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Diagnosis in psychiatry faces familiar challenges. Validity and utility remain elusive, and confusion regarding the fluid and arbitrary border between mental health and illness is increasing. The mainstream strategy has been conservative and iterative, retaining current nosology until something better emerges. However, this has led to stagnation. New conceptual frameworks are urgently required to catalyze a genuine paradigm shift.
Methods
We outline candidate strategies that could pave the way for such a paradigm shift. These include the Research Domain Criteria (RDoC), the Hierarchical Taxonomy of Psychopathology (HiTOP), and Clinical Staging, which all promote a blend of dimensional and categorical approaches.
Results
These alternative still heuristic transdiagnostic models provide varying levels of clinical and research utility. RDoC was intended to provide a framework to reorient research beyond the constraints of DSM. HiTOP began as a nosology derived from statistical methods and is now pursuing clinical utility. Clinical Staging aims to both expand the scope and refine the utility of diagnosis by the inclusion of the dimension of timing. None is yet fit for purpose. Yet they are relatively complementary, and it may be possible for them to operate as an ecosystem. Time will tell whether they have the capacity singly or jointly to deliver a paradigm shift.
Conclusions
Several heuristic models have been developed that separately or synergistically build infrastructure to enable new transdiagnostic research to define the structure, development, and mechanisms of mental disorders, to guide treatment and better meet the needs of patients, policymakers, and society.
The COVID-19 outbreak is a serious global public health issue with wide-ranging negative effects on people’s lives, which is reflected in steadily rising mental health problems. In order to appropriately respond to the increased occurrence of psychiatric illness, protect mental health and strengthen resilience it is necessary to include new technologies, such as extended reality (XR) or socially assistive robots (SAR) in not only psychiatric treatment but also in the prevention of psychiatric diseases. In this context, the use of new technologies offers innovative ways to strengthen resilience, self-efficacy and stress coping skills and plays an important role in improving psychological wellbeing.
Objectives
Preliminary results from studies at the Clinical Department of Psychiatry and Psychotherapeutic Medicine in Graz, Austria, dealing with new technologies in psychiatry, show new options for psychiatric settings.
Methods
Project AMIGA: The aim of this study is to test the effectiveness of a cognitive training session, conducted with the SAR named Pepper. In this randomized controlled trial, the effectiveness of SAR on depressive symptoms and correlates is evaluated in a sample of 60 individuals with major depression. While the intervention group will receive cognitive training with the SAR Pepper, the control group will receive “treatment-as-usual” therapy with a common PC software. Participants will receive 30 minutes of training 2 times per week over a period of 3 weeks.
Project XRes4HEALTH: The aim of this study is to develop an XR resilience training to increase resilience and stress coping mechanisms in healthcare workers. A total of 40 people will be included. To test the effectiveness of the resilience training, 3 XR training sessions of 15 minutes each will be held. A pre-post measurement will test the effectiveness of the training on wellbeing and stress levels as well as the acceptance and satisfaction with the training.
Project AI-REFIT: The overall goal of this study is to explore key information to increase resilience in healthy individuals who are at increased risk for mental health problems. Through a usability study, the artificial intelligence-based prototype app of the resilience training will be tested for acceptance, usability, functionality, and efficiency. During the resilience training, participants are wearing a smartwatch which measures psychophysiological parameters. Conclusions about the success of the therapy can be drawn based on digital data acquisition.
Results
New technologies including XR and SAR support classical psychiatric treatment in the topics of resilience and cognitive training as an add-on therapy in times of reduced availability of healthcare workers.
Conclusions
The rapid development of new technologies holds a lot of potential in the treatment of psychiatric disorders, which is why it is important to scientifically evaluate those innovative tools.
In support of the ICRF experiments planned on the Wendelstein 7-X (W7-X) stellarator, i.e. fast ion generation, wall conditioning, target plasma production and heating, a first experimental study on plasma production has been made in the Uragan-2M (U-2M) stellarator using W7-X-like two-strap antenna. In all the experiments, antenna monopole phasing was used. The W7-X-like antenna operation with launched radiofrequency power of ~100 kW have been performed in helium (p = (4–14) × 10−2 Pa) with the vacuum vessel walls pre-loaded with hydrogen. Production of plasma with a density higher than 1012 cm−3 was observed near the first harmonic of the hydrogen cyclotron frequency. Operation at first hydrogen harmonic is feasible in W7-X future ICRF experiments.
