Colour tunable photoluminescence studies of Dy3+/Eu3+ co-doped BaPbAlFB glasses for epoxy-free w-LED applications.

Barium lead alumino fluoroborate (BaPbAlFB) glasses singly and co-doped with Dy3+ and Eu3+ ions were prepared by melt quench method and studied their photoluminescence (PL) properties along with energy migration. Singly doped Dy3+/Eu3+ ions in BaPbAlFB glasses under 365 and 393 nm excitation wavelengths emit the PL bands through Dy: (4F9/2 → 6H15/2 and 4F9/2 → 6H13/2) and Eu: (5D0→7F2) transitions located at (Dy: 483 and 575 nm) and (Eu: 613 nm) respectively. Further, tunability of PL emissions is achieved by exciting the Dy3+/Eu3+ co-doped BaPbAlFB glasses at various wavelengths. The obtained CIE (0.34, 0.33) and CCT value (5080.4 K) of Dy3+/Eu3+ co-doped BaPbAlFB glass produced white light emission under 365 nm excitation wavelength. The corresponding CCT values of Dy3+/Eu3+ co-doped BaPbAlFB glasses varied from 1580 to 5080 K and their corresponding color emission changes from intense red to white light regime quite suitable for fabrication of epoxy-free w-LED devices.

The relationship between therapeutic alliance, frequency of consultation and uptake of telemedicine among patients seeking treatment for early psychosis: A moderated mediation model.

Background: Telehealth services ensure the delivery of healthcare services to a wider range of consumers through online platforms. Nonetheless, the acceptance and uptake of telehealth remain elusive. This study aims to understand the (a) uptake and (b) acceptability of telemedicine, (c) if therapeutic alliance mediates the relationship between the frequency of consultations with clinicians and the uptake of telemedicine in patients with early psychosis, and (d) role of education in moderating the relationship between therapeutic alliance and the uptake of telemedicine for their mental healthcare. Methods: A convenience sample of outpatients (n = 109) seeking treatment for early psychosis and their care providers (n = 106) were recruited from a tertiary psychiatric care centre. Sociodemographic and clinical characteristics, therapeutic alliance (Working Alliance Inventory), and telemedicine use were captured through self-administered surveys. The moderated mediation analysis was performed using PROCESS macro 3.4.1 with therapeutic alliance and level of education as the mediating and moderating factors, respectively. Results: The acceptance of telemedicine was high (possibly will use: 47.7%; definitely will use: 26.6%) whilst the uptake was low (11%). Therapeutic alliance mediated the relationship between the frequency of consultation and the uptake of telemedicine (ß: 0.326; CI: 0.042, 0.637). This effect was moderated by the level of education (ß: -0.058; p < 0.05). Conclusion: Therapeutic alliance mediates the relationship between the frequency of consultations and the uptake of telemedicine services with the level of education moderating this mediation. Focusing on the patients with lower education to improve their telemedicine knowledge and therapeutic alliance might increase the uptake.

Neurogenic Dysphagia.

This article provides an overview of neurogenic dysphagia, describing the evaluation and management of swallowing dysfunction in various neurologic diseases. The article will focus on stroke, Parkinson's disease, amyotrophic lateral sclerosis, and multiple sclerosis.

Structural Investigation and Optical Properties of Dysprosium (Dy3+) Ions Doped Oxyfluoro Antimony Borate Glasses for Photonics Applications.

