Social Risk and Dialysis Facility Performance in the First Year of the ESRD Treatment Choices Model.

Importance: The End-Stage Renal Disease Treatment Choices (ETC) model randomly selected 30% of US dialysis facilities to receive financial incentives based on their use of home dialysis, kidney transplant waitlisting, or transplant receipt. Facilities that disproportionately serve populations with high social risk have a lower use of home dialysis and kidney transplant raising concerns that these sites may fare poorly in the payment model. Objective: To examine first-year ETC model performance scores and financial penalties across dialysis facilities, stratified by their incident patients' social risk. Design, Setting, and Participants: A cross-sectional study of 2191 US dialysis facilities that participated in the ETC model from January 1 through December 31, 2021. Exposure: Composition of incident patient population, characterized by the proportion of patients who were non-Hispanic Black, Hispanic, living in a highly disadvantaged neighborhood, uninsured, or covered by Medicaid at dialysis initiation. A facility-level composite social risk score assessed whether each facility was in the highest quintile of having 0, 1, or at least 2 of these characteristics. Main Outcomes and Measures: Use of home dialysis, waitlisting, or transplant; model performance score; and financial penalization. Results: Using data from 125 984 incident patients (median age, 65 years [IQR, 54-74]; 41.8% female; 28.6% Black; 11.7% Hispanic), 1071 dialysis facilities (48.9%) had no social risk features, and 491 (22.4%) had 2 or more. In the first year of the ETC model, compared with those with no social risk features, dialysis facilities with 2 or more had lower mean performance scores (3.4 vs 3.6, P = .002) and lower use of home dialysis (14.1% vs 16.0%, P < .001). These facilities had higher receipt of financial penalties (18.5% vs 11.5%, P < .001), more frequently had the highest payment cut of 5% (2.4% vs 0.7%; P = .003), and were less likely to achieve the highest bonus of 4% (0% vs 2.7%; P < .001). Compared with all other facilities, those in the highest quintile of treating uninsured patients or those covered by Medicaid experienced more financial penalties (17.4% vs 12.9%, P = .01) as did those in the highest quintile in the proportion of patients who were Black (18.5% vs 12.6%, P = .001). Conclusions: In the first year of the Centers for Medicare & Medicaid Services' ETC model, dialysis facilities serving higher proportions of patients with social risk features had lower performance scores and experienced markedly higher receipt of financial penalties.

SUMO1 degrader induces ER stress and ROS accumulation through deSUMOylation of TCF4 and inhibition of its transcription of StarD7 in colon cancer.

Small molecule degraders of small ubiquitin-related modifier 1 (SUMO1) induce SUMO1 degradation in colon cancer cells and inhibits the cancer cell growth; however, it is unclear how SUMO1 degradation leads to the anticancer activity of the degraders. Genome-wide CRISPR-Cas9 knockout screen has identified StAR-related lipid transfer domain containing 7 (StarD7) as a critical gene for the degrader's anticancer activity. Here, we show that both StarD7 mRNA and protein are overexpressed in human colon cancer and its knockout significantly reduces colon cancer cell growth and xenograft progression. The treatment with the SUMO1 degrader lead compound HB007 reduces StarD7 mRNA and protein levels and increases endoplasmic reticulum (ER) stress and reactive oxygen species (ROS) production in colon cancer cells and three-dimensional (3D) organoids. The study further provides a novel mechanism of the compound anticancer activity that SUMO1 degrader-induced decrease of StarD7 occur through degradation of SUMO1, deSUMOylation and degradation of T cell-specific transcription 4 (TCF4) and thereby inhibition of its transcription of StarD7 in colon cancer cells, 3D organoids and patient-derived xenografts (PDX).

Capacity-achieving symbol distributions for directly modulated laser and direct detection systems.

