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Schizophrenia Research Apr 2022The current schizophrenia construct as delineated in the latest editions of the DSM and the ICD has some strengths, but also many weaknesses. It improved the reliability...
The current schizophrenia construct as delineated in the latest editions of the DSM and the ICD has some strengths, but also many weaknesses. It improved the reliability of the diagnosis, made communication among clinicians, users and families less ambiguous, is useful for education and training, and for reimbursement and insurance purposes. However, many serious weaknesses should be considered. The term "Schizophrenia" does not recognize the heterogeneity of the disorder and might nourish the belief that schizophrenia represents a unitary disease. In addition, there is no agreement on the existence and nature of a "core aspect" of the disorder. Stable dimensions, in particular negative symptoms and cognitive impairment, which are key determinants of functioning, are not de facto regarded as core aspects. Finally, the construct is associated to the notion of a poor outcome, to a high level of stigma and has acquired a derogatory connotation. We are not ready but should be prepared to abandon the current schizophrenia construct. Clinicians and researchers should be encouraged to complement the ICD/DSM diagnosis with an in-depth characterization of the individual clinical picture, along with other variables, such as family history, comorbidities, vulnerability factors and personal trajectory. The "Primary Psychoses" construct, together with improved cross-sectional and longitudinal phenotypes from representative population and patient cohorts, and the availability of artificial intelligence methods, could lead to a new and more precise taxonomy of psychotic disorders, and increase the probability of identifying meaningful biomarkers to improve prevention, diagnosis, prognosis, and treatment for people suffering from psychotic disorders.
Topics: Artificial Intelligence; Cross-Sectional Studies; Diagnostic and Statistical Manual of Mental Disorders; Humans; Psychotic Disorders; Reproducibility of Results; Schizophrenia
PubMed: 34924240
DOI: 10.1016/j.schres.2021.12.007 -
Evaluation and Program Planning Dec 2017Theory-based logic models are commonly developed as part of requirements for grant funding. As a tool to communicate complex social programs, theory based logic models...
Theory-based logic models are commonly developed as part of requirements for grant funding. As a tool to communicate complex social programs, theory based logic models are an effective visual communication. However, after initial development, theory based logic models are often abandoned and remain in their initial form despite changes in the program process. This paper examines the potential benefits of committing time and resources to revising the initial theory driven logic model and developing detailed logic models that describe key activities to accurately reflect the program and assist in effective program management. The authors use a funded special education teacher preparation program to exemplify the utility of drill down logic models. The paper concludes with lessons learned from the iterative revision process and suggests how the process can lead to more flexible and calibrated program management.
Topics: Education, Special; Logic; Models, Theoretical; Program Evaluation; Teacher Training
PubMed: 28886436
DOI: 10.1016/j.evalprogplan.2017.08.012 -
Cardiac Electrophysiology Clinics Sep 2015Lead malfunction is a common problem in implantable cardiac device patients and is expected to increase with the aging of leads. There is a weak indication for... (Review)
Review
Lead malfunction is a common problem in implantable cardiac device patients and is expected to increase with the aging of leads. There is a weak indication for extraction of superfluous leads with the potential for cardiac implantable electronic device interference and abandoned or redundant leads; much remains to be learned from clinical practice. Lead extraction, although safe in experienced hands, remains a high-risk procedure, especially in lower-volume centers and/or when performed by lower-volume operators. Therefore, a strategy of abandoning nonfunctioning leads is reasonable, and lead extractions should be reserved for cases with system infection or high lead burden.
Topics: Contraindications; Defibrillators, Implantable; Device Removal; Equipment Failure; Female; Humans; Male; Pacemaker, Artificial; Postoperative Complications
PubMed: 26304522
DOI: 10.1016/j.ccep.2015.05.006 -
PloS One 2018Removal of cardiac implantable electronic devices (CIEDs) by manual traction during orthotopic heart transplantation (OHT) sometimes results in retained lead fragments....
BACKGROUND
Removal of cardiac implantable electronic devices (CIEDs) by manual traction during orthotopic heart transplantation (OHT) sometimes results in retained lead fragments. Moreover, abandoned leads and retained lead fragments are a contraindication for magnetic resonance imaging (MRI) and may be a cause of CIED infection.
