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Abstract Background Emotional disorders such as depression and anxiety disorders share substantial similarities in their etiology and treatment. In recent decades, these commonalities have been increasingly recognized in classification systems and treatment programs crossing diagnostic boundaries. Methods To examine the prospective effects of different transdiagnostic markers on relevant treatment outcomes, we plan to track a minimum of N = 200 patients with emotional disorders during their routine course of cognitive behavioral therapy at two German outpatient clinics. We will collect a wide range of transdiagnostic markers, ranging from basic perceptual processes and self-report measures to complex behavioral and neurobiological indicators, before entering therapy. Symptoms and psychopathological processes will be recorded before entering therapy, between the 20th and 24th therapy session, and at the end of therapy. Discussion Our results could help to identify transdiagnostic markers with high predictive power, but also provide deeper insights into which patient groups with which symptom clusters are less likely to benefit from therapy, and for what reasons. Trial Registration The trial was preregistered at the German Clinical Trial Register (DRKS-ID: DRKS00031206; 2023–05-09).

Introduction: This paper presents a scoping review of empirical German-language research concerning the professionalization of Physical Education Teachers (PETs) and Physical Education Teacher Education (PETE). This paper provides detailed insight into research activities in the field and gives recommendations for further research. It points out possible thematic, methodical and theoretical commonalities and divergences between German-speaking and international/Anglophone discourses, as well as shared challenges for future research. Methods: Using a scoping review methodology, the original framework was adjusted and extended to fit the needs of a transparent and substantiated inductive approach to thematic mapping. Based on a definition of research on PETE, we formulated inclusion and exclusion criteria and manually searched articles in six periodical German-language journals and conference proceedings. 160 empirical articles from the period 2010 to 2018 were selected. First, they were analyzed and charted in two stages. In a descriptive analysis following a deductive approach, the research field was mapped along with the categories chronological--numerical development, methods, samples, participants, authorship, and theoretical frameworks. In a thematic synthesis process following an inductive paradigm, a two-dimensional categorization system was developed along which the articles were charted. This system not only enables reporting about numerical findings but also provides information about the nature and interrelation of research domains and topics. Second, Anglophone literature reviews and handbook articles served as a point of reference to compare and discuss results from the German language to the Anglophone discourse. Special attention was given to thematic comparisons concerning similar and differing research trends and challenges. Results: The review shows research foci and identifiable gaps in accordance with present developments in educational policy as well as a significant increase in numerical output in the evaluated time period. While research on particular phases and moments of PETE gathered substantial insights, results especially regarding the understanding of long-term, biographical, professional developments of PETs are lacking in both research fields. To better understand long-term educational developments of PETs and how they are influenced remains the main challenge for future research. While German-language and Anglophone research cultures both come from their own historical, theoretical and methodological traditions, several attempts to open discourses concerning theoretical frameworks, methodological developments and research foci were revealed. One example is the development of qualitative methods to research implicit orientations and constructs, which originate from a shared qualitative history. This can potentially lead to a better understanding of educational processes and how these implicit constructs effect teaching. Discussion and conclusion: With finding and outlining commonalities and divergences between German-language and Anglophone research, this review provides a basis and status quo outlining possibilities for further research, cooperation and exchange. Moreover, similar trends and challenges were identified on a meta-level. Especially concerning theoretical backgrounds and methodical developments, the different research communities can further mutually improve each other and should enhance interaction and exchange. The results outline several possibilities for mutual enrichment.

Abstract Toehold-mediated strand displacement (TMSD) is extensively utilized in dynamic DNA nanotechnology and for a wide range of DNA or RNA-based reaction circuits. Investigation of TMSD kinetics typically relies on bulk fluorescence measurements providing effective, bulk-averaged reaction rates. Information on individual molecules or even base pairs is scarce. In this work, we explore the dynamics of strand displacement processes at the single-molecule level using single-molecule force spectroscopy with a microfluidics-enhanced optical trap supported by state-of-the-art coarse-grained simulations. By applying force, we can trigger and observe TMSD in real-time with microsecond and nanometer resolution. We find TMSD proceeds very rapidly under load with single step times of 1 µs. Tuning invasion efficiency by introducing mismatches allows studying thousands of forward/backward invasion events on a single molecule and analyze the kinetics of the invasion process. Extrapolation to zero force reveals single step times for DNA invading DNA four times faster than for RNA invading RNA. We also study the kinetics of DNA invading RNA, a process that in the absence of force would rarely occur. Our results reveal the importance of sequence effects for the TMSD process and have relevance for a wide range of applications in nucleic acid nanotechnology and synthetic biology.

