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Introduction: Previously established categories for the classification of disease courses of unipolar depressive disorder (relapse, remission, recovery, recurrence) are helpful, but insufficient in describing the naturalistic disease courses over time. The intention of the present study was to identify frequent disease courses of depression by means of a cluster analysis., Methods: For the longitudinal cluster analysis, 555 datasets of patients who participated in the INDDEP (INpatient and Day clinic treatment of DEPression) study, were used. The present study uses data of patients with at least moderate depressive symptoms (major depression) over a follow-up period of 1 year after their in-patient or day-care treatments using the LIFE (Longitudinal Interval Follow-Up Evaluation)-interview. Eight German psychosomatic hospitals participated in this naturalistic observational study., Results: Considering only the Calinski-Harabatz index, a 2-cluster solution gives the best statistical results. In combination with other indices and clinical interpretations, the 5-cluster solution seems to be the most interesting. The cluster sizes are large enough and numerically balanced. The KML-cluster analyses revealed five well interpretable disease course clusters over the follow-up period: "sustained treatment response" ( N = 202, 36.4% of the patients), "recurrence" ( N = 80, 14.4%), "persisting relapse" ( N = 115, 20.7%), "temporary relapse" ( N = 95, 17.1%), and remission ( N = 63, 11.4%)., Conclusion: The disease courses of many patients diagnosed with a unipolar depression do not match with the historically developed categories such as relapse, remission, and recovery. Given this context, the introduction of disease course trajectories seems helpful. These findings may promote the implementation of new therapy options, adapted to the disease courses., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Martinek, Jarczok, Rottler, Hartmann, Zeeck, Weiß and von Wietersheim.)

Objectives: Bullying in the workplace is considered an interpersonal stress factor. Occupational stress and mental health among physicians is increasingly becoming the focus of public attention. The extent to which mobbing plays a role in this has hardly been investigated yet. The aim of this study is to provide data on the prevalence of bullying among hospital physicians in Germany and possible correlations with occupational stress and mental health., Methods: Within the framework of two cross-sectional studies, 692 hospital physicians in the field of psychiatry/psychotherapy (P/PT) and 667 hospital physicians in intensive care (IM) were interviewed at conferences. Standardized questionnaires on mobbing experience, occupational stress and mental health (single item from COPSOQ, BDI-II, ERI, MBI) were used., Results: Bullying was experienced by 4.6% (n=61) of the respondents. IM and women physicians were more often affected (not significant) and correlations with occupational stress (ERI), overcommitment (OC), emotional exhaustion (MBI) and depression (BDI-II) were found., Conclusion: Our data on a large cohort of physicians in specialties with different exposure profiles show that a relevant proportion is affected by bullying and that bullying is related to the experience of occupational stress as well as mental health impairments. From this, implications for institutional and individual prevention and support services can be derived., Competing Interests: Die Autorinnen/Autoren geben an, dass keine Interessenkonflikte vorliegen., (Thieme. All rights reserved.)

