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Several hypotheses may explain the association between substance use, posttraumatic stress disorder (PTSD), and depression. However, few studies have utilized a large multisite dataset to understand this complex relationship. Our study assessed the relationship between alcohol and cannabis use trajectories and PTSD and depression symptoms across 3 months in recently trauma-exposed civilians.
In total, 1618 (1037 female) participants provided self-report data on past 30-day alcohol and cannabis use and PTSD and depression symptoms during their emergency department (baseline) visit. We reassessed participant's substance use and clinical symptoms 2, 8, and 12 weeks posttrauma. Latent class mixture modeling determined alcohol and cannabis use trajectories in the sample. Changes in PTSD and depression symptoms were assessed across alcohol and cannabis use trajectories via a mixed-model repeated-measures analysis of variance.
Three trajectory classes (low, high, increasing use) provided the best model fit for alcohol and cannabis use. The low alcohol use class exhibited lower PTSD symptoms at baseline than the high use class; the low cannabis use class exhibited lower PTSD and depression symptoms at baseline than the high and increasing use classes; these symptoms greatly increased at week 8 and declined at week 12. Participants who already use alcohol and cannabis exhibited greater PTSD and depression symptoms at baseline that increased at week 8 with a decrease in symptoms at week 12.
Our findings suggest that alcohol and cannabis use trajectories are associated with the intensity of posttrauma psychopathology. These findings could potentially inform the timing of therapeutic strategies.
In Southeast Europe (SEE) standard treatment of patients with psychosis is largely based on pharmacotherapy with psychosocial interventions rarely available. DIALOG+ is a digital psychosocial intervention designed to make routine care therapeutically effective. This trial simultaneously examined effectiveness of DIALOG+ versus standard care on clinical and social outcomes (Aim 1) and explored intervention fidelity (Aim 2).
A hybrid type II effectiveness–implementation, cluster-randomized trial was conducted in five SEE countries: Bosnia and Herzegovina, Kosovo*, Montenegro, North Macedonia, and Serbia. The intervention was offered to patients six times across 12 months instead of routine care. The outcomes were subjective quality of life (primary), clinical symptoms, satisfaction with services, and economic costs. Intervention fidelity was operationalized as adherence to the protocol in terms of frequency, duration, content, and coverage. Data were analyzed using multilevel regression.
A total of 81 clinicians and 468 patients with psychosis were randomized to DIALOG+ or standard care. The intervention was delivered with high fidelity. The average number of delivered sessions was 5.5 (SD = 2.3) across 12 months. Patients in the intervention arm had better quality of life (MANSA) at 6 months (p = 0.03). No difference was found for other outcomes at 6 months. Due to disruptions caused by the COVID-19 pandemic, 12-month data were not interpretable.
DIALOG+ improved subjective quality of life of individuals with psychosis at 6 months (after four sessions), albeit with small effect size. The intervention has the potential to contribute to holistic care of patients with psychosis.
Racial and ethnic groups in the USA differ in the prevalence of posttraumatic stress disorder (PTSD). Recent research however has not observed consistent racial/ethnic differences in posttraumatic stress in the early aftermath of trauma, suggesting that such differences in chronic PTSD rates may be related to differences in recovery over time.
As part of the multisite, longitudinal AURORA study, we investigated racial/ethnic differences in PTSD and related outcomes within 3 months after trauma. Participants (n = 930) were recruited from emergency departments across the USA and provided periodic (2 weeks, 8 weeks, and 3 months after trauma) self-report assessments of PTSD, depression, dissociation, anxiety, and resilience. Linear models were completed to investigate racial/ethnic differences in posttraumatic dysfunction with subsequent follow-up models assessing potential effects of prior life stressors.
Racial/ethnic groups did not differ in symptoms over time; however, Black participants showed reduced posttraumatic depression and anxiety symptoms overall compared to Hispanic participants and White participants. Racial/ethnic differences were not attenuated after accounting for differences in sociodemographic factors. However, racial/ethnic differences in depression and anxiety were no longer significant after accounting for greater prior trauma exposure and childhood emotional abuse in White participants.
