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If current food consumption patterns continue, the agriculture sector must provide significantly more food in the coming years from the available land area. Some livestock systems engage in feed–food competition as arable land is used for livestock feed rather than as crops for food; reducing the global supply of food. There is a growing argument that to meet future-food demands sustainably, feed–food competition must be minimized. To this end, we evaluated the effectiveness of two refined metrics to quantify feed–food competition in three livestock systems; dairy and its beef, suckler beef and pig production in Ireland. The metrics are edible protein conversion ratio (EPCR) and the land-use ratio (LUR). The EPCR compares the amount of human digestible protein (HDP) in livestock feed against the amount of HDP the livestock produced, calculating how efficiently it produces HDP. However, the LUR compares the potential HDP from a crop system on the land used to produce the livestock's feed against the HDP the livestock system produced. In both metrics, a value <1 demonstrates an efficient system. The EPCR values for dairy beef (0.22) and suckler beef (0.29) systems consider them efficient producers, whereas pig production (1.51) is inefficient. The LUR values designate that only the dairy beef (0.58) is a net positive producer of HDP from the land used for its feed, with crop production producing more HDP than suckler beef (1.34) and pig production (1.73). Consequently, the LUR can be deemed to be more suitable to represent feed–food competition in livestock production.
Recent evidence has questioned modern psychiatric clinical practice, specifically the prescribing of “atypical” antipsychotics. Our Pan-European Research Group wished to ascertain clinical practice amongst European trainees, which treatments trainees would desire for themselves, and factors influencing this.
A semi-structured survey was constructed from prior literature, piloted, and a homogenous sample size of at least 50 was agreed upon from each country, with 50% minimum response rate. It was distributed via web-link, with questions on preference of antipsychotic for patients in given scenarios, and factors influencing choice. Physicians were asked for their preference should they develop psychosis.
i) Treatment choice of antipsychotic for patients
93% (n=600) of respondents chose to prescribe “atypical” antipsychotics (excluding Clozapine), 6% (n=42) choosing “typical” antipsychotics, 1% (n=6) choosing Clozapine as first-line therapy.
ii) Treatment choice if trainees developed psychosis
89% (n=530) of responders chose to prescribe “atypical” antipsychotics (excluding Clozapine), 7% (n=40) choosing “typical” antipsychotics, 4% (n=23) choosing Clozapine as first-line therapy.
iii) Factors influencing choice
These mapped onto three domains: cost, efficacy and side-effect profile (less than 5% other reasons). 79% (n=458) of those who responded felt efficacy most important, 46% (n=270) felt side-effect profile most important and 3% (n=16) considered cost of paramount importance.
38% (n=272) of those who responded to the survey stated that the CATIE trial had influenced their decision-making.
Psychiatry trainees’ choice of antipsychotic medication for both patients and themselves is based on perceived benefits, as opposed to evidence base and recent literature.
Guidelines produced for management of Bipolar Disorder illustrate change in evidence-base for treatment of acute and maintenance phases of illness. Our Pan-European Research Group assessed clinical practice and desired treatments amongst amongst Psychiatry trainees.
A semi-structured survey was piloted, and homogenous sample size (at least 50) agreed upon from each country, with 50% minimum response rate. It was distributed via web-link, questioning preference of mood stabiliser for patients, trainees themselves and factors influencing choice.
Tables 1 summarise choices.
Lithium and Sodium Valproate
2nd Generation Atypical antipsychotics
[Choice of mood stabiliser for patient/themselves]
Factors influencing decision-making mapped onto cost, efficacy and side-effect profile (less than 4% other reasons). 66% (n=538) of respondents felt efficacy most important, 25% (n=202) felt side-effect profile most important and 3% (n=24) considered cost of most importance.
No clear difference exists in choice of mood stabiliser for European trainees and their patients, and decisions based on perceived efficacy are generally in keeping with established guidelines.
There is growing concern about the influence of the pharmaceutical industry on psychiatric teaching and psychiatric professionalism as a whole. As a consequence, several national and international medical and psychiatric associations have issued guidelines to regulate the interactions between physicians and industry.
The EFPT-PRIRS study aims to provide the lacking data on the extent and nature of these interactions among psychiatric trainees across Europe.
