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Visual and auditory signs of patient functioning have long been used for clinical diagnosis, treatment selection, and prognosis. Direct measurement and quantification of these signals can aim to improve the consistency, sensitivity, and scalability of clinical assessment. Currently, we investigate if machine learning-based computer vision (CV), semantic, and acoustic analysis can capture clinical features from free speech responses to a brief interview 1 month post-trauma that accurately classify major depressive disorder (MDD) and posttraumatic stress disorder (PTSD).
N = 81 patients admitted to an emergency department (ED) of a Level-1 Trauma Unit following a life-threatening traumatic event participated in an open-ended qualitative interview with a para-professional about their experience 1 month following admission. A deep neural network was utilized to extract facial features of emotion and their intensity, movement parameters, speech prosody, and natural language content. These features were utilized as inputs to classify PTSD and MDD cross-sectionally.
Both video- and audio-based markers contributed to good discriminatory classification accuracy. The algorithm discriminates PTSD status at 1 month after ED admission with an AUC of 0.90 (weighted average precision = 0.83, recall = 0.84, and f1-score = 0.83) as well as depression status at 1 month after ED admission with an AUC of 0.86 (weighted average precision = 0.83, recall = 0.82, and f1-score = 0.82).
Direct clinical observation during post-trauma free speech using deep learning identifies digital markers that can be utilized to classify MDD and PTSD status.
To describe the pattern of transmission of SARS-CoV-2 during 2 nosocomial outbreaks of COVID-19 with regard to the possibility of airborne transmission.
Contact investigations with active case finding were used to assess the pattern of spread from 2 COVID-19 index patients.
A community hospital and university medical center in the United States, in February and March, 2020, early in the COVID-19 pandemic.
Two index patients and 421 exposed health care workers.
Exposed staff were identified by analyzing the EMR and conducting active case finding in combination with structured interviews. Staff were tested for COVID-19 by obtaining oropharyngeal/nasopharyngeal specimens, with RT-PCR testing to detect SARS-CoV-2.
Two separate index patients were admitted in February and March 2020, without initial suspicion for COVID-19 and without contact or droplet precautions in place; both patients underwent several aerosol generating procedures in this context. A total of 421 health care workers were exposed in total, and the results of the case contact investigations identified 8 secondary infections in health care workers. In all 8 cases, the staff had close contact with the index patients without sufficient personal protective equipment. Importantly, despite multiple aerosol generating procedures, there was no evidence of airborne transmission.
These observations suggest that, at least in a healthcare setting, a majority of SARS-CoV-2 transmission is likely to take place during close contact with infected patients through respiratory droplets, rather than by long-distance airborne transmission.
The death of a previously healthy 14-year-old boy on the tenth day following accidental fresh-water drowning allowed us to study light and electron microscopic findings of adult respiratory distress syndrome (ARDS) in a previously healthy lung. The patient was treated initially for aspiration pneumonia with corticosteroids and antibiotics, and later received high concentrations of inspired oxygen during mechanical ventilation.
Autopsy permission was obtained at the time of death. Six percent gludaraldehyde in Clark's buffer containing methylene blue was injected into the right upper lobe within 20 minutes of cardiac arrest and an autopsy was performed approximately 3 hours later. Fixed tissues (marked with the blue dye) were removed, sectioned, washed briefly in Clark's buffer and post-fixed in 2 percent OsO4; in Clark's buffer for 2 hours. These were dehydrated in a graded ethanol series and embedded in Epon 812. Ultra thin sections were double-stained with lead citrate and uranyl acetate and examined using the Phillips Model 300 electron microscope.
It is not clear to what extent associations between schizophrenia, cannabis use and cigarette use are due to a shared genetic etiology. We, therefore, examined whether schizophrenia genetic risk associates with longitudinal patterns of cigarette and cannabis use in adolescence and mediating pathways for any association to inform potential reduction strategies.
Associations between schizophrenia polygenic scores and longitudinal latent classes of cigarette and cannabis use from ages 14 to 19 years were investigated in up to 3925 individuals in the Avon Longitudinal Study of Parents and Children. Mediation models were estimated to assess the potential mediating effects of a range of cognitive, emotional, and behavioral phenotypes.
