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The increasing evidence that bipolar and unipolar affective disorders have different biological etiologies and courses of illness has been associated with an intensifying interest in specific treatment regimens for both disorders during the last decade. In this context, the question arose whether antidepressants exert similar efficacy in the acute treatment of bipolar compared to unipolar depression. Although the clinical impression does not indicate substantial differences in the efficacy of antidepressants between these groups of patients, empirical databases concerning this topic are rare. The present study compared the efficacy of antidepressants in 50 unipolar and 50 bipolar depressed inpatients (ICD-9 criteria) under naturalistic treatment conditions. Both groups of patients were mahed for age, gender and duration of illness. Clinical assessments of status at the time of admission and at discharge were used to rate response to antidepressant treatment. Analyses of the data revealed that both groups of patients needed the same time for treatment response and did not show any significant differences in ouome measures at discharge. These findings do not concur with the hypothesis formulated by some experts in the field of affective disorders that antidepressants are less effective in the acute treatment of bipolar depressed patients compared to unipolar depressed patients.
The Pisa syndrome is a rare asymmetric axial dystonia characterised by tonic lateral flexion of the trunk, subsequent to prolonged exposure to conventional or atypical antipsychotics. However, the illness has also been reported, although less frequently, in patients with neurodegenerative disorder like Parkinson syndrome. Drug-induced Pisa syndrome develops predominantly in females and older patients with brain disorder. It sometimes occurs after the addition of another antipsychotic drug to an established regimen of antipsychotics. It can also insidiously arise in antipsychotic-treated patients without any apparent reason. Largely unknown to psychiatrists, this condition can be difficult to distinguish from unusual posture appearing in patients with psychiatric disturbance, such as hysterical or catatonic postures. Clinical characteristics suggest that Pisa syndrome has features from acute and tardive dystonia underlying a possible complex pathophysiology. Definitive therapy is the withdrawal or reduction of the daily dose of antipsychotics; treatment with anticholinergics agents has also been proposed.
Up to date, Pisa syndrome has been essentially described with conventional antipsychotics. Nevertheless, it has been rarely mentioned outside Japan with atypical antipsychotics.
We here describe a case of Pisa syndrome during risperidone treatment in a 50-year-old inpatient woman, admitted for schizophrenia. Following the introduction of Risperidone, she has shown a right lateral flexion of the trunk. No organic etiology was found. This abnormal posture has persisted during all the Risperidone treatment and has vanished after the decrease of it.
Background: SMA is a neurodegenerative disease caused by biallelic deletion/mutation of SMN1. Copies of a similar gene (SMN2) modify disease severity. In a phase 1 study, SMN GRT onasemnogene abeparvovec (AVXS-101) improved outcomes of symptomatic SMA patients with two SMN2 copies (2xSMN2) dosed ≤6 months. Because motor neuron loss can be insidious and disease progression is rapid, early intervention is critical. This study evaluates AVXS-101 in presymptomatic SMA newborns. Methods: SPR1NT is a multicenter, open-label, phase 3 study enrolling ≥27 SMA patients with 2–3xSMN2. Asymptomatic infants ≤6 weeks receive a one-time intravenous AVXS-101 infusion (1.1x1014 vg/kg). Safety and efficacy are assessed through study end (18 [2xSMN2] or 24 months [3xSMN2]). Primary outcomes: independent sitting for ≥30 seconds (18 months [2xSMN2]) or assisted standing (24 months [3xSMN2]). Results: From April–September 2018, 7 infants received AVXS-101 (4 female; 6 with 2xSMN2) at ages 8–37 days. Mean baseline CHOP-INTEND score was 41.7 (n=6), which increased by 6.8, 11.0, 18.0, and 22.5 points at day 14 (n=4), month 1 (n=3), 2 (n=3), and 3 (n=2). Updated data available at the time of the congress will be presented. Conclusions: Preliminary data from SPR1NT show rapid motor function improvements in presymptomatic SMA patients.
A lasting legacy of the International Polar Year (IPY) 2007–2008 was the promotion of the Permafrost Young Researchers Network (PYRN), initially an IPY outreach and education activity by the International Permafrost Association (IPA). With the momentum of IPY, PYRN developed into a thriving network that still connects young permafrost scientists, engineers, and researchers from other disciplines. This research note summarises (1) PYRN’s development since 2005 and the IPY’s role, (2) the first 2015 PYRN census and survey results, and (3) PYRN’s future plans to improve international and interdisciplinary exchange between young researchers. The review concludes that PYRN is an established network within the polar research community that has continually developed since 2005. PYRN’s successful activities were largely fostered by IPY. With >200 of the 1200 registered members active and engaged, PYRN is capitalising on the availability of social media tools and rising to meet environmental challenges while maintaining its role as a successful network honouring the legacy of IPY.
We trained local public health workers on disaster recovery roles and responsibilities by using a novel curriculum based on a threat and efficacy framework and a training-of-trainers approach. This study used qualitative data to assess changes in perceptions of efficacy toward Hurricane Sandy recovery and willingness to participate in future disaster recoveries.
