<p>There is considerable confusion regarding the diagnosis of patients presenting with non-affective psychosis in the absence of a dementia or secondary to a general medical condition in the fifth decade and beyond. A number of different terms, diagnostic criteria and age-cut-offs have been applied to this presentation posing a challenge to clinicians and researchers alike. Despite diagnostic inconsistencies and conceptual uncertainty, a remarkably consistent clinical picture has emerged. However, many questions still remain with regards to its underlying etiopathophysiological mechanisms, treatment and prognosis, including whether it is distinct from schizophrenia and whether it might be a prelude to cognitive deterioration. Currently there is no official diagnostic designation for patients who develop a primary psychosis in late life, with patients being typically diagnosed as either schizophrenia or delusional disorder, although the validity of such a distinction has been questioned.</p> <p>The following prospective longitudinal study sets out to characterize the largest known group of patients (n=102) with first-episode, late-onset (>age 40) psychotic disorder on demographic, clinical, treatment and prognostic variables. Given that one of the most contentious issues in the characterization of these patients has been that of diagnostic classification, we examined whether the currently nosological distinction of schizophrenia (SCZ) from delusional disorder (DD) has validity and/or utility. Patients were classified as either SCZ (n=47) or DD (n=55) according to DSM-IV criteria, and were then compared on a number of validators proposed as part of the DSM-V development process. As predicted, there were no significant differences between the two groups. In conclusion, our analysis did not find the current diagnostic distinction of SCZ from DD in the late-onset population to be valid and/or useful. We recommend the use of the more general diagnostic term, “Late-Onset Psychotic Disorder”, to refer to all patients who develop a primary psychosis in their forties or beyond.</p> / Master of Science (MSc)

INTRODUCTION: The impact of marijuana use has become a national topic with the increase in state’s legalizing or decriminalizing the use of the drug. To understand the impact this new trend may have on the population, it is necessary to characterize the interaction between marijuana use and health outcomes. Previous research has focused on the acute effects of marijuana on mental health and longitudinal impacts of marijuana use in the adolescent population. However there are no previously published studies on the impact of early onset marijuana use on adult mental health. AIM: This study aims to determine the prevalence of early onset marijuana use and if there is a statically significant association between early onset marijuana use (<14 years old) and increased prevalence of adverse mental health outcomes in adult life. METHODS: This study was conducted using data from the 2014 National Survey on Drug Use and Health. The study population included 41, 285 participants 18 or older at the time of the cross-sectional survey. Adult mental health outcomes were modeled for both early onset marijuana users and non-early onset marijuana users using a multiple logistic regression model to calculate both adjusted and unadjusted odds ratios (AOR’s, OR’s) with 95% confidence intervals. Statistical analysis was performed to examine the association between early onset marijuana use and negative adult mental health outcomes including serious mental illness, any mental illness and lifetime depressive episodes. RESULTS: This study found that in adults aged 18 and older the prevalence of early onset marijuana use was 8.3%. The prevalence of early onset marijuana use varies by gender, with a prevalence of 5.1(95% CI 4.7-5.2) for males and 3.3(95% CI 3.1-3.5) for females. Early onset marijuana use had a statistically significant association with all three indicators of poor adult mental health. The AOR for early onset marijuana use and serious mental illness was 2.3(95% CI 1.972-2.758). The association between early onset marijuana use and adult depressive episode had an AOR of 2.1(95% CI1.906-2.389). DISCUSSION: These findings suggest that early onset marijuana use is a risk factor for adverse mental health outcomes in adulthood. Consistent with findings from other nationally representative surveys, the prevalence of early onset marijuana use is higher in males than females. Early onset marijuana use is associated with increased odds of past year serious mental illness and past year any mental illness. This suggests that legislature considering marijuana legalization must also consider policies addressing under age use of the drug. Further longitudinal research is needed to father assess the association between early onset marijuana use and adult mental health.

No description available.

