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Background: To describe preliminary results of a multi-center, randomized, blinded, placebo-controlled, pilot trial of shunt surgery in idiopathic normal pressure hydrocephalus (iNPH). Methods: Five sites of the Adult Hydrocephalus Clinical Research Network (AHCRN) randomized 18 patients scheduled for ventriculoperitoneal shunting based on CSF-drainage response. Patients were randomized to a Codman® Certas® Plus valve with SiphonGuard at either setting 4 (Active, N=9) or setting 8/”virtual off” (Placebo, N=9). Patients and assessors were blinded to the shunt setting. Outcomes included 10-meter gait velocity, cognitive function, and bladder activity scores. The prespecified primary analysis compared changes in 4-month gait velocity in the Active versus Placebo groups. Placebo-set shunts were then blindly adjusted to the active setting and all patients underwent 8 and 12-month post-surgical assessment. Results: At 4-months, gait velocity increased by 0.28±0.28m/s in the Active Group and 0.04±0.17m/s in the Placebo Group (p=0.071). Overactive Bladder (OAB-q) scores significantly improved in the Active versus Placebo groups (p=0.007). At 8 months, Placebo gait velocity increased by 0.36±0.27m/s and was comparable to the Active Group (0.40±0.20m/s; p=0.56). Conclusions: This AHCRN study shows a trend suggesting gait velocity improves more at an Active shunt setting than a Placebo shunt setting and demonstrates the feasibility of a placebo-controlled trial in iNPH.
The entire family is affected when a parent is severely ill. Parents often need and appreciate professional support when talking to children about illness and death. The family talk intervention (FTI) is family-centered and intends to promote communication about the illness and its consequences, support parenting to enhance family coping and help family members share experiences with each other to create a shared family history. This study aimed to explore potential effects of FTI in specialized palliative home care, as reported by parents.
This pre-post test intervention pilot was conducted in specialized palliative home care. A convergent mixed-method design was used to analyze interview and questionnaire data. Twenty families with dependent children were recruited from two specialized palliative home care units in Stockholm, Sweden.
Parents reported that family communication improved after participation in FTI as family members learned communication strategies that facilitated open sharing of thoughts and feelings. Increased open communication helped family members gain a better understanding of each other's perspectives. Parents reported that relationships with their partner and children had improved as they now shared several strategies for maintaining family relationships. Parents were also less worried following participation in FTI. The ill parents stated that they gained a sense of security and were less worried about the future.
Significance of results
This study adds to the evidence that FTI may be a useful intervention for families with dependent children and an ill parent in a palliative care setting. This trial is registered at ClinicalTrials.gov Identifier NCT03119545.
The objective of this study was to design and evaluate new means of complying to time constraints by presenting aircraft target taxi speeds on a head-up display (HUD). Four different HUD presentations were iteratively developed from paper sketches into digital prototypes. Each HUD presentation reflected different levels of information presentation. A subsequent evaluation included 32 pilots, with varying flight experience, in usability tests. The participants subjectively assessed which information was most useful to comply with time constraints. The assessment was based on six themes including information, workload, situational awareness, stress, support and usability. The evaluation consisted of computer-simulated taxi-runs, self-assessments and statistical analysis. Information provided by a graphical vertical tape descriptive/predictive HUD presentation, including alpha-numerical information redundancy, was rated most useful. Differences between novice and expert pilots can be resolved by incorporating combinations of graphics and alpha-numeric presentations. The findings can be applied for further studies of combining navigational and time-keeping HUD support during taxi.
Protecting tropical forests from deforestation is important for mitigating both biodiversity loss and anthropogenic climate change. In Amazonia, a common approach to protected area (PA) impact studies has been to investigate differences among broad PA categories, such as strictly protected, sustainable use and indigenous areas, yet these may be insufficient for the management of PAs at local scales. We used a matching method to compare impacts and carbon emissions avoided during 2011–2016 of individual PAs in the state of Acre (Brazil). Although most PAs had a positive impact and effectively prevented forest loss, we observed substantial variation among them in terms of impacts, pressures and emissions during our study period. The impacts varied from 3.6% avoided to 15.6% induced forest loss compared to expected levels of deforestation estimated for each PA using the matching method. All but a few PAs helped avoid substantial amounts of emissions. Our results emphasize the need for more PA impact studies that compare multiple PAs at the individual level in Amazonia and beyond.
