Search

Aim. To explore the effect of an Early Intensive-Upper Limb intervention (EI-UL) compared to EI-UL with integrated Multisensory Stimulation And Priming (MuSSAP) training on improving manual ability in infants with a unilateral brain lesion. Method. A pilot randomised clinical trial with pre- and postintervention and follow-up measurements (T0, T1, and T2) was conducted. Sixteen infants with a unilateral brain lesion (corrected age is 4-10 months) received home-based intervention with video coaching. Eight infants received EI-UL and eight infants received EI-UL with integrated MuSSAP training. Primary outcome was the Hand Assessment for Infants (HAI) score. Additionally, effects were explored on initiation of goal-directed movements in both groups and on attention in the EI-UL with integrated MuSSAP training group. Results. No significant group differences in HAI scores were found. Overall, HAI ‘Affected hand score’ increased between T0 and T1 ( p = 0.001 , Cohen ’ s d = 1.04 ) and between T0 and T2 ( p < 0.001 , Cohen ’ s d = 1.28 ); and the HAI ‘Both Hands Measure’ increased between T0 and T1 ( p < 0.001 , Cohen ’ s d = 1.72 ) and between T0 and T2 ( p < 0.001 , Cohen ’ s d = 1.81 ). At the start of the intervention, six infants (three in both groups) did not demonstrate initiation of goal-directed contralesional upper limb movements. During the intervention one infant receiving EI-UL and all three infants receiving EI-UL with integrated MuSSAP training started to initiate goal-directed movements. Conclusion. The results suggest manual ability of infants with unilateral brain lesion improved with both interventions. We hypothesize that the integrated MuSSAP training may facilitate attention and initiation of contralesional upper limb goal-directed movements. This trial is registered with NCT05533476).

Metabolic engineering of microorganisms aims to design strains capable of producing valuable compounds under relevant industrial conditions and in an economically competitive manner. From this perspective, and beyond the need for a catalyst, biomass is essentially a cost-intensive, abundant by-product of a microbial conversion. Yet, few broadly applicable strategies focus on the optimal balance between product and biomass formation. Here, we present a genetic control module that can be used to precisely modulate growth of the industrial bacterial chassis Pseudomonas putida KT2440. The strategy is based on the controllable expression of the key metabolic enzyme complex pyruvate dehydrogenase (PDH) which functions as a metabolic valve. By tuning the PDH activity, we accurately controlled biomass formation, resulting in six distinct growth rates with parallel overproduction of excess pyruvate. We deployed this strategy to identify optimal growth patterns that improved the production yield of 2-ketoisovalerate and lycopene by 2.5- and 1.38-fold, respectively. This ability to dynamically steer fluxes to balance growth and production substantially enhances the potential of this remarkable microbial chassis for a wide range of industrial applications.

We introduce and study a class of optimization problems we call replenishment problems with fixed turnover times: a very natural model that has received little attention in the literature. Clients with capacity for storing a certain commodity are located at various places; at each client the commodity depletes within a certain time, the turnover time, which is constant but can vary between locations. Clients should never run empty. The natural feature that makes this problem interesting is that we may schedule a replenishment (well) before a client becomes empty, but then the next replenishment will be due earlier also. This added workload needs to be balanced against the cost of routing vehicles to do the replenishments. In this paper, we focus on the aspect of minimizing routing costs. However, the framework of recurring tasks, in which the next job of a task must be done within a fixed amount of time after the previous one is much more general and gives an adequate model for many practical situations. Note that our problem has an infinite time horizon. However, it can be fully characterized by a compact input, containing only the location of each client and a turnover time. This makes determining its computational complexity highly challenging and indeed it remains essentially unresolved. We study the problem for two objectives: min–avg minimizes the average tour cost and min–max minimizes the maximum tour cost over all days. For min–max we derive a logarithmic factor approximation for the problem on general metrics and a 6-approximation for the problem on trees, for which we have a proof of NP-hardness. For min–avg we present a logarithmic factor approximation on general metrics, a 2-approximation for trees, and a pseudopolynomial time algorithm for the line. Many intriguing problems remain open.

