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The investigation of death due to suspected cardiac disease in the elderly, whether sudden unexpected or otherwise, should follow the same approach as in younger individuals. This should include a thorough scene investigation and review of the history of the events leading up to death (if witnessed), a complete autopsy, appropriate laboratory studies – at least a comprehensive drug screen, a microscopic examination of the tissues – and, finally, determining the cause and manner of death .
De Fruyt and De Clercq (this volume) and Sellbom (this volume) raise important issues surrounding the use of a five-factor model (FFM) of personality to conceptualize, assess, and diagnose personality disorder including how one includes a measure of impairment, the level of abstraction that is optimal (domains vs. facets), and the need for the development of formal test manuals, normative data, and means for identifying non-credible responding. In this response, the authors note their agreement with De Fruyt and De Clercq regarding the importance of assessing impairment but note that (a) it is already included to a large degree in the assessment of pathological FFM traits and (b) that they would prefer an approach that focuses explicitly on difficulties in occupational and social functioning. As to Sellbom’s comments suggesting that further work is necessary with regard to the development of test manuals, normative databases, and measures of valid responding – the authors agree and note some of the obstacles including the need for funding for the collection of normative data (and what consensus as to the kind – clinical only; community only; both) and development of test manuals. As to measures of credible responding, they note that many of these exist already for the family of FFM PD scales that they helped create and are aware of similar efforts for other popular measures of pathological traits.
The use of dimensional personality traits with explicit ties to general or normative personality has gone mainstream with instantiation in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the soon to be released 11th revision of the International Classification of Diseases (ICD-11). Much of the theoretical and empirical work that supports the transition to dimensional trait-based models of personality disorder has used the prominent five-factor model of personality to do so, which suggests that five basic dimensions capture much of the important and reliable personality variance: neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness. This chapter reviews this literature and demonstrates how general and pathological five-factor models of personality are parsimonious, valid, and useful. The authors believe that the use of such models for the diagnosis of personality disorder represents a much needed and empirically supported movement to integrate normative and pathological personality.
The changing nature of work compels corresponding changes in organization selection systems. In this chapter, we advocate for competency modeling and propose nine competencies that are becoming more instrumental for success in the modern workforce. We then propose predictor constructs and methods to measure these competencies and new ways to leverage technology in their assessment. Lastly, we discuss four challenges that organizations will face when advancing our solutions: (a) achieving buy-in for competency modeling; (b) the continued recognition of a criterion problem; (c) monitoring applicant reactions; and (d) acknowledging social and ethical issues that may arise with these proposed changes.
The purpose of this study was to examine how exposure to the armed conflict and the tsunami, perceived availability of resources, and perceived helpfulness of religious practices would predict depression, anxiety, posttraumatic stress, and psychosocial functioning in a multi-ethnic sample of Sri Lankan youth. A sample of Tamil (174), Sinhalese (332), and Muslim (215) children (girls=391) between 12 and 19 years (mean age =14.4, sd =1.9), completed a survey including demographic questions and items assessing exposure to the conflict and the tsunami, the perceived availability of resources, and perceived helpfulness of religious practices. Scales assessing depression, anxiety, posttraumatic stress, and psychosocial functioning were also completed. Four hierarchical multiple regression analyses were conducted with exposure to the conflict and tsunami, perceived availability of resources, and perceived helpfulness of religious beliefs as predictors, and with depression, anxiety, posttraumatic stress and psychosocial functioning as outcomes. The results revealed that exposure to the armed conflict significantly predicted posttraumatic stress (R2 =.03, F [1,494] = 12.77, p< .001), while exposure to the tsunami predicted anxiety (R2 =.03, F [2,506] = 7.8, p< .001), and perceived availability of resources predicted depression (R2=.09, F [4,499] = 11.83, p< .001) and psychosocial functioning (R2=.098, F [4,506] = 13.67, p< .001). The results suggest that exposure to traumatic events should not be assumed to be the only or even the most important variable when considering the overall psychological and psychosocial functioning of children in developing countries and traditional cultures. Implications for interventions, policy, and future research are discussed.
To examine the efficacy and tolerability of quetiapine SR in patients with schizophrenia switched from quetiapine IR.
Randomised, double-blind study (D1444C00146) using dual-matched placebo. Patients clinically stable on fixed doses of quetiapine IR received twice-daily quetiapine IR 400, 600 or 800 mg/day for 4 weeks. Stable patients were then randomised (1:2) to continue taking quetiapine IR or switch to the same total dose of quetiapine SR (active dose once-daily in the evening) for 6 weeks. Primary analysis: % of patients (modified ITT population) discontinuing due to lack of efficacy or with PANSS total increase ≥20% at any visit, using a 6% non-inferiority margin for the upper 95% CI of the treatment difference. Per-protocol (PP) analysis was also performed.
