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The Psychogeriatric Department of the Institute of Mental Health (IMH) in Singapore provides acute inpatient services for elderly patients with severe mental health problems. The average length of stay for inpatients in 2020 was 46 days, which was significantly higher than the ideal length of stay set by the hospital of 21 days. This contributed significantly to healthcare costs and reduced bed capacity for acute admissions from the Emergency Service. Prolonged inpatient stays can lead to physical decompensation including reduced muscle strength, pulmonary capacity and osteoporosis.[i]
[i] Creditor MC. Hazards of hospitalization of the elderly. Ann Intern Med. 1993 Feb 1;118(3):219-23. doi: 10.7326/0003-4819-118-3-199302010-00011. PMID: 8417639.
Objectives
We aimed to profile and identify patients in acute psychogeriatric wards who had prolonged inpatient stays.
Methods
A cross-sectional audit was performed. We used a data collection sheet to capture demographic, social and clinical information of all inpatients residing in the acute psychogeriatric wards on 1st November 2020, whose inpatient stays exceeded one month (over-stayers).
Results
Features
Total
26
%
Clinical
Diagnosis
Dementia
19
73.1
Schizophrenia
2
Depression
4
Obsessive Compulsive Disorder
1
Behavioral difficulties
18
69.2
Activities of Daily Living (ADLs) assistance
22
84.6
Social
Caregiver burnout
18
69.2
Poor relationships
3
11.5
Inadequate additional caregiver support
3
11.5
Demographic profile: Out of 57 inpatients (28 male patients and 29 female patients), 26 patients (46%) were over-stayers. Out of these 26 over-stayers, 18 patients (69%) were female and 14 patients (54%) were above age 70.
Clinical profile (n=26): 19 patients (73.1%) were diagnosed with dementia. 18 patients (69.2%) had severe Behavioral and Psychological Symptoms of Dementia (BPSD). 22 patients (84.6%) required assistance in their basic activities of daily living.
Social profile (n=26): Caregivers of 18 patients (69%) were burnt out by patient’s behavior problems, which is commonly seen in caregivers for patients with dementia[ii]. Family members of 3 patients (11.5%) were estranged from them. Caregivers of 3 patients (11.5%) had difficulty engaging additional caregiver support for ADL assistance.
The above profiles enabled the department of Geriatric Psychiatry in IMH to identify elderly patients at risk of prolonged hospital stay at the beginning of their admission and improve the care of these patients to reduce their length of stay.
The target backsheath field acceleration mechanism is one of the main mechanisms of laser-driven proton acceleration (LDPA) and strongly depends on the comprehensive performance of the ultrashort ultra-intense lasers used as the driving sources. The successful use of the SG-II Peta-watt (SG-II PW) laser facility for LDPA and its applications in radiographic diagnoses have been manifested by the good performance of the SG-II PW facility. Recently, the SG-II PW laser facility has undergone extensive maintenance and a comprehensive technical upgrade in terms of the seed source, laser contrast and terminal focus. LDPA experiments were performed using the maintained SG-II PW laser beam, and the highest cutoff energy of the proton beam was obviously increased. Accordingly, a double-film target structure was used, and the maximum cutoff energy of the proton beam was up to 70 MeV. These results demonstrate that the comprehensive performance of the SG-II PW laser facility was improved significantly.
We report the experimental results of the commissioning phase in the 10 PW laser beamline of the Shanghai Superintense Ultrafast Laser Facility (SULF). The peak power reaches 2.4 PW on target without the last amplifying during the experiment. The laser energy of 72 ± 9 J is directed to a focal spot of approximately 6 μm diameter (full width at half maximum) in 30 fs pulse duration, yielding a focused peak intensity around 2.0 × 1021 W/cm2. The first laser-proton acceleration experiment is performed using plain copper and plastic targets. High-energy proton beams with maximum cut-off energy up to 62.5 MeV are achieved using copper foils at the optimum target thickness of 4 μm via target normal sheath acceleration. For plastic targets of tens of nanometers thick, the proton cut-off energy is approximately 20 MeV, showing ring-like or filamented density distributions. These experimental results reflect the capabilities of the SULF-10 PW beamline, for example, both ultrahigh intensity and relatively good beam contrast. Further optimization for these key parameters is underway, where peak laser intensities of 1022–1023 W/cm2 are anticipated to support various experiments on extreme field physics.
