Effect of closing facilities on electroconvulsive therapy use in Glasgow

<p>Objectives: To assess the effect of closure of electroconvulsive therapy (ECT) centers on ECT use. Electroconvulsive therapy remains a recommended and effective treatment for mental disorders. Declining rates of ECT use in the United Kingdom have been observed over the last 20 years with anecdotal observations that use has declined as the result of centralization of provision. In Glasgow, there have been site closures in the north with no such rationing taking place in the south.</p> <p>Methods: A naturalistic retrospective survey of the number of ECT courses commenced each year in Glasgow, with a comparison made between the north and the south of the city. Data were available from 1996 to 2008.</p> <p>Results: Our analysis showed no change in the mean number of ECT courses commenced in southern AQ2 Glasgow (period 1, 42.25; period 2, 41.83; period 3, 31; F = 1.369; P = 0.298). There was a significant reduction in the mean number of ECT treatments commenced in northern Glasgow (period 1, 91.25; period 2, 51; period 3, 33.33; F = 10.06; P = 0.04).</p> <p>Conclusions: In northern Glasgow, where there have been 2 site closures since 1996, ECT use has declined. This trend was not replicated in the south of the city. This would suggest that the closure of ECT centers does reduce the use of ECT. However, there may be a number of confounding variables that could not be factored into the analysis because of lack of available data.</p&gt

Attitudes towards mental illness in Malawi: a cross-sectional survey

<p><b>Background:</b> Stigma and discrimination associated with mental illness are strongly linked to suffering, disability and poverty. In order to protect the rights of those with mental disorders and to sensitively develop services, it is vital to gain a more accurate understanding of the frequency and nature of stigma against people with mental illness. Little research about this issue has been conducted in sub Saharan Africa. Our study aimed to describe levels of stigma in Malawi.</p> <p><b>Method:</b> A cross-sectional survey of patients and relatives attending mental health and non-mental health related clinics in a general hospital in Blantyre, Malawi. Subjects were interviewed using an adapted version of the questionnaire developed for the World Psychiatric Association Program to Reduce Stigma and Discrimination Because of Schizophrenia.</p> <p><b>Results:</b> 210 subjects participated in our study. Most attributed mental disorder to alcohol and illicit drug abuse (95%). This was closely followed by brain disease (92.8%), spirit possession (82.8%) and then psychological trauma (76.1%). There were some associations found between demographic variables and single question responses, however no consistent trends were observed in stigmatising beliefs. These results should be interpreted with caution and in the context of existing research. Contrary to the international literature, having direct personal experience of mental illness seemed to have no positive effect on stigmatising beliefs in our sample.</p> <p><b>Conclusions:</b> Our study contributes to an emerging picture that individuals in sub Saharan Africa most commonly attribute mental illness to alcohol/ illicit drug use and spiritual causes. Our work adds weight to the argument that stigma towards mental illness is an important global health and human rights issue.</p&gt

Optimization of Islanded Microgrid Operation

Presently a lot of effort is being deployed in the area of microgrid development. In this aspect, the work presented here is in the direction of developing and coordinating various operational modules in an isolated microgrid system. The work presented in this report looks at the prospects of incorporating a consumer side load-scheduling algorithm that works in conjunction with the unit commitment and economic load dispatch. The unit commitment and economic load dispatch are run a day in advance to determine generator outputs for the following day. From the microgrid operator point of view, the load side scheduling helps reduce the stress on the system especially during peak hours thereby ensuring system stability and security. From the consumers’ point of view, the dynamic electricity prices within a day, which are a reflection of this time varying stress on the system, encourage them to endorse such a scheme and reduce their bills incurred. Owing to unpredictable weather conditions, running unit commitment and economic load dispatch in advance does not guarantee planned real-time generation in the microgrid scenario. Such variability in forecasted generation must be handled in any microgrid, while accounting for load demand uncertainties. To address this issue a load side energy management system and power balance scheme is proposed in this paper. The objective is to ascertain uninterrupted power to critical loads while managing other non-critical loads based on their priorities

The envirome and the connectome: exploring the structural noise in the human brain associated with socioeconomic deprivation

Complex cognitive functions are widely recognized to be the result of a number of brain regions working together as large-scale networks. Recently, complex network analysis has been used to characterize various structural properties of the large scale network organization of the brain. For example, the human brain has been found to have a modular architecture i.e. regions within the network form communities (modules) with more connections between regions within the community compared to regions outside it. The aim of this study was to examine the modular and overlapping modular architecture of the brain networks using complex network analysis. We also examined the association between neighborhood level deprivation and brain network structure – modularity and grey nodes. We compared network structure derived from anatomical MRI scans of 42 middle-aged neurologically healthy men from the least (LD) and the most deprived (MD) neighborhoods of Glasgow with their corresponding random networks. Cortical morphological covariance networks were constructed from the cortical thickness derived from the MRI scans of the brain. For a given modularity threshold, networks derived from the MD group showed similar number of modules compared to their corresponding random networks, while networks derived from the LD group had more modules compared to their corresponding random networks. The MD group also had fewer grey nodes – a measure of overlapping modular structure. These results suggest that apparent structural difference in brain networks may be driven by differences in cortical thicknesses between groups. This demonstrates a structural organization that is consistent with a system that is less robust and less efficient in information processing. These findings provide some evidence of the relationship between socioeconomic deprivation and brain network topology

