Excellence in forensic psychiatry services:International survey of qualities and correlates

Background Excellence is that quality that drives continuously improving outcomes for patients. Excellence must be measurable. We set out to measure excellence in forensic mental health services according to four levels of organisation and complexity (basic, standard, progressive and excellent) across seven domains: values and rights; clinical organisation; consistency; timescale; specialisation; routine outcome measures; research and development. Aims To validate the psychometric properties of a measurement scale to test which objective features of forensic services might relate to excellence: for example, university linkages, service size and integrated patient pathways across levels of therapeutic security.Method A survey instrument was devised by a modified Delphi process. Forensic leads, either clinical or academic, in 48 forensic services across 5 jurisdictions completed the questionnaire. Results Regression analysis found that the number of security levels, linked patient pathways, number of in-patient teams and joint university appointments predicted total excellence score. ConclusionsLarger services organised according to stratified therapeutic security and with strong university and research links scored higher on this measure of excellence. A weakness is that these were self-ratings. Reliability could be improved with peer review and with objective measures such as quality and quantity of research output. For the future, studies are needed of the determinants of other objective measures of better outcomes for patients, including shorter lengths of stay, reduced recidivism and readmission, and improved physical and mental health and quality of life.</p

Follow-up of blood-pressure lowering and glucose control in type 2 diabetes.

BACKGROUND In the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) factorial trial, the combination of perindopril and indapamide reduced mortality among patients with type 2 diabetes, but intensive glucose control, targeting a glycated hemoglobin level of less than 6.5%, did not. We now report results of the 6-year post-trial follow-up. METHODS We invited surviving participants, who had previously been assigned to perindopril–indapamide or placebo and to intensive or standard glucose control (with the glucose-control comparison extending for an additional 6 months), to participate in a post-trial follow-up evaluation. The primary end points were death from any cause and major macrovascular events. RESULTS The baseline characteristics were similar among the 11,140 patients who originally underwent randomization and the 8494 patients who participated in the post-trial follow-up for a median of 5.9 years (blood-pressure–lowering comparison) or 5.4 years (glucose-control comparison). Between-group differences in blood pressure and glycated hemoglobin levels during the trial were no longer evident by the first post-trial visit. The reductions in the risk of death from any cause and of death from cardiovascular causes that had been observed in the group receiving active blood-pressure–lowering treatment during the trial were attenuated but significant at the end of the post-trial follow-up; the hazard ratios were 0.91 (95% confidence interval [CI], 0.84 to 0.99; P=0.03) and 0.88 (95% CI, 0.77 to 0.99; P=0.04), respectively. No differences were observed during follow-up in the risk of death from any cause or major macrovascular events between the intensive-glucose-control group and the standard-glucose-control group; the hazard ratios were 1.00 (95% CI, 0.92 to 1.08) and 1.00 (95% CI, 0.92 to 1.08), respectively. CONCLUSIONS The benefits with respect to mortality that had been observed among patients originally assigned to blood-pressure–lowering therapy were attenuated but still evident at the end of follow-up. There was no evidence that intensive glucose control during the trial led to long-term benefits with respect to mortality or macrovascular events

Axiomatic systems and topological semantics for intuitionistic temporal logic

We propose four axiomatic systems for intuitionistic linear temporal logic and show that each of these systems is sound for a class of structures based either on Kripke frames or on dynamic topological systems. Our topological semantics features a new interpretation for the `henceforth' modality that is a natural intuitionistic variant of the classical one. Using the soundness results, we show that the four logics obtained from the axiomatic systems are distinct. Finally, we show that when the language is restricted to the `henceforth'-free fragment, the set of valid formulas for the relational and topological semantics coincide

Surface patterning of carbon nanotubes can enhance their penetration through a phospholipid bilayer

Nanotube patterning may occur naturally upon the spontaneous self-assembly of biomolecules onto the surface of single-walled carbon nanotubes (SWNTs). It results in periodically alternating bands of surface properties, ranging from relatively hydrophilic to hydrophobic, along the axis of the nanotube. Single Chain Mean Field (SCMF) theory has been used to estimate the free energy of systems in which a surface patterned nanotube penetrates a phospholipid bilayer. In contrast to un-patterned nanotubes with uniform surface properties, certain patterned nanotubes have been identified that display a relatively low and approximately constant system free energy (10 kT) as the nanotube traverses through the bilayer. These observations support the hypothesis that the spontaneous self-assembly of bio-molecules on the surface of SWNTs may facilitate nanotube transduction through cell membranes.Comment: Published in ACS Nano http://pubs.acs.org/doi/abs/10.1021/nn102763

Upper and Lower Bounds on Sizes of Finite Bisimulations of Pfaffian Dynamical Systems

In this paper we study a class of dynamical systems defined by Pfaffian maps. It is a sub-class of o-minimal dynamical systems which capture rich continuous dynamics and yet can be studied using finite bisimulations. The existence of finite bisimulations for o-minimal dynamical and hybrid systems has been shown by several authors; see e.g. Brihaye et al (2004), Davoren (1999), Lafferriere et al (2000). The next natural question to investigate is how the sizes of such bisimulations can be bounded. The first step in this direction was done by Korovina et al (2004) where a double exponential upper bound was shown for Pfaffian dynamical and hybrid systems. In the present paper we improve this bound to a single exponential upper bound. Moreover we show that this bound is tight in general, by exhibiting a parameterized class of systems on which the exponential bound is attained. The bounds provide a basis for designing efficient algorithms for computing bisimulations, solving reachability and motion planning problems

Seizures as the first manifestation of chromosome 22q11.2 deletion syndrome in a 40-year old man: a case report

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