Early tailored assertive community case management for hard-to-engage adolescents suffering from psychiatric disorders: an exploratory pilot study.

AIM: The study aims to evaluate the effects of assertive community treatment (ACT) on the mental health and overall functioning of adolescents suffering from severe psychiatric disorders and who refuse any traditional child psychiatric care. There are a few studies evaluating the effects of ACT on a population of adolescents with psychiatric disorders. This short report highlights the impact of an ACT programme tailored to the needs of these patients, not only as an alternative to hospitalization, but also as a new form of intervention for patients that are difficult to engage. METHODS: The effect of ACT on 35 adolescents using the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) as a measuring tool in pre- and post-intervention was evaluated. RESULTS: The results show that the intervention was associated with a significant improvement on the HoNOSCA overall score, with the following items showing significant amelioration: hyperactivity/focus problems, non-organic somatic symptoms, emotional symptoms, scholastic/language skills, peer relationships, family relationships and school attendance. CONCLUSION: ACT appears as a feasible intervention for hard-to-engage adolescents suffering from psychiatric disorders. The intervention seems to improve their mental health and functioning. This pilot study may serve as a basis to prepare a controlled study that will also take the costs of the intervention into account.

Growth, nodulation and nitrogen fixation of cowpea in soils amended with composted tannery sludge

Tannery wastes generation is increasing every year and a suitable method for tannery sludge management is necessary in order to decrease this environmental problem. The composting is recognized as a suitable method for sludge recycling.. The effect of tannery sludge compost (TSC) rates on growth, nodulation and N fixation of cowpea was investigated. Sandy and clayey soils were amended with TSC at rates of 0, 7.5, 15, 30, and 60 t ha-1. The shoot dry weight of cowpea plants 45 days after emergence (DAE) was greater in the TSC-amended than in the unamended soil. In the sandy soil, nodule dry weight increased with TSC application 45 DAE. In the clayey soil, 45 DAE, nodule dry weight decreased with TSC amendment levels greater than 7.5 t ha-1 compared to the unamended control. The application of TSC increased N accumulation in the cowpea plants. The results suggest that cowpea responds differently to TSC depending on the amendment rate and initial soil type.

Replication of an ivg protocol to estimate bioaccessible arsenic in materials from a gold mining area in Brazil

Tests for bioaccessibility are useful in human health risk assessment. No research data with the objective of determining bioaccessible arsenic (As) in areas affected by gold mining and smelting activities have been published so far in Brazil. Samples were collected from four areas: a private natural land reserve of Cerrado; mine tailings; overburden; and refuse from gold smelting of a mining company in Paracatu, Minas Gerais. The total, bioaccessible and Mehlich-1-extractable As levels were determined. Based on the reproducibility and the accuracy/precision of the in vitro gastrointestinal (IVG) determination method of bioaccessible As in the reference material NIST 2710, it was concluded that this procedure is adequate to determine bioaccessible As in soil and tailing samples from gold mining areas in Brazil. All samples from the studied mining area contained low percentages of bioaccessible As.

Fair Housing For Families with Children

What’s wrong with this advertisement? This wording used to be very familiar in our daily newspaper ads. But the federal Fair Housing Amendments Act was passed in 1988, making it illegal to refuse to rent or sell property to families because they have children. In 1992, the Iowa Civil Rights Act was amended to also prohibit discrimination against families with children. The law defines a family with children as follows: One or more individuals under the age of 18 living with a parent, or with a person having legal custody  A designee of such parent or legal guardian  Persons who are expecting a baby or who are seeking legal custody of a child.

Laboratory Evaluation of Asphalt-Rubber in Asphalt Paving Mixture, MLR-89-15, 1990

Interest in the use of ground rubber from used tires as a hot asphalt mix binder has been increasing due to the magnitude of the disposal problem posed by the annual addition of millions of waste tires to the refuse stream. This study evaluates, through laboratory means, the performance of asphalt-rubber as a hot mix binder as compared to conventional asphalt. The results indicate that asphalt-rubber outperforms its base asphalt in mixes of identical gradation and comparable void content on tests that are heavily dependent on binder characteristics (resilient modulus and indirect tension). An appreciable increase in rut resistance due to the use of asphalt-rubber is not indicated.

