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To improve the quality of physical health care of patients on antipsychotics.
The second purpose of our study was to look at the administrative and clinical issues that hinders physical health assessment in outpatient clinics.
Severe mental illness (SMI) is associated with high risk of physical co-morbidity and mortality and as such is a major public health concern.
Current guidelines are described, and adherence to the standards is audited
Retrospective case note audit.
New patients seen in the outpatient Clinic between January 06 – August 06 and were prescribed antipsychotics were included in the study.
The audit included 30 patients, seen in the Collingwood Court Outpatient clinic between February 06 – August 06. The majority of patients were male (59%) and were between the age group 30 – 49.Depression was the main diagnosis (10 patients) closely followed by Bipolar Affective Disorder & Psychosis. Out of the 30 Patients, no patient had complete base line investigation. Only 13(43%) patients has some investigation and of this only 10 (33%) had the results recorded in the notes. In around 50% of the patients there was request made to the GP for this investigations but no further corresponded from the GP or any records of this being done was noted in the notes. No patients has BMI or BP monitoring done at any time
This audit identifies shortcoming in physical health monitoring and possible reasons.
Spain has experienced one of the deepest recessions among European countries affected by the economic crisis. We investigated the effects of the recession on the frequency of mental disorders in Primary Care (PC).
A group of PC physicians selected into the study a random sample of patients attending primary care centres. These patients were administered the PRIME-MD for the assessment of mental disorders, in 2006 and again in 2010, before and during the financial crisis. Multivariate logistic regression models were used to assess the relationship of unemployment, mortgage payment difficulties, and eviction on risks of mental health disorders.
Compared with the pre-crisis period of 2006, the 2010 survey revealed substantial increases in the proportion of patients with mood, anxiety, somatoform, and alcohol-related disorders (p< 0.0001), but not in eating disorders (p = 0.172). Major depression (19.4% increase) and dysthymia (10.8), showed the greatest rise, followed generalized anxiety disorder (8.4) and panic attack disorder (7.3). Both alcohol dependence and alcohol abuse rose significantly, by 4.6% and 2.4% (OR = 11.6 and 4.5, p< 0.001), respectively. After correcting for the risks of unemployment, we observed a significant rise in attendance with depression associated with mortgage repayment difficulties (OR =2.12, p< 0.001) and evictions (OR = 2.95, p< 0.001).
Recession has significantly increased the frequency of mental health disorders, particularly among families experiencing unemployment and mortgage payment difficulties. Expanding mental health services in primary care settings to at-risk groups may help cope with rising mental health disorders in areas affected by recession.
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
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
m images will also have a factor
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.
To review the literature regarding screening for vestibular schwannoma in the context of demographic changes leading to increasing numbers of elderly patients presenting with asymmetric auditory symptoms.
A systematic review of the literature was performed, with narrative synthesis and statistical analysis of data where appropriate.
Vestibular schwannomas diagnosed in patients aged over 70 years exhibit slower growth patterns and tend to be of smaller size compared to those tumours in younger age groups. This fact, combined with reduced life expectancy, renders the probability of these tumours in the elderly requiring active treatment with surgery or stereotactic radiotherapy to be extremely low. Vestibular schwannomas in the elderly are much more likely to be managed by serial monitoring with magnetic resonance imaging. The weighted yield of magnetic resonance imaging in the diagnosis of vestibular schwannoma in all age groups is 1.18 per cent, with almost 85 scans required to diagnose 1 tumour.
An evidence-based approach to the investigation of asymmetric hearing loss and tinnitus in the elderly patient can be used to formulate guidelines for the rational use of magnetic resonance imaging in this population.
To measure the outcomes of laser treatment of cholesteatoma covering cochlear and vestibular fistulas.
Cholesteatoma matrix over the fistula was denatured; the power density was sufficient only to gradually heat, but not vaporise, the keratin-forming matrix. The denaturing speed was controlled so that the integrity of the fistula cover was maintained. The change in bone conduction threshold and the residual rate of cholesteatoma at the fistula were measured.
