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In the past few years, there has been an unprecedented increase in the number of forcibly displaced migrants worldwide, of which a substantial proportion is refugees and asylum seekers. Refugees and asylum seekers may experience high levels of psychological distress, and show high rates of mental health conditions. It is therefore timely and particularly relevant to assess whether current evidence supports the provision of psychosocial interventions for this population. We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) assessing the efficacy and acceptability of psychosocial interventions compared with control conditions (treatment as usual/no treatment, waiting list, psychological placebo) aimed at reducing mental health problems in distressed refugees and asylum seekers.
We used Cochrane procedures for conducting a systematic review and meta-analysis of RCTs. We searched for published and unpublished RCTs assessing the efficacy and acceptability of psychosocial interventions in adults and children asylum seekers and refugees with psychological distress. Post-traumatic stress disorder (PTSD), depressive and anxiety symptoms at post-intervention were the primary outcomes. Secondary outcomes include: PTSD, depressive and anxiety symptoms at follow-up, functioning, quality of life and dropouts due to any reason.
We included 26 studies with 1959 participants. Meta-analysis of RCTs revealed that psychosocial interventions have a clinically significant beneficial effect on PTSD (standardised mean difference [SMD] = −0.71; 95% confidence interval [CI] −1.01 to −0.41; I2 = 83%; 95% CI 78–88; 20 studies, 1370 participants; moderate quality evidence), depression (SMD = −1.02; 95% CI −1.52 to −0.51; I2 = 89%; 95% CI 82–93; 12 studies, 844 participants; moderate quality evidence) and anxiety outcomes (SMD = −1.05; 95% CI −1.55 to −0.56; I2 = 87%; 95% CI 79–92; 11 studies, 815 participants; moderate quality evidence). This beneficial effect was maintained at 1 month or longer follow-up, which is extremely important for populations exposed to ongoing post-migration stressors. For the other secondary outcomes, we identified a non-significant trend in favour of psychosocial interventions. Most evidence supported interventions based on cognitive behavioural therapies with a trauma-focused component. Limitations of this review include the limited number of studies collected, with a relatively low total number of participants, and the limited available data for positive outcomes like functioning and quality of life.
Considering the epidemiological relevance of psychological distress and mental health conditions in refugees and asylum seekers, and in view of the existing data on the effectiveness of psychosocial interventions, these interventions should be routinely made available as part of the health care of distressed refugees and asylum seekers. Evidence-based guidelines and implementation packages should be developed accordingly.
In 1936, Gerhard Gentzen published a proof of consistency for Peano Arithmetic using transfinite induction up to ε0, which was considered a finitistically acceptable procedure by both Gentzen and Paul Bernays. Gentzen’s method of arithmetising ordinals and thus avoiding the Platonistic metaphysics of set theory traces back to the 1920s, when Bernays and David Hilbert used the method for an attempted proof of the Continuum Hypothesis. The idea that recursion on higher types could be used to simulate the limit-building in transfinite recursion seems to originate from Bernays. The main difficulty, which was already discovered in Gabriel Sudan’s nearly forgotten paper of 1927, was that measuring transfinite ordinals requires stronger methods than representing them. This paper presents a historical account of the idea of nominalistic ordinals in the context of the Hilbert Programme as well as Gentzen and Bernays’ finitary interpretation of transfinite induction.
This article studies two questions related to al-Khansā'’s mutaqārib poem, rhyming in -ālahā: how was it changed through anthologisation and what is its relation to the Qur'ān and Surah 99? Whereas the six-verse excerpt in al-Mubarrad's Kāmil is full of Qur'ānic echoes, the Dīwān version of the poem has few such echoes. The analysis, however, opens up a possibility that the Qur'ān's first audience may well have recognised in Surah 99 features familiar to them from marthiyas.
Research has repeatedly shown that individuals and organisations tend to obtain information from others whose beliefs are similar to their own, forming “echo chambers” with their network ties. Echo chambers are potentially harmful for evidence-based policymaking as they can hinder policy learning and consensus building. Policy forums could help alleviate the effects of echo chambers if organisations with different views were to participate and to use the opportunities that forums provide to learn from those outside their networks. Applying exponential random graph models on survey data of the Irish climate change policy network, we find that policy actors do indeed tend to obtain policy advice from those whose beliefs are similar to their own. We also find that actors tend not to obtain policy advice from the those that they encounter at policy forums, suggesting forums are not enabling policy learning.
