bluuebunny/crossref_metadata_2025 huggingface dataset:
Seasonal Prediction from Arctic Sea Surface Temperatures: Opportunities and Pitfalls
Authors: Kolstad Erik W. , Årthun Marius
Published: August 2018

Arctic sea ice extent and sea surface temperature (SST) anomalies have been shown to be skillful predictors of weather anomalies in the midlatitudes on the seasonal time scale. In particular, below-normal sea ice extent in the Barents Sea in fall has sometimes preceded cold winters in parts of Eurasia. Here we explore the potential for predicting seasonal surface air temperature (SAT) anomalies in Europe from seasonal SST anomalies in the Nordic seas throughout the year. First, we show that fall SST anomalies not just in the Barents Sea but also in the Norwegian Sea have the potential to predict wintertime SAT anomalies in Europe. Norwegian Sea SST anomalies in spring are also significant predictors of European SAT anomalies in summer. Second, we demonstrate that the potential for prediction is sensitive to trends in the data. In particular, the lagged correlation between Norwegian Sea SST anomalies in spring and European SAT anomalies in summer is considerably higher for raw data than linearly detrended data, largely due to warming SST and SAT trends in recent decades. Third, we show that the potential for prediction has not been stationary in time. One key result is that, according to two twentieth-century reanalyses, the strength of the negative lagged correlation between Barents Sea SST anomalies in fall and European SAT anomalies in winter after 1979 is unprecedented since 1900.
Are tattoos associated with employment and wage discrimination? Analyzing the relationships between body art and labor market outcomes
Authors: French Michael T , Mortensen Karoline , Timming Andrew R
Published: August 2018

Do job applicants and employees with tattoos suffer a penalty in the labor market because of their body art? Previous research has found that tattooed people are widely perceived by hiring managers to be less employable than people without tattoos. This is especially the case for those who have visible tattoos (particularly offensive ones) that are difficult to conceal. Given this backdrop, our research surprisingly found no empirical evidence of employment, wage or earnings discrimination against people with various types of tattoos. In our sample, and considering a variety of alternative estimation techniques, not only are the wages and annual earnings of tattooed employees in the United States statistically indistinguishable from the wages and annual earnings of employees without tattoos, but tattooed individuals are also just as likely, and in some instances even more likely, to gain employment. These results suggest that, contrary to popular opinion as well as research findings with hiring managers and customers, having a tattoo does not appear to be associated with disadvantage or discrimination in the labor market.
Comparison of Patient‐ and Parent‐Reported Quality of Life for Patients Treated for Persistent Obstructive Sleep Apnea
Authors: Bergeron Mathieu , Duggins Angela L. , Cohen Aliza P. , Ishman Stacey L.
Published: August 2018

Objectives

To evaluate the impact of the treatment of persistent pediatric obstructive sleep apnea (OSA) on quality of life (QOL) with patient‐reported outcomes tools and to compare parent‐ and self‐reported Pediatric Quality of Life Inventory (PedsQL) scores.

Study Design

Prospective case series.

Setting

Multidisciplinary upper airway center at a tertiary pediatric institution.

Subjects and Methods

Children with persistent OSA referred to our multidisciplinary upper airway center from 2014 to 2016. Patients and their families completed validated questionnaires for QOL, including the Family Impact Questionnaire, the Obstructive Sleep Apnea–18, the PedsQL, and the Epworth Sleepiness Scale for Children and Adolescents. They completed the same surveys after treatment.

Results

Twenty‐three children (7 females) and their families were included in the study. Patients had a mean age of 12.7 years. Pretreatment, the mean obstructive apnea‐hypopnea index was 15.0 events/hour (95% CI, 8.7‐21.3); after treatment, the mean was 3.9 events/hour (P =. 003). The mean PedsQL score for children improved from 60.5 to 74.2 (P =. 04). The PedsQL score for parents did not significantly improve (61.6 to 63.8, P =. 39). There was a significant though weak association between OSA severity (R2 = 0.25, P =. 03) and PedsQL scores. The Family Impact Questionnaire negative subscore and Epworth Sleepiness Scale for Children and Adolescents scores did not change with treatment.

Conclusions

For children treated for persistent OSA, we found that self‐reported QOL significantly improved after treatment; however, parent‐reported QOL did not significantly change. It is unclear if parents underestimate or patients overestimate QOL after treatment. We suggest that patient‐reported outcomes be obtained when feasible.
Celebrities in Czech politics in 1996–2013
Authors: Petrovová Iva , Eibl Otto
Published: August 2018

The paper deals with the phenomenon of celebrity politics in the Czech Republic, particularly the involvement of celebrities in Czech politics between 1996 and 2013. The authors draw from the celebrity politics’ typologies of Paul ‘t Hart and Karen Tindall, and John Street. Employing a content analysis of newspaper articles from the journals MF Dnes and Blesk during the periods preceding the elections of the Chamber of Deputies, the authors shed light on celebrity involvement in Czech politics. Specifically, they trace three categories mentioned in the media: the celebrity expression of political topics in general, celebrity political endorsement and the candidacy of celebrities. Building upon the collected data, the authors interpret the results within the political and social context of the parliamentary period and indicate more general patterns of celebrity involvement in Czech politics.
Validity and reproducibility of the Functional Gait Assessment in persons after stroke
Authors: Van Bloemendaal Maijke , Bout Walter , Bus Sicco A , Nollet Frans , Geurts Alexander CH , Beelen Anita
Published: August 2018

Objective:

To evaluate construct validity and reproducibility of the Functional Gait Assessment (FGA) for measuring walking balance capacity in persons after stroke.

