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Multilayers that comprise thin films of heavy metals and ferromagnets have been shown to host Néel-type magnetic skyrmions at room temperature. Fresnel defocus imaging in Lorentz transmission electron microscopy is a widely used technique for recording magnetic information about skyrmions. However, the visibility of Néel-type skyrmions in Fresnel defocus images is typically low, both because only a small component of their magnetic field contributes to the signal and because of the presence of diffraction contrast from the polycrystalline multilayer structure. Here, we take advantage of the out-of-plane hysteresis in such samples to record background-subtracted Fresnel defocus images. We demonstrate an improvement in magnetic signal-to-noise ratio and spatial resolution by a factor of 3 for a (Pt/Co/NiFe)×5 multilayer. We also use simulated Fresnel defocus images of Néel-type magnetic skyrmions to understand the influence of defocus on apparent skyrmion size.
Sediments from the ST5 deep-sea bottom core collected from the south-east Aegean Sea between Symi and Tilos islands, Greece, were examined by quantitative mineralogical analysis and geochemical analysis to infer provenance and palaeoenvironmental control over sediment deposition. The mineralogical composition comprises carbonates (mainly calcite and Mg-calcite), quartz, feldspars, serpentine, amphibole and clay minerals. Chlorite is the most abundant clay mineral, whereas smectite and illite are less abundant than in the sediments in the south-west Aegean and the Cretan Sea. Semi-quantitative analysis of clay minerals from oriented clay fractions overestimates significantly the smectite content and underestimates the abundances of illite, chlorite and kaolinite. The studied sediments are enriched in MgO, Ni and Cr, which decrease in abundance with decreasing depth, following the distribution of serpentine. By contrast, the abundances of SiO2, Al2O3, Fe2O3, Na2O and K2O increase upcore. The regional S1 sapropel horizon is enriched in V and Co and has considerably greater Ba/Al ratios than the remaining sequence. The mineralogical and geochemical relationships indicate a strong ultrabasic influence, probably from the Marmaris ophiolite in the Lycian nappes. The clay mineral distribution suggests that the smectite was mainly of volcanogenic origin, the illite was supplied by the nearby landmasses of west Anatolia and the islands of Rhodes, Tilos and Symi and the contribution from the south-east Mediterranean was limited or totally lacking. The combined use of the mineralogical and geochemical analysis of bulk sediments rather than the clay fractions is not only extremely useful in tracing sediment provenance in relatively closed basins, but it also enables a more realistic assessment of the importance of water circulation patterns on sedimentation processes in such environments.
Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.
Aims
To examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.
Method
Genome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.
Results
Earlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.
Conclusions
AAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.
An accurate estimate of the average number of hand hygiene opportunities per patient hour (HHO rate) is required to implement group electronic hand hygiene monitoring systems (GEHHMSs). We sought to identify predictors of HHOs to validate and implement a GEHHMS across a network of critical care units.
Design:
Multicenter, observational study (10 hospitals) followed by quality improvement intervention involving 24 critical care units across 12 hospitals in Ontario, Canada.
Methods:
Critical care patient beds were randomized to receive 1 hour of continuous direct observation to determine the HHO rate. A Poisson regression model determined unit-level predictors of HHOs. Estimates of average HHO rates across different types of critical care units were derived and used to implement and evaluate use of GEHHMS.
Results:
During 2,812 hours of observation, we identified 25,417 HHOs. There was significant variability in HHO rate across critical care units. Time of day, day of the week, unit acuity, patient acuity, patient population and use of transmission-based precautions were significantly associated with HHO rate. Using unit-specific estimates of average HHO rate, aggregate HH adherence was 30.0% (1,084,329 of 3,614,908) at baseline with GEHHMS and improved to 38.5% (740,660 of 1,921,656) within 2 months of continuous feedback to units (P < .0001).
Conclusions:
Unit-specific estimates based on known predictors of HHO rate enabled broad implementation of GEHHMS. Further longitudinal quality improvement efforts using this system are required to assess the impact of GEHHMS on both HH adherence and clinical outcomes within critically ill patient populations.
