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To monitor the quality of physical health monitoring of patients prescribed depot antipsychotic medication in the North West Edinburgh Community Mental Health Team (CMHT). We also evaluated the completeness of prescriptions and Mental Health Act (Scotland) (Act) 2003 paperwork where relevant.
Antipsychotic medications are medicines for treating conditions such as Schizophrenia, but some may be associated with an increased risk of Metabolic Syndrome. Moreover, evidence indicates that patients with major mental disorder have a reduced life expectancy in comparison to those without such diagnoses. These two factors illustrate the importance of the physical health of this patient cohort being monitored on a regular basis. This project will evaluate how a local CMHT is performing, with the possibility of enacting service improvements if required.
The records of the 60 patients prescribed depot antipsychotic medication administered by this CMHT were reviewed. A check-list was created consisting of 14 categories analysing the quality of physical health monitoring, as well as compliance with prescription standards and, where relevant, Mental Health Act (Scotland) (Act) 2003 paperwork. We compared patient records against our checklist for the calendar year of 2019. The Scottish Intercollegiate Guidelines Network (SIGN) 131 (Management of Schizophrenia) section 5.2 was used as the gold standard for physical health monitoring against which the data we collected was compared.
We identified a wide range of flaws with the current system and implementation of monitoring, and difficulty in locating the required information. There was no consistent monitoring of physical observations on electronic record, nor an accepted alternative way in which this was documented. Furthermore, blood tests were not consistently obtained either by the service or GP practices in a reproducible manner. This led to discussions within the CMHT regarding creation of a new pathway for the monitoring of this patient cohort using a Quality Improvement model, with the ultimate goal to establish a regular physical health clinic.
There is significant evidence that patients with major mental disorder do not access healthcare as consistently as those without, leading to a disparity in life expectancy. In light of the fact that antipsychotic medications can be associated with Metabolic Syndrome, we have an even greater responsibility to tackle this marked health inequality by appropriately monitoring our patients. This was not done well in this particular CMHT, but this project will lead to improvements in the service and ultimately patient care.
Place a droplet of mineral oil on water and the oil will spread to cover the water surface in a thin film. In this paper we study the everted problem: an aqueous droplet deposited onto a deep layer of silicone oil. As it is energetically favourable for the oil phase to spread to cover the droplet surface completely, the droplet is ultimately engulfed in the oil layer. We present a detailed study of engulfment dynamics, from the instant the droplet impacts the oil surface until it finally sediments into the less dense oil. We study a broad range of droplet sizes (micrometric to millimetric) and oil kinematic viscosities ($10^2$–$10^5$ cSt), corresponding to a viscosity-dominated parameter regime. We find that droplet engulfment involves the rapid submersion of the droplet driven by capillary forces in the oil surface, followed by the much slower peeling of the droplet from the interface, to which it is adhered via a thin cloaking layer of oil formed during the earlier stage. The later peeling stage is driven by a combination of geometric constraints at the apparent contact line and gravity pulling on the droplet. Gravitational effects are therefore essential to complete engulfment, even for micrometric droplets. Furthermore, the opposing effects of geometry and gravity result in the longest engulfment times for droplets of intermediate size. Experiments at fixed droplet size reveal a power law dependence of engulfment time on oil kinematic viscosity, which we argue reflects the dynamical formation of the oil cloaking layer.
Motivated by the desire to understand complex transient behaviour in fluid flows, we study the dynamics of an air bubble driven by the steady motion of a suspending viscous fluid within a Hele-Shaw channel with a centred depth perturbation. Using both experiments and numerical simulations of a depth-averaged model, we investigate the evolution of an initially centred bubble of prescribed volume as a function of flow rate and initial shape. The experiments exhibit a rich variety of organised transient dynamics, involving bubble breakup as well as aggregation and coalescence of interacting neighbouring bubbles. The long-term outcome is either a single bubble or multiple separating bubbles, positioned along the channel in order of increasing velocity. Up to moderate flow rates, the life and fate of the bubble are reproducible and can be categorised by a small number of characteristic behaviours that occur in simply connected regions of the parameter plane. Increasing the flow rate leads to less reproducible time evolutions with increasing sensitivity to initial conditions and perturbations in the channel. Time-dependent numerical simulations that allow for breakup and coalescence are found to reproduce most of the dynamical behaviour observed experimentally, including enhanced sensitivity at high flow rate. An unusual feature of this system is that the set of steady and periodic solutions can change during temporal evolution because both the number of bubbles and their size distribution evolve due to breakup and coalescence events. Calculation of stable and unstable solutions in the single- and two-bubble cases reveals that the transient dynamics is orchestrated by weakly unstable solutions of the system that can appear and disappear as the number of bubbles changes.
COVID-19 altered research in Clinical and Translational Science Award (CTSA) hubs in an unprecedented manner, leading to adjustments for COVID-19 research.
CTSA members volunteered to conduct a review on the impact of CTSA network on COVID-19 pandemic with the assistance from NIH survey team in October 2020. The survey questions included the involvement of CTSAs in decision-making concerning the prioritization of COVID-19 studies. Descriptive and statistical analyses were conducted to analyze the survey data.
60 of the 64 CTSAs completed the survey. Most CTSAs lacked preparedness but promptly responded to the pandemic. Early disruption of research triggered, enhanced CTSA engagement, creation of dedicated research areas and triage for prioritization of COVID-19 studies. CTSAs involvement in decision-making were 16.75 times more likely to create dedicated diagnostic laboratories (95% confidence interval [CI] = 2.17–129.39; P < 0.01). Likewise, institutions with internal funding were 3.88 times more likely to establish COVID-19 dedicated research (95% CI = 1.12–13.40; P < 0.05). CTSAs were instrumental in securing funds and facilitating establishment of laboratory/clinical spaces for COVID-19 research. Workflow was modified to support contracting and IRB review at most institutions with CTSAs. To mitigate chaos generated by competing clinical trials, central feasibility committees were often formed for orderly review/prioritization.
