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Le TDA/H est caractérisé par des symptômes d’inattention pouvant inclure une hyperactivité et de l’impulsivité, suggérant un déficit du contrôle volontaire. Les mouvements oculomoteurs dépendent de structures cérébrales impliquées dans l’attention et le contrôle moteur, deux fonctions altérées dans le TDA/H. L’objectif de cette étude était d’évaluer l’effet du MPH sur les mouvements oculomoteurs de patients TDAH. Cinquante neuf patients TDA/H, naïfs de traitement (44 adultes ; 15 enfants) ont participé à l’étude. Des tâches de saccades et d’antisaccades ont été proposées à J1 (T1 et T2) aux patients non traités. Les mêmes tâches leur ont été proposées à J2 (T1 et T2), après une prise de MPH (10 mg per os). L’effet du traitement a été mesuré en comparant les performances à J1 et J2. L’effet test-retest a été mesuré en comparant les performances à T1 et T2. Les paramètres analysés étaient : le pourcentage d’anticipations et d’erreurs de direction ; la latence ; le gain (précision de la saccade sur la cible) ; la vitesse moyenne. Nous avons retrouvé un effet bénéfique du traitement sur le pourcentage d’anticipations (p < 0,009) ; sur le pourcentage d’erreurs de direction (p < 0,0002) ; sur les latences (p < 0,0008) et sur le gain (p < 0,01). Les performances des patients étaient significativement meilleures avec traitement que sans traitement de manière générale et en particulier dans les tâches d’antisaccades. Les dispersions individuelles étaient également moins importantes avec traitement que sans traitement (p < 0,0001). Aucun effet test-retest n’a été retrouvé. Le MPH modifie la programmation motrice et la réponse à l’inhibition des patients présentant un TDA/H. Le bénéfice du traitement peut s’observer grâce à des tâches de saccades réflexes ou des tâches plus cognitives telles que les antisaccades, dès la première prise de traitement. Ces résultats suggèrent que les mouvements oculomoteurs pourraient être un bon marqueur d’efficacité du MPH. Le MPH modifie la programmation motrice et la réponse à l’inhibition des patients présentant un TDA/H. Le bénéfice du traitement peut s’observer grâce à des tâches de saccades visuellement guidées ou des tâches plus cognitives telles que les antisaccades, dès la première prise de traitement. Ces résultats suggèrent que les mouvements oculomoteurs pourraient être un bon marqueur individuel d’efficacité du MPH.
Untreated disrupted sleep is an important precursor for the development of depression. Several studies have confirmed the negative impact of pre-sleep cognitive and emotional activity such as worry and negative affect on subsequent sleep. Emotional stress may affect latencies to sleep onset, to REM-sleep and other markers of sleep disruption such as arousals. The way we cope with emotional stressors and events may have important effects on subsequent sleep.
In this study we investigated the effects of a failure-experience on polysomnographically recorded sleep in volunteers. Furthermore we explored whether dispositional coping factors such as emotion regulation moderate this effect.
In contrast to the control condition the effect of the failure induction was clearly observed in emotional experience as well as within the physiological sleep architecture. Furthermore, we notice a tendency in which not only emotional experience, but also sleep physiology was affected by low and high emotional approach as emotion regulation style (cf. Stanton, 2000).
The present study has shown that emotional stress as a failure experience before sleep-goes together with a worsening of mood, an increase of level of rumination and enhanced sleep fragmentation with a moderating effect of emotion regulation as dispositional factor.
Beds in Israel's private psychiatric hospitals, where the standard of care is markedly lower than in state-run facilities, are being closed down. Their patients - many hospitalized for years - are being re-assessed and those still needing inpatient care transferred to state hospitals. The aim is to give a better quality of life, conduct a thorough psychiatric reappraisal and offer the latest therapeutic options.