Reconciliation of family and work life is an important topic for employees. Due to common work in shifts within the health care sector, this is even more essential for health care workers and has great implications in work satisfaction and individuals ́ health. Within all employees of the department of OB/GYN of the German university hospital Ulm, an anonymous and voluntary survey on compatibility of work and family was performed in the summer of 2017. The questionnaires consisted of established and newly designed tools to assess reconciliation of family/work life as well as work-family (WFC) and family-work conflict (FWC). Return rate of questionnaires was 63% (n=136). Physicians (n=33), nurses (n=53), and midwives (n=31) were grouped together as "medical staff" (n=115). There was no significant difference between employees with (n=73) or without children (n=59) regarding WFC and FWC. The group of nurses/midwives and the group of physicians had a significantly higher inter-role conflict (p<0.001) than the group of administrative staff. A negative correlation with "work satisfaction" was found for WFC and FWC. The group of nurses/midwives has significantly higher inter-role conflicts than the administrative staff. Especially the negative correlation of work satisfaction and inter-role conflicts shows the enormous need for improvement in sufficient compatibility of work and family life of employees in the health care sector. This needs to be addressed quickly and effectively as there is an alarming deficit of nurses and midwives in the German health care system., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Stress and depression are known to contribute to coronary artery disease (CAD) with catecholamines (CA), altering the balance to a pro- and anti-inflammatory stetting and potentially playing a key role in the underlying pathophysiology. This study aimed to elucidate the impact of social stress on the CA system and inflammation markers in patients suffering from CAD and depression., Methods: 93 subjects were exposed to the Trier Social Stress Test (TSST). Based on the results of the depression subscale of the Hospital Anxiety and Depression Scale (HADS, German Version) and the presence/absence of CAD, they were divided into four groups. A total of 21 patients suffered from CAD and depression (+D+CAD), 26 suffered from CAD alone (-D+CAD), and 23 suffered from depression only (+D-CAD); another 23 subjects served as healthy controls (-D-CAD). Subjects were registered at 09:00 AM at the laboratory. A peripheral venous catheter was inserted, and after a 60-min-resting period, the TSST was applied. Prior to and 5, 15, 30, and 60 min after the stress test, plasma epinephrine, norepinephrine, and dopamine concentrations (High Performance Liquid Chromatography (HPLC)) were measured together with the inflammation markers interleukin-6 (IL-6) and monocyte chemotactic protein-1 (MCP-1). High-sensitive C-reactive protein (hs-CRP, Enzyme-linked Immunosorbent Assay (ELISA)) was measured prior to TSST., Results: (+D-CAD) and (+D+CAD) patients showed significantly lower epinephrine and dopamine levels compared to the (-D+CAD) and (-D-CAD) participants at baseline (prior to TSST). Over the whole measurement period after the TSST, no inter-group difference was detected. Partial correlation (controlling for age, gender and Body Mass Index (BMI)) revealed a significant direct relation between MCP-1 and norepinephrine ( r = 0.47, p = 0.03) and MCP-1 and epinephrine ( r = 0.46, p = 0.04) in patients with -D+CAD at rest., Conclusions: The stress response of the CA system was not affected by depression or CAD, whereas at baseline we detected a depression-related reduction of epinephrine and dopamine release independent of CAD comorbidity. Reduced norepinephrine and dopamine secretion in the central nervous system in depression, known as 'CA-deficit hypothesis', are targets of antidepressant drugs. Our results point towards a CA-deficit in the peripheral nervous system in line with CA-deficit of the central nervous system and CA exhaustion in depression. This might explain somatic symptoms such as constipation, stomach pain, diarrhoea, sweating, tremor, and the influence of depression on the outcome of somatic illness such as CAD.

Objective: Patients and general practitioners often report on difficulties in finding a psychotherapist. In this prospective study, we investigate how much effort patients have to invest and how long it takes until they get an appointment with a psychotherapist., Methods: 69 patients who were recommended to have psychotherapy were followed-up by telephone calls during 3 months. They were asked what they did to find a therapist and what the answers of the therapists were., Results: Patients made on average 9.3 (SD 11.8) telephone calls to therapists (range 1-50). After three months, 57.7% of the patients had found a therapist or were on a waiting list. 15.3% were still seeking, 6.8% had quit seeking. 20.3% had not even started seeking., Conclusions: The results show that much effort is needed to find a psychotherapist, but also that the majority of the patients do find one. Reasons for quitting the search for a therapist might be ambivalence on the part of the patients, but also the marked barriers in the health system., Competing Interests: Die Autoren geben an, dass kein Interesenkonflikt besteht., (Thieme. All rights reserved.)

