Be honest about referrals

Although previous studies hint at the occurrence of substantial spatial variation in the accumulation rates of C and N in bogs, the extent to which rates may vary on high-resolution spatial and temporal scales is not known. A main reason for the lack of knowledge is that it is problematic to determine the precise age of peat at a given depth. We determined rates of carbon and nitrogen accumulation in the uppermost decimeters of a bog ecosystem using the pine method, which enables accurate dating of surface peat layers. We combined accumulation data with numerical and geostatistical analyses of the recent vegetation to establish the relationship between bog vegetation and rate of peat accumulation. Use of a laser technique for spatial positioning of 151 age-determined peat cores within a 20 × 20 m plot made it possible for us to give the first fine-scaled account of spatial and temporal variation in rates of mass, carbon, and nitrogen accumulation during the last century. Rates of C and N accumulation were highly variable at all spatial scales studied. For example, after ∼125 yr of peat growth, C and N accumulation varied by factors of five and four, respectively, from 25 to 125 g/dm2 for C, and from 0.7 to 2.6 g/dm2 for N. It takes ∼40 yr of peat accumulation before significant amounts of C are lost through decay. Hummocks built up by Sphagnum fuscum S. rubellum were able to maintain average rates of C accumulation that exceed 2 g·dm−2·yr−1 during 50 yr of growth. We argue that data on spatial variation in rates of C accumulation are necessary to understand the role of boreal peatlands in the greenhouse effect and global climate.

IntroductionThis study seeks to analyse the trend of homicide rate in México in last 30 years by age, gender and mechanism of death and identify the socioeconomic variables that better...

The present study compares admissions to mental hospitals in England in 1981 with comparable figures obtained for 1971. Patients were classified by place of birth and the two data sets reveal interesting similarities a decade apart. With schizophrenia the trend in 1981, as in 1971, is for the foreign born to have higher rates of admission in comparison to the native born; and as in 1971 the groups with the highest rate of admission are the Irish born and those born in the Caribbean and Poland. Overall rates of admission in 1981 for immigrants from India, Pakistan, Germany and Italy (like 1971) are lower than the native born rates. As in 1971 the Irish and Scots have extremely high rates of alcohol and drug related disorders, and although they also have high rates of personality disorders they are not as high as the 1971 rates. Those born in the Caribbean continue to show relatively low rates of admission for alcohol, drug and personality disorders. For Indian born males the 1981 figure for alcohol related admissions is twice that of 1971. There is an apparent increase in the rates of depression in 1981 compared to 1971 across all the groups which is affected by changes in recording procedures. There are other findings which are peculiar to only one sub-group, such as the very low re-admission rates for Pakistani women compared to the other groups. This paper provides some possible explanations to account for these variations in rates of admission.

1. Comparative statistics on the accomplishments of thirteen mental hospitals and three state schools for mental defectives are prepared each month by the Division of Statistics of the Massachusetts State Department of Mental Health. Sets of tables are made available to the Commissioner and the superintendents of the various state hospitals and schools. 2. Four factors in movement of patient population are analyzed each month: (1) Patients discharged to the community, (2) Patients dying in hospital, (3) Patients placed on visit, and (4) Patients leaving hospital on escape. For example, in the discharges (Table 1), the number of patients severing connection with the hospital during the month is compared with the number of cases under care during the same month. A discharge rate for the hospital is calculated which may be compared with the discharge rates of the other hospitals shown on the same table. Similar tables are made up which present the monthly death rates, visit rates and escape rates for all hos...

Background: The anxiety disorders specified in the fourth edition, text revision, of The Diagnostic and Statistical Manual (DSM-IV-TR) are identified universally in human societies, and also show substantial cultural particularities in prevalence and symptomatology. Possible explanations for the observed epidemiological variability include lack of measurement equivalence, true differences in prevalence, and limited validity or precision of diagnostic criteria. One central question is whether, through inadvertent “over-specification” of disorders, the post-DSM-III nosology has missed related but somewhat different presentations of the same disorder because they do not exactly fit specified criteria sets. This review canvases the mental health literature for evidence of cross-cultural limitations in DSM-IV-TR anxiety disorder criteria. Methods: Searches were conducted of the mental health literature, particularly since 1994, regarding cultural or race/ethnicity-related factors that might limit the universal...

