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To identify urinary catheter (UC)–associated urinary tract infection (CAUTI) incidence and risk factors.
Design:
A prospective cohort study.
Setting:
The study was conducted across 623 ICUs of 224 hospitals in 114 cities in 37 African, Asian, Eastern European, Latin American, and Middle Eastern countries.
Participants:
The study included 169,036 patients, hospitalized for 1,166,593 patient days.
Methods:
Data collection took place from January 1, 2014, to February 12, 2022. We identified CAUTI rates per 1,000 UC days and UC device utilization (DU) ratios stratified by country, by ICU type, by facility ownership type, by World Bank country classification by income level, and by UC type. To estimate CAUTI risk factors, we analyzed 11 variables using multiple logistic regression.
Results:
Participant patients acquired 2,010 CAUTIs. The pooled CAUTI rate was 2.83 per 1,000 UC days. The highest CAUTI rate was associated with the use of suprapubic catheters (3.93 CAUTIs per 1,000 UC days); with patients hospitalized in Eastern Europe (14.03) and in Asia (6.28); with patients hospitalized in trauma (7.97), neurologic (6.28), and neurosurgical ICUs (4.95); with patients hospitalized in lower–middle-income countries (3.05); and with patients in public hospitals (5.89).
The following variables were independently associated with CAUTI: Age (adjusted odds ratio [aOR], 1.01; P < .0001), female sex (aOR, 1.39; P < .0001), length of stay (LOS) before CAUTI-acquisition (aOR, 1.05; P < .0001), UC DU ratio (aOR, 1.09; P < .0001), public facilities (aOR, 2.24; P < .0001), and neurologic ICUs (aOR, 11.49; P < .0001).
Conclusions:
CAUTI rates are higher in patients with suprapubic catheters, in middle-income countries, in public hospitals, in trauma and neurologic ICUs, and in Eastern European and Asian facilities.
Based on findings regarding risk factors for CAUTI, focus on reducing LOS and UC utilization is warranted, as well as implementing evidence-based CAUTI-prevention recommendations.
Most gyrodactylids have a haptor armed with a pair of hamuli, two connecting bars and 16 marginal hooks. In some gyrodactylids, however, the haptor is disc-shaped and reinforced by additional sclerites. The genus Polyclithrum has arguably the most elaborate haptor in this group. This study aimed to gain better understanding of the anatomy of Polyclithrum by examining neuromusculature and haptoral armament of Polyclithrum ponticum, a species parasitizing Mugil cephalus in the Black Sea, with emphasis on haptoral sclerites and musculature in connection with host-attachment mechanisms. Musculature was stained by phalloidin, the nervous system by anti-serotonin and anti-FMRFamide antibodies, and haptoral sclerites were visualized in reflected light. The study provided new information on sclerites: in addition to previously described supplementary sclerites (A1–6), ear-shaped sclerites (ESSs) and two paired groups of ribs, reflected light revealed a rod-shaped process on the ESSs and a pair of small posterior sclerites. The sclerites were shown to be operated by 16 muscles, the most prominent of which were two transverse muscles connecting the hamular roots, three muscles attached to sclerite A2, the muscle fibres of anterior ribs and a set of extrinsic muscles. The nervous system consists of a pair of cerebral ganglia connected by a commissure and three pairs of nerve cords that unite in the haptor to form a loop between the opposite cords. The arrangement of sclerites and muscles suggests that Polyclithrum initiates the attachment by clamping a host's surface with longitudinally folded haptor and then secures its position with marginal hooks.
In Southeast Europe (SEE) standard treatment of patients with psychosis is largely based on pharmacotherapy with psychosocial interventions rarely available. DIALOG+ is a digital psychosocial intervention designed to make routine care therapeutically effective. This trial simultaneously examined effectiveness of DIALOG+ versus standard care on clinical and social outcomes (Aim 1) and explored intervention fidelity (Aim 2).
