Routine administration of Health Related Quality of Life (HRQoL) and needs assessment instruments to improve psychological outcome: a systematic review

Background. Routine administration of Health Related Quality of Life (HRQoL) and needs assessment instruments has been advocated as part of clinical care to aid the recognition of psychosocial problems, to inform clinical decision making, to monitor therapeutic response and to facilitate patient-doctor communication. However, their adoption is not without cost and the benefit of their use is unclear. Method. A systematic review was conducted. We sought experimental studies that examined the addition of routinely administered measures of HRQoL to care in both psychiatric and non-psychiatric settings. We searched the following databases: MEDLINE, EMBASE, CINAHL, PsycLIT and Cochrane Controlled Trials Register (to 2000). Data were extracted independently and a narrative synthesis of results was presented. Results. Nine randomized and quasi-randomized studies conducted in non-psychiatric settings were found. All the instruments used included an assessment of mental well-being, with specific questions relating to depression and anxiety. The routine feedback of these instruments had little impact on the recognition of mental disorders or on longer term psychosocial functioning. While clinicians welcomed the information these instruments imparted, their results were rarely incorporated into routine clinical decision making. No studies were found that examined the value of routine assessment and feedback of HRQoL or patient needs in specialist psychiatric care settings. Conclusions. Routine HRQoL measurement is a costly exercise and there is no robust evidence to suggest that it is of benefit in improving psychosocial outcomes of patients managed in non-psychiatric settings. Major policy initiatives to increase the routine collection and use of outcome measures in psychiatric settings are unevaluated

Routinely administered questionnaires for depression and anxiety : systematic review

Objectives To examine the effect of routinely administered psychiatric questionnaires on the recognition, management, and outcome of psychiatric disorders in non-psychiatric settings. Data sources Embase, Medline, PsycLIT, Cinahl, Cochrane Controlled Trials Register,and hand searches of key journals. Methods A systematic review of randomised controlled trials of the administration and routine feedback of psychiatric screening and outcome questionnaires to clinicians in non-psychiatric settings. narrative overview of key design features and end points, together with a random effects quantitative synthesis of comparable studies. Main outcome measures Recognition of psychiatric disorders after feedback of questionnaire results; interventions for psychiatric disorders and outcome of psychiatric disorders. Results Nine randomised studies were identified that examined the use of common psychiatric instruments in primary care and general hospital settings. Studies compared the effect of the administration of these instruments followed by the feedback of the results to clinicians, with administration with no feedback. Meta-analytic pooling was possible for four of these studies (2457 participants), which measured the effect of feedback on the recognition of depressive disorders. Routine administration and feedback of scores for all patients (irrespective of score) did not increase the overall rate of recognition of mental disorders such as anxiety and depression (relative risk of detection of depression by clinician after feedback 0.95, 95% confidence interval 0.83 to 1.09). Two studies showed that routine administration followed by selective feedback for only high scores increased the rate of recognition of depression (relative risk of detection of depression after feedback 2.64, 1.62 to 4.31). This increased recognition, however, did not translate into an increased rate of intervention. Overall, studies of routine administration of psychiatric measures did not show an effect on patient outcome. Conclusions The routine measurement of outcome is a costly exercise. Little evidence shows that it is of benefit in improving psychosocial outcomes of those with psychiatric disorder managed in non-psychiatric settings

Hybridized polymer matrix composites

The extent to which graphite fibers are released from resin matrix composites that are exposed to fire and impact conditions was determined. Laboratory simulations of those conditions that could exist in the event of an aircraft crash and burn situation were evaluated. The effectiveness of various hybridizing concepts in preventing this release of graphite fibers were also evaluated. The baseline (i.e., unhybridized) laminates examined were prepared from commercially available graphite/epoxy, graphite/polyimide, and graphite/phenolic materials. Hybridizing concepts investigated included resin fillers, laminate coatings, resin blending, and mechanical interlocking of the graphite reinforcement. The baseline and hybridized laminates' mechanical properties, before and after isothermal and humidity aging, were also compared. It was found that a small amount of graphite fiber was released from the graphite/epoxy laminates during the burn and impact conditions used in this program. However, the extent to which the fibers were released is not considered a severe enough problem to preclude the use of graphite reinforced composites in civil aircraft structure. It also was found that several hybrid concepts eliminated this fiber release. Isothermal and humidity aging did not appear to alter the fiber release tendencies