The present findings suggest prior differences in previous trauma exposure partially mediate the observed racial/ethnic differences in posttraumatic depression and anxiety symptoms following a recent trauma. Our findings further demonstrate that racial/ethnic groups show similar rates of symptom recovery over time. Future work utilizing longer time-scale data is needed to elucidate potential racial/ethnic differences in long-term symptom trajectories.
In 1978, Bracewell suggested the technique of nulling interferometry to directly image exoplanets which would enable characterisation of their surfaces, atmospheres, weather, and possibly determine their capacity to host life. The contrast needed to discriminate starlight reflected by a terrestrial-type planet from the glare of its host star lies at or beyond a forbidding
for an exo-Earth in the habitable zone around a Sun-like star at near-infrared wavelengths, necessitating instrumentation with extremely precise control of the light. Guided Light Interferometric Nulling Technology (GLINT) is a testbed for new photonic devices conceived to overcome the challenges posed by nulling interferometry. At its heart, GLINT employs a single-mode nulling photonic chip fabricated by direct-write technology to coherently combine starlight from an arbitrarily large telescope at 1 550 nm. It operates in combination with an actuated segmented mirror in a closed-loop control system, to produce and sustain a deep null throughout observations. The GLINT South prototype interfaces the 3.9-m Anglo-Australian Telescope and was tested on a sample of bright Mira variable stars. Successful and continuous starlight injection into the photonic chip was achieved. A statistical model of the data was constructed, enabling a data reduction algorithm to retrieve contrast ratios of about
. As a byproduct of this analysis, stellar angular diameters that were below the telescope diffraction limit (
100 mas) were recovered with 1
accuracy and shown to be in agreement with literature values despite working in the seeing-limited regime. GLINT South serves as a demonstration of the capability of direct-write photonic technology for achieving coherent, stable nulling of starlight, which will encourage further technological developments towards the goal of directly imaging exoplanets with future large ground based and space telescopes.
This paper analyzes suicides committed in Montenegro during the 2005-2008 period divided according to gender, age and the way these have been performed.In 2005 we have 25,02 suicides on 100000 habitans, and in next two years there is a growth in trend, thus in 1995, there are 16,3 suicides on 100000. Comparing to 1985 when suicide rate was 13,2/100000, and 2006 rate which was 31,87/100000, we can notice that period of social transition and big stress, lead to a rise in rate of suicides so average rate for period of 2005-2008 is 26,87/100000 which puts Montenegro into country with high suicide rate.The ratio of men and women who committed suicide is 1,7:1. The largest number of people who killed themselves are between 45 and 54 years old. The way that people use to perform suicide is mostly by hunging themselves 40% and firearm 31% which is near to average numbers in the world. This research shows that there is significant rise in suicide rate. As a conclusion, on the basis of cited literature, the authors lined up all risk factors which can explain significance rise in suicide rate.
Many studies describing print media representations of mental illnesses have showed that these depictions are frequently negative and contribute to consequent stigmatization of people with mental illness. The main objective of this international study was to identify predictors of stigmatizing and nonstigmatizing articles on mental illness in Czech Republic, Croatia and Slovakia.
The study sample comprised all articles pertaining to the topic of mental illness (N=450) chosen from 6 most widely read newspapers and magazines identified during five weeklong periods in 2007. The presence of stigmatization and destigmatization statements was coded and articles were grouped in positive, neutral, mixed and negative clusters. Negative/positive ratio (NPR) was used to assess the predictor value of different features of the article regarding stigmatization.
61.8% of articles contained some stigmatizing statements towards persons with mental illness. The highest NPR was found in articles published in tabloids (6.8), on the front page (3.7) and in the articles where psychotic disorder was mentioned (7.4) and mentally ill person figured as a source of information (1.8). Lowest NPR was found in magazines (0.6), articles in later sections (1.7) that mentioned eating disorders (0.3) and scientific surveys (0.1).
