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Research shows high levels of complex co-morbidities within psychiatric populations, and there is an increasing need for mental health practitioners to be able to draw on evidence-based psychological interventions, such as cognitive behavioural therapy (CBT), to work with this population effectively. One way CBT may be utilised when working with complexity or co-morbidity is to target treatment at a particular aspect of an individual’s presentation. This study uses a single-case A-B design to illustrate an example of using targeted diagnosis-specific CBT to address symptoms of a specific phobia of stairs in the context of a long-standing co-morbid diagnosis of schizophrenia. Results show the intervention to have been effective, with a change from a severe to mild phobia by the end of intervention. Clinical implications, limitations and areas for future research are discussed.
Key learning aims
(1) There are high levels of co-morbid, complex mental health problems within psychiatric populations, and an increasing need for mental health practitioners to be able to work with co-morbidity effectively.
(2) Cognitive behavioural therapy (CBT) remains one of the most well-evidenced psychological interventions with a large amount of research highlighting the effectiveness of diagnosis-specific CBT.
(3) One way evidence-based diagnosis-specific CBT approaches could be utilised when working with more complex co-morbidity may be to target an intervention at a specific set of symptoms.
(4) An example of using a targeted CBT intervention (to tackle a specific phobia of stairs in the context of a long-standing co-morbid diagnosis of schizophrenia and ongoing hallucinations) is presented. The outcomes show significant changes in the specific phobia symptoms, suggesting that CBT can be effectively used in this targeted manner within real-world clinical settings. The impact of co-morbid mental health difficulties on therapeutic process and outcomes are highlighted.
(5) The use of cognitive restructuring techniques was identified as key to engagement and therapeutic process, supporting the importance of including cognitive techniques in the treatment of phobias compared with purely behavioural exposure-based interventions.
The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.
The Icelandic crust is characterized by low δ18O values that originate from pervasive high-temperature hydrothermal alteration by 18O-depleted meteoric waters. Igneous rocks in Iceland with δ18O values significantly higher than unaltered oceanic crust (~5.7‰) are therefore rare. Here we report on rhyolitic intra-caldera samples from a cluster of Neogene central volcanoes in Borgarfjörður Eystri, Northeast Iceland, that show whole-rock δ18O values between +2.9 and +17.6‰ (n = 6), placing them among the highest δ18O values thus far recorded for Iceland. Extra-caldera rhyolite samples from the region, in turn, show δ18O whole-rock values between +3.7 and +7.8‰ (n = 6), consistent with the range of previously reported Icelandic rhyolites. Feldspar in the intra-caldera samples (n = 4) show δ18O values between +4.9 and +18.7‰, whereas pyroxene (n = 4) shows overall low δ18O values of +4.0 to +4.2‰, consistent with regional rhyolite values. In combination with the evidence from mineralogy and rock H2O contents, the high whole-rock δ18O values of the intra-caldera rhyolites appear to be the result of pervasive isotopic exchange during subsolidus hydrothermal alteration with 18O-enriched water. This alteration conceivably occurred in a near-surface hot spring environment at the distal end of an intra-caldera hydrothermal system, and was probably fed by waters that had already undergone significant isotope exchange with the country rock. Alternatively, 18O-enriched alteration fluids may have been produced during evaporation and boiling of standing water in former caldera lakes, which then interacted with the intra-caldera rock suites. Irrespective of the exact exchange processes involved, a previously unrecognized and highly localized δ18O-enriched rock composition exists on Iceland and thus probably within the Icelandic crust too.
Tomography produces complex volumetric datasets containing the entire internal structure and density of an object in three dimensions (3D). Interpreting volumetric data requires 3D visualization but needs specialized software distinguishable from more familiar tools used in animation for 3D surface data. This tutorial reviews 3D visualization techniques for volumetric data using the open-source tomviz software package. A suite of tools including two-dimensional (2D) slices, surface contours, and full volume rendering provide quantitative and qualitative analysis of volumetric information. The principles outlined here are applicable to a wide range of 3D tomography techniques and can be applied to volumetric datasets beyond materials characterization.
With manufacturers seeking investment opportunities in Africa, it is timely to explore the interaction of advanced manufacturing technology (AMT) and human resource management approaches there. Because research elsewhere suggests that the effects of the interaction differ across national boundaries, we investigated empowerment approaches and AMT utilisation in Nigeria and New Zealand. Using operational-level survey data from 153 manufacturing managers/CEOs in both countries, we explored the role of national culture on managerial attitudes towards employee empowerment during AMT adoption. Drawing on Hofstede’s cultural dimensions, our results suggest that the observed differences in AMT–empowerment interface are attributable to different national values. The results specifically indicated that during AMT adoption, New Zealand’s liberal culture encourages managers to empower employees more than does Nigeria’s authoritarian one. The results would particularly assist practitioners to recognise the traditional/conservative nature of African values when practicing HR in a country like Nigeria.
We measured the hydrogen and oxygen isotope composition (δ2H and δ18O) of precipitation and stream water from the Soft Plume River at multiple spatiotemporal scales on sub-Antarctic Marion Island, Indian sector of the Southern Ocean. Monthly precipitation δ2H and δ18O values ranged from -43.7‰ to -14.7‰ and from -7.0‰ to -3.3‰ (n=13), respectively. Stream water values ranged from -48.0‰ to -25.4‰ for δ2H and from -7.6‰ to -4.0‰ for δ18O (n=92). The monthly precipitation data yielded a local meteoric water line with the equation δ2H=8.4δ18O+11.4. There was no clear seasonality in isotope composition present in precipitation and stream water. Along the stream, no significant difference was observed between sites. However, δ2H and δ18O values were lower and more variable at the highest site. This is probably the result of the ‘amount effect’, where more precipitation fell at a higher elevation compared with a downstream site in the catchment. The findings illustrate spatiotemporal patterns in precipitation and stream water isotopes and provide insight into mechanisms affecting their composition on sub-Antarctic Marion Island.
