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All medical staff working within NHS psychiatric hospitals in the UK are required to complete mandatory life support training. However, there is no such mandatory requirement for associated training around the effective use of the emergency medical equipment used during medical emergencies on inpatient psychiatric wards. This quality improvement project focused on developing a sustainable educational intervention aimed at all staff types within one London inpatient psychiatric hospital. Staff of all grades and roles encountered frequent difficulties and delays in relation to the emergency medical bags and equipment, including issues around skill and confidence.
Methods
A survey was initially sent to medical and nursing staff working on an inpatient psychiatric unit, which highlighted participants’ lack of confidence in using the equipment. It emerged that staff exclusively handled the emergency medical equipment during relatively rare emergencies. This resulted in unfamiliarity with the equipment and consequent difficulties in using it competently. A novel educational intervention dedicated to upskilling staff with emergency medical equipment was created, focusing on contents and use of individual equipment within the medical emergency bag. Pre- and post-intervention quantitative feedback regarding confidence and familiarity was obtained using feedback forms containing Likert scales. Qualitative feedback was also obtained.
Results
More than six training cycles, each consisting of at least five training sessions, have now been completed with both qualitative and quantitative measures of improvement captured. Individuals noted on average a 31.62% (±3.605%) improvement in self-reported confidence and familiarity with equipment. The most frequently identified positive themes were that the intervention familiarised staff with equipment and was educational, whilst the most frequent suggestion for improvement were requests for additional sessions. From single idea to sustainable quality improvement, the team broadened and gained stakeholder support including clinical and nursing directors, pharmacy, junior doctors, nurses, and matrons.
Conclusion
The intervention has achieved sustainability and is being explored in other partnership psychiatric hospitals. Despite reported increased confidence in handling the emergency equipment, there is ongoing need to develop, maintain and practice these skills, across both the nursing and medical staff, to achieve better outcomes for psychiatric inpatients. Trainee psychiatrists intend to develop the project further, and the training will be incorporated as a mandatory requirement. The project links to the quality standards for mental health point 12 of the Resuscitation council UK. Next stage developments of the project include linking to feedback from emergencies as well as incorporating into existing simulation training.
In light of growing evidence suggesting that medical students are particularly susceptible to stress and ill health, the need to enhance their psychological well-being has been highlighted as a priority concern in medical education and policy. However, only a few studies have comprehensively addressed both positive and negative contributors to medical students' psychological well-being. Therefore, this study aims to provide a more holistic understanding of medical students' psychological well-being, the coping strategies they use and any barriers they face in seeking support, as well as outline potential areas of improvement within provisional well-being support.
Methods
This qualitative study involves semi-structured interviews with 25 medical students to gain in-depth insight into their experiences and perspectives on the factors influencing their psychological well-being during their medical training. The interviews were transcribed and analysed using thematic analysis.
Results
The study's results revealed that positive and negative factors influence medical students' psychological well-being. Positive factors such as study-life balance, academic achievement, meaningful relationships with staff and peers and time spent with close friends or family positively influenced students’ psychological well-being; while adverse educational, organisational and cultural factors negatively impacted students' well-being. Additionally, COVID-19 had negatively affected students’ academic, personal and social lives. Medical students mainly used active coping strategies, including planning, acceptance, positive reframing, and seeking support. However, some students reported facing barriers in seeking support, such as fear of stigma, lack of time/support, confidentiality concerns, and difficulty in accessing support. At the same time, there was an expressed need to improve well-being services or resource provision. Students have recommended various solutions to improve mental health support in schools, including addressing cultural and organisational changes within schools, increasing access to resources, reducing the stigma surrounding mental health, and promoting positive factors that support psychological well-being.
Conclusion
The findings highlight the importance of adopting a holistic approach that considers a variety of contributing factors affecting positively as well as negatively medical students’ well-being. It also highlights the need to provide a supportive and nurturing environment in medical schools and offer appropriate support and resources to help students cope with the stress and challenges of medical training.
Transitivity is the assumption that if a person prefers A to B and B to C, then that person should prefer A to C. This article explores a paradigm in which Birnbaum, Patton and Lott (1999) thought people might be systematically intransitive. Many undergraduates choose C = ($96, .85; $90, .05; $12, .10) over A = ($96, .9; $14, .05; $12, .05), violating dominance. Perhaps people would detect dominance in simpler choices, such as A versus B = ($96, .9; $12, .10) and B versus C, and yet continue to violate it in the choice between A and C, which would violate transitivity. In this study we apply a true and error model to test intransitive preferences predicted by a partially effective editing mechanism. The results replicated previous findings quite well; however, the true and error model indicated that very few, if any, participants exhibited true intransitive preferences. In addition, violations of stochastic dominance showed a strong and systematic decrease in prevalence over time and violated response independence, thus violating key assumptions of standard random preference models for analysis of transitivity.
