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Obsessive Compulsive Personality Disorder (OCPD) is a common, highly co-morbid disorder. Subjected to comparatively little research, OCPD shares aspects of phenomenology and neuropsychology with obsessive-compulsive spectrum disorders and neurodevelopmental disorders such as autism spectrum disorder (ASD). A greater understanding of this interrelationship would provide new insights into its diagnostic classification and generate new research and treatment heuristics.
To investigate the distribution of OCPD traits within a cohort of OCD patients. To evaluate the clinical overlap between traits of OCPD, OCD and ASD, as well as level of insight and treatment resistance.
We interviewed 73 consenting patients from a treatment seeking OCD Specialist Service. We evaluated the severity of OCPD traits (Compulsive Personality Assessment Scale; CPAS), OCD symptoms (Yale–Brown Obsessive Compulsive Scale; Y-BOCS), ASD traits (Adult Autism Spectrum Quotient; AQ) and insight (Brown Assessment of Beliefs Scale; BABS).
Out of 67 patients, 24 (36%) met DSM-IV criteria for OCPD, defined using the CPAS. Using Pearson's test, CPAS scores significantly (P < 0.01) correlated with total AQ and selected AQ domains but not with BABS. Borderline significant correlation was observed with Y-BOCS (P = 0.07). OCPD was not over-represented in a highly resistant OCD subgroup.
Disabling OCPD traits are common in the OCD clinic. They strongly associate with ASD traits, less strongly with OCD severity and do not appear related to poor insight or highly treatment-resistant OCD. The impact of OCPD on OCD treatment outcomes requires further research.
Disclosure of interest
This work did not receive funding from external sources. Over the past few years, Dr. Fineberg has received financial support in various forms from the following: Shire, Otsuka, Lundbeck, Glaxo-SmithKline, Servier, Cephalon, Astra Zeneca, Jazz pharmaceuticals, Bristol Myers Squibb, Novartis, Medical Research Council (UK), National Institute for Health Research (UK), Wellcome Foundation, European College of Neuropsychopharmacology, UK College of Mental Health Pharmacists, British Association for Psychopharmacology, International College of Obsessive-Compulsive Spectrum Disorders, International Society for Behavioural Addiction, World Health Organization, Royal College of Psychiatrists.
Short-term peripheral venous catheter–related bloodstream infection (PVCR-BSI) rates have not been systematically studied in resource-limited countries, and data on their incidence by number of device days are not available.
Prospective, surveillance study on PVCR-BSI conducted from September 1, 2013, to May 31, 2019, in 727 intensive care units (ICUs), by members of the International Nosocomial Infection Control Consortium (INICC), from 268 hospitals in 141 cities of 42 countries of Africa, the Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific regions. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System.
We followed 149,609 ICU patients for 731,135 bed days and 743,508 short-term peripheral venous catheter (PVC) days. We identified 1,789 PVCR-BSIs for an overall rate of 2.41 per 1,000 PVC days. Mortality in patients with PVC but without PVCR-BSI was 6.67%, and mortality was 18% in patients with PVC and PVCR-BSI. The length of stay of patients with PVC but without PVCR-BSI was 4.83 days, and the length of stay was 9.85 days in patients with PVC and PVCR-BSI. Among these infections, the microorganism profile showed 58% gram-negative bacteria: Escherichia coli (16%), Klebsiella spp (11%), Pseudomonas aeruginosa (6%), Enterobacter spp (4%), and others (20%) including Serratia marcescens. Staphylococcus aureus were the predominant gram-positive bacteria (12%).
PVCR-BSI rates in INICC ICUs were much higher than rates published from industrialized countries. Infection prevention programs must be implemented to reduce the incidence of PVCR-BSIs in resource-limited countries.
