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International Structural Magnetic Resonance Imaging Of Cortical Thickness In Older Adults With Bipolar Disorder
Full text linkThe presentation of bipolar disorder (BD) seems to change over the course of a lifetime. In older adults, BD seems to pose novel challenges including decreased cognitive functioning, psychiatric and medical comorbidities, increased susceptibility to medication side effects, and possibly even a shift toward more depressive symptoms. Despite these clinical findings, research into older adults with BD has lagged behind that of adolescents and young adults. As the global population ages, so too do individuals with BD. In fact, it is predicted that by 2030, 50% of patients with BD will be over the age of 60. This emphasizes why it is so important to gain a deeper understanding of how BD in older adulthood differs from its clinical presentation in adolescence and young adulthood. Similarly, while research has found extensive evidence to suggest the presence of structural abnormalities in the prefrontal cortices (PFC) of adolescents and young adults with BD, there has been insufficient exploration into the neuroanatomy of older adults with BD. The goal of this study is to explore the cortical thickness of the PFC in middle and older adults with BD (MOABD) compared to that of similarly aged healthy controls (HC). Parcellated PFC cortical thickness was generated from structural magnetic resonance imaging (MRI) data using Enhancing Neuro Imaging Genetics through Meta Analysis (ENIGMA) pipelines for MOABD (n=308) and HC (n=287) ages 40-70y from six international sites of the Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE-BD) research consortium. Regional ventral PFC (VPFC) and dorsal PFC (DPFC) thickness between MOABD and HC groups were compared with analysis-of-covariance models covarying for site, age, and sex. Additionally, main and group interactive effects of age were explored. Within the MOABD cohort, cortical associations with clinical variables such as BD subtype, history of psychotic features, lifetime comorbidity of substance use disorder, and current medications were also explored. Cortical thickness was significantly decreased in MOABD in the VPFC as well as the DPFC (psFDR\u3c.001). A main effect of age was observed in both the VPFC and the DPFC (psFDR\u3c.001). However, no significant interactions between age and diagnosis were observed. Additionally, MOABD who were taking lithium were found to have significantly greater cortical thickness in DPFC regions (psFDR\u3c.001) compared to MOABD not taking lithium. The consistency of some results with those in adolescents and younger adults with BD, such as those in VPFC, suggest that a portion of the cortical thickness decreases in BD may be neurodevelopmental and may persist into older age. This study’s findings support the theory that DPFC abnormalities may emerge later in life for individuals with BD. Medication findings concur with other research indicating that lithium may exert neuroprotective effects. However, longitudinal studies are needed to confirm any potential aging- and treatment-related changes
Pre-Admission Sleep Of Patients In The Intensive Care Unit: A Retrospective Observational Study
Full text linkThe medical intensive care unit (ICU) can be a challenging place for patients to get adequate sleep. Multiple environmental and pathophysiological factors can cause sleep deprivation in the ICU, which have been associated with adverse short and long-term outcomes. Although various factors have been hypothesized to impact quality of sleep in the ICU, research on the nature of patients’ pre-ICU sleep is very limited. Understanding the role that pre-ICU sleep plays in sleep quality in the ICU has the potential to inform public health measures to improve sleep and risk stratify critically ill patients. The objective of this study is to characterize the sleep quality of ICU patients prior to admission using sleep questionnaire data obtained from patients and their surrogates at the time of admission. We hypothesized that ICU patients have lower sleep quality prior to ICU admission when compared to sleep quality in non-critically ill patients. The data for this study was collected as part of baseline data for a randomized controlled trial on the use of daytime bright light to promote circadian alignment and shorten or prevent delirium among patients in the ICU. Enrolled patients were interviewed regarding their sleep routines prior to admission via the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS), and this data, along with baseline demographics and past medical history, were used for this study. Continuous and categorical variables were analyzed with descriptive statistical techniques using mean, standard deviation, and proportions as appropriate. Exploratory bivariate analysis was conducted to test for associations between demographic and clinical features and sleep characteristics using bivariate Pearson correlation, independent samples t-test, and analysis of variance (ANOVA). 68 participants were included in this study. The mean (+/- standard deviation) age was 70 +/- 10 years. 43% of the participants were female. 75% of the population was White and 21% Black. The most common reason for ICU admission was acute respiratory failure (43%). 