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An ageing population leading to more chronic disease is straining healthcare systems. This paper makes two core contributions to healthcare systems design research: Firstly, a systemic techno-behavioural approach is presented to support intervention design with value-effective health outcomes. The systemic techno-behavioural perspective takes into consideration the interaction between three angles: The current healthcare system in place, the technological opportunities for addressing an issue and a broader and deeper understanding of the behaviour of those involved. The purpose of considering these three angels is to create interventions that are more robust. This will help inform healthcare systems design researchers and other stakeholders. Secondly, it is proposed that interventions should be grounded in behavioural theory, a collection of theories are presented to be incorporated in the design process of interventions. The systemic techno-behavioural approach is applied to dementia care highlighting the need to understand the dynamic relationship between the context of the current healthcare delivery system, technology, and behaviour to improve quality of care during the progression of the disease.
Depression and obesity are highly prevalent, and major impacts on public health frequently co-occur. Recently, we reported that having depression moderates the effect of the FTO gene, suggesting its implication in the association between depression and obesity.
To confirm these findings by investigating the FTO polymorphism rs9939609 in new cohorts, and subsequently in a meta-analysis.
The sample consists of 6902 individuals with depression and 6799 controls from three replication cohorts and two original discovery cohorts. Linear regression models were performed to test for association between rs9939609 and body mass index (BMI), and for the interaction between rs9939609 and depression status for an effect on BMI. Fixed and random effects meta-analyses were performed using METASOFT.
In the replication cohorts, we observed a significant interaction between FTO, BMI and depression with fixed effects meta-analysis (β=0.12, P = 2.7 × 10−4) and with the Han/Eskin random effects method (P = 1.4 × 10−7) but not with traditional random effects (β = 0.1, P = 0.35). When combined with the discovery cohorts, random effects meta-analysis also supports the interaction (β = 0.12, P = 0.027) being highly significant based on the Han/Eskin model (P = 6.9 × 10−8). On average, carriers of the risk allele who have depression have a 2.2% higher BMI for each risk allele, over and above the main effect of FTO.
This meta-analysis provides additional support for a significant interaction between FTO, depression and BMI, indicating that depression increases the effect of FTO on BMI. The findings provide a useful starting point in understanding the biological mechanism involved in the association between obesity and depression.
Old age depression is often difficult to discriminate from dementia (particularly of Alzheimer type) – particularly cross-sectionally. Incident dementia is frequently associated with depressed mood and agitation; depression in the elderly goes together with executive and memory dysfunctions; associated psychotic symptoms and activity-of-daily-life dysfunctions are shared by both conditions as well as major risk factors as vascular and metabolic factors. Frequently both syndromes are “masking” each other; depression may furthermore present as the first clinical sign of Alzheimers disease.
Yet, both clinical syndromes/disorders emerging from quite different are pathogenic neurobiological mechanisms with differentiating neuropsychological, – imaging and – chemical features. Clinical tools can be derived and enable accurate differential diagnosis. Thus, the distinction between both syndromes is a first instance for biomarker supported differential diagnoses in psychiatry.
Disclosure of interest
The author has not supplied his declaration of competing interest.
The negative image of psychiatry is not only due to unfavourable communication with the media, but is basically a problem of self-conceptualization. It results both from unjustified prejudices of the general public, mass media and health care professionals and of own unfavourable coping with external and internal concerns.
Issues related to negative stereotypes of psychiatry include overestimation of coercion, associative stigma, lack of public knowledge, need of simplification of complex mental issues, problem of the continuum between normality and psychopathology, competition with medical and non-medical disciplines, and psychopharmacological treatment.
Issues related to psychiatry's own contribution to being underestimated include lack of a clear professional identity, lack of biomarkers supporting clinical diagnoses, limited consensus about best treatment options, lack of collaboration with other medical disciplines and low recruitment rates among medical students.
Much can be improved to achieve a positive self-concept, however, psychiatry will remain a profession with an exceptional position among the medical disciplines which should be seen as its specific strength.
Disclosure of interest
The author has not supplied his declaration of competing interest.
