The Nautilus.

v.10 (1896-1897)

A preliminary evaluation of the validity of at-risk criteria for bipolar disorders in help-seeking adolescents and young adults.

INTRODUCTION: We have developed ultra-high risk criteria for bipolar affective disorder (bipolar at-risk - BAR) which include general criteria such as being in the peak age range of the onset of the disorder and a combination of specific criteria including sub-threshold mania, depressive symptoms, cyclothymic features and genetic risk. In the current study, the predictive validity of these criteria were tested in help-seeking adolescents and young adults. METHOD: This medical file-audit study was conducted at ORYGEN Youth Health (OYH), a public mental health program for young people aged between 15 and 24years and living in metropolitan Melbourne, Australia. BAR criteria were applied to the intake assessments of all non-psychotic patients who were being treated in OYH on 31 January, 2008. All entries were then checked for conversion criteria. Hypomania/mania related additions or alterations to existing treatments or initiation of new treatment by the treating psychiatrist served as conversion criteria to mania. RESULTS: The BAR criteria were applied to 173 intake assessments. Of these, 22 patients (12.7%) met BAR criteria. The follow-up period of the sample was 265.5days on average (SD 214.7). There were significantly more cases in the BAR group (22.7%, n=5) than in the non-BAR group (0.7%, n=1) who met conversion criteria (p<.001). CONCLUSIONS: These findings support the notion that people who develop a first episode of mania can be identified during the prodromal phase. The proposed criteria need further evaluation in prospective clinical trials.

First episode schizophrenia and schizoaffective disorder: A psychiatric nosology

A nosological issue that has yet to be resolved relates to the diagnostic and clinical overlap of schizophrenia and schizoaffective disorder. Thus, the aim of this study was to compare, within a treated epidemiological cohort of first episode patients, the clinical characteristics of patients with schizophrenia (FES) or schizoaffective disorder (FESA). Medical fi le audit methodology was employed to collect information on 704 first episode psychosis patients (FEP), among which 283 patients had a fi nal diagnosis of FES and 64 patients with a fi nal diagnosis of FESA. These patients were treated at the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne, Australia. Patients with FES were signifi cantly more likely to have a longer prodrome (P = .020), longer duration of untreated psychosis (P < .001), and earlier age of onset (P = .004) compared to FESA. At service entry, FESA patients had more severe levels of psychopathology (P = .020), which was due to the presence of manic symptoms (P < .001); consequently, requiring a greater number of inpatient admissions (P = .017). At discharge, depressive symptoms were more severe in those with FESA (P = .011). There are signifi cant differences in the phenomenology of schizophrenia and schizoaffective disorder during early illness course; supporting the notion that these are two discernable disorders.

Gender differences in premorbid, entry, treatment, and outcome characteristics in a treated epidemiological sample of 661 patients with first episode psychosis.

OBJECTIVES: Gender differences in psychotic disorder have been observed in terms of illness onset and course; however, past research has been limited by inconsistencies between studies and the lack of epidemiological representative of samples assessed. Thus, the aim of this study was to elucidate gender differences in a treated epidemiological sample of patients with first episode psychosis (FEP). METHODS: A medical file audit was used to collect data on premorbid, entry, treatment and 18-month outcome characteristics of 661 FEP consecutive patients treated at the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne, Australia. RESULTS: Prior to onset of psychosis, females were more likely to have a history of suicide attempts (p=.011) and depression (p=.001). At service entry, females were more likely to have depressive symptoms (p=.007). Conversely, males had marked substance use problems that were evident prior to admission (p<.001) and persisted through treatment (p<.001). At service entry, males also experienced more severe psychopathology (p<.001) and lower levels of functioning (GAF, p=.008; unemployment/not studying p=.004; living with family, p=.003). Treatment non-compliance (p<.001) and frequent hospitalisations (p=.047) were also common for males with FEP. At service discharge males had significantly lower levels of functioning (GAF, p=.008; unemployment/not studying p=.040; living with family, p=.001) compared to females with FEP. CONCLUSIONS: Gender differences are evident in illness course of patients with FEP, particularly with respect to past history of psychopathology and functioning at presentation and at service discharge. Strategies to deal with these gender differences need to be considered in early intervention programs.

