To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Off-licence psychotropic use in people with intellectual disability and/or autism, in the absence of psychiatric illness, is a major public health concern in England.
Aims
To ascertain and compare views of psychiatrists and non-psychiatrists working with people with intellectual disability and/or autism on psychotropic medication optimisation for this population.
Method
A cross-sectional survey of 13 questions was disseminated online among psychiatrists and other health professionals working with people with intellectual disability and/or autism across England, using a non-discriminatory exponential snowballing technique leading to non-probability sampling. The questionnaire covered demographic characteristics, perceived barriers/benefits of psychotropic optimisation (including ethnicity) and views on implementation of a national medicine optimisation programme. Quantitative analysis used chi-squared, Mann–Whitney and unpaired t-tests, with significance taken as P < 0.05. Thematic analysis of free-text responses was undertaken with Braun and Clarke’s methodology.
Results
Of 219 respondents, significant differences in attitudes to most issues emerged between psychiatrists (n = 66) and non-psychiatrists (n = 149). Psychiatrists had less optimism of a successful national medication optimisation programme if commissioned, or achieving 50% reduction in psychotropic overprescribing and inappropriate psychotropic prescribing generally. Perceived barriers to reducing overmedication differed significantly between the psychiatrists and non-psychiatrists, Thematic analysis identified five themes (system issues, resources, medication challenges, family and carers, and training and alternatives/structure).
Conclusions
This is the first study to highlight important differences between psychiatrists and non-psychiatrists’ attitudes to psychotropic optimisation despite respondents overall being broadly supportive of its need. A major finding is the hitherto unquantified concerns of patient ethnicity and its impact on psychotropic optimisation principles.
The kinetic stability of collisionless, sloshing beam-ion ($45^\circ$ pitch angle) plasma is studied in a three-dimensional (3-D) simple magnetic mirror, mimicking the Wisconsin high-temperature superconductor axisymmetric mirror experiment. The collisional Fokker–Planck code CQL3D-m provides a slowing-down beam-ion distribution to initialize the kinetic-ion/fluid-electron code Hybrid-VPIC, which then simulates free plasma decay without external heating or fuelling. Over $1$–$10\;\mathrm{\unicode{x03BC} s}$, drift-cyclotron loss-cone (DCLC) modes grow and saturate in amplitude. The DCLC scatters ions to a marginally stable distribution with gas-dynamic rather than classical-mirror confinement. Sloshing ions can trap cool (low-energy) ions in an electrostatic potential well to stabilize DCLC, but DCLC itself does not scatter sloshing beam-ions into the said well. Instead, cool ions must come from external sources such as charge-exchange collisions with a low-density neutral population. Manually adding cool $\mathord {\sim } 1\;\mathrm{keV}$ ions improves beam-ion confinement several-fold in Hybrid-VPIC simulations, which qualitatively corroborates prior measurements from real mirror devices with sloshing ions.
National Action Plans (NAPs) are a possible implementation measure for the Global Plastics Treaty, through a NAP-based approach. Their effectiveness in other international agreements is contested, and their current format allows for weak, voluntary measures with limited accountability. By analysing stakeholder and country submissions to the Intergovernmental Negotiating Committee (INC) secretariat ahead of INC-2 negotiations in Paris, June 2023, conducting a literature review, and interviewing key actors, this study aims to determine the support that governments and stakeholders have for a NAP-based approach in the Treaty, and identify the key enablers needed to ensure that NAP-based approaches, if adopted in the Treaty, are effective. Results indicate that by INC-2, more than 85% of countries supported a NAP-based approach, suggesting a high chance of this approach being selected as the means of implementation of the Treaty. However, interviewees and literature reviews indicate that NAPs in their current form are not likely to be effective at delivering ambitious Treaty targets. Six key enablers to improve the effectiveness of plastics NAPs are identified. These enablers should be integrated into any plastics NAPs both independently, and as potential requirements of the Treaty to ensure that NAP-based approaches are effective and have the impact intended.
