Internet-delivered cognitive behavioural therapy for insomnia disorder in depressed patients treated at an outpatient clinic for mood disorders: protocol of a randomised controlled trial.

BACKGROUND: Major depression is a highly prevalent disorder causing severe personal distress, and high societal costs. Patients with depression often have comorbid insomnia disorder (ID) leading to even worse personal distress and worse treatment outcomes. Recent results from a non-randomised pilot study with internet-delivered Cognitive Behavioural Therapy (CBTi) for Insomnia (I-Sleep) added to regular depression care were promising regarding feasibility and initial effects on insomnia complaints and depression. However, no randomised controlled trial (RCT) has been performed yet to access the (cost-) effectiveness of I-Sleep for depression. Therefore, this protocol article presents the design of an RCT aimed to assess the (cost-) effectiveness of I-Sleep in addition to usual care for depression compared to usual care alone in depressed patients with a comorbid Insomnia Disorder (ID) treated at outpatient clinics for mood disorders.  METHODS /DESIGN: This is a multi-centre RCT with measurements at baseline and at 3, 6, 9, and 12 months of follow-up. Patients with depression and an ID are randomised to either I-Sleep treatment followed by regular depression care or to regular depression care alone. Our aim is to recruit one hundred and seventy-five patients from multiple outpatient clinics for mood disorders. The primary outcome is the change in depressive symptoms over 12 months of follow-up measured with the Patient Health Questionnaire (PHQ-9). Secondary outcomes are recovery from depression (PHQ-9), insomnia severity (Insomnia Severity Index, ISI), daily functioning (Work and Social Adjustment Scale, WSAS), general quality of life (EuroQol 5-level version, EQ-5D-5L), and societal costs (Adapted versions of the iMTA Productivity Cost Questionnaire, iPCQ and iMTA Medical Cost Questionnaire, iMCQ). DISCUSSION: We hypothesize that the addition of I-Sleep to usual care will result in a significant improvement in depression treatment outcomes and quality of life as well as a decrease in healthcare and societal costs compared to usual care alone. This study is the first pragmatic RCT evaluating the effectiveness and cost-effectiveness of adding CBTi to usual care for depression. TRIAL REGISTRATION: Netherlands Trial Register (NL8955). Registered on October 6th2020. https://trialsearch.who.int/Trial2.aspx?TrialID=NL8955.

Towards true unipolar ECG recording without the Wilson central terminal (preliminary results).

We present an innovative bio-potential front-end capable of recording true unipolar ECG leads for the first time without making use of the Wilson central terminal. In addition to the convenience in applications such as continuous monitoring and rapid diagnosis, the information in unipolar recordings may yield unique diagnostic information as it avoids the need to essentially subtract data or make use of the averaging effect imposed from the Wilson central terminal. The system also allows direct, real-time software calculation of signals corresponding to standard ECG leads which achieve correlations in excess of 92% with a gold standard ECG during a parallel in vivo recording. In addition, the implemented circuit is wideband (0.05-1000 Hz), compatible with standard (Ag/AgCl) bio-potential electrodes, and dry (paste-less) textile electrodes. The circuit is also low power, requiring less than 50 mW (when powered at 12 V) per standard ECG lead (two channels required). It is therefore well suited for wearable, long-term applications.

Learning the pseudoinverse solution to network weights.

The last decade has seen the parallel emergence in computational neuroscience and machine learning of neural network structures which spread the input signal randomly to a higher dimensional space; perform a nonlinear activation; and then solve for a regression or classification output by means of a mathematical pseudoinverse operation. In the field of neuromorphic engineering, these methods are increasingly popular for synthesizing biologically plausible neural networks, but the "learning method"-computation of the pseudoinverse by singular value decomposition-is problematic both for biological plausibility and because it is not an online or an adaptive method. We present an online or incremental method of computing the pseudoinverse precisely, which we argue is biologically plausible as a learning method, and which can be made adaptable for non-stationary data streams. The method is significantly more memory-efficient than the conventional computation of pseudoinverses by singular value decomposition.

Mobility and survival of Salmonella Typhimurium and human adenovirus from spiked sewage sludge applied to soil columns.

