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This project will work closely with existing service partners involved in street level services and focus on testing and evaluating three approaches for street level interventions for youth who are homeless and who have severe or moderate mentally illness. Youth will be asked to choose their preferred service approach:
Housing First related initiatives focused on interventions designed to move youth to appropriate and available housing and ongoing housing supports.
Treatment First initiatives to provide Mental Health/Addiction supports and treatment solutions, and; Simultaneous attention to both Housing and Treatment Together
Our primary objective is to understand the service delivery preferences of homeless youth and understand the outcomes of these choices. Our research questions include:
1. Which approaches to service are chosen by youth?
2. What are the differences and similarities between groups choosing each approach?
3. What are the critical ingredients needed to effectively implement services for homeless youth from the perspectives of youth, families and service providers?
Focus groups with staff and family members will occur to assist in understanding the nature of each of service approach, changes that evolve within services, & facilitators and barriers to service delivery. This work will be important in determining which approach is chosen by youth and why. Evaluating the outcomes with each choice will provide valuable information about outcomes for the service options chosen by youth. This assist in better identifying weaknesses in the services offered and inform further development of treatment options that youth will accept.
To determine if substance abuse significantly increases the risk of relapse in first episode psychosis patients over a two year follow-up even after adherence to medication is improved.
Relapse was based on ratings on the Scale for Assessment of Positive Symptoms and weekly ratings on Life Chart Schedule (WHO). Predictor variables included gender, duration of untreated psychosis (DUP), duration of untreated illness from the time of first psychiatric symptoms (DUI), age of onset, pre-morbid adjustment, co-morbid diagnosis of substance abuse at one year, time to remission of psychotic symptoms and adherence to medication. Univariate analyses were followed by logistic regression for rate of relapse and survival analysis with Cox proportional hazard regression was used for time to relapse as the dependent variable.
Of the 207 patients, 162 achieved remission of positive symptoms and were treated and followed for two years. Relapse rates were relatively low (21.6% in the first and 13.8% in 2nd year, respectively) with 33 weeks as the mean time to relapse. Relapse rates were significantly higher for patients with a co-morbid diagnosis of substance abuse (OR= 2.59, CI 1.28-5.21), especially for the second year (OR=3.66, CI 1.30-10.27) and for those with shorter DUI (OR=0.437, CI 0.209-0.914) after controlling for other predictors. Likelihood of relapse during follow-up was associated only with a co-morbid diagnosis of substance abuse (HR= 2.49, p=.01, CI 1.21-5.10).
Specialized treatment of substance abuse may further reduce risk of relapse even after improving adherence to medication.
Iraq and Afghanistan Veterans with posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) history have high rates of performance validity test (PVT) failure. The study aimed to determine whether those with scores in the invalid versus valid range on PVTs show similar benefit from psychotherapy and if psychotherapy improves PVT performance.
Veterans (N = 100) with PTSD, mild-to-moderate TBI history, and cognitive complaints underwent neuropsychological testing at baseline, post-treatment, and 3-month post-treatment. Veterans were randomly assigned to cognitive processing therapy (CPT) or a novel hybrid intervention integrating CPT with TBI psychoeducation and cognitive rehabilitation strategies from Cognitive Symptom Management and Rehabilitation Therapy (CogSMART). Performance below standard cutoffs on any PVT trial across three different PVT measures was considered invalid (PVT-Fail), whereas performance above cutoffs on all measures was considered valid (PVT-Pass).
Although both PVT groups exhibited clinically significant improvement in PTSD symptoms, the PVT-Pass group demonstrated greater symptom reduction than the PVT-Fail group. Measures of post-concussive and depressive symptoms improved to a similar degree across groups. Treatment condition did not moderate these results. Rate of valid test performance increased from baseline to follow-up across conditions, with a stronger effect in the SMART-CPT compared to CPT condition.
Both PVT groups experienced improved psychological symptoms following treatment. Veterans who failed PVTs at baseline demonstrated better test engagement following treatment, resulting in higher rates of valid PVTs at follow-up. Veterans with invalid PVTs should be enrolled in trauma-focused treatment and may benefit from neuropsychological assessment after, rather than before, treatment.
Through a collaboration among twenty legal scholars from eleven countries in North America, Europe and Asia, Patent Remedies and Complex Products presents an international consensus on the use of patent remedies for complex products such as smartphones, computer networks and the Internet of Things. It covers the application of both monetary remedies like reasonable royalties, lost profits, and enhanced damages, as well as injunctive relief. Readers will also learn about the effect of competition laws and agreements to license standards-essential patents on terms that are 'fair, reasonable and non-discriminatory' (FRAND) on patent remedies. Where national values and policy make consensus difficult, contributors discuss the nature and direction of further research required to resolve disagreements. This title is also available as Open Access on Cambridge Core.
Information and communications technology products are indispensable tools of modern life across the globe. Smartphones and laptops connect to a vast global computing infrastructure. Sophisticated medical equipment is ubiquitous in hospitals. Robotics increasingly enable manufacturing of every kind of product. Sensor networks facilitate the flow of urban traffic. The emergence of autonomous vehicles, products enabling augmented and virtual reality, the broad array of “Internet of Things” devices, and countless other innovations suggest that these kinds of products will continue to play an ever-growing role in the modern global economy.
A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.
This paper poses a hypothetical WTO challenge to the Passenger Name Records (PNR) Transfer Agreements the European Union has signed with the United States (as well as Australia and Canada). The focus will be on a possible citation of GATS Article XIV National Security Exception by the EU, and the viability of such a defense. Because of the absence of case law, this paper will also attempt to synthesize an acceptable standard for assessing GATS National Security Exception citations.
We sought to explore factors associated with depressive symptom severity among older persons (≥60 years of age) and to compare the depressive symptoms commonly experienced by older elderly (≥75 years) with those commonly experienced by younger elderly (<75 years).
Secondary analysis was conducted on data from a nationally representative survey.
Four parishes in Jamaica.
A total of 2,943 older community dwellers participated.
The survey included the Zung Self-rating Depression Scale (ZSDS), the Mini Mental State Examination (MMSE), and items on age, sex, and educational level. Linear regression analysis was used to determine the association between ZSDS score and: age, sex, MMSE score, and educational level. Logistic regression analysis was used to determine, for each ZSDS item, whether particular responses were more associated with older or younger elderly.
Higher ZSDS scores were associated with increasing age (B = 0.13, p < 0.001), lower MMSE score (B = −0.42, p < 0.001), the female sex (B = 3.52, p < 0.001), and lower educational level (B = −1.27, p < 0.001). The ZSDS items that were endorsed significantly more (p < 0.05) by older elderly related to negative evaluations about their functionality and value. Hopelessness was also more prominent among the older elderly. The items that were endorsed significantly more (p < 0.05) by the younger elderly had less of a focus.
Among older persons, increasing age was associated with marginally higher levels of depressive symptoms. Female gender, cognitive deficits, preoccupations about value and functionality, and feelings of hopelessness may serve as useful screening parameters.