Design:

Cross-sectional study.

Setting:

Inpatient and outpatient rehabilitation center.

Subjects:

Fifty-two persons post-stroke (median (25% and 75% percentiles)) time post-stroke 6 (5–10) weeks) with independent walking ability (mean gait speed 1.1 ± .4 m/s).

Methods:

Subjects completed a standardized FGA twice within one to eight days by the same investigator. Validity was evaluated by testing hypotheses on the association with two timed walking tests, Berg Balance Scale, and the mobility domain of the Stroke Impact Scale using correlation coefficients ( r), and with Functional Ambulation Categories using the Kruskal–Wallis test. Reproducibility of FGA scores was assessed with intraclass correlation coefficient and standard error of measurement.

Results:

Subjects scored a median of 22 out of 30 points at the first FGA. Moderate to high significant correlations ( r .61–.83) and significant differences in FGA median scores between the Functional Ambulation Categories were found. Eight hypotheses (80%) could be confirmed. Inter-rater, intra-rater, and test–retest reliability of the total scores were excellent. The standard error of measurement and minimal detectable change were 2 and 6 points, respectively. No relevant ceiling effect was observed.

Conclusion:

The FGA demonstrated good measurement properties in persons after stroke and yielded no ceiling effect in contrast to other capacity measures. In clinical practice, a measurement error of 6 points should be taken into account in interpreting changes in walking balance.
Dynamic bipedal locomotion over stochastic discrete terrain
Authors: Nguyen Quan , Agrawal Ayush , Martin William , Geyer Hartmut , Sreenath Koushil
Published: August 2018

Owing to their morphology and mechanical design, bipedal robots have the ability to traverse over a wide range of terrain including those with discrete footholds such as stepping stones. This paper addresses the challenge of planar dynamic robotic walking over stochastically generated stepping stones with significant variations in step length and step height, and where the robot has knowledge about the location of the next discrete foothold only one step ahead. Specifically, our approach utilizes a two-step periodic gait optimization technique to build a library of gaits parametrized by their resulting step lengths and step heights, as well as the initial configuration of the robot. By doing so, we address the problems involved during step transition when switching between the different walking gaits. We then use gait interpolation in real-time to obtain the desired gait. The proposed method is successfully validated on ATRIAS, an underactuated, human-scale bipedal robot, to achieve precise footstep placement. With no change in step height, step lengths are varied in the range of [23:78] cm. When both step length and step height are changed, their variation are within [30:65] cm and [−22:22] cm, respectively. The average walking speed of both these experiments is 0.6 m/s.
Active screening of gastrointestinal helminth infection in migrant workers in Thailand
Authors: Kaewpitoon Soraya J , Sangwalee Wararat , Kujapun Jirawoot , Norkaew Jun , Chuatanam Jirayut , Ponphimai Sukanya , Chavengkun Wasugree , Padchasuwan Natnapa , Meererksom Thirayu , Tongtawee Taweesak , Matrakool Likit , Panpimanmas Sukij , Wakkhuwatapong Parichart , Kaewpitoon Natthawut
Published: August 2018

Objective

This study aimed to detect gastrointestinal helminth infection in migrant workers in Thailand.

Methods

A cross-sectional survey study was conducted in 403 migrant workers in the factories of Nakhon Ratchasima Province, northeastern Thailand during October 2016 to June 2017. Gastrointestinal helminth infections were detected by the formalin ether acetate concentration technique and microscopy. The data were analyzed using the χ2-test and logistic regression.

Results

The rate of gastrointestinal helminth infection was 24.07%. The most common species involved in infection was O pisthorchis viverrini (11.91%), followed by hookworm (5.46%), Trichuris trichiura (5.21%), Strongyloides stercoralis (0.5%), Ascaris lumbricoides (0.5%), and Taenia spp. (0.5%). The majority of infections were found in men aged ≥40 years, married participants, uneducated participants, laborers, those who worked for 1 year, and those who had an income of 9000 to 12,000 THB.

