Correlation Between ECT Quality Measures and Likelihood to Transition From Acute to Continuation and Maintenance ECT.

OBJECTIVES: To evaluate the association between 3 ECT quality measures (seizure duration, Postictal Suppression Index [PSI], and heart rate response) and therapeutic compliance as indicated by transitioning from acute to continuation to maintenance phases of ECT. METHODS: This was a retrospective chart review of patients who received ECT between July 2016 and July 2019. ECT quality measures were lagged by 1 ECT session to examine the effect of the prior session's quality measure on progressing to a higher ECT phase at the subsequent ECT session. Associations with therapeutic compliance were analyzed using mixed-effects ordinal regression and mixed-effects partial proportional odds models. RESULTS: Seizure duration was associated with 8% higher adjusted odds of progressing to out of the acute phase (95% confidence interval [CI]: 2% to 15%, P = 0.007) and 18% higher adjusted odds of progressing to the maintenance phase (95% CI: 10% to 28%, P < 0.001); PSI was associated with 9% higher adjusted odds of progressing out of the acute phase (95% CI: 3% to 16%, P = 0.005), whereas heart rate response was not statistically associated with therapeutic compliance. Greater therapeutic compliance was also associated with bilateral electrode placement and older age. CONCLUSIONS: Longer seizure duration was associated with greater therapeutic compliance across all ECT phases, PSI was associated with progressing out of the acute phase, and heart rate response was not associated with therapeutic compliance. Our findings assist ECT psychiatrists in optimizing ECT quality measures to promote better compliance with ECT.

Erratum: Oriented Active Solids [Phys. Rev. Lett. 123, 238001 (2019)].

This corrects the article DOI: 10.1103/PhysRevLett.123.238001.

Impact of delirium on mortality in patients hospitalized for heart failure.

OBJECTIVE: Heart Failure (HF) is one of the leading causes of hospitalization in the United States accounting for ≈800,000 hospital discharges and $11 billion in annual costs. Delirium occurs in approximately 30% of elderly hospitalized patients and its incidence is significantly higher among those admitted to the critical care units. Despite this, there has been limited exploration of the clinical and economic impact of delirium in patients hospitalized with acute HF. We hypothesized that delirium in HF is associated with excess mortality and hospital costs. METHODS: We queried the 2001-2014 Nationwide Inpatient Sample to identify hospitalizations that included a primary discharge diagnosis of HF (ICD-9-CM: 428.xx) and stratified them by presence or absence of delirium (ICD-9-CM: 239.0, 290.41, 293.0, 293.1, 348.31). Differences in in-hospital mortality, length of stay (LOS), and hospital costs were assessed using propensity-score matched cohorts. RESULTS: Major predictors of delirium included advanced age, Caucasian race, underlying dementia or psychiatric diagnoses, higher Elixhauser Comorbidity Index, renal failure, cardiogenic shock, and coronary artery bypass surgery. In the propensity-score matched analysis of 76,411 hospitalization with delirium compared to 76,612 without delirium, in-hospital mortality (odds ratio: 1.67, 95% CI: 1.51-1.77), LOS (rate ratio [RR]: 1.47, 95% CI: 1.45-1.51), and hospital costs (RR: 1.44, 95% CI: 1.41-1.48) were all statistically higher in the presence of delirium (all p < 0.001). CONCLUSION: In patients hospitalized with HF, delirium is an independent predictor of increased in-hospital mortality, longer LOS, and excess hospital costs despite adjustment for baseline characteristics.

Layered Chiral Active Matter: Beyond Odd Elasticity.

