To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
To improve the quality of physical health care of patients on antipsychotics.
The second purpose of our study was to look at the administrative and clinical issues that hinders physical health assessment in outpatient clinics.
Severe mental illness (SMI) is associated with high risk of physical co-morbidity and mortality and as such is a major public health concern.
Current guidelines are described, and adherence to the standards is audited
Retrospective case note audit.
New patients seen in the outpatient Clinic between January 06 – August 06 and were prescribed antipsychotics were included in the study.
The audit included 30 patients, seen in the Collingwood Court Outpatient clinic between February 06 – August 06. The majority of patients were male (59%) and were between the age group 30 – 49.Depression was the main diagnosis (10 patients) closely followed by Bipolar Affective Disorder & Psychosis. Out of the 30 Patients, no patient had complete base line investigation. Only 13(43%) patients has some investigation and of this only 10 (33%) had the results recorded in the notes. In around 50% of the patients there was request made to the GP for this investigations but no further corresponded from the GP or any records of this being done was noted in the notes. No patients has BMI or BP monitoring done at any time
This audit identifies shortcoming in physical health monitoring and possible reasons.
Spain has experienced one of the deepest recessions among European countries affected by the economic crisis. We investigated the effects of the recession on the frequency of mental disorders in Primary Care (PC).
A group of PC physicians selected into the study a random sample of patients attending primary care centres. These patients were administered the PRIME-MD for the assessment of mental disorders, in 2006 and again in 2010, before and during the financial crisis. Multivariate logistic regression models were used to assess the relationship of unemployment, mortgage payment difficulties, and eviction on risks of mental health disorders.
Compared with the pre-crisis period of 2006, the 2010 survey revealed substantial increases in the proportion of patients with mood, anxiety, somatoform, and alcohol-related disorders (p< 0.0001), but not in eating disorders (p = 0.172). Major depression (19.4% increase) and dysthymia (10.8), showed the greatest rise, followed generalized anxiety disorder (8.4) and panic attack disorder (7.3). Both alcohol dependence and alcohol abuse rose significantly, by 4.6% and 2.4% (OR = 11.6 and 4.5, p< 0.001), respectively. After correcting for the risks of unemployment, we observed a significant rise in attendance with depression associated with mortgage repayment difficulties (OR =2.12, p< 0.001) and evictions (OR = 2.95, p< 0.001).
Recession has significantly increased the frequency of mental health disorders, particularly among families experiencing unemployment and mortgage payment difficulties. Expanding mental health services in primary care settings to at-risk groups may help cope with rising mental health disorders in areas affected by recession.
Although hypofractionated radiotherapy has been standardised in early breast cancer, even in post-mastectomy no such consensus has been developed for locally advanced breast cancer (LABC), probably due to complex planning and field matching. This study is directed towards dosimetric evaluation and comparison of toxicity, response and disease-free survival (DFS) comparison between hypofractionation and conventional radiotherapy in post-mastectomy LABC.
In total, 222 female breast cancer patients were randomly assigned to be treated with either hypofractionated radiotherapy (n = 120) delivering 40 Gy in 15 fractions over 3 weeks or conventional radiotherapy (n = 102) with 50 Gy in 25 fractions over 5 weeks after modified radical mastectomy (MRM) along with neoadjuvant and/or adjuvant chemotherapy. All patients were planned with treatment planning software and assessed regularly during and after treatment.
Median follow-up period was 178 weeks in conventional arm (CRA) and 182 weeks in hypofractionation arm (HFA). There exists a dosimetric difference between the two arms of treatment, in spite of similar dose coverage [planning treatment volume (PTV) D90 92·04% in CRA versus 92·5% in HFA; p = 0·49], average dose in HFA is less than that of CRA (p < 0·001); so is the maximum clinical target volume (CTV) dose (p < 0·001). Similarly, average lung dose in HFA arm is significantly lower than CRA (9·9 versus 10·84; p = 0·06), but the V20Gy of lung and V30Gy of heart had no difference. The toxicity of radiation was comparable with similar mean time to produce toxicity [CRA: 7 W, HFA: 10 W; hazard ratio 0·64, 95% confidence interval (CI) = 0·28–1·45]. Three-year recurrence event was alike in two arms (CRA: 4·9%, HFA: 5·8%; p = 0·76). Mean DFS in CRA is 230 weeks and that of HFA is 235 weeks with hazard ratio 1·01 (95% CI = 0·32–3·19; p = 0·987).
Though biologically effective dose (BED) in hypofractionation is lesser than that of conventional fractionation, there are indistinguishable toxicity, locoregional recurrence, distant failure rate and DFS between the two modalities.
We introduce a notion of complexity of diagrams (and, in particular, of objects and morphisms) in an arbitrary category, as well as a notion of complexity of functors between categories equipped with complexity functions. We discuss several examples of this new definition in categories of wide common interest such as finite sets, Boolean functions, topological spaces, vector spaces, semilinear and semialgebraic sets, graded algebras, affine and projective varieties and schemes, and modules over polynomial rings. We show that on one hand categorical complexity recovers in several settings classical notions of nonuniform computational complexity (such as circuit complexity), while on the other hand it has features that make it mathematically more natural. We also postulate that studying functor complexity is the categorical analog of classical questions in complexity theory about separating different complexity classes.
