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The purpose of this rejoinder is to emphasize several important areas of future research that were mentioned by one or both commentaries. First, the authors discuss issues related to multi-source assessment, such as the importance of further research on informant bias, and argue that the information gleaned from multiple sources is worth the added assessment burden. Second, they underscore the importance of longitudinal assessment both in capturing the treatment-relevant within-person processes through which personality pathology unfolds, as well as tracking therapeutic progress. They assert that a given measure’s ability to reliably and validly measure change over time should be considered when evaluating its clinical utility. Finally, they emphasize the need for greater attention to clinical utility of dimensional PD assessment measures.
The purpose of this chapter is to review the current state of the dimensional assessment of personality disorder (PD). The first part of the chapter serves as a review of the most well-established and commonly used measures of maladaptive personality traits. Measures that assess the psychosocial impairment associated with personality pathology also are reviewed. Areas of discontinuity among these measures (e.g., theoretical origin, method of scale construction, degree of correspondence with well-known trait dimensions, attention received in the empirical literature, degree of bipolarity of underlying dimensions) are emphasized, and the clinical utility of measures is evaluated. The second part of the chapter focuses on several controversial issues with which the field of dimensional PD assessment now is grappling. These issues include (a) the psychometric distinction of personality traits from personality functioning, (b) the incremental utility of adaptive trait assessment, (c) the question of maladaptive trait bipolarity, (d) facet-level differences versus domain-level similarity across competing PD trait models, and (e) the value of multi-source assessment.
As in many sciences, description is an important component of theory, research, and practical applications in clinical psychology. Despite this, considerable disagreement exists regarding how to describe the diverse manifestations of psychopathology that clinicians and researchers have observed. The disagreements are such that translating research across descriptive psychopathology models can be difficult or impossible, impeding scientific progress. As this chapter reviews, at least four major descriptive psychopathology approaches exist – clinical theory, descriptive psychiatry, quantitative models, and biological models – each of which has unique goals, units of observation, theoretical concepts, and research traditions. Through reviewing these dominant approaches, it is illustrated how diverging language, concepts, and methods can impede communication between scientists and practitioners working within different descriptive approaches. Beyond this, specific emerging descriptive psychopathology models (i.e., HiTOP, RDoC, and transdiagnostic processes) are reviewed, which have primarily developed as a response to descriptive psychiatry’s limitations (e.g., DSM) and may advance clinical psychology. Despite the promise of these emerging descriptive models, each is still primarily rooted in one traditional descriptive approach and retains that approach’s limitations. Thus, the chapter concludes by discussing the need to integrate descriptive psychopathology approaches and the challenges associated with this task.
In this chapter, we review the current state of personality disorder (PD) assessment practices. The review includes both traditional measures that are rooted in categorical conceptualizations of PD and dimensional measures that have emerged in response to mounting evidence that has called into question the validity of traditional PD classification approaches. The scope of this chapter includes prominent and promising models and measures of PD. Moreover, our review is focused on omnibus measures that present a relatively “complete” picture of personality pathology rather than measures that focus on the features of only one or a limited set of PDs. Finally, we address two important topics relevant to PD assessment. First, we discuss the cross-cultural PD assessment literature, which is characterized by a relative lack of strong cross-cultural research on the manifestation and measurement of PD. Second, we address the disconnect between research and applied practice of PD assessment.
Food insecurity is reported in approximately 28 % of individuals with diabetes in the USA and is associated with poor glycaemic and lipid control. The present study aimed to understand the direct and indirect pathways through which food insecurity impacts glycaemic control in individuals with diabetes.
Adults (n 615) with type 2 diabetes completed validated questionnaires after recruitment from two primary care clinics. Structural equation modelling was used to investigate mechanisms through which food insecurity influences diabetes self-care behaviours and glycaemic control, including investigation into possible direct and indirect effects of perceived stress and social support.
The final model showed that higher food insecurity was directly significantly related to increased stress (r=0·14, P<0·001) and increased glycosylated Hb (r=0·66, P=0·03). Higher stress was significantly related to poorer self-care (r=−0·54, P<0·001) and lower social support (r=−0·41, P<0·001). There was no significant direct association between food insecurity and self-care, or between perceived stress and glycaemic control.
Food insecurity had both a direct effect on glycaemic control and an indirect effect on self-care through stress. The indirect pathway suggests that efforts to address stress may influence the ability of individuals to perform diabetes self-care behaviours. The direct effect on glycaemic control suggests that pathways independent of self-care behaviours may also be necessary to improve diabetes outcomes. Results from the study suggest a multipronged approach is necessary to address food insecurity in individuals with diabetes.
