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Historical narratives can satisfy basic individual psychological needs. However, an over-reliance on a group's past can marginalize those who think differently – thus, homogenizing the culture and stifling creativity. By revising narratives to balance the power of collective narratives with the richness of individuality, we foster groups that encourage varied identities.
Floatation-REST (restricted environmental stimulation therapy) has shown promising potential as a therapeutic intervention in psychiatric conditions such as anxiety and anorexia nervosa. We speculate that the sensory deprivation might act as a kind of interoceptive training. Within our lab, interoceptive trait prediction error has been used to predict states of anxiety in autistic adults. There is also emerging research conceptualising interoceptive mismatches potentially playing a role in fatigue. Our aim was to run a feasibility study assessing the tolerability of Floatation-REST for participants with disabling fatigue. We also aimed to establish the feasibility of gathering data on mechanistic measures, such as heart rate variability (HRV) and interoception, during floatation.
Methods
Participants were recruited via online advertisements and were screened to check they scored at least 36 on the Fatigue Severity Scale (FSS). Pertinent medication changes and previous float experience within the last 6 weeks were amongst the exclusion criteria. Baseline measures included: Modified Fatigue Impact Scale (MFIS); Body Perception Questionaire; hypermobility questionnaire and Tellegen Absorption Scale. Participants completed four 90 minute sessions of floatation-REST across a 2–6 week period with 1 week of ecological momentary sampling (EMS) before and after. Immediate pre and post float measures included testing interoceptive sensibility, accuracy and awareness. HRV was measured during floatation. Change in energy was measured by retrospective subjective assessment, changes in validated fatigue scales and EMS.
Results
Baseline MFIS scores (median = 67.5; range = 55–77) indicated a high degree of severity of participant fatigue. 15 participants were recruited to the study. 13 participants started the float intervention and 11 completed all four sessions. No drop out was due to poor tolerability. Most adverse events were mild, expected and related to the pre/post float testing. HRV data was successfully captured throughout all sessions. Participant surveys described improvements in energy levels, sleep and relaxation and 73% “strongly agreed” to an overall positive effect. Furthermore, both statistically and clinically significant reductions were noted in the mean FSS scores (56.9 to 52.6; p = 0.044) and the MFIS scores (67.0 to 56.4; p = 0.003). Detailed energy assessment was obtained by EMS with 37 to 86 data points per participant.
Conclusion
Floatation-REST appears to be a feasible intervention for people with severe fatigue. EMS, HRV data, interoceptive data and other measures were reliably recorded. Reported subjective benefits were supported by an improvement in objective fatigue scores, though the lack of a control group makes these improvements speculative at present.
• To improve documentation of antidepressant prescribing in our service, aiming to improve frequency of review, and guide measurement of outcomes.
• Identify patients requiring medical review.
The standards that we audited against are that, for patients under The Early Intervention in Psychosis Service (EIPS), a diagnosis should be recorded alongside each antidepressant prescription and, according to EIPN guidelines, psychotropic medications should be reviewed every 6 months.
Population data from the UK indicates that lack of recording of a diagnosis is associated with increased duration of treatment, and reduced frequency of mental health reviews.
Methods
It was recorded for each patient whether they had an antidepressant prescribed, which medication, the documented indication, and their most recent medical review. Data was collected in a ‘snapshot' cross section of all 89 patients on the caseload in December 2023.
Data was obtained from carenotes by reviewing clinic letters and clinical notes; and cross-referencing with GP records.
Results
33 patients (37%) were prescribed an antidepressant. Of these, 25 (76%) had a recorded indication. The commonest indication was mixed anxiety and depression followed by depression. Sertraline was by far the commonest prescribed antidepressant (52%) followed by mirtazapine. 3 patients were prescribed combination antidepressants. 67 patients (84%) had had a medical review within 6 months.
Conclusion
Among patients with a first episode of psychosis, there is a significant comorbidity of depression and anxiety spectrum disorders.
Our standard was met for most patients but there were several exceptions, and we considered why 8 patients did not have a listed diagnosis. There can be a degree of diagnostic uncertainty in distinguishing anxiety and depressive disorders from negative symptoms, and the affective changes that are an established part of recovery from an acute psychotic episode. In these circumstances it may be appropriate to consider a trial of antidepressants in consultation with the patient. Some of these patients also have been on long-term therapy which preceded their referral to EIPS, leading to uncertainty of the indication and pre-morbid status.