We document characteristics of tephra, including facies and geochemistry, from 27 subsurface sites in the Sacramento–San Joaquin Delta, California, to obtain stratigraphic constraints in a complex setting. Analyzed tephra deposits correlate with: 1) an unnamed tephra from the Carlotta Formation near Ferndale, California, herein informally named the ash of Wildcat Grade (<~1.450 to >~ 0.780 Ma), 2) the Rockland ash bed (~ 0.575 Ma), 3) the Loleta ash bed (~ 0.390 Ma), and 4) middle Pleistocene volcanic ash deposits at Tulelake, California, and Pringle Falls, Bend, and Summer Lake, Oregon, herein informally named the dacitic ash of Hood (<~0.211 to >~ 0.180 Ma). All four tephra are derived from Cascades volcanic sources. The Rockland ash bed erupted from the southern Cascades and occurs in up to > 7-m-thick deposits in cores from ~ 40 m subsurface in the Sacramento–San Joaquin Delta. Tephra facies and tephra age constraints suggest rapid tephra deposition within fluvial channel and overbank settings, likely related to flood events shortly following volcanic eruption. Such rapidly deposited tephra are important chronostratigraphic markers that suggest varying sediment accumulation rates in Quaternary deposits below the modern Sacramento–San Joaquin Delta. This study provides the first steps in a subsurface Quaternary stratigraphic framework necessary for future hazard assessment.
Strategies to dissect phenotypic and genetic heterogeneity of major depressive disorder (MDD) have mainly relied on subphenotypes, such as age at onset (AAO) and recurrence/episodicity. Yet, evidence on whether these subphenotypes are familial or heritable is scarce. The aims of this study are to investigate the familiality of AAO and episode frequency in MDD and to assess the proportion of their variance explained by common single nucleotide polymorphisms (SNP heritability).
For investigating familiality, we used 691 families with 2–5 full siblings with recurrent MDD from the DeNt study. We fitted (square root) AAO and episode count in a linear and a negative binomial mixed model, respectively, with family as random effect and adjusting for sex, age and center. The strength of familiality was assessed with intraclass correlation coefficients (ICC). For estimating SNP heritabilities, we used 3468 unrelated MDD cases from the RADIANT and GSK Munich studies. After similarly adjusting for covariates, derived residuals were used with the GREML method in GCTA (genome-wide complex trait analysis) software.
Significant familial clustering was found for both AAO (ICC = 0.28) and episodicity (ICC = 0.07). We calculated from respective ICC estimates the maximal additive heritability of AAO (0.56) and episodicity (0.15). SNP heritability of AAO was 0.17 (p = 0.04); analysis was underpowered for calculating SNP heritability of episodicity.
AAO and episodicity aggregate in families to a moderate and small degree, respectively. AAO is under stronger additive genetic control than episodicity. Larger samples are needed to calculate the SNP heritability of episodicity. The described statistical framework could be useful in future analyses.
Aim was to examine depressive symptoms in acutely ill schizophrenia patients on a single symptom basis and to evaluate their relationship with positive, negative and general psychopathological symptoms.
Two hundred and seventy-eight patients suffering from a schizophrenia spectrum disorder were analysed within a naturalistic study by the German Research Network on Schizophrenia. Using the Calgary Depression Scale for Schizophrenia (CDSS) depressive symptoms were examined and the Positive and Negative Syndrome Scale (PANSS) was applied to assess positive, negative and general symptoms. Correlation and factor analyses were calculated to detect the underlying structure and relationship of the patient’s symptoms.
The most prevalent depressive symptoms identified were depressed mood (80%), observed depression (62%) and hopelessness (54%). Thirty-nine percent of the patients suffered from depressive symptoms when applying the recommended cut-off of a CDSS total score of > 6 points at admission. Negligible correlations were found between depressive and positive symptoms as well as most PANSS negative and global symptoms despite items on depression, guilt and social withdrawal. The factor analysis revealed that the factor loading with the PANSS negative items accounted for most of the data variance followed by a factor with positive symptoms and three depression-associated factors.
The naturalistic study design does not allow a sufficient control of study results for the effect of different pharmacological treatments possibly influencing the appearance of depressive symptoms.
Results suggest that depressive symptoms measured with the CDSS are a discrete symptom domain with only partial overlap with positive or negative symptoms.
