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Clinical intuition suggests that personality disorders hinder the treatment of depression, but research findings are mixed. One reason for this might be the way in which current assessment measures conflate general aspects of personality disorders, such as overall severity, with specific aspects, such as stylistic tendencies. The goal of this study was to clarify the unique contributions of the general and specific aspects of personality disorders to depression outcomes.
Patients admitted to the Menninger Clinic, Houston, between 2012 and 2015 (N = 2352) were followed over a 6–8-week course of multimodal inpatient treatment. Personality disorder symptoms were assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition Axis II Personality Screening Questionnaire at admission, and depression severity was assessed using the Patient Health Questionnaire-9 every fortnight. General and specific personality disorder factors estimated with a confirmatory bifactor model were used to predict latent growth curves of depression scores in a structural equation model.
The general factor predicted higher initial depression scores but not different rates of change. By contrast, the specific borderline factor predicted slower rates of decline in depression scores, while the specific antisocial factor predicted a U shaped pattern of change.
Personality disorder symptoms are best represented by a general factor that reflects overall personality disorder severity, and specific factors that reflect unique personality styles. The general factor predicts overall depression severity while specific factors predict poorer prognosis which may be masked in prior studies that do not separate the two.
Providing care for people with behavioural and psychological symptoms of dementia is stressful as these individuals are commonly labelled as aggressive or resistant to care. Few studies have evaluated the impact of providing support to professional caregivers working in long-term care. Our mixed methods pilot study evaluated the impact of the innovative Affect Education Model among health care providers from two Toronto nursing homes.
The two-person centred Affect Educational Model through the use of seven questions that encourage self-reflection teaches that problematic behaviours are co-constructed between individuals with BPSD and caregivers. Study procedures included recruiting nursing staff and personal support workers and teaching them the model in five weekly 30-minute group sessions. Qualitative measures in the form of focus groups were obtained. Quantitative measures were obtained through the use of five questionnaires.
Qualitative findings from focus groups identified four themes: facilitators and barriers perceived in current care delivery, the impact of the model experience on staff care delivery, reflections on being taught the model, and future model implementation. Quantitative results were also collected and discussed.
The use of both pharmacologic and nonpharmacologic treatment of individuals with BPSD may be greatly enhanced by an interpersonal two-person Affect Education Model that emphasizes the importance of calming down and self-reflection. Future directions include expanding the model to family caregivers through the use of multimedia resources.
Responsive behaviours in dementia are associated with poor outcomes for the person with dementia (PWD) and caregiver burnout. Family caregivers need a variety of tools to manage responsive behaviours. The Baycrest Quick-Response Caregiver Tool was developed to provide caregivers with a tool that can be used in real time. In this study, the feasibility, impact, and effectiveness of this new tool were studied in family caregivers and health care providers (HCP) using quantitative and qualitative measures.
Family caregivers were recruited and were asked to complete a pre-survey before being sent the link to the educational tool. One month after the telephone survey, caregivers were sent an online post-survey to gather their feedback on the tool and the impact of the tool on caregiver well -being. Healthcare providers were also recruited and reviewed the tool through an online feedback survey. The feasibility, impact, and effectiveness of the tool were assessed using quantitative and qualitative measures.
Caregivers had a moderate degree of and reported a high level of competence - these scores were maintained throughout the study. Caregivers reported that tool positively impacted their compassion towards the person with dementia (PWD), and that their interactions with improved. 100% of HCP who completed the feedback survey would recommend the tool to other HCP and to caregivers of PWD. The caregivers and HCP provided specific suggestions for improvement.
The Baycrest Quick-Response Caregiver Tool was found to be feasible and helpful. It provides caregivers and HCP with an additional approach for responsive behaviours.
A middle-aged gentleman presenting with dyspnoea was presumptively assumed to be a novel coronavirus suspect.
