How patients with insulin-treated type 1 and type 2 diabetes view their own and their physician's treatment goals.

To investigate the subjective treatment goals of insulin-treated diabetic patients. 297 type 1 and 205 type 2 diabetic patients, representative of the North-western Swiss population, filled out a self report questionnaire focusing on their own treatment goals using standardized measures wherever available. Factor analysis of the 16 items reflecting their treatment goals revealed four subscales (Crohnbach's alpha): High actual quality of life (0.73), weight reduction/maintenance and daily hassles (0.68), good medical care and knowledge (0.64) and good long term glucose control (0.71). Good long term glucose control was the single most important main treatment goal for most patients (type 1: 60.2%, type 2: 49.7%, p = 0.025). However, both type 1 and type 2 diabetic patients believed that this goal - especially the value of HbA1c - was overestimated (both p <0.0001), while high actual quality of life was underestimated (p = 0.003 and p = 0.05, respectively) by their physicians compared to their own assessment. Good long term glucose control (OR 1.63, p = 0.003) and high actual quality of life (OR 2.17, p <0.0001) were more important and weight reduction/maintenance and coping with daily hassles (OR 0.75, p = 0.07) were slightly less important treatment goals for type 1 than for type 2 diabetic patients. These differences in goals were best associated with the mode of insulin therapy, self-monitoring, and with the extent of diabetes education. Patients believe that physicians overestimate the importance of long term glucose control and underestimate the importance of actual quality of life. Diabetes education and self management have the largest impact on patients' own treatment goals

Conflict monitoring and adaptation as reflected by N2 amplitude in obsessive–compulsive disorder

Background. Feelings of doubt and perseverative behaviours are key symptoms of obsessive–compulsive disorder (OCD) and have been linked to hyperactive error and conflict signals in the brain. While enhanced neural correlates of error monitoring have been robustly shown, far less is known about conflict processing and adaptation in OCD. Method. We examined event-related potentials during conflict processing in 70 patients with OCD and 70 matched healthy comparison participants, focusing on the stimulus-locked N2 elicited in a flanker task. Conflict adaptation was evaluated by analysing sequential adjustments in N2 and behaviour, i.e. current conflict effects as a function of preceding conflict. Results. Patients with OCD showed enhanced N2 amplitudes compared with healthy controls. Further, patients showed stronger conflict adaptation effects on reaction times and N2 amplitude. Thus, the effect of previous compatibility was larger in patients than in healthy participants as indicated by greater N2 adjustments in change trials (i.e. iC, cI). As a result of stronger conflict adaptation in patients, N2 amplitudes were comparable between groups in incompatible trials following incompatible trials. Conclusions. Larger N2 amplitudes and greater conflict adaptation in OCD point to enhanced conflict monitoring leading to increased recruitment of cognitive control in patients. This was most pronounced in change trials and was associated with stronger conflict adjustment in N2 and behaviour. Thus, hyperactive conflict monitoring in OCD may be beneficial in situations that require a high amount of control to resolve conflict, but may also reflect an effortful process that is linked to distress and symptoms of OCD

What are disease perceptions and subjective treatment goals of insulin treated diabetic patients?

BACKGROUND: Despite increasing importance of patient self-management, little is known about their own perceptions and treatment goals. OBJECTIVES: The aim of this explorative study was to examine what diabetic patients perceive as most concerning and what their own treatment goals are. METHODS: A 23-item anonymous questionnaire was distributed among type 1 diabetic patients treated with and without an insulin pump and insulin treated type 2 diabetic patients in the outpatient clinic of a University Hospital. 86% of the questionnaires were returned (n = 124). RESULTS: In open-ended questions, patients in all three groups together felt mostly restricted by their loss of freedom (24%), the dietary restrictions (17%) and the need to measure blood glucose (17%). Patients treated with an insulin pump worried more about hypoglycaemia and less about dietary restrictions. In closed-ended questions, patients were mostly concerned about hypoglycaemia and developing complications. However, the main treatment goal of both groups together was long-term good blood glucose control (63%). Further patient goals were the prevention of complications (27%) and the preservation of a good quality of life. Quality of life was a more important goal for type 1 diabetic patients (29%) than for type 2 diabetic patients (0%). Patients thought that blood glucose control was more important for their physicians (main treatment goal for 86%) than for themselves. CONCLUSION: Insulin treated patients with diabetes spontaneously express concerns about their actual quality of life and daily hassles and mention long-term worries after explicit questioning. For their main treatment goals they choose mainly long-term goals. According to the patients, physicians tend to overestimate blood glucose control

