Changes in telepsychiatry regulations during the COVID-19 pandemic: 17 countries and regions' approaches to an evolving healthcare landscape.

BACKGROUND: During the COVID-19 pandemic, the use of telemedicine as a way to reduce COVID-19 infections was noted and consequently deregulated. However, the degree of telemedicine regulation varies from country to country, which may alter the widespread use of telemedicine. This study aimed to clarify the telepsychiatry regulations for each collaborating country/region before and during the COVID-19 pandemic. METHODS: We used snowball sampling within a global network of international telepsychiatry experts. Thirty collaborators from 17 different countries/regions responded to a questionnaire on barriers to the use and implementation of telepsychiatric care, including policy factors such as regulations and reimbursement at the end of 2019 and as of May 2020. RESULTS: Thirteen of 17 regions reported a relaxation of regulations due to the pandemic; consequently, all regions surveyed stated that telepsychiatry was now possible within their public healthcare systems. In some regions, restrictions on prescription medications allowed via telepsychiatry were eased, but in 11 of the 17 regions, there were still restrictions on prescribing medications via telepsychiatry. Lower insurance reimbursement amounts for telepsychiatry consultations v. in-person consultations were reevaluated in four regions, and consequently, in 15 regions telepsychiatry services were reimbursed at the same rate (or higher) than in-person consultations during the COVID-19 pandemic. CONCLUSIONS: Our results confirm that, due to COVID-19, the majority of countries surveyed are altering telemedicine regulations that had previously restricted the spread of telemedicine. These findings provide information that could guide future policy and regulatory decisions, which facilitate greater scale and spread of telepsychiatry globally.

Raman scattering study of GeSn under 〈1 0 0〉 and 〈1 1 0〉 uniaxial stress.

The application of strain into GeSn alloys can effectively modulate the band structures, thus creating novel electronic and photonic devices. Raman spectroscopy is a powerful tool for characterizing strain; however, the lack of Raman coefficient makes it difficult for accurate determination of strain in GeSn alloys. Here, we have investigated the Raman-strain function of Ge1-xSnxalong 〈1 0 0〉 and 〈1 1 0〉 directions. GeSn nanomembranes (NMs) with different Sn compositions are transfer-printed on polyethylene terephthalate substrates. External strain is introduced by bending fixtures with different radii, leading to uniaxial tensile strain up to 0.44%. Strain analysis of flexible GeSn NMs bent along 〈1 0 0〉 and 〈1 1 0〉 directions are performed by Raman spectroscopy. The linear coefficients of Raman-strain for Ge0.96Sn0.04are measured to be -1.81 and -2.60 cm-1, while those of Ge0.94Sn0.06are decreased to be -2.69 and -3.82 cm-1along 〈1 0 0〉 and 〈1 1 0〉 directions, respectively. As a result, the experimental ratio of linear coefficient (ROLC) of Ge, Ge0.96Sn0.04and Ge0.94Sn0.06are 1.34, 1.44 and 1.42, which agree well with theoretical ROLC values calculated by elastic compliances and phonon deformation potentials (PDPs). In addition, the compositional dependence of PDPs is analyzed qualitatively. These fundamental parameters are important in designing high performance strained GeSn electronic and photonic devices.

Dual nanotransfer printing for complementary plasmonic biosensors.

One of the main challenges in the widespread utilization of localized plasmon resonance-based biosensors is the fabrication of large-area and low-cost plasmonic nanostructures. In this work, we fabricated large-area and low-cost complementary plasmonic biosensors such as nanohole and nanodisk arrays using dual nanotransfer printing (NTP) with a single metal deposition and a single reusable mold. The suspended nanohole arrays and the suspended nanodisk arrays were fabricated using the subsequent dry etching process. We confirmed a maximum enhancement in bulk sensitivity in experiments and simulations by controlling the vertical and lateral etching depths of the dielectric layer underneath the gold (Au) nanohole and nanodisk arrays. Furthermore, we show that the surface sensitivity evaluated by atomic layer deposition of aluminum oxide increased because appropriate vertical and lateral etching depths allow the target analyte to access the additional near-field formed at the bottom of the Au nanostructure. The dual NTP method provides a practical solution for the realization of large-area and low-cost label-free plasmonic biosensing systems, with a reduction in complexity and cost of the fabrication process of complementary plasmonic structures and metasurfaces.

