Process mining to discover patterns in patient outcomes in a Psychological Therapies Service.

In the mental health sector, Psychological Therapies face numerous challenges including ambiguities over the client and service factors that are linked to unfavourable outcomes. Better understanding of these factors can contribute to effective and efficient use of resources within the Service. In this study, process mining was applied to data from the Northern Health and Social Care Trust Psychological Therapies Service (NHSCT PTS). The aim was to explore how psychological distress severity pre-therapy and attendance factors relate to outcomes and how clinicians can use that information to improve the service. Data included therapy episodes (N = 2,933) from the NHSCT PTS for adults with a range of mental health difficulties. Data were analysed using Define-Measure-Analyse model with process mining. Results found that around 11% of clients had pre-therapy psychological distress scores below the clinical cut-off and thus these individuals were unlikely to significantly improve. Clients with fewer cancelled or missed appointments were more likely to significantly improve post-therapy. Pre-therapy psychological distress scores could be a useful factor to consider at assessment for estimating therapy duration, as those with higher scores typically require more sessions. This study concludes that process mining is useful in health services such as NHSCT PTS to provide information to inform caseload planning, service management and resource allocation, with the potential to improve client's health outcomes.

Cooperativity enhancement in buckled-dome microcavities with omnidirectional claddings.

We describe a theoretical study of dipole emitters inside buckled-dome Fabry-Perot cavities with Si/SiO2-based omnidirectional Bragg mirrors. The low penetration depth of the mirrors contributes to low mode volumes, potentially enabling large enhancement of spontaneous emission into moderate-quality-factor cavity modes. Furthermore, the omnidirectional mirrors can significantly inhibit background emission. For a representative cavity operating in a fundamental spatial mode regime at λ ~1550 nm, and an optimally located emitter, we predict simultaneous enhancement of emission into the cavity mode by ~120 and suppression of background emission by ~25, implying the potential for a cooperativity C ~1500. This is combined with Q ~103, significantly lower than is required to attain similar values of C without background inhibition, and thus implying better compatibility for broad line-width emitters.

Visible-range hollow waveguides by guided buckling of Ta2O5/SiO2 multilayers.

Hollow waveguides operating near 550 nm wavelength were fabricated by guided formation of delamination buckles within Ta2O5/SiO2 multilayers. The fabrication process employed a pair of sequentially deposited 10-period Bragg mirrors separated by a patterned, low-adhesion fluorocarbon layer. Propagation loss as low as a few dB/cm was measured, consistent with theoretical predictions.

Bistability in buckled dome microcavities.

We describe optical bistability in monolithically integrated, curved-mirror Fabry-Perot microcavities. The cavities were fabricated by controlled formation of circular delamination buckles within sputtered Si/SiO(2) multilayers. The dominant source of the bistability is heating due to residual absorption in the mirror layers, which leads to out-of-plane deflection of the buckled mirror. Hysteresis occurs for submilliwatt input powers.

Wavelength interrogation of fiber Bragg grating sensors using tapered hollow Bragg waveguides.

We describe an integrated system for wavelength interrogation, which uses tapered hollow Bragg waveguides coupled to an image sensor. Spectral shifts are extracted from the wavelength dependence of the light radiated at mode cutoff. Wavelength shifts as small as ~10 pm were resolved by employing a simple peak detection algorithm. Si/SiO2-based cladding mirrors enable a potential operational range of several hundred nanometers in the 1550 nm wavelength region for a taper length of ~1 mm. Interrogation of a strain-tuned grating was accomplished using a broadband amplified spontaneous emission (ASE) source, and potential for single-chip interrogation of multiplexed sensor arrays is demonstrated.

Reliability of Addenbrooke's Cognitive Examination III in differentiating between dementia, mild cognitive impairment and older adults who have not reported cognitive problems.

