Recent physical conditions and health service utilization in people with common mental disorders and severe mental illness in England: Comparative cross-sectional data from a nationally representative sample

BACKGROUND.: Policies addressing the physical health of people with mental disorders have historically focused on those with severe mental illness (SMI), giving less prominence to the more prevalent common mental disorders (CMDs). Little is known about the comparative physical health outcomes of these patient groups. We aimed to first compare the: (a) number of past-year chronic physical conditions and (b) recent physical health service utilization between CMDs vs. SMI, and secondly compare these outcomes between people with CMDs vs. people without mental disorders. METHODS.: We analyzed cross-sectional data from the third Adult Psychiatric Morbidity Survey, a representative sample of the English population. We determined the presence of physical conditions and health service utilization by self-report and performed logistic regression models to examine associations of these outcomes between participant groups. RESULTS.: Past-year physical conditions were reported by the majority of participants (CMDs, n = 815, 62.1%; SMI = 27, 63.1%) with no variation in the adjusted odds of at least one physical condition between diagnoses (odds ratio [OR] = 0.96, 95% confidence intervals [CI] 0.42-1.98, p = 0.784). People with CMDs were significantly more likely to be recently hospitalized relative to with those with SMI (OR = 6.33, 95% CI 5.50-9.01, p < 0.05). Having a CMD was associated with significantly higher odds of past-year physical conditions and recent health service utilization (all p < 0.001) compared with the general population. CONCLUSIONS.: People with CMDs experience excess physical health morbidities in a similar pattern to those found among people with SMI, while their somatic hospitalization rates are even more elevated. Findings highlight the importance of recalibrating existing public health strategies to bring equity to the physical health needs of this patient group

Minimal important improvement thresholds for the six-minute walk test in a knee arthroplasty cohort: triangulation of anchor- and distribution-based methods.

BACKGROUND: The 6-minute walk test (6MWT) is a commonly used metric for measuring change in mobility after knee arthroplasty, however, what is considered an improvement after surgery has not been defined. The determination of important change in an outcome assessment tool is controversial and may require more than one approach. This study, nested within a combined randomised and observational trial, aimed to define a minimal important improvement threshold for the 6MWT in a knee arthroplasty cohort through a triangulation of methods including patient-perceived anchor-based thresholds and distribution-based thresholds. METHODS: Individuals with osteoarthritis performed a 6MWT pre-arthroplasty then at 10 and 26 weeks post-surgery. Each rated their perceived improvement in mobility post-surgery on a 7-point transition scale anchored from "much better" to "much worse". Based on these responses the cohort was dichotomised into 'improved' and 'not improved'. The thresholds for patient-perceived improvements were then identified using two receiver operating curve methods producing sensitivity and specificity indices. Distribution-based change thresholds were determined using two methods utilising effect size (ES). Agreement between the anchor- and distribution-based methods was assessed using kappa. RESULTS: One hundred fifty-eight from 166 participants in the randomised cohort and 222 from 243 in the combined randomised and observational cohort were included at 10 and 26 weeks, respectively. The slightly or more patient-perceived improvement threshold at 26 weeks (an absolute improvement of 26 m) was the only one to demonstrate sensitivity and specificity results both better than chance. At 10- and 26-weeks, the ES based on the mean change score divided by the baseline standard deviation (SD), was an absolute change of 24.5 and 37.9 m, respectively. The threshold based on a moderate ES (a 0.5 SD of the baseline score) was a change of 55.0 and 55.4 m at 10- and 26-weeks, respectively. The level of agreement between the 26-week anchor-based and distribution-based minimal absolute changes was very good (k = 0.88 (95 % CI 0.81 0.95)). CONCLUSION: A valid threshold of improvement for the 6MWT can only be proposed for changes identified from baseline to 26 weeks post-surgery. The level of agreement between anchor- and distribution-based methods indicates that a true minimal or more threshold of meaningful improvement following surgery is likely within the ranges proposed by the triangulation of all four methods, that is, 26 to 55 m

Accuracy of prescribing documentation by UK junior doctors undertaking psychiatry placements: a multi-centre observational study.

