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Impairments of contextual processing and theory of mind (ToM) have both been offered as accounts of the deviant language characterising formal thought disorder (FTD) in schizophrenia. This study investigated these processes in patients' dialogue. We predicted that FTD patients would show a decrement in linguistic alignment, associated with impaired ToM in dialogue.
Speech samples were elicited via participation in an interactive computer-based task and a semi-structured interview to assess contextual processing abilities and ToM skills in dialogue, respectively, and from an interactive card-sorting task to measure syntactic alignment. Degree of alignment in dialogue and the syntactic task, and evidence of ToM in (i) dialogue and (ii) a traditional ToM task were compared across schizophrenia patients with FTD (n = 21), non-FTD patients (n = 22) and healthy controls (n = 21).
FTD patients showed less alignment than the other two groups in dialogue, and than healthy controls on the syntactic task. FTD patients showed poorer performance on the ToM task than the other two groups, but only compared to the healthy controls in dialogue. The FTD group's degree of alignment in dialogue was correlated with ToM performance in dialogue but not with the traditional ToM task or with syntactic alignment.
In dialogue, FTD patients demonstrate an impairment in employing available contextual information to facilitate their own subsequent production, which is associated with a ToM deficit. These findings indicate that a contextual processing deficit impacts on exploiting representations via the production system impoverishing the ability to make predictions about upcoming utterances in dialogue.
Gastroenteropancreatic neuroendocrine tumours (GEP-NETs) are rare cancers most often found in the gastrointestinal system or the pancreas. However, patient-reported health state utilities based on clinical trials have not been previously reported in this disease area.
The CLARINET study collected the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 data from patients in both stable and progressive disease states, although data for the latter were only available during the early stage of progression due to trial design. Using published algorithms, data were mapped to EQ-5D utility values. Random-effects generalized least squares models were used to investigate the impacts of progression status, tumour site and other patient characteristics on mapped utility values.
In total, 1,053 observations from 204 patients were mapped to EuroQol (EQ-5D) utilities using the McKenzie mapping algorithm. The final random-effects model included age, gender, baseline utility and progression status as covariates; it was not feasible to investigate time-to-death utility due to a limited number of death in the CLARINET study. Tumour location (midgut versus pancreas) does not seem to affect utility. However, the difference in utilities based on progression status is statistically significant (p<.05) in the base case analysis, and the estimated utilities for stable and progressive disease are .776 and .726, respectively. Furthermore, scenario analyses showed that utility for progressive disease is numerically lower than for stable disease, but this may not be statistically significant in some scenarios.
Patients with GEP-NETs experience worse utility values in the progressive disease state compared to the stable disease state, based on patient-reported health-related quality of life (HRQL) data from the CLARINET study. The decline of utility in the progressive disease state may be underestimated because progressive HRQL data were only collected shortly after the progression event in the trial. The estimated trial-based utilities can be used in future economic evaluations for GEP-NET treatments and to provide more insights to physicians on patient-reported quality of life outcomes in GEP-NETs.
The mass changes of the Gulf of Alaska (GoA) glaciers are computed from the Gravity Recovery and Climate Experiment (GRACE) inter-satellite range-rate data for the period April 2003–September 2007. Through the application of unique processing techniques and a surface mass concentration (mascon) parameterization, the mass variations in the GoA glacier regions have been estimated at high temporal (10 day) and spatial (2 × 2 arc-degrees) resolution. The mascon solutions are directly estimated from a reduction of the GRACE K-band inter-satellite range-rate data and, unlike previous GRACE solutions for the GoA glaciers, do not exhibit contamination by leakage from mass change occurring outside the region of interest. The mascon solutions reveal considerable temporal and spatial variation within the GoA glacier region, with the largest negative mass balances observed in the St Elias Mountains including the Yakutat and Glacier Bay regions. The most rapid losses occurred during the 2004 melt season due to record temperatures in Alaska during that year. The total mass balance of the GoA glacier region was −84 ± 5 Gt a−1 contributing 0.23 ± 0.01 mm a−1 to global sea-level rise from April 2003 through March 2007. Highlighting the large seasonal and interannual variability of the GoA glaciers, the rate determined over the period April 2003–March 2006 is −102 ± 5 Gt a−1, which includes the anomalously high temperatures of 2004 and does not include the large 2007 winter balance-year snowfall. The mascon solutions agree well with regional patterns of glacier mass loss determined from aircraft altimetry and in situ measurements.
Atmospheric-pressure fluidized bed combustion (AFBC) produces solid residues that are different from the familiar pulverized coal ashes. When limestone beds are used to adsorb SOx, high-Ca residues, comprised largely of CaO and SO4, are produced. Leachates from high-Ca AFBC residues are strongly alkaline (pH >11) and contain high levels of dissolved solids (TDS >3000 mg/L). If water is added during handling, hydration of CaO may cause a temperature rise and hydration of CaSO4 may result in premature hardening of the residues. Trace elements and organic components may leach from disposal sites. This paper presents an overview of the nature of AFBC residues and the factors influencing their disposal.
This paper presents a brief review of the literature dealing with utilization of atmospheric-pressure fluidized bed combustion (AFBC) solid wastes. The uses that have been proposed for AFBC residues include the following: agricultural lime, waste neutralization and stabilization, low-strength backfill, soil cementing and asphaltic concrete aggregate. An evaluation of a high-Ca waste from a Canadian AFBC installation is discussed. The waste was found to be unsuitable for applications in Port-land cement concrete because of poor strength development and expansion in mortars. The waste was compatible with Portland cement for soil cementing purposes but the resulting mixes were not resistant to freezing and thawing. Applications in asphaltic concrete were found to be successful in the laboratory and a small field trial is in progress.
