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Attempts to reduce high utilisation of psychiatric inpatient care by targeting the critical time of hospital discharge have been rare. In Germany, until now no such intervention has been implemented, let alone subjected to a clinical trial.
“Effectiveness and Cost-Effectiveness of Needs-Oriented Discharge Planning and Monitoring for High Utilisers of Psychiatric Services” (NODPAM) is a multicentre RCT conducted in five psychiatric hospitals in Germany (Günzburg, Düsseldorf, Regensburg, Greifswald, and Ravensburg). Subjects asked to provide informed consent to participate have to be of adult age with a primary diagnosis of schizophrenia or affective disorder, and a defined high utilisation of psychiatric care during two years prior to the current admission. Subjects are asked to provide detailed outcome data at four measurement points during a period of 18 months. Recruitment (which started in April 06) is still ongoing. Thus, baseline data of about 350 participants will be presented.
Recruitment has been quite successful and the study has been generally well accepted by participating patients and their clinicians in in- and outpatient treatment settings. Subjects showed substantial initial impairment on outcome measures (e.g. needs, psychopathology, quality of life, and level of functioning) and high utilisation of mental health care. Further results on conduct and feasibility of the trial will be presented.
The first phase of this mulicentre trial was promising. The potential of this study to strengthen the integration of mental health care provision in Germany will be discussed.
Aim of this contribution is to describe the intervention used in the study “Effectiveness and Cost-Effectiveness of Needs-Oriented Discharge Planning and Monitoring for High Utilisers of Psychiatric Services” (NODPAM). This intervention applies principles of needs-led care and focusses on the inpatient-outpatient transition. The NODPAM intervention manual includes a range of predefined standardised options based on number and type of needs.
For the intervention group, a trained intervention worker provides a coherent package of needs-oriented discharge planning and monitoring focussing on the care process. He or she emphasises continuity of the care process vis-à-vis both patient and clinician (and carers if possible) via providing two manualised intervention sessions): (a) A discharge planning session takes place just before discharge with the patient and responsible clinician at the inpatient service; (b) A monitoring session takes place three months after discharge with the patient and outpatient clinician (office-based or public outpatient mental health service-based). A written treatment plan is signed by and forwarded to all participants after each session.
Acceptance of the intervention by patients and clinicians has been high so far. Further results on duration, participant characteristics, and participants' appraisal of the NODPAM intervention will be presented.
These first results indicate that the NODPAM intervention is feasible in inpatient mental health services in Germany. Discussion will focus on its applicability in other service systems.
The influence of pharmaceutical industry (PI) on clinical practice and research in psychiatry has been considered a serious problem. Strict rules and guidelines were developed to regulate the interactions between doctors and PI. However, there is an ongoing debate whether these were thoroughly implemented in practice and internalized by physicians. The objective of our study was to assess the attitudes and behaviors of trainees in psychiatry and child & adolescent psychiatry toward PI across Europe. Methodologically, a validated questionnaire with additional items was administered to1444 trainees in 20 European countries. The minimum response rate was set at 60%. We found a high variation across countries in number of interactions between trainees and PI representatives; Portugal and Turkey had the highest number of interactions. The majority (59.76%) agreed that interactions with PI representatives have an impact on physicians’ prescribing behavior; whereas only 29.26% and 19.79% agreed interactions with PI representatives and gifts from PI have impact on their own prescribing behavior, respectively. Most of the gifts were considered appropriate by the majority, except tickets to vacation spot and social dinner at a restaurant. Of the sample, 70.76% think they have not been given sufficient training regarding how to interact with PI representatives. Only less than 20% indicated they have guidelines at institutional or national level. In conclusion, there is substantial interaction between trainees and PI across countries. The majority feel inadequately trained regarding professional interaction with PI, and believes they are immune to the influence of PI.
Interactions between the pharmaceutical industry (PI) and psychiatrists have been under scrutiny recently, though there is little empirical evidence on the nature of the relationship and its intensity at psychiatry trainee level. We therefore studied the level of PI interactions and the underlying beliefs and attitudes in a large sample of European psychiatric trainees.
One thousand four hundred and forty-four psychiatric trainees in 20 European countries were assessed cross-sectionally, with a 62-item questionnaire.
The total number of PI interactions in the preceding two months varied between countries, with least interactions in The Netherlands (M (Mean) = 0.92, SD = 1.44, range = 0–12) and most in Portugal (M = 19.06, SD = 17.44, range = 0–100). Trainees were more likely to believe that PI interactions have no impact on their own prescribing behaviour than that of other physicians (M = 3.30, SD = 1.26 vs. M = 2.39, SD = 1.06 on a 5-point Likert scale: 1 “completely disagree” to 5 “completely agree”). Assigning an educational role to the pharmaceutical industry was associated with more interactions and higher gift value (IRR (incidence rate ratio) = 1.21, 95%CI = 1.12–1.30 and OR = 1.18, 95%CI = 1.02–1.37).