This paper presents an approach for evaluating exoskeleton support concepts through biomechanical analyses on a musculoskeletal human model. By simplifying the support forces of an exoskeleton as external forces, different support concepts can be biomechanically evaluated for the respective use case without concrete design specifications of the exoskeleton. This enables an estimation of the resulting relief and strain on the human body in the early stages of exoskeleton development. To present the approach, the use case of working at and above head height with a power tool is chosen.
Women carrying a fetus diagnosed with congenital heart disease often experience significant distress because of their medical diagnosis. Given the well-documented impact associated with elevated prenatal stress and critical importance of developing targeted interventions, this study aims to examine stressors, coping and resilience resources, and mental health treatment preferences in pregnant women receiving a congenital heart disease diagnosis to inform the development of a psychological intervention to reduce maternal distress prenatally.
Methods:
Three groups of participants were included consisting of two pregnant women carrying a fetus with congenital heart disease, five women of children (4−16 months) with congenital heart disease, and five paediatric cardiology medical providers. Responses were gathered via semi-structured interviews and analysed using qualitative thematic analysis.
Results:
Information regarding four broad areas were analysed of emotional distress during pregnancy; experience of initial diagnosis; coping and resilience; and perspectives on a mental health intervention in pregnancy. Anxiety regarding baby’s future, guilt following diagnosis, and various coping strategies emerged as primary themes among the participant sample. Medical staff corroborated mothers’ heightened anxiety and viewed a psychotherapeutic intervention during the prenatal period as essential and complimentary to standard of care.
Conclusion:
We identified salient themes and preferred components for a future psychological intervention delivered prenatally.
Practice Implications:
Patients’ and providers’ perspectives regarding the nature of maternal distress, resilience and treatment preferences can inform the development of interventions to support the emotional well-being of pregnant women carrying a fetus with congenital heart disease to optimise care and potentially improve outcomes for fetal brain development.
Prenatal maternal stress is associated with adverse offspring outcomes, which may be mediated by maternal stress hormones. However, evidence supporting the association between maternal stress and cortisol levels in high-risk pregnancies is limited. This study aims to determine the relationship between self-reported maternal mental distress and maternal salivary cortisol levels in pregnancies complicated by foetal CHD compared with healthy pregnancies.
Methods:
We recruited women with pregnancies complicated by foetal CHD and healthy pregnancies. Maternal saliva was collected between 22 and 40 gestational weeks. Standardized questionnaires measuring stress, depression, and anxiety were completed by patients. Generalized estimating equation was used to evaluate associations between maternal mental distress scales and cortisol levels.
Results:
We studied 165 women (55 CHD, 110 controls) and collected 504 cortisol samples (160 CHD, 344 controls). Women carrying CHD foetuses had higher stress, anxiety, and depression scores compared to women carrying healthy foetuses. However, maternal cortisol levels did not significantly differ in CHD and controls. Cortisol levels were higher in women carrying foetuses with functionally single-ventricle versus two-ventricle CHD. In both CHD and controls, there was no significant association between maternal stress, depression or anxiety scores and cortisol levels.
Conclusion:
Our data suggest that self-reported maternal stress, anxiety, and depression are not associated with maternal salivary cortisol levels in CHD and healthy pregnancies. The impact of maternal mental distress on foetal health may be through other mediating pathways other than maternal cortisol concentrations.
Serotonin transporter (SERT) and dopamine transporter (DAT) levels differ in patients with major depressive disorder (MDD) who are in a depressed state in comparison with healthy controls. In addition, a family history of depression is a potent risk factor for developing depression, and inherited vulnerability to serotonergic and dopaminergic dysfunction is suspected in this. The aim of this study was to examine the availabilities of midbrain SERT and striatal DAT in healthy subjects with and without a first-degree family history of MDD.
Methods
Eight healthy subjects with first-degree relatives with MDD and 16 sex- and age-matched healthy controls were recruited. The availabilities of SERT and DAT were approximated using SPECT, employing [123I] 2-((2-((dimethylamino)methyl)phenyl)thio)-5-iodophenylamine (ADAM) and [99mTc] TRODAT-1 as the ligands, respectively. There are missing data for one participant with a first-degree family history of MDD from the ADAM study, due to a lack of the radio-ligand at the time of experiment.
