A prospective study of the impact of subthreshold mixed states on the 24-month clinical outcomes of bipolar I disorder or schizoaffective disorder

Objectives: Subthreshold mixed states are common, yet their clinical significance is unclear. This study investigated the clinical outcomes of subthreshold mixed states in participants with bipolarI disorder or schizoaffective disorder, using the Cassidy and Benazzi criteria for manic and depressive mixed states, respectively.

Methods: The Bipolar Comprehensive Outcomes Study (BCOS) is a prospective observational study of treatment and outcomes for patients with bipolar I or schizoaffective disorder, bipolar type. Participants (N=239) were grouped based on study entry clinical presentation as having pure depression (n=63) if they satisfied DSM-IV-TR criteria for a Major Depressive Episode (MDE), depressive mixed state (DMX) if they also had at least three concurrent hypomanic symptoms (n=33), or not depressed (n=143) if they did not satisfy the criteria for MDE. Participants were similarly grouped as having pure mania (n=3) if they satisfied DSM-IV criteria for a Manic Episode, manic mixed state (MMX) if they also had at least two concurrent depressive symptoms (n=33), or not manic (n=203). Clinical data were collected by interview every 3-months over a 24-month period.

Results: Measures of quality of life, mental and physical health over the 24-month period were significantly worse for participants who were classified as having mixed states at study entry on most outcome measures compared to participants who were not in an illness episode at study entry. DMX was predictive of greater manic symptomatology over the 24 months compared to participants with pure depression.

Conclusion: In participants with a current episode of mood disorder, the presence of subthreshold symptoms of opposite polarity was associated with poorer clinical outcomes over a 24-month period.

Transcultural adaption and validation of the Spanish version of the Bipolar Depression Rating Scale (BDRS-S)

The Bipolar Depression Rating Scale (BDRS) arguably better captures symptoms in bipolar depression especially depressive mixed states than traditional unipolar depression rating scales. The psychometric properties of the Spanish adapted version, BDRS-S, are reported.

Atypical features and treatment choices in bipolar disorders: a result of the National Bipolar Mania Pathway Survey in China.

In this study, we examined the point prevalence rate of atypical features in bipolar disorder, and estimated the potential impact of these features on treatment practices in China. Using the atypical features criteria of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV), we documented the atypical symptoms in 3 906 consecutive participants with bipolar disorder enrolled at 26 psychiatric services across China. We further assessed the association between atypical features and the treatment approaches, including the prescription of antidepressants. The overall point prevalence rate of atypical features was 9.1% among patients with various bipolar disorder subtypes. When the definition was broadened to include atypical features B, the overall rate increased to 11.8%. Interestingly, among patients with the mixed state and remission subtypes, there was a significant difference in the rates of antidepressant medication usage between patients who met and those who did not meet the criteria for atypical features B. These findings indicate a trend of using antidepressants for these two types of patients with atypical features. Further, for both mixed state and remission patients, treatment approaches were related to atypical features B. Our findings provide evidence to assist clinicians to readily recognize atypical features in bipolar subtypes and can propose treatments based on these diagnoses.

On the efficiency of private and state-owned enterprises in mixed markets

We examine oligopoly models of vertical product differentiation in which producing firms face variable costs of quality development. We show that comparing to private oligopoly, mixed oligopoly – whereby state-owned enterprises (SOEs) and private firms coexist – enhances social welfare but reduces firms' profitability. We also demonstrate that Bertrand competition makes firms better off under mixed oligopoly but it makes firms worse off under private oligopoly compared with Cournot competition. These findings help to justify both the existence of SOEs and the efficiency of SOEs and private firms in mixed markets in transitional economies.

New H∞ control design for polytopic systems with mixed time-varying delays in state and input

This paper concerns with the problem of state-feedback H∞ control design for a class of linear systems with polytopic uncertainties and mixed time-varying delays in state and input. Our approach can be described as follows. We first construct a state-feedback controller based on the idea of parameter-dependent controller design. By constructing a new parameter-dependent Lyapunov-Krasovskii functional (LKF), we then derive new delay-dependent conditions in terms of linear matrix inequalities ensuring the exponential stability of the corresponding closed-loop system with a H∞ disturbance attenuation level. The effectiveness and applicability of the obtained results are demonstrated by practical examples.

