Crisis intervention for people with severe mental illnesses

Background A particularly difficult challenge for community treatment of people with serious mental illnesses is the delivery of an acceptable level of care during the acute phases of severe mental illness. Crisis-intervention models of care were developed as a possible solution. Objectives To review the effects of crisis-intervention models for anyone with serious mental illness experiencing an acute episode compared to the standard care they would normally receive. If possible, to compare the effects of mobile crisis teams visiting patients' homes with crisis units based in home-like residential houses. Search methods We searched the Cochrane Schizophrenia Group’s Study-Based Register of Trials. There is no language, time, document type, or publication status limitations for inclusion of records in the register. This search was undertaken in 1998 and then updated 2003, 2006, 2010 and September 29, 2014. Selection criteria We included all randomised controlled trials of crisis-intervention models versus standard care for people with severe mental illnesses that met our inclusion criteria. Data collection and analysis We independently extracted data from these trials and we estimated risk ratios (RR) or mean differences (MD), with 95% confidence intervals (CI). We assessed risk of bias for included studies and used GRADE to create a 'Summary of findings' table. Main results The update search September 2014 found no further new studies for inclusion, the number of studies included in this review remains eight with a total of 1144 participants. Our main outcomes of interest are hospital use, global state, mental state, quality of life, participant satisfaction and family burden. With the exception of mental state, it was not possible to pool data for these outcomes. Crisis intervention may reduce repeat admissions to hospital (excluding index admissions) at six months (1 RCT, n = 369, RR 0.75 CI 0.50 to 1.13, high quality evidence), but does appear to reduce family burden (at six months: 1 RCT, n = 120, RR 0.34 CI 0.20 to 0.59, low quality evidence), improve mental state (Brief Psychiatric Rating Scale (BPRS) three months: 2 RCTs, n = 248, MD -4.03 CI -8.18 to 0.12, low quality evidence), and improve global state (Global Assessment Scale (GAS) 20 months; 1 RCT, n = 142, MD 5.70, -0.26 to 11.66, moderate quality evidence). Participants in the crisis-intervention group were more satisfied with their care 20 months after crisis (Client Satisfaction Questionnaire (CSQ-8): 1 RCT, n = 137, MD 5.40 CI 3.91 to 6.89, moderate quality evidence). However, quality of life scores at six months were similar between treatment groups (Manchester Short Assessment of quality of life (MANSA); 1 RCT, n = 226, MD -1.50 CI -5.15 to 2.15, low quality evidence). Favourable results for crisis intervention were also found for leaving the study early and family satisfaction. No differences in death rates were found. Some studies suggested crisis intervention to be more cost-effective than hospital care but all numerical data were either skewed or unusable. We identified no data on staff satisfaction, carer input, complications with medication or number of relapses. Authors' conclusions Care based on crisis-intervention principles, with or without an ongoing homecare package, appears to be a viable and acceptable way of treating people with serious mental illnesses. However only eight small studies with unclear blinding, reporting and attrition bias could be included and evidence for the main outcomes of interest is low to moderate quality. If this approach is to be widely implemented it would seem that more evaluative studies are still neede

Interface Microstructures and Bond Formation in Ultrasonic Consolidation

The quality of ultrasonically consolidated parts critically depends on the bond quality between individual metal foils. This necessitates a detailed understanding of interface microstructures and ultrasonic bonding mechanism. There is a lack of information on interface microstructures in ultrasonically consolidated parts as well as a lack of consensus on the mechanism of metal ultrasonic welding, especially on matters such as plastic deformation and recrystallization. In the current work, interface microstructures of an ultrasonically consolidated multi-material Al 3003-Ni 201 sample were analyzed in detail using optical microscopy, scanning electron microscopy, energy dispersive spectroscopy, and orientation imaging microscopy. Based on the results of microstructural studies, the mechanism of metal ultrasonic welding has been discussed. The reasons for formation of defects/unbonded regions in ultrasonically consolidated parts have also been identified and discussedMechanical Engineerin

