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Recently, artificial intelligence-powered devices have been put forward as potentially powerful tools for the improvement of mental healthcare. An important question is how these devices impact the physician-patient interaction.
Aifred is an artificial intelligence-powered clinical decision support system (CDSS) for the treatment of major depression. Here, we explore the use of a simulation centre environment in evaluating the usability of Aifred, particularly its impact on the physician–patient interaction.
Twenty psychiatry and family medicine attending staff and residents were recruited to complete a 2.5-h study at a clinical interaction simulation centre with standardised patients. Each physician had the option of using the CDSS to inform their treatment choice in three 10-min clinical scenarios with standardised patients portraying mild, moderate and severe episodes of major depression. Feasibility and acceptability data were collected through self-report questionnaires, scenario observations, interviews and standardised patient feedback.
All 20 participants completed the study. Initial results indicate that the tool was acceptable to clinicians and feasible for use during clinical encounters. Clinicians indicated a willingness to use the tool in real clinical practice, a significant degree of trust in the system's predictions to assist with treatment selection, and reported that the tool helped increase patient understanding of and trust in treatment. The simulation environment allowed for the evaluation of the tool's impact on the physician–patient interaction.
The simulation centre allowed for direct observations of clinician use and impact of the tool on the clinician–patient interaction before clinical studies. It may therefore offer a useful and important environment in the early testing of new technological tools. The present results will inform further tool development and clinician training materials.
Interactions between smooth muscle cells (SMCs) and biomaterials must not result in phenotype changes as this may generate uncontrolled multiplication processes and occlusions in vascular grafts. The aim of this study was to relate the hydrolytic stability and biocompatibility of polyurethanes (PUs) on SMCs. A higher polycaprolactone (PCL) concentration was found to improve the hydrolytic stability of the material and the adhesion of SMCs. A material with 5% polyethylene glycol, 90% PCL, and 5% pentaerythritol presented high cell viability and adhesion, suggesting a contractile phenotype in SMCs depending on the morphology. Nevertheless, all PUs retained their elastic modulus over 120 days, similar to the collagen of native arteries (~10 MPa). Furthermore, aortic SMCs did not present toxicity (viability over 80%) and demonstrated adherence without any abnormal cell multiplication processes, which is ideal for the function to be fulfiled in situ in the vascular grafts.
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.
Determination of antibodies against ToRCH antigens at the beginning of pregnancy allows assessment of both the maternal immune status and the risks to an adverse pregnancy outcome. Age-standardised seroprevalences were determined in sera from 1009 women of childbearing age residing in Mexico, Brazil, Germany, Poland, Turkey or China using a multiparametric immunoblot containing antigen substrates for antibodies against Toxoplasma gondii, rubella virus, cytomegalovirus (CMV), herpes simplex viruses (HSV-1, HSV-2), Bordetella pertussis, Chlamydia trachomatis, parvovirus B19, Treponema pallidum and varicella zoster virus (VZV). Seroprevalences for antibodies against HSV-1 were >90% in samples from Brazil and Turkey, whereas the other four countries showed lower mean age-adjusted seroprevalences (range: 62.5–87.9%). Samples from Brazilian women showed elevated seroprevalences of antibodies against HSV-2 (40.1%), C. trachomatis (46.8%) and B. pertussis (56.6%) compared to the other five countries. Seroprevalences of anti-T. gondii antibodies (0.5%) and anti-parvovirus B19 antibodies (7.5%) were low in samples from Chinese women, compared to the other five countries. Samples from German women revealed a low age-standardised seroprevalence of anti-CMV antibodies (28.8%) compared to the other five countries. These global differences in immune status of women in childbearing age advocate country-specific prophylaxis strategies to avoid infection with ToRCH pathogens.
