Measurement of Time Dependent Reflection, Transmission, and Absorption in Laser Driven Silicon and GaAs Switches for 250 GHz Radiation

The reflectance (R) and transmittance (T) of Si and GaAs wafers irradiated by a 6 ns pulsed, 532 nm laser have been studied for s- and p-polarized 250 GHz radiation as a function of laser fluence and time. The measurements were carried out using precision timing of the R and T signals, allowing an accurate determination of the absorptance (A) where A=1-R-T. Both wafers had a maximum reflectance above 90% for a laser fluence ≥8 mJ/cm2. Both also showed an absorptance peak of ~50% lasting ~2 ns during the risetime of the laser pulse. Experimental results were compared with a stratified medium theory using the Vogel model for the carrier lifetime and the Drude model for permittivity. Modeling showed that the large absorptance at the early part of the rise of the laser pulse was due to the creation of a lossy, low carrier density layer. For Si, the measured R, T and A were in very good agreement with theory on both the nanosecond time scale and the microsecond scale. For GaAs, the agreement was very good on the nanosecond scale but only qualitatively correct on the microsecond scale. These results may be useful for planning applications of laser driven semiconductor switches.

Using the Psychiatry Resident-In-Training Examination (PRITE) to Assess the Psychiatry Medical Knowledge Milestones in Psychiatry

OBJECTIVE

The introduction of the Milestone Project underscored the need for objective assessments of resident progress across the competencies. Therefore, the authors examined the Psychiatry Resident-In-Training Examination (PRITE) utility for measuring improvements in medical knowledge (MK).

METHODS

The authors compared the mean performance for each MK subcompetency by resident year for all residents taking the PRITE from 2015 to 2017 (18,175 examination administrations). In addition, they surveyed psychiatry residency program directors regarding how well they thought they teach these subcompetencies.

RESULTS

Increases in MK subcompetencies by resident year were significant for Psychopathology (p < 0.003), Psychotherapy (p < 0.002), and Somatic Therapies (p < 0.000). Development, Clinical Neuroscience, and Practice of Psychiatry did not show statistically significant differences between postgraduate years. Eighty psychiatry program directors responded to the survey and felt optimistic about their ability to teach the Psychopathology, Psychotherapy, Somatic Therapies, and Practice of Psychiatry subcompetencies.

CONCLUSIONS

The PRITE measured significant improvements in medical knowledge for several of the core subcompetencies. The program director's responses would suggest that the lack of statistically significant differences found for Development and Clinical Neuroscience reflects areas in need of curricular development. The disparity between PRITE performance and program director perception of the Practice of Psychiatry subcompetency may reflect difficulties in defining the scope of this subcompetency. Overall, this suggests that structured examinations help measure improvements in certain subcompetencies and may also help identify curricular needs. However, there may be potential problems with the definition of some subcompetencies.

PTSD Following Suicide Attempts in Adolescents: a Case Series

The Diagnostic and Statistical Manual (DSM) does not specifically identify one's own suicide attempt as a potential source of trauma for the development of posttraumatic stress disorder (PTSD). PTSD following a near death experience in an adolescent may occur in both the adolescent and the parent. However, suicide-attempt-related PTSD (SA-PTSD) is scarce in the literature, particularly in the pediatric population. The authors review three cases of adolescent patients or their parents in an outpatient clinical practice who displayed varying severity of SA-PTSD symptoms. Information was obtained via self-report by adolescent, parent, or both. Screening for SA-PTSD symptoms was not explicitly sought; rather patients or parents volunteered such information de novo during clinical encounters which was then explored further. One adolescent had only brief PTSD-like experiences that faded with time and did not require intervention. A second adolescent reported long-term memory loss around the circumstances of their suicide attempt that may be related to medical morbidity; their parent had significant PTSD symptoms throughout treatment, and the parent was referred to their own therapy. A third adolescent was referred for cognitive-behavioral therapy (CBT) for the treatment of pervasive PTSD symptoms from a previous suicide attempt, with symptoms improving after treatment. A qualititative analysis suggests that more severe SA-PTSD symptoms are associated with 1) multiple prior suicide attempts; 2) more severe/higher morbidity suicide attempt; and 2) previous diagnosis of PTSD in patient or parent. Assessment for SA-PTSD is important to ensure that affected patients and their families are referred for appropriate resources and treatment. Of the very small sample of three cases, two required specific referral to treat PTSD symptoms in either the adolescent or the parent. The literature about SA-PTSD is extremely scarce. Only two studies systematically examined PTSD following suicide attempt, and none of these studies were in pediatric patients, making more robust quantitative or qualitative analysis limited at this time. Therefore, more research regarding epidemiology, risk factors, and treatment is needed.

New York State dairy veterinarians' perceptions of antibiotic use and resistance: A qualitative interview study

Antimicrobial resistance (AMR) limits the ability to prevent and treat infection, making AMR one of the foremost threats to human and animal health. Animal agriculture's large use of antibiotics in food animals is an important factor in AMR. As such, policies to reduce antibiotic use and combat AMR in animal agriculture in the United States (US) have been in place or are developed. One key to the success of these policies in the US is understanding how a major stakeholder - veterinarians treating dairy cattle - perceive the scale of antibiotic use, the threat of AMR and the utility of antibiotic use policies. We interviewed 9 dairy veterinarians in New York State and conducted an iterative thematic analysis of their responses, through which five themes were identified: 1. veterinarians' views of the frequency and reasons for antibiotic misuse, 2. their ideas on reducing antibiotic use, 3. perceptions of AMR within the dairy industry, 4. view of organic farming and how it relates to animal welfare, and 5. the impact of consumers' beliefs on the dairy industry. Participants viewed antibiotic overuse as largely due to farmers' concern for the welfare of their cattle and desire to treat ailments swiftly. Interviewees believed that it was possible to reduce antibiotic use through regulation, such as the Veterinary Feed Directive and improved herd management activities, such as better colostrum management, culture-based mastitis treatment, and improved housing conditions. They did not view the dairy industry as a significant contributor to AMR, particularly when compared to the human medical industry. Interviewees also offered their (unsolicited) opinion on organic dairy farming in the US and expressed frustration with the limited treatment options available in organic dairy farming and how this dynamic may potentially compromise animal welfare. Finally, they commented on the impact of consumers' beliefs on the dairy industry, expressing frustration with how misinformation about the dairy industry has led to consumer driven changes. As consumer beliefs have an impact on the dairy industry, this influence could be leveraged to further decrease antibiotic use. These findings can help guide future efforts in veterinarian-client communication and the development and implementation of effective policies in New York State. These results also highlight the need for more quantitative research on antibiotic use in the dairy industry, as without this data it will be difficult to ascertain the true impact of policy interventions.

