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Despite an increasing awareness of the importance of spirituality in mental health contexts, a ‘religiosity gap’ exists in the difference in the value placed on spirituality and religion by professionals compared with service users. This may be due to a lack of understanding about the complex ways people connect with spirituality within contemporary society and mental health contexts, and can result in people's spiritual needs being neglected, dismissed or pathologised within clinical practice. The aim of this qualitative systematic review is to characterise the experiences of spirituality among adults with mental health difficulties in published qualitative research.
An electronic search of seven databases was conducted along with forward and backward citation searching, expert consultation and hand-searching of journals. Thirty-eight studies were included from 4944 reviewed papers. The review protocol was pre-registered (PROSPERO:CRD42017080566).
A thematic synthesis identified six key themes: Meaning-making (sub-themes: Multiple explanations; Developmental journey; Destiny v. autonomy), Identity, Service-provision, Talk about it, Interaction with symptoms (sub-themes: Interactive meaning-making; Spiritual disruption) and Coping (sub-themes: Spiritual practices; Spiritual relationship; Spiritual struggles; Preventing suicide), giving the acronym MISTIC.
This qualitative systematic review provides evidence of the significant role spirituality plays in the lives of many people who experience mental health difficulties. It indicates the importance of mental health professionals being aware of and prepared to support the spiritual dimension of people using services. The production of a theory-based framework can inform efforts by health providers to understand and address people's spiritual needs as part of an integrated holistic approach towards care.
Background: EMBRACE (NCT02462759) Part 1 is a randomized, double-blind, sham-procedure controlled study assessing safety/tolerability of intrathecal nusinersen (12-mg equivalent dose) in symptomatic infants/children with SMA who were not eligible to participate in ENDEAR or CHERISH. Methods: Eligible participants had onset of SMA symptoms at ≤6 months with 3 SMN2 copies; onset at ≤6 months, age >7 months and 2 copies; or onset at >6 months, age ≤18 months, and 2/3 copies. Safety/tolerability was the primary endpoint. Exploratory endpoints included Hammersmith Infant Neurological Examination Section 2 (HINE-2) motor milestone attainment, change in ventilator use, and growth. Results: EMBRACE Part 1 was terminated early based on positive results from ENDEAR. Safety/tolerability was similar to previous trials. More nusinersen-treated (11/14;79%) vs. sham–treated individuals (2/7;29%) were HINE-2 motor milestone responders. Between Day 183 and 302, mean (SD) hours of ventilator use changed by +1.236 (3.712) hours in nusinersen-treated (n=12) and +2.123 (3.023) hours in sham–treated individuals (n=7). Similar increases in weight and body length were observed in nusinersen-treated and sham–treated individuals by Day 183. Conclusions: In EMBRACE Part 1, nusinersen demonstrated a favorable benefit-risk profile. These results add to the aggregated efficacy, safety/tolerability data of nusinersen in SMA.
The appropriate medical treatment test (ATT), included in the Mental Health Act (MHA) (1983, as amended 2007), aims to ensure that detention only occurs when treatment with the purpose of alleviating a mental disorder is available.
As part of the Assessing the Impact of the Mental Health Act (AMEND) project, this qualitative study aimed to assess professionals' understanding of the ATT, and its impact on clinical practice.
Forty-one professionals from a variety of mental health subspecialties were interviewed. Interviews were coded related to project aims, and themes were generated in an inductive process.
We found that clinicians are often wholly relied upon for the ATT. Considered treatment varied depending on the patient's age rather than diagnosis. The ATT has had little impact on clinical practice.
Our findings suggest the need to review training and support for professionals involved in MHA assessments, with better-defined roles. This may enable professionals to implement the ATT as its designers intended.
The discovery of the first electromagnetic counterpart to a gravitational wave signal has generated follow-up observations by over 50 facilities world-wide, ushering in the new era of multi-messenger astronomy. In this paper, we present follow-up observations of the gravitational wave event GW170817 and its electromagnetic counterpart SSS17a/DLT17ck (IAU label AT2017gfo) by 14 Australian telescopes and partner observatories as part of Australian-based and Australian-led research programs. We report early- to late-time multi-wavelength observations, including optical imaging and spectroscopy, mid-infrared imaging, radio imaging, and searches for fast radio bursts. Our optical spectra reveal that the transient source emission cooled from approximately 6 400 K to 2 100 K over a 7-d period and produced no significant optical emission lines. The spectral profiles, cooling rate, and photometric light curves are consistent with the expected outburst and subsequent processes of a binary neutron star merger. Star formation in the host galaxy probably ceased at least a Gyr ago, although there is evidence for a galaxy merger. Binary pulsars with short (100 Myr) decay times are therefore unlikely progenitors, but pulsars like PSR B1534+12 with its 2.7 Gyr coalescence time could produce such a merger. The displacement (~2.2 kpc) of the binary star system from the centre of the main galaxy is not unusual for stars in the host galaxy or stars originating in the merging galaxy, and therefore any constraints on the kick velocity imparted to the progenitor are poor.
