Pattern Course Research Articles

Borderline personality disorder in young adults: features of psychopathology and patterns of course

To identify the psychopathological features of borderline personality disorder (BPD) in adolescence, determine the trajectory of its further course, and develop criteria for differential diagnosis. Clinical/psychopathological and psychometric methods were used to study 143 patients. The patients were divided into two groups: a clinical group - 73 patients, who were inpatients or outpatients in the clinical departments of the Mental Health Research Center (MHRC) in 2019-2022, and a follow-up group - 70 patients who were inpatients or outpatients in the MHRC clinic in 2006-2010. The structure of BPD in adolescence was clinically heterogeneous, which allowed distinguishing three typological varieties: with phenomena of «affective storm», which was characterized by the dominance of affective disorders, including after completion of adolescence, with some stabilization of personality structure (type I); with the dominance of addictive patterns of the type of «adrenalinomania», in which one of the key positions was occupied by craving impairments, with a constant need to search for new extreme hobbies, the use of psychoactive substances, which persisted after the end of adolescence (type II); with the predominance of «cognitive dissociation», which was characterized by the most polymorphic picture of disorders, with the predominance of self-identification disorders with dissociative disorders that retain their severity after the end of adolescence (type III). An integrative assessment of outcomes showed that rather favorable results (47.37%) (χ2=23.37, p=0.001) prevailed at type I, type II was characterized by rather unfavorable (59.26%) and unfavorable results (22.22%) (χ2=12.75, p=0.013) and type III by rather unfavorable (79.17%) and unfavorable (8.33%) outcomes (χ2=16.75, p=0.002). In the nosological evaluation of the follow-up group, 80.0% of patients were diagnosed with BPD, in the rest of the patients there was a change in diagnosis: in 14.3% for schizotypal disorder, in 5.7% for an attack-like form of schizophrenia (χ2=13.8, p=0.008; χ2=14.5, p=0.006). BPD in adolescence was confirmed in the majority of cases in adulthood. The results confirm that the typological variants of BPD are of prognostic value and can serve to further develop therapeutic and socio-rehabilitation measures.

Psychopathological networks in psychosis and changes over time: A long-term cohort study of first-episode psychosis

IntroductionFirst-episode psychosis is a critical period for early interventions to reduce the risk of poor outcomes and relapse as much as possible. There are now many studies revealing the patterns of course in the short and medium terms, but uncertainties about the long-term outcomes of symptomatology remain to be ascertained.ObjectivesFirst, we ascertained whether the structure of psychopathological symptoms, dimensions and domains of psychopathology remains invariant over time between first-episode psychosis and long-term follow-up. Second, we analysed the changes in the interrelationships of psychopathological symptoms, dimensions and domains of psychopathology between FEP and long-term follow-up at three levels.MethodsWe performed network analysis to investigate first-episode and long-term stages of psychosis at three levels of analysis: micro, meso and macro. The sample was a cohort of 510 patients with first-episode psychoses from the SEGPEP study, who were reassessed at the long-term follow-up (n = 243). We used the Comprehensive Assessment of Symptoms and History (CASH) for their assessments.ResultsOur results showed a similar pattern of clustering between first episodes and long-term follow-up in seven psychopathological dimensions at the micro level, 3 and 4 dimensions at the meso level, and one at the macro level. They also revealed significant differences between first-episode and long-term network structure and centrality measures at the three levels.ConclusionsOur findings suggest that disorganization symptoms have more influence in long-term stabilized patients. The main results of the current study add evidence to the hierarchical, dimensional and longitudinal structuring of first-episode psychoses.DisclosureNo significant relationships.