Nasopharyngeal and oropharyngeal swabs were reported negative, and clinico-radiological workup revealed a case of adenoid cystic carcinoma (ACC) of the lung with metastases to the contralateral lung and the lumbar vertebrae.
ACC is a rare malignancy of exocrine glands. Most commonly found in the minor salivary glands, they may rarely occur in other sites. Primary ACC of the lung is a rare histologic subtype that is encountered infrequently in clinical practice for which standard guidelines do not exist.
Research on sickness absence has typically focussed on single diagnoses, despite increasing recognition that long-term health conditions are highly multimorbid and clusters comprising coexisting mental and physical conditions are associated with poorer clinical and functional outcomes. The digitisation of sickness certification in the UK offers an opportunity to address sickness absence in a large primary care population.
Lambeth Datanet is a primary care database which collects individual-level data on general practitioner consultations, prescriptions, Quality and Outcomes Framework diagnostic data, sickness certification (fit note receipt) and demographic information (including age, gender, self-identified ethnicity, and truncated postcode). We analysed 326 415 people's records covering a 40-month period from January 2014 to April 2017.
We found significant variation in multimorbidity by demographic variables, most notably by self-defined ethnicity. Multimorbid health conditions were associated with increased fit note receipt. Comorbid depression had the largest impact on first fit note receipt, more than any other comorbid diagnoses. Highest rates of first fit note receipt after adjustment for demographics were for comorbid epilepsy and rheumatoid arthritis (HR 4.69; 95% CI 1.73–12.68), followed by epilepsy and depression (HR 4.19; 95% CI 3.60–4.87), chronic pain and depression (HR 4.14; 95% CI 3.69–4.65), cardiac condition and depression (HR 4.08; 95% CI 3.36–4.95).
Our results show striking variation in multimorbid conditions by gender, deprivation and ethnicity, and highlight the importance of multimorbidity, in particular comorbid depression, as a leading cause of disability among working-age adults.
The fit note, introduced in England, Wales and Scotland in 2010, was designed to radically change the sickness certification process from advising on individuals’ inability to work to what they could do if adjustments were made available. Our review aimed to evaluate: (1) the percentage of fit notes utilizing the new “may be fit for work” option or advising on work adjustments, (2) the impact of the fit note on sickness absence and return to work, (3) demographic variation in fit note use.
We systematically searched in Embase, Cochrane CENTRAL, Pub Med, Worldcat, Ovid and PsychInfo from 1 Jan 2010–30 Nov 2016 for studies on working aged adults which included the search terms “fit note” or “fitnote”. Relevant abstracts were extracted and we assessed the quality of the papers and assessed bias using the modified Newcastle Ottawa Scale.
Nine papers met the inclusion criteria, four of which were based on the same cohort. Maybe fit notes made up just 6.6% of all fit notes. Work adjustments were most often recommended for patients who were less deprived, female and patients with physical health problems. Fit note advice for patients with physical health problems increased over time, but the opposite was seen for patients with mental health problems.
Further research needed to evaluate the use, impact and potential of the fit note, especially for patients with mental illness.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Polymeric electrolytes have attracted recent research interest because they offer the advantages of being safe and non-flammable, having no dendrite formation, and having no possibility of leakage. The incorporation of synthetic polymers to gel electrolytes has numerous disadvantages: for instance, the required preparation time for creating gel electrolytes from synthetic polymers is dubious and lengthy. Additionally, the conventional pristine polymer gel electrolyte layer has been reported to have low ionic conductivity. This work is focused on preparing a thin flexible gel electrolyte layer by using a naturally occurring wood-based nanofiber cellulose (NFC) hydrogel, to overcome the energy and time consumption of conventional processes. In addition, we use polyvinyl alcohol (PVA) as an additive to the NFC hydrogel in controlled amounts to fabricate a stable thin gel electrolyte layer. By using x-ray diffraction, optical microscopy, and Fourier transform infrared spectra studies, we were able to further our understanding of the microstructure of the films: i.e., the penetration and cross-linking (changes in the bonding structures) of semi-crystalline PVA and hydrogel to form a flexible gel electrolyte layer. The NFC hydrogel-PVA films resulted in much higher ionic conductivity values when compared to other existing pristine polymer electrolytes. The addition of KOH to the NFC hydrogel-PVA further enhanced the ionic conductivity. The best ionic conductivity recorded was 75 mS/cm for films with thickness in the range of 200–350 µm, which is comparable to the highest reported ionic conductivity values of gel electrolytes.
