Chronic alcoholism can result in severe liver conditions such as fatty liver disease and cirrhosis, potentially leading to life-threatening complications and premature death.

This study investigated the age-sex distribution of patients with alcohol addiction and aimed to identify differences in clinic department preferences based on their principal and additional diagnoses in Taiwan, in 2022.

We conducted a comprehensive analysis of the diagnostic patterns of 334 patients with alcohol addiction from the Taoyuan General Hospital, Ministry of Health and Welfare.

Figure 1 depicts patient demographics, highlighting 297 male and 37 female patients with alcohol-related disorders. Males aged 41-60 years were particularly dominant, as shown in Figure 2. Principal diagnoses, including alcoholic liver disease and acute pancreatitis, are detailed in Table 1. Additional diagnoses, such as chronic pancreatitis and esophageal varices, are presented in Table 2. For departmental preferences, Table 3 reveals the Gastrointestinal (GI) department as the top choice, followed by Kidney, Neurological, and Cardiovascular/Chest.Table 1.

Top 5 Principal Diagnoses of Alcohol Addiction Patients.

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The study revealed that patients with alcohol addiction often delay seeking psychiatric help instead of presenting for medical care only after liver or gastrointestinal complications occur. This underscores the crucial need for better health education regarding the relationship between alcohol addiction and liver disease. Prompt recognition and early intervention for substance addiction can significantly reduce these risks and improve patient outcomes.

None Declared

Adolescence is a period marked by highest vulnerability to the onset of depression, with profound implications for adult health. Neuroimaging studies have revealed considerable atrophy in brain structure in these patients with depression. Of particular importance are regions responsible for cognitive control, reward, and self-referential processing. However, the causal structural networks underpinning brain region atrophies in adolescents with depression remain unclear.

This study aimed to investigate the temporal course and causal relationships of gray matter atrophy within the brains of adolescents with depression.

We analyzed T1-weighted structural images using voxel-based morphometry in first-episode adolescent patients with depression (n=80, 22 males; age = 15.57±1.78) and age, gender matched healthy controls (n=82, 25 males; age = 16.11±2.76) to identify the disease stage-specific gray matter abnormalities. Then, with granger causality analysis, we arranged the patients’ illness duration chronologically to construct the causal structural covariance networks that investigated the causal relationships of those atypical structures.

Compared to controls, smaller volumes in ventral medial prefrontal cortex (vmPFC), dorsal anterior cingulate cortex (dACC), middle cingulate cortex (MCC) and insula areas were identified in patients with less than 1 year illness duration, and further progressed to the subgenual ACC, regions of default, frontoparietal networks in longer duration. Causal network results revealed that dACC, vmPFC, MCC and insula were prominent nodes projecting exerted positive causal effects to regions of the default mode and frontoparietal networks. The dACC, vmPFC and insula also had positive projections to the reward network, which included mainly the thalamus, caudate and putamen, while MCC also exerted a positive causal effect on the insula and thalamus.

These findings revealed the progression of structural atrophy in adolescent patients with depression and demonstrated the causal relationships between regions involving cognitive control, reward and self-referential processes.

None Declared

The COVID-19 pandemic has stressed global healthcare systems, with Taiwan’s National Health Insurance (NHI) playing a crucial role in prevention and treatment. Like other countries, Taiwan grappled with managing the virus alongside regular healthcare services, resulting in notable financial strain on hospitals after COVID-19 pandemic.

This study explores the financial implications of the psychiatric department at a medical center in Taiwan, highlighting the changing dynamics of healthcare costs and revenue during this period.

Data were collected monthly between January 2020 and September 2022, including the number of outpatient visits, inpatient patient-days, medical revenue, medical costs, and gross medical profit. Multivariate linear regression analysis confirmed the assumptions of the model and validated the findings.