The merged Be'er Ya'akov-Ness Ziona- Israel Prisons Service Mental Health Center set up a multidisciplinary team to conduct a coordinated process of reappraisal, preparation, reorganization and admission for these patients and their families. We found in the patients complex self-management problems, a high level of dependency, severe neglect, a range of tendencies to violence, and mistrust of the staff. The family members revealed high levels of anxiety and fear. Given this situation, a nursing staffer was appointed to liaise with the families, be freely available for consultation and act as patient advocate.
In this presentation we describe the core principles for this multidisciplinary reassessment and re-placement process, which began by assessing the patients in their setting of origin. We report on the planning of new interventions incorporating the latest therapeutic advances, exceptional incidents, changing the profile of the psychogeriatric ward, etc. We offer the conclusions and recommendations drawn from this change process, undergone equally by patients, family members and staff, and report on its results, which for many of the patients led to a more open care-setting in the community and for some a return home.
Food craving (FC) has been linked todepressive mood before. However, no study exists evaluating FC in a sample of bipolar disorder (BD).
This study aimed to determine the prevalence of FC in individuals with BD during euthymia.
Fifty individuals with a BD diagnosis according to the DSM-IV guidelines were drawn from the dedicated outpatient center of the University Clinic of Psychiatry Graz. Data were compared with data from a healthy control sample (HC, n=50). All probands took part in the BIPFAT study exploring shared pathophysiological pathways of obesity and brain function in BD. Participants completed a comprehensive diagnostic battery (including the Food Craving Questionnaire by White et al. 2002) measuring anamnestic, anthropometric, and clinical data. We performed a MANCOVA controlling for key covariates including gender, age, body mass index, smoking, mood stabilizing medication, and lipid levels.
BD patients exhibited significantly more total food craving (F=6.10, p=.016) and more sweets craving than controls (F=6.38, p=.014). Additionally, levels of fat craving were higher by trend in the male patient group than in the male control group (F=3.15, p=.087).
A higher prevalence of FC in BD patients than in controls suggests that FC may be of clinical importance in BD. Potentially, FC plays a role in the development of obesity, a well-known risk factor for unfavorable course of illness in BD. Furthermore, the impact of dysfunctions in the serotonergic system and/or an altered activation of the hypothalamic-pituitary-adrenal axis in relationship to increased FC are critically discussed.
Postgraduate medical trainees experience high rates of burnout, but evidence regarding psychiatric trainees is missing. We aim to determine burnout rates among psychiatric trainees, and identify individual, educational and work-related factors associated with severe burnout.
In an online survey psychiatric trainees from 22 countries were asked to complete the Maslach Burnout Inventory (MBI-GS) and provide information on individual, educational and work-related parameters. Linear mixed models were used to predict the MBI-GS scores, and a generalized linear mixed model to predict severe burnout.
This is the largest study on burnout and training conditions among psychiatric trainees to date. Complete data were obtained from 1980 out of 7625 approached trainees (26%; range 17.8–65.6%). Participants were 31.9 (SD 5.3) years old with 2.8 (SD 1.9) years of training. Severe burnout was found in 726 (36.7%) trainees. The risk was higher for trainees who were younger (P < 0.001), without children (P = 0.010), and had not opted for psychiatry as a first career choice (P = 0.043). After adjustment for socio-demographic characteristics, years in training and country differences in burnout, severe burnout remained associated with long working hours (P < 0.001), lack of supervision (P < 0.001), and not having regular time to rest (P = 0.001). Main findings were replicated in a sensitivity analysis with countries with response rate above 50%.
Besides previously described risk factors such as working hours and younger age, this is the first evidence of negative influence of lack of supervision and not opting for psychiatry as a first career choice on trainees’ burnout.
The science of studying diamond inclusions for understanding Earth history has developed significantly over the past decades, with new instrumentation and techniques applied to diamond sample archives revealing the stories contained within diamond inclusions. This chapter reviews what diamonds can tell us about the deep carbon cycle over the course of Earth’s history. It reviews how the geochemistry of diamonds and their inclusions inform us about the deep carbon cycle, the origin of the diamonds in Earth’s mantle, and the evolution of diamonds through time.
