Visualisation of the service use for individual clients with a Personality Disorder at Devon Partnership Trust to support clinical decision making

This is the final version of the posterIn Devon (county in South West England) the mental health services are provided by Devon Partnership Trust (DPT). DPT are aware that clients diagnosed with a Personality Disorder (PD) utilise a large volume of their services, which comes with the associated high cost. DPT commissioned a project to help them understand the patterns and trends that PD clients access their services, to inform decisions regarding system improvements. As part of this project we developed clear visualisations of individual client's service use, based on reported techniques to visualise temporal data. This visualisation captures and delivers the information in an easily accessible format, thus offering clinicians a visualisation tool to use both before and during a patient consultation that has the potential to save resources. (1) Time saved: A quick glance at the graphic provides information to a clinician that would otherwise require up to 20 minutes to scan pages of text; (2) Appointments saved: Using the graphic during client consultations to aid the discussions regarding their previous service use, and to explore together patterns of previous service use that did not have the desired outcome (preventing repetition). In response to the clinicians enthusiasm to have access to these individual client service use graphics, DPT plan to electronically embed the service use visualisations within their existing Carenotes so that they can be produced automatically on demand from data already on their system. Discussions are ongoing to tailor the visualisations to embed more information (such as waiting times, number of contacts and cost of services).Devon Partnership NHS Trus

Revision of the green lacewing subgenus Ankylopteryx (Sencera) (Neuroptera, Chrysopidae)

The Australasian and Oriental green lacewing subgenus Ankylopteryx (Sencera) Navás (Chrysopinae: Ankylopterygini) is examined and its diversity and placement among other members of the tribe Ankylopterygini is discussed. After study of specimens spanning the full distribution and anatomical range of variation for the subgenus, all prior putative species, resulting in the sole valid species are newly synonymized, Ankylopteryx (Sencera) anomala (Brauer). Accordingly, the following new synonymies are established: Sencera scioneura Navás, syn. n., Sencera feae Navás, syn. n., and Sencera exquisita Nakahara, syn. n. [all under the name Ankylopteryx (Sencera) anomala]. A lectotype is newly designated for Ankylopteryx (Sencera) anomala so as to stabilize the application of the name. To support our hypotheses, the wing and general body coloration as well as the male genitalia are reviewed. We elaborate on the possibility of Ankylopteryx (Sencera) anomala being nothing more than an autapomorphic species of Ankylopteryx Brauer, as it was originally described. The species is not sufficiently distinct to warrant recognition as a separate subgenus within the group, and most certainly not as its own genus as has been advocated by past authors. Nonetheless, we do not for now go so far as to synonymize the subgenus until a more extensive phylogenetic analysis is undertaken with multiple representative species from across Ankylopteryx and other ankylopterygine genera. Lastly, we comment on the biology of Ankylopteryx (Sencera) anomala in terms of the attraction of males to methyl eugenol and on the widespread practice of splitting within Chrysopidae

Wing venation of Neuropterida.

44 pages : color illustrations ; 26 cm.The wings of insects are one of their most prominent features and embody numerous characters and modifications congruent with the variety of their lifestyles. However, despite their evolutionary relevance, homology statements and nomenclature of wing structures remain understudied and sometimes confusing. Early studies on wing venation homologies often assumed Neuropterida (the superorder comprising the orders Raphidioptera, Megaloptera, and Neuroptera: snakeflies, alderflies and dobsonflies, and lacewings) to be ancient among Pterygota, and therefore relied on their pattern of venation for determining groundplans for insect wing venation schemata and those assumptions reciprocally influenced the interpretation of lacewing wings. However, Neuropterida are in fact derived among flying insects and thus a reconsideration of their wings is crucial. The identification of the actual wing venation of Neuropterida is rendered difficult by fusions and losses, but these features provide systematic and taxonomically informative characters for the classification of the different clades within the group. In the present study, we review the homology statements of wing venation among Neuropterida, with an emphasis on Chrysopidae (green lacewings), the family in which the highest degree of vein fusion is manifest. The wing venation of each order is reviewed according to tracheation, and colored schemata of the actual wing venation are provided as well as detailed illustrations of the tracheation in select families. According to the results of our study of vein tracheation, new homology statements and a revised nomenclature for veins and cells are proposed

Electrical behaviour, characteristics and properties of anodic aluminium oxide films coloured by nickel electrodeposition

