92 research outputs found
The effects of COVID-19 on self-harm in a high-secure psychiatry hospital
Purpose Self-harm, including death from suicide, remains a significant public health challenge. The prison population is known to be a high-risk group for self-harm and suicide. The purpose of this study is to explore the trends in the frequency of self-harm over the course of the COVID-19 pandemic within a high-secure hospital. The authors hypothesised that the pandemic could adversely affect the mental health of patients, which could increase the rates of self-harm. Reasons for changes in the frequency of self-harm and the strategies used in response to the pandemic were also investigated. Design/methodology/approach This paper encompasses findings from a quality improvement project that investigated self-harming behaviours from February 2020 to February 2021 in a high-secure psychiatric hospital. Incidents of self-harm were recorded based on the hospitalâs ward structure. Data was collected on the incidence of self-harm rates over the COVID-19 pandemic, with a focus on how the pandemic may have had an effect on self-harm. Findings This paper found an increase in the incidents of self-harm during the initial stages of the pandemic. The first national lockdown period yielded a rise in self-harm incidents from pre-COVID levels. The frequency of self-harm reduced following the first lockdown and returned to pre-COVID levels. The authors explored the psychological effects of COVID, isolation, interpersonal dynamics and changes in the delivery of care as reasons for these trends. Practical implications This study demonstrates the substantial challenges of the COVID-19 pandemic to secure psychiatric services. Having an awareness of how the pandemic can impact on self-harm is important, as it allows the correct balance of restriction of our patientsâ liberty to a degree deemed necessary to control the pandemic and the delivery of effective patient care. The key clinical implications include the importance of direct face-to-face patient contact, effective communication, therapeutic interventions and activities, the psychological impact of quarantine and the influence the pandemic can have on an individualâs function of self-harm. Originality/value This paper is the first, to the authorsâ knowledge, to explore the impact of COVID-19 in a high-security psychiatric hospital. The authors also explore possible explanations for the changes in the trends of self-harm and include the consideration of strategies for improving the prevention and management of self-harm in high-secure settings during a pandemic. </jats:sec
Patients embodied and as-a-body within bedside teaching encounters: A video ethnographic study
Open Access articleBedside teaching encounters (BTEs) involve doctorâpatientâstudent interactions, providing opportunities for students to learn with, from and about patients. How the differing concerns of patient care and student education are balanced in situ remains largely unknown and undefined. This video ethnographic study explores patient involvement during a largely student-centric activity: âfeedback sequencesâ where students learn clinical and practical skills. Drawing on a data subset from a multi-site study, we used Conversation Analysis to investigate verbal and non-verbal interactional practices to examine patientsâ inclusion and exclusion from teaching activities across 25 BTEs in General Practice and General Surgery and Medicine with 50 participants. Through analysis, we identified two representations of the patient: the patient embodied (where patients are actively involved) and the patient as-a-body (when they are used primarily as a prop for learning). Overall, patients were excluded more during physical examination than talk-based activities. Exclusion occurred through physical positioning of doctorâpatientâstudent, and through doctors and students talking about, rather than to, patients using medical jargon and online commentaries. Patientsâ exclusion was visibly noticeable through eye gaze: patientsâ middle-distance gaze coincided with medical terminology or complex wording. Inclusory activities maintained the patient embodied during teaching activities through doctorsâ skilful embedding of teaching within their care: including vocalising clinical reasoning processes through students, providing patients with a âwarrant to listenâ, allocating turns-at-talk for them and eye-contact. This study uniquely demonstrates the visible nature patient exclusion, providing firm evidence of how this affects patient empowerment and engagement within educational activities for tomorrowâs doctors
Chapter 5: Food Security
The current food system (production, transport, processing, packaging, storage, retail, consumption, loss and waste) feeds the great majority of world population and supports the livelihoods of over 1 billion people. Since 1961, food supply per capita has increased more than 30%, accompanied by greater use of nitrogen fertilisers (increase of about 800%) and water resources for irrigation (increase of more than 100%). However, an estimated 821 million people are currently undernourished, 151 million children under five are stunted, 613 million women and girls aged 15 to 49 suffer from iron deficiency, and 2 billion adults are overweight or obese. The food system is under pressure from non-climate stressors (e.g., population and income growth, demand for animal-sourced products), and from climate change. These climate and non-climate stresses are impacting the four pillars of food security (availability, access, utilisation, and stability)
