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Mental health services in Cambodia required rebuilding in their entirety after their destruction during conflict in the 1970s. During the late 1990s there was rapid growth and development of professional mental health training and education. Currently, basic mental healthcare is available primarily in urban areas and is provided by a mixture of government, non-government and private services. Despite the initial rapid growth of services and the development of a national mental health strategy in 2010, significant challenges remain in achieving an acceptable, standardised level of mental healthcare nationally.
In the theory of interaction noise from contra-rotating propellers with many blades, the usual far-field radiation formulae can be re-cast as a double integral, over a source surface, which can be evaluated asymptotically solely in terms of the contributions from critical points. The paper shows that these critical points have a particularly interesting physical meaning. They relate to locations on an event line, running between hub and tip, that represent the locus of the wake–blade interactions at a fixed point in time. The event line rotates at the speed of the spinning interaction tone but does not coincide with the radial variation in either the wake location or the rear blade leading edge. At the precise critical locations on the event line, it is shown that the Mach number of the event line is unity in the direction of the observer (the sonic condition) and the tangent to the event line – at a fixed time – is normal to a line drawn between it and the observer (the normal-edge condition). The zero-mode case is also considered, for which we show that, even though the event line rotates at infinite speed, there can still exist locations that satisfy the sonic and normal-edge conditions. The paper also discusses the physical meaning of the lower-order boundary solutions from the hub and tip.
Sustaining the impact of hepatitis B virus (HBV) vaccination on incidence and prevalence of HBV infection requires increasing and maintaining the uptake of vaccine among those at risk. In recent years, the level of vaccine uptake among people who inject drugs (PWID) in the UK has levelled-off. Data (2015–2016) from the national unlinked-anonymous monitoring survey of PWID, an annual survey that collects data from PWID across England, Wales and Northern Ireland, were used to examine HBV vaccine uptake. Data from participants who had injected drugs during the previous year were used to investigate sources of hepatitis B vaccine doses as well as factors associated with vaccine uptake. Among the 3175 anti-HBc-negative participants, 3138 (99%) reported their vaccination status; 23% (714) reported no vaccine uptake. Among those not vaccinated, 447 (63%) reported being sexually active and 116 (16%) reported sharing needles and syringes. Majority of those not vaccinated reported accessing services in the previous year that could have provided hepatitis B vaccine doses. These missed opportunities for vaccinating of PWID indicate a need for additional targeted interventions.
An analytical model is presented for the wake interaction tones produced by a contra-rotating propeller. We re-cast the usual far-field radiation formulae as a double integral over a nominal propeller source annulus. Assuming that the number of blades on both propellers is large, we evaluate the integral asymptotically in terms of its leading-order contributions from interior stationary or boundary critical points which represent the specific locations on the propeller annulus that dominate the sound radiation. The asymptotic approach is powerful producing results in the form of one-line algebraic formulae that contain no integrals or special functions yet remain accurate. The asymptotics show that sweep is not necessarily beneficial and can cause the blade design to become critical for particular tones and directions in terms of a continuum of interior points distributed along a line on the propeller source annulus producing a higher-order result and thus an enhanced radiated sound field. The paper also shows how the interior points are completely consistent with the sub- or super-critical gust response of a swept blade. Tones with low and zero azimuthal mode order are treated as special cases and the asymptotics show that, as the mode order reduces, the radiated sound becomes concentrated around the flight axis where even higher-order solutions are possible, including rings and annuli of stationary points around the propeller annulus. Full numerical calculations confirm the accuracy of the asymptotic approach.
Antineuronal antibodies are associated with psychosis, although their clinical significance in first episode of psychosis (FEP) is undetermined.
To examine all patients admitted for treatment of FEP for antineuronal antibodies and describe clinical presentations and treatment outcomes in those who were antibody positive.
Individuals admitted for FEP to six mental health units in Queensland, Australia, were prospectively tested for serum antineuronal antibodies. Antibody-positive patients were referred for neurological and immunological assessment and therapy.
Of 113 consenting participants, six had antineuronal antibodies (anti-N-methyl-D-aspartate receptor antibodies [n = 4], voltage-gated potassium channel antibodies [n = 1] and antibodies against uncharacterised antigen [n = 1]). Five received immunotherapy, which prompted resolution of psychosis in four.
