Electroconvulsive Therapy in Depression: Improvement in Quality of Life Depending on Age and Sex

Objectives It is uncertain if there are variations in the improvement of quality in life between sexes and age groups after electroconvulsive therapy (ECT). The aim of this study was to investigate how health-related quality of life changed after treatment and to examine differences in the results between sex and age groups. Methods This register-based study used data from the Swedish national quality register for ECT. The study population was patients diagnosed with depression who had received ECT. Health-related quality of life was quantified using the 3-level version the EuroQol 5-dimensional questionnaire (EQ-5D 3 L). Analysis of variance was used to compare change in EQ-5D score from pretreatment to posttreatment between sex and age groups. Results There was a statistically significant improvement in EQ-5D index score and EQ visual analog scale (VAS) score in all patient groups after ECT. The mean improvement in EQ-5D index score and EQ-VAS score ranged from 0.31 to 0.46 and 28.29 to 39.79, respectively. Elderly patients had greater improvement in EQ-5D index score and EQ-VAS score than younger patients. There was no significant difference in improvement between the sexes. The mean improvement in EQ-5D index score was 0.40 for male patients and 0.41 for female patients. Conclusions Electroconvulsive therapy had a considerable effect on health-related quality of life in patients with depression of both sexes and all age groups. The improvement was greatest in elderly patients, who more often had psychotic features. More studies are needed to investigate the long-term effects of ECT and to further explain the varying treatment results between elderly and younger patients.publishedVersio

Validity of diagnoses, treatment dates, and rating scales in the Swedish national quality register for electroconvulsive therapy

Background The Swedish national quality register for electroconvulsive therapy (Q-ECT) contains data on patients receiving treatment with electroconvulsive therapy (ECT) in Sweden. Aim This study determined the validity of diagnoses, treatment dates, and rating scales in the Q-ECT by investigating the degree of accordance between data from the Q-ECT and patient records. Materials and methods From January 2016 to December 2017, 200 treatment series were randomly selected from the Q-ECT. The corresponding patient records were requested from the treating hospitals. Data on the indicative diagnosis, dates for the first and the last ECT session, and rating scales were compared between the Q-ECT and patient records using (i) a strict and (ii) a liberal method of assessment. Using the liberal method, each variable was assessed as accordant if it belonged to the same diagnosis group, or if the dates differed by less than 1 week, or ratings differed by only 1 point on the Clinical Global Impression Scale (CGI- S), or no more than 3 points on the Montgomery Åsberg Depression Rating Scale between the Q-ECT and the patient record. Results A total of 179 patient records were received. The strict method of assessment showed an accordance of 89% or higher for all studied variables. The liberal method showed an accordance of 95% or higher. Conclusions We conclude that data on the studied variables in the Q-ECT have high validity. However, limited use of some rating scales makes the results uncertain. Measures can be taken to further improve the data quality.publishedVersio

Hydraulic stimulation strategies in enhanced geothermal systems (EGS) : a review

In enhanced geothermal systems (EGS), the natural permeability of deep rocks is normally not high enough and needs to be increased. Permeability increase can be achieved through various stimulation methods, such as hydraulic, chemical, and thermal stimulation. Among these, hydraulic stimulation is the most commonly used technique to increase both reservoir permeability and the specific area for heat exchange. A comprehensive understanding of the underlying processes towards an optimization of hydraulic stimulation performance while minimizing the potential of unwanted induced seismicity is a critical prerequisite for a successful development of any EGS site. In this paper, we review the hydraulic stimulation strategies that have been developed and implemented for EGS. We begin with a description of the underlying mechanisms through which the permeability and heat exchange area increases are achieved. We then discuss the mechanisms of fluid injection-induced seismicity during and after a hydraulic stimulation operation. After that, alternative hydraulic stimulation strategies, namely conventional hydraulic stimulation, multi-stage fracturing, and cyclic soft stimulation, are reviewed based on current research in theoretical studies as well as, laboratory, and in-situ field experiments. Finally, some representative EGS projects are reviewed, focusing on fluid injection strategies, seismic responses, and reservoir permeability enhancement performance. The review shows the importance and need of (a) a comprehensive geological characterization of the natural fracture system including the nearby fault zones as well as the in-situ stress conditions, prior to the development of the site, (b) a proper design of the well arrangement, such as the positioning of the injection and production wells, and (c) the selection of an appropriate fluid injection strategy for the system at hand

Laulut, lauluääni, piano, op13. Folklåt

Soitinnus: lauluääni, piano.Äänitetty: [25.9.1912, Helsinki, Hotelli Patria].1 teos