The fluid dynamics of the collision and coalescence of liquid drops has intrigued scientists and engineers for more than a century owing to its ubiquitousness in nature, e.g. raindrop coalescence, and industrial applications, e.g. breaking of emulsions in the oil and gas industry. The complexity of the underlying dynamics, which includes occurrence of hydrodynamic singularities, has required study of the problem at different scales – macroscopic, mesoscopic and molecular – using stochastic and deterministic methods. In this work, a multi-scale, deterministic method is adopted to simulate the approach, collision, and eventual coalescence of two drops where the drops as well as the ambient fluid are incompressible, Newtonian fluids. The free boundary problem governing the dynamics consists of the Navier–Stokes system and associated initial and boundary conditions that have been augmented to account for the effects of disjoining pressure as the separation between the drops becomes of the order of a few hundred nanometres. This free boundary problem is solved by a Galerkin finite element-based algorithm. The interplay of inertial, viscous, capillary and van der Waals forces on the coalescence dynamics is investigated. It is shown that, in certain situations, because of inertia two drops that are driven together can first bounce before ultimately coalescing. This bounce delays coalescence and can result in the computed value of the film drainage time departing significantly from that predicted from existing scaling theories.
Thinning and rupture of a thin film of a power-law fluid on a solid substrate under the balance between destabilizing van der Waals pressure and stabilizing capillary pressure is analysed. In a power-law fluid, viscosity is not constant but is proportional to the deformation rate raised to the
is the power-law exponent (
for a Newtonian fluid). In the first part of the paper, use is made of the slenderness of the film and the lubrication approximation is applied to the equations of motion to derive a spatially one-dimensional nonlinear evolution equation for film thickness. The variation with time remaining until rupture of the film thickness, the lateral length scale, fluid velocity and viscosity is determined analytically and confirmed by numerical simulations for both line rupture and point rupture. The self-similarity of the numerically computed film profiles in the vicinity of the location where the film thickness is a minimum is demonstrated by rescaling of the transient profiles with the scales deduced from theory. It is then shown that, in contrast to films of Newtonian fluids undergoing rupture for which inertia is always negligible, inertia can become important during thinning of films of power-law fluids in certain situations. The critical conditions for which inertia becomes important and the lubrication approximation is no longer valid are determined analytically. In the second part of the paper, thinning and rupture of thin films of power-law fluids in situations when inertia is important are simulated by solving numerically the spatially two-dimensional, transient Cauchy momentum and continuity equations. It is shown that as such films continue to thin, a change of scaling occurs from a regime in which van der Waals, capillary and viscous forces are important to one where the dominant balance of forces is between van der Waals, capillary and inertial forces while viscous force is negligible.
Coronary artery anomalies are a heterogeneous group of congenital disorders presenting with a wide spectrum of symptoms, ranging from vague chest pain to sudden cardiac death. Despite available data, there is no consensus about the classification, nomenclature, and outcomes of coronary anomalies in the normally connected heart. In this study, we aimed to investigate clinical and angiographic characteristics of coronary arterial anomalies, as well as the frequency of atherosclerotic involvement in anomalous coronaries, diagnosed at a tertiary referral centre.
We retrospectively reviewed coronary angiograms performed between 2011 and 2015 for the presence of a coronary anomaly. A total of 111 patients with a final diagnosis of coronary anomaly were included in the study group. We also recruited 110 age- and sex-matched patients who underwent coronary angiography because of symptomatic coronary artery disease as controls.
Among 36,893 coronary angiograms, 111 (0.30%) major coronary anomalies were found. Compared with controls, the prevalence of significant atherosclerotic coronary disease was lower in patients with coronary anomalies and stable symptoms (p=0.02); however, the prevalence of significant coronary atherosclerosis was similar among patients admitted with unstable angina or myocardial infarction (p>0.05). Compared with controls, patients with an anomalous left anterior descending coronary artery had significantly less atherosclerotic involvement than those in whom the left anterior descending artery was not anomalous (p=0.005).
Although coronary artery anomalies are cited as a cause for myocardial ischaemia, atherosclerotic coronary artery disease is also frequent and may offer an alternative explanation to ischaemic symptoms. No predisposition to accelerated atherosclerosis was found, however, and atherosclerotic involvement was less frequent in some anomalous vessels.
The Royal College of Psychiatrists is considering how best to introduce a post-MRCPsych-examination assessment (‘exit examination’) in anticipation of external pressures to ensure patient safety through the use of such assessments. The Psychiatric Trainees' Committee conducted an online survey to gather the views of psychiatrists regarding the possible format and content of this examination in the hope that this information can be used to design a satisfactory assessment.
Of the 2082 individuals who started the survey, 1735 completed all sections (83.3%). Participants included consultants and trainees from a range of subspecialties. There was general agreement that the content and structure of the exit examination should include assessment of clinical and communication skills.
