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This comprehensive textbook provides a modern, self-contained treatment for upper undergraduate and graduate level students. It emphasizes the links between structure, defects, bonding, and properties throughout, and provides an integrated treatment of a wide range of materials, including crystalline, amorphous, organic and nano- materials. Boxes on synthesis methods, characterization tools, and technological applications distil specific examples and support student understanding of materials and their design. The first six chapters cover the fundamentals of extended solids, while later chapters explore a specific property or class of material, building a coherent framework for students to master core concepts with confidence, and for instructors to easily tailor the coverage to fit their own single semester course. With mathematical details given only where they strengthen understanding, 400 original figures and over 330 problems for hands-on learning, this accessible textbook is ideal for courses in chemistry and materials science.
Over the past 15 years, there has been substantial growth in web-based psychological interventions. We summarize evidence regarding the efficacy of web-based self-directed psychological interventions on depressive, anxiety and distress symptoms in people living with a chronic health condition.
We searched Medline, PsycINFO, CINAHL, EMBASE databases and Cochrane Database from 1990 to 1 May 2019. English language papers of randomized controlled trials (usual care or waitlist control) of web-based psychological interventions with a primary or secondary aim to reduce anxiety, depression or distress in adults with a chronic health condition were eligible. Results were assessed using narrative synthases and random-effects meta-analyses.
In total 70 eligible studies across 17 health conditions [most commonly: cancer (k = 20), chronic pain (k = 9), arthritis (k = 6) and multiple sclerosis (k = 5), diabetes (k = 4), fibromyalgia (k = 4)] were identified. Interventions were based on CBT principles in 46 (66%) studies and 42 (60%) included a facilitator. When combining all chronic health conditions, web-based interventions were more efficacious than control conditions in reducing symptoms of depression g = 0.30 (95% CI 0.22–0.39), anxiety g = 0.19 (95% CI 0.12–0.27), and distress g = 0.36 (95% CI 0.23–0.49).
Evidence regarding effectiveness for specific chronic health conditions was inconsistent. While self-guided online psychological interventions may help to reduce symptoms of anxiety, depression and distress in people with chronic health conditions in general, it is unclear if these interventions are effective for specific health conditions. More high-quality evidence is needed before definite conclusions can be made.
Cohorting patients who are colonized or infected with multidrug-resistant organisms (MDROs) protects uncolonized patients from acquiring MDROs in healthcare settings. The potential for cross transmission within the cohort and the possibility of colonized patients acquiring secondary isolates with additional antibiotic resistance traits is often neglected. We searched for evidence of cross transmission of KPC+ Klebsiella pneumoniae (KPC-Kp) colonization among cohorted patients in a long-term acute-care hospital (LTACH), and we evaluated the impact of secondary acquisitions on resistance potential.
Genomic epidemiological investigation.
A high-prevalence LTACH during a bundled intervention that included cohorting KPC-Kp–positive patients.
Whole-genome sequencing (WGS) and location data were analyzed to identify potential cases of cross transmission between cohorted patients.
Secondary KPC-Kp isolates from 19 of 28 admission-positive patients were more closely related to another patient’s isolate than to their own admission isolate. Of these 19 cases, 14 showed strong genomic evidence for cross transmission (<10 single nucleotide variants or SNVs), and most of these patients occupied shared cohort floors (12 patients) or rooms (4 patients) at the same time. Of the 14 patients with strong genomic evidence of acquisition, 12 acquired antibiotic resistance genes not found in their primary isolates.
Acquisition of secondary KPC-Kp isolates carrying distinct antibiotic resistance genes was detected in nearly half of cohorted patients. These results highlight the importance of healthcare provider adherence to infection prevention protocols within cohort locations, and they indicate the need for future studies to assess whether multiple-strain acquisition increases risk of adverse patient outcomes.
