Comprehensive Evidence-Based Program Teaching Self-Management of Auditory Hallucinations on Inpatient Psychiatric Units

Patients hearing command hallucinations to harm whose only self-management strategies are to obey these commands, can represent serious safety concerns on inpatient psychiatric units. A comprehensive evidence-based program teaching self-management of auditory hallucinations on inpatient psychiatric units is described that includes five components: suggestions for staff education; patient self-assessment tools; an interview guide and safety protocol; a course to teach strategies for managing distressing voices and commands to harm; suggestions to improve staff communication; and a plan to extend the program from inpatient care settings into the community by sharing materials with community case managers and caregivers when patients are discharged

OPTIMISING KINETICS IN THE FREESTYLE FLIP TURN PUSH-OFF

INTRODUCTION: Turning technique is an important component in swimming performance with turn times positively correlating with final event time. However, little is known about the mechanics of an effective turn. This study sought to provide an exploratory analysis of how various kinetic and hydrodynamic variables during wall push-off are related to the wall exit velocity. METHODS: Thirty experienced male swimmers with body types of within one SD of the mean for selected anthropometric parameters reported for elite male adult swimmers (Mazza et al., 1994) were recruited for the study. During three freestyle flip turns, selected kinetic, hydrodynamic and kinematic variables of the wall pushoff were recorded. The wall push-off phase was measured from the point of maximum knee flexion during wall contact until the feet left the wall. Kinetics were recorded via a 2D vertically mounted forceplate which recorded peak push-off force and total impulse. The acceleration of each swimmer’s centre of gravity (CG) and wall exit velocity of the CG were calculated from underwater videography. Hydrodynamic peak drag force and drag impulse were calculated from the kinetic and kinematic data using a derivative of Newton’s second law. RESULTS: A stepwise regression was performed with wall exit velocity as the criterion variable and push-off time, peak propulsive force, total propulsive impulse, peak drag force, and total drag impulse as the independent variables. The stepwise regression yielded peak drag force, peak propulsive force and push-off time in the equation, with beta values indicating that the peak drag force carried the highest weighting of the three variables. CONCLUSIONS: The results of the stepwise regression indicated that an optimal combination of a low peak drag force, high peak propulsive force and increased wall time produced the fastest wall exit velocity. The inclusion of the peak drag force in the regression equation as the most important predictor of wall exit velocity highlights the importance of drag in turning technique. Factors such as very high push-off forces and exaggerated movements during wall push-off may lead to higher peak drag forces which, in turn, could be detrimental to the overall turning performance

Paediatric traumatic cardiac arrest: A Delphi study to establish consensus on definition and management

Aims Paediatric traumatic cardiac arrest (TCA) is associated with low survival and poor outcomes. The mechanisms that underlie TCA are different from medical cardiac arrest; the approach to treatment of TCA may therefore also need to differ to optimise outcomes. The aim of this study was to explore the opinion of subject matter experts regarding the diagnosis and treatment of paediatric TCA, and to reach consensus on how best to manage this group of patients.Methods An online Delphi study was conducted over three rounds, with the aim of achieving consensus (defined as 70% agreement) on statements related to the diagnosis and management of paediatric TCA. Participants were invited from paediatric and adult emergency medicine, paediatric anaesthetics, paediatric ICU and paediatric surgery, as well as Paediatric Major Trauma Centre leads and representatives from the Resuscitation Council UK. Statements were informed by literature reviews and were based on elements of APLS resuscitation algorithms as well as some concepts used in the management of adult TCA; they ranged from confirmation of cardiac arrest to the indications for thoracotomy.Results 73 experts completed all three rounds between June and November 2016. Consensus was reached on 14 statements regarding the diagnosis and management of paediatric TCA; oxygenation and ventilatory support, along with rapid volume replacement with warmed blood, improve survival. The duration of cardiac arrestand the lack of a response to intervention, along with cardiac standstill on ultrasound, help to guide the decision to terminate resuscitation.Conclusion This study has given a consensus-based framework to guide protocol development in the management of paediatric TCA, though further work is required in other key areas including its acceptability to clinicians

Effects of gabapentin on muscle spasticity and both induced as well as spontaneous autonomic dysreflexia after complete spinal cord injury

