Professional relations in multidisciplinary healthcare: a counselling psychology perspective

Primary care professionals work in settings which have traditionally been very hierarchical, and medical practitioners have occupied the dominant places in that hierarchy, possessing structural power through their affiliation with the social institution of medicine, and their control of funding. Counselling in primary care has been described as a fast evolving profession and Counselling Psychologists are filling many of these newly created posts, cautionary notes concerning the impact of the NHS reforms of recent years on the discipline have been raised. This study was designed to raise awareness of some key factors impacting on the process of communication in multidisciplinary working in primary care relevant to counselling psychologists, and to explore multidisciplinary working in health care from a psychological discourse analysis perspective. Three different workshops were run comprised of multidisciplinary groups brought together for the purpose of the study. Each team were trained in the Community Oriented Primary Care (COPQ model and then audio- and videotaped constructing a COPC programme to address depression in older people. Analysis of the group transcripts was carried out exploring power relations, competing agendas and ideological patterns. Conclusions are that 1. COPC may have had limited application due to difficulties implementing the nonhierarchical multidisciplinary working aspect of the model. 2. Counselling Psychology has much to contribute to multidisciplinary working and could foster true innovation in primary care through broadening the clinical perspective. 3. Counselling Psychologists need to be aware of the power of medical discourse in the environments in which they work, and the resistance of primary care to change which can emerge through the promotion of the medical agenda and the language used in multidisciplinaryworking in medical settings

The annual course of precipitation over much of the United States: observed versus GCM simulation

General Circulation Models (GCMs) may be useful in estimating the ecological impacts of global climatic change. We analyzed seasonal weather patterns over the conterminous United States and determined that regional patterns of rainfall seasonality appear to control the distributions of the Nation's major biomes. These regional patterns were compared to the output from three GCMs for validation. The models appear to simulate the appropriate seasonal climates in the northern tier of states. However, the spatial extent of these regions is distorted. None of the models accurately portrayed rainfall seasonalities in the southern tier of states, where biomes are primarily influenced by the Bermuda High

Anderson impurity solver integrating tensor network methods with quantum computing

Solving the Anderson impurity model typically involves a two-step process, where one first calculates the ground state of the Hamiltonian, and then computes its dynamical properties to obtain the Green's function. Here we propose a hybrid classical/quantum algorithm where the first step is performed using a classical computer to obtain the tensor network ground state as well as its quantum circuit representation, and the second step is executed on the quantum computer to obtain the Green's function. Our algorithm exploits the efficiency of tensor networks for preparing ground states on classical computers, and takes advantage of quantum processors for the evaluation of the time evolution, which can become intractable on classical computers. We demonstrate the algorithm using 20 qubits on a quantum computing emulator for SrVO3 with a multi-orbital Anderson impurity model within the dynamical mean field theory. The tensor network based ground state quantum circuit preparation algorithm can also be performed for up to 40 qubits with our available computing resources, while the state vector emulation of the quantum algorithm for time evolution is beyond what is accessible with such resources. We show that, provided the tensor network calculation is able to accurately obtain the ground state energy, this scheme does not require a perfect reproduction of the ground state wave function on the quantum circuit to give an accurate Green's function. This hybrid approach may lead to quantum advantage in materials simulations where the ground state can be computed classically, but where the dynamical properties cannot

Long-Term Survival With Tafamidis in Patients With Transthyretin Amyloid Cardiomyopathy