Regression analysis revealed a significant correlation between the number of patients and financial indicators (USD1). Medical revenue (Table. 1), grew by 82 USD for each outpatient visit(p<0.001, 95% CI:41–122), and grew by 70 USD for each inpatient-days(p=0.001, 95% CI:31–108). Medical costs (Table. 2), increased by 59 USD for every inpatient-days (p=0.01, 95% CI:15–102). Finally, the gross medical profits (Table. 3) increased by 72 USD for each outpatient visit (p=0.003, 95% CI:27–117).Table 1.

Multiple linear regression analysis of the impact of medical service on medical revenue.

During the COVID-19 outbreak, healthcare systems, including those in Taiwan, were tested for unparalleled service challenges. This study found that while outpatient services boosted profits, rising inpatient admissions strained finances, given their higher costs and staffing needs. After the pandemic, psychiatric departments should reconsider resource allocation to balance expenses and revenues. Effective management is crucial for patient outcomes, emphasizing the need for quality care and fiscal control. Future research must focus on fortifying healthcare resilience.

None Declared

The occurrence of depression in adolescence, a critical period of brain development, linked with neuroanatomical and cognitive abnormalities. Neuroimaging studies have identified hippocampal abnormalities in those of adolescent patients. However, few studies have investigated the atypically developmental trends in hippocampal subfields in adolescents with depression and their relationships with cognitive dysfunctions.

To explore the structural abnormalities of hippocampal subfields in patients with youth depression and examine how these abnormalities associated with cognitive deficits.

We included a sample of 79 first-episode depressive patients (17 males, age = 15.54±1.83) and 71 healthy controls (23 males, age = 16.18±2.85). The severity of these adolescent patients was assessed by depression scale, suicidal risk and self-harm behavior. Nine cognitive tasks were used to evaluate memory, cognitive control and attention abilities for all participants. Bilateral hippocampus were segmented into 12 subfields with T1 and T2 weighted images using Freesurfer v6.0. A mixed analysis of variance was performed to assess the differences in subfields volumes between all patients and controls, and between patients with mild and severe depression. Finally, LASSO regression was conducted to explore the associations between hippocampal subfields and cognitive abnormalities in patients.

We found significant subfields atrophy in the CA1, CA2/3, CA4, dentate gyrus, hippocampal fissure, hippocampal tail and molecular layer subfields in patients. For those patients with severe depression, hippocampal subfields showed greater extensive atrophy than those in mild, particularly in CA1-4 subfields extending towards the subiculum. These results were similar across various severity assessments. Regression indicated that hippocampal subfields abnormalities had the strongest associations with memory dysfunction, and relatively week associations with cognitive control and attention. Notably, CA4 and dentate gyrus had the highest weights in the regression model.

As depressive severity increases, hippocampal subfield atrophy tends to spread from CA regions to surrounding areas, and primarily affects memory function in patients with youth depression. These results suggest hippocampus might be markers in progression of adolescent depression, offering new directions for early clinical intervention.

None Declared

Sleep pattern alteration is a core feature of bipolar disorder (BD), often challenging to treat and affecting clinical outcomes. Suvorexant, a hypnotic agent that decreases wakefulness, has shown promising results in treating primary insomnia. To date, data on its use in BD are lacking. This study evaluated the efficacy and tolerability of adjunctive suvorexant for treatment-resistant insomnia in BD patients.

Thirty-six BD outpatients (19 BDI, 69.4% female, 48.9 [±15.2] years) were randomized for 1 week to double-blind suvorexant (10–20 mg/day) versus placebo. Then, all subjects who completed the randomized phase were offered open suvorexant for 3 months. Subjective total sleep time (sTST) and objective total sleep time (oTST) were assessed.

During the randomized control trial (RCT) phase, an overall increase in the oTST emerged, which was statistically significant for the Cole–Kripke algorithm (p = 0.035). The comparison between the suvorexant and placebo groups was limited by significant differences between measurements at baseline. During the open phase, no significant improvement was detected relative to either sTST and oTST. No adverse events nor major intolerances were reported.

