booth cell types farther away from the vessel.

Research progress and development trend of surgical robot and surgical instrument arm

BACKGROUND

In recent years, surgical robots have become an indispensable part of the medical field. Surgical robots are increasingly being used in the areas of gynaecological surgery, urological surgery, orthopaedic surgery, general surgery and so forth. In this paper, the development of surgical robots in different operations is reviewed and analysed. In the type of master-slave surgical robotic system, the robotic surgical instrument arms were located in the execution terminal of a surgical robot system, as one of the core components, and directly contact with the patient during the operation, which plays an important role in the efficiency and safety of the operation. In clinical, the arm function and design in different systems varies. Furtherly, the current research progress of robotic surgical instrument arms used in different operations is analysed and summarised. Finally, the challenge and trend are concluded.

METHODS

According to the classification of surgical types, the development of surgical robots for laparoscopic surgery, neurosurgery, orthopaedics and microsurgery are analysed and summarised. Then, focusing on the research of robotic surgical instrument arms, according to structure type, the research and application of straight-rod surgical instrument arm, joint surgical instrument arm and continuous surgical instrument arm are analysed respectively.

RESULTS

According to the discussion and summary of the characteristics of the existing surgical robots and instrument arms, it is concluded that they still have a lot of room for development in the future. Therefore, the development trends of the surgical robot and instrument arm are discussed and analysed in the five aspects of structural materials, modularisation, telemedicine, intelligence and human-machine collaboration.

CONCLUSION

Surgical robots have shown the development trend of miniaturisation, intelligence, autonomy and dexterity. Thereby, in the field of science and technology, the research on the next generation of minimally invasive surgical robots will usher in a peak period of development.

Evaluation of an HIV Pre-Exposure Prophylaxis Referral System: From Sexual Health Center to Federally Qualified Health Center Pre-Exposure Prophylaxis Clinic

Innovative delivery strategies are needed to facilitate access to HIV pre-exposure prophylaxis (PrEP). The objective of this study was to evaluate a navigator-facilitated PrEP referral process from a sexual health center (SHC) to a co-located PrEP clinic as an alternative delivery model. Electronic health record (EHR) data were used to calculate the number of clients seen at the SHC in 2019. Charts were manually reviewed to determine whether a PrEP clinic referral was made and document type of referral method: face-to-face appointment scheduling with the navigator (warm handoff), EHR messaging to navigator to schedule the appointment at a later time (EHR message), or provision of navigator's contact information to the client (card only). In 2019, 2481 unique potentially PrEP-eligible clients were seen at the SHC; 220 (9%) received a PrEP referral. Of referred clients, median age was 30 years (interquartile range, 24-34), 182 (83%) were male, 89 (40%) were non-Hispanic Black, and 24 (11%) were Latinx. In total, 94/220 (43%) referred clients attended an initial PrEP visit with a provider, and the proportion attending by referral method was 81%, 36%, and 27% for warm handoff, EHR message, and card only, respectively (p < 0.0001). Despite co-location of these two clinics, there were significant drop-offs along the PrEP care continuum for this referral system. Warm handoff was the most effective referral method, but further efforts are needed to understand barriers to referral. Implementation of same-day PrEP services at SHCs is one potential solution to engaging additional clients.

Multilevel Laser Induced Continuum Structure

Laser-induced-continuum-structure (LICS) allows for coherent control techniques to be applied in a Raman type system with an intermediate continuum state. The standard LICS problem involves two bound states coupled to one or more continua. In this paper, we discuss the simplest non-trivial multistate generalization of LICS which couples two bound levels, each composed of two degenerate states through a common continuum state. We reduce the complexity of the system by switching to a rotated basis of the bound states, in which different sub-systems of lower dimension evolve independently. We derive the trapping condition and explore the dynamics of the sub-systems under different initial conditions.

Changes in β-Cell Function in Offspring of Type-2 Diabetic Patients, as per Fasting and Two-Hour Plasma Glucose Levels

Background The changes in β-cell function in high-risk populations who are apparently in the normal glucose tolerant stage are still under investigation for designing earlier prevention strategies. This study analyzes changes in β-cell function and insulin sensitivity across fasting and two-hour glucose categories spanning normal glucose tolerance (NGT) to impaired glucose tolerance (IGT), in offspring of subjects with type-2 diabetes mellitus (T2DM) compared to the controls without a known family history of T2DM. Methods Offspring of T2DM patients (cases) and individuals without a family history of T2DM (controls) were the subjects for this cross-sectional study. All participants underwent a 75 g oral glucose tolerance test and blood samples were collected for plasma glucose, insulin, C-peptide and proinsulin, at zero, 30, 60, and 120 minutes.  Results A total of 358 cases (age 23.0 ± 10.8 years, 54% males) and 287 controls (age 28.4 ± 8.10 years, 65% males) were the subjects of this study. Cases and controls were divided into subgroups based on fasting and two-hour glucose categories spanning NGT to IGT. Compared to the reference category of controls (< 80 mg/dL for fasting glucose and < 84 mg/dL for two-hour glucose), cases with IGT had ~60% decline in both β-cell compensation (as measured as disposition index {0-120}) and insulin sensitivity (as measured as whole-body insulin sensitivity index {0-120}); adjusted for age, gender, and body mass index. From lower to higher fasting and two-hour glucose categories, there was a continuous and significant decline in β-cell compensation in both cases and controls. Significant reduction in first-phase insulin secretion, as measured as insulinogenic (0-30) index, was only observed among two-hour glucose categories, not among the fasting glucose categories. In the transition from late NGT cases to IGT cases, there was a significant decline in β-cell compensation, first-phase insulin secretion (more prominent than a decline in overall β-cell secretion) and the changes in whole-body insulin sensitivity were not statistically significant. Conclusions The decline in β-cell compensation was continuous and significant in offspring of subjects with type-2 diabetes and controls without a known family history of diabetes from early normal glucose tolerant ranges to impaired glucose tolerant ranges. Compared to the strictest glucose controlled category of controls, approximately 60% decline was observed in β-cell compensation and insulin sensitivity, in impaired glucose tolerant offspring of subjects with type-2 diabetes mellitus.

Gap or prehistoric monster? A history of the humanitarian-development nexus at UNICEF

Why has bridging the humanitarian-development divide been such a long-running endeavour, and why have so many frameworks to do so been proposed and picked apart over the years? Rather than contributing yet another 'mind the gap' approach, this paper seeks to articulate why such a lacuna emerged in the first place, and to explore how to exit a debate that has grown increasingly circular. To provide one possible answer to the questions above, the paper draws on the history of UNICEF (United Nations Children's Fund) in working across the 'humanitarian-development' nexus. Suggesting that the gap is more artefact than fact, derived from the institutionalisation of aid, the paper argues that focusing on the challenges and the concepts that inherently transcend humanitarian-development silos may enhance understanding of what it means-and what is needed-to operate at the intersection of humanitarian and development action on behalf of children.

