Identification of Violence in Psychiatric Case Presentations

Previous research on medical discourse suggests that physicians minimize patients\u27 social problems through conversational and linguistic interactions. There has been little assessment, however, of the neglect of violence by psychiatric staff. In an attempt to address this important area, the case presentations of 77 recently violent psychiatric patients were examined. A contextual analysis of the violence mentioned during the case presentations revealed four categories of identification violence as part of the primary problem, as a psychiatric disorder, as an unrelated incident, or not mentioned at all In nearly two-thirds of the case presentations, the violence was not identified as part of the primary problem The findings and case examples substantiate the assertion that social problems are neglected, minimized, or medicalized in medical discourse They also suggest that clinical protocol should be established to ensure more extensive consideration of the dangerousness implied by reported violenc

Urban American Indian Community Health Beliefs Associated with Addressing Cancer in the Northern Plains Region

American Indians residing in the Northern Plains region of the Indian Health Service experience some of the most severe cancer-related health disparities. We investigated ways in which the community climate among an American Indian population in an urban community in the Northern Plains region influences community readiness to address cancer. A Community Readiness Assessment, following the Community Readiness Model, conducted semi-structured interviews with eight educators, eight students, and eight community leaders from the American Indian community in Omaha’s urban American Indian population and established the Northern Plains region community at a low level of readiness to address cancer. This study reports on a subsequent qualitative study that analyzed all 24 interview transcriptions for emergent themes to help understand the prevailing attitude of the community toward cancer. A synthesis of six emergent themes revealed that the community’s perceptions of high levels of severity and barriers, paired with perceptions of low levels of susceptibility and benefits, lead to low levels of self-efficacy, all of which are reflected in minimal cues to action and little effort to address cancer. These findings, interpreted through the lens of the Health Belief Model, can inform the development of more community-based, comprehensive, and culturally appropriate approaches to address the multilevel determinants of health behaviors in relation to cancer among American Indians in the Northern Plains region

Offsprings of a point vortex

The distribution engendered by successive splitting of one point vortex are considered. The process of splitting a vortex in three using a reverse three-point vortex collapse course is analysed in great details and shown to be dissipative. A simple process of successive splitting is then defined and the resulting vorticity distribution and vortex populations are analysed

Mesoscale eddy-internal wave coupling. Part I : symmetry, wave capture, and results from the Mid-Ocean Dynamics Experiment

Author Posting. © American Meteorological Society, 2008. This article is posted here by permission of American Meteorological Society for personal use, not for redistribution. The definitive version was published in Journal of Physical Oceanography 38 (2008): 2556-2574, doi:10.1175/2008JPO3666.1.Vertical profiles of horizontal velocity obtained during the Mid-Ocean Dynamics Experiment (MODE) provided the first published estimates of the high vertical wavenumber structure of horizontal velocity. The data were interpreted as being representative of the background internal wave field, and thus, despite some evidence of excess downward energy propagation associated with coherent near-inertial features that was interpreted in terms of atmospheric generation, these data provided the basis for a revision to the Garrett and Munk spectral model. These data are reinterpreted through the lens of 30 years of research. Rather than representing the background wave field, atmospheric generation, or even near-inertial wave trapping, the coherent high wavenumber features are characteristic of internal wave capture in a mesoscale strain field. Wave capture represents a generalization of critical layer events for flows lacking the spatial symmetry inherent in a parallel shear flow or isolated vortex.Salary support for this analysis was provided by Woods Hole Oceanographic Institution bridge support funds

Development of an online intervention for the Rehabilitation Exercise and psycholoGical support After covid-19 InfectioN (REGAIN) trial [version 2; peer review: 2 approved]

