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Previous research has suggested an association between depression and subsequent acute stroke incidence, but few studies have examined any effect modification by sociodemographic factors. In addition, no studies have investigated this association among primary care recipients with hypertension.
We examined the anonymized records of all public general outpatient visits by patients aged 45+ during January 2007–December 2010 in Hong Kong to extract primary care patients with hypertension for analysis. We took the last consultation date as the baseline and followed them up for 4 years (until 2011–2014) to observe any subsequent acute hospitalization due to stroke. Mixed-effects Cox models (random intercept across 74 included clinics) were implemented to examine the association between depression (ICPC diagnosis or anti-depressant prescription) at baseline and the hazard of acute stroke (ICD-9: 430–437.9). Effect modification by age, sex, and recipient status of social security assistance was examined in extended models with respective interaction terms specified.
In total, 396 858 eligible patients were included, with 9099 (2.3%) having depression, and 10 851 (2.7%) eventually hospitalized for stroke. From the adjusted analysis, baseline depression was associated with a 17% increased hazard of acute stroke hospitalization [95% confidence interval (CI) 1.03–1.32]. This association was suggested to be even stronger among men than among women (hazard ratio = 1.29, 95% CI 1.00–1.67).
Depression is more strongly associated with acute stroke incidence among male than female primary care patients with hypertension. More integrated services are warranted to address their needs.
We investigate the turbulence statistics in a multiphase plume made of heavy particles (particle Reynolds number at terminal velocity is 450). Using refractive-index-matched stereoscopic particle image velocimetry, we measure the locations of particles whose buoyancy drives the formation of a multiphase plume, together with the local velocity of the induced flow in the ambient salt–water. Measurements of the mean axial flow in the plume centreplane follow Gaussian profiles and that of the mean radial flow is consistent with integral plume theory. The turbulence characteristics resemble those measured in a bubble plume, including strong anisotropy in the normal Reynolds stresses. However, we observe structural differences between the two multiphase plumes. First, the skewness of the probability density function of the axial velocity fluctuations is not that which would be predicted by simply reversing the direction of a bubble plume. Second, in contrast to a bubble plume, the particle plume has a non-negligible fluid-shear production term in the turbulent kinetic energy (TKE) budget. Third, the radial decay of all measured terms in the TKE budget is slower than those in a bubble plume. Despite these dissimilarities, a bigger picture emerges that applies to both flows. The TKE production by particles (or bubbles) roughly balances the viscous dissipation, except near the plume centreline. The one-dimensional power spectra of the velocity fluctuations show a
power law that puts both the particle and bubble plume in a category different from single-phase shear-flow turbulence.
Stigma and social exclusion related to mental health are of substantial public health importance for Europe. As part of ROAMER (ROAdmap for MEntal health Research in Europe), we used systematic mapping techniques to describe the current state of research on stigma and social exclusion across Europe. Findings demonstrate growing interest in this field between 2007 and 2012. Most studies were descriptive (60%), focused on adults of working age (60%) and were performed in Northwest Europe—primarily in the UK (32%), Finland (8%), Sweden (8%) and Germany (7%). In terms of mental health characteristics, the largest proportion of studies investigated general mental health (20%), common mental disorders (16%), schizophrenia (16%) or depression (14%). There is a paucity of research looking at mechanisms to reduce stigma and promote social inclusion, or at factors that might promote resilience or protect against stigma/social exclusion across the life course. Evidence is also limited in relation to evaluations of interventions. Increasing incentives for cross-country research collaborations, especially with new EU Member States and collaboration across European professional organizations and disciplines, could improve understanding of the range of underpinning social and cultural factors which promote inclusion or contribute toward lower levels of stigma, especially during times of hardship.
In 2010, the WHO called for innovative strategies to strengthen global health workers and develop an action framework on interprofessional education and collaborative practice. Studies consistently demonstrate health care delivered by teams working together improves quality, patient outcomes, patient satisfaction, efficiency, and job satisfaction. There is no place more evident for the need for collaboration than mental illness as it comprises the greatest burden of all illness worldwide due to its relationship to overall health, productivity, and longevity.
The purpose of the study was to explore the experiences of students, faculty, field supervisors, and preceptors in graduate psychiatric-mental health nursing and social work involved in an IPE course and clinical practica on co-occurring disorders.
