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The aim of this work was to identify factors associated with homelessness status in patients admitted to the psychiatric emergency ward of a French public teaching hospital over the 6-year study period (2001-2006).
The study was based on a retrospective review of the psychiatric emergency ward's administrative and medical computer databases. Each emergency care episode had accompanying data including demographic, financial, clinical, and management information.
During this 6-year study, the psychiatric service recorded 16,754 care episodes concerning 8,860 different patients, of which 591 were homeless (6.7%) and 8,269 were non-homeless (93.3%). The mean ± SD number of visits to the psychiatric emergency service was higher for homeless (4.9±12.3) than for non-homeless patients (1.7±2.4) (p< .001). A total of 331 homeless patients (56%) had more than one care episode, versus 2,180 (26%) for non-homeless patients. Factors associated with homelessness included male sex, single status, and the reception of social financial assistance. Schizophrenia (43.7%) and substance use disorders (31.0%) were the most frequent disorders in homeless patients. Aggressive behaviour and violence were reported equally in homeless and non-homeless patients. Homeless patients were hospitalized less often after having received care in the emergency ward.
Although there is near-universal access to free mental health care in France, our findings suggest that the quality and adequacy of subsequent care were not always guaranteed. Multidisciplinary and collaborative solutions are needed to improve the management of homeless patients.
Two common approaches to identify subgroups of patients with bipolar disorder are clustering methodology (mixture analysis) based on the age of onset, and a birth cohort analysis. This study investigates if a birth cohort effect will influence the results of clustering on the age of onset, using a large, international database.
The database includes 4037 patients with a diagnosis of bipolar I disorder, previously collected at 36 collection sites in 23 countries. Generalized estimating equations (GEE) were used to adjust the data for country median age, and in some models, birth cohort. Model-based clustering (mixture analysis) was then performed on the age of onset data using the residuals. Clinical variables in subgroups were compared.
There was a strong birth cohort effect. Without adjusting for the birth cohort, three subgroups were found by clustering. After adjusting for the birth cohort or when considering only those born after 1959, two subgroups were found. With results of either two or three subgroups, the youngest subgroup was more likely to have a family history of mood disorders and a first episode with depressed polarity. However, without adjusting for birth cohort (three subgroups), family history and polarity of the first episode could not be distinguished between the middle and oldest subgroups.
These results using international data confirm prior findings using single country data, that there are subgroups of bipolar I disorder based on the age of onset, and that there is a birth cohort effect. Including the birth cohort adjustment altered the number and characteristics of subgroups detected when clustering by age of onset. Further investigation is needed to determine if combining both approaches will identify subgroups that are more useful for research.
Immune dysfunction is thought to play a critical role in the pathophysiology of bipolar disorder (BD). Better insight into the genetic control of innate immune responses is of importance due to possible interactions with environmental risk factors such as infectious agents, particularly early in life.
Given the importance of Toll-like receptors (TLRs) in innate immunity, we analysed the association of selected genetic variants of TLR-2 and TLR-4, both major sensors of pathogenic infectious and non-infectious structures, with BD.
Explore possible implications of the innate arm of the immune response in BD.
Genomic DNAs from 572 BD patients and 202 controls were analyzed for the distribution of polymorphisms on the TLR-2 and TLR-4 loci using TaqMan®. Associations were examined using Chi-square test.
We found that TLR-4 rs1927914 AA and rs11536891 TT genotypes were more frequent in BD patients than in controls (corrected p; pc = .02 and .02 respectively) particularly in early-onset BD (EOBD) patients (pc = .004 and .006) born during the summer season (pc = 02 and .002 respectively). We also found that TLR-2 rs3804099 TT and rs4696480 TT genotypes were significantly more prevalent in EOBD group as compared to the late-onset BD (LOBD) subset, the latter only after excluding patients with positive family history of psychiatric disorders (pc=0.024 and 0.002 respectively).
We report an association between BD and TLR-2 and TLR-4 genetic variants suggesting an important role for pathogens in disease development.
