An evaluation of the aged mental health and primary care partnership program.

OBJECTIVE: To evaluate the Mental Health and Primary Care Partnership (MaP) pilot program which operated in a metropolitan Melbourne setting in 2020. METHOD: Data collection included: surveys, interviews, file audits, and an evaluation of routinely collected data, with MaP consumers, their carers, GPs, Practice Managers and Nurses located in Boroondara, and MaP and Aged Person's Mental Health Service staff. RESULTS: Thirty-five consumers aged between 66 and 101 years old (of whom 63% were female) received support from the MaP program throughout its 12-month operation. Statistically significant improvements in outcome measures assessing for psychological distress and symptoms of mental illness were observed. Strengths of the program included the single referral pathway and the provision of services for those not meeting criteria to access tertiary mental health support. Consumers and clinicians made recommendations for service improvement including provision of a longer duration of care to consumers and greater integration of community and primary care. CONCLUSIONS: It is hoped that the learnings from the MaP pilot program can be used to guide future program development.

Too late for early intervention? The Healthy Ageing Service's mental health response.

OBJECTIVES: This paper describes the rationale for and development of an innovative mental health service for people aged over 65 years living in Northern and Eastern Melbourne, Victoria, Australia. CONCLUSION: The Healthy Ageing Service (HAS) was established in July 2020 to provide care for people aged over 65 years experiencing mild-to-moderate mental health concerns. It embraces a prevention and early intervention model of care. It provides primary consultation and brief intervention, secondary consultation, and capacity building to the primary healthcare sector. This innovative service is a Commonwealth-funded partnership between two tertiary mental health service providers that incorporates the recommendations from two major Royal Commissions. It demonstrates a service that acts as a bridge between primary and specialist mental health care, thereby extending mental health services to target the 'missing middle' and is potentially a model for mental health service provision throughout Victoria and Australia.

Positive Impact of Routine Testing for Enterovirus and Parechovirus on Length of Hospitalization and Antimicrobial Use among Inpatients ≤6 Months of Age.

Enterovirus (EV) and parechovirus (PeV) are leading viral causes of central nervous system (CNS) infection among hospitalized neonates and young infants, yet testing for PeV is not routinely performed. The goal of our study was to determine how EV and PeV CSF RT-PCR testing impacted the duration of antibiotic use and the length of hospitalization (LOS) in children ≤6 months old with suspected CNS infection. This retrospective cohort study at Children's Mercy Kansas City evaluated data from patients ≤6 months old for whom routine CSF EV and PeV reverse transcription-PCR (RT-PCR) testing was performed during January 2011 to December 2018. Electronic data were abstracted from the electronic medical record, including demographics, systemic antimicrobial use, imaging data, herpes simplex virus (HSV) testing, and overall hospital charges. Among 1,926 patients, 345 (17.9%) were RT-PCR positive for EV and 172 (8.9%) were positive for PeV. A significantly shorter LOS was observed for patients with EV (51.6 h; P < 0.001) and PeV (66.3 h; P = 0.048) compared to patients that tested negative for both viruses (74.1 h). Discontinuation of empirical antibiotic therapy following test result availability occurred more frequently for PeV patients (57.8%; P = 0.03) and EV patients (65.4%; P < 0.001) than RT-PCR-negative patients (48.5%). Routine EV/PeV RT-PCR testing of cerebrospinal fluid (CSF) samples in children impacted care of hospitalized neonates and young infants. Rapid and prompt diagnosis has the potential to reduce antibiotic usage, length of stay, and patient charges.

Deaths Related to Hurricane Irma - Florida, Georgia, and North Carolina, September 4-October 10, 2017.

