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Advance Choice Documents (ACDs) have been recommended for inclusion in new mental health legislation for England and Wales based on evidence they reduce compulsory psychiatric admission, with particular benefit for Black people. As Black people disproportionately experience compulsory psychiatric admission in the UK, our aim was to explore potential barriers and enablers to effective ACD implementation for Black people with previous experience of compulsory admission.
Methods:
Six stakeholder workshops and one consensus workshop were held with: Black service users who had previously been involuntarily admitted, carers/supporters of Black service users, and mental health staff. Thematic analysis was conducted on workshop transcripts.
Results:
Participants were service users (n = 13), carers/supporters (n = 7), service users and carers/supporters (n = 3), and staff (n = 18). Thematic analysis identified themes of ‘training’, ‘completion’, ‘access’, and ‘use’ concerning ACD implementation. Stakeholders highlighted the importance of understanding the racialised experience of Black service users for effective ACD implementation. Strong communication between and amongst stakeholders and helpful systems for access were also emphasised. Stakeholders also recommended joint training and independent facilitation of ACDs to address Black service user-staff power imbalances.
Conclusions:
Known enablers and barriers to ACD implementation are important when considering ACDs for Black people, as is explicitly engaging with their experiences holistically, including racialised historical and individual experiences that underline some treatment preferences. Independent facilitation and shifts in service user-staff power dynamics present as key to realising the potential of ACDs to empower Black service users in relation to their care, and in turn to potentially reduce coercive care.
The 7th edition of the Canadian Stroke Best Practice Recommendations (CSBPR) is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners, and intended to drive healthcare excellence, improved outcomes and more integrated health systems. This edition includes a new module on the management of cerebral venous thrombosis (CVT). Cerebral venous thrombosis is defined as thrombosis of the veins of the brain, including the dural venous sinuses and/or cortical or deep veins. Cerebral venous thrombosis is a rare but potentially life-threatening type of stroke, representing 0.5–1.0% of all stroke admissions. The reported rates of CVT are approximately 10–20 per million and appear to be increasing over time. The risk of CVT is higher in women and often associated with oral contraceptive use and with pregnancy and the puerperium. This guideline addresses care for adult individuals who present to the healthcare system with current or recent symptoms of CVT. The recommendations cover the continuum of care from diagnosis and initial clinical assessment of symptomatic CVT, to acute treatment of symptomatic CVT, post-acute management, person-centered care, special considerations in the long-term management of CVT, including pregnancy and considerations related to CVT in special circumstances such as trauma and vaccination. This module also includes supporting materials such as implementation resources to facilitate the adoption of evidence into practice and performance measures to enable monitoring of uptake and effectiveness of recommendations.
Edited by
Roland Dix, Gloucestershire Health and Care NHS Foundation Trust, Gloucester,Stephen Dye, Norfolk and Suffolk Foundation Trust, Ipswich,Stephen M. Pereira, Keats House, London
This chapter explores the evolving use of rapid tranquillisation (RT) through the years, examining the complexities surrounding its definition and the factors that need consideration before, during and after its administration. Every acute disturbance experienced by a patient is different and a multidisciplinary approach with good communication is key. The chapter discusses the use of covert medication in
RT, the SafeWards approach to creating engaging and meaningful ward programmes for patients, laws for governing the use of restrictive procedures, and the medications used for RT and their routes of administration along with their potential side effects.
Internationally, an increasing proportion of emergency department visits are mental health related. Concurrently, psychiatric wards are often occupied above capacity. Healthcare providers have introduced short-stay, hospital-based crisis units offering a therapeutic space for stabilisation, assessment and appropriate referral. Research lags behind roll-out, and a review of the evidence is urgently needed to inform policy and further introduction of similar units.
Aims
This systematic review aims to evaluate the effectiveness of short-stay, hospital-based mental health crisis units.
Method
We searched EMBASE, Medline, CINAHL and PsycINFO up to March 2021. All designs incorporating a control or comparison group were eligible for inclusion, and all effect estimates with a comparison group were extracted and combined meta-analytically where appropriate. We assessed study risk of bias with Risk of Bias in Non-Randomized Studies – of Interventions and Risk of Bias in Randomized Trials.
Results
Data from twelve studies across six countries (Australia, Belgium, Canada, The Netherlands, UK and USA) and 67 505 participants were included. Data indicated that units delivered benefits on many outcomes. Units could reduce psychiatric holds (42% after intervention compared with 49.8% before intervention; difference = 7.8%; P < 0.0001) and increase out-patient follow-up care (χ2 = 37.42, d.f. = 1; P < 0.001). Meta-analysis indicated a significant reduction in length of emergency department stay (by 164.24 min; 95% CI −261.24 to −67.23 min; P < 0.001) and number of in-patient admissions (odds ratio 0.55, 95% CI 0.43–0.68; P < 0.001).
