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The Recovery and Wellness Movement is the framework within which we ask the chronically mentally ill to understand how they might best manage their lives.
The epistemological and cultural primacy of a patient′s psychiatric diagnosis minimizes effective involvement in the Recovery Movement.
The aim of this presentation is to present both the implications to the patient in being trapped in any diagnostic labyrinth and how she/he can“escape” into a DIFFERENT awareness of the meaning of her/his diagnosis while still actively pursueing meaningful Recovery goals.
Various cognitive behavior techniques will be discussed to highlight both how patients should understand the real albeit limited value of their diagnoses as well as understand the necessary self-evaluation and attitudinal changes that will allow them to understand how best to participate in the Recovery Movement. The desired result: Both patients and mental health professionals will learn to minimize any heuristic value in even the term-“Patient.”
To analyse associations between brain morphology and longitudinal and cross-sectional measures of outcomes in schizophrenia in a general population sample.
The sample was the Northern Finland 1966 Birth Cohort. In 1999–2001, structural brain MRI and measures of clinical and functional outcomes were analysed for 54 individuals with schizophrenia around the age of 34. Sex, total grey matter, duration of illness and the use of antipsychotic medication were used as covariates.
After controlling for multiple covariates, increased density of the left limbic area was associated with less hospitalisations and increased total white matter volume with being in remission. Higher density of left frontal grey matter was associated with not being on a disability pension and higher density of the left frontal lobe and left limbic area were related to better functioning. Higher density of the left limbic area was associated with better longitudinal course of illness.
This study, based on unselected general population data, long follow-up and an extensive database, confirms findings of previous studies, that morphological abnormalities in several brain structures are associated with outcome. The difference in brain morphology in patients with good and poor outcomes may reflect separable aetiologies and developmental trajectories in schizophrenia.
The creation, sharing and disseminating of a Psychiatric Diagnosis has multiple, interrelated components that must be approached with an ethical and legal awareness. It further involved an efficient and effective communication paradigm involving multiple professionals with varying points of view and multiple stakeholders, especially the patient.
This presentation will summarize first the underlying legal requirements for a valid, effective Psychiatric Diagnosid, looking especially at requirements pursuant to tort law: next, the focus will shift to the communication and sharing of said diagnosis with an emphasis on the underlying morality and efficacious justice if the diagnosis is effectively communicated. Finally, comments will be made specific to how the correct and effective diagnostic process moves Diagnosis per se into the newly emerging Field of Positive Psychology
Health care is transitioning from genetics to genomics, in which single-gene testing for diagnosis is being replaced by multi-gene panels, genome-wide sequencing, and other multi-genic tests for disease diagnosis, prediction, prognosis, and treatment. This health care transition is spurring a new set of increased or novel liability risks for health care providers and test laboratories. This article describes this transition in both medical care and liability, and addresses 11 areas of potential increased or novel liability risk, offering recommendations to both health care and legal actors to address and manage those liability risks.
The search for life in the Universe is a fundamental problem of astrobiology and modern science. The current progress in the detection of terrestrial-type exoplanets has opened a new avenue in the characterization of exoplanetary atmospheres and in the search for biosignatures of life with the upcoming ground-based and space missions. To specify the conditions favourable for the origin, development and sustainment of life as we know it in other worlds, we need to understand the nature of global (astrospheric), and local (atmospheric and surface) environments of exoplanets in the habitable zones (HZs) around G-K-M dwarf stars including our young Sun. Global environment is formed by propagated disturbances from the planet-hosting stars in the form of stellar flares, coronal mass ejections, energetic particles and winds collectively known as astrospheric space weather. Its characterization will help in understanding how an exoplanetary ecosystem interacts with its host star, as well as in the specification of the physical, chemical and biochemical conditions that can create favourable and/or detrimental conditions for planetary climate and habitability along with evolution of planetary internal dynamics over geological timescales. A key linkage of (astro)physical, chemical and geological processes can only be understood in the framework of interdisciplinary studies with the incorporation of progress in heliophysics, astrophysics, planetary and Earth sciences. The assessment of the impacts of host stars on the climate and habitability of terrestrial (exo)planets will significantly expand the current definition of the HZ to the biogenic zone and provide new observational strategies for searching for signatures of life. The major goal of this paper is to describe and discuss the current status and recent progress in this interdisciplinary field in light of presentations and discussions during the NASA Nexus for Exoplanetary System Science funded workshop ‘Exoplanetary Space Weather, Climate and Habitability’ and to provide a new roadmap for the future development of the emerging field of exoplanetary science and astrobiology.