Fault Tolerant Power Balancing Strategy in an Isolated Microgrid via Optimization

The increasing penetration of renewable energy generation (REG) in t he m icrogrid paradigm has brought with it larger uncertainty in the scheduled generation. This along with the inevitable variation between actual load and for ecasted load has further accentuated the issue of real - time power balancing. With the advent of sm art loads and meters supported by advanced communication technologies , several new possibilities for demand side management have opened up . In this paper , a real time optimization strategy for load side energy management system (EMS) and for power balance is proposed. The proposed strategy achieves power balance by optimizing load reduction . The objective is to ascertain uninterrupted power to critical loads and reduce non - critical loads depending on the priorities for various loads. To further enhance the flexibility of the system, the addition of a battery to the management model is also discussed. The proposed algorithm also makes the system tolerant to possible generator failures if battery is added to the system. The effectiveness of the proposed online power balancing strategy via optimization is demonstrated through various simulation case studies

The impact of business outsourcing on corporate real estate in India

Driven by Western companies\u27 requirements for efficiency and effectiveness, a trend towards outsourcing of business activities to India and other low-cost countries commenced in the early 1990s and has continued to grow at a surprisingly fast pace. In a relatively short timeframe India has become a global hub for back-office services, although the effect on the urban cities is yet to be fully comprehended. As American and European companies continue to relocate their information technology services and other back office works to the subcontinent, there has been a considerable flow-on effect on Indian corporate real estate. This paper addresses two key questions. Firstly, the factors important for Western companies\u27 outsourcing of organisational activities to India, and secondly, the effect of business outsourcing on corporate real estate locational requirements in India. A survey of corporate real estate representatives in India and the UK was conducted with the results providing an insight into the present state and possible future direction of outsourcing for India. This research presents a unique insight into the impacts of Western business outsourcing on corporate real estate in India, and presents findings that are useful to both organisations seeking to relocate business activities to India and for property market analysts looking to understand drivers behind this sustained demand for Indian corporate real estate

Sustained remission of rheumatoid arthritis with a specific serotonin reuptake inhibitor antidepressant: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>The mainstay of pharmacologic therapy for rheumatoid arthritis includes the use of disease-modifying agents like sulfasalazine and methothrexate, and more recently, anti-tumor necrosis factor-α agents. Depression remains a major co-morbidity in patients with rheumatoid arthritis and is thought to contribute to disability and mortality in these patients. Evidence now suggests that a biologic link exists between substrates responsible for inflammatory conditions and mood disorders. Most of this evidence comes from preclinical studies. Nevertheless, more research into this area is helping us to understand the possible mechanisms through which these conditions interact with each other.</p> <p>Case presentation</p> <p>We describe a 60-year-old Indian man with rheumatoid arthritis diagnosed 15 years ago who had minimal response to multiple therapies with disease-modifying agents and whose arthritis symptoms surprisingly remitted when he was started on a specific serotonin reuptake inhibitor antidepressant, three years ago, for co-morbid major depression. This remission has been maintained with this medication, and the patient is currently not taking any antirheumatoid medications.</p> <p>Conclusion</p> <p>Possible mechanisms linking substrates of mood disorders and inflammation are reviewed in this case report, particularly the serotonergic system. Evidence seems to suggest a significant interaction between the serotonergic systems and inflammation. This interaction seems to be bidirectional. An understanding of this relation is most important to gain insight not only into pathophysiological mechanisms underlying this condition, but also into how treatments for these conditions may complement each other and possibly provide greater therapeutic options in both of these disabling conditions.</p

Relationship of cognitive function in patients with schizophrenia in remission to disability: a cross-sectional study in an Indian sample

