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Several studies within the psychiatry literature have illustrated the importance of discharge planning and execution, as well as accessibility of outpatient follow-up post-discharge. We report the results of implementing a new seamless care transition policy to expedite post-discharge follow-up in the community Addiction and Mental Health (AMH) program in the Edmonton Zone, Alberta, Canada. The policy involved a distribution mechanism for assessment by a mental health therapist (MHT) within 7 days of discharge as well as a dedicated roster of community psychiatrists to accept newly discharged patients.

Our aim was to assess the feasibility of this novel policy and to assess its effect on our outcome measures of wait time to first outpatient MHT assessment and re-admission rate to hospital.

Our study involved a retrospective clinical audit with total sampling design and a comparison of data 1 year before (2015/2016 fiscal year) and 1 year after (2017/2018 fiscal year) the implementation of the seamless cund a slight decline in readmission rates after the implementation of our model in the subsequent fiscal year.

We envision that this policy will set a precedent with regard to streamlining post-discharge follow-up care for admitted inpatients, ultimately improving mental health outcomes for patients.

We envision that this policy will set a precedent with regard to streamlining post-discharge follow-up care for admitted inpatients, ultimately improving mental health outcomes for patients.In the course of the coronavirus disease 2019 pandemic, long-term nursing care facilities are faced with general and pandemic-specific demands. In our study, we examined their burden from the perspective of managers in long-term nursing care facilities and how it differed in outpatient and inpatient settings. A cross-sectional online survey of long-term care managers was conducted in April 2020 (n = 503) and December 2020/January 2021 (n = 294). Burdens have increased over the course of the pandemic especially for outpatient facilities and in terms of general demands referring to staff (e.g. (staff shortages and overload) and work organization (e.g. compliance with regulations on working hours or staffing ratio). Concerns about infections of people in need of care and of employees remain the highest burden in the course of the pandemic. This knowledge helps us to draw implications from the pandemic and to prepare for future crises.

Differential luminal enhancement [between true lumen (TL) and false lumen (FL)] results from differential flow patterns, most likely due to outflow restriction in the FL. We aimed to assess the impact of differential luminal enhancement at baseline computed tomography angiography on the risk of adverse events in patients with acute type B aortic dissection (TBAD).

Baseline computed tomography angiographies of patients with acute TBAD between 2007 and 2016 (n = 48) were analysed using three-dimensional software at multiple sites along the descending thoraco-abdominal aorta. At each location, we measured contrast density in TL and FL [Houndsfield unit (HU)], maximal diameter (cm) and circumferential FL extent (°). Outcome data were collected via retrospective chart review. Multivariable logistic regression models were employed to determine the independent risk of TL-FL differential luminal enhancement on aneurysm formation (maximal diameter ≥55 mm) and medical treatment failure.

Patients were predominately male (75%) and 52.8±12.9 years at diagnosis. The mean follow-up was 5.9±2.6 years, and 42% (n = 20/48) patients were diagnosed with thoraco-abdominal aortic aneurysm. The baseline absolute difference between FL and TL contrast density measured at 2 cm distal to primary entry tear (TL-FLabs-Tear) was significantly higher among patients who developed aneurysm (26 HU, IQR 15-53 vs 13 HU, IQR 4-24, P = 0.001). Aneurysm development during follow-up was predicted by TL-FLabs-Tear (odds ratio 1.07, P = 0.012) and baseline maximal aortic diameter (odds ratio 1.90, P < 0.001). High (≥18 HU) differential luminal enhancement was associated with lower rates of aneurysm-free survival and higher rates of medical treatment failure.

Differential luminal enhancement may be a novel predictor of aneurysm formation among patients with acute TBAD.

