Positron Generation and Acceleration in a Self-Organized Photon Collider Enabled by an Ultraintense Laser Pulse

We discovered a simple regime where a near-critical plasma irradiated by a laser of experimentally available intensity can self-organize to produce positrons and accelerate them to ultrarelativistic energies. The laser pulse piles up electrons at its leading edge, producing a strong longitudinal plasma electric field. The field creates a moving gamma-ray collider that generates positrons via the linear Breit-Wheeler process-annihilation of two gamma rays into an electron-positron pair. At the same time, the plasma field, rather than the laser, serves as an accelerator for the positrons. The discovery of positron acceleration was enabled by a first-of-its-kind kinetic simulation that generates pairs via photon-photon collisions. Using available laser intensities of 10^{22}  W/cm^{2}, the discovered regime can generate a GeV positron beam with a divergence angle of around 10° and a total charge of 0.1 pC. The result paves the way to experimental observation of the linear Breit-Wheeler process and to applications requiring positron beams.

The impact of negative and positive affectivity on the relationship between work-related psychological factors and work engagement in Japanese workers: a comparison of psychological distress

BACKGROUND

A previous study has shown that Japanese individuals generally exhibit behavior that suppresses the expression of positive emotions, which are strongly affected by affectivity traits. In the present study, to clarify the relationship between affectivity traits and work engagement (WE) or work-related psychosocial factors among Japanese workers, we compared it to the association between psychological distress and these same factors.

METHODS

A total of 1,000 full-time Japanese regular workers responded to an online survey that measured demographic variables, negative and positive affectivity, job demands and resources, WE, and psychological distress. A hierarchical multiple regression analysis was conducted separately, which used WE and psychological distress as dependent variables.

RESULTS

The proportion of variance explained by negative and positive affectivity was lower for WE than for psychological distress. However, the proportion of variance defined by job demands and resources was higher for WE than for psychological distress. The proportion of variance explained by all variables for negative and positive affectivity and job demands and resources, and their interactions was approximately equal for WE and psychological distress.

CONCLUSION

These results emphasize when researchers aim to evaluate the change of psychosocial factors in the workplace, such as improving the workplace environment among Japanese workers, it might be beneficial to measure positive indicators in addition to negative indicators. Furthermore, enriching job resources would be effective in improving WE and alleviating psychological distress.

Gender Differences in the Motivational Process of the Job Demands-Resources Model

Background

Achieving gender equality is an important goal in Japan. Consequently, this study aimed to examine gender differences in a series of associations between job demands or resources and job performance mediated by work engagement (WE) in the motivational process of the job demands-resources model.

Methods

This study recruited 671 non-manual workers (260 men and 411 women) through an online survey. The measured variables were demographic information, job demands or resources, WE, and job performance. Multiple-group structural equation modeling was used to analyze the data.

Results

Regarding the level of job demands or resources and WE, no significant difference was observed between men and women. Whereas, job performance was significantly higher in women than in men. Additionally, multiple-group structural equation modeling indicated that the model that imposed on all path coefficients for equality constraints had a better fit, and consequently, no gender differences.

Conclusion

Although the motivational process indicated no gender differences, job performance was higher in women than in men due to the management of a gender-equal and friendly work environment. Further comprehensive examinations, that use other variables not included in the present study, are required to understand women's high job performance.

Job satisfaction of Japanese midwives in the Tokyo metropolitan area

INTRODUCTION

We explore job satisfaction among Japanese midwives working in different institutions within the Tokyo metropolitan area and relate this to midwives' age.

METHODS

The study involved a questionnaire survey of 423 midwives working in 113 general hospitals, 70 clinics, and 58 midwifery centers in the Tokyo Metropolitan Area of Japan. The questionnaire consisted of items related to demographic and job satisfaction. Questionnaires were returned by 199 participants (47%).

RESULTS

Of the 199 midwives, 142 worked in general hospitals (71%), 26 worked in maternity clinics (13%), and 31 worked in midwifery centers (16%). Factor analysis extracted six job satisfaction factors labelled as: F1 'midwifery services', F2 'interpersonal relations', F3 'rewarding and autonomy', F4 'working environment', F5 'working conditions', and F6 'collaboration with doctors'. Job satisfaction scores for all factors were the highest among midwives working in midwifery centers, followed by those working in maternity clinics and hospitals. Job satisfaction of F1 and F3 of those working in midwifery centers was significantly higher than those working in hospitals and maternity clinics for the younger age group, while the scores of those working in maternity clinics became higher and closer to those working in midwifery centers for other age groups.

CONCLUSIONS

Job satisfaction of midwives varies by different institutions, particularly lowest for those working in hospitals than those working in midwifery clinics and centers. It is necessary to devise useful strategies for midwives in hospitals to enhance their satisfaction with midwifery services and to feel rewarded by and autonomy at work.

Commitment profiles among nurses: combinations of organizational commitment forms and work engagement, psychological distress, and turnover intention

To clarify the combined effect of the sub-factors of organizational commitment, this study examined the relationships between organizational commitment profiles and work engagement, psychological distress, and turnover intention among nurses. A cross-sectional survey was conducted; 455 nurses (38 men and 417 women) were included in the statistical analysis. We extracted six clusters through k-means cluster analysis and applied a one-way analysis of variance and χ² test for work engagement, psychological distress, and turnover intention. Consequently, significant differences were found in work engagement and turnover intention (both p<0.05), and no significant difference was found in psychological distress. These results indicate the formation of affective and normative commitment among nurses in working energetically or preventing turnover. Additionally, no negative effects related to increases in continuance commitment were identified in this study.

Ultrafast time-resolved 2D imaging of laser-driven fast electron transport in solid density matter using an x-ray free electron laser

High-power, short-pulse laser-driven fast electrons can rapidly heat and ionize a high-density target before it hydrodynamically expands. The transport of such electrons within a solid target has been studied using two-dimensional (2D) imaging of electron-induced Kα radiation. However, it is currently limited to no or picosecond scale temporal resolutions. Here, we demonstrate femtosecond time-resolved 2D imaging of fast electron transport in a solid copper foil using the SACLA x-ray free electron laser (XFEL). An unfocused collimated x-ray beam produced transmission images with sub-micron and ∼10 fs resolutions. The XFEL beam, tuned to its photon energy slightly above the Cu K-edge, enabled 2D imaging of transmission changes induced by electron isochoric heating. Time-resolved measurements obtained by varying the time delay between the x-ray probe and the optical laser show that the signature of the electron-heated region expands at ∼25% of the speed of light in a picosecond duration. Time-integrated Cu Kα images support the electron energy and propagation distance observed with the transmission imaging. The x-ray near-edge transmission imaging with a tunable XFEL beam could be broadly applicable for imaging isochorically heated targets by laser-driven relativistic electrons, energetic protons, or an intense x-ray beam.

Effects of work-family life support program on the work-family interface and mental health among Japanese dual-earner couples with a preschool child: A randomized controlled trial

OBJECTIVES

This study examined the effectiveness of a newly developed work-family life support program on the work-family interface and mental health indicators among Japanese dual-earner couples with a preschool child(/ren) using a randomized controlled trial with a waitlist.