Pharmacogenetics in schizophrenia comprises pharmacokinetical and pharmacodynamical aspects as well as an approach to identify candidate genes associated with therapy response or side effects. Firstly focussing on classical drug targets like dopaminergic or serotonergic receptors, currently also developmental and regulatory genes presumably associated with effects of antipsychotic therapy are identified. The aim of this study was to investigate associations between therapy response in schizophrenic patients and different polymorphisms previously been identified within a genome wide array in rodents treated with MK-801 and/or haloperidol combined with some well-known schizophrenia candidate genes. We genotyped for 200 different polymorphisms in 285 schizophrenic patients, who were treated with different antipsychotics within randomized controlled trials. Psychopathology was measured weekly using the PANSS scale. Correlations between psychopathology and genotypes were calculated by using a linear model (ANCOVA).
We found significant associations between some well-known candidate genes (e.g. D2-, 5HT1A-, and α1A-receptors) and different PANSS subscales at baseline and after four weeks of antipsychotic treatment considered as therapy response. Furthermore we also identified several significant associations between some genes introduced from the animal model and psychopathology at baseline and towards therapy response. Some of them were formerly described in the literature (e.g. Homer1, Phospholipase C and Transthyretin), but most of them have not been related to schizophrenia or antipsychotic treatment by now (e.g. PLEKHA6, CLIC6 and SOSTDC1).
This indicates an involvement of genes in the pathophysiology of schizophrenia apart from yet known candidate genes and might further help in detecting differential therapy response in individuals with schizophrenia.
Individuals with obsessive-compulsive disorder (OCD) and separation anxiety disorder (SAD) tend to present higher morbidity than do those with OCD alone. However, the relationship between OCD and SAD has yet to be fully explored.
Method:
This was a cross-sectional study using multiple logistic regression to identify differences between OCD patients with SAD (OCD + SAD, n = 260) and without SAD (OCD, n = 695), in terms of clinical and socio-demographic variables. Data were extracted from those collected between 2005 and 2009 via the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders project.
Results:
SAD was currently present in only 42 (4.4%) of the patients, although 260 (27.2%) had a lifetime diagnosis of the disorder. In comparison with the OCD group patients, patients with SAD + OCD showed higher chance to present sensory phenomena, to undergo psychotherapy, and to have more psychiatric comorbidities, mainly bulimia.
Conclusion:
In patients with primary OCD, comorbid SAD might be related to greater personal dysfunction and a poorer response to treatment, since sensory phenomena may be a confounding aspect on diagnosis and therapeutics. Patients with OCD + SAD might be more prone to developing specific psychiatric comorbidities, especially bulimia. Our results suggest that SAD symptom assessment should be included in the management and prognostic evaluation of OCD, although the psychobiological role that such symptoms play in OCD merits further investigation.
Quality improvement and patient safety (QIPS) competencies are increasingly important in emergency medicine (EM) and are now included in the CanMEDS framework. We conducted a survey aimed at determining the Canadian EM residents’ perspectives on the level of QIPS education and support available to them.
Methods
An electronic survey was distributed to all Canadian EM residents from the Royal College and Family Medicine training streams. The survey consisted of multiple-choice, Likert, and free-text entry questions aimed at understanding familiarity with QIPS, local opportunities for QIPS projects and mentorship, and the desire for further QIPS education and involvement.
Results
Of 535 EM residents, 189 (35.3%) completed the survey, representing all 17 medical schools; 77.2% of respondents were from the Royal College stream; 17.5% of respondents reported that QIPS methodologies were formally taught in their residency program; 54.7% of respondents reported being “somewhat” or “very” familiar with QIPS; 47.2% and 51.5% of respondents reported either “not knowing” or “not having readily available” opportunities for QIPS projects and QIPS mentorship, respectively; 66.9% of respondents indicated a desire for increased QIPS teaching; and 70.4% were interested in becoming involved with QIPS training and initiatives.
Conclusions
Many Canadian EM residents perceive a lack of QIPS educational opportunities and support in their local setting. They are interested in receiving more QIPS education, as well as project and mentorship opportunities. Supporting residents with a robust QIPS educational and mentorship framework may build a cohort of providers who can enhance the local delivery of care.
Applying sufficient tensile strain to Ge leads to a direct bandgap group IV semiconductor, which emits in the mid-infrared (MIR) wavelength range. However, highly strained-Ge cannot be directly grown on Si because of its large lattice mismatch. In this work, we have developed a process based on Ge micro-bridge strain redistribution intentionally landed to the Si substrate. Traction arms were then partially etched to keep locally strained-Ge micro-blocks. Large tunable uniaxial stresses up to 4.2% strain were demonstrated in Ge, which was bonded on Si. Our approach allows envisioning integrated strained-Ge on Si platform for MIR-integrated optics. Silicon photonics merge optical and electronic components that can be integrated together onto a single microchip.