Climatic risks and impacts in South Asia: extremes of water scarcity and excess
This paper reviews the current knowledge of climatic risks and impacts in South Asia associated with anthropogenic warming levels of 1.5°C to 4°C above pre-industrial values in the 21st century. It is based on the World Bank Report âTurn Down the Heat, Climate Extremes, Regional Impacts and the Case for Resilienceâ (2013). Many of the climate change impacts in the region, which appear quite severe even with relatively modest warming of 1.5â2°C, pose significant hazards to development. For example, increased monsoon variability and loss or glacial meltwater will likely confront populations with ongoing and multiple challenges. The result is a significant risk to stable and reliable water resources for the region, with increases in peak flows potentially causing floods and dry season flow reductions threatening agriculture. Irrespective of the anticipated economic development and growth, climate projections indicate that large parts of South Asiaâs growing population and especially the poor are likely to remain highly vulnerable to climate change
Sea-level rise impacts on transport infrastructure: the notorious case of the coastal railway line at Dawlish, England
Future climate change is likely to increase the frequency of coastal storms and floods, with major consequences for coastal transport infrastructure. This paper assesses the extent to which projected sea-level rise is likely to impact upon the functioning of the Dawlish to Teignmouth stretch of the London to Penzance railway line, in England. Using a semi-empirical modelling approach, we identify a relationship between sea-level change and rail incidents over the last 150 years and then use model-based sea-level predictions to extrapolate this relationship into the future. We find that days with line restrictions (DLRs) look set to increase by up to 1170%, to as many as 84â120 per year, by 2100 in a high sea-level rise scenario (0.55â0.81 m). Increased costs to the railway industry deriving from maintenance and line restrictions will be small (ÂŁ millions) in comparison with damage caused by individual extreme events (ÂŁ10s of millions), while the costs of diversion of the railway are higher still (ÂŁ100s of millions to billions). Socio-economic costs to the region are likely to be significant although they are more difficult to estimate accurately. Finally, we explain how our methodology is applicable to vulnerable coastal transport infrastructure worldwide
The Atacama Cosmology Telescope: A Measurement of the DR6 CMB Lensing Power Spectrum and its Implications for Structure Growth
We present new measurements of cosmic microwave background (CMB) lensing over
sq. deg. of the sky. These lensing measurements are derived from the
Atacama Cosmology Telescope (ACT) Data Release 6 (DR6) CMB dataset, which
consists of five seasons of ACT CMB temperature and polarization observations.
We determine the amplitude of the CMB lensing power spectrum at
precision ( significance) using a novel pipeline that minimizes
sensitivity to foregrounds and to noise properties. To ensure our results are
robust, we analyze an extensive set of null tests, consistency tests, and
systematic error estimates and employ a blinded analysis framework. The
baseline spectrum is well fit by a lensing amplitude of
relative to the Planck 2018 CMB power spectra
best-fit CDM model and relative to
the best-fit model. From our lensing power
spectrum measurement, we derive constraints on the parameter combination
of
from ACT DR6 CMB lensing alone and
when combining ACT DR6 and Planck NPIPE
CMB lensing power spectra. These results are in excellent agreement with
CDM model constraints from Planck or
CMB power spectrum measurements. Our lensing measurements from redshifts
-- are thus fully consistent with CDM structure growth
predictions based on CMB anisotropies probing primarily . We find no
evidence for a suppression of the amplitude of cosmic structure at low
redshiftsComment: 45+21 pages, 50 figures. Prepared for submission to ApJ. Also see
companion papers Madhavacheril et al and MacCrann et a
The Atacama Cosmology Telescope: DR6 Gravitational Lensing Map and Cosmological Parameters
We present cosmological constraints from a gravitational lensing mass map
covering 9400 sq. deg. reconstructed from CMB measurements made by the Atacama
Cosmology Telescope (ACT) from 2017 to 2021. In combination with BAO
measurements (from SDSS and 6dF), we obtain the amplitude of matter
fluctuations at 1.8% precision,
and the Hubble
constant at
1.6% precision. A joint constraint with CMB lensing measured by the Planck
satellite yields even more precise values: ,
and . These measurements agree
well with CDM-model extrapolations from the CMB anisotropies measured
