Perceived Burdensomeness and the Wish for Hastened Death in Persons With Severe and Persistent Mental Illness

Background: In several European countries, medical assistance in dying (MAID) is no longer confined to persons with a terminal prognosis but is also available to those suffering from persistent and unbearable mental illness. To date, scholarly discourse on MAID in this population has been dominated by issues such as decision-making capacity, uncertainty as to when a disease is incurable, stigmatization, isolation, and loneliness. However, the issue of perceived burdensomeness has received little attention. Objective: The study explores the possible impact of perceived burdensomeness on requests for MAID among persons with severe and persistent mental illness (SPMI). Method: Using the method of ethical argumentation, we discuss the issue of access to MAID for persons with SPMI and perceived burdensomeness. Conclusion: Perceived burdensomeness may be a contributing factor in the wish for hastened death among persons with SPMI. MAID is ethically unsupportable if SPMI causes the individual to make an unrealistic assessment of burdensomeness, indicating a lack of decision-making capacity in the context of that request. However, the possibility that some individuals with SPMI may perceive burdensomeness does not mean that they should be routinely excluded from MAID. For SPMI patients with intact decision-making capacity who feel their life is not worth living, perceived burdensomeness as a component of this intolerable suffering is not a sufficient reason to deny access to MAID

Usability of a Smartphone Application to Support the Prevention and Early Intervention of Anxiety in Youth

Anxiety disorders are among the most common psychiatric problems in youth, fail to spontaneously remit, and place some youth at risk for additional behavioral and emotional difficulties. Efforts to target anxiety have resulted in evidence-based interventions but the resulting prevention effects are relatively small, often weakening over time. Mobile health (mHealth) tools could be of use to strengthen the effects of anxiety prevention efforts. Although a large number of mHealth apps have been developed, few have been evaluated in terms of usability prior to clinical effectiveness testing. Because usability is one of the main barriers to mHealth usage and adoption, the objective of this research was to evaluate the usability of a smartphone application (app) corresponding to an indicated prevention and early intervention targeting youth anxiety. To accomplish this, 132 children (M age = 9.65; 63% girls) and 45 service providers (M age = 29.13, 87% female) rated our app along five established dimensions of usability (ease of use, ease of learning, quality of support information, satisfaction, and stigma) using a standardized group-based testing protocol. Findings showed that the app was highly and positively rated by both youth and providers, with some variations (lower ratings when errors occurred). Path analyses findings also showed that system understanding was significantly related to greater system satisfaction, but that such relation occurred through the quality of support information offered by the app

Designing a Mobile Application to Support the Indicated Prevention and Early Intervention of Childhood Anxiety

This paper presents the design of an mHealth application for prevention and early intervention of childhood anxiety. The application is based on REACH, a preventative-early intervention protocol for childhood anxiety. This paper describes the multidisciplinary design process, sharing lessons learned in developing an effective mHealth application. This mHealth application is unique due to participant age, preventive-early intervention focus, and utilization of mobile technology in a situated manner. A design process inspired by user-centered leveraging key informant interviews was used to identify application features, including game based strategies and an animated motivational avatar. Validation was performed through external review and a usability study performed with target end users of the application. Results suggest overall satisfaction, ease of use, and increased motivation

Binge flying: Behavioural addiction and climate change

Recent popular press suggests that ‘binge flying’ constitutes a new site of behavioural addiction. We theoretically appraise and empirically support this proposition through interviews with consumers in Norway and the United Kingdom conducted in 2009. Consistent findings from across two national contexts evidence a growing negative discourse towards frequent short-haul tourist air travel and illustrate strategies of guilt suppression and denial used to span a cognitive dissonance between the short-term personal benefits of tourism and the air travel’s associated long-term consequences for climate change. Tensions between tourism consumption and changing social norms towards acceptable flying practice exemplify how this social group is beginning to (re)frame what constitutes ‘excessive’ holiday flying, despite concomitantly continuing their own frequent air travels