Shape-Controlled 3D Periodic Metal Nanostructures Fabricated via Nanowelding.

A novel method for fabricating 3D metallic nanostructures to be used in polarized color filters based on nanoimprint lithography, electron-beam evaporation, and nanowelding is proposed. The shape of the nanostructures can be controlled by adjusting the temperature for the nanowelding process. Ag nanowires deposited on polymer patterns are accumulated by the nanowelding process to build up diverse 3D nanostructures. The morphologies of the fabricated 3D nanostructures are analyzed using scanning electron microscopy, atomic force microscopy, and focused ion beam; the heating temperature is varied from 90 to 130 °C in steps of 10 °C. In order to analyze the recrystallization phenomenon after welding, transmission electron microscopy is utilized. The 3D metallic nanostructure has different morphologies and optical properties corresponding to welding temperature conditions and accumulated layer thicknesses. Based on preliminary experimental results, the process parameters are optimized and a polarized color filter is fabricated. Optical characteristics of the filter are evaluated using polarizer and spectrometer. Through this work, it is shown that the proposed method is an effective way to realize various 3D metallic nanostructures for special optical properties, therefore the method based on nanowelding can be utilized in fabrication of functional metamaterials, optical filters, biosensors, and others.

Resistive switching device with highly asymmetric current-voltage characteristics: a solution to backward sneak current in passive crossbar arrays.

With the view towards future non-volatile random access memories that can be integrated at a large scale, extensive study on resistive switching (RS) devices arranged in a crossbar array is currently underway. Although the crossbar array architecture offers relatively simple and acceptable scalability, the presence of sneak current is recognized as a critical issue that needs to be resolved at device level. In addressing this issue, we demonstrate a new type of RS device fabricated by combining graphene oxide (G-O) and zinc oxide (ZnO) with highly asymmetric current-voltage (I-V) characteristics depending on the polarity of bias voltage. The distinctive highly asymmetric I-V characteristics result from the presence of a hetero-junction interface formed between the G-O and ZnO layers. This hetero-junction manifests resistance in the range of GΩ under both forward and reverse bias voltage when the device is in the OFF state, in contrast, when the device is in the ON state, it exhibits resistance in the range of MΩ or kΩ under forward bias and GΩ under reverse bias. We propose to employ demonstrated RS devices with highly asymmetric I-V characteristics to mitigate adverse effects of the sneak current.

Nonlinear secret image sharing scheme.

Over the past decade, most of secret image sharing schemes have been proposed by using Shamir's technique. It is based on a linear combination polynomial arithmetic. Although Shamir's technique based secret image sharing schemes are efficient and scalable for various environments, there exists a security threat such as Tompa-Woll attack. Renvall and Ding proposed a new secret sharing technique based on nonlinear combination polynomial arithmetic in order to solve this threat. It is hard to apply to the secret image sharing. In this paper, we propose a (t, n)-threshold nonlinear secret image sharing scheme with steganography concept. In order to achieve a suitable and secure secret image sharing scheme, we adapt a modified LSB embedding technique with XOR Boolean algebra operation, define a new variable m, and change a range of prime p in sharing procedure. In order to evaluate efficiency and security of proposed scheme, we use the embedding capacity and PSNR. As a result of it, average value of PSNR and embedding capacity are 44.78 (dB) and 1.74t⌈log2 m⌉ bit-per-pixel (bpp), respectively.

Direct Chemisorption-Assisted Nanotransfer Printing with Wafer-Scale Uniformity and Controllability.