Cognitive deficits have been reported during the early stages of bipolar disorder; however, the role of medication on such deficits remains unclear. The aim of this study was to compare the effects of lithium and quetiapine monotherapy on cognitive performance in people following first episode mania.
The design was a single-blind, randomised controlled trial on a cohort of 61 participants following first episode mania. Participants received either lithium or quetiapine monotherapy as maintenance treatment over a 12-month follow-up period. The groups were compared on performance outcomes using an extensive cognitive assessment battery conducted at baseline, month 3 and month 12 follow-up time-points.
There was a significant interaction between group and time in phonemic fluency at the 3-month and 12-month endpoints, reflecting greater improvements in performance in lithium-treated participants relative to quetiapine-treated participants. After controlling for multiple comparisons, there were no other significant interactions between group and time for other measures of cognition.
Although the effects of lithium and quetiapine treatment were similar for most cognitive domains, the findings imply that early initiation of lithium treatment may benefit the trajectory of cognition, specifically verbal fluency in young people with bipolar disorder. Given that cognition is a major symptomatic domain of bipolar disorder and has substantive effects on general functioning, the ability to influence the trajectory of cognitive change is of considerable clinical importance.
Application timing and environmental factors reportedly influence the efficacy of auxinic herbicides. In resistance-prone weed species such as Palmer amaranth (Amaranthus palmeri S. Watson), efficacy of auxinic herbicides recently adopted for use in resistant crops is of utmost importance to reduce selection pressure for herbicide-resistance traits. Growth chamber experiments were conducted comparing the interaction of different environmental effects with application time to determine the influence of these factors on visible phytotoxicity and hydrogen peroxide (H2O2) formation in A. palmeri. Temperature displayed a high degree of influence on 2,4-D and dicamba efficacy in general, with applications at the low-temperature treatment (31/20 C day/night) resulting in an increase in phytotoxicity compared with high-temperature treatments (41/30 C day/night). Application time across temperature treatments significantly affected 2,4-D–induced phytotoxicity, resulting in a ≥30% increase across rates with treatments at 4:00 PM compared with 8:00 AM. Temperature differential had a significant influence on dicamba efficacy based on visible phytotoxicity data, with a ≥46% increase with a high (37/20 C day/night) compared with a low differential (41/30 C day/night). Concentration of H2O2 in herbicide-treated plants was 34% higher under a high temperature differential compared with the low differential. Humidity treatments and application time interactions displayed undetected or inconsistent effects on visible phytotoxicity and H2O2 production. Overall, temperature-related influences seem to have the largest environmental effect on auxinic herbicides within conditions evaluated in this study. Leaf concentration of H2O2 appears to be generally correlated with phytotoxicity, providing a potentially useful tool in determining efficacy of auxinic herbicides in field settings.
Drawing on a landscape analysis of existing data-sharing initiatives, in-depth interviews with expert stakeholders, and public deliberations with community advisory panels across the U.S., we describe features of the evolving medical information commons (MIC). We identify participant-centricity and trustworthiness as the most important features of an MIC and discuss the implications for those seeking to create a sustainable, useful, and widely available collection of linked resources for research and other purposes.