Optical Tolerance Analysis of the Multi-Beam Limb Viewing Instrument STEAMR

In this paper, we report on an optical tolerance analysis of the submillimeter atmospheric multi-beam limb sounder, STEAMR. Physical optics and ray-tracing methods were used to quantify and separate errors in beam pointing and distortion due to reflector misalignment and primary reflector surface deformations. Simulations were performed concurrently with the manufacturing of a multi-beam demonstrator of the relay optical system which shapes and images the beams to their corresponding receiver feed horns. Results from Monte Carlo simulations show that the inserts used for reflector mounting should be positioned with an overall accuracy better than 100 μm (~ 1/10 wavelength). Analyses of primary reflector surface deformations show that a deviation of magnitude 100 μm can be tolerable before deployment, whereas the corresponding variations should be less than 30 μm during operation. The most sensitive optical elements in terms of misalignments are found near the focal plane. This localized sensitivity is attributed to the off-axis nature of the beams at this location. Post-assembly mechanical measurements of the reflectors in the demonstrator show that alignment better than 50 μm could be obtained

Optical Tolerance Analysis for the STEAMR Instrument

The optics of the STEAMR instrument is a complex system involving off-axis mirrors designed to achieve precise imaging of the 14 receiver channel beams from the far field to the corresponding feed horns. An initial optical design was generated by Swedish Space Corporation, which laid the framework for the subsequent IAP design that further developed the optical system to meet the mission performance requirements. Omnisys Instruments is now the prime contractor for the complete STEAMR instrument.Although simulations of the optics presently show good results, little is known about the sensitivity to mechanical errors, i.e. surface deviations and misalignments of the reflectors. This work encompasses a tolerance analysis for the complete optics chain consisting of a 28 reflector focal plane array (FPA) and 6 reflector relay optics. With six degrees of freedom for each reflector, the scale of the required mechanical tolerancing analysis is significant. The goal of this work is therefore to identify critical locations within the optics architecture that have the largest influence on performance.Being a multi-beam instrument, the optics requirements for STEAMR can be divided into two parts: pointing and beam quality. Pointing errors were analysed using the commercial software package ZEMAX, which offers built-in routines for performing Monte-Carlo simulations specifically for tolerancing problems. Beam quality, i.e. sidelobe levels, beam efficiency and polarization plane, were analysed using physical optics routines in GRASP. Simulations in both programs have been carried out using single element perturbation and Monte-Carlo simulations on the complete optics chain.In the first iteration of the analysis, all reflector surfaces were assumed to be perfect. In later analyses, surface errors were also added. Special attention was given to the 1.6 m x 0.8 m carbon fiber main reflector, which is the most sensitive in terms of errors in shape. By running the optical analysis in parallel and in close cooperation with the mechanical design, it has been possible to assume realistic errors for the different parts of the optics. Measurements of the feed horns done by IAP show excellent agreement with simulations, where sidelobe levels around -40 dB was predicted. Therefore, the beams of all feeds have been modelled as perfect Gaussians

Optical Tolerance Analysis for the STEAMR Instrument

The optics of the STEAMR instrument is a complex system involving off-axis mirrors designed to achieve precise imaging of the 14 receiver channel beams from the far field to the corresponding feed horns. An initial optical design was generated by Swedish Space Corporation, which laid the framework for the subsequent IAP design that further developed the optical system to meet the mission performance requirements. Omnisys Instruments is now the prime contractor for the complete STEAMR instrument.Although simulations of the optics presently show good results, little is known about the sensitivity to mechanical errors, i.e. surface deviations and misalignments of the reflectors. This work encompasses a tolerance analysis for the complete optics chain consisting of a 28 reflector focal plane array (FPA) and 6 reflector relay optics. With six degrees of freedom for each reflector, the scale of the required mechanical tolerancing analysis is significant. The goal of this work is therefore to identify critical locations within the optics architecture that have the largest influence on performance.Being a multi-beam instrument, the optics requirements for STEAMR can be divided into two parts: pointing and beam quality. Pointing errors were analysed using the commercial software package ZEMAX, which offers built-in routines for performing Monte-Carlo simulations specifically for tolerancing problems. Beam quality, i.e. sidelobe levels, beam efficiency and polarization plane, were analysed using physical optics routines in GRASP. Simulations in both programs have been carried out using single element perturbation and Monte-Carlo simulations on the complete optics chain.In the first iteration of the analysis, all reflector surfaces were assumed to be perfect. In later analyses, surface errors were also added. Special attention was given to the 1.6 m x 0.8 m carbon fiber main reflector, which is the most sensitive in terms of errors in shape. By running the optical analysis in parallel and in close cooperation with the mechanical design, it has been possible to assume realistic errors for the different parts of the optics. Measurements of the feed horns done by IAP show excellent agreement with simulations, where sidelobe levels around -40 dB was predicted. Therefore, the beams of all feeds have been modelled as perfect Gaussians