OBJECTIVE
To eliminate complications of retained lead fragments, we completely removed residual leads using an excimer laser sheath technique during OHT. We report our clinical experience and high success rate of lead extraction using the excimer laser sheath compared with manual traction during OHT.
METHODS AND RESULTS
We obtained data on 84 consecutive patients receiving OHT between August 2007 and August 2017. Thirty-nine of 84 patients had undergone CIED implantation before OHT and removal of all their leads was attempted during OHT. From 2007 to 2014, defibrillator and pacemaker leads were extracted by manual traction in all patients (N = 22). After 2015, all leads were extracted with the excimer laser sheath, and surgical assistance was prepared for the procedure (N = 17). Complete procedural success was achieved in 100% of patients in the excimer laser group and 77% of patients in the manual traction group.
CONCLUSION
Extraction of abandoned leads using the excimer laser sheath system during OHT is novel and safe technique, and has a higher success rate than extraction using manual traction during OHT.
Topics: Adult; Cohort Studies; Defibrillators, Implantable; Device Removal; Electrodes, Implanted; Female; Heart Transplantation; Humans; Lasers, Excimer; Male; Middle Aged; Pacemaker, Artificial; Retrospective Studies
PubMed: 30188917
DOI: 10.1371/journal.pone.0203172 -
Ecological Applications : a Publication... Apr 2022Conventional conservation policies in Europe notably rely on the passive restoration of natural forest dynamics by setting aside forest areas to preserve forest...
Conventional conservation policies in Europe notably rely on the passive restoration of natural forest dynamics by setting aside forest areas to preserve forest biodiversity. However, since forest reserves cover only a small proportion of the territory, conservation policies also require complementary conservation efforts in managed forests in order to achieve the biodiversity targets set up in the Convention on Biological Diversity. Conservation measures also raise the question of large herbivore management in and around set-asides, particularly regarding their impact on understory vegetation. Although many studies have separately analyzed the effects of forest management, management abandonment, and ungulate pressure on forest biodiversity, their joint effects have rarely been studied in a correlative framework. We studied 212 plots located in 15 strict forest reserves paired with adjacent managed forests in European France. We applied structural equation models to test the effects of management abandonment, stand structure, and ungulate pressure on the abundance, species richness, and diversity of herbaceous vascular plants and terricolous bryophytes. We showed that stand structure indices and plot-level browsing pressure had direct and opposite effects on herbaceous vascular plant species diversity; these effects were linked with the light tolerance of the different species groups. Increasing canopy cover had an overall negative effect on herbaceous vascular plant abundance and species diversity. The effect was two to three times greater in magnitude than the positive effects of browsing pressure on herbaceous plants diversity. On the other hand, a high stand density index had a positive effect on the species richness and diversity of bryophytes, while browsing had no effect. Forest management abandonment had few direct effects on understory plant communities, and mainly indirectly affected herbaceous vascular plant and bryophyte abundance and species richness and diversity through changes in vertical stand structure. Our results show that conservation biologists should rely on foresters and hunters to lead the preservation of understory vegetation communities in managed forests since, respectively, they manipulate stand structure and regulate ungulate pressure. Their management actions should be adapted to the taxa at stake, since bryophytes and vascular plants respond differently to stand and ungulate factors.
Topics: Biodiversity; Ecosystem; Forests; Herbivory; Plants; Tracheophyta; Trees
PubMed: 35019181
DOI: 10.1002/eap.2531 -
Environmental Science and Pollution... Jul 2020Generation, storage, and management of waste coming from industrial processes are a growing worldwide problem. One of the main contributors is the mining industry, in...