Completing the Continuum of Maternity Care and Associated Factors in Debre Berhan Town, Amhara, Ethiopia, 2020

Background

The continuum of maternity care is the continuity of maternal health care services that a woman practices antenatal care, skilled birth attendant, and postnatal care. Even though there are positive inclinations towards the continuum of maternity care, the problem is still significant. So, the purpose of this study was to assess the utilization of continuum maternity care and associated factors among women who gave birth in the last 12 months before the data collection period in Debre Berhan town.

Methods

A community-based cross-sectional study was conducted from February 17 to March 15/2020. The respondents were selected by using the cluster sampling technique. Face-to-face interview was used for data collection. EpiData software version 3.1 was used for data entry and exported to SPSS version 21 for further analysis. In multivariable logistic regression, a statistically significant association has declared a p-value <0.05.

Results

In this study, the proportion of women who completed the continuum of maternity care was 37.2% (95% CI: 33.4-41.1). Completing primary education (AOR: 2.73, 95% CI: 1.17-6.38), secondary education (AOR: 3.11, 95% CI: 1.32-7.31), college and above educational level (AOR: 4.15, 95% CI: 1.79-9.57), initiation of first ANC visit ≤16wks (AOR: 2.57, 95% CI: 1.41-4.68), knowing key pregnancy danger signs (AOR: 1.91, 95% CI: 1.15-3.19), and well prepared on birth and complication readiness (AOR: 1.59, 95% CI: 1.10-2.32) were found to positively increase the chance of completing maternity care in our study area.

Conclusion

Even if a higher proportion of mothers completed the continuum of maternity care in the study area than the finding at national level of 9.1% basing EDHS 2016 data, further interventions are mandatory to reach the acceptable level. Therefore, health promotion programs targeting mothers with no education and lower educational level are important to increase their awareness about the importance of completing all levels of maternity care, health education, and counseling regarding early initiation of ANC, pregnancy danger signs, and birth preparedness and complication readiness plan.

Cognitive and phenomenological characteristics of hallucination-proneness across the lifespan

INTRODUCTION

The impact of age on hallucination-proneness within healthy adult cohorts and its relation to underlying cognitive mechanisms is underexplored. Based on previously researched trends in relation to cognitive ageing, we hypothesised that older and younger adults, when compared to a middle adult age group, would show differential relations between hallucination-proneness and cognitive performance.

METHODS

A mixed methods, between-groups study was conducted with 30 young adults, 26 older adults, and 27 from a "middle adulthood" group. Participants completed a source memory task, jumbled speech task, Launay-Slade hallucination scale, unusual experiences schedule, and control measures of delusion-proneness and attitudes to mental health.

RESULTS

Compared to older age-groups, younger participants demonstrated better scores on the source memory task, and reported hearing more words in jumbled speech. Additionally, younger cohorts rated higher on hallucination-proneness and disclosed more unusual experiences on a customised schedule designed to gather further qualitative data. Jumbled speech scores positively correlated with hallucination-proneness scores, particularly for the "middle" age group. Source memory performance unexpectedly correlated positively with hallucination-proneness, although this may be the product of age differences in task performance.

CONCLUSIONS

Age differences in hallucination-proneness are evident on self-report and cognitive measures. Implications are discussed for potentially non-overlapping cognitive mechanisms underlying hallucination-proneness in non-clinical groups.

A linguistic approach to the psychosis continuum: (dis)similarities and (dis)continuities in how clinical and non-clinical voice-hearers talk about their voices

Introduction: "Continuum" approaches to psychosis have generated reports of similarities and differences in voice-hearing in clinical and non-clinical populations at the cohort level, but not typically examined overlap or degrees of difference between groups. Methods: We used a computer-aided linguistic approach to explore reports of voice-hearing by a clinical group (Early Intervention in Psychosis service-users; N = 40) and a non-clinical group (spiritualists; N = 27). We identify semantic categories of terms statistically overused by one group compared with the other, and by each group compared to a control sample of non-voice-hearing interview data (log likelihood (LL) value 6.63+=p < .01; effect size measure: log ratio 1.0+). We consider whether individual values support a continuum model. Results: Notwithstanding significant cohort-level differences, there was considerable continuity in language use. Reports of negative affect were prominent in both groups (p < .01, log ratio: 1.12+). Challenges of cognitive control were also evident in both cohorts, with references to "disengagement" accentuated in service-users (p < .01, log ratio: 1.14+). Conclusion: A corpus linguistic approach to voice-hearing provides new evidence of differences between clinical and non-clinical groups. Variability at the individual level provides substantial evidence of continuity with implications for cognitive mechanisms underlying voice-hearing.

A polynomial approach to the spectrum of Dirac-Weyl polygonal Billiards

The Schrödinger equation in a square or rectangle with hard walls is solved in every introductory quantum mechanics course. Solutions for other polygonal enclosures only exist in a very restricted class of polygons, and are all based on a result obtained by Lamé in 1852. Any enclosure can, of course, be addressed by finite element methods for partial differential equations. In this paper, we present a variational method to approximate the low-energy spectrum and wave-functions for arbitrary convex polygonal enclosures, developed initially for the study of vibrational modes of plates. In view of the recent interest in the spectrum of quantum dots of two dimensional materials, described by effective models with massless electrons, we extend the method to the Dirac-Weyl equation for a spin-1/2 fermion confined in a quantum billiard of polygonal shape, with different types of boundary conditions. We illustrate the method's convergence in cases where the spectrum is known exactly, and apply it to cases where no exact solution exists.

Searching and Intertwining: Climbing Plants and GrowBots

Applications in remote inspection and medicine have motivated the recent development of innovative thin, flexible-backboned robots. However, such robots often experience difficulties in maintaining their intended posture under gravitational and other external loadings. Thin-stemmed climbing plants face many of the same problems. One highly effective solution adopted by such plants features the use of tendrils and tendril-like structures, or the intertwining of several individual stems to form braid-like structures. In this paper, we present new plant-inspired robotic tendril-bearing and intertwining stem hardware and corresponding novel attachment strategies for thin continuum robots. These contributions to robotics are motivated by new insights into plant tendril and intertwining mechanics and behavior. The practical applications of the resulting GrowBots is discussed in the context of space exploration and mining operations.