Significant concentrations (∼6%, as CaS) of sulphides or other reduced-sulphur species in solid residues from a small-scale circulating fluidized bed (CFB) combustor have been reported in the literature. The presence of sulphides in similar quantities in residues from a utility-scale combustor would present significant difficulties with handling, disposal or utilization of the residues. This paper discusses the preliminary findings of an investigation of sulphur capture in a small-scale circulating fluidized bed combustion (CFBC) unit using a limestone bed and burning a high-S, high-Fe, Eastern Canadian coal. Data are presented on sulphur capture and chemical speciation for residue samples taken from a number of locations in the circulating bed during operation. The results are discussed in terms of probable mechanisms for the formation of sulphur compounds of reduced oxidation state in the bed and the combustion-gas cleaning system.
Progress in high-speed device technology is occurring by both scaling of conventional devices, such as MOSFETs and bipolars, and the development of new device structures which take advantage of multi-layer heterostructures. As scaling in lateral dimensions allows production of devices with dimensions approaching 0.lμm, vertical scaling has become a topic of concern. In this paper we focus on nanosecond thermal processing (NTP), anew area of process technology which uses a pulsed uv-laser to perform selective doping and epitaxy on nanosecond time scales. The rapid thermal cycles and precise control of impurity profiles inherent to the new technique addresses many of the problems faced in vertical scaling for silicon MOS and bipolar structures and in the fabrication of selective heteroepitaxial layers. Following a brief historical overview and description of the process, successful applications in the fabrication of submicron MOSFETs and narrow base bipolar transistors in silicon will be presented. Structural and electrical results will be presented for heteroepitaxial layers fabricated in the GexSi1-x and InxGa1-xAs material systems by the technique.
Few randomised controlled trials (RCTs) have examined potential preventive agents in high-risk community populations.
To determine whether a mental health literacy intervention, the promotion of physical activity, or folic acid plus vitamin B12 reduce depression symptoms in community-dwelling older adults with elevated psychological distress.
An RCT with a completely crossed 2 × 2 × 2 factorial design: (400 mcg/d folic acid + 100 mcg/d vitamin B12v. placebo)×(physical activity v. nutrition promotion control) × (mental health literacy v. pain information control). The initial target sample size was 2000; however, only 909 adults (60–74 years) met the study criteria. Interventions were delivered by mail with telephone calls. The main outcome was depressive symptoms on the Patient Health Questionnaire (PHQ–9) at 6 weeks, 6, 12 and 24 months. The Clinicaltrials.gov registration number is NCT00214682.
The drop-out rate was low (13.5%) from randomisation to 24-month assessment. Neither folic acid + B12 (F(3,856) = 0.83, P = 0.476) nor physical activity (F(3,856) = 1.65, P = 0.177) reduced depressive symptoms at any time point. At 6 weeks, depressive symptoms were lower for the mental health literacy intervention compared with its control condition (t(895) = 2.04, P = 0.042).
Mental health literacy had a transient effect on depressive symptoms. Other than this, none of the interventions significantly reduced symptoms relative to their comparator at 6 weeks or subsequently. Neither folic acid plus B12 nor physical activity were effective in reducing depressive symptoms.
There is no widely accepted, validated framework of health care emergency management capabilities (HEMCs) that can be used by facilities to guide their disaster preparedness and response efforts. We reviewed the HEMCs and the evaluation methods used by the Veterans Health Administration, The Joint Commission, the Institute of Medicine Metropolitan Medical Response System committee, the Department of Homeland Security, and the Department of Health and Human Services to determine whether a core set of HEMCs and evaluative methods could be identified.
Despite differences in the conceptualization of health care emergency management, there is considerable overlap among the agencies regarding major capabilities and capability-specific elements. Of the 5 agencies, 4 identified occupant safety and continuity of operations as major capabilities. An additional 5 capabilities were identified as major by 3 agencies. Most often the differences were related to whether a capability should be a major one versus a capability-specific element (eg, decontamination, management of resources). All of the agencies rely on multiple indicators and data sources to evaluate HEMCs. Few performance-based tools have been developed and none have been fully tested for their reliability and validity. Consensus on a framework and tools to measure HEMCs is needed. (Disaster Med Public Health Preparedness. 2009;3(Suppl 1):S45–S51)
Although the principles behind the care programme approach have generally been welcomed, its implementation has at best been patchy and at worst a complete failure. The principles behind supervision registers have not been welcomed by most psychiatrists. This paper presents a practical solution to the major problems associated with the implementation of the care programme approach and supervision registers by defining pragmatic criteria for inclusion on these registers and the services which should be provided to registered patients. This solution was agreed between purchasers and providers following a series of consultative meetings and this is a process which must be recommended.
The clinical features of a fatal case of the neuroleptic malignant syndrome are presented. The fatal episode was a recurrence of the syndrome after a milder episode 3 months earlier. Prescription of neuroleptics was continued unchanged following the latter, as a correct diagnosis was not made at the time. The case emphasises the importance of early recognition of the syndrome and the possibility of spontaneous remission of symptoms despite continued neuroleptic treatment.
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