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Gravitational waves from coalescing neutron stars encode information about nuclear matter at extreme densities, inaccessible by laboratory experiments. The late inspiral is influenced by the presence of tides, which depend on the neutron star equation of state. Neutron star mergers are expected to often produce rapidly rotating remnant neutron stars that emit gravitational waves. These will provide clues to the extremely hot post-merger environment. This signature of nuclear matter in gravitational waves contains most information in the 2–4 kHz frequency band, which is outside of the most sensitive band of current detectors. We present the design concept and science case for a Neutron Star Extreme Matter Observatory (NEMO): a gravitational-wave interferometer optimised to study nuclear physics with merging neutron stars. The concept uses high-circulating laser power, quantum squeezing, and a detector topology specifically designed to achieve the high-frequency sensitivity necessary to probe nuclear matter using gravitational waves. Above 1 kHz, the proposed strain sensitivity is comparable to full third-generation detectors at a fraction of the cost. Such sensitivity changes expected event rates for detection of post-merger remnants from approximately one per few decades with two A+ detectors to a few per year and potentially allow for the first gravitational-wave observations of supernovae, isolated neutron stars, and other exotica.
The interest in experiencing training abroad has grown and its benefits have been progressively recognized. For these reasons, several psychiatric trainees seek to extend their competencies, skills and knowledge through these exchange opportunities, such as the European Federation of Psychiatric Trainees (EFPT) Exchange Programme.
With this work we intend to describe these international experiences of being acquainted with a different health system and psychiatry training programme.
Reflect on the impact of these experiences, considering on how these can be used to benefit the patient care provided across countries, further to the professional and personal individual benefits that colleagues gain.
Presenting the testimonials of junior doctors from abroad that have had the opportunity to observe and collaborate in the current system of the United Kingdom.
The EFPT Exchange Programme is an excellent opportunity for psychiatry trainees to share experiences, knowledge and good practices. The cultural and social framework of psychiatry certainly has an impact on the approach to mental health problems, and being knowledgeable of these differences can provide benefits not only to the junior doctors who complete these exchanges abroad, but also to their colleagues working at their hosting institutions that become acquainted with different realities through their presence and feedback.
The benefits of these exchange mobility experiences are unequivocal. Therefore, it is fundamental to share these experiences and promote these opportunities.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Childhood maltreatment is one of the strongest predictors of adulthood depression and alterations to circulating levels of inflammatory markers is one putative mechanism mediating risk or resilience.
To determine the effects of childhood maltreatment on circulating levels of 41 inflammatory markers in healthy individuals and those with a major depressive disorder (MDD) diagnosis.
We investigated the association of childhood maltreatment with levels of 41 inflammatory markers in two groups, 164 patients with MDD and 301 controls, using multiplex electrochemiluminescence methods applied to blood serum.
Childhood maltreatment was not associated with altered inflammatory markers in either group after multiple testing correction. Body mass index (BMI) exerted strong effects on interleukin-6 and C-reactive protein levels in those with MDD.
Childhood maltreatment did not exert effects on inflammatory marker levels in either the participants with MDD or the control group in our study. Our results instead highlight the more pertinent influence of BMI.
Declaration of interest
D.A.C. and H.W. work for Eli Lilly Inc. R.N. has received speaker fees from Sunovion, Jansen and Lundbeck. G.B. has received consultancy fees and funding from Eli Lilly. R.H.M.-W. has received consultancy fees or has a financial relationship with AstraZeneca, Bristol-Myers Squibb, Cyberonics, Eli Lilly, Ferrer, Janssen-Cilag, Lundbeck, MyTomorrows, Otsuka, Pfizer, Pulse, Roche, Servier, SPIMACO and Sunovian. I.M.A. has received consultancy fees or has a financial relationship with Alkermes, Lundbeck, Lundbeck/Otsuka, and Servier. S.W. has sat on an advisory board for Sunovion, Allergan and has received speaker fees from Astra Zeneca. A.H.Y. has received honoraria for speaking from Astra Zeneca, Lundbeck, Eli Lilly, Sunovion; honoraria for consulting from Allergan, Livanova and Lundbeck, Sunovion, Janssen; and research grant support from Janssen. A.J.C. has received honoraria for speaking from Astra Zeneca, honoraria for consulting with Allergan, Livanova and Lundbeck and research grant support from Lundbeck.
