Predictors of substance use reduction in an epidemiological first-episode psychosis cohort

Aim To assess the predictors of a significant decrease or cessation of substance use (SU) in a treated epidemiological cohort of first-episode psychosis (FEP) patients. Method Participants were FEP patients of the Early Psychosis Prevention and Intervention Centre in Australia. Patients' medical files were reviewed using a standardized file audit. Data on 432 patients with FEP and baseline co-morbid substance use disorder (SUD) were available for analysis. Predictors of reduction/cessation of SU at follow up were examined using logistic regression analyses. Results In univariate analyses, a reduction/cessation of SU was predicted by baseline measures reflecting higher education, employment, accommodation with others, cannabis use disorder (CUD) only (rather than poly-SUDs), better global functioning and better premorbid social and occupational functioning, later age at onset of psychosis, and a diagnosis of non-affective psychosis. In multivariate analysis, CUD alone and better premorbid social and occupational functioning remained significant predictors. Conclusions Addressing SUDs and social and occupational goals in people with FEP may offer opportunities to prevent SUDs becoming more severe or entrenched. Further longitudinal research on recovery from SU and FEP is needed to disentangle directions of influence and identify key targets for intervention.

Simvastatin and ezetimibe in addition to nonpharmacological risk factor modification for achieving new low-density lipoprotein cholesterol targets

BACKGROUND: Though guidelines emphasize low-density lipoprotein cholesterol (LDL-C) lowering as an essential strategy for cardiovascular risk reduction, achieving target levels may be difficult. PATIENTS AND METHODS: The authors conducted a prospective, controlled, open-label trial examining the effectiveness and safety of high-dose fluvastatin or a standard dosage of simvastatin plus ezetimibe, both with an intensive guideline-oriented cardiac rehabilitation program, in achieving the new ATP III LDL-C targets in patients with proven coronary artery disease. 305 consecutive patients were enrolled in the study. Patients were divided into two groups: the simvastatin (40 mg/d) plus ezetimibe (10 mg/d) and the fluvastatin-only group (80 mg/d). Patients in both study groups received the treatment for 21 days in addition to nonpharmacological measures, including advanced physical, dietary, psychosocial, and educational activities. RESULTS: After 21 days of treatment, a significant reduction in LDL-C was found in both study groups as compared to the initial values, however, the reduction in LDL-C was significantly stronger in the simvastatin plus ezetimibe group: simvastatin plus ezetimibe treatment decreased LDL-C to a mean level of 57.7 +/- 1.7 mg/ml, while fluvastatin achieved a reduction to 84.1 +/- 2.4 mg/ml (p < 0.001). In the simvastatin plus ezetimibe group, 95% of the patients reached the target level of LDL-C < 100 mg/dl. This percentage was significantly higher than in patients treated with fluvastatin alone (75%; p < 0.001). The greater effectiveness of simvastatin plus ezetimibe was more impressive when considering the optional goal of LDL-C < 70 mg/dl (75% vs. 32%, respectively; p < 0.001). There was no difference in occurrence of adverse events between both groups. CONCLUSION: Simvastatin 40 mg/d plus ezetimibe 10 mg/d, on the background of a guideline-oriented standardized intensive cardiac rehabilitation program, can reach 95% effectiveness in achieving challenging goals (LDL < 100 mg/dl) using lipid-lowering medication in patients at high cardiovascular risk.

Fast ignition driven by quasi-monoenergetic ions: Optimal ion type and reduction of ignition energies with an ion beam array

Fast ignition of inertial fusion targets driven by quasi-monoenergetic ion beams is investigated by means of numerical simulations. Light and intermediate ions such as lithium, carbon, aluminum and vanadium have been considered. Simulations show that the minimum ignition energies of an ideal configuration of compressed Deuterium-Tritium are almost independent on the ion atomic number. However, they are obtained for increasing ion energies, which scale, approximately, as Z2, where Z is the ion atomic number. Assuming that the ion beam can be focused into 10 ?m spots, a new irradiation scheme is proposed to reduce the ignition energies. The combination of intermediate Z ions, such as 5.5 GeV vanadium, and the new irradiation scheme allows a reduction of the number of ions required for ignition by, roughly, three orders of magnitude when compared with the standard proton fast ignition scheme.

A Meta-Analytic Review of Mindfulness-Based Interventions on Symptom Reduction: A Critique and Guide for Future Investigation.

