scholarly journals The same or different psychiatrists for in- and out-patient treatment? A multi-country natural experiment

2018 ◽  
Vol 29 ◽  
Author(s):  
D. Giacco ◽  
V.J. Bird ◽  
T. Ahmad ◽  
M. Bauer ◽  
A. Lasalvia ◽  
...  
Keyword(s):  
Large Scale ◽  
Natural Experiment ◽  
Mental Healthcare ◽  
Routine Care ◽  
European Countries ◽  
Patient Treatment ◽  
Substantial Impact ◽  
Clinical Criteria ◽  
Somatisation Disorder ◽  
Secondary Outcomes

Abstract Aims A core question in the debate about how to organise mental healthcare is whether in- and out-patient treatment should be provided by the same (personal continuity) or different psychiatrists (specialisation). The controversial debate drives costly organisational changes in several European countries, which have gone in opposing directions. The existing evidence is based on small and low-quality studies which tend to favour whatever the new experimental organisation is. We compared 1-year clinical outcomes of personal continuity and specialisation in routine care in a large scale study across five European countries. Methods This is a 1-year prospective natural experiment conducted in Belgium, England, Germany, Italy and Poland. In all these countries, both personal continuity and specialisation exist in routine care. Eligible patients were admitted for psychiatric in-patient treatment (18 years of age), and clinically diagnosed with a psychotic, mood or anxiety/somatisation disorder. Outcomes were assessed 1 year after the index admission. The primary outcome was re-hospitalisation and analysed for the full sample and subgroups defined by country, and different socio-demographic and clinical criteria. Secondary outcomes were total number of inpatient days, involuntary re-admissions, adverse events and patients’ social situation. Outcomes were compared through mixed regression models in intention-to-treat analyses. The study is registered (ISRCTN40256812). Results We consecutively recruited 7302 patients; 6369 (87.2%) were followed-up. No statistically significant differences were found in re-hospitalisation, neither overall (adjusted percentages: 38.9% in personal continuity, 37.1% in specialisation; odds ratio = 1.08; confidence interval 0.94–1.25; p = 0.28) nor for any of the considered subgroups. There were no significant differences in any of the secondary outcomes. Conclusions Whether the same or different psychiatrists provide in- and out-patient treatment appears to have no substantial impact on patient outcomes over a 1-year period. Initiatives to improve long-term outcomes of psychiatric patients may focus on aspects other than the organisation of personal continuity v. specialisation.

scholarly journals Clinician checklist for assessing suitability of machine learning applications in healthcare

2021 ◽  
Vol 28 (1) ◽  
pp. e100251
Author(s):  
Ian Scott ◽  
Stacey Carter ◽  
Enrico Coiera
Keyword(s):  
Machine Learning ◽  
Large Scale ◽  
Clinical Decision Making ◽  
Improve Patient Care ◽  
Clinical Decision ◽  
Routine Care ◽  
Machine Learning Algorithms ◽  
Clinical Settings ◽  
Machine Learning Applications ◽  
Key Issues

Machine learning algorithms are being used to screen and diagnose disease, prognosticate and predict therapeutic responses. Hundreds of new algorithms are being developed, but whether they improve clinical decision making and patient outcomes remains uncertain. If clinicians are to use algorithms, they need to be reassured that key issues relating to their validity, utility, feasibility, safety and ethical use have been addressed. We propose a checklist of 10 questions that clinicians can ask of those advocating for the use of a particular algorithm, but which do not expect clinicians, as non-experts, to demonstrate mastery over what can be highly complex statistical and computational concepts. The questions are: (1) What is the purpose and context of the algorithm? (2) How good were the data used to train the algorithm? (3) Were there sufficient data to train the algorithm? (4) How well does the algorithm perform? (5) Is the algorithm transferable to new clinical settings? (6) Are the outputs of the algorithm clinically intelligible? (7) How will this algorithm fit into and complement current workflows? (8) Has use of the algorithm been shown to improve patient care and outcomes? (9) Could the algorithm cause patient harm? and (10) Does use of the algorithm raise ethical, legal or social concerns? We provide examples where an algorithm may raise concerns and apply the checklist to a recent review of diagnostic imaging applications. This checklist aims to assist clinicians in assessing algorithm readiness for routine care and identify situations where further refinement and evaluation is required prior to large-scale use.

