Greater need but reduced access: a population study of planned and elective surgery rates in adult mental health service users.

AIMS: Timely access to surgery is an essential part of healthcare. People living with mental health (MH) conditions may have higher rates of chronic illness requiring surgical care but also face barriers to care. There is limited evidence about whether unequal surgical access contributes to health inequalities in this group. METHODS: We examined 1.22 million surgical procedures in public and private hospitals in New South Wales (NSW), Australia, in 2019. In a cross-sectional study of 76,320 MH service users aged 18 and over, surgical procedure rates per 1,000 population were compared to rates for 6.23 million other NSW residents after direct standardisation for age, sex and socio-economic disadvantage. Rates were calculated for planned and emergency surgery, for major specialty groups, for the top 10 procedure blocks in each specialty group and for 13 access-sensitive procedures. Subgroup analyses were conducted for hospital and insurance type and for people with severe or persistent MH conditions. RESULTS: MH service users had higher rates of surgical procedures (adjusted incidence rate ratio [aIRR]: 1.53, 95% CI: 1.51-1.56), due to slightly higher planned procedure rates (aIRR: 1.22, 95% CI: 1.19-1.24) and substantially higher emergency procedure rates (aIRR: 3.60, 95% CI: 3.51-3.70). Emergency procedure rates were increased in all block groups with sufficient numbers for standardisation. MH service users had very high rates (aIRR > 4.5) of emergency cardiovascular, skin and plastics and respiratory procedures, higher rates of planned coronary artery bypass grafting, coronary angiography and cholecystectomy but lower rates of planned ophthalmic surgery, cataract repair, shoulder reconstruction, knee replacement and some plastic surgery procedures. CONCLUSIONS: Higher rates of surgery in MH service users may reflect a higher prevalence of conditions requiring surgical care, including cardiac, metabolic, alcohol-related or smoking-related conditions. The striking increase in emergency surgery rates suggests that this need may not be being met, particularly for chronic and disabling conditions which are often treated by planned surgery in private hospital settings in the Australian health system. A higher proportion of emergency surgery may have serious personal and health system consequences.

What explains regional variation in privately provided out-of-area residential placement costs for people with intellectual disability in Ireland?

BACKGROUND: Expenditure on residential placements for people with intellectual disability (ID) in Ireland is considerable and expected to increase. Despite this, there is limited evidence on the factors driving variation in privately provided 'out-of-area' residential placement costs, including across Community Health Organisations (CHOs)/regions. This is important to help inform the delivery of services at best value. METHODS: We analyse unit cost data from 2019 for a sample of 278 high-cost publicly funded privately provided out-of-area residential placements for people with ID in Ireland. We undertake univariate analysis of the relationship between costs and a wide range of variables using t-tests and one-way analysis of variance. We employ multivariable regression analysis to examine how raw differentials in unit costs across regions can be accounted for by individual-level characteristics. RESULTS: We estimate average unit costs of €264 170 per annum in our sample. The univariate analysis shows considerable variation in costs across a range of personal, disability, psychiatry/psychological, forensic issues, behaviour and supports and plans related variables. We also find wide variation in average unit costs across CHOs/regions (F = 4.58, P < 0.001), ranging from €213 380 to €331 880. The multivariable analysis shows that regional differences remain even after accounting for a wide range of individual characteristics that influence costs. CONCLUSIONS: Our analysis shows that while the majority of differences in costs across regions can be explained, there is potential for cost savings in the provision of high-cost publicly funded out-of-area residential placements in Ireland. Overall this can help to develop and implement a more sustainable disability residential funding model in a context of rising demand for services. It also has potential implications for the approach to procurement of services.

The Relativistic Proton Spectrometer: A Review of Sensor Performance, Applications, and Science.