IntroductionAlthough depressive disorders are frequently associated with relapses, the sustained efficacy of therapies after their termination has been insufficiently investigated.ObjectiveThe aim of this study was to evaluate the current evidence of enduring effects of psychotherapy, antidepressants and their combination after the end of treatment.MethodsPubMed and PsychINFO were systematically screened according to PRISMA guidelines (except for preregistration). Only randomized controlled trials (RCTs) between 1980 and 2022 comparing the efficacy of psychotherapy, antidepressants and their combination in adult depression at follow-up at least 12 months after termination of therapy, which could be acute phase, maintenance or relapse prevention therapy, were included. Risk of bias was assessed by using the Cochrane risk of bias tool.ResultsIn total 19 RCTs with a total of 1154 participants were included. Psychotherapy was significantly superior to pharmacotherapy regarding relapse rates and Beck Depression Inventory scores at follow-up after acute treatment in two of nine RCTs. Combined treatment performed significantly better than pharmacotherapy, but not psychotherapy, regarding relapse and remission in five out of nine RCTs at least 12 months after treatment termination. Pairwise meta-analyses indicated a superiority of combined treatment compared to pharmacotherapy alone regarding relapse, recurrence, and rehospitalization rates (RR=0.60, 95%-CI: 0.37-0.97, p=.041) and for psychotherapy compared to pharmacotherapy alone regarding relapse and recurrence rates (RR=0.58, 95%-CI: 0.38-0.89, p=.023), however comparative treatment effects between psychotherapy and combined treatment were insignificant.ConclusionsCurrent findings suggest a superiority of psychotherapy and combined treatment over pharmacotherapy alone in major depressive disorder depression. Major limitations were a low number of studies reporting follow-up data after termination of study periods and a heterogeneity in definitions of treatment outcomes. Practice guidelines and participatory decision-making processes for the choice of treatment should consider the current knowledge on long-term effects of antidepressant therapy methods more than has been the case to date.

Background Treatment expectations influence clinical outcomes in various physical and psychological conditions; however, no studies have explored their role in endometriosis treatment. It is necessary to understand how these expectations can be measured to study treatment expectations and their effects in clinical practice. This study aimed to psychometrically analyze and compare different treatment expectation measurements and describe treatment expectations in women with suspected endometriosis. Method Analysis of cross-sectional baseline data of a mixed-method clinical observational study of N=699 patients undergoing laparoscopy in Germany. Descriptives, bivariate associations, convergent and discriminant validity of four expectation measurements (Treatment Expectation Questionnaire (TEX-Q); Generic rating scale for previous treatment experiences, treatment expectations, and treatment effects (GEEE); numerical rating scales (NRS) assessing improvement and worsening of endometriosis symptoms, expected Pain Disability Index (PDI); range: 0 to 10) were estimated. A cluster analysis was performed on the three GEEE items. Results Most participants expected high improvement (M=6.68 to 7.20, SD=1.90 to 2.09) and low worsening (M=1.09 to 2.52, SD=1.80 to 2.25) of disability from laparoscopy. Participants who expected greater worsening expected more side effects (r=.31 to .60, p

Data-based predictions of individual Cognitive Behavioral Therapy (CBT) treatment response are a fundamental step towards precision medicine. Past studies demonstrated only moderate prediction accuracy (i.e. ability to discriminate between responders and non-responders of a given treatment) when using clinical routine data such as demographic and questionnaire data, while neuroimaging data achieved superior prediction accuracy. However, these studies may be considerably biased due to very limited sample sizes and bias-prone methodology. Adequately powered and cross-validated samples are a prerequisite to evaluate predictive performance and to identify the most promising predictors. We therefore analyzed resting state functional magnet resonance imaging (rs-fMRI) data from two large clinical trials to test whether functional neuroimaging data continues to provide good prediction accuracy in much larger samples. Data came from two distinct German multicenter studies on exposure-based CBT for anxiety disorders, the Protect-AD and SpiderVR studies. We separately and independently preprocessed baseline rs-fMRI data from n = 220 patients (Protect-AD) and n = 190 patients (SpiderVR) and extracted a variety of features, including ROI-to-ROI and edge-functional connectivity, sliding-windows, and graph measures. Including these features in sophisticated machine learning pipelines, we found that predictions of individual outcomes never significantly differed from chance level, even when conducting a range of exploratory post-hoc analyses. Moreover, resting state data never provided prediction accuracy beyond the sociodemographic and clinical data. The analyses were independent of each other in terms of selecting methods to process resting state data for prediction input as well as in the used parameters of the machine learning pipelines, corroborating the external validity of the results. These similar findings in two independent studies, analyzed separately, urge caution regarding the interpretation of promising prediction results based on neuroimaging data from small samples and emphasizes that some of the prediction accuracies from previous studies may result from overestimation due to homogeneous data and weak cross-validation schemes. The promise of resting-state neuroimaging data to play an important role in the prediction of CBT treatment outcomes in patients with anxiety disorders remains yet to be delivered.

