Adjustment Disorders Are Uniquely Suited for eHealth Interventions: Concept and Case Study

Background: Adjustment disorders (also known as mental distress in response to a stressor) are among the most frequently diagnosed mental disorders in psychiatry and clinical psychology worldwide. They are also commonly diagnosed in clients engaging in deliberate self-harm and in those consulting general practitioners. However, their reputation in research-oriented mental health remains weak since they are largely underresearched. This may change when the International Statistical Classification of Diseases-11 (ICD-11) by the World Health Organization is introduced, including a new conceptualization of adjustment disorders as a stress-response disorder with positively defined core symptoms. Objective: This paper provides an overview of evidence-based interventions for adjustment disorders. Methods: We reviewed the new ICD-11 concept of adjustment disorder and discuss the the rationale and case study of an unguided self-help protocol for burglary victims with adjustment disorder, and its possible implementation as an eHealth intervention. Results: Overall, the treatment with the self-help manual reduced symptoms of adjustment disorder, namely preoccupation and failure to adapt, as well as symptoms of depression, anxiety, and stress. Conclusions: E-mental health options are considered uniquely suited for offering early intervention after the experiences of stressful life events that potentially trigger adjustment disorders.

Peer Acceptance and Friendship as Predictors of Early Adolescents' Adjustment Across the Middle School Transition

This study examines several aspects of adolescents' pretransition peer relationships as predictors of their adjustment to middle school. Participants were 365 students (175 boys; 99% Caucasian) involved in the Time 1 (the spring of fifth grade) and Time 2 (the fall of sixth grade) assessments. Adolescents completed measures that assessed peer acceptance, number of friends, the quality of a specific mutual friendship, loneliness, depression, self-esteem, and involvement in school. Academic achievement and absentee data were obtained from student files. Regression analyses indicated that the pretransition peer variables predicted posttransition loneliness, self-esteem, school involvement, and academic achievement. The patterns of prediction varied slightly for each adjustment variable, with the most robust relationship being between peer acceptance and achievement. Results of repeated-measures MANOVAs indicated no differential changes in adjustment across time by gender. Implications for including a peer component in programs that prepare students for the middle school transition are discussed.

Consumption asymmetry and the stock market: New evidence through a threshold adjustment model

This paper investigates whether stock market wealth affects real consumption asymmetrically through a threshold adjustment model. The empirical findings for the US show that wealth produces an asymmetric effect on real consumption, with negative 'news' affecting consumption less than positive 'news.' Thus, policy makers may want to focus more attention on preventing asset 'bubbles' than on responding to negative asset shocks.

Table to accompany Religion and Spirituality in Adjustment Following Bereavement: An Integrative Review

This table accompanies the article entitled "Religion and Spirituality in Adjustment Following Bereavement: An Integrative Review," (Wortmann & Park, 2008). The table summarizes the results of published studies that contain a quantitative assessment of religion and an adjustment outcome in bereaved participants. Fields include author(s)'s last name, publication year, sample characteristics, independent religious/spiritual variable, adjustment variable, results, and study design.

RELATIONS AMONG REMEMBERED PARENTAL ACCEPTANCE AND BEHAVIORAL CONTROL IN CHILDHOOD, ADULTS' CURRENT PSYCHOLOGICAL ADJUSTMENT, AND CAREER INDECISIVENESS

This study tested the hypothesis that career indecisiveness among men tends to be associated with different levels of self-reported psychological adjustment and with different remembrances of parental (maternal and paternal) acceptance and behavioral control in childhood from those of women. One hundred twenty-six respondents ages 17 through 54 (M = 23.7 years, SD = 8.21 years) participated in this study. Thirty-seven where males; 90 were females. Measures used in this study included the Career Decision Scale, the Adult version of the Parental Acceptance-Rejection/Control Questionnaire for mothers and for fathers, and the Adult version of the Personality Assessment Questionnaire. Both men and women remembered their mothers as well as their fathers as being loving in childhood. Additionally, men and women remembered both parents as being moderately behaviorally controlling in childhood. Finally, both men and women reported a fair level of psychological maladjustment. And on average, both men and women were fairly indecisive about their careers. Results of analyses supported the hypothesis in that career indecisiveness among women but not men was significantly correlated with remembered maternal and paternal acceptance in childhood, as well as with self-reported psychological adjustment and age. However, only women’s self-reported psychological adjustment made a significant and unique contribution to variations in their reports of career indecisiveness. None of the predictor variables were significantly associated with career indecisiveness among men.

