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Although mania is the hallmark symptom of bipolar I disorder (BD-I), most patients initially present for treatment with depressive symptoms. Misdiagnosis of BD-I as major depressive disorder (MDD) is common, potentially resulting in poor outcomes and inappropriate antidepressant monotherapy treatment. Screening patients with depressive symptoms is a practical strategy to help healthcare providers (HCPs) identify when additional assessment for BD-I is warranted. The new 6-item Rapid Mood Screener (RMS) is a pragmatic patient-reported BD-I screening tool that relies on easily understood terminology to screen for manic symptoms and other BD-I features in <2 minutes. The RMS was validated in an observational study in patients with clinically confirmed BD-I (n=67) or MDD (n=72). When 4 or more items were endorsed (“yes”), the sensitivity of the RMS for identifying patients with BP-I was 0.88 and specificity was 0.80; positive and negative predictive values were 0.80 and 0.88, respectively. To more thoroughly understand screening tool use among HCPs, a 10-minute survey was conducted.
A nationwide sample of HCPs (N=200) was selected using multiple HCP panels; HCPs were asked to describe their opinions/current use of screening tools, assess the RMS, and evaluate the RMS versus the widely recognized Mood Disorder Questionnaire (MDQ). Results were reported by grouped specialties (primary care physicians, general nurse practitioners [NPs]/physician assistants [PAs], psychiatrists, and psychiatric NPs/PAs). Included HCPs were in practice <30 years, spent at least 75% of their time in clinical practice, saw at least 10 patients with depression per month, and diagnosed MDD or BD in at least 1 patient per month. Findings were reported using descriptive statistics; statistical significance was reported at the 95% confidence interval.
Among HCPs, 82% used a tool to screen for MDD, while 32% used a tool for BD. Screening tool attributes considered to be of the greatest value included sensitivity (68%), easy to answer questions (66%), specificity (65%), confidence in results (64%), and practicality (62%). Of HCPs familiar with screening tools, 70% thought the RMS was at least somewhat better than other screening tools. Most HCPs were aware of the MDQ (85%), but only 29% reported current use. Most HCPs (81%) preferred the RMS to the MDQ, and the RMS significantly outperformed the MDQ across valued attributes; 76% reported that they were likely to use the RMS to screen new patients with depressive symptoms. A total of 84% said the RMS would have a positive impact on their practice, with 46% saying they would screen more patients for bipolar disorder.
The RMS was viewed positively by HCPs who participated in a brief survey. A large percentage of respondents preferred the RMS over the MDQ and indicated that they would use it in their practice. Collectively, responses indicated that the RMS is likely to have a positive impact on screening behavior.
Approximately 70% of patients with bipolar disorder (BPD) are initially misdiagnosed, resulting in significantly delayed diagnosis of 7–10 years on average. Misdiagnosis and diagnostic delay adversely affect health outcomes and lead to the use of inappropriate treatments. As depressive episodes and symptoms are the predominant symptom presentation in BPD, misdiagnosis as major depressive disorder (MDD) is common. Self-rated screening instruments for BPD exist but their length and reliance on past manic symptoms are barriers to implementation, especially in primary care settings where many of these patients initially present. We developed a brief, pragmatic bipolar I disorder (BPD-I) screening tool that not only screens for manic symptoms but also includes risk factors for BPD-I (eg, age of depression onset) to help clinicians reduce the misdiagnosis of BPD-I as MDD.
Existing questionnaires and risk factors were identified through a targeted literature search; a multidisciplinary panel of experts participated in 2 modified Delphi panels to select concepts thought to differentiate BPD-I from MDD. Individuals with self-reported BPD-I or MDD participated in cognitive debriefing interviews (N=12) to test and refine item wording. A multisite, cross-sectional, observational study was conducted to evaluate the screening tool’s predictive validity. Participants with clinical interview-confirmed diagnoses of BPD-I or MDD completed a draft 10-item screening tool and additional questionnaires/questions. Different combinations of item sets with various item permutations (eg, number of depressive episodes, age of onset) were simultaneously tested. The final combination of items and thresholds was selected based on multiple considerations including clinical validity, optimization of sensitivity and specificity, and pragmatism.
A total of 160 clinical interviews were conducted; 139 patients had clinical interview-confirmed BPD-I (n=67) or MDD (n=72). The screening tool was reduced from 10 to 6 items based on item-level analysis. When 4 items or more were endorsed (yes) in this analysis sample, the sensitivity of this tool for identifying patients with BPD-I was 0.88 and specificity was 0.80; positive and negative predictive values were 0.80 and 0.88, respectively. These properties represent an improvement over the Mood Disorder Questionnaire, while using >50% fewer items.
This new 6-item BPD-I screening tool serves to differentiate BPD-I from MDD in patients with depressive symptoms. Use of this tool can provide real-world guidance to primary care practitioners on whether more comprehensive assessment for BPD-I is warranted. Use of a brief and valid tool provides an opportunity to reduce misdiagnosis, improve treatment selection, and enhance health outcomes in busy clinical practices.