497 patients were randomised (quetiapine SR 331, IR 166); completion rates were 91.5% and 94.0%, respectively. Few patients discontinued due to lack of efficacy or had a PANSS increase ≥20% in both the MITT (n=496) and PP populations (n=393): 9.1% and 5.3% for quetiapine SR and 7.2% and 6.2% for quetiapine IR, respectively. Quetiapine SR was non-inferior to quetiapine IR in the PP population (treatment difference: -0.83% [95% CI -6.75, 3.71]; p=0017) but not in the MITT population (treatment difference: 1.86% [95% CI -3.78, 6.57]; p=0.0431). The incidence (quetiapine SR 38.7%; IR 35.5%) and profile of AEs were similar in both groups.
Clinically-stable patients receiving quetiapine IR can be switched, without titration, to an equivalent once-daily dose of quetiapine SR without any clinical deterioration or compromise in tolerability.
A randomised study (D1444C00004) to show superior relapse prevention with quetiapine sustained release (SR) versus placebo.
327 patients with schizophrenia were switched to open-label, once-daily quetiapine SR dosed at 300 mg on Day 1, 600 mg on Day 2, then 400-800 mg for a 16-week stabilisation period. Stable patients (clinically and by dose) were randomised (n=197; double-blind phase) to either quetiapine SR (400-800 mg/day) or placebo. Primary endpoint: time from randomisation to psychiatric relapse (hospitalisation for worsening schizophrenia, PANSS increase ≥30%, CGI-I score ≥6, or need for additional antipsychotics). An independent Data Safety Monitoring Board (DSMB) monitored the study. Planned analyses: interim, after 45 and 60 relapses (to permit termination if a significant treatment difference in primary endpoint was observed); final, after 90 relapses.
Early termination occurred after the first interim analysis (following DSMB recommendation) as quetiapine SR (mean dose 669 mg/day; mean randomised-treatment period 4 months) was significantly superior to placebo for time to relapse: HR 0.16 (95% CI 0.08, 0.34; p<0.001). Numbers (%) of relapses were: 9 (10.7%), quetiapine SR; 36 (41.4%), placebo (interim ITT population). Estimated relapse rate at 6 months was: 14.3%, quetiapine SR; 68.2%, placebo (difference 54% [95% CI 42.5, 65.4; p<0.001]). Incidence of: treatment-related AEs 18% (quetiapine SR), 21% (placebo); total EPS-related AEs 1.1% and 1%, respectively. One patient in each group withdrew due to AEs.
Once-daily quetiapine SR (400-800 mg/day) was effective versus placebo in preventing relapse in patients with clinically-stable schizophrenia and was well tolerated during longer-term use.
Brain health diplomacy aims to influence the global policy environment for brain health (i.e. dementia, depression, and other mind/brain disorders) and bridges the disciplines of global brain health, international affairs, management, law, and economics. Determinants of brain health include educational attainment, diet, access to health care, physical activity, social support, and environmental exposures, as well as chronic brain disorders and treatment. Global challenges associated with these determinants include large-scale conflicts and consequent mass migration, chemical contaminants, air quality, socioeconomic status, climate change, and global population aging. Given the rapidly advancing technological innovations impacting brain health, it is paramount to optimize the benefits and mitigate the drawbacks of such technologies.
We propose a working model of Brain health INnovation Diplomacy (BIND).
We prepared a selective review using literature searches of studies pertaining to brain health technological innovation and diplomacy.
BIND aims to improve global brain health outcomes by leveraging technological innovation, entrepreneurship, and innovation diplomacy. It acknowledges the key role that technology, entrepreneurship, and digitization play and will increasingly play in the future of brain health for individuals and societies alike. It strengthens the positive role of novel solutions, recognizes and works to manage both real and potential risks of digital platforms. It is recognition of the political, ethical, cultural, and economic influences that brain health technological innovation and entrepreneurship can have.
By creating a framework for BIND, we can use this to ensure a systematic model for the use of technology to optimize brain health.
The transmission rate of methicillin-resistant Staphylococcus aureus (MRSA) to gloves or gowns of healthcare personnel (HCP) caring for MRSA patients in a non–intensive care unit setting was 5.4%. Contamination rates were higher among HCP performing direct patient care and when patients had detectable MRSA on their body. These findings may inform risk-based contact precautions.
Challenges faced by older people include losses of loved ones through death; declining health, mobility, and function of the five senses; loss of independence; diminishing cognitive ability; and the struggle with Erik Erikson’s final two stages of life, namely generativity versus stagnation and ego integrity versus despair. Those who dedicate their energies to helping the elderly meet these challenges will be well served by the toolbox of techniques within the rubric of interpersonal psychotherapy (IPT). This chapter will serve as a brief overview of IPT principles, a review of the extant scientific literature on its efficacy in late life, and case vignettes to illustrate how it was used for each of the four foci of IPT, namely, role transition, grief, role disputes, and interpersonal deficit.
The Murchison Widefield Array (MWA) is an open access telescope dedicated to studying the low-frequency (80–300 MHz) southern sky. Since beginning operations in mid-2013, the MWA has opened a new observational window in the southern hemisphere enabling many science areas. The driving science objectives of the original design were to observe 21 cm radiation from the Epoch of Reionisation (EoR), explore the radio time domain, perform Galactic and extragalactic surveys, and monitor solar, heliospheric, and ionospheric phenomena. All together
programs recorded 20 000 h producing 146 papers to date. In 2016, the telescope underwent a major upgrade resulting in alternating compact and extended configurations. Other upgrades, including digital back-ends and a rapid-response triggering system, have been developed since the original array was commissioned. In this paper, we review the major results from the prior operation of the MWA and then discuss the new science paths enabled by the improved capabilities. We group these science opportunities by the four original science themes but also include ideas for directions outside these categories.
