Planning for tomorrow whilst living for today: the views of people with dementia and their families on Advance Care Planning

Background: Advance care planning (ACP) is increasingly prominent in many countries; however, the evidence base for its acceptability and effectiveness is limited especially in conditions where cognition is impaired, as in dementia. Method: This qualitative study used semi-structured interviews with people with mild to moderate dementia (n = 17) and family carers (n = 29) to investigate their views about planning for their future generally and ACP specifically. Results: People with dementia and their families make a number of plans for the future. Most people undertook practical, personal, financial, and legal planning. However participants did not make formal advance care plans with the exception of appointing someone to manage their financial affairs. Five barriers to undertaking ACP were identified: lack of knowledge and awareness, difficulty in finding the right time, a preference for informal plans over written documentation, constraints on choice around future care, and lack of support to make choices about future healthcare. Conclusions: Health and social care professionals can build on people's preferences for informal planning by exploring the assumptions underlying them, providing information about the possible illness trajectory and discussing the options of care available. Health and social care professionals also have a role to play in highlighting the aspects of ACP which seem to be most relevant to the wishes and aspirations of people with dementia

Sustaining international careers: a peer group for psychiatrists working in global mental health.

Regular appraisal and revalidation are now a routine part of professional life for doctors in the UK. For British-trained psychiatrists working abroad (in either development/humanitarian or academic fields) this is a cause of insecurity, as most of the processes of revalidation are tailored to those working in the standard structures of the National Health Service. This article explores the degree to which a peer group for psychiatrists working abroad has achieved its aim of helping its members to fulfil their revalidation requirements. It gives recommendations for how those considering work abroad can maximise their chances of remaining recognised under the revalidation system

RF Properties and Their Variations in a 3D Printed Klystron Circuit and Cavities

Presently, the manufacturing of active RF devices like klystrons is dominated by expensive and time consuming cycles of machining and brazing. In this article we characterize the RF properties of X-band klystron cavities and an integrated circuit manufactured with a novel additive manufacturing process. Parts are 3D printed in 316L stainless steel with direct metal laser sintering, electroplated in copper, and brazed in one simple braze cycle. Standalone test cavities and integrated circuit cavities were measured throughout the manufacturing process. Un-tuned cavity frequency varies by less than 5% of intended frequency, and Q factors reach above 1200. A tuning study was performed, and unoptimized tuning pins achieved a tuning range of 138 MHz without compromising Q. Klystron system performance was simulated with as-built cavity parameters and realistic tuning. Together, these results show promise that this process can be used to cheaply and quickly manufacture a new generation of highly integrated high power vacuum devices.Comment: 8 pages, 16 figure

Homelessness and severe mental illness in low- and middle-income countries: scoping review

Background Despite being a global problem, little is known about the relationship between severe mental illness (SMI) and homelessness in low- and middle-income countries (LMICs). Homeless people with SMI are an especially vulnerable population and face myriad health and social problems. In LMICs, low rates of treatment for mental illness, as well as differing family support systems and cultural responses to mental illness, may affect the causes and consequences of homelessness in people with SMI. Aims To conduct a systematic, scoping review addressing the question: what is known about the co-occurrence of homelessness and SMI among adults living in LMICs? Method We conducted an electronic search, a manual search and we consulted with experts. Two reviewers screened titles and abstracts, assessed publications for eligibility and appraised study quality. Results Of the 49 included publications, quality was generally low: they were characterised by poor or unclear methodology and reporting of results. A total of 7 publications presented the prevalence of SMI among homeless people; 12 presented the prevalence of homelessness among those with SMI. Only five publications described interventions for this population; only one included an evaluation component. Conclusions Evidence shows an association between homelessness and SMI in LMICs, however there is little information on the complex relationship and direction of causality between the phenomena. Existing programmes should undergo rigorous evaluation to identify key aspects required for individuals to achieve sustainable recovery. Respect for human rights should be paramount when conducting research with this population. Declaration of interest None. </jats:sec

Future Distribution of Suitable Habitat for Pelagic Sharks in Australia Under Climate Change Models.