The schizophrenia polygenic score, based on single nucleotide polymorphisms meeting a training-set p threshold of 0.05, was associated with late-onset cannabis use (OR = 1.23; 95% CI = 1.08,1.41), but not with cigarette or early-onset cannabis use classes. This association was not mediated through lower IQ, victimization, emotional difficulties, antisocial behavior, impulsivity, or poorer social relationships during childhood. Sensitivity analyses adjusting for genetic liability to cannabis or cigarette use, using polygenic scores excluding the CHRNA5-A3-B4 gene cluster, or basing scores on a 0.5 training-set p threshold, provided results consistent with our main analyses.
Our study provides evidence that genetic risk for schizophrenia is associated with patterns of cannabis use during adolescence. Investigation of pathways other than the cognitive, emotional, and behavioral phenotypes examined here is required to identify modifiable targets to reduce the public health burden of cannabis use in the population.
Estimation of RMR using prediction equations is the basis for calculating energy requirements. In the present study, RMR was predicted by Harris–Benedict, Schofield, Henry, Mifflin–St Jeor and Owen equations and measured by indirect calorimetry in 125 healthy adult women of varying BMI (17–44 kg/m2). Agreement between methods was assessed by Bland–Altman analyses and each equation was assessed for accuracy by calculating the percentage of individuals predicted within ± 10 % of measured RMR. Slopes and intercepts of bias as a function of average RMR (mean of predicted and measured RMR) were calculated by regression analyses. Predictors of equation bias were investigated using univariate and multivariate linear regression. At group level, bias (the difference between predicted and measured RMR) was not different from zero only for Mifflin–St Jeor (0 (sd 153) kcal/d (0 (sd 640) kJ/d)) and Henry (8 (sd 163) kcal/d (33 (sd 682) kJ/d)) equations. Mifflin–St Jeor and Henry equations were most accurate at the individual level and predicted RMR within 10 % of measured RMR in 71 and 66 % of participants, respectively. For all equations, limits of agreement were wide, slopes of bias were negative, and intercepts of bias were positive and significantly (P < 0⋅05) different from zero. Increasing age, height and BMI were associated with underestimation of RMR, but collectively these variables explained only 15 % of the variance in estimation bias. Overall accuracy of equations for prediction of RMR is low at the individual level, particularly in women with low and high RMR. The Mifflin–St Jeor equation was the most accurate for this dataset, but prediction errors were still observed in about one-third of participants.
There is a substantial proportion of patients who drop out of treatment before they receive minimally adequate care. They tend to have worse health outcomes than those who complete treatment. Our main goal is to describe the frequency and determinants of dropout from treatment for mental disorders in low-, middle-, and high-income countries.
Respondents from 13 low- or middle-income countries (N = 60 224) and 15 in high-income countries (N = 77 303) were screened for mental and substance use disorders. Cross-tabulations were used to examine the distribution of treatment and dropout rates for those who screened positive. The timing of dropout was examined using Kaplan–Meier curves. Predictors of dropout were examined with survival analysis using a logistic link function.
Dropout rates are high, both in high-income (30%) and low/middle-income (45%) countries. Dropout mostly occurs during the first two visits. It is higher in general medical rather than in specialist settings (nearly 60% v. 20% in lower income settings). It is also higher for mild and moderate than for severe presentations. The lack of financial protection for mental health services is associated with overall increased dropout from care.
Extending financial protection and coverage for mental disorders may reduce dropout. Efficiency can be improved by managing the milder clinical presentations at the entry point to the mental health system, providing adequate training, support and specialist supervision for non-specialists, and streamlining referral to psychiatrists for more severe cases.