Filamentary structures can form within the beam of protons accelerated during the interaction of an intense laser pulse with an ultrathin foil target. Such behaviour is shown to be dependent upon the formation time of quasi-static magnetic field structures throughout the target volume and the extent of the rear surface proton expansion over the same period. This is observed via both numerical and experimental investigations. By controlling the intensity profile of the laser drive, via the use of two temporally separated pulses, both the initial rear surface proton expansion and magnetic field formation time can be varied, resulting in modification to the degree of filamentary structure present within the laser-driven proton beam.
There is increasing evidence for shared genetic susceptibility between schizophrenia and bipolar disorder. Although genetic variants only convey subtle increases in risk individually, their combination into a polygenic risk score constitutes a strong disease predictor.
To investigate whether schizophrenia and bipolar disorder polygenic risk scores can distinguish people with broadly defined psychosis and their unaffected relatives from controls.
Using the latest Psychiatric Genomics Consortium data, we calculated schizophrenia and bipolar disorder polygenic risk scores for 1168 people with psychosis, 552 unaffected relatives and 1472 controls.
Patients with broadly defined psychosis had dramatic increases in schizophrenia and bipolar polygenic risk scores, as did their relatives, albeit to a lesser degree. However, the accuracy of predictive models was modest.
Although polygenic risk scores are not ready for clinical use, it is hoped that as they are refined they could help towards risk reduction advice and early interventions for psychosis.
Declaration of interest
R.M.M. has received honoraria for lectures from Janssen, Lundbeck, Lilly, Otsuka and Sunovian.
To report a novel management strategy for mixed hearing loss in advanced otosclerosis.
A 50-year-old male was referred to St Thomas’ Hearing Implant Centre with otosclerosis; he was no longer able to wear conventional hearing aids because of recurrent otitis externa. The patient underwent short process incus vibroplasty (using the Med-El Vibrant Soundbridge device), followed at a suitable interval (six weeks) by stapes surgery. The main outcome measures were: pure tone audiometry, functional gain and monosyllabic word recognition scores.
Post-operative pure tone audiometry showed a reduction of the mean air–bone gap from 55 dB HL to 20 dB HL. The residual mixed hearing loss was rehabilitated with the Vibrant Soundbridge, with an average device gain of 32 dB. The monosyllabic word recognition scores in quiet at 65 dB improved from 37 to 100 per cent when using the Vibrant Soundbridge at six months after switch-on of the device.
Stapedotomy in conjunction with incus short process vibroplasty (i.e. inner-ear vibroplasty) is a safe and promising procedure for managing advanced otosclerosis with mixed hearing loss in selected patients.
A range of endophenotypes characterise psychosis, however there has been limited work understanding if and how they are inter-related.
This multi-centre study includes 8754 participants: 2212 people with a psychotic disorder, 1487 unaffected relatives of probands, and 5055 healthy controls. We investigated cognition [digit span (N = 3127), block design (N = 5491), and the Rey Auditory Verbal Learning Test (N = 3543)], electrophysiology [P300 amplitude and latency (N = 1102)], and neuroanatomy [lateral ventricular volume (N = 1721)]. We used linear regression to assess the interrelationships between endophenotypes.
The P300 amplitude and latency were not associated (regression coef. −0.06, 95% CI −0.12 to 0.01, p = 0.060), and P300 amplitude was positively associated with block design (coef. 0.19, 95% CI 0.10–0.28, p < 0.001). There was no evidence of associations between lateral ventricular volume and the other measures (all p > 0.38). All the cognitive endophenotypes were associated with each other in the expected directions (all p < 0.001). Lastly, the relationships between pairs of endophenotypes were consistent in all three participant groups, differing for some of the cognitive pairings only in the strengths of the relationships.
