Community-care unit model of residential mental health rehabilitation services in Queensland, Australia: predicting outcomes of consumers 1-year post discharge.

AIMS: Community care units (CCUs) are a model of residential psychiatric rehabilitation aiming to improve the independence and community functioning of people with severe and persistent mental illness. This study examined factors predicting improvement in outcomes among CCU consumers. METHODS: Hierarchical regression using data from a retrospective cohort (N = 501) of all consumers admitted to five CCUs in Queensland, Australia between 2005 and 2014. The primary outcome was changed in mental health and social functioning (Health of the Nation Outcome Scale). Secondary outcomes were disability (Life Skills Profile-16), service use, accommodation instability, and involuntary treatment. Potential predictors covered service, consumer, and treatment characteristics. Group-level and individualised change were assessed between the year pre-admission and post-discharge. Where relevant and available, the reliable and clinically significant (RCS) change was assessed by comparison with a normative sample. RESULTS: Group-level analyses showed statistically significant improvements in mental health and social functioning, and reductions in psychiatry-related bed-days, emergency department (ED) presentations and involuntary treatment. There were no significant changes in disability or accommodation instability. A total of 54.7% of consumers demonstrated reliable improvement in mental health and social functioning, and 43.0% showed RCS improvement. The majority (60.6%) showed a reliable improvement in psychiatry-related bed-use; a minority demonstrated reliable improvement in ED presentations (12.5%). Significant predictors of improvement included variables related to the CCU care (e.g. episode duration), consumer characteristics (e.g. primary diagnosis) and treatment variables (e.g. psychiatry-related bed-days pre-admission). Higher baseline impairment in mental health and social functioning (ß = 1.12) and longer episodes of CCU care (ß = 1.03) increased the likelihood of RCS improvement in mental health and social functioning. CONCLUSIONS: CCU care was followed by reliable improvements in relevant outcomes for many consumers. Consumers with poorer mental health and social functioning, and a longer episode of CCU care were more likely to make RCS improvements in mental health and social functioning.

Estimating remission from untreated major depression: a systematic review and meta-analysis.

BACKGROUND: Few studies have examined spontaneous remission from major depression. This study investigated the proportion of prevalent cases of untreated major depression that will remit without treatment in a year, and whether remission rates vary by disorder severity. METHOD: Wait-list controlled trials and observational cohort studies published up to 2010 with data describing remission from untreated depression at ≤ 2-year follow-up were identified. Remission was defined as rescinded diagnoses or below threshold scores on standardized symptom measures. Nineteen studies were included in a regression model predicting the probability of 12-month remission from untreated depression, using logit transformed remission proportion as the dependent variable. Covariates included age, gender, study type and diagnostic measure. RESULTS: Wait-listed compared to primary-care samples, studies with longer follow-up duration and older adult compared to adult samples were associated with lower probability of remission. Child and adolescent samples were associated with higher probability of remission. Based on adult samples recruited from primary-care settings, the model estimated that 23% of prevalent cases of untreated depression will remit within 3 months, 32% within 6 months and 53% within 12 months. CONCLUSIONS: It is undesirable to expect 100% treatment coverage for depression, given many will remit before access to services is feasible. Data were drawn from consenting wait-list and primary-care samples, which potentially over-represented mild-to-moderate cases of depression. Considering reported rates of spontaneous remission, a short untreated period seems defensible for this subpopulation, where judged appropriate by the clinician. Conclusions may not apply to individuals with more severe depression.

Comparison of rectal and tympanic core body temperature measurement in adult Guyanese squirrel monkeys (Saimiri sciureus sciureus).

BACKGROUND: Measuring core body temperature in a manner that is safe for animals and veterinary personnel is an important part of a physical examination. For nonhuman primates, this can involve increased restraint, additional stress, as well as the use of anesthetics and their deleterious effects on body temperature measurements. The purpose of this study was to compare two non-invasive methods of infrared tympanic thermometry to standard rectal thermometry in adult squirrel monkeys. METHODS: Tympanic temperatures were collected from 37 squirrel monkeys and compared to rectal temperatures using a human and veterinary infrared tympanic thermometer. RESULTS: Compared with rectal temperature measurements, the human tympanic thermometer readings were not significantly different, while the veterinary tympanic thermometer measurements were significantly higher (P<0.05). There were no differences between sexes. CONCLUSIONS: The tympanic thermometer designed for use in humans can be used in adult squirrel monkeys as an alternative to rectal thermometry for assessing core body temperature.

The dynamics of grazed woodlands in southwest Queensland, Australia and their effect on greenhouse gas emissions.

