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Trinucleotide repeats have been associated with schizophrenia, but the evidence, based on cross-sectional clinical information, is equivocal.
To examine the relationship between genomic CAG/CTG repeat size and premorbid development in schizophrenia.
Early development and premorbid functioning of 22 patients with DSM-IV diagnosis of schizophrenia were assessed by parental interviews. Repeat expansion detection (RED) technique was used to measure genomic CAG/CTG repeat size, and PCR for CAG repeat size at the ERDA-1 and CTG 18.1 loci.
There was an inverse association between CAG/CTG size and perinatal complications. Patients with speech and motor developmental delay had larger repeats. The results were not due to expansion in the ERDA-1 and CTG 18.1 genes.
CAG/CTG repeat expansion is associated with speech and motor developmental delay in schizophrenia. We propose that the developmental model may be useful for research into the genetics of schizophrenia.
This paper reports on a funded summit, which convened a multidisciplinary group of experts to provide consensus on the research priorities necessary for improving long-term community integration of individuals with traumatic brain injury (TBI) and their caregivers.
The 2-day summit was directed using the World Café Methodology, to engage stakeholders and collaboratively arrive at a consensus on the problems to be targeted in research. Participants (n=54), drawn from two Canadian provinces, included an interdisciplinary group of researchers, clinicians, representatives from brain injury associations, individuals with TBI, and caregivers. In small groups, participants discussed challenges to long-term community integration and potential initiatives that would address these barriers. Field notes from the discussions were analyzed using qualitative content analysis.
The consensus on prioritized research directions included developing interventions to optimize the functioning and participation of individuals with TBI, reducing caregiver burden, and evaluating how emerging technology can facilitate delivery of care.
The World Café Methodology was an effective method for developing research priorities. The breadth of expertise of participants and the collegial environment allowed for the identification of a broad perspective on important future research directions with potential to enhance the long-term community integration of individuals with brain injury.
We assessed the impact of a reflex urine culture protocol, an intervention aimed to reduce unnecessary urine culturing, in intensive care units at a tertiary care hospital. Significant decreases in urine culturing rates and reported rates of catheter-associated urinary tract infection followed implementation of the protocol.
The aims were to determine whether the timeliness of contact with a consultation–liaison psychiatry (CLP) service is associated with shorter lengths of stay (LOS), whether this relationship persists for stays greater than 4 days and whether this association varies with age. The length of stay was correlated with the time from admission to contact with the service (the referral lag (REFLAG)), and the REFLAG's proportion of length of stay (REFLAG/LOS) for all 140 in-patients, those with stays greater than 4 days, and for those under and over 65 years.
The length of stay was significantly correlated with referral lag and logREFLAG/logLOS for all patients and for patients with stays greater than 4 days. The correlations remained significant for both age groups, but were stronger in the younger group.
Timeliness of contact with CLP was associated with shorter length of stay, particularly in younger patients. Psychiatric factors influencing length of stay in older patients should be studied by CLP services.
Pulakos, Mueller Hanson, Arad, and Moye (2015) have stated that performance management (PM) best practices have resulted in the dissatisfaction of employees and managers with PM reviews and systems. The authors have suggested that the focus should be on driving critical PM behaviors that have been shown to increase engagement and performance. Corporate Leadership Council (2004) research demonstrated that increased engagement takes place when PM behaviors such as setting clear expectations, providing regular feedback, and helping employees develop and succeed occur. In addition, effective PM happens when employees are contributing to the process as well.
In the opening verses of his first letter to the Thessalonian community, among the very earliest texts of the New Testament, the Apostle Paul refers to three dramatis personae, God and Father, our Lord Jesus Christ, and the Holy Spirit:
Paul, Silvanus, and Timothy, To the church of the Thessalonians in God the Father and the Lord Jesus Christ: Grace to you and peace. We always give thanks to God for all of you and mention you in our prayers, constantly remembering before our God and Father your work of faith and labor of love and steadfastness of hope in our Lord Jesus Christ. For we know, brothers and sisters beloved by God, that he has chosen you, because our message of the gospel came to you not in word only, but also in power and in the Holy Spirit and with full conviction.
(1 Thess 1:1–5)
What is remarkable is that, even at this early stage, the community is clearly well acquainted with this triadic pattern. No explanation is offered; evidently none is necessary. The pattern is apparently already well established as the distinctively and typically Christian way of speaking of God.
Mass casualty triage is the process of prioritizing multiple victims when resources are not sufficient to treat everyone immediately. No national guideline for mass casualty triage exists in the United States. The lack of a national guideline has resulted in variability in triage processes, tags, and nomenclature. This variability has the potential to inject confusion and miscommunication into the disaster incident, particularly when multiple jurisdictions are involved. The Model Uniform Core Criteria for Mass Casualty Triage were developed to be a national guideline for mass casualty triage to ensure interoperability and standardization when responding to a mass casualty incident. The Core Criteria consist of 4 categories: general considerations, global sorting, lifesaving interventions, and individual assessment of triage category. The criteria within each of these categories were developed by a workgroup of experts representing national stakeholder organizations who used the best available science and, when necessary, consensus opinion. This article describes how the Model Uniform Core Criteria for Mass Casualty Triage were developed.