HGNN: Hyperedge-based graph neural network for MOOC Course Recommendation

Previous studies on Course Recommendation (CR) mainly focus on investigating the sequential relationships among courses (RNN is applied) and fail to learn the similarity relationships among learners. Moreover, existing RNN-based methods can only model courses’ short-term sequential patterns due to the inherent shortcomings of RNNs. In light of the above issues, we develop a hyperedge-based graph neural network, namely HGNN, for CR. Specifically, (1) to model the relationships among learners, we treat learners (i.e., hyperedges) as the sets of courses in a hypergraph, and convert the task of learning learners’ representations to induce the embeddings for hyperedges, where a hyperedge-based graph attention network is further proposed. (2) To simultaneously consider courses’ long-term and short-term sequential relationships, we first construct a course sequential graph across learners, and learn courses’ representations via a modified graph attention network. Then, we feed the learned representations into a GRU-based sequence encoder to infer their short-term patterns, and deem the last hidden state as the learned sequence-level learner embedding. After that, we obtain the learners’ final representations by a product pooling operation to retain features from different latent spaces, and optimize a cross-entropy loss to make recommendations. To evaluate our proposed solution HGNN, we conduct extensive experiments on two real-world datasets, XuetangX and MovieLens. We conduct experiments on MovieLens to prove the extensibility of our solution on other collections. From the experimental results, we can find that HGNN evidently outperforms other recent CR methods on both datasets, achieving 11.96% on P@20, 16.01% on NDCG@20, and 27.62% on MRR@20 on XuetangX, demonstrating the effectiveness of studying CR in a hypergraph, and the importance of considering both long-term and short-term sequential patterns of courses.

Integrating STEM into the Formal and Instructional Curriculum to Support Machine Construction Design

The design of machine construction is one of the subjects that often becomes a stumbling block for students of the Mechanical Engineering Education Study Program to graduate on time. Many factors cause it, including the weakness of students using STEM content in designing machine construction and the lack of contextual learning strategies for STEM-loaded courses with machine construction design tasks. This qualitative study aims to (1) identify the STEM content of the Scientific and Expertise Subject group, (2) describe the pattern of integrating STEM content in the formal and instructional curriculum, and (3) describe the learning pattern of the STEM content course. Research data were collected through document analysis, semi-open questionnaires, and FGD. The results showed (1) identified 15 scientific and skill courses containing STEM content that supported the work on machine construction design tasks, (2) integration of STEM-loaded courses in the formal curriculum was carried out by structuring their presentation before or at the same time as the presentation of the Mechanical Construction Design Course, being in the instructional curriculum is carried out by integrating learning experiences related to the design of machine construction in Lecture Event Unit, and (3) the learning pattern of courses containing STEM content should be carried out using a problem-based learning model where the problems are directly related to and or taken from machine construction design tasks.

The epidemiology of drug use disorders cross-nationally: Findings from the WHO’s World Mental Health Surveys

BackgroundIllicit drug use and associated disease burden are estimated to have increased over the past few decades, but large gaps remain in our knowledge of the extent of use of these drugs, and especially the extent of problem or dependent use, hampering confident cross-national comparisons. The World Mental Health (WMH) Surveys Initiative involves a standardised method for assessing mental and substance use disorders via structured diagnostic interviews in representative community samples of adults. We conducted cross-national comparisons of the prevalence and correlates of drug use disorders (DUDs) in countries of varied economic, social and cultural nature. Methods and findingsDSM-IV DUDs were assessed in 27 WMH surveys in 25 countries. Across surveys, the prevalence of lifetime DUD was 3.5%, 0.7% in the past year. Lifetime DUD prevalence increased with country income: 0.9% in low/lower-middle income countries, 2.5% in upper-middle income countries, 4.8% in high-income countries. Significant differences in 12-month prevalence of DUDs were found across country in income groups in the entire cohort, but not when limited to users. DUDs were more common among men than women and younger than older respondents. Among those with a DUD and at least one other mental disorder, onset of the DUD was usually preceded by the ‘other’ mental disorder. ConclusionsSubstantial cross-national differences in DUD prevalence were found, reflecting myriad social, environmental, legal and other influences. Nonetheless, patterns of course and correlates of DUDs were strikingly consistent. These findings provide foundational data on country-level comparisons of DUDs.

Predictors of tobacco and alcohol co-use from ages 15 to 32: The Amsterdam Growth and Health Longitudinal Study.

