Increased health care utilization and increased antiretroviral use in HIV-infected individuals with mental health disorders

Objectives The aims of the study were to describe the prevalence and associations of mental health disorder (MHD) among a cohort of HIV-infected patients attending the Victorian HIV/AIDS Service between 1984 and 2000, and to examine whether antiretroviral therapy use or mortality was influenced by MHD (defined as a record of service provision by psychiatric services on the Victorian Psychiatric Case Register). It was hypothesized that HIV-positive individuals with MHD would have poorer treatment outcomes, reduced responses to highly active antiretroviral therapy (HAART) and increased mortality compared with those without MHD. Methods This is a retrospective cohort of 2981 individuals (73% of the Victorian population diagnosed with HIV infection) captured on an HIV database which was electronically matched with the public Victorian Psychiatric Case Register (VPCR) (accounting for 95% of public system psychiatry service provision). The prevalence, dates and recorded specifics of mental health disorders at the time of the electronic match on 1 June 2000 are described. The association with recorded MHD, gender, age, AIDS illness, HIV exposure category, duration and type of antiviral therapy, treatment era (prior to 1986, post-1987 and pre-HAART, and post-HAART) on hospitalization and mortality at 1 September 2001 was assessed. Results Five hundred and twenty-five individuals (17.6% of the Victorian HIV-positive population) were recorded with MHD, most frequently coded as attributable to substance dependence/abuse or affective disorder. MHD was diagnosed prior to HIV in 33% and, of those diagnosed after HIV, 93.8% were recorded more than 1 year after the HIV diagnosis. Schizophrenia was recorded in 6% of the population with MHD. Hospitalizations for both psychiatric and nonpsychiatric illness were more frequent in those with MHD (relative risk 5.4; 95% confidence interval 3.7, 8.2). The total number of antiretrovirals used (median 6.4 agents vs 5.5 agents) was greater in those with MHD. When adjusted for antiretroviral treatment era, HIV exposure category, CD4 cell count and antiretroviral therapy, survival was not affected by MHD. Conclusions MHD is frequent in this population with HIV infection and is associated with increased healthcare utilization but not with reduced survival.

The National Mental Health Strategy and Geographical Access to Mental Health Services: Some empirical results

In 1992 the Australian Government adopted the National Mental Health Strategy in an attempt to improve the provision of mental health services. A component was to improve geographical access to hospital-based mental health services. This paper is concerned with determining if this objective has been achieved. Time-series data on patients (at a regional level) with mental illness in the State of Queensland are available for the years from 1968-69 to 2002-03. A change in regional classification by the Australian Bureau of Statistics complicates the analysis by precluding certain empirical tests such as converging utilisation rates by region. To overcome this problem, it was decided to apply concepts of concentration and equality that are commonly employed in industrial economics to the regional data. The empirical results show no evidence of improving regional access following the National Mental Health Strategy: in fact the statistical results show the opposite, i.e. declining regional access.

Some economic dimensions of the mental health jigsaw in Australia

The purpose of this paper is to demonstrate that, although there are some unique features associated with mental illness, such special features do not preclude economic analysis. As a mechanism for understanding how individual economic studies fit into the mental health sector, a conceptual framework of the components of mental health service provision is outlined. Emphasis is placed on, not simply institutional and market resources, but also on the services provided by relatives, self-help groups, etc. Australian data on parts of the mental health sector are employed to illustrate that some (and different) economic analyses can be undertaken in mental health. First, time-series data on public psychiatric hospitals are employed to demonstrate trends associated with deinstitutionalisation. Other data (for Queensland alone) indicate that there are state-based differences in the provision of such services. Second, attention is then directed to the analysis of time-series data on private fee-for-service psychiatric services. Various concepts and measures from industrial economics are applied to analyse the relative size of this service industry, the pricing behaviour of the profession, the service-mix of "the psychiatry firms" operating in Australia.