Methods
A hybrid type II effectiveness–implementation, cluster-randomized trial was conducted in five SEE countries: Bosnia and Herzegovina, Kosovo*, Montenegro, North Macedonia, and Serbia. The intervention was offered to patients six times across 12 months instead of routine care. The outcomes were subjective quality of life (primary), clinical symptoms, satisfaction with services, and economic costs. Intervention fidelity was operationalized as adherence to the protocol in terms of frequency, duration, content, and coverage. Data were analyzed using multilevel regression.
Results
A total of 81 clinicians and 468 patients with psychosis were randomized to DIALOG+ or standard care. The intervention was delivered with high fidelity. The average number of delivered sessions was 5.5 (SD = 2.3) across 12 months. Patients in the intervention arm had better quality of life (MANSA) at 6 months (p = 0.03). No difference was found for other outcomes at 6 months. Due to disruptions caused by the COVID-19 pandemic, 12-month data were not interpretable.
Conclusions
DIALOG+ improved subjective quality of life of individuals with psychosis at 6 months (after four sessions), albeit with small effect size. The intervention has the potential to contribute to holistic care of patients with psychosis.
An interesting aspect of complex plasma is its ability to self-organize into a variety of structural configurations and undergo transitions between these states. A striking phenomenon is the isotropic-to-string transition observed in electrorheological complex plasma under the influence of a symmetric ion wake field. Such transitions have been investigated using the Plasma Kristall-4 (PK-4) microgravity laboratory on the International Space Station. Recent experiments and numerical simulations have shown that, under PK-4-relevant discharge conditions, the seemingly homogeneous direct current discharge column is highly inhomogeneous, with large axial electric field oscillations associated with ionization waves occurring on microsecond time scales. A multi-scale numerical model of the dust–plasma interactions is employed to investigate the role of the electric field in the charge of individual dust grains, the ion wake field and the order of string-like structures. Results are compared with those for dust strings formed in similar conditions in the PK-4 experiment.
A cumulative environmental exposure score for schizophrenia (exposome score for schizophrenia [ES-SCZ]) may provide potential utility for risk stratification and outcome prediction. Here, we investigated whether ES-SCZ was associated with functioning in patients with schizophrenia spectrum disorder, unaffected siblings, and healthy controls.
Methods
This cross-sectional sample consisted of 1,261 patients, 1,282 unaffected siblings, and 1,525 healthy controls. The Global Assessment of Functioning (GAF) scale was used to assess functioning. ES-SCZ was calculated based on our previously validated method. The association between ES-SCZ and the GAF dimensions (symptom and disability) was analyzed by applying regression models in each group (patients, siblings, and controls). Additional models included polygenic risk score for schizophrenia (PRS-SCZ) as a covariate.
Results
ES-SCZ was associated with the GAF dimensions in patients (symptom: B = −1.53, p-value = 0.001; disability: B = −1.44, p-value = 0.001), siblings (symptom: B = −3.07, p-value < 0.001; disability: B = −2.52, p-value < 0.001), and healthy controls (symptom: B = −1.50, p-value < 0.001; disability: B = −1.31, p-value < 0.001). The results remained the same after adjusting for PRS-SCZ. The degree of associations of ES-SCZ with both symptom and disability dimensions were higher in unaffected siblings than in patients and controls. By analyzing an independent dataset (the Genetic Risk and Outcome of Psychosis study), we replicated the results observed in the patient group.
Conclusions
Our findings suggest that ES-SCZ shows promise for enhancing risk prediction and stratification in research practice. From a clinical perspective, ES-SCZ may aid in efforts of clinical characterization, operationalizing transdiagnostic clinical staging models, and personalizing clinical management.
Psychosis spectrum disorder has a complex pathoetiology characterised by interacting environmental and genetic vulnerabilities. The present study aims to investigate the role of gene–environment interaction using aggregate scores of genetic (polygenic risk score for schizophrenia (PRS-SCZ)) and environment liability for schizophrenia (exposome score for schizophrenia (ES-SCZ)) across the psychosis continuum.