METHODS

Participants who met the inclusion criteria were randomly allocated to the intervention or the control groups (n = 79 and n = 85, respectively). The program comprised two 3-h sessions with a 1-month interval between them and provided comprehensive skills by including self-management, couple management, and parenting management components. The program sessions were conducted on weekends in a community center room with 3-10 participants. Outcomes were assessed at baseline, 1-month, and 3-month follow-ups. Primary outcomes were work-family balance self-efficacy (WFBSE), four types of work-family spillovers (i.e., work-to-family conflict, family-to-work conflict, work-to-family facilitation, and family-to-work facilitation), psychological distress, and work engagement reported by the participants.

RESULTS

The program had significantly pooled intervention effects on WFBSE (P = .031) and psychological distress (P = .014). The effect sizes (Cohen's d) were small, with values of 0.22 at the 1-month follow-up and 0.24 at the 3-month follow-up for WFBSE, and -0.36 at the 3-month follow-up for psychological distress. However, the program had nonsignificant pooled effects on four types of work-family spillovers and work engagement.

CONCLUSIONS

The program effectively increased WFBSE and decreased psychological distress among Japanese dual-earner couples with a preschool child(/ren).

Suggestions for new organizational-level item pools for the national Stress Check Program from management philosophy and mission statement: A qualitative study using unsupervised learning

Objective

This study aimed to obtain suggestions for new organizational‐level item pools that companies could utilize to accomplish management philosophy and mission statements in the context of survey and work environment improvements for the national Stress Check Program.

Methods

A qualitative study was conducted using unsupervised learning. A large amount of text data related to management philosophy and mission statements were collected, that is, management messages described on the websites of all companies listed on the Tokyo Stock Exchange. For the main analysis, topic modeling was performed on the nouns from the management messages using Latent Dirichlet Allocation (LDA) to build a model consisting of 10 latent topics, each represented by a group of the 10 most frequently reoccurring nouns. Each group of nouns was qualitatively summarized based on the topic model.

Results

In total, 22 524 nouns were extracted from the management messages of 3575 companies. A topic model consisting of 10 latent topics was constructed using the LDA. The suggestion for new item pools included new technologies, business plans/strategies, company shareholders, health/happiness/wealth, profits/sales, development of society, a sustainable society, safety and security, customer/consumer satisfaction, corporate social responsibility, fairness, transparency, and human rights.

Conclusion

The suggestions for potential item pools were derived from management philosophy and mission statement that are not covered in the existing survey. The suggestions could be useful for motivating employers to implement work environment improvement. Future studies need to make definite items and investigate whether they correlate to job stressors and mental health among workers.

Super-strong magnetic field-dominated ion beam dynamics in focusing plasma devices

High energy density physics is the field of physics dedicated to the study of matter and plasmas in extreme conditions of temperature, densities and pressures. It encompasses multiple disciplines such as material science, planetary science, laboratory and astrophysical plasma science. For the latter, high energy density states can be accompanied by extreme radiation environments and super-strong magnetic fields. The creation of high energy density states in the laboratory consists in concentrating/depositing large amounts of energy in a reduced mass, typically solid material sample or dense plasma, over a time shorter than the typical timescales of heat conduction and hydrodynamic expansion. Laser-generated, high current–density ion beams constitute an important tool for the creation of high energy density states in the laboratory. Focusing plasma devices, such as cone-targets are necessary in order to focus and direct these intense beams towards the heating sample or dense plasma, while protecting the proton generation foil from the harsh environments typical of an integrated high-power laser experiment. A full understanding of the ion beam dynamics in focusing devices is therefore necessary in order to properly design and interpret the numerous experiments in the field. In this work, we report a detailed investigation of large-scale, kilojoule-class laser-generated ion beam dynamics in focusing devices and we demonstrate that high-brilliance ion beams compress magnetic fields to amplitudes exceeding tens of kilo-Tesla, which in turn play a dominant role in the focusing process, resulting either in a worsening or enhancement of focusing capabilities depending on the target geometry.

Association between the five-factor model of personality and work engagement: a meta-analysis

The purposes of this meta-analysis were (1) to examine the associations between work engagement (WE) and the personality dimensions of five-factor model and (2) to determine how much variance in WE is explained by these five factors. We performed a database search for studies related to personality traits and WE, and 36 papers that reported correlation coefficients were selected for the meta-analysis. After correcting for publication bias using the trim-and-fill method, conscientiousness had the strongest association with WE (ρ=0.41), followed by extraversion and openness to experience (0.38), neuroticism (-0.36), and agreeableness (0.27). Moreover, 30% of the WE variance could be explained by the five-factor model (R²=0.33, 95%CI=0.26-0.49) according to a path analysis using the weighted average correlation for unreliability. This proportion was higher than that from a previous meta-analysis of job satisfaction and job performance and was lower than that of personality and WE. Thus, to enhance WE, it is necessary to evaluate both the personality and the psychosocial work environment in detail.

The Effect of Nurses' Work-Life Balance on Work Engagement: The Adjustment Effect of Affective Commitment

Background

This study aimed to examine the effects of nurses' work-life balance (WLB), job demands and resources, and organizational attachment on their work engagement (WE). The second aim was to shed light on whether the relationships among WLB, job demands, resources, and WE are modulated by organizational attachment.

Methods

In total, 425 nurses working in a university hospital responded to the questionnaire. The primary statistical analysis method was hierarchical multiple regression with WE as the dependent variable.

Results

In the model in which all variables were applied, affective commitment (AC) (β = 0.41), family-to-work positive spillover (β = 0.25), and number of children (β = 0.13) were found to have a significant association with WE. Family-to-work negative spillover (FWNS) and AC had significant interaction effects. The result suggests that when AC was low, WE tended to decline further due to FWNS; however, when AC was high, WE did not change due to the effect of FWNS.

Conclusion

These results confirmed that to improve nurses' WE, hospital organizations should implement initiatives to facilitate WLB that considers nurses' household roles. Furthermore, high organizational attachment buffered the home's negative influence on work, thereby helping nurses work energetically.

Workaholism, Work Engagement and Child Well-Being: A Test of the Spillover-Crossover Model

This study examines how working parents' work attitudes (i.e., workaholism and work engagement) are associated with their child's psychological well-being. Based on the Spillover-Crossover model (SCM), we hypothesize that (a) work-to-family spillover (i.e., work-to-family conflict and facilitation) and (b) employee happiness will sequentially mediate the relationship between parents' work attitudes and their child's emotional and behavioral problems. A cross-sectional survey was conducted among Japanese dual-earner couples with pre-school child(ren). On the basis of valid data from 208 families, the hypothesized model was tested using structural equation modeling. For both fathers and mothers simultaneously, workaholism was positively related to work-to-family conflict, which, in turn, was negatively related to happiness. In contrast, work engagement was positively related to work-to-family facilitation, which, in turn, was positively related to happiness. Fathers' and mothers' happiness, in turn, were negatively related to their child's emotional and behavioral problems. Results suggest that parents' workaholism and work engagement are related to their child's emotional and behavioral problems in opposite ways, whereby parents' spillover and happiness mediate this relationship. These findings support the SCM and suggest that decreasing workaholism and improving work engagement may not only improve employees' happiness, but also decrease their child's emotional and behavioral problems.

