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The use of compulsory community treatment (CCT) in Australia is some of the highest worldwide despite limited evidence of effectiveness. Even within Australia, use varies widely across jurisdictions despite general similarities in legislation and health services. However, there is much less information on whether variation occurs within the same jurisdiction.
Aims
To measure variations in the use of CCT in a standardised way across the following four Australian jurisdictions: Queensland, South Australia, New South Wales (NSW) and Victoria. We also investigated associated sociodemographic variables.
Methods
We used aggregated administrative data from the Australian Institute of Health and Welfare.
Results
There were data on 402 060 individuals who were in contact with specialist mental health services, of whom 51 351 (12.8%) were receiving CCT. Percentages varied from 8% in NSW to 17.6% in South Australia. There were also wide variations within jurisdictions. In NSW, prevalence ranged from 2% to 13%, in Victoria from 6% to 24%, in Queensland from 11% to 25% and in South Australia from 6% to 36%. People in contact with services who were male, single and aged between 25 and 44 years old were significantly more likely to be subject to CCT, as were people living in metropolitan areas or those born outside Oceania.
Conclusions
There are marked variations in the use of CCT both within and between Australian jurisdictions. It is unclear how much of this variation is determined by clinical need and these findings may be of relevance to jurisdictions with similar clinician-initiated orders.
ConG is software for conducting economic experiments in continuous and discrete time. It allows experimenters with limited programming experience to create a variety of strategic environments featuring rich visual feedback in continuous time and over continuous action spaces, as well as in discrete time or over discrete action spaces. Simple, easily edited input files give the experimenter considerable flexibility in specifying the strategic environment and visual feedback. Source code is modular and allows researchers with programming skills to create novel strategic environments and displays.
We study a class of trust-based cooperation dilemmas that evolve in continuous time. Characteristic of these dilemmas is that as long as all n players continue to cooperate, their payoffs increase monotonically over time. Simultaneously, the temptation to defect increases too, as the first player to defect terminates the interaction and receives the present value of the payoff function whereas each of the other n — 1 players only receives a proportion δ (0 < δ < 1) of the defecting player's payoff. We introduce a novel experimental institution that we call the Real-Time Trust Game (RTTG) to examine this class of interactions. We then report the results from an iterated RTTG in which the values of n and δ are varied in a between-subjects design. In all conditions, cooperation breaks down in the population over iterations of the game. The rate of breakdown sharply increases as n increases and more slowly decreases as δ increases.
With wide-field phased array feed technology, the Australian Square Kilometre Array Pathfinder (ASKAP) is ideally suited to search for seemingly rare radio transient sources that are difficult to discover previous-generation narrow-field telescopes. The Commensal Real-time ASKAP Fast Transient (CRAFT) Survey Science Project has developed instrumentation to continuously search for fast radio transients (duration $\lesssim$ 1 s) with ASKAP, with a particular focus on finding and localising fast radio bursts (FRBs). Since 2018, the CRAFT survey has been searching for FRBs and other fast transients by incoherently adding the intensities received by individual ASKAP antennas, and then correcting for the impact of frequency dispersion on these short-duration signals in the resultant incoherent sum (ICS) in real time. This low-latency detection enables the triggering of voltage buffers, which facilitates the localisation of the transient source and the study of spectro-polarimetric properties at high time resolution. Here we report the sample of 43 FRBs discovered in this CRAFT/ICS survey to date. This includes 22 FRBs that had not previously been reported: 16 FRBs localised by ASKAP to $\lesssim 1$ arcsec and 6 FRBs localised to $\sim 10$ arcmin. Of the new arcsecond-localised FRBs, we have identified and characterised host galaxies (and measured redshifts) for 11. The median of all 30 measured host redshifts from the survey to date is $z=0.23$. We summarise results from the searches, in particular those contributing to our understanding of the burst progenitors and emission mechanisms, and on the use of bursts as probes of intervening media. We conclude by foreshadowing future FRB surveys with ASKAP using a coherent detection system that is currently being commissioned. This will increase the burst detection rate by a factor of approximately ten and also the distance to which ASKAP can localise FRBs.
