Psychologists' Perspectives on the Diagnostic Classification of Mental Disorders: Results from the WHO-IUPsyS Global Survey

BACKGROUND/PURPOSE: Revisions are underway for the two major diagnostic classification systems (DCSs) of mental disorders, the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). For the World Health Organization (WHO), improving clinical utility is a major priority for the ICD-11. International clinician surveys are informative in this regard, but such research has not been conducted among psychologists. This study investigates psychologists' views on DCSs in mental health care and how these views differ across countries, regions, and ICD-10 versus DSM-IV users. METHODS: WHO and the International Union of Psychological Science conducted an international online survey examining views of DCSs as part of the ICD revision process. Participants were 2,155 psychologists from 23 national psychological associations around the globe. Items addressed practical and conceptual issues related to DCSs and their clinical use. RESULTS: Majorities of participating psychologists were licensed, seeing patients, made diagnoses, and used a DCS regularly, the slight majority using the ICD-10 most often. The vast majority viewed the primary purpose of DCSs to be informing treatment decisions and facilitating clinical communication. Flexible diagnostic guidelines were preferred to strict criteria. Most respondents agreed that dimensional classification, severity, and functional impairment should be incorporated into a DCS, but with little agreement as to how or why. Significant percentages reported problems with their DCS including cross-cultural applicability, Western bias, stigmatizing terms, and a need for a national DCS. Clinicians favorably evaluated the ease of use and goodness of fit of most diagnoses, but identified some as problematic. There were more differences among regions and countries than between ICD-10 and DSM-IV users. CONCLUSIONS: Overall, psychologists' views reflect favorably upon the current ICD-10 and DSM-IV systems and categories, while also identifying areas for improvement. Findings underscore the priority of clinical utility in a DCS, the diverse purposes it must serve, and professional and cultural differences among its international users. Differences associated with countries/regions, DCSs, and psychologists and psychiatrists may be partially explained by country-level differences in health systems, cultural factors, and psychology. Implications for ICD-11 revisions, field trials, dissemination, and training efforts are discussed

Centrifugal Compressor Performance Making Enlightened Analysis Decisions

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Identifying patient concerns during consultations in tertiary burns services: development of the Adult Burns Patient Concerns Inventory

ObjectivesIdentifying the issues and concerns that matter most to burns survivors can be challenging. For a number of reasons, but mainly relating to patient empowerment, some of the most pressing concerns patients may have during a clinical encounter may not naturally be the focal point of that encounter. The Patient Concerns Inventory (PCI) is a tried and tested concept initially developed in the field of head and neck cancer that empowers patients during a clinical encounter through provision of a list of prompts that allows patients to self-report concerns prior to consultation. The aim of this study was to develop a PCI for adult burns patients.DesignContent for the PCI was generated from three sources: burns health-related quality of life tools, thematic analysis of one-to-one interviews with 12 adult burns patients and 17 multidisciplinary team (MDT) members. Content was refined using a Delphi consensus technique, with patients and staff members, using SurveyMonkey.SettingWithin outpatient secondary care.ParticipantsTwelve adult burns patients and MDT members from two regional burns centres.ResultsA total of 111 individual items were generated from the three sources. The Delphi process refined the total number of items to 58. The main emergent domains were physical and functional well-being (18 items), psychological, emotional and spiritual well-being (22 items), social care and social well-being (7 items) and treatment-related concerns (11 items).ConclusionsThe Adult Burns Patient Concerns Inventory is a 58-item, holistic prompt list, designed to be used in the outpatient clinic. It offers a new tool in burn care to improve communication between healthcare professionals and patients, empowering them to identify their most pressing concerns and hence deliver a more focused and targeted patient-centred clinical encounter