The P300 amplitude and latency are independent endophenotypes; the former indexing spatial visualisation and working memory, and the latter is hypothesised to index basic processing speed. Individuals with psychotic illnesses, their unaffected relatives, and healthy controls all show similar patterns of associations between endophenotypes, endorsing the theory of a continuum of psychosis liability across the population.
Eslicarbazepine is a novel anti-epileptic agent indicated for the treatment of partial-onset seizures. We present the case of an 18 year old female that presented to the Emergency Department four hours after a reported intentional ingestion of an estimated 5600 mg of eslicarbazepine. Although initially hemodynamically stable and neurologically normal, shortly after arrival she developed confusion, rigidity and clonus, followed by recurrent seizures, hypoxemia and cardiac arrest which responded to cardiopulmonary resuscitation and wide complex tachycardia requiring defibrillation. Treatment for refractory seizures included benzodiazepines and eventual intubation and sedation with propofol. Cardiac toxicity responded to sodium bicarbonate. In addition, empiric hemodialysis was performed. In this case report, we discuss the successful management of the first reported overdose of eslicarbazepine using supportive care and hemodialysis.
This paper reports three cases of severe post-stapedectomy granuloma, emphasising the variable presentation of this devastating complication and the challenges of its management.
A retrospective review was conducted of three cases of post-stapedectomy granuloma requiring surgical debulking between 2010 and 2015. Clinical symptoms, serial imaging, histopathology and post-operative outcomes were considered.
Intra-operatively, extensive granulation tissue with erosion of the otic capsule was found. There was spread along the VIIth and VIIIth cranial nerves to the cochlear nucleus in one patient. Post-operative clinical improvement was demonstrable, corroborated by diminution of contrast enhancement on serial magnetic resonance imaging. Facial nerve function recovered, tinnitus amelioration was variable and some otalgia persisted. Post-operative complications included grade IV facial weakness and late Pseudomonas aeruginosa meningitis, which all resolved.
To the authors’ knowledge, this paper reports the only case of post-stapedectomy granuloma tracking to the brainstem. Otalgia was present in all our cases, and may be deemed a red flag symptom of progressive bony destruction and otic capsule involvement. Although granuloma remains rare, it should be considered in any patient with worsening otological symptoms following stapes surgery.
I read this book with fascination and interest, and it confirmed my feeling that storytelling is central to psychiatric practice, alongside a deep respect for the patient's own spiritual journey. Two contemporary themes have been employed by the editors to enable psychiatrists better to understand – and therefore be more effective in the treatment of – their patients. First, the spiritual and religious concerns of patients, after years of neglect by psychiatry, have now been accepted as an integral part of psychiatric assessment and care. Second, there has been much recent interest from many quarters, including psychiatry, in the nature and application of narrative – what it is, how it affects the relationship with, and between, our patients, and how it makes for better treatment. These dual themes are maintained throughout this book, which is written for mental health professionals, hospital chaplains and others interested in the relationship of mental health to spirituality. The practical rather than theoretical is underscored, emphasising how users, carers and relatives can all enlist spirituality and narrative for their well-being.
The fourteen chapters range widely over different areas of psychiatric practice and theoretical viewpoint. Most are written by psychiatrists whose primary role has been the care of patients. Transcultural psychiatry is shown to be intimately involved with both narrative and the person's spiritual and religious convictions. Descriptive psychopathology depends entirely on the patient's story, which often includes their spiritual and religious understanding. Psychotherapy is greatly enriched by taking into account the spiritual aspects of life; story is pre-eminent, with narrative an essential aspect of therapy. Other chapters discuss the core psychiatric problems of depression, anxiety, psychosis, psychiatry of old age and mentally ill offenders, in all of which the interweaving themes of narrative and spirituality are prominent. There are moving stories from both a service user and from people seeking help from a mental health chaplain that show the significance of their beliefs in aiding the recovery process.
Spiritual issues still raise ethical and professional dilemmas in mental healthcare. This text use narrative excerpts and case illustrations to explore the importance and challenge of spirituality in clinical psychiatric practice and show how spiritual concerns can be included in a range of psychiatric treatment options.
