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The conservation of biodiversity and forest ecosystems from the perspective of increasingly pronounced climate changes represents a priority objective for present and future society. In recent decades, alongside traditional conservation methods, innovative tools such as PES (Payment for Ecosystem Services) have been introduced to support biodiversity conservation. The aim of this study is to analyze the impact of financial mechanisms for forest ecosystem conservation from the perspective of voluntary adoption by forest owners of additional conservation measures beyond those required by national environmental legislation. Through the conceptual literature review, 6069 articles were analyzed, which described the general context of the application of PES, the aims and objectives related to climate and environmental issues, the beneficiaries, as well as the legislative conditions, and the research direction in the last 7 years. The study aims to provide relevant information regarding the viability and potential impact of PES on achieving the goal of forest ecosystem conservation in Romania, during the period 2017–2023. We identified 904 cases involving 887 entities that have committed to the program for the voluntary adoption of additional measures. It has been stated that a PES approach can lead to increased efficiency in conservation actions. Following the temporal analysis of the number of applications, it was observed that in the first sessions there was a low number of applications, which means very high reluctance of the potential beneficiaries of PES, but once the first program was implemented, their interest increased. The study found a strong correlation between payments and the areas and number of plots under commitment, while there was a less strong correlation with the geographical region. Based on the data obtained, the potential impact of PES in Romania was evaluated at the social level, quantified in the number of applications submitted, and at the economic level, with the amount of money paid to applicants. The environmental impact was measured by analyzing the areas included in the subsidy mechanism and identifying the minimum 20% of the eligible areas, totally exempt from forestry interventions, which produce effects on forests, soil, water and environment. [ABSTRACT FROM AUTHOR]

Frost crack represents one of the main defects which affect European beech wood quality. Therefore, the purpose of this paper is to improve the knowledge regarding both the impact of frost crack on European beech wood quality and the frost crack characteristics which affect wood quality. In order to do this, nineteen European beech trunks with frost crack have been studied. Each trunk has been cross-cut every 1 meter and the characteristics of frost crack and frost crack star-shaped heart have been measured in each cross-cut section. The defects which accompany frost crack have also been identified in each cross-cut section. Moreover, the possibility of determining these defects using the IML RESIF500 – S Resistograph has been tested. The research has emphasized the existence of statistical correlations between frost crack star-shaped heart expansion, frost crack rib prominence and frost crack length. These correlations are expressed by multiple linear regressions. The presence of defects which affect wood structure leading to a decrease in penetration resistance can be determined accurately with the resistograph. Decay (in frost cracks older than 8 years) and ring shake have been identified as the most frequent defects which accompany frost crack. The measurements made on the frost cracks studied have been gathered in a graph which shows frost crack impact on European beech wood quality. The results obtained lead to the improvement of the criteria of European beech wood quality assessment by expanding the already existent knowledge and by identifying new aspects which may complete standing wood quality determination and sorting methods.

The Kp index is a measure of the midlatitude global geomagnetic activity and represents short‐term magnetic variations driven by solar wind plasma and interplanetary magnetic field. The Kp index is one of the most widely used indicators for space weather alerts and serves as input to various models, such as for the thermosphere and the radiation belts. It is therefore crucial to predict the Kp index accurately. Previous work in this area has mostly employed artificial neural networks to nowcast Kp, based their inferences on the recent history of Kp and on solar wind measurements at L1. In this study, we systematically test how different machine learning techniques perform on the task of nowcasting and forecasting Kp for prediction horizons of up to 12 hr. Additionally, we investigate different methods of machine learning and information theory for selecting the optimal inputs to a predictive model. We illustrate how these methods can be applied to select the most important inputs to a predictive model of Kp and to significantly reduce input dimensionality. We compare our best performing models based on a reduced set of optimal inputs with the existing models of Kp, using different test intervals, and show how this selection can affect model performance. Key Points: We tested a number of different machine learning algorithms for Kp prediction and validated them using K‐fold cross validationFeature selection methods allow reducing the number of input variables by up to a factor of 16Information from solar wind measurements at L1 is not sufficient for long‐term predictions of Kp [ABSTRACT FROM AUTHOR]

