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Evidence on the long-term comparative effectiveness of posttraumatic stress disorder (PTSD) psychotherapies in adults remains unknown. Therefore, we performed an extensive network meta-analysis of randomised controlled trials (RCTs) to determine the comparative effectiveness of psychotherapies for people diagnosed with PTSD.
Methods
A comprehensive search was conducted in Cochrane library, Embase, Medline-OVID, PubMed, Scopus, and Psych-Info until March 2021. Studies on the effectiveness of cognitive processing therapy (CPT), cognitive therapy (CT), eye movement desensitisation reprocessing (EMDR), narrative exposure therapy (NET), prolonged exposure (PE), cognitive behavioural therapy (CBT), present-centred therapy (PCT), brief eclectic psychotherapies (BEP), psychodynamic therapy (PDT) or combination therapies compared to no treatment (NT) or treatment as usual (TAU) in adults with PTSD were included. Frequentist and Bayesian approaches were used for analysis in R-software.
Results
We included 98 RCTs with 5567 participants from 18 897 studies. CPT, EMDR, CT, NET, PE, CBT, and PCT were significant to reduce PTSD symptoms (SMD range: −1.53 to −0.75; Certainty: very low to high) at immediate post-treatment and ranked accordingly. Longitudinal analysis found EMDR (1.02) and CPT (0.85) as the significant therapies with large effect size in short-term and long-term follow-up, respectively. NET and CPT showed higher proportion of loss of PTSD diagnosis (RR range: 5.51–3.45) while there were no significant psychotherapies for retention rate compared to NT.
Conclusions:
Our findings provide evidence for improving current guidelines and informing clinical decision-making for PTSD management. However, the best PTSD treatment plan should be tailored to patients' needs, characteristics, and clinician expertise.
Gravitational waves from coalescing neutron stars encode information about nuclear matter at extreme densities, inaccessible by laboratory experiments. The late inspiral is influenced by the presence of tides, which depend on the neutron star equation of state. Neutron star mergers are expected to often produce rapidly rotating remnant neutron stars that emit gravitational waves. These will provide clues to the extremely hot post-merger environment. This signature of nuclear matter in gravitational waves contains most information in the 2–4 kHz frequency band, which is outside of the most sensitive band of current detectors. We present the design concept and science case for a Neutron Star Extreme Matter Observatory (NEMO): a gravitational-wave interferometer optimised to study nuclear physics with merging neutron stars. The concept uses high-circulating laser power, quantum squeezing, and a detector topology specifically designed to achieve the high-frequency sensitivity necessary to probe nuclear matter using gravitational waves. Above 1 kHz, the proposed strain sensitivity is comparable to full third-generation detectors at a fraction of the cost. Such sensitivity changes expected event rates for detection of post-merger remnants from approximately one per few decades with two A+ detectors to a few per year and potentially allow for the first gravitational-wave observations of supernovae, isolated neutron stars, and other exotica.
Abnormal effort-based decision-making represents a potential mechanism underlying motivational deficits (amotivation) in psychotic disorders. Previous research identified effort allocation impairment in chronic schizophrenia and focused mostly on physical effort modality. No study has investigated cognitive effort allocation in first-episode psychosis (FEP).
Method
Cognitive effort allocation was examined in 40 FEP patients and 44 demographically-matched healthy controls, using Cognitive Effort-Discounting (COGED) paradigm which quantified participants’ willingness to expend cognitive effort in terms of explicit, continuous discounting of monetary rewards based on parametrically-varied cognitive demands (levels N of N-back task). Relationship between reward-discounting and amotivation was investigated. Group differences in reward-magnitude and effort-cost sensitivity, and differential associations of these sensitivity indices with amotivation were explored.
Results
Patients displayed significantly greater reward-discounting than controls. In particular, such discounting was most pronounced in patients with high levels of amotivation even when N-back performance and reward base amount were taken into consideration. Moreover, patients exhibited reduced reward-benefit sensitivity and effort-cost sensitivity relative to controls, and that decreased sensitivity to reward-benefit but not effort-cost was correlated with diminished motivation. Reward-discounting and sensitivity indices were generally unrelated to other symptom dimensions, antipsychotic dose and cognitive deficits.
Conclusion
This study provides the first evidence of cognitive effort-based decision-making impairment in FEP, and indicates that decreased effort expenditure is associated with amotivation. Our findings further suggest that abnormal effort allocation and amotivation might primarily be related to blunted reward valuation. Prospective research is required to clarify the utility of effort-based measures in predicting amotivation and functional outcome in FEP.