Methods
The sample consisted of 1699 patients, 1753 unaffected siblings, and 1542 healthy comparison participants. The Structured Interview for Schizotypy-Revised (SIS-R) was administered to analyse scores of total, positive, and negative schizotypy in siblings and healthy comparison participants. The PRS-SCZ was trained using the Psychiatric Genomics Consortiums results and the ES-SCZ was calculated guided by the approach validated in a previous report in the current data set. Regression models were applied to test the independent and joint effects of PRS-SCZ and ES-SCZ (adjusted for age, sex, and ancestry using 10 principal components).
Results
Both genetic and environmental vulnerability were associated with case-control status. Furthermore, there was evidence for additive interaction between binary modes of PRS-SCZ and ES-SCZ (above 75% of the control distribution) increasing the odds for schizophrenia spectrum diagnosis (relative excess risk due to interaction = 6.79, [95% confidential interval (CI) 3.32, 10.26], p < 0.001). Sensitivity analyses using continuous PRS-SCZ and ES-SCZ confirmed gene–environment interaction (relative excess risk due to interaction = 1.80 [95% CI 1.01, 3.32], p = 0.004). In siblings and healthy comparison participants, PRS-SCZ and ES-SCZ were associated with all SIS-R dimensions and evidence was found for an interaction between PRS-SCZ and ES-SCZ on the total (B = 0.006 [95% CI 0.003, 0.009], p < 0.001), positive (B = 0.006 [95% CI, 0.002, 0.009], p = 0.002), and negative (B = 0.006, [95% CI 0.004, 0.009], p < 0.001) schizotypy dimensions.
Conclusions
The interplay between exposome load and schizophrenia genetic liability contributing to psychosis across the spectrum of expression provide further empirical support to the notion of aetiological continuity underlying an extended psychosis phenotype.
Carbon-rich dust is known to form in the atmosphere of the semiregular variable star R Sculptoris. Such stardust, as well as the molecules and gas produced during the lifetime of the star, will be spread into the Galaxy via the mass-loss process. Probing this process is crucial to understand the chemical enrichment of the Galaxy. R Scl was observed using the ESO/VLTI MATISSE instrument in December 2018. Here we show the first images of the star between 3 and 10 R*. Using the complementary MIRA 3D image reconstruction and the RHAPSODY 1D intensity profile reconstruction code, we reveal the location of molecules and dust in the close environment of the star. Indeed, the C2H2 and HCN molecules are spatially located between 1 and 3.4 R* which is much closer to the star than the location of the dust. The R Scl spectrum is fitted by molecules and a dust mixture of 90% of amorphous carbon and 10% of silicone carbide. The inner boundary of the dust envelope is estimated by DUSTY at about 4.6 R*. We derive a mass-loss rate of 1.2 ± 0.4 × 10−6M⊙ yr−1however no clear SiC forming region has been detected in the MATISSE data.
There is evidence that environmental and genetic risk factors for schizophrenia spectrum disorders are transdiagnostic and mediated in part through a generic pathway of affective dysregulation.
Methods
We analysed to what degree the impact of schizophrenia polygenic risk (PRS-SZ) and childhood adversity (CA) on psychosis outcomes was contingent on co-presence of affective dysregulation, defined as significant depressive symptoms, in (i) NEMESIS-2 (n = 6646), a representative general population sample, interviewed four times over nine years and (ii) EUGEI (n = 4068) a sample of patients with schizophrenia spectrum disorder, the siblings of these patients and controls.
Results
The impact of PRS-SZ on psychosis showed significant dependence on co-presence of affective dysregulation in NEMESIS-2 [relative excess risk due to interaction (RERI): 1.01, p = 0.037] and in EUGEI (RERI = 3.39, p = 0.048). This was particularly evident for delusional ideation (NEMESIS-2: RERI = 1.74, p = 0.003; EUGEI: RERI = 4.16, p = 0.019) and not for hallucinatory experiences (NEMESIS-2: RERI = 0.65, p = 0.284; EUGEI: −0.37, p = 0.547). A similar and stronger pattern of results was evident for CA (RERI delusions and hallucinations: NEMESIS-2: 3.02, p < 0.001; EUGEI: 6.44, p < 0.001; RERI delusional ideation: NEMESIS-2: 3.79, p < 0.001; EUGEI: 5.43, p = 0.001; RERI hallucinatory experiences: NEMESIS-2: 2.46, p < 0.001; EUGEI: 0.54, p = 0.465).
