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This essay analyzes the rhetorical framing tactics of a group of disability activists to understand how they use key words, topic shifts, and other framing maneuvers to amplify marginalized voices in public debates. Focusing on a town hall meeting and a legislator update meeting between activists and lawmakers, the author uses "stasis" theory to analyze how these maneuvers (1) create gateways for marginalized voices to enter the discussion and (2) anchor deliberations around topics of importance to the disabled community. This suggests a more complex role for framing in face-to-face deliberative contexts than studies of framing strategies in written texts have traditionally considered. I argue that a multidimensional view of framing uniting consideration of word choice with attention to interactive dynamics is necessary to appreciate how framing maneuvers can not only shape the content of debates but amplify the voices of people excluded by the tacit rules of democratic deliberation.

Michelle JH Verdurmen,1 Arjan C Videler,2 Astrid M Kamperman,3 David Khasho,4 Christina M van der Feltz-Cornelis4,5 1Department of Personality Disorders, GGz Breburg, Tilburg, 2Department of Geriatric Psychiatry, GGz Breburg, Tilburg, 3Department of Psychiatry, Erasmus University Medical Center, Epidemiological and Social Psychiatric Research Institute, Rotterdam, 4Clinical Center of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, 5Department of Tranzo, Tilburg University, Tilburg, The Netherlands Background: Elderly patients with somatic symptom disorder (SSD) put a great burden on the health care delivery system. Cognitive behavioral therapy (CBT) is effective in adults with SSD. However, no studies have been conducted yet into CBT for SSD in later life.Objectives: We explored the feasibility of CBT for SSD in the elderly.Methods: This is a prospective pilot study comparing two outpatient specialty mental health settings for adults (

Summary: Background: Controllability analysis is an approach developed for evaluating the ability of a brain region to modulate function in other regions, which has been found to be altered in major depressive disorder (MDD). Both depressive symptoms and cognitive impairments are prominent features of MDD, but the case–control differences of controllability between MDD and controls can not fully interpret the contribution of both clinical symptoms and cognition to brain controllability and linked patterns among them in MDD. Methods: Sparse canonical correlation analysis was used to investigate the associations between resting-state functional brain controllability at the network level and clinical symptoms and cognition in 99 first-episode medication-naïve patients with MDD. Findings: Average controllability was significantly correlated with clinical features. The average controllability of the dorsal attention network (DAN) and visual network had the highest correlations with clinical variables. Among clinical variables, depressed mood, suicidal ideation and behaviour, impaired work and activities, and gastrointestinal symptoms were significantly negatively associated with average controllability, and reduced cognitive flexibility was associated with reduced average controllability. Interpretation: These findings highlight the importance of brain regions in modulating activity across brain networks in MDD, given their associations with symptoms and cognitive impairments observed in our study. Disrupted control of brain reconfiguration of DAN and visual network during their state transitions may represent a core brain mechanism for the behavioural impairments observed in MDD. Funding: National Natural Science Foundation of China (82001795 and 82027808), National Key R&D Program (2022YFC2009900), and Sichuan Science and Technology Program (2024NSFSC0653).

The rising popularity of wearable devices allows for extensive and unobtrusive collection of personal health data for extended periods of time. Recent studies have used machine learning to create predictive algorithms to assess symptoms of major depressive disorder (MDD) based on these data. This review evaluates the clinical relevance of these models. Studies were selected to represent the range of methodologies and applications of wearables for MDD algorithms, with a focus on wrist-worn devices. The reviewed studies demonstrated that wearable-based algorithms were able to predict symptoms of MDD with considerable accuracy. These models may be used in the clinic to complement the monitoring of treatments or to facilitate early intervention in high-risk populations. In a preventative context, they could prompt users to seek help for earlier intervention and better clinical outcomes. However, the lack of standardized methodologies and variation in which performance metrics are reported complicates direct comparisons between studies. Issues with reproducibility, overfitting, small sample sizes, and limited population demographics also limit the generalizability of findings. As such, wearable-based algorithms show considerable promise for predicting and monitoring MDD, but there is significant room for improvement before this promise can be fulfilled.