Abstrak Reactive Powder Concrete (RPC) merupakan jenis dari beton mutu ultra tinggi dengan karakteristik kuat tekan, dan kuat lentur yang sangat tinggi. Komponen penyusun RPC semen dengan kandungan yang tinggi, bahan yang sangat halus berupa silika dalam jumlah tinggi, dan tanpa agregat kasar. Pada penelitian ini dilakukan tinjauan sifat mekanis berupa uji kuat tekan dan kuat lentur RPC melalui perlakuan uap dengan abu sekam padi sebagai alternatif material pozzolan. Pengujian kuat tekan dilakukan pada kubus berukuran 70,7 x 70,7 x 70,7 mm umur 7 hari dan 28 hari, dan kuat lentur pada balok berukuran 70,7 x 70,7 x 300 mm umur 28 hari. Variasi abu sekam padi digunakan 15%, 20%, 25%, 30% dan 35% dari berat semen dengan jumlah benda uji sebanyak 3 sampel per variasi. Perawatan uap dimulai setelah satu hari pengecoran selama 72 jam pada suhu 90℃ kemudian dilakukan perendaman. Hasil pengujian menunjukan bahwa kuat tekan tertinggi umur 7 hari diperoleh pada variasi abu sekam padi 30% dan merupakan yang paling optimum dengan kuat tekan sebesar 108,37 MPa, selanjutnya pada RPC umur 28 hari kuat tekan tertinggi diperoleh pada variasi ASP 35% sebesar 116,59 MPa. Kemudian kuat lentur RPC tertinggi umur 28 hari diperoleh pada variasi abu sekam padi 30% dan merupakan yang paling optimum dengan kuat lentur sebesar 13,80 MPa. Hal ini menunjukkan bahwa abu sekam padi pada campuran RPC melalui perlakuan uap dapat dijadikan alternatif material pozzolan untuk menghasilkan kuat tekan dan kuat lentur RPC yang tinggi. Kata Kunci: Reactive Powder Concrete, Abu sekam padi, Kuat tekan, Kuat lentur, Perawatan uap Abstract Reactive Powder Concrete (RPC) is a type of ultra high quality concrete with very high compressive strength and flexural strength characteristics. High-content cement, a very fine material with a high silica content, and no coarse aggregate are the components of RPC. In this study, rice husk ash (RHA) was used as an alternative pozzolanic material, and steam treatment was utilized to study the mechanical properties of RPC through compressive strength and flexural strength tests. Examinations of compressive strength were performed using cubes of 70.7 x 70.7 x 70.7 mm at 7 days and 28 days, while tests of flexural strength were performed using beams size 70.7 x 70.7 x 300 mm at 28 days. With a total of three samples for each variation, rice husk ash was employed at rates of 15%, 20%, 25%, 30%, and 35% by weight of cement. After casting for one day at 90°C for 72 hours, steam treatment started before being submerged in water. The results revealed that the 30% variation of rice husk ash had the highest compressive strength at 7 days, with an optimal compressive strength of 108.37 MPa, followed at 28 days by the 35% variation of RHA, with a maximum compressive strength of 116.59 MPa. Furthermore, the highest flexural strength of RPC at 28 days ages was obtained at 30% variation of rice husk ash and was the optimum with a flexural strength of 13.80 MPa. This study indicates that rice husk ash can be utilized as a substitute pozzolanic material in RPC mixes to develop high compressive and flexural strengths. Keywords: Reactive Powder Concrete, Rice husk ash, Compressive strength, Flexural strength, Steam curing.

Abstract Introduction Chronic back pain is a widespread medical condition associated with high socioeconomic costs and increasing prevalence. Despite the advanced implementation of multidisciplinary approaches, providing a satisfactory treatment offer for those affected is often not possible. Exposure therapy (EXP) promises to be an effective and economical form of treatment and in a previous pilot study showed to be superior to cognitive behavioral therapy (CBT) in reducing perceived limitations of movement. The current study aims to further compare the efficacy of both treatment methods and identify those patient groups that particularly benefit from EXP. Methods The general objective of this randomized multicenter clinical trial (targeted N = 380) is to improve and expand the range of treatments available to patients with chronic back pain. As the primary objective of the study, two different psychological treatments (EXP and CBT) will be compared. The primary outcome measure is a clinically significant improvement in pain-related impairment, measured by the QPBDS, from baseline to 6-month follow-up. Secondary outcome measures are absolute changes and clinically significant improvements in variables coping, psychological flexibility, depressiveness, catastrophizing, exercise avoidance and fear of exercise, and intensity of pain. Participants are recruited in five psychological and medical centers in Germany and receive ten sessions of manualized therapy by trained licensed CBT therapists or clinical psychologists, who are currently in their post-gradual CBT training. Potential predictors of each treatment’s efficacy will be explored with a focus on avoidance and coping behavior. Conclusion This study will be the first RCT to compare CBT and EXP in chronic back pain in a large sample, including patients from different care structures due to psychological and medical recruitment centers. By identifying and exploring potential predictors of symptom improvement in each treatment group, this study will contribute to enable a more individualized assignment to treatment modalities and thus improves the care situation for chronic back pain and helps to create a customized treatment program for subgroups of pain patients. If our findings confirm EXP to be an efficacious and efficient treatment concept, it should gain more attention and be further disseminated. Trial registration ClinicalTrials.gov NCT05294081. Registered on 02 March 2022.

