CowMesh: a data-mesh architecture to unify dairy industry data for prediction and monitoring.

Dairy is an economically significant industry that caters to the huge demand for food products in people's lives. To remain profitable, farmers need to manage their farms and the health of the dairy cows in their herds. There are, however, many risks to cow health that can lead to significant challenges to dairy farm management and have the potential to lead to significant losses. Such risks include cow udder infections (i.e., mastitis) and cow lameness. As automation and data recording become more common in the agricultural sector, dairy farms are generating increasing amounts of data. Recently, these data are being used to generate insights into farm and cow health, where the objective is to help farmers manage the health and welfare of dairy cows and reduce losses from cow health issues. Despite the level of data generation on dairy farms, this information is often difficult to access due to a lack of a single, central organization to collect data from individual farms. The prospect of such an organization, however, raises questions about data ownership, with some farmers reluctant to share their farm data for privacy reasons. In this study, we describe a new data mesh architecture designed for the dairy industry that focuses on facilitating access to data from farms in a decentralized fashion. This has the benefit of keeping the ownership of data with dairy farmers while bringing data together by providing a common and uniform set of protocols. Furthermore, this architecture will allow secure access to the data by research groups and product development groups, who can plug in new projects and applications built across the data. No similar framework currently exists in the dairy industry, and such a data mesh can help industry stakeholders by bringing the dairy farms of a country together in a decentralized fashion. This not only helps farmers, dairy researchers, and product builders but also facilitates an overview of all dairy farms which can help governments to decide on regulations to improve the dairy industry at a national level.

Australian Defence Force Centre for Mental Health Second Opinion Clinic - first ten years of operation.

OBJECTIVES: The aim is to report the operation of the Australian Defence Force Centre for Mental Health (ADFCMH) Second Opinion Clinic (SOC) after its first 10 years of operation. METHOD: Demographic data and clinical data were recorded and analysed for all Australian Defence Force (ADF) personnel (n=209) seen at the clinic from 2011 to 2021. RESULTS: Assessment at the clinic led to a change in diagnosis from that given at the time of referral in 40.7% (n=85) of members seen. Of the total members assessed at the SOC, 55.9% (n=117) had been on an at least one operational deployment. Mood disorders were the most common mental disorders seen among personnel at the SOC. CONCLUSIONS: The ADFCMH SOC is a valuable clinical resource supporting ADF health services nationally and provides an example of an effective mental health tertiary referral service.

Veteran homelessness in Australia: What do we know? What has been done? What do we need to do?

OBJECTIVE: We report on the extent of veteran homelessness in Australia, what has already been done to address it and what actions are recommended to further improve the response. CONCLUSIONS: Work conducted by not-for-profit organisations and the Department of Veterans' Affairs are outlined with positive prospects for significant coordinated action to further address the situation reported.

Massed v. standard prolonged exposure therapy for PTSD in military personnel and veterans: 12-month follow-up of a non-inferiority randomised controlled trial.

BACKGROUND: The utilisation of massed therapy for treating posttraumatic stress disorder (PTSD) is gaining strength, especially prolonged exposure. However, it is unknown whether massed prolonged exposure (MPE) is non-inferior to standard prolonged exposure (SPE) protocols in the long term. The current study aimed to assess whether MPE was non-inferior to SPE at 12 months post-treatment, and to ascertain changes in secondary measure outcomes. METHODS: A multi-site non-inferiority randomised controlled trial (RCT) compared SPE with MPE in 12 clinics. The primary outcome was PTSD symptom severity (CAPS-5) at 12 months post-treatment commencement. Secondary outcome measures included symptoms of depression, anxiety, anger, disability, and quality of life at 12 weeks and 12 months post-treatment commencement. Outcome assessors were blinded to treatment allocation. The intention-to-treat sample included 138 Australian military members and veterans and data were analysed for 134 participants (SPE = 71, MPE = 63). RESULTS: Reductions in PTSD severity were maintained at 12 months and MPE remained non-inferior to SPE. Both treatment groups experienced a reduction in depression, anxiety, anger, and improvements in quality of life at 12 weeks and 12 months post-treatment commencement. Treatment effects for self-reported disability in the SPE group at 12 weeks were not maintained, with neither group registering significant effects at 12 months. CONCLUSIONS: The emergence of massed protocols for PTSD is an important advancement. The current study provides RCT evidence for the longevity of MPE treatment gains at 12 months post-treatment commencement and demonstrated non-inferiority to SPE. Promisingly, both treatments also significantly reduced the severity of comorbid symptoms commonly occurring alongside PTSD.