This Research Communication describes the effect of post-operative pain and non-steroidal anti-inflammatory drug (NSAID) treatment on heart rate variability (HRV) of dairy cows. Postoperative pain in farm animals is often left untreated, and HRV could be a promising tool for assessing pain. The aim of this study was to assess if postoperative state after subcutaneous surgery affects HRV in dairy cows and to determine whether this could be modulated by NSAID. Nine cows were inserted with an implantable electrocardiograph logger. Cows were divided into the NSAID treatment group and the control group. The cows in the NSAID group had higher HRV than the control group, indicating a higher sympathetic activity in control animals, most likely due to untreated post-operative pain. Besides the ethical need for treating pain in production animals, ongoing pain has an adverse effect on animal productivity. Thus post-operative pain alleviation is recommended.
Objectives: The need to consider the patient perspective in health technology assessments (HTA) has been widely recognized. In July 2012, the Finnish Medicines Agency (Fimea) published a national recommendation for integrating the patient perspective into the HTAs of pharmaceuticals. The aim of this study is to describe the development of the recommendation for integrating the patient perspective into the HTA process of pharmaceuticals in Finland.
Methods: The development of the recommendation was based on a review of international recommendations and experiences of patient and public involvement in HTA. The draft recommendation was tested in two focus group discussions (n = 7 patients) and three individual interviews among diabetes patients (type 1 or 2) using long-acting insulin treatment. The recommendation was open for public consultation in April 2012 and revised according to the comments received.
Results: Patients will be involved in multiple stages of Fimea's HTA process. The recommendation includes step-by-step instructions on how to assess the patient perspective. The main focus is on qualitative interviews, which will be conducted at the beginning of the assessments to gain information, particularly on patient preferences and values, including positive and negative outcomes important to patients and ethical and social aspects of the medicine's use.
Conclusions: The recommendation will act as a tool to integrate patients’ experiences, needs and preferences into Fimea's HTAs of pharmaceuticals.
Harriet Finne-Soveri, National Institute for Health and Welfare, Helsinki,
Teija Hammar, National Institute for Health and Welfare, Helsinki,
Anja Noro, National Institute for Health and Welfare, Helsinki,
Sari Anttila, National Supervisory Authority for Welfare and Health (Valvira), Helsinki,
Päivi Voutilainen, Ministry of Social Affairs and Health, Finland
Vincent Mor, Brown University, Rhode Island,Tiziana Leone, London School of Economics and Political Science,Anna Maresso, London School of Economics and Political Science
The constitution of Finland stipulates that society must guarantee adequate social, health and medical services for each of its 5.3 million inhabitants, and promote the health of the population. Due to decentralized governance, responsibility for financing long-term care for older people rests heavily on the shoulders of 336 relatively independent local authorities (municipalities), as does the delivery of long-term care services. Obliged by law to provide long-term care services for older dependent people, these municipalities are free either to provide services themselves or to purchase them from various for-profit or not-for-profit providers. Historically, municipalities have tended to rely on providing their own services.
According to the Statistical Yearbook on Social Welfare and Healthcare (National Institute for Health and Welfare, 2010), 87 per cent of all long-term care days in residential facilities were produced in public facilities, 10 per cent in not-for-profit private facilities and only 3 per cent in for-profit private facilities. In contrast, when it comes to sheltered housing for older people, officially known as ‘service houses’ or ‘sheltered housing’, only 42 per cent of long-term care days were furnished by public providers while the private sector provided 32 per cent of care days in not-for-profit facilities and 26 per cent in for-profit facilities. Chronic care hospitals, known as ‘health centres’, are predominantly public (95 per cent). Recent statistics are not available for home care. In all these types of facilities municipalities are responsible for monitoring care but they are aided in this task by other entities. The National Supervisory Authority for Welfare and Health (known as Valvira), supervised by the Ministry of Social Affairs and Health, undertakes a national supervisory role, together with six Regional State Administrative Agencies (AVI).
A surface roughness measurement system for snow is presented. It is based on a background board with scales on the edges and a digital camera. Analysis software is developed for automatic processing of images to produce calibrated profiles. The image analysis and calibration was fully automatic in >99% of the studied cases. In the others, the intensity adjustment or board detection needed manual intervention. Profile detection, control point picking and calibration always worked autonomously. The accuracy of the system depends on the photographing configuration, and is typically of the order of 0.1 mm vertically and 0.04 mm horizontally. The method tolerates relatively well cases of snowfall, traces of wiping the black background dry, uneven shading, reflected sunlight, reflected flash light, litter on the snow surface and a tilted plate. The repeatability of the system is at least 1%.