Trinitro-orcinolate and Trinitro-resorcinate - Sensitivity Trends in Nitroaromatic Energetic Materials

5-Methyl-2,4,6-trinitrobenzene-1,3-diol (trinitro-orcinol, H2TNO) as a close structural relative to the well-known energetic materials trinitroresorcinol (styphnic acid) and trinitrotoluene (TNT) is prepared in high purity and analyzed concerning its vapor pressure using the transpiration method. Several energetic coordination compounds (ECCs) of its respective anion were produced and compared with structurally close styphnate complexes to give an insight into physiochemical trends of the ECC. The synthesized compounds were further analyzed by elemental analysis, IR spectroscopy, differential thermal analysis and low temperature X-ray diffraction analysis. To classify the reported compounds among the energetic materials, they were tested for their sensitivities towards mechanical stimuli such as impact, friction and electrostatic discharge as well as their behavior towards flame

CERAD und NOSGER: Der prädiktive Wert dieser Verfahren in der Demenzdiagnostik einer Schweizer gerontopsychiatrischen Patientenpopulation

Zusammenfassung: Hintergrund: Die CERAD-Batterie (Consortium to Establish a Registry for Alzheimer's Disease) ist ein gängiges Screeninginstrument in der Diagnostik der Alzheimer-Demenz. Dem NOSGER (Nurses Observation' Scale for Geriatric Patients), eigentlich entwickelt, um Verhaltensauffälligkeiten im Alltag zu erfassen, scheint bei der Alzheimer-Demenz auch eine diagnostische Bedeutung zuzukommen. Material und Methode: In einer retrospektiven Studie mit 400 Patienten unserer Klinik, die bei unterschiedlichen psychiatrischen Erkrankungen kognitive Störungen aufwiesen, haben wir CERAD und NOSGER mittels logistischer Berechnung in uni- und multivariaten Modellen auf ihren prädiktiven Wert für die Diagnose Demenz untersucht. Ergebnisse: Im univariaten Modell waren alle CERAD-Subtests signifikante Prädiktoren für Demenz. Das beste multivariate Modell umfasste die Subtests "Verbale Flüssigkeit", "Wortliste Abrufen", "Konstruktive Praxie Abrufen" und MMS (Mini-Mental Status). Der NOSGER zeigte keinen prädiktiven diagnostischen Wert. Schlussfolgerung: Innerhalb einer gerontopsychiatrischen Population grenzt der CERAD Demenzpatienten von nicht dementen mit hoher Vorhersagewahrscheinlichkeit ab, während der NOSGER keinen prädiktiven Wert für die Diagnose Demenz aufweis

Evidence on the extent of harms experienced by children as a result of online risks: Implications for policy and research

This is an Accepted Manuscript of an article published by Taylor & Francis in Information, Communication and Society on 8/7/2014, available online: http://wwww.tandfonline.com/10.1080/1369118X.2014.934387Intense media and policy focus on issues of online child protection have prompted a resurgence of moral panics about children and adolescents' Internet use, with frequent confounding of different types of risk and harm and little reference to empirical evidence of actual harm. Meanwhile, within the academic literature, the quantity and quality of studies detailing the risks and opportunities of online activity for children and young people has risen substantially in the past 10 years, but this is also largely focused on risk rather than evidence of harm. Whilst this is understandable given the methodological and ethical challenges of studying Internet-related harms to minors, the very concept of risk is dependent on some prior understanding of harm, meaning that without efforts to study what harms are connected with children's online experiences, discussions of risk lack a strong foundation. This article makes a key contribution to the field by reviewing available evidence about the scale and scope of online harms from across a range of disciplines and identifying key obstacles in this research area as well as the major policy implications. The findings are based on a review of 148 empirical studies. Results were found in relation to main types of harms: health-related harms as a result of using pro-eating disorder, self-harm or pro-suicide websites; sex-related harms such as Internet-initiated sexual abuse of minors and cyber-bullying

On the structure of the set of bifurcation points of periodic solutions for multiparameter Hamiltonian systems

