634 research outputs found

    Variation in compulsory psychiatric inpatient admission in England:a cross-sectional, multilevel analysis

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    Background: Rates of compulsory admission have increased in England in recent decades, and this trend is accelerating. Studying variation in rates between people and places can help identify modifiable causes. Objectives: To quantify and model variances in the rate of compulsory admission in England at different spatial levels and to assess the extent to which this was explained by characteristics of people and places. Design: Cross-sectional analysis using multilevel statistical modelling. Setting: England, including 98% of Census lower layer super output areas (LSOAs), 95% of primary care trusts (PCTs), 93% of general practices and all 69 NHS providers of specialist mental health services. Participants: 1,287,730 patients. Main outcome measure: The study outcome was compulsory admission, defined as time spent in an inpatient mental illness bed subject to the Mental Health Act (2007) in 2010/11. We excluded patients detained under sections applying to emergency assessment only (including those in places of safety), guardianship or supervision of community treatment. The control group comprised all other users of specialist mental health services during the same period. Data sources: The Mental Health Minimum Data Set (MHMDS). Data on explanatory variables, characterising each of the spatial levels in the data set, were obtained from a wide range of sources, and were linked using MHMDS identifiers. Results: A total of 3.5% of patients had at least one compulsory admission in 2010/11. Of (unexplained) variance in the null model, 84.5% occurred between individuals. Statistically significant variance occurred between LSOAs [6.7%, 95% confidence interval (CI) 6.2% to 7.2%] and provider trusts (6.9%, 95% CI 4.3% to 9.5%). Variances at these higher levels remained statistically significant even after adjusting for a large number of explanatory variables, which together explained only 10.2% of variance in the study outcome. The number of provider trusts whose observed rate of compulsory admission differed from the model average to a statistically significant extent fell from 45 in the null model to 20 in the fully adjusted model. We found statistically significant associations between compulsory admission and age, gender, ethnicity, local area deprivation and ethnic density. There was a small but statistically significant association between (higher) bed occupancy and compulsory admission, but this was subsequently confounded by other covariates. Adjusting for PCT investment in mental health services did not improve model fit in the fully adjusted models. Conclusions: This was the largest study of compulsory admissions in England. While 85% of the variance in this outcome occurred between individuals, statistically significant variance (around 7% each) occurred between places (LSOAs) and provider trusts. This higher-level variance in compulsory admission remained largely unchanged even after adjusting for a large number of explanatory variables. We were constrained by data available to us, and therefore our results must be interpreted with caution. We were also unable to consider many hypotheses suggested by the service users, carers and professionals who we consulted. There is an imperative to develop and evaluate interventions to reduce compulsory admission rates. This requires further research to extend our understanding of the reasons why these rates remain so high. Funding: The National Institute for Health Research Health Services and Delivery Research programme

    CUBIC SPLINES FOR ESTIMATING LACTATION CURVES AND GENETIC PARAMETERS OF FIRST LACTATION HOLSTEIN COWS TREATED WITH BOVINE SOMATOTROPIN

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    The objective was to estimate genetic parameters and fit lactation curves for cows treated or not treated with bovine somatotropin (bST) and fit specific lactation curves for each animal for both random genetic and permanent environmental components from individual test-day milk, fat, and protein yields with a cubic spline model. A total of 70,752 test-day observations for first lactation Holstein cows recorded as treated bST and 73,387 test-day observations for untreated cows that calved between 1994 and early 1999 were obtained from Dairy Records Management Systems in Raleigh, North Carolina. The model included herd test-day, age at first calving, bST treatment, and days in lactation when test-day yield was recorded as fixed effects. Cubic splines were fitted for the overall lactation curve, additive genetic effects, and permanent environmental effects. The cubic splines used five predetermined intervals between days 0, 50, 135,220, and 305. Estimates of the (co)variances for the random components of cubic spline model with five knots were obtained with REML. Estimates of genetic parameters were calculated for the average test day model within each of the ten 30-d test day intervals. The estimates of heritability for milk, fat, and protein yields ranged from 0.09 to 0.15, 0.06 to 0.10, and 0.08 to 0.15 for test-day one to test-day ten. Estimates of genetic correlations between testdays ranged from 0.99 to 0.34 for milk yield, 0.99 to 0.49 for fat yield, and 0.99 to 0.36 for protein yield. Estimates of phenotypic correlations between test-days ranged from 0.67 to 0.27 for milk yield, 0.52 to 0.16 for fat yield, and 0.60 to 0.19 for protein yield. Differences between bST treated and untreated cows of 2 to 4 kg and 0.10 to 0.16 kg for milk and fat yields (smaller for protein yield) at day 90 were maintained until about day 305 of lactation