The analog front-end of a direct-conversion transmitter suffers from several performance-degrading circuit implementation impairments. The main impairments are power amplifier (PA) nonlinear distortion, in-phase/quadrature-phase (I/Q) imbalance, and local oscillator (LO) leakage. Each of these impairments has been treated separately in the literature as well as on the pages of this book. For details on state-of-the-art PA predistortion, the reader is referred to the related chapters in Part II of this book and the references therein, and for a comprehensive review on I/Q imbalance compensation, to Chapter 16 of this book and the literature cited therein. It has been demonstrated that, when treated separately, each of the impairments can be mitigated by using digital predistortion. What is often overlooked, however, is that in direct-conversion transmitters these impairments interact in a manner that may severely cripple the overall transmitted signal quality. In addition to the obvious effects of I/Q imbalance and LO leakage (mirror-frequency interference (MFI) and spurious signal energy at the LO frequency, respectively), there are several other performance-degrading phenomena arising from their interaction with the nonlinearity that need addressing. First, I/Q imbalance and LO leakage cause extra intermodulation distortion (IMD) products to appear at the PA output , . Effectively this means that even with access to ideal PA predistorter (PD) coefficients, spectral regrowth will not be fully mitigated. Second, the extra IMD products at the PA output will interfere with the estimation of an adaptive PA PD , . In other words, if the PA PD is trained with no regard for I/Q imbalance and LO leakage, the resulting PD will be biased, and thus the overall transmitted signal quality will be further compromised. Third, PA nonlinearity interferes with the estimation of the I/Q modulator (IQM) predistorter, yielding biased estimates. This makes it difficult to compensate for IQM impairments prior to PA PD estimation. These aspects will be discussed in more detail in Section 17.2.
The implementation challenges in building compact and low-cost radios for future wireless systems are continuously growing. This is partially due to the introduction of multi-antenna transmission techniques as well as the use of wideband communication waveforms and high-order symbol alphabets, in addition to the increasing demands for more efficient radio spectrum utilization through e.g. carrier aggregation and scattered spectrum use. In general, implementations of several parallel radios with wide operating bandwidth and high performance, in terms of linearity and spurious free dynamic range, are required in a single device. Then, to keep the overall implementation costs and size feasible, simplified radio architectures and lower-cost radio electronics are typically used. This in turn implies that various nonidealities in the deployed analog radio frequency (RF) modules, stemming from the unavoidable physical limitations of the electronics used, are expected to play a critical role in future radio devices.
Good examples of the above “dirty-RF” paradigm ,  are, e.g., oscillator phase noise, power amplifier (PA) nonlinearities, imperfections of the sampling and analog-to-digital (A/D) interface, in-phase/quadrature (I/Q) branch amplitude and phase mismatches, as well as nonlinearities of receiver small signal components like low-noise amplifiers (LNAs) and mixers. In this chapter, we will focus on the behavioral modeling and digital signal processing (DSP) based mitigation of I/Q imbalances and the resulting mirror-frequency interference in direct-conversion type radio transmitters and receivers. For generality, in most of the developments, the I/Q imbalances are assumed to be frequency-dependent within the processed bandwidth, which is then built in to both modeling as well as mitigation algorithms. Also an extensive list of state-of-the-art literature is given.
Almost every Finnish child and adolescent takes an interest in music in some form. However, many young people feel dissatisfaction with what music education institutions provide and fail to find them motivating. According to the results of a series of empirical studies, school music education can have a negative effect on many pupils and undermine their musical self-esteem. At the music education institutions where this research was undertaken, music was narrowly defined and there was an absence of contemporary music cultures. Forms of music making were limited and active music listening absent from lessons. Assessment too was a problem with many pupils feeling that the evaluation of their work lacked legitimacy and fairness.
The main implementation impairments degrading the performance of direct-conversion radio transmitters are in-phase/quadrature (I/Q) mismatch, local oscillator (LO) leakage, and power amplifier (PA) nonlinear distortion. In this article, we propose a recursive least-squares-based learning algorithm for joint digital predistortion (PD) of frequency-dependent PA and I/Q modulator impairments. The predistorter is composed of a parallel connection of two parallel Hammerstein (PH) predistorters and an LO leakage compensator, yielding a predistorter which as a whole is fully linear in the parameters. In the parameter estimation stage, proper feedback signal from the transmitter radio frequency (RF) stage back to the digital parts is deployed, combined with the indirect learning architecture and recursive least-squares training. The proposed structure is one of the first techniques to explicitly consider the joint estimation and mitigation of frequency-dependent PA and I/Q modulator impairments. Extensive simulation and measurement analysis is carried out to verify the operation and efficiency of the proposed PD technique. In general, the obtained results demonstrate linearization and I/Q modulator calibration performance clearly exceeding the performance of current state-of-the-art reference techniques.
