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Regarding the patient clientele with main diagnosis (MD) F19.*[ICD 10] new needs have been seen to emerge. The increase in the number of consumers of N-methylamphetamine (by 29 % in 2011) in Saxony correlates with an impressive increase of the number of inpatients and emphasizes the need of adapted treatment offers.
In this context, in 2009 an open-door ward (8 beds) for detoxification and motivation treatment for adults at age between 18-40 years with MD F19.* was opened which pursues an integrative therapeutic concept including both addiction-specific group- and talking therapy orientation and behavioral therapy approaches.
By using a pre-post study (pre: 2008, post I: 2010, post II: 2011, post III: 2012) selected key figures such as length of stay, readmission rate and kind of discharge, trends in individual substance-related detoxification motivation and associated mental disorders (F19.5) were monitored.
A continuous growing number of patients with MD F19.* has been achieved, marked by an increase of treated cases (pre: 77, post III: 156) and planned admissions (pre: 58 %, post III: 72%). Other data (length of stay, readmissions, treatment discontinuations) showed no significant changes. Individual detoxification motivation data point to a trend in favour of N-methylamphetamine. The number of patients with MD F19.5 (psychotic disorder) increased by >100 %.
The results refer to the necessity of identifying and monitoring valid quality indicators regarding our treatment concept. Therefore, those as yet evaluated indicators may act as a preliminary basis. Further projects are planned.
Detoxification treatment of adults at younger ages suffering from polysubstance dependence on our department pursues an integrative therapeutic concept. In addition to addiction-specific, topic-centred group and talk therapy orientation also behavioural therapy elements are included: a penalty points system provides negative sign stimuli for undesirable behaviour.
Since 2010, both rate of psychotic disorders and number of N-methylamphetamine consumers (P < 0.001) have been growing impressively while the proportion of repeated admissions amounted to > 55%. Dissatisfying trends were identified by longitudinal measurement, e.g. regarding ALOS, kind of discharge, bed occupancy.
Targeted changes in treatment were established in the 2nd half of 2014. In particular, the penalty point system was adapted towards less restrictive rules, combined with slightly reduced therapeutic intensity in order to come better on the disorder-related needs of the patients. Staffing level and structure remained stable.
Key figures including quality criteria and performance data such as LOS, kind of admission and discharge, service intensity, and bed occupancy were evaluated by a pre-post study (pre: 1st half of 2014, N = 76/post: 1st half of 2015, N = 77) using descriptive and test statistics.
Socio-demographic patient data remained stable. Regarding selected key figures there were significant changes (LOS > 21 days: P < 0.05; bed occupancy: P < 0.001; therapeutic contacts < 25 min: P < 0.001) and positive trends, e.g. decreased ratio of non-regular discharges.
Our data suggest that punishment-oriented interventions impede addressing specific needs of inpatients with multiple substance use whereas more need-oriented interventions may lead to improvements. Further evaluation including patient satisfaction is indispensable.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
A cadmium chloride activation treatment is essential for the production of high efficiency cadmium telluride (CdTe) solar cells. However, the effects of the treatment on the distributions of chlorine and sulphur within the device are not fully understood. Here, the detailed locations of chlorine and sulphur in a treated CdTe cell are determined in three dimensions by high resolution dynamic SIMS measurements. Chlorine is found to be present in grain boundaries, grain interiors, extended defects within the grain interiors, at the front interface, and in the cadmium sulphide layer. In each of these regions, the chlorine is likely to have significant effects on local electronic properties of the material, and hence overall device performance. Sulphur is found to have a U-shaped diffusion profile within CdTe grains, indicating a mixed grain boundary and lattice diffusion regime.
To summarize the available evidence on the effectiveness of psychological interventions for patients with post-traumatic stress disorder (PTSD).
We searched bibliographic databases and reference lists of relevant systematic reviews and meta-analyses for randomized controlled trials that compared specific psychological interventions for adults with PTSD symptoms either head-to-head or against control interventions using non-specific intervention components, or against wait-list control. Two investigators independently extracted the data and assessed trial characteristics.
The analyses included 4190 patients in 66 trials. An initial network meta-analysis showed large effect sizes (ESs) for all specific psychological interventions (ESs between −1.10 and −1.37) and moderate effects of psychological interventions that were used to control for non-specific intervention effects (ESs −0.58 and −0.62). ES differences between various types of specific psychological interventions were absent to small (ES differences between 0.00 and 0.27). Considerable between-trial heterogeneity occurred (τ2 = 0.30). Stratified analyses revealed that trials that adhered to DSM-III/IV criteria for PTSD were associated with larger ESs. However, considerable heterogeneity remained. Heterogeneity was reduced in trials with adequate concealment of allocation and in large-sized trials. We found evidence for small-study bias.
Our findings show that patients with a formal diagnosis of PTSD and those with subclinical PTSD symptoms benefit from different psychological interventions. We did not identify any intervention that was consistently superior to other specific psychological interventions. However, the robustness of evidence varies considerably between different psychological interventions for PTSD, with most robust evidence for cognitive behavioral and exposure therapies.
