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Majority of international guidelines for bipolar disorders are based on evidences from clinical trials. In contrast, the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was developed to adopt an expert-consensus paradigm which was more practical and specific to the atmosphere in Korea.
Objectives
In this study, preferred medication strategies for acute mania over six consecutively published KMAP-BP (2002, 2006, 2010, 2014, 2018, and 2022) were investigated.
Methods
A written survey using a nine-point scale was asked to Korean experts about the appropriateness of various treatment strategies and treatment agents. A written survey asked about the appropriateness of various treatment strategies and treatment agents commonly used by clinicians as the first-line.
Results
The most preferred option for the initial treatment of mania was a combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP) in every edition. Preference for combined treatment for euphoric mania increased, peaked in KMAP-BP 2010, and declined slightly. Either MS or AAP monotherapy was also considered a first-line strategy for mania, but not for all types of episodes, including mixed/psychotic mania. Among MSs, lithium and valproate are almost equally preferred except in the mixed subtype where valproate is the most recommended MS. The preference of valproate showed reverse U-shaped curve. This preference change of valproate may indicate the concern about teratotoxicity in women. Quetiapine, aripiprazole, and olanzapine were the preferred AAP for acute mania since 2014. This change might depend on the recent evidences and safety profile. In cases of unsatisfactory response to initial medications, switching or adding another first-line agent was recommended. The most notable changes over time included the increasing preference for AAPs.
Conclusions
The Korean experts have been increasingly convinced of the effectiveness of a combination therapy for acute mania. There have been evident preference changes: increased for AAP and decreased for carbamazepine.
Mental healthcare services that address a variety of primary complaints which are highly related to maladaptive personality traits among the general population are important to prevent developing psychiatric disorders.
Objectives
This study aimed to examine the effectiveness of a digital mental health service (named “Mindling”) that focuses on maladaptive personality traits in the general population.
Methods
Participants were recruited through a South Korean community website and screened for adults between the ages of 18 and 60 in terms of personality traits such as perfectionism, low self-esteem, social isolation, or anxiety. Participants were allocated to four intervention programs (Riggy, Pleaser, Shelly, and Jumpy) based on their screening results and were randomly assigned to digital treatment and waitlist groups. Each intervention program was conducted online for 10 weeks. The primary outcomes were all measured by self-report questionnaires; in addition to stress levels, each program included measures of perfectionism (Riggy), low self-esteem (Pleaser), loneliness (Shelly), and anxiety (Jumpy). The secondary outcomes included self-efficacy, depression, and other psychological states. All participants completed pre-treatment (baseline), intervention (week 5), and post-treatment (week 10) assessments, and the treatment group completed a separate follow-up assessment (week 14).
Results
In the treatment group, 70.05% of the participants completed the full course of the digital intervention. The mean scores for each primary outcome measure and some secondary outcome measures were significantly different between baseline and post-treatment in the treatment group for the Total, Riggy, Pleaser, Shelly, and Jumpy programs, but these differences were not observed in the waitlist group. In addition, mean differences between the treatment and waitlist groups at post-treatment assessment were significant for all primary outcome measures and some secondary outcome measures. Specifically, the levels of stress (Total program), perfectionism (Riggy), loneliness (Shelly), and anxiety (Jumpy) were significantly lower in the treatment group, while self-esteem (Pleaser) was higher. In addition, the mean differences between post-treatment and follow-up assessment data were not statistically significant for all primary outcome measures and nearly all secondary outcome measures.
Conclusions
This study validated the effectiveness of the digital intervention program targeting maladaptive personality traits and suggested its sustainable effects.
Tight focusing with very small f-numbers is necessary to achieve the highest at-focus irradiances. However, tight focusing imposes strong demands on precise target positioning in-focus to achieve the highest on-target irradiance. We describe several near-infrared, visible, ultraviolet and soft and hard X-ray diagnostics employed in a ∼1022 W/cm2 laser–plasma experiment. We used nearly 10 J total energy femtosecond laser pulses focused into an approximately 1.3-μm focal spot on 5–20 μm thick stainless-steel targets. We discuss the applicability of these diagnostics to determine the best in-focus target position with approximately 5 μm accuracy (i.e., around half of the short Rayleigh length) and show that several diagnostics (in particular, 3$\omega$ reflection and on-axis hard X-rays) can ensure this accuracy. We demonstrated target positioning within several micrometers from the focus, ensuring over 80% of the ideal peak laser intensity on-target. Our approach is relatively fast (it requires 10–20 laser shots) and does not rely on the coincidence of low-power and high-power focal planes.