Background: Up to half of people hospitalised with COVID-19 report diverse and persistent symptoms affecting quality of life for months and sometimes years after discharge (long-COVID). We describe the development of an online group exercise and behavioural support intervention for people who continue to experience such physical and/or emotional health problems more than three months after hospital discharge.  Methods: Intervention development was informed by the Medical Research Council framework for complex interventions. Our multidisciplinary team of academics, clinicians, and people with long-COVID, had collective expertise in the development and testing of complex interventions. We integrated a bio-psycho-social model of care drawing on rehabilitation literature for long-term health conditions and experiences from our pre-pilot study. Multiple stakeholder meetings were held to refine the intervention which was designed to be deliverable within the UK National Health Service. We adhere to TIDieR guidance for transparent and explicit reporting of telehealth interventions.  Results: The final REGAIN online exercise and behavioural support intervention consisted of an initial 1:1 consultation with a trained practitioner, followed by eight online group exercise, and six group support, sessions delivered over eight weeks. Participants could also access an online library of on-demand exercise and support videos. Conclusions: The final REGAIN intervention, combining exercise and behavioural support, is fully manualised with clear pathways to delivery and implementation. It is currently being tested in a randomised controlled trial. The intervention, developed with extensive patient and stakeholder engagement, could be incorporated into existing NHS rehabilitation programmes, should it prove to be clinically and cost-effective for people with long-COVID. Trial registration: International Standard Randomised Controlled Trial Number (ISRCTN) 11466448: Rehabilitation exercise and psychological support after COVID-19 infection: REGAIN

Clinical effectiveness of an online supervised group physical and mental health rehabilitation programme for adults with post-covid-19 condition (REGAIN study):multicentre randomised controlled trial

OBJECTIVE: To evaluate whether a structured online supervised group physical and mental health rehabilitation programme can improve health related quality of life compared with usual care in adults with post-covid-19 condition (long covid).DESIGN: Pragmatic, multicentre, parallel group, superiority randomised controlled trial.SETTING: England and Wales, with home based interventions delivered remotely online from a single trial hub.PARTICIPANTS: 585 adults (26-86 years) discharged from NHS hospitals at least three months previously after covid-19 and with ongoing physical and/or mental health sequelae (post-covid-19 condition), randomised (1:1.03) to receive the Rehabilitation Exercise and psycholoGical support After covid-19 InfectioN (REGAIN) intervention (n=298) or usual care (n=287).INTERVENTIONS: Best practice usual care was a single online session of advice and support with a trained practitioner. The REGAIN intervention was delivered online over eight weeks and consisted of weekly home based, live, supervised, group exercise and psychological support sessions.MAIN OUTCOME MEASURES: The primary outcome was health related quality of life using the patient reported outcomes measurement information system (PROMIS) preference (PROPr) score at three months. Secondary outcomes, measured at three, six, and 12 months, included PROMIS subscores (depression, fatigue, sleep disturbance, pain interference, physical function, social roles/activities, and cognitive function), severity of post-traumatic stress disorder, general health, and adverse events.RESULTS: Between January 2021 and July 2022, 39 697 people were invited to take part in the study and 725 were contacted and eligible. 585 participants were randomised. Mean age was 56 (standard deviation (SD) 12) years, 52% were female participants, mean health related quality of life PROMIS-PROPr score was 0.20 (SD 0.17), and mean time from hospital discharge was 323 (SD 144) days. Compared with usual care, the REGAIN intervention led to improvements in health related quality of life (adjusted mean difference in PROPr score 0.03 (95% confidence interval 0.01 to 0.05), P=0.02) at three months, driven predominantly by greater improvements in the PROMIS subscores for depression (1.39 (0.06 to 2.71), P=0.04), fatigue (2.50 (1.19 to 3.81), P&lt;0.001), and pain interference (1.80 (0.50 to 3.11), P=0.01). Effects were sustained at 12 months (0.03 (0.01 to 0.06), P=0.02). Of 21 serious adverse events, only one was possibly related to the REGAIN intervention. In the intervention group, 141 (47%) participants fully adhered to the programme, 117 (39%) partially adhered, and 40 (13%) did not receive the intervention.CONCLUSIONS: In adults with post-covid-19 condition, an online, home based, supervised, group physical and mental health rehabilitation programme was clinically effective at improving health related quality of life at three and 12 months compared with usual care.TRIAL REGISTRATION: ISRCTN registry ISRCTN11466448.</p

