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The aim of the project was to get a baseline of the number of patients who have had blood tests, ECG and physical health observations completed in the past 12 months.
There are 30 patients under Early Intervention in Psychosis team at Bassetlaw Hospital , Nottinghamshire. The elctronic notes and blood reporting system were checked for each of the patients, to get the data on blood test results , ECG reports and Physical health (Blood pressure, heart rate and weight) .
It was noted that 19/30 patients had Blood tests completed, 14/30 had ECG completed and 19/30 had physical health checks completed. All these patients except one were on antipsychotic medications.
Further work is still required in getting 100% results for all these different variables. This may include the need to review the process of how we engage the patients for physical healthcare checks. With the inclusion of a physical healthcare worker now, we might be able to improve results. Hence this evaluation would be redone in a years' time.
Co-occurrence of common mental disorders (CMD) with psychotic experiences is well-known. There is little research on the public mental health relevance of concurrent psychotic experiences for service use, suicidality, and poor physical health. We aim to: (1) describe the distribution of psychotic experiences co-occurring with a range of non-psychotic psychiatric disorders [CMD, depressive episode, anxiety disorder, probable post-traumatic stress disorder (PTSD), and personality dysfunction], and (2) examine associations of concurrent psychotic experiences with secondary mental healthcare use, psychological treatment use for CMD, lifetime suicide attempts, and poor self-rated health.
We linked a prospective cross-sectional community health survey with a mental healthcare provider database. For each non-psychotic psychiatric disorder, patients with concurrent psychotic experiences were compared to those without psychotic experiences on use of secondary mental healthcare, psychological treatment for CMD, suicide attempt, physical functioning, and a composite multimorbidity score, using logistic regression and Cox regressions.
In all disorders except for anxiety disorder, concurrent psychotic experiences were accompanied by a greater odds of all outcomes (odds ratios) for a unit change in composite multimorbidity score ranged between 2.21 [95% confidence interval (CI) 1.49–3.27] and 3.46 (95% CI 1.52–7.85). Hazard ratios for secondary mental health service use for non-psychotic disorders with concurrent psychotic experiences, ranged from 0.53 (95% CI 0.15–1.86) for anxiety disorders with psychotic experiences to 4.99 (95% CI 1.22–20.44) among those with PTSD with psychotic experiences.
Co-occurring psychotic experiences indicate greater public mental health burden, suggesting psychotic experiences could be a marker for future preventive strategies improving public mental health.
Group-based trajectory modeling holds promise for the study of prognostic indicators in the mood disorders because the courses that the individuals with these disorders follow are so highly variable. However, trajectory analyses of major depressive disorder have so far not included some of the more robust predictors of mood disorder outcome, nor have they described interactions between these predictors.
A group of 186 individuals aged 15–20 years with past or current depressive symptoms, who had recently begun taking a serotonin reuptake inhibitors antidepressant, underwent extensive baseline evaluations and were then followed for up to 2 years. Trajectory analyses used weekly ratings of depressive symptoms and the resulting groups were compared by the risk factors of sex, psychiatric comorbidity, negative emotionality, and childhood adversity.
A three-group solution provided the best statistical fit to the 2-year symptom trajectory. Negative emotionality and childhood adversity, though correlated, independently predicted membership in higher-morbidity groups. Female sex and comorbidity with generalized anxiety disorder (GAD) were also significantly more likely in the trajectory groups with higher symptom levels. However, the presence of GAD, rather than female sex, was the most important determinant of group membership. Negative emotionality was predictive of group membership only among women.
Trajectory analyses indicated that week-to-week variations in depressive symptoms across individuals could best be condensed into low, remitting and persistent symptom patterns. Female sex, anxiety symptoms, negative emotionality and childhood adversity were each independently associated with trajectories of higher morbidity but negative emotionality may be prognostically important only among women.
Following stage 1 palliation, delayed sternal closure may be used as a technique to enhance thoracic compliance but may also prolong the length of stay and increase the risk of infection.
We reviewed all neonates undergoing stage 1 palliation at our institution between 2010 and 2017 to describe the effects of delayed sternal closure.
