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Mood disorders require consistent management of symptoms to prevent recurrences of mood episodes. Circadian rhythm (CR) disruption is a key symptom of mood disorders to be proactively managed to prevent mood episode recurrences. This study aims to predict impending mood episodes recurrences using digital phenotypes related to CR obtained from wearable devices and smartphones.
The study is a multicenter, nationwide, prospective, observational study with major depressive disorder, bipolar disorder I, and bipolar II disorder. A total of 495 patients were recruited from eight hospitals in South Korea. Patients were followed up for an average of 279.7 days (a total sample of 75 506 days) with wearable devices and smartphones and with clinical interviews conducted every 3 months. Algorithms predicting impending mood episodes were developed with machine learning. Algorithm-predicted mood episodes were then compared to those identified through face-to-face clinical interviews incorporating ecological momentary assessments of daily mood and energy.
Two hundred seventy mood episodes recurred in 135 subjects during the follow-up period. The prediction accuracies for impending major depressive episodes, manic episodes, and hypomanic episodes for the next 3 days were 90.1, 92.6, and 93.0%, with the area under the curve values of 0.937, 0.957, and 0.963, respectively.
We predicted the onset of mood episode recurrences exclusively using digital phenotypes. Specifically, phenotypes indicating CR misalignment contributed the most to the prediction of episodes recurrences. Our findings suggest that monitoring of CR using digital devices can be useful in preventing and treating mood disorders.
There are growing concerns about the impact of the COVID-19 pandemic on the mental health of older adults. We examined the effect of the pandemic on the risk of depression in older adults.
We analyzed data from the prospective cohort study of Korean older adults, which has been followed every 2 years. Among the 2308 participants who completed both the third and the fourth follow-up assessments, 58.4% completed their fourth follow-up before the outbreak of COVID-19 and the rest completed it during the pandemic. We conducted face-to-face diagnostic interviews using Mini International Neuropsychiatric Interview and used Geriatric Depression Scale. We performed generalized estimating equations and logistic regression analyses.
The COVID-19 pandemic was associated with increased depressive symptoms in older adults [b (standard error) = 0.42 (0.20), p = 0.040] and a doubling of the risk for incident depressive disorder even in euthymic older adults without a history of depression (odds ratio = 2.44, 95% confidence interval 1.18–5.02, p = 0.016). Less social activities, which was associated with the risk of depressive disorder before the pandemic, was not associated with the risk of depressive disorder during the pandemic. However, less family gatherings, which was not associated with the risk of depressive disorder before the pandemic, was associated with the doubled risk of depressive disorder during the pandemic.
The COVID-19 pandemic significantly influences the risk of late-life depression in the community. Older adults with a lack of family gatherings may be particularly vulnerable.
Background: We sought to determine the minimum number of observations needed to determine hand hygiene (HH) compliance among healthcare workers. Methods: The study was conducted at a referral hospital. We retrospectively analyzed the result of HH monitoring from January to December 2018. HH compliance was calculated by dividing the number of observed HH actions by the total number of opportunities. Appropriate HH compliance rates were calculated based on the 6-step technique, modified from the World Health Organization (WHO) recommendation. The minimum number of required observations (n) was calculated by the following equation using overall mean value (r), absolute precision (d), and confidence interval (1-α) [The equation: n3 Zα/22×ρ×1-ρ/d2]. We considered ds of 5%, 10%, 20%, and 30%, with CIs of 99%, 95%, and 90%, respectively. Among the various cases, we focused on 10% for d and 95% for CI. Results: During the study period, 8,791 opportunities among 1,168 healthcare workers were monitored. The mean HH compliance and appropriate HH compliance rates were 80.3% and 59.7%, respectively (Table 1). The minimum number of observations required to determine HH compliance rates ranged from 2 (d, 30%; CI, 90%) to 624 (d, 5%; CI, 99%), and the minimum number of observations for optimal HH compliance ranged from 5 (d, 30%, CI, 90%) to 642 (d, 5%; CI, 99%) (Figure 1). At 10% absolute precision with 95% confidence, the minimum number of observations to determine HH and optimal HH compliance were 61 and 92, respectively. Conclusions: The minimum number of observations to determine HH compliance varies widely according to setting, but at least 5 were needed to determine optimal HH compliance.