UK psychiatrists believe that an exit assessment should focus on clinical and communication skills. It should assess both generic and subspecialty-specific competencies and incorporate a mixture of assessment techniques.
Heart failure (HF) is common among long-term care (LTC) residents, and may account for 40 per cent of acute-care transfers. Canadian Cardiovascular Society HF guidelines endorse standard therapies; yet LTC residents are less likely to receive treatment. This qualitative study employed focus groups to explore perceptions, from 18 physicians and nurse practitioners in three Ontario homes, on HF care practices and challenges. For example, participants reported challenges with HF diagnostic skills and procedural knowledge. They also identified the need for interprofessional collaboration and role clarification to improve HF care and outcomes. To address these challenges, multimodal interventions and bedside teaching are required. Leadership was viewed as essential to improve HF care. Several concerns arose regarding knowledge gaps and clinical deficits among primary-care providers who manage heart failure in LTC residents. Multimodal, clinically focused educational and interprofessional solutions are needed to improve HF care in long-term care.
We review clinical, neuroimaging, and genetic information on six individuals with isolated sulfite oxidase deficiency (ISOD).
All patients were examined, and clinical records, biochemistry, neuroimaging, and sulfite oxidase gene (SUOX) sequencing were reviewed.
Data was available on six individuals from four nuclear families affected by ISOD. Each individual began to seize within the first week of life. neurologic development was arrested at brainstem reflexes, and severe microcephaly developed rapidly. neuroimaging within days of birth revealed hypoplasia of the cerebellum and corpus callosum and damage to the supratentorial brain looking like severe hypoxic-ischemic injury that evolved into cystic hemispheric white matter changes. Affected individuals all had elevated urinary S-sulfocysteine and normal urinary xanthine and hypoxanthine levels diagnostic of ISOD. Genetic studies confirmed SUOX mutations in four patients.
ISOD impairs systemic sulfite metabolism, and yet this genetic disease affects only the brain with damage that is commonly confused with the clinical and radiologic features of severe hypoxic-ischemic encephalopathy.
Eighty-two hospitals of 66 cities in 30 countries (Argentina, Brazil, Colombia, Cuba, Dominican Republic, Egypt, Greece, India, Kosovo, Lebanon, Lithuania, Macedonia, Malaysia, Mexico, Morocco, Pakistan, Panama, Peru, Philippines, Poland, Salvador, Saudi Arabia, Serbia, Singapore, Slovakia, Sudan, Thailand, Turkey, Uruguay, and Vietnam) from 4 continents (America, Asia, Africa, and Europe).
Patients undergoing surgical procedures (SPs) from January 2005 to December 2010.
Data were gathered and recorded from patients hospitalized in INICC member hospitals by using the methods and definitions of the Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) for SSI. SPs were classified into 31 types according to International Classification of Diseases, Ninth Revision, criteria.
We gathered data from 7,523 SSIs associated with 260,973 SPs. SSI rates were significantly higher for most SPs in INICC hospitals compared with CDC-NHSN data, including the rates of SSI after hip prosthesis (2.6% vs 1.3%; relative risk [RR], 2.06 [95% confidence interval (CI), 1.8–2.4]; P<.001), coronary bypass with chest and donor incision (4.5% vs 2.9%; RR, 1.52 [95% CI, 1.4–1.6]; P<.001); abdominal hysterectomy (2.7% vs 1.6%; RR, 1.66 [95% CI, 1.4–2.0]; P<.001); exploratory abdominal surgery (4.1 % vs 2.0%; RR, 2.05 [95% CI, 1.6–2.6]; P<.001); ventricular shunt, 12.9% vs 5.6% (RR, 2.3 [95% CI, 1.9–2.6]; P<.001), and others.
SSI rates were higher for most SPs in INICC hospitals compared with CDC-NHSN data.
