Impact of persistent substance misuse on 1-year outcome in first-episode psychosis

Background: Substance misuse is a common comorbid problem in people presenting with first-episode psychosis and is associated with a poor short-term outcome.

Aims: The aim of this study is to examine differences in baseline characteristics and 1-year outcome between individuals with first-episode psychosis who have never misused substances, those who stop misusing substances after initial presentation and those who persistently misuse substances over the 1-year assessment period.

Method: Patients were recruited to the Northern Ireland First Episode Psychosis Study (n=272). Clinical assessments were performed at baseline and at 1 year (n=194) and data were collected from the case notes.

Results: Individuals with persistent substance misuse had more severe depression, more positive symptoms, poorer functional outcome and greater rates of relapse at 1 year than those who stopped and those who had never misused substances. There were no differences in outcome between people who had never misused substances and those who stopped misusing after presentation.

Conclusions: These results support assertive intervention targeted at comorbid substance misuse in individuals with first-episode psychosis.

Auditory observation of stepping actions can cue both spatial and temporal components of gait in Parkinson's disease patients

Objectives: A common behavioural symptom of Parkinson’s disease (PD) is reduced step length (SL). Whilst sensory cueing strategies can be effective in increasing SL and reducing gait variability, current cueing strategies conveying spatial or temporal information are generally confined to the use of either visual or auditory cue modalities, respectively. We describe a novel cueing strategy using ecologically-valid ‘action-related’ sounds (footsteps on gravel) that convey both spatial and temporal parameters of a specific action within a single cue.
Methods: The current study used a real-time imitation task to examine whether PD affects the ability to re-enact changes in spatial characteristics of stepping actions, based solely on auditory information. In a second experimental session, these procedures were repeated using synthesized sounds derived from recordings of the kinetic interactions between the foot and walking surface. A third experimental session examined whether adaptations observed when participants walked to action-sounds were preserved when participants imagined either real recorded or synthesized sounds.
Results: Whilst healthy control participants were able to re-enact significant changes in SL in all cue conditions, these adaptations, in conjunction with reduced variability of SL were only observed in the PD group when walking to, or imagining the recorded sounds.
Conclusions: The findings show that while recordings of stepping sounds convey action information to allow PD patients to re-enact and imagine spatial characteristics of gait, synthesis of sounds purely from gait kinetics is insufficient to evoke similar changes in behaviour, perhaps indicating that PD patients have a higher threshold to cue sensorimotor resonant responses.

A Note on Race, Ethnicity and Nativity Differences in Remarriage in the United States

The objectives of this study are to produce up-to-date estimates of race/ethnic/nativity differentials for remarriage and repartnership among women in the United States and to see if these differences are due to across-group differences in demographic characteristics. First, we produce lifetable estimates of remarriage and repartnering for white, black, U.S. born Latina and foreign born Latina women. Next, we estimate race/ethnic/nativity differentials for remarriage and repartnership using event-history analysis with and without controls for demographic characteristics. The results suggest a continued overall decline in remarriage rates, while many women repartner by cohabitating. Whites are more likely than blacks or Latinas to remarry and they are also more likely to repartner. Race/ethnic/nativity differentials remain even after accounting for variations in demographic characteristics. This suggests that race/ethnic/nativity differentials in remarriage and repartnering rates, rather than ameliorating disadvantages associated with divorce, reinforce these differentials.

High resolution monitoring of surface morphological change of building limestones in response to simulated salt weathering

A salt weathering simulation using a mix of sodium chloride (5%) and magnesium sulphate (5%) in a salt corrosion cabinet and five granular limestones is described. Progressive surface loss from vertical exposed faces was mapped using a high resolution (sub-millimetre) object scanner (Konica Minolta Vi9i). Patterns of loss are related to surface porosity/permeability measurements obtained using a hand-held gas permeameter. Introduction of this spatial dimension into damage assessment is seen as essential for understanding the initial conditions that allow surface loss to be triggered, and changes in surface characteristics as weathering proceeds which dictate subsequent decay in space and time. Preliminary observations suggest that scanning at this high resolution is particularly valuable in quantifying very subtle trends and distortions that are pre-cursors to material loss, including surface swelling and pore filling.

