Assertive community treatment as part of integrated care versus standard care: a 12-month trial in patients with first- and multiple-episode schizophrenia spectrum disorders treated with quetiapine immediate release (ACCESS trial)

The ACCESS trial examined the 12-month effectiveness of continuous therapeutic assertive community treatment (ACT) as part of integrated care compared to standard care in a catchment area comparison design in patients with schizophrenia spectrum disorders treated with quetiapine immediate release.

Effectiveness of integrated care including therapeutic assertive community treatment in severe schizophrenia spectrum and bipolar I disorders: the 24-month follow-up ACCESS II study

OBJECTIVE The ACCESS treatment model offers assertive community treatment embedded in an integrated care program to patients with psychoses. Compared to standard care and within a controlled study, it proved to be more effective in terms of service disengagement and illness outcomes in patients with schizophrenia spectrum disorders over 12 months. ACCESS was implemented into clinical routine and its effectiveness assessed over 24 months in severe schizophrenia spectrum disorders and bipolar I disorder with psychotic features (DSM-IV) in a cohort study. METHOD All 115 patients treated in ACCESS (from May 2007 to October 2009) were included in the ACCESS II study. The primary outcome was rate of service disengagement. Secondary outcomes were change of psychopathology, severity of illness, psychosocial functioning, quality of life, satisfaction with care, medication nonadherence, length of hospital stay, and rates of involuntary hospitalization. RESULTS Only 4 patients (3.4%) disengaged with the service. Another 11 (9.6%) left because they moved outside the catchment area. Patients received a mean of 1.6 outpatient contacts per week. Involuntary admissions decreased from 34.8% in the 2 previous years to 7.8% during ACCESS (P < .001). Mixed models repeated-measures analyses revealed significant improvements among all patients in psychopathology (effect size d = 0.64, P < .001), illness severity (d = 0.84, P = .03), functioning level (d = 0.65, P < .001), quality of life (d = 0.50, P < .001), and client satisfaction (d = 0.11, P < .001). At 24 months, 78.3% were fully adherent to medication, compared to 25.2% at baseline (P = .002). CONCLUSIONS ACCESS was successfully implemented in clinical routine and maintained excellent rates of service engagement and other outcomes in patients with schizophrenia spectrum disorders or bipolar I disorder with psychotic features over 24 months. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01888627.

Enhanced access to early visual processing of perceptual simultaneity in autism spectrum disorders

We compared judgements of the simultaneity or asynchrony of visual stimuli in individuals with autism spectrum disorders (ASD) and typically-developing controls using Magnetoencephalography (MEG). Two vertical bars were presented simultaneously or non-simultaneously with two different stimulus onset delays. Participants with ASD distinguished significantly better between real simultaneity (0 ms delay between two stimuli) and apparent simultaneity (17 ms delay between two stimuli) than controls. In line with the increased sensitivity, event-related MEG activity showed increased differential responses for simultaneity versus apparent simultaneity. The strongest evoked potentials, observed over occipital cortices at about 130 ms, were correlated with performance differences in the ASD group only. Superior access to early visual brain processes in ASD might underlie increased resolution of visual events in perception. © 2012 Springer Science+Business Media New York.

WiFi and LTE Coexistence in the Unlicensed Spectrum

Today, smart-phones have revolutionized wireless communication industry towards an era of mobile data. To cater for the ever increasing data traffic demand, it is of utmost importance to have more spectrum resources whereby sharing under-utilized spectrum bands is an effective solution. In particular, the 4G broadband Long Term Evolution (LTE) technology and its foreseen 5G successor will benefit immensely if their operation can be extended to the under-utilized unlicensed spectrum. In this thesis, first we analyze WiFi 802.11n and LTE coexistence performance in the unlicensed spectrum considering multi-layer cell layouts through system level simulations. We consider a time division duplexing (TDD)-LTE system with an FTP traffic model for performance evaluation. Simulation results show that WiFi performance is more vulnerable to LTE interference, while LTE performance is degraded only slightly. Based on the initial findings, we propose a Q-Learning based dynamic duty cycle selection technique for configuring LTE transmission gaps, so that a satisfactory throughput is maintained both for LTE and WiFi systems. Simulation results show that the proposed approach can enhance the overall capacity performance by 19% and WiFi capacity performance by 77%, hence enabling effective coexistence of LTE and WiFi systems in the unlicensed band.