Movement disorders associated with exposure to antipsychotic drugs are common and stigmatising but underdiagnosed.
To develop and evaluate a new clinical procedure, the ScanMove instrument, for the screening of antipsychotic-associated movement disorders for use by mental health nurses.
Item selection and content validity assessment for the ScanMove instrument were conducted by a panel of neurologists, psychiatrists and a mental health nurse, who operationalised a 31-item screening procedure. Interrater reliability was measured on ratings for 30 patients with psychosis from ten mental health nurses evaluating video recordings of the procedure. Criterion and concurrent validity were tested comparing the ScanMove instrument-based rating of 13 mental health nurses for 635 community patients from mental health services with diagnostic judgement of a movement disorder neurologist based on the ScanMove instrument and a reference procedure comprising a selection of commonly used rating scales.
Interreliability analysis showed no systematic difference between raters in their prediction of any antipsychotic-associated movement disorders category. On criterion validity testing, the ScanMove instrument showed good sensitivity for parkinsonism (90%) and hyperkinesia (89%), but not for akathisia (38%), whereas specificity was low for parkinsonism and hyperkinesia, and moderate for akathisia.
The ScanMove instrument demonstrated good feasibility and interrater reliability, and acceptable sensitivity as a mental health nurse-administered screening tool for parkinsonism and hyperkinesia.
Observational evidence in space and astrophysical plasmas with a long collisional mean free path suggests that more massive charged particles may be preferentially heated. One possible mechanism for this is the turbulent cascade of energy from injection to dissipation scales, where the energy is converted to heat. Here we consider a simple system consisting of a magnetized plasma slab of electrons and a single ion species with a cross-field density gradient. We show that such a system is subject to an electron drift wave instability, known as the universal instability, which is stabilized only when the electron and ion thermal speeds are equal. For unequal thermal speeds, we find from quasilinear analysis and nonlinear simulations that the instability gives rise to turbulent energy exchange between ions and electrons that acts to equalize the thermal speeds. Consequently, this turbulent heating tends to equalize the component temperatures of pair plasmas and to heat ions to much higher temperatures than electrons for conventional mass-ratio plasmas.
Treatment of medical patients with the inflammatory cytokine, interferon-α (IFN-α), is frequently associated with the development of clinical depressive symptomatology. Several important biological correlates of the effect of IFN-α on mood have been described, but the neuropsychological changes associated with IFN-α treatment are largely unexplored. The aim of the present preliminary study was to assess the effect of IFN-α on measures of emotional processing.
We measured changes in emotional processing over 6–8 weeks in 17 patients receiving IFN-α as part of their treatment for hepatitis C virus infection. Emotional processing tasks included those which have previously been shown to be sensitive to the effects of depression and antidepressant treatment, namely facial expression recognition, emotional categorisation and the dot probe attentional task.
Following IFN-α, patients were more accurate at detecting facial expressions of disgust; they also showed diminished attentional vigilance to happy faces. IFN-α produced the expected increases in scores on depression rating scales, but there was no correlation between these scores and the changes in emotional processing.
Our preliminary findings suggest that IFN-α treatment produces negative biases in emotional processing, and this effect is not simply a consequence of depression. It is possible that increased recognition of disgust may represent a neuropsychological marker of depressive disorders related to inflammation.
Recent studies have improved our understanding of nearshore marine ecosystems surrounding Ascension Island (central Atlantic Ocean), but little is known about Ascension's benthic environment beyond its shallow coastal waters. Here, we report the first detailed physical and biological examination of the seabed surrounding Ascension Island at 100–1000 m depth. Multibeam swath data were used to map fine scale bathymetry and derive seabed slope and rugosity indices for the entire area. Water temperature and salinity profiles were obtained from five Conductivity, Temperature, Depth (CTD) deployments, revealing a spatially consistent thermocline at 80 m depth. A camera lander (Shelf Underwater Camera System; SUCS) provided nearly 400 images from 21 sites (100 m transects) at depths of 110–1020 m, showing high variability in the structure of benthic habitats and biological communities. These surveys revealed a total of 95 faunal morphotypes (mean richness >14 per site), complemented by 213 voucher specimens constituting 60 morphotypes collected from seven targeted Agassiz trawl (AGT) deployments. While total faunal density (maximum >300 m−2 at 480 m depth) increased with rugosity, characteristic shifts in multivariate assemblage structure were driven by depth and substratum type. Shallow assemblages (~100 m) were dominated by black coral (Antipatharia sp.) on rocky substrata, cup corals (Caryophyllia sp.) and sea urchins (Cidaris sp.) were abundant on fine sediment at intermediate depths (250–500 m), and shrimps (Nematocarcinus spp.) were common at greater depths (>500 m). Other ubiquitous taxa included serpulid and sabellid polychaetes and brittle stars (Ophiocantha sp.). Cold-water corals (Lophelia cf. pertusa), indicative of Vulnerable Marine Ecosystems (VMEs) and representing substantial benthic carbon accumulation, occurred in particularly dense aggregations at <350 m but were encountered as deep as 1020 m. In addition to enhancing marine biodiversity records at this locality, this study provides critical baseline data to support the future management of Ascension's marine environment.
