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Comparisons of antipsychotics with placebo can be biased by unblinding due to side effects. Therefore, this meta-analysis compared the efficacy of antipsychotics for acute schizophrenia in trials using barbiturates or benzodiazepines as active placebos.
Randomized controlled trials (RCTs) in acute schizophrenia with at least 3 weeks duration and comparing any antipsychotic with barbiturates or benzodiazepines were eligible. ClinicalTrials.gov, CENTRAL, EMBASE, MEDLINE, PsycINFO, PubMed, WHO-ICTRP as well as previous reviews were searched up to 9 January 2018. Two separate meta-analyses, one for barbiturates and one for benzodiazepines, were conducted using random-effects models. The primary outcome was response to treatment, and mean values of schizophrenia rating scales and dropouts were analyzed as secondary outcomes. This study is registered with PROSPERO (CRD42018086263).
Seven barbiturate-RCTs (number of participants n = 1736), and two benzodiazepine-RCTs (n = 76) were included in the analysis. The studies were published between 1960 and 1968 and involved mainly chronically ill patients. More patients on antipsychotics in comparison to barbiturates achieved a ‘good’ response (36.2% v. 16.8%; RR 2.15; 95% CI 1.36–3.41; I2 = 48.9) and ‘any’ response (57.4% v. 27.8%; RR 2.07; 95% CI 1.35–3.18; I2 = 68.2). In a single small trial (n = 60), there was no difference between antipsychotics and benzodiazepines on ‘any’ response (74.7% v. 65%; RR 1.15; 95% CI 0.82–1.62).
Antipsychotic drugs were more efficacious than barbiturates, based on a large sample size. Response ratios were similar to those observed in placebo-controlled trials. The results on benzodiazepines were inconclusive due to the small number of studies and participants.
Positive symptoms are a useful predictor of aggression in schizophrenia. Although a similar pattern of abnormal brain structures related to both positive symptoms and aggression has been reported, this observation has not yet been confirmed in a single sample.
To study the association between positive symptoms and aggression in schizophrenia on a neurobiological level, a prospective meta-analytic approach was employed to analyze harmonized structural neuroimaging data from 10 research centers worldwide. We analyzed brain MRI scans from 902 individuals with a primary diagnosis of schizophrenia and 952 healthy controls.
The result identified a widespread cortical thickness reduction in schizophrenia compared to their controls. Two separate meta-regression analyses revealed that a common pattern of reduced cortical gray matter thickness within the left lateral temporal lobe and right midcingulate cortex was significantly associated with both positive symptoms and aggression.
These findings suggested that positive symptoms such as formal thought disorder and auditory misperception, combined with cognitive impairments reflecting difficulties in deploying an adaptive control toward perceived threats, could escalate the likelihood of aggression in schizophrenia.
Befriending by volunteers has the potential to reduce the frequent social isolation of patients with schizophrenia and thus improve health outcomes. However, trial-based evidence for its effectiveness is limited.
To conduct a randomised controlled trial of befriending for patients with schizophrenia or related disorders.
Patients were randomised to a befriending programme for 1 year or to receive information about social activities only (trial registration: ISRCTN14021839). Outcomes were assessed masked to allocation at the end of the programme; at 12 months and at a 6-month follow-up. The primary outcome was daily time spent in activities (using the Time Use Survey (TUS)) with intention-to-treat analysis.
A total of 124 patients were randomised (63 intervention, 61 active control) and 92 (74%) were followed up at 1 year. In the intervention group, 49 (78%) met a volunteer at least once and 31 (49%) had more than 12 meetings. At 1 year, mean TUS scores were more than three times higher in both groups with no significant difference between them (adjusted difference 8.9, 95% CI −40.7 to 58.5, P = 0.72). There were no significant differences in quality of life, symptoms or self-esteem. However, patients in the intervention group had significantly more social contacts than those in the control group at the end of the 12-month period. This difference held true at the follow-up 6 months later.
Although no difference was found on the primary outcome, the findings suggest that befriending may have a lasting effect on increasing social contacts. It may be used more widely to reduce the social isolation of patients with schizophrenia.
We generalise Simpson’s nonabelian Hodge correspondence to the context of projective varieties with Kawamata log terminal (klt) singularities. The proof relies on a descent theorem for numerically flat vector bundles along birational morphisms. In its simplest form, this theorem asserts that given any klt variety
and any resolution of singularities, any vector bundle on the resolution that appears to come from
numerically, does indeed come from
. Furthermore, and of independent interest, a new restriction theorem for semistable Higgs sheaves defined on the smooth locus of a normal, projective variety is established.
