Resting-state functional connectivity predicting clinical improvement following treatment in female adolescents with non-suicidal self-injury.

BACKGROUND Non-suicidal self-injury (NSSI) is highly prevalent among adolescents and predicts future psychopathology including suicide. To improve therapeutic decisions and clinical outcome of patients engaging in NSSI, it seems beneficial to determine neurobiological markers associated with treatment response. The present study investigated whether resting-state functional brain connectivity (RSFC) served to predict clinical improvements following treatment in adolescents engaging in NSSI. METHODS N = 27 female adolescents with NSSI took part in a baseline MRI exam and clinical outcome was assessed at follow-ups one, two and three years after baseline. During the follow-up period, patients received in- and/or outpatient treatment. Mixed-effects linear regression models were calculated to examine whether RSFC was associated with clinical improvement. RESULTS Patients' clinical outcome improved across time. Lower baseline RSFC between left paracentral gyrus and right anterior cingulate gyrus was associated with clinical improvement from baseline to one-year and from two-year to three-year follow-up. Lower and higher baseline RSFC in several inter- and intrahemispheric cortico-cortical and cortico-subcortical connections of interest were associated with clinical symptomatology and its severity, independent from time. LIMITATIONS A relatively small sample size constrains the generalizability of our findings. Further, no control group not receiving treatment was recruited, therefore clinical changes across time cannot solely be attributed to treatment. CONCLUSIONS While there was some evidence that RSFC was associated with clinical improvement following treatment, our findings suggest that functional connectivity is more predictive of severity of psychopathology and global functioning independent of time and treatment. We thereby add to the limited research on neurobiological markers as predictors of clinical outcome after treatment

Stability of Drugs Stored in Helicopters for Use by Emergency Medical Services: A Prospective Observational Study.

STUDY OBJECTIVE Drugs stored in rescue helicopters may be subject to extreme environmental conditions. The aim of this study was to measure whether drugs stored under the real-life conditions of a Swiss helicopter emergency medical service (HEMS) would retain their potency over the course of 1 year. METHODS A prospective, longitudinal study measuring the temperature exposure and concentration of drugs stored on 2 rescue helicopters in Switzerland over 1 year. The study drugs included epinephrine, norepinephrine, amiodarone, midazolam, fentanyl, naloxone, rocuronium, etomidate, and ketamine. Temperatures were measured inside the medication storage bags and the crew cabins at 10-minute intervals. Drug stability was measured on a monthly basis over the course of 12 months using high-performance liquid chromatography. The medications were considered stable at a minimum remaining drug concentration of 90% of the label claim. RESULTS Temperatures ranged from -1.2 °C to 38.1 °C (29.84 °F to 100.58 °F) inside the drug storage bags. Of all the temperature measurements inside the drug storage bags, 37% lay outside the recommended storage conditions. All drugs maintained a concentration above 90% of the label claim. The observation periods for rocuronium and etomidate were shortened to 7 months because of a supply shortage of reference samples. CONCLUSION Drugs stored under the real-life conditions of Swiss HEMS are subjected to temperatures outside the manufacturer's approved storage requirements. Despite this, all drugs stored under these conditions remained stable throughout our study. Real-life stability testing could be a way to extend drug exchange intervals

Sextiques rationelles nodales dans le plan projectif réel

This thesis studies nodal sextics (algebraic curves of degree six), and in particular rational sextics, in the real projective plane. Two such sextics with k nodes are called rigidly isotopic if they can be joined by a path in the space of real nodal sextics with k nodes. The main result of the first part of the thesis is a rigid isotopy classification of real nodal sextics without real nodes, generalizing Nikulin’s classification of non-singular sextics. In the second part we study sextics with real nodes and we describe the rigid isotopy classes of such sextics in the case where the sextics are dividing, i.e., their real part separates the complexification (the set of complex points) into two halves. As a main application, we give a rigid isotopy classification for those nodal real rational sextics which can be perturbed to maximal or next-to-maximal sextics in the sense of Harnack’s inequality. Our approach is based on the study of periods of K3 surfaces, drawing on the Global Torelli Theorem by Piatetski-Shapiro and Shafarevich and Kulikov’s surjectivity theorem, as well as Nikulin’s results on symmetric integral bilinear forms.Cette thèse est consacrée à l’étude des courbes sextiques nodales, et en particulier des sextiques rationnelles, dans le plan projectif réel. Deux sextiques nodales réelles ayant k points doubles sont dites rigidement isotopes si elles peuvent être reliées par un chemin dans l’espace des sextiques nodales réelles ayant k points doubles. Le résultat principal de la première partie de la thèse donne une classification à isotopie rigide près des sextiques nodales irréductibles sans points doubles réels, généralisant la classification des sextiques non-singulières obtenue par Nikulin. La seconde partie porte sur les sextiques ayant des points doubles réels : une classification est obtenue pour les sextiques nodales séparantes, c’est-à-dire celles dont la partie réelle sépare leur complexification (l’ensemble des points complexes) en deux composantes connexes. Ce résultat est appliqué au cas des sextiques rationnelles réelles pouvant être perturbées en des sextiques maximales ou presque maximales (dans le sens de l’inégalité de Harnack). L’approche retenue repose sur l’étude des périodes des surfaces K3, se basant notamment sur le Théorème de Torelli Global de Piatetski-Shapiro et Shafarevich et le Théorème de Surjectivité de Kulikov, ainsi que sur les résultats de Nikulin portant sur les formes bilinéaires symétriques intégrales

