Which doctors and with what problems contact a specialist service for doctors? A cross sectional investigation

Background: In the United Kingdom, specialist treatment and intervention services for doctors are underdeveloped. The MedNet programme, created in 1997 and funded by the London Deanery, aims to fill this gap by providing a self-referral, face-to-face, psychotherapeutic assessment service for doctors in London and South-East England. MedNet was designed to be a low-threshold service, targeting doctors without formal psychiatric problems. The aim of this study was to delineate the characteristics of doctors utilising the service, to describe their psychological morbidity, and to determine if early intervention is achieved. Methods: A cross-sectional study including all consecutive self-referred doctors (n = 121, 50% male) presenting in 2002–2004 was conducted. Measures included standardised and bespoke questionnaires both self-report and clinician completed. The multi-dimensional evaluation included: demographics, CORE (CORE-OM, CORE-Workplace and CORE-A) an instrument designed to evaluate the psychological difficulties of patients referred to outpatient services, Brief Symptom Inventory to quantify caseness and formal psychiatric illness, and Maslach Burnout Inventory. Results: The most prevalent presenting problems included depression, anxiety, interpersonal, self-esteem and work-related issues. However, only 9% of the cohort were identified as severely distressed psychiatrically using this measure. In approximately 50% of the sample, problems first presented in the preceding year. About 25% were on sick leave at the time of consultation, while 50% took little or no leave in the prior 12 months. A total of 42% were considered to be at some risk of suicide, with more than 25% considered to have a moderate to severe risk. There were no significant gender differences in type of morbidity, severity or days off sick. Conclusion: Doctors displayed high levels of distress as reflected in the significant proportion of those who were at some risk of suicide; however, low rates of severe psychiatric illness were detected. These findings suggest that MedNet clients represent both ends of the spectrum of severity, enabling early clinical engagement for a significant proportion of cases that is of importance both in terms of personal health and protecting patient care, and providing a timely intervention for those who are at risk, a group for whom rapid intervention services are in need and an area that requires further investigation in the UK

Organisation of cingulum bundle fibres connecting the anterior thalamic nuclei with the rodent anterior cingulate and retrosplenial cortices

Despite considerable interest in the properties of the cingulum bundle, descriptions of the composition of this major pathway in the rodent brain have not kept pace with advances in tract tracing. Using complementary approaches in rats and mice, this study examined the dense, reciprocal connections the anterior thalamic nuclei have with the cingulate and retrosplenial cortices, connections thought to be major contributors to the rodent cingulum bundle. The rat data came from a mixture of fluorescent and viral tracers, some injected directly into the bundle. The mouse data were collated from the Allen Mouse Brain Atlas. The projections from the three major anterior thalamic nuclei occupied much of the external medullary stratum of the cingulum bundle, where they were concentrated in its more medial portions. These anterior thalamic projections formed a rostral-reaching basket of efferents prior to joining the cingulum bundle, with anteromedial efferents taking the most rostral routes, often reaching the genu of the corpus callosum, while anterodorsal efferents took the least rostral route. In contrast, the return cortico-anterior thalamic projections frequently crossed directly through the bundle or briefly joined the internal stratum of the cingulum bundle, often entering the internal capsule before reaching the anterior thalamus. These analyses confirm that anterior thalamic connections comprise an important component of the rodent cingulum bundle, while also demonstrating the very different routes used by thalamo-cortical and cortico-thalamic projections. This information reveals how the composition of the cingulum bundle alters along its length

Pathogenic Mannheimia haemolytica invades differentiated bovine airway epithelial cells