29% of participants reported having a diagnosis of sleep apnea prior to admission. The average modified Rankin score (mRS) was 2 +/- 1.6, and the mean Acute Physiology and Chronic Health Evaluation (APACHE) score was 24 +/- 8.2. The mean global PSQI score was 6.6 +/- 4.2, and the mean ESS score was 10.0 +/- 5.9. Participants reported taking a mean of 34.4 +/- 36.8 minutes to fall asleep and getting a mean of 6.9 +/- 1.8 hours of actual sleep with a mean of 9.2 +/- 3.8 hours per night spent in bed. Reported mean sleep onset was 9:56 PM +/- 121.2 minutes and mean sleep offset (wake) time was 6:31 AM +/- 124.2 minutes. 44% of participants reported that they cannot get to sleep within 30 minutes at least one time per week. 19% required prescribed or over the counter medicine in the past month to help sleep, and 55% of participants characterized their sleep as very or fairly good. Exploratory bivariate analysis was conducted to assess possible associations between participants’ demographics and baseline medical history data and reported sleep habit data, global PSQI, and ESS scores. The following significant associations were found: non-White participants had a higher mean time to fall asleep than White participants (p=0.01); participants with diabetes had a higher mean ESS than those without diabetes (p=0.01); participants with hyperlipidemia had a lower global PSQI than those without hyperlipidemia (p=0.005); participants who reported sleep aid use had higher mean number of hours in bed than those who did not report sleep aid use (p=0.004). When compared to population norms, our findings of elevated global PSQI and ESS scores suggest that patients admitted to the ICU have worse habitual sleep and/or sleep-related symptoms. Often with the presence of many comorbidities, it is not unexpected that ICU patients might have worse baseline sleep than the general population, but the data in this domain is very limited. Further, the use of questionnaires like the PSQI and ESS to study sleep is an expanding area of research. Given the impact of poor sleep on health and the potential to prolong recovery time after the ICU, this and further research could inform interventions to improve sleep quality inside and out of the hospital. Prospective, large-scale research is needed to further investigate how baseline sleep characteristics impact critical illness onset and outcomes
Language, Categorization, and Control: Examining Exclusion in Refugee Regimes Through the Shift From Muhājir to Lājiʾ
Full text linkOnline Appendix to What Policy Combinations Worked?: The Effect of Policy Packages on Bank Lending during COVID-19
Full text linkEvaluating The Impact Of P. Falciparum Genetic Diversity On Pfrh5 Blood Stage Vaccine Protection Through A Multi-Method Approach
Full text linkMalaria remains a major global health threat as control efforts have stalled in recent years. Recently, theWHO began recommending two vaccines, RTS,S/AS01 and R21, both of which target the pre-erythrocytic stage of malaria. However, these vaccines are only partially protective and do not protect against the blood-stage of malaria where clinical disease begins. Therefore, a more broadly protective vaccine is still needed. Plasmodium falciparum reticulocyte-binding protein homolog 5 (PfRH5) is a leading candidate for next-generation blood-stage malaria vaccines with the most advanced formulation, RH5.1/Matrix-M, recently entering Phase 2b clinical trials. However, historically, malaria vaccine development has been challenged by the Plasmodium falciparum parasite’s extensive genetic diversity. Therefore, evaluating vaccine efficacy across genetically diverse parasite strains early in the development process is critical to its success. To address this, this study combines ex vivo and in vivo approaches to assess how naturally occurring mutations in PfRH5 may affect vaccine-induced protection. Using ex vivo growth inhibition assays on malaria clinical isolates, we found that PfRH5 vaccine-induced antibodies effectively inhibited parasite invasion across parasite variants. This is the first time the most potent anti-PfRH5 monoclonal antibodies have been tested against genetically diverse strains. While some parasites showed higher inhibition relative to wild-type, no isolate displayed evidence of immune escape, and structural analysis confirmed that none of the identified mutations compromised antibody binding. These findings support the strain-transcendent potential of RH5-based vaccines. To complement these findings, the framework for an in vivo sieve analysis was developed to assess whether specific PfRH5 variants are enriched in breakthrough infections from a Phase 2b trial in Burkina Faso, providing real-world insights into the potential for vaccine-driven immune selection. Together, this multi-method approach offers insight into the impact of PfRH5 genetic diversity on vaccine performance, highlights the most protective epitopes for inclusion in future vaccine designs, and serves as an early detection system for parasite variants that may compromise broad vaccine coverage
Assessing Impact Of Maternal Proximity To Unconventional Oil And Gas Wells On Neonatal Birthweight In Ohio: A Retrospective Cohort Study (2010–2017)
Full text linkAbstractBackground: Unconventional oil and gas development (UOGD) has expanded rapidly in the United States, particularly in states like Ohio, which is home to approximately 5,000 horizontal shale wells and more than 80,000 hydraulically fractured wells since 1952. Although oil and gas extraction has occurred in Ohio for over 60 years, the recent surge in UOGD activity has raised renewed public health concerns about environmental exposures during pregnancy. While previous studies have linked maternal proximity to UOGD with adverse birth outcomes, evidence remains limited regarding its association with birthweight and fetal growth indicators in high-production states such as Ohio.