Ultra-Fast Bioorthogonal Spin-Labeling and Distance Measurements in Mammalian Cells Using Small, Genetically Encoded Tetrazine Amino Acids

Studying protein structures and dynamics directly in the cellular environments in which they function is essential to fully understand the molecular mechanisms underlying cellular processes. Site-directed spin-labeling (SDSL)—in combination with double electron–electron resonance (DEER) spectroscopy—has emerged as a powerful technique for determining both the structural states and the conformational equilibria of biomacromolecules. In-cell DEER spectroscopy on proteins in mammalian cells has thus far not been possible due to the notable challenges of spin-labeling in live cells. In-cell SDSL requires exquisite biorthogonality, high labeling reaction rates and low background signal from unreacted residual spin label. While the bioorthogonal reaction must be highly specific and proceed under physiological conditions, many spin labels display time-dependent instability in the reducing cellular environment. Additionally, high concentrations of spin label can be toxic. Thus, an exceptionally fast bioorthogonal reaction is required that can allow for complete labeling with low concentrations of spin-label prior to loss of signal. Here we utilized genetic code expansion to site-specifically encode a novel family of small, tetrazine-bearing non-canonical amino acids (Tet-v4.0) at multiple sites in green fluorescent protein (GFP) and maltose binding protein (MBP) expressed both in E. coli and in human HEK293T cells. We achieved specific and quantitative spin-labeling of Tet-v4.0-containing proteins by developing a series of strained trans-cyclooctene (sTCO)-functionalized nitroxides—including a gem-diethyl-substituted nitroxide with enhanced stability in cells—with rate constants that can exceed 106 M−1 s−1. The remarkable speed of the Tet-v4.0/sTCO reaction allowed efficient spin-labeling of proteins in live HEK293T cells within minutes, requiring only sub-micromolar concentrations of sTCO–nitroxide added directly to the culture medium. DEER recorded from intact cells revealed distance distributions in good agreement with those measured from proteins purified and labeled in vitro. Furthermore, DEER was able to resolve the maltose-dependent conformational change of Tet-v4.0-incorporated and spin-labeled MBP in vitro and successfully discerned the conformational state of MBP within HEK293T cells. We anticipate the exceptional reaction rates of this system, combined with the relatively short and rigid side chains of the resulting spin labels, will enable structure/function studies of proteins directly in cells, without any requirements for protein purification

The mathematics teacher exchange and 'mastery' in England: The evidence for the efficacy of component practices

'Mastery’ is central to current policy in mathematics education in England, influenced by East Asian success in transnational assessments. We scrutinise the prospects for mastery pedagogies to improve pupil attainment in English primary schools. The Mathematics Teacher Exchange (MTE)—an element of the mastery innovation—involves teachers visiting Shanghai and then hosting Shanghai teachers in their schools. Informed by programme evaluation, core component practices are analysed, which were implemented by schools belonging to the first cohort of MTE schools. These consist of: varied and interactive teaching; meaningful and coherent mathematical activity; and full curriculum access for all. These elements are supported, optimally, by collaborative, embedded, and mathematically focused professional development. Details of the implemented pedagogy and forms of professional development are reported. Differences from prevailing practice in primary mathematics in England are highlighted. Evidence is reviewed from quasi-experimental trials, reviews and meta-analyses, and rigorous observational studies of the efficacy of practices similar to the MTE mastery pedagogy components in order to assess the prospects for increases in pupil attainment. The analysis suggests that many of the specific practices, if considered individually, have the potential to improve attainment, though overall policy ambitions may not be realised. Based on the review, component practices are identified for which existing evidence justifies immediate implementation by schools and teachers. In addition, practices that would benefit from further testing and evaluation are highlighted

Poor birth weight recovery among low birth weight/preterm infants following hospital discharge in Kampala, Uganda