Modeling of Cell Nuclear Mechanics: Classes, Components, and Applications

Cell nuclei are paramount for both cellular function and mechanical stability. These two roles of nuclei are intertwined as altered mechanical properties of nuclei are associated with altered cell behavior and disease. To further understand the mechanical properties of cell nuclei and guide future experiments, many investigators have turned to mechanical modeling. Here, we provide a comprehensive review of mechanical modeling of cell nuclei with an emphasis on the role of the nuclear lamina in hopes of spurring future growth of this field. The goal of this review is to provide an introduction to mechanical modeling techniques, highlight current applications to nuclear mechanics, and give insight into future directions of mechanical modeling. There are three main classes of mechanical models-schematic, continuum mechanics, and molecular dynamics-which provide unique advantages and limitations. Current experimental understanding of the roles of the cytoskeleton, the nuclear lamina, and the chromatin in nuclear mechanics provide the basis for how each component is subsequently treated in mechanical models. Modeling allows us to interpret assay-specific experimental results for key parameters and quantitatively predict emergent behaviors. This is specifically powerful when emergent phenomena, such as lamin-based strain stiffening, can be deduced from complimentary experimental techniques. Modeling differences in force application, geometry, or composition can additionally clarify seemingly conflicting experimental results. Using these approaches, mechanical models have informed our understanding of relevant biological processes such as migration, nuclear blebbing, nuclear rupture, and cell spreading and detachment. There remain many aspects of nuclear mechanics for which additional mechanical modeling could provide immediate insight. Although mechanical modeling of cell nuclei has been employed for over a decade, there are still relatively few models for any given biological phenomenon. This implies that an influx of research into this realm of the field has the potential to dramatically shape both future experiments and our current understanding of nuclear mechanics, function, and disease.

The Mammalian Spermatogenesis Single-Cell Transcriptome, from Spermatogonial Stem Cells to Spermatids

Spermatogenesis is a complex and dynamic cellular differentiation process critical to male reproduction and sustained by spermatogonial stem cells (SSCs). Although patterns of gene expression have been described for aggregates of certain spermatogenic cell types, the full continuum of gene expression patterns underlying ongoing spermatogenesis in steady state was previously unclear. Here, we catalog single-cell transcriptomes for >62,000 individual spermatogenic cells from immature (postnatal day 6) and adult male mice and adult men. This allowed us to resolve SSC and progenitor spermatogonia, elucidate the full range of gene expression changes during male meiosis and spermiogenesis, and derive unique gene expression signatures for multiple mouse and human spermatogenic cell types and/or subtypes. These transcriptome datasets provide an information-rich resource for studies of SSCs, male meiosis, testicular cancer, male infertility, or contraceptive development, as well as a gene expression roadmap to be emulated in efforts to achieve spermatogenesis in vitro.

Interdisciplinary Management of Acute Leukemia Across the Continuum of Care

OBJECTIVE

To describe the interdisciplinary management of acute leukemias across the continuum of care.

DATA SOURCE

Literature review and experiential knowledge.

CONCLUSION

Acute leukemia, including acute myelogenous leukemia, acute promyelocytic leukemia, and acute lymphoblastic leukemia, represent a heterogeneous group of hematologic malignancies with complex diagnostic requirements that drive risk-adapted treatment selection. Involvement of clinicians from a variety of specialties and disciplines is required to ensure safe and effective treatment, mitigate adverse events, and maintain or improve quality of life. Patient-centered communication, shared decision-making, and interdisciplinary communication are integral to patient outcomes.

IMPLICATIONS FOR NURSING PRACTICE

Oncology clinicians play a primary role in coordinating the interdisciplinary team and navigating the patient and caregiver experience across the acute leukemia continuum.

Predictors of Long-Term HIV Pre-exposure Prophylaxis Adherence After Study Participation in Men Who Have Sex With Men

BACKGROUND

Efficacy of HIV pre-exposure prophylaxis (PrEP) among men who have sex with men is well documented in randomized trials. After trial completion, participants are challenged with acquiring PrEP on their own and remaining adherent.

METHODS

This was a follow-up study of the TAPIR randomized controlled multicenter PrEP trial. Participants were contacted after their last TAPIR visit (ie, after study-provided PrEP was discontinued) to attend observational posttrial visits 24 and 48 weeks later. Adherence during TAPIR and posttrial visits was estimated by dried blood spot intracellular tenofovir diphosphate levels (adequate adherence defined as tenofovir diphosphate levels >719 fmol/punch). Binary logistic regression analysis assessed predictors of completing posttrial visits and PrEP adherence among participants completing ≥1 visit.

RESULTS

Of 395 TAPIR participants who were on PrEP as part of the TAPIR trial for a median of 597 days (range 3-757 days), 122 (31%) completed ≥1 posttrial visit (57% of University of California San Diego participants completed posttrial visits, whereas this was 13% or lower for other study sites). Among participants who completed ≥1 posttrial visit, 57% had adequate adherence posttrial. Significant predictors of adequate adherence posttrial were less problematic substance use, higher risk behavior, and adequate adherence in year 1 of TAPIR.

CONCLUSION

More than half of PrEP users followed after trial completion had successfully acquired PrEP and showed adequate adherence. Additional adherence monitoring and intervention measures may be needed for those with low PrEP adherence and problematic substance use during the first year of trial.

Pain Management in the Cancer Survivor

OBJECTIVES

To describe assessment and interdisciplinary management of pain in the cancer survivor over the continuum of cancer care.

DATA SOURCES

Review of the literature and treatment standards.

CONCLUSION

Pain remains a primary concern throughout the cancer trajectory across all age groups and diagnoses, emphasizing the need to integrate pain assessment and management across the continuum of cancer survivorship and across care settings. Types of pain, pain patterns, assessment of cancer pain in cancer survivors, current strategies and challenges for management, and effective communication and documentation of the process are described. Communication between and among health care clinicians in a way that effectively articulates the individual patient experience, including documentation in the electronic medical record, requires consistent workflows and terminology. The opioid crisis increases the urgency in effective strategies for interdisciplinary pain assessment and management.

IMPLICATIONS FOR NURSING PRACTICE

Oncology clinicians must be able to adequately assess pain, track pain over time, understand and implement a cadre of strategies to manage pain, and effectively pursue any suspicious pain patterns that may indicate recurrence or progression of cancer or other underlying etiologies. The oncology nurse is at the core of patient-clinician communication, critical to effectively describing pain as experienced by the individual patient and continues to play a key role in maintaining consistency of message that is necessary to manage pain over the continuum of cancer survivorship.