The security of the information transmitted, irrespective of the era and the channel selected, has always been one of the main concerns of those using various communication systems. This is particularly the case nowadays, when the Internet has made the mass distribution of any kind of information possible. Codes can be used to transmit data through various noisy channels and any errors that might occur can be corrected; it is therefore very important to design gappropriate codes with adequate parameters. This survey briefly outlines the evolution of the ways in which information has been collected, transmitted and used from the past to the present. [ABSTRACT FROM AUTHOR]

Frost crack represents one of the main defects which affect European beech wood quality. Therefore, the purpose of this paper is to improve the knowledge regarding both the impact of frost crack on European beech wood quality and the frost crack characteristics which affect wood quality. In order to do this, nineteen European beech trunks with frost crack have been studied. Each trunk has been cross-cut every 1 meter and the characteristics of frost crack and frost crack star-shaped heart have been measured in each cross-cut section. The defects which accompany frost crack have also been identified in each cross-cut section. Moreover, the possibility of determining these defects using the IML RESIF500 -- S Resistograph has been tested. The research has emphasized the existence of statistical correlations between frost crack star-shaped heart expansion, frost crack rib prominence and frost crack length. These correlations are expressed by multiple linear regressions. The presence of defects which affect wood structure leading to a decrease in penetration resistance can be determined accurately with the resistograph. Decay (in frost cracks older than 8 years) and ring shake have been identified as the most frequent defects which accompany frost crack. The measurements made on the frost cracks studied have been gathered in a graph which shows frost crack impact on European beech wood quality. The results obtained lead to the improvement of the criteria of European beech wood quality assessment by expanding the already existent knowledge and by identifying new aspects which may complete standing wood quality determination and sorting methods. [ABSTRACT FROM AUTHOR]

This study sought to describe clinical and demographic characteristics differentiating patients with DSM-III-R simple phobias comorbid with one or more of five DSM-III-R index anxiety disorders as compared with those with the index diagnoses alone. From 711 subjects participating in a multicenter, longitudinal, naturalistic study of anxiety disorders, 115 subjects with comorbid simple phobias were compared with 596 subjects without simple phobias in terms of demographic data, comorbidity with other disorders, somatic and psychosocial treatment received, and quality of life. In addition, episode characteristics, types of simple phobias found, and course of illness were specified. Subjects with simple phobias had more additional comorbid anxiety disorders by history than did those without. Mean length of intake episode was 22.43 years and severity was typically moderate. Fears of heights and animals were the most commonly represented simple phobias. Subjects with uncomplicated panic disorder were less likely to have comorbid simple phobias than were subjects with other index diagnoses, and subjects with simple phobia were more likely to have comorbid posttraumatic stress disorder than were these without simple phobia. Subjects with and without simple phobias did not differ by somatic or psychosocial treatment received or in terms of quality of life. Simple phobia appeared in this study to be a chronic illness of moderate severity for which behavioral treatment methods of recognized efficacy were not being frequently utilized. Uncomplicated panic disorder may reflect some type of resistance to phobia development. [ABSTRACT FROM AUTHOR]

The present study examined the impact of comorbid major depressive disorder (MDD) on psychiatric morbidity, panic symptomatology and frequency of other comorbid psychiatric conditions in subjects with panic disorder (PD). Four hundred thirty-seven patients with PD were evaluated at intake as part of a multicenter longitudinal study of anxiety disorders; 113 of these patients were also in an episode of MDD. Patients were diagnosed by DSM-III-R criteria utilizing structured clinical interviews. The 113 PD/MDD patients were compared with the 324 remaining PD subjects regarding panic symptoms at intake, sociodemographic, quality of life and psychiatric morbidity variables. Differences in frequency of other comorbid Axis I psychiatric disorders were assessed at intake; personality disorders were evaluated twelve months after intake. The results revealed the PD/MDD patients exhibit increased morbidity and decreased psychosocial functioning as compared to PD patients. Personality disorders were more prevalent in the PD/MDD group at six month follow-up assessment; the PD/MDD group also had an increased frequency of posttraumatic stress disorder (PTSD) and more comorbid Axis I anxiety disorders as compared to the PD group. The total number and frequency of panic symptoms was highly consistent between the two patient groups. [ABSTRACT FROM AUTHOR]

An abstract of the article "Echographic Parameters of Left Atrial Function as Prognostic Predictors in Patients with Left Ventricular Systolic Dysfunction Undergoing Coronary Artery Bypass Grafting" by L. Iliuta and colleagues is presented.

