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The family physician is key to facilitating access to psychiatric treatment for young people with first-episode psychosis, and this involvement can reduce aversive events in pathways to care. Those who seek help from primary care tend to have longer intervals to psychiatric care, and some people receive ongoing psychiatric treatment from the family physician.
Our objective is to understand the role of the family physician in help-seeking, recognition and ongoing management of first-episode psychosis.
We will use a mixed-methods approach, incorporating health administrative data, electronic medical records (EMRs) and qualitative methodologies to study the role of the family physician at three points on the pathway to care. First, help-seeking: we will use health administrative data to examine access to a family physician and patterns of primary care use preceding the first diagnosis of psychosis; second, recognition: we will identify first-onset cases of psychosis in health administrative data, and look back at linked EMRs from primary care to define a risk profile for undetected cases; and third, management: we will examine service provision to identified patients through EMR data, including patterns of contacts, prescriptions and referrals to specialised care. We will then conduct qualitative interviews and focus groups with key stakeholders to better understand the trends observed in the quantitative data.
These findings will provide an in-depth description of first-episode psychosis in primary care, informing strategies to build linkages between family physicians and psychiatric services to improve transitions of care during the crucial early stages of psychosis.
A longstanding scholarly debate asks what lasting changes revolution makes in political attitudes and behaviors. Scholars generally regard revolution as transformative, but research on revolution's behavioral and cultural legacies after transfers of state power has been limited. This study explores revolution's residual impact on individuals' electoral participation, civil society engagement, and social capital by comparing postrevolutionary Nicaraguans to their Central American neighbors. Using survey data on comparable samples of urban Central Americans, the research found higher electoral engagement in Nicaragua than in the other nations in the region that experienced major insurgencies but not revolution. It also found among Nicaraguans greater support for civil disobedience, greater school and union activism, and more frequent leftist political identification. Although revolution did leave residual effects in Nicaragua, more significant influence appears to have decayed rapidly.
The Protoplanetary Discussions conference—held in Edinburgh, UK, from 2016 March 7th–11th—included several open sessions led by participants. This paper reports on the discussions collectively concerned with the multi-physics modelling of protoplanetary discs, including the self-consistent calculation of gas and dust dynamics, radiative transfer, and chemistry. After a short introduction to each of these disciplines in isolation, we identify a series of burning questions and grand challenges associated with their continuing development and integration. We then discuss potential pathways towards solving these challenges, grouped by strategical, technical, and collaborative developments. This paper is not intended to be a review, but rather to motivate and direct future research and collaboration across typically distinct fields based on community-driven input, to encourage further progress in our understanding of circumstellar and protoplanetary discs.
Smoothed particle hydrodynamics (SPH) models of the recurrent nova RS Ophiuchi are presented, along with simple models for circumstellar absorption lines. The evolution of the model sodium line is similar to the behaviour in some Type Ia SNe, e.g. SN2006X.
Background: Dialectical Behaviour Therapy (DBT) is an evidence-based treatment effective in reducing deliberate self-harm. However, DBT is resource and time intensive, and few services are able to sustain a programme faithful to all aspects. Thus, modified or adapted versions of DBT have been developed, particularly for delivery in inpatient hospital settings. Aims: This study presents a description of the “Living Through Distress” (LTD) Group, which is based on the group skills training component of DBT. Method: Participants (n = 114) were patients of a psychiatric hospital who attended the LTD group. The main inclusion criterion for the LTD group was a history of deliberate self-harm. The outcome measures were frequency of incidents of deliberate self-harm, levels of distress tolerance, and mean numbers of bed days per year. Results: Upon completion of the group, there were significant reductions in participants’ reports of deliberate self-harm and significant increases in their distress tolerance levels, which were maintained at 3-month follow-up. There was also a reduction in participants’ mean number of inpatient days at 1-year and 2-year follow-up. Over 50% of participants had no admissions in the year subsequent to completing the group. Conclusions: As this study was not a randomized controlled trial, results must be interpreted with caution. However, the findings presented here are promising, and suggest that a briefer, less resource intense version of the group skills training component of DBT may be effective in reducing deliberate self-harm.
Results for a radiolysis model sensitivity study of radiolytically produced H2O2 are presented as they relate to Spent (or Used) Light Water Reactor uranium oxide (UO2) nuclear fuel (UNF) oxidation in a low oxygen environment. The model builds on previous reaction kinetic studies to represent the radiolytic processes occurring at the nuclear fuel surface. Hydrogen peroxide (H2O2) is the dominant oxidant for spent nuclear fuel in an O2-depleted water environment. The most sensitive parameters have been identified with respect to predictions under typical conditions. As compared with the full model with about 100 reactions, it was found that only 30 to 40 of the reactions are required to determine [H2O2] to one part in 10–5 and to preserve most of the predictions for major species. This allows a systematic approach for model simplification and offers guidance in designing experiments for validation.
