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This paper presents Parallel World Framework as a solution for simulations of complex systems within a time-varying knowledge graph and its application to the electric grid of Jurong Island in Singapore. The underlying modeling system is based on the Semantic Web Stack. Its linked data layer is described by means of ontologies, which span multiple domains. The framework is designed to allow what-if scenarios to be simulated generically, even for complex, inter-linked, cross-domain applications, as well as conducting multi-scale optimizations of complex superstructures within the system. Parallel world containers, introduced by the framework, ensure data separation and versioning of structures crossing various domain boundaries. Separation of operations, belonging to a particular version of the world, is taken care of by a scenario agent. It encapsulates functionality of operations on data and acts as a parallel world proxy to all of the other agents operating on the knowledge graph. Electric network optimization for carbon tax is demonstrated as a use case. The framework allows to model and evaluate electrical networks corresponding to set carbon tax values by retrofitting different types of power generators and optimizing the grid accordingly. The use case shows the possibility of using this solution as a tool for CO2 reduction modeling and planning at scale due to its distributed architecture.
Introduction: The Maximizing Aging Using Volunteer Engagement in the ED (MAUVE + ED) program connects specially trained volunteers with older patients whose personal and social needs are not always met within the busy ED environment. The objective of this study was to describe the development and implementation of the MAUVE + ED program and the activities performed with older patients by its volunteers. Methods: The MAUVE + ED program was implemented in the ED (annual census 65,000) of a large academic tertiary hospital in Toronto, Ontario. Volunteers were trained to identify and approach older patients and others at greater risk for adverse outcomes, including poor patient experience, in the ED and invite such patients to participate in the program. The program is available to all patients >65 years, and those with confusion, patients who were alone, those with mobility issues, and patients with increased length of stay in the ED. Volunteers documented their activities after each patient encounter using a standardized paper-based data collection form. Results: Over the program's initial 6-month period, the MAUVE + ED volunteers reported a total of 896 encounters with 718 unique patients. The median (IQR) time a MAUVE volunteer spent with a patient was 10 (5, 20) minutes, with a range of 1 to 130 minutes. The median (IQR) number of patients seen per shift was 7 (6, 9), with a range of 1 to 16 patients per shift. The most common activities the volunteer assisted with were therapeutic activities/social visits (n = 859; 95.9%), orientation activities (n = 501; 55.9%), and hydration assistance (n = 231; 25.8%). The least common were mobility assistance (n = 36; 4.0%), and vision/hearing assistance (n = 13; 1.5%). Conclusion: Preliminary data suggest the MAUVE + ED volunteers were able to enrich the experience of older adults and their families/carers in the ED.
Two-dimensional (2D) quantum materials offer a unique platform to explore mesoscopic phenomena driven by interfacial and topological effects. Their tunable electric properties and bidimensional nature enable their integration into sophisticated heterostructures with engineered properties, resulting in the emergence of new exotic phenomena not accessible in other platforms. This has fostered many studies on 2D ferromagnetism, proximity-induced effects, and quantum transport, demonstrating their relevance for fundamental research and future device applications. Here, we review ongoing progress in this lively research field with special emphasis on spin-related phenomena.
High rate of non-attendance in mental health treatment is a major problem in terms of lost economic resources and deteriorated quality of life for the patients.
The aim of the present study was to conduct an analysis of the influence of demographic and clinical variables on treatment attendance.
A naturalistic study of 2473 non-psychotic consecutive patients offered psychotherapeutic treatment. Demographic and clinical variables were registered at assessment. Bivariate and multiple logistic regression analyses of the associations between these variables and attendance were conducted.
675 (27.3%) did not show up and 289 (11.7%) dropped out of treatment. Regression analysis showed that younger age, few years of school, taking an education, unemployment, no sick leave, personality disorder, low or high GAF, no earlier treatment, no use of psychoactive medicine, and substance abuse were significant predictors for non-attendance.
No-show was predicted mainly by clinical factors, whereas drop-out was predicted by demographic variables. Results and strategies to reduce non-attendance were discussed.
