Reinvigorating and redesigning early intervention in psychosis services for young people in Auckland

RESUMO: Auckland tem sido pioneira na implementação de modelos de Intervenção Precoce em Psicose. No entanto, esta organização do serviço não mudou nos últimos 19 anos. Segundo os dados obtidos da utilização do serviço, no período de 1996 -2012 foram atendidos 997 doentes, que tinham um número médio de 89 contactos (IQR: 36-184), com uma duração média de 62 horas de contactos (IQR: 24-136). Estes doentes passaram um número médio de 338 dias (IQR: 93-757) em contacto com o programa. 517 doentes (52%) não necessitaram de internamento no hospital, e os que foram internados, ficaram uma mediana de 124 dias no hospital (IQR: 40-380). Os doentes asiáticos tiveram um aumento de 50% de probabilidade de serem internados no hospital. Este relatório inclui 15 recomendações para orientar as reformas para o serviço e, nomeadamente, delinear a importância de uma visão organizacional e dos seus componentes-chave. As recomendações incluem o reforço da gestão e da liderança numa estrutura de equipe mais integrada, com recursos dedicados a melhorar a consciencialização da comunidade, a educação e deteção precoce, bem como a capacidade de receber referenciações diretas. Os Indicadores Chave de Desempenho devem ser estabelecidos, mas os Exames de Estado Mental em risco, devem ser removidos. Auckland deve manter a faixa etária alvo atual. A duração do serviço deve ser aumentada para um mínimo de três anos, com a opção de aumentá-la para cinco anos. A proporção de gestor de cuidados para os doentes deve ser preconizada em 1:15, enquanto o pessoal de apoio não-clínico deve ser aumentado. Os psiquiatras devem ter uma carga de trabalho de cerca de 80 doentes por equivalente de tempo completo. Um serviço local de prestação de cuidados deve ser desenvolvido com, nomeadamente, intervenções culturais para responder às necessidades da população multicultural de Auckland. A capacidade de investigação deve ser incorporada no Serviço de Intervenção Precoce em Psicoses. Qualquer alteração deverá envolver contacto com todas as partes interessadas, e a Administração Regional de Saúde deve comprometer-se em tempo, recursos humanos e políticos para apoiar e facilitar a mudança do sistema, investindo de forma significativa para melhor servir a comunidade Auckland.----------------------------------- ABSTRACT: Auckland has been pioneering in the adoption of Early Intervention in Psychosis models but the design of the service has not changed in 19 years. In service utilisation data from 997 patients seen from 1996 -2012, patients had a median number of 89 contacts (IQR: 36-184), with a median duration of 62 hours of contact (IQR: 24-136). Patients spent a median number of 338 days (IQR: 93-757) in contact with the program. 517 patients (52%) did not require admission to hospital, and those who did spent a median of 124 days in hospital (IQR: 40-380). Asian patients had a 50% increased chance of being admitted to hospital. This report includes 15 recommendations to guide reforms to the service, including outlining the importance of vision and key components. It recommends strengthened managerial leadership and a more integrated team structure with dedicated resources for improved community awareness, education and early detection as well as the capacity to take direct referrals. Key Performance Indicators (KPIs) should be established but At Risk Mental States should be excluded. Auckland should maintain the current target age range. The duration of service should be increased to a minimum of three years, with the option to extend this to five years. The ratio of care co-ordinator to patients should be capped at 1:15 whilst non-clinical supporting staff should be increased. Psychiatrists should have a caseload of about 80 per FTE. A local Service Delivery framework should be developed, as should cultural interventions to meet the needs of the multicultural population of Auckland. Research capacity should be incorporated into the fabric of Early Intervention in Psychosis Services. Any changes should involve consultation with all stakeholders, and the DHB should commit to investing time, human and political resources to support and facilitate meaningful system change to best serve the Auckland community.

Chirality in the new generation of antidepressants: stereoselective analysis of the enantiomers of mirtazapine, N-demethylmirtazapine, and 8-hydroxymirtazapine by LC-MS.

