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Out of hours, there is only one on-site junior doctor. First year psychiatry trainees (CT1s) and GP trainees may have no prior experience in psychiatry. On-call shifts are therefore potentially daunting for new trainees.
Expand the resources available for trainees when on-call.
We issued questionnaires to CT1s asking if they would have appreciated more information about on-call scenarios and in what format.
Based on the questionnaire results we implemented some changes. These were:
– a printed “pocket-guide” summarising common on-call scenarios;
– a training video on common on-call scenarios.
The handout was given to new trainees in February 2016 and in August 2016. The video was shown to new trainees in August 2016. Trainees provided feedback on the resources.
Of 24 CT1s, 15 (63%) were “neutral” or “disagreed” that they had felt prepared for on-calls.
CT1s wanted additional resources, especially a paper handout or phone download.
Feedback on the “pocket-guide” from trainees in February 2016 (n = 8) was positive (62.5% reported increased confidence in on-call situations). Feedback is also being collected from trainees who received the guide in August 2016.
Trainees in August 2016 (n = 36) liked the video – no trainees “disagreed” with statements asking if the video had been useful.
The video improved the confidence of trainees about on-call situations by an average of 2.8 points.
We have expanded available resources relating to on-calls and improved confidence. Further improvements would include making resources more easily available in downloadable formats.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Subjective well-being in older people is strongly associated with emotional, physical and mental health. This study investigates subjective well-being in older adults in Ireland before and after the economic recession that commenced in 2008.
Cross-sectional data from the biennial European Social Survey (2002–2012) were analysed for two separate groups of older adults: one sampled before the recession and one after. Stratification and linear regression modelling were used to analyse the association between subjective well-being, the recession and multiple potential confounders and effect modifiers.
Data were analysed on 2013 individuals. Overall, subjective well-being among older adults was 1.30 points lower after the recession compared with before the recession (s.e. 0.16; 95% confidence interval 1.00–1.61; p<0.001) [pre-recession: 16.1, out of a possible 20 (s.d. 3.24); post-recession:14.8 (s.d. 3.72)]. Among these older adults, the pre- and post-recession difference was especially marked in women, those with poor health and those living in urban areas.
Subjective well-being was significantly lower in older adults after the recession compared with before the recession, especially in women with poor health in urban areas. Policy-makers need proactively to protect these vulnerable cohorts in future health and social policy. Future research could usefully focus on older people on fixed incomes whose diminished ability to alter their economic situation might make them more vulnerable to reduced subjective well-being during a recession.
Major depressive disorder (MDD) is a common and disabling condition with well-established heritability and environmental risk factors. Gene–environment interaction studies in MDD have typically investigated candidate genes, though the disorder is known to be highly polygenic. This study aims to test for interaction between polygenic risk and stressful life events (SLEs) or childhood trauma (CT) in the aetiology of MDD.
The RADIANT UK sample consists of 1605 MDD cases and 1064 controls with SLE data, and a subset of 240 cases and 272 controls with CT data. Polygenic risk scores (PRS) were constructed using results from a mega-analysis on MDD by the Psychiatric Genomics Consortium. PRS and environmental factors were tested for association with case/control status and for interaction between them.
PRS significantly predicted depression, explaining 1.1% of variance in phenotype (p = 1.9 × 10−6). SLEs and CT were also associated with MDD status (p = 2.19 × 10−4 and p = 5.12 × 10−20, respectively). No interactions were found between PRS and SLEs. Significant PRSxCT interactions were found (p = 0.002), but showed an inverse association with MDD status, as cases who experienced more severe CT tended to have a lower PRS than other cases or controls. This relationship between PRS and CT was not observed in independent replication samples.
CT is a strong risk factor for MDD but may have greater effect in individuals with lower genetic liability for the disorder. Including environmental risk along with genetics is important in studying the aetiology of MDD and PRS provide a useful approach to investigating gene–environment interactions in complex traits.
The main objectives were to assess medical students’ opinions about e-learning in psychiatry undergraduate medical education, and to investigate a possible relationship between learning styles and preferences for learning modalities.
During the academic year 2009/2010, all 231 senior Royal College of Surgeons in Ireland (RCSI) medical students in their penultimate year of study were invited to answer a questionnaire that was posted online on Moodle, the RCSI virtual learning environment.
In all, 186 students responded to the questionnaire, a response rate of 80%. Significantly more students stated a preference for live psychiatry tutorials over e-learning lectures. Students considered flexible learning, having the option of viewing material again and the ability to learn at one’s own pace with e-learning lectures, to be more valuable than having faster and easier information retrieval.
