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Prevalence estimates of childhood and adolescent mental health disorders appear to vary between 20 to 30% worldwide. It is therefore unsurprising that studies have yielded inconsistent findings in regards to the trends of prevalence of mental health disorders. Some reasons for the discrepancy in findings include use of survey data and its associated attrition and selection bias.
Objectives and aims
First, to determine and compare the prevalence of mental health disorders derived from a survey and a population cohort. Second, to evaluate trends of mental health prevalence over time.
As population data (i.e., linked health records) may be used to overcome the issues presented by survey data, we compared the prevalence estimated from a prospective survey cohort (the Western Australian Pregnancy Cohort (Raine study) to another estimate from a prospective population cohort (linked population data; data from the Hospital Morbidity Records and Mental Health Registration).
As expected, the Raine cohort yielded a larger estimate of prevalence when compared to the linked population data. However each cohort also revealed opposite trends of prevalence, where the Raine cohort showed the prevalence of mental health disorders to decrease as children age.
We therefore recommend that estimates of prevalence be interpreted with the type of cohort in mind, as estimates from survey cohorts will provide different information to that from population cohorts.
Postoperative cognitive impairment is among the most common medical complications associated with surgical interventions – particularly in elderly patients. In our aging society, it is an urgent medical need to determine preoperative individual risk prediction to allow more accurate cost–benefit decisions prior to elective surgeries. So far, risk prediction is mainly based on clinical parameters. However, these parameters only give a rough estimate of the individual risk. At present, there are no molecular or neuroimaging biomarkers available to improve risk prediction and little is known about the etiology and pathophysiology of this clinical condition. In this short review, we summarize the current state of knowledge and briefly present the recently started BioCog project (Biomarker Development for Postoperative Cognitive Impairment in the Elderly), which is funded by the European Union. It is the goal of this research and development (R&D) project, which involves academic and industry partners throughout Europe, to deliver a multivariate algorithm based on clinical assessments as well as molecular and neuroimaging biomarkers to overcome the currently unsatisfying situation.
Space Infrared Telescope for Cosmology and Astrophysics (SPICA), the cryogenic infrared space telescope recently pre-selected for a ‘Phase A’ concept study as one of the three remaining candidates for European Space Agency (ESA's) fifth medium class (M5) mission, is foreseen to include a far-infrared polarimetric imager [SPICA-POL, now called B-fields with BOlometers and Polarizers (B-BOP)], which would offer a unique opportunity to resolve major issues in our understanding of the nearby, cold magnetised Universe. This paper presents an overview of the main science drivers for B-BOP, including high dynamic range polarimetric imaging of the cold interstellar medium (ISM) in both our Milky Way and nearby galaxies. Thanks to a cooled telescope, B-BOP will deliver wide-field 100–350 $\mu$m images of linearly polarised dust emission in Stokes Q and U with a resolution, signal-to-noise ratio, and both intensity and spatial dynamic ranges comparable to those achieved by Herschel images of the cold ISM in total intensity (Stokes I). The B-BOP 200 $\mu$m images will also have a factor $\sim $30 higher resolution than Planck polarisation data. This will make B-BOP a unique tool for characterising the statistical properties of the magnetised ISM and probing the role of magnetic fields in the formation and evolution of the interstellar web of dusty molecular filaments giving birth to most stars in our Galaxy. B-BOP will also be a powerful instrument for studying the magnetism of nearby galaxies and testing Galactic dynamo models, constraining the physics of dust grain alignment, informing the problem of the interaction of cosmic rays with molecular clouds, tracing magnetic fields in the inner layers of protoplanetary disks, and monitoring accretion bursts in embedded protostars.
Introduction: Emergency hospital admissions are a growing concern for patients and health systems, globally. The objective of this study was to systematically review the evidence for diagnostic, medical, and surgical interventions that reduce emergency hospital admissions. Methods: We conducted a systematic review of systematic reviews by searching MEDLINE, PubMED, the Cochrane Database of Systematic Reviews, Google Scholar, and grey literature. Systematic reviews of any diagnostic, surgical, or medical interventions examining the effect on emergency hospital admissions among adults were included. The quality of reviews was assessed using AMSTAR and the quality of evidence was assessed using GRADE. The subsequent analysis was restricted to interventions with moderate or high-quality evidence only. Results: 13 051 titles and abstracts and 1 791 full-text articles were screened from which 42 systematic reviews were included. The reviews included an underlying evidence base of 215 randomized controlled trials with 135 282 patients. Of 20 unique diagnostic, medical, and surgical interventions identified, four had moderate (n = 4) or high (n = 0) quality evidence for significant reductions in hospital admissions in five patient populations. These were: cardiac resynchronization therapy for heart failure and atrial fibrillation, percutaneous aspiration for pneumothorax, early/routine coronary angiography for acute coronary syndrome (alone or comorbid with chronic kidney disease), and natriuretic peptide guided therapy for heart failure. Conclusion: We identified four interventions across five populations that when optimized, may lead to reductions in emergency hospital admissions. These finding can therefore help guide the development of quality indicators, standards, or practice guidelines.
