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While negative affect reliably predicts binge eating, it is unknown how this association may decrease or ‘de-couple’ during treatment for binge eating disorder (BED), whether such change is greater in treatments targeting emotion regulation, or how such change predicts outcome. This study utilized multi-wave ecological momentary assessment (EMA) to assess changes in the momentary association between negative affect and subsequent binge-eating symptoms during Integrative Cognitive Affective Therapy (ICAT-BED) and Cognitive Behavior Therapy Guided Self-Help (CBTgsh). It was predicted that there would be stronger de-coupling effects in ICAT-BED compared to CBTgsh given the focus on emotion regulation skills in ICAT-BED and that greater de-coupling would predict outcomes.
Adults with BED were randomized to ICAT-BED or CBTgsh and completed 1-week EMA protocols and the Eating Disorder Examination (EDE) at pre-treatment, end-of-treatment, and 6-month follow-up (final N = 78). De-coupling was operationalized as a change in momentary associations between negative affect and binge-eating symptoms from pre-treatment to end-of-treatment.
There was a significant de-coupling effect at follow-up but not end-of-treatment, and de-coupling did not differ between ICAT-BED and CBTgsh. Less de-coupling was associated with higher end-of-treatment EDE global scores at end-of-treatment and higher binge frequency at follow-up.
Both ICAT-BED and CBTgsh were associated with de-coupling of momentary negative affect and binge-eating symptoms, which in turn relate to cognitive and behavioral treatment outcomes. Future research is warranted to identify differential mechanisms of change across ICAT-BED and CBTgsh. Results also highlight the importance of developing momentary interventions to more effectively de-couple negative affect and binge eating.
Levamisole is an increasingly common cutting agent used with cocaine. Both cocaine and levamisole can have local and systemic effects on patients.
A retrospective case series was conducted of patients with a cocaine-induced midline destructive lesion or levamisole-induced vasculitis, who presented to a Dundee hospital or the practice of a single surgeon in Paisley, from April 2016 to April 2019. A literature review on the topic was also carried out.
Nine patients from the two centres were identified. One patient appeared to have levamisole-induced vasculitis, with raised proteinase 3, perinuclear antineutrophil cytoplasmic antibodies positivity and arthralgia which improved on systemic steroids. The other eight patients had features of a cocaine-induced midline destructive lesion.
As the use of cocaine increases, ENT surgeons will see more of the complications associated with it. This paper highlights some of the diagnostic issues and proposes a management strategy as a guide to this complex patient group. Often, multidisciplinary management is needed.
Introduction: Determining fluid status prior to resuscitation provides a more accurate guide for appropriate fluid administration in the setting of undifferentiated hypotension. Emergency Department (ED) point of care ultrasound (PoCUS) has been proposed as a potential non-invasive, rapid, repeatable investigation to ascertain inferior vena cava (IVC) characteristics. Our goal was to determine the feasibility of using PoCUS to measure IVC size and collapsibility. Methods: This was a planned secondary analysis of data from a prospective multicentre international study investigating PoCUS in ED patients with undifferentiated hypotension. We prospectively collected data on IVC size and collapsibility using a standard data collection form in 6 centres. The primary outcome was the proportion of patients with a clinically useful (determinate) scan defined as a clearly visible intrahepatic IVC, measurable for size and collapse. Descriptive statistics are provided. Results: A total of 138 scans were attempted on 138 patients; 45.7% were women and the median age was 58 years old. Overall, one hundred twenty-nine scans (93.5%; 95% CI 87.9 to 96.7%) were determinate. 131 (94.9%; 89.7 to 97.7%) were determinate for IVC size, and 131 (94.9%; 89.7 to 97.7%) were determinate for collapsibility. Conclusion: In this analysis of 138 ED patients with undifferentiated hypotension, the vast majority of PoCUS scans to investigate IVC characteristics were determinate. Future work should include analysis of the value of IVC size and collapsibility in determining fluid status in this group.
This is a secondary analysis of clinical trial data collected in 12 European countries. We examined changes in weight and weight-related quality of life among community patients with schizophrenia treated with aripiprazole (ARI) versus standard of care (SOC), consisting of other marketed atypical antipsychotics (olanzapine, quetiapine, and risperidone).
Five-hundred and fifty-five patients whose clinical symptoms were not optimally controlled and/or experienced tolerability problems with current medication were randomized to ARI (10–30 mg/day) or SOC. Weight and weight-related quality of life (using the IWQOL-Lite) were assessed at baseline, and weeks 8, 18 and 26. Random regression analysis across all time points using all available data was used to compare groups on changes in weight and IWQOL-Lite. Meaningful change from baseline was also assessed.
