Decision-making capacity for treatment in psychiatric and medical in-patients: Cross-sectional, comparative study

BackgroundIs the nature of decision-making capacity (DMC) for treatment significantly different in medical and psychiatric patients?AimsTo compare the abilities relevant to DMC for treatment in medical and psychiatric patients who are able to communicate a treatment choice.MethodA secondary analysis of two cross-sectional studies of consecutive admissions: 125 to a psychiatric hospital and 164 to a medical hospital. The MacArthur Competence Assessment Tool – Treatment and a clinical interview were used to assess decision-making abilities (understanding, appreciating and reasoning) and judgements of DMC. We limited analysis to patients able to express a choice about treatment and stratified the analysis by low and high understanding ability.ResultsMost people scoring low on understanding were judged to lack DMC and there was no difference by hospital (P=0.14). In both hospitals there were patients who were able to understand yet lacked DMC (39% psychiatric v. 13% medical in-patients, P&lt;0.001). Appreciation was a better ‘test’ of DMC in the psychiatric hospital (where psychotic and severe affective disorders predominated) (P&lt;0.001), whereas reasoning was a better test of DMC in the medical hospital (where cognitive impairment was common) (P=0.02).ConclusionsAmong those with good understanding, the appreciation ability had more salience to DMC for treatment in a psychiatric setting and the reasoning ability had more salience in a medical setting.</jats:sec

Quantifying flow regimes in a Greenland glacial fjord using iceberg drifters

Author Posting. © American Geophysical Union, 2014. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Geophysical Research Letters 41 (2014): 8411–8420, doi:10.1002/2014GL062256.Large, deep-keeled icebergs are ubiquitous in Greenland's outlet glacial fjords. Here we use the movement of these icebergs to quantify flow variability in Sermilik Fjord, southeast Greenland, from the ice mélange through the fjord to the shelf. In the ice mélange, a proglacial mixture of sea ice and icebergs, we find that icebergs consistently track the glacier speed, with slightly faster speeds near terminus and episodic increases due to calving events. In the fjord, icebergs accurately capture synoptic circulation driven by both along-fjord and along-shelf winds. Recirculation and in-/out-fjord variations occur throughout the fjord more frequently than previously reported, suggesting that across-fjord velocity gradients cannot be ignored. Once on the shelf, icebergs move southeastward in the East Greenland Coastal Current, providing wintertime observations of this freshwater pathway.Funding for this study was provided by National Science Foundation grants OCE-1130008 and ARC-0909274, and by the University of Oregon.2015-06-1

Quantifying flow regimes in a Greenland glacial fjord using iceberg drifters

Large, deep-keeled icebergs are ubiquitous in Greenland's outlet glacial fjords. Here we use the movement of these icebergs to quantify flow variability in Sermilik Fjord, southeast Greenland, from the ice mélange through the fjord to the shelf. In the ice mélange, a proglacial mixture of sea ice and icebergs, we find that icebergs consistently track the glacier speed, with slightly faster speeds near terminus and episodic increases due to calving events. In the fjord, icebergs accurately capture synoptic circulation driven by both along-fjord and along-shelf winds. Recirculation and in-/out-fjord variations occur throughout the fjord more frequently than previously reported, suggesting that across-fjord velocity gradients cannot be ignored. Once on the shelf, icebergs move southeastward in the East Greenland Coastal Current, providing wintertime observations of this freshwater pathway.Funded by The National Science Foundation. Grant Numbers: OCE-1130008, ARC-0909274 and The University of Oregon

On the fly collection development to support emergent energy research initiatives

Within the last few years, two major energy research initiatives have been undertaken on the Caltech campus: the Resnick Sustainability Institute (RSI) and the Joint Center for Artifical Photosynthesis (JCAP). RSI's research includes the production of electricity and fuels from renewable sources, the distribution and storage of energy, and other sustainability projects. JCAP's area of research is focused on achieving a system of artificial photosynthesis for utilizing solar energy. Both of these projects require resources from a broad range of fields, including chemistry, physics, biology, environmental &systems engineering, and more. This talk will give a brief description of some of the research being done in these projects, along with an overview of where energy research has traditionally been categorized in terms of collection development. A publication analysis will be presented to elucidate where information is being referenced from and where affiliated researchers are publishing, and how this correlates with the current collection holdings. Other considerations, such as identifying resources, outreach to groups about availability, and re-use of the collections, will also be discussed

Operator projection method applied to the single-particle Green's function in the Hubbard model

A new non-perturbative framework for many-body correlated systems is formulated by extending the operator projection method (OPM). This method offers a systematic expansion which enables us to project into the low-energy structure after extracting the higher-energy hierarchy. This method also opens a way to systematically take into account the effects of collective excitations. The Mott-Hubbard metal-insulator transition in the Hubbard model is studied by means of this projection beyond the second order by taking into account magnetic and charge fluctuations in the presence of the high-energy Mott-Hubbard structure. At half filling, the Mott-Hubbard gap is correctly eproduced between the separated two bands. Near half filling, a strongly renormalized low-energy single-particle excitations coexisting with the Mott-Hubbard bands are shown to appear. Signifcance of momentum-dependent self-energy in the results is stressed.Comment: 6 pages, final version to appear in J. Phys. Soc. Jp

Watching individual molecules flex within lipid membranes using SERS.