Lithium for suicide and readmission prevention after electroconvulsive therapy for unipolar depression: population-based register study

Background Electroconvulsive therapy (ECT) is effective for unipolar depression but relapse and suicide are significant challenges. Lithium could potentially lower these risks, but is used only in a minority of patients. Aims This study quantifies the effect of lithium on risk of suicide and readmission and identifies factors that are associate with readmission and suicide. Method This population-based register study used data from the Swedish National Quality Register for ECT and other Swedish national registers. Patients who have received ECT for unipolar depression as in-patients between 2011 and 2016 were followed until death, readmission to hospital or the termination of the study at the end of 2016. Cox regression was used to estimate hazard ratios (HR) of readmission and suicide in adjusted models. Results Out of 7350 patients, 56 died by suicide and 4203 were readmitted. Lithium was prescribed to 638 (9%) patients. Mean follow-up was 1.4 years. Lithium was significantly associated with lower risk of suicide (P = 0.014) and readmission (HR 0.84 95% CI 0.75-0.93). The number needed to be treated with lithium to prevent one readmission was 16. In addition, the following factors were statistically associated with suicide: male gender, being a widow, substance use disorder and a history of suicide attempts. Readmission was associated with young age, being divorced or unemployed, comorbid anxiety disorder, nonpsychotic depression, more severe symptoms before ECT, no improvement with ECT, not receiving continuation ECT or antidepressants, usage of antipsychotics, anxiolytics or benzodiazepines, severity of medication resistance and number of previous admissions. Conclusions More patients could benefit from lithium treatment

The Incidence of Dental Fracturing in Electroconvulsive Therapy in Sweden

Objectives  One adverse effect of electroconvulsive therapy (ECT) is dental fracture; thus, a bite guard and muscle relaxants are used to prevent it. Earlier research reported varying rates of dental fracture, but there is no large-scale study on the incidence of dental fracture during ECT. This study aimed to examine the incidence of dental fracture during ECT and to investigate whether the incidence differs between different sexes, age groups, diagnosis groups, electrode placements, or number of treatment sessions. Methods  This register-based study used data from the Swedish national quality register for ECT. All hospitals offering ECT report to this register, and the coverage ratio is about 90%. All registered patients who started an ECT series between January 2012 and January 2019 were included in this study, with the data representing 16,681 individuals, 38,862 series, and 254,906 sessions. Results  Forty-six dental fractures were identified, giving an incidence of dental fracture of 0.2% per series, 0.02% per session, and 0.3% per individual. We did not find any significant associations between dental fracture rates and male or female populations, age, or different diagnosis groups, nor was there any significant difference between dental fracture rates and electrode placement. The mean number of treatments was significantly higher in the dental fracture group than in patients without dental fracture. Conclusions  There is a minimal risk of dental fracture during ECT. Our findings, together with those of other studies, provide further motivation for the use of a bite guard and muscle relaxant

The incidence of dental fracturing in electroconvulsive therapy in Sweden

Objectives: One adverse effect of electroconvulsive therapy (ECT) is dental fracture; thus, a bite guard and muscle relaxants are used to prevent it. Earlier research reported varying rates of dental fracture, but there is no large-scale study on the incidence of dental fracture during ECT. This study aimed to examine the incidence of dental fracture during ECT and to investigate whether the incidence differs between different sexes, age groups, diagnosis groups, electrode placements, or number of treatment sessions. Methods: This register-based study used data from the Swedish national quality register for ECT. All hospitals offering ECT report to this register, and the coverage ratio is about 90%. All registered patients who started an ECT series between January 2012 and January 2019 were included in this study, with the data representing 16,681 individuals, 38,862 series, and 254,906 sessions. Results: Forty-six dental fractures were identified, giving an incidence of dental fracture of 0.2% per series, 0.02% per session, and 0.3% per individual. We did not find any significant associations between dental fracture rates and male or female populations, age, or different diagnosis groups, nor was there any significant difference between dental fracture rates and electrode placement. The mean number of treatments was significantly higher in the dental fracture group than in patients without dental fracture. Conclusions: There is a minimal risk of dental fracture during ECT. Our findings, together with those of other studies, provide further motivation for the use of a bite guard and muscle relaxant