Tobacco and alcohol are often used in tandem over time, but specific predictors of course and patterns of course over time need explication. We examined differences in alcohol and tobacco course among an adolescent population as they transitioned into young adulthood across a 17-year period. Data came from participants (n = 303 for ages 15-21, n = 196 for ages 21 to 32; 52% female and 54% female, respectively) enrolled in the Amsterdam Growth and Health Longitudinal Study, an epidemiologic investigation examining disease across the life span. We utilized parallel latent growth modeling to assess the impact of sex, personality traits, cholesterol, blood pressure, and body mass index (BMI), on initial status and linear change over time in course of tobacco and alcohol. Females reported less alcohol use at adolescent baseline (β = -21.79), less increase during adolescence (β = -7.92, p < .05), slower decrease during young adulthood (β = 4.67, p < .05), and more rapid decline in tobacco use during young adulthood (β = -70.85, p < .05), relative to males. Alcohol and tobacco use baseline status' and change over time were all significantly associated with one another during both adolescence and young adulthood (p < .05; aside from alcohol baseline and slope during young adulthood). Effects of BMI, cholesterol, blood pressure, and personality traits were also observed on tobacco and alcohol course. In light of the strong, but sex dependent relationship between alcohol and tobacco course, particularly from ages 15 to 21, prevention efforts to curb heavy alcohol and tobacco use should consider targeting course taking into account biological sex and other notable covariates. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The Labor Market Returns to a Community College Education for Noncompleting Students

ABSTRACTIn this study, I used data from California to estimate the returns to a community college education that does not result in a postsecondary credential. I found strong, positive returns to completed credits in career and technical education (CTE) fields that are closely linked to employment sectors that are not credential-intensive (sectors in which employment often does not require a college degree), such as public safety, skilled blue-collar trade and technical work, and accounting and bookkeeping, among others. In these sectors, students were able to convert the human capital acquired in their coursework into returns that far exceeded the cost of the coursework itself, making some noncompleting educational pathways a rational means of securing earnings gains. This finding is consistent with emerging research on skills-builder students and other segments of the community college student population who exhibit coherent patterns of course taking and enrollment that typically do not result in a postsecondary credential. Further investigations of high-return noncompleting pathways are warranted and could help colleges to target efforts to grow postsecondary completion opportunities for students through short-term certificates programs, while also aiding efforts to communicate to stakeholders the successes that cannot be measured by counting credentials or transfers.

The Philosophy of the Blast Smelting: Cognition and Development of the Technology

Based on the analysis of system properties of the blast furnace smelting identified its features as a large system and principles of construction of mathematical models to summarize knowledge about the processes and forecast of characteristics of the blast smelting. For real blast furnaces on influence the model obtained adequate results. Numerical investigation allowed to determine the of various factors on the processes to establish rational regimes for existing conditions and assess the prospects of transition to mini-coke and non-coke blast furnace smelting. The research revealed new patterns of course of the process of blast furnace /smelting.

The College Completion Puzzle: A Hidden Markov Model Approach

Higher education in America is characterized by widespread access to college but low rates of completion, especially among undergraduates at less selective institutions. We analyze longitudinal transcript data to examine processes leading to graduation, using Hidden Markov modeling. We identify several latent states that are associated with patterns of course taking, and show that a trained Hidden Markov model can predict graduation or nongraduation based on only a few semesters of transcript data. We compare this approach to more conventional methods and conclude that certain college-specific processes, associated with graduation, should be analyzed in addition to socio-economic factors. The results from the Hidden Markov trajectories indicate that both graduating and nongraduating students take the more difficult mathematical and technical courses at an equal rate. However, undergraduates who complete their bachelor’s degree within 6 years are more likely to alternate between these semesters with a heavy course load and the less course-intense semesters. The course-taking patterns found among college students also indicate that nongraduates withdraw more often from coursework than average, yet when graduates withdraw, they tend do so in exactly those semesters of the college career in which more difficult courses are taken. These findings, as well as the sequence methodology itself, emphasize the importance of careful course selection and counseling early on in student’s college career.

Ultrasound in diagnosis of anatomical variation of anterior and posterior tibial arteries.