After the rapid implementation of digital health services during the COVID-19 pandemic, a paucity of research exists about the suitability of remote consulting in people with intellectual disabilities and their carers, particularly for neuropsychiatric reviews.
Aim
This study examines when remote neuropsychiatric routine consulting is suitable for this population.
Method
A survey was conducted of people with intellectual disabilities and their carers, examining their preference between face-to-face and video consultations for ongoing neuropsychiatric reviews within a rural countywide intellectual disability service in Cornwall, England (population: 538 000). The survey was sent to all adults with intellectual disabilities open to the service on 30 July 2022, closing on 30 September 2022. Participants were asked to provide responses on 11 items predesigned and co-produced between clinicians and experts by experience. The entire service caseload of people had White ethnicity, reflecting the ethnic demographics of Cornwall. Responses received without consent were excluded from the study dataset.
Results
Of 271 eligible participants, 119 responses were received, 104 of whom consented to having their anonymised data used for research analysis. There were no significant differences between preferences and age and gender variables. There was no statistically significant difference regarding preference for the reintroduction of face-to-face appointments (52.0%) compared with video consultations (48.0%). Travel distance (>10 miles) to the clinical setting was important but did not outweigh benefits for those preferring a face-to-face appointment.
Conclusions
This study offers insights into the factors that influence preferences about what type of neuropsychiatric appointment is most suitable for people with intellectual disabilities.
The field of Galactic archaeology in the Milky Way (MW) has been significantly transformed by the advent of proper motions (PMs), but PM studies are still in their early stages in the M31 system. Measuring PMs in the M31 system poses a challenge for Gaia, limiting HST and JWST as the only reliable options. PM measurements of M31 satellites enable the estimation of M31’s total mass, examination of the dynamical stability of the Great Plane of Andromeda, and establishing connections to M31 substructures. We have successfully measured the PMs of NGC 147 and NGC 185 using multiepoch HST imaging data. Recently, we have obtained second-epoch HST imaging data for seven additional satellites through the HST program GO-16273. We present preliminary results from the PM measurements of these galaxies along with the implications. Finally, we discuss the future prospects of measuring PMs at the distance of M31.
Studies suggest that alcohol consumption and alcohol use disorders have distinct genetic backgrounds.
Methods
We examined whether polygenic risk scores (PRS) for consumption and problem subscales of the Alcohol Use Disorders Identification Test (AUDIT-C, AUDIT-P) in the UK Biobank (UKB; N = 121 630) correlate with alcohol outcomes in four independent samples: an ascertained cohort, the Collaborative Study on the Genetics of Alcoholism (COGA; N = 6850), and population-based cohorts: Avon Longitudinal Study of Parents and Children (ALSPAC; N = 5911), Generation Scotland (GS; N = 17 461), and an independent subset of UKB (N = 245 947). Regression models and survival analyses tested whether the PRS were associated with the alcohol-related outcomes.
Results
In COGA, AUDIT-P PRS was associated with alcohol dependence, AUD symptom count, maximum drinks (R2 = 0.47–0.68%, p = 2.0 × 10−8–1.0 × 10−10), and increased likelihood of onset of alcohol dependence (hazard ratio = 1.15, p = 4.7 × 10−8); AUDIT-C PRS was not an independent predictor of any phenotype. In ALSPAC, the AUDIT-C PRS was associated with alcohol dependence (R2 = 0.96%, p = 4.8 × 10−6). In GS, AUDIT-C PRS was a better predictor of weekly alcohol use (R2 = 0.27%, p = 5.5 × 10−11), while AUDIT-P PRS was more associated with problem drinking (R2 = 0.40%, p = 9.0 × 10−7). Lastly, AUDIT-P PRS was associated with ICD-based alcohol-related disorders in the UKB subset (R2 = 0.18%, p < 2.0 × 10−16).