Conclusions

Gastrointestinal helminth infection is still found in migrant workers. Therefore, active surveillance is required in this large group for investigating and eradicating this type of infection.
The Law of Levirate and Forced Marriage—Widow vs. Levir in Deuteronomy 25.5–10
Authors: Seidler Ayelet
Published: August 2018

The law of levirate marriage (Deut. 25.5–10) requires the levir to marry his sister-in-law, while at the same time allowing him to be released from this obligation. This article argues that these inherent contradictory trends relate to the fact that the law forces the levir to marry a woman whom he did not choose. This coercion runs counter to the biblical laws of marriage, which predicate marriage and divorce on the man's will. Through a close reading of the law this article seeks to demonstrate the tension reflected between two contradictory values: that of raising up the name of the deceased, on one hand, and a man's right to choose the woman he wishes, on the other. It appears that due to the levir's aversion towards the widow the legislator allows this to prevail over the moral obligation, but does not forgo expressing disapproval of this decision.
Antibiotic stewardship: ripartiamo dalla pratica clinica
Authors: Tascini Carlo
Published: August 2018

Antibiotic stewardship: a milestone in everyday clinical practice

Infectious diseases caused by multi-resistant pathogens are increasing worldwide and are challenging for clinicians, also in urological setting. The alarming situation is worsened by the limited perspective of new antibiotic developments. Several authors demonstrated that in Italy we have alarming data about resistance rates: in Campania about 58% of Escherichia coli are resistant to fluroquinolones, as 46% to sulfamethoxazole-trimethoprim. On the other hand, the resistance rate against fosfomycin is still low less than 5%. More alarming data are reported about Klebsiella pneumoniae: resistance rate to flurquinolones 65% and 58% to sulfamethoxazole-trimethoprim. A continuing uncritical, non-guideline-conform and overuse of antibiotics leads to selection of multidrug-resistant pathogens, which can colonize patients and make the treatment a real challenge. A revision of our approach to urinary tract infections at the light of antibiotic stewardiship principles are urgently required, in particular starting from the everyday clinical practice.
Gender Ideology: For a ‘Third Sex’ Without Reserve
Authors: Loughlin Gerard
Published: August 2018

‘Gender ideology’ is a term used by many, but especially the Vatican, to chastise the view that sexual difference is more than just male and female, sexuality more than desire of the opposite. Each of the three books discussed in this article defends some version of this supposed ideology; each argues—though in different ways—for the need to move beyond a dimorphic account of sexual difference. Their arguments are taken up and deployed against what is here presented as the ideology of sexual dimorphism, as it is seen in the body theology of John Paul II. It is argued that such a theology dehumanises intersexed people, along with homosexuals, and undermines Christian soteriology. The church needs to acknowledge as fully human all who don’t conform to heterosexual dimorphism; it needs to embrace a ‘third sex’ without reserve.
Urban political strategies in times of crisis: A multiscalar perspective on smart cities in Italy
Authors: Smigiel Christian
Published: August 2018

European cities are experiencing a mushrooming of a new urban imagery amid multiple types of crisis. In fact, the ‘smart city’ has become a widely spread vision used by a variety of powerful key actors as well as a top-down urban political strategy that is applied in order to promote new arrangements, models and technologies for almost all policy areas. By using the Italian case as a point of reference, this paper analyses how smart city strategies are institutionalized and embedded in times of crisis on different spatial scales. Therefore, the paper adapts a strategic-relational approach that provides a conceptual framework for understanding the spatial dimension of smart city strategies. It argues that smart city strategies reflect a set of multiscalar political strategies leading to new responsibilities and powers on a local scale, as well as the creation of new state territoriality. Smart cities in Italy are part of metropolitan reforms that strengthen the role of large cities while reproducing existing territorial inequalities. Furthermore, they are used to create new public–private partnerships and new investment opportunities on different spatial scales. In addition, a content analysis of smart city rankings and reports sheds light on the modes of representation of smart city strategies, analysing them as elements of policymaking in times of crisis.
Clinical Management of Bleeding Risk With Antidepressants
Authors: Bixby Alexandra L. , VandenBerg Amy , Bostwick Jolene R.
Published: August 2018

Objective: This nonsystematic review describes risk of bleeding in treatment with serotonin reuptake inhibitors (SRIs) and provide recommendations for the management of patients at risk of bleeding. Data Sources: Articles were identified by English-language MEDLINE search published prior to June 2018 using the terms SRI, serotonin and noradrenaline reuptake inhibitors, OR antidepressive agents, AND hemorrhage OR stroke. Study Selection and Data Extraction: Meta-analyses were utilized to identify information regarding risk of bleeding with antidepressants. Individual studies were included if they had information regarding bleeding risk with specific SRIs, timing of risk, or risk with medications of interest. Data Synthesis: SRIs increase risk of bleeding by 1.16- to 2.36-fold. The risk is synergistic between SRIs and nonsteroidal anti-inflammatory drugs (NSAIDs; odds ratio [OR] range between studies 3.17-10.9). Acid-reducing medications may mitigate risk of gastrointestinal bleeds in chronic NSAIDs and SRI users (OR range between studies 0.98-1.1). Antidepressants with low or no affinity for the serotonin transporter, such as bupropion or mirtazapine, may be appropriate alternatives for patients at risk of bleeding. Relevance to Patient Care and Clinical Practice: This review includes data regarding bleeding risk for specific antidepressants, concomitant medications, and risk related to duration of SRI use. Considerations and evidence-based recommendations are provided for management of SRI users at high bleeding risk. Conclusions: Clinicians must be aware of the risk of bleeding with SRI use, especially for patients taking NSAIDs. Patient education is prudent for those prescribed NSAIDs and SRIs concurrently.
CSF β-amyloid predicts prognosis in patients with multiple sclerosis
Authors: Pietroboni Anna M , Caprioli Michela , Carandini Tiziana , Scarioni Marta , Ghezzi Laura , Arighi Andrea , Cioffi Sara , Cinnante Claudia , Fenoglio Chiara , Oldoni Emanuela , De Riz Milena A , Basilico Paola , Fumagalli Giorgio G , Colombi Annalisa , Giulietti Giovanni , Serra Laura , Triulzi Fabio , Bozzali Marco , Scarpini Elio , Galimberti Daniela
Published: August 2018

Background:

The importance of predicting disease progression in multiple sclerosis (MS) has increasingly been recognized, and hence reliable biomarkers are needed.

