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Experiments were performed that (i) document the effect of the steady spanwise buffer layer blowing on the mean characteristics of the turbulent boundary layer for a range of momentum thickness Reynolds numbers from 4760 to 10 386, and (ii) document the effect of the buffer layer blowing on the unsteady characteristics and coherent vorticity in a boundary layer designed to provide sufficiently high spatial resolution. The spanwise buffer layer blowing of the order of $u_{\tau }$ is produced by a surface array of pulsating direct current (pulsed-DC) plasma actuators. This was found to substantially reduce the wall shear stress that was directly measured with a floating element coupled with a force sensor. The direct wall shear measurements agreed with values derived using the Clauser method to within $\pm 0.85$ %. The degree to which the buffer layer blowing affected $\tau _w$ was found to primarily depend on the inner variable spanwise spacing between the pulsed-DC actuator electrodes, i.e. ‘blowing sites’. Utilizing pairs of $[u,v]$ and $[u,w]$ hot-wire sensors, the latter experiments correlated significant reductions in the $\omega _y$ and $\omega _x$ vorticity components that resulted from the buffer layer blowing and translated into lower Reynolds stresses and turbulence production. The time scale to which these observed changes in the boundary layer characteristics would return to the baseline condition was subsequently documented. This revealed a recovery length of $x^+ \approx 86\,000$ that translated to a streamwise fetch of $x \approx 66\delta$. Finally, a comparison with the recent work by Cheng et al. (2021, J. Fluid Mech. vol. 918, A24) and Wei & Zhou (2024 in TSFP13, June 25–28, 2024) that followed our experimental approach to achieve comparable wall shear stress (drag) reductions has led to a new scaling based on the baseline boundary layer $\textit{Re}_{\tau }$ and buffer layer blowing velocity.
Attention-deficit hyperactivity disorder (ADHD) is one of the most common mental disorders in adolescents, and a full syndrome diagnosis requires a combination of persistent symptoms. In a multicentre cross-sectional study from Italy using a non-clinical sample from a secondary school comprising 440 adolescents, published in this issue of BJPsych Open, Gostoli et al examined whether unhealthy lifestyle habits are linked to both clinical manifestation of ADHD and subclinical symptomatology. In line with the literature, the authors demonstrate an association between clinical ADHD diagnosis, unhealthy lifestyle behaviours and psychosocial impairments. Modifiable, adverse lifestyle behaviours are also prevalent in subclinical ADHD manifestations. This observation may be important for child and adolescent psychiatry when considering targeted health promotion approaches that delay or prevent progression from subclinical to clinical ADHD. In this article, we discuss from a clinical perspective the putative relevance of addressing subclinical ADHD symptoms in the context of the existing literature.
Psychiatry and clinical psychology are closely related disciplines, and both overlap and affect each other. However, psychiatry is also substantially influenced by more basic psychological theories. Learning theories starting with behavioral concepts have been used for understanding and treating anxiety and addiction, for example. Cognitive theory has had a major impact on treatments for depression and psychosis. Therefore, in this chapter, we will present five psychological theories (psychoanalysis, behaviorism, cognitive theory, social learning, and mindfulness-based concepts) that we regard as historically most influential and useful for psychiatry. In addition, the stress-vulnerability model and the humanistic psychology approach will be outlined. The former provides a general etiological model of almost all psychiatric disorders, whereas the humanistic ideas help conceptualize and establish therapeutic stance and a good client–provider relationship.
The hippocampal formation represents a key region in the pathophysiology of schizophrenia. Aerobic exercise poses a promising add-on treatment to potentially counteract structural impairments of the hippocampal formation and associated symptomatic burden. However, current evidence regarding exercise effects on the hippocampal formation in schizophrenia is largely heterogeneous. Therefore, we conducted a systematic review and meta-analysis to assess the impact of aerobic exercise on total hippocampal formation volume. Additionally, we used data from a recent multicenter randomized-controlled trial to examine the effects of aerobic exercise on hippocampal formation subfield volumes and their respective clinical implications.
