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Patient death by suicide is a distressing occupational event associated with far-reaching impacts on professional practice and wellbeing. Psychiatrists are commonly tasked with suicide risk assessment and management and ultimately experience greater incidences of patient suicide in comparison with other medical specialists. Therefore, it is important to understand psychiatrists’ experiences of patient suicide and the required supports in an Irish context. This study investigated how patient suicide affects the personal and professional lives of consultant and non-consultant psychiatrists, and what resources/systems psychiatrists find helpful in mitigating the impact of a patient suicide.
Methods:
Survey data collected from 232 consultants and non-consultant clinicians was analysed using frequency analyses and Independent Samples t-tests,. Most participants were female (61.6%) and the largest age group represented was 50–59 years (28.4% of the sample).
Results:
Key personal and professional impacts in the aftermath of a patient’s suicide include pre-occupation with suicide, decreased self-confidence, sadness, burnout, desire for career change/break and fear of negative events following the suicide. A significant difference was observed across gender with respect to sense of responsibility (F = 3.69, dfs = 2,200, p = .026) with females displaying more feelings of responsibility (M = 3.9, SD = 3.1) than males (M = 2.8, SD = 2.7). Support from colleagues and line managers was largely identified as helpful in the aftermath of patient death by suicide.
Conclusions:
Ultimately, there is a need for greater access to guidelines/policy and occupational support for psychiatrists to assist their responses. This study provides much-needed insight into the landscape of experiences and needs of psychiatrists in Ireland who experienced a patient death by suicide.
This note critically examines the tendency of some international human rights treaty bodies to uncritically conflate sex tourism with human trafficking. Through analysis of concluding observations from the Committee on the Rights of the Child (CRC), the Committee on the Elimination of Discrimination Against Women (CEDAW), and the Committee on Economic, Social and Cultural Rights (CESCR), the note reveals a troubling pattern of equating these phenomena without adequate conceptual differentiation. While acknowledging that sex tourism can involve trafficking when the constitutive elements of the Palermo Protocol’s definition are satisfied – namely the act, means, and purpose requirements – this note argues that the wholesale characterization of sex tourism as trafficking is both conceptually inaccurate and potentially harmful. This conflation risks eliding the agency of individuals who make difficult but deliberate choices to participate in sex tourism, particularly women from the Global South.
Cilia exist ubiquitously in nature, and they are very effective in generating flow in a low Reynolds number environment. Inspired by nature, various artificial cilia have been invented for microfluidic applications, and a nature-mimicking tilted conical motion was often used for flow generation due to its simplicity and effectiveness. However, the current theoretical model for predicting the net flow rate generated by the tilted conical motion fails when the cilia are in close confinement, i.e. when the tips of the cilia are close to the ceiling of their channel or chamber, which is, in reality, the most practical way to enhance flow rate generation. Moreover, numerical simulations are very expensive for optimisation of such designs. In this study, we derive a new theoretical model, taking into account the tilting and opening angles of the cone, the height of the chamber and the length of the cilia. The results differ significantly from when the ceiling is not considered, and counter-intuitively in some cases the flow can even reverse. These unexpected results have important implications for artificial cilium design and applications. We validate the model with both numerical simulations and experiments using magnetic artificial cilia, and show that the flow optimisation based on tilted conical cilium motion can now be performed accurately in a realistic and practical manner. This study not only offers a simple tool for optimising designs of artificial cilium-based systems for microfluidic applications, but it also provides fresh insights for understanding natural cilium-driven flows.
Post-stroke neurocognitive disorders are highly prevalent, yet screening tools that are fit for culturally diverse populations are scarce. This study evaluates the impact of cultural differences on the Oxford Cognitive Screen (OCS), a stroke-specific screening tool.
Methods:
To evaluate cultural differences, we compared two populations with varying degrees of cultural diversity and Western, Educated, Industrialized, Rich and Democratic (WEIRD) characteristics. We adapted the Dutch OCS for Suriname through a multi-stage process. Using Bayesian hierarchical regression analysis, we compared 264 Surinamese participants, assessed with the adapted Dutch OCS, with 247 Belgian participants, assessed with the Dutch OCS, while controlling for age and education. We further investigated whether the associations of age and education with performance were comparable between the two populations.
Results:
Our findings revealed minimal differences in OCS performance between the Belgian and Surinamese populations. Both populations showed similar age-related decline and education-related improvement across all subtests, except for Picture naming, where the age-related decline was more pronounced in the Belgian population.
Conclusion:
These findings suggest that with minimal adaptation, the OCS is a viable tool for screening post-stroke neurocognitive disorders in culturally diverse populations.