Non-communicable chronic diseases (NCCDs) are the main cause of morbidity and mortality globally. Demographic aging has resulted in older populations with more complex healthcare needs. This necessitates a multilevel rethinking of healthcare policies, health education and community support systems with digitalization of technologies playing a central role. The European Innovation Partnership on Active and Healthy Aging (A3) working group focuses on well-being for older adults, with an emphasis on quality of life and healthy aging. A subgroup of A3, including multidisciplinary stakeholders in health care across Europe, focuses on the palliative care (PC) model as a paradigm to be modified to meet the needs of older persons with NCCDs. This development paper delineates the key parameters we identified as critical in creating a public health model of PC directed to the needs of persons with NCCDs. This paradigm shift should affect horizontal components of public health models. Furthermore, our model includes vertical components often neglected, such as nutrition, resilience, well-being and leisure activities. The main enablers identified are information and communication technologies, education and training programs, communities of compassion, twinning activities, promoting research and increasing awareness amongst policymakers. We also identified key ‘bottlenecks’: inequity of access, insufficient research, inadequate development of advance care planning and a lack of co-creation of relevant technologies and shared decision-making. Rethinking PC within a public health context must focus on developing policies, training and technologies to enhance person-centered quality life for those with NCCD, while ensuring that they and those important to them experience death with dignity.
One of the main goals of the Family Talk Intervention (FTI) is to increase communication within families with dependent children about illness-related consequences and to support parenting. FTI is family-centered and includes six manual-based meetings led by two interventionists. This study aims to evaluate the feasibility of the FTI in terms of acceptability from the perspective of parents in families with dependent children where one parent receives specialized palliative home care.
A descriptive design employing mixed methods was used to evaluate the FTI in specialized palliative home care. In total, 29 parents participated in interviews and responded to a questionnaire following FTI. Qualitative content analysis and descriptive statistics were used for analyses.
FTI responded to both the ill parent's and the healthy co-parent's expectations, and they recommended FTI to other families. Parents found the design of FTI to be well-structured and flexible according to their families’ needs. Many parents reported a wish for additional meetings and would have wanted FTI to start earlier in the disease trajectory. Parents also would have wished for a more thorough briefing with the interventionists to prepare before the start. The importance of the interventionists was acknowledged by the parents; their professional competence, engagement, and support were vital for finding ways to open communication within the family. The FTI meetings provided them with a setting to share thoughts and views. Parents clearly expressed that they would never have shared thoughts and feelings in a similar way without the meetings.
Significance of results
According to parents, FTI was found acceptable in a palliative home care context with the potential to add valuable support for families with minor children when a parent is suffering from a life-threatening illness.
Changes in the ward atmosphere of a psychiatric work rehabilitation unit were investigated. Both trainees and staff filled in the Community-Oriented Programs Environment Scale (COPES) before and after a new rehabilitation model was implemented. It was hypothesised that the levels of autonomy and practical orientation would increase from both the trainees’ and staff’s perspective concerning the real ward atmosphere and that the staff’s perceptions of an ideal ward atmosphere would change in the same way. The staff perceived an increased level of autonomy with respect to both the real ward atmosphere and to what constitutes an ideal ward atmosphere, which partly confirmed the hypotheses, but the level of practical orientation was stable. Concerning the staff’s estimate of an ideal ward atmosphere, further changes were an increased level of involvement and a decrease in spontaneity, which was not hypothesised, but was not in conflict with the philosophy behind the new model. From the trainee’s perspective there was no change of either autonomy or practical orientation. Instead, there was a decrease in personal problem orientation. Compared to an optimal profile, the ward atmosphere was beneficial, before as well as after implementation of the new programme. Differences were found between the staff and the trainees, but they were not large enough to separate the groups according to what is considered an optimal profile. The few changes found support earlier conclusions that the ward atmosphere is a stable phenomenon over time.
