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The French Headache Society proposes updated French guidelines for the management of migraine. This article presents the second part of the guidelines, which is focused on the pharmacological treatment of migraine, including both the acute treatment of attacks and the prophylaxis of episodic migraine as well as chronic migraine with and without medication overuse. The specific situations that can be encountered in women with migraine are also discussed, including pregnancy, menstrual migraine, contraception and hormonal replacement therapy.

The French Headache Society proposes updated French guidelines for the management of migraine. The first part of these recommendations is focused on the diagnosis and assessment of migraine. First, migraine needs to be precisely diagnosed according to the currently validated criteria of the International Classification of Headache Disorders, 3d version (ICHD-3). Migraine-related disability has to be assessed and we suggest to use the 6 questions of the headache impact test (HIT-6). Then, it is important to check for risk factors and comorbidities increasing the risk to develop chronic migraine, especially frequency of headaches, acute medication overuse and presence of depression. We suggest to use a migraine calendar and the Hospital Anxiety and Depression scale (HAD). It is also necessary to evaluate the efficacy and tolerability of current migraine treatments and we suggest to systematically use the self-administered Migraine Treatment Optimization Questionnaire (M-TOQ) for acute migraine treatment. Finally, a treatment strategy and a follow-up plan have to be proposed. Guidelines for pharmacological and non-pharmacological treatments are presented in the second and third part of the recommendations.

The French Headache Society proposes updated French guidelines for the management of migraine. This article presents the third part of the guidelines, which is focused on the non-pharmacological treatment of migraine, including physical exercise, dietary supplements and plants, diets, neuromodulation therapies, acupuncture, behavioral interventions and mindfulness therapy, patent foramen ovale closure and surgical nerve decompression.

•Therapists were positively surprised by the online capabilities and resilience of older patients to adapt to the online treatment program. Prejudices on limited effectiveness of online psychotherapy in older adults were counteracted.•COVID-19 related social distancing measures appeared to trigger feelings of rejection in patients with borderline personality traits, while it falsely validated indoor behavior of patients with avoidant personality traits.•Patients felt being taken seriously, especially because during the online group sessions they all received detailed comments on their homework (sent by email and discussed online).•Where the nonverbal sessions initially felt relaxing and fun, patients told us that these sessions also stimulated their mutual responsiveness (in schema therapy language “facilitated their happy child mode”).

Brominated flame-retardants (BFRs), including polybrominated diphenyl ethers (PBDEs) and hexabromocyclododecane (HBCD), were analysed in 77 eggs of 13 wild bird species from Gauteng and northern Free State (the industrial heartland of South Africa). BFRs were in all eggs, but not all BFRs were quantifiable. Concentrations ranged between 2.9 and 46 ng g−1wm (wet mass) and the predominant congeners were BDE-47, -153, -154, -183 and -209. The BFR compositional patterns of the congeners in eggs differed between species, feeding guilds, and habitats. Differences in associations of birds with humans seemed to have as much an influence as the trophic levels occupied by the maternal animals. The congener pattern of BFRs differed between terrestrial and aquatic species. The congener concentrations and patterns also differed from eggs from other countries, suggesting differences in sources. BFR concentrations in eggs from the current study area were below a reported no observed effect level (NOEL; 1 000 ng g−1wm). Although this suggests that the BFRs do not pose a risk, the NOEL was mostly based on information from birds from moderate and colder climates. This NOEL might not apply to birds from warmer climates with different life histories, as in the current study, because there are currently only draft regulations on importing BFRs or BFR-containing products in South Africa. The BFR-containing products otherwise destined for countries with BFR restrictions in place may now find their way to South Africa. The additional waste these poorly regulated products generate will eventually find their way to landfills ensuring that release to the environment and consequent exposures to biota will continue without effective interventions and waste management. Our findings indicate the need for on-going environmental monitoring to assess trends, identify hot spots, investigate effects, strengthen waste management, and the need to urgently implement the commitments under the Stockholm Convention.