Participants were 59.7% male, with a mean age of 38.5 years (SD 10.9) and mean baseline body mass index of 27.2 (SD 5.1). ARI participants lost an average of 1.7% of baseline weight in comparison to a gain of 2.1% by SOC participants (p < 0.0001) at 26 weeks. ARI participants experienced significantly greater increases in physical function, self-esteem, sexual life, and IWQOL-Lite total score. At 26 weeks, 20.7% of ARI participants experienced meaningful improvements in IWQOL-Lite score, versus 13.5% of SOC participants. A clinically meaningful change in weight was also associated with a meaningful change in quality of life (p < 0.001). A potential limitation of this study was its funding by a pharmaceutical company.
Compared to standard of care, patients with schizophrenia treated with aripiprazole experienced decreased weight and improved weight-related quality of life over 26 weeks. These changes were both statistically and clinically significant.
[Improvement in daily accessible risk assessments]
We show enhanced patient safety through a quality improvement methodology project in an intensive psychiatric care unit of a psychiatric hospital in southwest of Scotland. This is a project as part of the national patient safety programme in mental health. The Scottish Patient Safety Programme for Mental Health aims to systematically reduce harm experienced by people using mental health services in Scotland, by supporting frontline staff to test, gather real-time data and reliably implement interventions, before spreading across their catchment area.
Multidisciplinary staff worked together in improving recording of daily electronic and paper based risk assessments from a baseline of 20% to nearly 100% over a sixth month period. We expect better quality risk management by readily accessible risk assessments and safe practise through enhanced safety perception by the patients as well as staff. Patient and staff safety perception tools were designed to measure impact of improvement in risk management. We have seen drop in the number of critical incidents and challenging situations requiring restraint following coordinated approach to risk assessment and easy access to key information. We have been successful as the frontline staff became part of the process of change and this has enabled sustained improvement.
Psychological risk factors that lead to impaired work performance, negatively impacting mental and physical health, have emerged as a concern across clinical settings. Although depression and anxiety are linked to poor physician mental health, physician burnout characterized by work related stress due to chronic exhaustion from clinical work, cynicism toward meaning of the medical profession, and feelings of inadequacy toward work related accomplishments, may be an even stronger indicator of well-being. Literature suggests that work satisfaction among physicians is rapidly deteriorating owing to high rates of burnout and poor mental health. Although the relationship between work burnout (WB) and negative affectivity has been well documented, the association with positive affect, such as trait forgiveness (TF) has been overlooked. On that note, research shows that lifetime stress severity and lower levels of forgiveness predict worse mental and physical health. Since TF has been linked strongly with healthy workplace relationships, positive occupational outcomes and general well-being, its association with WB remains to be investigated. Therefore, the aim of the present study was to explore the link between TF and WB among physicians. We hypothesized that TF would be associated with reduced levels of burnout.
A total of 62 (F=23) medical residents at a Teaching Hospital consented for the study. Residents were administered surveys on WB (Maslach Burnout Inventory), workplace bullying, personal bullying (PB), interpersonal rejection sensitivity (IRS), perceived stress scale (PSS), TF, anxiety, and depression, all of which were anonymously submitted via electronically. Hierarchical multiple regression (HMR) models were used to determine the associations between WB, work environment social factors and TF. A p-value of <0.05 was considered significant.
The mean age 33.1 ± SD 4.2 years. HMR analysis using WB as main outcome contained 6 predictors: Model 1 contained depression and anxiety, Model 2 added PB, Model 3 added IRS and PSS, Model 4 added TF. Anxiety and TF were the only significant predictors (p= >0.05) accounting for 10.4% and 17.5% of the variance in WB scores, respectively.
The novel finding of the present study is that TF was associated with low levels of burnout. Additionally, WB was found to be linked to anxiety and depression which is in line with previous research. These data suggest that TF could be a potential resolution to the deleterious influence of burnout. Further exploration is needed in order to understand the psychology of forgiveness as a potential adjuvant and/or therapeutic intervention for physicians’ burnout. These results suggest that strategies including forgiveness training aimed at decreasing WB while increasing job satisfaction among physicians warrant further exploration.
Recent work takes both philosophical and scientific progress to consist in acquiring factive epistemic states such as knowledge. However, much of this work leaves unclear what entity is the subject of these epistemic states. Furthermore, by focusing only on states like knowledge, we overlook progress in intermediate cases between ignorance and knowledge – for example, many now celebrated theories were initially so controversial that they were not known. This paper develops an improved framework for thinking about intellectual progress. Firstly, I argue that we should think of progress relative to the epistemic position of an intellectual community rather than individual inquirers. Secondly, I show how focusing on the extended process of inquiry (rather than the mere presence or absence of states like knowledge) provides a better evaluation of different types of progress. This includes progress through formulating worthwhile questions, acquiring new evidence, and increasing credence on the right answers to these questions. I close by considering the ramifications for philosophical progress, suggesting that my account supports rejecting the most negative views while allowing us to articulate different varieties of optimism and pessimism.
