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Concerns are recurrently expressed that the therapeutic content of in-patient care is limited and lacking clear guidance. The perspectives of patients and staff regarding therapeutic priorities for psychiatric in-patient care have been little explored and compared.
The aim of this study was to examine patient and staff perspectives on the care priorities of psychiatric in-patients with psychosis.
We recruited 12 in-patients with psychosis and 12 multidisciplinary team staff. All participants undertook a semi-structured interview examining their perspectives on the therapeutic needs of people with psychosis during admission. Interviews were transcribed verbatim and thematic analysis conducted.
Three superordinate themes arose from patient interviews: ‘the importance of considering social circumstances and trauma’, ‘managing the intra- and interpersonal impact of psychosis’ and ‘lack of control and collaboration in care’ and three from staff interviews: ‘multidisciplinary facilitators of care’, ‘treating complexity and incorporating social factors’ and ‘restrictive practices preventing quality care provision’. Comparison of patient and staff themes identified unmet needs in addressing social marginalisation, trauma and distress, and the importance of collaborative treatment process and inclusion of spirituality.
There are gaps between staff and patient perspectives on important priorities for in-patient care that may help explain persistent patient dissatisfaction with in-patient care. Findings suggest the need for coproduced work to develop and test interventions that address broader therapeutic priorities.
To evaluate the long-term safety and tolerability of deutetrabenazine in patients with tardive dyskinesia (TD) at 2years.
In the 12-week ARM-TD and AIM-TD studies, deutetrabenazine showed clinically significant improvements in Abnormal Involuntary Movement Scale scores compared with placebo, and there were low rates of overall adverse events (AEs) and discontinuations associated with deutetrabenazine.
Patients who completed ARM-TD or AIM-TD were included in this open-label, single-arm extension study, in which all patients restarted/started deutetrabenazine 12mg/day, titrating up to a maximum total daily dose of 48mg/day based on dyskinesia control and tolerability. The study comprised a 6-week titration period and a long-term maintenance phase. Safety measures included incidence of AEs, serious AEs (SAEs), and AEs leading to withdrawal, dose reduction, or dose suspension. Exposure-adjusted incidence rates (EAIRs; incidence/patient-years) were used to compare AE frequencies for long-term treatment with those for short-term treatment (ARM-TD and AIM-TD). This analysis reports results up to 2 years (Week106).
343 patients were enrolled (111 patients received placebo in the parent study and 232 received deutetrabenazine). There were 331.4 patient-years of exposure in this analysis. Through Week 106, EAIRs of AEs were comparable to or lower than those observed with short-term deutetrabenazine and placebo, including AEs of interest (akathisia/restlessness [long-term EAIR: 0.02; short-term EAIR range: 0–0.25], anxiety [0.09; 0.13–0.21], depression [0.09; 0.04–0.13], diarrhea [0.06; 0.06–0.34], parkinsonism [0.01; 0–0.08], somnolence/sedation [0.09; 0.06–0.81], and suicidality [0.02; 0–0.13]). The frequency of SAEs (EAIR 0.15) was similar to those observed with short-term placebo (0.33) and deutetrabenazine (range 0.06–0.33) treatment. AEs leading to withdrawal (0.08), dose reduction (0.17), and dose suspension (0.06) were uncommon.
These results confirm the safety outcomes seen in the ARM-TD and AIM-TD parent studies, demonstrating that deutetrabenazine is well tolerated for long-term use in TD patients.
Presented at: American Academy of Neurology Annual Meeting; April 21–27, 2018, Los Angeles, California,USA
Funding Acknowledgements: Funding: This study was supported by Teva Pharmaceuticals, Petach Tikva, Israel
To evaluate long-term efficacy of deutetrabenazine in patients with tardive dyskinesia (TD) by examining response rates from baseline in Abnormal Involuntary Movement Scale (AIMS) scores. Preliminary results of the responder analysis are reported in this analysis.
In the 12-week ARM-TD and AIM-TD studies, the odds of response to deutetrabenazine treatment were higher than the odds of response to placebo at all response levels, and there were low rates of overall adverse events and discontinuations associated with deutetrabenazine.