We examine the energy distribution of the fast radio burst (FRB) population using a well-defined sample of 63 FRBs from the Australian Square Kilometre Array Pathfinder (ASKAP) radio telescope, 28 of which are localised to a host galaxy. We apply the luminosity-volume ($V/V_{\mathrm{max}}$) test to examine the distribution of these transient sources, accounting for cosmological and instrumental effects, and determine the energy distribution for the sampled population over the redshift range $0.01 \lesssim z \lesssim 1.02$. We find the distribution between $10^{23}$ and $10^{26}$ J Hz$^{-1}$ to be consistent with both a pure power-law with differential slope $\gamma=-1.96 \pm 0.15$, and a Schechter function with $\gamma = -1.82 \pm 0.12$ and downturn energy $E_\mathrm{max} \sim 6.3 \, \times 10^{25}$ J Hz$^{-1}$. We identify systematic effects which currently limit our ability to probe the luminosity function outside this range and give a prescription for their treatment. Finally, we find that with the current dataset, we are unable to distinguish between the evolutionary and spectral models considered in this work.
Fast radio burst (FRB) science primarily revolves around two facets: the origin of these bursts and their use in cosmological studies. This work follows from previous redshift–dispersion measure (z–DM) analyses in which we model instrumental biases and simultaneously fit population parameters and cosmological parameters to the observed population of FRBs. This sheds light on both the progenitors of FRBs and cosmological questions. Previously, we have completed similar analyses with data from the Australian Square Kilometer Array Pathfinder (ASKAP) and the Murriyang (Parkes) Multibeam system. In this manuscript, we use 119 FRBs with 29 associated redshifts by additionally modelling the Deep Synoptic Array (DSA) and the Five-hundred-metre Aperture Spherical radio Telescope (FAST). We also invoke a Markov chain Monte Carlo (MCMC) sampler and implement uncertainty in the Galactic DM contributions. The latter leads to larger uncertainties in derived model parameters than previous estimates despite the additional data and indicate that precise measurements of DM$_\textrm{ISM}$ will be important in the future. We provide refined constraints on FRB population parameters and derive a new constraint on the minimum FRB energy of log $E_{\mathrm{min}}$(erg)=39.47$^{+0.54}_{-1.28}$ which is significantly higher than bursts detected from strong repeaters. This result likely indicates a low-energy turnover in the luminosity function or may alternatively suggest that strong repeaters have a different luminosity function to single bursts. We also predict that FAST will detect 25–41% of their FRBs at $z \gtrsim 2$ and DSA will detect 2–12% of their FRBs at $z \gtrsim 1$.
Adaptive management studies of invasive plants on non-agricultural lands typically employ an empirical approach based on designed field experiments that permit rigorous statistical analysis of results to quantify outcomes and assess the efficacy of management practices. When habitat restoration is the primary goal of a project, traditional plot-based study designs (e.g., the randomized complete-block design) are sometimes infeasible (this is often true in aquatic habitats) or inappropriate (e.g., when the goal is to assess effects of management practices on survival or resprouting of individual plants, such as trees or shrubs). Moreover, the assumptions of distribution-specific parametric statistical methods such as ANOVA often cannot be convincingly verified or are clearly untenable when properly assessed. For these reasons, it is worthwhile to be aware of alternative study designs that do not employ plots as experimental units and nonparametric statistical methods that require only weak distributional assumptions. The purpose of this paper is to review several of these alternative study designs and nonparametric statistical methods that we have found useful in our own studies of invasive aquatic and terrestrial plants. We motivate each statistical method by a research question it is well suited to answer, provide corresponding references to the statistical literature, and identify at least one R function that implements the method. In the Supplementary Material, we present additional technical information about the statistical methods, numerical examples with data, and a set of complete R programs to illustrate application of the statistical methods.
In response to the COVID-19 pandemic, we rapidly implemented a plasma coordination center, within two months, to support transfusion for two outpatient randomized controlled trials. The center design was based on an investigational drug services model and a Food and Drug Administration-compliant database to manage blood product inventory and trial safety.
Methods:
A core investigational team adapted a cloud-based platform to randomize patient assignments and track inventory distribution of control plasma and high-titer COVID-19 convalescent plasma of different blood groups from 29 donor collection centers directly to blood banks serving 26 transfusion sites.
Results:
We performed 1,351 transfusions in 16 months. The transparency of the digital inventory at each site was critical to facilitate qualification, randomization, and overnight shipments of blood group-compatible plasma for transfusions into trial participants. While inventory challenges were heightened with COVID-19 convalescent plasma, the cloud-based system, and the flexible approach of the plasma coordination center staff across the blood bank network enabled decentralized procurement and distribution of investigational products to maintain inventory thresholds and overcome local supply chain restraints at the sites.