Over the past decade, mindfulness practices have been used with increasing frequency as therapeutic components within cognitive behavioral treatment regimens. As is standard practice, prescriptive uses of mindfulness intervention are incorporated to improve end-state functioning by ameliorating problematic symptoms and conditions. Common change-targets include the control of cognitive and emotional content for purposes of enhancing psychological self-regulation and physical well-being. The term mindfulness applies to a heterogeneous range of practices, methods, and techniques. While there is no singular agreed upon definition for mindfulness, as a process concept, the term connotes an immediate, non-thetic access to events, wherein each occasioning event is experienced in toto within the broader contextual event-field, and distinct from intervening conceptual themes being noticed. Training in mindfulness practices may be conducted using individual, group, or small class formats. The current paper provides a meta-analytic review of 44 treatment outcome studies (extracted 1982 through 2006), which examines the clinical utility of mindfulness as the primary therapeutic approach. Results indicated that average effect sizes for mindfulness based interventions fell within the medium range for construct category variables examined (d = .56). These findings suggest that mindfulness training is a cost-effective treatment for a wide array of contemporary psychological problems and diagnoses, in addition to fostering positive psychology attributes such as quality and satisfaction with life. A critique of the research and recommendations for future research, including a need to examine the role of mindfulness as a tool for cultivating increased psychological acceptance and life satisfaction, is presented.

The euro area's tightrope walk: debt and competitiveness in Italy and Spain. Bruegel Policy Contribution 2013/11, September 2013

Competitiveness adjustment in struggling southern euro-area members requires persistently lower inflation than in major trading partners, but low inflation worsens public debt sustainability. When average euro-area inflation undershoots the two percent target, the conflict between intra-euro relative price adjustment and debt sustainability is more severe. In our baseline scenario, the projected public debt ratio reduction in Italy and Spain is too slow and does not meet the European fiscal rule. Debt projections are very sensitive to underlying assumptions and even small negative deviations from GDP growth, inflation and budget surplus assumptions can easily result in a runaway debt trajectory. The case for a greater than five percent of GDP primary budget surplus is very weak. Beyond vitally important structural reforms, the top priority is to ensure that euro area inflation does not undershoot the two percent target, which requires national policy actions and more accommodative monetary policy. The latter would weaken the euro exchange rate, thereby facilitating further intra-euro adjustment. More effective policies are needed to foster growth. But if all else fails, the European Central Bank’s Outright Monetary Transactions could reduce borrowing costs.

Identification of specific problems and countermeasures targets for reducing alcohol related casualties. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Optimal input/output reduction in production processes

While conventional Data Envelopment Analysis (DEA) models set targets for each operational unit, this paper considers the problem of input/output reduction in a centralized decision making environment. The purpose of this paper is to develop an approach to input/output reduction problem that typically occurs in organizations with a centralized decision-making environment. This paper shows that DEA can make an important contribution to this problem and discusses how DEA-based model can be used to determine an optimal input/output reduction plan. An application in banking sector with limitation in IT investment shows the usefulness of the proposed method.

CO2 emissions reduction of Chinese light manufacturing industries:a novel RAM-based global Malmquist-Luenberger productivity index

Climate change has become one of the most challenging issues facing the world. Chinese government has realized the importance of energy conservation and prevention of the climate changes for sustainable development of China's economy and set targets for CO2 emissions reduction in China. In China industry contributes 84.2% of the total CO2 emissions, especially manufacturing industries. Data envelopment analysis (DEA) and Malmquist productivity (MP) index are the widely used mathematical techniques to address the relative efficiency and productivity of a group of homogenous decision making units, e.g. industries or countries. However, in many real applications, especially those related to energy efficiency, there are often undesirable outputs, e.g. the pollutions, waste and CO2 emissions, which are produced inevitably with desirable outputs in the production. This paper introduces a novel Malmquist-Luenberger productivity (MLP) index based on directional distance function (DDF) to address the issue of productivity evolution of DMUs in the presence of undesirable outputs. The new RAM (Range-adjusted measure)-based global MLP index has been applied to evaluate CO2 emissions reduction in Chinese light manufacturing industries. Recommendations for policy makers have been discussed.

A comprehensive approach to the euro-area debt crisis

The euro area‘s sovereign debt crisis continues though significant steps have been taken to resolve it. This paper proposes a comprehensive solution to the crisis based on three pillars: a plan to restore banking sector soundness in the whole euro area, a resolution of sovereign debt crisis -including a revision of EU assistance facilities and a reduction of the Greek public debt- and a strategy to foster growth and competitiveness. The paper provides novel estimates and analysis focusing on the current situation of Greece, Ireland, Portugal and Spain.

Debt Restructuring in the Euro Area: a Necessary but Manageable Evil?

There are two possible responses to the Greek debt crisis: ‘Plan A’, continued official lending, for as long as needed, with possible voluntary private sector involvement, and ‘Plan B’, coercive preemptive or post-default restructuring with significant face value reduction in privately-held debt. Both options have risks, but it is necessary to move to Plan B sooner or later. The impact on Greece could be mitigated by foreign bank ownership and proper liquidity support measures. The direct spillover impact on the rest of the euro area seems small. But there is the risk of contagion, which is a serious concern. There is a cautious case for delaying somewhat Plan B in order to prepare for it.