Clinical indication of nasal surgery for the CPAP intolerance in obstructive sleep apnea with nasal obstruction

OBJECTIVE

The role of isolated nasal surgery for obstructive sleep apnea (OSA) patients with nasal obstruction, especially for an intolerance for continuous positive airway pressure (CPAP), is unclear. The aim of this study was to assess the effects of surgery for OSA patients with symptomatic nasal obstruction and CPAP intolerance.

METHOD

Retrospectve comparative study.1037 OSA patients with apnea-hypopnea index (AHI) ≥ 20 were enrolled. Case-control study was performed between the male apnea patients undergoing nasal surgery: surgery group (n = 43) and the pair-matched apnea patients for age, sex, body mass index, and race: control group (n = 43). The surgery group suffering from nasal obstruction could not use continuous positive airway pressure, and the CPAP group free from nasal obstruction could use it successfully.

RESULTS

In surgery group, surgery significantly decreased the nasal resistance and Epworth sleepiness scale scores without changing the AHI. Surgery significantly increased the nadir of oxygen saturation and shortened the apnea-hypopnea duration. Although all of the surgery group failed to use positive airway pressure preoperatively, the 40 patients of the 43 CPAP intolerance patients were able to use CPAP postoperatively. The resting three patients were cured OSA or changed the treatment to oral appliance(OA). For both groups, the cutoff nasal resistance for differentiating the failure of positive airway pressure and its success was 0.31 Pa/cm³/s.

CONCLUSION

Isolated nasal surgery is effective for an intolerance of positive airway pressure in sleep apnea with nasal obstruction presumably by decreasing nasal resistance.

THU0503 PLUTO TRIAL: SENSITIVITY ANALYSES OF SRI4 RESPONSE WITH BELIMUMAB VS PLACEBO IN PAEDIATRIC PATIENTS WITH CHILDHOOD-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS (CSLE)

Background:

Belimumab (BEL) is the first treatment approved in children ≥5 years of age with cSLE. This recent approval was based on favourable results of the PLUTO trial, evaluating efficacy and safety of intravenous (IV) BEL, plus standard SLE therapy (SST), vs placebo (PBO), in children with cSLE.1

Objectives:

To evaluate the SLE Responder Index 4 (SRI4) sensitivity of response for the comparison of BEL vs PBO at Week (Wk) 52.

Methods:

In PLUTO (NCT01649765; GSK study BEL114055), an ongoing Phase 2, randomised, PBO-controlled, double-blind study, patients (pts) 5–17 years of age with active cSLE were randomised to monthly BEL 10 mg/kg IV, or PBO, plus SST, for 52 weeks. The primary efficacy endpoint was the SRI4 response rate at Wk 52. Pre-specified sensitivity analyses supporting the primary efficacy endpoint for the intention-to-treat (ITT) population included unadjusted, last observation carried forward (LOCF), completer responses, and response using SLE Disease Activity Index (SLEDAI) 2K proteinuria scoring rule (4-point score for proteinuria >0.5 g/24 h), all at Wk 52. Completers were pts who completed 52 weeks of treatment. Any pts who withdrew or received protocol-prohibited medication or a dose of allowable medication that resulted in treatment failure prior to the Wk 52 visit had missing data handled using LOCF (missing values imputed using the last previous non-missing value). Statistics are descriptive.

Results:

Overall, 93 pts were randomised (BEL, n=53; PBO, n=40). Majority (94.6%) of pts were female, mean (standard deviation [SD]) age was 14.0 (2.49) years and mean (SD) disease duration was 2.4 (1.93) years. By Wk 52, numerically more BEL (52.8%) than PBO (43.6%) pts were SRI4 responders; difference vs PBO 9.24; odds ratio (OR; 95% confidence interval [CI]) vs PBO 1.49 (0.64, 3.46). For each sensitivity analysis (unadjusted, LOCF, completer, and SLEDAI 2K responses) the odds of being a responder at Wk 52 were higher for pts receiving BEL vs PBO (Table).

Table.

Sensitivity analyses: SRI4 response at Wk 52

PBO(n=40)BEL(n=53)Unadjusted response (ITT), n*3953 n (%)17 (43.6)28 (52.8) Observed difference vs PBO9.24 OR (95% CI)†vs PBO1.45 (0.63, 3.33)LOCF response (ITT), n*3953 n (%)18 (46.2)30 (56.6) Observed difference vs PBO10.45 OR (95% CI)‡vs PBO1.51 (0.65, 3.52)Completer response (completers), n*3045 n (%)17 (56.7)27 (60.0) Observed difference vs PBO3.33 OR (95% CI)‡vs PBO1.16 (0.44, 3.09)Response using SLEDAI 2K (ITT), n*3953 n (%)17 (43.6)28 (52.8) Observed difference vs PBO9.24 OR (95% CI)‡vs PBO1.49 (0.64, 3.46)

*One pt was excluded because they did not have a baseline Safety of Estrogens in Lupus National Assessment (SELENA)-SLEDAI assessment;†calculated from a logistic regression model for the comparison between BEL and PBO without adjustment for any covariates;‡calculated from a logistic regression model for the comparison between BEL and PBO with covariates treatment group, baseline age (5–11 years vs 12–17 years), and baseline SELENA-SLEDAI score (≤12 vs ≥13)

Conclusion:

The results of the SRI4 primary efficacy endpoint sensitivity analyses further support a favourable effect for BEL vs PBO.

References:

[1]Brunner HI,et al.Arthritis Rheumatol.2018;70(59): 3224–5, Abst. 2867

Acknowledgments:

We acknowledge all PLUTO investigators (PRINTO, PRCSG and otherwise affiliated). Study funding: GSK.

Disclosure of Interests:

Nicolino Ruperto Consultant of: Ablynx, AbbVie, AstraZeneca-Medimmune, Biogen, Boehringer, Bristol-Myers Squibb, Eli-Lilly, EMD Serono, GSK, Hoffmann-La Roche, Janssen, Merck, Novartis, Pfizer, R-Pharma, Sanofi, Servier, Sinergie, Sobi and Takeda, Hermine Brunner Consultant of: Hoffman-La Roche, Novartis, Pfizer, Sanofi Aventis, Merck Serono, AbbVie, Amgen, Alter, AstraZeneca, Baxalta Biosimilars, Biogen Idec, Boehringer, Bristol-Myers Squibb, Celgene, EMD Serono, Janssen, MedImmune, Novartis, Pfizer, and UCB Biosciences, Speakers bureau: GSK, Roche, and Novartis, Masaaki Mori Grant/research support from: Abbvie Japan, Asahikasei Pharmaceutical, Ayumi Pharmaceutical, CSL Behring, Chugai Pharmaceutical, Japan Blood Products Organization, MSD K.K., Nippon Kayaku, UCB Japan, Consultant of: Daiichi Sankyo, Taisho Pharmaceutical, Jacqueline Clinch Consultant of: Alexion, Speakers bureau: Alexion, Reema Syed: None declared, Naomi Iwata Speakers bureau: Sanofi K.K, Damon Bass Shareholder of: GSK, Employee of: GSK, Beulah Ji Shareholder of: GSK, Employee of: GSK, Anne Hammer Shareholder of: GSK, Employee of: GSK, Mohamed Okily Shareholder of: GSK, Employee of: GSK, Gina Eriksson Shareholder of: GSK, Employee of: GSK, Holly Quasny Shareholder of: GSK, Employee of: GSK

