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The period before the formation of a persecutory delusion may provide causal insights. Patient accounts are invaluable in informing this understanding.
To inform the understanding of delusion formation, we asked patients about the occurrence of potential causal factors – identified from a cognitive model – before delusion onset.
A total of 100 patients with persecutory delusions completed a checklist about their subjective experiences in the weeks before belief onset. The checklist included items concerning worry, images, low self-esteem, poor sleep, mood dysregulation, dissociation, manic-type symptoms, aberrant salience, hallucinations, substance use and stressors. Time to reach certainty in the delusion was also assessed.
Most commonly it took patients several months to reach delusion certainty (n = 30), although other patients took a few weeks (n = 24), years (n = 21), knew instantly (n = 17) or took a few days (n = 6). The most frequent experiences occurring before delusion onset were: low self-confidence (n = 84); excessive worry (n = 80); not feeling like normal self (n = 77); difficulties concentrating (n = 77); going over problems again and again (n = 75); being very negative about the self (n = 75); images of bad things happening (n = 75); and sleep problems (n = 75). The average number of experiences occurring was high (mean 23.5, s.d. = 8.7). The experiences clustered into six main types, with patients reporting an average of 5.4 (s.d. = 1.0) different types.
Patients report numerous different experiences in the period before full persecutory delusion onset that could be contributory causal factors, consistent with a complex multifactorial view of delusion occurrence. This study, however, relied on retrospective self-report and could not determine causality.
The diurnal feeding patterns of dairy cows affects the 24 h robot utilisation of pasture-based automatic milking systems (AMS). A decline in robot utilisation between 2400 and 0600 h currently occurs in pasture-based AMS, as cow feeding activity is greatly reduced during this time. Here, we investigate the effect of a temporal variation in feed quality and quantity on cow feeding behaviour between 2400 and 0600 h as a potential tool to increase voluntary cow trafficking in an AMS at night. The day was allocated into four equal feeding periods (0600 to 1200, 1200 to 1800, 1800 to 2400 and 2400 to 0600 h). Lucerne hay cubes (CP = 19.1%, water soluble carbohydrate = 3.8%) and oat, ryegrass and clover hay cubes with 20% molasses (CP = 11.8%, water soluble carbohydrate = 10.7%) were offered as the ‘standard’ and ‘preferred’ (preference determined previously) feed types, respectively. The four treatments were (1) standard feed offered ad libitum (AL) throughout 24 h; (2) as per AL, with preferred feed replacing standard feed between 2400 and 0600 h (AL + P); (3) standard feed offered at a restricted rate, with quantity varying between each feeding period (20:10:30:60%, respectively) as a proportion of the (previously) measured daily ad libitum intake (VA); (4) as per VA, with preferred feed replacing standard feed between 2400 and 0600 h (VA + P). Eight non-lactating dairy cows were used in a 4 × 4 Latin square design. During each experimental period, treatment cows were fed for 7 days, including 3 days habituation and 4 days data collection. Total daily intake was approximately 8% greater (P < 0.001) for the AL and AL + P treatments (23.1 and 22.9 kg DM/cow) as compared with the VA and VA + P treatments (21.6 and 20.9 kg DM/cow). The AL + P and VA treatments had 21% and 90% greater (P < 0.001) dry matter intake (DMI) between 2400 and 0600 h, respectively, compared with the AL treatment. In contrast, the VA + P treatment had similar DMI to the VA treatment. Our experiment shows ability to increase cow feeding activity at night by varying feed type and quantity, though it is possible that a penalty to total DMI may occur using VA. Further research is required to determine if the implementation of variable feed allocation on pasture-based AMS farms is likely to improve milking robot utilisation by increasing cow feeding activity at night.
Open dialogue is an integrative approach to the organisation of specialist mental health services and therapeutic meetings.
This qualitative study sought to explore service users' and clinicians’ experiences of network meetings during the implementation of open dialogue in a modified version, for a UK-based mental health service.
In total 19 participants were interviewed (8 service users and 11 clinicians) and an inductive thematic analysis of the data was conducted.
