Physicians' perspectives on the treatment of patients with eating disorders in the acute setting

Abstract Background Hospitalisation for an eating disorder is rare, however treatment in the acute medical setting can be a life-saving admission. While the multidisciplinary team delivers overall patient care, medical decisions are the responsibility of the treating physicians. Treatment decisions directly impact on patient care and outcomes. This study aimed to explore the considerations that influence the medical decisions of physicians when treating patients with eating disorders in the acute setting. Method Semi-structured interviews were conducted with ten medical physicians who had previously treated eating disorders on a general medical unit in two Australian tertiary hospitals. An interview schedule, based on the literature and four relevant domains from the Consolidated Framework for Implementation Research, was developed. Interviews were audio recorded, transcribed verbatim and analyzed thematically. Coding and interim themes and sub-themes were developed by two dietitian researchers; these were further refined through researcher discussion and triangulation with two additional dietitian researchers. Results Ten doctors were interviewed (3 consultants (1 adult general medical and 2 paediatricians: 13–16 years medical experience), 2 registrars (4–7 years experience), 1 resident (1 year experience), and 4 interns (< 1 year experience). Doctors described memorable patient cases, related to hospital stays over several weeks. Interviews ranged in length from 58 min to 91 min. Four themes (with five sub-themes) were developed: 1) navigating uncertainty (focusing on processes and goals and seeking information), 2) being “the good doctor” (doing the right thing), 3) seeing the big picture (depending on key players and considering short and long-term), and 4) involving family and patient. Conclusions Non-specialist physicians described challenges in the treatment of eating disorders in the inpatient setting. They take a holistic approach that considers both short and longer-term goals, relying on specialist colleagues, the wider multidisciplinary team and sometimes family members to guide treatment decisions during admissions on general medical wards. Additional support, education and training centered on the key themes may increase physicians’ confidence and ability to make effective treatment decisions for this patient group. The results are relevant to all health professionals working in this field to better understand the priorities of medical physicians and to support them to achieve positive outcomes in the inpatient treatment of patients with eating disorders

Climatic and eustatic controls on the development of a Late Triassic source rock in the Jameson Land Basin, East Greenland

This work was undertaken as part of the continuing work of CASP in East Greenland. The sponsoring companies are thanked for their continued support of this work. Help in the field by T. Kinnaird and useful discussions with A. Whitham are gratefully acknowledged. The reviews of L. Clemmensen and an anonymous reviewer, and the input from S. Jones led to improvements to the original paper.Peer reviewedPostprin

A Kucha\v{r} Hypertime Formalism For Cylindrically Symmetric Spacetimes With Interacting Scalar Fields

The Kucha\v{r} canonical transformation for vacuum geometrodynamics in the presence of cylindrical symmetry is applied to a general non-vacuum case. The resulting constraints are highly non-linear and non-local in the momenta conjugate to the Kucha\v{r} embedding variables. However, it is demonstrated that the constraints can be solved for these momenta and thus the dynamics of cylindrically symmetric models can be cast in a form suitable for the construction of a hypertime functional Schr\"odinger equation.Comment: 5 pages, LaTeX, UBCTP-93-02

Classic but unexpected: a case of Jefferson fracture.

A man was found lying dead next to a ladder, with only a laceration surrounded by an abrasion visible upon external examination. No skull fractures were palpable. A CT scan and MRI showed a Jefferson fracture of the atlas, associated to a posterior displacement of the skull, a fracture of the dens of the axis, and fractures of the bodies of C5 and C6. Jefferson fractures typically result from a blow to the apex of the skull. In such cases, forensic pathologists should suspect the existence of a Jefferson fracture, particularly when no severe injuries are visible externally

Seismic tomographic imaging of the Eastern Mediterranean Mantle: Implications for terminal-stage subduction, the uplift of Anatolia, and the development of the North Anatolian Fault