Hagstromite, Pb8Cu2+(Te6+O6)2(CO3)Cl4, (IMA2019-093) is a new tellurate mineral from Otto Mountain near Baker, California, USA. It occurs on quartz in association with cerussite, fuettererite and thorneite. It is a secondary oxidation zone mineral and is presumed to have formed by oxidation of earlier formed tellurides, chalcopyrite and galena. Hagstromite occurs as light yellow–green blades, up to ~100 μm long. Crystals are transparent with adamantine to silky lustre. The mineral is brittle with two cleavages providing splintery fracture; the Mohs hardness is probably between 2 and 3. The calculated density is 7.062 g cm–3. Hagstromite is optically biaxial (+), with calculated indices of refraction for α = 2.045, β = 2.066 and γ = 2.102; 2Vmeas = 76(1)°; and optical orientation X = b, Y = a and Z = c. The Raman spectrum of hagstromite exhibits similarities with those of agaite and thorneite and confirms the presence of CO32–. The electron microprobe analyses provided the empirical formula Pb8.07Cu2+0.98Te6+1.96C1.17Cl3.83O15.34. Hagstromite is orthorhombic, space group Ibam, with a = 23.688(17), b = 9.026(8), c = 10.461(8) Å, V = 2237(3) Å3 and Z = 4. The crystal structure of hagstromite (R1 = 0.0659 for 284 I > 2σI reflections) contains a novel Cu2+Te6+2O12 chain assembled of corner-sharing Cu2+O4 squares and Te6+O6 octahedra. The O atoms in the chains form bonds with Pb2+ cations, which in turn bond to Cl– and CO32– anions, thereby creating a framework structure.
Employees who possess cross-cultural capabilities are increasingly sought after due to unparalleled numbers of cross-cultural interactions. Previous research has primarily focused on the bright side of these capabilities, including important individual and work outcomes. In contrast, the purpose of this study is to demonstrate that the cross-cultural capability of cultural intelligence (CQ) can lead to both positive and negative outcomes. Applying the general theory of confluence, we propose that expatriates high in CQ excel in customer relationship performance, while simultaneously behaving opportunistically. We also suggest that ethical relativism moderates these relationships. Using mixed methods, four separate studies generally support our predictions while also deepening our understanding of various forms of opportunism and the mechanism behind two seemingly opposing effects. Conceptual and managerial implications of CQ for opportunism, customer relationship performance, and ethics are discussed.
Injecting drug users experience higher rates of death and poorer health than their non-injecting peers.
Accurate assessment of drug users physical health needs forms an essential precursor to treatment.
To determine the completeness of documentation and accuracy of medical evaluation for a sample of injecting drug users.
To establish the detection rate of medical co morbidity in injecting drug using patients.
20 injecting drug users were randomly selected from the computer database The case notes of each of these patients were then checked for any physical health documentation and the quality of the documentation.
The medical databases of the acute hospital were then checked to identify if these patients have presented there and the medical conditions with which they have presented.
The patients were then asked during their outpatient appointment about their physical health condition and the last time they have been checked by the GP.
80% of the patients had some health related information’s documented in the notes. However when these were compared with the history from the patients during the follow up OP appointments and medical notes, only 20% of the notes had good quality health documentation. 60% was found to meet standards.
50% of the patients had an acute hospital presentation with drug related complication. Of these 20% was in the previous 1 year. In terms of GP contact, 25% had seen the GP within the last 6 months and another 40% within the previous 1 year
One in four people who attend hospital for physical health needs will have a mental health problem. the figures for patients over the age of 65 are significantly higher with 60% requiring mental health care during their hospital stay. (No Health without Mental Health, Academy of Medical Royal Colleges 2009).
Psychiatric co-morbidity affecting older people admitted to general hospitals is an independent predictor of poor outcome, including, increased mortality, length of stay, loss of independent function and discharge to care homes (Royal College of Psychiatrists, 2005).
To evaluate the quality of delivery of inpatient liaison psychiatry service to Mid Essex Hospitals.
To examine the referral pattern and reasons for referral.
To assess the timeliness of response and the effect of the consultation on the duration of stay.
To introduce measures to ensure better practice in the future.
All referrals to Old Age liaison psychiatry consultation service from August 2010 to February 2011 were identified from the computer database.
50 patients were randomly selected and their medical and psychiatric notes were analysed.
Information ‘s including Patient demographics, referring team, medical reason for admission, duration of stay, referral reason, clinical diagnosis, medical comorbidities, Psychiatric comorbidities and management by the liaison psychiatry team were collected using an audit tool.