Direct observations of microscale turbulence and thermohaline structure in the Kuroshio Front

Author Posting. © American Geophysical Union, 2012. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Journal of Geophysical Research 117 (2012): C08013, doi:10.1029/2011JC007228.Direct observations of microstructure near the Kuroshio Front were conducted in August 2008 and October 2009. These show negative potential vorticity (PV) in the mixed layer south of the front, where directly measured turbulent kinetic energy dissipation rates are an order magnitude larger than predicted by wind-scaling. These elevated dissipation rates scale better with an empirical scaling, which considers local wind and Ekman buoyancy flux driven by downfront wind. Near-zero PV in the thermocline under the Kuroshio mainstream is observed at 200–300 m depth, with dissipation exceeding open ocean thermocline values by factors of 10–100. Overall, the large turbulent dissipation rates measured in the Kuroshio can be categorized into two groups, one characterized by low Richardson number along the Kuroshio Front thermocline, and the other characterized by high stratification away from the Kuroshio mainstream. The former is attributed to mixing by unbalanced frontal ageostrophic flows, and the latter is attributed to internal wave breaking. On average, both groups appear in regions of large horizontal density gradients. Observed thermohaline structure shows low salinity tongues from the surface to over 300 m depth and deep cold tongues, extending upward from 500 to 100 m depth in a narrow (20 km) zone, suggesting down and upwelling driven by geostrophic straining, which is confirmed by Quasigeostrophic-Omega equation solutions. This implies that adiabatic along isopycnal subduction and diabatic diapycnal turbulent mixing acting in tandem at the Kuroshio Front likely contribute to NPIW formation.This study is supported by Sasagawa Scientific Research grant 20-701M (the Japan Science Society), Grant- in-Aid for Young Scientists (B) 20710002, and Excellent Young Researchers Overseas Visit Program 21-7283 awarded to T. Nagai. A. Tandon would like to acknowledge support from NSFPO- 0928138 and ONR N00014-09-1-0196.2013-03-0

A view of the Canary Basin thermocline circulation in winter

During January and February 1989 the recirculation of the subtropical gyre in the eastern North Atlantic was surveyed with a three-ship experiment. The analysis of hydrographic measurements and velocity data from a shipboard acoustic Doppler current profiler reveals the synoptic-scale circulation patterns and water mass distributions in the Canary Basin. The geostrophic transport stream function estimated with a horizontally varying reference level of no motion highlights the major currents in three layers representing the vertical structure of the horizontal circulation. The classical circulation scheme is shown by the stream function in the upper 200 m: the Azores, Canary, and North Equatorial currents. Unlike the deep-penetrating Azores Current, the Canary Current and the North Equatorial Current are restricted to the upper 200 m. Both carry North Atlantic Central Water along the water mass boundary with South Atlantic Central Water. South Atlantic Central Water flows through the passage between the Cape Verde archipelago and Africa via narrow currents into the area north of 14.5°N. At the southern edge of the subtropical gyre we identify an eastward flow of Antarctic Intermediate Water between 700 and 1200 m

Relocations: Diaspora, Travel, Migrancy

This is the final version. Available from Cambridge University Press via the DOI in this record.This chapter addresses a central dynamic in contemporary Irish culture, the relationship between Ireland and the rest of the world. A long history of emigration has made for a massive global Irish diaspora. These decades have seen the emergence of new critical approaches to the writing and culture of the Irish diaspora in Britain, the United States, and across the world. In addition, a number of Irish writers have spent much of their time writing about places other than Ireland (whether or not they happened to be living there at the time). This chapter takes on two related themes: recent Irish literature’s interest in representing spaces and conditions outside of Ireland, and the relationship between contemporary Irish literature and the global Irish diaspora