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The study was designed to establish and evaluate the impact of a 6-week Balint group on empathy and resilience in fourth-year medical students during their psychiatry rotation.
This prospective study used the Jefferson Scale of Empathy – Student Version and the Brief Resilience Scale before and after 6-week Balint groups. Participating students also completed a qualitative assessment of their experience.
Students who participated were enthusiastic regarding the value of Balint groups in promoting self-reflection and gaining insight into self- and patient-care dynamics. There was a significant difference in empathy scores pre- and post-Balint intervention. There was no significant difference in resilience scores.
The establishment of a 6-week Balint group for fourth-year medical students was successful in increasing empathy. Students reported a positive view of Balint and its beneficial role in this study group.
We illustrate the extraordinary potential of the (far-IR) Origins Survey Spectrometer (OSS) on board the Origins Space Telescope (OST) to address a variety of open issues on the co-evolution of galaxies and AGNs. We present predictions for blind surveys, each of 1000 h, with different mapped areas (a shallow survey covering an area of 10 deg2 and a deep survey of 1 deg2) and two different concepts of the OST/OSS: with a 5.9 m telescope (Concept 2, our reference configuration) and with a 9.1 m telescope (Concept 1, previous configuration). In 1 000 h, surveys with the reference concept will detect from ∼1.9×106 to ∼8.7×106 lines from ∼4.8×105 to 2.7×106 star-forming galaxies and from ∼1.4×104 to ∼3.8×104 lines from ∼1.3×104 to 3.5×104 AGNs. The shallow survey will detect substantially more sources than the deep one; the advantage of the latter in pushing detections to lower luminosities/higher redshifts turns out to be quite limited. The OST/OSS will reach, in the same observing time, line fluxes more than one order of magnitude fainter than the SPICA/SMI and will cover a much broader redshift range. In particular it will detect tens of thousands of galaxies at z ≥ 5, beyond the reach of that instrument. The polycyclic aromatic hydrocarbons lines are potentially bright enough to allow the detection of hundreds of thousands of star-forming galaxies up to z ∼ 8.5, i.e. all the way through the reionisation epoch. The proposed surveys will allow us to explore the galaxy–AGN co-evolution up to z ∼ 5.5−6 with very good statistics. OST Concept 1 does not offer significant advantages for the scientific goals presented here.
We describe the motivation and design details of the ‘Phase II’ upgrade of the Murchison Widefield Array radio telescope. The expansion doubles to 256 the number of antenna tiles deployed in the array. The new antenna tiles enhance the capabilities of the Murchison Widefield Array in several key science areas. Seventy-two of the new tiles are deployed in a regular configuration near the existing array core. These new tiles enhance the surface brightness sensitivity of the array and will improve the ability of the Murchison Widefield Array to estimate the slope of the Epoch of Reionisation power spectrum by a factor of ∼3.5. The remaining 56 tiles are deployed on long baselines, doubling the maximum baseline of the array and improving the array u, v coverage. The improved imaging capabilities will provide an order of magnitude improvement in the noise floor of Murchison Widefield Array continuum images. The upgrade retains all of the features that have underpinned the Murchison Widefield Array’s success (large field of view, snapshot image quality, and pointing agility) and boosts the scientific potential with enhanced imaging capabilities and by enabling new calibration strategies.
Involuntary admission can be traumatic and is associated with negative attitudes that persist after the episode of illness has abated.
We aimed to prospectively assess satisfaction with care at the points of involuntary admission and symptomatic recovery, and identify their sociodemographic, clinical and service experience predictors.
Levels of satisfaction with care, and clinical and sociodemographic variables were obtained from a representative cohort of 263 patients at the point of involuntary admission and from 155 of these patients 3 months after termination of the involuntary admission. Data were analysed with multiple linear regression modelling.
