Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 68
Filtrar
1.
Psychiatr Serv ; : appips202000166, 2020 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-32321388

RESUMO

This Open Forum focuses on specific challenges, contingency planning considerations, and downstream impacts of COVID-19 on inpatient psychiatric care. COVID-19 is a novel coronavirus that has been declared a pandemic. Challenges for inpatient psychiatry include risky close contact among staff and patients, space constraints, and structural barriers in care delivery. Nuanced considerations of five contingency planning strategies in response to COVID-19 are described, including COVID-19-specific precautions, visitor restrictions, physician workforce considerations, operational adjustments, and group therapy changes. Organized leadership and clear communication are identified as early priorities in pandemic response to minimize misinformation and address immediate challenges.

2.
Stereotact Funct Neurosurg ; : 1-7, 2020 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-32348997

RESUMO

BACKGROUND: The subthalamic nucleus (STN) is a common target for deep brain stimulation (DBS) in Parkinson's disease (PD) and is believed to serve a role in sensorimotor integration. In addition to therapeutic neuromodulation, DBS facilitates the recording of local-field potentials (LFPs) in order to further understand the neurophysiological basis of disease. The capacity to wirelessly transmit these signals in real time has overcome the obstacle of externalization of electrodes during LFP recordings. OBJECTIVE: Using the G102RS device (PINS Medical, China), we investigated the LFP changes in response to mechanical pain stimulation to further elucidate the representation of pain sensation in the basal ganglia. METHODS: LFPs from 2 patients who had undergone bilateral STN-DBS were wirelessly recorded during no stimulation, low-frequency stimulation (60 and 90 Hz), and high-frequency stimulation (130 and 150 Hz) while introducing painful and nonpainful stimuli. Power spectral analysis was conducted to compare the changes in ß frequency (13-30 Hz) during each stimulus. RESULTS: During painful stimuli, STN power spectra (n = 4) revealed a significant increase in ß activity compared to non-painful and no-stimulus epochs. Both low- and high-frequency stimulation produced a significant decrease in pain-related ß activity. CONCLUSION: These 2 cases have demonstrated the potential for acute noxious stimuli to exacerbate pathologic ß oscillatory activity in the STN. Our findings represent novel evidence of the neurophysiologic representation of pain in the STN of PD patients.

3.
Nanomaterials (Basel) ; 10(2)2020 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-32085553

RESUMO

The carbon supercapacitance strongly relies upon the electrolyte's nature, but the clear-cut structure-performance nexus remains elusive. Herein, a series of bio-carbons with gradually varied pore structure and surface chemistry are derived using a new salt template protocol (with eco-benign KNO3 as the template, activator, and porogen, and cheap gelatin as the carbon precursor), and are used as model systems to probe the dependence of the electrochemical mechanism of such nanocarbons on two typical electrolytes (KOH and EMIBF4). By only adjusting the KNO3 dosage, two pivotal figures of merit of biochar-multiscale porosity and surface functionalization-were finely modulated to construct electric double layers. Electrochemical data clarify that the combined porosity and doping effects all contribute to enhanced supercapacitance, but with only one of the two factors playing the leading role in different electrolytes. Kinetic analysis corroborates the fact that ample heteroatom doping can effectively compensate capacitance by intensive surface redox insertion in KOH, while a suitable pore size dispersion plays a preponderant part in self-amplifying the ion partitioning, and thus dictating a good charge separation in EMIBF4. A quasi-quantitative model of performance-structure relevance in EMIBF4 is judiciously conjectured to hint at a superb ion-pore-size compatibility, in which bi- or mono-layer ion confinement coupling in integrated single and double ion-sized pores is found to be more useful for curbing notorious over-screening effects and for changing the coordination number, Coulombic ordering, and phase conformation of EMIBF4 in several nm-sized nanopores. This unique energy storage fashion in ion-matching pores promotes the energy density of optimal samples to a novel level of 88.3 Wh kg-1 at 1 kW kg-1, which rivals the overwhelming majority of the reported carbon materials. In short, the comparison case study here reveals a valuable correlation of carbon's figure of merit and electrolyte type, which may act as a vital rudder to design electrolyte-contingent state-of-the-art supercapacitor materials.

