Maintaining social capital in offenders with schizophrenia spectrum disorder—An explorative analysis of influential factors

The importance of “social capital” in offender rehabilitation has been well established: Stable family and community relationships offer practical assistance in the resettlement process after being released from custody and can serve as motivation for building a new sense of self off the criminal past, thus reducing the risk of re-offending. This also applies to offenders with severe mental disorders. The aim of this study was to identify factors that promote or hinder the establishment or maintenance of social relationships upon release from a court-ordered inpatient treatment using a modern statistical method—machine learning (ML)—on a dataset of 369 offenders with schizophrenia spectrum disorder (SSD). With an AUC of 0.73, support vector machines (SVM) outperformed all the other ML algorithms. The following factors were identified as most important for the outcome in respect of a successful re-integration into society: Social integration and living situation prior to the hospitalization, a low risk of re-offending at time of discharge from the institution, insight in the wrongfulness of the offense as well as into the underlying psychiatric illness and need for treatment, addressing future perspectives in psychotherapy, the improvement of antisocial behavior during treatment as well as a detention period of less than 1 year emerged as the most predictive out of over 500 variables in distinguishing patients who had a social network after discharge from those who did not. Surprisingly, neither severity and type of offense nor severity of the psychiatric illness proved to affect whether the patient had social contacts upon discharge or not. The fact that the majority of determinants which promote the maintenance of social contacts can be influenced by therapeutic interventions emphasizes the importance of the rehabilitative approach in forensic-psychiatric therapy

Advantages of Machine Learning in Forensic Psychiatric Research—Uncovering the Complexities of Aggressive Behavior in Schizophrenia

Linear statistical methods may not be suited to the understanding of psychiatric phenomena such as aggression due to their complexity and multifactorial origins. Here, the application of machine learning (ML) algorithms offers the possibility of analyzing a large number of influencing factors and their interactions. This study aimed to explore inpatient aggression in offender patients with schizophrenia spectrum disorders (SSDs) using a suitable ML model on a dataset of 370 patients. With a balanced accuracy of 77.6% and an AUC of 0.87, support vector machines (SVM) outperformed all the other ML algorithms. Negative behavior toward other patients, the breaking of ward rules, the PANSS score at admission as well as poor impulse control and impulsivity emerged as the most predictive variables in distinguishing aggressive from non-aggressive patients. The present study serves as an example of the practical use of ML in forensic psychiatric research regarding the complex interplay between the factors contributing to aggressive behavior in SSD. Through its application, it could be shown that mental illness and the antisocial behavior associated with it outweighed other predictors. The fact that SSD is also highly associated with antisocial behavior emphasizes the importance of early detection and sufficient treatment

Operatives Outcome und perioperative Morbidität nach intensivierter neoadjuvanter Chemotherapie mit FLOT-Schema bei gastroösophagealen Karzinomen