IntroductionHealthcare expenses are reaching unaffordable levels worldwide and reverse innovation could play a role in decreasing these expenses and improving healthcare accessibility. The ReMotion Knee, a prosthetic knee primarily developed for low-income countries, could serve as a reverse innovation for people with a lower limb amputation. This study aimed to evaluate the ReMotion Knee as a potential reverse innovation in high-income countries, specifically in terms of functional mobility.MethodsNine participants with a transfemoral amputation or knee exarticulation were included in this randomised crossover trial. The ReMotion Knee was compared with the participants’ current prosthetic knee in terms of functional mobility and subjective experiences. The primary outcome in this study was the L test for functional mobility. Secondary outcomes were additional clinical performance tests and subjective experiences (balance confidence, walking comfort, test performance and fatigue).ResultsParticipants scored significantly better using their current prosthetic knee than using the ReMotion Knee on primary outcome, the L test (pConclusionsThe ReMotion Knee has the potential to become a reverse innovation after modifications improving velocity, walking comfort and weight limit. Collaboration between high-income and low-income countries can facilitate further development of the ReMotion Knee and could result in alternative products and treatments that could reduce healthcare costs while still providing a good quality of care.Trial registration numberNCT04700085.

A simple algebraic equation is presented here to estimate the magnitude of groundwater velocity based on data from a single-well injection-drift test thereby eliminating the time-consuming and costly extraction phase. A volume of tracer-amended water was injected by forced-gradient into a single well followed by monitoring of the conservative solute tracers under natural-gradient conditions as their upgradient portions drifted back through the well. The breakthrough curve data from the single well during the drift phase was analyzed to determine the mean travel times of the tracers. The estimated mean upgradient travel distance back through the single well and the mean travel times of the tracers were used in a simple algebraic equation to estimate groundwater velocity. The groundwater velocity based on the single-well injection-drift test was estimated to be approximately 0.64 ft per day. Two transects of observation wells were used to monitor the natural-gradient tracer transport downgradient of the injection well. The one-dimensional, or dual-well, transport of the tracer from the injection well to the nearest downgradient observation well indicated that the groundwater velocity was 0.55 ft per day. The two-dimensional, or multi-well, transport of the center of mass of the tracers indicated that the groundwater velocity was 0.60 ft per day; the dual- and multi-well results were in excellent agreement with those from the single-well and validated the simple algebraic equation. The new single-well method presented here is relatively simple, rapid, and does not require an extraction phase.

Contains fulltext : 251270.pdf (Publisher’s version ) (Open Access) Relational frame theory (RFT) is a modern behavioral account of human language and cognition, which focuses on relations or propositions, rather than associations, as core explanatory constructs. In an attempt to measure such propositions, RFT researchers have developed the implicit relational assessment procedure (IRAP). It has been argued that the size of an IRAP effect may provide a metric for psychological inflexibility. The current study aimed to determine whether psychological inflexibility, as measured by the self-focused Natural Language-IRAP (NL-IRAP), would be higher in a clinical sample of individuals with a diagnosis of PTSD (N=29) when compared to a non-clinical sample. Subsequently, the study investigated whether the self-focused NL-IRAP could be used to predict the presence of a clinical diagnosis, using a ROC analysis. As predicted, higher levels of psychological inflexibility were observed for the clinical group. The self-focused NL-IRAP also correctly classified the presence of PTSD (AUC = 76%) with a sensitivity level of 79.3% and a specificity level of 59.2%.Overall, the use of the IRAP as a non-associative clinical measure appears promising. 11 p.

Dose reduction of biologics for psoriasis could contribute to more efficient use of these expensive medicines. Evidence on opinions of patients with psoriasis regarding dose reduction is sparse. The objective of this study was therefore to explore patients’ perspectives towards dose reduction of biologics for psoriasis. A qualitative study was conducted, comprising semi-structured interviews with 15 patients with psoriasis with different characteristics and treatment experiences. Interviews were analyzed by inductive thematic analysis. Perceived benefits of biologic dose reduction according to patients were minimizing medication use, lowering risks of adverse effects and lowering societal healthcare costs. Patients reported to have experienced a large impact of their psoriasis, and expressed concerns about loss of disease control due to dose reduction. Fast access to flare treatment and adequate monitoring of disease activity were among reported preconditions. According to patients, they should have confidence in dose reduction effects and should be willing to change their effective treatment. Moreover, addressing information needs and involvement in decision-making were deemed important among patients. In conclusion, addressing patients’ concerns, fulfilling information needs, providing the possibility of resuming standard dose, and involving patients in decision-making are important according to patients with psoriasis when considering biologic dose reduction.

Although positive associations between emotion regulation and PTSD have been consistently found in the literature, only limited research has examined the reciprocal relations between the two constructs. Until now, no study has investigated the reciprocal relations between emotion regulation and PTSD in a clinical sample. This study will therefore shed light on the relations between emotion regulation and the recovery of PTSD over time, whilst also breaking emotion regulation down into its distinct facets. Repeated Measures ANOVAs and cross-lagged panel models will be used to analyse the data.