We conclude the following recommendations:
1. Prompt a review of antidepressant use in those identified without a clear indication, discussing risks and benefits with the patient at next review.
2. Arrange medical reviews for those exceeding the 6-monthly window.
3. Record last review for patients under shared care.
The unbridled positivity toward curiosity and creativity may be excessive. Both aid species survival through exploration and advancement. These beneficial effects are well documented. What remains is to understand their optimal levels and contexts for maximal achievement, health, and well-being. Every beneficial element to individuals and groups carries the potential for harm – curiosity and creativity included.
Blood-culture overutilization is associated with increased cost and excessive antimicrobial use. We implemented an intervention in the adult intensive care unit (ICU), combining education based on the DISTRIBUTE algorithm and restriction to infectious diseases and ICU providers. Our intervention led to reduced blood-culture utilization without affecting safety metrics.
Background: Blood cultures are often ordered when an infection is suspected; however, they have a low yield in most cases. The overuse of blood culture is associated with high contamination rates, resulting in excess diagnostics, unnecessary antibiotics, longer hospital stays, and higher hospital costs. We evaluated the safety of a multifaceted intervention, which encompassed education and blood-culture restriction, and its impact on blood-culture utilization and antibiotic use in adult intensive care unit (ICU) patients. Methods: The study was performed between October 2020 and October 2021 in the 12 general medicine and specialty ICUs of a quaternary academic care center. The intervention, implemented in April 2021, included providing education to ICU and infectious disease physicians based on an algorithm adapted from the Johns Hopkins DISTRIBUTE study in addition to restricting blood-culture ordering on these units to these providers. The month of April 2021 was excluded as a washout period. Study outcomes comprised blood-culture utilization, blood-culture positivity, days of therapy (DOT), and length of therapy (LOT), which were compared across the study periods using IRR or the Pearson χ2 test, as appropriate. In addition, 30-day mortality and 30-day ICU readmission were evaluated utilizing multiple COX regression models. Results: In total, 6,303 patients (2,087 MICU, 3,636 SICU, and 580 both) were included in the study, with a median age of 65 years (IQR, 21). Most participants were male (57.5%), with a median length of stay of 175 hours (IQR, 186). After the intervention, blood-culture utilization rates decreased from 15.4% to 12.4% (IRR 0.80, 95% CI, 0.76–0.85) (Fig. 1). There was no difference in blood-culture positivity between the preintervention period (11.05%) and the postintervention period (11.64%; P = .459). Days of therapy decreased from 1,180 to 1,130 per 1,000 patient days (IRR, 0.96; 95% CI, 0.95–0.98), and the length of therapy decreased from 602 to 579 per 1,000 patient days (IRR, 0.96; 95% CI, 0.94–0.99) (Fig. 2). There was no difference in 30-day mortality (P = .241) nor 30-day ICU readmission (P = .888) across the study periods after adjusting for potential confounders (Table 1). Conclusions: Our multifaceted intervention decreased blood-culture and antimicrobial utilization in the ICUs without significantly affecting the positivity rate, mortality, or readmission. This study suggests that educating providers on appropriate blood-culture use along with restriction could safely improve healthcare outcomes. Further studies are warranted to validate our results across various institutions and to evaluate the impact of blood-culture optimization in non-ICU patients.
The Maser Monitoring Organisation is a collection of researchers exploring the use of time-variable maser emission in the investigation of astrophysical phenomena. The forward directed aspects of research primarily involve using maser emission as a tool to investigate star formation. Simultaneously, these activities have deepened knowledge of maser emission itself in addition to uncovering previously unknown maser transitions. Thus a feedback loop is created where both the knowledge of astrophysical phenomena and the utilised tools of investigation themselves are iteratively sharpened. The project goals are open-ended and constantly evolving, however, the reliance on radio observatory maser monitoring campaigns persists as the fundamental enabler of research activities within the group.
Recently, remarkable progress has been made in understanding the formation of high mass stars. Observations provided direct evidence that massive young stellar objects (MYSOs), analogously to low-mass ones, form via disk-mediated accretion accompanied by episodic accretion bursts, possibly caused by disk fragmentation. In the case of MYSOs, the mechanism theoretically provides a means to overcome radiation pressure, but in practice it is poorly studied - only three accretion bursts in MYSOs have been caught in action to date. A significant contribution to the development of the theory has been made with the study of masers, which have proven to be a powerful tool for locating “bursting” MYSOs. This overview focuses on the exceptional role that masers play in the search and study of accretion bursts in massive protostars.
