Hasil untuk "Psychiatry"

A. Larner

Huaqi Zhao, Songnan Zhang, Xiang Peng et al.

Object detection is a critical component in the development of autonomous driving technology and has demonstrated significant growth potential. To address the limitations of current techniques, this paper presents an improved object detection method for autonomous driving based on a detection transformer (DETR). First, we introduce a multi-scale feature and location information extraction method, which solves the inadequacy of the model for multi-scale object localization and detection. In addition, we developed a transformer encoder based on the group axial attention mechanism. This allows for efficient attention range control in the horizontal and vertical directions while reducing computation, ultimately enhancing the inference speed. Furthermore, we propose a novel dynamic hyperparameter tuning training method based on Pareto efficiency, which coordinates the training state of the loss functions through dynamic weights, overcoming issues associated with manually setting fixed weights and enhancing model convergence speed and accuracy. Experimental results demonstrate that the proposed method surpasses others, with improvements of 3.3%, 4.5%, and 3% in average precision on the COCO, PASCAL VOC, and KITTI datasets, respectively, and an 84% increase in FPS.

Lawrence T. Lam, Lawrence T. Lam, Lawrence T. Lam et al.

BackgroundThis study aims to validate the Chinese version of the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) by employing both Classical Test Theory (CTT) and Item Response Theory (IRT) approaches.MethodsData were gathered through a population-based, cross-sectional health survey using an online self-reported questionnaire. The scale underwent Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). Measurement invariance by gender was assessed using standard procedures. The Grade Response Model (GRM) of the IRT analysis was applied to the data, estimating the discrimination and difficulty parameters at different thresholds. The results were analyzed both graphically and through parameter values.ResultsFactor analyses confirmed that a single-factor model of the scale fit the data well, with an overall Eigenvalue of 4.55, explaining 65.0% of the total variance. Model fit statistics were slightly better for males than for females. Measurement invariance examinations also yielded satisfactory Goodness-of-Fit statistics (CFI = 0.940, TFI = 0.910, RMSEA < 0.001) with minimal changes in item loadings and indicator threshold patterns across groups. The IRT results demonstrated high discrimination parameters, ranging from 2.17 to 3.67, and nearly evenly distributed difficulty parameters, ranging from -2.23 to 1.77. Graphical examinations indicated good performance of the scale across the latent trait continuum.ConclusionsThe results indicated that, as a single-factor scale, the instrument exhibits good quality at both the scale and item levels. It has high discriminative power and an adequate response set for assessing a full range of the latent trait, namely mental well-being.

Sophia Ulhaq, Kamel Cheradi, Abab Ahmed et al.

Eating disorders are serious mental health conditions associated with significant morbidity and mortality. High levels of demand on services have led to increases in wait times to access support. Early intervention of eating disorders is critical to prevent entrenchment of illness and improve prognosis, with long wait times associated with higher rates of relapse.The East London Community Eating Disorder Service has seen an increase in wait time for routine referral from the 2-week local target to 17 weeks. Additionally, there have been long wait times to access treatment, including therapy and psychiatry support.A quality improvement (QI) framework was used in June 2022 to tackle the issues with capacity and flow with an aim to reduce wait times for routine referral from 17 weeks to 2 weeks in 12 months.A QI project team was formed which sought to understand the demands and capacity of the system using process mapping.From this, the team created a driver diagram and used Plan, Do, Study, Act cycles to test change iteratively. Measurements and data were displayed on control and run charts to help learn from the change ideas tested.Improvements were made and sustained, including reduction of routine referral wait time from 17 weeks to 2 weeks in 12 months. Additionally, internal wait lists reduced from 73 patients on the psychiatry list to 0 in 3 months and from 50 families waiting for therapy to 0 in 7 months.A number of inactive cases reduced from 65 to 0 during testing, thus contributing to improved flow through the service. A striking £130 233.21 annual savings in agency staff expenditure was achieved by January 2023.This has enabled a positive culture shift in the service.

Michael Courtney, Michael Courtney, Daniel Carey et al.