Study objectives were determined by the EFPT research group (EFPT-RG), after discussion with national and international experts. A survey was then devised compiling previously published questionnaires extending them by questions with specific relevance to psychiatric trainees. The resulting questionnaire was piloted amongst members of the EFPT-RG, modified accordingly and subsequently distributed to the national study coordinators. All 24 EFPT member countries were invited to participate in the study and data collection is currently ongoing.
Preliminary analysis reveals the vast differences in industry - trainee relationships across European countries as well as major differences in personal attitudes towards these interactions.
EFPT-PRIRS will potentially have an impact on the regulation of the interactions between the pharmaceutical industry and psychiatric trainees.
Despite recent recent evidence and subsequent guidelines that have suggested factors such as side-effect profile and cost should be taken into account when prescribing antidepressant medication, relatively little evidence exists on decision-making in clinical practice.
Our Pan-European Research Group looked at clinical practice regarding antidepressants amongst Psychiatry trainees, treatments trainees would desire themselves, and factors influencing decision-making.
A semi-structured survey was constructed from recent literature, was piloted, and a homogenous sample size of at least 50 agreed upon from each country, with 50% the minimum response rate. It was distributed via web-link, questioning preference of antidepressant for patients, and factors influencing choice. Trainees were asked for their preference should they develop a moderate to severe depressive episode, and require medication.
Treatment choices are summarised in Table 1. 79% of trainees would prescribe similar antidepressants for themselves as for patients.
Factors influencing decision-making mapped onto three main domains: cost, efficacy and side-effect profile (5% other reasons). 86% (n = 548) of those who responded felt efficacy most important, 38% (n = 237) felt side-effect profile most important and 6% (n = 33) considered cost of most importance.
Some differences exist in choice of antidepressant for European trainees and their patients, and factors affecting choice conflict with evidence base and guideline suggestions.
Perinatal mental healthcare in Canada is characterized by under-diagnosis and under-treatment. Approaches to mental health screening can influence pregnant women’s uptake of treatment services.
To determine the acceptability of mental health screening in Canadian pregnant women.
This cross-sectional survey used the Barriers and Facilitators of Mental Health Screening Survey. The study included pregnant women who read/spoke English. The survey was administered via computer-tablet to women recruited from prenatal classes and maternity clinics in Alberta. Analyses included descriptive statistics and multivariable regression.
Respondents (n=459, 92% participation) were largely 25-34 years old (89%), Caucasian (83%), and partnered (95%). Almost two-thirds of women indicated they expected to be asked about mental health, with 35% reporting their provider asked. The majority (99.8%) indicated that they could be honest with their provider about their mental health if asked and 99.3% of those asked reported they were comfortable with screening. Women indicated a strong preference for routine screening, but identified sporadic assessment as threatening. Women were more likely to report screening as positive if: 1) they had been treated previously for depression/anxiety; or 2) they identified barriers to screening as: a) feeling worried that their concerns were unimportant to their provider; or b) feeling that their provider did not have time to talk about mental health. Women were less likely to report screening as positive if they expected their provider to ask about their mental health.
Findings confirm women’s acceptability of routine prenatal mental health assessment. Results will inform decision-making regarding routine perinatal mental healthcare.