Global oceans are absorbing over 90% of the heat trapped in our atmosphere due to accumulated anthropogenic greenhouse gases, resulting in increasing ocean temperatures. Such changes may influence marine ectotherms, such as sharks, as their body temperature concurrently increases toward their upper thermal limits. Sharks are high trophic level predators that play a key role in the regulation of ecosystem structure and health. Because many sharks are already threatened, it is especially important to understand the impact of climate change on these species. We used shark occurrence records collected by commercial fisheries within the Australian continental Exclusive Economic Zone (EEZ) to predict changes in future (2050-2099) relative to current (1956-2005) habitat suitability for pelagic sharks based on an ensemble of climate models and emission scenarios. Our predictive models indicate that future sea temperatures are likely to shift the location of suitable shark habitat within the Australian EEZ. On average, suitable habitat is predicted to decrease within the EEZ for requiem and increase for mackerel sharks, however, the direction and severity of change was highly influenced by the choice of climate model. Our results indicate the need to consider climate change scenarios as part of future shark management and suggest that more broad -scale studies are needed for these pelagic species

Shark conservation hindered by lack of habitat protection

Many of the world's shark populations are in decline, indicating the need for improved conservation and management. Well managed and appropriately located marine parks and marine protected areas (MPAs) have potential to enhance shark conservation by restricting fisheries and protecting suitable habitat for threatened shark populations. Here, we used shark occurrence records collected by commercial fisheries to determine suitable habitat for pelagic sharks within the Australian continental Exclusive Economic Zone (EEZ), and to quantify the amount of suitable habitat contained within existing MPAs. We developed generalised linear models using proportional occurrences of pelagic sharks for three families: Alopiidae (thresher), Carcharhinidae (requiem), and Lamnidae (mackerel) sharks. We also considered aggregated species from the Lamnidae and Carcharhinidae families ('combined sharks' in the models). Using a set of environmental predictors known to affect shark occurrence, including chlorophyll-a concentration, salinity, sea surface temperature, and turbidity, as well as geomorphological, geophysical, and sedimentary parameters, we found that models including sea surface temperature and turbidity were ranked highest in their ability to predict shark distributions. We used these results to predict geographic regions where habitat was most suitable for pelagic sharks within the Australian EEZ, and our results revealed that suitable habitat was limited in no-take zones within MPAs. For all shark groupings, suitable habitats were found mostly at locations exposed to fishing pressure, potentially increasing the vulnerability of the pelagic shark species considered. Our predictive models provide a foundation for future spatial planning and shark management, suggesting that strong fisheries management in addition to MPAs is necessary for pelagic shark conservation

Mapping the evidence on pharmacological interventions for non-affective psychosis in humanitarian non-specialised settings: a UNHCR clinical guidance.

BACKGROUND: Populations exposed to humanitarian emergencies are particularly vulnerable to mental health problems, including new onset, relapse and deterioration of psychotic disorders. Inadequate care for this group may lead to human rights abuses and even premature death. The WHO Mental Health Gap Action Programme Intervention Guide (mhGAP-IG), and its adaptation for humanitarian settings (mhGAP-HIG), provides guidance for management of mental health conditions by non-specialised healthcare professionals. However, the pharmacological treatment of people with non-affective psychosis who do not improve with mhGAP first-line antipsychotic treatments is not addressed. In order to fill this gap, UNHCR has formulated specific guidance on the second-line pharmacological treatment of non-affective psychosis in humanitarian, non-specialised settings. METHODS: Following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, a group of international experts performed an extensive search and retrieval of evidence on the basis of four scoping questions. Available data were critically appraised and summarised. Clinical guidance was produced by integrating this evidence base with context-related feasibility issues, preferences, values and resource-use considerations. RESULTS: When first-line treatments recommended by mhGAP (namely haloperidol and chlorpromazine) are not effective, no other first-generation antipsychotics are likely to provide clinically meaningful improvements. Risperidone or olanzapine may represent beneficial second-line options. However, if these second-line medications do not produce clinically significant beneficial effects, there are two possibilities. First, to switch to the alternative (olanzapine to risperidone or vice versa) or, second, to consider clozapine, provided that specialist supervision and regular laboratory monitoring are available in the long term. If clinically relevant depressive, cognitive or negative symptoms occur, the use of a selective serotonin reuptake inhibitor may be considered in addition or as an alternative to standard psychological interventions. CONCLUSIONS: Adapting scientific evidence into practical guidance for non-specialised health workers in humanitarian settings was challenging due to the paucity of relevant evidence as well as the imprecision and inconsistency of results between studies. Pragmatic outcome evaluation studies from low-resource contexts are urgently needed. Nonetheless, the UNHCR clinical guidance is based on best available evidence and can help to address the compelling issue of undertreated, non-affective psychosis in humanitarian settings