In a previous study women with long-term sequalae of child sexual abuse (CSA) were randomly assigned to analytic (Group A) or systemic group psychotherapy (Group S). Pre-post-analysis indicated that both therapies led to significant improvement, but overall Group S had significantly better outcome than Group A. As gains tended to rise in Group A during follow-up and decline in Group S, no statistically significant difference was detected in gains between the two treatment modalities after one year.
This study investigates if gains are maintained five year following termination, and if the groups differ in gains.
106 women started on allocated intervention. Psychological distress (GSI from SCL-90R), psycho-social functioning (GAF), and global life quality (GLQ), were assessed before and after treatment and one and five years following termination.
86 patients (81%) completed group therapy, 68 (64%) completed the one-year follow-up and 64 (60%) the five-year follow-up. At five year follow-up ANOVA was performed using treatment group as a between factor and the four time points as repeated measures. Intention to treat analysis demonstrated that improvement were significant on all measures (P < 0.000). Independent samples t-test on gains was NS for all measures.
Women with a history of CSA who were treated with Group A or Group S treatment maintained statistical significant improvement on GSI, GAF and GLQ five years post-treatment. No significant difference was found in gains between groups.
One out of four patients with eating disorders drop out of psychotherapeutic treatment. The high rate of dropout calls for ways to improve treatment adherence. Research indicates that continuous feedback to patient and therapist during treatment reduces the number of dropout and increases outcome; however there are only two published randomised trials on the effect of feedback on the treatment of eating disorders showing inconclusive results, and there are no randomised trials on the effect of feedback in group therapy.
We are investigating the impact of continuous feedback on dropout and outcome in group therapy. The hypothesis is that continuous feedback to patient and therapist on treatment progress and alliance will
1) reduce the number of dropouts and
2) increase treatment outcome.
We aim to discover if feedback is a way of improving adherence in group therapy for outpatients with eating disorders.
The trial is set up in a randomised design with 196 outpatients diagnosed with bulimia nervosa, binge eating disorder or eating disorder not otherwise specified, according to the DSM-IV. They are allocated to
a) systemic and narrative group therapy with feedback intervention or
b) systemic and narrative group therapy as usual.
In the experimental group, two sets of feedback measures are added to the treatment as usual: the outcome rating scale and the group session rating scale.
Results and conclusions
If the results will confirm the hypothesis, this trial will support feedback as a way to improve treatment adherence for outpatients with eating disorders.
Psychotherapeutic treatment is associated with significant reduction of symptoms in patients, and it is generally assumed that treatment improves health and decreases the need for additional health care. The present study investigates the long-term changes in utilization of health care services for patients referred to psychotherapeutic treatment in 2004 and 2005.
The study was a matched control study, which included 716 consecutive patients and 15,220 matched controls. Data from a comprehensive set of health care services were collected from central registries for an observation period of four years before intake and four years after ended treatment. Changes in utilization of health care services in eight health parameters were analyzed with t-test and with ANCOVA one and four year pre-post treatment.
Of the 761 patients, 216 patients did not show up for treatment, while 545 patients completed treatment; 228 responded and 201 did not respond to treatment. Data on treatment response was missing for the remaining 116 patients. Completer patients increased their use of all health care services with 296% (ES = 0.58) in the four year pre-post comparison, while the control group only increased with 99% (ES = 0.23). Four years after ended treatment completer patients still showed a consumption of health care services significantly above the control group on five out of eight health care parameters. Response status only affected one health care parameter.
Over a long-term period psychotherapy patients increased their utilization of health care services with a factor 3 compared to a control group.
Mental disorders are a primary cause of occupational impairments. This study investigated long-term changes in occupational functioning for patients referred to psychotherapeutic treatment at a Danish mental healthcare centre in 2004 and 2005.
We recruited 761 consecutive patients and 15,220 matched-control subjects. Data on number of days per year on sick leave, unemployment, and disability pension were collected from central registries over a 5-year observation period from 2002–2007. Differences in number of days with occupational impairments between and within groups were analyzed with t-test and with ANCOVA one and two year pre-post treatment.
