Low autocorrelated multi-phase sequences

The interplay between the ground state energy of the generalized Bernasconi model to multi-phase, and the minimal value of the maximal autocorrelation function, $C_{max}=\max_K{|C_K|}$, $K=1,..N-1$, is examined analytically and the main results are: (a) The minimal value of $\min_N{C_{max}}$ is $0.435\sqrt{N}$ significantly smaller than the typical value for random sequences $O(\sqrt{\log{N}}\sqrt{N})$. (b) $\min_N{C_{max}}$ over all sequences of length N is obtained in an energy which is about 30% above the ground-state energy of the generalized Bernasconi model, independent of the number of phases m. (c) The maximal merit factor $F_{max}$ grows linearly with m. (d) For a given N, $\min_N{C_{max}}\sim\sqrt{N/m}$ indicating that for m=N, $\min_N{C_{max}}=1$, i.e. a Barker code exits. The analytical results are confirmed by simulations.Comment: 4 pages, 4 figure

Factors associated with involuntary hospitalisation for psychiatric patients in Switzerland: a retrospective study.

Despite the scarce evidence for patients' benefits of coercion and its well-documented negative effects, the use of compulsion is still very common around Europe, with important variations among different countries. These variations have been partially explained by the different legal frameworks, but also by several individual-related, system-related and area-related characteristics, identified as predictors of the use of coercive measures. This study aimed to compare the socio-demographic and clinical profile as well as the referral and hospitalisation process of people voluntarily and involuntarily hospitalized in order to identify which factors could be associated with the use of coercion. All psychiatric admissions occurred between the 1st January 2015 and the 31st December 2015 were included in this retrospective study (n = 5027). The whole sample was split into two subgroups accordingly to the hospitalisation legal status at admission (voluntary vs involuntary) and differences between the two groups were examined. In order to identify the factors associated with coercion, all the variables reaching a p < .01 level of significance when comparing the two groups were included as independent variables into a multivariate logistic regression model. Globally, 62% of the admissions were voluntary and 38% were involuntary. Compared to the voluntary group, involuntary patients were significantly older, more frequently widowed and living in one specific district, and had a main diagnosis of schizophrenia (F20-F29) or organic mental disorders (F00-F09). People affected by organic mental disorders (F00-F09), with higher levels of psychotic symptoms, aggression and problems with medication adherence, were more likely to be involuntarily admitted. Moreover, living in District 1, being referred by a general practitioner, a general hospital or a psychiatric hospital and being involuntarily admitted during the previous 12 months, was associated with a higher risk of coercion. This study identified several individual-related, as well as system-related factors associated with the use of coercion. These results allowed us to trace a clearer profile of high-risk patients and to provide several inputs that could help local authorities, professionals and researchers to develop better-targeted alternative interventions reducing the use of coercion

Intensive Case Management for Addiction to promote engagement with care of people with severe mental and substance use disorders: an observational study.

Co-occurring severe mental and substance use disorders are associated with physical, psychological and social complications such as homelessness and unemployment. People with severe mental and substance use disorders are difficult to engage with care. The lack of treatment worsens their health and social conditions and increases treatment costs, as emergency department visits arise. Case management has proved to be effective in promoting engagement with care of people with severe mental and substance use disorders. However, this impact seemed mainly related to the case management model. The Intensive Case Management for Addiction (ICMA) aimed to improve engagement with care of people with severe mental and substance use disorders, insufficiently engaged with standard treatment. This innovative multidisciplinary mobile team programme combined Assertive Community Treatment and Critical Time Intervention methodologies. The aim of the study was to observe the impact of ICMA upon service use, treatment adherence and quality of support networks. Participants' psychosocial and mental functioning, and substance use were also assessed throughout the intervention. The study was observational. Eligible participants were all the people entering the programme during the first year of implementation (April 2014-April 2015). Data were collected through structured questionnaires and medical charts. Assessments were conducted at baseline and at 12 months follow-up or at the end of the programme if completed earlier. McNemar-Bowker's Test, General Linear Model repeated-measures analysis of variance and non-parametric Wilcoxon Signed Rank tests were used for the analysis. A total of 30 participants took part in the study. Results showed a significant reduction in the number of participants visiting the general emergency department compared to baseline. A significantly decreased number of psychiatric emergency department visits was also registered. Moreover, at follow-up participants improved significantly their treatment adherence, clinical status, social functioning, and substance intake and frequency of use. These promising results highlight the efficacy of the ICMA. The intervention improved engagement with care and the psychosocial situation of people with severe mental and substance use disorders, with consequent direct impact on their substance misuse

Economic feasibility study of total energy system options for the Massachusetts Institute of Technology

Includes bibliographical references (leaf 39)Prepared for the MIT Physical Plant Dep

The Code White protocol: a mixed somatic-psychiatric protocol for managing psychomotor agitation in the ED