We studied the effect of a cross-conjugated bridging group (χC) on charge-transfer in a push-pull chromophore system. The hyperpolarizability of such molecules was found to be comparable to that of a fully π-conjugated molecule (πC) with the same donor and acceptor. The cross-conjugated moiety was then applied as a pendant to a fully π-conjugated chromophore containing a tricyanopyrroline acceptor (TCP). The addition of a χC moiety did not alter the intrinsic hyperpolarizability and provides an avenue for extending and aiding πC systems. The molecules were examined by X-ray diffraction (XRD), hyper-Raleigh scattering (HRS) and UV-visible (UV-vis) spectroscopy. Experimental results were compared with the predictions of density functional theory (DFT). Cross-conjugated molecules have comparable β values, relative to πC molecules, due to reduced spatial overlap between the highest occupied molecular orbital (HOMO) and lowest unoccupied molecular orbital (LUMO). Thus, the χC architecture could facilitate independent modification of donor and acceptor strengths while minimizing unfavorable effects on electronic transitions and dipole moments.
Laser heating and annealing of hydrogenated amorphous silicon (a-Si:H) films is of interest for improved material properties. Due to the variety of possible laser treatments with regard to wavelength, pulse duration, scan time etc., the definition of laser impact on the material is a challenge which we try to approach by comparing properties of laser and oven treated materials. Here we report on the effect of oven heat treatment (up to TA= 575°C) on microstructure and hydrogen content of hydrogenated amorphous silicon films, as detected by measurements of infrared absorption and of effusion of hydrogen as well as of implanted helium. The latter technique has been found to measure isolated voids (cavities) of the size of silicon divacancies and larger. Undoped as well as phosphorus and boron doped plasma-deposited a-Si:H films of various hydrogen content (< 15 at.%) were investigated, including undoped device grade a-Si:H. The results show little indication for void-related microstructure in the as-deposited and annealed state for material with a concentration of silicon bonded hydrogen below 5 at. %. At higher hydrogen concentration, evidence is found that hydrogen out-diffusion due to annealing causes isolated voids in concentrations up to about 1020 cm-3. A possible mechanism for the annealing induced (micro-)void generation is discussed.
Incident depression in old age is driven by different factors compared to depression earlier in life: physical risk factors (esp. vascular diseases, macular degeneration, hip fracture and diabetes), sleep disturbances, handicaps and disabilities, social isolation, care-giving and bereavement are dominant risk factors but less so stressful life conditions. Some protective factors are especially active in the old age as optimism and experienced sense of life despite reduced physical health. In this context modifiable risk factors present as targets for prevention of depression in the population of elderly. In addition, general preventive measures as physical and mental activity and healthy food as well as maintenance of physical health are useful. Those measures need to be implemented in primary care programmes in addition with stepped care models in case of emergence of depressive symptoms and of full-blown depression. In contrast, universal prevention measures of late-life depression on a general population level are currently not evidence-based. We will present evidence from epidemiological and service care studies to demonstrate feasibility and efficacy of those preventive and treatment measures.
Two methods for the fabrication of flexible and stretchable photonic crystal slabs are demonstrated and compared. In both cases a periodically nanostructured polydimethylsiloxane (PDMS) membrane is used as substrate. The first method is based on oblique-angle vapor deposition of SiO as a high refractive index material onto the nanostructured membrane. The deposition is made at an angle of 45° to the surface. The grooves of the nanostructure are aligned such that shading effects cause an inhomogeneous layer thickness distribution on the surface. This supports controlled, periodic cracking of the high index layer upon stretching. In the second approach ZnO nanoparticles are spin-coated on the nanostructured PDMS membrane. Here, the membrane can be stretched and serves as a photonic crystal slab without the need of any further treatment. For both types of flexible photonic crystal slabs a shift of the guided mode resonances to longer wavelengths is observed upon stretching. For a 20% strain perpendicular to the grating grooves a resonance shift of more than 50 nm is obtained.
It is well known that exposure to ultraviolet (UV) light can result in various physical and psychological diseases. Therefore, there is a strong demand for a reliable sensor to monitor UV exposure levels in the physiologically relevant intensity ranges of mW/cm2. Here, we demonstrate a UV sensor based on a silica whispering gallery mode microresonator. This UV sensor works over physiologically relevant intensity ranges with linear performance both in the forward and backward operating directions, with very high signal-to-noise ratio that can be utilized in monitoring the UV exposure for various applications.