Of the 761 patients, 216 patients did not show up for treatment, while 545 patients completed treatment; 228 responded and 201 did not respond to treatment. Data on treatment response was missing for the remaining 116 patients. Completer patients’ days on sick leave increased significantly from 15.7 days two years before treatment to 23.1 days two years after treatment (p < 0.000) and significant more than the control group (5.4days : 7.5 days). Similar results were found for days on disability pension (p = 0.013). Unemployment did not show any significant change for completer patients compared to the control group (p = 0.569). Variations in results were seen, depending on treatment status as no-show, responder or non-responder.
Patients that received psychotherapeutic intervention showed long-term increases in days on sick leave and disability pension.
Several studies have found that women who have experienced child sexual abuse (CSA) develop Post-Traumatic Stress Disorder (PTSD) related to their victimization experiences. The current study evaluated the presence of PTSD symptoms five years after discharge among adult women suffering from sequalae from CSA.
This randomized prospective 5-year follow-up study included 106 women: 52 assigned to psychodynamic group psychotherapy and 54 assigned to systemic group psychotherapy. PTSD symptoms were evaluated at baseline, discharge and 1 and 5 years after discharge, using the crime-related post-traumatic stress disorder scale (CR-PTSD) from the Symptom Checklist-90-Revised (SCL-90-R). ANOVA was performed using treatment group as a between factor and the four time points as repeated measures.
PTSD symptoms were significantly reduced during therapy for both groups (P < 0.000), but the systemic group exhibited significantly more reduction of PTSD symptoms than the analytic group (P < 0.002) at discharge. Difference in trajectories was found for the two groups (P > 0.005). No difference in reduction of PTSD symptoms was found between groups at 1 and 5 year follow-up.
Symptoms of PTSD were reduced in women with a history of CSA participating in both analytic and systemic specialized incest group psychotherapy. Improvement was maintained for both groups at 5-year-follow-up. The trajectories of PTSD symptoms for the two groups differed significantly, however. Implications of the difference in trajectories for treatment planning will be discussed. The findings in the present study stress the importance of long-term follow-up studies in evidence-based research.
Though sleep disturbances are common among psychiatric patients, some patients may trivialize their problem and not discuss it with their doctors. This study thus aimed to assess patient profile that is associated with help seeking for sleep problems among psychiatric patients.
Outpatients from a tertiary psychiatric hospital were recruited for this study (n = 400). The pittsburgh sleep quality index was administered to identify cases of probable insomnia, and daytime impairment due to sleep disturbances was recorded. Participants were asked if they have ever consulted a doctor or any health professionals for their sleep problems. Sociodemographic information was recorded and clinical profile was obtained from the patient's medical records. Multivariate logistic regression was used to examine correlates of help-seeking behaviour among patients with probable insomnia.
275 cases of probable insomnia were identified. Among this group of patients, 38.9% had never sought help for their sleep problems. Participants who were single were less likely to seek help as compared to those who were widowed/separated/divorced (OR= 0.319, P = 0.023). Having a comorbid psychiatric condition was independently associated with increased odds of help seeking (OR= 1.952, P = 0.027). Participants who perceived greater daytime impairment due to sleep problems were more likely to seek help (OR= 1.465, P = 0.007).
The majority of psychiatry patients with sleep problems sought professional help, though there remained a substantial group that did not do so. There is a need to educate and create awareness of potential sleep problems among psychiatric patients, and to inform them of the availability of treatment.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Epistaxis is a common ENT presentation. The British National Formulary lists epistaxis as a common side effect of atorvastatin. This study aimed to better understand the relationship between epistaxis and atorvastatin use, and determine whether ENT doctors are aware of its side effect profile.
A retrospective analysis over 10 months identified 100 individuals who presented to hospital with epistaxis. A questionnaire of 24 ENT registrars was undertaken.
Of the 100 patients admitted with epistaxis, 27 were receiving atorvastatin and 21 simvastatin. None of the 24 ENT registrars were aware that epistaxis was a listed common side effect of atorvastatin.