The Euro Area's Tightrope Walk: Debt and Competitiveness in Italy and Spain

- Competitiveness adjustment in struggling southern euro-area members requires persistently lower inflation than in major trading partners, but low inflation worsens public debt sustainability. When average euro-area inflation undershoots the two percent target, the conflict between intra-euro relative price adjustment and debt sustainability is more severe. - In our baseline scenario, the projected public debt ratio reduction in Italy and Spain is too slow and does not meet the European fiscal rule. Debt projections are very sensitive to underlying assumptions and even small negative deviations from GDP growth, inflation and budget surplus assumptions can easily result in a runaway debt trajectory. - The case for a greater than five percent of GDP primary budget surplus is very weak. Beyond vitally important structural reforms, the top priority is to ensure that euro-area inflation does not undershoot the two percent target, which requires national policy actions and more accommodative monetary policy. The latter would weaken the euro exchange rate, thereby facilitating further intra-euro adjustment. More effective policies are needed to foster growth. But if all else fails, the European Central Bank’s Outright Monetary Transactions could reduce borrowing costs.

Államadósság, optimális politika, finanszírozás (State Debt, Optimal Policy, and Financing)

A fejlett ipari országoknak is az államadósság csökkentése vagy akár szinten tartása okozza az egyik legfontosabb gazdaságpolitikai dilemmát. Az euróövezet tagállamai esetében is ez a kritérium tűnik a legkevésbé teljesíthetőnek, de Japán és az Egyesült Államok is leküzdhetetlennek tűnő államadóssággal birkózik. A tanulmány rövid áttekintést ad néhány meghatározó közgazdasági megközelítésről, amelyek az államadósság szintjének hosszú távú alakulása mögött meghúzódó tényezőket, gazdaságpolitikai lépéseket magyarázzák. Végül az elméletek alapján tanulságokat fogalmaz meg a magyar államadósság kezelését illetően az 1990–2010 közötti folyamatok ismeretében. _____ The macroeconomic developments of the last decade have confirmed that one of the most important dilemmas that even developed economies have to face is the reduction or even sustaining of the state debt. In case of the eurozone member states this criterion is the most difficult to be accomplished, furthermore the United States and Japan are among the global powers that have to cope with state debts which seems to be insurmountable. The aim of this paper is to provide a brief overview of some decisive economic approaches (Barro [1979], Lucas and Stokey [1983], Marcet and Scott [2007], Martin [2009] etc.) that explain the factors behind the formation of long-run state debt level and economic policy measures accompanying state debt management. The paper also attempts to draw some lessons for the Hungarian state debt management in view of the 1990-2010 processes.

WATER RESOURCES, HEALTH, AND THE SUSTAINABILITY OF INTERVENTIONS TO ACHIEVE WATER AND SANITATION TARGETS OF THE MILLENNIUM DEVELOPMENT GOALS IN A CHANGING WORLD

This dissertation addresses sustainability of rapid provision of safe water and sanitation required to meet the Millennium Development Goals. Review of health-related literature and global statistics demonstrates engineers' role in achieving the MDGs. This review is followed by analyses relating to social, environmental, and health aspects of meeting MDG targets. Analysis of national indicators showed that inadequate investment, poor or nonexistent policies and governance are challenges to global sanitation coverage in addition to lack of financial resources and gender disparity. Although water availability was not found to be a challenge globally, geospatial analysis demonstrated that water availability is a potentially significant barrier for up to 46 million people living in urban areas and relying on already degraded water resources for environmental income. A daily water balance model incorporating the National Resources Conservation Services curve number method in Bolivian watersheds showed that local water stress is linked to climate change because of reduced recharge. Agricultural expansion in the region slightly exacerbates recharge reductions. Although runoff changes will range from -17% to 14%, recharge rates will decrease under all climate scenarios evaluated (-14% to -27%). Increasing sewer coverage may place stress on the readily accessible natural springs, but increased demand can be sustained if other sources of water supply are developed. This analysis provides a method for hydrological analysis in data scarce regions. Data required for the model were either obtained from publicly available data products or by conducting field work using low-cost methods feasible for local participants. Lastly, a methodology was developed to evaluate public health impacts of increased household water access resulting from domestic rainwater harvesting, incorporating knowledge of water requirements of sanitation and hygiene technologies. In 37 West African cities, domestic rainwater harvesting has the potential to reduce diarrheal disease burden by 9%, if implemented alone with 400 L storage. If implemented in conjunction with point of use treatment, this reduction could increase to 16%. The methodology will contribute to cost-effectiveness evaluations of interventions as well as evaluations of potential disease burden resulting from reduced water supply, such as reductions observed in the Bolivian communities.