The Gram-negative bacterium Mannheimia haemolytica is the primary bacterial species associated with bovine respiratory disease (BRD) which is responsible for significant economic losses to the livestock industries worldwide. Healthy cattle are frequently colonised by commensal serotype A2 strains, but disease is usually caused by pathogenic strains of serotype A1. For reasons that are poorly understood, a transition occurs within the respiratory tract and a sudden explosive proliferation of serotype A1 bacteria leads to the onset of pneumonic disease. Very little is known about the interactions of M. haemolytica with airway epithelial cells of the respiratory mucosa which might explain the different abilities of serotype A1 and A2 strains to cause disease. In the present study, host-pathogen interactions in the bovine respiratory tract were mimicked using a novel differentiated bovine bronchial epithelial cell (BBEC) infection model. In this model, differentiated BBECs were inoculated with serotype A1 or A2 strains of M. haemolytica and the course of infection followed over a five-day period by microscopic assessment and measurement of key proinflammatory mediators. We have demonstrated that serotype A1, but not A2, M. haemolytica invades differentiated BBECs by transcytosis and subsequently undergoes rapid intracellular replication before spreading to adjacent cells and causing extensive cellular damage. Our findings suggest that the explosive proliferation of serotype A1 M. haemolytica that occurs within the bovine respiratory tract prior to the onset of pneumonic disease is potentially due to bacterial invasion of, and rapid proliferation within, the mucosal epithelium. The discovery of this previously unrecognised mechanism of pathogenesis is important because it will allow the serotype A1-specific virulence determinants responsible for invasion to be identified and thereby provide opportunities for the development of new strategies for combatting BRD aimed at preventing early colonisation and infection of the bovine respiratory tract

Temporal differentiation of bovine airway epithelial cells grown at an air-liquid interface

There is an urgent need to develop improved, physiologically-relevant in vitro models of airway epithelia with which to better understand the pathological processes associated with infection, allergies and toxicological insults of the respiratory tract of both humans and domesticated animals. In the present study, we have characterised the proliferation and differentiation of primary bovine bronchial epithelial cells (BBECs) grown at an air-liquid interface (ALI) at three-day intervals over a period of 42 days from the introduction of the ALI. The differentiated BBEC model was highly representative of the ex vivo epithelium from which the epithelial cells were derived; a columnar, pseudostratified epithelium that was highly reflective of native airway epithelium was formed which comprised ciliated, goblet and basal cells. The hallmark defences of the respiratory tract, namely barrier function and mucociliary clearance, were present, thus demonstrating that the model is an excellent mimic of bovine respiratory epithelium. The epithelium was fully differentiated by day 21 post-ALI and, crucially, remained healthy and stable for a further 21 days. Thus, the differentiated BBEC model has a three-week window which will allow wide-ranging and long-term experiments to be performed in the fields of infection, toxicology or general airway physiology

Development and optimization of a differentiated airway epithelial cell model of the bovine respiratory tract

Cattle are subject to economically-important respiratory tract infections by various bacterial and viral pathogens and there is an urgent need for the development of more realistic in vitro models of the bovine respiratory tract to improve our knowledge of disease pathogenesis. In the present study, we have optimized the culture conditions in serum-free medium that allow bovine bronchial epithelial cells (BBECs) grown at an air-liquid interface to differentiate into a three-dimensional epithelium that is highly representative of the bovine airway. Epidermal growth factor was required to trigger both proliferation and differentiation of BBECs whilst retinoic acid was also essential for mucociliary differentiation. Triiodothyronine was demonstrated not to be important for the differentiation of BBECs. Oxygen concentration had a minimal effect although optimal ciliation was achieved when BBECs were cultured at 14% oxygen tension. Insert pore-density had a significant effect on the growth and differentiation of BBECs; a high-pore-density was required to trigger optimum differentiation. The established BBEC model will have wide-ranging applications for the study of bacterial and viral infections of the bovine respiratory tract; it will contribute to the development of improved vaccines and therapeutics and will reduce the use of cattle in in vivo experimentation

Manipulating Permeability as a Process for Controlling Crime: Balancing Security and Sustainability in Local Contexts