Methods
The meta-analysis comprised six studies that investigated the influence of aerobic exercise on total hippocampal formation volume compared to a control condition with a total of 186 people with schizophrenia (100 male, 86 female), while original data from 29 patients (20 male, 9 female) was considered to explore effects of six months of aerobic exercise on hippocampal formation subfield volumes.
Results
Our meta-analysis did not demonstrate a significant effect of aerobic exercise on total hippocampal formation volume in people with schizophrenia (g = 0.33 [−0.12 to 0.77]), p = 0.15), but our original data suggested significant volume increases in certain hippocampal subfields, namely the cornu ammonis and dentate gyrus.
Conclusions
Driven by the necessity of better understanding the pathophysiology of schizophrenia, the present work underlines the importance to focus on hippocampal formation subfields and to characterize subgroups of patients that show neuroplastic responses to aerobic exercise accompanied by corresponding clinical improvements.
Edited by
Allan Young, Institute of Psychiatry, King's College London,Marsal Sanches, Baylor College of Medicine, Texas,Jair C. Soares, McGovern Medical School, The University of Texas,Mario Juruena, King's College London
Bipolar disorders (BD) are recurrent conditions and many clinical and social impairments persist even with optimal pharmacotherapy. This chapter explores the development of psychological treatments, from initial uncertainties about offering therapies for BD, and then following the tentative steps to offer support to individuals with BD and to their families. Much of the focus is on the rationale, evolution and testing of specific psychological treatments. As well as examining any added value attained from providing psychological treatments alongside medications, we also consider how therapies might be further developed in the future. For example, we discuss how network meta-analysis might shed light on active ingredients that are common to all successful therapies and consider if these components might herald the introduction of multi-modal interventions. The chapter ends by noting the progress being made regarding the mediators and moderators of therapeutic effects and highlighting the importance of continuing to undertake efficacy trials but also comparative effectiveness trials that will enable researchers, clinicians and patients to determine how best to deploy psychological treatments in the real world.
Edited by
Allan Young, Institute of Psychiatry, King's College London,Marsal Sanches, Baylor College of Medicine, Texas,Jair C. Soares, McGovern Medical School, The University of Texas,Mario Juruena, King's College London
Accurate diagnoses are crucial in choosing the most appropriate evidence-based treatment for mood disorders. Structured clinical interviews are the gold standard to assess unipolar (UD) and bipolar disorders (BD); however, they require time, financial, and training resources that are often unavailable. As this is especially true outside of specialty clinics or tertiary care settings, self-ratings can be used for screening to facilitate the diagnostic process. Such tools have both strengths and weaknesses, but it is essential that a detailed clinical assessment still follows before providing a valid diagnosis for mood disorders. In this chapter, we review several screening tools for UD and BD that have substantial empirical support and/or are widely used. We list measures that have been used for other types of screening, for example, to assess severity of symptoms or focus on specific populations. Gaps, recent developments, such as digital approaches, and final conclusions for clinical practice are also discussed.
There is limited data on the organisation of paediatric echocardiography laboratories in Europe.
Methods:
A structured and approved questionnaire was circulated across all 95 Association for European Paediatric and Congenital Cardiology affiliated centres. The aims were to evaluate: (1) facilities in paediatric echocardiography laboratories across Europe, (2) accredited laboratories, (3) medical/paramedical staff employed, (4) time for echocardiographic studies and reporting, and (5) training, teaching, quality improvement, and research programs.
Results:
Respondents from forty-three centres (45%) in 22 countries completed the survey. Thirty-six centres (84%) have a dedicated paediatric echocardiography laboratory, only five (12%) of which reported they were European Association of Cardiovascular Imaging accredited. The median number of echocardiography rooms was three (range 1–12), and echocardiography machines was four (range 1–12). Only half of all the centres have dedicated imaging physiologists and/or nursing staff, while the majority (79%) have specialist imaging cardiologist(s). The median (range) duration of time for a new examination was 45 (20–60) minutes, and for repeat examination was 20 (5–30) minutes. More than half of respondents (58%) have dedicated time for reporting. An organised training program was present in most centres (78%), 44% undertake quality assurance, and 79% perform research. Guidelines for performing echocardiography were available in 32 centres (74%).
