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To describe the characteristics of people in Central and Eastern Sydney (CES), NSW, who had a General Practice Management Plan (GPMP) and claimed for at least one private allied health service item; and to examine if allied health service use results in less hospitalisations over a five-year period.
The number of people living with chronic health conditions is increasing in Australia. The Chronic Disease Management programme was introduced to the Medicare Benefits Schedule (MBS) to provide a more structured approach to managing patients with chronic conditions and complex care needs. The programme supports general practitioners claiming up to one GPMP and one Team Care Arrangement every year, and the patient additionally claiming for up to five private allied health services visits.
A prospective longitudinal study was conducted. The sample consisted of 5771 participants in CES who had a GPMP within a two-year health service utilisation baseline period (2007–2009). The analysis used the 45 and Up Study questionnaire data linked to the MBS, hospitalisation, death and emergency department data for the period 2006–2014.
Of the eligible participants, 43% (2460) had at least one allied health service item claim in the subsequent 12 months. Allied health services were reported as physiotherapy, podiatry and other allied health services. The highest rates of allied health service use were among participants aged 85 years and over (49%). After controlling for confounding factors, a significant difference was found between having claimed for five or more physiotherapy services and emergency admissions (HR: 0.83; 95% CI: 0.72–0.95) and potentially preventable hospitalisations (HR: 0.79; 95% CI: 0.64–0.96) in the subsequent five years. Use of allied health service items was well targeted towards those with chronic and complex care needs, and use of physiotherapy services was associated with less avoidable hospitalisations.
The stellar ultraviolet radiation (UVR) has been studied in the last decade and has been found to be an important factor to determine the habitability of planetary surfaces. It is known that UVR can be a constraint for life. However, most of the studies of UVR and habitability have missed some fundamental aspects: i) Accurate estimation of the planetary atmospheric attenuation, ii) The biological inferences used to represent the impact of the stellar UVR on life are theoretical and based on the action spectrum (for DNA or microorganisms) or considering parameters as the “lethal dose” obtained from non-astrobiological experiments. Therefore, the conclusions reached by previous studies about the UVR habitability of planetary bodies may be inaccurate. In this work, we propose how to address these studies in a more accurate way through an interdisciplinary approach that combines astrophysics, microbiology, and photobiology and by the use of specially designed laboratory experiments.
A study conducted as part of the development of the Eleventh International Classification of Mental Disorders for Primary Health Care (ICD-11 PHC) provided an opportunity to test the relationships among depressive, anxious and somatic symptoms in PHC.
Primary care physicians participating in the ICD-11 PHC field studies in five countries selected patients who presented with somatic symptoms not explained by known physical pathology by applying a 29-item screening on somatic complaints that were under study for bodily stress disorder. Patients were interviewed using the Clinical Interview Schedule-Revised and assessed using two five-item scales that measure depressive and anxious symptoms. Structural models of anxious-depressive symptoms and somatic complaints were tested using a bi-factor approach.
A total of 797 patients completed the study procedures. Two bi-factor models fit the data well: Model 1 had all symptoms loaded on a general factor, along with one of three specific depression, anxiety and somatic factors [x2 (627) = 741.016, p < 0.0011, RMSEA = 0.015, CFI = 0.911, TLI = 0.9]. Model 2 had a general factor and two specific anxious depression and somatic factors [x2 (627) = 663.065, p = 0.1543, RMSEA = 0.008, CFI = 0.954, TLI = 0.948].
These data along with those of previous studies suggest that depressive, anxious and somatic symptoms are largely different presentations of a common latent phenomenon. This study provides support for the ICD-11 PHC conceptualization of mood disturbance, especially anxious depression, as central among patients who present multiple somatic symptoms.
Norovirus (NoV) is a major cause of acute gastroenteritis (AGE). In this study, we investigated the genetic diversity of NoV strains identified in children under 5 years of age with AGE in four provinces of Angola. Faecal samples from 343 children were screened for NoV by an in house real-time PCR assay and genotyping was performed by partial capsid gene sequencing. NoV was detected in 17.4% (58/334) of the samples, with high detection rates in children <6 months old (19%) and in children aged 12–24 months (23%). Genotype diversity was large, as demonstrated by the 11 identified genotypes. GII.4 was the predominant genotype (20% of all NoV-positive samples), followed by GII.6 (15%), GI.3 (12%), GII.7 (10%) and by other genotypes to a lesser extent. Two GII.4 variants, New Orleans 2009 and Sydney 2012, were detected and several genetic clusters were observed for genotypes GI.3, GII.6 and GII.7. The present study shows high detection rates and genetic diversity of circulating NoV genotypes in paediatric AGE samples from Angola. This information emphasises the importance of continuous assessment of NoV burden and evolution in the target population.