Three powerful and devastating hurricanes from the 2017 Atlantic hurricane season (Harvey [August 17-September 1], Irma [August 30-September 13], and Maria [September 16-October 2]) resulted in the deaths of hundreds of persons. Disaster-related mortality surveillance is critical to an emergency response because it provides government and public health officials with information about the scope of the disaster and topics for prevention messaging. CDC's Emergency Operations Center collaborated with state health departments in Florida, Georgia, and North Carolina to collect and analyze Hurricane Irma-related mortality data to understand the main circumstances of death. The most common circumstance-of-death categories were exacerbation of existing medical conditions and power outage. Further analysis revealed two unique subcategories of heat-related and oxygen-dependent deaths in which power outage contributed to exacerbation of an existing medical condition. Understanding the need for subcategorization of disaster-related circumstances of death and the possibility of overlapping categories can help public health practitioners derive more effective public health interventions to prevent deaths in future disasters.

piRNAs Are Associated with Diverse Transgenerational Effects on Gene and Transposon Expression in a Hybrid Dysgenic Syndrome of D. virilis.

Sexual reproduction allows transposable elements (TEs) to proliferate, leading to rapid divergence between populations and species. A significant outcome of divergence in the TE landscape is evident in hybrid dysgenic syndromes, a strong form of genomic incompatibility that can arise when (TE) family abundance differs between two parents. When TEs inherited from the father are absent in the mother's genome, TEs can become activated in the progeny, causing germline damage and sterility. Studies in Drosophila indicate that dysgenesis can occur when TEs inherited paternally are not matched with a pool of corresponding TE silencing PIWI-interacting RNAs (piRNAs) provisioned by the female germline. Using the D. virilis syndrome of hybrid dysgenesis as a model, we characterize the effects that divergence in TE profile between parents has on offspring. Overall, we show that divergence in the TE landscape is associated with persisting differences in germline TE expression when comparing genetically identical females of reciprocal crosses and these differences are transmitted to the next generation. Moreover, chronic and persisting TE expression coincides with increased levels of genic piRNAs associated with reduced gene expression. Combined with these effects, we further demonstrate that gene expression is idiosyncratically influenced by differences in the genic piRNA profile of the parents that arise though polymorphic TE insertions. Overall, these results support a model in which early germline events in dysgenesis establish a chronic, stable state of both TE and gene expression in the germline that is maintained through adulthood and transmitted to the next generation. This work demonstrates that divergence in the TE profile is associated with diverse piRNA-mediated transgenerational effects on gene expression within populations.

Doppler Passive Fathometry.

Passive fathometry is a technique whereby broadband ambient ocean noise received on an array of hydrophones is averaged and cross-correlated to produce a sub-bottom profile [Siderius, Harrison, and Porter (2006). J. Acoust. Soc. Am. 120, 1315-1323]. Here this technique is extended to determine the vertical velocity of the array, and compensate for it, without any prior knowledge, i.e., Doppler Passive Fathometry. For Fourier transform lengths beyond a certain limit, the differing Doppler between the direct and bottom reflected paths spoils the correlation match, however it is shown by using some experimental data, where the array was known to suffer from arbitrary but near periodic motion, that compensation is possible, enabling continuing time integration. In the process, the vertical velocity becomes known. Velocity, with peak value ∼±1 m/s, is plotted against time and shown to be 90° out of phase with depth, as expected for periodic motion. Since stationary targets have already been detected by noise correlation [Harrison (2008). J. Acoust. Soc. Am. 123, 1834-1837], it is implied that the range of moving targets can also be determined.

The ocean noise coherence matrix and its rank.

An expression for the cross-spectral density matrix of ocean noise naturally separates into a Toeplitz part and a Hankel part [Harrison (2017). J. Acoust. Soc. Am. 141, 2812-2820]. The Toeplitz part is shown to be substantially rank-deficient for all practical acoustic cases, which has implications for adaptive beam forming. The influence of the Hankel part on passive fathometry is investigated, and its effect on adaptive beam forming is shown to be weak or negligible. Numerical demonstrations of these findings including beam patterns and eigenvalue spectra derived via circulant matrices are given based on a simple half-space with a Rayleigh reflection coefficient. Two sets of experimental data are revisited in this context, deriving eigenvalue spectra, beam patterns, and passive fathometry impulse responses with conventional and adaptive processing and differing amounts of averaging. The solution to a long-standing puzzle of processing inconsistency is suggested.