Coupling between tidal mudflats and salt marshes affects marsh morphology

It is generally assumed that coastal salt marshes are capable of adapting to moderately fast rising sea levels although local sediment availability crucially affects this capability. While there is an increasing awareness that local sediment availability is inherently related to sediment dynamics on the adjacent tidal mudflat, our current understanding of the interactions between salt marshes and tidal flats is very limited. To address this knowledge gap, we measured suspended sediment concentrations alongside hydrodynamic, morphological and sediment deposition measurements over a total period of 16weeks in a wave-exposed macro-tidal mudflat-salt marsh system on the UK east coast (Tillingham). Our results show that local sediment supply to the salt marsh is strongly linked to intertidal sediment dynamics and that the vast majority of suspended sediment deposited on the marsh originates from wind-wave induced intertidal sediment resuspension in very close vicinity (5mmyr⁠−1, thereby increasing the slope of the tidal mudflat-salt marsh transition and making the salt marsh susceptible to lateral erosion. Consequently, the marsh edge retreats at a rate of approximately 0.8myr⁠−1. Our study shows that the response of coastal salt marshes to climate change is a function of the coupled tidal mudflat-salt marsh system, rather than their vertical sediment accretion rates alone. Therefore, the idea that salt marsh adaptability relies on local sediment supply needs to be expanded, incorporating the morphology and long-term evolution of the adjacent tidal mudflats.NERC-funded projects Coastal Biodiversity and Ecosystem Services Sustainability (CBESS; grant no: NE/J015423/1) and BLUE-coast (grant no: NE/N015878/1)

DuraTable Enterprises Inc.

In late 2017, DuraTable received a number of unsolicited inquiries regarding its interest in selling out in a going private transaction, mostly from private equity firms. Since the chairman of the board and founder, Gary Reynolds, was approaching retirement age and the largest single shareholder who had provided the seed capital to start the company was over 80 years old, Mr. Reynolds was willing to consider a sale and provided information to four or five of them to prepare bids. DuraTable was a closely held company with relatively few individuals holding the vast majority of shares. As such, DuraTable’s shares traded infrequently. As a result, Mr. Reynolds questioned if even the share price itself appropriately reflected the value of the company. As he looked forward to a meeting that would be held with Pierce the following week, Mr. Reynolds asked himself, ‘What price would reflect a fair valuation of DuraTable’s operations?

An Update on the Science of Acidification in the Adirondack Park

This paper provides a review of the science pertaining to all aspects of acidification in the Adirondack Park, updating an earlier review of the science (Cook et al. 2002). The review supports an ongoing social science investigation into the willingness to pay for ecological improvements that would result from reduced acid deposition. This paper builds a bridge between the physical science and social science by providing the background that will allow researchers to accurately summarize the crucial elements of ecological status and improvement in a stated preference survey.acid rain, acidification, stated preference, willingness to pay, benefit estimation

Early Higgs Boson Discovery in Non-minimal Higgs Sectors

Particle physics models with more than one Higgs boson occur in many frameworks for physics beyond the standard model, including supersymmetry, technicolor, composite Higgs, and "little Higgs" models. If the Higgs sector contains couplings stronger than electroweak gauge couplings, there will be heavy Higgs particles that decay to lighter Higgs particles plus heavy particles such as $W$, $Z$, and $t$. This motivates searches for final states involving multiple $W$, $Z$, $t$, and $\bar{b}b$ pairs. A two Higgs doublet model with custodial symmetry is a useful simplified model to describe many of these signals. The model can be parameterized by the physical Higgs masses and the mixing angles \al and \be, so discovery or exclusion in this parameter space has a straightforward physical interpretation. We illustrate this with a detailed analysis of the process $gg \to A$ followed by $A \to h Z$ and $h \to WW$. For m_{A} \simeq 330\GeV, m_{h} \simeq 200\GeV we can get a 4.5\si signal with 1 fb${}^{-1}$ of integrated luminosity at the Large Hadron Collider.Comment: 4 pages, 3 figure

Dynamics of salt marsh margins are related to their 3-dimensional

The three-dimensional configuration of sedimentary landforms in intertidal environments represents a major control on regional hydrodynamics. It modulates the location and magnitude of forces exerted by tidal currents and waves on the landform itself and on engineered infrastructure such as sea walls or coastal defences. Furthermore, the effect is reflexive with the landforms representing an integrated, long-term response to the forces exerted on them. There is a strong reciprocal linkage between form and process (morphodynamics) in the coastal zone which is significantly lagged and poorly understood in the case of cohesive, vegetated sediments in the intertidal zone. A method is presented that links the geometric properties of the tidal at-saltmarsh interface to the history and potential future evolution of that interface. A novel quantitative classification scheme that is capable of separating marsh margins based on their functional form is developed and is applied to demonstrate that relationships exist between landform configuration and morphological evolution across a regional extent. This provides evidence of a spatially variable balance between self-organised and external controls on morphodynamic evolution and the first quantitative basis for a quick assessment procedure for likely future dynamism.Foreshore Assessment using Space Technology (FAST) EU 7th Framework Programme FP7-SPACE-2013-1 The Isaac Newton Trust

Imaging Hepatocellular Carcinoma With 68Ga-Citrate PET: First Clinical Experience.