Understanding Economic Abuse Through an Intersectional Lens: Financial Abuse, Control, and Exploitation of Women's Productive and Reproductive Labor

Financial abuse refers to men's control over money, assets, and women's education or paid work. As a corrective to existing undertheorization of men's (and their family's) abuse of and control over women's unpaid (domestic) labor, this article proposes a new conceptualization of economic abuse. Drawing upon life-history interviews with 41 South Asian women from the United Kingdom and India, this article explores control and abuse in relation to financial resources and women's paid work as well as unpaid work. It utilizes an intersectional perspective to explore how gender, migration status, race/ethnicity, and class can improve understanding of women's experiences as a continuum of economic abuse.

Addressing the Gender Continuum: A Concept Analysis

INTRODUCTION

The purpose of this concept analysis aims to bring awareness of the gender continuum to nurse educators and students and break down gender stereotypes.

METHOD

Using the Walker and Avant concept analysis approach, this analysis is based on a transcultural nursing theory framework.

RESULTS

Gender continuum is an umbrella concept, accounting for components beyond how a person identifies. These components include how one conforms to gender roles, expresses gender outwardly, and anatomical or biological characteristics one possesses.

DISCUSSION

Nursing students must recognize gender alternatives beyond male and female to provide culturally competent care for transgender and gender nonconforming patients. The impact of this analysis can result in a better understanding of the gender continuum among nurse educators and the dissemination of knowledge to nursing students. Broader knowledge of this concept can lead to dissolution of gender binaries in health care and more culturally competent care provision for all patients.

Soft Poly-Limbs: Toward a New Paradigm of Mobile Manipulation for Daily Living Tasks

We present the design and development of the fluid-driven, wearable, Soft Poly-Limb (SPL), from the Greek word polys, meaning many. The SPL utilizes the numerous traits of soft robotics to enable a novel approach in providing safe and compliant mobile manipulation assistance to healthy and impaired users. This wearable system equips the user with a controllable additional limb that is capable of complex three-dimensional motion in space. Similar to an elephant trunk, the SPL is able to manipulate objects using a variety of end effectors, such as suction adhesion or a soft grasper, as well as its entire soft body to conform around an object, able to lift 2.35 times its own weight. To develop these highly articulated soft robotic limbs, we provide a novel set of systematic design rules, obtained through varying geometrical parameters of the SPL through experimentally verified finite element method models. We investigate performance of the limb by testing the lifetime of the new SPL actuators, evaluating its payload capacity, operational workspace, and capability of interacting close to a user through a spatial mobility test. Furthermore, we are able to demonstrate limb controllability through multiple user-intent detection modalities. Finally, we explore the limb's ability to assist in multitasking and pick and place scenarios with varying mounting locations of the SPL around the user's body. Our results highlight the SPL's ability to safely interact with the user while demonstrating promising performance in assisting with a wide variety of tasks, in both work and general living settings.

High Capacity Garnet-Based All-Solid-State Lithium Batteries: Fabrication and 3D-Microstructure Resolved Modeling

The development of high-capacity, high-performance all-solid-state batteries requires the specific design and optimization of its components, especially on the positive electrode side. For the first time, we were able to produce a completely inorganic mixed positive electrode consisting only of LiCoO₂ and Ta-substituted Li₇La₃Zr₂O₁₂ (LLZ:Ta) without the use of additional sintering aids or conducting additives, which has a high theoretical capacity density of 1 mAh/cm². A true all-solid-state cell composed of a Li metal negative electrode, a LLZ:Ta garnet electrolyte, and a 25 μm thick LLZ:Ta + LiCoO₂ mixed positive electrode was manufactured and characterized. The cell shows 81% utilization of theoretical capacity upon discharging at elevated temperatures and rather high discharge rates of 0.1 mA (0.1 C). However, even though the room temperature performance is also among the highest reported so far for similar cells, it still falls far short of the theoretical values. Therefore, a 3D reconstruction of the manufactured mixed positive electrode was used for the first time as input for microstructure-resolved continuum simulations. The simulations are able to reproduce the electrochemical behavior at elevated temperature favorably, however fail completely to predict the performance loss at room temperature. Extensive parameter studies were performed to identify the limiting processes, and as a result, interface phenomena occurring at the cathode active material/solid-electrolyte interface were found to be the most probable cause for the low performance at room temperature. Furthermore, the simulations are used for a sound estimation of the optimization potential that can be realized with this type of cell, which provides important guidelines for future oxide based all-solid-state battery research and fabrication.

Redefining Prevention and Care: A Status-Neutral Approach to HIV

Recent biomedical advances inspire hope that an end to the epidemic of HIV is in sight. Adopting new approaches and paradigms for treatment and prevention in terms of both messaging and programming is a priority to accelerate progress. Defining the key sequential steps that comprise engagement in HIV care has provided a useful framework for clinical programs and motivated quality improvement initiatives. Recently, the same approach has been applied to use of pre-exposure prophylaxis for HIV prevention. Building on the various prevention and care continua previously proposed, we present a novel schematic that incorporates both people living with HIV and people at risk, making it effectively "status-neutral" in that it proposes the same approach for engagement, regardless of one's HIV status. This multidirectional continuum begins with an HIV test and offers 2 divergent paths depending on the results; these paths end at a common final state. To illustrate how this continuum can be utilized for program planning as well as for monitoring, we provide an example using data for New York City men who have sex with men, a population with high HIV incidence and prevalence.

The quantitative analysis of neurodegenerative disease: classification, noda, constellations, and multivariate geometry

A variety of methods are available for the quantitative description and analysis of neurodegenerative disease. If neurodegenerative disease exists as a series of distinct disorders, then classificatory methods such as hierarchical cluster analysis (HCA) and decision tree analysis (DTA) can be used to classify cases into groups more objectively. If neurodegenerative disease consists of overlapping phenotypes, then the Braun-Blanquet 'nodal' system and 'constellation diagrams' implicitly recognise intermediate cases and reveal their relationships to the main groupings. By contrast, if cases are more continuously distributed without easily distinguishable disease entities, then methods based on spatial geometry, such as a triangular system or principal components analysis (PCA), may be more appropriate as they display cases spatially according to their similarities and differences. This review compares the different methods and concludes that as a result of the heterogeneity and overlap commonly present plus the multiplicity of possible descriptive variables, methods such as PCA are likely to be particularly useful in the quantitative analysis of neurodegenerative disease. A more general application of such methods, however, has implications for studies of disease risk factors and pathogenesis and in clinical trials.

