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There is growing interest in lifestyle interventions as stand-alone and add-on therapies in mental health care due to their potential benefits for both physical and mental health outcomes. We evaluated lifestyle interventions focusing on physical activity, diet, and sleep in adults with severe mental illness (SMI) and the evidence for their effectiveness. To this end, we conducted a meta-review and searched major electronic databases for articles published prior to 09/2022 and updated our search in 03/2024. We identified 89 relevant systematic reviews and assessed their quality using the SIGN checklist. Based on the findings of our meta-review and on clinical expertise of the authors, we formulated seven recommendations. In brief, evidence supports the application of lifestyle interventions that combine behavioural change techniques, dietary modification, and physical activity to reduce weight and improve cardiovascular health parameters in adults with SMI. Furthermore, physical activity should be used as an adjunct treatment to improve mental health in adults with SMI, including psychotic symptoms and cognition in adults with schizophrenia or depressive symptoms in adults with major depression. To ameliorate sleep quality, cognitive behavioural informed interventions can be considered. Additionally, we provide an overview of key gaps in the current literature. Future studies should integrate both mental and physical health outcomes to reflect the multi-faceted benefits of lifestyle interventions. Moreover, our meta-review highlighted a relative dearth of evidence relating to interventions in adults with bipolar disorder and to nutritional and sleep interventions. Future research could help establish lifestyle interventions as a core component of mental health care.
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.
In recent years, the significance of terahertz (THz) and (sub-)THz communications has grown substantially due to its promising trade-off between higher capacity compared to microwave-based communication and better resilience against weather dependent influences (e.g., fog and rain). While electronic and optoelectronic techniques have been extensively explored, each offering distinct advantages and limitations, they have predominantly been demonstrated and discussed as individual experiments, making performance comparison challenging. This paper addresses this gap by systematically benchmarking electronic and optoelectronic signal generation approaches under comparable conditions. Our experiments incorporate various receiver types, revealing that best performance is achieved by combining optoelectronic signal generation techniques at the transmitter in combination with an all-electric intradyne receiver. This results in a remarkable line rate of 200 Gbit/s over a distance of 52 m. To our knowledge, this represents the highest line rate achieved for technically relevant transmission distances for indoor access or outdoor small cell networks.
Mathematical models of polyelectrolyte gels are often simplified by assuming the gel is electrically neutral. The rationale behind this assumption is that the thickness of the electric double layer (EDL) at the free surface of the gel is small compared to the size of the gel. Hence, the thin-EDL limit is taken, in which the thickness of the EDL is set to zero. Despite the widespread use of the thin-EDL limit, the solutions in the EDL are rarely computed and shown to match to the solutions for the electrically neutral bulk. The aims of this paper are to study the structure of the EDL and establish the validity of the thin-EDL limit. The model for the gel accounts for phase separation, which gives rise to diffuse interfaces with a thickness described by the Kuhn length. We show that the solutions in the EDL can only be asymptotically matched to the solutions for an electrically neutral bulk, in general, when the Debye length is much smaller than the Kuhn length. If the Debye length is similar to or larger than the Kuhn length, then phase separation can be initiated in the EDL. This phase separation spreads into the bulk of the gel and gives rise to electrically charged layers with different degrees of swelling. Thus, the thin-EDL limit and the assumption of electroneutrality only generally apply when the Debye length is much smaller than the Kuhn length.
Mortality shocks such as the one induced by the COVID-19 pandemic have substantial impact on mortality models. We describe how to deal with them in the period effect of the Lee–Carter model. The main idea is to not rely on the usual normal distribution assumption as it is not always justified. We consider a mixture distribution model based on the peaks-over-threshold method, a jump model, and a regime switching model and introduce a modified calibration procedure to account for the fact that varying amounts of data are necessary for calibrating different parts of these models. We perform an extensive empirical study for nine European countries, comparing the models with respect to their parameters, quality of fit, and forecasting performance. Moreover, we define five exemplary scenarios regarding the future development of pandemic-related mortality. As a result of our evaluations, we recommend the peaks-over-threshold approach for applications with a possibility of extreme mortality events.