Abstract Background The assessment of illness severity in the prehospital setting is essential for guiding appropriate medical interventions. The National Advisory Committee for Aeronautics (NACA) score is a validated tool commonly used for this purpose. However, the potential benefits of using bitemporal documentation of NACA scores to capture the dynamic changes in emergency situations remain uncertain. The objective of this study was to evaluate the potential benefit of bitemporal NACA score documentation in the prehospital setting, specifically in assessing the dynamic changes of emergencies and facilitating quality improvement through enhanced documentation practices. Methods In this retrospective study, data from prehospital emergency patients were analyzed who received care from the physician response unit between January 1, 2018, and May 31, 2021. Patient demographics, NACA scores, indications for emergency care, and changes in NACA scores were extracted from medical records. Statistical analyses were performed to examine the associations between NACA scores, emergency categories, indications, and changes in NACA scores. Results The study included 4005 patients, predominantly categorized as NACA III (33.7% at initial assessment, 41.8% at subsequent assessment) and NACA IV (31.6% at initial assessment, 22.4% at subsequent assessment). There was a significant improvement in NACA scores during the provision of prehospital care (p

Popliteal pseudoaneurysms are a rare vascular pathology, usually caused by trauma or iatrogenic interventions. Idiopathic cases are exceptionally uncommon. This case report aims to describe the diagnosis and successful endovascular treatment of an idiopathic pseudoaneurysm of the popliteal artery in a 90-year-old bedridden female patient presented with acute pain and swelling in the left knee at the emergency department. The patient underwent successful endovascular treatment with a covered stent and thrombin injection, leading to complete exclusion of the pseudoaneurysm. Popliteal pseudoaneurysms are a rare pathology, and idiopathic cases are even more uncommon. Endovascular therapy for popliteal pseudoaneurysms is associated with lower morbidity and mortality rates compared to open surgical repair. This case report highlights the importance of interdisciplinary collaboration between vascular surgeons and interventional radiologists in the management of rare vascular pathologies.

BackgroundIndividuals with anxiety disorders (ADs) often display hypervigilance to threat information, although this response may be less pronounced following psychotherapy. This study aims to investigate the unconscious recognition performance of facial expressions in patients with panic disorder (PD) post-treatment, shedding light on alterations in their emotional processing biases.MethodsPatients with PD (n=34) after (exposure-based) cognitive behavior therapy and healthy controls (n=43) performed a subliminal affective recognition task. Emotional facial expressions (fearful, happy, or mirrored) were displayed for 33 ms and backwardly masked by a neutral face. Participants completed a forced choice task to discriminate the briefly presented facial stimulus and an uncovered condition where only the neutral mask was shown. We conducted a secondary analysis to compare groups based on their four possible response types under the four stimulus conditions and examined the correlation of the false alarm rate for fear responses to non-fearful (happy, mirrored, and uncovered) stimuli with clinical anxiety symptoms.ResultsThe patient group showed a unique selection pattern in response to happy expressions, with significantly more correct “happy” responses compared to controls. Additionally, lower severity of anxiety symptoms after psychotherapy was associated with a decreased false fear response rate with non-threat presentations.ConclusionThese data suggest that patients with PD exhibited a “happy-face recognition advantage” after psychotherapy. Less symptoms after treatment were related to a reduced fear bias. Thus, a differential facial emotion detection task could be a suitable tool to monitor response patterns and biases in individuals with ADs in the context of psychotherapy.

The usual homeopathic remedy, “globules,” does not contain any pharmacologically active ingredient. However, many patients and practitioners report beneficial effects of homeopathic treatment on various health outcomes. Experimental and clinical research of the last two decades analyzing the underlying mechanisms of the placebo effect could explain this phenomenon, with patients’ treatment expectations as the predominant mechanism. Treatment expectations can be optimized through various factors, such as prior information, communication, and treatment context. This narrative review analyses how homeopathy successfully utilizes these factors. Subsequently, it is discussed what evidence-based medicine could learn from homeopathic practice to optimize treatment expectations (e.g., using an empathic, patient-centered communication style, deliberately selecting objects in practice rooms, or using clear treatment rituals and salient contextual stimuli) and thereby treatment effectiveness. Homeopathic remedy does not work beyond the placebo effect but is recommended or prescribed as an active treatment by those who believe in it. Thus, practitioners need to understand the manner in which homeopathy (as an example of inert treatment) works and are advised to reintegrate its underlying effective placebo mechanisms into evidence-based medicine. This promises to increase treatment efficacy, tolerability, satisfaction, and compliance with evidence-based treatments, and addresses the desires patients are trying to satisfy in homeopathy in an ethical, fully informed way that is grounded in evidence-based medicine.