From positive psychology to psychopathology: the continuum of attention-deficit hyperactivity disorder

BACKGROUND

Integration of positive psychology into clinical research and treatment has been slow. This integration can be facilitated by the conceptualisation of mental disorders as the high, symptomatic extreme of continuous normal variation. This assumes that there is also a low, positive extreme, which is, however, unchartered territory. This study aims to examine how well current measures capture the low extreme of mental disorder continua, using attention-deficit hyperactivity disorder (ADHD) as an example.

METHODS

The ability of three validated scales to capture ADHD as a continuous trait was examined using Item Response Theory in a sample of 9,882 adolescents from the UK population-representative Twins Early Development Study. These scales were: the Strengths and Weakness of ADHD Symptoms and Normal behaviour scale (SWAN), Strength and Difficulties Questionnaire (SDQ - hyperactivity subscale), and Conners' Parent Rating Scale (Conners).

RESULTS

Only the SWAN reliably differentiated interindividual differences between participants lying at any level of the continuous ADHD latent trait, including the extreme low, positive end (z-scores from -3 to +3). The SDQ showed low reliability across the ADHD latent trait. In contrast, the Conners performed best at differentiating individuals scoring at or above the mean to the high symptomatic range (z-scores from 0 to +3). The SWAN was the only measure to provide indicators of 'positive mental health', endorsed in the presence of particularly good attentive abilities.

CONCLUSIONS

Scales such as the SWAN that reliably capture ADHD as a continuous trait, including the positive end, are important for not missing meaningful variation in population-based studies. Indicators of positive mental health may be helpful in clinical practice, as positive attributes have been shown to directly influence as well as buffer negative effects of psychiatric symptoms.

Transitioning young adults from paediatric to adult care and the HIV care continuum in Atlanta, Georgia, USA: a retrospective cohort study

Introduction: The transition from paediatric to adult HIV care is a particularly high‐risk time for disengagement among young adults; however, empirical data are lacking.

Methods: We reviewed medical records of 72 youth seen in both the paediatric and the adult clinics of the Grady Infectious Disease Program in Atlanta, Georgia, USA, from 2004 to 2014. We abstracted clinical data on linkage, retention and virologic suppression from the last two years in the paediatric clinic through the first two years in the adult clinic.

Results: Of patients with at least one visit scheduled in adult clinic, 97% were eventually seen by an adult provider (median time between last paediatric and first adult clinic visit = 10 months, interquartile range 2–18 months). Half of the patients were enrolled in paediatric care immediately prior to transition, while the other half experienced a gap in paediatric care and re‐enrolled in the clinic as adults. A total of 89% of patients were retained (at least two visits at least three months apart) in the first year and 56% in the second year after transition. Patients who were seen in adult clinic within three months of their last paediatric visit were more likely to be virologically suppressed after transition than those who took longer (Relative risk (RR): 1.76; 95% confidence interval (CI): 1.07–2.9; p = 0.03). Patients with virologic suppression (HIV‐1 RNA below the level of detection of the assay) at the last paediatric visit were also more likely to be suppressed at the most recent adult visit (RR: 2.3; 95% CI: 1.34–3.9; p = 0.002).

Conclusions: Retention rates once in adult care, though high initially, declined significantly by the second year after transition. Pre‐transition viral suppression and shorter linkage time between paediatric and adult clinic were associated with better outcomes post‐transition. Optimizing transition will require intensive transition support for patients who are not virologically controlled, as well as support for youth beyond the first year in the adult setting.

The Rationale Behind the New Alzheimer's Disease Conceptualization: Lessons Learned During the Last Decades

In the last decades, progress in neuroimaging techniques and cerebrospinal fluid assays has enabled the characterization of several Alzheimer's disease (AD) biomarkers. This knowledge has shifted the conceptualization of AD from a clinical-pathological construct, where its diagnosis required the presence of dementia with distinct pathologic features, toward a clinical-biological one that recognizes AD as a pathological continuum with a clinical picture that ranges from normal cognition to a dementia stage. Specifically, AD is now divided into three stages: preclinical (abnormal biomarkers and no or only subtle cognitive impairment), mild cognitive impairment or prodromal AD (abnormal pathophysiological biomarkers and episodic memory impairment), and dementia (abnormal biomarkers and clear cognitive and functional impairment). The possibility of assessing AD pathophysiology in vivo before the onset of clinical symptoms in the preclinical stage provides the unprecedented opportunity to intervene at earlier stages of the continuum in secondary prevention trials. Currently, large cohort studies of cognitively healthy participants are undergoing with the main aim of disentangling the natural history of AD to identify individuals with an increased risk of developing AD in the near future to be recruited in these clinical trials. In this paper, we review how the concept of AD has changed over the years as well as discuss the implications of this conceptual change.

The impact of a private-public partnership delivery system on the HIV continuum of care in a South Indian city

We characterized the impact of a Private-Public Partnership (PPP) on the continuum of HIV care (e.g., treatment initiation, ART effectiveness and loss to follow-up) among adults enrolled at a private hospital/ART link center in the southern state of Karnataka, India from 2007 through 2012. Data on 2326 adults in care were compiled using an electronic database supplemented with medical chart abstraction. Survival methods with staggered entries were used to analyze time to ART initiation and loss to follow-up as well as associated factors. Mixed effects linear regression models were used to assess ART effectiveness. The mean age of adults in care was 36 years; 40% were male. The majority were married, had less than primary education, and less than 45 US dollars (3000 Indian Rupee) monthly income. The mean CD4 at presentation was 527 cells/mm³. The median time from ART eligibility to initiation was 5 and 2 months for before and after the PPP, respectively (p < 0.001). Becoming eligible after PPP was associated with more rapid treatment initiation (Hazard Ratio: [95% Confidence Interval] 1.49 [1.11, 1.99]). Moreover, among the 1639 persons lost to follow-up, more rapid loss was observed before the PPP (12.77 months) vs. after (13.37 months) (p = 0.25) and there was a significant interaction between ART status and calendar time before and after the PPP (p < 0.001). Being on treatment was associated with a lower likelihood of becoming lost before the PPP (HR: [95% CI] 0.33 [0.27, 0.42]), but this association was reversed after the PPP (HR: [95% CI] 1.77 [1.54, 2.04]), p-value for interaction <0.001. Treatment response measured by CD4 was comparable before and after the PPP (p = 0.088). Our findings suggest that PPP models of ART delivery may improve HIV treatment initiation and loss to follow-up without compromising the effectiveness of treatment. Efforts to expand these system-level interventions should be considered with on-going evaluation.

