Consultant psychiatrists' experience of the impact of the COVID-19 pandemic on mental health services.

OBJECTIVES: The novel coronavirus 2019 (COVID-19) has spread worldwide threatening human health. To reduce transmission, a 'lockdown' was introduced in Ireland between March and May 2020. The aim of this study is to capture the experiences of consultant psychiatrists during lockdown and their perception of it's impact on mental health services. METHODS: A questionnaire designed by the Royal College of Psychiatrists was adapted and circulated to consultant members of the College of Psychiatrists of Ireland following the easing of restrictions. The questionnaire assessed the perceived impact on referral rates, mental health act provision, availability of information technology (IT), consultant well-being and availability of personal protective equipment (PPE). Thematic analysis was employed to analyse free-text sections. RESULTS: Response rate was 32% (n = 197/623). Consultants reported an initial decrease/significant decrease in referrals in the first month of lockdown (68%, n = 95/140) followed by an increase/significant increase in the second month for both new (83%, n = 100/137) and previously attending patients (65%, n = 88/136). Social isolation and reduced face-to-face mental health supports were among the main reasons identified. The needs of children and older adults were highlighted. Most consultants (76%, n = 98/129) felt their working day was affected and their well-being reduced (52%, n = 61/119). The majority felt IT equipment availability was inadequate (67%, n = 88/132). Main themes identified from free-text sections were service management, relationship between patients and healthcare service and effects on consultants' lives. CONCLUSIONS: The COVID-19 pandemic has placed increased pressure on service provision and consultant wellness. This further supports the longstanding need to increase mental health service investment.

Guideline for the management of hip fractures 2020: Guideline by the Association of Anaesthetists.

We convened a multidisciplinary Working Party on behalf of the Association of Anaesthetists to update the 2011 guidance on the peri-operative management of people with hip fracture. Importantly, these guidelines describe the core aims and principles of peri-operative management, recommending greater standardisation of anaesthetic practice as a component of multidisciplinary care. Although much of the 2011 guidance remains applicable to contemporary practice, new evidence and consensus inform the additional recommendations made in this document. Specific changes to the 2011 guidance relate to analgesia, medicolegal practice, risk assessment, bone cement implantation syndrome and regional review networks. Areas of controversy remain, and we discuss these in further detail, relating to the mode of anaesthesia, surgical delay, blood management and transfusion thresholds, echocardiography, anticoagulant and antiplatelet management and postoperative discharge destination. Finally, these guidelines provide links to supplemental online material that can be used at readers' institutions, key references and UK national guidance about the peri-operative care of people with hip and periprosthetic fractures during the COVID-19 pandemic.

Genetic algorithm-based control of birefringent filtering for self-tuning, self-pulsing fiber lasers.

Polarization-based filtering in fiber lasers is well-known to enable spectral tunability and a wide range of dynamical operating states. This effect is rarely exploited in practical systems, however, because optimization of cavity parameters is nontrivial and evolves due to environmental sensitivity. Here, we report a genetic algorithm-based approach, utilizing electronic control of the cavity transfer function, to autonomously achieve broad wavelength tuning and the generation of Q-switched pulses with variable repetition rate and duration. The practicalities and limitations of simultaneous spectral and temporal self-tuning from a simple fiber laser are discussed, paving the way to on-demand laser properties through algorithmic control and machine learning schemes.

An Irish Experience in Establishing and Evaluating an Intern Led Teaching Programme.

Near-Peer Teaching is a relatively new and expanding area of medical education. The benefit to medical students has been demonstrated in numerous contexts around the world. Our aim was to establish a structured Intern-Led Teaching (ILT) programme in the context of an Irish Intern Training Network affiliated to an Irish Medical School. We then sought to evaluate the success of this programme. Seventy interns were enrolled in the ILT programme and completed a Train the Trainer course involving teaching methods and skills of effective feedback. Following this, the intern tutors delivered several one-hour teaching sessions in small groups to final year medical students on a weekly basis. At the end of each teaching block, a feedback questionnaire was distributed to participating students to evaluate their experiences of this new teaching modality. Tutorial topics were varied. They included clinical examination, history taking, prescribing, and emergencies. Eighty-one percent of students found the intern-led tutorials to be beneficial compared to tutorials run by more senior doctors. Additionally, students felt that with intern led tutorials they could ask questions they otherwise would not. There was a more comfortable environment, and information taught was considered more relevant. A significant number of students felt less nervous about the final medical examinations after the intern-led tutorials. The establishment of a structured intern-led teaching programme was well received by final year medical students. This project shows that interns are a valuable teaching resource in the medical school and should be included in medical schools' curricula.

