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Current ultra-high-risk (UHR) criteria appear insufficient to predict imminent onset of first-episode psychosis, as a meta-analysis showed that about 20% of patients have a psychotic outcome after 2 years. Therefore, we aimed to develop a stage-dependent predictive model in UHR individuals who were seeking help for co-morbid disorders.
Baseline data on symptomatology, and environmental and psychological factors of 185 UHR patients (aged 14–35 years) participating in the Dutch Early Detection and Intervention Evaluation study were analysed with Cox proportional hazard analyses.
At 18 months, the overall transition rate was 17.3%. The final predictor model included five variables: observed blunted affect [hazard ratio (HR) 3.39, 95% confidence interval (CI) 1.56–7.35, p < 0.001], subjective complaints of impaired motor function (HR 5.88, 95% CI 1.21–6.10, p = 0.02), beliefs about social marginalization (HR 2.76, 95% CI 1.14–6.72, p = 0.03), decline in social functioning (HR 1.10, 95% CI 1.01–1.17, p = 0.03), and distress associated with suspiciousness (HR 1.02, 95% CI 1.00–1.03, p = 0.01). The positive predictive value of the model was 80.0%. The resulting prognostic index stratified the general risk into three risk classes with significantly different survival curves. In the highest risk class, transition to psychosis emerged on average ⩾8 months earlier than in the lowest risk class.
Predicting a first-episode psychosis in help-seeking UHR patients was improved using a stage-dependent prognostic model including negative psychotic symptoms (observed flattened affect, subjective impaired motor functioning), impaired social functioning and distress associated with suspiciousness. Treatment intensity may be stratified and personalized using the risk stratification.
Although there is evidence for the effectiveness of interventions for psychosis among ultra-high-risk (UHR) groups, health economic evaluations are lacking. This study aimed to determine the cost effectiveness and cost–utility of cognitive–behavioural therapy (CBT) to prevent first-episode psychosis.
The Dutch Early Detection and Intervention Evaluation study was a randomized controlled trial of 196 UHR patients with an 18-month follow-up. All participants were treated with routine care (RC) for non-psychotic disorders. The experimental group (n = 95) received add-on CBT to prevent first-episode psychosis. We report the intervention, medical and travel costs, as well as costs arising from loss of productivity. Treatment response was defined as psychosis-free survival and quality-adjusted life years (QALYs) gained.
In the cost-effectiveness analysis, the proportion of averted psychoses was significantly higher in the CBT condition (89.5% v. 76.2%). CBT showed a 63.7% probability of being more cost effective, because it was less costly than RC by US$844 (£551) per prevented psychosis. In the cost–utility analysis, QALY health gains were slightly higher for CBT than for RC (0.60 v. 0.57) and the CBT intervention had a 52.3% probability of being the superior treatment because, for equal or better QALY gains, the costs of CBT were lower than those of RC.
Add-on preventive CBT for UHR resulted in a significant reduction in the incidence of first psychosis. QALY gains show little difference between the two conditions. The CBT intervention proved to be cost saving.
Gallium nitride wafer epitaxy on large diameter substrates is critical for the future fabrication of large area UV linear or 2D imaging arrays, as well as for the economical production of other GaN-based devices. Typical group III-nitride deposition is now performed on 2-inch diameter or smaller sapphire substrates. Reported here are visible blind, UV GaN p-i-n photodetectors which have been fabricated on 3-inch diameter (0001) sapphire substrates by RF atomic nitrogen plasma MBE. The uniformity across the wafer of spectral responsivity and shunt resistance (R0) for the p-i-n photodetectors has been characterized. Spectral responsivity and 1/f noise as a function of temperature exceeding 250°C will be presented for the GaN p-i-n photodetectors. Spectral response with >0.17 A/W at peak wavelength and having 4-6 orders of magnitude visible rejection has been achieved. 1/f noise typically less than 10−14 A/Hz1/2 at room temperature also has been achieved with GaN p-i-n photodiodes. The results have been correlated with proposed models for dark current and 1/f noise in GaN diodes.
Depression is a clinically relevant dimension, associated with both positive and negative symptoms, in patients with schizophrenia. However, in siblings it is unknown whether depression is associated with subclinical positive and negative symptoms.
Depressive symptoms and their association with positive and negative symptoms were examined in 813 healthy siblings of patients with a non-affective psychotic disorder, 822 patients and 527 healthy controls. Depressive episodes meeting DSM-IV-TR criteria (lifetime) and depressed mood (lifetime) were assessed with the Comprehensive Assessment of Symptoms and History (CASH) in all three groups. In the patient group, the severity of positive and negative psychosis symptoms was assessed with the CASH. In the siblings and healthy controls, the severity of subclinical psychosis symptoms was assessed with the Community Assessment of Psychic Experiences (CAPE).