BackgroundRoutine screening programmes for hazardous alcohol use in the ED miss large numbers of patients. We investigated whether patient-related or staff-related factors cause screening failures and whether unscreened patients are at increased risk of hazardous alcohol use.MethodsThis is a secondary analysis of a prospective study. From November 2012 to November 2013, all adult patients visiting a Dutch inner city ED were screened for hazardous alcohol consumption using the Alcohol Use Disorders Identification Test-Consumption. Reasons for failure of screening were categorised as: (A) patient is unable to cooperate (due to illness or pain, decreased consciousness or incomprehension due to intoxication, psychiatric, cognitive or neurological disorder or language barrier), (B) healthcare professional forgot to ask, (C) patient refuses cooperation and (D) screening was recently performed (<6 months ago). Presence of risk factors for hazardous alcohol use was compared between screened and unscreened patients.ResultsOf the 28 019 ED patients, 18 310 (65%) were screened and 9709 (35%) were not. In 7150 patients staff forgot to screen, whereas 2559 patients were not screened due to patient factors (2340 being unable and 219 unwilling). Patients with any of these risk factors were less likely to be screened: male sex, alcohol-related visit, any intoxication, head injury, any kind of wound and major trauma. In multivariate analysis, all these risk factors were independently associated with not being screened. Patients with at least one risk factor for hazardous alcohol use were less likely to be screened. Highest prevalence of risk factors was found in patients unable or unwilling to cooperate.ConclusionPatients who do not undergo routine screening for alcohol use at triage in the ED have an increased risk for hazardous alcohol use. These data highlight the importance of screening patients, especially those initially unwilling or unable to cooperate, at a later stage.

•Are cognitive deficits more pronounced in older adults with psychotic depression, compared to older adults with nonpsychotic depression?•Older patients with psychotic depression show more cognitive deficits on all cognitive domains, except for verbal fluency, compared to patients with nonpsychotic depression.•Researchers should be aware of the adverse influences not only of depression severity and advancing age but also of psychotic features in older patients.

ABSTRACTBackground:Fear of cancer recurrence (FCR) is one of the greatest problems with which cancer survivors have to deal. High levels of FCR are characterized by intrusive thoughts about cancer-related events and re-experiencing these events, avoidance of reminders of cancer, and hypervigilance, similar to post-traumatic stress disorder (PTSD). Eye movement desensitization and reprocessing (EMDR) therapy focuses on these images and memories. It is effective in reducing PTSD and may be effective in reducing high levels of FCR.Objective:The aim of the present study is to investigate the effectiveness of EMDR for severe FCR in breast and colorectal cancer survivors.Method:A multiple-baseline single-case experimental design (n = 8) was used. Daily repeated measurements for FCR were taken during the baseline phase and treatment phase, post-treatment, and at the 3 month follow-up. Participants answered the Cancer Worry Scale (CWS) and the Fear of Cancer Recurrence Inventory, Dutch version (FCRI-NL) five times, i.e. at the start and at the end of each phase (baseline, treatment, post-treatment, and follow-up). The study was prospectively registered at clinicaltrials.gov (NL8223).Results:Visual analysis and effect size calculation by Tau-U were executed for the daily questionnaire on FCR. The weighted average Tau-U score was .63 (p < .01) for baseline versus post-treatment, indicating large change, and .53 (p < .01) between baseline and follow-up, indicating moderate change. The scores on the CWS and FCRI-NL-SF decreased significantly from baseline to follow-up.Conclusion:The results seem promising for EMDR therapy as a potentially effective treatment for FCR. Further research is recommended.

Hybrid classical–quantum algorithms aim to variationally solve optimization problems using a feedback loop between a classical computer and a quantum co-processor, while benefiting from quantum resources. Here we present experiments that demonstrate self-verifying, hybrid, variational quantum simulation of lattice models in condensed matter and high-energy physics. In contrast to analogue quantum simulation, this approach forgoes the requirement of realizing the targeted Hamiltonian directly in the laboratory, thus enabling the study of a wide variety of previously intractable target models. We focus on the lattice Schwinger model, a gauge theory of one-dimensional quantum electrodynamics. Our quantum co-processor is a programmable, trapped-ion analogue quantum simulator with up to 20 qubits, capable of generating families of entangled trial states respecting the symmetries of the target Hamiltonian. We determine ground states, energy gaps and additionally, by measuring variances of the Schwinger Hamiltonian, we provide algorithmic errors for the energies, thus taking a step towards verifying quantum simulation.

