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Schizophrenia often presents in adolescence (13–18 years), is more likely to have a poor prognosis and young people are also more prone to adverse effects. Clearer guidance is needed in order to plan treatment for early onset cases more effectively.
We aimed to evaluate effects of atypical antipsychotic medications for psychosis in adolescents.
We searched the Cochrane Schizophrenia Group's Register. References of all identified studies were inspected for further trials.
All relevant RCTs that compared atypical antipsychotic medication with pharmacological or non-pharmacological interventions in adolescents with psychosis were included. We reliably selected, quality assessed and extracted data from trials.
There were 13 RCTs with a total of 1112 participants. Adolescents improved more on standard dose of risperidone (1.5 – 6.0 mg) against low dose of risperidone (0.15 – 0.6 mg) (1 RCT, n = 255, RR 0.54 CI 0.38 to 0.75). Participants on clozapine were three times more likely to have drowsiness as compared to haloperidol (1 RCT, n = 21, RR 3.30 CI 1.23 to 8.85, NNH 2 CI 2 to 17). Lesser number of adolescents on atypical antipsychotics left the study due to adverse effects (3 RCTs, n = 187, RR 0.65 CI 0.36 to 1.15) than on typical antipsychotics.
There is no convincing evidence that atypical-antipsychotic medications are superior over typical antipsychotic medications. There is some evidence to show that adolescents respond better to standard-dose as opposed to lower dose of medications. Larger, more robust, trials are required.
Childhood-onset schizophrenia, although rare, is schizophrenia with onset prior to the age of 13 years, appear to have a poor long term prognosis. Antipsychotic medication is one way of managing this rare but serious mental illness.
To examine the effects of antipsychotic medication for childhood-onset schizophrenia.
We searched the Cochrane Schizophrenia Group Trials Register and inspected references of all identified studies for further trials. We included all RCTs involving children and young people with a diagnosis of childhood onset schizophrenia comparing any antipsychotic drug with another antipsychotic or placebo. We reliably selected, quality assessed and extracted data from trials.
From a total of 2062 citations, we identified six relevant trials. A few results from one study favoured the atypical antipsychotic clozapine over haloperidol in treating treatment resistant childhood-onset schizophrenia (n = 21, WMD CGAS 17.00 CI 7.74 to 26.26; n = 21, WMD Bunney-Hamburg Psychosis Rating Scale −3.60 CI −6.64 to −0.56).
Participants on clozapine, however, were three times more likely to have drowsiness (1 RCT, n = 21, RR 3.30 CI 1.23 to 8.85, NNH 2 CI 2 to 17) and half of the children receiving clozapine had neutropenia (1 RCT, n = 21, RR 12, CI 0.75 to 192.86).
There is little conclusive evidence regarding the effects of antipsychotic medication for those with early onset schizophrenia. Some benefits were identified in using the atypical antipsychotic clozapine but the benefits were offset by an increased risk of serious adverse effects. Larger, more robust, trials are required.
Transitions from child and adolescent mental health services to adult mental health services have been quite troublesome for young people in the UK. There is strong evidence throughout the literature that long waiting lists and rigid adult services criteria hamper dramatically transitions across services. Little knowledge exists about transitions from forensic adolescent services to adult services.
To interview health-care professionals and young offenders in transition of care from forensic child and adolescent mental health services in England.
This study aimed to bridge the current literature gap in regards to transitions across forensic services and the complexities resulting from disruptive care.
This study adopted a prospective design to identify young offenders referred to adult services over a six-month period. We utilized semi-structured interviews. Health-care professionals were interviewed about their transition views and perspectives. Young offenders were followed-up within a month of their transition and were interviewed.
The numbers of transitions within forensic settings are much lower compared to those of general transitions across mental health services in England. Transition delays were a repetitive theme across interviews due to lack of bed availability, especially in medium secure hospitals, and poor multi-agency communication. Commissioning determines age boundaries along with transfer destination for each service.
Ineffective liaison among different sectors might impact adversely young people and hallmark their long-stay in the system. Therefore, continuity of care within forensic services should be looked warily along with the role of policy shaped by commissioning. Multiple transitions can repeatedly traumatize young people moving across services.
Prevalence studies show that nearly 80% of young offenders present psychiatric comorbidity. Juvenile offenders are at 3 times higher risk of being diagnosed with a psychiatric disorder. Recent systematic reviews have mainly focused on youth in detention neglecting youth in the community. Females and ethnic minorities have been overlooked in the literature in spite of the increasing rates of psychiatric disorders striking these groups.