Diagnosing dementia can be challenging for clinicians, given the array of factors that contribute to changes in cognitive function. The Addenbrooke's Cognitive Examination III (ACE-III) is commonly used in dementia assessments, covering the domains of attention, memory, fluency, visuospatial and language. This study aims to (1) assess the reliability of ACE-III to differentiate between dementia, mild cognitive impairment (MCI) and controls and (2) establish whether the ACE-III is useful for diagnosing dementia subtypes. Client records from the Northern Health and Social Care Trust (NHSCT) Memory Service (n = 2,331, 2013-2019) were used in the analysis including people diagnosed with Alzheimer's disease (n = 637), vascular dementia (n = 252), mixed dementia (n = 490), MCI (n = 920) and controls (n = 32). There were significant differences in total ACE-III and subdomain scores between people with dementia, MCI and controls (p < 0.05 for all), with little overlap between distribution of total ACE-III scores (< 39%) between groups. The distribution of total ACE-III and subdomain scores across all dementias were similar. There were significant differences in scores for attention, memory and fluency between Alzheimer's disease and mixed dementia, and for visuospatial and language between Alzheimer's disease-vascular dementia (p < 0.05 for all). However, despite the significant differences across these subdomains, there was a high degree of overlap between these scores (> 73%) and thus the differences are not clinically relevant. The results suggest that ACE-III is a useful tool for discriminating between dementia, MCI and controls, but it is not reliable for discriminating between dementia subtypes. Nonetheless, the ACE-III is still a reliable tool for clinicians that can assist in making a dementia diagnosis in combination with other factors at assessment.

Chatbots to Support Mental Wellbeing of People Living in Rural Areas: Can User Groups Contribute to Co-design?

Digital technologies such as chatbots can be used in the field of mental health. In particular, chatbots can be used to support citizens living in sparsely populated areas who face problems such as poor access to mental health services, lack of 24/7 support, barriers to engagement, lack of age appropriate support and reductions in health budgets. The aim of this study was to establish if user groups can design content for a chatbot to support the mental wellbeing of individuals in rural areas. University students and staff, mental health professionals and mental health service users (N = 78 total) were recruited to workshops across Northern Ireland, Ireland, Scotland, Finland and Sweden. The findings revealed that participants wanted a positive chatbot that was able to listen, support, inform and build a rapport with users. Gamification could be used within the chatbot to increase user engagement and retention. Content within the chatbot could include validated mental health scales and appropriate response triggers, such as signposting to external resources should the user disclose potentially harmful information or suicidal intent. Overall, the workshop participants identified user needs which can be transformed into chatbot requirements. Responsible design of mental healthcare chatbots should consider what users want or need, but also what chatbot features artificial intelligence can competently facilitate and which features mental health professionals would endorse.

Circulating PTH and PTHrP levels before and after treatment of tumor induced hypercalcemia with Pamidronate Disodium (APD).

The effect of lowering ionized calcium on circulating parathyroid hormone (PTH) and parathyroid hormone-related protein (PTHrP) was assessed in twenty patients with hypercalcemia of malignancy following treatment with Pamidronate Disodium. Ionized calcium levels fell rapidly in all treated patients. PTH concentrations were initially suppressed below normal in 18 patients, but rose from 0.48 +/- 0.42 pmol/L to 3.63 +/- 3.13 pmol/L (p less than 0.01) after treatment, reaching higher than normal values in some patients even in the presence of persistent hypercalcemia. PTHrP concentrations did not change significantly after treatment. These findings are consistent with an increased sensitivity of parathyroid tissue to changes in ionized calcium following prolonged exposure to hypercalcemia. Regulation of tumor secretion of PTHrP by calcium was not apparent within the range of calcium concentrations in this study.

Hypothyroidism affects reproductive refractoriness and the seasonal oestrous period in Welsh Mountain ewes.