Conclusion:
Facilities, staffing levels, study times, standards in teaching/training, and quality assurance vary widely across paediatric echocardiography laboratories in Europe. Greater support and investment to facilitate improvements in staffing levels, equipment, and governance would potentially improve European paediatric echocardiography laboratories.
To reduce sleep problems in people living with dementia using a multi-component intervention.
Design:
Cluster-randomized controlled study with two parallel groups and a follow-up of 16 weeks.
Setting:
Using external concealed randomization, 24 nursing homes (NH) were allocated either to the intervention group (IG, 12 clusters, 126 participants) or the control group (12 clusters, 116 participants).
Participants:
Participants were eligible if they had dementia or severe cognitive impairment, at least two sleep problems, and residence of at least two weeks in a NH.
Intervention:
The 16-week intervention consists of six components: (1) assessment of sleep-promoting activities and environmental factors in NHs, (2) implementation of two “sleep nurses,” (3) basic education, (4) advanced education for staff, (5) workshops to develop sleep-promoting concepts, and (6) written information and education materials. The control group (CG) received standard care.
Measurements:
Primary outcome was ≥ two sleep problems after 16 weeks assessed with the Sleep Disorders Inventory (SDI).
Results:
Twenty-two clusters (IG = 10, CG = 12) with 191 participants completed the study. At baseline, 90% of people living with dementia in the IG and 93% in the CG had at least two sleep problems. After 16 weeks, rates were 59.3% (IG) vs 83.8% (CG), respectively, a difference of −24.5% (95% CI, −46.3% – −2.7%; cluster-adjusted odds ratio 0.281; 95% CI 0.087–0.909). Secondary outcomes showed a significant difference only for SDI scores after eight and 16 weeks.
Conclusions:
The MoNoPol-Sleep intervention reduced sleep problems of people living with dementia in NH compared to standard care.
Stable water isotope records of six firn cores retrieved from two adjacent plateaus on the northern Antarctic Peninsula between 2014 and 2016 are presented and investigated for their connections with firn-core glacio-chemical data, meteorological records and modelling results. Average annual accumulation rates of 2500 kg m−2 a−1 largely reduce the modification of isotopic signals in the snowpack by post-depositional processes, allowing excellent signal preservation in space and time. Comparison of firn-core and ECHAM6-wiso modelled δ18O and d-excess records reveals a large agreement on annual and sub-annual scales, suggesting firn-core stable water isotopes to be representative of specific synoptic situations. The six firn cores exhibit highly similar isotopic patterns in the overlapping period (2013), which seem to be related to temporal changes in moisture sources rather than local near-surface air temperatures. Backward trajectories calculated with the HYSPLIT model suggest that prominent δ18O minima in 2013 associated with elevated sea salt concentrations are related to long-range moisture transport dominated by westerly winds during positive SAM phases. In contrast, a broad δ18O maximum in the same year accompanied by increased concentrations of black carbon and mineral dust corresponds to the advection of more locally derived moisture with northerly flow components (South America) when the SAM is negative.
Political debates are structured by underlying conflict dimensions, such as left-right and economic and cultural ideology, which form the basis for voter choice and party competition. However, we know little about how voters arrive at perceptions of parties' positions on these dimensions. We examine how the emphasis parties place on the different issues that make up a higher-level ideological dimension affects perceptions of their position on that dimension. Using two population-based survey experiments, we present respondents with either short or long statements that communicate the same issue stances. We then test whether the length of statements affects positional perceptions on the higher-level dimension. The empirical results show support for our hypotheses and imply that political parties – and the context in which they compete – can affect their perceived position even if underlying issue stances remain stable.