Four dominant themes were identified: (1) open dialogue delivery, (2) the impact of open dialogue principles; (3) intense interactions and enhanced communication, and (4) organisational challenges. Clinicians considered open dialogue as a preferred, but challenging way of working, while being therapeutic. The data indicated that service users' experiences of network meetings were mixed. There was a wide variety of service user views as to what the purpose of a network meeting was and for some witnessing reflective conversations felt strange. However, the majority described feeling listened to and understood, excluding one service user who described their experience as distressing. Clinicians expressed an authentic self in their interactions with service users and both service users and clinicians described network meetings as emotionally expressive, although this was described as overwhelming at times.
The results of this thematic analysis indicate that service users' and clinicians’ experiences of open dialogue warrant further investigation. The intensity of interactions in network meetings should be carefully considered with service users before gaining consent to commence treatment. Implementation of open dialogue should be monitored to assess clinician- and service-level adherence to the principles of the approach.
Introduction: Endotracheal intubation (ETI) is a lifesaving procedure commonly performed by emergency department (ED) physicians that may lead to patient discomfort or adverse events (e.g., unintended extubation) if sedation is inadequate. No ED-based sedation guidelines currently exist, so individual practice varies widely. This study's objective was to describe the self-reported post-ETI sedation practice of Canadian adult ED physicians. Methods: An anonymous, cross-sectional, web-based survey featuring 7 common ED scenarios requiring ETI was distributed to adult ED physician members of the Canadian Association of Emergency Physicians (CAEP). Scenarios included post-cardiac arrest, hypercapnic and hypoxic respiratory failure, status epilepticus, polytrauma, traumatic brain injury, and toxicology. Participants indicated first and second choice of sedative medication following ETI, as well as bolus vs. infusion administration in each scenario. Data was presented by descriptive statistics. Results: 207 (response rate 16.8%) ED physicians responded to the survey. Emergency medicine training of respondents included CCFP-EM (47.0%), FRCPC (35.8%), and CCFP (13.9%). 51.0% of respondents work primarily in academic/teaching hospitals and 40.4% work in community teaching hospitals. On average, responding physicians report providing care for 4.9 ± 6.8 (mean ± SD) intubated adult patients per month for varying durations (39.2% for 1–2 hours, 27.8% for 2–4 hours, and 22.7% for ≤1 hour). Combining all clinical scenarios, propofol was the most frequently used medication for post-ETI sedation (38.0% of all responses) and was the most frequently used agent except for the post-cardiac arrest, polytrauma, and hypercapnic respiratory failure scenarios. Ketamine was used second most frequently (28.2%), with midazolam being third most common (14.5%). Post-ETI sedation was provided by > 98% of physicians in all situations except the post-cardiac arrest (26.1% indicating no sedation) and toxicology (15.5% indicating no sedation) scenarios. Sedation was provided by infusion in 74.6% of cases and bolus in 25.4%. Conclusion: Significant practice variability with respect to post-ETI sedation exists amongst Canadian emergency physicians. Future quality improvement studies should examine sedation provided in real clinical scenarios with a goal of establishing best sedation practices to improve patient safety and quality of care.
The cognitive process of worry, which keeps negative thoughts in mind and elaborates the content, contributes to the occurrence of many mental health disorders. Our principal aim was to develop a straightforward measure of general problematic worry suitable for research and clinical treatment. Our secondary aim was to develop a measure of problematic worry specifically concerning paranoid fears.
An item pool concerning worry in the past month was evaluated in 250 non-clinical individuals and 50 patients with psychosis in a worry treatment trial. Exploratory factor analysis and item response theory (IRT) informed the selection of scale items. IRT analyses were repeated with the scales administered to 273 non-clinical individuals, 79 patients with psychosis and 93 patients with social anxiety disorder. Other clinical measures were administered to assess concurrent validity. Test-retest reliability was assessed with 75 participants. Sensitivity to change was assessed with 43 patients with psychosis.