Initiating advance care planning on end-of-life issues in dementia: Ambiguity among UK and Dutch physicians

Background
In dementia, advance care planning (ACP) of end-of-life issues may start as early as possible in view of the patient’s decreasing ability to participate in decision making. We aimed to assess whether practicing physicians in the Netherlands and the United Kingdom who provide most of the end-of-life care, differ in finding that ACP in dementia should start at diagnosis.

Methods
In a cross-sectional study, we surveyed 188 Dutch elderly care physicians who are on the staff of nursing homes and 133 general practitioners from Northern Ireland. We compared difference by country in the outcome (perception of ACP timing), rated on a 1–5 agreement scale. Regression analyses examined whether a country difference can be explained by contrasts in demographics, presence, exposure and role perceptions.

Results
There was wide variability in agreement with the initiation of ACP at dementia diagnosis, in particular in the UK but also in the Netherlands (60.8% agreed, 25.3% disagreed and 14.0% neither agreed, nor disagreed). Large differences in physician characteristics (Dutch physicians being more present, exposed and adopting a stronger role perception) hardly explained the modest country difference. The perception that the physician should take the initiative was independently associated with agreeing with ACP at diagnosis.

Conclusions
There is considerable ambiguity about initiating ACP in dementia at diagnosis among physicians practicing in two different European health care systems and caring for different patient populations. ACP strategies should accommodate not only variations in readiness to engage in ACP early among patient and families, but also among physicians.

Projeto, Desenvolvimento e implementação de um Robô Voador de Inspiração Biológica

Este trabalho consiste no projeto, desenvolvimento e implementação de uma máquina voadora de inspiração biológica. Para a sua construção, é elaborado um estudo do voo nos seres biológicos de forma a obter alguma informação para o seu dimensionamento e é elaborada uma análise de projetos que utilizem as mesmas características de voo. Com os dados recolhidos neste estudo, é elaborado o projeto da máquina. Numa última fase, com recurso a materiais leves, é implementada uma máquina capaz de exercer as forças envolvidas no voo, força de propulsão e força de sustentação, e são elaborados estudos a fim de perceber quais os pontos fortes e os pontos fracos da mesma.

Practice variations in the production of health

This study investigates three questions related to medical practice variation. First, it tests whether average length of stay across Portuguese National Health Service hospitals varies when controlling for differences in patients’ characteristics. Second, it looks at hospital-level characteristics in order to find out whether these are able to explain differences in average length of stay across hospitals. Finally, it proposes a best practice average length of stay for each of the six episodes of care analyzed. To perform the analysis, administrative data from the Diagnosis-Related groups’ data set for the year of 2012 was used. A replication of a hierarchical two-stage model with hospital fixed effects was carried out. The results show that after taking patients’ characteristics into account, variation in average length of stay across hospitals exists. This variation cannot be explained by hospital-level characteristics.

Regional differences in self-reported screening, prevalence and management of cardiovascular risk factors in Switzerland.

BACKGROUND: In Switzerland, health policies are decided at the local level, but little is known regarding their impact on the screening and management of cardiovascular risk factors (CVRFs). We thus aimed at assessing geographical levels of CVRFs in Switzerland.¦METHODS: Swiss Health Survey for 2007 (N = 17,879). Seven administrative regions were defined: West (Leman), West-Central (Mittelland), Zurich, South (Ticino), North-West, East and Central Switzerland. Obesity, smoking, hypertension, dyslipidemia and diabetes prevalence, treatment and screening within the last 12 months were assessed by interview.¦RESULTS: After multivariate adjustment for age, gender, educational level, marital status and Swiss citizenship, no significant differences were found between regions regarding prevalence of obesity or current smoking. Similarly, no differences were found regarding hypertension screening and prevalence. Two thirds of subjects who had been told they had high blood pressure were treated, the lowest treatment rates being found in East Switzerland: odds-ratio and [95% confidence interval] 0.65 [0.50-0.85]. Screening for hypercholesterolemia was more frequently reported in French (Leman) and Italian (Ticino) speaking regions. Four out of ten participants who had been told they had high cholesterol levels were treated and the lowest treatment rates were found in German-speaking regions. Screening for diabetes was higher in Ticino (1.24 [1.09 - 1.42]). Six out of ten participants who had been told they had diabetes were treated, the lowest treatment rates were found for German-speaking regions.¦CONCLUSIONS: In Switzerland, cardiovascular risk factor screening and management differ between regions and these differences cannot be accounted for by differences in populations' characteristics. Management of most cardiovascular risk factors could be improved.

