An evaluation of a community-based program for homeless adults with mental disorders and comorbid alcohol drug and mental disorders

Limited research has been conducted evaluating programs that are designed to improve the outcomes of homeless adults with mental disorders and comorbid alcohol, drug and mental disorders. This study conducted such an evaluation in a community-based day treatment setting with clients of the Harris County Mental Health and Mental Retardation Authority's Bristow Clinic. The study population included all clients who received treatment at the clinic for a minimum of six months between January 1, 1995 and August 31, 1996. An electronic database was used to identify clients and to track their program involvement. A profile was developed of the study participants and their level of program involvement included an examination of the amount of time spent in clinical, social and other interventions, the type of interventions encountered and the number of interventions encountered. Results were analyzed to determine whether social, demographic and mental history affected levels of program involvement and the effects of the levels of program involvement on housing status and psychiatric functioning status.^ A total of 101 clients met the inclusion criteria. Of the 101 clients, 96 had a mental disorder, and five had comorbidity. Due to the limited numbers of participants with comorbidity, only those with mental disorders were included in the analysis. The study found the Bristow Clinic population to be primarily single, Black, male, between the ages of 31 and 40 years, and with a gross family income of less than $4,000. There were more persons residing on the streets at entry and at six months following treatment than in any other residential setting. The most prevalent psychiatric diagnoses were depressive disorders and schizophrenia. The Global Assessment of Functioning (GAF) scale which was used to determine the degree of psychiatric functioning revealed a modal GAF score of 31--40 at entry and following six months in treatment. The study found that the majority of clients spent less than 17 hours in treatment, had less than 51 encounters and had clinical, social, and other encounters. In regard to social and demographic factors and levels of program involvement, there were statistically significant associations between gender and ethnicity and the types of interventions encountered as well as the number of interventions encountered. There was also a statistically significant difference between the amount of time spent in clinical interventions and gender. Relative to outcomes measured, the study found female gender to be the only background variable that was significantly associated with improved housing status and the female gender and previous MHMRA involvement to be statistically associated with improvement in GAF score. The total time in other (not clinical or social) interventions and the total number of encounters with other interventions were also significantly associated with improvement in housing outcome. The analysis of previous services and levels of program involvement revealed significant associations between time spent in social and clinical interventions and previous hospitalizations and previous MHMRA involvement.^ Major limitations of this study include the small sample size which may have resulted in very little power to detect differences and the lack of generalizability of findings due to site locations used in the study. Despite these limitations, the study makes an important contribution to the literature by documenting the levels of program involvement and the social and demographic factors necessary to produce outcomes of improved housing status and psychiatric functioning status. ^

Short-term functional outcome and premorbid adjustment in clinical high-risk patients. Results of the EPOS project

PURPOSE In patients with schizophrenia, premorbid psychosocial adjustment is an important predictor of functional outcome. We studied functional outcome in young clinical high-risk (CHR) patients and how this was predicted by their childhood to adolescence premorbid adjustment. METHODS In all, 245 young help-seeking CHR patients were assessed with the Premorbid Adjustment Scale, the Structured Interview for Prodromal Syndromes (SIPS) and the Schizophrenia Proneness Instrument (SPI-A). The SIPS assesses positive, negative, disorganised, general symptoms, and the Global Assessment of Functioning (GAF), the SPI-A self-experienced basic symptoms; they were carried out at baseline, at 9-month and 18-month follow-up. Transitions to psychosis were identified. In the hierarchical linear model, associations between premorbid adjustment, background data, symptoms, transitions to psychosis and GAF scores were analysed. RESULTS During the 18-month follow-up, GAF scores improved significantly, and the proportion of patients with poor functioning decreased from 74% to 37%. Poor premorbid adjustment, single marital status, poor work status, and symptoms were associated with low baseline GAF scores. Low GAF scores were predicted by poor premorbid adjustment, negative, positive and basic symptoms, and poor baseline work status. The association between premorbid adjustment and follow-up GAF scores remained significant, even when baseline GAF and transition to psychosis were included in the model. CONCLUSION A great majority of help-seeking CHR patients suffer from deficits in their functioning. In CHR patients, premorbid psychosocial adjustment, baseline positive, negative, basic symptoms and poor working/schooling situation predict poor short-term functional outcome. These aspects should be taken into account when acute intervention and long-term rehabilitation for improving outcome in CHR patients are carried out.