Thirty-six fistulas were assessed. There were seven cochlear fistulas. All were 5 mm or less in maximum length. For the entire group, the average change in bone conduction threshold was −0.3 dB. For cochlear fistulas, the average change in bone conduction was + 0.2 dB. The distribution of hearing results for the entire group was Gaussian; the apparent changes in hearing could be attributed to errors associated with testing. All patients underwent second-stage surgery. In all cases, the cholesteatoma was completely cleared from the fistula site. There were no facial palsies.
Laser denaturing of cholesteatoma matrix over fistulas measuring 5 mm or less of vestibular apparatus and the cochlea is effective at eliminating cholesteatoma, and is not associated with cochlear hearing loss or facial palsy.
Information regarding deformations in large and complex systems is necessary in the prediction of structural failures caused by un-natural flexural occurrences. Sensing systems which are used to predict shapes, in order to develop a global surface picture require high precision and lower time lag. In this work, a unique bio-inspired training mechanism for support vector regression is presented for shape sensing in structures mounted with Fiber Bragg Gratings. Experimental validation was carried out on a simply supported beam, loaded at different positions and an aircraft wing model for different types of bending. The resulting deflections at specified locations along the length of the beam and on both surfaces of the wing were interpreted from the wavelength shifts of the corresponding Fiber Bragg Gratings through the specially modified Support Vector Regression. The method has shown high accuracy, low computational requirements and enhanced prediction times. The proposed bio-inspired training method has also been compared with two conventional training methodologies.
An excellent laboratory for studying large scale magnetic fields is the grand design face-on spiral galaxy M51. Due to wavelength-dependent Faraday depolarization, linearly polarized synchrotron emission at different radio frequencies gives a picture of the galaxy at different depths: Observations at L-band (1 – 2 GHz) probe the halo region while at C- and X-band (4 – 8 GHz) the linearly polarized emission probe the disk region of M51. We present new observations of M51 using the Karl G. Jansky Very Large Array (VLA) at S-band (2 – 4 GHz), where previously no polarization observations existed, to shed new light on the transition region between the disk and the halo. We discuss a model of the depolarization of synchrotron radiation in a multilayer magneto-ionic medium and compare the model predictions to the multi-frequency polarization data of M51 between 1 – 8 GHz. The new S-band data are essential to distinguish between different models. Our study shows that the initial model parameters, i.e. the total regular and turbulent magnetic field strengths in the disk and halo of M51, need to be adjusted to successfully fit the models to the data.
To evaluate the survival outcomes and toxicities experienced by non-metastatic head and neck cancer (HNC) patients receiving modulated radiotherapy (RT).
Materials and methods
A total of 608 HNC patients treated consecutively from March 2010 to December 2014 with common subsites (oral cavity, oropharynx, hypopharynx, larynx and nasopharynx) of HNCs formed the study group. Eligible patients included those treated with radical or postoperative RT between March 2010 and December 2014. More than 90% patients received modulated RT [intensity-modulated radiotherapy (IMRT) or volumetric-modulated arc therapy (VMAT)] with concurrent chemotherapy as per stage guidelines. Demographic parameters and disease-related factors were analysed. Disease-free survival (DFS) was calculated from end date of RT till last follow-up or last date of disease control. Overall survival (OS) was calculated from date of registration to last follow-up date if alive. The primary endpoint was survival. The statistical analyses were performed using SPSS version 20.0 and Kaplan–Meier method was used for calculation survival.
Among the evaluable patients, the median age was 60 years (range: 16–93) with male preponderance (male:female – 513:95). Majority were squamous cell carcinoma 93·4% (568/608). The subsites treated were oral cavity 36·8% (224). oropharynx 26·4% (161), larynx 19·7% (120), hypopharynx 10% (62) and nasopharynx 6·4% (41). RT intent was radical in 63·5% (386) and postoperative in 36·5% (222), with 59·5% (362) receiving concurrent chemotherapy. At last follow-up, 348 (57·2%) patients were alive, 169 (27·7%) patients had succumbed to disease and 120 (24·6%) patients had recurrent disease. Out of 120 recurrent cases loco-regional recurrence, nodal recurrence and distant metastases were seen in 62 (51·7%), 25 (20·8%), 33 (27·5%), respectively. In the entire study cohort at 2 year OS and DFS was 80 and 79% whereas 3 years OS and DFS was 70 and 75%, respectively.
