Couple Relationships In Persons With Schizophrenia: Intimacy, Passion, And Commitment

Couple relationships are a normative, yet crucial, aspect of human existence. They are a need shared by all mankind and thus serve as a powerful rehabilitative and beneficial tool among populations with special needs, including persons with mental illnesses. In the present study, 30 partners with chronic schizophrenia were compared to 20 normative partners regarding three aspects of couple relations - intimacy, commitment, and passion. Additionally, participants were asked to rate these three aspects in both their actual relationship and an ideal relationship. The schizophrenia cohort rated its actual relationships as lower in intimacy, commitment, and passion compared to the normative cohort. Also, disparities between perceptions of the aspects in both actual and ideal relationships were greater for the cohort with schizophrenia. Implications for practitioners are discussed with regard to their work in the couplehood field with persons with serious mental illnesses as well as in consciousness work among the normative community

Demonstration of a Hybrid Space Architecture During RIMPAC 2020

The Micro-Satellite Military Utility (MSMU) Project Arrangement (PA) is an agreement under the Responsive Space Capabilities (RSC) Memorandum of Understanding (MOU) that involves the Departments and Ministries of Defence of Australia, Canada, Germany, Italy, the Netherlands, New Zealand, Norway, United Kingdom and United States. MSMU’s charter is to inform a space enterprise that provides military users with reliable access to a broad spectrum of information in an opportunistic environment. Research and Development teams from MSMU partner nations supported Exercise Rim of the Pacific (RIMPAC) 2020 which took place 17 to 31 August 2020 in the Hawaiian region. RIMPAC 2020 provided an opportunity to explore the military utility of a Hybrid Space Architecture (HSA) of satellites including traditional government and commercial satellites, as well as micro-satellites and nanosatellites, by leveraging contributions across the MSMU partner nations. The objective was to continue testing the hypothesis that an HSA, mostly composed of small satellites, can bring significant value to the operational theatre. The MSMU PA partner nations have leveraged several multi-national exercises, with the first being the Exercise RIMPAC 2018. Previous exercises enabled multinational technology advancements, interoperability testing, process refinement, and capability developments to make advancements towards MSMU’s goal to address the warfighter’s need for diverse ISR capabilities. The most recent accomplishment was a major integration effort across mission planning tools, space-based Intelligence, Surveillance and Reconnaissance (ISR) data providers, and exploitation tools. The MSMU team accessed ~256 space-based sensors (EO – Electro Optical, SAR – Synthetic Aperture Radar, AIS – Automatic Identification System) to collect maritime domain and ISR data over a harbor, airfields and open sea. Data was exploited via international channels in order to determine the success rate of capturing pertinent data to be later exploited and disseminated. This paper describes results from the experiment and offers insights into the HSA military utility

Uganda's experience in Ebola virus disease outbreak preparedness, 2018-2019.

BACKGROUND: Since the declaration of the 10th Ebola Virus Disease (EVD) outbreak in DRC on 1st Aug 2018, several neighboring countries have been developing and implementing preparedness efforts to prevent EVD cross-border transmission to enable timely detection, investigation, and response in the event of a confirmed EVD outbreak in the country. We describe Uganda's experience in EVD preparedness. RESULTS: On 4 August 2018, the Uganda Ministry of Health (MoH) activated the Public Health Emergency Operations Centre (PHEOC) and the National Task Force (NTF) for public health emergencies to plan, guide, and coordinate EVD preparedness in the country. The NTF selected an Incident Management Team (IMT), constituting a National Rapid Response Team (NRRT) that supported activation of the District Task Forces (DTFs) and District Rapid Response Teams (DRRTs) that jointly assessed levels of preparedness in 30 designated high-risk districts representing category 1 (20 districts) and category 2 (10 districts). The MoH, with technical guidance from the World Health Organisation (WHO), led EVD preparedness activities and worked together with other ministries and partner organisations to enhance community-based surveillance systems, develop and disseminate risk communication messages, engage communities, reinforce EVD screening and infection prevention measures at Points of Entry (PoEs) and in high-risk health facilities, construct and equip EVD isolation and treatment units, and establish coordination and procurement mechanisms. CONCLUSION: As of 31 May 2019, there was no confirmed case of EVD as Uganda has continued to make significant and verifiable progress in EVD preparedness. There is a need to sustain these efforts, not only in EVD preparedness but also across the entire spectrum of a multi-hazard framework. These efforts strengthen country capacity and compel the country to avail resources for preparedness and management of incidents at the source while effectively cutting costs of using a "fire-fighting" approach during public health emergencies