In the framework of fully cooperative multi-agent systems, independent (non-communicative) agents that learn by reinforcement must overcome several difficulties to manage to coordinate. This paper identifies several challenges responsible for the non-coordination of independent agents: Pareto-selection, non-stationarity, stochasticity, alter-exploration and shadowed equilibria. A selection of multi-agent domains is classified according to those challenges: matrix games, Boutilier's coordination game, predators pursuit domains and a special multi-state game. Moreover, the performance of a range of algorithms for independent reinforcement learners is evaluated empirically. Those algorithms are Q-learning variants: decentralized Q-learning, distributed Q-learning, hysteretic Q-learning, recursive frequency maximum Q-value and win-or-learn fast policy hill climbing. An overview of the learning algorithms’ strengths and weaknesses against each challenge concludes the paper and can serve as a basis for choosing the appropriate algorithm for a new domain. Furthermore, the distilled challenges may assist in the design of new learning algorithms that overcome these problems and achieve higher performance in multi-agent applications.
The present work reports the covalent functionalization of few-wall CNTs (FWCNTs) by ferrocene derivatives to i) improve their dispersion efficiency in water and ii) to graft electroactive chemical groups on their side-walls in order to promote electron transfer to biomolecules. The functionalized CNTs (f-CNTs) are used to modify a glassy carbon electrode and this modified electrode is used for oxidizing the cofactor NADH (dihydronicotinamide adenine dinucleotide).
This work demonstrates the patterning of polymethylmethacrylate (PMMA) by ablation with Ar8+ ion laser (λ = 46.9 nm) pumped by pulse, high-current, capillary-discharge. For focusing a long-focal spherical mirror (R = 2100 mm) covered by 14 double-layer Sc-Si coating was used. The ablated focal spots demonstrate not only that the energy of our laser is sufficient for such experiments, but also that the design of focusing optics must be more sophisticated: severe aberrations were revealed — an irregular spot shape and strong astigmatism with astigmatic difference as large as 16 mm. In some cases, on the bottom of ablated spots a laser-induced periodic surface structure appeared. Finally, an illumination of the sample through quadratic hole 7.5 × 7.5 µm, standing in contact with PMMA substrate ablated from the surface a strongly developed two-dimensional diffraction pattern (period in the center about 125 nm).
In a setting where potable water is contaminated with Legionella pneumophila serogroup 1, we performed two case control studies. The first case control study consisted of 17 cases of nosocomial Legionnaires' disease (LD) and 33 control (the patients who were admitted to the ward where the case was admitted immediately before and after the case) subjects. Cases had a higher mortality rate 65% vs 12% (P < 0.004); were more likely to have received assisted ventilation (P < 0.00001); to have nasogastric tubes (P < 0.0004) and to be receiving corticosteroids or other immunosuppressive therapy (P < 0.0001). Based on the results of this study, sterile water was used to flush nasogastric tubes and to dilute nasogastric feeds. Only 3 cases of nosocomial LD occurred during the next year compared with 12 the previous year (P < 0.0001). Nine cases subsequently occurred and formed the basis for the second case-control study. Eighteen control subjects were those patients admitted to the same unit where the case developed LD, immediately before and after the case. The mortality rate for the cases was 89% vs 6% for controls (P < 0.00003). The only other significant difference was that cases were more likely to be receiving corticosteroids or other immunosuppressive therapy 89% vs 39% ( < 0.01). We hypothesized that microaspiration of contaminated potable water by immunocompromised patients was a risk factor for nosocomial Legionnaires' disease. From 17 March 1989 onwards such patients were given only sterile potable water. Only two cases of nosocomial LD occurred from June 1989 to September 1990 and both occurred on units where the sterile water policy was not in effect. We conclude that aspiration of contaminated potable water is a possible route for acquisition of nosocomial LD in our hospital and that provision of sterile potable water to high risk patients (those who are receiving corticosteroids or other immunosuppressive drugs; organ transplant recipients or hospitalized in an intensive care unit) should be mandatory.
A series of isothermal annealing experiments have been performed in the range 790–920°C under N2 flow in order to study the deuterium out-diffusion kinetics of Mg-doped GaN grown on sapphire under deuterated ammonia. The deuterium concentration was measured by SIMS analysis before and after each annealing step. The kinetics closely follow a first-order law. The activation energy related to the deuterium out-diffusion process is 3.1 eV. In addition, deuterium effusion measurements were performed measuring the molecular HD flux while the specimens were annealed in ultra high vacuum with a linear heating rate. In contrast to SIMS, this method detects the species that migrated out of the sample. Effusion peaks of the HD flux at 360 and 490°C are attributed to the fragmentation of adsorbed CHxDy complexes. The molecular HD flux starts increasing at 800°C which is the onset of the GaN decomposition and has its maximum at 920°C. This HD flux is accompanied by the desorption of H and D containing radicals and molecules desorbing above 900°C.