OBJECTIVES: Medical records are critical to patient care, but often contain incomplete information. In UK hospitals, record-keeping is traditionally undertaken by junior doctors, who are increasingly completing early-career placements in psychiatry, but negative attitudes towards psychiatry may affect their performance. Little is known about the accuracy of medical records in psychiatry in general. This study aimed to evaluate the accuracy of Electronic Medical Records (EMRs) pertinent to clinical decision-making ("rationale") for prescribing completed by junior doctors during a psychiatry placement, focusing on the differences between psychotropic vs. non-psychotropic drugs and the temporal association during their placement. RESULTS: EMRs of 276 participants yielding 780 ward round entries were analysed, 100% of which were completed by Foundation Year or General Practice specialty training junior doctors rather than more senior clinicians. Compared with non-psychotropic drugs, documentation of prescribing rationale for psychotropic drugs was less likely (OR = 0.24, 95% CI 0.16-0.36, p < 0.001). The rate of rationale documentation significantly declined over time especially for psychotropic drugs (p < 0.001). Prescribing documentation of non-psychotropic drugs for people with mental illness is paradoxically more accurate than that of psychotropic drugs. Early-career junior doctors are therefore increasingly shaping EMRs of people receiving psychiatric care

Control of an open-loop hydraulic offshore wind turbine using a variable-area orifice

The research work disclosed in this publication is partly funded by the Malta Government Scholarship Scheme.The viability of offshore wind turbines is presently affected by a number of technical issues pertaining to the gearbox and power electronic components. Current work is considering the possibility of replacing the generator, gearbox and electrical transmission with a hydraulic system. Efficiency of the hydraulic transmission is around 90% for the selected geometries, which is comparable to the 94% expected for conventional wind turbines. A rotor-driven pump pressurises seawater that is transmitted across a large pipeline to a centralised generator platform. Hydroelectric energy conversion takes place in Pelton turbine. However, unlike conventional hydro-energy plants, the head available at the nozzle entry is highly unsteady. Adequate active control at the nozzle is therefore crucial in maintaining a fixed line pressure and an optimum Pelton turbine operation at synchronous speed. This paper presents a novel control scheme that is based on the combination of proportional feedback control and feed forward compensation on a variable area nozzle. Transient domain simulation results are presented for a Pelton wheel supplied by sea water from an offshore wind turbine-driven pump across a 10 km pipeline.peer-reviewe

The Lattice and Simplex Structure of States on Pseudo Effect Algebras

We study states, measures, and signed measures on pseudo effect algebras with some kind of the Riesz Decomposition Property, (RDP). We show that the set of all Jordan signed measures is always an Abelian Dedekind complete $\ell$-group. Therefore, the state space of the pseudo effect algebra with (RDP) is either empty or a nonempty Choquet simplex or even a Bauer simplex. This will allow represent states on pseudo effect algebras by standard integrals

On the lattice structure of probability spaces in quantum mechanics

Let C be the set of all possible quantum states. We study the convex subsets of C with attention focused on the lattice theoretical structure of these convex subsets and, as a result, find a framework capable of unifying several aspects of quantum mechanics, including entanglement and Jaynes' Max-Ent principle. We also encounter links with entanglement witnesses, which leads to a new separability criteria expressed in lattice language. We also provide an extension of a separability criteria based on convex polytopes to the infinite dimensional case and show that it reveals interesting facets concerning the geometrical structure of the convex subsets. It is seen that the above mentioned framework is also capable of generalization to any statistical theory via the so-called convex operational models' approach. In particular, we show how to extend the geometrical structure underlying entanglement to any statistical model, an extension which may be useful for studying correlations in different generalizations of quantum mechanics.Comment: arXiv admin note: substantial text overlap with arXiv:1008.416

Bloom’s Syndrome and PICH Helicases Cooperate with Topoisomerase IIα in Centromere Disjunction before Anaphase

Centromeres are specialized chromosome domains that control chromosome segregation during mitosis, but little is known about the mechanisms underlying the maintenance of their integrity. Centromeric ultrafine anaphase bridges are physiological DNA structures thought to contain unresolved DNA catenations between the centromeres separating during anaphase. BLM and PICH helicases colocalize at these ultrafine anaphase bridges and promote their resolution. As PICH is detectable at centromeres from prometaphase onwards, we hypothesized that BLM might also be located at centromeres and that the two proteins might cooperate to resolve DNA catenations before the onset of anaphase. Using immunofluorescence analyses, we demonstrated the recruitment of BLM to centromeres from G2 phase to mitosis. With a combination of fluorescence in situ hybridization, electron microscopy, RNA interference, chromosome spreads and chromatin immunoprecipitation, we showed that both BLM-deficient and PICH-deficient prometaphase cells displayed changes in centromere structure. These cells also had a higher frequency of centromeric non disjunction in the absence of cohesin, suggesting the persistence of catenations. Both proteins were required for the correct recruitment to the centromere of active topoisomerase IIα, an enzyme specialized in the catenation/decatenation process. These observations reveal the existence of a functional relationship between BLM, PICH and topoisomerase IIα in the centromere decatenation process. They indicate that the higher frequency of centromeric ultrafine anaphase bridges in BLM-deficient cells and in cells treated with topoisomerase IIα inhibitors is probably due not only to unresolved physiological ultrafine anaphase bridges, but also to newly formed ultrafine anaphase bridges. We suggest that BLM and PICH cooperate in rendering centromeric catenates accessible to topoisomerase IIα, thereby facilitating correct centromere disjunction and preventing the formation of supernumerary centromeric ultrafine anaphase bridges