Conclusion:
The rapid creation of a plasma coordination center for outpatient transfusions is infrequent in the academic setting. Distributing more than 3,100 plasma units to blood banks charged with managing investigational inventory across the U.S. in a decentralized manner posed operational and regulatory challenges while providing opportunities for the plasma coordination center to contribute to research of global importance. This program can serve as a template in subsequent public health emergencies.
Post-procedural antimicrobial prophylaxis is not recommended by professional guidelines but is commonly prescribed. We sought to reduce use of post-procedural antimicrobials after common endoscopic urologic procedures.
Design:
A before-after, quasi-experimental trial with a baseline (July 2020–June 2022), an implementation (July 2022), and an intervention period (August 2022–July 2023).
Setting:
Three participating medical centers.
Intervention:
We assessed the effect of a bundled intervention on excess post-procedural antimicrobial use (ie, antimicrobial use on post-procedural day 1) after three types of endoscopic urologic procedures: ureteroscopy and transurethral resection of bladder tumor or prostate. The intervention consisted of education, local champion(s), and audit-and-feedback of data on the frequency of post-procedural antimicrobial-prescribing.
Results:
1,272 procedures were performed across all 3 sites at baseline compared to 525 during the intervention period; 644 (50.6%) patients received excess post-procedural antimicrobials during the baseline period compared to 216 (41.1%) during the intervention period. There was no change in the use of post-procedural antimicrobials at sites 1 and 2 between the baseline and intervention periods. At site 3, the odds of prescribing a post-procedural antimicrobial significantly decreased during the intervention period relative to the baseline time trend (0.09; 95% CI 0.02–0.45). There was no significant increase in post-procedural unplanned visits at any of the sites.
Conclusions:
Implementation of a bundled intervention was associated with reduced post-procedural antimicrobial use at one of three sites, with no increase in complications. These findings demonstrate both the safety and challenge of guideline implementation for optimal perioperative antimicrobial prophylaxis.
This trial was registered on clinicaltrials.gov, NCT04196777.
Shark vertebrae and their centra (vertebral bodies) are high-performance structures able to survive millions of cycles of high amplitude strain despite lacking a repair mechanism for accumulating damage. Shark centra consist of mineralized cartilage, a biocomposite of bioapatite (bAp), and collagen, and the nanocrystalline bAp's contribution to functionality remains largely uninvestigated. Using the multiple detector energy-dispersive diffraction (EDD) system at 6-BM-B, the Advanced Photon Source, and 3D tomographic sampling, the 3D functionality of entire centra were probed. Immersion in ethanol vs phosphate-buffered saline produces only small changes in bAp d-spacing within a great hammerhead centrum. EDD mapping under in situ loading was performed an entire blue shark centrum, and 3D maps of bAp strain showed the two structural zones of the centrum, the corpus calcareum and intermedialia, contained opposite-signed strains approaching 0.5%, and application of ~8% nominal strain did not alter these strain magnitudes and their spatial distribution.
Pathogenic CACNA1A mutations can result in paroxysmal attacks of encephalopathy, hemiplegia and cerebral edema. We report two patients with CACNA1A-associated encephalopathy, hemiplegia and contralateral hemispheric cerebral edema treated successfully with intravenous magnesium sulfate and dexamethasone. One patient met the clinical criteria for familial hemiplegic migraine. There is a paucity of guidance in the literature on how to manage these patients. Despite some discrepancies in the treatment protocols in our two cases, they indicate that magnesium and dexamethasone could be part of the treatment algorithm for these patients. Further research to delineate appropriate dosing and duration of therapy is needed.
This work aimed to demonstrate that a website, www.epidemic-em.org, encompassing “static” resources, and videos, as well as other tools, can be used to strengthen public health emergency management capacity during epidemic response.
Methods:
Existing resources were updated and developed for self-directed Emergency Operations Centers’ capacity strengthening, in order to encompass current best practices, and to emphasize how public health emergency management concepts can support epidemic response activities. These materials formed the core of the website, launched in June 2020, to which country case studies were added. In 2021, a pilot virtual training program was designed using recorded video lectures and interviews with global experts in addition to the website material, which was delivered to South African responders.
