Towards Reconnecting: Creative Formulation and Understanding Dissociation

Purpose: The term dissociation can describe a coping strategy to protect oneself against something unwanted in the moment, a disconnection from sensations and experiences in the here and now. Although the more severe experiences of dissociation have been the subject of intense study over the last two decades, much less has been written about clients commonly seen in mental health services with mild to moderate dissociative conditions. Specifically, this study attends to therapeutic work with a client who experienced moderate dissociation, which caused disruptions to her autobiographical narrative and sense-of-self. Design/methodology/approach: This single case design details the therapeutic journey of a Caucasian woman in her early 40s, who experienced moderate dissociation. The report illustrates how the process of creative artwork formulation helped address unwanted dissociative experiences whilst enhancing other coping strategies. Findings: The client’s personal resources combined with a creative and responsive approach to formulation and re-formulation facilitated the process of reconnecting with herself and others through developing awareness of her strengths and past means of coping, finally developing a consistent self-narrative. Practical implications: The experiences of a creative approach to formulation are discussed in relation to the client’s past traumas and case relevant theory. These preliminary findings suggest creative artwork formulation is an effective tool in terms of developing trust and shared understanding within the therapeutic relationship and meaning making processes throughout therapy. Originality/value: This case study presents an account of creative artwork formulation used as a method of formulation and reformulation specifically with a client experiencing moderate dissociative experiences following interpersonal traumas. Further, the report discusses the ways in which creative artwork formulation facilitated memory exploration and integration, as well as containing meaning making and healing

Experiences of Therapeutic Relationships on Hospital Wards, Dissociation and Making Connections

An interpretative phenomenological analysis sought to explore how people reporting moderate to high levels of dissociation experienced relationships with multidisciplinary hospital ward staff. Three superordinate themes were developed. Firstly, the theme Multiple Me and Multiple Them explores the instability experienced by the participants as they managed their dissociative experiences alongside many inconsistencies. Secondly, Recognising, Meeting or Neglecting Interpersonal and Care Needs, reflects upon participants’ needs within therapeutic relationships. Thirdly, Between the Needs of the Internal System: navigating between “better on my own” and “someone to talk to”, discusses the confusion and understanding around dissociation and the importance of working with parts, not around them. Findings suggested the current culture of some hospital wards directly influenced participants’ distress, which could lead to further dissociation as a means of coping with perceived threats. Reflections upon relational complexities and developing ward-based treatment are discussed

Non-Gaussian states for continuous variable quantum computation via Gaussian maps

We investigate non-Gaussian states of light as ancillary inputs for generating nonlinear transformations required for quantum computing with continuous variables. We consider a recent proposal for preparing a cubic phase state, find the exact form of the prepared state and perform a detailed comparison to the ideal cubic phase state. We thereby identify the main challenges to preparing an ideal cubic phase state and describe the gates implemented with the non-ideal prepared state. We also find the general form of operations that can be implemented with ancilla Fock states, together with Gaussian input states, linear optics and squeezing transformations, and homodyne detection with feed forward, and discuss the feasibility of continuous variable quantum computing using ancilla Fock states.Comment: 8 pages, 6 figure

The Higgs boson in the MSSM in light of the LHC

We investigate the expectations for the light Higgs signal in the MSSM in different search channels at the LHC. After taking into account dark matter and flavor constraints in the MSSM with eleven free parameters, we show that the light Higgs signal in the $gamma\gamma$ channel is expected to be at most at the level of the SM Higgs, while the $h\rightarrow b\bar{b}$ from W fusion and/or the $h \rightarrow\tau\bar\tau$ can be enhanced. For the main discovery mode, we show that a strong suppression of the signal occurs in two different cases: low $M_A$ or large invisible width. A more modest suppression is associated with the effect of light supersymmetric particles. Looking for such modification of the Higgs properties and searching for supersymmetric partners and pseudoscalar Higgs offer two complementary probes of supersymmetry.Comment: 19 pages, 8 figure

From programme theory to logic models for multispecialty community providers: a realist evidence synthesis