Conclusions
The results, and internal replication, suggest that the effects of known genetic and non-genetic risk factors for psychosis are mediated in part through an affective pathway, from which early states of delusional meaning may arise.
This study attempted to replicate whether a bias in probabilistic reasoning, or ‘jumping to conclusions’(JTC) bias is associated with being a sibling of a patient with schizophrenia spectrum disorder; and if so, whether this association is contingent on subthreshold delusional ideation.
Methods
Data were derived from the EUGEI project, a 25-centre, 15-country effort to study psychosis spectrum disorder. The current analyses included 1261 patients with schizophrenia spectrum disorder, 1282 siblings of patients and 1525 healthy comparison subjects, recruited in Spain (five centres), Turkey (three centres) and Serbia (one centre). The beads task was used to assess JTC bias. Lifetime experience of delusional ideation and hallucinatory experiences was assessed using the Community Assessment of Psychic Experiences. General cognitive abilities were taken into account in the analyses.
Results
JTC bias was positively associated not only with patient status but also with sibling status [adjusted relative risk (aRR) ratio : 4.23 CI 95% 3.46–5.17 for siblings and aRR: 5.07 CI 95% 4.13–6.23 for patients]. The association between JTC bias and sibling status was stronger in those with higher levels of delusional ideation (aRR interaction in siblings: 3.77 CI 95% 1.67–8.51, and in patients: 2.15 CI 95% 0.94–4.92). The association between JTC bias and sibling status was not stronger in those with higher levels of hallucinatory experiences.
Conclusions
These findings replicate earlier findings that JTC bias is associated with familial liability for psychosis and that this is contingent on the degree of delusional ideation but not hallucinations.
Involution old age limit is related to general health, cultural and economic living conditions.
Two stages of old age are currently recognized: early old age (65 to 75 years) and over 75 years - late old age period.
Old age period is the third life cycle period in which aging of the brain and eventual pathological changes with respective organic psychopathological onsets are finalized.
In many countries, number of the population over 65 years of age increases. The same applies for our country.
Term of psychic disorders includes miscellaneous psychic conditions, pathologic in terms of symptom intensity, personality and social behavior changes, and reflects on social life of the ill individual and its family.
Psychiatric syndromes and disorders in older population Rogina divides into two groups:
- disorders of emotional reacting and behavior, without manifestations of other organic brain or physical disorders and
- alternations caused by primary brain pathology, clinically presented as organic brain psycho-syndrome with different intensity and different pathogenesis etymology (cardiovascular, cerebro-vascular, neoplastic, metabolic, etc.)
A combination of physical illness and mental disorder is the most common cause of the first hospitalization in older age.
We are witnessing increased divorce rate, and consequently the need to resolve problems related to child custody. According to some data, every third marriage results in disintegration. The child often becomes an object and tools in resolving this complex issue.
Family environment is a natural environment of a child, one of the crucial factors in process of child's socialization. Basic generator of named socialization is a family atmosphere conditioned by predominant feelings in domestic relations. These relations are realized within the mother-child-father triangle adjoined by other members of the family. The evolution of civilization leads to changes in behavior and concept of human rights.
Divorce proceeding itself is one of the rights of both parents, i.e. adult members. From legal point of view, position of minors is passive, defensive. Therefore, divorce may be presented as exercising divorce rights consumed by adults. The most dramatic conflict in divorce proceeding is so called child custody, used by the parents as figurehead for exercising rights on their child.
During the course of exercising parental rights, there are some parents where we can identify a competence and confrontation of equal rights or conflict of individual parental rights.
An expert being summoned to the court in divorce proceeding, related to issues of child custody is most frequently a psychologist, psychiatrist, social worker by its vocation, and seldom, pedagogue or psychotherapist.
Family, school and society are somewhat similar to the palace- If you take away a stone from its foundation, everything starts to collapse.
Torture is considered as physical or mental harassment, torment, causing pain, injuries and humiliation of an innocent person occurring during the shorter or longer period of time.
