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Background: Self-injurious behaviours (SIB) are repetitive, non-accidental movements that result in physical damage inflicted upon oneself, without suicidal intent. SIB are prevalent among children with autism spectrum disorder and can lead to permanent disability or death. Neuromodulation at a locus of neural circuitry implicated in SIB, the nucleus accumbens (NAc), may directly influence these behaviours. Methods: We completed a phase I, open-label clinical trial of deep brain stimulation (DBS) of the NAc in children with severe, treatment-refractory SIB (ClinicalTrials.gov NCT03982888). Participants were monitored for 12 months following NAc-DBS to assess the primary outcomes of safety and feasibility. Secondary outcomes included serial assessments of SIB, ambulatory actigraphy, and changes in brain glucose metabolism induced by DBS. Results: Six children underwent NAc-DBS without any serious adverse events. NAc-DBS resulted in significant reductions in SIB and SIB-associated behaviours across multiple standardized scales, concurrent with clinically meaningful improvements in quality-of-life. Ambulatory actigraphy showed reductions in high-amplitude limb movements and positron emission tomography revealed treatment-induced reductions in metabolic activity within the thalamus, striatum, and temporoinsular cortex. Conclusions: This first-in-children phase 1 clinical trial demonstrates the safety and feasibility of NAc-DBS in children with severe, refractory SIB at high risk of physical injury and death and supports further investigations.
Mental Health problems and substance misuse during pregnancy constitute a serious social problem due to high maternal-fetal morbidity (Cook et al, 2017; JOCG, 39(10) ,906-915) and low detection and treatment rates (Carmona et al. Adicciones. 2022;34(4):299-308)
Objectives
Our study aimed to develop and test the feasibility and acceptability of a screening and treatment clinical pathway in pregnancy, based on the combination of e-Health tools with in-person interventions and, secondly, describe the prevalence of mental illness and substance use problems in this population.
Methods
1382 pregnant women undergoing her first pregnancy visit were included in a tailored clinical pathway and sent a telematic (App) autoapplied questionnaire with an extensive battery of measures (WHO (Five) Well-Being [WHO-5],Patient Health Questionnaire [PHQ-9], General Anxiety Disorder [GAD-7], Alcohol Use Disorders Identification Test [AUDIT], Drug Abuse Screening Test [DAST], Columbia Suicide Severity Rating Scale [C-SSRS] and specifically designed questions on self-harm and psychopharmacological drugs).
Patients who did not respond to the questionnaire on their own received a counseling call.
Based on the screening results, patients were classified into five groups according to severity (Figure 1) and assigned a specific action pathway (Figure 2) that included a range of intervention intensity that goes from an individual psychiatric appointment to no intervention.
Results
Of the 1382 women included in the clinical pathway, 565(41%) completed the evaluation questionnaires. Of these, 205 (36%) were screened as positive (Grades III,IV or V. Table 1) and 3(0.5%) were classified as needing urgent care. Of the patients offered on-line groups (100), 40% (40) were enrolled in them.Table 1:
Grade distribution of those screened as positives
Grade III
97 (17,2%)
Grade IV
105 (18,6%)
Grade V
3 (0,5%)
Concerning prevalence rates, 73 (12,9%) patients endorsed at least moderate anxiety according to GAD-7 (≥10), 65 (11,5%) endorsed at least moderate depression according to PHQ-9 (≥ 10), 17 were positive on DAST (3%) and 63 (11%) patients scored above the threshold in AUDIT-C(≥ 3) for alcohol use.
Image:
Image 2:
Conclusions
High prevalence rates suggest that effective detection and treatment mechanisms should be integrated into usual care. The use of standardized clinical pathways can help with this aim, allowing better clinical management and referral to treatment, but still face challengues to increase retention. The use of e-health tools offers the opportunity to improve accessibility and therapeutic outcomes through online interventions.
Blood-based biomarkers offer a more feasible alternative to Alzheimer’s disease (AD) detection, management, and study of disease mechanisms than current in vivo measures. Given their novelty, these plasma biomarkers must be assessed against postmortem neuropathological outcomes for validation. Research has shown utility in plasma markers of the proposed AT(N) framework, however recent studies have stressed the importance of expanding this framework to include other pathways. There is promising data supporting the usefulness of plasma glial fibrillary acidic protein (GFAP) in AD, but GFAP-to-autopsy studies are limited. Here, we tested the association between plasma GFAP and AD-related neuropathological outcomes in participants from the Boston University (BU) Alzheimer’s Disease Research Center (ADRC).