Analyses of the first aircraft multi-frequency, Polarimetric synthetic aperture radar (SAR) data acquired over the southwestern Greenland ice sheet are presented. Data were collected on 31 August 1989 by the Jet Propulsion Laboratory SAR using the NASA DC-8 aircraft. Along with curvilinear patterns associated with large-scale morphologic features such as crevasses, lakes and streams, frequency and polarization dependencies are observed in the P-, L-and C-band image products. Model calculations that include firn grain-size and volumetric water content suggest that tonal variations in and between the images are attributable to large-scale variations in the snow-and ice-surface characteristics, especially snow wetness. In particular, systematic trends in back-scatter strength observed at C-band across regions of changing snow wetness are suggestive of a capability to delineate boundaries between snow facies. Ice lenses and ice pipes are the speculated cause for similar trends in P-band back-scatter. Finally, comparison between SEASAT SAR data collected in 1978 and these airborne data collected in 1989 indicate a remarkable stability of surface patterns associated with the locations of supraglacial lake and stream systems.
As usual, this report contains contributions from a number of authors, as follows: § 2, P. D. Jackson and M. P. FitzGerald; §§ 3 and 4, F. J. Kerr and D. L. Crawford; §5, P. O. Lindblad; §§ 6A and C, R. Wielen; §§ 6B and 7, J. Einasto; §§ 6D and E, K. C. Freeman, § 6F, M Fujimoto. The layout follows previous practice, except that a new Section 7 on the galactic environment has been added. A longer version of the Report will be published by the University of Maryland and will be distributed to all members of Commission 33 and to astronomical institutions.
While a number of site testing campaigns are in progress throughout the world, the dominant efforts seem to be associated with plans for very large telescopes. These plans, improved telescope technology, and the realization that astronomical observations from space will put increasing demands on ground-based observing facilities have given new impetus to site identification and to the optimum utilization of existing sites. A most excellent review of the factors involved in site identification is now available in the Proceedings of the ESO Workshop on Site Testing for Future Large Telescopes, edited by A. Ardeberg and L. Woltjer 1981. These Proceedings and Woolf’s review (1982, Ann. Rev. Astron. Astrophys. 20 367) provide a solid background of current site evaluation factors.
The Parkes multibeam pulsar survey uses a 13-element receiver operating at a wavelength of 20 cm to survey the inner Galactic plane with remarkable sensitivity. To date we have collected and analyzed data from 45% of the survey region (|b| < 5°; 260° < l < 50°), and have discovered 440 pulsars, in addition to re-detecting 190 previously known ones. Most of the newly discovered pulsars are at great distances, as inferred from a median dispersion measure (DM) of 400 cm−3 pc.
When the editors invited me to contribute an essay to Eminent Economists II: Their Life Philosophies, I found the adjective intimidating. My hesitance grew as I reviewed the list of contributors to the first Eminent Economists volume and reread their magnificent, moving essays. I wondered, “Why not Salient Economists? That I could live with.” My muse (a librarian and sometime bookseller) replied: “Yeah … just think how many copies that would sell!”
My title is an attempt to reduce the gap between expectations and results. But even this reframing of the task left me uncomfortable with the idea of writing about something as self-conscious as a life philosophy. Until recently unaware even of having had one, I doubted my ability to articulate one worth reading about. Besides, didn’t those who would be interested already know me well enough to infer what my philosophy must be?
Several factors made me agree to write the essay. First, the invitation came as I finished up a third of a century (literally thirty-three and a third years) at the University of California, San Diego, in preparation for starting a second job at Oxford. That seemed a salient time to summarize what I had learned about my profession. I also had a vivid memory of my colleague Sir Clive Granger, whose 2009 death prevented him from contributing to Eminent Economists II, at a UCSD gathering in his honor. He explained the even more ambitious turn his research had lately taken by saying, “Winning a Nobel Prize is one of those things that builds self-coni dence.” I thought, “What in the world are the other things?” When the invitation came I saw that it might be one – one that didn’t require anything as difficult as discovering cointegration.
