Incarcerated paraesophageal hernia complicated by pancreatic damage and unusual comorbidity: Two retrospective case series.

INTRODUCTION: About 1% of paraesophageal hernias (PEH) require emergency surgery due to obstruction or gangrene. We present two complicated cases of incarcerated PEH. Presentation of cases: A patient aged 18 with trisomy 21 was admitted after four days of vomiting and epigastric pain. CT scan revealed a large PEH. The stomach was massively dilated with compression of adjacent viscera and the celiac trunk. The stomach was repositioned laparoscopically and deflated by endoscopy in an attempt to avoid resection. During second look laparoscopy a gastrectomy was necessary. The patient was reoperated for intestinal obstruction, and treated for dehiscence of the esophagojejunostomy and a pancreatic fistula. A patient aged 65 with hereditary spastic paresis had two days history of emesis and epigastric pain. Upon arrival he was hemodynamically unstable and a CT scan revealed perforation of the herniated stomach. A subtotal gastrectomy without reconstruction was performed with vacuum closure of the abdomen. Later a gastrectomy was completed with a Roux-en-Y reconstruction. Except from reoperation for wound dehiscence after 14 days, the recovery was uneventful. DISCUSSION: Trisomy 21 and hereditary spastic paresis may increase the risk of developing PEH. Challenges in regard to symptom evaluation may delay diagnosis. The pressure of the dilated stomach can give rise to ischemic and mechanical damage from compression of major blood vessels and organs. Urgent diagnosis and gastric deflation is required. CONCLUSIONS: In patients with known PEH or with comorbidity that may increase the risk of PEH, this diagnosis should be considered early on.

Silicon surface passivation by PEDOT: PSS functionalized by SnO2 and TiO2 nanoparticles.

In this paper, we present a study of silicon surface passivation based on the use of spin-coated hybrid composite layers. We investigate both undoped poly(3,4-ethylenedioxythiophene)/poly-(styrenesulfonate) (PEDOT:PSS), as well as PEDOT:PSS functionalized with semiconducting oxide nanomaterials (TiO2 and SnO2). The hybrid compound was deposited at room temperature by spin coating-a potentially lower cost, lower processing time and higher throughput alternative compared with the commonly used vacuum-based techniques. Photoluminescence imaging was used to characterize the electronic properties of the Si/PEDOT:PSS interface. Good surface passivation was achieved by PEDOT:PSS functionalized by semiconducting oxides. We show that control of the concentration of semiconducting oxide nanoparticles in the polymer is crucial in determining the passivation performance. A charge carrier lifetime of about 275 µs has been achieved when using SnO2 nanoparticles at a concentration of 0.5 wt.% as a filler in the composite film. X-ray diffraction (XRD), scanning electron microscopy, high resolution transmission electron microscopy (HRTEM), energy dispersive x-ray in an SEM, and µ-Raman spectroscopy have been used for the morphological, chemical and structural characterization. Finally, a simple model of a photovoltaic device based on PEDOT:PSS functionalized with semiconducting oxide nanoparticles has been fabricated and electrically characterized.

The effect of a training course in aggression management on mental health nurses' perceptions of aggression: a cluster randomised controlled trial.

Nurses' attitudes towards patient aggression may influence their behaviour towards patients. Thus, their enhanced capacity to cope with aggressive patients may nurture more positive attitudes and alleviate adverse feelings emanating from patient aggression. This cluster randomised controlled trial conducted on six psychiatric wards tested the hypotheses that a 5 day training course in aggression management would positively influence the following outcome measures: Nurses' perception and tolerance towards patient aggression and resultant adverse feelings. A repeated measures design was employed to monitor change. No effect was found. The short time frame between the training course and the follow up measurement or non-responsiveness of the measurement instruments may explain this finding.

Femtosecond formation of coupled phonon-plasmon modes in InP: Ultrabroadband THz experiment and quantum kinetic theory.

The ultrafast transition of an optical phonon resonance to a coupled phonon-plasmon system is studied. After 10-fs photoexcitation of i-InP, the buildup of coherent beats of the emerging hybrid modes is directly monitored via ultrabroadband THz spectroscopy. The anticrossing is mapped out as a function of time and density. A quantum kinetic theory of microscopic carrier-carrier and carrier-LO-phonon interactions explains the delayed formation of the collective modes. The buildup time is quantitatively reproduced to scale with the oscillation cycle of the upper branch of the coupled resonance.