Prospective population-based studies of psychiatric comorbidity following trauma and severe stress exposure in children are limited.
To examine incident psychiatric comorbidity following stress disorder diagnoses in Danish school-aged children using Danish national healthcare system registries.
Children (6–15 years of age) with a severe stress or adjustment disorder (ICD-10) between 1995 and 2011 (n = 11 292) were followed prospectively for an average of 5.8 years. Incident depressive, anxiety and behavioural disorder diagnoses were examined relative to an age- and gender-matched comparison cohort (n = 56 460) using Cox proportional hazards regression models. Effect modification by gender was examined through stratified analyses.
All severe stress and adjustment disorder diagnoses were associated with increased rates for all incident outcome disorders relative to the comparison cohort. For instance, adjustment disorders were associated with higher rates of incident depressive (rate ratio RR = 6.8; 95% CI 6.0–7.7), anxiety (RR = 5.3; 95% CI 4.5–6.4), and behavioural disorders (RR = 7.9; 95% CI 6.6–9.3). Similarly, PTSD was also associated with higher rates of depressive (RR = 7.4; 95% CI 4.2–13), anxiety (RR = 7.1; 95% CI 3.5–14) and behavioural disorder (RR = 4.9; 95% CI 2.3–11) diagnoses. There was no evidence of gender-related differences.
Stress disorders varying in symptom constellation and severity are associated with a range of incident psychiatric disorders in children. Transdiagnostic assessments within a longitudinal framework are needed to characterise the course of post-trauma or severe stressor psychopathology.
I am a theoretical astrophysicist, and my professional work requires a foundation in classical mechanics and fluid dynamics, and it then draws on statistical mechanics, relativity, and quantum mechanics. How is a student to see the underlying connections between these vast subjects? Professor Pranawa Deshmukh's book ‘Foundations of Classical Mechanics’ (FoCM) provides an excellent exposition to the underlying unity of physics, and is a valuable resource for students and professionals who specialize in any area of physics.
It was 2011 and I was Chair of the Department of Physics and Astronomy at the University of Western Ontario (UWO). An important global trend in education is internationalization: the effort to increase the international mobility of students and faculty, and increase partnerships in research and teaching. The present-day leading universities in the world are the ones that long ago figured out the benefits of academic mobility and exchanges. As part of our internationalization efforts at UWO, I was keen on building ties with the renowned Indian Institute of Technology (IIT) campuses in India. I invited Professor Deshmukh of the IIT Madras to come to UWO to spend a term in residence and also teach one course. That course turned out to be Classical Mechanics. How enlightening to find out that Professor Deshmukh had already developed extensive lecture materials in this area, including a full videographed lecture course ‘Special Topics in Classical Mechanics’ that is available on YouTube. Not surprising then, the course he taught at UWO was a tour-de-force of classical mechanics that also, notably, included topics that are considered to be ‘modern’, including chaos theory and relativity. Many of our students appreciated, highly, the inclusion of special relativity and, for example, to be able to finally understand a resolution to the mind-bending Twin Paradox. We were lucky to have Professor Deshmukh bring his diverse expertise to Canada, and UWO in particular, and it established personal and research links between individuals, and more generally between UWO and the IITs, which continue today.
The FoCM book is a further extension of the broad approach that Professor Deshmukh has brought to his teaching. This is not just another book on Classical Mechanics, due to both its approach and extensive content. The chapters are written in a conversational style, with everyday examples, historical anecdotes, short biographical sketches, and pedagogical features included.
The ASEAN region is fast emerging as a growing market in the global e-commerce landscape. With a total population of 650 million, a rising middle class and a newly established economic community in 2015, the region is often considered as the next gold rush for e-commerce and internet-based operations. Despite the hype about the potential of the region, many challenges remain before e-commerce can truly flourish in each ASEAN member country. Cross-border e-commerce is challenging in the ASEAN region due to different national rules and regulations as well as quality of infrastructure. It is with these developments in mind that e-commerce has become an increasingly important area of focus in ASEAN economic cooperation.
This chapter examines the role played by e-commerce in ASEAN economic integration by focusing on a number of issues. We begin by discussing some of the basic concepts and definitions related to e-commerce in Section 2. This will then lead to an examination of the state of e-commerce in the ASEAN region in Section 3. Section 4 discusses the framework for ASEAN cooperation in the development of e-commerce and some of the challenges that lies ahead. Section 5 concludes.
Definition, Concepts and Framework
OECD provides a comprehensive definition of e-commerce:
An e-commerce transaction is the sale or purchase of goods or services, conducted over computer networks by methods specifically designed for the purpose of receiving or placing of orders. The goods or services are ordered by those methods, but the payment and the ultimate delivery of the goods or services do not have to be conducted online. An e-commerce transaction can be between enterprises, households, individuals, governments, and other public or private organisations. To be included are orders made over the web, extranet or electronic data interchange. The type is defined by the method of placing the order. To be excluded are orders made by telephone calls, facsimile or manually typed e-mail.