Dementia is a leading cause of morbidity and mortality without pharmacologic prevention or cure. Mounting evidence suggests that adherence to a Mediterranean dietary pattern may slow cognitive decline, and is important to characterise in at-risk cohorts. Thus, we determined the reliability and validity of the Mediterranean Diet and Culinary Index (MediCul), a new tool, among community-dwelling individuals with mild cognitive impairment (MCI). A total of sixty-eight participants (66 % female) aged 75·9 (sd 6·6) years, from the Study of Mental and Resistance Training study MCI cohort, completed the fifty-item MediCul at two time points, followed by a 3-d food record (FR). MediCul test–retest reliability was assessed using intra-class correlation coefficients (ICC), Bland–Altman plots and κ agreement within seventeen dietary element categories. Validity was assessed against the FR using the Bland–Altman method and nutrient trends across MediCul score tertiles. The mean MediCul score was 54·6/100·0, with few participants reaching thresholds for key Mediterranean foods. MediCul had very good test–retest reliability (ICC=0·93, 95 % CI 0·884, 0·954, P<0·0001) with fair-to-almost-perfect agreement for classifying elements within the same category. Validity was moderate with no systematic bias between methods of measurement, according to the regression coefficient (y=−2·30+0·17x) (95 % CI −0·027, 0·358; P=0·091). MediCul over-estimated the mean FR score by 6 %, with limits of agreement being under- and over-estimated by 11 and 23 %, respectively. Nutrient trends were significantly associated with increased MediCul scoring, consistent with a Mediterranean pattern. MediCul provides reliable and moderately valid information about Mediterranean diet adherence among older individuals with MCI, with potential application in future studies assessing relationships between diet and cognitive function.
Amorphous TiO2 and SnO2 electron transport layers (ETLs) were deposited by low-temperature atomic layer deposition (ALD). Surface morphology and x-ray photoelectron spectroscopy (XPS) indicate uniform and pinhole free coverage of these ALD hole blocking layers. Both mesoporous and planar perovskite solar cells were fabricated based on these thin films with aperture areas of 1.04 cm2 for TiO2 and 0.09 cm2 and 0.70 cm2 for SnO2. The resulting cell performance of 18.3 % power conversion efficiency (PCE) using planar SnO2 on 0.09 cm2 and 15.3 % PCE using mesoporous TiO2 on 1.04 cm2 active areas are discussed in conjunction with the significance of growth parameters and ETL composition.
Escherichia coli O157 are zoonotic bacteria for which cattle are an important reservoir. Prevalence estimates for E. coli O157 in British cattle for human consumption are over 10 years old. A new baseline is needed to inform current human health risk. The British E. coli O157 in Cattle Study (BECS) ran between September 2014 and November 2015 on 270 farms across Scotland and England & Wales. This is the first study to be conducted contemporaneously across Great Britain, thus enabling comparison between Scotland and England & Wales. Herd-level prevalence estimates for E. coli O157 did not differ significantly for Scotland (0·236, 95% CI 0·166–0·325) and England & Wales (0·213, 95% CI 0·156–0·283) (P = 0·65). The majority of isolates were verocytotoxin positive. A higher proportion of samples from Scotland were in the super-shedder category, though there was no difference between the surveys in the likelihood of a positive farm having at least one super-shedder sample. E. coli O157 continues to be common in British beef cattle, reaffirming public health policy that contact with cattle and their environments is a potential infection source.
An unworked quartz vein-hosted gold deposit occurs in the Clew bay area of County Mayo, western Ireland. The veins are late-Caledonian in age and transect greenschist-facies poly-deformed Silurian quartzites. The veins contain disseminated arsenopyrite that may be a primary mineral source for elevated levels of arsenic (As) found in groundwater samples recovered from wells related spatially to the gold deposit. Levels from 5 to 188 μg/L (significantly above the 7.5 μg/L threshold for safe drinking water) have been detected. A series of element distribution maps using a scanning electron microscope (Hitachi model S-4700) linked to an energy-dispersive spectrometer (INCA® Oxford Instruments) and mineral distribution maps generated by QEMSCAN® (Quantitative Evaluation of Minerals by Scanning electron microscopy) were used to map the distribution of the primary arsenopyrite and related secondary As-bearing phases. Laser Raman microspectroscopy was used to identify the secondary As-bearing phases. 'Island weathering' of primary arsenopyrite together with hydrated pseudomorphs of arseniosiderite, pharmacosiderite and scorodite after arsenopyrite are recorded. Circulating groundwater hydrates the primary arsenopyrite, providing the release mechanism that forms the secondary As-bearing phases that occur as microfracture infills together with muscovite and biotite. The textural relationships between the primary and secondary As minerals indicate their potential as mineral sources of As that could enter transport pathways leading to its release into groundwater.
