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Like many other aspects of the world of work, PM has undergone substantial changes over the years, especially in the last decade. This chapter discusses the changing nature of PM practice and PM research, as well as the PM-related implications of other, more general, changes in the nature of work. It is clear that PM practices will continue to be impacted by the changing nature of work. As such, our PM research needs to continue to evolve, to meet the realities of the changing nature of PM practice. We offer several suggestions in this regard.
While there is suggestion that early onset of psychosis is a determinant of outcome; knowledge regarding correlates of later onset age is more limited. This study explores the characteristics of patients developing psychosis after age 26, towards the end of the usual age range of early intervention programs, in order to identify potential specific needs of such patients.
Two hundred and fifty-six early psychosis patients aged 18–35 were followed-up prospectively over 36 months. Patients with onset after 26 (“later onset”, LO) were compared to the rest of the sample.
LO patients (32% of the sample) had shorter DUP, were less likely to be male, had better premorbid functioning and were more likely to have been exposed to trauma. They had greater insight at presentation and less negative symptoms overall. The trajectories for positive and depressive symptoms were similar in both groups. Evolution of functional level was similar in both groups, but while LO patients recovered faster, they were significantly less likely to return to premorbid functional level.
Later psychosis onset correlates with better premorbid functioning and higher rate of trauma exposure; the latter should therefore be a treatment focus in such patients. LO patients were less likely to return to premorbid functional level, which suggests that current treatment strategies may not be efficient to help patients maintain employment. The possibility of distinct illness mechanisms according to onset age and the more central role for trauma in patients with onset after age 26 needs to be further explored.
Recent evidences have consistently reported lower glutamate (Glu) levels in various brain regions, including the medial prefrontal cortex (mPFC), in chronic schizophrenia but findings in the early (EP) or in the prodromal phase of the disorder are equivocal. Although regular cannabis use has been associated with an increased risk of subsequent psychosis and with a perturbed Glu signalling, to date, the critical question of whether or not Glu abnormalities exist in EP and are related to cannabis use remains unanswered. Magnetic resonance spectroscopy was used to measure [GlumPFC] of 35 EP subjects (18 of whom were regular cannabis users) and 33 healthy controls (HC). For correlative analysis, neuropsychological performances were scored by a comprehensive cognitive battery. [GlumPFC] was lower in EP users comparing to both HC and EP non-users (P = 0.001 and P = 0.01, respectively), while no differences were observed between HC and EP non-users. In EP users Glu declined with age (r = −0.46; P = 0.04) but this relationship was not observed in non-users. Among neuropsychological profiles, working memory was the only domain that differentiates patients depending on their cannabis use, with users having poorer performances. In summary, our research revealed that cannabis use in EP is associated with Glu decreased levels, which are normally not seen in the early phase of the disorder. This finding is in line with previous 1H-MRS studies in cannabis users without a psychotic disorder and sheds light for the role of cannabis use in the progression of the disease.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Violent behaviour (VB) occurs in first episode of schizophrenia and can have devastating impact both on victims and patients themselves. A better knowledge of the underlying mechanisms of VB may pave the way to preventive treatments.
1) To explore the nature of the link between impulsivity and VB in early psychosis (EP) patients; 2) To explore the interactions between impulsivity and substance abuse, insight, and positive symptoms, the main dynamic risk factors of VB described to date.
Design and methods
Post hoc analysis of data acquired in the frame of a 36-months EP cohort study. A total of 265 EP patients, aged 18 to 35, treated at TIPP (Treatment and early Intervention in Psychosis Program), at the Department of Psychiatry in Lausanne, Switzerland, were included in the study. Logistic regression analyzes were performed as well as mediation analysis and interaction analysis
Our data suggest that impulsivity is a predictor of VB when analyzed independently and as part of a multi-factorial model. Impulsivity continues to differentiate violent patients from non-violent ones at the end of the program. In addition, the relationship between impulsivity and VB is not mediated by substance abuse. Finally, the effect of impulsivity on the probability of VB is potentiated by the interaction of different levels of insight and positive symptoms.
Early intervention strategies in psychotic disorders should include evaluation of impulsivity considering it is linked to increased risk of VB and may respond to treatment.
The efficient and effective movement of research into practice is acknowledged as crucial to improving population health and assuring return on investment in healthcare research. The National Center for Advancing Translational Science which sponsors Clinical and Translational Science Awards (CTSA) recognizes that dissemination and implementation (D&I) sciences have matured over the last 15 years and are central to its goals to shift academic health institutions to better align with this reality. In 2016, the CTSA Collaboration and Engagement Domain Task Force chartered a D&I Science Workgroup to explore the role of D&I sciences across the translational research spectrum. This special communication discusses the conceptual distinctions and purposes of dissemination, implementation, and translational sciences. We propose an integrated framework and provide real-world examples for articulating the role of D&I sciences within and across all of the translational research spectrum. The framework’s major proposition is that it situates D&I sciences as targeted “sub-sciences” of translational science to be used by CTSAs, and others, to identify and investigate coherent strategies for more routinely and proactively accelerating research translation. The framework highlights the importance of D&I thought leaders in extending D&I principles to all research stages.