Patients with TD who completed ARM-TD or AIM-TD were included in this open-label, single-arm extension study, in which all patients restarted/started deutetrabenazine 12mg/day, titrating up to a maximum total daily dose of 48mg/day based on dyskinesia control and tolerability. The study comprised a 6-week titration and a long-term maintenance phase. The cumulative proportion of AIMS responders from baseline was assessed. Response was defined as a percent improvement from baseline for each patient from 10% to 90% in 10% increments. AlMS score was assessed by local site ratings for this analysis.
343 patients enrolled in the extension study (111 patients received placebo in the parent study and 232 patients received deutetrabenazine). At Week 54 (n=145; total daily dose [mean±standard error]: 38.1±0.9mg), 63% of patients receiving deutetrabenazine achieved ≥30% response, 48% of patients achieved ≥50% response, and 26% achieved ≥70% response. At Week 80 (n=66; total daily dose: 38.6±1.1mg), 76% of patients achieved ≥30% response, 59% of patients achieved ≥50% response, and 36% achieved ≥70% response. Treatment was generally well tolerated.
Patients who received long-term treatment with deutetrabenazine achieved response rates higher than those observed in positive short-term studies, indicating clinically meaningful long-term treatment benefit.
Presented at: American Academy of Neurology Annual Meeting; April 21–27, 2018, Los Angeles, California, USA.
Funding Acknowledgements: This study was supported by Teva Pharmaceuticals, Petach Tikva, Israel.
Hospital environmental surfaces are frequently contaminated by microorganisms. However, the causal mechanism of bacterial contamination of the environment as a source of transmission is still debated. This prospective study was performed to characterize the nature of multidrug-resistant organism (MDRO) transmission between the environment and patients using standard microbiological and molecular techniques.
Prospective cohort study at 2 academic medical centers.
A prospective multicenter study to characterize the nature of bacterial transfer events between patients and environmental surfaces in rooms that previously housed patients with 1 of 4 ‘marker’ MDROs: methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Clostridium difficile, and MDR Acinetobacter baumannii. Environmental and patient microbiological samples were obtained on admission into a freshly disinfected inpatient room. Repeat samples from room surfaces and patients were taken on days 3 and 7 and each week the patient stayed in the same room. The bacterial identity, antibiotic susceptibility, and molecular sequences were compared between organisms found in the environment samples and patient sources.
We enrolled 80 patient–room admissions; 9 of these patients (11.3%) were asymptomatically colonized with MDROs at study entry. Hospital room surfaces were contaminated with MDROs despite terminal disinfection in 44 cases (55%). Microbiological Bacterial Transfer events either to the patient, the environment, or both occurred in 12 patient encounters (18.5%) from the microbiologically evaluable cohort.
Microbiological Bacterial Transfer events between patients and the environment were observed in 18.5% of patient encounters and occurred early in the admission. This study suggests that research on prevention methods beyond the standard practice of room disinfection at the end of a patient’s stay is needed to better prevent acquisition of MDROs through the environment.
The solar magnesium II core-to-wing ratio has been a well-studied proxy for chromospheric activity since 1978. Daily measurements at high spectral (0.1 nm) resolution began with the launch of the Solar Radiation and Climate Experiment (SORCE) in 2003. The next generation of measurements from the Extreme Ultraviolet Sensor (EUVS) on the Geostationary Operational Environmental Satellite 16 (GOES-16) will add high time cadence (every 30 seconds) to the observational Mg II irradiance record. We present a comparison of the two measurements during the period of overlap.
Ultraviolet (UV) Solar spectral Irradiance (SSI) has been measured from orbit on a regular basis since the beginning of the space age. These observations span four Solar Cycles, and they are crucial for our understanding of the Sun-Earth connection and space weather. SSI at these wavelengths are the main drivers for the upper atmosphere including the production and destruction of ozone in the stratosphere. The instruments that measure UV SSI not only require good preflight calibration, but also need a robust method to maintain that calibration on orbit. We will give an overview of the catalog of current and former UV SSI measurements along with the calibration philosophy of each instrument and an estimation of the uncertainties in the published irradiances.
