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A number of community based surveys have identified an increase in psychological symptoms and distress but there has been no examination of symptoms at the more severe end of the mental health spectrum.
We aimed to analyse numbers and types of psychiatric presentations to inform planning for future demand on mental health services in light of the COVID-19 pandemic.
We analysed electronic data between January and April 2020 for 2534 patients referred to acute psychiatric services, and tested for differences in patient demographics, symptom severity and use of the Mental Health Act 1983 (MHA), before and after lockdown. We used interrupted time-series analyses to compare trends in emergency department and psychiatric presentations until December 2020.
There were 22% fewer psychiatric presentations the first week and 48% fewer emergency department presentations in the first month after lockdown initiated. A higher proportion of patients were detained under the MHA (22.2 v. 16.1%) and Mental Capacity Act 2005 (2.2 v. 1.1%) (χ2(2) = 16.3, P < 0.0001), and they experienced a longer duration of symptoms before seeking help from mental health services (χ2(3) = 18.6, P < 0.0001). A higher proportion of patients presented with psychotic symptoms (23.3 v. 17.0%) or delirium (7.0 v. 3.6%), and fewer had self-harm behaviour (43.8 v. 52.0%, χ2(7) = 28.7, P < 0.0001). A higher proportion were admitted to psychiatric in-patient units (22.2 v. 18.3%) (χ2(6) = 42.8, P < 0.0001) after lockdown.
UK lockdown resulted in fewer psychiatric presentations, but those who presented were more likely to have severe symptoms, be detained under the MHA and be admitted to hospital. Psychiatric services should ensure provision of care for these patients as well as planning for those affected by future COVID-19 waves.
Khongso /kʰɔŋ˧˩so˧˩/ is an SVO Tibeto-Burman language spoken by between two and three thousand speakers in Paletwa Township, Southern Chin State, Myanmar (Dryer 2008, Wright 2009). The speakers live in 17 villages primarily along the Michaung River (see Figure 1).1 Khongso is mutually intelligible with Anu, which has a population of 700 and is spoken west of the Khongso area (So-Hartmann 1988, Wright 2009, Lewis, Simons & Fennig 2016). The ISO code for Khongso and Anu is anl and the glottolog code is anuu1241.
During the late eighteenth and early nineteenth centuries, as is well known, the town of Belfast experienced growth and development. One obvious indication of this growth was the expansion of its population. Following a visit to the town in 1812, the writer John Gamble estimated that Belfast's population stood at 30,000, which number included some 4,000 Catholics. ‘A few years ago’, he remarked, emphasising the significance of this latter figure, ‘there was scarcely a Catholic in the place’. If Gamble's estimate of 30,000 was correct, then Belfast had grown by over 11,000 since 1791, when its population had stood at just 18,320, and in the decades that followed it continued to grow, rising to 37,277 in 1821 and 75,308 in 1841. But it was not just in terms of the expansion and diversification of its population that the changing nature of Belfast could be measured. Transformation could also be seen in the shape and appearance of the town. Between c.1760 and 1790, as Sean Connolly has recently noted, ‘an extensive programme of urban improvement pushed the town well beyond its historic boundaries and gave it both a new appearance and a much-extended range of urban amenities’. During this period Belfast acquired ‘some of its most significant older buildings’, including the Exchange and Assembly Rooms, First Belfast Presbyterian Church, the Poor House and the White Linen Hall, and in the years that followed more were to come. The Belfast Academical Institution, an impressive building based on a plan by Sir John Soane, opened in 1814, and a General Hospital was erected the following year in Frederick Street. In 1816, St George's Church appeared on High Street and the Commercial Buildings, combining ‘an excellent commercial hotel, a spacious and handsome news-room, and behind these an area with a piazza for the use of merchants’, were constructed on Waring Street in 1822.
These interrelated processes of demographic growth and urban development were to have significant impacts on the lives of Belfast’s inhabitants. Population growth, for instance, altered the nature of sociability and personal relations in the town. Prior to 1750, as Raymond Gillespie has noted, ‘Belfast remained an intimate town … a place still based on face-to-face encounters in which people knew the genealogical matrix within which they operated’.
Urban spaces in nineteenth-century Ireland is a wide-ranging and innovative collection of essays, which offers new insights on the Irish urban experience. Adopting a spatial approach, the essays presented in this collection move beyond study of events that happened and people who lived in the towns and cities of nineteenth-century Ireland, instead exploring the ways in which particular urban spaces were constructed and experienced. Focusing on a range of urban spaces, from individual streets and districts, to schools, asylums and entire cities, they highlight both the multifaceted nature of the Irish urban experience and the potential of the spatial approach to the study of history.
