The stigma of pigmentary disorders

One of the major barriers to individuals with pigmentary disorders in achieving their life goals is the stigma of their disorder. This paper provides a review of the existing research regarding stigma reduction, focusing on public stigma, and looking at approaches used within the mental health and other stigmatized communities. A main focus of pigmentary disorder advocates is to eliminate this stigma to remove the barrier it has on success and self-efficacy. Approaching this task from a perspective well-informed by previous research is important to both ensure that stigma reduction resources are spent wisely, and that anti-stigma approaches are effective

Low-cost, thin-film, mass-manufacturable carbon electrodes for detection of the neurotransmitter dopamine

A flexible, thin-film carbon electrode is reported for detection of the key neurotransmitter dopamine using standard electroanalytical techniques of cyclic voltammetry, differential pulse voltammetry and square wave voltammetry. The thin-film electrode has been explored as a possible low-cost solution to detect low concentrations of dopamine and its performance has been compared with a commercially available screen printed carbon electrode. It was found that the thin-film electrode is more sensitive than the screen printed electrode, and can faithfully detect dopamine between 50 pM and 1 mM concentrations. The electrode provides a limit of detection of ~ 50 pM, displays good selectivity between dopamine and ascorbic acid, and is able to show a level of differentiation between the two compounds in terms of peak currents as well as oxidative potentials at physiologically relevant concentrations. This is in contrast to the screen printed electrode which is unable to discriminate between dopamine and ascorbic acid at the same concentrations. The key advantages of the presented electrode system are its low-cost, flexible substrate, and the ability to achieve very low levels of dopamine detection without requiring any electrode surface modification steps, a key factor in reducing fabrication costs and overall device complexity

Impact of process variables on the micromeritic and physicochemical properties of spray-dried microparticles, part II: physicochemical characterisation of spray-dried materials

YesObjectives  In this work we investigated the residual organic solvent content and physicochemical properties of spray-dried chlorothiazide sodium (CTZNa) and potassium (CTZK) salts. Methods  The powders were characterised by thermal, X-ray diffraction, infrared and dynamic vapour sorption (DVS) analyses. Solvent levels were investigated by Karl–Fischer titration and gas chromatography. Key findings  Spray-drying from water, methanol (MeOH) and mixes of MeOH and butyl acetate (BA) resulted in amorphous microparticles. The glass transition temperatures of CTZNa and CTZK were ∼192 and ∼159°C, respectively. These materials retained their amorphous nature when stored at 25°C in dry conditions for at least 6 months with no chemical decomposition observed. DVS determined the critical relative humidity of recrystallisation of CTZNa and CTZK to be 57% RH and 58% RH, respectively. The inlet temperature dependant oxidation of MeOH to formaldehyde was observed; the formaldehyde was seen to deposit within the amorphous matrix of spray-dried product. Spray-drying in the open blowing mode coupled with secondary drying resulted in a three-fold reduction in residual BA (below pharmacopoeial permitted daily exposure limit) compared to spray-drying in the closed mode. Conclusions  Experiments showed that recirculation of recovered drying gas increases the risk of deposition of residual solvents in the spray-dried product.The Irish Research Council for Science and Engineering Technology (IRCSET), the Solid State Pharmaceutical Cluster (SSPC), supported by Science Foundation Ireland under grant number (07/SRC/B1158) and the Irish Drug Delivery Research Network, a Strategic Research Cluster grant (07/SRC/B1154) under the National Development Plan co-funded by EU Structural Funds and Science Foundation Ireland

The generalised anxiety stigma scale (GASS): psychometric properties in a community sample

<p>Abstract</p> <p>Background</p> <p>Although there is substantial concern about negative attitudes to mental illness, little is known about the stigma associated with Generalised Anxiety Disorder (GAD) or its measurement. The aim of this study was to develop a multi-item measure of Generalised Anxiety Disorder stigma (the GASS).</p> <p>Methods</p> <p>Stigma items were developed from a thematic analysis of web-based text about the stigma associated with GAD. Six hundred and seventeen members of the public completed a survey comprising the resulting 20 stigma items and measures designed to evaluate construct validity. Follow-up data were collected for a subset of the participants (n = 212).</p> <p>Results</p> <p>The factor structure comprised two components: Personal Stigma (views about Generalised Anxiety Disorder); and Perceived Stigma (views about the beliefs of most others in the community). There was evidence of good construct validity and reliability for each of the Generalised Anxiety Stigma Scale (GASS) subscales.</p> <p>Conclusions</p> <p>The GASS is a promising brief measure of the stigma associated with Generalised Anxiety Disorder.</p

Systematic review of studies of mental health nurses' experience of anger and of its relationships with their attitudes and practice

IntroductionEmotional regulation is important in mental health nursing practice but individual emotions may require different regulation strategies. There is ample evidence that nurses experience anger specifically during their work, for example when experiencing patient aggression. It is, therefore, important to consolidate what is known about how anger manifests in mental health nursing practice.AimWe aimed to systematically identify, evaluate, and synthesise results from studies about mental health nurses and anger, where anger was measured objectively.MethodsSystematic literature review based on PRISMA guidelines.Results.We identified 12 studies. A range of validated and non-validated instruments were used. Mental health nurses may have lower levels of anger than normative samples but anger is commonly reported as an issue for them. Anger was studied in relation to its links with i) clinical management of patients, notably violence containment; and ii) employment issues more generally, notably job motivation. Anger is related to nurses’ attitudes about the acceptability of coercion but there is no evidence that it results in more coercion.Implications for practiceNurses should be aware of the potential influence of anger on their practice. Anger, specifically, should be considered when supporting mental health nurses, for example in clinical supervision. Emotional regulation training should target anger