The domain layer for mixed-initiative interaction in generative design

The design space exploration formalism has developed data structures and algorithms of sufficient complexity and scope to support conceptual layout, massing, and enclosure configurations. However, design remains a human enterprise. To support the user in designing with the formalism, we have developed an interaction model that addresses the interleaving of user actions with the formal operations of design space exploration. The central feature of our interaction model is the modeling of control based on mixed-initiative. Initiative is sometimes taken by the designer and sometimes by the formalism in working on a shared design task. The model comprises three layers, domain, task, and dialogue. In this paper we describe the formulation of the domain layer of our mixed-initiative interaction model for design space exploration. We present the view of the domain as understood in the formalism in terms of the three abstract concepts of state, move, and structure. In order to support mixed initiative, it is necessary to develop a shared view of the domain. The domain layer addresses this problem by mapping the designer's view onto the symbol substrate. First, we present the designer's view of the domain in terms of problems, solutions, choices, and history. Second, we show how this view is interleaved with the symbol-substrate through four domain layer constructs, problem state, solution state, choice, and exploration history. The domain layer presents a suitable foundation for integrating the role of the designer with a description formalism. It enables the designer to maintain exploration freedom in terms of formulating and reformulating problems, generating solutions, making choices, and navigating the history of exploration.

"Sins of their fathers" : culturally at risk children and the colonial state in Asia

In contact with their foreign surroundings, European enclaves throughout imperial Asia and Africa formed new cultural communities. Nevertheless, over time as Cooper and Stoler (1997) have argued, such colonial communities became subject to the same bourgeois project as experienced in the metropolitan centres to which they remained connected. If, in terms of that project, metropolitan European society was deemed vulnerable from a brutish and unruly working class, these colonial outposts of Western society were even more vulnerable to what was deemed to be the more insidious dangers of miscegenation and cultural hybridity. Where nineteenth century educators typically suggested that working class children were “at risk” of not being able to benefit from, and simultaneously representing “a risk to”, the emerging opportunities of bourgeois capitalist society, this “risk” was accentuated in the colonies by the additional category of race. Focussing on the question of children of mixed parentage as a category of “children at risk”, this paper examines the way educationists and politicians responded to what was perceived as “civilisational decline” in four such communities - the Dutch East Indies, British India, (British) Australia and French Indo-China - to demonstrate the universality of these concerns in Imperial Asia.

Educational reform in North Cyprus : towards the making of a nation/state?

The Turkish Republic of North Cyprus (TRNC) aspires to take its place in Europe and the global ‘knowledge economy’. In order to do so, it needs not only to be politically recognised as legitimate and to develop the kinds of economic and governance structures that signify a functional state, but also to produce a cultural imaginary of itself as a nation. In this paper, we mobilise Appadurai’s theorisation of deterritorialisation, flows and context generation in order to examine the ways in which the implementation of educational reforms inTRNC might contribute to this ambition.We show that the ethnoscape and financescape combine to make education reform difficult, with specific challenges arising from the mixed commitment of the workforce, the capacity of the education bureaucracy to align support with policy mandates, and the ‘fit’ between the policy and local needs. We conclude by suggesting that TRNC faces the dilemma of working with cultural heterogeneity: Appadurai identifies this as a key ideoscape challenge for all nation/states.

The impact of school tobacco policies on student smoking in Washington State, United States and Victoria, Australia

This paper measures tobacco polices in statewide representative samples of secondary and mixed schools in Victoria, Australia and Washington, US (N = 3,466 students from 285 schools) and tests their association with student smoking. Results from confounder-adjusted random effects (multi-level) regression models revealed that the odds of student perception of peer smoking on school grounds are decreased in schools that have strict enforcement of policy (odds ratio (OR) = 0.45; 95% CI: 0.25 to 0.82; p = 0.009). There was no clear evidence in this study that a comprehensive smoking ban, harsh penalties, remedial penalties, harm minimization policy or abstinence policy impact on any of the smoking outcomes.

