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The COVID-19 pandemic has shown that all emergencies, major incidents and disease outbreaks can have substantial mental health consequences, and it has demonstrated the proven need for additional care for populations in the wake of disasters. This book brings together practice and recent developments in pre-hospital emergency care, emergency medicine and major trauma care with the wellbeing, psychosocial and mental health aspects of preparing for and responding to emergencies, incidents, terrorism, disasters, epidemics, and pandemics. Practical suggestions are included for future planning to provide better care for people caught up in emergencies. Setting it apart from other books on emergency preparedness is its specific focus on the psychosocial demands imposed on staff of healthcare and responding services. Featuring expert contributions from a wide variety of disciplines, this book appeals to people working within mental healthcare, emergency care, pre-hospital medicine, Blue Light services, public health, humanitarian care, emergency planning, and disaster management.
The number of incidences of violence and restrictive practices within acute inpatient psychiatric wards are significantly high which makes these units less conducive for recovery and less therapeutic. Staff and patient survey results highlighted their concerns and their desire to have a safe environment to work and a less volatile therapeutic environment.
The aim of this QI project was to reduce violence and restrictive practices within acute inpatient units.
PDSA cycle was used to achieve the objective.
Primary and secondary drivers were identified and were illustrated using driver diagram. Three units were identified for pilot study. The group has agreed to collate change ideas from service users and restraint data from internal system will be used to review the impact of changes.
Meeting were conducted with service users from these units to populate change ideas. Additionally, the Acute care group also outlined some practice related change ideas such as enhanced recruitment of substantive staff, safety pods, introducing safety huddles, revising therapeutic planner, developing safe care champions and inclusion of professionals from various disciplines such as drama therapist, sports technicians and peer support workers that are traditionally not included in MDT. The change ideas were implemented in one of the selected units.
The group reviewed the feasibility of change ideas and agreed on change ideas that got more support from service users which were projectors to play music, soothing DVDs to assist with relaxation and ear defenders.
All change ideas were implemented on the pilot units.
The QI project has enabled the trust to reduce the number of violence and restrictive practices on all the three units, with a team approach and using a multipronged approach, co-production and openness key to positive results.
In due course we also liaised with the wards to get qualitative feedback from the service users to see how they felt about this new change.
A year after the initial data was collected, to see if there had been the intended 50 per cent reduction in violence and restrictive practices. The team were delighted to find that they had exceeded this aim with a 56 per cent reduction with only 12.3 incidents being reported over the 3-month period.
The QI project on pilot wards have enabled to reduce the number of violence and restrictive practices on all the three units.
Team approach and using a multipronged approach, coproduction and openness key to positive results.
The next step is to implement these change ideas on all other units and looking into the economic value and saving as part of this project, given lesser incidents and staff requirements.
This chapter draws together a selection of the key themes that recur in Section 3 of this book. One of the features of this section is that the authors focus on occurrences that are, statistically, uncommon. In terms of risk, these events are relatively moderate to low in probability but high in psychosocial impact. Thus, each of the serious events and types of incident covered in this section of the book pose threats to people, their families and communities, and to whole societies.
Perhaps, then, it might appear odd that the editors have selected these matters for inclusion in this book. Commentaries on them, which range from disasters through sectarian division and bloodshed to extremism, radicalisation and terrorism, are included in our quest for learning and inspiration in general terms as much as finding solutions to these and other circumstances that affect people.
Few studies have investigated the patterns of posttraumatic stress disorder (PTSD) symptom change in prolonged exposure (PE) therapy. In this study, we aimed to understand the patterns of PTSD symptom change in both PE and present-centered therapy (PCT).
Participants were active duty military personnel (N = 326, 89.3% male, 61.2% white, 32.5 years old) randomized to spaced-PE (S-PE; 10 sessions over 8 weeks), PCT (10 sessions over 8 weeks), or massed-PE (M-PE; 10 sessions over 2 weeks). Using latent profile analysis, we determined the optimal number of PTSD symptom change classes over time and analyzed whether baseline and follow-up variables were associated with class membership.
Five classes, namely rapid responder (7–17%), steep linear responder (14–22%), gradual responder (30–34%), non-responder (27–33%), and symptom exacerbation (7–13%) classes, characterized each treatment. No baseline clinical characteristics predicted class membership for S-PE and M-PE; in PCT, more negative baseline trauma cognitions predicted membership in the non-responder v. gradual responder class. Class membership was robustly associated with PTSD, trauma cognitions, and depression up to 6 months after treatment for both S-PE and M-PE but not for PCT.
