How do voiced retroflex stops evolve? Evidence from typology and an articulatory study

The present article illustrates that the specific articulatory and aerodynamic requirements for voiced but not voiceless alveolar or dental stops can cause tongue tip retraction and tongue mid lowering and thus retroflexion of front coronals. This retroflexion is shown to have occurred diachronically in the three typologically unrelated languages Dhao (Malayo-Polynesian), Thulung (Sino-Tibetan), and Afar (East-Cushitic). In addition to the diachronic cases, we provide synchronic data for retroflexion from an articulatory study with four speakers of German, a language usually described as having alveolar stops. With these combined data we supply evidence that voiced retroflex stops (as the only retroflex segments in a language) did not necessarily emerge from implosives, as argued by Haudricourt (1950), Greenberg (1970), Bhat (1973), and Ohala (1983). Instead, we propose that the voiced front coronal plosive /d/ is generally articulated in a way that favours retroflexion, that is, with a smaller and more retracted place of articulation and a lower tongue and jaw position than /t/

Wird die Rolle von psychischen Erkrankungen beim Suizid überbewertet?

In the scientific literature, it is often said that 90% of all suicides are the consequences of a~mental illness. Nevertheless, recent reports and comments cast doubt on this view and point out that such a~limitation might hamper effective suicide prevention. In this overview we will outline and discuss important results on how often suicides are the consequence of mental illnesses and whether the association between mental illnesses and suicide might be overestimated.Mental illnesses and especially affective disorders increase the risk of suicide by 30 to 50~times. Nevertheless, they explain only a~certain percentage of all suicides. Observational and treatment studies indicate that mental illness is only one factor of several that lead to suicide. Among other factors are relationship problems, drug abuse, severe somatic illnesses, job problems, financial worries or juridical threats.Suicidal behaviour is an indicator of deep unhappiness but not necessarily caused by a~mental illness. Many persons with mental illnesses do not show suicidal behaviour. On the other hand, not all people who take their own lives have a~mental illness. This has significant consequences for universal and indicated prevention of suicide. ZUSAMMENFASSUNG Die Aussage, dass Suizide zu 90 % Folge psychischer Erkrankungen sind, wird häufig in der wissenschaftlichen Literatur zitiert. Neuere Analysen und Kommentare ziehen das aber in Zweifel und betonen die Notwendigkeit, vielfältigere Ursachen für Suizidereignisse zu beachten, auch um die Prävention von Suiziden nicht auf das Erkennen und Behandeln psychischer Erkrankungen zu reduzieren. Das Ziel dieser Übersichtsarbeit ist die Darstellung und Bewertung wichtiger empirischer Befunde zu der Frage, ob die Rolle psychischer Störungen beim Suizid überbewertet wird.Psychische Störungen erhöhen das Risiko eines Suizides um das bis zu 30- bis 50-Fache gegenüber der Allgemeinbevölkerung, dennoch wird dadurch nur ein Teil aller Suizide erklärt. Aus Beobachtungs- und Therapiestudien ergeben sich deutliche Hinweise, dass psychische Störungen nur ein Faktor unter mehreren sind, die zu Suizid führen. Eine Rolle spielen beispielsweise auch Beziehungsprobleme, Substanzmissbrauch, Belastungen durch schwere körperliche Erkrankungen, akute Krisen im Beruf, Probleme mit Finanzen und juristische Belastungen.Suizidales Verhalten weist auf eine tiefe Unzufriedenheit hin, aber nicht notwendigerweise auf eine psychische Erkrankung. Viele Menschen mit einer psychischen Erkrankung zeigen kein suizidales Verhalten und nicht alle Menschen, die sich ihr Leben nehmen, haben eine psychische Erkrankung. Diese Erkenntnisse haben erhebliche Konsequenzen für die universale und indizierte Prävention von Suiziden

Deep transformation models for functional outcome prediction after acute ischemic stroke

In many medical applications, interpretable models with high prediction performance are sought. Often, those models are required to handle semi-structured data like tabular and image data. We show how to apply deep transformation models (DTMs) for distributional regression which fulfill these requirements. DTMs allow the data analyst to specify (deep) neural networks for different input modalities making them applicable to various research questions. Like statistical models, DTMs can provide interpretable effect estimates while achieving the state-of-the-art prediction performance of deep neural networks. In addition, the construction of ensembles of DTMs that retain model structure and interpretability allows quantifying epistemic and aleatoric uncertainty. In this study, we compare several DTMs, including baseline-adjusted models, trained on a semi-structured data set of 407 stroke patients with the aim to predict ordinal functional outcome three months after stroke. We follow statistical principles of model-building to achieve an adequate trade-off between interpretability and flexibility while assessing the relative importance of the involved data modalities. We evaluate the models for an ordinal and dichotomized version of the outcome as used in clinical practice. We show that both, tabular clinical and brain imaging data, are useful for functional outcome prediction, while models based on tabular data only outperform those based on imaging data only. There is no substantial evidence for improved prediction when combining both data modalities. Overall, we highlight that DTMs provide a powerful, interpretable approach to analyzing semi-structured data and that they have the potential to support clinical decision making.Comment: Preprint under revie

