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Coordinated specialty care (CSC) is widely accepted as an evidence-based treatment for first episode psychosis (FEP). The NAVIGATE intervention from the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) study is a CSC intervention which offers a suite of evidence-based treatments shown to improve engagement and clinical outcomes, especially in those with shorter duration of untreated psychosis (DUP). Coincident with the publication of this study, legislation was passed by the United States Congress in 2014–15 to fund CSC for FEP via a Substance Abuse and Mental Health Services Administration (SAMHSA) block grant set-aside for each state. In Michigan (MI) the management of this grant was delegated to Network180, the community mental health authority in Kent County, with the goal of making CSC more widely available to the 10 million people in MI. Limited research describes the outcomes of implementation of CSC into community practices with no published accounts evaluating the use of the NAVIGATE intervention in a naturalistic setting. We describe the outcomes of NAVIGATE implementation in the state of MI.
In 2014, 3 centers in MI were selected and trained to provide NAVIGATE CSC for FEP. In 2016 a 4th center was added, and 2 existing centers were expanded to provide additional access to NAVIGATE. Inclusion: age 18–31, served in 1 of 4 FEP centers in MI. Data collection began in 2015 for basic demographics, global illness (CGI q3 mo), hospital/ED use and work/school (SURF q3 mo) and was expanded in 2016 to include further demographics, diagnosis, DUP, vital signs; and in 2018 for clinical symptoms with the modified Colorado Symptom Inventory (mCSI q6 mo), reported via an online portal. This analysis used data until 12/31/19. Mixed effects models adjusted by age, sex and race were used to account for correlated data within patients.
N=283 had useable demographic information and were included in the analysis. Age at enrollment was 21.6 ± 3.0 yrs; 74.2% male; 53.4% Caucasian, 34.6% African American; 12.9 ± 1.7 yrs of education (N=195). 18 mo retention was 67% with no difference by sex or race. CGI scores decreased 20% from baseline (BL) to 18 mo (BL=3.5, N=134; 15–18 mo=2.8, N=60). Service utilization via the SURF was measured at BL (N=172) and 18 mo (N=72): psychiatric hospitalizations occurred in 37% at BL and 6% at 18 mo (p<0.01); ER visits occurred in 40% at BL and 13% at 18 mo (p<0.01). 44% were working or in school at BL and 68% at 18 mo (p<0.01). 21% were on antipsychotics (AP) at BL (N=178) and 85% at 18 mo (N=13) with 8% and 54% on long acting injectable-AP at BL and 18 mo, respectively. Limitations include missing data and lack of a control group.
The implementation of the NAVIGATE CSC program for FEP in MI resulted in meaningful clinical improvement for enrollees. Further support could make this evidence-based intervention available to more people with FEP.
Supported by funds from the SAMHSA Medicaid State Block Grant set-aside awarded to Network180 (Achtyes, Kempema). The funders had no role in the design of the study, the analysis or the decision to publish the results.
We describe an ultra-wide-bandwidth, low-frequency receiver recently installed on the Parkes radio telescope. The receiver system provides continuous frequency coverage from 704 to 4032 MHz. For much of the band (
), the system temperature is approximately 22 K and the receiver system remains in a linear regime even in the presence of strong mobile phone transmissions. We discuss the scientific and technical aspects of the new receiver, including its astronomical objectives, as well as the feed, receiver, digitiser, and signal processor design. We describe the pipeline routines that form the archive-ready data products and how those data files can be accessed from the archives. The system performance is quantified, including the system noise and linearity, beam shape, antenna efficiency, polarisation calibration, and timing stability.
Little is known about emotional quality-of-life in paediatric heart disease in low- and middle-income countries where the prevalence of uncorrected lesions is high. Research on emotional quality-of-life and its predictors in these settings is key to planning interventions.
Ten-year retrospective cross-sectional study of children aged 6–17 years with uncorrected congenital or acquired heart disease in 12 low- and middle-income countries was conducted. Emotional functioning score of the PedsQL TM 4.0 generic core scale and data on patient-reported limitation in sports participation were collected via in-person interview and analysed using regression analyses.
Ninety-four children reported mean emotional functioning scores of 71.94 (SD 25.32) [95% CI 66.75–77.13] with lower scores independently associated with having a parent with a chronic illness or who had died (p = 0.005), having less than three siblings (p = 0.007), and reporting a subjective limitation in carrying an item equivalent to a 4 lb load (p = 0.021). Patient-reported limitation in sports participation at least “sometimes” was present in 69% and was independently associated with experiencing symptoms at least once a month (p < 0.001).