Improving medical record keeping is a key part of the World Health Organization’s (WHO’s; Geneva, Switzerland) drive to standardize and evaluate emergency medical team (EMT) response to sudden onset disasters (SODs).
In response to the WHO initiative, the UK EMT is redeveloping its medical record template in line with the WHO minimum dataset (MDS) for daily reporting. When changing a medical record, it is important to understand how well it functions before it is implemented.
The redeveloped medical record was piloted at a UK EMT deployment course using simulated patients in order to examine ease of use by practitioners, and rates of data capture for key MDS variables.
Some parts of the form were consistently poorly filled in, and the way in which the form was completed suggested that the flow of the form did not align with the recorder’s natural thought processes when under pressure.
Piloting of a single-sheet triplicate medical record during an EMT deployment simulation led to significant modifications to improve data capture and function.
Jafar AJN, Fletcher RJ, Lecky F, Redmond AD. A pilot of a UK emergency medical team (EMT) medical record during a deployment training course. Prehosp Disaster Med. 2018;33(4):441–447.
Two overlapping but conceptually distinct approaches have been developed to describe how members of intimate dyads deal with adversity. In the social support approach, it is typically assumed that one individual has a problem and the other offers assistance in dealing with the problem. In the dyadic coping approach, an ideal is offered in which both members of the couple “own” the problem and take responsibility for coping with it as a team. A selective review of dyadic coping research is provided, including a range of research methods (linguistic analysis, qualitative interviews, experimental studies, and longitudinal projects). Most notably, these studies have shown that in the context of an ill partner, the healthy partner’s construal of the illness as a “we-disease” that is tackled jointly by both partners predicts better health outcomes and higher quality relationship assessments over time. The primary insight from dyadic coping is that the roles of “victim” and “helper” are not always necessary; couples can cope as equal partners, regardless of who is primarily impacted by the stressor. Useful contributions from the social support literature include insights into the conditions under which specific types of support are most effective (“optimal matching”) and how social psychological processes affect the quality of support exchanges. An integration of the two perspectives and directions for future research are suggested.
Introduction: Advanced care planning (ACP) and Goals of Care (GOC) discussions are becoming increasingly common in our emergency departments (ED). The national ACP task group has found that the majority of Canadians have not had prior ACP/GOC discussions, nor have they obtained proper documentation of their wishes. The task of having these difficult but important conversations falls frequently to the ED. Despite this, our emergency medicine (EM) residents receive little formal training in ACP discussions. To address this need, we developed and implemented a workshop in ACP/GOC conversations for the University of Alberta EM academic curriculum. Methods: A literature search was performed to identify best practices for ACP discussions in the ED, barriers to ACP in the ED, and tools for identifying ED patients appropriate for ACP. Experts in ACP/palliative care and staff ED physicians were asked to identify previous difficult ACP discussions and highlight aspects of these cases that were challenging in the ED environment. These experiences, best practices and published APC curricula informed the development of a 3-hour case-based workshop that was implemented in the 2016/17 academic year for EM staff and residents. Results: Cases utilized in the workshop emphasized common ACP/GOC situations that occur in the emergency department: Case 1: An 84 year old with C1 GOC whose family did not accept the GOC designation. Case 2: A 72 year old with multiple comorbidities arriving intubated with no GOC documented. Case 3: An 82 year old with decreased LOC whose family asks for an ACP discussion in the ED. Participants were divided into groups (5-6 members). Each small group analyzed and discussed each case before the participants reconvened and discussed their opinions in one large group. ACP experts from palliative care, emergency medical services and EM facilitated the discussions highlighting the best practices from the literature for each case reviewed. Pre and post Likert surveys were distributed to workshop participants to assess changes in confidence in a variety of domains. A Wilcoxon Signed Rank Test showed statistically significant improvement in learner confidence within the following areas (N=21; P<0.05): identifying patients appropriate for GOC discussions, initiating GOC discussions, and identifying barriers to GOC, in the ED. The majority (89%) of participants agreed the workshops should become part of our academic curriculum. Conclusion: An ACP/GOC workshop was successfully implemented and further ACP/GOC sessions are planned for the upcoming academic year. Looking ahead, we will look at using other teaching modalities such as simulation to further enhance the delivery of the curriculum. We will also attempt to capture defined physician behaviors (e.g. documenting GOC in the ED chart, sending letters to family physicians documenting GOC discussions) to gauge uptake of the workshop principles into clinical practice.