We investigate the capacity-achieving symbol distributions for directly modulated laser (DML) and direct-detection (DD) systems utilizing probabilistic constellation shaped pulse amplitude modulation formats. DML-DD systems utilize a bias tee to feed the DC bias current and AC-coupled modulation signals. Also, an electrical amplifier is commonly utilized to drive the laser. Thus, most DML-DD systems are subject to the constraints of the average optical power and peak electrical amplitude. We compute the channel capacity of the DML-DD systems under these constraints by using the Blahut-Arimoto algorithm to obtain the capacity-achieving symbol distributions. We also carry out experimental demonstration to verify our computation results. We show that the probabilistic constellation shaping (PCS) technique marginally increases the capacity of DML-DD system when the optical modulation index (OMI) is less than 1. However, the PCS technique allows us to increase the OMI larger than 1 without clipping distortions. As a result, we can increase the capacity of DML-DD system by using the PCS technique in comparison with the uniformly distributed signals.

Medicare Advantage Enrollment Among Beneficiaries With End-Stage Renal Disease in the First Year of the 21st Century Cures Act.

Importance: Before 2021, most Medicare beneficiaries with end-stage renal disease (ESRD) were unable to enroll in private Medicare Advantage (MA) plans. The 21st Century Cures Act permitted these beneficiaries to enroll in MA plans effective January 2021. Objective: To examine changes in MA enrollment among Medicare beneficiaries with ESRD after enactment of the 21st Century Cures Act overall and by race or ethnicity and dual-eligible status. Design, Setting, and Participants: This cross-sectional time-trend study used data from Medicare beneficiaries with ESRD (both kidney transplant recipients and those undergoing dialysis) between January 2019 and December 2021. Data were analyzed between June and October 2022. Exposures: 21st Century Cures Act. Main Outcomes and Measures: Primary outcomes were the proportion of Medicare beneficiaries with prevalent ESRD who switched from traditional Medicare to MA between 2020 and 2021 and those with incident ESRD who newly enrolled in MA in 2021. Individuals who stayed in traditional Medicare were enrolled in 2020 and 2021 and those who switched to MA were enrolled in traditional Medicare in 2020 and MA in 2021. Results: Among 575 797 beneficiaries with ESRD in 2020 or 2021 (mean [SD] age, 64.7 [14.2] years, 42.2% female, 34.0% Black, and 7.7% Hispanic or Latino), the proportion of beneficiaries enrolled in MA increased from 24.8% (December 2020) to 37.4% (December 2021), a relative change of 50.8%. The largest relative increases in MA enrollment were among Black (72.8% relative increase), Hispanic (44.8%), and dual-eligible beneficiaries with ESRD (73.6%). Among 359 617 beneficiaries with TM and prevalent ESRD in 2020, 17.6% switched to MA in 2021. Compared with individuals who stayed in traditional Medicare, those who switched to MA had modestly more chronic conditions (6.3 vs 6.1; difference, 0.12 conditions [95% CI, 0.10-0.16]) and similar nondrug spending in 2020 (difference, $509 [95% CI, -$58 to $1075]) but were more likely to be Black (difference, 19.5 percentage points [95% CI, 19.1-19.9]) and have dual Medicare-Medicaid eligibility (difference, 20.8 percentage points [95% CI, 20.4-21.2]). Among beneficiaries who were newly eligible for Medicare ESRD benefits in 2021, 35.2% enrolled in MA. Conclusions and Relevance: Results suggest that increases in MA enrollment among Medicare beneficiaries with ESRD were substantial the first year after the 21st Century Cures Act, particularly among Black, Hispanic, and dual-eligible individuals. Policy makers and MA plans may need to assess network adequacy, disenrollment, and equity of care for beneficiaries who enrolled in MA.

Effect of Water Vapor on Oxidation Processes of the Cu(111) Surface and Sublayer.

Copper-based catalysts have different catalytic properties depending on the oxidation states of Cu. We report operando observations of the Cu(111) oxidation processes using near-ambient pressure scanning tunneling microscopy (NAP-STM) and near-ambient pressure X-ray photoelectron spectroscopy (NAP-XPS). The Cu(111) surface was chemically inactive to water vapor, but only physisorption of water molecules was observed by NAP-STM. Under O2 environments, dry oxidation started at the step edges and proceeded to the terraces as a Cu2O phase. Humid oxidation of the H2O/O2 gas mixture was also promoted at the step edges to the terraces. After the Cu2O covered the surface under humid conditions, hydroxides and adsorbed water layers formed. NAP-STM observations showed that Cu2O was generated at lower steps in dry oxidation with independent terrace oxidations, whereas Cu2O was generated at upper steps in humid oxidation. The difference in the oxidation mechanisms was caused by water molecules. When the surface was entirely oxidized, the diffusion of Cu and O atoms with a reconstruction of the Cu2O structures induced additional subsurface oxidation. NAP-XPS measurements showed that the Cu2O thickness in dry oxidation was greater than that in humid oxidation under all pressure conditions.

