What is the impact of psychiatric decision units on mental health crisis care pathways? Protocol for an interrupted time series analysis with a synthetic control study

Background The UK mental health system is stretched to breaking point. Individuals presenting with mental health problems wait longer at the ED than those presenting with physical concerns and finding a bed when needed is difficult – 91% of psychiatric wards are operating at above the recommended occupancy rate. To address the pressure, a new type of facility – psychiatric decision units (also known as mental health decision units) – have been introduced in some areas. These are short-stay facilities, available upon referral, targeted to help individuals who may be able to avoid an inpatient admission or lengthy ED visit. To advance knowledge about the effectiveness of this service for this purpose, we will examine the effect of the service on the mental health crisis care pathway over a 4-year time period; the 2 years proceeding and following the introduction of the service. We use aggregate service level data of key indicators of the performance of this pathway. Methods Data from four mental health Trusts in England will be analysed using an interrupted time series (ITS) design with the primary outcomes of the rate of (i) ED psychiatric presentations and (ii) voluntary admissions to mental health wards. This will be supplemented with a synthetic control study with the same primary outcomes, in which a comparable control group is generated for each outcome using a donor pool of suitable National Health Service Trusts in England. The methods are well suited to an evaluation of an intervention at a service delivery level targeting population-level health outcome and the randomisation or ‘trialability’ of the intervention is limited. The synthetic control study controls for national trends over time, increasing our confidence in the results. The study has been designed and will be carried out with the involvement of service users and carers. Discussion This will be the first formal evaluation of psychiatric decision units in England. The analysis will provide estimates of the effect of the decision units on a number of important service use indicators, providing much-needed information for those designing service pathways

A comparison of filtration rates among pelagic tunicates using kinematic measurements

Author Posting. © The Author(s), 2009. This is the author's version of the work. It is posted here by permission of Springer for personal use, not for redistribution. The definitive version was published in Marine Biology 157 (2010): 755-764, doi:10.1007/s00227-009-1359-y.Salps have higher filtration rates than most other holoplankton, and are capable of packaging and exporting primary production from surface waters. A method of kinematic analysis was employed to accurately measure salp feeding rates. The data were then used to explain how diverse body morphologies and swimming motions among species and lifecycle stages influence salp feeding performance. We selected five species, representing a range of morphologies and swimming styles, and used digitized outlines from video frames to measure body-shape change during a pulse cycle. Time-varying body volume was then calculated from the digitized salp outlines to estimate the amount of fluid passing through the filtering mesh. This non-invasive method produced higher feeding rates than other methods and revealed that body volume, pulse frequency and degree of contraction are important factors for determining volume filtered. Each species possessed a unique combination of these three characteristics that resulted in comparable filtration (range: 0.44 - 15.33 ml s-1) and normalized filtration rates (range: 0.21 – 1.27 s-1) across species. The convergence of different species with diverse morphologies on similar normalized filtration suggests a tendency towards a flow optimum.This work was supported by NSF project OCE-0647723

Data-driven inference for the spatial scan statistic

<p>Abstract</p> <p>Background</p> <p>Kulldorff's spatial scan statistic for aggregated area maps searches for clusters of cases without specifying their size (number of areas) or geographic location in advance. Their statistical significance is tested while adjusting for the multiple testing inherent in such a procedure. However, as is shown in this work, this adjustment is not done in an even manner for all possible cluster sizes.</p> <p>Results</p> <p>A modification is proposed to the usual inference test of the spatial scan statistic, incorporating additional information about the size of the most likely cluster found. A new interpretation of the results of the spatial scan statistic is done, posing a modified inference question: what is the probability that the null hypothesis is rejected for the original observed cases map with a most likely cluster of size k, taking into account only those most likely clusters of size k found under null hypothesis for comparison? This question is especially important when the p-value computed by the usual inference process is near the alpha significance level, regarding the correctness of the decision based in this inference.</p> <p>Conclusions</p> <p>A practical procedure is provided to make more accurate inferences about the most likely cluster found by the spatial scan statistic.</p

Locally Optimal Load Balancing

This work studies distributed algorithms for locally optimal load-balancing: We are given a graph of maximum degree $\Delta$, and each node has up to $L$ units of load. The task is to distribute the load more evenly so that the loads of adjacent nodes differ by at most $1$. If the graph is a path ($\Delta = 2$), it is easy to solve the fractional version of the problem in $O(L)$ communication rounds, independently of the number of nodes. We show that this is tight, and we show that it is possible to solve also the discrete version of the problem in $O(L)$ rounds in paths. For the general case ($\Delta > 2$), we show that fractional load balancing can be solved in $\operatorname{poly}(L,\Delta)$ rounds and discrete load balancing in $f(L,\Delta)$ rounds for some function $f$, independently of the number of nodes.Comment: 19 pages, 11 figure

