Remote exposure to traumatic events and PTSD symptoms among U.S. Air Force intelligence personnel: Moderating effects of morally injurious experiences.

OBJECTIVES: U.S. Air Force (USAF) intelligence, surveillance, and reconnaissance (ISR) personnel continuously view high-resolution, real-time imagery and video feeds that include intermittent exposure to graphic events. This brief report examined whether cumulative exposure (still imagery, video, and audio) to graphic events was associated with posttraumatic stress disorder (PTSD) symptoms among USAF ISR personnel. We also examined whether morally injurious experiences (MIEs)-as well as three MIE subtypes: (a) personal moral transgressions, (b) transgressions by others, and (c) feelings of betrayal by others-moderated the association between ISR work-related traumatic exposure and PTSD symptoms. METHOD: Participants were 277 USAF ISR personnel assigned to intelligence units. RESULTS: We found two significant moderation effects. First, we found that the association between ISR remote graphic media exposure and PTSD symptoms was strongest for participants with higher levels of MIE exposure. Second, we found that the ISR remote graphic media exposure-PTSD symptoms association was strongest among participants who reported higher levels of MIEs that were self-directed; that is, they reported being troubled with believing they had violated their own morals, values, or principles. CONCLUSIONS: Findings emphasize the importance of moral injury in understanding PTSD symptoms in ISR personnel. Specifically, because MIEs and PTSD are possible in remote combat agents, prevention and intervention efforts for ISR actors should directly target this special population with recognition that (a) remote combat exposure can be traumatic and (b) perceived violations of moral beliefs or values may be central to any posttraumatic psychopathology. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Emerging Use of Ultra-High-Field 7T MRI in the Study of Intracranial Vascularity: State of the Field and Future Directions.

Cerebrovascular disease is a major source of mortality that commonly requires neurosurgical intervention. MR imaging is the preferred technique for imaging cerebrovascular structures, as well as regions of pathology that include microbleeds and ischemia. Advanced MR imaging sequences such as time-of-flight, susceptibility-weighted imaging, and 3D T2-weighted sequences have demonstrated excellent depiction of arterial and venous structures with and without contrast administration. While the advantages of 3T compared with 1.5T have been described, the role of ultra-high-field (7T) MR imaging in neurovascular imaging remains poorly understood. In the present review, we examine emerging neurosurgical applications of 7T MR imaging in vascular imaging of diverse conditions and discuss current limitations and future directions for this technique.

Structural MRI at 7T reveals amygdala nuclei and hippocampal subfield volumetric association with Major Depressive Disorder symptom severity.

Subcortical volumetric changes in major depressive disorder (MDD) have been purported to underlie depressive symptomology, however, the evidence to date remains inconsistent. Here, we investigated limbic volumes in MDD, utilizing high-resolution structural images to allow segmentation of the hippocampus and amygdala into their constituent substructures. Twenty-four MDD patients and twenty matched controls underwent structural MRI at 7T field strength. All participants completed the Montgomery-Asberg Depression Rating Scale (MADRS) to quantify depressive symptomology. For the MDD group, volumes of the amygdala right lateral nucleus (p = 0.05, r2 = 0.24), left cortical nucleus (p = 0.032, r2 = 0.35), left accessory basal nucleus (p = 0.04, r2 = 0.28) and bilateral corticoamygdaloid transition area (right hemisphere p = 0.032, r2 = 0.38, left hemisphere p = 0.032, r2 = 0.35) each displayed significant negative associations with MDD severity. The bilateral centrocortical (right hemisphere p = 0.032, r2 = 0.31, left hemisphere p = 0.032, r2 = 0.32) and right basolateral complexes (p = 0.05, r2 = 0.24) also displayed significant negative relationships with depressive symptoms. Using high-field strength MRI, we report the novel finding that MDD severity is consistently negatively associated with amygdala nuclei, linking volumetric reductions with worsening depressive symptoms.

Correlation of factor IXa subsite modulations with effects on substrate discrimination.