Social difference, cultural arbitrary and identity : an analysis of a new national curriculum document in a non-secular environment

This article focuses on the idea of the Curriculum as a 'selection from the cultures of society' and as a site of contestation for legitimacy and identity affirmation. The purpose is to shed some light on the nature of curricular reform being advocated in a specific context - Malta. Throughout the past four years, there has been a revamping of the National Minimum Curriculum (NMC) document in Malta, established in 1988. The 'old' National Minimum Curriculum was subject to criticism focusing on a variety of issues (echoing criticisms levelled at similar National Curricula elsewhere), including issues concerning difference and identity. The first part of the article deals briefly with the issues concerning difference raised in this criticism, focusing on the issues of class, race/ethnicity, gender and disability. The second part focuses on the long and gradual build up towards the development of the new National Curriculum document. The process centres around two documents, the preliminary Tomorrow's Schoolsdocument and the draft NMC document. The issues of equity and the affirmation of social difference, as well as the move towards de-streaming, are discussed. It is argued that this process of reform benefited from the criticism of the earlier NMC document. The process of reform involved an attempt at widespread participation by various stakeholders - parents, teachers, students, unions, women's organisations, disabled person's organisations etc. The final section focuses on the final new NMC document. In this section, the authors explore the compromises, which have been made in reaction to the draft document, indicating the interests at play. Whose cultural arbitrary is reflected in the final document? The article concludes with a discussion centring around lessons to be drawn from a process of curricular reform, involving issues related to identity and difference, carried out in a country characterised by a non-secular environment.peer-reviewe

Reducing weight gain in people with schizophrenia, schizoaffective disorder, and first episode psychosis: describing the process of developing the STructured lifestyle Education for People With SchizophrEnia (STEPWISE) intervention

Background Obesity is twice as common in people with schizophrenia as the general population and associated with significantly worsened psychiatric and physical health. Despite National Institute for Health and Care Excellence guidelines for the management of psychosis recommending that mental health services offer lifestyle programmes to people with schizophrenia to improve physical health, this is not currently occurring. The aim of the STEPWISE research programme was to develop a lifestyle intervention addressing obesity and preventing weight gain in people with schizophrenia, schizoaffective disorder, or first episode psychosis taking antipsychotic medication, through an approach and fundamental principles drawn from existing diabetes and diabetes prevention interventions. This paper describes the often under-reported process of developing such an intervention from first principles. Methods Following an extensive literature review, an iterative cycle of development with input from people with schizophrenia, mental healthcare professionals, facilitators, and other stakeholders, a new weight management intervention for the target group was developed. A set of four core weekly sessions was piloted in Sheffield, followed at 3-monthly intervals by three booster sessions and telephone support contact once every 2 weeks, to form an intervention lasting 12 months. Facilitators were provided with a 4-day training package to support delivery of the intervention. Results This paper reports the process of development, including challenges and how these were addressed. It describes how user input influenced the structure, topics, and approach of the intervention. The outcome of this process was a feasible and acceptable lifestyle intervention to support people with schizophrenia, schizoaffective disorder, or first episode psychosis to manage their weight. This pilot provided opportunities for refinement of the intervention and facilitator training prior to testing in a multi-centre randomised controlled trial. Key findings from the pilot were linked to accessibility, focus, uptake, and retention, which influenced session length, travel arrangements, refreshment, breaks, and supporting tools to incentivise participants. Conclusions The STEPWISE intervention has been evaluated in a randomised controlled trial in 10 mental health trusts in England, and the results will be published in the British Journal of Psychiatry and the NIHR Journals Library