Some of the factors which were associated with better emotional quality-of-life were similar to those identified in previous studies in patients with corrected defects. Patient-reported limitation in sports participation is common. In addition to corrective surgery and exercise, numerous other interventions which are practicable during surgical missions might improve emotional quality-of-life.
In 2010, South Africa (SA) hosted the Fédération Internationale de Football Association (FIFA) World Cup (soccer). Emergency Medical Services (EMS) used the SA mass gathering medicine (MGM) resource model to predict resource allocation. This study analyzed data from the World Cup and compared them with the resource allocation predicted by the SA mass gathering model.
Prospectively, data were collected from patient contacts at 9 venues across the Western Cape province of South Africa. Required resources were based on the number of patients seeking basic life support (BLS), intermediate life support (ILS), and advanced life support (ALS). Overall patient presentation rates (PPRs) and transport to hospital rates (TTHRs) were also calculated.
BLS services were required for 78.4% (n = 1279) of patients and were consistently overestimated using the SA mass gathering model. ILS services were required for 14.0% (n = 228), and ALS services were required for 3.1% (n = 51) of patients. Both ILS and ALS services, and TTHR were underestimated at smaller venues.
The MGM predictive model overestimated BLS requirements and inconsistently predicted ILS and ALS requirements. MGM resource models, which are heavily based on predicted attendance levels, have inherent limitations, which may be improved by using research-based outcomes.
Detailed imaging and spectroscopic analysis of the centers of nearby S0 and spiral galaxies shows the existence of “composite bulges”, where both classical bulges and disky pseudobulges coexist in the same galaxy. As part of a search for supermassive black holes in nearby galaxy nuclei, we obtained VLT-SINFONI observations in adaptive-optics mode of several of these galaxies. Schwarzschild dynamical modeling enables us to disentangle the stellar orbital structure of the different central components, and to distinguish the differing contributions of kinematically hot (classical bulge) and kinematically cool (pseudobulge) components in the same galaxy.
Since the Green Revolution, the public-sector's agricultural research strategy for increasing food crop productivity has been explicitly based on the premise that technology can cross political and agro-climatic boundaries, primarily through the ‘training and visit’ system of extension (also known as ‘transfer of technology’ and the ‘pipeline’ model). Today, a different strategy is emerging. Efforts to develop the necessary institutional capacity for more client-oriented participatory research, particularly in plant breeding, are now a central part of the public-sector agricultural research strategy. Greater use of participatory and gender-analysis approaches in agricultural research has significant conceptual and methodological implications for impact assessment and institutional learning.
Site-specific, risk-adjusted incidence rates of intensive care unit (ICU)-acquired infections were obtained through standardized surveillance in 8 ICUs in Greece. High rates were observed for central line-associated bloodstream infection (12.1 infections per 1,000 device-days) and ventilator-associated pneumonia (12.5 infections per 1,000 device-days). Gram-negative microorganisms accounted for 60.4% of the isolates recovered, and Acinetobacter species were predominant. To reduce infection rates in Greek ICUs, comprehensive infection control programs are required.
A high proportion of viable pollen grains must germinate to study the physiology of pollen growth to reduce the confounding effects of environmental influences on pollen germination. The objectives of this study were to evaluate the nuclear state and develop a suitable medium and culture method for in vitro germination of johnsongrass pollen. Johnsongrass pollen was trinucleate, and in vitro tests for pollen viability using Alexander's stain and a fluorochromatic reaction method (FCR) indicated johnsongrass pollen was viable (92.6 to 98.4%). A factorial treatment arrangement of four concentrations of sucrose, two concentrations of boric acid, and two concentrations of calcium nitrate were used to determine the optimum pollen-germination medium composition in suspension culture, agar culture, and cellophane membrane culture. Germination was highest in a suspension culture with a medium containing 0.3 M sucrose, 2.4 mM boric acid, and 3 mM calcium nitrate. Pollen germination using this medium was 78.9% when anthers were harvested just before anthesis.