In equilibrium liquid crystals, chirality leads to a variety of spectacular three-dimensional structures, but chiral and achiral phases with the same broken continuous symmetries have identical long-time, large-scale dynamics. In this Letter, starting from active model H^{*}, the general hydrodynamics of a pseudoscalar in a momentum-conserving fluid, we demonstrate that chirality qualitatively modifies the dynamics of layered liquid crystals in active systems in both two and three dimensions due to an active "odder" elasticity. In three dimensions, we demonstrate that the hydrodynamics of active cholesterics differs fundamentally from smectic-A liquid crystals, unlike their equilibrium counterpart. This distinction can be used to engineer a columnar array of vortices, with an antiferromagnetic vorticity alignment, that can be switched on and off by external strain. A two-dimensional chiral layered state-an array of lines on an incompressible, freestanding film of chiral active fluid with a preferred normal direction-is generically unstable. However, this instability can be tuned in easily realizable experimental settings when the film is either on a substrate or in an ambient fluid.

A nonequilibrium force can stabilize 2D active nematics.

Suspensions of actively driven anisotropic objects exhibit distinctively nonequilibrium behaviors, and current theories predict that they are incapable of sustaining orientational order at high activity. By contrast, here we show that nematic suspensions on a substrate can display order at arbitrarily high activity due to a previously unreported, potentially stabilizing active force. This force moreover emerges inevitably in theories of active orientable fluids under geometric confinement. The resulting nonequilibrium ordered phase displays robust giant number fluctuations that cannot be suppressed even by an incompressible solvent. Our results apply to virtually all experimental assays used to investigate the active nematic ordering of self-propelled colloids, bacterial suspensions, and the cytoskeleton and have testable implications in interpreting their nonequilibrium behaviors.

Swimmer Suspensions on Substrates: Anomalous Stability and Long-Range Order.

We present a comprehensive theory of the dynamics and fluctuations of a two-dimensional suspension of polar active particles in an incompressible fluid confined to a substrate. We show that, depending on the sign of a single parameter, a state with polar orientational order is anomalously stable (or anomalously unstable), with a nonzero relaxation (or growth) rate for angular fluctuations, not parallel to the ordering direction, at zero wave number. This screening of the broken-symmetry mode in the stable state does lead to conventional rather than giant number fluctuations as argued by Bricard et al., Nature 503, 95 (2013), but their bend instability in a splay-stable flock does not exist and the polar phase has long-range order in two dimensions. Our theory also describes confined three-dimensional thin-film suspensions of active polar particles as well as dense compressible active polar rods, and predicts a flocking transition without a banding instability.

Phases and excitations of active rod-bead mixtures: simulations and experiments.

We present a large-scale numerical study, supplemented by experimental observations, on a quasi-two-dimensional active system of polar rods and spherical beads confined between two horizontal plates and energised by vertical vibration. For a low rod concentration Φr, our observations are consistent with a direct phase transition, as bead concentration Φb is increased, from the isotropic phase to a homogeneous flock. For Φr above a threshold value, an ordered band dense in both rods and beads occurs between the disordered phase and the homogeneous flock, in both experiments and simulations. Within the size ranges accessible, we observe only a single band, whose width increases with Φr. Deep in the ordered state, we observe broken-symmetry "sound" modes and giant number fluctuations. The direction-dependent sound speeds and the scaling of fluctuations are consistent with the predictions of field theories of flocking; sound damping rates show departures from such theories, but the range of wavenumbers explored is modest. At very high densities, we see phase separation into rod-rich and bead-rich regions, both of which move coherently.

Oriented Active Solids.

We present a complete analysis of the linearized dynamics of active solids with uniaxial orientational order, taking into account a hitherto overlooked consequence of rotation invariance. Our predictions include a purely active response of two-dimensional orientationally ordered solids to shear, the possibility of stable active solids with quasi-long-range order in two dimensions and long-range order in three dimensions, generic instability of the solid for one sign of active forcing, and the instability of the uniaxially ordered phase in momentum-conserved systems for large active forcing irrespective of its sign.

Kepler Orbits in Pairs of Disks Settling in a Viscous Fluid.

