Are our policies and laws leading to treatment delays for people with schizophrenia?

Under Australian mental health laws, people with schizophrenia can only be involuntarily committed to a mental health facility if they are assessed and it is determined that their illness is making them dangerous to themselves or others. To determine whether they are to undergo involuntary treatment, mental health workers must assess people against an ‘Obligatory Dangerousness Criterion’. This criterion is an advance on methods used prior to the mid-1970s, when many countries authorised involuntary commitment to a mental health facility on medical certification alone, without court approval or any proof of an emergency situation. An Obligatory Dangerousness Criterion is now widely used in Australia, the USA, and some areas of Canada and Europe as the means by which patients are assessed for the appropriateness of involuntary (compulsory) treatment. There is no doubt the policy underpinning its use was well intentioned; an Obligatory Dangerousness Criterion was originally developed in an attempt to bett er balance the rights of the mentally ill with the need to protect the public. However, over time some experts have begun to raise questions about the utility of this criterion, suggesting that it sometimes means patients don’t get access to necessary treatment as quickly as they should

Does case management improve outcomes for people with schizophrenia?

The Australian and New Zealand clinical practice guidelines recommend intensive case management for people with first-episode psychosis or an acute relapse of schizophrenia. Often initiated following discharge from hospital or transfer from community-based acute care, case management is a collaborative, community-based program designed to ensure people receive quality health care and integrated support services. Case management may provide substantial benefits for people suffering severe mental illnesses like schizophrenia, however, before case management services are made universally available, more work needs to be done to determine when, and for whom, these services are most effective

Mid-Pleistocene thin-skinned glaciotectonic thrusting of the Aberdeen Ground Formation, Central Graben region, central North Sea

This paper presents the results of a high-resolution 2D seismic survey of mid-Pleistocene glaciogenic sediments in the Central Graben region of the central North Sea. Sediments have undergone major glaciotectonic thrusting and folding associated with the repeated southerly advance of a mid-Pleistocene ice sheet. The total observed length of the thrust-stacked section is approximately 5–6 km, comprising a series of discrete thrust slices, which range in length from  700 m. The basal detachment of the thrust complex occurs at a depth of ca. 220 m below the sea bed within the upper Aberdeen Ground Formation. A thin-skinned glaciotectonic model involving proglacial to ice-marginal glaciotectonic thrusting followed by post-tectonic deposition is proposed. Initial ice advance led to the over-pressurizing of groundwater within a laterally extensive sand sheet in the upper Aberdeen Ground Formation, promoting the formation of a major décollement surface at the base of the developing thrust-stack. Over-pressurization of the groundwater system is thought to have occurred in response to rapid ice advance, suggesting that the development of large-scale thrust complexes may be associated with surge-type behaviour. The proposed model evidences complex dynamics of mid-Pleistocene ice sheets within the central North Sea

'Thrown at twins' - A qualitative study exploring the lived experience of Australian osteopaths who regularly treat paediatric patients.

BACKGROUND: and purpose: Little is known about the training and experience of osteopaths who treat paediatric patients, and graduates report feeling unprepared for this aspect of practice. The purpose of this study was to investigate the lived experience of Australian osteopaths who regularly treat these patients, in order to better understand their individual educational pathways and their management of this population. MATERIALS AND METHODS: Osteopaths who reported regularly treating paediatric patients were recruited through the Osteopathy Research and Innovation Network (ORION) national practice-based network. Semi-structured interviews were completed, transcribed and thematically analysed using the principles of Descriptive Phenomenology to compile qualitative data. RESULTS: Ten osteopaths were interviewed, whose age ranged from 33 to 71 years and with 15-46 years of clinical experience. Proportion of paediatric patients ranged from 20 to 90 % of participants' caseload according to self-report. Seven themes were identified that reflected the lived experience of treating paediatric patients: 1) Variable pathways to practice, 2) Challenges and rewards, 3) Scope of practice, 4) Team-based care, 5) Importance of entry-level skills, 6) Family-centred care, and 7) Success. CONCLUSION: The study found a diversity of educational pathways, that paediatric practice was highly rewarding, the scope of practice was based on diagnostic skills and experience, the practitioners had extensive team-based professional networks, practice reflected a family-centred care model, and personal measures of success were multifactorial. These results give insight into this area of practice to guide further research

Understanding the rift, the (still) uneasy bedfellows of History and Organization Studies

Although the use of History has become increasingly discussed and more widely applied within Organization Studies (OS), its relevance for OS still remains far from centrally accepted. This article historicizes the relationship between Sociology and History as a means of better understanding the tensions, perceived and real, that exist between History and Organization Studies. In particular we analyse three differences of epistemological standpoint (method, objectivity and usefulness) that are commonly seen as the foundation stones to incompatibility. Perhaps surprisingly for an analysis of apparent disciplinary differences, we find that these distinctions in terms of approach, once closely examined, are rarely clear-cut and historians and OS scholars are frequently closer in intention and method than they are distant. However, despite their large intersection of interests, we argue that important distinctions between the two fields should be acknowledged. Our contribution to the debates over the need for more historical approaches within OS therefore centrally rests on abandoning aspirations for fully integrative models of working together, in favour of cooperative modes that concede the fields’ differences. This subtle shift of emphasis will, we believe, greatly benefit OS scholars who hope to include historical perspectives in their work