Abstract Organoids are engineered 3D miniature tissues that are defined by their organ-like structures, which drive a fundamental understanding of human development. However, current organoid generation methods are associated with low production throughputs and poor control over size and function including due to organoid merging, which limits their clinical and industrial translation. Here, we present a microfluidic platform for the mass production of lumenogenic embryoid bodies and functional cardiospheres. Specifically, we apply triple-jet in-air microfluidics for the ultra-high-throughput generation of hollow, thin-shelled, hydrogel microcapsules that can act as spheroid-forming bioreactors in a cytocompatible, oil-free, surfactant-free, and size-controlled manner. Uniquely, we show that microcapsules generated by in-air microfluidics provide a lumenogenic microenvironment with near 100% efficient cavitation of spheroids. We demonstrate that upon chemical stimulation, human pluripotent stem cell-derived spheroids undergo cardiomyogenic differentiation, effectively resulting in the mass production of homogeneous and functional cardiospheres that are responsive to external electrical stimulation. These findings drive clinical and industrial adaption of stem cell technology in tissue engineering and drug testing.

BackgroundFrontline staff in psychiatry need to perform at a very high professional level in order to ensure patient and community safety. At the same time they are exposed to high levels of stress and workplace trauma. This may have severe consequences for their professional quality of life. In addition, health care workers in general have higher incidence levels of childhood adversity than the general population. The CRITIC (CRITical Incidents and aggression in Caregivers) Study aims to improve increased understanding of the interaction between personal life history (childhood adversity and benevolence), individual capabilities, exposure to trauma and violence at work and Professional Quality of Life (ProQOL).MethodThe Critic Study is a cross-sectional survey of these aspects in frontline, treatment and administrative staff in clinical and forensic psychiatry. We aim to include 360 participants. Participants will be asked to complete questionnaires on childhood adversity and childhood benevolence (assessing personal life history), professional quality of life, current trauma and violence exposure, current mental health (depression, anxiety and stress), coping, social support, work engagement and resilience. In this study we will examine the moderating role of adverse and benevolent childhood experiences in the association between workplace trauma exposure and professional quality of life. Finally, a theoretical model on the relationships between trauma, stress and coping in the context of professional functioning will be tested using structural equation modelling.DiscussionThe CRITIC study examines which factors influence the complex relationship between childhood adversity and benevolence, and ProQOL in healthcare workers. It also aims to provide insight into the complex relationship between personal life history, individual characteristics, exposure to trauma and violence at work and ProQOL. The results can be used for designing interventions to increase resilience to trauma and to improve professional quality of life among health care professionals.Trial registrationThe CRITIC study has been approved by the Medical Ethical Committee of the Erasmus Medical Centre, under trial registration number NL73417.078.20

Abstract Background This study took place to enable the measurement of the effects on mental health of a psychosocial intervention in Rwanda. It aimed to establish the capacities of the Self-Reporting Questionnaire (SRQ-20) to screen for mental disorder and to assess symptom change over time in a Rwandan community setting. Methods The SRQ-20 was translated into Kinyarwanda in a process of forward and back-translation. SRQ-20 data were collected in a Rwandan setting on 418 respondents; a random subsample of 230 respondents was assessed a second time with a three month time interval. Internal reliability was tested using Cronbach's alpha. The optimal cut-off point was determined by calculating Receiver Operating Curves, using semi-structured clinical interviews as standard in a random subsample of 99 respondents. Subsequently, predictive value, likelihood ratio, and interrater agreement were calculated. The factor structure of the SRQ-20 was determined through exploratory factor analysis. Factorial invariance over time was tested in a multigroup confirmatory factor analysis. Results The reliability of the SRQ-20 in women (α = 0.85) and men (α = 0.81) could be considered good. The instrument performed moderately well in detecting common mental disorders, with an area under the curve (AUC) of 0.76 for women and 0.74 for men. Cut-off scores were different for women (10) and men (8). Factor analysis yielded five factors, explaining 38% of the total variance. The factor structure proved to be time invariant. Conclusions The SRQ-20 can be used as a screener to detect mental disorder in a Rwandan community setting, but cut-off scores need to be adjusted for women and men separately. The instrument also shows longitudinal factorial invariance, which is an important prerequisite for assessing changes in symptom severity. This is a significant finding as in non-western post-conflict settings the relevance of diagnostic categories is questionable. The use of the SRQ-20 can be considered an alternative option for measuring the effect of a psychosocial intervention on mental health. Trial registration Nederlands Trial Register NTR1120.

