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We propose and implement an interpretable machine learning classification model for Explainable AI (XAI) based on expressive Boolean formulas. Potential applications include credit scoring and diagnosis of medical conditions. The Boolean formula defines a rule with tunable complexity (or interpretability) according to which input data are classified. Such a formula can include any operator that can be applied to one or more Boolean variables, thus providing higher expressivity compared to more rigid rule- and tree-based approaches. The classifier is trained using native local optimization techniques, efficiently searching the space of feasible formulas. Shallow rules can be determined by fast Integer Linear Programming (ILP) or Quadratic Unconstrained Binary Optimization (QUBO) solvers, potentially powered by special-purpose hardware or quantum devices. We combine the expressivity and efficiency of the native local optimizer with the fast operation of these devices by executing non-local moves that optimize over the subtrees of the full Boolean formula. We provide extensive numerical benchmarking results featuring several baselines on well-known public datasets. Based on the results, we find that the native local rule classifier is generally competitive with the other classifiers. The addition of non-local moves achieves similar results with fewer iterations. Therefore, using specialized or quantum hardware could lead to a significant speedup through the rapid proposal of non-local moves.

Background There is uncertainty about factors associated with involuntary in-patient psychiatric care. Understanding these factors would help in reducing coercion in psychiatry. Aims To explore variables associated with involuntary care in the largest database of involuntary admissions published. Method We identified 166 102 public mental health hospital admissions over 5 years in New South Wales, Australia. Demographic, clinical and episode-of-care variables were examined in an exploratory, multivariable logistic regression. Results A total of 54% of eligible admissions included involuntary care. The strongest associations with involuntary care were referral from the legal system (odds ratio 4.98, 95% CI 4.61–5.38), and psychosis (odds ratio 4.48, 95% CI 4.31–4.64) or organic mental disorder (odds ratio 4.40, 95% CI 3.85–5.03). There were moderately strong associations between involuntary treatment and substance use disorder (odds ratio 2.68, 95% CI 2.56–2.81) or affective disorder (odds ratio 2.06, 95% CI 1.99–2.14); comorbid cannabis and amphetamine use disorders (odds ratio 1.65, 95% CI 1.57–1.74); unmarried status (odds ratio 1.62, 95% CI 1.49–1.76) and being born in Asia (odds ratio 1.42, 95% CI 1.35–1.50), Africa or the Middle East (odds ratio 1.32, 95% CI 1.24–1.40). Involuntary care was less likely for people aged >75 years (odds ratio 0.68, 95% CI 0.62–0.74), with comorbid personality disorder (odds ratio 0.90, 95% CI 0.87–0.94) or with private health insurance (odds ratio 0.89, 95% CI 0.86–0.93). Conclusions This research strengthens the evidence linking diagnostic, socioeconomic and cultural factors to involuntary treatment. Targeted interventions are needed to reduce involuntary admissions in disadvantaged groups.

Introduction This paper will describe the research protocol for the Deadly Aboriginal and Torres Strait Islander Nursing and Midwifery Mentoring (DANMM) Project, which will determine the feasibility and acceptability of a cultural mentoring programme designed for Aboriginal and Torres Strait Islander nurses and midwives across five diverse local health districts in New South Wales, Australia. Government and health agencies highlight the importance of culturally appropriate and safe environments for Aboriginal people. Specifically, New South Wales Health prioritises workforce strategies that support Aboriginal people to enter and stay in the health workforce. However, retaining Aboriginal nurses and midwives remains challenging. The DANMM Project aligns with these local and state-wide health plans and strategies, addressing critical issues of workforce cultural safety and retention.Methods and analysis A mixed-methods study design will be employed to assess feasibility, acceptability and preliminary efficacy of the DANMM Programme across five publicly funded local health districts in New South Wales, Australia. Adhering to cultural safety, a project cultural governance group will be formed. Quantitative outcome measures include the use of questionnaires (Nursing Workplace Satisfaction Questionnaire, Ganngaleh nga Yagaleh Cultural Safety assessment tool). Resource implications will be measured using the Organisational Commitment and Health Professional Program Readiness Assessment Compass. These will be triangulated with individual and group yarning circles to provide a holistic evaluation of the programme.Ethics and dissemination The study has ethics approval: Aboriginal Health and Medical Research Council (#2054/23); New South Wales Health Human Research Committees (Greater Western Human Research Committee #2022/ETH01971, Murrumbidgee—site-specific approval, Sydney Local Health District—site-specific approval, Western Sydney Local Health District—site-specific approval and Mid North Coast—site-specific approval); and Charles Sturt University Human Research Committee (#2054/23). Findings will be disseminated through peer-reviewed articles, conferences and through roundtable discussions with key stakeholders.

Abstract Background The distribution of the duration that clinical cases of COVID-19 occupy hospital beds (the ‘length of stay’) is a key factor in determining how incident caseloads translate into health system burden. Robust estimation of length of stay in real-time requires the use of survival methods that can account for right-censoring induced by yet unobserved events in patient progression (e.g. discharge, death). In this study, we estimate in real-time the length of stay distributions of hospitalised COVID-19 cases in New South Wales, Australia, comparing estimates between a period where Delta was the dominant variant and a subsequent period where Omicron was dominant. Methods Using data on the hospital stays of 19,574 individuals who tested positive to COVID-19 prior to admission, we performed a competing-risk survival analysis of COVID-19 clinical progression. Results During the mixed Omicron-Delta epidemic, we found that the mean length of stay for individuals who were discharged directly from ward without an ICU stay was, for age groups 0–39, 40–69 and 70 +, respectively, 2.16 (95% CI: 2.12–2.21), 3.93 (95% CI: 3.78–4.07) and 7.61 days (95% CI: 7.31–8.01), compared to 3.60 (95% CI: 3.48–3.81), 5.78 (95% CI: 5.59–5.99) and 12.31 days (95% CI: 11.75–12.95) across the preceding Delta epidemic (1 July 2021–15 December 2021). We also considered data on the stays of individuals within the Hunter New England Local Health District, where it was reported that Omicron was the only circulating variant, and found mean ward-to-discharge length of stays of 2.05 (95% CI: 1.80–2.30), 2.92 (95% CI: 2.50–3.67) and 6.02 days (95% CI: 4.91–7.01) for the same age groups. Conclusions Hospital length of stay was substantially reduced across all clinical pathways during a mixed Omicron-Delta epidemic compared to a prior Delta epidemic, contributing to a lessened health system burden despite a greatly increased infection burden. Our results demonstrate the utility of survival analysis in producing real-time estimates of hospital length of stay for assisting in situational assessment and planning of the COVID-19 response.