Knowledge about branching pattern of the popliteal artery is very important in any clinical settings involving the anterior and posterior tibial arteries. This study aims to elucidate the anatomical variation patterns and common types of anterior tibial artery (ATA) and posterior tibial arteries (PTA) in the general population in China. Anatomical variations of ATA, PTA, and peroneal artery were evaluated with ultrasound in a total of 942 lower extremity arteries in 471 patients. Three patterns of course in the PTA were ultrasonographically identified: 1) PTA1: normal anatomy with posterior tibial artery entering tarsal tunnel to perfuse the foot (91.5%), 2) PTA2: tibial artery agenetic, and replaced by communicating branches of peroneal artery entering tarsal tunnel above the medial malleolus to perfuse the foot (5.9%), and 3) PTA3: hypoplastic or aplastic posterior tibial artery communicating above the medial malleolus with thick branches of peroneal artery to form a common trunk entering into the tarsal tunnel (2.4%). In cases where ATA was hypoplastic or aplastic, thick branches of the peroneal artery replaced the anterior tibial artery to give rise to dorsalis pedis artery, with a total incidence of 3.2 % in patients, and were observed more commonly in females than in males. Hypoplastic or aplastic termini of ATA and PTA, with perfusion of the foot solely by the peroneal artery, was identified in 1 case. In another case, both communicating branches of the peroneal artery and PTA entered the tarsal tunnel to form lateral and medial plantar arteries. Anatomical variation of ATA and PTA is relatively common in the normal population. Caution should be exercised with these variations when preparing a peroneal artery vascular pedicle flap grafting. Ultrasound evaluation provides accurate and reliable information on the variations.

Predicting course of illness in patients with severe obsessive-compulsive disorder.

Few data are available to inform clinical expectations about course and prognosis of severe obsessive-compulsive disorder (OCD). Such information is necessary to guide clinicians and to inform criteria for invasive interventions for severe and intractable OCD. This study sought to examine course and prospective predictors of a chronic course in patients with severe OCD over 5 years. A selected subset of adults in the Brown Longitudinal Obsessive-Compulsive Study (BLOCS) was included. Adult BLOCS participants were enrolled between 2001 and 2006. All participants in the current study (N = 113) had DSM-IV OCD diagnosis, severe OCD symptoms at baseline, and at least 1 year of follow-up data. Cox proportional hazard models were used to examine the general pattern of course in the severe OCD sample based on Longitudinal Interval Follow-Up Evaluation (LIFE) psychiatric status ratings, as well as test predictors of chronically severe course. Results indicated that approximately half of patients with severe OCD at baseline had illness drop to a moderate or lower range of severity during 5 years of follow-up (50.4%) and that marked improvement was rare after 3 years of severe illness. The only unique predictor of a more chronically severe course was patient report of ever having been housebound for a week or more due to OCD symptoms (P < .05). Findings of this study were 3-fold: (1) half of participants with severe OCD have symptom improvement over 5 years of follow-up, (2) the majority of participants that drop out of the severe range of symptom severity do so within the first 3 years of follow-up, and (3) patient-reported history of being housebound for 1 week or more due to OCD is a significant predictor of OCD's remaining severe over the 5-year follow-up.

Technology Student Characteristics: Course Taking Patterns as a Pathway to STEM Disciplines

Rising concern about America’s ability to maintain its competitive position in the global economy has renewed interest in STEM education. The power and the promise of STEM education is based on the need for technological literacy. Technology education is a discipline devoted to the delivery of technological literacy for all. Nevertheless, a decision to pursue a STEM major is a longitudinal process that builds during secondary education and carries into postsecondary studies. When analyzed appropriately, course-taking patterns may offer valuable insight into a student’s academic history and momentum through college as well as illuminate patterns that effectively and wisely engage academic resources that may shape students’ entrance in STEM related careers. This study utilized High School Transcipt Study data to examine and compare the patterns of STEM courses taken by technology students and those of high school students as a whole, the patterns of courses taken by technology students and those of high school students as a whole, and the GPAs of technology students with the GPAs of other high school student GPAs. Findings revealed that there was a significant difference in overall GPA between technology students, as defined in this study, and the general student population of the data set. There was also a significant difference in GPAs between technology students and the general student population in STEM courses.

