Shared decision-making in ongoing outpatient psychiatric treatment

Objective: Research on patient involvement in decision-making in psychiatry has focused on first encounters. This study investigated what decisions are made, level of patient involvement and factors influencing patient involvement in ongoing outpatient visits. Methods:72 visits conducted by 20 psychiatrists were video recorded. Patients had a diagnosis of depression or schizophrenia. Results: On average, there was one medication related and one other decision per visit. Some psychiatrists involved patients more in decisions, as did female psychiatrists. Involvement was lower when patients had more negative symptoms. Conclusion: Involvement in decision-making appears to be influenced by the individual psychiatrist and specific symptoms but not visit length. Practice implications:It is noteworthy that patient involvement is not influenced by length of the visit given that this would be a barrier in busy clinical practice. The next step would be to identify the communication patterns of psychiatrists who involve patients more in decision-making

Practical long-distance quantum key distribution system using decoy levels

Quantum key distribution (QKD) has the potential for widespread real-world applications. To date no secure long-distance experiment has demonstrated the truly practical operation needed to move QKD from the laboratory to the real world due largely to limitations in synchronization and poor detector performance. Here we report results obtained using a fully automated, robust QKD system based on the Bennett Brassard 1984 protocol (BB84) with low-noise superconducting nanowire single-photon detectors (SNSPDs) and decoy levels. Secret key is produced with unconditional security over a record 144.3 km of optical fibre, an increase of more than a factor of five compared to the previous record for unconditionally secure key generation in a practical QKD system.Comment: 9 page

Anorgasmia in women

This article reports on the etiology and treatment of anorgasmia. Etiological factors include childhood and adolescent experiences, current individual attitudes, and lifestyle factors, as well as the quality and dynamics of past and present committed relationships. It is important to assess the nature of each of the previously mentioned factors in determining the nature of the orgasmic dysfunction as well as assisting in the development of a treatment plan. Treatment approaches for anorgasmia need to address individual factors (e.g., performance anxiety, poor body image) as well as interpersonal problems. A systemic treatment framework would appear to be the most useful approach to treat this sexual dysfunction, as this type of strategy identifies and treats the difficulties experienced by the anorgasmic woman within the total context of her life. Of course, this approach necessitates the involvement of the partner in therapy, and treatment is unlikely to be effective unless the problems experienced by both the woman and her partner are addressed. Limitations of past research in terms of inadequate evaluation of treatment, low sample sizes, and poorly defined interventions are discussed. Finally, directions for future research to advance our understanding of the most effective treatments for anorgasmia are considered. <br /

Comparative Judgement Modeling to Map Forced Marriage at Local Levels

Forcing someone into marriage against their will is a violation of their human rights. In 2021, the county of Nottinghamshire, UK, launched a strategy to tackle forced marriage and violence against women and girls. However, accessing information about where victims are located in the county could compromise their safety, so it is not possible to develop interventions for different areas of the county. Comparative judgement studies offer a way to map the risk of human rights abuses without collecting data that could compromise victim safety. Current methods require studies to have a large number of participants, so we develop a comparative judgement model that provides a more flexible spatial modelling structure and a mechanism to schedule comparisons more effectively. The methods reduce the data collection burden on participants and make a comparative judgement study feasible with a small number of participants. Underpinning these methods is a latent variable representation that improves on the scalability of previous comparative judgement models. We use these methods to map the risk of forced marriage across Nottinghamshire thereby supporting the county's strategy for tackling violence against women and girls.Comment: Submitted. 31 pages, 8 figure

Monte Carlo Simulations of Conformal Theory Predictions for the 3-state Potts and Ising Models

The critical properties of the 2D Ising and 3-state Potts models are investigated using Monte Carlo simulations. Special interest is given to measurement of 3-point correlation functions and associated universal objects, i.e. structure constants. The results agree well with predictions coming from conformal field theory confirming, for these examples, the correctness of the Coulomb gas formalism and the bootstrap method.Comment: 11 pages, 6 Postscript figures, uses Revte

Partial encapsulation of Pd particles by reduced ceria-zirconia

Direct observation of metal-oxide interfaces with atomic resolution can be achieved by cross-sectional high-resolution transmission electron microscopy (HRTEM). Using this approach to study the response of a model, single-crystal thin film automotive exhaust-gas catalyst, Pd particles supported on the (111) ceria-zirconia (CZO) surface, to a redox cycle, we have found two distinct processes for the partial encapsulation of the Pd particles by the reduced CZO surface that depend on their relative crystallographic orientations. In the case of the preferred orientation found for Pd particles on CZO, Pd(111)[110]//CZO(111)[110]Pd(111)[110]∕∕CZO(111)[110], a flat and sharp metal/oxide interface was maintained upon reduction, while ceria-zirconia from the adjacent surface tended to accumulate on and around the Pd particle. In rare cases, Pd particles with other orientations tended to sink into the oxide support upon reduction. Possible mechanisms for these encapsulation processes are proposed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87836/2/201915_1.pd