Efficacy results are inconsistent. During the RCT phase, only a small increase in the objective oTST emerged, while during the open phase, no significant improvement was detected. While this is the first ever study of suvorexant in BD-related insomnia, the limitation of the small sample and the high rate of dropouts limits the generalizability of these findings. Larger studies are needed to assess suvorexant in treating BD-related insomnia.

Human societies are changing where and how water flows through the atmosphere. However, these changes in the atmospheric water cycle are not being managed, nor is there any real sense of where these changes might be headed in the future. Thus, we develop a new economic theory of atmospheric water management, and explore this theory using creative story-based scenarios. These scenarios reveal surprising possibilities for the future of atmospheric water management, ranging from a stock market for transpiration to on-demand weather. We discuss these story-based futures in the context of research and policy priorities in the present day.

Humanity is modifying the atmospheric water cycle, via land use, climate change, air pollution, and weather modification. Historically, atmospheric water was implicitly considered a ‘public good’ since it was neither actively consumed nor controlled. However, given anthropogenic changes, atmospheric water can become a ‘common-pool’ good (consumable) or a ‘club’ good (controllable). Moreover, advancements in weather modification presage water becoming a ‘private’ good, meaning both consumable and controllable. Given the implications, we designed a theoretical framing of atmospheric water as an economic good and used a combination of methods in order to explore possible future scenarios based on human modifications of the atmospheric water cycle. First, a systematic literature search of scholarly abstracts was used in a computational text analysis. Second, the output of the text analysis was matched to different parts of an existing economic goods framework. Then, a group of global water experts were trained and developed story-based scenarios. The resultant scenarios serve as creative investigations of the future of human modification of the atmospheric water cycle. We discuss how the scenarios can enhance anticipatory capacity in the context of both future research frontiers and potential policy pathways including transboundary governance, finance, and resource management.

Story-based scenarios reveal novel future pathways for the management of the atmospheric water cycle.

Evaluation of adult antibiotic order sets (AOSs) on antibiotic stewardship metrics has been limited. The primary outcome was to evaluate the standardized antimicrobial administration ratio (SAAR). Secondary outcomes included antibiotic days of therapy (DOT) per 1,000 patient days (PD); selected antibiotic use; AOS utilization; Clostridioides difficile infection (CDI) cases; and clinicians’ perceptions of the AOS via a survey following the final study phase.

This 5-year, single-center, quasi-experimental study comprised 5 phases from 2017 to 2022 over 10-month periods between August 1 and May 31.

The study was conducted in a 752-bed tertiary care, academic medical center.

Our institution implemented AOSs in the electronic medical record (EMR) for common infections among hospitalized adults.

For the primary outcome, a statistically significant decreases in SAAR were detected from phase 1 to phase 5 (1.0 vs 0.90; P < .001). A statistically significant decreases were detected in DOT per 1,000 PD (4,884 vs 3,939; P = .001), fluoroquinolone orders (407 vs 175; P < .001), carbapenem orders (147 vs 106; P = .024), and clindamycin orders (113 vs 73; P = .01). No statistically significant change in mean vancomycin orders was detected (991 vs 902; P = .221). A statistically significant decrease in CDI cases was also detected (7.8, vs 2.4; P = .002) but may have been attributable to changes in CDI case diagnosis. Clinicians indicated that the AOSs were easy to use overall and that they helped them select the appropriate antibiotics.

Implementing AOS into the EMR was associated with a statistically significant reduction in SAAR, antibiotic DOT per 1,000 PD, selected antibiotic orders, and CDI cases.

In this paper, we explore how critically important ecosystems on the land provide evaporation to the atmosphere, which will later fall as precipitation elsewhere. Using a model-based analysis that tracks water flowing through the atmosphere, we find that more than two-thirds of the precipitation over critically important ecosystem areas is supplied by evaporation from other land. Likewise, more than 40% of the evaporation from critically important ecosystems falls as precipitation on other land. We conclude our work by discussing the policy implications for how these critically important ecosystems connect spatially distant wild and working lands via the atmospheric water cycle.