There are frequent interactions between European psychiatric trainees and the PI, with significant variation between countries. We identified several factors affecting this interaction, including attribution of an educational role to the PI. Creating alternative educational opportunities and specific training dedicated to PI interactions may therefore help to reduce the impact of the PI on psychiatric training.
Thromboxane (TX) A2 and the activation of its receptor have been shown to modulate vasoconstriction, platelet aggregation, but also dopaminergic and serotonergic signaling.
As dopaminergic and serotonergic systems play a crucial role in the pathophysiology of schizophrenia and as these systems are main targets of antipsychotics, we hypothesized that antipsychotics might also influence TXA2 production.
We measured levels of TXB2, the metabolite of the very unstable molecule TXA2, in the stimulated blood of 10 healthy female subjects in a whole blood assay using the toxic shock syndrome toxin-1 (TSST-1) and the monoclonal antibody against the surface antigen CD3 combined with the protein CD40 (OKT3/CD40) as stimulants. Blood was either supplemented with antipsychotics (chlorpromazine, clozapine, and its metabolite N-desmethylclozapine with four different concentrations each) or not.
Under TSST-1 as well as OKT3/CD40 stimulation, mean TXB2 concentrations were significantly (p < 0.05) decreased by clozapine over all of the applied concentrations. N-desmethylclozapine led to a decrease in TXB2 levels under TSST-1 stimulation only. Chlorpromazine did not show any significant influence on TXB2 production.
Clozapine might, complementary to serotonin and dopamine receptor binding, act on the dopaminergic and serotonergic system via a modulation of TXA2 production. Additionally, side effects of clozapine such as orthostatic hypotension may be a result of the reported TXA2 changes.
Introduction: Literature suggests that up to 25% of people with HIV in North America are unaware of their status and are at risk to transmit the virus unknowingly. A high proportion of HIV patients are diagnosed when the disease is more advanced, with CD4 counts < 200. This study examined the rates of HIV testing, detection, and treatment of clients at an inner city shelter and detoxification centre after the introduction of a point of care testing (POCT) program by on-site community paramedics (CP). Methods: In 2013, in collaboration with a regional HIV program, CP received training and instituted an HIV POCT program and post-test counselling initiative. A retrospective electronic database review from October 16, 2013 to October 15, 2014 of adult patients who received testing was performed. Demographic and testing details of each patient encounter were abstracted and select variables were compared to a historic population who received POC HIV testing at an inner city emergency department (ED) in the same city. Results: 1,207 HIV POC tests were performed on 997 patients during the pilot. 57% of the patients tested were less than 40 years of age (range 18-73 years) compared to 55% in the historic ED population. A total of 9 reactive cases were identified in the study population including 3 new cases, 5 previously known cases, and 1 false reactive result. The mean age of the new cases was 47 years, vs 44 in the historical control. All 3 new cases were referred to a local HIV clinic for further care and treatment. New HIV cases represented 0.25% of total tests performed, which is less than the expected prevalence rate of 1% for this population, as well as the rate of 1.4% found in the ED population. Conclusion: Despite lower than expected reactive rates, the large scale implementation of a CP HIV POCT program in an inner city shelter and detoxification centre is feasible. All patients with new reactive tests were immediately connected to care. Future research will focus on risk factors and barriers to testing.
Estimates of the proportion of illness transmitted by food for different enteric pathogens are essential for foodborne burden-of-disease studies. Owing to insufficient scientific data, a formal synthesis of expert opinion, an expert elicitation, is commonly used to produce such estimates. Eleven experts participated in an elicitation to estimate the proportion of illnesses due to food in Australia for nine pathogens over three rounds: first, based on their own knowledge alone; second, after being provided with systematic reviews of the literature and Australian data; and finally, at a workshop where experts reflected on the evidence. Estimates changed significantly across the three rounds (P = 0·002) as measured by analysis of variance. Following the workshop in round 3, estimates showed smoother distributions with significantly less variation for several pathogens. When estimates were combined to provide combined distributions for each pathogen, the width of these combined distributions reflected experts’ perceptions of the availability of evidence, with narrower intervals for pathogens for which evidence was judged to be strongest. Our findings show that the choice of expert elicitation process can significantly influence final estimates. Our structured process – and the workshop in particular – produced robust estimates and distributions appropriate for inclusion in burden-of-disease studies.