4.
Am J Geriatr Psychiatry ; 28(2): 226-236, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31340887

RESUMO

Substance use disorders (SUDs) among older persons are among the fastest growing health problems in the United States. The number of older persons is projected to exceed 72.1 million persons by 2030, following a trend of general population growth in the mid-1940s to 1960s. The generation, known as "baby boomers," who refashioned drug use during their 20-30s, are increasingly continuing drug habits into later life. This review aims to assess the epidemiology, impact, and treatment of geriatric SUDs. Academic databases including PubMed, PsychInfo, Ovid, and Medline, were queried up to December 2018 for terms of "geriatric," "older," "elderly," "substance abuse," "drug," "drug use," "drug abuse," "drug dependency," "illicit drugs," and "geriatric psychiatry." Articles identified included 17 government documents, 29 studies based upon government documents, 43 studies not related to US government surveys, 19 review articles, 9 commentary pieces, 4 newspaper articles, 2 textbooks, and 1 published abstract. Evaluated studies and documents together suggest that older individuals are using illicit drugs and meeting criteria for SUDs at higher rates than previous geriatric cohorts resulting in substantial negative impacts on medical and psychiatric conditions. These findings represent a novel trend since previous cohorts of older individuals were thought to rarely use illicit substances. Current treatment models are inadequate to address the new wave of older individuals with SUDs. The fields of geriatrics, addiction, and geriatric psychiatry must work together to establish comprehensive care models and treatment modalities for addressing this emerging public health concern.

5.
Trials ; 20(1): 749, 2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31856908

RESUMO

BACKGROUND: Deep-brain stimulation targeting the subthalamic nucleus (STN) can be used to treat motor symptoms and dyskinesia in the advanced stages of Parkinson's disease (PD). High-frequency stimulation (HFS) of the STN can lead to consistent, long-term improvement of PD symptoms. However, the effects of HFS on the axial symptoms of PD, specifically freezing of gait, can be limited or cause further impairment. While this can be alleviated via relatively low-frequency stimulation (LFS) in selected patients, LFS does not control all motor symptoms of PD. Recently, the National Engineering Laboratory for Neuromodulation reported preliminary findings regarding an efficient way to combine the advantages of HFS and LFS to form variable-frequency stimulation (VFS). However, this novel therapeutic strategy has not been formally tested in a randomized trial. METHODS/DESIGN: We propose a multicenter, double-blind clinical trial involving 11 study hospitals and an established deep-brain stimulation team. The participants will be divided into a VFS and a constant-frequency stimulation group. The primary outcome will be changes in stand-walk-sit task scores after 3 months of treatment in the "medication off" condition. Secondary outcome measures include specific item scores on the Freezing of Gait Questionnaire and quality of life. The aim of this trial is to investigate the efficacy and safety of VFS compared with constant-frequency stimulation. DISCUSSION: This is the first randomized controlled trial to comprehensively evaluate the effectiveness and safety of VFS of the STN in patients with advanced PD. VFS may represent a new option for clinical treatment of PD in the future. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03053726. Registered on February 15, 2017.