Prevalence, predictors, and consequences of long-term refusal of antipsychotic treatment in first-episode psychosis.

OBJECTIVE: Studies investigating medication adherence in psychosis are limited by the need of a certain degree of medication adherence and the inclusion of mostly multiple-episode patients. By contrast, noninformed consent, epidemiological studies in first-episode psychosis (FEP) allow the assessment of an important subgroup of patients who persistently refuse antipsychotic medication and thereby never receive an adequate antipsychotic trial. The present study aims to assess the prevalence and predictors of such a "medication refusal" subgroup and its association with illness outcome. METHODS: The present file audit study assessed medication adherence in an epidemiological cohort of 605 FEP patients who were treated within the Early Psychosis Prevention and Intervention Centre for up to 18 months. Medication adherence was categorized into full adherence, nonadherence, and persistent medication refusal. Predictors were analyzed using logistic regression models. RESULTS: During the 18-month treatment period, 204 patients (33.7%) were fully adherent, 287 (47.4%) displayed at least 1 phase of nonadherence, and 114 patients (18.8%) were persistent medication refusers. Poor premorbid functioning, comorbid substance use, and poor insight predicted both medication refusal and nonadherence; a forensic history and no previous contact to psychiatric care were specifically predictive of medication refusal. With respect to illness outcome, nonadherent patients were worse off when compared with fully adherent patients, and medication refusers were even worse off compared with nonadherent patients. CONCLUSIONS: Within a nonselected epidemiological FEP cohort, almost 20% of patients are persistent medication refusers. The found predictors may help to identify the individual risk of persistent medication refusal and may enable an early (preventive) treatment adaptation.

L'esquerda ecològica: residus industrials i geografia humana

L'article presenta una visió global de la problemitica dels residus industrials des d'una doble perspectiva que destaca el caracter sbcioterritorial dels impactes, associats a la seva preskncia en el medi, i els conflictes que s'esdevenen entorn a les opcions de gestió actualment vigents. Després d'examinar els residus en relació amb la producció industrial, i la producció i "eliminació", dels residus industrials des de la dimensió territorial, es fa un reph de les polítiques de gestió, sobre la base de diferents palsos productors, i s'estudien les implicacions socio-polítiques dels models de gestió, tot centrant-se en l'analisi de les iniciatives ciutadanes alemanyes i de les mobilitzacions a Catalunya en resposta al cepla Director per a la Gestió dels Residus Industrials a Catalunyau. A les conclusions s'enceta una reflexió a l'entorn de la recerca en Geografia Humana i l'anilisi dels residus industrials, i es plantegen les implicacions tebriques i epistemologiques de cara a una visió social dels problemes ambientals.

The underestimation of compliance to direct help requests explained by adaptive sampling