The English auxiliary system exhibits many lexical exceptions and subregularities, and considerable dialectal variation, all of which are frequently omitted from generative analyses and discussions. This paper presents a detailed, movement-free account of the English Auxiliary System within Sign-Based Construction Grammar (Sag 2010, Michaelis 2011, Boas & Sag 2012) that utilizes techniques of lexicalist and construction-based analysis. The resulting conception of linguistic knowledge involves constraints that license hierarchical structures directly (as in context-free grammar), rather than by appeal to mappings over such structures. This allows English auxiliaries to be modeled as a class of verbs whose behavior is governed by general and class-specific constraints. Central to this account is a novel use of the feature aux, which is set both constructionally and lexically, allowing for a complex interplay between various grammatical constraints that captures a wide range of exceptional patterns, most notably the vexing distribution of unstressed do, and the fact that Ellipsis can interact with other aspects of the analysis to produce the feeding and blocking relations that are needed to generate the complex facts of EAS. The present approach, superior both descriptively and theoretically to existing transformational approaches, also serves to undermine views of the biology of language and acquisition such as Berwick et al. (2011), which are centered on mappings that manipulate hierarchical phrase structures in a structure-dependent fashion.
We present well-resolved large-eddy simulations of turbulent flow through a straight, high aspect ratio cooling duct operated with water at a bulk Reynolds number of
and an average Nusselt number of
. The geometry and boundary conditions follow an experimental reference case and good agreement with the experimental results is achieved. The current investigation focuses on the influence of asymmetric wall heating on the duct flow field, specifically on the interaction of turbulence-induced secondary flow and turbulent heat transfer, and the associated spatial development of the thermal boundary layer and the inferred viscosity variation. The viscosity reduction towards the heated wall causes a decrease in turbulent mixing, turbulent length scales and turbulence anisotropy as well as a weakening of turbulent ejections. Overall, the secondary flow strength becomes increasingly less intense along the length of the spatially resolved heated duct as compared to an adiabatic duct. Furthermore, we show that the assumption of a constant turbulent Prandtl number is invalid for turbulent heat transfer in an asymmetrically heated duct.
Ferroelectrics are promising for nonvolatile memories. However, the difficulty of fabricating ferroelectric layers and integrating them into complementary metal oxide semiconductor (CMOS) devices has hindered rapid scaling. Hafnium oxide is a standard material available in CMOS processes. Ferroelectricity in Si-doped hafnia was first reported in 2011, and this has revived interest in using ferroelectric memories for various applications. Ferroelectric hafnia with matured atomic layer deposition techniques is compatible with three-dimensional capacitors and can solve the scaling limitations in 1-transistor-1-capacitor (1T-1C) ferroelectric random-access memories (FeRAMs). For ferroelectric field-effect-transistors (FeFETs), the low permittivity and high coercive field Ec of hafnia ferroelectrics are beneficial. The much higher Ec of ferroelectric hafnia, however, makes high endurance a challenge. This article summarizes the current status of ferroelectricity in hafnia and explains how major issues of 1T-1C FeRAMs and FeFETs can be solved using this material system.
We present a novel bonding process for gallium nitride-based electronic devices on diamond heat spreaders. In the proposed technology, GaN devices are transferred from silicon (Si) onto single (SCD) and polycrystalline diamond (PCD) substrates by van der Waals bonding. Load-pull measurements on Si and SCD heat spreaders at 3 GHz and 50 V drain bias show comparable power-added-efficiency and output power (Pout) levels. A thermal analysis of the hybrids was performed by comparison of 2 × 1mm2 AlGaN/GaN Schottky diodes on Si, PCD, and SCD, which exhibit a homogeneous field in the channel in contrast to gated transistors. Significantly different currents are observed due to the temperature dependent mobility in the 2DEG channel. These measurements are supported by a 3D thermal finite element analysis, which suggests a large impact of our transfer technique on the thermal resistance of these devices. In summary, we show a promising new GaN-on-diamond technology for future high-power, microwave GaN device applications.
Cognitive decline is an important complication of joint replacement surgeries in senior people.
We determined incidence rates of dementia diagnosis following endoprosthetic joint replacement surgery (upper and lower extremities). The observation period covered up to 28 quarters using German claims data comprising 154,604 cases 65 years and older. Effects were controlled for cerebrovascular and vascular risk factors, age, sex, the presence of a diagnosis of delirium, and regular prescription of sedative or analgesic drugs (SAD).
The rate of incident dementia diagnoses in people without joint replacement surgery was 21.34 per 1,000 person years, compared with 80.76 incident cases when joint replacement surgery was conducted during the quarter of the incident dementia diagnosis; rates declined to 21.77 incident cases 7 and more quarters after joint replacement surgery had taken place. This pattern was maintained when controlling for delirium diagnosis and regular prescription of SAD. Among 10,563 patients with at least one joint replacement surgery, patients with a diagnosis of delirium in the quarter of the surgery were at increased risk of a dementia diagnosis compared to patients without such a diagnosis (HR=2.00, p < 0.001).
In people surviving the high-risk phase for dementia immediately after surgery, long-term risk of dementia may reach the level of those without surgery. These findings encourage consequent perioperative management to reduce the risk of dementia as well as prospective studies of potentially beneficial effects of joint replacement surgery on mid- to long-term recovery of mobility and cognition in geriatric patients.
In this review article, we discuss selected developments regarding the role of the equation of state in simulations of core-collapse supernovae. There are no first-principle calculations of the state of matter under supernova conditions since a wide range of conditions is covered, in terms of density, temperature, and isospin asymmetry. Instead, model equation of state are commonly employed in supernova studies. These can be divided into regimes with intrinsically different degrees of freedom: heavy nuclei at low temperatures, inhomogeneous nuclear matter where light and heavy nuclei coexist together with unbound nucleons, and the transition to homogeneous matter at high densities and temperatures. In this article, we discuss each of these phases with particular view on their role in supernova simulations.