Is there a motherhood penalty? decomposing the family wage gap in Colombia

The aim of this paper is to provide an estimation and decomposition of the motherhood wage penalty in Colombia. Our empirical strategy was based on the matching procedure designed by Ñopo (The Review of Economics and Statistics, 90(2), 290–299, 2008a ) for the case of gender wage gaps. This is an alternative procedure to the well-known Blinder–Oaxaca decomposition method. Using the cross-sectional data of the Colombian Living Standard Survey, the wage gap was decomposed into four components, according to the characteristics of mothers and non-mothers. Three of the components are explained by differences in observable characteristics of women, while the other is the unexplained part of the gap. We found that mothers earn, on average, 1.73 % less than their counterparts without children and that this gap slightly decreased when the group included older women. It is observed from the results that, once schooling was included as a matching variable, the unexplained part of the gap considerably decreased and became non-significant. Thus, we did not find evidence of wage discrimination against mothers in the Colombian labor market. Copyright Springer Science+Business Media New York 2013

Identification of Summer Origins of Songbirds Migrating through Southern Canada in Autumn

Stable hydrogen isotopes (δD) in flight feathers were measured to investigate the summer origins of five species of boreal-breeding warblers captured during fall migration at Canadian Migration Monitoring Network (CMMN) stations spread across southern Canada. Mean δD varied among stations and species within stations, but there was broad overlap in δD values. Although isotope ratios indicate that migrants at each station come from a wide range of latitudes, they are unable to provide much longitudinal discrimination. Band recoveries are sparse, but indicate that in general western Canadian warblers move southeast in fall, eastern birds move southwest, and there is a transition zone in the Great Lakes region. Combining knowledge of migratory direction with isotope results increases discrimination of breeding areas. Isotope results support fall migratory movements by Blackpoll Warbler (Dendroica striata) and Northern Waterthrush (Seiurus novaboracensis) that are more easterly than for other species, and in all study species, birds from more northern regions passed through southern Canada later in the season. Migration monitoring stations capture birds from broad areas of latitude, and migrants passing through each province appear to come from largely different portions of the Canadian breeding range, so a few stations placed in each province should suffice collectively to sample birds from most of the boreal forest. Migration monitoring in southern Canada, therefore, has the potential to monitor status of boreal forest birds in Canada that are unsampled by other monitoring programs.

The biometeorology of high-altitude insect layers.

Flight at high altitude is part of a migration strategy that maximises insect population displacement. This thesis represents the first substantial analysis of insect migration and layering in Europe. Vertical-looking entomological radar has revealed specific characteristics of high-altitude flight: in particular layering (where a large proportion of the migrating insects are concentrated in a narrow altitude band). The meteorological mechanisms underpinning the formation of these layers are the focus of this thesis. Aerial netting samples and radar data revealed four distinct periods of high-altitude insect migration: dawn, daytime, dusk, and night-time. The most frequently observed nocturnal profiles during the summertime were layers. It is hypothesised that nocturnal layers initiate at a critical altitude (200–500 m above ground level) and time (20:00–22:00 hours UTC). Case study analysis, statistical analysis, and a Lagrangian trajectory model showed that nocturnal insect layers probably result from the insects’ response to meteorological conditions. Temperature was the variable most correlated with nocturnal insect layer presence and intensity because insects are poikilothermic, and temperatures experienced during high-altitude migration in temperate climates are expected to be marginal for many insects’ flight. Hierarchical effects were detected such that other variables—specifically wind speed—were only correlated with insect layer presence and intensity once temperatures were warm. The trajectory model developed comprised: (i) insect flight characteristics; (ii) turbulent winds (which cause vertical spread of the layer); and (iii) mean wind speed, which normally leads to horizontal displacements of hundreds of kilometres in a single migratory flight. This thesis has revealed that there is considerable migratory activity over the UK in the summer months, and a range of fascinating phenomena can be observed (including layers). The UK has moved from one of the least studied to perhaps the best studied environments of aerial insect migration and layering in the world.