ABSTRACT Current guidelines published by the Centers for Disease Control and Prevention (CDC) and American Academy of Pediatrics (AAP) recommend empiric antibiotics for all neonates born to mothers with a diagnosis of chorioamnionitis due to the risk of early onset sepsis (EOS). EOS is difficult to diagnose due to nonspecific symptoms and a lack of reliable tests, can progress quickly, and is potentially fatal or have neurodevelopmental consequences for survivors. Antibiotics are frequently prescribed in the hospital and are lifesaving in the setting of a serious infection. Conversely, overuse of antibiotics has potential negative effects to individuals and the population as a whole. Antibiotic resistant infections are a consequence of antibiotic misuse, are costly and difficult to treat, and pose a risk to patients hospitalized. To examine this problem at The University of Vermont Medical Center (UVMMC) a retrospective chart review was preformed. Data on the maternal risk factors associated with EOS were collected in addition to clinical characteristics of their neonates and entered into a neonatal early onset sepsis (NEOS) calculator to determine the specific risk of infection to each infant. Treatment of the infant was compared to the NEOS calculator and CDC recommendations. Using posterior probability to determine a more specific risk profile better targets antibiotic therapy to ensure all infants that need treatment receive it, while reducing the number of infants treated empirically. UVMMC currently treats 78% of infants according to CDC guidelines. Use of the NEOS calculator would reduce antibiotic treatment to 18% of term neonates born to mothers with a diagnosis of chorioamnionitis. Using a new tool to determine risk of EOS may safely reduce the number of infants receiving antibiotic treatment.

Das grampositive Bakterium Staphylococcus epidermidis ist ein wesentlicher Bestandteil der kommensalen Flora der Haut und der Schleimhäute des Menschen. Jedoch stellen diese Bakterien eine häufige Ursache nosokomialer Katheter-assozierter Infektionen bei immunsupprimierten Patienten dar. Dies liegt zum einen an der Fähigkeit von S. epidermidis, Biofilm zu bilden. Diese physikalische Barriere schützt die Bakterien vor dem Immunsystem sowie vor Antibiotika. Dabei zählen sie zu den häufigsten Erregern von Infektionen an implantierten Fremdkörpern mit Plastikoberflächen, wie z. B. Venenkathetern, künstlichen Herzklappen oder Gefäßprothesen. Zum anderen stellt die Antibiotikaresistenzentwicklung unter S. epidermidis ein zunehmendes Problem dar. Vor allem die late-onset Sepsis, die durch S. epidermidis als Erreger verursacht werden kann, stellt für Frühgeborene eine Gefahr dar. Ziel der vorliegenden Arbeit war, für S. epidermidis als häufigsten und klinisch bedeutsamen KoNS zu eruieren, ob die zunehmende Dauer des stationären Krankenhausaufenthaltes von sehr kleinen Frühgeborenen mit einer höheren Rate an ica-Präsenz, Biofilmbildung und Antibiotikaresistenz assoziiert ist, sowie die Verbreitungswege und das Reservoir für diese S. epidermidis-Stämme zu identifizieren. Hierzu wurden sequenzielle Isolate von S. epidermidis bei Müttern, Kindern und vom Krankenhauspersonal gewonnen und mittels MLST (Multilocus-Sequence-Typing) klonal typisiert. Sie wurden auf Antibiotikaresistenzen, Biofilmbildung und Präsenz des icaA-Gens, das eine Rolle bei der Biofilmbildung spielt, sowie des mecA-Gens untersucht und mit Isolaten, die aus Blutkulturen oder Venenkatheter des Kindes isoliert wurden, verglichen. Es fiel auf, dass die Isolate der sehr kleinen Frühgeborenen deutlich mehr Virulenzfaktoren, wie z.B. Biofilmbildung, hohe Antibiotikaresistenzraten sowie die Präsenz des mecA- und des icaA- Gens, als die maternalen Stämme besaßen. Im Vergleich mit den Ergebnissen der untersuchten Personalstämme liegt der Verdacht nahe, dass oftmals auch das Personal als Transmitter, vor allem von Klonen mit mehreren Virulenzfaktoren, dient. Das Krankenhaus-Milieu scheint dabei ein ideales Reservoir für die Ausbreitung