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The number of mental health-related 999 calls to emergency services has increased in recent years. However, emergency services staff have an unfavourable reputation when it comes to supporting people experiencing mental health problems.
To assess the levels of explicit and implicit mental health stigma among accident and emergency, ambulance and police staff, and draw comparisons with the general population. Additional analyses sought to identify which variables predict mental health stigma among emergency services staff.
A cross-sectional survey of 1837 participants, comprising four independent groups (accident and emergency, ambulance and police staff, and the general population).
Levels of mental health stigma across all four groups were lower than those reported in recent surveys of the general population by the ‘Time to Change’ campaign. Within this study, explicit levels of mental health stigma were lower among the general population compared with emergency services staff. There was no difference between emergency service professions, nor were there any between-group differences in terms of implicit mental health stigma. The only consistent predictors of mental health stigma were attitudes and future behavioural intentions, whereby increased stigma was predicted by increased fear, reduced sympathy and greater intended discrimination.
Our findings suggest that levels of mental health stigma have improved over time, but there is room for improvement in emergency services staff. Interventions to improve mental health stigma may be most effective if, in line with the cognitive–behavioural model of stigma, they target attitudes and behavioural intentions.
ABSTRACT IMPACT: This work will help to understand a novel therapeutic approach to a common type of acute myeloid leukemia. OBJECTIVES/GOALS: FMS-like tyrosine kinase 3 (or FLT3) mutations occur in ˜30% of acute myeloid leukemia (AML) cases. FLT3 tyrosine kinase domain (TKD) mutations are particularly important in relapsed/refractory FLT3 mutant AML, which portends poor prognosis. This study describes a therapeutic approach to overcoming resistance conferred by FLT3-TKD mutations. METHODS/STUDY POPULATION: To understand the efficacy of a novel type 1 FLT3 inhibitor (NCGC1481), as a monotherapy and combination therapy, several assays were utilized to interrogate functionality of these therapies. Cell lines and patient samples containing aspartate 835 to tyrosine mutations (D835Y, the most common TKD alteration) and phenylalanine 691 to leucine (F691L) were utilized to examine the effects of NCGC1481 with and without other targeted therapies like MEK inhibitors. Specifically, assays measuring viability, cell death using flow cytometry, in vitro clonogenicity, cellular signaling, and xenograft survival were examined in these FLT3-TKD AML models. Synergy was also measured using well described methods, which also allowed for appropriate dose finding for drug combination experiments. RESULTS/ANTICIPATED RESULTS: Our novel type 1 FLT3 inhibitor (NCGC1481) was particularly effective in the most common FLT3 TKD mutant, D835Y. NCGC1481 reduced viability and cell signaling, while also inducing cell death and prolonging xenograft survival in the FLT3-D835Y model system. In contrast, clinically approved FLT3 inhibitors were less effective at suppressing AML cells expressing FLT3-D835Y. In the case of FLT3-F691L, most of the FLT3 inhibitors tested, including NCGC1481, suppressed canonical FLT3 signaling, but did not significantly reduce viability or leukemic clonogenicity. However, when NCGC1481 was combined with other targeted agents like MEK inhibitors, at synergistic doses, eradication of the FLT3-F691L AML clone was substantially increased. DISCUSSION/SIGNIFICANCE OF FINDINGS: In AML, response to FLT3 inhibitor therapy is often short-lived, with resistance sometimes occurring via FLT3-TKD mutations. Given the dismal prognosis of relapsed FLT3 mutant AML, novel therapies are necessary. This study describes efficacy of a novel FLT3 inhibitor, along with its synergistic activity when combined with other targeted agents.
Whole-grain wheat, in particular coloured varieties, may have health benefits in adults with chronic metabolic disease risk factors. Twenty-nine overweight and obese adults with chronic inflammation (high-sensitivity C-reactive protein) > 1·0 mg/l) replaced four daily servings of refined grain food products with bran-enriched purple or regular whole-wheat convenience bars (approximately 41–45 g fibre, daily) for 8 weeks in a randomised, single-blind parallel-arm study where body weight was maintained. Anthropometrics, blood markers of inflammation, oxidative stress, and lipaemia and metabolites of anthocyanins and phenolic acids were compared at days 1, 29 and 57 using repeated-measures ANOVA within groups and ANCOVA between groups at day 57, with day 1 as a covariate. A significant reduction in IL-6 and increase in adiponectin were observed within the purple wheat (PW) group. TNF-α was lowered in both groups and ferulic acid concentration increased in the regular wheat (RW) group. Comparing between wheats, only plasma TNF-α and glucose differed significantly (P < 0·05), that is, TNF-α and glucose decreased with RW and PW, respectively. Consumption of PW or RW products showed potential to improve plasma markers of inflammation and oxidative stress in participants with evidence of chronic inflammation, with modest differences observed based on type of wheat.