We simultaneously generalize Silver’s perfect set theorem for co-analytic equivalence relations and Harrington-Marker-Shelah’s Dilworth-style perfect set theorem for Borel quasi-orders, establish the analogous theorem at the next definable cardinal, and give further generalizations under weaker definability conditions.
Uninsured patients are more likely than the general population to use tobacco and less likely to quit.
To determine if the mode of delivering the PHS Guidelines influenced the effectiveness of smoking cessation among patients in a safety net setting.
Six free clinics were randomly assigned to a training program delivered by an academic physician or community partner plus video support. A repeated cross-sectional survey of patients was conducted at three waves to assess effectiveness to promote quitting.
Tobacco use was triple the rate of the US population: 57.7% (Wave 1), 44.7% (Wave 2), and 48.9% (Wave 3). Patients were more likely to report receipt of at least one evidence-based strategy to promote quitting at Wave 2 (AOR = 2.33, 95% CI (1.18–4.58)). Patients treated in clinics trained by the community partner were significantly more likely to report receiving cessation assistance at Wave 2 (AOR 2.54, 95%CI 1.29–5.00) and the trend was similar, but not significant at Wave 3. Patients in the community partner-led arm were significantly less likely to report tobacco use at Wave 3 (AOR 0.59, 95% CI 0.35–0.99).
Implementation of the PHS Guidelines in free clinics demonstrates preliminary efficacy, with delivery by community partners offering greater scalability.
We show that the isomorphism problems for left distributive algebras, racks, quandles and kei are as complex as possible in the sense of Borel reducibility. These algebraic structures are important for their connections with the theory of knots, links and braids. In particular, Joyce showed that a quandle can be associated with any knot, and this serves as a complete invariant for tame knots. However, such a classification of tame knots heuristically seemed to be unsatisfactory, due to the apparent difficulty of the quandle isomorphism problem. Our result confirms this view, showing that, from a set-theoretic perspective, classifying tame knots by quandles replaces one problem with (a special case of) a much harder problem.
We studied the association between chlorhexidine gluconate (CHG) concentration on skin and resistant bacterial bioburden. CHG was almost always detected on the skin, and detection of methicillin-resistant Staphylococcus aureus, carbapenem-resistant Enterobacteriaceae, and vancomycin-resistant Enterococcus on skin sites was infrequent. However, we found no correlation between CHG concentration and bacterial bioburden.
The Rio Grande Cone is a major fanlike depositional feature in the continental slope of the Pelotas Basin, Southern Brazil. Two representative sediment cores collected in the Cone area were retrieved using a piston core device. In this work, the organic matter (OM) in the sediments was characterized for a continental vs. marine origin using chemical proxies to help constrain the origin of gas in hydrates. The main contribution of OM was from marine organic carbon based on the stable carbon isotope (δ13C-org) and total organic carbon/total nitrogen ratio (TOC:TN) analyses. In addition, the 14C data showed important information about the origin of the OM and we suggest some factors that could modify the original organic matter and therefore mask the “real” 14C ages: (1) biological activity that could modify the carbon isotopic composition of bulk terrestrial organic matter values, (2) the existence of younger sediments from mass wasting deposits unconformably overlying older sediments, and (3) the deep-sediment-sourced methane contribution due to the input of “old” (>50 ka) organic compounds from migrating fluids.
Objectives: This study aimed to evaluate the influence of lower limb loss (LL) on mental workload by assessing neurocognitive measures in individuals with unilateral transtibial (TT) versus those with transfemoral (TF) LL while dual-task walking under varying cognitive demand. Methods: Electroencephalography (EEG) was recorded as participants performed a task of varying cognitive demand while being seated or walking (i.e., varying physical demand). Results: The findings revealed both groups of participants (TT LL vs. TF LL) exhibited a similar EEG theta synchrony response as either the cognitive or the physical demand increased. Also, while individuals with TT LL maintained similar performance on the cognitive task during seated and walking conditions, those with TF LL exhibited performance decrements (slower response times) on the cognitive task during the walking in comparison to the seated conditions. Furthermore, those with TF LL neither exhibited regional differences in EEG low-alpha power while walking, nor EEG high-alpha desynchrony as a function of cognitive task difficulty while walking. This lack of alpha modulation coincided with no elevation of theta/alpha ratio power as a function of cognitive task difficulty in the TF LL group. Conclusions: This work suggests that both groups share some common but also different neurocognitive features during dual-task walking. Although all participants were able to recruit neural mechanisms critical for the maintenance of cognitive-motor performance under elevated cognitive or physical demands, the observed differences indicate that walking with a prosthesis, while concurrently performing a cognitive task, imposes additional cognitive demand in individuals with more proximal levels of amputation.