Dysprosium oxide-doped glasses with a composition of 60B2O3-10Sb2O3-10Al2O3-10NaF-(10-x) LiF-xDy2O3 (x = 0.1,0.5, 1.0,1.5,2.0,2.5 mol%) were prepared using a conventional melt-quenching technique. The glasses were characterized through various analytical investigations, including X-ray diffraction (XRD), Fourier transform infrared (FTIR) spectroscopy, refractive index, density, optical absorption, excitation, photoluminescence (PL) studies, decay measurements and radiation shielding parameters. The XRD and FT-IR confirms the glassy nature and functional groups present in the titled glass. The absorption spectra were used to determine the oscillator strength of the Dy3+ absorption transitions as well as the bond created with the O-2 ion in the titled glass network. The degree of the suitability of developed glasses for lasing applications was demonstrated by radiative parameters determined using Judd-Ofelt theory. In the prepared glass samples, the optical bandgap measurements indicate the presence of non-bridging oxygen (NBOs), localization of charges and donor centers in the titled glasses. Due to the de-excitation of 4F9/2 to the corresponding 6H15/2,6H13/2 and 6H11/2 states, the PL emission spectrum shows two main strong emissions at blue(480nm), yellow (575nm) and one less emission at red (663nm). The CIE coordinates determined using PL emission spectra reveal the coordinates that are falling within the white light region. Various shielding parameters such as mass attenuation coefficient, mean free path, effective atomic number were estimated to understand the radiative shielding nature of the titled glasses. Within the addition of Dy2O3, it was found that the shielding parameters values of the titled glass samples are increasing. The Mass Attenuation Coefficient, Half Value Layer and Mean Free Path of the as prepared glasses has been compared with different types of concretes to understand the shielding effectiveness of prepared glass.

Towards a youth mental health paradigm: a perspective and roadmap.

Most mental disorders have a typical onset between 12 and 25 years of age, highlighting the importance of this period for the pathogenesis, diagnosis, and treatment of mental ill-health. This perspective addresses interactions between risk and protective factors and brain development as key pillars accounting for the emergence of psychopathology in youth. Moreover, we propose that novel approaches towards early diagnosis and interventions are required that reflect the evolution of emerging psychopathology, the importance of novel service models, and knowledge exchange between science and practitioners. Taken together, we propose a transformative early intervention paradigm for research and clinical care that could significantly enhance mental health in young people and initiate a shift towards the prevention of severe mental disorders.

Mapping the schizophrenia quality of life scale to EQ-5D, HUI3 and SF-6D utility scores in patients with schizophrenia.

OBJECTIVES: The current study aimed to map the disease-specific Schizophrenia Quality of Life Scale (SQLS) onto the three- and five-level EuroQol five-dimension (EQ-5D-3 L and EQ-5D-5 L), Health Utility Index Mark 3 (HUI3) and Short Form six-dimensional (SF-6D) preference-based instruments to inform future cost-utility analyses for treatment of patients with schizophrenia. METHODS: Data from 251 outpatients with schizophrenia spectrum disorders was included for analysis. Ordinary least square (OLS), Tobit and beta regression mixture models were employed to estimate the utility scores. Three regression models with a total of 66 specifications were determined by goodness of fit and predictive indices. Distribution of the original data to the distributions of the data generated using the preferred estimated models were then compared. RESULTS: EQ-5D-3 L and EQ-5D-5 L were best predicted by the OLS model, including SQLS domain scores, domain-squared scores, age, and gender as explanatory predictors. The models produced the best performance index and resembled most closely with the observed EQ-5D data. HUI3 and SF-6D were best predicted by the OLS and Tobit model respectively. CONCLUSION: The current study developed mapping models for converting SQLS scores into generic utility scores, which can be used for economic evaluation among patients with schizophrenia.

The role of patient perceptions and hyperfunctional voice disorders in predicting voice therapy attendance.

OBJECTIVES/HYPOTHESIS: Attendance is essential to voice therapy's effectiveness in the treatment of voice and laryngeal disorders. With such high rates of drop-out and non-attendance, it is important to understand the factors that influence this behavior. This study sought to identify potential predictors of attendance to voice therapy at an interdisciplinary voice clinic. STUDY DESIGN: Single-institution retrospective cohort study. METHODS: In this retrospective cohort study, patients evaluated at an interdisciplinary voice clinic who received a referral for voice therapy were identified. Age, gender, voice-related diagnoses, Voice Handicap Index-10 scores, Reflux Symptom Index scores, and measures of patient perceptions (self-rated severity, importance of voice in one's life, and "feelings about voice therapy") were recorded to evaluate associations with attendance to at least one therapy session. Standard statistical analysis and logistic regressions were performed. RESULTS: Of 168 subjects included, 111 (66.1 %) attended at least one session of voice therapy. Patients diagnosed with primary hyperfunctional voice disorders had a significantly higher attendance rate than other groups. Attenders had higher self-ratings of severity and more positive "feelings about voice therapy" compared to non-attenders. Regression models found three significant predictors of therapy attendance: primary diagnosis of hyperfunctional voice disorder, self-rated severity, and "feelings about voice therapy." CONCLUSION: In this cohort, patients with more positive feelings about voice therapy, higher self-rated severity, and a diagnosis of primary hyperfunctional voice disorder were more likely to attend voice therapy.