Inter-Ethnic Dynamics in the Wake of Terrorist Attacks: Evidence from the 2015 Baga Massacre

2020 ◽  
Vol 26 (2) ◽  
Author(s):  
Alessandro Belmonte
Keyword(s):  
Ethnic Groups ◽  
Large Scale ◽  
Natural Experiment ◽  
Individual Characteristics ◽  
The State ◽  
Terrorist Attacks ◽  
Boko Haram ◽  
Far North ◽  
North East

AbstractThis paper investigates the consequences for inter-group conflicts of terrorist attacks. I study the 2015 Baga massacre, a large scale attack conducted by Boko Haram at the far North-East state of Borno, Nigeria, as a quasi-natural experiment and examine a set of attitudes in the aftermath of the event of Christians and Muslims throughout the country. Comparing individuals, outside the region of Borno, interviewed by Afrobarometer immediately after the massacre and those interviewed the days before within same regions and holding fixed a number of individual characteristics, I document that the informational exposure to the event rendered Christians less amiable to neighboring Muslims and Muslims less likely to recognize the legitimacy of the state. Nonetheless, Muslims increased their view of the elections as a device to remove leaders in office, event that took place 2 months later with the election of the challenger, Muhammadu Buhari. My findings indicate that terrorist attacks may generate a relevant and heterogeneous backlash across ethnic groups.

scholarly journals The Relationships among Self-Worth Contingency on Others’ Approval, Appearance Comparisons on Facebook, and Adolescent Girls’ Body Esteem: A Cross-Cultural Study

2021 ◽  
Vol 18 (3) ◽  
pp. 901 ◽  
Author(s):  
Michael Prieler ◽  
Jounghwa Choi ◽  
Hye Eun Lee
Keyword(s):  
South Korea ◽  
Cultural Context ◽  
Large Scale ◽  
Body Esteem ◽  
Asian Country ◽  
Cross Cultural ◽  
European Countries ◽  
Self Worth ◽  
Appearance Comparison

The present study examined the relationship between appearance-related social comparison on social networking services (SNSs) and body esteem in a cross-cultural context (three European countries, i.e., Austria, Belgium, and Spain, versus one Asian country, i.e., South Korea). The role of self-worth contingency on others’ approval was considered to be a psychological and cultural factor. Utilizing a large-scale cross-national survey of early and middle adolescents in 2017, the responses of female adolescents (N = 981) were analyzed. The results generally support the findings from previous studies but also reveal cultural differences. Appearance comparison on Facebook negatively influenced girls’ body esteem in all European countries, but not in South Korea. Self-worth contingency on others’ approval negatively influenced girls’ body esteem across all four countries. Finally, a positive relationship between self-worth contingency on others’ approval and appearance comparison on Facebook was found in all European countries, but not among Korean girls. These findings suggest the importance of self-worth contingency on others’ approval and cultural contexts can be used to study the effects of body image-related SNS use.

scholarly journals Normative positions towards COVID-19 contact-tracing apps: findings from a large-scale qualitative study in nine European countries

2021 ◽  
pp. 1-14
Author(s):  
Federica Lucivero ◽  
Luca Marelli ◽  
Nora Hangel ◽  
Bettina Maria Zimmermann ◽  
Barbara Prainsack ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Large Scale ◽  
European Countries ◽  
Contact Tracing

Large-Scale Simulation of the Clocking Impact of 2D Combustor Profile on a Two Stage High Pressure Turbine

2014 ◽  
Author(s):  
Thomas E. Dyson ◽  
David B. Helmer ◽  
James A. Tallman
Keyword(s):  
High Pressure ◽  
Large Scale ◽  
High Pressure Turbine ◽  
Cfd Simulations ◽  
Two Stage ◽  
Substantial Impact ◽  
Sliding Mesh ◽  
Wall Flow ◽  
End Wall ◽  
Film Flows

This paper presents sliding-mesh unsteady CFD simulations of high-pressure turbine sections of a modern aviation engine in an extension of previously presented work [1]. The simulation included both the first and second stages of a two-stage high-pressure turbine. Half-wheel domains were used, with source terms representing purge and film flows. The end-wall flow-path cavities were incorporated in the domain to a limited extent. The passage-to-passage variation in thermal predictions was compared for a 1D and 2D turbine inlet boundary condition. Substantial impact was observed on both first and second stage vanes despite the mixing from the first stage blade. Qualitative and quantitative differences in surface temperature distributions were observed due to different ratios between airfoil counts in the two domains.

scholarly journals Rethinking convective quasi-equilibrium: observational constraints for stochastic convective schemes in climate models

2008 ◽  
Vol 366 (1875) ◽  
pp. 2579-2602 ◽  
Author(s):  
J. David Neelin ◽  
Ole Peters ◽  
Johnny W.-B Lin ◽  
Katrina Hales ◽  
Christopher E Holloway
Keyword(s):  
Water Vapour ◽  
Large Scale ◽  
Climate Models ◽  
Sensitivity Study ◽  
Continuous Phase ◽  
Quasi Equilibrium ◽  
Moist Convection ◽  
Spatial Averaging ◽  
Substantial Impact ◽  
Long Range Correlations

