BackgroundYuli Veterans Hospital (YVH) has been the largest mental hospital for the patients with chronic and severe mental illness in Taiwan for the past 50 years. While this hospital used to be a symbol of hopelessness among patients and their families and an unspoken shame among Taiwan psychiatry and mental health circles it now represents an example of how an old, custodial hospital can be transformed into a very different institution. In this case study we will describe the features of this transformation, which, over the past 20 years, has aimed to help extended stay inpatients with severe mental illness to integrate into the local community of Yuli even though it is not their original home.MethodsUsing historical documents and oral narratives from Yuli inhabitants, workers and patients of YVH, we will offer a case study of the Yuli model.ResultsThere are four main components of the Yuli model: holistic medical support, vocational rehabilitation, case management, and the residential program. The four components help patients recover two essential features of their lives: vocational life and ordinary daily routines. As the process of recovery evolves, patients gradually regain inner stability, dignity, self-confidence, and a sense of control. The four components are critical to rebuild the structure and order of life of the patients and are indispensable and interdependent parts of one service package. They operate simultaneously to benefit the patients to the greatest degree possible.DiscussionThere are many challenges to the further development and financial viability of the model of services developed at YVH. There are also important questions concerning the replicability of the Yuli model in other sociocultural and service system contexts.ConclusionThis case study reveals the possibility of transforming a custodial mental hospital into a hospital providing high quality care. Hospital and community are not in opposition. They are part of a continuum of care for the patients. We reinterpret and redefine the boundary and function of hospital and community, and thereby create a new service model, the Yuli Model, to help patients to reintegrate into the community. The Yuli model, which particularly focuses on the needs of people with long-standing illness and prolonged hospital stay, illustrates one approach to linking hospital and community in a creative and constructive manner.

Study on the vulnerability and robustness of urban public transit networks (PTNs) has great implications for PTNs planning and emergency management, particularly considering passengers’ dynamic behaviors. We made a complex weighted network analysis based on passenger flow for Beijing’s bus stop network and multimodal transit network coupled with bus and urban rail systems. The analysis shows that there are small-world or scale-free properties in these two networks, which make them display different robustness under link or node failures. With consideration of the dynamic flow redistribution, we propose a model based on coupled map lattices to analyze the cascading failures of these two weighted networks. We find that the dynamic flow redistribution can significantly improve the tolerance of small-world or scale-free PTN against random faults. Because of the coupling of bus and rail systems, the multimodal network with scale-free topology and flow distribution structures displays an increasing tolerance even against intentional attack; however, its cascade is also much more intense once the failure is triggered. We find some thresholds of topological and flow coupling strength in the spreading process, which can be exploited to develop strategies to control cascade failures.

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We assessed the efficacy and tolerability of the augmentation of antidepressants (ATDs) with atypical antipsychotics (AAPs) to treat patients with major depressive disorder. A retrograde study to identify relevant patient data included databases of PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Database of Abstracts of Reviews of Effects. Data from 17 trials, involving 3807 participants, were identified. The remission rate (RR) and overall response rate (ORR) of adjunctive treatment with AAPs were significantly higher than placebo treatment: RR=1.90 (95%CI=1.61-2.23, z=7.74, P<0.00001) and ORR=1.68 (95%CI=1.45-1.94, z=7.07, P<0.00001). We found that the short-term (4 weeks) treatment [ORR=1.70 (95%CI=0.98-2.95, Z=1.89, P=0.06)] was significantly different from the long-term (6-12 weeks) treatment [ORR=1.68 (95%CI=1.45-1.94, z=7.07, P<0.00001)]. No significant difference in ORR was observed between groups with or without sedative drugs. The discontinuation rate due to adverse effects was higher for adjunctive treatment with AAPs: ORR=3.32 (95%CI=2.35-4.70, z=6.78, P<0.00001). These results demonstrate that the augmentation of ATDs with AAPs (olanzapine, quetiapine, aripiprazole, and risperidone) was more effective than a placebo in improving response and remission rates, although associated with a higher discontinuation rate due to adverse effects.

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A coupled network model consisting of bus and subway systems is proposed, and the statistic properties of the three networks: bus, subway and coupled networks of Beijing are studied with the theory of complex network. The result shows that the three networks have typical properties of small-world. We propose three parameters to depict the coupled network, they are: the coupled parameter β the influence parameter S and the node tolerance parameter γ. We use the binary influence model to simulate a feedback process and cascading failure in the coupled network and we obtain the conclusions: (1) The cascading size grows with β; (2) The cascading size grows with S, but it has a critical point; (3) The cascading size grows with the decrease of γ, when γ≤0.3, the cascading failure will extent to the whole network.

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