Higher baseline awareness of illness (B = 0.19, P < 0.001) and older age (B = 0.05, P = 0.001) were associated with more satisfaction with care at baseline and follow-up. Transition to greater satisfaction with care was associated with improvements in awareness of illness (B = 0.13, P < 0.001) and in symptoms (B = 0.05, P = 0.02), as well as older age (B = 0.04, P = 0.01). Objective coercive experiences were not associated with variation in satisfaction with care.
There is wide variation in satisfaction with coercive care. Greater satisfaction with care is positively associated with clinical variables such as increased awareness of illness.
A theoretical model of individuals' experiences before, during and after involuntary admission has not yet been established.
To develop an understanding of individuals' experiences over the course of the involuntary admission process.
Fifty individuals were recruited through purposive and theoretical sampling and interviewed 3 months after their involuntary admission. Analyses were conducted using a Straussian grounded theory approach.
The ‘theory of preserving control’ (ToPC) emerged from individuals' accounts of how they adapted to the experience of involuntary admission. The ToPC explains how individuals manage to reclaim control over their emotional, personal and social lives and consists of three categories: ‘losing control’, ‘regaining control’ and ‘maintaining control’, and a number of related subcategories.
Involuntary admission triggers a multifaceted process of control preservation. Clinicians need to develop therapeutic approaches that enable individuals to regain and maintain control over the course of their involuntary admission.
Little is known about the prevalence of mental health outcomes in UK personnel at the end of the British involvement in the Iraq and Afghanistan conflicts.
We examined the prevalence of mental disorders and alcohol misuse, whether this differed between serving and ex-serving regular personnel and by deployment status.
This is the third phase of a military cohort study (2014–2016; n = 8093). The sample was based on participants from previous phases (2004–2006 and 2007–2009) and a new randomly selected sample of those who had joined the UK armed forces since 2009.
The prevalence was 6.2% for probable post-traumatic stress disorder, 21.9% for common mental disorders and 10.0% for alcohol misuse. Deployment to Iraq or Afghanistan and a combat role during deployment were associated with significantly worse mental health outcomes and alcohol misuse in ex-serving regular personnel but not in currently serving regular personnel.
The findings highlight an increasing prevalence of post-traumatic stress disorder and a lowering prevalence of alcohol misuse compared with our previous findings and stresses the importance of continued surveillance during service and beyond.
Declaration of interest:
All authors are based at King's College London which, for the purpose of this study and other military-related studies, receives funding from the UK Ministry of Defence (MoD). S.A.M.S., M.J., L.H., D.P., S.M. and R.J.R. salaries were totally or partially paid by the UK MoD. The UK MoD provides support to the Academic Department of Military Mental Health, and the salaries of N.J., N.G. and N.T.F. are covered totally or partly by this contribution. D.Mu. is employed by Combat Stress, a national UK charity that provides clinical mental health services to veterans. D.MacM. is the lead consultant for an NHS Veteran Mental Health Service. N.G. is the Royal College of Psychiatrists’ Lead for Military and Veterans’ Health, a trustee of Walking with the Wounded, and an independent director at the Forces in Mind Trust; however, he was not directed by these organisations in any way in relation to his contribution to this paper. N.J. is a full-time member of the armed forces seconded to King's College London. N.T.F. reports grants from the US Department of Defense and the UK MoD, is a trustee (unpaid) of The Warrior Programme and an independent advisor to the Independent Group Advising on the Release of Data (IGARD). S.W. is a trustee (unpaid) of Combat Stress and Honorary Civilian Consultant Advisor in Psychiatry for the British Army (unpaid). S.W. is affiliated to the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response at King's College London in partnership with Public Health England, in collaboration with the University of East Anglia and Newcastle University. The views expressed are those of the author(s) and not necessarily those of the National Health Service, the NIHR, the Department of Health, Public Health England or the UK MoD.