The Eastern Mediterranean captures the eastwest transition from active subduction of Earth'soldest oceanic lithosphere to continental collision, making it an ideal location to study terminalstagesubduction. Asthenospheric or subductionrelated processes are the main candidates for the region's ∼2kmuplift and Miocene volcanism; however, their relative importance is debated. To address these issues, wepresent new P and S wave relative arrivaltime tomographic models that reveal fast anomalies associatedwith an intact Aegean slab in the west, progressing to a fragmented, partially continental, Cyprean slabbelow central Anatolia. We resolve a gap between the Aegean and Cyprean slabs, and a horizontal tear in theCyprean slab below the Central Anatolian Volcanic Province. Below eastern Anatolia, the completelydetached “Bitlis” slab is characterized by fast wave speeds at ∼500 km depth. Assuming slab sinkingrates mirror ArabiaAnatolia convergence rates, the Bitlis slab's location indicates an Oligocene (∼26 Ma)breakoff. Results further reveal a strong velocity contrast across the North Anatolian Fault likelyrepresenting a 40–60 km decrease in lithospheric thickness from the Precambrian lithosphere north of thefault to a thinned Anatolian lithosphere in the south. Slow uppermostmantle wave speeds below activevolcanoes in eastern Anatolia, and ratios of P to S wave relative traveltimes, indicate a thin lithosphere andmelt contributions. Positive central and eastern Anatolian residual topography requires additional supportfrom hot/buoyant asthenosphere to maintain the 1–2 km elevation in addition to an almost absentlithospheric mantle. Smallscale fast velocity structures in the shallow mantle above the Bitlis slab maytherefore be drips of Anatolian lithospheric mantle

Somewhere in Europe (1947): locating Hungary within a shifting geopolitical landscape

Somewhere in Europe/Valahol Európában (Radványi, 1947) was one of the first films made in Hungary after 1945. Financed by the Hungarian Communist Party (MKP), it loudly proclaimed a broad European pertinence in an effort to privilege the universal narrative of childhoods disrupted by the war over narrowly national political concerns. The film’s story of a gang of half-starved children battling for survival in a bombed-out Central European landscape places it squarely within a transnational post-war film-making tradition. Similarities with both Italian neorealism and Soviet socialist realist cinema indicate a shared European experience of the war, but is also attributable to the international training and experience of the film’s personnel. The director Radványi had worked in the Italian industry, while the scriptwriter was the well-known film theorist Béla Balázs, who had worked in Weimar Germany and Soviet Russia. This article argues that in spite of its ostensible commitment to a communist and humanist ideology, the film gives an insight into the Hungarian national obsession with territorial integrity. Hungary’s participation in World War II on the side of the Axis, and its position as a defeated nation under Allied occupation, are seen to complicate the film text. This article contends that in spite its transnational flavour, the film’s focus on lost children wandering a borderless Europe suggests a preoccupation with the country’s uncertain position within a shifting geopolitical landscape. In turn, the film’s official reading by Nemeskürty shows an eagerness to accept the film’s representation of Hungary as a blameless victim of the war, and gives evidence of a need to insert a (false) break between the country’s wartime past as a member of the Axis, and the country’s 1968 present as a member of the Communist world order

Pulpa de café : composición, tecnología y utilización

Copy from microficheVersión en inglés disponible en la Biblioteca Digital del IDRC: Coffee pulp : composition, technology, and utilizatio

Coffee pulp : composition, technology, and utilization

Spanish version available in IDRC Digital Library: Pulpa de café : composición, tecnología y utilizaciónCompilation on the use of coffee pulp as animal feed, particularly in Central America - discusses coffee plant production, food composition of coffee by-products; agri product processing, ensiling , and drying; antiphysiological factors, such as caffeine and acids, and their impact on animal nutrition and animal production. Bibliography, statistical data

Positional Power in Hierarchies

Power is a core concept in the analysis and design of organisations. In this paper we consider positional power in hierarchies. One of the problems with the extant literature on positional power in hierarchies is that it is mainly restricted to the analysis of power in terms of the bare positions of the actors. While such an analysis informs us about the authority structure within an organisation, it ignores the decision-making mechanisms completely. The few studies which take into account the decision-making mechanisms make all use of adaptations of well-established approaches for the analysis of power in non-hierarchical organisations such as the Banzhaf measure; and thus they are all based on the structure of a simple game, i.e. they are ‘membershipbased’. We demonstrate that such an approach is in general inappropriate for characterizing power in hierarchies as it cannot be extended to a class of decision-making mechanisms which allow certain actors to terminate a decision before all other members have been involved. As this kind of sequential decision-making mechanism turns out to be particularly relevant for hierarchies, we suggest an action-b! ased approach - represented by an extensive game form - which can take the features of such mechanisms into account. Based on this approach we introduce a power score and measure that can be applied to ascribe positional power to actors in sequential decision making mechanisms