Rydberg atom arrays are among the leading contenders for the demonstration of quantum speedups. Motivated by recent experiments with up to 289 qubits [Ebadi et al., Science 376, 1209 (2022)0036-807510.1126/science.abo6587], we study the maximum-independent-set problem on unit-disk graphs with a broader range of classical solvers beyond the scope of the original paper. We carry out extensive numerical studies and assess problem hardness, using both exact and heuristic algorithms. We find that quasiplanar instances with Union-Jack-like connectivity can be solved to optimality for up to thousands of nodes within minutes, with both custom and generic commercial solvers on commodity hardware, without any instance-specific fine-tuning. We also perform a scaling analysis, showing that by relaxing the constraints on the classical simulated annealing algorithms considered in Ebadi et al., our implementation is competitive with the quantum algorithms. Conversely, instances with larger connectivity or less structure are shown to display a time-to-solution potentially orders of magnitudes larger. Based on these results, we propose protocols to systematically tune problem hardness, motivating experiments with Rydberg atom arrays on instances orders of magnitude harder (for established classical solvers) than previously studied.

We study quantum interior-point methods (QIPMs) for second-order cone programming (SOCP), guided by the example use case of portfolio optimization (PO). We provide a complete quantum circuit-level description of the algorithm from problem input to problem output, making several improvements to the implementation of the QIPM. We report the number of logical qubits and the quantity and/or depth of non-Clifford T gates needed to run the algorithm, including constant factors. The resource counts we find depend on instance-specific parameters, such as the condition number of certain linear systems within the problem. To determine the size of these parameters, we perform numerical simulations of small PO instances, which lead to concrete resource estimates for the PO use case. Our numerical results do not probe large enough instance sizes to make conclusive statements about the asymptotic scaling of the algorithm. However, already at small instance sizes, our analysis suggests that, due primarily to large constant prefactors, poorly conditioned linear systems, and a fundamental reliance on costly quantum state tomography, fundamental improvements to the QIPM are required for it to lead to practical quantum advantage.

We provide a modular circuit-level implementation and resource estimates for several methods of block-encoding a dense $N\times N$ matrix of classical data to precision $\epsilon$; the minimal-depth method achieves a $T$-depth of $\mathcal {O}(\log (N/\epsilon)),$ while the minimal-count method achieves a $T$-count of $\mathcal{O} (N \log(\log(N)/\epsilon))$. We examine resource tradeoffs between the different approaches, and we explore implementations of two separate models of quantum random access memory. As a part of this analysis, we provide a novel state preparation routine with $T$-depth $\mathcal {O}(\log (N/\epsilon))$, improving on previous constructions with scaling $\mathcal {O}(\log ^{2} (N/\epsilon))$. Our results go beyond simple query complexity and provide a clear picture into the resource costs when large amounts of classical data are assumed to be accessible to quantum algorithms.

BackgroundAn association exists between psychosis and criminal offending, which evidence suggests can be reduced by effective mental health care for this vulnerable population. However mental health services often lose contact with people after diagnosis. The association between the first episode of psychosis and criminal offending highlights the need for effective mental health care for this vulnerable population.AimsTo investigate the association between the first diagnosis of psychosis (FDP) in prison or hospital and subsequent mental health service contact following release from prison or discharge from hospital.Materials and methodsIndividuals with a FDP either in prison (n = 492) or hospital setting (n = 24,910) between July 2006 and December 2011 in NSW (Australia), were followed post-release or discharge until their first mental health service contact in the community, the occurrence of an offence, death, or completion of the study period at the end of December 2012. Cox regression models were used to examine the predictors for the mental health service contacts following release or discharge.ResultsOver 70% of those with a FDP in prison or hospital had a psychosis-related or any community-based mental health service contact following release or discharge between July 2006 and December 2012. Those with a FDP in prison were more likely to have no contact with mental health services than those in hospital with no prior offence record (hazard ratio, HR = 3.14, 95% CI: 2.66–3.72 and adjusted hazard ratio, aHR = 3.05, 95% CI: 2.56–3.63) within a median follow-up time of 25 days for the prison group and 26 days for hospital group. Males, individuals of Aboriginal heritage and individuals diagnosed with substance-related psychoses compared to those with schizophrenia and related psychoses were less likely to have a mental health service contact following release or discharge in both the univariable and multivariable analysis.ConclusionThis study suggests that prior offending or a previous prison episode represents a barrier to mental health service contact in the community for those with a FDP. Effective rehabilitation planning while exiting prison and discharge planning from hospital are essential to the successful reintegration of these individuals with a FDP.

Summary: Background: Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally. Methods: We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age- and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation. Findings: We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries’ COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries’ income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well. Interpretation: Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue. Funding: None.