Risks of complicated acute appendicitis in patients with psychiatric disorders.

BACKGROUND: Acute appendicitis often presents with vague abdominal pain, which fosters diagnostic challenges to clinicians regarding early detection and proper intervention. This is even more problematic with individuals with severe psychiatric disorders who have reduced sensitivity to pain due to long-term or excessive medication use or disturbed bodily sensation perceptions. This study aimed to determine whether psychiatric disorder, psychotropic prescription, and treatment compliance increase the risks of complicated acute appendicitis. METHODS: The diagnosis records of acute appendicitis from four university hospitals in Korea were investigated from 2002 to 2020. A total of 47,500 acute appendicitis-affected participants were divided into groups with complicated and uncomplicated appendicitis to determine whether any of the groups had more cases of psychiatric disorder diagnoses. Further, the ratio of complicated compared to uncomplicated appendicitis in the mentally ill group was calculated regarding psychotropic dose, prescription duration, and treatment compliance. RESULTS: After adjusting for age and sex, presence of psychotic disorder (odds ratio [OR]: 1.951; 95% confidence interval [CI]: 1.218-3.125), and bipolar disorder (OR: 2.323; 95% CI: 1.194-4.520) was associated with a higher risk of having complicated appendicitis compared with absence of psychiatric disorders. Patients who are taking high-daily-dose antipsychotics, regardless of prescription duration, show high complicated appendicitis risks; High-dose antipsychotics for < 1 year (OR: 1.896, 95% CI: 1.077-3.338), high-dose antipsychotics for 1-5 years (OR: 1.930, 95% CI: 1.144-3.256). Poor psychiatric outpatient compliance was associated with a high risk of complicated appendicitis (OR: 1.664, 95% CI: 1.014-2.732). CONCLUSIONS: This study revealed a close relationship in the possibility of complicated appendicitis in patients with severe psychiatric disorders, including psychotic and bipolar disorders. The effect on complicated appendicitis was more remarkable by the psychiatric disease entity itself than by psychotropic prescription patterns. Good treatment compliance and regular visit may reduce the morbidity of complicated appendicitis in patients with psychiatric disorders.

Medicaid Expansion and Incidence of Kidney Failure among Nonelderly Adults.

BACKGROUND: Low-income individuals without health insurance have limited access to health care. Medicaid expansions may reduce kidney failure incidence by improving access to chronic disease care. METHODS: Using a difference-in-differences analysis, we examined the association between Medicaid expansion status under the Affordable Care Act (ACA) and the kidney failure incidence rate among all nonelderly adults, aged 19-64 years, in the United States, from 2012 through 2018. We compared changes in kidney failure incidence in states that implemented Medicaid expansions with concurrent changes in nonexpansion states during pre-expansion, early postexpansion (years 2 and 3 postexpansion), and later postexpansion (years 4 and 5 postexpansion). RESULTS: The unadjusted kidney failure incidence rate increased in the early years of the study period in both expansion and nonexpansion states before stabilizing. After adjustment for population sociodemographic characteristics, Medicaid expansion status was associated with 2.20 fewer incident cases of kidney failure per million adults per quarter in the early postexpansion period (95% CI, -3.89 to -0.51) compared with nonexpansion status, a 3.07% relative reduction (95% CI, -5.43% to -0.72%). In the later postexpansion period, Medicaid expansion status was not associated with a statistically significant change in kidney failure incidence (-0.56 cases per million per quarter; 95% CI, -2.71 to 1.58) compared with nonexpansion status and the pre-expansion time period. CONCLUSIONS: The ACA Medicaid expansion was associated with an initial reduction in kidney failure incidence among the entire, nonelderly, adult population in the United States; but the changes did not persist in the later postexpansion period. Further study is needed to determine the long-term association between Medicaid expansion and changes in kidney failure incidence.