There is a high level of stigmatizing statements in the studied articles. As the strongest predictors of stigmatizing content we have identified articles that are published in tabloids and articles with reference to psychosis. Contrary to this, eating disorders had the least stigmatizing depiction as well as articles containing scientific data.
Faster detection and differentiation of the existence of the clinical picture of primary disease and comorbid disease that was generated polipragmatic medicament approach.
Results of the work:
The rapid differentiation of established diagnosis of primary and secondary neurologic disease. Body symptoms be reduced only after a month of treatment with symptomatic infusion and sedative. benzodiazepine 15 mg pro die. It was madopar test despite clinical neurologists and psychiatrists dilemma contributed fully that this symptom was not about schizophrenia but about medicament parkinsonism caused by various sort of therapy.
Side effects of depot antipsychotic therapy and pharmacotherapy lead to parkinsonism medicament which is wrongly recognized as depression and, unfortunately, later as an outpatient during the catatonia of schizophrenia. Include depot therapy with extreme caution, only in cases where the pre-clinical detail, examined the patient, especially when there is any organic changes in the brain or suspicion of intellectual inferiority.
The influence of pharmaceutical industry (PI) on clinical practice and research in psychiatry has been considered a serious problem. Strict rules and guidelines were developed to regulate the interactions between doctors and PI. However, there is an ongoing debate whether these were thoroughly implemented in practice and internalized by physicians. The objective of our study was to assess the attitudes and behaviors of trainees in psychiatry and child & adolescent psychiatry toward PI across Europe. Methodologically, a validated questionnaire with additional items was administered to1444 trainees in 20 European countries. The minimum response rate was set at 60%. We found a high variation across countries in number of interactions between trainees and PI representatives; Portugal and Turkey had the highest number of interactions. The majority (59.76%) agreed that interactions with PI representatives have an impact on physicians’ prescribing behavior; whereas only 29.26% and 19.79% agreed interactions with PI representatives and gifts from PI have impact on their own prescribing behavior, respectively. Most of the gifts were considered appropriate by the majority, except tickets to vacation spot and social dinner at a restaurant. Of the sample, 70.76% think they have not been given sufficient training regarding how to interact with PI representatives. Only less than 20% indicated they have guidelines at institutional or national level. In conclusion, there is substantial interaction between trainees and PI across countries. The majority feel inadequately trained regarding professional interaction with PI, and believes they are immune to the influence of PI.
Interplay between nervous and immune systems plays an important part in clinical presentation and course of affective disorders.
The aim of the study has been to assess the relation between soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble intercellular cell adhesion molecule-1 (sICAM-1), in acute and remission phase of bipolar depression, in regard to acute and long-term measures of overall severity of the bipolar disorder.
The study has explored serum levels of sVCAM-1 and sICAM-1 in 43 patients with bipolar depression. The adhesion molecules’ levels of patient group have been analyzed in acute and remission phases, in regard to bipolarity index (BPIX) and in regard to global functioning (measured by Global Assesment of Functioning Scale- GAF)
The acute serum levels of sICAM-1 have been associated to BPIX. Moreover, sVCAM-1 serum selevels have been associated to BPIX in both phases of the disorder. In addition, acute sVCAM-1 levels have been associted to GAF score in accute phase.
Our results suggest that cellular adhesion is an important factor in clinical presentation and overall severity of bipolar disorder.
There is paucity of published literature on antidepressants in a cost-consequence study design.
Measuring clinical outcomes of pharmacotherapy.
Costs and consequences determination in depressive episode acute medical care.
Cost-consequence analysis;Setting-Serbian tertiary university clinic(2010-2012). Patient visits to attending psychiatrists:baseline, 3,8 weeks. HDRS-17 and Q-LES-Q-SF scale were applied in each of control visits. Resource use patterns and costs were evidenced for up to 14 weeks from study entry. Micro-costing approach allowed for most direct and indirect costs measurement. Costs were expressed in national currency-Central Serbian Dinar(1€≈115.85CSD;2012). Societal perspective and 14 weeks time horizon were adopted. Random selection of 65 depressive patients was based on clinical criteria and their assignment to either one of three different treatment protocols.5 patients were lost to follow up.