solcher gefährlichen S. epidermidis-Stämme zu sein. / Staphylococcus epidermidis is usually a commensal inhabitant of the human skin and mucosa. However, they are a common cause of nosocomial infections, especially in context with medical devices and catheters in immunocompromised patients. This is due to the ability of Staphylococcus epidermidis to form biofilms on inert surfaces of medical devices, like intravenous catheters or artificial arthroplastics. Furthermore the development of antibiotic resistances among Staphylococcus epidermidis is another problem. Especially the late-onset-sepsis is a danger for very low birth weight premature infants. The aim of the study was to identify for S. epidermidis isolates in very preterm infants, if a longer stay in the hospital is associated with a higher carriage of the ica-operon, a higher antibiotic resistance and the ability to form biofilms. The reservoir and the means of distribution of these nosocomial isolates should be idendified. Therefore sequential isolates were taken from mothers, their children and from the hospital staff. They were clonally typified by MLST (Multilocus-Sequence-Typing) and tested for antibiotic resistances, biofilm formation and the presence of the icaA- and mecA gene. Then they were compared with isolates from blood cultures or venous catheters from the preterm infants. Herby it was remarkable that the isolates of the very premature infants had more virulence factors, e.g. formation of biofilm, antibiotic resistances and the presence of the icaA- and mecA gene, as the maternal isolates. Compared to the results of the isolates from the medical staff it could be suggested that the staff transmits these opportunistic pathogens. The hospital environment seems to be an ideal reservoir for these dangerous S. epidermidis isolates.

Das Visus-VEP wird angewendet bei Patienten mit eingeschränkter Kooperation (Kinder, retardierte Personen), unklarer Visusminderung, funktionellen Sehstörungen, Verdacht auf Simulation sowie zur Verlaufskontrolle von Erkrankungen der Sehbahn. Ziel dieser Arbeit war es, die bisherigen Methoden zu optimieren. An 20 augengesunden Probanden wurden monokular Messungen mit Sinusgitter-Reizen bei 12 Ortsfrequenzen zwischen 1 und 20 cpd durchgeführt. Die Präsentation erfolgte jeweils im Pattern-reversal- und Pattern-onset-Modus. Die VEP-Signale wurden über eine auf der Position Oz liegende Elektrode sowie über zusätzlich zwei laterale (L, R) und eine kraniale Elektrode (O) abgeleitet. Durch ein mittels Igor Pro© geschriebenes Programm wurden zur Auswertung für jede Versuchsperson insgesamt 12 Graphen erstellt, in denen die Fourier-Amplitude als Funktion der Ortsfrequenzen aufgetragen wurde, sog. Tuning-Kurven: Für beide Reizmuster wurde neben der Oz -Ableitung eine 3-Punkt- (VEP-Signale von Oz, L, R) und eine 4-Punkt-Laplacian-Ableitung (VEP-Signale von Oz, L, R, O) durchgeführt. Zusätzlich erfolgte jeweils eine alleinige Auswertung der Fourier-Amplitude der Reizfrequenz sowie eine Auswertung unter Einbeziehen der ersten Oberwelle der Reizfrequenz im Fourier-Spektrum. Der Einfluss dieser Methoden auf die Grenzortsfrequenz, die Amplitude, das Signal-Rausch-Verhältnis (SNR) und die Anzahl der signifikanten Antworten wurde untersucht. Die Elektrodenanordnung hatte keinen signifikanten Einfluss auf die Grenzortsfrequenz. Beim Pattern-reversal-Reiz waren durch die Laplacian-Ableitungen die Amplituden signifikant niedriger, beim Pattern-onset-Reiz bestand diesbezüglich kein Unterschied. Für den Pattern-reversal-Reiz erbrachte 4-Punkt-Laplacian das beste SNR, für den Pattern-onset-Reiz gab es hierbei keine signifikanten Unterschiede. Bei der Zahl der signifikanten Datenpunkte erwiesen sich beide Laplacian-Anordnungen bei beiden Reizmustern als vorteilhaft. Auch Mackay et al. (2003a,b) erreichten durch eine 3-Punkt-Laplacian-Anordnung ein verbessertes SNR und mehr signifikante Ereignisse. Trotz des Mehraufwandes empfehlen wir aufgrund dieses Ergebnisses in der Klinik die Verwendung einer Laplacian-Ableitung. Wegen