Food insecurity among people with severe mental disorder in a rural Ethiopian setting: a comparative, population-based study

Aim. In low-income African countries, ensuring food security for all segments of the population is a high priority. Mental illness is associated consistently with poverty, but there is little evidence regarding the association with food insecurity. The aim of this study was to compare the levels of food insecurity in people with severe mental disorders (SMD) with the general population in a rural African setting with a high burden of food insecurity. Method. Households of 292 community-ascertained people with a specialist-confirmed diagnosis of SMD (including schizophrenia and bipolar disorder) were compared with 284 households without a person with SMD in a rural district in south Ethiopia. At the time of the study, no mental health services were available within the district. Food insecurity was measured using a validated version of the Household Food Insecurity Access Scale. Disability was measured using the World Health Organisation Disability Assessment Schedule 2.0. Result. Severe household food insecurity was reported by 32.5% of people with SMD and 15.9% of respondents from comparison households: adjusted odds ratio 2.82 (95% confidence interval 1.62 to 4.91). Higher annual income was associated independently with lower odds of severe food insecurity. When total disability scores were added into the model, the association between SMD and food insecurity became non-significant, indicating a possible mediating role of disability. Conclusion. Efforts to alleviate food insecurity need to target people with SMD as a vulnerable group. Addressing the disabling effects of SMD would also be expected to reduce food insecurity. Access to mental health care integrated into primary care is being expanded in this district as part of the Programme for Improving Mental health carE (PRIME). The impact of treatment on disability and food insecurity will be evaluated

COMPTEL observations of gamma‐ray flares in October 1991

The COMPTEL experiment on GRO images 0.75–30 MeV celestial gamma‐radiation that falls within its 1 steradian field of view. During observation 12 (primary target Cen A) in October 1991 the sun had been in the fov and several solar flares associated with the active region 6891 had been observed. Time profile and energy spectra had been produced, using COMPTEL’s primary mode of operation (the telescope mode). Additionally the number of counts received in the D2‐single burst detector (the secondary mode of operation) are given. We summarize the preliminary results on all of these flares

COMPTEL’s solar flare catalog

COMPTEL, the imaging gamma‐ray telescope, capable of detecting gamma rays in the range of 0.1–30 MeV, is one of four instruments aboard NASA’s Compton Gamma‐Ray Observatory. The Comptel burst detectors (single Defector Mode) have a field of view of ∼2.5 π sr. These detectors of COMPTEL permit measurements of energy spectra and time histories of solar flare gamma‐ray emission. A search through the Single Detector Mode’s data is being conducted. We summarize the preliminary results of this search

COMPTEL gamma ray and neutron measurements of solar flares

COMPTEL on the Compton Gamma Ray Observatory has measured the flux of x‐rays and neutrons from several solar flares. These data have also been used to image the Sun in both forms of radiation. Unusually intense flares occurred during June 1991 yielding data sets that offer some new insight into of how energetic protons and electrons are accelerated and behave in the solar environment. We summarize here some of the essential features in the solar flare data as obtained by COMPTEL during June 1991

Neutron and gamma‐ray measurements of the solar flare of 1991 June 9

The COMPTEL Imaging Compton Telescope on‐board the Compton Gamma Ray Observatory measured significant neutron and γ‐ray fluxes from the solar flare of 9 June 1991. The γ‐ray flux had an integrated intensity (≳1 MeV) of ∼30 cm−2, extending in time from 0136 UT to 0143 UT, while the time of energetic neutron emission extended approximately 10 minutes longer, indicating either extended proton acceleration to high energies or trapping and precipitation of energetic protons. The production of neutrons without accompanying γ‐rays in the proper proportion indicates a significant hardening of the precipitating proton spectrum through either the trapping or extended acceleration process

BATSE Observations of Gamma-Ray Burst Spectra. IV. Time-Resolved High-Energy Spectroscopy

We report on the temporal behavior of the high-energy power law continuum component of gamma-ray burst spectra with data obtained by the Burst and Transient Source Experiment. We have selected 126 high fluence and high flux bursts from the beginning of the mission up until the present. Much of the data were obtained with the Large Area Detectors, which have nearly all-sky coverage, excellent sensitivity over two decades of energy and moderate energy resolution, ideal for continuum spectra studies of a large sample of bursts at high time resolution. At least 8 spectra from each burst were fitted with a spectral form that consisted of a low-energy power law, a spectral break at middle energies and a high-energy continuum. In most bursts (122), the high-energy continuum was consistent with a power law. The evolution of the fitted high-energy power-law index over the selected spectra for each burst is inconsistent with a constant for 34% of the total sample. The sample distribution of the average value for the index from each burst is fairly narrow, centered on -2.12. A linear trend in time is ruled out for only 20% of the bursts, with hard-to-soft evolution dominating the sample (100 events). The distribution for the total change in the power-law index over the duration of a burst peaks at the value -0.37, and is characterized by a median absolute deviation of 0.39, arguing that a single physical process is involved. We present analyses of the correlation of the power-law index with time, burst intensity and low-energy time evolution. In general, we confirm the general hard-to-soft spectral evolution observed in the low-energy component of the continuum, while presenting evidence that this evolution is different in nature from that of the rest of the continuum.Comment: 30 pages, with 2 tables and 9 figures To appear in The Astrophysical Journal, April 1, 199