Research findings that link personality factors to functioning and symptoms in schizophrenia are inconsistent, and further studies are needed within the area. The purpose of this study was to investigate how personality, as measured by the Temperament and Character Inventory (TCI), was related to demographic factors, subtypes of diagnoses, level of functioning, and aspects of psychological health, including sense of coherence, perceived control, and self-esteem, among people with schizophrenia. Subjects were 104 individuals, aged 20–55 years, in psychiatric outpatient care. The results indicated that personality was not related to subtypes of diagnoses or demographic characteristics of the respondents, but to level of functioning and all aspects of psychological health. Especially self-directedness distinguished three groups of functioning and was highly correlated with the different aspects of psychological health. The article discusses how knowledge of schizophrenic patients’ personality structure might be used for tailoring psychiatric treatments.
ADHD in childhood is associated with development of negative psychosocial and behavioural outcomes in adults. Yet, relatively little is known about which childhood and adulthood factors are predictive of these outcomes and could be targets for effective interventions. To date follow-up studies have largely used clinical samples from the United States with children ascertained at baseline using broad criteria for ADHD including all clinical subtypes or the use of DSM III criteria.
To identify child and adult predictors of comorbid and psychosocial comorbid outcomes in ADHD in a UK sample of children with DSM-IV combined type ADHD.
One hundred and eighteen adolescents and young adults diagnosed with DSM-IV combined type ADHD in childhood were followed for an average of 6 years. Comorbid mental health problems, drug and alcohol use and police contact were compared for those with persistent ADHD, sub-threshold ADHD and population norms taken from the Adult Psychiatric Morbidity Study 2007. Predictors included ADHD symptomology and gender.
Persistent ADHD was associated with greater levels of anger, fatigue, sleep problems and anxiety compared to sub-threshold ADHD. Comorbid mental health problems were predicted by current symptoms of hyperactivity-impulsivity, but not by childhood ADHD severity. Both persistent and sub-threshold ADHD was associated with higher levels of drug use and police contact compared to population norms.
Young adults with a childhood diagnosis of ADHD showed increased rates of comorbid mental health problems, which were predicted by current levels of ADHD symptoms. This suggests the importance of the continuing treatment of ADHD throughout the transitional years and into adulthood. Drug use and police contact were more common in ADHD but were not predicted by ADHD severity in this sample.
The phase evolution of reactive radio frequency (RF) magnetron sputtered Cr0.28Zr0.10O0.61 coatings has been studied by in situ synchrotron X-ray diffraction during annealing under air atmosphere and vacuum. The annealing in vacuum shows t-ZrO2 formation starting at ∼750–800 °C, followed by decomposition of the α-Cr2O3 structure in conjunction with bcc-Cr formation, starting at ∼950 °C. The resulting coating after annealing to 1140 °C is a mixture of t-ZrO2, m-ZrO2, and bcc-Cr. The air-annealed sample shows t-ZrO2 formation starting at ∼750 °C. The resulting coating after annealing to 975 °C is a mixture of t-ZrO2 and α-Cr2O3 (with dissolved Zr). The microstructure coarsened slightly during annealing, but the mechanical properties are maintained, with no detectable bcc-Cr formation. A larger t-ZrO2 fraction compared with α-Cr2O3 is observed in the vacuum-annealed coating compared with the air-annealed coating at 975 °C. The results indicate that the studied pseudo-binary oxide is more stable in air atmosphere than in vacuum.
The aim of this study was to examine (a) the development of vocabulary and grammar in children with family-risk (FR) of dyslexia and their peers with no such risk (NoFR) between ages 1;6 and 6;0, and (b) whether FR-status exerted an effect on the direction of temporal relationships between these two constructs. Groups were assessed at seven time-points using standardised tests and parental reports. Results indicated that although FR and NoFR children had a similar development in the earlier years, the FR group appeared to perform significantly more poorly on vocabulary at the end of the preschool period. Results showed no significant effect of FR status on the cross-lagged relations between lexical and grammatical skills, suggesting a similar developmental pattern of cross-domain relations in both groups. However, FR status seemed to have a significantly negative association with vocabulary and grammar scores at age 6;0, resulting in language outcomes in favour of NoFR children.