Mirtazapine is an antidepressant that acts specifically on noradrenergic and sertonergic receptors. A LC-MS method was developed that allows the simultaneous analysis of the R-(-)- and S-(+)-enantiomers of mirtazapine (MIR), demethylmirtazapine (DMIR), and 8-hydroxymirtazapine (8-OH-MIR) in plasma of MIR-treated patients. The method involves a 3-step liquid-liquid extraction, an HPLC separation on a Chirobiotic V column, and MS detection in electrospray mode. The limit of quantification (LOQ) for all enantiomers was 0.5 ng/mL, and the intra- and interday CVs were within 3.3% to 11.7% (concentration ranges 5-50 ng/mL). A method is also presented for the quantitative analysis of glucuroconjugated MIR and 8-OH-MIR. S-(+)-8-OH-MIR is present in plasma mainly as its glucuronide. Preliminary data suggest that in all patients, except in those comedicated with CYP2D6 inhibitors such as fluoxetine and thioridazine, R-(-)-MIR concentrations were higher than those of S-(+)MIR. Moreover, fluvoxamine seems also to inhibit the metabolism of MIR. Therefore, this method seems to be suitable for the stereoselective assay of MIR and its metabolites in plasma of patients comedicated with MIR and other drugs for routine and research purposes.

Sample preparation and heavy metal determination by atomic spectrometry /

Microwave digestions of mercury in Standards Reference Material (SRM) coal samples with nitric acid and hydrogen peroxide in quartz vessels were compared with Teflon® vessel digestion by using flow injection cold vapor atomic absorption spectrometry. Teflon® vessels gave poor reproducibiUty and tended to deliver high values, while the digestion results from quartz vessel show good agreement with certificate values and better standard deviations. Trace level elements (Ag, Ba, Cd, Cr, Co, Cu, Fe, Mg, Mn, Mo, Pb, Sn, Ti, V and Zn) in used oil and residual oil samples were determined by inductively coupled plasma-optical emission spectrometry. Different microwave digestion programs were developed for each sample and most of the results are in good agreement with certified values. The disagreement with values for Ag was due to the precipitation of Ag in sample; while Sn, V and Zn values had good recoveries from the spike test, which suggests that these certified values might need to be reconsidered. Gold, silver, copper, cadmium, cobalt, nickel and zinc were determined by continuous hydride generation inductively coupled plasma-optical emission spectrometry. The performance of two sample introduction systems: MSIS™ and gas-liquid separator were compared. Under the respective optimum conditions, MSIS^"^ showed better sensitivity and lower detection limits for Ag, Cd, Cu, Co and similar values for Au, Ni and Zn to those for the gas-liquid separator.

The identification, distribution and persistence of oxamyl and its degradation products in planted corn seed, seedling root and soil from oxamyl-treated corn seeds

A simple method was developed for treating corn seeds with oxamyl. It involved soaking the seeds to ensure oxamyl uptake, centrifugation to draw off excess solution, and drying under a stream of air to prevent the formation of fungus. The seeds were found to have an even distribution of oxamyl. Seeds remained fungus-free even 12 months after treatment. The highest nonphytotoxic treatment level was obtained by using a 4.00 mg/mL oxamyl solution. Extraction methods for the determination of oxamyl (methyl-N'N'-dimethyl-N-[(methylcarbamoyl)oxy]-l-thiooxamimidate), its oxime (methyl-N',N'-dimethyl-N-hydroxy-1-thiooxamimidate), and DMCF (N,N-dimethyl-1-cyanoformanade) in seed" root, and soil were developed. Seeds were processed by homogenizing, then shaking in methanol. Significantly more oxamyl was extracted from hydrated seeds as opposed to dry seeds. Soils were extracted by tumbling in methanol; recoveries range~ from 86 - 87% for oxamyl. Root was extracted to 93% efficiency for oxamyl by homogenizing the tissue in methanol. NucharAttaclay column cleanup afforded suitable extracts for analysis by RP-HPLC on a C18 column and UV detection at 254 nm. In the degradation study, oxamyl was found to dissipate from the seed down into the soil. It was also detected in the root. Oxime was detected in both the seed and soil, but not in the root. DMCF was detected in small amounts only in the seed.

Détection de nouvelles candidates au rang de naines brunes de types spectraux plus tardifs que T5 avec le Wide-field Infrared Survey Explorer (WISE)

