The impact on staff of working with personality disordered offenders: A systematic review

© 2015 Freestone et al. Background: Personality disordered offenders (PDOs) are generally considered difficult to manage and to have a negative impact on staff working with them. Aims: This study aimed to provide an overview of studies examining the impact on staff of working with PDOs, identify impact areas associated with working with PDOs, identify gaps in existing research,and direct future research efforts. Methods: The authors conducted a systematic review of the English-language literature from 1964-2014 across 20 databases in the medical and social sciences. Results: 27 papers were included in the review. Studies identified negative impacts upon staff including: negative attitudes, burnout, stress, negative counter-transferential experiences; two studies found positive impacts of job excitement and satisfaction, and the evidence related to perceived risk of violence from PDOs was equivocal. Studies demonstrated considerable heterogeneity and meta-analysis was not possible. The overall level of identified evidence was low: 23 studies (85%) were descriptive only, and only one adequately powered cohort study was found. Conclusions: The review identified a significant amount of descriptive literature, but only one cohort study and no trials or previous systematic reviews of literatures. Clinicians and managers working with PDOs should be aware of the potential impacts identified, but there is an urgent need for further research focusing on the robust evaluation of interventions to minimise harm to staff working with offenders who suffer from personality disorder Copyright

Effects of an attention demanding task on dynamic stability during treadmill walking

<p>Abstract</p> <p>Background</p> <p>People exhibit increased difficulty balancing when they perform secondary attention-distracting tasks while walking. However, a previous study by Grabiner and Troy (<it>J. Neuroengineering Rehabil</it>., 2005) found that young healthy subjects performing a concurrent Stroop task while walking on a motorized treadmill exhibited <it>decreased </it>step width variability. However, measures of variability do not directly quantify how a system responds to perturbations. This study re-analyzed data from Grabiner and Troy 2005 to determine if performing the concurrent Stroop task directly affected the dynamic stability of walking in these same subjects.</p> <p>Methods</p> <p>Thirteen healthy volunteers walked on a motorized treadmill at their self-selected constant speed for 10 minutes both while performing the Stroop test and during undisturbed walking. This Stroop test consisted of projecting images of the name of one color, printed in text of a different color, onto a wall and asking subjects to verbally identify the color of the text. Three-dimensional motions of a marker attached to the base of the neck (C5/T1) were recorded. Marker velocities were calculated over 3 equal intervals of 200 sec each in each direction. Mean variability was calculated for each time series as the average standard deviation across all strides. Both "local" and "orbital" dynamic stability were quantified for each time series using previously established methods. These measures directly quantify how quickly small perturbations grow or decay, either continuously in real time (local) or discretely from one cycle to the next (orbital). Differences between Stroop and Control trials were evaluated using a 2-factor repeated measures ANOVA.</p> <p>Results</p> <p>Mean variability of trunk movements was significantly reduced during the Stroop tests compared to normal walking. Conversely, local and orbital stability results were mixed: some measures showed slight increases, while others showed slight decreases. In many cases, different subjects responded differently to the Stroop test. While some of our comparisons reached statistical significance, many did not. In general, measures of variability and dynamic stability reflected different properties of walking dynamics, consistent with previous findings.</p> <p>Conclusion</p> <p>These findings demonstrate that the decreased movement variability associated with the Stroop task did <it>not </it>translate to greater dynamic stability.</p

Diagnostic strategy and timing of intervention in infected necrotizing pancreatitis: an international expert survey and case vignette study

AbstractBackgroundThe optimal diagnostic strategy and timing of intervention in infected necrotizing pancreatitis is subject to debate. We performed a survey on these topics amongst a group of international expert pancreatologists.MethodsAn online survey including case vignettes was sent to 118 international pancreatologists. We evaluated the use and timing of fine needle aspiration (FNA), antibiotics, catheter drainage and (minimally invasive) necrosectomy.ResultsThe response rate was 74% (N = 87). None of the respondents use FNA routinely, 85% selectively and 15% never. Most respondents (87%) use a step-up approach in patients with infected necrosis. Walled-off necrosis (WON) is considered a prerequisite for endoscopic drainage and percutaneous drainage by 66% and 12%, respectively. After diagnosing infected necrosis, 55% routinely postpone invasive interventions, whereas 45% proceed immediately to intervention. Lack of consensus about timing of intervention was apparent on day 14 with proven infected necrosis (58% intervention vs. 42% non-invasive) as well as on day 20 with only clinically suspected infected necrosis (59% intervention vs. 41% non-invasive).DiscussionThe step-up approach is the preferred treatment strategy in infected necrotizing pancreatitis amongst expert pancreatologists. There is no uniformity regarding the use of FNA and timing of intervention in the first 2–3 weeks of infected necrotizing pancreatitis

Agricultural Investments and Hunger in Africa Modelling Potential Contributions to SDG 2 - Zero Hunger

We use IFPRI’s IMPACT framework of linked biophysical and structural economic models to examine developments in global agricultural production systems, climate change, and food security. Building on related work on how increased investment in agricultural research, resource management, and infrastructure can address the challenges of meeting future food demand, we explore the costs and implications of these investments for reducing hunger in Africa by 2030. This analysis is coupled with a new investment estimation model, based on the perpetual inventory methodology (PIM), which allows for a better assessment of the costs of achieving projected agricultural improvements. We find that climate change will continue to slow projected reductions in hunger in the coming decades—increasing the number of people at risk of hunger in 2030 by 16 million in Africa compared to a scenario without climate change. Investments to increase agricultural productivity can offset the adverse impacts of climate change and help reduce the share of people at risk of hunger in 2030 to five percent or less in Northern, Western, and Southern Africa, but the share is projected to remain at ten percent or more in Eastern and Central Africa. Investments in Africa to achieve these results are estimated to cost about 15 billion USD per year between 2015 and 2030, as part of a larger package of investments costing around 52 billion USD in developing countries