Effect of massed v. standard prolonged exposure therapy on PTSD in military personnel and veterans: a non-inferiority randomised controlled trial.

BACKGROUND: A short, effective therapy for posttraumatic stress disorder (PTSD) could decrease barriers to implementation and uptake, reduce dropout, and ameliorate distressing symptoms in military personnel and veterans. This non-inferiority RCT evaluated the efficacy of 2-week massed prolonged exposure (MPE) therapy compared to standard 10-week prolonged exposure (SPE), the current gold standard treatment, in reducing PTSD severity in both active serving and veterans in a real-world health service system. METHODS: This single-blinded multi-site non-inferiority RCT took place in 12 health clinics across Australia. The primary outcome was PTSD symptom severity measured by the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) at 12 weeks. 138 military personnel and veterans with PTSD were randomised. 71 participants were allocated to SPE, with 63 allocated to MPE. RESULTS: The intention-to-treat sample included 138 participants, data were analysed for 134 participants (88.1% male, M = 46 years). The difference between the mean MPE and SPE group PTSD scores from baseline to 12 weeks-post therapy was 0.94 [95% confidence interval (CI) -4.19 to +6.07]. The upper endpoint of the 95% CI was below +7, indicating MPE was non-inferior to SPE. Significant rates of loss of PTSD diagnosis were found for both groups (MPE 53.8%, SPE 54.1%). Dropout rates were 4.8% (MPE) and 16.9% (SPE). CONCLUSIONS: MPE was non-inferior to SPE in significantly reducing symptoms of PTSD. Significant reductions in symptom severity, low dropout rates, and loss of diagnosis indicate MPE is a feasible, accessible, and effective treatment. Findings demonstrate novel methods to deliver gold-standard treatments for PTSD should be routinely considered.

Australian military and veterans' mental health care: improving assessment of military personnel and veterans.

OBJECTIVE: To describe key practical knowledge and skill components required for clinicians involved with the assessment of military personnel and veterans. CONCLUSIONS: Assessment of military and veterans' mental health issues involves a tailored history-taking process that includes specific aspects of service, transition and reporting requirements. Recommendations for the detailed assessment of military personnel and veterans are provided. Comorbid conditions, chronic pain and the needs of both women and older veterans are also discussed.

Keeping military in mind: The Royal Australian & New Zealand College of Psychiatrists' Military and Veterans' Mental Health Network.

OBJECTIVE: The objective of this study is to introduce The Royal Australian & New Zealand College of Psychiatrists (RANZCP) Military and Veterans' Mental Health Network (The Network) and profile its inaugural members. METHODS: We implemented an online survey of demographic, professional and practice characteristics of network members; self-rated knowledge of military and veterans' mental health; reasons for joining The Network; and suggestions as to how The Network could best support members' needs. Quantitative survey responses were analysed descriptively. Qualitative responses were analysed thematically. RESULTS: Thirty-two out of 60 network members returned the survey. The membership was predominately male and 50 years of age or older. One-half had completed their fellowship or specialty 20 or more years ago. A high level of self-rated knowledge with respect to the assessment and management of current and ex-serving military personnel was reported. Knowledge of the assessment and management of current and ex-serving emergency services personnel was lower. CONCLUSION: There are RANZCP members with an active interest, expertise and knowledge in the field of military, veterans' and emergency services personnel mental health; this affirms the significant role the RANZCP can play in this area. There is a need to expand, diversify and ensure sustainability of the workforce.