Results
SERT availability in the midbrain was significantly lower in subjects with a first-degree family history of MDD than in healthy subjects. However, DAT availability was no different between two groups.
Conclusions
The results with regard to the midbrain SERT level suggest the heritability of MDD.
The current emphasis of schistosomiasis control is placed on preventive chemotherapy using praziquantel. However, reinfection may occur rapidly in the absence of complementary interventions. Recent studies from Senegal suggest that predatory prawns might feed on intermediate host snails and thus impact on schistosomiasis transmission. We designed a study with four repeated cross-sectional surveys pertaining to prawns and snails, coupled with a single cross-sectional parasitological survey among humans. We assessed for potential associations between the presence/density of prawns and snails and correlation with Schistosoma infection in a composite sample of school-aged children and adults. The study was carried out between October 2015 and December 2016 in 24 villages located near the Agnéby and Mé coastal river systems in south-eastern Côte d'Ivoire. At each site, snails and prawns were collected, and in each village, 150 individuals were subjected to stool and urine examination for the diagnosis of Schistosoma mansoni and S. haematobium. We found peaks of relative abundance of intermediate host snails in the villages of the Agnéby River system, while predatory prawns were predominantly recorded in the Mé River system. A negative association was observed between intermediate host snail densities and riverine prawns; however, no pattern was found between this trend in the predator–prey relationship and the prevalence of human schistosomiasis.
The microbiota-gut-brain axis and membrane dysfunction in the brain has attracted increasing attention in the field of psychiatric research. However, the possible interactive role of gut microbiota and brain function in the prodromal stage of schizophrenia has not been studied yet.
Methods:
To explore this, we collected fecal samples and performed Magnetic Resonance Spectroscopy (MRS) scans in 81 high risk (HR) subjects, 19 ultra-high risk (UHR) subjects and 69 health controls (HC). Then we analyzed the differences in gut microbiota and choline concentrations in the anterior cingulate cortex (ACC).
Results:
Presences of the orders Clostridiales, Lactobacillales and Bacteroidales were observed at increase levels in fecal samples of UHR subjects compared to the other two groups. The composition changes of gut microbiota indicate the increased production of Short Chain Fatty Acids (SCFAs), which could activate microglia and then disrupt membrane metabolism. Furthermore, this was confirmed by an increase of choline levels, a brain imaging marker of membrane dysfunction, which is also significantly elevated in UHR subjects compared to the HR and HC groups.
Conclusion:
Both gut microbiome and imaging studies of UHR subjects suggest the membrane dysfunction in the brain and hence might support the membrane hypothesis of schizophrenia.
Knowledge about vegetation dynamics during the last glacial and deglacial periods in southeastern North America is under-constrained owing to low site density and problematic chronologies. New pollen records from two classic sites, Anderson Pond, TN, and Jackson Pond, KY, supported by AMS 14C age models, span 25.2–13.7 ka and 31.0–15.4 ka, respectively. A transition from Pinus dominance to Picea dominance is recorded at Jackson Pond ca. 26.2 ka, ~ coincident with Heinrich Event H2. Anderson and Jackson Ponds record a transition from conifer to deciduous-tree dominance ~ 15.9 and 15.4 ka, respectively, marking the development of no-analog vegetation characterized by moderate to high abundances of Picea, Quercus, Carya, Ulmus, Fraxinus, Ostrya/Carpinus, Cyperaceae, and Poaceae, and preceding by ~ 2000 yr the advent of similar no-analog vegetation in glaciated terrain to the north. No-analog vegetation developed as a time-transgressive, south-to-north pattern, mediated by climatic warming. Sporormiella abundances are consistently low throughout the Jackson and Anderson Pond records, suggesting that megafaunal abundances and effects on vegetation varied regionally or possibly that the Sporormiella signal was not well-expressed at these sites. Additional records with well-constrained chronologies are necessary to assess patterns and mechanisms of vegetation dynamics during the last glacial and deglacial periods.