That urban history has developed slowly in Ireland has long been acknowledged. Writing in 1981, David Harkness and Mary O’Dowd remarked that ‘[t]he study of the town in Ireland has too long been neglected’ and in a wide-ranging historiographical survey, published some five years later, Mary E. D aly made a similar point, highlighting a ‘past neglect of urban history’ in Ireland. For Daly, this ‘neglect’ was attributable to causes both scholarly and cultural. These included Irish historians’ tendency to focus on politics and the ‘struggle for national independence’, and ‘the popular belief that towns were somehow alien to Irish culture’. It should, however, be noted that a tendency to overlook the history of Ireland's urban centres was by no means unique to the twentieth century. Indeed, as Rosemary Sweet has demonstrated, while the eighteenth and early nineteenth centuries were marked, in England, by an ‘abundance of descriptive urban literature’, reflecting the ‘flourishing condition of English towns’, such literature was limited in Ireland. There, its production was hampered by a fragile ‘civic tradition’ and the hangovers of Ireland's troubled seventeenth century, which ‘left the eighteenth-century urban inhabitants a legacy of contested history’ that provided ‘a powerful check on the expression of communal sentiment’.
Whatever the causes, immediate or long-term, of the ‘neglect’ of urban history in Ireland, it appeared by the late 1980s that things were beginning to change: ‘the history of Irish towns and cities is being explored with an unprecedentedly high level of attention’, Daly observed in her 1986 survey, though this increased attention was not sufficient to prevent the conclusion that the study of urban history in Ireland remained at ‘an early stage’. In the intervening period, further development has taken place, though whether Irish urban history has today reached a point of full maturity is open to debate. Much work remains to be done and comparing Irish urban history with its British counterpart proves revealing, for in Ireland, as David Dickson has observed, ‘the pursuit of urban history has in recent decades been far weaker than in the neighbouring island’. Yet if we might conclude that Irish urban history continues to develop slowly, it is important to note that it has continued to develop. Whatever may be said of the speed of its development, urban history remains a fixture on the Irish historiographical scene and has recently shown encouraging signs of growth.
Efforts to address child trafficking require intensive collaboration among professionals of varied disciplines. Healthcare professionals have a major role in this multidisciplinary approach. Training is essential for all professionals, and policies and protocols may assist in fostering an effective, comprehensive response to victimization.
It is not known whether associations between child problem behaviours and maternal depression can be accounted for by comorbid borderline personality disorder (BPD) dysfunction.
To examine the contributions of maternal depression and BPD symptoms to child problem behaviours.
Depression trajectories over the fist-year postpartum were generated using repeated measurement from a general population sample of 997 mothers recruited in pregnancy. In a stratified subsample of 251, maternal depression and BPD symptoms were examined as predictors of child problem behaviours at 2.5 years.
Child problem behaviours were predicted by a high maternal depression trajectory prior to the inclusion of BPD symptoms. This association was no longer significant after the introduction of BPD symptoms.
Risks for child problem behaviours currently attributed to maternal depression may arise from more persistent and pervasive difficulties found in borderline personality dysfunction.
Different experimental conditions at a versatile high-energy beamline equipped with a two-dimensional detector have been compared for powder diffraction and pair distribution function (PDF) experiments. In particular, sample size and sample to detector distances have been evaluated on a standard sample, to evaluate their effects in both Q and real space. Two illustrative cases are also discussed. The average structure and local distortions in a BaTiO3 powder with 100 nm particle size show that spurious ripples in the PDF are suppressed by increased counting statistics. Effects of small amounts of a crystalline impurity phase on a SiO2.Al2O3.Na2O.CaO glass have been quantified.
Training for the clinical research workforce does not sufficiently prepare workers for today’s scientific complexity; deficiencies may be ameliorated with training. The Enhancing Clinical Research Professionals’ Training and Qualifications developed competency standards for principal investigators and clinical research coordinators.
Clinical and Translational Science Awards representatives refined competency statements. Working groups developed assessments, identified training, and highlighted gaps.
Forty-eight competency statements in 8 domains were developed.
Training is primarily investigator focused with few programs for clinical research coordinators. Lack of training is felt in new technologies and data management. There are no standardized assessments of competence.
The translation of discoveries to drugs, devices, and behavioral interventions requires well-prepared study teams. Execution of clinical trials remains suboptimal due to varied quality in design, execution, analysis, and reporting. A critical impediment is inconsistent, or even absent, competency-based training for clinical trial personnel.
In 2014, the National Center for Advancing Translational Science (NCATS) funded the project, Enhancing Clinical Research Professionals’ Training and Qualifications (ECRPTQ), aimed at addressing this deficit. The goal was to ensure all personnel are competent to execute clinical trials. A phased structure was utilized.
This paper focuses on training recommendations in Good Clinical Practice (GCP). Leveraging input from all Clinical and Translational Science Award hubs, the following was recommended to NCATS: all investigators and study coordinators executing a clinical trial should understand GCP principles and undergo training every 3 years, with the training method meeting the minimum criteria identified by the International Conference on Harmonisation GCP.
We anticipate that industry sponsors will acknowledge such training, eliminating redundant training requests. We proposed metrics to be tracked that required further study. A separate task force was composed to define recommendations for metrics to be reported to NCATS.