0746 Dynamics of Sleep Stage Transitions in Patients with Narcolepsy and Other Hypersomnias

Introduction

Narcolepsy is a chronic sleep disorder characterized by excessive daytime sleepiness and abnormal REM sleep phenomena. Narcolepsy can be distinguished into type 1 (NT1; with cataplexy) and type 2 (NT2; without cataplexy). It has been reported that sleep stage sequences at sleep-onset as well as sleep-wake dynamics across the night may be useful in the differential diagnosis of hypersomnia. Here we studied dynamic features of sleep stage transitions during whole night sleep in patients with NT1, NT2, and other types of hypersomnia (o-HS).

Methods

Twenty patients with NT1, 14 patients with NT2, and 35 patients with o-HS underwent overnight PSG. Transition probabilities between sleep stages (wake, N1, N2, N3, and REM) and survival curves of continuous runs of each sleep stage were compared between groups. Transition-specific survival curves of continuous runs of each sleep stage, dependent on the subsequent stage of the transition, were also compared.

Results

The probability of transitions from N1-to-wake was significantly greater in NT1 than in NT2 and o-HS while that from N1-to-N2 was significantly smaller in NT1 than in NT2 and o-HS. The probability of transitions from N2-to-REM was significantly smaller in NT1 than in o-HS. Wake and N1 were significantly more continuous in NT1 than in NT2; specifically, N1 followed by N2 was significantly more continuous in NT1 than in NT2 and o-HS. N2 was significantly less continuous in NT1 and NT2 than in o-HS; this was specifically confirmed for N2 followed by N1/wake. REM sleep was significantly less continuous in NT1 than in NT2 and o-HS; specifically, REM sleep followed by wake was significantly less continuous in NT1 than in o-HS. Continuity of N3 did not differ significantly between groups.

Conclusion

Dynamics of sleep stage transitions differed between NT1, NT2, and o-HS. Dynamic features of sleep such as sleep instability, persistency of wake/N1, and REM fragmentation may differentiate NT1 from NT2, while N2 continuity may differentiate narcolepsy from o-HS. The results suggest that sleep transition analysis may be of clinical utility and provide insights into the underlying pathophysiology of hypersomnia and narcolepsy.

Support

JSPS KAKENHI (18K17891 to AK).

Effect of Small Focus on Electron Heating and Proton Acceleration in Ultrarelativistic Laser-Solid Interactions

Acceleration of particles from the interaction of ultraintense laser pulses up to 5×10^{21}  W cm^{-2} with thin foils is investigated experimentally. The electron beam parameters varied with decreasing spot size, not just laser intensity, resulting in reduced temperatures and divergence. In particular, the temperature saturated due to insufficient acceleration length in the tightly focused spot. These dependencies affected the sheath-accelerated protons, which showed poorer spot-size scaling than widely used scaling laws. It is therefore shown that maximizing laser intensity by using very small foci has reducing returns for some applications.

Enhancing laser beam performance by interfering intense laser beamlets

Increasing the laser energy absorption into energetic particle beams represents a longstanding quest in intense laser-plasma physics. During the interaction with matter, part of the laser energy is converted into relativistic electron beams, which are the origin of secondary sources of energetic ions, γ-rays and neutrons. Here we experimentally demonstrate that using multiple coherent laser beamlets spatially and temporally overlapped, thus producing an interference pattern in the laser focus, significantly improves the laser energy conversion efficiency into hot electrons, compared to one beam with the same energy and nominal intensity as the four beamlets combined. Two-dimensional particle-in-cell simulations support the experimental results, suggesting that beamlet interference pattern induces a periodical shaping of the critical density, ultimately playing a key-role in enhancing the laser-to-electron energy conversion efficiency. This method is rather insensitive to laser pulse contrast and duration, making this approach robust and suitable to many existing facilities.

Enhanced coupling of laser energy to the target particles is a fundamental issue in laser-plasma interactions. Here the authors demonstrate increased photon absorption leading into higher laser to electron and proton energy transfer through the interference of multiple coherent beamlets.

The Effect of Alternative Scoring Procedures on the Measurement Properties of a Self-Administered Depression Scale

Abstract. To investigate the effect of response alternatives/scoring procedures on the measurement properties of the Center for Epidemiologic Studies Depression Scale (CES-D) which has the four response alternatives, a polytomous item response theory (IRT) model was applied to the responses of 2,061 workers and university students (1,640 males, 421 females). Test information functions derived from the polytomous IRT analyses on the CES-D data with various scoring procedures indicated that: (1) the CES-D with its standard (0-1-2-3) scoring procedure should be useful for screening to detect subjects with “at high-risk” of depression if the θ point showing the highest information corresponds to the cut-off point, because of its extremely higher information; (2) the CES-D with the 0-1-1-2 scoring procedure could cover wider range of depressive severity, suggesting that this scoring procedure might be useful in cases where more exhaustive discrimination in symptomatology is of interest; and (3) the revised version of CES-D with replacing original positive items into negatively revised items outperformed the original version. These findings have never been demonstrated by the classical test theory analyses, and thus the utility of this kind of psychometric testing should be warranted to further investigation for the standard measures of psychological assessment.

A genome-wide association study identifies two novel susceptibility loci and trans population polygenicity associated with bipolar disorder

Genome-wide association studies (GWASs) have identified several susceptibility loci for bipolar disorder (BD) and shown that the genetic architecture of BD can be explained by polygenicity, with numerous variants contributing to BD. In the present GWAS (Phase I/II), which included 2964 BD and 61 887 control subjects from the Japanese population, we detected a novel susceptibility locus at 11q12.2 (rs28456, P=6.4 × 10-9), a region known to contain regulatory genes for plasma lipid levels (FADS1/2/3). A subsequent meta-analysis of Phase I/II and the Psychiatric GWAS Consortium for BD (PGC-BD) identified another novel BD gene, NFIX (Pbest=5.8 × 10-10), and supported three regions previously implicated in BD susceptibility: MAD1L1 (Pbest=1.9 × 10-9), TRANK1 (Pbest=2.1 × 10-9) and ODZ4 (Pbest=3.3 × 10-9). Polygenicity of BD within Japanese and trans-European-Japanese populations was assessed with risk profile score analysis. We detected higher scores in BD cases both within (Phase I/II) and across populations (Phase I/II and PGC-BD). These were defined by (1) Phase II as discovery and Phase I as target, or vice versa (for 'within Japanese comparisons', Pbest~10-29, R2~2%), and (2) European PGC-BD as discovery and Japanese BD (Phase I/II) as target (for 'trans-European-Japanese comparison,' Pbest~10-13, R2~0.27%). This 'trans population' effect was supported by estimation of the genetic correlation using the effect size based on each population (liability estimates~0.7). These results indicate that (1) two novel and three previously implicated loci are significantly associated with BD and that (2) BD 'risk' effect are shared between Japanese and European populations.