Conclusions
Short-stay mental health crisis units are effective for reducing emergency department wait times and in-patient admissions. Further research should investigate the impact of units on patient experience, and clinical and social outcomes.
In this study, we investigate the process of generating single-sentence representations for the purpose of Dialogue Act (DA) classification, including several aspects of text pre-processing and input representation which are often overlooked or underreported within the literature, for example, the number of words to keep in the vocabulary or input sequences. We assess each of these with respect to two DA-labelled corpora, using a range of supervised models, which represent those most frequently applied to the task. Additionally, we compare context-free word embedding models with that of transfer learning via pre-trained language models, including several based on the transformer architecture, such as Bidirectional Encoder Representations from Transformers (BERT) and XLNET, which have thus far not been widely explored for the DA classification task. Our findings indicate that these text pre-processing considerations do have a statistically significant effect on classification accuracy. Notably, we found that viable input sequence lengths, and vocabulary sizes, can be much smaller than is typically used in DA classification experiments, yielding no significant improvements beyond certain thresholds. We also show that in some cases the contextual sentence representations generated by language models do not reliably outperform supervised methods. Though BERT, and its derivative models, do represent a significant improvement over supervised approaches, and much of the previous work on DA classification.
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 scientific community and most mainstream agriculturalists typically design fertilizer recommendations to provide a ‘sufficient level of available nutrients’ to meet the annual N, P and K requirements of common field crops. Soil balancing is another approach to managing soil fertility that focuses on the levels of Ca, Mg and K to achieve a desired base cation saturation ratio (BCSR). Soil balancing is believed to be practiced frequently by organic and other alternative farmers but is viewed skeptically by conventional agricultural scientists due to a lack of support for the idea in the published scientific literature. This study represents a pioneering effort to collect systematic data on the extent of soil balancing, how it is practiced and the types of outcomes reported by organic farmers. Our survey of over 850 farmers who grow certified organic corn in Indiana, Michigan, Ohio and Pennsylvania found that over half report using a soil-balancing approach based on BCSR. Their practice of soil balancing frequently includes more than management of base cations, but also uses a wide range of soil amendment products (such as purchased organic NPK fertilizers, micronutrients, microbial stimulants and soil inoculants) other than those applied specifically for cation balance. Farms that rely on vegetable and dairy production for most of their income, and Amish farmers who rely on horses for fieldwork, were more likely to report using a soil-balancing program. Self-described soil balancers perceived positive agronomic outcomes from the use of a BCSR program, including improvements in soil physical and biological properties and improved crop health and quality. Although farmers in our study report extensive use and positive perceived outcomes from soil-balancing methods, the scientific research literature has been unable to reproduce evidence that manipulating soil base cation levels has any systematic effect on crop yield. Future research could consider the interacting effects of BCSR with other field management practices to more closely approximate the actual practices of farmers.
Breakthrough Listen is a 10-yr initiative to search for signatures of technologies created by extraterrestrial civilisations at radio and optical wavelengths. Here, we detail the digital data recording system deployed for Breakthrough Listen observations at the 64-m aperture CSIRO Parkes Telescope in New South Wales, Australia. The recording system currently implements two modes: a dual-polarisation, 1.125-GHz bandwidth mode for single-beam observations, and a 26-input, 308-MHz bandwidth mode for the 21-cm multibeam receiver. The system is also designed to support a 3-GHz single-beam mode for the forthcoming Parkes ultra-wideband feed. In this paper, we present details of the system architecture, provide an overview of hardware and software, and present initial performance results.
The north-west European population of Bewick’s Swan Cygnus columbianus bewickii declined by 38% between 1995 and 2010 and is listed as ‘Endangered’ on the European Red List of birds. Here, we combined information on food resources within the landscape with long-term data on swan numbers, habitat use, behaviour and two complementary measures of body condition, to examine whether changes in food type and availability have influenced the Bewick’s Swan’s use of their main wintering site in the UK, the Ouse Washes and surrounding fens. Maximum number of Bewick’s Swans rose from 620 in winter 1958/59 to a high of 7,491 in winter 2004/05, before falling to 1,073 birds in winter 2013/14. Between winters 1958/59 and 2014/15 the Ouse Washes supported between 0.5 and 37.9 % of the total population wintering in north-west Europe (mean ± 95 % CI = 18.1 ± 2.4 %). Swans fed on agricultural crops, shifting from post-harvest remains of root crops (e.g. sugar beet and potatoes) in November and December to winter-sown cereals (e.g. wheat) in January and February. Inter-annual variation in the area cultivated for these crops did not result in changes in the peak numbers of swans occurring on the Ouse Washes. Behavioural and body condition data indicated that food supplies on the Ouse Washes and surrounding fens remain adequate to allow the birds to gain and maintain good body condition throughout winter with no increase in foraging effort. Our findings suggest that the recent decline in numbers of Bewick’s Swans at this internationally important site was not linked to inadequate food resources.