The role of the basic state in the ENSO-monsoon relationship and implications for predictability

The impact of systematic model errors on a coupled simulation of the Asian Summer monsoon and its interannual variability is studied. Although the mean monsoon climate is reasonably well captured, systematic errors in the equatorial Pacific mean that the monsoon-ENSO teleconnection is rather poorly represented in the GCM. A system of ocean-surface heat flux adjustments is implemented in the tropical Pacific and Indian Oceans in order to reduce the systematic biases. In this version of the GCM, the monsoon-ENSO teleconnection is better simulated, particularly the lag-lead relationships in which weak monsoons precede the peak of El Nino. In part this is related to changes in the characteristics of El Nino, which has a more realistic evolution in its developing phase. A stronger ENSO amplitude in the new model version also feeds back to further strengthen the teleconnection. These results have important implications for the use of coupled models for seasonal prediction of systems such as the monsoon, and suggest that some form of flux correction may have significant benefits where model systematic error compromises important teleconnections and modes of interannual variability.

Understanding El Niño in ocean-atmosphere general circulation models: progress and challenges

Determining how El Niño and its impacts may change over the next 10 to 100 years remains a difficult scientific challenge. Ocean–atmosphere coupled general circulation models (CGCMs) are routinely used both to analyze El Niño mechanisms and teleconnections and to predict its evolution on a broad range of time scales, from seasonal to centennial. The ability to simulate El Niño as an emergent property of these models has largely improved over the last few years. Nevertheless, the diversity of model simulations of present-day El Niño indicates current limitations in our ability to model this climate phenomenon and to anticipate changes in its characteristics. A review of the several factors that contribute to this diversity, as well as potential means to improve the simulation of El Niño, is presented.

Differences in glutamic acid and 5'-ribonucleotide contents between flesh and pulp of tomatoes and the relationship with umami taste

A difference in taste characteristics between the outer flesh and the inner pulp of tomatoes has been observed; in particular the pulp, which contains the seeds, had more umami taste. Analysis of the free amino acids and 5 '-ribonucleotides in the different parts of 13 varieties of tomatoes showed that in all cases the pulp contained higher levels of glutamic acid, 5 '-adenosine monophosphate (AMP), 5 '-guanosine monophosphate, 5 '-uridine monophosphate, and 5 '-cytidine monophosphate. The mean concentration of glutamic acid in the flesh was 1.26 g/kg and that in the pulp 4.56 g/kg but in some varieties the difference between pulp and flesh was more than 6-fold. For AMP, the mean concentration in the flesh was 80 mg/kg and that in the pulp was 295 mg/kg with one variety showing an 11-fold difference between pulp and flesh. These differences in concentration of these compounds, which are known to possess umami characteristics, provide an explanation for the perceived difference in umami taste between the flesh and pulp of tomatoes.

Numerical modeling of the propagation environment in the atmospheric boundary layer over the Persian Gulf

Strong vertical gradients at the top of the atmospheric boundary layer affect the propagation of electromagnetic waves and can produce radar ducts. A three-dimensional, time-dependent, nonhydrostatic numerical model was used to simulate the propagation environment in the atmosphere over the Persian Gulf when aircraft observations of ducting had been made. A division of the observations into high- and low-wind cases was used as a framework for the simulations. Three sets of simulations were conducted with initial conditions of varying degrees of idealization and were compared with the observations taken in the Ship Antisubmarine Warfare Readiness/Effectiveness Measuring (SHAREM-115) program. The best results occurred with the initialization based on a sounding taken over the coast modified by the inclusion of data on low-level atmospheric conditions over the Gulf waters. The development of moist, cool, stable marine internal boundary layers (MIBL) in air flowing from land over the waters of the Gulf was simulated. The MIBLs were capped by temperature inversions and associated lapses of humidity and refractivity. The low-wind MIBL was shallower and the gradients at its top were sharper than in the high-wind case, in agreement with the observations. Because it is also forced by land–sea contrasts, a sea-breeze circulation frequently occurs in association with the MIBL. The size, location, and internal structure of the sea-breeze circulation were realistically simulated. The gradients of temperature and humidity that bound the MIBL cause perturbations in the refractivity distribution that, in turn, lead to trapping layers and ducts. The existence, location, and surface character of the ducts were well captured. Horizontal variations in duct characteristics due to the sea-breeze circulation were also evident. The simulations successfully distinguished between high- and low-wind occasions, a notable feature of the SHAREM-115 observations. The modeled magnitudes of duct depth and strength, although leaving scope for improvement, were most encouraging.