In-depth interviews were conducted to understand how graduate level professionals learn from and with each other.
Participants grew to have a broader perspective of approaches to patient care through understanding discipline specific strengths and knowledge and by letting go of assumptions about the skills and scope of practice of the other professional group. Students who had prior practice experience in mental health settings were able to engage more in the course and described a richer learning experience in the course and practica settings than students who had less experience.
IPE courses facilitate understanding of each discipline’s theoretical underpinnings and how disciplines function and engage as a team in practice settings. Increasing the number of courses and practica opportunities in graduate programs and inclusion of more health professions disciplines is warranted.
According to the World Health Organization (WHO) mental and substance use disorders will surpass all physical diseases as the major cause of disability by the year 2020. The abuse of alcohol results in 2.5 million deaths annually, including 320,000 young people between the age of 15 and 29, and at least 15.3 million people have drug use disorders (WHO, 2013). The Indiana University Center for Health Policy studied the economic impact of substance abuse in Indiana and found that substance abuse and addiction have a powerful impact on all sectors of our society including education, criminal justice, health, workforce and public safety. Total cost for the state in 2008 was $7.3 billion and the professional capacity for nurturing the health of our citizens is woefully inadequate. With funding from the Substance Abuse and Mental Health Services Administration, faculty at Indiana University's Schools of Nursing, Social Work, and Medicine integrated Screening Brief Intervention and Referral to Treatment (SBIRT) into our health care education systems in order to improve the health of the large number of adolescents and adults at risk for one or more substance use disorders. SBIRT training was incorporated in select courses in each of the three schools using tailored webbased educational modules and face-to-face motivational interview (MI) training to prepare participants' for clinical practica. Innovative curricular materials will be presented as well as preliminary data on participants' knowledge, skills and attitudes related to training.
Studies suggest that alcohol consumption and alcohol use disorders have distinct genetic backgrounds.
We examined whether polygenic risk scores (PRS) for consumption and problem subscales of the Alcohol Use Disorders Identification Test (AUDIT-C, AUDIT-P) in the UK Biobank (UKB; N = 121 630) correlate with alcohol outcomes in four independent samples: an ascertained cohort, the Collaborative Study on the Genetics of Alcoholism (COGA; N = 6850), and population-based cohorts: Avon Longitudinal Study of Parents and Children (ALSPAC; N = 5911), Generation Scotland (GS; N = 17 461), and an independent subset of UKB (N = 245 947). Regression models and survival analyses tested whether the PRS were associated with the alcohol-related outcomes.
In COGA, AUDIT-P PRS was associated with alcohol dependence, AUD symptom count, maximum drinks (R2 = 0.47–0.68%, p = 2.0 × 10−8–1.0 × 10−10), and increased likelihood of onset of alcohol dependence (hazard ratio = 1.15, p = 4.7 × 10−8); AUDIT-C PRS was not an independent predictor of any phenotype. In ALSPAC, the AUDIT-C PRS was associated with alcohol dependence (R2 = 0.96%, p = 4.8 × 10−6). In GS, AUDIT-C PRS was a better predictor of weekly alcohol use (R2 = 0.27%, p = 5.5 × 10−11), while AUDIT-P PRS was more associated with problem drinking (R2 = 0.40%, p = 9.0 × 10−7). Lastly, AUDIT-P PRS was associated with ICD-based alcohol-related disorders in the UKB subset (R2 = 0.18%, p < 2.0 × 10−16).
AUDIT-P PRS was associated with a range of alcohol-related phenotypes across population-based and ascertained cohorts, while AUDIT-C PRS showed less utility in the ascertained cohort. We show that AUDIT-P is genetically correlated with both use and misuse and demonstrate the influence of ascertainment schemes on PRS analyses.
Little is known about long-term employment outcomes for patients with first-episode schizophrenia-spectrum (FES) disorders who received early intervention services.
We compared the 10-year employment trajectory of patients with FES who received early intervention services with those who received standard care. Factors differentiating the employment trajectories were explored.
Patients with FES (N = 145) who received early intervention services in Hong Kong between 1 July 2001 and 30 June 2002 were matched with those who entered standard care 1 year previously. We used hierarchical clustering analysis to explore the 10-year employment clusters for both groups. We used the mixed model test to compare cluster memberships and piecewise regression analysis to compare the employment trajectories of the two groups.