Secure, dynamic and distributed access control stack for database applications

In database applications, access control security layers are mostly developed from tools provided by vendors of database management systems and deployed in the same servers containing the data to be protected. This solution conveys several drawbacks. Among them we emphasize: 1) if policies are complex, their enforcement can lead to performance decay of database servers; 2) when modifications in the established policies implies modifications in the business logic (usually deployed at the client-side), there is no other possibility than modify the business logic in advance and, finally, 3) malicious users can issue CRUD expressions systematically against the DBMS expecting to identify any security gap. In order to overcome these drawbacks, in this paper we propose an access control stack characterized by: most of the mechanisms are deployed at the client-side; whenever security policies evolve, the security mechanisms are automatically updated at runtime and, finally, client-side applications do not handle CRUD expressions directly. We also present an implementation of the proposed stack to prove its feasibility. This paper presents a new approach to enforce access control in database applications, this way expecting to contribute positively to the state of the art in the field.

Secure, dynamic and distributed access control stack for database applications

In database applications, access control security layers are mostly developed from tools provided by vendors of database management systems and deployed in the same servers containing the data to be protected. This solution conveys several drawbacks. Among them we emphasize: (1) if policies are complex, their enforcement can lead to performance decay of database servers; (2) when modifications in the established policies implies modifications in the business logic (usually deployed at the client-side), there is no other possibility than modify the business logic in advance and, finally, 3) malicious users can issue CRUD expressions systematically against the DBMS expecting to identify any security gap. In order to overcome these drawbacks, in this paper we propose an access control stack characterized by: most of the mechanisms are deployed at the client-side; whenever security policies evolve, the security mechanisms are automatically updated at runtime and, finally, client-side applications do not handle CRUD expressions directly. We also present an implementation of the proposed stack to prove its feasibility. This paper presents a new approach to enforce access control in database applications, this way expecting to contribute positively to the state of the art in the field.

Brief report: preliminary proposal of a conceptual model of a digital environment for developing mathematical reasoning in students with Autism Spectrum Disorders

There is clear evidence that in typically developing children reasoning and sense-making are essential in all mathematical learning and understanding processes. In children with autism spectrum disorders (ASD), however, these become much more significant, considering their importance to successful independent living. This paper presents a preliminary proposal of a digital environment, specifically targeted to promote the development of mathematical reasoning in students with ASD. Given the diversity of ASD, the prototyping of this environment requires the study of dynamic adaptation processes and the development of activities adjusted to each user’s profile. We present the results obtained during the first phase of this ongoing research, describing a conceptual model of the proposed digital environment. Guidelines for future research are also discussed.

Synergistic interaction between gold nanoparticles and nickel phthalocyanine in layer-by-layer (LbL) films: evidence of constitutional dynamic chemistry (CDC)

The concept of constitutional dynamic chemistry (CDC) based on the control of non-covalent interactions in supramolecular structures is promising for having a large impact on nanoscience and nanotechnology if adequate nanoscale manipulation methods are used. In this study, we demonstrate that the layer-by-layer (LbL) technique may be used to produce electroactive electrodes with ITO coated by tetrasulfonated nickel phthalocyanine (NiTsPc) alternated with poly(allylamine hydrochloride) (PAH) incorporating gold nanoparticles (AuNP), in which synergy has been achieved in the interaction between the nanoparticles and NiTsPc. The catalytic activity toward hydrogen peroxide (H(2)O(2)) in multilayer films was investigated using cyclic voltammetry, where oxidation of H(2)O(2) led to increased currents in the PAH-AuNP/NiTsPc films for the electrochemical processes associated with the phthalocyanine ring and nickel at 0.52 and 0.81 V vs. SCE, respectively, while for PAH/NiTsPc films (without AuNP) only the first redox process was affected. In control experiments we found out that the catalytic activity was not solely due to the presence of AuNP, but rather to the nanoparticles inducing NiTsPc supramolecular structures that favored access to their redox sites, thus yielding strong charge transfer. The combined effects of NiTsPc and AuNP, which could only be observed in nanostructured LbL films, point to another avenue to pursue within the CDC paradigm.

Dynamic Design of Piezoelectric Laminated Sensors and Actuators using Topology Optimization

Sensors and actuators based on piezoelectric plates have shown increasing demand in the field of smart structures, including the development of actuators for cooling and fluid-pumping applications and transducers for novel energy-harvesting devices. This project involves the development of a topology optimization formulation for dynamic design of piezoelectric laminated plates aiming at piezoelectric sensors, actuators and energy-harvesting applications. It distributes piezoelectric material over a metallic plate in order to achieve a desired dynamic behavior with specified resonance frequencies, modes, and enhanced electromechanical coupling factor (EMCC). The finite element employs a piezoelectric plate based on the MITC formulation, which is reliable, efficient and avoids the shear locking problem. The topology optimization formulation is based on the PEMAP-P model combined with the RAMP model, where the design variables are the pseudo-densities that describe the amount of piezoelectric material at each finite element and its polarization sign. The design problem formulated aims at designing simultaneously an eigenshape, i.e., maximizing and minimizing vibration amplitudes at certain points of the structure in a given eigenmode, while tuning the eigenvalue to a desired value and also maximizing its EMCC, so that the energy conversion is maximized for that mode. The optimization problem is solved by using sequential linear programming. Through this formulation, a design with enhancing energy conversion in the low-frequency spectrum is obtained, by minimizing a set of first eigenvalues, enhancing their corresponding eigenshapes while maximizing their EMCCs, which can be considered an approach to the design of energy-harvesting devices. The implementation of the topology optimization algorithm and some results are presented to illustrate the method.