Better understanding of interplay among symptoms, cognition and functioning in first-episode psychosis (FEP) is crucial to promoting functional recovery. Network analysis is a promising data-driven approach to elucidating complex interactions among psychopathological variables in psychosis, but has not been applied in FEP.
Method
This study employed network analysis to examine inter-relationships among a wide array of variables encompassing psychopathology, premorbid and onset characteristics, cognition, subjective quality-of-life and psychosocial functioning in 323 adult FEP patients in Hong Kong. Graphical Least Absolute Shrinkage and Selection Operator (LASSO) combined with extended Bayesian information criterion (BIC) model selection was used for network construction. Importance of individual nodes in a generated network was quantified by centrality analyses.
Results
Our results showed that amotivation played the most central role and had the strongest associations with other variables in the network, as indexed by node strength. Amotivation and diminished expression displayed differential relationships with other nodes, supporting the validity of two-factor negative symptom structure. Psychosocial functioning was most strongly connected with amotivation and was weakly linked to several other variables. Within cognitive domain, digit span demonstrated the highest centrality and was connected with most of the other cognitive variables. Exploratory analysis revealed no significant gender differences in network structure and global strength.
Conclusion
Our results suggest the pivotal role of amotivation in psychopathology network of FEP and indicate its critical association with psychosocial functioning. Further research is required to verify the clinical significance of diminished motivation on functional outcome in the early course of psychotic illness.
Cognitive impairment is a core feature of schizophrenia and has been observed in both familial (FHR) and clinical high-risk (CHR) samples. Nonetheless, there is a paucity of research directly contrasting cognitive profiles in these two high-risk states and first-episode schizophrenia. This study aimed to compare cognitive functions in patients with first-episode schizophrenia-spectrum disorder (FES), their unaffected siblings (FHR), CHR individuals and healthy controls.
Method
A standardized battery of cognitive assessments was administered to 69 FES patients, 71 help-seeking CHR individuals without family history of psychotic disorder, 50 FHR participants and 68 controls. FES and CHR participants were recruited from territory-wide early intervention service for psychosis in Hong Kong. CHR status was ascertained using Comprehensive Assessment of At-Risk Mental State.
Results
Among four groups, FES patients displayed the largest global cognitive impairment and had medium-to-large deficits across all cognitive tests relative to controls. CHR and FHR participants significantly underperformed in most cognitive tests than controls. Among various cognitive tests, digit symbol coding demonstrated the greatest magnitude of impairment in FES and CHR groups compared with controls. No significant difference between two high-risk groups was observed in global cognition and all individual cognitive tests except digit symbol coding which showed greater deficits in CHR than in FHR participants.
Conclusion
Clinical and familial risk groups experienced largely comparable cognitive impairment that was intermediate between FES and controls. Digit symbol coding may have the greatest discriminant capacity in distinguishing FES and CHR from healthy controls, and between two high-risk samples.
In Wilson's disease (WD), brain magnetic resonance images (MRI) show increased signal intensity in T2 weighted images in the lenticular nuclei, thalamus and brainstem, including the substantia nigra. A poor therapeutic response to levodopa in WD suggests the mechanism of a postsynaptic abnormality. However positron emission tomography studies show an involvement of the nigrostriatal presynaptic dopaminergic pathway.
Case report:
We report the clinical manifestations in a case of WD with akinetic-rigid syndrome and initial hesitation. The brain MRI showed an increased signal intensity lesion in the substantia nigra region, in addition to basal ganglion and thalamic lesions. However, dopamine transporter (DAT) imaging with 99mTc-TRODAT-1 revealed a nonsignificantly increased DAT uptake, suggesting a normal presynaptic nigrostriatal dopaminergic terminal.
Conclusion:
We suggest that significant heterogeneity can be found in WD patients and a normal presynaptic dopaminergic pathway may occur in some patients, even those with typical akinetic-rigid syndrome and evidence of substantia nigra involvement in the brain on MRI.