We show experimentally that a pair of disks settling at negligible Reynolds number (∼10^{-4}) displays two classes of bound periodic orbits, each with transitions to scattering states. We account for these dynamics, at leading far-field order, through an effective Hamiltonian in which gravitational driving endows orientation with the properties of momentum. This treatment is successfully compared against the measured properties of orbits and critical parameters of transitions between types of orbits. We demonstrate a precise correspondence with the Kepler problem of planetary motion for a wide range of initial conditions, find and account for a family of orbits with no Keplerian analog, and highlight the role of orientation as momentum in the many-disk problem.

Stress fluctuations in transient active networks.

Inspired by experiments on dynamic extensile gels of biofilaments and motors, we propose a model of a network of linear springs with kinetics consisting of growth at a prescribed rate, death after a lifetime drawn from a distribution, and birth at a randomly chosen node. The model captures features such as the build-up of self-stress, that are not easily incorporated into hydrodynamic theories. We study the model numerically and show that our observations can largely be understood through a stochastic effective-medium model. The resulting dynamically extending force-dipole network displays many features of yielded plastic solids, and offers a way to incorporate strongly non-affine effects into theories of active solids. A rather distinctive form for the stress distribution, and a Herschel-Bulkley dependence of stress on activity, are our major predictions.

Defect Unbinding in Active Nematics.

We formulate the statistical dynamics of topological defects in the active nematic phase, formed in two dimensions by a collection of self-driven particles on a substrate. An important consequence of the nonequilibrium drive is the spontaneous motility of strength +1/2 disclinations. Starting from the hydrodynamic equations of active nematics, we derive an interacting particle description of defects that includes active torques. We show that activity, within perturbation theory, lowers the defect-unbinding transition temperature, determining a critical line in the temperature-activity plane that separates the quasi-long-range ordered (nematic) and disordered (isotropic) phases. Below a critical activity, defects remain bound as rotational noise decorrelates the directed dynamics of +1/2 defects, stabilizing the quasi-long-range ordered nematic state. This activity threshold vanishes at low temperature, leading to a reentrant transition. At large enough activity, active forces always exceed thermal ones and the perturbative result fails, suggesting that in this regime activity will always disorder the system. Crucially, rotational diffusion being a two-dimensional phenomenon, defect unbinding cannot be described by a simplified one-dimensional model.

Hydrodynamic instabilities in active cholesteric liquid crystals.

We describe the basic properties and consequences of introducing active stresses, with principal direction along the local director, in cholesteric liquid crystals. The helical ground state is found to be linearly unstable to extensile stresses, without threshold in the limit of infinite system size, whereas contractile stresses are hydrodynamically screened by the cholesteric elasticity to give a finite threshold. This is confirmed numerically and the non-linear consequences of instability, in both extensile and contractile cases, are studied. We also consider the stresses associated to defects in the cholesteric pitch ([Formula: see text] lines) and show how the geometry near to the defect generates threshold-less flows reminiscent of those for defects in active nematics. At large extensile activity [Formula: see text] lines are spontaneously created and can form steady-state patterns sustained by constant active flows.

Effect of Antidepressant Switching vs Augmentation on Remission Among Patients With Major Depressive Disorder Unresponsive to Antidepressant Treatment: The VAST-D Randomized Clinical Trial.

