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A retrospective evaluation was undertaken of the clinical and economic effectiveness of three in-patient rehabilitation units across one London National Health Service trust. Information on admission days and costs 2 years before and 2 years after the rehabilitation placement, length of rehabilitation placement and the discharge pathway was collected on 22 service users.
There were statistically significant reductions in hospital admission days in the 2 years following rehabilitation compared with the 2 years before, further reflected in significantly lower bed costs. Longer length of rehabilitation placement was correlated with fewer admission days after the placement. A substantial proportion of the sample went into more independent living, some with no further admissions at follow-up.
The findings suggest that in-patient rehabilitation is both clinically and cost effective: if benefits are sustained they will offset the cost of the rehabilitation placement.
This study investigated the trends in tuberculosis mortality through time in Switzerland. Information on the decline in mortality before chemotherapies were introduced may be useful in developing countries where drug-resistant tuberculosis is now becoming a major problem. Swiss data were collected from historical records and comparative data were obtained from the literature for England and Wales, New York, Japan, Brazil and Sierra Leone. Logistic curves were fitted to examine the rate of decline before introduction of pharmacotherapies and these show that the decline would have continued without the introduction of chemical therapies, including antibiotics. In Switzerland, England and Wales and New York, the decline had occurred long before the introduction of specific anti-tuberculosis agents. In Brazil and Japan, chemical therapy was co-incident with the decline in tuberculosis mortality rates. Overall, it is suggested that the effective control of tuberculosis can be achieved through a combination of chemical interventions, conservative therapy (rest, good nutrition, ventilation, etc.) as well as public health interventions addressing hygiene, nutrition, reducing exposure to infections and educating the population about tuberculosis.
Cognitive therapy has been found to be effective in decreasing the recurrence of suicide attempts. A theoretical aim of cognitive therapy is to improve problem-solving skills so that suicide no longer remains the only available option. This study examined the differential rate of change in problem-solving appraisal following suicide attempts among individuals who participated in a randomized controlled trial for the prevention of suicide.
Changes in problem-solving appraisal from pre- to 6-months post-treatment in individuals with a recent suicide attempt, randomized to either cognitive therapy (n=60) or a control condition (n=60), were assessed by using the Social Problem-Solving Inventory-Revised, Short Form.
Improvements in problem-solving appraisal were similarly observed for both groups within the 6-month follow-up. However, during this period, individuals assigned to the cognitive therapy condition demonstrated a significantly faster rate of improvement in negative problem orientation and impulsivity/carelessness. More specifically, individuals receiving cognitive therapy were significantly less likely to report a negative view toward life problems and impulsive/carelessness problem-solving style.
Cognitive therapy for the prevention of suicide provides rapid changes within 6 months on negative problem orientation and impulsivity/carelessness problem-solving style. Given that individuals are at the greatest risk for suicide within 6 months of their last suicide attempt, the current study demonstrates that a brief cognitive intervention produces a rapid rate of improvement in two important domains of problem-solving appraisal during this sensitive period.
There is a lack of tools to assess the needs of older people with enduring mental illness who have ‘graduated’ from adult mental health services and little is known about this population. the Elderly Psychiatric Needs Schedule (EPNS) was developed and applied to older people with enduring mental illness in contact with the old age and general adult components of an inner-city mental health service.
The EPNS proved reliable (mean agreement 96%, mean Kappa κ=0.90). the mean number of needs identified was 7.6, of which 4.3 were unmet and 3.3 were met.
The EPNS provided a reliable method of needs assessment in this population. the authors offer the EPNS as a tool to assess service needs of older adults with functional psychiatric disorders having ‘graduated’ from adult mental health services.