Hydrogen lithography has been used to template phosphine-based surface chemistry to fabricate atomic-scale devices, a process we abbreviate as atomic precision advanced manufacturing (APAM). Here, we use mid-infrared variable angle spectroscopic ellipsometry (IR-VASE) to characterize single-nanometer thickness phosphorus dopant layers (δ-layers) in silicon made using APAM compatible processes. A large Drude response is directly attributable to the δ-layer and can be used for nondestructive monitoring of the condition of the APAM layer when integrating additional processing steps. The carrier density and mobility extracted from our room temperature IR-VASE measurements are consistent with cryogenic magneto-transport measurements, showing that APAM δ-layers function at room temperature. Finally, the permittivity extracted from these measurements shows that the doping in the APAM δ-layers is so large that their low-frequency in-plane response is reminiscent of a silicide. However, there is no indication of a plasma resonance, likely due to reduced dimensionality and/or low scattering lifetime.
Recent declines of wild pollinators and infections in honey, bumble and other bee species have raised concerns about pathogen spillover from managed honey and bumble bees to other pollinators. Parasites of honey and bumble bees include trypanosomatids and microsporidia that often exhibit low host specificity, suggesting potential for spillover to co-occurring bees via shared floral resources. However, experimental tests of trypanosomatid and microsporidial cross-infectivity outside of managed honey and bumble bees are scarce. To characterize potential cross-infectivity of honey and bumble bee-associated parasites, we inoculated three trypanosomatids and one microsporidian into five potential hosts – including four managed species – from the apid, halictid and megachilid bee families. We found evidence of cross-infection by the trypanosomatids Crithidia bombi and C. mellificae, with evidence for replication in 3/5 and 3/4 host species, respectively. These include the first reports of experimental C. bombi infection in Megachile rotundata and Osmia lignaria, and C. mellificae infection in O. lignaria and Halictus ligatus. Although inability to control amounts inoculated in O. lignaria and H. ligatus hindered estimates of parasite replication, our findings suggest a broad host range in these trypanosomatids, and underscore the need to quantify disease-mediated threats of managed social bees to sympatric pollinators.
Introduction: Prehospital field trauma triage (FTT) standards were reviewed and revised in 2014 based on the recommendations of the Centers for Disease Control and Prevention. The FTT standard allows a hospital bypass and direct transport, within 30 min, to a lead trauma hospital (LTH). Our objectives were to assess the impact of the newly introduced prehospital FTT standard and to describe the emergency department (ED) management and outcomes of patients that had bypassed closer hospitals. Methods: We conducted a 12-month multi-centred health record review of paramedic and ED records following the implementation of the 4 step FTT standard (step 1: vital signs and level of consciousness (physiologic), step 2: anatomical injury, step 3: mechanism and step 4: special considerations) in nine paramedic services across Eastern Ontario. We included adult trauma patients transported as urgent that met FTT standard, regardless of transport time. We developed and piloted a data collection tool and obtained consensus on all definitions. The primary outcome was the rate of appropriate triage to a LTH which was defined as: ISS ≥12, admitted to intensive care unit (ICU), non-orthopedic surgery, or death. We have reported descriptive statistics. Results: 570 patients were included: mean age 48.8, male 68.9%, falls 29.6%, motor vehicle collisions 20.2%, stab wounds 10.5%, transported to a LTH 76.5% (n = 436). 72.2% (n = 315) of patients transported to a LTH had bypassed a closer hospital and 126/306 (41.2%) of those were determined to be an appropriate triage to LTH (9 patients had missing outcomes). ED management included: CT head/cervical spine 69.9%, ultrasound 53.6%, xray 51.6%, intubation 15.0%, sedation 11.1%, tranexamic acid 9.8%, blood transfusion 8.2%, fracture reduction 6.9%, tube thoracostomy 5.9%. Outcomes included: ISS ≥ 12 32.7%, admitted to ICU 15.0%, non-orthopedic surgery 11.1%, death 8.8%. Others included: admission to hospital 57.5%, mean LOS 12.8 days, orthopedic surgery 16.3% and discharged from ED 37.3%. Conclusion: Despite a high number of admissions, the majority of trauma patients bypassed to a LTH were considered over-triaged, with a low number of ED procedures and non-orthopedic surgeries. Continued work is needed to appropriately identify patients requiring transport to a LTH.
