Individualized Training of Back Muscles Using Iterative Learning Control of a Compliant Balance Board.

Here we present the GyroTrainer, a bespoke mechatronic balance board system designed to trigger activation of the back muscles while the user engages in a balance-challenging game. The GyroTrainer uses admittance control coupled with an iterative learning approach so as to tailor the admittance control parameters, i.e. difficulty level, according to the user's skill. Our experimental evaluation demonstrated that an individualized admittance control stiffness could be identified for each user, which corresponds with a desired level of difficulty and increased back muscle activity. A first game implementation demonstrates the feasibility of utilizing the GyroTrainer system and the individually identified admittance control stiffness for gamification of back muscle training.

Study of electronic structure in the L-edge spectroscopy of actinide materials: UO2 as an example.

While the electronic structure calculation for actinide materials, using ligand-field phenomenology in conjunction with density functional theory (LFDFT) treating configurations with single or two open-shells 5f and 6d electrons, is well established and currently practiced, the consideration of the three open-shells electron configurations for LFDFT treatment is a challenging task addressed in the present work. Herein, we report the first-principles method, developed for the first time on the basis of LFDFT, to evaluate the uranium L3-edge X-ray absorption near-edge structure (XANES), which requires non-equivalent active electrons within the 2p, 5f and 6d orbitals of the uranium ion. The theoretical results, when compared with the experimental XANES data measured from uranium dioxide fresh fuel pellets and rector-exposed spent fuel materials, show good agreement with the experimental findings elucidating the local oxidation in the spent fuel materials. This report is relevant for the commonly used L-edge spectroscopy of actinide isotopes and important for understanding the structural, optical and electronic properties of actinide-based materials.

[Cross-sectional data of inpatient residents of a rehabilitation center with schizophrenic psychosis diagnosis]. / Querschnittsuntersuchung von Bewohnern einer stationären Eingliederungsmaßnahme mit der Diagnose einer Psychose aus dem schizophrenen Formenkreis.

Cross-sectional data of inpatient residents of a rehabilitation center with schizophrenic psychosis diagnosis Abstract. OBJECTIVE: The objective of this study is to evaluate the level of neuropsychological functioning, quality of life, content of treatment, abnormal psychology as well as the level of functioning and medication in children and adolescents who suffer from a schizophrenia spectrum disorder, treated as rehabilitation inpatients. METHODS: Forty-two patients could be examined, therefore, the IRAOS, the WAIS-IV, the TMT-A/-B, the FBB-P (patient's version), the ILK-P, the SANS/SAPS, the BPRS, the BSCL, the GAF, the CGAS, and the CGI were used. RESULTS: Patients' average age at onset of the disorder was 14.49 years (± 2.90). The total value of IQ was 87.00 (± 15.02), the value of TMT-A was 73.05 (± 14.51), and of the TMT-B 75.62 (± 15.15). The value for the content of treatment in the summary-score of the FBB-P was 3.05 (± 0.49). The value of the total-score in ILK-P was 2.10 (± 0.70). The summary-score of the SANS was 5.00 (± 2.90) and of the SAPS 3.00 (± 2.70). The BPRS-summary-score's value was 30.70 (± 7.80), the BSCL-GSI's value was 0.90 (± 0.50). GAF and CGAS were at 48.30 (± 12.80), respectively 51.00 (± 12.30). Clozapin has been prescribed in 25.0 % of the cases as first or second neuroleptic medication. CONCLUSION: We investigated patients with VEOS and EOS living in a rehabilitation center. Usually, the course of their illness is much more severe and chronic than it is seen in a common department for child and adolescent psychiatry. Findings indicate a clear impairment in the level of neuropsychological and global functioning in contrast to rather low to moderate burden of positive/negative deficits. Satisfactory results of treatment and quality of life could be evaluated in spite of the aforementioned impairments. Medication did not conform to current guidelines, especially concerning Clozapin. Findings of the subsequent follow-up will show, if the impairment will improve under inpatient rehabilitation conditions.

Relations between movement disorders and psychopathology under predominantly atypical antipsychotic treatment in adolescent patients with schizophrenia.