A 10-item general worry scale (Dunn Worry Questionnaire; DWQ) and a five-item paranoia worry scale (Paranoia Worries Questionnaire; PWQ) were developed. All items were highly discriminative (DWQ a = 1.98–5.03; PWQ a = 4.10–10.7), indicating small increases in latent worry lead to a high probability of item endorsement. The DWQ was highly informative across a wide range of the worry distribution, whilst the PWQ had greatest precision at clinical levels of paranoia worry. The scales demonstrated excellent internal reliability, test-retest reliability, concurrent validity and sensitivity to change.
The new measures of general problematic worry and worry about paranoid fears have excellent psychometric properties.
Local attitudes towards carnivores often reflect the degree of damage they are perceived to cause. Consequently, understanding the interactions between people and these species is essential to conservation efforts. This study investigated local perceptions of three Cerrado canid species and current chicken management practices, to identify the potential damage they cause and how this relates to peoples’ attitudes towards these species. Results from structured interviews at 50 ranches in Goiás, Brazil, highlighted that general knowledge about Cerrado canids differed significantly by species, with interviewees unable to correctly answer questions about the hoary fox Lycalopex vetulus and crab-eating fox Cerdocyon thous in comparison to the maned wolf Chrysocyon brachyurus. Chicken coops were identified as the most effective method for preventing predation, yet only 44% of respondents employed this method. Using a perceived predation measure, interviewees reported chicken predation by all three Cerrado canids even though most of these events were stated to occur during the day, outside the species’ active periods. Reported predation events were a strong predictor of attitude. Participants who experienced predation events reported they did not like having a Cerrado canid on their property. However, 86% of the respondents agreed that Cerrado canids should nevertheless be protected. Our findings support the need to incorporate the human dimension in canid and broader carnivore conservation issues.
The current study examines experiences of interpersonal mistreatment in federal litigation among a random sample of 4,608 practicing attorneys. Using both quantitative and qualitative survey data, we documented the nature and interplay of general incivility, gender-related incivility, and unwanted sexual attention. Nearly 75% of female attorneys had experienced some form of this misconduct in the previous five years, compared to half of male attorneys. An in-depth examination of instigators revealed that not only fellow attorneys but also federal judges, court personnel, marshals, and court security officers instigated the inappropriate behavior. We further found that most attorneys responded to this mistreatment with avoidance and denial; few used or trusted existing reporting mechanisms. The current study surpassed simple prevalence estimates to document effects of interpersonal mistreatment on the professional well-being of targeted attorneys. We discuss implications of these results, drawing on theories of social dominance, sex-role spillover, cognitive stress, organizations, and intervention.
The role of trial judges in the litigation process is frequently debated. Are judges to be dispassionate adjudicators, disengaged referees in a sport in which attorneys compete? Or are they charged with a more active role in promoting the substance, form, and process of justice? In the present paper, we explore the judicial role in addressing gender bias in federal litigation, using data gathered for the Eighth Circuit Gender Fairness Task Force. The federal judges of this circuit were surveyed about their experiences, observations, and opinions of gender-biased conduct. Results indicated that although judges viewed judicial intervention as an appropriate response to gender bias, they had little personal experience with intervention in such a situation. Fur thermore, when specific hypothetical scenarios were presented, they generally agreed that the described conduct was inappropriate but offered little consensus regarding the best course of action for an attorney or judge confronted with such behavior. The Eighth Circuit data thus provide the basis for expanded understanding of the conduct at issue, the options for action in response, and the persistent discrepancy in viewpoints on gender bias and the judicial role.