Reduced-state MLSE for an IM/DD system using PAM modulation.

The performance of a high-speed intensity-modulation (IM)/direct-detection (DD) transmission system could be limited by the bandwidth of optical transceivers. One popular way to cope with this performance limitation is to utilize the maximum likelihood sequence estimation (MLSE) at the receiver. However, a practical problem of MLSE is its high implementation complexity. Even though the channel impulse response can be truncated by using a two-tap filter before applying the MLSE, it still faces an implementation problem when used for multi-level modulation formats. In this paper, we propose and demonstrate a reduced-state MLSE for band-limited IM/DD transmission systems using M-ary pulse amplitude modulation (PAM-M) formats. We use a conventional Viterbi algorithm to search a reduced-state trellis, which is constructed by using the coarse pre-decision of the signal equalized by a feed-forward equalizer. Thus, the proposed MLSE reduces the implementation complexity significantly. We evaluate the performance of the proposed reduced-state MLSE over 100∼140-Gb/s PAM-4/6/8 transmission systems implemented by using a 1.3-µm directly modulated laser. The results show that the proposed MLSE achieves almost the same performance as the conventional MLSE but reduces the implementation complexity by a factor of 4∼10 when the complexity is assessed by the number of multiplications and additions.

Enhanced LoRaWAN Adaptive Data Rate for Mobile Internet of Things Devices.

A long-range wide area network (LoRaWAN) is one of the leading communication technologies for Internet of Things (IoT) applications. In order to fulfill the IoT-enabled application requirements, LoRaWAN employs an adaptive data rate (ADR) mechanism at both the end device (ED) and the network server (NS). NS-managed ADR aims to offer a reliable and battery-efficient resource to EDs by managing the spreading factor (SF) and transmit power (TP). However, such management is severely affected by the lack of agility in adapting to the variable channel conditions. Thus, several hours or even days may be required to converge at a level of stable and energy-efficient communication. Therefore, we propose two NS-managed ADRs, a Gaussian filter-based ADR (G-ADR) and an exponential moving average-based ADR (EMA-ADR). Both of the proposed schemes operate as a low-pass filter to resist rapid changes in the signal-to-noise ratio of received packets at the NS. The proposed methods aim to allocate the best SF and TP to both static and mobile EDs by seeking to reduce the convergence period in the confirmed mode of LoRaWAN. Based on the simulation results, we show that the G-ADR and EMA-ADR schemes reduce the convergence period in a static scenario by 16% and 68%, and in a mobility scenario by 17% and 81%, respectively, as compared to typical ADR. Moreover, we show that the proposed schemes are successful in reducing the energy consumption and enhancing the packet success ratio.

Resource Allocation to Massive Internet of Things in LoRaWANs.

A long-range wide area network (LoRaWAN) adapts the ALOHA network concept for channel access, resulting in packet collisions caused by intra- and inter-spreading factor (SF) interference. This leads to a high packet loss ratio. In LoRaWAN, each end device (ED) increments the SF after every two consecutive failed retransmissions, thus forcing the EDs to use a high SF. When numerous EDs switch to the highest SF, the network loses its advantage of orthogonality. Thus, the collision probability of the ED packets increases drastically. In this study, we propose two SF allocation schemes to enhance the packet success ratio by lowering the impact of interference. The first scheme, called the channel-adaptive SF recovery algorithm, increments or decrements the SF based on the retransmission of the ED packets, indicating the channel status in the network. The second approach allocates SF to EDs based on ED sensitivity during the initial deployment. These schemes are validated through extensive simulations by considering the channel interference in both confirmed and unconfirmed modes of LoRaWAN. Through simulation results, we show that the SFs have been adaptively applied to each ED, and the proposed schemes enhance the packet success delivery ratio as compared to the typical SF allocation schemes.

Reduced awareness of surroundings is the most central domain in the network structure of posttraumatic stress disorder symptoms.