An abstract of the article "Diagnostic value of ecofree space around the aortic prosthesis for infective endocarditis" by L. Iliuta, C. Savulescu, H. Moldovan, D. P. Gherghiceanu, and colleagues is presented.

Background: COVID-19 presented significant challenges to psychiatric staff, while social distancing and remote working necessitated digital communications. NHS England prioritised staff wellbeing. Arts-based creativity interventions appear to improve psychological wellbeing, so this study evaluated online Creativity Workshops as a staff support response for COVID-19-related stress., Methods: Participants were staff from a South London NHS psychiatric hospital. Group Creativity Workshops were facilitated via Microsoft Teams. Acceptability data on pre- and post-workshop mood and attitudes were self-reported by participants. Feasibility data were gathered from adherence to number of workshop components delivered., Results: Eight workshops were delivered in May-September 2020 ( N  = 55) with high adherence to components. Participants reported significantly increased positive mood and attitudes towards themselves and others; and decreased stress and anxiety., Conclusions: Online Creativity Workshops appear feasible and acceptable in reducing stress in psychiatric staff. Integrating a programme of Creativity Workshops within healthcare staff support may benefit staff wellbeing.

The major and minor salivary glands are responsible for saliva production, a fluid drained in the oral cavity that will be involved in several functions at this level. The present study aimed to compare the microanatomy of the major (parotid, mandibular, sublingual) and minor salivary glands (von Ebner's and Weber's) of the Wistar rat, from a histological, histochemical and morphometrically point of view. Predominantly serous glands (parotid, mandibular and von Ebner's) showed differences in the secretion composition on both PAS and alcian blue reactions. The same observations were identified also for the mostly mucous salivary glands (sublingual and Weber). In terms of surface dimensions, the measurements suggested that the mucous acini have a greater surface compared with the serous ones, and, at the same time, a better-represented polymorphism. In conclusion, the major and minor salivary glands in Wistar rats, a commonly used species in experimental procedures, showed similarities with other species including humans, but some structural traits are breed-specific, this finding is very important for an extensive understanding of the morphophysiology of the salivary glands., (© 2023 Wiley-VCH GmbH. Published by John Wiley & Sons Ltd.)

People with acute psychiatric conditions experience heightened stress, which is associated with worsened symptoms and increased violence on psychiatric wards. Traditional stress management techniques can be challenging for patients. Virtual reality (VR) relaxation appears promising to reduce stress; however, research on VR for psychiatric wards is limited. This mixed-methods study investigated feasibility and acceptability of integrating a VR relaxation clinic within acute psychiatric services. The study evaluated a VR relaxation session for inpatients and outpatients with acute psychiatric conditions (N = 42) and therapists' (N = 6) experience facilitating VR sessions for patients. Self-report assessments of psychological wellbeing were completed by patients pre- and post-VR. Patients and therapists provided qualitative feedback. The number of violent incidents and restrictive practices on the wards in the 12 weeks before VR implementation was compared to the first 12 weeks of VR. Post-VR, there were statistically significant increases in patients' relaxation, happiness, and connectedness to nature, and decreases in stress, anxiety, and sadness. Qualitative findings indicate patients found sessions enjoyable, relaxing, and helpful. Therapists provided positive feedback but highlighted practical challenges. Violent incidents and restrictive practices halved during VR implementation. VR relaxation appears feasible and acceptable in acute services. Larger studies should evaluate potential impact on psychiatric wards., Competing Interests: Declaration of Competing Interest Wim Veling is cofounder of VRelax BV, the company that has developed the VR application in collaboration with University Medical Center Groningen, and holds shares in VRelax BV. To address this competing interest, Wim Veling had an advisory role in study design and was not involved in data collection or data analysis. Some of the co-authors were also therapist participants in the study, which will have impacted on the reporting of the findings. There are no other conflicts of interest., (Copyright © 2023. Published by Elsevier B.V.)

This paper describes a mental health-awareness audio tour of the National Gallery, London, and evaluates the development and implementation of the tour. This smartphone-based audio tour was co-produced by Gallery staff, young people with lived experience of mental health issues, academics, and technologists. Interviews (N = 22) were conducted with developers and data-collectors (who had gathered feedback from Gallery visitors who undertook the tour) with responses analysed thematically. Participants highlighted the value of the arts to raise awareness about mental health, and the importance of teamwork, lived experience, and co-production, but also raised the challenges of integrating low-budget projects into large-scale venues.