The alien cynipid wasp Dryocosmus kuriphilus Yasumatsu, 1951 is a serious pest of chestnuts (Castanea spp.) in Japan, North America and Europe, causing fruit losses while inducing galls in buds. While D. kuriphilus galls have a recognizable and roughly invariable globular shape, their size varies, reaching up to 4 cm in diameter. Among other factors, such variation may depend on different climatic conditions in different attacked areas. Here, we sampled and measured 375 D. kuriphilus galls from 25 localities throughout the Iberian Peninsula, including both cold and rainy northern (Eurosiberian) areas and warm and dry central-southern (Mediterranean) areas, to test the effects of climate and geographical location on gall morphology. The analyses indicate that gall mass and volume follow a pattern that can be associated with a climatic cline. In particular, the Eurosiberian galls were smaller than the Mediterranean galls according to differences in climatic conditions. In the southern areas, the greater insolation regime does not allow the chestnut trees to be distributed at lower altitudes, but the high rainfall and humidity regime of the mountain enclaves allow their presence. These conditions of insolation and precipitation seem to influence the morphological characteristics of the galls of D. kuriphilus.
Rewetting is the establishment of water–surface contact that occurs during quenching of high temperature surfaces by water jet impingement. Rewetting is an unexpectedly complex phenomenon that has been reported to occur at surface temperatures significantly higher than the superheating limit of water. The presence of intermittently wet and dry episodes, and in particular the occurrence of so-called explosive boiling, is one of the theories to explain the contact of water with high temperature surfaces. However, there is a lack of experimental data in the literature to prove the presence of explosive boiling and intermittent wetting due to the small duration and scale of the rewetting phenomenon. In this study, recordings of the jet stagnation zone during rewetting are provided at a frame rate of 81 kfps. The high-speed recordings show a flashing regime consisting of intermittent (dry) bubble-rich and (wet) bubble-free periods at frequencies up to 40 kHz when the rewetted surface temperature exceeds the water superheat limit. As far as the authors know, these are the first direct observations of intermittent dry–wet periods occurring in the jet stagnation zone during quenching by water jet impingement. The dependency of the flashing frequency on initial surface temperature is quantified. A correlation between the size of the rewetting patch and the flashing frequency is found. Finally, a hypothesis to explain the role of water subcooling in maintaining the water–surface contact at surface temperatures well above the superheating limit of water is presented.
To determine the association between functional impairment, as reported in a lay-administered structured interview (CIDI), and severity of depression, depressive symptoms and risk factors for depression.
We undertook a cross-sectional study of 5442 consecutive attendees at general practices in seven Spanish provinces participating in the PredictD-Spain study on predictors of depression. Participants were administered the depression section of the Composite International Diagnostic Interview (WHO-CIDI 2.1), allowing diagnoses by the ICD-10 and DSM-IV classifications for depressive episodes. Impairment was measured using the CIDI question about whether symptoms seriously interfered with important areas of functioning, such as work or looking after the house and family. We measured a set of 39 known risk factors for depression.
Firstly, the 6-month prevalence of a depressive episode according to ICD-10 was 28.7% (1563) and of major depression according to DSM-IV it was 13.6% (742). Secondly, out of the 1563 patients with a depressive episode according to ICD-10, nearly half (47.9%; n=749) had no impairment in important areas of functioning.
As the ICD-10 criteria for depressive diagnoses do not include the criteria that symptoms cause impairment in social, occupational or other important areas of functioning, a large number of false positive cases are included in reported prevalence rates; and secondly, the measurement of functional impairment, at least operationalized using a lay-administered structured interview such as CIDI, is not enough, in epidemiological research studies, to assess the clinical importance of depressive symptoms.
Several studies suggest that severe mental illness is associated with tobacco smoking.
In this study, we measure the frequency of tobacco smokers in a sample of 149 severe mental illness inpatients. We compare the tobacco smoking rate with the general population one and with other studies rates.
65 (43%) of the 149 patients were female and 84 (57%) male. The main diagnoses of the studied population was schizophrenia (80%).The main finding was that according to other studies, the percentage of smokers in our hospital 65 (43%) was consistently high and greater than in general population. Only 9 (13%) of the smokers group were women.
Tobacco smoking rate is higher in psychiatric inpatients than in general population.
The Ganser syndrome has been evolving more in terms of the nosological conception than in relation to its clinic characteristics, with the hypothesis of a hysterical etipopathogenesis in conflict with the psychotic etiopathogenesis, the malingering, and the factitious disorders, adding the possibility of predisposing organic damage underneath.