Australian military and veteran's mental health care part 1: an introduction to cultural essentials for clinicians.

OBJECTIVE: This article aims to define the cultural specificity of Australian military and veterans, and introduce some of the essential clinician knowledge, skills and attitudes required for effective cultural competence in the management of mental health (MH) conditions in this population. CONCLUSION: Military culture has the defining characteristics of the military as an organisation with a formal structure, as a cultural group governed by norms and shared values, and as a social group that provides people with identities. Key requirements for cultural competence introduced here are basic knowledge of the military structure, norms and identity; clinical skills including basic assessment and awareness of the commonly occurring MH disorders; and an exploration of attitudes of both the clinician and the military or veteran patient. Further research is needed, particularly in terms of assessing clinician's cultural competence.

Sub-syndromal PTSD: what is important to know in military personnel and veterans?

OBJECTIVE: To assist healthcare professionals in their management of military personnel and veterans by providing information on the importance of sub-syndromal PTSD. CONCLUSION: Sub-syndromal PTSD occurs when persons experience many of the symptoms of PTSD, with some impairment, but do not meet full diagnostic criteria. Found to be associated with a range of mental health conditions including alcohol abuse, higher rates of suicidal ideas and delayed-onset PTSD, it should be seen as 'symptoms that are predictive of later disorder'. Patients with this condition need accurate assessment, trauma-focused therapy and follow-up to address the symptoms and, potentially, prevent development of PTSD.

Outlier Detection in Health Record Free-Text using Deep Learning.

In recent years, machine learning approaches have been successfully applied to analysis of patient symptom data in the context of disease diagnosis, at least where such data is well codified. However, much of the data present in Electronic Health Records (EHR) is unlikely to prove suitable for classic machine learning approaches. In particular, the use of free (or unstructured) text for clinical notes presents significant analytical opportunities, but also unique difficulties. Furthermore, the wide dispersal of health data relating to individuals necessitates the development of decentralized solutions. We provide, in this paper, an overview of our approach to develop a neural network framework for patient classification in the environment of EHRs where data may be heterogeneous, incomplete (containing missing values), and noisy. In this paper we describe our system which provides prediction of outlier cases which are likely to relate to frequent attender patients, which acheives an Area-Under-the-Curve score of up to 0.92.

The changing face of posttraumatic stress disorder in modern warfare.

OBJECTIVES: This study examined aspects of modern warfare and determined whether they have changed the clinical presentation of posttraumatic stress disorder (PTSD). CONCLUSIONS: The relationship between PTSD, mild traumatic brain injury, unmanned aerial vehicle operations and women in combat examined. It was concluded that there are significant changes in how contemporary combat veterans may present with PTSD.

Pokorny's complaint: the insoluble problem of the overwhelming number of false positives generated by suicide risk assessment.

Alex Pokorny's 1983 prospective study of suicide found that 96.3% of high-risk predictions were false positives, and that more than half of the suicides occurred in the low-risk group and were hence false negatives. All subsequent prospective studies, including the recent US Army Study To Assess Risk and Resilience in Servicemembers (STARRS), have reported similar results. We argue that since risk assessment cannot be a practical basis for interventions aimed at reducing suicide, the alternative is for mental health services to carefully consider what amounts to an adequate standard of care, and to adopt the universal precaution of attempting to provide that to all of our patients.

Update on the management of post-traumatic stress disorder.

Post-traumatic stress disorder occurs in people exposed to life-threatening trauma. GPs may be seeing more patients with post-traumatic stress disorder as military personnel return from overseas deployments. The condition can present in various ways. To reduce the likelihood of missed or delayed diagnosis GPs can screen at-risk populations. A comprehensive assessment is recommended. Specialist referral may be required, particularly if there are other mental health problems. Trauma-focused psychological therapies should be offered as the first line of treatment for post-traumatic stress disorder. Usually 8-12 sessions are needed for a therapeutic effect. If drug treatment is needed, selective serotonin reuptake inhibitors are the first line. Other drugs used in post-traumatic stress disorder include antipsychotics, anticonvulsants and prazosin.