Existing digital mental health interventions are mainly focused on the symptoms of specific mental disorders such as depression and anxiety. However, digital mental health interventions aiming enhancement of mental health in the general population are rare. Considering that the psychological discomfort of the general public is more complex and subtle, interventions focusing on maladaptive personality and interpersonal schema rather than symptoms per se can be an alternative.
Objectives
To this end, concise tools for measuring the core personality and interpersonal patterns known to cause psychological discomfort among potential users of digital mental health interventions are essential. For this purpose, the Schema Scale was developed and our study aims to validate and confirm psychometric properties of the scale.
Methods
This cross-sectional study was carried out between July and August 2022. Participants were 234 adults aged between 19 to 39 who completed an online survey including the Schema Scale and other 15 questionnaires. Exploratory factor analysis were conducted to construct the factorial structure model.
Results
Exploratory factor analysis showed a five-factor structure with a total variance of 57%; factor 1 consisted of lack of belongingness and poor social skills, factor 2 of lack of patience hot-tempered coping style, factor 3 of maladaptive perfectionism, factor 4 of self-sacrifice and lack of self-confidence and factor 5 of items representing pessimistic and anxious mindset. Internal consistency of each factor was good(Cronbach’s alpha=0.712~0.882), and correlations with existing measures were significant.
Conclusions
The five personality Schema Scale appears to be a short(total 35 items) and a valid tool for measuring five essential personality and interpersonal patterns for adults aged 20~30 years. This tool has been developed for online use and therefore has the advantage of being easily accessible. Most importantly, based on the results of the Schema Scale, the individualized digital interventions can be recommended that targets maladaptive psychological patterns.
Obsessive-compulsive disorder (OCD) and schizophrenia are often reported as co-morbid conditions. However, the evidence of an association between OCD and the risk of schizophrenia is limited. This study investigated the risk of schizophrenia in patients newly diagnosed with OCD using a nationally representative sample cohort in South Korea.
Methods
Data were obtained from the 2002–2013 Korean National Health Insurance Service-National Sample Cohort of the National Health Insurance Service. Using propensity score matching, 2509 patients with OCD and a control group of 7527 patients were included in the analysis. Chi-squared tests were used to investigate and compare the general characteristics of the study population. The risk of schizophrenia was analysed using the Cox proportional hazard model.
Results
The incidence rate was 45.79/10 000 person-year for patients with OCD and 4.19/10 000 person-year for patients without OCD. Patients with OCD had a higher risk of schizophrenia compared to the control group after adjusting for covariates (hazard ratio = 10.46, 95% confidence interval = 6.07–18.00).
Conclusions
This study identified an association between the diagnosis of OCD and the risk of schizophrenia in a South Korean national representative cohort. Further research using a prospective design to clarify the causality of OCD in schizophrenia in a controlled environment should be conducted to validate these findings.
Acute facial palsy is a consequence of various diseases, with the number of patients increasing with advancing age. This study aimed to analyse the clinical characteristics of acute peripheral facial palsy in older adults.
Methods
A total of 30 patients with a mean age of 68.4 ± 9.1 years were included in the study. All patients received a standardised investigation and follow up. The hospital charts of the patients with acute facial palsy were reviewed retrospectively.
Results
The predominant causes of acute facial palsy in older adults were: Bell's palsy, Ramsay Hunt syndrome, trauma, otitis media and malignancy. At baseline, complete and incomplete facial palsies were seen in 26.7 per cent and 73.3 per cent of patients, respectively. The overall rates of good recovery, partial recovery and no recovery were 66.7 per cent, 10 per cent and 23.3 per cent, respectively. Increased age led to a significantly lower level of recovery in older adults.
Conclusion
Bell's palsy and Ramsay Hunt syndrome were the most common aetiologies of acute facial palsy in older adults, and such patients are likely to have incomplete recovery. Active early treatment is necessary for achieving good outcomes in older adults.