Objectives: The aim of this study was to analyze and describe process and outcomes of two pilot assessments based on the HTA Core Model, discuss the applicability of the model, and explore areas of development.
Methods: Data were gathered from HTA Core Model and pilot Core HTA documents, their validation feedback, questionnaires to investigators, meeting minutes, emails, and discussions in the coordinating team meetings in the Finnish Office for Health Technology Assessment (FINOHTA).
Results: The elementary structure of the HTA Core Model proved useful in preparing HTAs. Clear scoping and good coordination in timing and distribution of work would probably help improve applicability and avoid duplication of work.
Conclusions: The HTA Core Model can be developed into a platform that enables and encourages true HTA collaboration in terms of distribution of work and maximum utilization of a common pool of structured HTA information for national HTA reports.
Objectives: The aim of this study was to develop and test a generic framework to enable international collaboration for producing and sharing results of health technology assessments (HTAs).
Methods: Ten international teams constructed the HTA Core Model, dividing information contained in a comprehensive HTA into standardized pieces, the assessment elements. Each element contains a generic issue that is translated into practical research questions while performing an assessment. Elements were described in detail in element cards. Two pilot assessments, designated as Core HTAs were also produced. The Model and Core HTAs were both validated. Guidance on the use of the HTA Core Model was compiled into a Handbook.
Results: The HTA Core Model considers health technologies through nine domains. Two applications of the Model were developed, one for medical and surgical interventions and another for diagnostic technologies. Two Core HTAs were produced in parallel with developing the model, providing the first real-life testing of the Model and input for further development. The results of formal validation and public feedback were primarily positive. Development needs were also identified and considered. An online Handbook is available.
Conclusions: The HTA Core Model is a novel approach to HTA. It enables effective international production and sharing of HTA results in a structured format. The face validity of the Model was confirmed during the project, but further testing and refining are needed to ensure optimal usefulness and user-friendliness. Core HTAs are intended to serve as a basis for local HTA reports. Core HTAs do not contain recommendations on technology use.
To determine whether recently diagnosed adult–onset asthma is associated with serologic evidence of chronic Chlamydia pneumoniae infection, we performed a case-control study in a primary care clinic of cases with asthma (25 adults reporting first symptoms of asthma within 2 years of enrollment) and 45 concurrently enrolled sex and age (±10 years) matched non-asthmatic controls with normal pulmonary function. C. pneumoniae-specific IgA, IgG and IgG4 antibodies, and circulating immune complexes (CIC) were measured by microimmunofluorescence testing. Results showed that frequencies of IgG litres > 16 (92%), IgG4 litres > 16 (20%) and CIC > 4 (60%) in asthma patients were not significantly different from those of controls. However, asthmatics had a significantly higher prevalence of C. pneumoniae-specific IgA litres > 10 (72% of cases vs 44% of controls, P < 0·05). After adjustment for the effects of age, sex and smoking, the odds ratio for an association of IgA and asthma was 3·7 (95% confidence interval 1·2–11·5). We conclude that recently symptomalic reversible airway obstruction in adults is associated with the presence of C. pneumoniae-specific IgA antibodies, a proposed indicator of chronic respiratory C. pneumoniae infection.
From a Scandinavian perspective, the current scenario for dance education practice and research appears quite challenging. One great challenge seems to be preserving the basic values of democracy, equity, and access of the Nordic educational system that is being contested by neoliberal policies, much like elsewhere in the Western world. I am echoing Sue Stinson about the concerns that accountability and standardization have generated in preparing future dance teachers. The restraints seem to creep in from all directions. From the European Union and the Bologna process, higher education is affected by directives that compel us to reformulate the program goals in terms derived from Bloom's taxonomy (Bloom 1956). On the national level, increasing governmental regulations regarding higher education have altered the criteria for allocating funds, and beginning in January 2010 the whole system will drastically change toward privatization. Another significant national development is more difficult to discern but is even more disturbing.