Coupled with the social practice of female hypergamy, the male surplus within the never-married population means that today's Chinese marriage market is extremely tight in particular for men from a rural background and the least privileged socio-economic categories. Drawing on quantitative data from a survey conducted in 2014–2015, this article sheds light on the situation of single men who are past prime marriage age in three rural districts of Shaanxi particularly affected by this phenomenon. It compares single men's characteristics to those of their married counterparts and offers insights into the heterogeneity of single men with the aim of challenging some commonly accepted assumptions about bachelorhood in rural China. Results suggest a strong internalization of the various characteristics, centred on being able to offer social mobility to a potential wife, that a man is expected to have to be attractive to women in a context where women have more choice in mate selection. We conclude that mate selection is highly marked by class, social norms, social interactions, health, generation and age, and requires the mobilization of certain amounts of individual, social and economic resources. Unwanted bachelorhood would thus be better understood using an intersectional approach rather than mainly in numeric terms.
E. J. Lowe has defended a modal ontological argument that draws upon Plantinga's version. Briefly, the argument is this: God is a necessary being; possibly, God exists; hence, God exists. In this article, I accept the validity of Lowe's modal ontological argument and focus on how he seeks to justify the argument's possibility claim in reference to his essence-based account of modal knowledge. I argue that here Lowe's defence fails. I have two complaints. I call them ‘the modified “perfect island” objection’ and ‘the conflicting possibilities objection’. Both of these refer to the concern that Lowe's modal epistemology is too permissive: it permits justification of possibility claims that question the acceptability of the underlying modal epistemology.
EU law – Investigating the displacement of Social Europe at moments of EU enlargement – Sweden as an example of how Social Europe can be displaced – Enlargement of 1995 and austerity policy – Enlargement of 2004 and posted workers – Enlargement of 2007 and ‘vulnerable’ EU-migrants
Recent proliferation of surveillance systems is mostly attributed to advances in both image-processing techniques and hardware enhancement of smart cameras, as well as the ubiquity of sensor-driven architectures. Owing to these capabilities, new aspects are coming to the forefront. This paper addresses the current state-of-the-art and provides researchers with an overview of existing surveillance solutions, analyzing their properties as a system and drawing attention to relevant challenges when developing, deploying and managing them. Also, some of the more prominent application domains are highlighted here. In an effort to understand the development of the advanced solutions, based on their most distinctive characteristics, we propose a taxonomy for surveillance systems to help classify them and reveal gaps in existing research. We conclude by identifying promising future research lines.
Many adults with autism spectrum disorder (ASD) remain undiagnosed. Specialist assessment clinics enable the detection of these cases, but such services are often overstretched. It has been proposed that unnecessary referrals to these services could be reduced by prioritizing individuals who score highly on the Autism-Spectrum Quotient (AQ), a self-report questionnaire measure of autistic traits. However, the ability of the AQ to predict who will go on to receive a diagnosis of ASD in adults is unclear.
We studied 476 adults, seen consecutively at a national ASD diagnostic referral service for suspected ASD. We tested AQ scores as predictors of ASD diagnosis made by expert clinicians according to International Classification of Diseases (ICD)-10 criteria, informed by the Autism Diagnostic Observation Schedule-Generic (ADOS-G) and Autism Diagnostic Interview-Revised (ADI-R) assessments.
Of the participants, 73% received a clinical diagnosis of ASD. Self-report AQ scores did not significantly predict receipt of a diagnosis. While AQ scores provided high sensitivity of 0.77 [95% confidence interval (CI) 0.72–0.82] and positive predictive value of 0.76 (95% CI 0.70–0.80), the specificity of 0.29 (95% CI 0.20–0.38) and negative predictive value of 0.36 (95% CI 0.22–0.40) were low. Thus, 64% of those who scored below the AQ cut-off were ‘false negatives’ who did in fact have ASD. Co-morbidity data revealed that generalized anxiety disorder may ‘mimic’ ASD and inflate AQ scores, leading to false positives.
The AQ's utility for screening referrals was limited in this sample. Recommendations supporting the AQ's role in the assessment of adult ASD, e.g. UK NICE guidelines, may need to be reconsidered.