Objectives:

To investigate the prognostic role of cerebrospinal fluid (CSF) amyloid beta1–42 (Aβ) levels by the determination of a cut-off value to classify patients in slow and fast progressors. To evaluate possible association with white matter (WM) and grey matter (GM) damage at early disease stages.

Methods:

Sixty patients were recruited and followed up for 3–5 years. Patients underwent clinical assessment, brain magnetic resonance imaging (MRI; at baseline and after 1 year), and CSF analysis to determine Aβ levels. T1-weighted volumes were calculated. T2-weighted scans were used to quantify WM lesion loads.

Results:

Lower CSF Aβ levels were observed in patients with a worse follow-up Expanded Disability Status Scale (EDSS; r = −0.65, p < 0.001). The multiple regression analysis confirmed CSF Aβ concentration as a predictor of patients’ EDSS increase ( r = −0.59, p < 0.0001). Generating a receiver operating characteristic curve, a cut-off value of 813 pg/mL was determined as the threshold able to identify patients with worse prognosis (95% confidence interval (CI): 0.690–0.933, p = 0.0001). No differences in CSF tau and neurofilament light chain (NfL) levels were observed ( p > 0.05).

Conclusion:

Low CSF Aβ levels may represent a predictive biomarker of disease progression in MS.
“You never really know who’s looking”: Imagined surveillance across social media platforms
Authors: Duffy Brooke Erin , Chan Ngai Keung
Published: August 2018

Social media users are routinely counseled to cultivate their online personae with acumen and diligence. But universal prescriptions for impression management may prove for vexing for college students, who confront oft-conflicting codes of normative self-presentation in digital contexts. Against this backdrop, our research sought to examine the online self-presentation activities of emerging adults (18–24) across an expansive social media ecology that included Facebook, Instagram, LinkedIn, Snapchat, and Twitter. Drawing upon in-depth interviews with 28 Fcollege-aged youth, we highlight how the imagined surveillance of various social actors steered their self-presentation practices in patterned ways. After exploring three distinct responses to imagined surveillance—including the use of privacy settings, self-monitoring, and pseudonymous accounts (including “Finstas,” or fake + Instagram)—we consider the wider implications of a cultural moment wherein users are socialized to anticipate the incessant monitoring of social institutions: family, educators, and above all, (future) employers.
Adaptive robust control of quadrotor with a 2-degree-of-freedom robotic arm
Authors: Jiao Ran , Chou Wusheng , Ding Rui , Dong Mingjie
Published: August 2018

The control of quadrotor equipped with a robotic arm has received growing challenges. This article proposes a new adaptive control strategy of quadrotor equipped with a 2-degree-of-freedom robotic arm. To consider the positional variety of the center of gravity caused by the motion of the robotic arm, the kinematic and dynamic models are built. Based on the presented models, a backstepping and sliding mode controller with a terminal sliding mode manifold is first applied to cope with the condition in which the robotic arm is motionless relative to the quadrotor. As the evolvement of the backstepping and sliding mode controller, a novel adaptive backstepping and sliding mode controller is then designed for the vehicle with the robotic arm wavering. The robustness and effectiveness of the proposed control law are investigated through both simulations and flight tests. With the proposed control laws, several simulations are conducted in conditions of both a variable and a constant center of gravity, and the performance of hovering is tested with a variable center of gravity in an experiment. Overall results show that the proposed adaptive backstepping control could estimate and compensate the variable center of gravity which may seriously influence the stabilization of quadrotor flying in the air.
Late-Onset Systemic Lupus Erythematosus With Lupus Nephritis in a 74-Year-Old Male: A Brief Case and Review
Authors: Kutky Meherzad , Aloudat Sarah
Published: August 2018

Rationale:

Late-onset systemic lupus erythematosus (SLE) represents a specific subgroup of SLE, and although there is no strict age cut-off, 50 years is commonly used as the minimum age for disease onset. In this report, we present a case of a 74-year-old male with late-onset SLE and biopsy-proven lupus nephritis (LN).

Presenting concerns of the patient:

A 74-year-old male was referred to the nephrology clinic with a rapidly rising creatinine from a baseline of 60 µmol/L to 176 µmol/L. His labs showed pancytopenia, a positive antinuclear antibodies (ANA), and hypocomplementemia.

Diagnoses:

Renal biopsy showed focal proliferative glomerulonephritis that was immune-mediated and immunofluorescence showed C3, IgM, IgA, IgG, lambda, and C1q diffuse mesangial and glomerular basement membrane staining. Together these findings were in keeping with a diagnosis of stage III LN.