This study investigates the relationship between white matter hyperintensities (WMHs) and longitudinal cognitive decline in older adults. Using data from The Irish Longitudinal Study on Ageing (TILDA), we examined WMH characteristics, including volume, location, and microstructural integrity, in a community-dwelling population of 497 individuals over a six-year period. WMHs were categorised into phenotypes based on their size, fractional anisotropy (FA), and mean diffusivity (MD), with subtypes for periventricular and deep white matter lesions. We hypothesised that larger, microstructurally compromised lesions would be associated with accelerated cognitive decline. We isolated 11,933 WMHs, with an average of 24 WMHs per individual. Of these lesions, 6,056 (51%) were classified as Low Volume – High FA, 3193 (27%) were classified as Low Volume – Low FA and 2684 (22%) were classified as High Volume, Low FA. Our findings demonstrate that high-volume, low FA deep (p = 0.05) and periventricular (p = 0.004) lesions were significantly linked to cognitive decline (X = 12.9, p = 0.004), whereas small periventricular lesions with near normal microstructural properties do not predict cognitive decline. These results suggest that distinct WMH phenotypes may serve as markers for differential risks of cognitive impairment, providing potential targets for early intervention in at-risk populations.

D.E. Ogolo, E.C. Ajare, O. Okwuoma et al.

Background and objectives: While various pathologies affecting the foramen magnum region can have severe consequences, little research has been conducted on the unique morphological patterns in the West African subregion. The study aimed to assess these patterns and their implications for surgeries, comparing them with global standards. Methods: A descriptive study was conducted on 315 patients over a two-year period, excluding those with specific abnormalities. Measurements obtained from cranial 1.5T MRI scans included anteroposterior and transverse diameters of the foramen magnum. From these, the foramen magnum area and index were calculated. The data was analyzed by inferential, comparative and descriptive statistics, and a p value < 0.05 was regarded as statistically significant. Results: On average, the transverse and anteroposterior diameters were 28.51 mm and 33.02 mm for males and 28.39 mm and 33.47 mm for females, with a slightly smaller foramen magnum area in males (7.42 cm²) compared to females (7.47 cm²). Despite these differences, the variations were not statistically significant. However, the foramen magnum indices indicated medium size configuration for females and large size configuration for males, aligning with global trends. Conclusion: The study concluded that West Africans exhibited lower foramen magnum area and indices compared to other regions, with minor differences between sexes. Females tended to have a medium size configuration, while males tended to have a larger size configuration. These findings provide valuable insights for clinicians, highlighting the importance of considering ethno-regional variations in surgical approaches and interventions related to the craniocervical junction.

Chongyun Wu, Tao Wu, Luodan Yang

Heather Marriott, Renata Kabiljo, Guy P Hunt et al.

Abstract Amyotrophic lateral sclerosis (ALS) displays considerable clinical and genetic heterogeneity. Machine learning approaches have previously been utilised for patient stratification in ALS as they can disentangle complex disease landscapes. However, lack of independent validation in different populations and tissue samples have greatly limited their use in clinical and research settings. We overcame these issues by performing hierarchical clustering on the 5000 most variably expressed autosomal genes from motor cortex expression data of people with sporadic ALS from the KCL BrainBank (N = 112). Three molecular phenotypes linked to ALS pathogenesis were identified: synaptic and neuropeptide signalling, oxidative stress and apoptosis, and neuroinflammation. Cluster validation was achieved by applying linear discriminant analysis models to cases from TargetALS US motor cortex (N = 93), as well as Italian (N = 15) and Dutch (N = 397) blood expression datasets, for which there was a high assignment probability (80–90%) for each molecular subtype. The ALS and motor cortex specificity of the expression signatures were tested by mapping KCL BrainBank controls (N = 59), and occipital cortex (N = 45) and cerebellum (N = 123) samples from TargetALS to each cluster, before constructing case-control and motor cortex-region logistic regression classifiers. We found that the signatures were not only able to distinguish people with ALS from controls (AUC 0.88 ± 0.10), but also reflect the motor cortex-based disease process, as there was perfect discrimination between motor cortex and the other brain regions. Cell types known to be involved in the biological processes of each molecular phenotype were found in higher proportions, reinforcing their biological interpretation. Phenotype analysis revealed distinct cluster-related outcomes in both motor cortex datasets, relating to disease onset and progression-related measures. Our results support the hypothesis that different mechanisms underpin ALS pathogenesis in subgroups of patients and demonstrate potential for the development of personalised treatment approaches. Our method is available for the scientific and clinical community at https://alsgeclustering.er.kcl.ac.uk .

