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This chapter describes Psychosis Identification and Early Referral (PIER), a clinical and public health system for identifying, treating, and rehabilitating young people at risk for major psychosis and psychotic disorders. A specialized clinical team educates key sectors of the community in identifying very early signs and symptoms of a likely psychosis in youth ages 10–25. The team then rigorously assesses those referred and found at risk and provides family-aided assertive community treatment. This model was originally developed for schizophrenia in young adults, and it has been adapted for the much younger and less seriously symptomatic and disabled at-risk population. The model includes flexible, in-vivo clinical treatment, family psychoeducation, cognitive-behavioral therapy, occupational therapy, supported education and supported employment, and psychiatric and nursing care. PIER has been tested across six population-representative sites in the United States; within testing periods, very few participating youths have experienced psychosis and about 90 percent are in school or working. It has been replicated widely enough that it is available to over 15 percent of the US population.
This national pre-pandemic survey compared demand and capacity of adult community eating disorder services (ACEDS) with NHS England (NHSE) commissioning guidance.
Results
Thirteen services in England and Scotland responded (covering 10.7 million population). Between 2016–2017 and 2019–2020 mean referral rates increased by 18.8%, from 378 to 449/million population. Only 3.7% of referrals were from child and adolescent eating disorder services (CEDS-CYP), but 46% of patients were aged 18–25 and 54% were aged >25. Most ACEDS had waiting lists and rationed access. Many could not provide full medical monitoring, adapt treatment for comorbidities, offer assertive outreach or provide seamless transitions. For patient volume, the ACEDS workforce budget was 15%, compared with the NHSE workforce calculator recommendations for CEDS-CYP. Parity required £7 million investment/million population for the ACEDS.
Clinical implications
This study highlights the severe pressure in ACEDS, which has increased since the COVID-19 pandemic. Substantial investment is required to ensure NHS ACEDS meet national guidance, offer evidence-based treatment, reduce risk and preventable deaths, and achieve parity with CEDS-CYP.
Experience gained from responding to major outbreaks may have influenced the early coronavirus disease-2019 (COVID-19) pandemic response in several countries across Africa. We retrospectively assessed whether Guinea, Liberia and Sierra Leone, the three West African countries at the epicentre of the 2014–2016 Ebola virus disease outbreak, leveraged the lessons learned in responding to COVID-19 following the World Health Organization's (WHO) declaration of a public health emergency of international concern (PHEIC). We found relatively lower incidence rates across the three countries compared to many parts of the globe. Time to case reporting and laboratory confirmation also varied, with Guinea and Liberia reporting significant delays compared to Sierra Leone. Most of the selected readiness measures were instituted before confirmation of the first case and response measures were initiated rapidly after the outbreak confirmation. We conclude that the rapid readiness and response measures instituted by the three countries can be attributed to their lessons learned from the devastating Ebola outbreak, although persistent health systems weaknesses and the unique nature of COVID-19 continue to challenge control efforts.
An accurate estimate of the average number of hand hygiene opportunities per patient hour (HHO rate) is required to implement group electronic hand hygiene monitoring systems (GEHHMSs). We sought to identify predictors of HHOs to validate and implement a GEHHMS across a network of critical care units.
Design:
Multicenter, observational study (10 hospitals) followed by quality improvement intervention involving 24 critical care units across 12 hospitals in Ontario, Canada.
Methods:
Critical care patient beds were randomized to receive 1 hour of continuous direct observation to determine the HHO rate. A Poisson regression model determined unit-level predictors of HHOs. Estimates of average HHO rates across different types of critical care units were derived and used to implement and evaluate use of GEHHMS.
Results:
During 2,812 hours of observation, we identified 25,417 HHOs. There was significant variability in HHO rate across critical care units. Time of day, day of the week, unit acuity, patient acuity, patient population and use of transmission-based precautions were significantly associated with HHO rate. Using unit-specific estimates of average HHO rate, aggregate HH adherence was 30.0% (1,084,329 of 3,614,908) at baseline with GEHHMS and improved to 38.5% (740,660 of 1,921,656) within 2 months of continuous feedback to units (P < .0001).
Conclusions:
Unit-specific estimates based on known predictors of HHO rate enabled broad implementation of GEHHMS. Further longitudinal quality improvement efforts using this system are required to assess the impact of GEHHMS on both HH adherence and clinical outcomes within critically ill patient populations.
Fama, or fame, is a central concern of late medieval literature. Where fame came from, who deserved it, whether it was desirable, how it was acquired and kept were significant inquiries for a culture that relied extensively on personal credit and reputation. An interest in fame was not new, being inherited from the classical world, but was renewed and rethought within the vernacular revolutions of the later Middle Ages. The work of Geoffrey Chaucer shows a preoccupation with ideas on the subject of fama, not only those received from the classical world but also those of his near contemporaries; via an engagement with their texts, he aimed to negotiate a place for his own work in the literary canon, establishing fame as the subject-site at which literary theory was contested and writerly reputation won. Chaucer's place in these negotiations was readily recognized in his aftermath, as later writers adopted and reworked postures which Chaucer had struck, in their own bids for literary place. This volume considers the debates on fama which were past, present and future to Chaucer, using his work as a centre point to investigate canon formation in European literature from the late Middle Ages and into the Early Modern period. Isabel Davis is Senior Lecturer in Medieval Literature at Birkbeck, University of London; Catherine Nall is Senior Lecturer in Medieval Literature at Royal Holloway, University of London. Contributors: Joanna Bellis, Alcuin Blamires, Julia Boffey, Isabel Davis, Stephanie Downes, A.S.G. Edwards, Jamie C. Fumo, Andrew Galloway, Nick Havely, Thomas A. Prendergast, Mike Rodman Jones, William T. Rossiter, Elizaveta Strakhov.