Background: Hyperkalaemia is a common electrolyte abnormality seen in critically ill patients. In haemorrhagic shock, it may contribute to cardiac arrest and has been identified as a potential marker for tissue hypoxia. However, the significance of its role in haemorrhagic shock and its contribution to mortality remains unclear. This study aimed to examine the potential underlying pathophysiology and evaluate the incidence and characteristics of patients with hyperkalaemia on hospital arrival in bleeding trauma patients before transfusions and its mortality. Methods: A retrospective cohort study was conducted on adult patients with traumatic bleeding admitted to a European Major Trauma Centre between January 2016 and December 2021. Patients were classified according to their serum potassium levels on arrival, and relevant clinical parameters between non-hyperkalaemic and hyperkalaemic patients were compared. Results: Among the 83 patients in this study, 8 (9.6 %) presented with hyperkalaemia on arrival. The median shock index showed a higher tendency in the hyperkalaemic group. Hyperkalaemia was found to be more common among younger patients who sustained penetrating trauma. Mortality rates were higher in the hyperkalaemic group, but the difference was not statistically significant. Conclusion: Our results suggest that hyperkalaemia occurs frequently in bleeding trauma patients on hospital arrival pre-transfusions, indicating a more severe illness. Our findings provide insights into the pathophysiology and characteristics of hyperkalaemia in bleeding trauma patients. Further studies are required to investigate the mechanisms by which hyperkalaemia contributes to mortality in haemorrhagic shock patients.

[Background] Although in most countries psychotherapy trainings focus on one treatment orientation, such an approach is associated with systematic shortcomings. The priorities from teaching one theoretical framework should be moved to a more rigorous orientation in science and evidence-based practice, and to the needs of patients, even if strategies of different theoretical approaches need to be combined. [Method] We discuss whether competence-based trainings in psychological treatments offer a better framework to facilitate the progress of psychological treatments to a professional academic discipline with transtheoretical exchange, and we provide an example of a transtheoretical education in the basic competences of psychological treatments. A transtheoretical education program requires an umbrella model for case formulation and a transtheoretical definition of intervention goals. [Results] We provide an adaptation of the traditional model distinguishing vulnerability/resilience, exacerbation, and maintenance of clinical problems for case conceptualization. Dynamic network models offer a further perspective for developing modern, transtheoretical case formulations. Treatment methods should be better classified according to their transtheoretical goals, which offers opportunities to better compare or combine them. We report a case example of how to transform a general competence-based approach in the training of psychological treatments in the academic education system, which found exceptional acceptance from participating students. [Conclusion] Thus, a rigorous competence-based approach to training early clinicians in applying psychological treatments helps to bridge the artificial divide between psychotherapeutic traditions. It also supports the evolution of psychological treatments into an academically robust and highly professional, integrative discipline.

ObjectiveAlthough empathy is known to be a strength, recent studies suggest that empathy can be a risk factor for psychopathology under certain conditions in children. This study examines parental mental illness as such a condition. Further, it aims to investigate whether maladaptive emotion regulation (ER) mediates the relationship between empathy and psychopathological symptoms of children.MethodsParticipants were 100 children of parents with a mental illness (55% female) and 87 children of parents without a mental illness (50% female) aged 6 - 16 years and their parents.ResultsGreater cognitive empathy was related to more psychopathological symptoms in COPMI, but not in COPWMI. In addition, in COPMI maladaptive ER mediated this relationship. In contrast, greater affective empathy was associated with more psychopathological symptoms regardless of whether parents had a mental illness.ConclusionOur findings highlight the importance of implementing preventive programs for COPMI that specifically target the reduction of maladaptive ER.

Splayed leg is a condition where the legs are stretched outwards or sideways from their normal position under the body which is often suffered by young birds. This disorder is usually left untreated, because it is considered as a permanent disability condition that cannot be treated without examining the cause. Some of the splayed legs in chicks can be improved by treating both their legs in the correct position. Early diagnosis of splayed leg and continued appropriate therapy is needed so that the condition of the foot can be restored to normal. Incorrect diagnosis and therapy will cause the bird's feet to become permanently disabled, so the bird will suffer for the rest of its life. The diagnosis and treatment of splayed leg cases have been developed with varying results. The purpose of this review is to evaluate the diagnosis, therapy, and prevention of the occurrence of splayed legs in birds, which can be used as a reference to improve bird welfare.

