Abstract
Background
Schizophrenia and related disorders are highly disabling and create substantial burdens for families, communities, and health care systems. Although pharmacological treatments can ...often lessen the psychotic symptoms that are a hallmark of schizophrenia, they do not lessen the social and cognitive deficits that create the greatest impediments to community engagement and functional recovery. This study builds on prior research on psychosocial rehabilitation by comparing the effectiveness of two treatments demonstrated as efficacious in improving social and community functioning, Cognitive Enhancement Therapy (CET) and a version of Social Skills Training (HOPES/SST).
Methods
The study uses a randomized cluster design in which a pair of clinicians at community- and hospital-based mental service centers deliver either CET or HOPES to at least one group of 6-8 eligible clients for 12 months. Clinicians are trained and then supervised weekly, with ongoing process measurement of treatment fidelity, attendance, satisfaction, and retention, and use of other services. Measures administered at baseline and at 6 and 12 months while in treatment, and then at 18 and 24 months after treatment include social adjustment, quality of life, social skills, positive and negative symptoms, and neuro- and social cognition. We hypothesize that CET will be associated with greater improvements than SST in both the primary outcome of community functioning and the secondary outcomes of neuro- and social cognition and social skills. Secondarily, we hypothesize that more cognitive impairment at baseline and younger age will predict more benefit from CET compared to HOPES.
Discussion
Resource shortages endemic in mental health services and exacerbated by the pandemic highlight the importance of identifying the most effective approach to improving social and community functioning. We aim to improve understanding of the impact of two efficacious psychosocial treatments and to improve clinicians’ ability to refer to both treatments the individuals who are most likely to benefit from them. We expect the result to be programmatic improvements that improve the magnitude and durability of gains in community functioning.
Trial registration
ClinicalTrial.gov
NCT04321759
, registered March 25, 2020.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
Objective
The clinical decision-making process in paediatric arthritis lacks an objective, reliable bedside imaging tool. The aim of this study was to develop a US scanning protocol and ...assess the reliability of B-mode and Doppler scoring systems for inflammatory lesions of the paediatric ankle.
Methods
As part of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) US group, 19 paediatric rheumatologists through a comprehensive literature review developed a set of standardized views and scoring systems to assess inflammatory lesions of the synovial recesses as well as tendons of the paediatric ankle. Three rounds of scoring of still images were followed by one practical exercise. Agreement among raters was assessed using two-way single score intraclass correlation coefficients (ICC).
Results
Of the 37 initially identified views to assess the presence of ankle synovitis and tenosynovitis, nine views were chosen for each B-mode and Doppler mode semi-quantitative evaluation. Several scoring exercises and iterative modifications resulted in a final highly reliable scoring system: anterior tibiotalar joint ICC: 0.93 (95% CI 0.92, 0.94), talonavicular joint ICC: 0.86 (95% CI 0.81, 0.90), subtalar joint ICC: 0.91 (95% CI 0.88, 0.93) and tendons ICC: 0.96 (95% CI 0.95, 0.97).
Conclusion
A comprehensive and reliable paediatric ankle US scanning protocol and scoring system for the assessment of synovitis and tenosynovitis were successfully developed. Further validation of this scoring system may allow its use as an outcome measure for both clinical and research applications.
Musculoskeletal ultrasound (MSUS) is increasingly being used in the evaluation of pediatric musculoskeletal diseases. In order to provide objective assessments of arthritis, reliable MSUS scoring ...systems are needed. Recently, joint-specific scoring systems for arthritis of the pediatric elbow, wrist, and finger joints were proposed by the Childhood Arthritis and Rheumatology Research Alliance (CARRA) MSUS workgroup. This study aimed to assess the reliability of these scoring systems when used by sonographers with different levels of expertise.
Members of the CARRA MSUS workgroup attended training sessions for scoring the elbow, wrist, and finger. Subsequently, scoring exercises of B mode and power Doppler (PD) mode still images for each joint were performed. Interreader reliability was determined using 2-way single-score intraclass correlation coefficients (ICCs) for synovitis and Cohen Formula: see text for tenosynovitis.
