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Current service organization is not adapted for youth with or at risk of mental illness. Access, engagement and continuity of care are notorious challenges, particularly during transition from adolescence to adulthood, when youths are transferred to adult services. An HTA was initiated to evaluate the efficacy of programs for which admission is not a function of the legal age of majority.
A systematic review of systematic reviews identified literature published between 2000 and 2017 in 4 databases. To be selected, studies had to focus on specialised mental healthcare early intervention (EI) programs targeting both adolescents and young adults. Contextual and experiential data were collected through interviews with local leading experts. Article selection and quality assessment using ROBIS were conducted with inter rater agreement. The analytical framework developed includes 4 domains: access, engagement and continuity, recovery as well as meaningfulness and acceptability.
1841 references were identified. Following inclusion/exclusion criteria, 5 studies were selected, 3 of which focused on EI for psyschosis. EI programs alone do not seem to decrease duration of untreated psychosis. EI including a multi focus campaign were more successful. EI does, however, seem to decrease hospitalisation for psychosis. The experience of service users and professionals with inter agency collaboration and person-centred care models were analysed to identify facilitating and inhibiting implementation factors.
Healthcare policies need to support further research and development of EI where admission is not a function of the legal age of majority and diagnostic, particularly for youths at risk.
OBJECTIVES/SPECIFIC AIMS: Because clinical trial results are instrumental in the approval of a new drug or changes to the practice of medicine, ensuring the accuracy and validity of collected data is critical in the clinical trial process. This function, routinely carried out by clinical trial monitors in industry-sponsored trials, is often lacking in investigator-initiated trials (IITs) conducted in academia. To address this challenge, we have developed a self-study module that can be used to cross-train academic researchers in essential concepts and practical approaches to monitoring. Furthermore, we are applying a framework drawn from implementation science in the development and launch of this initiative. This framework, as used in other educational programs, is employed here to close the gap between initiative and practice, thereby effectively disseminating this training would improve the quality of clinical trials in academia. METHODS/STUDY POPULATION: This research project applied exploration, installation and implementation stages of the implementation science process by 1) exploring the need for a new initiative, 2) disseminating results, 3) engaging stakeholders, 4) creating standard operating procedures (SOPs) for installation and implementation, 5) studying user satisfaction and effectiveness, 6) addressing feedback and 7) conducting implementation. RESULTS/ANTICIPATED RESULTS: From literature review and internet searches we determined that although numerous GCP training resources exist, most are too broad and lack the practical approaches to meet the complex requirements of monitoring. Moreover, most of the offerings identified are costly or inaccessible. With only about 65% of IITs reported as being monitored (Figures 1 and 2), it appears that there is a clear need for training tools that are easily available to a broader audience. And because monitoring skills are substantially different from those associated with research coordination, it is not surprising that research professionals believed that they would need additional training to become proficient. To address this need, we began developing a monitoring module. We engaged key stakeholders from academia and industry to gain insights into their needs. The results indicated that although our training module was effective, supplementary information on the fundamentals of clinical trials should be included for those new to the field. After incorporating suggested changes and completing the module, we conducted user testing to determine if our module is ready to be broadly disseminated (Figures 3 and 4). Following positive feedback from the group, we are currently in the process of disseminating our module and studying its impact. DISCUSSION/SIGNIFICANCE OF IMPACT: IITs are instrumental in translating academic research into product development. Deficiencies in the quality control of these trials can lead to inadequacies in data accuracy and validity that could lead to significant delays in bringing innovative therapies to patients. Recent NIH policies require data and safety monitoring for all of the trials it supports. The latest addendum to ICH GCP, E6(R2), discusses a need for quality management across the clinical trial lifecycle. As we continue to disseminate and share information during the development of our self-study monitoring module, we are engaging key stakeholders from academia, government, and private institutions to understand and address quality challenges in conducting clinical trials. Finally, this research informs dissemination and implementation research, specifically for creating training for academic research professionals.
It has long been claimed that “maltreatment begets maltreatment,” that is, a parent's history of maltreatment increases the risk that his or her child will also suffer maltreatment. However, significant methodological concerns have been raised regarding evidence supporting this assertion, with some arguing that the association weakens in samples with higher methodological rigor. In the current study, the intergenerational transmission of maltreatment hypothesis is examined in 142 studies (149 samples; 227,918 dyads) that underwent a methodological quality review, as well as data extraction on a number of potential moderator variables. Results reveal a modest association of intergenerational maltreatment (k = 80; d = 0.45, 95% confidence interval; CI [0.37, 0.54]). Support for the intergenerational transmission of specific maltreatment types was also observed (neglect: k = 13, d = 0.24, 95% CI [0.11, 0.37]; physical abuse: k = 61, d = 0.41, 95% CI [0.33, 0.49]; emotional abuse: k = 18, d = 0.57, 95% CI [0.43, 0.71]; sexual abuse: k = 18, d = 0.39, 95% CI [0.24, 0.55]). Methodological quality only emerged as a significant moderator of the intergenerational transmission of physical abuse, with a weakening of effect sizes as methodological rigor increased. Evidence from this meta-analysis confirms the cycle of maltreatment hypothesis, although effect sizes were modest. Future research should focus on deepening understanding of mechanisms of transmission, as well as identifying protective factors that can effectively break the cycle of maltreatment.
Current organization of mental health services in Canada imposes a rupture during youth transition to adulthood, when severe mental health disorders start appearing. This can have a major impact on youth recovery and social integration. A health technology assessment (HTA) was initiated to evaluate the efficacy of programs that simultaneously target adolescents and young adults to support decision making.