Sprays are a class of multiphase flows which exhibit a wide range of drop size and velocity scales spanning several orders of magnitude. The objective of the current work is to experimentally investigate the prospect of dynamical similarity in these flows. We are also motivated to identify a choice of length and time scales which could lead towards a universal description of the drop size and velocity spectra. Towards this end, we have fabricated a cohort of geometrically similar pressure swirl atomizers using micro-electromechanical systems (MEMS) as well as additive manufacturing technology. We have characterized the dynamical characteristics of the sprays as well as the drop size and velocity spectra (in terms of probability density functions, p.d.f.s) over a wide range of Reynolds (
) and Weber numbers (
) using high-speed imaging and phase Doppler interferometry, respectively. We show that the dimensionless Sauter mean diameter (
) scaled to the boundary layer thickness in the liquid sheet at the nozzle exit (
) exhibits self-similarity in the core region of the spray, but not in the outer zone. In addition, we show that global drop size spectra in the sprays show two distinct characteristics. The spectra from varying
collapse onto a universal p.d.f. for drops of size
, a residual effect of
persists in the size spectra. We explain this characteristic by the fact that the physical mechanisms that cause large drops is different from that which is responsible for the small drops. Similarly, with the liquid sheet velocity at the nozzle exit (
) as the choice of velocity scale, we show that drops moving with a velocity
collapse onto a universal p.d.f., while drops with
exhibit a residual effect of
. From these observations, we suggest that physically accurate models for drop size and velocity spectra should rely on piecewise descriptions of the p.d.f. rather than invoking a single mathematical form for the entire distribution. Finally, we show from a dynamical modal analysis that the conical liquid sheet flapping characteristics exhibit a sharp transition in Strouhal number (
) at a critical
Achieving a consistent level of robot utilisation throughout 24 h maximises automatic milking system (AMS) utilisation. However, levels of robot utilisation in the early morning hours are typically low, caused by the diurnal feeding behaviour of cows, limiting the inherent capacity and total production of pasture-based AMS. Our objective was to determine robot utilisation throughout 24 h by dairy cows, based on milking frequency (MF; milking events per animal per day) in a pasture-based AMS. Milking data were collected from January and February 2013 across 56 days, from a single herd of 186 animals (Bos taurus) utilising three Lely A3 robotic milking units, located in Tasmania, Australia. The dairy herd was categorised into three equal sized groups (n=62 per group) according to the cow’s mean daily MF over the duration of the study. Robot utilisation was characterised by an interaction (P< 0.001) between the three MF groups and time of day, with peak milking time for high MF cows within one h of a fresh pasture allocation becoming available, followed by the medium MF and low MF cows 2 and 4 h later, respectively. Cows in the high MF group also presented for milking between 2400 and 0600 h more frequently (77% of nights), compared to the medium MF group (57%) and low MF group (50%). This study has shown the formation of three distinct groups of cows within a herd, based on their MF levels. Further work is required to determine if this finding is replicated across other pasture-based AMS farms.
Clinicians who deal with patients with anorexia nervosa are well acquainted with their patients' inability to recognise their emaciation. The patients' insistence that they are normal weight or even overweight, against clear evidence to the contrary, led Bruch (1962) to state that the misperception reaches “delusional proportions”. Studies of body size perception in anorexia nervosa that have used the ‘body part’ method have invariably found that the patients overestimate their body size (Slade & Russell, 1973; Crisp & Kalucy, 1974; Pierloot & Houben, 1978; Garner et al, 1976; Button et al, 1977; Fries, 1977; Casper et al, 1979) but the majority have not found any significant difference in size estimation between patients and controls (Slade, 1985).
We present observations of 50 deg2 of the Mopra carbon monoxide (CO) survey of the Southern Galactic Plane, covering Galactic longitudes l = 300–350° and latitudes |b| ⩽ 0.5°. These data have been taken at 0.6 arcmin spatial resolution and 0.1 km s−1spectral resolution, providing an unprecedented view of the molecular clouds and gas of the Southern Galactic Plane in the 109–115 GHz J = 1–0 transitions of 12CO, 13CO, C18O, and C17O.
We present a series of velocity-integrated maps, spectra, and position-velocity plots that illustrate Galactic arm structures and trace masses on the order of ~106 M⊙ deg−2, and include a preliminary catalogue of C18O clumps located between l = 330–340°. Together with the information about the noise statistics of the survey, these data can be retrieved from the Mopra CO website and the PASA data store.
