“It’s a matter of building bridges…” – feasibility of a carer involvement intervention for inpatients with severe mental illness

Background Family and friends (carer) involvement in the treatment of people with mental illness is widely recommended. However, the implementation remains poor, especially during hospital treatment, where carers report being excluded from care decisions. Methods We developed structured clinical procedures to maximise carer involvement in inpatient treatment. The aim of this study was to test their feasibility across four inpatient wards in East London and explore experiences of the participants. The intervention was delivered by clinicians (social therapists, nurses and psychiatrists) who were trained by the research team. Thirty patients and thirty carers received the intervention and completed research assessments and qualitative interviews after the intervention. 80% of the patients were followed up after six weeks of admission to complete quantitative questionnaires. Six clinicians were interviewed to explore their views on the intervention. Thematic analysis was used to analyse qualitative data. Results The intervention was found to be feasible to be delivered within the first week of admission in more than a half of the patients (53%) who provided consent. The main reasons why the interventions was not delivered in the remaining 47% of patients included staff or carers not being available, withdrawal of consent from the patient or patient being discharged prior to the intervention. Two themes were identified through thematic analysis. The first captured participant experiences of the intervention as facilitating a three-way collaborative approach to treatment. The second covered how patients’ mental states and practicalities of inpatient care acted as barriers and facilitators to the intervention being implemented. Conclusions Carer involvement in hospital treatment for mental illness is more difficult to implement than is commonly thought. This study has shown that a simple structured approach can facilitate a trialogue and that patients, clinicians and carers appreciate this approach to care. Our intervention provides clear and simple manualised clinical procedures that clinicians can follow. However, even the implementation of such procedures may be challenging in the absence of wider organisational support. The involvement of senior managers and clinical leaders might play a key role in overcoming barriers and support front-line clinicians to prioritise and implement carer involvement

Giving patients choices during involuntary admission : a new intervention

Background: People who receive involuntary treatment are some of the most vulnerable in psychiatric services. They are more likely to have poorer social and clinical outcomes and to be disillusioned with and disengaged from care. Research indicates that patients’ experience in the first week of involuntary treatment is a critical period: a better experience of care in the first week predicts better quality of life and reduced readmission 1 year later. Patients have identified involvement in clinical decisions as key to improving their experience of care. The aim of this study was to test the feasibility and acceptability of an intervention to facilitate involvement in decision making for involuntary inpatients called OPeNS (Options, Preferences, Negotiate, and Summarise). Methods: This was a mixed method study. The OPeNS intervention was developed based on previous research carried out by a multidisciplinary team. Clinicians were trained to deliver it to involuntary inpatients. Feasibility indices (rates of participation in the intervention and time required to deliver it) were collected. Patients (N = 14) and clinicians (N = 5) provided qualitative data on their experience of the intervention in semi-structured interviews which were analysed using thematic analysis. Results: The OPeNS intervention was found to be acceptable by both patients and clinicians and feasible to conduct within the first week of involuntary treatment. Patients’ and clinicians’ experiences of the intervention fall into two themes: ‘Enabling a different dynamic’ and ‘Clashing with usual practices and priorities’. Conclusion: The OPeNS intervention provides a structure that can be used by clinicians across disciplines to facilitate involving involuntary patients in decision making. Although challenges related to changing usual practices were identified, the intervention was received positively and was feasible to conduct in the first week of involuntary treatment

Application of cosmic microwave background techniques to a gravitational wave stochastic background

The detection of gravitational waves by the LIGO and Virgo collaborations has allowed us to view the universe in new way and given us direct measurements of black holes for the first time. In coming years we will be able to measure not only individual burst sources but also the stochastic background of gravitational waves permeating the universe. This will be a treasure trove of information about the universe, from which we will be able to learn about a vast range of areas including astrophysics (such as that of compact binaries), cosmology of cosmic strings and inflation and even the nuclear physics involved in neutron stars. This is particularly exciting because of what we have already been able to measure from the observations we have, such as putting constraints on the Hubble constant. It will, however, lead to new challenges, in particular how best to analyse the background. The purpose of this thesis is to use analogies to the cosmic microwave background angular power spectra in order to generate and compare two different formalisms for this analysis — one based upon the amplitude signals and one on the gravitational wave Stokes parameter. I will show their respective strengths and weaknesses in analysing the forthcoming data and, specifically, we will see that the Stokes parameters calculations are able convey information about anisotropic and correlated signals that the amplitudes cannot. I will also consider how well we will be able to measure a given background by studying the sensitivity of different detectors to these different formalisms, showing that a detector in motion has many advantages over one that is effectively stationary. Finally, I apply these techniques to showing that we can use multiple independent measurements to recover the angular power spectra for a given background.Open Acces

