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Aim: Deep brain stimulation (DBS) is a safe and effective treatment option for people with refractory obsessive-compulsive disorder (OCD). Yet our understanding of predictors of response and prognostic factors remains rudimentary, and long-term comprehensive follow-ups are lacking. We aim to investigate the efficacy of DBS therapy for OCD patients, and predictors of clinical response., Methods: Eight OCD participants underwent DBS stimulation of the nucleus accumbens (NAc) in an open-label longitudinal trial, duration of follow-up varied between 9 months and 7 years. Post-operative care involved comprehensive fine tuning of stimulation parameters and adjunct multidisciplinary therapy., Results: Six participants achieved clinical response (35% improvement in obsessions and compulsions on the Yale Brown Obsessive Compulsive Scale (YBOCS)) within 6-9 weeks, response was maintained at last follow up. On average, the YBOCS improved by 45% at last follow up. Mixed linear modeling elucidated directionality of symptom changes: insight into symptoms strongly predicted (P = 0.008) changes in symptom severity during DBS therapy, likely driven by initial changes in depression and anxiety. Precise localization of DBS leads demonstrated that responders most often had their leads (and active contacts) placed dorsal compared to non-responders, relative to the Nac., Conclusion: The clinical efficacy of DBS for OCD is demonstrated, and mediators of changes in symptoms are proposed. The symptom improvements within this cohort should be seen within the context of the adjunct psychological and biopsychosocial care that implemented a shared decision-making approach, with flexible iterative DBS programming. Further research should explore the utility of insight as a clinical correlate of response. The trial was prospectively registered with the ANZCTR (ACTRN12612001142820)., (© 2023 The Authors. Psychiatry and Clinical Neurosciences published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Psychiatry and Neurology.)

Wolff-Parkinson-White (WPW) syndrome is a congenital cardiac preexcitation syndrome that presents with an uninhibited electrical conduction between the atria and ventricles via an accessory pathway that has the potential for life-threatening arrhythmias. This is a case report of an asymptomatic/undiagnosed 43-year-old female with an incidental finding of WPW pattern during hardware removal surgery of the right hip while under general anesthesia. The identification of asymptomatic patients can be difficult because there may be only subtle changes on the electrocardiogram but could still pose as life-threatening in the presence of supraventricular tachycardia. Because of the potential risks, recommendations were given to follow up with the cardiology department to establish an accurate diagnosis. After recognition, the perioperative anesthetic goal was to prepare for any potential arrhythmia, minimize triggers, and provide proper follow-up so that appropriate testing could be conducted to properly diagnose and manage WPW., Competing Interests: Name: Cory Groves, APRN, CRNA, DNAP Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None., (Copyright © by the American Association of Nurse Anesthetists.)

Severe and refractory psychiatric patients can experience complex and profound changes in symptomology, functioning and well-being from deep brain stimulation (DBS) therapy. Currently, the efficacy of DBS is assessed by clinician rated scales of primary symptoms, yet this does not capture the multitude of DBS mediated changes or represent the patient perspective. We aimed to elucidate the patient perspective in psychiatric DBS application by investigating 1) symptomatic, and 2) psychosocial changes, 3) therapeutic expectations and satisfaction, 4) decision-making capacity, and 5) clinical care recommendations from treatment refractory obsessive-compulsive disorder (OCD) DBS patients. Participants enrolled in an open label clinical trial of DBS therapy for OCD who had reached clinical response were invited to participate in a follow up survey. Participants completed a 1) feedback survey relating to goals, expectations, and satisfaction of therapy, and 2) self-report questionnaires on psychosocial functioning including quality of life, cognitive insight, locus of control, rumination, cognitive flexibility, impulsivity, affect, and well-being. Greatest change was reported for quality of life, rumination, affect and cognitive flexibility. Participants reported realistic expectations, high satisfaction, adequate pre-operative education and decision-making capacity; and advocated for greater access to DBS care and more widespread support services. This is the first identified investigation on psychiatric patient perspectives of functioning and therapeutic outcomes following DBS. Insights from the study have implications for informing psychoeducation, clinical practices, and neuroethical debates. We encourage a greater patient-centred and biopsychosocial approach in evaluating and managing OCD DBS patients, by considering personally meaningful goals and addressing symptomatic and psychosocial recovery., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

Doctor Montagu Lomax was a retired General Practioner, whose service in English lunatic asylums during the First World War inspired him to write The experiences of an asylum doctor: with suggestions for asylum and lunacy law reform . Published in 1921, the book acted as a catalyst for lunacy reform and stimulated improvements in the mental health services in the United Kingdom. Lomax spent the remainder of his retirement campaigning for lunacy reform. He suffered financial and personal hardship following the publication of the book and was castigated by his own profession. On the centenary of the publication of Experiences , this article explores the background and motivation of a remarkable man.