Automatic cluster remover (ACR) settings regulate the end of milking by detaching the clusters based on milk flow dropping below a preset level, which needs to be standardised for different breeds of dairy animals based on their production. A study was conducted to find out the best ACR setting for milking Indian crossbred cows based on milkability, milking irregularities and milk quality. Fifty six crossbred dairy cows in lactations 1 to 4 were categorised into three groups based on the level of production; low (N = 16; <12 kg/d), medium (N = 32; 12–18 kg/d) and high (N = 08; >18 kg/d). The ACR settings tested were 0.1, 0.2, 0.3 and 0.4 kg/min, keeping the vacuum level and pulsation settings constant. The ACR settings significantly (P < 0.01) affected the milk yield at all levels of production with a significant effect (P < 0.01) on machine-on time at 0.4 kg/min. The yield during the first 2 min of milking, average flow and peak flow rates were not affected at any level of production. The average electrical conductivity in milk was significantly (P < 0.01) lower for the low and medium yield cows without affecting the mean somatic cell count. At 0.4 kg/min, more cluster reattachments were needed because of significant amount of milk remaining in the udders post-cluster removal.
We report the synthesis of a novel polymer gel electrolyte primarily based on cellulose extracted from wood along with gelatin, polyacrylic acid (PAA) and potassium hydroxide (KOH) added as additives in minute amounts in various stages. We also study and report the variation of ionic conductivity with variation of various additives. We found that, with variation of additives to hydrogel, its stability and degree of crystallinity are varied. The results were confirmed using x-ray diffraction and Fourier transform infrared spectra studies. An average best ionic conductivity of 96.89mS/cm was reported for a hydrogel: gelatin: PAA: KOH system, which is one of the best reported values of ionic conductivity for gel electrolytes.
Spin coating and drop casting are viable methods for rapid and low-cost additive manufacturing of components for flexible devices and sensors. We investigated the cumulative effects of layering a conductive polymer composite 2 wt% MWCNT filler in PEDOT:PSS on a Mylar substrate for application to electromagnetic interference (EMI) shielding. The optical transmittace of spin coated composite layers is 90%, 45%, and 20% with a thickness of 0.05 µm, 0.15 µm, and 0.45 µm respectively. Drop cast composite layers have 0% transmittance due to their much greater starting thickness of 4.4 µm. The addition of isopropyl alcohol (IPA) to the solution mixture and substrate heating to 40 °C improves the conductivity, and drying time of the cured composite layers to 10 min. This study shows that the cumulative effects of composite layering are additive, but the electrical properties do not scale the same way. A significant increase in the EMI SE is mainly attributed to the enhanced electrical conductivity of the composite. The insertion of a 50 µm gap in between two 15 µm composite layers accentuates the EMI shielding effectiveness (SE) significantly to a peak of 21 dB within a narrow frequency range in the Ku-band tested.
Conventional approaches to evidence that prioritise randomised controlled trials appear increasingly inadequate for the evaluation of complex mental health interventions. By focusing on causal mechanisms and understanding the complex interactions between interventions, patients and contexts, realist approaches offer a productive alternative. Although the approaches might be combined, substantial barriers remain.
Declaration of interest
All authors had financial support from the National Institute for Health Research Health Services and Delivery Research Programme while completing this work. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the National Health Service, the National Institute for Health Research, the Medical Research Council, Central Commissioning Facility, National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre, the Health Services and Delivery Research Programme or the Department of Health. S.P.S. is part funded by Collaboration for Leadership in Applied Health Research and Care West Midlands. K.B. is editor of the British Journal of Psychiatry.