Global ecosystems are interconnected via atmospheric water vapor flows. Land use change can modify evaporation from land, altering atmospheric moisture recycling and potentially leading to significant changes in downwind precipitation and associated ecological impacts. We combine insights on global ecosystem-regulated moisture recycling with an analysis of critical natural assets (CNA, the 30% of global land providing most of nature's contributions to people) to reveal the sources and sinks of atmospheric water cycle regulation. We find that 65% of the precipitation over CNA is supplied by evaporation from other land areas. Likewise, CNA regions supply critical moisture as precipitation to terrestrial natural ecosystems and production systems worldwide, with 44% of CNA evaporation falling on terrestrial surfaces. Specifically, the Congo River basin emerges as a hotspot of overlap between local atmospheric water cycle maintenance and concentration of nature's contributions to people. Our results suggest global priority areas for conservation efforts beyond and in support of CNA, emphasizing the importance of sparsely populated managed forests and rangelands, along with wild forests, for fostering moisture recycling to and within CNA. This work also underlines the manifold benefits associated with achieving United Nations Sustainable Development Goal #15, to sustainably manage terrestrial life and conserve biodiversity.

Critically important ecosystems are essential for connecting distant landscapes via the atmospheric water cycle.

Identifying neuroimaging biomarkers of antidepressant response may help guide treatment decisions and advance precision medicine.

To examine the relationship between anhedonia and functional neurocircuitry in key reward processing brain regions in people with major depressive disorder receiving aripiprazole adjunct therapy with escitalopram.

Data were collected as part of the CAN-BIND-1 study. Participants experiencing a current major depressive episode received escitalopram for 8 weeks; escitalopram non-responders received adjunct aripiprazole for an additional 8 weeks. Functional magnetic resonance imaging (on weeks 0 and 8) and clinical assessment of anhedonia (on weeks 0, 8 and 16) were completed. Seed-based correlational analysis was employed to examine the relationship between baseline resting-state functional connectivity (rsFC), using the nucleus accumbens (NAc) and anterior cingulate cortex (ACC) as key regions of interest, and change in anhedonia severity after adjunct aripiprazole.

Anhedonia severity significantly improved after treatment with adjunct aripiprazole.

There was a positive correlation between anhedonia improvement and rsFC between the ACC and posterior cingulate cortex, ACC and posterior praecuneus, and NAc and posterior praecuneus. There was a negative correlation between anhedonia improvement and rsFC between the ACC and anterior praecuneus and NAc and anterior praecuneus.

Eight weeks of aripiprazole, adjunct to escitalopram, was associated with improved anhedonia symptoms. Changes in functional connectivity between key reward regions were associated with anhedonia improvement, suggesting aripiprazole may be an effective treatment for individuals experiencing reward-related deficits. Future studies are required to replicate our findings and explore their generalisability, using other agents with partial dopamine (D2) agonism and/or serotonin (5-HT2A) antagonism.

To determine the association between blood markers of white matter injury (e.g., serum neurofilament light and phosphorylated neurofilament heavy) and a novel neuroimaging technique measuring microstructural white matter changes (e.g., diffusion kurtosis imaging) in regions (e.g., anterior thalamic radiation and uncinate fasciculus) known to be impacted in traumatic brain injury (TBI) and associated with symptoms common in those with chronic TBI (e.g., sleep disruption, cognitive and emotional disinhibition) in a heterogeneous sample of Veterans and non-Veterans with a history of remote TBI (i.e., >6 months).