The results have been collected and is currently being statistically analysed. They would available in the next few weeks.
Transitions from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) can often be problematic due to high eligibility thresholds, inconsistent support during transition and limited participation from young people. The TRACK Study highlighted several clinical, organizational and policy related reasons for Services to develop and implement transition protocols effectively.
Aims and objectives
This audit aims to examine whether the Trust's Transitions Policy is adhered to during transitions of young people across services. It also aims to review the qualitative experience of young people and professionals involved.
A Questionnaire Survey method was used to collect quantitative and qualitative data from involved professionals and young people who moved from CAMHS into AMHS (Aug11–Jan12). The data was analyzed against the audit criteria, which relate to specific aspects of the Transitions Policy.
A variable response rate showed that majority of the young people and involved professionals were satisfied with the planning and transfer of care with high policy adherence rates. Young people wished for better communication, more information on the nature of services offered and greater support, while professionals hoped for greater consideration of engagement levels and joint working. Alternative support was requested for declined referrals.
Improved adherence to the Transitions Policy can be achieved through proper planning, better communication, more joint working and regular feedback from young people and professionals. It can also help to achieve higher standards and continuity of clinical care to meet the needs of young people.
60% of older people admitted to general hospital will have or develop a mental disorder (Department of Health, 2001). Mental disorder in this population is an independent predictor of poor outcome and is associated with increased mortality, greater length of stay, loss of independent function and higher rates of institutionalisation (The Royal College of Psychiatrists, 2005).
Aims & Objectives:
To examine if the liaison psychiatric intervention has improved the outcome for the patients and to introduce measures to improve quality, safety and efficiency within the service practice in the future
A total of 128 patients were referred to the geriatric liaison psychiatry service in a 6 months period between from an acute general hospital .50 patients were randomly selected from these referrals. Data's were collected from both the case notes as well as clinical information system using an audit data collection tool.
Majority (62%) were seen within 24 hours and 82% were seen within 48 hours. The main diagnosis was depression closely followed by dementia. Only a small minority (8%) of the patient needed inpatient psychiatric admission. 50% of the patients were discharged within a week of the Liaison assessment and majority of the cases (70%) patients were able to go back home.
Identification of mental illness in the acute hospital settings remains low. In spite of dementia being extremely common diagnosis, very few did appear to have been referred to the specialist memory service. Liaison Psychiatry intervention possibly improved outcomes for patients and the services.
Previous literature has demonstrated a strong association between cigarette smoking, suicidal ideation and suicide attempts. This association has not previously been examined in a causal inference framework and could have important implications for suicide prevention strategies.
We aimed to examine the evidence for an association between smoking behaviours (initiation, smoking status, heaviness, lifetime smoking) and suicidal thoughts or attempts by triangulating across observational and Mendelian randomisation analyses.
First, in the UK Biobank, we calculated observed associations between smoking behaviours and suicidal thoughts or attempts. Second, we used Mendelian randomisation to explore the relationship between smoking and suicide attempts and ideation, using genetic variants as instruments to reduce bias from residual confounding and reverse causation.
Our observational analysis showed a relationship between smoking behaviour, suicidal ideation and attempts, particularly between smoking initiation and suicide attempts (odds ratio, 2.07; 95% CI 1.91–2.26; P < 0.001). The Mendelian randomisation analysis and single-nucleotide polymorphism analysis, however, did not support this (odds ratio for lifetime smoking on suicidal ideation, 0.050; 95% CI −0.027 to 0.127; odds ratio on suicide attempts, 0.053; 95% CI, −0.003 to 0.110). Despite past literature showing a positive dose-response relationship, our results showed no clear evidence for a causal effect of smoking on suicidal ideation or attempts.
This was the first Mendelian randomisation study to explore the effect of smoking on suicidal ideation and attempts. Our results suggest that, despite observed associations, there is no clear evidence for a causal effect.