Welsh Mountain ewes (n = 6) were rendered hypothyroid by daily treatment with methylthiouracil (35 mg/kg), beginning in early August and ending in late February. Plasma thyroxine levels were reduced by mid-September to about 33% of those in untreated ewes (n = 6). The two groups of ewes were held under natural daylengths until 5 October, then on 12 h light: 12 h darkness (12L:12D) until 28 February when the photoperiod was reduced to 8L:16D. The onset of reproductive cyclicity in October was similar in both groups of ewes but the end of the reproductive period occurred later (P less than 0.05) in the hypothyroid ewes (29 January +/- 7 days (S.E.M.] than in the untreated controls (6 January +/- 7 days). As a result, the duration of the seasonal reproductive period was significantly (P less than 0.05) longer in the hypothyroid (122 +/- 9 days) than in the untreated ewes (91 +/- 10 days). The number of oestrous cycles (duration 15.4 and 15.7 days in the hypothyroid and untreated ewes respectively) was 7.0 +/- 0.6 in the hypothyroid ewes and 5.0 +/- 0.5 (P less than 0.05) in the normal ewes. Reducing the photo-period overcame the reproductive refractoriness and anoestrus in both groups, the hypothyroid ewes beginning to cycle on 13 April (+/- 0.5 days) after an anoestrous period of 72.8 +/- 7.1 days. The untreated ewes began to cycle 2 weeks later on 26 April (+/- 1.7 days) after an anoestrous period of 112.0 +/- 8.5 days (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of cutaneous reactivity to recently marketed dermatologic products.

BACKGROUND: Reports of purported sensitization reactions to widely used prescription dermatologicals have raised questions concerning the clinical significance of these reports. The current study was designed to compare irritant and sensitization potentials of such marketed products and to evaluate the risks involved in their usage. METHODS: One hundred and eight healthy adult volunteers were evaluated for primary irritation and hypersensitivity following application under a double-blind paradigm of eight leading prescription dermatologic products and the vehicle cream of one product according to an intensified version of the Shelanski and Shelanski "Repeated Insult Patch Test." RESULTS: No clinically significant irritant or sensitization reactions were associated with applications of topical formulations containing clobetasol propionate, doxepin hydrochloride, metronidazole, mupirocin, oxiconazole nitrate, and terbinafine hydrochloride. The doxepin hydrochloride cream vehicle was also found to be nonirritating and nonsensitizing. Both calcipotriene and ketoconazole were moderate irritants and possible sensitization reactions were also associated with ketoconazole. CONCLUSION: Although every topically applied chemical has the potential to cause an adverse response in some individuals, the data obtained in this study for eight commercially available prescription dermatologic products indicate that most are quite safe and have very low risks of clinically significant irritation or sensitization.

Reliability of testing measures in Duchenne or Becker muscular dystrophy.

In a multiinstitutional collaborative study, we ascertained the interevaluator and intraevaluator reliability of six physical therapists who performed assessment measures on 36 boys (11.7 +/- 3.9 years) with Duchenne or Becker muscular dystrophy. Upper and lower extremities were evaluated by manual muscle testing for function, range of motion, and strength. The data were analyzed using intraclass correlation coefficients (ICCs). For the interevaluator phase, ICCs were as follows: average muscle strength, .90; range of motion, .76; and upper extremity functional performance, .58. For the intraevaluator phase, corresponding ICCs were .80 to .96; .33 to .97; .34 to 1.00. Our results confirm and extend observations by others that these assessment measures are sufficiently reliable for use in a multiinstitutional collaborative effort. Such results can be used to design clinical trials that have sufficient statistical power to detect changes in the rate of disease progression. Investigators planning clinical trials in a multiinstitutional collaborative setting should first standardize the assessment methods, provide evaluator training, and document reliability.

A homogeneous method to quantify mRNA levels: a hybridization of RNase protection and scintillation proximity assay technologies.

A novel method to measure mRNA levels has been developed by combining the detection capabilities of RNase protection (RPA) with the quantification advantages of scintillation proximity assay (SPA) technology. Sample processing is reduced to the addition of a single reagent post RNase digestion. As a model system, the inducible expression of rat apolipoprotein-A1 mRNA has been measured by both traditional gel-based RPAs and the SPA-based RPA assay. Results demonstrate that the ribonuclease protection proximity assay (RiPPA) faithfully reproduces the gel-based results and is at least as sensitive as many existing methods.