BACKGROUND: A key feature of factor IXa is its allosteric transformation from an enzymatically latent form into a potent procoagulant. Although several small molecules have been found to be capable of partially affecting FIXa function (i.e. ethylene glycol, Ca(2+), and low molecular weight heparin [LMWH]), the resulting modest changes in peptidolytic activity have made the study of their mechanisms of action challenging. As these effects provide hints about potential regulatory forces that may be operational in the full expression of FIXa coagulant activity, their description remains of great interest. Studies of crystal structures have yielded insights into the structural changes induced by these effectors, but there remains a paucity of information to correlate any given structural change with specific consequences for FIXa function. OBJECTIVES: To correlate structural changes induced by these modulators with defined consequences for FIXa substrate discrimination and function. METHODS: A peptidomics-based mass spectrometry (MS) approach was used to examine the patterns of hydrolysis of four combinatorial chemistry-derived pentapeptide libraries by FIXa under various conditions in a soluble, active enzyme system. RESULTS: Ethylene glycol specifically altered the S3 subsite of FIXa to render it more tolerant to side chains at the P3 substrate position, whereas Ca(2+) enhanced tolerance at the S2 subsite. In contrast, LMWH altered both the S2 and S1' subsites. CONCLUSIONS: These results demonstrate the role of plasticity in regulating FIXa function with respect to discrimination of extended substrate sequences, as well as providing crucial insights into active site modulations that may be capitalized on by various physiologic cofactors of FIXa and in future drug design.

Information needs of the 'frontline' public health workforce.

OBJECTIVES: To explore the information needs of the 'frontline' public health workforce, whether needs are being met and barriers to meeting needs. STUDY DESIGN: A qualitative research study using in-depth semi-structured interviews. METHODS: A qualitative study, comprising eight semi-structured interviews, was conducted with one representative of each of eight categories of frontline public health professional (children's centre manager, community development worker, community midwife, district nurse, health visitor, community pharmacist, practice nurse and school nurse) to determine their public health role, information needs and barriers to meeting needs. Interviews were tape-recorded and data were analysed to identify themes for each category and common themes. RESULTS: Respondents expressed similar needs, some of which could be met by a dedicated library and knowledge service, given adequate funding, and some of which need input from management. The library could supply: news bulletins and up-to-date information, especially local information; targeted local websites and databases; training in literature-searching skills, basic information technology (IT) skills and critical appraisal; course and work support, with access to local library facilities; a literature search support service; signposting, with a named library contact; and access to information for patients. Management input is required to remedy basic structural barriers, including: lack of IT equipment and training; lack of time to access information; lack of funding for courses and professional development; and lack of communication of information from higher levels. CONCLUSIONS: Some information needs can be met by improvements and widening of access to library services, which may need increased funding. However, some barriers to meeting information needs require action elsewhere in the public health management structure. Changes need to be made in communication of public health strategy, and engagement needs to be improved between higher managerial levels and the frontline workforce.

Development of a scale to measure problem use of short message service: the SMS Problem Use Diagnostic Questionnaire.

This exploratory study examines a subset of mobile phone use, the compulsive use of short message service (SMS) text messaging. A measure of SMS use, the SMS Problem Use Diagnostic Questionnaire (SMS-PUDQ), was developed and found to possess acceptable reliability and validity when compared to other measures such as self-reports of time spent using SMS and scores on a survey of problem mobile phone use. Implications for the field of addiction research, technological and behavioral addictions in particular, are discussed, and directions for future research are suggested.

Scintigraphic measurement of tracheal mucus velocity in vivo.

Mucociliary clearance (MCC) is an important mechanism for removing inhaled particles, secretions and cellular debris from the respiratory tract. Here, a direct measurement of tracheal mucus velocity (TMV) for assessment of MCC, suitable for clinical and research use, is reported, and a comparison is made of TMV in normal subjects and patients with chronic obstructive pulmonary disease (COPD). A 0.1-mL bolus of radiolabelled (2-5 MBq), technetium-labelled macroaggregated human albumin (99mTc MAA) was injected through the cricothyroid membrane into the trachea of 20 young (< 50 yrs) and 12 older (> 50 yrs) normal subjects and 34 patients with COPD. Repeat studies were carried out in 13 normal subjects and 16 COPD patients. Movement of the bolus in the trachea was recorded (15 min) using a gamma camera interfaced to a computer. Data were analysed using specifically designed software. The test was well tolerated by subjects and patients, and no significant adverse events were reported. No significant differences were observed between data recorded from different regions of the bolus (leading edge, peak, trailing edge) by analysis of variance (ANOVA). Bland-Altman plots of the repeat studies indicated that data were more variable in normal subjects (coefficient of repeatability (COR) 10.3 mm.min-1) than in COPD patients (COR 5.5 mm.min-1). TMV (mean +/- SD) in young normal subjects (n = 20) was 10.7 +/- 3.5 mm.min-1. TMV was reduced in older normal subjects (n = 12; 6.5 +/- 2.6 mm.min-1) and further reduced in COPD (n = 34; 2.1 +/- 2.7 mm.min-1). In conclusion, this technique can be used to measure tracheal mucus velocity rapidly and safely in healthy subjects and patients with respiratory tract disease. This study has confirmed that tracheal mucus velocity declines with age and is further impaired in patients with chronic obstructive pulmonary disease.