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Le cefalee primarie sono patologie frequenti e, spesso, invalidanti. Le cefalee tensive, l’emicrania e l’algia vascolare facciale sono le forme più comuni. Dopo l’eliminazione di una cefalea secondaria (correlata a una causa che richiede una gestione specifica, spesso in urgenza), la diagnosi di una cefalea primaria si basa sull’identificazione di caratteri specifici (tipo, intensità, localizzazione, segni associati, ecc.), che sono richiamati nella classificazione internazionale delle cefalee (attualmente alla sua 3a versione). Le cefalee croniche quotidiane con o senza abuso di farmaci sono complicanze comuni che devono essere studiate. La gestione terapeutica coinvolge l’educazione del paziente, i trattamenti farmacologici e, anche, trattamenti non farmacologici la cui efficacia è variabile.

Although haloperidol is the most widely used drug in the treatment of delirium, evidence on the relevance of atypical antipsychotics (AAPs) is growing.

•The long-term prognosis of late-life depression is poor in terms of mortality and course.•Depression in later life is a chronic and disabling disorder, in which treatment is probably still suboptimal.•An unfavorable course is associated with a younger age at onset of depression, higher baseline depression, chronic pain, neuroticism and loneliness.•Patients with a partial remission might benefit from interventions targeting chronic diseases and loneliness.•Considering the poor prognosis and high dropout among depressed older patients in this study, much could be gained by improving prevention and treatment strategies.

Quantum state tomography is the standard technique for estimating the quantum state of small systems. But its application to larger systems soon becomes impractical as the required resources scale exponentially with the size. Therefore, considerable effort is dedicated to the development of new characterization tools for quantum many-body states. Here we demonstrate matrix product state tomography, which is theoretically proven to allow for the efficient and  accurate estimation of a broad class of quantum states. We use this technique to reconstruct the dynamical state of a trapped-ion quantum simulator comprising up to 14 entangled and individually controlled spins: a size far beyond the practical limits of quantum state tomography. Our results reveal the dynamical growth of entanglement and describe its complexity as correlations spread out during a quench: a necessary condition for future demonstrations of better-than-classical performance. Matrix product state tomography should therefore find widespread use in the study of large quantum many-body systems and the benchmarking and verification of quantum simulators and computers.

The occurrence of well-established risk factors for depression differs across the lifespan. Risk factors may be more strongly associated with depression at ages when occurrence, and therefore expectance, is relatively low (“on-time off-time” hypothesis). This large-scale study examined absolute and relative risks of established risk factors for depression across the lifespan.

To investigate associations between testosterone levels and major depressive disorder (MDD) in older men and women.

Background Non-maturation is a frequent complication of radiocephalic arteriovenous fistulas (RCAVF). In an animal model, liposomal prednisolone improved maturation of experimental fistulas. The Liposomal Prednisolone to Improve Hemodialysis Fistula Maturation (LIPMAT) study investigates if liposomal prednisolone improves RCAVF maturation.Methods and results The LIPMAT study is an investigator-initiated, multicenter, double-blinded, placebo-controlled randomized controlled trial with 1:1 randomization to liposomal prednisolone or placebo. Eighty patients receiving an RCAVF will be included. The primary outcome is the cephalic vein diameter six weeks after surgery, measured by ultrasound. The LIPMAT study started in May 2016. Enrollment is expected to be completed by the end of 2017.Conclusions The LIPMAT study is the first to evaluate the efficacy of liposomal prednisolone to enhance RCAVF maturation.

Background:In Huntington’s disease (HD) the innate immune system is activated, as reflected by increased plasma levels of different cytokines. Objective:To explore whether increased cytokine levels are associated with neuropsychiatric symptoms and cognitive dysfunction in HD mutation carriers. Method:Plasma cytokine levels of TNF-alpha, interleukin (IL)-1ra, IL-1β, IL-5, IL-6, IL-8 and Il-10 were assessed in 124 HD mutation carriers at two time points 2 years apart (totalling 214 observations). Using multilevel regression analysis, cytokines were analysed in relation to neuropsychiatric symptoms and cognitive dysfunction. Depressed mood was assessed with the depression subscale of the Problem Behaviours Assessment (PBA), apathy with the Apathy Scale, and irritability with the Irritability Scale. Cognitive functioning was assessed using the Mini-Mental State Examination (MMSE) and a battery of executive cognitive functioning tests, aggregated into an executive cognitive functioning (ExCog) score. Results:Inverse associations were found in adjusted models between IL-6 and ExCog score (β= –0.114; p = 0.01) and between IL-1ra and ExCog score (β= –0.110; p = 0.02). No associations between cytokine levels and any of the other neuropsychiatric symptom scores remained statistically significant in adjusted models. Conclusion:Higher plasma levels of IL-6 and IL-1ra are weakly associated with cognitive dysfunction in HD, but not with other neuropsychiatric symptoms.

