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Catatonia is a frequent, complex and severe identifiable syndrome of motor dysregulation. However, its pathophysiology is poorly understood.
We aimed to provide a systematic review of all brain imaging studies (both structural and functional) in catatonia.
We identified 137 case reports and 18 group studies representing 186 individual patients with catatonia. Catatonia is often associated with brain imaging abnormalities (in more than 75% of cases). The majority of the case reports show diffuse lesions of white matter, in a wide range of brain regions. Most of the case reports of functional imaging usually show frontal, temporal, or basal ganglia hypoperfusion. These abnormalities appear to be alleviated after successful treatment of clinical symptoms. Structural brain magnetic resonance imaging studies are very scarce in the catatonia literature, mostly showing diffuse cerebral atrophy. Group studies assessing functional brain imaging after catatonic episodes show that emotional dysregulation is related to the GABAergic system, with hypoactivation of orbitofrontal cortex, hyperactivation of median prefrontal cortex, and dysconnectivity between frontal and motor areas.
In catatonia, brain imaging is abnormal in the majority of cases, and abnormalities more frequently diffuse than localised. Brain imaging studies published so far suffer from serious limitations and for now the different models presented in the literature do not explain most of the cases. There is an important need for further studies including a better clinical characterisation of patients with catatonia, functional imaging with concurrent catatonic symptoms and the use of novel brain imaging techniques.
The aim of the present study was to estimate prevalence rates of psychiatric and substance use disorders in male and female prisoners on admission to prison in the north of France and compare the frequency of these disorders to the general population.
This cross-sectional survey on Mental Health in the Prison Population (MHPP), conducted between March 2014 and April 2017, interviewed 653 randomly selected men and women who had recently been committed to the French general population prison system in the Nord and Pas-de-Calais departments. For each subject, the Mini International Neuropsychiatric Interview (MINI), a standardized psychiatric interview, was used to screen for psychiatric and substance use disorders. The prevalence rates were then compared with data from the Mental Health in the General Population (MHGP) survey, a general population survey that used the same assessment methodology as MHPP in the Nord and Pas-de-Calais departments. A control sample was taken from the MHGP survey with a ratio of one case (MHPP) to three controls (MHGP) matching on age and sex.
The sample was primarily composed of French men, most of them single with low educational levels at the time of imprisonment. The mean age was 31.7 (standard deviation = 9.9; min = 18; max = 67). Most of the subjects included were first-time prisoners. The prevalence of affective disorders among newly incarcerated individuals was 31.2% with higher rates for major depressive disorder (27.2%). The prevalence of anxiety disorders was 44.4% with higher rates for generalized anxiety disorder (25.2%). The prevalence of psychotic syndromes was 6.9%. The prevalence of substance use disorders was 53.5% and a suicide risk was identified in 31.4% of the prisoners interviewed. Higher prevalence rates were found in the MHPP when compared with the MHGP for all psychiatric and substance use disorders assessed except for dysthymia and current isolated psychotic syndrome.
Our study shows very high levels of prevalence for psychiatric and substance use disorders in recently committed French prisoners.
Bipolar disorder is a serious psychiatric illness that usually emerges during adolescence or early adulthood, and patients are likely to experience recurrent episodes throughout their lives. The treatment of bipolar disorder is complicated by the difficulty in distinguishing between subtly different disease subtypes (bipolar I, bipolar II, rapid cycling and mixed episodes), each of which is associated with a different probability of treatment success. Furthermore, physicians are faced with an array of treatment options that includes mood stabilisers, antidepressants, and typical and atypical antipsychotics.
Mood disorders that have no medical or pharmacological causes are divided into depressive disorders (unipolar, or major depressive disorder) and bipolar disorders. In bipolar disorders, both depressive and manic episodes occur sequentially.
A manic episode is characterised as an abnormally excited mood that is experienced by a patient for a distinct period (at least a week). Diagnosis of mania requires that a patient’s work and social life be significantly affected, or that the patient needs hospitalisation. Diagnosis also requires the presence of three or more of the following symptoms: inflated self-esteem or grandiosity; decreased need for sleep; increased talkativeness; racing thoughts/ideas; distraction; increased goal-directed activity; excessive involvement in pleasurable activities .
We study compact complex three-dimensional manifolds with vanishing second Betti number. In particular, we show that a compact complex manifold homeomorphic to the six-dimensional sphere does carry any non-constant meromorphic function.