Helping behavior is any intentional behavior that benefits another living being or group (Hogg & Vaughan, 2010). People tend to underestimate the probability that others will comply with their direct requests for help (Flynn & Lake, 2008). This implies that when they need help, they will assess the probability of getting it (De Paulo, 1982, cited in Flynn & Lake, 2008) and then they will tend to estimate one that is actually lower than the real chance, so they may not even consider worth asking for it. Existing explanations for this phenomenon attribute it to a mistaken cost computation by the help seeker, who will emphasize the instrumental cost of “saying yes”, ignoring that the potential helper also needs to take into account the social cost of saying “no”. And the truth is that, especially in face-to-face interactions, the discomfort caused by refusing to help can be very high. In short, help seekers tend to fail to realize that it might be more costly to refuse to comply with a help request rather than accepting. A similar effect has been observed when estimating trustworthiness of people. Fetchenhauer and Dunning (2010) showed that people also tend to underestimate it. This bias is reduced when, instead of asymmetric feedback (getting feedback only when deciding to trust the other person), symmetric feedback (always given) was provided. This cause could as well be applicable to help seeking as people only receive feedback when they actually make their request but not otherwise. Fazio, Shook, and Eiser (2004) studied something that could be reinforcing these outcomes: Learning asymmetries. By means of a computer game called BeanFest, they showed that people learn better about negatively valenced objects (beans in this case) than about positively valenced ones. This learning asymmetry esteemed from “information gain being contingent on approach behavior” (p. 293), which could be identified with what Fetchenhauer and Dunning mention as ‘asymmetric feedback’, and hence also with help requests. Fazio et al. also found a generalization asymmetry in favor of negative attitudes versus positive ones. They attributed it to a negativity bias that “weights resemblance to a known negative more heavily than resemblance to a positive” (p. 300). Applied to help seeking scenarios, this would mean that when facing an unknown situation, people would tend to generalize and infer that is more likely that they get a negative rather than a positive outcome from it, so, along with what it was said before, people will be more inclined to think that they will get a “no” when requesting help. Denrell and Le Mens (2011) present a different perspective when trying to explain judgment biases in general. They deviate from the classical inappropriate information processing (depicted among other by Fiske & Taylor, 2007, and Tversky & Kahneman, 1974) and explain this in terms of ‘adaptive sampling’. Adaptive sampling is a sampling mechanism in which the selection of sample items is conditioned by the values of the variable of interest previously observed (Thompson, 2011). Sampling adaptively allows individuals to safeguard themselves from experiences they went through once and turned out to lay negative outcomes. However, it also prevents them from giving a second chance to those experiences to get an updated outcome that could maybe turn into a positive one, a more positive one, or just one that regresses to the mean, whatever direction that implies. That, as Denrell and Le Mens (2011) explained, makes sense: If you go to a restaurant, and you did not like the food, you do not choose that restaurant again. This is what we think could be happening when asking for help: When we get a “no”, we stop asking. And here, we want to provide a complementary explanation for the underestimation of the probability that others comply with our direct help requests based on adaptive sampling. First, we will develop and explain a model that represents the theory. Later on, we will test it empirically by means of experiments, and will elaborate on the analysis of its results.

Healthcare Power of Attorney

A health care power of attorney (HC-POA) is a document authorizing an attorney-in-fact (your designated agent) to make health care decisions on your behalf if you (the principal) are unable, in the judgment of your attending physician, to make health care decisions. Health care is defined as any care, treatment, service or procedure required to maintain, diagnose or treat a physical or mental condition. Through your HC-POA, you may authorize someone else to consent, refuse or withdraw consent to health care on your behalf. The attorney-in-fact is permitted to make only health care-related decisions on your behalf. In exercising this authority, the attorney-in-fact must act consistently with your desires (as stated in the HC-POA document).

Health Care Power of Attorney FAQs

A health care power of attorney (HC-POA) is a document authorizing an attorney-in-fact (your designated agent) to make health care decisions on your behalf if you (the principal) are unable, in the judgment of your attending physician, to make health care decisions. Health care is defined as any care, treatment, service or procedure required to maintain, diagnose or treat a physical or mental condition. Through your HC-POA, you may authorize someone else to consent, refuse or withdraw consent to health care on your behalf.

Diagnostics VIH tardifs en 2009 en Suisse: motivation a un dépistage systématique du VIH [Late diagnoses of HIV infection in 2009 in Switzerland: towards a universal HIV testing?]