During the study period, 193 patients underwent stage 1 palliation, of whom 12 died before an attempt at sternal closure. Among the 25 patients who underwent primary sternal closure, 4 (16%) had sternal reopening within 24 hours. Among the 156 infants who underwent delayed sternal closure at 4 [3,6] days post-operatively, 11 (7.1%) had one or more failed attempts at sternal closure. Patients undergoing primary sternal closure had a shorter duration of mechanical ventilation and intensive care unit length of stay. Patients who failed delayed sternal closure had a longer aortic cross-clamp time (123±42 versus 99±35 minutes, p=0.029) and circulatory arrest time (39±28 versus 19±17 minutes, p=0.0009) than those who did not fail. Failure of delayed sternal closure was also closely associated with Technical Performance Score: 1.3% of patients with a score of 1 failed sternal closure compared with 18.9% of patients with a score of 3 (p=0.0028). Among the haemodynamic and ventilatory parameters studied, only superior caval vein saturation following sternal closure was different between patients who did and did not fail sternal closure (30±7 versus 42±10%, p=0.002). All patients who failed sternal closure did so within 24 hours owing to hypoxaemia, hypercarbia, or haemodynamic impairment.
When performed according to our current clinical practice, sternal closure causes transient and mild changes in haemodynamic and ventilatory parameters. Monitoring of SvO2 following sternal closure may permit early identification of patients at risk for failure.
Cytokines and vitamin D both have a role in modulating the immune system, and are also potentially useful biomarkers in mental illnesses such as major depressive disorder (MDD) and schizophrenia. Studying the variability of cytokines and vitamin D in a healthy population sample may add to understanding the association between these biomarkers and mental illness. To assess genetic and environmental contributions to variation in circulating levels of cytokines and vitamin D (25-hydroxy vitamin D: 25(OH)D3), we analyzed data from a healthy adolescent twin cohort (mean age 16.2 years; standard deviation 0.25). Plasma cytokine measures were available for 400 individuals (85 MZ, 115 DZ pairs), dried blood spot sample vitamin D measures were available for 378 individuals (70 MZ, 118 DZ pairs). Heritability estimates were moderate but significant for the cytokines transforming growth factor-β1 (TGF-β1), 0.57 (95% CI 0.26–0.80) and tumor necrosis factor-receptor type 1 (TNFR1), 0.50 (95% CI 0.11–0.63) respectively. Measures of 25(OH)D3 were within normal range and heritability was estimated to be high (0.86, 95% CI 0.61–0.94). Assays of other cytokines did not generate meaningful results. These potential biomarkers may be useful in mental illness, with further research warranted in larger sample sizes. They may be particularly important in adolescents with mental illness where diagnostic uncertainty poses a significant clinical challenge.
In this paper, a rigid–flexible planar parallel manipulator (PPM) actuated by three linear ultrasonic motors for high-accuracy positioning is proposed. Based on the extended Hamilton's principle, a rigid–flexible dynamic model of the proposed PPM is developed utilizing exact boundary conditions. To derive an appropriate low-order dynamic model for the design of the controller, the assumed modes method is employed to discretize elastic motion. Then to investigate the interaction between the rigid and elastic motions, a proportional derivative feedback controller combined with a feed-forward-computed torque controller is developed to achieve motion tracking while attenuating the residual vibration. Then the controller is extended to incorporate an input shaper for the further suppression of residual vibration of flexible linkages. Computer simulations are presented as well as experimental results to verify the proposed dynamic model and controller. The input shaping method is verified to be effective in attenuating residual vibration in a highly coupled rigid–flexible PPM. The procedure employed for dynamic modeling and control analysis provides a valuable contribution into the vibration suppression of such a PPM.
A novel rigid-body control design methodology for 6-degree-of-freedom (dof) parallel kinematic mechanisms (PKMs) is proposed. The synchronous control of PKM joints is addressed through a novel formulation of contour and lag errors. Robust performance as a control specification is addressed. A convex combination controller design approach is applied to address the problem of simultaneously satisfying multiple closed-loop specifications. The applied dynamic modeling approach allows the design methodology to be extended to 6-dof spatial PKMs. The methodology is applied to the design of a 6-dof PKM-based meso-milling machine tool and simulations are conducted.
The effect of axial forces on the dynamic properties is formulated and investigated for a 3-PRR planar parallel manipulator with three flexible intermediate links. A dynamic model of the manipulator system is developed based on the assumed mode method with the consideration of the effect of longitudinal forces on lateral stiffness is included. The flexible intermediate links are modeled as Euler–Bernoulli beams with pinned-pinned boundary conditions, which are verified by experimental modal tests. Natural frequencies of bending vibration of the intermediate links are derived as the functions of axial force and rigid-body motion of the manipulator. Dynamic behavior including the effect of axial forces on lateral deformation is investigated, and configuration-dependant frequencies are analyzed. Numerical simulations of configuration-dependent frequency properties and axial forces are performed to illustrate the effect of axial forces on the dynamic behaviors of the flexible parallel manipulator. Simulation results of mode amplitudes, deformations, axial forces, inertial, and coupling forces are presented, and further validate the theoretical derivations. These analyses and results provide a new and valuable insight to the design and control of the parallel manipulators with flexible intermediate links.