Gender Differences: A Lifetime Analysis of the Economic Burden of Alzheimer's Disease

BackgroundGender is one of the best-established differences in risk for Alzheimer's disease (AD) and other forms of dementia, with women being at greater risk. However, the financial implications are unknown. This study aims at understanding the economic burden of AD by gender. MethodThis study takes a life-time perspective to investigate the burden of AD over the course of the disease. Nationally representative Medicare Current Beneficiary Survey data were used to estimate the course of illness of AD from age 65 to death and the incremental costs of AD on Medicare and Medicaid. Published data on the use and costs of assisted living facilities, home health care, and informal care were imputed into the course of illness to calculate the lifetime costs of these services. ResultsFemales and males have distinctively different patterns of course of illness of AD. Women face higher risks of having AD (15.5% vs. 13.1%) and of serving as informal caregivers for AD patients (6.8% vs. 4.0%) before death. Medicare and Medicaid account for major payers of AD care for both genders, but the greatest economic challenge of AD to women is the cost of the informal care they deliver, resulting in women bearing six times the cost of men. ConclusionPublic policy interventions that aim at curing or slowing the progress of AD will greatly benefit the welfare and economic status of women.

Co-Occurrence of Separate BCR-ABL1-Positve and JAK2V617F-Positive Clones in 23 Patients Reveals Biologic and Clinical Importance

Background:The simultaneous detection of a BCR-ABL1 rearrangement and a JAK2V617F mutation in the same patient is a very rare event and has previously been described in case reports or very small series of cases only.Aim:1) To establish the incidence of cases with concurrent BCR-ABL1 rearrangement and JAK2V617F mutation. 2) Evaluate whether one clone harbours both mutations or whether there are two independent clones. 3) Establish whether these patients have additional concurrent gene mutations and how they influence the evolution of both diseases.Patients and Methods:A total of 27,907 patients with suspected myeloproliferative neoplasms (MPN) where studied in parallel for BCR-ABL1 and JAK2V617F mutation from May 2005 to June 2014 at our institution. BCR-ABL1 analysis was performed by multiplex RT-PCR and JAK2V617F mutation analysis by melting curve based LightCycler assay. A total of 23 patients (0.08%) were positive for both mutations. Eleven patients were male and 12 were female with a median age at diagnosis of 72 years (range 46-80 years). Of fifteen patients 2 or more sample time points were available for follow-up analyses (median follow-up: 4 years, range: 5 months - 9 years). Both BCR-ABL1 and JAK2V617F mutation loads were assessed by quantitative real time PCR. In addition, 22/23 cases were analyzed upon detection of co-occurrence of both clones with a pan-myeloid gene panel consisting of 25 genes: TET2, RUNX1, PHF6, ASXL1, CBL, DNMT3A, SF3B1, TP53, BCOR, BRAF, ETV6, EZH2, FLT3 (TKD), GATA1, GATA2, IDH1, IDH2, KIT, KRAS, MPL, NPM1, NRAS, SRSF2, U2AF1, and WT1. Either complete coding genes or hotspots were first amplified by a microdroplet-based assay (RainDance, Lexington, MA) and subsequently sequenced with a MiSeq instrument (Illumina, San Diego, CA). RUNX1 was sequenced on the 454 Life Sequence NGS platform (Roche 454, Branford, CT). The median coverage per amplicon was 2,215 reads (range 100-24,716). The lower limit of detection was set at a cut-off of 1.5%.Results:At the time point of detection of both mutations morphological assessment was available in 12 patients. The remaining 5 showed features typical for CML. Bone marrow blast count was <5% in all cases. Cytogenetics was available in 18/23 cases (78.3%). The classical t(9;22)(q34;q11) was identifiable in 16/18 patients. Two patients had a normal karyotype as they were in complete cytogenetic remission of their CML (due to TKI treatment) at diagnosis of the JAK2 V617F positive clone. In the majority of patients (n=16) the JAK2V617F mutation predated the BCR-ABL1 clone, in 4 patients CML was known before the detection of the JAK2V617 positive clone, in 1 patient both were diagnosed simultaneously and in another 2 patients information in this regard was lacking. BCR-ABL1 transcript types distributed as follows: b2a2 and/or b3a2 (n=18), and e1a2 (n=5).The continuous quantitative assessment of BCR-ABL1 and JAK2V617F mutational loads in 15 patients showed asynchronous patterns of courses in all cases giving proof of these aberrations representing two different clones in these cases. When treatment with TKI was initiated, the BCR-ABL1 clone decreased while the JAK2V617F clone either remained stable or increased in all 15 cases. Next generation sequencing revealed further mutations in 13/22 analyzed patients (56.5%). One mutation was detected in 8 patients, 4 patients revealed 2, and one patient even 3 different additional mutations. In detail, mutations in the following genes were detected: TET2 (n=8), ASXL1 (n=4), RUNX1 (n=2), CBL (n=1), DNMT3A (n=1), PHF6 (n=1) SF3B1 (n=1) and TP53 (n=1). These mutations were traced and quantified retrospectively. Data suggests that they were most probably present in the JAK2V617F positive clone. This again supports the theory of both clones being independent of each other.Conclusions:1) Co-occurrence of BCR-ABL1 and JAK2V617F is a very rare event (0.08%). 2) BCR-ABL1 and JAK2V617F represent two different clones. 3) Additional gene mutations are detected in 56% of these cases and all seem to be within the JAK2V617F positive clone. 4) Clinically, the BCR-ABL1 clone is easily controlled with TKI, however, the combined management of the JAK2V617F clone is more challenging especially when a fibrotic phase of the disease takes over. The long-term effect of JAK2-inhibitors in the management of these patients is yet to be established. DisclosuresMartin-Cabrera:MLL Munich Leukemia Laboratory: Employment. Haferlach:MLL Munich Leukemia Laboratory: Employment, Equity Ownership. Haferlach:MLL Munich Leukemia Laboratory: Employment, Equity Ownership. Kern:MLL Munich Leukemia Laboratory: Employment, Equity Ownership. Schnittger:MLL Munich Leukemia Laboratory: Employment, Equity Ownership.