Sozialismus ohne Wachstum und Technologie? Die Linke in der Schweiz und die Umweltfrage 1968–1990

Die Arbeiterbewegung hat sich ursprünglich der sozioökonomischen Schattenseite der Industrialisierung verschrieben. Für die ökologischen Nebenfolgen der technoökonomischen Entwicklung haben die linken Gesellschaftskritiker insofern kein Gespür gezeigt, als der historische Naturschutz bis in die 1970er Jahre eine traditionelle Domäne der Konservativen war. Die Linke verstand sich selbst als „progressiv“ und glaubte, einzig mit dem Fortschreiten von Wachstum und Technologie die Utopie einer sozialistischen Zukunft realisieren zu können. Dann aber – im Zuge der ökologischen Zäsur Ende der 1960er Jahre – wurde das Verhältnis zur Natur aus einer neuen Perspektive betrachtet. Die sich für die Umwelt zuständig fühlenden Kräfte gruppierten sich um. Das Umweltthema geriet in das Blickfeld der Arbeiterparteien, die sich mit dem eigenen Fortschrittsmythos auseinander zu setzen hatten. Wie haben die „Progressiven“ die Diskussion um die Grenzen der wirtschaftlichen und technologischen Entwicklung geführt? Welche traditionellen Denkmuster wurden im Zuge der Lernprozesse ökologisch aufgebrochen? Welchen Einfluss hatte der Umweltdiskurs der Linken auf das gesamtgesellschaftliche Reden und Denken über die Umwelt?

Genomic and genetic dissection of an archaeal regulon

The extremely halophilic archaeon Halobacterium sp. NRC-1 can grow phototrophically by means of light-driven proton pumping by bacteriorhodopsin in the purple membrane. Here, we show by genetic analysis of the wild type, and insertion and double-frame shift mutants of Bat that this transcriptional regulator coordinates synthesis of a structural protein and a chromophore for purple membrane biogenesis in response to both light and oxygen. Analysis of the complete Halobacterium sp. NRC-1 genome sequence showed that the regulatory site, upstream activator sequence (UAS), the putative binding site for Bat upstream of the bacterio-opsin gene (bop), is also present upstream to the other Bat-regulated genes. The transcription regulator Bat contains a photoresponsive cGMP-binding (GAF) domain, and a bacterial AraC type helix–turn–helix DNA binding motif. We also provide evidence for involvement of the PAS/PAC domain of Bat in redox-sensing activity by genetic analysis of a purple membrane overproducer. Five additional Bat-like putative regulatory genes were found, which together are likely to be responsible for orchestrating the complex response of this archaeon to light and oxygen. Similarities of the bop-like UAS and transcription factors in diverse organisms, including a plant and a γ-proteobacterium, suggest an ancient origin for this regulon capable of coordinating light and oxygen responses in the three major branches of the evolutionary tree of life. Finally, sensitivity of four of five regulon genes to DNA supercoiling is demonstrated and correlated to presence of alternating purine–pyrimidine sequences (RY boxes) near the regulated promoters.

Antiviral activities of the soluble extracellular domains of type I interferon receptors

Alternative splicing leads to the expression of multiple isoforms of the subunits (IFNAR1 and IFNAR2) of the type I IFN receptor. Here we describe two transcripts representing extracellular forms of ovine IFNAR1 and show that soluble extracellular forms of both IFNAR2 and IFNAR1, prepared in recombinant form in Escherichia coli, have antiviral (AV) activity in the absence of IFN. Exposure of Madin-Darby bovine kidney cells to the extracellular domain (R2E) of IFNAR2 at concentrations as low as 10 nM afforded complete protection against vesicular stomatitis virus and led to the rapid activation of the transcription factors ISGF3 and GAF. Although R2E can bind IFN (Kd ≈70 nM), activity was observed irrespective of whether or not ligand was present. R2E was inactive on mouse L929 cells but active on L929 cells expressing a membraneanchored, ovine/human chimeric IFNAR2 with an ovine extracellular domain. The data suggest that AV activity is conferred by the ability of soluble R2E to associate with the transfected IFNAR2 subunit rather than resident murine IFNAR1. Soluble extracellular forms of IFNAR1 have lower AV activity than R2E on Madin-Darby bovine kidney cells but are less species-specific and protect wild-type L929 cells as efficiently as the transfected cell line, presumably by interacting with one of the murine receptor subunits.