IMPORTANCE: Less than one-third of patients with major depressive disorder (MDD) achieve remission with their first antidepressant. OBJECTIVE: To determine the relative effectiveness and safety of 3 common alternate treatments for MDD. DESIGN, SETTING, AND PARTICIPANTS: From December 2012 to May 2015, 1522 patients at 35 US Veterans Health Administration medical centers who were diagnosed with nonpsychotic MDD, unresponsive to at least 1 antidepressant course meeting minimal standards for treatment dose and duration, participated in the study. Patients were randomly assigned (1:1:1) to 1 of 3 treatments and evaluated for up to 36 weeks. INTERVENTIONS: Switch to a different antidepressant, bupropion (switch group, n = 511); augment current treatment with bupropion (augment-bupropion group, n = 506); or augment with an atypical antipsychotic, aripiprazole (augment-aripiprazole group, n = 505) for 12 weeks (acute treatment phase) and up to 36 weeks for longer-term follow-up (continuation phase). MAIN OUTCOMES AND MEASURES: The primary outcome was remission during the acute treatment phase (16-item Quick Inventory of Depressive Symptomatology-Clinician Rated [QIDS-C16] score ≤5 at 2 consecutive visits). Secondary outcomes included response (≥50% reduction in QIDS-C16 score or improvement on the Clinical Global Impression Improvement scale), relapse, and adverse effects. RESULTS: Among 1522 randomized patients (mean age, 54.4 years; men, 1296 [85.2%]), 1137 (74.7%) completed the acute treatment phase. Remission rates at 12 weeks were 22.3% (n = 114) for the switch group, 26.9% (n = 136)for the augment-bupropion group, and 28.9% (n = 146) for the augment-aripiprazole group. The augment-aripiprazole group exceeded the switch group in remission (relative risk [RR], 1.30 [95% CI, 1.05-1.60]; P = .02), but other remission comparisons were not significant. Response was greater for the augment-aripiprazole group (74.3%) than for either the switch group (62.4%; RR, 1.19 [95% CI, 1.09-1.29]) or the augment-bupropion group (65.6%; RR, 1.13 [95% CI, 1.04-1.23]). No significant treatment differences were observed for relapse. Anxiety was more frequent in the 2 bupropion groups (24.3% in the switch group [n = 124] vs 16.6% in the augment-aripiprazole group [n = 84]; and 22.5% in augment-bupropion group [n = 114]). Adverse effects more frequent in the augment-aripiprazole group included somnolence, akathisia, and weight gain. CONCLUSIONS AND RELEVANCE: Among a predominantly male population with major depressive disorder unresponsive to antidepressant treatment, augmentation with aripiprazole resulted in a statistically significant but only modestly increased likelihood of remission during 12 weeks of treatment compared with switching to bupropion monotherapy. Given the small effect size and adverse effects associated with aripiprazole, further analysis including cost-effectiveness is needed to understand the net utility of this approach. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01421342.

Silent flocks: constraints on signal propagation across biological groups.

Experiments find coherent information transfer through biological groups on length and time scales distinctly below those on which asymptotically correct hydrodynamic theories apply. We present here a new continuum theory of collective motion coupling the velocity and density fields of Toner and Tu to the inertial spin field recently introduced to describe information propagation in natural flocks of birds. The long-wavelength limit of the new equations reproduces the Toner-Tu theory, while at shorter wavelengths (or, equivalently, smaller damping), spin fluctuations dominate over density fluctuations, and second-sound propagation of the kind observed in real flocks emerges. We study the dispersion relation of the new theory and find that when the speed of second sound is large, a gap in momentum space sharply separates first- from second-sound modes. This gap implies the existence of silent flocks, namely, of medium-sized systems across which information cannot propagate in a linear and underdamped way, either under the form of orientational fluctuations or under that of density fluctuations, making it hard for the group to achieve coordination.

A Comparison of Homeless Male Veterans in Metropolitan and Micropolitan Areas in Nebraska: A Methodological Caveat.