A novel rare variant R292H in RTN4R affects growth cone formation and possibly contributes to schizophrenia susceptibility

Reticulon 4 receptor (RTN4R) plays an essential role in regulating axonal regeneration and plasticity in the central nervous system through the activation of rho kinase, and is located within chromosome 22q11.2, a region that is known to be a hotspot for schizophrenia (SCZ) and autism spectrum disorder (ASD). Recently, rare variants such as copy-number variants and single-nucleotide variants have been a focus of research because of their large effect size associated with increased susceptibility to SCZ and ASD and the possibility of elucidating the pathophysiology of mental disorder through functional analysis of the discovered rare variants. To discover rare variants with large effect size and to evaluate their role in the etiopathophysiology of SCZ and ASD, we sequenced the RTN4R coding exons with a sample comprising 370 SCZ and 192 ASD patients, and association analysis using a large number of unrelated individuals (1716 SCZ, 382 ASD and 4009 controls). Through this mutation screening, we discovered four rare (minor allele frequency <1%) missense mutations (R68H, D259N, R292H and V363M) of RTN4R. Among these discovered rare mutations, R292H was found to be significantly associated with SCZ (P=0.048). Furthermore, in vitro functional assays showed that the R292H mutation affected the formation of growth cones. This study strengthens the evidence for association between rare variants within RTN4R and SCZ, and may shed light on the molecular mechanisms underlying the neurodevelopmental disorder.

Rare genetic variants in CX3CR1 and their contribution to the increased risk of schizophrenia and autism spectrum disorders

CX3CR1, a G protein-coupled receptor solely expressed by microglia in the brain, has been repeatedly reported to be associated with neurodevelopmental disorders including schizophrenia (SCZ) and autism spectrum disorders (ASD) in transcriptomic and animal studies but not in genetic studies. To address the impacts of variants in CX3CR1 on neurodevelopmental disorders, we conducted coding exon-targeted resequencing of CX3CR1 in 370 Japanese SCZ and 192 ASD patients using next-generation sequencing technology, followed by a genetic association study in a sample comprising 7054 unrelated individuals (2653 SCZ, 574 ASD and 3827 controls). We then performed in silico three-dimensional (3D) structural modeling and in vivo disruption of Akt phosphorylation to determine the impact of the detected variant on CX3CR1-dependent signal transduction. We detected a statistically significant association between the variant Ala55Thr in CX3CR1 with SCZ and ASD phenotypes (odds ratio=8.3, P=0.020). A 3D structural model indicated that Ala55Thr could destabilize the conformation of the CX3CR1 helix 8 and affect its interaction with a heterotrimeric G protein. In vitro functional analysis showed that the CX3CR1-Ala55Thr mutation inhibited cell signaling induced by fractalkine, the ligand for CX3CR1. The combined data suggested that the variant Ala55Thr in CX3CR1 might result in the disruption of CX3CR1 signaling. Our results strengthen the association between microglia-specific genes and neurodevelopmental disorders.

Common variants on 2p16.1, 6p22.1 and 10q24.32 are associated with schizophrenia in Han Chinese population

Many schizophrenia susceptibility loci have been identified through genome-wide association studies (GWASs) in European populations. However, until recently, schizophrenia GWASs in non-European populations were limited to small sample sizes and have yielded few loci associated with schizophrenia. To identify genetic risk variations for schizophrenia in the Han Chinese population, we performed a two-stage GWAS of schizophrenia comprising 4384 cases and 5770 controls, followed by independent replications of 13 single-nucleotide polymorphisms in an additional 4339 schizophrenia cases and 7043 controls of Han Chinese ancestry. Furthermore, we conducted additional analyses based on the results in the discovery stage. The combined analysis confirmed evidence of genome-wide significant associations in the Han Chinese population for three loci, at 2p16.1 (rs1051061, in an exon of VRK2, P=1.14 × 10-12, odds ratio (OR)=1.17), 6p22.1 (rs115070292 in an intron of GABBR1, P=4.96 × 10-10, OR=0.77) and 10q24.32 (rs10883795 in an intron of AS3MT, P=7.94 × 10-10, OR=0.87; rs10883765 at an intron of ARL3, P=3.06 × 10-9, OR=0.87). The polygenic risk score based on Psychiatric Genomics Consortium schizophrenia GWAS data modestly predicted case-control status in the Chinese population (Nagelkerke R2: 1.7% ~5.7%). Our pathway analysis suggested that neurological biological pathways such as GABAergic signaling, dopaminergic signaling, cell adhesion molecules and myelination pathways are involved in schizophrenia. These findings provide new insights into the pathogenesis of schizophrenia in the Han Chinese population. Further studies are needed to establish the biological context and potential clinical utility of these findings.

High-resolution copy number variation analysis of schizophrenia in Japan

Recent schizophrenia (SCZ) studies have reported an increased burden of de novo copy number variants (CNVs) and identified specific high-risk CNVs, although with variable phenotype expressivity. However, the pathogenesis of SCZ has not been fully elucidated. Using array comparative genomic hybridization, we performed a high-resolution genome-wide CNV analysis on a mainly (92%) Japanese population (1699 SCZ cases and 824 controls) and identified 7066 rare CNVs, 70.0% of which were small (<100 kb). Clinically significant CNVs were significantly more frequent in cases than in controls (odds ratio=3.04, P=9.3 × 10^-9, 9.0% of cases). We confirmed a significant association of X-chromosome aneuploidies with SCZ and identified 11 de novo CNVs (e.g., MBD5 deletion) in cases. In patients with clinically significant CNVs, 41.7% had a history of congenital/developmental phenotypes, and the rate of treatment resistance was significantly higher (odds ratio=2.79, P=0.0036). We found more severe clinical manifestations in patients with two clinically significant CNVs. Gene set analysis replicated previous findings (e.g., synapse, calcium signaling) and identified novel biological pathways including oxidative stress response, genomic integrity, kinase and small GTPase signaling. Furthermore, involvement of multiple SCZ candidate genes and biological pathways in the pathogenesis of SCZ was suggested in established SCZ-associated CNV loci. Our study shows the high genetic heterogeneity of SCZ and its clinical features and raises the possibility that genomic instability is involved in its pathogenesis, which may be related to the increased burden of de novo CNVs and variable expressivity of CNVs.

Boosting laser-ion acceleration with multi-picosecond pulses

Using one of the world most powerful laser facility, we demonstrate for the first time that high-contrast multi-picosecond pulses are advantageous for proton acceleration. By extending the pulse duration from 1.5 to 6 ps with fixed laser intensity of 1018 W cm-2, the maximum proton energy is improved more than twice (from 13 to 33 MeV). At the same time, laser-energy conversion efficiency into the MeV protons is enhanced with an order of magnitude, achieving 5% for protons above 6 MeV with the 6 ps pulse duration. The proton energies observed are discussed using a plasma expansion model newly developed that takes the electron temperature evolution beyond the ponderomotive energy in the over picoseconds interaction into account. The present results are quite encouraging for realizing ion-driven fast ignition and novel ion beamlines.