The phenomenon of migration among medical personnel from less developed countries is a large one, with negative effects on the origin country, but more worrying is graduates' propensity to migrate during or immediately after university studies. The analysis of the labor market in the health sector from the last two decades shows us greater attractiveness of employment in (more) economically developed states compared to the demand from the health sector in graduates' origin countries. This research's purpose is to identify the determinants of the propensity to study and work abroad of medical students as a defined factor for better employment, and to identify the push factors in the origin country. As a result of the dichotomous nature of the dependent variables, logistic regression was applied. The independent variables (gender, residence, medical specialization, grades and perceived economic status) were used to identify the odds of the intention to migrate for studies. The results highlighted a higher propensity to migrate for studies among medical students, with opportunities offered by universities differing across countries and geographical areas. Moreover, students with a lower level of household income have openness to migrate, the tuition fees being managed through part-time/temporary employment during studies.

The pandemic disrupted all activities, so it became necessary to understand, but also rethink, the complexity of economic resilience to better deal with future shocks. A component that can signal the resilience potential of a socio-economic system is smart city response, using technology to make services more efficient. This paper aims to analyze the relationship between smart cities and urban resilience to determine whether urban resilience is significantly influenced by urban smartness. Given the EU SDGs Strategy and the Implementation of RRF Programs, we have also identified the main driving forces that can amplify the impact of smart city development policies on local resilience. The results highlighted that at the European level, smart cities are significantly correlated with urban resilience; urban resilience is explained by the variation in urban smartness; resilience is correlated with all smart city dimensions, highly in (post-)pandemic, redefining a "new normal" in resilience approaches for smart cities. We also stressed the emerging, more complex content of the economic resilience concept and the new structural approach of smart cities resilience for the post-COVID-19 period.

Aim: The arts have the potential to increase public awareness about mental health and reduce stigma. However, arts-based projects to raise awareness have been small-scale. In this study, a mental health-awareness audio tour of The National Gallery in London was co-produced and narrated by young adults with relevant lived experience. The study investigated the acceptability of the tour to the public and evaluated its impact on public attitudes about mental health., Methods: Participants were Gallery visitors over four consecutive days. The tour led visitors on 10 stops through the Gallery. Each stop focused on artworks and Gallery spaces, challenged common myths about mental health, and invited visitors to consider their personal views. Participants completed measures of mood and attitudes about mental health pre- and post-tour and provided narrative feedback., Results: Pre-tour, participants (N = 213) reported high levels of happiness, compassion towards people with mental health conditions, comfort talking about mental health, and positive attitudes about mental health. Post-tour, participants (N = 111) reported significant increases in happiness, comfort, and positive attitudes. In feedback, participants (N = 85) reported that strengths of the tour were the music, inclusion of lived experience, art and mental health links, and reported that the tour was informative, innovative, and improved mental health awareness., Conclusions: The tour increased positive attitudes, despite positive baseline attitudes, indicating the feasibility of arts-based interventions in major venues to reduce stigma. Sampling limitations and participant retention suggest that arts-based projects to raise awareness should target more diverse audiences and consider data collection strategies in large venues., (© 2022 The Authors. Early Intervention in Psychiatry published by John Wiley & Sons Australia, Ltd.)