To perform a meta-analysis on the prevalence rates of various mental disorders including depression, psychosis, PTSD, conduct disorder, ADHD, learning disabilities and personality disorders among young offenders. Self-harm and suicidal behaviour are examined too.
To compare the prevalence of psychiatric disorders among young offenders across custody and community and to emphasise on gender, age, and ethnic variations.
Relevant studies have been identified with computer-assisted searching and scanning of reference lists. Prevalence of mental disorders based on gender, age and ethnicity along with potential moderating factors are extracted from the included studies. Meta-regression is performed to test covariates that might have contributed to differences in prevalence rates across studies.
After searching the relevant literature, 99 studies were determined to be eligible for data extraction.
Young offenders with ongoing mental health problems comprise a vulnerable group within forensic psychiatric services that needs special attention. More prevalence studies should be conducted to improve mental health provision. Ethnic, gender, and age variations across young offenders should be addressed and turn interventions into a tailored process that responds to the young person's particular treatment needs.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
For people with mental illness that are violent, a range of interventions have been adopted with the aim of reducing violence outcomes. Many of these interventions have been borrowed from other (offender) populations and their evidence base in a Serious Mental Illness (SMI) population is uncertain.
To aggregate the evidence base for non-pharmacological interventions in reducing violence amongst adults with SMI and PD (Personality Disorder), and to assess the efficacy of these interventions. We chose to focus on distinct interventions rather than on holistic service models where any element responsible for therapeutic change would be difficult to isolate.
We performed a systematic review and narrative synthesis of non-pharmacological interventions intended to reduce violence in a SMI population and in patients with a primary diagnosis of PD. Five online databases were searched alongside a manual search of seven relevant journals, and expert opinion was sourced. Eligibility of all returned articles was independently assessed by two authors, and quality of studies was appraised via the Cochrane Collaboration Tool for Assessing Risk of Bias.
We included 23 studies of diverse psychological and practical interventions, with a range of experimental and quasi-experimental study designs that included 7 Randomised Controlled Trials (RCTs). The majority were studies of Mentally Disordered Offenders. The stronger evidence existed for patients with a SMI diagnosis receiving Cognitive Behavioural Therapy or modified Reasoning & Rehabilitation (R&R). For patients with a primary diagnosis of PD, a modified version of R&R appeared tolerable and Enhanced Thinking Skills showed some promise in improving attitudes over the short-term, but studies of Dialectical Behaviour Therapy in this population were compromised by high risk of experimental bias. Little evidence could be found for non-pharmacological, non-psychological interventions.
The evidence for non-pharmacological interventions for reducing violence in this population is not conclusive. Long-term outcomes are lacking and good quality RCTs are required to develop a stronger evidence base.
Epiphytes are an important component of the diversity of tropical forests, and they also have several ecological functions. Vegetation heterogeneity is one of the features responsible for the high biodiversity of the Atlantic Forest, especially in the domain’s seasonal semideciduous forest (SSF). This biodiversity presents as high endemism and species richness. Owing to the seasonal nature of SSF, organisms that require high humidity (e.g. epiphytes) would be expected to show low species richness in these forests. The aims of this study were to conduct a survey of the vascular epiphytes in remnants of montane SSF in the Serra do Ibitipoca, Brazil, and to evaluate the importance of habitat heterogeneity for the richness and composition of species in these areas. We also evaluated whether the intrinsic characteristics of the SSF phytophysiognomy and fragmentation could result in low species richness and a high number of accidental epiphyte species. The study was conducted in the course of 18 expeditions undertaken between September 2013 and December 2016, covering five fragments of montane SSF (totalling 23.6 ha). We recorded 96 species (only one of which is an accidental epiphyte), distributed across 41 genera and 10 families. This is the highest epiphytic species richness recorded in Brazilian SSF to date. The results refuted the initial hypothesis and reinforce the importance to the epiphytic community of conservation of fragments with different structures.
Cerrado sensu stricto (a physiognomy of the Cerrado domain, the Brazilian savanna) is subject to the annual occurrence of fire. Data on the epiphytic community in this physiognomy is scarce, as is evaluation of the influence of fire on its structure and composition. The aim of this study was to describe the structure of the vascular epiphyte community and its relationships with phorophytes in the Cerrado domain, Southeast Region of Brazil, after the passage of fire. We found the greatest abundance of epiphytes in the upper strata (65% of the individuals occurring above 3 m in height) and the dominance of three generalist species (Tillandsia streptocarpa, T. recurvata and Epiphyllum phyllanthus), suggesting that fire has an influence on the structure and composition of the epiphytic community.
