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Reward Deficiency Syndrome (RDS) is an umbrella term for all drug and nondrug addictive behaviors, due to a dopamine deficiency, “hypodopaminergia.” There is an opioid-overdose epidemic in the USA, which may result in or worsen RDS. A paradigm shift is needed to combat a system that is not working. This shift involves the recognition of dopamine homeostasis as the ultimate treatment of RDS via precision, genetically guided KB220 variants, called Precision Behavioral Management (PBM). Recognition of RDS as an endophenotype and an umbrella term in the future DSM 6, following the Research Domain Criteria (RDoC), would assist in shifting this paradigm.
Encephalitis causes high morbidity and mortality. An incidence of 4.3 cases of encephalitis/100 000 population has been reported in the UK. We performed a retrospective evaluation of the diagnosis and management of adults admitted to hospital with a clinical diagnosis of encephalitis/meningoencephalitis. Clinical, laboratory and radiological data were collated from electronic records. Thirty-six patients, median age 55 years and 24 (67%) male were included. The aetiology was confirmed over nine months in 25 (69%) of whom 16 were infections (six viral, seven bacterial, two parasitic and one viral and parasitic co-infection); 7 autoimmune; 1 metabolic and 1 neoplastic. Of 24 patients with fever, 15 (63%) had an infection. The median time to computed topography, magnetic resonance imaging and electroencephalography (EEG) was 1, 8 and 3 days respectively. Neuroimaging was abnormal in 25 (69%) and 17 (89%) had abnormal EEGs. Only 19 (53%) received aciclovir treatment. Six (17%) made good recoveries, 16 (44%) had moderate disability, 8 (22%) severe disability and 6 (17%) died. Outcomes were worse for those with an infectious cause. In summary, a diagnosis was made in 69.4% of patients admitted with encephalitis/meningoencephalitis. Autoimmune causes are important to consider at an early stage due to a successful response to treatment. Only 53% of patients received aciclovir on admission. Neuroimaging and EEG studies were delayed. The results of this work resulted in further developing the clinical algorithm for managing these patients.
Cash-for-care schemes offering cash payments in place of conventional social services are becoming commonplace in developed welfare states; however, there is little evidence about the impact of such schemes on older people. This paper reports on the impact and outcomes for older people of the recent English Individual Budget (IB) pilot projects (2005–07). It presents quantitative data on outcome measures from structured interviews with 263 older people who took part in a randomised controlled trial and findings from semi-structured interviews with 40 older people in receipt of IBs and with IB project leads in each of the 13 pilot sites. Older people spent their IBs predominantly on personal care, with little resources left for social or leisure activities; and had higher levels of psychological ill-health, lower levels of wellbeing, and worse self-perceived health than older people in receipt of conventional services. The qualitative interviews provide insights into these results. Potential advantages of IBs included increased choice and control, continuity of care worker, and the ability to reward some family carers. However, older people reported anxieties about the responsibility of organising their own support and managing their budget. For older people to benefit fully from cash-for-care schemes they need sufficient resources to purchase more than basic personal care; and access to help and advice in planning and managing their budget.
Increased public and institutional awareness of both the benefits and threats of nitrogen has the potential to greatly increase the efficacy of nitrogen policy.
Insufficient recognition of the financial, behavioural and cultural barriers to achieving an optimal nitrogen future risks policy antagonisms and failure.
Here we examine some of the key societal levers for and barriers to achieving an optimal nitrogen future in Europe, drawing lessons from the more-developed societal and policy challenge of climate change mitigation.
Key findings/state of knowledge
There is currently a very low level of public and media awareness of nitrogen impacts and policies. However, awareness is high regarding the threats and benefits of ‘carbon’ to society (e.g. energy use and enhanced climate change).
Many national climate change mitigation policies now overtly recognize the importance of societal choice, and are increasingly utilizing behavioural change strategies to achieve greenhouse gas emission reduction targets.
In achieving an optimal nitrogen future, lessons can and should be learned from existing climate change-focused communication and behavioural science (e.g. use of a ‘segmented strategy’ to reach disparate groups of stakeholders).
Key sectors where societal choice has the potential to greatly influence nitrogen use efficiency include food production, consumption and waste.
As in other countries, improving collaboration between health and social care services is a long-established objective of English social policy. A more recent priority has been the personalisation of social care for adults and older people through the introduction of individualised funding arrangements. Individual budgets (IBs) were piloted in 13 English local authorities from 2005 to 2007, but they explicitly excluded NHS resources and services. This article draws on interviews with lead officers responsible for implementing IBs. It shows how the contexts of local collaboration created problems for the implementation of the personalisation pilots, jeopardised inter-sectoral relationships and threatened some of the collaborative arrangements that had developed over the previous decade. Personal budgets for some health services have subsequently also been piloted. These will need to build upon the experiences of the social care IB pilots, so that policy objectives of personalisation do not undermine previous collaborative achievements.
This article aims to explore the concept of choice in public service policy in England, illustrated through findings of the Individual Budgets (IB) evaluation. The evaluation tested the impact of IBs as a mechanism to increase choice of access to and commissioning of social care services around the individual through a randomised trial and explored the experiences and perspectives of key groups through a large set of interviews. The article presents a re-examination of these interview data, using three ‘antagonisms of choice’ proposed in the literature – choice and power relations, choice and equity, and choice and the public nature of decisions – as organising themes. The randomised trial found that IB holders perceived they had more control over their lives and appreciated the extra choice over use of services, albeit with variations by user group. However, problems of power relations, equity and the constraints implied by the public nature of decision-making were complicating and limiting factors in producing the benefits envisaged. The focus on choice in policy, especially as implemented by IBs, emphasises an individualistic approach. The findings suggest that addressing broader issues relating to power, equity and an understanding of the public nature of choice will be of value in realising more of the benefits of the policy.
