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In many countries, we have seen an increase in economic inequality over the past 20 to 25 years. The populations might therefore have changed their attitude about how and how much different countries should intervene to reduce the extent of economic inequality. A question is whether there is any connection between changes in redistribution preferences and trends in economic inequality in the prosperous Nordic welfare states. This article contributes by examining whether there are differences in redistribution attitude and changes herein based upon socio-economic criteria, which might include self-interest arguments. Nordic countries are interesting because there have been differences in development, and even strong growth in economic inequality, especially in Sweden and Denmark, although these countries in the literature have been seen as highly equal societies. The analysis shows that support for redistribution is relatively stable over time in each country, but also that there are major differences between countries, with support being much higher in Finland compared with Denmark. Females, discriminated groups and the unemployed generally support redistribution to a higher degree. Ageing generally increases redistributional support, while more education reduces support for government redistribution in Finland. In all four countries, the highest income groups are less supportive of redistribution of income.
Established and emerging technologies—such as wearable sensors, smartphones, mobile apps, and artificial intelligence—are shaping positive healthcare models and patient outcomes. These technologies have the potential to become precision health (PH) innovations. However, not all innovations meet regulatory standards or have the required scientific evidence to be used for health applications. In response, an assessment framework was developed to facilitate and standardize the assessment of innovations deemed suitable for PH.
A scoping literature review undertaken through PubMed and Google Scholar identified approximately 100 relevant articles. These were then shortlisted (n = 12) to those that included specific metrics, criteria, or frameworks for assessing technologies that could be applied to the PH context.
The proposed framework identified nine core criteria with subcriteria and grouped them into four categories for assessment: technical, clinical, human factors, and implementation. Guiding statements with response options and recommendations were used as metrics against each criterion.
The proposed framework supports health services, health technology innovators, and researchers in leveraging current and emerging technologies for PH innovations. It covers a comprehensive set of criteria as part of the assessment process of these technologies.
To evaluate the prevalence of severe acute respiratory syndrome coronavirus-2 infection in patients presenting with epistaxis to a tertiary otolaryngology unit.
A prospective study was conducted of 40 consecutive patients presenting with epistaxis referred to our tertiary otolaryngology unit. A group of 40 age-matched controls were also included. All patients underwent real-time reverse transcriptase polymerase chain reaction testing for severe acute respiratory syndrome coronavirus-2. Symptoms of fever, cough and anosmia were noted in the study group.
The mean age was 66.5 ± 22.4 years in the study group. There were 22 males (55 per cent) and 18 females (45 per cent). The mean age in the control group was 66.3 ± 22.4 years (p = 0.935). There were six positive cases for severe acute respiratory syndrome coronavirus-2 (15 per cent) in the epistaxis group and one case (2.5 per cent) in the control group. The difference was statistically significant (p = 0.05).
Epistaxis may represent a presenting symptom of severe acute respiratory syndrome coronavirus-2 infection. This may serve as a useful additional criterion for screening patients.
Decades of commitment to the basic principles of the Danish welfare state have been discarded with a new social policy reducing the benefits for people already at the bottom of the income ladder. The political intention is to increase job search via economic incentives that increase the gap between benefit income and market income. Using a panel dataset with benefit recipients, we show that the intended job search effect did not materialise to any significant extent; rather, the affected people became poorer because the vast majority of individuals could not respond to the economic incentives in the intended manner. Joblessness was not due to lack of incentives. This study confirms the importance of employability and self-efficacy, but it shows that health is an underlying variable that explains both of these factors and the recipients’ difficulties in getting a job. The results have two major social policy implications. Access to early retirement schemes should be easier for recipients who have serious health problems and therefore cannot respond to economic incentives, and there should be an increased focus on how to help the recipients without major health problems to develop self-efficacy.
Despite prenatal diagnosis, prenatal intervention, and immediate postnatal intervention, patients with hypoplastic left heart syndrome and intact or highly restrictive atrial septum have the highest risk for mortality. Charts for all infants diagnosed with hypoplastic left heart syndrome from 2009 to 2017 were retrospectively reviewed and compared, including pulmonary vein Doppler patterns on fetal echocardiogram and evidence of pulmonary lymphangiectasia on fetal MRI. Of the 81 newborns with hypoplastic left heart syndrome, we defined two groups. Group 1 patients had an adequate atrial septal communication (n = 69), while Group 2 met criteria for intact/restrictive septum (n = 12). No patient in Group 1 had a type C pulmonary vein Doppler pattern, while no patient in Group 2 had a type A pulmonary vein Doppler pattern. The two patients with pulmonary lymphangiectasia had type C pulmonary vein Doppler pattern and an intact atrial septum and did not survive. Survival to discharge for Group 1 was 83% compared to 58% for Group 2 (p = 0.116). Survival to stage 2 palliation was 71% for Group 1 compared to 50% for Group 2 (p = 0.186). Only 4 of the initial 12 patients from Group 2 are alive, which is an overall survival of 33%. Our experience supports previous evidence that fetal echocardiography can identify those patients with the greatest likelihood for postnatal intervention as well as those at highest risk for mortality. Fetal MRI is a novel imaging modality that may help providers separate patients at highest risk for mortality, regardless of pulmonary vein Doppler pattern.