Contains fulltext : 251274.pdf (Publisher’s version ) (Closed access) Previous studies have called for the inclusion of social support in the treatment of PTSD. The current review identifies interventions for adults with PTSD symptoms, which include a significant other as a source of social support. 11 articles focusing on eight interventions were found, including a total of 495 participants who had experienced trauma. These interventions were divided according to level of involvement of the significant other in treatment. Significant others were either passively or actively involved in the treatment. Preliminary results show that interventions actively involving a significant other in the treatment of the patient with posttraumatic stress symptoms were most effective in reducing PTSD symptoms. The current review provides recommendations for future research and suggests that significant others should be actively involved in the treatment of PTSD symptoms. 11 p.

Transcranial electric stimulation (tES) is being investigated for the relief of seizures in medically refractory epilepsy patients. In a quest to optimize the electrode placement and current for improvement of the outcome, we are investigating the exploitation of the pre-stimulation planning using finite element simulations based on individual anatomy from MRI [RM1] scans. A crucial step is validating the stimulation modeling accuracy, but commercial setups for validation do not exist.Hereto, we developed a three-layer head phantom, consisting of skin, skull, and brain tissue, that captures the crucial anatomical features and provides a convenient way of verifying the induced electric fields. It also enables systematic characterization of the uncertainties and variations in conductivity and anatomy. Experiments on the three-layer phantom bridge the gap between simulations and clinical practice since they also allow for using clinical hardware and electrodes.The developed phantom consists of an agar and salt brain layer, a graphite-doped polyurethane skull, and a skin layer made from agar gel with a different conductivity. In this way the solid skull separates the two gel layers, preventing possible ion drift over the layers. The anatomy is based on the ICBM 152 linear model, an average of 152 MRI scans, which enables us to intuitively link measurements and simulations. To perform the systematic characterization experiments, hardware and software were designed in-house. This allows for stimulations and measurements on the phantom in a cheap and modular way. The designed hardware consists of a PID-controlled tES stimulator, which can deliver 4 mA with a frequency up to 100 Hz, and a four-channel differential sensing board based on the OpenBCI Ganglion board.A realistic and modular phantom expands the possibilities of preclinical tES research by providing a tool to validate electric field simulations as well as experiment with clinical hardware and anatomical variations.

What is this summary about? This summary presents findings from recent research involving people with psoriasis, based on an article originally published in the Journal of the European Academy of Dermatology and Venereology . Psoriasis is a condition that primarily affects the skin. However, it can also influence people's mental health, social activities, work, and relationships too. Current assessment tools used by doctors and nurses do not cover the complete experience of people with psoriasis, which often include other medical conditions and can leave these individuals feeling that treatment has not been successful. Researchers conducted a study in which people with psoriasis, doctors, and nurses were asked in virtual meetings and via questionnaires what freedom from disease in psoriasis means to them. What were the results? In addition to skin symptoms, the areas of mental health, well-being, treatment, and relationships with healthcare teams were found to be important aspects to be addressed. What do the results of the study mean? Focusing on all five aspects of freedom from disease will help people with psoriasis manage their psoriasis with confidence.

Posttraumatic stress disorder (PTSD) is associated with impairments in relationship functioning. However, interactions within romantic relationships could also positively affect the recovery of posttraumatic stress symptoms. Therefore, in this present project, data is collected on the patient’s recovery from posttraumatic stress symptoms and the dyad’s self-reported partner responsiveness, relationship satisfaction, coping and attachment. The first study will investigate the relationships between posttraumatic stress symptoms, partner responsiveness and relationship satisfaction, by comparing main effect, buffering (moderation) and responsiveness deterioration (mediation) models. The second study examines whether partner responsiveness, dyadic coping and relationship satisfaction have a buffering effect on the recovery from posttraumatic stress symptoms. The third study investigates the interrelations between attachment and partner responsiveness.

Pancreatic ductal adenocarcinoma (PDAC) remains one of the most aggressive malignancies with a 5-year survival rate of only 9%. Despite the fact that changes in glycosylation patterns during tumour progression have been reported, no systematic approach has been conducted to evaluate its potential for patient stratification. By analysing publicly available transcriptomic data of patient samples and cell lines, we identified here two specific glycan profiles in PDAC that correlated with progression, clinical outcome and epithelial to mesenchymal transition (EMT) status. These different glycan profiles, confirmed by glycomics, can be distinguished by the expression of O-glycan fucosylated structures, present only in epithelial cells and regulated by the expression of GALNT3. Moreover, these fucosylated glycans can serve as ligands for DC-SIGN positive tumour-associated macrophages, modulating their activation and inducing the production of IL-10. Our results show mechanisms by which the glyco-code contributes to the tolerogenic microenvironment in PDAC., Rodriguez et al. present a transcriptomic analysis of glycosylation associated gene profiles, including bulk patient sequencing, sc-RNA seq, cell lines and organoids, to examine glycosylation in PDAC. They find 2 specific glycan profiles correlating with progression, clinical outcome and EMT, and conclude that the glyco-code contributes to the tolerogenic microenvironment in PDAC.