While prior studies have consistently linked immigration attitudes with public support for the welfare state, it is not yet clear how individuals process immigrant-related information in their home contexts and combine that with their existing immigration attitudes to update their attitudes toward the welfare state. In this paper, we consider how context (i.e., immigrant welfare participation rates in individuals’ home states) works in tandem with immigration attitudes to shape Americans’ support for the welfare state. We merge state contextual data on the welfare consumption rates of immigrants with micro-level public opinion data from the Cumulative American National Election Survey (CANES) for the years from 2004 to 2016. Our results suggest that individuals’ immigration attitudes and the degree of immigrant welfare participation in their home contexts combine to influence Americans’ welfare spending attitudes. More specifically, among individuals with unfavorable immigration attitudes, higher levels of immigrant welfare participation in their state contexts lead to significantly lower levels of welfare support. Likewise, in states with high-immigrant welfare participation rates, negative immigration attitudes have a stronger negative effect on welfare support. These findings suggest that Americans’ support for the welfare state is not only determined by their existing immigration attitudes but also the reality of immigrant welfare usage in their home contexts.
We aimed to develop a new ice cream made from goat milk inoculated with the probiotic bacteria Limosilactobacillus fermentum CABA16. The physicochemical characteristics, meltdown behaviour and sensory properties of ice cream produced with and without the probiotic bacteria were analysed. The ice cream with added L. fermentum was further evaluated for probiotic viability during frozen storage and simulated gastrointestinal conditions. Results showed that the addition of L. fermentum CABA16 decreased the pH to 6.25 (P < 0.05), but had no effect on physicochemical properties such as overrun and melting behaviour of ice cream samples. The viable probiotic count was 6.71 log CFU/g with a survival rate of 90%, which was registered after 120 days of frozen storage. Considering the probiotic cell viability during gastrointestinal conditions, exposure to bile and pancreatin for 6 hours resulted in a decline of 3.6 log CFU/g cycles in ice cream samples previously stored at −18 °C for 120 days. Overall, the goat milk ice cream inoculated with L. fermentum received good sensory scores, and satisfactory probiotic viability (6.7–7 log CFU/g) was maintained throughout the 120 days of frozen storage.
El estudio científico de la literatura lírica náhuatl contenida en manuscritos novohispanos como Cantares mexicanos y Romances de los señores de la Nueva España se ha enfocado en su traducción, estética, temática e interpretación. Esto ha permitido una mayor comprensión de la forma y estilística literaria mexica, así como de su manera de percibir el mundo en relación con su visión política y religiosa. Este estudio propone una aproximación etnohistórico-gastronómica a los elementos comestibles enunciados en los cantares para la interpretación de su contenido ideológico, poniendo atención en aspectos como su transformación culinaria, consumo compartido, simbolismo y significado. Se establece un inventario de sustantivos comestibles y se identifica la presencia de procedimientos culinarios, usos terapéuticos y significados mítico-religiosos que complementan la interpretación del discurso en los cantares. Para ello, se revisaron exhaustivamente los manuscritos, se introdujeron nuevas traducciones y se cotejaron las coincidencias con crónicas y herbarios-recetarios contemporáneos. La aportación consiste en la novedosa aplicación de un enfoque que pone en evidencia la presencia de elementos comestibles en la literatura lírica náhuatl y abre nuevas vías para la lectura e interpretación, más allá de lo literario y formal, de otros documentos literarios novohispanos tempranos.
Salmonella enterica is a Gram-negative bacterium responsible approximately for 155,000 deaths annually. S. enterica is one of the most important foodborne pathogens, affecting mainly people in developed countries. The human immune system produces antibacterial peptides and proteins like lactoferrin (LF). This work addresses the hypothesis that bovine lactoferrin (bLF) and its derivative peptides bLactoferricin17-30, bD-Lactoferricin17-30, bLactoferrampin265-284, bD-Lactoferrampin265-284 and bLF-chimera have antimicrobial activity on planktonic cells and pre-formed biofilms of S. enterica. Planktonic Salmonella enterica ATCC 14028 were treated with bLF and bLF-peptides for two hours, and bacterial viability was determined by counting colony-forming units/ml. In addition, S. enterica biofilms were pre-formed or established on an abiotic surface, and viability or disruption was assessed in the presence of bLF and bLF-peptides by counting colony-forming units/ml or using the live/dead viability kit. We observed that bLF and bLF-peptides were bactericidal against planktonic S. enterica, killing more than 80% of cultures after two hours of treatment. The bactericidal effect was concentration and time-dependent. In addition, bLF, bLFampin165-284, and bLF-chimera showed an anti-biofilm effect against Salmonella biofilms pre-formed during 8 and 12 hours on the abiotic surface, disorganizing more than 50% of the biofilms after 4 or 6 hours of treatment. We conclude that bLF and its peptides show antimicrobial activity against planktonic cells and pre-formed biofilms of S. enterica on abiotic surfaces and could potentially be a therapeutic solution to combat Salmonella infections.