by Planck. To compare these constraints to those from the KiDS, DES, and HSC
galaxy surveys, we revisit those data sets with a uniform set of assumptions,
and find from all three surveys are lower than that from ACT+Planck
lensing by varying levels ranging from 1.7-2.1. These results motivate
further measurements and comparison, not just between the CMB anisotropies and
galaxy lensing, but also between CMB lensing probing on
mostly-linear scales and galaxy lensing at on smaller scales. We
combine our CMB lensing measurements with CMB anisotropies to constrain
extensions of CDM, limiting the sum of the neutrino masses to eV (95% c.l.), for example. Our results provide independent
confirmation that the universe is spatially flat, conforms with general
relativity, and is described remarkably well by the CDM model, while
paving a promising path for neutrino physics with gravitational lensing from
upcoming ground-based CMB surveys.Comment: 30 pages, 16 figures, prepared for submission to ApJ. Cosmological
likelihood data is here:
https://lambda.gsfc.nasa.gov/product/act/actadv_prod_table.html ; likelihood
software is here: https://github.com/ACTCollaboration/act_dr6_lenslike . Also
see companion papers Qu et al and MacCrann et al. Mass maps will be released
when papers are publishe
Drivers for global agricultural land use change: The nexus of diet, population, yield and bioenergy
The nexus of population growth and changing diets has increased the demands placed on agriculture to supply food for human consumption, animal feed and fuel. Rising incomes lead to dietary changes, from staple crops, towards commodities with greater land requirements, e.g. meat and dairy products. Despite yield improvements partially offsetting increases in demand, agricultural land has still been expanding, causing potential harm to ecosystems, e.g. through deforestation. We use country-level panel data (1961-2011) to allocate the land areas used to produce food for human consumption, waste and biofuels, and to attribute the food production area changes to diet, population and yields drivers. The results show that the production of animal products dominates agricultural land use and land use change over the 50-year period, accounting for 65% of land use change. The rate of extensification of animal production was found to have reduced more recently, principally due to the smaller effect of population growth. The area used for bioenergy was shown to be relatively small, but formed a substantial contribution (36%) to net agricultural expansion in the most recent period. Nevertheless, in comparison to dietary shifts in animal products, bioenergy accounted for less than a tenth of the increase in demand for agricultural land. Population expansion has been the largest driver for agricultural land use change, but dietary changes are a significant and growing driver. China was a notable exception, where dietary transitions dominate food consumption changes, due to rapidly rising incomes. This suggests that future dietary changes will become the principal driver for land use change, pointing to the potential need for demand-side measures to regulate agricultural expansion. (C) 2015 Elsevier Ltd. All rights reserved
CMB-S4: Forecasting Constraints on Primordial Gravitational Waves
CMB-S4---the next-generation ground-based cosmic microwave background (CMB)
experiment---is set to significantly advance the sensitivity of CMB
measurements and enhance our understanding of the origin and evolution of the
Universe, from the highest energies at the dawn of time through the growth of
structure to the present day. Among the science cases pursued with CMB-S4, the
quest for detecting primordial gravitational waves is a central driver of the
experimental design. This work details the development of a forecasting
framework that includes a power-spectrum-based semi-analytic projection tool,
targeted explicitly towards optimizing constraints on the tensor-to-scalar
ratio, , in the presence of Galactic foregrounds and gravitational lensing
of the CMB. This framework is unique in its direct use of information from the
achieved performance of current Stage 2--3 CMB experiments to robustly forecast
the science reach of upcoming CMB-polarization endeavors. The methodology
allows for rapid iteration over experimental configurations and offers a
flexible way to optimize the design of future experiments given a desired
scientific goal. To form a closed-loop process, we couple this semi-analytic
tool with map-based validation studies, which allow for the injection of
additional complexity and verification of our forecasts with several
independent analysis methods. We document multiple rounds of forecasts for
CMB-S4 using this process and the resulting establishment of the current
reference design of the primordial gravitational-wave component of the Stage-4
experiment, optimized to achieve our science goals of detecting primordial
gravitational waves for at greater than , or, in the
absence of a detection, of reaching an upper limit of at CL.Comment: 24 pages, 8 figures, 9 tables, submitted to ApJ. arXiv admin note:
text overlap with arXiv:1907.0447
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