There were significantly more patients who received the early intervention service in the good employment cluster (early intervention: N = 98 [67.6%]; standard care: N = 76 [52.4%]; P = 0.009). In the poor employment cluster, there was a significant difference in the longitudinal pattern between early intervention and standard care for years 1–5 (P < 0.0001). The number of relapses during the first 3 years, months of full-time employment during the first year and years of education were significant in differentiating the clusters of the early intervention group.
Results suggest there was an overall long-term benefit of early intervention services on employment. However, the benefit was not sustained for all patients. Personalisation of the duration of the early intervention service with a focus on relapse prevention and early vocational reintegration should be considered for service enhancement.
Declaration of interests
No relevant conflicts of interests reported by C.L.M.H., Y.N.S., P.S., H.H.P. and K.K.Y. S.K.W.C., W.C.C. and E.H.M.L. report that they are members of the working group of the Early Assessment Service for Young People with Psychosis (EASY) programme of the Hospital Authority in Hong Kong. E.Y.H.C. is the convener of the working group of the EASY programme of the Hospital Authority in Hong Kong.
In this paper we present an experimental and theoretical study of weak bubble plumes in unstratified and stationary water. We define a weak bubble plume as one that spreads slower than the linear rate of a classic plume. This work focuses on the characteristics of the mean flow in the plume, including centreline velocity, plume spreading and entrainment of ambient water. A new theory based on diffusive spreading instead of an entrainment hypothesis is used to describe the lateral spreading of the bubbles and the associated plume. The new theory is supported by the experimental data. With the measured data of liquid volume fluxes and the new theory, we conclude that the weak bubble plume is a decreasing entrainment process, with the entrainment coefficient
in the weak bubble plume decreasing with height
, and taking on values much smaller than those in a classic bubble plume. An additional non-dimensional diffusion coefficient,
, is also needed to describe the evolution of the volume and kinematic momentum fluxes for the mean flow in the weak bubble plume. Here,
is the effective turbulent diffusion coefficient,
is the terminal rise velocity of the bubbles, and
is the kinematic buoyancy flux of the source. Finally, we provide a unified framework for the mean flow characteristics, including volume flux, momentum flux and plume spreading for the classic and weak bubble plumes, which also provides insight on the transition from classic to weak bubble plume behaviour.
We present the turbulent kinetic energy (t.k.e.) budget of a dilute bubble plume in its asymptotic state. The budget is derived from an experimental dataset of bubble plumes formed inside an unstratified water tank. The experiments cover both the adjustment phase and asymptotic state of the plume. The diameters
of air bubbles are in the range 1–4 mm and the air void fraction
is between 0.7 % and 1.8 %. We measured the three components of the instantaneous liquid velocity vector with a profiling acoustic Doppler velocimeter. From the experiments, we found the following inside the heterogeneous bubble core of the plume: (i) the probability density functions of the standardized liquid fluctuations are very similar to those of homogeneous bubble swarms rising with and without background liquid turbulence; (ii) the characteristic temporal frequency
at which bubbles inject t.k.e. into the liquid agrees with the prediction
observed and theoretically derived for homogeneous bubble swarms (
is the bubble slip velocity); (iii) the liquid turbulence is anisotropic with the ratio of turbulence intensities between the vertical and horizontal components in the range 1.9–2.1; (iv) the t.k.e. production by air bubbles is much larger than that by liquid mean shear; and (v) an increasing fraction of the available work done by bubbles is deposited into liquid turbulence as one moves away from the plume centreline. Together with the existing knowledge of homogeneous bubble swarms, our results of the heterogeneous bubble plume support the view that millimetre-sized bubbles create specific patterns of liquid fluctuations that are insensitive to flow conditions and can therefore be possibly modelled by a universal form.
We experimentally investigate the informational theory of legislative
committees (Gilligan and Krehbiel 1989). Two committee members provide policy-relevant
information to a legislature under alternative legislative rules.