Psychosocial stress increases cardiovascular risk, which coincides with enhanced oxidative DNA damage. Increased sympathetic tone-related catecholamine release causes oxidative stress, which contributes to catecholamine-related cardiotoxicity. Therefore, we tested the hypothesis whether acute psychosocial stress induces oxidative DNA damage, its degree being related to the cardiovascular risk profile and depending on the sympathetic stress response. After assessment of the prospective cardiovascular Münster score (PROCAM) to determine the risk of acute myocardial infarction, 83 male and 12 female healthy volunteers underwent the Trier social stress test for groups (TSST-G). Heart rate variability was quantified by measuring the standard deviation (SDNN) and root mean square of successive differences (RMSSD) between normal-to-normal inter-beat intervals. Salivary α-amylase (sAA) activity was assessed as a surrogate for noradrenaline plasma concentrations. Oxidative DNA damage was determined using whole-blood single-cell gel electrophoresis ("tail moment" in the "comet assay"). A total of 33 subjects presented with a prospective risk of myocardial infarction (risk+) vs. 59 subjects without risk (risk-). The TSST-G stress significantly increased blood pressure, heart rate, and sAA in both groups, while oxidative DNA damage was only increased in the risk+ group. Immediately after the TSST-G, the "tail moment" showed significant inverse linear relations with both SDNN and RMSSD. Acute psychosocial stress may cause oxidative DNA damage, the degree of which is directly related to the individual cardiovascular risk profile and depends on the stress-induced increase in the sympathetic tone.

Objective: To date, there is only a limited number of studies evaluating the implementation and effects of treatment guidelines. Therefore, this study aimed to determine how many patients diagnosed with a major depression were treated in compliance with the German treatment guideline after hospital treatment, and whether a deviation from the guideline resulted in a less favorable development., Methods: Five hundred two patients, which originally participated in the INDDEP-study, were included. Data were collected at admission and discharge from eight different psychosomatic (psychotherapeutic) hospitals in Germany as well as 3 months and 1 year after hospital treatment. Data on depressive symptomatology were assessed by QIDS-C (clinical interviews). By phone interviews, the clinical course and the outpatient treatments were assessed. Statistical analyses compared patients who were treated in compliance with the German treatment guideline with those who were not., Results: Seventy-nine point one percent of the outpatient treatments complied with the treatment guideline. Eleven point eight percent of the patients were treated with medication only, 60.2% with psychotherapy only, and 28.0% with a combination. There was no difference in the clinical outcome (depression) with regard to guideline compliance. Cases in which deviation from the guideline occurred (20.9%) were younger and had a less severe depressive symptomatology at admission and after hospital treatment., Conclusion: After treatment in a psychosomatic hospital or day hospital, the majority of patients with a depressive disorder received adjacent treatment in accordance with the German guideline and with a clear focus on psychotherapy. Deviations from the guideline did not result in a less favorable course of the illness., Clinical Trial Registration: ISRCTN20317064, retrospectively registered 31.07.2012., (Copyright © 2020 Weiß, Zeeck, Rottler, Weiß, Hartmann, von Wietersheim and The INDDEP Study Group.)