An evidence-based emergency department (ED) atrial fibrillation and flutter (AFF) pathway was developed to improve care. The primary objective was to measure rates of new anticoagulation (AC) on ED discharge for AFF patients who were not AC correctly upon presentation.
This is a pre-post evaluation from April to December 2013 measuring the impact of our pathway on rates of new AC and other performance measures in patients with uncomplicated AFF solely managed by emergency physicians. A standardized chart review identified demographics, comorbidities, and ED treatments. The primary outcome was the rate of new AC. Secondary outcomes were ED length of stay (LOS), referrals to AFF clinic, ED revisit rates, and 30-day rates of return visits for congestive heart failure (CHF), stroke, major bleeding, and death.
ED AFF patients totalling 301 (129 pre-pathway [PRE]; 172 post-pathway [POST]) were included; baseline demographics were similar between groups. The rates of AC at ED presentation were 18.6% (PRE) and 19.7% (POST). The rates of new AC on ED discharge were 48.6 % PRE (95% confidence interval [CI] 42.1%-55.1%) and 70.2% POST (62.1%-78.3%) (20.6% [p<0.01; 15.1-26.3]). Median ED LOS decreased from 262 to 218 minutes (44 minutes [p<0.03; 36.2-51.8]). Thirty-day rates of ED revisits for CHF decreased from 13.2% to 2.3% (10.9%; p<0.01; 8.1%-13.7%), and rates of other measures were similar.
The evidence-based pathway led to an improvement in the rate of patients with new AC upon discharge, a reduction in ED LOS, and decreased revisit rates for CHF.
Here, we report reproducible and accurate measurement of crystallographic parameters using scanning transmission electron microscopy. This is made possible by removing drift and residual scan distortion. We demonstrate real-space lattice parameter measurements with <0.1% error for complex-layered chalcogenides Bi2Te3, Bi2Se3, and a Bi2Te2.7Se0.3 nanostructured alloy. Pairing the technique with atomic resolution spectroscopy, we connect local structure with chemistry and bonding. Combining these results with density functional theory, we show that the incorporation of Se into Bi2Te3 causes charge redistribution that anomalously increases the van der Waals gap between building blocks of the layered structure. The results show that atomic resolution imaging with electrons can accurately and robustly quantify crystallography at the nanoscale.
As health threats appear with increasing regularity in our food systems and other food crises loom worldwide, we look to rural areas to provide local and nutritious foods. Educationally, we seek approaches to food studies that engage students and their communities and, ultimately, lead to positive action. Yet food studies receive only generic coverage and tangential attention within existing curricula. This article, reporting a pilot study located at Canada's geographic and cultural edge, focuses on local knowledge about past and present food practices. Objectives are to test pedagogies that bring all students greater opportunities for engagement and learning about their physical environment and food history, and that can be applied to rural and, with modifications, urban settings. Three critical, place-base pedagogical approaches — experiential, discovery and arts-based — to classroom teaching and learning are discussed, as well as implications for educational leadership, teacher training and curriculum development.
In 1967, all London medical schools were separate institutions based on their teaching hospitals, many of which had moved from their original central sites. Successive attempts at merger met resistance, but by 2000 there were just five undergraduate schools, all incorporated in large multi-faculty colleges with the exception of St George's.
IMPERIAL COLLEGE LONDON
In the north-west, Imperial College absorbed St Mary's Hospital in 1989 and in 1997 also took in Charing Cross and Westminster Hospitals (already merged in 1983).
Charing Cross Hospital
Early development of general practice teaching
Charing Cross Hospital medical school started in the mid-nineteenth century at the hospital building near The Strand, London. It was small, taking twenty to thirty new students annually. General practice teaching started in the 1950s when students were invited to stay with a general practitioner (usually an alumnus) for three weeks in their final year. Most practices were outside London (often rural), enabling students to experience the daily life of a general practitioner, including out of hours work and living with his family.
Charing Cross Hospital moved to Fulham in 1974, and the annual school intake increased to 120. The final-year general practice attachment expanded accordingly and the Dean, Professor Glenister, initiated plans for an undergraduate general practice teaching unit. The education committee of the north and west London faculty of the RCGP took great interest in the developments, especially as the GMC was threatening to remove accreditation from schools that did not have departments of general practice.
Late Quaternary terrestrial climate records from the semi-arid zone of the Western Cape of South Africa are rare. However, palaeoenvironmental information may be inferred from ancient termite mounds of the region. Calcrete lenses in these mounds have δ13C and δ18O values that show systematic changes with radiocarbon dates, which range from 33,629–36,709 to 21,676–23,256 cal yr BP. These dates confirm that these heuweltjies had been present in the landscape since the last glacial period. The decrease in δ13C and δ18O from 33,629–36,709 to 21,676–23,256 cal yr BP indicates that climate information is recorded by the calcretes. It is suggested that a progressive decline in air temperature and an increase in moisture availability, and a decline in abundance of C4 or CAM plants, occurred in the region during the time heuweltjie calcite precipitated.