An Unexpected Role for Cell Density Rather than IgM in Cell-Surface Display of the Fc Receptor for IgM on Human Lymphocytes.

The Fc receptor for IgM, FcMR, is unusual in that it is preferentially expressed by cells of the adaptive immune system. It is, moreover, the only constitutively expressed Fc receptor on human T cells. Efforts to decipher the normal functions of FcMR have been complicated by species-specific expression patterns in lymphocytes from mice (B cells) versus humans (B, NK, and T cells). In human cells, FcMR cell-surface expression has been reported to be low at baseline ex vivo, with one suggested contribution being ligand-induced internalization by serum IgM. Indeed, preincubation overnight in IgM-free culture medium is recommended for studies of FcMR because surface display is increased under these conditions. We investigated FcMR display on human lymphocytes in PBMCs and found that, surprisingly, cell-surface FcMR was unaffected by IgM abundance and was instead downregulated in high-cell density cultures by a yet undefined mechanism. We further found that ex vivo processing of whole blood decreased surface FcMR, supporting the idea that FcMR expression is likely to be greater on circulating lymphocytes than previously appreciated. Collectively, these findings prompt new predictions of where and when FcMR might be available for functional interactions in vivo.

A cross-sectional study on the frequency and risk factors for neonatal hypoglycemia in babies born in rural Kerala.

Introduction: Glucose is the main source of energy for the developing brain. Hypoglycemia is a commonly encountered and treatable problem in the neonatal period. The newborn baby should be breastfed soon after delivery and continued on demand breastfeeding. As families become nuclear, mothers may not have the necessary skills and knowledge about the importance of exclusive breastfeeding. Health care workers play an important role in preparing the mothers for exclusive breastfeeding and ensuring that the newborn remains euglycemic. Problems encountered during breastfeeding should be corrected on an individual basis, and uninterrupted feeding should be ensured as per BFHI guidelines. Aim: To find out the frequency and risk factors of hypoglycemia and its relation to feeding in babies of GDM mothers, large for gestational age, and small for gestational age babies in a baby-friendly hospital adhering to the BFHI guidelines. Materials and Methods: A single-center, observational study was carried out among 160 consecutively born babies born to mothers with gestational diabetes, large for gestational age and small for gestational age for a period of one year from October 2018 to September 2019. Data was collected using an interviewer administered proforma and from antenatal and postnatal records. Glucose monitoring was done and values were recorded. Data was analysed using SPSS software. Qualitative data was expressed as percentage. and quantitative data was expressed as mean and standard deviation. Association with risk factors was studied using the Chi-squared test. Results: The overall incidence of hypoglycemia was 15.3% in our study. The main risk factors identified were prematurity and small for gestational age. Maximum incidence of hypoglycemia was noted in the first 24 hours after birth. Incidence of hypoglycemia in exclusively breastfed babies was only 10.5% compared to those on formula feeds where breastfeeding was contraindicated due to medical reasons and where the incidence was found to be 33.3%. Incidence of hypoglycemia was 50%. The most common symptoms of hypoglycemia were jitteriness and poor feeding. Eleven per cent of babies had asymptomatic hypoglycemia. In babies detected to have hypoglycemia, prompt treatment with oral feeds or intravenous (IV) dextrose was started. There was no mortality in the study population. Conclusion: Incidence of hypoglycemia was maximum in the first hour of life, highlighting the need to start early feeds and to do meticulous monitoring in high-risk babies like pre-term babies, small for gestational age, large for gestational age and babies of diabetic mothers. The incidence of hypoglycemia in exclusively the breastfed group was 10.5%. This showed that confident and successful breastfeeding with the support of health care staff should be the norm to prevent hypoglycemia, and preparation for breastfeeding should begin right from the antenatal period.

Lifetime Prevalence and Correlates of Schizophrenia and Other Psychotic Disorders in Singapore.