This paper evaluates the impact of a higher court articulating doctrine as either a “rule” or a “standard.” The legal doctrine we evaluate concerns police searches based upon information supplied by confidential informants. The Supreme Court’s Aguilar-Spinelli test was a rule, and its Illinois v. Gates “totality of the circumstances” test is a standard. Using a data set of circuit court opinions from 1951 to 1999, we compare circuit-level implementation of these two doctrines. The results suggest that rules are more effective than standards at constraining ideological voting in lower courts.
The severe acute respiratory syndrome coronavirus disease-2 (SARS-CoV-2) pandemic of 2020-2021 created unprecedented challenges for clinicians in critical care transport (CCT). These CCT services had to rapidly adjust their clinical approaches to evolving patient demographics, a preponderance of respiratory failure, and transport utilization stratagem. Organizations had to develop and implement new protocols and guidelines in rapid succession, often without the education and training that would have been involved pre-coronavirus disease 2019 (COVID-19). These changes were complicated by the need to protect crew members as well as to optimize patient care. Clinical initiatives included developing an awake proning transport protocol and a protocol to transport intubated proned patients. One service developed a protocol for helmet ventilation to minimize aerosolization risks for patients on noninvasive positive pressure ventilation (NIPPV). While these clinical protocols were developed specifically for COVID-19, the growth in practice will enhance the care of patients with other causes of respiratory failure. Additionally, these processes will apply to future respiratory epidemics and pandemics.
The world presents an array of constantly changing sights and sounds, tactile and vestibular experiences, far too much to be attended and processed at any one time. Perceivers must make sense of this dynamically changing flux of stimulation by selecting events and properties of events that provide information that is meaningful and relevant to their needs, goals, and actions as they change across time. Adults are highly skilled at selectively attending to this multisensory stimulation in a way that optimizes perception and learning and supports their actions and goals. However, this selective attention presents a remarkable challenge for young infants – how to learn to attend to the dimensions of stimulation that optimize meaningful perception and action and to filter out stimulation that is less relevant.
This paper summarizes a multi-state, multi-year study assessing the potential for local agriculture in northern New England. While largely rural, this region's agricultural sector differs greatly from the rest of the United States, and demand for locally produced food has been increasing. To assess this unique economic landscape, researchers and Cooperative Extension at the Universities of Maine, New Hampshire, and Vermont investigated four key areas: (1) local food capacities, (2) constraints to agricultural expansion, (3) consumer preferences for local and organic produce, and (4) the role of intermediaries as alternative local food outlets. The project included input from local farmers, Extension members, restaurants, and the general public. We present the four research areas in a sequential, overlapping fashion. The timing of our research was such that each step in the process informed the next and can be used as a template for assessing a region's potential for local agricultural production.
U.S. opinion of the Second Boer War (1899–1902) was highly divided. The debate over the war served as a proxy for fights over domestic issues of immigration, inequality, and race. Anglo-American Republicans’ support for the British was undergirded by belief in Anglo-Saxon racial superiority. Caucasian but non-Anglo Democrats and Populists disputed the Anglo-Saxonist assumptions and explicitly equated the plight of the Boers to the racial and economic inequalities they faced in the United States. They utilized Anglophobia, republican ideology, and anti-modernist jeremiads to discredit their opponents and to elevate an alternative racial fiction: universal whiteness. Reports written by the celebrity journalist Richard Harding Davis while covering the Boer War, along with a wide array of other sources, illustrate the discursive underpinning of the debate. They also suggest the effectiveness of the pro-Boer argument in reshaping the racial opinions of some Anglo-Saxon elites. Although Davis arrived in South Africa a staunch supporter of transatlantic Anglo-Saxonism, he came to link the Boers with the republican values and frontier heritage associated with the U.S.’ own history. The equation of the South African Republic's resistance against the British Empire with that of the U.S.’ own war of independence highlighted contradictions between Anglo-Saxonism and American exceptionalism. As a result, Anglo-Saxonism was weakened. Davis and others increasingly embraced a notion of racial identity focused on color. Thus, public reaction to the Boer War contributed to the ongoing rise of a new wave of herrenvolk democratic beliefs centered on a vision of white racial hybridity across the social and political divisions separating Americans of European descent.