Abstract Background Despite increasing investment in suicide prevention, Australian suicide rates have increased steadily in the past decade. In response to growing evidence for multicomponent intervention models for reducing suicide, the LifeSpan model has been developed as the first multicomponent, evidence-based, system-wide approach to suicide prevention in Australia. The LifeSpan model consists of nine evidence-based strategies. These include indicated, selective and universal interventions which are delivered simultaneously to community and healthcare systems over a 2-year implementation period. This study will evaluate the effectiveness of the LifeSpan model in reducing suicide attempts and suicide deaths in four geographically defined regions in New South Wales, Australia. Methods We outline the protocol for a stepped-wedge, cluster randomized controlled trial. Following a 6-month transition phase, the trial sites will move to the 2-year active implementation phase in 4-monthly intervals with evaluation extending a minimum of 24 months after establishment of the full active period. Analysis will be undertaken of the change attributable to the invention across the four sites. The primary outcome for the study is the rate of attempted suicide in the regions involved. Rate of suicide deaths within each site is a secondary outcome. Discussion If proven effective, the LifeSpan model for suicide prevention could be more widely delivered in Australian communities, providing a valuable new approach to tackle rising suicide rates. LifeSpan has the potential to significantly contribute to the mental health of Australians by improving help-seeking for suicide, facilitating early detection, and improving aftercare to reduce re-attempts. The findings from this research should also contribute to the evidence base for multilevel suicide prevention programs internationally. Trial registration Australia New Zealand Clinical Trials Register, ID: ACTRN12617000457347 . Prospectively registered on 28 March 2017. https://www.anzctr.org.au/TrialSearch.aspx#&&conditionCode=&dateOfRegistrationFrom=&interventionDescription=&interventionCodeOperator=OR&primarySponsorType=&gender=&distance=&postcode=&pageSize=20&ageGroup=&recruitmentCountryOperator=OR Protocol Version: 1.0, 31 May 2019.

COVID-19 has increased the need for mental health care but disrupted its delivery. We examined impacts of the first year of the COVID-19 pandemic on consumer experience of NSW hospital and community mental health services, compared to their pre-COVID baseline. We also examined whether increased telehealth use was associated with changes in the quantity or experience of community mental health care. Data were 73,488 Your Experience of Service (YES) surveys from state mental health services in New South Wales (NSW), Australia, grouped into three periods: pre-COVID (January 2018 to March 2020), early-COVID (April to June 2020) and stable-COVID (July to December 2020). Experience scores were compared using mixed effects ordinal logistic regression. Supplementary questions on telehealth and community care (n=621) were examined by multinomial logistic regression. Experience scores improved significantly during the early-COVID period for community consumers and during the stable-COVID period for hospital consumers. Of community clients, 78% received some or all care by telehealth. Positive experience was more likely when most or all care was by telehealth and the amount of care increased. A reduced quantity of care, regardless of care modality, was the strongest predictor of worse experience. Increased service provision and telehealth support were well received over the first year of the pandemic. When contact hours are reduced due to COVID-19 risk mitigation strategies, it is vital to provide alternative methods of care such as telephone, or internet support, rather than just reducing face to face contact hours. Experience Framework This article is associated with the Quality & Clinical Excellence lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens.

With the long-term goal of studying models of quantum gravity in the lab, we propose holographic teleportation protocols that can be readily executed in table-top experiments. These protocols exhibit similar behavior to that seen in the recent traversable-wormhole constructions of Gao et al. [J. High Energy Phys., 2017, 151 (2017)] and Maldacena et al. [Fortschr. Phys., 65, 1700034 (2017)]: information that is scrambled into one half of an entangled system will, following a weak coupling between the two halves, unscramble into the other half. We introduce the concept of teleportation by size to capture how the physics of operator-size growth naturally leads to information transmission. The transmission of a signal through a semiclassical holographic wormhole corresponds to a rather special property of the operator-size distribution that we call size winding. For more general systems (which may not have a clean emergent geometry), we argue that imperfect size winding is a generalization of the traversable-wormhole phenomenon. In addition, a form of signaling continues to function at high temperature and at large times for generic chaotic systems, even though it does not correspond to a signal going through a geometrical wormhole but, rather, to an interference effect involving macroscopically different emergent geometries. Finally, we outline implementations that are feasible with current technology in two experimental platforms: Rydberg-atom arrays and trapped ions.

In Brown et al. [PRX Quantum, 4, 010321 (2023)], we discuss how holographic quantum gravity may be simulated using quantum devices and we give a specific proposal—teleportation by size and the phenomenon of size winding. Here, we elaborate on what it means to do quantum gravity in the lab and how size winding connects to bulk gravitational physics and traversable wormholes. Perfect size winding is a remarkable fine-grained property of the size wave function of an operator; we show from a bulk calculation that this property must hold for quantum systems with a nearly AdS_{2} bulk. We then examine in detail teleportation by size in three systems—the Sachdev-Ye-Kitaev model, random matrices, and spin chains—and discuss prospects for realizing these phenomena in near-term quantum devices.

BackgroundThe success of electronic medical records (EMRs) is dependent on implementation features, such as usability and fit with clinical processes. The use of EMRs in mental health settings brings additional and specific challenges owing to the personal, detailed, narrative, and exploratory nature of the assessment, diagnosis, and treatment in this field. Understanding the determinants of successful EMR implementation is imperative to guide the future design, implementation, and investment of EMRs in the mental health field. ObjectiveWe intended to explore evidence on effective EMR implementation for mental health settings and provide recommendations to support the design, adoption, usability, and outcomes. MethodsThe scoping review combined two search strategies that focused on clinician-facing EMRs, one for primary studies in mental health settings and one for reviews of peer-reviewed literature in any health setting. Three databases (Medline, EMBASE, and PsycINFO) were searched from January 2010 to June 2020 using keywords to describe EMRs, settings, and impacts. The Proctor framework for implementation outcomes was used to guide data extraction and synthesis. Constructs in this framework include adoption, acceptability, appropriateness, feasibility, fidelity, cost, penetration, and sustainability. Quality assessment was conducted using a modified Hawker appraisal tool and the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. ResultsThis review included 23 studies, namely 12 primary studies in mental health settings and 11 reviews. Overall, the results suggested that adoption of EMRs was impacted by financial, technical, and organizational factors, as well as clinician perceptions of appropriateness and acceptability. EMRs were perceived as acceptable and appropriate by clinicians if the system did not interrupt workflow and improved documentation completeness and accuracy. Clinicians were more likely to value EMRs if they supported quality of care, were fit for purpose, did not interfere with the clinician-patient relationship, and were operated with readily available technical support. Evidence on the feasibility of the implemented EMRs was mixed; the primary studies and reviews found mixed impacts on documentation quality and time; one primary study found downward trends in adverse events, whereas a review found improvements in care quality. Five papers provided information on implementation outcomes such as cost and fidelity, and none reported on the penetration and sustainability of EMRs. ConclusionsThe body of evidence relating to EMR implementation in mental health settings is limited. Implementation of EMRs could benefit from methods used in general health settings such as co-designing the software and tailoring EMRs to clinical needs and workflows to improve usability and acceptance. Studies in mental health and general health settings rarely focused on long-term implementation outcomes such as penetration and sustainability. Future evaluations of EMRs in all settings should consider long-term impacts to address current knowledge gaps.