We have studied the structural and dynamical parameters
of two samples of elliptical-like-objects (ELOs)
formed in a set of self-consistent hydrodynamical simulations.
ELO stellar masses,
projected half- stellar mass radii, and stellar central
l.o.s. velocity dispersions have been found to
define a dynamical Fundamental Plane (FP),
whose physical origin we report on.
One can solve the Jeans equation analytically for
equilibrated dark matter structures, once given two pieces of input
from numerical simulations. These inputs are 1) a connection between
phase-space density and radius, and 2) a connection between velocity
anisotropy and density slope, the α – β relation. The first
(phase-space density vs. radius) has been analysed through several
different simulations, however the second (α – β relation) has not
been quantified yet. We perform a large set of numerical experiments
in order to quantify the slope and zero-point of the α – β
relation. This allows us to conclude that equilibrated dark matter
structures indeed have zero central velocity anisotropy,
slope of α0 ≈ –0.8, and outer anisotropy of
approximately β∞ ≈ 0.5.
Recent X-ray observations have been showing that the old vision of
clusters as peacefully relaxed structures is in most cases absolutely
wrong. Coupled with optical and radio observations, these X-ray data
show evidence for violent mechanisms. Results based on XMM-Newton gas
temperature maps for four clusters will be presented here.
We use the weak gravitational lensing effect to study the mass distribution of a
sample of 50 southern Abell
clusters (0.05 < z < 0.3) having LX > 5 × 1044 erg s-1 observed with ESO-VLT
under uniform sky conditions and subarsecond (0.6'') image quality. Their dynamical
equibrium is assesed through comparison of the clusters mass estimates made by weak-lensing,
velocity-dispersions and X-ray techniques. So far, for 24 clusters (Cypriano
et al. 2004),
we find: a) the center of their mass and light distributions are coincident for
77% of the sample; b) the elongations of the fitted mass profiles and of the light
of the cD galaxies generally match with each other; c) although most
of the clusters are found to be in dynamical equilibrium, those with TX ≥ 8 keV
(or σv ≥ 1120 km s-1) are the discordant ones. The preliminary
bright arc statistics for our whole sample (LZLS) suggests the presence of a
cut-off at z ~ 0.07 which is qualitatively consistent with predictions done
in a ΛCDM cosmology (Meneghetti et al. 2003).
We have developed an analytic model for a preheated, polytropic IGM in
hydrostatic equilibrium within a NFW potential in which the evolution
of the halo structure between major merger events proceeds inside-out
by accretion. For a polytropic index of 1.2, consistent with both many
observational results and predictions from high-resolution gasdynamical
simulations, our model is capable of reproducing faithfully all the
observed X-ray properties of nearby relaxed, non-cooling flow groups
and clusters of galaxies with a universal level of energy injection of
about half a keV (see Solanes et al. 2005 for details).
Caustics are formally singular structures that frequently
form in collisionless media. The non-negligible velocity dispersion of dark matter
particles renders their density finite. We evaluated the maximum density of
the caustics within the framework of secondary infall model of formation of
dark matter haloes. The result is
then used to demonstrate that caustics can be probed
by properly stacking the weak-lensing signal of about 600 haloes.
CFHTLS accompanied by X-ray observations and the
space-based experiments like SNAP or DUNE can provide
us with the required statistics.
The extension of our results to more realistic models including
the effects of mergers is outlined.
The inner Galaxy is completely dominated by baryons, contrary to the
predictions of CDM cosmology, whilst the observations are
compatible with MOND if the local circular speed is smaller than 220 km s-1
and the asymptotic circular velocity close to 170 km s-1.
We investigate the well-known correlations between the dynamical mass-to-light ratio M/L and other global observables of elliptical (E) and lenticular (S0) galaxies. We construct two-integral Jeans and three-integral Schwarzschild dynamical models for a sample of 25 E/S0 galaxies with SAURON integral-field stellar kinematics to about one effective (half-light) radius Re. The comparison of the dynamical M/L with the (M/L)pop inferred from the analysis of the stellar population, indicates that dark matter in early-type galaxies contributes ~30% of the total mass inside one Re, in agreement with previous studies, with significant variations from galaxy to galaxy. Our results suggest a variation in M/L at constant (M/L)pop, which seems to be linked to the galaxy dynamics. We speculate that fast rotating galaxies have lower dark matter fractions than the slow rotating and generally more massive ones.