Accuracy of telepsychiatric assessment of new routine outpatient referrals

<p>Abstract</p> <p>Background</p> <p>Studies on the feasibility of telepsychiatry tend to concentrate only on a subset of clinical parameters. In contrast, this study utilises data from a comprehensive assessment. The main objective of this study is to compare the accuracy of findings from telepsychiatry with those from face to face interviews.</p> <p>Method</p> <p>This is a primary, cross-sectional, single-cluster, balanced crossover, blind study involving new routine psychiatric referrals. Thirty-seven out of forty cases fulfilling the selection criteria went through a complete set of independent face to face and video assessments by the researchers who were blind to each other's findings.</p> <p>Results</p> <p>The accuracy ratio of the pooled results for DSM-IV diagnoses, risk assessment, non-drug and drug interventions were all above 0.76, and the combined overall accuracy ratio was 0.81. There were substantial intermethod agreements for Cohen's kappa on all the major components of evaluation except on the Risk Assessment Scale where there was only weak agreement.</p> <p>Conclusion</p> <p>Telepsychiatric assessment is a dependable method of assessment with a high degree of accuracy and substantial overall intermethod agreement when compared with standard face to face interview for new routine outpatient psychiatric referrals.</p

Structural brain abnormalities in the common epilepsies assessed in a worldwide ENIGMA study

Progressive functional decline in the epilepsies is largely unexplained. We formed the ENIGMA-Epilepsy consortium to understand factors that influence brain measures in epilepsy, pooling data from 24 research centres in 14 countries across Europe, North and South America, Asia, and Australia. Structural brain measures were extracted from MRI brain scans across 2149 individuals with epilepsy, divided into four epilepsy subgroups including idiopathic generalized epilepsies (n =367), mesial temporal lobe epilepsies with hippocampal sclerosis (MTLE; left, n = 415; right, n = 339), and all other epilepsies in aggregate (n = 1026), and compared to 1727 matched healthy controls. We ranked brain structures in order of greatest differences between patients and controls, by meta-analysing effect sizes across 16 subcortical and 68 cortical brain regions. We also tested effects of duration of disease, age at onset, and age-by-diagnosis interactions on structural measures. We observed widespread patterns of altered subcortical volume and reduced cortical grey matter thickness. Compared to controls, all epilepsy groups showed lower volume in the right thalamus (Cohen's d = -0.24 to -0.73; P < 1.49 × 10-4), and lower thickness in the precentral gyri bilaterally (d = -0.34 to -0.52; P < 4.31 × 10-6). Both MTLE subgroups showed profound volume reduction in the ipsilateral hippocampus (d = -1.73 to -1.91, P < 1.4 × 10-19), and lower thickness in extrahippocampal cortical regions, including the precentral and paracentral gyri, compared to controls (d = -0.36 to -0.52; P < 1.49 × 10-4). Thickness differences of the ipsilateral temporopolar, parahippocampal, entorhinal, and fusiform gyri, contralateral pars triangularis, and bilateral precuneus, superior frontal and caudal middle frontal gyri were observed in left, but not right, MTLE (d = -0.29 to -0.54; P < 1.49 × 10-4). Contrastingly, thickness differences of the ipsilateral pars opercularis, and contralateral transverse temporal gyrus, were observed in right, but not left, MTLE (d = -0.27 to -0.51; P < 1.49 × 10-4). Lower subcortical volume and cortical thickness associated with a longer duration of epilepsy in the all-epilepsies, all-other-epilepsies, and right MTLE groups (beta, b < -0.0018; P < 1.49 × 10-4). In the largest neuroimaging study of epilepsy to date, we provide information on the common epilepsies that could not be realistically acquired in any other way. Our study provides a robust ranking of brain measures that can be further targeted for study in genetic and neuropathological studies. This worldwide initiative identifies patterns of shared grey matter reduction across epilepsy syndromes, and distinctive abnormalities between epilepsy syndromes, which inform our understanding of epilepsy as a network disorder, and indicate that certain epilepsy syndromes involve more widespread structural compromise than previously assumed

A systems-level analysis highlights microglial activation as a modifying factor in common epilepsies

Aims: The causes of distinct patterns of reduced cortical thickness in the common human epilepsies, detectable on neuroimaging and with important clinical consequences, are unknown. We investigated the underlying mechanisms of cortical thinning using a systems-level analysis. // Methods: Imaging-based cortical structural maps from a large-scale epilepsy neuroimaging study were overlaid with highly spatially resolved human brain gene expression data from the Allen Human Brain Atlas. Cell-type deconvolution, differential expression analysis and cell-type enrichment analyses were used to identify differences in cell-type distribution. These differences were followed up in post-mortem brain tissue from humans with epilepsy using Iba1 immunolabelling. Furthermore, to investigate a causal effect in cortical thinning, cell-type specific depletion was used in a murine model of acquired epilepsy. // Results: We identified elevated fractions of microglia and endothelial cells in regions of reduced cortical thickness. Differentially expressed genes showed enrichment for microglial markers, and in particular, activated microglial states. Analysis of post-mortem brain tissue from humans with epilepsy confirmed excess activated microglia. In the murine model, transient depletion of activated microglia during the early phase of the disease development prevented cortical thinning and neuronal cell loss in the temporal cortex. Although the development of chronic seizures was unaffected, the epileptic mice with early depletion of activated microglia did not develop deficits in a non-spatial memory test seen in epileptic mice not depleted of microglia. // Conclusions: These convergent data strongly implicate activated microglia in cortical thinning, representing a new dimension for concern and disease modification in the epilepsies, potentially distinct from seizure control