Christopher C. H. Cook, Professor of Spirituality, Theology & Health at Durham University,
Andrew Powell, Founding Chair, Spirituality and Psychiatry Special Interest Group of the Royal College of Psychiatrists,
Andrew Sims, Author of the first three editions of Symptoms in the Mind: An Introduction to Descriptive Psychopathology 1988–2008
In Chapter 1, ‘Narrative in psychiatry, theology and spirituality’, it was suggested that narratives have a beginning and an end. Stories continue, of course, yet at a given point the narrator will have to identify a place to start and a place to stop telling the story. The choice of the beginning and of the ending will significantly frame the narrative and thus influence its impact, meaning and scope. This has been evident throughout the book, with some authors offering narratives that go back to childhood, or narratives that end with a death, but with none that attempts to tell the story of a whole life from birth to death. This is partly due to limitations of space, but it is also because the narratives included have focused primarily on matters of spiritual interest. Of course, if these narrators were to tell the story again after a period of time, they might have more to say, as in the case of a patient who is asked by their doctor ‘How have things been since your last appointment?’ Each ending of each narration is thus, at least potentially, the beginning of another narrative still to be told.
Importantly, in the present context, every human life must have a beginning and an ending, reflected in its unique narrative, and usually beginning with an account of the family into which a new human life is born. An autobiography generally concludes in the present moment, since the author cannot write, although they may speculate, about what is yet to happen. A biography concludes with a death, and perhaps with a reflection of the enduring impact on the lives of others of a life lived well – or badly.
Each clinical encounter is a privileged opportunity given to the clinician to share in an autobiographical narrative. It usually begins (if told chronologically – which it may well not be) with a history of the family of origin and the personal life history. It must of necessity end in the present moment and it is in the nature of the clinical encounter that both patient and doctor are likely to be speculating about what might happen next.
Spirituality and Psychiatry was published by RCPsych Publications in 2009. As editors of that volume, we have been gratified to note its warm reception and that the book was felt to have made a constructive contribution to the debate about the place of spirituality in contemporary clinical practice. So why, 6 years on, might it be timely for a further volume on the topic?
First, we are aware that there were gaps and omissions in Spirituality and Psychiatry. For example, it did not have much to say about affective disorders or about forensic psychiatry, and it did not have an author who wrote as an identified user of mental health services.
Second, while Spirituality and Psychiatry sought to be relevant to clinical practice and included a series of case histories, we realised in the course of our work as editors that it presented more questions than answers in relation to good practice in this newly developing field. Issues raised by spirituality in mental healthcare continue to be the subject of controversy, and we therefore felt that a second volume, with a different approach, could helpfully further the debate.
Third, while the evidence base has continued to grow steadily over the past 6 years, an important theme to emerge concerns the management of professional and ethical boundaries relating to spirituality and faith in clinical practice. There is therefore a need for a book that is cognisant of recent research literature, but which is also anchored in the realities of clinical practice. The present volume does not seek to review the recent quantitative research literature, although most contributors have made at least some reference to it. It does seek to address the realities of clinical practice in the context of the ongoing professional debate.
Fourth, for service users, spirituality and faith are closely connected with questions of relationship, transcendence and finding meaning and purpose in life – all of these questions being often best explored by way of narrative (or story). Narrative has provided an important theme in recent years in both medicine (Greenhalgh & Hurwitz, 1998; Roberts & Holmes, 1999; Engel et al, 2008) and theology (Loughlin, 1999).
The collective response of electrons in an ultrathin foil target irradiated by an ultraintense (
) laser pulse is investigated experimentally and via 3D particle-in-cell simulations. It is shown that if the target is sufficiently thin that the laser induces significant radiation pressure, but not thin enough to become relativistically transparent to the laser light, the resulting relativistic electron beam is elliptical, with the major axis of the ellipse directed along the laser polarization axis. When the target thickness is decreased such that it becomes relativistically transparent early in the interaction with the laser pulse, diffraction of the transmitted laser light occurs through a so called ‘relativistic plasma aperture’, inducing structure in the spatial-intensity profile of the beam of energetic electrons. It is shown that the electron beam profile can be modified by variation of the target thickness and degree of ellipticity in the laser polarization.