In the few weight loss studies assessing diet quality, improvements have been minimal and recommended calculation methods have not been used. This secondary analysis of a parallel group randomised trial (regsitered: https://clinicaltrials.gov/ct2/show/NCT03367936) assessed whether self-monitoring with feedback (SM + FB) v. self-monitoring alone (SM) improved diet quality. Adults with overweight/obesity (randomised: SM n 251, SM + FB n 251; analysed SM n 170, SM + FB n 186) self-monitored diet, physical activity and weight. Real-time, personalised feedback, delivered via a study-specific app up to three times daily, was based on reported energy, fat and added sugar intake. Healthy Eating Index 2015 (HEI-2015) scores were calculated from 24-hour recalls. Higher scores represent better diet quality. Data were collected August 2018 to March 2021 and analysed spring 2022. The sample was mostly female (78·9 %) and white (85·4 %). At baseline, HEI-2015 total scores and bootstrapped 95 % CI were similar by treatment group (SM + FB: 63·11 (60·41, 65·24); SM: 61·02 (58·72, 62·81)) with similar minimal improvement observed at 6 months (SM + FB: 65·42 (63·30, 67·20); SM: 63·19 (61·22, 64·97)) and 12 months (SM + FB: 63·94 (61·40, 66·29); SM: 63·56 (60·81, 65·42)). Among those who lost ≥ 5 % of baseline weight, HEI-2015 scores improved (baseline: 62·00 (58·94, 64·12); 6 months: 68·02 (65·41, 71·23); 12 months: 65·93 (63·40, 68·61)). There was no effect of the intervention on diet quality change. Clinically meaningful weight loss was related to diet quality improvement. Feedback may need to incorporate more targeted nutritional content.
Metamaterial lenses are appealing thin alternatives to conventional dielectric lenses. In this contribution we describe their design and application in two exemplary 77 GHz automotive radar sensors operating in monostatic and bistatic modes. The frontends are built around commercially available MMICs and small feed antennas are used in coordination with the six-layer printed circuit board-based realizations of metamaterial lenses. The design follows the principles of dielectric lenses, while the required local phase shift is obtained from a set of metasurface bandpasses. Their design uses a novel interpolation procedure to extract layout parameters for a given phase shift. Despite the small structural sizes due to the high frequency, the fabricated frequency-selective surfaces show very good performance in the required frequency range. Verification measurements were conducted on single bandpasses as well as on metamaterial lenses mounted on the radar frontend. The results agree very well with the simulation and confirm the applicability of thin lenses operating at mm-wave frequencies for automotive radar applications.
Even before the onset of psychotic symptoms, individuals with schizophrenia display cognitive impairments. Simultaneously, increasing amounts of individuals exhibit dysfunction of the blood–brain barrier (BBB). However, the impact of BBB dysfunction on neurocognitive impairment in people with first-episode psychosis has not yet been investigated.
Aims
To advance understanding of said relationship, we considered one of the largest first-episode psychosis cohorts with cerebrospinal fluid parameters available, and investigated whether BBB dysfunction is related to working memory, working speed and attention.
Method
We conducted a retrospective chart review of 121 in-patients diagnosed with a first episode of a schizophrenia spectrum disorder. Patients underwent neurocognitive testing and a lumbar puncture within routine clinical care. To define BBB dysfunction, albumin cerebrospinal fluid/serum quotients, immunoglobulin G ratios and oligoclonal band types were evaluated, and gender-specific differences investigated. Neurocognitive functioning was assessed by the Wechsler Adult Intelligence Scale, Test of Attentional Performance and Repeatable Battery for the Assessment of Neuropsychological Status. We performed simple and multiple linear regression analyses to interpret associations of interest.
Results
Of those tested, 16% showed an alteration in albumin quotients and 12% had an oligoclonal band type indicating BBB dysfunction. Notably, male patients were more likely to have an increased albumin quotient and a higher immunoglobulin G ratio than female patients. We found no significant association between BBB dysfunction and neurocognitive assessments.
Conclusions
The hypothesised relationship between BBB and neurocognitive impairments was not detectable in our retrospective cohort. Further cerebrospinal fluid-based studies with a longitudinal assessment of cognitive functioning and disease trajectory are urgently needed.
Diabetes mellitus (DM) is one of the most frequent metabolic complications associated with pregnancy, affecting both the prognosis of the pregnant woman and the newborn. Pregestational DM type 1 (T1DM) and type 2 (T2DM) and gestational DM (GDM) are associated with an increased risk of pregnancy complications such as miscarriage, fetal malformations, macrosomia, preeclampsia, and neonatal hypoglycemia, among others. The aim of this review was to evaluate the efficacy and safety of using the Dexcom G6 device (Dexcom, Co., USA) to continuously self-monitor blood glucose levels during pregnancy. This report was requested by the Spanish Ministry of Health.
Methods
We systematically searched for articles published to July 2021 in the MEDLINE, Embase, and Web of Science databases. We included experimental and observational primary studies addressing the safety, efficacy, and cost effectiveness of the Dexcom G6 device for gestational and pregestational diabetes.