THE DISCHARGED PSYCHIATRIC PATIENT: POST-HOSPITAL ADJUSTMENT AND FACTORS AFFECTING REHOSPITALIZATION

Discharged psychiatric patients were studied six months post-discharge to determine those demographic, social and clinical characteristics affecting positive or negative adjustment and the degree to which the use of mental health services and medication compliance mediated the effects. With the exception of those with primary or secondary diagnoses of OBS, substance abuse or mental retardation, sixty-three psychiatric subjects between the ages of eighteen and sixty-four were chosen from all admissions into the hospital and interviewed six months after discharge using a specially designed questionnaire.^ The subjects' adjustment to community living was found to be marginal. Although not engaged in destructive activities, over half were living with their family members who supported them financially and emotionally. Most were unemployed and had been so for a long time. Others worked sporadically and frequently changed residences. Most did have substantial social ties with extended family and with friends with whom they interacted regularly, but one-fourth were socially isolated. Almost three-quarters continued to obtain regular mental health services after discharge and followed medication instructions under the supervision of their physician. The use of mental health services after discharge and the use of medication did not appear to affect the subjects' community adaption or their rate of rehospitalization.^ Forty percent of those discharged were rehospitalized by the end of the follow-up period. Four levels of risk of rehospitalization emerged. The highest risk was associated with a history of five or more prior hospitalizations, living alone, and social isolation. One third or more of the subjects expressed a need for more counseling, leisure time activities, case-manager assistance, vocational guidance, supervised housing, and placement into a transitional residential treatment program.^ Recommendations were made to enhance the ability to predict recidivism, to develop interorganizational casework management programs linking the patient and family to the community mental health system and to create computerized tracking and monitoring programs that systematically report patient treatment regimen and progress cross-sectionally and longitudinally. ^

The cost effective management of Central Line-Associated Bloodstream Infections (CLABSIs) comparing the central line bundle to antimicrobialcoated central venous catheters: A systematic review

Central Line-Associated Bloodstream Infections (CLABSIs) are one of the most costly and preventable cases of morbidity and mortality among intensive care units (ICUs) in health care today. In 2008, the Centers for Medicare and Medicaid Services Medicare Program, under the Deficit Reduction Act, announced it will no longer reimburse hospitals for such adverse events among those related to CLABSIs. This reveals the financial burden shift onto the hospital rather than the health care payer who can now withhold reimbursements. With this weighing more heavily on hospital management, decision makers will need to find a way to completely prevent cases of CLABSI or simply pay for the financial consequences. ^ To reduce the risk of CLABSIs, several clinical, preventive interventions have been studied and even instituted including the Central Line (CL) Bundle and Antimicrobial Coated Central Venous Catheters (AM-CVCs). I carried out a formal systematic review on the topic to compare the cost-effectiveness of the Central Line (CL) Bundle to the commercially available antimicrobial coated central venous catheters (AM-CVCs) in preventing CLABSIs among critically and chronically ill patients in the U.S. Evidence was assessed for inclusion against predefined criteria. I, myself, conducted the data extraction. Ten studies were included in the review. Efficacy in reducing the mean incidence rate of CLABSI by the CL Bundle and AM-CVC interventions were compared with one another including costs. ^ The AM-CVC impregnated with antibiotics, rifampin-minocycline (AI-RM) is more clinically effective than the CL Bundle in reducing the mean rate of CLABSI per 1,000 catheter days. The lowest mean incidence rate of CLABSI per 1,000 catheter days among the AM-CVC studies was as low as zero in favor of the AI-RM. Moreover, the review revealed that the AI-RM appears to be more cost-effective than the CL Bundle. Results showed the adjusted incremental cost of the CL Bundle per ICU patient requiring a CVC to be approximately $196 while the AI-RM at only an additional cost of $48 per ICU patient requiring a CVC. ^ Limited data regarding the cost of the CL Bundle made it difficult to make a true comparison to the direct cost of the AM-CVCs. However, using the result I did have from this review, I concluded that the AM-CVCs do appear to be more cost-effective in decreasing the mean rate of CLABSI while also minimizing incremental costs per CVC than the CL Bundle. This review calls for further research addressing the cost of the CL Bundle and compliance and more effective study designs such as randomized control trials comparing the efficacy and cost of the CL Bundle to the AM-CVCs. Barriers that may face health care managers when implementing the CL Bundle or AM-CVCs include additional costs associated with the intervention, educational training and ongoing reinforcement as well as creating a new culture of understanding.^

Adjustment methods of national input-output tables for harmonized and consistent multi-regional input-output databases

Despite the fact that input–output (IO) tables form a central part of the System of National Accounts, each individual country's national IO table exhibits more or less different features and characteristics, reflecting the country's socioeconomic idiosyncrasies. Consequently, the compilers of a multi-regional input–output table (MRIOT) are advised to thoroughly examine the conceptual as well as methodological differences among countries in the estimation of basic statistics for national IO tables and, if necessary, to carry out pre-adjustment of these tables into a common format prior to the MRIOT compilation. The objective of this study is to provide a practical guide for harmonizing national IO tables to construct a consistent MRIOT, referring to the adjustment practices used by the Institute of Developing Economies, JETRO (IDE-JETRO) in compiling the Asian International Input–Output Table.