Salmonella is a leading cause of bacterial foodborne illness. We report the collaborative investigative efforts of US and Canadian public health officials during the 2013–2014 international outbreak of multiple Salmonella serotype infections linked to sprouted chia seed powder. The investigation included open-ended interviews of ill persons, traceback, product testing, facility inspections, and trace forward. Ninety-four persons infected with outbreak strains from 16 states and four provinces were identified; 21% were hospitalized and none died. Fifty-four (96%) of 56 persons who consumed chia seed powder, reported 13 different brands that traced back to a single Canadian firm, distributed by four US and eight Canadian companies. Laboratory testing yielded outbreak strains from leftover and intact product. Contaminated product was recalled. Although chia seed powder is a novel outbreak vehicle, sprouted seeds are recognized as an important cause of foodborne illness; firms should follow available guidance to reduce the risk of bacterial contamination during sprouting.
This article explores the three-dimensional flow structure of a streamwise-oriented vortex incident on a finite aspect-ratio wing. The vertical positioning of the incident vortex relative to the wing is shown to have a significant impact on the unsteady flow structure. A direct impingement of the streamwise vortex produces a spiralling instability in the vortex just upstream of the leading edge, reminiscent of the helical instability modes of a Batchelor vortex. A small negative vertical offset develops a more pronounced instability while a positive vertical offset removes the instability altogether. These differences in vertical position are a consequence of the upstream influence of pressure gradients provided by the wing. Direct impingement or a negative vertical offset subject the vortex to an adverse pressure gradient that leads to a reduced axial velocity and diminished swirl conducive to hydrodynamic instability. Conversely, a positive vertical offset removes instability by placing the streamwise vortex in line with a favourable pressure gradient, thereby enhancing swirl and inhibiting the growth of unstable modes. In every case, the helical instability only occurs when the properties of the incident vortex fall within the instability threshold predicted by linear stability theory. The influence of pressure gradients associated with separation and stall downstream also have the potential to introduce suction-side instabilities for a positive vertical offset. The influence of the wing is more severe for larger vortices and diminishes with vortex size due to weaker interaction and increased viscous stability. Helical instability is not the only possible outcome in a direct impingement. Jet-like vortices and a higher swirl ratio in wake-like vortices can retain stability upon impact, resulting in the laminar vortex splitting over either side of the wing.
Expert judgement has been used since the actuarial profession was founded. In the past, there has often been a lack of transparency regarding the use of expert judgement, even though those judgements could have a very significant impact on the outputs of calculations and the decisions made by organisations. The lack of transparency has a number of dimensions, including the nature of the underlying judgements, as well as the process used to derive those judgements. This paper aims to provide a practical framework regarding expert judgement processes, and how those processes may be validated. It includes a worked example illustrating how the process could be used for setting a particular assumption. It concludes with some suggested tools for use within expert judgement. Although primarily focussed on the insurance sector, the proposed process framework could be applied more widely without the need for significant changes.
Richard A. Barnes, Professor of International Law at the University of Hull Law School and Director of the McCoubrey Centre for International Law,
Vassilis P. Tzevelekos, Senior Lecturer in Public International Law at the University of Hull Law School
René Magritte's famous painting showing a pipe and painted text informing the reader that ‘[t]his is not a pipe’ is susceptible to varying interpretations. The truth of the painter's message depends on whether ‘this’ refers to the pipe depicted or to the painting. Its title, ‘The Treachery of Images’, is in a sense self-explanatory. The message on the canvas invites observers to question the painting itself, inasmuch as the pipe is not an actual pipe, but a depiction of a pipe. One might see in that self-referential work the preoccupation of the surrealist painter not to mislead his audience or to challenge our perceptions of être. Foucault used Magritte's painting to support his view that modernity falsely links reality with its visual representation. Although we might use Magritte's provocative image to highlight the distinction between law as it is (lex lata) and as it ought to be (de lege ferenda) or, indeed, between law and representations of law, this is not our main focus. Instead, the provocation reflected in our title for this introductory chapter is intended to highlight that, regardless of whether R2P is (depicted as) law or an endeavouring doctrine deprived of normative power, its representations and the narratives that flow from them may have ramifications within several areas of international law and for the general order of international law. By critically reflecting on the ideas and meaning of R2P we become engaged in the process of renewing our understanding of international law and its purposes. This is also the challenge we extended to our contributing authors: to look beyond R2P.