6.
Nanomaterials (Basel) ; 9(12)2019 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-31766673

RESUMO

Supercapacitors have the rapid charge/discharge kinetics and long stability in comparison with various batteries yet undergo low energy density. Theoretically, square dependence of energy density upon voltage reveals a fruitful but challenging engineering tenet to address this long-standing problem by keeping a large voltage window in the compositionally/structurally fine-tuned electrode/electrolyte systems. Inspired by this, a facile salt-templating enables hierarchically porous biochars for supercapacitors filled by the high-voltage ionic liquids (ILs). Resultant nanostructures possess a coherent/interpenetrated framework of curved atom-thick sidewalls of 0.8-/1.5-nanometer pores to reconcile the pore-size-dependent adlayer structures of ILs in nanopores. Surprisingly, this narrow dual-model pore matches ionic radii of selected ILs to accommodate ions by unique coupled nano-/bi-layer nanoconfinements, augmenting the degree of confinement (DoC). The high DoC efficiently undermines the coulombic ordering networks and induces the local conformational oscillations, thus triggering an anomalous but robust charge separation. This novel bi-/mono-layer nanoconfinement combination mediates harmful overscreening/overcrowding effects to reinforce ion-partitioning, mitigating long-lasting conflicts of power/energy densities. This interesting result differs from a long-held viewpoint regarding the sieving effect that ion-in-pore capacitance peaks only if pore size critically approaches the ion dimension. Optimal biocarbon finally presents a very high/stable operational voltage up to 4 V and specific energy/power rating (88.3 Whkg-1 at 1 kWkg-1, 47.7 Whkg-1 albeit at a high battery-accessible specific power density of 20 kWkg-1), overwhelmingly outperforming most hitherto-reported supercapacitors and some batteries. Such attractive charge storage level can preliminarily elucidate an alternative form of a super-ionic-state high-energy storage linked with both the coordination number and coulombic periodism of the few ion-sized mesopores inside carbon electrodes, escalating supercapacitors into a novel criterion of charge delivery.

7.
Psychiatr Clin North Am ; 42(4): 597-609, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31672210

RESUMO

Self-help and automated technologies can be useful for behavioral and mental health education and interventions. These technologies include interactive media, online courses, artificial intelligence-powered chatbots, voice assistants, and video games. Self-help media can include books, videos, audible media like podcasts, blog and print articles, and self-contained Internet sites. Social media, online courses, and mass-market mobile apps also can include such media. These technologies serve to decrease geospatial, temporal, and financial barriers. This article describes different self-help and automated technologies, how to implement such technologies in existing clinical services, and how to implement according to patient needs.

8.
IEEE Trans Neural Syst Rehabil Eng ; 27(10): 1952-1961, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31502982

RESUMO

Non-volitional discontinuation of motion, namely bradykinesia, is a common motor symptom among patients with Parkinson's disease (PD). Evaluating bradykinesia severity is an important part of clinical examinations on PD patients in both diagnosis and monitoring phases. However, subjective evaluations from different clinicians often show low consistency. The research works that explore objective quantification of bradykinesia are mostly based on highly-integrated sensors. Although these sensor-based methods demonstrate applaudable performance, it is unrealistic to promote them for wide use because the special devices they require are far from popularized in daily lives. In this paper, we take advantage of computer vision and machine learning technologies, proposing a vision-based method to automatically and objectively quantify bradykinesia severity. Three bradykinesia-related items are investigated in our study: finger tapping, hand clasping and hand pro/supination. In our method, human pose estimation technology is utilized to extract kinematic characteristics and supervised-learning-based classifiers are employed to generate score ratings. Clinical experiment on 60 patients shows that the scoring accuracy of our method over 360 examination videos is 89.7%, which is competitive with other related works. The devices our method requires are only a camera for instrumentation and a laptop for data processing. Therefore, our method can produce reliable assessment results on Parkinsonian bradykinesia with minimal device requirement, showing great potential of realizing long-term remote monitoring on patients' condition.