We analyse the pressure-driven radial flow of a shear-thinning fluid between two parallel plates. Complex fluid rheology may significantly affect the hydrodynamic features of such non-Newtonian flows, which remain not fully understood, compared with Newtonian flows. We describe the shear-thinning rheology using the Ellis model and present a theoretical framework for calculating the pressure distribution and the flow rate–pressure drop relation. We first derive a closed-form expression for the pressure gradient, which allows us to obtain semi-analytical expressions for the pressure, velocity and flow rate–pressure drop relation. Specifically, we provide the corresponding asymptotic solutions for small and large values of the dimensionless flow rates. We further elucidate the entrance length required for the radial velocity of a shear-thinning fluid to reach its fully developed form, showing that this length approximates the Newtonian low-Reynolds-number value at low shear rates, but may strongly depend on the fluid’s shear-thinning rheology and exceed the Newtonian value at high shear rates. We validate our theoretical results with finite-element numerical simulations and find excellent agreement. Furthermore, we compare our semi-analytical, asymptotic and finite-element simulation results for the pressure distribution with the experimental measurements of Laurencena & Williams (Trans. Soc. Rheol. vol. 18, 1974, pp. 331–355), showing good agreement. Our theoretical results using the Ellis model capture the interplay between the shear-thinning and the zero-shear-rate effects on the pressure drop, which cannot be explained using a simple power-law model, highlighting the importance of using an adequate constitutive model to accurately describe non-Newtonian flows of shear-thinning fluids.
Anorexia nervosa (AN) is often regarded as ‘difficult to treat’. This may in part be due to co-occurring diagnoses and traits that are less directly targeted either at the point of formulation or in treatment. Schema therapy may be suitable for individuals with AN who have not benefited from first-line interventions. It offers a schema formulation and change techniques that target broader characterological ways of being. However, schema therapy is typically 18 months duration or longer, and therefore not well-suited to services with resource constraints. We present a schema-informed cognitive behavioural therapy (CBT) approach for AN, based on a formulation that encapsulates the experience of chronic unmet emotional need and which uses cognitive and behavioural techniques to target schema and schema mode change over a relatively brief treatment. We argue that the experiential techniques of schema therapy can augment the change process for those with AN, by gradually turning up the ‘emotional heat’ and increasing tolerance for emotion. After outlining this proposed model, we present findings from a case series of n=11 patients with AN or atypical AN. All patients had received first-line eating disorder treatment(s) previously and n=8/11 had prior experience of day or in-patient treatment. Results supported the acceptability and feasibility of schema-informed CBT for AN: no patients discontinued treatment early, mean number of sessions was 31 (SD 10.28), and patient satisfaction was high. Improvements were seen in AN psychopathology, depression/anxiety, schemas and schema modes, mostly with medium effect sizes. We propose areas for future research and consideration.
Key learning aims
(1) To understand the rationale for a schema-informed CBT approach for anorexia nervosa.
(2) To understand the key components of schema-informed CBT for anorexia nervosa, including treatment objectives, stages of treatment and core methods.
(3) To evaluate the empirical evidence for schema-informed CBT with anorexia nervosa.
(4) To critically reflect on future opportunities for research and clinical practice with schema-informed CBT and eating disorders.
There is increasing demand for milk and dairy products and an associated increase in milk production in Asia and Africa, making them important emerging dairy markets for the future. To the best of our knowledge, there has been little effort to comprehensively review literature on dairy production in these regions despite the changing situation, growth and challenges that require sustainable solutions. Thus, the objective of this review was to present an overview and evaluation of the dairy industry in selected countries in Eastern Africa and Asia using recent literature. The countries were selected based on the potential of dairy production in the respective regions. It focused on two types of countries: those in East Africa, which are at different stages of intensification regarding the global production issue, and those in Asia, which have large dairy industries. Based on this, Ethiopia, Kenya and Tanzania were selected from eastern Africa, while India, Pakistan and China were selected from Asia. The review revealed that dairy production in Eastern Africa predominantly relies on small-scale production systems. Factors such as inadequate feed, disease prevalence, poor access to breeding and formal/organized market pose significant challenges to this region's dairy industry. However, recent efforts have focused on improving productivity through technology adoption, livestock breeding programmes and market development initiatives. In contrast, Asia showcases a diverse range of dairy production systems. Countries like India are known for their large-scale dairy operations involving both indigenous and exotic dairy breeds. Additionally, cooperative models and public-private partnerships have contributed to the growth of the dairy sector in Asian countries. Nevertheless, challenges such as land/feed availability, environmental concern, and market competitiveness remain areas for improvement. While Eastern Africa aims to enhance small-scale farming systems through partly upgrading scale of production, innovation and market access, Asia seeks to bridge the gaps in productivity and sustainability.
