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This chapter works out what seems to be a paradox: secession, a process of splitting and division of Member States can lead to strengthening solidarity. The research question is whether a claim of secession contravenes per se the founding European value of solidarity enshrined in Article 2 (TEU). After a brief introduction, the chapter analyses the concept of secession, its meanings, effects and moral implications of a process of withdrawing from a EU Member State. It follows by analysing the concept of solidarity and its EU legal-politico perspectives. It finally concludes by presenting an alternative vision to the dominant presumption that considers that self-determination from a democratic state implies necessarily an egoist economic and political reason.
Linked historical records typically are unrepresentative of the population from which they are drawn even if the method of linking is restricted to time-invariant matching criteria. An example drawn from Canadian census records illustrates the nature of bias that may afflict even a carefully linked sample. The use of potentially time-varying match criteria doubles the size of a linked sample at a modest cost in terms of additional bias. This trade-off is attractive for some research purposes if care is taken in the uses to which the data are put. Reweighting to mitigate the effects of bias in visible characteristics is desirable.
Psychosocial interventions in families of children with cancer are considered an effective way of empowering family members to tackle the complex hurdles they face. The ability of parents to develop adaptive coping strategies during the child's treatment is not only important to their own mental and physical health, but also to their child's well-being and long-term adjustment with the disease.
The aim of this review was to evaluate the existing literature for the period from 2009 to 2017 on psychosocial interventions targeting families of children with cancer. We searched the PubMed database using the following combination of keywords: “cancer AND children AND (intervention OR training) AND (mothers OR primary caregivers OR parents OR fathers OR siblings).”
After careful evaluation of 995 papers, 17 full-text papers were found to match our criteria (12 randomized controlled trials and 5 quasi-experimental studies). The quality of the studies was assessed using the Delphi score questionnaire, and the score of the reviewed studies ranged from 3 to 5. The findings suggest that most interventions reduced distress and improved coping strategies among participants. Interventions, mainly cognitive behavioral therapy and problem-solving skills training targeting maternal distress, were associated with improved adjustment outcomes in mothers of children with cancer.
Significance of results
Psychosocial interventions are helpful, and efforts should be made to promote them in a larger scale. Protocols should be implemented to ensure that all parents benefit. Computer-assisted methods may provide additional benefit by improving cancer-related knowledge and cancer-related communication.
Ecosystem engineers such as the Antarctic scallop (Adamussium colbecki) shape marine communities. Thus, changes to their lifespan and growth could have far-reaching effects on other organisms. Sea ice is critical to polar marine ecosystem function, attenuating light and thereby affecting nutrient availability. Sea ice could therefore impact longevity and growth in polar bivalves unless temperature is the overriding factor. Here, we compare the longevity and growth of A. colbecki from two Antarctic sites: Explorers Cove and Bay of Sails, which differ by sea-ice cover, but share similar seawater temperatures, the coldest on Earth (-1.97°C). We hypothesize that scallops from the multiannual sea-ice site will have slower growth and greater longevity. We found maximum ages to be similar at both sites (18–19 years). Growth was slower, with higher inter-individual variability, under multiannual sea ice than under annual sea ice, which we attribute to patchier nutrient availability under multiannual sea ice. Contrary to expectations, A. colbecki growth, but not longevity, is affected by sea-ice duration when temperatures are comparable. Recent dramatic reductions in Antarctic sea ice and predicted temperature increases may irrevocably alter the life histories of this ecosystem engineer and other polar organisms.
Porous metals represent a class of materials where the interplay of ligament length, width, node structure, and local geometry/curvature offers a rich parameter space for the study of critical length scales on mechanical behavior. Colloidal crystal templating of three-dimensionally ordered macroporous (3DOM, i.e., inverse opal) tungsten provides a unique structure to investigate the mechanical behavior at small length scales across the brittle–ductile transition. Micropillar compression tests show failure at 50 MPa contact pressure at 30 °C, implying a ligament yield strength of approximately 6.1 GPa for a structure with 5% relative density. In situ SEM frustum indentation tests with in-plane strain maps perpendicular to loading indicate local compressive strains of approximately 2% at failure at 30 °C. Increased sustained contact pressure is observed at 225 °C, although large (20%) nonlocal strains appear at 125 °C. The elevated-temperature mechanical performance is limited by cracks that initiate on planes of greatest shear under the indenter.
A Nutrition Society member-led meeting was held on 9 January 2020 at The University of Surrey, UK. Sixty people registered for the event, and all were invited to participate, either through chairing a session, presenting a ‘3 min lightning talk’ or by presenting a poster. The meeting consisted of an introduction to the topic by Dr Barbara Fielding, with presentations from eight invited speakers. There were also eight lightning talks and a poster session. The meeting aimed to highlight recent research that has used stable isotope tracer techniques to understand human metabolism. Such studies have irrefutably shaped our current understanding of metabolism and yet remain a mystery to many. The meeting aimed to de-mystify their use in nutrition research.
