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A core question in the debate about how to organise mental healthcare is whether in- and out-patient treatment should be provided by the same (personal continuity) or different psychiatrists (specialisation). The controversial debate drives costly organisational changes in several European countries, which have gone in opposing directions. The existing evidence is based on small and low-quality studies which tend to favour whatever the new experimental organisation is.
We compared 1-year clinical outcomes of personal continuity and specialisation in routine care in a large scale study across five European countries.
This is a 1-year prospective natural experiment conducted in Belgium, England, Germany, Italy and Poland. In all these countries, both personal continuity and specialisation exist in routine care. Eligible patients were admitted for psychiatric in-patient treatment (18 years of age), and clinically diagnosed with a psychotic, mood or anxiety/somatisation disorder.
Outcomes were assessed 1 year after the index admission. The primary outcome was re-hospitalisation and analysed for the full sample and subgroups defined by country, and different socio-demographic and clinical criteria. Secondary outcomes were total number of inpatient days, involuntary re-admissions, adverse events and patients’ social situation. Outcomes were compared through mixed regression models in intention-to-treat analyses. The study is registered (ISRCTN40256812).
We consecutively recruited 7302 patients; 6369 (87.2%) were followed-up. No statistically significant differences were found in re-hospitalisation, neither overall (adjusted percentages: 38.9% in personal continuity, 37.1% in specialisation; odds ratio = 1.08; confidence interval 0.94–1.25; p = 0.28) nor for any of the considered subgroups. There were no significant differences in any of the secondary outcomes.
Whether the same or different psychiatrists provide in- and out-patient treatment appears to have no substantial impact on patient outcomes over a 1-year period. Initiatives to improve long-term outcomes of psychiatric patients may focus on aspects other than the organisation of personal continuity v. specialisation.
Accurate three-dimensional dosimetry is essential in modern radiotherapy techniques such as volumetric-modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT). In this research work, the PRESAGE® dosimeter was used as quality assurance (QA) tool for VMAT planning for head and neck (H&N) cancer.
Material and method
Computer tomography (CT) scans of an Image Radiation Oncology Core (IROC) H&N anthropomorphic phantom with both IROC standard insert and PRESAGE® insert were acquired separately. Both CT scans were imported into the Pinnacle (9.4 version) TPS for treatment planning, where the structures [planning target volume (PTV), organs at risk) and thermoluminescent detectors (TLDs) were manually contoured and used to optimise a VMAT plan. Treatment planning was done using VMAT (dual arc: 182°–178°, 178°–182°). Beam profile comparisons and gamma analysis were used to quantify agreement with film, PRESAGE® measurement and treatment planning system (TPS) calculated dose distribution.
The average ratio of TLD measured to calculated doses at the four PTV locations in the H&N phantom were between 0·95 to 0·99 for all three VMAT deliveries. Dose profiles were taken along the left–right, the anterior–posterior and superior–inferior axes, and good agreement was found between the PRESAGE® and Pinnacle profile. The mean value of gamma results for three VMAT deliveries in axial and sagittal planes were found to be 94·24 and 93·16% when compared with film and Pinnacle, respectively. The average values comparing the PRESAGE® results and dose values calculated on Pinnacle were observed to be 95·29 and 94·38% in the said planes, respectively, using a 5%/3 mm gamma criteria.
The PRESAGE® dose measurements and calculated dose of pinnacle show reasonable agreement in both axial and sagittal planes for complex dual arc VMAT treatment plans. In general, the PRESAGE® dosimeter is found to be a feasible QA tool of VMAT plan for H&N cancer treatment.