The design and the early commissioning of the ELI-Beamlines laser facility’s 30 J, 30 fs, 10 Hz HAPLS (High-repetition-rate Advanced Petawatt Laser System) beam transport (BT) system to the P3 target chamber are described in detail. It is the world’s first and with 54 m length, the longest distance high average power petawatt (PW) BT system ever built. It connects the HAPLS pulse compressor via the injector periscope with the 4.5 m diameter P3 target chamber of the plasma physics group in hall E3. It is the largest target chamber of the facility and was connected first to the BT system. The major engineering challenges are the required high vibration stability mirror support structures, the high pointing stability optomechanics as well as the required levels for chemical and particle cleanliness of the vacuum vessels to preserve the high laser damage threshold of the dielectrically coated high-power mirrors. A first commissioning experiment at low pulse energy shows the full functionality of the BT system to P3 and the novel experimental infrastructure.
The COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) project is a large international collaborative effort to analyze individual-level phenotype data from twins in multiple cohorts from different environments. The main objective is to study factors that modify genetic and environmental variation of height, body mass index (BMI, kg/m2) and size at birth, and additionally to address other research questions such as long-term consequences of birth size. The project started in 2013 and is open to all twin projects in the world having height and weight measures on twins with information on zygosity. Thus far, 54 twin projects from 24 countries have provided individual-level data. The CODATwins database includes 489,981 twin individuals (228,635 complete twin pairs). Since many twin cohorts have collected longitudinal data, there is a total of 1,049,785 height and weight observations. For many cohorts, we also have information on birth weight and length, own smoking behavior and own or parental education. We found that the heritability estimates of height and BMI systematically changed from infancy to old age. Remarkably, only minor differences in the heritability estimates were found across cultural–geographic regions, measurement time and birth cohort for height and BMI. In addition to genetic epidemiological studies, we looked at associations of height and BMI with education, birth weight and smoking status. Within-family analyses examined differences within same-sex and opposite-sex dizygotic twins in birth size and later development. The CODATwins project demonstrates the feasibility and value of international collaboration to address gene-by-exposure interactions that require large sample sizes and address the effects of different exposures across time, geographical regions and socioeconomic status.
Whether monozygotic (MZ) and dizygotic (DZ) twins differ from each other in a variety of phenotypes is important for genetic twin modeling and for inferences made from twin studies in general. We analyzed whether there were differences in individual, maternal and paternal education between MZ and DZ twins in a large pooled dataset. Information was gathered on individual education for 218,362 adult twins from 27 twin cohorts (53% females; 39% MZ twins), and on maternal and paternal education for 147,315 and 143,056 twins respectively, from 28 twin cohorts (52% females; 38% MZ twins). Together, we had information on individual or parental education from 42 twin cohorts representing 19 countries. The original education classifications were transformed to education years and analyzed using linear regression models. Overall, MZ males had 0.26 (95% CI [0.21, 0.31]) years and MZ females 0.17 (95% CI [0.12, 0.21]) years longer education than DZ twins. The zygosity difference became smaller in more recent birth cohorts for both males and females. Parental education was somewhat longer for fathers of DZ twins in cohorts born in 1990–1999 (0.16 years, 95% CI [0.08, 0.25]) and 2000 or later (0.11 years, 95% CI [0.00, 0.22]), compared with fathers of MZ twins. The results show that the years of both individual and parental education are largely similar in MZ and DZ twins. We suggest that the socio-economic differences between MZ and DZ twins are so small that inferences based upon genetic modeling of twin data are not affected.
Understanding viral transmission dynamics within populations of reservoir hosts can facilitate greater knowledge of the spillover of emerging infectious diseases. While bat-borne viruses are of concern to public health, investigations into their dynamics have been limited by a lack of longitudinal data from individual bats. Here, we examine capture–mark–recapture (CMR) data from a species of Australian bat (Myotis macropus) infected with a putative novel Alphacoronavirus within a Bayesian framework. Then, we developed epidemic models to estimate the effect of persistently infectious individuals (which shed viruses for extensive periods) on the probability of viral maintenance within the study population. We found that the CMR data analysis supported grouping of infectious bats into persistently and transiently infectious bats. Maintenance of coronavirus within the study population was more likely in an epidemic model that included both persistently and transiently infectious bats, compared with the epidemic model with non-grouping of bats. These findings, using rare CMR data from longitudinal samples of individual bats, increase our understanding of transmission dynamics of bat viral infectious diseases.