Traffic based energy consumption optimisation to improve the lifetime and performance of ad hoc wireless sensor networks

Ad hoc wireless sensor networks (WSNs) are formed from self-organising configurations of distributed, energy constrained, autonomous sensor nodes. The service lifetime of such sensor nodes depends on the power supply and the energy consumption, which is typically dominated by the communication subsystem. One of the key challenges in unlocking the potential of such data gathering sensor networks is conserving energy so as to maximize their post deployment active lifetime. This thesis described the research carried on the continual development of the novel energy efficient Optimised grids algorithm that increases the WSNs lifetime and improves on the QoS parameters yielding higher throughput, lower latency and jitter for next generation of WSNs. Based on the range and traffic relationship the novel Optimised grids algorithm provides a robust traffic dependent energy efficient grid size that minimises the cluster head energy consumption in each grid and balances the energy use throughout the network. Efficient spatial reusability allows the novel Optimised grids algorithm improves on network QoS parameters. The most important advantage of this model is that it can be applied to all one and two dimensional traffic scenarios where the traffic load may fluctuate due to sensor activities. During traffic fluctuations the novel Optimised grids algorithm can be used to re-optimise the wireless sensor network to bring further benefits in energy reduction and improvement in QoS parameters. As the idle energy becomes dominant at lower traffic loads, the new Sleep Optimised grids model incorporates the sleep energy and idle energy duty cycles that can be implemented to achieve further network lifetime gains in all wireless sensor network models. Another key advantage of the novel Optimised grids algorithm is that it can be implemented with existing energy saving protocols like GAF, LEACH, SMAC and TMAC to further enhance the network lifetimes and improve on QoS parameters. The novel Optimised grids algorithm does not interfere with these protocols, but creates an overlay to optimise the grids sizes and hence transmission range of wireless sensor nodes.

The impact of general intellectual ability and white matter volume on the functional outcome of patients with bipolar disorder and their relatives

Background: There is substantial evidence that cognitive deficits and brain structural abnormalities are present in patients with Bipolar Disorder (BD) and in their first-degree relatives. Previous studies have demonstrated associations between cognition and functional outcome in BD patients but have not examined the role of brain morphological changes. Similarly, the functional impact of either cognition or brain morphology in relatives remains unknown. Therefore we focused on delineating the relationship between psychosocial functioning, cognition and brain structure, in relation to disease expression and genetic risk for BD. Methods: Clinical, cognitive and brain structural measures were obtained from 41 euthymic BD patients and 50 of their unaffected first-degree relatives. Psychosocial function was evaluated using the General Assessment of Functioning (GAF) scale. We examined the relationship between level of functioning and general intellectual ability (IQ), memory, attention, executive functioning, symptomatology, illness course and total gray matter, white matter and cerebrospinal fluid volumes. Limitations: Cross-sectional design. Results: Multiple regression analyses revealed that IQ, total white matter volume and a predominantly depressive illness course were independently associated with functional outcome in BD patients, but not in their relatives, and accounted for a substantial proportion (53%) of the variance in patients' GAF scores. There were no significant domain-specific associations between cognition and outcome after consideration of IQ. Conclusions: Our results emphasise the role of IQ and white matter integrity in relation to outcome in BD and carry significant implications for treatment interventions. © 2010 Elsevier B.V.

Radio range adjustment for energy efficient wireless sensor networks

In wireless ad hoc sensor networks, energy use is in many cases the most important constraint since it corresponds directly to operational lifetime. Topology management schemes such as GAF put the redundant nodes for routing to sleep in order to save the energy. The radio range will affect the number of neighbouring nodes, which collaborate to forward data to a base station or sink. In this paper we study a simple linear network and deduce the relationship between optimal radio range and traffic. We find that half of the power can be saved if the radio range is adjusted appropriately compared with the best case where equal radio ranges are used.

