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Central and North West London's Clinical Ethics Committee (CEC) offers a non-judgmental space to discuss ethical concerns and challenges and provide ethical guidance. This project aims to publicise these ethical dilemmas and guidance to inform decision making trust-wide.
A Clinical Ethics Committee (CEC) encompasses a diverse range of figures, from psychiatrists and general practitioners to members of the clergy and experts by experience. The CEC in Central and North West London have been meeting regularly since 2003 to provide ethical assistance to a wide range of medical, surgical and psychiatric teams. Complex ethical cases are presented by the treating team, allowing a subsequent discussion of the ethical theories and frameworks within the case with the committee members. This synthesis of information can then assist the treating team in the shaping of ethical based solutions to their dilemmas.
The committee wished to encourage ethical based clinical thinking within the trust and enable others to learn from the valuable insights already provided by the CEC over the years.
Case notes, recorded from the last 17 years of meetings of the Clinical Ethics Committee were reviewed. 98 cases were identified between 2003-2019. The contemporaneous case reports were then anonymised and indexed into one easy to use file. This file was published on the local intranet and publicised to staff.
The cases were compiled into a PDF document which is available for all staff members within the trust on the intranet. This resource is open to all clinical staff, and serves the dual purpose of encouraging ethical-based thinking and also promoting the ethics committee to those who might be in need of assistance.
Clinical decisions can be complex and nuanced, often complicated by multiple viewpoints and ways of thinking. The database demonstrates the use of ethical dimensions by the ethics committee to inform decision making in a series of varied clinical and management dilemmas. The project required careful consideration around preservation of confidentiality as well as overcoming the logistical barriers of trust-wide dissemination. The result is a document that will allow ethical based decision-making to be embedded into everyday practice.
Evidence-based infection control strategies are needed for healthcare workers (HCWs) following high-risk exposure to severe acute respiratory coronavirus virus 2 (SARS-CoV-2). In this study, we evaluated the negative predictive value (NPV) of a home-based 7-day infection control strategy.
HCWs advised by their infection control or occupational health officer to self-isolate due to a high-risk SARS-CoV-2 exposure were enrolled between May and October 2020. The strategy consisted of symptom-triggered nasopharyngeal SARS-CoV-2 RNA testing from day 0 to day 7 after exposure and standardized home-based nasopharyngeal swab and saliva testing on day 7. The NPV of this strategy was calculated for (1) clinical coronavirus disease 2019 (COVID-19) diagnosis from day 8–14 after exposure, and for (2) asymptomatic SARS-CoV-2 detected by standardized nasopharyngeal swab and saliva specimens collected at days 9, 10, and 14 after exposure. Interim results are reported in the context of a second wave threatening this essential workforce.
Among 30 HCWs enrolled, the mean age was 31 years (SD, ±9), and 24 (80%) were female. Moreover, 3 were diagnosed with COVID-19 by day 14 after exposure (secondary attack rate, 10.0%), and all cases were detected using the 7-day infection control strategy: the NPV for subsequent clinical COVID-19 or asymptomatic SARS-CoV-2 detection by day 14 was 100.0% (95% CI, 93.1%–100.0%).
Among HCWs with high-risk exposure to SARS-CoV-2, a home-based 7-day infection control strategy may have a high NPV for subsequent COVID-19 and asymptomatic SARS-CoV-2 detection. Ongoing data collection and data sharing are needed to improve the precision of the estimated NPV, and here we report interim results to inform infection control strategies in light of a second wave threatening this essential workforce.