A new approach is proposed to analyze Bremsstrahlung X-rays that are emitted from laser-produced plasmas (LPP) and are measured by a stack type spectrometer. This new method is based on a spectral tomographic reconstruction concept with the variational principle for optimization, without referring to the electron energy distribution of a plasma. This approach is applied to the analysis of some experimental data obtained at a few major laser facilities to demonstrate the applicability of the method. Slope temperatures of X-rays from LPP are determined with a two-temperature model, showing different spectral characteristics of X-rays depending on laser properties used in the experiments.
We analyzed birth order differences in means and variances of height and body mass index (BMI) in monozygotic (MZ) and dizygotic (DZ) twins from infancy to old age. The data were derived from the international CODATwins database. The total number of height and BMI measures from 0.5 to 79.5 years of age was 397,466. As expected, first-born twins had greater birth weight than second-born twins. With respect to height, first-born twins were slightly taller than second-born twins in childhood. After adjusting the results for birth weight, the birth order differences decreased and were no longer statistically significant. First-born twins had greater BMI than the second-born twins over childhood and adolescence. After adjusting the results for birth weight, birth order was still associated with BMI until 12 years of age. No interaction effect between birth order and zygosity was found. Only limited evidence was found that birth order influenced variances of height or BMI. The results were similar among boys and girls and also in MZ and DZ twins. Overall, the differences in height and BMI between first- and second-born twins were modest even in early childhood, while adjustment for birth weight reduced the birth order differences but did not remove them for BMI.
This study was conducted to investigate the angles and orientation of semicircular canals, and the coplanarity of functional canal pairs.
Methods:
Fluid signals in semicircular canals were reconstructed with three-dimensional reconstruction software using 20 temporal bone magnetic resonance images of normal subjects. The angles between each pair of semicircular canals were measured.
Results:
The mean angles between the anterior and horizontal semicircular canal plane, the horizontal and posterior semicircular canal plane, and the anterior and posterior semicircular canal plane were 83.7°, 82.5° and 88.4°, respectively. Pairs of contralateral synergistic canal planes were formed 15.1° between the right and left horizontal semicircular canal planes, 21.2° between the right anterior and left posterior semicircular canal, and 21.7° between the left anterior and right posterior semicircular canal.
Conclusion:
Each semicircular canal makes an almost right angle with other canals, but synergistically acting functional canal pairs of both ears do not lie in exactly the same plane.
Depression is common after acute coronary syndrome (ACS) with adverse effects on prognosis. There is little evidence on whether depression treatment improves quality of life (QoL) in ACS patients. The aim of this study was to investigate the effects of co-morbid depression and its treatment on QoL in ACS.
Method
In total, 1152 patients were recruited at baseline, 2–14 weeks after a confirmed ACS episode, and 828 were followed 1 year thereafter. Of 446 baseline participants with co-morbid depressive disorders, 300 were randomized to a 24-week double blind trial of escitalopram or placebo, while the remaining 146 received medical treatment only (MTO). QoL was measured by the World Health Organization Quality of Life –Abbreviated form (WHOQOL-BREF).
Results
At baseline, QoL was significantly lower in patients with co-morbid depressive disorder than those without. QoL improvement was significantly greater in those receiving escitalopram than those receiving placebo over the 24-week treatment period. In the 1-year follow-up, the better outcomes associated with escitalopram remained evident against both placebo and MTO.
Conclusions
Depression was significantly associated with worse QoL even in patients with recently developed ACS. Depression treatment was associated with QoL improvement in ACS patients in the 24-week treatment period, the effects of which extended to 1 year.
In February 2012, an outbreak of gastroenteritis was reported in school A; a successive outbreak was reported at school B. A retrospective cohort study conducted in school A showed that seasoned green seaweed with radishes (relative risk 7·9, 95% confidence interval 1·1–56·2) was significantly associated with illness. Similarly, a case-control study of students at school B showed that cases were 5·1 (95% confidence interval 1·1–24·8) times more likely to have eaten seasoned green seaweed with pears. Multiple norovirus genotypes were detected in samples from students in schools A and B. Norovirus GII.6 isolated from schools A and B were phylogenetically indistinguishable. Green seaweed was supplied by company X, and norovirus GII.4 was isolated from samples of green seaweed. Green seaweed was assumed to be linked to these outbreaks. To our knowledge, this is the first reported norovirus outbreak associated with green seaweed.