Conclusions
AUDIT-P PRS was associated with a range of alcohol-related phenotypes across population-based and ascertained cohorts, while AUDIT-C PRS showed less utility in the ascertained cohort. We show that AUDIT-P is genetically correlated with both use and misuse and demonstrate the influence of ascertainment schemes on PRS analyses.
In the field of psychopathology there is still a lack of consensus on how mental disorders, such as depression, should be classified and explained. Many of our current classifications suffer from disorder heterogeneity and are conceptually vague. While some researchers have argued that mental disorders are better explained from a biological perspective, others have made the case for pluralistic and integrative explanations. Using depression as an extended example, we explore the challenges in classifying and explaining psychopathology. We begin by evaluating the current approaches to classification, including frameworks for what we consider a mental disorder. This is followed by a detailed summary of current explanatory perspectives in psychiatry. The relationship between classification and explanation presents unique theoretical challenges in understanding mental disorders. We suggest that by adjusting our focus from understanding syndromes to clinical phenomena we can advance our understanding of mental disorders.
Given an $\unicode[STIX]{x1D6FC}>1$ and a $\unicode[STIX]{x1D703}$ with unbounded continued fraction entries, we characterize new relations between Sturmian subshifts with slope $\unicode[STIX]{x1D703}$ with respect to (i) an $\unicode[STIX]{x1D6FC}$-Hölder regularity condition of a spectral metric, (ii) level sets defined in terms of the Diophantine properties of $\unicode[STIX]{x1D703}$, and (iii) complexity notions which we call $\unicode[STIX]{x1D6FC}$-repetitiveness, $\unicode[STIX]{x1D6FC}$-repulsiveness and $\unicode[STIX]{x1D6FC}$-finiteness—generalizations of the properties known as linear repetitiveness, repulsiveness and power freeness, respectively. We show that the level sets relate naturally to (exact) Jarník sets and prove that their Hausdorff dimension is $2/(\unicode[STIX]{x1D6FC}+1)$.
Clinical reasoning is one of the central components of psychological assessment. The identification of a client's psychological difficulties and the subsequent depiction of their onset, development, and interrelationships enables clinicians to plan treatment in a systematic and effective manner. In an article (Ward, Vertue, & Haig, 1999), we outlined the abductive theory of method (ATOM) and argued that it offered a useful framework for highlighting and integrating the major phases of psychological assessment. These phases involve detecting clinical phenomena, postulating psychological mechanisms, developing a case formulation, and evaluating a case formulation. In this article we present a revised version of the adaptation of ATOM and elaborate on the related clinical dimensions of assessment.
Necessary and sufficient conditions for the symbolic dynamics of a given Lorenz map to be fully embedded in the symbolic dynamics of a piecewise continuous interval map are given. As an application of this embedding result, we describe a new algorithm for calculating the topological entropy of a Lorenz map.
We show how multifractal properties of a measure supported by a fractal F⊆[0,1] may be expressed in terms of complementary intervals of F and thus in terms of spectral triples and the Dixmier trace of certain operators. For self-similar measures this leads to a non-commutative integral over F equivalent to integration with respect to an auxiliary multifractal measure.
This paper reviews current research on workplace violence in the USA and offers suggestions concerning the roles that mental health professionals with forensic expertise can play in this expanding field.
Aims
To clarify the role of the mental health professional in evaluating issues related to workplace violence.
Method
Manual and computer literature searches were performed.
Results
The incidence of reported workplace violence is on the rise and can be devastating beyond the immediate injury. Forensically oriented mental health professionals can assist companies by providing pre-employment screenings, fitness-for-duty evaluations and threat assessment by using the results of current research on potentially violent individuals.
Conclusions
With the growing interest in workplace violence come many opportunities for mental health professionals to assist companies in assessment, intervention and prevention.
Recommend this
Email your librarian or administrator to recommend adding this to your organisation's collection.