Separation of measured noise coherence matrix into Toeplitz and Hankel parts.

The cross-spectral density of ocean ambient noise is usually estimated from the product of the complex hydrophone signals, each of which already corresponds to the summed responses of sources from all angles. The true coherence is the integral over all angles of the angle-dependent product. The influence of this distinction on necessary time integration in geoacoustic inversion and passive fathometry is explored, and a meaningful separation of the cross-spectral density matrix into Toeplitz and Hankel parts is proposed. Various processing techniques are applied to synthesized data and some experimental vertical array data in a passive fathometry context. Passive fathometry is only sensitive to the Hankel part of the matrix.

Efficient modeling of range-dependent ray convergence effects in propagation and reverberation.

In an earlier paper [Harrison (2013). J. Acoust. Soc. Am. 133, 3777-3789] the computationally efficient energy flux approach to modeling sound propagation was modified to include focusing, ray convergence, and caustic-like behavior. The derivation started with the coherent normal mode sum but retained only terms that interfered on a scale of a ray cycle distance. Here, by starting with the adiabatic mode sum, the formulation is extended to a slowly varying range-dependent environment and applied to the target-echo and reverberation model, Artemis. Some examples are given.

The mechanism of ubihydroquinone oxidation at the Qo-site of the cytochrome bc1 complex.

1. Recent results suggest that the major flux is carried by a monomeric function, not by an intermonomer electron flow. 2. The bifurcated reaction at the Qo-site involves sequential partial processes, - a rate limiting first electron transfer generating a semiquinone (SQ) intermediate, and a rapid second electron transfer in which the SQ is oxidized by the low potential chain. 3. The rate constant for the first step in a strongly endergonic, proton-first-then-electron mechanism, is given by a Marcus-Brønsted treatment in which a rapid electron transfer is convoluted with a weak occupancy of the proton configuration needed for electron transfer. 4. A rapid second electron transfer pulls the overall reaction over. Mutation of Glu-295 of cyt b shows it to be a key player. 5. In more crippled mutants, electron transfer is severely inhibited and the bell-shaped pH dependence of wildtype is replaced by a dependence on a single pK at ~8.5 favoring electron transfer. Loss of a pK ~6.5 is explained by a change in the rate limiting step from the first to the second electron transfer; the pK ~8.5 may reflect dissociation of QH. 6. A rate constant (<10(3)s(-1)) for oxidation of SQ in the distal domain by heme bL has been determined, which precludes mechanisms for normal flux in which SQ is constrained there. 7. Glu-295 catalyzes proton exit through H(+) transfer from QH, and rotational displacement to deliver the H(+) to exit channel(s). This opens a volume into which Q(-) can move closer to the heme to speed electron transfer. 8. A kinetic model accounts well for the observations, but leaves open the question of gating mechanisms. For the first step we suggest a molecular "escapement"; for the second a molecular ballet choreographed through coulombic interactions. This article is part of a Special Issue entitled: Respiratory complex III and related bc complexes.

Development and face validation of strategies for improving consultation skills.

While formative workplace based assessment can improve learners' skills, it often does not because the procedures used do not facilitate feedback which is sufficiently specific to scaffold improvement. Provision of pre-formulated strategies to address predicted learning needs has potential to improve the quality and automate the provision of written feedback. To systematically develop, validate and maximise the utility of a comprehensive list of strategies for improvement of consultation skills through a process involving both medical students and their clinical primary and secondary care tutors. Modified Delphi study with tutors, modified nominal group study with students with moderation of outputs by consensus round table discussion by the authors. 35 hospital and 21 GP tutors participated in the Delphi study and contributed 153 new or modified strategies. After review of these and the 205 original strategies, 265 strategies entered the nominal group study to which 46 year four and five students contributed, resulting in the final list of 249 validated strategies. We have developed a valid and comprehensive set of strategies which are considered useful by medical students. This list can be immediately applied by any school which uses the Calgary Cambridge Framework to inform the content of formative feedback on consultation skills. We consider that the list could also be mapped to alternative skills frameworks and so be utilised by schools which do not use the Calgary Cambridge Framework.