The population structure of Staphylococcus aureus is changing globally but the situation regarding dominant clones in sub-Saharan Africa is not clear. We therefore assessed changes in the population structure of clinical S. aureus isolates obtained in 2007 (n = 75) and 2012 (n = 75) from Northeastern Nigeria. A reduction in resistance to penicillin, gentamicin, erythromycin and clindamycin was observed in 2012. A decrease of methicillin resistance rates (13·3% to 8·0%) was associated with the decline of the ST241 MRSA clone. The proportion of Panton–Valentine leukocidin (PVL)-positive isolates also decreased from 65·3% to 44%, and was linked with the emergence of PVL-negative ST601 clone in 2012. The significant decline in antibiotic resistance in the study area is in contrast to the worldwide trend of increasing resistance rates.
The prevalence of natural carriage and molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci (MR-CoNS) isolates in a Jordanian community were investigated. The MRSA nasal carriage rate in 227 healthy volunteers was 7·5% and the majority (81%) of MRSA harboured the resistance element SCCmec type IVe and were of a novel spa type t9519 (76%); other significant spa gene types were t223 (14·7%) and t044 (5·9%). All MRSA isolates were susceptible to other classes of antibiotics, and tested positive for at least three virulence factor encoding genes, but only two harboured the pvl gene. MR-CoNS carriage was 54·2% and these isolates were characterized by single, double and untypable SCCmec elements, with Staphylococcus epidermidis SCCmec type IVa predominating. Of eight subjects with nasal co-colonization of MR-CoNS + MRSA, three shared SCCmec type IV in both groups of organisms. This is the first report of methicillin-resistant staphylococci carriage in a Jordanian community and its findings are important for epidemiological study and infection control measures of these organisms.
EMU is a wide-field radio continuum survey planned for the new Australian Square Kilometre Array Pathfinder (ASKAP) telescope. The primary goal of EMU is to make a deep (rms ∼ 10 μJy/beam) radio continuum survey of the entire Southern sky at 1.3 GHz, extending as far North as +30° declination, with a resolution of 10 arcsec. EMU is expected to detect and catalogue about 70 million galaxies, including typical star-forming galaxies up to z ∼ 1, powerful starbursts to even greater redshifts, and active galactic nuclei to the edge of the visible Universe. It will undoubtedly discover new classes of object. This paper defines the science goals and parameters of the survey, and describes the development of techniques necessary to maximise the science return from EMU.
Attempts to reduce high utilisation of mental health inpatient care by targeting the critical time of hospital discharge are rare. In this study, we test the effect of a needs-oriented discharge planning intervention on number and duration of psychiatric inpatient treatment episodes (primary), as well as on outpatient service use, needs, psychopathology, depression and quality of life (secondary).
Four hundred and ninety-one adults with a defined high utilisation of mental health care gave informed consent to participate in a multicentre RCT carried out at five psychiatric hospitals in Germany (Düsseldorf, Greifswald, Regensburg, Ravensburg and Günzburg). Subjects allocated to the intervention group were offered a manualised needs-led discharge planning and monitoring intervention with two intertwined sessions administered at hospital discharge and 3 months thereafter. Outcomes were assessed at four measurement points during a period of 18 months following discharge.
Intention-to-treat analyses showed no effect of the intervention on primary or secondary outcomes.
Process evaluation pending, the intervention cannot be recommended for implementation in routine care. Other approaches, e.g. team-based community care, might be more beneficial for people with persistent and severe mental illness.
Decline in social functioning occurs in individuals who later develop psychosis.
To investigate whether baseline differences in disability are present in those who do and those who do not make a transition to psychosis in a group clinically at high risk and whether disability is a risk factor for transition.
Prospective multicentre, naturalistic field study with an 18-month follow-up period on 245 help-seeking individuals clinically at high risk. Disability was assessed with the Disability Assessment Schedule of the World Health Organization (WHODAS–II).
At baseline, the transition group displayed significantly greater difficulties in making new friends (z =−3.40, P = 0.001), maintaining a friendship (z =−3.00, P = 0.003), dealing with people they do not know (z =−2.28, P = 0.023) and joining community activities (z =−2.0, P = 0.05) compared with the non-transition group. In Cox regression, difficulties in getting along with people significantly contributed to the prediction of transition to psychosis in our sample (β = 0.569, s.e. = 0.184, Wald = 9.548, P = 0.002, hazard ratio (HR) = 1.767, 95% CI 1.238–2.550).
Certain domains of social disability might contribute to the prediction of psychosis in a sample clinically at high risk.