Solid state ion transport and phase behaviour in composites of N,N-methyl propylpyrrolidinium tetrafluoroborate and amorphous polyethylene oxide

The binary and ternary addition of 2 wt.% LiBF₄ and 2 wt.% amorphous polyethylene oxide (aPEO) respectively to the plastic crystal forming salt P₁₃BF₄ (where P₁₃⁺=methylpropyl pyrrolidinium cation) was investigated with specific focus on the phase behaviour and evaluation of transport characteristics. Differential scanning calorimetry (DSC), optical thermomicroscopy, solid state nuclear magnetic resonance (NMR), and AC impedance spectroscopy were used to develop an understanding of the conduction process in the pure and mixed systems. The morphology of the ternary compound appeared as hexagonal spherulites upon solidification. Multinuclear NMR Pulsed Field Gradient measurements (¹H,¹⁹F,⁷Li) to probe both cation and anion diffusion coefficients are reported. The anion is shown to be the most diffusive (at 320 K:¹⁹F=2.5×10⁻¹¹ m² s⁻¹; 1H: 1.8×10⁻¹¹ m² s⁻¹; ⁷Li: 1.1×10⁻¹¹ m² s⁻¹) in the ternary compound, with enhanced conductivity (2.7×10⁻⁵ S cm⁻¹ at 310 K) just below the melt.

Lithium doped N,N-dimethyl pyrrolidinium tetrafluoroborate organic ionic plastic crystal electrolytes for solid state lithium batteries

The organic ionic plastic crystal material N,N-dimethyl pyrrolidinium tetrafluoroborate ([C1mpyr][BF4]) has been mixed with LiBF4 from 0 to 8 wt% and shown to exhibit enhanced ionic conductivity, especially in the higher temperature plastic crystal phases (phases II and I). The materials retain their solid state well above 100 °C with the melt not being observed up to 300 °C. Interestingly the conductivity enhancement is highest with the lowest level of LiBF4 addition in phase II, but then the order of enhancement is reversed in phase I. In all cases, a conductivity drop is observed at the II → I phase transition (105 °C) which is associated with increased order in the pure matrix, as previously reported, although the conductivity drop is least for the highest LiBF4 amount (8 wt%). The 8 wt% sample displays different conductivity behaviours compared to the lower LiBF4 concentrations, with a sharp increase above 50 °C, which is apparently not related to the formation of an amorphous phase, based on XRD data up to 120 °C. Symmetric cells, Li/OIPC/Li, were prepared and cycled at 50 °C and showed evidence of significant preconditioning with continued cycling, leading to a lower over-potential and a concomitant decrease in the cell resistivity as measured by EIS. An SEM investigation of the Li/OIPC interfaces before and after cycling suggested significant grain refinement was responsible for the decrease in cell resistance upon cycling, possibly as a result of an increased grain boundary phase.

A potential-controlled switch on/off mechanism for selective excitation in mixed electrochemiluminescent systems

We demonstrate the complete, rapid, and reversible switching between the emissions from two electrogenerated chemiluminescence (ECL) systems contained within the same solution, controlled by simple modification of the applied potential. The fundamental bases of the approach are the ability to selectively 'switch on' luminophores at distinct oxidation potentials, and an intriguing observation that the emission from the well-known electrochemiluminescent complex, fac-Ir(ppy)3, (where ppy is 2-phenylpyridinato), can be selectively 'switched-off' at high overpotentials. The dependence of this phenomenon on high concentrations of the co-reactant implicates quenching of the excited [Ir(ppy)3]* state by electron transfer. Rapid spectral scanning during modulation of the applied potential reveals well resolved maxima for mixtures comprising either green and red or green and blue luminophores, illustrating the vast potential of this approach for multiplexed ECL detection.

Annihilation electrogenerated chemiluminescence of mixed metal chelates in solution : Modulating emission colour by manipulating the energetics

We demonstrate the mixed annihilation electrogenerated chemiluminescence of tris(2,2′-bipyridine)ruthenium(ii) with various cyclometalated iridium(iii) chelates. Compared to mixed ECL systems comprising organic luminophores, the absence of T-route pathways enables effective predictions of the observed ECL based on simple estimations of the exergonicity of the reactions leading to excited state production. Moreover, the multiple, closely spaced reductions and oxidations of the metal chelates provide the ability to finely tune the energetics and therefore the observed emission colour. Distinct emissions from multiple luminophores in the same solution are observed in numerous systems. The relative intensity of these emissions and the overall emission colour are dependent on the particular oxidized and reduced species selected by the applied electrochemical potentials. Finally, these studies offer insights into the importance of electronic factors in the question of whether the reduced or oxidized partner becomes excited in annihilation ECL. This journal is