We investigated a large multistate outbreak that occurred in the United States in 2015–2016. Epidemiologic, laboratory, and traceback studies were conducted to determine the source of the infections. We identified 907 case-patients from 40 states with illness onset dates ranging from July 3, 2015 to March 2, 2016. Sixty-three percent of case-patients reported consuming cucumbers in the week before illness onset. Ten illness sub-clusters linked to events or purchase locations were identified. All sub-clusters investigated received cucumbers from a single distributor which were sourced from a single grower in Mexico. Seventy-five cucumber samples were collected, 19 of which yielded the outbreak strain. Whole genome sequencing performed on 154 clinical isolates and 19 cucumber samples indicated that the sequenced isolates were closely related genetically to one another. This was the largest US foodborne disease outbreak in the last ten years and the third largest in the past 20 years. This was at least the fifth multistate outbreak caused by contaminated cucumbers since 2010. The outbreak is noteworthy because a recall was issued only 17 days after the outbreak was identified, which allowed for the removal of the contaminated cucumbers still available in commerce, unlike previous cucumber associated outbreaks. The rapid identification and response of multiple public health agencies resulted in preventing this from becoming an even larger outbreak.
Objectives: A growing body of research suggests that regular participation in long-term exercise is associated with enhanced cognitive function. However, less is known about the beneficial effects of acute exercise on semantic memory. This study investigated brain activation during a semantic memory task after a single session of exercise in healthy older adults using functional magnetic resonance imaging (fMRI). Methods: Using a within-subjects counterbalanced design, 26 participants (ages, 55–85 years) underwent two experimental visits on separate days. During each visit, participants engaged in 30 min of rest or stationary cycling exercise immediately before performing a Famous and Non-Famous name discrimination task during fMRI scanning. Results: Acute exercise was associated with significantly greater semantic memory activation (Famous>Non-Famous) in the middle frontal, inferior temporal, middle temporal, and fusiform gyri. A planned comparison additionally showed significantly greater activation in the bilateral hippocampus after exercise compared to rest. These effects were confined to correct trials, and as expected, there were no differences between conditions in response time or accuracy. Conclusions: Greater brain activation following a single session of exercise suggests that exercise may increase neural processes underlying semantic memory activation in healthy older adults. These effects were localized to the known semantic memory network, and thus do not appear to reflect a general or widespread increase in brain blood flow. Coupled with our prior exercise training effects on semantic memory-related activation, these data suggest the acute increase in neural activation after exercise may provide a stimulus for adaptation over repeated exercise sessions. (JINS, 2019, 25, 557–568)
Foodborne non-typhoidal salmonellosis causes approximately 1 million illnesses annually in the USA. In April 2015, we investigated a multistate outbreak of 65 Salmonella Paratyphi B variant L(+) tartrate(+) infections associated with frozen raw tuna imported from Indonesia, which was consumed raw in sushi. Forty-six (92%) of 50 case-patients interviewed ate sushi during the week before illness onset, and 44 (98%) of 45 who specified ate sushi containing raw tuna. Two outbreak strains were isolated from the samples of frozen raw tuna. Traceback identified a single importer as a common source of tuna consumed by case-patients; this importer issued three voluntary recalls of tuna sourced from one Indonesian processor. Four Salmonella Weltevreden infections were also linked to this outbreak. Whole-genome sequencing was useful in establishing a link between Salmonella isolated from ill people and tuna. This outbreak highlights the continuing foodborne illness risk associated with raw seafood consumption, the importance of processing seafood in a manner that minimises contamination with pathogenic microorganisms and the continuing need to ensure imported foods are safe to eat. People at higher risk for foodborne illness should not consume undercooked animal products, such as raw seafood.