Recent studies have provided new data on the teratogenicity of lithium. Less is known about the risk of miscarriage after lithium use during pregnancy. The aim of this study was to investigate the association between lithium use during pregnancy and miscarriage. Participants were women with bipolar I disorder and one or more pregnancies, of which information on medication use and pregnancy outcome was available (n = 443). The unadjusted odds ratios for miscarriage after lithium use during pregnancy was calculated. Multilevel logistic regression was used to calculate the odds ratio, adjusted for the age at conception and the clustering of pregnancies per woman. Miscarriages occurred in 20.8% of the lithium-exposed pregnancies (16/77), compared with 10.9% of the unexposed pregnancies (40/366) (OR = 2.14; 95% CI: 1.13-4.06). The adjusted odds ratio of miscarriage after lithium use during pregnancy was 2.94 (95% CI: 1.39-6.22). Lithium use during pregnancy may increase the risk of miscarriage.

Living microtissues are used in a multitude of applications as they more closely resemble native tissue physiology, as compared to 2D cultures. Microtissues are typically composed of a combination of cells and materials in varying combinations, which are dictated by the applications’ design requirements. Their applications range wide, from fundamental biological research such as differentiation studies to industrial applications such as cruelty-free meat production. However, their translation to industrial and clinical settings has been hindered due to the lack of scalability of microtissue production techniques. Continuous microfluidic processes provide an opportunity to overcome this limitation as they offer higher throughput production rates as compared to traditional batch techniques, while maintaining reproducible control over microtissue composition and size. In this review, we provide a comprehensive overview of the current approaches to engineer microtissues with a focus on the advantages of, and need for, the use of continuous processes to produce microtissues in large quantities. Finally, an outlook is provided that outlines the required developments to enable large-scale microtissue fabrication using continuous processes.

bespreking proefschrift Astrid Vellinga To know or not to be. Development of an instrument to assess decision-making capacity of cognitively impaired elderly patients. Academisch Proefschrift Vrije Universiteit Amsterdam, 2006. ISBN 90 9020 757 0

Introduction For idiopathic inflammatory myopathies (IIM) (‘myositis’) standard initial treatment is high-dosed glucocorticoids, which results in relatively slow improvement of muscle strength. Early immunosuppression or modulation by intensive treatment (‘hit-early, hit-hard’) may induce faster reduction of disease activity and prevent chronic disability due to disease-induced structural muscle damage. Intravenous immunoglobulin (IVIg) in addition to standard glucocorticoid treatment may be promising in this regard as was shown in various studies: add-on IVIg improved symptoms and muscle strength in refractory myositis patients and monotherapy IVIg improved outcomes after 9 weeks, in about half of treatment-naive patients.Hypothesis We hypothesise that early add-on IVIg leads to a greater clinical response after 12 weeks in patients with newly diagnosed myositis, in comparison to prednisone monotherapy. Second, we expect that early treatment with add-on IVIg leads to a faster time to improvement and sustained positive effects on multiple secondary outcomes.Methods The Time Is Muscle trial is a phase-2 double-blind placebo-controlled randomised trial. Forty-eight patients with IIM will be treated with IVIg or placebo at baseline (within 1 week after diagnosis) and after 4 and 8 weeks, in addition to standard therapy with prednisone. The primary outcome is the Total Improvement Score (TIS) of the myositis response criteria at 12 weeks. At baseline, and after 4, 8, 12, 26 and 52 weeks, relevant secondary outcomes will be assessed, including time to moderate improvement (TIS≥40), mean daily prednisone dosage, physical activity, health-related quality of life, fatigue and MRI muscle imaging parameters.Ethics and dissemination Ethical approval was obtained from the medical ethics committee of the Academic Medical Centre, University of Amsterdam, the Netherlands (2020_180; including a first amendment approval at the 12 April 2023; A2020_180_0001). The results will be distributed through conference presentations and peer-reviewed publications.Trial registration number EU Clinical trials register (2020-001710-37).

