Volunteering in the care of people with severe mental illness: a systematic review

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Microphysical investigation of the seeder and feeder region of an Alpine mixed-phase cloud

The seeder-feeder mechanism has been observed to enhance orographic precipitation in previous studies. However, the microphysical processes active in the seeder and feeder region are still being understood. In this paper, we investigate the seeder and feeder region of a mixed-phase cloud passing over the Swiss Alps, focusing on (1) fallstreaks of enhanced radar reflectivity originating from cloud top generating cells (seeder region) and (2) a persistent lowlevel feeder cloud produced by the boundary layer circulation (feeder region). Observations were obtained from a multidimensional set of instruments including ground-based remote sensing instrumentation (Ka-band polarimetric cloud radar, microwave radiometer, wind profiler), in situ instrumentation on a tethered balloon system, and ground-based aerosol and precipitation measurements. The cloud radar observations suggest that ice formation and growth were enhanced within cloud top generating cells, which is consistent with previous observational studies. However, uncertainties exist regarding the dominant ice formation mechanism within these cells. Here we propose different mechanisms that potentially enhance ice nucleation and growth in cloud top generating cells (convective overshooting, radiative cooling, droplet shattering) and attempt to estimate their potential contribution from an ice nucleating particle perspective. Once ice formation and growth within the seeder region exceeded a threshold value, the mixedphase cloud became fully glaciated. Local flow effects on the lee side of the mountain barrier induced the formation of a persistent low-level feeder cloud over a small-scale topographic feature in the inner-Alpine valley. In situ measurements within the low-level feeder cloud observed the production of secondary ice particles likely due to the Hallett-Mossop process and ice particle fragmentation upon ice-ice collisions. Therefore, secondary ice production may have been partly responsible for the elevated ice crystal number concentrations that have been previously observed in feeder clouds at mountaintop observatories. Secondary ice production in feeder clouds can potentially enhance orographic precipitation

A longitudinal, Bologna-compatible model curriculum "communicationand social competencies" : results of an interdisciplinary workshop of German-speaking medical schools

Zielsetzung: Ziel des Projekts ist es, ein longitudinales Modell-Curriculum "Kommunikative und soziale Kompetenzen" für die medizinische Ausbildung zur Diskussion zu stellen. Vorgehen und Ergebnisse: Auf einem 2-tägigen Workshop wurde interfakultär und interdisziplinär auf der Grundlage des "Basler Consensus Statements: Kommunikative und soziale Kompetenzen im Medizinstudium" ein Curriculum entwickelt, das deutschsprachigen Fakultäten bei der Planung und Implementierung als Vorlage dienen kann. Das Modell lässt sich als Gesamt-Curriculum oder in Teilmodulen implementieren. Es kann auch bei der Umstellung auf Bachelor- und Masterstudiengänge genutzt werden. Das longitudinale Modell-Curriculum weist neben 131 definierten Ausbildungszielen geeignete didaktische Konzepte und Prüfungsformate auf und gibt Vorschläge, zu welchem Zeitpunkt die verschiedenen Fächer die entsprechenden Lernziele vermitteln können. Fazit: Mit diesem longitudinalen "Modell-Curriculum Kommunikative und Soziale Kompetenzen" liegt für den deutschen Sprachraum erstmalig ein curriculares Instrument vor, das breite Anwendung an einer Vielzahl deutscher, österreichischer und schweizerischer Fakultäten finden und eine Umsetzung des Bologna-Prozesses auch fakultätsübergreifend vereinfachen kann. Schlüsselwörter: Modell-Curriculum, kommunikative/soziale Kompetenzen, Basler Consensus Statement, medizinische Ausbildung, Didaktik, Prüfung, Bologna-ProzessAim: The aim of the project is to present and discuss a longitudinal model curriculum "Communication and social competencies" for undergraduate medical education. Procedure and results: In a two-day workshop, a multidisciplinary, cross-faculty group of medical educators developed a curriculum model based on the "Basel Consensus Statement". It can now be used by German-speaking medical schools as a blueprint for curriculum planning and implementation processes. The modular structure enables it to be implemented either in whole or in part. The model can also be used to facilitate the conversion of medical education into Bachelor and Master degree programmes. The longitudinal model curriculum features 131 educational objectives and makes suggestions for didactic concepts and assessment tools. For various disciplines, it also recommends at what point in time specific topics should be taught. Conclusion: The longitudinal model curriculum "Communication and social competencies", based on the educational objectives of the "Basel Consensus Statement", is a new curricular instrument that can be used by German, Austrian and Swiss medical schools. It can help to simplify the realisation of the Bologna process, also across different faculties. Keywords: model curriculum, communication/social competencies, Basel Consensus Statement, undergraduate medical education, didactic, assessment, Bologna proces

Quality of life in caregivers of patients with schizophrenia: A literature review

<p>Abstract</p> <p>Background</p> <p>A couple of decades ago, hospitals or psychiatric institutions were in charge of caring for patients with schizophrenia; however, nowadays this role is performed by one or more patient's relatives. Evidence shows that informal caregivers experience negative changes in their quality of life (QOL). The aim of this study is to review the main factors associated with the QOL of caregivers of people with schizophrenia.</p> <p>Methods</p> <p>A search through databases from journals published last decade between 1998 and 2008 was performed. In accordance with the inclusion criteria, titles and abstracts of citations obtained from the search were examined independently by two authors and irrelevant articles discarded. The full text of those studies considered relevant by either reviewer were obtained and assessed independently. Where differences of opinion rose they were resolved by discussion. Out of the 258 references, 37 were included in the review.</p> <p>Studies which assessed factors associated with caregivers of people with schizophrenia's quality of life were included and the information summarized.</p> <p>Results</p> <p>Evidence suggest that physical, emotional and economic distress affect negatively caregiver's QOL as a result of a number of unfulfilled needs such as, restoration of patient functioning in family and social roles, economic burden, lack of spare time, among other factors.</p> <p>Conclusion</p> <p>Decreased QOL may be associated with caregivers' burden, lack of social support, course of the disease and family relationships problems. In addition, in developing countries, QOL is affected by caregivers' economic burden. High quality research is needed in order to identify factors associated with QOL over time and testing the efficacy of interventions aiming to improve QOL in caregivers of patients with schizophrenia.</p