Cognitive theories of obsessive–compulsive disorder (OCD) stress the importance of dysfunctional beliefs in the development and maintenance of the disorder. However, a neurobiological understanding of these cognitive models, including thought-action fusion (TAF), is surprisingly lacking. Thus, this functional magnetic resonance imaging study aimed to investigate whether altered functional connectivity (FC) is associated with the TAF paradigm in OCD patients.
Forty-one OCD patients and 47 healthy controls (HCs) participated in a functional magnetic resonance imaging study using a TAF task, in which they were asked to read the name of a close or a neutral person in association with positive and negative statements.
The conventional TAF condition (negative statements/close person) induced significant FC between the regions of interest (ROIs) identified using multivoxel pattern analysis and the visual association areas, default mode network subregions, affective processing, and several subcortical regions in both groups. Notably, sparser FC was observed in OCD patients. Further analysis confined to the cortico-striato-thalamo-cortical (CSTC) and affective networks demonstrated that OCD patients exhibited reduced ROI FC with affective regions and greater ROI FC with CSTC components in the TAF condition compared to HCs. Within the OCD patients, middle cingulate cortex–insula FC was correlated with TAF and responsibility scores.
Our TAF paradigm revealed altered context-dependent engagement of the CSTC and affective networks in OCD patients. These findings suggest that the neurobiology of cognitive models corresponds to current neuroanatomical models of OCD. Further, they elucidate the underlying neurobiological mechanisms of OCD at the circuit-based level.
There has been little consensus on Japans welfare regime since Esping-Andersens [1990. The Three Worlds of Welfare Capitalism. Cambridge: Polity Press] unclear categorisation of Japan as his only non-Western welfare state. This article is the first attempt to analyse academic research published in both English and Japanese. It presents a review of 40 collected studies (including 15 Western, 6 Asian and 19 Japanese articles), reached a wide variety of conclusions, defining Japan as eight different types: We point out that while the majority of Western studies tend to run statistical models including Japan among otherwise Western welfare states with little theoretical justification, Japanese scholars tend to focus on Japan as a single case. The two very different approaches may have something to learn from each other, as in thesis antithesis synthesis. Now that we are aware of very different approaches to and conclusions about Japans welfare regime, the topic appears ripe for greater co-operation between scholars.
The hippocampus is not a uniform structure, but rather consists of multiple, functionally specialized subfields. Few studies have explored hippocampal subfield volume difference in the same sample of major depressive disorder (MDD) and bipolar disorder (BD) cases. We aimed to investigate the difference of hippocampal subfield volume between patents with MDD and BD and healthy controls (HCs).
A total of 102 MDD and 55 BD patients and 135 HCs were recruited and underwent T1-weighted image. Hippocampal subfield volume was calculated by automated segmentation and volumetric procedures developed by Iglesias et al. and implemented in FreeSurfer. Volume differences between the groups were analyzed using the analysis of covariance and controlling for age, sex, and total intracranial cavity volume.
Patients with MDD had significantly reduced volumes in the bilateral cornu ammonis 1 (CA1), CA4, the granule cell layer (GCL), molecular layer (ML), whole hippocampus, the left CA2/3, and right presubiclum and subiculum. Patients with BD had significantly reduced volumes in the right CA1, GCL, and the whole hippocampus as compared to HCs. No significant volume differences were observed between the MDD and BD groups. Illness duration was negatively correlated with volumes of the left CA1, CA4, ML, presubiculum, subiculum, and the whole hippocampus in patients with BD.
We observed hippocampal subfield volume reductions in both MDD and BD, a finding which more prominent in MDD. The inverse correlation between BD illness duration and hippocampal subfield volume may evidence the neuroprogressive nature of BD.
