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be an algebraic fiber space, and let
be a line bundle on
. In this article, we obtain a curvature formula for the higher direct images of
restricted to a suitable Zariski open subset of
. Our results are particularly meaningful if
is semi-negatively curved on
and strictly negative or trivial on smooth fibers of
. Several applications are obtained, including a new proof of a result by Viehweg–Zuo in the context of a canonically polarized family of maximal variation and its version for Calabi–Yau families. The main feature of our approach is that the general curvature formulas we obtain allow us to bypass the use of ramified covers – and the complications that are induced by them.
The effects of dietary fibre (DF) and protein on insulin response, lipidaemia and inflammatory biomarkers were studied in a model experiment with juvenile obese Göttingen minipigs. After 20 weeks feeding on a high-fat fructose-rich low-DF diet, forty-three 30-week-old minipigs (31·3 (sem 4·0) kg body weight) were allocated to low- or high-DF and -protein diets for 8 weeks in a 2 × 2 factorial design. High DF contents decreased (P = 0·006) while high protein increased (P < 0·001) the daily gain. High protein contents increased fasting plasma concentrations of glucose (P = 0·008), NEFA (P = 0·015), ghrelin (P = 0·008) and non-fasting LDL:HDL ratios (P = 0·015). High DF increased ghrelin (P = 0·036) and C-peptide levels (P = 0·011) in the non-fasting state. High protein increased the gene expression of fructose-bisphosphatase 1 in liver tissue (P = 0·043), whereas DF decreased fatty acid synthase expression in adipose tissue (P = 0·035). Interactions between DF and protein level were observed in the expression of leptin receptor in adipose tissue (P = 0·031) and of PPARγ in muscle (P = 0·018) and adipose tissue (P = 0·004). In conclusion, high DF intake reduced weight gain and had potential benefit on β-cell secretory function, but without effect on the lipid profile in this young obese model. High dietary protein by supplementing with whey protein did not improve insulin sensitivity or lipidaemia, and combining high DF with high protein did not alleviate the risk of metabolic abnormalities.
This paper examines the impact of exports and its main determinants on the financial performance of the Romanian wine industry. We draw on a dataset consisting of mixed firm-level (i.e., 207 companies) data, Google Trends data, and regional variables covering the period from 2009 to 2017. We show that Romanian wine exports, at the firm level, are positively affected by regional wine yields (especially in the case of red wine varieties), temperature, and firm agglomeration, and negatively impacted by firm size. We also find a close positive correlation between financial performance and exports. (JEL Classifications: F61, L66, C23)
The generation mechanism of screech harmonics in supersonic exhausts is revealed using shadowgraph imaging and acoustic far-field measurements for a rectangular, high aspect-ratio nozzle. The coherent information associated with screech and its harmonics, i.e. flow structures and acoustic radiation pattern, is extracted from the time-resolved shadowgraph images. We show that, for large lateral distortions of the jet plume, the passage of screech associated flow structures triggers the screech-cyclic formation of shocks, which travel downstream and merge with the original shocks. The interaction of the shock waves with the flow structures associated with screech alters the appearance of the perturbations in the mixing layer, which constitute the higher harmonics of screech. Visualisations of the acoustic radiation pattern expose that the third and higher screech tone harmonics originate from these interaction locations. Further, the occurrence of mode resonance between the screech and its harmonics is demonstrated, where the mode resonance location coincides with the screech tone origin.
be the poset of cyclic subgroups of a finite group
be the class of
-groups of order
). Consider the function
. In this paper, we determine the second minimum value of
, as well as the corresponding minimum points. Since the problem of finding the second maximum value of
has been solved for
, we focus on the case of odd primes in determining the second maximum.
There is little or no information comparing working experience, including burnout, amongst psychiatry residents internationally. We present preliminary findings from six of the first countries to complete data collection.
Objectives and aims
To obtain data from psychiatric residents in over twenty countries regarding rates of burnout, depression and suicidality and their associations with working conditions and personality traits.
An online survey incorporating the Maslach Burnout Inventory General Survey (MBI-GS), Areas of Work Life Survey (AWLS), Patient Health Questionnaire-9 (PHQ-9), Suicide Ideation and Behaviour Questionnaire (SIBQ), Big Five Inventory - 10 (BFI-10) and questions on demographics and working circumstances was designed, and checked by national co-ordinators for suitability in each participating country, prior to agreeing the final version. This was then translated and back-translated before being sent to participants. A stratified hierarchy sample methodology was developed and used to obtain the best possible study population in each country. This allowed us to maximise participation despite major differences in ease of access to residents across the study countries. The aim of studying the whole resident population was achieved in a large number of countries. Data was then analysed by the study statistician using SPSS. No funding was received for the study.