While cross-sectional imaging with computed tomography (CT) and magnetic resonance imaging is the primary method for diagnosing hepatocellular carcinoma (HCC), they provide little biological insight into this molecularly heterogeneous disease. Nuclear imaging tools that can detect molecular subsets of tumors could greatly improve diagnosis and management of HCC. To this end, we conducted a patient study to determine whether HCC can be resolved using 68Ga-citrate positron emission tomography (PET). One patient with recurrent HCC was injected with 300 MBq of 68Ga-citrate and imaged with PET/CT 249 minutes post injection. Four (28%) of 14 hepatic lesions were avid for 68Ga-citrate. One extrahepatic lesion was not PET avid. The average maximum standardized uptake value (SUVmax) for the lesions was 7.2 (range: 6.2-8.4), while the SUVmax of the normal liver parenchyma was 4.7 and blood pool was 5.7. The avid lesions were not significantly larger than the quiescent lesions, and a prior contrast CT showed uniform enhancement among the lesions, suggesting that tumor signals are due to specific binding of the radiotracer to the transferrin receptor, rather than enhanced vascularity in the tumor microenvironment. Further studies are required in a larger patient cohort to verify the molecular basis of radiotracer uptake and the clinical utility of this tool

Southern North Sea storm surge event of 5 December 2013: Water levels, waves and coastal impacts

The storm surge event that affected the coastal margins of the southern North Sea on 5–6 December 2013 produced the highest still water levels on record at several tide gauges on the UK east coast. On east-facing coasts south of the Humber estuary and north-facing Norfolk, water levels were higher than in the twentieth century benchmark surge event of 31 January–1 February 1953. Maximum significant wave heights were highest off the North Norfolk coast (peak Hs = 3.8 m offshore, 2.9 m inshore) and lowest off the Suffolk coast (Hs = 1.5–1.8 m inshore); comparable offshore wave heights in 1953 were 7–8 m and ca. 3 m. The lower wave heights, and their short duration, in 2013 explain both localised breaching, overtopping, and back-barrier flooding associated with gravel ridges and relatively low earthen banks as well as the lack of failure in more highly-engineered coastal defences. On barrier coasts and within estuaries, the signal of maximum runup was highly variable, reflecting the modification of the tide–surge–wave signal by inshore bathymetry and the presence of a range of coastal ecosystems. The landscape impacts of the December 2013 surge included the notching of soft rock cliffs and cliffline retreat; erosion of coastal dunes; and the augmentation or re-activation of barrier island washover deposits. Whilst surge event-related cliff retreat on the rapidly eroding cliffs of the Suffolk coast lay within the natural variability in inter-annual rates of retreat, the impact of the surge on upper beach/sand dune margins produced a pulse of shoreline translation landwards equivalent to about 10 years of ‘normal’ shoreline retreat. The study of east coast surges over the last 60 years, and the identification of significant phases of landscape change — such as periods of rapid soft rock cliff retreat and the formation of new gravel washovers on barrier islands — points to the importance of high water levels being accompanied by high wave activity. Future developments in early warning systems and evacuation planning require information on the variable impacts of such extreme events.This paper is a contribution to NERC BESS Consortium grant A hierarchical approach to the examination of the relationship between biodiversity and ecosystem service flows across coastal margins (grant reference NE/J015423/1). Table 5 incorporates information gathered as part of an EU FP7 Collaborative Project Resilience-Increasing Strategies for Coasts — toolkit (RISC_KIT).This is the final published version. It first appeared at http://www.sciencedirect.com/science/article/pii/S0012825215000628#