Sektionskonzept Meta(daten), Terminologien und Provenienz zur Einrichtung einer Sektion im Verein Nationale Forschungsdateninfrastruktur (NFDI) e.V

Die Sektion befasst sich mit den Themenbereichen (Meta)daten, Terminologien und Provenienz. Aufgabenfelder der Sektion umfassen organisatorische Aspekte (Kollaboration, Wissenstransfer), inhaltliche Aspekte (z.B. Modellierung/Ontologien) und infrastrukturelle Perspektiven (Entwicklung von Standards / Basisdiensten). Eine der wesentlichen Aufgaben der Sektion wird sein, die Arbeit der NFDI-Konsortien im Bereich (Meta)daten, Terminologien und Provenienz entlang der FAIR Kriterien wechselseitig sichtbar zu machen, zu harmonisieren und nachnutzbar zu machen. Hierbei wird die Sektion in enger Rückkopplung mit den Sektionen “Common Infrastructures” sowie “Ethical, Social and Legal Aspects” insbesondere die Themenbereiche Terminologien und Provenienz bearbeiten. (1) Im Themenbereich Metadaten und Forschungsdaten - im Folgenden kurz (Meta)daten - beschäftigt sich die Sektion mit Fragen zur (Meta-)daten-Harmonisierung, Auffindbarkeit von Daten, allgemeine Daten- und Metadaten-Standards mit Blick auf ein mögliches NFDI-Kernmetadatenformat sowie Formatumwandlungen und Persistent-Identifier-Systemen. (2) Im Themenbereich Terminologien beschäftigt sich die Sektion mit community- und disziplinenübergreifenden Definitionen von Top-Level Ontologien und Mappings von Ontologien sowie Best Practices zur Modellierung von Terminologien, Vokabularen und Ontologien sowie darauf aufbauenden Diensten zur Datenintegration (z.B. Terminology Service, Knowledge Graphs etc.). (3) Im Themenbereich Provenienz befasst sich die Sektion mit rechtlichen, technischen und kulturellen Aspekten des Entstehungskontextes von (Meta)daten (z.B. im Rahmen von Experimenten, Laborbüchern, Digitalisierungsprozessen etc.) und entwirft Vorschläge für einheitliche und nachvollziehbare Dokumentationsverfahren zur Beantwortung der Fragen nach dem was, wo, wann, wer, wie und warum der Datenerzeugung und Datenprozessierung. Hierbei entwickelt die Sektion Empfehlungen für die Abbildung der Provenienz in einem möglichen NFDI-Kernmetadatenformat

Circle of Willis variants and their association with outcome in patients with middle cerebral artery-M1-occlusion stroke.

BACKGROUND An incomplete circle of Willis (CoW) has been associated with a higher risk of stroke and might affect collateral flow in large vessel occlusion (LVO) stroke. We aimed to investigate the distribution of CoW variants in a LVO stroke and transient ischemic attack (TIA) cohort and analyze their impact on 3-month functional outcome. METHODS CoW anatomy was assessed with time-of-flight magnetic resonance angiography (TOF-MRA) in 193 stroke patients with acute middle cerebral artery (MCA)-M1-occlusion receiving endovascular treatment (EVT) and 73 TIA patients without LVO. The main CoW variants were categorized into four vascular models of presumed collateral flow via the CoW. RESULTS 82.4% (n = 159) of stroke and 72.6% (n = 53) of TIA patients had an incomplete CoW. Most variants affected the posterior circulation (stroke: 77.2%, n = 149; TIA: 58.9%, n = 43; p = 0.004). Initial stroke severity defined by the National Institutes of Health Stroke Scale (NIHSS) on admission was similar for patients with and without CoW variants. CoW integrity did not differ between groups with favorable (modified Rankin Scale [mRS]): 0-2) and unfavorable (mRS: 3-6) 3-month outcome. However, we found trends towards a higher mortality in patients with any type of CoW variant (p = 0.08) and a higher frequency of incomplete CoW among patients dying within 3 months after stroke onset (p = 0.119). In a logistic regression analysis adjusted for the potential confounders age, sex and atrial fibrillation, neither the vascular models nor anterior or posterior variants were independently associated with outcome. CONCLUSION Our data provide no evidence for an association of CoW variants with clinical outcome in LVO stroke patients receiving EVT