Identifying gaps in HIV service delivery across the diagnosis-to-treatment cascade: findings from health facility surveys in six sub-Saharan countries

Introduction: Despite the rollout of antiretroviral therapy (ART), challenges remain in ensuring timely access to care and treatment for people living with HIV. As part of a multi-country study to investigate HIV mortality, we conducted health facility surveys within 10 health and demographic surveillance system sites across six countries in Eastern and Southern Africa to investigate clinic-level factors influencing (i) use of HIV testing services, (ii) use of HIV care and treatment and (iii) patient retention on ART.

Methods: Health facilities (n = 156) were sampled within 10 surveillance sites: Nairobi and Kisumu (Kenya), Karonga (Malawi), Agincourt and uMkhanyakude (South Africa), Ifakara and Kisesa (Tanzania), Kyamulibwa and Rakai (Uganda) and Manicaland (Zimbabwe). Structured questionnaires were administered to in-charge staff members of HIV testing, prevention of mother-to-child transmission (PMTCT) and ART units within the facilities. Forty-one indicators influencing uptake and patient retention along the continuum of HIV care were compared across sites using descriptive statistics.

Results: The number of facilities surveyed ranged from six in Malawi to 36 in Zimbabwe. Eighty percent were government-run; 73% were lower-level facilities and 17% were district/referral hospitals. Client load varied widely, from less than one up to 65 HIV testing clients per provider per week. Most facilities (>80%) delivered services or interventions that would support patient retention in care such as delivering free services, offering PMTCT within antenatal care, pre-ART monitoring and adherence counselling. Many facilities under-delivered in several areas, however, such as targeted testing for high-risk groups (21%) and mobile testing (36%). There were also intra-site and inter-site differences, including in the delivery of Option B+ (ranging from 6% in Kisumu to 93% in Kyamulibwa), and nurse-led ART initiation (ranging from 50% in Kisesa to 100% in Karonga and Agincourt). Only facilities in Malawi did not require additional lab tests for ART initiation. Stock-outs of HIV test kits and antiretroviral drugs were particularly common in Tanzania.

Conclusions: We identified a high standard of health facility performance in delivering strategies that may support progression through the continuum of HIV care. HIV testing policy and practice was particularly weak. Inter- and intra-country differences in quality and coverage represent opportunities to improve the delivery of comprehensive services to people living with HIV.

Exploring the salt-cocrystal continuum with solid-state NMR using natural-abundance samples: implications for crystal engineering

There has been significant recent interest in differentiating multicomponent solid forms, such as salts and cocrystals, and, where appropriate, in determining the position of the proton in the X-H⋯A-YX-⋯H-A+-Y continuum in these systems, owing to the direct relationship of this property to the clinical, regulatory and legal requirements for an active pharmaceutical ingredient (API). In the present study, solid forms of simple cocrystals/salts were investigated by high-field (700 MHz) solid-state NMR (ssNMR) using samples with naturally abundant 15N nuclei. Four model compounds in a series of prototypical salt/cocrystal/continuum systems exhibiting {PyN⋯H-O-}/{PyN+-H⋯O-} hydrogen bonds (Py is pyridine) were selected and prepared. The crystal structures were determined at both low and room temperature using X-ray diffraction. The H-atom positions were determined by measuring the 15N-1H distances through 15N-1H dipolar interactions using two-dimensional inversely proton-detected cross polarization with variable contact-time (invCP-VC) 1H→15N→1H experiments at ultrafast (νR ≥ 60-70 kHz) magic angle spinning (MAS) frequency. It is observed that this method is sensitive enough to determine the proton position even in a continuum where an ambiguity of terminology for the solid form often arises. This work, while carried out on simple systems, has implications in the pharmaceutical industry where the salt/cocrystal/continuum condition of APIs is considered seriously.

Do Non-Reflective Thinkers Apply Extreme Personal Meanings to their Activated Moods?

BACKGROUND

The integrative cognitive model of mood swings proposes that mood symptoms are driven by extreme, self-referent appraisals. For example, if activated mood is appraised positively, this prompts selection of mood regulation strategies that act to up-regulate mood. Appraisals are driven by fast and automatic Type 1 cognitive processes, which, left unchecked, can cause activated mood to escalate.

AIMS

It was hypothesized that greater propensity to override these automatic processes by engaging in reflective (Type 2) thinking would be negatively associated with extreme appraisals of activation and activation.

METHOD

Study 1 (n = 150) was a cross-sectional survey consisting of measures of activation, extreme appraisals, and an objective performance-based measure of the propensity to engage in reflective thought (cognitive reflection test; CRT). In Study 2 (n = 241) participants completed these measures plus three alternative measures of effortful cognitive engagement (CRT-2, Need for Cognition and Actively Open-Minded Thinking).

RESULTS

In Study 1, propensity to engage in reflective thought (higher CRT scores) was not significantly associated with activated mood or extreme appraisals, but activated mood and extreme appraisals were positively correlated. In study 2, the association between activation and extreme appraisals was replicated. Predicted associations between alternative measures of reflective thinking, activated mood, and extreme appraisals were not found.

CONCLUSIONS

Extreme appraisals of internal states may be a psychological mechanism underlying activated mood. Propensity to reflect on and override default cognitions was unrelated to these extreme appraisals and activated mood. Further research in a clinical sample using mood-relevant measures of reflective thinking is warranted.

Varieties of Voice-Hearing: Psychics and the Psychosis Continuum

Hearing voices that are not present is a prominent symptom of serious mental illness. However, these experiences may be common in the non-help-seeking population, leading some to propose the existence of a continuum of psychosis from health to disease. Thus far, research on this continuum has focused on what is impaired in help-seeking groups. Here we focus on protective factors in non-help-seeking voice-hearers. We introduce a new study population: clairaudient psychics who receive daily auditory messages. We conducted phenomenological interviews with these subjects, as well as with patients diagnosed with a psychotic disorder who hear voices, people with a diagnosis of a psychotic disorder who do not hear voices, and matched control subjects (without voices or a diagnosis). We found the hallucinatory experiences of psychic voice-hearers to be very similar to those of patients who were diagnosed. We employed techniques from forensic psychiatry to conclude that the psychics were not malingering. Critically, we found that this sample of non-help-seeking voice hearers were able to control the onset and offset of their voices, that they were less distressed by their voice-hearing experiences and that, the first time they admitted to voice-hearing, the reception by others was much more likely to be positive. Patients had much more negative voice-hearing experiences, were more likely to receive a negative reaction when sharing their voices with others for the first time, and this was subsequently more disruptive to their social relationships. We predict that this sub-population of healthy voice-hearers may have much to teach us about the neurobiology, cognitive psychology and ultimately the treatment of voices that are distressing.

