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Patients in medium secure hospitals may be at particularly increased risk of coronavirus disease 2019 (COVID-19) infection and complications. We undertook a service evaluation involving all current in-patients within a single, English medium secure hospital to describe the uptake of the COVID-19 vaccine among this population. Data regarding capacity to consent to the vaccine, acceptance/refusal of this (and reasons for refusal) and demographics was retrospectively collected from the patients’ clinical records and analysed. In total, 85 patients (92.4% of eligible patients) had capacity to decide if they wanted the COVID-19 vaccine. Of these 68 (80.0%) consented and 17 (20.0%) declined to consent. A similar proportion of patients aged under and over 40 years old consented to have the vaccine. Those from a Black Asian minority ethnic background were more likely to decline the vaccine than White British patients. The reasons for capacitous refusal appeared similar to those seen in the general population.
Social determinants of health have the potential to influence mental health and addictions-related emergency department (ED) visits and the likelihood of admission to hospital. We aimed to determine how social determinants of health, individually and in combination, relate to the likelihood of hospital admission at the time of postpartum psychiatric ED visits.
Among 10 702 postpartum individuals (female based on health card) presenting to the ED for a psychiatric reason in Ontario, Canada (2008–2017), we evaluated the relation between six social determinants of health (age, neighbourhood quintile [Q, Q1 = lowest, Q5 = highest], rurality, immigrant category, Chinese or South Asian ethnicity and neighbourhood ethnic diversity) and the likelihood of hospital admission from the ED. Poisson regression models generated relative risks (RR, 95% CI) of admission for each social determinant, crude and adjusted for clinical severity (diagnosis and acuity) and other potential confounders. Generalised estimating equations were used to explore additive interaction to understand whether the likelihood of admission depended on intersections of social determinants of health.
In total, 16.0% (n = 1715) were admitted to hospital from the ED. Being young (age 19 or less v. 40 or more: RR 0.60, 95% CI 0.45–0.82), rural-dwelling (v. urban-dwelling: RR 0.75, 95% CI 0.62–0.91) and low-income (Q1 v. Q5: RR 0.81, 95% CI 0.66–0.98) were each associated with a lower likelihood of admission. Being an immigrant (non-refugee immigrant v. Canadian-born/long-term resident: RR 1.29, 95% CI 1.06–1.56), of Chinese ethnicity (v. non-Chinese/South Asian ethnicity: RR 1.88, 95% CI 1.42–2.49); and living in the most v. least ethnically diverse neighbourhoods (RR 1.24, 95% CI 1.01–1.53) were associated with a higher likelihood of admission. Only Chinese ethnicity remained significant in the fully-adjusted model (aRR 1.49, 95% CI 1.24–1.80). Additive interactions were non-significant.
For the most part, whether a postpartum ED visit resulted in admission from the ED depended primarily on the clinical severity of presentation, not on individual or intersecting social determinants of health. Being of Chinese ethnicity did increase the likelihood of admission independent of clinical severity and other measured factors; the reasons for this warrant further exploration.
Anecdotal evidence suggests the use of bolus tube feeding is increasing in the long-term home enteral tube feed (HETF) patients. A cross-sectional survey to assess the prevalence of bolus tube feeding and to characterise these patients was undertaken. Dietitians from ten centres across the UK collected data on all adult HETF patients on the dietetic caseload receiving bolus tube feeding (n 604, 60 % male, age 58 years). Demographic data, reasons for tube and bolus feeding, tube and equipment types, feeding method and patients’ complete tube feeding regimens were recorded. Over a third of patients receiving HETF used bolus feeding (37 %). Patients were long-term tube fed (4·1 years tube feeding, 3·5 years bolus tube feeding), living at home (71 %) and sedentary (70 %). The majority were head and neck cancer patients (22 %) who were significantly more active (79 %) and lived at home (97 %), while those with cerebral palsy (12 %) were typically younger (age 31 years) but sedentary (94 %). Most patients used bolus feeding as their sole feeding method (46 %), because it was quick and easy to use, as a top-up to oral diet or to mimic mealtimes. Importantly, oral nutritional supplements (ONS) were used for bolus feeding in 85 % of patients, with 51 % of these being compact-style ONS (2·4 kcal (10·0 kJ)/ml, 125 ml). This survey shows that bolus tube feeding is common among UK HETF patients, is used by a wide variety of patient groups and can be adapted to meet the needs of a variety of patients, clinical conditions, nutritional requirements and lifestyles.
