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Restricting access to lethal means is an effective suicide prevention strategy. However, there is little discussion in the literature about the potential contribution of prescribing practices on discharge from inpatient psychiatric care (which has been established as a high-risk period for suicide) to suicide deaths by overdose of prescribed medication. This study aimed to assess the quantity, toxicity and potential lethality of psychotropic medication being prescribed on discharge from psychiatric care to those with and without indices of suicidality.
Patient demographic, clinical and prescription data were collected from 50 randomly selected charts following discharge from inpatient psychiatric care. Psychotropic medications (dose × duration) on discharge were converted to their equivalent doses of neuroleptics, antidepressants and anxiolytics to rate toxicity and potential lethality, using the Maudsley Prescribing Guidelines. Mood stabilizing medications were also documented.
39% of prescriptions analysed contained toxic and potentially fatal doses of either neuroleptic or antidepressant equivalent medication.
Patient discharge from inpatient psychiatric care presents a golden opportunity to moderate access to potentially fatal psychotropic medication. Iatrogenic provision of lethal means for suicide during a period of increased risk and in a group at increased suicide risk may impact suicide prevention efforts and requires further in-depth research. Current prescribing practices may be a missed opportunity to intervene in this regard.
Endophenotypes are laboratory-based measures hypothesized to lie in the causal chain between genes and clinical disorder, and to serve as a more powerful way to identify genes associated with the disorder. One promise of endophenotypes is that they may assist in elucidating the neurobehavioral mechanisms by which an associated genetic polymorphism affects disorder risk in complex traits. We evaluated this promise by testing the extent to which variants discovered to be associated with schizophrenia through large-scale meta-analysis show associations with psychophysiological endophenotypes.
We genome-wide genotyped and imputed 4905 individuals. Of these, 1837 were whole-genome-sequenced at 11× depth. In a community-based sample, we conducted targeted tests of variants within schizophrenia-associated loci, as well as genome-wide polygenic tests of association, with 17 psychophysiological endophenotypes including acoustic startle response and affective startle modulation, antisaccade, multiple frequencies of resting electroencephalogram (EEG), electrodermal activity and P300 event-related potential.
Using single variant tests and gene-based tests we found suggestive evidence for an association between contactin 4 (CNTN4) and antisaccade and P300. We were unable to find any other variant or gene within the 108 schizophrenia loci significantly associated with any of our 17 endophenotypes. Polygenic risk scores indexing genetic vulnerability to schizophrenia were not related to any of the psychophysiological endophenotypes after correction for multiple testing.
The results indicate significant difficulty in using psychophysiological endophenotypes to characterize the genetically influenced neurobehavioral mechanisms by which risk loci identified in genome-wide association studies affect disorder risk.
The emergence of invasive fungal wound infections (IFIs) in combat casualties led to development of a combat trauma-specific IFI case definition and classification. Prospective data were collected from 1133 US military personnel injured in Afghanistan (June 2009–August 2011). The IFI rates ranged from 0·2% to 11·7% among ward and intensive care unit admissions, respectively (6·8% overall). Seventy-seven IFI cases were classified as proven/probable (n = 54) and possible/unclassifiable (n = 23) and compared in a case-case analysis. There was no difference in clinical characteristics between the proven/probable and possible/unclassifiable cases. Possible IFI cases had shorter time to diagnosis (P = 0·02) and initiation of antifungal therapy (P = 0·05) and fewer operative visits (P = 0·002) compared to proven/probable cases, but clinical outcomes were similar between the groups. Although the trauma-related IFI classification scheme did not provide prognostic information, it is an effective tool for clinical and epidemiological surveillance and research.
