Mental Health Clinicians’ Perceptions of the diagnosis of Bipolar Disorder: A Q-study

This thesis was written to fulfil the requirements of the University’s Doctorate in Clinical Psychology. The thesis is made up of three sections: a review of the research literature focused on service users’ experience of psychiatric diagnosis, an empirical paper exploring clinicians’ perceptions of the diagnosis of Bipolar Disorder and an executive summary outlining the study designed for dissemination in clinical practice. The literature review identified four important aspects of mental health diagnosis for service users: whether service users wanted to be told about their diagnosis, the communication of the diagnosis, positive aspects of being given a psychiatric diagnosis and disadvantages of receiving a psychiatric diagnosis. Accuracy, timing and communication of diagnostic feedback were all thought to be important for service users receiving a mental health diagnosis, whilst fostering hope was paramount in positive experiences. The review concluded that service users held a wide variety of different perceptions of psychiatric diagnosis and recommended that clinicians were offered specific training on feeding back a mental health diagnosis to service users. The empirical paper used Q-methodology to explore the subjective viewpoints of mental health clinicians on the diagnosis of Bipolar Disorder. This study noted the mixed literature on the use of the diagnostic label in mental health services and aimed to explore whether clinical practice mirrored the previous research. A total of 19 mental health clinicians completed Q-sorts in which they were asked to rank statements about the diagnostic label of Bipolar Disorder. Three main factors emerged: (1) Seeing the person and their experience, (2) Promoting quality through standardised processes and (3) Understanding the function of diagnostic labels. All three factors agreed that sufficient time should be taken to assess for Bipolar Disorder and that communication using purely the diagnostic label was not helpful. Holding different perspectives on the diagnosis of Bipolar Disorder is likely to make it difficult to provide consistent, high-quality care for service users and it was suggested that services may benefit from better integration of these viewpoints moving forward. The executive summary outlines an overview of the empirical paper that can be disseminated to mental health services

The influence of aggregate size fraction and horizon position on microbial community composition

peer-reviewedThe influence of horizon position and aggregate size on bacterial and fungal community composition was determined. From nine sites, soils were collected from the top three horizon positions (H1, H2 and H3). Physical fractionation separated samples into large macroaggregate (LM, >2000 μm), macroaggregate (MAC, >250 μm), microaggregate (MIC, <250 μm), and silt and clay (SC, 53 μm) fractions. In all samples, the structure of the bacterial and fungal community composition was assessed via restriction fragment length polymorphism (T-RFLP), and for the four aggregate sizes from the top two horizons positions an in-depth analysis of the bacterial community was conducted using next generation sequencing (NGS). Bacterial and fungal communities both differed between aggregate-sizes. Changes in the composition of the bacterial and fungal communities also occurred among horizon positions, with a significant interaction between aggregate size and horizon position evident for the bacterial community. Using NGS, it was shown that aggregate-size had a significant effect on the bacterial community in both horizon positions at both the phyla and family taxonomic levels. MAC and MIC significantly differed in the % relative abundance of bacterial groups, potentially indicating differing predation pressures. These results indicate that both horizon position and aggregate size support distinct microbial communities. Understanding these parameters is critical in our comprehension of the patterns of microbial diversity in soil

Are patients in heart failure trials representative of primary care populations? A systematic review.

BACKGROUND: Guidelines recommend drug treatment for patients with heart failure with a reduced ejection fraction (HFrEF), however the evidence for benefit in patients with mild disease, such as most in primary care, is uncertain. Importantly, drugs commonly used in heart failure account for one in seven of emergency admissions for adverse drug reactions. AIM: To determine to what extent patients included in studies of heart failure treatment with beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and aldosterone antagonists were representative of a typical primary care population with HFrEF in England. DESIGN & SETTING: Systematic review of randomised controlled trials (RCTs) of drug treatment in patients with HFrEF. METHOD: MEDLINE, MEDLINE In-Process, EMBASE, and CENTRAL were searched from inception to March 2015. The characteristics of the patient's New York Heart Association (NYHA) classification were compared with a primary care reference population with HFrEF. RESULTS: Of the 30 studies included, two had incomplete data. None had a close match (defined as ≤10% deviation from reference study) for NYHA class I disease; 5/28 were a close match for NYHA class II; 5/28 for NYHA class III; and 18/28 for NYHA class IV. In general, pre-existing cardiovascular conditions, risk factors, and comorbidities were representative of the reference population. CONCLUSION: Patients recruited to studies typically had more severe heart failure than the reference primary care population. When evidence from sicker patients is generalised to less sick people, there is increased uncertainty about benefit and also a risk of harm from overtreatment. More evidence is needed on the effectiveness of treatment of heart failure in asymptomatic patients with NYHA class I