A systematic review of systematic reviews was conducted. Four databases were searched (MEDLINE, Embase, Applied Social Sciences Index and Abstracts, and CINAHL) for articles published between 2000 and 2017. Article selection and quality assessment (ROBIS tool) were performed and inter-rater agreement was measured. To be included, the systematic review had to study specialized models or programs serving both adolescents and young adults. An analytical framework was constructed based on the categorization of performance measures for early intervention and the five dimensions of recovery. Group and individual interviews were conducted to collect contextual and experiential data.
A total of 1,054 references were identified. After applying the selection criteria, five systematic reviews were selected. The majority of programs identified were developed for early psychosis. This HTA did not identify specialized programs for other types of mental illness or at-risk youth. Evidence on early interventions for psychosis is emerging in regards to their efficacy in improving functional and clinical recovery. However, evidence has yet to be established for their impact on access. Contextual and experiential data from our organization validated and completed the scientific findings. Facilitating and constraining factors in the implementation of a person-centered care model and inter-agency collaboration were identified.
Services targeting at-risk youth should be developed as part of a continuum of care that is adapted to clinical stages so that all youths living with psychological distress can be treated, regardless of diagnosis or age. These services may draw inspiration from models of early intervention for psychosis. Recommendations from this HTA are currently being put into action in the West Island of Montreal.
Steady states of inviscid, compressible and axisymmetric swirling flows of a single-phase, inert, thermodynamically supercritical fluid in a rotating, finite-length, straight, long circular pipe are studied. The fluid thermodynamic behaviour is modelled by the van der Waals equation of state. A nonlinear partial differential equation for the solution of the flow streamfunction is derived from the fluid equations of motion in terms of the inlet flow specific total enthalpy, specific entropy and circulation functions. This equation reflects the complicated, nonlinear thermo-physical interactions in the flows, specifically when the inlet state temperature and density profiles vary around the critical thermodynamic point, flow compressibility is significant and the inlet swirl ratio is high. Several types of solutions of the resulting nonlinear ordinary differential equation for the axially independent case describe the flow outlet state when the pipe is sufficiently long. The approach is applied to an inlet flow described by a solid-body rotation with uniform profiles of the axial velocity and temperature. The solutions are used to form the bifurcation diagrams of steady compressible flows of real fluids as the inlet swirl level and the centreline inlet density are increased at a fixed inlet Mach number and temperature. Focus is on heavy-molecule fluids with low values of
. Computed results provide theoretical predictions of the critical swirl levels for the exchange of stability of the columnar state and for the appearance of non-columnar states and of vortex breakdown states as a function of inlet centreline density. The difference in the dynamical behaviour between that of a calorically perfect gas and of a real gas is explored. The analysis sheds new fundamental light on the complex dynamics of high-Reynolds-number, compressible, subsonic swirling flows of real gases.
be a member of a certain class of convex ellipsoids of finite/infinite type in
. In this paper, we prove that every holomorphic function in
can be approximated by holomorphic functions on
. For the case
, the continuity up to the boundary is additionally required. The proof is based on
bounds in the additive Cousin problem.
A new species of Begonia (B. lecongkietii N.S.Lý & M.Hughes) is described from Mount Dầu in the South Central Coast Region, Vietnam, an area with an abundance of recently described endemic plant taxa. The new species is allied to Begonia lamxayana Souvann., which occurs 600 km away in Laos, differing chiefly in having larger villose tepals with an undulate margin and larger androecium with 86–116 (versus 20–30) stamens. Begonia lecongkietii is considered Critically Endangered, owing to its small area of occupancy and decline of habitat quality.
ON OCTOBER 30, 1990, PRECISELY AT MIDNIGHT, the flag of a reunited Germany was raised over the Reichstag in Berlin, accompanied by celebratory fireworks across the city. This act signaled the end of one state, the German Democratic Republic (GDR), and the continuation of another, the Federal Republic of Germany (FRG), albeit slightly enlarged: the five new federal states comprising the former GDR were united with the Federal Republic and adopted its legal, political, and economic structures. Hence, the GDR had officially ceased to exist.
There is no doubt that the events leading up to the collapse of the GDR and the subsequent process of unification were challenging: East and West Germany were socialized in quite different ways, and especially for the people in the East, life as they knew it changed completely: economically, politically, ideologically, socially, and culturally. Wolfgang Thierse, an East German citizen before unification and later the president of the German Bundestag, described it in the following way during a speech on the occasion of the twenty-fifth anniversary of the fall of the Wall: “When a strong, successful community and a failed, collapsed, rejected system come together, then the weights are clearly distributed: One is the norm which the others have to take over; one is the teacher, the other the apprentice; in the case of the one, everything can stay as is; in the case of the other, everything has to change; German unity is for some the confirmation of the status quo, for the others it causes a radical upheaval.” It is clear that the process of growing together was experienced differently by East and West Germans: While many East Germans initially felt heightened optimism for freedom and a less complicated life than the GDR offered, the process of unification was overshadowed by uncertainty, doubt, vulnerability, mourning, and a sense of loss that brought about a yearning (especially among the older GDR generation) for the small, familiar country in which they had grown up and a sense of nostalgia for the former GDR that became known as Ostalgie. But it was also difficult for West Germans: many felt that they were carrying a disproportionate share of the cost for integrating the two former states.