Participants and Methods:
This sample included 45 participants from the BU ADRC who had a plasma sample within 5 years of death and donated their brain for neuropathological examination. Most recent plasma samples were analyzed using the Simoa platform. Neuropathological examinations followed the National Alzheimer’s Coordinating Center procedures and diagnostic criteria. The NIA-Reagan Institute criteria were used for the neuropathological diagnosis of AD. Measures of GFAP were log-transformed. Binary logistic regression analyses tested the association between GFAP and autopsy-confirmed AD status, as well as with semi-quantitative ratings of regional atrophy (none/mild versus moderate/severe) using binary logistic regression. Ordinal logistic regression analyses tested the association between plasma GFAP and Braak stage and CERAD neuritic plaque score. Area under the curve (AUC) statistics from receiver operating characteristics (ROC) using predicted probabilities from binary logistic regression examined the ability of plasma GFAP to discriminate autopsy-confirmed AD status. All analyses controlled for sex, age at death, years between last blood draw and death, and APOE e4 status.
Results:
Of the 45 brain donors, 29 (64.4%) had autopsy-confirmed AD. The mean (SD) age of the sample at the time of blood draw was 80.76 (8.58) and there were 2.80 (1.16) years between the last blood draw and death. The sample included 20 (44.4%) females, 41 (91.1%) were White, and 20 (44.4%) were APOE e4 carriers. Higher GFAP concentrations were associated with increased odds for having autopsy-confirmed AD (OR=14.12, 95% CI [2.00, 99.88], p=0.008). ROC analysis showed plasma GFAP accurately discriminated those with and without autopsy-confirmed AD on its own (AUC=0.75) and strengthened as the above covariates were added to the model (AUC=0.81). Increases in GFAP levels corresponded to increases in Braak stage (OR=2.39, 95% CI [0.71-4.07], p=0.005), but not CERAD ratings (OR=1.24, 95% CI [0.004, 2.49], p=0.051). Higher GFAP levels were associated with greater temporal lobe atrophy (OR=10.27, 95% CI [1.53,69.15], p=0.017), but this was not observed with any other regions.
Conclusions:
The current results show that antemortem plasma GFAP is associated with non-specific AD neuropathological changes at autopsy. Plasma GFAP could be a useful and practical biomarker for assisting in the detection of AD-related changes, as well as for study of disease mechanisms.
People presenting to hospital in a crisis of mental ill-health usually present via Emergency Departments, and are often admitted for brief interventions. Unlike drug treatments, the evidence base for brief non-pharmacological interventions has not been systematically evaluated.
Objectives
1. To describe brief non-pharmacological interventions used in Emergency Departments and inpatient psychiatric units, for those in a crisis of mental ill-health, and evaluate the study types and outcome measures used to evaluate them;
2. To conduct a systematic review of this evidence
Methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, DARE, Embase, MEDLINE, PsycINFO, and relevant government and non-government organisation websites for peer reviewed journal articles, including both qualitative and quantitative articles. Interventions were sorted into Categories and Types to manage heterogeneity.
Results
We found 47 studies. Interventions were highly varied, and we created a taxonomy to understand this heterogeneity. Most studies were quasi-experimental trials (n=26; 55%) or qualitative studies (n=13; 27%) and only 8 RCTs (17%). Twelve were high quality (26%). Interventions were mostly found to have no effect on measured outcomes, though outcome measures may not have been best suited to expected domains of change.There was a broad range of outcome foci reflecting inconsistency in goals of interventions. No interventions were found to reduce the incidence of self-harm on the inpatient ward. One study suggests that inpatient safety planning may reduce readmission rates. Aggression-related outcomes for inpatient sensory modulation rooms were equivocal. Brief admissions with psychotherapy may reduce suicide attempt repetition and re-hospitalization, whereas brief admissions without psychotherapy may improve function but not re-hospitalization rates. Face-to-face psychoeducation for panic in the ED was associated with a reduction in ED presentation rates, but brochure-only psychoeducation may increase ED presentation rates.
Conclusions
This review found little evidence to guide much of what clinicians do for people in crisis in hospital. There is a need to develop a framework for brief non-pharmacological interventions, address the quality and size of studies, and identify consistent outcome measures for non-pharmacological interventions. The data is insufficient to make clear recommendations for appropriate brief non-pharmacological interventions for people in crisis in Emergency Departments and Psychiatric Inpatient Units. Multiple promising interventions are available for further study, however there is a dearth of research and more rigorous testing is needed.
To investigate the prevalence of bony dehiscence in the tympanic facial canal in patients with acute otitis media with facial paresis compared to those without facial paresis.