Flavonoids are natural compounds derived from different types of vegetables, fruits, and medicinal herbal plants. Hesperidin, a flavanone (a class of flavonoids) glycoside is found abundantly in citrus fruits such as oranges, lemons tangerines and limes and is known to possess significant benefits, such as anti-inflammatory, anti-stress, antioxidant, growth promoting, anticancer and immunological properties. Hesperidin enhances mucosal and humoral immunity by increasing intestinal intraepithelial lymphocyte numbers, lymphoid organs (thymus, spleen and bursa) indices, as well as improving anti-avian influenza and anti-Newcastle disease antibody titres in poultry. In addition, hesperidin is a strong chain-breaking antioxidant that provides potent cellular antioxidant defence against the damaging effects induced by peroxide hydrogen. As a natural antioxidant, hesperidin could help mitigate heat stress during summer by decreasing heterophil-to-lymphocyte ratios, and quenching reactive oxygen species generated by summer heat stress. The aim of this review was to elucidate the biological effects and health benefits of hesperidin as an alternative of synthetic immune boosters and growth promoters in poultry diets.
The Khyber Pakhtunkhwa province of North-West Pakistan has endured increased levels of violence in recent years. The psychological sequelae of such trauma including the presence of dissociative symptoms has been minimally investigated to date. The study examines psychopathology experienced including the presence of dissociative symptoms, and ascertain what factors are potentially predictive of these symptoms.
Third-level students (n=303) completed psychometric instruments relating to their experience of traumatic events and assessed depression, anxiety and dissociative symptoms.
Symptoms suggestive of post-traumatic stress disorder were evident in 28% of individuals. Symptoms relating to intrusive experiences and alterations in reactivity predicted dissociative, depressive and anxiety symptoms (p<0.01).
Trauma related to violence in this study was associated with significant pathology including dissociative symptoms. Identification and subsequent treatment of dissociative symptoms in individuals who have experienced trauma, may have a significant ameliorating effect on levels of functioning and thus should be included in clinical assessment.
Avian influenza virus (AIV) type A subtype H9N2 usually causes mild asymptomatic infections, and is mostly undetected and is, therefore, under-reported. This has allowed the virus to rapidly evolve via mutations and reassortments in its genome with other avian influenza subtypes especially H1N1, H5N1 and H7N3 thereby introducing new variant strains and producing severe disease. It has been reported that the AIV H9N2 donated its internal genes for the devastating 1997 Hong Kong outbreak and furthermore, it may be the cause of the next influenza pandemic. There are many factors such as its wide host range, ability to cross the species barrier, ecological diversity, antiviral resistance and zoonotic importance that make it an excellent candidate for the next influenza pandemic. These and other factors like ineffective vaccination, negative immunological pressures, lack of surveillance, which contribute to its continuous persistence and evolutionary dynamics are discussed in this paper. It is important to take the necessary measures to control and prevent its unchecked circulation to prevent the future outbreaks.
The consumption of n-3 PUFAs is low, particularly the long chain (>18 carbon atoms) fatty acids that are most commonly found in fish oils. These dietary fatty acids have been shown to have a great effect on the health and immune status of different species including humans, rats and poultry. The current paper reviews studies on the effect of dietary polyunsaturated fatty acids on B- and T-cell subpopulations in peripheral blood, spleen, and thymus of poultry.
Zinc (Zn) is an important nutrient in poultry and its deficiency has been linked with various disorders, in addition to depressed growth and performance. It is now recognised that Zn has a major role in antioxidation, growth and development, production, immunity and stress related issues. Supplementation of Zn can improve growth, augment immunity, enhance antioxidant capacity, increase endocrine secretion and interact with other minerals in the gut. In this review, some of the basic information regarding the importance and activity of Zn within the body and the addition of Zn in poultry diets is discussed.
The compression and decompression behaviors of graphite oxide have been investigated using in situ Raman measurements in a diamond-anvil cell at room temperature. The so-called G band (in-plane E2g mode ∼1600 cm-1) was followed to 49 GPa during compression and back to ambient under decompression. The Raman frequency of the G band increases sublinearly with increasing hydrostatic pressure, eventually nearly flattening out at the highest pressure measured. This trend is reversed upon decompression, fully recovering to the ambient spectrum. The increased broadening suggests a reversible disordering of the structure without significant sp2-sp3 rehybridization under pressure.