The diagnosis of hyperandrogenism is dependent on the accuracy and precision of measurement of the clinical features and the laboratory androgen assays. Hyperandrogenism in the context of polycystic ovary syndrome (PCOS) is a term used loosely to encompass both the clinical features of acne, hirsuties and androgenic alopecia and the laboratory evidence of hyperandrogenaemia. The relationship between acne and biochemical hyperandrogenaemia is well established but the number of women with acne in unselected populations is so great that it makes the link with PCOS unconvincing, particularly since the incidence of acne seems to be greater than that of PCOS. Anovulation is assessed by measuring the serum progesterone during the mid-luteal phase. Consecutive series of women with either a single symptom or various combinations of symptoms would be subjected to formal receiver operating characteristic (ROC) analysis to determine the optimal diagnostic characteristics.
In May 1980 an extensive outbreak of gastroenteritis occurred in a private school in the city of Rio de Janeiro. Examination of faeces and paired sera showed that this outbreak was caused by both rotavirus and a virulent strain of Shigella sonnei. In the first 19 stool samples collected seven (37%) had rotavirus only, six (32%) had Sh. sonnei only, while four (21 %) had both agents. Examination of the second and third stool collections revealed only the presence of Sh. sonnei. The 18 paired sera showed seroconversion for rotavirus in four cases (22%) and in seven cases (39 %) for Sh. sonnei. The overall attack rate of the disease was approximately 75 %, the nursery and kindergarten having higher attack rates. Students in all grades became sick at the same time, and the unimodal curve of the onset dates of symptoms indicates a common source outbreak. Evidence suggested a contaminated water supply.
We present the analysis of Hubble Space Telescope blue spectra at intermediate spectral resolution for the nuclei of 23 nearby disk galaxies. These objects were selected to have nebular emission in their nuclei, and span a range of emission-line classifications as well as Hubble types. Here we focus on the stellar population as revealed by the continuum spectral energy distribution measured within the central 0.″13 (∼8 pc) of these galaxies. The data were modeled with linear combinations of single-age stellar population synthesis models. The large majority (∼80%) of the surveyed nuclei have spectra whose features are consistent with a predominantly old ($\gtrsim 5 \times 10^9$ yr) stellar population. Approximately 25% of these nuclei show evidence of a component with age younger than 1 Gyr, with the incidence of these stars related to the nebular classification. Successful model fits imply an average reddening corresponding to AV∼0.4 mag and stellar metallicity of (1–2.5)$Z_\odot$. Our findings reinforce the picture wherein Seyfert nuclei and the majority of low-ionization nuclear emission-line regions (LINERs) are predominantly accretion-powered, and suggest that much of the central star formation in HII nuclei is actually circumnuclear.To search for other articles by the author(s) go to: http://adsabs.harvard.edu/abstract_service.html
The actual situation with respect to the use of an RF linac driver
for heavy ion inertial fusion (HIF) is discussed. At present, there is
no high current heavy ion linac under construction. However, in the
course of linac projects for e−, p, d, or highly
charged ions several developments were made, which may have some impact
on the design of a HIF driver. Medium- and low-β superconducting
structures suited for pulsed high current beam operation are actually
designed and investigated at several laboratories. A superconducting 40
MeV, 125 mA cw linac for deuteron acceleration is designed for the
Inertial Fusion Material Irradiation Facility (IFMIF). The Institute
for Applied Physics (IAP) is developing a superconducting 350-MHz,
19-cell prototype CH-cavity for β = 0.1. The prototype cavity will
be ready for tests in 2004. A superconducting main HIF driver linac
would considerably reduce the power losses. Moreover, it would allow
for an efficient linac operation at a higher duty factor.
1.4-AMeV room-temperature High Current Injector HSI at Gesellschaft
für Schwerionenforschung (GSI) has been in routine operation for
more than 2 years now. With a mass-to-charge ratio of up to 65, a
current limit of 15 mA for U4+, and an energy range from 2.2
AkeV up to 1.4 AMeV, this linac is suited to gain useful experience on
the way toward the design of a HIF RF driver. The status and technical
improvements of that A/q ≤ 65, 91-MV linac are reported. Beam
dynamics calculations for Bi1+-beams show that powerful
focusing elements at the linac front end are the bottleneck with
respect to a further increase in beam current. Besides superconducting
and pulsed wire quadrupoles, the potential of the Gabor-plasma lenses
He implantation followed by thermal anneal is a well-established technique for creating layers or bands of cavities in silicon. This process is a consequence of the interaction between He and ion-implant-induced vacancies. Applications of such cavity layers include gettering and localized minority carrier lifetime control, and compliant substrates for lattice-mismatched heteroepitaxy. Studies have shown that the presence of interstitial-type defects can lead to the shrinkage of He-cavities due to the interstitial capture by the cavities. However, few of them deal with the interaction of cavities with vacancies. Here we present results on the formation of He-cavities in Si in the presence of atomic hydrogen and vacancies produced by effusion of hydrogen. Following a helium implant, samples were hydrogenated with an electron cyclotron resonance (ECR) hydrogen plasma. Control samples without any hydrogenation were also used. We studied the influence of hydrogen on void morphology. While hydrogen enhances void size at higher energy implants, the enhancement effect is absent in lower energy implants. The results underscore the role of vacancies in void formation and growth.