We investigate the factors associated with the occurrence and abundance of external and blood parasites in African penguins (Spheniscus demersus), an endangered seabird that breeds exclusively on the coasts of Namibia and South Africa. External parasites were collected using the dust-ruffling method from 171 African Penguins admitted at a rehabilitation facility in the Western Cape, South Africa. Additionally, blood smears were obtained upon admission and weekly during rehabilitation and examined for blood parasites. Fleas Parapsyllus longicornis humboldti, ticks Ornithodoros capensis and lice Austrogoniodes demersus were recovered from 93, 63 and 40%, respectively, of the penguins upon admission to the centre. Rescue location and age group were identified as significant determinants of flea abundance, whereas month of admission was a significant determinant of tick abundance. Blood parasites were also common on admission, with Babesia being the most frequent (46% prevalence) whereas Borrelia was recorded sporadically (1.2%) and Plasmodium was recorded once. The prevalence and abundance of ticks on admission was positively associated with Babesia infection on admission. Our findings demonstrate the variability and contributing factor of parasite infections in an endangered species of penguin, and highlight the need for additional research on the parasite–host dynamics involving these potential disease vectors.
The science of studying diamond inclusions for understanding Earth history has developed significantly over the past decades, with new instrumentation and techniques applied to diamond sample archives revealing the stories contained within diamond inclusions. This chapter reviews what diamonds can tell us about the deep carbon cycle over the course of Earth’s history. It reviews how the geochemistry of diamonds and their inclusions inform us about the deep carbon cycle, the origin of the diamonds in Earth’s mantle, and the evolution of diamonds through time.
Virtual patient software allows health professionals to practise their skills by interacting with tools simulating clinical scenarios. A natural language dialogue system can provide natural interaction for medical history-taking. However, the large number of concepts and terms in the medical domain makes the creation of such a system a demanding task. We designed a dialogue system that stands out from current research by its ability to handle a wide variety of medical specialties and clinical cases. To address the task, we designed a patient record model, a knowledge model for the task and a termino-ontological model that hosts structured thesauri with linguistic, terminological and ontological knowledge. We used a frame- and rule-based approach and terminology-rich resources to handle the medical dialogue. This work focuses on the termino-ontological model, the challenges involved and how the system manages resources for the French language. We adopted a comprehensive approach to collect terms and ontological knowledge, and dictionaries of affixes, synonyms and derivational variants. Resources include domain lists containing over 161,000 terms, and dictionaries with over 959,000 word/concept entries. We assessed our approach by having 71 participants (39 medical doctors and 32 non-medical evaluators) interact with the system and use 35 cases from 18 specialities. We conducted a quantitative evaluation of all components by analysing interaction logs (11,834 turns). Natural language understanding achieved an F-measure of 95.8%. Dialogue management provided on average 74.3 (±9.5)% of correct answers. We performed a qualitative evaluation by collecting 171 five-point Likert scale questionnaires. All evaluated aspects obtained mean scores above the Likert mid-scale point. We analysed the vocabulary coverage with regard to unseen cases: the system covered 97.8% of their terms. Evaluations showed that the system achieved high vocabulary coverage on unseen cases and was assessed as relevant for the task.
Hemorrhage is the leading cause of preventable death in combat, although early recognition of hemorrhage is still challenging on the battlefield.
The objective of this study was to describe the shock index (SI) in a healthy military population, and to measure its variation during a controlled blood loss, simulated by blood donation.
A prospective observational study that enrolled military subjects, volunteers for blood donation, was conducted. Demographic and clinical information, concerning both the patient and the blood collection, were recorded. Baseline vital signs were measured, before and after donation, in a 45° supine position. Statistical analysis was performed after calculation of SI.
A total of 483 participants were included in the study. The mean blood donation volume was 473mL (SD = 44mL). The median pre- and post-blood donation SI were significantly different: 0.54 (IQR = 0.48-0.63) and 0.57 (IQR = 0.49-0.66), respectively (P = .002). Changes in pre-/post-donation blood pressure (BP) and heart rate (HR) also reached statistical difference but represented a clinically poor relevance. The multivariate analysis showed no significant associations between SI variations and age, sex, body mass index (BMI), sport activities, blood donation volume, and enteral volume replacement (EVR).
In this model of mild hemorrhage, SI exhibited significant variations but failed to reach clinical relevance. Further studies are needed to prove the benefit of SI calculation as a possible parameter for early recognition of hemorrhage in combat casualties at the point of injury.
Pasquier P, Duron S, Pouget T, Carbonnel AC, Boutonnet M, Malgras B, Barbier O, de Saint Maurice G, Sailliol A, Ausset S, Martinaud C. Use of shock index to identify mild hemorrhage: an observational study in military blood donors. Prehosp Disaster Med. 2019;34(3):303–307.