Organization and management researchers praise the value of care in the workplace. However, they overlook the conflict between caring for work and for coworkers, which resonates with the dilemma of care allocation highlighted by ethicists of care. Through an in-depth qualitative study of two organizations, we examine how this dilemma is confronted in everyday organizational life. We draw on the concept of boundary work to explain how employees negotiate the boundary of their caring responsibilities in ways that grants or denies care to coworkers. We argue that the possibility of an ethics of care for coworkers requires boundary work that suspends the separation of personal and professional selves and constitutes the worker as a whole person. We contribute to research on care in organizations by showing how care for coworkers may be enabled or undermined by maintaining or suppressing the care allocation dilemma.
To assess the usual dietary intake of twenty micronutrients and to identify their food sources in a representative sample of Greek children and adolescents.
Cross-sectional data from the Hellenic National Nutrition and Health Survey (HNNHS). Vitamin and mineral intakes were estimated from two 24 h dietary recalls by sex and age groups. Estimates were calculated using the National Research Council method and the statistical software package Stata13 to account for within- and between-person variations. The prevalence of nutrients’ inadequacy among sample was estimated using the estimated average requirement (EAR) cut-point method. The contribution of food groups to nutrient intake was estimated to identify micronutrients food sources.
Children and adolescents aged 1–19 years (n 577) who provided sufficient and plausible 24-h recalls.
A substantial percentage of children and adolescents had insufficient intakes of numerous micronutrients. Usual intake of vitamins D, K and potassium was inadequate in practically all individuals. Vitamin A, folate, Ca and Mg were also insufficient to a considerable percentage, especially in girls aged 14–18 years. Pantothenic acid was highlighted as nutrient of interest since only one out of ten boys 9–13 years and girls 14–19 years had intake above the EAR. Data demonstrated that food groups highly ranked in energy contribution were not necessarily important sources of micronutrients.
Results suggest that micronutrient density of Greek children and adolescents’ diet should be improved. These findings might be used by public health policy-makers to help young people optimise their food choices in Greece.
There is some evidence that repetitive transcranial magnetic stimulation (rTMS) may be effective in treating depression. Using an intensive methodology of rTMS in two drug-resistant patients, we observed a good antidepressant effect, but also, induction of manic symptoms.
Older literature had repeatedly documented that physically frail male schizophrenics tended to be withdrawn with apathy, blunted affect and poor prognosis. However, in female schizophrenics, signs of virilism portend poor prognosis and severe deterioration. Three published studies of 92 male schizophrenics, from India, Iran and Japan, showed negative correlations between testosterone (T) levels and negative symptoms.
Twenty-eight (18 male and 10 female) patients, aged 25-67 (mean=34.8) years, who fulfilled DSM-IV TR criteria for schizophrenia were selected, with the approval of local ethical committee. Serum levels of T, dihydrotestosterone and DHEA were estimated by radioimmunoassay. Neuropsychological tests were administered for each patient. Pearson correlation test, linear regression analysis and independent ‘t’ test were used for statistical analysis.
Mean PANSS score for all 28 patients was 82.3; 18 patients had predominantly positive symptoms and 10 had predominantly negative symptoms. Independent ‘t’ test did not show any significant difference for any of the serum hormone levels between the groups of patients based on PANSS scores. However, when women were excluded, T levels were significantly lower in negative symptom dominant group (p=0.05). A correlation between serum T levels, but not of other hormones, and the total scores on all neuropsychological test results was also noted (p=0.017); verbal fluency showed the greatest correlation, followed by working memory. But when women were excluded, this significance disappeared.
Negative symptoms correlate negatively with T levels, but only in men. Neuropsychological findings correlate with T levels as well.
The aim of this study was to assess the outcome of the comorbid conditions of panic disorder after 1 year of treatment, emphasizing the detection of residual symptoms and their relationship to other clinical variables.
Subjects (N=64) were assessed by the Structured Clinical Interview for DSM-III-R and the Eysenck Personality Questionnaire. Comorbidity with other disorders, scores on Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale were assessed at baseline and after 12 months. Criteria for residual anxiety/somatic symptoms were defined.
Reduction in generalized anxiety disorder rates accounted for a significant decrease in comorbidity at 1-year follow-up, with regard to baseline assessment.When the more severe symptoms of the disorder had remitted, a third of the patients referred physical symptoms with some concern over a fluctuating state of anxiety. The said symptoms were neither a recurrence of panic disorder nor did they account for other anxiety or somatoform disorders. Lower scores on extraversion predict higher risk of residual symptoms.
The persistence of residual anxiety/somatic symptoms in a third of the patients who apparently achieved a good response to treatment of panic disorder might characterize a minor form of chronic persistence of this condition.
The subgroup of patients with residual symptoms would not be detectable by follow-up studies, which focus on the assessment of relapse of panic disorder by means of strictly defined diagnostic criteria.
Sex differences have been described in depression and more recently in antidepressant response. Animal models and in particular the Forced Swim Test (FST), are widely used to investigate the behavioural response to stress and to antidepressant treatment.
The present study explored sex differences in the stress response during the FST and examined whether antidepressant treatment alleviates the sex-differentiated stress response.
Adult male and female Wistar rats were subjected to a 15 min FST session and then treated with three injections of sertraline 10 mg/kg or vehicle at 0, 19 and 23 hours post-FST. Twenty-four hours after the first FST, they had a second 5 min FST session and their behaviour was recorded.