Is human emotional behavior based on primary biological mechanism that human inherited not only from close animal predecessors, but also significantly more distant kinds on evolutionary ladder?
Results of researches indicate that aggressiveness is stable pattern of behavior in children and young people. Aggressive behavior of humans decreases over the years, although certain types of personalities preserve stability of aggressive behavior.
Psychological profile of torturer includes diagnostical category of antisocial personality disorder.
Mental consequences resulting from torture are depression, psychosomatic reactions, aggression, state of anxiety. The contribution of victimology is significant, particularly from aspect of “selecting” psychopathological reaction. It is also important whether the torturer is known to be victims or it is a stranger. It is understandable that consequences are much more severe with people who had unfortunate to be tortured by known person.
The most common psychopathological reactions are:
1. Fear lived during the torture.
2. Depressive reaction.
3. Aggression - which may not be demonstrated in adequate manner, may be shifted to other people, which may create interpersonal disputes, before all for the victim and represents one of physical consequences resulting from torture.
Torture prevention is problem of individuals, community and society as whole.
Degradation of authorities in one society leads to moral erosion, and on its part, to torture on all functioning levels.
A structured psychoeducation is a method of treatment of patients and their families with the approved therapeutical effect.
Background and Aims:
In our hospital psychoeducation is a part of early interventions directed to first episodes of psychotic patients (that includes first 5 years of psychosis). Duration of the programme is one year and it has been influenced by simmilar experiences in Great Britain and PORT˘s recommendations (Sshizophrenia Patient Outcomes Research Team). A specific quality of the programme is collaboration of group psychotherapy approach conducted by group analysts and psychoeducation conducted by cognitive-behavioral therapists. All therapists involved in the programme have been supervised monthly by proffesionals.
The psychoeducation is common for all patients and their family members.
Number of hospitalisations, cognitive, emotional and social functioning, changes of basic beliefs and present symptoms have been estimated during the programme.
Methods:
The aim of the poster presentation is to evaluate the efficacy of treatment and rehabilitation of patients that participate in the programme together with pharmacotherapy in order to achieve better treatment efficacy. Patient that have been involved in the both psychoeducation and pharmacotherapy are compared to patients treated with drugs only. Questionnaires that measure self-esteem and loneliness have been used.
Results and Conclusions:
Since actual psychoeducation ends at the end of this year, the first results of two first grades are expected at the beginning of 2008.
Single-photon emission computed tomography (SPECT) is a valid method for measuring regional cerebral blood flow (rCBF). Recent studies regarding rCBF in patients with first episode psychosis (FEP) reported heterogeneous results, but were limited with small sample size. Neuroimaging can help us in setting the diagnosis of illness, as well as in following the progress and finding more effective treatment for psychotic disorders.
Objectives
To compare, baseline alterations of the rCBF using SPECT with psychopathological status in FEP during acute phase.
Aims
To investigate the changes of rCBF in patients with FEP during acute phase.
Methods
We conducted a study on 40 drug – naïve patients with FEP at acute phase of illness during their hospitalization at Zagreb University hospital centre. The diagnosis was confirmed using diagnostic and statistical manual of mental disorders, fifth edition. rCBF was measured with SPECT and psychopathological status rated with the Positive and Negative Syndrome Scale.
Results
Our findings showed moderate to severe parieto-temporal perfusion deficits, mild to moderate parieto-fronto-temporal perfusion deficits or borderline perfusion deficits in all but one patient.
Conclusion
Our results showed alteration in rCBF at the beginning of the illness that indicate a biological market of psychotic disorder.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
First-degree relatives of patients with psychotic disorder have higher levels of polygenic risk (PRS) for schizophrenia and higher levels of intermediate phenotypes.
Methods
We conducted, using two different samples for discovery (n = 336 controls and 649 siblings of patients with psychotic disorder) and replication (n = 1208 controls and 1106 siblings), an analysis of association between PRS on the one hand and psychopathological and cognitive intermediate phenotypes of schizophrenia on the other in a sample at average genetic risk (healthy controls) and a sample at higher than average risk (healthy siblings of patients). Two subthreshold psychosis phenotypes, as well as a standardised measure of cognitive ability, based on a short version of the WAIS-III short form, were used. In addition, a measure of jumping to conclusion bias (replication sample only) was tested for association with PRS.