A small subgroup of patients admitted to hospital with FEP have antineuronal antibodies detectable in serum and are responsive to immunotherapy. Early diagnosis and treatment is critical to optimise recovery.
Introduction: Trauma teams have been shown to improve outcomes in severely injured patients. The criteria used to mobilize trauma teams is highly variable and debated. This study was undertaken to define the triage accuracy at our level 1 trauma centre and identify the criteria predictive of appropriate activations. Methods: A 3-month prospective observational study was performed and all patients presenting to the ER who received a trauma flag were identified. Patient demographics, vital signs, trauma team activation and criteria for activation were documented. Trauma activations were deemed appropriate if the patient met any of the following; airway intervention, needle/tube thoracostomy, resuscitative thoracotomy, ED blood product transfusion, invasive hemodynamic monitoring, central line insertion, emergent OR (<8 hours), admission to ICU, and death within 72 hours. Over and undertriage rates were calculated and a multivariate logistic regression was performed to identify activation criteria predictive of appropraite activations. The activation criteria were then modified and the prospective study was repeated to assess the impact on triage accuracy. Results: Between September to December 2015, 188 patients received a trauma flag. 137 patients met the activation criteria, however only 78 received a trauma team activation. 57% of patients who had TTA met the definition of appropriate activation, while 45% who met criteria for activation met the definition of appropriate. The rates of under and overtriage were 30.4% and 30.3%, respectively. Logistic regression revealed the following criteria to be predictive of appropriate activation; hypotension (OR 10.2 95% CI 2.3,45.5), arrival by HEMS (OR 3.2, 95% CI 1.4,7.6), pedestrian struck (OR 3.5, 95% CI 1.4,8.5) and fall (OR 5.1, 95% CI 1.7, 15.1). Tachycardia (OR 1.1, 95% 0.3,4.6) and high energy MVC (OR 1.4, 95% CI 0.7,3.1) were not found to be predictive. The post-modification study occured between September to December 2016. Data analysis to assess the impact of criteria alteration are currently underway and will be presented at CAEP 2017. Conclusion: Triage accuracy for the mobilization of a multi-disciplinary trauma team is important, both to ensure optimal patient care as well as to reduce unnecessary resource strain. Our previous criteria lead to high rates of undertriage and subsequent modifications have been made. The impact of these changes will be ascertained and presented at CAEP 2017.
Obesity is undoubtedly caused by a chronic positive energy balance. However, the early metabolic and hormonal responses to overeating are poorly described. This study determined glycaemic control and selected gut hormone responses to nutrient intake before and after 7 d of high-fat overfeeding. Nine healthy individuals (five males, four females) performed a mixed meal tolerance test (MTT) before and after consuming a high-fat (65 %), high-energy (+50 %) diet for 7 d. Measurements of plasma glucose, NEFA, acylated ghrelin, glucagon-like peptide-1 (GLP-1), gastric inhibitory polypeptide (GIP) and serum insulin were taken before (fasting) and at 30-min intervals throughout the 180-min MTT (postprandial). Body mass increased by 0·79 (sem 0·14) kg after high-fat overfeeding (P<0·0001), and BMI increased by 0·27 (sem 0·05) kg/m2 (P=0·002). High-fat overfeeding also resulted in an 11·6 % increase in postprandial glucose AUC (P=0·007) and a 25·9 % increase in postprandial insulin AUC (P=0·005). Acylated ghrelin, GLP-1 and GIP responses to the MTT were all unaffected by the high-fat, high-energy diet. These findings demonstrate that even brief periods of overeating are sufficient to disrupt glycaemic control. However, as the postprandial orexigenic (ghrelin) and anorexigenic/insulintropic (GLP-1 and GIP) hormone responses were unaffected by the diet intervention, it appears that these hormones are resistant to short-term changes in energy balance, and that they do not play a role in the rapid reduction in glycaemic control.