Under the open rule, the legislature is free to make any decision;
under the closed rule, the legislature chooses between a member’s
proposal and a status quo. We find that even in the
presence of biases, the committee members improve the legislature’s
decision by providing useful information. We obtain evidence for two
additional predictions: the outlier principle,
according to which more extreme biases reduce the extent of
information transmission; and the distributional
principle, according to which the open rule is more
distributionally efficient than the closed rule. When biases are
less extreme, we find that the distributional principle dominates
the restrictive-rule principle, according to
which the closed rule is more informationally efficient. Overall,
our findings provide experimental support for Gilligan and
Krehbiel’s informational theory.
The increasing tropospheric ozone concentration [O3] strongly affects plant growth. However, the response of belowground processes in rice (Oryza sativa L.) systems to higher O3 is not well understood. The grain production, belowground biomass partitioning, root morphology and activity of rice (cv. Shanyou 63) were investigated in a free-air O3 enrichment platform at four key growth stages. Elevated O3 (EO3, 50% above the ambient O3) significantly decreased the grain yield and total biomass at the grain milky mature stage, root biomass at the tillering stage and root to shoot ratios (RRS) at the flowering and grain filling stages. The effects of EO3 on root morphology and activity varied among rice growth stage. EO3 significantly decreased root length, density, area, diameter and volume at the flowering stage, but EO3 significantly decreased various root morphological indices at the tillering, grain filling and milky mature stages. EO3 significantly increased the specific root respiration rate (root activity) and root respiration rate (autotrophic respiration) at grain filling and milky mature stages. Higher root autotrophic respiration and lower RRS in response to EO3 would reduce allocation of assimilated carbon to root growth, adversely affecting rice productivity. Our findings are critical for understanding the O3-induced impairment of belowground processes and carbon cycling in rice cropping systems and breeding of O3-tolerant cultivars under higher [O3] scenarios.
We present a generalisation of the Kármán–Howarth–Monin (K–H–M) equation to include variable-density (VD) effects. The derived equation (i) reduces to the original K–H–M equation when density is a constant and (ii) leads to a VD analogue of the
-law with the same value of constant (
) appearing as the prefactor of the dissipation rate. The equation is employed to understand negative turbulent kinetic energy production in a
turbulent round jet with an initial density ratio of 4.2. From a Reynolds-averaged Navier–Stokes (RANS) perspective, negative production means that the mean flow is strengthened at the expense of the energy of turbulent fluctuations. We show that the associated energy transfer is accomplished by the deformation of smaller turbulent eddies into large ones in the development region of the jet and is captured by the linear scale-by-scale energy transfer term in the VD K–H–M equation. The nonlinear transfer term of the VD K–H–M equation depicts a conventional forward cascade for all eddies having a size less than the Eulerian integral length scale, regardless of their orientation. The net effect is a retarded energy cascade in the non-Boussinesq jet that has not been accounted for by existing turbulence theories. Implications of this observation for turbulence modelling are discussed.
Diarrhea is a common cause of morbidity and mortality and the incidence of diarrhea in the world has changed little over the past four decades. To assess the prevalence of and healthcare practices for diarrhea, a cross-sectional study was conducted in Pudong, Shanghai, China. In October 2014, a total of 5324 community residents were interviewed. Respondents were asked if they had experienced diarrhea (defined as ⩾3 passages of watery, loose, bloody, or mucoid stools within a 24-h period) in the previous month prior to the interview. The monthly prevalence of diarrhea was 4·1% (95% CI: 3·3–4·8), corresponding to an incidence rate of 0·54 episodes per person-year. The proportion of individuals with diarrhea who sought healthcare was 21·2% (95% CI: 13·4–29·0). Diarrhea continues to impose a considerable burden on the community and healthcare system in Pudong. Young age and travel were identified as predictors of increased diarrhea occurrence.