How does public perception of antibiotic use on dairy farms contribute to self-reported purchasing of organic?

The United States regulates the use of antibiotics in agricultural settings to address the global antibiotic resistance problem. Conventional dairy cows treated with antibiotics are kept in the herd and after the withholding period milk is harvested. On organic farms, the US organic standard on antibiotic use requires sick dairy cows to be treated, but treated cows must be removed from the herd and their milk can never again be sold as certified organic. This study investigated the US public's perceptions of the organic dairy farming, antibiotic use on dairy farms, and whether these perceptions affect consumer's self‐reported purchasing behavior for organic. We used a nationally representative phone‐based survey of 1000 US adults and characterized participants’ self‐reported (i) knowledge of the legality of antibiotic use on dairy farms (conventional and organic) and (ii) frequency of purchasing organic instead of conventional dairy products, as well as several demographic and other variables. The results indicated that participants’ knowledge about antibiotic use practices in dairy farming have no effect on their self‐reported purchasing behavior for organic or conventional dairy products. However, respondents who were familiar with the regulations of antibiotic use on dairy farms were more likely to oppose the US organic standard on antibiotic use in dairy farming and thought that past antibiotic use should not permanently remove a cow's organic status. These findings contribute to understanding of public perceptions that shape the US dairy organic market.

Practical Application

Income, employment, health and political values, but not consumers’ knowledge about antibiotic use in dairy farming, affect self‐reported purchasing behavior for organic dairy products. However, consumers who are familiar with the regulations of antibiotic use on US dairy farms disagree with the US organic standard on antibiotic use mandating loss of organic status for any cattle treated with antibiotics. These findings may be useful to organic markets.

Study of the Effect of Reflections on High-Power, 110 GHz Pulsed Gyrotron Operation

The effect of reflection is studied experimentally and theoretically on a high-power 110 GHz gyrotron operating in the TE_22,6 mode in 3 μs pulses at 96 kV, 40 A. The experimental setup allows variation of the reflected power from 0 to 33 % over a range of gyrotron operating conditions. The phase of the reflection is varied by translating the reflector along the axis. Operating at a higher efficiency point, at 4:40 T with 940 kW of output power, reflected power exceeding 11% causes a switch from operation in the TE_22,6 to simultaneous operation in the TE_22,6 and TE_21,6 modes with a large decrease of the total gyrotron output power. This switching effect is in good agreement with simulations using the MAGY code. Operating at a more stable point, 4:44 T with 580 kW of output power, when the reflection is increased, the output power remains in the TE_22,6 mode but it decreases monotonically with increasing reflection, dropping to 200 kW at 33% reflection. Furthermore, at a reflection above 22%, a power modulation at 25 to 30 MHz is observed, independent of the phase of the reflected wave. Such a modulated signal may be useful in spectroscopic and other applications.

Survey of perceptions and attitudes of an international group of veterinarians regarding antibiotic use and resistance on dairy cattle farms

Veterinarians are the main source of information for farmers regarding the responsible use of antibiotics in farm animals and how to reduce the risk of antibiotic resistance. Consequently, understanding how veterinarians perceive their clients' and colleagues' antibiotic use and their own beliefs about the development of antibiotic resistance is essential to determining areas in which antibiotic use practices can be improved to minimize the emergence of antibiotic resistance. An international cross-sectional study was carried out using a questionnaire designed to elucidate perceptions, attitudes, and concerns of dairy veterinarians regarding antibiotic use and the emergence of antibiotic resistance in dairy farming. The questionnaire was initially administered to veterinarians attending the International Bovine Mastitis Conference in Milano, Italy, 2018, followed by veterinarian members of the National Mastitis Council, and all conference registrants. A total of 71 participants from 21 countries participated in the survey, the majority were from the United States and member countries of the European Union. Logistic regression analysis was conducted to identify predictors of veterinarians' level of concern about the development of antibiotic resistance on their clients' farms. Associations were described with odds ratios (ORs) and the associated 95 % confidence intervals (95 % CIs). Free text responses where participants shared their views on the reason for overprescribing antibiotics by veterinarians were analyzed using thematic analysis. Participants perceived that nearly half of their clients overuse or inappropriately use antibiotics, and nearly half of their colleagues overprescribe or inappropriately prescribe antibiotics. After controlling for other factors, the odds of veterinarians being concerned about antibiotic resistance on dairy farms they served decreased by a factor of 0.91 for each additional year of participants' experience working with dairy cattle (OR = 0.91, 95 % CI = 0.84-0.99). Participants concerned about antibiotic resistance on clients' dairy farms were also more likely to consider better adherence to drug labelling as important for reducing farmers' antibiotic use (OR = 6.86, 95 % CI = 1.21-38.93). Thematic analysis revealed four themes surrounding the perceived reasons for veterinarians' overprescribing of antibiotics: (i) knowledge, (ii) attitudes, (iii) barriers, and (iv) rules and regulations. The study findings will aid in the development of strategies to improve antibiotic use in dairy farming and educational initiatives looking to enhance the communication between veterinarians and farmers about judicious use of antibiotics.

Phase Measurements of a 140-GHz Confocal Gyro-Amplifier

The phase stability of a 140GHz, 1kW pulsed gyro-amplifier system and the phase dependence on the cathode voltage were experimentally measured. To optimize the measurement precision, the amplifier was operated at 47 kV and 1 A, where the output power was ∼ 30W. The phase was determined to be stable both pulse-to-pulse and during each pulse, so far as the cathode voltage and electron beam current are constant. The phase variation with voltage was measured and found to be 130±30°/kV, in excellent agreement with simulations. The electron gun used in this device is non-adiabatic, resulting in a steep slope of the beam pitch factor with respect to cathode voltage. This was discovered to be the dominant factor in the phase dependence on voltage. The use of an adiabatic electron gun is predicted to yield a significantly smaller phase sensitivity to voltage, and thus a more phase-stable performance. To our knowledge, these are the first phase measurements reported for a gyro-amplifier operating at a frequency above W-band.