There has been major concern about the ‘over-representation’ of Black and ethnic minority groups amongst people detained under the Mental Health Act (MHA). We explored the effect of patient ethnicity on detention following an MHA assessment, once confounding variables were controlled for.
Prospective data were collected for all MHA assessments over 4-month periods in the years 2008, 2009, 2010 and 2011 each in three regions in England: Birmingham, West London and Oxfordshire. Logistic regression modelling was conducted to predict the outcome of MHA assessments – either resulting in ‘detention’ or ‘no detention’.
Of the 4423 MHA assessments, 2841 (66%) resulted in a detention. A diagnosis of psychosis, the presence of risk, female gender, level of social support and London as the site of assessment predicted detention under the MHA. Ethnicity was not an independent predictor of detention.
There is no evidence for that amongst those assessed under the MHA, ethnicity has an independent effect on the odds of being detained.
Criteria for mild cognitive impairment (MCI) consider impairment in instrumental activities of daily living (IADL) as exclusionary, but cross-sectional studies suggest that some high-level functional deficits are present in MCI. This longitudinal study examines informant-rated IADL in MCI, compared with cognitively normal (CN) older individuals, and explores whether functional abilities, particularly those with high cognitive demand, are predictors of MCI and dementia over a 2-year period in individuals who were CN at baseline.
A sample of 602 non-demented community dwelling individuals (375 CN and 227 with MCI) aged 70–90 years underwent baseline and 24-month assessments that included cognitive and medical assessments and an interview with a knowledgeable informant on functional abilities with the Bayer Activities of Daily Living Scale.
Significantly more deficits in informant-reported IADL with high cognitive demand were present in MCI compared with CN individuals at baseline and 2-year follow-up. Functional ability in CN individuals at baseline, particularly in activities with high cognitive demand, predicted MCI and dementia at follow-up. Difficulties with highly cognitively demanding activities specifically predicted amnestic MCI but not non-amnestic MCI whereas those with low cognitive demand did not predict MCI or dementia. Age, depressive symptoms, cardiovascular risk factors and the sex of the informant did not contribute to the prediction.
IADL are affected in individuals with MCI, and IADL with a high cognitive demand show impairment predating the diagnosis of MCI. Subtle cognitive impairment is therefore likely to be a major hidden burden in society.
The Department of Materials and Metallurgical Engineering faculty at the South Dakota School of Mines and Technology (SDSM&T) has developed a unique undergraduate program that integrates research, extracurricular activities, and outreach experiences. A common thread throughout the program is an introduction to the artistic and historical background of metallurgical engineering. These activities use kinesthetic learning to promote student learning of metallurgical engineering, aspects often not traditionally included in engineering curricula. These programs are similar to those envisioned by the National Academy of Engineering in response to the changing needs of engineering. These are described in two visionary books published by the National Research Council.
A major focus of the program integrates blacksmithing activities with curricular, extracurricular, and outreach activities. All SDSM&T students are invited to a weekly blacksmithing activity called Hammer-in. Blacksmithing-related laboratories were added to the curriculum. Additionally, students developed a portable blacksmithing laboratory with faculty supervision. The laboratory has been taken to K-12 schools, including Native American schools on reservations, to reach out to regional students, thereby promoting interest in STEM careers. The success of these activities led to their incorporation into a National Science Foundation Research Experience for Undergraduate (REU) at SDSM&T called Back to the Future that focuses on understanding new technologies through historical antecedents. The SDSM&T students who participated in this REU used this experience as part of their junior/senior design courses. This program has increased enrollment in the department and has led to better learning outcomes for the students.
Identify trends of enrolment and key challenges when recruiting infants with complex cardiac diseases into a multi-centre, randomised, placebo-controlled drug trial and assess the impact of efforts to share successful strategies on enrolment of subjects.
Rates of screening, eligibility, consent, and randomisation were determined for three consecutive periods of time. Sites collectively addressed barriers to recruitment and shared successful strategies resulting in the Inventory of Best Recruiting Practices. Study teams detailed institutional practices of recruitment in post-trial surveys that were compared with strategies of enrolment initially proposed in the Inventory.