Nanotransfer printing techniques have attracted significant attention due to their outstanding simplicity, cost-effectiveness, and high throughput. However, conventional methods via a chemical medium hamper the efficient fabrication with large-area uniformity and rapid development of electronic and photonic devices. Herein, we report a direct chemisorption-assisted nanotransfer printing technique based on the nanoscale lower melting effect, which is an enabling technology for two- or three-dimensional nanostructures with feature sizes ranging from tens of nanometers up to a 6 in. wafer-scale. The method solves the major bottleneck (large-scale uniform metal catalysts with nanopatterns) encountered by metal-assisted chemical etching. It also achieves wafer-scale, uniform, and controllable nanostructures with extremely high aspect ratios. We further demonstrate excellent uniformity and high performance of the resultant devices by fabricating 100 photodetectors on a 6 in. Si wafer. Therefore, our method can create a viable route for next-generation, wafer-scale, uniformly ordered, and controllable nanofabrication, leading to significant advances in various applications, such as energy harvesting, quantum, electronic, and photonic devices.

The Relationship Between Frontostriatal Connectivity and Striatal Dopamine Function in Schizophrenia: An 18F-DOPA PET and Diffusion Tensor Imaging Study in Treatment Responsive and Resistant Patients.

OBJECTIVE: Striatal dopamine dysfunction caused by cortical abnormalities is a leading hypothesis of schizophrenia. Although prefrontal cortical pathology is negatively correlated with striatal dopamine synthesis, the relationship between structural frontostriatal connectivity and striatal dopamine synthesis has not been proved in patients with schizophrenia with different treatment response. We therefore investigated the relationship between frontostriatal connectivity and striatal dopamine synthesis in treatment-responsive schizophrenia (non-TRS) and compared them to treatment-resistant schizophrenia (TRS) and healthy controls (HC). METHODS: Twenty-four patients with schizophrenia and twelve HC underwent [18F] DOPA PET scans to measure dopamine synthesis capacity (the influx rate constant Kicer) and diffusion 3T MRI to measure structural connectivity (fractional anisotropy, FA). Connectivity was assessed in 2 major frontostriatal tracts. Associations between Kicer and FA in each group were evaluated using Spearman's rho correlation coefficients. RESULTS: Non-TRS showed a negative correlation (r=-0.629, p=0.028) between connectivity of dorsolateral prefrontal cortex-associative striatum (DLPFC-AST) and dopamine synthesis capacity of associative striatum but this was not evident in TRS (r=-0.07, p=0.829) and HC (r=-0.277, p=0.384). CONCLUSION: Our findings are consistent with the hypothesis of dysregulation of the striatal dopaminergic system being related to prefrontal cortex pathology localized to connectivity of DLPFC-AST in non-TRS, and also extend the hypothesis to suggest that different mechanisms underlie the pathophysiology of non-TRS and TRS.

High Performance Flexible Visible-Blind Ultraviolet Photodetectors with Two-Dimensional Electron Gas Based on Unconventional Release Strategy.

Interdigitated photodetectors (IPDs) based on the two-dimensional electron gas (2DEG) at the AlGaN/GaN interface have gained prominence as high sensitivity ultraviolet (UV) PDs due to their excellent optoelectronic performance. However, most 2DEG-IPDs have been built on rigid substrates, thus limiting the use of 2DEG-IPDs in flexible and wearable applications. In this paper, we have demonstrated high performance flexible AlGaN/GaN 2DEG-IPDs using AlGaN/GaN 2DEG heterostructure membranes created from 8 in. AlGaN/GaN on insulator (AlGaN/GaNOI) substrates. The interdigitated AlGaN/GaN heterostructure has been engineered to reduce dark current by disconnecting the conductive channel at the heterostructure interface. Photocurrent has been also boosted by the escaped carriers from the 2DEG layer. Therefore, the utilization of a 2DEG layer in transferrable AlGaN/GaN heterostructure membranes offers great promises for high performance flexible 2DEG-IPDs for advanced UV detection systems that are critically important in myriad biomedical and environmental applications.

An Intrinsically Micro-/Nanostructured Pollen Substrate with Tunable Optical Properties for Optoelectronic Applications.