    Monte Carlo investigation of the magnetic anisotropy in Fe/Dy multilayers

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    By Monte Carlo simulations in the canonical ensemble, we have studied the magnetic anisotropy in Fe/Dy amorphous multilayers. This work has been motivated by experimental results which show a clear correlation between the magnetic perpendicular anisotropy and the substrate temperature during elaboration of the samples. Our aim is to relate macroscopic magnetic properties of the multilayers to their structure, more precisely their concentration profile. Our model is based on concentration dependent exchange interactions and spin values, on random magnetic anisotropy and on the existence of locally ordered clusters that leads to a perpendicular magnetisation. Our results evidence that a compensation point occurs in the case of an abrupt concentration profile. Moreover, an increase of the noncollinearity of the atomic moments has been evidenced when the Dy anisotropy constant value grows. We have also shown the existence of inhomogeneous magnetisation profiles along the samples which are related to the concentration profiles

    Religious perspectives on the use of psychopharmaceuticals as an enhancement technology

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    The use of psychopharmaceuticals as an enhancement technology has been the focus of attention in the bioethics literature. However, there has been little examination of the challenges that this practice creates for religious traditions that place importance on questions of being, authenticity and identity. We asked expert commentators from six major world religions to consider the issues raised by psychopharmaceuticals as an enhancement technology. These commentaries reveal that in assessing the appropriate place of medical therapies, religious traditions, like secular perspectives, rely upon ideas about health and disease and about normal human behavior. But unlike secular perspectives, faith traditions explicitly concern themselves with ways in which medicine should or should not be used to live a ‘good life’. KEYWORDS: Enhancement; bioethics, psychopharmacology, religio

    Magnetisation switching in a ferromagnetic Heisenberg nanoparticle with uniaxial anisotropy: A Monte Carlo investigation

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    We investigate the thermal activated magnetisation reversal in a single ferromagnetic nanoparticle with uniaxial anisotropy using Monte Carlo simulations. The aim of this work is to reproduce the reversal magnetisation by uniform rotation at very low temperature in the high energy barrier hypothesis, that is to realize the N\'eel-Brown model. For this purpose we have considered a simple cubic nanoparticle where each site is occupied by a classical Heisenberg spin. The Hamiltonian is the sum of an exchange interaction term, a single-ion anisotropy term and a Zeeman interaction term. Our numerical data of the thermal variation of the switching field are compared to an approximated expression and previous experimental results on Co nanoparticles

    Heritability of Clinical Mastitis Incidence and Relationships with Sire Transmitting Abilities for Somatic Cell Score, Udder Type Traits, Productive Life, and Protein Yield

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    The objective of this study was to determine the relationships among daughter clinical mastitis during first and second lactations and sire transmitting abilities for somatic cell score, udder type traits, productive life, and protein yield. Data on clinical mastitis during first lactation were available for 1795 daughters (in six Pennsylvania herds, one Minnesota herd, and one Nebraska herd) of 283 Holstein sires. Data on clinical mastitis during second lactation were available for 1055 of these daughters. A total of 479 cows had 864 clinical episodes during first lactation, and 230 cows had 384 clinical episodes during second lactation. Clinical mastitis incidence and the total number of clinical episodes during each lactation were regressed on herd-season of calving (a classification variable), age at first calving, lactation length, and sire transmitting abilities taken one at a time. Linear effects, nonlinear effects, and odds ratios were estimated for sire transmitting abilities. Separate analyses were conducted on dependent variables that considered clinical mastitis from: all organisms, coagulase-negative staphylococci, coliform species, streptococci other than Streptococcus agalactiae, and the most common environmental organisms (coliform species and streptococci other than Streptococcus agalactiae). Heritability of clinical mastitis ranged from 0.01 to 0.42. Daughters of sires that transmit the lowest somatic cell score had the lowest incidence of clinical mastitis and the fewest clinical episodes during first and second lactations. Daughters of sires that transmit longer productive life, shallower udders, deeper udder cleft, and strongly attached fore udders had either fewer clinical episodes or lower clinical mastitis incidence during first and second lactations. The incidence of clinical mastitis and the number of clinical episodes per lactation may be reduced by selection for lower somatic cell score, longer productive life, shallower udders, deeper udder cleft, or strongly attached fore udders

    Religious perspectives on umbilical cord blood banking

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    Umbilical cord blood is a valuable source of haematopoietic stem cells. There is little information about whether religious affiliations have any bearing on attitudes to and decisions about its collection, donation and storage. The authors provided information about umbilical cord blood banking to expert commentators from six major world religions (Catholicism, Anglicanism, Islam, Judaism, Hinduism and Buddhism) and asked them to address a specific set of questions in a commentary. The commentaries suggest there is considerable support for umbilical cord blood banking in these religions. Four commentaries provide moral grounds for favouring public donation over private storage. None attach any particular religious significance to the umbilical cord or to the blood within it, nor place restrictions on the ethnicity or religion of donors and recipients. Views on ownership of umbilical cord blood vary. The authors offer a series of general points for those who seek a better understanding of religious perspectives on umbilical cord blood banking
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