Backgroud: Network models suggest that co-occurring symptoms are conceptualized as a syndrome due to interactions, rather than a categorical entity with an underlying common cause.Aim: Our study aimed to examine the network structure and centrality of Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV posttraumatic stress disorder (PTSD) symptoms, including essential and associated features.Methods: We constructed a network structure of 21 intertwined symptoms, evaluated with the Clinician-Administered PTSD Scale (CAPS), in 249 PTSD patients who have been exposed to various types of traumatic events (73% being traffic or other accidents) and were beginning psychiatric treatment. In addition, we estimated the centrality of the 21 symptoms through network analysis. Each of the symptoms was defined as ordered-categorical variables.Results: The network, with 21 symptoms, demonstrated a strong correlation among difficulty concentrating, reduced awareness of surroundings, and derealization. In addition, reduced awareness of surroundings was estimated as the most central symptom, whereas inability to recall important aspects of trauma was estimated as the least central symptom in the subjects. A community-detection analysis estimated that the 21 PTSD symptoms were organized into three clinically meaning clusters.Conclusion: Although dissociative features have been defined as associative symptoms rather than essential symptoms for the DSM diagnostic criteria, reduced awareness of surroundings may be regarded as the most central symptom in patients in the early phase of PTSD. Thus, evaluation and intervention for dissociative features may be needed in clinical practice and studies on PTSD.

Knee Joint and Quadriceps Dysfunction in Individuals With Anterior Knee Pain, Anterior Cruciate Ligament Reconstruction, and Meniscus Surgery: A Cross-Sectional Study.

CONTEXT: While arthrogenous muscle inhibition associated with knee injuries is evident, the relative magnitude of functional deficiency related to each individual knee pathology is unclear. OBJECTIVE: To compare the knee joint and quadriceps dysfunction among patients with anterior knee pain (AKP) without surgical history and those with surgical history (anterior cruciate ligament reconstruction [ACLR]; meniscus surgery) without current AKP, with matched healthy controls. DESIGN: Cross-sectional study. SETTING: Laboratory. PARTICIPANTS: A total of 66 patients with knee pathologies and 30 controls. MAIN OUTCOME MEASURES: Pain perception and lower-extremity functional outcomes were assessed. Knee joint function was measured by replication tests. Quadriceps function was measured by strength, voluntary activation, and torque-generating capacity. RESULTS: Patients with AKP reported greater pain perception compared with the other knee conditions (4.3 vs 0.1 of 10 in Numeric Pain Rating Scale, P < .0001). Compared with the controls: (1) patients with AKP showed a greater error on knee-flexion replications at 75° (2.9° vs 5.4°, P = .002), (2) patients with AKP and ACLR showed less quadriceps strength (AKP: 3.3 vs 2.6 N·m/kg, P = .002; ACLR: 3.3 vs 2.7 N·m/kg, P = .02) and voluntary activation (AKP: 0.982 vs 0.928, P < .0001; ACLR: 0.982 vs 0.946, P = .003), and (3) all knee pathologies reported lower scores on functional outcomes (79 vs 65 of 80 points in Lower-Extremity Functional Scale, P < .0001) and showed less quadriceps torque-generating capacity (10.7 vs 7.8 N·m/s/kg, P < .0001). Among the knee pathologies, patients with AKP showed less quadriceps voluntary activation compared with the patients with meniscus surgery (0.928 vs 0.964, P = .03). CONCLUSION: As patients with AKP had an additional impairment in knee joint flexion replications and reported a less score in functional outcomes, knee pain may produce a greater impact on functional deficiency.

Reliability and Validity of the Korean Version of Clinician-Administered Posttraumatic Stress Disorder Scale for DSM-5.

