Prevalence and Correlates of Bipolar Spectrum Disorder in the World Mental Health Survey Initiative

Context: There is limited information on the prevalence and correlates of bipolar spectrum disorder in international population-based studies using common methods. Objectives: To describe the prevalence, impact, patterns of comorbidity, and patterns of service utilization for bipolar spectrum disorder (BPS) in the World Health Organization World Mental Health Survey Initiative. Design, Setting, and Participants: Crosssectional, face-to-face, household surveys of 61 392 community adults in 11 countries in the Americas, Europe, and Asia assessed with the World Mental Health version of the World Health Organization Composite International Diagnostic Interview, version 3.0, a fully structured, lay-administered psychiatric diagnostic interview. Main Outcome Measures: Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) disorders, severity, and treatment. Results: The aggregate lifetime prevalences were 0.6% for bipolar type I disorder (BP-I), 0.4% for BP-II, 1.4% for subthreshold BP, and 2.4% for BPS. Twelve-month prevalences were 0.4% for BP-I, 0.3% for BP-II, 0.8% for subthreshold BP, and 1.5% for BPS. Severity of both manic and depressive symptoms as well as suicidal behavior increased monotonically from subthreshold BP to BP-I. By contrast, role impairment was similar across BP subtypes. Symptom severity was greater for depressive episodes than manic episodes, with approximately 74.0% of respondents with depression and 50.9% of respondents with mania reporting severe role impairment. Three-quarters of those with BPS met criteria for at least 1 other disorder, with anxiety disorders (particularly panic attacks) being the most common comorbid condition. Less than half of those with lifetime BPS received mental health treatment, particularly in low-income countries, where only 25.2% reported contact with the mental health system. Conclusions: Despite cross-site variation in the prevalence rates of BPS, the severity, impact, and patterns of comorbidity were remarkably similar internationally. The uniform increases in clinical correlates, suicidal behavior, and comorbidity across each diagnostic category provide evidence for the validity of the concept of BPS. Treatment needs for BPS are often unmet, particularly in low-income countries.

Effect of Multiple Cranial Burr Hole Surgery on Prevention of Recurrent Ischemic Attacks in Children with Moyamoya Disease

Moyamoya disease (MMD) is an uncommon cerebrovascular disorder characterized by progressive stenosis of the terminal portion of the internal carotid artery and its main branches. Direct and indirect bypass techniques have been devised with the aim of promoting neoangiogenesis. The current study aimed to investigate the role of multiple cranial burr hole (MCBH) operations in the prevention of cerebral ischemic attacks in children with MMD. Seven children suffering from progressive MMD were submitted to the MCBH and arachnoid opening technique. Ten to 20 burr holes were drilled in the fronto-temporo-parieto-occipital area of each hemisphere in each patient, depending on the site and extent of the disease. All patients were evaluated pre- and postoperatively by means of Barthel index (BI), CT, MR, angio-MR, and angiography. Patients had no recurrence of ischemic attacks postoperatively. Neoangiogenesis was observed in both hemispheres. One patient developed a persistent subdural collection after surgery, thus requiring placement of a subdural-peritoneal shunt. Postoperative BI was statistically significantly improved (P = 0.02). This report suggests that MCBH for revascularization in MMD is a simple procedure with a relatively low risk of complications and effective for preventing cerebral ischemic attacks in children. In addition, MCBH may be placed as an adjunct to other treatments for MMD.

Use of Performance Measurement in the Public Sector: the case of the police service

Many public organisations have been under great pressure in recent years to increase the efficiency and transparency of outputs, to rationalise the use of public resources, and to increase the quality of service delivery. In this context, public organisations were encouraged to introduce the New Public Management reforms with the goal of improving the efficiency and effectiveness of the performance organisation through a new public management model. This new public management model is based on measurement by outputs and outcomes, a clear definition of responsibilities, the transparency and accountability of governmental activities, and on a greater value for citizens. What type of performance measurement systems are used in police services? Based on the literature, we see that multidimensional models, such as the Balanced Scorecard, are important in many public organisations, like municipalities, universities, and hospitals. Police services are characterised by complex, diverse objectives and stakeholders. Therefore, performance measurement of these public services calls for a specific analysis. Based on a nationwide survey of all police chiefs of the Portuguese police force, we find that employee performance measurement is the main form of measurement. Also, we propose a strategic map for the Portuguese police service.