Results:
The website has been accessed in more than 135 countries, demonstrating widespread reach and interest in online and freely accessible materials to support public health emergency operations. Over 30 people participated in the pilot virtual training, and the evaluation showed improvement in knowledge, confidence in using emergency management concepts for epidemic response, and positive feedback on the virtual modality.
Conclusions:
Online tools can expand access to materials and resources for public health emergency management capacity strengthening. Virtual modalities can further serve as a powerful complement, and perhaps replacement, for traditional in-person technical assistance, despite some limitations.
Large-scale geological structures have controlled the long-term development of the bed and thus the flow of the West Antarctic Ice Sheet (WAIS). However, complete ice cover has obscured the age and exact positions of faults and geological boundaries beneath Thwaites Glacier and Pine Island Glacier, two major WAIS outlets in the Amundsen Sea sector. Here, we characterize the only rock outcrop between these two glaciers, which was exposed by the retreat of slow-flowing coastal ice in the early 2010s to form the new Sif Island. The island comprises granite, zircon U-Pb dated to ~177–174 Ma and characterized by initial ɛNd, 87Sr/86Sr and ɛHf isotope compositions of -2.3, 0.7061 and -1.3, respectively. These characteristics resemble Thurston Island/Antarctic Peninsula crustal block rocks, strongly suggesting that the Sif Island granite belongs to this province and placing the crustal block's boundary with the Marie Byrd Land province under Thwaites Glacier or its eastern shear margin. Low-temperature thermochronological data reveal that the granite underwent rapid cooling following emplacement, rapidly cooled again at ~100–90 Ma and then remained close to the Earth's surface until present. These data help date vertical displacement across the major tectonic structure beneath Pine Island Glacier to the Late Cretaceous.
Edited by
Richard Williams, University of South Wales,Verity Kemp, Independent Health Emergency Planning Consultant,Keith Porter, University of Birmingham,Tim Healing, Worshipful Society of Apothecaries of London,John Drury, University of Sussex
This chapter introduces themes that recur throughout this book, and reflects on a collection of topics that are covered. One key theme concerns the common areas and differences in people’s responses and needs before, during, and after emergencies, incidents, disasters, and disease outbreaks (EIDD). It presents a strategic approach to meeting people’s mental health needs. Four areas common to EIDD are identified. First, preparedness before EIDD is critical to shaping how societies, communities, families, and people respond and recover. Second, a wide range of stressors have impacts on people affected by EIDD, and adversity and socioeconomic disadvantage play substantial parts in how people react, cope, and adapt. Third, the impacts of displacement are huge. Fourth, the wellbeing, psychosocial, and mental health agendas of care are extremely important aspects of the care that is required to meet the needs of survivors of EIDD and, often, those of their relatives.
Imagery-based survey is capable of producing archaeological datasets that complement those collected through field-based survey methods, widening the scope of analysis beyond regions. The Geospatial Platform for Andean Culture, History and Archaeology (GeoPACHA) enables systematic registry of imagery survey data through a ‘federated’ approach. Using GeoPACHA, teams pursue problem-specific research questions through a common data schema and interface that allows for inter-project comparisons, analyses and syntheses. The authors present an overview of the platform's rationale and functionality, as well as a summary of results from the first survey campaign, which was carried out by six projects distributed across the central Andes, five of which are represented here.
Earlier cancer diagnosis and advances in science are resulting in improved patient and societal outcomes. However, payer frameworks and methods can find it difficult to keep pace with scientific progress, evolution of endpoints, and assess the wider value of these advances.
Methods
A multidisciplinary, international group of experts working in the cancer field was brought together to reach consensus on key principles of defining and assessing of cancer treatment value. A Delphi-based approach including surveys, virtual panels, interviews and structured online discussions was used to reach consensus. This work was initiated and funded by AstraZeneca.
Results
Twenty-four experts from across the world (including patient advocates, oncologists, health economists, regulators, members of payer and health technology assessment (HTA) bodies) reached consensus on seven key principles across two themes, oncology relevant endpoints and dimensions of value. Three of the seven principles were found to be of particular relevance to HTA bodies and payers: assessing broad economic impact of new medicines (including socio-economic and caregiver impact), where early-stage cancer treatments can enhance patients’ ability to lead productive lives and contribute to economic activity; consider other value aspects of relevance to patients and society; use of Managed Entry Agreements (MEAs) supported by ongoing evidence collection to help address decision-maker evidence needs and address clinical uncertainty.