In recent decades, architectural historians, preservationists, and the general public have shown a growing interest in Fascist-era buildings. Many of the most high-profile examples are those associated with the monumental excesses of the regime. However, new attention has also been focused on more modest buildings that are significant examples of interwar Italian modernism or Rationalism, including former party headquarters (case del fascio). Taking as primary examples works by Giuseppe Terragni, the architect most often associated with Rationalism, as well by Luigi Carlo Danieri and Luigi Vietti, whose interwar contributions to Italian modernism have been less often the focus of scholarly attention, this article traces the postwar histories of case del fascio with the aim of better understanding the ways in which architecture and politics intersect and some of the consequences of this for the contemporary Italian architectural landscape.
40% of people with dementia have disturbed sleep but there are currently no known effective treatments. Studies of sleep hygiene and light therapy have not been powered to indicate feasibility and acceptability and have shown 40–50% retention. We tested the feasibility and acceptability of a six-session manualized evidence-based non-pharmacological therapy; Dementia RElAted Manual for Sleep; STrAtegies for RelaTives (DREAMS-START) for sleep disturbance in people with dementia.
We conducted a parallel, two-armed, single-blind randomized trial and randomized 2:1 to intervention: Treatment as Usual. Eligible participants had dementia and sleep disturbances (scoring ≥4 on one Sleep Disorders Inventory item) and a family carer and were recruited from two London memory services and Join Dementia Research. Participants wore an actiwatch for two weeks pre-randomization. Trained, clinically supervised psychology graduates delivered DREAMS-START to carers randomized to intervention; covering Understanding sleep and dementia; Making a plan (incorporating actiwatch information, light exposure using a light box); Daytime activity and routine; Difficult night-time behaviors; Taking care of your own (carer's) sleep; and What works? Strategies for the future. Carers kept their manual, light box, and relaxation recordings post-intervention. Outcome assessment was masked to allocation. The co-primary outcomes were feasibility (≥50% eligible people consenting to the study) and acceptability (≥75% of intervention group attending ≥4 intervention sessions).
In total, 63out of 95 (66%; 95% CI: 56–76%) eligible referrals consented between 04/08/2016 and 24/03/2017; 62 (65%; 95% CI: 55–75%) were randomized, and 37 out of 42 (88%; 95% CI: 75–96%) adhered to the intervention.
DREAM-START for sleep disorders in dementia is feasible and acceptable.
OBJECTIVES/SPECIFIC AIMS: Determine timing of risk of readmissions within 30 days among patients first discharged to a skilled nursing facilities (SNF) after heart failure hospitalization and subsequently discharged home. METHODS/STUDY POPULATION: This was a retrospective cohort study of patients with SNF stays of 30 days or less following discharge from a heart failure hospitalization. Patients were followed for 30 days following discharge from SNF. We categorized patients based on SNF length of stay (LOS): 1–6 days, 7–13 days, 14–30 days. We then fit a piecewise exponential Bayesian model with the outcome as time to readmission after discharge from SNF for each group. Our event of interest was unplanned readmission; death and planned readmissions were considered as competing risks. Our model examined 2 different time intervals following discharge from SNF: 0–3 days post SNF discharge and 4–30 days post SNF discharge. We reported the hazard rate (credible interval) of readmission for each time interval. We examined all Medicare fee-for-service (FFS) patients 65 and older admitted from July 2012 to June 2015 with a principal discharge diagnosis of HF, based on methods adopted by the Centers for Medicare and Medicaid Services (CMS) for hospital quality measurement. RESULTS/ANTICIPATED RESULTS: Our study included 67,585 HF hospitalizations discharged to SNF and subsequently discharged home [median age, 84 years (IQR; 78–89); female, 61.0%]; 13,257 (19.2%) were discharged with home care, 54,328 (80.4%) without. Median length of SNF admission was 17 days (IQR; 11–22). In total, 16,333 (24.2%) SNF discharges to home were readmitted within 30 days of SNF discharge; median time to readmission was 9 days (IQR; 3–18). The hazard rate of readmission for each group was significantly increased on days 0–3 after discharge from SNF compared with days 4–30 after discharge from SNF. In addition, the hazard rate of readmission during the first 0–3 days after discharge from SNF decreased as the LOS in SNF increased. DISCUSSION/SIGNIFICANCE OF IMPACT: The hazard rate of readmission after SNF discharge following heart failure hospitalization is highest during the first 6 days home. Length of stay at SNF also has an effect on risk of readmission immediately after discharge from SNF; patients with a longer length of stay in SNF were less likely to be readmitted in the first 3 days after discharge from SNF.