Mental health research funding priorities in high-income countries must balance longer-term investment in identifying neurobiological mechanisms of disease with shorter-term funding of novel prevention and treatment strategies to alleviate the current burden of mental illness. Prioritising one area of science over others risks reduced returns on the entire scientific portfolio.
Background: Approximately, one-third of TIA clinics use the ABCD2 score to triage referrals. However, the usefulness of the score is limited because of its low specificity for non-cerebrovascular/mimic conditions. Timely access of referred patients to specialized TIA clinics may reduce recurrent stroke. Methods: The SpecTRA project implemented a novel electronic triage system in the TIA clinic that services Vancouver Island (BC), which replaced the existing ABCD2 triage model. A clinical classifier generating an ACVS probability score was calculated on the basis of the clinic referral form information. Next, a time-varying ABCD2-based risk score derived from Johnston et al. (2007) was calculated, which is then weighted by the ACVS probability score to produce a finalized triage score. Time-to-care was compared pre- (2013/14) and post- (2014/15) implementation. Results: One year results show a statistically significant improvement in that time-to-care for ACVS patients (ABCD2 4/5) was one day earlier with the new triage system (median= 4days since symptom onset; N=250) compared to the previous year (median=5days; N=255) (Mann-Whitney U=38130, p< 0.001). No difference in unit arrival times (median= 5days) for non-cerebrovascular patients was observed (Mann-Whitney U=5563, p= 0.15). Conclusions: The performance of our ACVS triage system highlights quality improvement potential in time-to-care for outpatient TIA clinics.
Bipolar disorder is a highly heritable polygenic disorder. Recent
enrichment analyses suggest that there may be true risk variants for
bipolar disorder in the expression quantitative trait loci (eQTL) in the
We sought to assess the impact of eQTL variants on bipolar disorder risk
by combining data from both bipolar disorder genome-wide association
studies (GWAS) and brain eQTL.
To detect single nucleotide polymorphisms (SNPs) that influence
expression levels of genes associated with bipolar disorder, we jointly
analysed data from a bipolar disorder GWAS (7481 cases and 9250 controls)
and a genome-wide brain (cortical) eQTL (193 healthy controls) using a
Bayesian statistical method, with independent follow-up replications. The
identified risk SNP was then further tested for association with
hippocampal volume (n = 5775) and cognitive performance
(n = 342) among healthy individuals.
Integrative analysis revealed a significant association between a brain
eQTL rs6088662 on chromosome 20q11.22 and bipolar disorder (log Bayes
factor = 5.48; bipolar disorder P =
5.85×10–5). Follow-up studies across multiple independent
samples confirmed the association of the risk SNP (rs6088662) with gene
expression and bipolar disorder susceptibility (P =
3.54×10–8). Further exploratory analysis revealed that
rs6088662 is also associated with hippocampal volume and cognitive
performance in healthy individuals.
Our findings suggest that 20q11.22 is likely a risk region for bipolar
disorder; they also highlight the informative value of integrating
functional annotation of genetic variants for gene expression in
advancing our understanding of the biological basis underlying complex
disorders, such as bipolar disorder.
Malaria remains a life-threatening parasitic infection endemic throughout much of the world. It is estimated that in 2010 there were 216 million infections and 655 000 deaths due to malaria, with the majority of deaths among African children. In nonendemic countries, it is one of the most common causes of fever in returned travelers and recent immigrants, and several thousand people with malaria arrive in nonendemic countries yearly.
Malaria is a mosquito-borne protozoal infection caused by one of four human Plasmodium species (Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, and Plasmodium malariae), or with the monkey parasite, Plasmodium knowlesi, which has been increasingly described in parts of Southeast Asia. Malaria endemic countries are shown in Figure 200.1. Given the risk of rapid progression to severe disease in nonimmune individuals, a high index of suspicion is critical when evaluating patients with febrile illness following travel to malarious areas, especially those endemic for P. falciparum. Proper treatment of malaria requires knowledge of the infecting species and where it was acquired, since drug resistance patterns vary geographically. Widespread chloroquine-resistant P. falciparum (CRPF) malaria and emergence of resistance to other drugs have complicated treatment and prophylaxis.