Numerical simulations and laboratory experiments were jointly conducted to investigate a bathtub vortex under the influence of a protruding cylinder in a rotating tank. In the set-up, a central drain hole is placed at the bottom of the tank and a top-down cylinder is suspended from the rigid top lid, with fluid supplied from the sidewall for mass conservation. The cylinder is protruded to produce the Taylor column effect. The flow pattern depends on the Rossby number ($\mathit{Ro}= U/ fR$), the Ekman number ($\mathit{Ek}= \nu / f{R}^{2} )$ and the height ratio, $h/ H$, where $R$ is the radius of the cylinder, $f$ is the Coriolis parameter, $\nu $ is the kinematic viscosity of the fluid, $h$ is the vertical length of the cylinder and $H$ is the height of the tank. It is found appropriate to choose $U$ to be the average inflow velocity of fluid entering the column beneath the cylinder. Steady-state solutions obtained by numerically solving the Navier–Stokes equations in the rotating frame are shown to have a good agreement with flow visualizations and particle tracking velocimetry (PTV) measurements. It is known that at $\mathit{Ro}\sim 1{0}^{- 2} $, the central downward flow surrounded by the neighbouring Ekman pumping forms a classic one-celled bathtub vortex structure when there is no protruding cylinder ($h/ H= 0$). The influence of a suspended cylinder ($h/ H\not = 0$) leads to several findings. The bathtub vortex exhibits an interesting two-celled structure with an inner Ekman pumping (EP) and an outer up-drafting motion, termed Taylor upwelling (TU). The two regions of up-drafting motion are separated by a notable finite-thickness structure, identified as a (thin-walled) Taylor column. The thickness ${ \delta }_{T}^{\ast } $ of the Taylor column is found to be well correlated to the height ratio and the Ekman number by ${\delta }_{T} = { \delta }_{T}^{\ast } / R= {(1- h/ H)}^{- 0. 32} {\mathit{Ek}}^{0. 095} $. The Taylor column presents a barrier to the fluid flow such that the fluid from the inlet may only flow into the inner region through the narrow gaps, one above the Taylor column and one beneath it (conveniently called Ekman gaps). As a result, five types of routes along which the fluid may flow to and exit at the drain hole could be identified for the multi-celled vortex structure. Moreover, the flow rates associated with the five routes were calculated and compared to help understand the relative importance of the component flow structures. The weaker influence of the Taylor column effect on the bathtub vortex at $\mathit{Ro}\sim 1$ or even higher $\mathit{Ro}\sim 1{0}^{2} $ is also discussed.
From the Surface Velocity Program (SVP) drifter current data, a detailed and complete track of strong ocean currents in the north-western Pacific is provided using the bin average method. The focus of this study is on the Kuroshio, the strong western boundary current of the North Pacific flowing northward along the east coast of Taiwan and then turning eastward off southern Japan. With its average flow speed of about 2 knots, the Kuroshio can significantly increase the ship's speed for a “super-slow-steaming” container ship travelling at speeds of 12 knots between the ports of Southeast Asia and Japan. By properly utilizing knowledge of strong ocean currents to follow the Kuroshio on the northbound runs and avoid it on the return trip, considerable fuel can be saved and the transit time can be reduced. In the future, the detailed Kuroshio saving-energy route could be built into electronic chart systems for all navigators and shipping routers.
Fluorescent nanodiamonds (FNDs) with a size in the range of 10 – 100 nm have been produced by ion irradiation and annealing, and isolated by differential centrifugation. Single particle spectroscopic characterization with confocal fluorescence microscopy and fluorescence correlation spectroscopy indicates that they are photostable and useful as an alternative to far-red fluorescent proteins for bioimaging applications. We demonstrate the application by performing in vivo imaging of bare and bioconjugated FND particles (100 nm in diameter) in C. elegans and zebrafishes and exploring the interactions between this novel nanomaterial and the model organisms. Our results indicate that FNDs can be delivered to the embryos of both organisms by microinjection and eventually into the hatched larvae in the next generation. No deleterious effects have been observed for the carbon-based nanoparticles in vivo. The high fluorescence brightness, excellent photostability, and nontoxic nature of the nanomaterial have allowed long-term imaging and tracking of embryogenesis in the organisms.
In this study, the theory of micropolar fluids is employed to study the stability problem of flow between two concentric rotating cylinders. The field equations subject to no-slip conditions (non-zero velocity and microrotation velocity components) at the wall surfaces are solved. The analytical solutions of the velocity and microrotation velocity fields as well as the shear stress difference, couple stress and strain rate for basic flow are obtained. The equations with respect to non-axisymmetric disturbances are derived and solved by a direct numerical procedure. It is found that non-zero wall-surface microrotation velocity makes the flow faster and more unstable. Moreover, it tends to reduce the limits of critical non-axisymmetric disturbances. The effect on the stability characteristics can be magnified by increasing the microstructure or couple-stress parameter or the microinertia parameter for the cases of corotating cylinders and a stationary outer cylinder or by decreasing the radius ratio or the microinertia parameter for the case of counterrotating cylinders.