Interventions:

Treatment included hemodialysis and induction with pulse methylprednisone and cyclophosphamide. He was then placed on the Euro-Lupus Protocol.

Outcomes:

One year after the diagnosis, he was off dialysis, had no signs of fluid retention or uremia, and his creatinine had stabilized at ~ 330 µmol/L.

Lessons learned:

To the best of our knowledge, this case represents the oldest known biopsy-confirmed case of late-onset SLE and LN. Late-onset SLE is uncommon and often overlooked as classical symptoms such as malar rash or photosensitivity may not be present. The American College of Rheumatology (ACR) guidelines for treatment of LN can be applied to these patients but physicians should be cognizant of the fact that these patients may not tolerate immunosuppressive therapy as well as younger patients.
Access to Higher Education of Afro-Peruvians: Disentangling the Influence of Skin Color and Social Origins in the Peruvian Stratification System
Authors: Benavides Martin , León Juan , Galindo Claudia , Herring Cedric
Published: August 2018

Despite recent efforts by the Peruvian government to rectify centuries of injustice against Afro-Peruvians, not much is known about the relative influence of discrimination and social origins on Afro-Peruvians’ access to higher education. Using data from the 2014 Specialized Study of Afro-Peruvian Population and logistic regression, the authors examine the influence of skin color and social origins on access to higher education for Afro-Peruvians. The results suggest that after controlling for individual and contextual indicators, the darkest Afro-Peruvians had significantly lower odds of accessing higher education than the lightest Afro-Peruvians. In addition, Afro-Peruvians whose mothers enrolled in secondary education or beyond had higher odds of accessing higher education than those whose mothers only attained primary education or less. More important, there was an interaction effect between skin color and social origins such that differences in access to higher education between darkest and the lightest Afro-Peruvians were observed only for those whose mothers had obtained secondary or a higher degrees and not for those whose mothers completed primary school or less. The effects of colorism persisted mainly in higher social status contexts.
Increased Dental Use May Affect Changes in Treated and Untreated Dental Caries in Young Children
Authors: Lin M. , Thornton-Evans G. , Griffin S.O. , Wei L. , Junger M. , Espinoza L.
Published: August 2018

Introduction:

From 1999–2004 to 2011–2014, untreated dental caries prevalence decreased among US children aged 2 to 5 y, regardless of family income. Policies were concurrently initiated for children to increase access to preventive dental services in dental, primary, and community settings and to restorative care in dental settings.

Objectives:

We aimed to examine 1) whether changes in prevalence and severity of untreated and treated caries between the periods varied by family income and 2) to what degree increased past-year dental visit (PYDV) contributed to the changes.

Methods:

We used data for 3,822 children in the National Health and Nutrition Examination Survey 1999 to 2004 and 2011 to 2014. Caries prevalence included prevalence of untreated caries with ≥1 decayed teeth (dt) and prevalence of treated caries with ≥1 filled teeth (ft). Caries severity included number of dt and ft among those with ≥1 dt or ft. We estimated changes in caries outcomes among low- and higher-income children with models—one controlling for sociodemographics and another controlling for sociodemographics and PYDV. Significant changes ( P < 0.05) becoming insignificant after controlling for PYDV provide insight on the contribution of PYDV to changes in outcomes.

Results:

Prevalence of untreated caries decreased for low- and higher-income children, with a slightly larger decrease for low-income children; dt decreased only for low-income children; and estimated decreases did not vary by model. An increase in prevalence of treated caries was observed only among low-income children but became minimized and insignificant after controlling for PYDV. Similarly, after controlling for PYDV, the increase in ft among low-income children lost significance, whereas the increase among higher-income children remained.

Conclusion:

Untreated caries among children aged 2 to 5 y declined from 1999–2004 to 2011–2014, with larger declines among low-income children. While changes in PYDV contributed to increases in treated caries, particularly for low-income children, additional factors appear to have contributed to decreased untreated caries.

Knowledge Transfer Statement:

For young children, the degree and direction of changes in caries over the last decade varied by outcome measure (e.g., untreated or treated) and family poverty status. Examining the effect of increased dental utilization on changes in untreated and treated caries outcomes can help identify those policies that contribute to changes in these outcomes and highlight the potential role of the different caries assessment criteria used in dental offices versus those in a population-based survey.
The cost of shift work: Absenteeism in a large German automobile plant
Authors: Frick Bernd , Simmons Robert , Stein Friedrich
Published: August 2018

Using a balanced panel of some 400 organizational units in a large automobile plant, we analyse changes in absenteeism following a company innovation intended to improve worker health and well-being. During the period under consideration (January 2009–December 2011) the firm replaced its traditional shift schedule associated with high health risks for workers with an ergonomically more advantageous system. Our findings show that this innovation was accompanied by a statistically significant and economically relevant decrease in absenteeism. However, when workers started to express discontent with the new system, management after a few months implemented another shift system that was, from an ergonomical perspective, again associated with higher health risks than those associated with the second one. Absentee figures quickly returned to their initial levels. This suggests that short-term leisure preferences can override long-term health concerns in worker responses to the implementation of different shift schedules.
Optimizing psychotherapy dosage for comorbid depression and personality disorders (PsyDos): a pragmatic randomized factorial trial using schema therapy and short-term psychodynamic psychotherapy
Authors: Kool Marit , Van Henricus L. , Bartak Anna , de Maat Saskia C. M. , Arntz Arnoud , van den Eshof Johanna W. , Peen Jaap , Blankers Matthijs , Bosmans Judith E. , Dekker Jack J. M.
Published: August 2018