OBJECTIVE: To examine relations between movement disorders (MD) and psychopathological symptoms in an adolescent population with schizophrenia under treatment with predominantly atypical antipsychotics. METHOD: MD symptoms and psychopathology were cross-sectionally assessed in 93 patients (aged 19.6 +/- 2.2 years) using Tardive Dyskinesia Rating Scale (TDRS), Abnormal Involuntary Movement Scale (AIMS), Extrapyramidal Symptom Scale (EPS), Barnes Akathisia Scale (BAS), Brief Psychiatric Rating Scale (BPRS) and the Schedule for Assessment of Negative/Positive Symptoms (SANS/SAPS). RESULTS: All patients with MD symptoms (n = 37; 39.8 %) showed pronounced global psychpathological signs (SANS/SAPS, BPRS: p = 0.026, p = 0.033, p = 0.001) with predominant anergia symptoms (p = 0.005) and inclinations toward higher anxiety- and depression-related symptoms (p = 0.051) as well as increased thought disturbance (p = 0.066). Both negative symptoms and anergia showed trends for positive correlations with tardive dyskinesia (p = 0.068; p = 0.065) as well as significant correlations with parkinsonism symptoms (p = 0.036; p = 0.023). Akathisia symptoms correlated significantly with hostile and suspicious symptoms (p = 0.013). A superfactor-analysis revealed four factors supporting the aforementioned results. CONCLUSION: MD symptoms and psychopathology are in some respects related to each other. Motor symptoms representing on the one hand trait characteristics of schizophrenia might additionally be triggered by antipsychotics and finally co-occur with more residual symptoms within a long-term treatment.

[A university department as a psychiatric service centre for children and adolescents]. / Eine Universitätsklinik als psychiatrisches Versorgungszentrum für Kinder und Jugendliche.

The article reports on a system of care for psychiatrically ill children and adolescents that has been designed, established and expanded since 1980 by a university department in a rural region. The department is responsible for the mental health care of three counties with altogether 807 000 inhabitants. The development of this system of care was due in great part to the model program of the German Federal Government for the reform of mental health care that comprised 14 model regions, out of which the region of Marburg and its surrounding counties was the only one with a focus on the situation of psychiatrically ill children and adolescents. With the aid of this model program, a comprehensive evaluation of existing psychiatric services was carried out and at the same time, new services for this clientele were established such as a mobile child and adolescent psychiatric service and a day hospital. A particular focus was laid on the development of a complete network of psychiatric services with manifold, and over the years well proven, cooperation measures. Finally, the quality of mental health care was significantly increased by a continuous evaluation of services and the implementation of two institutes for psychotherapeutic training. Several research initiatives in the field of social psychiatry have contributed to this amelioration and at the same time, to a successful integration of mental health care and research.

Prevalence of movement disorders in adolescent patients with schizophrenia and in relationship to predominantly atypical antipsychotic treatment.

OBJECTIVE: To examine prevalence of movement disorders (MDs) such as tardive dyskinesia (TD), parkinsonism or akathisia in an adolescent population with schizophrenia and in relationship to predominantly atypical antipsychotic treatment. METHOD: Ninety-three patients (aged 19.6+/-2.2 years) were ascertained in this cross-sectional/retrospective study. 76 patients (81.7%) received atypical, 10 (10.8%) typical antipsychotics and 7 (7.5%) combinations of atypical/typical antipsychotics. MD symptoms were assessed using Tardive Dyskinesia Rating Scale (TDRS), Abnormal Involuntary Movement Scale (AIMS), Extrapyramidal Symptom Scale (EPS), Barnes Akathisia Scale (BAS). RESULTS: Movement disorder symptoms were found in 37 patients (39.8%) fulfilling strict/subthreshold criteria for TD (5.4/11.8%), parkinsonism (2.2/25.8%) or akathisia (1.1/11.8%), respectively. Patients treated with typical antipsychotics displayed a significantly higher EPS-score (P=0.036) and a tendency towards a higher BAS-score (P=0.061) compared to patients with atypical antipsychotics. Treatment durations with typical/atypical antipsychotics showed trends towards advantages of atypical antipsychotics with regard to parkinsonism/akathisia symptoms (P=0.061; P=0.054), but not with regard to TD symptoms (P=0.003), possibly due to confounding effects. CONCLUSION: Under treatment with atypical antipsychotics MD symptoms are less prevalent and less pronounced than under typical antipsychotics. We speculate that the finding of relatively high prevalence rates of subthreshold MD symptoms may be, at least partially, explained by previous or combined therapy with typical antipsychotics.

MRI of merkel cell carcinoma: histologic correlation and review of the literature.

OBJECTIVE: The objective of this study was to determine the MRI characteristics of Merkel cell carcinoma, with an emphasis on histologic correlation. MATERIALS AND METHODS: The demographic information about 15 patients from our institution and their MRI examinations were retrospectively reviewed by three musculoskeletal radiologists by consensus for lesion location and intrinsic characteristics. The study group was composed of three women and 12 men who ranged in age from 48 to 87 years, with a mean age of 75 years. Histology results of resected specimens were reviewed in all cases and were correlated with imaging. RESULTS: MRI showed skin thickening, subcutaneous reticular stranding (n = 9, 60%); multiple anatomically aligned subcutaneous soft-tissue masses, representing lymphatic tumor nodules (n = 5, 33%); lymph node enlargement with fine, compressed, retained fatty tissue (n = 5, 33%); nodal necrosis (n = 1); and perifascial and intramuscular metastases (n = 2). Histology confirmed the lymphatic nature of the soft-tissue Merkel cell tumors. CONCLUSION: Patients with Merkel cell tumors may present at imaging with subcutaneous lymphatic reticular stranding, multiple subcutaneous masses, and lymph node metastases. Often there is massive lymph node enlargement with fine, compressed, retained fatty tissue.