Students prefer traditional in-class studying, even when they are offered a rich e-learning environment. Understanding students’ learning styles has been identified as an important element for e-learning development, delivery and instruction, which can lead to improved student performance.
Graduate entry medical students’ views of psychiatry may differ from those of school leavers. This study hypothesised that (i) exposure to a psychiatry attachment is associated with a positive change in attitudes towards psychiatry in both graduate entry and non-graduate entry students, (ii) graduate entry students exhibit a more positive attitude to psychiatry compared to non-graduate entry students and (iii) graduate entry students are more interested in a career in psychiatry than non-graduate entry students.
In this study 247 medical students (118 females and 129 males) completing their psychiatry rotation were invited to complete questionnaires examining career choice, attitudes to psychiatry and career attractiveness for a range of specialties including surgery, medicine, general practice and psychiatry before and after their psychiatry attachment. Questionnaires were distributed prior to commencement of their attachment and redistributed on the final day of the attachment.
Of the 165 participants in the study, 75 students entered medicine via the traditional route (without a primary degree), 49 entered via the graduate entry programme and 41 had a primary degree. Overall, medical students displayed positive attitudes towards psychiatry. However, while there was an improvement in attitudes towards psychiatry and the career attractiveness of psychiatry on completion of the rotation, no differences were found between graduate and non-graduate entry students. Psychiatry and general practice had lower ratings for career attractiveness than other specialities. No significant changes were found in the first and second choice of specialty.
Our results show that improvements in attitude and career attractiveness do not necessarily correlate with increased choice of psychiatry as a specialty. Graduate entry has been considered a possible opportunity for increasing recruitment in psychiatry but our results suggest that this may not be the case. Follow-up studies are required to determine whether career attractiveness correlates with future career choice.
Sleep loss produces abnormal increases in reward seeking but the mechanisms underlying this phenomenon are poorly understood. The present study examined the influence of one night of sleep deprivation on neural responses to a monetary reward task in a sample of late adolescents/young adults.
Using a within-subjects crossover design, 27 healthy, right-handed late adolescents/young adults (16 females, 11 males; mean age 23.1 years) underwent functional magnetic resonance imaging (fMRI) following a night of sleep deprivation and following a night of normal sleep. Participants' recent sleep history was monitored using actigraphy for 1 week prior to each sleep condition.
Following sleep deprivation, participants exhibited increased activity in the ventral striatum (VS) and reduced deactivation in the medial prefrontal cortex (mPFC) during the winning of monetary reward, relative to the same task following normal sleep conditions. Shorter total sleep time over the five nights before the sleep-deprived testing condition was associated with reduced deactivation in the mPFC during reward.
These findings support the hypothesis that sleep loss produces aberrant functioning in reward neural circuitry, increasing the salience of positively reinforcing stimuli. Aberrant reward functioning related to insufficient sleep may contribute to the development and maintenance of reward dysfunction-related disorders, such as compulsive gambling, eating, substance abuse and mood disorders.
Patients with major depressive disorder (MDD) present with highly heterogeneous symptom profiles. We aimed to examine whether individual differences in amygdala activity to emotionally salient stimuli were related to heterogeneity in lifetime levels of depressive and subthreshold manic symptoms among adults with MDD.
We compared age- and gender-matched adults with MDD (n = 26) with healthy controls (HC, n = 28). While undergoing functional magnetic resonance imaging, participants performed an implicit emotional faces task: they labeled a color flash superimposed upon initially neutral faces that dynamically morphed into one of four emotions (angry, fearful, sad, happy). Region of interest analyses examined group differences in amygdala activity. For conditions in which adults with MDD displayed abnormal amygdala activity versus HC, within-group analyses examined amygdala activity as a function of scores on a continuous measure of lifetime depression-related and mania-related pathology.
Adults with MDD showed significantly greater right-sided amygdala activity to angry and happy conditions than HC (p < 0.05, corrected). Multiple regression analyses revealed that greater right-amygdala activity to the happy condition in adults with MDD was associated with higher levels of subthreshold manic symptoms experienced across the lifespan (p = 0.002).
Among depressed adults with MDD, lifetime features of subthreshold mania were associated with abnormally elevated amygdala activity to emerging happy faces. These findings are a first step toward identifying biomarkers that reflect individual differences in neural mechanisms in MDD, and challenge conventional mood disorder diagnostic boundaries by suggesting that some adults with MDD are characterized by pathophysiological processes that overlap with bipolar disorder.