A wealth of new information about the structure of the maser disk in NGC 4258 has been obtained from a series of 18 VLBA observations spanning three years, as well as from 32 additional epochs of spectral monitoring data from 1994 to the present, acquired with the VLA, Effelsberg, and GBT. The warp of the disk has been defined precisely. The thickness of the maser disk has been measured to be 12 micro-arcseconds (FWHM), which is slightly smaller than previously quoted upper limits. Under the assumption that the masers trace the true vertical distribution of material in the disk, from the condition of hydrostatic equilibrium the sound speed is 1.5 km s−1, corresponding to a thermal temperature of 600K. The accelerations of the high velocity maser components have been accurately measured for many features on both the blue and red side of the spectrum. The azimuthal offsets of these masers from the midline (the line through the disk in the plane of the sky) and derived projected offsets from the midline based on the warp model correspond well with the measured offsets. This result suggests that the masers are well described as discrete clumps of masing gas, which accurately trace the Keplerian motion of the disk. However, we have continued to search for evidence of apparent motions caused by “phase effects.” This work provides the foundation for refining the estimate of the distance to NGC 4258 through measurements of feature acceleration and proper motion. The refined estimate of this distance is expected to be announced in the near future.
Drawing a distinction between cortical and subcortical dementias seems both useful and justified. Recent research has, however, cast doubt on the clinical, neuropsychological, neuroimaging and neuroanatomical basis of the distinction.
To arrive at a reasoned conclusion about the relationship between the two types of dementia and the validity of distinguishing between them.
The historical and recent clinical and scientific literature on subcortical dementia was reviewed.
The traditional claim that subcortical dementia has distinct clinical manifestations, neuroimaging findings and a neuropathological profile is not altogether borne out by the literature. Some studies show that frontal executive dysfunction and the profile of memory deficits are not significantly different from those seen in Alzheimer's disease. Neuropathological findings also overlap.
The category of subcortical dementia may be clinically useful in highlighting the likelihood that an individual with dementia is more likely to suffer from bradyphrenia and motor difficulties. As neuroscience advances a preoccupation with the distinction may hinder the assessment and treatment of individual cases.
Silicon-carbon alloys were deposited by electron cyclotron resonance chemical vapor deposition (ECR-CVD) using either halogenated or non-halogenated precursors for the Si and C sources. Halogenated precursors were chosen for initial experiments to try to reduce the H content and to improve the microstructure of the silicon carbide (SiCx) films. While a wide range of compositions has been deposited using the halogenated precursors, only a limited range has been deposited so far with the non-halogenated precursors. Electron spectroscopy for chemical analysis (ESCA) and Fourier transform infrared (FTIR) spectroscopy show that compositions ranging from near-stoichiometric SiCx to extremely C-rich can be deposited by controlling the deposition temperature, plasma power and C/Si ratio of the halogenated precursors. At the highest C/Si-precursor ratio, the deposited film is electrically conductive with a measured resistivity of 0.067ω-cm, contains only 3-atomic-percent Si and should be considered a Si-doped carbon (C:Si) film. The excellent transparency, especially that of the C:Si films, allowed the assignment of FTIR absorption bands that are usually masked by graphitic inclusions and other impurities. A weak absorption band at 1180cm−1 was found to correlate with the electrical conductivity of the films and was attributed to the asymmetric “bond-and-a-half” Si=C stretch in a Si=C=C functional group where the pi electrons are distributed equally between the three atoms. Additional results show etching of the substrate by reactive Cl from the halogenated precursors can have a dramatic effect on the microstructure, porosity and moisture stability of the films. For experiments involving halogenated precursors, the C:Si films are much more stable than the near-stoichiometric SiCx because C:Si is deposited at lower plasma powers that do not etch the Si substrate. Finally, preliminary results show that near-stoichiometric SiCx films deposited using non-halogenated precursors are much more stable with respect to moisture incorporation than those deposited with halogenated precursors.
We present the first VLBI measurement of interstellar ammonia (NH3) masers. Two masers were found toward the ultracompact Hii regions, W51-e1 and e2. The masers are unresolved in angle and smaller than 0.1 milliarcseconds. Unless these masers are highly beamed, they appear to be saturated.
Studies of H2O masers have demonstrated the power of VLBI techniques to measure relative positions with sufficient accuracy (∼ 10 μas) to determine proper motions and to estimate distances to maser sources throughout the Galaxy. The distance to four H2O masers have been determined, and the distance to the center of the Galaxy has been determined to be 7.1 ± 1.5 kpc from observations of the H2O masers in Sgr-B2. Proper motion distances for other H2O masers, and possibly for OH masers, may allow the determination of the fundamental parameters describing the size (Ro) and rotation rate (Θo) of the Galaxy with accuracies of better than 10%. Finally, the measurement of the proper motions of H2O masers in nearby galaxies (< 10 Mpc) is feasible and offers the possibility of direct calibration of the extragalactic distance scale.
On 1984 October 6 we conducted a 3-station intercontinental Mark II VLBI experiment in order to study the very luminous water vapor maser source in the nucleus of the galaxy NGC 3079, which was detected first by Haschick and Baan (1985) using the Haystack Observatory 36.6 m antenna. The cross correlation spectrum for the longest Owens Valley to MPI baseline is presented in Figure 1 and shows the phase variation across the width of the brightest feature at 955.7 km s−1 to be less than 10 degrees of phase.
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