HIV Infection Linked to Substance Use Among Hospitalized Patients With Severe Mental Illness

Last June the National Institute of Mental Health adopted new priorities to address the AIDS epidemic among people with severe mental illness. Besides prevention and treatment, the priorities emphasize the need for a fuller understanding of the extent and social organization of sexual and drug use behavior, the nationwide prevalence of HIV, and the nature of causality between mental illness and HIV infection (1)

A Comparison of Clinical and Judicial Procedures for Reviewing Requests for Involuntary Medication in New York

The Rivers v. Katz decision substituted judicial review for administrative review of requests for involuntary medication of patients in New York State mental hospitals. This change, prompted by concern for the rights of involuntarily committed patients, did not delay or diminish the use of involuntary medication in a large state hospital. Advantages of judicial review include a better understanding by clinicians of the legal basis for involuntary medication and greater patient participation in the review procedure. Disadvantages include lack of an independent clinical review and increased costs

A Lifetime Alcohol or Other Drug Use Disorder and Specific Psychiatric Symptoms Predict Sexual Risk for HIV Infection Among People With Severe Mental Illness

To clarify the relative contributions of psychiatric and alcohol or other drug (AOD) use disorders on sexual risk for HIV infection among people with severe mental illness, we interviewed 195 psychiatric patients. In the prior 6 months the 100 (51%) sexually active patients had a mean of 3.9 sex partners and 27.5 sex episodes; 49% had known high-risk sex partners; 34% used AOD during sex; 28% traded sex; and 59% never used condoms. The likelihood of being sexually active decreased with age and cognitive symptoms, increased with excited symptoms, and was more than twice as high for African-American patients as others. The likelihood of trading sex increased with cognitive symptoms. The likelihood of having a sexually transmitted disease history (reported by 32% of all patients) increased with depressed/anxious symptoms, a lifetime AOD use diagnosis (obtained for 57% of patients), and was more than twice as high for African-American patients as others. HIV prevention interventions that address specific psychiatric conditions and developmental and cultural issues of psychiatric patients should be developed and tested

Rivers in practice: clinicians' assessments of patients' decision-making capacity

Since the Rivers v. Katz decision in 1986, clinicians in New York State have been required to assess patient decision-making capacity before judicial review of petitions to administer involuntary medication. The authors examined 42 capacity assessments made by psychiatrists at a large state hospital in New York City. Although the capacity assessments were often incomplete and rarely addressed the treatment decision, most clinicians judged patients as lacking capacity to make treatment decisions. The findings suggest that psychiatrists may view capacity assessments as irrelevant because of the manifestly grave nature of patients' illnesses or may not differentiate the capacity assessment from the mental status examination. The capacity assessment may nonetheless be a useful tool because it encourages clinicians to discuss the proposed treatment with patients and to present information more effectively in court

Outcome of Involuntary Medication in a State Hospital System

Objective: The purpose of the study was to examine the course of involuntarily administered medication in a state hospital population. Method: The authors retrospectively examined the records of all 51 involuntarily medicated patients in six state hospitals in New York City in a single calendar year. Clinical course was recorded for the period of involuntary medication and for 12 months thereafter. These patients were compared to 51 patients on the same wards who accepted medication. Results: Clinicians assessed involuntarily medicated patients as more dangerous to themselves or others and less delusional after treatment than the comparison patients. Long-acting intramuscular antipsychotics were prescribed more frequently for involuntarily medicated patients. No differences were observed in rates of discharge, outpatient cooperation, or rehospitalization. Half of the patients in both groups remained continuously institutionalized, and of those who left the hospital, only 30% of the involuntarily medicated group and 40% of the comparison group took medication as outpatients. Conclusions: For these chronically severely ill patients, involuntary medication did not appear to enhance insight or cooperation or result in rapid return to the community. Involuntary medication is often a necessary short-term, in-hospital management strategy, but it does not replace the need to develop comprehensive, long-term inpatient and community-based approaches to the management of treatment refusal

The Role of Climate and Bed Topography on the Evolution of the Tasman Glacier Since the Last Glacial Maximum

Mountain glaciers respond to climatic changes by advancing or retreating, leaving behind a potentially powerful record of climate through moraine deposition. Estimates of past climate have been made based on the moraine record alone, using geometrical arguments; however, these methods necessarily ignore the effects of glacier dynamics and bed modification. Here, a one-dimensional coupled mass balance-flowline model is used to place constraints on the climate of the Late-glacial (13.5–11.6 kyr ago) and Last Glacial Maximum (LGM, 28 – 17.5 kyr ago) based on the well-mapped and -dated moraines at Tasman Glacier/Lake Pukaki, South Island, New Zealand. Due to the highly-dynamic nature of the system, distinct longitudinal bed profiles are considered for each of the glaciations modelled; the reconstructions show that terminal overdeepenings are likely present in all bed profiles, and hundreds of metres of sediment has been deposited in the glacier valley since the LGM. Using the coupled model and calculated bed topography, a 2.2°C temperature depression from the present is necessary to reproduce the Lateglacial ice extent, and 7.0°C is required for the early LGM, assuming presentday precipitation. The modelled Late-glacial ice extent is more sensitive to precipitation variability than that during the LGM, but the Tasman Glacier during both periods is primarily driven by temperature changes. While the Tasman Glacier shrank between the early and late LGM, modelling demonstrates that changes in bed topography due to erosion, transport and deposition of sediment are a major driver in reduction of glacier extent; a temperature increase of only 0.1°C is required to cause the transition between the two periods, which may be attributable to interannual, zero-trend climate variability. Thus, the consideration of the coupled glacier-sediment system is critical in accurately reconstructing past climate. Future work focusing on modelling this coupled system, such that the bed profile can evolve interactively with glacier flow, will be critical in better resolving transient events such as the early to late LGM transition