Differential luminal enhancement may be a novel predictor of aneurysm formation among patients with acute TBAD.The interactions of dogs and wildlife are receiving increasing attention across the globe. Evidence suggests that dogs can negatively affect wildlife in a variety of ways, including through the risk of predation, by hybridizing with other Canis species, by acting as a reservoir or vector of pathogens, and by competing with wildlife for resources. A multitude of observations and case studies for each of these interactions has led to calls to prioritize increased management of dogs, for instance, through population reduction, vaccination, movement restrictions, and enhanced care of the dogs themselves. Here, I argue that while the risks that dogs present to wildlife are real, they vary in their importance across the globe. Furthermore, often the approaches used to address these risks are championed without a full understanding of the likelihood of success given the necessary spatial scale of management, the availability of alternative management approaches, and the role dogs play in societies. For instance, culling, vaccination, and animal husbandry approaches in reducing the impacts of dogs on wildlife sometimes fail to recognize that local human populations actively recruit replacement dogs, that vaccination often fails to reach levels necessary for herd immunity, and that enhanced dog husbandry may have indirect impacts on wildlife by requiring environmentally impactful activities. I suggest there is a need for attention not only to identify the impacts of dogs but also to determine where and when such interactions with wildlife are problematic and the likelihood of success for any proposed management approach. The impacts of dogs should be mediated in a context-specific manner that accounts for factors such as the local density of dogs, the susceptibility of local wildlife populations to the risks that dog populations may represent, and the local societal norms that underpin how dogs might be managed.Across a species range, multiple sources of environmental heterogeneity, at both small and large scales, create complex landscapes of selection, which may challenge adaptation, particularly when gene flow is high. One key to multidimensional adaptation may reside in the heterogeneity of recombination along the genome. Structural variants, like chromosomal inversions, reduce recombination, increasing linkage disequilibrium among loci at a potentially massive scale. In this study, we examined how chromosomal inversions shape genetic variation across a species range, and ask how their contribution to adaptation in the face of gene flow varies across geographic scales. We sampled the seaweed fly Coelopa frigida along a bioclimatic gradient stretching across 10° of latitude, a salinity gradient and a range of heterogeneous, patchy habitats. We generated a chromosome-level genome assembly to analyse 1,446 low-coverage whole genomes collected along those gradients. We found several large non-recombining genomic regions, including putative inversions. In contrast to the collinear regions, inversions and low recombining regions differentiated populations more strongly, either along an ecogeographic cline or at a fine-grained scale. selleck These genomic regions were associated with environmental factors and adaptive phenotypes, albeit with contrasting patterns. Altogether, our results highlight the importance of recombination in shaping adaptation to environmental heterogeneity at local and large scales.The prospect of ovarian rejuvenation offers the tantalising prospect of treating age-related declines in fertility or in pathological conditions such as premature ovarian failure. The concept of ovarian rejuvenation was invigorated by the indication of the existence of oogonial stem cells (OSCs), which have been shown experimentally to have the ability to differentiate into functional follicles and generate oocytes; however, their clinical potential remains unknown. Furthermore, there is now growing interest in performing ovarian rejuvenation in situ. One proposed approach involves injecting the ovary with platelet rich plasma (PRP). PRP is a component of blood that remains after the in vitro removal of red and white blood cells. It contains blood platelets, tiny anucleate cells of the blood, which are responsible for forming athrombus to prevent bleeding. In addition, PRP contains an array of cytokines and growth factors, as well as a number of small molecules.The utility ofPRP has been investigatedin a rangment.Intra- and inter-sexual communications are vital to the survival and reproductive success of animals. In species that cycle in and out of breeding or other physiological condition, sensory function can be modulated to optimize communication at crucial times. Little is known, however, about how widespread this sensory plasticity is across taxa, whether it occurs in multiple senses or both sexes within a species, and what potential modulatory substances and substrates are involved. Thus, studying modulation of sensory communication in a single species can provide valuable insights for understanding how sensory abilities can be altered to optimize detection of salient signals in different sensory channels and social contexts. The African cichlid fish Astatotilapia burtoni uses multimodal communication in social contexts such as courtship, territoriality, and parental care and shows plasticity in sensory abilities. In this review, we synthesize what is known about how visual, acoustic, and chemosensory communicathanisms contributing to plasticity of sensory function. This type of sensory plasticity revealed in males and females of A. burtoni is likely more widespread among diverse animals than currently realized, and future studies should take an integrative and comparative approach to better understand the proximate and ultimate mechanisms modulating communication abilities across taxa.Performance-based financing (PBF) is a complex health systems intervention aimed at improving the coverage and quality of care. Several studies have shown a positive impact of PBF on health service coverage, often coupled with improvements in quality, but relatively little is known about the mechanisms driving those results. This article presents results of a randomized impact evaluation in Cameroon designed to isolate the role of specific components of the PBF approach with four study groups (i) PBF with explicit financial incentives linked to results, (ii) direct financing with additional resources available for health providers not linked to performance, (iii) enhanced supervision and monitoring without additional resources and (iv) a control group. Overall, results indicate that, when compared with the pure control group, PBF in Cameroon led to significant increases in utilization for several services (child and maternal vaccinations, use of modern family planning), but not for others like antenatal care visits and facility-based deliveries.