On Human Terms – A First Evaluation of a Massive Open Online Course (MOOC) in Ergonomics

The Massive Open Online Course (MOOC) ‘Work and Technology on Human Terms’ (www.onhumanterms.org ) was launched in July 2017 with the aim to contribute to safer and healthier workplaces by increasing the knowledge about how products, systems, and work organizations can be designed on human terms. The purpose of this paper is to present the results of a first evaluation of the MOOC. The online course was used in four different university courses in Ergonomics in Sweden, two given at Chalmers University of Technology in Gothenburg and two given at Link\uf6ping University. The MOOC material was used in different ways in the courses: (1) suggested voluntary, alternative material for the students’ self-studies, (2) scheduled activity for self-studies with appointed chapters, and (3) mandatory, selected course material being discussed in follow-up seminars. Data for the evaluation was collected through questionnaires and semi-structured interviews with students and teachers. The results showed that the MOOC served as a repetition of lectured material and gave increased understanding of the theories. The recorded interviews with practitioners and researchers in the MOOC highlighted the importance of the subject in real working life. The knowledge tests were appreciated as rehearsal of understanding. However, the MOOC in parallel with the other course material was also considered to be too much work by some students. A recommendation is to carefully consider how to use and integrate the MOOC as a meaningful, individual, theoretical learning activity for the students. Thereby the lectures in classroom could focus more on discussions and problem-solving regarding the topics and less on basic theory

Interannual variability of cut-off low systems over the European sector: The role of blocking and the Northern Hemisphere circulation modes

An earlier developed multidecadal database of Northern Hemisphere cut-off low systems (COLs), covering a 41 years period (from 1958 to 1998) is used to study COLs interannual variability in the European sector (25 degrees-47.5 degrees N, 50 degrees W-40 degrees E) and the major factors controlling it. The study focus on the influence on COLs interannual variability, of larger scale phenomena such as blocking events and other main circulation modes defined over the Euro-Atlantic region. It is shown that there is a very large interannual variability in the COLs occurrence at the annual and seasonal scales, although without significant trends. The influence of larger scale phenomena is seasonal dependent, with the positive phase of the NAO favoring autumn COL development, while winter COL occurrence is mostly related to blocking events. During summer, the season when more COLs occur, no significant influences were found

Shell evolution approaching the N = 20 island of inversion: Structure of 26Na

The levels in 26Na with single particle character have been observed for the first time using the d(25Na, pγ ) reaction at 5 MeV/nucleon. The measured excitation energies and the deduced spectroscopic factors are in good overall agreement with (0+1)ħω(0+1)ħω shell model calculations performed in a complete spsdfpspsdfp basis and incorporating a reduction in the N=20 gapN=20 gap. Notably, the 1p3/21p3/2 neutron configuration was found to play an enhanced role in the structure of the low-lying negative parity states in 26Na, compared to the isotone 28Al. Thus, the lowering of the 1p3/21p3/2 orbital relative to the 0f7/20f7/2 occurring in the neighbouring Z=10Z=10 and 12 nuclei – 25,27Ne and 27,29Mg – is seen also to occur at Z=11Z=11 and further strengthens the constraints on the modelling of the transition into the island of inversion

STRUCTURE OF Na-26 VIA A NOVEL TECHNIQUE USING (d, p gamma) WITH A RADIOACTIVE Na-25 BEAM

States in 26Na were populated in the (d, pγ) reaction, induced by bombarding deuterium target nuclei with an intense reaccelerated beam of 25Na ions from the ISAC2 accelerator at TRIUMF. Gamma-rays were recorded in coincidence with protons and used to extract differential cross sections for 21 states up to the neutron decay threshold of 5 MeV. Results for levels below 3 MeV are discussed in detail and compared with shell model calculations and with previous work. The angular distributions of decay gamma-rays were measured for individual states and are compared to theoretically calculated distributions, highlighting some issues for future work

Towards Na via (d,p) with SHARC and TIGRESS and a novel zero-degree detector

Nucleon transfer experiments have in recent years begun to be exploited in the study of nuclei far from stability, using radioactive beams in inverse kinematics. New techniques are still being developed in order to perform these experiments. The present experiment is designed to study the odd-odd nucleus Na which has a high density of states and therefore requires gamma-ray detection to distinguish between them. The experiment employed an intense beam of up to 3×10 pps of Na at 5.0 MeV/nucleon from the ISAC-II facility at triumf. The new silicon array SHARC was used for the first time and was coupled to the segmented clover gamma-ray array TIGRESS. A novel thin plastic scintillator detector was employed at zero degrees to identify and reject reactions occurring on the carbon component of the (CD) target. The efficiency of the background rejection using this detector is described with respect to the proton and gamma-ray spectra from the (d,p) reaction. © Published under licence by IOP Publishing Ltd