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Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.
The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.
We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.
We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.
Our research group demonstrated that vitamin A restriction affected meat quality of Angus cross and Simmental steers. Therefore, the aim of this study is to highlight the genotype variations in response to dietary vitamin A levels. Commercial Angus and Simmental steers (n = 32 per breed; initial BW = 337.2 ± 5.9 kg; ~8 months of age) were fed a low-vitamin A (LVA) (1017 IU/kg DM) backgrounding diet for 95 days to reduce hepatic vitamin A stores. During finishing, steers were randomly assigned to treatments in a 2 × 2 factorial arrangement of genotype × dietary vitamin A concentration. The LVA treatment was a finishing diet with no supplemental vitamin A (723 IU vitamin A/kg DM); the control (CON) was the LVA diet plus supplementation with 2200 IU vitamin A/kg DM. Blood samples were collected at three time points throughout the study to analyze serum retinol concentration. At the completion of finishing, steers were slaughtered at a commercial abattoir. Meat characteristics assessed were intramuscular fat concentration, color, Warner-Bratzler shear force, cook loss and pH. Camera image analysis was used for determination of marbling, 12th rib back fat and longissimus muscle area (LMA). The LVA steers had lower (P < 0.001) serum retinol concentration than CON steers. The LVA treatment resulted in greater (P = 0.03) average daily gain than the CON treatment, 1.52 and 1.44 ± 0.03 kg/day, respectively; however, there was no effect of treatment on final BW, DM intake or feed efficiency. Cooking loss and yield grade were greater and LMA was smaller in LVA steers (P < 0.05). There was an interaction between breed and treatment for marbling score (P = 0.01) and percentage of carcasses grading United States Department of Agriculture (USDA) Prime (P = 0.02). For Angus steers, LVA treatment resulted in a 16% greater marbling score than CON (683 and 570 ± 40, respectively) and 27% of LVA Angus steers graded USDA Prime compared with 0% for CON. Conversely, there was no difference in marbling score or USDA Quality Grades between LVA and CON for Simmental steers. In conclusion, feeding a LVA diet during finishing increased marbling in Angus but not in Simmental steers. Reducing the vitamin A level of finishing diets fed to cattle with a high propensity to marble, such as Angus, has the potential to increase economically important traits such as marbling and quality grade without negatively impacting gain : feed or yield grade.
The proportion of international medical graduates (IMGs) in Ireland has increased from 13.4% in 2000 to over 33% in 2010. Many of their countries of origin have different cultures, expectations of the doctor–patient relationship and communication styles than Ireland. These differences can adversely impact on the quality of care provided by IMGs. There is a lack of research on the impact of cultural differences on communication in the Irish context.
Semi-structured interviews were conducted with 16 IMGs in Drogheda Department of Psychiatry. Transcripts were analysed using nVivo10, a specialised computer programme for conducting qualitative analysis and analysed thematically.
General themes emerged relating to IMG experience of cultural differences in medicine and psychiatry and cultural differences in communication. IMGs did not find their proficiency in English to be a barrier to communication but did find accents, culture-specific sayings and non-verbal cues to be challenging. Differences in doctors’ status relative to patients and different expectations of the doctor–patient relationship were challenging and, at times, frustrating and annoying. It was generally recognised that training in cross-cultural communication skills would be beneficial to new IMGs although a small minority recognised no such issues. Significant differences in attitude to patient confidentiality in Ireland versus the country of origin were identified.
Consideration should be given to providing specific cross-cultural communication skills training for all IMGs training in Ireland focusing not just on verbal and non-verbal communication but also differences in the doctor–patient relationship, patient and relative expectations and medical confidentiality requirements.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Many medications administered to patients with schizophrenia possess anticholinergic properties. When aggregated, pharmacological treatments may result in a considerable anticholinergic burden. The extent to which anticholinergic burden has a deleterious effect on cognition and impairs ability to participate in and benefit from psychosocial treatments is unknown.
Seventy patients were followed for approximately 3 years. The MATRICS consensus cognitive battery (MCCB) was administered at baseline. Anticholinergic burden was measured with the Anticholinergic Cognitive Burden (ACB) scale. Ability to benefit from psychosocial programmes was measured using the DUNDRUM-3 Programme Completion Scale (D-3) at baseline and follow-up. Psychiatric symptoms were measured using the PANSS. Total antipsychotic dose was measured using chlorpromazine equivalents. Functioning was measured using the Social and Occupational Functioning Assessment Scale (SOFAS).
Mediation analysis found that the influence of anticholinergic burden on ability to participate and benefit from psychosocial programmes was completely mediated by the MCCB. For every 1-unit increase on the ACB scale, change scores for DUNDRUM-3 decreased by −0.27 points. This relationship appears specific to anticholinergic burden and not total antipsychotic dose. Moreover, mediation appears to be specific to cognition and not psychopathology. Baseline functioning also acted as mediator but only when MCCB was not controlled for.
Anticholinergic burden has a significant impact on patients’ ability to participate in and benefit from psychosocial treatment programmes. Physicians need to be mindful of the cumulative effect that medications can have on patient cognition, functional capacity and ability to benefit from psychosocial treatments.