Reducing or eliminating seclusion from mental health care settings has been a national priority for Australia since 2005. This paper describes Australia's national seclusion data collection, and summarises changes in seclusion rates in Australian public mental health services. Seclusion events per 1000 patient days were calculated from 2009-2010 to 2014-2015 utilising state and territory administrative data sources. Combined national data were used to calculate results for a number of service characteristics, such as target population and location of the service. The rate of seclusion events decreased by 43% over the 6 years. Child and adolescent services reported consistently higher rates of seclusion, but a shorter duration of seclusion episodes, compared with other service types. There is high variation in seclusion rates between individual services (range 0.0-53.0 seclusion events per 1000 bed days in 2014-2015). Seclusion event rates in Australia's specialised public acute mental health hospital services are declining. The use of existing administrative data was instrumental in establishing a national data source to facilitate the monitoring and reporting of progress of seclusion reduction strategies.

Organ Donation Breakthrough Collaborative

Since the appearance of the Ambient Intelligence paradigm, as an evolution of the Ubiquitous Computing, a great deal of the research efforts in this ?eld have been mainly aimed at anticipating user actions and needs, out of a pre?xed set. However, Ambient Intelligence is not just constrained to user behaviour pattern matching, but to wisely supervise the whole environment, satisfying those unforeseen requirements or needs, by means of rational decisions. This work points at the lack of commonsense reasoning, as the main reason underlying the existance of these idiots savant systems, capable of accomplishing very speci?c and complex tasks, but incapable of making decisions out of the pre?xed behavioral patterns. This work advocates for the integration of the commonsense reasoning and understanding capabilities as the key elements in bridging the gap between idiot savant systems and real Ambient Intelligence systems.

Inefficiencies in the process to acquire and manage real property have a significant impact on the ability of transportation agencies to develop and deliver transportation projects effectively. Acquisition of real property is frequently on the critical path of transportation projects. Delays in acquiring real property are one of the main reasons (along with environmental reviews and utility relocations) for project delays and cost overruns. Current right-of-way practice and procedural manuals are the products of forty years of statutes, case law, regulations, management styles, and best practices, brought into compliance with the requirements in the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (Uniform Act). State procedures vary widely because of differences in state laws. Local agencies are required to follow state DOT procedural manuals when they use state or federal funding. Questions arise as new staff try to understand the reason or underlying basis for requirements. Contractors and consultants face a wide array of requirements and forms among the various states. This report provides (a) improved, integrated real property procedures and business practices in the project development and delivery process; and (b) suggestions to improve property management practices. An online survey, follow-up interviews, and a peer exchange meeting were used to determine which business practices are critical to the mission of the project development and delivery process and real property management. The research compared a typical right-of-way business model currently in compliance with the Uniform Act and federal regulations with an improved model based upon an objective analysis of its key elements. The research produced (a) an integrated model of the transportation project development and delivery process, including a real property acquisition and relocation assistance model in accordance with 42 U.S.C. 4601 et seq.; (b) a reference real property acquisition and relocation assistance work schedule; and (c) a discussion of issues and challenges affecting project development and delivery that typically involve real property components, as well as strategies to address those issues and challenges. Standalone versions of the integrated model and reference work schedule were also developed and are included with this report on an attached CD-ROM (CRP-CD 154) or on the Transportation Research Board’s website.

Global demand for (individual) mobility and motorization is increasing rapidly. Mobility is important to economic and social development, especially in urban centers (Dohmel 2008). But mobility is also considered a main reason for accelerating climate change in the form of CO2 emissions (IPCC 2007). Politicians, media, NGOs and (city) governments identify mobility as a core domain to design and launch strategies and measures mitigating climate change in urban centers. In recent years, strategies and measures incorporated were often less effective because customer needs and demands were not met sufficiently and the costs of (individual) mobility were increased by regulations and taxation. The leading idea of this paper is to design a conceptual framework, whereby open innovation approaches and pricing as key elements are applied to customer-focused strategies and measures mitigating climate change in urban centers.