Porous anodic films on 1050 aluminium substrate were coloured by AC electrodeposition of nickel. Several experiments were performed at different deposition voltages and nickel concentrations in the electrolyte in order to correlate the applied electrical power to the electrical behaviour, as well as the characteristics and properties of the coatings. The content of nickel inside the coatings reached 1.67 g/m2, depending on the experimental conditions. According to the applied AC voltage in comparison with the threshold voltage Ut, the coating either acted only as a capacitor when U\Ut and, when U[Ut, the behaviour during the anodic and cathodic parts of the power sine wave was different. In particular, due to the semi-conducting characteristics of the barrier layer, additional oxidation of the aluminium substrate occurred during the anodic part of the electrical signal, whilst metal deposition (and solvent reduction) occurred during the cathodic part; these mechanisms correspond to the blocked and pass directions of the barrier layer/electrolyte junction, respectively

Association between gestational levels of toxic metals and essential elements and cerebral palsy in children

Introduction Cerebral palsy (CP) is the most common motor disability in childhood, but its causes are only partly known. Early-life exposure to toxic metals and inadequate or excess amounts of essential elements can adversely affect brain and nervous system development. However, little is still known about these as perinatal risk factors for CP. This study aims to investigate the associations between second trimester maternal blood levels of toxic metals, essential elements, and mixtures thereof, with CP diagnoses in children. Methods In a large, population-based prospective birth cohort (The Norwegian Mother, Father, and Child Cohort Study), children with CP diagnoses were identified through The Norwegian Patient Registry and Cerebral Palsy Registry of Norway. One hundred forty-four children with CP and 1,082 controls were included. The relationship between maternal blood concentrations of five toxic metals and six essential elements and CP diagnoses were investigated using mixture approaches: elastic net with stability selection to identify important metals/elements in the mixture in relation to CP; then logistic regressions of the selected metals/elements to estimate odds ratio (OR) of CP and two-way interactions among metals/elements and with child sex and maternal education. Finally, the joint effects of the mixtures on CP diagnoses were estimated using quantile-based g-computation analyses. Results The essential elements manganese and copper, as well as the toxic metal Hg, were the most important in relation to CP. Elevated maternal levels of copper (OR = 1.40) and manganese (OR = 1.20) were associated with increased risk of CP, while Hg levels were, counterintuitively, inversely related to CP. Metal/element interactions that were associated with CP were observed, and that sex and maternal education influenced the relationships between metals/elements and CP. In the joint mixture approach no significant association between the mixture of metals/elements and CP (OR = 1.00, 95% CI = [0.67, 1.50]) was identified. Conclusion Using mixture approaches, elevated levels of copper and manganese measured in maternal blood during the second trimester could be related to increased risk of CP in children. The inverse associations between maternal Hg and CP could reflect Hg as a marker of maternal fish intake and thus nutrients beneficial for foetal brain development

Association between gestational levels of toxic metals and essential elements and cerebral palsy in children

IntroductionCerebral palsy (CP) is the most common motor disability in childhood, but its causes are only partly known. Early-life exposure to toxic metals and inadequate or excess amounts of essential elements can adversely affect brain and nervous system development. However, little is still known about these as perinatal risk factors for CP. This study aims to investigate the associations between second trimester maternal blood levels of toxic metals, essential elements, and mixtures thereof, with CP diagnoses in children.MethodsIn a large, population-based prospective birth cohort (The Norwegian Mother, Father, and Child Cohort Study), children with CP diagnoses were identified through The Norwegian Patient Registry and Cerebral Palsy Registry of Norway. One hundred forty-four children with CP and 1,082 controls were included. The relationship between maternal blood concentrations of five toxic metals and six essential elements and CP diagnoses were investigated using mixture approaches: elastic net with stability selection to identify important metals/elements in the mixture in relation to CP; then logistic regressions of the selected metals/elements to estimate odds ratio (OR) of CP and two-way interactions among metals/elements and with child sex and maternal education. Finally, the joint effects of the mixtures on CP diagnoses were estimated using quantile-based g-computation analyses.ResultsThe essential elements manganese and copper, as well as the toxic metal Hg, were the most important in relation to CP. Elevated maternal levels of copper (OR = 1.40) and manganese (OR = 1.20) were associated with increased risk of CP, while Hg levels were, counterintuitively, inversely related to CP. Metal/element interactions that were associated with CP were observed, and that sex and maternal education influenced the relationships between metals/elements and CP. In the joint mixture approach no significant association between the mixture of metals/elements and CP (OR = 1.00, 95% CI = [0.67, 1.50]) was identified.ConclusionUsing mixture approaches, elevated levels of copper and manganese measured in maternal blood during the second trimester could be related to increased risk of CP in children. The inverse associations between maternal Hg and CP could reflect Hg as a marker of maternal fish intake and thus nutrients beneficial for foetal brain development

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700