Cues and knowledge structures used by mental-health professionals when making risk assessments

Background: Research into mental-health risks has tended to focus on epidemiological approaches and to consider pieces of evidence in isolation. Less is known about the particular factors and their patterns of occurrence that influence clinicians’ risk judgements in practice. Aims: To identify the cues used by clinicians to make risk judgements and to explore how these combine within clinicians’ psychological representations of suicide, self-harm, self-neglect, and harm to others. Method: Content analysis was applied to semi-structured interviews conducted with 46 practitioners from various mental-health disciplines, using mind maps to represent the hierarchical relationships of data and concepts. Results: Strong consensus between experts meant their knowledge could be integrated into a single hierarchical structure for each risk. This revealed contrasting emphases between data and concepts underpinning risks, including: reflection and forethought for suicide; motivation for self-harm; situation and context for harm to others; and current presentation for self-neglect. Conclusions: Analysis of experts’ risk-assessment knowledge identified influential cues and their relationships to risks. It can inform development of valid risk-screening decision support systems that combine actuarial evidence with clinical expertise

Bystanders, parcelling, and an absence of trust in the grooming interactions of wild male chimpanzees

The evolution of cooperation remains a central issue in socio-biology with the fundamental problem of how individuals minimize the risks of being short-changed (‘cheated’) should their behavioural investment in another not be returned. Economic decisions that individuals make during interactions may depend upon the presence of potential partners nearby, which o ers co operators a temptation to defect from the current partner. The parcelling model posits that donors subdivide services into parcels to force cooperation, and that this is contingent on opportunities for defection; that is, the presence of bystanders. Here we test this model and the e ect of bystander presence using grooming interactions of wild chimpanzees. We found that with more bystanders, initiators gave less grooming at the beginning of the bout and were more likely to abandon a grooming bout, while bouts were less likely to be reciprocated. We also found that the groomer’s initial investment was not higher among frequent groomers or stronger reciprocators, suggesting that contrary to current assumptions, grooming decisions are not based on trust, or bonds, within dyads. Our work highlights the importance of considering immediate social context and the in uence of bystanders for understanding the evolution of the behavioural strategies that produce cooperation

A feasibility study of psychological strengths and well-being assessment in individuals living with recurrent depression

Current conceptualizations of mental illness focus on assessing psychopathology. A balanced approach would assess strengths that individuals bring to coping with illness. This study measures psychological strengths in individuals with recurrent depression, their coping strategies, and their perceptions of the usefulness of strengths assessment as a component of psychological assessment. Individuals (N = 112) with recurrent depression completed an online questionnaire measuring several psychological strengths, including gratitude, forgiveness, spirituality, and hope. Participants also described their use of coping strategies and their reaction to the utility of the two-continua model of mental health. A subset (n = 10) completed a follow-up telephone interview. Higher levels of gratitude, self-forgiveness, hope, and spirituality and lower levels of optimism were indicative of higher life satisfaction. Self-forgiveness, spirituality, and gratitude were predictors of happiness. Higher levels of hope and self-forgiveness predicted positive affect whereas lower levels of self-forgiveness predicted negative affect. Participants reported using a range of coping resources and indicated that they valued strengths assessment, perceiving the two-continua model of mental health as empowering. The researcher discusses implications for clinical practice

How uncertainty affects career behaviour : a narrative approach

Despite increased uncertainty in the environment, the role of uncertainty in people’s careers is poorly understood. Those few theories that account for uncertainty portray it as a negative influence on people’s career and should therefore be reduced or avoided. This article presents an empirical study that investigated the impact of uncertainty on people’s career behaviour using a narrative approach. The findings reveal that people have different understandings of career uncertainty, which leads to distinct differences in subsequent career behaviour. Specifically, we identified four qualitatively different meanings of career uncertainty we have called Stabiliser, Glider, Energiser and Adventurer. The findings add to the existing literature by showing how each meaning of career uncertainty affects career decision making, criteria to gauge career success and meaning, and negotiating transitions. This significantly broadens current conceptualisation of career uncertainty and its impact on career behaviour than existing literature

Layering in structural-functional grammars

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Role and Discipline Relationships in a Transdisciplinary Biomedical Team: Structuration, Values Override and Context Scaffolding

Though accepted that "team science" is needed to tackle and conquer the health problems that are plaguing our society significant empirical evidence of team mechanisms and functional dynamics is still lacking in abundance. Through grounded methods the relationship between scientific disciplines and team roles was observed in a United States National Institutes of Health-funded (NIH) research consortium. Interviews and the Organizational Culture Assessment Instrument (OCAI) were employed.. Findings show strong role and discipline idiosyncrasies that when viewed separately provide different insights into team functioning and change receptivity. When considered simultaneously, value-latent characteristics emerged showing self-perceived contributions to the team. This micro/meso analysis suggests that individual participation in team level interactions can inform the structuration of roles and disciplines in an attempt to tackle macro level problems.Comment: Presented at COINs13 Conference, Chile, 2013 (arxiv:1308.1028