Multisensor change detection with nonlinear canonical correlation

The analysis of multi-modal and multi-sensor images is nowadays of paramount importance for Earth Observation (EO) applications. There exist a variety of methods that aim at fusing the different sources of information to obtain a compact representation of such datasets. However, for change detection existing methods are often unable to deal with heterogeneous image sources and very few consider possible nonlinearities in the data. Additionally, the availability of labeled information is very limited in change detection applications. For these reasons, we present the use of a semi-supervised kernel-based feature extraction technique. It incorporates a manifold regularization accounting for the geometric distribution and jointly addressing the small sample problem. An exhaustive example using Landsat 5 data illustrates the potential of the method for multi-sensor change detection.

Pancreatic Trauma in Children

Objectives and Study: To document the demographics, mechanisms and outcome of traumatic pancreatitis in children at a single large tertiary referral centre in Australia. Methods: We undertook a 10-year retrospective audit of children admitted to the Royal Children's Hospital [RCH], Melbourne, Australia with a hospital coded diagnosis which included pancreatic injury between 1993 and 2002. Data included patient demographics, source of admission, mechanism of injury, pancreatic complications, associated injuries, Intensive Care Unit [ICU] admission, results of any operative findings, results of any acute computed tomography (CT) and/or ultrasound (US) imaging of pancreas, selected laboratory findings and length of stay. Results: We identified two distinct groups of patients in the 91 documented cases of pancreatic trauma (median age 8.0 yr, range 0.6-15.8 yr; M:F 2.5:1.0). Fifty-nine had a history of abdominal trauma and elevated serum lipase but no CT or ultrasound evidence of pancreatic injury (Group A). Thirty-two had a history of abdominal trauma, elevated serum lipase but also had CT scan and/or ultrasound evidence of pancreatic injury[Group B]. Patients with ''less severe'' injury based on normal imaging had a lower initial lipase level [Group A, median 651 U/L (interquartile range 520 - 1324) vs, Group B, 1608 U/L (interquartile range 680-3526); P = 0.005] and shorter admission time [Group A, 9.0 days (interquartile range 5.5-15.5) vs Group B, 13.4 days (interquartile range 6.8 - 23.8), P = 0.04]. There were no differences with respect to mortality [Group A, 13.5 % vs Group B, 12.5 %] but patients with evidence of injury on imaging were more likely to have surgical intervention [P = 0.0001]. The single most important overall cause of pancreatic trauma was involvement in a motor vehicle accident as a passenger or pedestrian. However, in children with high-grade ductal injury, bicycle handlebar injuries were most common. Associated injuries were common in both groups. Conclusion: Significant pancreatic injury can occur in the absence of abnormality on medical imaging. Pancreatic trauma commonly occurs in the context of multiple injuries after motor vehicle accidents in children and bicycle handlebar injuries, especially in boys. Most children can be treated conservatively, with surgical intervention being limited to high-grade ductal injury.

Design Gráfico na Construção da Identidade visual da Marca Turística em City Branding.

Esta dissertação apresenta um estudo sobre a participação de Design Gráfico no projeto de identidade visual das marcas turísticas de cidades. O foco recai sobre a coerência da visualidade gráfica da marca com relação ao posicionamento socioeconômico e cultural das cidades, como instâncias de empreendimentos turísticos. O estudo do posicionamento das marcas de cidades foi baseado no livro Competitive Identity (ANHOLT, 2007), também, em Anholt city branding index (2006) e nas atualizações parciais desse índice (ANHOLT, 2009 e 2011). Além disso, as marcas gráficas de 30 cidades e os respectivos dados sobre seu posicionamento, como empreendimentos turísticos, foram coletadas em websites oficiais das cidades na internet. Tendo como base essas 30 cidades com um a marca gráfica turística da cidade, foi proposta uma classificação visual dessas baseando-se em três principais categorias: Categorização conceitual; a Categorização cinéticosensorial; Categorização visual. Com base nessas informações e na classificação da visualidade das marcas gráficas pesquisadas, foi realizado um estudo comparado, visando estabelecer coerências entre a comunicação visual da marca gráfica e o posicionamento socioeconômico e cultural das cidades turísticas. Diante disso, apresentam-se em destaque as marcas das cidades São Paulo e Melbourne, como um exemplo nacional e outro internacional da criatividade gráfica aplicada e da coerência entre o posicionamento do empreendimento turístico e a identidade visual da marca

