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Northern Ireland presents itself as an anomaly – a region in which only 31.8% of doctors enter into any training programme after completion of the Foundation Programme, but where Core Psychiatry has been consistently oversubscribed. Here, we aim to find what other regions can learn from this success. All doctors of any grade, working in psychiatry, who had been though the Foundation Programme were questioned on their motivations for becoming a psychiatry trainee.
Sixty-two doctors currently working in psychiatry responded, including over 60% of current trainees, and 45% stated they had not considered a career in psychiatry before their foundation attachment. Over 80% preferred foundation placements in FY2 only, rather than in either foundation year 1 or FY2.
This survey identifies that for the majority of people who ultimately chose to train in psychiatry, in a region that has consistently attracted candidates to core and higher level training, completion of a foundation psychiatry post was an influencing factor in this decision. A strong majority of doctors prefer the foundation psychiatry placement to be offered in FY2.
Recent evidence suggests that cannabidiol (CBD), a non-intoxicating ingredient present in cannabis extract, has an antipsychotic effect in people with established psychosis. However, the effect of CBD on the neurocognitive mechanisms underlying psychosis is unknown.
Patients with established psychosis on standard antipsychotic treatment were studied on separate days at least one week apart, to investigate the effects of a single dose of orally administered CBD (600 mg) compared to a matched placebo (PLB), using a double-blind, randomized, PLB-controlled, repeated-measures, within-subject cross-over design. Three hours after taking the study drug participants were scanned using a block design functional magnetic resonance imaging (fMRI) paradigm, while performing a verbal paired associate learning task. Fifteen psychosis patients completed both study days, 13 completed both scanning sessions. Nineteen healthy controls (HC) were also scanned using the same fMRI paradigm under identical conditions, but without any drug administration. Effects of CBD on brain activation measured using the blood oxygen level-dependent hemodynamic response fMRI signal were studied in the mediotemporal, prefrontal, and striatal regions of interest.
Compared to HC, psychosis patients under PLB had altered prefrontal activation during verbal encoding, as well as altered mediotemporal and prefrontal activation and greater mediotemporal-striatal functional connectivity during verbal recall. CBD attenuated dysfunction in these regions such that activation under its influence was intermediate between the PLB condition and HC. CBD also attenuated hippocampal-striatal functional connectivity and caused trend-level symptom reduction in psychosis patients.
This suggests that normalization of mediotemporal and prefrontal dysfunction and mediotemporal-striatal functional connectivity may underlie the antipsychotic effects of CBD.
To assess potential transmission of antibiotic-resistant organisms (AROs) using surrogate markers and bacterial cultures.
A 1,260-bed tertiary-care academic medical center.
The study included 25 patients (17 of whom were on contact precautions for AROs) and 77 healthcare personnel (HCP).
Fluorescent powder (FP) and MS2 bacteriophage were applied in patient rooms. HCP visits to each room were observed for 2–4 hours; hand hygiene (HH) compliance was recorded. Surfaces inside and outside the room and HCP skin and clothing were assessed for fluorescence, and swabs were collected for MS2 detection by polymerase chain reaction (PCR) and selective bacterial cultures.
Transfer of FP was observed for 20 rooms (80%) and 26 HCP (34%). Transfer of MS2 was detected for 10 rooms (40%) and 15 HCP (19%). Bacterial cultures were positive for 1 room and 8 HCP (10%). Interactions with patients on contact precautions resulted in fewer FP detections than interactions with patients not on precautions (P < .001); MS2 detections did not differ by patient isolation status. Fluorescent powder detections did not differ by HCP type, but MS2 was recovered more frequently from physicians than from nurses (P = .03). Overall, HH compliance was better among HCP caring for patients on contact precautions than among HCP caring for patients not on precautions (P = .003), among nurses than among other nonphysician HCP at room entry (P = .002), and among nurses than among physicians at room exit (P = .03). Moreover, HCP who performed HH prior to assessment had fewer fluorescence detections (P = .008).
Contact precautions were associated with greater HCP HH compliance and reduced detection of FP and MS2.
The push to implement Open Access (OA) as the new standard for academic research dissemination is creating very real pressures on academic journals. In Canada, the Social Science and Humanities Research Council (SSHRC) recently adopted a policy requiring that journals applying for its Aid to Scholarly Journals (ASJ) grant make their scholarly content freely accessible after no more than a 12-month delay. For journals such as the Canadian Journal of Political Science (CJPS) that not only publish high-quality, peer-reviewed articles to a specialized audience but also support the work of scholarly associations through the revenues they generate, the push to move to OA comes with a number of challenges. The Canadian Political Science Association (CPSA) and the Société québécoise de science politique (SQSP) established a committee to chart the best course of action for the CJPS in light of this changing landscape. This article summarizes the key findings of the committee and underscores some of the challenges of OA for journals with a profile similar to the CJPS, as well as for the broader research ecosystem that they support.