Several therapeutic treatments like individual psychotherapy, group therapy, creative therapies and talks with the nursing staff are components in an inpatient psychosomatic (psychotherapeutic) treatment or a psychosomatic day hospital treatment. In Germany, these therapies have to be documented by the administration with so called OPS-Codes. These codes are reported to the Institute for Reimbursement in Hospitals (InEK). With the data of the INDDEP-study it should be investigated how the therapies of 7 hospitals and 8 day-hospitals compare to each other. In addition, it should be studied, if the amount of the documented therapies is connected to the outcome in these hospitals. In the INDDEP-study, data of patients with major depression were assessed at 4 measurement points (admission, discharge, 3 months and 12 months follow up). In addition, the OPS codes of the treatments were documented. The results show that it is possible to get a rough estimation of the psychotherapeutic doses by the OPS-codes. The results show significant differences between the hospitals in terms of the intensity and professional group composition of the treatments. This result is confirmed for in-patient and day hospital treatments. Correlation analyses showed no significant correlation between the total amount of therapy and the improvement in depressive symptoms. It is assumed that there are moderating variables (patient-, therapy and process-related) which moderate the relation between doses and outcome. This should be identified in further studies., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: The autonomic nervous system (ANS) processes underlying attachment-related mother-child interactions are not well understood. We aimed to describe and compare the responsivity of the ANS for mothers and their infants during the different phases of the Strange Situation Procedure (SSP)., Methods: Continuous measurements of the sympathetic (SNS) and parasympathetic (PNS) branches of the ANS were obtained simultaneously in 91 mothers and their infants (range 10-15 months). Heart rate (HR), respiratory sinus arrhythmia (RSA), pre-ejection period (PEP) and left ventricular ejection time (LVET), were calculated for the baseline period (e1) and seven subsequent episodes (e2-e8) of the SSP., Results: The largest difference between the mother and infant was during e7, when the stranger went into the room where the infant was while the mother waited outside the room. Mothers showed reduced SNS-activity or stress reduction while the child showed PNS withdrawal or increased stress response. Additionally, LVET was found to be a marker for SNS changes in the one-year-old infant during SSP., Conclusion: Mothers and infants showed different stress-related ANS responses during e7. Since this study showed that simultaneous measurement of ANS responses in mother-child dyads during the SSP is feasible, future studies can assess both mother and child stress responses in different contexts. The measure of LVET may be a valid SNS-reactivity measure in the one-year-olds. Since the separation episode e7 led to the strongest ANS responses, future studies might assess stress responses in more normative circumstances, such as child care programs., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Introduction: Waiting times for the admission into a so called psychosomatic hospital in Germany prevent the necessary immediate treatment. They lead to further incapacity for work and chronic manifestation of the disease. It is reported that most psychosomatic hospitals have waiting times, but there are no studies on data on that. Therefore, it was the aim of this study to access prospectively in a defined region, how long it takes for the patients to get an outpatient preliminary talk and thereafter, how long they have to wait for their admission., Methods: 7 hospitals out of the region of South-Württemberg took part on this study, 2 of them had bigger day hospitals. Data were assessed prospectively in 2015 over 9 months, in total 916 admissions were assessed., Results: The waiting time until a preliminary talk, in which the indication for inpatient treatment was secured, was in the mean 25 days (SD=31). The waiting time after this talk until admission was 56 days (SD=47). Patients who waited for a day treatment had to wait even longer. An urgency remark, given by the therapist of the preliminary talk, as well as a private illness insurance led to shorter waiting times. The diagnosis had no influence on the waiting time., Conclusions: The waiting times are substantial and imply a burden for the patient and also for the health care system. It is recommended to assess and publish these waiting times on a regularly basis. Politics, but also the actors in the health care system should discuss if and how this deficit can be changed., Competing Interests: Alle Autoren sind in der Leitung oder als Angestellte in den beforschten Kliniken tätig. Ansonsten bestehen keine Interessenkonflikte., (© Georg Thieme Verlag KG Stuttgart · New York.)

During art therapy self-experience workshops in Vietnam and Germany, the authors noticed that there were differences in how the groups expressed their feelings in paintings. This led the authors to a comparative, explorative study. In this study workshop participants from Germany and Vietnam (29 in each group) were instructed to draw pictures related to basic emotions like sadness, disgust, anger, or happiness. Then, the paintings were evaluated by using rating scales with which formal and content-oriented criteria can be assessed. The interrater reliability was good. The results showed some statistically significant differences. The Vietnamese participants used smaller formats and more colors with stronger color application. They preferred simpler forms than the Germans. The German participants painted in a more abstract manner, while the Vietnamese participants used more concrete images and tended to scenic expressions (representation of stories). There are some reasons which might explain these differences: It is known that cultural influences play an important role in the arts as well as in the way creative arts are taught in a particular society. The expression of emotions is culture-specific as well. The Vietnamese participants were, however, interested in the possibilities art therapy offers and felt that there are good chances for this therapy to develop in their country.