The study of connectivity patterns in networks has brought novel insights across diverse fields ranging from neurosciences to epidemic spreading or climate. In this context, betweenness centrality has demonstrated to be a very effective measure to identify nodes that act as focus of congestion, or bottlenecks, in the network. However, there is not a way to define betweenness outside the network framework. By analytically linking dynamical systems and network theory, we provide a trajectory-based formulation of betweenness, called Lagrangian betweenness, as a function of Lyapunov exponents. This extends the concept of betweenness beyond the context of network theory relating hyperbolic points and heteroclinic connections in any dynamical system to the structural bottlenecks of the network associated with it. Using modeled and observational velocity fields, we show that such bottlenecks are present and surprisingly persistent in the oceanic circulation across different spatio-temporal scales and we illustrate the role of these areas in driving fluid transport over vast oceanic regions. Analyzing plankton abundance data from the Kuroshio region of the Pacific Ocean, we find significant spatial correlations between measures of diversity and betweenness, suggesting promise for ecological applications., (© 2021. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Laparoscopy is accepted in penetrating abdominal trauma (PAT), but its role in blunt trauma (BAT) remains a controversial one. Our study assessed the utility of diagnostic laparoscopy (DL) and therapeutic laparoscopy (TL) in abdominal trauma between December 2006 and January 2016. We analysed the indication for laparoscopy, type of lesions, TL, conversion rate, complications and length of hospital stay. 49 patients had a DL: 42 males and 7 females, with a mean age of 36.1+-13.3. We had 20 PAT and 30BAT. The indications for laparoscopy were: diagnosis of penetration in PAT, suspicion of hollow organ injury or diaphragm injury, active bleeding in organ injuries in BAT. 11/48 of preoperative ultrasounds and 4/48 of CT's were false negative. In 3 of 20 PAT, DL was negative and in 4 nontherapeutic. There were 4 TL's and 7 conversions. The main injuries in BAT were: 9 hollow organ perforations, 6 mesenteric lacerations, 2 diaphragmatic and 2 splenic injuries. There were 10 TL's, 9 conversions and 14 TL. The operative time and length of hospital stay was higher in the conversion group. There were 6 complications and 3 mortalities. There were no missed injuries. An unnecessary laparotomy was avoided in 18/49 cases (36.73%). In selected cases of PAT and BAT with equivocal clinical and imaging diagnosis, laparoscopy is a useful tool with therapeutic role, that reduces unnecessary laparotomies, complication rate and hospital stay., (Celsius.)

Laparoscopy of abdominal wall defects becomes more and more actual, considering the well-known advantages of minimally invasive surgery, and the reduced incidence of post-operative ventral infections and recurrence rates compared to the the open repair with or without mesh. We hereby present the technique of the laparoscopic repair of small ventral hernias (defect 2 centimetres), using the Ventralex mesh, which is bi-faceted, polypropylene and PTFE, circular preformed, it has 8 centimeters in diameter, fixated with 4 transparietal sutures. The mesh is created for open surgery but it is placed in the intraperitoneal cavity. This technique was used for 28 patients,16 women and 12 men, with an average age of 53,3 years (29-72 years), consisting of: 22 umbilical hernias (UH), 2 epigastric hernias (EH), one left-side Spiegelian hernia, one incisional hernia after an open surgery for an umbilical hernia with a Ventralex mesh, and 2 trocar eventrations (TE) after a laparoscopic cholecystectomy. Mean operating time was 52 minutes (42-70 minutes), post-operative hospital stay of 1,8 days (1-5 days). The main advantages are: circular preformed mesh, diameter of 8 centimeters, transfascial suture fixation, correct mesh placement and unfolding may be verified by laparoscopy, reduced costs. The technique is easy to reproduce., (Celsius.)

A Lagrangian flow network is constructed for the atmospheric blocking of Eastern Europe and Western Russia in summer 2010. We compute the most probable paths followed by fluid particles, which reveal the Omega-block skeleton of the event. A hierarchy of sets of highly probable paths is introduced to describe transport pathways when the most probable path alone is not representative enough. These sets of paths have the shape of narrow coherent tubes flowing close to the most probable one. Thus, even when the most probable path is not very significant in terms of its probability, it still identifies the geometry of the transport pathways.

We consider paths in weighted and directed temporal networks, introducing tools to compute sets of paths of high probability. We quantify the relative importance of the most probable path between two nodes with respect to the whole set of paths and to a subset of highly probable paths that incorporate most of the connection probability. These concepts are used to provide alternative definitions of betweenness centrality. We apply our formalism to a transport network describing surface flow in the Mediterranean sea. Despite the full transport dynamics is described by a very large number of paths we find that, for realistic time scales, only a very small subset of high probability paths (or even a single most probable one) is enough to characterize global connectivity properties of the network.

