Positive associations between mean ambient temperature and involuntary admissions to psychiatric facilities

BACKGROUND: Temperature increases in the context of climate change affect numerous mental health outcomes. One such relevant outcome is involuntary admissions as these often relate to severe (life)threatening psychiatric conditions. Due to a shortage of studies into this topic, relationships between mean ambient temperature and involuntary admissions have remained largely elusive. AIMS: To examine associations between involuntary admissions to psychiatric institutions and various meteorological variables. METHODS: Involuntary admissions data from 23 psychiatric institutions in the Netherlands were linked to meteorological data from their respective weather stations. Generalized additive models were used, integrating a restricted maximum likelihood method and thin plate regression splines to preserve generalizability and minimize the risk of overfitting. We thus conducted univariable, seasonally stratified, multivariable, and lagged analyses. RESULTS: A total of 13,746 involuntary admissions were included over 21,549 days. In univariable and multivariable models, we found significant positive associations with involuntary admissions for ambient temperature and windspeed, with projected increases of up to 0.94% in involuntary admissions per degree Celsius temperature elevation. In the univariable analyses using all data, the strongest associations in terms of significance and explained variance were found for mean ambient temperature (p = 2.5 × 10-6, Variance Explained [r2] = 0.096%) and maximum ambient temperature (p = 8.65 × 10-4, r2 = 0.072%). We did not find evidence that the lagged associations explain the associations for ambient temperature better than the direct associations. CONCLUSION: Mean ambient temperature is consistently but weakly associated with involuntary psychiatric admissions. Our findings set the stage for further epidemiological and mechanistic studies into this topic, as well as for modeling studies examining future involuntary psychiatric admissions.</p

Acceptance of online therapy for children and adolescents with digital media use disorders:perspectives from child and adolescent psychiatrists and psychotherapists in Germany

Online therapies have the potential to improve access to psychological services for individuals in need while alleviating the burden on healthcare systems. However, child and adolescent psychiatrists and psychotherapists (CAPPs) rarely integrate these services into their daily practice. This exploratory study investigates CAPPs' acceptance of online therapy, with a focus on treating children and adolescents with digital media use disorders (DMUD). The study aimed to examine attitudes toward online therapy for DMUD treatment and to identify barriers and facilitating factors to its implementation. A cross-sectional online survey (5-10 min) was distributed to 1000 members of a German practitioner network, with 142 respondents completing it in full. Attitudes toward online therapy were assessed using adapted versions of the Attitude towards Telemedicine in Psychiatry and Psychotherapy (ATiPP) questionnaire. Barriers and facilitating factors were explored using open-ended questions. Descriptive statistics, correlations, and regressions were used to analyze the closed-ended questions, while responses to open-ended questions were categorized. CAPPs reported considerable experience with DMUD, but less experience with online therapy. Attitudes towards online therapy were generally neutral, with less favorable views on its use for DMUD treatment. Key barriers to implementation in outpatient care included technical challenges, lack of personal contact or control, and concerns about data security. Facilitators included access to adequate technical resources, user-friendly and evidence-based programs, interactive tools, and opportunities for regular face-to-face interactions. The results highlight the need to develop online therapy solutions that align practitioners' needs and acceptance. However, further qualitative and quantitative research with more representative samples is essential for a more comprehensive understanding of this topic

Psychometric Validation of the German Version of the Rapid Assessment of Physical Activity (RAPA):A Secondary Analysis of Cross-Sectional Survey Data

Background and Aims: Regular physical activity holds numerous health benefits for older people, yet the majority of older people do not meet the World Health Organization's physical activity recommendations. Brief physical activity screening tools can support healthcare professionals in identifying patients who would benefit from physical activity promotion and counselling. The Rapid Assessment of Physical Activity (RAPA) questionnaire is a validated brief physical activity screening tool designed for clinical practice. Methods: We conducted a psychometric validation of a new German translation of the RAPA by performing a secondary analysis of survey data from 234 former cardiac rehabilitation patients (mean [SD] age 69 +/- 11 years, 23% female) in Austria. For psychometric validation, we used the following survey measures: the new German version of the RAPA, two customized questions about physical activity behavior, one customized question about perceived health self-management, and the German version of the EuroQol health-related quality of life questionnaire. We performed Spearman's correlations to assess the relationship between the German RAPA and the other measures (i.e., physical activity behavior, self-management of health and health-related quality of life). Results: Aerobic physical activity level according to the RAPA correlated significantly with weekly frequency (Spearman's rho = 0.31, 95% CI [0.18, 0.43], p &lt; .001) and volume of PA (rho = 0.34, 95% CI [0.21, 0.45], p &lt; .001), as well as perceived health self-management and five out of six dimensions of the EuroQol questionnaire. Conclusion: Our data demonstrate convergent validity and contribute to the psychometric validation of the new German version of the RAPA. These initial findings lend themselves to future dedicated psychometric validation studies of the German RAPA (against gold-standard physical activity questionnaires or direct physical activity measures) to further explore the potential of this tool for use in German-speaking geriatrics healthcare

