Images of psychiatry and psychiatrists.

OBJECTIVE: This study surveyed medical teaching faculty to determine their attitudes toward psychiatry and psychiatrists. METHOD: We conducted a multisite survey of a probability sample of 1057 teaching medical faculty members from 15 academic teaching centers in the United Kingdom, Europe, and Asia stratified by early, middle, and late career stage. The average response rate across countries was 65%. RESULTS: The outstanding findings were that 90% of respondents considered that psychiatrists were not good role models for medical students, 84% thought psychiatric patients were unsuitable to be treated outside of specialized facilities, and 73% thought psychiatric patients were emotionally draining. We noted statistically significant differences by country, gender, career stage, and specialty. CONCLUSION: These results highlight why recruitment into psychiatry is problematic in many countries and suggest that greater attention should be given to improving the perception of psychiatrists as good role models and the efficacy of psychiatric treatments

Periodic limb movements in tetraplegia

Objective: To establish the prevalence of Periodic Limb Movements during Sleep (PLMS) in patients with tetraplegia, controlling for obstructive sleep apnea. To explore whether demographic and injury characteristics affect PLMS. Study Design: Retrospective cohorts. Setting and Participants: One hundred seventy-three participants with acute (12 months) tetraplegia who underwent full overnight diagnostic sleep studies. Interventions and outcome measures: Two hundred sixty-two sleep study recordings were included. A randomly selected subgroup of 21 studies was assessed for PLM during wakefulness. Data were analysed according to the current American Academy of Sleep Medicine guidelines. Results: Of the participants, 41.6% (43(15.7) years and 14.9% female) had a motor and sensory complete lesion. Sleep was poor with both OSA (87.8% with apnea hypopnoea index ≥ 5) and PLMS (58.4% with PLMS per hour PLMSI > 15) highly prevalent. There was no difference in the PLMSI between those with OSA (36.3(39.8)) or without (42.2(37.7), P = 0.42). PLMS were evident during REM and NREM sleep in all of the 153 patients with PLMSI > 15. All 21 participants in the subgroup of studies analysed for the PLM during quiet wakefulness, exhibited limb movements. None of the modelled variables (injury completeness, gender, OSA severity or time since injury) significantly predicted a PLMSI > 15 (P = 0.343). Conclusion: In conclusion, this study confirms the high prevalence of PLM in tetraplegia and the presence of leg movements in NREM and REM sleep along with wakefulness after controlling for OSA. No associations between the presence of PLMS and patient characteristics or injury specific aspects were found

Payoff- and Sex-Biased Social Learning Interact in a Wild Primate Population.

Social learning in animals is now well documented, but few studies have determined the contexts shaping when social learning is deployed. Theoretical studies predict copying of conspecifics gaining higher payoffs [1-4], a bias demonstrated in primates only in captivity [5]. In the wild, research has shown selective attention toward the philopatric sex, a group's stable core [6]. Here, we report the first rigorous experimental test of the existence of a payoff bias in wild primates and its interaction with the sex of the model. We created a payoff bias in which an immigrant alpha male in each of three groups of wild vervet monkeys received five times more food upon opening a foraging box than did the philopatric alpha female, whereas in two control groups, male and female models received the same amount of food. We tested whether this payoff asymmetry would override the previously documented selective learning from resident females. Group members were tested after having watched both models. When both models received the same amount of food, audience members copied the female model significantly more than the male model, confirming previous findings. However, when a marked payoff bias was introduced, male, but not female, vervet monkeys significantly more often copied the male model receiving a higher payoff. These results demonstrate behavioral flexibility in the dispersing sex in these primates and suggest that the philopatric sex can afford to be more conservative in their social learning. Our findings show that multiple social-learning biases can coexist and interact within the same species

The burden of co-existing dermatological disorders and their tendency of being overlooked among patients admitted to muhimbili national hospital in Dar es Salaam, Tanzania