Beim Magenkarzinom handelt es sich um eine vergleichsweise häufige Krebserkrankung mit nach wie vor schlechter Prognose. Die aktuelle 5-Jahres-Überlebensrate liegt in Deutschland bei kaum mehr als 30%. Die Entwicklung neuer Ansätze und die Optimierung bestehender Therapieoptionen sind daher von großer Wichtigkeit. Goldstandard ist derzeit ein multimodales Konzept: Die MAGIC Studie ebnete 2006 den Weg für die perioperative Chemotherapie. Bei der Wahl eines neoadjuvanten Schemas haben sich aufgrund guter Ansprechraten Kombinationstherapien mit 5-FU und Platinderivaten etabliert. Durch Zugabe von Docetaxel lässt sich die Ansprechrate erhöhen sowie das Gesamtüberleben und progressionsfreie Intervall verlängern – wenngleich auch nicht ohne eine gesteigerte Chemotoxizität. Als Konsequenz wurde im sogenannten FLOT-Schema 5-FU, Docetaxel und Oxaliplatin mit Leucovorin kombiniert, was sich als wirksames und vergleichsweise sicheres Protokoll erwies. Die Durchführung einer adjuvanten Chemotherapie hingegen gestaltet sich oft schwierig. Häufige Gründe hierfür sind ein unerwarteter postoperativer Krankheitsprogress, Tod des Patienten oder schwerere postoperative Komplikationen, die die Durchführung einer Chemotherapie unmöglich machen. Aus diesem Grund empfiehlt die aktuelle Leitlinie, den Behandlungsfokus bei fortgeschrittenen Tumoren auf den neoadjuvanten Therapieabschnitt zu legen. Schulz et al. erläuterten bereits Durchführbarkeit und Wirksamkeit der auf 6 Zyklen verlängerten Docetaxel-basierten neoadjuvanten Chemotherapie (NeoFLOT) als intensiviertes Regime bei Patienten mit Adenokarzinomen des Magens und des gastroösophagealen Übergangs. In unserer retrospektiv angelegten Studie untersuchten wir nun, ob sich die Toxizität eines intensivierten neoadjuvanten Chemotherapieregimes negativ auf den postoperativen Verlauf auswirkt. Zu diesem Zweck wurden Daten von 540 Patienten mit Magenkarzinom erhoben und die Patienten in drei Gruppen eingeteilt (ChT mit NeoFLOT, ChT mit Standardschema oder primär operativ). Bezüglich klassischer Gastrektomiekomplikationen wie Anastomosenleck, Abszess- und Fistelbildung, Nachblutung oder Ileus erwies sich die prolongierte Chemotherapie als sicheres Regime. Allerdings bestand im NeoFLOT-Kollektiv etwa nahezu achtmal so häufig Bedarf für Bluttransfusionen gegenüber der Standardggruppe, außerdem zeigte sich ein Trend zu häufigeren Lymphfisteln als in den Vergleichsgruppen. Dementsprechend erwies sich die NeoFLOT-Therapie als durchführbare Behandlungsoption ohne Zunahme der allgemeinen perioperativen Morbidität und Mortalität, dafür aber mit dem positiven Effekt einer erhöhten R0-Resektionsrate. Die Notwendigkeit einer Bluttransfusion erscheint jedoch in der Folge wahrscheinlicher. Das NeoFLOT-Regime ist dementsprechend gegebenenfalls nicht für alle Patienten gleich gut geeignet. Behandler sollten sich der möglicherweise auftretenden Transfusionspflichtigkeit bewusst sein und sorgfältig vorbestehende Risikofaktoren eines Patienten eruieren, zum Beispiel das Vorliegen präoperativer Anämien oder Blutgerinnungsstörungen. In mehreren Studien wurde bereits der negative Effekt perioperativer Bluttransfusionen auf den postoperativen Heilungsverlauf, das Gesamtüberleben und die Rezidivbildung diskutiert. Zwar konnte mit der hier vorliegenden Studie gezeigt werden, dass die NeoFLOT-Patienten häufiger einer Bluttransfusion bedurften, eine eindeutige Kausalität konnte allerdings nicht gezeigt werden. Um unser Ergebnis zu verifizieren und mögliche Verzerreffekte zu minimieren, empfiehlt sich ein direkter Vergleich in einem randomisiert, prospektiven Setting

Offenders and non-offenders with schizophrenia spectrum disorders: the crime-preventive potential of sufficient embedment in the mental healthcare and support system

Background: Suffering from schizophrenia spectrum disorder (SSD) has been well-established as a risk factor for offending. However, the majority of patients with an SSD do not show aggressive or criminal behavior. Yet, there is little research on clinical key features distinguishing offender from non-offender patients. Previous results point to poorer impulse control, higher levels of excitement, tension, and hostility, and worse overall cognitive functioning in offender populations. This study aimed to detect the most indicative distinguishing clinical features between forensic and general psychiatric patients with SSD based on the course of illness and the referenced hospitalization in order to facilitate a better understanding of the relationship between violent and non-violent offenses and SSD. Methods: Our study population consisted of forensic psychiatric patients (FPPs) with a diagnosis of F2x (ICD-10) or 295.x (ICD-9) and a control group of general psychiatric patients (GPPs) with the same diagnosis, totaling 740 patients. Patients were evaluated regarding their medical (and, if applicable, criminal) history and the referenced psychiatric hospitalization. Supervised machine learning (ML) was used to exploratively evaluate predictor variables and their interplay and rank them in accordance with their discriminative power. Results: Out of 194 possible predictor variables, the following 6 turned out to have the highest influence on the model: olanzapine equivalent at discharge from the referenced hospitalization, a history of antipsychotic prescription, a history of antidepressant, benzodiazepine or mood stabilizer prescription, medication compliance, outpatient treatment(s) in the past, and the necessity of compulsory measures. Out of the seven algorithms applied, gradient boosting emerged as the most suitable, with an AUC of 0.86 and a balanced accuracy of 77.5%. Discussion: Our study aimed to identify the most influential illness-related predictors, distinguishing between FPP and GPP with SSD, thus shedding light on key differences between the two groups. To our knowledge, this is the first study to compare a homogenous sample of FPP and GPP with SSD regarding their symptom severity and course of illness using highly sophisticated statistical approaches with the possibility of evaluating the interplay of all factors at play