Background

Patients with comorbid depression and personality disorders suffer from a heavy disease burden while tailored treatment options are limited, accounting for a high psychological and economic burden. Little is known about the effect of treatment dosage and type of psychotherapy for this specific co-morbid patient population, in terms of treatment-effect and cost-effectiveness. This study aims to compare treatment outcome of 25 versus 50 individual therapy sessions in a year. We expect the 50-session condition to be more effective in treating depression and maintaining the effect. Secondary objectives will be addressed in order to find therapy-specific and non-specific mechanisms of change.

Methods

In a mono-center pragmatic randomized controlled trial with a 2 × 2 factorial design, 200 patients with a depressive disorder and personality disorder(s) will be included. Patients will be recruited from a Dutch mental health care institute for personality disorders. They will be randomized over therapy dosage (25 vs 50 sessions in a year) and type of therapy (schema therapy vs short-term psychodynamic supportive psychotherapy). The primary clinical outcome measure will be depression severity and remission. Changes in personality functioning and quality of life will be investigated as secondary outcomes. A priori postulated effect moderators and mediators will be collected as well. All patients are assessed at baseline and at 1, 2, 3, 6, 9–12 months (end of therapy) and at follow up (6 and 12 months after end of treatment). Alongside the trial, an economic evaluation will be conducted. Costs will be collected from a societal perspective.

Discussion

This trial will be the first to compare two psychotherapy dosages in patients with both depression and personality disorders. Insight in the effect of treatment dosage for this patient group will contribute to both higher treatment effectiveness and lower costs. In addition, this study will contribute to the limited evidence base on treating patients with both depression and personality disorders. Understanding the processes that account for the therapeutic changes could help to gain insight in what works for whom.

Trial registration

This trial has been registered on July 20th 2016, Netherlands Trial Register, part of the Dutch Cochrane Centre (NTR5941).
The Assessment of Negative and Positive Features in Schizophrenia
Authors: Johnstone Eve C.
Published: August 2018

It has become customary to classify the typical abnormalities of the mental state of schizophrenic patients into positive and negative features, with reference to behavioural excesses and deficits. Positive features are pathological by their presence and negative features represent the loss of some normal function. Positive features are generally considered to include delusions, hallucinations and positive formal thought disorder (Fish, 1962). Some studies (e.g. Johnstone et al, 1978) have also included incongruity of affect under this heading. Negative features include affective flattening, poverty of speech, retardation, apathy, lack of sociability. There is some evidence that the clinical correlates of positive and negative features may not be the same (Owens & Johnstone, 1980). Some workers (Andreasen & Olsen, 1982) but not others (Pogue-Geile & Harrow, 1984) have found that among schizophrenic patients positive and negative symptoms were negatively correlated. Although the nature of the relationship between positive and negative features is not entirely established and may not be simple (Wing, 1978) certain generalisations may be applied:

(a)

Positive features are characteristic of earlier and negative of later phases of the illness (Pfohl & Winokur, 1982).

(b)

The effects of drugs upon positive features are greater than those upon negative features. Thus neuroleptics produce more marked improvement (Johnstone et al, 1978; Angrist et al, 1980) and amphetamine more marked exacerbation (Angrist et al, 1980) of positive than of negative features.

(c)

Positive features have been said to be relatively variable and negative features relatively stable (Ovchinnikov, 1968; Snezhnevsky, 1968).
The Manchester Scale
Authors: Hyde Clive E.
Published: August 2018

The Manchester Scale (Krawiecka et al, 1977) was developed as a short, easy to administer instrument, sensitive to change, for screening patients with chronic psychosis.
II. Impairments in Schizophrenics in Cross-sectional and Longitudinal Perspective — The Mannheim Experience in Two Independent Samples
Authors: Biehl Hugo , Maurer Kurt , Jung Eleonore , Krumm Bertram
Published: August 2018

Trimble (1986) has pointed out a shortcoming of the current wave of literature on negative symptoms: there is no overall consensus within psychiatry as to which symptoms and signs are to be considered positive and which negative (Kayton, 1973; Carpenter et al, 1976; Sheldrich et al, 1977; WHO, 1979; Andreasen, 1979; Jablensky, 1981; Crow, 1982, this volume; Rosen et al, 1984; Zubin, 1985; Kulhara et al, 1986).
Emerging Issues in Medical Ethics
Authors: Nadelson Carol C.
Published: August 2018

Ethical principles are influenced by personal values and beliefs, and by societal context. They are not immutable. In medicine, as new technologies have developed and changes in health-care delivery have resulted, historically held views about the responsibilities, obligations and relationships between health-care providers and patients have been challenged.
Evaluating the Transfer of Care from Psychiatric Hospitals to District-Based Services
Authors: Leff Julian
Published: August 2018

In July 1983 the Regional Medical Officer of the North East Thames Regional Health Authority (NETRHA) appeared on television to announce the closure of Claybury Hospital and much of Friern Hospital over a ten-year period.