The number of screened patients increased by 30% between the Initial Period and the Intermediate Period (p = 0.007), whereas eligibility decreased slightly by 7%. Of those eligible for entry into the study, the rate of consent increased by 42% (p = 0.025) and randomisation increased by 71% (p = 0.10). During the Final Period, after launch of a competing trial, fewer patients were screened (−14%, p = 0.06), consented (−19%, p = 0.12), and randomised (−34%, p = 0.012). Practices of recruitment in the post-trial survey closely mirrored those in the Inventory.
Early identification and sharing of best strategies of recruitment among all recruiting sites can be effective in increasing recruitment of critically ill infants with congenital cardiac disease and possibly other populations. Strategies of recruitment should focus on those that build relationships with families and create partnerships with the medical providers who care for them. Competing studies pose challenges for enrolment in trials, but fostering trusting relationships with families can result in successful enrolment into multiple studies.
To investigate nutrition literacy among adult grocery buyers regarding energy-related labelling terms on food packaging.
Qualitative interviews and quantitative surveys to determine shoppers’ understanding of energy terms (‘energy’, ‘calories’ and ‘kilojoules’) and how energy terms affect perceptions of healthiness and intentions to purchase breakfast cereals, muesli bars and frozen meals.
Individual in-depth interviews and surveys in two metropolitan supermarkets, Sydney, Australia.
Australian adults (interview n 40, survey n 405) aged 18–79 years.
The relationship between energy and perceived healthiness of food varied by product type: higher energy breakfast cereals were perceived to be healthier, while lower energy frozen meals were seen as healthier choices. Likewise, intentions to purchase the higher energy product varied according to product type. The primary reason stated for purchasing higher energy products was for sustained energy. Participants from households of lower socio-economic status were significantly more likely to perceive higher energy products as healthier. From the qualitative interviews, participants expressed uncertainty about their understanding of kilojoules, while only 40 % of participants in intercept surveys correctly answered that kilojoules and calories measured the same thing.
Australian consumers have a poor understanding of energy and kilojoules and tend to perceive higher energy products as healthier and providing sustained energy. This has implications regarding the usefulness of industry front-of-pack labelling initiatives and quick service restaurant menu labelling that provides information on energy content only. Comprehensive and widely communicated education campaigns will be essential to guide consumers towards healthier choices.
We investigated pure FCC metals including Aluminum, Nickel, Silver, and 70/30 Copper Zinc (alpha-brass) alloy for the indentation size effect (ISE) and the bilinear behavior using a single Berkovich indenter tip in a single test machine. The results were consistent with those reported by Elmustafa and Stone, 2003 of the ISE and the bilinear behavior using two separate indenter tips (Berkovich and Vickers) from two separate machines. This behavior is mechanistic in nature and is observed regardless of the type of the self similar indenter tip employed. Furthermore, the research presented in this paper would seem to also validate the conclusions that Elmustafa et al (2004) articulate that the Strain Gradient Plasticity collapses at small scales and that the bilinear behavior of these FCC metals is attributed to the presence of long range shear stresses induced by geometrically necessary dislocations. Also, we observed what has been defined as a “tapping” issue for materials with high E/H ratios when using the CSM. The CSM protocol results in erroneous hardness results at very shallow depths for high E/H ratio soft metals due to the so called “tapping” of the stylus as articulated by Pharr et al. (2009). This method should only be used as a secondary technique to the load control protocol when examining the ISE effect.
Escherichia coli, like other gram-negative bacteria, is protected from the surrounding harsh environment by a cell wall consisting of the peptidoglycan and outer membrane. Whereas the cytoplasmic membrane is the selective barrier, the cell wall provides mechanical strength for the cell. As bacteria navigate various environments, osmotic pressure can change dramatically due to changes in local solute concentration. The peptidoglycan together with the cellular proteins mitigates the osmotic stress that would otherwise cause lysis. The mechanical properties of E. coli cells and its individual layers have been largely indeterminable until the recent development of probe-based measurement tools. Since their invention, scientists have reported significant data measuring elasticity, modulus, and stiffness using atomic force microscopy (AFM). Fundamentally, in order to determine these mechanical properties through probe-based techniques, the contact area and load should be well defined. The load can be precisely calculated through the AFM cantilever spring constant. However, the silicon tip contact area can only be estimated, potentially leading to compounding uncertainties. Therefore, we developed a methodology to determine nanomechanical properties of E. coli using a nanoindenter.