How do we create, and improve, the evidence base?

Providing best clinical care involves using the best available evidence of effectiveness to inform treatment decisions. Producing this evidence begins with trials and continues through synthesis of their findings towards evidence incorporation within comprehensible, usable guidelines, for clinicians and patients at the point of care. However, there is enormous wastage in this evidence production process, with less than 50% of the published biomedical literature considered sufficient in conduct and reporting to be fit for purpose. Over the last 30 years, independent collaborative initiatives have evolved to optimise the evidence to improve patient care. These collaborations each recommend how to improve research quality in a small way at many different stages of the evidence production and distillation process. When we consider these minimal improvements at each stage from an 'aggregation of marginal gains' perspective, the accumulation of small enhancements aggregates, thereby greatly improving the final product of 'best available evidence'. The myriad of tools to reduce research quality leakage and evidence loss should be routinely used by all those with responsibility for ensuring that research benefits patients, that is, those who pay for research (funders), produce it (researchers), take part in it (patients/participants) and use it (clinicians, policy makers and service commissioners)

SCUBA-2 Ultra Deep Imaging EAO Survey (STUDIES). IV. Spatial Clustering and Halo Masses of Submillimeter Galaxies

We analyze an extremely deep 450 μm image (1σ = 0.56 mJy beam−1) of a sime300 arcmin2 area in the CANDELS/COSMOS field as part of the Sub-millimeter Common User Bolometric Array-2 Ultra Deep Imaging EAO Survey. We select a robust (signal-to-noise ratio ≥4) and flux-limited (≥4 mJy) sample of 164 submillimeter galaxies (SMGs) at 450 μm that have K-band counterparts in the COSMOS2015 catalog identified from radio or mid-infrared imaging. Utilizing this SMG sample and the 4705 K-band-selected non-SMGs that reside within the noise level ≤1 mJy beam−1 region of the 450 μm image as a training set, we develop a machine-learning classifier using K-band magnitude and color–color pairs based on the 13-band photometry available in this field. We apply the trained machine-learning classifier to the wider COSMOS field (1.6 deg2) using the same COSMOS2015 catalog and identify a sample of 6182 SMG candidates with similar colors. The number density, radio and/or mid-infrared detection rates, redshift and stellar-mass distributions, and the stacked 450 μm fluxes of these SMG candidates, from the S2COSMOS observations of the wide field, agree with the measurements made in the much smaller CANDELS field, supporting the effectiveness of the classifier. Using this SMG candidate sample, we measure the two-point autocorrelation functions from z = 3 down to z = 0.5. We find that the SMG candidates reside in halos with masses of sime(2.0 ± 0.5) × 1013 h −1 M ☉ across this redshift range. We do not find evidence of downsizing that has been suggested by other recent observational studies

‘ASMR’ autobiographies and the (life-)writing of digital subjectivity

For years now, a growing online subculture has been exchanging videos designed to induce ‘autonomous sensory meridian response’ (ASMR), a mysterious, blissfully relaxing tingling sensation held to alleviate anxiety, pain, insomnia and depression. Emerging from online health forums, ASMR culture today centres on YouTube, where ‘ASMRtists’ have used the feedback mechanisms built into social media platforms to refine a repertoire of ‘trigger’ techniques. Exemplifying a wider trend for using ‘ambient media’ as mood modulators and task facilitators (Roquet, 2016 Ambient Media: Japanese Atmospheres of Self. London: University of Minnesota Press.), ASMR culture’s use of the word ‘trigger’ is telling, gesturing towards what Halberstam ((2014) You Are Triggering Me! The Neo-Liberal Rhetoric of Harm, Danger and Trauma. Bully Bloggers. Available at: https://bullybloggers.wordpress.com/2014/07/05/you-are-triggering-me-the-neo-liberal-rhetoric-of-harm-danger-and-trauma/ (accessed 8 August 2018)) sees as a shift away from the Freudian notion of ‘memory as a palimpsest’ towards one of memory as ‘a live wire sitting in the psyche waiting for a spark’, whereby digital subjects become black-boxed nodes in a cybernetic circuit. This shift has serious implications for the humanities and is particularly resonant for scholars of life-writing. As McNeill ((2012) There is no “I” in network: Social networks sites and posthuman auto/biography. Biography 35(1): 65–82.) argues, digital technologies ‘complicate[] definitions of the self and its boundaries, both dismantling and sustaining the humanist subject in practices of personal narrative’ (p. 65). The resulting friction is highlighted in ‘ASMR autobiographies’: texts narrating the author’s experiences of ASMR and their discovery of online ASMR communities. Echoing familiar auto/biographical forms, from medical case histories and coming out narratives to tales of religious conversion, these texts show that the models of subjectivity we have inherited from Enlightenment philosophy, religion, psychology and Romantic literature retain some cultural purchase. But they also suggest digital media are fostering new understandings of personhood informed by cybernetics, evolutionary psychology, behaviourism and neuroscience. Focusing on works by Andrew MacMuiris, Andrea Seigel and Jon Kersey while also addressing a range of other texts, this article asks what ASMR autobiographies can tell us about digital subjectivity

