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Intolerance of uncertainty (IU) is a cognitive bias that leads to perception and intolerance of uncertainty and has associated negative cognitive, emotional, and behavioural responses. It plays a strong role in social anxiety disorder (SAD; Counsell et al., 2017). Our experimental study examined the impact of uncertainty related to a social stressor on SAD using a speech task. We examined features of SAD including anticipatory anxiety, anxiety during the task, willingness to perform the task, and avoidance of the task. Undergraduate students (N = 110, 88% female) with significant social anxiety completed a series of questionnaires, then were randomised to one of two conditions related to level of uncertainty about an impromptu speech task. The experimental condition (state IU) did not predict any of the outcome variables, while trait IU significantly predicted anxiety levels. Results indicate that increased uncertainty of a social situation does not impact acute anxiety levels in SAD and reinforce the strong role of trait IU as a transdiagnostic cognitive variable. Neither trait nor state IU predicted the willingness and avoidance variables. Results also highlighted the central role of the experience of anxiety on avoidance behaviours, above cognitive factors such as IU.
Childhood trauma and adversity are common across societies and have strong associations with physical and psychiatric morbidity throughout the life-course. One possible mechanism through which childhood trauma may predispose individuals to poor psychiatric outcomes is via associations with brain structure. This study aimed to elucidate the associations between childhood trauma and brain structure across two large, independent community cohorts.
Methods
The two samples comprised (i) a subsample of Generation Scotland (n=1,024); and (ii) individuals from UK Biobank (n=27,202). This comprised n=28,226 for mega-analysis. MRI scans were processed using Free Surfer, providing cortical, subcortical, and global brain metrics. Regression models were used to determine associations between childhood trauma measures and brain metrics and psychiatric phenotypes.
Results
Childhood trauma associated with lifetime depression across cohorts (OR 1.06 GS, 1.23 UKB), and related to early onset and recurrent course within both samples. There was evidence for associations between childhood trauma and structural brain metrics. This included reduced global brain volume, and reduced cortical surface area with highest effects in the frontal (β=−0.0385, SE=0.0048, p(FDR)=5.43x10−15) and parietal lobes (β=−0.0387, SE=0.005, p(FDR)=1.56x10−14). At a regional level the ventral diencephalon (VDc) displayed significant associations with childhood trauma measures across both cohorts and at mega-analysis (β=−0.0232, SE=0.0039, p(FDR)=2.91x10−8). There were also associations with reduced hippocampus, thalamus, and nucleus accumbens volumes.
Discussion
Associations between childhood trauma and reduced global and regional brain volumes were found, across two independent UK cohorts, and at mega-analysis. This provides robust evidence for a lasting effect of childhood adversity on brain structure.
Major depressive disorder (MDD) was previously associated with negative affective biases. Evidence from larger population-based studies, however, is lacking, including whether biases normalise with remission. We investigated associations between affective bias measures and depressive symptom severity across a large community-based sample, followed by examining differences between remitted individuals and controls.
Methods
Participants from Generation Scotland (N = 1109) completed the: (i) Bristol Emotion Recognition Task (BERT), (ii) Face Affective Go/No-go (FAGN), and (iii) Cambridge Gambling Task (CGT). Individuals were classified as MDD-current (n = 43), MDD-remitted (n = 282), or controls (n = 784). Analyses included using affective bias summary measures (primary analyses), followed by detailed emotion/condition analyses of BERT and FAGN (secondary analyses).
Results
For summary measures, the only significant finding was an association between greater symptoms and lower risk adjustment for CGT across the sample (individuals with greater symptoms were less likely to bet more, despite increasingly favourable conditions). This was no longer significant when controlling for non-affective cognition. No differences were found for remitted-MDD v. controls. Detailed analysis of BERT and FAGN indicated subtle negative biases across multiple measures of affective cognition with increasing symptom severity, that were independent of non-effective cognition [e.g. greater tendency to rate faces as angry (BERT), and lower accuracy for happy/neutral conditions (FAGN)]. Results for remitted-MDD were inconsistent.
Conclusions
This suggests the presence of subtle negative affective biases at the level of emotion/condition in association with depressive symptoms across the sample, over and above those accounted for by non-affective cognition, with no evidence for affective biases in remitted individuals.