Reward Deficiency Syndrome (RDS) is an umbrella term for all drug and nondrug addictive behaviors, due to a dopamine deficiency, “hypodopaminergia.” There is an opioid-overdose epidemic in the USA, which may result in or worsen RDS. A paradigm shift is needed to combat a system that is not working. This shift involves the recognition of dopamine homeostasis as the ultimate treatment of RDS via precision, genetically guided KB220 variants, called Precision Behavioral Management (PBM). Recognition of RDS as an endophenotype and an umbrella term in the future DSM 6, following the Research Domain Criteria (RDoC), would assist in shifting this paradigm.
Natural samples of the substituted basic Cu(II) chloride series, Cu4–xMx2+(OH)6Cl2(M = Zn, Ni, or Mg) were investigated by single-crystal X-ray diffraction in order to elucidate compositional boundaries associated with paratacamite and its congeners. The compositional ranges examined are Cu3.65Zn0.35(OH)6Cl2 – Cu3.36Zn0.64(OH)6Cl2 and Cu3.61Ni0.39(OH)6Cl2 – Cu3.13Ni0.87(OH)6Cl2, along with a single Mg-bearing phase. The majority of samples studied have trigonal symmetry (R3̄m) analogous to that of herbertsmithite (Zn) and gillardite (Ni), with a ≈ 6.8, c ≈ 14.0 Å. Crystallographic variations for these samples caused by composition are compared with both published and new data for the R3̄m sub-cell of paratacamite, paratacamite-(Mg) and paratacamite-(Ni). The observed trends suggest that the composition of end-members associated with the paratacamite congeners depend upon the nature of the substituting cation.
Oxyspirura petrowi is a heteroxenous parasitic nematode that has been reported in high prevalences from birds in the Order Galliformes experiencing population declines in the USA. There is a paucity of information regarding the natural history O. petrowi, including the life cycle and effects of infection on wild bird populations. In order to study the life cycle of this parasite, we collected plains lubber grasshoppers (Brachystola magna) from a field location in Mitchell County, Texas. We found third-stage larvae (L3) in 37.9% (66/174) B. magna. We determined that they were O. petrowi through morphological comparison of L3 from experimentally infected Acheta domesticus and by sequence analysis. Then, we showed that B. magna are a potential intermediate hosts for O. petrowi infections in northern bobwhites (Colinus virginianus) in a laboratory setting by experimental infection. We first detected shedding of eggs in feces using a fecal float technique 52 days post infection. In addition, we recovered 87 O. petrowi from experimentally infected northern bobwhites. Although we detected shedding in feces, recovery of eggs was low (>5 eggs/g). Future work is needed to understand shedding routes and shedding patterns of northern bobwhites infected with O. petrowi.
Edited by
Isabel Davis, Senior Lecturer in Medieval Literature at Birkbeck, University of London,Catherine Nall, Senior Lecturer in Medieval Literature at Royal Holloway, University of London
Edited by
Isabel Davis, Senior Lecturer in Medieval Literature at Birkbeck, University of London,Catherine Nall, Senior Lecturer in Medieval Literature at Royal Holloway, University of London
Edited by
Isabel Davis, Senior Lecturer in Medieval Literature at Birkbeck, University of London,Catherine Nall, Senior Lecturer in Medieval Literature at Royal Holloway, University of London
Edited by
Isabel Davis, Senior Lecturer in Medieval Literature at Birkbeck, University of London,Catherine Nall, Senior Lecturer in Medieval Literature at Royal Holloway, University of London
Edited by
Isabel Davis, Senior Lecturer in Medieval Literature at Birkbeck, University of London,Catherine Nall, Senior Lecturer in Medieval Literature at Royal Holloway, University of London
Edited by
Isabel Davis, Senior Lecturer in Medieval Literature at Birkbeck, University of London,Catherine Nall, Senior Lecturer in Medieval Literature at Royal Holloway, University of London
Edited by
Isabel Davis, Senior Lecturer in Medieval Literature at Birkbeck, University of London,Catherine Nall, Senior Lecturer in Medieval Literature at Royal Holloway, University of London
Edited by
Isabel Davis, Senior Lecturer in Medieval Literature at Birkbeck, University of London,Catherine Nall, Senior Lecturer in Medieval Literature at Royal Holloway, University of London
Finland's March 2003 general election saw Anneli Jäätteenmäki lead her opposition Centre Party to a narrow victory over Prime Minister Paavo Lipponen's Social Democrat-led ‘rainbow government’. A generally lacklustre campaign, highlighted by concerns over unemployment, Finland's place in Europe and uncomfortable foreign policy decisions, is notable for making Jäätteenmäki Finland's first female prime minister and for making the country the first in the EU to have women as both prime minister and president. These distinctions proved fleeting, as scandal –‘Iraqgate’– drove Jäätteenmäki from office after only two months. Scandal aside, the election demonstrates the difficulties for still-new EU members of juggling domestic economic concerns with European and broader international commitments.