A boarding school outbreak of pertussis in adolescents : value of laboratory diagnostic methods

Culture for Bordetella pertussis (B. pertussis) is the traditional gold standard for laboratory diagnosis of pertussis but is insensitive, especially later in the course of illness and in vaccinated persons. Interpretation of serology is limited by the lack of an appropriate reference standard. An outbreak of pertussis in a crowded boarding-school dormitory allowed evaluation of laboratory correlates of infection. Questionnaires, serum samples and throat swabs were collected from members of the exposed group. Serum samples from unexposed controls of a similar age group were used for comparison. B. pertussis PCR was performed on throat swabs, and sera were tested for IgA antibodies against whole-cell (WC) B. pertussis antigen and IgG antibodies to pertussis toxin (PT). The Centers for Disease Control and Prevention definition for pertussis was used to define clinical cases. We evaluated the use of a previously published cut-off for PT IgG of 125 EIA units (EU)/ml. Completed questionnaires were obtained from 115 students, of whom 85 (74%) reported coughing symptoms, including 32 (28%) who met the clinical case definition for pertussis. B. pertussis was detected by PCR in 17 (15%) and WC IgA in 22 (19%) students; neither correlated with symptoms, but dormitory of residence strongly predicted PCR status. The mean PT IgG geometric mean concentration, in this situation of high pertussis exposure, correlated with severity of symptoms and was significantly higher in both symptomatic and asymptomatic children exposed during the outbreak (P&lt;0&middot;001) than in control children. A cut-off for PT IgG of 125 EU/ml was too high in an outbreak situation to be sensitive enough to identify pertussis cases. A case of pertussis in a crowded boarding-school dormitory resulted rapidly in an outbreak. Serology and PCR were useful in identifying the outbreak and commencing disease control measures. The use of serology has mostly been evaluated in community serosurveys, where it is not possible to determine if immunity reflects vaccination, asymptomatic disease or symptomatic disease. This outbreak gave us the opportunity to evaluate the value of serology and PCR in the presence of confirmed exposure to pertussis.<br /

Exploring the role of professional associations in collective learning in London and New York's advertising and law professional service firm clusters.

The value of regional economies for collective learning has been reported by numerous scholars. However often work has been criticised for lacking analytical clarity and failing to explore the architectures of collective learning and the role of the knowledge produced in making firms in a cluster economy successful. This paper engages with these problematics and investigates how collective learning is facilitated in the advertising and law professional service firm clusters in London and New York. It explores the role of professional associations and investigates how they mediate a collective learning process in each city. It argues that professional associations seed urban communities of practice that emerge outside of the formal activities of professional associations. In these communities individual with shared interests in advertising and law learn from one-another and are therefore able to adapt and evolve one-another approaches to common industry challenges. The paper suggests this is another form of the variation Marshall highlighted in relation to cluster-based collective learning. The paper also shows how the collective learning process is affected by the presence, absence and strength of an institutional thickness. It is therefore argued that a richer understanding of institutional affects is needed in relation to CL

Geriatric pharmacotherapy : optimisation through integrated approach in the hospital setting

Since older patients are more vulnerable to adverse drug-related events, there is a need to ensure appropriate prescribing in these patients in order to prevent misuse, overuse and underuse of drugs. Different tools and strategies have been developed to reduce inappropriate prescribing; the available measures can be divided into medication assessment tools, and specific interventions to reduce inappropriate prescribing. Implicit criteria of inappropriate prescribing focus on appropriate dosing, search for drug-drug interactions, and increase adherence. Explicit criteria are consensus-based standards focusing on drugs and diseases and include lists of drugs to avoid in general or lists combining drugs with clinical data. These criteria take into consideration differences between patients, and stand for a medication review, by using a systematic approach. Different types of interventions exist in order to reduce inappropriate prescribing in older patients, such as: educational interventions, computerized decision support systems, pharmacist-based interventions, and geriatric assessment. The effects of these interventions have been studied, sometimes in a multifaceted approach combining different techniques, and all types seem to have positive effects on appropriateness of prescribing. Interdisciplinary teamwork within the integrative pharmaceutical care is important for improving of outcomes and safety of drug therapy. The pharmaceutical care process consists offour steps, which are cyclic for an individual patient. These steps are pharmaceutical anamnesis, medication review, design and follow-up of a pharmaceutical care plan. A standardized approach is necessary for the adequate detection and evaluation of drug-related problems. Furthermore, it is clear that drug therapy should be reviewed in-depth, by having full access to medical records, laboratory values and nursing notes. Although clinical pharmacists perform the pharmaceutical care process to manage the patient’s drug therapy in every day clinical practice, the physician takes the ultimate responsibility for the care of the patient in close collaboration with nurses