Achenbach’s hand and digital paroxysmal haematomas: a possible association with joint hypermobility syndrome in two sibling cases

A pair of middle-aged sisters is presented who experienced episodes of spontaneous, relatively atraumatic, acute onset, painful sub-cutaneous bleeding into the digits of their hands over a number of preceding years. A literature search revealed they had Achenbach’s syndrome, which is a benign and self-limiting condition that resolves completely within 2–4 days. However, a hitherto unreported association between Achenbach’s syndrome and joint hypermobility with its abnormal collagen is made, along with a tentative causality hypothesis that perhaps in the presence of atypical connective tissue, the architecture and integrity of the peripheral capillary bed of the hand could be adversely affected and therefore predispose towards paroxysmal palm and/or finger bleeds.

Depression and memory function – evidence from cross-lagged panel models with unit fixed effects in ELSA and HRS

Background Individuals with depression are often found to perform worse on cognitive tests and to have an increased risk of dementia. The causes and the direction of these associations are however not well understood. We looked at two specific hypotheses, the aetiological risk factor hypothesis and the reverse causality hypothesis. Method We analysed observational data from two cohorts, English Longitudinal Study of Ageing (ELSA) and Health and Retirement Study (HRS), using cross-lagged panel models with unit fixed effects. Each model was run once with depression and repeated with cognition as the dependent variable and the other variable as the main explanatory variable. All models were estimated separately for contemporaneous effects and lagged effects up to 8 years in the past. We contrasted the results with models making the random effects assumption. Results Evidence from the fixed effects models is mixed. We find no evidence for the reverse causality hypothesis in ELSA and HRS. While there is no evidence for the aetiological risk factors hypothesis in ELSA, results from HRS indicate some effects. Conclusion Our findings suggest that current levels of cognitive function do not influence future levels of depression. Results in HRS provide some evidence that current levels of depressive symptoms influence future cognition.

Abstract 345: Forecasting the Number of Out-Of-Hospital Cardiac Arrest in the Young Using Generalized Additive Model

Introduction: Accurate forecasting could help in resource planning and evaluation of intervention efforts to reduce out-of-hospital cardiac arrest. Hypothesis: Generalized additive model can rapidly and accurately forecast the number of OHCA in the young (1-35 years old) when compared to other auto regressive moving average (ARIMA) based models. Methods: Data were obtained from CARES in Chicago from May 2013 to December 2017. Monthly forecasts of the number of OHCA were performed using a generative additive model framework using the open source software Prophet and R. The first 50 months served as training and the last 6 months served as testing. Results: Figure 1 shows the distribution of the number of cases over the 3-year study period showing yearly seasonality and upward trend. Figure 2 shows the forecast of the number of arrest (middle line) along with the actual number of arrest (dots). The shaded band represents the 95% confidence interval of the prediction. Figure 3 show the comparison of the 6-month forecast and actual data. This model has low root mean square error score when compared with other ARIMA based models (2 vs. 4). Conclusion: Accurate time series forecasting of the number of OHCA arrests could be achieved. Time series analysis and forecasting are essential tools in evaluating the effectiveness of intervention efforts to reduce OHCA as they allow for causality hypothesis testing.

Rocking the boat of vitamin D research in schizophrenia and depression

SUMMARYA review of studies on vitamin D in schizophrenia and depression found insufficient evidence to inform advice for clinicians. On the basis of the review, I suggest advice for researchers, including better controlling for confounders in observational studies, testing the reverse causality hypothesis, studying vitamin D as a treatment or prevention specifically in patients with more pigmented skin, and prospective community trials of vitamin D supplementation combined with lifestyle advice.DECLARATION OF INTERESTNone.

Effect of Earnings Per Shares on Capital Structure Choice of Listed Non-Financial Firms in Nigeria

The main objective of this paper is to examine the effect of financial performance on capital structure of listed non-financial firms in Nigeria. This was guided by assessing the earnings per share on capital structure choice. The causal research design was adopted while a total of 87 samples was included in the study. The estimated results are statistically significant at all levels of Capital Structure. Based on the significance of these results it was concluded that both the efficiency risk and franchise value hypotheses of the reverse causality hypothesis are observable in the capital structure choice of the firms.

A prospective evaluation of the depression–nutrient intake reverse causality hypothesis in a cohort of community-dwelling older Canadians

Studies have investigated the potential protective effects that diet may have on late-life depression incidence. This disorder can, however, affect the person’s food intake, widely known as the reverse causality hypothesis of depression. To test this hypothesis, we compared mean nutrient intakes from three 24-h recalls during the year depression was detected (Geriatric Depression Scale ≥11 or antidepressant medication) with intakes from 1 year earlier among community-dwelling older adults (67–83 years) followed up annually in the 4-year Québec Longitudinal Study on Nutrition and Aging, who were free of depression and cognitive impairment at baseline. Participants (n 158, 64·4 % female) who became depressed and had data available for all follow-up years were matched by age group and sex with non-depressed participants. General linear mixed models were adjusted for percentage changes in physical activity, functional autonomy and stressful life events reported at the time of positive screening. A significant group effect for the dietary intake of all three B-vitamins was observed, as depression cases had consistently lower dietary intakes than controls (P<0·01). Over time, intakes of dietary vitamin B12 declined within depressed participants in bivariate analysis, but there was no time×group effect for any nutrient tested in the multivariate analyses. Intakes of energy, protein, saturated fat and total dietary fibre did not change in cases v. controls. Among community-dwelling older adults, declines in dietary vitamins B6, B12 and folate may precede depression incidence. To help preventative efforts by programmes and practitioners, longitudinal cohorts of longer duration should investigate the extent of the decline in dietary intakes relative to the time of depression.

February Drying in Southeastern Brazil and the Australian Monsoon: Global Mechanism for a Regional Rainfall Feature

A dry February rainfall signal in southeastern Brazil is shown to be a robust, repeatable feature of climatology. This February depression or minimum in climatological rain curves has an amplitude of about 30% of the seasonal mean and coincides with a poleward excursion of tropical barotropic easterlies to about 25°S in austral midsummer. Momentum budget decomposition indicates that stationary eddy momentum flux [u*υ*] near 150 hPa in Australian longitudes is a main sink in that latitude belt’s zonal momentum budget. A physical linkage among these phenomena is suggested by statistically significant interannual correlations among February anomalies of southeastern Brazil rainfall, zonal-mean zonal wind, and indices of the Australian monsoon. To test a causality hypothesis that the sharply peaked Australian region monsoon drives the sharp climatological dry signal over Brazil, an observation-inspired tropospheric heating signal near Australia is added to the temperature equation of the full-physics Community Atmosphere Model. Results indicate the near linearity of the global subtropical responses for the modest (roughly 1 and 2 K day−1) magnitudes and scales of imposed heating. Consistent with the hypothesis, this imposed heating robustly causes easterly changes to subtropical, barotropic, zonal-mean momentum, a westward displacement of the mean synoptic-scale pattern in the western Atlantic (the western edge of the subtropical high), and reduced rainfall in southeastern Brazil. These results are closely analogous to the previous findings on a related boreal summer subtropical signal.