Introduction: The current study aimed to establish the lifetime prevalence of schizophrenia and other psychotic disorders, its sociodemographic correlates and association with physical disorders using data from the Singapore Mental Health Study (SMHS 2016). Methods: A two-phase design comprising population-level screening of psychotic symptoms using the World Health Organization Composite International Diagnostic Interview version 3.0 psychosis screen followed by clinical reappraisal based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria were used to establish the prevalence. Results: A total of 6,126 respondents completed the first phase of the study, giving a response rate of 69.5%. 5.2% (n = 326) of respondents endorsed at least one symptom in the psychosis screen. After the phase two clinical reappraisal interviews and adjusting for false-negative rate, the corrected prevalence of schizophrenia and other psychotic disorders was 2.3% (95% CI: 2.3-2.3%). The odds of having DSM-IV schizophrenia and other psychotic disorders was significantly higher among those of Malay ethnicity (OR = 3.9, 95% CI 1.4-11.0), and those who were unemployed (OR = 4.3, 95% CI 1.2-15.9). 80.4% of those with a psychotic disorder had consulted a doctor or a mental health professional for their symptoms. Conclusions: Our results indicate that approximately 2.3% of Singapore's community-dwelling adult population had a lifetime diagnosis of schizophrenia and other psychotic disorders. While the treatment gap of the disorder was relatively small, the severe nature of the disorder emphasizes the need for continued outreach and early diagnosis and treatment.

White light emission from Dy3+-doped ZnO + Bi2O3 + BaF2 + B2O3 + TeO2 glasses: Structural and spectroscopic properties.

The ZnO + Bi2O3 + BaF2 + B2O3 + TeO2 (ZnBiBaBFTe) host glass was prepared by melt quenching technique with the aim of achieving white light emission from Dy3+ ions. Their structural and spectroscopic properties were systemically investigated by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), UV-Visible absorption, emission spectra and decay times. Judd-Ofelt (JO) parameters (Ωλ) evaluated from absorption spectrum were utilized to calculate the radiative parameters for 4F9/2 level of Dy3+ ions. The optical band gap energy of as-prepared glasses were calculated for the indirect, (αhυ)1/2 and direct, (αhυ)2 allowed transitions. The emission spectra of Dy3+:ZnBiBaBFTe glasses showed two intense peaks at 575 nm (4F9/2→6H13/2) and 481 nm (4F9/26H15/2) upon 386 nm excitation. The highest emission intensity was observed at 1.0 mol% of Dy3+ for 4F9/2→6H13/2 transition and the results are used in conjunction with lifetime measurements to derive spectroscopic parameters for the stimulated emission cross-section (25.2 × 10-22 cm2), gain bandwidth (5.86 × 10-28 cm3), and favourable quantum efficiency (74.2%). Moreover, white light can be realized with a CIE coordinates by adjusting the concentration of Dy3+ ions in ZnBiBaBFTe host glass. Efficient spectroscopic values and realizable white lighting in Dy3+-doped ZnBiBaBFTe glasses may have potential applications in laser illumination devices.

Antiobesity efficacy of asiatic acid: down-regulation of adipogenic and inflammatory processes in high fat diet induced obese rats.

In the current study, we evaluated the effects of Asiatic acid (AA) on lipid metabolic markers in HFD-induced obese Sprague-Dawley rat model. AA (20 mg/kg BW) was administered orally to HFD-fed rats for 42 days. Changes in body composition, glucose, insulin resistance (IR) and lipid profiles of tissues, plasma and the pattern of gene expression of peroxisome proliferator-activated receptor-γ (PPAR-γ) and its target genes fatty-acid synthase (FAS), adipocyte protein-2 (aP2) and uncoupling protein-2 (UCP-2) and pro-inflammatory factor tumor necrosis factor (TNF)-α were observed in experimental rats. Oral administration of AA exerts therapeutic effects similar to orlistat in attenuating body weight gain, glucose, IR, plasma and tissue lipids and mRNA levels of PPAR-γ, FAS, aP2 and inflammatory factor TNF-α and increasing UCP-2 expression in HFD-fed rats. Hence, these findings concluded that AA attenuate HFD-induced obesity by modulating PPAR-γ and its target genes and regulate lipid metabolism, suggesting their possible antiobesity effects.

Trajectories of symptom severity and functioning over a three-year period in a psychosis high-risk sample: A secondary analysis of the Neurapro trial.