einer Verminderung der Amplitudenhöhe kann jedoch die Laplacian-Ableitung in wenigen Fällen bei Personen mit sehr niedrigen VEP-Amplituden von Nachteil sein. Eine Auswertung mit Oberwelle lieferte keine signifikanten Unterschiede für die Grenzortsfrequenzen. Die Amplituden lagen hierbei signifikant höher. Für den Pattern-onset-Reiz wurde das SNR sogar niedriger, für den Pattern-reversal-Reiz änderte es sich nicht. Bezüglich der Anzahl der signifikanten Datenpunkte bestand kein Einfluss der Oberwelle. Wegen der letzten beiden Punkte bewerten wir eine Auswertung mit erster Oberwelle nicht als vorteilhaft in der klinischen Routine. Bei einzelnen Patienten mit besonders niedrigen Amplituden im VEP kann diese Auswertungsmethode jedoch eine Möglichkeit sein. Für den Pattern-onset-Reiz lagen die Grenzortsfrequenzen signifikant höher, ihr Spektrum war vergleichbar mit denen der Studien von Strasburger et al. (1996) und Bach et al. (2008). Im Hinblick auf die Amplitude bestand zwischen den beiden Reizmuster entgegen Strasburger et al. (1996) und Parry et al. (1999) in unserer Studie kein signifikanter Unterschied. Bei 12 Versuchspersonen konnten beim Pattern-onset-Reiz aus den Messdaten keine Tuning-Kurven erstellt werden, da es bei den niedrigen Ortsfrequenzen wieder zu einem Anstieg der VEP-Amplitude gekommen war. In einem Nachexperiment erscheinen Helligkeitsartefakte des Monitors als wahrscheinlichste Ursache, für die der Pattern-onset-Reiz anfällig ist (Fahle & Bach, 2006). Wegen eines zusätzlichen Zeitaufwandes durch nicht auswertbare Messungen oder sogar verfälschter objektiver Visus-Werte durch falsch hohe VEP-Amplituden beim Pattern-onset-Reiz, empfehlen wir für die Praxis den Einsatz von Pattern-reversal-Mustern. In weiterführende Studien sollte der Einfluss der in unserer Arbeit untersuchten Parameter (Reizart, Oberwelle, Ableitung) bei unterschiedlichen Augenerkrankungen sowie bei Personen mit besonders niedrigem Visus erforscht werden. / Objective assessment of visual acuity by visual evoked potentials: Influence of electrode arrangement, harmonics and stimulus pattern

Dementia is characterized as a progressive loss of brain function that results in the deterioration of many cognitive and physical abilities. Alzheimer’s disease (AD) is the most common form of dementia, causing steady declines in memory, functional abilities, and mental functioning. With a projected increase of degenerative illnesses, such as AD, family caregiving for individuals with the disease is also steadily increasing. Caring for an individual with AD has been characterized as a “career,” and within this career are a number of key transitions, including the onset of caregiving. Preexisting caregiving research reveals a number of negative consequences for AD family caregivers, including depression, overload, and physical health complications. The purpose of this study was to examine how different patterns of caregiving onset (gradual and abrupt) and role occupancy (how many roles the caregiver is holding) impact mental health and physical health outcomes for AD caregivers. This study also explored how cognitive decline and behavioral problems found within the care-recipient have the potential to moderate these relationships. Cross-sectional, quantitative data from one hundred participants completing self-administered surveys was used in this study. A series of one-way ANOVAS and multiple regression analyses were conducted to address the study’s aims. Results indicated that care-recipient cognition and behavioral problems moderated the relationship between caregiving onset and mental health outcomes, including depression, role overload, and role captivity for caregivers who experienced a more abrupt entry into the caregiving role. Results suggest the importance of considering moderating factors within the caregiving career, as well as different caregiving onset transitions. Clinical implications of the findings are discussed, as well as directions for future research, including prospective caregiving research.