Reduced neural activity of the prefrontal cognitive control circuitry during response inhibition to negative words in people with schizophrenia

BACKGROUND: Schizophrenia is characterized by deficits in executive control and impairments in emotion processing. This study assessed the nature and extent of potential alterations in the neural substrates supporting the interaction between cognitive control mechanisms and emotion attribution processes in people with schizophrenia. METHODS: Functional magnetic resonance imaging was performed during a verbal emotional go/no-go task. People with schizophrenia and healthy controls responded to word stimuli of a prespecified emotional valence (positive, negative or neutral) while inhibiting responses to stimuli of a different valence. RESULTS: We enrolled 20 people with schizophrenia and 23 controls in the study. Healthy controls activated an extensive dorsal prefrontal–parietal network while inhibiting responses to negative words compared to neutral words, but showed deactivation of the midcingulate cortex while inhibiting responses to positive words compared to neutral words. People with schizophrenia failed to activate this network during response inhibition to negative words, whereas during response inhibition to positive words they did not deactivate the cingulate, but showed increased responsivity in the frontal cortex. LIMITATIONS: Sample heterogeneity is characteristic of studies of schizophrenia and may have contributed to more variable neural responses in the patient sample despite the care taken to control for potentially confounding variables. CONCLUSION: Our results showed that schizophrenia is associated with aberrant modulation of neural responses during the interaction between cognitive control and emotion processing. Failure of the frontal circuitry to regulate goal-directed behaviour based on emotion attributions may contribute to deficits in psychosocial functioning in daily life

Self-harm and suicidal ideation among young people is more often recorded by child protection than health services in an Australian population cohort

OBJECTIVE: We investigated patterns of service contact for self-harm and suicidal ideation recorded by a range of human service agencies - including health, police and child protection - with specific focus on overlap and sequences of contacts, age of first contact and demographic and intergenerational characteristics associated with different service responses to self-harm.METHODS: Participants were 91,597 adolescents for whom multi-agency linked data were available in a longitudinal study of a population cohort in New South Wales, Australia. Self-harm and suicide-related incidents from birth to 18 years of age were derived from emergency department, inpatient hospital admission, mental health ambulatory, child protection and police administrative records. Descriptive statistics and binomial logistic regression were used to examine patterns of service contacts.RESULTS: Child protection services recorded the largest proportion of youth with reported self-harm and suicidal ideation, in which the age of first contact for self-harm was younger relative to other incidents of self-harm recorded by other agencies. Nearly 40% of youth with a health service contact for self-harm also had contact with child protection and/or police services for self-harm. Girls were more likely to access health services for self-harm than boys, but not child protection or police services.CONCLUSION: Suicide prevention is not solely the responsibility of health services; police and child protection services also respond to a significant proportion of self-harm and suicide-related incidents. High rates of overlap among different services responding to self-harm suggest the need for cross-agency strategies to prevent suicide in young people.</p

Training dual-task walking in community-dwelling adults within 1 year of stroke: A protocol for a single-blind randomized controlled trial

Background: Community ambulation is a highly complex skill requiring the ability to adapt to increased environmental complexity and perform multiple tasks simultaneously. After stroke, individuals demonstrate a diminished ability to perform dual-tasks. Current evidence suggests that conventional rehabilitation does not adequately address gait-related dual-task impairments after stroke, which may be contributing to low levels of participation and physical inactivity in community-dwelling stroke survivors. The objective of this study is to investigate the efficacy of dual-task gait training in community-dwelling adults within 1 year of stroke. Specifically, we will compare the effects of dual-task gait training and single-task gait training on cognitive-motor interference during walking at preferred speed and at fastest comfortable speed (Aim 1), locomotor control during obstacle negotiation (Aim 2), and spontaneous physical activity (Aim 3). Methods/design: This single-blind randomized controlled trial will involve 44 individuals within 12 months of stroke. Following baseline evaluation, participants will be randomly allocated to single- or dual-task gait training. Both groups will receive 12, 30-minute sessions provided one-on-one over 4–6 weeks in an outpatient therapy setting. Single-task gait training involves practice of gait activities incorporating motor relearning principles. Dual-task gait training involves an identical gait training protocol; the critical difference being that the dual-task gait training group will practice the gait activities while simultaneously performing a cognitive task for 75% of the repetitions. Blinded assessors will measure outcomes at baseline, post-intervention, and 6 months after completion of the intervention. The primary outcome measure will be dual-task effects on gait speed and cognition during unobstructed walking. Secondary outcomes include spatiotemporal and kinetic gait parameters during unobstructed single- and dual-task walking at preferred and fastest comfortable walking speeds, gait parameters during high and low obstacle crossing, spontaneous physical activity, executive function, lower extremity motor function, Timed Up and Go, balance self-efficacy, number of falls, and stroke-related disability. Hypotheses for each aim will be tested using an intention-to-treat analysis with repeated measures ANOVA design. Discussion: This trial will provide evidence to help clinicians make decisions about the types of activities to include in rehabilitation to improve dual-task walking after stroke