There was no apparent difference in the proportion of patients admitted with epistaxis taking atorvastatin versus simvastatin. Epistaxis is an unknown side effect of atorvastatin; doctors have an obligation to be aware of the pharmaceutical literature and to consider alternatives, particularly in re-admissions cases.
Prior research on Hodgins’ (2008) typology of offenders with schizophrenia spectrum disorders (SSD) has revealed inconsistencies in the number of subgroups and the operationalization of the concept. This study addressed these inconsistencies by applying latent class analysis (LCA) based on the most frequently explored variables in prior research. This novel case-centred methodology identified similarities and differences between the subjects contained in the sample instead of the variables explored. The LCA was performed on 71 variables taken from data on a previously unstudied sample of 370 case histories of offenders with SSD in a centre for inpatient forensic therapies in Switzerland. Results were compared with Hodgins’ theoretically postulated patient typologies and confirm three separate homogeneous classes of schizophrenic delinquents. Previous inconsistencies and differences in operationalizations of the typology of offenders with SDD to be found in the literature are discussed.
Non-tuberculous mycobacterium encephalitis is rare. Since 2013, a global outbreak of Mycobacterium chimaera infection has been attributed to point-source contamination of heater cooler units used in cardiac surgery. Disseminated M. chimaera infection has presented many unique challenges, including non-specific clinical presentations with delays in diagnosis, and a high mortality rate among predominantly immunocompetent adults. Here, we describe three patients with fatal disseminated Mycobacterium chimaera infection showing initially non-specific, progressively worsening neurocognitive decline, including confusion, delirium, depression and apathy. Autopsy revealed widespread granulomatous encephalitis of the cerebrum, brain stem and spinal cord, along with granulomatous chorioretinitis. Cerebral involvement and differentiation between mycobacterial granulomas and microangiopathic changes can be assessed best on MRI with contrast enhancement. The prognosis of M. chimaera encephalitis appears to be very poor, but might be improved by increased awareness of this new syndrome and timely antimicrobial treatment.
This presentation will enable the learner to:
1.Describe the clinical, radiological and neuropathological findings of Mycobacterium chimaera encephalitis
2.Be aware of this rare form of encephalitis, and explain its diagnosis, prognosis and management
In Canada, recreational use of cannabis was legalized in October 2018. This policy change along with recent publications evaluating the efficacy of cannabis for the medical treatment of epilepsy and media awareness about its use have increased the public interest about this agent. The Canadian League Against Epilepsy Medical Therapeutics Committee, along with a multidisciplinary group of experts and Canadian Epilepsy Alliance representatives, has developed a position statement about the use of medical cannabis for epilepsy. This article addresses the current Canadian legal framework, recent publications about its efficacy and safety profile, and our understanding of the clinical issues that should be considered when contemplating cannabis use for medical purposes.
Simulation-based training has a fundamental role in medical education as it allows the learner to gain experience managing emergencies in a safe, controlled environment.
This 1-day course consisted of eight high-fidelity simulation scenarios, followed by a video-assisted debrief focusing on the technical and non-technical (communication skills, teamwork, leadership and situational awareness) aspects of managing ENT and head and neck emergencies.
Eight courses have run since June 2014. Post-course questionnaires demonstrated that candidates’ confidence scores in managing airway and head and neck emergencies increased following completion of the course (p < 0.0001).
This was the first fully immersive ENT simulation course developed in the region. The learning objectives for each scenario were mapped to the ENT Intercollegiate Surgical Curriculum Programme. Feedback from the course indicated a continued demand for this style of training, leading to its inclusion in the training calendar.