The lessons learned from the COVID-19 pandemic emphasize the pivotal role of CTSAs in prioritizing studies and establishing the necessary research infrastructure, and the importance of prompt and flexible research leadership with decision-making capacity to manage future pandemics.
Rock debris covers ~30% of glacier ablation areas in the Central Himalaya and modifies the impact of atmospheric conditions on mass balance. The thermal properties of supraglacial debris are diurnally variable but remain poorly constrained for monsoon-influenced glaciers over the timescale of the ablation season. We measured vertical debris profile temperatures at 12 sites on four glaciers in the Everest region with debris thickness ranging from 0.08 to 2.8 m. Typically, the length of the ice ablation season beneath supraglacial debris was 160 days (15 May to 22 October)—a month longer than the monsoon season. Debris temperature gradients were approximately linear (r2 > 0.83), measured as −40°C m–1 where debris was up to 0.1 m thick, −20°C m–1 for debris 0.1–0.5 m thick, and −4°C m–1 for debris greater than 0.5 m thick. Our results demonstrate that the influence of supraglacial debris on the temperature of the underlying ice surface, and therefore melt, is stable at a seasonal timescale and can be estimated from near-surface temperature. These results have the potential to greatly improve the representation of ablation in calculations of debris-covered glacier mass balance and projections of their response to climate change.
The duration of incoming quitline calls may serve as a crude proxy for the potential amount of reactive counseling provided.
To explore whether call duration may be useful for monitoring quitline capacity and service delivery.
Using data on the duration of incoming quitline calls to 1-800-QUIT-NOW from 2012 through 2015, we examined national trends and state-level variation in average call duration. We estimated a regression model of average call duration as a function of total incoming calls, nationally and by state, controlling for confounders.
From 2012 through 2015, average call duration was 11.4 min, nationally, and was 10 min or longer in 33 states. Average call duration was significantly correlated with quitline service provider. Higher incoming call volume was significantly associated with lower average call duration in 32 states and higher average call duration in five states (P-value <0.05). The relationship between call volume and call duration was not correlated with quitline service provider.
Variation in average call duration across states likely reflects different service delivery models. Average call duration was associated with call volume in many states. Significant changes in call duration may highlight potential quitline capacity issues that warrant further investigation.
Childhood maltreatment (CM) plays an important role in the development of major depressive disorder (MDD). The aim of this study was to examine whether CM severity and type are associated with MDD-related brain alterations, and how they interact with sex and age.
Within the ENIGMA-MDD network, severity and subtypes of CM using the Childhood Trauma Questionnaire were assessed and structural magnetic resonance imaging data from patients with MDD and healthy controls were analyzed in a mega-analysis comprising a total of 3872 participants aged between 13 and 89 years. Cortical thickness and surface area were extracted at each site using FreeSurfer.
CM severity was associated with reduced cortical thickness in the banks of the superior temporal sulcus and supramarginal gyrus as well as with reduced surface area of the middle temporal lobe. Participants reporting both childhood neglect and abuse had a lower cortical thickness in the inferior parietal lobe, middle temporal lobe, and precuneus compared to participants not exposed to CM. In males only, regardless of diagnosis, CM severity was associated with higher cortical thickness of the rostral anterior cingulate cortex. Finally, a significant interaction between CM and age in predicting thickness was seen across several prefrontal, temporal, and temporo-parietal regions.
Severity and type of CM may impact cortical thickness and surface area. Importantly, CM may influence age-dependent brain maturation, particularly in regions related to the default mode network, perception, and theory of mind.
The United States today has the highest incarceration rate, as well as the largest number of people living under correctional control more broadly (including probation and parole), than any other country on the globe. The size of the American criminal justice system is not only internationally unparalleled, but it is also historically unprecedented. This apparatus is also deeply racialized. African Americans, Latinos, and indigenous populations (Hawaiian, Puerto Rican, Native American), are all represented in U. S. jails and prisons in numbers dramatically disproportionate to their representation in the population as a whole, and every non-White population is incarcerated at a rate far surpassing that of Whites. Notably, however, while the scale of today’s criminal justice system is unsurpassed and unprecedented, its severe racial disproportionality has always been a defining feature. Only by taking a close look at the long and deeply racialized history of the American criminal justice system, and more specifically at the regularly discriminatory application of the law as well as the consistent lack of equal justice under the law over time, can we fully understand not only why the American criminal justice system remains so unjust, but also why prison populations rose so dramatically when they did.
Registered nurses (RNs) and licensed practical nurses (LPNs) provide the skilled component of nursing care in Canadian residential long-term care facilities, yet we know little about this important workforce. We surveyed 309 RNs and 448 LPNs from 91 nursing homes across Western Canada and report descriptively on their demographics and work and health-related outcomes. LPNs were significantly younger than RNs, worked more hours, and had less nursing experience. LPNs also experienced significantly more dementia-related responsive behaviours from residents compared to RNs. Younger LPNs and RNs reported significantly worse burnout (emotional exhaustion) and poorer mental health compared to older age groups. Significant differences in demographics and work- and health-related outcomes were also found within the LPN and RN samples by province, region, and owner-operator model. These findings can be used to inform important policy decisions and workplace planning to improve quality of work life for nurses in residential long-term care facilities.
Children with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.
Materials and methods
We sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.
A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.
The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.