Long-term field experiments were conducted at Agra, Solapur and Hisar from 2000 to 2008 to identify efficient tillage and nutrient management practices and to develop predictive models that would describe the relationship between crop yields and monthly rainfall for rainfed pearl millet grown on arid and semi-arid Inceptisol, Vertisol and Aridisol soils. Nine treatments comprising a factorial combination of three tillage practices, viz., conventional tillage (CT), low tillage + interculture (LT1) and low tillage + herbicide (LT2) and three fertilizer treatments viz., 100% N from an organic source (F1), 50% organic N + 50% inorganic N (F2) and 100% inorganic N (F3) were tested in a split-plot design at the three locations. Studies revealed that tillage and fertilizer treatments, and their interactions, significantly influenced pearl millet grain yields at the three locations. Prediction models describing the relation between grain yield and monthly rainfall indicated that rainfall occurring in June, July and August at Agra; June and July at Solapur; and June and August at Hisar significantly influenced pearl millet grain yield attained by different treatments. The R2 values of the model ranged from 0.64 to 0.81 at Agra; 0.63 to 0.92 at Solapur, and 0.75 to 0.89 at Hisar. When averaged over all the treatment combinations, mean pearl millet grain yields varied from 1590 to 1744 kg ha−1 at Agra; 1424 to 1786 kg ha−1 at Solapur; and 1675 to 1766 kg ha−1 at Hisar while their corresponding sustainability yield indice (SYI) varied from 35.4 to 42.2%, 19.9 to 45.6% and 64.1 to 68.3%, respectively. At Agra (Inceptisol), CTF3 resulted in significantly higher mean net returns (Rs 11 439 ha−1), benefit-cost ratio (2.33), rainwater use efficiency (RWUE) (3.52 kg ha−1 mm−1) and the second best SYI (39.9%). At Solapur (Vertisol), the LT1F3 resulted in significantly higher net returns (Rs 12 818 ha−1), benefit-cost ratio (3.52), RWUE (3.89 kg ha−1 mm−1) and the fourth best SYI (42.6%). At Hisar (Aridisol), the LT1F3 treatment gave higher net returns (Rs 3866 ha−1), benefit-cost ratio (1.26), RWUE (5.05 kg ha−1 mm−1) and the fourth best SYI (67.8%). These treatment combinations can be recommended for their respective locations to achieve maximum RWUE, productivity and profitability.
Due to its unprecedented scale, the Pakistan flood disaster tested the limits of disaster management and coordination. Under the leadership of the World Health Organization, the Global Health Cluster system for coordinating activities improved collaboration and efficiency in conducing rapid needs assessments. However, the involvement of non-Cluster members was lacking, and information on existing service provision was not collected adequately. The present rapid health needs assessment process under the Cluster system will be discussed, using the recent floods in Pakistan as an example.
The 12-lead electrocardiogram shows a broad range of abnormal patterns in trained athletes. The primary end point of this study was to investigate P wave dispersion, and P wave durations and related factors in different genders applying for registration to the School of Physical Education and Sports.
Methods and Results
From 2006 to 2009, a total of 2093 students – 1674 boys with a mean age of 19.8 plus or minus 1.9 years and 419 girls with a mean age of 19.1 plus or minus 1.8 years – were included in the study. All 12 leads of the resting electrocardiogram were evaluated for P wave dispersion and electrocardiogram abnormalities. Baseline parameters such as age, body weight, body height, and body mass index, as well as electrocardiogram findings such as P wave maximal duration and P wave dispersion, were significantly higher in boys than in girls. Of all the parameters tested with correlation analysis, only gender (p = 0.03) (r = 0.04), body weight (p < 0.001) (r = 0.07), body height (p = 0.004) (r = 0.06), and body mass index (p = 0.01) (p = 0.05) were correlated with P wave dispersion.
The frequencies of all electrocardiogram abnormalities, P wave dispersion, and P wave maximal duration were higher in boys as compared with girls in an unselected student population applying for registration to the School of Physical Education and Sports; in addition, P wave dispersion was correlated with gender, body weight, body height, and body mass index.
The thermal behaviour of a rotating roller, subjected to surface heat sources is studied in this paper using an analytical solution, developed for this purpose. The roller is composed of a solid cylinder, rotating with a constant angular velocity, and is heated at its peripheral surface by two different heat sources. The analytical solution is entirely explicit and does not necessitate any hypothesis neither on the speed nor on the physical or geometrical parameters of the roller. The characteristic parameters are presented in dimensionless forms and are used to analyse the temperature distribution as function of their variations. Thermal maps are also presented using the proposed solution. They show that the thermal gradients are localized at the vicinity of the friction zone, and that the thermal gradients zones decrease when the angular speed increases.