Soft tissue abscess used to be an easy emergency department (ED) presentation: perform an incision and drainage (I + D) and discharge your patient. Times have changed. Methicillin-resistant Staphylococcus aureus (MRSA) is now a major cause of soft tissue abscess in ED patients. MRSA is, by definition, resistant to cloxacillin and cephalosporins. Almost all Canadian strains are susceptible to vancomycin and linezolid. MRSA strains are variably susceptible to trimethoprim-sulfamethoxazole (TMP-SMX), tetra/doxycycline, and clindamycin, with pooled Canadian clindamycin resistance just over 40%.
Journals use social media to increase the awareness of their publications. Infographics show research findings in a concise and visually appealing manner, well suited for dissemination on social media platforms. We hypothesized that infographic abstracts promoted on social media would increase the dissemination and online readership of the parent research articles.
Methods
Twenty-four articles were chosen from the six issues of CJEM published between July 2016 and June 2017 and randomized to infographic or control groups. All articles were disseminated through the journal’s social media accounts (Twitter and Facebook). Control articles were promoted using a screen capture image of each article’s abstract on the journal’s social media accounts. Infographic articles were promoted similarly using a visual infographic. Infographics were also published and promoted on the CanadiEM.org’s website and social media channels. Abstract views, full-text views, and the change in Altmetric score were compared between groups using unpaired two-tailed t-tests.
Results
There were no significant differences in the groups at baseline. Abstract views (mean, 95% CI) were higher in the infographics (379, 287-471) than the control group (176, 136-215, p<0.001). Mean change in Altmetric scores was higher in the infographics (26, 18-34) than in the control group (3, 2-4, p<0.0001). There was no difference in full-text views between the infographics (50, 0-101) and control groups (25, 18-32).
Conclusion
The promotion of CJEM articles using infographics on social media and the CanadiEM.org website increased Altmetric scores and abstract views. Infographics may have a role in increasing awareness of medical literature.
In 2015 and 2016, the Canadian Journal of Emergency Medicine (CJEM) Social Media (SoMe) Team collaborated with established medical websites to promote CJEM articles using podcasts and infographics while tracking dissemination and readership.
Methods
CJEM publications in the “Original Research” and “State of the Art” sections were selected by the SoMe Team for podcast and infographic promotion based on their perceived interest to emergency physicians. A control group was composed retrospectively of articles from the 2015 and 2016 issues with the highest Altmetric score that received standard Facebook and Twitter promotions. Studies on SoMe topics were excluded. Dissemination was quantified by January 1, 2017 Altmetric scores. Readership was measured by abstract and full-text views over a 3-month period. The number needed to view (NNV) was calculated by dividing abstract views by full-text views.
Results
Twenty-nine of 88 articles that met inclusion were included in the podcast (6), infographic (11), and control (12) groups. Descriptive statistics (mean, 95% confidence interval) were calculated for podcast (Altmetric: 61, 42-80; Abstract: 1795, 1135-2455; Full-text: 431, 0-1031), infographic (Altmetric: 31.5, 19-43; Abstract: 590, 361-819; Full-text: 65, 33-98), and control (Altmetric: 12, 8-15; Abstract: 257, 159-354; Full-Text: 73, 38-109) articles. The NNV was 4.2 for podcast, 9.0 for infographic, and 3.5 for control articles.
Discussion
Limitations included selection bias, the influence of SoMe promotion on the Altmetric scores, and a lack of generalizability to other journals.
Conclusion
Collaboration with established SoMe websites using podcasts and infographics was associated with increased Altmetric scores and abstract views but not full-text article views.
There have been few published controlled studies of multi-component weight management programmes that include an energy deficit diet (EDD), for adults with intellectual disabilities and obesity. The objective of this study was to conduct a single-blind, cluster randomised controlled trial comparing a multi-component weight management programme to a health education programme. Participants were randomised to either TAKE 5, which included an EDD or Waist Winners Too (WWToo), based on health education principles. Outcomes measured at baseline, 6 months (after a weight loss phase) and 12 months (after a 6-month weight maintenance phase), by a researcher blinded to treatment allocation, included: weight; BMI; waist circumference; physical activity; sedentary behaviour and health-related quality of life. The recruitment strategy was effective with fifty participants successfully recruited. Both programmes were acceptable to adults with intellectual disabilities, evidenced by high retention rates (90 %). Exploratory efficacy analysis revealed that at 12 months there was a trend for more participants in TAKE 5 (50·0 %) to achieve a clinically important weight loss of 5–10 %, in comparison to WWToo (20·8 %) (OR 3·76; 95 % CI 0·92, 15·30; 0·064). This study found that a multi-component weight management programme that included an EDD, is feasible and an acceptable approach to weight loss when tailored to meet the needs of adults with intellectual disabilities and obesity.