We aimed to reparameterize and validate an existing dengue model, comprising an entomological component (CIMSiM) and a disease component (DENSiM) for application in Malaysia. With the model we aimed to measure the effect of importation rate on dengue incidence, and to determine the potential impact of moderate climate change (a 1 °C temperature increase) on dengue activity. Dengue models (comprising CIMSiM and DENSiM) were reparameterized for a simulated Malaysian village of 10 000 people, and validated against monthly dengue case data from the district of Petaling Jaya in the state of Selangor. Simulations were also performed for 2008-2012 for variable virus importation rates (ranging from 1 to 25 per week) and dengue incidence determined. Dengue incidence in the period 2010–2012 was modelled, twice, with observed daily weather and with a 1 °C increase, the latter to simulate moderate climate change. Strong concordance between simulated and observed monthly dengue cases was observed (up to r = 0·72). There was a linear relationship between importation and incidence. However, a doubling of dengue importation did not equate to a doubling of dengue activity. The largest individual dengue outbreak was observed with the lowest dengue importation rate. Moderate climate change resulted in an overall decrease in dengue activity over a 3-year period, linked to high human seroprevalence early on in the simulation. Our results suggest that moderate reductions in importation with control programmes may not reduce the frequency of large outbreaks. Moderate increases in temperature do not necessarily lead to greater dengue incidence.
In this paper, we demonstrate deposition methods and conditions that allow the control of the electrical properties of doped ZnTe grown by RF magnetron sputtering using both nitrogen and copper as dopants. The carrier density of the films was characterized using a van der Pauw Hall effect measurement method. We demonstrate how the concentration of nitrogen in the plasma during the growth of the film impacts the conductivity of the ZnTe films. Films with hole concentrations in excess of 1018 cm-3 and a high degree of crystallinity were successfully grown. Similarly, we demonstrate that the hole concentration in the Cu-doped ZnTe can be varied by varying the amount of copper introduced in the films. We also observe that annealing the copper doped ZnTe films increases the carrier density, whereas annealing the nitrogen doped ZnTe films causes a decrease in carrier concentration and conductivity.
The Ultra-Fast Flash Observatory (UFFO), which will be launched onboard the
Lomonosov spacecraft, contains two crucial instruments: UFFO Burst
Alert & Trigger Telescope (UBAT) for detection and localization of Gamma-Ray Bursts
(GRBs) and the fast-response Slewing Mirror Telescope (SMT) designed for the observation
of the prompt optical/UV counterparts. Here we discuss the in-space calibrations of the
UBAT detector and SMT telescope. After the launch, the observations of the standard X-ray
sources such as pulsar in Crab nebula will provide data for necessary calibrations of
UBAT. Several standard stars will be used for the photometric calibration of SMT. The
celestial X-ray sources, e.g. X-ray binaries with bright optical sources
in their close angular vicinity will serve for the cross-calibration of UBAT and SMT.
The Ultra-Fast Flash Observatory (UFFO) Pathfinder for Gamma-Ray Bursts (GRBs) consists
of two telescopes. The UFFO Burst Alert & Trigger Telescope (UBAT) handles the
detection and localization of GRBs, and the Slewing Mirror Telescope (SMT) conducts the
measurement of the UV/optical afterglow. UBAT is equipped with an X-ray detector, analog
and digital signal readout electronics that detects X-rays from GRBs and determines the
location. SMT is equipped with a stepping motor and the associated electronics to rotate
the slewing mirror targeting the GRBs identified by UBAT. First the slewing mirror points
to a GRB, then SMT obtains the optical image of the GRB using the intensified CCD and its
readout electronics. The UFFO Data Acquisition system (UDAQ) is responsible for the
overall function and operation of the observatory and the communication with the satellite
main processor. In this paper we present the design and implementation of the electronics
of UBAT and SMT as well as the architecture and implementation of UDAQ.