Ik Zie, Ik Zie, Wat Jij Ook Ziet … I See, I See, What You Also See …

Ouadi-Maachi, I (2016). Ik Zie, Ik Zie, Wat Jij Ook Ziet … I See, I See, What You Also See … Een ontwerpgericht onderzoek naar de invloed van visuele beelden in het ontwikkelingsperspectief van de ‘Nederlands als tweede taal’(NT2) leerling om een eventuele taalbarrière tussen de leraar en de ouders te doorbreken. Juli,11, 2016, Heerlen, Nederland: Open Universiteit.

Hedonisme en Eudemonisme bij Activiteiten in Verband met Depressieve Symptomen en Welbevinden bij Ouderen in Verpleeghuizen

Het onderzoek beoogt het vergroten van het inzicht in het verband tussen het ervaren van hedonisme en eudemonisme bij activiteiten enerzijds en depressie en welbevinden anderzijds bij ouderen op somatische afdelingen in verpleeghuizen, teneinde te kunnen bijdragen aan een verbetering van hun kwaliteit van leven. Het betrof een cross-sectioneel survey onderzoek met het ervaren hedonisme en eudemonisme als predictoren, de ernst van depressieve symptomen als primaire uitkomstmaat en welbevinden als secundaire uitkomstmaat. In totaal namen 59 bewoners deel aan dit onderzoek met een gemiddelde leeftijd van 87.9 jaar (SD = 5.9), waarvan 51 (86.4%) vrouwen. Bewoners met ernstige gedrags- of communicatiestoornissen werden uitgesloten. De mate van depressieve symptomen werd gemeten met de Geriatrische Depressie Schaal (GDS-8) (Gerritsen et al., 2007); de levenstevredenheid met de Satisfaction With Life Scale (SWSL) (Arrindell, Heesink, & Feij, 1999); het positief en negatief affect met de Positive and Negative Affect Schedule (PANAS) (Engelen, Peuter, Victoir, Diest, & Van den Bergh, 2006); de hedonische en eudemonische ervaringen bij activiteiten met een voor dit onderzoek ontwikkelde vragenlijst; en de afhankelijkheid bij de Activiteiten Dagelijks Leven (ADL) met de Barthel Index (Mahoney & Barthel, 1965). Er waren significante negatieve verbanden tussen depressieve symptomen en het ervaren van hedonisme, R² = .14, B = -.56, 95% Cl [-1.07, -.06] en van eudemonisme, R² = .12, B = -.53, 95% Cl [-1.05, .00]. De regressieanalyse van hedonisme én eudemonisme samen gaf echter geen significante effecten op depressieve symptomen. Opvallend was de sterke correlatie (r = .90) tussen hedonische en eudemonische ervaringen. Er zijn geen verbanden gevonden tussen het ervaren van hedonisme en eudemonisme aan de ene kant en het subjectief welbevinden aan de andere kant, te weten levenstevredenheid, positief en negatief affect. Echter bij instrumentele activiteiten van het dagelijks leven (o.a. boodschappen doen en bed opmaken) had eudemonisme een positief verband, R² = .20, B = 3.55, 95% Cl [.75, 6.34] en hedonisme een negatief verband, R² = .20, B = -2.71, 95% Cl [-.5.50, .08] met negatief affect.

Het Effect van de Kanker Nazorg Wijzer* op Werkgerelateerde Problematiek en Kwaliteit van Leven bij Werkende Ex-Kankerpatiënten