Cytokeratin 13, Cytokeratin 17, and Ki-67 Expression in Human Acquired Cholesteatoma and Their Correlation With Its Destructive Capacity

OBJECTIVES

Cholesteatoma is a nonneoplastic destructive lesion of the temporal bone with debated pathogenesis and bone resorptive mechanism. Both molecular and cellular events chiefly master its activity. Continued research is necessary to clarify factors related to its aggressiveness. We aimed to investigate the expression of Ki-67, cytokeratin 13 (CK13) and cytokeratin 17 (CK17) in acquired nonrecurrent human cholesteatoma and correlate them with its bone destructive capacity.

METHODS

A prospective quantitative immunohistochemical study was carried out using fresh acquired cholesteatoma tissues (n=19), collected during cholesteatoma surgery. Deep meatal skin tissues from the same patients were used as control (n=8). Cholesteatoma patients were divided into 2 groups and compared (invasive and noninvasive) according to a grading score for bone resorption based upon clinical, radiologic and intraoperative findings. To our knowledge, the role of CK17 in cholesteatoma aggressiveness was first investigated in this paper.

RESULTS

Both Ki-67 and CK17 were significantly overexpressed in cholesteatoma than control tissues (P<0.001 for both Ki-67 and CK17). In addition, Ki-67 and CK17 were significantly higher in the invasive group than noninvasive group of cholesteatoma (P=0.029, P=0.033, respectively). Furthermore, Ki-67 and CK17 showed a moderate positive correlation with bone erosion scores (r=0.547, P=0.015 and r=0.588, P=0.008, respectively). In terms of CK13, no significant difference was found between cholesteatoma and skin (P=0.766).

CONCLUSION

Both Ki-67 and CK17 were overexpressed in cholesteatoma tissue and positively correlated with bone resorption activity. The concept that Ki-67 can be a predictor for aggressiveness of cholesteatoma was supported. In addition, this is the first study demonstrating CK17 as a favoring marker in the aggressiveness of acquired cholesteatoma.

Cross-national epidemiology of panic disorder and panic attacks in the world mental health surveys

CONTEXT

The scarcity of cross-national reports and the changes in Diagnostic and Statistical Manual version 5 (DSM-5) regarding panic disorder (PD) and panic attacks (PAs) call for new epidemiological data on PD and PAs and its subtypes in the general population.

OBJECTIVE

To present representative data about the cross-national epidemiology of PD and PAs in accordance with DSM-5 definitions.

DESIGN AND SETTING

Nationally representative cross-sectional surveys using the World Health Organization Composite International Diagnostic Interview version 3.0.

PARTICIPANTS

Respondents (n = 142,949) from 25 high, middle, and lower-middle income countries across the world aged 18 years or older.

MAIN OUTCOME MEASURES

PD and presence of single and recurrent PAs.

RESULTS

Lifetime prevalence of PAs was 13.2% (SE 0.1%). Among persons that ever had a PA, the majority had recurrent PAs (66.5%; SE 0.5%), while only 12.8% fulfilled DSM-5 criteria for PD. Recurrent PAs were associated with a subsequent onset of a variety of mental disorders (OR 2.0; 95% CI 1.8-2.2) and their course (OR 1.3; 95% CI 1.2-2.4) whereas single PAs were not (OR 1.1; 95% CI 0.9-1.3 and OR 0.7; 95% CI 0.6-0.8). Cross-national lifetime prevalence estimates were 1.7% (SE 0.0%) for PD with a median age of onset of 32 (IQR 20-47). Some 80.4% of persons with lifetime PD had a lifetime comorbid mental disorder.

CONCLUSIONS

We extended previous epidemiological data to a cross-national context. The presence of recurrent PAs in particular is associated with subsequent onset and course of mental disorders beyond agoraphobia and PD, and might serve as a generic risk marker for psychopathology.

Differences in caregivers' psychological distress and associated factors by care recipients' gender and kinship

OBJECTIVES

In this study, we examined the level of psychological distress of Japanese caregivers according to various combinations of the gender of care recipients and the kinship of caregivers (spouse, son, daughter, or daughter-in-law). Furthermore, we explored the associated factors that could exacerbate or alleviate psychological distress.

METHODS

We utilized a cross-sectional descriptive design and implemented a self-administered questionnaire survey with a two-stage stratified sample of community-dwelling caregivers of frail elderly persons throughout Japan. We surveyed 1279 caregiving families, and 1020 questionnaires were completed by primary caregivers (response rate: 79.8%), with 945 respondents providing data on the Japanese version of the Kessler 6 psychological distress scale (K6).

RESULTS

Caregivers' K6 scores varied significantly by care recipients' gender and their relationship with the caregiver. K6 scores were significantly higher among daughters-in-law caring for fathers-in-law than among daughters-in-law caring for mothers-in-law, wives caring for husbands, or daughters or sons caring for mothers. 'Negative influence of caregiving' and 'anxious about continuing caregiving' were factors that commonly exacerbated caregivers' psychological distress. Further analyses involving interactions indicated that the effects of 'anxious about continuing caregiving' and 'personal growth through caregiving' on the psychological distress of daughters-in-law varied by care recipients' gender as did the effects of an alleviating factor, 'keeping their own pace', on daughters.

CONCLUSIONS

Psychological distress levels among family caregivers, as well as exacerbating and alleviating factors, varied depending on the gender and kinship of care recipients.

Detection of serum melanoma-associated antigen D4 in patients with squamous cell carcinoma of the esophagus

Despite improvements in surgical techniques, perioperative management, and multidisciplinary therapy, treatment outcomes of patients with esophageal squamous cell carcinoma (ESCC) remain poor. Therefore, development of novel molecular biomarkers, which either predict patient survival or become therapeutic targets, is urgently required. In the present study, to facilitate early detection of ESCC and predict its clinical course, we investigated the relationship of the serum level of melanoma-associated antigen (MAGE)-D4 to patients' clinicopathological characteristics. Using quantitative real-time reverse transcription-polymerase chain reaction and enzyme-linked immunosorbent assays, we determined the levels of MAGE-D4 mRNA and protein in cell lysates and conditioned medium of cultures, respectively, of nine ESCC cell lines. Further, we determined MAGE-D4 levels in serum samples collected from 44 patients with ESCC who underwent radical esophagectomy without neoadjuvant therapy as well as from 40 healthy volunteers. Samples of conditioned medium and cell lysates contained comparable levels of MAGE-D4 that correlated closely with the levels of MAGE-D4 mRNA. Preoperative MAGE-D4 levels in the sera of 44 patients with ESCC, which varied from 0 to 2,354 pg/mL (314 ± 505 pg/mL, mean ± standard deviation), were significantly higher compared with those of healthy volunteers. By setting the cutoff at the highest value for healthy volunteers (50 pg/mL), the MAGE-D4-positive group of patients was more likely to have shorter disease-specific and disease-free survival compared with those of the MAGE-D4-negative group, although the differences were not statistically significant. Our results indicate that the elevation of preoperative serum MAGE-D4 levels in some patients with ESCC was possibly caused by excess production of MAGE-D4 by tumor cells followed by its release into the circulation. Clinical implications of serum MAGE-D4 levels should be validated in a large population of patients with ESCC.