In this work, we report evidences of the improvement of X-ray attenuation efficiency by the addition of a very small amount of Graphene Oxide (GO) in polymer-based nanocomposite. Poly(vinylidene fluoride) (PVDF) homopolymer and barium sulfate (BaSO4) nanoparticles were mixed. PVDF/BaSO4 nanocomposite was found to attenuate 9.14% of a 20 kV X-ray beam. The addition of only 4.0 wt % of GO nanosheets to the nanocomposite improved this X-Ray attenuation efficiency to 24.56%. The respective linear attenuation coefficients (μ) were 39.9 cm-1 and 54.4 cm-1, respectively. The X-ray attenuation gradually decreases until 6.71% and 17.62%, respectively, for the X-ray beam with higher energy (100 kV). Fourier transform infrared data revealed that, due to the lack of the bending vibration modes of CF2 molecule at 656 cm-1, 688 cm-1, 723 cm-1, 776 cm-1and 796 cm-1, characteristics of the γ-crystalline phase of PVDF, the nanocomposites casted from solution are mostly in the β-ferroelectric phase of PVDF, besides the γ-paraelectric phase. SEM micrographs were used to evaluate the dispersion state of graphene sheets and the BaSO4 nanoparticles into the polymeric matrix. UV-Vis spectrometry and Differential Scanning Calorimetry (DSC) were also performed in order to complement the structural analysis. The results confirm that the addition of graphene sheets in PVDF polymer-based nanocomposites enhances the X-ray shielding efficiency. The phenomenon is discussed in terms of the reported anomalous negative thermal expansion coefficient of graphene sheets
The constant search for the improvement of the performance of materials of industrial application, evaluated under aspects of weight reduction, greater resistance, greater resistance to wear and better thermal stability, among others, associated with the search for the development of ecologically viable products, that convert the context of environmental degradation in preservation and sustainability, reflects the need to conduct research that results in new materials. The objective of this work is to obtain composites of the AA6061 aluminum alloy reinforced with different contents of coke coal blast-furnace slag by powder metallurgy. The processing of these materials was done by sieving, mixing and compacting powders of reinforced aluminum alloy with 5, 10 and 15% of blast-furnace slag. The cold uniaxial compaction was realized at a pressure of 500MPa. The obtained materials were sintered at 580°C for 3h under inert atmosphere. Unreinforced aluminum alloy samples were also produced. The characterization of the materials was realized by density and hardness measurements and three-point bending tests. The analysis of its microstructure was realized by scanning electron microscopy. As results, the composites presented a homogeneous distribution of the reinforcing particles and also a progressive improvement of the hardness and the bending strength with the increase of the slag content, producing an increase of 79% in hardness and 128% in flexural strength, when compared to the material without reinforcement obtained by the same process. Such results give the coke coal blast-furnace slag a new possibility of exploitation in the metal-mechanical sector, besides contributing with the environmental issue.
where λ is a positive parameter and f has exponential critical growth. We first establish the existence of a non-zero weak solution. Then, by assuming that f is odd, we prove that the number of solutions increases when the parameter λ becomes large. In the proofs we apply variational methods in a suitable weighted Sobolev space consisting of functions with rapid decay at infinity.
In this retrospective study, we compared automated surveillance with conventional surveillance to detect surgical site infection after primary total hip or knee arthroplasty. Automated surveillance demonstrated better efficacy than routine surveillance in SSI diagnosis, sensitivity, and predictive negative value in hip and knee arthroplasty.
The global population of jaguars Panthera onca has decreased significantly since the beginning of the 20th century. Given the scarcity of demographic and biological information, estimating population parameters is critical for the design of conservation measures. The jaguar's elusive behaviour makes it impossible to estimate and monitor populations by direct observation. We propose a non-invasive genetic sampling approach and demonstrate its potential for large-scale monitoring. Sex identification was optimized for faecal samples of jaguars and other felids. We also optimized a set of 11 microsatellite markers for reliable identification of individuals. We estimated the effectiveness of faecal sample genotyping in two distinct Brazilian biomes: the Pantanal and the semi-arid Caatinga. Almost 90% of the samples that were molecularly identified as jaguar (n = 90) were successfully genotyped and were assigned to 30 individuals. Genetic diversity was generally high but was significantly lower in the Caatinga population. We show that non-invasive genetic sampling can be a reliable tool to study population parameters and to monitor the genetic status of jaguar populations in different habitats. It may also be useful for future surveys of jaguars that address ecological, behavioural and conservation issues, and could provide a baseline for non-invasive genetic studies of other wild felid populations.