Background: Within the framework of psychosomatic consultation in the workplace (PSIW), external expert psychotherapists offered consultation sessions for employees at the company premises in order to establish a first contact. In contrast to the first contact usually established in regular care, PSIW explicitly focuses on the workplace and enables in-company actors to get closely involved, if the patient's consent is provided. The new model of care helps to identify mental problems at an early stage and is clinically effective. Reliable data considering the user's point of view is missing., Objectives: How satisfied are users of the new model of care compared to users of regular care?, Material and Methods: A total of 189 people from in-company (n = 91) or regular medical consultations (n = 98) made statements before first contact (t1) and 12 weeks (t2) after the initial contact. They reported satisfaction with the offer (t2), further treatment (t2), and depressiveness (t1, t2) by means of self-assessment tools. On the basis of an OLS (ordinary least squares) regression analysis, we investigated how treatment quality (clinical improvement, further treatment) and the place of treatment influenced user satisfaction (dependent variable), while controlling for selection bias and the different degrees of depression at baseline., Results: Higher clinical improvement predicted more satisfaction with the received treatment in both (b = 1.2, CI 0.802-1.548). The mean value (MV) of satisfaction was 1.6 points higher if further treatment took place (CI 0.236-2.909). PSIW users showed a 1.8 points higher MV of satisfaction than people in regular care (CI 0.322-3.302)., Conclusions: PSIW users consider PSIW as positive in terms of treatment success and service quality.

Background: Child maltreatment (CM) and attachment experiences are closely linked to alterations in the human oxytocin (OXT) system. However, human data about oxytocin receptor (OXTR) protein levels are lacking. Therefore, we investigated oxytocin receptor (OXTR) protein levels in circulating immune cells and related them to circulating levels of OXT in peripheral blood. We hypothesized reduced OXTR protein levels, associated with both, experiences of CM and an insecure attachment representation. Methods: OXTR protein expressions were analyzed by western blot analyses in peripheral blood mononuclear cells (PBMC) and plasma OXT levels were determined by radioimmunoassay (RIA) in 49 mothers. We used the Childhood Trauma Questionnaire (CTQ) to assess adverse childhood experiences. Attachment representations (secure vs. insecure) were classified using the Adult Attachment Projective Picture System (AAP) and levels of anxiety and depression were assessed with the German version of the Hospital Depression and Anxiety scale (HADS-D). Results: CM-affected women showed significantly lower OXTR protein expression with significantly negative correlations between the OXTR protein expression and the CTQ sum score, whereas plasma OXT levels showed no significant differences in association with CM. Lower OXTR protein expression in PBMC were particularly pronounced in the group of insecurely attached mothers compared to the securely attached group. Anxiety levels were significantly higher in CM-affected women. Conclusion: This study demonstrated a significant association between CM and an alteration of OXTR protein expression in human blood cells as a sign for chronic, long-lasting alterations in this attachment-related neurobiological system.

In previous studies, it was found that patients treated at a psychosomatic outpatient clinic (PSOC) for common mental disorders showed more severe symptoms than those who used a psychotherapeutic consultation service at the workplace (PSIW). This study examines whether the higher symptom severity of the PSOC patients in comparison to their PSIW counterparts is also related to higher levels of occupational stress as measured by the demand-control-support model (DCS). N = 253 participants (PSIW n = 100; PSOC n = 153) provided self-reported data on demands, decision latitude, social support, and health before consultation. The association between mental health care setting, symptom level and demands, decision latitude, and social support was assessed by means of a path model. Results of the path model indicated that the higher level of depression in PSOC patients was related to higher levels of demands and lower levels of social support. Demands and social support were found to be indirectly associated with treatment setting. No interaction effect between demands, decision latitude, social support, and depression was found. Results of this study reveal that the working conditions influenced the pathway to care process via symptom severity., Competing Interests: The authors declare no conflict of interest. Eva Rothermund is senior physician and Harald Gündel and Michael Hölzer each director of a clinic that offers the service of PSIW to interested organisations and companies. Amira Barrech, Reinhold Kilian, Edit Rottler, Lucia Jerg-Bretzke, Monika Annemarie Rieger and Marc Nicolas Jarczok declare no conflict of interest. The founding sponsors had no role in the design of the study, in the collection, analyses, or interpretation of data, in the writing of the manuscript, and in the decision to publish the results.

