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We conducted a secondary analysis of data from the National Audit of Psychosis to identify factors associated with use of community treatment orders (CTOs) and assess the quality of care that people on CTOs receive.
Between 1.1 and 20.2% of patients in each trust were being treated on a CTO. Male gender, younger age, greater use of in-patient services, coexisting substance misuse and problems with cognition predicted use of CTOs. Patients on CTOs were more likely to be screened for physical health, have a current care plan, be given contact details for crisis support, and be offered cognitive–behavioural therapy.
CTOs appear to be used as a framework for delivering higher-quality care to people with more complex needs. High levels of variation in the use of CTOs indicate a need for better evidence about the effects of this approach to patient care.
Stars with masses between ∼0.7 and 8 M⊙ end their lives as Planetary Nebulae (PNe). With the MegaCam at CFHT, we have carried out a survey of the central 16 sq. degrees of Andromeda (M31) reaching the outer disk and halo, using a narrow-band [OIII]5007 and a broad-band g filter. This survey extends previous PN samples both in uniform area coverage and depth. We identify ∼4000 PNe in M31, of which ∼3000 are new discoveries. We detect PNe down to ∼6 mag below the bright cut-off of the PN luminosity function (PNLF), ∼2 mag deeper than in previous works. We detect a steep rise in the number of PNe at ∼4.5 mag fainter than the bright cut-off. It persists as we go radially outwards and is steeper than that seen in the Magellanic clouds. We explore possible reasons for this rise, which give insights into the stellar population of M31.
Deflection missions to near-Earth asteroids will encounter non-negligible uncertainties in the physical and orbital parameters of the target object. In order to reliably assess future impact threat mitigation operations such uncertainties have to be quantified and incorporated into the mission design. The implementation of deflection demonstration missions offers the great opportunity to test our current understanding of deflection relevant uncertainties and their consequences, e.g., regarding kinetic impacts on asteroid surfaces. In this contribution, we discuss the role of uncertainties in the NEOTωIST asteroid deflection demonstration concept, a low-cost kinetic impactor design elaborated in the framework of the NEOShield project. The aim of NEOTωIST is to change the spin state of a known and well characterized near-Earth object, in this case the asteroid (25143) Itokawa. Fast events such as the production of the impact crater and ejecta are studied via cube-sat chasers and a flyby vehicle. Long term changes, for instance, in the asteroid's spin and orbit, can be assessed using ground based observations. We find that such a mission can indeed provide valuable constraints on mitigation relevant parameters. Furthermore, the here proposed kinetic impact scenarios can be implemented within the next two decades without threatening Earth's safety.
Hematologic malignancies make up about 9% of the new cancer cases in the USA in 2013. Of the new hematologic cancer cases, approximately 53% were lymphoma, 32% were leukemia, and 15% were myeloma. The management of pain in hematologic cancers presents a constellation of problems that are distinctly different from those associated with solid tumors. We will review four cases of patients who presented with pain associated with hematologic cancer that illustrate the unique complexity and breadth of the problems to be addressed. We will then discuss considerations that should be taken that affect the assessment of risks and the selection of analgesic treatment, and the monitoring of clinical response.
Beaches and dunes of the open coast form one of the globe’s longest ecological interfaces, linking the oceans with the land. These systems are of great importance to society as prime sites for housing and recreation, buffers against storms, and providers of fisheries and mineral resources. By contrast, their unique ecological attributes and biodiversity are much less recognized. In this chapter, we provide a synthesis of the key ecological features and functions of beaches and dunes, outline the main elements of their faunal biodiversity, examine human threats and their biological consequences, and sketch some salient issues in management to achieve conservation of these unique ecosystems. It is apparent that the range of ecosystem goods and services is broad, but nutrient cycling, water filtration, and the provision of habitat and prey for a diverse range of animals are often the key ecological traits. Contrary to common perceptions, beaches and dunes contain a diverse and unique set of species, many of which are found nowhere else. In addition to the complement of highly adapted invertebrates, many wildlife species (e.g. birds, turtles, fishes) are dependent on beaches and dunes for nesting and feeding, and they use these habitats extensively. Human pressures on sandy shorelines and their biodiversity are numerous. Coastal squeeze is, however, the most pervasive, trapping beaches and their biota between the pressures of development from the terrestrial side and the consequences of climate change from the marine side. Beaches are also naturally malleable habitats whose interlinkages, including the exchange of organisms, with the abutting dunes and surf zones are essential to their functioning. Unfortunately, human actions intended to arrest the dynamics of beach habitats, such as seawalls and dune stabilizations, run counter to these natural dynamics and generally produce negative environmental outcomes. These present a set of formidable management challenges when the primary goal is to conserve intact ecosystems and biodiversity, calling for more systematic approaches in conservation design and implementation for beach and dune ecosystems.
