Mental health following acquisition of disability in adulthood-the impact of wealth

BACKGROUND: Acquisition of a disability in adulthood has been associated with a reduction in mental health. We tested the hypothesis that low wealth prior to disability acquisition is associated with a greater deterioration in mental health than for people with high wealth. METHODS: We assess whether level of wealth prior to disability acquisition modifies this association using 12 waves of data (2001-2012) from the Household, Income and Labour Dynamics in Australia survey-a population-based cohort study of working-age Australians. Eligible participants reported at least two consecutive waves of disability preceded by at least two consecutive waves without disability (1977 participants, 13,518 observations). Fixed-effects linear regression was conducted with a product term between wealth prior to disability (in tertiles) and disability acquisition with the mental health component score of the SF-36 as the outcome. RESULTS: In models adjusted for time-varying confounders, there was evidence of negative effect measure modification by prior wealth of the association between disability acquisition and mental health (interaction term for lowest wealth tertile: -2.2 points, 95% CI -3.1 points, -1.2, p<0.001); low wealth was associated with a greater decline in mental health following disability acquisition (-3.3 points, 95% CI -4.0, -2.5) than high wealth (-1.1 points, 95% CI -1.7, -0.5). CONCLUSION: The findings suggest that low wealth prior to disability acquisition in adulthood results in a greater deterioration in mental health than among those with high wealth.

Communicating about the management of medications as patients move across transition points of care: an observation and interview study

RATIONALE, AIMS AND OBJECTIVES: As patients move across transition points, effective medication management is critical for patient safety. The aims of this study were to examine how health professionals, patients and family members communicate about managing medications as patients moved across transition points of care and to identify possible sources of communication failure.

METHOD: A descriptive approach was used involving observations and interviews. The emergency departments and medical wards of two hospitals were involved. Observations focused on how health professionals managed medications during interactions with other health professionals, patients and family members, as patients moved across clinical settings. Follow-up interviews with participants were also undertaken. Thematic analysis was completed of transcribed data, and descriptive statistics were used to analyse characteristics of communication failure.

RESULTS: Three key themes were identified: environmental challenges, interprofessional relationships, and patient and family beliefs and responsibilities. As patients moved between environments, insufficient tracking occurred about medication changes. Before hospital admission, patients participated in self-care medication activities, which did not always involve exemplary behaviours or match the medications that doctors prescribed. During observations, 432 instances of communication failure (42.8%) were detected, which related to purpose, content, audience and occasion of the communication.

CONCLUSIONS: Extensive challenges exist involving the management of medications at transition points of care. Bedside handovers and ward rounds can be utilized as patient counselling opportunities about changes in the medication regimen. Greater attention is needed on how patients in the community make medication-related decisions.

Artificial water points facilitate the spread of an invasive vertebrate in arid Australia

Summary: The spread of invasive species after their initial introduction is often facilitated by human actions. In some cases, invaders only become established in habitats where dominant native species have been displaced as a result of human actions or where humans inadvertently provide essential resources such as food, water or shelter. We investigated if dams that provide water for livestock have facilitated the cane toad's (Rhinella marina) invasion of a hot semi-arid landscape by providing toads with a resource subsidy and hence refuge from extreme heat and aridity. To determine the relationship between the presence of surface water and habitat occupancy by toads, we surveyed natural and artificial water features for cane toads during the annual dry season. We used radiotracking and acoustic tags to determine whether movement patterns and shelter use of cane toads were focussed around dams. To determine whether dams provide toads with refuge from extreme heat and aridity, we deployed plaster models with internal thermometers to estimate ambient temperatures and toad desiccation rates in shelter sites. To determine whether dams alleviate the stress experienced by toads, we measured plasma corticosterone levels of toads that sheltered in and away from dams. Toads were present in sites with standing water and absent from waterless sites. Most radiotracked toads sheltered within 1 m of water. Toad movements were focussed around water. Toads tracked with passive acoustic telemetry over a 6-month dry season were highly resident at dams. Plaster models placed in toad shelter sites away from the water lost 27% more mass and experienced higher temperatures than models placed near the water's edge. Toads that sheltered in terrestrial shelters exhibited higher plasma corticosterone levels compared to toads that sheltered near dams. Dams provide toads with refuge habitats where they are less at risk from overheating and dehydration. Synthesis and applications. Artificial water points can facilitate biological invasions in arid regions by providing a resource subsidy for water-dependent invasive species. Our study suggests that there is scope to control populations of water-dependent invasive vertebrates in arid regions by restricting their access to artificial water points.

Approximation of centroid end-points and switch points for replacing type reduction algorithms

Despite several years of research, type reduction (TR) operation in interval type-2 fuzzy logic system (IT2FLS) cannot perform as fast as a type-1 defuzzifier. In particular, widely used Karnik-Mendel (KM) TR algorithm is computationally much more demanding than alternative TR approaches. In this work, a data driven framework is proposed to quickly, yet accurately, estimate the output of the KM TR algorithm using simple regression models. Comprehensive simulation performed in this study shows that the centroid end-points of KM algorithm can be approximated with a mean absolute percentage error as low as 0.4%. Also, switch point prediction accuracy can be as high as 100%. In conjunction with the fact that simple regression model can be trained with data generated using exhaustive defuzzification method, this work shows the potential of proposed method to provide highly accurate, yet extremely fast, TR approximation method. Speed of the proposed method should theoretically outperform all available TR methods while keeping the uncertainty information intact in the process.

Saving the United States from lurching to another sentencing crisis: taking proportionality seriously and implementing fair fixed penalties

We make recommendations regarding how the United States cansignificantly lower its incarceration rate, while at the same time ensuring that community safety is not diminished. Moreover, we identify and recommend a consolidation and extension of the positive aspects of the current sentencing regime.