There is broad interest in developing photonically active substrates from naturally abundant, minimally processed materials that can help to overcome the environmental challenges of synthetic plastic substrates while also gaining inspiration from biological design principles. To date, most efforts have focused on rationally engineering the micro- and nanoscale structural properties of cellulose-based materials by tuning fibril and fiber dimensions and packing along with chemical modifications, while there is largely untapped potential to design photonically active substrates from other classes of natural materials with distinct morphological features. Herein, the fabrication of a flexible pollen-derived substrate is reported, which exhibits high transparency (>92%) and high haze (>84%) on account of the micro- and nanostructure properties of constituent pollen particles that are readily obtained from nature and require minimal extraction or processing to form the paper-like substrate based on colloidal self-assembly. Experiments and simulations confirm that the optical properties of the pollen substrate are tunable and arise from light-matter interactions with the spiky surface of pollen particles. In a proof-of-concept example, the pollen substrate is incorporated into a functional perovskite solar cell while the tunable optical properties of the intrinsically micro-/nanostructured pollen substrate can be useful for a wide range of optoelectronic applications.

The relationship between dopamine receptor blockade and cognitive performance in schizophrenia: a [11C]-raclopride PET study with aripiprazole.

Aripiprazole's effects on cognitive function in patients with schizophrenia are unclear because of the difficulty in disentangling specific effects on cognitive function from secondary effects due to the improvement in other schizophrenic symptoms. One approach to address this is to use an intermediate biomarker to investigate the relationship between the drug's effect on the brain and change in cognitive function. This study aims to investigate aripiprazole's effect on working memory by determining the correlation between dopamine D2/3 (D2/3) receptor occupancy and working memory of patients with schizophrenia. Seven patients with schizophrenia participated in the study. Serial positron emission tomography (PET) scans with [11C]raclopride were conducted at 2, 26, and 74 h after the administration of aripiprazole. The subjects performed the N-back task just after finishing the [11C]raclopride PET scan. The mean (±SD) D2/3 receptor occupancies were 66.9 ± 6.7% at 2 h, 65.0 ± 8.6% at 26, and 57.7 ± 11.2% at 74 h after administering aripiprazole. Compared with performance on the zero-back condition, performance in memory-loaded conditions (one-, two-, and three-back conditions) was significantly related to D2/3 receptor occupancy by aripiprazole (error rate: ß = -2.236, t = -6.631, df = 53.947, and p = 0.001; reaction time: ß = -9.567, t = -2.808, df = 29.967, and p = 0.009). Although the sample size was relatively small, these results suggest that aripiprazole as a dopamine-partial agonist could improve cognitive function in patients with schizophrenia.

Transparent Displays Utilizing Nanopatterned Quantum Dot Films.

We report the realization of a transparent display using glass covered by a nanopatterned quantum dot (QD) film with good transmittance. The film was fabricated by nanoimprint lithography (NIL) and spin coating of colloidal QDs with specificexcitation maxima. The produced nanopatterned QD film was attached to transparent glass, enabling active image generation using a laser light source of a specific wavelength. Selective light emission was induced by strongly exciting the laser-exposed film surface, creating desired images, with color modulationenabled by controlling the QD layer (dozens of nanometers in size) via nanopatterning. The nanopatterned QD film used for image generation exhibits excellent transmittance (>80%), and can be used for transparent displays, with image realization in both bright and dark spaces. The fabricated displays have wide viewing anglesowing to their good light emission characteristics, and the fabrication through spin coating renders the fabrication process simple and applicable to large areas.

Microneedles integrated with a triboelectric nanogenerator: an electrically active drug delivery system.

In this study, a combined system of microneedles and a triboelectric nanogenerator (TENG) has been developed for drug delivery. A triboelectric device, which converts mechanical energy into alternating current (AC), was chosen to replace the electrophoresis (EP) effect. To directly generate triboelectricity from salmon deoxyribonucleic acid (SDNA)-based microneedles, a triboelectric series of SDNA film and chargeable polymers (polyimide and Teflon) was studied. The electrical output of the two charged polymers was compared to find a material that could be highly charged with SDNA. The electrical output was also compared as a function of the concentration of a drug embedded in the SDNA film, and the results confirmed that drug intercalation affected the carrier diffusion. The mechanical strength of the microneedles was assessed by histological analysis of their penetration into porcine cadaver skin. Furthermore, the output voltage of a system incorporating microneedles and TENG in cadaver skin, and in vitro drug release into gelatin were evaluated to examine potential application as an electrically active drug delivery system. The electrical output voltage of this system was ∼95 V. The mechanism of triboelectric perturbation to the skin has also been discussed. The system developed in this work is a new, facile approach toward effective drug delivery that replaces the existing EP method and expands the application of TENGs.