STUDIES ON ABLATION OF OBJECTS TRAVERSING AN ATMOSPHERE

Ablation-type thermal protection of objects traversing an atmosphere - earth and mar

Chemically engineering ligand selectivity at the free fatty acid receptor 2 based on pharmacological variation between species orthologs

When it is difficult to develop selective ligands within a family of related G-protein-coupled receptors (GPCRs), chemically engineered receptors activated solely by synthetic ligands (RASSLs) are useful alternatives for probing receptor function. In the present work, we explored whether a RASSL of the free fatty acid receptor 2 (FFA2) could be developed on the basis of pharmacological variation between species orthologs. For this, bovine FFA2 was characterized, revealing distinct ligand selectivity compared with human FFA2. Homology modeling and mutational analysis demonstrated a single mutation in human FFA2 of C4.57G resulted in a human FFA2 receptor with ligand selectivity similar to the bovine receptor. This was exploited to generate human FFA2-RASSL by the addition of a second mutation at a known orthosteric ligand interaction site, H6.55Q. The resulting FFA2-RASSL displayed a >100-fold loss of activity to endogenous ligands, while responding to the distinct ligand sorbic acid with pEC(50) values for inhibition of cAMP, 5.83 ± 0.11; Ca(2+) mobilization, 4.63 ± 0.05; ERK phosphorylation, 5.61 ± 0.06; and dynamic mass redistribution, 5.35 ± 0.06. This FFA2-RASSL will be useful in future studies on this receptor and demonstrates that exploitation of pharmacological variation between species orthologs is a powerful method to generate novel chemically engineered GPCRs

Hyperspherical Harmonics, Separation of Variables and the Bethe Ansatz

The relation between solutions to Helmholtz's equation on the sphere $S^{n-1}$ and the [{\gr sl}(2)]^n Gaudin spin chain is clarified. The joint eigenfuctions of the Laplacian and a complete set of commuting second order operators suggested by the $R$--matrix approach to integrable systems, based on the loop algebra \wt{sl}(2)_R, are found in terms of homogeneous polynomials in the ambient space. The relation of this method of determining a basis of harmonic functions on $S^{n-1}$ to the Bethe ansatz approach to integrable systems is explained.Comment: 14 pgs, Plain Tex, preprint CRM--2174 (May, 1994

Quality management approach in construction equipment manufacturing

Over the recent decades, quality management practises have been documented extensively, with concepts often being termed the latest management fad. This study tackles a debate that has been a topic of discussion within academic literature for several decades; is Total Quality Management a management fad, which should be replaced by a new quality philosophy. This paper presents the TQM versus Six Sigma debate, by critically reviewing existing literature on the two approaches, as well as providing results from research within a leading construction equipment manufacturer. The results highlight that Six Sigma should be implemented using TQM as a foundation; thus presenting the overall finding that TQM and Six Sigma are compliments, not substitutes

Children's construction task performance and spatial ability: controlling task complexity and predicting mathematics performance.

This paper presents a methodology to control construction task complexity and examined the relationships between construction performance and spatial and mathematical abilities in children. The study included three groups of children (N = 96); ages 7-8, 10-11, and 13-14 years. Each group constructed seven pre-specified objects. The study replicated and extended previous findings that indicated that the extent of component symmetry and variety, and the number of components for each object and available for selection, significantly predicted construction task difficulty. Results showed that this methodology is a valid and reliable technique for assessing and predicting construction play task difficulty. Furthermore, construction play performance predicted mathematical attainment independently of spatial ability

Markov modeling of moving target defense games

We introduce a Markov-model-based framework for Moving Target Defense (MTD) analysis. The framework allows modeling of broad range of MTD strategies, provides general theorems about how the probability of a successful adversary defeating an MTD strategy is related to the amount of time/cost spent by the adversary, and shows how a multi-level composition of MTD strategies can be analyzed by a straightforward combination of the analysis for each one of these strategies. Within the proposed framework we define the concept of security capacity which measures the strength or effectiveness of an MTD strategy: the security capacity depends on MTD specific parameters and more general system parameters. We apply our framework to two concrete MTD strategies