Jaswal & Akhtar provide several quotes ostensibly from people with autism but obtained via the discredited techniques of Facilitated Communication and the Rapid Prompting Method, and they do not acknowledge the use of these techniques. As a result, their argument is substantially less convincing than they assert, and the article lacks transparency.
Household surveys are one of the most commonly used tools for generating insight into rural communities. Despite their prevalence, few studies comprehensively evaluate the quality of data derived from farm household surveys. We critically evaluated a series of standard reported values and indicators that are captured in multiple farm household surveys, and then quantified their credibility, consistency and, thus, their reliability. Surprisingly, even variables which might be considered ‘easy to estimate’ had instances of non-credible observations. In addition, measurements of maize yields and land owned were found to be less reliable than other stationary variables. This lack of reliability has implications for monitoring food security status, poverty status and the land productivity of households. Despite this rather bleak picture, our analysis also shows that if the same farm households are followed over time, the sample sizes needed to detect substantial changes are in the order of hundreds of surveys, and not in the thousands. Our research highlights the value of targeted and systematised household surveys and the importance of ongoing efforts to improve data quality. Improvements must be based on the foundations of robust survey design, transparency of experimental design and effective training. The quality and usability of such data can be further enhanced by improving coordination between agencies, incorporating mixed modes of data collection and continuing systematic validation programmes.
Modern high-throughput molecular and analytical tools offer exciting opportunities to gain a mechanistic understanding of unique traits of weeds. During the past decade, tremendous progress has been made within the weed science discipline using genomic techniques to gain deeper insights into weedy traits such as invasiveness, hybridization, and herbicide resistance. Though the adoption of newer “omics” techniques such as proteomics, metabolomics, and physionomics has been slow, applications of these omics platforms to study plants, especially agriculturally important crops and weeds, have been increasing over the years. In weed science, these platforms are now used more frequently to understand mechanisms of herbicide resistance, weed resistance evolution, and crop–weed interactions. Use of these techniques could help weed scientists to further reduce the knowledge gaps in understanding weedy traits. Although these techniques can provide robust insights about the molecular functioning of plants, employing a single omics platform can rarely elucidate the gene-level regulation and the associated real-time expression of weedy traits due to the complex and overlapping nature of biological interactions. Therefore, it is desirable to integrate the different omics technologies to give a better understanding of molecular functioning of biological systems. This multidimensional integrated approach can therefore offer new avenues for better understanding of questions of interest to weed scientists. This review offers a retrospective and prospective examination of omics platforms employed to investigate weed physiology and novel approaches and new technologies that can provide holistic and knowledge-based weed management strategies for future.
Our 2015-2016 ALMA 1.3 to 0.87 mm observations (resolution ~200 au) of the massive protocluster NGC6334I revealed that an extraordinary outburst had occurred in the dominant millimeter dust core MM1 (luminosity increase of 70×) when compared with earlier SMA data. The outburst was accompanied by the flaring of ten maser transitions of three species. We present new results from our recent JVLA observations of Class II 6.7 GHz methanol masers and 6 GHz excited OH masers in this region. Class II masers had not previously been detected toward MM1 in any interferometric observations recorded over the past 30 years that targeted the bright masers toward other members of the protocluster (MM2 and MM3=NGC6334F). Methanol masers now appear both toward and adjacent to MM1 with the strongest spots located in a dust cavity ~1 arcsec (1300 au) north of the MM1B hypercompact HII region. In addition, new excited OH masers appear on the non-thermal source CM2. These data reveal the dramatic effects of episodic accretion onto a deeply-embedded high mass protostar and demonstrate its ongoing impact on the surrounding protocluster.
We present subarcsecond resolution pre- and post-outburst JVLA continuum and water maser observations of the massive protostellar outburst source NGC6334I-MM1. The continuum data at 5 and 1.4 cm reveal that the free-free emission powered by MM1B, modeled as a hypercompact HII region from our 2011 JVLA data, has dropped by a factor of 5.4. Additionally, the water maser emission toward MM1, which had previously been strong (500 Jy) has dramatically reduced. In contrast, the water masers in other locations in the protocluster have flared, with the strongest spots associated with CM2, a non-thermal radio source that appears to mark a shock in a jet emanating 2″ (2600 au) northward from MM1. The observed quenching of the HCHII region suggests a reduction in uv photon production due to bloating of the protostar in response to the episodic accretion event.