The use of organic nonlinear optical (ONLO) materials in electro-optic (EO) modulators requires that the active molecular components (chromophores) be acentrically oriented. The fundamental molecular constituents are in a condensed, glassy phase. Molecular orientation in such systems is typically achieved by applying a DC poling field to the glassy material. We are developing efficient coarse-grained classical Monte Carlo (MC) methods to simulate the order of such systems. The most challenging aspects of these simulations are convergence to an experimentally relevant equilibrium ensemble and verification of simulation accuracy. We use a variety of molecular descriptions and a variety of MC methods to achieve proper order in the shortest number of computational cycles possible. Herein, we illustrate a few examples of the types of calculations and compare with experimental results with representative amorphous organic materials, including electro-optic chromophores.
Defect structures in Rubidium Titanyl Phosphate (RTP) crystals (non-doped and doped) grown by the Top Seeded Solution Growth (TSSG) method were characterized using Synchrotron White Beam X-ray Topography. Main defects observed in non-doped crystals are growth sector boundaries while both growth sector boundaries and growth striations are observed in the Nb single doped and (Nb,Yb)-codoped crystals with relatively few linear defects such as dislocations. Results show that the overall crystalline quality is lowered as more doping elements are incorporated. Details of defect distributions are correlated with the growth process to facilitate high quality growth of doped RTP.
The warm white light emission from the MOS capacitor containing the Zr-doped HfO2 high-k thin film on a p-type Si wafer under various post deposition annealing temperatures has been investigated. The light intensity is affected by the annealing temperature and the magnitude of the stress voltage. The annealing temperature changes the defect density and the physical thickness of the high-k stack. The high stress voltage induces the strong light emission because of the passage of a large current through the conductive path. The broad band emission spectrum covers the visible and near IR wavelength range with a large color rendering index. This new light emission device has a very long lifetime of > 1,000 hours at the atmosphere without a protection layer. The device is made of the IC compatible material and fabrication process, which favors the application over a wide range of products.
We have been studying a number of nanosystems that either have potential applications in bioimaging and/or light-activated therapies, or are bioderived. The standard Z-scan technique was routinely used for most of the measurements which were carried out in a wide wavelength range, typically from ∼550 nm to 1.6 μm. The range of nanoparticles studied has included colloidal semiconductor nanoparticles (e.g. CdS, CdSe), plasmonic nanoparticles, metal clusters, lanthanide-doped fluoride and oxide nanocrystals as well as core-shell systems. Among the bioderived systems studied especially interesting one is that of protein amyloid fibers.
Many of these materials exhibit nonlinear absorption features due not only to the typical two-photon absorption processes, but also due to multiple-photon absorption taking place, especially at longer wavelengths (e.g. three- four- and five-photon processes). On the other hand, absorption saturation processes may prevail or compete with multi-photon absorption in certain wavelength ranges in some of these materials, especially those characterized by broadband absorption due to surface plasmon excitation.
We investigated theoretically the transmission spectra in one-dimensional photonic quasicrystals (1DPQ) made up from dielectric materials organized in accordance to a discrete varying electric permittivity profile that obeys an analogous of the quasiperiodic potential in the so-called Audry-André (AA) model, in order to modulate the refraction index. Our results show that due to the incommensurate dielectric distribution, the spectrum splits into a fractal set of pass- and forbidden-band structure. By studying the transmission spectra as a function of the modulation phase ϕ, we found boundary states lying within the gaps localized either on the left or on the right boundary of the system, characterizing the so-called topological states.
Single crystals of semiorganic nonlinear optical material Triglycine Sodium Halides(TGSH) have been grown from aqueous solution by slow evaporation technique at constant temperature. The powder X-ray diffraction of the grown crystals is recorded and indexed. Functional groups present in the samples are identified by FTIR spectral analysis. The optical absorption studies shows that the UV cut off wavelength is around 300nm and has a wide transparency window. The powder second harmonic generation efficiency of the crystals is measured by Kurtz and Perry powder technique using Nd:YAG laser and it is 1.5 times for Triglycine Sodium Chloride, 1.2 times for Triglycine Sodium Bromide and 1.4 times for Triglycine potassium Iodide crystals that of the standard KDP crystals. Triglycine Sodium halide crystals show very good stability under laser irradiation with no signs of decomposition. Laser damage threshold energy density of Triglycine Sodium Iodide is found to be 857 MW/cm2 and 540MW/cm2 for Triglycine Sodium Chloride crystals.