Files with: A Systematic Search and Mapping Review of Studies on Intracerebral Microdialysis of Amino Acids, and Systematized Review of Studies on Circadian Rhythms (https://doi.org/10.5334/jcr.172) AND Sleep and Microdialysis: An Experiment and a Systematic Review of Histamine and Several Amino Acids (https://doi.org/10.5334/jcr.183)

Research has shown that social relationships with both parents and significant others influence youth mental health through perceived social support. However, there is no consensus on the (causal) relations between symptom distress and perceived social support, and it is unknown whether the source of social support matters. Non-parental significant others often become more important in youth, but those with a lot of stress tend to fall back on their parents for support. Therefore, by conducting a cross-lagged panel analysis, this study will focus on the reciprocal relations between symptom distress and sources of perceived social support in youth aged 12-24. The results of this study will not only contribute to the accumulation of scientific knowledge, but also to the future design of preventive interventions.

Introduction. Hemispatial neglect is a disabling post-stroke attention deficit for which there is no effective cognitive intervention. Immersive virtual reality (IVR) may increase treatment engagement and efficacy, as it allows to train cognition in a 3D, dynamic, rich and multisensory environment. We designed an IVR multisensory patient-tailored rehabilitation game to rebalance spatial attention in hemispatial neglect patients. The current study aims to evaluate the efficacy and feasibility of this new rehabilitation approach. Method. A longitudinal cross-over placebo-controlled study design will be used to compare the effect of 10 hours of an active and 10 hours of a placebo IVR gamified intervention. We will recruit a minimum of 8 and maximum of 24 stroke patients with hemispatial neglect for the left side of space in two rehabilitation centres. The primary outcome is response times on invalid-cued left-sided compared to right-sided targets on a Posner cueing task. The secondary outcomes include performance on a computerized cancellation task, pen-and-paper administered cancellation and line bisection task, performance on the sustained attention to response task and symptoms in daily life evaluated with the Catherina Bergego Scale. To evaluate feasibility, we will systematically document the number of successfully recruited patients, cybersickness symptoms, their experience with the rehabilitation game and study whether patient’s experience predicts drop-out from the trial. Discussion. Our study will assess whether our IVR multisensory patient-tailored rehabilitation game can promote recovery of hemispatial neglect and whether it is feasible in stroke patients.

The current study aims to explore whether traumatic exposure and social network are related in adolescents, and whether social intelligence plays a mediating role in this potential relationship.

Powder bed printing is a 3D-printing process that creates freeform geometries from powders, with increasing traction for personalized medicine potential. Little is known about its applications for biopharmaceuticals. In this study, the production of tablets containing alkaline phosphatase using powder bed printing for the potential treatment of ulcerative colitis (UC) was investigated, as was the coating of these tablets to obtain ileo-colonic targeting. The printing process was studied, revealing line spacing as a critical factor affecting tablet physical properties when using hydroxypropyl cellulose as the binder. Increasing line spacing yielded tablets with higher porosity. The enzymatic activity of alkaline phosphatase (formulated in inulin glass) remained over 95% after 2 weeks of storage at 45 °C. The subsequent application of a colonic targeting coating required a PEG 1500 sub-coating. In vitro release experiments, using a gastrointestinal simulated system, indicated that the desired ileo-colonic release was achieved. Less than 8% of the methylene blue, a release marker, was released in the terminal ileum phase, followed by a fast release in the colon phase. No significant impact from the coating process on the enzymatic activity was found. These tablets are the first to achieve both biopharmaceutical incorporation in powder bed printed tablets and ileo-colonic targeting, thus might be suitable for on-demand patient-centric treatment of UC.

This study assesses whether social functioning of veteran families can be improved by examining the effectiveness of After-Deployment-Adaptive-Parenting-Tools (ADAPT), a group-based program tackling family problems by enhancing parenting and emotion regulation skills in veterans and their partners

revised assessment of Croton L. sect. Geiseleria (A. Gray) Baill. is provided. The section as now circumscribed includes 84 species ranging across warm areas of the Americas. A nuclear ITS phylogeny of 150 accessions from 83 species and a chloroplast trnL-F phylogeny of 89 accessions from 65 species were generated to confirm correct phylogenetic placement of the species and to determine if any species previously included in the section should now be excluded. Seven new species are described, and we present a taxonomic synopsis that lists all currently accepted species along with their synonyms, distributions, and pertinent comments. We also recognize four subsections within Croton sect. Geiseleria and list their corresponding species. Based on both morphological and molecular criteria, we now recognize C. lagunillae Croizat as a distinct species, rather than as a variety of C. guildingii Griseb. (now treated as C. suavis Kunth), and we treat C. ramillatus Croizat var. magniglandulifer V. W. Steinm. as a species, C. magniglandulifer (V. W. Steinm.) B. W. van Ee. We also exclude C. tetradenius Baill. from Croton sect. Geiseleria (A. Gray) Baill. along with related species such as C. pulegiodorus Baill. and C. leptobotryus Müll. Arg., which are either members of Croton sect. Adenophylli Griseb. or else may merit new sectional status. We also exclude C. waltherioides Urb., although it is not clear to which section of Croton it belongs.