The DSM-5 introduced purging disorder (PD) as an other specified feeding or eating disorder characterized by recurrent purging in the absence of binge eating. The current study sought to describe the long-term outcome of PD and to examine predictors of outcome.
Women (N = 84) who met research criteria for PD completed a comprehensive battery of baseline interview and questionnaire assessments. At an average of 10.24 (3.81) years follow-up, available records indicated all women were living, and over 95% were successfully located (n = 80) while over two-thirds (n = 58) completed follow-up assessments. Eating disorder status, full recovery status, and level of eating pathology were examined as outcomes. Severity and comorbidity indicators were tested as predictors of outcome.
Although women experienced a clinically significant reduction in global eating pathology, 58% continued to meet criteria for a DSM-5 eating disorder at follow-up. Only 30% met established criteria for a full recovery. Women reported significant decreases in purging frequency, weight and shape concerns, and cognitive restraint, but did not report significant decreases in depressive and anxiety symptoms. Quality of life was impaired in the physical, psychological, and social domains. More severe weight and shape concerns at baseline predicted meeting criteria for an eating disorder at follow-up. Other baseline severity indicators and comorbidity did not predict the outcome.
Results highlight the severity and chronicity of PD as a clinically significant eating disorder. Future work should examine maintenance factors to better adapt treatments for PD.
Mental ill-health is a known risk factor for suicide mortality. However, the relationship between physical ill-health and suicide is less clear. This study examined the relationship between different aspects of physical ill-health and the risk of suicide death.
Data for 1 196 364 adults (aged 18 years and over) were identified from the 2011 Northern Ireland Census and linked to death registrations until the end of 2015. Multivariate logistic regression was used to construct models to test associations with likelihood ratio tests for interactions.
Over one in eight individuals (13.7%) reported multimorbidity (⩾2 physical health conditions) and one in four (25.4%) identified having limitation of daily activities. During follow-up, 51 672 individuals died; 877 due to suicide. The gradient in suicide risk by number of physical conditions disappeared following adjustment for activity limitation. Individuals with a lot of activity limitation were over three times more likely to die by suicide (OR = 3.13, 95% CI 2.50–3.93) compared to those with no limitations though this was reduced to OR = 1.72 (95% CI 1.35–2.20) with adjustment for poor mental health. The relationship between activity limitation and suicide was most pronounced at younger ages (18–34 years).
This study suggests that it is the effect that physical illness has on a person's life, in terms of disruption to daily activity, rather than the number of conditions that predicts suicide risk, especially at younger ages. Improved awareness and better management of mental wellbeing of individuals with physical health conditions may help to reduce suicides, especially in younger people.
Outpatient interventions for adult anorexia nervosa typically have a modest impact on weight and eating disorder symptomatology. This study examined whether adding a brief online intervention focused on enhancing motivation to change and the development of a recovery identity (RecoveryMANTRA) would improve outcomes in adults with anorexia nervosa.
Participants with anorexia nervosa (n = 187) were recruited from 22 eating disorder outpatient services throughout the UK. They were randomised to receiving RecoveryMANTRA in addition to treatment as usual (TAU) (n = 99; experimental group) or TAU only (n = 88; control group). Outcomes were measured at end-of-intervention (6 weeks), 6 and 12 months.
Adherence rates to RecoveryMANTRA were 83% for the online guidance sessions and 77% for the use of self-help materials (workbook and/or short video clips). Group differences in body mass index at 6 weeks (primary outcome) were not significant. Group differences in eating disorder symptoms, psychological wellbeing and work and social adjustment (at 6 weeks and at follow-up) were not significant, except for a trend-level greater reduction in anxiety at 6 weeks in the RecoveryMANTRA group (p = 0.06). However, the RecoveryMANTRA group had significantly higher levels of confidence in own ability to change (p = 0.02) and alliance with the therapist at the outpatient service (p = 0.005) compared to the control group at 6 weeks.
Augmenting outpatient treatment for adult anorexia nervosa with a focus on recovery and motivation produced short-term reductions in anxiety and increased confidence to change and therapeutic alliance.