Objectives: Clinical management of patients presenting with acute psycho­motor agitation is difficult, often because there is no predefined protocol for dealing with it. The main objective of this article is to describe our ­institution’s Code White mixed somatic-psychiatric protocol for managing acute agitation in an emergency department. Its second objective is to ­present data on how long it took to initiate and complete treatment. Methods: We retrospectively analysed 250 clinical situations over 3 years (2014–2016) from the hospital emergency department in the canton of Neuchâtel, Switzerland. Results: The median time from emergency department arrival to treatment initiation was 7 minutes; the median duration of treatment was 119 minutes. The rate of hospitalisation after emergency department treatment was 49.2%. Conclusion: This mixed somatic-psychiatric protocol seemed to reduce both the time before treatment initiation and treatment duration for ­patients presenting with acute psychomotor agitation in an emergency ­department. Implications for practice: The Code White protocol improved the emergency department’s ability to keep acutely agitated patients flowing smoothly and efficiently through it to other units or to discharge. On the qualitative level, it also improved staff safety and peace of mind, allowing them to carry out their many tasks more calmly

Endogenous chemical exchange saturation transfer (CEST) MR imaging for the diagnosis and therapy response assessment of brain tumors: A systematic review

Purpose: To generate a narrative synthesis of published data on the use of endogenous chemical exchange saturation transfer (CEST) MR imaging in brain tumors. Materials and Methods: A systematic database search (PubMed, Ovid Embase, Cochrane Library) was used to collate eligible studies. Two researchers independently screened publications according to predefined exclusion and inclusion criteria, followed by comprehensive data extraction. All included studies were subjected to a bias risk assessment using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Results: The electronic database search identified 430 studies, of which 36 studies fulfilled the inclusion criteria. The final selection of included studies was categorized into 5 groups as follows: grading gliomas, 19 studies (areas under the curve (AUC) 0.500-1.000); predicting molecular subtypes of gliomas, 5 studies (AUC 0.610-0.920); distinction of different brain tumor types, 7 studies (AUC 0.707-0.905); therapy response assessment, 3 studies (AUC not given) and differentiating recurrence from treatment-related changes, 5 studies (AUC 0.880- 0.980). A high bias risk was observed in a substantial proportion of studies. Conclusion: Endogenous CEST imaging offers valuable, potentially unique information in brain tumors, but its diagnostic accuracy remains incompletely known. Further research is required to assess the method’s role in support of molecular genetic diagnosis, to investigate its use in the post treatment phase, and to compare techniques with a view to standardization

Predicting involuntary hospitalization in psychiatry: A machine learning investigation.

Coercion in psychiatry is a controversial issue. Identifying its predictors and their interaction using traditional statistical methods is difficult, given the large number of variables involved. The purpose of this study was to use machine-learning (ML) models to identify socio-demographic, clinical and procedural characteristics that predict the use of compulsory admission on a large sample of psychiatric patients. We retrospectively analyzed the routinely collected data of all psychiatric admissions that occurred between 2013 and 2017 in the canton of Vaud, Switzerland (N = 25,584). The main predictors of involuntary hospitalization were identified using two ML algorithms: Classification and Regression Tree (CART) and Random Forests (RFs). Their predictive power was compared with that obtained through traditional logistic regression. Sensitivity analyses were also performed and missing data were imputed through multiple imputation using chain equations. The three models achieved similar predictive balanced accuracy, ranging between 68 and 72%. CART showed the lowest predictive power (68%) but the most parsimonious model, allowing to estimate the probability of being involuntarily admitted with only three checks: aggressive behaviors, who referred the patient to hospital and primary diagnosis. The results of CART and RFs on the imputed data were almost identical to those obtained on the original data, confirming the robustness of our models. Identifying predictors of coercion is essential to efficiently target the development of professional training, preventive strategies and alternative interventions. ML methodologies could offer new effective tools to achieve this goal, providing accurate but simple models that could be used in clinical practice

Feasibility and Accessibility of a Tailored Intervention for Informal Caregivers of People with Severe Psychiatric Disorders: a Pilot Study

Objectives: This study aimed to assess the acceptability and feasibility of a new tailored intervention for informal caregivers: the Ensemble (Together) program. Methods: An open pre–post within-subject comparison pilot study was conducted. Twenty-one informal caregivers completed the five-session Ensemble program. Two measurement tools were used: The Brief Symptom Inventory (BSI) and the Life Orientation Scale (LOT-R). Results: The results showed that informal caregivers were in need of individual support and were ready to participate in the Ensemble program independent of the patient’s diagnosis or stage of illness. The participants were very satisfied, and 95.4% completed the program. The preliminary results also showed that in five sessions, informal caregivers’ Global Severity Index measured by the BSI and their optimism about their future (measured by the LOT-R) were significantly improved. Conclusion: This pilot study provided preliminary results concerning the feasibility and acceptability of the tailored Ensemble program and indicates the need for a randomized trial. The Ensemble program is appropriate for both the acute and chronic phases of disease. Individualized brief and useful interventions for informal caregivers may provide more positive outcomes in care