The majority of studies showing multisensory attention benefits have focused on brief audiovisual events. Here we examined whether attention benefits can occur for auditory and visual signals that change in synchrony over time. In the first two experiments we found no evidence that attention was captured more by synchronous compared to asynchronous audiovisual and visual looming signals. The results of our third experiment suggested that attention was not preferentially oriented towards synchronous compared to asynchronous audiovisual and visual looming signals. In the fourth experiment, we found no evidence for better sustained attention for synchronous compared to asynchronous audiovisual looming and unisensory signals. Together, these findings indicate that synchronous multisensory looming signals are not always prioritized by our information processing system. Future multisensory research should focus on more conceptual clarity and deepen our understanding of the specific stimulus, task and contextual features affecting the strength and quality of multisensory integration. ispartof: Journal Of Cognitive Psychology vol:33 issue:3 pages:282-303 status: published

Contains fulltext : 238962.pdf (Publisher’s version ) (Open Access) 3 p.

We consider the dispersed p → -neighbor k -supplier problem. In the classical k -supplier problem, we have to select k suppliers in a metric space such that the maximum distance between a customer and its closest supplier is minimized. Here, we generalize this problem to the case where each customer possibly needs service from more than one supplier. Moreover, the selected suppliers should not be too close to each other, i.e., they need to be dispersed. For the classical k -supplier problem, and its special case the k -center problem, there is a 3- and a 2-approximation respectively. We show that these guarantees can also be given in the case when customers need service from multiple suppliers, without imposing dispersion constraints. If we generalize the problem to the dispersed case, without imposing neighboring constraints, we get inapproximability results depending on the measure of dispersion. We also show (almost) matching upper bounds. Finally, we show that adding both the neighbor requirement and the dispersion requirement leads to an inapproximable problem.

Telemedicine intensive care unit (Tele-ICU) programs entail command centers staffed with intensivists and critical care nurses who electronically aid with and deliver real-time information to frontline clinicians. The benefits of Tele-ICU are numerous, but the barriers to it often prove insurmountable, accounting for slow adoption in rural and underserved areas where it is needed the most. Remote monitoring can quickly detect patient deterioration, while consultation provided by a remote intensivist expands the capabilities of smaller facilities. The emergence of the coronavirus disease 2019 (COVID-19) pandemic has brought about a sense of urgency, paving the way for the successful adaptation of tele-intensive care concepts. The goal of this scoping review is to map out the available published data regarding healthcare professionals' experiences with implementing Tele-ICU modalities during the COVID-19 pandemic. A primary literature search was performed on PubMed/MEDLINE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases from October 2020 to October 2021. Of the 1,083 records screened, 19 were identified as meeting our inclusion criteria and selected for the final scoping review. Five major areas of Tele-ICU use were identified: teleconsultation, telerounding, telemonitoring, family visitation via teleconference, and changing of hospital infrastructure. A heterogeneous mix of improvised Tele-ICU platforms emerged with a common theme of interdisciplinary and family collaboration in the care of critically ill patients. Existing Tele-ICU systems were expanded, and novel programs were launched. A groundbreaking national network in the U.S. (NETCCN) will standardize the deployment of Tele-ICU and expand its reach. Future research should focus on determining accurate costs and the most reliable forms of remote communication, physician compact agreement licensure, the practical composition of Tele-ICU teams, and standardized access to the electronic health record.

Uniquely among mammalian organs, skin is capable of marked size change in adults, yet the mechanisms underlying this notable capacity are unclear. Here, we use a system of controlled tissue expansion in mice to uncover cellular and molecular determinants of skin growth. Through machine learning–guided three-dimensional tissue reconstruction, we capture morphometric changes in growing skin. We find that most growth is driven by the proliferation of the epidermis in response to mechanical tension, with more limited changes in dermal and subdermal compartments. Epidermal growth is achieved through preferential activation and differentiation of Lgr6 + stem cells of the epidermis, driven in part by the Hippo pathway. By single-cell RNA sequencing, we uncover further changes in mechanosensitive and metabolic pathways underlying growth control in the skin. These studies point to therapeutic strategies to enhance skin growth and establish a platform for understanding organ size dynamics in adult mammals.