Al-spiking in contacts to Si were studied on a microscopic scale by a detailed cross sectional TEM analysis. Electron spectroscopic imaging and energy dispersive x-ray microanalysis with a I nm high-current electron probe formed by a field emission gun helped to identify the Al-diffusion paths and the reaction mechanisms which lead to contact failure. Combinations of advanced PVD-Ti/TiN barrier layers and cold/hot or high-pressure AlSiCu-fills revealed that the highly rugged TiN barrier sidewalls and thick Ti sidewall layers are the weak points which cause Al-spiking.
Today different Al-fill techniques are used for the fill of submicron contacts and vias. The integration aspects of the most promising approaches, Al-reflow, cold/hot Al-planarization and high pressure Al-fill (Forcefill) are compared to the widely used W-plug technique. The filling properties are discussed with respect to future applications in ULSI devices. Special attention is given to the barrier stability in contacts and the influence on patterning. Various electrical data and reliability results are compared to metallizations with W-plugs. The implications of the Al-fill processes on chip design, especially on the size and shape of holes, the pattern density, the possibility of producing stacked contacts/vias and the metal to contact/via overlap are considered also. In an outlook for future developments, e.g. the introduction of low k dielectrics, the inverse metallization architecture with (dual) damascene interconnects and the emerging Cu metallizations, Alfill processes are facing new challenges which will be discussed.
Among the long period variable stars included in the Hipparcos observing program, 245 large-amplitude ones require brightness predictions during the mission in order to allocate the necessary observing time. We present the computation of the light ephemerides with numeric and symbolic methods using AAVSO’s 75-year data on maxima and minima dates and magnitudes and 20 years of individuai observations; the evaluation and revision of the ephemerides using ground-based observations compiled monthly by the AAVSO from observers world-wide and real-time monitoring of ephemerides stars from satellite observations performed at ESOC; the statistical results derived from one-and-a-half years of simultaneous ground-based and Hipparcos observations. We show the usefulness of all this work in understanding the physics of these pulsating variable stars.
Red blood cells or artificial vesicles may be conveniently represented by capsules, i.e. liquid droplets surrounded by deformable membranes. The aim of this paper is to assess the importance of viscoelastic properties of the membrane on the motion of a capsule freely suspended in a viscous liquid subjected to shear flow. A regular perturbation solution of the general problem is obtained when the particle is initially spherical and undergoing small deformations. With a purely viscous membrane (infinite relaxation time) the capsule deforms into an ellipsoid and has a continuous flipping motion. When the membrane relaxation time is of the same order as the shear time, the particle reaches a steady ellipsoidal shape which is oriented with respect to streamlines at an angle that varies between 45° and 0°, and decreases with increasing shear rates. Furthermore it is predicted that the deformation reaches a maximum value, which is consistent with experimental observations of red blood cells.
Examination of the substructure of crystalline solids by diffractographic methods has recently developed into an independent field of work alongside atomicstructure analysis. Diffraction micrography with electrons is characterized by the small size of the distortion fields and the high resolving power in small crystal ranges (1000-3000Å thickness). X-ray diffraction micrography is characterized by great reciprocation between wave field and distortion field and by undisturbed preparation and undisturbed testing in the large crystal ranges (up to 15 cm2). There are two groups of examination methods for diffraction micrography with X-rays: (1) Examination with a finely limited, polychromatic or monochromatic X-ray source and moving sample, according to A. R. Lang et al. (2) Examination with a parallel-ray beam of polychromatic or monochromatic X-rays with fixed sample, in accordance with Berg-Barrett et al. For the examination of coarse defects in single-crystalline and poly crystalline matter, the parallel-beam method offers a wide scope for studies in the physics and applications of single-crystal line and polycrystalline solids. This paper therefore includes a summary of the methods using collimation systems and grating diaphragms. Measuring techniques and results are illustrated with the help of reflection and transmission pictures on various crystals. The various methods and refined measuring technique of the parallel-beam method enable the following to be defined: (1) Localization of crystallites from 20 μ diam. upward in a surface up to 15 cm2. (2) Determination of the faces of averted crystallites from 20 µ diam. upward in crystal surfaces. (3) Angle of avertence of crystallites or curvature angles of net faces from 1 to 3° in crystal surfaces up to 15 cm2. (4) Subangle grain boundaries, slip bands, and dislocation lines; also distortion fields (from 20 μ upward) resulting from mechanical, thermal, and radiation damage.