A meta-analysis of ethnic differences in pathways to care at the first episode of psychosis

Objective: We sought to systematically review the literature on ethnic differences in the likelihood of general practitioner (GP) involvement, police involvement, and involuntary admission on the pathway to care of patients with first-episode psychosis (FEP). Method: We searched electronic databases and conducted forward and backward tracking to identify relevant studies. We calculated pooled odds ratios (OR) to examine the variation between aggregated ethnic groups in the indicators of the pathway to care. Results: We identified seven studies from Canada and England that looked at ethnic differences in GP involvement (n = 7), police involvement (n = 7), or involuntary admission (n = 5). Aggregated ethnic groups were most often compared. The pooled ORs suggest that Black patients have a decreased likelihood of GP involvement (OR = 0.70, 0.57-0.86) and an increased likelihood of police involvement (OR = 2.11, 1.67-2.66), relative to White patients. The pooled ORs were not statistically significant for patients with Asian backgrounds (GP involvement OR = 1.23, 0.87-1.75; police involvement OR = 0.86, 0.57-1.30). There is also evidence to suggest that there may be ethnic differences in the likelihood of involuntary admission; however, effect modification by several sociodemographic factors precluded a pooling of these data. Conclusion: Ethnic differences in pathways to care are present at the first episode of psychosis

Sex and gender differences in symptoms of early psychosis: a systematic review and meta-analysis

First-episode psychosis (FEP) can be quite variable in clinical presentation, and both sex and gender may account for some of this variability. Prior literature on sex or gender differences in symptoms of psychosis have been inconclusive, and a comprehensive summary of evidence on the early course of illness is lacking. The objective of this study was to conduct a systematic review and meta-analysis of the literature to summarize prior evidence on the sex and gender differences in the symptoms of early psychosis. We conducted an electronic database search (MEDLINE, Scopus, PsycINFO, and CINAHL) from 1990 to present to identify quantitative studies focused on sex or gender differences in the symptoms of early psychosis. We used random effects models to compute pooled standardized mean differences (SMD) and risk ratios (RR), with 95% confidence intervals (CI), for a range of symptoms. Thirty-five studies met the inclusion criteria for the systematic review, and 30 studies were included in the meta-analysis. All studies examined sex differences. Men experienced more severe negative symptoms (SMD =  - 0.15, 95%CI =  - 0.21, - 0.09), whereas women experienced more severe depressive symptoms (SMD = 0.21, 95%CI = 0.14, 0.27) and had higher functioning (SMD = 0.16, 95%CI = 0.10, 0.23). Women also had a lower prevalence of substance use issues (RR = 0.65, 95%CI = 0.61, 0.69). Symptoms of early psychosis varied between men and women; however, we were limited in our ability to differentiate between biological sex and gender factors. These findings may help to inform early detection and intervention efforts to better account for sex and gender differences in early psychosis presentation

The African, Caribbean and European (ACE) Pathways to Care study: A qualitative exploration of similarities and differences between African-origin, Caribbean-origin and European-origin groups in pathways to care for psychosis

Objectives: This paper reports on a qualitative exploration of the reasons for differences in pathways to care and duration of untreated psychosis (DUP) in the African, Caribbean and European (ACE) Pathways to Care study from the perspective of respondents to the study and their families. Setting: Ontario, Canada. Participants: Thirty-four participants in total. Twenty-five young people who had experienced a first episode of psychosis and nine family members. Participants were part of the ACE Pathways to Care study. Design: We implemented six focus groups. Furthermore, we implemented four in-depth interviews with two African-origin young women, one Caribbean-origin woman, and one European-origin woman with lived experience of psychosis. Results: Factors that influenced help-seeking delays across the three groups were: personal awareness of symptoms, family members\u27 knowledge of psychotic symptoms and knowledge of mental health services. Youth and their family members described how stigma played a key role in pathways to care by stopping them from asking for help. The way in which stigma operated on the three groups\u27 members, from feeling ashamed to feeling guilty for their mental illnesses, helped to explain differences in DUP between the groups. Guilt feelings emerged as a prominent theme among members from the African and Caribbean groups and it was not discussed in the European focus group. Delay in entering into first-episode psychosis programmes was also influenced by the stigma perceived by young people in healthcare settings. This had an impact on the therapeutic relationships, disclosure of symptoms and overall trust in the healthcare system. Conclusions: The findings of this paper suggest that stigma, especially internalised stigma, may operate in different ways in European-origin, African-origin and Caribbean-origin groups. These findings could inform the development of more equitable services for people in early stages of psychosis