An urgent neurology assessment clinic was created at our institution to improve access to prompt neurological assessment, and has been in operation for over a decade. We assessed its timeliness and impact.
The clinic database was examined retrospectively for trends in the volume and waiting time to assessments, neurologic diagnoses, and whether neurologic assessment changed patients’ diagnoses. Before and after implementation, the frequency of emergency department neurology assessments and hospital admissions for neurological investigation were compared.
In the first decade, 25145 referrals were received; 12460 patients were accepted and assessed within an average of 3.8 working days. The most common problems seen included headache and seizure (20.2% each). Overall, 44.6% of assessments resulted in a change to the referring diagnosis; this proportion varied by the type of problem seen (from 10.5% for seizures to 92.5% for psychiatric disturbances). From the pre- to post-opening periods, there were fewer emergency room neurological assessments (35.7% reduction) and fewer hospital admissions for neurological investigation (4.4/week to 2.2/week, 50% reduction).
The urgent neurology clinic model at our institution has provided excellent service, including wait times of a few days, to a catchment of over two million Canadians for over a decade; clinic assessments have affected diagnoses and patient care.
An intervention study was undertaken to evaluate the impact of an education program on the incidence of central line–associated bloodstream infection (CLABSI) in 2 intensive care units. There was a nonsignificant reduction in the incidence of CLABSI (odds ratio, 0.46 [95% confidence interval, 0.21–1.02]; P = .04) despite a significant increase in knowledge of CLABSI prevention by the staff of both intensive care units after the education program.
We analyzed the impact of introducing an alcohol-based hand gel and an educational program on hand hygiene adherence among healthcare workers in an intensive care unit. Adherence to hand hygiene was significantly higher after the intervention for the night shift work period (P = .001), among nursing assistants (P = .001), among nurses (P = .007) on weekend days (P = .016), and for invasive procedures (P = .012).
CST has supplied 1.5 million tons of tin plate slabs to the world market
since 1997 for several final applications, including D&I, Draw
Cans, Double Reduction, Easy Open End. After CSTs hot strip mill
was commissioned in September 2002, the Company has supplied
hot coils for the foreign market tin plate production since March
2003. In partnership with its customers, CST defined criteria for slab
application based on continuous casting quality events and continuous
casting parameters, and their relationship with the quality
results on the final product.
Referral of movement disorder patients for deep brain stimulation surgery was examined to determine whether referred patients were representative of gender proportions in our population, and reasons why patients do not proceed to surgery.
Demographic information on referrals to the surgical program was retrospectively reviewed from our database and from a detailed chart review.
Although almost equal numbers of movement disorder patients are male and female, of the 91 patients referred for surgery, only 31% were female. Sixty-one percent of referred patients did not undergo surgery. Of these, the majority were denied for medical reasons, including cognitive decline (21%), psychiatric concerns (5%) and neurological reasons (42%).
Almost one-third of patients referred for movement disorder surgery were denied for medical reasons. This underscores the importance of evaluation of all potential patients by a multidisiplinary team to fully assess suitablity for stereotactic surgery. Interestingly, women were under-represented in those referred. In order that all appropriate patients have the opportunity to consider surgery, education of both physicians and patients, and different strategies to approach females regarding surgery may allow more patients to benefit from this treatment.
Silicon based devices are expected to achieve the limit of possible
downscaling in 10 to 15 years. Thus, the search of new materials to
construct smaller, faster and more energy efficient devices has been a
very active research area. Carbon nanotubes (CNTs) are very good
candidates to construct nanoelectronic and nanophotonic devices [1,2,3]
due to unique physical properties, such as its metallic or
semiconducting characteristics depending only its diameter and chirality
[4,5] and capability of caring high current densities (up to 1010A/cm2).
In this work we develop nanofabrication techniques of single-walled
carbon nanotubes (SWNTs) based devices using a combination of electron
beam and optical lithography with Atomic Force Microscopy (AFM). We used
both CVD-grown nanotubes  and HipCO-NTs  suspended on aqueous
solution and deposited on the substrate. Atomic Force Microscopy (AFM)
in tapping mode (Multimode Nanoscope IV, Digital Instruments) was used
to CVD sample characterization, study of CNT deposition and to localize
and index the nanotubes on substrate using lithography patterns as
references, making possible to selectively construct metallic contacts
on the CNTs.