Embedding Bioprinting of Low Viscous, Photopolymerizable Blood-Based Bioinks in a Crystal Self-Healing Transparent Supporting Bath

Protein-based hydrogels have great potential to be used as bioinks for biofabrication-driven tissue regeneration strategies due to their innate bioactivity. Nevertheless, their use as bioinks in conventional 3D bioprinting is impaired due to their intrinsic low viscosity. Using embedding bioprinting, a liquid bioink is printed within a support that physically holds the patterned filament. Inspired by the recognized microencapsulation technique complex coacervation, crystal self-healing embedding bioprinting (CLADDING) is introduced based on a highly transparent crystal supporting bath. The suitability of distinct classes of gelatins is evaluated (i.e., molecular weight distribution, isoelectric point, and ionic content), as well as the formation of gelatin-gum arabic microparticles as a function of pH, temperature, solvent, and mass ratios. Characterizing and controlling this parametric window resulted in high yields of support bath with ideal self-healing properties for interaction with protein-based bioinks. This support bath achieved transparency, which boosted light permeation within the bath. Bioprinted constructs fully composed of platelet lysates encapsulating a co-culture of human mesenchymal stromal cells and endothelial cells are obtained, demonstrating a high-dense cellular network with excellent cell viability and stability over a month. CLADDING broadens the spectrum of photocrosslinkable materials with extremely low viscosity that can now be bioprinted with sensitive cells without any additional support

An objective diagnosis of gout and calcium pyrophosphate deposition disease with machine learning of Raman spectra acquired in a point-of-care setting

Objective: Raman spectroscopy is proposed as a next-generation method for the identification of monosodium urate (MSU) and calcium pyrophosphate (CPP) crystals in synovial fluid. As the interpretation of Raman spectra requires specific expertise, the method is not directly applicable for clinicians. We developed an approach to demonstrate that the identification process can be automated with the use of machine learning techniques. The developed system is tested in a point-of-care-setting at our outpatient rheumatology department. Methods: We collected synovial fluid samples from 446 patients with various rheumatic diseases from three centres. We analysed all samples with our Raman spectroscope and used 246 samples for training and 200 samples for validation. Trained observers classified every Raman spectrum as MSU, CPP or other. We designed two one-against-all classifiers, one for MSU and one for CPP. These classifiers consisted of a principal component analysis model followed by a support vector machine. Results: The accuracy for classification of CPP using the 2023 ACR/EULAR CPPD classification criteria was 96.0% (95% CI: 92.3, 98.3), while the accuracy for classification of MSU using the 2015 ACR/EULAR gout classification criteria was 92.5% (95% CI: 87.9, 95.7). Overall, the accuracy for classification of pathological crystals was 88.0% (95% CI: 82.7, 92.2). The model was able to discriminate between pathological crystals, artifacts and other particles such as microplastics. Conclusion: We here demonstrate that potentially complex Raman spectra from clinical patient samples can be successfully classified by a machine learning approach, resulting in an objective diagnosis independent of the opinion of the medical examiner.</p

Worldwide application and valuation of extracorporeal membrane oxygenation support during the COVID-19 pandemic (WAVES)

