A new scale to assess the therapeutic relationship in community mental health care: STAR

Background. No instrument has been developed specifically for assessing the clinician-patient therapeutic relationship (TR) in community psychiatry. This study aimed to develop a measure of the TR with clinician and patient versions using psychometric principles for test construction. Method. A four-stage prospective study was undertaken, comprising qualitative semi-structured interviews about TRs with clinicians and patients and their assessment of nine established scales for their applicability to community care, administering an amalgamated scale of more than 100 items, followed by Principal Components Analysis (PCA) of these ratings for preliminary scale construction. test-retest reliability of the scale and administering the scale in a new sample to confirm its factorial structure. The sample consisted of patients with severe mental illness and a designated key worker in the care of 17 community mental health teams in England and Sweden. Results. New items not covered by established scales were identified, including clinician helpfulness in accessing services, patient aggression and family interference. The new patient (STAR-P) and clinician scales (STAR-C) each have 12 items comprising three subscales: positive collaboration and positive clinician input in both versions, non-supportive clinician input in the patient version, and emotional difficulties in the clinician version. Test-retest reliability was r = 0(.)76 for STAR-P and r = 0(.)68 for STAR-C. The factorial structure of the new scale was confirmed with a good fit. Conclusions. STAR is a specifically developed, brief scale to assess TRs in community psychiatry with good psychometric properties and is suitable for use in research and routine care

Friends and Symptom Dimensions in Patients with Psychosis: A Pooled Analysis

PMCID: PMC3503760This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

The non-unique Universe

The purpose of this paper is to elucidate, by means of concepts and theorems drawn from mathematical logic, the conditions under which the existence of a multiverse is a logical necessity in mathematical physics, and the implications of Godel's incompleteness theorem for theories of everything. Three conclusions are obtained in the final section: (i) the theory of the structure of our universe might be an undecidable theory, and this constitutes a potential epistemological limit for mathematical physics, but because such a theory must be complete, there is no ontological barrier to the existence of a final theory of everything; (ii) in terms of mathematical logic, there are two different types of multiverse: classes of non-isomorphic but elementarily equivalent models, and classes of model which are both non-isomorphic and elementarily inequivalent; (iii) for a hypothetical theory of everything to have only one possible model, and to thereby negate the possible existence of a multiverse, that theory must be such that it admits only a finite model

How do psychiatrists address delusions in first meetings in acute care? A qualitative study

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Shear Strength of Continuous Lightly Reinforced Concrete Joist Systems

The objective of this research is to study the shear strength of continuous lightly reinforced concrete joist systems. Six two span joists, with and without web reinforcement, and two multiple web joists without web reinforcement were tested. The main focus of this study was to determine the shear cracking capacity and to investigate load sharing between joists. Shear cracking loads are determined using crack pattern and stirrup strain analyses. Behavior is evaluated in both the .o,.irive and the negative moment regions. The primary variables in this research are the longitudinal reinforcement ratio, p,.. (0.76% and 1.04% for negative moment regions and from 0.79% to 2.43% for positive moment regions), and nominal stirrup strength, Pvfvy (0 to 70 psi) for single web joists and placement of the load in multiple web joists. Stirrup effectiveness in joists is analyzed based upon ACI provisions and the number of stirrups intercepted by the critical shear crack. Nominal shear stresses and load sharing between the joists are compared with current ACI design pro , The tests indicate that ACI 318-89 overestimates the shear cracking load and shear capacity of lightly reinforced concrete joists in negative moment regions, and under estimates the shear cracking load but not the shear capacity in positive moment regiOns. In the study, the stirrup contribution in both the negative and positive moment regions equaled or exceeded the value predicted by ACI 318-89. In the positive moment regions of members with stirrups, the concrete contribution to shear capacity was often below the shear cracking load, contrary to the usual assumption. The study indicates that significant load sharing occurs between the joists, but that the load sharing is adequate only to distribute local overloads. The additional I 0% in the concrete contribution to shear capacity, as allowed by ACI 318-89, is not available for joist systems as a whole