Individuals who are unaware of their HIV infection constitute a fragile and a critical population both from a personal and from a community-based point of view: if the infection is diagnosed too late, the outcome can be complicated by AIDS-defining diseases, whose prognosis may remain unfavourable even after the initiation of a potent antiretroviral therapy. These patients contribute to the virus spreading into the community, owing to a high viral load. It is now necessary to recognise the limits of a risk behaviour and disease-driven HIV screening policy. Since 2006, the American guidelines recommend a routine HIV testing for all patients age 13 to 64 years unless they specifically refuse the test (opt-out). In Switzerland, the recommendations remain so far risk-centred.

Prevalence and predictors of suicide attempt in an incidence cohort of 661 young people with first-episode psychosis

OBJECTIVES: Studies investigating suicidal behaviour in psychosis rarely focus on incidence cohorts of first-episode patients. This is important, because patients who refuse study participation have higher rates of comorbid substance use disorders and longer duration of untreated psychosis as well as worse course illness, variables potentially linked to higher prevalence of suicidal behaviour. The aims of the present study were therefore to examine the prevalence and predictors of suicide and suicide attempt before and during the first 18-24 months of treatment. METHOD: A retrospective file audit of 661 patients was carried out. RESULTS: Six patients (0.9%) died by suicide, 93 (14.3%) attempted suicide prior to entry, and 57 (8.7%) did so during treatment. Predictors of suicide attempt were: previous attempt (odds ratio (OR)=45.54, 95% confidence interval (CI)=9.46-219.15), sexual abuse (OR=8.46, 95%CI=1.88-38.03), comorbid polysubstance (OR=13.63, 95%CI=2.58-71.99), greater insight (OR=0.17, 95%CI=0.06-0.49), lower baseline Global Assessment of Functioning Scale and Scale of Occupational and Functional Assessment score (OR=0.96, 95%CI=0.62-0.91; OR=0.98, 95%CI=0.95-0.99), and longer time in treatment (OR=1.05, 95%CI=1.03-1.08). CONCLUSIONS: The prevalence of suicidal behaviour was high, indicating that suicidal behaviour in incidence populations is higher than in non-epidemiological cohorts of first-episode patients. The rate of repetition of suicide attempt among the sample, however, was lower than expected, suggesting that specialist services can play a role in reducing suicide risk.

Kalkkisaostuslaitteiston suunnittelu Biolan Oy:n lannoite- ja kasvualustatehtaan varastoja ja kompostointikentältä tulevien suoto- ja hulevesien käsittelyyn

Tässä diplomityössä oli tavoitteena löytää ratkaisu Biolan Oy:n lannoiteja kasvualustatehtaan varastoja kompostointikentältä tulevien suotoja hulevesien käsittelyyn. Erityisenä kiinnostuksen kohteena oli suotoja hulevesien sisältämän fosforin poistamisen ratkaisun löytäminen. Ratkaisua päätettiin lähteä hakemaan kemiallisen saostuksen kautta. Fosforin kemiallinen saostus toteutetaan nykypäivänä useimmiten raudan ja alumiini yhdisteiden avulla, mutta tämän työn lähtökohtana oli saostuksen suorittaminen kalkilla. Yhtenä työn lähtökohtana oli myös muodostuvan, fosforipitoisen, kalkkisakan hyödyntäminen Biolan Oy:n kasvualustatehtaan tuottamien kasvualustojen ravinnelähteenä, jolloin yleisesti ongelmana pidetty jätevesiliete muuttuu mahdollisuudeksi.