One of the most notable currents in social, cultural and political historiography is the interrogation of the categories of 'elite' and 'popular' politics and their relationship to each other, as wellas the exploration of why and how different sorts of people engaged with politics and behaved politically. While such issues are timeless, they hold a special importance for a society experiencing rapid political and social change, like early modern England. No one has done more to define these agendas for early modern historians than John Walter. His work has been hugely influential, and at itsheart has been the analysis of the political agency of ordinary people. The essays in this volume engage with the central issues of Walter's work, ranging across the politics of poverty, dearth and household, popular political consciousness and practice more broadly, and religion and politics during the English revolution. This outstanding collection, bringing together some of the leading historians of this period with some of the field's rising stars, will appeal to anyone interested in the social, cultural and political history of early modern England or issues of popular political consciousness and behaviour more generally.
MICHAEL J. BRADDICK is professor of history at the University of Sheffield. PHIL WITHINGTON is professor of history at the University of Sheffield.
CONTRIBUTORS: Michael J. Braddick, J. C. Davis, Amanda Flather, Steve Hindle, Mark Knights, John Morrill, Alexandra Shepard, Paul Slack, Richard M. Smith, Clodagh Tait, Keith Thomas, Phil Withington, Andy Wood, Keith Wrightson.
We present low-frequency spectral energy distributions of 60 known radio pulsars observed with the Murchison Widefield Array telescope. We searched the GaLactic and Extragalactic All-sky Murchison Widefield Array survey images for 200-MHz continuum radio emission at the position of all pulsars in the Australia Telescope National Facility (ATNF) pulsar catalogue. For the 60 confirmed detections, we have measured flux densities in 20 × 8 MHz bands between 72 and 231 MHz. We compare our results to existing measurements and show that the Murchison Widefield Array flux densities are in good agreement.
In 1642, Anne Read's husband died of grief. In the same year, Sir Con Magennis died tormented by his evil deeds and ‘much … affrighted with the apprehension and conceipt that … Mr Tudge [a minister he had slain] was still in his presence’.Early modern people attributed huge consequence to ‘passions’ (they would not have used the word ‘emotion’) like grief, anger and fear. When uncontrolled, ‘passion’ started wars and ended life. Little wonder that contemporaries urged the restraint of potentially damaging feelings. However, there were times when emotions were particularly difficult to check.
John Walter's recent work on the collection of documents called the 1641 Depositions has assisted in building a new understanding of the outbreak of waves of violence in Ireland in 1641–2 and subsequently. The depositions contain testimonies from about 3,000 people, mostly British Protestant settlers, who had been dispossessed of their lands, homes and goods by Catholic rebels. Some had been confronted by crowds of local people, though as the rebellion continued, gentlemen tended to take over the leadership of these attacks. Either way, most of the deponents could identify at least some of those involved. The majority had been threatened with violence, and many bore tales of loss of property, personal injury and the torture and violent deaths of their family members, friends and neighbours. There were also accounts of incidents of desecration of sacred space and iconoclasm and of the deliberate humiliation of victims, who were routinely stripped and insulted. The depositions also contain a later set of ‘examinations’, usually conducted to probe particular crimes that had occurred in the early 1640s. The testimonies here included those of both settler and native witnesses and alleged perpetrators. It is no surprise, therefore, that Nicholas Canny should have described the depositions as ‘a body of material which is emotional’. Historians of the period often reflect on the emotional state of the Gaelic Irish and Old English participants, to paint a picture of simmering humiliation, shame, resentment, hostility, fear, hatred, anxiety and despair that led to outpourings of vengeful rage. Though economic and other grievances are pinpointed as arousing these emotions, they are regularly fathered above all on religion: Inga Jones argues that ‘religion has the capacity to arouse passions which go beyond what political and localist concerns can stimulate, a passion which … could and did spill over into unrestrained slaughter’.