Patients reported more lifetime depressed mood and more depressive episodes than both siblings and controls. Siblings had a higher chance of meeting lifetime depressive episodes than the controls; no significant differences in depressed mood were found between siblings and controls. In all three groups the number and duration of depressive symptoms were associated with (sub)clinical negative symptoms. In the patients and siblings the number of depressive symptoms was furthermore associated with (sub)clinical positive symptoms. Finally, lifetime depressed mood showed familial clustering but this clustering was absent for lifetime depressive episodes.
These findings suggest that a co-occurring genetic vulnerability for both depressive and psychotic symptomatology exists on a clinical and a subclinical level.
Gallium nitride wafer epitaxy on large diameter substrates is critical for the future fabrication of large area UV linear or 2D imaging arrays, as well as for the economical production of other GaN-based devices. Typical group III-nitride deposition is now performed on 2-inch diameter or smaller sapphire substrates. Reported here are visible blind, UV GaN p-in photodetectors which have been fabricated on 3-inch diameter (0001) sapphire substrates by RF atomic nitrogen plasma MBE. The uniformity across the wafer of spectral responsivity and shunt resistance (R0) for the p-i-n photodetectors has been characterized. Spectral responsivity and 1/f noise as a function of temperature exceeding 250°C will be presented for the GaN p-i-n photodetectors. Spectral response with >0.17 A/W at peak wavelength and having 4-6 orders of magnitude visible rejection has been achieved. 1/f noise typically less than 10-14 A/Hz1/2 at room temperature also has been achieved with GaN p-i-n photodiodes. The results have been correlated with proposed models for dark current and 1/f noise in GaN diodes.
In-situ cathodoluminescence (CL) is presented as a technique to optimize GaN, and AlGaN films deposited by MBE using an RF plasma as a source of reactive nitrogen. Excitation of the MBE grown nitride films is conveniently achieved in the preparation chamber using an Auger electron gun. The photoemission is monitored through a side port and dispersed with a 1/8 m monochromator with a typical resolution of 3 nm. The in-situ CL spectra of AlGaN and GaN films provides quick determination of both material composition, doping, and quality from the position and width of the band edge emission. The use of CL for the assessment of material composition in the growth of nitride materials is extremely beneficial since the complementary technique of RHEED oscillations is not routinely observed for these systems. The determination of material quality using CL has been used to optimize growth conditions for GaN PIN junction photovoltaic detectors on (0001) sapphire. Detectors having peak responsivity of 0.175 AAV at the GaN band edge of 365 nm and a UV to visible rejection ratio of greater than 105 have been fabricated. The high rejection ratio is accredited to the reduction of the yellow defect levels in the MBE grown material. Material optimization using in-situ CL for growth of AlGaN MODFETs having drain currents of 425 ma/mm and gm of 66 mS/mm is discussed.
AlGaN photodiode detectors are grown on (0001) sapphire by RF atomic nitrogen plasma molecular beam epitaxy. Both individual detectors and 1 × 10 element arrays are fabricated. The individual detectors have active areas of 0.5 mm2, 1.0 mm2, and 2.0 mm2. Individual elements in the l × 10 detector arrays range in size from 250×250 μm to 450×450 μm. The detectors are fabricated using a chlorine-based reactive ion etch (RIE) and refractory metal ohmic contacts. At room temperature, GaN p-i-n photovoltaic detectors show peak responsivity at 360 nm as high as 0.198 A/W, corresponding to an internal quantum efficiency of 85%. These detectors also exhibit five orders of magnitude of rejection for radiation longer than 500 nm. The electrical and spectral characteristics of these detectors are examined at elevated temperatures. The short wavelength UV responsivity remains fairly constant at elevated temperatures, while the peak responsivity actually increases with increasing temperature. The smooth surface morphology of heavily doped p-type material grown by MBE makes possible diode structures with a p-type bottom layer. The effect of the spectrally broader p-type material in the photodiode responsivity will be discussed.
X-band performance, high temperature DC operation, and uniformity have been evaluated for 1 μm gate AlGaN/GaN HEMTs grown by RF atomic nitrogen plasma MBE. Deposition and fabrication were performed on 2-inch (0001) saphirre substrates to determine process uniformity. HEMTs with 300 μm total gate width and dual gate finger geometry have been fabricated with 650–700 cm2/V s mobility. Maximum frequency cut-offs on the order of of 8–10 were achieved. DC performance at room temperature was >500 mA/mm, and external transconductance was >70mS/mn. The transistors operated at test temperatures of 425°C.
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