Building a USDL repository as a service using MDE

The decision to represent the USDL abstract syntax as a metamodel, shown as a set of UML diagrams, has two main benefits: the ability to show a well- understood standard graphical representation of the concepts and their relation- ships to one another, and the ability to use object-oriented frameworks such as Eclipse Modeling Framework (EMF) to assist in the automated generation of tool support for USDL service descriptions.

Les viveurs de Paris : drame en cinq actes et huit tableaux. [Suivi de] La Médée de Nanterre : tragédie fantaisiste en trois parties et en vers de Bohême : traduction en gaulois de la traduction en italien de la tragédie française de Médée. Livr. 304 / par M. Xavier de Montépin... ; par Th. Cogniard, É. Grange et Bourdois...

Collection : Théâtre contemporain illustré ; 303e et 304e livraisons

Les viveurs de Paris : drame en cinq actes et huit tableaux. [Suivi de] La Médée de Nanterre : tragédie fantaisiste en trois parties et en vers de Bohême : traduction en gaulois de la traduction en italien de la tragédie française de Médée. Livr. 303 / par M. Xavier de Montépin... ; par Th. Cogniard, É. Grange et Bourdois...

Collection : Théâtre contemporain illustré ; 303e et 304e livraisons

"Müde Alte" [Illustration] : nach einer Original-Radierung

Hermann Struck

Müde Wanderer [Illustration]

Leopold Pilichowski

La problemática de las mujeres filicidas : Las reescrituras de Medea de Eurípides en dos Medeas argentinas y el diálogo intertextual con Médée Kali de Laurent Gaudé

Fil: Delbueno, María Silvina. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; Argentina.

La problemática de las mujeres filicidas : Las reescrituras de Medea de Eurípides en dos Medeas argentinas y el diálogo intertextual con Médée Kali de Laurent Gaudé

Fil: Delbueno, María Silvina. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; Argentina.

La problemática de las mujeres filicidas : Las reescrituras de Medea de Eurípides en dos Medeas argentinas y el diálogo intertextual con Médée Kali de Laurent Gaudé

Fil: Delbueno, María Silvina. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; Argentina.

J. Charrière : fabricant d'instruments et appareils de chirurgie et de méde?cine en tous genres...

Precede al tít.: Maison Charrière, Exposition Nationale de l'Industrie de 1844.

Beskrifning öfwer swenska mynt och kongl. skåde-penningar : som til denna tid, antingen i stora cabinetter wårkeligen äro go̊mde, eller i böcker finnas afritade : tillika med efterrättelse om hwad i fremmande länder, med och emot swerige, under någon stempel utkommit : hwarjemte fo̊ljer fo̊rtekning på de, öfwer inhemske enskilte personer, präglade minnes-märcken /

Last item in table of contents starts on p. 370.

Life events and social support among patients with major depressive disorder

The study is part of a research project of 269 psychiatric patients with major depression, Vantaa Depression Study, in the Department of Mental Health and Alcohol Research of the National Public Health Institute and the Department of Psychiatry of the Peijas Medical Care District. The aim was to study at the onset of MDE psychosocial differences in subgroups of patients and clustering of events into time before depression and its prodromal phase, to study whether more severe life events and less social support predict poorer outcome in all patients, but most among those currently in partial remission, whether social support declines as a consequence of time spent in MDE, is sensitive to improvement, and whether social support is influenced by neuroticism and extraversion. After screening, a semistructured interview (SCAN, version 2.0) was used for the presence of DSM-IV MDE, and other psychiatric diagnoses. Life events and social support were studied with semistructured methods (IRLE, Paykel 1983; IMSR, Brugha et al. 1987), perceived social support and neuroticism/extraversion with questionnaires (PSSS-R, Blumenthal et al. 1987; EPI, Eysenck and Eysenck 1964) at baseline, 6 and 18 months. At the onset of depression life events were common. No major differences between subgroups of patients were found; the younger had more events, whereas those with comorbid alcoholism and personality disorders perceived less support. Although events were distributed evenly between the time before depression, the prodromal phase and the index MDE, two thirds of the patients attributed their depression to some life event. Adversities and poor perceived support influenced the outcome of all psychiatric patients, most in the subgroup of full remission. In the partial remission group, the impact of severe events and in the MDE, perceived support was important. Low objective and subjective support were predicted by longer time spent in MDE. Along with improvement subjective support improved. Neuroticism and extraversion were associated with the size of social network and perceived support and predicted change of perceived support. In conclusion, adversities were common in all phases of depression. They may thus have many roles; before depression they may precipitate it, in the prodromal phase worsen symptoms, and during the MDE, the outcome of depression. Patients often attributed their depression to a life event. Psychosocial subgroup differences were quite small. Perceived support predicted the outcome of depression, and time spent in MDE objective and subjective support. Neuroticism and extraversion may modify the level and change particularly in perceived support, thereby indirectly effecting vulnerability to depression.