Individuals with bipolar disorder demonstrate abnormal social function. Neuroimaging studies in bipolar disorder have shown functional abnormalities in neural circuitry supporting face emotion processing, but have not examined face identity processing, a key component of social function. We aimed to elucidate functional abnormalities in neural circuitry supporting face emotion and face identity processing in bipolar disorder.
Twenty-seven individuals with bipolar disorder I currently euthymic and 27 healthy controls participated in an implicit face processing, block-design paradigm. Participants labeled color flashes that were superimposed on dynamically changing background faces comprising morphs either from neutral to prototypical emotion (happy, sad, angry and fearful) or from one identity to another identity depicting a neutral face. Whole-brain and amygdala region-of-interest (ROI) activities were compared between groups.
There was no significant between-group difference looking across both emerging face emotion and identity. During processing of all emerging emotions, euthymic individuals with bipolar disorder showed significantly greater amygdala activity. During facial identity and also happy face processing, euthymic individuals with bipolar disorder showed significantly greater amygdala and medial prefrontal cortical activity compared with controls.
This is the first study to examine neural circuitry supporting face identity and face emotion processing in bipolar disorder. Our findings of abnormally elevated activity in amygdala and medial prefrontal cortex (mPFC) during face identity and happy face emotion processing suggest functional abnormalities in key regions previously implicated in social processing. This may be of future importance toward examining the abnormal self-related processing, grandiosity and social dysfunction seen in bipolar disorder.
Core-shell PLLA microparticles were successfully fabricated using a novel
coaxial nozzle design. These particles were synthesized with different
components in the core/shell layers representing three classes of systems of
interest for drug delivery applications: PVA/PLLA, PLLA/PEG, and oleic
acid/PLLA. The components were characterized for their physical properties
and interfacial energies, and optimal conditions for the operation were
determined. To facilitate the particle characterization, each phase was
doped with a different fluorescent dye to aid in the confirmation of a
core/shell structure via fluorescence microscopy.
Depression in the context of bipolar disorder (BDd) is often misdiagnosed as unipolar disorder depression (UDd) leading to poor clinical outcomes for many bipolar sufferers. We examined neural circuitry supporting emotion regulation in females with either BDd or UDd as a first stage toward identifying biomarkers that may differentiate BDd from UDd.
Fifty-seven females aged 18–45 years participated in this study: 23 with UDd, 18 with bipolar disorder type I depression (BDId) and 16 healthy females. During 3-T functional magnetic resonance imaging (fMRI), the participants performed an emotional face n-back (EFNBACK) task, that is an n-back task with high (2-back) and low (0-back) memory load conditions flanked by two positive, negative or neutral face distracters. This paradigm examines executive control with emotional distracters–emotion regulation.
High memory load with neutral face distracters elicited greater bilateral and left dorsal anterior midcingulate cortex (dAMCC) activity in UDd than in healthy and BDId females respectively, and greater bilateral putamen activity in both depressed groups versus healthy females. High memory load with happy face distracters elicited greater left putamen activity in UDd than in healthy females. Psychotropic medication was associated with greater putamen activity to these contrasts in UDd females.
During high memory load with neutral face distracters, elevated dAMCC activity in UDd suggests abnormal recruitment of attentional control circuitry to maintain task performance, whereas elevated putamen activity unrelated to psychotropic medication in BDId females may suggest an attentional bias toward ambiguous neutral face distracters. Differential patterns of functional abnormalities in neural circuitry supporting attentional control during emotion regulation, especially in the dAMCC, is a promising neuroimaging measure to distinguish UDd from BDId in females.
In this investigation, an apatite/collagen composite coating was formed at 37C on a NiTi shape memory alloy (SMA) through electrochemical deposition using double-strength simulated body fluid (2SBF) which contained dissolved collagen. Surface characteristics, wettability and stability of the composite coating were subsequently studied. Scanning electron microscope (SEM) examination of the surface of composite coatings revealed that many collagen fibers were embedded in apatite with flake-like structure and apatite nanocrystals nucleated and grew on collagen fibrils. Energy dispersive X-ray (EDX) spectroscopy analysis showed that the Ca : P ratio of the composite coating was about 1.35, which is close to that of octocalcium phosphate. Transmission electron microscopy (TEM) and Fourier transform infrared spectroscopy (FTIR) analysis were also conducted for the composite coating. Compared to bare NiTi SMA samples, the potentiodynamic polarization curves of NiTi SMA samples with the composite coating displayed lower corrosion current density, more positive corrosion and breakdown potential, suggesting that the composite coating was chemically stable and provided corrosion resistance for NiTi SMA.
