Factors relating to boundaries and self-disclosure within mental health contexts

Section A: Presents a systematic literature review synthesising and critiquing the evidence-base surrounding the use, and impact of therapist self-disclosure in cross-cultural therapy contexts with clients from ethnic minority groups. The review found that as well as mirroring the use and impact of therapist self-disclosure in more generalised therapy contexts, therapist self-disclosure was used to invite conversations about therapists’ and clients’ cultural or ethnic differences and identities. This included therapists using self-disclosure to validate clients’ experiences of racism or oppression and assert their commitment to an anti-racist stance. Risks to therapist self-disclosure within cross-cultural contexts are discussed, and findings and clinical implications are considered in the context of developing therapist cultural competency. The review found that studies had some methodological limitations (such as relying predominantly on self-report methods), and future research should further explore self-disclosure as the mechanism of change, and other possible therapist and client intersecting, or mediating factors. Section B: Presents a grounded theory study exploring how case-managers in Early Intervention in Psychosis Services (EIPS) develop their understanding and practice around navigating boundaries. EIPS are a unique service model, in which an assertive outreach approach is adopted. Case-managers employ flexible boundaries to meet clients in the community and support them towards recovery and holistic goals. Current boundary theory is therefore not easily applied to this clinical context. Participants were 13 EIPS case-managers. Semi-structured interviews with participants were analysed using grounded theory. A concentric model emerged, defining different layers of influence impacting case-managers navigation of boundaries. The model also depicted how case-managers navigated boundaries with clients over time. This model adds to current boundary theory outside of therapy contexts, and can be used as a tool in clinical practice to guide clinicians’ thinking and reflection around boundaries within EIPS. Other relevant clinical and research implications are discussed

Nonpathogenic Free-Living Amoebae in Arkansas Recreational Waters

Selected recreational waters of Arkansas were sampled for pathogenic free-living limax amoebae. Water quality parameters were determined for correlation with amoebic population densities and species diversity. Cultural criteria and animal inoculation revealed no pathogenic strains. The possibility of introduction and/or induction of pathogenic amoebic strains by environmental factors requires further ecological investigations

An investigation into the routes to inpatient care at the Pantang Hospital in Ghana via the criminal justice system

Objectives: To develop knowledge of routes by which patients are admitted to Pantang hospital via the courts or police and to explore the factors that prevent discharge, rehabilitation or transfer to prison of these patients.Setting: Pantang Psychiatric Hospital, Accra, Ghana, West AfricaDesign: A cross-sectional exploratory qualitative study.Participants: Adult patients with a psychiatric diagnosis who had been admitted to hospital following involvement with the criminal justice system and their families; and stakeholders (participants who had experience working with mentally disordered offenders).Methods: A descriptive and ethnographic survey of patients plus interviews with key stakeholders in mental health and criminal justice. Data were analysed using hybrid thematic analysis.Results: Patients arrived at Pantang Psychiatric Hospital following referral by the arresting police authorities, through court referral, or directly from prisons. All participants reported lack of understanding of the mental health and criminal justice systems, and interface between the two. Most patients and family members reported they feared the stigmaof mental illness and patients’ criminal charges would interrupt the patients’ successful reintegration into the community.Conclusion: This study revealed that forensic mental health patients in the Pantang Hospital entered through one of three ways; direct entry through the community-based policing system; on order through the court system; and referrals directly from the prison system. Inadequate staffing and other resources resulted in delays in completing thenecessary psychiatric assessments.Keywords: Inpatient psychiatric care, forensic mental health, stigma, Ghana, psychiatryFunding: The study was funded locally and by a grant received from the Faculty of Forensic Psychiatry, Royal College of Psychiatrists in the UK

Management of work-relevant upper limb disorders: a review

Background Upper limb disorders (ULDs) are clinically challenging and responsible for considerable work loss. There is a need to determine effective approaches for their management. Aim To determine evidence-based management strategies for work-relevant ULDs and explore whether a biopsychosocial approach is appropriate. Methods Literature review using a best evidence synthesis. Data from articles identified through systematic searching of electronic databases and citation tracking were extracted into evidence tables. The information was synthesized into high-level evidence statements, which were ordered into themes covering classification/diagnosis, epidemiology, associations/risks and management/treatment, focusing on return to work or work retention and taking account of distinctions between non-specific complaints and specific diagnoses. Results Neither biomedical treatment nor ergonomic workplace interventions alone offer an optimal solution; rather, multimodal interventions show considerable promise, particularly for occupational outcomes. Early return to work, or work retention, is an important goal for most cases and may be facilitated, where necessary, by transitional work arrangements. The emergent evidence indicates that successful management strategies require all the players to be onside and acting in a coordinated fashion; this requires engaging employers and workers to participate. Conclusions The biopsychosocial model applies: biological considerations should not be ignored, but psychosocial factors are more influential for occupational outcomes. Implementation of interventions that address the full range of psychosocial issues will require a cultural shift in the way the relationship between upper limb complaints and work is conceived and handled. Dissemination of evidence-based messages can contribute to the needed cultural shift

Pathogenic Free-Living Amoebae in Arkansas Recreational Waters

Selected recreational waters of Arkansas were sampled for pathogenic free-living limax amoebae. Water quality parameters were determined for correlation with amoebic population densities and species diversity. Cultural criteria and animal inoculation revealed no pathogenic strains. The feasibility of introduction and/or induction of pathogenic amoebic strains by environmental factors necessitates further ecological investigaitons