Introduction: Upper gastrointestinal bleeding (UGIB) is a common presentation to the emergency department (ED). Early endoscopy within 24 hours has been shown to reduce re-bleeding rates and lower mortality. However, low-risk patients can often be managed through outpatient follow-up. The aim of this study was to compare the timing and appropriateness of endoscopy and proton pump inhibitor (PPI) use in a tertiary care ED setting for low- and high-risk patients determined using the Glasgow Blatchford Score (GBS). Methods: Retrospective chart review was conducted to examine the management of patients presenting with an UGIB in 2016 to the University of Alberta Hospital ED. TANDEM and Emergency Department Information System (EDIS) databases were used to identify patients using specific ICD-10 codes and the CEDIS presenting complaints of vomiting blood or blood in stool/melena. Patients with GBS 0-3 were categorized as low-risk and those with GBS > 3 were considered high-risk with appropriateness of and time to endoscopy, disposition of patient at 24 hours, and use of PPIs determined for each group. Results: A total of 400 patients were included. A total of 319/400 patients (80%) underwent esophagogastroduodenoscopy (EGD). EGD was performed within 24 hours in 37% of patients (29/78) with GBS 0 to 3 and in 77% (248/322) with GBS greater than 3. Of the remaining high-risk patients, 11% (36/322) underwent EGD after 24 hours and 12% (38/322) did not undergo EGD. The endoscopic diagnoses were peptic ulcer disease (PUD) in 41% of patients (130/319), esophagitis in 18% (56/319), and varices in 14% (45/319). PPIs (data available 375/400) were administered (mainly intravenously) to 93% (279/300) of high-risk and 79% (59/75) of low-risk patients. Data on patient disposition showed 60/322 (19%) high-risk patients were discharged from the ED within 24 hours and only 31/60 (52%) of these underwent EGD before discharge. Of 29 low-risk patients undergoing EGD within 24 hours, 9 (31%) were admitted, 17 (59%) were discharged from ED, and 3 (10%) were kept for observation in the ED greater than 24 hours. Of low-risk patients, 76% (59/78) were discharged from the ED within 24 hours. Conclusion: A majority of patients presenting with UGIB appropriately received endoscopy within 24 hours. 19% of high-risk patients were discharged from the ED. Earlier discharge for low-risk patients can be improved as only 76% of low-risk patients were discharged from the ED within 24 hours. As expected, PPI use was high in these patients.
Introduction: Acute upper gastrointestinal bleeding (UGIB) is a common presentation to emergency departments (ED). Of these patients, 35-45% receive a blood transfusion. Guidelines for blood transfusion in UGIB have been well established, and recommend a hemoglobin (Hb) level below 70 g/L as the transfusion target in a stable patient. There is no consensus on a transfusion threshold for unstable UGIB. There is limited data regarding physician practices in the ED. The aim of our study is to determine the appropriateness, by expert consensus, of blood transfusions in UGIB in a tertiary care hospital ED. Methods: We retrospectively reviewed patients presenting with UGIB to the University of Alberta Hospital ED in 2016. These patients were then screened for blood transfusions. Data were obtained from the patient records. Chart derived data were verified with records obtained from the blood bank. For each patient, the history, vitals, Glasgow Blatchford Score (GBS), relevant labs, and record of blood transfusions were collected and organized into a case summary. Each patient summary was presented individually to a panel of three expert clinicians (2 Gastroenterology, 1 Emergency Medicine), who then decided on the appropriateness of each blood transfusion by consensus. Results: Blood transfusions (data available 395/400) were given to 51% (202/395) of patients presenting with UGIB. Of these, 86% (174/202) were judged to be appropriate. Of the 395 patients, 34% (135/395) had a Hb of <70 g/L. Of these, 93% (126/135) were transfused, and all of these were considered appropriate. 18% (70/395) had a Hb between 71-80. 74% (52/70) of these patients were given blood, and 79% (41/52) were considered appropriate. 13% (50/395) of the patients had a Hb between 81-90, with 28% (14/50) receiving a transfusion. Of these, 36% (5/14) were deemed to be appropriate. 35% (140/395) of patients had a Hb of >90. 7% (10/140) of these received blood. 20% (2/10) were considered appropriate. Conclusion: The panel of expert clinicians judged 86% of the blood transfusions to be appropriate. All transfusions under the recommended guideline of 70 g/L were considered appropriate. In addition, the majority of transfusions above a Hb of 70 g/L were considered appropriate, but 37% were not. Further studies evaluating the feasibility of current guideline recommendations in an ED setting are required. Educational interventions should be created to reduce inappropriate blood transfusions above a Hb 70 g/L.
Similar to visual hallucinations in visually impaired patients, auditory hallucinations are often suggested to occur in adults with hearing impairment. However, research on this association is limited. This observational, cross-sectional study tested whether auditory hallucinations are associated with hearing impairment, by assessing their prevalence in an adult population with various degrees of objectified hearing impairment.
Hallucination presence was determined in 1007 subjects aged 18–92, who were referred for audiometric testing to the Department of ENT-Audiology, University Medical Center Utrecht, the Netherlands. The presence and severity of hearing impairment were calculated using mean air conduction thresholds from the most recent pure tone audiometry.