Is conditioned pain modulation (CPM) affected by negative emotional state?

Background Conditioned pain modulation (CPM) is an experimental paradigm, which describes the inhibition of responses to a noxious or strong-innocuous stimulus, the test stimulus (TS), by the additional application of a second noxious or strong-innocuous stimulus, the conditioning stimulus (CS). As inadequate CPM efficiency has been assumed to be predisposing for clinical pain, the search for moderating factors explaining inter-individual variations in CPM is ongoing. Psychological factors have received credits in this context. However, research concerning associations between CPM and trait factors relating to negative emotions has yielded disappointing results. Yet, the influence of anxious or fearful states on CPM has not attracted much interest despite ample evidence that negative affective states enhance pain. Our study aimed at investigating the effect of fear induction by symbolic threat on CPM. Methods Thirty-seven healthy participants completed two experimental blocks: one presenting aversive pictures showing burn wounds (high-threat block) and one presenting neutral pictures (low-threat block). Both blocks contained a CPM paradigm with contact heat as TS and hot water as CS; subjective numerical ratings as well as contact-heat evoked potentials (CHEPs) were assessed. Results We detected an overall inhibitory CPM effect for CHEPs amplitudes but not for pain ratings. However, we found no evidence for a modulation of CPM by threat despite threat ratings indicating that our manipulation was successful. Discussion These results suggest that heat/thermal CPM is resistant to this specific type of symbolic threat induction and further research is necessary to examine whether it is resistant to fearful states in general. Significance The attempt of modulating heat conditioned pain modulation (CPM) by emotional threat (fear/anxiety state) failed. Thus, heat CPM inhibition again appeared resistant to emotional influences. Pain-related brain potentials proved to be more sensitive for CPM effects than subjective ratings

Kinetics of Martensite Decomposition and Microstructure Stability of Ti-6246 during Rapid Heating to Service Temperatures

The aerospace alloy Ti-6246 was subjected to inductive heat treatments with high heating and quenching rates (up to 1500 K/s) while being applied to an in situ diffraction study at the HEMS beamline P07B at DESY. Thereby, the characterization of the emerging phases was possible at any point in the process. The heat treatment schedules include the preparation of Ti-6246 samples by means of a homogenization treatment and subsequent quenching to trigger α″-martensite formation. In order to simulate fast reheating within the scope of application, the samples were reheated to the upper range of possible service temperatures (550–650 °C) with a heating rate of 100 K/s. In a second heat treatment design, the homogenized and quenched sample state was exposed to high-temperature tempering at 840 °C, which aims for the elimination of α″. Again, fast reheating to the same service temperatures was executed. With the aim of this approach, the stability of the microstructure consisting of α-Ti, β-Ti and α″-martensite was characterized. Further, the martensite decomposition path was analyzed. It shows a two-tier nature, firstly approaching the bcc β-unit cell in the low-temperature range (<400 °C) but subsequently transforming into an hcp-like unit cell and later on into equilibrium α-Ti

Mimicking CHO large‐scale effects in the single multicompartment bioreactor : a new approach to access scale‐up behavior