Introduction: Domestic violence and abuse (DVA) are prevalent among persons with severe mental illness (SMI), being involved as victim, perpetrator, or both. Aims: To assess rates of DVA victimization and perpetration in patients with SMI. We also aimed to assess whether DVA victimization was associated with DVA perpetration, and whether this was mediated by dispositional anger in patients with SMI. Lastly, we aimed to examine whether gender moderated the associations between DVA victimization and perpetration. Methods: We conducted a nation-wide survey on victimization in patients with SMI. In 942 patients DVA perpetration of physical assault and victimization of physical assault, sexual coercion or psychological aggression over the past year were assessed using the revised Conflict Tactics Scale. Anger was assessed using the dispositional anger reactions scale. Correlation and mediation analyses were conducted, followed by a moderated mediation to assess whether effects of anger differed between men and women. Results: The prevalence rate of perpetration of physical assault was 22%, for victimization 27% and 52% for both. We found a strong positive correlation between perpetrated physical assault and victimization of mild physical assault and between both the perpetration and victimization of severe physical assault. Anger mediated the link between being a victim of psychological aggression and being a perpetrator of DVA. Women were more likely to perpetrate violence if they were victims of mild physical assault compared to men. Other moderation effects by gender were not observed. Conclusion and implications: This study reveals persistent high DVA rates among patients with SMI. Overall, anger had no mediating effect on the association between victimization and perpetration of violence, except for psychological aggression and perpetration of DVA. This study emphasizes the importance of routine violence discussions in SMI care while taking context into account. However, further research on underlying mechanisms and interventions to improve discussions and care for victims and/or perpetrators of DVA is necessary. [ABSTRACT FROM AUTHOR]

Stiffening of the brain extracellular matrix (ECM) in glioblastoma promotes tumor progression. Previously, we discovered that protein kinase R (PKR)‐like endoplasmic reticulum kinase (PERK) plays a role in glioblastoma stem cell (GSC) adaptation to matrix stiffness through PERK/FLNA‐dependent F‐actin remodeling. Here, we examined the involvement of PERK in detecting stiffness changes via focal adhesion complex (FAC) formation. Compared to control GSCs, PERK‐deficient GSCs show decreased vinculin and tensin expression, while talin and integrin‐β1 remain constant. Furthermore, vimentin was also reduced while tubulin increased, and a stiffness‐dependent increase of the differentiation marker GFAP expression was absent in PERK‐deficient GSCs. In conclusion, our study reveals a novel role for PERK in FAC formation during matrix stiffening, which is likely linked to its regulation of F‐actin remodeling. [ABSTRACT FROM AUTHOR]