The Relativistic Proton Spectrometer (RPS) on the Van Allen Probes spacecraft was a particle spectrometer designed to measure the flux, angular distribution, and energy spectrum of protons from ∼ 60 MeV to ∼ 2000 MeV . RPS provided new information about the inner Van Allen belt: a nearby region of space that had been relatively unexplored because of the difficulties of making charged particle measurements there and the associated hazards to satellite operations. We met the primary mission objective of providing accurate data for the AP9 radiation specification model at the high energies where there were little to no data prior to the Van Allen Probes mission. Along the way, we were able to demonstrate the long-term stability of parts of the Inner Belt by comparison with short-lived space science missions that operated decades prior to Van Allen Probes. The most significant surprises were the agreement between RPS and some of those historical measurements and the discovery of a trapped population of > 30 MeV leptons at the outer edge of the inner belt. This end-of-mission paper summarizes the instrument performance, calibration, data products, and specific science and engineering results, and includes suggestions for future investigations of intense radiation fields like those found within the inner belt.

Ictal face perception disturbance, tattoos, and reclaiming the self.

We present a case of a young man with frightening ictal disturbance of face perception, or prosopometamorphopsia, arising from the left temporo-occipital region, leading to significant psychosocial impairment. A vivid forearm tattoo of the ictal experience conveyed its nature to the treating team and facilitated a psychotherapeutic process leading to significant psychosocial recovery. This case highlights the marked psychosocial and developmental impacts of epilepsy and the benefit of incorporating these into assessment and treatment.

Automated Interictal Epileptiform Discharge Detection from Scalp EEG Using Scalable Time-series Classification Approaches.

Deep learning for automated interictal epileptiform discharge (IED) detection has been topical with many published papers in recent years. All existing works viewed EEG signals as time-series and developed specific models for IED classification; however, general time-series classification (TSC) methods were not considered. Moreover, none of these methods were evaluated on any public datasets, making direct comparisons challenging. This paper explored two state-of-the-art convolutional-based TSC algorithms, InceptionTime and Minirocket, on IED detection. We fine-tuned and cross-evaluated them on a public (Temple University Events - TUEV) and two private datasets and provided ready metrics for benchmarking future work. We observed that the optimal parameters correlated with the clinical duration of an IED and achieved the best area under precision-recall curve (AUPRC) of 0.98 and F1 of 0.80 on the private datasets, respectively. The AUPRC and F1 on the TUEV dataset were 0.99 and 0.97, respectively. While algorithms trained on the private sets maintained their performance when tested on the TUEV data, those trained on TUEV could not generalize well to the private data. These results emerge from differences in the class distributions across datasets and indicate a need for public datasets with a better diversity of IED waveforms, background activities and artifacts to facilitate standardization and benchmarking of algorithms.

Increases in Future AR Count and Size: Overview of the ARTMIP Tier 2 CMIP5/6 Experiment.

The Atmospheric River (AR) Tracking Method Intercomparison Project (ARTMIP) is a community effort to systematically assess how the uncertainties from AR detectors (ARDTs) impact our scientific understanding of ARs. This study describes the ARTMIP Tier 2 experimental design and initial results using the Coupled Model Intercomparison Project (CMIP) Phases 5 and 6 multi-model ensembles. We show that AR statistics from a given ARDT in CMIP5/6 historical simulations compare remarkably well with the MERRA-2 reanalysis. In CMIP5/6 future simulations, most ARDTs project a global increase in AR frequency, counts, and sizes, especially along the western coastlines of the Pacific and Atlantic oceans. We find that the choice of ARDT is the dominant contributor to the uncertainty in projected AR frequency when compared with model choice. These results imply that new projects investigating future changes in ARs should explicitly consider ARDT uncertainty as a core part of the experimental design.

Neurological factors and Cesarean section in Australian women with epilepsy.