Access to cognitive behaviour therapy for those with psychosis (CBTp) remains poor. The most frequently endorsed barrier to implementation is a lack of resources. To improve access to CBTp, we developed a brief form of CBTp that specifically targets voice-related distress. The results of our pilot trial of guided self-help CBT for voices (GiVE) suggest that the therapy is both acceptable and beneficial. The present study aims to explore the subjective patient experience of accessing GiVE in the context of a trial. We interviewed nine trial participants using the Change Interview and a mixed methods approach. Most participants reported at least one positive change that they attributed to GiVE. We extracted five themes: (1) changes that I have noticed; (2) I am not alone; (3) positive therapy experiences; (4) I want more therapy; and (5) helping myself. The themes indicate that participating in the GiVE trial was generally a positive experience. The main areas in which participants experienced changes were improved self-esteem, and the ability to cope with voices. Positive changes were facilitated by embracing and enacting ‘self-help’ and having support both in and out of the therapy sessions. The findings support the use of self-help materials with those distressed by hearing voices, but that support both within and outside the clinical setting can aid engagement and outcomes. Overall, the findings support the continued investigation of GiVE.
Key learning aims
(1) To explore participants’ experience of accessing GiVE as part of a trial.
(2) To identify what (if any) changes participants noticed over the course of the GiVE trial.
(3) To identify what participants attribute these changes to.
Recent work has demonstrated that Goshen points overlap in time with another group of unfluted lanceolate points from the Plains, Plainview points. This has raised the question of whether the two types should be kept separate or consolidated into a single type. We sought to resolve this issue by applying geometric morphometric methods to a sample of points from well-documented Goshen and Plainview assemblages. We found that their shapes were statistically indistinguishable, which indicates that Goshen and Plainview points should be assigned to the same type. Because Plainview points were recognized before Goshen points, it is the latter type name that should be dropped. Sinking Goshen into Plainview allows us to move beyond taxonomic issues and toward understanding both the spatiotemporal variation that exists among Plainview assemblages and what it can tell us about the adaptations and social dynamics of Plainview groups.
This paper documents the catastrophic decline of the ‘Critically Endangered’ Fatu Hiva Monarch Pomarea whitneyi since 2000 and presents population dynamics and conservation actions for the species between 2008 and 2017. The Fatu Hiva Monarch conservation programme has prevented the extinction of the species thus far. However, after an initial increase in the population size within the management area between 2008 and 2012, recruitment subsequently declined. Improvements in the method of trapping to control cats in 2016 and 2017 coincided with encouraging results in terms of juvenile monarch survival rates, although two adult birds disappeared during the same period. The initial hypothesis, that the population would recover once the main threat, black (or ship) rat Rates Rattus predation, was effectively controlled in the breeding territories, has not proved to be correct. An alternative hypothesis assumes that cat predation, mainly on young birds, is limiting monarch recovery. Control of feral cats has been undertaken since 2010, but the implementation of a new trapping method (leg-hold traps) combined with a significant increase in cat trapping effort, has coincided with an increase in the number of cats culled, as well as monarch post-fledging survival in 2016 and 2017. For the first time in the project, no mortality has been observed for monarch chicks, fledged juveniles or immature birds. If this alternative hypothesis holds, we would expect to recruit young birds into the monarch population in the next year or two. First, this will reduce the likelihood that the Fatu Hiva Monarch will become extinct and second, provide a source population to either repopulate the island following the eradication of rats and cats or to translocate birds to a rat and cat free island.
Important Bird and Biodiversity Areas (IBAs) are sites identified as being globally important for the conservation of bird populations on the basis of an internationally agreed set of criteria. We present the first review of the development and spread of the IBA concept since it was launched by BirdLife International (then ICBP) in 1979 and examine some of the characteristics of the resulting inventory. Over 13,000 global and regional IBAs have so far been identified and documented in terrestrial, freshwater and marine ecosystems in almost all of the world’s countries and territories, making this the largest global network of sites of significance for biodiversity. IBAs have been identified using standardised, data-driven criteria that have been developed and applied at global and regional levels. These criteria capture multiple dimensions of a site’s significance for avian biodiversity and relate to populations of globally threatened species (68.6% of the 10,746 IBAs that meet global criteria), restricted-range species (25.4%), biome-restricted species (27.5%) and congregatory species (50.3%); many global IBAs (52.7%) trigger two or more of these criteria. IBAs range in size from < 1 km2 to over 300,000 km2 and have an approximately log-normal size distribution (median = 125.0 km2, mean = 1,202.6 km2). They cover approximately 6.7% of the terrestrial, 1.6% of the marine and 3.1% of the total surface area of the Earth. The launch in 2016 of the KBA Global Standard, which aims to identify, document and conserve sites that contribute to the global persistence of wider biodiversity, and whose criteria for site identification build on those developed for IBAs, is a logical evolution of the IBA concept. The role of IBAs in conservation planning, policy and practice is reviewed elsewhere. Future technical priorities for the IBA initiative include completion of the global inventory, particularly in the marine environment, keeping the dataset up to date, and improving the systematic monitoring of these sites.