In our study, 2 years and 3 years OS and DFS rates are found comparable to the international data with acceptable toxicity profile with the use of modulated RT. It seems to be possible because of stringent departmental protocols and good medical physics support. Our data re-validates need and benefit of advanced RT techniques like IG-IMRT and VMAT for both postoperative and radical HNC treatment at the cost of minimal long-term side effects. Future stringent follow-up and quality of life issues are being considered in a prospective manner.
The study of solar rotation has a 150-year history. Early studies were restricted to looking at the movement of sunspots; much later came studies using other tracers such as supergranules, and spectroscopic measurements using Doppler shifts of spectral lines. These studies also found evidence of other large-scale flows, such as the meridional flows in the north-south direction and the zonal flows, or torsional oscillations, parallel to the equator. However, until the 1980s, the study of solar rotation and large-scale flows was restricted to what could be observed on the solar surface. The advent of good helioseismic data changed that and gave us the means to study flows in the solar interior. Instruments like GONG, MDI and HMI have now collected helioseismic data for two solar cycles and these also allow us to study the large scale flows and their variations with time and solar activity. We review what the long data sets tell us about the these flows and discuss some of the differences between solar cycles 23 and 24.
The evolution of vortex rings in isodensity and isoviscosity fluid has been studied analytically using a novel mathematical model. The model predicts the spatiotemporal variation in peak vorticity, circulation, vortex size and spacing based on instantaneous vortex parameters. This proposed model is quantitatively verified using experimental measurements. Experiments are conducted using high-speed particle image velocimetry (PIV) and laser induced fluorescence (LIF) techniques. Non-buoyant vortex rings are generated from a nozzle using a constant hydrostatic pressure tank. The vortex Reynolds number based on circulation
is varied in the range 100–1500 to account for a large range of operating conditions. Experimental results show good agreement with theoretical predictions. However, it is observed that neither Saffman’s thin-core model nor the thick-core equations could correctly explain vortex evolution for all initial conditions. Therefore, a transitional theory is framed using force balance equations which seamlessly integrate short- and long-time asymptotic theories. It is found that the parameter
is the vortex half-spacing and
denotes the standard deviation of the Gaussian vorticity profile, governs the regime of vortex evolution. For higher values of
, evolution follows short-time behaviour, while for
, long-time behaviour is prominent. Using this theory, many reported anomalous observations have been explained.
Distinguishing temporal patterns of depressive symptoms during pregnancy and after childbirth has important clinical implications for diagnosis, treatment, and maternal and child outcomes. The primary aim of the present study was to distinguish patterns of chronically elevated levels of depressive symptoms v. trajectories that are either elevated during pregnancy but then remit after childbirth, v. patterns that increase after childbirth.
The report uses latent growth mixture modeling in a large, population-based cohort (N = 12 121) to investigate temporal patterns of depressive symptoms. We examined theoretically relevant sociodemographic factors, exposure to adversity, and offspring gender as predictors.
Four distinct trajectories emerged, including resilient (74.3%), improving (9.2%), emergent (4.0%), and chronic (11.5%). Lower maternal and paternal education distinguished chronic from resilient depressive trajectories, whereas higher maternal and partner education, and female offspring gender, distinguished the emergent trajectory from the chronic trajectory. Younger maternal age distinguished the improving group from the resilient group. Exposure to medical, interpersonal, financial, and housing adversity predicted membership in the chronic, emergent, and improving trajectories compared with the resilient trajectory. Finally, exposure to medical, interpersonal, and financial adversity was associated with the chronic v. improving group, and inversely related to the emergent class relative to the improving group.
There are distinct temporal patterns of depressive symptoms during pregnancy, after childbirth, and beyond. Most women show stable low levels of depressive symptoms, while emergent and chronic depression patterns are separable with distinct correlates, most notably maternal age, education levels, adversity exposure, and child gender.