Simplifying instanton corrections to N=4 SYM correlators

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Evidence-based practice, research utilization, and knowledge translation in chiropractic: a scoping review

Background: Evidence-based practice (EBP) gaps are widespread across health disciplines. Understanding factors supporting the uptake of evidence can inform the design of strategies to narrow these EBP gaps. Although research utilization (RU) and the factors associated with EBP have been reported in several health disciplines, to date this area has not been reviewed comprehensively in the chiropractic profession. The purpose of this review was to report on the current state of knowledge on EBP, RU, and knowledge translation (KT) in chiropractic. Methods: A scoping review using the Arksey and O'Malley framework was used to systematically select and summarize existing literature. Searches were conducted using a combination of keywords and MeSH terms from the earliest date available in each database to May 2015. Quantitative and thematic analyses of the selected literature were conducted. Results: Nearly 85 % (56/67) of the included studies were conducted in Canada, USA, UK or Australia. Thematic analysis for the three categories (EBP, RU, KT) revealed two themes related to EBP (attitudes and beliefs of chiropractors; implementation of EBP), three related to RU (guideline adherence; frequency and sources of information accessed; and perceived value of websites and search engines), and three related to KT (knowledge practice gaps; barriers and facilitators to knowledge use; and selection, tailoring, and implementation of interventions). EBP gaps were noted in the areas of assessment of activity limitation, determination of psychosocial factors influencing pain, general health indicators, establishing a prognosis, and exercise prescription. While most practitioners believed EBP and research to be important and a few studies suggested that traditional and online educational strategies could improve patient care, use of EBP and guideline adherence varied widely. Conclusion: Findings suggest that the majority of chiropractors hold favourable attitudes and beliefs toward EBP. However, much remains to be done for chiropractors to routinely apply evidence into clinical practice. Educational strategies aimed at practicing chiropractors can lead to more EBP and improved patient care. The chiropractic profession requires more robust dissemination and implementation research to improve guideline adherence and patient health outcomes

Exploring assessment of medical students\u27 competencies in pain medicine - A review

Introduction: Considering the continuing high prevalence and public health burden of pain, it is critical that medical students are equipped with competencies in the field of pain medicine. Robust assessment of student expertise is integral for effective implementation of competency-based medical education. Objective: The aim of this review was to describe the literature regarding methods for assessing pain medicine competencies in medical students. Method: PubMed, Medline, EMBASE, ERIC, and Google Scholar, and BEME data bases were searched for empirical studies primarily focusing on assessment of any domain of pain medicine competencies in medical students published between January 1997 and December 2016. Results: A total of 41 studies met the inclusion criteria. Most assessments were performed for low-stakes summative purposes and did not reflect contemporary theories of assessment. Assessments were predominantly undertaken using written tests or clinical simulation methods. The most common pain medicine education topics assessed were pain pharmacology and the management of cancer and low-back pain. Most studies focussed on assessment of cognitive levels of learning as opposed to more challenging domains of demonstrating skills and attitudes or developing and implementing pain management plans. Conclusion: This review highlights the need for more robust assessment tools that effectively measure the abilities of medical students to integrate pain-related competencies into clinical practice. A Pain Medicine Assessment Framework has been developed to encourage systematic planning of pain medicine assessment at medical schools internationally and to promote continuous multidimensional assessments in a variety of clinical contexts based on well-defined pain medicine competencies

Integrated predictive modelling of JET H-mode plasma with type-I ELMs

It is well known that edge plasma parameters influence performance in many different ways (profile stiffness is probably one of the best known examples). In ELMy H-mode a thin region with improved transport characteristics (Edge Transport Barrier) c

‘Opt-out’ referrals after identifying pregnant smokers using exhaled air carbon monoxide: impact on engagement with smoking cessation support

Background. In the UK, free smoking cessation support is available to pregnant women; only a minority access this. ‘Opt-out’ referrals to stop smoking services (SSS) are recommended by UK guidelines. These involve identifying pregnant smokers using exhaled carbon monoxide (CO) and referring them for support unless they object. Methods. To assess impact of ‘opt-out’ referrals for pregnant smokers on SSS uptake and effectiveness, we conducted a ‘before-after’ service development evaluation. In a six-month ‘before’ period there was a routine ‘opt-in’ referral system for self-reported smokers at antenatal ‘booking’ appointments. In a six-month ‘after’ period, additional ‘opt-out’ referrals were introduced at 12 weeks ultrasound appointments; women with CO≥4ppm were referred to, and outcome data were collected from, local SSS. Results. Approximately 2300 women attended antenatal care in each period. Before the implementation 536 (23.4%) women reported smoking at ‘booking’ and 290 (12.7%) were referred to SSS. After the implementation 524 (22.9%) women reported smoking at ‘booking’, an additional 156 smokers (6.8%) were identified via the ‘opt-out’ referrals and, in total, 421 (18.4%) were referred to SSS. Over twice as many women set a quit date with the SSS after ‘opt-out’ referrals were implemented (121 (5.3%, 95%CI: 4.4%-6.3%) compared to 57 (2.5%, 95%CI: 1.9%-3.2%) before implementation) and reported being abstinent four weeks later (93 (4.1%, 95%CI: 3.3%-4.9%) compared to 46 (2.0%, 1.5%-2.7%) before implementation). Conclusions. In a hospital with an ‘opt-in’ referral system, adding CO screening with ‘opt-out’ referrals as women attended ultrasound examinations doubled numbers of pregnant smokers setting quit dates and reporting smoking cessation