Effects of Egocentric Projection and Identification on Narrative Persuasion in Foodborne Illness Messages

This study conceptually and empirically distinguishes two mental processes in narrative processing of food safety health messages-identification with and egocentric projection onto story characters. Two studies examined the effects of narrative autobiographical accounts of contracting foodborne illness (salmonella) because of careless food preparation. Both studies consistently found that identification increased, but egocentric projection decreased audience members' behavioral intention to perform safe food handling practices, indicating that egocentric projection and identification represent unique mental processes and yield distinct persuasive outcomes. In addition, confirmatory factor analyses provided evidence that egocentric projection and identification are distinct constructs. Implications for the role of identification and egocentric projection for understanding narrative processing and for health persuasion are discussed.

Second Harmonic 527-GHz Gyrotron for DNP-NMR: Design and Experimental Results

We report the design and experimental demonstration of a frequency tunable terahertz gyrotron at 527 GHz built for an 800 MHz Dynamic Nuclear Polarization enhanced Nuclear Magnetic Resonance (DNP-NMR) spectrometer. The gyrotron is designed at the second harmonic (ω = 2ω c) of the electron cyclotron frequency. It produces up to 9.3 W continuous microwave (CW) power at 527.2 GHz frequency using a diode type electron gun operating at V = 16.65 kV, Ib = 110 mA in a TE11,2,1 mode, corresponding to an efficiency of ~0.5%. The gyrotron is tunable within ~ 0.4 GHz by combining voltage and magnetic field tuning. The gyrotron has an internal mode converter that produces a Gaussian-like beam that couples to the HE11 mode of an internal 12 mm i.d. corrugated waveguide periscope assembly leading up to the output window. An external corrugated waveguide transmission line system is built including a corrugated taper from 12 mm to 16 mm i.d. waveguide followed by 3 m of the 16 mm i.d. waveguide The microwave beam profile is measured using a pyroelectric camera showing ~ 84% HE11 mode content.

Subterahertz Photonic Crystal Klystron Amplifier

This Letter reports the successful experimental demonstration of amplification of subterahertz radiation in a klystron with photonic crystal cavities. The klystron has six cavities, with each cavity having a series of oversized photonic crystal cells made up of a 5×3 array of square posts. The center post is removed from each cell to form a highly oversized (0.8  mm∼λ/4) beam tunnel, with power coupling from cell to cell through the tunnel. The pulsed electron beam is operated at 23.5 kV, 330 mA in a 0.5 T solenoidal field. At 93.7 GHz, a small-signal gain of 26 dB and a saturated output power of 30 W are obtained. Experimental results are in very good agreement with the predictions of a particle-in-cell code. The successful achievement of high gain operation of a photonic crystal klystron amplifier is promising for the future extension of klystron operation well into the terahertz frequency region.

Measurement of Dielectric Multipactor Thresholds at 110 GHz

We report experimental measurements of the threshold for multipactor discharges on dielectric surfaces at 110 GHz. Multipactor was studied in two geometries: electric field polarized parallel to or perpendicular to the sample surface. Measured multipactor thresholds ranged from 15 to 34  MV/m, more than 10 times higher than those found at conventional microwave frequencies. Measured thresholds were compared with prior data at lower frequencies, showing agreement with theoretical predictions that thresholds increase linearly with frequency. Measurements of the rf power dissipated in the multipactor show low dissipation (≤1%) for the parallel electric field case, but very strong dissipation for the perpendicular case, also in agreement with theoretical predictions. The agreement between experiment and theory over a wide range of frequencies provides a strong basis for the understanding of dielectric multipactor discharges.

Laser-driven semiconductor switch for generating nanosecond pulses from a megawatt gyrotron

A laser-driven semiconductor switch (LDSS) employing silicon (Si) and gallium arsenide (GaAs) wafers has been used to produce nanosecond-scale pulses from a 3 μs, 110 GHz gyrotron at the megawatt power level. Photoconductivity was induced in the wafers using a 532 nm laser, which produced 6 ns, 230 mJ pulses. Irradiation of a single Si wafer by the laser produced 110 GHz RF pulses with a 9 ns width and >70% reflectance. Under the same conditions, a single GaAs wafer yielded 24 ns 110 GHz RF pulses with >78% reflectance. For both semiconductor materials, a higher value of reflectance was observed with increasing 110 GHz beam intensity. Using two active wafers, pulses of variable length down to 3 ns duration were created. The switch was tested at incident 110 GHz RF power levels up to 600 kW. A 1-D model is presented that agrees well with the experimentally observed temporal pulse shapes obtained with a single Si wafer. The LDSS has many potential uses in high power millimeter-wave research, including testing of high-gradient accelerator structures.

Generation of High-Power, Reversed-Cherenkov Wakefield Radiation in a Metamaterial Structure

We present the first demonstration of high-power, reversed-Cherenkov wakefield radiation by electron bunches passing through a metamaterial structure. The structure supports a fundamental transverse magnetic mode with a negative group velocity leading to reversed-Cherenkov radiation, which was clearly verified in the experiments. Single 45 nC electron bunches of 65 MeV traversing the structure generated up to 25 MW in 2 ns pulses at 11.4 GHz, in excellent agreement with theory. Two bunches of 85 nC with appropriate temporal spacing generated up to 80 MW by coherent wakefield superposition, the highest rf power that metamaterial structures ever experienced without damage. These results demonstrate the unique features of metamaterial structures that are very attractive for future high-gradient wakefield accelerators, including two-beam and collinear accelerators. Advantages include the high shunt impedance for high-power generation and high-gradient acceleration, the simple and rugged structure, and a large parameter space for optimization.

[Proteomic analysis of contaminants in recombinant membrane hemeproteins expressed in E. coli and isolated by metal affinity chromatography]

Contaminating proteins have been identified by “shotgun” proteomic analysis in 14 recombinant preparations of human membrane heme- and flavoproteins expressed in Escherichia coli and purified by immobilized metal ion affinity chromatography. Immobilized metal ion affinity chromatography of ten proteins was performed on Ni2+-NTA-sepharose 6B, and the remaining four proteins were purified by ligand affinity chromatography on 2',5'-ADP-sepharose 4B. Proteomic analysis allowed to detect 50 protein impurities from E. coli. The most common contaminant was Elongation factor Tu2. It is characterized by a large dipole moment and a cluster arrangement of acidic amino acid residues that mediate the specific interaction with the sorbent. Peptidyl prolyl-cis-trans isomerase SlyD, glutamine-fructose-6-phosphate aminotransferase, and catalase HPII that contained repeating HxH, QxQ, and RxR fragments capable of specific interaction with the sorbent were identified among the protein contaminants as well. GroL/GroS chaperonins were probably copurified due to the formation of complexes with the target proteins. The Ni2+ cations leakage from the sorbent during lead to formation of free carboxyl groups that is the reason of cation exchanger properties of the sorbent. This was the putative reason for the copurification of basic proteins, such as the ribosomal proteins of E. coli and the widely occurring uncharacterized protein YqjD. The results of the analysis revealed variation in the contaminant composition related to the type of protein expressed. This is probably related to the reaction of E. coli cell proteome to the expression of a foreign protein. We concluded that the nature of the protein contaminants in a preparation of a recombinant protein purified by immobilized metal ion affinity chromatography on a certain sorbent could be predicted if information on the host cell proteome were available.