Fuelwood scarcity creates a widespread environmental problem that places a major burden on women and children in the rural areas of developing countries. Consequently, many governments, donors and non-governmental organizations have encouraged on-farm fuelwood production and agroforestry practices. Whether, however, fuelwood from different sources can be easily substituted is an important empirical question as the degree of substitutability can depend on local markets and households' resource endowments and incomes. In this paper, we examine the substitution between three fuelwood sources among rural households in western Kenya: fuelwood collected off-farm, fuelwood produced on-farm, and that which is purchased. Using household-specific shadow prices for fuelwood and male and female wages, we find that strict gender divisions in household labor result in limited substitution between fuelwood sources. Among the implications are that programs and policies promoting agroforestry will have limited success without first addressing the structural differences in labor markets.
OBJECTIVES/SPECIFIC AIMS: The population of cancer survivors is rapidly growing in the United States. Long term and late effects of cancer, combined with ongoing management of other chronic conditions, make cancer survivors particularly vulnerable to polypharmacy and its adverse effects. We examined patterns of prescription medication use and polypharmacy in a population-based sample of cancer survivors. METHODS/STUDY POPULATION: Using data from the Medical Expenditure Panel Survey (MEPS), we matched cancer survivors (n=5216) to noncancer controls (n=19,588) by age, sex, and survey year. We defined polypharmacy as using 5 or more unique medications. We also estimated proportion of respondents prescribed specific medications within therapeutic classes and total prescription expenditures. RESULTS/ANTICIPATED RESULTS: A higher proportion of cancer survivors were prescribed 5 or more unique medications (64.0%, 95% CI 62.3%–65.8%) compared with noncancer controls (51.5%, 95% CI 50.4%–52.6%), including drugs with abuse potential. Across all therapeutic classes, a higher proportion of newly (≤1 year since diagnosis) and previously (>1 years since diagnosis) diagnosed survivors were prescribed medications compared to controls, with large differences in central nervous system agents (65.8% vs. 57.4% vs. 46.2%), psychotherapeutic agents (25.4% vs. 26.8% vs. 18.3%), and gastrointestinal agents (31.9% vs. 29.6% vs. 22.0%). Specifically, nearly 10% of cancer survivors were prescribed benzodiazepines and/or opioids compared to about 5% of controls. Survivors had more than double prescription expenditures (median $1633 vs. $784 among noncancer controls). Findings persisted similarly across categories of age and comorbidity. DISCUSSION/SIGNIFICANCE OF IMPACT: Cancer survivors were frequently prescribed a higher number of unique medications and inappropriate medications or drugs with abuse potential, increasing risk of adverse drug events, financial toxicity, poor adherence, and drug-drug interactions. Adolescent and young adult survivors appear at increased risk of polypharmacy.
There is a growing interest in using cognitive–behavioural therapy (CBT) with people who have Asperger syndrome and comorbid mental health problems.
To examine whether modified group CBT for clinically significant anxiety in an Asperger syndrome population is feasible and likely to be efficacious.
Using a randomised assessor-blind trial, 52 individuals with Asperger syndrome were randomised into a treatment arm or a waiting-list control arm. After 24 weeks, those in the waiting-list control arm received treatment, while those initially randomised to treatment were followed up for 24 weeks.
The conversion rate for this trial was high (1.6:1), while attrition was 13%. After 24 weeks, there was no significant difference between those randomised to the treatment arm compared with those randomised to the waiting-list control arm on the primary outcome measure, the Hamilton Rating Scale for Anxiety.
Trials of psychological therapies with this population are feasible. Larger definitive trials are now needed.
Composite nanostructured foams consisting of a metallic shell deposited on a polymeric core were formed by plating copper via electroless deposition on electrospun polycaprolactone (PCL) fiber mats. The final structure consisted of 1000-nm scale PCL fibers coated with 100s of nm of copper, leading to final core-shell thicknesses on the order of 1000-3000 nm. The resulting open cell, core-shell foams had relative densities between 4 and 15 %. By controlling the composition of the adjuncts in the plating bath, particularly the composition of formaldehyde, the relative thickness of copper coating as the fiber diameter could be controlled. As-spun PCL mats had a nominal compressive modulus on the order of 0.1 MPa; adding a uniform metallic shell increased the modulus up to 2 MPa for sub-10 % relative density foams. A computational materials science analysis using density functional theory was used to explore the effects pre-treatment with Pd may have on the density of nuclei formed during electroless plating.