Fever in a patient who has recently traveled to an area endemic for malaria should be considered a medical emergency. The minimum incubation period is generally considered to be 7 days after inoculation, and of greatest concern is the patient who has traveled to a P. falciparum endemic area within 2 months of presentation, since an incubation period of 2 to 4 weeks is typical for falciparum malaria.
Whether for business, tourism, study, or aid work, more individuals are traveling to more parts of the world. The World Tourism Organization estimates that in 2011, there were 990 million international tourist arrivals worldwide. Health problems associated with travel are common, especially in developing countries where as many as 22% to 64% of travelers self-report a travel-associated health problem and 8% seek healthcare while traveling or after return. Healthcare providers can play a critical role in minimizing the risk of illness and injury during travel.
While administration of travel-related vaccinations and malaria prophylaxis remain cornerstones of the pre-travel consultation, providing advice on managing chronic medical conditions, food and water hygiene, physical safety, and disease vector avoidance is also important. Noninfectious causes of morbidity and mortality such as injury and exacerbation of chronic illness are typically the most common health issues travelers encounter. Important considerations include:
Pre-existing medical conditions, current medications, and allergies
Itinerary, including details of travel within countries, duration of stay, and sequence of countries visited
Purpose of travel, accommodations, and activities
Previous vaccination history and recommended vaccines for the itinerary
Need for prophylactic and self-treatment medications, including those for malaria prevention, treatment of travelers’ diarrhea, and altitude sickness.
Referral to a travel health specialist should be considered, particularly for medically complex travelers, for those traveling to developing nations, and when travel-specific vaccines are indicated. Since vaccines typically take 10 to 14 days to elicit full immune responses, and some require a primary series to become effective, travelers should ideally be evaluated in a travel clinic at least 4 to 6 weeks prior to departure. However, when this is not possible travelers should still be seen, even when travel is imminent.
Thin diamond foils are needed in many particle accelerator experiments regarding nuclear and atomic physics, as well as in some interdisciplinary research. Particularly, nanodiamond texture is attractive for this purpose as it possesses a unique combination of diamond properties such as high thermal conductivity, mechanical strength and high radiation hardness; therefore, it is a potential material for energetic ion beam stripper foils. At the ORNL Spallation Neutron Source (SNS), the installed set of foils must be able to survive a nominal five-month operation period, without the need for unscheduled costly shutdowns and repairs. Thus, a single nanodiamond foil about the size of a postage stamp is critical to the entire operation of SNS and similar sources in U.S. laboratories and around the world. We are investigating nanocrystalline, polycrystalline and their admixture films fabricated using a hot filament chemical vapor deposition (HFCVD) system for H- stripping to support the SNS at Oak Ridge National Laboratory. Here we discuss optimization of process variables such as substrate temperature, process gas ratio of H2/Ar/CH4, substrate to filament distance, filament temperature, carburization conditions, and filament geometry to achieve high purity diamond foils on patterned silicon substrates with manageable intrinsic and thermal stresses so that they can be released as free standing foils without curling. An in situ laser reflectance interferometry tool (LRI) is used for monitoring the growth characteristics of the diamond thin film materials. The optimization process has yielded free standing foils with no pinholes. The sp3/sp2 bonds are controlled to optimize electrical resistivity to reduce the possibility of surface charging of the foils. The integrated LRI and HFCVD process provides real time information on the growth of films and can quickly illustrate growth features and control over film thickness. The results are discussed in the light of development of nanodiamond foils that will be able to withstand a few MW proton beam and hopefully will be able to be used after possible future upgrades to the SNS to greater than a 3MW beam.