Background: Although D-dimer levels are significantly associated with cardioembolic infarction, the significance of D-dimer levels in relation to the severity and functional outcomes of other stroke subtypes, such as lacunar and large artery atherosclerosis infarction, remains unclear. The purpose of this study was to evaluate whether elevated initial D-dimer levels are significantly and cross-sectionally associated with poor functional outcomes at each time point during a 9-month follow-up period. We also investigated the significance of D-dimer levels in longitudinal temporal changes of functional outcomes in these patients. Methods: We recruited 146 patients with lacunar infarction and 161 patients with large artery atherosclerosis infarction who were consecutively admitted to our hospital after acute stroke. Serum D-dimer levels were evaluated initially and the modified Rankin scale were measured initially and at 1-, 3-, 6-, and 9-month follow-up visits. Results: Patients with higher D-dimer levels had significantly worse initial functional outcomes, and these worse outcomes were maintained throughout the 9-month follow-up period compared with the low D-dimer group. However, regardless of stroke subtype, D-dimer levels did not influence long-term changes in functional outcomes over the 9-month follow-up period. Conclusion: This study suggests that elevated D-dimer levels can be used as a surrogate marker for poor functional outcomes only during the acute stage. Further evaluation of serum D-dimer levels could provide a helpful predictive marker for stroke prognosis.
Decreased hemoglobin levels increase the risk of developing dementia among the elderly. However, the underlying mechanisms that link decreased hemoglobin levels to incident dementia still remain unclear, possibly due to the fact that few studies have reported on the relationship between low hemoglobin levels and neuroimaging markers. We, therefore, investigated the relationships between decreased hemoglobin levels, cerebral small-vessel disease (CSVD), and cortical atrophy in cognitively healthy women and men.
Cognitively normal women (n = 1,022) and men (n = 1,018) who underwent medical check-ups and magnetic resonance imaging (MRI) were enrolled at a health promotion center. We measured hemoglobin levels, white matter hyperintensities (WMH) scales, lacunes, and microbleeds. Cortical thickness was automatically measured using surface based methods. Multivariate regression analyses were performed after controlling for possible confounders.
Decreased hemoglobin levels were not associated with the presence of WMH, lacunes, or microbleeds in women and men. Among women, decreased hemoglobin levels were associated with decreased cortical thickness in the frontal (Estimates, 95% confidence interval, −0.007, (−0.013, −0.001)), temporal (−0.010, (−0.018, −0.002)), parietal (−0.009, (−0.015, −0.003)), and occipital regions (−0.011, (−0.019, −0.003)). Among men, however, no associations were observed between hemoglobin levels and cortical thickness.
Our findings suggested that decreased hemoglobin levels affected cortical atrophy, but not increased CSVD, among women, although the association is modest. Given the paucity of modifiable risk factors for age-related cognitive decline, our results have important public health implications.
A 19-year-old man with paroxysmal kinesigenic dyskinesia (PKD) taking 200mg carbamazepine per day for six years was admitted to our hospital because of a medical certificate for soldiers. The dyskinesias were usually precipitated by sudden movements and these attacks occurred several times a day and had a brief duration (less than one minute). The drug was abruptly withdrawn seven days before the brain imaging and video-electroencephalography monitoring. Magnetic resonance imaging showed cytotoxic edema in the splenium, which were completely resolved three months later (Figure).
Whether an association exists between cerebral microbleeds (CMBs) and functional recovery after ischemic stroke is unclear. We aimed to evaluate the association between CMBs and functional outcome after acute ischemic stroke.
Consecutive patients with acute stroke were enrolled, and all patients were stratified into good and poor functional outcome groups at discharge and 6 months after ischemic stroke by using a modified Rankin Scale score. Cardiovascular risk factors, CMBs, and white matter hyperintensities were compared between these two outcome groups. Logistic regression analysis was used to estimate the risk of poor functional outcomes.
A total of 225 patients were enrolled, 121 of whom were classified as having a good functional outcome at discharge and 142 as having a good 6-month functional outcome. The presence of CMBs was associated with a poor functional outcome at discharge [CMBs (+) patients in poor vs. good functional group; 48.1% vs. 30.6%; p=0.007] and 6 months [53.0% vs. 30.3%; p=0.001]. After adjustment for confounding factors, only the presence of infratentorial CMBs was associated with a poor functional outcome at discharge and 6 months. The poor functional outcome group had more CMBs than the good outcome group at 6 months.