9.
Psychiatr Serv ; 70(8): 674-680, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31035893

RESUMO

OBJECTIVE: Psychosocial rehabilitation has been established as a critical component of client-centered recovery-oriented services for people with serious mental illness. Despite its importance, the implementation of mental health rehabilitation services in low- or middle-income countries has not been well studied. In this study, the authors document the regional challenges of planning and implementing mental health rehabilitation services in clubhouses in Hunan Province in the People's Republic of China. METHODS: Participants were purposively selected and consisted of diverse stakeholders, including rehabilitation directors and psychiatric hospital leaders in Hunan Province, China. Information was collected from 33 individuals by using three focus groups, 23 semistructured interviews of key informants, and participant observation. Interview transcripts were coded and analyzed by using standard qualitative methods. RESULTS: Implementation challenges were characterized by four themes: skepticism toward psychosocial rehabilitation services, resource shortage, insufficient system integration and incentives, and stigma of mental illness. CONCLUSIONS: Psychosocial rehabilitation is an emerging public health priority in China. This study on clubhouses in Hunan Province used qualitative methods to inform future directions for service development and research. Early identification of regional implementation challenges is a first step in assessing the applicability of psychosocial rehabilitation services locally in Hunan Province. Successful implementation of clubhouse psychosocial rehabilitation services will benefit not only from strong government commitment but also from developing standard evaluations of evidence-based practices, tackling stigma, and addressing low resource investment.

10.
Trials ; 20(1): 44, 2019 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-30642370

RESUMO

BACKGROUND: Recent clinical observations have reported the potential benefit of vagus nerve stimulation (VNS) as an adjunctive therapy for pediatric epilepsy. Preliminary evidence suggests that VNS treatment is effective for seizure reduction and mental development in young participants between 3 and 6 years of age who suffer from intractable epilepsy. However, robust clinical evidence for quantifying the difference of the efficacy and safety of VNS treatment in this specific patient population has yet to be reported. METHODS/DESIGN: A two-armed, multicenter, randomized, double-blind, prospective trial will be carried out to evaluate whether VNS is beneficial and safe for pediatric epilepsy. Pediatric participants aged between 3 to 6 years old with intractable epilepsy will be recruited and randomly assigned to experimental and control groups with a 1:1 allocation using a computer-generating randomization schedule. Before enrollment, informed consent will be signed by the parents of the participants and the study researchers. Participants in the experimental group will receive electrical stimulation over 24 weeks under standard stimulation parameters. Participants in the control group will not receive any stimulation during the 12 weeks of the double-blind period. The guardians of the participants are required to keep a detailed diary to record seizure activity. Outcome assessments including seizure frequency, Gesell Mental Developmental Scale scores, use of antiepileptic drugs and dosages, and adverse events will be collected at baseline, 6, 12, 18 and/or 24 weeks after electrical stimulation is initiated. The effects of treatment will be analyzed with time and treatment group comparisons. DISCUSSION: This trial will evaluate quantitative differences in efficacy and safety with/without VNS treatment for pediatric participants aged between 3 to 6 years with intractable epilepsy and will explore whether the current age range of VNS therapy can be expanded. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03062514 , Registered on 23 February 2017.


Assuntos
Ondas Encefálicas , Encéfalo/fisiopatologia , Epilepsia Resistente a Medicamentos/terapia , Estimulação do Nervo Vago , Fatores Etários , Criança , Comportamento Infantil , Desenvolvimento Infantil , Pré-Escolar , Método Duplo-Cego , Epilepsia Resistente a Medicamentos/diagnóstico , Epilepsia Resistente a Medicamentos/fisiopatologia , Feminino , Humanos , Masculino , Estudos Multicêntricos como Assunto , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento , Estimulação do Nervo Vago/efeitos adversos
11.
IEEE Trans Neural Syst Rehabil Eng ; 27(2): 118-128, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30605104