In this study, we tried to compare the efficacy and safety of betaxolol vs. metoprolol immediately postoperatively in coronary artery bypass grafting (CABG) patients and to determine whether prophylaxy for atrial fibrillation (AF) with betaxolol could reduce hospitalization and economic costs after cardiac surgery. Our trial was open-label, randomized, multicentric enrolling 1352 coronary surgery patients randomized to receive betaxolol or metoprolol. The primary endpoints were the composites of 30-day mortality, in-hospital AF (safety endpoints), duration of hospitalization and immobilization, quality of life, and the above endpoint plus in-hospital embolic event, bradycardia, gastrointestinal symptoms, sleep disturbances, cold extremities (efficacy plus safety endpoint). At the end of the study the incidence and probability of early postoperative AF with betaxolol was lower than with metoprolol in coronary surgery (P<0.0001). In the two study groups minor side effects were similar and no major complication was reported (P<0.001). Patient compliance was good and the general condition improved due to shortened hospitalization and immobilization with subsequent improvement in the psychological status, less arrhythmias and lack of significant side effects. In conclusion, because of its efficacy and safety, betaxolol was superior to metoprolol for the prevention of the early postoperative AF in coronary surgery.

Twelve women, five of them housewives, exposed in their residences to electromagnetic fields (EMFs)emitted by radio-television broadcasting stations for a mean period of 13 years, were investigated. The EMFs in the balconies of the homes were (mean + S.D.) 4.3 + 1.4 V/m in the year 2000 and 3.7 + 1.3 V/m in 2005, while the exposure in the nearby area was <2.0 V/m. The EMF exposed women showed in 2000 reduced blood NK lymphocytes as well as PHA stimulated PBMC proliferation and IL-2 and IFN-gamma release. In the year 2005, the EMF exposed women and 48 control women with similar ages(mean 43 years), smoking habits, atopy and social level were investigated. State (temporary) and trait(tendency of the personality) anxiety were determined by STAI I and II, respectively. Blood cytotoxic activity and lymphocyte subsets were also determined. The ratio STAI I/STAI II of the EMF exposed group was lower than that of the control group. The blood cytotoxic activity of the exposed women was lower (p<0.01), percent of B CD45+-CD19+ lymphocytes higher and percent of CD45+-CD3+-CD8+ cells lower (p<0.05). Moreover, cytotoxic activity/CD45+-CD16+-56+ NK lymphocytes of the controls was negatively correlated with STAI I and STAI II (p<0.001). In conclusion, this study demonstrates reduced blood cytotoxic activity and increased trait anxiety in relation to state anxiety in EMF exposed women. An effect of EMFs on immune functions, in part mediated by nervous mechanisms, may be hypothesized. However, the influence of lifestyle may not be excluded.

Background: Systemic embolisation occurs in 22% to 50% of patients with infective endocarditis (IE). Up to 65% of embolic events (EE) involve the central nervous system which increases the mortality rate. Several echocardiographic studies have demonstrated higher embolic rates with the increase of vegetation (VEG) dimensions and mobility., Aim: To define echocardiographic parameters which can help in identifying patients with a high risk of EE and to assess the value of transesophageal echocardiography (TEE) in predicting EE in patients with IE., Methods: 236 patients (58% male, mean age 47.8+/-6) diagnosed with IE according to Duke criteria were followed for 3 years or until cardiac surgery. Echocardiographic parameters measured on VEG included the maximum length, thickness, the narrowest diameter, neck and mobility., Results: The rate of EE was 51.27% without any significant differences with respect to gender, age, fever, anaemia, VEG site or the presence of a significant regurgitation murmur. The univariate analysis showed a significant correlation between EE and IE caused by staphylococcus, IE of the right heart, and the length as well as mobility of VEG. The only independent predictors of EE were the maximum VEG length >15 mm and the increased mobility of VEG with a maximal displacement angle >60.7 degrees. In 23% of patients EE occurred after the initiation of antibiotic treatment. VEG in this group were big and very mobile (length >15 mm, maximal angle of displacement >65 degrees)., Conclusions: 1. Vegetation dimension and mobility determined by TEE are important predictors of the embolic risk. 2. Significant echocardiographic predictors of embolic events included vegetation length >15 mm, neck/thickness ratio >0.69, and maximal angle of displacement of vegetation during cardiac cycle >60.7 degrees. 3. During antibiotic treatment, the embolic risk depends only on vegetation mobility and dimension.