We observed several swarms of repeating low-frequency (1–5 Hz) seismic events during a 3 week period in May–June 2010, near the summit of Mount Rainier, Washington, USA, that likely were a result of stick–slip motion at the base of alpine glaciers. The dominant set of repeating events (‘multiplets’) featured >4000 individual events and did not exhibit daytime variations in recurrence interval or amplitude. Volcanoes and glaciers around the world are known to produce seismic signals with great variability in both frequency content and size. The low-frequency character and periodic recurrence of the Mount Rainier multiplets mimic long-period seismicity often seen at volcanoes, particularly during periods of unrest. However, their near-surface location, lack of common spectral peaks across the recording network, rapid attenuation of amplitudes with distance, and temporal correlation with weather systems all indicate that ice-related source mechanisms are the most likely explanation. We interpret the low-frequency character of these multiplets to be the result of trapping of seismic energy under glacial ice as it propagates through the highly heterogeneous and attenuating volcanic material. The Mount Rainier multiplet sequences underscore the difficulties in differentiating low-frequency signals due to glacial processes from those caused by volcanic processes on glacier-clad volcanoes.
Youth and young adult suicide has increasingly appeared on international vital statistics as a rising trend of concern in age-specific mortality over the past 50 years. The reporting of suicide deaths in 5-year age bands, which has been the international convention to date, may mask a greater understanding of year-on-year factors that may accelerate or ameliorate the emergence of suicidal thoughts, acts and fatal consequences. The study objective was to identify any year-on-year period of increased risk for youth and young adult suicide in the UK and Ireland.
Collation and examination of international epidemiological datasets on suicide (aged 18–35) for the UK and Ireland 2000–2006 (N = 11 964). Outcome measures included the age distribution of suicide mortality in international datasets from the UK and Ireland, 2000–2006.
An accelerated pattern of risk up to the age of 20 for the UK and Ireland which levels off moderately thereafter was uncovered, thus identifying a heretofore unreported age-related epidemiological transition for suicide.
The current reporting of suicide in 5-year age bands may conceal age-related periods of risk for suicide. This may have implications for suicide prevention programmes for young adults under age 21.
We assess and compare: (a) the attitudes of final-year medical students in 2010 to their 1994 counterparts; (b) the attitudes of third-year medical students with those of their final-year colleagues; (c) the impact of two different teaching modules on students' attitudes. All students completing the year 3 psychiatry preclinical module and the final-year clinical clerkship were asked to anonymously complete three well-validated attitudinal questionnaires on the first and final day of their module in psychiatry.
These data indicate that Irish medical students have a positive attitude to psychiatry even prior to the start of their clinical training in psychiatry. This attitude is significantly more positive now than it was in 1994. A positive attitudinal change was brought about only by the final-year psychiatric clerkship. Students who have completed a degree prior to medicine are less likely to express an interest in a career in psychiatry.
If we are to address the recruitment difficulties in psychiatry we need to look at innovative and specific ways of translating these positive attitudes into careers in psychiatry.
Glyphosate is widely used for weed control in the grape growing industry in southern Australia. The intensive use of glyphosate in this industry has resulted in the evolution of glyphosate resistance in rigid ryegrass. Two populations of rigid ryegrass from vineyards, SLR80 and SLR88, had 6- to 11-fold resistance to glyphosate in dose-response studies. These resistance levels were higher than two previously well-characterized glyphosate-resistant populations of rigid ryegrass (SLR77 and NLR70), containing a modified target site or reduced translocation, respectively. Populations SLR80 and SLR88 accumulated less glyphosate, 12 and 17% of absorbed glyphosate, in the shoot in the resistant populations compared with 26% in the susceptible population. In addition, a mutation within the target enzyme 5-enolpyruvylshikimate-3-phosphate synthase (EPSPS) where Pro106 had been substituted by either serine or threonine was identified. These two populations are more highly resistant to glyphosate as a consequence of expressing two different resistance mechanisms concurrently.