Ray convergence in a flux-like propagation formulation.

The energy flux formulation of waveguide propagation is closely related to the incoherent mode sum, and its simplicity has led to development of efficient computational algorithms for reverberation and target echo strength, but it lacks the effects of convergence or modal interference. By starting with the coherent mode sum and rejecting the most rapid interference but retaining beats on a scale of a ray cycle distance it is shown that convergence can be included in a hybrid formulation requiring minimal extra computation. Three solutions are offered by evaluating the modal intensity cross terms using Taylor expansions. In the most efficient approach the double summation of the cross terms is reduced to a single numerical sum by solving the other summation analytically. The other two solutions are a local range average and a local depth average. Favorable comparisons are made between these three solutions and the wave model Orca with, and without, spatial averaging in an upward refracting duct. As a by-product, it is shown that the running range average is very close to the mode solution excluding its fringes, given a relation between averaging window size and effective number of modes which, in turn, is related to the waveguide invariant.

Synthetic array processing of ocean ambient noise for higher resolution seabed bottom loss estimation.

Predicting transmission loss in the ocean often strongly depends on the bottom loss. Bottom loss can be estimated using ocean noise and vertical array beam-forming [Harrison and Simons, J. Acoust. Soc. Am. 112, 1377-1389 (2002)]. With finite length arrays, the bottom loss estimate using this method can be smoothed due to beam widths. This paper describes how the noise coherence function can be synthetically expanded, which is similar to extending the length of an array. A full wave ocean noise model is used to demonstrate, in simulation, how this leads to improvements in the resolution of bottom loss estimates.

Molecular mechanism of ligand recognition by NR3 subtype glutamate receptors.

NR3 subtype glutamate receptors have a unique developmental expression profile, but are the least well-characterized members of the NMDA receptor gene family, which have key roles in synaptic plasticity and brain development. Using ligand binding assays, crystallographic analysis, and all atom MD simulations, we investigate mechanisms underlying the binding by NR3A and NR3B of glycine and D-serine, which are candidate neurotransmitters for NMDA receptors containing NR3 subunits. The ligand binding domains of both NR3 subunits adopt a similar extent of domain closure as found in the corresponding NR1 complexes, but have a unique loop 1 structure distinct from that in all other glutamate receptor ion channels. Within their ligand binding pockets, NR3A and NR3B have strikingly different hydrogen bonding networks and solvent structures from those found in NR1, and fail to undergo a conformational rearrangement observed in NR1 upon binding the partial agonist ACPC. MD simulations revealed numerous interdomain contacts, which stabilize the agonist-bound closed-cleft conformation, and a novel twisting motion for the loop 1 helix that is unique in NR3 subunits.

Student perceptions of the progress test in two settings and the implications for test deployment.

BACKGROUND: The Progress Test (PT) was developed to assess student learning within integrated curricula. Whilst it is effective in promoting and rewarding deep approaches to learning in some settings, we hypothesised that implementation of the curriculum (design and assessment) may impact on students' preparation for the PT and their learning. Aim To compare students' perceptions of and preparations for the PT at two medical schools. METHOD: Focus groups were used to generate items for a questionnaire. This was piloted, refined, and then delivered at both schools. Exploratory factor analysis identified the main factors underpinning response patterns. ANOVA was used to compare differences in response by school, year group and gender. RESULTS: Response rates were 640 (57%) and 414 (47%) at Schools A and B, respectively. Three major factors were identified: the PT's ability to (1) assess academic learning (2) support clinical learning; (3) the PT's impact on exam preparation. Significant differences were found between settings. In the school with early clinical contact, more frequent PTs and no end of unit tests, students were more likely to appreciate the PT as a support for learning, perceive it as fair and valid, and use a deeper approach to learning-but they also spent longer preparing for the test. CONCLUSION: Different approaches to the delivery of the PT can impact significantly on student study patterns. The learning environment has an important impact on student perceptions of assessment and approach to learning. Careful decisions about PT deployment must be taken to ensure its optimal impact.