Although polyphenols inhibit glucose absorption and transport in vitro, it is uncertain whether this activity is sufficient to attenuate glycaemic response in vivo. We examined this using orange juice, which contains high levels of hesperidin. We first used a combination of in vitro assays to evaluate the potential effect of hesperidin and other orange juice components on intestinal sugar absorption and then tested whether this translated to an effect in healthy volunteers. Hesperidin attenuated transfer of 14C-labelled glucose across differentiated Caco-2/TC7 cell monolayers. The involvement of the sugar transporter GLUT2 was demonstrated by experiments carried out in the absence of Na to exclude the contribution of sodium-glucose linked transporter 1 and further explored by the use of Xenopus laevis oocytes expressing human GLUT2 or GLUT5. Fructose transport was also affected by hesperidin partly by inhibition of GLUT5, while hesperidin, even at high concentration, did not inhibit rat intestinal sucrase activity. We conducted three separate crossover interventions, each on ten healthy volunteers using orange juice with different amounts of added hesperidin and water. The biggest difference in postprandial blood glucose between orange juice and control, containing equivalent amounts of glucose, fructose, sucrose, citric acid and ascorbate, was when the juice was diluted (ΔCmax=–0·5 mm, P=0·0146). The effect was less pronounced when the juice was given at regular strength. Our data indicate that hesperidin can modulate postprandial glycaemic response of orange juice by partial inhibition of intestinal GLUT, but this depends on sugar and hesperidin concentrations.
We present observations of 50 deg2 of the Mopra carbon monoxide (CO) survey of the Southern Galactic Plane, covering Galactic longitudes l = 300–350° and latitudes |b| ⩽ 0.5°. These data have been taken at 0.6 arcmin spatial resolution and 0.1 km s−1spectral resolution, providing an unprecedented view of the molecular clouds and gas of the Southern Galactic Plane in the 109–115 GHz J = 1–0 transitions of 12CO, 13CO, C18O, and C17O.
We present a series of velocity-integrated maps, spectra, and position-velocity plots that illustrate Galactic arm structures and trace masses on the order of ~106 M⊙ deg−2, and include a preliminary catalogue of C18O clumps located between l = 330–340°. Together with the information about the noise statistics of the survey, these data can be retrieved from the Mopra CO website and the PASA data store.
The discovery of the first electromagnetic counterpart to a gravitational wave signal has generated follow-up observations by over 50 facilities world-wide, ushering in the new era of multi-messenger astronomy. In this paper, we present follow-up observations of the gravitational wave event GW170817 and its electromagnetic counterpart SSS17a/DLT17ck (IAU label AT2017gfo) by 14 Australian telescopes and partner observatories as part of Australian-based and Australian-led research programs. We report early- to late-time multi-wavelength observations, including optical imaging and spectroscopy, mid-infrared imaging, radio imaging, and searches for fast radio bursts. Our optical spectra reveal that the transient source emission cooled from approximately 6 400 K to 2 100 K over a 7-d period and produced no significant optical emission lines. The spectral profiles, cooling rate, and photometric light curves are consistent with the expected outburst and subsequent processes of a binary neutron star merger. Star formation in the host galaxy probably ceased at least a Gyr ago, although there is evidence for a galaxy merger. Binary pulsars with short (100 Myr) decay times are therefore unlikely progenitors, but pulsars like PSR B1534+12 with its 2.7 Gyr coalescence time could produce such a merger. The displacement (~2.2 kpc) of the binary star system from the centre of the main galaxy is not unusual for stars in the host galaxy or stars originating in the merging galaxy, and therefore any constraints on the kick velocity imparted to the progenitor are poor.
HESS J1614–518 and HESS J1616–508 are two tera-electron volt γ-ray sources that are not firmly associated with any known counterparts at other wavelengths. We investigate the distribution of interstellar medium towards the tera-electron volt γ-ray sources using results from a 7-mm-wavelength Mopra study, the Mopra Southern Galactic Plane CO Survey, the Millimetre Astronomer’s Legacy Team-45 GHz survey and [C i] data from the HEAT telescope. Data in the CO(1–0) transition lines reveal diffuse gas overlapping the two tera-electron volt sources at several velocities along the line of sight, while observations in the CS(1–0) transition line reveal several interesting dense gas features. To account for the diffuse atomic gas, archival H i data was taken from the Southern Galactic Plane Survey. The observations reveal gas components with masses ~103 to 105 M⊙ and with densities ~102 to 103 cm−3 overlapping the two tera-electron volt sources. Several origin scenarios potentially associated with the tera-electron volt γ-ray sources are discussed in light of the distribution of the local interstellar medium. We find no strong convincing evidence linking any counterpart with HESS J1614–518 or HESS J1616–508.