Long-term course of adolescent schizophrenia.

Our study investigated premorbid functioning, course, and outcome in early-onset schizophrenia. All inpatients with DSM-III-R diagnoses of schizophrenia (n = 101) consecutively admitted between 1983 and 1988 to the Department of Child and Adolescent Psychiatry at the University of Marburg in Germany were included. To assess premorbid adaptation and precursor symptoms, we administered the Instrument for the Retrospective Assessment of the Onset of Schizophrenia, which we modified to assess children and adolescents. Symptomatology was measured by the Scale for the Assessment of Negative Symptoms, the Scale for the Assessment of Positive Symptoms, and the Brief Psychiatric Rating Scale. In addition, the Global Assessment of Functioning was applied. Followup data for 81 patients (80.2%) were available. The mean duration of schizophrenia at followup was 9.5 +/- 2.2 years. Assessment of the highest level of adaptive functioning revealed very good or good outcome in 19.8 percent of the patients, fair or poor outcome in 38.2 percent, and very poor outcome and gross impairment in 42.0 percent. Premorbid adjustment was the best predictor of outcome in our schizophrenia sample. A poor prognosis was found in patients with premorbid developmental delays and those who were introverted and withdrawn before their psychotic state.

MR imaging of avascular scaphoid nonunion before and after vascularized bone grafting.

OBJECTIVE: To investigate the magnetic resonance (MR) imaging appearances of chronic nonunion of the scaphoid with proximal pole avascular necrosis before and after insertion of a vascularized bone graft, using computed tomography (CT) as the imaging gold standard. DESIGN AND PATIENTS: A retrospective study was performed involving MR imaging (n=26), CT scans (n=37) and radiographs (n=52) of 13 men (mean age 29 years, age range 20-38 years) with avascular scaphoid nonunion. Avascular necrosis of the scaphoid proximal pole was confirmed intraoperatively (n=13). MR images were acquired preoperatively and following placement of a vascularized bone graft. Scaphoid MR signal characteristics were assessed for evidence of vascular bone graft incorporation and revascularization of the bone marrow of the proximal pole of the scaphoid and compared with the gold standard of CT. Surgical and clinical notes were reviewed with a minimum 3 year imaging and clinical follow-up in all patients. RESULTS: Graft incorporation with revascularization of the proximal pole of the scaphoid was documented in 9 patients (69%). Graft failure with persistent pseudoarthrosis and avascular necrosis of the scaphoid was seen in 4 patients (31%). CONCLUSIONS: MR imaging is useful to determine whether vascularized bone graft incorporation and revascularization of the proximal pole of the scaphoid has occurred in the setting of avascular scaphoid nonunion.

Lack of association between the -759C/T polymorphism of the 5-HT2C receptor gene and clozapine-induced weight gain among German schizophrenic individuals.

Weight gain is a major side effect of treatment with clozapine and other antipsychotics. Recent studies suggest an important role of the serotonin type 2C receptor gene (5-HT2CR) in antipsychotic-induced weight gain. However, investigations pertaining to a possible association between a -759C/T polymorphism (C allele) of the 5-HT2CR and weight gain induced by clozapine and/or other antipsychotics have yielded inconsistent results. We investigated the -759C/T polymorphism of the 5-HT2CR in relation to clozapine-induced change in body mass index (BMI) (kg/m) in 97 German patients with schizophrenia and found no association between the -759C allele and weight gain after 12 weeks of clozapine treatment. In addition, confounding effects of initial BMI, age, sex and duration of illness on change in BMI could not be detected by multiple linear regression analysis. Our data do not support an involvement of the -759C/T polymorphism of the 5-HT2CR in clozapine-induced weight gain in German patients with schizophrenia. Further pharmacogenetic studies pertaining to antipsychotic-induced weight gain are warranted.

Fatal pericardial tamponade after Wallstent implantation for malignant superior vena cava syndrome.

PURPOSE: To report a rare, fatal complication of superior vena cava Wallstent implantation. CASE REPORT: A 59-year-old man presenting with superior vena cava syndrome caused by small-cell lung cancer underwent stent implantation of 2 kissing Wallstents >1.5 cm above the right atrium. Despite correct stent deployment, vessel perforation occurred in a section not encased by tumor, which led to fatal pericardial tamponade shortly after the procedure. Autopsy revealed perforation of a stent strut through the caval wall into the pericardial space. Anatomical and methodological reasons are discussed. CONCLUSIONS: The interventionist should be aware of this rare complication. Alternative stent designs avoiding the sharp ends of Wallstents and Palmaz stents should be considered.