Using capture-recapture analysis we estimate the effective size of the active Amazon Mechanical Turk (MTurk) population that a typical laboratory can access to be about 7,300 workers. We also estimate that the time taken for half of the workers to leave the MTurk pool and be replaced is about 7 months. Each laboratory has its own population pool which overlaps, often extensively, with the hundreds of other laboratories using MTurk. Our estimate is based on a sample of 114,460 completed sessions from 33,408 unique participants and 689 sessions across seven laboratories in the US, Europe, and Australia from January 2012 to March 2015.
When participants in psychophysical experiments are asked to estimate or identify stimuli which differ on a single physical dimension, their judgments are influenced by the local experimental context — the item presented and judgment made on the previous trial. It has been suggested that similar sequential effects occur in more naturalistic, real-world judgments. In three experiments we asked participants to judge the prices of a sequence of items. In Experiment 1, judgments were biased towards the previous response (assimilation) but away from the true value of the previous item (contrast), a pattern which matches that found in psychophysical research. In Experiments 2A and 2B, we manipulated the provision of feedback and the expertise of the participants, and found that feedback reduced the effect of the previous judgment and shifted the effect of the previous item's true price from contrast to assimilation. Finally, in all three experiments we found that judgments were biased towards the centre of the range, a phenomenon known as the “regression effect” in psychophysics. These results suggest that the most recently-presented item is a point of reference for the current judgment. The findings inform our understanding of the judgment process, constrain the explanations for local context effects put forward by psychophysicists, and carry practical importance for real-world situations in which contextual bias may degrade the accuracy of judgments.
We report a study of the effects the choice set on financial decision making related to retirement savings and risky investment. The participants were presented with either a full range of choice options or a limited subset of the feasible options. The choices of saving and risk are affected by the position of each option in the range of presented options. This result demonstrated that the range of the options offered as possible saving rates and levels of investment risk influences decisions about saving and risk. The study was conducted on a sample of working people, and we controlled whether the participants can financially afford in their real life the decisions taken in the test. In addition, various measures of risk aversion did not account for the risk taken in each condition. Surprisingly, only the simplest and most direct risk preference measure was a significant predictor of the responses within a particular choice set context, although the actual choices were still very much influenced by the range. Thus, the results reported here suggest that financial judgments and choices are relative, which corroborates, in an important practical domain, previous related work with abstract gambles and hypothetical risky investments.
In this chapter the major conservation issues bears face is reviewed and management actions that can address these conservation issues are highlighted. The future of bears across the world is bright for some species but dark for others. In some areas such as North America and in parts of Europe and Asia, bear populations have increased and stabilized because of increased management effort and increasing support for bears and their needs by the humans who share habitat with them. However, for most bear species, the future is uncertain. Andean bears continue to be threatened by habitat loss and human encroachment. In much of Asia outside Japan, Asiatic black bear, sloth bear, and sun bear populations are increasingly threatened by unmanaged excessive mortality combined with habitat loss to timber harvest, plantation agriculture, and human encroachment. The long-term future for polar bears is threatened by the unmanageable threat of climate change. Giant pandas are fragmented into small populations despite intense conservation efforts. Improving public and political support for bears is the most important need if we are to realize successful bear conservation and management.
XRF maps of a uranium ore sample have been analyzed using software that allows the graphical spatial correlations of all detected elements to be measured. The association of uranium with arsenic, nickel and cesium was explored; all showed unique finely-granular microscopic patterns that could be used to assist the recovery of uranium and rare earths.
High definition video from a towed camera system was used to describe the deep-sea benthic habitats within an elongate depression located at the western margin of Rockall Bank in the Hatton–Rockall Basin. At depths greater than 1190 m, an extensive area (10 km long by 1.5 km wide) of what appeared to be reduced sediments, bacterial mats and flocculent matter indicated possible cold-seep habitat. Plumes of sediment-rich fluid were observed alongside raised elongate features that gave topographic relief to the otherwise flat seafloor. In the deepest section of the depression (1215 m) dense flocculent matter was observed suspended in the water column, in places obscuring the seabed. Away from the bacterial mats, the habitat changed rapidly to sediments dominated by tube-dwelling polychaete worms and then to deep-sea sedimentary habitats more typical for the water depth (sponges and burrowing megafauna in areas of gentle slopes, and coral gardens on steeper slopes).
