Demographic, clinical, and service-use characteristics related to the clinician’s recommendation to transition from child to adult mental health services

Purpose: The service configuration with distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) may be a barrier to continuity of care. Because of a lack of transition policy, CAMHS clinicians have to decide whether and when a young person should transition to AMHS. This study describes which characteristics are associated with the clinicians’ advice to continue treatment at AMHS. Methods: Demographic, family, clinical, treatment, and service-use characteristics of the MILESTONE cohort of 763 young people from 39 CAMHS in Europe were assessed using multi-informant and standardized assessment tools. Logistic mixed models were fitted to assess the relationship between these characteristics and clinicians’ transition recommendations. Results: Young people with higher clinician-rated severity of psychopathology scores, with self- and parent-reported need for ongoing treatment, with lower everyday functional skills and without self-reported psychotic experiences were more likely to be recommended to continue treatment. Among those who had been recommended to continue treatment, young people who used psychotropic medication, who had been in CAMHS for more than a year, and for whom appropriate AMHS were available were more likely to be recommended to continue treatment at AMHS. Young people whose parents indicated a need for ongoing treatment were more likely to be recommended to stay in CAMHS. Conclusion: Although the decision regarding continuity of treatment was mostly determined by a small set of clinical characteristics, the recommendation to continue treatment at AMHS was mostly affected by service-use related characteristics, such as the availability of appropriate services

Cohort profile : demographic and clinical characteristics of the MILESTONE longitudinal cohort of young people approaching the upper age limit of their child mental health care service in Europe

Purpose: The presence of distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) impacts continuity of mental health treatment for young people. However, we do not know the extent of discontinuity of care in Europe nor the effects of discontinuity on the mental health of young people. Current research is limited, as the majority of existing studies are retrospective, based on small samples or used non-standardised information from medical records. The MILESTONE prospective cohort study aims to examine associations between service use, mental health and other outcomes over 24 months, using information from self, parent and clinician reports. Participants: Seven hundred sixty-three young people from 39 CAMHS in 8 European countries, their parents and CAMHS clinicians who completed interviews and online questionnaires and were followed up for 2 years after reaching the upper age limit of the CAMHS they receive treatment at. Findings to date: This cohort profile describes the baseline characteristics of the MILESTONE cohort. The mental health of young people reaching the upper age limit of their CAMHS varied greatly in type and severity: 32.8% of young people reported clinical levels of self-reported problems and 18.6% were rated to be ‘markedly ill’, ‘severely ill’ or ‘among the most extremely ill’ by their clinician. Fifty-seven per cent of young people reported psychotropic medication use in the previous half year. Future plans: Analysis of longitudinal data from the MILESTONE cohort will be used to assess relationships between the demographic and clinical characteristics of young people reaching the upper age limit of their CAMHS and the type of care the young person uses over the next 2 years, such as whether the young person transitions to AMHS. At 2 years follow-up, the mental health outcomes of young people following different care pathways will be compared. Trial registration number: NCT03013595

[P-value and the probability of direction of effect]

The p-value has been widely criticized in the scientific literature for its naive use in classifying results as 'significant' and 'non significant'. Much has been written about it; for example, see the American Statistical Association position statement of march 2016. To date, few alternative measures have been suggested and few changes were observed in the scientific practice regarding the use of p-value despite general agreement on the critics raised on it. In this paper, we use an alternative measure to p-value. It consists in the probability of the direction of the effect, that is the strength of empirical evidence in favour of the alternative directional hypothesis. In the context of scientific research, reporting the probability of the direction of the effect is easier to understand. Moreover, it focuses on the effect in the study rather than on the value under the null hypothesis, which sometimes has little meaning or has been used opportunistically. The proposal is not intended as an alternative to using the confidence interval, but as a probabilistic metric to be used instead of the p-value when we refer to particular hypotheses to be tested

Long-term exposure to low-level arsenic in drinking water is associated with cause-specific mortality and hospitalization in the Mt. Amiata area (Tuscany, Italy)