In response to the sustainability agenda, planning policy in the UK, USA and Australia has shifted to promote compact, high-density, mixed-used residential developments in walkable and permeable street networks close to public transport (Commonwealth of Australia, 1995; DETR, 1998; American Planning Association, 2007). This is to encourage walking and the use of public transport and to reduce car-use, energy use, pollution, congestion and urban sprawl. However, although permeability is assumed to represent a positive built environment feature which reduces crime by promoting more "eyes on the street" (Jacobs, 1961), a significant body of research in the field of environmental criminology challenges this assumptions. This paper reviews the theories and evidence associated with permeability and crime.Pedestrian access ways (PAWs) are often associated with crime and this paper discusses research which was directed at providing practical guidance to local governments on how they could better manage existing PAWs in Western Australia (WA). A morphological analysis of existing PAWs was undertaken which analysed the purposes, roles, functionality, users and dynamics of PAWs in a variety of different settings. In addition to crime (which had commonly be used as an excuse to close PAWs), the research considered issues such as amenity, walkability, equity and sustainability. A suite of five tools for assessing and reducing crime risk were developed, which attempt to balance security and sustainability issues. Contrary to assumptions, most PAWs were not subject to high levels of crime and many were vital to the community. Intriguingly, findings indicated that neighbourhood permeability can potentially be manipulated (via the management, closure or construction of new PAWs) to achieve the desired outcomes of reducing crime and of enhancing walkability, liveability and ultimately, the sustainability and well-being of communities

Burnout and psychiatric morbidity among medical students entering clinical training: a three year prospective questionnaire and interview-based study

BACKGROUND: Mental distress among medical students is often reported. Burnout has not been studied frequently and studies using interviewer-rated diagnoses as outcomes are rarely employed. The objective of this prospective study of medical students was to examine clinically significant psychiatric morbidity and burnout at 3(rd )year of medical school, considering personality and study conditions measured at 1(st )year. METHODS: Questionnaires were sent to 127 first year medical students who were then followed-up at 3(rd )year of medical school. Eighty-one of 3(rd )year respondents participated in a diagnostic interview. Personality (HP5-i) and Performance-based self-esteem (PBSE-scale) were assessed at first year, Study conditions (HESI), Burnout (OLBI), Depression (MDI) at 1(st )and 3(rd )years. Diagnostic interviews (MINI) were used at 3(rd )year to assess psychiatric morbidity. High and low burnout at 3(rd )year was defined by cluster analysis. Logistic regressions were used to identify predictors of high burnout and psychiatric morbidity, controlling for gender. RESULTS: 98 (77%) responded on both occasions, 80 (63%) of these were interviewed. High burnout was predicted by Impulsivity trait, Depressive symptoms at 1(st )year and Financial concerns at 1(st )year. When controlling for 3(rd )year study conditions, Impulsivity and concurrent Workload remained. Of the interviewed sample 21 (27%) had a psychiatric diagnosis, 6 of whom had sought help. Unadjusted analyses showed that psychiatric morbidity was predicted by high Performance-based self-esteem, Disengagement and Depression at 1(st )year, only the later remained significant in the adjusted analysis. CONCLUSION: Psychiatric morbidity is common in medical students but few seek help. Burnout has individual as well as environmental explanations and to avoid it, organisational as well as individual interventions may be needed. Early signs of depressive symptoms in medical students may be important to address. Students should be encouraged to seek help and adequate facilities should be available

Analysis of syngas methanation for bio-SNG production from wastes: kinetic model development and pilot scale validation

Bio-substitute natural gas (or bio-SNG) produced from gasification of waste fuels and subsequent methanation of the product gas could play a crucial role in the decarbonisation of heating and transportation, and could be a vital part of the energy mix in the coming decades. Although the methanation of trace quantities of carbon oxides has been practiced commercially for many years, methanation from syngas poses a more severe problem due to the high and unstable concentrations of reactants in the produced gas. In this work, a low-Ni methanation cat alyst was tested in a differential reactor to derive a kinetic model that could determine a practical operating scheme for the first methanation step of a typical bio-SNG process. The model, comprising water gas shift and methanation reactions, along with their reverse reactions, was used for realistic modelling of the methanation process using high quality syngas, obtained from steam-oxygen gasification of wastes and gas plasma conversion, and to better determine the operation conditions in the first reactor of a bio-SNG pilot plant in Swindon (UK). The tests undertaken show that the catalyst was performing as expected using the waste-derived syngas at industrially relevant conditions, when compared to predictions of models derived from works using bottled gases. This gives confidence that the same approach can be used for the detailed design and operation of once through methanation reactor elements and process system configuration for bio-SNG production at larger scale