In this work, we focus on a multi-hole pressure-probe-based flow measurement system for wind tunnel measurements that provides real-time feedback to a robot probe-manipulator, rendering the system autonomous. The system relies on a novel, computationally efficient flow analysis technique that translates the probe's point measurements of velocity and pressure into an updatable mean flow map that is accompanied by an uncertainty metric. The latter provides guidance to the manipulator when planning the optimal probe path. The probe is then guided by the robot in the flow domain until an available time budget has been exhausted, or until the uncertainty metric falls below a prescribed target threshold in the entire flow domain. We assess the capabilities of our new measurement system using computational fluid dynamics data, for which the ground truth is available in the form of a mean flow field. An application in a real wind tunnel setting is provided as well.
Reward processing has been proposed to underpin the atypical social feature of autism spectrum disorder (ASD). However, previous neuroimaging studies have yielded inconsistent results regarding the specificity of atypicalities for social reward processing in ASD.
Aims
Utilising a large sample, we aimed to assess reward processing in response to reward type (social, monetary) and reward phase (anticipation, delivery) in ASD.
Method
Functional magnetic resonance imaging during social and monetary reward anticipation and delivery was performed in 212 individuals with ASD (7.6–30.6 years of age) and 181 typically developing participants (7.6–30.8 years of age).
Results
Across social and monetary reward anticipation, whole-brain analyses showed hypoactivation of the right ventral striatum in participants with ASD compared with typically developing participants. Further, region of interest analysis across both reward types yielded ASD-related hypoactivation in both the left and right ventral striatum. Across delivery of social and monetary reward, hyperactivation of the ventral striatum in individuals with ASD did not survive correction for multiple comparisons. Dimensional analyses of autism and attention-deficit hyperactivity disorder (ADHD) scores were not significant. In categorical analyses, post hoc comparisons showed that ASD effects were most pronounced in participants with ASD without co-occurring ADHD.
Conclusions
Our results do not support current theories linking atypical social interaction in ASD to specific alterations in social reward processing. Instead, they point towards a generalised hypoactivity of ventral striatum in ASD during anticipation of both social and monetary rewards. We suggest this indicates attenuated reward seeking in ASD independent of social content and that elevated ADHD symptoms may attenuate altered reward seeking in ASD.
Hyperbolic random graphs (HRGs) and geometric inhomogeneous random graphs (GIRGs) are two similar generative network models that were designed to resemble complex real-world networks. In particular, they have a power-law degree distribution with controllable exponent $\beta$ and high clustering that can be controlled via the temperature $T$.
We present the first implementation of an efficient GIRG generator running in expected linear time. Besides varying temperatures, it also supports underlying geometries of higher dimensions. It is capable of generating graphs with ten million edges in under a second on commodity hardware. The algorithm can be adapted to HRGs. Our resulting implementation is the fastest sequential HRG generator, despite the fact that we support non-zero temperatures. Though non-zero temperatures are crucial for many applications, most existing generators are restricted to $T = 0$. We also support parallelization, although this is not the focus of this paper. Moreover, we note that our generators draw from the correct probability distribution, that is, they involve no approximation.
Besides the generators themselves, we also provide an efficient algorithm to determine the non-trivial dependency between the average degree of the resulting graph and the input parameters of the GIRG model. This makes it possible to specify the desired expected average degree as input.
Moreover, we investigate the differences between HRGs and GIRGs, shedding new light on the nature of the relation between the two models. Although HRGs represent, in a certain sense, a special case of the GIRG model, we find that a straightforward inclusion does not hold in practice. However, the difference is negligible for most use cases.
