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Out of hours, there is only one on-site junior doctor. First year psychiatry trainees (CT1s) and GP trainees may have no prior experience in psychiatry. On-call shifts are therefore potentially daunting for new trainees.
Expand the resources available for trainees when on-call.
We issued questionnaires to CT1s asking if they would have appreciated more information about on-call scenarios and in what format.
Based on the questionnaire results we implemented some changes. These were:
– a printed “pocket-guide” summarising common on-call scenarios;
– a training video on common on-call scenarios.
The handout was given to new trainees in February 2016 and in August 2016. The video was shown to new trainees in August 2016. Trainees provided feedback on the resources.
Of 24 CT1s, 15 (63%) were “neutral” or “disagreed” that they had felt prepared for on-calls.
CT1s wanted additional resources, especially a paper handout or phone download.
Feedback on the “pocket-guide” from trainees in February 2016 (n = 8) was positive (62.5% reported increased confidence in on-call situations). Feedback is also being collected from trainees who received the guide in August 2016.
Trainees in August 2016 (n = 36) liked the video – no trainees “disagreed” with statements asking if the video had been useful.
The video improved the confidence of trainees about on-call situations by an average of 2.8 points.
We have expanded available resources relating to on-calls and improved confidence. Further improvements would include making resources more easily available in downloadable formats.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Angiostrongylus cantonensis is a pathogenic nematode and the cause of neuroangiostrongyliasis, an eosinophilic meningitis more commonly known as rat lungworm disease. Transmission is thought to be primarily due to ingestion of infective third stage larvae (L3) in gastropods, on produce, or in contaminated water. The gold standard to determine the effects of physical and chemical treatments on the infectivity of A. cantonensis L3 larvae is to infect rodents with treated L3 larvae and monitor for infection, but animal studies are laborious and expensive and also raise ethical concerns. This study demonstrates propidium iodide (PI) to be a reliable marker of parasite death and loss of infective potential without adversely affecting the development and future reproduction of live A. cantonensis larvae. PI staining allows evaluation of the efficacy of test substances in vitro, an improvement upon the use of lack of motility as an indicator of death. Some potential applications of this assay include determining the effectiveness of various anthelmintics, vegetable washes, electromagnetic radiation and other treatments intended to kill larvae in the prevention and treatment of neuroangiostrongyliasis.
Children of parents with mood and psychotic disorders are at elevated risk for a range of behavioral and emotional problems. However, as the usual reporter of psychopathology in children is the parent, reports of early problems in children of parents with mood and psychotic disorders may be biased by the parents' own experience of mental illness and their mental state.
Independent observers rated psychopathology using the Test Observation Form in 378 children and youth between the ages of 4 and 24 (mean = 11.01, s.d. = 4.40) who had a parent with major depressive disorder, bipolar disorder, schizophrenia, or no history of mood and psychotic disorders.
Observed attentional problems were elevated in offspring of parents with major depressive disorder, bipolar disorder and schizophrenia (effect sizes ranging between 0.31 and 0.56). Oppositional behavior and language/thought problems showed variable degrees of elevation (effect sizes 0.17 to 0.57) across the three high-risk groups, with the greatest difficulties observed in offspring of parents with bipolar disorder. Observed anxiety was increased in offspring of parents with major depressive disorder and bipolar disorder (effect sizes 0.19 and 0.25 respectively) but not in offspring of parents with schizophrenia.
Our results suggest that externalizing problems and cognitive and language difficulties may represent a general manifestation of familial risk for mood and psychotic disorders, while anxiety may be a specific marker of liability for mood disorders. Observer assessment may improve early identification of risk and selection of youth who may benefit from targeted prevention.