In this short overview we summarize our knowledge of twenty five pulsars showing GPS characteristics. Especially, we will focus on two objects. The first is PSR B1800–21 - a Vela-like GPS pulsar with a variable spectrum. The second is PSR J1740+1000 - a pulsar that shows high frequency turnover based on our most recent observations using the Giant Meterwave Radio Telescope and the Green Bank Telescope.
Crab Pulsar (PSR B0531+21) is known to emit pulsed emission in all bands of the electromagnetic spectrum. It also emits giant radio pulses (GRPs) frequently, which are roughly a hundred to million times brighter than the normal pulses. We aim to study whether there is a significant X-ray enhancement correlated with the occurrence of GRPs, using simultaneous observations with the ASTROSAT, the Giant Meterwave Radio telescope (1300 MHz) and the Ooty Radio telescope (325 MHz). This required determination of fixed pipeline offsets between different instruments. We find the offset between ASTROSAT and GMRT to be −30.181 ± 0.095 ms and that between ASTROSAT and ORT to be −18.4 ± 0.2 ms. Our preliminary results with 1300 MHz data also show a break in pulse intensity distribution at ~ 33 Jy in the main pulse and ~ 28 Jy in the inter-pulse.
The frequencies of the global resonant modes of oscillation of the Sun depend on its structure and dynamics. Since we are able to observe and determine frequencies of many of the Sun's oscillation modes, the observed frequencies can be “inverted” to determine solar structure and dynamics. Inversions of solar oscillation frequencies have proved to be extremely successful in determining solar internal structure and dynamics as well as in testing solar models and inputs to solar models. We discuss here some of the major results that have been obtained through inversions. Recent reviews of inversions for solar structure and dynamics may be found in Christensen-Dalsgaard (2002), Basu and Antia (2008), and Howe (2009).
There are a number of sources, both ground based and space based, for helioseismic data. The Birmingham Solar Oscillation Network (BiSON; Chaplin et al., 1996) is the predominant ground-based source of data for modes of low spherical-harmonic degree ℓ (0 ≤ ℓ ≤ 3) while the Global Oscillation Network Group (GONG; Hill et al., 1996) is the source of ground-based intermediate degree modes (ℓ up to about 150). Instruments such as Global Oscillations at Low Frequencies (GOLF; Gabriel et al., 1997) and Variability of solar Irradiance and Gravity Oscillations (VIRGO; Lazrek et al., 1997) on the Solar and Heliospheric Observatory provide space-based data on low-degree modes, while MDI was until recently the source of intermediate degree data. The Helioseismic and Magnetic Imager (HMI; Scherrer et al., 2012) on board the Solar Dynamic Observatory (SDO) collects data on modes up to ℓ = 3000, though the frequencies of all visible modes cannot be determined easily.
As described in Chapter 9, inversions to determine solar structure proceed through the linearization of the oscillation equations around a known solar model. What is obtained from the inversions is the relative differences in the structure – in particular between the sound speed, density, or adiabatic index Γ1 profiles – of the Sun and the model.
The study characterizes a collection of 67 neonatal septicaemic Escherichia coli isolates on the basis of phylogroup, serotype, virulence, antibiotic resistance and also the association of CTX-M-producing E. coli and the ST131 clone in a developing country. Phylogroups B2 and D were predominant (33% and 19%, respectively). The most prevalent virulence factors (VFs) were traT (69%) and iucC (68%) and most VFs were concentrated in the B2 isolates. High levels of resistance (⩾70%) to cefotaxime, ciprofloxacin and trimethoprim/sulfamethoxazole was recorded but meropenem remained the most active antimicrobial. Six (9%) of the study isolates belonged to the ST131 clone, five of which were from the same hospital, and were either indistinguishable or closely related by pulsed-field gel electrophoresis. Although the prevalence of CTX-M-15-producing isolates was high (81%), the ST131 clone was relatively infrequent (11%) in extended spectrum β-lactamase (ESBL)-producers. The ST131 clone was characterized by the presence of blaCTX-M-15, qnrS, aac(6′)-Ib-cr, IncF plasmids and virulence determinants such as iucC, papC, traT, usp, hlyA, iroNE.coli, cnf, and sat. We conclude that clonal spread of ST131 did not contribute directly to the high prevalence of CTX-M-15 in our settings.
