Models of advance directives in mental health care: stakeholder views

<i>Objective</i>: The aim of this study was to examine perceptions of the place of advance directives in mental health care. <i>Methods</i>: Postal survey of stakeholders was carried out to assess their views on different models of advance directives in mental health care. A total of 473 responded. <i>Results</i>: In all, 28% of psychiatrists thought advance directives were needed compared to 89% of voluntary organisations and above two–thirds of the other stakeholder groups. There were clear tensions between patient autonomy and right to treatment which underpin many of the concerns raised. Autonomy provided by advance directive can be contrasted with a co–operative partnership approach to advance planning. The legal status of advance directives is important for some people in relation to treatment refusal. There was general concern about the practical issues surrounding their implementation. <i>Conclusion</i>: There is a wide range of views in all stakeholder groups about the possible form advance directives should take. Although there is a widespread desire to increase patient involvement in treatment decisions, which advance directives could possibly help to realise, they may also have unwanted consequences for mental health services and individuals

The introduction and evaluation of Community Care Orders following the Mental Health (Patients in the Community) Act 1995

Community Care Orders (CCOs) were introduced in Scotland in the Mental Health (Patients in the Community) Act 1995, which also saw the reduction of leave of absence. The aim of the study was to evaluate the use of CCOs in the first 33 months of their availability and to assess psychiatrists' and patients' views on their usefulness. Three data sources were used: (1) Mental Welfare Commission; (2) a named patient survey to consultant psychiatrists; (3) interviews with patients. Forty-five CCOs were used between 1 April 1996 and 31 December 1998. Half of these were judged successful by consultants. Conditions were varied and the impact on patients' lives could be extensive. There is confusion over the ability of CCOs to enforce medication but 77% implicitly or explicitly mentioned medication. CCO use has been low but set against the negative expectations of psychiatrists might be judged more successful than expected

Changes to leave of absence in Scotland: the views of patients

Sixty-four patients were interviewed about changes to leave of absence brought about by the Mental Health (Patients in the Community) Act 1995 in the context of their views about services and medication. Few patients were clear about the change in the law,which suggests that more has to be done to inform patients of their rights and legal status. A number of patients reported difficulty in negotiating preferred medication with their psychiatrists and felt compelled to take medication that resulted in debilitating side-effects. A third of patients eligible to be interviewed agreed to an interview and ethical and practical difficulties in accessing patients for this type of research are discussed

The end of indefinitely renewable leave of absence in Scotland: the impact of the Mental Health (Patients in the Community) Act 1995

The Mental Health (Patients in the Community) Act 1995 restricted leave of absence (LOA) for detained patients in Scotland to 12 months. This study looked at the impact on patients who were affected by this restriction. A total of 266 patients were identified from Mental Welfare Commission records: 194 reached the new maximum, 47 were 'transitional', 16 were on improperly long LOA and 9 were on community care orders (CCOs) following LOA but not maximum LOA. Of this 194, 12 were transferred to guardianship and the remainder became voluntary patients. The responsible medical officers (RMOs) would have liked to renew LOA for 71% of patients. In 90% of cases RMOs renewed LOA to ensure compliance with medication. Patients were significantly more likely to be compliant with medication while on LOA than post-LOA. A minority (28%) were recorded as being involved in 'incidents' post-LOA. There were 37% who were known to have a substance use problem in their management. The results suggest that RMOs may have been conservative in using LOA

Isolation predicts compositional change after discrete disturbances in a global meta-study

Globally, anthropogenic disturbances are occurring at unprecedented rates and over extensive spatial and temporal scales. Human activities also affect natural disturbances, prompting shifts in their timing and intensities. Thus, there is an urgent need to understand and predict the response of ecosystems to disturbance. In this study, we investigated whether there are general determinants of community response to disturbance across different community types, locations, and disturbance events. We compiled 14 case studies of community response to disturbance from four continents, twelve aquatic and terrestrial ecosystem types, and eight different types of disturbance. We used community compositional differences and species richness to indicate community response. We used mixed-effects modeling to test the relationship between each of these response metrics and four potential explanatory factors: regional species pool size, isolation, number of generations passed, and relative disturbance intensity. We found that compositional similarity was higher between pre- and post-disturbance communities when the disturbed community was connected to adjacent undisturbed habitat. The number of generations that had passed since the disturbance event was a significant, but weak, predictor of community compositional change; two communities were responsible for the observed relationship. We found no significant relationships between the factors we tested and changes in species richness. To our knowledge, this is the first attempt to search for general drivers of community resilience from a diverse set of case studies. The strength of the relationship between compositional change and isolation suggests that it may be informative in resilience research and biodiversity management