Les naines brunes sont, en termes de masse, les objets astrophysiques intermédiaires entre les planètes géantes gazeuses et les étoiles de faible masse. Elles se forment de la même manière que les étoiles, par contraction gravitationnelle d’un fragment de nuage de gaz moléculaire ayant atteint la limite de Jeans, mais se différencient par leur incapa- cité à produire les réactions de fusion de l’hydrogène dans leur cœur. Les naines brunes sont par conséquent des objets qui se refroidissent graduellement, et dont les propriétés spectrales évoluent au cours du temps. Ce mémoire présente la recherche de nouvelles candidates de type spectral T tardif et Y, dans le but de compléter le relevé des naines brunes du voisinage solaire. Cette recherche est motivée par deux objectifs principaux. Premièrement, un échantillon com- plet des objets de faible masse est nécessaire pour contraindre correctement la limite aux faibles masses de la fonction de masse initiale des nuages interstellaires, problème clé en astrophysique actuellement. Deuxièmement, les naines brunes de types spectraux tardifs sont les objets stellaires dont les propriétés atmosphériques sont les plus semblables à celles des planètes géantes gazeuses. Par conséquent, la recherche de nouvelles naines brunes permet indirectement d’améliorer nos connaissances des exoplanètes, sans être contraints par la proximité d’étoiles brillantes. À partir du WISE All-Sky Source Catalog, nous avons établi un échantillon de 55 candidates naines brunes répondant aux critères photométriques attendus. Parmi ces can- didates, 17 ont fait l’objet d’un suivi photométrique en bande J à l’Observatoire du Mont-Mégantic, et 9 ont pu être détectées. De ces 9 détections, 4 objets présentent des mouvements propres cohérents avec ceux de naines brunes.

Assessment of meat authenticity using bioinformatics, targeted peptide biomarkers and high-resolution mass spectrometry

In recent years, we observed a significant increase of food fraud ranging from false label claims to the use of additives and fillers to increase profitability. Recently in 2013, horse and pig DNA were detected in beef products sold from several retailers. Mass spectrometry has become the workhorse in protein research and the detection of marker proteins could serve for both animal species and tissue authentication. Meat species authenticity will be performed using a well defined proteogenomic annotation, carefully chosen surrogate tryptic peptides and analysis using a hybrid quadrupole-Orbitrap mass spectrometer. Selected mammalian meat samples were homogenized, proteins were extracted and digested with trypsin. The samples were analyzed using a high-resolution mass spectrometer. The chromatography was achieved using a 30 minutes linear gradient along with a BioBasic C8 100 × 1 mm column at a flow rate of 75 µL/min. The mass spectrometer was operated in full-scan high resolution and accurate mass. MS/MS spectra were collected for selected proteotypic peptides. Muscular proteins were methodically analyzed in silico in order to generate tryptic peptide mass lists and theoretical MS/MS spectra. Following a comprehensive bottom-up proteomic analysis, we were able to detect and identify a proteotypic myoglobin tryptic peptide [120-134] for each species with observed m/z below 1.3 ppm compared to theoretical values. Moreover, proteotypic peptides from myosin-1, myosin-2 and -hemoglobin were also identified. This targeted method allowed a comprehensive meat speciation down to 1% (w/w) of undesired product.

Fibre optic sensor for the detection of adulterant traces in coconut oil

The design and development of a fibre optic evanescent wave refractometer for the detection of trace amounts of paraffin oil and palm oil in coconut oil is presented. This sensor is based on a side-polished plastic optical fibre. At the sensing region, the cladding and a small portion of the core are removed and the fibre nicely polished. The sensing region is fabricated in such a manner that it sits perfectly within a bent mould. This bending of the sensing region enhances its sensitivity. The oil mixture of different mix ratios is introduced into the sensing region and we observed a sharp decrease in the output intensity. The observed variation in the intensity is found to be linear and the detection limit is 2% (by volume) paraffin oil/palm oil in coconut oil. The resolution of this refractometric sensor is of the order of 10−3. Since coconut oil is consumed in large volumes as edible oil in south India, this fibre optic sensor finds great relevance for the detection of adulterants such as paraffin oil or palm oil which are readily miscible in coconut oil. The advantage of this type of sensor is that it is inexpensive and easy to set up. Another attraction of the side-polished fibre is that only a very small amount of analyte is needed and its response time is only 7 s.

Learning-Based Approach to Real Time Tracking and Analysis of Faces

This paper describes a trainable system capable of tracking faces and facialsfeatures like eyes and nostrils and estimating basic mouth features such as sdegrees of openness and smile in real time. In developing this system, we have addressed the twin issues of image representation and algorithms for learning. We have used the invariance properties of image representations based on Haar wavelets to robustly capture various facial features. Similarly, unlike previous approaches this system is entirely trained using examples and does not rely on a priori (hand-crafted) models of facial features based on optical flow or facial musculature. The system works in several stages that begin with face detection, followed by localization of facial features and estimation of mouth parameters. Each of these stages is formulated as a problem in supervised learning from examples. We apply the new and robust technique of support vector machines (SVM) for classification in the stage of skin segmentation, face detection and eye detection. Estimation of mouth parameters is modeled as a regression from a sparse subset of coefficients (basis functions) of an overcomplete dictionary of Haar wavelets.