The Craniofacial Biology Research Group in the School of Dentistry at The University of Adelaide is entering an exciting new phase of its studies of dental development and oral health in twins and their families. Studies of the teeth and faces of Australian twins have been continuing for nearly 30 years, with three major cohorts of twins recruited over that time, and currently we are working with twins aged 2 years old to adults. Cross-sectional data and records relating to teeth and faces of twins are available for around 300 pairs of teenage twins, as well as longitudinal data for 300 pairs of twins examined at three different stages of development, once with primary teeth, once at the mixed dentition stage, and then again when the permanent teeth had emerged. The third cohort of twins comprises over 600 pairs of twins recruited at around birth, together with other family members. The emphasis in this third group of twins has been to record the timing of emergence of the primary teeth and also to sample saliva and dental plaque to establish the timing of colonization of decay-forming bacteria in the mouth. Analyses have confirmed that genetic factors strongly influence variation in timing of primary tooth emergence. The research team is now beginning to carry out clinical examinations of the twins to see whether those who become colonized earlier with decay-forming bacteria develop dental decay at an earlier age. By making comparisons within and between monozygotic (MZ) and dizygotic (DZ) twin pairs and applying modern molecular approaches, we are now teasing out how genetic, epigenetic, and environmental factors interact to influence dental development and also oral health.
We surveyed Ronald McDonald Houses (RMHs) to assess infection prevention and control (IPC) practices. A diverse patient population is served by RMH. Most sites have locally written IPC guidelines, and consultation resources vary, increasing the potential for inconsistent IPC practices. RMH would benefit from a standardized IPC guideline.
Following its meeting in May, 2010, the IAU Executive Committee requested that a Working Group on NEOs within Div. III be re-activated and carry out the following activities:
a)investigate and formulate requirements for an international ground- and/or space-based NEO survey, to detect, track and characterize (optical/IR, radar) 90% of all NEOs with D >40 m and to establish as such a permanent International NEO Early Warning System; to submit to the President, Vice-President and OC of Division III by March 31, 2011, a progress report and by March 31, 2012, a final report on this matter, to be forwarded to the President and General Secretary of the IAU;
b)assemble a SOC in order to write and submit to the IAU Assistant General Secretary before December 1, 2010, a proposal for a GA IAU Symposium or a GA Special Session, to be held during the IAU XXVIII General Assembly, August 20-31, 2012 in Beijing, on theoretical and observational aspects of NEO research in general, and on requirements and other aspects of a permanent International NEO Early Warning System in particular;
c)prepare and submit to the IAU General Secretary by January 31, 2012, a Resolution for consideration by the IAU XXVIII General Assembly in Beijing, August 2012, asking for international action and support to establish an International NEO Early Warning System; such a Resolution, if accepted by the IAU XXVIII General Assembly, to be addressed to the IAU National Members, to the United Nations Committee on the Peaceful Uses of Outer Space (UN-COPUOS), and to the International Council for Science (ICSU).
We describe 22 patients from a multistate outbreak of Serraría marcescens bacteremia that was linked to contaminated prefilled syringes of heparin and saline supplied by 1 manufacturer. Contents of unused syringes were cultured in pools samples from 25 (5.3%) of 472 syringes grew S. marcescens. Despite good clinical outcomes overall, patients had substantial morbidity.
This project sought to evaluate the impact of a hospital-based Palliative Care Consultation (PCC) service utilizing a common practice: the resident mortality review conference.
Internal Medicine residents used a revised chart audit tool during the mortality review conference, which included domains described in the Clinical Practice Guidelines for Quality Palliative Care (2004). This study attempted to transform the common practice into a methodology for collecting data that could be used as a platform to assess the quality of hospital care near the end of life. In this review, the residents were asked not only “what care was delivered appropriately?” but “what could we have done?” to relieve the patient's and family's suffering.
The results showed that the mortality review process could be used to assess care at the end of life. It also showed that those patients who received a PCC received better care. Symptoms were addressed at a significantly higher rate for those patients who received a PCC than for those who did not. Specifically, these were symptoms of pain (75% vs. 51%, p <.0001), dyspnea (75% vs. 59%, p < 0.0001), nausea (28% vs. 18%, p < 0.0001), and agitation (53% vs. 33%, p < 0.0001).
Significance of results:
The mortality review process was found to be valuable in assessing care delivery for patients near the end of life. The tool yielded results that were consistent with findings of other studies looking at pain and symptom management, advance care planning, and the rate of palliative care consults across major diagnostic categories, supporting the face validity of the mortality review process.
In 2001 scientists from the New South Wales National Parks and Wildlife Service (now Department of Environment and Climate Change), La Trobe University and an environmental consulting firm investigated a mysterious death of grass outside a cave in Australia's Snowy Mountains. Heavy rains had washed dead bogong moths (Agrotis infusa) from the cave and grass touched by this outwash died. Investigations revealed that arsenic concentrated in the dead bogong moths poisoned the grass. Worryingly, arsenic occurred in the bodies or the droppings of three mammal species eating bogong moths, so arsenic contamination was spreading in the food chain.
The arsenic came from the plains of Queensland and western New South Wales, where bogong moths breed in autumn (Figure 27.1). The grubs, called cutworm caterpillars, eat grasses and crops before pupating in the soil to develop into winged adult moths. Arsenic-based insecticides were used intensively in the early 20th century and some are still available, so cutworm caterpillars probably absorb arsenic when eating crops. The adults migrate to the Snowy Mountains, aestivating during summer in caves until cooler weather when they return to the plains (Figure 27.2).
The bogong migration is amazing and inspirational, part of the natural legacy bequeathed by the Australian environment to its human occupants. By contrast, the moths' residual arsenic toxicity is disturbing, showing how human intervention may squander or spoil rich natural assets.