Interrogating individual molecules within bio-membranes is key to deepening our understanding of biological processes essential for life. Using Raman spectroscopy to map molecular vibrations is ideal to non-destructively 'fingerprint' biomolecules for dynamic information on their molecular structure, composition and conformation. Such tag-free tracking of molecules within lipid bio-membranes can directly connect structure and function. In this paper, stable co-assembly with gold nano-components in a 'nanoparticle-on-mirror' geometry strongly enhances the local optical field and reduces the volume probed to a few nm(3), enabling repeated measurements for many tens of minutes on the same molecules. The intense gap plasmons are assembled around model bio-membranes providing molecular identification of the diffusing lipids. Our experiments clearly evidence measurement of individual lipids flexing through telltale rapid correlated vibrational shifts and intensity fluctuations in the Raman spectrum. These track molecules that undergo bending and conformational changes within the probe volume, through their interactions with the environment. This technique allows for in situ high-speed single-molecule investigations of the molecules embedded within lipid bio-membranes. It thus offers a new way to investigate the hidden dynamics of cell membranes important to a myriad of life processes.We acknowledge financial support from EPSRC grant EP/G060649/1, EP/I012060/1, ERC grant LINASS 320503. FB acknowledges support from the Winton Programme for the Physics of Sustainability.This is the final published version. It's also available from Nature Publishing at http://www.nature.com/srep/2014/140812/srep05940/full/srep05940.html

Anomalous Workfunction Anisotropy in Ternary Acetylides

Anomalous anisotropy of workfunction values in ternary alkali metal transition metal acetylides is reported. Workfunction values of some characteristic surfaces in these emerging semiconducting materials may differ by more than $\approx$ 2 eV as predicted by Density Functional Theory calculations. This large anisotropy is a consequence of the relative orientation of rod-like [MC$_{2}$]$_{\infty}$ negatively charged polymeric subunits and the surfaces, with M being a transition metal or metalloid element and C$_{2}$ refers to the acetylide ion C$_{2}^{2-}$, with the rods embedded into an alkali cation matrix. It is shown that the conversion of the seasoned Cs$_{2}$Te photo-emissive material to ternary acetylide Cs$_{2}$TeC$_{2}$ results in substantial reduction of its $\approx$ 3 eV workfunction down to 1.71-2.44 eV on the Cs$_{2}$TeC$_{2}$(010) surface while its high quantum yield is preserved. Similar low workfunction values are predicted for other ternary acetylides as well, allowing for a broad range of applications from improved electron- and light-sources to solar cells, field emission displays, detectors and scanners.Comment: Accepted for publication in Phys. Rev.

Efficacy and safety of the anti-IL-12/23 p40 monoclonal antibody, ustekinumab, in patients with active psoriatic arthritis despite conventional non-biological and biological anti-tumour necrosis factor therapy: 6-month and 1-year results of the phase 3, multicentre, double-blind, placebo-controlled, randomised PSUMMIT 2 trial

Objective: Assess ustekinumab efficacy (week 24/week 52) and safety (week 16/week 24/week 60) in patients with active psoriatic arthritis (PsA) despite treatment with conventional and/or biological anti-tumour necrosis factor (TNF) agents. Methods: In this phase 3, multicentre, placebo-controlled trial, 312 adults with active PsA were randomised (stratified by site, weight (&#8804;100 kg/&#62;100 kg), methotrexate use) to ustekinumab 45 mg or 90 mg at week 0, week 4, q12 weeks or placebo at week 0, week 4, week 16 and crossover to ustekinumab 45 mg at week 24, week 28 and week 40. At week 16, patients with &#60;5% improvement in tender/swollen joint counts entered blinded early escape (placebo→45 mg, 45 mg→90 mg, 90 mg→90 mg). The primary endpoint was &#8805;20% improvement in American College of Rheumatology (ACR20) criteria at week 24. Secondary endpoints included week 24 Health Assessment Questionnaire-Disability Index (HAQ-DI) improvement, ACR50, ACR70 and &#8805;75% improvement in Psoriasis Area and Severity Index (PASI75). Efficacy was assessed in all patients, anti-TNF-naïve (n=132) patients and anti-TNF-experienced (n=180) patients. Results: More ustekinumab-treated (43.8% combined) than placebo-treated (20.2%) patients achieved ACR20 at week 24 (p&#60;0.001). Significant treatment differences were observed for week 24 HAQ-DI improvement (p&#60;0.001), ACR50 (p&#8804;0.05) and PASI75 (p&#60;0.001); all benefits were sustained through week 52. Among patients previously treated with &#8805;1 TNF inhibitor, sustained ustekinumab efficacy was also observed (week 24 combined vs placebo: ACR20 35.6% vs 14.5%, PASI75 47.1% vs 2.0%, median HAQ-DI change −0.13 vs 0.0; week 52 ustekinumab-treated: ACR20 38.9%, PASI75 43.4%, median HAQ-DI change −0.13). No unexpected adverse events were observed through week 60. Conclusions: The interleukin-12/23 inhibitor ustekinumab (45/90 mg q12 weeks) yielded significant and sustained improvements in PsA signs/symptoms in a diverse population of patients with active PsA, including anti-TNF-experienced PsA patients