We recently reported that the neuropathic pain medication, gabapentin (GBP; Neurontin), significantly attenuated both noxious colorectal distension (CRD)-induced autonomic dysreflexia (AD) and tail pinch-induced spasticity compared to saline-treated cohorts 2–3 weeks after complete high thoracic (T4) spinal cord injury (SCI). Here we employed long-term blood pressure telemetry to test, firstly, the efficacy of daily versus acute GBP treatment in modulating AD and tail spasticity in response to noxious stimuli at 2 and 3 weeks post-injury. Secondly, we determined whether daily GBP alters baseline cardiovascular parameters, as well as spontaneous AD events detected using a novel algorithm based on blood pressure telemetry data. At both 14 and 21 days after SCI, irrespective of daily treatment, acute GBP given 1 h prior to stimulus significantly attenuated CRD-induced AD and pinch-evoked tail spasticity; conversely, acute saline had no such effects. Moreover, daily GBP did not alter 24 h mean arterial pressure (MAP) or heart rate (HR) values compared to saline treatment, nor did it reduce the incidence of spontaneous AD events compared to saline over the three week assessment period. Power spectral density (PSD) analysis of the MAP signals demonstrated relative power losses in mid frequency ranges (0.2–0.8 Hz) for all injured animals relative to low frequency MAP power (0.02–0.08 Hz). However, there was no significant difference between groups over time post-injury; hence, GBP had no effect on the persistent loss of MAP fluctuations in the mid frequency range after injury. In summary, the mechanism(s) by which acute GBP treatment mitigate aberrant somatosensory and cardiophysiological responses to noxious stimuli after SCI remain unclear. Nevertheless, with further refinements in defining the dynamics associated with AD events, such as eliminating requisite concomitant bradycardia, the objective repeatability of automatic detection of hypertensive crises provides a potentially useful tool for assessing autonomic function pre- and post-SCI, in conjunction with experimental pharmacotherapeutics for neuropathic pain, such as GBP

Effects of insulin on intracellular GLUT4 vesicles in adipocytes: Evidence for a secretory mode of regulation

The facilitative glucose transporter, GLUT4 undergoes insulin-dependent movement to the cell surface in adipocytes, The magnitude of the insulin effect is much greater for CLUT4 than other recycling proteins such as the CD-MPR, In the present study we have studied the colocalisation of these proteins in adipocytes in an effort to explain this selective insulin-dependent recruitment of CLUT4, Using immunofluorescence microscopy or immuno-EM on 3T3-L1 adipocytes we find that there is considerable colocalisation between these proteins particularly within the area of the TGN, However, the distribution of CD-MPR was not significantly effected by insulin. The insulin-dependent recruitment of GLUT4 was concomitant with a selective decrease in GLUT4 labelling of cytoplasmic vesicles whereas the amount of CLUT4 in the TGN region (approx. 50% of total GLUT4) was relatively unaffected. To explore the possibility that the cytoplasmic GLUT4(+) vesicles represent an intracellular insulin-responsive storage compartment we performed quantitative immuno-EM on whole mounts of intracellular vesicles isolated from basal and insulin-stimulated adipocytes. These studies revealed that: (1) GLUT4 and CD-MPR were concentrated in small (30-200 nm) vesicles at a labelling density of 1-20+ gold particles/vesicle; (2) there was significant overlap between both proteins in that 70% of the total GLUT4 pool colocalised with CD-MPR; (3) a significant amount of GLUT4 (approx, 50% of total) was found in a subpopulation of vesicles that contained as little as 5% of the total CD-MPR pool; (4) the GLUT4(+)/CD-MPR(-) vesicles were highly insulin-responsive, and (5) the total number of GLUT4(+) vesicles, but not CD-MPR(+) vesicles, decreased by approx. 30% in response to insulin treatment. These data are consistent with a model in which GLUT4 is selectively sorted into a vesicular compartment in adipocytes that is recruited to the plasma membrane by insulin stimulation

PBjam: A Python package for automating asteroseismology of solar-like oscillators

Asteroseismology is an exceptional tool for studying stars by using the properties of observed modes of oscillation. So far the process of performing an asteroseismic analysis of a star has remained somewhat esoteric and inaccessible to non-experts. In this software paper we describe PBjam, an open-source Python package for analyzing the frequency spectra of solar-like oscillators in a simple but principled and automated way. The aim of PBjam is to provide a set of easy-to-use tools to extract information about the radial and quadrupole oscillations in stars that oscillate like the Sun, which may then be used to infer bulk properties such as stellar mass, radius and age or even structure. Asteroseismology and its data analysis methods are becoming increasingly important as space-based photometric observatories are producing a wealth of new data, allowing asteroseismology to be applied in a wide range of contexts such as exoplanet, stellar structure and evolution, and Galactic population studies.Comment: 12 Pages, 4 figures. Accepted for publication in AJ. Associated software available at https://doi.org/10.5281/zenodo.430007

Educational interventions to prevent paediatric abusive head trauma in babies younger than one year old: A systematic review and meta-analyses