Introduction: Medication discrepancies are unintended differences between a patient’s outpatient and inpatient medication regimens, and occur in up to 60% of hospital admissions. Canadian emergency departments (EDs) have implemented medication reconciliation forms that are pre-populated with outpatient medication dispensing data in order to reduce medication discrepancies and resultant adverse drug events. However, these forms may introduce errors of commission by prompting prescribers to reorder discontinued or potentially harmful medications. Our objective was to evaluate the incidence of medication discrepancies and errors of commission after the implementation of pre-populated medication reconciliation forms. Methods: This chart review included admitted patients who were enrolled in a parent study in which a research pharmacist prospectively collected best-possible medication histories (BPMHs) in the ED using all available information sources. Following discharge, research assistants uninvolved with the parent study compared medication orders documented within 48 h of admission with the BPMH to identify medication discrepancies and errors of commission. Errors of commission were defined as inappropriate continuations of medications and reordering discontinued medications. An independent panel adjudicated the clinical significance of the errors. We used regression methods to identify factors associated with errors. The sample size was limited by enrolment into the parent study. Results: Of 151 patients, 71 (47%; 95%CI 39.2-54.9) were exposed to 112 medication errors. Of these errors, 75.9% (85/112; 95%CI 67.1-82.9) were discrepancies, of which 18.8% (16/85; 95%CI 12.0-28.4) were clinically significant. Errors of commission made up 24.1% (27/112; 95%CI 17.3-32.8) of all errors, of which 37.0% (10/27; 95%CI 18.8-55.2) were clinically significant. Taking 8 or more medications was associated with a 5-fold greater odds of experiencing a medication error after controlling for confounders (OR 5.00; 95%CI 2.45-10.17; p<0.001). Conclusion: Clinically significant medication discrepancies and errors of commission remain common despite the implementation of electronically pre-populated medication reconciliation forms. Prospective studies are needed to evaluate whether using pre-populated medication reconciliation forms increases the risk of introducing errors of commission.
The collision between aqueous drops in air typically leads to coalescence after impact. Rebounding of the droplets with similar sizes at atmospheric conditions is not generated, unless with significantly large pressure or high impact parameters exhibiting near-grazing collision. Here we demonstrate experimentally the creation of a non-coalescent regime through addition of a small amount of water-soluble surfactant. We perform a direct simulation to account for the continuum and short-range flow dynamics of the approaching interfaces, as affected by the soluble surfactant. Based on the immersed-boundary formulation, a conservative scheme is developed for solving the coupled surface-bulk convection–diffusion concentration equations, which presents excellent mass preservation in the solvent as well as conservation of total surfactant mass. We show that the Marangoni effect, caused by non-uniform distributions of surfactant on the droplet surface and surface tension, induces stresses that oppose the draining of gas in the interstitial gap, and hence prohibits merging of the interfaces. In such gas–liquid systems, the repulsion caused by the addition of surfactant, as frequently observed in liquid–liquid systems such as emulsions in the form of an electric double-layer force, was found to be too weak to dominate in the attainable range of interfacial separation distances. These results thus identify the key mechanisms governing the impact dynamics of surfactant-coated droplets in air and imply the potential of using a small amount of surfactant to manipulate impact outcomes, for example, to prevent coalescence between droplets or interfaces in gases.
There is considerable confusion concerning the species of Sarcocystis in South American camelids (SAC). Several species names have been used; however, proper descriptions are lacking. In the present paper, we redescribe the macroscopic sarcocyst forming Sarcocystis aucheniae and describe and propose a new name, Sarcocystis masoni for the microscopic sarcocyst forming species. Muscles samples were obtained from llamas (Lama glama) and guanacos (Lama guanicoe) from Argentina and from alpacas (Vicugna pacos) and llamas from Peru. Individual sarcocysts were processed by optical and electron microscopy, and molecular studies. Microscopic sarcocysts of S. masoni were up to 800 µm long and 35–95 µm wide, the sarcocyst wall was 2·5–3·5 µm thick, and had conical to cylindrical villar protrusions (vp) with several microtubules. Each vp had 11 or more rows of knob-like projections. Seven 18S rRNA gene sequences obtained from sarcocysts revealed 95–96% identity with other Sarcocystis spp. sequences reported in the GenBank. Sarcocysts of S. aucheniae were macroscopic, up to 1·2 cm long and surrounded by a dense and laminar 50 µm thick secondary cyst wall. The sarcocyst wall was up to 10 µm thick, and had branched vp, appearing like cauliflower. Comparison of the 11 sequences obtained from individual macroscopic cysts evidenced a 98–99% of sequence homology with other S. aucheniae sequences. In conclusion, 2 morphologically and molecularly different Sarcocystis species, S. masoni (microscopic cysts) and S. aucheniae (macroscopic cysts), were identified affecting different SAC from Argentina and Peru.