This is the final version. Available from the publisher via the DOI in this record.Background: The NHS policy of constructing multispecialty community providers (MCPs) rests on a complex set of assumptions about how health systems can replace hospital use with enhanced primary care for people with complex, chronic or multiple health problems, while contributing savings to health-care budgets. Objectives: To use policy-makers’ assumptions to elicit an initial programme theory (IPT) of how MCPs can achieve their outcomes and to compare this with published secondary evidence and revise the programme theory accordingly. Design: Realist synthesis with a three-stage method: (1) for policy documents, elicit the IPT underlying the MCP policy, (2) review and synthesise secondary evidence relevant to those assumptions and (3) compare the programme theory with the secondary evidence and, when necessary, reformulate the programme theory in a more evidence-based way. Data sources: Systematic searches and data extraction using (1) the Health Management Information Consortium (HMIC) database for policy statements and (2) topically appropriate databases, including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Applied Social Sciences Index and Abstracts (ASSIA). A total of 1319 titles and abstracts were reviewed in two rounds and 116 were selected for full-text data extraction. We extracted data using a formal data extraction tool and synthesised them using a framework reflecting the main policy assumptions. Results: The IPT of MCPs contained 28 interconnected context–mechanism–outcome relationships. Few policy statements specified what contexts the policy mechanisms required. We found strong evidence supporting the IPT assumptions concerning organisational culture, interorganisational network management, multidisciplinary teams (MDTs), the uses and effects of health information technology (HIT) in MCP-like settings, planned referral networks, care planning for individual patients and the diversion of patients from inpatient to primary care. The evidence was weaker, or mixed (supporting some of the constituent assumptions but not others), concerning voluntary sector involvement, the effects of preventative care on hospital admissions and patient experience, planned referral networks and demand management systems. The evidence about the effects of referral reductions on costs was equivocal. We found no studies confirming that the development of preventative care would reduce demands on inpatient services. The IPT had overlooked certain mechanisms relevant to MCPs, mostly concerning MDTs and the uses of HITs. Limitations: The studies reviewed were limited to Organisation for Economic Co-operation and Development countries and, because of the large amount of published material, the period 2014–16, assuming that later studies, especially systematic reviews, already include important earlier findings. No empirical studies of MCPs yet existed. Conclusions: Multidisciplinary teams are a central mechanism by which MCPs (and equivalent networks and organisations) work, provided that the teams include the relevant professions (hence, organisations) and, for care planning, individual patients. Further primary research would be required to test elements of the revised logic model, in particular about (1) how MDTs and enhanced general practice compare and interact, or can be combined, in managing referral networks and (2) under what circumstances diverting patients from in-patient to primary care reduces NHS costs and improves the quality of patient experience.National Institute for Health Research (NIHR

Continuous Variable Quantum Cryptography using Two-Way Quantum Communication

Quantum cryptography has been recently extended to continuous variable systems, e.g., the bosonic modes of the electromagnetic field. In particular, several cryptographic protocols have been proposed and experimentally implemented using bosonic modes with Gaussian statistics. Such protocols have shown the possibility of reaching very high secret-key rates, even in the presence of strong losses in the quantum communication channel. Despite this robustness to loss, their security can be affected by more general attacks where extra Gaussian noise is introduced by the eavesdropper. In this general scenario we show a "hardware solution" for enhancing the security thresholds of these protocols. This is possible by extending them to a two-way quantum communication where subsequent uses of the quantum channel are suitably combined. In the resulting two-way schemes, one of the honest parties assists the secret encoding of the other with the chance of a non-trivial superadditive enhancement of the security thresholds. Such results enable the extension of quantum cryptography to more complex quantum communications.Comment: 12 pages, 7 figures, REVTe

Urinary biomarker concentrations of captan, chlormequat, chlorpyrifos and cypermethrin in UK adults and children living near agricultural land