Livestock and aquaculture production is under political and social pressure, especially in the European Union (EU), to decrease pollution and environmental damage arising due to animal agriculture. The EU has banned the use of antibiotics and other chemicals, which have been shown to be effective in promoting growth and reducing environment pollutants because of the risk caused to humans by chemical residues in food and by antibiotic resistance being passed on to human pathogens. As a result of this, scientists have intensified efforts in exploiting plants, plant extracts or natural plant compounds as potential natural alternatives for enhancing the livestock productivity. This paper discusses work on the effects of various phytochemicals and plant secondary metabolites in ruminant and fish species. The focus is on (i) plants such as Ananas comosus (pine apple), Momordica charantia (bitter gourd) and Azadirachta indica (neem) containing anthelmintic compounds and for their use for controlling internal parasites; (ii) plants containing polyphenols and their applications for protecting proteins from degradation in the rumen, increasing efficiency of microbial protein synthesis in rumen and decreasing methane emission; for using as antioxidants, antibacterial and antihelmintic agents; and for changing meat colour and for increasing n-3 fatty acids and conjugated linoleic acid in meat; (iii) saponin-rich plants such as quillaja, yucca and Sapindus saponaria for increasing the efficiency of rumen fermentation, decreasing methane emission and enhancing growth; for producing desired nutritional attributes such as lowering of cholesterol in monogastric animals; for increasing growth of fish (common carp and Nile tilapia) and for changing male to female ratio in tilapia; and for use as molluscicidal agents; (iv) Moringa oleifera leaves as a source of plant growth factor(s), antioxidants, beta-carotene, vitamin C, and various glucosinolates and their degraded products for possible use as antibacterial, antioxidant, anticarcinogenic and antipest agents; (v) Jatropha curcas toxic variety with high levels of various phytochemicals such as trypsin inhibitor, lectin, phytate and phorbol esters in seeds limiting the use of seed meal in fish and livestock diets; and the use of phorbol esters as bio-pesticidal agent; and (vi) lesser-known legumes such as Entada phaseoloides seeds containing high levels of trypsin inhibitor and saponins, Sesbania aculeate seeds rich in non-starch polysaccharides and Mucuna pruriens var. utilis seeds rich in l-3,4-dihydroxyphenylalanine and their potential as fish feed; Cassia fistula seeds as a source of antioxidants; and the use of Canavalia ensiformis, C. gladiata and C. virosa seeds containing high levels of trypsin inhinitor, lectins and canavanine. The paper also presents some challenges and future areas of work in this field.
In this work, organic light emitting devices (OLEDs) based on a blue-emitting fluorescent guest/host-system from Merck OLED Materials GmbH is investigated. OLEDs comprising a hole transport layer (HTL), the emissive film Merck Blue Host:Merck Blue Guest (MBH:MBG), a hole-blocking film and the electron transport layer (ETL) were prepared by vacuum thermal evaporation. The hole-blocking capabilities of aluminum(III)bis(2-methyl-8-quinolinato)4-phenylphenolate (BAlq) and the host material MBH were investigated. By employing an additional HBL, the current efficiency could be increased from 5.7 to 7.4 cd/A. Furthermore, 2,3,5,6-tetrafluoro-7,7,8,8-tetracyano-quinodimethane (F4-TCNQ) doping of the HTL was investigated. Devices with 4,7-diphenyl-1,10-phenanthroline (BPhen) or 1,3,5-Tris-(N-phenylbenzimidazol-2-yl)benzene (TPBI) as alternative ETLs were fabricated and conclusions were drawn regarding the charge balance in the devices. It was found that employing tris-(8-hydroxyquinoline) aluminum (Alq3) as ETL leads to the best lifetimes of about 2000 hours at a constant current of 20 mA/cm2 while p-doping in combination with BPhen as ETL leads to the highest efficiency of 5.7 lm/W max. and 4.4 lm/W at 1000 cd/m2.
Size exclusion chromatography (SEC) has been used to separate single wall carbon nanotubes (SWNT) dispersed by chemical modification in organic solvents and by DNA in aqueous solution. The chromatographic detection includes size sensitive detectors, multi-angle light scattering (MALS) and intrinsic viscosity (IV), which can provide information on the size and shape of the SEC fractions. The dispersions were also characterized by small angle neutron scattering (SANS) and atomic force microscopy (AFM). Chemical modification was accomplished by covalent attachment of octadecyl amine to acid treated SWNT and by covalent attachment of butyl groups through free radical grafting. Both covalent attachment methods produced dispersions that contained impurities or clusters of SWNT. The DNA dispersions produced the best dispersions, being predominately single nanotubes.