Photonic-band-gap gyrotron amplifier with picosecond pulses

We report the amplification of 250 GHz pulses as short as 260 ps without observation of pulse broadening using a photonic-band-gap circuit gyrotron traveling-wave-amplifier. The gyrotron amplifier operates with a device gain of 38 dB and an instantaneous bandwidth of 8 GHz. The operational bandwidth of the amplifier can be tuned over 16 GHz by adjusting the operating voltage of the electron beam and the magnetic field. The amplifier uses a 30 cm long photonic-band-gap interaction circuit to confine the desired TE03-like operating mode while suppressing lower order modes which can result in undesired oscillations. The circuit gain is >55 dB for a beam voltage of 23 kV and a current of 700 mA. These results demonstrate the wide bandwidths and a high gain achievable with gyrotron amplifiers. The amplification of picosecond pulses of variable lengths, 260-800 ps, shows good agreement with the theory using the coupled dispersion relation and the gain-spectrum of the amplifier as measured with quasi-CW input pulses.

Operation of a 140 GHz Gyro-amplifier using a Dielectric-loaded, Sever-less Confocal Waveguide

The design and experimental results of a 140 GHz gyro-amplifier that uses a dielectric-loaded, sever-less confocal waveguide are presented. The gyro-traveling wave amplifier uses the HE₀₆ mode of a confocal geometry with power coupled in and out of the structure with Vlasov-type, quasi-optical couplers. Dielectric loading attached to the side of the confocal structure suppresses unwanted modes allowing zero-drive stable operation at 48 kV and 3A of beam current. The confocal gyro-amplifier demonstrated a peak circuit gain of 35 dB, a bandwidth of 1.2 GHz and a peak output power of 550 W at 140.0 GHz.

Reducing Resistance to Narrative Persuasion About Binge Drinking: The Role of Self-Activation and Habitual Drinking Behavior

This study explores the effects of habitual health risk behaviors and self-activation on resistance to narrative persuasion. In two experiments, heavier drinkers were more resistant to an anti-binge-drinking narrative public service announcement (PSA) in which a binge drinker suffers a negative outcome. Specifically, heavier drinkers were more likely to generate counterarguments, unrealism judgments, and negative evaluations about the message compared to lighter drinkers or nondrinkers. However, activating self-concept when processing the persuasive narrative reduced unrealism judgments and negative evaluations, particularly among heavier drinkers. Self-activation also decreased perceived freedom threat among both heavier and lighter drinkers, which further led to higher perceived risk of binge drinking. Theoretical and practical implications are discussed.

Theory of Linear and Nonlinear Gain in a Gyroamplifier using a Confocal Waveguide

The linear and nonlinear theory of a gyroamplifier using a confocal waveguide is presented. A quasi-optical approach to describing the modes of a confocal waveguide is derived. Both the equations of motion and the mode excitation equation are derived in detail. The confocal waveguide circuit has the advantage of reducing mode competition but the lack of azimuthal symmetry presents challenges in calculating the gain. In the linear regime, the gain calculated using the exact form factor for the confocal waveguide agrees with an azimuthally averaged form factor. A beamlet code including velocity spread effects has been written to calculate the linear and nonlinear (saturated) gain. It has been successfully benchmarked against the MAGY code for azimuthally symmetric cases. For the confocal waveguide, the beamlet code shows that the saturated gain is reduced when compared with results obtained using an azimuthally averaged form factor. The beamlet code derived here extends the capabilities of nonlinear gyroamplifier theory to configurations that lack azimuthal symmetry.

Coherent Cherenkov-Cyclotron Radiation Excited by an Electron Beam in a Metamaterial Waveguide

An electron beam passing through a metamaterial structure is predicted to generate reversed Cherenkov radiation, an unusual and potentially very useful property. We present an experimental test of this phenomenon using an intense electron beam passing through a metamaterial loaded waveguide. Power levels of up to 5 MW are observed in backward wave modes at a frequency of 2.40 GHz using a one microsecond pulsed electron beam of 490 keV, 84 A in a 400 G magnetic field. Contrary to expectations, the output power is not generated in the Cherenkov mode. Instead, the presence of the magnetic field, which is required to transport the electron beam, induces a Cherenkov-cyclotron (or anomalous Doppler) instability at a frequency equal to the Cherenkov frequency minus the cyclotron frequency. Nonlinear simulations indicate that the Cherenkov-cyclotron mode should dominate over the Cherenkov instability at a lower magnetic field where the highest output power is obtained.

When Bad Things Happen to a Protagonist Like You: The Role of Self in Resistance to Negatively Framed Health Narratives

This study examines when and how shared risk-relevant experience (autobiographic similarity) influences resistance to negatively framed health narratives. We conducted a 2 (narrative perspective: 1st vs. 3rd person) × 2 (processing motive: experiential vs. analytical) randomized experiment with a short narrative depicting the negative effects of an illicitly used study drug. For those autobiographically similar to the study drug user, a 1st-person narration (vs. 3rd-person) produced greater transportation only when participants processed to understand the story (experiential condition), whereas the reverse was found when participants processed for the persuasive message (analytical condition). Transportation was a significant mediator that transferred these interactive effects onto greater perceived risk only among those with autobiographic similarity. This study highlights the active role played by the audience's self-concept in narrative persuasion and addresses boundary conditions for overcoming defensive resistance.

