Exploring the role of mental imagery in the experience of self-injury:an interpretative phenomenological analysis

Background: Research has implicated causal, mediating and meaningful roles for mental imagery in the experience of psychological distress, including self-injury. Aims: The present study aimed to further the understanding of this relationship through exploring the lived experiences of mental imagery from the perspective of those who self-injure. Method: This study employed an inductive qualitative design using semi-structured interviews and Interpretative Phenomenological Analysis (IPA). Ten participants were recruited from universities in North West England. Results: Three main themes were identified from the analysis: (i) The origins and precipitants of self-injurious imagery; (ii) What it is like toexperience self-injurious imagery; and (iii) The meaning and interpretation of self-injurious imagery. Conclusions: The study findings indicate that mental imagery is an important experience for those who self-injure. Clinical and research implications of the findings are discussed

Some Lessons from Scandinavia and Australia

This paper examines the transparency of public-private partnerships (PPPs). The key question is “How has transparency and accountability been implemented in PPPs?”.PPPs in infrastructure have been presented as enabling synergy and as a major alternative to previous contracting out techniques. These partnerships have most usually involved the preferential use of private finance, highly complex ‘bundled’ infrastructure delivery contract arrangements and new governance and accountability assumptions. Risk management is also particularly important to PPPs. Contracts between the governments and partnering private firms, however, have also been more complex and have not necessarily lead to simple synergy, but to more negotiations and governance structures. One ongoing concern from critics has been the accusation of illegitimacy due to the use by governments of these contracts to hold project information secret, rather than providing details of the deals to citizens. This paper first presents the transparency concept as it relates to modern day infrastructure PPPs. Second, the paper discusses how transparency and PPPs are related, and suggests a typology of transparency based on degree on openness and phases of the PPP process. Third, the paper examines empirical evidence on transparency elements in PPP contracts and governance structures based on two cases from Scandinavia and Australia. Fourth, the paper concludes by observing how different transparency dimensions relate to the different phases in a PPP project, including the important point about the contract institution that defines a PPP. The paper also concludes by suggesting some ways forward to improve transparency in future PPPs to enhance legitimacy

A Market-Based Alternative to Government?

One of the paradoxes of the past few decades has been the continuity and even growth of infrastructure Public-Private Partnerships (PPPs) despite the loud voices of critics and harsh judgments of some academics. Indeed, there is little doubt about the success of PPPs judging on the basis of increasing global interest, the frequency of use in countries such as the United Kingdom or Australia, or by the spectacular delivery of timely new infrastructure. There has been considerable work undertaken to date on the multiple meanings of PPP more generally, on the multiple disciplinary languages spoken by commentators and on the evaluation challenges faced by those interested in assessing PPPs as projects or activities. There has been less work undertaken, however, on the meanings given to how PPP has been judged as ‘successful’ by implementing governments. Indeed, the criteria on which governments might judge PPP as a success story seems to be inherently ambiguous and as politically oriented as it is oriented towards more traditional utilitarian policy goals concerned with project delivery or efficiency. In view of the continuity of PPPs post-GFC, the very nature of ‘PPP success’ needs serious rethinking. This paper explores the notion of ‘success’ for PPP and argues that short of embarrassing and large scale corruption or widespread incompetence, PPP and PPP projects are inevitably judged as ‘successful’ in government. This is not only because the PPP concept itself is so wonderfully amorphous and ambiguous, but because each strand of PPP has multiple goals. Infrastructure PPPs for example, have fifteen or so different goals. The criteria for success are therefore multi-faceted and themselves incorporate the very goals of government itself. It is inevitable that PPPs are seen by government to help create public value as well as private value. The paper uses theories of policy success and evaluation studies to assess how ‘success’ is interpreted. The paper concludes that many of the claims for PPP success and failure are therefore, to an extent, self defining exercises

Stellar Populations in the Phoenix Dwarf (dIrr/dSph) Galaxy as Observed by HST/WFPC2

We present HST/WFPC2 photometry of the central regions of the Phoenix dwarf. Accurate photometry allows us to: 1) confirm the existence of the horizontal branch previously detected by ground-based observations, and use it to determine a distance to Phoenix, 2) clearly detect the existence of multiple ages in the stellar population of Phoenix, 3) determine a mean metallicity of the old red giant branch stars in Phoenix, and suggest that Phoenix has evolved chemically over its lifetime, 4) extract a rough star formation history for the central regions which suggests that Phoenix has been forming stars roughly continuously over its entire lifetime.Comment: Accepted by AJ, 22 pages including 6 figures + 1 figure in JPEG forma

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Private Sector Development Strategy: Some Critical Issues

This paper aims to articulate aspects of the Private Sector Development Strategies of two key Development Banks in order to reflect on commonalities and differences. The paper reviews these strategies and focuses on what is included and what is omitted, as well as commenting on the characteristics of these strategies as corporate direction setting. The degree to which strategies seem to have incorporated organisational learning, power relationships and cultural contexts is then assessed