This presentation will describe a prospective study, due to commence in March 2010, to evaluate the use of Protected Engagement Time in adult acute inpatient wards in three mental health trusts in England.
Patients on acute psychiatric wards in the UK have recurrently reported that they are unhappy with the ward environment, that they are bored and have little to do, that wards are intimidating, and above all, that contact between staff and patients is often identified as too limited in both quantity and quality, and as lacking therapeutic content.
Protected Engagement Time (PET) has emerged as a promising initiative for improving quantity and usefulness of staff-patient contact. During fixed periods of the day, staff are asked to focus solely on patient contact, and are relieved of their administrative duties. However, we do not have any evidence about whether it works or how it should be implemented to achieve the best results.
This study aims to address this lack of evidence and will have three components:
a) A national survey investigating how widespread PET now is in England
b) Evaluation of the effects of PET on patients and staff by comparing 12 wards with PET and 12 wards without, by investigating staff-patient interactions, patient satisfaction, staff burnout and perceptions of the ward environment.
c) In-depth qualitative case studies on three wards with PET.
The objectives for each component and the measures used will be described in detail in the presentation, in addition to an update of study progress.
Dans le cadre du développement de la classification internationale des maladies (CIM-11), les groupes de travail ont développé des propositions avec pour objectif d’améliorer l’utilité clinique de la classification. Ces propositions sont testées via la plateforme internet « Réseau Mondial de Pratique Clinique (RMPC) » permettant de conduire à des études cliniques électroniques dans les langues officielles de l’OMS, dont le français. Cette étude s’intéresse aux catégories diagnostiques des troubles de l’alimentation et des conduites alimentaires (TCA). Des nouveaux diagnostics ont été proposés tels que le trouble d’hyperphagie et le trouble d’évitement et de restriction de l’apport alimentaire.
– évaluer l’impact des changements spécifiques des TCA entre la CIM-10 et la CIM-11 auprès des membres francophones du RMPC ;
– évaluer la validité, l’utilité clinique des nouvelles propositions et l’accord inter-juges des participants.
Étude mixte, internationale, conduite par internet auprès des membres francophones du RMPC.
Membres du RMPC maîtrisant le français (environ 1000 professionnels) et exerçant une activité clinique.
La population cible recevra un email d’invitation. Les participants seront amenés à lire deux vignettes puis à poser des diagnostics et à répondre à des questions complémentaires, en se basant sur la CIM-10 ou la CIM-11 qu’ils auront reçu de façon aléatoire.
Les vignettes représenteront des cas cliniques réels et reflèteront les changements spécifiques entre la CIM-10 et la CIM-11. Elles seront ainsi présentées par pair (8 pairs possibles).
– interparticipants portant sur l’utilisation du système diagnostique (10 ou 11) et l’attribution du diagnostic en fonction des changements spécifiques ;
– intra-participant sur l’évaluation des pairs de vignettes.
Cette étude doit permettre d’évaluer les nouvelles propositions CIM en français, en tenant compte des spécificités culturelles et linguistiques de la francophonie.
Stigma against mental illness and the mentally ill is well known. However, stigma against psychiatrists and mental health professionals is known but not discussed widely. Public attitudes and also those of other professionals affect recruitment into psychiatry and mental health services. The reasons for this discriminatory attitude are many and often not dissimilar to those held against mentally ill individuals. In this Guidance paper we present some of the factors affecting the image of psychiatry and psychiatrists which is perceived by the public at large. We look at the portrayal of psychiatry, psychiatrists in the media and literature which may affect attitudes. We also explore potential causes and explanations and propose some strategies in dealing with negative attitudes. Reduction in negative attitudes will improve recruitment and retention in psychiatry. We recommend that national psychiatric societies and other stakeholders, including patients, their families and carers, have a major and significant role to play in dealing with stigma, discrimination and prejudice against psychiatry and psychiatrists.