The small ice-free areas of Antarctica provide an essential habitat for most evident terrestrial biodiversity, as well as being disproportionately targeted by human activity. Visual detection of disturbance within these environments has become a useful tool for measuring areas affected by human impact, but questions remain as to what environmental consequences such disturbance actually has. To answer such questions, several factors must be considered, including the climate and biotic and abiotic characteristics. Although a body of research has established the consequences of disturbance at given locations, this paper was conceived in order to assess whether their findings could be generalized as a statement across the Antarctic continent. From a review of 31 studies within the Maritime Antarctic, Continental Antarctic and McMurdo Dry Valleys regions, we found that 83% confirmed impacts in areas of visible disturbance. Disturbance was found to modify the physical environment, consequently reducing habitat suitability as well as directly damaging biota. Visible disturbance was also associated with hydrocarbon and heavy metal contamination and non-native species establishment, reflecting the pressures from human activity in these sites. The results add significance to existing footprint measurements based on visual analysis, should aid on-the-ground appreciation of probable impacts in sites of disturbance and benefit environmental assessment processes.
The idea of predistribution has the potential to offer a valuable and distinctive approach to political philosophers, political scientists, and economists, in thinking about social justice and the creation of more egalitarian economies. It is also an idea that has drawn the interest of politicians of the left and centre-left, promising an alternative to traditional forms of social democracy. But the idea of predistribution is not well understood, and stands in need of elucidation. This article explores ways of drawing the conceptual and normative distinction between predistribution and redistribution, examining those general categories when considering the roles of public services and fiscal transfers, and looking at the ways in which government policies can empower and disempower different individuals and groups within the economy. This article argues that the most initially plausible and common-sensical ways of drawing the distinction between predistributive and redistributive public policies collapse when put under analytical pressure. It concludes that the distinction between predistribution and redistribution is best seen in terms of the aims or effects of policies rather than a deeper division of policy types, and argues that, once seen in those terms, predistribution is a central concern of social justice.
Alcohol use disorders (AUD) are common, particularly in patients attending mental health services. Clinicians are often hesitant to explore with patients their relationship with alcohol and the role that it has in their presenting complaint, despite being ideally placed to optimise on a ‘teachable moment’ and initiate treatment, where necessary. This article provides an overview of AUD and their identification and management options.
After reading this article you will be able to:
• understand key concepts and definitions of alcohol use disorders
• recognise and assess alcohol use disorders
• manage alcohol use disorders in clinical settings.
I have a very particular reason to be grateful to Stewart Sutherland, our late President, which is connected to some of the themes of this lecture, so want to begin by recalling a long conversation I had with him on these topics.
We conducted active surveillance of acute respiratory viral infections (ARIs) among residents and healthcare personnel (HCP) at a long-term care facility during the 2015–2016 respiratory illness season. ARIs were observed among both HCP and patients, highlighting the importance of including HCP in surveillance programs.
With the shift from deinstitutionalization to community care in mental health services, relatives of persons with severe and enduring mental illnesses have had to take over the role as primary caregivers. Disturbed family dynamics have been observed within families with an ‘ill’ member. Although schizophrenia and related mental illnesses are biologically based disorders, environmental stress (including stress within family relationships) plays a major role in the onset and maintenance of symptoms. With this study, we assume that family dynamics play a central role in the course of severe psychiatric illness and hypothesized that dysfunction within family systems is a prognostic indicator of hospitalization in the course of schizophrenia/bipolar and schizoaffective disorders.
Prospective, observational cohort study evaluating family functioning of 121 patients (schizophrenia/bipolar and schizoaffective disorder) from community at baseline and followed-up over 12-month period after recruitment. Measurements included demographics, diagnosis, Family Assessment Device – General Functioning, Perceived Criticism Scale, Brief Psychiatric Rating Scale, Global Assessment of Functioning and Social Support Questionnaire-6.
Significant differences found between patients admitted and not admitted during the 12-month time period for age (p = 0.003), Brief Psychiatric Rating Scale (BPRS; p = 0.026), Family Assessment Device – General Functioning (FAD-GF; p = 0.007) and Social Support Questionnaire total satisfaction level (p = 0.042) at baseline. Bivariate analysis showed that those admitted into hospital were younger with a higher BPRS score, less social satisfaction and disturbed family dynamics. FAD-GF (p = 0.006) and age (p = 0.022) were significant independent predictors for admission.