We present a fast and accurate data-driven surrogate model for divertor plasma detachment prediction leveraging the latent feature space concept in machine learning research. Our approach involves constructing and training two neural networks: an autoencoder that finds a proper latent space representation (LSR) of plasma state by compressing the multi-modal diagnostic measurements and a forward model using multi-layer perception (MLP) that projects a set of plasma control parameters to its corresponding LSR. By combining the forward model and the decoder network from autoencoder, this new data-driven surrogate model is able to predict a consistent set of diagnostic measurements based on a few plasma control parameters. In order to ensure that the crucial detachment physics is correctly captured, highly efficient 1D UEDGE model is used to generate training and validation data in this study. The benchmark between the data-driven surrogate model and UEDGE simulations shows that our surrogate model is capable of providing accurate detachment prediction (usually within a few per cent relative error margin) but with at least four orders of magnitude speed-up, indicating that performance-wise, it has the potential to facilitate integrated tokamak design and plasma control. Comparing with the widely used two-point model and/or two-point model formatting, the new data-driven model features additional detachment front prediction and can be easily extended to incorporate richer physics. This study demonstrates that the complicated divertor and scrape-off-layer plasma state has a low-dimensional representation in latent space. Understanding plasma dynamics in latent space and utilising this knowledge could open a new path for plasma control in magnetic fusion energy research.
This article is a clinical guide which discusses the “state-of-the-art” usage of the classic monoamine oxidase inhibitor (MAOI) antidepressants (phenelzine, tranylcypromine, and isocarboxazid) in modern psychiatric practice. The guide is for all clinicians, including those who may not be experienced MAOI prescribers. It discusses indications, drug-drug interactions, side-effect management, and the safety of various augmentation strategies. There is a clear and broad consensus (more than 70 international expert endorsers), based on 6 decades of experience, for the recommendations herein exposited. They are based on empirical evidence and expert opinion—this guide is presented as a new specialist-consensus standard. The guide provides practical clinical advice, and is the basis for the rational use of these drugs, particularly because it improves and updates knowledge, and corrects the various misconceptions that have hitherto been prominent in the literature, partly due to insufficient knowledge of pharmacology. The guide suggests that MAOIs should always be considered in cases of treatment-resistant depression (including those melancholic in nature), and prior to electroconvulsive therapy—while taking into account of patient preference. In selected cases, they may be considered earlier in the treatment algorithm than has previously been customary, and should not be regarded as drugs of last resort; they may prove decisively effective when many other treatments have failed. The guide clarifies key points on the concomitant use of incorrectly proscribed drugs such as methylphenidate and some tricyclic antidepressants. It also illustrates the straightforward “bridging” methods that may be used to transition simply and safely from other antidepressants to MAOIs.
Clinically significant weight gain (CSWG) is associated with increased morbidity and mortality. This study describes CSWG and comorbidities observed in patients with bipolar I disorder (BD-I) and schizophrenia (SZ) after initiating select second-generation antipsychotics (SGAs).
Methods
Percent change in weight, CSWG (=7% weight increase), and incident comorbidities within 12 months of treatment were assessed among patients initiating oral SGAs of moderate-to-high weight gain risk using medical records/claims (OM1 Real-World Data Cloud; January 2013-February 2020). Oral SGAs included clozapine (SZ), iloperidone (SZ), paliperidone (SZ), olanzapine, olanzapine/fluoxetine (BD-I), quetiapine, and risperidone. Outcomes were stratified by baseline body mass index and reported descriptively.
Results
Among patients with BD-I (N = 9142) and SZ (N = 8174), approximately three-quarters were overweight/obese at baseline. During treatment (mean duration = 30 weeks), average percent weight increase was 3.7% (BD-I) and 3.3% (SZ). Average percent weight increase was highest for underweight/normal weight patients (BD-I = 5.5%; SZ = 4.8%), followed by overweight (BD-I = 3.8%; SZ = 3.4%) and obese patients (BD-I = 2.7%; SZ = 2.3%). Within 3 months of treatment, 12% of all patients experienced CSWG. A total of 11.3% (BD-I) and 14.7% (SZ) of patients developed coronary artery disease, hypertension, dyslipidemia, or type 2 diabetes within 12 months of treatment; development of comorbidities was highest among overweight/obese patients and those with CSWG.
Conclusions
Patients who were underweight/normal weight at baseline had the greatest percent change in weight during treatment. Increased comorbidities were observed within 12 months of treatment, specifically among overweight/obese patients and those with CSWG. The magnitude of weight gain and development of comorbidities were similar for patients with BD-I and SZ.