Salvage pharyngolaryngectomy with total esophagectomy following definitive chemoradiotherapy

Historically, total pharyngolaryngectomy with total esophagectomy has been the standard radical surgical treatment for synchronous cancer of the thoracoabdominal esophagus and pharyngolaryngeal region, and for cancer of the cervical esophagus that has invaded as far as the thoracic esophagus. Although definitive chemoradiotherapy that enables preservation of the larynx has often been the first choice of treatment for cancers involving the cervical esophagus, total pharyngolaryngectomy with total esophagectomy is required as a salvage therapy for cases involving failure of complete remission or locoregional recurrence after chemoradiotherapy. However, salvage esophageal surgery after definitive high-dose chemoradiotherapy is generally associated with high morbidity and mortality. The aim of this study was to examine the short-term outcome of salvage total pharyngolaryngectomy with total esophagectomy. From 2001 to 2014, nine patients underwent salvage total pharyngolaryngectomy with total esophagectomy at the Department of Gastroenterological Surgery, Nagoya University. The mortality and morbidity rates were high at 22% and 89%, respectively. Four patients (44%) developed tracheal necrosis, which in two patients eventually led to lethal hemorrhage. Salvage total pharyngolaryngectomy with total esophagectomy is an uncommon and highly demanding surgical procedure that should be carefully planned and conducted in selected centers of excellence. Measures must be taken to preserve the tracheal blood supply, thus avoiding fatal complications.

Pathogenesis and Bone Resorption in Acquired Cholesteatoma: Current Knowledge and Future Prospectives

Cholesteatoma is a cystic non tumorous lesion of the temporal bone that has the ability to destroy nearby structures by its power to cause bone resorption and as a result, fatal complications prevail. We aimed to conduct a comprehensive review for pathogenesis of acquired cholesteatoma, bone resorption mechanisms, and offer a future vision of this serious disease. We have reviewed different theories for pathogenesis of acquired cholesteatoma including the most relevant and updated ones with special emphasis on the mechanisms of bone resorption through Medline/PubMed research using the keywords 'aetiopathogenesis, bone resorption, acquired cholesteatoma, temporal bone, and cytokines.' In order to strengthen our study, we searched the reference lists of identified reviews. Cholesteatoma is a subject of debate among otolaryngologists since it was prescribed firstly. Over many decades, several theories were postulated for aetiopathogenesis of cholesteatoma with a tendency to follow more than one theory to explain the proper nature of that disease. Until now, the mechanism of bone resorption has yet to be more clarified. In the last century, a leap has occurred in the field of biomolecular cholesteatoma research which improved our knowledge about its pathophysiology and bone destructive mechanism. However, surgery is still the only available treatment. We conclude that discovery of new therapeutic choices for cholesteatoma other than surgery by the use of anti-growth, anti-proliferative, apoptotic agents as well as medications that antagonize osteoclastogenesis should be the main concern in the future clinical and experimental research work. Also, searching for predictors of the aggressiveness of cholesteatoma can affect the timing of intervention and prevent occurrence of complications.

Azapirones for Attention Deficit Hyperactivity Disorder: A Systematic Review

INTRODUCTION

No meta-analysis has evaluated azapirones (serotonin1A receptor partial agonists) as anxiolytics for attention deficit hyperactivity disorder (ADHD).

METHODS

Randomized controlled trials (RCTs) and single-arm trials published before October 27, 2015 were retrieved from major healthcare databases and clinical trial registries. Relative risk and 95% confidence intervals were calculated.

RESULTS

5 RCTs (n=429) and 3 single-arm studies (n=70) were identified. 3 RCTs compared buspirone vs. methylphenidate in children/adolescents, one buspirone patches vs. placebo patches in children/adolescents, and one atomoxetine plus buspirone vs. atomoxetine vs. placebo in adults. The single-arm studies were buspirone trails in children/adolescents. All-cause discontinuation rates and adverse events did not differ between pooled buspirone and methylphenidate groups. No other meta-analyses of buspirone efficacy and safety vs. comparators were conducted due to insufficient data. 2 RCTs found no significant differences in parent and teacher ADHD-Rating Scale total scores between buspirone and methylphenidate, while one reported that methylphenidate improved parent and teacher ADHD-RS total scores vs. buspirone.

DISCUSSION

It remains unclear whether buspirone use has benefit for ADHD patients and therefore further evidence is needed for better clinical use of buspirone in patients with ADHD.

Association between Parental Workaholism and Body Mass Index of Offspring: A Prospective Study among Japanese Dual Workers

The purpose of the study was to investigate the association between parental workaholism and child body mass index (BMI) among Japanese dual-income families. In 2011, 379 dual-income families from urban Tokyo with children aged 0-5 years were recruited for a baseline survey, and 160 (42.2%) were followed up in 2012. Demographics, workaholism, work demands, work control, time spent with children, and parental and child weights and heights were assessed using a questionnaire. Structural equation modeling was performed to determine the association between maternal and paternal workaholism in 2011 and child BMI in 2012, considering the mediating effects of time spent with children. Paternal workaholism showed a direct significant positive association with child BMI after 1 year (standardized coefficient: 0.19; p < 0.001), while maternal workaholism was not associated with child BMI. Both maternal and paternal time spent with children did not mediate the association. Paternal work demands showed a strong positive association with workaholism but paternal work control did not. Paternal, but not maternal, workaholism was associated with an increase in child BMI over 1 year. Interventions that target workaholism by reducing paternal work demands might be effective in preventing overweight in offspring.

The Piccolo Intronic Single Nucleotide Polymorphism rs13438494 Regulates Dopamine and Serotonin Uptake and Shows Associations with Dependence-Like Behavior in Genomic Association Study

Piccolo (PCLO) inhibits methamphetamine-induced neuropharmacological effects via modulation of dopamine (DA) uptake and regulation of the transport of synaptic vesicles in neuronal cells. Clinical studies have recently suggested that the single nucleotide polymorphism (SNP) rs13438494 in the intron 24 of the PCLO gene is associated with psychiatric disorder, in the meta-analysis of GWAS. Therefore, in this study, we attempted to evaluate the possible role of the PCLO SNP in the mechanisms of uptake of monoamines. To characterize rs13438494 in the PCLO gene, we constructed plasmids carrying either the C or A allele of the SNP and transiently transfected them into SH-SY5Y cells to analyze genetic effects on the splicing of PCLO mRNA. The C and A allele constructs produced different composition of the transcripts, indicating that the intronic SNP does affect the splicing pattern. We also transfected DA and serotonin (5-hydroxytryptamine; 5- HT) transporters into cells and analyzed their uptakes to elucidate the association to psychiatric disorders. In the cells transfected with the C allele, both the DA and 5-HT uptake were enhanced compared to the A allele. We also conducted a clinical study, in order to clarify the genetic associations. PCLO rs13438494 exhibits a relationship with the symptoms of drug dependence or related parameters, such as the age of first exposure to methamphetamine, eating disorders, tobacco dependence and fentanyl requirement. Our findings suggest that rs13438494 is associated with drug abuse and contributes to the pathogenesis of psychiatric disorders via modulation of neurotransmitter turnover.