Background: Cognitive deficits in various domains have been consistently replicated in patients with schizophrenia. Most studies looking at the relationship between cognitive dysfunction and functional disability are from developed countries. Studies from developing countries are few. The purpose of the present study was to compare the neurocognitive function in patients with schizophrenia who were in remission with that of normal controls and to determine if there is a relationship between measures of cognition and functional disability. &lt;p/&gt;Methods: This study was conducted in the Psychiatric Unit of a General Hospital in Mumbai, India. Cognitive function in 25 patients with schizophrenia in remission was compared to 25 normal controls. Remission was confirmed using the brief psychiatric rating scale (BPRS) and scale for the assessment of negative symptoms (SANS). Subjects were administered a battery of cognitive tests covering aspects of memory, executive function and attention. The results obtained were compared between the groups. Correlation analysis was used to look for relationship between illness factors, cognitive function and disability measured using the Indian disability evaluation and assessment scale. &lt;p/&gt;Results: Patients with schizophrenia showed significant deficits on tests of attention, concentration, verbal and visual memory and tests of frontal lobe/executive function. They fared worse on almost all the tests administered compared to normal controls. No relationship was found between age, duration of illness, number of years of education and cognitive function. In addition, we did not find a statistically significant relationship between cognitive function and scores on the disability scale. &lt;p/&gt;Conclusion: The data suggests that persistent cognitive deficits are seen in patients with schizophrenia under remission. The cognitive deficits were not associated with symptomatology and functional disability. It is possible that various factors such as employment and family support reduce disability due to schizophrenia in developing countries like India. Further studies from developing countries are required to explore the relationship between cognitive deficits, functional outcome and the role of socio-cultural variables as protective factors

Magnetic order, disorder, and excitations under pressure in the Mott insulator Sr2IrO4

Protected by the interplay of on-site Coulomb interactions and spin-orbit coupling, Sr₂IrO₄ at high pressure is a rare example of a Mott insulator with a paramagnetic ground state. Here, using optical Raman scattering, we measure both the phonon and magnon evolution in Sr2IrO4 under pressure and identify three different magnetically-ordered phases, culminating in a spin-disordered state beyond 18 GPa. A strong first-order structural phase transition drives the magnetic evolution at ∼10 GPa with reduced structural anisotropy in the IrO₆ cages, leading to increasingly isotropic exchange interactions between the Heisenberg spins and a spin-flip transition to c-axis-aligned antiferromagnetic order. In the disordered phase of Heisenberg Jeff = 1/2 pseudospins, the spin excitations are quasielastic and continuous to 10 meV, potentially hosting a gapless quantum spin liquid in Sr₂IrO₄

Two-year prognostic utility of plasma p217+tau across the Alzheimer’s continuum

Background: Plasma p217+tau has shown high concordance with cerebrospinal fluid (CSF) and positron emission tomography (PET) measures of amyloid- (A ) and tau in Alzheimer’s Disease (AD). However, its association with longitudinal cognition and comparative performance to PET A and tau in predicting cognitive decline are unknown. Objectives: To evaluate whether p217+tau can predict the rate of cognitive decline observed over two-year average follow-up and compare this to prediction based on A (18F-NAV4694) and tau (18F-MK6240) PET. We also explored the sample size required to detect a 30% slowing in cognitive decline in a 2-year trial and selection test cost using p217+tau (pT+) as compared to PET A (A+) and tau (T+) with and without p217+tau pre-screening. Design: A prospective observational cohort study. Setting: Participants of the Australian Imaging, Biomarker & Lifestyle Flagship Study of Ageing (AIBL) and Australian Dementia Network (ADNeT). Participants: 153 cognitively unimpaired (CU) and 50 cognitively impaired (CI) individuals. Measurements: Baseline p217+tau Simoa assay 18F-MK6240 tau-PET and 18F-NAV4694 A -PET with neuropsychological follow-up (MMSE, CDR-SB, AIBL-PACC) over 2.4 ± 0.8 years. Results: In CI, p217+tau was a significant predictor of change in MMSE ( = −0.55, p \u3c 0.001) and CDR-SB ( =0.61, p \u3c 0.001) with an effect size similar to A Centiloid (MMSE = −0.48, p = 0.002; CDR-SB = 0.43, p = 0.004) and meta-temporal (MetaT) tau SUVR (MMSE: = −0.62, p \u3c 0.001; CDR-SB: = 0.65, p \u3c 0.001). In CU, only MetaT tau SUVR was significantly associated with change in AIBL-PACC ( = −0.22, p = 0.008). Screening pT+ CI participants into a trial could lead to 24% reduction in sample size compared to screening with PET for A+ and 6–13% compared to screening with PET for T+ (different regions). This would translate to an 81–83% biomarker test cost-saving assuming the p217+tau test cost one-fifth of a PET scan. In a trial requiring PET A+ or T+, p217+tau pre-screening followed by PET in those who were pT+ would cost more in the CI group, compared to 26–38% biomarker test cost-saving in the CU. Conclusions: Substantial cost reduction can be achieved using p217+tau alone to select participants with MCI or mild dementia for a clinical trial designed to slow cognitive decline over two years, compared to participant selection by PET. In pre-clinical AD trials, p217+tau provides significant cost-saving if used as a pre-screening measure for PET A+ or T+ but in MCI/mild dementia trials this may add to cost both in testing and in the increased number of participants needed for testing