Results
Two non-comparative prospective studies were identified. One study of 25 pregnant women with T1DM, which evaluated glycemic control and complications during pregnancy and postpartum, reported stable hemoglobin A1c levels during gestation in women using the Dexcom G6 device. The percentage of time spent in the therapeutic glucose range (63 to 140 mg/dL) was 59 percent; 38 percent was in the hyperglycemic range and 3 percent was in the hypoglycemic range. Although some patients reported mild erythematous and edematous reactions to the sensor, no moderate or severe reactions or infections occurred at the sensor insertion site. The other study in pregnant women with T1DM (n=20), T2DM (n=3), or GDM (n=9) showed adequate accuracy of the Dexcom G6 device, compared with the reference method, especially when the sensor is placed on the arm.
Conclusions
Randomized controlled trials are required to assess the effectiveness and safety of the Dexcom G6 device in maintaining adequate glucose control during pregnancy in women with DM. Studies are also needed to compare the Dexcom G6 device with conventional capillary blood glucose self-monitoring or other monitoring methods. No cost-effectiveness studies have been conducted for the Dexcom G6 device in this patient population.
The COVID-19 pandemic interrupts the relatively steady trend of improving longevity observed in many countries over the last decades. We claim that this needs to be addressed explicitly in many mortality modelling applications, for example, in the life insurance industry. To support this position, we provide a descriptive analysis of the mortality development of several countries up to and including the year 2020. Furthermore, we perform an empirical and theoretical investigation of the impact a mortality jump has on the parameters, forecasts and implied present values of the popular Lee–Carter mortality model. We find that COVID-19 has resulted in substantial mortality shocks in many countries. We show that such shocks have a large impact on point and interval forecasts of death rates and, consequently, on the valuation of mortality-related insurance products. We obtain similar findings under the Cairns–Blake–Dowd mortality model, which demonstrates that the effects caused by COVID-19 show up in a variety of models. Finally, we provide an overview of approaches to handle extreme mortality events such as the COVID-19 pandemic in mortality modelling.
The consistent association between therapeutic alliance and outcome underlines the importance of identifying factors which predict the development of a positive alliance. However, only few studies have examined the association between pretreatment characteristics and alliance formation in patients with schizophrenia.
Objective
The study examined whether symptoms and insight would predict the therapeutic alliance in psychotherapy of schizophrenia. Further, the associations and differences between patient and therapist alliance ratings were studied.
Methods
Eighty patients with schizophrenia spectrum disorders received manual-based psychotherapy. Assessment of symptoms and insight was conducted at baseline, and questionnaire-based alliance ratings were obtained three weeks into treatment. Patient and therapist alliance ratings were examined separately.
Results
Patient and therapist alliance ratings were not significantly correlated (r = 0.17). Patient ratings of the alliance were significantly higher than the ratings of their therapists (d = 0.73). More insight in psychosis significantly predicted higher patient ratings of the alliance. Less positive and negative symptoms were significant predictors of higher therapist alliance ratings.
Conclusion
The findings indicate that symptoms and insight have an influence on the therapeutic alliance in the treatment of schizophrenia spectrum disorders. Patients' and therapists' perceptions of the alliance do not seem to demonstrate much convergence.
A new two-phase model for concentrated suspensions is derived that incorporates a constitutive law combining the rheology for non-Brownian suspension and granular flow. The resulting model exhibits a yield-stress behaviour for the solid phase depending on the collision pressure. This property is investigated for the simple geometry of plane Poiseuille flow, where an unyielded or jammed zone of finite width arises in the centre of the channel. For the steady states of this problem, the governing equations are reduced to a boundary value problem for a system of ordinary differential equations and the conditions for existence of solutions with jammed regions are investigated using phase-space methods. For the general time-dependent case a new drift-flux model is derived using matched asymptotic expansions that takes into account the boundary layers at the walls and the interface between the yielded and unyielded region. The drift-flux model is used to numerically study the dynamic behaviour of the suspension flow, including the appearance and evolution of an unyielded or jammed regions.