The acquisition of competence in diagnostic reasoning is essential for medical trainees. Exposure to a variety of patient presentations helps develop the skills of diagnostic reasoning, but reliance on ad hoc clinical encounters is inefficient and does not guarantee timely exposure for all trainees. We present a novel teaching series led by emergency physicians that builds upon the existing medical education literature to teach diagnostic reasoning to preclinical (2nd year) medical students. The series used emergency department simulations involving patient actors and simulated vital signs to provide students with exposure to three acute care presentations: chest pain, abdominal pain, and headache. Emergency physicians coached and provided immediate feedback to the students as they actively worked through diagnostic reasoning. The participating medical students reported benefit from these sessions immediately following the sessions and in an 18-month follow-up survey where the students could consider the impact of the sessions on their clinical clerkship. Students felt that the sessions had assisted them in recognizing the key features of relevant diagnoses during clerkship as well as providing a helpful adjunct to their in-class learning.
Resistance to aryloxyphenoxypropionate and cyclohexanedione herbicides was identified in four wild oat populations from western Canada. Populations UM1, UM2, and UM3 originated from northwestern Manitoba and UM33 from south-central Saskatchewan. Field histories indicated that these populations were exposed to repeated applications of diclofop-methyl and sethoxydim over the previous 10 yr. The populations differed in their levels and patterns of cross-resistance to these and five other acetyl-CoA carboxylase inhibitors (ACCase inhibitors). UM1, UM2, and UM3 were resistant to diclofop-methyl, fenoxaprop-p-ethyl, and sethoxydim. In contrast, UM33 was resistant to the aryloxyphenoxy propionate herbicides but not to sethoxydim. The dose of sethoxydim required to reduce growth of UM1 by 50% was 150 times greater than for a susceptible population (UM5) or UM33 based on shoot dry matter reductions 21 d after treatment. This population differed from UM2 and UM3 that had R/S ratios of less than 10. In the field UM1 also exhibited a very high level of resistance to sethoxydim. In contrast to susceptible plants that were killed at the recommended dosage, shoot dry matter of resistant plants treated at eight times the recommended dosage was reduced by only 27%. In growth chamber experiments none of the four populations was cross-resistant to herbicides from five different chemical families.
Our aim was to develop and test a brief measure of generativity and ego-integrity that is suitable for use in palliative care settings.
Method:
Two measures of generativity and ego-integrity were modified and combined to create a new 11-item questionnaire, which was then administered to 143 adults. A principal-component analysis with oblique rotation was performed in order to identify underlying components that can best account for variation in the 11 questionnaire items.
Results:
The two-component solution was consistent with the items that, on conceptual grounds, were intended to comprise the two constructs assessed by the questionnaire.
Significance of Results:
Results suggest that the selected 11 items were good representatives of the larger scales from which they were selected, and they are expected to provide a useful means of measuring these concepts near the end of life.
Optimal communication is essential in ensuring that the palliative care needs of patients are met. This continues to be an area of concern for healthcare providers. The goal of our present review was to gain a deeper understanding of the communication experiences of patients with palliative care needs that have been identified within the qualitative literature.
Method:
A systematic search for qualitative research papers was undertaken in February of 2012. Five databases (ASSIA, CINAHL, MEDLINE, PsychArticles, and PsychINFO) were searched using the search terms [“palliative care” OR “terminal care” OR “end of life care”] AND [“experience” OR “perspective” OR “qualitative” OR “interview”] AND [“patients” OR “clients” OR “service-user”]. Meta-synthesis was conducted on the data within the found papers.