There was no statistically significant difference in terms of therapeutic response by the HDRS scores before and after introducing treatment groups(χ2=4.339; ?=0.362). QALY value increased by 11.77(SSRI group);8.93(SNRI)and 12.54 (heterocyclics). Mean cost per QALY was 9,937.51 CSD for SSRI; 7,138.27 CSD in SNRI; and 6,164.96 CSD for heterocyclics. There were 28.69 depression with free days in SSRI, 21.78 days in SNRI, and 30.59 days in heterocyclic group. Cost-effectiveness assessment was was 346.38 CSD per day(SSRI); 327.74 CSD(SNRI), and 201.54 CSD(heterocyclics).
Heterocyclic antidepressants provide highest'value for money' in terms of QALY in depressive episode treatment and its treatment is most cost effective. Cost-consequence evaluations have heavier impact to clinical decision making with regards to major depressive disorder treatment in the absence of clear clinical superiority of any major pharmacological protocol.
Interactions between the pharmaceutical industry (PI) and psychiatrists have been under scrutiny recently, though there is little empirical evidence on the nature of the relationship and its intensity at psychiatry trainee level. We therefore studied the level of PI interactions and the underlying beliefs and attitudes in a large sample of European psychiatric trainees.
One thousand four hundred and forty-four psychiatric trainees in 20 European countries were assessed cross-sectionally, with a 62-item questionnaire.
The total number of PI interactions in the preceding two months varied between countries, with least interactions in The Netherlands (M (Mean) = 0.92, SD = 1.44, range = 0–12) and most in Portugal (M = 19.06, SD = 17.44, range = 0–100). Trainees were more likely to believe that PI interactions have no impact on their own prescribing behaviour than that of other physicians (M = 3.30, SD = 1.26 vs. M = 2.39, SD = 1.06 on a 5-point Likert scale: 1 “completely disagree” to 5 “completely agree”). Assigning an educational role to the pharmaceutical industry was associated with more interactions and higher gift value (IRR (incidence rate ratio) = 1.21, 95%CI = 1.12–1.30 and OR = 1.18, 95%CI = 1.02–1.37).
There are frequent interactions between European psychiatric trainees and the PI, with significant variation between countries. We identified several factors affecting this interaction, including attribution of an educational role to the PI. Creating alternative educational opportunities and specific training dedicated to PI interactions may therefore help to reduce the impact of the PI on psychiatric training.
to assess the subjective perception of HRQoL in medical students’ sample; and
to ascertain predictors of better perception of HRQoL in medical students.
We have assessed and compared scores of Short Form Health Survey (SF-36), used for the assessment of HRQoL in sample of 561 medical students and 332 control participants. Also, we have used linear regression to identify predictors of better perception of HRQoL in the sample of medical students.
The results indicate that medical students had statistically significantly higher total score of SF-36. The statistically significant predictors of better perception of HRQoL in medical students were: male gender, younger age and higher grade year of studies and non-medical students was male gender. The other sociodemographic and academic variables did not emerge as possible predictors of better perception of HRQoL.
Medical students perceive their health much better than other university students do but female, older and second year medical students have worse perception of their HRQoL. In non-medical university students females had worse perception of their HRQoL. Those points should be potential target areas for specific prevention and treatment in order to achieve better quality of life of medical students and life of nonmedical students.
Immune alterations are considered an important factor in etiopathogenesis of bipolar disorder.
The aim of the study has been to assess the relation between soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble intercellular cell adhesion molecule-1 (sICAM-1), in acute and remission phase of mania, in regard to severity of depressive and manic symptoms.