Uniquely among mammalian organs, skin is capable of marked size change in adults, yet the mechanisms underlying this notable capacity are unclear. Here, we use a system of controlled tissue expansion in mice to uncover cellular and molecular determinants of skin growth. Through machine learning-guided three-dimensional tissue reconstruction, we capture morphometric changes in growing skin. We find that most growth is driven by the proliferation of the epidermis in response to mechanical tension, with more limited changes in dermal and subdermal compartments. Epidermal growth is achieved through preferential activation and differentiation of Lgr6

After a hurricane, for example hurricane Irma in Sint-Maarten, the navy can provide aid by bringing supplies, helping to clear roads and evacuating victims. If the destinations cannot be reached over land via a port, resources can be transported using smaller ships and helicopters, called connectors. This has to be done eciently so that the supply provision can start as soon as possible. Planning such an operation is known as the ship-to-shore problem, which is a combination of a heterogeneous vehicle routing and a bin-packing problem, which we prove to be an NP-hard problem. The aim is to schedule the connector trips to the shore and determine what resources should be loaded onto the connectors for each of their trips while minimising the duration of the operation. Connectors have dierent sizes, weight capacities, speeds and (un)loading times. Scheduling such an operation is currently done manually, which we mimic using a greedy heuristic. We aim to determine the quality of the greedy heuristic and determine in what cases it performs well and in what cases improvements can be found. To determine the quality, we solve the problem using a branch-and-price algorithm in which we take a set of ways to feasibly load the connectors as input. We use data provided by the Royal Netherlands Navy to construct 98 instances and nd that the greedy heuristic can nd an optimal solution in the majority of the cases. However, when the problem is less constrained in terms of the equirements regarding the order in which the resources should be delivered, the greedy heuristic is more likely to choose a suboptimal trip and can result in a solution that is far from optimal.

Contains fulltext : 283565.pdf (Publisher’s version ) (Open Access) Deployment-related posttraumatic stress disorder (PTSD) impacts social functioning in families. Therefore, it is important to examine the factors that contribute to social functioning in families that are confronted with deployment-related PTSD. The goal of this study was to assess the association between PTSD symptom severity and social functioning using self-report questionnaires in an outpatient veteran sample and to test the mediating roles of emotion regulation (Study 1, N = 100) and mentalization (Study 2, N = 38). Study 1 demonstrated that emotion regulation problems fully mediated PTSD associated family dysfunctioning. Study 2 did not demonstrate a mediation role of mentalization, but also did not demonstrate an association between PTSD and social dysfunctioning. Maladaptive mentalization was associated with poor child adjustment. Critically, a between-study comparison revealed that PTSD symptom severity was significantly higher in Study 1 than in Study 2. Overall, our findings suggest that social dysfunctioning may only appear when a given severity threshold of PTSD is reached, in which emotion regulation might be a key clinical factor. Maladaptive mentalization may be critical for post-deployment child adjustment. Future research should further examine social functioning in samples with different PTSD severity profiles and include the role of mentalization. Longitudinal data are needed to gain further insight into the causal relationships among the factors considered and the etiological pathways that lead to developing social dysfunction over time. 7 p.

Immersive virtual reality (IVR) may boost neglect recovery, as it can provide an engaging experience in a 3D environment. We designed an IVR rehabilitation game for neglect patients using the Oculus Rift. Multisensory cues were presented in the neglected visual field in a patient-tailored way. We acquired pilot data in 15 neurologically healthy controls and 7 stroke patients. First, we compared cybersickness before and after VR exposure. Second, we assessed the user experience through a questionnaire. Third, we tested whether neglect symptoms corresponded between the VR game and a computerized cancelation task. Fourth, we evaluated the effect of the multisensory cueing on target discrimination. Last, we tested two algorithms to tailor the game to the characteristics of the neglected visual field. Cybersickness significantly reduced after VR exposure in six stroke patients and was low in healthy controls. Patients rated the user experience neutral to positive. In addition, neglect symptoms were consistent between a computerized cancelation and VR rehabilitation task. The multisensory cue positively affected target discrimination in the game and we successfully presented sensory stimulation to the neglected visual field in a patient-tailored way. Our results show that it is promising to use gamified patient-tailored immersive VR for neglect rehabilitation. ispartof: Applied Neuropsychology-Adult vol:29 issue:5 pages:1-21 ispartof: location:United States status: Published online