Avaliação do projeto Final - Recursos Hídrico do Tarrafal – Cabo Verde

A avaliacão do projecto do recursos hidricos do Tarrafal (Cabo Verde ) tem por base dois objectivos: 1) Cumprir as obrigag8es do contrato, o qual roquor uwa avaliação.o final, a 2) Sujeitar-se aon requisitos da CID pars a avaliação final. Desta formal a extenslo deta avaliaqlo 6 male quo ura simples rovialo, reopondendo a obrigaqos do contracto. Esta avaliagKot tern por fim estimar a forma coo o projecto atinglu ou doixou do atingir os objectivos propostos. An recomendaga4s quo safram desta avalia qio dovem sorvir para melhorar os projectos om andamento quo integram no sistema da CID. Ambos o fundos da CID o do contracto foram utilizados nesta avaliaqlo Os pontos apresentados nests documento slo da equipe do avaliaqlo o n~o representan necessariamente 0s da Administraqlo o/ou do Executivo da CID. B. A.VLICrUi)Z DA Ai1ALIAj!O Todo o projecto do Recurnos Hfdricos do Tarrafal eat inserido dontro do pris1m desta avalia.lo. Zbora outrou relatdrios tenham servido do fontes do infor=qlo, a proeantj oxamina o projecto dead. o porfodo da preparaqEo at o trmino C. EQU!!' DE AYALIACKO A equioe roi Joloeada polo Dean ( tipo do reitor do faculdads )# Director da Cemara don Adminintradoras da CID Dr. drnont Briskoyp o polo Director do Executivo, Dr. John L. Fiecher. A avaliaqgo foi orientada pole repartiglo do Executivo da CID. 0 Dr. Barry Re. Baintonp agents director do projectop coordenou o processo do avaliaqEo. 0 Dr. Gerald 3stlockq director do programus Internacionais do agricultura na Universidade do Arizonap foi selocionado coo lider da equips . 0 Dr. Howard Peterson, professor do agriculture • ongenharia do irrgaqIo da Universidade do Utah, foi selecionado coma segundo mumbro da equips. 0 Dr. Peterson ji tinha cumprido dues misses no projecto em Cabo Verde. 0 Dr. Jean Ruley Kearns, conselheiro director da CID no poriodo do 1982-83p fot selecionado comc sondo o tarceiro membro da equipe. D. ATODO DE AVALIAQXO Os pianos proliminares para conduzir a avaliaqo foram feitos numa rounibo inicial em Tucson ( Arizona ) a 5 do novembro do 1982. Nessa rounilo foi deci dido quo o Dr. Matlock visitaria o projecto durante o afs do novembro do 1982. A visita fot planojada do forma a coincidir com a presenga do Kern Stutlor, director coordenador do projectop quo devoria astar am Cabo lirde nessa data co.mpletando os trabalho a preparando o relat6rio final. Uma c6pia do Procasio do Avaliaglo pola AID assim como cdpias do relatdrios anteriores a outros docunontos rolevantea foram diatribufdos aos membros da equips duranto a reunigo inicial. Oa docu ientos examinados polos membros da equip. encontram-se listados na secção /III, Referiencias

Rate of undesirable events at beginning of academic year: retrospective cohort study.

OBJECTIVE: To determine whether an increase in the rate of undesirable events occurs after care provided by trainees at the beginning of the academic year. DESIGN: Retrospective cohort study using administrative and patient record data. SETTING: University affiliated hospital in Melbourne, Australia. PARTICIPANTS: 19,560 patients having an anaesthetic procedure carried out by first to fifth year trainees starting work for the first time at the hospital over a period of five years (1995-2000). MAIN OUTCOME MEASURES: Absolute event rates, absolute rate reduction, and rate ratios of undesirable events. RESULTS: The rate of undesirable events was higher at the beginning of the academic year compared with the rest of the year (absolute event rate 137 v 107 per 1000 patient hours, relative rate reduction 28%, P<0.001). The overall adjusted rate ratio for undesirable events was 1.40, 95% confidence interval 1.24 to 1.58. This excess risk was seen for all residents, regardless of their level of seniority. The excess risk decreased progressively after the first month, and the trend disappeared fully after the fourth month of the year (rate ratio for fourth month 1.21, 0.93 to 1.57). The most important decreases were for central and peripheral nerve injuries (relative difference 82%), inadequate oxygenation of the patient (66%), vomiting/aspiration in theatre (53%), and technical failures of tracheal tube placement (49%). CONCLUSIONS: The rate of undesirable events was greater among trainees at the beginning of the academic year regardless of their level of clinical experience. This suggests that several additional factors, such as knowledge of the working environment, teamwork, and communication, may contribute to the increase.