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Relapse rates for individuals with anorexia nervosa after intensive hospital treatment (in-patient or full-time day care) are high. Better knowledge about the difficulties and opportunities that arise during this transition is needed to identify factors that support or hinder continued recovery upon discharge.
The aim of this study was to explore the experiences of adult patients and their chosen carers on the process of transitioning from intensive eating disorder treatment settings to the community.
Semi-structured interviews were conducted with patients with anorexia nervosa (n = 11) discharged from day or in-patient care from specialised eating disorder units across the UK, and their chosen carers (n = 20). Data were analysed with inductive thematic analysis.
Four interrelated themes were identified for both groups. For patients, themes were continuity of care, ambivalence about continued recovery, the value of social support and a call for enhanced transition support. For carers, themes were the impact of the eating disorder on themselves and the family, perceptions of recovery and support post-discharge, the impact of previous treatment and care experiences, and desire to create a supportive transition process.
The study provides an insight into the unique challenges that individuals with anorexia nervosa face upon leaving intensive treatment. A lack of post-discharge planning, support system and identity formation outside of anorexia nervosa were perceived as barriers to continued recovery. Patients and carers advocated for transition support that incorporates a phased, inclusive approach with accessible professional and social support in the community.
Strong recommendations have been made for the periodic developmental surveillance, screening, and evaluation of children with CHD. This supports similar calls for all at-risk children in order to provide timely, structured early developmental intervention that may improve outcomes. The aim of this study was to determine the accuracy of screening for language delay after life-saving therapies using the parent-completed vocabulary screen of the language Development Survey, by comparing screening with the individually administered language scores of the Bayley Scales of Infant and Toddler Development, Third edition.
In total, 310 (92.5%) of 335 eligible term-born children, born between 2004 and 2011, receiving complex cardiac surgery, heart or liver transplantation, or extracorporeal membrane oxygenation in infancy, were assessed at 21.5 (2.8) months of age (lost, 25 (7.5%)), through developmental/rehabilitation centres at six sites as part of the Western Canadian Complex Pediatric Therapies Follow-up Group.
Vocabulary screening delay was defined as scores ⩽15th percentile. Language delay defined as scores >1 SD below the mean was calculated for language composite score, receptive and expressive communication scores of the Bayley-III. Delayed scores for the 310 children were as follows: vocabulary, 144 (46.5%); language composite, 125 (40.3%); receptive communication, 98 (31.6%); and expressive communication, 124 (40%). Sensitivity, specificity, positive predictive values, and negative predictive values of screened vocabulary delay for tested language composite delay were 79.2, 75.7, 68.8, and 84.3%, respectively.
High rates of language delay after life-saving therapies are concerning. Although the screening test appears to over-identify language delay relative to the tested Bayley-III, it may be a useful screening tool for early language development leading to earlier referral for intervention.
This paper investigates how childhood socio-economic position influences the risk for midlife depressive and anxiety disorders at 45 years of age, assessed by the Clinical Interview Schedule in 9377 participants of the 1958 British Birth Cohort. Socio-economic position was measured by Registrar General Social Class in childhood and adulthood. The association of paternal manual socio-economic position with any diagnosis at 45 years of age was accounted for after adjustment for adult socio-economic position. Manual socio-economic position in women at 42 years of age was associated with midlife depressive disorder and any diagnosis; these associations were diminished by adjustment for childhood psychological disorders. Effects of childhood socio-economic position on adult depressive disorders may be mediated through adult socio-economic position.
Treatment guidelines identify few adequately powered trials to guide recommendations for anorexia nervosa.
To evaluate the effectiveness of three readily available National Health Service treatments for adolescents (aged 12–18 years) with anorexia nervosa.
Multicentre randomised controlled trial of 167 young people comparing in-patient, specialist out-patient and general child and adolescent mental health service (CAMHS) treatment.
Each group made considerable progress at 1 year, with further improvement by 2 years. Full recovery rates were poor (33% at 2 years, 27% still with anorexia nervosa). Adherence to in-patient treatment was only 50%. Neither in-patient nor specialist out-patient therapy demonstrated advantages over general CAMHS treatment by intention to treat, although some CAMHS out-patients were subsequently admitted on clinical grounds. In-patient treatment (randomised or after out-patient transfer) predicted poor outcomes.