Background: Posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) are known psychological outcomes that can co-occur in the aftermath of a traumatic event. However, it is less clear how these outcomes interact – particularly for female survivors of conflict-related sexual violence (CRSV) – and to what extent intermediary factors play a role in this relationship. Methods: In a sample of 192 war survivors from Bosnia & Herzegovina (n = 104 experienced CRSV, n = 88 did not), a structural equation model (LISREL 8.8) tested CRSV as a traumatic event, 'positive reinterpretation' (as a strategy of approach coping) and 'behavioural disengagement' (as a strategy of avoidance coping), and PTSD and PTG as psychosocial outcomes. A difference in the mechanisms by which PTG and PTSD interact in the two subgroups was hypothesised, given the differences in the nature of the trauma they experienced. Results: Through multiple indirect relationships, results showed that CRSV survivors respond to their trauma with both PTSD and PTG, suggesting a dual PTSDPTG mechanism. As for coping strategies, positive reinterpretation predicted greater PTG, and behavioural disengagement predicted greater PTSD. In the sample of nonsexual violence survivors, positive reinterpretation also remained a significant predictor of PTG. Conclusions: Positive reinterpretation as a coping strategy appears to be a stable characteristic that independently predicts PTG, irrespective of trauma type. Mental health professionals should take into account this mechanism when addressing the needs of CRSV survivors, but also war survivors more generally. Reframing traumatic events and post-trauma sequalae during treatment could lead to PTG and enhance recovery.

Biomass is often used to scale the contributions of individuals and their functional traits to a community or ecosystem. However, accurate biomass measurements can require destructive sampl...

—Croton kinondoensis, a new species from Kenya, is described and illustrated here with photographs. It is found in the sacred Kaya Kinondo Forest, one of the last remaining coastal forests patches in Kenya. Its morphology and systematic position based on ITS and trnL-F DNA sequence data clearly place it within the Adenophorus Group of Croton, a clade of ca. 15 species otherwise known only from Madagascar and the Comoros Archipelago. Its closest affinities appear to lie with Croton mayottae, from the island of Mayotte, and C. menabeensis, from northwestern Madagascar. This new species likely represents an independent dispersal of Croton from Madagascar to mainland Africa.

The consultation function of centers of excellence is still used to a limited extent. In this article we explain possibilities and contributions of highly specialized consultation to support standard mental healthcare by means of vignettes. Case descriptions from the consultation practice of four centers of excellence are presented. More intensive use of consultation options by mental health care providers can help improve the quality, efficiency and effectiveness of care.

Peer reviewed: True, Although well-established therapies exist for post-traumatic stress disorder (PTSD), barriers to seek mental health care are high. Technology-based interventions may play a role in improving the reach of efforts to treat, especially when therapist availability is low. The goal of the current randomized controlled trial was to pilot the efficacy of a computer-based trauma intervention with elements of virtual reality (VR; 3MR system) and limited therapist involvement for the treatment of PTSD in a childhood sexual abuse (CSA) and war veteran sample and to compare this to "treatment as usual" (TAU). TAU consisted of evidence-based approaches such as imaginal exposure, EMDR, or narrative exposure therapy. A total of 44 patients with PTSD were included and randomly assigned to 12 sessions of 3MR intervention or TAU (completer n 3MR = 12, TAU = 18). Several measures (PCL-5, BDI-II, OQ-45-2, and the M.I.N.I. 5.0.0.) were administered to measure symptoms of PTSD and depression and scores of overall well-being at pre, post, and a three-month follow-up measurement. Analyses suggest that symptoms of PTSD and depression in the 3MR condition decreased, and overall well-being increased between pre and post measurements. Results did not indicate any clear differences between the treatment conditions over time which suggests that treatment gains of the 3MR intervention seem no less than those of TAU. Finally, both treatment conditions produced similar remission rates of PTSD and depression. Therefore, the 3MR intervention could possibly constitute an appropriate treatment alternative. The small sample size as well as evident drop-out rates in the 3MR condition (45%) do warrant further research. The procedures of this study were approved by the Medical Ethical Research Committee (MERC) of the Erasmus Medical Center in Rotterdam (MEC-NL46279.078.13) and pre-registered via ClinicalTrials.gov (Protocol Record CI1-12-S028-1).