Circle of Willis variants and their association with outcome in patients with middle cerebral artery-M1-occlusion stroke

BACKGROUND: An incomplete circle of Willis (CoW) has been associated with a higher risk of stroke and might affect collateral flow in large vessel occlusion (LVO) stroke. We aimed to investigate the distribution of CoW variants in a LVO stroke and transient ischemic attack (TIA) cohort and analyze their impact on 3-month functional outcome. METHODS: CoW anatomy was assessed with time-of-flight magnetic resonance angiography (TOF-MRA) in 193 stroke patients with acute middle cerebral artery (MCA)-M1-occlusion receiving endovascular treatment (EVT) and 73 TIA patients without LVO. The main CoW variants were categorized into four vascular models of presumed collateral flow via the CoW. RESULTS: 82.4% (n = 159) of stroke and 72.6% (n = 53) of TIA patients had an incomplete CoW. Most variants affected the posterior circulation (stroke: 77.2%, n = 149; TIA: 58.9%, n = 43; p = 0.004). Initial stroke severity defined by the National Institutes of Health Stroke Scale (NIHSS) on admission was similar for patients with and without CoW variants. CoW integrity did not differ between groups with favorable (modified Rankin Scale [mRS]): 0-2) and unfavorable (mRS: 3-6) 3-month outcome. However, we found trends towards a higher mortality in patients with any type of CoW variant (p = 0.08) and a higher frequency of incomplete CoW among patients dying within 3 months after stroke onset (p = 0.119). In a logistic regression analysis adjusted for the potential confounders age, sex and atrial fibrillation, neither the vascular models nor anterior or posterior variants were independently associated with outcome. CONCLUSION: Our data provide no evidence for an association of CoW variants with clinical outcome in LVO stroke patients receiving EVT

How does mental health care perform in respect to service users' expectations? Evaluating inpatient and outpatient care in Germany with the WHO responsiveness concept

<p>Abstract</p> <p>Background</p> <p>Health systems increasingly try to make their services more responsive to users' expectations. In the context of the World Health Report 2000, WHO developed the concept of health system <it>responsiveness </it>as a performance parameter. <it>Responsiveness </it>relates to the system's ability to respond to service users' legitimate expectations of non-medical aspects. We used this concept in an effort to evaluate the performance of mental health care in a catchment area in Germany.</p> <p>Methods</p> <p>In accordance with the method WHO used for its <it>responsiveness </it>survey, <it>responsiveness </it>for inpatient and outpatient mental health care was evaluated by a standardised questionnaire. <it>Responsiveness </it>was assessed in the following domains: <it>attention, dignity</it>, <it>clear communication</it>, <it>autonomy, confidentiality, basic amenities, choice </it>of health care provider, <it>continuity</it>, and <it>access to social support</it>. Users with complex mental health care needs (i.e., requiring social and medical services or inpatient care) were recruited consecutively within the mental health services provided in the catchment area of the Hanover Medical School.</p> <p>Results</p> <p>221 persons were recruited in outpatient care and 91 in inpatient care. Inpatient service users reported poor <it>responsiveness </it>(22%) more often than outpatients did (15%); however this was significant only for the domains <it>dignity </it>and <it>communication</it>. The best performing domains were <it>confidentiality </it>and <it>dignity</it>; the worst performing were <it>choice</it>, <it>autonomy </it>and <it>basic amenities </it>(only inpatient care). <it>Autonomy </it>was rated as the most important domain, followed by <it>attention </it>and <it>communication</it>. <it>Responsiveness </it>within outpatient care was rated worse by people who had less money and were less well educated. Inpatient <it>responsiveness </it>was rated better by those with a higher level of education and also by those who were not so well educated. 23% of participants reported having been discriminated against in mental health care during the past 6 months.</p> <p>The results are similar to prior <it>responsiveness </it>surveys with regard to the overall better performance of outpatient care. Where results differ, this can best be explained by certain characteristics that are applicable to mental health care and also by the users with complex needs. The expectations of <it>attention </it>and <it>autonomy</it>, including participation in the treatment process, are not met satisfactorily in inpatient and outpatient care.</p> <p>Conclusion</p> <p><it>Responsiveness </it>as a health system performance parameter provides a refined picture of inpatient and outpatient mental health care. Reforms to the services provided should be orientated around domains that are high in importance, but low in performance. Measuring <it>responsiveness </it>could provide well-grounded guidance for further development of mental health care systems towards becoming better patient-orientated and providing patients with more respect.</p