Risk factors for cesarean section by category of health service

OBJECTIVE: To analyze the rate of cesarean section and differences in risk factors by category of health service, either public or private. METHODS: A cross-sectional study was carried out including all pregnant women in labor admitted to hospitals in the city of Rio Grande, Southern Brazil, between January 1 and December 31, 2007. A pre-coded and pre-tested questionnaire was used to collect on social, demographic, obstetric and newborn care information. Two regression models were constructed: one for public users and the other one for private ones. Poisson regression was used in each model in the multivariate analysis. Prevalence rates and 95% confidence intervals were calculated for each adjusted factor. RESULTS: The rate of cesarean section was 43% and 86% among public and private users. Sociodemographic factors and twin births have a more significant impact among public users as well as number of pregnancies (25% vs. 13% reduction in public and private users, respectively) and previous cesarean section (86% vs. 24% increase in public and private users, respectively). Prenatal care visits and hospital admissions affected the outcome only in women users of public services. CONCLUSIONS: Cesarean section rates were high in both groups studied, but it was twice as high among women cared in the private sector. Associated factors differ in magnitude by category of service used.

Workload balancing in distributed virtual reality environments

Virtual Reality (VR) has grown to become state-of-theart technology in many business- and consumer oriented E-Commerce applications. One of the major design challenges of VR environments is the placement of the rendering process. The rendering process converts the abstract description of a scene as contained in an object database to an image. This process is usually done at the client side like in VRML [1] a technology that requires the client’s computational power for smooth rendering. The vision of VR is also strongly connected to the issue of Quality of Service (QoS) as the perceived realism is subject to an interactive frame rate ranging from 10 to 30 frames-per-second (fps), real-time feedback mechanisms and realistic image quality. These requirements overwhelm traditional home computers or even high sophisticated graphical workstations over their limits. Our work therefore introduces an approach for a distributed rendering architecture that gracefully balances the workload between the client and a clusterbased server. We believe that a distributed rendering approach as described in this paper has three major benefits: It reduces the clients workload, it decreases the network traffic and it allows to re-use already rendered scenes.

Convex optimization framework for intermediate deadline assignment in soft and hard real-time distributed systems

It is generally challenging to determine end-to-end delays of applications for maximizing the aggregate system utility subject to timing constraints. Many practical approaches suggest the use of intermediate deadline of tasks in order to control and upper-bound their end-to-end delays. This paper proposes a unified framework for different time-sensitive, global optimization problems, and solves them in a distributed manner using Lagrangian duality. The framework uses global viewpoints to assign intermediate deadlines, taking resource contention among tasks into consideration. For soft real-time tasks, the proposed framework effectively addresses the deadline assignment problem while maximizing the aggregate quality of service. For hard real-time tasks, we show that existing heuristic solutions to the deadline assignment problem can be incorporated into the proposed framework, enriching their mathematical interpretation.

Integrating inaccessibility in response time analysis of CAN networks

Controller Area Network (CAN) is a fieldbus network suitable for small-scale Distributed Computer Controlled Systems, being appropriate for transferring short real-time messages. Nevertheless, it must be understood that the continuity of service is not fully guaranteed, since it may be disturbed by temporary periods of network inaccessibility [1]. In this paper, such temporary periods of network inaccessibility are integrated in the response time analysis of CAN networks. The achieved results emphasise that, in the presence of temporary periods of network inaccessibility, a CAN network is not able to provide different integrity levels to the supported applications, since errors in low priority messages interfere with the response time of higher priority message streams.

A feedback-based decentralised coordination model for distributed open real-time systems

Moving towards autonomous operation and management of increasingly complex open distributed real-time systems poses very significant challenges. This is particularly true when reaction to events must be done in a timely and predictable manner while guaranteeing Quality of Service (QoS) constraints imposed by users, the environment, or applications. In these scenarios, the system should be able to maintain a global feasible QoS level while allowing individual nodes to autonomously adapt under different constraints of resource availability and input quality. This paper shows how decentralised coordination of a group of autonomous interdependent nodes can emerge with little communication, based on the robust self-organising principles of feedback. Positive feedback is used to reinforce the selection of the new desired global service solution, while negative feedback discourages nodes to act in a greedy fashion as this adversely impacts on the provided service levels at neighbouring nodes. The proposed protocol is general enough to be used in a wide range of scenarios characterised by a high degree of openness and dynamism where coordination tasks need to be time dependent. As the reported results demonstrate, it requires less messages to be exchanged and it is faster to achieve a globally acceptable near-optimal solution than other available approaches.

A framework for offloading real-time applications in a distributed environment

This work focuses on highly dynamic distributed systems with Quality of Service (QoS) constraints (most importantly real-time constraints). To that purpose, real-time applications may benefit from code offloading techniques, so that parts of the application can be offloaded and executed, as services, by neighbour nodes, which are willing to cooperate in such computations. These applications explicitly state their QoS requirements, which are translated into resource requirements, in order to evaluate the feasibility of accepting other applications in the system.