Poly(butylene fumerate) (PBF) and poly(butylene fumerate)-co-(butylene maleate) (PBFcBM) have been synthesized from the ring opening and condensation reactions of maleic anhydride (MA) and 1,3-butanediol (BD). PBFcBM synthesized in this way contains greater than 85% maleate groups. Both PBF and PBFcBM have a glass transition temperature (Tg) below room temperature and therefore cannot be electrospun using the conventional electrospinning process as a non-porous film results. To facilitate production of nonwoven micro- and nano-fiber mats, a UV-source (λ=356 nm) was used in combination with a photoinitator loaded polymer solution to initiate the crosslinking reaction of the fumerate and maleate functional groups as the fibers were produced. The resulting non-woven fiber mats are potentially suitable scaffolds for tissue engineering and drug delivery application.
A facile electrophoretic deposition method was successfully applied to achieve novel nanoclay-reinforced polyacrylamide nanocomposite thin films. A special curled architecture of the re-aggregated nanoclay-platelets was identified, providing a possible source for realizing the interlocking mechanism in the nanocomposites. The curled architecture could be the result from strain releasing when the thin films were peeled off from the substrates. Through micro-/nano-indentation and in situ observation of the deformation during tensile test with an atomic force microscope (AFM), the localized deformation mechanism of the synthesized materials was investigated in further details. The results implied that a localized crack diversion mechanism worked in the synthesized nanocomposite thin films, which resembled its nature counterpart-nacre. The deformation behavior and fracture mechanism were discussed with reference to lamellar structure, interfacial strength between the nanoclays and the polyacrylamide matrix, and nanoclay agglomeration.
The extracellular matrix plays a crucial role in defining the mechanical properties of connective tissues like cornea, heart, tendon, bone and cartilage among many others. The unique properties of these collagenous tissues arise because of both the hierarchal structure of collagens and the presence of negatively charged proteoglycans (PGs) which hold collagen fibers together. Here, in an effort to understand the mechanics of these structures, using the nonlinear Poison-Boltzmann (PB) equation, we study the electrostatic contribution to the elasticity of corneal stroma due to the presence of negatively charged PG glycosminoglycans (GAGs). Since collagens and GAGs have a regular hexagonal arrangement inside the corneal stroma, a triangular unit cell is chosen. The finite element method is used to solve the PB equation inside this domain and to obtain the electric potential and ionic distributions. Having the ion and potential distributions throughout the unit cell, the electrostatic free energy is computed and the tissue elasticity is calculated using the energy method. It is shown that as the ionic bath concentration increases; the electrostatic contribution to tissue elasticity is reduced.
Over the past twenty years, the use of rapid prototyping techniques for processing of medical devices has seen rapid growth. A number of rapid prototyping techniques currently exist for producing a broad range of medical devices using metals, ceramics, polymers, and composite materials. One promising rapid prototyping technology for creating medical devices with small scale features is two photon polymerization; this scalable photopolymerization technique enables processing of photosensitive materials such as organically-modified ceramic materials. In this study, two photon polymerization was used to produce microneedles that mimic the anatomy of the mosquito fascicle. The labrum of the mosquito was replicated in the mosquito-like microneedle. On the other hand, the maxillae of the mosquito were not replicated in the mosquito-like microneedle; the absence of these features was attributed to inadequate mechanical support of the maxillae. This study suggests that two photon polymerization and other rapid prototyping technologies may be used to produce biomimetic drug delivery devices that imitate the intricate structures found in nature.
We report the structural transformation and the transport studies of Silver doped hydroxyapatites Ca10-xAgx(PO4)6(OH)2 (0.0 ≤ x ≤ 1.5). A dramatic increase in the conductivity by two orders of magnitude for hydroxyapatite in presence of silver ions is recorded using impedance spectroscopy measurements in the temperature range of 450°C to 650°C. The characteristic surface plasmon resonance effect is used to explore the presence of silver nano-particles, and Ag+ ions in hydroxyapatite using optical absorption measurements. The activation energy has been found to be 0.07 eV in silver doped composition in comparison to 0.39 eV for the parent hydroxyapatite. The sintering temperature dependence and compositional variation on the structural transformations from hydroxyapatite into tricalcium phosphate phases have been explored using Raman Spectroscopy and X-ray diffraction techniques.