OBJECTIVES: To analyze the records of the pregnancies of 2283 Australian women with epilepsy in the Australian Register of Antiepileptic Drugs in Pregnancy database to identify neurological factors relevant to the Cesarean sections carried out in these pregnancies. RESULTS: The Cesarean section rate in Australian women overall increased by an average of 0.59% annually over 20 years, from 26.0% to its calculated 2020 value of 37.3%. For the operations in women with epilepsy, the corresponding figures were 0.71% annually, and 34.4% and 48.7%. The average annual rate of increase for pre-labor operations was 0.89% to a 2020 value of 39.1%, the annual rate for operations during labor showing no statistically significant change. Multivariate regression analysis identified a number of characteristics of women with epilepsy that were statistically significantly associated with an increased likelihood of Cesarean section, but of these only seizures continuing to occur in the third trimester and having chronic illness, in particular migraine, were neurological ones. In 70 migraine-affected women, the Cesarean section rate was 51.4%, compared with 39% in the remaining pregnancies (P < 0.05). CONCLUSIONS: Having seizures in the final trimester of pregnancy and having chronic neurological illness, especially migraine, favored Cesarean section being carried out in Australian women with epilepsy, but did not adequately account for the increasing rates of occurrence of the operation over the past 20 years.

Determining concentric and eccentric force-velocity profiles during squatting.

PURPOSE: The force-velocity relationship of muscular contraction has been extensively studied. However, previous research has focussed either on isolated muscle or single-joint movements, whereas human movement consists of multi-joint movements (e.g. squatting). Therefore, the purpose of this study was to investigate the force-velocity relationship of isovelocity squatting. METHODS: Fifteen male participants (24 ± 2 years, 79.8 ± 9.1 kg, 177.5 ± 6 cm) performed isovelocity squats on a novel motorised isovelocity device (Kineo Training System) at three concentric (0.25, 0.5, and 0.75 m s-1) and three eccentric velocities (- 0.25, - 0.5, and - 0.75 m s-1). Peak vertical ground reaction forces, that occurred during the isovelocity phase, were collected using dual force plates (2000 Hz) (Kistler, Switzerland). RESULTS: The group mean squat force-velocity profile conformed to the typical in vivo profile, with peak vertical ground reaction forces during eccentric squatting being 9.5 ± 19% greater than isometric (P = 0.037), and occurring between - 0.5 and - 0.75 m s-1. However, large inter-participant variability was identified (0.84-1.62 × isometric force), with some participants being unable to produce eccentric forces greater than isometric. Sub-group analyses could not identify differences between individuals who could/could not produce eccentric forces above isometric, although those who could not tended to be taller. CONCLUSIONS: These finding suggest that variability exists between participants in the ability to generate maximum eccentric forces during squatting, and the magnitude of eccentric increase above isometric cannot be predicted solely based on a concentric assessment. Therefore, an assessment of eccentric capabilities may be required prior to prescribing eccentric-specific resistance training.

The Magnetic Electron Ion Spectrometer: A Review of On-Orbit Sensor Performance, Data, Operations, and Science.

Measurements from NASA's Van Allen Probes have transformed our understanding of the dynamics of Earth's geomagnetically-trapped, charged particle radiation. The Van Allen Probes were equipped with the Magnetic Electron Ion Spectrometers (MagEIS) that measured energetic and relativistic electrons, along with energetic ions, in the radiation belts. Accurate and routine measurement of these particles was of fundamental importance towards achieving the scientific goals of the mission. We provide a comprehensive review of the MagEIS suite's on-orbit performance, operation, and data products, along with a summary of scientific results. The purpose of this review is to serve as a complement to the MagEIS instrument paper, which was largely completed before flight and thus focused on pre-flight design and performance characteristics. As is the case with all space-borne instrumentation, the anticipated sensor performance was found to be different once on orbit. Our intention is to provide sufficient detail on the MagEIS instruments so that future generations of researchers can understand the subtleties of the sensors, profit from these unique measurements, and continue to unlock the mysteries of the near-Earth space radiation environment. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11214-021-00855-2.

The leptin to adiponectin ratio (LAR) is reduced by sleeve gastrectomy in adults with severe obesity: a prospective cohort study.

