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Cognitive deficits are a well-established feature of bipolar disorders (BD), even during periods of euthymia, but risk factors associated with cognitive deficits in euthymic BD are still poorly understood. We aimed to validate classification criteria for the identification of clinically significant cognitive impairment, based on psychometric properties, to estimate the prevalence of neuropsychological deficits in euthymic BD, and identify risk factors for cognitive deficits using a multivariate approach.
We investigated neuropsychological performance in 476 euthymic patients with BD recruited via the French network of BD expert centres. We used a battery of tests, assessing five domains of cognition. Five criteria for the identification of neuropsychological impairment were tested based on their convergent and concurrent validity. Uni- and multivariate logistic regressions between cognitive impairment and several clinical and demographic variables were performed to identify risk factors for neuropsychological impairment in BD.
One cut-off had satisfactory psychometric properties and yielded a prevalence of 12.4% for cognitive deficits in euthymic BD. Antipsychotics use were associated with the presence of a cognitive deficit.
This is the first study to validate a criterion for clinically significant cognitive impairment in BD. We report a lower prevalence of cognitive impairment than previous studies, which may have overestimated its prevalence. Patients with euthymic BD and cognitive impairment may benefit from cognitive remediation.
We assessed clinicians’ continuing professional development (CPD) needs at family practice teaching clinics in the province of Quebec. Our mixed methodology design comprised an environmental scan of training programs at four family medicine departments, an expert panel to determine priority clinical situations for senior care, a supervisors survey to assess their perceived CPD needs, and interviews to help understand the rationale behind their needs. From the environmental scan, the expert panel selected 13 priority situations. Key needs expressed by the 352 survey respondents (36% response rate) included behavioral and psychological symptoms of dementia, polypharmacy, depression, and cognitive disorders. Supervisors explained that these situations were sometimes complex to diagnose and manage because of psychosocial aspects, challenges of communicating with patients and families, and coordination of interprofessional teams. Supervisors also reported more CPD needs in long-term and home care, given the presence of caregivers and complexity of senior care in these settings.
The concurrent ageing of parental care-givers and people with intellectual disabilities is driving academic and social welfare concern for a post-parental care ‘crisis’. The ‘crisis’ typically pertains to a transition from primary care in the family home precipitated by the death or incapacity of older parents without a pre-planned pathway to post-parental care. This crisis is amplified in rural communities given low service engagement with families and a deficit of disability-supported accommodation and services. Academics, service providers and policy makers have responded through a problematisation of post-parental care planning. This focus continues to normalise informal care, burdens families with responsibility for planning, and diverts attention from structural deficits in the socio-political carescape. This paper attends to the Australian policy landscape in which long-term care-giving for families living with intellectual disability is enmeshed. It contends that the dyadic and didactic model of informal long-term care has profound implications for social service support and post-parental care planning. Problematisation of carers’ ‘need’ to relinquish primary care and for people with intellectual disabilities to transition to independent and supported living is necessary to unsettle the dominant policy and service discourse around the provision of services to sustain informal care-giving. Innovation is then needed to forge pathways of support for families in rural communities planning on continuing, transitioning and transforming care arrangements across the lifespan.
The relationship between residual depressive symptoms, cognition and functioning in patients with euthymic bipolar disorder is a subject of debate.
To assess whether cognition mediates the association between residual depressive symptoms and functioning in patients with bipolar disorder who were euthymic.
We included 241 adults with euthymic bipolar disorder in a multicentre cross-sectional study. We used a battery of tests to assess six cognition domains. A path analysis was then used to perform a mediation analysis of the relationship between residual depressive symptoms, cognitive components and functioning.
Only verbal and working memory were significantly associated with better functioning. Residual depressive symptoms were associated with poorer functioning. No significant relationship was found between residual depressive symptoms and any cognitive component.
Cognition and residual depressive symptoms appear to be two independent sources of variation in the functioning of people with euthymic bipolar disorder.