Doordat kanker vaker in een vroeg stadium wordt ontdekt en de behandelingen effectiever zijn, is de kans om te overleven toegenomen. Om ex-kankerpatiënten te kunnen begeleiden na hun ziekte is de Kanker Nazorg Wijzer (KNW) ontwikkeld: een online interventie voor ex-kankerpatiënten ter ondersteuning van ervaren problemen op diverse gebieden waaronder werkhervatting. De KNW bestaat uit modules met informatie, advies, training en feedback-op-maat voor die betreffende probleemgebieden. In het huidige onderzoek stond het effect van de KNW op werkgerelateerde problematiek bij werkende ex-kankerpatiënten centraal en werd ook het effect op kwaliteit van leven gemeten. Verwacht werd dat na zes maanden gebruik van de KNW het aantal werkzame uren (werkhervatting), de werktevredenheid en kwaliteit van leven bij de gebruikers (interventiegroep) meer is toegenomen dan bij de niet-gebruikers (controlegroep) en dat de problemen op het werk en de onvervulde behoefte aan werkgerelateerde informatie meer is afgenomen. Additief werd verondersteld dat, binnen de interventiegroep, de respondenten die specifiek de werkmodule hadden gebruikt een groter verschil laten zien tussen de voor- en nameting met betrekking tot de werkgerelateerde problematiek. Op basis van voorgaand onderzoek zijn sekse, leeftijd, opleiding en actieve coping meegenomen als confounders evenals de voormetingscores van de afhankelijke variabelen. Het betreft een gerandomiseerd experiment naar de effecten van de KNW. Respondenten zijn geworven bij 22 Nederlandse ziekenhuizen en werden random toegewezen aan de interventiegroep of controlegroep. Voor de effectmeting is alleen de data van werkende ex-kankerpatiënten gebruikt. Effecten werden getoetst met multiple regressie analyses waarbij werd gecorrigeerd voor de genoemde confouders. In de interventiegroep (N = 245) waren 156 werkende ex-kankerpatiënten (85.3% vrouw, leeftijd M = 50.7) en in de controlegroep (N = 236) waren dit er 134 (85.1% vrouw, leeftijd M = 51.2). De MRA gaf na correctie van de voormetingscores en confounders aan dat het gebruik van de KNW zorgde voor een significante verbetering van kwaliteit van leven op de subschalen fysiek functioneren (p = 0.005), emotioneel functioneren (p = 0.026), sociaal functioneren (p = 0.002) en vermoeidheid (p = 0.021). De MRA gaf geen significant effect van het gebruik van de KNW op de werkgerelateerde problematiek. Additief gaf een vergelijking binnen de interventiegroep tussen de gebruikers van de werkmodule (N = 25) en de niet gebruikers (N = 131) aan dat het aantal gewerkte uren significant meer was toegenomen onder de gebruikers (t (68) = 1.680, p = 0.049).

O Efeito da Terapia Cognitivo Comportamental na Anorexia Nervosa: uma meta-análise