The Ultra-High Risk (UHR) for psychosis group is known to be heterogeneous with diverse outcomes. This study aimed to: 1. Identify subclasses of UHR individuals based on trajectories of symptomatic and functional change over time, 2. Identify predictors of these trajectories. A sample of 304 UHR individuals participating in the Neurapro trial were followed over an average of 40 months. All participants received cognitive-behavioural case management (CBCM). Symptomatic and functional profiles were investigated using latent class growth analysis. Multinomial regression was employed to investigate predictors of classes. Identified trajectories showed mostly parallel slopes (i.e. improving symptoms/functioning over time), which were primarily distinct regarding the severity of symptomatology/level of functioning at baseline (i.e. the intercept). Higher symptomatic/lower functioning classes were predicted by higher substance use, older age, female gender, and lower cognitive functioning. No divergent trajectories were identified as all classes improved over time. This may reflect effective treatment through CBCM, natural illness course, or effective engagement with mental health services. Nonetheless, classes highest in symptoms/lowest in functioning still showed considerable impairment during follow-up, highlighting the need for targeted intervention in these subgroups. The study emphasizes the need for more clinical attention directed towards UHR patients being female or using substances.

Evaluating Singapore's CHAT Assessment Service by the World Mental Health Organisation (WHO) "Youth-Friendly" Health Services Framework.

Young people experience high rates of mental health issues. However, many do not seek professional help. In order to encourage help-seeking behavior among young people, it is important to ensure that services are youth-friendly. This study aims to evaluate the Community Health Assessment Team (CHAT)'s mental health assessment service model using the World Health Organization (WHO) youth-friendly health service framework of accessibility, acceptability, and appropriateness (AAA), and to ascertain the extent to which the CHAT service model is youth-friendly. Three hundred young people aged 16-30 years, who had gone through CHAT mental health assessments, completed a 27-item questionnaire. Majority rated the items in the questionnaire favorably. Our results suggest that majority of the young people who accessed CHAT mental health assessment service found it to be youth-friendly.

Motivations to quit smoking and challenges faced during cessation among individuals with first episode psychosis in Singapore.

AIMS: The prevalence of smoking has been noted to be higher among individuals with mental illness, particularly among those with schizophrenia and related psychosis than in the general population. The present paper sought to examine the motivations and challenges to quit smoking among first episode psychosis patients (N = 281) enrolled in the Early Psychosis Intervention Programme (EPIP) in Singapore. METHODS: Questionnaires were used to collect details on an individual's smoking status, cessation attempts, motivations to quit, and challenges to stop smoking. Using baseline data, multiple linear regressions were conducted to examine the socio-demographic correlates of motivations and challenges of smoking cessation behaviour. RESULTS: Of the study sample, 59.4% reported to have never smoked while 39.9% were currently smoking or had attempted smoking. Health reasons and cost were the most highly endorsed motivations to stop smoking; whereas cravings, stress, and boredom were highly endorsed as challenges to stop smoking. Socio-demographic factors such as age, educational level, and marital status were also found to be associated with the motivations to stop smoking and challenges faced during smoking cessation. CONCLUSIONS: The present study highlights the most highly endorsed motivations and challenges reported among individuals with first episode psychosis (FEP) in an Asian population. Given that the literature examining motivations and challenges to quit smoking has predominantly focused on the general population, results from the current study have implications for the formulation of smoking cessation programmes targeted at individuals with mental illness, particularly those with FEP.

N-Methyl-D-Aspartate(NMDA) Receptor and Voltage-Gated Potassium Channel (VGKC) Antibody-Associated Encephalitides Presenting as First Episode Acute Psychosis.