In this work Spectroscopic Ellipsometry (SE) was used to study metal induced crystallization (MIC) on amorphous silicon films in order to analyze the influence of different annealing conditions on their structural properties. The variation of the metal thickness has shown to be determinant on the time needed to full crystallize silicon films. Films of 100 nm thickness crystallize after 2h at 500°C using 1 nm of Ni deposited on it. When reducing the average metal thickness down to 0.05 nm the same silicon film will need almost 10 hours to be totally crystallized. Using a new approach on the modelling procedure of the SE data we show to be possible to determine the Ni remaining inside the crystallized films. The method consists in using Ni as reference on the Bruggeman Effective Medium Approximation (BEMA) layer that will simulated the optical response of the crystallized silicon. Silicon samples and metal layers with different thicknesses were analyzed and this new method has shown to be sensible to changes on the initial metal/silicon ratio. The nickel distribution inside the silicon layers was independently measured by Rutherford Backscattering Spectroscopy (RBS) to check the data obtained from the proposed approach.
We present the first results from our next-generation microlensing survey, the SuperMACHO project. We are using the CTIO 4m Blanco telescope and the MOSAIC imager to carry out a search for microlensing toward the Large Magellanic Cloud (LMC). We plan to ascertain the nature of the population responsible for the excess microlensing rate seen by the MACHO project. Our observing strategy is optimized to measure the differential microlensing rate across the face of the LMC. We find this derivative to be relatively insensitive to the details of the LMC's internal structure but a strong discriminant between Galactic halo and LMC self lensing. In December 2003 we completed our third year of survey operations. 2003 also marked the first year of real-time microlensing alerts and photometric and spectroscopic followup. We have extracted several dozen microlensing candidates, and we present some preliminary light curves and related information. Similar to the MACHO project, we find SNe behind the LMC to be a significant contaminant - this background has not been completely removed from our current single-color candidate sample. Our follow-up strategy is optimized to discriminate between SNe and true microlensing.To search for other articles by the author(s) go to: http://adsabs.harvard.edu/abstract_service.html
This paper briefly describes the principle of operation and science goals of the AMANDA high energy neutrino telescope located at the South Pole, Antarctica. Results from an earlier phase of the telescope, called AMANDA-BIO, demonstrate both reliable operation and the broad astrophysical reach of this device, which includes searches for a variety of sources of ultrahigh energy neutrinos: generic point sources, Gamma-Ray Bursts and diffuse sources. The predicted sensitivity and angular resolution of the telescope were confirmed by studies of atmospheric muon and neutrino backgrounds. We also report on the status of the analysis from AMANDA-II, a larger version with far greater capabilities. At this stage of analysis, details of the ice properties and other systematic uncertainties of the AMANDA-II telescope are under study, but we have made progress toward critical science objectives. In particular, we present the first preliminary flux limits from AMANDA-II on the search for continuous emission from astrophysical point sources, and report on the search for correlated neutrino emission from Gamma Ray Bursts detected by BATSE before decommissioning in May 2000. During the next two years, we expect to exploit the full potential of AMANDA-II with the installation of a new data acquisition system that records full waveforms from the in-ice optical sensors.
The contents of phenolic compounds, protein precipitation capacity (PPC) and in vitro gas production of tropical browse species were evaluated. The stoichiometric relationship between in vitro gas measured on incubation of tannin-containing browses in buffered rumen fluid and calculated from short chain fatty acid (SCFA) production was investigated. Crude protein (CP) contents in the browses ranged from 54 to 300 g/kg dry matter (DM). Total phenol (TP), tannins (T) and condensed tannins (TP and T as tannic acid equivalent; CT, as leucocyanidin equivalent) ranged from 17–250, 7–214, and 0–260 g/kg DM respectively, and PPC from 0 to 1066 μg BSA precipitated/g DM. CP content of browses was negatively correlated with TP, T, CT and PPC. A significant correlation was observed between per cent change in gas production on addition of polyethylene glycol (PEG) and the contents of phenolics (r = 0.76 for both TP and T). Addition of PEG to tannin-containing browses increased in vitro gas production. PPC was significantly correlated with TP (r = 0.87; P<0.001), T (r = 0.83; P<0.001), and CT (r = 0.41; P<0.05). A good relationship (R2 = 0.94; P<0.001) was observed between measured in vitro gas production and that calculated from SCFA. The molar proportions of SCFA were not affected by the inclusion of PEG (P>0.05). The relationship between in vitro gas measured on incubation of browse leaves and that calculated from SCFA allows prediction of SCFA from gas production.