Embodying compassion: A systematic review of the views of nurses and patients

© 2018 John Wiley & Sons Ltd Aims and objectives: To provide a review of empirical research investigating how compassion is expressed by nurses and received by patients in hospital settings. Background: Compassion is viewed as an important and fundamental part of a health professional practice. Universally, reports from both media and government agencies have addressed perceived deficits of compassion in healthcare with nurses accused of a lack of compassion. Research into compassion to date has largely focused on the problematic nature of compassion such as burnout, fatigue and other negative personal and work-related outcomes. Design: A systematic literature review of empirical research guided by a meta-ethnographic approach supported the systematic comparison and translation of the included studies. Six online databases were searched from January 2006–December 2016. Methods: This review was carried out according to the PRISMA-P reporting guidelines. How compassion in healthcare was defined was extracted alongside findings on how compassion was expressed by nurses and received by patients. Synthesis of the research was completed resulting in new interpretations. Results: Eleven papers met the inclusion criteria and were included in the review. Multiple differing definitions of compassion in healthcare were applied. Nurses embody and enact compassion through behaviours such as spending time with patients and communicating effectively with patients. Patients experience compassion through a sense of togetherness with nurses. Conclusion: Existing research demonstrated dissonance between the expression of compassion by nurses and how compassion is experienced by patients. The themes identified in this review should be considered by health professionals providing patient care. Relevance to clinical practice: Health providers should acknowledge and account for the time that nurses need with patients to demonstrate compassion in practice. Nursing education relating to the expression of compassion should articulate both the subjectivity and ambiguity of the term and examine the relationship between compassion and suffering

'It gives you an understanding you can't get from any book.' The relationship between medical students' and doctors' personal illness experiences and their performance: a qualitative and quantitative study

Background: anecdotes abound about doctors' personal illness experiences and the effect they have on their empathy and care of patients. We formally investigated the relationship between doctors' and medical students' personal illness experiences, their examination results, preparedness for clinical practice, learning and professional attitudes and behaviour towards patients.Methods: newly-qualified UK doctors in 2005 (n = 2062/4784), and two cohorts of students at one London medical school (n = 640/749) participated in the quantitative arm of the study. 37 Consultants, 1 Specialist Registrar, 2 Clinical Skills Tutors and 25 newly-qualified doctors participated in the qualitative arm. Newly-qualified doctors and medical students reported their personal illness experiences in a questionnaire. Doctors' experiences were correlated with self-reported preparedness for their new clinical jobs. Students' experiences were correlated with their examination results, and self-reported anxiety and depression. Interviews with clinical teachers, newly-qualified doctors and senior doctors qualitatively investigated how personal illness experiences affect learning, professional attitudes, and behaviour.Results: 85.5% of newly-qualified doctors and 54.4% of medical students reported personal illness experiences. Newly-qualified doctors who had been ill felt less prepared for starting work (p < 0.001), but those who had only experienced illness in a relative or friend felt more prepared (p = 0.02). Clinical medical students who had been ill were more anxious (p = 0.01) and had lower examination scores (p = 0.006). Doctors felt their personal illness experiences helped them empathise and communicate with patients. Medical students with more life experience were perceived as more mature, empathetic, and better learners; but illness at medical school was recognised to impede learning.Conclusion: the majority of the medical students and newly qualified doctors we studied reported personal illness experiences, and these experiences were associated with lower undergraduate examination results, higher anxiety, and lower preparedness. However reflection on such experiences may have improved professional attitudes such as empathy and compassion for patients. Future research is warranted in this area