Investigating the relationship between social cognition, neuropsychological function and post-traumatic stress disorder in acquired brain injury

Literature suggests that aspects of social cognition, as well as neuropsychological difficulties play a key role in the development and maintenance of Post-Traumatic Stress Disorder (PTSD) symptoms in brain injury survivors. The present study aimed to explore the direct relationship between measures of neuropsychological function and social cognition, and psychological outcomes related to PTSD. A quantitative, cross-sectional, correlational design was employed, using correlational and multivariate regression methods of analysis. Forty-nine adult brain injury survivors were administered a range of measures of neuropsychological function (memory, executive function and attention); social cognition (Mentalization, emotion recognition, social judgment making and emotion-based decision-making) and Psychological outcomes related to PTSD (depression, anxiety, anger and PTSD symptoms). Significant relationships were found between measures of Mentalization, attention and memory, and symptoms relating to depression and PTSD. Selective visual attention and Mentalization were found to account for 37% of the relevant variance for depressive symptoms, while Mentalization and delayed memory recall accounted for 24% of the relevant variance for PTSD symptoms. Different measures of Mentalization showed unexpected correlation directions, which had significant implications for the role Mentalization might play in maintaining PTSD symptoms. The findings suggest an association between aspects of social cognition and neuropsychological functioning, and psychological outcomes related to PTSD. It is thought that impairments in these areas could play a role in maintaining these outcomes in Acquired Brain Injury survivors

Building service capacity within a Regional District Mental Health Service: recommendations from an indigenous mental health symposium

[Abstract]: In response to recent developments within the mental health services of south-east Queensland, the Toowoomba District Mental Health Service (TDMHS) has developed a Model of Service Delivery, which outlines the range of services provided for consumers across their lifespan. Indigenous consumers of the TDMHS come from a wide area of communities in the surrounding shires (Rural, remote and metropolitan areas (RRMA) 4-7). It was recognised by the service that Indigenous mental health consumers have unique needs and, because of these needs, this area of service delivery required greater attention and further development. In December 2004, a symposium was organised by the service to bring together a range of speakers and delegates working in the area of Indigenous mental health to discuss issues and work towards developing strategies to enable the service to better meet the needs of Indigenous consumers in this region of south-east Queensland. Issues: The symposium program consisted of keynote speakers and invited papers and culminated with an afternoon workshop that collated the symposium’s main issues and themes around building service capacity for Indigenous mental health consumers. The objective of the workshop was ‘Identifying ways to meet Indigenous mental health needs’. This workshop gave the delegates a chance to reflect, discuss and brainstorm the major issues of concern relating to this question. A group facilitator guided the discussion and organised the delegates into groups to evaluate, debate and propose recommendations for each of the major issues that emerged. Lessons learned: The feedback and discussion arising from the workshop is presented. Sixteen major themes emerged from the workshop. Seven of these were voted by the participants as being dominant and in greatest need of discussion: (1) communication; (2) cultural respect; (3) culturally appropriate clinical tools; (4) supportive management; (5) patient compliance; (6) career structure; and (7) empowerment. These seven themes are discussed and recommendations arising from the workshop are noted

Barriers to the up-take of telemedicine in Australia - A view from providers

Introduction: The continued poorer health status of rural and remote Australians when compared with their urban counterparts is cause for concern. The use of advanced technology to improve access to health care has the potential to assist in addressing this problem. Telemedicine is one example of such technology which has advanced rapidly in its capacity to increase access to healthcare services or provide previously unavailable services. The important anticipated benefits of greater access to healthcare services are improved health outcomes and more cost-effective delivery

Clinical communication skills learning outcomes among first year medical students are consistent irrespective of participation in an interview for admission to medical school

Background: Although contentious most medical schools interview potential students to assess personal abilities such as communication. Aims: To investigate any differences in clinical communication skills (CCS) between first year students admitted to UQ medical school with or without an admissions interview. Methods: A retrospective analysis of 1495 student assessment scores obtained after structured communication skills training (CCS) between 2007 and 2010. Results: The average assessment score was 3.76 ([95% CI, 3.73-3.78]) and adjusting for student characteristics, showed no main effect for interview (p=0.89). The strongest predictor of scores was gender with females achieving significantly higher scores (3.91 [95% CI, 3.54-4.28] vs. 3.76 [95% CI, 3.39-4.13]; p≤0.001). Conclusions: Data show no differences in post-training assessment measures between students who were interviewed during selection or not. Further research about the quality and retention of communications skills after training is warranted

A decade of Australian Rural Clinical School graduates: Where are they and why?