Assessing dimensional and categorical aspects of depression: validation of the AMDP Depression Scale.

BACKGROUND: A new observer depression scale which is based on the descriptive operationalized classification principles of ICD-10 is introduced. The AMDP Depression Scale (AMDP-DS), a 22-item clinician-rated inventory, provides the opportunity of dimensional as well as categorical depression severity assessment. METHODS: A sample of 50 patients with depressive symptoms were assessed with the AMDP-DS by two raters in a joint rater session. A number of widely used depression scales were applied separately by an independent rater. The ICD-10 symptom checklist was used for categorical assessment of depressive disorders. RESULTS: The inter-rater reliability for the total score of the AMDP-DS was excellent (Intraclass coefficient: 0.97). There were high correlations with the sum scores of the other scales under study. The correlations between the ICD-10 symptom-checklist and the AMDP-DS ranged from 0.75 to 0.89 for the total sample and 0.44 to 0.51 for patients with acute depressive episode. LIMITATIONS: The results are limited by the method of a joint rater setting and the relatively small subsample of patients with depressive episode. CONCLUSIONS: The AMDP-DS satisfies the requirements of psychometric criteria with a sufficient degree. A new depression scale designed to cover dimensional as well as categorical aspects has successfully been developed.

The effectiveness of two interventions in the management of patient violence in acute mental inpatient settings: report on a pilot study.

Systematic risk assessment and training courses have been suggested as interventions to deal with patient violence in psychiatric institutions. A dual centre prospective feasibility study was conducted on two Swiss psychiatric admission wards to test the hypothesis that such interventions will reduce the frequency and severity of violent events and coercion. A systematic aggression risk assessment, in combination with a standardized training course in aggression management was administered and the frequency and severity of aggressive incidents and the frequency of coercive measures were registered. The incidence rates of aggressive incidents and attacks showed no significant reduction from the baseline through risk prediction and staff training, but the drop in coercive measures was highly significant. A 'ward effect' was detected with one ward showing a decline in attacks with unchanged incidence rates of coercion and the other ward showing the opposite. The severity of the incidents remained unchanged whilst the subjective severity declined after the training course. We conclude that a systematic risk assessment and a training course may assist in reducing the incidence rate of coercive measures on psychiatric acute admission wards. Further testing of the interventions is necessary to measure the effect of the training alone and to counteract 'ward effects'.

Light-induced gaps in semiconductor band-to-band transitions.

We observe a triplet around the third harmonic of the semiconductor band gap when exciting 50-100 nm thin GaAs films with 5 fs pulses at 3 x 10(12) W/cm(2). The comparison with solutions of the semiconductor Bloch equations allows us to interpret the observed peak structure as being due to a two-band Mollow triplet. This triplet in the optical spectrum is a result of light-induced gaps in the band structure, which arise from coherent band mixing. The theory is formulated for full tight-binding bands and uses no rotating-wave approximation.

[Resources in schizophrenic patients. Validity testing of a new rating scale to assess health features]. / Ressourcen schizophrener Patienten. Validitätsprüfung des Erhebungsbogens zur Erfassung gesunder Anteile.

Biopsychosocial concepts and Antonovsky's salutogenesis model gave rise to new treatment approaches and research prospects in health-related fields. Also in psychiatry, there is increasing interest to obtain information on patients' resources. There are, nevertheless, only a few instruments developed particularly for this assessment. The new EGA rating scale offers the possibility to assess patient resources as abilities and health-maintaining features in four areas of life. To test the validity of the EGA, 39 schizophrenic patients participated in the current study. Those with more health-maintaining features in the EGA showed significantly fewer psychic and somatic symptoms (SCL-90 R), better social and occupational functioning (SOFAS), higher sense of coherence (SOC), and better social adjustment(FSI). They were significantly younger at the beginning of their disease and had more frequently held jobs during the previous 12 months. The findings point to satisfactory concept- and criterion-related validity and reliability of the EGA rating scale as well as to its possible application in course studies, individual diagnosis, therapy evaluation, and indication. Early medical and therapeutic intervention and increased use of working aid programs are recommended.