We examined how genotype–environment correlation processes differ as a function of adolescent age. We tested whether adolescent age moderates genetic and environmental influences on positivity and negativity in mother–adolescent and father–adolescent relationships using parallel samples of twin parents from the Twin and Offspring Study in Sweden and twin/sibling adolescents from the Nonshared Environment in Adolescent Development Study. We inferred differences in the role of passive and nonpassive genotype–environment correlation based on biometric moderation findings. The findings indicated that nonpassive gene–environment correlation played a stronger role for positivity in mother– and father–adolescent relationships in families with older adolescents than in families with younger adolescents, and that passive gene–environment correlation played a stronger role for positivity in the mother–adolescent relationship in families with younger adolescents than in families with older adolescents. Implications of these findings for the timing and targeting of interventions on family relationships are discussed.
Exposure of healthcare personnel to bloodborne pathogens (BBPs) can be prevented in part by using safety-engineered sharp devices (SESDs) and other safe practices, such as double gloving. In some instances, however, safer devices and practices cannot be utilized because of procedural factors or the lack of a manufactured safety device for the specific clinical use. In these situations, a standardized system to examine requests for waiver from expected practices is necessary
Before-after program analysis.
Large academic medical center.
Vanderbilt University Medical Center developed a formalized system for an improved waiver process, including an online submission and tracking site, and standards surrounding implementation of core safe practices. The program’s impact on sharp device injuries and utilization of double gloving and blunt sutures was examined.
Following implementation of the enhanced program, there was an increase in the amount of undergloves and blunt sutures purchased for surgical procedures, suggesting larger utilization of these practices. The rate of sharp device injuries of all at-risk employees decreased from 2.32% to 2.12%, but this decline was not statistically significant (P = .14). The proportion of reported injuries that were deemed preventable significantly decreased from 72.7% (386/531) before implementation to 63.9% (334/523; P = .002) after implementation of the enhanced program.
An enhanced BBP protection program was successful at providing guidance to increase safe practices and at improving the management of SESD waiver requests and was associated with a reduction in preventable sharp device injuries.
We present an analysis of the parsec-scale jet structure of the quasar 4C+21.35 with a resolution of 0.1 milliarcseconds based on 63 epochs of Very Long Baseline Array observations at 43 GHz from 2007 June to 2014 May along with the Fermi LAT γ-ray light curve and multi-frequency optical photometric and polarimetric data. We find that the innermost jet of the quasar consists of a very compact core of size ~0.03 mas, as well as feature A1 located 0.16 ± 0.03 mas from the core. The distance of A1 remains fairly stable, but its position angle with respect to the core changes from -10 to +10 deg. We detect 4 superluminal knots in the inner jet with apparent speeds ranging from 10c to 20c. The first two components appeared in the jet during the high γ-ray state of the quasar from mid-2010 to early 2011, while the fourth knot appears to be connected with the γ-ray active state in late 2013 - early 2014. The first knot can be associated with the dramatic VHE flare in 2010 June and possesses an extreme Doppler factor ~60. We find that maxima in the γ-ray light curve coincide with epochs of interaction between the moving knots and the core and feature A1. This suggests that the core and A1 are recollimation shocks where γ-ray flares occur. The Chandra 0.5-6 keV image reveals the existence of X-ray emission in the kiloparsec scale jet of the quasar that can be explained via inverse Compton scattering off the cosmic microwave background by relativistic electrons if no deceleration occurs between the parsec- and kiloparsec-scale jets.
This chapter reviews the use of genetics in Drosophila to advance sleep research. Short-term memory can be evaluated in flies using an associative learning paradigm, aversive phototaxic suppression (APS). In 2008, the ventral lateral neurons (LNvs) were shown to promote wakefulness [44-46]. The LNvs are an extensively well-studied neuronal group that is a key part of the clock neurons network that controls circadian behaviors such as locomotor activity rhythms. Plasticity and memory consolidation only represent one of potential avenues for pursuing sleep function, many of the studies that have used Drosophila genetics to pursue functional questions focused on the relationship between sleep and plasticity. Along with the growing genetic toolbox it seems that the fly, in combination with human genetic studies, is uniquely poised to push our understanding of sleep mechanisms and function rapidly forward.