Introduction: The Australian Rural Clinical School (RCS) initiative has been addressing the rural medical workforce shortage at the medical education level for over a decade. A major expectation of this initiative is that it will improve rural medical workforce recruitment and subsequent retention through a rurally based undergraduate clinical training experience. The longitudinal nature of these workforce initiatives means that definitive evidence of its impact on the shortage of rural doctors is yet to be provided; however, to date cross-sectional studies are accumulating a measure of efficacy for these initiatives by monitoring early career factors such as internship location choice and speciality choice of RCS graduates. This article reports on a study in one RCS that is monitoring the impact of rural undergraduate clinical training on trends in workforce participation patterns of its graduates as long as 9 years in the workforce. Career location and speciality choice are reported as well as perspectives on early career intentions and the reality of making career and life decisions as a doctor in the medical workforce

Invasive carbapenem-resistant Enterobacteriaceae infection at a paediatric hospital: A case series

Background. There are no paediatric reports of invasive infection caused by carbapenem-resistant Enterobacteriaceae (CRE) from Africa. Objectives. To document a series of cases of CRE infections at a tertiary children’s hospital in Cape Town, South Africa, describing the clinical and microbiological findings in these children.Methods. A retrospective, descriptive study was completed using data from a series of children with invasive CRE infection between 2010 and 2015, sourced from their clinical notes and microbiology results.Results. The first of 10 invasive CRE infections during the study period occurred in November 2012. Nine CRE infections were caused by Klebsiella pneumoniae, and one by both K. pneumoniae and Escherichia coli. The median age was 25 months (interquartile range (IQR) 5 - 60). All 10 CRE infections were hospital acquired. The median length of hospitalisation before CRE infection was 28.5 days (IQR 20 - 44). Eight of the children were exposed to carbapenems during the 12-month period prior to invasive CRE infection. Six were treated with colistin and carbapenem combination therapy, of whom 2 died, including 1 of a non-CRE event. The other 4 children received colistin monotherapy. All these children died, including 2 from non-CRE events.Conclusions. Children with invasive CRE infection and severe underlying disease must be treated with combination antibiotic therapy. Strict infection control practice and antibiotic stewardship are necessary to contain the spread of CRE and limit the number of new infections

Vortex phases and glassy dynamics in the highly anisotropic superconductor HgBa2_{2}CuO4+δ_{4+δ}

We present an extensive study of vortex dynamics in a high-quality single crystal of HgBa$_{2}$CuO$_{4+δ}$, a highly anisotropic superconductor that is a model system for studying the effects of anisotropy. From magnetization M measurements over a wide range of temperatures T and fields H, we construct a detailed vortex phase diagram. We find that the temperature-dependent vortex penetration field H$_{p}$(T), second magnetization peak H$_{smp}$(T), and irreversibility field H$_{irr}$(T) all decay exponentially at low temperatures and exhibit an abrupt change in behavior at high temperatures T/Tc >~ 0.5. By measuring the rates of thermally activated vortex motion (creep) S(T, H) = |dlnM(T, H)/dlnt|, we reveal glassy behavior involving collective creep of bundles of 2D pancake vortices as well as temperature- and time-tuned crossovers from elastic (collective) dynamics to plastic flow. Based on the creep results, we show that the second magnetization peak coincides with the elastic-to-plastic crossover at low T, yet the mechanism changes at higher temperatures

Using ceftazidime-avibactam for persistent carbapenem-resistant Serratia marcescens infection highlights antimicrobial stewardship challenges with new beta-lactam-inhibitor combination antibiotics

The newer beta-lactam-inhibitor combination (BLIC) antibiotics are available in South Africa (SA) for the treatment of carbapenem-resistant Enterobacterales infections. We describe the successful use of ceftazidime-avibactam (CA) for the treatment of a child with persistent carbapenem-resistant Serratia marcescens bacteraemia, and the challenges faced using this lifesaving antibiotic, including access to susceptibility testing, procurement process, cost and complexity of deciding when, how and for how long to use it. Furthermore, the burden of carbapenem resistance is increasing in SA, and inappropriate use of CA and other newer BLIC antibiotics, such as ceftolozane-tazobactam, will inevitably endanger their longevity. A careful balance must be struck between removing unnecessary obstacles and delays in initiating these antibiotics for life-threatening infections, and additional antimicrobial stewardship-guided interventions aimed at preserving their therapeutic use