N-polar and Ga-polar GaN grown on c-plane sapphire by a metal-organic chemical vapor deposition (MOCVD) system were used to fabricate platinum deposited Schottky contacts for hydrogen sensing at room temperature. Wurtzite GaN is a polar material. Along the c-axis, there are N-face (N-polar) or Ga-face (Ga-polar) orientations on the GaN surface. The Ohmic contacts were formed by lift-off of e-beam deposited Ti (200 Å)/Al (1000 Å)/Ni (400 Å)/Au (1200 Å). The contacts were annealed at 850°C for 45 s under a flowing N2 ambient. Isolation was achieved with 2000 Å plasma enhanced chemical vapor deposited SiNx formed at 300°C. A 100 Å of Pt was deposited by e-beam evaporation to form Schottky contacts. After exposure to hydrogen, Ga-polar GaN Schottky showed 10% of current change, while the N-polar GaN Schottky contacts became fully Ohmic. The N-polar GaN Schottky diodes showed stronger and faster response to 4% hydrogen than that of Ga-polar GaN Schottky diodes. The abrupt current increase from N-polar GaN Schottky exposure to hydrogen was attributed to the high reactivity of the N-face surface termination. The surface termination dominates the sensitivity and response time of the hydrogen sensors made of GaN Schottky diodes. Current-voltage characteristics and the real-time detection of the sensor for hydrogen were investigated. These results demonstrate that the surface termination is crucial in the performance of hydrogen sensors made of GaN Schottky diodes.
AlGaN/GaN high electron mobility transistors (HEMTs) with a polarized Polyvinylidene difluoride (PVDF) film coated on the gate area exhibited significant changes in channel conductance upon exposure to different ambient pressures. The PVDF thin film was deposited on the gate region with an inkjet plotter. Next, the PDVF film was polarized with an electrode located 2 mm above the PVDF film at a bias voltage of 10 kV and 70 °C. Variations in ambient pressure induced changes in the charge in the polarized PVDF, leading to a change of surface charges on the gate region of the HEMT. Changes in the gate charge were amplified through the modulation of the drain current in the HEMT. By reversing the polarity of the polarized PVDF film, the drain current dependence on the pressure could be reversed. Our results indicate that HEMTs have potential for use as pressure sensors.
There has been significant recent interest in the use of surface-functionalized thin film and nanowire wide bandgap semiconductors, principally GaN, InN, ZnO and SiC, for sensing of gases, heavy metals, UV photons and biological molecules. For the detection of gases such as hydrogen, the semiconductors are typically coated with a catalyst metal such as Pd or Pt to increase the detection sensitivity at room temperature. Functionalizing the surface with oxides, polymers and nitrides is also useful in enhancing the detection sensitivity for gases and ionic solutions. The wide energy bandgap of these materials make them ideal for solar-blind UV detection, which can be of use for detecting fluorescence from biotoxins. The use of enzymes or adsorbed antibody layers on the semiconductor surface leads to highly specific detection of a broad range of antigens of interest in the medical and homeland security fields. We give examples of recent work showing sensitive detection of glucose, lactic acid, prostate cancer and breast cancer markers and the integration of the sensors with wireless data transmission systems to achieve robust, portable sensors.
Antibody-functionalized, Au-gated AlGaN/GaN high electron mobility transistors (HEMTs) were used to detect Perkinsus marinus. The antibody was anchored to the gate area through immobilized thioglycolic acid. The AlGaN/GaN HEMT were grown by a molecular beam epitaxy system (MBE) on sapphire substrates. Infected sea waters were taken from the tanks in which Tridacna crocea infected with P. marinus were living and dead. The AlGaN/GaN HEMT showed a rapid response of drain-source current in less than 5 seconds when the infected sea waters were added to the antibody-immobilized surface. The recyclability of the sensors with wash buffers between measurements was also explored. These results clearly demonstrate the promise of field-deployable electronic biological sensors based on AlGaN/GaN HEMTs for Perkinsus marinus detection.