Psychotropic medication utilization in a child and adolescent mental health service

Objectives: This study aimed to identify rates and correlates of psychotropic drug utilization in children and adolescents in inpatient and outpatient settings. Methods: A retrospective chart review examined 122 inpatient and 126 outpatient charts from a metropolitan child and youth mental health service in Brisbane, Australia. Results: Inpatients received more psychotropic medication than outpatients (71% vs. 25%; p < 0.01). Patients receiving medication were older, had longer hospital admissions, and more complex presentations, including history of abuse or suicide attempts and more diagnoses (all p < 0.01). Selective serotonin reuptake inhibitors (SSRIs) were the most frequently used drug class (44% inpatients; 14% outpatients), primarily indicated for mood disorders (31%). SSRIs and newer antidepressants (ADs) were used more frequently in patients with a high suicide risk (p < 0.01). Atypical antipsychotics (APs) were also used (inpatients 23%; outpatients 3%), primarily for behavioral disturbances. Half of those receiving medication (51%) received polypharmacy (> 1 concurrent drug), with up to four drugs used at one time. Rates of polypharmacy were highest among patients receiving antipsychotics. Conclusions: Use of psychotropic medication is frequent in this population. Future research should initially focus on inpatients and intensive treatment settings and examine both safety and efficacy of interventions for depression in young people, atypical antipsychotics for behavioral disturbances, and polypharmacy.

Relations between physiologic parameters and pulse transit time during loaded breathing

Pulse transit time (PTT) is a non-invasive measure, defined as time taken for the pulse pressure waves to travel from the R-wave of electrocardiogram to a selected peripheral site. Baseline PTT value is known to be influenced by physiologic variables like heart rate (HR), blood pressure (BP) and arterial compliance (AC). However, few quantitative data are available describing the factors which can influence PTT measurements in a child during breathing. The aim of this study was to investigate the effects of changes in breathing efforts on PTT baseline and fluctuations. Two different inspiratory resistive loading (IRL) devices were used to simulate loaded breathing in order to induce these effects. It is known that HR can influence the normative PTT value however the effect of HR variability (HRV) is not well-studied. Two groups of 3 healthy children ( 0.05) HR changes during all test activities. Results showed that HRV is not the sole contributor to PTT variations and suggest that changes in other physiologic parameters are also equally important. Hence, monitoring PTT measurement can be indicative of these associated changes during tidal or increased breathing efforts in healthy children.

The value of time in least developed countries:the African studies : final report

This is a report on a study designed to test the applicability of conventional Stated Preference and Revealed Preference models for valuing the time savings of rural travellers in least developed countries and to develop and demonstrate a robust methodology for estimating values of travel time savings which could be used in developing countries.

Transfer of patients from health care centres to special care services:analysis of travel distances in Nordic countries

Objectives: This paper highlights the importance of analysing patient transportation in Nordic circumpolar areas. The research questions we asked are as follows: How many Finnish patients have been transferred to special care intra-country and inter-country in 2009? Does it make any difference to health care policymakers if patients are transferred inter-country? Study design: We analysed the differences in distances from health care centres to special care services within Finland, Sweden and Norway and considered the health care policy implica tions. Methods: An analysis of the time required to drive between service providers using the "Google distance meter" (http://maps.google.com/); conducting interviews with key Finnish stakeholders; and undertaking a quantitative analyses of referral data from the Lapland Hospital District. Results: Finnish patients are generally not transferred for health care services across national borders even if the distances are shorter. Conclusion: Finnish patients have limited access to health care services in circumpolar are as across the Nordic countries for 2 reasons. First, health professionals in Norway and Sweden do not speak Finnish, which presents a language problem. Second, The Social Insurance Institution of Finland does not cover the expenditures of travel or the costs of medicine. In addition, it seems that in circumpolar areas the density of Finnish service providers is greater than Swedish ones, causing many Swedish citizens to transfer to Finnish health care providers every year. However, future research is needed to determine the precise reasons for this.

Leaders' sensemaking under crises:emerging cognitive consensus over time within management teams

When facing a crisis, leaders' sensemaking can take a considerable amount of time due to the need to develop consensus in how to deal with it so that vision formation and sensegiving can take place. However, research into emerging cognitive consensus when leaders deal with a crisis over time is lacking. This is limiting a detailed understanding of how organizations respond to crises. The findings, based on a longitudinal analysis of cognitive maps within three management teams at a single organization, highlight considerable individual differences in cognitive content when starting to make sense of a crisis. Evidence for an emerging viable prescriptive mental model for the future was found, but not so much in the management as a whole. Instead, the findings highlight increasing cognitive consensus based on similarities in objectives and cause-effect beliefs within well-defined management teams over time.