The audience eats more if a movie character keeps eating: An unconscious mechanism for media influence on eating behaviors

Media's presentation of eating is an important source of influence on viewers' eating goals and behaviors. Drawing on recent research indicating that whether a story character continues to pursue a goal or completes a goal can unconsciously influence an audience member's goals, a scene from a popular movie comedy was manipulated to end with a character continuing to eat (goal ongoing) or completed eating (goal completed). Participants (N = 147) were randomly assigned to a goal status condition. As a reward, after viewing the movie clip viewers were offered two types of snacks: ChexMix and M&M's, in various size portions. Viewers ate more food after watching the characters continue to eat compared to watching the characters complete eating, but only among those manipulated to identify with a character. Viewers were more likely to choose savory food after viewing the ongoing eating scenes, but sweet dessert-like food after viewing the completed eating scenes. The results extend the notion of media influence on unconscious goal contagion and satiation to movie eating, and raise the possibility that completing a goal can activate a logically subsequent goal. Implications for understanding media influence on eating and other health behaviors are discussed.

Comparing Positive and Negative Political Advertising on Radio

Compared to positive political ads, negative political ads presented on radio appear to be a two-edged sword that can sometimes cut the sponsor more than the target. In an experiment with college students, negative issue ads were perceived as relatively fair and resulted in a competitive advantage for the sponsor of the ad over the target of the ad. But negative image ads were seen as relatively unfair and resulted in a backlash against the sponsor. Negative ad arguments were remembered more than were arguments from positive ads.

Framing Effects in Narrative and Non-Narrative Risk Messages

Narrative messages are increasingly popular in health and risk campaigns, yet gain/loss framing effects have never been tested with such messages. Three experiments examined framing in narrative messages. Experiment 1 found that only the character's decision, not framing, influenced judgments about characters in a narrative derived from a prospect theory context. Experiment 2 found that a framing effect that occurred when presented in a decision format did not occur when the same situation was presented as a narrative. Using a different story/decision context, Experiment 3 found no significant difference in preference for surgery over radiation therapy in a narrative presentation compared to a non-narrative presentation. The results suggest that health and risk campaigns cannot assume that framing effects will be the same in narrative messages and non-narrative messages. Potential reasons for these differences and suggestions for future research are discussed.

Acknowledging individual responsibility while emphasizing social determinants in narratives to promote obesity-reducing public policy: a randomized experiment

This study tests whether policy narratives designed to increase support for obesity-reducing public policies should explicitly acknowledge individual responsibility while emphasizing social, physical, and economic (social) determinants of obesity. We use a web-based, randomized experiment with a nationally representative sample of American adults (n = 718) to test hypotheses derived from theory and research on narrative persuasion. Respondents exposed to narratives that acknowledged individual responsibility while emphasizing obesity’s social determinants were less likely to engage in counterargument and felt more empathy for the story’s main character than those exposed to a message that did not acknowledge individual responsibility. Counterarguing and affective empathy fully mediated the relationship between message condition and support for policies to reduce rates of obesity. Failure to acknowledge individual responsibility in narratives emphasizing social determinants of obesity may undermine the persuasiveness of policy narratives. Omitting information about individual responsibility, a strongly-held American value, invites the public to engage in counterargument about the narratives and reduces feelings of empathy for a character that experiences the challenges and benefits of social determinants of obesity.

A Reconceptualization of Pseudohallucinations in the Case of "Kate"

In the case study of "Kate" (Shapiro, Bussing, & Nguyen, 2014), we discussed a case of a 16-year-old adolescent who initially presented with auditory hallucinations and secondary delusional thinking. A more thorough examination of the underlying dynamics of the patient and family pointed away from a diagnosis of a psychotic disorder, and the consideration of "pseudohallucinations"—conversion disorder symptoms in the form of psychiatric symptoms—was felt key by the treating child psychiatrist in tailoring treatment for Kate and her family. We  discussed potential definitions of "pseudohallucinations" and used a psychodynamic formulation as a conceptual framework to provide treatment in the form of cognitive-behavioral therapy, psychodynamic therapy, and family therapy. Kate improved during the course of treatment, and thankfully avoided long-term treatment with antipsychotic medications. In response to three thoughtful and stimulating commentaries on the original case study by Pienkos (2014), Westerman (2014), and Mertin (2014), we discuss other ways in which Kate's case can be conceptualized, and we further explore the phenomenon of non-psychotic hallucinations. We focus on the main thematic elements in these commentaries, namely, Kate’s struggle for autonomy and independence as a main driver in symptom formation; the theoretical approach to the case; and the continued focus on the hallucinatory experiences.

Pseudohallucinations in an Adolescent: Considerations for Diagnosis and Treatment in the Case of "Kate"

Hallucinations are usually considered a hallmark of severe psychopathology, most commonly psychotic or thought disorders such as schizophrenia or other organic brain syndromes. However, several studies describe '"non-psychotic hallucinations" occurring in children and adolescents who experience hallucinations without other core symptoms of true psychosis, such as the presence of a thought disorder, disorganized behavior, and pervasive dysfunction. Some authors describe the controversial subject of "pseudohallucinations," which appears to be more representative of conversion disorder symptoms rather than psychotic symptoms. We present a case of "Kate," a 16-year-old adolescent female who required psychiatric hospitalization for auditory hallucinations with secondary delusional thinking. She was initially given a diagnosis of psychotic disorder, not otherwise specified (NOS), and treated with an antipsychotic and an antidepressant. At outpatient follow-up, although Kate continued to endorse hallucinations and delusional thinking, her symptoms were not felt to be part of a true psychotic disorder. The hallucinations could be viewed as a product of extreme anxiety; a diagnosis of generalized anxiety disorder (GAD) was made, and Kate was maintained on the antidepressant and antipsychotic medications. However, this did not entirely explain Kate's symptoms. The consideration of "pseudohallucinations" as conversion disorder symptoms in the form of psychiatric symptoms was key to making an accurate diagnosis, predicting prognosis, and tailoring treatment for Kate and her parents. A total of 29 months of a combination of both cognitive-behavioral and psychodynamic treatment by the first author (MAS) included both weekly individual therapy and weekly therapy with her parents for the first 12 months, biweekly individual and parents therapy for the next eight months, and monthly individual sessions for the final nine months, during which Kate was 18 years old. During the initial course of treatment, the antipsychotic was tapered and discontinued without precipitating an exacerbation of symptoms. Symptoms continued to improve throughout treatment with both patient and parents. We discuss the differences between psychosis and “pseudopsychosis” and the reasons for making the distinction in this case. We also discuss the possible explanation for these "pseudohallucinations" in Kate and how treatment was tailored. Finally, we discuss the implications for diagnosis, prognosis, and treatment of this and similar cases of non-psychotic hallucinations.