Infratentorial cerebral microbleeds were significantly associated with worse functional outcomes not only in the early phase of ischemic stroke but also in the chronic phase. These findings suggest that the presence of infratentorial CMBs can predict poor functional outcome after acute ischemic stroke.
Epidemiological studies have reported that higher education (HE) is associated with a reduced risk of incident Alzheimer's disease (AD). However, after the clinical onset of AD, patients with HE levels show more rapid cognitive decline than patients with lower education (LE) levels. Although education level and cognition have been linked, there have been few longitudinal studies investigating the relationship between education level and cortical decline in patients with AD. The aim of this study was to compare the topography of cortical atrophy longitudinally between AD patients with HE (HE-AD) and AD patients with LE (LE-AD).
We prospectively recruited 36 patients with early-stage AD and 14 normal controls. The patients were classified into two groups according to educational level, 23 HE-AD (>9 years) and 13 LE-AD (≤9 years).
As AD progressed over the 5-year longitudinal follow-ups, the HE-AD showed a significant group-by-time interaction in the right dorsolateral frontal and precuneus, and the left parahippocampal regions compared to the LE-AD.
Our study reveals that the preliminary longitudinal effect of HE accelerates cortical atrophy in AD patients over time, which underlines the importance of education level for predicting prognosis.
Non-destructive high-throughput phenotyping based on phenomics is an emerging technology for assessing the genetic diversity of various traits and screening in breeding programmes. In this study, non-destructive measurements of leaf temperature and chlorophyll fluorescence were conducted to investigate the physiological responses of soybean (Glycine max) to salt stress so as to set up a non-destructive screening method. Two-week-old seedlings of soybean in the V2 stage were treated with 0, 12.5, 25, 50 and 100 mM NaCl to induce salt stress. Three parameters, photosynthesis rate, stomatal conductance and chlorophyll fluorescence, decreased significantly, while soybean leaf temperature increased by exhibiting a positive correlation with NaCl concentration (P< 0.001). Soybean leaf temperature increased significantly at 50 mM NaCl when compared with the untreated control, although no visual symptom was observed. We selected leaf temperature as a major physiological parameter of salt stress as its measurement is much easier, faster and cheaper than that of other physiological parameters. Therefore, leaf temperature can be used for evaluating the responses to salt stress in soybean as a non-destructive and phenomic parameter. The results of this study suggest that non-destructive parameters such as chlorophyll fluorescence and leaf temperature are useful tools for assessing the genetic diversity of soybean with regard to salt stress tolerance and to screen salt stress-tolerant soybean for breeding.
Social support programs for dementia caregivers were widely used in order to reduce care burden. We investigated which types of social supports can reduce psychological and non-psychological burdens of dementia caregivers, and explored the mechanism of those social supports.
We evaluated 731 community-dwelling dementia patients and their caregivers from the National Survey of Dementia Care in South Korea. We investigated the five types of social supports (emotional support, informational support, tangible support, positive social interaction, affectionate support) using the Medical Outcomes Study Social Support Survey in each caregiver. The mechanisms of specific types of social support on psychological/non-psychological burden were examined using path analysis.
Positive social interaction and affectionate support reduced psychological burden via direct and indirect paths. Tangible support reduced the non-psychological burden via direct and indirect paths. Informational support and emotional support were not helpful for reducing psychological or non-psychological burden. A maximum of 20% of psychological burden could be relieved by positive social interaction and 10.3% of that could be reduced by affectionate support. Tangible support was associated with a 15.1% maximal improvement in non-psychological burden.
In order to reduce caregiver burden in dementia effectively, psychosocial interventions should be tailored to target type of caregiver burden.