The radiation of cynodonts and the ground plan of mammalian morphological diversity

Cynodont therapsids diversified extensively after the Permo-Triassic mass extinction event, and gave rise to mammals in the Jurassic. We use an enlarged and revised dataset of discrete skeletal characters to build a new phylogeny for all main cynodont clades from the Late Permian to the Early Jurassic, and we analyse models of morphological diversification in the group. Basal taxa and epicynodonts are paraphyletic relative to eucynodonts, and the latter are divided into cynognathians and probainognathians, with tritylodonts and mammals forming sister groups. Disparity analyses reveal a heterogeneous distribution of cynodonts in a morphospace derived from cladistic characters. Pairwise morphological distances are weakly correlated with phylogenetic distances. Comparisons of disparity by groups and through time are non-significant, especially after the data are rarefied. A disparity peak occurs in the Early/Middle Triassic, after which period the mean disparity fluctuates little. Cynognathians were characterized by high evolutionary rates and high diversity early in their history, whereas probainognathian rates were low. Community structure may have been instrumental in imposing different rates on the two clades

Mid-mantle deformation inferred from seismic anisotropy

With time, convective processes in the Earth's mantle will tend to align crystals, grains and inclusions. This mantle fabric is detectable seismologically, as it produces an anisotropy in material properties—in particular, a directional dependence in seismic-wave velocity. This alignment is enhanced at the boundaries of the mantle where there are rapid changes in the direction and magnitude of mantle flow, and therefore most observations of anisotropy are confined to the uppermost mantle or lithosphere and the lowermost-mantle analogue of the lithosphere, the D" region. Here we present evidence from shear-wave splitting measurements for mid-mantle anisotropy in the vicinity of the 660-km discontinuity, the boundary between the upper and lower mantle. Deep-focus earthquakes in the Tonga–Kermadec and New Hebrides subduction zones recorded at Australian seismograph stations record some of the largest values of shear-wave splitting hitherto reported. The results suggest that, at least locally, there may exist a mid-mantle boundary layer, which could indicate the impediment of flow between the upper and lower mantle in this region

A Natural Supersymmetric Model with MeV Dark Matter

It has previously been proposed that annihilating dark matter particles with MeV-scale masses could be responsible for the flux of 511 keV photons observed from the region of the Galactic Bulge. The conventional wisdom, however, is that it is very challenging to construct a viable particle physics model containing MeV dark matter. In this letter, we challenge this conclusion by describing a simple and natural supersymmetric model in which the lightest supersymmetric particle naturally has a MeV-scale mass and the other phenomenological properties required to generate the 511 keV emission. In particular, the small ($\sim$ $10^{-5}$) effective couplings between dark matter and the Standard Model fermions required in this scenario naturally lead to radiative corrections that generate MeV-scale masses for both the dark matter candidate and the mediator particle.Comment: 4 pages, 1 figure. v2: Small modification to discussion of spectru

Serum lipid responses to psyllium fiber: differences between pre- and post-menopausal, hypercholesterolemic women

<p>Abstract</p> <p>Background</p> <p>Cardiovascular disease is the leading cause of death in women and men. Psyllium, a soluble fiber has been known to reduce serum lipids. In this pilot study, we evaluated whether menopausal status would affect the serum lipid responses to psyllium fiber in women.</p> <p>Methods</p> <p>Eleven post-menopausal and eight pre-menopausal women with serum total cholesterol >200 mg/dL were included in the study. Subjects consumed their habitual diet and 15 g psyllium/d for 6 weeks. Psyllium was incorporated into cookies. Each cookie contained ≈5 g of psyllium fiber. Subjects ate one cookie in each meal.</p> <p>Results</p> <p>With psyllium fiber, total cholesterol concentration was significantly lower (≈5.2%, P < 0.05) in post-menopausal women but not in pre-menopausal women (≈1.3%). Also, there was a significant decrease in HDL-cholesterol in post-menopausal women (≈10.2%, P < 0.05). There were no significant changes observed in concentrations of LDL-cholesterol, triglycerides, apolipoprotein A1, and apolipoprotein B in both pre- and post-menopausal women with psyllium.</p> <p>Conclusion</p> <p>In this pilot study, post- and pre-menopausal, hypercholesterolemic women responded differently to psyllium fiber supplementation. Post-menopausal women would benefit from addition of psyllium to their diets in reducing the risk for heart diseases. The results of this study should be used with caution because the study was based on a small sample size.</p

Increased consumption of fruit and vegetables for the primary prevention of cardiovascular diseases

There is increasing evidence that high consumption of fruit and vegetables is beneficial for cardiovascular disease (CVD) prevention