Barriers and facilitators to initial and continued attendance at community-based lifestyle programmes among families of overweight and obese children: a systematic review.

The success of childhood weight management programmes relies on family engagement. While attendance offers many benefits including the support to make positive lifestyle changes, the majority of families referred to treatment decline. Moreover, for those who do attend, benefits are often compromised by high programme attrition. This systematic review investigated factors influencing attendance at community-based lifestyle programmes among families of overweight or obese children. A narrative synthesis approach was used to allow for the inclusion of quantitative, qualitative and mixed-method study designs. Thirteen studies met the inclusion criteria. Results suggest that parents provided the impetus for programme initiation, and this was driven largely by a concern for their child's psychological health and wellbeing. More often than not, children went along without any real reason or interest in attending. Over the course of the programme, however, children's positive social experiences such as having fun and making friends fostered the desire to continue. The stigma surrounding excess weight and the denial of the issue amongst some parents presented barriers to enrolment and warrant further study. This study provides practical recommendations to guide future policy makers, programme delivery teams and researchers in developing strategies to boost recruitment and minimise attrition.

Towards 'smart lasers': self-optimisation of an ultrafast pulse source using a genetic algorithm.

Short-pulse fibre lasers are a complex dynamical system possessing a broad space of operating states that can be accessed through control of cavity parameters. Determination of target regimes is a multi-parameter global optimisation problem. Here, we report the implementation of a genetic algorithm to intelligently locate optimum parameters for stable single-pulse mode- locking in a Figure-8 fibre laser, and fully automate the system turn-on procedure. Stable ultrashort pulses are repeatably achieved by employing a compound fitness function that monitors both temporal and spectral output properties of the laser. Our method of encoding photonics expertise into an algorithm and applying machine-learning principles paves the way to self-optimising 'smart' optical technologies.

Modulation Instability and Phase-Shifted Fermi-Pasta-Ulam Recurrence.

Instabilities are common phenomena frequently observed in nature, sometimes leading to unexpected catastrophes and disasters in seemingly normal conditions. One prominent form of instability in a distributed system is its response to a harmonic modulation. Such instability has special names in various branches of physics and is generally known as modulation instability (MI). The MI leads to a growth-decay cycle of unstable waves and is therefore related to Fermi-Pasta-Ulam (FPU) recurrence since breather solutions of the nonlinear Schrödinger equation (NLSE) are known to accurately describe growth and decay of modulationally unstable waves in conservative systems. Here, we report theoretical, numerical and experimental evidence of the effect of dissipation on FPU cycles in a super wave tank, namely their shift in a determined order. In showing that ideal NLSE breather solutions can describe such dissipative nonlinear dynamics, our results may impact the interpretation of a wide range of new physics scenarios.

Highly efficient mid-infrared difference-frequency generation using synchronously pulsed fiber lasers.

We report the development of a high average power, picosecond-pulse, mid-infrared source based on difference-frequency generation (DFG) of two synchronous master oscillator power fiber amplifier systems. The generated idler can be tuned over the range 3.28-3.45 µm delivering greater than 3.4 W of average power, with a maximum pump to total DFG power conversion efficiency of 78%. The benefits of a synchronously pumped scheme, compared to CW seeding of DFG sources, are discussed.

Dark solitons in laser radiation build-up dynamics.

We reveal the existence of slowly decaying dark solitons in the radiation build-up dynamics of bright pulses in all-normal dispersion mode-locked fiber lasers, numerically modeled in the framework of a generalized nonlinear Schrödinger equation. The evolution of noise perturbations to quasistationary dark solitons is examined, and the significance of background shape and soliton-soliton collisions on the eventual soliton decay is established. We demonstrate the role of a restoring force in extending soliton interactions in conservative systems to include the effects of dissipation, as encountered in laser cavities, and generalize our observations to other nonlinear systems.