When NETRHA announced its decision, the policy to be pursued was innovative because it involved psychiatric hospitals serving inner-city populations, and because there was apparently no intention to achieve its aim by decanting patients into other psychiatric hospitals, as had been done with the closures of St Wulstan's and Banstead Hospitals. Although the run-down of psychiatric hospitals had been occurring at a steady rate in the United States and in England and Wales since the early 1950s, there had been few attempts to evaluate the policy, and none had been in any sense comprehensive (this supplement, paper 7). Clinicians and research workers in the field of social psychiatry were well aware of the need for large-scale evaluative studies, since protagonists and opponents of the policy of deinstitutionalisation were locked in a polemical argument which was pursued with increasing stridency through lack of reliable information.
Cost Management: The Economist's Viewpoint
Authors: Maynard Alan
Published: August 2018

The role of the economist is to evaluate therapeutic options so as to identify both the value of what is given up to provide care (the cost) and the value of what is gained, in terms of improved health status (the benefit). The function of the economic evaluation is to inform choices: these will be determined by clinicians and managers. By informing the choice process, the economic calculus makes decisionmaking more ‘transparent’ and makes those who allocate resources more accountable to their peers, purchasers, and patients.
Debits and Credits in the Management of Depression
Authors: Henry John A.
Published: August 2018

Concern over the cost of health care is playing an increasing role in Great Britain, but evaluation of benefit is generally inadequate. This is particularly true in the case of depression, for which the cost of drugs is 1.9% of the National Health Service pharmaceutical budget. Since differences in effectiveness between antidepressant drugs are difficult to demonstrate, quality-of-life studies may help to identify outcome differences. At present, the worst outcome of depressive illness - suicide - absolves carers from further costs. An assessment is needed which takes into account both the direct and indirect costs of depression; this should include the costs of investment into improving diagnosis. Even without financial analyses, it is clear that some cases of suicide can be prevented by prescribing less toxic drugs, but research is needed to investigate whether use of these drugs also reduces the costs of overdose.
Conclusion
Authors: Beaumont George
Published: August 2018

Antidepressants, as the term is currently understood, were introduced into clinical practice in the late 1950s. The first of these was imipramine, shortly to be followed by amitriptyline and then by a series of related compounds - all chemically ‘tricyclics’. These subsequently became known as the ‘first-generation’ antidepressants; imipramine and amitriptyline in particular have since become the standards against which others have been compared.
Dopamine Receptors and Antipsychotic Drug Response
Authors: Sunahara Roger K. , Seeman Philip , Tol Hubert H. M. Van , Niznik Hyman B.
Published: August 2018

Dopamine receptors have been divided into two major types – D1and D2– based primarily on pharmacological and biochemical criteria. Recent advances in the molecular biology of the dopamine receptor system have allowed the identification and characterisation of at least five distinct neuronal dopamine receptor genes (D1to D5). These genes encode dopamine receptors belonging to the D1receptor family, termed D1and D5, and three D2-like receptors, termed D2, D3and D4. These receptors are distinguished on the basis of their primary structure, chromosomal location, mRNA size and tissue distribution, and biochemical and pharmacological differences. Although individually these receptor subtypes may not be directly and exclusively involved in the maintenance or expression of schizophrenia, alterations of any of the receptors may contribute to the perturbation or instability of dopaminergic homeostasis in the brain. What was once thought to be a simple two-receptor system seems to have emerged as an intricate and interactive entity. This review summarises what is currently understood about dopamine receptors, their role in antipsychotic drug action, and their association with psychosis.
Methodological and Design Issues in Clinical Trials of New Neuroleptics: an Overview
Authors: Awad A. George
Published: August 2018

The recent development of new neuroleptics that differ from the conventional neuroleptics in both mechanism of action and side-effects profile has introduced problems in their clinical assessment, and highlighted ongoing issues in the design and methodology of clinical trials. These issues are broadly grouped and discussed as follows: sampling problems and selection of patients; design issues; problems in measurement; ensuring compliance; recognition of extrapharmacological issues; and statistical models. For patients to benefit from the development of new neuroleptics, clinical settings have to be prepared for testing their efficacy and safety without too much delay in well designed clinical trials.
Reducing Dosage in Maintenance Treatment of Schizophrenia
Authors: Schooler Nina R.
Published: August 2018

This paper reviews the assumptions and efficacy of two strategies for dose reduction during maintenance treatment in schizophrenia: low dose and targeted medication. Studies of low-dose treatment suggest that it can be used for relatively short periods of time or if the dosage reduction is moderate. Studies of targeted treatment suggest that relapse risk increases significantly compared with standard-dose treatment and that there are few offsetting advantages. The paper also reports initial findings from the NIMH Treatment Strategies in Schizophrenia Study, which compares low dose, targeted treatment and a standard dose in the context of two forms of family treatment. Early stabilisation of patients is lower than expected, but patient characteristics are useful in predicting likelihood of stabilisation.
Biological Factors in Schizophrenia Structural and Functional Aspects
Authors: Syvälahti E. K. G.
Published: August 2018