Abstract Background Chronic pain usually lasts several years. During this time, value-oriented aspects of life often fade into the background in favour of coping with the pain, which is associated with a lower quality of life. Psychotherapeutic methods such as Acceptance and Commitment Therapy can alleviate this. However, for those who suffer from chronic pain, access to such therapies is limited. Electronic health interventions provide access to evidence-based methods. The aim of this study was to investigate the effectiveness and feasibility of a brief electronic values-based intervention on patients with chronic back pain. Methods A study with a replicated AB single-case experimental design was conducted with 28 participants suffering from chronic back pain. Participants answered daily questions concerning their pain intensity and quality of life (wellbeing, pain catastrophising, acceptance of chronic pain, engaged living) for 10 to 17 days. The subsequent mobile intervention on value-oriented activities lasted an additional 10 days. During this time, daily assessments continued. Our analysis was performed using a hierarchical two-level modelling approach as well as visual and descriptive analysis. Results The majority of participants did not measurably benefit from the intervention. Neither model-based inference nor visual analysis indicated plausible intervention effects. The results of one responder and one non-responder are presented. In their qualitative feedback, most participants described being satisfied with the intervention. The perceived usefulness of psychotherapy as a treatment for chronic back pain increased from pre- to post-intervention (p

BackgroundCoronavirus disease 19 (COVID-19)-associated pulmonary aspergillosis (CAPA) emerged as important fungal complications in patients with COVID-19-associated severe acute respiratory failure (ARF). Whether mould active antifungal prophylaxis (MAFP) can prevent CAPA remains elusive so far.MethodsIn this observational study, we included all consecutive patients admitted to intensive care units with COVID-19-associated ARF between September 1, 2020, and May 1, 2021. We compared patients with versus without antifungal prophylaxis with respect to CAPA incidence (primary outcome) and mortality (secondary outcome). Propensity score adjustment was performed to account for any imbalances in baseline characteristics. CAPA cases were classified according to European Confederation of Medical Mycology (ECMM)/International Society of Human and Animal Mycoses (ISHAM) consensus criteria.ResultsWe included 132 patients, of whom 75 (57%) received antifungal prophylaxis (98% posaconazole). Ten CAPA cases were diagnosed, after a median of 6 days following ICU admission. Of those, 9 CAPA cases were recorded in the non-prophylaxis group and one in the prophylaxis group, respectively. However, no difference in 30-day ICU mortality could be observed. Thirty-day CAPA incidence estimates were 1.4% (95% CI 0.2-9.7) in the MAFP group and 17.5% (95% CI 9.6-31.4) in the group without MAFP (p = 0.002). The respective subdistributional hazard ratio (sHR) for CAPA incidence comparing the MAFP versus no MAFP group was of 0.08 (95% CI 0.01-0.63; p = 0.017).ConclusionIn ICU patients with COVID-19 ARF, antifungal prophylaxis was associated with significantly reduced CAPA incidence, but this did not translate into improved survival. Randomized controlled trials are warranted to evaluate the efficacy and safety of MAFP with respect to CAPA incidence and clinical outcomes.

Abstract Backround Dysfunctional interpersonal beliefs (DIBs) are a key symptom domain in numerous mental disorders. Because DIBs exert a strong influence on social experience and behavior, they play an important role in a mental disorder's development and progression. To date, only the Interpersonal Cognitive Distortions Scale (ICDS) captures DIBs independently of specific disorders, populations, or contexts. The present study's aim was to psychometrically evaluate and validate a German translation of the ICDS. Methods The ICDS was administered along with indicators of convergent (rejection sensitivity, depressive expectations, interpersonal trust, interpersonal problems, perceived social support), discriminant (self-efficacy, perseverative negative thinking, optimism), and clinical validity (psychopathology, perceived stress, well-being) to a pooled sample incorporating non-clinical (N = 114) and clinical (N = 94) participants. Results An exploratory factor analysis (EFA) suggested a five-factor solution (factor loadings: .44 to .85). Correlational analyses demonstrated acceptable convergent (ρ = -.29 to -.35, ρ = .27 to .59), suboptimal discriminant (ρ = -.27 to -.38, ρ = .52), and acceptable clinical validity (ρ = -.21, ρ = .36 to .44) at the total-scale level. However, results at the subscale level were mixed and required nuanced interpretation. Likewise, internal consistency was acceptable at the total-scale level (α = .76), but ranged from good to poor at the subscale level (α = .61 to .80). DIBs mediated the negative relationship between mental disorder onset and psychopathology levels. Discussion Our results imply DIBs' relevance to mental health and related outcomes. When working with the ICDS’s German version, we recommend employing only the “insecurity” subscale, as this was the only scale revealing acceptable psychometric properties. Future studies should improve the construct validity of the ICDS (and its subscales), e.g., by adding more items to the respective subscales and further classes of DIBs.