Objective: Two procedures for treating major depressive disorder were compared with regard to their respective effects on mood and cognition., Background: Fourteen patients underwent treatment with electroconvulsive therapy and 14 underwent treatment with repetitive transcranial magnetic stimulation. Patients were tested on three occasions: before initiation of treatment, at the end of treatment, and 2 weeks after the end of treatment., Methods: Electroconvulsive therapy was applied unilaterally approximately three times per week for 2 to 4 weeks. Repetitive transcranial magnetic stimulation was applied in sessions of 1600 stimuli at 10 Hertz and 90% of motor threshold intensity to the left dorsolateral prefrontal cortex daily (Monday through Friday) for 2 consecutive weeks., Results: Results indicate that electroconvulsive therapy had a more positive effect on mood than did a 2-week trial of repetitive transcranial magnetic stimulation. With regard to cognitive outcome measures, electroconvulsive therapy exerted a deleterious but transient effect on various components of memory that were no longer detected 2 weeks after the end of treatment; however, there was evidence of persistent retrograde amnesia after treatment with electroconvulsive therapy. As a group, repetitive transcranial magnetic stimulation patients experienced only a modest reduction in depression severity but there was no evidence of anterograde or retrograde memory deficits in the aftermath of treatment with repetitive transcranial magnetic stimulation., Conclusions: Findings suggest that electroconvulsive therapy is associated with transient negative cognitive side effects, most of which dissipate in the days after treatment. Deficits of this sort are not apparent after treatment with a 2-week course of repetitive transcranial magnetic stimulation.

Background: Several brain imaging studies of antidepressant pharmacologic treatment utilizing single photon emission computed tomography (SPECT) have reported a normalization of deficits in cerebral blood flow (CBF) associated with recovery; other studies report no change, or a reduction in CBF following successful treatment. There have been no published SPECT studies of seasonal affective disorder (SAD) assessing response to light treatment in relation to changes in regional CBF (rCBF). In this study, we sought to test the hypothesis that increases in rCBF would be observed in SAD patients who responded to light treatment., Methods: Ten depressed patients with SAD underwent functional brain imaging studies with 99mTc-hexamethylpropyleneamine oxime SPECT before and after light treatment., Results: Relative increases in rCBF were observed in all brain regions compared to cerebellum in treatment responders, whereas nonresponders showed no change or decreases in rCBF relative to cerebellum. Significant differences in mean percentage change in rCBF between responders (n = 5) and nonresponders (n = 5) were detected in frontal and cingulate cortex, and thalamus., Conclusions: These findings provide preliminary support for the hypothesis that an increase in rCBF is associated with recovery from depression in SAD.

High resolution single photon emission computed tomography (SPECT) was used to evaluate regional cerebral blood flow (rCBF) in 14 acutely depressed elderly patients and 29 normal subjects. SPECT images of the two groups were randomized and blindly read. Foci of decreased radionuclide uptake were assessed by number and location. The total number of rCBF defects per whole brain study was significantly greater in the depressed patients than in the normal subjects. A significantly greater number of rCBF defects was found most strikingly in the lateral frontal and less prominently in the lateral and medial temporal brain regions of the depressed patients.

Single photon emission computed tomography (SPECT) is a widely available neuroimaging technique for the three-dimensional assessment of regional cerebral blood flow. The clinical utility of SPECT in neuropsychiatry is well established, and research devoted to its use in primary psychiatric disorders has been gaining momentum. In this review recent developments in SPECT neuroimaging are described, including the utility of SPECT in the differential diagnosis of the dementias and other neuropsychiatric conditions; SPECT studies of patients with affective disorders, at baseline and after treatment; and SPECT studies utilizing innovative techniques such as neuroreceptor imaging and activation strategies. Advances in SPECT research methodology and study design that may contribute to clarifying the pathophysiology of psychiatric disorders are examined.

This study examines a large cohort of subjects with social phobia, as part of a larger naturalistic and longitudinal study of 711 subjects with anxiety disorders. We focused on 176 subjects who were in an episode of social phobia at intake. We were particularly interested in evaluating the diagnostic distinction between generalized and specific social phobia. We compared these two groups along demographic characteristics, comorbidities, psychosocial functioning (health, role functioning, social functioning, and emotional functioning) and global assessment scores. We found that generalized social phobics tended to have an earlier age of onset as compared to the specific group; however, this is not a statistically significant difference at this level of analysis. The two groups did not differ for the current comorbidities examined. We observed no differences in the treatment received by the two types of social phobia subjects, and the two groups functioned equally well in terms of health and fulfilling social roles. In addition, we examined adverse childhood events (i.e., death of a parent, childhood abuse) and found no evidence for any differential impact these events might have on the type of social phobia. Although we did observe significantly greater fear of public speaking among the specific compared to the generalized group, which may indicate a qualitative difference between the subtypes, our results suggest that for most parameters, generalized and specific social phobia represent a continuum of similar and overlapping entities.