Bovine tuberculosis (bTB) is an important disease of cattle caused by infection with Mycobacterium bovis, a pathogen that may be extremely difficult to eradicate in the presence of a true wildlife reservoir. Our objective was to identify and review relevant literature and provide a succinct summary of current knowledge of risk factors for transmission of infection of cattle. Search strings were developed to identify publications from electronic databases to February 2015. Abstracts of 4255 papers identified were reviewed by three reviewers to determine whether the entire article was likely to contain relevant information. Risk factors could be broadly grouped as follows: animal (including nutrition and genetics), herd (including bTB and testing history), environment, wildlife and social factors. Many risk factors are inter-related and study designs often do not enable differentiation between cause and consequence of infection. Despite differences in study design and location, some risk factors are consistently identified, e.g. herd size, bTB history, presence of infected wildlife, whereas the evidence for others is less consistent and coherent, e.g. nutrition, local cattle movements. We have identified knowledge gaps where further research may result in an improved understanding of bTB transmission dynamics. The application of targeted, multifactorial disease control regimens that address a range of risk factors simultaneously is likely to be a key to effective, evidence-informed control strategies.
We collected naturally infested Pinus resinosa Aiton (Pinaceae) and P. sylvestris Linnaeus to investigate phenological patterns and quantify parasitism by a suite of native hymenopteran parasitoids on two woodwasps (Hymenoptera: Siricidae): the invading non-native European woodwasp, Sirex noctilio Fabricius, and a co-colonising native, S. nigricornis Fabricius. We sampled a total of 76 trees from two field sites in 2010 and seven sites in 2011. In raw abundance, S. noctilio outnumbered S. nigricornis by 2:1 in 2010 and by 7.5:1 in 2011. We collected the egg/early instar parasitoid, Ibalia leucospoides ensiger Norton (Hymenoptera: Ibaliidae); four species of Rhyssinae (Hymenoptera: Ichneumonidae) late larval parasitoids; and Pseudorhyssa nigricornis (Ratzeburg) (Hymenoptera: Ichneumonidae), a cleptoparasitoid of rhyssines. Variation in siricid and parasitoid species assemblage and abundance was explained primarily by site, with tree-level factors playing a secondary role. Parasitism was significantly lower in P. sylvestris (13.6%±4.1 SE), a naturalised pine from Europe, than in the native P. resinosa (28.5%±5.0). Total parasitism was 27.6%±5.0 in 2010 and 20.9%±4.7 in 2011. This study represents the most robust analysis of the diverse woodwasp and parasitoid assemblage infesting pines in North America.
To make informed choices, patients need information about negative as
well as positive effects of treatments. There is little information about
negative effects of psychological interventions.
To determine the prevalence of and risk factors for perceived negative
effects of psychological treatment for common mental disorders.
Cross-sectional survey of people receiving psychological treatment from
184 services in England and Wales. Respondents were asked whether they
had experienced lasting bad effects from the treatment they received.
Of 14 587 respondents, 763 (5.2%) reported experiencing lasting bad
effects. People aged over 65 were less likely to report such effects and
sexual and ethnic minorities were more likely to report them. People who
were unsure what type of therapy they received were more likely to report
negative effects (odds ratio (OR) = 1.51, 95% CI 1.22–1.87), and those
that stated that they were given enough information about therapy before
it started were less likely to report them (OR = 0.65, 95% CI
One in 20 people responding to this survey reported lasting bad effects
from psychological treatment. Clinicians should discuss the potential for
both the positive and negative effects of therapy before it starts.
The problem of adverse effects of psychotherapy has been recognised for
decades, yet research on causes and prevention of harm has failed to
progress. There is confusion between different definitions and a lack of
systematic recording and reporting. A new framework for moving this field
forward is proposed.