Accuracy in gamma camera measurements of point source velocities.

Mucociliary clearance is impaired in many diseases of the respiratory system. We have developed a method for measuring tracheal mucus velocity by the dynamic study of a single point source of radioactivity deposited in the trachea by cricothyroid injection. Preliminary results suggest that patients with airways disease have very low tracheal mucus velocities (<2 mm x min(-1)). The aim of this experiment was to explore the ability of current scintillation detection systems to track a single point as it moves in a dynamic study in small increments and at low velocity (movements of the order of 1 mm). Background noise was estimated to contribute an error in positioning of 0.16 mm (1 standard deviation). Overall errors in velocity were estimated at 0.2 mm x min(-1). This suggests that standard instrumentation in use in most nuclear medicine departments has the capacity to measure accurately velocities as low as 1 mm x min(-1).

Ciliary defects in healthy subjects, bronchiectasis, and primary ciliary dyskinesia.

To develop criteria to aid in the diagnosis of primary ciliary dyskinesia (PCD) we analyzed quantitatively the incidence and the range of ciliary ultrastructural abnormalities in healthy subjects and in patients with respiratory tract disease. The beat frequency and ultrastructure of nasal respiratory tract cilia, including ciliary orientation, were measured in 62 healthy subjects (31 nonsmokers, 20 exsmokers, and 11 smokers), ranging in age from 1 to 76 yr, and in 51 patients with respiratory tract disease. In healthy subjects, ciliary beat frequency (CBF) ranged between 9.6 and 15.3 Hz, the incidence of microtubule defects varied between 0 to 9%, the mean number of inner dynein arms per cilium ranged from 3.0 to 7.1, and the mean number of outer dynein arms per cilium ranged from 7.4 to 9.0. The deviation of cilia in healthy subjects varied between 8 and 29 degrees. By comparing the data for ciliary defects in healthy subjects with the data obtained from patients with respiratory disease, we identified two patient groups: patients with PCD (n = 31) and patients with respiratory tract disease not due to PCD. For comparison with the PCD patients, a group of 20 patients with bronchiectasis was selected and analyzed. Patients with PCD had significantly lower CBF (p < 0.001), significantly higher incidences of peripheral and central tubule defects (p < 0.01), and greater ciliary disorientation (p < 0.005). There was a strong correlation between CBF and the number of outer dynein arm numbers, but not with inner dynein arm numbers, suggesting that inner and outer dynein arms may play different functional roles in producing ciliary motility.(ABSTRACT TRUNCATED AT 250 WORDS)

Mucociliary function, ciliary ultrastructure, and ciliary orientation in Young's syndrome.

BACKGROUND: Mucociliary clearance is impaired in patients with Young's syndrome (obstructive azoospermia with recurrent sinobronchial disease), cystic fibrosis, and primary ciliary dyskinesia. No defect of cilia or mucus has been detected in Young's syndrome. METHODS: Ciliary function and ultrastructure, including ciliary orientation, were studied quantitatively in 20 patients with Young's syndrome and 20 normal subjects to determine the incidences of ciliary defects. Nasal ciliated epithelium was obtained from each subject and used for measurement of ciliary beat frequency and ultrastructural analyses. Ciliary orientation was determined by measuring ciliary deviation in electron micrographs; ciliary deviation is a measure of the relative orientation of cilia in relation to each other in which high values indicate ciliary disorientation. RESULTS: Ciliary beat frequency and the incidence of microtubular defects and numbers of dynein arms did not differ between patients with Young's syndrome and control subjects. In patients with Young's syndrome basal ciliary deviation (16.0 degrees) was similar to that in control subjects (14.1 degrees), but at the ciliary tip ciliary deviation (21.9 degrees) was greater than in healthy subjects (14.5 degrees). CONCLUSION: The relative disorientation of the distal ciliary axoneme in patients with Young's syndrome compared with normal subjects may be due to a structural defect but is more likely to be a consequence of abnormal mucus.