We present a highly detailed study of calving dynamics at Tunabreen, a tidewater glacier in Svalbard. A time-lapse camera was trained on the terminus and programmed to capture images every 3 seconds over a 28-hour period in August 2015, producing a highly detailed record of 34 117 images from which 358 individual calving events were distinguished. Calving activity is characterised by frequent events (12.8 events h−1) that are small relative to the spectrum of calving events observed, demonstrating the prevalence of small-scale calving mechanisms. Five calving styles were observed, with a high proportion of calving events (82%) originating at, or above, the waterline. The tidal cycle plays a key role in the timing of calving events, with 68% occurring on the falling limb of the tide. Calving activity is concentrated where meltwater plumes surface at the glacier front, and a ~ 5 m undercut at the base of the glacier suggests that meltwater plumes encourage melt-under-cutting. We conclude that frontal ablation at Tunabreen may be paced by submarine melt rates, as suggested from similar observations at glaciers in Svalbard and Alaska. Using submarine melt rate to calculate frontal ablation would greatly simplify estimations of tidewater glacier losses in prognostic models.
Strong strain-mediated magnetoelectric (ME) coupling in magnetic/ferroelectric heterostructures has great potential for different high-frequency multiferroic devices. In this article, we present the most recent progress in integrated multiferroic devices. Integrated magnetic tunable inductors with a wide operation frequency range, integrated nonreciprocal bandpass filters with dual magnetic and electric-field tunability based on magnetostatics surface waves, and novel radio-frequency nanomechanical ME resonators with pico-Tesla sensitivity for direct current magnetic fields are presented. Finally, a new antenna miniaturization mechanism, acoustically actuated nanomechanical ME antennas, which can successfully miniaturize the size by 1–2 orders, is introduced. With the advantages of high magnetic field sensitivity, highest antenna gain among all nanoscale antennas at similar frequency, integrated capability with complementary metal oxide semiconductor technology, and ground-plane immunity from metallic surfaces and the human body, ME antennas have a bright future for biomedical applications, wearable antennas, and the Internet of Things due to their unique and particular properties.
The properties of the acoustic modes are sensitive to magnetic activity. The unprecedented long-term Kepler photometry, thus, allows stellar magnetic cycles to be studied through asteroseismology. We search for signatures of magnetic cycles in the seismic data of Kepler solar-type stars. We find evidence for periodic variations in the acoustic properties of about half of the 87 analysed stars. In these proceedings, we highlight the results obtained for two such stars, namely KIC 8006161 and KIC 5184732.
Introduction: Resuscitation is a dynamic, complex and time-sensitive field which encompasses management of both critically-ill patients as well as large multidisciplinary teams. Expertise in this area has not been adequately defined, and to date, no research has directly examined the decision-making and cognitive processes involved. The evolving paradigm of competency-based medical education (CBME) makes better defining expertise in this field of critical importance to aid in the development of both educational and assessment methods. The technique of cognitive task analysis (CTA) has been used in a variety of fields to explicate the cognitive underpinnings of experts. Experts, however, often have limited insight and incomplete recall of their decision-making processes. We hypothesized that the use of eye-tracking, which provides the combination of first-person video as well as an overlying gaze indicator, could be used to enhance CTA to better understand the defining characteristics of experts in resuscitation. Methods: Over an 18-month period a sample of 11 traumatic resuscitations were obtained, each led by one of four pre-selected expert physicians outfitted with the Tobii Pro Eye-Tracking Glasses. After each resuscitation, the participant was debriefed using a cued-recall, think-aloud protocol while watching his or her corresponding eye-tracking video. A subsequent qualitative analysis of the resulting video and debrief transcript was performed using an ethnographic approach to establish emerging themes and behaviours of the expert physicians. Results: The expert participants demonstrated specific, common patterns in their cognitive processes. In particular, participants exhibited similar anticipatory and visual behaviours, dynamic communication strategies and the ability to distinguish between task-relevant and task-redundant information. All participants reported that this technique uncovered otherwise subconscious aspects of their cognition. Conclusion: The novel combination of eye-tracking technology to supplement the CTA of expert resuscitationists enriched our understanding of expertise in this field and yielded specific findings that can be applied to better develop and assess resuscitation skills.
We examined longitudinally the course and predictors of treatment resistance in a large cohort of first-episode psychosis (FEP) patients from initiation of antipsychotic treatment. We hypothesized that antipsychotic treatment resistance is: (a) present at illness onset; and (b) differentially associated with clinical and demographic factors.
The study sample comprised 323 FEP patients who were studied at first contact and at 10-year follow-up. We collated clinical information on severity of symptoms, antipsychotic medication and treatment adherence during the follow-up period to determine the presence, course and predictors of treatment resistance.