Results and conclusions
Data from Croatia (n=106), France (n=374), Hungary (n=81), Italy (n=180), Romania (n=52) and United Kingdom (n>2000) revealed marked differences between countries in the factors studied including in working circumstances, rates of burnout and suicidality. The associations discovered may help further improve psychiatric training experience internationally.
As this is a time of great change in Romanian psychiatry we considered it was useful to analyze the availability of various types of psychotherapy and the commitment of psychiatry residents to psychotherapy training, comparing with data from 1998.
Same protocol study like in 1998 was used. The data from National Centre for Medical Training were analyzed. We examined the total number of residents undergoing psychotherapy training, year of residency and the type of psychotherapy they chose.
In 2009, there are 726 psychiatry residents in Romania (180 in 1998) distributed in 11 (6 in 1998) university training centres. We registered a response rate of 81.8% (77.7% in 1998), and only 30.13% residents are involved/ in a specific psychotherapy training comparing with 48.5% in 1998. The types of psychotherapy were: cognitive behavioural therapy, positive psychotherapy, transactional analysis, psychoanalysis, psychodrama, hypnosis, existential psychotherapy.
Even though training in psychotherapy is included in curricula like compulsory topic since 2007, the availability of psychotherapeutic training for residents is still restricted, due to high costs, the need to self-finance the training, organizational difficulties and low number of training centres and trainers.
The development of a therapeutic alliance with the patient is a challenge for emergency psychiatry. The therapeutic alliance could reduce the number of non-voluntary admissions and of compulsory administration of medication. Moreover, a better dialogue with the patients could increase the patients’ compliance with ambulatory care, and could prevent inutile hospitalizations. To evaluate the level of satisfaction with the emergency psychiatric treatment we created and validated a 10-item questionnaire. The questionnaire focuses on the “human quality” and the empathy of the psychiatrist, but also on his professional skills, the delay in the waiting room before medical evaluation, the level of satisfaction concerning the proposed care and a comparison between psychiatrists, nurses and the security staff. The same questionnaire is proposed to the patients and to the psychiatrists. The validation is still running and focuses on around 5000 patients admitted in emergency during one year (June 2007-June 2008). Preliminary results are discussed, taking into account diagnosis and differences between patients and psychiatrists about their therapeutic alliance.
Spice shops, selling ethnobotanical plants like Salvia divinorum, Mitragina speciosa, Amanita muscaria and others, have become very numerous in Romania, first of all because they are legal, second of all because more and more young people are tempted to experiment new sensations. These plants can cause different psychiatric illnesses and associating theme with alcohol or drugs can also be fatal.
Our objective was to present the case of a 25 year old male patient consulted at emergency service, and admitted in our department, presenting psychomotor agitation, anxiety and the specific elements of a psychotic episode, delusions and hallucinations, after smoking a cigarette with sage and night-shade.
The symptomatology remitted rapidly, after approximately 12 hours, revealing the complications of psychoactive substance use.
This case shows the importance of knowledge of psychiatrists concerning the psychoactive substances of ethnobotanical plants, because of their legality and easy procuration possibility. We consider that the role of psychiatrists in mediatizing the side effects of these plants is very important.
The literature shows that fighting against stigma with actions on a less grandiose scale seems to be more effective. (Sartorius, 2002)An example is interventions directed at medical personnel including psychiatrists, who are often important sources of stigmatization. The general public and even health professionals tend to hold a stereotyped image of those with schizophrenia. Before starting an educational program anti-stigma we consider important to know which are the most frequent misconceptions of medical personnel.
This study want to assess the most frequent misconceptions associated with patients with schizophrenia between medical personnel.
Material and methods:
we applied a questionnaire to three groups: medical students before studying psychiatry, medical personnel working in psychiatric setting and health professionals in general hospital.
health professionals contribute to stigmatisation of mental illness, using inadequate terms in defining psychiatric affection and a inadequate attitude; the majority of third group don't understand mental illness and avoids contact with psychiatric patients.
The study underlines the presence of misconceptions associated with patients with schizophrenia between health professionals and the results could be used for a concrete plan for fighting against stigma of this psychiatric disease.
In the field of psychiatric expertise, formal quality criteria such as organization, duration and extent of psychiatric exploration are of significant importance to ensure better transparency and reliability. Psychiatric diagnosis should be made according to DSM-IV or ICD-10 criteria. Following an extensive literature review (medline 1980-2007) we will discuss the importance of the use of The Mini International Neuropsychiatric Interview (M.I.N.I.), and other validated clinical diagnosis tools in psychiatric expert practice.
Beside the clinical validated scales, patients with neurotic or personality disorder require particular clinical experience for a good diagnostic assessment, especially because little evidence based medicine in psychiatric expert practice is available. Thus, we emphasize the interest of a good educational program about expert practice for residents.
Large epidemiological studies are required in order to clarify the evolution of patients after the expertise process. Furthermore, randomized studies should optimize the efficacy of a specific combined therapeutic program concerning patients with somatoform disorders.