Evolution-in-Materio is a computational paradigm in which an algorithm reconfigures a material's properties to achieve a specific computational function. This article addresses the question of how successful and well performing Evolution-in-Materio processors can be designed through the selection of nanomaterials and an evolutionary algorithm for a target application. A physical model of a nanomaterial network is developed which allows for both randomness, and the possibility of Ohmic and non-Ohmic conduction, that are characteristic of such materials. These differing networks are then exploited by differential evolution, which optimises several configuration parameters (e.g., configuration voltages, weights, etc.), to solve different classification problems. We show that ideal nanomaterial choice depends upon problem complexity, with more complex problems being favoured by complex voltage dependence of conductivity and vice versa. Furthermore, we highlight how intrinsic nanomaterial electrical properties can be exploited by differing configuration parameters, clarifying the role and limitations of these techniques. These findings provide guidance for the rational design of nanomaterials and algorithms for future Evolution-in-Materio processors., (© 2022 Massachusetts Institute of Technology.)

Deep brain stimulation is an emerging therapy for treatment-refractory obsessive-compulsive disorder patients. Yet, accessibility is limited, treatment protocols are heterogeneous and there is no guideline or consensus on the best practices. Here, we combine evidence from scientific investigations, expert opinions and our clinical expertise to propose several clinical recommendations from the pre-operative, surgical and post-operative phases of deep brain stimulation care for treatment-refractory obsessive-compulsive disorder patients. A person-centered and biopsychosocial approach is adopted. Briefly, we discuss clinical characteristics associated with response, the use of improved educational materials, an evaluative consent process, comprehensive programming by an expert clinician, a more global assessment of treatment efficacy, multi-disciplinary adjunct psychotherapy and the importance of peer support programs. Furthermore, where gaps are identified, future research suggestions are made, including connectome surgical targeting, scientific evaluation of hardware models and health economic data. In addition, we encourage collaborative groups of data and knowledge sharing by way of a clinical registry and a peer group of programming clinicians. We aim to commence a discussion on the determinants of deep brain stimulation efficacy for treatment-refractory obsessive-compulsive disorder patients, a rare and severe patient group, and contribute to more standardized and evidence-based practices.

Nitrate pollution in oxygenated karst aquifers is common due to nitrification and anthropogenic inputs. However, the shift of nitrogen sources influenced by enhanced rural tourism activities and land use changes are not well understood. In this study, hydrochemistry and dual nitrate isotopes of water samples from a rural karst basin in Chongqing, southwestern China were employed to investigate the nitrate fate and its decadal change during the periods from 2007-2008 and 2017-2019. The results showed that δ 15 N-NO 3 and δ 18 O-NO 3 values at the groundwater basin resurgence averaged 9 ± 3.4‰ and 2.5 ± 3.4‰, respectively, with a mean NO 3 - concentration of 19.7 ± 5.4 mg/L in 2017-2019, clearly exceeding natural background levels. The dual isotope results suggested that nitrification occurred at the sampled sites. From 2007-2008 to 2017-2019, the mean δ 15 N-NO 3 values from the primary sink point and the resurgence of the underground river water samples increased from -0.2 ± 2.1 to 11.2 ± 4.8‰, 4.2 ± 0.9 to 9.0 ± 3.4‰, respectively. A Bayesian mixing model in R (MixSIAR) based on the isotopes revealed that soil organic nitrogen, and manure and sewage proportions for the groundwater increased by 34% and 23%, respectively, while chemical fertilizer and atmospheric precipitation proportions decreased by 32% and 25%, respectively. These decadal changes resulted from reforestation practices and enhanced rural tourism activities in the basin, which were evidenced by the change of land use patterns. The elevated nitrogen load from the rapid development of rural tourism is likely to increase this contamination in the near future if the infrastructure cannot meet the demands. The results from this study could contribute to minimizing environmental health risks in drinking water when rural tourism activities are increasing., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The coronavirus disease 2019 (COVID-19) outbreak caused worldwide disruptions to healthcare systems. The emerging evidence indicates that mental health problems have consequently become an occupational hazard in frontline healthcare workers., Aim: We aimed to develop a psychological preparedness training (PPT) programme to support frontline health workers in three resource-limited hospitals in South Africa dealing with the COVID-19 outbreak and to evaluate its effectiveness using an audit tool. We established a theoretical framework and goals for a psychological preparedness programme to support healthcare workers at the study sites., Setting: Data were collected at the Dora Nginza Hospital, Nelson Mandela Academic Hospital and Elizabeth Donkin Hospital., Methods: We employed an observational, descriptive, and cross-sectional design. A group psychological intervention was developed and implemented at the three sites in South Africa, from mid-April 2020 over 20 weeks. We collected data using an audit tool to measure healthcare workers' perceptions of the outbreak before and after the intervention. We analysed the data to test for a statistically significant difference between the pre-intervention and post-intervention audit tools., Results: We supported 761 healthcare workers during the 20 weeks of the programme. Statistical analysis showed a significant positive change from pre- to post-intervention measures in perceptions of health worker about the outbreak, their anxiety associated with the outbreak, their ability to control reactions to stress and the perception of their ability to support others. Feedback comments indicated that the programme was beneficial for the majority of those who attended., Conclusion: Health workers who attended the programme reported improvement in stress levels and in perceptions about their ability to cope with the outbreak, as well as in their perceptions of being able to support others., (© 2022. The Authors.)