From the 23% of the patients, who were treatment resistant, 84% were treatment resistant from illness onset. Multivariable regression analysis revealed that diagnosis of schizophrenia, negative symptoms, younger age at onset, and longer duration of untreated psychosis predicted treatment resistance from illness onset.
The striking majority of treatment-resistant patients do not respond to first-line antipsychotic treatment even at time of FEP. Clinicians must be alert to this subgroup of patients and consider clozapine treatment as early as possible during the first presentation of psychosis.
Clozapine remains the only evidence-based antipsychotic for treatment-resistant schizophrenia (TRS). The ability to predict which patients with their first onset of schizophrenia would subsequently meet criteria for treatment resistance (TR) could help to diminish the severe functional disability which may ensue if TR is not recognized and correctly treated.
This is a 5-year longitudinal assessment of clinical outcomes in a cohort of 246 first-episode schizophrenia spectrum patients recruited as part of the NIHR Genetics and Psychosis (GAP) study conducted in South London from 2005 to 2010. We examined the relationship between baseline demographic and clinical measures and the emergence of TR. TR status was determined from a review of electronic case records. We assessed for associations with early-, and late-onset TR, and non-TR, and differences between those TR patients treated with clozapine and those who were not.
Seventy per cent (n = 56) of TR patients, and 23% of the total study population (n = 246) were treatment resistant from illness onset. Those who met criteria for TR during the first 5 years of illness were more likely to have an early age of first contact for psychosis (<20 years) [odds ratio (OR) 2.49, 95% confidence interval (CI) 1.25–4.94] compared to those with non-TR. The relationship between an early age of first contact (<20 years) and TR was significant in patients of Black ethnicity (OR 3.71, 95% CI 1.44–9.56); and patients of male gender (OR 3.13 95% CI 1.35–7.23).
For the majority of the TR group, antipsychotic TR is present from illness onset, necessitating increased consideration for the earlier use of clozapine.
Introduction: Crisis decision-making is an important responsibility of the resuscitation team leader but a difficult process to study. The purpose of this study was to evaluate visual and behavioural differences between team leaders with different objective performance scores using gaze-tracking technology. Methods: Twenty-eight emergency medicine residents in different stages of training completed four simulated resuscitation scenarios. Participants wore gaze-tracking glasses during each station. An outside expert blinded to participant training level assessed performances using a validated assessment tool for simulation scenarios. Several visual endpoints were measured, including time, frequency, order, and latency to observation of task-relevant and task-redundant items. Non-visual endpoints included behaviours such as summarizing, verbalizing concerns, and calling for definitive treatments, among others. Results: Preliminary findings suggest significant differences between high and low performers. High performers check vitals signs faster, and look at patients and vital signs more often than low performers. Low-performing leaders display a more fixed gaze when starting a scenario. Lastly, high performers summarize, verbalize concerns, predict and prepare for future steps, and call for definitive treatment more often than low performers. Conclusion: There are significant differences between high and low-performing resuscitation team leaders in terms of their visual and behavioural patterns. These differences identify potential focus points for competency evaluations, and may direct educational interventions that could facilitate more efficient development of expertise. The potential to study crisis decision-making behaviours and performances using the methods and metrics identified, both in simulated and real-world settings, is substantial.
Terrestrial time-lapse photography offers insight into glacial processes through high spatial and temporal resolution imagery. However, oblique camera views complicate measurement in geographic coordinates, and lead to reliance on specific imaging geometries or simplifying assumptions for calculating parameters such as ice velocity. We develop a novel approach that integrates time-lapse imagery with multitemporal DEMs to derive full three-dimensional coordinates for natural features tracked throughout a monoscopic image sequence. This enables daily independent measurement of horizontal (ice flow) and vertical (ice melt) velocities. By combining two terrestrial laser scanner surveys with a 73 days sequence from Sólheimajökull, Iceland, variations in horizontal ice velocity of ~10% were identified over timescales of ~25 days. An overall decrease of ~3.0 m surface elevation showed asynchronous rate changes with the horizontal velocity variations, demonstrating a temporal disconnect between the processes of ice surface lowering and mechanisms of glacier movement. Our software, ‘Pointcatcher’, is freely available for user-friendly interactive processing of general time-lapse sequences and includes Monte Carlo error analysis and uncertainty in projection onto DEM surfaces. It is particularly suited for analysis of challenging oblique glacial imagery, and we discuss good features to track, both for correction of camera motion and for deriving ice velocities.