The creation of an international network of clinicians with experience in psychiatric expert practice could be an important tool, in order to develop and promote evidence based guidelines for diagnosis and therapeutic issues around psychiatric expert practice.
There has been no evidence about the prescribing practices in psychiatric care in Eastern Europe.
To examine the patterns of psychotropic prescribing in five countries of Eastern Europe.
We conducted a one-day census of psychiatric treatments used in eight psychiatric hospitals in Albania, Croatia, Macedonia, Serbia and Romania. We examined clinical records and medication charts of 1304 patients.
The use of polypharmacy was frequent across all diagnostic groups. Only 6.8% of patients were on monotherapy. The mean number of prescribed drugs was 2.8 (SD 0.97) with 26.5% receiving two drugs, 42.1% receiving three drugs and 22.1% being prescribed four or more psychotropic drugs. Typical antipsychotics were prescribed to 63% and atypical antipsychotics to 40% of patients with psychosis. Older generations of antidepressants were prescribed to 29% of patients with depression. Anxiolitic drugs were prescribed to 20.4% and benzodiazepines to 68.5% of patients. One third of patients received an anticholinergic drug on a regular basis.
Older generation antipsychotics and antidepressants were used more frequently than in the countries of Western Europe. Psychotropic polypharmacy is a common practice. There is a need for adopting more evidence-based practice in psychiatric care in these countries.
The psychiatry is a relatively new field of medicine, which appeared because of the society's demands in taking care of a specific group of patients. These needs still exist and some studies showed that the demand for psychiatrists (Workforce NHS), or at least for psychiatric services (Vernon, 2009), will grow, above all also in developing countries (Patel, 2009).
Concern about recruitment and retention of psychiatrists is longstanding.
Purpose of this study was the evaluation of studies and data related with recruitment issues. Method consist in analysis of data published related with this topic and trying to find the causes and the ways to improve the actual situation.
Was remarqued the insufficient representation of psychiatrists in the physician workforce throughout the world (Rao, 2003) and the increasing number of unoccupied vacancies in psychiatry (Brokington, 2002). Most developing countries need to increase and improve training of mental health professionals. Once trained, these professionals should be encouraged to remain in their country in positions that make the best use of their skills.
Recruitment in psychiatry remain a problem, strongly related with definition of identity of psychiatrists and with community view regarding this need of taking care for this category of patients.
The treatment of alcohol withdrawal with delirium implicate evaluations of multiple factors and even numerous guidelines are available the clinical practice shows important differences between centres.
The purpose of study is to evaluate the pharmacological intervention in delirium tremens in different Romanian settings.
Material and methods:
A case vignette was distributed between 50 psychiatrists, with similar professional experience, from 18 different psychiatric centres, with demand of establish the diagnostic and prescribe the treatment what they consider necessary. We evaluated the results concerning the diagnosis and pharmacological treatment.
Response rates was 56%, all psychiatrist recognised the diagnostic conform DSM IV “Alcohol withdrawal with delirium. Alcohol dependence.” The pharmacological treatments were different concerning the substance and also concerning the recommended doses. The proposed classes are benzodiazepines, anticonvulsivants, neuroleptics and other psychotrops.
This study wants to underline the high diversity of treatment in psychiatry for the same diagnosis.
The interest of educational programs concerning crisis intervention in the managament violent behaviour remains a challenge for emergencies departments. A preliminary study done in Geneva (Caihol et al., 2007) showed a significant reduction in violent behavior during 5 months in emergency psychiatry, after the introduction of a specific educational program. The aim of this study was to evaluate the impact of a specific staff educational crisis intervention on managing violent behaviour after the end of the 5 month planned study. Thus, two year after the initial study, we re-evaluated the impact of the educational program by another project focusing on the management of agitation in emergency. We included all patients admitted in emergency during a same 5-month period (N= around 2000 patients), in order to determine if the promising initial published data could be extended on long term? The percentage of patients with violent behaviour will be compared with the data of the previous study, before and after educational programs. The results will be correlated with different factors which could influence the data: sociodemographic factors, diagnosis, staff characteristics.
Cailhol L, Allen M, Moncany AH, Cicotti A, Virgillito S, Barbe RP, Lazignac C, Damsa C. Violent behavior of patients admitted in emergency following drug suicidal attempt: a specific staff educational crisis intervention. Gen Hosp Psychiatry 2007;29: 42-44.
The purpose of this presentation is to familiarize the attendants with a systemic view of treatment of patients with alcohol problems. The systemic approach takes account of relational and interactional issues which gives a new understanding of alcohol use as a symptom.
There will be treated theoretical aspects of family transactions and constellations in alcoholic systems, showed how to investigate the systemic function of drinking and how to use this knowledge in therapy.
This systemic view of treatment for patients with alcohol problems offer a new perspective and new resources in our therapeutically approach, for all psychiatrists, not only for those who practice systemic family therapy.