This Research Communication describes an investigation into the viability of an Intermittently Aerated Sequencing Batch Reactor (IASBR) for the treatment of dairy processing wastewater at laboratory-scale. A number of operational parameters have been varied and the effect has been monitored in order to determine optimal conditions for maximising removal efficiencies. These operational parameters include Hydraulic Retention Time (HRT), Solids Retention Time (SRT), aeration rate and cycle length. Real dairy processing wastewater and synthetic wastewater have been treated using three laboratory-scale IASBR units in a temperature controlled room. When the operational conditions were established, the units were seeded using sludge from a municipal wastewater treatment plant for the first experiment, and sludge from a dairy processing factory for the second and third experiment. In experiment three, the reactors were fed on real wastewater from the wastewater treatment plant at this dairy processing factory. These laboratory-scale systems will be used to demonstrate over time that the IASBR system is a consistent, viable option for treatment of dairy processing wastewater in this sector. In this study, the capacity of a biological system to remove both nitrogen and phosphorus within one reactor will be demonstrated. The initial operational parameters for a pilot-scale IASBR system will be derived from the results of the study.
This Review describes the objectives and methodology of the DairyWater project as it aims to aid the Irish dairy processing industry in achieving sustainability as it expands. With the abolition of European milk quotas in March 2015, the Republic of Ireland saw a surge in milk production. The DairyWater project was established in anticipation of this expansion of the Irish dairy sector in order to develop innovative solutions for the efficient management of water consumption, wastewater treatment and the resulting energy use within the country's dairy processing industry. Therefore, the project can be divided into three main thematic areas: dairy wastewater treatment technologies and microbial analysis, water re-use and rainwater harvesting and environmental assessment. In order to ensure the project remains as relevant as possible to the industry, a project advisory board containing key industry stakeholders has been established. To date, a number of large scale studies, using data obtained directly from the Irish dairy industry, have been performed. Additionally, pilot-scale wastewater treatment (intermittently aerated sequencing batch reactor) and tertiary treatment (flow-through pulsed ultraviolet system) technologies have been demonstrated within the project. Further details on selected aspects of the project are discussed in greater detail in the subsequent cluster of research communications.
This Research Communication describes the initial operation of a pilot-scale intermittently aerated sequencing batch reactor system, which is located at an Irish dairy processing factory. Laboratory-scale research has facilitated the design specifications and operational parameters necessary for the construction and running of a pilot-scale. Laboratory scale research was necessary prior to the pilot scale system to ensure high quality treatment and nutrient removal efficiencies. The pilot system operates with a hydraulic retention time of 4 d, a solids retention time of 16 d and a cycle length of 12 hours. There are 4 non-aeration and aeration phases within the system's react phase. This system has a 3000 l working volume, treating 375 l of wastewater per cycle, 750 l daily. The system was seeded from an aeration tank at the dairy processing factory where the unit is located. The system is operating with the goal to remove both nitrogen and phosphorus from the wastewater biologically, reducing the need for chemical treatment. Currently, the system is performing with high efficiency, treating the wastewater to an acceptable level according to the Irish Environmental Protection Agency for discharge into surrounding water bodies. Therefore, the initial removal results demonstrate this technology's suitability for the treatment of high strength dairy wastewaters.
Every nuclear weapons program for decades has relied extensively on illicit imports of nuclear-related technologies. This book offers the most detailed public account of how states procure what they need to build nuclear weapons, what is currently being done to stop them, and how global efforts to prevent such trade could be strengthened. While illicit nuclear trade can never be stopped completely, effective steps to block illicit purchases of nuclear technology have sometimes succeeded in slowing nuclear weapons programs and increasing their costs, giving diplomacy more chance to work. Hence, this book argues, preventing illicit transfers wherever possible is a key element of an effective global non-proliferation strategy.
The early and effective detection of neurocognitive disorders poses a key diagnostic challenge. We examined performance on common cognitive bedside tests according to differing delirium syndromal status and clinical (motor) subtypes in hospitalized elderly medical inpatients.
A battery of nine bedside cognitive tests was performed on elderly medical inpatients with DSM-IV delirium, subsyndromal delirium (SSD), and no delirium (ND). Patients with delirium were compared according to clinical (motor) subtypes.