NICMOS Images of the GG Tau Circumbinary Disk

We present deep, near-infrared images of the circumbinary disk surrounding the pre-main-sequence binary star, GG Tau A, obtained with NICMOS aboard the Hubble Space Telescope. The spatially resolved proto-planetary disk scatters roughly 1.5% of the stellar flux, with a near-to-far side flux ratio of ~1.4, independent of wavelength, and colors that are comparable to the central source; all of these properties are significantly different from the earlier ground-based observations. New Monte Carlo scattering simulations of the disk emphasize that the general properties of the disk, such as disk flux, near side to far side flux ratio and integrated colors, can be approximately reproduced using ISM-like dust grains, without the presence of either circumstellar disks or large dust grains, as had previously been suggested. A single parameter phase function is fitted to the observed azimuthal variation in disk flux, providing a lower limit on the median grain size of 0.23 micron. Our analysis, in comparison to previous simulations, shows that the major limitation to the study of grain growth in T Tauri disk systems through scattered light lies in the uncertain ISM dust grain properties. Finally, we use the 9 year baseline of astrometric measurements of the binary to solve the complete orbit, assuming that the binary is coplanar with the circumbinary ring. We find that the estimated 1 sigma range on disk inner edge to semi-major axis ratio, 3.2 < Rin/a < 6.7, is larger than that estimated by previous SPH simulations of binary-disk interactions.Comment: 40 pages, 8 postscript figures, accepted for publication in Ap

The Mass Distributions of Starless and Protostellar Cores in Gould Belt Clouds

Using data from the SCUBA Legacy Catalogue (850 um) and Spitzer Space Telescope (3.6 - 70 um), we explore dense cores in the Ophiuchus, Taurus, Perseus, Serpens, and Orion molecular clouds. We develop a new method to discriminate submillimeter cores found by SCUBA as starless or protostellar, using point source photometry from Spitzer wide field surveys. First, we identify infrared sources with red colors associated with embedded young stellar objects (YSOs). Second, we compare the positions of these YSO-candidates to our submillimeter cores. With these identifications, we construct new, self-consistent starless and protostellar core mass functions (CMFs) for the five clouds. We find best fit slopes to the high-mass end of the CMFs of -1.26 +/- 0.20, -1.22 +/- 0.06, -0.95 +/- 0.20, and -1.67 +/- 0.72 for Ophiuchus, Taurus, Perseus, and Orion, respectively. Broadly, these slopes are each consistent with the -1.35 power-law slope of the Salpeter IMF at higher masses, but suggest some differences. We examine a variety of trends between these CMF shapes and their parent cloud properties, potentially finding a correlation between the high-mass slope and core temperature. We also find a trend between core mass and effective size, but we are very limited by sensitivity. We make similar comparisons between core mass and size with visual extinction (for A_V >= 3) and find no obvious trends. We also predict the numbers and mass distributions of cores that future surveys with SCUBA-2 may detect in each of these clouds.Comment: 56 pages, 18 figures, fixed typo in Eq 1, results in paper remain unchange

Friends and Symptom Dimensions in Patients with Psychosis: A Pooled Analysis

Background Having friends is associated with more favourable clinical outcomes and a higher quality of life in mental disorders. Patients with schizophrenia have fewer friends than other mentally ill patients. No large scale studies have evaluated so far what symptom dimensions of schizophrenia are associated with the lack of friendships. Methods Data from four multi-centre studies on outpatients with schizophrenia and related disorders (ICD F20-29) were included in a pooled analysis (N = 1396). We established whether patients had close friends and contact with friends by using the equivalent items on friendships of the Manchester Short Assessment of Quality of Life or of the Lancashire Quality of Life Profile. Symptoms were measured by the Brief Psychiatric Rating Scale or by the identical items included in the Positive and Negative Syndrome Scale. Results Seven hundred and sixty-nine patients (55.1%) had seen a friend in the previous week and 917 (65.7%) had someone they regarded as a close friend. Low levels of negative symptoms and hostility were significantly associated with having a close friend and contact with a friend. Overall, almost twice as many patients with absent or mild negative symptoms had met a friend in the last week, compared with those with moderate negative symptoms. Conclusions Higher levels of negative symptoms and hostility are specifically associated with the lack of friendships in patients with psychotic disorders. These findings suggest the importance of developing effective treatments for negative symptoms and hostility in order to improve the probability of patients with schizophrenia to have friends

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