Method
A retrospective case–control study was conducted on acute otitis media patients with facial paresis undergoing high-resolution temporal bone computed tomography.
Results
Forty-eight patients were included (24 per group). Definitive determination of the presence of a bony dehiscence was possible in 44 out of 48 patients (91.7 per cent). Prevalence of bony dehiscence in acute otitis media patients with facial paresis was not different from that in acute otitis media patients without facial paresis (p = 0.21). Presence of a bony dehiscence was associated with a positive predictive value of 66.7 per cent in regard to development of facial paresis. However, an intact bony tympanic facial canal did not prevent facial paresis in 44.8 per cent of cases (95 per cent confidence interval = 34.6–55.6).
Conclusion
Prevalence of bony dehiscence in acute otitis media patients with facial paresis did not differ from that in acute otitis media patients without facial paresis. An intact tympanic bony facial canal does not protect from facial paresis development.
Positive symptoms are a useful predictor of aggression in schizophrenia. Although a similar pattern of abnormal brain structures related to both positive symptoms and aggression has been reported, this observation has not yet been confirmed in a single sample.
Method
To study the association between positive symptoms and aggression in schizophrenia on a neurobiological level, a prospective meta-analytic approach was employed to analyze harmonized structural neuroimaging data from 10 research centers worldwide. We analyzed brain MRI scans from 902 individuals with a primary diagnosis of schizophrenia and 952 healthy controls.
Results
The result identified a widespread cortical thickness reduction in schizophrenia compared to their controls. Two separate meta-regression analyses revealed that a common pattern of reduced cortical gray matter thickness within the left lateral temporal lobe and right midcingulate cortex was significantly associated with both positive symptoms and aggression.
Conclusion
These findings suggested that positive symptoms such as formal thought disorder and auditory misperception, combined with cognitive impairments reflecting difficulties in deploying an adaptive control toward perceived threats, could escalate the likelihood of aggression in schizophrenia.
In most countries, male pigs are physically castrated soon after birth to reduce the risk of boar taint and to avoid behaviours such as fighting and mounting. However, entire male pigs are more feed efficient and deposit less fat than barrows. In addition, many animal welfare organizations are lobbying for a cessation of castration, with a likelihood that this could lead to inferior pork unless an alternative method is used to control boar taint. An alternative to physical castration is immunization against gonadotrophin releasing factor (GnRF) which allows producers to capitalize on the superior feed efficiency and carcass characteristics of boars without the risk of boar taint. From a physiological perspective, immunized pigs are entire males until shortly after the second dose, typically given 4 to 6 weeks before slaughter. Following full immunization, there is a temporary suppression of testicular function and a hormonal status that resembles that of a barrow. Nutrient requirements will be different in these two phases, before and after full immunization. Given that there have been few published studies comparing the lysine requirements of entire males and barrows in contemporary genotypes, it is useful to use gilt requirements as a benchmark. A series of meta-analyses comparing anti-GnRF immunized boars and physical castrates and use of nutritional models suggest that the lysine requirement of entire males before the second immunization is 5% higher than for gilts, from 25 to 50 kg BW, and by 8% from 50 to 95 kg. Given that the penalty in growth performance for having inadequate dietary lysine is greater in males than in gilts or barrows, it is important to ensure that lysine requirements are met to obtain the maximum benefits of entire male production during this phase. After the second immunization, the lysine requirement of immunized males decreases and may become more like that of barrows. In addition, a consistent effect of full immunization is a marked increase in voluntary feed intake from about 10 days after the second dose. Putting these together, the estimated lysine requirement, expressed in terms of diet composition, falls to 94% of the gilt level. Although general principles can be described now, further research is needed to fully define the lysine requirements of immunized boars. It is important that the temporal pattern of tissue deposition rates and feed intake be explored to be incorporated into models to predict nutrient requirements over the period of rapidly changing metabolism.
In November 2009, we initiated a multistate investigation of Salmonella Montevideo infections with pulsed-field gel electrophoresis pattern JIXX01.0011. We identified 272 cases in 44 states with illness onset dates ranging from 1 July 2009 to 14 April 2010. To help generate hypotheses, warehouse store membership card information was collected to identify products consumed by cases. These records identified 19 ill persons who purchased company A salami products before onset of illness. A case-control study was conducted. Ready-to-eat salami consumption was significantly associated with illness (matched odds ratio 8·5, 95% confidence interval 2·1–75·9). The outbreak strain was isolated from company A salami products from an environmental sample from one manufacturing plant, and sealed containers of black and red pepper at the facility. This outbreak illustrates the importance of using membership card information to assist in identifying suspect vehicles, the potential for spices to contaminate ready-to-eat products, and preventing raw ingredient contamination of these products.