Diabetes mellitus is a syndrome with disordered metabolism and inappropriate hyperglycaemia due to either the deficiency of insulin secretion or to a combination of insulin resistance and inadequate insulin secretion to compensate. Depressive disorders have been found to occur at increased prevalence rates among patients with Type 1 and Type 2 Diabetes Mellitus 9. Depression has the additional importance in diabetes because of its association with poor compliance with diabetic treatment, poor glycemic control and an increased risk of micro and macro vascular complications. An accurate estimate of depression prevalence is needed to keep and gauge the potential impact of depression management in patients with co-morbid diabetes 22. Better recognition and better treatment of depression are important in themselves but they could also improve medical outcome by substantial portion in patients of diabetes
Total of 527 cases of Diabetes were screened for major depressive disorder (MDD) by using DSMIV based criteria system. Montgomeny Asberg Depression rating scale (MADRS) and Clinical Global Impression (Severity) (CGI) scale to access severity.
1. Major depressive disorder is inordinately high among the sample of adult diabetic patients occurring at the rates of 2 - 6 times greater than those observed in general population.
2. Majority of patients with diabetes who have major depressive disorder have depression of moderate severity and not just mild depressive symptomatology.
3. The presence of major depressive disorder is significantly associated with poorer glycemic control.
To determine incidence of complicated grief in the families of enforced disappearance in the conflict torn Kashmir valley. Complicated GRIEF is a recently identified symptom complex marked by continued separation distress and bereavement related accompanying traumatic distress.
A total of 100 family members who were recruited from a workshop conducted by department of psychiatry and MEDICENS SAN FRONTIERS with family members of enforced disappearances were screened by psychiatrists.
COMPLICATED GREIF was very prevalent, 79% screened positive for complicated grief, PTSD was present in 30% of screened, 41% met criteria for major depressive disorder, 38% neither met criteria for major depressive disord: er nor PTSD, even though everybody who met criteria for PTSD had major depressive disorder as comorbidity.
COMPLICATED GRIEF is a important diagnosis in this subgroup of population and results into significant distress and dysfunction and hence warrants attention.
There are many advantages to improve communication between primary care and Psychiatric services. In Ireland various models of liaison with primary care are still in early stages of experimentation in some parts. We devised a pilot project of consultation-liaison model in west of Ireland.
There are 11 general practitioners working in the catchment area. All of them were given information and five agreed to participate. Based on random allocation two general practitioners were placed in experimental group. Three other general practitioners were allocated to control group. All patients from these surgeries were enrolled in study. In experimental group face to face meetings between psychiatrist and general practitioners were arranged before and after seeing patients in clinics. Feedback and exchange of information took place during these meetings. Meetings were arranged on monthly basis for six month starting in December 2009. While in the control group communication and referral was through usual method of writing letters.
Assessment of data was based on comparison of outcome in two sets of patients and surgeries. We collected data regarding number of admissions, compliance with appointments, changes in medications, number of referrals to secondary care, number of discharges back to general practitioners. Results show quantitative benefits of collaborative model in the lines of more patients being discharged back to GP and less missed appointments. There was also trend of reduced admission rate but this was statistically not significant.
Particulate matter (PM) specimens from a traffic site were sampled on Teflon filters using a low volume sampler. The sampling campaign ran over a one-year period with sampling frequency of twice a week for both PM2.5 and PM10. X-ray diffraction (XRD) methods, which are not commonly used in PM analysis, have been utilized successfully to identify crystalline phases present, including secondary pollutants. XRD data confirmed results obtained by X-ray fluorescence, positive matrix factorization modeling, and scanning electron microscopy. PM2.5 consisted mainly of secondary sulfates, like Mascagnite [(NH4)2SO4], Koktaite [(NH4)2Ca(SO4)2·H2O], and Gypsum [CaSO4·2H2O]. For PM10, it was found that the major phases are mostly originating from natural sources, such as dust storms and sea salts, in addition to secondary compounds, such as sodium nitrate. The main phases identified were Calcite, Quartz, Gypsum, Halite, and Palygorskite.