Neuroimaging studies of depression have demonstrated treatment-specific changes involving the limbic system and regulatory regions in the prefrontal cortex. While these studies have examined the effect of short-term, interpersonal or cognitive-behavioural psychotherapy, the effect of long-term, psychodynamic intervention has never been assessed. Here, we investigated recurrently depressed (DSM-IV) unmedicated outpatients (N=16) and control participants matched for sex, age, and education (N=17) before and after 15 months of psychodynamic psychotherapy. Participants were scanned at two time points, during which presentations of attachment-related scenes with neutral descriptions alternated with descriptions containing personal core sentences previously extracted from an attachment interview. Outcome measure was the interaction of the signal difference between personal and neutral presentations with group and time, and its association with symptom improvement during therapy. Signal associated with processing personalized attachment material varied in patients from baseline to endpoint, but not in healthy controls. Patients showed a higher activation in the left anterior hippocampus/amygdala, subgenual cingulate, and medial prefrontal cortex before treatment and a reduction in these areas after 15 months. This reduction was associated with improvement in depressiveness specifically, and in the medial prefrontal cortex with symptom improvement more generally. This is the first study documenting neurobiological changes in circuits implicated in emotional reactivity and control after long-term psychodynamic psychotherapy.
We describe an ultra-wide-bandwidth, low-frequency receiver recently installed on the Parkes radio telescope. The receiver system provides continuous frequency coverage from 704 to 4032 MHz. For much of the band (
), the system temperature is approximately 22 K and the receiver system remains in a linear regime even in the presence of strong mobile phone transmissions. We discuss the scientific and technical aspects of the new receiver, including its astronomical objectives, as well as the feed, receiver, digitiser, and signal processor design. We describe the pipeline routines that form the archive-ready data products and how those data files can be accessed from the archives. The system performance is quantified, including the system noise and linearity, beam shape, antenna efficiency, polarisation calibration, and timing stability.
There is a wealth of literature on the observed association between childhood trauma and psychotic illness. However, the relationship between childhood trauma and psychosis is complex and could be explained, in part, by gene–environment correlation.
The association between schizophrenia polygenic scores (PGS) and experiencing childhood trauma was investigated using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) and the Norwegian Mother, Father and Child Cohort Study (MoBa). Schizophrenia PGS were derived in each cohort for children, mothers, and fathers where genetic data were available. Measures of trauma exposure were derived based on data collected throughout childhood and adolescence (0–17 years; ALSPAC) and at age 8 years (MoBa).
Within ALSPAC, we found a positive association between schizophrenia PGS and exposure to trauma across childhood and adolescence; effect sizes were consistent for both child or maternal PGS. We found evidence of an association between the schizophrenia PGS and the majority of trauma subtypes investigated, with the exception of bullying. These results were comparable with those of MoBa. Within ALSPAC, genetic liability to a range of additional psychiatric traits was also associated with a greater trauma exposure.
Results from two international birth cohorts indicate that genetic liability for a range of psychiatric traits is associated with experiencing childhood trauma. Genome-wide association study of psychiatric phenotypes may also reflect risk factors for these phenotypes. Our findings also suggest that youth at higher genetic risk might require greater resources/support to ensure they grow-up in a healthy environment.
Single crystal gold clusters (10 nm in size) have been collectively manipulated on mono- and bi-layered MoS2 islands (up to 20 µm) grown on SiO2 using AFM. On the monolayer the clusters tend to move in a direction corresponding to the zigzag alignment of the Mo and S atoms, and assemble into long striation patterns parallel to the scan direction. The distance between consecutive stripes is inversely proportional to the cluster concentration and size. A more detailed observation based on SEM shows that within each stripe the clusters remain separated by gaps of few nm in width possibly caused by electrostatic repulsion and/or the roughness of the SiO2 substrate (∼2 nm). The stripes also proved to be thermally stable, preserving their superstructures up to 823 K. On the bilayer gold clusters are much less prone to move and assemble into stripes. These results suggest that the formation of nanostructures resulting from collective manipulation of metal clusters can be oriented by a properly chosen scan path in a rather straightforward way (as compared to one-by-one displacement of single clusters). The goal of forming µm-long but nm-thin wires with a geometrically defined shape could be easily reached with the use of smoother substrates or TMD materials with lesser charge transfer to metals adsorbed on them.