There is limited information on the exposure to pesticides experienced by UK residents living near agricultural land. This study aimed to investigate their pesticide exposure in relation to spray events. Farmers treating crops with captan, chlormequat, chlorpyrifos or cypermethrin provided spray event information. Adults and children residing ≤100 m from sprayed fields provided first-morning void urine samples during and outwith the spray season. Selected samples (1–2 days after a spray event and at other times (background samples)) were analysed and creatinine adjusted. Generalised Linear Mixed Models were used to investigate if urinary biomarkers of these pesticides were elevated after spray events. The final data set for statistical analysis contained 1518 urine samples from 140 participants, consisting of 523 spray event and 995 background samples which were analysed for pesticide urinary biomarkers. For captan and cypermethrin, the proportion of values below the limit of detection was greater than 80%, with no difference between spray event and background samples. For chlormequat and chlorpyrifos, the geometric mean urinary biomarker concentrations following spray events were 15.4 μg/g creatinine and 2.5 μg/g creatinine, respectively, compared with 16.5 μg/g creatinine and 3.0 μg/g creatinine for background samples within the spraying season. Outwith the spraying season, concentrations for chlorpyrifos were the same as those within spraying season backgrounds, but for chlormequat, lower concentrations were observed outwith the spraying season (12.3 μg/g creatinine). Overall, we observed no evidence indicative of additional urinary pesticide biomarker excretion as a result of spray events, suggesting that sources other than local spraying are responsible for the relatively low urinary pesticide biomarkers detected in the study population

Multicentre cohort study to define and validate pathological assessment of response to neoadjuvant therapy in oesophagogastric adenocarcinoma.

BACKGROUND: This multicentre cohort study sought to define a robust pathological indicator of clinically meaningful response to neoadjuvant chemotherapy in oesophageal adenocarcinoma. METHODS: A questionnaire was distributed to 11 UK upper gastrointestinal cancer centres to determine the use of assessment of response to neoadjuvant chemotherapy. Records of consecutive patients undergoing oesophagogastric resection at seven centres between January 2000 and December 2013 were reviewed. Pathological response to neoadjuvant chemotherapy was assessed using the Mandard Tumour Regression Grade (TRG) and lymph node downstaging. RESULTS: TRG (8 of 11 centres) was the most widely used system to assess response to neoadjuvant chemotherapy, but there was discordance on how it was used in practice. Of 1392 patients, 1293 had TRG assessment; data were available for clinical and pathological nodal status (cN and pN) in 981 patients, and TRG, cN and pN in 885. There was a significant difference in survival between responders (TRG 1-2; median overall survival (OS) not reached) and non-responders (TRG 3-5; median OS 2·22 (95 per cent c.i. 1·94 to 2·51) years; P < 0·001); the hazard ratio was 2·46 (95 per cent c.i. 1·22 to 4·95; P = 0·012). Among local non-responders, the presence of lymph node downstaging was associated with significantly improved OS compared with that of patients without lymph node downstaging (median OS not reached versus 1·92 (1·68 to 2·16) years; P < 0·001). CONCLUSION: A clinically meaningful local response to neoadjuvant chemotherapy was restricted to the small minority of patients (14·8 per cent) with TRG 1-2. Among local non-responders, a subset of patients (21·3 per cent) derived benefit from neoadjuvant chemotherapy by lymph node downstaging and their survival mirrored that of local responders

Quantum optical coherence can survive photon losses: a continuous-variable quantum erasure correcting code

A fundamental requirement for enabling fault-tolerant quantum information processing is an efficient quantum error-correcting code (QECC) that robustly protects the involved fragile quantum states from their environment. Just as classical error-correcting codes are indispensible in today's information technologies, it is believed that QECC will play a similarly crucial role in tomorrow's quantum information systems. Here, we report on the first experimental demonstration of a quantum erasure-correcting code that overcomes the devastating effect of photon losses. Whereas {\it errors} translate, in an information theoretic language, the noise affecting a transmission line, {\it erasures} correspond to the in-line probabilistic loss of photons. Our quantum code protects a four-mode entangled mesoscopic state of light against erasures, and its associated encoding and decoding operations only require linear optics and Gaussian resources. Since in-line attenuation is generally the strongest limitation to quantum communication, much more than noise, such an erasure-correcting code provides a new tool for establishing quantum optical coherence over longer distances. We investigate two approaches for circumventing in-line losses using this code, and demonstrate that both approaches exhibit transmission fidelities beyond what is possible by classical means.Comment: 5 pages, 4 figure