Naudan lietelannan käsittelymenetelmien taloudellinen vertailu

Maataloudessa syntyvä lanta on arvokas lannoite ja maanparannusaine, jonka käsittelystä aiheutuu sekä kustannuksia että ympäristövaikutuksia. Muita haasteita ovat esimerkiksi lannan mikrobit, lannan levitykseen soveltuvan ajankohdan lyhyys, lannan ravinteiden sovittaminen kasvien tarpeisiin ja lannan ravinteiden määrä suhteessa levityskelpoisen peltoalan määrään. Tutkimuksen tavoitteena oli tunnistaa naudan lietelannan käsittelyketjuihin liittyvät kustannukset ja osoittaa eri käsittelyketjujen kustannusten eroavaisuudet. Tavoitteena oli myös tunnistaa ja osoittaa käsittelyketjujen laadulliset erot. Kustannukset selvitettiin kustannuslaskelmin ja laadulliset erot SWOT-menetelmällä. Tutkimuksen kohteeksi valittiin 6 tilakokoluokkaa ja käsittelyketjuiksi lietelanta-, kompostointi- ja mädätysketju. Tutkimuksessa alhaisimmat kustannukset olivat lietelantaketjulla, jonka kustannukset 25 – 250 naudan tilalla olivat 5 200 – 6 600 €/a ja yksikkökustannukset 1 – 9 €/m3. Mädätysketjun kustannukset vastaavissa tilakokoluokissa olivat noin 33 000 – 50 000 €/a ja yksikkökustannukset 8 – 55 €/m3. Kompostointiketjun kustannukset olivat 35 000 – 143 000 €/a ja yksikkökustannukset 24 – 58 €/m3. Lietelantaketjun edullisuus johtui vähäisistä laite- ja rakennusinvestoinneista ja pienistä työmääristä ja kompostointiketjun kalleus suurista tukiaine- ja investointikustannuksista. Käsittelyketjujen asettaminen paremmuusjärjestykseen oli hankalaa. Työn määrä oli pienin lietelantaketjussa ja toiseksi pienin suurilla tiloilla mädätysketjussa. Kompostointiketjulla itse levitykseen kuluva aika oli pienin. Ravinteiden osalta mädätysketju oli parhain ja kompostointiketju huonoin. Ympäristövaikutuksiltaan ja hajuhaitoiltaan kompostointi- ja mädätysketju olivat parhaimmat. Mikrobien osalta parhain oli kompostointiketju.

Jätteen rinnakkaispolton rooli ja rajaehdot Suomen jätestrategiassa

Suomen jätehuolto on kokemassa murrosta kuluvina aikoina. Pienimuotoinen jätteen rinnakkaispoltto, joka on ollut Suomen jätehuollolle ominaista, uhkaa koitua kannattamattomaksi ja loppua kokonaan. Tässä työssä pyritään selvittämään jätteen rinnakkaispolton rooli ja rajaehdot Suomen jätestrategiassa nytkun jätehuolto on muuttunut uusien direktiivien voimaan astumisen myötä. Työssäkäsitellään rinnakkaispolttoa koskevaa lainsäädäntöä ja sen vaikutusta polton tulevaisuuteen. Rajaehtoja on tarkasteltu savukaasupäästöjen, päästörajojen ja tuhkan ominaisuuksien muuttumisen avulla polttosuhteen muuttuessa. Lisäksi työssä on arvioitu jätteenpolttoasetuksen aiheuttamat lisäkustannukset jätettä polttaville voimalaitoksille ja pohdittu, miten kustannukset on kompensoitavissa. Työn perusteella vaikuttaa siltä, että jätteen rinnakkaispoltolla voi tulevaisuudessakin olla merkittävä rooli Suomen jätehuollossa. Jätteen energiahyödyntämistä joudutaan lisäämään tulevaisuudessa rutkasti, jotta saavutettaisiin vaadittu jätteen hyötykäyttötaso. Rinnakkaispolton alalta on Suomessa huippuosaamista ja laitospotentiaalia on valmiina, joten rinnakkaispoltto tarjoaa helpon mahdollisuuden jätteen hyödyntämisasteen parantamiseen. Kriittiseksi tekijäksimuodostuu se, voiko yhdyskuntajätteistä valmistettua polttoainetta polttaa sähkön ja lämmön yhteistuotantoon tarkoitetuilla laitoksilla. Mikäli se olisi mahdollista, voisi tämän työn perusteella rinnakkaispoltolla olla suuri rooli suomalaisessa jätehuollossa ja sen tulevaisuudessa.