This paper presents a multi-agent behavior to cooperatively rescue a faulty robot using a sound signal. In a robot team, the faulty robot should be immediately recalled since it may seriously obstruct other robots, or collected matters in the faulty robot may be lost. For the rescue mission, we first developed a sound localization method, which estimates the sound source from a faulty robot by using multiple microphone sensors. Next, since a single robot cannot recall the faulty robot, the robots organized a heterogeneous rescue team by themselves with pusher, puller, and supervisor. This self-organized team succeeded in moving the faulty robot to a safe zone without help from any global positioning systems. Finally, our results demonstrate that a faulty robot among multi-agent robots can be immediately rescued with the cooperation of its neighboring robots and interactive communication between the faulty robot and the rescue robots. Experiments are presented to test the validity and practicality of the proposed approach.
The Ultra-Fast Flash Observatory (UFFO), which will be launched onboard theLomonosov spacecraft, contains two crucial instruments: UFFO BurstAlert & Trigger Telescope (UBAT) for detection and localization of Gamma-Ray Bursts(GRBs) and the fast-response Slewing Mirror Telescope (SMT) designed for the observationof the prompt optical/UV counterparts. Here we discuss the in-space calibrations of theUBAT detector and SMT telescope. After the launch, the observations of the standard X-raysources such as pulsar in Crab nebula will provide data for necessary calibrations ofUBAT. Several standard stars will be used for the photometric calibration of SMT. Thecelestial X-ray sources, e.g. X-ray binaries with bright optical sourcesin their close angular vicinity will serve for the cross-calibration of UBAT and SMT.
The Ultra-Fast Flash Observatory (UFFO) Pathfinder for Gamma-Ray Bursts (GRBs) consistsof two telescopes. The UFFO Burst Alert & Trigger Telescope (UBAT) handles thedetection and localization of GRBs, and the Slewing Mirror Telescope (SMT) conducts themeasurement of the UV/optical afterglow. UBAT is equipped with an X-ray detector, analogand digital signal readout electronics that detects X-rays from GRBs and determines thelocation. SMT is equipped with a stepping motor and the associated electronics to rotatethe slewing mirror targeting the GRBs identified by UBAT. First the slewing mirror pointsto a GRB, then SMT obtains the optical image of the GRB using the intensified CCD and itsreadout electronics. The UFFO Data Acquisition system (UDAQ) is responsible for theoverall function and operation of the observatory and the communication with the satellitemain processor. In this paper we present the design and implementation of the electronicsof UBAT and SMT as well as the architecture and implementation of UDAQ.
One of the unexplored domains in the study of gamma-ray bursts (GRBs) is the early timephase of the optical light curve. We have proposed Ultra-Fast Flash Observatory (UFFO) toaddress this question through extraordinary opportunities presented by a series of smallspace missions. The UFFO is equipped with a fast-response Slewing Mirror Telescope thatuses a rapidly moving mirror or mirror array to redirect the optical beam rather thanslewing the entire spacecraft or telescope to aim the optical instrument at the GRBposition. The UFFO will probe the early optical rise of GRBs with sub-second response, forthe first time, opening a completely new frontier in GRB and transient studies. Its fastresponse measurements of the optical emission of dozens of GRB each year will provideunique probes of the burst mechanism and test the prospect of GRB as a new standardcandle, potentially opening up the z > 10 universe. We describe the current limit inearly photon measurements, the aspects of early photon physics, our soon-to-be-launchedUFFO-pathfinder mission, and our next planned mission, the UFFO-100.
The Slewing Mirror Telescope (SMT) is the UV/optical telescope of UFFO-pathfinder. TheSMT optical system is a Ritchey-Chrétien (RC) telescope of 100 mm diameter pointed bymeans of a gimbal-mounted flat mirror in front of the telescope. The RC telescope has a17 × 17arcmin2 in Field of View and 4.3 arcsec resolution (full width halfmaximum of the point spread function) The beam-steering mirror enables the SMT to access a35 × 35degree region and point and settle within 1 sec. All mirrors were fabricated toabout 0.02 wavelengths RMS in wave front error (WFE) and 84.7% average reflectivity over200 nm ~ 650 nm. The RC telescope was aligned to 0.05 wavelengths RMS in WFE (testwavelength 632.8 nm). In this paper, the technical details of the RC telescope and slewingmirror system assembly, integration, and testing are given shortly, and performance testsof the full SMT optical system are reported.