The South Carolina rural-urban HIV continuum of care

The HIV continuum of care model is widely used by various agencies to describe the HIV epidemic in stages from diagnosis through to virologic suppression. It identifies the various points at which persons living with HIV (PLWHIV) within a population fail to reach their next step in HIV care. The rural population in the Southern United States is disproportionally affected by the HIV epidemic. The purpose of this study was to examine these rural-urban disparities using the HIV care continuum model and determine at what stages these differences become apparent. PLWHIV aged 13 years and older in South Carolina (SC) were identified using data from the enhanced HIV/AIDS Reporting System. The percentages of PLWHIV linked to care, retained in care, and virologically suppressed were determined. Rural versus urban residence was determined using the Office of Management and Budget classification. There were 14,523 PLWHIV in SC at the end of 2012; 11,193 (77%) of whom were categorized as urban and 3305 (22%) as rural. There was no difference between urban and rural for those who had received any care: 64% versus 64% (p = .61); retention in care 53% versus 53% (p = .71); and virologic suppression 49% versus 48% (p = .35), respectively. The SC rural-urban HIV cascade represents the first published cascade of care model using rural versus urban residence. Although significant health care disparities exist between rural and urban residents, there were no major differences between rural and urban residents at the various stages of engagement in HIV care using the HIV continuum of care model.

Towards an integrated primary and secondary HIV prevention continuum for the United States: a cyclical process model

Introduction

Every new HIV infection is preventable and every HIV-related death is avoidable. As many jurisdictions around the world endeavour to end HIV as an epidemic, missed HIV prevention and treatment opportunities must be regarded as public health emergencies, and efforts to quickly fill gaps in service provision for all people living with and vulnerable to HIV infection must be prioritized.

Discussion

We present a novel, comprehensive, primary and secondary HIV prevention continuum model for the United States as a conceptual framework to identify key steps in reducing HIV incidence and improving health outcomes among those vulnerable to, as well as those living with, HIV infection. We further discuss potential approaches to address gaps in data required for programme planning, implementation and evaluation across the elements of the HIV prevention continuum.

Conclusions

Our model conceptualizes opportunities to monitor and quantify primary HIV prevention efforts and, importantly, illustrates the interplay between an outcomes-oriented primary HIV prevention process and the HIV care continuum to move aggressively forward in reaching ambitious reductions in HIV incidence. To optimize the utility of this outcomes-oriented HIV prevention continuum, a key gap to be addressed includes the creation and increased coordination of data relevant to HIV prevention across sectors.

Psychopathology and affect dysregulation across the continuum of psychosis: a multiple comparison group study

AIM

There is evidence that psychotic-like phenomena can be detected within the general population and that psychotic experiences lie on a continuum that also spans affective states. We aimed to investigate comparisons of a first-episode psychosis group, an 'at-risk mental state group' and a help-seeking control group with non-patients to explore whether affective states lie on a continuum of psychosis.

METHOD

Measures of psychotic-like experiences, social anxiety and depression were administered to 20 patients experiencing first-episode psychosis (FEP), 113 patients experiencing an 'at-risk' mental state (ARMS), 28 patients who were help-seeking but not experiencing a FEP or ARMS (HSC) and 30 non-clinical participants (NC).

RESULTS

For distress in relation to psychotic-like experiences, the FEP, ARMS and HSC groups scored significantly higher than the NC group for the perceptual abnormalities and non-bizarre ideas. In terms of severity of psychotic experiences, the FEP scored the highest, followed by the ARMS group, followed by the HSC and NC groups. The clinical groups scored significantly higher for depression than the non-clinical group. Interestingly, only the FEP and the ARMS groups scored significantly higher than non-patients for social anxiety.

CONCLUSIONS

These findings suggest that a psychosis continuum exists; however, this does not suggest that both psychosis and affective symptoms lie on the same continuum, rather it would appear the presence of such affective states that may affect help-seeking behaviour and clinical status. The implications of these findings for clinical practice are discussed.

Cortical thickness in individuals with non-clinical and clinical psychotic symptoms

Symptoms that are linked to psychosis are also experienced by individuals who are not in need of care. In the present study, cortical thickness was investigated in these individuals. Fifty individuals with non-clinical auditory verbal hallucinations (most of them also experienced other non-clinical psychotic symptoms), 50 patients with a psychotic disorder and auditory verbal hallucinations, and 50 healthy control subjects underwent structural magnetic resonance imaging. Data were analysed using FreeSurfer. Cortical thickness in the pars orbitalis, paracentral lobule, fusiform gyrus and inferior temporal gyrus was lowest in patients, intermediate in the non-clinical hallucinating group, and highest in control subjects. The patients also showed thinning in widespread additional areas compared to the two other groups, whereas both hallucinating groups showed similar levels of thinning in the insula. Ranking the levels of cortical thickness per brain region across groups revealed that for 88% of brain regions, cortical thickness was lowest in patients, intermediate in the non-clinical hallucinating group, and highest in controls. These findings show that individuals with non-clinical psychotic symptoms show a similar but less pronounced pattern of cortical thinning as patients with a psychotic disorder, which is suggestive of a similar, but milder underlying pathophysiology in this group compared to the psychosis group.

Continuum model of tendon pathology - where are we now?

Chronic tendon pathology is a common and often disabling condition, the causes of which remain poorly understood. The continuum model of tendon pathology was proposed to provide a model for the staging of tendon pathology and to assist clinicians in managing this often complex condition (Br. J. Sports Med., 43, 2009, 409). The model presents clinical, histological and imaging evidence for the progression of tendon pathology as a three-stage continuum: reactive tendinopathy, tendon disrepair and degenerative tendinopathy. It also provides clinical information to assist in identifying the stage of pathology, in addition to proposed treatment approaches for each stage. The usefulness of such a model is determined by its ability to incorporate and inform new and emerging research. This review examines the degree to which recent research supports or refutes the continuum model and proposes future directions for clinical and research application of the model.