Bariatric surgery is known to reduce leptin and increase adiponectin levels, but the influence of sleeve gastrectomy on the leptin: adiponectin ratio (LAR), a measure of insulin sensitivity and cardiovascular risk, has not previously been described. We sought to determine the influence of sleeve gastrectomy on LAR in adults with severe obesity.In a single centre prospective cohort study of adults undergoing laparoscopic sleeve gastrectomy over a four-month period in our unit, we measured LAR preoperatively and 12 months after surgery. Of 22 patients undergoing sleeve gastrectomy, 17 (12 females, 12 with type 2 diabetes) had follow-up LAR measured at 12.1 ± 1 months. Mean body weight decreased from 130.6 ± 30.8 kg to 97.6 ± 21.6 kg, body mass index (BMI) from 46.9 ± 7.8 to 35.3 ± 7.2 kg m-2 and excess body weight from 87.5 ± 31.3 to 41.3 ± 28.8% (all p < 0.001). The reduction in leptin from 40.7 ± 24.9 to 30.9 ± 30.5 ng/ml was not significant (p = 0.11), but adiponectin increased from 4.49 ± 1.6 to 8.93 ± 6.36 µg/ml (p = 0.005) and LAR decreased from 8.89 ± 4.8 to 5.26 ± 6.52 ng/µg (p = 0.001), equivalent to a 70.9% increase in insulin sensitivity. The correlation with the amount of weight lost was stronger for LAR than it was for leptin or adiponectin alone. In this single-centre, interventional prospective cohort, patients undergoing laparoscopic sleeve gastrectomy had a substantial reduction in their LAR after 12 months which was proportional to the amount of weight lost. This may indicate an improvement in insulin sensitivity and a reduction in cardiovascular risk.

Empirically Estimated Electron Lifetimes in the Earth's Radiation Belts: Van Allen Probe Observations.

We use measurements from NASA's Van Allen Probes to calculate the decay time constants for electrons over a wide range of energies (30 keV to 4 MeV) and L values ( L = 1.3-6.0) in the Earth's radiation belts. Using an automated routine to identify flux decay events, we construct a large database of lifetimes for near-equatorially mirroring electrons over a 5-year interval. We provide the first accurate estimates of the long decay timescales in the inner zone ( ∼ 100 days), which are highly resolved in energy and free from proton contamination. In the slot region and outer zone, we compare our lifetime calculations with prior empirical estimates and find good quantitative agreement (lifetimes ∼ 1-20 days). The comparisons suggest that some prior estimates may overestimate electron lifetimes between L ≈ 2.5-4.5 due to instrumental effects and/or background contamination. Previously reported two-stage decays are explicitly demonstrated to be a consequence of using integral fluxes.

Empirically Estimated Electron Lifetimes in the Earth's Radiation Belts: Comparison With Theory.

We compute quasilinear diffusion rates due to pitch angle scattering by various mechanisms in the Earth's electron radiation belts. The calculated theoretical lifetimes are compared with observed decay rates, and we find excellent qualitative agreement between the two. The overall structure of the observed lifetime profiles as a function of energy and L is largely due to plasmaspheric hiss and Coulomb scattering. The results also reveal a local minimum in lifetimes in the inner zone at lower energy ( ∼ 50 keV), attributed to enhanced scattering via ground-based very low frequency transmitters, and a reduction in lifetimes at higher L and energy ( > 1 MeV), attributed to enhanced electromagnetic ion cyclotron wave scattering. In addition, we find significant quantitative disagreement at L < 3 . 5 , where the theoretical lifetimes are typically a factor of ∼ 10 larger than the observed, pointing to an additional loss process that is missing from current models. We discuss potential factors that could contribute to this disagreement.

Electron Microburst Size Distribution Derived With AeroCube-6.