BACKGROUND: For diagnosis of post-traumatic stress disorder (PTSD), the Clinician-Administered PTSD Scale (CAPS) is one of the most widely used structured diagnostic interviews. METHODS: In this study, we aimed to develop and validate the Korean version of CAPS for the Diagnostic and Statistical Manual of Mental Disorders, 5th edition ([DSM-5] K-CAPS-5). Seventy-one subjects with PTSD, 74 with mood disorder or anxiety disorder, and 99 as healthy controls were enrolled. The Korean version of the structured clinical interview for DSM-5-research version was used to assess the convergent validity of K-CAPS-5. BDI-II, BAI, IES-R, and STAI was used to evaluate the concurrent validity. RESULTS: All subjects completed various psychometric assessments including K-CAPS-5. K-CAPS-5 presented good internal consistency (Cronbach's α = 0.92) and test-retest reliability (r = 0.91). K-CAPS-5 showed strong correlations with the structured clinical interview for DSM-5 PTSD (k = 0.893). Among the three subject groups listed above there were significant differences in the K-CAPS-5 total score. The data were best explained by a six-factor model. CONCLUSION: These results demonstrated the good reliability and validity of K-CAPS-5 and its suitability for use as a simple but structured instrument for PTSD assessment.

Cooperative Traffic Signal Control with Traffic Flow Prediction in Multi-Intersection.

As traffic congestion in cities becomes serious, intelligent traffic signal control has been actively studied. Deep Q-Network (DQN), a representative deep reinforcement learning algorithm, is applied to various domains from fully-observable game environment to traffic signal control. Due to the effective performance of DQN, deep reinforcement learning has improved speeds and various DQN extensions have been introduced. However, most traffic signal control researches were performed at a single intersection, and because of the use of virtual simulators, there are limitations that do not take into account variables that affect actual traffic conditions. In this paper, we propose a cooperative traffic signal control with traffic flow prediction (TFP-CTSC) for a multi-intersection. A traffic flow prediction model predicts future traffic state and considers the variables that affect actual traffic conditions. In addition, for cooperative traffic signal control in multi-intersection, each intersection is modeled as an agent, and each agent is trained to take best action by receiving traffic states from the road environment. To deal with multi-intersection efficiently, agents share their traffic information with other adjacent intersections. In the experiment, TFP-CTSC is compared with existing traffic signal control algorithms in a 4 × 4 intersection environment. We verify our traffic flow prediction and cooperative method.

Exploratory Factor Analysis of the Beck Anxiety Inventory and the Beck Depression Inventory-II in a Psychiatric Outpatient Population.

BACKGROUND: To further understand the relationship between anxiety and depression, this study examined the factor structure of the combined items from two validated measures for anxiety and depression. METHODS: The participants were 406 patients with mixed psychiatric diagnoses including anxiety and depressive disorders from a psychiatric outpatient unit at a university-affiliated medical center. Responses of the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI)-II, and Symptom Checklist-90-Revised (SCL-90-R) were analyzed. We conducted an exploratory factor analysis of 42 items from the BAI and BDI-II. Correlational analyses were performed between subscale scores of the SCL-90-R and factors derived from the factor analysis. Scores of individual items of the BAI and BDI-II were also compared between groups of anxiety disorder (n = 185) and depressive disorder (n = 123). RESULTS: Exploratory factor analysis revealed the following five factors explaining 56.2% of the total variance: somatic anxiety (factor 1), cognitive depression (factor 2), somatic depression (factor 3), subjective anxiety (factor 4), and autonomic anxiety (factor 5). The depression group had significantly higher scores for 12 items on the BDI while the anxiety group demonstrated higher scores for six items on the BAI. CONCLUSION: Our results suggest that anxiety and depressive symptoms as measured by the BAI and BDI-II can be empirically differentiated and that particularly items of the cognitive domain in depression and those of physical domain in anxiety are noteworthy.

Add-on Eye Movement Desensitization and Reprocessing (EMDR) Therapy for Adults with Post-traumatic Stress Disorder Who Failed to Respond to Initial Antidepressant Pharmacotherapy.

This study examined the add-on efficacy of eye movement desensitization and reprocessing (EMDR) therapy among adult civilians with post-traumatic stress disorder (PTSD) who continued to be symptomatic after more than 12 weeks of initial antidepressant treatment. Scores for the Clinician Administered PTSD Scale (CAPS) were rated pre- and post-EMDR and at a 6-month follow-up. After an average of six sessions of EMDR treatment, seven of 14 patients (50%) showed more than a 30% decrease in CAPS score and eight (57%) no longer met the criteria for PTSD. Our results indicate that EMDR could be successfully added after failure of initial pharmacotherapy for PTSD.

