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A fully-automated unsaturated triaxial device is developed at the Advanced Soil Mechanic Laboratory of the Sharif University of Technology (SUT) to investigate the hydromechanical behavior of unsaturated soils under any complicated path. The main improvements of the developed device are (1) the ability to continuously measure accurately different stress/strain variables during long duration of unsaturated tests. This is of great importance in capturing the sudden deformations of the specimen, under wetting (2) providing a user-friendly controller software enabling the definition of any desired stress/strain variable and stress/strain paths under either stress-controlled or strain-controlled conditions. Finally, to evaluate the performance of the developed apparatus, two wetting tests were carried out to study the effect of initial shear stress on the hydromechanical behavior of unsaturated reconstituted specimens of Gorgan loess. In these wetting tests, the specimens were wetted under isotropic and anisotropic stress states by stepwise reduction of suction to approach to the saturated condition. The obtained results showed the excellent performance of the developed device to accurately follow the defined stress path along with the continuous measurement of stress/strain variables. The tested collapsible soil specimen that was wetted under the effect of initial shear stress exhibited a larger volume decrease accompanied by a larger degree of saturation compared to those of the specimen wetted under the isotropic stress state with the same initial mean net stress.

Background: Although not approved for the treatment of anxiety (except trifluoperazine) there is ongoing off-label, unapproved use of first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) for anxiety. There have been systematic reviews and meta-analyses on the use of antipsychotics in anxiety disorders, most of which focused on SGAs. Aims and objectives: The specific aims of this umbrella review are to: (1) Evaluate the evidence of efficacy of FGAs and SGAs in anxiety disorders as an adjunctive treatment to traditional antidepressant treatments and other non- antipsychotic medications; (2) Compare monotherapy with antipsychotics to first-line treatments for anxiety disorders in terms of effectiveness, risks, and side effects. The review protocol is registered on PROSPERO. (CRD42021237436). Methods: An initial search was undertaken to identify systematic reviews and meta-analyses from inception until 2020, with an updated search completed August 2021 and January 2023. The searches were conducted in PubMed, MEDLINE (Ovid), EMBASE (Ovid), APA PsycInfo (Ovid), CINAHL Complete (EBSCOhost), and the Cochrane Library through hand searches of references of included articles. Review quality was measured using the AMSTAR-2 (A MeaSurement Tool to Assess Systematic Reviews) scale. Results: The original and updated searches yielded 1796 and 3744 articles respectively, of which 45 were eligible. After final review, 25 systematic reviews and meta- analyses were included in the analysis. Most of the systematic reviews and meta-analyses were deemed low-quality through AMSTAR-2 with only one review being deemed high-quality. In evaluating the monotherapies with antipsychotics compared to first-line treatments for anxiety disorder there was insufficient evidence due to experimental designs. There was limited evidence suggesting efficacy of antipsychotic agents in anxiety disorders other than quetiapine in generalized anxiety disorder (GAD) and monotherapy or augmentation with olanzapine in meta-analyses. Discussion and conclusions: This umbrella review indicates a lack of high-quality studies of antipsychotics in anxiety disorders outside of the use of quetiapine in GAD. Although potentially effective for anxiety, FGAs and SGAs may have risks and side effects that outweigh their efficacy. Further long-term and larger-scale studies of antipsychotics in anxiety are needed. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of the study was to investigate factors that influence vocational rehabilitation program enrollment and employment at discharge of veterans with psychiatric and co-occurring alcohol and other substance use disorders enrolled at a veteran health administration (VHA) medical center. Methods: A sample of 2,550 veteran patients referred for VHA vocational rehabilitation between 2016 and 2021 were examined for the current study. The current study was classified as quality improvement/assurance, thus resulting in exempt research by the U.S. Department of Veteran Affairs Institutional Review Board. Results: Veterans with active alcohol use disorders (AUDs) and co-occurring depression, anxiety, post-traumatic stress disorder, or bipolar disorders were less likely to be enrolled for vocational rehabilitation program services compared to those without these co-occurring diagnoses. Veterans with AUD (active & inremission status combined into one category) and a diagnosis of anxiety were less likely to be employed at discharge compared to veterans with AUDs and no anxiety diagnosis (anxiety diagnosis - 3.5% vs. no anxiety diagnosis - 5.8%). Discussion: VHA vocational rehabilitation can be an effective intervention to assist veterans in reintegrating back into the community. Yet, there appears to be some disparities in the program enrollment and employment at discharge, dependingon the nature of the psychiatric diagnosis. Investigating the factors contributing (mediating or moderating) to these discrepancies are needed. Although it appears access is not the issue in being referred for vocational rehabilitation services, other factors are likely contributing to program entry. [ABSTRACT FROM AUTHOR]