Results:
A line-of-argument synthesis of 15 studies yielded four overarching themes: talking—facilitating and inhibiting factors; the importance of humanitarian qualities within communication encounters; perceptions of autonomy within communication experiences; and individual differences in preferences for honesty within interactions.
Significance of results:
Our findings are discussed in relation to existing literature and offer a deeper insight into the communication experiences of this clinical population. A number of clinical implications are offered for the healthcare professionals who are providing support to patients with palliative care needs.
The National Environmental Policy Act (NEPA) clearly has a role to play in how projects with a federal nexus prepare for climate change. To help agencies improve their consideration of climate change, the Council on Environmental Quality in February 2010 released the NEPA draft guidance, which addresses both emissions and the effects of climate change on agency actions and the affected environment. We analyzed every available final environmental impact statement (154 total) released in July 2011–April 2012, and found that very few incorporated the climate adaptation elements of the 2010 draft guidance. Even the environmental impact statements with the most attention to climate change adaptation considered the effect of climate change with respect to only a limited number of the elements of the affected environment, failed to fully compare the various alternatives, or used short,qualitative statements rather than full analysis based on the best available science. We explore the possible reasons for this and present recommendations for overcoming these obstacles.
Frequent emergency department (ED) users are inconsistently defined and poorly studied in Canada. The purpose of this study was to develop uniform definitions, quantify ED burden, and characterize adult frequent users of a suburban community ED.
Methods:
We retrospectively reviewed the administrative database of the WestView ED in Alberta for patients ≥ 18 years of age presenting during the fiscal year of 2010. Adult frequent users and extreme frequent users were defined as patients with yearly visit numbers greater than the 95th and 99th percentiles, respectively. Demographic information including age, sex, ED length of stay, diagnoses, Canadian Triage and Acuity Scale (CTAS) level, and disposition were collected and stratified by ED frequency of use categories.
Results:
The study included 22,333 ED visits by 14,223 patients. Frequent users represented 3.1% of patients and 13.8% of visits. Extreme frequent users represented 0.8% of patients, 5.4% of visits, and 568,879 cumulative ED minutes (395 days). Nonfrequent users had one to four, frequent users had five or more, and extreme frequent users had eight or more visits over a 12-month period. Frequent users and extreme frequent users had a significantly longer ED length of stay overall and in most age categories. Alcohol-related behavioural disorders, anxiety, nausea/vomiting, and chronic obstructive pulmonary disease were prominent diagnoses, suggesting that psychiatric, somatic, and chronic illnesses may underlie recurrent visits. Admission rates were significantly higher for frequent compared to nonfrequent users.
Conclusions:
We propose reproducible definitions for adult frequent and extreme frequent ED users and provide information on the characteristics and burden of care of these groups at a community Canadian suburban ED. Adoption of these definitions would allow comparison across centres in future research and facilitate targeted interventions for frequent and extreme frequent ED users.
Occupational exposures to blood and other bodily fluids occur in approximately 5 per 100 persons every year in US hospitals. Since the provision of health care in the deployed environment poses unique challenges to hospital personnel, it is important to characterize the rates of occupational exposures and understand the prevalence of blood-borne pathogens (BBPs) in host nations.
Methods.
A retrospective review of public health and laboratory records at a US military trauma center in Afghanistan from October 1, 2010, to March 31, 2012.
Results.
A total of 65 occupational exposures were reported, including 47 (72%) percutaneous and 18 (28%) mucocutaneous, with a yearly rate of 8.6 exposures per 100 persons. During 6-month deployment cycles, the majority of exposures (46.2%) occurred in the first 2 months after arrival in Afghanistan. Physicians reported the most exposures (26%), and the operating room (48%) was the most common hospital location. The prevalence of hepatitis B and hepatitis C among local national source patients (n = 59 ) was 8.9% and 2.3%, respectively, with no cases of HIV or syphilis detected. In contrast, there were no BBPs detected in coalition source (n = 12) or exposed (n = 57) patients.
Conclusions.
The characteristics of occupational exposures in this deployed environment were comparable to those of US-based hospitals. Standard practices used to reduce occupational exposures, such as use of personal protective equipment and safety devices, should continue to be prioritized in the deployed setting. Although BBP rates are not well defined in Afghanistan, our results were consistent with those of prior epidemiologic studies.