Interdisciplinary Pedagogical Experience for Health Human Resources Focused on the Holistic Promotion of Health and the Prevention of the Disease

The object of this experience is to offer the students the opportunity to take part in the construction of a pedagogic strategy centred on the ludic, for the promotion of the integral health and the prevention of the disease with an educational community; directed to supporting and qualifying the well-being so much individually as group. The project is designed to five years, about interdisciplinary character (Speech Therapy, Medicine, Psychology, Nursery, Occupational Therapy), interinstitutional (Universidad del Rosario, Universidad de San Buenaventura y Universidad de Cundinamarca) and intersectorial (Education and Health). It considers the different actors of the educational community and school and the home as propitious scenes for the strengthening potential, beside being the fundamental spaces for the construction of knowledges and learnings concerning the integral health. To achieve the target, one has come constructing from the second semester of 2003, one pedagogic strategy centred on the ludic and the creativity, from which they are planned, they develop and evaluate the actions of promotion of skills, values, behaviors and attitudes in the care of the health and the prevention of disease, orientated to the early, opportune and effective detection of risk factors and problematic of the development that they affect the integral health. The above mentioned strategy raises a so called scene Bienestarópolis: A healthy world for conquering, centred on prominent figures, spaces and elements that alternate between the fantasy and the reality to facilitate the approximation, the interiorización and the appropriation of the integral health. Across this one, the children motivated by the adults enter an imaginary world in that theirs desires, knowledges and attitudes are the axis of his development. Since Vigotsky raises it, in the game the child realizes actions in order to adapt to the world that surrounds it acquiring skills for the learning. The actions of the project have involved 410 children and 25 teachers, of the degrees Zero, The First and The Second of basic primary; 90 parents of family, and an average of 40 students and 8 teachers of the already mentioned disciplines.

Development of chemical separation processes for the treatment and monitoring of metallic cations and oxoanions in polluted waters

The chemical contamination of natural waters is a global problem with a worldwide impact. Considering the relevance of this problem, this thesis is intended, on one hand, to develop different separation/preconcentration techniques based on membranes ability to permeate anions for the transport of toxic oxyanions of chromium(VI) and arsenic contained in aqueous matrices. In particular, we have investigated supported liquid membranes and polymer inclusion membranes, both of which contain the commercial quaternary ammonium salt Aliquat 336 as a carrier, as well as commercial anion exchange membranes. On the other hand, we have focused on the development of chemical sensors to facilitate the monitoring of several metals from different aqueous matrices. Thus, a selective optical sensor for Cr(VI) based on polymeric membranes containing Aliquat 336 as an ionophore has been designed. Additionally, mercury-based screen-printed electrodes have been evaluated for for cadmium, lead, copper and zinc detection.

Combinatorial peptide ligand libraries and plant proteomics: a winning strategy at a price

The mechanism of action and properties of a solid-phase ligand library made of hexapeptides (combinatorial peptide ligand libraries or CPLL), for capturing the "hidden proteome", i.e. the low- and very low-abundance proteins constituting the vast majority of species in any proteome, as applied to plant tissues, are reviewed here. Plant tissues are notoriously recalcitrant to protein extraction and to proteome analysis. Firstly, rigid plant cell walls need to be mechanically disrupted to release the cell content and, in addition to their poor protein yield, plant tissues are rich in proteases and oxidative enzymes, contain phenolic compounds, starches, oils, pigments and secondary metabolites that massively contaminate protein extracts. In addition, complex matrices of polysaccharides, including large amount of anionic pectins, are present. All these species compete with the binding of proteins to the CPLL beads, impeding proper capture and identification / detection of low-abundance species. When properly pre-treated, plant tissue extracts are amenable to capture by the CPLL beads revealing thus many new species among them low-abundance proteins. Examples are given on the treatment of leaf proteins, of corn seed extracts and of exudate proteins (latex from Hevea brasiliensis). In all cases, the detection of unique gene products via CPLL capture is at least twice that of control, untreated sample.

PETS2009: dataset and challenge

This paper describes the crowd image analysis challenge that forms part of the PETS 2009 workshop. The aim of this challenge is to use new or existing systems for i) crowd count and density estimation, ii) tracking of individual(s) within a crowd, and iii) detection of separate flows and specific crowd events, in a real-world environment. The dataset scenarios were filmed from multiple cameras and involve multiple actors.