Despite national guidance recommending testing and vaccination of household contacts of hepatitis B-infected pregnant women, provision and uptake of this is sub-optimal. The aim of this study was to evaluate the use of in-home dried blood spot (DBS) testing to increase testing and vaccination of household contacts of hepatitis B-infected pregnant women as an alternative approach to conventional primary-care follow-up. The study was conducted across two London maternity trusts (North Middlesex and Newham). All hepatitis B surface antigen-positive pregnant women identified through these trusts were eligible for inclusion. The intervention of in-home DBS testing for household contacts was introduced at North Middlesex Trust from November 2010 to December 2011. Data on testing and vaccination uptake from GP records across the two trusts were compared between baseline (2009) and intervention (2010–2011) periods. In-home DBS service increased testing uptake for all ages (P < 0·001) with the biggest impact seen in partners, where testing increased from 30·3% during the baseline period to 96·6% during the intervention period in North Middlesex Trust. Although impact on vaccine uptake was less marked, improvements were observed for adults. The provision of nurse-led home-based DBS may be useful in areas of high prevalence.
In June 2014 Public Health England confirmed a case of Legionnaires' disease (LD) in a neonate following birth at home in a hired birthing pool incorporating a heater and a recirculation pump which had been filled in advance of labour. The case triggered a public health investigation and a microbiological survey of an additional ten heated birthing pools hired or recently hired to the general public across England. The birthing pool used by the parent of the confirmed case was identified as the source of the neonate's infection following detection of Legionella pneumophila ST48 in both patient and environmental samples. Legionella species were detected by quantitative polymerase chain reaction but not culture in a further three pools together with other opportunistic pathogens identified by culture and matrix-assisted laser desorption ionization–time of flight (MALDI–ToF) mass spectrometry. A Patient Safety Alert from NHS England and Public Health England was issued stating that heated birthing pools filled in advance of labour should not be used for home births. This recommendation remains in place. This investigation in conjunction with other recent reports has highlighted a lack of awareness regarding the microbiological safety of heated birthing pools and their potential to be a source of LD and other opportunistic infections. Furthermore, the investigation raised important considerations with regards to microbiological sampling and testing in such incidents. Public health authorities and clinicians should consider LD in the differential diagnosis of severe respiratory infection in neonates within 14 days of a water birth.
Northeastern North America has produced an incredible number of late Pleistocene faunal remains; however, many of these were discovered and excavated prior to the development of radiocarbon dating. Moreover, many of the 14C dates that do exist for such specimens were assayed prior to the development of purified collagen extraction methods, were performed on botanical remains of unspecified association with the faunal remains, or were accepted without concerns of young-carbon contamination from museum preservatives. Here, we present a set of high-precision accelerator mass spectrometry (AMS) dates obtained on Pleistocene faunal specimens from Connecticut, New Jersey, and Pennsylvania. Our data contain both newly discovered specimens and specimens that have resided in museum collections for over a century.
Monitoring infections and risk in people who inject drugs (PWID) is important for informing public health responses. In 2011, a novel hepatitis C antibody (anti-HCV) avidity-testing algorithm to identify samples compatible with recent primary infection was introduced into a national surveillance survey. PWID are recruited annually, through >60 needle-and-syringe programmes and prescribing services. Of the 980 individuals that could have been at risk of HCV infection, there were 20 (2%) samples that were compatible with recent primary infection. These were more common among: those imprisoned ⩾5 times [8/213; adjusted odds ratio (aOR) 8·7, 95% confidence interval (CI) 2·04–37·03]; women (8/230; aOR 3·8, 95% CI 1·41–10·38); and those ever-infected with hepatitis B (5/56; aOR 6·25, 95% CI 2·12–18·43). This study is the first to apply this algorithm and to examine the risk factors associated with recently acquired HCV infection in a national sample of PWID in the UK. These findings highlight underlying risks and suggest targeted interventions are needed.
People who inject drugs are vulnerable to infections and injuries at injection sites, but these have rarely been studied in those injecting image- and performance-enhancing drugs (IPEDs). This study examined the factors associated with reported symptoms of injection site infections and injuries in IPED injectors. Of the 366 male IPED injectors surveyed, 42% reported ever having redness, swelling and tenderness (36% in the preceding year), and 6·8% had ever had an abscess or open wound at an injection site. Having these symptoms was associated with a range of factors related to drug use and healthcare utilization. One sixth (17%) of those reporting redness, tenderness and swelling had ever sought treatment, as had the majority (76%) of those reporting an abscess, sore or open wound. Most common sources of advice were emergency clinics and General Practitioners. Interventions are needed to support access to appropriate injecting equipment and provide targeted harm reduction advice.