Objective: Common mental disorders like mood and anxiety disorders and somatoform disorders have high costs, yet under-treatment is still frequent. Many people with common mental disorders are employed, so the workplace is potentially a suitable context in which to provide early treatment. Our study investigates whether a change of setting (workplace versus standard care) improves access to treatment for common mental disorders., Methods: Conditional latent profile analysis was applied to identify user profiles for work ability (WAI), clinical symptoms like depression (patient health questionnaire depression, PHQ-9), health-related quality of life (QoL, SF-12), and work-related stress (Maslach Burnout Inventory, irritation scale). Patients were recruited consecutively, via psychotherapeutic consultation in the workplace (n = 174) or psychotherapeutic consultation in outpatient care (n = 193)., Results: We identified four user profiles in our model: 'severe' (n = 99), 'moderate I-low QoL' (n = 88), 'moderate II-low work ability' (n = 83), and 'at risk' (n = 97). The 'at risk' profile encompassed individuals with reduced work ability (36.0, 34.73 to 37.37), only mild clinical symptoms (PHQ-9 5.7, 4.92 to 6.53), no signs of work-related stress and good quality of life. A higher proportion of the 'at risk' group than of the 'severe' group sought help via the psychotherapeutic consultation in the workplace (OR 0.287, P < 0.01); this effect remained after controlling for gender., Conclusions: Offering secondary mental health care in the workplace is feasible and accepted by users. Offering treatment in the workplace as an alternative to standard outpatient settings is a viable strategy for improving access to treatment for common mental disorders., Competing Interests: MAR received a partial salary from Suedwestmetall and DM received a salary from Daimler AG. CASSIDIAN (now Airbus) provided funding and support for this study. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background: This study compares the effectiveness of psychotherapeutic consultation in the workplace (PSIW) with psychotherapeutic outpatient care (PSOC) in Germany., Methods: Work ability (WAI), quality of life (SF-12), clinical symptoms (PHQ) and work-related stress (MBI, IS) were assessed in 367 patients seeking mental health care via two routes (PSIW n = 174; PSOC n = 193) before consultation and 12 weeks later. Changes in outcome variables were assessed using covariance analysis with repeated measures (ANCOVA) with sociodemographic variables (propensity score method), therapy dose, setting and symptom severity as covariates., Results: The PSIW and PSOC groups included 122 and 66 men respectively. There were 102 first-time users of mental healthcare in the PSIW group and 83 in the PSOC group. There were group differences in outcome variables at baseline (p < 0.05); PSIW patients were less impaired overall. There were no group difference in sociodemographic variables, number of sessions within the offer or symptom severity. There was no main effect of group on outcome variables and no group*time interaction. Work-related stress indicators did not change during the intervention, but work ability improved in both groups (F = 10.149, p = 0.002; baseline M = 27.2, SD = 8.85); follow-up M = 28.6, SD = 9.02), as did perceived mental health (SF-12 MCS), depression (PHQ-9) and anxiety (PHQ-7). Effect sizes were between η(2) = 0.028 and η(2) = 0.040., Conclusions: Psychotherapeutic consultation is similarly effective in improving patients' functional and clinical status whether delivered in the workplace or in an outpatient clinic. Offering mental health services in the workplace makes it easier to reach patients at an earlier stage in their illness and thus enables provision of early and effective mental health care., Trial Registration: DRKS00003184 , retrospectively registered 13 January 2012.