A number of factors have been proposed as being linked to schizophrenia: genetic, psychological, endocrinological, metabolic, environmental, virological, and auto-immunological factors, as well as neurotransmitter systems and structural disorders of the brain. All may act as predisposing, triggering, or functionally modulating factors in what is probably a condition composed of several types of disorder with varying aetiology. Neuroanatomical and neuromorphological data have revealed ventricular enlargement and diminished frontal and temporal lobe volume in some patients. These changes are concentrated particularly in the hippocampus/parahippocampal gyrus/amygdala, but are relatively small and span some overlap with healthy subjects. Twin studies suggest that at least some of these changes may result from other than genetic factors. Functional disturbances of the brain have also been connected with frontal and temporal structures in some schizophrenic patients. Of the single neurotransmitter substances, dopamine and serotonin appear to represent some of the central restitutive mechanisms whose function is to maintain mental stability; the understanding of their interplay with other neurotransmitters such as noradrenaline, acetylcholine, GABA, and glutamate, should provide a more integrated view of both normal and disturbed brain function.
Prenatal Factors in the Pathogenesis of Schizophrenia
Authors: Huttunen Matti O. , Machon Ricardo A. , Mednick Sarnoff A.
Published: August 2018

The excess of winter–spring births among individuals suffering from schizophrenia provides strong evidence for the existence of some prenatally occurring factors in the pathogenesis of schizophrenia. Recent epidemiological findings suggest that maternal viral infections during the second trimester of pregnancy may play a crucial role in the aetiology of adult schizophrenia. A ‘two-hit window’ hypothesis of the mechanism of action of prenatal factors in the pathogenesis of schizophrenia suggests at least two time-specific prenatal aetiological events. The observed association between prenatal viral infection and increased incidence of adult schizophrenia need not be a direct cytotoxic result of the viral infection, but may be caused indirectly, for example from foetal minor cerebral haemorrhages produced by the anticoagulant effects of aspirin.
The Epidemiology of Early Schizophrenia
Authors: Häfner H. , Maurer K. , Löffler W. , Fätkenheuer B. , Heiden W. An Der , Riecher-Rössler A. , Behrens S. , Gattaz W. F.
Published: August 2018

For the investigation of the early course of schizophrenia starting from onset, the standardised Interview for the Retrospective Assessment of the Onset of Schizophrenia was developed and validated. In a representative sample of 267 first-admitted German schizophrenics of a broad diagnosis from a population of 1.5 million, the age at which different diagnostic and onset definitions were satisfied, the symptoms at the time of the interview, and the accumulation of positive and negative symptoms until first admission were assessed. Comparison between the two sexes and three age groups yielded hardly any differences in the accumulation of symptoms and their course until first admission, except for a slightly shorter period of negative symptoms in young males and a slightly longer one in older women – which contradicts prevailing opinion. At the time of the interview, no significant sex differences were found with respect to the core symptoms of schizophrenia (negative and first-rank symptoms), but clear and substantial differences emerged in disease behaviour. The significantly higher age at first onset in women is explained, on the basis of animal experiments and a clinical study, by the neuromodulatory effect of oestrogen on D2receptors and by a higher vulnerability threshold in women.
Effect of an Open-Door Policy Combined with a Structured Activity Programme on the Residual Symptoms of Schizophrenic In-Patients
Authors: Jin Zhengshu
Published: August 2018

Fifty female schizophrenic patients on the same locked ward were randomly assigned to experimental and control groups. Experimental group subjects were given as much autonomy and freedom as possible (they were permitted to leave the ward at will) and were encouraged to take part in collective activities. The control group were not permitted to leave the ward and did not take part in these activities. All patients were evaluated at enrolment and after six months – using Chinese versions of the Scale for Assessment of Negative Symptoms and the Brief Psychiatric Rating Scale – by psychiatrists who were blind to patients' treatment status. After the six-month intervention the severity of all types of both negative and positive symptoms and the mean dosage of medication in the experimental group were significantly less than in the control group.
A Rating Instrument for the Evaluation of In-Patient Rehabilitation Programmes in China
Authors: Li Gongan , Hu Xiong , Jin Dezhen , Tian Weicai , Phillips Michael R.
Published: August 2018

To objectively evaluate in-patient rehabilitation programmes in China, we developed a new rating scale: the Inpatient Psychiatric Rehabilitation Outcome Scale (IPROS). The scale has five subscales: performance in occupational therapy, daily activities, socialisation, personal hygiene, and level of interest in external events. Evaluators (physicians or nurses) observe patients for one week before coding items on a five-point scale. Comparison of four independent evaluators' results for 32 schizophrenic patients assessed on two separate occasions indicated that the inter-rater and test-retest reliability for the overall IPROS score and for the five subscale scores was excellent (all ICC values ≥0.973). Validity was evaluated by comparing IPROS results with those of five other independently assessed clinical measures for 101 chronic schizophrenic patients before and after a six-month rehabilitation programme; concurrent validity and longitudinal validity were satisfactory (correlation coefficients 0.37–0.81, all P values <0.01).