We investigated the microstructural evolution of Sn96.4Ag2.8Cu0.8 solder through in situ heating transmission electron microscopy observations. As-soldered bump consisted of seven layers, containing the nanoeutectic lamella structure of AuSn and Au5Sn phases, and the polygonal grains of AuSn2 and AuSn4, on Au-plated Cu bond pads. Here, we found that there are two nanoeutectic lamellar layers with lamella spacing of 40 and 250 nm. By in situ heating above 140°C, the nanoeutectic lamella of AuSn and Au5Sn was decomposed with structural degradation by sphering and coarsening processes of the lamellar interface. At the third layer neighboring to the lamella layer, on the other hand, Au5Sn particles with a zig-zag shape in AuSn matrix became spherical and were finally dissipated in order to minimize the interface energy between two phases. In the other layers except both lamella layers, polycrystal grains of AuSn2 and AuSn4 grew by normal grain growth during in situ heating. The high interface energy of nanoeutectic lamella and polygonal nanograins, which are formed by rapid solidification, acted as a principal driving force on the microstructural change during the in situ heating.
Background: Mortality associated with depression may be influenced by severity of depression and gender. We investigated the differential impacts on all-cause mortality of late-life depression by the type of depression (major depressive disorder, MDD; minor depressive disorder, MnDD; subsyndromal depression, SSD) and gender after adjusting comorbid conditions in the randomly sampled elderly.
Methods: One thousand community-dwelling elderly individuals were enrolled. Standardized face-to-face clinical interviews, neurological examination, and physical examination were conducted to diagnose depressive disorders and comorbid cognitive disorders. Depressive disorders were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria and SSD to study-specific operational criteria. Five-year survivals were compared between groups using Cox proportional hazards models.
Results: By the end of 2010, 174 subjects (17.4%) died. Depressive disorder (p = 0.001) and its interaction term with gender (p < 0.001) were significant in predicting five-year survival. MDD was an independent risk factor for mortality in men (hazard ratio = 3.65, 95% confidence interval = 1.67–7.96) whereas MnDD and SSD were not when other risk factors were adjusted.
Conclusions: MDD may directly confer the risk of mortality in elderly men whereas non-major depression may be just an indicator of increased mortality in both genders.
The oxidation behavior of Cu50Zr50 and Cu46Zr46Al8 glasses during continuous heating up to 1073 K has been investigated, with special emphasis on the oxidation resistance in the supercooled liquid (SCL) state. For Cu50Zr50, the oxide layer mostly consists of monoclinic ZrO2 (m-ZrO2), while for Cu46Zr46Al8, the oxide layer consists of two different layers: an outer layer consisting of tetragonal ZrO2 (t-ZrO2) + Al2O3 + metallic Cu (oxidation product from the SCL state of the glass matrix) and inner layer comprised of m-ZrO2 + metallic Cu islands (oxidation product from the crystallized matrix). Cu-enriched regions consisting of Cu51Zr14 (in Cu50Zr50) or AlCu2Zr + Cu70Zr15Al15 + Cu51Zr14 (in Cu46Zr46Al8) are present below the oxide layer. The present study shows that the addition of Al (8 at.%) in Cu50Zr50 results in a significant deterioration of the oxidation resistance in the SCL state since the solutionizing of Al in t-ZrO2 leads to a higher oxygen ion vacancy concentration, thus providing a higher activity of oxygen ions.
The purpose of this study is to develop new transparent conducting oxide (TCO) films by using combinatorial approach and to apply them for organic light emitting diodes (OLED) and/or thin film photovoltaic devices. For this, we have explored several TCO films with multi-components and optimized their properties by employing combinatorial sputtering system. For the first, we have fabricated combinatorial libraries composed Zn-In-Sn-O (ZITO) to reduce In content comparing with Sn-doped indium oxide (ITO). The ZITO films showed amorphous structure at the substrate temperature ranged RT∼ 350 °C, high transmittance over 85% at the visible range wavelength, and resistivity as low as 3x10-4∼10-3Ωcm. These results reveal that the ZITO films have indium composition as low as 30∼40% comparing with equivalent ITO films. Furthermore, we have fabricated OLED on glass substrates by using the amorphous ZITO anode. OLED fabricated on amorphous ZITO-coated glasses have exhibited good characteristics comparable to OLED on ITO films. Besides OLED, the amorphous ZITO TCO can be applied for other optoelectronic devices like electronic paper, thin film photovoltaic, and smart window.