(Disaster Med Public Health Preparedness. 2011;5:129-137)
This paper provides the first analysis of imports and exports of fish leather by the USA. Estimates of minimum levels of trade were obtained from the records of the United States Fish and Wildlife Service for 1997–2001, and possible conservation consequences were considered. Data show that imported leather items used the skins of at least 51 types of fish. Of the 41 identified to species level, six were freshwater fish, eight diadromous and 27 were fully marine. Eels and hagfishes (marketed as ‘eelskin’; eight named species), stingrays (10 named species) and sharks (15 named species) dominated the trade. An average of 725 000 fish-leather products, worth over US$ 6 million, was imported each year to the USA. A significant decline in fish leather imports over the five-year period studied derived largely from changes in ‘eelskin’ imports. Fish leather in the USA was reportedly sourced primarily from the Republic of Korea, mainland China and Thailand, although the records were flawed. About 93% of leather products were obtained from wild fish. Exports from the USA totalled approximately 5% of imports by volume. Many of the fish species comprising the largest imports for leather were characterized by low resilience to exploitation, with one-third of known species considered threatened or near threatened by the World Conservation Union (IUCN). This pilot assessment indicates the need for better record keeping if sustainability of fish exploitation for leather is to be evaluated.
The number of suicides in prison has increased over recent years. This is the first study to describe the clinical care of a national sample of prison suicides.
To describe the clinical and social circumstances of self-inflicted deaths among prisoners.
A national clinical survey based on a 2-year sample of self-inflicted deaths in prisoners. Detailed clinical and social information was collected from prison governors and prison health care staff.
There were 172 self-inflicted deaths: 85 (49%; 95% CI 42–57) were of prisoners on remand; 55 (32%; 95% CI 25–39) occurred within 7 days of reception into prison. The commonest method was hanging or self-strangulation (92%; 95% CI 88–96). A total of 110 (72%; 95% CI 65–79) had a history of mental disorder. The commonest primary diagnosis was drug dependence (39, 27%; 95% CI 20–35). Eighty-nine (57%; 95% CI 49–64) had symptoms suggestive of mental disorder at reception into prison.
Suicide prevention measures should be concentrated in the period immediately following reception into prison. Because hanging is the commonest method of suicide, removal of potential ligature points from cells should be a priority.
The Paediatric Pain Profile (PPP) is a 20-item behaviour rating scale designed to assess pain in children with severe neurological disability. We assessed the validity and reliability of the scale in 140 children (76 females, mean age 9 years 11 months, SD 4 years 7 months; range 1 to 18 years), unable to communicate through speech or augmentative communication. Parents used the PPP to rate retrospectively their child's behaviour when ‘at their best’ and when in pain. To assess interrater reliability, two raters concurrently observed and individually rated each child's behaviour. To assess construct validity and responsiveness of the scale, behaviour of 41 children was rated before and for four hours after administration of an ‘as required’ analgesic. Behaviour of 30 children was rated before surgery and for five days after. Children had significantly higher scores when reported to have pain than ‘at their best’ and scores increased in line with global evaluations of pain. Internal consistency ranged from 0.75 to 0.89 (Cronbach's alpha) and interrater reliability from 0.74 to 0.89 (intraclass correlation). Sensitivity (1.00) and specificity (0.91) were optimized at a cut-off of 14/60. PPP score was significantly greater before administration of the analgesic than after (paired-sample t-tests, p<0.001). Though there was no significant difference in mean pre- and postoperative scores, highest PPP score occurred in the first 24 hours after surgery in 14 (47%) children. Results suggest that the PPP is reliable and valid and has potential for use both clinically and in intervention research.
Las repeticiones de trinucleótidos se han asociado con la esquizofrenia, pero los datos, basados en información clínica transversal, son equívocos.
Examinar la relación entre el tamaño de la repetición de CAG/CTG genómico y el desarrollo premórbido en la esquizofrenia.
Se evaluó por entrevistas con los padres el desarrollo temprano y el funcionamiento premórbido de 22 pacientes con diagnóstico de esquizofrenia del DSM IV. Se utilizó la técnica de detección de la expansión de repeticiones (DER) para medir el tamaño de la repetición de CAG/CTG genómico, y la RCP para el tamaño de la repetición de CAG en los loci ERDA-1 y CTG 18.1.
Hubo una asociación inversa entre el tamaño de CAG/CTG y las complicaciones perinatales. Los pacientes con retraso evolutivo del habla y motor tenían repeticiones mayores. Los resultados no se debían a la expansión en los genes ERDA-1 y CTG 18.1.
La expansión de la repetición de CAG/CTG se asocia con retraso evolutivo del habla y motor en la esquizofrenia. Proponemos que el modelo evolutivo puede ser útil para la investigación en la genética de la esquizofrenia.
A postal study was completed by 138 members of the Tuberous Sclerosis Association for individuals with severe learning disabilities from tuberous sclerosis complex (TSC) (78 males, median 20 years of age; 60 females median 19 years 6 months of age) to investigate the abilities and care needs of these adolescents and young adults. Results were compared with a Salford community survey of young people with severe learning disability (SLD) from a variety of causes (42 males, median 17 years; 29 females, median 17 years 8 months of age). Those with SLD associated with TSC had a higher level of verbal disability and were more dependent for managing toileting and bathing. The young people with TSC were less able to interact socially, showing autistic behaviour. Sexually, they were less aware and less active. Only 20 were thought by their parents to have received sex education.