Corrugated Waveguide Mode Content Analysis Using Irradiance Moments

We present a novel, relatively simple method for determining the mode content of the linearly polarized modes of a corrugated waveguide using the moments of the intensity pattern of the field radiated from the end of the waveguide. This irradiance moment method is based on calculating the low-order irradiance moments, using measured intensity profiles only, of the radiated field from the waveguide aperture. Unlike the phase retrieval method, this method does not use or determine the phase distribution at the waveguide aperture. The new method was benchmarked numerically by comparison with sample mode mixtures. The results predict less than ±0.7% error bar in the retrieval of the mode content. The method was also tested using high-resolution experimental data from beams radiated from 63.5 mm and 19 mm corrugated waveguides at 170 and 250 GHz, respectively. The results showed a very good agreement of the mode content retrieved using the irradiance moment method versus the phase retrieval technique. The irradiance moment method is most suitable for cases where the modal power is primarily in the fundamental HE₁₁ mode, with <8% of the power in high-order modes.

Deeper Processing Is Associated With Support for Policies to Reduce Obesity

Health communication researchers have become increasingly interested in factors that predict support for health-related policy. Previous studies have shown that judgments about issues that are influenced by political ideology can be modified by the depth with which receivers process messages related to that issue. In this study, we test whether the same pattern is found for causal attributions about obesity and, ultimately, support for policies to reduce obesity. A national, random sample of U.S. adults read a story about both individual and societal causes of obesity. The longer the time participants spent on the study, and the more words they generated in a thought-listing procedure (operationalizations of depth of processing), the more likely participants were to support policies to reduce obesity, a traditionally liberal position. The same measures of depth of processing did not influence causal explanation of obesity overall, but the more time political moderates spent on the study, the more likely they were to both attribute societal explanations for obesity's causes and to support policies to combat obesity. We conclude with a discussion of this study's application to health communication campaigns and future research directions.

Zonisamide for weight loss in adolescents

Obesity in children and adolescents is a growing epidemic in the United States, and physicians are increasingly looking for safe and effective treatments. In recent years, pharmacologic treatment has been considered for severe and refractory cases of adolescent obesity. We present a case of an obese adolescent who presented to an inpatient psychiatric unit with a body mass index (BMI) of 37.8 (>98th percentile for age). He was started on zonisamide for the purposes of weight loss, and a steady decrease in weight and BMI was noted through 4 months of outpatient follow-up. During this time, the patient's weight decreased from 126.8 kg to 106.2 kg, a 20.6-kg loss, representing a 16.25% reduction in weight. His most recent BMI decreased to 31.7 (96th percentile for age). We discuss the potential use of zonisamide for weight loss in adolescents, considering the potential risks and benefits.

Simple Correctors for Elimination of High-Order Modes in Corrugated Waveguide Transmission Lines

When using overmoded corrugated waveguide transmission lines for high power applications, it is necessary to control the mode content of the system. Ideally, overmoded corrugated transmission lines operate in the fundamental HE₁₁ mode and provide low losses for long distances. Unwanted higher order modes (HOMs), particularly LP₁₁ and HE₁₂, are often excited in the experimental systems due to practical misalignments in the transmission line system. This paper discusses how the unwanted modes propagate along with the fundamental mode in the transmission line system by formulating an equation that relates the center of power offset and angle of propagation of a beam (for the HE₁₁ and LP₁₁ modes) or the waist size and phase front radius of curvature of a beam (for the HE₁₁ and HE₁₂ modes). By introducing two miter bend correctors into the transmission system-miter bends that have slightly angled or ellipsoidal mirrors-the HOMs can be precisely manipulated in the system. This technique can be used to eliminate small quantities of unwanted modes, thereby creating a nearly pure fundamental mode beam with minimal losses. Examples of these applications are calculated and show the theoretical conversion of up to 10% HOM content into the fundamental HE₁₁ mode with minimal losses.

Effects of messages emphasizing environmental determinants of obesity on intentions to engage in diet and exercise behaviors

Introduction

Reducing rates of obesity will require interventions that influence both individual decisions and environmental factors through changes in public policy. Previous work indicates that messages emphasizing environmental determinants increases support for public policies, but some suspect this strategy may undermine motivation to engage in diet and exercise.

Methods

Study 1 involved 485 adults recruited from a shopping mall in New York. Study 2 involved 718 adult members of a Web-based national panel of US adults. Respondents in both studies were randomly assigned to read a story that emphasized environmental determinants of health or a control condition. The stories varied in the extent to which they described the story character as taking personal responsibility for weight management. Logistic regression and ordered logit models were used to test for differences in intentions to engage in diet and exercise behaviors based on which story the participant read. Analyses were also performed separately by participants’ weight status.

Results

In both studies, messages that acknowledged personal responsibility while emphasizing environmental causes of obesity increased intentions to engage in healthy behavior for at least 1 weight status group.

Conclusion

Emphasizing factors outside of personal control appears to enhance rather than undermine motivations to engage in healthy diet and exercise behavior.

Photonic-band-gap traveling-wave gyrotron amplifier

We report the experimental demonstration of a gyrotron traveling-wave-tube amplifier at 250 GHz that uses a photonic band gap (PBG) interaction circuit. The gyrotron amplifier achieved a peak small signal gain of 38 dB and 45 W output power at 247.7 GHz with an instantaneous -3  dB bandwidth of 0.4 GHz. The amplifier can be tuned for operation from 245-256 GHz. The widest instantaneous -3  dB bandwidth of 4.5 GHz centered at 253.25 GHz was observed with a gain of 24 dB. The PBG circuit provides stability from oscillations by supporting the propagation of transverse electric (TE) modes in a narrow range of frequencies, allowing for the confinement of the operating TE03-like mode while rejecting the excitation of oscillations at nearby frequencies. This experiment achieved the highest frequency of operation for a gyrotron amplifier; at present, there are no other amplifiers in this frequency range that are capable of producing either high gain or high output power. This result represents the highest gain observed above 94 GHz and the highest output power achieved above 140 GHz by any conventional-voltage vacuum electron device based amplifier.