Out of 829 participants with hearing impairment, 16.2% (n = 134) had experienced auditory hallucinations in the past 4 weeks; significantly more than the non-impaired group [5.8%; n = 10/173; p < 0.001, odds ratio 3.2 (95% confidence interval 1.6–6.2)]. Prevalence of auditory hallucinations significantly increased with categorized severity of impairment, with rates up to 24% in the most profoundly impaired group (p < 0.001). The corrected odds of hallucination presence increased 1.02 times for each dB of impairment in the best ear. Auditory hallucinations mostly consisted of voices (51%), music (36%), and doorbells or telephones (24%).
Our findings reveal that auditory hallucinations are common among patients with hearing impairment, and increase with impairment severity. Although more research on potential confounding factors is necessary, clinicians should be aware of this phenomenon, by inquiring after hallucinations in hearing-impaired patients and, conversely, assessing hearing impairment in patients with auditory hallucinations, since it may be a treatable factor.
The major impact of the livestock sector on the environment may be reduced by feeding agricultural co-products to animals. Since the last decade, co-products from biodiesel production, such as rapeseed meal (RSM), became increasingly available in Europe. Consequently, an increase in RSM content in livestock diets was observed at the expense of soybean meal (SBM) content. Cultivation of SBM is associated with high environmental impacts, especially when emissions related to land use change (LUC) are included. This study aims to assess the environmental impact of replacing SBM with RSM in finishing pig diets. As RSM has a lower nutritional value, we assessed the environmental impact of replacing SBM with RSM using scenarios that differed in handling changes in nutritional level. Scenario 1 (S1) was the basic scenario containing SBM. In scenario 2 (S2), RSM replaced SBM based on CP content, resulting in reduced energy and amino acid content, and hence an increased feed intake to realize the same growth rate. The diet of scenario 3 (S3) was identical to S2; however, we assumed that pigs were not able to increase their feed intake, leading to reduced growth performance. In scenario 4 (S4), the energy and amino acid content were increased to the same level of S1. Pig performances were simulated using a growth model. We analyzed the environmental impact of each scenario using life-cycle assessment, including processes of feed production, manure management, piglet production, enteric fermentation and housing. Results show that, expressed as per kg of BW, replacing SBM with RSM in finishing pig diets marginally decreased global warming potential (GWP) and energy use (EU) but decreased land use (LU) up to 12%. Between scenarios, S3 had the maximum potential to reduce the environmental impact, due to a lower impact per kg of feed and an increased body protein-to-lipid ratio of the pigs, resulting in a better feed conversion ratio. Optimization of the body protein-to-lipid ratio, therefore, might result in a reduced environmental impact of pig production. Furthermore, the impact of replacing SBM with RSM changed only marginally when emissions related to direct (up to 2.9%) and indirect LUC (up to 2.5%) were included. When we evaluated environmental impacts of feed production only, which implies excluding other processes along the chain as is generally found in the literature, GWP decreased up to 10%, including LUC, EU up to 5% and LU up to 16%.
In this paper we consider matrix representations of compact groups over the field of the complex numbers. We shall deal mainly with finite groups.
The Kronecker product of two irreducible representations σ1 and σ2 of a group is in general a reducible representation of . The explicit reduction of such a product to irreducible representations σ3 can be performed by means of a unitary matrix, the elements of which are called Wigner coefficients or Clebsch-Gordan coefficients [1; 25; 27].
The prototype for applications of group theory to physics, and to mathematical physics, is the quantum theory of angular momentum  ; the use of such techniques is now almost universal, and familiarly (through somewhat imprecisely) known as “Racah algebra”. To categorize, group theoretically, those characteristics which underlay this applicability to physical problems, Wigner  isolated two significant conditions, and designated groups possessing these properties as simply reducible.
The two conditions for simple reducibility are:
(a)Every element is equivalent to its reciprocal, i.e., all classes are ambivalent.
(b) The Kronecker (or “direct“) product of any two irreducible representations of the group contains no representation more than once.
In this paper we consider representations of groups over the field of the complex numbers.
The nth-Kronecker power σ⊗n of an irreducible representation σ of a group can be decomposed into the constituents of definite symmetry with respect to the symmetric group Sn. In the special case of the general linear group GL(N) in N dimensions the decomposition of the defining representation at once provides irreducible representations of GL(N) [9; 10; 11].
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