The aim was to examine the scale, source, and relevance of variation between general practices in respect of the rates with which patients consulted with illnesses falling in each of several diagnostic groups. This study involved a general practice morbidity survey conducted over two years, 1970-72. All patients who consulted their general practitioners were identified and the number of these who consulted with diagnoses attributable to each of the 18 main chapters of the International classification of diseases were counted. Patients who consulted for more than one diagnosis within a chapter were counted once only; those who consulted for one or more diagnoses in each of several chapters were counted once for each chapter. This was a national survey involving general practitioners in England and Wales. The study involved 214,524 patients from 53 selected general practices (115 doctors) who were registered with their general practitioners for the whole of the year 1970-71 and for whom their morbidity data had been linked with their social data from the 1971 census. Using the numbers of patients on the practice lists as denominators, practice patient consulting rates (PPCR) were calculated for each practice and for each ICD chapter. Variability in chapter PPCR was examined by calculating coefficients of variation and, after allowance for random variation, coefficients of residual variation. There were large interpractice (doctor) variations in all chapter rates. These variations were only marginally attributable to: chance; different age, sex and social class mixes of practice populations; geographical locations; and practice organisation. The rates were, however, consistent from one year to the next for any one practice. Approximately half of the interpractice (doctor) diagnostic variability was associated with overall patient consulting behaviour. When the effects of this behaviour were discounted, any major residual diagnostic variability was confined largely to ICD chapters I-V, XVI, and XVII, ie, those chapters where aetiology forms the basis of classification. Variations in recorded diagnostic rates are mainly due to the consistent but idiosyncratic and selective exclusion by practitioners of some components from the total set which often coexist in a new diagnosis. Because of the scale of interpractice diagnostic variability, the use of algorithms and information technology is largely precluded from outcome studies, auditing procedures, and studies of practice work loads in general. However, (1) the consistency of any individual doctor's pattern of diagnostic recording from one year to another permits studies of trends; and (2) given a reasonable number of recording practices, the population mean practice consulting rates can be estimated with sufficient accuracy for many epidemiological research and administrative uses.

Resumo Esse estudo investiga os motivos que levam diferentes educadores a planejarem atividades com seus estudantes em um centro de ciências. Além disso, buscou-se: a) analisar as concepções desses educadores sobre o papel/função do centro de ciências; b) compreender, a partir das falas dos educadores, como se deu a sua participação durante a visita nesse espaço; c) identificar se há uma tentativa de articulação por parte dos educadores entre as ações desenvolvidas no contexto escolar e as atividades realizadas no centro de ciências. Trata-se de um estudo qualitativo de caráter exploratório. Para a coleta de dados, foram realizadas entrevistas semiestruturadas com 15 educadores após a visita realizada com seus estudantes em um centro de ciências da Grande Vitória, no estado do Espírito Santo. Os resultados evidenciaram que o principal motivo estabelecido pelos educadores ao planejar visitas com seus estudantes no centro investigado é a possibilidade de vincular a teoria, que é discutida e ensinada no contexto escolar, com situações práticas envolvendo demonstrações/experimentações que constituem os principais elementos mediadores desses espaços. Esse resultado aponta para uma necessidade de reflexão/formação dos educadores no sentido de repensar as potencialidades educativas dos centros de ciências e as possíveis articulações a serem desenvolvidas com vistas às práticas pedagógicas estabelecidas no contexto escolar.