OBJECTIVE: The outcomes of COVID-19 patients on venovenous extracorporeal membrane oxygenation (VV-ECMO) varied. We aim to investigate the variability concerning location and timeframe. We conducted a retrospective analysis of data from 351 institutions in 53 countries. The primary outcome was survival to hospital discharge or death up to 90 days from ECMO start. The associations between calendar time (month and year) of ECMO initiation and the primary outcome were examined by Cox regression modeling. Multivariable survival analyses were adjusted for the time of ECMO start, age, body mass index, APACHE II, SOFA, and the duration of mechanical ventilation before ECMO. RESULTS: 1060 adult COVID-19 patients enrolled in the COVID-19 Critical Care Consortium (COVID Critical) international registry and required VV-ECMO support. The study period is from January 2020 to December 2021. The median age was 51 years old, and 70% were male patients. Most patients were from Europe (39.3%) and North America (37.4%). The in-hospital mortality of the entire cohort was 47.12%. In North America and Europe, there was an increased probability of death from May 2020 through February 2021. Latin America showed a steady rate of survival until late in the study. South Asia, the Middle East, and Africa showed an increased chance of mortality around May 2020. In the Asian-Pacific region, after February 2021, there was an increased probability of death. The time of ECMO initiation and advanced patient age were associated with increased mortality. CONCLUSION: Variability in the outcomes of COVID-19 patients on VV-ECMO existed within different regions. This variability reflects the differences in resources, policies, patient selection, management, and possibly COVID-19 virus subtypes. Our findings might help guide global response in the future by early adoption of patient selection protocols, worldwide policies, and delivery of resources

The impact of different radiology report formats on patient information processing:a systematic review

Background: Since radiology reports are primarily written for health professionals, patients may experience difficulties understanding jargon and terminology used, leading to anxiety and confusion. Objectives: This review evaluates the impact of different radiology report formats on outcomes related to patient information processing, including perception, decision (behavioral intention), action (actual health behavior), and memory (recall of information). Methods: PubMed, Web of Science, EMBASE, and PsycInfo were searched for relevant qualitative and quantitative articles describing or comparing ways of presenting diagnostic radiology reports to patients. Two reviewers independently screened for relevant articles and extracted data from those included. The quality of articles was assessed using the Mixed Methods Appraisal Tool. Results: Eighteen studies, two qualitative and sixteen quantitative, were included. Sixteen studies compared multiple presentation formats, most frequently traditional unmodified reports (n = 15), or reports with anatomic illustrations (n = 8), lay summaries (n = 6) or glossaries (n = 6). Glossaries, illustrations, lay summaries, lay reports or lay conclusions all significantly improved participants’ cognitive perception and perception of communication of radiology reports, compared to traditional reports. Furthermore, these formats increased affective perception (e.g., reduced anxiety and worry), although only significant for lay reports and conclusions. Conclusion: Modifying traditional radiology reports with glossaries, illustrations or lay language enhances patient information processing. Key Points: Question Identifying the impact of different radiology report formats on outcomes related to patient information processing to enhance patient engagement through online access to radiology reports. Findings Lay language summaries, glossaries with patient-oriented definitions, and anatomic illustrations increase patients’ satisfaction with and understanding of their radiology reports. Clinical relevance To increase patients’ satisfaction, perceived usefulness and understanding with radiology reports, the use of lay language summaries, glossaries with patient-oriented definitions, and anatomic illustrations is recommended. These modifications decrease patients’ unnecessary insecurity, confusion, anxiety and physician consultations after viewing reports.</p

CTGAN-driven synthetic data generation:A multidisciplinary, expert-guided approach (TIMA)

OBJECTIVE: We generated synthetic data starting from a population of two hundred thirty-eight adults SARS-CoV-2 positive patients admitted to the University Hospital of Brussels, Belgium, in 2020, utilizing a Conditional Tabular Generative Adversarial Network (CTGAN)-based technique with the aim of testing the performance, representativeness, realism, novelty, and diversity of synthetic data generated from a small patient sample. A Multidisciplinary Approach (TIMA) incorporates active participation from a medical team throughout the various stages of this process. METHODS: The TIMA committee scrutinized data for inconsistencies, implementing stringent rules for variables unlearned by the system. A sensitivity analysis determined 100,000 epochs, leading to the generation of 10,000 synthetic data. The model's performance was tested using a general-purpose dataset, comparing real and synthetic data. RESULTS: Outcomes indicate the robustness of our model, with an average contingency score of 0.94 across variable pairs in synthetic and real data. Continuous variables exhibited a median correlation similarity score of 0.97. Novelty received a top score of 1. Principal Component Analysis (PCA) on synthetic values demonstrated diversity, as no patient pair displayed a zero or close-to-zero value distance. Remarkably, the TIMA committee's evaluation revealed that synthetic data was recognized as authentic by nearly 100%. CONCLUSIONS: Our trained model exhibited commendable performance, yielding high representativeness in the synthetic dataset compared to the original. The synthetic dataset proved realistic, boasting elevated levels of novelty and diversity