Giant pericardial cyst.

We report the excision of the largest pericardial cyst yet described. Despite causing collapse of the left lower lobe, and bronchitis, an excellent symptomatic result was obtained.

Orientation of respiratory tract cilia in patients with primary ciliary dyskinesia, bronchiectasis, and in normal subjects.

A reproducible technique, utilising a graphics tablet and a personal computer for measuring ciliary orientation from electron micrographs of ciliated epithelium, was assessed. Ciliary deviation was measured in 47 normal subjects (mean ciliary deviation +/- 1 SD was 14.6 (3.3 degrees)), in eight patients with bronchiectasis and normal ciliary function (15.1 (6.5 degrees], and in seven patients with primary ciliary dyskinesia (38.7 (7.8 degrees); significantly greater than the first two groups). Measurements of ciliary deviation at the tip, base, and basal feet showed very little variation along the ciliary shaft in all three groups, suggesting that valid measurements of ciliary deviation can be made at any level of the cilium. Mean ciliary deviation in normal subjects was always less than 30 degrees; all patients with a mean ciliary deviation of greater than 30 degrees had recurrent respiratory tract disease. Four of seven patients with primary ciliary dyskinesia had ciliary disorientation; in one this was the only defect. Measurements of inter- and intraobserver variability using this method showed a maximum difference between observations of 4.1 degrees. It is suggested that ciliary orientation should be measured in patients suspected of having defective ciliary function or structure, or both.

Primary malignant non-seminomatous germ cell tumour of the mediastinum treated by surgery and chemotherapy.

Primary malignant germ cell tumours of the mediastinum are rare and are associated with poor survival when treated with surgery alone or with surgery when chemotherapy has failed. Recent improvements in combination chemotherapy have given some prospect of cure. A patient treated with primary surgical excision and postoperative chemotherapy, who remains free of disease 24 months after completion of treatment is reported here.

Cystic fibrosis serum does not inhibit human ciliary beat frequency.

The effect of cystic fibrosis (CF) serum on human respiratory tract ciliary beat frequency (CBF) was studied to investigate the possible relevance of CF-serum-induced disruption of rabbit tracheal ciliary motility to human disease. Nasal ciliated epithelium from patients with CF and from normal subjects was incubated at 37 degrees C in CF serum, in normal human serum (NHS), or in nutrient medium. CBF was measured photometrically at time intervals up to 3 h. The effect of CF serum on human trachea and of CF serum, NHS, and rabbit serum on rabbit tracheal CBF was also studied. Mean CBF for all the normal and CF nasal cilia incubated in CF serum, NHS, or nutrient medium was not significantly different and did not fall during 3 h. Human tracheal CBF did not fall during 3 h. The CBF for rabbit trachea in rabbit serum did not slow and rabbit trachea in NHS slowed after 150 min. Rabbit trachea in CF serum beat more slowly than all the other groups (p less than 0.001) progressing to ciliostasis between 45 and 150 min. We conclude that human respiratory tract ciliary motility, as measured by CBF in vitro, is unaffected by factors in CF serum that impair rabbit tracheal ciliary activity.

Screening for ciliary dyskinesia - a spectrum of defects of motility and structure.

Ciliary motility and ultrastructure were studied in cystic fibrosis, bronchiectasis and Kartagener's syndrome and normal control subjects. In cilia from patients with Kartagener's syndrome, beat frequency was slower and there were more microtubular abnormalities and fewer dynein arms than for each of the other groups. In Kartagener's syndrome, ciliary motility and outer dynein arm numbers were positively correlated and there was a wide variation in each. Cystic fibrosis ciliary beat frequency and ultrastructure were normal.