Abstract At the heart of recent progress in AdS/CFT is the question of subregion duality, or entanglement wedge reconstruction: which part(s) of the boundary CFT are dual to a given subregion of the bulk? This question can be answered by appealing to the quantum error correcting properties of holography, and it was recently shown that robust bulk (entanglement wedge) reconstruction can be achieved using a universal recovery channel known as the twirled Petz map. In short, one can use the twirled Petz map to recover bulk data from a subset of the boundary. However, this map involves an averaging procedure over bulk and boundary modular time, and hence it can be somewhat intractable to evaluate in practice. We show that a much simpler channel, the Petz map, is sufficient for entanglement wedge reconstruction for any code space of fixed finite dimension — no twirling is required. Moreover, the error in the reconstruction will always be non-perturbatively small. From a quantum information perspective, we prove a general theorem extending the use of the Petz map as a general-purpose recovery channel to subsystem and operator algebra quantum error correction.

Background: The use of amphetamines is a global public health concern. We summarise global data on use of amphetamines and mental health outcomes. Methods: A systematic review and meta-analysis (CRD 42017081893). We searched Medline, EMBASE, PsycInfo for methamphetamine or amphetamine combined with psychosis, violence, suicidality, depression or anxiety. Included studies were human empirical cross-sectional surveys, case-control studies, cohort studies and randomised controlled trials that assessed the association between methamphetamine and one of the mental health outcomes. Random effects meta-analysis was used to pool results for any use of amphetamines and amphetamine use disorders. Findings: 149 studies were eligible and 59 were included in meta-analyses. There was significant heterogeneity in effects. Evidence came mostly from cross-sectional studies. Any use of amphetamines was associated with higher odds of psychosis (odds ratio [OR] = 2.0, 95%CI 1.3–3.3), violence (OR = 2.2, 95%CI 1.2–4.1; adjusted OR [AOR] = 1.4, 95%CI 0.8–2.4), suicidality OR = 4.4, 95%CI 2.4–8.2; AOR = 1.7, 95%CI 1.0–2.9) and depression (OR = 1.6, 95%CI 1.1–2.2; AOR = 1.3, 95%CI 1.2–1.4). Having an amphetamine use disorder was associated with higher odds of psychosis (OR = 3.0, 95%CI 1.9–4.8; AOR = 2.4, 95%CI 1.6–3.5), violence (OR = 6.2, 95%CI 3.1–12.3), and suicidality (OR = 2.3, 95%CI 1.8–2.9; AOR = 1.5, 95%CI 1.3–1.8). Interpretation: Methamphetamine use is an important risk factor for poor mental health. High quality population-level studies are needed to more accurately quantify this risk. Clinical responses to methamphetamine use need to address mental health harms. Keywords: Amphetamines, Anxiety, Depression, Mental health, Methamphetamine, Psychosis, Substance use, Suicidality, Violence

Introduction Colorectal cancer (CRC) mortality is significantly higher in those with severe mental illness (SMI) compared with the general population, despite similar incidence rates, suggesting that barriers to optimal screening and cancer care may contribute to disparities in CRC mortality in those with SMI. This study aims to compare participation in Australia’s National Bowel Cancer Screening Programme (NBCSP) in those with SMI and those in the general population. We will also investigate treatment pathways after diagnosis to determine whether treatment variations could explain differences in CRC mortality.Methods and analysis We will undertake a retrospective cohort study of Australians using linked administrative data to assess differences in screening and cancer care between those with and without SMI, aged 50–74 years on or after 1 January 2006. People with SMI will be defined using antipsychotic medication prescription data. The comparison group will be people enrolled in Medicare (Australia’s universal healthcare system) who have not been prescribed antipsychotic medication. Data on outcomes (NBCSP participation, follow-up colonoscopy, CRC incidence and CRC-cause and all-cause mortality) and confounders will be obtained from national-based and state-based administrative health datasets. All people in New South Wales, aged 50–74 with a new diagnosis of CRC on or after 1 January 2006, will be ascertained to examine stage at diagnosis and cancer treatment in those with and without SMI. Poisson regression will be used to calculate incidence rates and rate ratios for each outcome.Ethics and dissemination Ethics approval has been obtained from the University of Queensland Human Research Ethics Committee, the Australian Institute of Health and Welfare Ethics Committee and data custodians from every Australian State/Territory. Findings will be disseminated via publications in peer-reviewed journals and presented at appropriate conferences.Trial registration number ACTRN12620000781943.