Narrative persuasion, causality, complex integration, and support for obesity policy

Narrative messages have the potential to convey causal attribution information about complex social issues. This study examined attributions about obesity, an issue characterized by interrelated biological, behavioral, and environmental causes. Participants were randomly assigned to read one of three narratives emphasizing societal causes and solutions for obesity or an unrelated story that served as the control condition. The three narratives varied in the extent to which the character in the story acknowledged personal responsibility (high, moderate, and none) for controlling her weight. Stories that featured no acknowledgment and moderate acknowledgment of personal responsibility, while emphasizing environmental causes and solutions, were successful at increasing societal cause attributions about obesity and, among conservatives, increasing support for obesity-related policies relative to the control group. The extent to which respondents were able to make connections between individual and environmental causes of obesity (complex integration) mediated the relationship between the moderate acknowledgment condition and societal cause attributions. We conclude with a discussion of the implications of this work for narrative persuasion theory and health communication campaigns.

When non-epileptic seizures fool the experts

Even when non-epileptic seizures are correctly diagnosed, appropriate treatment recommendations may not be fully or correctly implemented. We present a case of a 17-year-old girl with frequent non-epileptic seizures who presented for frequent trips to the emergency room (ER) and was admitted to an inpatient Child and Adolescent Psychiatric Facility. Despite being informed that episodes were non-epileptic seizures, various staff and healthcare providers at the psychiatric hospital continued to send the patient to the ER to treat suspected epileptic seizures. We discuss possible reasons why this may have occurred, including psychosocial and emotional reactions of staff members to the episodes. This discussion may also help to explain the persistence of the patient's episodes. We also present options for minimizing the potential for future mismanagement of non-epileptic seizures.

Low-Loss Transmission Lines for High-Power Terahertz Radiation

Applications of high-power Terahertz (THz) sources require low-loss transmission lines to minimize loss, prevent overheating and preserve the purity of the transmission mode. Concepts for THz transmission lines are reviewed with special emphasis on overmoded, metallic, corrugated transmission lines. Using the fundamental HE(11) mode, these transmission lines have been successfully implemented with very low-loss at high average power levels on plasma heating experiments and THz dynamic nuclear polarization (DNP) nuclear magnetic resonance (NMR) experiments. Loss in these lines occurs directly, due to ohmic loss in the fundamental mode, and indirectly, due to mode conversion into high order modes whose ohmic loss increases as the square of the mode index. An analytic expression is derived for ohmic loss in the modes of a corrugated, metallic waveguide, including loss on both the waveguide inner surfaces and grooves. Simulations of loss with the numerical code HFSS are in good agreement with the analytic expression. Experimental tests were conducted to determine the loss of the HE(11) mode in a 19 mm diameter, helically-tapped, three meter long brass waveguide with a design frequency of 330 GHz. The measured loss at 250 GHz was 0.029 ± 0.009 dB/m using a vector network analyzer approach and 0.047 ± 0.01 dB/m using a radiometer. The experimental results are in reasonable agreement with theory. These values of loss, amounting to about 1% or less per meter, are acceptable for the DNP NMR application. Loss in a practical transmission line may be much higher than the loss calculated for the HE(11) mode due to mode conversion to higher order modes caused by waveguide imperfections or miter bends.

A case of severe adolescent obsessive-compulsive disorder treated with inpatient hospitalization, risperidone and sertraline

BACKGROUND

The initial treatment of obsessive-compulsive disorder (OCD) has generally been limited to serotonergic agents, cognitive-behavioral therapy (CBT), or a combination of the two. These findings were supported by the POTS study for OCD in children and adolescents. However, treatment with serotonergic agents or CBT can take several weeks before benefit is seen; severe cases of OCD may require more immediate treatment.

CASE REPORT

The authors present a case of severe OCD in an adolescent that required immediate treatment due to her critical medical condition. The patient's symptoms included not eating or taking medications or fluids by mouth due to fears of contamination. A medical hospitalization was previously required due to dehydration. As treatment with an SSRI would not have quick enough onset and the patient was initially resistant to participating in CBT, the patient was psychiatrically hospitalized and first started on liquid risperidone. After several doses of risperidone, the patient was able to participate in CBT and start sertraline.

DISCUSSION

The authors discuss the differential diagnosis of such a patient, including the continuum of OCD symptoms and psychotic symptoms. The authors discuss the different treatment options, including the utilization of inpatient psychiatric hospitalization. The authors discuss the potential risks and benefits of using atypical antipsychotics in lieu of benzodiazepines for the initial treatment of severe adolescent OCD. The authors also discuss other current treatment recommendations and rationale for the treatment that was pursued.

CONCLUSIONS

This patient received benefit of her symptoms relatively quickly with psychiatric hospitalization and an atypical antipsychotic. The diagnosis of a psychotic disorder should be considered. These treatment options must be weighed against the risks of atypical antipsychotics, including extrapyramidal symptoms, weight gain, and metabolic syndrome; benzodiazepines also have their risks and benefits. Additionally, the cost of time and finances of inpatient hospitalization must be considered. More research is needed regarding the short- and long-term efficacy and safety of antipsychotics in the treatment of OCD in the child and adolescent population.

Mode Content Determination of Terahertz Corrugated Waveguides Using Experimentally Measured Radiated Field Patterns

This work focuses on the accuracy of the mode content measurements in an overmoded corrugated waveguide using measured radiated field patterns. Experimental results were obtained at 250 GHz using a vector network analyzer with over 70 dB of dynamic range. The intensity and phase profiles of the fields radiated from the end of the 19 mm diameter helically tapped brass waveguide were measured on planes at 7, 10, and 13 cm from the waveguide end. The measured fields were back propagated to the waveguide aperture to provide three independent estimates of the field at the waveguide exit aperture. Projecting that field onto the modes of the guide determined the waveguide mode content. The three independent mode content estimates were found to agree with one another to an accuracy of better than ±0.3%. These direct determinations of the mode content were compared with indirect measurements using the experimentally measured amplitude in three planes, with the phase determined by a phase retrieval algorithm. The phase retrieval technique using the planes at 7, 10, and 13 cm yielded a mode content estimate in excellent agreement, within 0.3%, of the direct measurements. Phase retrieval results using planes at 10, 20, and 30 cm were less accurate due to truncation of the measurement in the transverse plane. The reported measurements benefited greatly from a precise mechanical alignment of the scanner with respect to the waveguide axis. These results will help to understand the accuracy of mode content measurements made directly in cold test and indirectly in hot test using the phase retrieval technique.