Spent culture medium can provide valuable information regarding the physiological state of a bovine preimplantation embryos through non-invasive analysis of the sum/depleted metabolite constituents. Metabolomics has become of great interest as an adjunct technique to morphological and cleavage-rate assessment, but more importantly, in improving our understanding of metabolism. In this study, in vitro produced bovine embryos developing at different rates were evaluated using proton nuclear magnetic resonance (1H NMR). Spent culture medium from individually cultured embryos (2-cell to blastocyst stage) were divided into two groups based on their cleavage rate fast growing (FG) and slow growing (SG; developmentally delayed by 12–24 h), then analyzed by a 600 MHz NMR spectrometer. Sixteen metabolites were detected and investigated for sum/depletion throughout development. Data indicate distinct differences between the 4-cell SG and FG embryos for pyruvate (P < 0.05, n = 9) and at the 16-cell stage for acetate, tryptophan, leucine/isoleucine, valine and histidine. Overall sum/depletion levels of metabolites demonstrated that embryos produced glutamate, but consumed histidine, tyrosine, glycine, methionine, tryptophan, phenylalanine, lysine, arginine, acetate, threonine, alanine, pyruvate, valine, isoleucine/leucine, and lactate with an overall trend of higher consumption of these metabolites by FG groups. Principal component analysis revealed distinct clustering of the plain medium, SG, and FG group, signifying the uniqueness of the metabolomic signatures of each of these groups. This study is the first of its kind to characterize the metabolomic profiles of SG and FG bovine embryos produced in vitro using 1H NMR. Elucidating differences between embryos of varying developmental rates could contribute to a better understanding of embryonic health and physiology.
OBJECTIVES/SPECIFIC AIMS: The goal of this study is to use patient-centered qualitative techniques to determine what strategies caregivers use to cope with the stress of a child having recently (ie, within the past month) undergone surgical removal of a brain tumor. Results will eventually be evaluated and compared with results of quantitative measures of psychosocial risk and distress as well as demographic and medical characteristics. METHODS/STUDY POPULATION: All caregivers of patients with a newly diagnosed brain tumor requiring neurosurgery admitted to Children’s of Alabama (with English or Spanish-speaking parents) are eligible for enrollment. Participants are enrolled during their child’s initial hospitalization for surgical removal of a brain tumor. Approximately 1 month after hospital discharge, during a routine follow-up clinic visit, caregivers participate in a semistructured interview with a research assistant. Interview questions are used to obtain information about parent and family coping by asking first broadly about stress management over the previous month and then specifically about individual coping strategies. Semistructured interviews are audio recorded, transcribed, and coded for common themes. Interviews are coded by using specific words or phrases to describe various domains of the experience from the caregiver’s perspective. Each participant is given a study ID and study IDs are logged with each code word or phrase endorsed during the interview. RESULTS/ANTICIPATED RESULTS: To date, 22 caregivers have been enrolled and 15 have completed interviews. The most common coping mechanisms fall into the domains of active, avoidance, emotion-focused, and spiritual coping. Active coping consists of information seeking (eg, taking notes, internet research, asking questions), openly communicating emotions, celebrating small victories (eg, focusing on a good scan or test result, thinking that the diagnosis or treatment could have been worse), planning (eg, focusing on 1 d at a time), and maintaining normalcy (eg, maintaining extracurricular activities, returning to school if possible, continuing to see family and friends). Avoidance coping consists of evading discussions about emotions, withdrawal from family members, denial (eg, keeping a cancer diagnosis from the child), and avoiding seeing people or participating in activities. Emotion-focused coping consists of crying, laughing, and staying strong in front of the patient. In general, those who self-identify as coping poorly tend to be those who utilized more avoidance-focused coping strategies. Further, caregivers tended to identify active coping strategies (eg, taking notes, focusing on 1 appointment or treatment at a time) as the most helpful. DISCUSSION/SIGNIFICANCE OF IMPACT: It will be helpful for providers to more deeply understand the experience of caregivers whose children have recently undergone brain tumor resection and the strategies used to cope with the stress of the first month postsurgery. This information can be used to create standardized interventions for use during posthospitalization clinic visits. For example, if families continue to endorse that active coping mechanisms are the most helpful, providers can assist caregivers in developing these strategies (eg, uniformly provide notebooks and encourage caregivers to keep track of questions and appointment information, pair caregivers who are struggling with others who use more active coping strategies). Those utilizing more avoidance coping strategies may need more coaching and recommendations. A brief assessment could potentially be developed for caregivers dealing with this diagnosis, in order to quickly assess coping strategies and provide appropriate recommendations. Future analyses will determine whether initial coping strategies and adjustment are predicted by child age or medical information.