A new generation of implantable brain–computer interfaces (BCI) devices have been tested for the first time in a human clinical trial, with significant success. These intelligent implants detect specific neuronal activity patterns, such as an epileptic seizure, and provide information to help patients to respond to the upcoming neuronal events. By forecasting a seizure, the technology keeps patients in the decisional loop; the device gives control to patients on how to respond and decide on a therapeutic course ahead of time. Being kept in the decisional loop can positively increase patients’ quality of life; however, doing so does not come free of ethical concerns. There is currently a lack of evidence concerning the various impacts of closed-loop system BCIs on patients’ decisionmaking processes, especially how being in the decisional loop impacts patients’ sense of autonomy. This article addresses these gaps by providing data that we obtained from a first-in-human clinical trial involving patients implanted with advisory brain devices. This article explores ethical issues related to the risks involved in being kept in the decisional loop.
We studied the breeding biology of Tahiti Monarch Pomarea nigra, a ‘Critically Endangered’ forest bird endemic to Tahiti (French Polynesia). Nest activity was monitored from 1998 to 2002, and again from 2008 to 2015. During these 12 years, only 2–13 breeding pairs per year produced hatchlings. Egg-laying occurred all year, but usually increased between August and January, peaking around November. Of the 200 nests monitored, 33 (16%) were abandoned shortly after construction, 71 had an egg laid immediately after the nest were completed (34 %) and 96 nests (46 %) had a pre-incubation phase of 18.9 ± 1.9 days (3–62 days; n = 47 nests), during which the birds visited the nest on an irregular basis. Half (49 of 96) of these nests were abandoned before an egg was laid, with incubation subsequently commencing at the remaining nests (n = 47). Although both sexes incubated for an average of 13.6 ± 0.3 days (range 13–15), the female usually spent more time incubating than the male. Only one young per nest was ever observed. The average nestling phase was 15.5 ± 0.7 days (range 13 to 20 days). Parents continue to feed the young after fledging for 74 ± 4.7 days (range 42–174). As with many tropical island endemics, the Tahiti Monarch has low reproductive productivity as indicated by the fact that: 1) only 56% of pairs attempt to lay an egg in any one year, 2) most pairs attempt only one brood per year and 3) the considerable length of the nesting and fledging phases. Because of its low productivity, maximising the reproductive success of the Tahiti Monarch is essential to secure its recovery.
The extent to which indices of maternal physiological arousal (skin conductance augmentation) and regulation (vagal withdrawal) while parenting predict infant attachment disorganization and behavior problems directly or indirectly via maternal sensitivity was examined in a sample of 259 mothers and their infants. Two covariates, maternal self-reported emotional risk and Adult Attachment Interview attachment coherence were assessed prenatally. Mothers' physiological arousal and regulation were measured during parenting tasks when infants were 6 months old. Maternal sensitivity was observed during distress-eliciting tasks when infants were 6 and 14 months old, and an average sensitivity score was calculated. Attachment disorganization was observed during the Strange Situation when infants were 14 months old, and mothers reported on infants' behavior problems when infants were 27 months old. Over and above covariates, mothers' arousal and regulation while parenting interacted to predict infant attachment disorganization and behavior problems such that maternal arousal was associated with higher attachment disorganization and behavior problems when maternal regulation was low but not when maternal regulation was high. This effect was direct and not explained by maternal sensitivity. The results suggest that maternal physiological dysregulation while parenting places infants at risk for psychopathology.
In the introduction to this book we set ourselves the task of exploring critically the relationship dynamics that are at the heart of political communication. As we have seen, since the foundation of the state these dynamics have been in perpetual flux and have waxed and waned as political parties have come and gone and as new communication technologies have added to the multiplicity of means by which political communication, in its many different forms and with its many different agenda, can occur. Political communication can, in many ways, be described as an ever-ongoing contest for support that is played out in the media. While what we refer to as ‘the media’ has changed hugely over the past decade or so, it is clear that, whatever their effect in levelling the playing field, the new technologies have certainly added additional platforms to the age-old competition for support of a party, candidate or idea.