RESUMO

Deep brain stimulation (DBS) is an established treatment for patients with Parkinson's disease (PD). Sleep disorders are common complications of PD and affected by subthalamic DBS treatment. To achieve more precise neuromodulation, chronicsleepmonitoringand closed-loop DBS toward sleep-wake cycles could potentially be utilized. Local field potential (LFP) signals that are sensed by the DBS electrode could be processed as primary feedback signals. This is the first study to systematically investigate the sleep-stage classification based on LFPs in subthalamic nucleus (STN). With our newly developed recording and transmission system, STN-LFPs were collected from 12 PD patients during wakefulness and nocturnal polysomnography sleep monitoring at one month after DBS implantation. Automatic sleep-stage classificationmodels were built with robust and interpretable machine learning methods (support vector machine and decision tree). The accuracy, sensitivity, selectivity, and specificity of the classification reached high values (above90% at most measures) at group and individual levels. Features extracted in alpha (8-13 Hz), beta (13-35 Hz), and gamma (35-50 Hz) bandswere found to contribute the most to the classification. These results will directly guide the engineering development of implantable sleepmonitoring and closed-loopDBS and pave the way for a better understanding of the STN-LFP sleep patterns.


Assuntos
Estimulação Encefálica Profunda , Eletroencefalografia/classificação , Fases do Sono/fisiologia , Núcleo Subtalâmico/fisiologia , Adulto , Idoso , Algoritmos , Árvores de Decisões , Eletrodos Implantados , Feminino , Humanos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/terapia , Polissonografia , Máquina de Vetores de Suporte , Vigília/fisiologia
12.
Clin Auton Res ; 29(2): 195-204, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30328033

RESUMO

OBJECTIVE: Epilepsy and seizures can have dramatic effects on cardiac function. The aim of the present study was to investigate deceleration capacity, acceleration capacity and their 24-h fluctuations of heart rate variability in patients with drug-resistant epilepsy. METHODS: Deceleration capacity, acceleration capacity of heart rate and their 24-h dynamics derived from the phase rectified signal averaging method as well as traditional measures were analyzed in 39 patients with drug-resistant epilepsy and 33 healthy control subjects using 24-h electrocardiogram recordings. The discriminatory power of heart rate variability measures were validated by assessment of the area under the receiver operating characteristic curve. Net reclassification improvement and integrated discrimination improvement models were also estimated. RESULTS: Both deceleration capacity and absolute values of acceleration capacity were significantly lower in patients with drug-resistant epilepsy. The abnormal suppression of absolute deceleration capacity and acceleration capacity values were observed throughout the 24-h recording time (peaked at about 3 to 5 A.M.). Deceleration capacity had the greatest discriminatory power to differentiate the patients from the healthy controls. Moreover, in both net reclassification improvement and integrated discrimination improvement models, the combination of acceleration capacity or deceleration capacity with traditional heart rate variability measures has greater discriminatory power than any of the single heart rate variability features. INTERPRETATION: Drug-resistant epilepsy was associated with a significant inhibition of vagal modulation of heart rate, which was more pronounced during the night than during the day. These findings indicate that phase rectified signal averaging method may serve as a complementary approach for characterizing and understanding the neuro-pathophysiology in epilepsy, and may provide a new clue to sudden unexpected death in epilepsy.

13.
Conf Proc IEEE Eng Med Biol Soc ; 2019: 1480-1483, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31946173

RESUMO

A general voltage injection testing device is presented to test the immunity of active implantable neurostimulator (INS) to electromagnetic fields over the frequency range 16.6Hz to 80MHz. The proposed device consists of test circuit and transfer tooling, which is designed to conduct Electromagnetic Compatibility (EMC) test of INS with output-only functionality. In the test circuit, a tissue-electrode interface model and its board layout are provided to satisfy impedance continuity and test channel consistency. In order to adapt to different types of stimulators and electrode specifications, transfer circuits and several kinds of transfer tooling are created. In accordance with ISO14708-3, Voltage injection tests have been carried out with the device and an INS with 16 electrodes. The results show that the device can meet test requirements and is useful for EMC test. Besides, the device can provide references for other manufacturers and organizations to accomplish voltage injection test.