AIMS: This study investigated the survival and transport of sewage sludge-borne pathogenic organisms in soils. METHODS AND RESULTS: Undisturbed soil cores were treated with Salmonella enterica ssp. enterica serovar Typhimurium-lux (STM-lux) and human adenovirus (HAdV)-spiked sewage sludge. Following an artificial rainfall event, these pathogens were analysed in the leachate and soil sampled from different depths (0-5 cm, 5-10 cm and 10-20 cm) after 24 h, 1 and 2 months. Significantly more STM-lux and HAdV leached through the soil cores when sewage sludge was present. Significantly more STM-lux were found at all soil depths, at all time periods in the sewage sludge treatments, compared to the controls. The rate of decline of STM-lux in the controls was more rapid than in the sewage sludge treatments. Survival and transport of HAdV were minimal. CONCLUSIONS: The presence of sewage sludge can significantly influence the transport and survival of bacterial pathogens in soils, probably because of the presence of organic matter. Environmental contamination by virus is unlikely because of strong soil adsorption. SIGNIFICANCE AND IMPACT OF THE STUDY: This study suggests that groundwater contamination from vertical movement of pathogens is a potential risk and that it highlights the importance of the treatment requirements for biosolids prior to their application to land.

[Clozapine use and abrupt smoking cessation; a potentially life-threatening combination]. / Clozapinegebruik en abrupt stoppen met roken; een potentieel levensbedreigende combinatie.

A 58-year-old man was in a period of 3 weeks twice admitted to a general hospital with symptoms of clozapine intoxication, i.e. loss of consciousness. We are of the opinion that the patient developed clozapine intoxication because he had been prescribed clozapine (300 mg/day) and at the same time had suddenly stopped smoking. The link is confirmed in the literature. We therefore recommend that clozapine-dosage be adjusted to a patient's smoking behaviour.

Code-division-multiplexed electrical impedance tomography spectroscopy.

Electrical impedance tomography uses multiple impedance measurements to image the internal conductivity of an object, such as the human body. Code-division multiplexing is proposed as a new method that can provide simultaneous impedance measurements of the multiple channels. Code division provides clear advantages of a wide frequency range at reduced cost and reduced complexity of sources. A potential drawback is the lack of perfectly orthogonal code sets. This caused an increase of 0.62% in root-mean-square spectral error when two codes were used to record two impedance channels simultaneously on a low-pass filter network. The method described provides images and spectra which are equivalent to the conventional time-multiplexed method, with increases in frequency resolution and measurement speed which may be of benefit in some applications of electrical impedance tomography spectroscopy.

An active 2-d silicon cochlea.

In this paper, we present an analog integrated circuit design for an active 2-D cochlea and measurement results from a fabricated chip. The design includes a quality factor control loop that incorporates some of the nonlinear behavior exhibited in the real cochlea. This control loop varies the gain and the frequency selectivity of each cochlear resonator based on the amplitude of the input signal.

[A patient with feigned mental incompetence requiring medical treatment]. / Een patiënt die wilsonbekwaamheid simuleert en voor wie somatische behandeling is geïndiceerd.

A woman at the presumed age of 60 years was suspected of malingering cognitive impairment, due to her social circumstances (illegal residency) and was consequently unable to give permission for treatment. She was suffering from locally advanced mammary carcinoma, diagnosed according to the Breast Imaging Reporting and Data System in stage 5. In order to assess mental incompetence, an algorithm from the Royal Dutch Medical Association (KNMG) is a useful tool. The algorithm contains questions for determining whether a patient is able to make choices, if he/she understands medical information and can apply this to his/her own situation and whether he/she is able to logically consider the choice. Mental incompetence is a legally defined status - there is no straightforward relation between mental incompetence and the underlying diagnosis, in this case malingering. Since feigning mental incompetence has its own limitations, the subjective judgment of the physician is important. In the case presented, medical treatment i.e. chemotherapy was started in accordance with the Dutch Medical Treatment Contracts Act (WGBO) for a patient with cognitive impairment. Compulsory treatment was not necessary because the patient did not resist either physically or verbally. If a critical situation is to be prevented or is threatening, then there is no difference between genuine or feigned mental incompetence.

An address-event vision sensor for multiple transient object detection.

We present a vision sensor chip designed to detect multiple transient objects - objects that either move or change in light intensity - and output their locations using address-event representation. The sensor uses a novel onset detector to detect transient objects and a dynamically-wired winner-takes-all circuit to group pixels and select the brightest pixel in each object. This paper describes the circuits and also presents measurements that characterize the performance of the sensor chip.