This study outlines the development of an approach to evaluate the sources, sinks, and magnitudes of greenhouse gas emissions from a grazed semiarid rangeland dominated by mulga (Acacia aneura) and how these emissions may be altered by changes in management. This paper describes the modification of an existing pasture production model (GRASP) to include a gas emission component and a dynamic tree growth and population model. An exploratory study was completed to investigate the likely impact of changes in burning practices and stock management on emissions. This study indicates that there is a fundamental conflict between maintaining agricultural productivity and reducing greenhouse gas emissions on a given unit of land. Greater agricultural productivity is allied with the system being an emissions source while production declines and the system becomes a net emissions sink as mulga density increases. Effective management for sheep production results in the system acting as a net source (approximately 60-200 kg CO2 equivalents/ha/year). The magnitude of the source depends on the management strategies used to maintain the productivity of the system and is largely determined by starting density and average density of the mulga over the simulation period. Prior to European settlement, it is believed that the mulga lands were burnt almost annually. Simulations indicate that such a management approach results in the system acting as a small net sink with an average net absorption of greenhouse gases of 14 kg CO2 equivalents/ha/year through minimal growth of mulga stands. In contrast, the suppression of fire and the introduction of grazing results in thickening of mulga stands and the system can act as a significant net sink absorbing an average of 1000 kg CO2 equivalents/ha/year. Although dense mulga will render the land largely useless for grazing, land in this region is relatively inexpensive and could possibly be developed as a cost-effective carbon offset for greenhouse gas emissions elsewhere. These results also provide support for the hypothesis that changes in land management, and particularly, suppression of fire is chiefly responsible for the observed increases in mulga density over the past century.

Impacts of climate change and climate variability on the competitiveness of wheat and beef cattle production in Emerald, north-east Australia.

Emerald, north-east Queensland, is at the northern margin of the wheat cropping region of Australia. The Emerald region was previously used predominantly for grazing beef cattle; however, cropping has developed in importance over the past 30 years. We use historical climate records (1890-1998) to simulate and compare wheat yields, grass production and live-weight gain (LWG) over time. The cropping expansion from the 1970s to the early 1990s has occurred in a unique period in the 108-year record with the highest average wheat yields, lowest wheat yield variability and the greatest relative productivity of wheat production against grass production. If this window of opportunity is a result of long-term climate variability, then cropping is likely to decline in the region as conditions return to those experienced earlier in the record. If this increase is related to climate change, then cropping is likely to persist in the region with productivity maintained at current levels particularly through the yield-enhancing effects of increased atmospheric CO2 concentrations. However, this persistence will be influenced by the frequencies of El Niño conditions that may increase with global warming. The high relative productivities experienced over the past few decades have probably biased producers' expectations, and applications for drought support need to take into account the longer-term perspective provided by this analysis. Nevertheless, the last 6 years have the lowest simulated mean LWG production on the record. The identification of poor production periods depended on the production element being addressed and the timescale involved.

Global change and the mulga woodlands of southwest Queensland: greenhouse gas emissions, impacts, and adaptation.

The possibility of trading greenhouse gas emission permits as a result of the Kyoto Protocol has spurred interest in developing land-based sinks for greenhouse gases. Extensive grazing lands that have the potential to develop substantial woody biomass are one obvious candidate for such activities. However, such activities need to consider the possible impacts on existing grazing and the possible impacts of continuing CO2 buildup in the atmosphere and resultant climate change. We used simulation models to investigate these issues in the mulga (Acacia aneura) woodlands of southwest Queensland. The simulation results suggest that this system can be managed to act as either a net source or a net sink of greenhouse gases under current climate and CO2 and under a range of global change scenarios. The key component in determining source or sink status is the management of the woody mulga. The most effective means of permanently increasing carbon stores and hence reducing net emissions is to exclude both burning and grazing. There are combinations of management regimes, such as excluding fire with light grazing, which, on average, allows productive grazing but transient carbon storage. The effects of increased CO2 on ecosystem carbon stores were unexpected. Carbon stores increased (7-17%) with doubling of CO2 only in those simulations where burning did not occur, but decreased when burnt. This occurred because the substantial increases in grass growth with doubling of CO2 (34-56%) enabled more fires, killing off the establishing cohorts needed to ensure continued carbon accumulation. On average, the doubling of atmospheric CO2 concentration increased grass growth by 44%, which is identical with mean literature values, suggesting that this result may be applicable in other ecosystems where fire has a similar function. A sensitivity analysis of the CO2 response of mulga showed only minor impacts. We discuss additional uncertainties and shortcomings.

Effects of exercise on riboflavin requirements: biological validation in weight reducing women.

The present study was designed to evaluate our previous estimates for riboflavin requirement, 0.96 mg/1000 kcal during nonexercise and 1.16 mg/1000 kcal during exercise in overweight women. Two groups of 6 weight reducing women consumed either 1.16 mg riboflavin/1000 kcal (HR) or 0.96 mg/1000 kcal (MR). The study was two, 3 period by 2 treatment (exercise or nonexercise) crossover designs, one design at each level of riboflavin. Erythrocyte glutathione reductase activity coefficients (AC) significantly increased in both groups from 1.16 +/- .02 to 1.20 +/- .03 in group HR and from 1.31 +/- .04 to 1.36 +/- .02 in the MR group during nonexercise and exercise, respectively. ACs increased in the HR group due to an increase in total enzyme activity while ACs increased in the MR group due to a decrease in basal enzyme activity reflecting decreased flavin availability. There were no differences in aerobic capacity, weight loss, nor change in lean body mass between the two groups. Thus, 0.96 mg/1000 kcal was not adequate during either nonexercise or exercise periods while the 1.16 mg/1000 kcal was adequate.