Wildlife reintroduction projects often face resistance from local residents who see potential conflicts with the species or lack trust or confidence in the agencies and professionals involved in reintroduction. Yet the linkages between trust, confidence, risk perceptions, attitudes towards the species and local support for its reintroduction are not well known. The Dual-Mode Model of Cooperation and Cognitive Hierarchy Model were theoretical frameworks used to shed light on these linkages by exploring the potential roles trust and confidence play as mediators between risk perceptions and attitudes towards, and support for, reintroduced elk in Tennessee (USA). A mail survey of 1005 residents living in the five-county area surrounding the North Cumberland Elk Restoration Zone assessed resident attitudes and risk perceptions towards the reintroduced elk, trust towards the managing wildlife agency and support for continued conservation efforts. A structural equation model revealed that trust and confidence play positive roles in mitigating risk perceptions and improving support for the reintroduction of elk. The findings confirm the roles public trust and confidence play in wildlife reintroductions and should help agencies work towards building local trust and confidence, minimizing risks, improving attitudes and increasing the chances for successful outcomes for the species and people.
Very few zircon-bearing, kimberlite-hosted mantle eclogite xenoliths have been identified to date; however, the zircon they contain is crucial for our understanding of subcratonic lithospheric mantle evolution and eclogite genesis. In this study, we constrain the characteristics of zircon from mantle eclogite xenoliths based on existing mineralogical and geochemical data from zircons from different geological settings, and on the inferred origin of mantle eclogites. Given the likely origin and subsequent evolution of mantle eclogites, we infer that the xenoliths can contain zircons with magmatic, metamorphic and xenogenic (i.e. kimberlitic zircon) origins. Magmatic zircon can be inherited from low-pressure mafic oceanic crust precursors, or might form during direct crystallization of eclogites from primary mantle-derived melts at mantle pressures. Metamorphic zircon within mantle eclogites has a number of possible origins, ranging from low-pressure hydrothermal alteration of oceanic crustal protoliths to metasomatism related to kimberlite magmatism. This study outlines a possible approach for the identification of inherited magmatic zircon within subduction-related mantle eclogites as well as xenogenic kimberlitic zircon within all types of mantle eclogites. We demonstrate this approach using zircon grains from kimberlite-hosted eclogite xenoliths from the Kasai Craton, which reveals that most, if not all, of these zircons were most likely incorporated as a result of laboratory-based contamination.
One of the primary uses for transmission electron microscopy (TEM) is to measure diffraction pattern images in order to determine a crystal structure and orientation. In nanobeam electron diffraction (NBED), we scan a moderately converged electron probe over the sample to acquire thousands or even millions of sequential diffraction images, a technique that is especially appropriate for polycrystalline samples. However, due to the large Ewald sphere of TEM, excitation of Bragg peaks can be extremely sensitive to sample tilt, varying strongly for even a few degrees of sample tilt for crystalline samples. In this paper, we present multibeam electron diffraction (MBED), where multiple probe-forming apertures are used to create multiple scanning transmission electron microscopy (STEM) probes, all of which interact with the sample simultaneously. We detail designs for MBED experiments, and a method for using a focused ion beam to produce MBED apertures. We show the efficacy of the MBED technique for crystalline orientation mapping using both simulations and proof-of-principle experiments. We also show how the angular information in MBED can be used to perform 3D tomographic reconstruction of samples without needing to tilt or scan the sample multiple times. Finally, we also discuss future opportunities for the MBED method.
To determine whether combinations of diagnosis and procedures codes can improve the detection of prosthetic hip and knee joint infections from administrative databases.
Design:
We performed a validation study of all readmissions from January 1, 2010, until December 31, 2016, following primary arthroplasty comparing the diagnosis and procedure codes obtained from an administrative database based upon the International Classification of Disease, Tenth Revision (ICD-10) to the reference standard of chart review.