Objective: COVID-19 has left no healthcare system untouched. In New South Wales (NSW), the most populous state in Australia, COVID-19 case numbers have to date been relatively low. However, that does not mean the state’s healthcare system has been unaffected. Preparations to create sufficient capacity to accommodate a COVID-19 surge resulted in widespread deferment of scheduled medical procedures and appointments. Patterns of healthcare-seeking behaviour changed, with a reluctance to visit healthcare settings. The aim of this study was to quantify the changes in activity seen in the NSW health system in the first half of 2020. Methods: Healthcare data were drawn from multiple sources, including primary care, ambulance, emergency departments and inpatient settings. Volumes of healthcare activity in 2020, overall, by urgency of cases and by reasons for care were compared with the figures for the same period in 2019. Changes in the modality of care provision were also examined. Results: In March to June 2020, compared with the same period in 2019, primary care face-to-face consultations decreased by 22.1%, breast screening activity by 51.5%, ambulance incidents by 7.2%, emergency department visits by 13.9%, public hospital inpatient episodes by 14.3%, and public hospital planned surgical activity by 32.6%. Conclusion: There were substantial declines in a wide range of healthcare activities across the NSW health system between March and June 2020 due to the impact of the COVID-19 pandemic. Although activity levels were recovering by September 2020, they had not yet returned to ‘normal’. The implications of these changes – and the indirect impact of COVID-19 – require further study.

Introduction Cancer deaths are a major contributor to premature mortality in people with mental health conditions. Some cancers occur more often in people with mental health conditions because of increased risk factors. However, most premature cancer mortality in people with mental health conditions arises from increased cancer case fatality rates due to health care related factors. While there is substantial evidence that a problem exists, further evidence is needed to support effective action and the translation of research findings into better policy, services and care. Objectives and Approach The NSW Mental Health Living Longer program involves population-wide data linkage that combines records from nine NSW data collections. Our collection includes over 120 million records for more than nine million people. This presentation focuses on the use of linked data to develop indicators to support reporting on premature breast and cervical cancer mortality for women living with mental illness. These indicators will be used to identify variation in care, assess areas for targeted intervention, and evaluate the effectiveness of research translation into more effective care. Results This work is ongoing and will be finalised by August 2020. We will use regression techniques to examine predictors of participation in breast and cervical cancer screening for women who use mental health services in NSW. These results will be used to assess geographical variation in risk-adjusted screening participation rates. We will also present methods and results for measuring incidence and stage at presentation, as well as 5 year survival for women who use mental health services in NSW. Conclusion / Implications If cancer survival is a key measure of the effectiveness of healthcare systems, then reduced survival in people with mental health problems reflects less effective health care. Improving screening and treatment services is likely to be the most important strategy for reducing the cancer mortality gap for women with mental illness.

Objectives: Despite the tremendous growth of peripheral nerve blocks, no standard format exists to document their performance. Our objective was to create a peripheral nerve block form based on key elements of literature evidence and on our own group consensus.Results: We describe the process and results of our multi-institutional effort to construct a standardized peripheral nerve block procedure form.Conclusion: A form was developed to help meet the medical, legal, and billing requirements of documentation consistent with the performance of peripheral nerve block. [ABSTRACT FROM AUTHOR]

Introduction Surgery (oesophagectomy), with neoadjuvant chemo(radio)therapy, is the main curative treatment for patients with oesophageal cancer. Several surgical approaches can be used to remove an oesophageal tumour. The Ivor Lewis (two-phase procedure) is usually used in the UK. This can be performed as an open oesophagectomy (OO), a laparoscopically assisted oesophagectomy (LAO) or a totally minimally invasive oesophagectomy (TMIO). All three are performed in the National Health Service, with LAO and OO the most common. However, there is limited evidence about which surgical approach is best for patients in terms of survival and postoperative health-related quality of life.Methods and analysis We will undertake a UK multicentre randomised controlled trial to compare LAO with OO in adult patients with oesophageal cancer. The primary outcome is patient-reported physical function at 3 and 6 weeks postoperatively and 3 months after randomisation. Secondary outcomes include: postoperative complications, survival, disease recurrence, other measures of quality of life, spirometry, success of patient blinding and quality assurance measures. A cost-effectiveness analysis will be performed comparing LAO with OO. We will embed a randomised substudy to evaluate the safety and evolution of the TMIO procedure and a qualitative recruitment intervention to optimise patient recruitment. We will analyse the primary outcome using a multi-level regression model. Patients will be monitored for up to 3 years after their surgery.Ethics and dissemination This study received ethical approval from the South-West Franchay Research Ethics Committee. We will submit the results for publication in a peer-reviewed journal.Trial registration number ISRCTN10386621.

Purpose Health systems must move from recognition to action if we are to address premature mortality in people with mental illness. Population data registers are an essential tool for planning and monitoring improvement efforts. The Mental Health Living Longer (MHLL) programme establishes a population-wide data linkage to support research translation and service reform in New South Wales (NSW), Australia.Participants A total of 8.6 million people who have had contact with NSW public and private health services between July 2001 and June 2018 are currently included in the study. Data include more than 120 million linked records from NSW data collections covering public and private hospital care, emergency departments, ambulance, community mental health services, cancer notifications and care, and death registrations. Linkage is occurring with population-wide breast and cervical cancer screening programmes. Data will be updated 6 monthly.Findings to date The cohort includes 970 145 people who have received mental healthcare: 79% have received community mental healthcare, 35% a general hospital admission with a primary mental health diagnosis and 25% have received specialist mental health inpatient care. The most frequent pattern of care is receipt of community mental healthcare only (50%). The median age of the mental health cohort is 34 years, and three-quarters are younger than 53 years. Eleven per cent of the mental health cohort had died during the observation period. Their median age at death was 69 years, which was younger than the median age at death for people accessing other health services.Future plans The MHLL programme will examine (i) all-cause mortality, (ii) suicide, (iii) cancer mortality and (iv) medical mortality. Within each theme, the programme will quantify the problem in mental health service users compared with the NSW population, describe the people most affected, describe the care received, identify predictors of premature mortality, and identify variation and opportunities for change.