<p>Abstract</p> <p>Background</p> <p>Healthy infants typically regain their birth weight by 21 days of age; however, failure to do so may be due to medical, nutritional or environmental factors. Globally, the incidence of low birth weight deliveries is high, but few studies have assessed the postnatal weight changes in this category of infants, especially in Africa. The aim was to determine what proportion of LBW infants had not regained their birth weight by 21 days of age after discharge from the Special Care Unit of Mulago hospital, Kampala.</p> <p>Methods</p> <p>A cross sectional study was conducted assessing weight recovery of 235 LBW infants attending the Kangaroo Clinic in the Special Care Unit of Mulago Hospital between January and April 2010. Infants aged 21 days with a documented birth weight and whose mothers gave consent to participate were included in the study. Baseline information was collected on demographic characteristics, history on pregnancy, delivery and postnatal outcome through interviews. Pertinent infant information like gestation age, diagnosis and management was obtained from the medical records and summarized in the case report forms.</p> <p>Results</p> <p>Of the 235 LBW infants, 113 (48.1%) had not regained their birth weight by 21 days. Duration of hospitalization for more than 7 days (AOR: 4.2; 95% CI: 2.3 - 7.6; p value < 0.001) and initiation of the first feed after 48 hours (AOR: 1.9; 95% CI 1.1 - 3.4 p value 0.034) were independently associated with failure to regain birth weight. Maternal factors and the infant's physical examination findings were not significantly associated with failure to regain birth weight by 21 days of age.</p> <p>Conclusion</p> <p>Failure to regain birth weight among LBW infants by 21 days of age is a common problem in Mulago Hospital occurring in almost half of the neonates attending the Kangaroo clinic. Currently, the burden of morbidity in this group of high-risk infants is undetected and unaddressed in many developing countries. Measures for consideration to improve care of these infants would include; discharge after regaining birth weight and use of total parenteral nutrition. However, due to the pressure of space, keeping the baby and mother is not feasible at the moment hence the need for a strong community system to boost care of the infant. Close networking with support groups within the child's environment could help alleviate this problem.</p

Design and development of the ‘POD Adventures’ smartphone game: a blended problem-solving intervention for adolescent mental health in India

Introduction: Digital technology platforms offer unparalleled opportunities to reach vulnerable adolescents at scale and overcome many barriers that exist around conventional service provision. This paper describes the design and development of POD Adventures, a blended problem-solving game-based intervention for adolescents with or at risk of anxiety, depression and conduct difficulties in India. This intervention was developed as part of the PRemIum for ADolEscents (PRIDE) research programme, which aims to establish a suite of transdiagnostic psychological interventions organised around a stepped care system in Indian secondary schools. Methods and materials: Intervention development followed a person-centered approach consisting of four iterative activities: (i) review of recent context-specific evidence on mental health needs and preferences for the target population of school-going Indian adolescents, including a multiple stakeholder analysis of school counselling priorities and pilot studies of a brief problem-solving intervention; (ii) new focus group discussions with N=46 student participants and N=8 service providers; (iii) co-design workshops with N=22 student participants and N=8 service providers; and (iv) user-testing with N=50 student participants. Participants were aged 12-17 years and recruited from local schools in New Delhi and Goa, including a subgroup with self-identified mental health needs (N=6). Results: Formative data from existing primary sources, new focus groups and co-design workshops supported a blended format for delivering a brief problem-solving intervention, with counsellors supporting use of a game-based app on ‘offline’ smartphones. User-testing with prototypes identified a need for simplification of language, use of concrete examples of concepts and practice elements to enhance engagement. There were also indications that participants most valued relatability and interactivity within real-world stories with judicious support from an in-app guide. The final prototype comprised a set of interactive and gamified vignettes and a structured set of problem-solving questions to consolidate and generalise learning while encouraging real-world application. Discussion: Findings shaped the design of POD Adventures and its delivery as an open-access blended intervention for secondary school students with a felt need for psychological support, consistent with an early intervention paradigm. A randomised controlled trial is planned to evaluate processes and impacts of POD Adventures when delivered for help-seeking students in low-resource school settings