Magnesium sulfate given to women before birth at <30 weeks' gestation reduces the risk of cerebral palsy in their children. Our study aimed to assess the impact of a local quality improvement programme, primarily using plan-do-study-act cycles, to increase the use of antenatal magnesium sulfate. After implementing our quality improvement programme, an average of 86% of babies delivered at <30 weeks' gestation were exposed to antenatal magnesium sulfate compared with a historical baseline rate of 63%. Our study strengthens the case for embedding quality improvement programmes in maternal perinatal care to reduce the impact of cerebral palsy on families and society., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Previous work demonstrated that implementing a quality improvement (QI) program improves the uptake of guideline-recommended antenatal magnesium sulphate, a critical intervention known to reduce cerebral palsy risk. Here we estimate potential cost savings attributable to the improved uptake. By expanding coverage from 63 to 83% of eligible women, we estimated that five children potentially would not have received a diagnosis of cerebral palsy, a potential cost saving of $AU4.8 million in lifetime healthcare costs. Our findings strengthen the case for embedding QI approaches in perinatal care to reduce the incidence of cerebral palsy., (© 2021 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

The United Nations Educational, Scientific, and Cultural Organization (UNESCO) has recognized more than 350 karst areas of global importance through various designations (Biosphere Reserve, World Heritage Sites, Ramsar Sites, and Global Geoparks) with at least one UNESCO protected area with karst in 86 countries (Gunn 2020). In August 2020, Western Kentucky University, the George Wright Society, and the UNESCO Mammoth Cave Biosphere Region hosted Conservation of Fragile Karst Resources: A Virtual Workshop on Sustainability and Community in support of UNESCO science programs . The purpose of this meeting was to enhance communication and the sharing of ideas and resources between major conservation and science programs that protect, study, or manage cave and karst resources, with particular interest to those of international significance. This special issue is published in celebration and support of the UIS International Year of Caves and Karst and as a call-to-action to better explore, understand, and protect the value of cave and karst areas to humanity in both our everyday lives as well as our natural and cultural heritage., (© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021.)

Background: Worldwide, stroke is the second leading cause of death and disability. The burden of stroke in countries like Nepal is increasing. The purpose of this study is to describe the epidemiology, clinical features, and functional outcomes of individuals with stroke in a rehabilitation hospital in Nepal., Methods: A prospective descriptive study was conducted among individuals with stroke presenting for inpatient rehabilitation to the Nepal's first interdisciplinary inpatient stroke rehabilitation unit over a one-year period; from 1 April 2018 - 30 March 2019., Results: Twenty-four individuals were enrolled, with average age of 56.8 years (SD 11.9, range 38-79). Seventeen patients (71%) presented with ischemic stroke. Hypertension was the most common modifiable stroke risk factor observed, present in 21 (88%) of individuals. Median rehabilitation length of stay was 32.5 days (IQR 15.3 - 68.8). Median Modified Barthel Index at admission was 25.0 (IQR 8.5-57.0) and at discharge was 67.0 (IQR 46.0-88.0), a statistically significant improvement (Z = -3.408, p = 0.001). Median Modified Rankin Scale on admission was 5.0 (IQR 4.0-5.0) and at discharge was 4.0 (IQR 3.6-4.8; Z = -3.276, p = 0.001)., Conclusions: Most individuals with stroke admitted for interdisciplinary stroke rehabilitation demonstrated "severe" levels of disability and dependency on admission, and "moderate" levels of disability and dependency at the time of discharge. Hypertension represents a strategic target for primary and secondary prevention of stroke. With the burden of stroke increasing in Nepal, it is imperative to improve long-term availability and access to comprehensive stroke care for all affected individuals.

Flow cytometry is a powerful technology used in research, drug development and clinical sample analysis for cell identification and characterization, allowing for the simultaneous interrogation of multiple targets on various cell subsets from limited samples. Recent advancements in instrumentation and fluorochrome availability have resulted in significant increases in the complexity and dimensionality of flow cytometry panels. Though this increase in panel size allows for detection of a broader range of markers and sub-populations, even in restricted biological samples, it also comes with many challenges in panel design, optimization, and downstream data analysis and interpretation. In the current paper we describe the practices we established for development of high-dimensional panels on the Aurora spectral flow cytometer to aid clinical sample analysis.