Seventeen pediatric rheumatologists with different levels of MSUS expertise (1-15 yrs) completed a 2-hour training session and calibration exercise for each joint. Excellent reliability (ICC > 0.75) was found after the first scoring exercise for all the finger and elbow views evaluated on B mode and PD mode, and for all of the wrist views on B mode. After a second training session and a scoring exercise, the wrist PD mode views reached excellent reliability as well.
The preliminary CARRA MSUS scoring systems for assessing arthritis of the pediatric elbow, wrist, and finger joints demonstrate excellent reliability among pediatric MSUS sonographers with different levels of expertise. With further validation, this reliable joint-specific scoring system could serve as a clinical tool and scientific outcome measure.
There exists limited understanding of the long-term dynamics of the seagrass Zostera noltii and how this is influenced by anthropogenic pressures. Milford Haven is a heavily industrialised estuary ...and also one of the important sites for Zostera sp. in the UK. In this study we examine all available long-term spatial variability and abundance data of Zostera noltii within Milford Haven using historic datasets. Results show that Z. noltii in all sites have shown meadow expansion when compared to the first obtainable records. Little change in abundance over the past 10–15years for the two sites confirms certain seagrass populations to be robust and thriving. We hypothesise that these populations are showing a level of resilience to the high nutrient levels, disturbance and high turbidity present within the water column of the Haven.
Photodissociation of Propargyl Chloride at 193 nm McCunn, Laura R; Bennett, Doran I. G; Butler, Laurie J ...
The journal of physical chemistry. A, Molecules, spectroscopy, kinetics, environment, & general theory,
01/2006, Letnik:
110, Številka:
3
Journal Article
Recenzirano
The photodissociation of propargyl chloride (C3H3Cl) has been studied at 193 nm. Ion imaging experiments with state-selective detection of the Cl atoms and single-photon ionization of the C3H3 ...radicals were performed, along with measurements of the Cl + C3H3 and HCl + C3H2 recoil kinetic energy distributions, using a scattering apparatus with electron bombardment ionization detection to resolve the competing Cl and HCl elimination channels. The experiments allow the determination of the Cl (2P3/2) and Cl (2P1/2) (hereafter Cl*) branching fractions associated with the C−Cl bond fission, which are determined to be 0.5 ± 0.1 for both channels. Although prior translational spectroscopy studies by others had concluded that the low velocity signal at the Cl+ mass was due to daughter fragments of the HCl elimination products, the present work shows that Cl atoms are produced with a bimodal recoil kinetic energy distribution. The major C−Cl bond fission channel, with a narrow recoil kinetic energy distribution peaking near 40 kcal/mol, produces both Cl and Cl*, whereas the minor (5%) channel, partitioning much less energy to relative kinetic energy, produces only ground spin−orbit state Cl atoms. The maximum internal energy of the radicals produced in the low-recoil-kinetic-energy channel is consistent with this channel producing electronically excited propargyl radicals. Finally, in contrast to previous studies, the present work determines the HCl recoil kinetic energy distribution and identifies the possible contribution to this spectrum from propargyl radicals cracking to C3 + ions in the mass spectrometer.
Abstract
A nationwide tuberculosis outbreak linked to a viable bone allograft product contaminated with Mycobacterium tuberculosis was identified in June 2021. Our subsequent investigation identified ...73 healthcare personnel with new latent tuberculosis infection following exposure to the contaminated product, product recipients, surgical instruments, or medical waste.
This article is the last in the series focusing on long-term conditions. It explores the educational needs and preparation of district nurses in order to meet the drive to efficiently and effectively ...care for people with long-term conditions in the home setting. It encompasses the findings of a small scale exploratory study conducted with district nurses from one PCT. The findings reveal a well informed and flexible workforce who value their core skills, some of whom are already adopting case management principles in their daily activities. However, the district nurses also expressed feelings of immense insecurity and change associated with their role. Educational deficits relating to long-term conditions and district nurses were discovered, indicating that educational and clinical leadership is paramount in order to meet the needs of this group of patients.