Abstract Background Reward sensitivity constitutes a potential key mechanism regarding the etiology and maintenance of mental disorders, especially depression. However, due to a lack of longitudinal studies, the temporal dynamics are not clear yet. Although some evidence indicates that reward processing could be a transdiagnostic mechanism of disorders, these observations could be also a product of comorbidity with depression. This study aimed at investigating the temporal dynamics of reward sensitivity and the course of psychopathological symptoms in a longitudinal investigation, while taking a possible mediating role of depression into account. Methods We conducted a three-wave longitudinal online survey with a 4-week interval. A total of N = 453 participants filled out all three questionnaires. Reward sensitivity was assessed with the Positive Valence System Scale-21 (PVSS-21), depression with the Patient Health Questionnaire (PHQ-9), eating disorder symptoms with the Eating Disorder Examination-Questionnaire-8 (EDE-Q-8), social anxiety with the Mini-social phobia inventory (Mini-SPIN) and alcohol consumption with the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). Cross-lagged panels and mediation analyses were calculated using path analyses. Results Depressive and eating disorder symptoms predicted reward insensitivity at later points in time. Effects were larger from T2 to T3. A bidirectional relationship concerning social anxiety was found. Higher alcohol consumption predicted higher reward sensitivity. Depression at T2 fully mediated the association between psychopathological symptoms at T1 and reward sensitivity at T3 for social anxiety and eating disorder symptoms. Conclusions Our findings imply that reduced reward sensitivity seems to be a consequence rather than an antecedent of psychopathological symptoms. Comorbid depression plays a crucial role in other mental disorders regarding observed hyposensitivity towards rewards. Therefore, our results do not support a transdiagnostic notion of reward sensitivity, but they indicate a potential role of reward sensitivity for symptom persistence. Trial registration The study was preregistered at the Open Science Framework (OSF) ( https://archive.org/details/osf-registrations-6n3s8-v1 ; registration DOI https://doi.org/10.17605/OSF.IO/6N3S8 ).

Abstract Background Placebo effects are a well-established phenomenon in the treatment of depression. However, the mechanism underlying these effects are not fully understood. Treatment expectations are considered one explanation for why placebos work. Treatment expectations are likely to be affected by clinician-patient interactions. This study aims to investigate the role of the communicated treatment rationale in modulating treatment expectations and its effects on the treatment outcomes of a pharmacological and a psychological active placebo intervention for depression. In this study, treatment expectations are modulated by presenting illness models that are either congruent or incongruent with the treatment intervention that follows. Methods This 2 × 2 randomized controlled trial will involve patients with major depression. Participants will either receive a biological or a psychological illness model from a clinician. Following this, they are randomly assigned to receive either a pharmacological or a psychological active placebo intervention. The illness model and the treatment are either congruent or incongruent with each other, resulting in four groups. In addition, a natural course control group will be included. Discussion This study will provide insights into the mechanism of expectation modulation in active placebo treatments for major depression. The results may provide insights for clinicians to improve their communication with patients by focusing on treatment expectations. By identifying the factors that contribute to placebo effects, this study has the potential to improve the effectiveness of existing depression treatments and reduce the burden of this highly prevalent mental health condition. Trial registration This trial has been registered prospectively at ClinicalTrials.gov under the identifier: NCT04719663. Registered on January 22, 2021.

Abstract Covid-19 patients who require admission to an intensive care unit (ICU) have a higher risk of mortality. Several risk factors for severe Covid-19 infection have been identified, including cardiovascular risk factors. Therefore, the aim was to investigate the association between cardiovascular (CV) risk and major adverse cardiovascular events (MACE) and mortality of Covid-19 ARDS patients admitted to an ICU. A prospective cross-sectional study was conducted in a university hospital in Graz, Austria. Covid-19 patients who were admitted to an ICU with a paO2/fiO2 ratio

BackgroundKetamine and esketamine offer a novel approach in the pharmacological treatment of major depressive disorder (MDD). This meta-analysis aimed to investigate the placebo response in double-blind, randomized controlled studies (RCTs) on patients with MDD receiving ketamine or esketamine.MethodsFor this systematic review and meta-analysis Medline (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), PsycInfo and Embase databases were systematically searched for citations published up to March 17, 2023. A total number of 5017 abstracts was identified. Quality of the included trials was assessed with the Cochrane risk-of-bias tool. The meta-analysis was performed using a restricted maximum likelihood model. This study is registered with PROSPERO, number CRD42022377591.ResultsA total number of 14 studies and 1100 participants (593 in the medication group and 507 in the placebo group) meeting the inclusion criteria were selected. We estimated the pooled effect sizes of the overall placebo (dpl = -1.85 [CI 95%: -2.9 to -0.79] and overall treatment (dtr = -2.57; [CI 95% -3.36 to -1.78]) response. The overall placebo response accounts for up to 72% of the overall treatment response. Furthermore, we performed subgroup analysis of 8 studies for the for the 7 days post-intervention timepoint. Seven days post-intervention the placebo response (dpl 7d = -1.98 [CI 95%: -3.26 to -0.69]) accounts for 66% of the treatment response (dtr 7d = - 3.01 [CI 95%, -4.28 to -1.74]).ConclusionKetamine and esketamine show large antidepressant effects. However, our findings suggest that the placebo response plays a significant role in the antidepressant response and should be used for the benefit of the patients in clinical practice.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42022377591.

