Alchemical Efficiency

A brief poem describing the far reaching impact of body bequeathal

The economics of waiting time in mental health

This thesis empirically explores aspects of the economics of waiting times in the mental health context. Waiting times are of persistent policy concern as they risk poorer treatment outcomes and threaten the desired principles of timely and equitable access. The empirical applications focus on first-episode psychosis patients and early intervention in psychosis (EIP) services in the English National Health Service where policymakers recently placed new emphasis on reducing waiting times. Analyses are based on the nationally representative Mental Health and Learning Disabilities Dataset 2011 to 2015. We develop procedures to measure various dimensions of waiting times at the patient level – such as duration of untreated psychosis, inpatient waiting time, and referral-to-treatment waiting time. We apply generalised linear modelling to accommodate the heavy-tailed distribution of waiting time and use duration analysis to overcome the challenge of right-censoring. We further make use of difference-in-difference and matching techniques to evaluate the impact of the newly introduced EIP waiting time target. We found significant socioeconomic inequalities in duration of untreated psychosis. Also, hallucinations and delusions, as well as previous mental health service use, were influencing factors for patients to access services. Waiting for a care coordinator was associated with a clinically significant deterioration in patient outcomes independent of treatment intensity. The implementation of the EIP waiting time target led to an increased probability of waiting below target whereas waiting times along the distribution did not improve. However, waiting times improved already in anticipation of the policy change with little evidence of unintended effects such as re-prioritisation of patients or gaming behaviour of providers. Results of this thesis can help to inform the development of strategies to reduce inequalities in access to EIP services, and the prospective implementation of waiting time targets in other mental health service areas as well as its adaptation to other countries

A Polish Grandmother

A touching tribute to an amazing grandmother

Improving access to services for psychotic patients: does implementing a waiting time target make a diference

Objective: In April 2015, the English National Health Service started implementing the first waiting time targets in mental health care. This study aims to investigate the effect of the 14-day waiting time target for early intervention in psychosis (EIP) services after the first six months of its implementation. Study design: We analyse a cohort of first-episode psychosis patients from the English administrative Mental Health and Learning Disabilities Dataset 2011 to 2015. We compare patients being treated by EIP services (treatment) with those receiving care from standard community mental health services (control). We combine nonparametric matching with a difference-in-difference approach to account for observed and unobserved group differences. We analyse the probability of waiting below target and look at different percentiles of the waiting time distribution. Results: EIP patients had an 11.6–18.4 percentage point higher chance of waiting below target post-policy compared to standard care patients. However, post-policy trends at different percentiles of the waiting time distribution were not different between groups. Conclusions: Mental health providers seem to respond to waiting time targets in a similar way as physical health providers. The increased proportion waiting below target did not, however, result in an overall improvement across the waiting time distribution

Mission Possible: BioMedical Experiments on the Space Shuttle

Biomedical research, both applied and basic, was conducted on every Shuttle mission from 1981 to 2011. The Space Shuttle Program enabled NASA investigators and researchers from around the world to address fundamental issues concerning living and working effectively in space. Operationally focused occupational health investigations and tests were given priority by the Shuttle crew and Shuttle Program management for the resolution of acute health issues caused by the rigors of spaceflight. The challenges of research on the Shuttle included: limited up and return mass, limited power, limited crew time, and requirements for containment of hazards. The sheer capacity of the Shuttle for crew and equipment was unsurpassed by any other launch and entry vehicle and the Shuttle Program provided more opportunity for human research than any program before or since. To take advantage of this opportunity, life sciences research programs learned how to: streamline the complicated process of integrating experiments aboard the Shuttle, design experiments and hardware within operational constraints, and integrate requirements between different experiments and with operational countermeasures. We learned how to take advantage of commercial-off-the-shelf hardware and developed a hardware certification process with the flexibility to allow for design changes between flights. We learned the importance of end-to-end testing for experiment hardware with humans-in-the-loop. Most importantly, we learned that the Shuttle Program provided an excellent platform for conducting human research and for developing the systems that are now used to optimize research on the International Space Station. This presentation will include a review of the types of experiments and medical tests flown on the Shuttle and the processes that were used to manifest and conduct the experiments. Learning Objective: This paper provides a description of the challenges related to launching and implementing biomedical experiments aboard the Space Shuttle