Nodal rational sextics in the real projective plane

This thesis studies nodal sextics (algebraic curves of degree six), and in particular rational sextics, in the real projective plane. Two such sextics with k nodes are callled rigidly isotopic if they can be joined by a path in the space of real nodal sextics with k nodes. The main result of the first part of the thesis is a rigid isotopy classification of real nodal sextics without real nodes, generalizing Nikulin's classification of non-singular sextics. In the second part we study sextics with real nodes and we describe the rigid isotopy classes of such sextics in the case where the sextics are dividing, i.e., their real part separates the complexifcation (the set of complex points) into two halves. As a main application, we give a rigid isotopy classification for those nodal real rational sextics which can be perturbed to maximal or next-to-maximal sextics in the sense of Harnack's inequality

Pain sensitivity as a state marker and predictor for adolescent non-suicidal self-injury.

BACKGROUND The pain analgesia hypothesis suggests that reduced pain sensitivity (PS) is a specific risk factor for the engagement in non-suicidal self-injury (NSSI). Consistent with this, several studies found reduced PS in adults as well as adolescents with NSSI. Cross-sectional studies in adults with borderline personality disorder (BPD) suggest that PS may (partially) normalize after remission or reduction of BPD symptoms. The objective of the present study was to investigate the development of PS over 1 year in a sample of adolescents with NSSI and to investigate whether PS at baseline predicts longitudinal change in NSSI. METHODS N = 66 adolescents who underwent specialized treatment for NSSI disorder participated in baseline and 1-year follow-up assessments, including heat pain stimulation for the measurement of pain threshold and tolerance. Associations between PS and NSSI as well as BPD and depressive symptoms were examined using negative binomial, logistic, and linear regression analyses. RESULTS We found that a decrease in pain threshold over time was associated with reduced NSSI (incident rate ratio = 2.04, p = 0.047) and that higher pain tolerance at baseline predicted lower probability for NSSI (odds ratio = 0.42, p = 0.016) 1 year later. However, the latter effect did not survive Holm correction (p = 0.059). No associations between PS and BPD or depressive symptoms were observed. CONCLUSION Our findings suggest that pain threshold might normalize with a decrease in NSSI frequency and could thus serve as a state marker for NSSI

Brief Psychotherapeutic Intervention Compared with Treatment as Usual for Adolescents with Nonsuicidal Self-Injury: Outcomes over a 2-4-Year Follow-Up.

INTRODUCTION The "Cutting Down Programme" (CDP), a brief psychotherapeutic intervention for treating nonsuicidal self-injury (NSSI) in adolescents, was comparable to high-quality treatment as usual (TAU) in a previous randomized controlled trial (RCT). OBJECTIVE The aim of the study was to evaluate the long-term outcomes of the CDP over up to 4 years. METHODS Assessments of NSSI, suicide attempts, borderline personality disorder (BPD), depression, and quality of life took place 2 to 4 years (T3) after enrollment in a RCT. The evolution of NSSI, suicide attempts, depression, and quality of life was analyzed using (generalized) linear mixed-effects models. Ordered logistic regression was used for analyzing BPD diagnoses. Data from T0, T2, and T3 are reported. RESULTS Out of 74 patients, 70 (95%) were included in the T3 assessment. The frequency of NSSI events alongside with suicide attempts and depression further decreased between T2 and T3 and BPD between T0 and T3 in both groups. Quality of life remained stable in both groups between T2 and T3. Both groups received substantial but comparable additional treatment between T2 and T3. More treatment sessions during the follow-up period were linked to larger improvements of NSSI. CONCLUSIONS The CDP was found to be as effective as TAU in promoting recovery from NSSI and comorbid symptoms in the long term. Results suggest that treatment effects from a brief psychotherapeutic intervention may endure and even further improve after completion of the program. However, additional treatment seems to improve chances for recovery independent from CDP versus TAU