School-based gardens (SBGs) are contributing to improvements in many areas of education, including nutrition, health, connectedness and engagement of students. While considerable research has been conducted in other parts of the world, research in Australia provides limited understanding of the impact of SBGs. The aim of this paper is to give a reflective viewpoint on the impact of SBGs in Australia from the perspective of an Aboriginal philosophical approach called Dadirri. The philosophy highlights an Australian Aboriginal concept, which exists but has different meanings across Aboriginal language groups. This approach describes the processes of deep and respectful listening. The study uses photovoice as a medium to engage students to become researchers in their own right. Using this methodology, students have control over how they report what is significant to them. The use of photovoice as a data collection method is contextualised within the Aboriginal philosophical approach to deep listening. For the first author, an Aboriginal researcher (Clague), the journey is to find a research process that maintains cultural integrity and resonates with the participants by affirming that a culturally sensitive approach to learning is important.
To review the current clinical practice and guidelines for testing and treating vitamin D deficiency in adolescents admitted to a tier 4 adolescent psychiatric unit in north London. The blood test results of 56 patients admitted between 2012 and 2014 were examined to determine whether vitamin D levels had been tested. For those individuals who were tested for vitamin D, results were analysed by gender and ethnicity.
Results
Of 56 patients admitted, 48% were tested for vitamin D deficiency and in 81.5% of cases we uncovered deficiency or severe deficiency; 18.5% had the minimum levels of vitamin D for bone health as per our trust guidelines.
Clinical implications
Adolescents within tier 4 adolescent mental health services may be at higher risk of vitamin D deficiency and so assessment of vitamin D levels should be considered as part of a standard physical health review for this group of young people.
We conducted a clinical trial to determine if prophylactic anticonvulsants in brain tumour patients (without prior seizures) reduced seizure frequency. We stopped accrual at 100 patients on the basis of the interim analysis.
Methods:
One hundred newly diagnosed brain tumour patients received anticonvulsants (AC Group) or not (No AC Group) in this prospective randomized unblinded study. Sixty patients had metastatic, and 40 had primary brain tumours. Forty-six (46%) patients were randomized to the AC Group and 54 (54%) to the No AC Group. Median follow-up was 5.44 months (range 0.13 -30.1 months).
Results:
Seizures occurred in 26 (26%) patients, eleven in the AC Group and 15 in the No AC Group. Seizure-free survivals were not different; at three months 87% of the AC Group and 90% of the No AC Group were seizure-free (log rank test, p=0.98). Seventy patients died (unrelated to seizures) and survival rates were equivalent in both groups (median survival = 6.8 months versus 5.6 months, respectively; log rank test, p=0.50). We then terminated accrual at 100 patients because seizure and survival rates were much lower than expected; we would need ≥ 900 patients to have a suitably powered study.
Conclusions:
These data should be used by individuals contemplating a clinical trial to determine if prophylactic anticonvulsants are effective in subsets of brain tumour patients (e.g. only anaplastic astrocytomas). When taken together with the results of a similar randomized trial, prophylactic anticonvulsants are unlikely to be effective or useful in brain tumour patients who have not had a seizure.
In 1976, David Sugden and Brian John developed a classification for Antarctic landscapes of glacial erosion based upon exposed and eroded coastal topography, providing insight into the past glacial dynamics of the Antarctic ice sheets. We extend this classification to cover the continental interior of Antarctica by analysing the hypsometry of the subglacial landscape using a recently released dataset of bed topography (BEDMAP2). We used the existing classification as a basis for first developing a low-resolution description of landscape evolution under the ice sheet before building a more detailed classification of patterns of glacial erosion. Our key finding is that a more widespread distribution of ancient, preserved alpine landscapes may survive beneath the Antarctic ice sheets than has been previously recognized. Furthermore, the findings suggest that landscapes of selective erosion exist further inland than might be expected, and may reflect the presence of thinner, less extensive ice in the past. Much of the selective nature of erosion may be controlled by pre-glacial topography, and especially by the large-scale tectonic structure and fluvial valley network. The hypotheses of landscape evolution presented here can be tested by future surveys of the Antarctic ice sheet bed.
This chapter introduces some recent developments in the areas of human reasoning and decision making. Regarding decision making, the chapter focuses on decision-under-risk, using problems which are explicitly described in linguistic or symbolic terms. Human common-sense reasoning is far more sophisticated than any current artificial intelligence models can capture; yet people's performance on, for example, simple conditional inference, while perhaps explicable in probabilistic terms, is by no means effortless and noise-free. It may be that human reasoning and decision making function best in the context of highly adapted cognitive processes such as basic learning, deploying world knowledge, or perceptuomotor control. Indeed, what is striking about human cognition is the ability to handle, even to a limited extent, reasoning and decision making in novel, hypothetical, verbally stated scenarios, for which our past experience and evolutionary history may have provided us with only minimal preparation.