Dissipative time-domain one-dimensional model for viscothermal acoustic propagation in wind instruments.

Accurate modeling of the acoustic propagation in tubes of varying cross section in musical acoustics must include the effects of the viscous and thermal boundary layers. Models of viscothermal losses are classically written in the frequency domain. An approximate time-domain model is proposed in which all of the physical parameters of the instrument, the bore shape or the wave celerity, are explicit coefficients. The model depends on absolute tabulated constants, which only reflect that the pipe is axisymmetric. It can be understood as a telegrapher's equations augmented by an adjustable number of auxiliary unknowns. A global energy is dissipated. A time discretization based on variational approximation is proposed along with numerical experiments and comparisons with other models.

[Is evidence-based medicine killing psychiatry softly? A critical review of "evidence-based psychiatry" from an epistemological and ethical perspective]. / L'evidence-based medicine, un projet épistémologique et éthique en porte-à-faux avec la psychiatrie ?

Current mainstream psychiatric discourse and practice rely mostly on a dominant technological paradigm where mental distress is understood as a "faulty mechanism" which needs "fixing" through medical means. As such, evidence-based medicine (EBM), a recent medical concept which encourages technological knowledge and hence technological understanding and interventions, was embraced by contemporary psychiatry. EBM is a proposition which seeks to regulate clinical decision-making by putting forth the idea of a hierarchy of evidence, where information yielded from randomized controlled trials (RCTs) and meta-analyses have definite precedence over other forms or sources of information. Thus, because EBM favors these evidence-producing tools, RCTs and meta-analyses, it purports that the knowledge that counts is that which is measurable and specific; necessary conditions for its detection by such tools. In doing so, EBM devalues and arguably even ignores other forms of evidence and warrants for clinical decision-making. From the standpoint of ethics, it purports that the "right" thing to do is to apply the evidence produced by EBM in a clinical setting. Other forms of evidence and relevant information regarding clinical decision-making which cannot be produced or measured by EBM are ethically devalued. Reviewed literature in the field of philosophy of psychiatry thus argues that EBM is ill-suited for psychiatry. It has a reductive view of the epistemological and related ethical issues regarding psychiatric practice. It cannot, by design, account for the specificities of psychiatry, notably in terms of diagnoses; their complexity easily renders the evidence created by EBM of questionable validity. It also cannot account for the specificities of psychiatric therapeutics. Outcomes related to the mind are incorrectly translated into specific and measurable results, and amongst other points, non-specific therapeutic factors, the ones discredited by EBM, are core to mental health care: nonsense. This leads the current critical review to consider that psychiatry would perhaps benefit from the development of its own evidentiary framework, taking into account its unique epistemological position, where subjectivity, context and values cannot be downplayed in the hierarchy of evidence, in the hierarchy of warrants for decision-making. This discussion inevitably raises the question of the object of study of psychiatry, which appears to be somewhat different than that of medicine. It also forces a conversation on the goals of psychiatry; they appear more complex than the achievement of measurable and specific health outcomes. Although a definite alternative to EBM in psychiatry has yet to be established, the literature, and this paper, point towards the idea of a more flexible evidentiary framework for psychiatry, one where ethical issues, including the ethics of what counts as evidence, should be of crucial importance.

Internet Addiction, Hikikomori Syndrome, and the Prodromal Phase of Psychosis.

Computers, video games, and technological devices are part of young people's everyday lives. Hikikomori is a Japanese word describing a condition that mainly affects adolescents or young adults who live isolated from the world, cloistered within their parents' homes, locked in their bedrooms for days, months, or even years on end, and refusing to communicate even with their family. These patients use the Internet profusely, and only venture out to deal with their most imperative bodily needs. Although first described in Japan, cases have been described from around the world. This is the first published report from Canada. The disorder shares characteristics with prodromal psychosis, negative symptoms of schizophrenia, or Internet addiction, which are common differential or comorbid diagnoses. However, certain cases are not accompanied by a mental disorder. Psychotherapy is the treatment of choice although many cases are reluctant to present. The exact place of hikikomori in psychiatric nosology has yet to be determined. We searched Medline up to 12th May, 2015 supplemented by a hand search of the bibliographies of all retrieved articles. We used the following search terms: Hikikomori OR (prolonged AND social AND withdrawal). We found 97 potential papers. Of these 42 were in Japanese, and 1 in Korean. However, many of these were cited by subsequent English language papers that were included in the review. Following scrutiny of the titles and abstracts, 29 were judged to be relevant. Further research is needed to distinguish between primary and secondary hikikomori and establish whether this is a new diagnostic entity, or particular cultural or societal manifestations of established diagnoses.

[Fifty years of residency in Psychiatry at the University of Montreal: relevance and necessity of the Residents' Association]. / Cinquante ans de résidence : nécessité et pertinence de l'ARPUM.

OBJECTIVES: In the context of the fiftieth anniversary celebrations of the Département de psychiatrie de l'Université de Montréal, the present article offers to retrace the history of the Psychiatry Resident's Association (ARPUM). Since the Association's activities and demands reflected the concerns of the time, a depiction of the Residency Program and exploration of the historical and administrative context, in each key period, is also undertaken. METHODS: Multiple psychiatrists from every decade, who were once active members of the Association, were interviewed and asked to describe the Residency Program at their time, with its positive and negative aspects, based on their own personal experience as a resident, but also as a member of the organization. The interviewees were also invited to share their recollections of the various Association's demands, representations, activities and functioning, depending on the issues and periods. Various private and public archives were also used, in order to contextualize the residents' experiences and the Association's work. RESULTS: A brief exploration of the historical and political context that led to the creation of the organization is explained. Training and working conditions of residents at that time are reported, enabling the understanding of the first demands when the group was born. Historical jumps are then proposed, from decades to decades, in order to depict key issues, whether they were academic, clinical or organizational, through which the Association worked, over the evolution of the Residency Program. The internal functioning and its occasional problems throughout the years are also described, as is the role in organizing social and educational events. CONCLUSIONS: The Residency Program is in constant mutation, and the Association has played its part in shaping the psychiatric training at the Université de Montréal. Multiple positive and tangible impacts were and are still made possible from the collaborative work between the Département de psychiatrie, the Residency Program and the Resident's Association.

Systematic review of the pharmacological treatment of alcohol use disorders in individuals infected with hepatitis C.

Treating alcohol use disorders (AUD) is critical in individuals suffering from hepatitis C infection (HCV). Aside from psychosocial interventions, pharmacological treatment is effective for decreasing alcohol consumption and promoting abstinence. However, unique factors belonging to HCV-infected individuals, such as baseline hepatic vulnerability and possible ongoing hepatitis C treatment, complicate AUD drug therapy. The goal of this review is to systematically identify, summarize, and evaluate the existing evidence on the pharmacological management of AUD in HCV-infected individuals. MEDLINE, Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials were searched for English- and French-language articles published from 1993 to December 2013. The search criteria focused on clinical trials and observational studies assessing the efficacy and/or safety of pharmacological management of AUD in patients infected with HCV. Of 421 identified studies, three were included for analysis. Two were observational studies assessing the safety of disulfiram. One was a randomized controlled trial assessing the efficacy and safety of baclofen. There is paucity of data regarding the efficacy and safety of pharmacological treatment of AUD in HCV-infected individuals, with studies being small series and showing significant heterogeneity. No strong recommendations can be made based on the current studies as to which pharmacological option should be preferred in this sub-population.