Heterogeneity of genetic parameters for calving difficulty in Holstein heifers in Ireland

Calving difficulty is a trait that greatly affects animal welfare, herd profitability, and the amount of labor required by cattle farmers. It is influenced by direct and maternal genetic components. Selection and breeding strategies can optimize the accuracy of genetic evaluations and correctly emphasize calving difficulty in multiple-trait indices provided there are accurate estimates of genetic parameters. In Ireland, large differences exist in the age at which heifers first give birth to calves. The objective of this study was to estimate genetic parameters for calving difficulty in first-parity Holsteins and to determine whether these differed with age of the heifer at calving. Transformed calving difficulty records for 18,798 Holstein heifers, which calved between January 2002 and May 2006, were analyzed using univariate, multitrait, and random regression linear sire-maternal grandsire models. The model that 1) fitted a second-order random regression of dam age at first parity for the direct component, 2) treated the maternal component as a single trait regardless of dam age, and 3) fitted a single residual variance component was optimal. Heritabilities for direct (0.13) and maternal (0.04) calving difficulty were significantly different from zero. These 2 components were moderately negatively correlated (¿0.47). Estimates of direct genetic variance and heritability were heterogeneous along the dam age trajectory, decreasing initially with dam age before subsequently increasing. Heritability estimates ranged between 0.11 and 0.37 and were higher for records with younger and older dams at parturition. Genetic correlations between the direct components of calving difficulty decreased from unity to 0.5 with increasing distance between dam ages at parturition. The results of this study indicated that heterogeneity of direct genetic variance existed for calving difficulty, depending on dam age at first parturition

SFX-01 in hospitalised patients with community-acquired pneumonia during the COVID-19 pandemic : a double-blind, randomised, placebo-controlled trial

We acknowledge the members of the STAR-COVID data monitoring committee: Aran Singanayagam (Imperial College, London, UK), Timothy Hinks (University of Oxford, Oxford, UK), Oriol Sibila (Hospital Clinic, Barcelona, Spain), Alex McConnachie (University of Glasgow, Glasgow, UK) and Petra Rauchhaus (University of Dundee, Dundee, UK). This trial was delivered by Tayside Clinical Trials Unit, a UKCRC registered clinical trials unit. Thanks to Clare Clarke, Jennifer Taylor, Angela Strachan, Heather Loftus and Jodie Strachan (Ninewells Hospital and Medical School, Dundee, UK) and Diane Cassidy (University of Dundee). We thank all study participants and their families.Peer reviewe

On the origin and evolution of the material in 67P/Churyumov-Gerasimenko

International audiencePrimitive objects like comets hold important information on the material that formed our solar system. Several comets have been visited by spacecraft and many more have been observed through Earth- and space-based telescopes. Still our understanding remains limited. Molecular abundances in comets have been shown to be similar to interstellar ices and thus indicate that common processes and conditions were involved in their formation. The samples returned by the Stardust mission to comet Wild 2 showed that the bulk refractory material was processed by high temperatures in the vicinity of the early sun. The recent Rosetta mission acquired a wealth of new data on the composition of comet 67P/Churyumov-Gerasimenko (hereafter 67P/C-G) and complemented earlier observations of other comets. The isotopic, elemental, and molecular abundances of the volatile, semi-volatile, and refractory phases brought many new insights into the origin and processing of the incorporated material. The emerging picture after Rosetta is that at least part of the volatile material was formed before the solar system and that cometary nuclei agglomerated over a wide range of heliocentric distances, different from where they are found today. Deviations from bulk solar system abundances indicate that the material was not fully homogenized at the location of comet formation, despite the radial mixing implied by the Stardust results. Post-formation evolution of the material might play an important role, which further complicates the picture. This paper discusses these major findings of the Rosetta mission with respect to the origin of the material and puts them in the context of what we know from other comets and solar system objects