Mental health pharmacists views on shared decision-making for antipsychotics in serious mental illness

Background People diagnosed with serious mental illnesses (SMIs) such as schizophrenia and bipolar affective disorder are frequently treated with antipsychotics. National guidance advises the use of shared decision-making (SDM) in antipsychotic prescribing. There is currently little data on the opinions of health professionals on the role of SDM. Objective To explore the views and experiences of UK mental health pharmacists regarding the use of SDM in antipsychotic prescribing in people diagnosed with SMI. Setting The study was conducted by interviewing secondary care mental health pharmacists in the UK to obtain qualitative data. Methods Semi-structured interviews were recorded. An inductive thematic analysis was conducted using the method of constant comparison. Main outcome measure Themes evolving from mental health pharmacists on SDM in relation to antipsychotic prescribing in people with SMI. Results Thirteen mental health pharmacists were interviewed. SDM was perceived to be linked to positive clinical outcomes including adherence, service user satisfaction and improved therapeutic relations. Despite more prescribers and service users supporting SDM, it was not seen as being practised as widely as it could be; this was attributed to a number of barriers, most predominantly issues surrounding service user’s lacking capacity to engage in SDM and time pressures on clinical staff. The need for greater effort to work around the issues, engage service users and adopt a more inter-professional approach was conveyed. Conclusion The mental health pharmacists support SDM for antipsychotic prescribing, believing that it improves outcomes. However, barriers are seen to limit implementation. More research is needed into overcoming the barriers and measuring the benefits of SDM, along with exploring a more inter-professional approach to SDM.

Mitigating congestion by integrating time forecasting and realtime information aggregation in cellular networks

An iterative travel time forecasting scheme, named the Advanced Multilane Prediction based Real-time Fastest Path (AMPRFP) algorithm, is presented in this dissertation. This scheme is derived from the conventional kernel estimator based prediction model by the association of real-time nonlinear impacts that caused by neighboring arcs’ traffic patterns with the historical traffic behaviors. The AMPRFP algorithm is evaluated by prediction of the travel time of congested arcs in the urban area of Jacksonville City. Experiment results illustrate that the proposed scheme is able to significantly reduce both the relative mean error (RME) and the root-mean-squared error (RMSE) of the predicted travel time. To obtain high quality real-time traffic information, which is essential to the performance of the AMPRFP algorithm, a data clean scheme enhanced empirical learning (DCSEEL) algorithm is also introduced. This novel method investigates the correlation between distance and direction in the geometrical map, which is not considered in existing fingerprint localization methods. Specifically, empirical learning methods are applied to minimize the error that exists in the estimated distance. A direction filter is developed to clean joints that have negative influence to the localization accuracy. Synthetic experiments in urban, suburban and rural environments are designed to evaluate the performance of DCSEEL algorithm in determining the cellular probe’s position. The results show that the cellular probe’s localization accuracy can be notably improved by the DCSEEL algorithm. Additionally, a new fast correlation technique for overcoming the time efficiency problem of the existing correlation algorithm based floating car data (FCD) technique is developed. The matching process is transformed into a 1-dimensional (1-D) curve matching problem and the Fast Normalized Cross-Correlation (FNCC) algorithm is introduced to supersede the Pearson product Moment Correlation Co-efficient (PMCC) algorithm in order to achieve the real-time requirement of the FCD method. The fast correlation technique shows a significant improvement in reducing the computational cost without affecting the accuracy of the matching process.