Vehicle-treated females exhibited 66% longer duration and 70% shorter latency of immobility than males, suggesting enhanced levels of despair. Sertraline did not significantly affect immobility, but exerted its antidepressant effect by elongating swimming duration in both sexes and shortening climbing behaviour in males only. In contrast, to vehicle-treated rats, no sex differences were observed in sertraline-treated rats in any of these behavioural parameters. However, sex-differences in head swinging behaviour, which is unaffected by sertraline treatment, were still observed in sertraline-treated rats.
Females appear more vulnerable than males to the FST, but the post-treatment organisation of FST behaviour is not sex-differentiated. Antidepressants seem to modulate the behavioural response in FST in a sex-specific way, due to sex differences in baseline FST performance. Consequently, the sex-differentiated stress response profile during FST is attenuated by antidepressant treatment.
To determine the prevalence of metabolic syndrome (MS) in outpatients treated with antipsychotics included in a primary-health-care database.
A cross-sectional study was carried out assessing an administrative outpatients claim-database from 5 primary-health-centers. Subjects on antipsychotics for more than 3 months were included. The control group was formed by the outpatients included in the database without exposition to any antipsychotic drugs. MS was defined according to the modified NCEP-ATP III criteria, and required confirmation of at least 3 of the 5 following components: body mass index >28.8 kg/m2, triglycerides >150 mg/ml, HDL-cholesterol <40 mg/ml (men)/<50 mg/ml (women), blood pressure >130/85 mmHg, and fasting serum glucose >110 mg/dl.
We identified 742 patients [51.5% women, aged 55.1 (20.7) years] treated with first- or second-generation antipsychotics during 27.6 (20.3) months. Controls were 85.286 outpatients [50.5% women, aged 45.5 (17.7) years]. MS prevalence was significantly higher in subjects on antipsychotics: 27.0% (95% CI, 23.8–30.1%) vs. 14.4% (14.1–14.6%); age- and sex-adjusted OR = 1.38 (1.16–1.65, P < 0.001). All MS components, except high blood pressure, were significantly more prevalent in the antipsychotic group, particularly body mass index >28.8 kg/m2: 33.0% (29.6–36.4%) vs. 17.8% (17.6–18.1%), adjusted OR = 1.63 (1.39–1.92, P < 0.001), and low HDL-cholesterol levels: 48.4% (44.8–52.0%) vs. 29.3% (29.0–29.6%); adjusted OR = 1.65 (1.42–1.93, P < 0.001). Compared with the reference population, subjects with schizophrenia or bipolar disorder (BD), but not dementia, showed a higher prevalence of MS.
Compared with the general outpatient population, the prevalence of MS was significantly higher in patients with schizophrenia or BD treated with antipsychotics.
Mixed bipolar states are not infrequent and may be extremely difficult to treat. Lithium, anticonvulsants including valproate and carbamazepine, and antipsychotics such as olanzapine, ziprasidone, and aripiprazole have been reported to be at least partially effective in controlled clinical trials, but many patients do not respond to pharmacological approaches. Electroconvulsive therapy has been tested to be efficacious for the treatment of both manic and depressive episodes, but much less evidence is available with regards to mixed states. The aim of the review was to report the available evidence for the use of electroconvulsive therapy in mixed bipolar states.
A systematic review of the literature on treatment of mixed states, focused on electroconvulsive therapy, was made, beginning in August 1992 and ending in March 2007. The key words were “electroconvulsive therapy” and “mixed bipolar”.
Only three studies met the required quality criteria and were included. This literature suggests that ECT is an effective, safe, and probably underutilized treatment of mixed states. Recent technical developments have made ECT more friendly, tolerable, and safe. Potential alternatives, such as vagus nerve stimulation, deep brain stimulation, or transcranial stimulation, are still far to be proved as effective as ECT.
The aim of the current study was to explore the changing interrelationships among clinical variables through the stages of schizophrenia in order to assemble a comprehensive and meaningful disease model.
Twenty-nine centers from 25 countries participated and included 2358 patients aged 37.21 ± 11.87 years with schizophrenia. Multiple linear regression analysis and visual inspection of plots were performed.
The results suggest that with progression stages, there are changing correlations among Positive and Negative Syndrome Scale factors at each stage and each factor correlates with all the others in that particular stage, in which this factor is dominant. This internal structure further supports the validity of an already proposed four stages model, with positive symptoms dominating the first stage, excitement/hostility the second, depression the third, and neurocognitive decline the last stage.
The current study investigated the mental organization and functioning in patients with schizophrenia in relation to different stages of illness progression. It revealed two distinct “cores” of schizophrenia, the “Positive” and the “Negative,” while neurocognitive decline escalates during the later stages. Future research should focus on the therapeutic implications of such a model. Stopping the progress of the illness could demand to stop the succession of stages. This could be achieved not only by both halting the triggering effect of positive and negative symptoms, but also by stopping the sensitization effect on the neural pathways responsible for the development of hostility, excitement, anxiety, and depression as well as the deleterious effect on neural networks responsible for neurocognition.