Participants with complete imaging and blood data (N=24) were sampled from a larger multisite study of chronic mild-moderate TBI. Participants ranged in age from young to middle-aged (mean age = 34.17, SD age = 10.96, range = 19-58) and primarily male (66.7%). The number of distinct TBIs ranged from 1-5 and the time since most recent TBI ranged from 0-30 years. Scores on a cognitive screener (MoCA) ranged from 22-30 (mean = 26.75). We performed bivariate correlations with mean kurtosis (MK) in the anterior thalamic radiation (ATR; left, right) uncinate fasciculus (UF; left, right), and serum neurofilament light (NFL), and phosphorylated neurofilament heavy (pNFH). Both were log transformed for non-normality. Significance threshold was set at p<0.05.

pNFH was significantly and negatively correlated to MK in the right (r=-0.446) and left (r=-0.599) UF and right (r=-0.531) and left (r=-0.469) ATR. NFL showed moderate associations with MK in the right (r=-0.345) and left (r=-0.361) UF and little to small association in the right (r=-0.063) and left (r=-0.215) ATR. In post-hoc analyses, MK in both the left (r=0.434) and right (r=0.514) UF was positively associated with performance on a frontally-mediated list-learning task (California Verbal Learning Test, 2nd Edition; Trials 1-5 total).

Results suggest that serum pNFH may be a more sensitive blood marker of microstructural complexity in white matter regions frequently impacted by TBI in a chronic mild-moderate TBI sample. Further, it suggests that even years after a mild-moderate TBI, levels of pNFH may be informative regarding white matter integrity in regions related to executive functioning and emotional disinhibition, both of which are common presenting problems when these patients are seen in a clinical setting.

Craft story recall test in the National Alzheimer’s Coordinating Center Uniformed Data Set 3 (NACC UDS3) neuropsychological battery has been employed to assess verbal memory and assist clinical diagnosis of mild cognitive impairment (MCI) and dementia. While a Chinese version of the test was adapted, no existing literature has examined the diagnostic validity of the test in Chinese Americans. This study aimed to evaluate the predictive validity of both immediate and delayed recall.

The Chinese version of Craft Story was administered in to 78 Chinese participants per their language preference of Mandarin or Cantonese. Outcome measures were verbatim and paraphrase recall of the story immediately and after a 20-minute delay. A multiple linear regression was performed to investigate the association of each outcome measure with age, education, gender, age when moved to the U.S., years in the U.S., and testing language. To assess its diagnostic value, cutoff standard deviation scores of -1.5 and -2.0 from the mean of the clinically cognitive normal participants were generated for MCI and dementia diagnoses, respectively. Due to the small sample size, a normative group fitting the mean age (73 years), years of education (12 years), and the majority gender (female) of the current sample were used to identify standard cut points. A receiver-operating characteristic analysis was used to compare predicted diagnosis with actual clinical diagnosis obtained through patients’ overall performance and a consensus meeting by licensed clinicians.

Younger age (p < 0.05) and being tested in Mandarin (p < .01) were positively associated with immediate and delayed recall. Strong positive correlations between each measure were observed (all p < .001), indicating a significant relationship between information encoded and retained. Among all the participants, 15 (19.2%) were diagnosed with MCI and 22 (28.2%) with dementia. For MCI diagnosis, the standard cutoff scores demonstrated adequate sensitivity (verbatim=82%, paraphrase=91%) but low specificity (verbatim=44%, paraphrase=67%) in all outcome measures. For dementia diagnosis, delayed recall showed strong sensitivity (100%) and adequate specificity (75%) in both verbatim and paraphrasing scores. Immediate recall paraphrase (sensitivity = 95%, specificity = 50%) showed a better sensitivity but lower specificity than verbatim scoring (sensitivity = 86%, specificity = 58%). The accuracy was higher in delayed recall for both MCI and dementia diagnosis. A preliminary analysis on the optimal cut points indicated higher cutoff scores to distinguish MCI and dementia from clinically cognitive normal population, and from each other (e.g., the optimal cut point for delayed verbatim in distinguishing MCI from normal is 8.0 (sensitivity=89%, specificity=73%, AUC=84.3%)).

Consistent with previous literature, Craft Story delayed recall served as a more accurate diagnostic tool for both MCI and dementia compared to immediate recall in older Chinese Americans. However, poor specificity might increase the chance of following false positive subjects in clinical trials. In addition, testing language appeared to impact performance on verbal memory recall of constructed information. Thus, future studies should focus on developing normative scores that address both the overall cultural differences of Chinese Americans and the heterogeneity within this population.