This study proposes a novel time-varying, endogenous fiscal reaction function, and investigates whether and how the US government responded to the rising debt to assess the sustainability of its debt over 1916 to 2022. The reaction function is estimated via a state space model using Bayesian methods by treating its coefficient as an unobservable stochastic process. Although there is evidence that the government considered long-term projections of the interest rate in its fiscal decisions, the response to debt was largely driven by unobservable non-economic factors and by large and persistent shocks. We find that the government was more proactive about constraining debt increases during the 20th century than previously thought (such as in Bohn, 1998), but it has become less aggressive ever since. The debt-GDP ratio was sustainable for almost the entire sample period, but its steady state value has been rising consistently in recent years. The government’s response to debt contributed 6.0 percentage points to the surplus-GDP ratio in the postwar 20th century, but only 3.6 percentage points afterward.
The blood-milk barrier (BMB) forms at parturition when the gland switches form a non-lactating state to one of copious milk production and becomes leaky again when milk removal ceases and mammary involution is initiated. In this review the importance of the BMB in milk production and, in particular, its hormonal regulation is explored. Tight junctions (TJ) between adjacent mammary epithelial cells form a barrier to the two-directional paracellular movement of small molecules between the blood and milk and are responsible for establishing and maintaining the BMB. They form part of the cell's junctional complex and consist of transmembrane proteins that are linked to the mammary cell's cytoskeleton. This means that when, during lactation, TJ become “leaky” the resulting perturbation of the cytoskeleton interferes with the cell's secretory function. As such, TJ are involved in regulating and maintaining milk production. Mammary TJ are under hormonal control, with progesterone, glucocorticoids, prolactin, parathyroid hormone-related peptide (PTHrP) and serotonin (5-HT) being the key hormones. Progesterone prevents closure of TJ and the immediate prepartum drop in its concentration is a prerequisite for TJ closure. A simultaneous increase in the levels of glucocorticoids and prolactin is necessary for full TJ closure and initiation and maintenance of lactation. Both PTHrP and 5-HT are important hormones in maintaining extracellular calcium concentrations, a requirement for maintaining TJ integrity. Whereas PTHrP reduces TJ permeability, necessary for establishing and maintaining milk production, 5-HT has an opening effect on TJ. The latter may help speed up mammary involution and facilitate the movement of immune factors into the gland, preventing intramammary infections. In summary, mammary TJ make up the BMB and play a role in establishing and maintaining milk production and are under hormonal control, with progesterone, glucocorticoids, PTHrP and 5-HT being key regulatory hormones and prolactin likely playing a supporting role.
To examine the knowledge, experience and attitudes of nurses working in nursing homes in relation to the administration of antipsychotic medications to individuals diagnosed with behavioural and psychological symptoms of dementia (BPSD).
Methods:
Questionnaires comprising 17 questions were distributed to 120 nurses working in nursing homes to evaluate their knowledge of and attitudes to the utilisation of antipsychotic medication for BPSD.
Results:
Of the 70 nurses who completed the study questionnaire, 68 (97.1%) were confident with their knowledge of managing BPSD symptoms in dementia patients; 49 (70.0%) stated that antipsychotic medications were associated with a noticeable improvement in BPSD symptoms (n = 49, 70.0%) and were mostly commenced at an appropriate stage of the patients illness (n = 47, 67.1%). Music therapy was the most commonly noted (58.6% of nurses) utilised alternative therapy, although only 46% nursing staff reported that there were sufficient alternative therapies available. Qualitative themes of note included the importance of communication between nursing staff, health professionals and family members and an ongoing requirement for training nursing staff regarding antipsychotic prescribing and dispensing in BPSD.
Conclusions:
Nurses working in nursing homes demonstrated confidence in their knowledge of treatment strategies in managing BPSD in dementia patients. However, concerns were expressed regarding the limited availability of non-pharmacological interventions.
This article examines the theology of Katherine Parr, sixth and surviving wife of Henry VIII, through a close reading of her mature work, The Lamentation of a Sinner. In particular, I treat Parr’s theological use of the epistle to the Romans to inform and structure her doctrine of the work of Christ within The Lamentation. I argue that Parr follows the structure of Romans in her opening lament over sin, her central discussion of the cross of Christ, and her application of this theology to the Christian lives of the people of England’s church. I also posit Parr’s use of several overlapping motifs for Christ’s work within The Lamentation’s treatment of the atonement and its relationship to the Protestant understanding of justification by faith.