\ud Skin diseases are underestimated and overlooked by most clinicians despite being common in clinical practice. Many patients are hospitalized with co-existing dermatological conditions which may not be detected and managed by the attending physicians. The objective of this study was to determine the burden of co-existing and overlooked dermatological disorders among patients admitted to medical wards of Muhimbili National hospital in Dar es Salaam. A hospital-based descriptive cross-sectional study conducted at Muhimbili National hospital in Dar es Salaam, Tanzania. Patients were consecutively recruited from the medical wards. Detailed interview to obtain clinico-demographic characteristics was followed by a complete physical examination. Dermatological diagnoses were made mainly clinically. Appropriate confirmatory laboratory investigations were performed where necessary. Data was analyzed using the 'Statistical Package for Social Sciences' (SPSS) program version 10.0. A p-value of < 0.5 was statistically significant. Three hundred and ninety patients admitted to medical wards were enrolled into the study of whom, 221(56.7%) were females. The mean age was 36.7 ± 17.9 (range 7-84 years). Overall, 232/390 patients (59.5%) had co-existing dermatological disorders with 49% (191/390) having one, 9% (36/390) two and 5 patients (1%) three. A wide range of co-existing skin diseases was encountered, the most diverse being non-infectious conditions which together accounted for 36.4% (142/390) while infectious dermatoses accounted for 31.5% (123/390). The leading infectious skin diseases were superficial fungal infections accounting for 18%. Pruritic papular eruption of HIV/AIDS (PPE) and seborrheic eczema were the most common non-infectious conditions, each accounting for 4.3%. Of the 232/390 patients with dermatological disorders, 191/232 (82.3%) and 154/232 (66.3%) had been overlooked by their referring and admitting doctors respectively. Dermatological disorders are common among patients admitted to medical wards and many are not detected by their referring or admitting physicians. Basic dermatological education should be emphasized to improve knowledge and awareness among clinicians.\u

The images of psychiatry scale: development, factor structure, and reliability.

BACKGROUND: This analysis is based on a survey questionnaire designed to describe medical educators' views of psychiatry and psychiatrists. Our goals in this paper were to assess the psychometric properties of the survey questions by (a) using exploratory factor analysis to identify the basic factor structure underlying 37 survey items; (b) testing the resulting factor structure using confirmatory factor analysis; and (c) assessing the internal reliability of each identified factor. To our knowledge, this is the first attempt to use these techniques to psychometrically assess a scale measuring the strength of stigma that medical educators attached to psychiatry. METHODS: Survey data were collected from a random sample of 1,059 teaching faculty in 23 academic teaching sites in 15 countries. We conducted exploratory and confirmatory factor analysis to identify the scale structure and Cronbach's alpha to assess internal consistency of the resulting scales. RESULTS: Results showed that a two-factor solution was the best fit for the data. Following exploratory factor analysis, we conducted confirmatory factor analysis on a split half of the sample. Results highlighted several items with low loadings. Excluding factors with low correlations and allowing for several correlated variances resulted in a good fitting model explaining 95% of the variance in the data. CONCLUSIONS: We identified two unidimensional scales. The Images Scale contained 11 items measuring stereotypic content concerning psychiatry and psychiatrists. The Efficacy of Psychiatry Scale contained 5 items addressing perceptions of the challenges and effectiveness of psychiatry as a discipline

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

Alternative organizing in times of crisis : resistance assemblages and socio-spatial solidarity

This paper draws on research conducted in Greece, where, during the last seven years, an acute socio-economic crisis has led to the emergence of a number of alternative organizational forms. By foregrounding the term drasis, the unexpected unfolding of an event in a specific space and time, we discuss how these alternative forms assemble differential capacities in order to resist the neoliberal ordering of socio-spatial and economic relations. In particular, we focus on two self-organized spaces, namely, a social centre and a squatted public garden and discuss two concrete instances of drasis. We propose that drasis instigates the establishment and evolution of transformative, prefigurative organizing through three interrelated processes, namely, the formation of resistance assemblages, social learning and socio-spatial solidarity. The paper offers three propositions, suggesting that drasis provides the socio-material conditions through which new resistance formations challenge the established productive forces of society and co-produce alternative forms of civic life.© 2017 published by SAGE. This is an author produced version of a paper published in European Urban and Regional Studies, uploaded in accordance with the publisher’s self- archiving policy. The final published version (version of record) is available online at http://journals.sagepub.com/doi/10.1177/0969776416683001. Some minor differences between this version and the final published version may remain. We suggest you refer to the final published version should you wish to cite from it

Exercising control at the urban scale: Towards a theory of spatial organisation and surveillance

The purpose of this chapter is to explore how urban spaces are implicated in the control and surveillance of users in a culture saturated by the notion of the self as a consuming body or entity. Using the work of Foucault on disciplinary cultures, Lefebvre in relation to the production of space, and other seminal theorists such as Baudrillard, Bauman, Shields, and Walzer, a model for analysing the three dimensions of social spatialisation is proposed and illustrated by reference to contemporary public spaces, and specifically spaces of mundane leisure such as shopping malls and high streets. The chapter deals with how the public realm as a controlling space has been theorised in terms of opposition to such controlling tendencies—from the flaneur, through the self-constructed narratives of De Certeau’s walker to the digitally ‘enhanced’ individual today, appropriating space via technology and their own projects in tinder and so on, and other potentially subversive media