Aberrant right subclavian artery-esophageal fistula and severe gastrointestinal bleeding after surgical correction of scimitar syndrome

Scimitar syndrome and gastrointestinal bleeding from an aberrant right subclavian artery-esophageal fistula are each extremely rare. Although scimitar syndrome and aberrant right subclavian artery are typically asymptomatic in adults, fistulous connection between the aberrant artery and the esophagus is associated with a poor prognosis. Outcomes are contingent upon timely diagnosis and prompt surgical repair. Prolonged nasogastric and endotracheal intubation can lead to gastrointestinal bleeding in patients who have an aberrant right subclavian artery or other vascular ring. We recommend neither embolization nor the use of endovascular stents as anything other than a temporizing measure in the management of aberrant right subclavian artery injury. These methods can stop acute hemorrhage; however, sentinel bleeding will eventually occur and require definitive ligation. We report the case of a 57-year-old woman in whom an aberrant right subclavian artery-esophageal fistula developed after surgical correction of symptomatic scimitar syndrome. Massive gastrointestinal bleeding resulted from prolonged nasogastric and endotracheal intubation. To our knowledge, this is the first report of aberrant right subclavian artery and scimitar syndrome in the same patient, and the 4th report of a patient's surviving a fistula between the aberrant artery and the esophagus.

Using theory to identify beliefs associated with support for policies to raise the price of high-fat and high-sugar foods

Public policies designed to dramatically raise the price of high-fat and high-sugar foods have received substantial attention from researchers and the media. Although econometric studies suggest that these policies could reduce obesity rates, they are likely to face substantial public opposition. This study used the theory of perceived responsibility and social motivation as a framework to analyze data from a politically diverse convenience sample of 500 adults in upstate New York. The authors examined associations between attribution beliefs and policy support to identify what types of scientific evidence and accompanying messages appear most likely to generate public support for price-raising policies. Results suggest that public health advocates and health communicators could benefit from an increased emphasis on advertising for unhealthy foods as a cause of obesity and the food industry's (manufacturers, advertisers, markets, and restaurants) responsibility for addressing the problem.

Amplification of picosecond pulses in a 140-GHz gyrotron-traveling wave tube

An experimental study of picosecond pulse amplification in a gyrotron-traveling wave tube (gyro-TWT) has been carried out. The gyro-TWT operates with 30 dB of small signal gain near 140 GHz in the HE₀₆ mode of a confocal waveguide. Picosecond pulses show broadening and transit time delay due to two distinct effects: the frequency dependence of the group velocity near cutoff and gain narrowing by the finite gain bandwidth of 1.2 GHz. Experimental results taken over a wide range of parameters show good agreement with a theoretical model in the small signal gain regime. These results show that in order to limit the pulse broadening effect in gyrotron amplifiers, it is crucial to both choose an operating frequency at least several percent above the cutoff of the waveguide circuit and operate at the center of the gain spectrum with sufficient gain bandwidth.

Continuous-Wave Operation of a Frequency-Tunable 460-GHz Second-Harmonic Gyrotron for Enhanced Nuclear Magnetic Resonance

The design, operation, and characterization of a continuous-wave (CW) tunable second-harmonic 460-GHz gyrotron are reported. The gyrotron is intended to be used as a submillimeter-wave source for 700-MHz nuclear magnetic resonance experiments with sensitivity enhanced by dynamic nuclear polarization. The gyrotron operates in the whispering-gallery mode TE_11,2 and has generated 16 W of output power with a 13-kV 100-mA electron beam. The start oscillation current measured over a range of magnetic field values is in good agreement with theoretical start currents obtained from linear theory for successive high-order axial modes TE_11,2,q. The minimum start current is 27 mA. Power and frequency tuning measurements as a function of the electron cyclotron frequency have also been carried out. A smooth frequency tuning range of 1 GHz was obtained for the operating second-harmonic mode either by magnetic field tuning or beam voltage tuning. Long-term CW operation was evaluated during an uninterrupted period of 48 h, where the gyrotron output power and frequency were kept stable to within ±0.7% and ±6 ppm, respectively, by a computerized control system. Proper operation of an internal quasi-optical mode converter implemented to transform the operating whispering-gallery mode to a Gaussian-like beam was also verified. Based on the images of the gyrotron output beam taken with a pyroelectric camera, the Gaussian-like mode content of the output beam was computed to be 92% with an ellipticity of 12%.

Continuous-Wave Operation of a Frequency-Tunable 460-GHz Second-Harmonic Gyrotron for Enhanced Nuclear Magnetic Resonance

The design, operation, and characterization of a continuous-wave (CW) tunable second-harmonic 460-GHz gyrotron are reported. The gyrotron is intended to be used as a submillimeter-wave source for 700-MHz nuclear magnetic resonance experiments with sensitivity enhanced by dynamic nuclear polarization. The gyrotron operates in the whispering-gallery mode TE(11,2) and has generated 16 W of output power with a 13-kV 100-mA electron beam. The start oscillation current measured over a range of magnetic field values is in good agreement with theoretical start currents obtained from linear theory for successive high-order axial modes TE(11,2,q). The minimum start current is 27 mA. Power and frequency tuning measurements as a function of the electron cyclotron frequency have also been carried out. A smooth frequency tuning range of 1 GHz was obtained for the operating second-harmonic mode either by magnetic field tuning or beam voltage tuning. Long-term CW operation was evaluated during an uninterrupted period of 48 h, where the gyrotron output power and frequency were kept stable to within ±0.7% and ±6 ppm, respectively, by a computerized control system. Proper operation of an internal quasi-optical mode converter implemented to transform the operating whispering-gallery mode to a Gaussian-like beam was also verified. Based on the images of the gyrotron output beam taken with a pyroelectric camera, the Gaussian-like mode content of the output beam was computed to be 92% with an ellipticity of 12%.

Psychosocial stress and abdominal pain in adolescents

Children and adolescents may express psychiatric symptoms via somatic complaints. Likewise, children with chronic somatic illnesses are likely to experience psychiatric sequelae. We report three cases of adolescents who were admitted to general paediatrics services for abdominal pain and/or nausea and vomiting with a negative medical workup. In each case, a clear psychosocial stressor was evident. It is possible that somatic symptoms without clear medical causes may reflect psychosocial stress, but it is difficult to discern whether the psychosocial issues preceded the somatic complaints or were a result of them. Making an accurate diagnosis is difficult, and broaching such a subject with patients and their families is a delicate matter. More research is needed to determine appropriate screening tools for identifying cases where psychosocial stress may play a relevant role in symptom presentation, as well as potential treatment modalities for such cases.