Orientador: Lígia Maria Suppo Souza Rugolo / Resumo: A sepse neonatal tardia é importante causa de morbidade e mortalidade em recém-nascidos prematuros. Os sinais e sintomas são inespecíficos, o que dificulta o diagnóstico. As citocinas são potentes mediadores inflamatórios que desempenham importante papel na patogênese da infecção. Níveis séricos aumentados de citocinas são observados durante infecções. A Interleucina 8 (IL-8) tem função de atrair e ativar neutrófilos, mantendo o processo inflamatório. O objetivo deste estudo foi determinar os níveis séricos e urinários da IL-8 em recém-nascidos prematuros com sepse tardia confirmada por culturas (sangue, urina ou líquor) ou associada com meningite, e avaliar se os níveis urinários de IL-8 podem ser utilizados como teste diagnóstico da sepse neonatal tardia. Amostras de sangue e urina foram coletadas de 36 RN prematuros com suspeita clínica de sepse tardia e os exames foram repetidos após 48 horas do início do estudo. Os valores séricos e urinários da IL-8 foram determinados pelo método de ELISA e a IL-8 urinária foi ajustada pelo valor da creatinina urinária. Dois grupos foram constituídos: Grupo séptico: 19 RN com sepse confirmada por culturas ou associada a meningite, idade gestacional (IG) de 31 ± 2,5 semanas, peso de nascimento (PN) de 1350 ± 420g, idade pós-natal (IPN) de 9,7 ± 5,3 dias e Grupo não infectado: 17 RN nos quais o diagnóstico de sepse foi excluído, IG 31 ± 2,1 sem, PN 1510 ± 380g, IPN 6,9 ± 4,1 dias. A mediana dos níveis séricos da IL-8 não diferiu estatisticamente entre os grupos séptico e não infectado (929 x 624 pg/ml; p=0,079) mas os níveis urinários (IL-8 ur/cr) foram significativamente maiores no grupo séptico (249 x 41,7; p<0,001). O ponto de corte ótimo da IL-8 sérica foi de 304 pg/ml com sensibilidade de 84% (IC 95%: 60 a 95%) e especificidade de 47% (IC 95%: 23 a 72%)... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Late onset sepsis (LOS) is an important cause of morbidity and mortality in preterm infants. However, the diagnosis of LOS is difficult. Elevated serum levels of cytokines have been found during infections and this plays a critical role in the pathogenesis of infections. Interleukin 8 (IL-8) attracts and activates neutrophils which is crucial for the maintenance of the inflamatory process. The aim of this study was to determine serum and urine IL-8 levels in preterm infants with clinical LOS and positive culture (blood, urine ou cerebrospinal fluid) or meningitis and to evaluate if IL-8 levels can be a useful test for the diagnosis of LOS. Blood and urine were obtained from 36 premature babies with clinical signs of LOS and the collection of the samples were repeated after two days. Serum and urine IL-8 levels were determined by ELISA and the urine IL-8 concentration was corrected with the urine creatinine level. Nineteen preterm infants with sepsis (positive cultures or meningitis) - LOS Group: gestational age (GA) 31 ± 2.5wk, Birth Weight (BW) 1.35 ± 0.42 Kg, postnatal age(PNA) 9.7 ± 5.3 days and 17 noninfected - Control Group: GA 31 ± 2.1wk, BW 1.51 ± 0.38, PNA 6.9 ± 4.1 days, were studied. The medium serum IL-8 levels were not statistically different between groups (LOS vs Control, 929 x 624 pg/ml; p=0,079) but urine IL-8 levels were significantly higher in the LOS group when compared with the noninfected (249 x 41,7 p<0,001). The optimal cut-off point was 304pg/ml for serum IL8 with 84% sensitivity (95% CI: 60-95%) and 47% specificity (95% CI: 23-72%). The cut-off point for urine IL-8 was 89 with 100% sensitivity (95% CI: 82-100%) and 100% specificity (95%CI:81-100%). Two days after of clinical signs of LOS, urine IL-8 levels decreased in LOS group (p<0,001). The decrease in serum IL-8 levels in the LOS group was not statistically different (p=0,123)... (Complete abstract, click electronic address below) / Doutor