The Time to Change (TTC) anti-stigma campaign, launched in January 2009 in England, intends to make fundamental improvements across England in: public knowledge, attitudes and discriminatory behaviour in relation to people with mental illness. To be effective and valid the campaign must reach a wide range of diverse audiences. This study explores attitudes of people from ethnic minority communities in relation to mental health.
The study investigates:
1) General attitudes and perceptions about mental illness in ethnic minority communities
2) How we might increase awareness about mental wellbeing and decrease stigma in ethnic minority communities.
Ten focus groups with members of ethnic minority groups were conducted. Five groups consisted of service users and five were composed of non-service users. Two groups comprised participants from an Indian origin, two Somali origin, two Afro-Caribbean origin and the other groups were mixed.
We will present findings regarding the ways in which traditional perceptions of mental health and personal experiences of ethnic minority service users affect their perceptions of sources of support such as family, friends, medical staff and religion and how this feedback could inform ant-stigma interventions.
The study suggests that in order to maximise the impact of anti-stigma campaigns, attention should be given to sources of discrimination and traditional perceptions of mental illness which are emphasised by ethnic minority groups. When planning anti-stigma campaigns it is important to incorporate experiences and perceptions from a wide range of audiences.
Les patients souffrant de maladies mentales meurent en moyenne 25 ans plus tôt que la population générale. Les causes de mortalité sont notamment liées aux maladies cardiovasculaires, en lien avec le syndrome métabolique. Peu de littérature explore les comorbidités somatiques et psychiatriques dans les Antilles françaises. L’objectif principal de cette étude préliminaire est de décrire au centre de crise du CHU de Martinique la population hospitalisée sur le plan somatique (syndrome métabolique) et sur le plan des comorbidités psychiatriques (dont les comorbidités psychotraumatiques).
Dans cette étude prospective où 49 patients ont été inclus de façon aléatoire entre février et juillet 2013, nous avons évalué les éléments suivants : syndrome métabolique, MINI, THQ, IESR.
Cette population est âgée de 44 ans en moyenne. Le syndrome métabolique est retrouvé chez 33 % de la population. Les comorbidités psychiatriques : 75 % de dépression, 57 % de risque suicidaire moyen à élevé. Au niveau des évènements traumatisants (médiane du nombre d’évènements traumatisants à 6) : 45 % déclarent avoir subi des agressions sexuelles, 43 % des catastrophes naturelles. Le score total de l’IESR a un score médian à 37,5.
Ces résultats rappellent la nécessité de systématiser la recherche du syndrome métabolique et des évènements traumatiques en hospitalisation en psychiatrie.
Social contact is one of the most effective strategies for improving inter-group relations and is supported by decades of positive evidence. Several studies specifically support social contact interventions as a way of reducing stigma against people with mental health problems. Despite the effectiveness of this approach, some social groups have few opportunities for social contact in the real world.
Using the England Time to Change anti-stigma campaign as an example, we investigate the feasibility and effectiveness of delivering social contact interventions at the mass population level to reduce stigma and discrimination against people with mental health problems.
To investigate: (i) the feasibility of scaling up social contact interventions to reduce stigma and discrimination against people with mental health problems and (ii) the effectiveness of mass population social contact interventions to: improve intended stigmatising behaviour, increase willingness to disclose mental health problems and to promote engagement in antistigma activities.
Two types of mass participation social contact programmes within England's Time to Change campaign were evaluated via self-report questionnaire. Participants at social contact events were asked about the occurrence and quality of contact, attitudes, readiness to discuss mental health, and intended behaviour towards people with mental health problems.
Findings on feasibility and effectiveness of social contact programmes will be presented.