A relation between multipath group velocity, mode number, and ray cycle distance.

Weston's ray invariant or "characteristic time" in a range-dependent environment is exactly equivalent to the Wentzel-Kramers-Brillouin phase integral for ducted normal modes. By considering a ray element it is shown that the ray invariant can also be written in terms of ray cycle distance and cycle time. This leads to a useful formula for group velocity in terms of cycle distance and mode number. Drawing a distinction between the ray and wave interpretation, the Airy phase (i.e., the existence of a group velocity minimum) can be included in this approach. Favorable comparisons are made with group velocities derived from a normal mode model. The relationship is valid for variable sound speed and variable bathymetry, and this is demonstrated numerically. The formula is applicable to active sonar, multipath pulse shape, target signatures, reverberation, tomography, and underwater communications.

Bayesian geoacoustic inversion using wind-driven ambient noise.

This paper applies Bayesian inversion to bottom-loss data derived from wind-driven ambient noise measurements from a vertical line array to quantify the information content constraining seabed geoacoustic parameters. The inversion utilizes a previously proposed ray-based representation of the ambient noise field as a forward model for fast computations of bottom loss data for a layered seabed. This model considers the effect of the array's finite aperture in the estimation of bottom loss and is extended to include the wind speed as the driving mechanism for the ambient noise field. The strength of this field relative to other unwanted noise mechanisms defines a signal-to-noise ratio, which is included in the inversion as a frequency-dependent parameter. The wind speed is found to have a strong impact on the resolution of seabed geoacoustic parameters as quantified by marginal probability distributions from Bayesian inversion of simulated data. The inversion method is also applied to experimental data collected at a moored vertical array during the MAPEX 2000 experiment, and the results are compared to those from previous active-source inversions and to core measurements at a nearby site.

At the limit? Using operational data to estimate train driver human reliability.

Human reliability analysis plays an important role in the safety assessment and management of rail operations. This paper discusses how the increasing availability of operational data can be used to develop an understanding of train driver reliability. The paper derives human reliability data for two driving tasks, stopping at red signals and controlling speed on approach to buffer stops. In the first of these cases, a tool has been developed that can estimate the number of times a signal is approached at red by trains on the Great Britain (GB) rail network. The tool has been developed using big data techniques and ideas, recording and analysing millions of pieces of data from live operational feeds to update and summarise statistics from thousands of signal locations in GB on a daily basis. The resulting driver reliability data are compared to similar analyses of other train driving tasks. This shows human reliability approaching the currently accepted limits of human performance. It also shows higher error rates amongst freight train drivers than passenger train drivers for these tasks. The paper highlights the importance of understanding the task specific performance limits if further improvements in human reliability are sought. It also provides a practical example of how big data could play an increasingly important role in system error management, whether from the perspective of understanding normal performance and the limits of performance for specific tasks or as the basis for dynamic safety indicators which, if not leading, could at least become closer to real time.

Target time smearing with short transmissions and multipath propagation.

In active sonar the target echo level is often estimated with a propagation model that adds all multipath arrivals. If the (post-correlator) transmitted pulse is short compared to the multipath time spread then there is effectively an extra loss (which may be substantial) since only a few of the paths contribute to the target echo at any one instant. This well known "time-smearing" loss is treated in a self-consistent manner with previous calculations of reverberation [Harrison, J. Acoust. Soc. Am. 114, 2744-2756 (2003)] to estimate the target response and the signal-to-reverberation-ratio. Again isovelocity water, Lambert's law, and reflection loss proportional to angle are assumed. In this important short pulse regime the target response becomes independent of boundary reflection properties but proportional to transmitted pulse length. Thus the signal-to-reverberation-ratio becomes independent of pulse length. The effect on signal-to-ambient-noise is also investigated and the resulting formulas presented in a table.