Generation, storage, and management of waste coming from industrial processes are a growing worldwide problem. One of the main contributors is the mining industry, in particular tailings generated by historical mining, which are barely maintained, especially in developing countries. Assessing the impact of a mining site to surrounding soils and ecosystems can be complex, especially when determining mobility and accessibility of the contaminants is required to perform ecological and human health risk assessment. As an effort to obtain information regarding mobility and accessibility of some potentially toxic elements (Zn, Pb, and As) from an historical mining site of northwestern Mexico, the abandoned mine tailings of San Felipe de Jesús in central Sonora and adjacent agricultural soils were investigated. Mobility and accessibility were assessed by means of sequential extraction procedures and using simulated physiological media. Additionally, an assessment of accidental oral intake was calculated considering the bioaccessible fractions. Results show that higher concentrations of contaminants were found in sulfide-rich tailings (Zn = 92,540; Pb = 21,288; As = 19,740 mg kg) compared with oxide-rich tailings (Zn = 43,240; Pb = 14,763; As = 13,401 mg kg). Concentrations in agricultural soils were on average Zn = 4755, Pb = 2840, and As = 103 mg kg. Zinc was mainly recovered from labile fractions in oxide-rich tailings (~ 60%) and in a lower amount from sulfide-rich tailings (~ 30%). Pb and As were mainly associated with residual fractions (80-95%) in both types of tailings. The percentage of mobile fractions (sum of water-soluble, exchangeable, and bound to carbonate fractions) in agricultural soils was as follows: Zn ~ 60%, Pb ~ 15%, and As ~ 70%. Regarding the phytoaccessible fraction, the studied elements in mine tailings and agricultural soil samples exceeded the threshold limits, except for As in agricultural soils. According to data obtained, toxic effects were also calculated. As for daily oral intake for non-carcinogenic effects in adults and children, only Pb and As exceeded reference dose values, especially in children exposed to sulfide-rich tailings and agricultural soils. Regarding carcinogenic effects of Pb and As, most of the samples were above acceptable risk values.
Topics: Child; Ecosystem; Environmental Monitoring; Humans; Lead; Metals, Heavy; Mexico; Soil Pollutants; Zinc
PubMed: 32372357
DOI: 10.1007/s11356-020-09051-1 -
Cardiovascular Diagnosis and Therapy Apr 2021In patients undergoing transvenous lead extraction (TLE) transesophageal echocardiography (TEE) provide valuable information after procedure.
BACKGROUND
In patients undergoing transvenous lead extraction (TLE) transesophageal echocardiography (TEE) provide valuable information after procedure.
METHODS
We analyzed data from 936 TEE performed in patients undergoing TLE between 2015 and 2019 (mean follow-up 566.23±224.47 days) and assessed the role of echocardiographic phenomena after procedure.
RESULTS
Increment in tricuspid regurgitation (TR) was observed in 9% of patients after TLE. Factors increasing the risk of TR were: binding sites between lead and right ventricle (RV) (OR: 5.429), tricuspid valve (TV) (OR: 3.42), superior vena cava (SVC) (OR: 3.30) and lead-to-lead adhesions (OR: 2.88). Predisposing factors of residual structures after TLE were: asymptomatic masses on the leads (AMEL) (OR: 1.68), binding sites between SVC and cardiac structures (OR: 1.72), and multiple leads (OR: 1.30). Probability of vegetation remnants increased in the presence of abandoned leads (OR: 7.91). The risk factors of tamponade were: dwell time of the oldest lead (OR: 1.17), lead-to-lead adhesion (OR: 22.47), binding sites between lead and TV (OR: 6.08), RA (OR: 11.50), SVC (OR: 4.47), higher LVEF (OR: 2.35; P=0.006), female gender (OR: 5.43), multiple leads (OR: 2.11), looped leads (OR: 4.90) and AMEL (OR: 6.42). The risk of lead fracture was increased by: lead-to-lead adhesion (OR: 5.69), fibrosis binding the lead to RV (OR: 5.16), RA (OR: 2.39) and dwell time of the oldest lead (OR: 1.068). The mortality rate was 11.97% during follow-up. The risk of death was increased by: severe TR and vegetation remnants.
CONCLUSIONS
The most important phenomena evaluated after TLE are: tricuspid valve function, residual fibrosis and vegetation remnants, progression of pericardial effusion and retained lead fragments. Postoperative TEE provides information about the results of TLE and helps establish further management.
PubMed: 33968618
DOI: 10.21037/cdt-20-871 -
Chemosphere Nov 2022Abandoned mines with untreated waste cause environmental pollution. The complex mixture of mining waste includes high metal content, anthropogenic chemicals and sterile...