Setting:
Four tertiary-care hospitals in Toronto, Canada, from 2010 to 2016.
Participants:
Individuals who had a primary arthroplasty were identified using procedure codes.
Intervention:
Chart review of readmissions identified the presence of a prosthetic joint infection and, if present, the surgical procedure performed.
Results:
Overall, 27,802 primary arthroplasties were performed. Among 8,844 readmissions over a median follow-up of 669 days (interquartile range, 256–1,249 days), a PJI was responsible for or present in 586 of 8,844 (6.6%). Diagnosis codes alone exhibited a sensitivity of 0.88 (95% CI, 0.85–0.92) and positive predictive value (PPV) of 0.78 (95% CI, 0.74–0.82) for detecting a PJI. Combining a PJI diagnosis code with procedure codes for an arthroplasty and the insertion of a peripherally inserted central catheter improved detection: sensitivity was 0.92 (95% CI, 0.88–0.94) and PPV was 0.78 (95% CI, 0.74–0.82). However, procedure codes were unable to identify the specific surgical approach to PJI treatment.
Conclusions:
Compared to PJI diagnosis codes, combinations of diagnosis and procedure codes improve the detection of a PJI in administrative databases.
Fluoroquinolones (FQs) and extended-spectrum cephalosporins (ESCs) are associated with higher risk of Clostridioides difficile infection (CDI). Decreasing the unnecessary use of FQs and ESCs is a goal of antimicrobial stewardship. Understanding how prescribers perceive the risks and benefits of FQs and ESCs is needed.
Methods:
We conducted interviews with clinicians from 4 hospitals. Interviews elicited respondent perceptions about the risk of ESCs, FQs, and CDI. Interviews were audio recorded, transcribed, and analyzed using a flexible coding approach.
Results:
Interviews were conducted with 64 respondents (38 physicians, 7 nurses, 6 advance practice providers, and 13 pharmacists). ESCs and FQs were perceived to have many benefits, including infrequent dosing, breadth of coverage, and greater patient adherence after hospital discharge. Prescribers stated that it was easy to make decisions about these drugs, so they were especially appealing to use in the context of time pressures. They described having difficulty discontinuing these drugs when prescribed by others due to inertia and fear. Prescribers were skeptical about targeting specific drugs as a stewardship approach and felt that the risk of a negative outcome from under treatment of a suspected bacterial infection was a higher priority than the prevention of CDI.
Conclusions:
Prescribers in this study perceived many advantages to using ESCs and FQs, especially under conditions of time pressure and uncertainty. In making decisions about these drugs, prescribers balance risk and benefit, and they believed that the risk of CDI was acceptable in compared with the risk of undertreatment.
We report on the case of a patient who developed an acute meningitis and, after a period of about two weeks, without any neuropsychiatric problems, an acute paranoid-hallucinatory and catatonic syndrome. The symptomatology is discussed, in relation with the diagnostic difficulties of differentiating between a biphasic meningo-encephalitis with an organic psychosis or a first manifestation of an endogenous psychosis.
Low platelet MAO-B activity has been associated with various forms of impulsive behaviour and suicidality. The present study investigated the relationship between MAO-B activity in platelets and aspects of suicidality in depressed patients and controls.
Method:
In 87 patients with affective spectrum disorders (58% suffering from a Major Depressive Episode - MDE) the potential association between platelet MAO-B activity and suicidality was examined. 59 of the patients had committed suicide attempt recently (SA - “suicide attempters”), 28 patients were acutely depressed without having shown suicidal thoughts or suicidal behaviour in the past (NA - “non suicide attempters”).
Results:
SA and NA were comparable as to their diagnoses and general demographic and psychopathological parameters. MAO-B activity did not differ between SA and NA. No systematic correlations existed between MAO-B activity and any dimensions of suicidal behaviour or psychopathology. As a single finding only a weak positive association of higher MAO-B activity in SA with a fatal intention of the suicide attempt was observed.