Hybrid approaches to estimating freeway travel times using point traffic detector data

The accurate and reliable estimation of travel time based on point detector data is needed to support Intelligent Transportation System (ITS) applications. It has been found that the quality of travel time estimation is a function of the method used in the estimation and varies for different traffic conditions. In this study, two hybrid on-line travel time estimation models, and their corresponding off-line methods, were developed to achieve better estimation performance under various traffic conditions, including recurrent congestion and incidents. The first model combines the Mid-Point method, which is a speed-based method, with a traffic flow-based method. The second model integrates two speed-based methods: the Mid-Point method and the Minimum Speed method. In both models, the switch between travel time estimation methods is based on the congestion level and queue status automatically identified by clustering analysis. During incident conditions with rapidly changing queue lengths, shock wave analysis-based refinements are applied for on-line estimation to capture the fast queue propagation and recovery. Travel time estimates obtained from existing speed-based methods, traffic flow-based methods, and the models developed were tested using both simulation and real-world data. The results indicate that all tested methods performed at an acceptable level during periods of low congestion. However, their performances vary with an increase in congestion. Comparisons with other estimation methods also show that the developed hybrid models perform well in all cases. Further comparisons between the on-line and off-line travel time estimation methods reveal that off-line methods perform significantly better only during fast-changing congested conditions, such as during incidents. The impacts of major influential factors on the performance of travel time estimation, including data preprocessing procedures, detector errors, detector spacing, frequency of travel time updates to traveler information devices, travel time link length, and posted travel time range, were investigated in this study. The results show that these factors have more significant impacts on the estimation accuracy and reliability under congested conditions than during uncongested conditions. For the incident conditions, the estimation quality improves with the use of a short rolling period for data smoothing, more accurate detector data, and frequent travel time updates.

Diversity and knowledge in the age of nation-building: Space and time in the thought of Yanagita Kunio

The study examines the thought of Yanagita Kunio (1875–1962), an influential Japanese nationalist thinker and a founder of an academic discipline named minzokugaku. The purpose of the study is to bring into light an unredeemed potential of his intellectual and political project as a critique of the way in which modern politics and knowledge systematically suppresses global diversity. The study reads his texts against the backdrop of the modern understanding of space and time and its political and moral implications and traces the historical evolution of his thought that culminates in the establishment of minzokugaku. My reading of Yanagita’s texts draws on three interpretive hypotheses. First, his thought can be interpreted as a critical engagement with John Stuart Mill’s philosophy of history, as he turns Mill’s defense of diversity against Mill’s justification of enlightened despotism in non-Western societies. Second, to counter Mill’s individualistic notion of progressive agency, he turns to a Marxian notion of anthropological space, in which a laboring class makes history by continuously transforming nature, and rehabilitates the common people (jomin) as progressive agents. Third, in addition to the common people, Yanagita integrates wandering people as a countervailing force to the innate parochialism and conservatism of agrarian civilization. To excavate the unrecorded history of ordinary farmers and wandering people and promote the formation of national consciousness, his minzokugaku adopts travel as an alternative method for knowledge production and political education. In light of this interpretation, the aim of Yanagita’s intellectual and political project can be understood as defense and critique of the Enlightenment tradition. Intellectually, he attempts to navigate between spurious universalism and reactionary particularism by revaluing diversity as a necessary condition for universal knowledge and human progress. Politically, his minzokugaku aims at nation-building/globalization from below by tracing back the history of a migratory process cutting across the existing boundaries. His project is opposed to nation-building from above that aims to integrate the world population into international society at the expense of global diversity.

Personality and performance: Assessing the mediating role of mental model formation in the personality-performance relationship

Personality has long been linked to performance. Evolutions in this relationship have brought forward new questions regarding the true nature of how personality impacts performance. Both direct and indirect relationships have been proven significant. This study further investigated potential indirect relationships by including a mediating variable, mental model formation, in the personality-performance relationship. Undergraduate students were assessed in a 6-week period, Time 1 - Time 2 experiment. Conceptualizations of personality included measures of the Big 5 model and Self-efficacy, with performance measured by content quiz and overall course scores. Findings showed that the Big 5 personality traits, extraversion and agreeableness, positively and significantly impacted commonality with the instructor's mental model. However, commonality with the instructor's mental model did not impact performance. In comparison, commonality with an expert mental model positively and significantly impacted performance for both the content quiz and overall course score. Furthermore, similarity with an expert mental model positively and significantly impacted overall course performance. Hypothesized full mediation of mental model formation for the personality-performance relationship was not supported due to a lack of direct effect relationships required for mediation. However, a revised conceptualization of results emerged. Findings from the current study point to the novel and unique role mental models play in the personality-performance relationship. While personality traits do impact mental model formation, accuracy in the mental models formed is critical to performance.