Aerial applications of pelleted tebuthiuron {N-[5-(1,1-dimethylethyl)-1,3,4-thiadiazol-2-yl]-N,N′-dimethylurea} at 0.5 kg/ha reduced creosotebush [Larrea tridentata (DC.) Coville] density by up to 86% and by 99% when applied at 1 kg/ha in February or March. Grass production 32 months after treatment was 174 to 305% greater in tebuthiuron-treated plots than on untreated ran gel and, but forb production in treated plots was reduced 38% or more and the poisonous half-shrub broom snakeweed [Gutierrezia sarothrae (Pursh) Britt. and Rusby] was reduced 94% or more.
The precise control of organic thin film processing by organic vapor phase deposition (OVPD®) is presented and analyzed on device level. OVPD® offers accurate and individual control of deposition layer properties like mixing of several materials (co-deposition) and the control of various morphologies by a wide process parameter space given by, e.g. substrate temperature, deposition rate and pressure. The benefit of precise co-deposition is demonstrated by an OLED with a sensitive twofold-doped emissive layer and revealed a doping level of 0.26% for the red dopant with a std. dev. of 0.38%. The effect of the various morphologies is investigated by optimizing the efficiency of molecular organic solar cells consisting of copper phthalocyanine (CuPc) and C60. With defined process parameters efficiencies of up to 3.0% were demonstrated.
We present initial results from a survey of the Orion A and B molecular clouds made with the InfraRed Array Camera (IRAC) onboard the Spitzer Space Telescope. This survey encompasses a total of 5.6 square degrees with the sensitivity to detect objects below the hydrogen burning limit at an age of 1 Myr. These observations cover a number of known star forming regions, from the massive star forming clusters in the Orion Nebula and NGC 2024, to small groups of low mass stars in the L1641. We combine the IRAC photometry with photometry from the 2MASS point source catalog and use the resulting seven band data to identify stars with infrared excesses due to dusty disks and envelopes. Using the presence of an infrared excess as an indicator of youth, we show the distribution of young stars and protostars in the two molecular clouds. We find that roughly half of the stars are found in dense clusters surrounding the two regions of recent massive star formation in the Orion clouds, NGC 2024 and the Orion Nebula.
We model the L1551 IRS5 source as a system containing two protostars, each surrounded by a circumstellar disk, both encircled by a circumbinary disk, and all disks surrounded by an extended infalling flattened envelope With this composite model, we can calculate self-consistently the spectral energy distribution of the source the shape of the ice and silicate features, and the spatial intensity distributions of the envelope and disks. We compare our model results with the observations, determining the physical parameters of the disks and the envelope. We find that flattened envelope collapse models are required in order to explain the observations and that the infall rate of the envelope is much larger than the accretion rates of the binary disks.
Strained Silicon On Insulator wafers are today envisioned as a natural and powerfulenhancement to standard SOI and/or bulk-like strained Si layers. For MOSFETs applications, thisnew technology potentially combines enhanced devices scalability allowed by thin films andenhanced electron and hole mobility in strained silicon. This paper is intended to demonstrate byexperimental results how a layer transfer technique such as the Smart Cut™ technology can be usedto obtain good quality tensile Strained Silicon On insulator wafers. Detailed experiments andcharacterizations will be used to characterize these engineered substrates and show that they arecompatible with the applications.
First results on formation of thin film GeOI structures by the Smart Cut™ technology are presented in this paper. Thin single crystal layers of Ge have been successfully transferred, via oxide bonding layer, onto standard Si substrates with diameters ranging from 100 to 200 mm. Compared to SOI manufacturing, the development of GeOI requires adaptation to the available germanium material, since the starting material can be either bulk Ge or an epitaxial layer. Some results will be presented for GeOI formation according to the different technological options. Germanium splitting kinetics will be discussed and compared to already published results. To show good quality of the GeOI structures, detailed characterization has been done by TEM cross sections for defect densities, interfaces abruptness and layers homogeneities evaluation. AFM was used for surface roughness measurements. These results help define procedures that are required to achieve large diameter high quality GeOI structures.
Intracellular bacteria of the genus Wolbachia are found in most filarial nematodes, but are lacking in some species like Acanthocheilonema viteae. Due to their symbiotic nature and their role in the pathology of filarial infections they are considered to be potential targets for intervention against filarial infections in man. Infection of A. viteae (a species which does not naturally carry Wolbachia) with Wolbachia bacteria could allow comparative studies on the effect of the endobacterium on the parasite and on the host's immune systems. As a step towards such studies we microinjected adult female A. viteae with Wolbachia obtained from Litomosoides sigmodontis. The bacteria were isolated from L. sigmodontis by density-gradient centrifugation, microinjected into A. viteae worms and bacterial DNA detected by PCR with Wolbachia specific primers (ftsZ gene). Microinjected worms were cultured in vitro, and 81% survived for 10 days. Implantation of microinjected worms into Meriones unguiculatus, the rodent host of A. viteae resulted in 38% survival. The DNA of the microinjected worms recovered from jirds 8 weeks after implantation contained Wolbachia DNA as shown by PCR, suggesting that Wolbachia of L. sigmodontis can be horizontally transmitted to A. viteae.