Results
In both discovery and replication sample, evidence for an association between PRS and subthreshold psychosis phenotypes was observed in the relatives of patients, whereas in the controls no association was observed. Jumping to conclusion bias was similarly only associated with PRS in the sibling group. Cognitive ability was weakly negatively and non-significantly associated with PRS in both the sibling and the control group.
Conclusions
The degree of endophenotypic expression of schizophrenia polygenic risk depends on having a sibling with psychotic disorder, suggestive of underlying gene–environment interaction. Cognitive biases may better index genetic risk of disorder than traditional measures of neurocognition, which instead may reflect the population distribution of cognitive ability impacting the prognosis of psychotic disorder.
The objectives of this paper are to: (1) identify contextual factors such as policy that impacted the implementation of community-based primary health care (CBPHC) innovations among 12 Canadian research teams and (2) describe strategies used by the teams to address contextual factors influencing implementation of CBPHC innovations. In primary care settings, consideration of contextual factors when implementing change has been recognized as critically important to success. However, contextual factors are rarely recorded, analyzed or considered when implementing change. The lack of consideration of contextual factors has negative implications not only for successfully implementing primary health care (PHC) innovations, but also for their sustainability and scalability. For this evaluation, data collection was conducted using self-administered questionnaires and follow-up telephone interviews with team representatives. We used a combination of directed and conventional content analysis approaches to analyze the questionnaire and interview data. Representatives from all 12 teams completed the questionnaire and 11 teams participated in the interviews; 40 individuals participated in this evaluation. Four themes representing contextual factors that impacted the implementation of CBPHC innovations were identified: (I) diversity of jurisdictions (II) complexity of interactions and collaborations (III) policy, and (IV) the multifaceted nature of PHC. The teams used six strategies to address these contextual factors including: (1) conduct an environmental scan at the beginning (2) maintaining engagement among partners and stakeholders by encouraging open and inclusive communication; (3) contextualizing the innovation for different settings; (4) anticipating and addressing changes, delays, and the need for additional resources; (5) fostering a culture of research and innovation among partners and stakeholders; and (6) ensuring information about the innovation is widely available. Implementing CBPHC innovations across jurisdictions is complex and involves navigating through multiple contextual factors. Awareness of the dynamic nature of context should be considered when implementing innovations.
The development of laser wakefield accelerators (LWFA) over the past several years has led to an interest in very compact sources of X-ray radiation – such as “table-top” free electron lasers. However, the use of conventional undulators using permanent magnets also implies system sizes which are large. In this work, we assess the possibilities for the use of novel mini-undulators in conjunction with a LWFA so that the dimensions of the undulator become comparable with the acceleration distances for LWFA experiments (i.e., centimeters). The use of a prototype undulator using laser machining of permanent magnets for this application is described and the emission characteristics and limitations of such a system are determined. Preliminary electron propagation and X-ray emission measurements are taken with a LWFA electron beam at the University of Michigan.
Species that belong to the Aphidius eadyi group have been used as biocontrol agents against Acyrthosiphon pisum worldwide. However, despite their extensive use, there are still gaps in our knowledge about their taxonomy and distribution. In this study, we employed an integrative taxonomic approach by combining genetic analyses (mtDNA COI barcoding) with standard morphological analyses and geometric morphometrics of forewing shape. We identified three species within the A. eadyi species group, viz., A. smithi, A. eadyi and A. banksae. Genetic separation of all three species was confirmed, with mean genetic distances between species ranging from 5 to 7.4%. The following morphological characters were determined as the most important for separating species of the A. eadyi group: number and shape of costulae on the anterolateral part of the petiole, shape of the central areola on the propodeum, and shape and venation of the forewings. The differences in wing shape of all three species were statistically significant, but with some overlapping. We identified A. banksae as a widely distributed pea aphid parasitoid, whose known range covers most of the western Palaearctic (from the UK to Israel). Aphidius banksae is diagnosed and redescribed.