Deficiencies of micro (Zn, B) and secondary (S) nutrients are well-documented in soil as well as in cereal crops, leading to decreased crop yields and low nutritional quality of food. We evaluated the effects of coated urea on maize yield, N and Zn uptake, and input cost relationships. Field experiments were conducted on maize to test boron-coated (BCU), sulphur-coated (SCU) and zinc-coated urea (ZnCU) during 2013 and 2014. On the basis of 2 years’ average data, the highest grain yield was achieved with 0.5% BCU, 5% SCU and 2.5% ZnCU as zinc sulphate hepta hydrate. These treatments increased yields by 5.4, 12.8 and 9.9% over prilled urea (PU), respectively. Application of 0.5% BCU (supplying 1.4 kg B ha−1), 5% SCU (supplying 14.1 kg S ha−1) and 2.5% ZnCU (supplying 7.05 kg Zn ha−1) registered the highest N concentrations and uptake in grain and stover. Total N uptake (grain + stover) was increased by 7.6, 16.7 and 17.1% with BCU, SCU and ZnCU treatments over PU. As compared to PU, Zn concentration in maize grain was significantly higher and total Zn uptake (grain + stover) increased by 32.4% with 2.5% ZnCU. Coated urea materials also enhanced the partial factor productivity (PFPN), agronomic efficiency (AEN), recovery efficiency (REN) and harvest index (HIN) over those of PU. From the economic viewpoint this study suggests that coating of urea with 0.3% boron, 5% sulphur or 2% zinc gives maximum net returns and benefit-cost ratio. Our data indicate that coating of B, Zn and S onto urea increases maize yield, profitability and nitrogen use efficiency in the western Indo-Gangetic plains of India.
Topdressing of N fertilizer, whenever leaf greenness, as measured by Chlorophyllmeter (SPAD), falls below the threshold value can be used for site-specific N management in wheat cultivation. Herein, a field experiment was conducted to analyse the effect of SPAD-based N management on wheat productivity and N use efficiency during the dry season of 2010/11 and 2011/12 on acid lateritic soil of eastern India. The experiment had 12 treatments, with nine treatments combining three SPAD thresholds (38, 40 and 42) and three N levels (15, 25 and 35 kg N ha−1) as real time N management (RTNM), one fixed time N management (FTNM), one farmers’ fertilizer practise (FFP) and control (Zero N), with three replications. The grain yield of RTNM ranged from 90 to 113% as that of FTNM, but using considerably less N. Maintaining SPAD threshold of 40 up to heading stage by topdressing 25 kg N ha−1 at each time (N25S40) caused the highest grain yield (4483 kg ha−1). While saving 22.5 kg N ha−1 (18.8%), N25S40 increased agronomic N use efficiency by 58.5%, nitrogen recovery efficiency by 15.1% and partial factor productivity of applied N by 26.4% when compared with conventional fertilizer recommendations (i.e. FTNM). The SPAD-based N management strategy was found very promising in efficiently managing N fertilizer in wheat for improving wheat productivity and N use efficiency.