Laser Shock Micro-Forming as an Emerging Technique for Microsystems Shaping and Adjustment

Continuous and long-pulse lasers have been extensively used for the forming of metal sheets for macroscopic mechanical applications. However, for the manufacturing of Micro-Mechanical Systems (MMS), the applicability of such type of lasers is limited by the long relaxation time of the thermal fields responsible for the forming phenomena. As a consequence, the final sheet deformation state is attained only after a certain time, what makes the generated internal residual stress fields more dependent on ambient conditions and might difficult the subsequent assembly process. The use of short pulse (ns) lasers provides a suitable parameter matching for the laser forming of an important range of sheet components used in MEMS. The short interaction time scale required for the predominantly mechanic (shock) induction of deformation residual stresses allows the successful processing of components in a medium range of miniaturization (particularly important according to its frequent use in such systems). In the present paper, Laser Shock Micro-Forming (LSμF) is presented as an emerging technique for Microsystems parts shaping and adjustment along with a discussion on its physical foundations and practical implementation possibilities developed by the authors.

AVR adjustment of Synchronous Generators in Weak Grids under Faulty Conditions.

In weak grids, an important problem with voltage stability and protections coordination of power plants exists. This problem appears because all the generation groups are connected to the same bus bar. As a result, if a fault occurs in any of the generation groups, or in the bus bar that connect them, the system voltage will have large oscillations. Hence, in weak grids the correct adjustment of AVR (Automatic Voltage Regulator) is critical. In this work an experimental study of differents AVR adjustments against fault in weak grids is described.

El "Anclaje y Ajuste", una herramienta de Marketing para analizar el poder de las referencias en el Arte, el Diseño y la Arquitectura = "Anchoring and Adjustment", a Marketing tool to analyse references in Art, Design and Architecture

El "Anclaje y Ajuste", una herramienta de Marketing para analizar el poder de las referencias en el Arte, el Diseño y la Arquitectura = "Anchoring and Adjustment", a Marketing tool to analyse references in Art, Design and Architecture

Adjustment of conformational flexibility is a key event in the thermal adaptation of proteins

3-Isopropylmalate dehydrogenase (IPMDH, E.C. 1.1.1.85) from the thermophilic bacterium Thermus thermophilus HB8 is homologous to IPMDH from the mesophilic Escherichia coli, but has an approximately 17°C higher melting temperature. Its temperature optimum is 22–25°C higher than that of the E. coli enzyme; however, it is hardly active at room temperature. The increased conformational rigidity required to stabilize the thermophilic enzyme against heat denaturation might explain its different temperature-activity profile. Hydrogen/deuterium exchange studies were performed on this thermophilic-mesophilic enzyme pair to compare their conformational flexibilities. It was found that Th. thermophilus IPMDH is significantly more rigid at room temperature than E. coli IPMDH, whereas the enzymes have nearly identical flexibilities under their respective optimal working conditions, suggesting that evolutionary adaptation tends to maintain a “corresponding state” regarding conformational flexibility. These observations confirm that conformational fluctuations necessary for catalytic function are restricted at room temperature in the thermophilic enzyme, suggesting a close relationship between conformational flexibility and enzyme function.

Experience-dependent corticofugal adjustment of midbrain frequency map in bat auditory system

Recent studies of corticofugal modulation of auditory information processing indicate that cortical neurons mediate both a highly focused positive feedback to subcortical neurons “matched” in tuning to a particular acoustic parameter and a widespread lateral inhibition to “unmatched” subcortical neurons. This cortical function for the adjustment and improvement of subcortical information processing is called egocentric selection. Egocentric selection enhances the neural representation of frequently occurring signals in the central auditory system. For our present studies performed with the big brown bat (Eptesicus fuscus), we hypothesized that egocentric selection adjusts the frequency map of the inferior colliculus (IC) according to auditory experience based on associative learning. To test this hypothesis, we delivered acoustic stimuli paired with electric leg stimulation to the bat, because such paired stimuli allowed the animal to learn that the acoustic stimulus was behaviorally important and to make behavioral and neural adjustments based on the acquired importance of the acoustic stimulus. We found that acoustic stimulation alone evokes a change in the frequency map of the IC; that this change in the IC becomes greater when the acoustic stimulation is made behaviorally relevant by pairing it with electrical stimulation; that the collicular change is mediated by the corticofugal system; and that the IC itself can sustain the change evoked by the corticofugal system for some time. Our data support the hypothesis.