Predicting inpatient violence in acute psychiatric wards using the Brøset-Violence-Checklist: a multicentre prospective cohort study.

The Norwegian Brøset-Violence-Checklist (BVC) is one of the few instruments that is suitable for short-term prediction of violence of psychiatric inpatients by nursing staff in routine care. The instrument assesses the presence or absence of six behaviours or states frequently observed before a violent incident. We conducted a study to elucidate whether the predictive properties of the BVC are retained in other psychiatric settings than the original north-Norwegian validation dataset. During their admission period, 219 consecutive patients admitted to six acute psychiatric wards were assessed as to the risk for attack using a German version of the BVC (BVC-G). Data on preventive measures were concurrently collected. Aggressive incidents were registered using an instrument equivalent to the Staff Observation of Aggression Scale (SOAS-R). Fourteen attacks towards staff were observed with incident severity ranging from 5 to 18 of a possible 22 points. BVC-G sensitivity was 64.3%, the specificity 93.9%, the positive predictive value 11.1%, and the area under the receiver operating characteristic curve 0.88. In some false positive cases intense preventive measures had been implemented. The predictive accuracy of the BVC-G proved consistent with the Norwegian original.

The perception of aggression by nurses: psychometric scale testing and derivation of a short instrument.

Patient aggression is a serious problem in psychiatric nursing. Nurses' attitudes towards aggression have been identified as mediating the choice of nursing interventions. To date, investigations are lacking which elucidate the stability of one of the few scales for measuring the attitude of aggression. This study aimed to investigate the test-retest stability of the Perception of Aggression Scale and to derive a shortened version. In order to test the reliability of the Perception of Aggression Scale items, three groups of psychiatric nurses were requested to fill in the Perception of Aggression Scale twice (30 student nurses after 4 days, 32 qualified nurses after 14 days and 36 qualified nurses after 70 days). We derived the shortened version from an independent data set obtained from 729 psychiatry nurses using principal component analysis, aiming to maximize parsimony and Cronbach's alpha. Amongst competing short versions, we selected those with the highest reliability at 70 or 14 day retest. A scale using 12 of the original 32 items was derived yielding alphas of r = 0.69 and r = 0.67 for the two POAS factors with retest reliabilities of r = 0.76 and r = 0.77. The shortened scale offers a practical and viable alternative to the longer version.

Coercive procedures and facilities in Swiss psychiatry.

BACKGROUND: Coercive measures in psychiatry,although in many cases effective in violence management and injury reduction, have been criticised from a consumerist point of view. METHOD: A questionnaire regarding coercive facilities and procedures was dispatched to the charge nurses of 86 acute psychiatric admission wards in German speaking Switzerland covering a catchment area of 75% of the Swiss population. RESULTS: 95% of all wards responded rendering the survey representative. The majority of wards have seclusion rooms and 55% of charge nurses perceive seclusion facilities as adequate. Two to twenty staff members are involved in overwhelming dangerous patients and some discontent is expressed at the haphazard fashion in which such events occur. Almost 70% of the wards use a form for reporting, 42 % of wards keep statistics on violent incidents and 17% of wards have access to these data. Of all wards 84% register injections against patients' will, 83% seclusion, and 78% mechanical restraint and a minority of wards register the coercive administration of oral medication, forced nutrition, threats of coercive measures in case of pharmacological non-compliance. DISCUSSION: Isolation, the coercive administration of medicine and restraint techniques are sensitive forms of treatment. Deficits reported by the charge nurses point to the need for enhanced facilities and improved forms of coercion management such as training in the use of mechanical restraints and the overwhelming of dangerous patients. CONCLUSION: The data show considerable differences in the facilities, the use, and the recording of coercive measures in the area under scrutiny.

Disturbed circadian rest-activity cycles in schizophrenia patients: an effect of drugs?

The circadian rest-activity cycle of schizophrenia patients stabilized for more than a year on monotherapy with a "classical" neuroleptic (haloperidol, flupentixol) or with the atypical neuroleptic clozapine was documented by continuous activity monitoring for 3-7 weeks. In this pilot study, the three patients treated with clozapine had remarkably highly ordered restactivity cycles, whereas the four patients on classical neuroleptics had minor to major circadian rhythm abnormalities. This is the first documentation of circadian rest-activity cycle disturbances in schizophrenia related to class of drug.