A total of 198 patients (mean age 79.14 ± 8.26) were assessed with full syndromal delirium (FSD: n = 110), SSD (n = 45), and ND (n = 43). Delirium status was not associated with differences in terms of gender distribution, age, or overall medication use. Dementia burden increased with greater delirium status. Overall, the ability to meaningfully engage with the tests varied from 59% for the Vigilance B test to 85% for Spatial Span Forward test and was lowest in patients with FSD, where engagement ranged from 32% for the Vigilance B test to 77% for the Spatial Span Forwards test. The ND group was distinguished from SSD group for the Months of the year backwards, Vigilance B, global VSP, Clock Drawing test, and Interlocking Pentagons test. The SSD group was distinguished from the FSD group by Vigilance A, Spatial Span Forward, and Spatial Span Backwards. Regarding differences among motor subtypes in terms of percentage engagement and performance, the No subtype group had higher ratings across all tests. Delirious patients with no subtype had significantly lower scores on the DRS-R98 than for the other three subtype categories.
Simple bedside tests of attention, vigilance, and visuospatial ability are useful in distinguishing neurocognitive disorders, including SSD from other presentations.
Background: The importance of economic evaluation in decision making is growing with increasing budgetary pressures on health systems. Diverse economic evidence is available for a range of interventions across national contexts within Europe, but little attention has been given to identifying evidence gaps that, if filled, could contribute to more efficient allocation of resources. One objective of the Research Agenda for Health Economic Evaluation project is to determine the most important methodological evidence gaps for the ten highest burden conditions in the European Union (EU), and to suggest ways of filling these gaps.
Methods: The highest burden conditions in the EU by Disability Adjusted Life Years were determined using the Global Burden of Disease study. Clinical interventions were identified for each condition based on published guidelines, and economic evaluations indexed in MEDLINE were mapped to each intervention. A panel of public health and health economics experts discussed the evidence during a workshop and identified evidence gaps.
Results: The literature analysis contributed to identifying cross-cutting methodological and technical issues, which were considered by the expert panel to derive methodological research priorities.
Conclusions: The panel suggests a research agenda for health economics which incorporates the use of real-world evidence in the assessment of new and existing interventions; increased understanding of cost-effectiveness according to patient characteristics beyond the “-omics” approach to inform both investment and disinvestment decisions; methods for assessment of complex interventions; improved cross-talk between economic evaluations from health and other sectors; early health technology assessment; and standardized, transferable approaches to economic modeling.
Conventional bedside tests of visuospatial function such as the clock drawing (CDT) and intersecting pentagons tests (IPT) are subject to considerable inconsistency in their delivery and interpretation. We compared performance on a novel test – the letter and shape drawing (LSD) test – with these conventional tests in hospitalised elderly patients.
The LSD, IPT, CDT and the Montreal Cognitive Assessment (MoCA) were performed in 40 acute elderly medical inpatients at University Hospital Limerick The correlation between these tests was examined as well as the accuracy of the visuospatial tests to identify significant cognitive impairment on the MoCA.
The patients (mean age 81.0±7.71; 21 female) had a median MoCA score of 15.5 (range=1–29). There was a strong, positive correlation between the LSD and both the CDT (r=0.56) and IPT (r=0.71). The correlation between the LSD and MoCA (r=0.91) was greater than for the CDT and IPT (both 0.67). The LSD correlated highly with all MoCA domains (ranging from 0.54 to 0.86) and especially for the domains of orientation (r=0.86), attention (0.81) and visuospatial function (r=0.73). Two or more errors on the LSD identified 90% (26/29) of those patients with MoCA scores of ⩽20, which was substantially higher than for the CDT (59%) and IPT (55%).
The LSD is a novel test of visuospatial function that is brief, readily administered and easily interpreted. Performance correlates strongly with other tests of visuospatial ability, with favourable ability to identify patients with significant impairment of general cognition.
Because polarization encodes geometrical information about unresolved scattering regions, it provides a unique tool for analyzing the 3-D structures of supernovae (SNe) and their surroundings. SNe of all types exhibit time-dependent spectropolarimetric signatures produced primarily by electron scattering. These signatures reveal physical phenomena such as complex velocity structures, changing illumination patterns, and asymmetric morphologies within the ejecta and surrounding material. Interpreting changes in polarization over time yields unprecedentedly detailed information about supernovae, their progenitors, and their evolution.
Begun in 2012, the SNSPOL Project continues to amass the largest database of time-dependent spectropolarimetric data on SNe. I present an overview of the project and its recent results. In the future, combining such data with interpretive radiative transfer models will further constrain explosion mechanisms and processes that shape SN ejecta, uncover new relationships among SN types, and probe the properties of progenitor winds and circumstellar material.