There are many reasons why agricultural researchers carefully evaluate approaches to experimental data analysis. Agricultural experiments are typically highly complex, with many types of variables often collected at a wide range of temporal and spatial scales. Furthermore, research in the developing world is often conducted on-farm where simple and conventional experimental designs are often unsuitable. Recently, a variant of stochastic dominance called stochastic efficiency with respect to a function (SERF) has been developed and used to analyse long-term experimental data. Unlike traditional stochastic dominance approaches, SERF uses the concept of certainty equivalents (CEs) to rank a set of risk-efficient alternatives instead of finding a subset of dominated alternatives. This study evaluates the efficacy of the SERF methodology for analysing conventional and conservation tillage systems using 14 years (1990–2003) of economic budget data collected from 36 experimental plots at the Iowa State University Northeast Research Station near Nashua, IA, USA. Specifically, the SERF approach is used to examine which of two different tillage systems (chisel plough and no-till) on continuous corn (Zea mays) and corn/soyabean (Glycine max) rotation cropping systems are the most risk-efficient in terms of maximizing economic profitability (gross margin and net return) by crop across a range of risk aversion preferences. In addition to the SERF analysis, we also conduct an economic analysis of the tillage system alternatives using mean-standard deviation and coefficient of variation for ranking purposes. Decision criteria analysis of the economic measures alone provided somewhat contradictive and non-conclusive rankings, e.g. examination of the decision criteria results for gross margin and net return showed that different tillage system alternatives were the highest ranked depending on the criterion and the cropping system (e.g. individual or rotation). SERF analysis results for the tillage systems were also dependent on the cropping system (individual, rotation or whole-farm combined) and economic outcome of interest (gross margin or net return) but only marginally on the level of risk aversion. For the individual cropping systems (continuous corn, rotation corn and rotation soyabean), the no-till tillage and rotation soyabean system was the most preferred and the chisel plough tillage and continuous corn system the least preferred across the entire range of risk aversion for both gross margin and net return. The no-till tillage system was preferred to the chisel plough tillage system when ranking within the continuous corn and the corn-soyabean rotation cropping systems for both gross margin and net return. Finally, when analysing the tillage system alternatives on a whole-farm basis (i.e. combined continuous corn and corn-soybean rotation), the no-till tillage system was clearly preferred to the chisel plough tillage system for both gross margin and net return. This study indicates that the SERF method appears to be a useful and easily understood tool to assist farm managers, experimental researchers and, potentially, policy makers and advisers on problems involving agricultural risk.
We begin our investigation of the research laboratories by focusing on the overarching purpose for which they were created: to solve complex, interdisciplinary problems. Activities surrounding problem solving drive much of what transpires in these research labs. It has long been a central assumption of cognitive studies of science and technology that the cognitive resources scientists bring to bear in problem solving are not different in kind from those used in more ordinary instances, but rather lie along a continuum. Construing the problem-solving strategies that scientists have developed as sophisticated, highly reflective outgrowths of ordinary reasoning and representational practices allows researchers in this area to both draw from and inform the study of the nature of cognition.
The idea that problem solving plays a significant role in cognitive processes has been central to cognitive psychology since its emergence in the mid-20th century. Earlier, however, the notion that problem solving is an important part of the processes involved in learning, creativity, insight, and cognitive/conceptual change was represented in Dewey's analysis of the essential elements of effective pedagogy in How We Think:
The best, indeed the only preparation is arousal to a perception of something that needs explanation, something unexpected, puzzling, peculiar. When the feeling of a genuine perplexity lays hold of any mind (no matter how the feeling arises), that mind is alert and inquiring, because stimulated from within. The shock, the bite, of a question will force the mind to go wherever it is capable of going, better than will the most ingenious pedagogical devices unaccompanied by this mental ardor. […]
In this chapter we consider the role of emotion in research practices by examining a class of expressions we have coded and analyzed as implicating emotion, affect, or motivation in the interview data. As noted, this book with its current focus was not planned at the time we began to analyze interview data, and we did not approach coding with the explicit goal of identifying expressions of this kind within the interviews conducted. However, while we were seeking to describe and code cognitive practices as evidenced in the interviews, we found striking examples of interview text that did not fit traditional cognitive categories, but seemed rather to have an affective or emotional tone. Other passages seemed expressive of desires, goals, and aspirations. Although not clearly cognitive, passages of these kinds seemed intimately related to and interwoven with accounts of problem formulation and solving, leading us eventually to code “affect/motivation” as a higher-order category and for this book to include it in the domain of general sense-making that is characteristic of laboratory activity. As Thagard remarked recently, “Affect is a natural subject for a dynamical theory that emphasizes the flow of thought and the complex interactions of emotion and cognition” (2008, p. 51). We also found that affective, emotional, and motivational expressions related intimately to identity formations, as is discussed in some detail in the next chapter.
