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To compare the treatment of patients with early psychosis, 2 years after the introduction of an integrated model of enhanced management within a public adult mental health service, with an historic cohort from the same service.
Variables examined in the 2001 cohort were compared with 2008 patients. Computer database review and a file audit were conducted for all patients with early psychosis across the first 2 years of the program.
Compared to the historic cohort, patients in the current cohort were 24% less likely to have been admitted (P = 0.004). There were statistically significant reductions in involuntary status and use of a locked unit. Rates of police involvement in admission and use of seclusion were also reduced, though this trend was not significant. Average length of stay was reduced. Median duration of untreated psychosis was 3 months in both 2001 and 2008 cohorts.
The introduction of an integrated model of management within an area mental health service for patients with early psychosis contributed to significant reductions in admissions, involuntary status and use of a locked ward. The data suggests that enhanced treatment of early psychosis patients can be offered within generic services.
Distinguishing a disorder of persistent and impairing grief from normative grief allows clinicians to identify this often undetected and disabling condition. As four diagnostic criteria sets for a grief disorder have been proposed, their similarities and differences need to be elucidated.
Participants were family members bereaved by US military service death (N = 1732). We conducted analyses to assess the accuracy of each criteria set in identifying threshold cases (participants who endorsed baseline Inventory of Complicated Grief ⩾30 and Work and Social Adjustment Scale ⩾20) and excluding those below this threshold. We also calculated agreement among criteria sets by varying numbers of required associated symptoms.
All four criteria sets accurately excluded participants below our identified clinical threshold (i.e. correctly excluding 86–96% of those subthreshold), but they varied in identification of threshold cases (i.e. correctly identifying 47–82%). When the number of associated symptoms was held constant, criteria sets performed similarly. Accurate case identification was optimized when one or two associated symptoms were required. When employing optimized symptom numbers, pairwise agreements among criteria became correspondingly ‘very good’ (κ = 0.86–0.96).
The four proposed criteria sets describe a similar condition of persistent and impairing grief, but differ primarily in criteria restrictiveness. Diagnostic guidance for prolonged grief disorder in International Classification of Diseases, 11th Edition (ICD-11) functions well, whereas the criteria put forth in Section III of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) are unnecessarily restrictive.
We aimed to evaluate residence in evacuation areas (storm areas) as a risk factor for food and waterborne disease (FWBD) associated with Hurricane Sandy flooding.
We captured 9601 incident outpatient and inpatient FWBD hospital discharge diagnoses for residents of the greater New York City area. We used Poisson or negative binomial regression models to compare the covariate-adjusted risk for a FWBD diagnosis, pre-Sandy (10/28-11/09, 2001-2011) vs. post-Sandy (10/28-11/09, 2012), for residents of “storm” and “non-storm” areas.
Outpatient FWBD risk was lower for storm area residents after Hurricane Sandy (risk ratio [RR]=0.58, 95% confidence interval [CI]: 0.46-0.74), and varied by age, sex, and county. However, storm area residents 65 years of age or older experienced higher risk after Hurricane Sandy (RR=2.16, 95% CI: 1.11-4.19), albeit based on few cases. Inpatient FWBD risk was lower for non-storm area residents after Hurricane Sandy (RR=0.79, 95% CI: 0.66-0.95), and varied by age, race, and county, although there was no significant change for storm area residents (RR=0.86, 95% CI: 0.69-1.08). Those ≥65 years of age were also at lower risk for inpatient FWBD diagnosis, yet the effect was weaker for storm area (RR=0.89, 95% CI: 0.67-1.18) than for non-storm area residents (RR=0.68, 95% CI: 0.52-0.89).
Hurricane preparation, mitigation, and response activities in the greater New York City area may have led to “protective” effects for FWBD. (Disaster Med Public Health Preparedness. 2016;10:503–511)
Jens Hjorth, Dark Cosmology Centre, Niels Bohr Institute, University of Copenhagen, Juliane Maries Vej 30, DK-2100 Copenhagen Ø, Denmark,
Joshua S. Bloom, Astronomy Department, University of California, 601 Campbell Hall, Berkeley, CA 94720, USA
The discovery and localization of the first afterglows of GRBs rapidly led to the establishment of the long-sought distance scale for the sources (see Chapter 4), which began an earnest observational hunt for their progenitors. A preponderance of evidence linked long-duration, soft-spectrum GRBs with the death of massive stars. The observations of the GRB-supernova (SN) connection, the main subject of this chapter, present the most direct evidence of this physical link.
Well before the afterglow era, Paczyński (1986) noted that “cosmological” distances of GRBs would imply that the energy release in gamma rays would be comparable to the energy release in a typical SN explosion. Seen as more than just a coincidence, this energetics connection between GRBs and the death of massive stars was fleshed out into what is now referred to as the collapsar model (Woosley 1993, 1996, MacFadyen & Woosley 1999). Briefly, the collapsar involves the core-collapse explosion of a stripped-envelope massive star. Matter flows towards a newly formed black hole or rapidly spinning, highly magnetized neutron star (“magnetar”; e.g., Bucciantini et al. 2009). Powerful jets plow through the collapsing star along the spin axis, eventually obtain relativistic speeds, and produce GRBs. Enough 56Ni is produced near the central compact source to power a supernova explosion of the star. The original “failed Ib” model posited that little 56Ni would be produced during core collapse of a massive star that produces a GRB, and thus no traditional SN would be visible.