Distinct profiles of treatment response emerged that were similar across interventions. By and large, no baseline variables predicted responder class. Responder status was a strong predictor of future symptom severity for PE, whereas response to PCT was not as strongly associated with future symptoms.
Background: Computer-delivered cognitive behavioural therapy (cCBT) is an effective alternative to provider-delivered treatment for depression and anxiety, but high attrition poses a significant challenge to its use. Peer support is a feasible approach to improving cCBT engagement, but less is known about its acceptability among Veterans. Aims: To obtain feedback from Veterans (n = 24) with depression and/or anxiety on their preferences for (a) activities of Veterans Administration Peer Support Specialists (VA PSS) in helping Veterans use Moving Forward, a cCBT-based protocol developed by VA, and (b) methods for delivering support to Veterans using this programme. Method: Four focus groups (5–7 Veterans per group) provided feedback to be used in the development of a peer-supported engagement intervention to help Veterans with depression and anxiety use Moving Forward. Content areas included roles that a VA PSS might play in supporting the use of and engagement in Moving Forward, as well as methods of delivering that support. Results: Veteran preferences for PSS activity focused on practical aspects of using Moving Forward, including orientation to the programme, technical support, and monitoring progress. Feedback also suggested that Veterans preferred more personal roles for the PSS, including emotional support, as well as application of Moving Forward to ‘real life’ problems. Conclusions: The findings extend the literature on online, patient-facing mental health protocols by identifying emotional support and ‘real life’ skills application as Veteran-preferred components of a peer-support protocol designed to enhance use of and engagement in cCBT for depression and anxiety.
This paper is intended to provide an outline of how the lead and line formed a vital, but often overlooked, role in safe navigation during the 16th Century, with some comments on its later use up to, and into the 20th Century. During this period, the development of the more mathematical dead-reckoning and the more exciting astro-navigation attracted the attention of the literate commentators who were responsible for record keeping while the often illiterate sailors got on with practising their craft. Also, May (1970), has commented that, “the navigators during the great age of discovery must have made extensive use of the lead and line, but references are extremely sparse, for all their rough log-books were destroyed and only the most important references to their navigational proceedings were copied into the fair accounts of their voyages which have come down to us.”
Every sailor, at the back of his or her mind, is aware that the nearest land is likely to be directly beneath the ship's keel and he or she is interested to know just how near. For over two thousand years, mariners measured depth of water by using a sounding rod in shallow areas and the lead and line in deeper water. This paper considers how, during the “Dark Ages”, sailors in the North Sea might have navigated, including the use of sounding rods and lead lines for way-finding during a time when no other navigational instruments were available. Because of the lack of contemporary records the authors firstly consider the use of depth finding in earlier and later times to shed light on how the early North Sea sailors might have operated. The latter part of this paper takes account of the earlier discussion, together with some records of North Sea voyaging, to suggest how “Dark Age” sailors might have used sounding rods, the lead and line, and other techniques to navigate around and across the North Sea.
Resistance to infections with Heligmosomoides bakeri is associated with a significant quantitative trait locus (QTL–Hbnr1) on mouse chromosome 1 (MMU1). We exploited recombinant mice, with a segment of MMU1 from susceptible C57Bl/10 mice introgressed onto MMU1 in intermediate responder NOD mice (strains 1094 and 6109). BALB/c (intermediate responder) and C57Bl/6 mice (poor responder) were included as control strains and strain 1098 (B10 alleles on MMU3) as NOD controls. BALB/c mice resisted infection rapidly and C57Bl/6 accumulated heavy worm burdens. Fecal egg counts dropped by weeks 10–11 in strain 1098, but strains 1094 and 6109 continued to produce eggs, harbouring more worms when autopsied (day 77). PubMed search identified 3 genes (Ctla4, Cd28, Icos) as associated with ‘Heligmosomoides’ in the B10 insert. Single nucleotide polymorphism (SNP) differences in Ctla4 could be responsible for regulatory changes in gene function, and a SNP within a splice site in Cd28 could have an impact on function, but no polymorphisms with predicted effects on function were found in Icos. Therefore, one or more genes encoded in the B10 insert into NOD mice contribute to the response phenotype, narrowing down the search for genes underlying the H. bakeri resistance QTL, and suggest Cd28 and Ctla4 as candidate genes.