R2P is an ambiguous and ambitious concept in international law. Its main ambiguity concerns its legal value rather than its content. Unlike many other concepts of international law, R2P has quickly found a place within United Nations (UN) documents that define, elaborate and structure it. However, no consensus exists over its normative force for the time being. Important as this question is (especially for ‘black letter’ positivists), this is not the main concern of our book. The history of international law contains numerous examples of legal ‘ghosts’ that generated ample debate, yet never managed to cross the Rubicon of normativity.
We present the Three-mm Ultimate Mopra Milky Way Survey, a new mm-wave molecular-line mapping survey of the southern Galactic Plane, and its first data releases and science results. ThrUMMS maps a 60° × 2° sector of our Galaxy's fourth quadrant, using a combination of fast mapping techniques with the Mopra radio telescope, simultaneously in the J = 1→0 lines of 12CO, 13CO, C18O, and CN near 112 GHz, at 1′.2 and 0.3 km s−1 resolution, with 1.2 K/ch sensitivity for 12CO and 0.7 K/ch for the other transitions. The calibrated data cubes from these observations are made freely available to the community on the ThrUMMS website, http://www.astro.ufl.edu/thrumms, after processing through our pipeline. Here, we summarise the first science results, on global variations in the iso-CO line ratios and on a detailed multiwavelength study of the GMCs near l=333°.
The Murchison Widefield Array is a Square Kilometre Array Precursor. The telescope is located at the Murchison Radio–astronomy Observatory in Western Australia. The MWA consists of 4 096 dipoles arranged into 128 dual polarisation aperture arrays forming a connected element interferometer that cross-correlates signals from all 256 inputs. A hybrid approach to the correlation task is employed, with some processing stages being performed by bespoke hardware, based on Field Programmable Gate Arrays, and others by Graphics Processing Units housed in general purpose rack mounted servers. The correlation capability required is approximately 8 tera floating point operations per second. The MWA has commenced operations and the correlator is generating 8.3 TB day−1 of correlation products, that are subsequently transferred 700 km from the MRO to Perth (WA) in real-time for storage and offline processing. In this paper, we outline the correlator design, signal path, and processing elements and present the data format for the internal and external interfaces.
Efforts to understand the political implications of categorical prejudices—like racism and sexism—are complicated by the intersectional nature of social groups. Evaluating attitudes toward members of a single social category (e.g., African-Americans) in isolation can produce misleading conclusions, as racial cues commonly coincide with gender cues and create meaningful subgroups (McConnaughy and White 2014). The idea that different subgroups of women experience distinctive forms of discrimination is reflected in the concept of “double jeopardy.” Double jeopardy suggests that black and Hispanic women experience discrimination differently from white women or men of color because they simultaneously belong to a low-status gender group and a low-status racial/ethnic group (King 1988; Levin et al. 2002; cf. Sidanius and Veniegas 2000). As a result, women who are racial or ethnic minorities face a cumulative discrimination that extends beyond racism or sexism alone (King 1988; Purdie-Vaughns and Eibach 2008).
To investigate rates of septorhinoplasty and rhinoplasty in Scotland between 2006 and 2010, and to establish the impact of government legislation.
Data on the rates of rhinoplasty and septorhinoplasty were collected and analysed according to specialty, region and year.
In 2006, 754 septorhinoplasty and rhinoplasty cases were recorded (147 per million population), rising to 893 (171 per million population) in 2010. Mean annual rates per million population were 152 (87 per cent of procedures) in ENT, 13.9 (8 per cent) in plastic surgery and 8.7 (8 per cent) in oromaxillofacial surgery. After 2009, there was a 43 per cent reduction in the rhinoplasty rate (p < 0.0001), although the oromaxillofacial surgery rate increased by 68 per cent (p < 0.05). Over the same period, the septorhinoplasty rate increased in ENT (46 per cent, p < 0.0001), and declined in plastic surgery (24 per cent, p = 0.49) and oromaxillofacial surgery (45 per cent, p = 0.05). Overall, the rate for rhinoplasty plus septorhinoplasty only declined by 1 per cent. There was significant regional variation.
Overall, septorhinoplasty rates have increased and rhinoplasty rates have decreased. There was only a 1 per cent decrease in the overall rate following the 2009 legislation. Practice differs between regions.