Samasooliste paaride perekonnapõhiõigus Eestis ja Euroopa Inimõiguste Kohtu praktikas

https://www.ester.ee/record=b5508881*es

Placental Mesenchymal Stem Cell-Derived Extracellular Vesicles Promote Myelin Regeneration in an Animal Model of Multiple Sclerosis.

Mesenchymal stem/stromal cells (MSCs) display potent immunomodulatory and regenerative capabilities through the secretion of bioactive factors, such as proteins, cytokines, chemokines as well as the release of extracellular vesicles (EVs). These functional properties of MSCs make them ideal candidates for the treatment of degenerative and inflammatory diseases, including multiple sclerosis (MS). MS is a heterogenous disease that is typically characterized by inflammation, demyelination, gliosis and axonal loss. In the current study, an induced experimental autoimmune encephalomyelitis (EAE) murine model of MS was utilized. At peak disease onset, animals were treated with saline, placenta-derived MSCs (PMSCs), as well as low and high doses of PMSC-EVs. Animals treated with PMSCs and high-dose PMSC-EVs displayed improved motor function outcomes as compared to animals treated with saline. Symptom improvement by PMSCs and PMSC-EVs led to reduced DNA damage in oligodendroglia populations and increased myelination within the spinal cord of treated mice. In vitro data demonstrate that PMSC-EVs promote myelin regeneration by inducing endogenous oligodendrocyte precursor cells to differentiate into mature myelinating oligodendrocytes. These findings support that PMSCs' mechanism of action is mediated by the secretion of EVs. Therefore, PMSC-derived EVs are a feasible alternative to cellular based therapies for MS, as demonstrated in an animal model of the disease

Inglise keele õpperaamat.

Digiteeritud Euroopa Regionaalarengu Fondi rahastusel, projekti "Eesti teadus- ja õppekirjandus" (2014-2020.12.03.21-0848) raames.https://www.ester.ee/record=b1569349*es

Effect of ciliary neurotrophic factor (CNTF) on motoneuron survival

We have demonstrated that the extensive degeneration of motoneurons in the rat facial nucleus after transection of the facial nerve in newborn rats can be prevented by local ciliary neurotrophic factor (CNTF) administration. CNTF differs distinctly from known neurotrophic molecules such as NGF, BDNF and NT-3 in both its molecular characteristics (CNTF is a cytosolic rather than a secretory molecule) and its broad spectrum of biological activities. CNTF is expressed selectively by Schwann cells and astrocytes of the peripheral and central nervous system, respectively, but not by target tissues of the great variety of CNTF -responsive neurons. CNTF mRNA is not detectable by Northern blot or PCR analysis during embryonic development and immediately after birth. However, during the second post-natal week, a more than 30-fold increase in CNTF mRNA and pro tein occurs in the sciatic nerve. Since the period of low CNTF levels in peripheral nerves coincides with that of high vulnerability of motoneurons (i.e. axonallesion results in degeneration of motoneuron cell bodies), insufficient availability of CNTF may be the reason for the rate of lesioninduced cell death of early post-natal motoneurons. Highly enriched embryonic chick motoneurons in culture are supported at survival rates higher than 60% by CNTF, even in single cell cultures, indicating that CNTF acts directly on motoneurons. In contrast to CNTF, the members of the neurotrophin gene family (NGF, BDNF and NT-3) do not support the survival of motoneurons in culture. However, aFGF and bFGF show distinct survival activities which are additive to those of CNTF, resulting in the survival of virtually all motoneurons cultured in the presence of CNTF and bFGF