One theme that emerges clearly from the chapters is that whether one defines political communication as persuasion, public discourse, an effort to set the agenda or an attempt to frame an issue in a particular way, and whether one is considering print, broadcast or social media in terms of campaigning techniques, an integral part of the political communication process has always been, and remains, convincing the electorate to choose between aspirants to high office. During the early decades of independence the revolutionary generation of ‘politicians by accident’ monopolised electoral competition, producing – depending on one's vantage point – a remarkable stability or stagnation.
Negative campaigning has been part and parcel of Irish electoral history from the first days of the state established by the Anglo-Irish Treaty of 1921. The civil war produced a tradition of negative campaigning that endured for decades and was characterised by vitriolic and personalised attacks on political leaders. Fianna Fáil and its republican allies were the chief targets of ‘red scares’ during the 1920s and early 1930s, though as Fianna Fáil switched from opposition to government it launched its own witch-hunt against putative Bolsheviks in parties such as Labour and Clann na Poblachta. Election campaigns are now substantially less confrontational than during the early decades of the state, in spite of the natural preference of journalists and broadcasters for gladiatorial contests between aspiring politicians.
This book presents an overview of political communication in the Republic of Ireland from a multiplicity of perspectives and sources. It brings together academics and practitioners to examine the development and current shape of political communication in modern Ireland. It also examines what the future holds for political communication in an increasingly gatekeeper-free media landscape.The field of political communication, where journalists, public relations professionals and politicians intersect and interact, has always been a highly contested one fuelled by suspicion, mutual dependence and fraught relationships.While politicians need the media they remain highly suspicious of journalists. While journalists remain wary of politicians, they need access to them for information. For most of the time, what emerges is a relatively stable relationship of mutual dependence with the boundaries policed by public relation professions.However, every so often, in times of political crisis or upheaval, this relationship gives way to a near free-for-all. Politicians, spokespersons and sometimes even journalists, become fair game in the battle for public accountability and support. The determination of public relations professions to avoid this and keep the relationship based on mutual dependence has become a central component of modern statecraft and systems of governance. The need to keep politicians and the media ‘on message’ and use the media to inform, shape and manage public discourse has become central to the workings of government, opposition and interest groups.On the other hand, the packaging of politics has potentially troublesome implications for the democratic process. In the era of the instant news cycle, new technologies and constant opinion polling, just where does information end and misinformation begin? With millions being spent annually on advisors and ‘spin-doctors’, just where does media access end and media manipulation begin?
While political journalism plays a central role in the political process it remains a hugely under-researched area of enquiry in Ireland. This is regrettable as political journalism holds those whom we elect to public account, it offers insights into the workings of political parties and governments, it is often the first draft of political history, and, occasionally it makes or breaks political careers. Taking the long view, this chapter presents a snapshot of how political journalism has evolved over the course of the last 90 years or so. Using digital newspaper archives it sheds some light on political journalism and political journalists in the early years of the state. Through interviews it examines the role that television played in transforming political journalism from passive reporting to critical analysis and commentary. Finally, amid a rapidly changing media environment, it examines the factors that impact on political journalism today.
A new state, a new parliament, 1919–61
When Dáil Éireann was established in 1919 it fell to a journalist, Piaras Béaslaí, to propose the adoption of the proclamation of independence. Béaslaí, who had worked on the Freeman's Journal and been imprisoned for his part in the 1916 Rising, was one of a number of journalists who combined newspaper work with republican activities. At the Irish Independent, reporters Michael Knightly and Hugh Smith had been active during the Rising and, along with Ned Lawlor and Paddy Quinn, reported the bitter and divisive Treaty Debates in December 1920 and January 1921 (Smyllie, 1948). Hugh Curran reported on these debates for the Irish Times and some months later, that paper's future editor, Robert Smyllie, first encountered Michael Collins. While Smyllie had expected ‘a sinister, beetle-browed, scowling kind of anarchist, who would cut your throat as soon as he would look at you’ he found Collins to be ‘a big, jovial, open-faced young man with a great shock of black hair and a wide grin that explained to me, at any rate, the astonishing hold that he had on his followers’ (Smyllie, 1948). The establishment of a new parliament and its move to Leinster House in 1922 entailed a process of negotiation regarding the facilities afforded to journalists. In June 1923 the political correspondents walked out of the Dáil halfway through a debate in protest at the lack of facilities provided for them.