Information on the time spent completing cognitive testing is often collected, but such data are not typically considered when quantifying cognition in large-scale community-based surveys. We sought to evaluate the added value of timing data over and above traditional cognitive scores for the measurement of cognition in older adults.

We used data from the Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (LASI-DAD) study (N = 4,091), to assess the added value of timing data over and above traditional cognitive scores, using item-specific regression models for 36 cognitive test items. Models were adjusted for age, gender, interviewer, and item score.

Compared to Quintile 3 (median time), taking longer to complete specific items was associated (p < 0.05) with lower cognitive performance for 67% (Quintile 5) and 28% (Quintile 4) of items. Responding quickly (Quintile 1) was associated with higher cognitive performance for 25% of simpler items (e.g., orientation for year), but with lower cognitive functioning for 63% of items requiring higher-order processing (e.g., digit span test). Results were consistent in a range of different analyses adjusting for factors including education, hearing impairment, and language of administration and in models using splines rather than quintiles.

Response times from cognitive testing may contain important information on cognition not captured in traditional scoring. Incorporation of this information has the potential to improve existing estimates of cognitive functioning.

Assessing the cost utility of health technologies for pediatric patients requires robust utility values for child health states, but the methods for valuing these pediatric health states are much less established than those for valuing adult health states. This is partly because the elicitation of preferences for child health states poses many normative, ethical, and practical challenges.

This presentation examines the conceptual issues in the valuation of health states in children by addressing the following questions.

• (i) Normative theories of health state values: What are we attempting to elicit?

• (ii) Sources of preferences: Whose preferences should we elicit, and from which perspective?

• (iii) Valuation methodologies: How should we elicit preferences?

• (iv) Attaching different values to child and adult health: Is a lack of consistency problematic?

To answer these questions, we used desk research (non-systematic literature reviews) and findings from a two-part workshop held in April 2021. The workshop included 25 participants with expertise in health economics, health state valuation, child health, health technology assessment (HTA) decision-making, and ethics.

We identified a lack of consensus on what is being elicited for both adults and children. Many HTA agencies recommend that the public be involved in utility generation exercises, but some criteria for defining who constitutes a member of the public exclude children. Of the many candidate sample types, perspectives, and methodologies, only a few were deemed relevant, acceptable, and feasible for use in the child health context. In addition, there were diverging views on whether it is possible to compare and integrate adult and child value sets with different properties.

Several questions remain to be answered before the public and other stakeholders can have confidence in child health state valuation protocols. We propose a research agenda, including both empirical and conceptual work, to inform future methodological development and to help HTA agencies make recommendations about how child utility values should be generated.

Response to lithium in patients with bipolar disorder is associated with clinical and transdiagnostic genetic factors. The predictive combination of these variables might help clinicians better predict which patients will respond to lithium treatment.

To use a combination of transdiagnostic genetic and clinical factors to predict lithium response in patients with bipolar disorder.

This study utilised genetic and clinical data (n = 1034) collected as part of the International Consortium on Lithium Genetics (ConLi+Gen) project. Polygenic risk scores (PRS) were computed for schizophrenia and major depressive disorder, and then combined with clinical variables using a cross-validated machine-learning regression approach. Unimodal, multimodal and genetically stratified models were trained and validated using ridge, elastic net and random forest regression on 692 patients with bipolar disorder from ten study sites using leave-site-out cross-validation. All models were then tested on an independent test set of 342 patients. The best performing models were then tested in a classification framework.

The best performing linear model explained 5.1% (P = 0.0001) of variance in lithium response and was composed of clinical variables, PRS variables and interaction terms between them. The best performing non-linear model used only clinical variables and explained 8.1% (P = 0.0001) of variance in lithium response. A priori genomic stratification improved non-linear model performance to 13.7% (P = 0.0001) and improved the binary classification of lithium response. This model stratified patients based on their meta-polygenic loadings for major depressive disorder and schizophrenia and was then trained using clinical data.

Using PRS to first stratify patients genetically and then train machine-learning models with clinical predictors led to large improvements in lithium response prediction. When used with other PRS and biological markers in the future this approach may help inform which patients are most likely to respond to lithium treatment.