Abandoned mines with untreated waste cause environmental pollution. The complex mixture of mining waste includes high metal content, anthropogenic chemicals and sterile rocks. Adverse effects of contaminated soils have been widely assessed by the use of plants. The aim of this study was to assess the chronic toxicity of a contaminated soil by waste from an abandoned gold mine on Lactuca sativa and its relationship with the bioavailability and bioaccumulation of Zn, Cu and Pb. Soil samples were taken from the site of mining waste stacking and a reference site in La Planta (Argentina). Contamination indices were calculated and acute and chronic exposures on L. sativa were carried out. Phytotoxicity indices, morphological and biochemical parameters, and concentrations of Zn, Cu and Pb in pseudo total and bioavailable soil fractions and in plant tissue were determined. Concentration- and time-dependent toxicity effects were observed, especially on plant width, fresh aerial biomass, leaf area and percentage of plants with completely necrotic aerial biomass. High levels of Zn (1453.3 ± 220.3 μg g) were found in plant tissue compared to Pb (277.2 ± 18.0 μg g) and Cu (255.3 ± 25.6 μg g). Toxicological endpoints correlated with metal uptake and mining waste concentration. In addition, bioaccumulation factors correlated with mobilisable and water soluble fractions. The concentration of Pb in aerial biomass surpassed the permissible concentrations in leaf vegetables, even at the reference site, indicating that lettuce crop consumption could be risky for the local population's health. This study demonstrated a strong relationship between metal bioavailability, toxicity endpoints and bioaccumulation, contributing with novel information to future ecotoxicological risk assessments and remediation plans.
Topics: Bioaccumulation; Biological Availability; Environmental Monitoring; Gold; Lead; Lactuca; Metals, Heavy; Mining; Plants; Soil; Soil Pollutants; Water; Zinc
PubMed: 35961448
DOI: 10.1016/j.chemosphere.2022.135855 -
The Journal of Perinatal & Neonatal...Neonaticide is the leading cause of death for infants younger than 24 hours. Since Safe Haven laws have been in place, a large reduction in infant deaths has occurred. A... (Review)
Review
BACKGROUND
Neonaticide is the leading cause of death for infants younger than 24 hours. Since Safe Haven laws have been in place, a large reduction in infant deaths has occurred. A literature review concluded that many healthcare staff members are unknowledgeable regarding Safe Haven infants, laws, and surrendering events. This lack of knowledge could lead to delayed care and poor patient outcomes.
METHODS
The researcher used Lewin's change theory to conduct a quasi-experimental study using a pre/posttest design.
RESULTS
Data revealed a statistically significant increase in staff knowledge of Safe Haven events, roles and teamwork after a new policy, an educational intervention, and a simulation intervention occurred.
CONCLUSION
Safe Haven laws have assisted in saving thousands of infants' lives since 1999 by allowing mothers to legally surrender their infant to any place deemed safe by the state's law. Because of this, healthcare staff should be knowledgeable of their roles and responsibilities during a relinquishment. Safe Haven policies, annual education, and annual simulations can assist healthcare staff in their preparedness and confidence of such events and increase patient outcomes.
Topics: Infant; Female; Child; Humans; Child, Abandoned; Mothers; Educational Status
PubMed: 37102560
DOI: 10.1097/JPN.0000000000000727 -
Cancer Prevention Research... Apr 2018Marine omega-3 fatty acids promote resolution of inflammation and have potential to reduce risk of obesity-related breast cancer. For prevention trials in obese women,...
Marine omega-3 fatty acids promote resolution of inflammation and have potential to reduce risk of obesity-related breast cancer. For prevention trials in obese women, inflammatory cytokines, aromatase, and measures of breast immune cell infiltration are logical, as are biomarkers of growth factor, adipokine, and estrogen signaling. Where best to look for marker change: in the circulation (easiest), in benign breast tissue (most relevant), or in visceral adipose (inflammation often most marked)? A null biomarker modulation trial may reflect limitations in design, source and dose of fatty acids, or biomarkers and should not lead to premature abandonment of marine omega-3 fatty acids for cancer prevention. .
Topics: Biomarkers; Breast Neoplasms; Docosahexaenoic Acids; Fatty Acids, Omega-3; Female; Fibrocystic Breast Disease; Humans
PubMed: 29559515
DOI: 10.1158/1940-6207.CAPR-18-0061