Spin polarized liquid 3He

We have employed the constrained variational method to study the influence of spin polarization on the ground state properties of liquid $^3{\rm He}$. The spin polarized phase, we have found, has stronger correlation with respect to the unpolarized phase. It is shown that the internal energy of liquid $^3{\rm He}$ increases by increasing polarization with no crossing point between polarized and unpolarized energy curves over the liquid density range. The obtained internal energy curves show a bound state, even in the case of fully spin polarized matter. We have also investigated the validity of using a parabolic formula for calculating the energy of spin polarized liquid $^3{\rm He}$. Finally, we have compared our results with other calculations.Comment: 16 pages, 6 figure

Hematoma Enlargement Among Patients with Traumatic Brain Injury: Analysis of a Prospective Multicenter Clinical Trial

Observational studies suggest that hematomas continue to enlarge during hospitalization in patients with traumatic brain injury (TBI). There is limited data regarding factors associated with hematoma enlargement and on whether hematoma enlargement contributes directly to death and disability in patients with TBI. We analyzed data collected as part of the Resuscitation Outcomes Consortium Hypertonic Saline and TBI Study. Hematoma enlargement was ascertained and collected as a predefined safety endpoint. We evaluated the effect of hematoma enlargement on the risk of death and disability at 6 months based on the Extended Glasgow Outcome Scale (GOSE) (dichotomized as \u3e4 or ≤4) using stepwise logistic regression analysis. We adjusted for age (continuous variable), admission GCS score (dichotomized at \u3e5 and ≤5), and computed tomography (CT) scan classification (Marshall grades entered as a categorical variable). Of the 1200 patients with severe TBI analyzed, 238 (19.8%) patients were reported to have hematoma enlargement as an adverse event. The proportion of patients who reached favorable outcome at 6 months was significantly lower (defined by GOSE of \u3e4) among patients with hematoma enlargement (29.0% vs. 40.1%, p\u3c.0001). The proportion of patients who died within 6 months was significantly higher among patients with hematoma enlargement (31.9% vs. 20.7%, p\u3c.0001). After adjusting for age, admission GCS score, and initial injury score, the odds of favorable outcome was lower in patients with hematoma enlargement (odds ratio 0.7, 95% confidence interval [CI]; 0.5–0.97). Our results suggest that hematoma enlargement may be a direct contributor to death and disability in patients with TBI at 6 months. Future clinical trials must continue to evaluate new therapeutic interventions aimed at reducing hematoma enlargement with a favorable risk benefit ratio in patients with TBI

Extracting spectral density function of a binary composite without a-priori assumption

The spectral representation separates the contributions of geometrical arrangement (topology) and intrinsic constituent properties in a composite. The aim of paper is to present a numerical algorithm based on the Monte Carlo integration and contrainted-least-squares methods to resolve the spectral density function for a given system. The numerical method is verified by comparing the results with those of Maxwell-Garnett effective permittivity expression. Later, it is applied to a well-studied rock-and-brine system to instruct its utility. The presented method yields significant microstructural information in improving our understanding how microstructure influences the macroscopic behaviour of composites without any intricate mathematics.Comment: 4 pages, 5 figures and 1 tabl

Pesticide Use in Northern Ireland’s Arable Crops from 1992–2016 and Implications for Future Policy Development

Publication history: Accepted - 31 July 2018; Published online - 8 August 2018Since the 1960s, the objective for the United Kingdom (UK) government policy and legislation on crop protection practices has been to minimise the impact of pesticide use in agriculture and horticulture to the wider environment. Subsequent European Union (EU) policy and legislation have also targeted this objective through a demanding approvals process, competency tests for users, maximum residue limits, regular post-registration monitoring and the promotion of integrated pest and disease management techniques. However, none of this substantive regulation refers to target reduction levels for pesticide use. Since 1992, the number of arable farms in Northern Ireland has decreased by 61% with a consequent reduction of 34% in the area of arable crops grown. Despite this reduction in area of arable crops grown, the area treated by the major pesticide groups increased by 49% due to intensification, but the weight of major pesticides applied to arable crops decreased by 37%. However, the intensity of application measured by the total quantity of all pesticides applied to the basic area of arable crops treated remained relatively constant at approximately 3.2 kg/ha. Pesticide usage trends and reduction policies in other geographic regions are also discussed for comparative purposes.Our funding providers, the Department of Agriculture, Environment and Rural Affairs, Northern Ireland and the Department of Environment, Food and Rural Affairs, Great Britain