While covering all commentaries, our response specifically focuses on the following issues: How can the hypothesis of emotional distancing (qua art framing) be compatible with stipulating high levels of felt negative emotions in art reception? Which concept of altogether pleasurable mixed emotions does our model involve? Can mechanisms of predictive coding, social sharing, and immersion enhance the power of our model?
West Antarctic climate and surface mass balance (SMB) records are sparse. To fill this gap, regional atmospheric climate modelling is useful, providing that such models are employed at sufficiently high horizontal resolution and coupled with a snow model. Here we present the results of a high-resolution (5.5 km) regional atmospheric climate model (RACMO2) simulation of coastal West Antarctica for the period 1979–2015. We evaluate the results with available in situ weather observations, remote-sensing estimates of surface melt, and SMB estimates derived from radar and firn cores. Moreover, results are compared with those from a lower-resolution version, to assess the added value of the resolution. The high-resolution model resolves small-scale climate variability invoked by topography, such as the relatively warm conditions over ice-shelf grounding zones, and local wind speed accelerations. Surface melt and SMB are well reproduced by RACMO2. This dataset will prove useful for picking ice core locations, converting elevation changes to mass changes, for driving ocean, ice-sheet and coupled models, and for attributing changes in the West Antarctic Ice Sheet and shelves to changes in atmospheric forcing.
The large-scale thickness distribution of sea ice was measured during several campaigns in the European Arctic north of Svalbard from 2007 using an airborne electromagnetic induction device. In August 2010 and April-May 2011, this was complemented by extensive on-ice work including measurements of snow thickness and freeboard. Ice thicknesses show a clear difference between the seasons, with thicker ice during spring than in summer. In spring 2011, negative freeboard and flooding were observed as a result of the extensive snow cover. We find that the characteristics of the first-year sea ice allow combining observations from different years. The ice thickness in the marginal ice zone increases with increasing latitude and increasing distance to the ice edge; however, in the inner ice pack from ∼100 km from the ice edge the thickness remains almost constant. Modal ice thickness in spring reaches 2.4 m whereas in summer it is 1.0–1.4 m. Our study provides new insight into ice thickness distributions of a typical ice cover consisting of mainly first- and second-year ice, which may become the dominant ice type in the Arctic in the future.
Pulsed laser deposition is one of the most flexible growth methods for high-quality epitaxial multifunctional thin films and short-period superlattices. The following examples of current research interest demonstrate the state-of-the art: First, it is shown that the magnetoelectric performance of multiferroic BiFeO3–BaTiO3 (001)-oriented superlattices depends on the crystalline coherence of the different layers at the interfaces. Second, it is exemplified that dielectric-plasmonic superlattices built from the electrically insulating oxide MgO and the metallically conducting nitride TiN are promising metamaterials with hyperbolic dispersion. As a third example, it is demonstrated that LaNiO3- and LaMnO3-based superlattices with (001)-, (011)-, and (111)-out-of-plane orientation and controlled single layer thickness from 2 to 15 atomic monolayers show metal-insulator transitions and tunable gaps, in partial agreement with density functional theory calculations. Underlined by these examples, it is shown that the precise control of an epitaxially coherent, or two-dimensional layer-by-layer growth, named after Jan van der Merwe, is a prerequisite to achieve the desired functionality of oxide–oxide and oxide–nitride superlattices.
Dynamic CT angiography provides haemodynamic assessment combined with detailed information on complex cardiac anatomy in patients with congenital malformations such as multistage correction of Fallot’s Pentalogy.
Why are negative emotions so central in art reception far beyond tragedy? Revisiting classical aesthetics in the light of recent psychological research, we present a novel model to explain this much discussed (apparent) paradox. We argue that negative emotions are an important resource for the arts in general, rather than a special license for exceptional art forms only. The underlying rationale is that negative emotions have been shown to be particularly powerful in securing attention, intense emotional involvement, and high memorability, and hence is precisely what artworks strive for. Two groups of processing mechanisms are identified that conjointly adopt the particular powers of negative emotions for art's purposes. The first group consists of psychological distancing mechanisms that are activated along with the cognitive schemata of art, representation, and fiction. These schemata imply personal safety and control over continuing or discontinuing exposure to artworks, thereby preventing negative emotions from becoming outright incompatible with expectations of enjoyment. This distancing sets the stage for a second group of processing components that allow art recipients to positively embrace the experiencing of negative emotions, thereby rendering art reception more intense, more interesting, more emotionally moving, more profound, and occasionally even more beautiful. These components include compositional interplays of positive and negative emotions, the effects of aesthetic virtues of using the media of (re)presentation (musical sound, words/language, color, shapes) on emotion perception, and meaning-making efforts. Moreover, our Distancing-Embracing model proposes that concomitant mixed emotions often help integrate negative emotions into altogether pleasurable trajectories.