Photogrammetric processing of archival stereo imagery offers the opportunity to reconstruct glacier volume changes for regions where no such data exist, and to better constrain the contribution to sea-level rise from small glaciers and ice caps. The ability to derive digital elevation model (DEM) measurements of glacier volume from photogrammetry relies on good-quality, well-distributed ground reference data, which may be difficult to acquire. This study shows that ground-control points (GCPs) can be identified and extracted from point-cloud airborne lidar data and used to control photogrammetric glacier models. The technique is applied to midtre Lovénbreen, a small valley glacier in northwest Svalbard. We show that the amount of ground control measured and the elevation accuracy of GCP coordinates (based on known and theoretical error considerations) has a significant effect on photogrammetric model statistics, DEM accuracy and the subsequent geodetic measurement of glacier volume change. Models controlled with fewer than 20 lidar control points or GCPs from sub-optimal areas within the swath footprint overestimated volume change by 14–53% over a 2 year period. DEMs derived from models utilizing 20–25 or more GCPs, however, gave volume change estimates within ∼4% of those from repeat lidar data (−0.51 m a−1 between 2003 and 2005). Our results have important implications for the measurement of glacier volume change from archival stereo-imagery sources.
This paper addresses the dynamic simulation and control of structural vibrations of a 3-PRR parallel manipulator with three flexible intermediate links, to which are bonded lead zirconate titanate (PZT) actuators and sensors. Flexible intermediate links are modelled as Euler–Bernoulli beams with pinned-pinned boundary conditions. A PZT actuator controller is designed based on strain rate feedback (SRF) control. Control moments from PZT actuators are transformed to force vectors in modal space and are incorporated in the dynamic model of the manipulator. The dynamic equations are developed based on the assumed mode method for the flexible parallel manipulator with multiple PZT actuator and sensor patches. Numerical simulation is performed and the results indicate that the proposed active vibration control strategy is effective. Spectral analyses of structural vibrations further illustrate that deformations from structural vibration of flexible links are suppressed to a significant extent when the proposed vibration control strategy is employed, while the deflections caused by inertial and coupling forces are not reduced.
This article examines the market for cocaine in India during the early twentieth century and the efforts of the colonial state to control it. The British authorities issued regulations to prohibit the drug's use as early as 1900, and yet by the start of World War I, cocaine's appeal had become socially diverse and geographically wide. This account of a significant market for a powerful new drug suggests that Indian society was able to rapidly develop a demand for such products even when the colonial state had no part in their introduction. Indians used these new products in complex ways—as medicines, as tonics, and as intoxicants, albeit through the localized medium of the everyday paan leaf. The study points to a reconsideration of a number of debates about the history of drugs and modern medicines in Asia.
Objectives: The aim of this study was to assess the cost-effectiveness of a class-based exercise program supplementing a home-based program when compared with a home-based program alone. In addition, we estimated the probability that the supplementary class program is cost-effective over a range of values of a decision maker's willingness to pay for an additional quality-adjusted life-year (QALY).
Methods: The resource use and effectiveness data were collected as part of the clinical trial detailed elsewhere. Unit costs were estimated from published sources. The net benefit approach to cost-effectiveness analysis is used to estimate the probability of the intervention being cost-effective.
Results: The addition of a supplementary class-based group results in an increase in QALYs and lower costs. For all plausible values of a decision maker's willingness to pay for a QALY, the supplementary class group is likely to be cost-effective.
Conclusions: The addition of a class-based exercise program is likely to be cost-effective and, on current evidence, should be implemented.
Subalternity, in this collection, has been interpreted in its widest possible sense. As defined twenty years ago by Ranajit Guha, the concept appears narrow and limited by its origins in Marxist theory (Guha 1982: 1–7). As it has been used over the last two decades it has taken on a broader meaning so that the ‘subaltern’ is the dominated party in any power relationship and the study of subalternity is of relationships characterised by ‘dominance without hegemony’. The importance of the concept of subalternity lies in its recognition of the ‘autonomous domain’ of the subaltern agent or agents. While dominated, the subaltern is not entirely obliterated and retains values, ideas and modes of action that are not prescribed by the dominant and which can draw upon beliefs and experiences exclusive to the individual or group. In other words the subaltern always has the potential to oppose or resist the dominant as he or she may draw upon alternative values and ideas and can refer back to different experiences and behavioural expectations. As such the position of the dominant group is often a precarious de facto arrangement rather than a generally accepted de jure agreement (Ludden 2002; Chaturvedi 2000).
Sports invite subalternity. In the first place this is because sports, especially those organized games of the modern period, are all about contest and competition in which victory or defeat are the anticipated outcomes of the exercise.