Oxytocin (OT) plays a crucial role in parental-infant bonding and attachment. Recent functional imaging studies reveal specific attachment and reward related brain regions in individuals or within the parent-child dyad. However, the time course and functional stage of modulatory effects of OT on attachment-related processing, especially in fathers, are poorly understood. To elucidate the functional and neural mechanisms underlying the role of OT in paternal-child attachment, we performed an event-related potential study in 24 healthy fathers who received intranasal OT in a double-blind, placebo-controlled, within-subject experimental design. Participants passively viewed pictures of their own child (oC), a familiar (fC) and an unfamiliar child (ufC) while event-related potentials were recorded. Familiarity of the child's face modulated a broad negativity at occipital and temporo-parietal electrodes within a time window of 300-400ms, presumably reflecting a modulation of the N250 and N300 ERP components. The oC condition elicited a more negative potential compared to the other familiarity conditions suggesting different activation of perceptual memory representations and assignment of emotional valence. Most importantly, this familiarity effect was only observed under placebo (PL) and was abolished under OT, in particular at left temporo-parietal electrodes. This OT induced attenuation of ERP responses was related to habitual attachment representations in fathers. In summary, our results demonstrate an OT-specific effect at later stages of attachment-related face processing presumably reflecting both activation of perceptual memory representations and assignment of emotional value., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Hydrothermal carbonization (HTC) produces carbon-rich nano-micro size particles. In this study, magnetic hydrochar (MHC) was prepared from model compound cellulose by simply adding ferrites during HTC. The effects of ferrites on HTC were evaluated by characterizing solid MHC and corresponding process liquid. Additionally, magnetic stability of MHC was tested by magnetic susceptibility method. Finally, MHC was used as support media for anaerobic films in anaerobic digestion (AD). Ash-free mass yield was around 50% less in MHC than hydrochar produced without ferrites at any certain HTC reaction condition, where organic part of MHC is mainly carbon. In fact, amorphous hydrochar was growing on the surface of inorganic ferrites. MHC maintained magnetic susceptibility regardless of reaction time at reaction temperature 250°C. Pronounced inhibitory effects of magnetic hydrochar occurred during start-up of AD but diminished with prolong AD times. Visible biofilms were observed on the MHC by laser scanning microscope after AD., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

In this study, influence of feedwater pH (2-12) was studied for hydrothermal carbonization (HTC) of wheat straw at 200 and 260°C. Acetic acid and KOH were used as acidic and basic medium, respectively. Hydrochars were characterized by elemental and fiber analyses, SEM, surface area, pore volume and size, and ATR-FTIR, while HTC process liquids were analyzed by HPLC and GC. Both hydrochar and HTC process liquid qualities vary with feedwater pH. At acidic pH, cellulose and elemental carbon increase in hydrochar, while hemicellulose and pseudo-lignin decrease. Hydrochars produced at pH 2 feedwater has 2.7 times larger surface area than that produced at pH 12. It also has the largest pore volume (1.1 × 10(-1) ml g(-1)) and pore size (20.2 nm). Organic acids were increasing, while sugars were decreasing in case of basic feedwater, however, phenolic compounds were present only at 260°C and their concentrations were increasing in basic feedwater., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objective: To assess anxiety and depression symptoms, suicidal ideation, and health-related quality of life (HRQOL) in a large series of consecutive patients with primary hyperparathyroidism (pHPT) before and after parathyroidectomy., Design: This prospective multicenter study investigated preoperative and postoperative depression, anxiety, suicidal ideation, and HRQOL in patients with pHPT and compared these variables with a control group with nontoxic thyroid nodules., Patients: The study included 194 patients with pHPT and 186 control subjects., Main Outcome Measures: Depression was evaluated with the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire-9, which also assessed suicidal ideation. Anxiety was evaluated with the HADS. Health-related quality of life was measured with the 36-Item Short Form survey., Results: Parathyroidectomy achieved a 98% cure rate. Preoperatively, severe depression (HADS score ≥ 11) was seen in 20% of the pHPT group and 9% of the control group. The Patient Health Questionnaire-9 detected moderate to severe depression in 17% of the patients with pHPT and 7% of the control subjects. Patients with pHPT had higher HADS anxiety scores (mean, 7.7) than control subjects (P < .01) or the German normative sample (P < .001). Compared with control subjects, patients with pHPT had significantly lower 36-Item Short Form survey preoperative physical and mental health summary scores (42.7 vs 49.5 and 41.2 vs 46.8, respectively; P = .001 for both comparisons). At 12 months follow-up, depression and anxiety decreased significantly in patients with pHPT; the prevalence of suicidal ideation was more than halved from the baseline (10.7% vs 22%; P = .008). Both physical and mental health scores (45.7 and 47.7, respectively) improved in patients with pHPT (P < .001 each) but not in control subjects., Conclusions: Depression, anxiety, and decreased HRQOL appear to be related to pHPT. Successful parathyroidectomy seems to reduce psychopathologic symptoms and improve HRQOL in this setting.