In 1992, an American-Chinese expedition successfully recovered three ice cores (308.6, 93.2 and 34.5m) from the Guliya ice cap (summit 6710 m a.s.l) in the far western Kunlun on the Qinghai–Tibetan Plateau, China. Guliya resembles a “polar” icecap with 10 m, 200 m and basal temperatures of –15.6°, –5.9° and –2.1°C, respectively. The 308.6 m core to bedrock is the longest ice core retrieved from an elevation greater than 4000 m a.s.l. and provides the first ice-core history from the western side of the Qinghai Plateau. The Plateau experiences a pronounced annual precipitation cycle during which 70–80% of annual total precipitation falls in the summer monsoon season. This leads to a marked visible stratigraphy in the glaciers which allows accurate dating of the ice cores and reconstruction of the net mass accumulation.
This paper presents (1) the results of the geophysical program to determine ice thickness, ice flow and surface topography, (2) an assessment of net accumulation from stake measurements, snow pits and shallow core samples, and (3) the analyses of the upper 100 m of the 308.6 m core which provide a 1000 year history, including the ‘“Little Ice Age”, which is compared with Chinese historical records. Extended periods of positive accumulation on Guliya are closely contemporaneous with dry periods in eastern China. A trans-Pacific teleconnection is suggested by the strong temporal coherence between extended wet and dry phases on Guliya and on the Quelccaya ice cap, Peru.
The first ice-core record of both the Holocene and Wisconsin/Würm Late Glacial Stage (LGS) from the subtropics has been extracted from three ice cores to bedrock from the Dunde ice cap on the north-central Qinghai-Tibetan Plateau. Ice thicknesses at the ice-cap summit average 138 m, the bedrock surface is relatively flat, surface and basal temperatures are −7.3 and −4.7°C, respectively and the ice cap exhibits radial flow away from the summit dome. These records reveal a major change in the climate of the plateau ∼10 000 years ago and suggest that LGS conditions were colder, wetter and dustier than Holocene conditions. This is inferred from the more negative δ18O ratios, increased dust content, decreased soluble aerosol concentrations, and reduced ice-crystal sizes, which characterize the LGS part of the cores. Total β radioactivity from shallow ice cores indicates that over the last 24 years the average accumulation rate has been ∼400 mm a−1 at the summit. The ice cores have been dated using a combination of annual layers in the insoluble dust and δ18O in the upper sections of core, visible dust layers which are annual, and ice-flow modeling. The oxygen-isotope record which serves as a temperature proxy indicates that the last 60 years have been the warmest in the entire record.
We thank Liu Jun for his comment on our recent paper (Wang et al. 2014) and are grateful for his calling our attention to this apparent contradiction, and we welcome the opportunity to reply. Based on the sensitive high-resolution ion microscope (SHRIMP) U–Pb zircon age for a volcanic tuff bed within the upper part of the Guanling Formation, we suggested in our study that the age of the fossil horizon of the Panxian fauna is 244 ± 1.3 Ma, which is 14 Ma earlier than the previously estimated age that Li, Rieppel & LaBarbera (2004) published in Science. However, Liu Jun argued that this conclusion is confused, that there is no 14 Ma difference and that there is agreement between the biostratigraphic data and the new radiometric age.
Following recent molecular phylogenetic studies in Old World Gesneriaceae the nomenclatural implications for names in Henckelia are examined. New combinations are made in Codonoboea and Loxocarpus to account for species now excluded from Henckelia. A list is presented in which the current position of all species hitherto assigned to Henckelia is given, including the new combination Henckelia rotundata (Barnett) D.J.Middleton & Mich.Möller. A new combination in Oreocharis is made.
A suspected dengue fever outbreak occurred in 2010 at a solitary construction site in Shenzhen city, China. To investigate this epidemic, we used serological, molecular biological, and bioinformatics techniques. Of nine serum samples from suspected patients, we detected seven positive for dengue virus (DENV) antibodies, eight for DENV-1 RNA, and three containing live viruses. The isolated virus, SZ1029 strain, was sequenced and confirmed as DENV-1, showing the highest E-gene homology to D1/Malaysia/36000/05 and SG(EHI)DED142808 strains recently reported in Southeast Asia. Further phylogenetic tree analysis confirmed their close relationship. At the epidemic site, we also detected 14 asymptomatic co-workers (out of 291) positive for DENV antibody, and DENV-1-positive mosquitoes. Thus, we concluded that DENV-1 caused the first local dengue fever outbreak in Shenzhen. Because no imported case was identified, the molecular fingerprints of the SZ1029 strain suggest this outbreak may be due to vertical transmission imported from Southeast Asia.