Antidepressants are important in the treatment of depression, and selective serotonin reuptake inhibitors are first-line pharmacologic options. However, only 50% to 70% of patients respond to first treatment and <40% remit. Since depression is associated with substantial morbidity, mortality, and family burden, it is unfortunate and demanding on health resources that patients must remain on their prescribed medications for at least 4 weeks without knowing whether the particular antidepressant will be effective. Studies have suggested a number of predictors of treatment response, including clinical, psychophysiological, neuroimaging, and genetics, each with varying degrees of success and nearly all with poor prognostic sensitivity and specificity. Studies are yet to be conducted that use multiple measures from these different domains to determine whether sensitivity and specificity can be improved to predict individual treatment response. It is proposed that a focus on standardized testing methodologies across multiple testing modalities and their integration will be crucial for translation of research findings into clinical practice.
This paper looks at the navigational challenges faced by William Dampier when, as Captain of the Royal Navy ship Roebuck, in 1699, he approached, and then found his way along the coast of Western Australia (at that time known as New Holland). A discussion of the methods and instruments available to Dampier is followed by consideration of how, and with what success, he went about his task. Dampier's own account of the voyage was included in his book A Voyage to New Holland (Dampier, 1703) although this is likely to have been heavily edited, and perhaps even rewritten by a “man of letters” to make it more attractive to the general public. For this reason and, bearing in mind that autobiographical work may contain omissions or otherwise be slanted to show the writer in his best light, the navigational information in his book has been cross-checked with the Roebuck's original Master's Log, held by the UK National Archives at Kew (Documents ADM 52/94). Jacob Hughes was the ship's Master, but the Log entries were written in at least two hands.
This chapter focuses on capacities and capacity development for energy transitions. The transitions put forward in GEA require a transformation of energy systems that demand significant changes in the way energy is supplied and used today, irrespective of whether the technologies involved are new to the world or to a country, its producers or users.
Energy transitions are, by definition, long-term, socially embedded processes in the course of which capacities at the individual, organizational, and systems levels, as well as the policies for capacity development themselves, will inevitably change. From this perspective, capacity development can no longer be seen as a simple aggregation of individual skills and competences or the introduction of a new “technology.” Rather, it is a broad process of change in production and consumption patterns, knowledge, skills, organizational forms, and – most importantly – in the established practices and norms of the actors involved, or what are called informal institutions. In other words, a host of new and enhanced capacities will be needed over time. Informal institutions are reflected in a range of beliefs and boundaries that shape choices about new energy technologies. These can include engineering beliefs about what is feasible or worth attempting and boundaries that shape the processes of choice, such as lines of research to pursue, kinds of products to produce, or practices of consultation and dialogue. They also emerge as “path dependence” in contexts where earlier investments result in high sunk costs, habits and practices are entrenched, and “expert views” are shaped by earlier thinking that narrows the range of choices to established technologies and evaluation techniques.
The authors give a personal account of the use of astro navigation during the years before GPS became the primary aid for oceanic navigation. The paper also contains an account of the support provided by The Nautical Almanac (NA) together with its associated tables and computer programs which ease the tedium of sight reduction while leaving the satisfaction to be found in successful astro observations at sea.
An early version of Section 2 of this paper formed part of a presentation made at the Symposium After Longitude – Modern Navigation in Context which took place at the UK National Maritime Museum from 22–23 March 2012.
In the middle years of the 20th Century, few merchant ships were fitted with radar and, on those that were, shipmasters often looked upon it as a distraction from a watchkeeper's proper duties rather than as a useful aid to navigation.
For shipmasters of that persuasion, the only place to keep watch was outside the wheelhouse on an exposed bridge wing; mostly the starboard wing because the COLREGS (‘Collision Regulations’ or, more properly, ‘The International Regulations for Preventing Collisions at Sea’) required us to give way to ships approaching from the starboard side. Well, the bridge wing was an attractive place to spend a few hours on a calm, tropical night, but it could be highly disagreeable and sometimes, I thought, actually dangerous, in a North Atlantic rainstorm.
The January 2009 issue of the Journal of Navigation included a paper (John Wilde Crosbie 2009) entitled, “Revisiting the lessons of the early steering and sailing rules for an e-navigation age.” Following a description of the development of the COLREGS from the early 19th century, he concluded that the current steering and sailing rules should be replaced by a single rule more suited to modern conditions. This might take the form of a rule stating that a vessel taking action to avoid collision should not pass ahead of the other vessel. Such a rule would require a radical change in the philosophy of collision avoidance at sea, and evidence is required that it would be both effective and acceptable by mariners. Radar simulator experiments, conducted by the author some years ago in another context, suggest that this might be the case. An analysis of the experimental results and some conclusions are reported in this paper. The author recommends that further trials, specifically designed to test the Crosbie proposals, would be desirable.