Desiderius Erasmus was a significant figure in early sixteenth-century England, and many of his works were translated into English during the reign of Henry VIII. In the process of translation the original intention of these works was subverted as Erasmus's reputation was appropriated by his translators and their patrons for their own purposes. His works were recast in English form to serve a variety of different agendas, from those of Henrician conservatives to Protestants pushing for more radical religious reform. This article looks at some of these translations, showing how they illustrate the variations in religious attitudes during these volatile years and the competing claims for validation. In particular, Erasmus's pronouncements on the importance of Scripture translation were annexed and deployed in the debate over the English Bible, demonstrating how his views about translation were in themselves translated to reflect the political and religious needs of the English situation.
Computerised cognitive–behavioural therapy (cCBT) for depression has the potential to be efficient therapy but engagement is poor in primary care trials.
We tested the benefits of adding telephone support to cCBT.
We compared telephone-facilitated cCBT (MoodGYM) (n = 187) to minimally supported cCBT (MoodGYM) (n = 182) in a pragmatic randomised trial (trial registration: ISRCTN55310481). Outcomes were depression severity (Patient Health Questionnaire (PHQ)-9), anxiety (Generalized Anxiety Disorder Questionnaire (GAD)-7) and somatoform complaints (PHQ-15) at 4 and 12 months.
Use of cCBT increased by a factor of between 1.5 and 2 with telephone facilitation. At 4 months PHQ-9 scores were 1.9 points lower (95% CI 0.5–3.3) for telephone-supported cCBT. At 12 months, the results were no longer statistically significant (0.9 PHQ-9 points, 95% CI −0.5 to 2.3). There was improvement in anxiety scores and for somatic complaints.
Telephone facilitation of cCBT improves engagement and expedites depression improvement. The effect was small to moderate and comparable with other low-intensity psychological interventions.
Background: The phenomenological heterogeneity of auditory hallucinations (AHs) means individual models struggle to account for all aspects of the experience. One alternative is that distinct subtypes of AHs exist, with each requiring their own unique explanatory model and tailored cognitive behavioural intervention strategies. Aims: This exploratory study tested for the presence of one specific potential AH-subtype, hypervigilance hallucinations (HV-AHs). Method: Four specific aspects of the phenomenology of AHs (chosen on the basis of the predicted phenomenology of HV-AHs) were assessed using a semi-structured interview in 32 individual AHs taken from reports from 15 patients with psychosis. Results: Cluster analysis (at the level of the individual AH-experience) offered support for the existence of a distinct HV-AH subtype, characterized by hearing threatening, externally-located voices when attention was externally-focused. Other clusters identified all shared the contrasting properties of occurring in quiet contexts when patients’ attention was internally focused. Conclusions: The results offered tentative support for the existence of an HV-AH subcategorization and justifies future research in larger samples. Potential implications for models of AHs are also considered.
The paper reports on the fourth (2010) season of fieldwork of the Cyrenaican Prehistory Project, and on further results of analyses of artefacts and organic materials collected in the 2009 season. Ground-based LiDar has provided both an accurate 3D scan of the Haua Fteah cave and information on the cave's morphometry or origins. The excavations in the cave focussed on Middle Palaeolithic or Middle Stone Age ‘Pre-Aurignacian’ layers below the base of the Middle Trench beside the McBurney Deep Sounding (Trench D) and on Final Palaeolithic ‘Oranian’ layers beside the upper part of the Middle Trench (Trench M). Although McBurney referred to the upper part of the Deep Sounding as more or less sterile, the 2010 excavations found evidence for small-scale but regular human presence in the form of stone artefacts and debitage, though given the sedimentary context the latter are unlikely to represent in situ knapping. The excavations of Trench M extended from the basal Capsian layers investigated in 2009 through Oranian layers to the transition with the Dabban Upper Palaeolithic. Some 17,000 lithic pieces have been studied from the Capsian and Oranian layers excavated in Trench M, in an area measuring less than 2 m by 1 m by 1.1 m deep, along with numerous animal bones, molluscs, and macrobotanical remains, as well as occasional shell beads. Preliminary studies of the lithics, bones, molluscs, and plant remains are revealing the changing character of late Pleistocene (Oranian) and early Holocene (Capsian) occupation in the Haua Fteah. Alongside the work in the Haua Fteah, the project continued its assessment of the Quaternary and archaeological sequences of the Cyrenaican coastland and completed a transect survey of surface lithic materials and their landform contexts from the pre-desert across the Gebel Akhdar to the coast, with a new focus on the al-Marj basin. Significant differences are emerging in patterns of Middle Palaeolithic and later hominin occupation and palaeodemography.