Cognitive Ability, Wages, and Meritocracy

This paper presents new evidence from the NLSY on the importance of meritocracy in American society. In it, we find that general intelligence, or g -- a measure of cognitive ability--is dominant in explaining test score variance. The weights assigned to tests by g are similar for all major demographic groups. These results support Spearman's theory of g. We also find that g and other measures of ability are not rewarded equally across race and gender, evidence against the view that the labor market is organized on meritocratic principles. Additional factors beyond g are required to explain wages and occupational choice. However, both blue collar and white collar wages are poorly predicted by g or even multiple measures of ability. Observed cognitive ability is only a minor predictor of social performance. White collar wages are more g loaded than blue collar wages. Many noncognitive factors determine blue collar wages.

Professional Judgment and Emergency Fund Programs: An Opportunity to Improve

In Spring 2020, during the onset of the COVID-19 pandemic, the number of students facing financial hardships increased as job losses mounted and schools closed their campuses. Schools, the federal government, and other organizations stepped in to help students deal with emergencies; but there are often hurdles to quickly getting emergency aid into the hands of students. While Title IV of the Higher Education Act provides a viable response mechanism through its emergency aid provisions, these provisions are underutilized. In this paper, we discuss ways in which schools can more effectively use professional judgment authority to quickly get emergency aid to students when they need it. We also discuss ways in which Congress can improve federal policy by removing needless restrictions

Comparison of rapid laboratory tests for failure of passive transfer in the bovine

peer-reviewedBackground Failure of passive transfer of maternal immunity via colostrum can occur in the bovine, and a number of blood tests have been developed to test calves for this failure. It is not clear which test is most suitable for this purpose. The objective was to examine the most commonly used tests for failure of passive transfer and to decide which is most suitable for routine laboratory use. 126 serum samples were taken from calves of dairy cows after birth but prior to colostrum feeding, and at 48 h of age. Five different tests were compared against radial immunodiffusion which is considered the appropriate reference method. These tests were serum gamma-glutamyltransferase levels, serum protein levels, serum globulin levels, an enzyme linked immunosorbent assay and the zinc sulphate turbidity test. Results The tests examined displayed high sensitivity but widely varying specificity. Examination of the use of different cut-off points allowed some improvement in specificity at the expense of sensitivity, but the tests which had performed best at the original cut-off points still displayed the best performance. Gamma-glutamyltransferase levels as a measure of colostrum absorption returned, in this study, the best balance between sensitivity and specificity. The ELISA used in this study and serum globulin levels displayed performance similar to the gamma-glutamyltransferase levels. Serum total protein was less successful than others examined at providing both sensitivity and specificity but may, when performed via refractometer, be useful for on-farm testing. As currently performed the poor sensitivity for which the zinc sulphate turbidity test is most often criticized is evident. Modification of the cut-off point to increase specificity is less successful at balancing these parameters than the ELISA, gamma-glutamyltransferase levels, and globulin levels. Conclusions Gamma-glutamyltransferase levels, ELISA testing and circulating globulin levels performed best in detecting failure of passive transfer in serum samples, although all three had some practical considerations

Medicalising the moral: the case of depression as revealed in internet blogs

Depression is regularly declared to be equivalent to a bodily illness, yet critics have long contested this ‘medical’ view of mental disorders. Following the ideas of Szasz and Foucault, we describe an alternative ‘moral’ view of depression, which emphasises the agency of the individual and presents depression as a potentially problematic but meaningful response that can be regarded as an aspect of character. We use popular internet blogs by people with depression to explore these contrasting conceptions, which can also be found in other research and information on depression. In blogs, the medical view is used to challenge what bloggers perceive as a persistently influential moral view, by deflecting criticism and responsibility and disowning unwanted aspects of the self. At the same time, bloggers make positive use of the moral concept of depression when discussing recovery. The moral view enables people to take active steps to address their difficulties and to integrate the experience of depression into their understanding of themselves in a challenging yet rewarding process of personal development. We suggest that the moral view of depression represents an enduring aspect of our understanding of ourselves, which the medical view has been superimposed onto, but has not managed to suppress