Purposive and snowball sampling were used to select trainers and trainees from participating local public health departments in jurisdictions impacted by Hurricane Sandy in October 2012. Two focus groups totaling 29 local public health workers were held in April and May of 2015. Focus group participants discussed the content and quality of the curriculum, training logistics, and their willingness to engage in future disaster recovery efforts.
The training curriculum improved participants’ understanding of and confidence in their disaster recovery work and related roles within their agencies (self-efficacy); increased their individual- and agency-level sense of role-importance in disaster recovery (response-efficacy); and enhanced their sense of their agencies’ effective functioning in disaster recovery. Participants suggested further training customization and inclusion of other recovery agencies.
Threat- and efficacy-based disaster recovery trainings show potential to increase public health workers’ sense of efficacy and willingness to participate in recovery efforts. (Disaster Med Public Health Preparedness. 2016;10:615–622)
The late Eocene – early Miocene Alpine–Carpathian fold-and-thrust belt (FTB) lies in the transition between the Eastern Alps and the Western Carpathians, SE of the Bohemian crystalline massif. Our study shows the involvement of crystalline basement from the former European Jurassic continental margin in two distinct events. A first extensional event coeval with Eggerian–Karpatian (c. 28–16 Ma) thin-skinned thrusting reactivated the rift basement fault array and resulted from the large degree of lower plate bending promoted by high lateral gradients of lithospheric strength and slab pull forces. Slab break-off during the final stages of collision around Karpatian times (c. 17–16 Ma) promoted large-wavelength uplift and an excessive topographic load. This load was reduced by broadening the orogenic wedge through the reactivation of the lower-plate deep detachment beneath and ahead of the thin-skinned thrust front (with the accompanying positive inversion of the basement fault array) and ultimately, by the collapse of the hinterland summits, enhanced by transtensional faulting. Although this work specifically deals with the involvement of the basement in the Alpine–Carpathian Junction, the main conclusions are of general interest to the understanding of orogenic systems.
The local public health agency (LPHA) workforce is at the center of the public health emergency preparedness system and is integral to locally driven disaster recovery efforts. Throughout the disaster recovery period, LPHAs have a primary responsibility for community health and are responsible for a large number of health services. In the face of decreasing preparedness funding and increasing frequency and severity of disasters, LPHAs continue to provide essential disaster life cycle services to their communities. However, little is known about the confidence that LPHA workers have in performing disaster recovery-related duties. To date, there is no widely used instrument to measure LPHA workers’ sense of efficacy, nor is there an educational intervention designed specifically to bolster disaster recovery-phase efficacy perceptions. Here, we describe the important role of the LPHA workforce in disaster recovery and the operational- and efficacy-related research gaps inherent in today’s disaster recovery practices. We then propose a behavioral framework that can be used to examine LPHA workers’ disaster recovery perceptions and suggest a research agenda to enhance LPHA workforce disaster recovery efficacy through an evidence-informed educational intervention. (Disaster Med Public Health Preparedness. 2015;9:403–408)
Cognition is increasingly being recognized as an important aspect of psychotic disorders and a key contributor to functional outcome. In the past, comparative studies have been performed in schizophrenia and schizo-affective disorder with regard to cognitive performance, but the results have been mixed and the cognitive measures used have not always assessed the cognitive deficits found to be specific to psychosis. A set of optimized cognitive paradigms designed by the Cognitive Neuroscience Test Reliability and Clinical Applications for Schizophrenia (CNTRACS) Consortium to assess deficits specific to schizophrenia was used to measure cognition in a large group of individuals with schizophrenia and schizo-affective disorder.
A total of 519 participants (188 with schizophrenia, 63 with schizo-affective disorder and 268 controls) were administered three cognitive paradigms assessing the domains of goal maintenance in working memory, relational encoding and retrieval in episodic memory and visual integration.
Across the three domains, the results showed no major quantitative differences between patient groups, with both groups uniformly performing worse than healthy subjects.
The findings of this study suggests that, with regard to deficits in cognition, considered a major aspect of psychotic disorder, schizophrenia and schizo-affective disorder do not demonstrate major significant distinctions. These results have important implications for our understanding of the nosological structure of major psychopathology, providing evidence consistent with the hypothesis that there is no natural distinction between cognitive functioning in schizophrenia and schizo-affective disorder.
Still, if you will not fight for the right when you can easily win without bloodshed, if you will not fight when your victory will be sure and not so costly, you may come to the moment when you will have to fight with all the odds against you and only a precarious chance for survival.
Sir Winston Churchill, The Gathering Storm (1948)
We do not accept the view that regulators lacked the power to protect the financial system. They had ample power in many arenas and they chose not to use it. To give just three examples: the Securities and Exchange Commission could have required more capital and halted risky practices at the big investment banks. It did not. The Federal Reserve Bank of New York and other regulators could have clamped down on Citigroup’s excesses in the run-up to the crisis. They did not. Policy makers and regulators could have stopped the runaway mortgage securitization train. They did not. In case after case after case, regulators continued to rate the institutions they oversaw as safe and sound even in the face of mounting troubles, often downgrading them just before their collapse. And where regulators lacked authority, they could have sought it. Too often, they lacked the political will – in a political and ideological environment that constrained it – as well as the fortitude to critically challenge the institutions and the entire system they were entrusted to oversee.