Assuntos
Campos Eletromagnéticos , Neuroestimuladores Implantáveis , Impedância Elétrica , Eletrodos
14.
J Microbiol ; 56(12): 886-892, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30484158

RESUMO

Statin response shows great interindividual variations. Recently, emerging studies have shown that gut microbiota is linked to therapeutic responses to drugs, including statins. However, the association between the gut bacteria composition and statin response is still unclear. In this study, gut microbiota of 202 hyperlipidemic patients with statin sensitive (SS) response and statin resistant (SR) response in East China were investigated by high throughput sequencing to compare the gut bacteria composition and biodiversity in distinct statin response patients. Higher biodiversity was detected in Group SS than Group SR. Specifically, group SS showed significantly increased proportion of genera Lactobacillus (P = 0.001), Eubacterium (P = 0.004), Faecalibacterium (P = 0.005), and Bifidobacterium (P = 0.002) and decreased proportion of genus Clostridium (P = 0.001) compared to Group SR. The results indicated that higher gut biodiversity was associated with statin sensitive response. The increased genera Lactobacillus, Eubacterium, Faecalibacterium, Bifidobacterium, and decreased genus Clostridium in patient gut microbiota may predict patient's statin response, and hence may guide statin dosage adjustments.


Assuntos
Bactérias/classificação , Bactérias/efeitos dos fármacos , Microbioma Gastrointestinal/efeitos dos fármacos , Trato Gastrointestinal/microbiologia , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Bactérias/genética , Bifidobacterium/efeitos dos fármacos , Biodiversidade , China , Clostridium/efeitos dos fármacos , DNA Bacteriano/genética , Eubacterium/efeitos dos fármacos , Faecalibacterium/efeitos dos fármacos , Fezes/microbiologia , Microbioma Gastrointestinal/genética , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Hipercolesterolemia/tratamento farmacológico , Lactobacillus/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade
15.
Opt Express ; 26(19): 24940-24952, 2018 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-30469602

RESUMO

A novel insulator string leakage current-monitoring sensor based on a fiber Bragg grating (FBG), cantilever beam, and spiral coil is demonstrated. The spiral coil is used to convert the leakage current into the force exerted on the cantilever structure, which is obtained by measuring the strain of the FBG. Experimental results show that the linear regression correlation coefficient is 0.99964. In addition, although the leakage current measurement is not sufficiently accurate, the 50-Hz component measurement is accurate. The sensor is suitable for use as an insulator string flashover warning and has promising prospects for future grid security protection applications.

16.
IEEE Trans Neural Syst Rehabil Eng ; 26(11): 2189-2199, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30334764

RESUMO

The timed up-and-go (TUG) test has been widely accepted as a standard assessment for measuring the basic functional mobility of patients with Parkinson's disease. Several basic mobility sub-tasks "Sit," "Sit-to-Stand," "Walk," "Turn," "Walk-Back," and "Sit-Back" are included in a TUG test. It has been shown that the time costs of these sub-tasks are useful clinical parameters for the assessment of Parkinson's disease. Several automatic methods have been proposed to segment and time these sub-tasks in a TUG test. However, these methods usually require either well-controlled environments for the TUG video recording or information from special devices, such as wearable inertial sensors, ambient sensors, or depth cameras. In this paper, an automatic TUG sub-task segmentation method using video-based activity classification is proposed and validated in a study with 24 Parkinson's disease patients. Videos used in this paper are recorded in semi-controlled environments with various backgrounds. The state-of-the-art deep learning-base 2-D human pose estimation technologies are used for feature extraction. A support vector machine and a long short-term memory network are then used for the activity classification and the subtask segmentation. Our method can be used to automatically acquire clinical parameters for the assessment of Parkinson's disease using TUG videos-only, leading to the possibility of remote monitoring of the patients' condition.