Convective quasi-equilibrium (QE) has for several decades stood as a key postulate for parametrization of the impacts of moist convection at small scales upon the large-scale flow. Departures from QE have motivated stochastic convective parametrization, which in its early stages may be viewed as a sensitivity study. Introducing plausible stochastic terms to modify the existing convective parametrizations can have substantial impact, but, as for so many aspects of convective parametrization, the results are sensitive to details of the assumed processes. We present observational results aimed at helping to constrain convection schemes, with implications for each of conventional, stochastic or ‘superparametrization’ schemes. The original vision of QE due to Arakawa fares well as a leading approximation, but with a number of updates. Some, like the imperfect connection between the boundary layer and the free troposphere, and the importance of free-tropospheric moisture to buoyancy, are quantitatively important but lie within the framework of ensemble-average convection slaved to the large scale. Observations of critical phenomena associated with a continuous phase transition for precipitation as a function of water vapour and temperature suggest a more substantial revision. While the system's attraction to the critical point is predicted by QE, several fundamental properties of the transition, including high precipitation variance in the critical region, need to be added to the theory. Long-range correlations imply that this variance does not reduce quickly under spatial averaging; scaling associated with this spatial averaging has potential implications for superparametrization. Long tails of the distribution of water vapour create relatively frequent excursions above criticality with associated strong precipitation events.

scholarly journals Forms and directions of migration from the countries of the Middle East in 1990-2017

2018 ◽  
Vol 26 (4) ◽  
pp. 730-741
Author(s):  
Maram Homsi
Keyword(s):  
Middle East ◽  
International Migration ◽  
Large Scale ◽  
European Countries ◽  
The Political ◽  
Official Statistics ◽  
Demographic Development ◽  
Development Trends ◽  
Political Factors

The article examines the modern forms and directions of migration from the countries of the Middle East in the period from 1990 to 2017. It is shown that the high emigration potential of the countries of the Middle East is formed not only by socio-economic and political factors, but also by demographic development trends. Based on a detailed study of official statistics, special attention is paid to the study of the dynamics and geography of international migration in the region. Detailed donor countries and recipient countries of migrants from the Middle East. The political and ethnocultural consequences of large-scale migration from this region to European countries are considered.

Analysis of Crack Initiation and Treatment in the South-to-North Water Diversion Suining Two Station Project

2013 ◽  
Vol 368-370 ◽  
pp. 1123-1127
Author(s):  
Ze Jun Liu ◽  
Jun Hao Wang ◽  
Qing Shan Zheng ◽  
Yue Xin She ◽  
Yi Jiang
Keyword(s):  
Crack Initiation ◽  
Large Scale ◽  
Water Diversion ◽  
Regulatory Requirements ◽  
Substantial Impact ◽  
Geological Conditions ◽  
Project Construction ◽  
Long Time ◽  
North Water ◽  
Better Than

For projects, especially large-scale projects, due to the long time of project construction, the construction of the complexity of the geological conditions, sometimes inevitably lead to quality defects.How scientific and reasonable quality defects hidden works to take remedial measures, or effective correction to restore the loss of time, cost, quality, safety,become an important engineering problem.Some cracks, will not have a substantial impact on the project, you can take measures to deal with to ensure proper implementation of the project.The article takes the analysis of crack initiation and Treatment in the Suining two station project.There are a lot of reference in processing defects in the country's large projects.Statistical indicators from the implementation of the results, analysis shows that to achieve even better than the regulatory requirements, and achieved the expected results.

scholarly journals In-Patient Treatment of Fibromyalgia: A Controlled Nonrandomized Comparison of Conventional Medicine versus Integrative Medicine including Fasting Therapy

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Andreas Michalsen ◽  
Chenying Li ◽  
Katharina Kaiser ◽  
Rainer Lüdtke ◽  
Larissa Meier ◽  
...  
Keyword(s):  
Integrative Medicine ◽  
Multimodal Treatment ◽  
Primary Outcome ◽  
Conventional Medicine ◽  
Fibromyalgia Impact Questionnaire ◽  
Treatment Strategies ◽  
Well Being ◽  
Patient Treatment ◽  
Beneficial Effects ◽  
Secondary Outcomes

Fibromyalgia poses a challenge for therapy. Recent guidelines suggest that fibromyalgia should be treated within a multidisciplinary therapy approach. No data are available that evaluated multimodal treatment strategies of Integrative Medicine (IM). We conducted a controlled, nonrandomized pilot study that compared two inpatient treatment strategies, an IM approach that included fasting therapy and a conventional rheumatology (CM) approach. IM used fasting cure and Mind-Body-Medicine as specific methods. Of 48 included consecutive patients, 28 were treated with IM, 20 with CM. Primary outcome was change in the Fibromyalgia Impact Questionnaire (FIQ) score after the 2-week hospital stay. Secondary outcomes included scores of pain, depression, anxiety, and well being. Assessments were repeated after 12 weeks. At 2 weeks, there were significant improvements in the FIQ (P<0.014) and for most of secondary outcomes for the IM group compared to the CM group. The beneficial effects for the IM approach were reduced after 12 weeks and no longer statistically significant with the exception of anxiety. Findings indicate that a multimodal IM treatment with fasting therapy might be superior to CM in the short term and not inferior in the mid term. Longer-term studies are warranted to assess the clinical impact of integrative multimodal treatment in fibromyalgia.

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