Objective: This analysis describes subjects who met rigorous criteria for DSM-III-R agoraphobia without a history of panic disorder and makes inferences from these data regarding relationships among agoraphobia without a history of panic disorder, panic disorder, and panic disorder with agoraphobia., Method: Twenty-six subjects (seven men and 19 women) with agoraphobia without a history of panic disorder were identified from among 711 subjects recruited for a multicenter, longitudinal anxiety disorder study. Narrative transcripts prepared by raters from study evaluations were coded for limited symptom attacks, situational panic, catastrophic cognitions, and possible precipitants and stressors, course, and somatic and psychosocial treatments received., Results: Sixty-five percent of the subjects reported experiences consistent with situational panic attacks, and 57% had definite or probable limited symptom attacks; these attacks usually preceded or appeared at the same time as avoidance behavior. Eighty-one percent had catastrophic cognitions associated with agoraphobia. Twenty-six percent reported a likely precipitating factor for symptom onset, and 30% reported a definite or probable major life stressor within 6 months before symptom onset. Cognitive-behavioral treatments were relatively infrequently used. Course was relatively unchanged across the follow-up period., Conclusions: These data support a view of agoraphobia without a history of panic disorder on a continuum with uncomplicated panic disorder and with panic disorder and agoraphobia, rather than as a separate diagnosis.

From 11 sites in New England and Missouri, 711 patients with > or = one of five index anxiety disorders were recruited onto a longitudinal study in which they were interviewed every 6 months regarding symptoms, course, and treatments received. Of the five disorders studied, panic disorder without agoraphobia was the disorder most often found as a sole diagnosis and generalized anxiety disorder (GAD) was least often found alone, both as lifetime diagnoses or when restricted to cases active at intake. Panic disorder with agoraphobia and agoraphobia without history of panic disorder (AWOPD) had three specific diagnoses with which they were frequently comorbid: social phobia, simple phobia, and GAD. AWOPD, social phobia, and GAD were frequently found in the presence of each other. It is possible that the experience of anxiety due to any syndromal cause may decrease the threshold for an individual to experience other anxiety symptoms or disorders. Clinicians should be aware of these patterns of comorbidity in order to formulate accurate differential diagnoses and prescribe treatments in a rational manner.

The goals of this study were to delineate the courses of social phobia and to determine whether the course of generalized and specific social phobia differed. In the Harvard/Brown Longitudinal Study of Anxiety Research Project, 66 specific and 74 generalized social phobic subjects were identified for whom adequate course data were available. These subjects had been followed prospectively with a standardized follow-along measure of psychopathology. The probability of remission was calculated for each individual group and both groups combined. Demographics were the same for both groups except that the specific social phobia group had a marginally higher mean score on the Global Assessment Scale. Complete remission for the combined group was not different from that for either subgroup and was 0.11 at 65 weeks. Social phobia appears to be a disorder with considerable long-term morbidity. Surprisingly, both subtypes took a comparably long time to remit and were similar in their high level of psychosocial dysfunction.

Recently there has been increasing interest in the relationship of the personality and the anxiety disorders. This paper presents comorbidity findings between DSM-III-R personality pathology and several DSM-III-R anxiety disorders and makes direct comparisons between anxiety groups. This is the most extensive comparison of this kind reported thus far. This report is on the first 475 anxiety patients who were recruited from multiple sites to take part in a naturalistic study of anxiety. All had a DSM-III-R diagnosis of panic, agoraphobia, social phobia, or generalized anxiety disorder (GAD). Previous studies which found a high comorbidity between the anxiety and the personality pathology were confirmed, with a significantly higher prevalence of personality pathology occurring with social phobia and GAD. Among our patients, all of whom had anxiety disorders, the presence of comorbid major depression is associated with an increase in the levels of comorbid personality pathology--as previously described in the literature. The relationship between low social functioning and the presence of personality pathology was confirmed, however, the relationship appears to be specific to certain areas of functioning, a new finding. There is a clinically important relationship between Personality Diagnostic Questionnaire--Revised personality pathology and the anxiety disorders characterized by different prevalences of personality disorders in different anxiety disorders and specific areas of social dysfunction.