Early career investigators have few opportunities for targeted training in supportive oncology research. To address this need, we developed, implemented, and evaluated an intensive, six-day workshop on methods in supportive oncology research for trainees and junior faculty across multiple disciplines.
A multidisciplinary team of supportive oncology researchers developed a workshop patterned after the clinical trials workshop offered jointly by the American Society of Clinical Oncology and American Association of Cancer Research. The curriculum included lectures and a mentored experience of writing a research protocol. Each year since 2015, the workshop has accepted and trained 36 early career investigators. Over the course of the workshop, participants present sections of their research protocols daily in small groups led by senior researchers, and have dedicated time to write and revise these sections. Primary outcomes for the workshop included the frequency of completed protocols by the end of the workshop, a pre- and posttest assessing participant knowledge, and follow-up surveys of the participants and their primary mentors.
Over three years, the workshop received 195 applications; 109 early career researchers were competitively selected to participate. All participants (109/109, 100%) completed writing a protocol by the end of their workshop. Participants and their primary mentors reported significant improvements in their research knowledge and skills. Each year, participants rated the workshop highly in terms of satisfaction, value, and likelihood of recommending it to a colleague. One year after the first workshop, most respondents (29/30, 96.7%) had either submitted their protocol or written at least one other protocol.
Significance of results
We developed a workshop on research methods in supportive oncology. More early career investigators applied for the workshop than capacity, and the workshop was fully attended each year. Both the workshop participants and their primary mentors reported improvement in research skills and knowledge.
Marx holds that capitalism is exploitative, but not unjust. Kant crafted a theory of right that explains why human beings are treated unjustly when the social system deprives them of the conditions of a free life. This essay attempts to relate Kant’s and Marx’s views to one another and to the capitalist social system, which these two thinkers studied at different stages of development. The economic and social theories of Fichte and Hegel are also employed to help make sense of the points of agreement and of disagreement between Kant and Marx concerning the ways modern capitalism deprives workers of freedom and whether this deprivation should be condemned as unjust.
Raw materials used in feed manufacture are contaminated with high (>104 cfu/g) levels of enterobacteriaceae indicating the potential for contamination with pathogenic bacteria such as salmonella (Wood et al. 2001). There is urgent need to reduce the contamination of animal feed with zoonoses such as salmonella and campylobacter. During manufacture of feedingstuffs, heat and moisture are used to process and sterilise feed but this can also provide conditions for microbial growth. High temperature treatment used to sterilise feed will not protect feedingstuffs from recontamination, if residual microbial contamination remains in the feed mill. It is essential to understand the influence of feed processing and the feed mill environment on the microbial contamination of feed.
Bacteria belonging to the family Enterobacteriaceae enter the animal feed chain as normal contaminants of raw materials used in the manufacture of animal feeds. The family Enterobacteriaceae encompasses 30 established genera, including Salmonella spp, Escherichia spp, Shigella spp and Yersinia spp. Many of the genera exhibit pathogenicity towards man, animals, insects and plants and many of the pathogenic forms produce toxins. A number of the genera in this family occur regularly in association with animals; they are found as indigenous members of the gut microflora where they may either produce no harmful effects, or are capable of causing disease in both endothermic and ectothermic animals. There is a recognised association between the risk of isolation of salmonella and degree of Enterobacteriaceae contamination (Veldman et al. 1995). This has led to the consideration of recording Enterobacteriaceae contamination levels in feed stuffs as an indicator of feed hygiene and potential limits to the degree of contamination being set by the major retailers. This paper sets out data gathered from the routine analysis of feed raw materials examined for Enterobacteriaceae contamination.