Meat, eggs, dairy products, and risk of breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort

Background: A Western diet is associated with breast cancer risk. Objective: We investigated the relation of meat, egg, and dairy product consumption with breast cancer risk by using data from the European Prospective Investigation into Cancer and Nutrition (EPIC). Design: Between 1992 and 2003, information on diet was collected from 319,826 women. Disease hazard ratios were estimated with multivariate Cox proportional hazard models. Results: Breast cancer cases (n = 7119) were observed during 8.8 y (median) of follow-up. No consistent association was found between breast cancer risk and the consumption of any of the food groups under study, when analyzed by both categorical and continuous exposure variable models. High processed meat consumption was associated with a modest increase in breast cancer risk in the categorical model (hazard ratio: 1.10; 95% CI: 1.00, 1.20; highest compared with lowest quintile: P for trend = 0.07). Subgroup analyses suggested an association with butter consumption, limited to premenopausal women (hazard ratio: 1.28; 95% CI: 1.06, 1.53; highest compared with lowest quintile: P for trend = 0.21). Between-country heterogeneity was found for red meat (Q statistic = 18.03; P = 0.05) and was significantly explained (P = 0.023) by the proportion of meat cooked at high temperature. Conclusions: We have not consistently identified intakes of meat, eggs, or dairy products as risk factors for breast cancer. Future studies should investigate the possible role of high-temperature cooking in the relation of red meat intake with breast cancer risk. Am J Clin Nutr 2009;90:602-12

A novel DAX-1 (NR0B1) mutation in a boy with X-linked adrenal hypoplasia congenita

BACKGROUND: X-linked adrenal hypoplasia congenita (AHC) is caused by mutations in DAX-1 (NR0B1) playing a key role in adrenal and reproductive development. CASE PRESENTATION: Herein we report a 2.5-year-old boy who presented with acute adrenal failure. Family history revealed unexplained death in three brothers of the patient's mother during infancy. Molecular analysis of the DAX-1 gene revealed the presence of a novel hemizygous mutation, c.870C>A in exon 1, leading to the formation of a premature stop codon. The same mutation was identified in the patient's mother. The truncated mutant protein is most likely misfolded, sequestered in the endoplasmic reticulum and therefore cannot bind to and activate its target DNA sequences in the nucleus. CONCLUSIONS: DAX-1 mutation must be considered when diagnosis of primary adrenocortical insufficiency is made, especially if there is a history of unexplained death of maternal male relatives

A novel DAX-1 (NR0B1) mutation in a boy with X-linked adrenal hypoplasia congenita

AbstractBackground: X-linked adrenal hypoplasia congenita (AHC) is caused by mutations in DAX-1 (NR0B1) playing a key role in adrenal and reproductive development. Case presentation: Herein we report a 2.5-year-old boy who presented with acute adrenal failure. Family history revealed unexplained death in three brothers of the patient's mother during infancy. Molecular analysis of the DAX-1 gene revealed the presence of a novel hemizygous mutation, c.870C>A in exon 1, leading to the formation of a premature stop codon. The same mutation was identified in the patient's mother. The truncated mutant protein is most likely misfolded, sequestered in the endoplasmic reticulum and therefore cannot bind to and activate its target DNA sequences in the nucleus. Conclusions: DAX-1 mutation must be considered when diagnosis of primary adrenocortical insufficiency is made, especially if there is a history of unexplained death of maternal male relatives

Continuous secondary-ice production initiated by updrafts through the melting layer in mountainous regions

An accurate prediction of the ice crystal number concentration in clouds is important to determine the radiation budget, the lifetime, and the precipitation formation of clouds. Secondary-ice production is thought to be responsible for the observed discrepancies between the ice crystal number concentration and the ice-nucleating particle concentration in clouds. The Hallett-Mossop process is active between -3 and -8 degrees C and has been implemented into several models, while all other secondary-ice processes are poorly constrained and lack a well-founded quantification. During 2h of measurements taken on a mountain slope just above the melting layer at temperatures warmer than -3 degrees C, a continuously high concentration of small plates identified as secondary ice was observed. The presence of drizzle drops suggests droplet fragmentation upon freezing as the responsible secondary-ice mechanism. The constant supply of drizzle drops can be explained by a recirculation theory, suggesting that melted snowflakes, which sedimented through the melting layer, were reintroduced into the cloud as drizzle drops by orographically forced updrafts. Here we introduce a parametrization of droplet fragmentation at slightly sub-zero temperatures, where primary-ice nucleation is basically absent, and the first ice is initiated by the collision of drizzle drops with aged ice crystals sedimenting from higher altitudes. Based on previous measurements, we estimate that a droplet of 200 mu m in diameter produces 18 secondary-ice crystals when it fragments upon freezing. The application of the parametrization to our measurements suggests that the actual number of splinters produced by a fragmenting droplet may be up to an order of magnitude higher