Assuntos
Limitação da Mobilidade , Doença de Parkinson/classificação , Doença de Parkinson/fisiopatologia , Idoso , Algoritmos , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Postura , Reprodutibilidade dos Testes , Máquina de Vetores de Suporte , Gravação em Vídeo , Caminhada
17.
Curr Psychiatry Rep ; 20(10): 85, 2018 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-30155593

RESUMO

PURPOSE OF REVIEW: Mental health clinicians should understand how technologies augment, enhance, and provide alternate means for the delivery of mental healthcare. These technologies can be used asynchronously, in which the patient and the clinician need not be communicating at the same time. This contrasts with synchronous technologies, in which patient and clinician must communicate at the same time. RECENT FINDINGS: The review is based on research literature and the authors' clinical and healthcare administration experiences. Asynchronous technologies can exist between a single clinician and a single patient, such as patient portal e-mail and messaging, in-app messaging, asynchronous telepsychiatry via store-and-forward video, and specialty patient-to-provider mobile apps. Asynchronous technologies have already been used in different countries with success, and can alleviate the psychiatric workforce shortage and improve barriers to access. Multiple studies referred to in this review demonstrate good retention and acceptability of asynchronous psychotherapy interventions by patients. Asynchronous technologies can alleviate access barriers, such as geographical, scheduling, administrative, and financial issues. It is important for clinicians to understand the efficacy, assess the ethics, and manage privacy and legal concerns that may arise from using asynchronous technologies.


Assuntos
Saúde Mental , Aplicativos Móveis , Psiquiatria/métodos , Telemedicina/métodos , Humanos , Psicoterapia
18.
Epilepsy Res ; 146: 151-159, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30165244

RESUMO

OBJECTIVE: The aim of this study was to investigate the variations and the circadian rhythm of multi-domain parameters of heart rate variability (HRV) in patients with drug-resistant epilepsy. METHODS: Time domain HRV parameters of 24-hour data, frequency and non-linear domain HRV parameters were calculated using a 24-hour ambulatory electrocardiogram (ECG) from subjects in a resting and awake state (5-min data from 9:00-10:00 a.m.). Circadian fluctuation (24 one-hour segments) and the night (00:00 - 05:00)/ day (07:30 - 09:30) ratio of each HRV parameter were measured in (i) refractory epilepsy (n = 51) and (ii) healthy, age and sex matched controls (n = 50). Cosinor fit method was used to quantify the pattern of the circadian rhythm of HRV. RESULTS: Compared to healthy controls, patients with drug-resistant epilepsy had significantly decreased time domain (mean_RR, STDRR, RMSSD, pNN50, HRV_triangular_index), frequency domain (VLF_power, LF_power, HF_power, Total_power) and non-linear domain (Poincaré SD1, SD2, D2) HRV measurements. There were also overall reductions in amplitude and the baseline of circadian curves of HRV parameter in the patients group, especially nocturnal inhibition of cardiac autonomic modulations was stronger than that in daytime. The majority of differences in HRV values between the two groups reached a maximum in early morning (usually 5:00 or 6:00 a.m.). No significant differences were found in the night/day ratios of multi-domain HRV measurements between patients and healthy controls (p = 0.862). CONCLUSIONS: The significant suppression of HRV parameters in patients with refractory epilepsy may reflect the inhibitions of both sympathetic and parasympathetic activities. This is notably the first time that marked circadian diversity of HRV measurments between the patient and control groups were found and quantified by cosinor fit method. The difference in amplitude increased during night with peak occurrence between 5:00 or 6:00 a.m. These findings may be linked to cardiac autonomic dysfunction and subsequent sudden unexpected death in epilepsy (SUDEP), which is reported to often occur during night or early morning. Taken together, HRV parameters may be potential bio-markers for predicting SUDEP.