Persistent pain is common and inadequately treated in cancer patients. Behavioral pain interventions are a recommended part of multimodal pain treatments, but they are underused in clinical care due to barriers such as a lack of the resources needed to deliver them in person and difficulties coordinating their use with clinical care. Pain coping skills training (PCST) is an evidence-based behavioral pain intervention traditionally delivered in person. Delivering this training via the web would increase access to it by addressing barriers that currently limit its use. We conducted a patient pilot study of an 8-week web-based PCST program to determine the acceptability of this approach to patients and the program features needed to meet their needs. Focus groups with healthcare providers identified strategies for coordinating the use of web-based PCST in clinical care.
Participants included 7 adults with bone pain due to multiple myeloma or metastasized breast or prostate cancer and 12 healthcare providers (4 physicians and 8 advanced practice providers) who treat cancer-related bone pain. Patients completed web-based PCST at home and then took part in an in-depth qualitative interview. Providers attended focus groups led by a trained moderator. Qualitative analyses identified themes in the patient and provider data.
Patients reported strongly favorable responses to web-based PCST and described emotional and physical benefits. They offered suggestions for adapting the approach to better fit their needs and to overcome barriers to completion. Focus groups indicated a need to familiarize healthcare providers with PCST and to address concerns about overburdening patients. Providers would recommend the program to patients they felt could benefit. They suggested applying a broad definition of cancer pain and having various types of providers help coordinate program its use with clinical care.
Significance of results:
Web-based PCST was acceptable to patients and providers. Our findings suggest that patients could benefit from this approach, especially if patient and provider barriers are addressed.
Skeletal remains from a burial in New South Wales exhibit evidence of fatal
trauma, of a kind normally indicative of sharp metal weapons, yet the burial
dates to the mid thirteenth century—600 years before European settlers
reached the area. Could sharp-edged wooden weapons from traditional
Aboriginal culture inflict injuries similar to those resulting from later,
metal blades? Analysis indicates that the wooden weapons known as
‘Lil-lils’ and the fighting boomerangs
(‘Wonna’) both have blades that could fit within the
dimensions of the major trauma and are capable of having caused the fatal
Flickering is a well-known, though poorly understood, signature of accretion in cataclysmic variables. HT Cas is an excellent system in which to study flickering because its well determined characteristics allow a calibration of the experimental system (see Horne et al. 1991).
Patterson (1981) argues that the flickering in HT Cas originates from regions very near the white dwarf. In U Gem, the flickering appears to be associated with the bright spot (Warner & Nather 1971). In RW Tri, the flickering occurs throughout the disk but is centrally concentrated (Horne & Stiening 1985); the same holds true for V2051 Oph (Warner & Cropper 1983).
HT Cas is a 16m.4 eclipsing dwarf nova with a binary period of 106 min and an inclination of ∼ 81°. The entire eclipse last about 15 min with the white dwarf totally eclipsed for ∼ 5 min. The mass ratio is 0.15 with the white dwarf having mass ∼ 0.6M⊙ (Horne et al. 1991).
We obtained 20 eclipses of HT Cas between 1982 and 1991 in U, B and V at Mt. Palomar and also McDonald Observatory with 0.5 – 2 sec integrations. These data were folded on the ephemeris given by Horne et al. (1991) and corrected for the 30 sec drift in the phasing as noted by Wood et al. (1995).
Higher education institutions have an unavoidable responsibility to address the looming economic, environmental and social crises imperilling humans and ecosystems by placing ‘education for sustainability’ at the heart of their concerns. Yet, for over three decades, the practice of ‘higher education for sustainability’ (HEfS) has encountered significant barriers to implementation, begging the question as to why. Drawing on a diverse, interdisciplinary literature, we identify four structural impediments to implementing HEfS: (1) disciplinary contestation, which creates confusion over what ‘sustainability’ means; (2) institutional fragmentation, which prevents the interdisciplinary dialogue that sustainability demands; (3) economic globalisation, which transforms higher education into just another market opportunity; and (4) ‘fast and frugal’ habits of reasoning, which steer time-pressed academics towards poorly integrated decisions and unsustainable positions. Our analysis highlights that wider structural change within and beyond the academy will be required if higher education institutions are to meet their responsibilities and drive the necessary social transformation.