We present low-frequency spectral energy distributions of 60 known radio pulsars observed with the Murchison Widefield Array telescope. We searched the GaLactic and Extragalactic All-sky Murchison Widefield Array survey images for 200-MHz continuum radio emission at the position of all pulsars in the Australia Telescope National Facility (ATNF) pulsar catalogue. For the 60 confirmed detections, we have measured flux densities in 20 × 8 MHz bands between 72 and 231 MHz. We compare our results to existing measurements and show that the Murchison Widefield Array flux densities are in good agreement.
The Southern Ocean is the largest of the high-nutrient, low-chlorophyll (HNLC) regions of the world ocean. Phytoplankton production fails to utilise completely the pool of inorganic nutrients in the euphotic zone, giving rise to low phytoplankton bio-mass and leaving relatively high summer nutrient concentrations. This enigma is of considerable significance for our understanding of the role of the oceans in the global carbon cycle. Various limiting factors have been considered: low light, low temperature, absence of necessary trace elements, grazing pressure and other means of biomass removal.
The dynamics of nitrogen uptake by phytoplankton are of particular importance. Classically, nitrate mixed into the surface layer during winter provides the nitrogen pool for growth in the spring bloom. Some organic material is exported to depth, whilst the remainder is recycled, providing ammonium and other reduced species as nitrogenous substrates for growth during the remainder of the season. The oxidation state of the inorganic nitrogen supply thus identifies new and recycled carbon fixation. Whilst this is convenient “shorthand” for the nitrogen nutrition of carbon export in much of the ocean, it is an inappropriate model for the Southern Ocean. Here, nitrate and ammonium use are simultaneous, and nitrate is never exhausted by the annual phytoplankton production.
We speculate that a range of environmental factors combine to make the large pool of nitrate partially inaccessible to phytoplankton. in addition to the documented effects of low iron availability and high ammonium concentrations, the low temperatures characteristic of the Southern Ocean may decrease nitrate availability because of the increased energetic overheads in its uptake and reduction. This in turn makes ammonium an important nitrogenous substrate, and its production by zooplankton and heterotrophic microorganisms is an important component of the plankton nitrogen cycle. There is some evidence that ammonium production by large grazing animals may stimulate phytoplankton growth. Microbial removal of nitrogen from sedimenting phytoplankton cells may result in local decoupling between the carbon and nitrogen cycles, allowing some reduced nitrogen to remain in the euphotic zone whilst carbon is exported to depth.
In April 1966, thousands of artists, musicians, performers and writers from across Africa and its diaspora gathered in the Senegalese capital, Dakar, to take part in the First World Festival of Negro Arts (Premier Festival Mondial des arts nègres). The international forum provided by the Dakar Festival showcased a wide array of arts and was attended by such celebrated luminaries as Duke Ellington, Josephine Baker, Aimé Césaire, André Malraux and Wole Soyinka. Described by Senegalese President Léopold Sédar Senghor, as ‘the elaboration of a new humanism which this time will include all of humanity on the whole of our planet earth’, the festival constituted a highly symbolic moment in the era of decolonization and the push for civil rights for black people in the United States. In essence, the festival sought to perform an emerging Pan-African culture, that is, to give concrete cultural expression to the ties that would bind the newly liberated African ‘homeland’ to black people in the diaspora. This volume is the first sustained attempt to provide not only an overview of the festival itself but also of its multiple legacies, which will help us better to understand the ‘festivalization’ of Africa that has occurred in recent decades with most African countries now hosting a number of festivals as part of a national tourism and cultural development strategy.