Islands of linkage in an ocean of pervasive recombination reveals two-speed evolution of human cytomegalovirus genomes

Human cytomegalovirus (HCMV) infects most of the population worldwide, persisting throughout the host's life in a latent state with periodic episodes of reactivation. While typically asymptomatic, HCMV can cause fatal disease among congenitally infected infants and immunocompromised patients. These clinical issues are compounded by the emergence of antiviral resistance and the absence of an effective vaccine, the development of which is likely complicated by the numerous immune evasins encoded by HCMV to counter the host's adaptive immune responses, a feature that facilitates frequent super-infections. Understanding the evolutionary dynamics of HCMV is essential for the development of effective new drugs and vaccines. By comparing viral genomes from uncultivated or low-passaged clinical samples of diverse origins, we observe evidence of frequent homologous recombination events, both recent and ancient, and no structure of HCMV genetic diversity at the whole-genome scale. Analysis of individual gene-scale loci reveals a striking dichotomy: while most of the genome is highly conserved, recombines essentially freely and has evolved under purifying selection, 21 genes display extreme diversity, structured into distinct genotypes that do not recombine with each other. Most of these hyper-variable genes encode glycoproteins involved in cell entry or escape of host immunity. Evidence that half of them have diverged through episodes of intense positive selection suggests that rapid evolution of hyper-variable loci is likely driven by interactions with host immunity. It appears that this process is enabled by recombination unlinking hyper-variable loci from strongly constrained neighboring sites. It is conceivable that viral mechanisms facilitating super-infection have evolved to promote recombination between diverged genotypes, allowing the virus to continuously diversify at key loci to escape immune detection, while maintaining a genome optimally adapted to its asymptomatic infectious lifecycle

Institutionalization and Structuration: Studying the Links between Action and Institution

Institutional theory and structuration theory both contend that institutions and actions are inextricably linked and that institutionalization is best understood as a dynamic, ongoing process. Institutionalists, however, have pursued an empirical agenda that has largely ignored how institutions are created, altered, and reproduced, in part, because their models of institutionalization as a process are underdeveloped. Structuration theory, on the other hand, largely remains a process theory of such abstraction that it has generated few empirical studies. This paper discusses the similarities between the two theories, develops an argument for why a fusion of the two would enable institutional theory to significantly advance, develops a model of institutionalization as a structuration process, and proposes methodological guidelines for investigating the process empirically

Guidelines for the presentation and visualisation of lifelog content

Lifelogs offer rich voluminous sources of personal and social data for which visualisation is ideally suited to providing access, overview, and navigation. We explore through examples of our visualisation work within the domain of lifelogging the major axes on which lifelogs operate, and therefore, on which their visualisations should be contingent. We also explore the concept of ‘events’ as a way to significantly reduce the complexity of the lifelog for presentation and make it more human-oriented. Finally we present some guidelines and goals which should be considered when designing presentation modes for lifelog conten

Recent advances in understanding and managing diverticulitis.

In the past few decades, the increasing socioeconomic burden of acute diverticulitis (AD) has become evident, and with the growth of the population age, this significant economic impact will likely continue to rise. Furthermore, recent evidence showed an increased rate of hospital admissions especially evident among women and younger individuals. The natural history and pathophysiology of this clinical condition is still to be fully defined, and efforts continue to be made in the identification of risk factors and the establishment of relative preventive strategies. The actual therapeutic strategies aimed to modulate gut microbiota, such as rifaximin or probiotics, or to reduce mucosal inflammation, such as mesalazine, present a relatively poor efficacy for both the prevention of the first AD episode (primary prevention) and its recurrence (secondary prevention). In the last few years, the main goal achieved has been in the management of AD in that uncomplicated AD can, to a larger extent, be managed in an outpatient setting with no or little supportive therapy, a strategy that will certainly impact on the health costs of this disease. The problem of AD recurrence remains a topic of debate. The aim of this review is to present updated evidence on AD epidemiology and relative open clinical questions and to analyze in detail predisposing and protective factors with an attempt to integrate their possible modes of action into the several pathogenic mechanisms that have been suggested to contribute to this multifactorial disease. A unifying hypothesis dealing with the colonic luminal and extra-luminal microenvironments separately is provided. Finally, evidence-based changes in therapeutic management will be summarized. Because of an ascertained multifactorial pathogenesis of uncomplicated and complicated AD, it is probable that a single ‘causa prima’ will not be identifiable, and a better stratification of patients could allow one to pursue tailored therapeutic algorithm strategies