Farm Management in Australia: The Way Forward

This paper summarises the outcomes of a National Workshop in Farm Management, 5-6 December 2002, organised by the University of Sydney, Faculty of Rural Management, Orange. At this Workshop leading farmers, industry leaders, corporate representatives, academics, researchers and extension officers explored the future of farm management (education, research and consultancy) in Australia. Major outcomes were that farm management practice is proceeding informally to undertake decisions supporting socially and ecologically friendly, sustainable commercial production agriculture. However the risks of lack of integration, a reductionist approach to only on-farm practice, stagnation of academic programs to respond to leading edge industry initiatives, as well as ill-defined boundaries for farm management research were identified. The analysis indicated that formal educational models, research and extension-consultancy frameworks of an holistic nature, and a multiple bottom line perspective, were appropriate avenues for the future development of farm management practice and research. Workshop participants perceived that a farm management strand emphasising business management rather than technology could be a better educational model. Also there was an emphasis in highlighting the importance of linked development and partnership amongst the different players. The Workshop created the conditions for development of networks among industry, education and consultative research.Farm Management,

Reduction of Uranium by Bacterial Products

The Old Rifle Mill Processing site at Rifle, CO, contains uranium contaminated groundwater. The presence of uranium is one of the major problems at Department of Energy legacy sites. There is an initiative for attenuation of uranium by the Department of Energy. Uranium undergoes oxidation/reduction reactions with the substances at the site. Uranium’s oxidation state determines its solubility and mobility in the aquifer. The oxidation reduction pathways at this site have mineralogical, microbial and geochemical components. Understanding the oxidation/reduction pathways of these components will allow for better predictions of the changes and movement of uranium. Sulfide [S2- ] and Ferrous [Fe2] ions are products of microbial activity. These ions can reduce uranium [U(VI)], but bicarbonate ions [HCO3-] in the aquifers slows down the reaction. However, we believe that organic matter in the environment enhances U(VI) reduction by Fe2+and S2- in the absence of microbes. To address this, U(VI) was mixed with Fe2+ or S2- in autoclaved biomass from Rifle and artificial groundwater for seven to eleven days. Aqueous samples from the vials will be analyzed for Uranium presence using ICP-MS [Inductively Coupled Plasma- Mass Spectrometry]. The biomass from each of the samples will be analyzed using XAS [X-Ray Absorption Spectroscopy] to determine the ionization state of Uranium. Based on the data, we can conclude that there is a significant decrease of the concentration of uranium from the reaction when the biomass was not sterilized. There were no differences within in the vials that had Fe2+ or S2-. The XAS data shows a mixture of U(IV) and U(VI) in the biomasss and more U(IV) in the biomass that was not sterilized. This suggests that the bacterial products alone is not completely responsible for the reduction of uranium

All that fractures is not bone: microscopic anatomy of vertebral bodies.

Abstract for poster P25 presented at Bone Research Society, Winchester 28/6/2018 All that fractures is not bone: microscopic anatomy of vertebral bodies. Alan Boyde and David Mills, Dental Physical Sciences, QMUL, London E1 4NS Objectives: To understand interface between cortical shell and cancellous bone in human vertebral bodies, age changes, and probable mechanical significance. Archival material, 3-4 mm mid-body vertical slices, 80 L2 embedded PMMA: blocks polished, carbon coated, 20 kV qBSE SEM; high contrast resolution x-ray microtomography (XMT: 44 hour scans); iodine vapour staining and further BSE SEM, uncoated. Some 10µm laser ablation machined sections from block surfaces for polarised light microscopy (PLM). 50 L4 macerated for 3D BSE SEM. Mineral concentration: cortex contains lamellar bone and more highly mineralised tissues: ligament, dense fibrous periosteum, or Sharpey fibre bone. 2D SEM with iodine staining, PLM: uncalcified osteoid, ligament, fibrous periosteum, and Sharpey fibres can be distinguished. 3D SEM: inimitable branching bundle morphology of bone collagen lamellae was displayed on all (re)modelled surfaces of trabeculae and endocortex, modified where penetrated by any Sharpey fibres at ectocortex. However, the greatest part of the most exterior cortex is composed of strictly parallel ─ non-branching ─ collagen, either mostly longitudinal ─ ligament ─ or decussating layers of dense fibrous periosteum. Ligament tissue becomes incorporated in the bone organ by calcification extending into it from the mineralising front of bone tissue proper. Owing to endocortical resorbtion, sections of the entire shell thickness can be composed of non-bone. Calcified tissues in vertebral cortical shells include matrices which are, emphatically, not bone: they have a different structure, their collagen is not made by osteoblasts, and generally reach a higher level of mineralisation than bone: they will be assessed as ‘thicker bone’ with CT. Further, these phases cannot be recognised from bone by clinical imaging, and it is highly improbable that they will be distinguished using decalcification and staining LM histology. If lamellar structure is ideal, then the anterior cortex in particular is not. The proportion of calcified ligament tissue masquerading as bone dramatically increases in anterior collapse, often in hand with thickening of this cortex. It remains to be elucidated whether failure is favoured by this less auspicious and perhaps more fragile structure. A vicious circle