Astronauts will encounter isolated, confined and extreme (ICE) conditions during future missions, and will have to be able to adapt. Until recently, however, few places on Earth could serve as acceptable space analogues (i.e., submarine and polar regions). The coronavirus disease-2019 (COVID-19)-related lockdowns around the globe provided a good opportunity to obtain more comprehensive datasets on the impact of prolonged isolation on human functioning in a very large sample.

Seven hundred forty-eight individuals (Belgium 442, Spain 183, Germany 50, Italy 50, US 23; Mean age ± SD: 41 ± 14 years, with an age range of 18–83 years; 66% women) filled out an online survey assessing the impact of the COVID-lockdown on psychological, exercise and general health variables a first time near the beginning of the initial lockdown (hereafter ‘T1’; 24 ± 13 days after the start of the first lockdown; i.e., 3 weeks after the start of the first lockdown) and a second time a couple of weeks thereafter (hereafter ‘T2’; 17 ± 5 days after the first online survey; i.e., 6 weeks after the start of the first lockdown).

From T1 to T2 an improvement of subjective sleep quality was observed (P = 0.003), that was related to an increase in subjective sleep efficiency and a decrease in sleep latency and disturbance (P ≤ 0.013). Weekly sitting time decreased, and the weekly amount of moderate and vigorous physical activity increased from T1 to T2 (P ≤ 0.049). No differences from T1 to T2 were observed in terms of mood, loneliness and state anxiety. A lower amount of sitting time was significantly correlated with improved subjective sleep quality (r = 0.096, P = 0.035) and with an increased amount of moderate (r = −0.126, P = 0.005) and vigorous (r = −0.110, P = 0.015) physical activity.

Compared to 3 weeks into the first COVID-imposed lockdown, 6-weeks after the start of the first COVID-imposed lockdown, physical activity and subjective sleep scores were positively impacted. The present, large sample size study further confirms exercise as a worthwhile countermeasure to psycho-physiological deconditioning during confinement.

Investing in stricter biodiversity conservation and wildlife protection to reduce the number of emerging diseases and, consequently, the risk of pandemics such as coronavirus disease-19 (COVID-19), must integrate a social-ecological perspective. Biodiversity conservation, in order to be effective as disease prevention, requires consideration of people's needs, knowledge and institutions within their locally specific contexts. To meet this goal, future biodiversity research and conservation policy should apply six social-ecological principles for shaping future practices of co-existence of societies and nature.

The COVID-19 pandemic, presumably originating in a spillover event from natural wildlife reservoirs into the human population, sets a new benchmark for the indirect cost of biodiversity exploitation. To reverse the trend of increasing pandemic risk, biodiversity conservation and wildlife protection must be strengthened globally. In this paper, we argue that such preventive measures explicitly need to employ a social-ecological approach. In particular, attention must be paid to the societal relations to nature to avoid falling for simplistic solutions that neglect regional and local particularities of both, biodiversity and local communities. We emphasize the importance of avoiding a Western-biased view and acknowledging the factors and causations of infectious disease emergence in industrialized countries. To reduce the emergence of zoonotic and vector-borne diseases in their specific contexts, we propose applying a social-ecological systems approach by integrating plural local knowledge and values, established practices, formal and informal institutions, as well as technology. We further introduce six social-ecological principles for shaping transformations in the Anthropocene to maintain and build more resilient and sustainable communities. By operationalizing these inter- and transdisciplinary principles, biodiversity conservation can be effectively implemented as infectious disease prevention.

A social-ecological approach to biodiversity conservation can pave the way for an effective and socially just reduction of future pandemic risks.

Comparisons of antipsychotics with placebo can be biased by unblinding due to side effects. Therefore, this meta-analysis compared the efficacy of antipsychotics for acute schizophrenia in trials using barbiturates or benzodiazepines as active placebos.

Randomized controlled trials (RCTs) in acute schizophrenia with at least 3 weeks duration and comparing any antipsychotic with barbiturates or benzodiazepines were eligible. ClinicalTrials.gov, CENTRAL, EMBASE, MEDLINE, PsycINFO, PubMed, WHO-ICTRP as well as previous reviews were searched up to 9 January 2018. Two separate meta-analyses, one for barbiturates and one for benzodiazepines, were conducted using random-effects models. The primary outcome was response to treatment, and mean values of schizophrenia rating scales and dropouts were analyzed as secondary outcomes. This study is registered with PROSPERO (CRD42018086263).