AbstractBackgroundPaediatric abusive head trauma (AHT) occurs in young children due to violent shaking or blunt impact. Educational and behavioural programmes modifying parent/infant interactions may aid primary prevention. This systematic review aims to assess the effectiveness of such interventions to prevent AHT in infants.MethodsWe searched Embase, MEDLINE, PsycINFO, The Cochrane library, CINAHL databases and trial registries to September 2021, for studies assessing the effectiveness of educational and behavioural interventions in preventing AHT. Eligible interventions had to include messaging about avoiding or dangers of infant shaking. Randomised controlled trials (RCTs) reporting results for primary (AHT, infant shaking) or secondary outcomes (including parental responses to infant crying, mental wellbeing), and non-randomised studies (NRSs) reporting primary outcomes were included. Evidence from combinable studies was synthesised using random-effects meta-analyses. Certainty of evidence was assessed using GRADE framework. PROSPERO registration CRD42020195644.FindingsOf 25 identified studies, 16 were included in meta-analyses. Five NRSs reported results for AHT, of which four were meta-analysed (summary odds ratio [OR] 0.95, 95 % confidence intervals [CI] 0.80–1.13). Two studies assessed self-reported shaking (one cluster-RCT, OR 0.11, 95 % CI 0.02–0.53; one cohort study, OR 0.36, 95 % CI 0.20–0.64, not pooled). Meta-analyses of secondary outcomes demonstrated marginal improvements in parental response to inconsolable crying (summary mean difference 1.58, 95 % CI 0.11–3.06, on a 100-point scale) and weak evidence that interventions increased walking away from crying infants (summary incidence rate ratio 1.52, 95 % CI 0.94–2.45). No intervention effects were found in meta-analyses of parental mental wellbeing or other responses to crying.InterpretationLow certainty evidence suggests that educational programmes for AHT prevention are not effective in preventing AHT. There is low to moderate certainty evidence that educational interventions have no effect or only marginally improve some parental responses to infant crying

The Star Formation Reference Survey. I. Survey Description and Basic Data

Star formation is arguably the most important physical process in the cosmos. It is a fundamental driver of galaxy evolution and the ultimate source of most of the energy emitted by galaxies. A correct interpretation of star formation rate (SFR) measures is therefore essential to our understanding of galaxy formation and evolution. Unfortunately, however, no single SFR estimator is universally available or even applicable in all circumstances: the numerous galaxies found in deep surveys are often too faint (or too distant) to yield significant detections with most standard SFR measures, and until now there have been no global, multi-band observations of nearby galaxies that span all the conditions under which star-formation is taking place. To address this need in a systematic way, we have undertaken a multi-band survey of all types of star-forming galaxies in the local Universe. This project, the Star Formation Reference Survey (SFRS), is based on a statistically valid sample of 369 nearby galaxies that span all existing combinations of dust temperature, SFR, and specific SFR. Furthermore, because the SFRS is blind with respect to AGN fraction and environment it serves as a means to assess the influence of these factors on SFR. Our panchromatic global flux measurements (including GALEX FUV+NUV, SDSS ugriz, 2MASS JHKs, Spitzer 3-8{\mu}m, and others) furnish uniform SFR measures and the context in which their reliability can be assessed. This paper describes the SFRS survey strategy, defines the sample, and presents the multi-band photometry collected to date.Comment: 48 pages, 12 figures, 10 tables. Accepted by PASP. This version edited to correct references and typographical error

Variation in treatment of acute childhood wheeze in emergency departments of the United Kingdom and Ireland: An international survey of clinician practice

© 2015, BMJ Publishing Group. All rights reserved. Objective: National clinical guidelines for childhood wheeze exist, yet despite being one of the most common reasons for childhood emergency department (ED) attendance, signi ficant variation in practice occurs in other settings. We, therefore, evaluated practice variations of ED clinicians in the UK and Ireland. Design: Two-stage survey undertaken in March 2013. Stage one examined department practice and stage two assessed ED consultant practice in acute childhood wheeze. Questions interrogated pharmacological and other management strategies, including inhaled and intravenous therapies. Setting and participants: Member departments of Paediatric Emergency Research in the United Kingdom and Ireland and ED consultants treating children with acute wheeze. Results: 30 EDs and 183 (81%) clinicians responded. 29 (97%) EDs had wheeze guidelines and 12 (40%) had care pathways. Variation existed between clinicians in dose, timing and frequency of inhaled bronchodilators across severities. When escalating to intravenous bronchodilators, 99 (54%) preferred salbutamol first line, 52 (28%) magnesium sulfate (MgSO4) and 27 (15%) aminophylline. 87 (48%) administered intravenous bronchodilators sequentially and 30 (16%) concurrently, with others basing approach on case severity. 146 (80%) continued inhaled therapy after commencing intravenous bronchodilators. Of 170 who used intravenous salbutamol, 146 (86%) gave rapid boluses, 21 (12%) a longer loading dose and 164 (97%) an ongoing infusion, each with a range of doses and durations. Of 173 who used intravenous MgSO4, all used a bolus only. 41 (24%) used non-invasive ventilation. Conclusions: Signi ficant variation in ED consultant management of childhood wheeze exists despite the presence of national guidance. This reflects the lack of evidence in key areas of childhood wheeze and emphasises the need for further robust multicentre research studies