This study analyzed the association between changes over time in illness self-management skills and personal recovery in patients with schizophrenia and other severe mental illnesses and determined the degree to which this association was mediated by changes in clinical and functional recovery. The rationale for the hypothesized directions of association and mediation originated from a recent randomized controlled trial (RCT) on Illness Management and Recovery (IMR), the relations between these concepts suggested in a conceptual framework of IMR, and from the results of three meta-analyses. Moreover, earlier studies indicated the relevance of examining personal recovery as an outcome for people with severe mental illnesses. Outpatient participants' data were used in this RCT (N = 165). Difference scores were constructed for all concepts by subtracting scores measured at baseline (T1) from scores at follow-up measurement (T3). We used mediation analysis to describe pathways between changes in illness management (assessed using the Illness Management and Recovery scale client version) and changes in personal recovery (assessed using the Mental-Health Recovery Measure), mediated by changes in clinical (assessed using the Brief Symptom Inventory) and functional recovery (assessed using the Social Functioning Scale). We applied the baseline data of all concepts as covariates. As inferential tests to determine the significance of the indirect paths, confidence intervals were constructed using bootstrap techniques. The results showed that the improvement in overall illness management was directly associated with improvements in personal recovery (B =.30), and indirectly through improvements in clinical recovery (indirect effect =.13) and functional recovery (indirect effect =.08). The main conclusion is that self-reported illness management appears to be more strongly and directly associated with personal recovery than indirectly via clinical and functional recovery. This analysis supports the relevance of self-management interventions such as IMR for the personal recovery of people with severe mental illnesses. [ABSTRACT FROM AUTHOR]

The rising popularity of wearable devices allows for extensive and unobtrusive collection of personal health data for extended periods of time. Recent studies have used machine learning to create predictive algorithms to assess symptoms of major depressive disorder (MDD) based on these data. This review evaluates the clinical relevance of these models. Studies were selected to represent the range of methodologies and applications of wearables for MDD algorithms, with a focus on wrist-worn devices. The reviewed studies demonstrated that wearable-based algorithms were able to predict symptoms of MDD with considerable accuracy. These models may be used in the clinic to complement the monitoring of treatments or to facilitate early intervention in high-risk populations. In a preventative context, they could prompt users to seek help for earlier intervention and better clinical outcomes. However, the lack of standardized methodologies and variation in which performance metrics are reported complicates direct comparisons between studies. Issues with reproducibility, overfitting, small sample sizes, and limited population demographics also limit the generalizability of findings. As such, wearable-based algorithms show considerable promise for predicting and monitoring MDD, but there is significant room for improvement before this promise can be fulfilled. [ABSTRACT FROM AUTHOR]

Objective: To provide up‐to‐date clinical guidance on the efficacy of lamotrigine in bipolar disorder (BD). Methods: Eligible studies were identified during a systematic literature search according to PRISMA‐guidelines. We included randomized controlled trials (RCTs) and cohort studies that quantitatively assessed lamotrigine's efficacy in BD. We divided the included studies into three groups: 1. acute treatment of depression, 2. acute treatment of mania and hypomania, and 3. maintenance treatment. Analyses were stratified by control group (placebo vs active comparator) and treatment strategy (monotherapy vs add‐on treatment). Results: We included 20 RCTs (n = 1166 lamotrigine users) and 20 cohort studies (n = 11,141 lamotrigine users). Twenty‐four of these studies were included in meta‐analyses. During depressive episodes, greater decreases in depressive symptomatology were associated with initiation of lamotrigine as add‐on treatment than with placebo (SMD −0.30 [95% CI = −0.51, −0.10], df = 3, p = 0.004). Decreases in depressive symptomatology did not differ significantly between lamotrigine and the active comparator (SMD −0.28 [95% CI = −1.06, 0.50], df = 3, p = 0.488). As a maintenance treatment, lamotrigine was associated with a significantly lower relapse/recurrence rate than placebo (risk ratio (RR) 0.84 [95% CI = 0.71, 0.99], df = 2, p = 0.037). Relapse/recurrence rates did not differ significantly between lamotrigine and lithium (RR 1.06 [95% CI = 0.89, 1.25], df = 2, p = 0.513). A qualitative assessment of high‐quality register‐based studies found that lamotrigine was associated with lower hospital admission rates than other commonly used treatment regimes. Conclusions: There is substantial evidence for the efficacy of lamotrigine in BD, specifically as add‐on treatment during acute depressive episodes and as maintenance treatment for preventing relapse and recurrence. [ABSTRACT FROM AUTHOR]