Mental health problems are inseparable from the environment. With virtual reality (VR), computer-generated interactive environments, individuals can repeatedly experience their problematic situations and be taught, via evidence-based psychological treatments, how to overcome difficulties. VR is moving out of specialist laboratories. Our central aim was to describe the potential of VR in mental health, including a consideration of the first 20 years of applications. A systematic review of empirical studies was conducted. In all, 285 studies were identified, with 86 concerning assessment, 45 theory development, and 154 treatment. The main disorders researched were anxiety (n = 192), schizophrenia (n = 44), substance-related disorders (n = 22) and eating disorders (n = 18). There are pioneering early studies, but the methodological quality of studies was generally low. The gaps in meaningful applications to mental health are extensive. The most established finding is that VR exposure-based treatments can reduce anxiety disorders, but there are numerous research and treatment avenues of promise. VR was found to be a much-misused term, often applied to non-interactive and non-immersive technologies. We conclude that VR has the potential to transform the assessment, understanding and treatment of mental health problems. The treatment possibilities will only be realized if – with the user experience at the heart of design – the best immersive VR technology is combined with targeted translational interventions. The capability of VR to simulate reality could greatly increase access to psychological therapies, while treatment outcomes could be enhanced by the technology's ability to create new realities. VR may merit the level of attention given to neuroimaging.
In the early 1980s there was an editorial in The Lancet entitled ‘ECT in Britain: a shameful state of affairs’ (Lancet, 1981). This was at a time when ECT was the main target of the anti-psychiatry movement and there were regular protests outside Royal College of Psychiatrists’ meetings about the use of ECT. Paradoxically, several of the UK randomised controlled trials of ECT had been published and others were under way, so the evidence base for the efficacy was stronger than it had ever been. The College had just completed its first survey of the use and practice of ECT, concluding that standards of practice were low, equipment was outdated and regional variations were enormous. The author of The Lancet editorial concluded that it was not ECT that was bringing psychiatry in disrepute, it was psychiatrists and the way they practised.
The College conducted further surveys of practice in the late 1980s and early 1990s, sadly showing that standards were improving little. The Special Committee on ECT (now Special Committee on ECT and Related Treatments) began running regular training courses which several thousand psychiatrists have now attended. More recently there have been increasing numbers of anaesthetic and nursing delegates.
Thirty years on, we now have a third edition of The ECT Handbook, guidelines from NICE endorsing the use of ECT (National Institute for Clinical Excellence, 2003; National Collaborating Centre for Mental Health, 2010) and we have ECTAS.
Over the first 20 years the rate of ECT steadily fell and if the slope had not levelled out it would have crossed zero in 2012. This did not happen, and the past 10 years have shown a levelling of the rates of giving ECT, with some areas showing a rise. National figures are no longer collected. This contrasts with the situation in North America, where the rates of ECT use have been rising, and raises the view that ECT may be underused, causing patients with severe and chronic depression to suffer for much longer, as antidepressant after antidepressant is changed.
Whatever the future of ECT, it is vitally important that when it is given, it is given appropriately, safely and with due concern to a patient's consent and dignity. The ECT Accreditation Service aims to assure and improve the quality of the administration of ECT.
There should ideally be a designated area for ECT within each general psychiatry unit; this is recommended on the basis of patient convenience and economy of nurse staffing. However, it is recognised that with the numbers of patients undergoing ECT falling, there is an increasing trend for psychiatric services to share one facility in an attempt to maintain standards of anaesthetic and psychiatric practice within the confines of a National Health Service budget.
The design of the ECT suite will depend on the type of service provided. The minimum requirement for a local unit with small patient numbers is two rooms: a treatment room and a recovery room. An ECT unit where patients would be required to wait before treatment will need a waiting room in addition. A suite providing ECT to neighbouring psychiatric units should ideally include an ECT office and a final post-ECT waiting area.
The waiting room should be a comfortable, relaxing and informal environment, with a range of distractions, for example an outside window, pictures and magazines, and toilet facilities should be available. Patients’ arrival should be booked to provide a smooth throughput with the minimum amount of waiting time. Patients waiting for ECT should not be able to see into the treatment area while the treatment is taking place, and patients waiting for treatment should not be in the same room as patients who have completed their treatment.