This study suggests that social contact interventions can be used by anti-stigma campaigns to reduce stigma and discrimination against people with mental health problems. Further investigation is needed regarding the maintenance of these changes
Stigma and social exclusion related to mental health are of substantial public health importance for Europe. As part of ROAMER (ROAdmap for MEntal health Research in Europe), we used systematic mapping techniques to describe the current state of research on stigma and social exclusion across Europe. Findings demonstrate growing interest in this field between 2007 and 2012. Most studies were descriptive (60%), focused on adults of working age (60%) and were performed in Northwest Europe—primarily in the UK (32%), Finland (8%), Sweden (8%) and Germany (7%). In terms of mental health characteristics, the largest proportion of studies investigated general mental health (20%), common mental disorders (16%), schizophrenia (16%) or depression (14%). There is a paucity of research looking at mechanisms to reduce stigma and promote social inclusion, or at factors that might promote resilience or protect against stigma/social exclusion across the life course. Evidence is also limited in relation to evaluations of interventions. Increasing incentives for cross-country research collaborations, especially with new EU Member States and collaboration across European professional organizations and disciplines, could improve understanding of the range of underpinning social and cultural factors which promote inclusion or contribute toward lower levels of stigma, especially during times of hardship.
Despite the perception that doctors should be ‘invincible’, mental illness is common in this population. Doctors and medical students have low levels of help-seeking for their own mental health problems often only presenting to mental health services once a crisis arises. Fear of exposure to stigmatization is a crucial factor to symptom concealment.
‘The Wounded Healer’ is an anti-stigma intervention that has been described as an innovative method of pedagogy that blends science with the humanities. The Wounded Healer has been delivered to more than 5000 medical students and doctors in countries all over the world.
We conducted a cross-sectional, mixed methods study. Immediately following the intervention we distributed paper questionnaires to participants who attended the Wounded Healer that contained stigma constructs. Answers were on a Likert-type scale and there was also space for free-text comments.
303/378 (80%) of participants recruited for the study responded. 246/303 (81%) of respondents either agreed or strongly agreed that the talk made them more accepting of medics suffering from psychopathology. 223/303 (73%) of respondents either agreed or strongly agreed that they were more aware of the importance of engaging in help-seeking behavior when under mental distress.
Many respondents reported in the free-text comments that the Wounded Healer was inspirational and that every medical student should receive this intervention.
A majority of respondents responded positively to the stigma constructs. This may have implications for medical students and doctors in mental distress by helping to reduce stigma and by encouraging help-seeking behavior.
The assessment of needs among patients with severe mental disorders is one of the most studied measures in treatment planning and monitoring of mental health services. Nevertheless, studies on this subject are scarce in Brazil, even following the recent expansion of community services.
To investigate the prevalence and correlates of unmet needs among outpatients with psychotic disorders in Brazilian community mental health services.
This is a cross-sectional study with a random sample of 401 outpatients with psychotic disorders in the city of Santos, Brazil. Needs were assessed through interviews with patients using the Camberwell Assessment of Needs (CAN), which investigates 22 clinical, social and basic needs. The Positive and Negative Symptom Scale (PANSS) was used to assess symptoms. Data were analyzed with multiple linear regression, using p < 0.05. Independent variables were introduced in hierarchical levels, as follows: 1) demographic variables; 2) history and severity of illness; and, 3) service utilization.
The most reported needs were psychotic symptoms (67.0%), information needs (55.0%), psychological distress (41.8%) and money (41.5%). The mean number of unmet needs was 2.91 (+-2.56). A greater number of unmet needs was significantly associated to lower education, more negative symptoms and general psychopathology, all with p = 0.001.
The most reported needs were clinical and social. The number of unmet needs was consistent with the results of international studies. Furthermore, the association of greater unmet needs with lower education and higher symptoms severity may indicate the need for further and comprehensive psychosocial interventions.
Our social environment can have important consequences for the development of emotional processes, mental health problems and/or wellbeing among individuals and communities. Recent research suggests that stigma and discrimination has been increasing, as measured by social distance of the general public. The context of public stigma in relation to people with mental health problems could have significant consequences in terms of exclusion and thus, impact the health and well-being of people with mental illness.
Aims and Objectives
To describe new research in the field of social psychiatry which investigates the impact of the macro-social context on individuals, especially in terms of stigma and social exclusion.
This session will present recent research which looks at aggregate population data including structural policies or legislation in addition to public attitudes or beliefs and how this relates to individual outcomes of mental health and well-being including self-stigma, unemployment and suicide.