Background: Planning for neurology training necessitated a reflection on the experience of graduates. We explored practice characteristics, and training experience of recent graduates. Methods: Graduates from 2010-2014 completed a survey. Results: Response rate was 37% of 211. 56% were female. 91% were adult neurologists. 65% practiced in an outpatient setting. 63% worked in academics. 85% completed subspecialty training (median 1 year). 36% work 3 days a week or less. 82% took general call (median 1 night weekly). Role preparation was considered very good or excellent for most; however poor or fair ratings were 17% in advocacy and 8% in leadership. Training feedback was at least “good” for 87%. Burnout a few times a week or more was noted by 5% (6% during residency, particularly PGY1 and 5). 64% felt overly burdened by paperwork. Although most felt training was adequate, it was poor or fair at preparing for practice management (85%) and personal balance (55%). Most conditions were under-observed in training environment. Many noted a need for more independent practice development and community neurology. Conclusions: Although our training was found to be very good, some identified needs included advocacy training, and more training in general neurology in the longitudinal outpatient/community settings.
There are striking global inequities in our knowledge of the incidence, aetiology, and outcome of psychotic disorders. For example, only around 10% of research on incidence of psychotic disorders originates in low- and middle-income countries. We established INTREPID I to develop, implement, and evaluate, in sites in India (Chengalpet), Nigeria (Ibadan), and Trinidad (Tunapuna-Piarco), methods for identifying and recruiting untreated cases of psychosis, as a basis for investigating incidence and, subsequently, risk factors, phenomenology, and outcome. In this paper, we compare case characteristics and incidence rates across the sites.
In each site, to identify untreated cases of psychoses in defined catchment areas, we established case detection systems comprising mental health services, traditional and spiritual healers, and key informants.
Rates of all untreated psychoses were 45.9 (per 1 00 000 person-years) in Chengalpet, 31.2 in Ibadan, and 36.9 in Tunapuna-Piarco. Duration of psychosis prior to detection was substantially longer in Chengalpet (median 232 weeks) than in Ibadan (median 13 weeks) and Tunapuna-Piarco (median 38 weeks). When analyses were restricted to cases with a short duration (i.e. onset within preceding 2 years) only, rates were 15.5 in Chengalpet, 29.1 in Ibadan, and 26.5 in Tunapuna-Piarco. Further, there was evidence of age and sex differences across sites, with an older average age of onset in Chengalpet and higher rates among women in Ibadan.
Our findings suggest there may be differences in rates of psychoses and in the clinical and demographic profiles of cases across economically and socially distinct settings.
Cortical atrophy is a biomarker of Alzheimer’s disease (AD) that correlates with clinical symptoms. This study examined changes in cortical thickness from before to after an exercise intervention in mild cognitive impairment (MCI) and healthy elders. Thirty physically inactive older adults (14 MCI, 16 healthy controls) underwent MRI before and after participating in a 12-week moderate intensity walking intervention. Participants were between the ages of 61 and 88. Change in cardiorespiratory fitness was assessed using residualized scores of the peak rate of oxygen consumption (V̇O2peak) from pre- to post-intervention. Structural magnetic resonance images were processed using FreeSurfer v5.1.0. V̇O2peak increased an average of 8.49%, which was comparable between MCI and healthy elders. Overall, cortical thickness was stable except for a significant decrease in the right fusiform gyrus in both groups. However, improvement in cardiorespiratory fitness due to the intervention (V̇O2peak) was positively correlated with cortical thickness change in the bilateral insula, precentral gyri, precuneus, posterior cingulate, and inferior and superior frontal cortices. Moreover, MCI participants exhibited stronger positive correlations compared to healthy elders in the left insula and superior temporal gyrus. A 12-week moderate intensity walking intervention led to significantly improved fitness in both MCI and healthy elders. Improved V̇O2peak was associated with widespread increased cortical thickness, which was similar between MCI and healthy elders. Thus, regular exercise may be an especially beneficial intervention to counteract cortical atrophy in all risk groups, and may provide protection against future cognitive decline in both healthy elders and MCI. (JINS, 2015, 21, 757–767)
The flow inside a constant-width wind-tunnel contraction is simulated by solving the Reynolds-Averaged Navier-Stokes equations with an eddy-viscosity turbulence model. The results show the presence of longitudinal vortices near the sidewalls centreline. This confirms a former hypothesis involving the generation of skew-induced longitudinal vorticity within the sidewalls boundary layers. Detailed analysis reveals that the flow structure is influenced by viscous effects in the boundary layers and streamline curvature in the potential flow. Three-dimensional boundary-layer profiles on the contraction sidewall are analysed in the framework of the streamline co-ordinate system and its associated hodographic diagram. The resulting profiles help understand the generation of secondary flows and the associated longitudinal vorticity.