BackgroundPsychosis is more prevalent among people in prison compared with the community. Early detection is important to optimise health and justice outcomes; for some, this may be the first time they have been clinically assessed.AimsDetermine factors associated with a first diagnosis of psychosis in prison and describe time to diagnosis from entry into prison.MethodThis retrospective cohort study describes individuals identified for the first time with psychosis in New South Wales (NSW) prisons (2006–2012). Logistic regression was used to identify factors associated with a first diagnosis of psychosis. Cox regression was used to describe time to diagnosis from entry into prison.ResultsOf the 38 489 diagnosed with psychosis for the first time, 1.7% (n = 659) occurred in prison. Factors associated with an increased likelihood of being diagnosed in prison (versus community) were: male gender (odds ratio (OR) = 2.27, 95% CI 1.79–2.89), Aboriginality (OR = 1.81, 95% CI 1.49–2.19), older age (OR = 1.70, 95% CI 1.37–2.11 for 25–34 years and OR = 1.63, 95% CI 1.29–2.06 for 35–44 years) and disadvantaged socioeconomic area (OR = 4.41, 95% CI 3.42–5.69). Eight out of ten were diagnosed within 3 months of reception.ConclusionsAmong those diagnosed with psychosis for the first time, only a small number were identified during incarceration with most identified in the first 3 months following imprisonment. This suggests good screening processes are in place in NSW prisons for detecting those with serious mental illness. It is important these individuals receive appropriate care in prison, have the opportunity to have matters reheard and possibly diverted into treatment, and are subsequently connected to community mental health services on release.Declaration of interestNone.

Purpose People with intellectual disability (ID) experience high rates of physical and mental health problems, while access to appropriate healthcare is often poor. This cohort was established to develop an epidemiological profile related to the health, health service use, disability services, mortality and corrective services records of people with ID.Participants The cohort contains 92 542 people with ID (40% females) with a median age of 23 years (IQR: 12–43 years) and 2 004 475 people with a neuropsychiatric or developmental disorder diagnosis (50% females) with a median age of 51 years (IQR: 29–73 years) from New South Wales, Australia. The whole sample contains records for 2 097 017 individuals with most data sets spanning financial years 1 July 2001 to 30 June 2016. A wide range of data from linked population data sets are included in the areas of disability, health, corrective services and targeted specialist support services in public schools, Public Guardian and Ombudsman services.Findings to date This study includes one of the largest cohorts of people with ID internationally. Our data have shown that the presence of ID is significantly associated with emergency department presentations and psychiatric readmissions after the first psychiatric admission based on a subcohort of people with a psychiatric admission. Adults with ID experience premature mortality and over-representation of potentially avoidable deaths compared with the general population.Future plans Within the health service system, we will examine different components, that is, inpatient, emergency adult services, children and younger people services and costs associated with healthcare as well as mortality, cause and predictors of death. The neuropsychiatric and developmental disorders comparison cohort allows comparisons of the physical health, mental health and service use profiles of people with ID and those with other neuropsychiatric disorders.

The existence of quantum error-correcting codes is one of the most counterintuitive and potentially technologically important discoveries of quantum-information theory. In this paper, we study a problem called “covariant quantum error correction”, in which the encoding is required to be group covariant. This problem is intimately tied to fault-tolerant quantum computation and the well-known Eastin-Knill theorem. We show that this problem is equivalent to the problem of encoding reference-frame information. In standard quantum error correction, one seeks to protect abstract quantum information, i.e., information that is independent of the physical incarnation of the systems used for storing the information. There are, however, other forms of information that are physical—one of the most ubiquitous being reference-frame information. The basic question we seek to answer is whether or not error correction of physical information is possible and, if so, what limitations govern the process. The main challenge is that the systems used for transmitting physical information, in addition to any actions applied to them, must necessarily obey these limitations. Encoding and decoding operations that obey a restrictive set of limitations need not exist a priori. Equivalently, there may not exist covariant quantum error-correcting codes. Indeed, we prove a no-go theorem showing that no finite-dimensional, group-covariant quantum codes exist for Lie groups with an infinitesimal generator [e.g., U(1), SU(2), and SO(3)]. We then explain how one can circumvent this no-go theorem using infinite-dimensional codes, and we give an explicit example of a covariant quantum error-correcting code using continuous variables for the group U(1). Finally, we demonstrate that all finite groups have finite-dimensional codes, giving both an explicit construction and a randomized approximate construction with exponentially better parameters. Our results imply that one can, in principle, circumvent the Eastin-Knill theorem.

Quantum error correction and symmetry arise in many areas of physics, including many-body systems, metrology in the presence of noise, fault-tolerant computation, and holographic quantum gravity. Here, we study the compatibility of these two important principles. If a logical quantum system is encoded into n physical subsystems, we say that the code is covariant with respect to a symmetry group G if a G transformation on the logical system can be realized by performing transformations on the individual subsystems. For a G-covariant code with G a continuous group, we derive a lower bound on the error-correction infidelity following erasure of a subsystem. This bound approaches zero when the number of subsystems n or the dimension d of each subsystem is large. We exhibit codes achieving approximately the same scaling of infidelity with n or d as the lower bound. Leveraging tools from representation theory, we prove an approximate version of the Eastin-Knill theorem for quantum computation: If a code admits a universal set of transversal gates and corrects erasure with fixed accuracy, then, for each logical qubit, we need a number of physical qubits per subsystem that is inversely proportional to the error parameter. We construct codes covariant with respect to the full logical unitary group, achieving good accuracy for large d (using random codes) or n (using codes based on W states). We systematically construct codes covariant with respect to general groups, obtaining natural generalizations of qubit codes to, for instance, oscillators and rotors. In the context of the AdS/CFT correspondence, our approach provides insight into how time evolution in the bulk corresponds to time evolution on the boundary without violating the Eastin-Knill theorem, and our five-rotor code can be stacked to form a covariant holographic code.