Conclusion:
Our findings do not support a consistent association of platelet MAO-B activity and suicidal behaviour in general, but specific facts of suicidality might be associated.
In the treatment of MDD, insufficient treatment outcome and the delayed onset of action still remain major problems.
Measuring plasma concentrations, i.e. TDM is a possible option to improve therapeutic outcomes.
Aim
The aim of this prospective and naturalistic study was to evaluate the economic and clinical benefit of TDM for depressed inpatients treated with citalopram.
Methods
Inpatients with MDD according to ICD-10 were included and treated with citalopram. Psychopathology was assessed by the 17-item Hamilton Depression (HAMD-17) rating scale in weekly intervals for five weeks. In parallel, serum concentrations of citalopram were measured.
Results
55 patients were included (27f). 84% of the patients with citalopram plasma concentrations below 50 ng/ml (n = 36) were non-responders in week five. Among patients who achieved plasma concentrations ≥50 ng/ml (n = 19) on day 7, 47% became responder at week five (p = 0.025). Patients with plasma levels ≥50 ng/ml had a significantly shorter duration of hospitalization (49 ± 20) than patients below 50 ng/ml (72 ± 37; p = 0.033).
Conclusion
Our results show that citalopram plasma levels above 50 ng/ml are predictive for later treatment outcome and that TDM is cost effective due to reduced duration of hospitalization.
A significant part computer game players and internet users show clinical features of abuse and addiction (loss of control, withdrawal symptoms, tolerance, continuation of game play even with increasing negative consequence in social and academic life). Similar mechanisms are suggested to underlie the pathogenesis and maintenance of internet and computer game addiction and substance-related addictions.
Objectives
Neuroscientific research on internet and computer game addiction is sparse, yet emerging. To review previous studies is the objective of the present project.
Aims
We aim to identify common findings regarding the neurophysiological processes underlying internet and computer game addiction. This could be helpful for establishing a sound model for these emerging disorders.
Methods
Neuroscientific studies on internet and computer game addiction were systematically searched in “Pubmed”, “Google scholar” and “PsychInfo”. Titles were examined first to screen potential articles, followed by abstracts, and then manuscripts were downloaded. The reference sections of downloaded manuscripts were examined for additional references not located in the searches.
Results
Neuroscientific research on internet and computer game addiction is mainly located in the Asian area, probably due to a higher regional prevalence. Methodologies range from ERP, resting state EEG, resting state fMRI, VBM to PET, investigating very different concepts of addiction, including impulsivity, craving, reward processing and cue-reactivity.
Conclusions
Addicted internet and computer game users are overall suggested to have altered brain mechanisms similar to individuals with substance addictions. However, a sound model on the neurophysiologic alterations has not been established yet.
Forty-three patients with schizophrenia were investigated with a short neurocognitive screening battery focussing on working memory and executive functions. As compared to healthy controls, patients showed impairments in the modified card sorting test, in verbal fluency and all span tasks with exception of digit span forward. Patients who were treated with atypicals showed better performance in the digit ordering test (manipulation task) when compared to a group of patients who received conventional antipsychotics; this difference was not due to disease severity, age or education. Manipulation tasks might be useful for neurocognitive follow-up and intervention studies.
A proinflammatory state in a subgroup of depressed patients has been reported repeatedly (e.g. increased interleukin-6 and tumour necrosis factor-alpha). COX-2 inhibitors down-regulate increased inflammatory markers and are therefore investigated as an add-on therapy in depression. Proinflammatory cytokines and/or kynurenine metabolites may predict the outcome of treatment with COX-2 inhibitors.
Objectives
To prove or disapprove the hypothesis of a better therapy response in the group of add-on celecoxib to sertraline, particularly in patients with a more pronounced proinflammatory state at baseline. The aim is to find a biological predictor (cytokines and/or kynurenine metabolites) for treatment outcome.