Beyond clustering: mean-field dynamics on networks with arbitrary subgraph composition

Clustering is the propensity of nodes that share a common neighbour to be connected. It is ubiquitous in many networks but poses many modelling challenges. Clustering typically manifests itself by a higher than expected frequency of triangles, and this has led to the principle of constructing networks from such building blocks. This approach has been generalised to networks being constructed from a set of more exotic subgraphs. As long as these are fully connected, it is then possible to derive mean-field models that approximate epidemic dynamics well. However, there are virtually no results for non-fully connected subgraphs. In this paper, we provide a general and automated approach to deriving a set of ordinary differential equations, or mean-field model, that describes, to a high degree of accuracy, the expected values of system-level quantities, such as the prevalence of infection. Our approach offers a previously unattainable degree of control over the arrangement of subgraphs and network characteristics such as classical node degree, variance and clustering. The combination of these features makes it possible to generate families of networks with different subgraph compositions while keeping classical network metrics constant. Using our approach, we show that higher-order structure realised either through the introduction of loops of different sizes or by generating networks based on different subgraphs but with identical degree distribution and clustering, leads to non-negligible differences in epidemic dynamics

Discussion of Factors Controlling Army Helicopter Reliability

The Army\u27s interest in significant aviation improvements actually started, or at least gained steam, in the 1960\u27s during the extended combat we had in southeast Asia where a lot of problems in the utilization of the rotary wing aircraft came to a head, and I\u27ll talk about those in more detail. What I would like to do is go through how the Army has responded to those problems that were revealed, through R&D and even more specifically in the diagnostics area. When I say diagnostics, what I\u27m talking about is the second category of NDI that I see, the first category being the one I think that most people here have a prime interest in and that is the one time, static inspection during manufacture, a verification of quality control. The other type is the repetitive in-service inspection

Stolen Wages in the Nation's Capital: Fixing DC's Broken Wage Theft Claims Process

Today in the District of Columbia ("the District" or "DC"), low wage workers are being shortchanged. Policies currently in place make it very difficult, to nearly impossible, for victims of wage theft to hold employers accountable for failing to pay wages owed. The Wage Theft Prevention Act of 2014, co-introduced on February 4, 2014 by Councilmembers Vincent Orange, Jim Graham, and Mary Cheh, would provide needed accountability and stronger protections to ensure that those working an honest day receive honest pay for their labor. This document provides an introduction to the current barriers affecting workers in the District, and presents an overview of the ways in which the Wage Theft Prevention Act of 2014 would ameliorate these problems; thereby making the District a better place for workers and responsible businesses

Multi-phase ecological change on Indian subcontinent from the late Miocene to Pleistocene recorded in the Nicobar Fan

Modern grasslands on the Indian subcontinent, North and South America, and East Africa expanded widely during the late Miocene - earliest Pleistocene, likely in response to increasing aridity. Grasses utilizing the C4 photosynthetic pathway are more tolerant of high temperatures and dry conditions, and because they induce less C isotope fractionation than plants using the C3 pathway, the expansion of C4 grasslands can be traced through the δ13C of organic matter in soils and terrigenous marine sediments. We present a high-resolution record of the elemental and isotopic composition of bulk organic matter in the Nicobar Fan sediments from IODP Site U1480, off western Sumatra, to elucidate the timing and pace of the C3-C4 plant transition within the ∼1.5 × 106 km2 catchments of the Ganges/Brahmaputra river system, which continue to supply voluminous Himalaya-derived sediments to the Bay of Bengal. Using a multi-proxy approach to correct for the effects of marine organic matter and account for major sources of uncertainty, we recognize two phases of C4 expansion starting at ∼7.1 Ma, and at ∼3.5 Ma, with a stepwise transition at ∼2.5 Ma. These intervals appear to coincide with periods of Indian Ocean and East Asian monsoon intensification, as well as the expansion of Northern Hemisphere glaciation starting at ∼2.7 Ma. Our data from the deep sea for a multi-phased C4 expansion on the Indian subcontinent are in agreement with terrestrial data from the Indian Siwaliks