The treatment room should be accessible from the waiting area. In the treatment area the patient is assisted onto a trolley or bed and prepared for treatment. This room should be well lit and contain all the equipment necessary for routine and emergency treatment. It should be big enough to allow unrestricted staff movements. Adequate work surfaces and a sink with hot and cold water should be available. There should be a clock with a second hand. If nitrous oxide and/or anaesthetic inhalation agents are ever used, the treatment room should be equipped with scavenging equipment and agent monitoring. There should be good sound-proofing between the waiting area and treatment room.
The recovery area must be large enough to accommodate easily the trolleys and associated monitors of all the patients who are regaining consciousness, and there should be enough room for recovery nursing staff to work in.
A pneumocele occurs when an aerated cranial cavity pathologically expands; a pneumatocele occurs when air extends from an aerated cavity into adjacent soft tissues forming a secondary cavity. Both pathologies are extremely rare with relation to the mastoid. This paper describes a case of a mastoid pneumocele that caused hypoglossal nerve palsy and an intracranial pneumatocele.
A 46-year-old man presented, following minor head trauma, with hypoglossal nerve palsy secondary to a fracture through the hypoglossal canal. The fracture occurred as a result of a diffuse temporal bone pneumocele involving bone on both sides of the hypoglossal canal. Further slow expansion of the mastoid pneumocele led to a secondary middle fossa pneumatocele. The patient refused treatment and so has been managed conservatively for more than five years, and he remains well.
While most patients with otogenic pneumatoceles have presented acutely in extremis secondary to tension pneumocephalus, our patient has remained largely asymptomatic. Aetiology, clinical features and management options of temporal bone pneumoceles and otogenic pneumatoceles are reviewed.
This paper presents the first major data release and survey description for the ANU WiFeS SuperNovA Programme. ANU WiFeS SuperNovA Programme is an ongoing supernova spectroscopy campaign utilising the Wide Field Spectrograph on the Australian National University 2.3-m telescope. The first and primary data release of this programme (AWSNAP-DR1) releases 357 spectra of 175 unique objects collected over 82 equivalent full nights of observing from 2012 July to 2015 August. These spectra have been made publicly available via the WISEREP supernova spectroscopy repository.
We analyse the ANU WiFeS SuperNovA Programme sample of Type Ia supernova spectra, including measurements of narrow sodium absorption features afforded by the high spectral resolution of the Wide Field Spectrograph instrument. In some cases, we were able to use the integral-field nature of the Wide Field Spectrograph instrument to measure the rotation velocity of the SN host galaxy near the SN location in order to obtain precision sodium absorption velocities. We also present an extensive time series of SN 2012dn, including a near-nebular spectrum which both confirms its ‘super-Chandrasekhar’ status and enables measurement of the sub-solar host metallicity at the SN site.
The decomposition of the 21 cm rotation curve of galaxies into contribution from the disk and dark halo depends on the adopted mass to light ratio (M/L) of the disk. Given the vertical velocity dispersion (σz) of stars in the disk and its scale height (hz), the disk surface density and hence the M/L can be estimated. Earlier works have used this technique to conclude that galaxy disks are submaximal. Here we address an important conceptual problem: star-forming spirals have an old (kinematically hot) disk population and a young cold disk population. Both of these populations contribute to the integrated light spectra from which σz is measured. The measured scale height hz is for the old disk population. In the Jeans equation, σz and hz must pertain to the same population. We have developed techniques to extract the velocity dispersion of the old disk from integrated light spectra and from samples of planetary nebulae. We present the analysis of the disk kinematics of the galaxy NGC 628 using IFU data in the inner regions and planetary nebulae as tracers in the outer regions of the disk. We demonstrate that using the scale height of the old thin disk with the vertical velocity dispersion of the same population, traced by PNe, results in a maximal disk for NGC 628. Our analysis concludes that previous studies underestimate the disk surface mass density by ~ 2, sufficient to make a maximal disk for NGC 628 appear like a submaximal disk.