Respiratory syncytial virus infection reduces lung inflammation and fibrosis in mice exposed to vanadium pentoxide.

BACKGROUND: Vanadium pentoxide (V2O5) exposure is a cause of occupational bronchitis and airway fibrosis. Respiratory syncytial virus (RSV) is a ubiquitous pathogen that causes airway inflammation. It is unknown whether individuals with pre-existing respiratory viral infection are susceptible to V2O5-induced bronchitis. We hypothesized that respiratory viral infection will exacerbate vanadium-induced lung fibrosis. METHODS: In this study we investigated the effect of RSV pre- or post-exposure to V2O5 in male AKR mice. Mice were pre-exposed by intranasal aspiration to RSV or media vehicle prior to intranasal aspiration of V2O5 or saline vehicle at day 1 or day 7. A parallel group of mice were treated first with V2O5 or saline vehicle at day 1 and day 7 then post-exposed to RSV or media vehicle at day 8. RESULTS: V2O5-induced airway inflammation and fibrosis were decreased by RSV pre- or post-exposure. Real time quantitative RT-PCR showed that V2O5 significantly increased lung mRNAs encoding pro-fibrogenic growth factors (TGF-beta1, CTGF, PDGF-C) and collagen (Col1A2), but also increased mRNAs encoding anti-fibrogenic type I interferons (IFN-alpha, -beta) and IFN-inducible chemokines (CXCL9 and CXCL10). RSV pre- or post-exposure caused a significantly reduced mRNAs of pro-fibrogenic growth factors and collagen, yet reduced RNA levels of anti-fibrogenic interferons and CXC chemokines. CONCLUSIONS: Collectively these data suggest that RSV infection reduces the severity of V2O5-induced fibrosis by suppressing growth factors and collagen genes. However, RSV suppression of V2O5-induced IFNs and IFN-inducible chemokines suggests that viral infection also suppresses the innate immune response that normally serves to resolve V2O5-induced fibrosis.

Bacterial lipopolysaccharide enhances PDGF signaling and pulmonary fibrosis in rats exposed to carbon nanotubes.

Engineered multi-walled carbon nanotubes (MWCNT) represent a possible health risk for pulmonary fibrosis due to their fiber-like shape and potential for persistence in the lung. We postulated that bacterial lipopolysaccharide (LPS), a ubiquitous agent in the environment that causes lung inflammation, would enhance fibrosis caused by MWCNT. Rats were exposed to LPS and then intratracheally instilled with MWCNT or carbon black (CB) nanoparticles 24 hours later. Pulmonary fibrosis was observed 21 days after MWCNT exposure, but not with CB. LPS alone caused no fibrosis but enhanced MWCNT-induced fibrosis. LPS plus CB did not significantly increase fibrosis. MWCNT increased platelet-derived growth factor-AA (PDGF-AA), a major mediator of fibrosis. PDGF-AA production in response to MWCNT, but not CB, was synergistically enhanced by LPS. Immunostaining showed PDGF-AA in bronchiolar epithelial cells and macrophages. Since macrophages engulfed MWCNT, were positive for PDGF-AA, and mediate fibroblast responses, experiments were performed with rat lung macrophages (NR8383 cells) and rat lung fibroblasts in vitro. LPS exposure increased PDGF-A mRNA levels in NR8383 cells and enhanced MWCNT-induced PDGF-A mRNA levels. Moreover, LPS increased MWCNT- or CB-induced PDGF receptor-alpha (PDGF-Ralpha) mRNA in fibroblasts. Our data suggest that LPS exacerbates MWCNT-induced lung fibrosis by amplifying production of PDGF-AA in macrophages and epithelial cells, and by increasing PDGF-Ralpha on pulmonary fibroblasts. Our findings also suggest that individuals with pre-existing pulmonary inflammation are at greater risk for the potential adverse effects of MWCNT.