During the scale‐up of biopharmaceutical production processes, insufficiently predictable performance losses may occur alongside gradients and heterogeneities. To overcome such performance losses, tools are required to explain, predict, and ultimately prohibit inconsistencies between laboratory and commercial scale. In this work, we performed CHO fed‐batch cultivations in the single multicompartment bioreactor (SMCB), a new scale‐down reactor system that offers new access to study large‐scale heterogeneities in mammalian cell cultures. At volumetric power inputs of 20.4-1.5 W m-3, large‐scale characteristics like long mixing times and dissolved oxygen (DO) heterogeneities were mimicked in the SMCB. Compared to a reference bioreactor (REFB) set‐up, the conditions in the SMCB provoked an increase in lactate accumulation of up to 87%, an increased glucose uptake, and reduced viable cell concentrations in the stationary phase. All are characteristic for large‐scale performance. The unique possibility to distinguish between the effects of changing power inputs and observed heterogeneities provided new insights into the potential reasons for altered product quality attributes. Apparently, the degree of galactosylation in the evaluated glycan patterns changed primarily due to the different power inputs rather than the provoked heterogeneities. The SMCB system could serve as a potent tool to provide new insights into scale‐up behavior and to predict cell line‐specific drawbacks at an early stage of process development.Deutsche ForschungsgemeinschaftGerman Research Foundation (DFG

Ion mobility spectrometry for microbial volatile organic compounds: a new identification tool for human pathogenic bacteria

Presently, 2 to 4 days elapse between sampling at infection suspicion and result of microbial diagnostics. This delay for the identification of pathogens causes quite often a late and/or inappropriate initiation of therapy for patients suffering from infections. Bad outcome and high hospitalization costs are the consequences of these currently existing limited pathogen identification possibilities. For this reason, we aimed to apply the innovative method multi-capillary column–ion mobility spectrometry (MCC-IMS) for a fast identification of human pathogenic bacteria by determination of their characteristic volatile metabolomes. We determined volatile organic compound (VOC) patterns in headspace of 15 human pathogenic bacteria, which were grown for 24 h on Columbia blood agar plates. Besides MCC-IMS determination, we also used thermal desorption–gas chromatography–mass spectrometry measurements to confirm and evaluate obtained MCC-IMS data and if possible to assign volatile compounds to unknown MCC-IMS signals. Up to 21 specific signals have been determined by MCC-IMS for Proteus mirabilis possessing the most VOCs of all investigated strains. Of particular importance is the result that all investigated strains showed different VOC patterns by MCC-IMS using positive and negative ion mode for every single strain. Thus, the discrimination of investigated bacteria is possible by detection of their volatile organic compounds in the chosen experimental setup with the fast and cost-effective method MCC-IMS. In a hospital routine, this method could enable the identification of pathogens already after 24 h with the consequence that a specific therapy could be initiated significantly earlier

Can we forecast poor outcome in herpes simplex and varicella zoster encephalitis? A narrative review

Herpes simplex virus (HSV) and varicella zoster virus (VZV) are among the most commonly diagnosed infectious causes of sporadic encephalitis worldwide. Despite treatment, mortality and morbidity rates remain high, especially for HSV encephalitis. This review is intended to provide an overview of the existing scientific literature on this topic from the perspective of a clinician who is confronted with serious decisions about continuation or withdrawal of therapeutic interventions. We performed a literature review searching two databases and included 55 studies in the review. These studies documented or investigated specifically outcome and predictive parameters of outcome of HSV and/or VZV encephalitis. Two reviewers independently screened and reviewed full-text articles meeting the inclusion criteria. Key data were extracted and presented as a narrative summary. Both, HSV and VZV encephalitis have mortality rates between 5 and 20% and complete recovery rates range from 14 to 43% for HSV and 33 to 49% for VZV encephalitis. Prognostic factors for both VZV and HSV encephalitis are older age and comorbidity, as well as severity of disease and extent of magnetic resonance imaging (MRI) lesions on admission, and delay in treatment initiation for HSV encephalitis. Although numerous studies are available, the main limiting factors are the inconsistent patient selection and case definitions as well as the non-standardised outcome measures, which hampers the comparability of the studies. Therefore, larger and standardised observational studies applying validated case definitions and outcome measures including quality of life assessment are required to provide solid evidence to answer the research question