Wideband saturable absorption in few-layer molybdenum diselenide (MoSe2) for Q-switching Yb-, Er- and Tm-doped fiber lasers.

We fabricate a free-standing molybdenum diselenide (MoSe2) saturable absorber by embedding liquid-phase exfoliated few-layer MoSe2 flakes into a polymer film. The MoSe2-polymer composite is used to Q-switch fiber lasers based on ytterbium (Yb), erbium (Er) and thulium (Tm) gain fiber, producing trains of microsecond-duration pulses with kilohertz repetition rates at 1060 nm, 1566 nm and 1924 nm, respectively. Such operating wavelengths correspond to sub-bandgap saturable absorption in MoSe2, which is explained in the context of edge-states, building upon studies of other semiconducting transition metal dichalcogenide (TMD)-based saturable absorbers. Our work adds few-layer MoSe2 to the growing catalog of TMDs with remarkable optical properties, which offer new opportunities for photonic devices.

Duration-tunable picosecond source at 560 nm with watt-level average power.

A pulse source at 560 nm that is tunable in duration between 50 ps and 2.7 ns with >1 W of average power and near diffraction-limited beam quality is demonstrated. The source is based on efficient (up to 50%) second-harmonic generation in a periodically poled lithium tantalate crystal of a linearly polarized fiber-integrated Raman amplifier operating at 1120 nm. A duration-tunable ytterbium master-oscillator power-fiber amplifier is used to pulse-pump the Raman amplifier, which is seeded by a continuous-wave distributed-feedback laser diode at 1120 nm. The performance of the system using two different master oscillator schemes is compared. A pulse energy of up to 765 nJ is achieved with a conversion efficiency of 25% from the ytterbium fiber pump, demonstrating a compact and turn-key architecture for obtaining high peak-power radiation at 560 nm.

Fiber-integrated frequency-doubling of a picosecond Raman laser to 560 nm.

We report the development of a fiber-integrated picosecond source at 560 nm by second harmonic generation of a Raman fiber laser. A picosecond ytterbium master oscillator power fiber amplifier is used to pulse-pump a Raman amplifier, which is seeded by a continuous wave distributed feedback laser diode operating at 1120 nm. The pulse train generated at 1120 nm is frequency-doubled in a fiber-coupled periodically-poled lithium niobate crystal module, producing 450 mW of average power at 560 nm with a pulse duration of 150 ps at a repetition rate of 47.5 MHz. The near diffraction-limited (M(2) = 1.02) collimated output beam is ideal for super-resolution microscopy applications.

Fiber grating compression of giant-chirped nanosecond pulses from an ultra-long nanotube mode-locked fiber laser.

We demonstrate that the giant chirp of coherent, nanosecond pulses generated in an 846 m long, all-normal dispersion, nanotube mode-locked fiber laser can be compensated using a chirped fiber Bragg grating compressor. Linear compression to 11 ps is reported, corresponding to an extreme compression factor of ∼100. Experimental results are supported by numerical modeling, which is also used to probe the limits of this technique. Our results unequivocally conclude that ultra-long cavity fiber lasers can support stable dissipative soliton attractors and highlight the design simplicity for pulse-energy scaling through cavity elongation.

Stimulated Brillouin scattering of visible light in small-core photonic crystal fibers.

We characterize stimulated Brillouin scattering (SBS) of visible light in small-core photonic crystal fiber (PCF). Threshold powers under 532 nm excitation agree with established theory, in contrast to measured values up to five times greater than expected for Brillouin scattering of 1550 nm light. An isolated, single-peaked signal at a Stokes shift of 33.5 GHz is observed, distinct from the multi-peaked Stokes spectra expected when small-core PCF is pumped in the infrared. This wavelength-dependence of the Brillouin threshold, and the corresponding spectrum, are explained by the acousto-optic interactions in the fiber, governed by dimensionless length scales that relate the modal area to the core size, and the pump wavelength to PCF hole pitch. Our results suggest new opportunities for exploiting SBS of visible light in small-core PCFs.

Chirped pulse formation dynamics in ultra-long mode-locked fiber lasers.