Disruptive behavior disorders (DBD) are heterogeneous at the clinical and the biological level. Therefore, the aims were to dissect the heterogeneous neurodevelopmental deviations of the affective brain circuitry and provide an integration of these differences across modalities.
Methods
We combined two novel approaches. First, normative modeling to map deviations from the typical age-related pattern at the level of the individual of (i) activity during emotion matching and (ii) of anatomical images derived from DBD cases (n = 77) and controls (n = 52) aged 8–18 years from the EU-funded Aggressotype and MATRICS consortia. Second, linked independent component analysis to integrate subject-specific deviations from both modalities.
Results
While cases exhibited on average a higher activity than would be expected for their age during face processing in regions such as the amygdala when compared to controls these positive deviations were widespread at the individual level. A multimodal integration of all functional and anatomical deviations explained 23% of the variance in the clinical DBD phenotype. Most notably, the top marker, encompassing the default mode network (DMN) and subcortical regions such as the amygdala and the striatum, was related to aggression across the whole sample.
Conclusions
Overall increased age-related deviations in the amygdala in DBD suggest a maturational delay, which has to be further validated in future studies. Further, the integration of individual deviation patterns from multiple imaging modalities allowed to dissect some of the heterogeneity of DBD and identified the DMN, the striatum and the amygdala as neural signatures that were associated with aggression.
OBJECTIVES/GOALS: The Fulkerson Home Food Inventory (HFI) is widely used to assess the home food environment, a key target of behavioral weight loss trials. However, no standardized report is available. We created publicly available procedures to automate and standardize HFI reporting, yielding a personalized report to enhance this measures clinical utility. METHODS/STUDY POPULATION: Parents in the TEENS adolescent behavioral weight loss trial complete the HFI at 0-, 2-, 4-, 8-, and 12m and receive personalized reports at each timepoint. In REDCap, participants identify foods available in their home. HFI syntax is applied to calculate the obesogenic home food availability score. Categories of foods found are identified, with specific guidance provided to enhance their home food environment. Prior to automation, procedures were time intensive and error prone. To address this, HFI data are exported into Excel by a PowerShell (v7.2) command-line script using Python (v3.10) with the REDCap API. Results are calculated with F# (v6.0) using Microsoft Excel Interop API and inserted into a report template with F# using the Microsoft Publisher Interop API. This process is repeated at each timepoint. RESULTS/ANTICIPATED RESULTS: The new automated procedures significantly reduce time to generate reports and enhance accuracy. Procedures yield a 2-page individualized report that includes the obesogenic home food environment score and identifies categories of healthy items found (e.g., fruits, vegetables, whole grains) as well as areas of improvement (e.g., high-fat dairy products, processed meats). Specific items found in each category are identified. The report identifies food found in the home (e.g., chicken nuggets) with suggested healthier substitutions (e.g., lean chicken breast). This syntax and commands will be made publicly available for use in the scientific and clinical community. DISCUSSION/SIGNIFICANCE: These publicly available procedures optimize, automate, and standardize reporting for the HFI. Procedures improve efficiency within large-scale clinical trials and yield a personalized report to enhance the clinical utility of this measure and empower participants to make informed decisions about their health behaviors.
The success and longevity of coalition governments depends on the ability to keep conflicts between coalition members at bay. The risk of such conflicts is often assessed by drawing on proxy measures, such as the ideological heterogeneity among government parties. This article presents a new approach to measuring the atmosphere between government parties. The ‘coalition mood’ is a time-varying measure that draws on applause patterns between coalition partners during legislative debates. The article exemplifies the measurement approach based on automated analyses of over 105,000 plenary debates in Germany and Austria. The article then assesses the measure's face, concurrent and predictive validity. It finds the measure well aligned with qualitative evidence, shows that the coalition mood is correlated with poll ratings of the government parties and helps to predict the duration of legislative processes. The conclusion highlights future applications of the coalition mood for research on coalition politics and public policy.