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Increased system robustness is one of the promises of modularity. However, research on the topic has provided conflicting findings. By generating more than 2000 system architectures, this paper shows that the relation between modularity and robustness is multifaceted: Modularity decreases topological robustness, increases robustness to change propagation, and provides economic benefits. Results here confirm the importance of modularity, enable reconciliation of opposing findings from prior research, and guides researchers and practitioners in the selection of appropriate robustness measures.
Healthcare systems are under strain, this creates a challenge for designers to develop solutions for better health and care delivery. This paper presents a sandbox of illustrative design themes used to improve health systems based on state of the art research projects. These were collated from presentations at The Second International Meeting on Healthcare Systems Design Research, held at DTU-Technical University of Denmark. Attending groups were mapped based on their research keywords, target journals and methodologies in order to gain insight on the communities research landscape.
How can we design and engineer research that leads to the development and effective implementation of complex healthcare interventions? We advocate for a systems design-based approach when initiating clinical research to anticipate the proposition of complex interventions. Using cognitive care as an example, we investigate how hybrid design-inspired methodologies can promote organisational effectiveness and how strong clinical evidence can support successful conceptualisation and uptake of novel interventions into routine clinical practice.
Interactive computer-supported information visualisations are being increasingly used in design. However, while there are frameworks that discuss how traditional representations, such as sketches, CAD models and static diagrams support design tasks, no such mapping exists for interactive visualisations of product-related information. As novel contributions, this paper reviews the design literature for the use of information visualisations. Moreover, using systems theory and Gestalt principles, insights on the applicability of such information visualisations for various design tasks are given.
Immersive visualisations introduce new possibilities for experiencing design, and as such for presenting information. To date, studies in design have focused mostly on immersive visualisations supporting product decisions. However, little attention has been paid to information presentation, e.g. in design reviews, for decisions in the boardroom, and/or for client presentations. This study with industry practitioners identifies information presentation practices and challenges, develops an immersive visualisation prototype, and explores opportunities for the use of immersive visualisations.
With respect to mental health disorders, there are cultural and migration-related differences in the personal experience and the way of dealing with them. However, the association between migration experiences and the development and the continuation of mental health disorders respectively, remain unclear. Epidemiological studies on mental health disorders of migrants rarely exist, even though such information is decisive for the appropriate medical care of this target group. We therefore conducted a cross-sectional survey regarding mental health of immigrants in Germany attending in non-health specific counseling agencies of welfare associations. Besides somatization symptoms (Beschwerdeliste (BL)) and symptoms of mental disorders (depression: patients’ health questionnaire (PHQ-D); anxiety: GAD-7; hazardous alcohol consumption: AUDIT), data on the social and occupational situation, as well as on the migration background was acquired. Data of n= 506 immigrants (55.5% female) were analyzed (age: 54.7 ± 12.4). The immigrants stems from the states of the former Soviet Union (n= 196), Turkey (n= 77), Italy (n= 95) and Spain (n= 67). Overall, 27.1% show evidence for a somatization disorder, 15.8% for a depressive disorder and 23.1% for increased anxiety (GAD-7 ≥ 5). 16.0% of the respondents show evidence of hazardous alcohol consumption. The study provides empirically profound information about the mental health of immigrants, who attend non-health specific counseling agencies. The analysis, subject to the migration status and socio-demographic factors, allows the development of measures of the enhancement of health care for this group regarding mental health.
Aim was to evaluate influencing factors of response and symptomatic remission in first-episode schizophrenia patients treated with risperidone or haloperidol.
229 first-episode schizophrenic patients were examined within a double blind controlled trial of the German Study Group on first-episode schizophrenia with biweekly PANSS ratings. Response was defined according to the definition by Lieberman et al. (2003) and symptomatic remission as the severity component of the consensus remission criteria by the Remission in Schizophrenia Working Group. Sociodemographic, psychopathological and functional variables as well as the treatment applied were evaluated regarding their potential predictive validity for treatment outcome. Univariate tests, logistic regression and CART-analyses were consulted as statistical methods.
126 patients (55%) achieved response and 118 patients (52%) symptomatic remission at discharge with no significant differences between the risperidone (51%) and haloperidol (49%) treated patients. Better baseline functioning, early treatment response, less depressive symptoms and a shorter duration of untreated psychosis were revealed significant predictors of response. Patients with symptomatic remission also had a significantly shorter duration of untreated psychosis and significantly less depressive symptoms at baseline. Logistic regression and CART-analyses revealed low general psychopathology, early treatment response and a high score in the Strauss-Carpenter-Prognostic-Scale at admission to be significantly positive predictive for symptomatic resolution.
Early treatment response, depressive symptoms and the level of psychosocial functioning were revealed to significantly predict outcome, with no significant differences between risperidone and haloperidol. The importance of an early adequate symptom control and the implementation of early intervention programs is highlighted.
Although a series of DNA-sequence variants in proposed disposition genes for schizophrenia have been identified, the mechanisms to translate the genetic vulnerability for schizophrenia to the manifestation of the disease remain obscure. The analysis of the relationship of disease-associated alleles and combinations of alleles (haplotypes) to the clinical features and associated neurobiological correlates offer a tool to increase our understanding of the aetiology of schizophrenia.