Design
This is a dual-center, randomized, double-blind, placebo-controlled, parallel group phase IIa study. It investigates the mean change in clinical outcome and in serum cytokine and kynurenine levels from baseline to endpoint (week 6) in patients with major depression (HAMD-17 ≥ 22) treated with sertraline plus celecoxib versus sertraline plus placebo for six weeks. 51 depressed patients of both gender, aged between 18 and 60 years without any recent inflammatory disease were enrolled. The study comprises six study visits (6x ratings, 3x blood collections) during six weeks of treatment and a follow-up visit 10 weeks after baseline. Cytokines were measured by Enzyme-linked Immunosorbent Assay (ELISA), kynurenine and its metabolites by High Performance Liquid Chromatography (HPLC).
Results and Conclusion
The study was completed quite recently and the results are in progress.
Excessive behaviors, especially among adolescents, have become a matter of growing concern und are discussed as non-substance-related addiction disorders. Epidemiological surveys show that especially computer game addiction and pathological gambling are to be regarded as widespread in minors, according to prevalence estimations up to 2.1% for pathological gambling and 2.7% for computer game addiction. Clinically many studies supported that both forms of behavioural addictions are related to remarkable psychosocial and psychopathological strain, like depressive symptoms and anxiety. However, research on disorder-specific risk factors still is limited.
To address this uncertainty, a survey among a representative sample of 3967 German adolescents, aged between 12 and 18 years was conducted. Prevalence rates of both, pathological gambling and computer game addiction were calculated and supposed predisposing factors like affectivity, Violence Approving Norms, social insecurity, and self-efficacy were assessed.Prevalence for pathological gambling was 2.2% and 3.4% for addictive computer gaming. Further analyses show that there are rather similarities than discrepancies between both clinical groups, especially concerning heightened negative affectivity and social insecurity. However, it turned out that pathological gamblers revealed higher rates in Violent Approving norms and addicted computer gamers showed significantly diminished self-efficacy.The results point to similar etiopathological pathways, like affect-dysregulation for both investigated behavioural addictions in minors. Notwithstanding, some specific factors turned out to be primarily related to gambling resp. gaming.
En psychiatrie, la contention médicale reste une pratique courante qui peut s’avérer traumatisante pour le patient. Elle doit toujours être associée à une sédation. Nous avons voulu réaliser un état des lieux de cette prise en charge médicamenteuse dans notre établissement.
Matériels et méthodes
Pendant 1 mois (janvier 2015), nous avons ciblé les patients sous énoxaparine sodique en préventif grâce au logiciel de prescription (Pharma®). Pour chaque patient, nous avons vérifié qu’il s’agissait bien d’une contention physique. Puis, une analyse des traitements prescrits était réalisée (médicaments, associations, posologies…).
Résultats
Quatorze patients ont été inclus dans l’étude (8 hommes et 6 femmes, âge moyen : 33 ans). En moyenne, les patients ont été contenus 4 jours [1–10], l’énoxaparine sodique a été initié 24 h [0–72] après le début de la contention et administré pendant 2 jours [0–6]. Les patients ont reçu entre 0 et 3 antipsychotiques différents (cyamémazine, lévomépromazine et halopéridol) indiqués dans les états psychotiques aigus dont le plus prescrit était le cyamémazine (10/14 patients) à une posologie moyenne de 50 mg à j1, 115 mg à j2 et j3. Concernant les benzodiazépines, les patients ont reçu en moyenne une seule benzodiazépine et principalement le lorazépam (7/14) à une posologie de 4 mg à j1, 5,5 mg à j2 et j3 ou le diazépam (4/14) à une posologie de 7,5 mg à j1, 22,5 mg à j2 et 27,5 mg à j3.
Discussion et conclusion
Les patients contenus reçoivent donc peu de psychotropes, à posologies faibles par rapport aux doses habituelles en psychiatrie (exemple : cyamémazine jusqu’à 600 mg). Un groupe de travail sur la contention en psychiatrie est actuellement en cours dans l’établissement afin d’émettre des recommandations sur les modalités de prescription des psychotropes pour éviter une contention physique durable.