To identify potential participants for clinical trials, electronic health records (EHRs) are searched at potential sites. As an alternative, we investigated using medical devices used for real-time diagnostic decisions for trial enrollment.
To project cohorts for a trial in acute coronary syndromes (ACS), we used electrocardiograph-based algorithms that identify ACS or ST elevation myocardial infarction (STEMI) that prompt clinicians to offer patients trial enrollment. We searched six hospitals’ electrocardiograph systems for electrocardiograms (ECGs) meeting the planned trial’s enrollment criterion: ECGs with STEMI or > 75% probability of ACS by the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI). We revised the ACI-TIPI regression to require only data directly from the electrocardiograph, the e-ACI-TIPI using the same data used for the original ACI-TIPI (development set n = 3,453; test set n = 2,315). We also tested both on data from emergency department electrocardiographs from across the US (n = 8,556). We then used ACI-TIPI and e-ACI-TIPI to identify potential cohorts for the ACS trial and compared performance to cohorts from EHR data at the hospitals.
Receiver-operating characteristic (ROC) curve areas on the test set were excellent, 0.89 for ACI-TIPI and 0.84 for the e-ACI-TIPI, as was calibration. On the national electrocardiographic database, ROC areas were 0.78 and 0.69, respectively, and with very good calibration. When tested for detection of patients with > 75% ACS probability, both electrocardiograph-based methods identified eligible patients well, and better than did EHRs.
Using data from medical devices such as electrocardiographs may provide accurate projections of available cohorts for clinical trials.
Lecture-capture software allows instructors to record their class presentations for students to review as necessary. Although this technology has long been considered too expensive for large-scale use, it is quickly becoming ubiquitous and deployable using ordinary computers and consumer-grade software. Using survey and final-grade data from a three-semester trial in a large introductory-level political science course, the authors demonstrate students almost universally approve of the technology and support its use in future classes. Students are most likely to use recordings when they study for exams and catch up on material after being absent from class. Additionally, certain subgroups—primarily international students and those who are performing poorly in the class—are more likely to watch archived recordings. However, these data demonstrate that positive evaluations and increased usage may not translate into better grades; viewing lectures does not appear to substantially improve individual performance.
A sensor which detects mechanical stresses and stores the position and the strength of these loads by color change of embedded quantum dots (QDs) is presented. The top and bottom electrodes of the sensor are inkjet-printed which leads to a fast and accurate deposition of thin (approx. 50 - 300 nm) and conductive layers. The used silver and poly(3,4-ethylenedioxythio-phene) polystyrene sulfonate (PEDOT:PSS) inks are optimized in terms of printability and opportunities of functionality forming without influencing the active layer of the sensor. The active layer of the sensor is spin-coated and consists of the QDs embedded in semi-conducting poly(9-vinylcarba-zole) (PVK). The hole transport characteristic of PVK and the band level alignment of the used materials ensures the preferred injection of only one type of charge carrier into the QDs. As a result the mechanical stress is visualized by a decreasing in photoluminescence (PL) of the QDs.
To advance mental health care use by developing recommendations to increase trust from the general public and patients, those who have been in contact with services, those who have never been in contact and those who care for their families in the mental health care system.
We performed a systematic literature search and the retrieved documents were evaluated by two independent reviewers. Evidence tables were generated and recommendations were developed in an expert and stakeholder consensus process.
We developed five recommendations which may increase trust in mental health care services and advance mental health care service utilization.
Trust is a mutual, complex, multidimensional and dynamic interrelationship of a multitude of factors. Its components may vary between individuals and over time. They may include, among others, age, place of residence, ethnicity, culture, experiences as a service user, and type of disorder. For mental health care services, issues of knowledge about mental health services, confidentiality, continuity of treatment, dignity, safety and avoidance of stigma and coercion are central elements to increase trust.
Evidence-based recommendations to increase mutual trust of service users and psychiatrists have been developed and may help to increase mental health care service utilization.
We present our joint efforts to study variable stars in open clusters. This includes a new catalogue, a photometric survey for new variables, and the database WEBDA. Our tools will shed more light on stellar variability in open clusters.
The real-time electronic performance of a gallium nitride nanowire-based field effect transistor was investigated at five-minute intervals over thirty minutes of continuous irradiation by Xenon-124 relativistic heavy ions. An initial current surge that resulted in device improvement rather than device failure was observed. The current surge, and subsequent electronic behavior, was modeled using a combined thermionic emission-tunnelling approach, leading to information about barrier height, carrier concentrations, expected temperature behavior, and tunnelling.