Novel commercially available software has enabled registration of both CT and MRI images to rapidly fuse with X-ray fluoroscopic imaging. We describe our initial experience performing cardiac catheterisations with the guidance of 3D imaging overlay using the VesselNavigator system (Philips Healthcare, Best, NL). A total of 33 patients with CHD were included in our study. Demographic, advanced imaging, and catheterisation data were collected between 1 December, 2016 and 31 January, 2019. We report successful use of this technology in both diagnostic and interventional cases such as placing stents and percutaneous valves, performing angioplasties, occlusion of collaterals, and guidance for lymphatic interventions. In addition, radiation exposure was markedly decreased when comparing our 10–15-year-old coarctation of the aorta stent angioplasty cohort to cases without the use of overlay technology and the most recently published national radiation dose benchmarks. No complications were encountered due to the application of overlay technology. 3D CT or MRI overlay for CHD intervention with rapid registration is feasible and aids decisions regarding access and planned angiographic angles. Operators found intraprocedural overlay fusion registration using placed vessel guidewires to be more accurate than attempts using bony structures.
To examine the factors that influence mental health professional's prescription of antidepressant.
There are many studies on factors affecting decision of mental health professionals regarding selection of antidepressant. The clinical experience of the developing countries is different from that of the developed countries where nonpharmacological attributes of a drug like affordability and availability play a greater role in prescription of drug.
A semi-structured questionnaire was used to investigate which antidepressant was the preferred choice of psychiatrists and nurses and factors which influenced their decision making. Ethical permissions were obtained from local research and ethics committees.
The results of this study show that health professional would consider efficacy (64%) and tolerability (24%) to be the most important factors in choice of anti psychotics for themselves while efficacy (56%) and cost (24%) would be considered important factor while prescribing drugs to the patient.
Beside efficacy other factors like cost & affordability found to be the important factor in influencing the decision of the psychiatrists.
Stigmatization of individuals with mental illnesses is widespread and serves as a major barrier to treatment. Specific alterations in mental health literacy about a disorder and its perceived treatability can change this social attitude. Assessing awareness of bipolar disorder is important as the WHO ranked bipolar disorder as the sixth cause of disability.
To assess mental health literacy (knowledge, attitudes and beliefs) in bipolar disorder among Saudi population.
Cross sectional study is currently conducted. We are using valid reliable questionnaire assessing the level of awareness, knowledge, attitude and behavior toward bipolar disorder. It is distributed to adult Saudi citizen (> 17 years of age) in malls, university and hospitals in Riyadh. People who are known to have psychiatric disorder and their caregivers or who works as psychiatrists and psychologists are excluded.
There are 200 samples collected, and 14 were excluded according to exclusion criteria. Fifty-two percent of our preliminary sample has heard about bipolar disorder, and more than half of them believe that neurotransmitter disturbances, substance use and psychological trauma are more likely to be causes of bipolar. In contrast, 49% of the sample did not choose psychiatric medication as effective treatment for bipolar, whereas more than half of them chose praying.
It is a first-of-its-kind research study in Saudi Arabia determining the current mental health literacy of bipolar disorder in Saudi Arabia. We are aiming to increase the sample size to reach 1000 participants. Further study will be needed to investigate possible interventions to improve such problem.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Chikungunya virus (CHIKV) is a re-emerging pathogen of global importance. We attempted to gain an insight into the organisation, distribution and mutational load of the virus strains reported from different parts of the world. We describe transmission dynamics and genetic characterisation of CHIKV across the globe during the last 65 years from 1952 to 2017. The evolutionary pattern of CHIKV was analysed using the E1 protein gene through phylogenetic, Bayesian and Network methods with a dataset of 265 sequences from various countries. The time to most recent common ancestor of the virus was estimated to be 491 years ago with an evolutionary rate of 2.78 × 10−4 substitutions/site/year. Genetic characterisation of CHIKV strains was carried out in terms of variable sites, selection pressure and epitope mapping. The neutral selection pressure on the E1 gene of the virus suggested a stochastic process of evolution. We identified six potential epitope peptides in the E1 protein showing substantial interaction with human MHC-I and MHC-II alleles. The present study augments global epidemiological and population dynamics of CHIKV warranting undertaking of appropriate control measures. The identification of epitopic peptides can be useful in the development of epitope-based vaccine strategies against this re-emerging viral pathogen.