Importantly, we assigned codes for affective and motivational expressions in both laboratories (A and D) and across levels of expertise, from PI to novice.
In this chapter we describe the contexts of science practice that we studied and the approaches to the data collection and analysis that are the basis of this text. Along the way we note methodological issues and controversies as they relate to our analysis and apply more generally to the use of qualitative methods in psychology. Thus this chapter is comparable to the methods section of a traditional research study, but it contains departures in form in keeping with the theoretical aims of this text.
PARTICIPANTS, CONTEXT, AND HISTORY
Our framing assumption is that the cognitive practices of the laboratory are both situated in the laboratory and distributed across systems of interacting persons, artifacts, instruments, and traditions. The situated approach to cognition construes intelligent behavior as arising within particular settings such that its features are dependent on that setting, in contrast with a view of cognition as an abstract realm or self-regulating process. The assertion is that “problem solving is carried out in conjunction with the environment” (Brown, Collins, & Duguid, 1989, p. 36, emphasis added). By distributed, we mean that we regard brain and environment as co-constituting a single complex system, inasmuch as the forms of sense-making and problem solving that occur would not be possible in isolation from that environment, including the social environment.
George Kelly used “scientist” as a metaphor for “person” to emphasize that understanding science practice – how scientists think and what they do – enables us to understand human nature more profoundly. In turn, understanding human nature invites critical appraisal of our notions of science as an activity of persons:
Psychologists are likely to be very much in earnest about making their discipline into a science. (Unfortunately, not many are as concerned as they might be about making science into something.)…But what would happen if one were to envision all human endeavor in those same terms the psychologists have found so illuminating in explaining themselves to their students? And indeed, might it not be that in doing so one would see the course of individual life, as well as human progress over the centuries, in clearer perspective? Scientists are men, and while it does not follow that men are scientists, it is quite appropriate to ask if it is not their human character that makes scientists what they are. This leads us to the question of how that human character can be better construed so as to account for scientists, and whether our construction can still explain as well the accomplishments that fall far short of what we, at this transient moment in our history, think good science is (George Kelly, unpublished manuscript quoted in Bannister & Mair, 1968, pp. 2–3).
In the previous chapter we examined emotion in terms of sense-making because of its intricate interrelation with cognitive practices evidenced in the laboratories. We now turn to a topic closely related to emotion: identity. Like emotion, the topic of identity is critical to any focus on the acting person, the central unit of analysis we embrace. In contemporary theory identity frequently emerges as a form of action, accomplishment, display, or performance situated within networks of meanings and practices; people identify as or with various options. Because performances are many and varied, the term “identities” might be more accurate to the subject matter.
As was the case for emotion, this subject matter is vital to our interest in avoiding both social and cognitive reductionism in analyzing the practices of the biomedical engineering laboratory communities. Wenger, for whom identity is of central concern in Communities of Practice (1998), noted that “the concept of identity serves as a pivot between the social and the individual, so that each can be talked about in terms of the other. It avoids a simplistic individual-social dichotomy without doing away with the distinction…it is the social, the cultural, the historical with a human face” (Wenger, 1998, p. 145). Even more strongly, he argued that “the formation of a community of practice is also the negotiation of identities” (p. 149).