The purpose of the present study was to evaluate the effects of β-carotene on the cell viability and antioxidant status of hepatocytes from chronically ethanol-fed rats. Rats in the ethanol group were given an ethanol-containing liquid diet that provided 36% of total energy as ethanol, while rats in the control group were fed an isoenergetic diet without ethanol. After 4 weeks, hepatocytes were taken out and cultured for 24 h. Hepatocytes from the rats in the control and ethanol groups were cultured in medium without (HC, HE) or with β-carotene (HC+B, HE+B). The results showed that lactate dehydrogenase leakage was significantly increased in the HE compared with that in the HC group. However, lactate dehydrogenase leakage of the HE+B group was similar to that of the HC group. When compared with the HC group, activities of glutathione peroxidase and catalase in the HE group were significantly decreased by 54 and 31%, respectively. Catalase activity in the HE+B group was significantly increased by 61% compared with that in the HE group. However, activities of glutathione reductase and superoxide dismutase showed no difference among the groups. The level of glutathione in the HC+B and HE+B groups was significantly increased to 155 and 143% compared with those in the HC and HE groups, respectively. The concentration of lipid peroxides showed no difference among the groups. The present results demonstrate that β-carotene improved the cell viability of hepatocytes, and increased catalase activities and glutathione levels in hepatocytes from chronically ethanol-fed rats.
To determine risk factors for hemodialysis catheter-related bloodstream infections (HCRBSIs) and investigate whether use of maximal sterile barrier precautions would prevent HCRBSIs.
Setting:
Tertiary-care medical center hemodialysis unit.
Design:
Open trial with historical comparison and case-control study of risk factors for HCRBSIs.
Methods:
Prospective surveillance was used to compare HCRBSI rates for 1 year before and after implementation of maximal sterile barrier precautions. A case–control study compared 50 case-patients with HCRBSI with 51 randomly selected control-patients.
Results:
The HCRBSI rate was 1.6% per 100 dialysis runs (CI95, 1.1%–2.3%) in the first year and 0.77% (CI95, 0.5%–1.1%) in the second year (P = .0106). The most frequent cause of HCRBSI was MRSA in the first year (15 of 32) and MSSA in the second year (13 of 18). Ten MRSA blood isolates in the first year were identical by PFGE. Diabetes mellitus was a risk factor for HCRBSI. Age, gender, site of hemodialysis central venous catheter (CVC), other underlying diseases, coma score, APACHE II score, serum albumin level, and cholesterol level were not associated with HCRBSI and did not change between the 2 years. Hospital stay was prolonged for case-patients (32.78 ± 20.96 days) versus control-patients (22.75 ± 17.33 days), but mortality did not differ.
Conclusions:
Use of maximal sterile barrier precautions during the insertion of CVCs reduced HCRBSIs in dialysis patients and seemed cost-effective. Diabetes mellitus was associated with HCRBSI. An outbreak of MRSA in the first year was likely caused by cross-infection via medical personnel.
Prospective studies were conducted for nosocomial Pseudomonas aeruginosa infections from February 1, 1994, to October 30,1995. Of 97 P aeruginosa isolates from 97 patients, 35 were resistant to ceftazidime. Logistic regression revealed previous cephalosporin or piperacillin use as independent risk factors for nosocomial ceftazidime-resistant P aeruginosa infection. Pulsed-field gel electrophoresis revealed that four nosocomial ceftazidime-resistant P aeruginosa infections were caused by cross-infection, probably through medical personnel.
The clinical significance in schizophrenia of positive and negative symptoms at discharge was assessed.
Method
Of schizophrenic patients fulfilling DSM–III criteria, 113 were recruited for this study. Personal, social and psychopathological data were collected and all cases were followed up at one and two years after discharge.
Results
The presence of positive symptoms (64 cases), without concomitant negative symptoms, did not predict the follow-up social function and positive symptom score. Conversely, the presence of negative symptoms (31 cases) predicted worse social functioning (P < 0.05 to P < 0.005) and higher positive symptom scores (P < 0.01) at follow-up using MANOVA. Eighteen cases (15.9%) had neither positive nor negative symptoms and had the best clinical outcome.
Conclusions
Negative, but not positive, symptoms assessed at discharge are an important predictor of poor outcome. In addition, negative symptoms may themselves expose a biological vulnerability to the presence of positive symptoms.
The microstructure of Y-Ba-Cu-O compound, sintered at 950°C for 16h, was examined by using transmission electron microscope(TEM). For the furnace cooling sample, two variants of–orthorhombic YBa2-Cu3O7−x (O-Y123) twins, grown on (110) and (110) planes, respectively, are crystallographically related to the matrix and produce a Widmanstatten morphology. The orientation relationship between the lath twin and the matrix is (001)T//(001) and [100]T//[010]M. The O-Y123 compound is unstable under tne electron irradition. Twin boundaries are identified as S-boundaries. The minor phases as Y2BaCuO5 (Y211) and BaCuO2 were also observed. For the air cooling sample, no superconductivity above 77K was found. The major phase is tetragonal Y123 (T-Y123), while small amount of 0-Y123 is also existent.