BackgroundWith significant numbers of individuals in the criminal justice system having mental health problems, court-based diversion programmes and liaison services have been established to address this problem.AimsTo examine the effectiveness of the New South Wales (Australia) court diversion programme in reducing re-offending among those diagnosed with psychosis by comparing the treatment order group with a comparison group who received a punitive sanction.MethodThose with psychoses were identified from New South Wales Ministry of Health records between 2001 and 2012 and linked to offending records. Cox regression models were used to identify factors associated with re-offending.ResultsA total of 7743 individuals were identified as diagnosed with a psychotic disorder prior to their court finalisation date for their first principal offence. Overall, 26% of the cohort received a treatment order and 74% received a punitive sanction. The re-offending rate in the treatment order group was 12% lower than the punitive sanction group. ‘Acts intended to cause injury’ was the most common type of the first principal offence for the treatment order group compared with the punitive sanction group (48% v. 27%). Drug-related offences were more likely to be punished with a punitive sanction than a treatment order (12% v. 2%).ConclusionsAmong those with a serious mental illness (i.e. psychosis), receiving a treatment order by the court rather than a punitive sanction was associated with reduced risk for subsequent offending. We further examined actual mental health treatment received and found that receiving no treatment following the first offence was associated with an increased risk of re-offending and, so, highlighting the importance of treatment for those with serious mental illness in the criminal justice system.

This paper examines the perceptions of practitioners of the new directions taken by NZICA with respect to its academic and professional programme requirements to obtain CA Institute membership. The “future viability of any professional body is dependent on continuously attracting new members, ideally the best and the brightest new tertiary graduates”, and this is “undoubtedly the case for New Zealand’s professional accounting body, the New Zealand Institute of Chartered Accountants (NZICA)” (Malthus & Fowler 2009, p. 26). In this study, the concurrent triangulation approach to mixed methods described by Creswell (2009) was used to collect data. This approach enabled the results of the two quantitative and qualitative databases to be integrated and compared. It was found that accounting practitioners felt the changes made by NZICA may devalue the brand, while the reduction in liberal papers would result in a narrower degree. Overall, accounting practitioners agreed that three to four years of tertiary accounting education was adequate, a broader four-year course would result in a better-rounded graduates. The reduction in the length of the tertiary programme caused concern that future graduates would be less mature. Accounting practitioners also felt that the changes would harm the credibility of NZICA internationally. However, some accounting practitioners did welcome the fact that the NZICA membership requirements will be more aligned with Institute of Chartered Accountants Australia. Accounting practitioners felt that the new technical modules would offer more flexibility. They believed that the four technical modules should repeat the material taught at university, as long as a balance was maintained between technical and practical skills. They also believed that the changes would result in an increased onus on the employer. Additionally, accounting practitioners agreed that on-the-job training should not replace a tertiary qualification in accounting. Accounting practitioners noted that on-the-job training replacing tertiary education meant that individuals who learn better through practical experience would be advantaged. However, if there was no tertiary education, then graduates would face a steep learning curve.

In the context of quantum theories of spacetime, one overarching question is how quantum information in the bulk spacetime is encoded holographically in boundary degrees of freedom. It is particularly interesting to understand the correspondence between bulk subregions and boundary subregions in order to address the emergence of locality in the bulk quantum spacetime. For the AdS/CFT correspondence, it is known that this bulk information is encoded redundantly on the boundary in the form of an error-correcting code. Having access only to a subregion of the boundary is as if part of the holographic code has been damaged by noise and rendered inaccessible. In quantum-information science, the problem of recovering information from a damaged code is addressed by the theory of universal recovery channels. We apply and extend this theory to address the problem of relating bulk and boundary subregions in AdS/CFT, focusing on a conjecture known as entanglement wedge reconstruction. Existing work relies on the exact equivalence between bulk and boundary relative entropies, but these are only approximately equal in bulk effective field theory, and in similar situations it is known that predictions from exact entropic equalities can be qualitatively incorrect. We show that the framework of universal recovery channels provides a robust demonstration of the entanglement wedge reconstruction conjecture as well as new physical insights. Most notably, we find that a bulk operator acting in a given boundary region’s entanglement wedge can be expressed as the response of the boundary region’s modular Hamiltonian to a perturbation of the bulk state in the direction of the bulk operator. This formula can be interpreted as a noncommutative version of Bayes’s rule that attempts to undo the noise induced by restricting to only a portion of the boundary. To reach these conclusions, we extend the theory of universal recovery channels to finite-dimensional operator algebras and demonstrate that recovery channels approximately preserve the multiplicative structure of the operator algebra.

This paper focuses on the posture the oil company BP adopted when faced with a legitimacy crisis during one of the worst environmental disasters in history. Against a backdrop of a discussion of the rhetorical aspects of image repair discourse and organisational legitimacy, Hearit’s strategy of corporate apologia was employed to determine the posture BP adopted in relation to the crisis. This paper adds to the literature on image repair strategies by heeding a call by Hearit for the context within which corporate apologia takes place to be taken account of, an approach that warrants a distinct line of research. The literature was further extended by complementing Hearit's strategy with semiotics and analysing its use in both the annual and sustainability reports. The additional focus on the sustainability reports is important, due to the high premium placed on sustainability in the changing business environment. On a practical level this paper contributes to an understanding of how organisations use sustainability reports to respond to legitimacy challenges.