For the present it may safely be stated that on growing grass, bovine B. tuberculosis remain alive and virulent, for a period of at least 49 days in summer, in the south of England. Simultaneously with the experiments described above, a feeding experiment on guinea-pigs has been carried out, to discover whether the bacilli, proved to be infective for these animals by inoculation are, after exposure on grass for varying times, capable of setting up infection by the alimentary route. For this purpose a number of colonies of a dozen guinea-pigs each is being fed on grass at increasing intervals after the time of infection. These experiments, which are in progress, are it is hoped preliminary to the feeding of calves on similarly infected pasture.
Autopsies on all the guinea-pigs kept for as long as 20 months failed to reveal any trace of tuberculosis, although the grass grazed by the animals was proved by subcutaneous inoculation to bear virulent organisms, which might have been expected to reach the alimentary tract in considerable numbers, at least in the earlier experiments.
By repeated infection of a grazing area it has been possible to induce tuberculosis in guinea-pigs grazed in the open and in those fed indoors on cut grass. In the 1932 experiment a total of thirty guinea-pigs were allowed access to plots of grass which had been infected, one, four and eight days previously and all failed to become infected. The combined experiments (1932 and 1933) suggest that under some weather conditions, animals, although admitted to pasture within a very short time of its infection may escape infection with tuberculosis, but that repeated infection of pasture results in a high incidence of disease in animals grazing on it.
In a previous paper (Maddock, 1934), it has been shown that healthy calves may be infected with bovine tubercle bacilli when grazed upon pasture infected at intervals with emulsions of the virulent organisms. These infections were designedly heavy, and it was felt that this orientating experiment should be followed by one in which pasture infection was secured in a way more closely approximating to the natural.
Governments and managers have generally conducted inadequate
cost-benefit analysis (CBA) by failing to incorporate environmental
impact costs. This is not a straightforward task, owing
to the intangibility, in monetary terms, of most environmental
goods and services. By means of a theoretical example, we present
a practical approach to correct cost-benefit analysis for environmental
externalities that do not need natural resource
valuations. The theoretical example is based on ventures that
potentially pollute river waters. However, we think that the
methodological approach presented here may be used to internalize
(in monetary terms) the costs of negative external impacts
on the environment, which may result from any type of venture
The small population of wild dog Lycaon pictus (n = 3 to 30) in Hluhluwe-Umfolozi Park (HUP) has declined since 1992. The survival of dogs in HUP is dependent on the reintroduction of more dogs; however, wild dog reintroduction programmes are fraught with problems and many have failed. In this paper the diet and capture success of the wild dog pack in the Hluhluwe Section, and the influence of dietary considerations on the success of the future reintroduction of wild dogs in this reserve, are investigated. Diet choice was determined from scat analysis, personal observation and field staff records. Eight ungulate prey species were identified from scat analysis: nyala Tragelaphus angasi and impala Aepyceros melampus were the most abundant ungulate species in HUP and accounted for 77% of the diet. On the whole, wild dogs included prey types in the diet consistent with a rate-maximizing foraging approach, although some prey were clearly taken opportunistically. The dogs preyed mostly on small- (> 25 kg) to medium-sized (40–90 kg) prey, while the young of large (< 90 kg) prey species or scavenged carcasses supplemented the diet during the dry season. Adult nyala were taken more frequently than other age classes, but wild dog preyed on juvenile impala more than expected. Female prey were taken more frequently than males but selection did not differ from prey population sex ratios. Prey capture success was similar to that of previous studies from both open and densely wooded habitats and the wild dogs successfully caught 48% of all prey species pursued. Results suggest that wild dogs are quite capable of adapting both their diet choice and foraging technique to the dense vegetation in HUP. We conclude that prey type, prey availability and habitat constraints on prey capture success, will not affect the reintroduction of more wild dogs into HUP.
The Interview Schedule for Social Interactions (ISSI) was used to assess the social environment of 65 British inner-city patients suffering from severe neurotic disorder; all patients were offered a 12-week course of intensive day treatment with an educational and psychodynamic basis. Compared with a general population in Canberra, the neurosis sufferers had lower (morbid) scores on the ISSI for the extent and quality of their social relationships. Of the 34 subjects who completed treatment and attended for the post-treatment investigation, 21 attained a PSE score below the level for ‘caseness'. Twenty-five subjects who attended for follow-up at 18–24 months had improved significantly on all four of the standard ISSI measures, although they had not done so immediately after treatment. This suggests that although symptoms may improve at the time of treatment, social relationships improve only over several months.
The experiments have shown that although butter of exceptionally fine flavour can be produced by the use of pure culture starters of S. paracitrovorus under laboratory control, the uncertainties under practical conditions, due to its weak growth, are too marked to warrant its general use. Both S. citrovorus and S. paracitrovorus are unable to compete successfully with the inevitable contaminants encountered in practice. The value of vegetable media such as grass, silage and bean agar for growing streptococci such as S. paracitrovorus has been confirmed, but as observed by Orla-Jensen et al. the subsequent growth in milk media lacks the vigour which might be expected.
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