Heating coils utilize the concept of resistive heating to convert electrical energy into thermal energy. Uniform heating of the target area is the key performance indicator for heating coil design. Highly uniform distribution of temperature can be achieved by using a dense metal distribution in the area under consideration, however, this increases the cost of production significantly. A low-cost and efficient heating coil should have excellent temperature uniformity while having minimum metal consumption. In this work, space-filling fractal curves, such as Peano curve, Hilbert curve and Moore curve of various orders, have been studied as geometries for heating coils. In order to compare them in an effective way, the area of the geometries has been held constant at 30 mm × 30 mm and a constant power of 2 W has been maintained across all the geometries. Further, the thickness of the metal coils and their widths have been kept constant for all geometries. Finite Element Analysis (FEA) results show Hilbert and Moore curves of order-4, and Peano curve of order-3 outperform the typical double-spiral heater in terms of temperature uniformity and metal coil length.
Dielectric elastomer actuators (DEAs), which are inherently complaint capacitors, are emerging as pseudo-muscular actuators with a wide range of applications. In order to achieve high stretchability for large DEA actuation, carbon nanotube (CNT) and other 1D materials-based electrodes are used to maintain conductance at large strains. These electrodes are typically fabricated using spray coating or filter transfer method and resemble a perforated electrode under high magnification. Hence, there can be a loss of field and stray capacitance when multiple layers of carbon nanotubes (CNTs)-based electrodes are used. This study investigates the effect of microscopic perforations on the nature of electric fields and on the capacitance of multi-layered CNT-based DEA structures with various dimensions and geometric properties of the electrodes. It has been found that the capacitance decreases with increase in the perforations however its effect is limited for a reasonable coverage. The change in normalized is found to be negligible (∼5%) for an electrode coverage area of over 90%, however, the maximum output work reduces by 18.2%. This analysis is important to develop robust and reliable CNT-based DEA structures, without using excessive CNTs which can lead to increased mechanical stiffness of the electrodes.
This review focuses on state-of-the-art research and development in the areas of flexible and stretchable inorganic solar cells, explains the principles behind the main technologies, highlights their key applications, and discusses future challenges.
Flexible and stretchable solar cells have gained a growing attention in the last decade due to their ever-expanding range of applications from foldable electronics and robotics to wearables, transportation, and buildings. In this review, we discuss the different absorber and substrate materials in addition to the techniques that have been developed to achieve conformal and elastic inorganic solar cells which show improved efficiencies and enhanced reliabilities compared with their organic counterparts. The reviewed absorber materials range from thin films, including a-Si, copper indium gallium selenide, cadmium telluride, SiGe/III–V, and inorganic perovskite to low-dimensional and bulk materials. The development techniques are generally based on either the transfer-printing of thin cells onto various flexible substrates (e.g., metal foils, polymers, and thin glass) with or without shape engineering, the direct deposition of thin films on flexible substrates, or the etch-based corrugation technique applied on originally rigid cells. The advantages and disadvantages of each of these approaches are analyzed in terms of achieved efficiency, thermal and mechanical reliability, flexibility/stretchability, and economical sustainability.
Early laryngeal cancer treated with definitive radiotherapy or surgery has a high cure rate. This study evaluated the patterns of treatment failure and long-term results of early laryngeal cancers treated with definitive radiotherapy.
From January 2002 to December 2014, a total of 242 patients with early-stage laryngeal cancers were treated with radical radiotherapy.
All patients had squamous cell carcinoma of the larynx (92 per cent male and 8 per cent female). Median follow-up was 4.5 years. The majority of patients were smokers (57.4 per cent). Local failure was seen in 12.5 per cent of stage I patients and 22.8 per cent of stage II patients. The 5-year overall survival and disease specific survival were 84 per cent and 91 per cent, respectively.
In summary, radiotherapy is a suitable treatment modality for patients with early-stage laryngeal cancer, with an overall locoregional control rate of 84 per cent. Patients who fail radiotherapy may still undergo salvage laryngectomy.
Frascati international research criteria for HIV-associated neurocognitive disorders (HAND) are controversial; some investigators have argued that Frascati criteria are too liberal, resulting in a high false positive rate. Meyer et al. recommended more conservative revisions to HAND criteria, including exploring other commonly used methodologies for neurocognitive impairment (NCI) in HIV including the global deficit score (GDS). This study compares NCI classifications by Frascati, Meyer, and GDS methods, in relation to neuroimaging markers of brain integrity in HIV.