Functional and work disability and treatment received by patients with major depressive disorder

This study is one part of a collaborative depression research project, the Vantaa Depression Study (VDS), involving the Department of Mental and Alcohol Research of the National Public Health Institute, Helsinki, and the Department of Psychiatry of the Peijas Medical Care District (PMCD), Vantaa, Finland. The VDS includes two parts, a record-based study consisting of 803 patients, and a prospective, naturalistic cohort study of 269 patients. Both studies include secondary-level care psychiatric out- and inpatients with a new episode of major depressive disorder (MDD). Data for the record-based part of the study came from a computerised patient database incorporating all outpatient visits as well as treatment periods at the inpatient unit. We included all patients aged 20 to 59 years old who had been assigned a clinical diagnosis of depressive episode or recurrent depressive disorder according to the International Classification of Diseases, 10th edition (ICD-10) criteria and who had at least one outpatient visit or day as an inpatient in the PMCD during the study period January 1, 1996, to December 31, 1996. All those with an earlier diagnosis of schizophrenia, other non-affective psychosis, or bipolar disorder were excluded. Patients treated in the somatic departments of Peijas Hospital and those who had consulted but not received treatment from the psychiatric consultation services were excluded. The study sample comprised 290 male and 513 female patients. All their psychiatric records were reviewed and each patient completed a structured form with 57 items. The treatment provided was reviewed up to the end of the depression episode or to the end of 1997. Most (84%) of the patients received antidepressants, including a minority (11%) on treatment with clearly subtherapeutic low doses. During the treatment period the depressed patients investigated averaged only a few visits to psychiatrists (median two visits), but more to other health professionals (median seven). One-fifth of both genders were inpatients, with a mean of nearly two inpatient treatment periods during the overall treatment period investigated. The median length of a hospital stay was 2 weeks. Use of antidepressants was quite conservative: The first antidepressant had been switched to another compound in only about one-fifth (22%) of patients, and only two patients had received up to five antidepressant trials. Only 7% of those prescribed any antidepressant received two antidepressants simultaneously. None of the patients was prescribed any other augmentation medication. Refusing antidepressant treatment was the most common explanation for receiving no antidepressants. During the treatment period, 19% of those not already receiving a disability pension were granted one due to psychiatric illness. These patients were nearly nine years older than those not pensioned. They were also more severely ill, made significantly more visits to professionals and received significantly more concomitant medications (hypnotics, anxiolytics, and neuroleptics) than did those receiving no pension. In the prospective part of the VDS, 806 adult patients were screened (aged 20-59 years) in the PMCD for a possible new episode of DSM-IV MDD. Of these, 542 patients were interviewed face-to-face with the WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN), Version 2.0. Exclusion criteria were the same as in the record-based part of the VDS. Of these, 542 269 patients fulfiled the criteria of DSM-IV MDE. This study investigated factors associated with patients' functional disability, social adjustment, and work disability (being on sick-leave or being granted a disability pension). In the beginning of the treatment the most important single factor associated with overall social and functional disability was found to be severity of depression, but older age and personality disorders also significantly contributed. Total duration and severity of depression, phobic disorders, alcoholism, and personality disorders all independently contributed to poor social adjustment. Of those who were employed, almost half (43%) were on sick-leave. Besides severity and number of episodes of depression, female gender and age over 50 years strongly and independently predicted being on sick-leave. Factors influencing social and occupational disability and social adjustment among patients with MDD were studied prospectively during an 18-month follow-up period. Patients' functional disability and social adjustment were alleviated during the follow-up concurrently with recovery from depression. The current level of functioning and social adjustment of a patient with depression was predicted by severity of depression, recurrence before baseline and during follow-up, lack of full remission, and time spent depressed. Comorbid psychiatric disorders, personality traits (neuroticism), and perceived social support also had a significant influence. During the 18-month follow-up period, of the 269, 13 (5%) patients switched to bipolar disorder, and 58 (20%) dropped out. Of the 198, 186 (94%) patients were at baseline not pensioned, and they were investigated. Of them, 21 were granted a disability pension during the follow-up. Those who received a pension were significantly older, more seldom had vocational education, and were more often on sick-leave than those not pensioned, but did not differ with regard to any other sociodemographic or clinical factors. Patients with MDD received mostly adequate antidepressant treatment, but problems existed in treatment intensity and monitoring. It is challenging to find those at greatest risk for disability and to provide them adequate and efficacious treatment. This includes great challenges to the whole society to provide sufficient resources.