In the present work, a previously developed neural network approach for analyzing spherical indentation experiments is applied to prestressed specimens to determine the effect of residual stresses on the identified stress–strain curves. Within this scope, a comparison to other measurement errors has been made, which are caused by surface preparation and anisotropy of the material. To validate the experimental and analysis approach, the effect of compressive and tensile prestresses was also simulated using a three-dimensional finite element model. The material investigated is a rolled 2024 T351, which is widely used for manufacturing airplanes. It is shown that the existing neural network approach is able to determine the stress–strain behavior in agreement with that obtained from tensile tests. The method is robust against most error sources, such as surface roughness, coarse grain structure, and anisotropy, if a sufficient number of experiments are available. The most important influencing factor can be the residual stress causing errors up to 20% in the identified stress–strain curves.
Catalysis is the essential technology for chemical transformation, including production of fuels from the fossil resources petroleum, natural gas, and coal. Typical catalysts for these conversions are robust porous solids incorporating metals, metal oxides, and/or metal sulfides. As efforts are stepping up to replace fossil fuels with biomass, new catalysts for the conversion of the components of biomass will be needed. Although the catalysts for biomass conversion might be substantially different from those used in the conversion of fossil feedstocks, the latter catalysts are a starting point in today's research. Major challenges lie ahead in the discovery of efficient biomass conversion catalysts, as well as in the discovery of catalysts for conversion of CO2 and possibly water into liquid fuels.
Substituting used tyres for anthracite in the EAF in France and inBelgium is reported. First trials have been carried out in Lorraine in1997 in the frame of a partnership between Usinor (now ArcelorMittal), Michelin and Ademe. The substitution process has beeneventually implemented by LME in cooperation with Aliapur over theyears 2002-2003. Industeel Belgium got started on substitution in2004. To day, both steel plants have achieved stable operation, witha regular load of 8 to 12 kg used tyres per ton of steel, thus allowingsignificant and sustainable savings on anthracite.
A neural network-based analysis method for the identification of a viscoplasticity model from spherical indentation data, developed in the first part of this work [J. Mater. Res.21, 664 (2006)], was applied for different metallic materials. Besides the comparison of typical parameters like Young’s modulus and yield stress with values from tensile experiments, the uncertainties in the identified material parameters representing modulus, hardening behavior, and viscosity were investigated in relation to different sources. Variations in the indentation position, tip radius, force application rate, and surface preparation were considered. The extensive experimental validation showed that the applied neural networks are very robust and show small variation coefficients, especially regarding the important parameters of Young’s modulus and yield stress. On the other hand, important requirements were quantified, which included a very good spherical indenter geometry and good surface preparation to obtain reliable results.
In this paper, a new method for the identification of material parameters is presented. Neural networks, which are trained on the basis of finite element simulations, are used to solve the inverse problem. The material parameters to be identified are part of a viscoplasticity model that has been formulated for finite deformations and implemented in the finite element code ABAQUS. A proper multi-creep loading history was developed in a previous paper using a phenomenological model for viscoplastic spherical indentation. Now, this phenomenological model is replaced by a more realistic finite element model, which provides fast computation and numerical solutions of high accuracy at the same time. As a consequence, existing neural networks developed for the phenomenological model have been extended from a power law hardening with two material parameters to an Armstrong–Frederick hardening rule with three parameters. These are the yield stress, the initial slope of work hardening, and maximum hardening stress of the equilibrium response. In addition, elastic deformation is taken into account. The viscous part is based on a Chaboche-like overstress model, consisting of two material parameters determining velocity dependence and overstress as a function of the strain rate. The method has been verified by additional finite element simulations. Its application for various metals will be presented in Part II, [J. Mater. Res.21, 677 (2006)].
Thin films of polytetrafluoroethylene (PTFE) were prepared by pulsed-laser deposition (PLD) from bulk PTFE targets using 157 nm F2-laser radiation. The films were analyzed by means of optical polarization microscopy, stylus profilometry, XPS, XRD, FTIR spectroscopy, and by capacitance measurements. The effect of substrate temperature, Ts, on the morphology and crystallinity of the films was studied. Films treated at sufficiently high Ts consist mainly of spherulite-like crystallites. Films with a thickness of more than about 155 nm are continuous, pinhole-free, well adherent to the substrate, and have a composition which is similar to that of the target material. The minimum film thicknesses and deposition rates are much lower than those achieved with pressed PTFE powder targets using 248 nm KrF-laser ablation. This is related to the different deposition mechanisms. Film formation based on KrF-laser ablation of pressed powder targets is mainly related to the condensation of large particulates transferred in a particle jet from the target to the substrate. F2–laser ablation and film formation seems to be based on the ablation and condensation of small fragments. Correspondingly, the morphology, crystallinity, and the optical and dielectrical properties of films significantly differ from each other.