In DSM-III, it was considered as a factitious disorder with psychotic symptoms, and since the DSM-III-R it is included as a Dissociative Disorder NOS.
We show in a table similarities and differences between Ganser Syndrome and factitious and malingering disorders, the disorders most commonly mistaken with Ganser Syndrome.
There are some indications in the literature that the use of dopamine antagonists can modify the risk of developing different types of neoplasms.
We have reviewed last studies which have reported the possible relationship between cancer and neuroleptic treatment.
Results and Conclusions:
Antipsychotics which increase the level of prolactin, could possible increase the risk of developing breast and endometrial cancer in patients with schizophrenia. Other studies, shows a marked apoptotic effect of phenothiazines in brain-derived cancer cells.
The aim of this study was to measure the reliability, validity, and classification accuracy of a Spanish translation of a measure of DSM-IV diagnostic criteria for Pathological Gambling. Participants were 263 male and 23 female patients seeking treatment for pathological gambling and a matched non-psychiatric control sample of 259 men and 24 women. A Spanish translation of a 19-item measure of DSM-IV diagnostic criteria for Pathological Gambling was administered along with other validity measures. The DSM-IV diagnostic criteria were found to be reliable with an internal consistency coefficient alpha of .95 in the combined sample. Evidence of satisfactory convergent validity included moderate to high correlations with other measures of problem gambling. Using the standard DSM-IV cut-score of five, the ten criteria were found to yield satisfactory classification accuracy results with a high hit rate (.95), high sensitivity (.92), high specificity (.99), low false positive (.01), and low false negative rate (.08). Lowering the cut score to four resulted in modest improvements in classification accuracy and reduced the false negative rate from .08 to .05. The Spanish translation of a measure of DSM-IV diagnostic criteria for Pathological Gambling demonstrated satisfactory psychometric properties and a cut score of four improved diagnostic precision.
There are currently over 600 million people aged over 60 and it is predicted that, by 2025, the number will double and, by 2050 there will be over 2 billion people aged 60 and above and the number of over 60's will be greater than the number of children under the age of 15. Co-morbid physical and mental health conditions are associated with an aging population and many of this population will suffer from stroke, hypertension, loneliness, depression, dementia, mobility and sight problems. The traditional approach of caring for people in hospitals is increasingly inappropriate for many of the elderly population and primary care is often the first point of contact for many people seeking access to health and social care. In 2008, the WHO and Wonca (World Organisation of Family Doctors) published a document about the integration of mental health into primary care across spectrum. We will be describing the principles and method of integration of mental health problems in old age into primary care using examples from the Australian and UK setting. Also we will examine the role non-governmental organisations can play in the process of integration. Caring for the elderly is rewarding and possible in the primary care setting. The current situation where many elderly people do not have access to an integrated health care system is unacceptable. Using data and a series of case vignettes we will illustrate that primary care has an important role to play within an integrated system.
There is an excess of death from natural causes among people with major psychiatric disorders. Several reasons have been argued to explain this excess of death (Antipsychotic Agents, high nicotine dependence…).
Our objective was to examine and compare mortality rates in a historical cohort study of 166 psychiatric inpatients along one year.
Mortality rates were examined in our cohort of patients from January 1, 2003 to December 31, 2003.
11(6.62%) patients died along the year studied. Only 2 (18%) of the died patient were women. The main cause of mortality in our cohort of patients was cardiovascular diseases.
Inpatients with major psychiatric disorders appear to be at greater risk for cardiovascular mortality than those in the general population.
N-acetil-aspartate (NAA) is located inside the soma and dendrites. Its believed to be an indirect indicator of the metabolic activity of these cells. Phosphomonoesters (PME) are involved in synthesis of neuronal membranes and phosphodiesters (PDE) in its degradation. Glutamine, an aminoacid produced by glial cells, is transported into the neurone for its transformation into glutamate and gamma aminobutyric acid.