Fragments of possible fired clay found at Boncuklu Höyük, central Turkey, appear to derive from rudimentary vessels, despite the later ninth- and early eighth-millennium cal. bc and thus ‘Aceramic’ dates for the site. This paper will examine the evidence for such fired clay vessels at Boncuklu and consider their implications as examples of some of the earliest pottery in Anatolia. The discussion will examine contextual evidence for the role of these fragments and consider their relative rarity at the site and the implications for the marked widespread adoption of pottery in southwest Asia c. 7000–6700 cal. bc.
Recent spectropolarimetric surveys of bright, hot stars have found that ~10% of OB-type stars contain strong (mostly dipolar) surface magnetic fields (~kG). The prominent paradigm describing the interaction between the stellar winds and the surface magnetic field is the magnetically confined wind shock (MCWS) model. In this model, the stellar wind plasma is forced to move along the closed field loops of the magnetic field, colliding at the magnetic equator, and creating a shock. As the shocked material cools radiatively it will emit X-rays. Therefore, X-ray spectroscopy is a key tool in detecting and characterizing the hot wind material confined by the magnetic fields of these stars. Some B-type stars are found to have very short rotational periods. The effects of the rapid rotation on the X-ray production within the magnetosphere have yet to be explored in detail. The added centrifugal force due to rapid rotation is predicted to cause faster wind outflows along the field lines, leading to higher shock temperatures and harder X-rays. However, this is not observed in all rapidly rotating magnetic B-type stars. In order to address this from a theoretical point of view, we use the X-ray Analytical Dynamical Magnetosphere (XADM) model, originally developed for slow rotators, with an implementation of new rapid rotational physics. Using X-ray spectroscopy from ESA’s XMM-Newton space telescope, we observed 5 rapidly rotating B-types stars to add to the previous list of observations. Comparing the observed X-ray luminosity and hardness ratio to that predicted by the XADM allows us to determine the role the added centrifugal force plays in the magnetospheric X-ray emission of these stars.
This article explores the philosophical concept of akrasia, also known as weakness of will, and demonstrates its relevance to clinical practice. In particular, it challenges an implicit notion of control over one's actions that might impede recovery from substance misuse. Reflecting on three fictional case vignettes, we show how philosophical work on akrasia helps avoid this potentially harmful notion of control by supporting a holistic engagement with people for whom substance misuse is a problem. We argue that such engagement enhances their prospects of recovery by focusing on agency over time, as opposed to individual lapses.
Background: Research has suggested that female athletes have a higher incidence of concussion compared to their male counterparts. As such, programs designed to improve knowledge and attitudes of concussion should target this high-risk population. Previous work demonstrated the effect of a novel Concussion-U educational presentation on knowledge and attitudes of concussion amongst male Bantam and Midget AAA hockey players. The objective of this study was to determine if the same presentation was effective in improving the knowledge and attitudes of concussion in a cohort of elite female hockey players. Methods: 26 elite female high-school aged (14-17) hockey players from the province of New Brunswick consented to participate in the study. Each participant completed a modified version of Rosenbaum and Arnett’s Concussion Knowledge and Attitudes Survey questionnaire immediately before and after a Concussion-U educational presentation. Results were compared across the two time-points to assess the effectiveness of the presentation. Results: Concussion knowledge and attitude scores significantly (p<.001) increased from pre-presentation to post-presentation by 12.5% and 13.4%, respectively. Conclusions: A Concussion-U educational presentation resulted in increased knowledge and improved attitudes towards concussion in elite female hockey players. Future research should examine the long-term retention of these improvements.
During 1990 we surveyed the southern sky using a multi-beam receiver at frequencies of 4850 and 843 MHz. The half-power beamwidths were 4 and 25 arcmin respectively. The finished surveys cover the declination range between +10 and −90 degrees declination, essentially complete in right ascension, an area of 7.30 steradians. Preliminary analysis of the 4850 MHz data indicates that we will achieve a five sigma flux density limit of about 30 mJy. We estimate that we will find between 80 000 and 90 000 new sources above this limit. This is a revised version of the paper presented at the Regional Meeting by the first four authors; the surveys now have been completed.