The study has explored serum levels of sVCAM-1 and sICAM-1 in 40 patients with mania. The adhesion molecules' levels of patient group have been analyzed in acute and remission phases, in regard to severity of depressive sympotoms (measured by Hamilton Depression Scale) and in regard to severity of manic symptoms (measured by Young Mania Rating Scale).
The acute serum levels of sVCAM-1 have been inversily associated to YMRS score and directly associated to HAMD score, in acute phase. Serum levels of sICAM-1 have shown no association to severity of affective symptoms, in both phases of the disorder.
Our results suggest that cellular adhesion acute could be one of the factors mediating affective symptoms presentation in bipolar mania.
Immune parameters are frequently associated with mood disorders and affective temperaments. In our study, we investigate the role of soluble intercellular adhesion molecule-1 (sICAM-1) in affective temperaments and mood symptoms in healthy adults.
Healthy adults were screened for psychiatric disorders using the non-patient version of the Structured Clinical Interview for DSM-IV-I and II. Affective temperaments were evaluated with Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire (TEMPS-A). State mood symptoms were assessed using the Young Mania Rating Scale (YMRS) and Montgomery-Åsberg Depression Rating Scale (MADRS). Serum sICAM-1 levels were measured using enzyme-linked immunosorbent assay.
We identified no association between sICAM-1 levels and affective temperament scores. We identified correlation between sICAM-1 levels and manic symptoms measured by YMRS. Furthermore, sICAM-1 was a significant predictor of manic symptoms in a linear regression model with age, gender, BMI and smoking habits as confounding variables.
Our findings suggest that sICAM-1 could be a relevant immune factor for severity of state affective symptoms and could contribute to better understanding of complexity of affective disorders.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The yellow-necked mouse, Apodemus flavicollis, can be considered as a model for genetic polymorphism produced by the frequent presence of supernumerary or B chromosomes (Bs). Host genetic background is rarely taken into account in studies of parasite sex ratio. The main aim of this study was to investigate the range of infrapopulation sex ratios for nematode parasites of the yellow-necked mouse and to determine which factors most influence variation in parasite sex ratios. Six nematode species found in the collected yellow-necked mice were analysed. We confirmed the predominant pattern of female-biased sex ratios in vertebrate parasite infrapopulations. The presence of B chromosomes in host genomes played an important role in infrapopulations of Heligmosomoides polygyrus, Syphacia stroma and Trichuris muris, as hosts with B chromosomes carried a higher proportion of males. The relative increase of males in infrapopulations could result from a shift in parasite life history strategy, induced by adaptation to the specific host genotypes (Bs present). In a meta-analysis with previously published data, the sex determination system was demonstrated to play a significant role in nematode sex ratio variation, as well as specific life history patterns, such as the place of egg hatching.
Persistent infection with one or more highly oncogenic human papillomaviruses (HPVs) or high-risk-HPV (HR-HPV) is necessary but not a sufficient aetiological agent for the development of cervical neoplasia. A number of viral, host, environmental and behavioural factors are suggested to be associated with the progression of cervical disorder. This study aimed to evaluate the impact of environmental and behavioural cofactors on the development of cervical disorders in HR-HPV-infected women in Serbia. A total of 541 women have been tested by PCR for the presence of HPV on the cervix. HPV genotypes were determined by direct DNA sequencing. Women identified as HR-HPV-positive were further classified into four subgroups according to their cytological status. All relevant information about demographical and behavioural factors was obtained by interviewer-based questionnaire. A number of analytical and descriptive statistical methods were used for processing the data. The cofactors found to be of significance for the progression of cervical disease were older age, body mass index >25, lower educational level, long-term smoking, previous genital infections and cervical interventions. On the other hand, condom use was found to have a protective role. Information about these cofactors might be very important for the development of more efficient cancer prevention programmes and promotion of anti-HPV vaccination.