This paper deals with periodic solutions of the Hamilton equation with many parameters. Theorems on global bifurcation of solutions with periods $2\pi/j,$ $j\in\mathbb{N},$ from a stationary point are proved. The Hessian matrix of the Hamiltonian at the stationary point can be singular. However, it is assumed that the local topological degree of the gradient of the Hamiltonian at the stationary point is nonzero. It is shown that (global) bifurcation points of solutions with given periods can be identified with zeros of appropriate continuous functions on the space of parameters. Explicit formulae for such functions are given in the case when the Hessian matrix of the Hamiltonian at the stationary point is block-diagonal. Symmetry breaking results concerning bifurcation of solutions with different minimal periods are obtained. A geometric description of the set of bifurcation points is given. Examples of constructive application of the theorems proved to analytical and numerical investigation and visualization of the set of all bifurcation points in given domain are provided. This paper is based on a part of the author's thesis [W. Radzki, ``Branching points of periodic solutions of autonomous Hamiltonian systems'' (Polish), PhD thesis, Nicolaus Copernicus University, Faculty of Mathematics and Computer Science, Toru\'{n}, 2005].Comment: 35 pages, 4 figures, PDFLaTe

The consumption of Internet child pornography and violent and sex offending

Background: There is an ongoing debate on whether consumers of child pornography pose a risk for hands-on sex offenses. Up until now, there have been very few studies which have analyzed the association between the consumption of child pornography and the subsequent perpetration of hands-on sex offenses. The aim of this study was to examine the recidivism rates for hands-on and hands-off sex offenses in a sample of child pornography users using a 6 year follow-up design.Methods: The current study population consisted of 231 men, who were subsequently charged with consumption of illegal pornographic material after being detected by a special operation against Internet child pornography, conducted by the Swiss police in 2002. Criminal history, as well as recidivism, was assessed using the criminal records from 2008.Results: 4.8% (n = 11) of the study sample had a prior conviction for a sexual and/or violent offense, 1% (n = 2) for a hands-on sex offense, involving child sexual abuse, 3.3% (n = 8) for a handsoff sex offense and one for a nonsexual violent offense. When applying a broad definition of recidivism, which included ongoing investigations, charges and convictions, 3% (n = 7) of the study sample recidivated with a violent and/or sex offense, 3.9% (n = 9) with a hands-off sex offense and 0.8% (n = 2) with a hands-on sex offense.Conclusion: Consuming child pornography alone is not a risk factor for committing hands-on sex offenses at least not for those subjects who had never committed a hands-on sex offense. The majority of the investigated consumers had no previous convictions for hands-on sex offenses. For those offenders, the prognosis for hands-on sex offenses, as well as for recidivism with child pornography, is favorable

Predicting violent infractions in a Swiss state penitentiary: A replication study of the PCL-R in a population of sex and violent offenders

BACKGROUND: Research conducted with forensic psychiatric patients found moderate correlations between violence in institutions and psychopathy. It is unclear though, whether the PCL-R is an accurate instrument for predicting aggressive behavior in prisons. Results seem to indicate that the instrument is better suited for predicting verbal rather than physical aggression of prison inmates. METHODS: PCL-R scores were assessed for a sample of 113 imprisoned sex and violent offenders in Switzerland. Logistic regression analyses were used to estimate physical and verbal aggression as a function of the PCL-R sum score. Additionally, stratified analyses were conducted for Factor 1 and 2. Infractions were analyzed as to their motives and consequences. RESULTS: The mean score of the PCL-R was 12 points. Neither the relationship between physical aggression and the sum score of the PCL-R, nor the relationship between physical aggression and either of the two factors of the PCL-R were significant. Both the sum score and Factor 1 predicted the occurrence of verbal aggression (AUC=0.70 and 0.69), while Factor 2 did not. CONCLUSION: Possible explanations are discussed for the weak relationship between PCL-R scores and physically aggressive behavior during imprisonment. Some authors have discussed whether the low base rate of violent infractions can be considered an explanation for the non-significant relation between PCL-R-score and violence. The base rate in this study, however, with 27%, was not low. It is proposed that the distinction between reactive and instrumental motives of institutional violence must be considered when examining the usefulness of the PCL-R in predicting in-prison physical aggressive behavior