Development and Assessment of the Effectiveness of an Undergraduate General Education Foreign Language Requirement

AbstractThis article describes a faculty‐led, multiyear process of formulating learning objectives and assessing the effectiveness of a foreign language requirement for all College of Arts and Sciences undergraduates at a research university. Three interrelated research questions were addressed: (1) What were the levels and patterns of language courses completed under the language requirement compared to those under the previous curriculum? (2) To what extent was the oral proficiency learning objective being attained? and (3) How did oral proficiency vary by course level and the patterns of courses completed to satisfy the language requirement? The oral proficiency of 614 students was assessed with the Simulated Oral Proficiency Interview and categorized in terms of ACTFL ratings. Study findings indicated that 76% of students met or exceeded the objective of the Intermediate Mid level of oral proficiency and that oral proficiency differed by course level and the pattern of courses completed to satisfy the language requirement. In particular, the impact of completing an advanced‐level course was clear, which in turn had implications for curricular policies and academic advising. It is argued that faculty‐led evaluation of program effectiveness, in which assessment approaches are both summative and formative and findings are routinely used to improve educational practices as well as document student learning, is the necessary context for developing an evidence‐based approach to undergraduate language education.

Insights on innovation and technology management curriculum in public universities in Turkey

To achieve technological capabilities that can lead to sustainable competitive advantage, there is a need for a highly qualified workforce that is capable of innovating and managing technology. Therefore, education on technology and innovation management is increasing in importance, especially for developing countries. Technology and innovation management courses in higher education constitutes the significant part of the formal education in the field, hence the effectiveness of these courses has become a major issue. However, in previous literature, several researchers tried to discover the ideal basic characteristics of curricula for technology and innovation management education and particularly for graduate and undergraduate courses in terms of content and theory and practice balance in universities This study aims to explore and reveal the current status of technology and innovation management courses in business administration and engineering faculties, science, technology and social sciences institutes in 95 public universities in Turkey. The findings are evaluated in terms of meeting the required major patterns of courses that are determined based on the theoretical background. Differences are considered as improvement requirements and related recommendations to practitioners are presented. Study reveals that existing courses in the explored higher education institutions are still not sufficient in number and quality to provide the knowledge and skills that create professionals who are competent in technology and innovation management.