Initial research highlights the importance of macro-micro contexts for the social exclusion of people with mental health problems. Further research is needed to further delineate the mechanism of how individual internalize their social environment and how we might better intervene at the population level to improve the mental health and well-being of communities.
Dr Nick Martin has made enormous contributions to the field of behavior genetics over the past 50 years. Of his many seminal papers that have had a profound impact, we focus on his early work on the power of twin studies. He was among the first to recognize the importance of sample size calculation before conducting a study to ensure sufficient power to detect the effects of interest. The elegant approach he developed, based on the noncentral chi-squared distribution, has been adopted by subsequent researchers for other genetic study designs, and today remains a standard tool for power calculations in structural equation modeling and other areas of statistical analysis. The present brief article discusses the main aspects of his seminal paper, and how it led to subsequent developments, by him and others, as the field of behavior genetics evolved into the present era.
Professor Nicholas G. Martin, from QIMR Berghofer Medical Research Institute in Brisbane, Australia, is a world leader in the effort to understand the genetic architecture underlying disordered gambling. This article pays tribute to Nick and his almost two decades of gambling research, highlighting his many strengths, ranging from the use of ingenious recruitment approaches, twin study methods, genomewide association studies, to facilitating international collaborations.
The Meeting Centre Support Programme (MCSP) is a community-based approach to support people living with dementia and their families. It was developed in the Netherlands and has been implemented in other European Countries (Italy, Poland and the UK) within the JPND-MEETINGDEM project.
To assess the relationship between background characteristics of people with dementia participating in MCSP, mood, quality of life (QoL) and experienced stigma, and to explore if and how the experienced stigma changed after 6 months of participation in MCSP.
A pretest (M1) post-test (M7) control group design with matched groups regarding severity of dementia was applied. In each country, a minimum of 25 participants using MCSP were compared with people with dementia receiving ‘usual care’. Data were collected with the Stigma Impact Scale, Cornell Scale for Depression in Dementia, Global Deterioration Scale and two QoL scales (QoL-AD & DQoL). Differences in background characteristics were taken into account in the analyses.
The preliminary analysis on 116 participants at baseline shows that the level of stigma was low to moderate. People felt more socially rejected in the UK than in Poland and Italy. The level of perceived stigmatization appeared negatively correlated with QoL areas and positively correlated with negative mood. Changes after 6 months will be presented.
It is expected that after 6 months people living with dementia participating in MCSP will experience less stigma, as in contrast with usual care MCSP promotes social integration of people with dementia and person-centered support.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The new channels of communication as social media (e.g. Facebook and Twitter) and the social marketing campaign (i.e. campaign focused on enabling, encouraging and supporting behavioural changes among target audiences) can represent useful strategies to challenge stigma attached to mental disorders.
To evaluate the efficacy of the social marketing campaign of the time to change (SMC-TTC) anti-stigma programme on the target population in England during 2009–2014.
To assess the impact of the SMC-TTC anti-stigma programme in terms of:
– use of the social media channels;
– levels of awareness of the SMC-TTC;
– changes in knowledge, attitude, and behaviour related to mental disorders.
Participants completed the mental health knowledge schedule (MAKS), the community attitudes toward mental illness (CAMI) and the reported and intended behaviour scale (RIBS), together with an ad-hoc schedule on socio-demographic characteristics.
In total, 10526 people were interviewed, it was found a growing usage of the SMC-TTC media channels and of the level of awareness of the campaign (P < 0.001). Being aware of the SMC-TTC was found to be associated with higher score at MAKS (OR = .95, CI = .68 to 1.21; P < .001), at “tolerance and support” CAMI subscale (OR = .12, CI = .09 to .16; P < .001) and RIBS (OR = .71, CI = .51 to .92; P < .001), controlling for confounders.
In the general population, SMC-TTC has been found to be effective in improving attitudes and behaviours towards people with mental disorders.
Considering these promising results obtained in England, social media can represent the possible way forward for challenging stigma. The future on-going evaluation of the SMC-TTC may further shed light on the essential role of social media in reducing of stigma and discrimination.
Disclosure of interest
The authors have not supplied their declaration of competing interest.