Flexible Plasmonic Color Filters Fabricated via Nanotransfer Printing with Nanoimprint-Based Planarization.

We investigated the preparation and performance of large-area transmission-type flexible plasmonic color filters (PCFs). These large-area PCFs were fabricated based on a nanotransfer printing (nTP) process that involves nanoimprint-based planarization. This process is a simple surface treatment for easy transfer of a metal to a flexible plastic substrate and formation of patterned aluminum nanodots and nanoholes on a substrate surface with poor roughness. Rabbit-ear structures can form during the nTP process, and this phenomenon was analyzed by numerical simulation. As defects were not detected in a 10 000-round bending test, the PCFs fabricated using this nTP process have excellent mechanical properties.

Three Cases of Cutaneous Warts Treated With Moxibustion.

Moxibustion is a treatment that uses thermal stimulation generated when herbal materials are burned, indirectly or directly, on the affected area or acupoint. Three cases are presented to report the efficacy of direct moxibustion on cutaneous warts. Three patients with chronic cutaneous warts received direct moxibustion made of Artemisia argyi (Dongbang Inc., Chungnam, Korea). Moxa burning was performed using moxa cones. Approximately 80% of a cone was burned, until patients reported feeling a burning sensation, at which time the cone was removed and another one burned. As part of this approach, patients underwent 5-19 moxibustion procedures during and after wart removal. After warts were completely eliminated, moxa burning was performed on each patient until approximately 60% of a cone was burned or the patient felt heat sensitization but no pain. In these cases, moxibustion seemed to have an effect on cutaneous warts. A possible mechanism is that direct moxibustion likely induces tissue damage from burning and, subsequently, a wound healing effect at a different temperature level. Our reports suggest that it would be worthwhile to conduct further studies on the safety and efficacy of moxibustion on warts or to develop a medical device that uses modified moxibustion.

Post-Traumatic Stress Disorder, Depression, and Heart-Rate Variability among North Korean Defectors.

OBJECTIVE: This study evaluated the symptoms of post-traumatic stress disorder (PTSD) among North Korean defectors and their level of suicidal ideation and the correlation between these and heart-rate variability (HRV) to explore the possibility of using HRV as an objective neurobiological index of signs of autonomic nervous system disorder. METHODS: A total of 32 North Korean defectors (nine men, 23 women) were selected as subjects, and their HRV was measured after they completed the Minnesota Multiphasic Personality Inventory-PTSD (MMPI-PTSD) scale and the Beck Depression Inventory (BDI). RESULTS: 1) Low-frequency (LF)/high-frequency (HF) ratios in the HRV index and MMPI-PTSD scores were correlated (r=0.419, p<0.05), as were BDI item 9 (suicidal ideation) and MMPI-PTSD scores (r=0.600, p<0.01). 2) A regression analysis of LF/HF ratios and MMPI-PTSD scores revealed an R-value of 13.8% (Adj. R(2)=0.138, F=4.695, p=0.041), and a regression analysis of BDI item 9 and MMPI-PTSD scores showed an R-value of 32.8% (Adj. R(2)=0.328, F=11.234, p=0.003). In other words, the LF/HF ratio (ß=0.419) and BDI item 9 (ß=0.600) appear to be risk factors in predicting MMPI-PTSD scores. CONCLUSION: The LF/HF ratio, a standard index of autonomic nervous system activity, can be used as an objective neurobiological index to analyze PTSD among North Korean defectors presenting with various mental and physical symptoms, and the approximate level of suicide -ideation can act as a predicting factor for PTSD.