On the use of code mobility mechanisms in real-time systems

Applications with soft real-time requirements can benefit from code mobility mechanisms, as long as those mechanisms support the timing and Quality of Service requirements of applications. In this paper, a generic model for code mobility mechanisms is presented. The proposed model gives system designers the necessary tools to perform a statistical timing analysis on the execution of the mobility mechanisms that can be used to determine the impact of code mobility in distributed real-time applications.

Experiences on the implementation of a cooperative embedded system framework

As the complexity of embedded systems increases, multiple services have to compete for the limited resources of a single device. This situation is particularly critical for small embedded devices used in consumer electronics, telecommunication, industrial automation, or automotive systems. In fact, in order to satisfy a set of constraints related to weight, space, and energy consumption, these systems are typically built using microprocessors with lower processing power and limited resources. The CooperatES framework has recently been proposed to tackle these challenges, allowing resource constrained devices to collectively execute services with their neighbours in order to fulfil the complex Quality of Service (QoS) constraints imposed by users and applications. In order to demonstrate the framework's concepts, a prototype is being implemented in the Android platform. This paper discusses key challenges that must be addressed and possible directions to incorporate the desired real-time behaviour in Android.

Online robust optimization framework for QoS guarantees in distributed soft real-time systems

In distributed soft real-time systems, maximizing the aggregate quality-of-service (QoS) is a typical system-wide goal, and addressing the problem through distributed optimization is challenging. Subtasks are subject to unpredictable failures in many practical environments, and this makes the problem much harder. In this paper, we present a robust optimization framework for maximizing the aggregate QoS in the presence of random failures. We introduce the notion of K-failure to bound the effect of random failures on schedulability. Using this notion we define the concept of K-robustness that quantifies the degree of robustness on QoS guarantee in a probabilistic sense. The parameter K helps to tradeoff achievable QoS versus robustness. The proposed robust framework produces optimal solutions through distributed computations on the basis of Lagrangian duality, and we present some implementation techniques. Our simulation results show that the proposed framework can probabilistically guarantee sub-optimal QoS which remains feasible even in the presence of random failures.

A framework for QoS-Aware service-based mobile systems

In this paper we propose a framework for the support of mobile application with Quality of Service (QoS) requirements, such as voice or video, capable of supporting distributed, migration-capable, QoS-enabled applications on top of the Android Operating system.

Optimising and adapting the QoS of a dynamic set of inter-dependent tasks

Due to the growing complexity and adaptability requirements of real-time systems, which often exhibit unrestricted Quality of Service (QoS) inter-dependencies among supported services and user-imposed quality constraints, it is increasingly difficult to optimise the level of service of a dynamic task set within an useful and bounded time. This is even more difficult when intending to benefit from the full potential of an open distributed cooperating environment, where service characteristics are not known beforehand and tasks may be inter-dependent. This paper focuses on optimising a dynamic local set of inter-dependent tasks that can be executed at varying levels of QoS to achieve an efficient resource usage that is constantly adapted to the specific constraints of devices and users, nature of executing tasks and dynamically changing system conditions. Extensive simulations demonstrate that the proposed anytime algorithms are able to quickly find a good initial solution and effectively optimise the rate at which the quality of the current solution improves as the algorithms are given more time to run, with a minimum overhead when compared against their traditional versions.

Real-time tracking and reporting of dynamic events in hierarchical wireless sensor networks

Wireless Sensor Networks (WSNs) are highly distributed systems in which resource allocation (bandwidth, memory) must be performed efficiently to provide a minimum acceptable Quality of Service (QoS) to the regions where critical events occur. In fact, if resources are statically assigned independently from the location and instant of the events, these resources will definitely be misused. In other words, it is more efficient to dynamically grant more resources to sensor nodes affected by critical events, thus providing better network resource management and reducing endto- end delays of event notification and tracking. In this paper, we discuss the use of a WSN management architecture based on the active network management paradigm to provide the real-time tracking and reporting of dynamic events while ensuring efficient resource utilization. The active network management paradigm allows packets to transport not only data, but also program scripts that will be executed in the nodes to dynamically modify the operation of the network. This presumes the use of a runtime execution environment (middleware) in each node to interpret the script. We consider hierarchical (e.g. cluster-tree, two-tiered architecture) WSN topologies since they have been used to improve the timing performance of WSNs as they support deterministic medium access control protocols.