[Differences in caregivers' cognitive appraisal, coping strategies, and perceived influence on life by care recipients' sex and kinship with primary caregivers]

Objectives This study was aimed at examining whether caregivers' cognitive appraisal, coping strategies, and perceived influence on life vary according to care recipients' sex and caregivers' kinship (e.g., spouse, son, daughter, or daughter-in-law).Methods We contacted 1,110 relatively large visiting nursing stations in 37 prefectures, 83 of which agreed to participate in the study. Station managers were requested to select up to 20 families with an elderly person to care for. A questionnaire that included measures for caregivers' cognitive appraisal, coping strategies toward family caregiving, and caregivers' perception, which measures the perceptions of negative and positive influences on family life through caregiving, was administered to the 1,278 families selected by the nursing stations. From this pool, 1,020 questionnaires (79.8%) were returned, completed anonymously by primary caregivers.Results Two-way analysis of variance was used to analyze the care recipients' sex and kinship with primary caregivers. The analysis revealed significant interactions regarding the level of care required and approximately half of the scales measuring cognitive appraisal, coping strategies, and perceived influence on life. The level of care required was higher for male care recipients than for female care recipients when recipients were cared for by their daughters. Husbands caring for wives and daughters-in-law caring for fathers-in-law were more likely to feel "restricted in their social life," have difficulty "keeping pace" with caregiving, and have "negative influence on life." Husbands caring for wives felt less "personal growth through caregiving" than wives caring for husbands. Daughters caring for fathers perceived a lower "positive acceptance of caregiving role" than those caring for mothers. Husbands caring for wives tended not to seek "informal support." Care recipients' sex had little influence on caregivers' cognitive appraisal, coping strategies, and caregivers' perceptions of negative and positive influences on family life. Regarding the main effects of caregivers' kinship, spousal caregivers felt more anxious about continuous caregiving but felt more "fulfilled" and "positively accepted" in their caregiving role.Conclusion Cognitive appraisal and coping strategies toward family caregiving, and the caregivers' perceptions of negative and positive influences on life might vary according to care recipients' sex and caregivers' kinship. Our findings suggest the necessity for long-term care insurance services to incorporate not only care for the care recipients but also a strategy to deal with the psychological burden of family caregivers.

Trace lithium is inversely associated with male suicide after adjustment of climatic factors

BACKGROUND

Previously, we showed the inverse association between lithium in drinking water and male suicide in Kyushu Island. The narrow variation in meteorological factors of Kyushu Island and a considerable amount of evidence regarding the role of the factors on suicide provoked the necessities of adjusting the association by the wide variation in sunshine, temperature, rain fall, and snow fall.

METHODS

To keep the wide variation in meteorological factors, we combined the data of Kyushu (the southernmost city is Itoman, 26°) and Hokkaido (the northernmost city is Wakkanai, 45°). Multiple regression analyses were used to predict suicide SMRs (total, male and female) by lithium levels in drinking water and meteorological factors.

RESULTS

After adjustment of meteorological factors, lithium levels were significantly and inversely associated with male suicide SMRs, but not with total or female suicide SMRs, across the 153 cities of Hokkaido and Kyushu Islands. Moreover, annual total sunshine and annual mean temperature were significantly and inversely associated with male suicide SMRs whereas annual total rainfall was significantly and directly associated with male suicide SMRs.

LIMITATIONS

The limitations of the present study include the lack of data relevant to lithium levels in food and the proportion of the population who drank tap water and their consumption habits.

CONCLUSIONS

The present findings suggest that trace lithium is inversely associated with male but not female suicide after adjustment of meteorological factors.

The Usability of CAT System for Assessing the Depressive Level of Japanese-A Study on Psychometric Properties and Response Behavior

BACKGROUND

An innovative measurement system using a computerized adaptive testing technique based on the item response theory (CAT) has been expanding to measure mental health status. However, little is known about details in its measurement properties based on the empirical data. Moreover, the response time (RT) data, which are not available by a paper-and-pencil measurement but available by a computerized measurement, would be worth investigating for exploring the response behavior.

PURPOSE

We aimed at constructing the CAT to measure depressive symptomatology in a community population and exploring its measurement properties. Also, we examined the relationships between RTs, individual item responses, and depressive levels.

METHOD

For constructing the CAT system, responses of 2061 workers and university students to 24 depression scale plus four negatively revised positive affect items were subjected to a polytomous IRT analysis. The stopping rule was set for standard error of estimation < 0.30 or the maximum 15 items displayed. The CAT and non-adaptive computer-based test (CBT) were administered to 209 undergraduates, and 168 of them administered again after 1 week.

RESULTS

On average, the CAT was converged by 10.4 items. The θ values estimated by CAT and CBT were highly correlated (r = 0.94 and 0.95 for the 1st and 2nd measurements) and with the traditional scoring procedures (r's > 0.90). The test-retest reliability was at a satisfactory level (r = 0.86). RTs to some items significantly correlated with the θ estimates. The mean RT varied by the item contents and wording, i.e., the RT to positive affect items required additional 2 s or longer than the other subscale items.

CONCLUSION

The CAT would be a reliable and practical measurement tool for various purposes including stress check at workplace.

Associations between DSM-IV mental disorders and subsequent non-fatal, self-reported stroke

OBJECTIVES

To examine the associations between a wide range of mental disorders and subsequent onset of stroke. Lifecourse timing of stroke was examined using retrospectively reconstructed data from cross-sectional surveys.

METHODS

Data from the World Mental Health Surveys were accessed. This data was collected from general population surveys over 17 countries of 87,250 adults. The Composite International Diagnostic Interview retrospectively assessed lifetime prevalence and age at onset of DSM-IV mental disorders. A weighted subsample (n=45,288), was used for analysis in the present study. Survival analyses estimated associations between first onset of mental disorders and subsequent stroke onset.

RESULTS

Bivariate models showed that 12/16 mental disorders were associated with subsequent stroke onset (ORs ranging from 1.6 to 3.8). However, after adjustment for mental disorder comorbidity and smoking, only significant relationships between depression and stroke (OR 1.3) and alcohol abuse and stroke (OR 1.5) remained. Among females, having a bipolar disorder was also associated with increased stroke incidence (OR 2.1). Increasing number of mental disorders was associated with stroke onset in a dose-response fashion (OR 3.3 for 5+ disorders).

CONCLUSIONS

Depression and alcohol abuse may have specific associations with incidence of non-fatal stroke. General severity of psychopathology may be a more important predictor of non-fatal stroke onset. Mental health treatment should be considered as part of stroke risk prevention. Limitations of retrospectively gathered cross sectional surveys design mean further research on the links between mental health and stroke incidence is warranted.