Zirconolite glass-ceramics are being developed as potential wasteforms for the disposition of Pu wastes in the UK. Previous studies utilised a variety of surrogates whilst this work uses both cold-press and sinter and hot isostatic press methods to validate the wasteform with PuO2. A cold press and sinter sample was fabricated as part of a validation study for plutonium incorporation in hot isostatically pressed (HIPed) wasteforms. The results confirmed the cold-press and sinter, achieved successful waste incorporation and a microstructure and phase assemblage that was in agreement with those expected of a HIPed equivalent. A HIP sample was fabricated of the same composition and characterised by SEM and XRD. Results were in agreement with the sintered sample and achieved complete waste incorporation into the glass-ceramic wasteform. These samples have demonstrated successful incorporation of PuO2 into glass-ceramic HIPed wasteforms proposed for processing Pu-based waste-streams in the UK.
In this paper, we address the problem of how to account for second-order statistics of turbulent flows using low-complexity stochastic dynamical models based on the linearized Navier–Stokes equations. The complexity is quantified by the number of degrees of freedom in the linearized evolution model that are directly influenced by stochastic excitation sources. For the case where only a subset of velocity correlations are known, we develop a framework to complete unavailable second-order statistics in a way that is consistent with linearization around turbulent mean velocity. In general, white-in-time stochastic forcing is not sufficient to explain turbulent flow statistics. We develop models for coloured-in-time forcing using a maximum entropy formulation together with a regularization that serves as a proxy for rank minimization. We show that coloured-in-time excitation of the Navier–Stokes equations can also be interpreted as a low-rank modification to the generator of the linearized dynamics. Our method provides a data-driven refinement of models that originate from first principles and captures complex dynamics of turbulent flows in a way that is tractable for analysis, optimization and control design.
Caprine and bovine milks have a similar overall gross composition, but vary considerably in the ratios of their casein components. These differences in colloidal casein micelles could affect directly or indirectly the heat stability of caprine and bovine milks at their natural pH. In the present work, the differences in colloidal stability of caprine and bovine milk have been studied by analysing the effect of heat treatment and skimming on precipitation of proteins. Raw and heated milk samples (70 °C/5 min, 80°C/5 min and 90°C/5 min) were centrifuged at 600, 2000, and 4500 g. The amount of precipitate formed after skimming was measured and the protein composition of both precipitates and supernatants analysed using the SDS-PAGE (sodium dodecyl sulphate polyacrylamide gel electrophoresis) and densitometry. In caprine milk, the heat treatment prior to skimming had a statistically significant effect on protein precipitation. Centrifugal force had a statistically significant effect on amount of precipitate for both milks, but the amount was 2 to 4 times higher for caprine milk. When defatting the milk for electrophoresis, a centrifugal force of 600 g appeared to be the most appropriate, in order to avoid protein loss and a possible error in the interpretation of results. Results of this study could also serve as the basis for further investigations on adjusting the skimming conditions for caprine milk in industrial dairy processing environment.
Loess deposits in the Vojvodina region, northern Serbia, are among the oldest and most complete loess-paleosol sequences in Europe to date. These thick sequences contain a detailed paleoclimatic record from the late Early Pleistocene. Based on the correlation of detailed magnetic susceptibility (MS) records from Vojvodina with the Chinese loess record and deep-sea isotope stratigraphy we here reconfirm and expand on a stratigraphic model of the Vojvodinian loess-paleosol chronostratigraphic sequence following the Chinese loess stratigraphic system.
Variations in MS, dust accumulation rates, and the intensity of pedogenesis demonstrate evidence for a Middle Pleistocene climatic and environmental transition. The onset of loess deposition in Vojvodina also indicates a direct link between dust generation in Europe and that in the interior of Eurasia since the Early Pleistocene. The youngest part of the Early Pleistocene and oldest part of the Middle Pleistocene is characterised by relatively uniform dust accumulation and soil formation rates as well as relatively high magnetic susceptibility values. In contrast, the last five interglacial-glacial cycles are characterised by sharp environmental differences between high dust accumulation rates during the glacials and low rates observed during soil development. The data presented in this study demonstrate the great potential of Vovjodina's loess archives for accurate reconstruction of continental Eurasian Pleistocene climatic and environmental evolution.