Review clinical trials performed on schizophrenic patients with SF-MRI, with 31P y 1H, to measure concentration of NAA, PME, PDE and glutamine.
Detecting chemichal alterations that could be used as indicators in schizophrenia.
NAA concentration in temporal and frontal cortex of schizophrenic patients, are significantly lower than in healthy controls. In other trials, differences in NAA concentration (measured in prefrontal cortex) have not been found, comparing patients during their first psychotic episode and healthy controls. Lowered concentrations of PME and increased ones of PDE in prefrontal cortex of schizophrenic patients have been found. Glutamine levels are increased in schizophrenic patients, being directely correlated with the duration of the process. These levels are reduced when antipsychotic drugs are used.
The decrease on NAA levels at schizophrenia onset and on healthy relatives remark its value as an endophenotypical indicator, but not as an illness indicator. Changes on PME and PDE concentrations cannot be used as illness indicators. The increase on glutamine synthesis could be due to glutamatergic hypofunction in schizophrenic patients, but there are other factors that may cause it, so it cannot be used as an indicator.
The objetive of this study is to examine the efficacy of group psychoeducational therapy for inpatients with DSM-IV schizophrenia.
Fourteen in-patients with DSM-IV schizophrenia were randomly assigned to a treatment group or a control group. Both groups received standard medication as prescribed by their treating physicians, but the treatment group also recibed a two-months course of psychoeducational psychotherapy. Outcome was evaluated using Clinical Global Impression-Schizophrenia Scale.
Patients who attended psychoeducational group showed a improvement in CGI-SCH score.
The results suggest that psychoeducational psychotherapy can improve the treatment of schizophrenia.
Psychoeducational psychotherapy has no side-effects and is relatively inexpensive.
The coexistence of comorbidity in schizophrenia (somatic, dual pathology, personality…) can conditionate evolution and prognosis in this severe mental illness, those aspects should be taken in account to planify treatments and follow up issues.
We are interested in this work in evaluate previous and developed comorbidity in schizophrenic patients; we also analyzed comorbidity consequences in clinical, therapeutical management, treatment adherence, relapses and hospitalizations.
Material and method:
In 50 Schizophrenic patients (DSM-IV TR Diagnostic criteria) with at least one previous psychotic episode we have studied longitudinal and transversally sociodemographic, clinical and therapeutical variables, related comorbidity (somatic, drugs related and dual pathology) and evolution, prognosis, clinical, treatment adherence and tolerance variables were also studied. We also evaluate psychopathologic and medical status (EEG, EKG, Chest RX, BMI, body weight, general analysis) secondary effects were registered. Uxue and CGI were the scales used.
Between 20% and 25% had other medical conditions, and 25-30% had some kind of drug abuse, those were who had worse prognosis, more secondary effects and usually were treated with classic antipsychotics.
The results are discussed, and we propose integrative treatments for schizophrenia and the co morbidities, focusing on affectivity and tolerance.
It is necessary to explore the possibilities of brief intervention of smoking cessation in bipolar disorder (BD) that may act on the level of motivation for change.
Assess the effectiveness of the 3 A's intervention (Ask, Advise and Assess) in a sample of euthymic BD patients.
260 patients diagnosed with BD that were in the euthymic phase and attended the Community care centers of Spain that have been evaluated for their history of smoking habits and current use.
Patients who consumed in the last month qualified for the level of motivation for change (measured by URICA scale); before and after conducting a brief intervention of no more than 30 minutes in total, divided in three contacts during a month, two face to face and one phone contact.
The 49% of the evaluated patients showed an actual use of cigarettes with an average of 28.73 (SD 11.82) years of consumption, with a mean consumption of 21.00 (SD 10.40) cigarettes per day and a level of nicotine dependency of 5.72 (SD 3.03). The 67% of patients were in the Contemplation stage of change, after the intervention 18% progressed to the stage of motivation and 14% ended up in the Stage of Ready for Change. In the third appointment the 21.4% of the smokers reported a reduction of the consumption.
The results seem to confirm its effectiveness, although it should be considered the possibility of carrying out specific tools of brief intervention for this sort of patients.