One of the unexplored domains in the study of gamma-ray bursts (GRBs) is the early time
phase of the optical light curve. We have proposed Ultra-Fast Flash Observatory (UFFO) to
address this question through extraordinary opportunities presented by a series of small
space missions. The UFFO is equipped with a fast-response Slewing Mirror Telescope that
uses a rapidly moving mirror or mirror array to redirect the optical beam rather than
slewing the entire spacecraft or telescope to aim the optical instrument at the GRB
position. The UFFO will probe the early optical rise of GRBs with sub-second response, for
the first time, opening a completely new frontier in GRB and transient studies. Its fast
response measurements of the optical emission of dozens of GRB each year will provide
unique probes of the burst mechanism and test the prospect of GRB as a new standard
candle, potentially opening up the z > 10 universe. We describe the current limit in
early photon measurements, the aspects of early photon physics, our soon-to-be-launched
UFFO-pathfinder mission, and our next planned mission, the UFFO-100.
The UFFO (Ultra-Fast Flash Observatory) is a GRB detector on board the Lomonosov
satellite, to be launched in 2013. The GRB trigger is provided by an X-ray detector,
called UBAT (UFFO Burst Alarm & Trigger Telescope), which detects X-rays from the GRB
and then triggers to determine the direction of the GRB and then alerts the Slewing Mirror
Telescope (SMT) to turn in the direction of the GRB and record the optical photon fluxes.
This report details the calibration of the two components: the MAPMTs and the YSO crystals
and simulations of the UBAT. The results shows that this design can observe a GRB within a
field of view of ±35° and can trigger in a time scale as short as 0.2 – 1.0 s
after the appearance of a GRB X-ray spike.
The Ultra-Fast Flash Observatory (UFFO) is a space observatory for optical follow-ups of
gamma ray bursts (GRBs), aiming to explore the first 60 seconds of GRBs optical emission.
UFFO is utilized to catch early optical emissions from GRBs within few sec after trigger
using a Gimbal mirror which redirects the optical path rather than slewing entire
spacecraft. We have developed a 15 cm two-axis Gimbal mirror stage for the UFFO-Pathfinder
which is going to be on board the Lomonosov satellite which is to be launched in 2013. The
stage is designed for fast and accurate motion with given budgets of 3 kg of mass and 3
Watt of power. By employing stepping motors, the slewing mirror can rotate faster than 15
deg/sec so that objects in the UFFO coverage (60 deg × 60 deg) can be targeted in
~1 sec. The obtained targeting resolution is better 2 arcmin using a close-loop
control with high precision rotary encoder. In this presentation, we will discuss details
of design, manufacturing, space qualification tests, as well as performance tests.
The Ultra-Fast Flash Observatory (UFFO) aims to detect the earliest moment of Gamma-Ray
Bursts (GRBs) which is not well known, resulting into the enhancement of GRB mechanism
understanding. The pathfinder mission was proposed to be a scaled-down version of UFFO,
and only contains the UFFO Burst Alert & Trigger Telescope (UBAT) measuring the
X-ray/gamma-ray with the wide-field of view and the Slewing Mirror Telescope (SMT) with a
rapid-response for the UV/optical photons. Once the UBAT detects a GRB candidate with the
position accuracy of 10 arcmin, the SMT steers the UV/optical photons from the candidate
to the telescope by the fast rotatable mirror and provides the early UV/optical photons
measurements with 4 arcsec accuracy. The SMT has a modified Ritchey-Chrètien telescope
with the aperture size of 10 cm diameter including the rotatable mirror and the image
readout by the intensified charge-coupled device. There is a key board called the UFFO
Data Acquisition system (UDAQ) that manages the communication of each telescope and also
of the satellite and the UFFO overall operation. This pathfinder is designed and built
within the limited size and weight of ~20 kg and the low power consumption up to
~30 W. We will discuss the design and performance of the UFFO-pathfinder, and its
integration to the Lomonosov satellite.