Methods: We conducted a retrospective cohort study of 965,272 live singleton births in Ohio from 2010 to 2017. Maternal residential proximity to active UOGD wells was calculated using Euclidean distance within mutually exclusive buffer zones (≤2 km, 2–5 km, 5–10 km, \u3e10 km/No Exposure). Exposure was assessed during the year prior to delivery and across trimesters. Low birthweight (LBW), small for gestational age (SGA), and continuous birthweight were modeled using logistic and linear regression, adjusting for maternal age, BMI, race/ethnicity, infant sex, WIC participation, and outdoor concentrations of fine particulate matter (PM2.5).
Results: Maternal residence within 5–10 km of active UOGD was consistently associated with increased odds of LBW (OR: 1.10; 95% CI: 1.05–1.16). This association remained consistent across extended and sensitivity models that included additional environmental and maternal health covariates. Binary exposure models using proximity cutoffs of ≤5 km and ≤10 km yielded similar patterns, with the 10 km model showing a significant association (OR = 1.09; 95% CI: 1.05–1.14). Trimester-specific models showed the strongest association in the second trimester. Continuous birthweight decreased with exposure at 2–10 km but unexpectedly increased within ≤2 km. SGA was also significantly associated with 5–10 km exposure, even among term births.
Conclusion: These findings suggest that maternal residential proximity to UOGD, particularly during the second trimester, is associated with increased odds of adverse birth outcomes including low birthweight and small for gestational age status
Association Between Greenspace And Weight-Related Outcomes In Later Adulthood: A Longitudinal Study Using Uk Biobank Data
Full text linkOverweight and obesity are escalating global health concerns, greenspace may support healthierweight, and air pollution may mitigate the effect, but its effects across population subgroups and over time remain underexplored. According to the longitudinal analysis, this study found that greenspace exposure within 300 m was more strongly associated with lower BMI and overweight risk than exposure within 1000 m; for example, the presence of greenspace within 300 m reduced the odds of overweight (OR = 0.791, 95% CI: 0.672–0.933), while the same measure within 1000 m was associated with higher odds of obesity (OR = 1.275, 95% CI: 1.08–1.505). Stratified analyses revealed stronger protective effects among older adults (e.g., BMI reduction of 0.282 kg/m² for age \u3e60, β = -0.282, 95% CI: -0.378, -0.185), females (e.g., OR for obesity = 0.714, 95% CI: 0.713–0.714), and low-income groups (e.g., OR for obesity = 0.875, 95% CI: 0.795– 0.963). Group-based trajectory analysis indicated that higher greenspace exposure was associated with more favorable BMI trajectories over time, particularly showing flatter or declining patterns among normal-weight individuals across younger age groups. These findings underscore the importance of enhancing greenspace, especially in underserved areas, and call for targeted urban planning policies that ensure equitable access to high-quality, publicly available green environments
Reward Vs. Penalty: Differential Effects On Cardiovascular Reactivity And Task Performance
No full textIntroduction: Motivational incentives such as rewards and penalties shape cognitive performance, yet little is known about how these effects interact with physiological responses. This study examined how different types of incentives influence behavioral performance and cardiovascular reactivity during a cognitive control task, drawing on the Biopsychosocial (BPS) model of challenge and threat. Methods: A total of 141 adults completed a Stroop task under three conditions: Low Reward–Low Penalty (LRLP), High Reward–Low Penalty (HRLP), and Low Reward–High Penalty (LRHP). Physiological signals (e.g., heart rate, inter-beat interval, pre-ejection period, cardiac output) were recorded continuously. Task order was counterbalanced (HRLP first vs. LRHP first). Behavioral performance was measured by accuracy and reaction time. Mixed-effects models tested the effects of incentive condition, task order, and physiological reactivity on performance. Results: Participants responded faster in the reward-based condition but more accurately in the penalty-based condition. Incentive conditions did not influence physiology on their own, but effects emerged depending on task order. When reward came first, the following penalty-based condition triggered stronger cardiovascular responses (increased HR, reduced IBI, and PEP), and vice versa for the reward-based condition when penalty came first. Physiological reactivity predicted higher accuracy only under penalty-based conditions, especially for participants who began with the reward condition or showed stronger early physiological reactivity. Conclusion: Motivational incentives and their sequence shape both physiological reactivity and cognitive performance. Starting with rewards may support later performance under penalty conditions by enhancing physiological readiness. These findings offer insight into how motivational framing and ordering influence decision-making and may help reduce errors in applied settings like healthcare