Aim: Acute psychosis is not an uncommon presenting feature in immune-mediated encephalitides. Most patients improve if properly diagnosed and treated expediently with immunotherapy. Our study aimed to describe the frequency, clinical spectrum, and long-term outcomes in patients presenting with acute psychosis who have anti-N-methyl-D-aspartate (NMDA) receptor or anti-voltage-gated potassium channel (VGKC) encephalitis. Method: We recruited patients aged 16-50 years presenting with less than 1 month of psychotic and neurological symptoms including cognitive dysfunction, seizures, abnormal movements, and/or autonomic dysfunction. Results: Between September 2011 and October 2013, 60 patients with first episode acute psychosis were screened; 15 were recruited and included for analyses. Four (26.7%) patients were diagnosed with anti-NMDA receptor encephalitis and 1 (6.7%) with anti-VGKC encephalitis. We found that the mean serum white blood cell (WBC) count (12.8 × 109/L ± 4.8 vs. 7.9 × 109/L ± 2.6; p = 0.05) and cerebrospinal fluid WBC count (106 cells/µl ± 101 vs. 8.5 cells/µl ± 18.9; p = 0.05) were higher in positive cases. Certain prodromal features such as fever, headache, confusion, facial dyskinesia, and hypersalivation were also more likely to be present in positive cases. Patients with autoimmune encephalitis also tended to be more unwell, with the majority requiring intensive care, had lower global assessment of functioning scores (30 ± 10 vs. 53.7 ± 21.2, p = 0.09), and were not well enough to complete standard psychiatric and cognitive assessments at presentation. Conclusion: Autoimmune encephalitis is not uncommon in patients with acute psychosis. Elevated WBC counts, certain prodromal features, and a more severe illness at presentation should prompt appropriate evaluation.

Relationship between obstructive sleep apnea and difficulty of anesthesia induction in children undergoing tonsillectomy.

OBJECTIVE: To determine whether anesthesiologists need to rely on polysomnography (PSG) when predicting need for airway intervention during induction in patients with sleep-disordered breathing (SDB). METHODS: Prospective case-control observational study at a tertiary care pediatric hospital. Children between the ages of 2-17 undergoing tonsillectomy were divided into three groups: those presenting with OSA observed by history and/or physical examination alone (SDB; n = 33), those with OSA determined by preoperative PSG (OSA; n = 32), and a control group (n = 35) undergoing tonsillectomy for recurrent tonsillitis. An anesthesiologist ranked each case on the level of intervention required to maintain ventilation. RESULTS: Age, height and BMI were associated with greater induction difficulty (r's > .225, p's < .025). Compared to controls, induction difficulty was significantly greater for the SDB group (mean difference = -0.751, 95% confidence interval [CI] = -1.241, -0.261, p = .003), but not for the OSA group (p = .061). No significant difference in induction difficulty was observed between SDB and OSA groups. In a subgroup analysis of the OSA group, an apnea-hypopnea index (AHI) > 10 correlated with increased level of intervention during induction (r = .228, p = .022). Race was also associated with AHI >10 (odds ratio = 3.859, 95% CI = 1.485, 10.03, p = .006). CONCLUSION: Children with OSA undergoing tonsillectomy require more airway intervention during induction than children with recurrent tonsillitis. Age and BMI were correlated with greater induction difficulty, suggesting that PSG data should be considered in light of these clinical characteristics to ensure an optimal postoperative course for children undergoing tonsillectomy.

Treatment preferences and help-seeking behaviors for sleep problems among psychiatric outpatients.

OBJECTIVE: To understand treatment preferences and help-seeking behaviors among psychiatric patients for their sleep problems, and to examine determinants of problem recognition and help-seeking among patients with sleep difficulties. METHOD: A cross-sectional survey was conducted among psychiatric outpatients in Singapore (n=400). Participants completed questionnaires that assessed their sleep quality, daytime fatigue, help-seeking behavior, treatment preferences for sleep problems, and sociodemographic information. Multiple logistic regressions were used to identify correlates of patients who recognized their sleep difficulties and of those who had sought help. RESULTS: Mental health professionals were the most preferred choice (60.8%) for consultation on sleep problems. Among patients with poor sleep quality (n=275), 28.4% denied having any problems and 38.9% had not sought help. Patients with chronic physical comorbidity were less likely to recognize their sleep problems (OR=0.432, p-value=0.009), while those with psychiatric comorbidity were twice as likely to perceive the problems (OR=2.094, p-value=0.021) and to seek help (OR=1.957, p-value=0.022). Daytime fatigue was associated with higher odds of problem recognition (OR=1.106, p-value=0.001) and help-seeking (OR=1.064, p-value=0.016). CONCLUSION: A considerable number of patients did not perceive their poor sleep as an issue and had not sought help for it. General sleep hygiene education is needed for psychiatric patients.