A change detection approach to flood mapping in urban areas using TerraSAR-X

Very high-resolution Synthetic Aperture Radar sensors represent an alternative to aerial photography for delineating floods in built-up environments where flood risk is highest. However, even with currently available SAR image resolutions of 3 m and higher, signal returns from man-made structures hamper the accurate mapping of flooded areas. Enhanced image processing algorithms and a better exploitation of image archives are required to facilitate the use of microwave remote sensing data for monitoring flood dynamics in urban areas. In this study a hybrid methodology combining radiometric thresholding, region growing and change detection is introduced as an approach enabling the automated, objective and reliable flood extent extraction from very high-resolution urban SAR images. The method is based on the calibration of a statistical distribution of “open water” backscatter values inferred from SAR images of floods. SAR images acquired during dry conditions enable the identification of areas i) that are not “visible” to the sensor (i.e. regions affected by ‘layover’ and ‘shadow’) and ii) that systematically behave as specular reflectors (e.g. smooth tarmac, permanent water bodies). Change detection with respect to a pre- or post flood reference image thereby reduces over-detection of inundated areas. A case study of the July 2007 Severn River flood (UK) observed by the very high-resolution SAR sensor on board TerraSAR-X as well as airborne photography highlights advantages and limitations of the proposed method. We conclude that even though the fully automated SAR-based flood mapping technique overcomes some limitations of previous methods, further technological and methodological improvements are necessary for SAR-based flood detection in urban areas to match the flood mapping capability of high quality aerial photography.

A new rapid detection threshold method for use with older adults: reducing fatigue whilst maintaining accuracy

Taste and smell detection threshold measurements are frequently time consuming especially when the method involves reversing the concentrations presented to replicate and improve accuracy of results. These multiple replications are likely to cause sensory and cognitive fatigue which may be more pronounced in elderly populations. A new rapid detection threshold methodology was developed that quickly located the likely position of each individuals sensory detection threshold then refined this by providing multiple concentrations around this point to determine their threshold. This study evaluates the reliability and validity of this method. Findings indicate that this new rapid detection threshold methodology was appropriate to identify differences in sensory detection thresholds between different populations and has positive benefits in providing a shorter assessment of detection thresholds. The results indicated that this method is appropriate at determining individual as well as group detection thresholds.

Temporal and spatial variability of auroral forms in the 10–14 MLT sector: Relationship to plasma convection and solar wind-magnetosphere coupling

Ground-based observations of dayside auroral forms and magnetic perturbations in the arctic sectors of Svalbard and Greenland, in combination with the high-resolution measurements of ionospheric ion drift and temperature by the EISCAT radar, are used to study temporal/spatial structures of cusp-type auroral forms in relation to convection. Large-scale patterns of equivalent convection in the dayside polar ionosphere are derived from the magnetic observations in Greenland and Svalbard. This information is used to estimate the ionospheric convection pattern in the vicinity of the cusp/cleft aurora. The reported observations, covering the period 0700-1130 UT, on January 11, 1993, are separated into four intervals according to the observed characteristics of the aurora and ionospheric convection. The morphology and intensity of the aurora are very different in quiet and disturbed intervals. A latitudinally narrow zone of intense and dynamical 630.0 nm emission equatorward of 75 degrees MLAT, was observed during periods of enhanced antisunward convection in the cusp region. This (type 1 cusp aurora) is considered to be the signature of plasma entry via magnetopause reconnection at low magnetopause latitudes, i.e. the low-latitude boundary layer (LLB I,). Another zone of weak 630.0 nm emission (type 2 cusp aurora) was observed to extend up to high latitudes (similar to 79 degrees MLAT) during relatively quiet magnetic conditions, when indications of reverse (sunward) convection was observed in the dayside polar cap. This is postulated to be a signature of merging between a northward directed IMF (B-z > 0) and the geomagnetic field poleward of the cusp. The coexistence of type 1 and 2 auroras was observed under intermediate circumstances. The optical observations from Svalbard and Greenland were also used to determine the temporal and spatial evolution of type 1 auroral forms, i.e. poleward-moving auroral events occurring in the vicinity of a rotational convection reversal in the early post-noon sector. Each event appeared as a local brightening at the equatorward boundary of the pre-existing type 1 cusp aurora, followed by poleward and eastward expansions of luminosity. The auroral events were associated with poleward-moving surges of enhanced ionospheric convection and F-layer ion temperature as observed by the EISCAT radar in Tromso. The EISCAT ion flow data in combination with the auroral observations show strong evidence for plasma flow across the open/closed field line boundary.