ObjectiveChildren of parents with a mental illness are at heightened risk to develop a mental illness themselves due to genetics and environmental factors. Although parenting stress (PS) is known to be associated with increased psychopathology in parents and children, there is no study investigating PS multimodally in a sample of parents with a mental illness. This study aims to compare PS of parents with and without a mental illness and further to examine the relationship between PS and psychopathology of children.MethodsParticipants were parents with a mental illness and parents without a mental illness and their children aged four to sixteen years. We assessed PS multimodally using a questionnaire, parents’ evaluation of children’s behavior (relational schemas) and psychophysiological arousal of parents during free speech task.ResultsSelf-reported PS was increased, and evaluation of children’s behavior was more negative and less positive in parents with a mental illness compared to parents without a mental illness. Children’s psychopathology was associated with self-reported PS and relational schemas of parents. Regarding psychophysiological arousal, parents with a mental illness showed reduced reactivity in heart rate from baseline to free speech task in comparison to parents without a mental illness.ConclusionsOur findings highlight the importance of implementing intervention programs to reduce PS for parents and children. In particular, parents with a mental illness might benefit from specific intervention programs in order to interrupt the transgenerational transmission of mental disorders.

[Introduction] The ICD-11 and DSM-5 are the leading systems for the classification of mental disorders, and their relevance for clinical work and research, as well as their impact for policy making and legal questions, has increased considerably. In recent years, other frameworks have been proposed to supplement or even replace the ICD and the DSM, raising many questions regarding clinical utility, scientific relevance, and, at the core, how best to conceptualize mental disorders. [Method] As examples of the new approaches that have emerged, here we introduce the Hierarchical Taxonomy of Psychopathology (HiTOP), the Research Domain Criteria (RDoC), systems and network approaches, process-based approaches, as well as a new approach to the classification of personality disorders. [Results and Discussion] We highlight main distinctions between these classification frameworks, largely related to different priorities and goals, and discuss areas of overlap and potential compatibility. Synergies among these systems may provide promising new avenues for research and clinical practice.

As open science principles continue to gain traction, striking a balance between patient privacy and data accessibility has become more crucial in medical research than ever before. Encryption-based pseudonymization is a powerful tool to ensure compliance with data protection regulations from both local institutional guidelines and broader regional regulations, such as the General Data Protection Regulation of the European Union. Employing this type of pseudonymization protects the privacy and security of research participants, and allows researchers to effortlessly comply with data security regulations. The pseudonymization workflow however, can vary significantly across research projects, limiting the usability of supporting software tools. Here we present ALIIAS, a customizable pseudonymization framework that allows easy and flexible deployment of custom pseudonymization software, dedicated to the specific ethical and experimental requirements of individual research projects. Features include compatibility with hardware security tokens paired with two-factor authentication, integration to the survey web application LimeSurvey, as well as custom-format pseudonyms and automatic barcode generation. Collectively, these features make ALIIAS suitable for integration into various research infrastructures and lower the initial barrier to incorporating cutting-edge encryption-based pseudonymization in translational and clinical research practices.

ObjectiveThis study investigated and compared the attitudes of healthy Iranian individuals (n = 302) in forms of two groups of caregivers and non-caregivers of cancer patients about the communication with cancer patients, and their personal wish to know the diagnosis if they ever had cancer. In addition, this study aimed to identify how many participants in the caregivers’ group had spoken with their family member affected by cancer about their illness.MethodsCaregivers (50.7%) and non-caregivers (49.3%) responded to two questionnaires regarding their general attitudes about communicating with cancer patients, and their willingness to know about their illness if they had cancer.ResultsThe majority of participants (92.8%), especially in the caregiver group, agreed with the right of patients to know the diagnosis and prognosis, and also wished to know if they ever had cancer. However, around 64% of caregivers never talked about cancer with the affected patients.ConclusionParticipants generally believed that patients have the right to know the diagnosis and prognosis, and they also wished to know if they ever had cancer. However, in reality many cancer patients are not included in communication sessions in Iran. Health professionals should focus on how to create a balance between medical bioethics with cultural influences on communication with patients.