Reintroductions are used to re-establish populations of species within their indigenous range, but their outcomes are variable. A key decision when developing a reintroduction strategy is whether to include a temporary period of confinement prior to release. Pre-release confinement is primarily used for the purpose of quarantine or as a delayed-release tactic to influence the performance or behaviour of founders post-release. A common difference between these approaches is that quarantine tends to be conducted in ex situ captivity, whereas delayed releases tend to involve in situ confinement at the release site. Although these practices are commonly viewed independently, it may be possible for a single confinement period to be used for both purposes. We tested whether temporarily holding wild eastern bettongs Bettongia gaimardi in ex situ captivity for 95–345 days prior to release (delayed release) influenced their body mass, pouch occupancy or survival during the first 1.5 years post-release, compared to founders released without confinement (immediate release). Our results suggest that exposing founders to captivity did not alter their body mass or performance post-release, despite being heavier and having fewer pouch young when released. We conclude that, for this species, ex situ captivity does not represent a tactical opportunity to improve post-release performance but can be used for quarantine without affecting the probability of establishment.
Genetic and environmental contributions to preferences for rational and experiential thinking were examined in 100 pairs of monozygotic and 73 pairs of same-sex dizygotic Australian twins. Univariate analyses for experiential thinking and working memory capacity (WMC) revealed genetic effects accounted for 44% and 39% of the variability respectively, with non-shared environmental effects accounting for the balance. For rational thinking, the univariate models produced ambiguous results about the relative roles of heritability and shared environment, but a subsequent Cholesky analysis suggested genetic effects accounted for 34%, with the balance, 66%, explained by the non-shared environment. The Cholesky analysis revealed that shared genetic effects accounted for 60%, and non-shared environment accounted for 40% of the relationship between preference for rational thinking and WMC.
This chapter focuses on defining and illustrating multimedia learning of metacognitive strategies, and reviews the empirical literature on multimedia learning of metacognitive strategies. It provides suggestions for augmenting contemporary cognitive theories of multimedia learning, proposes empirically based principles for designing multimedia environments aimed at fostering metacognitive strategies, and recommends several areas for future research. The chapter specifies self-regulated learning (SRL) as a concept superordinate to metacognition that incorporates both metacognitive monitoring (i.e., knowledge of cognition or metacognitive knowledge) and metacognitive control, as well as processes related to manipulating contextual conditions and planning for future activities within a learning episode. More research on multimedia learning of metacognitive strategies is needed to determine the optimal length of various phases of training programs and their effectiveness in laboratory versus real-world settings, as well as the retention and transfer of strategies to other domains and computer-based learning environments (CBLEs).
The new 1 m f/4 fast-slew Zadko Telescope was installed in June 2008 about 70 km north of Perth, Western Australia. It is the only metre-class optical facility at this southern latitude between the east coast of Australia and South Africa, and can rapidly image optical transients at a longitude not monitored by other similar facilities. We report on first imaging tests of a pilot program of minor planet searches, and Target of Opportunity observations triggered by the Swift satellite. In 12 months, 6 gamma-ray burst afterglows were detected, with estimated magnitudes; two of them, GRB 090205 (z = 4.65) and GRB 090516 (z = 4.11), are among the most distant optical transients imaged by an Australian telescope. Many asteroids were observed in a systematic 3-month search. In September 2009, an automatic telescope control system was installed, which will be used to link the facility to a global robotic telescope network; future targets will include fast optical transients triggered by high-energy satellites, radio transient detections, and LIGO gravitational wave candidate events. We also outline the importance of the facility as a potential tool for education, training, and public outreach.
Frailty puts individuals at increased risk for poor health outcomes. Elderly individuals use a disproportionate amount of emergency department (ED) resources. To investigate the relationship between frailty markers and the effect on ED use by community-dwelling seniors, we conducted a secondary analysis of a 22-month prospective randomized control trial in Montreal, Canada, using the Service Intégrés pour les Personnes Âgées en Perte d’Autonomie (SIPA) database. We assessed a sample of 565 individuals using five frailty markers: physical activity, strength, cognition, energy, and mobility. Univariate and multivariable logistic regression was performed to assess for potential relationship between frailty markers and ED visits. The findings revealed that 70 per cent of the participants had at least three frailty markers. No relationship was found between frailty markers and ED visits. These results suggest that in severely functionally disabled, community-dwelling elderly, the presence of frailty markers does not appear to predict ED visits.