We present an update of the ‘key points’ from the Antarctic Climate Change and the Environment (ACCE) report that was published by the Scientific Committee on Antarctic Research (SCAR) in 2009. We summarise subsequent advances in knowledge concerning how the climates of the Antarctic and Southern Ocean have changed in the past, how they might change in the future, and examine the associated impacts on the marine and terrestrial biota. We also incorporate relevant material presented by SCAR to the Antarctic Treaty Consultative Meetings, and make use of emerging results that will form part of the Intergovernmental Panel on Climate Change (IPCC) Fifth Assessment Report.
Up to 13% of psychiatric patients are readmitted shortly after discharge. Interventions that ensure successful transitions to community care may play a key role in preventing early readmission.
To describe and evaluate interventions applied during the transition from in-patient to out-patient care in preventing early psychiatric readmission.
Systematic review of transitional interventions among adults admitted to hospital with mental illness where the study outcome was psychiatric readmission.
The review included 15 studies with 15 non-overlapping intervention components. Absolute risk reductions of 13.6 to 37.0% were observed in statistically significant studies. Effective intervention components were: pre- and post-discharge patient psychoeducation, structured needs assessments, medication reconciliation/education, transition managers and in-patient/out-patient provider communication. Key limitations were small sample size and risk of bias.
Many effective transitional intervention components are feasible and likely to be cost-effective. Future research can provide direction about the specific components necessary and/or sufficient for preventing early psychiatric readmission.
Earth-like planets have anelastic mantles, whereas giant planets may have anelastic cores. As for the fluid parts, the tidal dissipation of these regions, gravitationally perturbed by a companion, highly depends on its internal friction and thus its internal structure. Therefore, modeling this kind of interaction presents a high interest to constrain planetary interiors, whose properties are still quite uncertain. Here, we examine the anelastic tidal dissipation in deep planetary interiors, in presence of a fluid envelope, and taking into account its dependence on the rheology.
Taking plausible values for the anelastic parameters, and discussing the frequency-dependence of the anelastic dissipation, we show how this mechanism may compete with the dissipation in fluid layers, when applied to Jupiter- and Saturn-like planets. We also discuss the case of the icy giants Uranus and Neptune. Finally, we show how the results may be implemented to describe the dynamical evolution of planetary systems.
To describe the development of the Oxford WebQ, a web-based 24 h dietary assessment tool developed for repeated administration in large prospective studies; and to report the preliminary assessment of its performance for estimating nutrient intakes.
We developed the Oxford WebQ by repeated testing until it was sufficiently comprehensive and easy to use. For the latest version, we compared nutrient intakes from volunteers who completed both the Oxford WebQ and an interviewer-administered 24 h dietary recall on the same day.
A total of 116 men and women.
The WebQ took a median of 12·5 (interquartile range: 10·8–16·3) min to self-complete and nutrient intakes were estimated automatically. By contrast, the interviewer-administered 24 h dietary recall took 30 min to complete and 30 min to code. Compared with the 24 h dietary recall, the mean Spearman's correlation for the 21 nutrients obtained from the WebQ was 0·6, with the majority between 0·5 and 0·9. The mean differences in intake were less than ±10 % for all nutrients except for carotene and vitamins B12 and D. On rare occasions a food item was reported in only one assessment method, but this was not more frequent or systematically different between the methods.
Compared with an interviewer-based 24 h dietary recall, the WebQ captures similar food items and estimates similar nutrient intakes for a single day's dietary intake. The WebQ is self-administered and nutrients are estimated automatically, providing a low-cost method for measuring dietary intake in large-scale studies.
Quasicrystalline Al-Cu-Fe powders were used as a novel filler material in poly(p-phenylene sulfide) (PPS). These polymer/quasicrystal composites showed useful properties that may be beneficially exploited in applications such as dry bearings and composite gears. Al-Cu-Fe quasicrystalline filler significantly improved wear resistance to volume loss in polymer-based composites. In addition to improving the composite wear resistance, the Al-Cu-Fe filler showed low abrasion to the 52100 chrome steel counterface. Furthermore, mechanical testing results showed a two-fold increase in the storage modulus of the reinforced composites compared with the polymer samples. In addition, the Al-Cu-Fe filler was compared to its constituent metals, aluminum oxide, and silicon carbide in PPS. Chemical analysis of the wear interface by X-ray spectroscopy indicated the generation of a third body oxide layer during wear. The fabrication in addition to the thermal, mechanical, and wear properties of these unique materials is described.