Background: Localised oesophageal cancer can be curatively treated with surgery (oesophagectomy) but the procedure is complex with a risk of complications, negative effects on quality of life and a recovery period of 6–9 months. Minimal-access surgery may accelerate recovery. Objectives: The ROMIO (Randomised Oesophagectomy: Minimally Invasive or Open) study aimed to establish the feasibility of, and methodology for, a definitive trial comparing minimally invasive and open surgery for oesophagectomy. Objectives were to quantify the number of eligible patients in a pilot trial; develop surgical manuals as the basis for quality assurance; standardise pathological processing; establish a method to blind patients to their allocation in the first week post surgery; identify measures of postsurgical outcome of importance to patients and clinicians; and establish the main cost differences between the surgical approaches. Design: Pilot parallel three-arm randomised controlled trial nested within feasibility work. Setting: Two UK NHS departments of upper gastrointestinal surgery. Participants: Patients aged ≥ 18 years with histopathological evidence of oesophageal or oesophagogastric junctional adenocarcinoma, squamous cell cancer or high-grade dysplasia, referred for oesophagectomy or oesophagectomy following neoadjuvant chemo(radio)therapy. Interventions: Oesophagectomy, with patients randomised to open surgery, a hybrid open chest and minimally invasive abdomen or totally minimally invasive access. Main outcome measure: The primary outcome measure for the pilot trial was the number of patients recruited per month, with the main trial considered feasible if at least 2.5 patients per month were recruited. Results: During 21 months of recruitment, 263 patients were assessed for eligibility; of these, 135 (51%) were found to be eligible and 104 (77%) agreed to participate, an average of five patients per month. In total, 41 patients were allocated to open surgery, 43 to the hybrid procedure and 20 to totally minimally invasive surgery. Recruitment is continuing, allowing a seamless transition into the definitive trial. Consequently, the database is unlocked at the time of writing and data presented here are for patients recruited by 31 August 2014. Random allocation achieved a good balance between the arms of the study, which, as a high proportion of patients underwent their allocated surgery (69/79, 87%), ensured a fair comparison between the interventions. Dressing patients with large bandages, covering all possible incisions, was successful in keeping patients blind while pain was assessed during the first week post surgery. Postsurgical length of stay and risk of adverse events were within the typical range for this group of patients, with one death occurring within 30 days among 76 patients. There were good completion rates for the assessment of pain at 6 days post surgery (88%) and of the patient-reported outcomes at 6 weeks post randomisation (74%). Conclusions: Rapid recruitment to the pilot trial and the successful refinement of methodology indicated the feasibility of a definitive trial comparing different approaches to oesophagectomy. Although we have shown a full trial of open compared with minimally invasive oesophagectomy to be feasible, this is necessarily based on our findings from the two clinical centres that we could include in this small preliminary study. Trial registration: Current Controlled Trials ISRCTN59036820. Funding: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 48. See the NIHR Journals Library website for further project information.

This paper examines whether selected stakeholder groups believe accounting should continue to be taught asan elective subject in its current form at New Zealand secondary schools or whether incorporating a financialliteracy component would increase the subject’s relevance to students. A mixed method approach combiningqualitative and quantitative research methods was used. An electronically administered survey was used toobtain the responses of secondary school accounting teachers, while additional insight in the form of semistructuredinterviews was obtained from other stakeholders.Although respondents generally agreed that students benefited from accounting as an elective subject atsecondary school, all agreed that the development of financial literacy skills was important. Difficulties inintroducing a new core subject into an already overcrowded curriculum were acknowledged. However, thisdifficulty could be overcome by making modifications to the subject “Accounting”. As the most widespread,existing “finance” related subject, Accounting would be the most appropriate vehicle through which to teachfinancial literacy.

There has been a long and heated debate in the world of antitrust about the likely effects of vertical integration on competition and welfare. The publication of the European Commission’s Guidelines on the assessment of Non-horizontal mergers in November 2007 has again brought this debate into the spotlight. Competition authorities find themselves faced with the complex task of balancing the potential pro-competitive efficiencies of these mergers against the concerns that, in some circumstances, vertically-integrated firms could use their presence at multiple levels of the production chain to strategically soften competition. This paper outlines the current thinking on vertical mergers as presented in the Guidelines and examines, through an evaluation of a past Competition Tribunal decision, how the South African competition authorities have handled the complexities presented by vertical transactions.

This paper documents and shares our experience of navigating the journal-review process. By providing apersonal account we aim to provide a piece that will resonate with those who have had similar experiences.We adopted a case-study approach using the reviews of the manuscript by two anonymous reviewers and theauthors' responses. The paper confirms the emotive nature of the manuscript-review process and details someof the vagaries associated with the review process, highlighting our frustrations with it. An extensive literaturecritiquing the manuscript peer-review process exists. This is understandable given the requirement foracademics to publish their research findings in peer-reviewed journals. In view of this extensive literature,what is surprising is the dearth of studies detailing how authors have managed to navigate their way throughthe process.

This paper illustrates how the New Zealand Police use non-financial annual report disclosures in response toadverse media publicity. This longitudinal case study spans the reporting periods ending 30 June 2000through to 30 June 2007. It involves a detailed examination of the narrative disclosures and images containedin the annual reports, including the Commissioner’s Overview and the Outcome Reports during this time.Three controversial items covered by the media were traced through the annual reports to establish whetherthe New Zealand Police use image repair discourse supplemented by semiotics in non-financial annual reportdisclosures to repair organisational legitimacy. The analysis found that non-financial disclosures together withimage repair discourse strategies were used by the New Zealand Police, a public sector agency, to repairorganisational legitimacy. This paper provides a valuable contribution to researchers and practitioners as itextends the understanding of how public sector agencies use non-financial annual report disclosures.

BACKGROUND: Practices relating to acute peptic ulcer bleeding (APUB) outside of guideline recommendations are unknown.

This exploratory study investigates the extent to which 82 New Zealand local government authorities report intellectual capital in their annual reports. A disclosure index, constructed with the assistance of a 14-member local government stakeholder panel, was applied to the annual reports as part of a content analysis. Findings indicate that the overall level of intellectual capital disclosure was varied, with the majority of disclosures being narrative in nature. Findings also indicate that despite a significant portion of total annual expenditure being attributed to employees/staff, the level of human capital reporting was low.

The Balanced Budget Act (BBA) of 1997 created an opportunity for improving long-term care for the rural frail elderly by granting permanent provider status to the Program of All-Inclusive Care for Elders (PACE) under Medicare. PACE is a unique managed care model that provides comprehensive, integrated acute and long-term services for frail elders and program providers assume full financial risk. However, all existing PACE sites are currently located in urban settings. This article reviews the PACE provisions in the BBA legislation and describes the current PACE model. Two possible adaptations of the model are discussed for expanding PACE into rural areas. Keywords: Balanced Budget Act of 1997, long-term care, rural, frail elders, family caregivers, Program of All-Inclusive Care (PACE), Medicare restructuring http://dx.doi.org/10.14574/ojrnhc.v2i1.476