OBJECTIVES/GOALS: Pancreatic cysts are comprised of both precancerous mucinous lesions and non-mucinous lesions with minimal malignant potential. Our goal is to improve our ability to classify the type of cyst using a combination of novel radiomic features and cyst fluid proteolytic activity. METHODS/STUDY POPULATION: Preoperative pancreatic protocol CT images from 30 patients with proteolytic assay characterization, followed by surgical resection with a pathologically confirmed pancreatic cyst diagnosis between 2016-2019 will be used in this study. We will contour images using the widely available software 3D Slicer, and extract radiomic features using IBEX software. We will analyze area under the ROC curves to identify the radiomic features that best differentiate mucinous from non-mucinous cysts, and identify features to be cross validated. The predictive ability of identified radiomic features combined with proteolytic assay will be determined by performing multiple logistic regression analysis and comparing AUROC analysis. We will determine sensitivity and specificity for individual, as well as combinations of, analytes to determine the optimal classifier. RESULTS/ANTICIPATED RESULTS: We anticipate that the predictive ability, sensitivity, and specificity of utilizing radiomic features combined with proteolytic assay data will exceed the performance of any individual test. DISCUSSION/SIGNIFICANCE OF IMPACT: This work is designed to provide a predictive radiomic model that will enable us to better identify mucinous cysts that require further evaluation, and potentially prevent unnecessary surgery in other patients. Ultimately, we would like to improve the accuracy of noninvasive radiographic evaluation using radiomic markers. CONFLICT OF INTEREST DESCRIPTION: Dr. Charles Craik is a co-founder of Alaunus Biosciences, Inc.
Epstein-Barr virus (EBV) encephalitis is rare and shows a wide range of clinical manifestations. We report an immunocompromised patient with EBV encephalitis diagnosed by EBV-specific PCR and antibody testing in the cerebrospinal fluid who presented with psychiatric symptoms and cognitive dysfunction in the absence of any neurological impairments or infectious signs. Clinical recovery and clearance of cerebrospinal fluid EBV DNA appeared following ganciclovir treatment within 6 weeks.
Borna disease virus (BDV) appears to cause meningoencephalitis and schizophreniform psychosis in sporadic cases according to earlier cerebrospinal fluid (CSF) inoculation experiments (Rott et al, 1991). However, CSF parameters in BDV seropositive psychiatric patients proved nearly all normal; only the most sensitive CSF/serum index I-BDV for intrathecally produced BDV specific IgG was pathologic in 10.5–29.0% (according to different methodological limits) of patients. An increase in sensitivity was attempted to detect specific IgG in CSF in a part of the cases by concentration. Concentration procedure does not significantly increase methodological bias according to a statistical analysis of the results. Our findings support the hypothesis that BDV may cause or contribute to the pathogenesis of a diagnostically broad pattern of psychiatric syndromes. The occurence of a spectrum of diagnoses is expected from non-specificity of psychiatric symptoms in other infectious diseases of the brain as well as from results in experimental Borna disease (BD) in animals, when a majority of the animals showed rather unspecific symptomatology due to slight, preferentially limbic encephalitis. Slight deficiencies from an earlier BDV infection could explain continuing symptoms in a part of the cases. Recurrences years after infection are well known in experimental and natural BD in animals. It remains open, whether this mechanism could play a more prominent role in a form of “symptomatic” cyclothymia and “symptomatic” schizophrenia, although the results of CSF investigations are more clear in BDV seropositive patients with major psychoses.
eCME aims to create an electronic Continuous Medical Education system to aid the simple and cost-effective transfer of medical skills across Europe by proposing a unified integral panEuropean mechanism of accreditation for CME courses as expertise appears concentrated in a limited numbers of centers of excellence within Europe while researchers in smaller centers have difficulties in accessing information and acquiring the necessary skills.
The eCME project will produce an on-line e-learning pilot in the English and Greek languages, with a multilingual potential, blended with hands-on medical courses, which focuses on the two critical and continuously evolving domains of clinical psychiatry and neuroimaging. This is achieved with the deployment of ICTs in order to develop an advanced, multi-lingual and secure e-learning platform through which CME can be carried out remotely across Europe. eCME incorporates content of a wide variety of multimedia formats taking advantage of the ever-increasing internet bandwidth availability across Europe.
The concept of an electronic CME accreditation tool was acceptable to the Psychiatrists surveyed. The project results are expected to have a significant impact in the established practices of continuing vocational training of medical professionals, enabling them to maintain, develop and increase their knowledge, skills and professional performance, with subsequent benefits to the services they offer to their patients.