We will explore this relationship in a series of case-control samples by (1) extracting schizophrenia-associated alleles and haplotypes of postulated susceptibility and modifying genes, (2) testing these identified genetic markers for association with neuropsychological and neuroimaging features of schizophrenia.
Neuropsychological deficits are considered endophenotypes for schizophrenia, because they are not only found in patients but also in many of their unaffected relatives, albeit in attenuated form. It is not yet clear which of these deficits in relatives are related to genetic or to environmental causes. We tested effects of inferred genetic liability for schizophrenia on neurocognitive variables to address this problem.
Twenty-eight patients with schizophrenia, 129 non-affected biological parents and 143 matched controls were assessed with an extensive neuropsychological test battery including tests of attention, memory, executive functioning and motor soft signs. Twenty-two parents had an ancestral history of schizophrenia and therefore were hypothesized to be more likely than their spouses without such a history (n = 17) to carry a genetic risk for schizophrenia.
Unaffected parents of schizophrenic patients showed significant deficits in a wide array of neuropsychological tasks and task domains. However, comparison of more likely and less likely carriers of illness-related genes showed specifically attentional and executive functioning, but not memory, to vary with degree of inferred genetic loading.
Attentional and executive (frontal) impairments vary with genetic loading for schizophrenia and can be considered true endophenotypes for this disorder. Consequently, these functions are particularly suited to evaluate the functional impact of candidate genes for schizophrenia in future studies.
Disturbances of the oculomotor system are promising endophenotypes for schizophrenia. In two separate studies, we examined antisaccade task performance, a measure of inhibitory control, in first degree relatives of schizophrenic patients (genetic risk without manifest disorder) and in clinical high risk subjects with symptoms suggestive of a prodromal phase of schizophrenia.
In the first study, 41 parents of schizophrenia patients and 22 controls were tested with with a prosaccade task and an antisaccade task. Parents were grouped into more likely, less likely, and indeterminate risk carriers. The second study involved 160 subjects clinically at risk for schizophrenia, 32 first episode schizophrenic patients, and 76 healthy controls.
In study 1 we found an increase of antisaccade latencies and error rates in parents of schizophrenics which varied with inferred genetic load, more likely gene carriers performing worst. In study 2, antisaccade performance varied with symptom load: subjects at risk with basic symptoms only were unimpaired, while at-risk subjects who had experienced brief psychotic episodes (BLIPS) showed deficits similar to first episode patients.
Reduced inhibitory control of oculomotor performance is associated with genetic loading for schizophrenia, and also with symptoms placing subjects at imminent risk of psychosis.
The WHO Collaborative Study on Psychological Problems in General Health Care examined the frequency, form, course and outcome of psychological problems in general health care settings. A total of 25,916 general health care attenders at 15 sites in 14 countries were screened using the 12-item General Health Questionnaire (GHQ-12). Of those screened, 5,438 were assessed in detail using a Primary Health Care version of the Composite International Diagnostic Interview (CIDI-PHC) in conjunction with the Brief Disability Questionnaire, the Social Disability Schedules, a self rated overall health status form and the 28-item General Health Questionnaire. The analysis has shown that sleep problems were common at all sites with: 26.8% of all patients having some form of sleep problem and 15% of the patients examined had trouble falling or staying asleep. Of those with sleep problems, 51.5% had a well-defined International Classification of Diseases 10th Revision (ICD-10) mental disorder (such as depression, anxiety, somatoform disorders or alcohol problems) and 48.5% of those with sleep problems for at least two weeks or more did not fulfil the criteria for any well defined ICD-10 diagnosis. Persons with sleep problems reported a degree of disability in the performance of their daily activities and social roles even when they had no symptoms of psychological disorders. When such symptoms were present the disability was significantly increased.
Purpose of this study was to assess subjective well-being in schizophrenia inpatients and to find variables predictive for response and remission of subjective well-being.
The subjective well-being under neuroleptic treatment scale (SWN-K) was used in 232 schizophrenia patients within a naturalistic multicenter trial. Early response was defined as a SWN-K total score improvement of 20% and by at least 10 points within the first 2 treatment weeks, response as an improvement in SWN-K total score of at least 20% and by at least 10 points from admission to discharge and remission in subjective well-being as a total score of more or equal to 80 points at discharge. Logistic regression and CART analyses were used to determine valid predictors of subjective well-being outcome.
Twenty-nine percent of the patients were detected to be SWN-K early responders, 40% fulfilled criteria for response in subjective well-being and 66% fulfilled criteria for remission concerning subjective well-being. Among the investigated predictors, SWN-K early improvement and the educational status were significantly associated with SWN-K response. The SWN-K total score at baseline showed a significant negative predictive value for response. Baseline SWN-K total score, PANSS global subscore, and side effects as well as the educational status were found to be significantly predictive for remission.
Depressive symptoms should be radically treated and side effects closely monitored to improve the patient's subjective well-being. The important influence of subjective well-being on overall treatment outcome could be underlined.