Since at least 1742, the mineralogical collection of the Muséum National d'Histoire Naturelle (MNHN) in Paris has hosted, under the reference number 22.U, a biconvex lens-shaped obsidian artifact, also described as a mirror, measuring 250 mm in diameter and finely polished on both faces. It has usually been ascribed to the shipment sent by Hernán Cortez in 1522 to the Emperor Charles V, which was captured by a French privateer. We investigated the object using modern techniques. The elemental composition of the obsidian determined by the particle induced X-ray emission (PIXE) method showed that the raw material originates from the Mullumica deposit (Ecuador). Documentary investigations revealed that the lens (renumbered No. 176.101) was sent in 1737 from Quito, Ecuador (at that time part of the viceroyalty of Peru), to France by members of the Godin–La Condamine geodesic expedition (1735–1743). The mirror is thus among the rare Ecuadorian archeological or colonial artifacts to have reached the Old World during the eighteenth century.
Hospital-based health technology assessment (HB-HTA) needs to consider all relevant data to help decision-making, including patients’ preferences. In this study, we comprehensively describe the process of identification, refinement and selection of attributes and levels for a discrete choice experiment (DCE).
A mixed-methods design was used to identify attributes and levels explaining low back pain (LBP) patients’ choice for a non-surgical treatment. This design combined a systematic literature review with a patients’ focus group, one-on-one interactions with experts and patients, and discussions with stakeholder committee members. Following the patient's focus group, ranking exercises were conducted. A consensus about the attributes and levels was researched during discussions with committee members.
The literature review yielded 40 attributes to consider in patients’ treatment choice. During the focus group, one additional attribute emerged. The ranking exercises allowed selecting eight attributes for the DCE. These eight attributes and their levels were discussed and validated by the committee members who helped reframe two levels in one of the attributes and delete one attribute. The final seven attributes were: treatment modality, pain reduction, onset of treatment efficacy, duration of efficacy, difficulty in daily living activities, sleep problem, and knowledge about their body and pain.
This study is one of the few to comprehensively describe the selection process of attributes and levels for a DCE. This may help ensure transparency and judge the quality of the decision-making process. In the context of a HB-HTA unit, this strengthens the legitimacy to perform a DCE to better inform decision-makers in a patient-centered care approach.
Hand hygiene is the primary measure for reducing nosocomial infections based on 7 steps recommended by the WHO. The aim of this study was to assess the duration and the quality of hand hygiene before and after simulation-based training (SBT).
The study took place in a University Hospital Pediatric Department among its residents and nurses. In assessment A, 10 hand-rubbing procedures per participant during a work day were scored by observers using a validated, anatomically based assessment scale. Two weeks later, all participants received a didactic course and SBT, followed 1 month later by assessment B, observation of 10 hand-rubbing procedures. Assessments were performed by 2 independent observers. Before-and-after testing was used to evaluate the demonstration of theoretical knowledge.
In total, 22 participants were included, for whom 438 hand hygiene procedures were assessed: 218 for assessment A and 220 for assessment B. The duration of hand rubbing increased from 31.16 seconds in assessment A to 35.75 seconds in assessment B (P=.04). In assessment A, participants averaged 6.33 steps, and in assessment B, participants averaged 6.03 steps (difference not significant). Significant improvement in scores was observed between assessments A and B, except for the dorsal side of the right hand. The wrist and interdigital areas were the least-cleaned zones. A difference between assessments A and B was observed for nail varnish (P=.003) but not for long nails or jewelry. Theoretical scores increased from 2.83 to 4.29 (scale of 0–5; P<.001).
This study revealed that an optimal number of steps were performed during hand-rubbing procedures and that SBT improved the duration and quality of hand hygiene, except for the dorsal right side. Emphasis should be placed on the specific hand areas that remained unclean after regular hand-rubbing procedures.
Based on the data from the Next Generation Virgo cluster Survey (NGVS), we statistically study the photometric properties of globular clusters (GCs), ultra-compact dwarfs (UCDs) and dwarf nuclei in the Virgo core (M87) region. We found an obvious negative color (g - z) gradient in GC system associate with M87, i.e. GCs in the outer regions are bluer. However, such color gradient does not exist in UCD system, neither in dwarf nuclei system around M87. In addition, we found that many UCDs are surrounded by extended, low surface brightness envelopes. The dwarf nuclei and UCDs show different spatial distributions from GCs, with dwarf nuclei and UCDs (especially for the UCDs with visible envelopes) lying at larger distances to the Virgo center. These results support the view that UCDs (at least for a fraction of UCDs) are more tied to dwarf nuclei than to GCs.