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

L'effet de la dispersion chromatique sur le taux d'erreur de transmission par fibre optique pour un débit de 10Gb/s

La propagation de la lumière dans la fibre optique est influencée par de nombreux phénomènes physiques. Outre l'atténuation linéique, la dispersion chromatique constitue le principal phénomène physique néfaste pour la propagation optique dans les réseaux opérant à 10Gb/s. De surcroît, le phénomène de piaillement de la source optique du transmetteur contribue à augmenter l'impact de la dispersion chromatique. Le but de cette recherche est de voir l'effet de la dispersion chromatique sur un signal transmis et de quantifier l'erreur de transmission due à ce phénomène afin de pouvoir augmenter le débit de transmission des réseaux de 2.5Gb/s à 10Gb/s. Ainsi, un simulateur avec une interface graphique a été réalisé. Il permet d'observer l'effet de la dispersion chromatique, du piaillement et du bruit sur un signal transmis à un débit et une distance prédéterminés. De plus, il montre le diagramme de l'oeil du signal après la transmission. Finalement, il permet de calculer l'erreur de transmission sur le signal avec une nouvelle approche

Pequenas cidades do estuário do rio Amazonas: fluxo econômico, crescimento urbano e as novas velhas urbanidades da pequena cidade de Ponta de Pedras

The intensification of urbanization process in the Amazon in recent decades caused many socio-spatial-environmental modifications. The emergence of cities as an important element within the regional space is one of these changes. Predominantly, these cities are small towns, with less than twenty thousand inhabitants, with infrastructure weak or even no existence of this, their economy are based on transferring of public resources and these cities are deficient in economic activities characterized as urban. In this sense, this paper aims to discuss the urban specificities of small towns of the Estuarine Region of Amazon River and to study the importance and characteristics of these cities in the regional economy, focusing on the city of Ponta de Pedras, located in Para State, Marajo Island.A intensificação do processo de urbanização na Amazônia, verificado nas últimas décadas, causou muitas transformações sócio-espacial-ambientais. Entre estas mudanças está a emergência das cidades como importante elemento dentro do espaço regional. Predominantemente, estas cidades são pequenos aglomerados urbanos, com menos de vinte mil habitantes, com fraca ou nenhuma infra-estrutura, as quais têm como base econômica principal o repasse de recursos públicos e carecem de atividades econômicas caracterizadas como urbanas. Nesse sentido, o presente artigo, tem como objetivo discutir a compreensão das especificidades do urbano nas pequenas cidades do estuário do rio Amazonas e estudar a importância e características dessas cidades na economia Regional, enfocando a cidade de Ponta de Pedras, localizada no estado do Pará, ilha de Marajó

Myocardial protection with prophylactic oral metoprolol during coronary artery bypass grafting surgery: evaluation by troponin I

INTRODUCTION: Biochemical markers of myocardial injury are frequently altered after cardiac surgery. So far there is no evidence whether oral beta-blockers may reduce myocardial injury after coronary artery bypass grafting. OBJECTIVE: To determine if oral administration of prophylactic metoprolol reduces the release of cardiac troponin I in isolated coronary artery bypass grafting, not complicated by new Q waves. METHODS: A prospective randomized study, including 68 patients, divided in 2 groups: Group A (n=33, control) and B (n=35, beta-blockers). In group B, metoprolol tartrate was administered 200 mg/day. The myocardial injury was assessed by troponin I with 1 hour and 12 hours after coronary artery bypass grafting. RESULTS: No significant difference between groups regarding pre-surgical, surgical, complication in intensive care (15% versus 14%, P=0.92) and the total number of hospital events (21% versus 14%, P=0.45) was observed. The median value of troponin I with 12 hours in the study population was 3.3 ng/ml and was lower in group B than in group A (2.5 ng/ml versus 3.7 ng/ml, P<0,05). In the multivariate analysis, the variables that have shown to be independent predictors of troponin I release after 12 hours were: no beta-blockers administration and number of vessels treated. CONCLUSION: The results of this study in uncomplicated coronary artery bypass grafting, comparing the postoperative release of troponin I at 12 hours between the control group and who used oral prophylactic metoprolol for at least 72 hours, allow to conclude that there was less myocardial injury in the betablocker group, giving some degree of myocardial protection