Demonstrating the equivalence of constructs is a key requirement for cross-cultural empirical research. The major purpose of this paper is to demonstrate how to assess measurement and functional equivalence or invariance using the 9-item, 3-factor Love of Money Scale (LOMS, a second-order factor model) and the 4-item, 1-factor Pay Level Satisfaction Scale (PLSS, a first-order factor model) across 29 samples in six continents (N = 5973). In step 1, we tested the configural, metric and scalar invariance of the LOMS and 17 samples achieved measurement invariance. In step 2, we applied the same procedures to the PLSS and nine samples achieved measurement invariance. Five samples (Brazil, China, South Africa, Spain and the USA) passed the measurement invariance criteria for both measures. In step 3, we found that for these two measures, common method variance was non-significant. In step 4, we tested the functional equivalence between the Love of Money Scale and Pay Level Satisfaction Scale. We achieved functional equivalence for these two scales in all five samples. The results of this study suggest the critical importance of evaluating and establishing measurement equivalence in cross-cultural studies. Suggestions for remedying measurement non-equivalence are offered.
In this paper we present the analytical description of two processes
dealing with the skin-layer ponderomotive acceleration method of fast ion
generation by a short laser pulse: ion density rippling in the underdense
plasma region and generation of ion beams by trapped electromagnetic field
in plasma. Some numerical examples of hydrodynamic simulation illustrating
these processes are shown. The effect of using the laser pulse consisting
of different frequency components on the ion density rippling and on
phenomena connected with trapped electromagnetic field is analyzed.
Both influenza and respiratory syncytial virus (RSV) cause epidemics of respiratory illness of variable severity during the winter season. Influenza in particular has been blamed for hospital winter bed pressures, although it is thought that RSV may also play a role. Human metapneumovirus (hMPV) is a new respiratory virus reported to be important in children; only a limited number of studies are available for adult populations. We aimed to determine initially the burden of virologically confirmed infections, i.e. influenza, RSV and hMPV using polymerase chain reaction (PCR) technology and, in addition, to assess the feasibility of this approach as a surveillance tool for these respiratory viruses. Adult patients admitted to hospital in the previous 24 hours with onset of acute respiratory symptoms in the last 14 days were asked to participate. Informed written consent was obtained and nose and throat swabs taken. Multiplex PCR for influenza A (H1N1 and H3N2), influenza B and RSV A and B were carried out together with a separate PCR for hMPV. A total of 219 patients in 2001–2002 and 216 in 2002–2003 were tested and the combined results for both seasons were: 8 positive for influenza A/H1N1, 14 for influenza A/H3N2, 2 for influenza B, 14 for RSV A and 6 for RSV B. Most patients (261/435) were >65 years and most positives (30/44) were found within this age group. A number of patients aged >65 years who were positive for influenza (12/15) reported having had vaccine. In total, 373 samples were tested for hMPV and 20 were found positive across all age groups except the 45–54 years age group. As influenza activity was low during the study period the impact of infection on admissions could not be assessed. Nevertheless the viruses studied accounted for 15% of hospital admissions for respiratory infection. Most patients were aged >65 years, as expected. In the two years studied RSV and hMPV were each responsible for as many hospitalized cases of respiratory infection as influenza. Influenza infection must be considered even in those who give a history of vaccination. The molecular methods used in this study showed that surveillance of these respiratory viruses can be conducted and may help in the management of patients.
Generation of high speed dense plasma blocks is well known from
hydrodynamic theory and computations (PIC) with experimental confirmation
by Badziak et al. (2005) since ps laser
pulses with power above TW are available. These blocks may be used for
fusion flame generation (thermonuclear propagation) in uncompressed solid
state deuterium and tritium for very high gain uncomplicated operation in
power stations. Hydrodynamic theory from computations from the end of
1970s to recent, genuine two fluid computations support the skin layer
accelerations (SLA), by nonlinear (ponderomotive) forces as measured now
in details under the uniquely selected conditions to suppress relativistic
self-focusing by high contrast ratio and to keep plane geometry
interaction. It is shown how the now available PW-ps laser pulses may
provide the very extreme conditions for generating the fusion flames in
solid state density DT.
In this paper the results of numerical computations of rippling
smoothing basing on the broad-band laser irradiation method for the laser
intensity range 1016−1017 W/cm2
and short-pulse (<10 ps) interaction with plasma are described.