Subthreshold carrier-LO phonon dynamics in semiconductors with intermediate polaron coupling: a purely quantum kinetic relaxation channel.

Femtosecond transmission spectra of highly polar CdTe are compared to more covalent GaAs contrasting semiclassical kinetics with two-time quantum kinetics based on the Dyson equation. Nonequilibrium heavy holes in CdTe show ultrafast energy redistribution via the Fröhlich mechanism even if photoexcited below the LO phonon energy. This subthreshold relaxation is a genuine quantum kinetic effect. It gains importance if the polaron self-energy is comparable to the phonon energy. Conservation of the free-particle energies is not required under these conditions.

Bose-Einstein condensation quantum kinetics for a gas of interacting excitons.

A quantum kinetics of the Bose-Einstein condensation in the self-consistent (s.c.) Hartree-Fock-Bogoliubov (HFB) model of the interacting Bose gas is formulated and numerically solved for the example of excitons scattering with a thermal bath of acoustic phonons. The theory describes the condensation in real time starting from a nonequilibrium initial state towards the equilibrium HFB solution. The s.c. changes of the spectrum are automatically incorporated in the scattering terms.

Signature of electron-plasmon quantum kinetics in GaAs

We predict a carrier-density dependent oscillation, which is superimposed on the decay of the coherent control photon echo signal of a semiconductor. It reflects the oscillatory transfer of excitation back and forth between electrons and a mixed plasmon-phonon mode. This signature provides obvious and unique evidence for the finite duration of the interaction process, i.e., evidence for the collective Coulomb quantum kinetics. The theoretical predictions for the model semiconductor GaAs are reproduced in corresponding experiments.

Topologic distribution of different types of neurons in the human putamen.

OBJECTIVE: To test the assumption that the various types of neuron in the human putamen appear to be randomly distributed and to quantify the way in which they are arranged, stochastic geometry, multivariate analysis and the interactive evaluation technique were employed. STUDY DESIGN: Twenty-seven human putamina without demonstrable signs of neurologic change were dissected out, fixed in 4% formalin and embedded in paraffin. The 20-micron paraffin sections were stained in an aldehyde-fuchsin and cresyl-violet solution, which makes it possible to distinguish between seven different neuron populations in the putamen. The gravity centers, size and form factors of these neurons were determined morphometrically under a light microscope. The data obtained were used to calculate the spatial distribution of the neurons by interactive and structure analytical methods. RESULTS: Visual point field analysis revealed an irregular arrangement of the different types of neurons. Point process analysis detected a significant hard core process of type 1 and a cluster process of type 6 neurons. With nearest neighborhood analysis, significant differences were found between certain populations of neurons and Poisson processes. Comparison of the results of multivariate cluster analysis with the investigator-dependent results of visual point field analysis showed clear differences. CONCLUSION: By means of structure analytical methods, the arrangement of different populations of neurons can be demonstrated. Some neuronal distributions are detectable only by using one of these techniques. The question of random or nonrandom distribution of the neurons in the human putamen can now be answered definitively: arrangement of the different populations of neurons is structured.

[Antidepressive therapy by modifying sleep]. / Antidepressive Therapie durch Beeinflussung des Schlafes.

Depressive symptoms are unspecific and occur in several psychiatric disorders. Sleep disturbances are also frequently present in depressed patients. As a consequence, it has been established that a number of modulations of the sleep-wake cycle can have an antidepressive effect. Total sleep deprivation or deprivation in the second half of the night have proven successful. The main limitation of the otherwise well tolerated treatment is the short duration of the antidepressive effect, which is mostly reversed in nearly all patients after the following night's sleep. New approaches are to shift the timing of sleep to earlier to ensure a possible longer-lasting effect. In clinical praxis the following manipulations should not be used: sleep deprivation in the first half of the night (not successful), REM-sleep deprivation (experimental setting), induced sleep prolongation (negative risk-benefit-ratio). In addition to patients with affective disorders sleep deprivation has proved relevant in patients with schizophrenia (depressed and/or with predominantly negative symptoms) and premenstrual dysphoric disorder. Very few side effects have been reported. Although many hypotheses have been tested, the mechanism of action underlying the antidepressive effect of sleep deprivation is still unknown.