Hannes Gahnfelt, Per F. G. Carlsson, Christina Blomdahl

Intensive treatments for posttraumatic stress disorder (PTSD) are gaining increased research support. Treatment models targeting Complex PTSD and previously treatment-resistant PTSD have shown a good effect. A pilot study was performed to assess the feasibility of an 8-day intensive treatment program for severe PTSD in a Swedish public healthcare setting. Eleven participants completed treatment, and overall, the reduction in PTSD symptoms was considerable. Also, loss of diagnosis at 3-month follow-up was 100%. No adverse events occurred, and no elevation of suicidal intentions was reported. Symptom exacerbation could not be observed in the data and dropout due to the intensity of the treatment format did not occur. Based on these positive results, it is recommended that further research with larger samples is conducted. If found safe and effective, the 8-day treatment program could be an important addition to psychiatric healthcare.

Luca Paun, Alexandre Lavé, Gianpaolo Jannelli et al.

Posterior fossa atypical teratoid rhabdoid tumor (ATRT) is a rare childhood tumor usually associated with a dismal prognosis. Although upfront surgical gross total resection (GTR) has classically been the first line of treatment, new multimodal treatments, including two-stage surgery, are showing promising results in terms of overall survival (OS) and complication rate. We present a case of a 9-month-old child treated with two-staged surgery and chemotherapy. When deemed risky, multimodal treatments, including staged surgeries, can be a safe alternative to reduce surgical mortality and morbidity. At 23 months old, the patient had normal global development and no major impact on quality of life. We, therefore, discuss the most recent advancements from a treatment perspective, including molecular targeting.

Ye Yuan, Yongtong Zhu, Jiaqi Wang et al.

IntroductionSpiking neural networks (SNNs), inspired by biological neural networks, have received a surge of interest due to its temporal encoding. Biological neural networks are driven by multiple plasticities, including spike timing-dependent plasticity (STDP), structural plasticity, and homeostatic plasticity, making network connection patterns and weights to change continuously during the lifecycle. However, it is unclear how these plasticities interact to shape neural networks and affect neural signal processing.MethodHere, we propose a reward-modulated self-organization recurrent network with structural plasticity (RSRN-SP) to investigate this issue. Specifically, RSRN-SP uses spikes to encode information, and incorporate multiple plasticities including reward-modulated spike timing-dependent plasticity (R-STDP), homeostatic plasticity, and structural plasticity. On the one hand, combined with homeostatic plasticity, R-STDP is presented to guide the updating of synaptic weights. On the other hand, structural plasticity is utilized to simulate the growth and pruning of synaptic connections.Results and discussionExtensive experiments for sequential learning tasks are conducted to demonstrate the representational ability of the RSRN-SP, including counting task, motion prediction, and motion generation. Furthermore, the simulations also indicate that the characteristics arose from the RSRN-SP are consistent with biological observations.

Justin M. Campbell, Jim Ballard, Kevin Duff et al.

Introduction: Essential tremor (ET) was long considered a monosymptomatic disorder, but this view has given way to a more comprehensive clinical picture that involves consideration of non-tremor symptoms (e.g., balance impairment, cognitive impairment). Recently, the novel designation of “ET-plus” was proposed to reclassify ET patients who demonstrate these non-tremor clinical features, but the prevalence of ET-plus remains poorly defined. The primary aim of our study was to estimate the prevalence of ET-plus among presurgical patients with ET by applying this reclassification scheme. Methods: We performed a retrospective review of patients with ET being considered for deep brain stimulation or focused ultrasound thalamotomy. Patient demographics and data from their clinical workups were collected. As part of their clinical workup, patients were screened for preexisting balance and cognitive impairment. Patients with ET were designated as ET-plus if they had balance impairment, cognitive impairment, or tremor at rest. We performed a series of Pearson correlations to examine how individual clinical and demographic variables were related. Results: We identified 92 patients who met the study criteria. Our results indicate that 87% of the presurgical patients in our cohort met the criteria for reclassification as ET-plus. In addition, we observed robust correlations between patient age and balance impairment, cognitive impairment, history of falls, family history of tremor, and ET-plus reclassification. Conclusion: We propose that balance and gait impairment should be assessed preoperatively alongside neuropsychological evaluation to improve the counseling and treatment of patients with ET-plus.

Engie Prifti, Eleni N. Tsakiri, Ergina Vourkou et al.