The Relationship between Therapeutic Alliance and Service User Satisfaction in Mental Health Inpatient Wards and Crisis House Alternatives: A Cross-Sectional Study

Background Poor service user experiences are often reported on mental health inpatient wards. Crisis houses are an alternative, but evidence is limited. This paper investigates therapeutic alliances in acute wards and crisis houses, exploring how far stronger therapeutic alliance may underlie greater client satisfaction in crisis houses. Methods and Findings Mixed methods were used. In the quantitative component, 108 crisis house and 247 acute ward service users responded to measures of satisfaction, therapeutic relationships, informal peer support, recovery and negative events experienced during the admission. Linear regressions were conducted to estimate the association between service setting and measures, and to model the factors associated with satisfaction. Qualitative interviews exploring therapeutic alliances were conducted with service users and staff in each setting and analysed thematically. Results We found that therapeutic alliances, service user satisfaction and informal peer support were greater in crisis houses than on acute wards, whilst self-rated recovery and numbers of negative events were lower. Adjusted multivariable analyses suggest that therapeutic relationships, informal peer support and negative experiences related to staff may be important factors in accounting for greater satisfaction in crisis houses. Qualitative results suggest factors that influence therapeutic alliances include service user perceptions of basic human qualities such as kindness and empathy in staff and, at service level, the extent of loss of liberty and autonomy. Conclusions and Implications We found that service users experience better therapeutic relationships and higher satisfaction in crisis houses compared to acute wards, although we cannot exclude the possibility that differences in service user characteristics contribute to this. This finding provides some support for the expansion of crisis house provision. Further research is needed to investigate why acute ward service users experience a lack of compassion and humanity from ward staff and how this could be changed

Extended scope of nursing practice: a multicentre randomised controlled trial of appropriately trained nurses and pre-registration house officers in pre-operative assessment in elective general surgery

Aim/ Principal Research Question:1) To determine whether pre-operative assessment carried out by an appropriately trained nurse (ATN) is equivalent in quality to that carried out by a pre-registration house officer (PRHO).2) To assess whether pre-assessments carried out by ATNs and PRHOs are equivalent in terms of cost.3) To determine whether assessments carried out by ATNs are acceptable to patients.4) To investigate the quality of communication between senior medical staff and ATNs.Factors of Interest:The extended role of appropriately trained nurses and pre-registration house officers in pre-operative assessment in elective general surgery.Methods:The study design was principally a prospective randomised equivalence trial but was accompanied by additional qualitative assessment of patient and staff perceptions, and an economic evaluation.The intervention consisted of a pre-operative assessment carried out by either an ATN or a PRHO. Of the patients who completed the study with a full evaluation, 926 patients were randomised to the PRHO arm of the trial and 948 to the ATN arm. Three ATNs took part in the study, one from each centre, together with a total of 87 PRHOs.Immediately following the initial assessment of a patient by a PRHO or an ATN, one of a number of clinical research fellows, all specialist registrars in anaesthetics, repeated the assessment and recorded it on a study form, together with a list of investigations required. The clinical research fellow then evaluated the competency of the initial assessor by comparing the quality of their assessment with their own. Any deficiencies in ordering of investigations and referral to other specialities were met in order to maximise patient care.Sample groups:All patients attending at one site for assessment prior to general anaesthetic for elective general, vascular, urological or breast surgery were potentially included in the study. Of 1907 patients who were randomised, 1874 completed the study with a full evaluation.The study was carried out at four NHS hospitals, three of which were teaching hospitals, in three NHS Trusts in Southampton, Sheffield and Doncaster.Outcome measures:Three areas of ATN and PRHO performance were judged separately, history taking, examination and ordering of tests, and each was graded into one of four categories, the most important of which was under-assessment, which would possibly have affected peri-operative management. In the case of ordering of tests, it was possible to have both over- and under-assessed a patient on different tests.Findings:The pre-operative assessments carried out by the ATNs were essentially equivalent to those performed by the PRHOs in terms of under-assessment that might possibly have affected peri-operative management, although there was variation between the ATNs in terms of the quality of history taking. This may be related to the low number of patients seen at one study site.PRHOs ordered significantly more unnecessary tests than the ATNs. The substitution of ATNs for PRHOs was calculated to be cost neutral.The results of the qualitative assessment showed that the use of ATNs for pre-operative assessment was acceptable to patients; however, there was no evidence that communication between senior medical staff and those carrying out pre-operative assessments was improved by their introduction.Conclusions:This study demonstrated no reason to inhibit the development of fully nurse-led pre-operative assessment, provided that the nurses are appropriately trained and maintain sufficient workload to retain skills.Implications for Further Research:Further research is needed in the following areas:1) the extent and type of training needed for nurses undertaking the pre-operative assessment role2) the use, costs and benefits of routine pre-operative testing.<br/