A novel electronic CME accreditation system like eCME could represent the means to addressing the European lack of access and thus gap of Psychiatric training.
To conduct a three-arm partial randomised controlled trail to evaluate the effectiveness of expedited regular supportive psychotherapy and assertive case management for patients presenting with suicidal ideation or self-harm to the emergency department (ED).
we expect expedited regular supportive psychotherapy plus assertive case management will reduce the suicidality and/or suicidal behaviour in patients by at least 20% at 4 weeks compared to patients receiving only assertive case management or routine care and these differences will be sustained at 6 months.
This will be a longitudinal, prospective, three-arm controlled single-rater-blinded partial randomized clinical trial with a recruitment period of 12 months and an observation period of 6 months for each participant. Patients in the intervention group will receive regular face-to-face or over the phone brief supportive psychotherapy during weekdays following presentation to the ED with suicidal ideation or self-harm until patients are actively enrolled in regular community mental health services with active case management by the therapist. Patients in the control and the assertive outreach arms will each receive the usual follow-up services offered routinely to regular patients and assertive outreach patients respectively who present to the ED with suicidal ideation or self-harm.
Recruitment will commence in February 2016 and we expect the results of the study to be available by September 2017.
If our hypothesis is proved correct, our intervention will be a new model for caring for patients with self-harm and suicidal ideation and is expected to reduce suicide rates.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Modern Catholic Social Teaching (CST) developed in an historical context that posed dramatic challenges to the institutional Church and lay faithful. The French Revolution (1789–1799), the Napoleonic era (1799–1815), and industrial revolution, and waves of succeeding uprisings in 1820, 1830, 1848, and 1870 represented radical challenges to existing political structures, such that Old Regime conceptions of the State and Church alliance of Throne and Altar were no longer tenable. The emergence of the modern secular state in traditionally Catholic lands often included the suppression of religious orders, charitable and educational institutions, and control over clergy and hierarchy. The Church struggled in this revolutionary age of ideology – torn between laissez-faire liberalism and revolutionary socialism. The Catholic movement, primarily of laity, grew in response to these challenges, under the rubrics of the “Religious Question” of freedom of religion, and Church–State relations generally, and of the “Social Question” or how to address the growing number of rootless and impoverished industrial workers in an increasingly secularized political and cultural environment. The revival of neoscholastic philosophy of society became the paradigm through which Pius IX and especially Leo XIII were able to engage modernity on evangelical and natural law foundations.
The reception of Brahms’s music beyond his home city of Hamburg began in 1853, when the young composer made his first extended journey and presented his compositions to some of the leading figures of German contemporary music: Robert Schumann, Robert Franz and Franz Liszt. Each reacted to these unpublished works in distinctive ways.
Robert Schumann, with whom Brahms spent the whole month of October in Düsseldorf, was instantly enthralled.
Brahms never studied at a music conservatory, nor did he ever teach at one. However, in private, individually negotiated settings, he was active as a teacher throughout his musical life in many ways. From his youth onwards, he gave piano lessons and sporadic theory lessons [see Ch. 1 ‘Childhood in Hamburg’]; later, he acted as occasional adviser to younger composers on many occasions, and even took on some regular students.
The young Brahms studied piano with Otto Cossel from 1840, changing to Eduard Marxsen in 1843, who also subsequently gave him composition lessons. At the age of fourteen at the latest, he began to give piano lessons himself, initially for free as a favour but soon in order to earn an income [see Ch. 8 ‘Finances’]. The few surviving statements of four of his students reveal that in these years he neither enjoyed teaching, nor was he particularly good at it.
We investigate the implications of providing loan officers with a nonlinear compensation structure that rewards loan volume and penalizes poor performance. Using a unique data set provided by a large international commercial bank, we examine the main activities that loan officers perform: loan prospecting, screening, and monitoring. We find that when loan officers are at risk of losing their bonuses, they increase prospecting and monitoring. We further show that loan officers adjust their behavior more toward the end of the month when bonus payments are approaching. These effects are more pronounced for loan officers with longer tenures at the bank.