Unlike in Classical Arabic, this study hypothesized that word-initial consonant clusters exist in Najdi Arabic as a result of first vowel deletion. The goal of this study was to investigate the word-initial consonant cluster patterns of Najdi Arabic and measure the sonority scale of this particular position. Ten native Najdi Arabic speakers were asked to pronounce 24 words and 24 sentences that contained all the possible consonant cluster patterns that could occur in Najdi Arabic. The output of the subjects revealed that Najdi Arabic does have initial consonant clusters in certain environments and that the minimum sonority distance was one step between the first and second onsets. The study found that the sonority distance between the first and second onsets plays a role in forming initial consonant clusters in Najdi. Additionally, the existence of less-marked consonant clusters was found to be more frequent than the more marked ones. Finally, the study proposed examining the pattern of the deleted vowel in future studies to determine whether it plays a role in the results.

abstract: The North American Monsoon (NAM) is a late summer increase in precipitation fundamentally caused by a wind shift that is evident in the southwestern United States and northwest Mexico from approximately June-August. Increased precipitation during these months bring an increased regional threat from heavy rains, blowing dust, and damaging storms. (Adams and Comrie 1997). Researchers in Phoenix, AZ theorized that using surface dewpoint measurements was an objective way to officially mark the start of the NAM in Phoenix, AZ (and Tucson, AZ). Specifically, they used three consecutive days at or above a certain dewpoint temperature (Franjevic 2017). The justification for this method was developed by Reitan (1957) who established that 25.4mm (1.00”) of integrated precipitable water (IPW) was a sufficient threshold to create storm activity in the NAM region. He also determined (Reitan 1963) that a strong correlation existed between (IPW) and surface dewpoint (Td), whereas, Td could be used as a proxy to determine IPW. I hypothesize that the correlation coefficients between IPW and Td will be greatest when using seasonal mean averages of IPW and Td, and they will decrease with shortened mean timescales (from seasonal to three-days). Second, I hypothesize that there is a unique relationship between IPW/Td that may signal monsoon onset. To conduct this study, I used the North American Regional Reanalysis (NARR) dataset (1979-2015). For ten locations in the Southwest, I conducted a series of statistical analyses between IPW, Td, and accumulated precipitation. I determined that there is a correlation between the two as set forth by Reitan (1963) as well as (Benwell 1965; Smith 1966; Ojo 1970). However, from the results I concluded this relationship is highly variable, spatially and temporally. Additionally, when comparing the three-hour, three-day, and the weekly mean measurements, I can conclude that, for my study, timescale averaging did enhance the IPW/Td relationship from three-hour to weekly as expected. The temporal and spatial evolution of the IPW/Td correlation as presented in this thesis may provide a framework for future research that reevaluates the NAM’s domain and the associated methods for determining its onset. / Dissertation/Thesis / Masters Thesis Geography 2017