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Research suggests that an increased risk of physical comorbidities might have a key role in the association between severe mental illness (SMI) and disability. We examined the association between physical multimorbidity and disability in individuals with SMI.
Data were extracted from the clinical record interactive search system at South London and Maudsley Biomedical Research Centre. Our sample (n = 13,933) consisted of individuals who had received a primary or secondary SMI diagnosis between 2007 and 2018 and had available data for Health of Nations Outcome Scale (HoNOS) as disability measure. Physical comorbidities were defined using Chapters II–XIV of the International Classification of Diagnoses (ICD-10).
More than 60 % of the sample had complex multimorbidity. The most common organ system affected were neurological (34.7%), dermatological (15.4%), and circulatory (14.8%). All specific comorbidities (ICD-10 Chapters) were associated with higher levels of disability, HoNOS total scores. Individuals with musculoskeletal, skin/dermatological, respiratory, endocrine, neurological, hematological, or circulatory disorders were found to be associated with significant difficulties associated with more than five HoNOS domains while others had a lower number of domains affected.
Individuals with SMI and musculoskeletal, skin/dermatological, respiratory, endocrine, neurological, hematological, or circulatory disorders are at higher risk of disability compared to those who do not have those comorbidities. Individuals with SMI and physical comorbidities are at greater risk of reporting difficulties associated with activities of daily living, hallucinations, and cognitive functioning. Therefore, these should be targeted for prevention and intervention programs.
Long-term care (LTC) patients are often sent to emergency departments (EDs) by ambulance. In this novel extended care paramedic (ECP) program, specially trained paramedics manage LTC patients on site. The objective of this pilot study was to describe the dispatch and disposition of LTC patients treated by ECPs and emergency paramedics.
Data were collected from consecutive calls to 15 participating LTC facilities for 3 months. Dispatch determinants, transport rates, and relapse rates were described for LTC patients attended by ECPs or emergency paramedics. ECP involvement in end-of-life care was identified.
Of 238 eligible calls, 140 (59%) were attended by an ECP and 98 (41%) by emergency paramedics. Although the top three determinants were the same in each group, the overall distribution of dispatch determinants and acuity differed. In the ECP cohort, 98 of 140 (70%) were treated and released, 33 of 140 (24%) had “facilitated transfer” arranged by an ECP, and 9 of 140 (6%) were immediately transported to the ED by ambulance. In the emergency paramedic cohort, 77 of 98 (79%) were immediately transported to the ED and 21 of 98 (21%) were not transported. In the ECP group, 6 of 98 (6%) patients not transported triggered a 911 call within 48 hours for a related clinical reason, although none of the patients not transported by emergency paramedics relapsed.
ECP involvement in LTC calls was found to reduce transports to the ED with a low rate of relapse. These pilot data generated hypotheses for future study, including determination of appropriate populations for ECP care and analysis of appropriate and safe nontransport.
High temperature multi-source co-evaporation has been the most successful approach to fabricate record efficiency Cu(InGa)Se2 devices, yet many groups have been unable to replicate this success when transferring these methods to the Cu2ZnSnSe4 system. The difficulties stem from the dramatic differences in the thermochemical properties which result in decomposition and loss of volatile species, such as Zn and SnSe, at temperatures needed for growth. In co-evaporation, decomposition and element loss must be managed throughout the entire growth process, from the back contact interface to the final terminating surface of the film. The beginning and ending phases of deposition encompass different kinetic regimes suggesting a phased approach to growth may be helpful. A series of depositions with different effusion profiles were used to demonstrate the effects of decomposition during different stages of growth. Secondary phase detection can be challenging in CZTSe, but a combination of SEM imaging and thin cross-section depth profile by EDS were found to best identify and locate the secondary phases that occur during different phases of growth for co-evaporated Cu2ZnSnSe4 films.
Deposition with a uniform incident flux followed by shuttered vacuum cool-down yielded films with a ZnSe phase at the absorber/Mo interface and Cu-rich composition at the surface of the exposed film. Devices from these absorber layers never exceeded conversion efficiencies of 1%. Decomposition at the surface could be prevented by continuing effusion of Se and Sn during the cool-down of the substrate. Resulting films demonstrated more faceted grains as well as significantly improved device performance. Secondary phases that traditionally form at the back contact during the beginning of growth were minimized by decreasing the substrate temperature to 300°C during the initial stages of deposition which reduced the ZnSe formed at the Mo interface. The thermochemical origin of the secondary phases will be discussed and the performance of representative devices will be presented.
Eriocheir sinensis, the Chinese mitten crab, is a native of east Asia and predominantly lives in freshwater but migrates seawards to breed. In 1912 a specimen was collected in the River Aller, a tributary of the Weser, Germany and now this exotic species has a European distribution from Finland to the Atlantic coast of southern France. In the UK, the mitten crab has been reported from the Humber, Medway and Thames catchments. Although the population in Thames had remained low, recent evidence suggests it is increasing, which has potential environmental implications.