Calcium phosphate (CaP) materials are commonly used in bone tissue engineering applications since they closely resemble the chemistry of bone and teeth. The inorganic component of mineralized tissue is multiphasic in nature-thus to better replicate those tissues, CaP materials should also be multiphasic. Combustion synthesis is a process that creates multiphasic CaP (HCaP) with low energy input over a relatively short time. The structure and chemistry of HCaP synthesized via auto-ignition combustion synthesis (AICS) varies greatly with respect to structural hydration. Product hydration was accomplished by modifying hydrogen and oxygen content in the combustion reaction by changing the amount of fuel, urea [ ] pre-reaction, and heating or sintering products post-reaction. The reaction equation for this specific system is given below. Calcium nitrate [ ], and ammonium nitrate [ ] are the components that form HCaP. Urea acts as an ignition source and fuel. Changes in the amount of urea dictate the amount of excess hydrogen to form water within the reaction. Excess products formed include water, carbon dioxide, and nitrogen. Salts of the reactants were mixed with 10 milliliters of de-ionized water in a Pyrex beaker, heated on a hot plate for 20 minutes or until the reactants began to foam, and then placed in a muffle furnace at 1000°C until the foam ignited in a combustion reaction. This was noted by the progression of a combustion wave throughout the foam. Post-AICS, products were heated at 105°C for 8 hours and 24 hours and massed to determine water content of the product. Subsequently, the products were sintered at 1000°C for 8 hours and massed again. The primary products formed using AICS are hydroxyapatite (HA), á-tricalcium calcium phosphate (TCP) and hydrated forms of tricalcium phosphate (HTCP). During low temperature heating, 105°C, water content decreases as time increases and the products began to densify. Initial results indicate that surface porosity decreases during the powder densification. XRD shows that peak intensity increases after low temperature heating, indicating an increase in crystallinity and grain orientation. XRD confirms that both crystalline and amorphous phases occur in the hydroxyapatite (HA), á-TCP and HTCP products. The amount of structural hydration has an effect on CaP, and these effects are noted by an increase in density and decrease in porosity as structurally bound water is removed from the system. Future research will be dedicated to determining hydration ratio (amount of urea in the reaction to the amount of water within the products) and a Ca:P ratio that result in optimal powder porosity, ductility and grain size generating a multiphasic HCaP implant biomaterial that accurately replicates natural bony tissue.
The role of rectal carriage of Staphylococcus aureus as a risk factor for nosocomial S. aureus infections in critically ill patients has not been fully discerned.
Nasal and rectal swabs for S. aureus were obtained on admission and weekly thereafter until discharge or death from 204 consecutive patients admitted to the surgical intensive care unit and liver transplant unit.
Overall, 49.5% (101 of 204) of the patients never harbored S. aureus, 21.6% (44 of 204) were nasal carriers only, 3.4% (7 of 204) were rectal carriers only, and 25.5% (52 of 204) were both nasal and rectal carriers. Infections due to S. aureus developed in 15.7% (32 of 204) of the patients; these included 3% (3 of 101) of the non-carriers, 18.2% (8 of 44) of the nasal carriers only, 0% (0 of 7) of the rectal carriers only, and 40.4% (21 of 52) of the patients who were both nasal and rectal carriers (P = .001). Patients with both rectal and nasal carriage were significantly more likely to develop S. aureus infection than were those with nasal carriage only (odds ratio, 3.9; 95% confidence interval, 1.18 to 7.85; P = .025). By pulsed-field gel electrophoresis, the infecting rectal and nasal isolates were clonally identical in 82% (14 of 17) of the patients with S. aureus infections.
Rectal carriage represents an underappreciated reservoir for S. aureus in patients in the intensive care unit and liver transplant recipients. Rectal plus nasal carriage may portend a greater risk for S. aureus infections in these patients than currently realized.
Bacterial protein synthesis is the target for several classes
of established antibiotics. This report describes the
characterization of a novel translation inhibitor produced by
the soil bacterium Flexibacter. The dipeptide antibiotic
TAN1057 A/B was synthesized and designated GS7128. As reported
previously, TAN1057 inhibits protein synthesis in both
Escherichia coli and Staphylococcus aureus,
leaving transcription unaffected. Cell-free translation systems
from E. coli were used to further dissect the mechanism
of translational inhibition. Binding of mRNA to ribosomes was
unaffected by the drug, whereas the initiation reaction was
reduced. Elongation of translation was completely inhibited
by GS7128. Detailed analysis showed that the peptidyl transferase
reaction was strongly inhibited, whereas tRNA binding to both
A- and P-site was unaffected. Selection and analysis of
drug-resistant mutants of S. aureus suggests that drug
uptake may be mediated by a dipeptide transport mechanism.