The Spatial Structure of the Annual Cycle in Surface Temperature: Amplitude, Phase, and Lagrangian History

The climatological annual cycle in surface air temperature, defined by its amplitude and phase lag with respect to solar insolation, is one of the most familiar aspects of the climate system. Here, the authors identify three first-order features of the spatial structure of amplitude and phase lag and explain them using simple physical models. Amplitude and phase lag 1) are broadly consistent with a land and ocean end-member mixing model but 2) exhibit overlap between land and ocean and, despite this overlap, 3) show a systematically greater lag over ocean than land for a given amplitude. Based on previous work diagnosing relative ocean or land influence as an important control on the extratropical annual cycle, the authors use a Lagrangian trajectory model to quantify this influence as the weighted amount of time that an ensemble of air parcels has spent over ocean or land. This quantity explains 84% of the space–time variance in the extratropical annual cycle, as well as features 1 and 2. All three features can be explained using a simple energy balance model with land and ocean surfaces and an advecting atmosphere. This model explains 94% of the space–time variance of the annual cycle in an illustrative midlatitude zonal band when incorporating the results of the trajectory model. The aforementioned features of annual variability in surface air temperature thus appear to be explained by the coupling of land and ocean through mean atmospheric circulation.Earth and Planetary Science

The value of initial condition large ensembles to robust adaptation decision-making

© The Author(s), 2020. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Mankin, J. S., Lehner, F., Coats, S., & McKinnon, K. A. The value of initial condition large ensembles to robust adaptation decision-making. Earth's Future, 8(10), (2020): e2012EF001610, doi:10.1029/2020EF001610.The origins of uncertainty in climate projections have major consequences for the scientific and policy decisions made in response to climate change. Internal climate variability, for example, is an inherent uncertainty in the climate system that is undersampled by the multimodel ensembles used in most climate impacts research. Because of this, decision makers are left with the question of whether the range of climate projections across models is due to structural model choices, thus requiring more scientific investment to constrain, or instead is a set of equally plausible outcomes consistent with the same warming world. Similarly, many questions faced by scientists require a clear separation of model uncertainty and that arising from internal variability. With this as motivation and the renewed attention to large ensembles given planning for Phase 7 of the Coupled Model Intercomparison Project (CMIP7), we illustrate the scientific and policy value of the attribution and quantification of uncertainty from initial condition large ensembles, particularly when analyzed in conjunction with multimodel ensembles. We focus on how large ensembles can support regional‐scale robust adaptation decision‐making in ways multimodel ensembles alone cannot. We also acknowledge several recently identified problems associated with large ensembles, namely, that they are (1) resource intensive, (2) redundant, and (3) biased. Despite these challenges, we show, using examples from hydroclimate, how large ensembles provide unique information for the scientific and policy communities and can be analyzed appropriately for regional‐scale climate impacts research to help inform risk management in a warming world.F. L. has been supported by the Swiss NSF (grant no. PZ00P2_174128), the NSF Division of Atmospheric and Geospace Sciences (grant no. AGS‐0856145, Amendment 87), and the Regional and Global Model Analysis (RGMA) component of the Earth and Environmental System Modeling Program of the U.S.Department of Energy’s Office of Biological & Environmental Research (BER) via NSF IA 1844590. This is SOEST publication no. 11115

Decoding the precision of historical temperature observations

Historical observations of temperature underpin our ability to monitor Earth’s climate. We identify a pervasive issue in archived observations from surface stations, wherein the use of varying conventions for units and precision has led to distorted distributions of the data. Apart from the original precision being generally unknown, the majority of archived temperature data are found to be misaligned with the original measurements because of rounding on a Fahrenheit scale, conversion to Celsius, and re-rounding. Furthermore, we show that commonly used statistical methods including quantile regression are sensitive to the finite precision and to double-rounding of the data after unit conversion. To remedy these issues, we present a Hidden Markov Model that uses the differing frequencies of specific recorded values to recover the most likely original precision and units associated with each observation. This precision-decoding algorithm is used to infer the precision of the 644 million daily surface temperature observations in the Global Historical Climate Network database, providing more accurate values for the 63% of samples found to have been biased by double-rounding. The average absolute bias correction across the dataset is 0.018 ◦C, and the average inferred precision is 0.41 ◦C, even though data are archived at 0.1 ◦C precision. These results permit better inference of when record temperatures occurred, correction of rounding effects, and identification of inhomogeneities in surface temperature time series, amongst other applications. The precision-decoding algorithm is generally applicable to rounded observations–including surface pressure, humidity, precipitation, and other temperature data–thereby offering the potential to improve quality-control procedures for many datasets.Earth and Planetary Science