This study explored differences between homeless male veterans in metropolitan and micropolitan cities in Nebraska on sociodemographic, housing, clinical, and psychosocial characteristics as well as health service use. A convenience sample of 151 homeless male veterans (112 metropolitan, 39 micropolitan) were recruited from Veterans Affairs facilities and area shelters in Omaha, Lincoln, Grand Island, and Hastings in Nebraska. Research staff conducted structured interviews with homeless veterans. Results showed that compared to homeless veterans in metropolitans, those in micropolitans were more likely to be White, unmarried, living in transitional settings, and were far more transient but reported greater social support and housing satisfaction. Veterans in micropolitans also reported more medical problems, diagnoses of anxiety and personality disorders, and unexpectedly, were more likely to report using various health services and less travel time for services. Together, these findings suggest access to homeless and health services for veterans in micropolitan areas may be facilitated through Veterans Affairs facilities and community providers that work in close proximity to one another. Many homeless veterans in these areas are transient, making them a difficult population to study and serve. Innovative ways to provide outreach to homeless veterans in micropolitan and more rural areas are needed.

Activating membranes.

We present a general dynamical theory of a membrane coupled to an actin cortex containing polymerizing filaments with active stresses and currents, and demonstrate that active membrane dynamics [S. Ramaswamy et al., Phys. Rev. Lett. 84, 3494 (2000)] and spontaneous shape oscillations emerge from this description. We also consider membrane instabilities and patterns induced by the presence of filaments with polar orientational correlations in the tangent plane of the membrane. The dynamical features we predict should be seen in a variety of cellular contexts involving the dynamics of the membrane-cytoskeleton composite and cytoskeletal extracts coupled to synthetic vesicles.

Defect turbulence in a dense suspension of polar, active swimmers.

We study the effects of inertia in dense suspensions of polar swimmers. The hydrodynamic velocity field and the polar order parameter field describe the dynamics of the suspension. We show that a dimensionless parameter R (ratio of the swimmer self-advection speed to the active stress invasion speed [Phys. Rev. X 11, 031063 (2021)2160-330810.1103/PhysRevX.11.031063]) controls the stability of an ordered swimmer suspension. For R smaller than a threshold R_{1}, perturbations grow at a rate proportional to their wave number q. Beyond R_{1} we show that the growth rate is O(q^{2}) until a second threshold R=R_{2} is reached. The suspension is stable for R>R_{2}. We perform direct numerical simulations to characterize the steady-state properties and observe defect turbulence for R

Phase-synchronized state of oriented active fluids.

We present a theory for self-driven fluids, such as motorized cytoskeletal extracts or microbial suspensions, that takes into account the underlying periodic duty cycle carried by the constituent active particles. We show that an orientationally ordered active fluid can undergo a transition to a state in which the particles synchronize their phases. This spontaneous breaking of time-translation invariance gives rise to flow instabilities distinct from those arising in phase-incoherent active matter. Our work is of relevance to the transport of fluids in living systems and makes predictions for concentrated active-particle suspensions and optically driven colloidal arrays.

Live soap: stability, order, and fluctuations in apolar active smectics.

We construct a hydrodynamic theory of noisy, apolar active smectics in bulk suspension or on a substrate. Unlike purely orientationally ordered active fluids, active apolar smectics can be dynamically stable in Stokesian bulk suspensions. Smectic order in these systems is quasilong ranged in dimension d=2 and long ranged in d=3. We predict reentrant Kosterlitz-Thouless melting to an active nematic in our simplest model in d=2, a nonzero second-sound speed parallel to the layers in bulk suspensions, and that there are no giant number fluctuations in either case. We also briefly discuss possible instabilities in these systems.

Two-temperature activity induces liquid-crystal phases inaccessible in equilibrium.

In equilibrium hard-rod fluids, and in effective hard-rod descriptions of anisotropic soft-particle systems, the transition from the isotropic (I) phase to the nematic phase (N) is observed above the rod aspect ratio L/D=3.70 as predicted by Onsager. We examine the fate of this criterion in a molecular dynamics study of a system of soft repulsive spherocylinders rendered active by coupling half the particles to a heat bath at a higher temperature than that imposed on the other half. We show that the system phase-separates and self-organizes into various liquid-crystalline phases that are not observed in equilibrium for the respective aspect ratios. In particular, we find a nematic phase for L/D=3 and a smectic phase for L/D=2 above a critical activity.