Mediating Role of Anxiety and Depression in the Relationship between Posttraumatic Stress Symptoms and Illness Intrusiveness.

BACKGROUND: Posttraumatic stress symptoms (PTSS) in patients with psychological trauma lead to poor health-related quality of life. Understanding of the relationships among PTSS, anxiety, depression, and illness intrusiveness will guide the development of efficient approaches to enhance subjective well-being in patients with psychological trauma. This study investigated whether anxiety and depression mediate the relationship between PTSS and illness intrusiveness in the hope of providing more comprehensive and effective trauma treatment. METHODS: Psychiatric outpatients who visited the trauma clinic of a university hospital (n = 260) participated in this study. Assessments were conducted for PTSS, anxiety, depression, and illness intrusiveness. Structural equation modeling and path analysis were performed to analyze the mediating effects of anxiety and depression on the relationship between PTSS and illness intrusiveness. RESULTS: PTSS had both direct and indirect exacerbating effects on illness intrusiveness. Anxiety exhibited the largest direct exacerbating effect on illness intrusiveness. The indirect effects of PTSS on illness intrusiveness through anxiety alone and through a depression-to-anxiety pathway were significant, but the indirect effect through depression alone was not. CONCLUSION: The findings demonstrate that anxiety, both independently and as part of an interrelated pathway with depression, partially mediates the relationship between PTSS and illness intrusiveness. Appropriate interventions and a comprehensive approach to alleviate anxiety and depression could mitigate the negative effects of PTSS on illness intrusiveness in patients with psychological trauma.

A Brief Screening Tool for PTSD: Validation of the Korean Version of the Primary Care PTSD Screen for DSM-5 (K-PC-PTSD-5).

The purpose of this study was to develop and evaluate psychometrically the Korean version of the Primary Care Posttraumatic Stress Disorder Screen for the Diagnostic and Statistical Manual-fifth edition (K-PC-PTSD-5). In total, 252 participants were interviewed with the Structured Clinical Interview for Diagnostic and Statistical Manual-fifth edition-research version (SCID-5-RV). The K-PC-PTSD-5 showed good internal consistency (α = 0.872), test-retest reliability (r = 0.89), and concurrent validity (r = 0.81). A score of 3 was identified as the threshold for clinically significant posttraumatic stress disorder (PTSD) symptoms. Overall, the results indicate that the K-PC-PTSD-5 is a useful, timesaving instrument for screening PTSD symptoms.

Carrier-phase-estimation algorithm featuring fast trackability for high-speed coherent WDM PON based on RSOA.

There have been substantial efforts to implement high-speed (>10 Gb/s) upstream transmission using reflective semiconductor optical amplifiers (RSOAs) in a coherent wavelength-division-multiplexed (WDM) passive optical network (PON). In such a network, it is necessary to estimate the carrier phase of upstream optical signal to retrieve the phase-modulated information created by RSOA. However, due to the severe waveform distortions caused by the limited modulation bandwidth of RSOA (typically less than 3 GHz), previously reported carrier phase estimation (CPE) algorithms cannot accurately estimate the carrier phase of high-speed quadrature phase-shift keying (QPSK) signal generated from the RSOA seeded by a distributed-feedback (DFB) laser. We propose a novel CPE method capable of tracking the carrier phase rapidly by using a small number of symbols (e.g., 15 symbols) even when the waveforms are severely distorted by the limited modulation bandwidth of RSOA. The proposed CPE method utilizes the linear relationship between the intensity modulation and phase modulation indices inherent in the semiconductor opto-electronic device. By using the proposed method, we demonstrate the transmission of 25.78-Gb/s QPSK signal in a 20-km long loopback fiber link. In this experiment, a commercial DFB laser (linewidth: 3 MHz) is used as the seed light instead of an expensive narrow-linewidth laser. Also shown through the experiment is that the proposed CPE method is highly unsusceptible to variations of parameters required in the proposed method, such as the number of test phases, the accuracy of linewidth enhancement factor, and the accuracy of the normalized amplitude of DC component.