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

The influence of aggregate size fraction and horizon position on microbial community composition

The influence of horizon position and aggregate size on bacterial and fungal community composition was determined. From nine sites, soils were collected from the top three horizon positions (H1, H2 and H3). Physical fractionation separated samples into large macroaggregate (LM, >2000 μm), macroaggregate (MAC, >250 μm), microaggregate (MIC, <250 μm), and silt and clay (SC, 53 μm) fractions. In all samples, the structure of the bacterial and fungal community composition was assessed via restriction fragment length polymorphism (T-RFLP), and for the four aggregate sizes from the top two horizons positions an in-depth analysis of the bacterial community was conducted using next generation sequencing (NGS). Bacterial and fungal communities both differed between aggregate-sizes. Changes in the composition of the bacterial and fungal communities also occurred among horizon positions, with a significant interaction between aggregate size and horizon position evident for the bacterial community. Using NGS, it was shown that aggregate-size had a significant effect on the bacterial community in both horizon positions at both the phyla and family taxonomic levels. MAC and MIC significantly differed in the % relative abundance of bacterial groups, potentially indicating differing predation pressures. These results indicate that both horizon position and aggregate size support distinct microbial communities. Understanding these parameters is critical in our comprehension of the patterns of microbial diversity in soil

The CO5 configuration of the 7 km Atlantic Margin Model: large-scale biases and sensitivity to forcing, physics options and vertical resolution

We describe the physical model component of the standard Coastal Ocean version 5 configuration (CO5) of the European north-west shelf (NWS). CO5 was developed jointly between the Met Office and the National Oceanography Centre. CO5 is designed with the seamless approach in mind, which allows for modelling of multiple timescales for a variety of applications from short-range ocean forecasting to climate projections. The configuration constitutes the basis of the latest update to the ocean and data assimilation components of the Met Office's operational Forecast Ocean Assimilation Model (FOAM) for the NWS. A 30.5-year non-assimilating control hindcast of CO5 was integrated from January 1981 to June 2012. Sensitivity simulations were conducted with reference to the control run. The control run is compared against a previous non-assimilating Proudman Oceanographic Laboratory Coastal Ocean Modelling System (POLCOMS) hindcast of the NWS. The CO5 control hindcast is shown to have much reduced biases compared to POLCOMS. Emphasis in the system description is weighted to updates in CO5 over previous versions. Updates include an increase in vertical resolution, a new vertical coordinate stretching function, the replacement of climatological riverine sources with the pan-European hydrological model E-HYPE, a new Baltic boundary condition and switching from directly imposed atmospheric model boundary fluxes to calculating the fluxes within the model using a bulk formula. Sensitivity tests of the updates are detailed with a view toward attributing observed changes in the new system from the previous system and suggesting future directions of research to further improve the system

An inter-laboratory comparison of multi-enzyme and multiple substrate-induced respiration assays to assess method consistency in soil monitoring

peer-reviewedThe use of indicators in soil monitoring schemes to detect changes in soil quality is receiving increased attention, particularly the application of soil biological methods. However, to date, the ability to compare information from different laboratories applying soil microbiological techniques in broad-scale monitoring has rarely been taken into account. This study aimed to assess the consistency and repeatability of two techniques that are being evaluated for use as microbiological indicators of soil quality; multi-enzyme activity assay and multiple substrate induced respiration (MSIR). Data was tested for intrinsic (within-plate) variation, inter-laboratory repeatability (geometric mean regression and correlation coefficient) and land-use discrimination (principal components analysis, PCA). Intrinsic variation was large for both assays suggesting that high replicate numbers will be required. Inter-laboratory repeatability showed diverging patterns for the enzyme assay and MSIR. Discrimination of soils was significant for both techniques with relatively consistent patterns, however combined laboratory discrimination analyses for each technique showed inconsistent correspondence between the laboratories. These issues could be addressed through the adoption of reliable analytical standards for biological methods along with adequate replication. However, until the former is addressed, dispersed analyses are not currently advisable for monitoring schemes.UK Department of Environment, Food and Rural Affairs (Defra