A retrospective cross-sectional survey of self-reported acute gastrointestinal infection (AGI) incidence in the community was performed in Poland, from December 2008 to November 2009. The aim of the study was to estimate the magnitude and distribution of self-reported AGI, in order to calibrate the routine AGI surveillance system in Poland. The study population were randomly selected residents of all Polish regions, having a fixed telephone line. An equal number of telephone interviews were collected each month, requesting the interviewee to identify gastrointestinal symptoms that had occurred in the previous 4 weeks. The international AGI case definition was used. In total 3583 complete interviews were obtained. The compliance ratio was 26%. Of 3583 respondents, 240 (6·7%) individuals fulfilled the AGI case definition. The annualized incidence of acute gastroenteritis was 0·9/person-year (95% confidence interval 0·8–1·0). Comparison of the obtained annual AGI estimate (33·3 million infections) with the number of cases reported to national surveillance during the corresponding period (73 512), yielded an underreporting factor of 453 cases occurring in the community for each reported case. Of the 240 AGI cases, 30·4% consulted a general practitioner, and 4·6% were admitted to hospital. Samples for microbiological confirmation were collected from four (1·6%) cases. This first population-based study in eastern Europe has confirmed that AGI places a high burden on Polish society, which is underestimated by national surveillance data. Efforts are necessary to improve AGI reporting and diagnostic practices in order to increase the effectiveness of the Polish surveillance system in detecting threats related to new AGI pathogens, new routes of transmission or the potential for international spread.
To determine if a dedicated teaching attending for medical student education improves medical student, attending physician, and resident perceptions and satisfaction.
Two dedicated teaching attending physician shifts were added to the clinical schedule each week. A before-after trial compared medical student evaluations from 2000 to 2004 (preteaching attending physician) to medical student evaluations from 2005 to 2006 (teaching attending physician). Attending physician and resident perceptions and satisfaction with the teaching attending physician shifts using a 5-point Likert-type scale (1 = poor to 5 = excellent) were also assessed.
Eighty-nine (100%) medical students participated, with 63 preteaching attending physician and 26 teaching attending physician rotation evaluations. The addition of teaching attending physician shifts improved mean medical student satisfaction with bedside teaching (4.1 to 4.5), lecture satisfaction (4.2 to 4.8), preceptor scores (4.3 to 4.8), and perceived usefulness of the rotation (4.5 to 5.0) (all p < 0.05). Thirteen attending physicians (93%) participated in the crosssectional questionnaire. The addition of teaching attending physician shifts improved faculty ratings of their medical student interactions by ≥ 1.5 points for all items (p ≤ 0.001). Faculty perceptions of their resident interactions improved for quality of bedside teaching (3.1 to 4.0), their availability to hear resident presentations (3.4 to 4.2), and their supervision of residents (3.4 to 4.1) (p ≤ 0.01). Residents (n = 35) noted minor improvements with the timeliness of patient dispositions, faculty bedside teaching, and attending physician availability.
The addition of select teaching attending physician shifts had the greatest effect on medical student and faculty perceptions and satisfaction, with some improvements for residents.
Nous sommes heureux de publier de larges extraits d'un article paru dans la Revue suisse de medécine militaire (Bâle, décembre 1972), et que celle-ci nous autorise aimablement à reproduire. L'auteur, colonel sanitaire de làarmée suisse et médecin-chef d'une zone territoriale, y expose ses idées personnelles sur la médecine de catastrophe et le recyclage dans des établissements formant le personnel médical, les auxiliaires spécialisés et les secouristes sanitaires. Or, ce sujet est de nature, sans doute, à intéresser nos lecteurs. Car la Croix-Rouge se trouve confrontée aujourd'hui à des problèmes de secours en masse et, lors de conflits ou à la suite de désastres naturels, les problèmes de médecine et de chirurgie viennent au premier plan et Us concernent aussi Men les mèdecins que les infirmiers et secouristes, dont certains travaillent sous le signe de la croix rouge, du croissant rouge ou du lion-et-soleil rouge (Réd.).
In this report, we describe recent efforts in fabricating new nanocarbon-supported titanium dioxide structures that exhibit high surface area and improved electrical conductivity. Nanocarbons consisting of single-walled carbon nanotubes and carbon aerogel nanoparticles were used to support titanium dioxide particles and produce monoliths with densities as low as 80 mg/cm 3. The electrical conductivity of the nanocarbon-supported titanium dioxide was dictated by the conductivity of the nanocarbon support while the pore structure was dominated by the titanium dioxide aerogel particles. The conductivity of the monoliths presented here was 72 S/m and the surface area was 203 m2/g.
A tool has been developed that can be used to characterize or validate a BEOL interconnect technology. It connects various process assumptions directly to electrical parameters including resistance. The resistance of narrow copper lines is becoming a challenging parameter, not only in terms of controlling its value but also understanding the underlying mechanisms. The resistance was measured for 45nm-node interconnects and compared to the theory of electron scattering. This work will demonstrate how valuable it is to directly link the electrical models to the physical on-wafer dimensions and in turn to the process assumptions. For example, one can generate a tolerance pareto for physical and or electrical parameters that immediately identifies those process sectors that have the largest contribution to the overall tolerance. It also can be used to easily generate resistance versus capacitance plots which provide a good BEOL performance gauge. Several examples for 45nm BEOL will be given to demonstrate the value of these tools.