To analyse the preliminary results of CyberKnife stereotactic radiotherapy (SBRT) boost in primary head and neck cancer patients among Indian population.
Methods and materials
A total of nine patients of primary head and neck cancer were treated with CyberKnife SBRT boost after intensity-modulated radiation therapy (IMRT). The median phase 1 IMRT dose was 54 Gy/27 fractions. Histological types included squamous cell carcinoma (n=7) and adenoid cystic carcinoma (n=2). Response was evaluated using positron emission tomography/computed tomography and detailed clinical examination.
As a preliminary analysis with median follow up of 8 months (range: 6–19 months), phase 2 median tumour volume of 16·3 cc and a median dose of 5 Gy per fraction, eight patients had loco-regionally stable disease and one had distant metastasis. With objective assessment five patients had complete response. Treatment was well tolerated with no grade 3 or more acute toxicities directly related to CyberKnife boost.
CyberKnife SBRT boost is an attractive option for primary head and neck cancers especially where disease is in close proximity to critical structures hindering radical dose delivery. Future prospective analysis and optimum assessment of total biological effective dose (BED) in a properly selected case might actually benefit the use of CyberKnife SBRT boost.
Under controlled irradiation of low energy carbon ions, photoluminescence (PL) study of InAs quantum dots prepared with different capping structures (GaAs and InAlGaAs) was carried out. Samples were investigated by varying implantation energy from 15 keV to 50 keV with fluence ranging between 3 × 1011ions/cm2 and 8 × 1011 ions/cm2. For fixed fluence of 4 × 1011ions/cm2, low temperature PL showed enhancement in a certain range of energy, along with a blue shift in the PL peak wavelength. In contrast, with varying fluence at fixed implantation energy of 50 keV, PL enhancement was not significant, rather a drop in PL intensity was noted at higher fluence from 5 × 1011 to 8 × 1011 ions/cm2. Moreover, carbon ion implantation caused a blue shift in the PL emission peak for both energy and fluence variations. PL intensity suppression was possibly caused by the formation of non-radiative recombination centers (NRCs) near the capping layer, while the corresponding blue shift might be attributed to stress generation in the capping layer due to implantation. As-grown and implanted InAlGaAs capped samples did not exhibit much variation in full width at half maxima of PL spectra; however, significant variation was observed for the GaAs capped sample. These results validate that InAlGaAs-capped QDs are more immune to ion implantation.
Metastases to the parotid region are relatively infrequent and originate primarily from head and neck cancer. Metastases of an infraclavicular origin are uncommon. Moreover, metastasis from the carcinoma of urinary bladder (CUB) to any part of the head and neck, including parotid gland, is rare. Surgery and chemotherapy are usually offered. We report a case of solitary parotid metastasis from CUB, who was successfully treated with stereotactic body radiotherapy (SBRT) using CyberKnife. SBRT is a safe alternative in cases unwilling/unfit for surgery.
Renal metastasis is relatively unusual in patients with differentiated thyroid carcinoma.
The clinicoradiological parameters of a series of patients with differentiated thyroid carcinoma and renal metastasis were assessed, together with follow-up data.
Results and conclusion:
The series comprised 4 male patients over the age of 45 years with extensive disease at the primary site. Retro-sternal extension of a large goitre was observed in three patients. The primary tumour was 4 cm or larger in all patients (range, 4–14 cm), and three patients had associated lymph node metastasis. None had any genito-urinary symptoms at presentation. Two patients had isolated renal metastases with no other distant metastases, while the others had extensive multi-organ involvement. The bilateral occurrence of lesions was a hallmark, being observed in all cases. Ultrasound-guided fine needle aspiration cytology and 131I scintigraphy were pivotal in confirming the diagnosis. Evidence of ‘flip-flop’ between 131I study and fluoro-deoxyglucose positron emission tomography was noted in one patient, while the other three demonstrated concordant lesions in both modalities. At a minimum follow-up period of four years after diagnosis, three patients demonstrated stable disease with radioiodine therapy, and one had expired due to a poorly differentiated lung carcinoma which developed subsequently.