Computer-Assisted Learning Systems (CALSs) have the potential to transform learning by supporting and augmenting students’ ability to accurately monitor and regulate key cognitive, affective, metacognitive, motivational and social processes. Recent advances in the cognitive, learning, computational, and engineering sciences make is possible to significantly augment existing CALSs both as research tools (e.g., examine temporally unfolding self-regulatory processes) as well as instructional tools (e.g., foster metacognitive skills). The goal of this chapter is to present research on self-regulation in CALSs by providing examples from contemporary systems and also how we use multimodal multichannel data (e.g., log files, eye tracking, facial expressions of emotions, physiological sensors, concurrent verbalizations) to examine cognitive, affective, and metacognitive (CAM) self-regulatory processes in these systems. As such, we first provide a brief history of research in SRL with CALSs and discuss how different CALSs have been used to study and foster SRL. We will then present and discuss conceptual and theoretical issues derived from several models, frameworks, and theories of SRL that focus on CAM processes. Following this, we discuss several dichotomies related to CAM and the challenges they pose for the measurement and support of SRL with CALSs. Lastly, we present challenges and future directions that need to be addressed by interdisciplinary researchers to advance the field of SRL and CALSs.
be a field and
a standard graded
-algebra. We denote by
the homology algebra of the Koszul complex on a minimal set of generators of the irrelevant ideal of
. We discuss the relationship between the multiplicative structure of
and the property that
is a Koszul algebra. More generally, we work in the setting of local rings and we show that certain conditions on the multiplicative structure of Koszul homology imply strong homological properties, such as existence of certain Golod homomorphisms, leading to explicit computations of Poincaré series. As an application, we show that the Poincaré series of all finitely generated modules over a stretched Cohen–Macaulay local ring are rational, sharing a common denominator.
Wernicke’s encephalopathy (WE) is a serious neurologic condition resulting from thiamine deficiency. The majority of cases involve alcoholism; however, nonalcohol-associated WE does occur and is under-recognized. We discuss a case of a 22-year-old man with a history of Crohn’s disease who presented to our emergency department with multiple neurologic complaints related to WE.
Single wall carbon nanotubes (SWCNTs) were incorporated into lithium ion battery anodes as conductive additives in mesocarbon microbead (MCMB) composites and as a free-standing support for silicon active materials. In the traditional MCMB composite, 0.5% w/w SWCNTs were used to replace 0.5% w/w SuperP conductive additives. The composite with 0.5% SWCNTs had nearly three times the conductivity which leads to improved electrochemical performance at higher discharge rates with a 20% increase in capacity at greater than a C/2 rate. The thermal stability and safety was measured using differential scanning calorimetry (DSC), and a 35% reduction in exothermic energy released was measured using the highly thermally conductive SWCNTs as an additive. Alternatively, free-standing SWCNT papers were coated with increasing amounts of silicon using a low pressure chemical vapor deposition technique and a silane precursor. Increasing the amount of silicon deposited led to a significant increase in specific capacity (>2000 mAh/g) and coulombic efficiency (>90%). At the highest silicon loading, the surface area of the electrode was reduced by over an order of magnitude which leads to lower solid electrolyte interface formation and improved safety as measured by DSC.
Stroke is one of the leading causes of death worldwide. Currently more than two thirds of the burden of stroke occurs in developing countries. Development of strategies for prevention and management of stroke in these countries requires data on incidence, risk factors and management practices that are relevant to the specific socioeconomic and cultural factors present in these populations. Yet currently available data come almost exclusively from developed countries. Herein, we aim to discuss some of the issues, impediments and opportunities faced by researchers undertaking population-based studies on the burden of stroke in developing countries. Important criteria to be addressed include the establishment of productive working relationships with both local collaborators and the community; the identification of an appropriate population group; and development of a working protocol which takes into account potential language barriers and the need for cultural sensitivity. When possible the protocol should include similar methods to studies conducted elsewhere so that comparisons can be made between regions. Furthermore, the results of such studies should be disseminated in an appropriate and timely manner to the local community and appropriate government and nongovernment organisations. This will enable the development and implementation of prevention and intervention programs to reduce the impact of stroke in these nations.
This paper describes the implementation, merits and future potential of the eCPA – a computer-based Care Programme Approach (CPA) system for care planning. The system is designed to improve the quality of information in CPA care plans and, for the first time, to enable the rapid and standardised adoption of evidence-based good practice by all community mental health team (CMHT) staff.
Early work with size-tunable periodic particle arrays (PPAs) fabricated by nanosphere lithography (NSL) demonstrated that the localized surface plasmon resonance (LSPR) could be tuned throughout the visible region of the spectrum. Further developments of the NSL technique have produced a myriad of nanoparticle configurations. Presented in this paper are several array types and examples of their utility in current applications. Both the sensitivity and tunability of the LSPR have been firmly established using single layer PPAs. Magnetic force microscopy (MFM) has been used to show that double layer PPAs act as single domain magnets and give strong MFM contrast. Angle-resolved NSL has produced nanogap and nano-overlap structures with manipulation resolution of one nanometer. Nanowell structures extend the original twodimensional structure into the third dimension. Exploitation of this flexible, materials-general NSL technique allows for investigation of the catalytic, electrochemical, magnetic, optical and thermodynamic properties of nanoparticles.
For many decades thinness has been a desirable attribute for women in prosperous northern European and American cultures. Over the last 20 years or so the acceptable female shape has become even slimmer (Garner & Garfinkel, 1980). The increased emphasis on thinness among women is also apparent from the rising number of articles on slimming in women's magazines in recent years.
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