Two hundred forty-one people living with HIV (PLWH) without current substance use disorder or severe (confounding) comorbid conditions underwent comprehensive neurocognitive testing and brain structural magnetic resonance imaging and magnetic resonance spectroscopy. Participants were classified using Frascati criteria versus Meyer criteria: concordant unimpaired [Frascati(Un)/Meyer(Un)], concordant impaired [Frascati(Imp)/Meyer(Imp)], or discordant [Frascati(Imp)/Meyer(Un)] which were impaired via Frascati criteria but unimpaired via Meyer criteria. To investigate the GDS versus Meyer criteria, the same groupings were utilized using GDS criteria instead of Frascati criteria.
When examining Frascati versus Meyer criteria, discordant Frascati(Imp)/Meyer(Un) individuals had less cortical gray matter, greater sulcal cerebrospinal fluid volume, and greater evidence of neuroinflammation (i.e., choline) than concordant Frascati(Un)/Meyer(Un) individuals. GDS versus Meyer comparisons indicated that discordant GDS(Imp)/Meyer(Un) individuals had less cortical gray matter and lower levels of energy metabolism (i.e., creatine) than concordant GDS(Un)/Meyer(Un) individuals. In both sets of analyses, the discordant group did not differ from the concordant impaired group on any neuroimaging measure.
The Meyer criteria failed to capture a substantial portion of PLWH with brain abnormalities. These findings support continued use of Frascati or GDS criteria to detect HIV-associated CNS dysfunction.
In the present study, an effective secondary selection of transgressive variants from a homozygous population of Pusa Sugandh 3 (PS3) has led to the development of basmati variant SKUA 494. SKUA 494 exhibited a grain yield (7.9 t/ha) with superiority of 21.5% over its progenitor (6.5 t/ha). Besides, the genotype revealed an earliness of about 13 and 15 days for flowering and maturity, respectively. Hulling, milling and head rice recovery traits of SKUA 494 were comparatively better over the controls PS3 and Pusa Basmati 1509. No significant differences in the cooking quality were observed in SKUA 494 over its parental line. Quality traits of SKUA 494 revealed an intermediate score for alkali spreading value, besides similar values for gel consistency and amylose content in comparison to PS3. On the basis of stability variables, stability index and overall mean for most of the traits, SKUA 494 depicted stable performance across the locations and over the years. Molecular analysis based on simple sequence repeat markers revealed polymorphism at locus flanking the quantitative trait loci for days to heading (Hd6) between SKUA 494 and its parent (PS3). Based on overall superiority in the performance and adaptability of SKUA 494, the variety has been recommended to farmers for general cultivation under temperate ecology.
The effect of cooling rate on the phase composition of gas atomized Raney type catalysts was studied using the Ni-75 at.% Al composition. The resulting particles were sieved into 3 standard size fractions and analysed using XRD with Rietveld refinement: as expected the three phases, Al₃Ni₂, Al₃Ni, and Al-Al₃Ni eutectic were identified. Differing phase compositions in the 3 size ranges were identified offering a possible explanation for varying catalytic activity with cooling rate, the higher cooling rates experienced by the smaller droplets allow less time for the peritectic conversion of Al₃Ni₂ to Al₃Ni to proceed. This in turn results in a more Al-rich residual liquid, increasing the volume fraction of eutectic. This was further confirmed when analysing the microstructure using SEM backscatter imaging. Al₃Ni₂ was found to be encased in a shell of Al₃Ni characteristic of peritectic reactions. The remainder of the alloy was found to consist of Al-Al₃Ni eutectic. The SEM backscatter imaging also indicated that the larger particles displayed and a more globular structure than smaller particles. Similar Raney type Ni-75 at.% Al doped with 1.5 at.% Cr were synthesised using the same method and sieved into the same 3 standard size fractions. It was found that the Cr doped alloys exhibited a more dendritic character than the undoped samples in the corresponding size fraction, although the material still displayed an increasingly dendritic character with increasing cooling rate. The phase composition found by Rietveld refinement also followed a similar trend to the undoped samples with decreasing amounts of Al₃Ni formed at the higher cooling rates. However, significant amounts of an additional phase, Al₁₃Cr₂, were also observed. Rietveld refinement found that a larger amount of Al₁₃Cr₂ was present than could be accounted for by the addition of 1.5 at.% Cr . This can be explained by the substitution of Ni onto the Cr lattice, as confirmed by Rietveld refinement. Al₁₃Cr₂ was found to be located mostly at the boundary of the Al₃Ni and Al-Al₃Ni eutectic phases during elemental mapping and quantitative image analysis of backscattered electron micrographs. This indicates that precipitation of Al₁₃Cr₂ is towards the end of the solidification process. The relatively large amounts of the Al-rich Al₁₃Cr₂ may explain the enhanced catalytic activity observed following leaching of Cr-doped Raney catalysts.