Long-term ice-core records of Alpine glaciers are usually taken from cold-firn areas at high altitudes, as on Mont Blanc and Monte Rosa. Perennial ice bodies at lower altitudes, however, also bear information about the past. Recent findings from the remains of such ice (the Oetztal iceman found in Austria; wooden bows at Lötschen Pass, Switzerland) clearly indicate the hitherto little-recognized fact that small, more-or-less static perennial ice bodies which are cold and frozen to the underlying bedrock may contain very old ice and, hence, important palaeoclimatic information about warm periods with minimum ice extent in the Alps. Since autumn 1998, investigations have been initiated on a crest-type location or “miniature ice cap” at Piz Murtèl, Engadine, Swiss Alps. First results from shallow drilling, temperature data-logging, geodetic surveying, visual observation, finite-element modelling of simplified basic two-dimensional configurations and comparison to earlier measurements at similar sites provide promising perspectives concerning a little-studied phenomenon with considerable scientific-environmental research potential. Specific characteristics of the investigated site, and probably of many other comparable mountain sites, are: cold ice (about –4°C at 10 m depth), no basal sliding, small mass turnover, striking lack of a firn zone, accumulation mainly by superimposed ice, and direct access to old layers (centuries, millennia?) at the ice/bedrock interface.
Among the polychaetes, the family Cirratulidae is one of the most challenging taxonomically because most of the currently used diagnostic characters change during ontogeny. It is therefore necessary to use a combination of characters to make an accurate identification. The present work is the first of a planned revision of the genus Cirratulus from coastal zones of Argentina. The examined material came from the two largest natural history museums of the country, and showed several morphotypes. Some specimens corresponded to described species, but others were undoubtedly undescribed. Among the previously known Cirratulidae, Cirratulus jucundus (Kinberg, 1866) and Cirratulus patagonicus (Kinberg, 1866), formerly distributed for Antarctica are now also present in coastal continental areas of Argentina. The new species Cirratulus mianzanii sp. nov. is described from subtidal areas off Peninsula Valdés, Patagonia. This species is distinguished from its congeners by the segmental origin of both tentacular filaments and first pair of branchiae in the junction between the peristomium and first chaetiger. Branchiae arise some distance from the notopodium but not at the dorsal midline of the body. Ventral groove present along the body, with a fine dark midline. Capillary chaetae are serrate seen under an optical microscope, and the segmental origin of neuro- and notopodial spines is different from other species of the genus.
Within the framework of core-drilling through the permafrost of the active rock glacier Murtèl–Corvatsch in the Swiss Alps, subfossil stem remains of seven different bryophyte species were found at a depth of 6 m below surface and about 3 m below the permafrost table in samples from massive ice. The composition of the moss species points to the former growth of the recovered mosses in the nearest surroundings of the drill site. A total of 127 pollen and spores captured by the mosses and representing 23 taxa were determined. The local vegetation during deposition time must be characterized as a moss-rich alpine grassland meadow rich in Cyperaceae, Poaceae, Chenopodiaceae and Asteraceae, comparable to today’s flora present around the study site. For l4C analysis, accelerator mass spectrometry had to be used due to the small sample mass (about 0.5 mg Carbon content). The mean conventional 14C age of 2250 ± 100 years (1σ variability) corresponds to ranges in the calibrated calendar age of 470–170 BC and 800 BC to AD 0 at statistical probabilities of 68% and 95%, respectively. This result is compared with the present-day flow field as determined by high-precision photogrammetry and with information about the thickness, vertical structure and flow of the permafrost from borehole measurements. Total age of the rock glacier as a landform is on the order of 104 years; the development of the rock glacier most probably started around the onset of the Holocene, when the area it now occupies became definitely deglaciated. The bulk of the ice/rock mixture within the creeping permafrost must be several thousand years old. Characteristic average values are estimated for (1) surface velocities through time (cm a-1), (2) long-term ice and sediment accretion rates (mm a-1) on the debris cone from which the rock glacier develops, (3) retreat rates (1–2 mm a-1) of the cliff which supplies the debris to the debris cone and rock glacier, and (4) ice content of the creeping ice/rock mixture (50–90% by volume). The pronounced supersaturation of the permafrost explains the steady-state creep mode of the rock glacier.
Previous studies of overall arthropod disparity have compared Cambrian and Recent biotas, without considering taxa of intermediate age. This study explored morphological diversity among Carboniferous arthropods, primarily from the well-known Westphalian Mazon Creek Lagerstätte. Over 100 arthropod species, belonging to 48 orders, were examined. The data set is composed of nearly equal numbers of crustacean, arachnid, and insect species, with lower numbers of merostomes. Trilobites have not been found at Mazon Creek. However, some Late Carboniferous trilobite species were included in order to obtain a more representative picture of global Carboniferous arthropod disparity.
The absence, presence, or state of 66 shared characters was recorded for each species, as well as individual autapomorphies. Overall disparity was determined from the Euclidean distance analysis between taxa or variance along principal coordinates analyses (PCO) axes. Results indicate that arthropod disparity has not been greatly reduced throughout the Phanerozoic as was previously suggested. However, the regions of occupied morphospace have rotated over time.