Abstract Tau accumulation is clearly linked to pathogenesis in Alzheimer’s disease and other Tauopathies. However, processes leading to Tau fibrillization and reasons for its pathogenicity remain largely elusive. Mical emerged as a novel interacting protein of human Tau expressed in Drosophila brains. Mical is characterized by the presence of a flavoprotein monooxygenase domain that generates redox potential with which it can oxidize target proteins. In the well-established Drosophila Tauopathy model, we use genetic interactions to show that Mical alters Tau interactions with microtubules and the Actin cytoskeleton and greatly affects Tau aggregation propensity and Tau-associated toxicity and dysfunction. Exploration of the mechanism was pursued using a Mical inhibitor, a mutation in Mical that selectively disrupts its monooxygenase domain, Tau transgenes mutated at cysteine residues targeted by Mical and mass spectrometry analysis to quantify cysteine oxidation. The collective evidence strongly indicates that Mical’s redox activity mediates the effects on Tau via oxidation of Cys322. Importantly, we also validate results from the fly model in human Tauopathy samples by showing that MICAL1 is up-regulated in patient brains and co-localizes with Tau in Pick bodies. Our work provides mechanistic insights into the role of the Tau cysteine residues as redox-switches regulating the process of Tau self-assembly into inclusions in vivo, its function as a cytoskeletal protein and its effect on neuronal toxicity and dysfunction.

Yuji Naya, Yuji Naya, Yuji Naya et al.

Parveen Kumar, Vishal Kanaiyalal Patel, Renish Bhupenderbhai Bhatt et al.

Background: There are mixed views on categorizing pornography as addiction or as a sexual compulsivity or a subset of hypersexual behavior. Due to rise in the Internet access and technologies, the possibilities of conduit for sexual interactions, online pornography, and other type of repetitive behaviors have increased. Aims: The current study aimed to find the prevalence of problematic pornography use and attitude toward pornography. Methodology: A cross-sectional study was carried out among 1,050 undergraduate medical students to assess the prevalence of pornography addiction and attitude toward pornography. A Google document containing structured questionnaire in 3 different parts: (a) demographic details of students, (b) Problematic Pornography Consumption Scale, and (c) attitudes toward pornography scale. This Google document was shared with all the undergraduate students through email address and WhatsApp group. Participants who did not respond to the questionnaire were sent 3 reminders at a gap of 3 days. The responses were recorded in Excel sheet and analyzed using Epi-Info software. Results: Prevalence of problematic pornography use among participants was 12.5%. There was statistically high prevalence of problematic pornography use among male participants ( P < .001), nearly daily consumption of pornography per week ( P < .001) and more than 20 min of consumption per day ( P <.001). A statistical significant negative correlation was shown (r = −0.483, P < .001) between age of first exposure to pornography and problematic pornography consumption score. Males, being in a relationship, and those with problematic pornography use had higher score on attitude toward pornography scale. Conclusion: It is important to provide education to students about the effects of problematic pornography use because there is negative correlation between exposure to pornographic imagery on the Internet and levels of genital and sexual esteem; pornography use was associated with poor quality of life, and depressive and anxiety symptoms. Gender-specific discussions so as to promote sexual health and participation in media literacy education would be beneficial for young people in changing attitude toward pornography.

Elisabeth A. Spronck, Astrid Vallès, Margit H. Lampen et al.

Huntington disease (HD) is a fatal, neurodegenerative genetic disorder with aggregation of mutant Huntingtin protein (mutHTT) in the brain as a key pathological mechanism. There are currently no disease modifying therapies for HD; however, <i>HTT</i>-lowering therapies hold promise. Recombinant adeno-associated virus serotype 5 expressing a microRNA that targets <i>HTT</i> mRNA (AAV5-miHTT) is in development for the treatment of HD with promising results in rodent and minipig HD models. To support a clinical trial, toxicity studies were performed in non-human primates (NHP, <i>Macaca fascicularis</i>) and Sprague-Dawley rats to evaluate the safety of AAV5-miHTT, the neurosurgical administration procedure, vector delivery and expression of the mi<i>HTT</i> transgene during a 6-month observation period. For accurate delivery of AAV5-miHTT to the striatum, real-time magnetic resonance imaging (MRI) with convection-enhanced delivery (CED) was used in NHP. Catheters were successfully implanted in 24 NHP, without neurological symptoms, and resulted in tracer signal in the target areas. Widespread vector DNA and mi<i>HTT</i> transgene distribution in the brain was found, particularly in areas associated with HD pathology. Intrastriatal administration of AAV5-miHTT was well tolerated with no clinically relevant changes in either species. These studies demonstrate the excellent safety profile of AAV5-miHTT, the reproducibility and tolerability of intrastriatal administration, and the delivery of AAV5-miHTT to the brain, which support the transition of AAV5-miHTT into clinical studies.

D. Galin

C. Macfie

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J. Davis