Course of Depression and Mortality Among Older Primary Care Patients

: Depression is a treatable illness that disproportionately places older adults at increased risk for mortality. : We sought to examine whether there are patterns of course of depression severity among older primary care patients that are associated with increased risk for mortality. : Our study was a secondary analysis of data from a practice-based randomized controlled trial within 20 primary care practices located in greater New York City, Philadelphia, and Pittsburgh. : The study sample consisted of 599 adults aged 60 years and older recruited from primary care settings. Participants were identified though a two-stage, age-stratified (60-74 years; older than 75 years) depression screening of randomly sampled patients. Severity of depression was assessed using the 24-item Hamilton Depression Rating Scale (HDRS). : Longitudinal analysis via growth curve mixture modeling was carried out to classify patterns of course of depression severity across 12 months. Vital status at 5 years was ascertained via the National Death Index Plus. : Three patterns of change in course of depression severity over 12 months were identified: 1) persistent depressive symptoms, 2) high but declining depressive symptoms, 3) low and declining depressive symptoms. After a median follow-up of 52.0 months, 114 patients had died. Patients with persistent depressive symptoms were more likely to have died compared with patients with a course of high but declining depressive symptoms (adjusted hazard ratio 2.32, 95% confidence interval [1.15-4.69]). : Persistent depressive symptoms signaled increased risk of dying in older primary care patients, even after adjustment for potentially influential characteristics such as age, smoking status, and medical comorbidity.

Intervention for first episode psychosis in India – The SCARF experience

IntroductionThere have been very few studies or programs in India on early intervention for first episode psychoses. This paper reports the findings of a pilot program, part of a collaboration with the Prevention and Early Intervention Program for Psychoses, Montreal. MethodologyA sample of 47 patients with first episode psychosis were followed up for 2 years. Complete data was available on 39 subjects at 2 years. This data was analyzed for socio-demographic and clinical variables and its relationship with outcomes and DUP. Those who had a PANSS score <60 and GAF >80 were categorized to be in remission (N=28) and others as continually ill (N=10). ResultsThere was significant improvement from baseline to 1st year with maximal improvement seen at 3 months after intake. However, improvement between 1 and 2 years was not significant. More women relapsed and more men dropped out. 25 out of 28 subjects with shorter DUP (<2 years) were in remission at 2 years as against 3 out of 10 with >2 years DUP. Three different patterns of course of the disorder were found. Single episode followed by total remission for 2 years (N=20; 52.6%) was the commonest. The others were relapses followed by remissions (N=8; 21.1%), and continuous illness (N=10; 26.3%). ConclusionEarly intervention is effective and more so if DUP is shorter. PANSS scores and GAF at baseline are not predictive of later outcomes. Medication adherence in therapeutic engagement and psychosocial needs should be considered in the implementation of early intervention programs in our cultural context.

The importance of oxidative damage of the lungs for the occurrence of acute lung abscess

Summary. Results of pathomorphological and immunohistochemical investigations in pulmonary tissue species from patients with acute lung abscess have been analyzed in the paper. Three clinical and morphological patterns of course of the disease were defined. Particularities of mitochondrial superoxide dismutase and malone dialdehyde expression in the lung were shown.

Patients with early-onset systemic juvenile idiopathic arthritis show more inflammation and worse outcome

Methods Retrospective analysis of clinical data. Early-onset (EO) was defined as the start of SJIA prior to age 18 months. Variables included: demographic and clinical features at onset and outcome variables during disease course (pattern of course, presence of clinical joint damage [using the Juvenile Arthritis Damage Index or JADI], radiographic joint damage [erosions], destructive hip disease, disability [CHAQ > 0.5], growth retardation, development of macrophage activation syndrome [MAS], need for biologic agents, and death). Patients with EO were compared with patients with disease onset at age ≥ 18 months. Chi square and Mann-Whitney tests were used for comparisons.