BACKGROUND: Tafamidis is approved in many countries for the treatment of transthyretin amyloid cardiomyopathy. This study reports data on the long-term efficacy of tafamidis from an ongoing long-term extension (LTE) to the pivotal ATTR-ACT (Tafamidis in Transthyretin Cardiomyopathy Clinical Trial). METHODS: Patients with transthyretin amyloid cardiomyopathy who completed ATTR-ACT could enroll in an LTE, continuing with the same tafamidis dose or, if previously treated with placebo, randomized (2:1) to tafamidis meglumine 80 or 20 mg. All patients in the LTE transitioned to tafamidis free acid 61 mg (bioequivalent to tafamidis meglumine 80 mg) following a protocol amendment. In this interim analysis, all-cause mortality was assessed in patients treated with tafamidis meglumine 80 mg in ATTR-ACT continuing in the LTE, compared with those receiving placebo in ATTR-ACT transitioning to tafamidis in the LTE. RESULTS: Median follow-up was 58.5 months in the continuous tafamidis group (n=176) and 57.1 months in the placebo to tafamidis group (n=177). There were 79 (44.9%) deaths with continuous tafamidis and 111 (62.7%) with placebo to tafamidis (hazard ratio, 0.59 [95% CI, 0.44-0.79]; P<0.001). Mortality was also reduced in the continuous tafamidis (versus placebo to tafamidis) subgroups of: variant transthyretin amyloidosis (0.57 [0.33-0.99]; P=0.05) and wild-type transthyretin amyloidosis (0.61 [0.43-0.87]; P=0.006); and baseline New York Heart Association class I and II (0.56 [0.38-0.82]; P=0.003) and class III (0.65 [0.41-1.01]; P=0.06). CONCLUSIONS: In the LTE, patients initially treated with tafamidis in ATTR-ACT had substantially better survival than those first treated with placebo, highlighting the importance of early diagnosis and treatment in transthyretin amyloid cardiomyopathy. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01994889 and NCT02791230

Responding to the crisis: are policies aimed at a strong indigenous industrial base a necessary condition for sustainable economic growth?

peer-reviewedWe examine whether a strong indigenous manufacturing base is a necessary condition for sustainable economic growth in the case of two small, open economies, Ireland and Sweden. Sweden has been impacted by the economic crisis to a lesser degree than Ireland; we explore (through a manufacturing activity lens) the reasons for the asymmetric impacts and ask if the nature of the shock is related to 'Economic Sovereignty' and to the type of industrial policy. We argue Sweden was less affected given that its indigenous firms control the highly export-focused and technology-based engineering sector whereas in Ireland high-technology sectors are controlled by foreign firms. In terms of policy implications, we suggest that industrial policy should aim for sustainable economic activity and growth such that industrial activity within the economy should be able to minimise the impact of asymmetric shocks such as the current global economic recession.ACCEPTEDpeer-reviewe

Fish and Invertebrate Use of Restored vs. Natural Oyster Reefs in a Shallow Temperate Latitude Estuary

Coastal marine habitats continue to be degraded, thereby compelling largescale restoration in many parts of the world. Whether restored habitats function similarly to natural habitats and fully recover lost ecosystem services is unclear. In estuaries, oyster reefs have been degraded by multiple anthropogenic activities including destructive fishing practices and reduced water quality, motivating restoration to maintain oyster fisheries and other ecosystem services, often at relatively high cost. We compared fish and invertebrate communities on recently restored (0–1 year post-restoration), older restored (3–4 years post-restoration), and natural oyster reefs to determine if and when restored reefs support functionally similar faunal communities. To test the influence of landscape setting on the faunal communities, the restored and natural reefs, as well as a control without reef present, were distributed among three landscapes (on the edge of salt marsh away from seagrass [salt marsh landscape], on mudflats [mudflat landscape], and near to seagrass and salt marsh [seagrass landscape]). Oyster density and biomass were greatest on restored reef habitat, as were those of non-oyster bivalve species. Total abundance of invertebrates was much greater on oyster reefs than in control plots, regardless of reef or landscape type, yet were frequently highest on older restored reefs. Meanwhile, juvenile fish densities were greatest on natural reefs, at intermediate densities on older restored reefs, and least abundant on controls. When comparing the effects of reef age and landscape setting, juvenile fish densities were greatest on younger reefs within the mudflat landscape. Collectively, these results indicate that oyster reefs harbor higher densities of resident invertebrate prey, which may explain why reef habitat is also important for juvenile fish. Laboratory and field experiments supported the notion that gag grouper (a predatory demersal fish) forage more effectively on oyster reefs than on unstructured mud bottom, whereas our experiments suggest that flounders that utilize oyster reefs likely forage on adjacent mud bottom. Because landscape setting influenced fish and invertebrate communities on restored reefs, the ecological consequences of landscape setting should be incorporated into restoration decision making and site selection to enhance the recovery of ecosystem goods and services