Abstract Background Arsenic in drinking water is a global public health concern. This study aims to investigate the association between chronic low-level exposure to arsenic in drinking water and health outcomes in the volcanic area of Mt. Amiata in Italy, using a residential cohort study design. Methods Chronic exposure to arsenic in drinking water was evaluated using monitoring data collected by the water supplier. A time-weighted average arsenic exposure was estimated for the period 2005–2010. The population-based cohort included people living in five municipalities in the Mt. Amiata area between 01/01/1998 and 31/12/2019. Residence addresses were georeferenced and each subject was matched with arsenic exposure and socio-economic status. Mortality and hospital discharge data were selected from administrative health databases. Cox proportional hazard models were used to test the associations between arsenic exposure and outcomes, with age as the temporal axis and adjusting for gender, socio-economic status and calendar period. Results The residential cohort was composed of 30,910 subjects for a total of 407,213 person-years. Analyses reported risk increases associated with exposure to arsenic concentrations in drinking water > 10 µg/l for non-accidental mortality (HR = 1.07 95%CI:1.01–1.13) and malignant neoplasms in women (HR = 1.14 95%CI:0.97–1.35). Long-term exposure to arsenic concentrations > 10 µg/l resulted positively associated with several hospitalization outcomes: non-accidental causes (HR = 1.06 95%CI:1.03–1.09), malignant neoplasms (HR = 1.10 95%CI:1.02–1.19), lung cancer (HR = 1.85 95%CI:1.14–3.02) and breast cancer (HR = 1.23 95%CI:0.99–1.51), endocrine disorders (HR = 1.13 95%CI:1.02–1.26), cardiovascular (HR = 1.12 95%CI:1.06–1.18) and respiratory diseases (HR = 1.10 95%CI:1.03–1.18). Some risk excesses were also observed for an exposure to arsenic levels below the regulatory standard, with evidence of exposure-related trends. Conclusions Our population-based cohort study in the volcanic area of Mt. Amiata showed that chronic exposure to arsenic concentrations in drinking water above the current regulatory limit was associated with a plurality of outcomes, in terms of both mortality and hospitalization. Moreover, some signs of associations emerge even at very low levels of exposure, ​​below the current regulatory limit, highlighting the need to monitor arsenic concentrations continuously and implement policies to reduce concentrations in the environment as far as possible

Joint Analysis of Short and Long-Term Effects of Air Pollution

We present a bivariate Bayesian space-time geostatistical model for exposure assessment and disease risk estimation. We use data from a panel study of 113 children on respiratory health in the high risk area of Valle del Mela (Sicily, IT). Data and gaseous pollutants were collected on 12 weeks in 21 locations 2007\u20132008. The model consists in an exposure model to predict pollutant concentrations at children\u2019s residential addresses; a bivariate disease model. The original features are the joint specification of a spatial long-term effect and a spatiotemporal short-term effect of the pollutant concentrations and uncertainty propagatio

The Spectroscopic Characterization of Halogenated Pollutants through the Interplay between Theory and Experiment: Application to R1122

In the last decade, halogenated ethenes have seen an increasing interest for different applications; in particular, in refrigeration, air-conditioning and heat pumping. At the same time, their adverse effects as atmospheric pollutants require environmental monitoring, especially by remote sensing spectroscopic techniques. For this purpose, an accurate characterization of the spectroscopic fingerprint—in particular, those of relevance for rotational–vibrational spectroscopy—of the target molecules is strongly needed. This work provides an integrated computational–theoretical investigation on R1122 (2-Chloro-1,1-difluoro-ethylene, ClHC=CF2), a compound widely employed as a key intermediate in different chemical processes. State-of-the-art quantum chemical calculations relying on CCSD(T)-based composite schemes and hybrid CCSD(T)/DFT approaches are used to obtain an accurate prediction of the structural, rotational and vibrational spectroscopic properties. In addition, the equilibrium geometry is obtained by exploiting the semi-experimental method. The theoretical predictions are used to guide the analysis of the experimentally recorded gas-phase infrared spectrum, which is assigned in the 400–6500 cm−1 region. Furthermore, absorption cross sections are accurately determined over the same spectral range. Finally, by using the obtained spectroscopic data, a first estimate of the global warming potential of R1122 vibrational spectra is obtained

Line-by-line spectroscopic parameters of HFC-32 ro-vibrational transitions within the atmospheric window around 8.2\u202f\u3bcm

Difluoromethane (CH2F2,HFC-32) presents strong ro-vibrational bands within the 8\u201312 \u3bcm atmospheric window and hence it represents a greenhouse gas able of contributing to global warming. Numerous spectroscopic studies have been devoted to this molecule, however, much information on line-by-line parameters, like line intensities and broadening parameters, is still lacking. In this work, line-by-line spectroscopic parameters are retrieved for several CH2F2 ro-vibrational transitions belonging to the \u3bd7 band located around 8.5 \u3bcm. Self-broadening as well N2\u2013 and O2\u2013 broadening experiments are carried out at room temperature by using a tunable diode laser (TDL) spectrometer. The line shape analysis of CH2F2 self-broadened spectra leads to the determination of resonant frequencies, integrated absorption coefficients and self-broadening parameters, while CH2F2\u2013N2 and CH2F2\u2013O2 broadening coefficients are obtained from foreign-broadening measurements. In addition, the broadening parameters of CH2F2 in air are derived from the N2\u2013 and O2\u2013 broadening coefficients. The results of the present work provide fundamental information to measure the concentration profiles of this molecule in the atmosphere through remote sensing spectroscopic techniques