In this contribution we investigate the connection between clusters of galaxies and their large-scale environment, with an emphasis on clusters which are well characterized by their X-ray emission. We show that this connection is so tight that clusters can be used as perfect tracers of the large-scale matter distribution and thus for cosmological tests. The correlation of the X-ray traced cluster mass and the optical luminosity of the galaxy content of clusters shows that the dark matter and galaxy distribution are tightly connected, but we also observe a scatter which is so far not well understood. We further explore the correlation of the galaxy population mix with the geometry of the large-scale structure features. On larger scales we also find correlations of the properties of galaxy clusters with the density of their large-scale structure environment.To search for other articles by the author(s) go to: http://adsabs.harvard.edu/abstract_service.html
In this paper a new loading history for extracting the stress–strain curve as well as the viscosity and creep behavior from indentation experiments is developed. It is based on a simple model describing the viscoplastic spherical indentation with a power-law hardening rule and a velocity-dependent overstress. Using this model, patterns were generated consisting of load-depth data and corresponding material parameters. The loading history for the simulation of the patterns was considered as a variable combination of loading and creep processes. To compare the identification potential of different loading histories, the inverse problem of determining the viscoplastic material parameters was solved by using neural networks. The emerging loading history uses a multiple-creep process with equidistant load steps and allows an identification of material parameters with much higher accuracy than with single creep. It will be used for further work, where the identification method is generalized using more realistic finite element simulations for a finite deformation elastic–viscoplastic material behavior.
Non-linear stress-strain curves of various films with thickness of one to four microns were determined from nanoindentation experiments with a Berkovich indenter. The measured load-depth data are analysed using a method based on neural networks. An inverse mapping of depth-dependent dimensionless hardness and stiffness data yields the material parameters describing a non-linear elastic-plastic stress-strain curve of the Armstrong-Frederick type. Suppositions for the application of this method are a sufficiently different hardness between film and substrate, and hardness and stiffness data available in a depth range of 10 to 200% of the film thickness. For all films considered a significant thickness dependence in strength has been observed. In addition, a remarkable influence of the substrate material on the strength of the film material was found and has been confirmed by focussed ion beam microscopy.
The ablation rate of sintered polytetrafluoroethylene (PTFE) targets has been investigated as a function of wavelength within the range $193 \le\lambda\le1064$ nm and pulse durations $5 \le\tau _{l}\le 25$ ns by means of various different lasers. In this parameter range, the apparent optical properties of targets and the depth of energy deposition are determined mainly by the scattering of the laser light. Therefore, measurements of the scattered light were performed for samples of various thicknesses by means of a modified UV-VIS spectrometer. For selected wavelengths, the angular distribution of the reflected and transmitted light intensity was determined. From these measurements, the coefficients for linear absorption, linear scattering and the scattering anisotropy were calculated using the inverse adding doubling algorithm. The results were tested by Monte Carlo simulation. With these coefficients the apparent optical penetration depths were estimated. These are about one order of magnitude larger than the ablation depths per pulse, which were determined from the weight loss of the targets.Laser deposition
A device for spherical indentation using a tip radius of 2 mm and loads up to 10 kN is presented. This facility can be applied, for example, to verify methods for characterizing the behavior of materials exhibiting homogeneous and isotropic constitutive properties. The indentation device can be driven both load- and depth-controlled. The accuracy of measurements is about 1 N for load and 0.2 μm for depth at a total depth of 200 μm. Two materials, an austenitic steel and an aluminum alloy, have been tested and their Young's moduli have been determined. For determining Young's modulus from spherical indentation data, use is made of a so-called Lt method, which had been developed in Ref. 1. Results obtained in this way are compared with corresponding values measured by one-dimensional homogeneous tensile experiments.
In this paper we consider elastic plastic materials that are tested by spherical indentation. Finite element calculations, which take into account nonlinear geometry properties, are carried out in order to determine the influence of the plastic history on the unloading response of the material. Two different iterative methods are proposed for determining Young's modulus under the assumption of a bilinear plasticity law. The first method deals with loading and unloading parts of the indentation test, whereas the second one deals only with unloading parts of the indentation test.