Fobia social e transtorno de pânico: relação temporal com dependência de substâncias psicoativas Fobia Social y trastorno de pánico: relación temporaria con dependencia de sustancias psicoactivas Social phobia and panic disorder: temporal relation with psychoactive substance dependence

INTRODUÇÃO: O estudo tem por objetivo: 1) determinar a prevalência de transtorno do pânico e de fobia social em pacientes hospitalizados devido ao transtorno do uso de substâncias psicoativas; 2) determinar o relacionamento temporal entre o início desses transtornos de ansiedade e o começo do uso de substâncias psicoativas. MÉTODO: Os diagnósticos psiquiátricos foram obtidos através de entrevista clínica semi-estruturada (SCID-I), baseada nos critérios do DSM-IV. Um questionário foi desenvolvido pelos autores, visando a estudar o relacionamento temporal entre o início do transtorno do uso de substâncias e o princípio do transtorno do pânico e da fobia social. RESULTADOS: Apenas 1 (2 %) paciente apresentou transtorno de pânico antecedendo o uso de substâncias psicoativas. A maioria dos pacientes com ataques de pânico preenchiam critérios para o diagnóstico de transtorno de ansiedade induzido pelo uso de substâncias: 11 (22.9 %) dos pacientes tiveram ataques de pânico apenas durante a intoxicação ou na síndrome de abstinência, ou seja, secundariamente ao uso de drogas. Quanto à fobia social, 16 (33.3 %) pacientes apresentavam este transtorno, sendo que, em todos, a fobia social iniciou antes de começar o uso de substâncias psicoativas. CONCLUSÕES: Os achados confirmam a elevada freqüência de fobia social em pacientes dependentes de substâncias psicoativas e reforçam a hipótese da auto-medicação nesta comorbidade, uma vez que esta fobia tende a preceder o uso de drogas. Quanto ao transtorno de pânico, na nossa amostra, este parece derivar de uma complicação do uso de substâncias psicoativas.<br>INTRODUCCIÓN: el estudio tiene por objetivo: 1) determinar la predominancia del trastorno de pánico y de fobia social en pacientes hospitalizados debido al trastorno del uso de sustancias psicoactivas; 2) determinar el relacionamiento temporáneo entre el inicio de esos trastornos de ansiedad y el comienzo del uso de sustancias psicoactivas. MÉTODO: los diagnósticos psiquiátricos fueron obtenidos a través de entrevista clínica semi-estructurada (SCID-I), basada en los criterios do DSM-IV. Un cuestionario fue desenvuelto por los autores, visando estudiar el relacionamiento temporáneo entre el inicio del trastorno del uso de sustancias, y el principio de trastorno de pánico y de la fobia social. RESULTADOS: apenas 1 (2.1 %) paciente presentó trastorno de pánico antes del uso de sustancias psicoactivas. La mayoría de los pacientes con ataques de pánico, cumplían criterios para el diagnóstico de trastorno de ansiedad inducido por el uso de sustancias: 11 (22.9%) de los pacientes tuvieron ataques de pánico apenas durante la intoxicación o en el síndrome de abstinencia, o sea, secundariamente al uso de drogas. Cuanto a la fobia social, 16 (33.3%) pacientes presentaban este trastorno, siendo que, en todos, la fobia social se inició antes de comenzar el uso de sustancias psicoactivas. CONCLUSIONES: lo descubierto confirma la elevada frecuencia de fobia social en pacientes dependientes de sustancias psicoactivas, y refuerza la hipótesis de la auto-medicación en esta comorbidad, una vez que esta fobia tiende a preceder el uso de drogas. Cuanto al trastorno de pánico, en nuestra muestra, este parece derivar de una complicación del uso de sustancias psicoactivas.<br>INTRODUCTION: The objective of this study is: 1) to determine the prevalence of panic disorder and social phobia in patients hospitalized due to the use of psychoactive substances; 2) to determine the temporal relation between the beginning of these anxiety disorders and the beginning of the use of psychoactive substances. METHODS: The psychiatric diagnoses were made by means of semi-structured clinical interviews (SCID-I), based on DSM-IV criteria. A questionnaire was developed by the authors for the purpose of studying the temporal relation between the beginning of the disorder due to psychoactive substances and the beginning of panic disorder and social phobia. RESULTS: Only 1 (2 %) patient had panic disorder before using psychoactive substances. Most of the patients suffering from panic disorder fulfilled the criteria for the diagnosis of anxiety disorder induced by use of the substance: 11 (22.9 %) of them had panic attacks only while under the effect of drugs or during the withdrawal syndrome, i.e., secondarily to the use of drugs. Sixteen (33.3 %) of the patients had social phobia, and in all of them, the social phobia began before the use of psychoactive substances. CONCLUSIONS: The findings confirmed the high frequency of social phobia in psychoactive substance-dependent patients and they reinforce the self-medication hypothesis in this comorbidity, since that kind of phobia tends to precede the use of drugs. As for panic disorder, in our sample it appears to derive from a complication of the use of psychoactive substances