The Financial Crisis Inquiry Commission Report (2011)
Introduction: Ideology Overwhelms Experience
The financial crisis sprang from two mutually reinforcing institutional transformations – one on Wall Street and another in Washington. Fueled by an explosive mix of megamergers, massive capital formation, increased leverage, and runaway technical wizardry, the Wall Street business model evolved from providing a diversified mix of financial services for valued clients to one dominated by the investment of a firm’s own capital in increasingly complex and risky securities, often at the expense of a firm’s customers who came to be viewed as counterparties. The most telltale sign of Wall Street’s transformation was the exponential growth and increasing importance of precisely the kind of proprietary trading, particularly of CMOs, at the center of the financial crisis. Facilitating all this was a parallel retreat in Washington’s oversight of the financial industry.
On Monday, September 15, 2008, Lehman Brothers, a prominent investment bank that traces its roots to 1850, declared bankruptcy and thereupon triggered a global financial crisis. Literally overnight, borrowing came to a standstill, and widely held assets could not be converted into cash. The liquidity crunch immediately crippled banks owning substantial amounts of securities linked to subprime mortgages and spread very quickly to every sector of the global economy and all types of debt securities. Unable to sell even normally safe and highly liquid investments, on Tuesday, September 16, 2008, the Primary Reserve Fund, the oldest money market fund in the United States, in an action eerily reminiscent of Depression-era bank runs, shocked the financial community by freezing customer accounts and indefinitely halting withdrawals. Ordinary consumers were thus harshly reminded that there were no safe havens for their savings in this economic storm, adding another layer of uncertainty and instability to the financial markets. Within weeks of the Lehman bankruptcy, the resulting shock to the financial system inflicted severe and long-lasting damages on the economy, throwing tens of millions of people out of work and slowing economic growth. Half a decade later, the global economy still limps along in the aftermath of the financial crisis.
The financial crisis sprang from a precipitous decline in the value of mortgage-related securities. The bursting of the mortgage bubble completely wiped out Lehman’s capital base. Other venerable Wall Street institutions including Merrill Lynch and Bear Stearns narrowly averted total collapse through hastily arranged mergers with Bank of America and JPMorgan Chase, respectively. Virtually every major financial institution had massive exposure to the mortgage market relative to its capital base, and even those banks not in danger of imminent collapse suffered staggering losses severely limiting their ability to engage in ordinary consumer lending activities and basic interbank transactions. Because of the financial sector’s centrality to capital and credit markets, the U.S. Congress authorized a $700 billion government bailout to prevent further failures and safeguard the financial system from total collapse.
Beginning roughly in the last two decades of the twentieth century and culminating with the 2008 financial crisis, the dominant Wall Street business model transformed from a customer-driven focus with a minor proprietary trading component to one where principal transactions, and in particular trading in mortgage-backed securities, came to dominate the profits and attention of the brightest minds in the financial industry. This transformation represents a major shift in Wall Street’s business model. The bulk of Wall Street’s profits today are no longer derived from providing financial services to clients. Instead, Wall Street firms generate profits mostly from investing their own capital. The rise of principal transactions occurred not coincidentally just as the financial industry was also experiencing enormous growth in scale as, in the two decades preceding the financial crisis, every major Wall Street firm went from being a privately funded partnership to a publicly held company.
In Chapter two we introduced the idea that profit disjunction occurs when the profits of Wall Street are not aligned with the prosperity of the economy as a whole. In this chapter, we examine how Wall Street profits became unhinged from and dangerous to the general welfare of society. We describe not only how Wall Street became dependent on proprietary trading and the perverse compensation incentives encouraging moral hazard and excessive risk taking, but also how Wall Street became so large that its potential failure as a business sector threatened the stability of the global economy. Our purpose in doing so is not simply to address the issue of “too big to fail” and the bailout. Our objective is to demonstrate how the shift in Wall Street’s business model from serving clients to proprietary trading accompanied a crisis in Wall Street values that in no small measure contributed to the financial crisis. We are concerned, in other words, not only with the threats Wall Street poses to the general economy when it fails, but also with the dangers it creates when it is successful following the postmillennial proprietary trading business model. We begin our analysis, however, by recalling a long bygone era when ongoing customer relations, based upon trust and mutuality, were an essential foundation for the creation and success of the financial industry.
This timely book answers complex and perplexing questions raised by Wall Street's role in the financial crisis. What are the economic and moral connections between Wall Street and the overall economy? How did we arrive at this point in history where our most powerful financial institutions thwart rather than promote free markets, prosperity and even social cohesion? Can the fractured relationship between Wall Street and Main Street be repaired? Wall Street Values chronicles the transformation of Wall Street's business model from serving clients to proprietary trading and explains how this shift undermined the ethical foundations of the modern financial industry. Michael A. Santoro and Ronald J. Strauss argue that post-millennial Wall Street is not only 'too big to fail' but also a threat to the economy even when it succeeds.