Demonstration of Universal Parametric Entangling Gates on a Multi-Qubit Lattice

We show that parametric coupling techniques can be used to generate selective entangling interactions for multi-qubit processors. By inducing coherent population exchange between adjacent qubits under frequency modulation, we implement a universal gateset for a linear array of four superconducting qubits. An average process fidelity of $\mathcal{F}=93\%$ is estimated for three two-qubit gates via quantum process tomography. We establish the suitability of these techniques for computation by preparing a four-qubit maximally entangled state and comparing the estimated state fidelity against the expected performance of the individual entangling gates. In addition, we prepare an eight-qubit register in all possible bitstring permutations and monitor the fidelity of a two-qubit gate across one pair of these qubits. Across all such permutations, an average fidelity of $\mathcal{F}=91.6\pm2.6\%$ is observed. These results thus offer a path to a scalable architecture with high selectivity and low crosstalk

Review-Electrode Kinetics and Electrolyte Stability in Vanadium Flow Batteries

Two aspects of vanadium flow batteries are reviewed: electrochemical kinetics on carbon electrodes and positive electrolyte stability. There is poor agreement between reported values of kinetic parameters; however, most authors report that kinetic rates are faster for VIV/VV than for VII/VIII. Cycling the electrode potential increases the rates of both reactions initially due to roughening but when no further roughening is observed, the VII/VIII and VIV/VV reactions are affected oppositely by the pretreatment potential. Anodic pretreatment activates the electrode for the VII/VIII reaction, and deactivates it for VIV/VV. Three states of the carbon surface are suggested: reduced and oxidized states R and O, respectively, both with low electrocatalytic activity, and an intermediate state M with higher activity. The role of surface functional groups and the mechanisms of electron transfer for the VII/VIII and VIV/VV reactions are still not well understood. The induction time for precipitation of V2O5 from positive electrolytes decreases with temperature, showing an Arrhenius-type dependence with an activation energy of 1.79 eV in agreement with DFT calculations based on a VO(OH)3 intermediate. It also decreases exponentially with increasing VV concentration and increases exponentially with increasing sulphate concentration. Both arsenate and phosphate are effective additives for improving thermal stability

Emissions pathways, climate change, and impacts on California

The magnitude of future climate change depends substantially on the greenhouse gas emission pathways we choose. Here we explore the implications of the highest and lowest Intergovernmental Panel on Climate Change emissions pathways for climate change and associated impacts in California. Based on climate projections from two state-of-the-art climate models with low and medium sensitivity (Parallel Climate Model and Hadley Centre Climate Model, version 3, respectively), we find that annual temperature increases nearly double from the lower B1 to the higher A1fi emissions scenario before 2100. Three of four simulations also show greater increases in summer temperatures as compared with winter. Extreme heat and the associated impacts on a range of temperature-sensitive sectors are substantially greater under the higher emissions scenario, with some interscenario differences apparent before midcentury. By the end of the century under the B1 scenario, heatwaves and extreme heat in Los Angeles quadruple in frequency while heat-related mortality increases two to three times; alpine subalpine forests are reduced by 50–75%; and Sierra snowpack is reduced 30–70%. Under A1fi, heatwaves in Los Angeles are six to eight times more frequent, with heat-related excess mortality increasing five to seven times; alpine subalpine forests are reduced by 75–90%; and snowpack declines 73–90%, with cascading impacts on runoff and streamflow that, combined with projected modest declines in winter precipitation, could fundamentally disrupt California’s water rights system. Although interscenario differences in climate impacts and costs of adaptation emerge mainly in the second half of the century, they are strongly dependent on emissions from preceding decades