The key emphasis in the above definition is on transactions carried out over computer networks which today mostly involve the internet. The definition also suggests that the delivery of goods and services does not have to be conducted online.
Armed conflict has contributed to an unprecedented number of internally displaced persons (IDPs), individuals who are forced out of their homes but remain within their country. IDPs often urgently require shelter, food, and healthcare, yet prediction of when IDPs will migrate to an area remains a major challenge for aid delivery organizations. We sought to develop an IDP migration forecasting framework that could empower humanitarian aid groups to more effectively allocate resources during conflicts.
We modeled monthly IDP migration between provinces within Syria and within Yemen using data on food prices, fuel prices, wages, location, time, and conflict reports. We compared machine learning methods with baseline persistence methods of forecasting.
We found a machine learning approach that more accurately forecast migration trends than baseline persistence methods. A random forest model outperformed the best persistence model in terms of root mean square error of log migration by 26% and 17% for the Syria and Yemen datasets, respectively.
Integrating diverse data sources into a machine learning model appears to improve IDP migration prediction. Further work should examine whether implementation of such models can enable proactive aid allocation for IDPs in anticipation of forecast arrivals.
Space Infrared Telescope for Cosmology and Astrophysics (SPICA), the cryogenic infrared space telescope recently pre-selected for a ‘Phase A’ concept study as one of the three remaining candidates for European Space Agency (ESA's) fifth medium class (M5) mission, is foreseen to include a far-infrared polarimetric imager [SPICA-POL, now called B-fields with BOlometers and Polarizers (B-BOP)], which would offer a unique opportunity to resolve major issues in our understanding of the nearby, cold magnetised Universe. This paper presents an overview of the main science drivers for B-BOP, including high dynamic range polarimetric imaging of the cold interstellar medium (ISM) in both our Milky Way and nearby galaxies. Thanks to a cooled telescope, B-BOP will deliver wide-field 100–350
m images of linearly polarised dust emission in Stokes Q and U with a resolution, signal-to-noise ratio, and both intensity and spatial dynamic ranges comparable to those achieved by Herschel images of the cold ISM in total intensity (Stokes I). The B-BOP 200
m images will also have a factor
30 higher resolution than Planck polarisation data. This will make B-BOP a unique tool for characterising the statistical properties of the magnetised ISM and probing the role of magnetic fields in the formation and evolution of the interstellar web of dusty molecular filaments giving birth to most stars in our Galaxy. B-BOP will also be a powerful instrument for studying the magnetism of nearby galaxies and testing Galactic dynamo models, constraining the physics of dust grain alignment, informing the problem of the interaction of cosmic rays with molecular clouds, tracing magnetic fields in the inner layers of protoplanetary disks, and monitoring accretion bursts in embedded protostars.
To review the literature regarding screening for vestibular schwannoma in the context of demographic changes leading to increasing numbers of elderly patients presenting with asymmetric auditory symptoms.
A systematic review of the literature was performed, with narrative synthesis and statistical analysis of data where appropriate.
Vestibular schwannomas diagnosed in patients aged over 70 years exhibit slower growth patterns and tend to be of smaller size compared to those tumours in younger age groups. This fact, combined with reduced life expectancy, renders the probability of these tumours in the elderly requiring active treatment with surgery or stereotactic radiotherapy to be extremely low. Vestibular schwannomas in the elderly are much more likely to be managed by serial monitoring with magnetic resonance imaging. The weighted yield of magnetic resonance imaging in the diagnosis of vestibular schwannoma in all age groups is 1.18 per cent, with almost 85 scans required to diagnose 1 tumour.
An evidence-based approach to the investigation of asymmetric hearing loss and tinnitus in the elderly patient can be used to formulate guidelines for the rational use of magnetic resonance imaging in this population.
There is evidence of increased morbidity, decreased quality of life, and premature mortality in people living with HIV (PLHIV) who smoke tobacco compared to PLHIV who do not smoke tobacco. Evidence-based screening for tobacco dependence, pharmacological treatment, and treatment monitoring and education into relapse prevention are not readily available in low- and middle-income countries (LMIC). We evaluated the effects of a brief tobacco dependence intervention in improving knowledge on the health effects of smoking and intention to quit smoking in PLHIV in Nepal, a low-income country in south Asia.
Using a quasi-experimental design, we assigned 59 smokers to participate in the intervention and 67 in the control group. The 1.5 h smoking cessation intervention emphasized harms of smoking, reasons for smoking and quitting, causes of relapse in previous quit attempts, and quitting strategies. We collected data at baseline and immediately post-intervention.
Findings indicate that a brief smoking cessation intervention produced a significant increase in smoking-related knowledge and intention to quit among PLHIV. The positive effects of our intervention remained significant after adjusting for potential confounders.
Our brief tobacco dependence intervention was effective in improving knowledge on the health effects of smoking and intention to quit among PLHIV. Further studies are required to evaluate the effectiveness of our intervention in increasing smoking cessation among PLHIV in LMIC.