By the end of the last decade, robotic telescopes were established as effective alternatives to the traditional role of astronomer in planning, conducting and reducing time-domain observations. By the end of this decade, machines will play a much more central role in the discovery and classification of time-domain events observed by such robots. While this abstraction of humans away from the real-time loop (and the nightly slog of the nominal scientific process) is inevitable, just how we will get there as a community is uncertain. I discuss the importance of machine learning in astronomy today, and project where we might consider heading in the future. I will also touch on the role of people and organisations in shaping and maximising the scientific returns of the coming data deluge.
We present photometry and spectroscopy of the peculiar Type II supernova SN 2010jp, also named PTF10aaxi. The light curve exhibits a linear decline with a relatively low peak absolute magnitude of only −15.9 (unfiltered), and a low radioactive decay luminosity at late times that suggests a low synthesized nickel mass of about 0.003 M⊙ or less. Spectra of SN 2010jp display an unprecedented triple-peaked Hα line profile, showing: (1) a narrow central component that suggests shock interaction with a dense circumstellar medium (CSM); (2) high-velocity blue and red emission features centered at −12,600 and +15,400 km s−1; and (3) very broad wings extending from −22,000 to +25,000 km s−1. We propose that this line profile indicates a bipolar jet-driven explosion, with the central component produced by normal SN ejecta and CSM interaction at mid and low latitudes, while the high-velocity bumps and broad line wings arise in a nonrelativistic bipolar jet. Jet-driven SNe II are predicted for collapsars resulting from a wide range of initial masses above 25 M⊙, especially at the sub-solar metallicity consistent with the SN host environment. It also seems consistent with the apparently low 56Ni mass that may accompany black hole formation. We speculate that the jet survives to produce observable signatures because the star's H envelope was very low mass, having been mostly stripped away by the previous eruptive mass loss.
Grizzled (gr) is a recessive gene with complete penetrance but reduced viability. It is linked with waltzer (v) in linkage group X, the recombination frequency being 14·6 ± 2·6%. Its visible effect is to dilute the yellow pigment of the hairs. Body weight is reduced by about 25% atbirth and remains at about 10–20% below that of non-grizzled litter mates. Viability up to the time of classification is about 50–60% of that of non-grizzled litter mates. The mortality of grizzled homo-zygotes occurs at all stages from about 10 days of gestation up to the time of classification. No specific cause of the mortality was evident.
Factors contributing to India’s vulnerability to the AIDS epidemic include pervasive poverty, low levels of education and high gender stratification. This study uses data collected in the 1998–99 National Family Health Survey-2 (NFHS-2) to investigate the relationship between aspects of women’s autonomy and four measures of HIV-related knowledge and behaviour – awareness and knowledge of HIV/AIDS, condom awareness and condom use – in three culturally contrasting states in India: Kerala (n=2884), Karnataka (n=4357) and Uttar Pradesh (n=8981). The NFHS-2 is a nationally representative survey of India, with a sampling scheme that was designed such that each state sample can be generalized back to represent ever-married women aged 15–49 living in the state. Kerala scores highest in the four health outcome measures, followed by Karnataka and then Uttar Pradesh, but condom use is lowest in Karnataka. Kerala also leads in the four dimensions of autonomy examined and in socio-demographic status, followed again by Karnataka and Uttar Pradesh. Despite these observed differences, in all three states, women with greater autonomy as measured by this study were more likely to be knowledgeable about AIDS and condoms and to use condoms, after controlling for socio-demographic factors. These results concur with other studies focusing on women’s autonomy and health outcomes around the world, and point to the importance of incorporating a gender-based approach to AIDS prevention programmes in India.
Pancreatic polypeptide (PP) is a gut hormone released from the pancreas in response to food ingestion and remains elevated for up to 6 h postprandially. Plasma levels are elevated in patients with pancreatic tumours. An intravenous infusion of PP has been reported to reduce food intake in man, suggesting that PP is a satiety hormone. We investigated whether a lower infusion rate of PP would induce significant alterations in energy intake. The study was randomised and double-blinded. Fourteen lean fasted volunteers (five men and nine women) received 90 min infusions of PP (5 pmol/kg per min) and saline on two separate days. The dose chosen was half that used in a previous human study which reported a decrease in appetite but at supra-physiological levels of PP. One hour after the end of the infusion, a buffet lunch was served and energy intake measured. PP infusion was associated with a significant 11 % reduction in energy intake compared with saline (2440 (se 200) v. 2730 (se 180) kJ; P < 0·05). Preprandial hunger as assessed by a visual analogue score was decreased in the PP-treated group compared to saline. These effects were achieved with plasma levels of PP within the pathophysiological range of pancreatic tumours.