Seven barbiturate-RCTs (number of participants n = 1736), and two benzodiazepine-RCTs (n = 76) were included in the analysis. The studies were published between 1960 and 1968 and involved mainly chronically ill patients. More patients on antipsychotics in comparison to barbiturates achieved a ‘good’ response (36.2% v. 16.8%; RR 2.15; 95% CI 1.36–3.41; I2 = 48.9) and ‘any’ response (57.4% v. 27.8%; RR 2.07; 95% CI 1.35–3.18; I2 = 68.2). In a single small trial (n = 60), there was no difference between antipsychotics and benzodiazepines on ‘any’ response (74.7% v. 65%; RR 1.15; 95% CI 0.82–1.62).

Antipsychotic drugs were more efficacious than barbiturates, based on a large sample size. Response ratios were similar to those observed in placebo-controlled trials. The results on benzodiazepines were inconclusive due to the small number of studies and participants.

The creation of a medical incident response plan for the treatment of injured victims contaminated during a chemical incident challenges more man one of me rescue services involved in civil emergency response. Our main objective the was to create an incident management plan compatible with existing rescue service logistics and resources.

Under the supervision of the Schutzkommission des Inneren and with delegates from emergency medical services, fire, technical rescue services, and the German Army, a consensus conference to investigate the general conditions necessary and the existing structure available for managing victims of chemical incidents, was created. Typical injury patterns and their treatment in respect to decontamination procedures were considered, the necessary structure for casualty treatment and decontamination areas were derived, and commercially available products were tested for their usefulness in this situation. Standard operating procedures and algorithms were developed to aid realization of the concept. The suitability of the personal protective equipment and the question, if under these conditions the procedures of advanced life support can be performed, was evaluated in a standardized simulator model. The necessary training for rescue personnel involved was defined. To validate the concept, an exercise was performed.

All persons present at a chemical incident are to be classified as being contaminated. Injured persons must be separated into triage categories, and life threatening conditions treated before being decontaminated. Decontamination at the incident scene is necessary to prevent the transportation of the contaminant away from the incident scene. The principles of the decontamination of injured persons are based on the following pillars: triage, early removal of clothing, management of personal belongings and valuables, basic life support, spot decontamination, management and sealing of open wounds, application of antidotes, and primary decontamination of ambulant and non-ambulant victims.

The cooperation and the definition of roles between fire services (decontamination) and emergency medical services (triage and treatment) are necessary.

The concept uses existing decontamination vehicles used for the decontamination of fire fighters, by expanding its inventory with medical equipment, and extra technical apparatus. Using a modular approach, the system can be easily augmented by further units to treat multiple numbers of victims. However, demands on all rescue services involved are high, and must be complemented with an equally high standard of training, especially where rescue services have to learn skills not akin to their standard duties. An implementation of the system covering all geographical areas with specialized units is not possible, therefore a risk analysis to optimally position limited resources has to be conducted. Legislative bodies must strive to allow for an uncomplicated integration and disposition of disaster management resources.

This is a copy of the slides presented at the meeting but not formally written up for the volume.

Complex oxides show a broad spectrum of intrinsic functionalities, such as ferroelectricity, magnetism, superconductivity or multiferroic behavior, which can be utilized and combined in electronic devices by the growth and design of heterostructures. Physical properties may arise in such multilayers that are not found in either of their constituents. A spectacular example for such a phenomenon, a conducting and highly mobile electron gas, is formed at the interface between the two insulating, dielectric perovskites LaAlO3 and SrTiO3 [1] which can be easily tuned by transverse electric fields [2]. In our contribution we will present recent studies of the microstructure of the multilayer and we will correlate them with the transport properties of the electron gas. [1] A. Ohtomo, H. Y. Hwang, Nature 427, 423-426 (2004). [2] S. Thiel, G. Hammerl, A. Schmehl, C. W. Schneider, J. Mannhart, Science 313, 1942-1945 (2006).