The onset of progressive cerebellar ataxia in early childhood is considered a key feature of ataxiatelangiectasia (A-T), accompanied by ocular apraxia, telangiectasias, immunodeficiency, cancer susceptibility and hypersensitivity to ionizing radiation.
We describe the clinical features and course of three Mennonite children who were diagnosed with A-T following the completion of therapy for lymphoid malignancies.
Prior to cancer therapy, all had non-progressive atypical neurological abnormalities, with onset by age 30 months, including dysarthria, dyskinesia, hypotonia and/or dystonia, without telangiectasias. Cerebellar ataxia was noted in only one of the children and was mild until his death at age eight years. None had severe infections. All three children were “cured” of their lymphoid malignancies, but experienced severe adverse effects from the treatments administered. The two children who received cranial irradiation developed supratentorial primitive neuroectodermal tumors of the brain, an association not previously described, with fatal outcomes.
The range of neurological presentations of A-T is broad. Ataxia and telangiectasias may be minimal or absent and the course seemingly non-progressive. The diagnosis of A-T should be considered in all children with neuromotor dysfunction or peripheral neuropathy, particularly those who develop lymphoid malignancies. The consequences of missing the diagnosis may be dire. Radiation therapy and radiomimetic drugs should be avoided in individuals with A-T.
This study compares the demographic and clinical characteristics of homebound (HB) elders referred for psychiatric services (N = 251) with those of inpatients (IP) admitted to a geriatric psychiatry unit (N = 594). Demographically, HB patients were older (78.8 vs. 74.7 years), were more likely to be women (83% vs. 68%), were widowed (54% vs. 44%), and had fewer years of education (10.3 vs. 11.1), but were similar in race, income, and proportion living alone. Clinically, HB patients had less functional disability, less severe depression, less cognitive impairment, and fewer medical problems. However, they were similar in the distribution of most psychiatric diagnoses except dementia (higher in the IP group) and dementia with depression (higher in the HB group). Outcome data for the HB group over 15 (range, 1 to 38) months revealed medical hospitalization in 20.7%, psychiatric hospitalization in 16.3%, nursing home placement in 9.2%, and mortality in 8.4%. These preliminary data show that the HB group had psychiatric problems that were comparable to those of the IP group but were not as severely impaired.
Swimming capabilities and in situ measurement of muscle activity
from adult Atlantic salmon (Salmo salar) at two seasonal temperatures were measured using radio transmitted electromyogram (EMG) signals. Forced sustained levels of activity and critical swimming speeds were determined and correlated to radio transmitted EMG signals using a modified Blazka swim speed chamber. There were no differences in swimming performance levels between tagged and untagged individuals. At 18 °C, sustained activity and critical swimming speeds were approximately 70% and 20% higher than at 12 °C, respectively. No differences in
burst activity were observed at these temperatures. EMGs recorded from salmon during ascent of an artificial flume at cold temperatures revealed that overall muscle activity is greater than that observed for critical swimming speeds. This implies that white muscle may be recruited at this
temperature. However, in contrast, most activity at 18 °C is below that observed during critical swimming speed. Moreover, salmon required almost twice as long to traverse the flume at 18 °C than at 12 °C. Together, our data demonstrates that salmon may recruit white muscle fibres and incur an oxygen debt at colder temperature as a strategy for ascending velocity obstructions at a quicker rate.
Errors in variables due to nonsynchronous trading and benchmark error are significant problems for capital market research. This paper develops the use of direct and reverse regression to bound true coefficient estimates when the data exhibit error structures arising from these two sources both separately and jointly. The approach appears to have broad applicability for capital markets research. As an example, the paper reexamines the small-firm effect to show that it cannot be attributed to nonsynchronous trading or benchmark error in the estimated variance of the market portfolio. This result is shown to hold even when the tax-selling effect is controlled for by excluding January returns.
Robert Putnam extolled the virtue of social capital by arguing that social networks, civil society, and trust contribute to democracy. Subsequent research, however, identified a weakness in the social capital “model” in its underspecification of the mechanisms by which social capital affects political systems. This article proposes the concept of political capital as a likely product of social capital that links civil society participants to the political system. The article tests this two-stage model of social capital and political capital and their effects on democratization using survey data from eight Latin American nations. Results find that civil society engagement in 2004 affected political capital variables, which, in turn, had positive effects on system-level democracy measures in 2010. The article thus shows that political capital serves as an intervening variable between social capital and democracy and democratization.
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