Childhood maltreatment is an important factor associated with adverse mental health outcomes including geriatric depression and the “big five” personality characteristics. The objective of this study was to evaluate a model where personality characteristics mediate the relationship between childhood maltreatment and geriatric depression.
In this cross-sectional study, elderly subjects from socioeconomically disadvantaged neighborhoods of Porto Alegre, Brazil (n = 260) completed the Childhood Trauma Questionnaire (CTQ), NEO-Five Factor Inventory (NEO-FFI), and Mini International Neuropsychiatric Interview 5.0 (MINI plus). We used structural equation modeling (SEM) to evaluate the mediation hypothesis.
The five personality factors (neuroticism, extraversion, agreeableness, openness, and conscientiousness) were related to childhood maltreatment and depression. Mediation analysis revealed that neuroticism and extraversion are complete mediators, agreeableness and conscientiousness are partial mediators, and openness is not a mediator.
These ﬁndings support the hypothesis in which childhood maltreatment is associated with geriatric depression and mediated by personality factors. These results suggest that reducing the maladaptive personality trait in elderly people who suffered childhood maltreatment could prevent geriatric depression.
“Melodrama” as a descriptive concept—in contrast to a pejorative understanding—expresses a typically modern form of experience as radical immanence of human and political life and therefore seems appropriate to get to the depth of Karl Mannheim's critique of modernity as the loss of any metaphysical system from, or on which, knowledge and knowledge claims could be derived or based. An analysis of his modernity critique as melodrama presents a reading of Mannheim that goes deeper and beyond his reception as a sociologist of knowledge: his sociology of knowledge appears then “only” as a consequence to found knowledge under non- metaphysical, nonreligious, or non- idealist, that is, contingent conditions (of modernity) by relating styles of thought to social and historical contexts and standpoints (“Standorte”) from where they originated and in which they are functioning. Mannheim argues against any attempt to restore metaphysical systems, and he does not regret the loss of transcendence and metaphysics, but rather opens knowledge and political action to anti- essentialist (ideology) critique and to plurality. We see herein seeds for the development of a political theory of optionality.
The Problematic and Structure of the Chapter
In the present chapter we discuss Karl Mannheim's notion of modernity alongside the question of what we can learn from this for political theory. This discussion, of course, touches upon Mannheim's most famous approach, namely his sociology of knowledge. In doing so, this chapter will, however, understand his sociology of knowledge not as something independent, historically spatially non- relational and itself noncontingent, but rather as a consequence of his understanding of modernity, having the character that Mannheim ascribes to every (other) social and political theory. More concretely: Mannheim's understanding of modernity demands a radical immanent conceptualization and explanation of knowledge, as all metaphysical and transcendental claims would have become impossible. The only way to approach knowledge, therefore, is to understand knowledge as deeply anchored and rooted in society and in sociohistorical contexts (“Standorte”). Mannheim's sociology of knowledge is thus a radical accommodation of sociological and political inquiry to conditions of modernity (as he viewed it; see below), that is, of the immanence of social and political life and subsequently of their analysis and of all action within it and without reference to metaphysics and/ or religion.
Hans Morgenthau's Scientific Man vs. Power Politics appeared in 1946, one year after he received tenure at the University of Chicago. Thus, the monograph demarcates the beginning of Morgenthau's career in the United States, to which he had emigrated nine years earlier. Three main aspects seem important for understanding this work. The first is Morgenthau's bewilderment about American political culture and, as he perceived it, its cheerful optimism about the betterment of politics, society, and humanity in general. The second aspect is the nature of the argument: Scientific Man is a dogmatic tract, an attempt to hammer home certain philosophical positions—positions that were largely unpopular in the U.S. social sciences in the 1940s (and later)—rather than a reflective scholarly elaboration of certain philosophical commitments. The third is Morgenthau's place between two academic cultures: Morgenthau's language in his American writings partly stems from, but also tries to leave behind, his European academic socialization. The monograph thus reflects the author's peculiar situation, as he inhabits two sometimes crucially different semantic and cultural contexts, but fails to bridge or broker them.