Clinical guidelines advise against prescribing more than one antipsychotic with limited exceptions. Despite this, surveys continue to report high antipsychotic polypharmacy rates. The aim of the study was to investigate the effectiveness of a multi-faceted intervention in reducing prescribing of antipsychotic polypharmacy on general adult psychiatry wards, compared with guidelines alone. A pragmatic cluster randomized controlled trial recruited 19 adult psychiatric units (clusters) from the South West of England. Participants were all ward doctors and nurses. The multi-faceted intervention comprised: an educational/CBT workbook; an educational visit to consultants; and a reminder system on medication charts. The odds of being prescribed antipsychotic polypharmacy in those patients prescribed antipsychotic medication was significantly lower in the intervention than control group when adjusted for confounders (OR 0.43, 95% CI 0.21-0.90, p=0.028). There was considerable between-unit variation in polypharmacy rates and in the change in rates between baseline and follow-up (5 months after baseline). The intervention reduced levels of polypharmacy prescribing compared to guidelines alone although the effect size was relatively modest. Further work is needed to elicit the factors that were active in changing prescribing behaviour.

Simple analytical models are developed in order to study how up-stream variations in accumulation rate and ice thickness, and horizontal convergence/ divergence of the flow influence the age and annual layer-thickness profiles in a steady-state ice sheet. Generally, a decrease/increase of the accumulation rate and an increase/decrease of the ice thickness in the up-stream direction (i.e. opposite to the flow direction) results in older/younger ice at a given depth in the ice sheet than would result if the up-stream accumulation rate and ice thickness were constant along the flow line.Convergence/divergence of the up-stream flow will decrease/increase the effect of the accumulation-rate and ice-thickness gradients, whereas convergence/divergence has no influence at all on the age and layer-thickness profiles if the up-stream accumulation rate and ice thickness are constant along the flow line.A modified column-flow model, i.e. a model for which the strain-rate profile (or, equivalently, the horizontal velocity profile) is constant down to the depth corresponding to the Holocene/Wisconsinan transition 10 750 year BP., seems to work well for dating the ice back to 10 000–11 000 year B P. at sites in the slope regions of the Greenland ice sheet. For example, the model predicts the experimentally determined age profile at Dye 3 on the south Greenland ice sheet with a relative root-mean-square error of only 3% back toc. 10 700 year B.P. As illustrated by the Milcent location on the western slope of the central Greenland ice sheet, neglecting up-stream accumulation-rate and ice-thickness gradients, may lead to dating errors as large as 3000–000 years forc. 10 000 year old ice.However, even if these gradients are taken into account, the simple model fails to give acceptable ages for 10 000 year old ice at locations on slightly sloping ice ridges with strongly divergent flow, as for example the Camp Century location. The main reason for this failure is that the site of origin of the ice cannot be determined accurately enough by the simple models, if the flow is strongly divergent.With this exception, the simple models are well suited for dating the ice at locations where the available data or the required accuracy do not justify application of elaborate numerical models. The formulae derived for the age-depth profiles can easily be worked out on a pocket calculator, and in many cases will be a sensible alternative to using numerical flow models.

Infiltration characteristics of frozen soils are of prime interest for a variety of concerns, including water conservation, runoff, flooding, and erosion. Although frozen soil infiltration is typically not associated with irrigation practices, winter and spring irrigation in northern and north-western China is conducted mostly during the freeze-thaw period when water is available. The shortage of water resources is an important factor affecting and restricting development of crop and livestock in northern and northwestern parts of China. Therefore, improving irrigation efficiency and determining irrigation parameters have become key problems for agricultural management. This paper examines the infiltration characteristics during different freeze-thaw stages through the winter based on water infiltration in a green bean standing stubble field. The variation in 90-minute cumulative infiltration capacity and final infiltration rate were examined for the transient freeze-thaw stage, the steady freezing stage, and the thawing stage. Results showed that during the transient freezing stage, the effect of the frozen layer on infiltration characteristics was limited only at the beginning of infiltration. During the steady freezing stage, cumulative infiltration and final infiltration rates decreased as soil frost depth increased. During the thawing stage, cumulative infiltration and final infiltration rates increased with the increase in thaw depth. The exchanges of water and heat between surface soil and atmosphere and the phase change of soil water were the main reasons for the variation in infiltration characteristics. Results from this study have practical significance for directing the winter and spring irrigation in seasonally frozen soil areas and also have hydrologic implications for predicting runoff and flooding associated with rainfall and snowmelt on frozen soil.