This provides further evidence supporting importance of promoting better family functioning through modified family dynamics, integrating and involving family into the care of such patients.
No net loss approaches to environmental policy claim that policy should maintain aggregate levels of natural capital. Substitutability between natural assets allows losses in some assets to be compensated for by gains in others while maintaining overall levels of natural capital. This paper argues that significant goods that matter to people’s well-being will be lost through a policy of no net loss. The concepts of natural capital and ecosystem services that underpin the no net loss approach to environmental policy cannot capture important dimensions of value that are central to human well-being.
The Nine Years War, also known as Tyrone's Rebellion, raged across Ireland for ten years from 1593–1603, as a confederation of Irish lords led by Hugh O'Neill, second earl of Tyrone, almost succeeded in extinguishing English power in Ireland. It retains a popular image of being a guerrilla war by Irish lords to throw off English rule that was ultimately doomed to failure, since primitive Ireland could never hope to match the economic and military strength of Gloriana's England. The conflict has often been portrayed as a no-holds-barred conflict in which brutality was the norm. The orgy of bloodshed and cataclysmic famine in Ulster which brought the war to its close helped cement this image. The war in Ireland generated a reputation in Europe as one of uncommon savagery, with subsequent English publications attributing the bulk of that aggression and cruelty to the Irish. This appears very neat and uncontentious. However, the narrative is riven with fabrications which began during the war and have proliferated in modern historiography.
Many assumptions about the nature and course of the war are not borne out by the evidence, yet they continue to permeate the historiography of the conflict. Two of the most pervasive strands of this myth are of particular concern: the primitivism of the Irish, and the savagery of the English campaign to suppress the Gaelic lords. In truth, the Irish were anything but primitive, and in many ways were more advanced and adaptive than their English adversaries. Nevertheless, both English and Irish writers sought to portray the Irish as crude and unsophisticated. The modern critical vogue for equating the closing stages of the war with genocide is equally founded upon questionable sources. A reassessment of the contemporary accounts suggests the horrors in Ulster were overstated at the time, and later interpretations have emphasised aspects of the devastation caused by war to apportion blame to one side of the conflict, in this case the English. Whilst English officers and soldiers did not view themselves as bloodthirsty or acting contrary to accepted norms, the popular and academic interpretation of the conflict has often been one of untrammelled cruelty by crown forces.
Human sacrifice is a well-attested and much mythologised phenomenon of human society, but what constitutes human sacrifice? Why is socially sanctioned violence considered sacrifice? And why are human lives sacrificed? New research uses archaeological case studies from Scandinavia to understand performative violence.
This chapter explores the popular organizing that arose in Mexico’s southwest state of Guerrero during the Cold War. It concludes that the movement’s identification with the language of nationalism and economic and social expectations that arose with the revolution of 1910 distinguishes it from many of the contemporary Marxist-inspired movements in Latin America. Following a series of government assaults on peaceful protesters demanding democratic inclusion, the teacher-activists who had led the initial opposition – Genaro Vázquez Rojas and Lucio Cabañas – each founded an armed guerrilla movement. While these both remained small, the chapter argues that they enjoyed the support of a broader base that hid them, fed them, and suffered the consequences of unrestrained government violence. Guerrero was, ultimately, the site of Mexico’s guerra sucia. This history also helps us understand the disappearance of Ayotzinapa’s teachers-in-training in 2014. Those students attended a school distinguished for producing radical opposition leaders since its post-revolutionary inception, including, during the Cold War, Lucio Cabañas.
The Royal College of Psychiatrists recommends that a specially designated space for ECT treatment should be available (ECTAS, 2018). As the number of patients being referred for ECT continues to decline (Buley et al., 2017) the availability of ECT for patients who require it may be compromised. The College ECT Committee is supportive in helping clinics to find alternative treatments for depression which may be delivered in the ECT centre. A number of centres already provide additional services to ECT, for example clozapine and depot clinics. ECT clinics are also used for the delivery of rTMS (Chapter 15) and ketamine infusions (Chapter 17).
Transcranial magnetic stimulation (TMS) is a relatively new neuro stimulation technique, which has become available in a handful of centres in the UK over the past five years. The technique involves placing a high intensity magnetic coil on the scalp and delivering a rapidly changing magnetic field, which alters the electrical properties of the underlying cortical neurons. Repetitive transcranial magnetic stimulation (rTMS) involves repetitive trains of magnetic stimulations over a defined period of time.