Iconographic architecture as signs and symbols in Dubai

This study seeks to investigate the impact of architectural icons on the cities that they are built in, especially those in Dubai to understand the perceptions and associations of ordinary people with these icons, thus analysing their impact on the quality of life in the city. This is an important study with the advent of ‘iconism’ in architecture that has a growing acceptance and demand, wherein the status of a piece of architecture is predetermined as an icon by the media and not necessarily by the people. There is no denying that the fastest means of appearing on the world map is through icons, which Dubai evidently achieved, and there are many supporters of this phenomenon as a means of progress and development, the bonus being instant fame and status. But the symbolism employed in these icons, specifically for this part of the world, many argue may not be relevant to the people or the region, thus leading to a loss of identity and sense of belonging that is a vital component in the overall sense of pride. This study thus evaluates architecture as a service industry that is not only to satisfy the personal egos of the architects or the clients. It has an important role to leave a mark on the end users and not only on the glossy architectural journals. The study presents views on what really leaves a mark on the people’s memory, addressing the scale, the grandness, the location, the size, the technology and the materials that may or may not contribute to the iconic status of an architectural project from the people’s perspective. Further the study investigates if an icon is one that could be a forced landmark or it is one that people associate with, relate to and one that gives them the sense of belonging and pride, binding them together. The expressive iconic forms with the metaphors emerging, may or may not add to the quality of a place, create places of spaces or it may result in more of form accommodating functions.Thus it is imperative to understand that though today Dubai with its multiple icons that are jewels in the crown of Dubai, reflecting awe and splendor, what does this architecture do for the people and thus in leaving an imprint on the peoples mind collectively. The study analyzes the dimensions that make certain kind of architecture stand out. Some of these dimensions are physical and others are difficult to measure, thus it addresses the tangible and intangible factors that result in the icon and the associated symbolism with it. The relevance and meaning of these symbols will have to stand the test of time to leave an ever-lasting impression on generations to come. The literature review was the first part of the study and the theoretical studies were divided into three pivot areas in this thesis: evolution of architecture as signs and symbols, international iconic architecture and its impact, architecture as identity through symbolism. The study also focusses on Dubai as an emerging iconic city concentrating on the needs of people and impact of these icons on people specifically, further highlighting the issues of legibility, context and identity in Dubai. The empirical study examines this argument about iconic architecture through questionnaires and interviews. A comparison is drawn between different segments of people in the community, one set of samples being those who are closely associated with these icons through the process of decision making or building, the others who have very minimal knowledge and association with these icons. The findings thus indicate both the well-established criteria for awarding an iconic status and also the intangible often ignored aspects in iconic image building. Thus, the study suggests a paradigm that could provide more human based elements in the iconic architecture and the selected symbols in representing these icons. Certain recommendations supporting the perception of people towards icons, their needs and local considerations are further made to make cities more liveable and joyful for the people they are intended for.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

In Vitro and In Silico Vibrational-Rotational Spectroscopic Characterization of the Next-Generation Refrigerant HFO-1123

Very short-lived substances have recently been proposed as replacements for hydrofluorocarbons (HFCs), in turn being used in place of ozone-depleting substances, in refrigerant applications. In this respect, hydro-fluoro-olefins (HFOs) are attracting particular interest because, due to their reduced global warming potential, they are supposed to be environmentally friendlier. Notwithstanding this feature, they represent a new class of compounds whose spectroscopic properties and reactivity need to be characterized to allow their atmospheric monitoring and to understand their environmental fate. In the present work, the structural, vibrational, and ro-vibrational properties of trifluorothene (HFO-1123, F2C = CHF) are studied by state-of-the-art quantum chemical calculations. The equilibrium molecular structure has an expected error within 2 mÅ and 0.2° for bond lengths and angles, respectively. This represents the first step toward the computation of highly accurate rotational constants for both the ground and first excited fundamental vibrational levels, which reproduce the available experimental data well within 0.1%. Centrifugal distortion parameters and vibrational−rotational coupling terms are computed as well and used to solve some conflicting experimental results. Simulation of the vibrational transition frequencies and intensities beyond the double harmonic approximation and up to three quanta of vibrational excitation provides insights into the couplings ruling the vibrational dynamics and guides the characterization of the gas-phase infrared spectrum experimentally recorded in the range of 200−5000 cm−1. The full characterization of the IR features is completed with the experimental determination of the absorption cross sections over the 400−5000 cm−1 region from which the radiative forcing and global warming potential of HFO-1123 are derive