Conclusions
Incentivizing access to early-stage treatments can promote cancer control, improved outcomes and generate long-term societal benefit. Furthermore, early diagnosis and treatment at earlier stages of cancer can be cost-effective, and sometimes cost-saving, as well as provide opportunities for cure. Expanding value components in therapy assessments to include, for example, insurance value, the value of choice, scientific spillovers, and wider societal perspectives, along with structured MEAs to manage clinical uncertainty and balance budgets will help realize the potential to eliminate cancer as the cause of death.
This study investigated the effects of Lacticaseibacillus rhamnosus HN001 supplementation on the architecture and gene expression in small intestinal tissues of piglets used as an animal model for infant humans. Twenty-four 10-d-old entire male piglets (4·3 (sd 0·59) kg body weight) were fed an infant formula (IF) (control) or IF supplemented with 1·3 × 105 (low dose) or 7·9 × 106 (high dose) colony-forming units HN001 per ml of reconstituted formula (n 8 piglets/treatment). After 24 d, piglets were euthanised. Samples were collected to analyse the histology and gene expression (RNAseq and qPCR) in the jejunal and ileal tissues, blood cytokine concentrations, and blood and faecal calprotectin concentrations. HN001 consumption altered (false discovery rate < 0·05) gene expression (RNAseq) in jejunal tissues but not in ileal tissues. The number of ileal goblet cells and crypt surface area increased quadratically (P < 0·05) as dietary HN001 levels increased, but no increase was observed in the jejunal tissues. Similarly, blood plasma concentrations of IL-10 and calprotectin increased linearly (P < 0·05) as dietary HN001 levels increased. In conclusion, supplementation of IF with HN001 affected the architecture and gene expression of small intestine tissue, blood cytokine concentration and frequencies, and blood calprotectin concentrations, indicating that HN001 modulated small intestinal tissue maturation and immunity in the piglet model.
In July 2021, Public Health Wales received two notifications of salmonella gastroenteritis. Both cases has attended the same barbecue to celebrate Eid al–Adha, two days earlier. Additional cases attending the same barbecue were found and an outbreak investigation was initiated. The barbecue was attended by a North African community’s social network. On same day, smaller lunches were held in three homes in the social network. Many people attended both a lunch and the barbecue. Cases were defined as someone with an epidemiological link to the barbecue and/or lunches with diarrhoea and/or vomiting with date of onset following these events. We undertook a cohort study of 36 people attending the barbecue and/or lunch, and a nested case-control study using Firth logistic regression. A communication campaign, sensitive towards different cultural practices, was developed in collaboration with the affected community. Consumption of a traditional raw liver dish, ‘marrara’, at the barbecue was the likely vehicle for infection (Firth logistic regression, aOR: 49.99, 95%CI 1.71–1461.54, p = 0.02). Meat and offal came from two local butchers (same supplier) and samples yielded identical whole genome sequences as cases. Future outbreak investigations should be relevant to the community affected by considering dishes beyond those found in routine questionnaires.
Though diet quality is widely recognised as linked to risk of chronic disease, health systems have been challenged to find a user-friendly, efficient way to obtain information about diet. The Penn Healthy Diet (PHD) survey was designed to fill this void. The purposes of this pilot project were to assess the patient experience with the PHD, to validate the accuracy of the PHD against related items in a diet recall and to explore scoring algorithms with relationship to the Healthy Eating Index (HEI)-2015 computed from the recall data. A convenience sample of participants in the Penn Health BioBank was surveyed with the PHD, the Automated Self-Administered 24-hour recall (ASA24) and experience questions. Kappa scores and Spearman correlations were used to compare related questions in the PHD to the ASA24. Numerical scoring, regression tree and weighted regressions were computed for scoring. Participants assessed the PHD as easy to use and were willing to repeat the survey at least annually. The three scoring algorithms were strongly associated with HEI-2015 scores using National Health and Nutrition Examination Survey 2017–2018 data from which the PHD was developed and moderately associated with the pilot replication data. The PHD is acceptable to participants and at least moderately correlated with the HEI-2015. Further validation in a larger sample will enable the selection of the strongest scoring approach.