Caseinophosphopeptides (CPP) were detected for the first time in ileostomy fluid, collected at 2 h intervals for 10 h post milk and CPP ingestion, from human volunteers with an ileostomy. The level of CPP present in ileostomy fluid obtained from milk-fed volunteers was markedly higher than that from volunteers fed with selected CPP preparations. The findings are based on HPLC analysis in combination with peptide-bound P determination, thin-layer electrophoresis and amino acid analysis, together with ELISA studies using polyclonal antibodies raised against a set of CPP to detect immunoreactive CPP in ileostomy fluid. These procedures allowed the detection of nm concentrations of CPP. CPP, which can be released during intestinal digestion, may function as bioactive constituents and carriers for different minerals, especially Ca, and may be used as ingredients in functional foods or pharmaceutical preparations.
To be successfully integrated in nano-electronics devices, silicon quantum dots (Si-QDs) density, density uniformity, size and size dispersion must be controlled with a great precision. Nanometric size Si-QDs can be deposited on insulators by SiH4 CVD. Their formation includes two steps : nucleation and growth. We study the experimental parameters which influence each step in order to improve the control of the Si-QDs morphology.
We show that the nucleation step is governed by the reactivity of the substrate with the Si precursors. On SiO2, OH groups are identified as nucleation sites. By controlling the OH density on the SiO2 surface, we can monitor the Si-QDs density on more than one decade for the same process conditions. Moreover, Si-QDs density as high as 1.5 1012 /cm2 can be obtained. On the contrary, the growth step depends on process conditions. By modifying the gas phase composition, i.e by using SiH2Cl2 as Si precursor, we can grow the nuclei already formed during the nucleation step without formation of new Si-QDs. We discuss the advantages of this process to improve the control of the Si-QDs size and limit the size dispersion.
A case of atypical movement of the intimal flap (tear) during aortic aneurysm dissection is reported. Aortic dissection is caused by the sudden development of a tear in the aortic intima, opening the way for a column of blood driven by the force of the arterial pressure to enter the aortic wall, destroying the media and stripping the intima from the adventitia for variable distance along the length of the aorta. Echocardiographically, aortic dissection is characterized by separation of the normal single dominant echo from the aortic wall in the region of the dissection into two discrete echoes. The inner echo arises from the tunica intima, whereas the outer echo arises from the medial and adventitial structures external to the tear and it is possible to identify two lumens separated by an intimal flap within the aorta. The two echoes generally move in unison with one another, i.e. movement of the flap away from the true lumen during systole and recoil during diastole as the blood flows from true to false lumen. The dissection flap can also move inward during systole owing to the suction caused by high-velocity flow (Venturi effect), as shown in this case report. In any instances, motion of the intimal flap during the cardiac cycle is strong evidence of dissecting aneurysm.
Intra-operative segmental wall motion abnormalities (SWMA) detected by transoesophageal echocardio- graphy (TOE) have been shown to be a sensitive indicator of myocardial ischaemia. To determine the incidence and characteristics of segmental wall motion abnormalities and to relate these changes to peri-operative myocardial ischaemia, biplane TEE, electrocardiogram (ECG) (II + V5) and pulmonary capillary wedge pressure (PCWP) were continuously monitored in 62 consecutive patients with ischaemic heart disease undergoing non-cardiac surgery. Short-axis view at mid-papillary level in transverse scan (T-scan) and long-axis in longitudinal (L-scan) two-chamber view were used for wall motion analysis. New segmental wall motion abnormalities were detected in 16 of 64 patients (25%) using biplane transoesophageal echocardiography. Monoplane transoesophageal echocardiography showed a sensitivity of 75% and a specificity of 100%, electrocardiogram two lead showed a sensitivity of 56% and a specificity of 98%, whereas pulmonary capillary wedge pressure had a sensitivity of 25%, and a specificity of 93% and pressure rate quotient (PRQ) < 1 demonstrated sensitivity of 19% and a specificity of 92% in the detection of myocardial ischaemia. It is concluded that the long-axis view of the left ventricle provides additional information for the detection of segmental wall motion abnormalities. Neither changes in haemodynamic performance nor in electrocardiography leads II and V5 match those of transoesophageal echocardiography for the identification of myocardial ischaemia.