Distributed power control algorithm for multiple access systems based on Verhulst model

In this paper the continuous Verhulst dynamic model is used to synthesize a new distributed power control algorithm (DPCA) for use in direct sequence code division multiple access (DS-CDMA) systems. The Verhulst model was initially designed to describe the population growth of biological species under food and physical space restrictions. The discretization of the corresponding differential equation is accomplished via the Euler numeric integration (ENI) method. Analytical convergence conditions for the proposed DPCA are also established. Several properties of the proposed recursive algorithm, such as Euclidean distance from optimum vector after convergence, convergence speed, normalized mean squared error (NSE), average power consumption per user, performance under dynamics channels, and implementation complexity aspects, are analyzed through simulations. The simulation results are compared with two other DPCAs: the classic algorithm derived by Foschini and Miljanic and the sigmoidal of Uykan and Koivo. Under estimated errors conditions, the proposed DPCA exhibits smaller discrepancy from the optimum power vector solution and better convergence (under fixed and adaptive convergence factor) than the classic and sigmoidal DPCAs. (C) 2010 Elsevier GmbH. All rights reserved.

Dynamic Behavior of the Jahn-Teller distorted Cu(H2O)(6)(2+) ion in Cu2+ doped Cs-2[Zn(H2O)(6)](ZrF6)(2) and the crystal structure of the host lattice

The temperature dependence of the X- and Q-band EPR spectra of Cs-2[Zn(H2O)(6)](ZrF6)(2) containing similar to1% Cu2+ is reported. All three molecular g-values vary with temperature, and their behavior is interpreted using a model in which the potential surface of the Jahn-Teller distorted Cu(H2O)(6)(2+) ion is perturbed by an orthorhombic strain induced by interactions with the surrounding lattice. The strain parameters are significantly smaller than those reported previously for the Cu(H2O)(6)(2+) ion in similar lattices. The temperature dependence of the two higher g-values suggests that in the present compound the lattice interactions change slightly with temperature. The crystal structure of the Cs-2[Zn(H2O)(6)](ZrF6)(2) host is reported, and the geometry of the Zn(H2O)(6)(2+) ion is correlated with lattice strain parameters derived from the EPR spectrum of the guest Cu2+ complex.

Ambulatory blood pressure and Doppler echocardiographic indexes of borderline hypertensive men presenting an exaggerated blood pressure response during dynamic exercise

Borderline hypertension (BH) has been associated with an exaggerated blood pressure (BP) response during laboratory stressors. However, the incidence of target organ damage in this condition and its relation to BP hyperreactivity is an unsettled issue. Thus, we assessed the Doppler echocardiographic profile of a group of BH men (N = 36) according to office BP measurements with exaggerated BP in the cycloergometric test. A group of normotensive men (NT, N = 36) with a normal BP response during the cycloergometric test was used as control. To assess vascular function and reactivity, all subjects were submitted to the cold pressor test. Before Doppler echocardiography, the BP profile of all subjects was evaluated by 24-h ambulatory BP monitoring. All subjects from the NT group presented normal monitored levels of BP. In contrast, 19 subjects from the original BH group presented normal monitored BP levels and 17 presented elevated monitored BP levels. In the NT group all Doppler echocardiographic indexes were normal. All subjects from the original BH group presented normal left ventricular mass and geometrical pattern. However, in the subjects with elevated monitored BP levels, fractional shortening was greater, isovolumetric relaxation time longer, and early to late flow velocity ratio was reduced in relation to subjects from the original BH group with normal monitored BP levels (P<0.05). These subjects also presented an exaggerated BP response during the cold pressor test. These results support the notion of an integrated pattern of cardiac and vascular adaptation during the development of hypertension.

Harvesting dynamic aspects from a real rational map : the bulb of period 5

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Dynamic QoS-Aware coalition formation

Users of wireless devices increasingly demand access to multimedia content with speci c quality of service requirements. Users might tolerate di erent levels of service, or could be satis ed with di erent quality combinations choices. However, multimedia processing introduces heavy resource requirements on the client side. Our work tries to address the growing demand on resources and performance requirements, by allowing wireless nodes to cooperate with each other to meet resource allocation requests and handle stringent constraints, opportunistically taking advantage of the local ad-hoc network that is created spontaneously, as nodes move in range of each other, forming a temporary coalition for service execution. Coalition formation is necessary when a single node cannot execute a speci c service, but it may also be bene cial when groups perform more e ciently when compared to a single s node performance.