To examine the association between cardiorespiratory fitness and dietary patterns in adolescents.
Food choice was assessed using the validated New Zealand Adolescent FFQ. Principal components analysis was used to determine dietary patterns. Trained research assistants measured participants’ height and body mass. Cardiorespiratory fitness was assessed in a subset of participants using the multistage 20 m shuttle run. The level and stage were recorded, and the corresponding VO2max was calculated. Differences in mean VO2max according to sex and BMI were assessed using t tests, while associations between cardiorespiratory fitness and dietary patterns were examined using linear regression analyses adjusted for age, sex, school attended, socio-economic deprivation and BMI.
Secondary schools in Otago, New Zealand.
Students (n 279) aged 14–18 years who completed an online lifestyle survey during a class period.
Principal components analysis produced three dietary patterns: ‘Treat Foods’, ‘Fruits and Vegetables’ and ‘Basic Foods’. The 279 participants who provided questionnaire data and completed cardiorespiratory fitness testing had a mean age of 15·7 (sd 0·9) years. Mean VO2max was 45·8 (sd 6·9) ml/kg per min. The ‘Fruits and Vegetables’ pattern was positively associated with VO2max in the total sample (β=0·04; 95 %CI 0·02, 0·07), girls (β=0·06; 95 % CI 0·03, 0·10) and boys (β=0·03; 95 % CI 0·01, 0·05).
These results indicate that increase in cardiorespiratory fitness was associated with a healthier dietary pattern, suggesting both should be targeted as part of a global lifestyle approach. Longitudinal studies are needed to confirm this association in relation to health outcomes in New Zealand adolescents.
It is unknown whether prodromal services improve outcomes in those who go on to develop psychosis, and whether these patients are demographically different from the overall first-episode population.
To compare sociodemographic features, duration of untreated psychosis, hospital admission and frequency of compulsory treatment in the first year after the onset of psychosis in patients who present to prodromal services with patients who did not present to services until the first episode of psychosis.
We compared two groups of patients with first-episode psychosis: one who made transition after presenting in the prodromal phase and the other who had presented with a first episode.
The patients who had presented before the first episode were more likely to be employed and less likely to belong to an ethnic minority group. They had a shorter duration of untreated psychosis, and were less likely to have been admitted to hospital and to have required compulsory treatment.
Patients who develop psychosis after being engaged in the prodromal phase have a better short-term clinical outcome than patients who do not present until the first episode. Patients who present during first episodes may be more likely to have sociodemographic features associated with relatively poor outcomes.
To examine the potential associations between diet quality and multiple measures of body composition in a sample of New Zealand adolescents aged 14–18 years.
Cross-sectional survey of eleven high schools in Otago, New Zealand. Each participant completed an online FFQ and a New Zealand Diet Quality Index for Adolescents (NZDQI-A) score was calculated based on variety and adequacy of intake for five major food groups. Besides height and waist circumference measurements, body composition was assessed using segmental bio-impedance analysis. Generalized estimating equations were used to examine associations between diet quality and body composition in models adjusted for sex, age, ethnicity and socio-economic status.
High schools in Otago, New Zealand.
High-school students (n 681, 56 % male, mean age 16·1 (sd 1·5) years) participating in the Otago School Students Lifestyle Survey Two.
Higher NZDQI-A scores were significantly associated with lower body fat percentage (β=−0·19; 95 % CI −0·35, −0·04; P=0·014), fat-to-lean mass ratio (β=−0·26; 95 % CI −0·46, −0·05; P=0·016) and lower fat mass index (β=−0·23; 95 % CI −0·45, −0·004; P=0·046) after multivariate adjustment. No association was found between NZDQI-A and BMI, waist circumference or waist-to-height ratio.
Diet quality, as measured by NZDQI-A, was associated only with measures of body fat, not measures of overall body size. Measures specific to body fat should be used for more accurate ascertainment of body composition in examining the diet–body composition associations in this age group.