In this final chapter we focus on the interactions between convection, magnetic fields and rotation in stars that, like our Sun, possess deep outer convection zones, with the aim of relating theory to observations. Following on from the treatment of planetary dynamos in Chapter 7, we begin by considering the large-scale fields that are responsible for the solar cycle and survey attempts to model solar and stellar dynamos, ranging from mean-field dynamo theory to the results of the latest massive computations (Charbonneau 2010).
Then we turn to small-scale behaviour at the solar surface. Over the past two decades detailed observations – from the ground, from the stratosphere and from space – have revealed a wealth of detailed information about the structure and properties of magnetic features on the Sun and on other magnetically active stars. Although the idealized theoretical models that we have described in previous chapters do explain the general behaviour of magnetic fields at the surface of a vigorously convecting star, any more detailed confrontation of theory with observations demands a more precise description of the stellar plasma. Two properties are particularly important. The first is the role of ionization: in the Sun, hydrogen is ionized just below the visible photosphere, with resulting changes to the equation of state and the value of γ that affect the superadiabatic gradient and lead to the presence of a deep convection zone (Stix 2002).
The last thirty years have seen great leaps forward in the subject of magnetoconvection. Computational techniques can now explain exotic nonlinear behaviour, transition to chaos and the formation of structures that can be observed on the surface of the Sun. Here, two leading experts present the current state of knowledge of the subject. They provide a mathematical and numerical treatment of the interactions between electrically conducting fluids and magnetic fields that lead to the complex structures and rich behaviour observed on the Sun and other stars, as well as in the interiors of planets like the Earth. The authors' combined analytical and computational approach provides a model for the study of a wide range of related problems. The discussion includes bifurcation theory, chaotic behaviour, pattern formation in two and three dimensions, and applications to geomagnetism and to the properties of sunspots and other features at the solar surface.
The original motivation for studying magnetoconvection came from the interplay between magnetic fields and convection that is observed in sunspots. Since then this subject has developed into a fascinating and important topic in its own right. We therefore decided to write a comprehensive monograph that would cover all aspects of magnetoconvection from the viewpoint of applied mathematics, and as a branch of astrophysical (or geophysical) fluid dynamics. Thus we shall emphasize the role of nonlinear dynamics, and focus on idealized model problems rather than on ambitious realistic simulations.
The properties of convection in an electrically conducting fluid with an imposed magnetic field are interesting not only in themselves but also as the richest example of double-diffusive behaviour. Linear theory allows both steady and oscillatory solutions, while theoretical descriptions of nonlinear behaviour demonstrate the power of bifurcation theory, with examples of bifurcation sequences that lead to chaos, as well as of group-theoretic applications to pattern selection. These mathematical results can all be related to carefully constructed numerical experiments.
Although we shall adopt an applied mathematical approach, our discussion is particularly relevant to the behaviour of magnetic fields at the surface of the Sun, which are now being observed in unprecedented detail, both from the ground and from space. Convection also interacts with magnetic fields in the solar interior, as it does in other stars, and is a key component of solar and stellar dynamos.