By modeling giant chirped pulse formation in ultra-long, normally dispersive, mode-locked fiber lasers, we verify convergence to a steady-state consisting of highly chirped and coherent, nanosecond-scale pulses, which is in good agreement with recent experimental results. Numerical investigation of the transient dynamics reveals the existence of dark soliton-like structures within the envelope of the initial noisy pulse structure. Quasi-stationary dark solitons can persist throughout a large part of the evolution from noise to a stable dissipative soliton solution of the mode-locked laser cavity.

De novo mutations in schizophrenia implicate chromatin remodeling and support a genetic overlap with autism and intellectual disability.

Schizophrenia is a serious psychiatric disorder with a broadly undiscovered genetic etiology. Recent studies of de novo mutations (DNMs) in schizophrenia and autism have reinforced the hypothesis that rare genetic variation contributes to risk. We carried out exome sequencing on 57 trios with sporadic or familial schizophrenia. In sporadic trios, we observed a ~3.5-fold increase in the proportion of nonsense DNMs (0.101 vs 0.031, empirical P=0.01, Benjamini-Hochberg-corrected P=0.044). These mutations were significantly more likely to occur in genes with highly ranked probabilities of haploinsufficiency (P=0.0029, corrected P=0.006). DNMs of potential functional consequence were also found to occur in genes predicted to be less tolerant to rare variation (P=2.01 × 10(-)(5), corrected P=2.1 × 10(-)(3)). Genes with DNMs overlapped with genes implicated in autism (for example, AUTS2, CHD8 and MECP2) and intellectual disability (for example, HUWE1 and TRAPPC9), supporting a shared genetic etiology between these disorders. Functionally CHD8, MECP2 and HUWE1 converge on epigenetic regulation of transcription suggesting that this may be an important risk mechanism. Our results were consistent in an analysis of additional exome-based sequencing studies of other neurodevelopmental disorders. These findings suggest that perturbations in genes, which function in the epigenetic regulation of brain development and cognition, could have a central role in the susceptibility to, pathogenesis and treatment of mental disorders.

Excess of rare novel loss-of-function variants in synaptic genes in schizophrenia and autism spectrum disorders.

Schizophrenia (SZ) and autism spectrum disorders (ASDs) are complex neurodevelopmental disorders that may share an underlying pathology suggested by shared genetic risk variants. We sequenced the exonic regions of 215 genes in 147 ASD cases, 273 SZ cases and 287 controls, to identify rare risk mutations. Genes were primarily selected for their function in the synapse and were categorized as: (1) Neurexin and Neuroligin Interacting Proteins, (2) Post-synaptic Glutamate Receptor Complexes, (3) Neural Cell Adhesion Molecules, (4) DISC1 and Interactors and (5) Functional and Positional Candidates. Thirty-one novel loss-of-function (LoF) variants that are predicted to severely disrupt protein-coding sequence were detected among 2 861 rare variants. We found an excess of LoF variants in the combined cases compared with controls (P=0.02). This effect was stronger when analysis was limited to singleton LoF variants (P=0.0007) and the excess was present in both SZ (P=0.002) and ASD (P=0.001). As an individual gene category, Neurexin and Neuroligin Interacting Proteins carried an excess of LoF variants in cases compared with controls (P=0.05). A de novo nonsense variant in GRIN2B was identified in an ASD case adding to the growing evidence that this is an important risk gene for the disorder. These data support synapse formation and maintenance as key molecular mechanisms for SZ and ASD.

Fiber-integrated 780 nm source for visible parametric generation.

We report the development of a fully fiber-integrated pulsed master oscillator power fibre amplifier (MOPFA) source at 780 nm, producing 3.5 W of average power with 410 ps pulses at a repetition rate of 50 MHz. The source consists of an intensity modulated 1560 nm laser diode amplified in an erbium fiber amplifier chain, followed by a fiber coupled periodically poled lithium niobate crystal module for frequency doubling. The source is then used for generating visible light through four-wave mixing in a length of highly nonlinear photonic crystal fiber: 105 mW at 668 nm and 95 mW at 662 nm are obtained, with pump to anti-Stokes conversion slope efficiencies exceeding 6% in both cases.