A CONTINUUM HARD-SPHERE MODEL OF PROTEIN ADSORPTION

Protein adsorption plays a significant role in biological phenomena such as cell-surface interactions and the coagulation of blood. Two-dimensional random sequential adsorption (RSA) models are widely used to model the adsorption of proteins on solid surfaces. Continuum equations have been developed so that the results of RSA simulations can be used to predict the kinetics of adsorption. Recently, Brownian dynamics simulations have become popular for modeling protein adsorption. In this work a continuum model was developed to allow the results from a Brownian dynamics simulation to be used as the boundary condition in a computational fluid dynamics (CFD) simulation. Brownian dynamics simulations were used to model the diffusive transport of hard-sphere particles in a liquid and the adsorption of the particles onto a solid surface. The configuration of the adsorbed particles was analyzed to quantify the chemical potential near the surface, which was found to be a function of the distance from the surface and the fractional surface coverage. The near-surface chemical potential was used to derive a continuum model of adsorption that incorporates the results from the Brownian dynamics simulations. The equations of the continuum model were discretized and coupled to a CFD simulation of diffusive transport to the surface. The kinetics of adsorption predicted by the continuum model closely matched the results from the Brownian dynamics simulation. This new model allows the results from mesoscale simulations to be incorporated into micro- or macro-scale CFD transport simulations of protein adsorption in practical devices.

The hypothesis of a continuum in suicidality: a discussion on its validity and practical implications

The idea of a progression in suicide phenomena, from death wishes to suicide attempts and completed suicides, is quite old and widely present in literature. This model of interpreting suicidality has great relevance in preventative approaches, since it gives the opportunity of intercepting suicidal trajectories at several different stages. However, this may not be the case for many situations, and the hypothesis of a continuum can be true only in a limited number of cases, probably embedded with a specific psychopathological scenario (e.g. depression) and with a frequency that should not permit generalisations. This paper reviews the available evidence about the existence and validity of this construct, and discusses its practical implications.

Assessment of colorectal cancer molecular features along bowel subsites challenges the conception of distinct dichotomy of proximal versus distal colorectum

OBJECTIVE

Colorectal cancer is typically classified into proximal colon, distal colon and rectal cancer. Tumour genetic and epigenetic features differ by tumour location. Considering a possible role of bowel contents (including microbiome) in carcinogenesis, this study hypothesised that tumour molecular features might gradually change along bowel subsites, rather than change abruptly at splenic flexure.

DESIGN

Utilising 1443 colorectal cancers in two US nationwide prospective cohort studies, the frequencies of molecular features (CpG island methylator phenotype (CIMP), microsatellite instability (MSI), LINE-1 methylation and BRAF, KRAS and PIK3CA mutations) were examined along bowel subsites (rectum, rectosigmoid junction, sigmoid, descending colon, splenic flexure, transverse colon, hepatic flexure, ascending colon and caecum). The linearity and non-linearity of molecular relations along subsites were statistically tested by multivariate logistic or linear regression analysis.

RESULTS

The frequencies of CIMP-high, MSI-high and BRAF mutations gradually increased from the rectum (<2.3%) to ascending colon (36-40%), followed by falls in the caecum (12-22%). By linearity tests, these molecular relations were significantly linear from rectum to ascending colon (p<0.0001), and there was little evidence of non-linearity (p>0.09). Caecal cancers exhibited the highest frequency of KRAS mutations (52% vs 27-35% in other sites; p<0.0001).

CONCLUSIONS

The frequencies of CIMP-high, MSI-high and BRAF mutations in cancer increased gradually along colorectum subsites from the rectum to ascending colon. These novel data challenge the common conception of discrete molecular features of proximal versus distal colorectal cancers, and have a substantial impact on clinical, translational and epidemiology research, which has typically been performed with the dichotomous classification of proximal versus distal tumours.

How do auditory verbal hallucinations in patients differ from those in non-patients?

Auditory verbal hallucinations (AVHs) are experienced by individuals with various clinical diagnoses, such as psychosis, but also a significant minority of healthy individuals from the general population may experience them. Although much research has been carried out the past few decades, the mechanisms and factors underlying the emergence of AVHs is still poorly understood. One way of clarifying this issue involves comparing AVHs in patient and non-patient populations. In particular, differences between these groups will provide important information concerning the emergence of AVHs. After a general presentation and discussion of the notion of a continuum hypothesis, studies comparing patients with non-patients experiencing AVHs will be reviewed. This will comprise studies examining the phenomenological characteristics of AVHs in addition to neuroimaging and cognitive studies. Although we are beginning to elucidate important differences on a phenomenological level between these two types of AVHs, far too few studies have directly compared patient and non-patient AVHs in terms of underlying cerebral correlates and cognitive mechanisms. Nevertheless, and based on recent research on phenomenological differences, two issues stand out that need to be addressed, namely, the highly negative emotional content of AVHs in patients and the early onset of AVHs in non-patients populations. Suggestions for future research will be discussed.

Cycle decompositions: From graphs to continua

We generalise a fundamental graph-theoretical fact, stating that every element of the cycle space of a graph is a sum of edge-disjoint cycles, to arbitrary continua. To achieve this we replace graph cycles by topological circles, and replace the cycle space of a graph by a new homology group for continua which is a quotient of the first singular homology group [Formula: see text]. This homology seems to be particularly apt for studying spaces with infinitely generated [Formula: see text], e.g. infinite graphs or fractals.

A dimensional approach to the psychosis spectrum between bipolar disorder and schizophrenia: the Schizo-Bipolar Scale

BACKGROUND

There is increasing evidence for phenomenological, biological and genetic overlap between schizophrenia and bipolar disorder, bringing into question the traditional dichotomy between them. Neurobiological models linked to dimensional clinical data may provide a better foundation to represent diagnostic variation in neuropsychiatric disorders.

METHOD

To capture the interaction between psychosis and affective symptoms dimensionally, we devised a brief descriptive scale based on the type and relative proportions of psychotic and affective symptoms over the illness course. The scale was administered to a series of 762 patients with psychotic disorders, including schizophrenia, schizoaffective and psychotic bipolar disorder assessed as part of the Bipolar-Schizophrenia Network for Intermediate Phenotypes (B-SNIP) study.

RESULTS

The resulting Schizo-Bipolar Scale scores across these disorders showed neither a clear dichotomy nor a simple continuous distribution. While the majority of cases had ratings close to prototypic schizophrenia or bipolar disorder, a large group (45% of cases) fell on the continuum between these two prototypes.

CONCLUSIONS

Our data suggest a hybrid conceptualization model with a representation of cases with prototypic schizophrenia or bipolar disorder at the extremes, but a large group of patients on the continuum between them that traditionally would be considered schizoaffective. A dimensional approach, using the Schizo-Bipolar Scale, characterized patients across a spectrum of psychopathology. This scale may provide a valuable means to examine the relationships between schizophrenia and psychotic bipolar disorder.