Introdução: A Anorexia Nervosa (AN) é a perturbação do comportamento alimentar (PCA) com a maior taxa de mortalidade de todos os transtornos psiquiátricos. Carateriza-se pela recusa em manter um peso corporal normal mínimo, pela distorção da imagem corporal e por um obsessivo medo de ganhar peso. Os comportamentos patológicos a ela associados podem levar a uma semi-inanição que necessita de cuidados médicos pluridisciplinares, muitas vezes, em regime de internamento. Vários ensais clínicos avaliaram a eficácia da Terapia Cognitivo- Comportamental (TCC), indicando que ela favorece a remissão ou a diminuição da frequência de episódios de compulsão alimentar, dos comportamentos purgativos e da restrição alimentar. Objetivo: Combinar os resultados da melhor evidência científica de forma a avaliar a eficácia da TCC em comparação com outras terapias utilizadas no tratamento da AN. Métodos: A pesquisa realizou-se nas bases de dados eletrónicas da MEDLINE, Psyc-Info, Embase, CCTR e de forma manual, incluindo ensaios clínicos controlados randomizados que comparam a TCC com qualquer outro tipo de intervenção no tratamento da AN. Resultados: Foram incluídos 10 estudos que envolveram 957 pacientes: dos quais 571 (59,7%) foram submetidos a tratamento com Terapia cognitivo comportamental e 556 (49,3%) a outras terapias. Não se registaram diferenças significativas nos resultados obtidos em diversos outcomes, exceto nas subescalas Restrições (z=3,03; p=0,02), Preocupações alimentares (z=2,98; p=0,002) e Preocupações com a forma (z=1,71; p=0,09) do EDE e nos scores da escala GAF (z=1,87; p=0,06). Registaram-se diferenças estatisticamente significativas no número de episódios bulímicos (z=2,61; p=0,009), número de episódios de indução de vómito (z=2,11; p=0,03) e no número de episódios de uso indevido de laxantes (z=3,04; p=0,002). Conclusão: A utilização da Terapia Cognitivo-Comportamental no tratamento de doentes com AN parece melhorar bastante os sintomas da doença, revelando-se particularmente eficaz nos resultados obtidos na Eating Disorder Examination Scale. A sua utilização parece levar a uma melhoria no scores da GAF, evidenciando uma melhoria geral do estado de saúde dos pacientes (redução dos episódios de vómito, bulimia e uso de laxantes). / Página | viii ABSTRACT Background: Anorexia Nervosa is an eating disorder with the highest mortality rate of all psychiatric disorders. It is characterized by refusal to maintain a minimally normal body weight, the distortion of body image and obsessive fear of gaining weight. The pathological behaviors associated with it can lead to semi-starvation, requiring medical treatment and multidisciplinary inpatient care. Several clinical trials evaluated the efficacy of Cognitive Behavioral Therapy (CBT) in lead to remission or reduction of the frequency of bingue eating episodes, purgative behaviors and food restriction. Objective: Combining the results of the best scientific evidence to assess the efficacy of CBT in comparison with other therapies used in the treatment of AN. Methods: The research was carried out in electronic databases of MEDLINE, Psyc- Info, Embase, CCTR and manually, including randomized controlled trials that compared CBT with any other type of intervention in the treatment of AN. Results: Of which 571 (59.7%) were treated with cognitive behavioral therapy and 556 (49.3%) to other therapies: 10 studies involving 957 patients were included. No significant differences in the results obtained in different outcomes, except subscales Restrictions (z = 3.03, p = 0.02), Eating Concerns (z = 2.98, p = 0.002) and Shape Concerns (z = 1.71, p = 0.09) in the scores of EDE and the GAF scale (z = 1.87, p = 0.06). There were statistically significant differences in the number of bulimic episodes (z = 2.61, p = 0.009), number of episodes of induced vomiting (z = 2.11, p = 0.03) and the number of occurrences of use misuse of laxatives (z = 3.04, p = 0.002). Conclusion: The use of cognitive-behavioral therapy in the treatment of patients with AN seems to greatly improve the symptoms of the disease, revealing particularly effective results in the Eating Disorder Examination Scale. Its use seems to lead to an improvement in the GAF scores, showing a general improvement of the health status of patients (reduction of episodes of vomiting, bulimia and laxative use).

Vielfalt betreuter Kindheiten. Ethnographische Fallstudien zu den Bildungs- und Betreuungsarrangements 2-4jähriger Kinder

Kinder werden gemeinhin als Adressaten, aber weniger als Akteure von institutionellen Angeboten der Bildung und Betreuung in früher Kindheit wahrgenommen – und das obwohl sie ein komplexes Leben zwischen Familie, Kindertagesbetreuung und Vorschule führen. Das Forschungsprojekt CHILD - Children in the Luxembourgian Day Care System hat das Feld der frühen Bildung und Betreuung von der Position der Kinder aus betrachtet und in kindheitstheoretischer und praxisanalytischer Perspektive nach der Vielfalt betreuter Kindheiten gefragt. Vom Standpunkt der Kinder aus differenziert sich das Luxemburger Feld von Bildung und Betreuung in früher Kindheit in vielfältige Bildungs- und Betreuungsarrangements aus. Sie bestimmen nicht nur die Erfahrungen, die Kinder mit nicht-familialer Bildung und Betreuung machen – und man muss hinzufügen: die nur Kinder machen –, sondern sie bedingen auch die strukturelle Position der Kinder als Mitgestalter von Bildungs- und Betreuungslandschaften früher Kindheit. Bildungs- und Betreuungsarrangements sind eine Domäne der Kinder, obwohl sie sich in einem Zusammenspiel vieler aufeinander bezogener Orte, Kontexte und Akteure realisieren. In diesem Forschungsbericht werden acht ethnographische Fallstudien präsentiert, welche die Multilokalität, Multikontextualität und Multiperspektivität der Bildungs- und Betreuungsarrangements zwei- bis vierjähriger Kinder im Lichte der Alltagspraxis der Kinder analysieren. Die acht Fallstudien zeigen daher nicht nur, dass und wie Kinder zur täglichen Herstellung des Feldes früher Bildung und Betreuung beitragen, sie machen auch die Vielfalt betreuter Kindheiten in Luxemburg sichtbar. (DIPF/Orig.)