How landscapes respond to, and evolve from, large jökulhlaups (glacial outburst floods) is poorly constrained due to limited observations and detailed monitoring. We investigate how melt of glacier ice transported and deposited by multiple jökulhlaups during the 2010 eruption of Eyjafjallajökull, Iceland, modified the volume and surface elevation of jökulhlaup deposits. Jökulhlaups generated by the eruption deposited large volumes of sediment and ice, causing significant geomorphic change in the Gígjökull proglacial basin over a 4-week period. Observation of these events enabled robust constraints on the physical properties of the floods which informs our understanding of the deposits. Using ground-based LiDAR, GPS observations and the satellite-image-derived ArcticDEMs, we quantify the post-depositional response of the 60 m-thick Gígjökull sediment package to the meltout of buried ice and other geomorphic processes. Between 2010 and 2016, total deposit volume reduced by −0.95 × 106 m3 a−1, with significant surface lowering of up to 1.88 m a−1. Surface lowering and volumetric loss of the deposits is attributed to three factors: (i) meltout of ice deposited by the jökulhlaups; (ii) rapid melting of the buried Gígjökull glacier snout; and (iii) incision of the proglacial meltwater system into the jökulhlaup deposits.
The proliferation of a wide variety of family forms has challenged the centrality and necessity of the traditional nuclear family as a context for successful socialization. Views of the importance of the gender of parents, sexual orientation of parents, biological relatedness of family members, and new routes to parenthood are challenged. Increases in divorce, the rise in the number of stepfamilies, cohabitating couples, single parents, and adoption raise further questions about the links between both the number of parents and the biological ties among family members. The gender, sexual orientation, or biological relatedness of the agent of delivery of the critical ingredients for socialization (i.e., stimulation, nurturance ,guidance, limit setting) or the family form in which these processes are enacted are less important than the processes themselves. Second, an interdependent model of family functioning is proposed, which reflects the increasing degree of outsourcing of tasks and responsibilities. To maximize assistance available to a full range of family forms, it is critical that policy makers recognize the diversity of family forms and develop suitable policies.
The goal of this chapter is to address how urban dynamics at the neighborhood level are linked to children’s development. We first review trends in the spatial concentration of poverty and inequality in the United States in recent decades. Then, we turn to theoretical models describing how local communities, with a focus on urban settings, influence children’s development. We then cover methodological issues and focus on one critical issue, selection bias, and then briefly review study designs as related to this challenge. Finally, we provide an overview of empirical studies linking neighborhood, socioeconomic conditions, and children’s development, notably their educational, behavioral, and socioemotional outcomes.
Philosophers through the ages have stressed time as a critical variable in life, and developmentalists today pretend to a lifespan framework. Paradoxically, many construals of time are still neglected in developmental science. This chapter focuses on time and fleshes out three developmental perspectives on time: the chronosystem from the bioecological systems framework, transaction, and specificity.
Bioecological systems theory characterizes development as a joint function of process, person, context, and time. The principle of transaction in development asserts that characteristics of individuals shape their experiences, and reciprocally experiences shape the characteristics of individuals, through time. Finally, the specificity principle contends that understanding lifespan development depends critically on what is studied in whom, how, and when. Time fits integrally into each prevailing developmental perspective.
In this chapter, we argue that the timing of societal events in an individual’s life plays a major role in shaping that life through interacting developmental processes at multiple levels. We focus on classic research by Elder showing how two such events in historical proximity dramatically altered the lives of California children who were born at opposite ends of the 1920s, 1920–21 and 1928–29, the Great Depression of the 1930s followed by World War II (1941–45) and the Korean War (1950–53). We employ insights from both Elder’s cohort historical life course approach and developmental science including recent work on developmental neuroscience to understand the life-long impact of exposure to events that occur at different times in life, and the mechanisms through which these exposures may influence development, as well as experiences that may provide turning points in development.
In this opening chapter we provide a chronology of the relatively recent recognition that an understanding of children’s lives across time requires that context in terms of historical time and place also needs to consider culture . Early efforts often failed to recognize this fundamental premise and instead studied children out of context.
The emergence of the life course perspective with its recognition of the centrality of changing historical contexts as necessary for an adequate understanding of children’s development was a major step forward in theorizing about children’s development. Moreover, in the past several decades, the life course perspective has also evolved and now recognizes the role of both individual and collective agency in shaping both individual outcomes and those at other levels of analysis. Moreover, as prior work has long recognized, it is increasingly accepted that secular changes co-occur and often come as a package.
For example, war, famine, migration, and economic hardship generally operate together. We also underscore the increasing appreciation of cross-disciplinary dialogue as necessary for understanding issues such as children’s genetic influences and how they are constrained in their expression by historical and environmental factors.