Contains fulltext : 285185.pdf (Publisher’s version ) (Open Access) Background: The number of studies that have researched the ability to mentalize in individuals with anxiety and related disorders is limited. Often, no distinction is made between different anxiety and related disorders in the examination of mentalization. Objective: The goal of this study was to obtain insight into mentalization in anxiety and related disorders, and to compare this ability between these disorders. Method: A systematic literature search was performed to identify studies in which performance on a mentalization task was compared between a patient group diagnosed with an anxiety or a related disorder, and a control group. Meta-analyses were performed on the included articles. Results: The initial search yielded 2844 articles, of which 26 studies on 1056 patients were included. Patients diagnosed with anxiety and related disorders showed a deficit in mentalization when compared to healthy controls (SMD = -0.60, p 0.001). A deficit was found in all patient groups: Patients with anxiety disorders (SMD = -0.39, p = 0.007), obsessive-compulsive and related disorders (SMD = -0.78, p = 0.01), and trauma and stressor related disorders showed significant deficits (SMD = -0.77, p = 0.02) as compared to healthy controls. Conclusion: The results indicated impaired mentalization in anxiety and related disorders, with specific deficiencies in posttraumatic stress disorder, social anxiety, and obsessive-compulsive disorders. Mentalization could provide a clinical target in treatment of these disorders. 10 p.

Homologous recombination repair deficiency (HRD) is observed in 10% of patients with castrate-resistant prostate cancer (PCa). Preliminary data suggest that HRD-PCa might be more responsive to immune checkpoint inhibitors (ICIs). In this study, we compare the tumor immune landscape and peripheral T cell receptor (TCR) repertoire of patients with and without HRD-PCa to gain further insight into the immunogenicity of HRD-PCa. Immunohistochemistry was performed on tumor tissue of 81 patients, including 15 patients with HRD-PCa. Peripheral TCR sequencing was performed in a partially overlapping cohort of 48 patients, including 16 patients with HRD-PCa. HRD patients more frequently had intratumoral CD3+, CD3+CD8−FoxP3− or Foxp3+ TILs above median compared to patients without DNA damage repair alterations (DDRwt; CD3+ and Foxp3+: 77% vs 35%, p = .013; CD3+CD8−FoxP3−: 80% vs 44%, p = .031). No significant difference in CD8+ TILs or PD-L1 expression was observed. In peripheral blood, HRD patients displayed a more diverse TCR repertoire compared to DDRwt patients (p = .014). Additionally, HRD patients shared TCR clusters with low generation probability, suggesting patient-overlapping T cell responses. A pooled analysis of clinical data from 227 patients with molecularly characterized PCa suggested increased efficacy of ICIs in HRD-PCa. In conclusion, patients with HRD-PCa display increased TIL density and an altered peripheral TCR repertoire. Further research into the efficacy of ICIs and the presence of shared neoantigens in HRD-PCa is warranted.

Background: Physician-reported clinical outcome and quality of life (QoL) measures are currently used to assess outcomes and direct treatment of plaque psoriasis. However, people with psoriasis may have different criteria for judging treatment success. Objectives: To build a unified consensus on the definition of ‘freedom from disease’ from a European stakeholder group, including people with psoriasis, dermatologists and nurses. Methods: The modified Delphi consensus methodology was used to define ‘freedom from disease’, with a consensus group consisting of people with psoriasis, nurses and dermatologists. This methodology involved people with psoriasis during the entire process and consisted of a 15-member Facilitating Consensus Panel to drive the programme content and a larger Voting Consensus Panel to vote on defining ‘freedom from disease’. The Facilitating Panel agreed on disease domains, and aspects of each domain were put forward to the Voting Consensus Panel to establish relative importance. Following two voting rounds, a meeting was held to agree on a final consensus statement. Results: The Facilitating Panel consisted of six patient advocacy group representatives, three specialist nurses and six dermatologists. Voting rounds 1 and 2 were completed by 166 and 130 respondents from the Voting Consensus Panel, respectively. The outputs from both rounds of voting were similar, focusing on normality of living, symptom control, and a relationship of mutual respect and trust between the individual with psoriasis and their healthcare professional. The consensus statement emphasizes that ‘freedom from disease’ is multifaceted and includes the following domains ‘management of clinical symptoms’, ‘psychosocial elements’, ‘QoL and well-being’, ‘treatment’ and ‘healthcare team support’. ‘Freedom from disease’ means all aspects are addressed. Conclusions: Freedom from disease in psoriasis is a multicomponent concept including five main domains. This diverse and multifaceted patient perspective will help us to improve understanding of the outcomes of treatment interventions in people with psoriasis.

Dose reduction of biologics for psoriasis is applied in daily practice, although guidelines are lacking. Striving for clear criteria is important, as it leads to a consistent application of dose reduction. To achieve consensus on criteria for biologic dose reduction in psoriasis patients with stable and low disease activity. An online Delphi procedure (eDelphi) was conducted. Dutch dermatologists were invited to participate in a maximum of 3 voting rounds. Proposed statements were selected based on literature review and included criteria for the application of dose reduction and dosing schedules. Biologic dose reduction was defined as ‘application of injection interval prolongation’. Proposed statements were rated using a 9-point Likert scale; consensus was reached when ≥70% of all voters rated ‘agree’ (7–9) and