The recognition of negative facial affect is impaired in people with schizophrenia. The neural underpinnings of this deficit and its relationship to the symptoms of psychosis are still unclear.
To examine the association between positive and negative psychotic symptoms and activation within the amygdala and extrastriate visual regions of patients with schizophrenia during fearful and neutral facial expression processing.
Functional magnetic resonance imaging was used to measure neural responses to neutral and fearful facial expressions in 11 patients with schizophrenia and 9 healthy volunteers during an implicit emotional task.
No association between amygdala activation and positive symptoms was found; the activation within the left superior temporal gyrus was negatively associated with the negative symptoms of the patients.
Our results indicate an association between impaired extrastriate visual processing of facial fear and negative symptoms, which may underlie the previously reported difficulties of patients with negative symptoms in the recognition of facial fear.
With a dynamical mass Mdyn ~ 1.3×105 M⊙ and a lower limit Mcl > 5 × 104 M⊙ from star counts, Westerlund 1 is the most massive young open cluster known in the Galaxy and thus the perfect laboratory to study massive star evolution. We have developed a comprehensive spectral classification scheme for supergiants based on features in the 6000–9000Å range, which allows us to identify > 30 very luminous supergiants in Westerlund 1 and ~ 100 other less evolved massive stars, which join the large population of Wolf-Rayet stars already known. Though detailed studies of these stars are still pending, preliminary rough estimates suggest that the stars we see are evolving to the red part of the HR diagram at approximately constant luminosity.
UK general practitioners (GPs) refer patients with common mental disorders to community mental health nurses.
To determine the effectiveness and cost-effectiveness of this practice.
Randomised trial with three arms: usual GP care, generic mental health nurse care, and care from nurses trained in problem-solving treatment; 98 GPs in 62 practices referred 247 adult patients with new episodes of anxiety, depression and life difficulties, to 37 nurses.
There were 212 (86%) and 190 (77%) patients followed up at 8 and 26 weeks respectively. No significant differences between groups were found in effectiveness at either point. Mean differences in Clinical Interview Schedule – Revised scores at 26 weeks compared with GP care were –1.4 (95% Cl –5.5 to 2.8) for generic nurse care, and 1.1 (–2.9 to 5.1) for nurse problem-solving. Satisfaction was significantly higher in both nurse-treated groups. Mean extra costs per patient were £283 (95% Cl 154–411) for generic nurse care, and £315 (183–481) for nurse problem-solving treatment.
GPs should not refer unselected patients with common mental disorders to specialist nurses. Problem-solving should be reserved for patients who have not responded to initial GP care.
This study investigates the presence of sensory modulation dysfunction (SMD) among children with attention-deficit-hyperactivity disorder (ADHD). Twenty-six children with ADHD (mean age 8.3 years, 18 males, 8 females), and 30 typically developing children (mean age 8.2 years, 21 males, 9 females) were tested using a laboratory procedure that gauges responses to repeated sensory stimulation by measuring electrodermal reactivity (EDR). Parental report measures of limitations in sensory, emotional, and attentional dimensions were administered using the Short Sensory Profile, the Leiter International Performance Scale–Revised, Parent Rating subscales, and the Child Behavior Checklist (CBCL). Compared to the typical sample, the children with ADHD displayed greater abnormalities in sensory modulation on both physiological and parent-report measures. The children with ADHD also displayed more variability in responses. Within the group with ADHD, levels of SMD were highly correlated with measures of psychopathology on the CBCL. Implications of findings relate to the importance of considering sensory processing abilities in a subgroup of children with ADHD.
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