Identification Of A Fitness Determinant Required For Bacteroides Survival Under High Magnesium Stress
No full textMagnesium (Mg²⁺) is essential for bacterial physiology, contributing to membrane stability, nucleic acid neutralization, and enzymatic activity. For pathogenic bacteria such as Salmonella enterica serovar Typhimurium, Mg²⁺ limitation is a common stress encountered during infection, particularly within the phagosome, where the host actively restricts access to divalent cations as part of nutritional immunity. Commensal species such as Bacteroides thetaiotaomicron, which reside in the intestinal lumen, are likely to experience different Mg²⁺ levels due to factors such as host dietary intake, host secretions, and microbial competition. Whereas enteric pathogens such as S. Typhimurium activate the PhoP/PhoQ system in response to Mg²⁺ limitation, the strategies used by commensal gut bacteria to withstand Mg²⁺ stress remain unclear. As major contributors to polysaccharide degradation, immune modulation, and other host-associated processes, Bacteroides species play a pivotal role in promoting gut health. Enhancing their colonization and persistence therefore holds significant therapeutic potential. In this study, we examine the genetic determinants that promote the survival of Bacteroides thetaiotaomicron under conditions of cytoplasmic Mg²⁺ stress, identifying candidate factors that may contribute to its fitness within the gut environment
Insights Into Medical Surveillance Among Engineered Stone Countertop Workers In The United States Of America
Full text linkBackground: An alarming rise in the number of cases of silicosis, a progressive and incurable lung disease, among engineered stone (ES) workers has prompted concern about the extent of the problem in the U.S. and whether ES can be used safely. Overexposure to high levels of respirable crystalline silica (RCS) during fabrication or installation of ES can increase the risk of developing a more severe case of silicosis. Medical surveillance studies on US ES workers are limited.Aim: The overall objective of this study was to better understand the state of medical surveillance for ES workers using employer surveys and employee data from members of the National Stone Institute (NSI) and the International Surface Fabricator Association (IFSA), two trade associations representing industry.
Methods: An electronic survey was given to NSI and ISFA member companies to assess industry characteristics and operations. Medical screening results, including medical questionnaires, spirometry reports, and chest x-rays findings, were obtained for 60 employees of one stone countertop fabrication company. Spirometry lower limit of normal for FEV1, FVC, and FEV1/FVC ratios were calculated using GLI data and NHANES data with age, height, sex-adjustment, and with and without race-adjustments, and descriptive analysis was performed.
Results: The survey completed by 266 employers indicated a median of 10 employees (range 1-460) per company. Most companies (95.9%) reported working with both natural and ES and performing countertop fabrication and installation (81.6%). A minority reported having performed air sampling for RCS (42.5%). Most employers reported the use of both hand tools (80.5%) and automated machines such as CNC (add%) to process stone. 62.4% of employers reported providing respiratory protection, but only 53.6% of these employers have a written protocol, and only 42.8% of these have performed respirator FIT testing. Only 18.8% of employers reported performing pre-placement exams, and over 50% of these were missing one or more key components, such as a chest X-ray. 60 employee medical screening and surveillance records from one fabrication company indicated that most employees were Hispanic males with an average age of 38.9 + 11.8 and an average employment tenure of 6.3 + 6.8. Most were either fabricators (26.7%) or installers (50%). Spirometry data indicated that using GLI normative values without race correction, 5.6% had findings suggestive of restrictive physiology, and none had obstructive physiology. Chest imaging B-read reports noted only 2/59 had abnormalities (1/2 perfusion and opacities and a 2nd hilar adenopathy), changes (especially opacities) concerning for possible early silicosis.
Conclusion: Overall, the majority of 266 ES stone companies are not performing recommended medical surveillance exams and workplace monitoring for silica. A review of medical surveillance records from 60 employees showed variable quality of testing. Almost all had normal spirometry and unremarkable chest imaging, except for one chest X-ray B-read suggestive of silicosis. The results identify opportunities to improve medical surveillance and compliance with OSHA silica regulations among ES employers and ES workers