AbstractRecently, cerebral structural covariance networks (SCNs) have been shown to partially overlap with functional networks. However, although for some of these SCNs a strong association with age is reported, less is known about the association of individual SCNs with separate cognition domains and the potential mediation effect in this of cerebral small vessel disease (SVD). In 219 participants (aged 75–96 years) with mild cognitive deficits, 8 SCNs were defined based on structural covariance of gray matter intensity with independent component analysis on 3DT1-weighted magnetic resonance imaging (MRI). Features of SVD included volume of white matter hyperintensities (WMH), lacunar infarcts, and microbleeds. Associations with SCNs were examined with multiple linear regression analyses, adjusted for age and/or gender. In addition to higher age, which was associated with decreased expression of subcortical, premotor, temporal, and occipital–precuneus networks, the presence of SVD and especially higher WMH volume was associated with a decreased expression in the occipital, cerebellar, subcortical, and anterior cingulate network. The temporal network was associated with memory (p= 0.005), whereas the cerebellar–occipital and occipital–precuneus networks were associated with psychomotor speed (p= 0.002 and p< 0.001). Our data show that a decreased expression of specific networks, including the temporal and occipital lobe and cerebellum, was related to decreased cognitive functioning, independently of age and SVD. This indicates the potential of SCNs in substantiating cognitive functioning in older persons.

In this paper, we report our progress towards the realization of a continuous guided atomic beam in the degenerate regime. So far, we have coupled into a magnetic guide a flux of a few 108atoms/s at 60 cm/s with a propagation in the guide over more than 2 meters. At this stage, the collision rate is not high enough to start an efficient forced evaporative cooling. Here we describe a new approach to reach the collisional regime. It is based on a pulsed feeding of the magnetic guide at a high repetition rate. The overlap of the packets of atoms occurs in the guide and leads to a continuous guided beam. We discuss different ways to increase the collision rate of this beam while keeping the phase space density constant by shaping the external potential.

A comprehensive understanding of how human disturbance affects tropical forest ecosystems is critical for the mitigation of future losses in global biodiversity. Although many genetic studies of tropical forest fragmentation have been conducted to provide insight into this issue, relatively few have incorporated landscape data to explicitly test the effects of human disturbance on genetic differentiation among populations. In this study, we use a newly developed landscape genetic approach that relies on a genetic algorithm to simultaneously optimize resistance surfaces to investigate the effects of human disturbance in the Udzungwa Mountains of Tanzania, which is an important part of a universally recognized biodiversity hotspot. Our study species is the endangered Udzungwa red colobus monkey (Procolobus gordonorum), which is endemic to the Udzungwa Mountains and a known indicator species that thrives in large and well-protected blocks of old growth forest. Population genetic analyses identified significant population structure among Udzungwa red colobus inhabiting different forest blocks, and Bayesian cluster analyses identified hierarchical structure. Our new method for creating composite landscape resistance models found that the combination of fire density on the landscape and distance to the nearest village best explains the genetic structure observed. These results demonstrate the effects that human activities are having in an area of high global conservation priority and suggest that this ecosystem is in a precarious state. Our study also illustrates the ability of our novel landscape genetic method to detect the impacts of relatively recent landscape features on a long-lived species.