Microbursts are an impulsive increase of electrons from the radiation belts into the atmosphere and have been directly observed in low Earth orbit and the upper atmosphere. Prior work has estimated that microbursts are capable of rapidly depleting the radiation belt electrons on the order of a day; hence, their role to radiation belt electron losses must be considered. Losses due to microbursts are not well constrained, and more work is necessary to accurately quantify their contribution as a loss process. To address this question, we present a statistical study of > 35 keV microburst sizes using the pair of AeroCube-6 CubeSats. The microburst size distribution in low Earth orbit and the magnetic equator was derived using both spacecraft. In low Earth orbit, the majority of microbursts were observed, while the AeroCube-6 separation was less than a few tens of kilometers, mostly in latitude. To account for the statistical effects of random microburst locations and sizes, Monte Carlo and analytic models were developed to test hypothesized microburst size distributions. A family of microburst size distributions were tested, and a Markov chain Monte Carlo sampler was used to estimate the optimal distribution of model parameters. Finally, a majority of observed microbursts map to sizes less than 200 km at the magnetic equator. Since microbursts are widely believed to be generated by scattering of radiation belt electrons by whistler mode waves, the observed microburst size distribution was compared to whistler mode chorus size distributions derived in prior literature.

Protecting quantum entanglement from leakage and qubit errors via repetitive parity measurements.

Protecting quantum information from errors is essential for large-scale quantum computation. Quantum error correction (QEC) encodes information in entangled states of many qubits and performs parity measurements to identify errors without destroying the encoded information. However, traditional QEC cannot handle leakage from the qubit computational space. Leakage affects leading experimental platforms, based on trapped ions and superconducting circuits, which use effective qubits within many-level physical systems. We investigate how two-transmon entangled states evolve under repeated parity measurements and demonstrate the use of hidden Markov models to detect leakage using only the record of parity measurement outcomes required for QEC. We show the stabilization of Bell states over up to 26 parity measurements by mitigating leakage using postselection and correcting qubit errors using Pauli-frame transformations. Our leakage identification method is computationally efficient and thus compatible with real-time leakage tracking and correction in larger quantum processors.

Statistical Properties of Electron Curtain Precipitation Estimated With AeroCube-6.

Curtain precipitation is a recently discovered stationary, persistent, and latitudinally narrow electron precipitation phenomenon in low Earth orbit. Curtains are observed over consecutive passes of the dual AeroCube-6 CubeSats while their in-track lag varied from a fraction of a second to 65 s, with dosimeters that are sensitive to >35-keV electrons. This study uses the AeroCube-6 mission to quantify the statistical properties of 1,634 curtains observed over 3 years. We found that many curtains are narrower than 10 km in the latitudinal direction with 90% narrower than 20 km. We examined the geographic, magnetic local time, and geomagnetic dependence of curtains. We found that curtains are observed in the late-morning and premidnight magnetic local times, with a higher occurrence rate at premidnight, and curtains are observed more often during times of enhanced Auroral Electrojet. We found a few curtains in the bounce loss cone region above the North Atlantic, whose electrons were continuously scattered for at least 6 s. Such observations suggest that continuous curtain precipitation may be a significant loss of >35-keV electrons from the magnetosphere into the atmosphere. We hypothesize that the curtains observed in the bounce loss cone were accelerated by parallel electric fields, and we show that this mechanism is consistent with the observations.

Exploring the Interface of Oncology and Palliative Care in Ireland

Aims To explore the integration and delivery of oncology led referrals to palliative care (PC) by examining physician attitudes and referral practices. Methods An online survey was circulated to oncologists and PC physicians in Ireland. Results The study (N = 100) comprised sixty-nine oncologists (69%) and thirty-one PC physicians (31%). Ninety-two(92%) believe patients with advanced cancer should receive concurrent treatment, however only 53% of oncologists(N = 37) routinely refer. Regarding end-of-life (EOL) care: 81% of oncologists (N = 55) are directly involved in its administration, despite 84% (N = 53) agreeing patients benefit when PC specialists coordinate EOL care. Conclusion The gulf between positive attitudes and limited implementation suggests the need for interdisciplinary changes to facilitate integration of PC in clinical practice in Ireland.