First-line in-patient psychiatric treatment does not provide advantages over out-patient management. Out-patient treatment failures do very poorly on transfer to in-patient facilities.
Aspirin is commonly administered for acute
coronary syndromes in the prehospital setting. Few
studies have addressed the incidence of adverse
effects associated with prehospital administration
of aspirin. Objective: To determine the incidence
of adverse events following the administration of
aspirin by prehospital personnel.
Multi-center, retrospective, case series that
involved all patients who received aspirin in the
prehospital setting from (01 August 1999–31
January 2000). Patient encounter forms of the
emergency medical services (EMS) of a metropolitan
fire department were reviewed. All patients who
had a potential cardiac syndrome (i.e., chest
pain, dyspnea) as documented on the EMS forms were
included in the review. Exclusion criteria
included failure to meet inclusion criteria, and
chest pain secondary to apparent noncardiac causes
(i.e., trauma). Hospital charts were reviewed from
a subset of patients at the participating
hospitals. The major outcome was an adverse event
following prehospital administration of aspirin.
This outcome was evaluated during the EMS
encounter, at emergency department discharge, or
at six and 24-hours post-aspirin ingestion. An
adverse event secondary to aspirin ingestion was
defined as anaphylaxis or allergic reactions, such
as rash or respiratory changes.
A total of 25,600 EMS encounter forms were
reviewed, yielding 2,399 patients with a potential
cardiac syndrome. Prior to EMS arrival, 585
patients had received aspirin, and 893 were
administered aspirin by EMS personnel. No patients
had an adverse event during the EMS encounter. Of
these patients, 229 were transported to
participating hospitals and 219 medical records
were available for review with no adverse
reactions recorded during their hospital
Aspirin is rarely associated with adverse events
when administered by prehospital personnel for
presumed coronary syndromes.
In discussions about the causes of biological diversity, viewpoints have often been grouped into ‘isms’ (neutralism, selectionism, gradualism, punctuationism), and debated as if they were coherent warring parties. This kind of usage seems more political than scientific. Fortunately, the current group of ‘isms’ is disappearing. Experiments prove hypotheses wrong, however passionately their proponents believe in them. The latest approximations to the truth do not often emerge as victories, or even as compromises, but rather as mosaics of old and new.
Vestiges of the ‘isms’ still remain. For example, it has been customary either to argue that evolutionary replacements and polymorphisms are both predominantly driven by selection or that both are predominantly neutral. Yet, as first pointed out by Fisher (1930), most replacements could be driven by selection even if most polymorphisms were neutral (because selected replacements would contribute little to the standing variation). It is worth considering Fisher's argument, which did not allow for many polymorphisms maintained by selection, to see whether it is compatible with current data.
The debates between “neutralists” and “selectionists” were initially about amino acid replacements in evolution. Here it has transpired that the selectionist view was nearer the truth.
XANES (X-ray Absorption Near Edge Spectroscopy) has been employed to evaluate the efficacy of a process designed to encapsulate and reduce TcO4- in cement matrices, thereby immobilizing Tc. The oxidation state of Se following bioremediation of Se by bacteria has also been determined by XANES. The XANES measurements were performed at the Stanford Synchrotron Radiation Laboratory (SSRL) and the National Synchrotron Light Source (NSLS) at the respective K edges of Tc (21.0 keV) and Se (12.7 keV). Comparison of the XANES spectra of Tc in untreated cement to Tc in slag treated cement and to the chemical shifts of reference materials, shows that the oxidation state of Tc is the same in both cements. Thus, the addition of a reducing agent to the cement formulation does not significantly reduce the TcO4-. The common soil bacterium, Bacillus subtilis, is known to incorporate Se on or within the cell wall when exposed to a Se(IV) solution. The Se XANES spectra of B. subtilis, as well as bacillus isolated from selenium rich soil, show that the organisms reduce selenite to the red allotrope of elemental Se.
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