Collapsible soils such as loess are particular types of problematic soils, whose collapse potential have caused severe damages to the buildings and structures. Loess is susceptible to large and sudden volume reduction upon wetting in constant normal stress or upon increasing normal stress in constant water content or a combination of these two stress paths. In this research both of these collapse induced paths: wetting and stress paths are investigated on undisturbed specimens of a Loess to observe the effect of various parameters on the collapse behavior of the tested soil., Seven controlled matric suction unsaturated oedometer tests have been conducted on undisturbed specimens taken from loessial soil of Gorgan, a city in Golestan province in Iran to study the collapse mechanisms of this type of soils. Two identical sets of unsaturated oedometer apparatuses designed and developed at Sharif University of Technology, with the capability of controlling matric suction have been utilized. In these tests, the matric suction, vertical net stress, volumetric water content, and vertical deformation of the samples have been controlled and recorded. Tests have been performed under two separate stress paths: constant matric suction with varying vertical net stress (loading and unloading) and constant vertical net stress with varying matric suction (wetting and drying). Obtained results show the high collapse potential of the tested soil and significant effects of stress path, matric suction, and vertical net stress on the collapse behavior of the tested soil.

Background: The prevalence of schizophrenia in the United States ranges between 0.5% and 1%. This difficult-to-treat disorder is marked by the presentation of symptoms that are both positive (i.e. hallucinations) and negative (i.e. blunted affect), as well as disturbances in cognition and affect. Several second-generation antipsychotics (i.e. olanzapine, risperidone.) have been utilized for their varying effects on the symptoms of schizophrenia, yet 20% to 60% of patients with schizophrenia are considered treatment-resistant. While clozapine is shown to be the most effective antipsychotic, negative symptoms commonly persist in clozapine-treated patients. Research shows that oxytocin has neuromodulatory effects on social perception and enhances empathy and attentional engagement in individuals with schizophrenia, suggesting it may have therapeutic effects on negative symptoms. The present study presents a pilot prospective research study evaluating the efficacy of combining clozapine and sublingual oxytocin for the reduction of positive and negative symptoms. Methods: Prospective research study evaluated 25 treatment resistant schizophrenic patients who were admitted to the persistent psychotic disorder unit at a private hospital, with an average treatment duration of 2.9 months with a range between 1 and 9 months. All have been followed as outpatient for up to 30 months after discharge. All patients were 18 years or older and met the DSM-5 criteria for schizophrenia. The Positive and Negative Syndrome Scale (PANSS) was used to assess the efficacy of the combination treatment. Clozapine was prescribed to all 25 patients after they had failed to improve in three different trials of other antipsychotic medications. Sublingual oxytocin (10 IU 2x per day; 20 IU 3x per day) was prescribed to 25 of the patients only after the improvement in positive symptoms on the PANSS with clozapine had plateaued. Due to a history of intranasal substance use in all the patients, oxytocin was administered sublingual to ensure adequate and less variable absorption of the neuropeptide. Results: A time-series analysis demonstrated a significant decrease in PANSS scores across admission, stabilization of clozapine and stabilization of oxytocin (p <.02) with the overall average PANSS score on admission was 102; after stabilization on clozapine, the average score decreased to 68. After administration oxytocin (8 weeks) the average score decreased further to 47 and improved PANSS score were not related to serum clozapine levels. Clinical and family notes indicated clinically meaningful improvements in affect, eye contact, and ability to socialize. These gains have been sustained over the full range of our observations. Families self-reported an increased ability to participate in social roles and activities. Discussion: The combined effect extends the current research of augmenting sublingual oxytocin and clozapine for individuals with previously treatment-resistant symptoms. Though each patient benefitted from clozapine alone, negative symptoms persisted. Patients, their families, and treatment program staff all observed a significant reduction in the patients’ anxiety and an improvement in the patients’ relatedness. While this case series cannot establish that oxytocin is responsible for the clinical improvements seen here, it does suggest that it may improve negative symptoms and social functioning in patients with treatment-resistant schizophrenia showing incomplete improvement with clozapine alone. The present study suggests the need for future research to explore the possibility that oxytocin can mitigate the negative symptoms of schizophrenia. [ABSTRACT FROM AUTHOR]

Mothball ingestion has been previously cited to induce toxic-leukoencephalopathy, secondary to the destructive effects of paradichlorobenzene on central nervous system white matter. This case presents a 37-year-old woman who experienced a neuropsychiatric syndrome consistent with paradichlorobenzene-induced toxic leukoencephalopathy after two decades of mothball abuse. Her clinical presentation was insidious, involving fluctuating cognitive decline, depression, and psychosis. This was further complicated by an human immunodeficiency virus infection and concomitant cocaine abuse. Ultimately, her clinical findings were attributed to a reversible toxic-leukoencephalopathy from mothball ingestion, and her magnetic resonance imaging findings were consistent with symmetric leukoencephalopathy and atrophy. Though leukoencephalopathy in human immunodeficiency virus has numerous potential etiologies, a patient with a history of substance abuse warrants consideration of toxin-induced leukoencephalopathy, and further inquiry regarding abuse of other substances is appropriate.