Scintillating nanoparticles with a SiO2 core and a Gd2O3 shell doped with Eu3+ were synthesized with a sol-gel process. Based on transmission electron microscopy (TEM) data, a ∼13 nm Gd2O3 shell was successfully coated onto ∼220 nm mono-dispersed SiO2 nanocores. Eu3+ ions at concentrations of nominally 5 at% exhibited photoluminescent (PL) emission from the SiO2/Gd2O3 nanoparticles after being calcined at 800 0C for 2 h. The SiO2 remained amorphous after calcining, while the Gd2O3 crystallized to a cubic structure. The PL emission was from the 5D0-7F2 transitions of Eu3+ at 609 and 622 nm. Photoluminescence excitation (PLE) data showed that emission from Eu3+ could result from direct excitation, but was dominated by the oxygen to europium charge-transfer band (CTB) between 250 and 280 nm for Eu3+ doped in Gd2O3. The quantum yield (QY) from thin films drop cast from a mixture of 20 mg of calcined nanoparticles in 500 μL of polymethylmethacrylate (PMMA) and excited in the CTB was 20% for SiO2/Gd2O3:Eu3+ core/shell scintillation nanoparticles. Finally, the above core/shell nanoparticles were passivated with a shell of SiO2 to create e.g. SiO2/Gd2O3:Eu3+/SiO2 nanoparticles. The QYs for this nanostructure were lower than unpassivated nanoparticles which was attributed to a weak CTB for the amorphous SiO2 shell and a higher density of interface quenching sites.
It remains unclear if the excess of neurological soft signs, or of certain types of neurological soft signs, is common to all psychoses, and whether this excess is simply an epiphenomenon of the lower general cognitive ability present in psychosis.
To investigate whether an excess of neurological soft signs is independent of diagnosis (schizophrenia v. affective psychosis) and cognitive ability (IQ).
Evaluation of types of neurological soft signs in a prospective cohort of all individuals presenting with psychoses over 2 years (n=310), and in a control group from the general population (n=239).
Primary (P<0.001), motor coordination (P<0.001), and motor sequencing (P<0.001) sign scores were significantly higher in people with any psychosis than in the control group. However, only primary and motor coordination scores remained higher when individuals with psychosis and controls were matched for premorbid and current IQ.
Higher rates of primary and motor coordination signs are not associated with lower cognitive ability, and are specific to the presence of psychosis.
Writing African History is an essential work for anyone who wants to write, or even seriously read, African history. It will replace Daniel McCall's classic Africa in Time Perspective as the introduction to African history for the next generation and as a reference for professional historians, interested readers, and anyone who wants to understand how African history is written. Africa in Time Perspective was written in the 1960s, when African history was a new field of research. This new book reflects the development of African history since then. It opens with a comprehensive introduction by Daniel McCall, followed by a chapter by the editor explaining what African history is [and is not] in the context of historical theory and the development of historical narrative, the humanities, and social sciences. The first half of the book focuses on sources of historical data while the second half examines different perspectives on history. The editor's final chapter explains how to combine various sorts of evidence into a coherent account of African history. Writing African History will become the most important guide to African history for the 21st century.
Contributors: Bala Achi, Isaac Olawale Albert, Diedre L. Badéjo, Dorothea Bedigian, Barbara M. Cooper, Henry John Drewal, Christopher Ehret, Toyin Falola, David Henige, Joseph E. Holloway, John Hunwick, S. O. Y. Keita, William G. Martin, Daniel McCall, Susan Keech McIntosh, Donatien Dibwe Dia Mwembu, Kathleen Sheldon, John Thornton, and Masao Yoshida.
John Edwards Philips is Professor of International Society, Hirosaki University, and author of Spurious Arabic: Hausa and Colonial Nigeria [Madison, University of Wisconsin African Studies Center, 2000].
Conventional experiments designed to investigate the mechanical properties of polycrystalline geological materials are generally restricted to measurements of whole-rock properties. However, when comparing the measurements with theoretical models, it is frequently essential to understand how the deformation is accommodated at the grain-scale. This is particularly true for polymineralic rocks because in this case most theories express the whole-rock properties as some function of the properties of their constituent minerals, and hence the contribution which each phase makes to those properties must be measured if the theories are to be fully assessed. The penetrating nature of neutrons offers a method of addressing this problem. By performing deformation experiments in the neutron beam-line and collecting neutron diffraction patterns at different applied loads, the lattice parameters of all the mineral phases present may be determined as a function of load. The elastic strain experienced by each phase is then easily determined. Moreover, the strain in different lattice directions is also obtained. From this information a wide range of problems relevant for the characterization of the elastic and plastic deformation behaviour of polymineralic geological materials can be explored. An experimental technique for carrying out such experiments is described, and its validity is demonstrated by showing that the results obtained from deforming an elastically isotropic olivine + magnesiowüstite sample agree, to within very tight bounds, with the behaviour predicted by theory for elastically isotropic composites.