IMPORTANCE: Observational studies indicate that lower blood pressure (BP) increases risk for cognitive decline in elderly individuals. Older persons are at risk for impaired cerebral autoregulation; lowering their BP may compromise cerebral blood flow and cognitive function. OBJECTIVE: To assess whether discontinuation of antihypertensive treatment in older persons with mild cognitive deficits improves cognitive, psychological, and general daily functioning. DESIGN, SETTING, AND PARTICIPANTS: A community-based randomized clinical trial with a blinded outcome assessment at the 16-week follow-up was performed at 128 general practices in the Netherlands. A total of 385 participants 75 years or older with mild cognitive deficits (Mini-Mental State Examination score, 21-27) without serious cardiovascular disease who received antihypertensive treatment were enrolled in the Discontinuation of Antihypertensive Treatment in Elderly People (DANTE) Study Leiden from June 26, 2011, through August 23, 2013 (follow-up, December 16, 2013). Intention-to-treat analyses were performed from January 20 through April 11, 2014. INTERVENTIONS: Discontinuation (n = 199) vs continuation (n = 186) of antihypertensive treatment (allocation ratio, 1:1). MAIN OUTCOMES AND MEASURES: Change in the overall cognition compound score. Secondary outcomes included changes in scores on cognitive domains, the Geriatric Depression Scale–15, Apathy Scale, Groningen Activity Restriction Scale (functional status), and Cantril Ladder (quality of life). RESULTS: Compared with 176 participants undergoing analysis in the control (continuation) group, 180 in the intervention (discontinuation) group had a greater increase (95% CI) in systolic BP (difference, 7.36 [3.02 to 11.69] mm Hg; P = .001) and diastolic BP (difference, 2.63 [0.34 to 4.93] mm Hg; P = .03). The intervention group did not differ from the control group in change (95% CI) in overall cognition compound score (0.01 [−0.14 to 0.16] vs −0.01 [−0.16 to 0.14]; difference, 0.02 [−0.19 to 0.23]; P = .84). The intervention and control groups did not differ significantly in secondary outcomes, including differences (95% CIs) in change in compound scores of the 3 cognitive domains (executive function, −0.07 [−0.29 to 0.15; P = .52], memory, 0.08 [−0.12 to 0.29; P = .43], and psychomotor speed, −0.85 [−1.72 to 0.02; P = .06]), symptoms of apathy (0.17 [−0.65 to 0.99; P = .68]) and depression (0.14 [−0.20 to 0.48; P = .41]), functional status (−0.72 [−1.52 to 0.09; P = .08]), and quality-of-life score (−0.09 [−0.34 to 0.16; P = .46]). Adverse events were equally distributed. CONCLUSIONS AND RELEVANCE: In older persons with mild cognitive deficits, discontinuation of antihypertensive treatment did not improve cognitive, psychological, or general daily functioning at the 16-week follow-up. TRIAL REGISTRATION: trialregister.nl Identifier: NTR2829

Altered cardiac autonomic control has often been reported in depressed persons and might play an important role in the increased risk for cardiovascular disease (CVD). A negative association between cardiac autonomic control and depression might become specifically clinically relevant in persons 60 years or older as CVD risk increases with age.

To explore the decision-making process involving elderly subjects with mild cognitive impairment and a relative when asked to participate in a clinical trial.

To compare alcohol use between depressed and nondepressed older adults, and to investigate correlates of alcohol abstinence and at-risk alcohol consumption in depressed older adults.

Les syndromes post-ponction lombaires (SPPL) surviennent au décours d’une brèche durale et se manifestent essentiellement par des céphalées apparaissant lors de la mise en orthostatisme. Leur évolution est habituellement bénigne et les complications rares. Toutefois, le retentissement fonctionnel est majeur entraînant la prolongation de l’hospitalisation, des arrêts de travail et parfois, par manque d’explication, des consultations itératives. Malheureusement, la fréquence des SPPL reste élevée (15 à 40 % au décours d’une PL diagnostique), bien qu’un certain nombre de mesures préventives et des recommandations existent. L’utilisation d’aiguilles de petit diamètre et à pointe de crayon permet une prévention optimale. L’évolution du SPPL peut être favorable après quelques jours, toutefois au-delà de 4jours le traitement de référence par « blood patchépidural » doit être proposé. L’objectif de cette revue est de faire une synthèse de la littérature concernant le SPPL, et de partager l’expérience de notre centre d’urgence des céphalées, avec l’utilisation d’aiguille de petit diamètre 25 G atraumatique (pencan, 0,5×90mm or 0,5×103mm, Braun, Germany).