Assuntos
Ritmo Circadiano , Epilepsia Resistente a Medicamentos/fisiopatologia , Frequência Cardíaca , Adolescente , Adulto , Sistema Nervoso Autônomo/fisiopatologia , Criança , Ritmo Circadiano/fisiologia , Eletrocardiografia Ambulatorial , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino , Fotoperíodo , Descanso/fisiologia , Vigília/fisiologia , Adulto Jovem
19.
J Mech Phys Solids ; 112: 187-208, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29713095

RESUMO

Micro-electromechanical systems (MEMS) that rely on structural vibrations have many important applications, ranging from oscillators and actuators, to energy harvesters and vehicles for measurement of mechanical properties. Conventional MEMS, however, mostly utilize two-dimensional (2D) vibrational modes, thereby imposing certain limitations that are not present in 3D designs (e.g., multi-directional energy harvesting). 3D vibrational microplatforms assembled through the techniques of controlled compressive buckling are promising because of their complex 3D architectures and the ability to tune their vibrational behaviour (e.g., natural frequencies and modes) by reversibly changing their dimensions by deforming their soft, elastomeric substrates. A clear understanding of such strain-dependent vibration behaviour is essential for their practical applications. Here, we present a study on the linear and nonlinear vibration of such 3D mesostructures through analytical modeling, finite element analysis (FEA) and experiment. An analytical solution is obtained for the vibration mode and linear natural frequency of a buckled ribbon, indicating a mode change as the static deflection amplitude increases. The model also yields a scaling law for linear natural frequency that can be extended to general, complex 3D geometries, as validated by FEA and experiment. In the regime of nonlinear vibration, FEA suggests that an increase of amplitude of external loading represents an effective means to enhance the bandwidth. The results also uncover a reduced nonlinearity of vibration as the static deflection amplitude of the 3D structures increases. The developed analytical model can be used in the development of new 3D vibrational microplatforms, for example, to enable simultaneous measurement of diverse mechanical properties (density, modulus, viscosity etc.) of thin films and biomaterials.

20.
Epilepsy Behav ; 83: 168-174, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29709876

RESUMO

OBJECTIVE: Vagus nerve stimulation (VNS) is an adjunctive treatment in drug-resistant epilepsy. The alterations in heart rate dynamics through VNS are not well understood. This study aimed to determine changes in heart rhythm complexity in association with VNS and to relate the findings to the outcome of VNS treatment in patients with drug-resistant epilepsy. METHODS: We prospectively analyzed 32 patients with drug-resistant epilepsy, who underwent VNS implantation, and 32 age- and sex-matched healthy control subjects. The interictal heartbeat intervals were analyzed using the heart rhythm complexity with multiscale entropy (MSE) and traditional heart rate variability (HRV) analyses based on ambulatory 24-hour electrocardiograms (ECGs). RESULTS: Patients had significantly decreased complexity indices (Slope 5, Area 1-5, Area 6-15, Area 6-20) on MSE analysis and decreased HRV measurements (standard deviation of the heartbeat interval (SDNN), square root of the mean of sum of squares of the differences between adjacent RR intervals (RMSSD), pNN50, very low frequency (VLF), low frequency (LF), high frequency (HF), total power (TP)) in time and frequency domain analyses. After one year of VNS treatment in patients with drug-resistant epilepsy, there was a trend in an elevated MSE profile with significant higher values between the scales 1 and 9. Vagus nerve stimulation induces a more significant increase of MSE in VNS responders than those in the nonresponders. The conventional HRV measurements did not change. CONCLUSION: Our results suggest that heart rhythm complexity is impaired in patients with drug-resistant epilepsy, and this is at least partially reversed by VNS treatment. Furthermore, VNS-induced effects on heart rate complexity may be associated with the therapeutic response to VNS in patients with drug-resistant epilepsy.


Assuntos
Epilepsia Resistente a Medicamentos/diagnóstico , Epilepsia Resistente a Medicamentos/terapia , Entropia , Frequência Cardíaca/fisiologia , Estimulação do Nervo Vago/métodos , Adulto , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Epilepsia Resistente a Medicamentos/fisiopatologia , Eletrocardiografia Ambulatorial/métodos , Eletrocardiografia Ambulatorial/tendências , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Nervo Vago/fisiologia , Estimulação do Nervo Vago/tendências , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA