- Judith Johnson
- Lucy Pointon
- Rebecca Talbot
- William Lea
Background Poor mental health in medical students is a global concern. Effective interventions are required, which are tailored towards the training-related stressors medical students experience. The Reboot coaching programme is an online, tailored intervention based on cognitive-behavioural principles. Aims To evaluate whether the Reboot coaching programme tailored for medical students was feasible and associated with improvements in mental health outcome indicators. Methods Medical students participated in two group online workshops and a one-to-one coaching call with a Reboot-trained licensed psychological therapist. Participants provided data at: baseline (T1), post-workshops (T2), post-coaching call (T3) and 4-month follow-up (T4). Outcome measures included resilience, confidence, burnout and depression. Feedback was provided regarding the workshops at T2. Results 115 participants (93/80.9% women; mage = 23.9; SD = 2.8) were recruited, 83 (72.2%) completed all intervention elements and 82 (71.3%) provided T4 data, surpassing recruitment and retention targets. There were significant improvements following baseline in resilience ( ps < .001), confidence ( ps < .001), burnout ( ps < .001) and depression ( ps ≤ .001). Most participants agreed the workshops imparted useful skills (n = 92; 99%) and would recommend Reboot to others (n = 89; 95.6%). Conclusions Existing interventions have produced mixed results regarding their effectiveness in improving medical students’ mental health. Reboot is a feasible intervention in this group which is associated with improvements in resilience, confidence, burnout and depression. Further controlled studies of Reboot are now needed.
Objective To develop international consensus-based recommendations for early referral of individuals with suspected polymyalgia rheumatica (PMR). Methods A task force including 29 rheumatologists/internists, 4 general practitioners, 4 patients and a healthcare professional emerged from the international giant cell arteritis and PMR study group. The task force supplied clinical questions, subsequently transformed into Population, Intervention, Comparator, Outcome format. A systematic literature review was conducted followed by online meetings to formulate and vote on final recommendations. Levels of evidence (LOE) (1–5 scale) and agreement (LOA) (0–10 scale) were evaluated. Results Two overarching principles and five recommendations were developed. LOE was 4–5 and LOA ranged between 8.5 and 9.7. The recommendations suggest that (1) each individual with suspected or recently diagnosed PMR should be considered for specialist evaluation, (2) before referring an individual with suspected PMR to specialist care, a thorough history and clinical examination should be performed and preferably complemented with urgent basic laboratory investigations, (3) individuals with suspected PMR with severe symptoms should be referred for specialist evaluation using rapid access strategies, (4) in individuals with suspected PMR who are referred via rapid access, the commencement of glucocorticoid therapy should be deferred until after specialist evaluation and (5) individuals diagnosed with PMR in specialist care with a good initial response to glucocorticoids and a low risk of glucocorticoid related adverse events can be managed in primary care. Conclusions These are the first international recommendations for referral of individuals with suspected PMR, which complement the European Alliance of Associations for Rheumatology/American College of Rheumatology management guidelines for established PMR.
Background Observational studies of polypharmacy and the risk of death or stroke in individuals with atrial fibrillation (AF) have produced inconsistent findings. By using propensity score matching (PSM) and Cox regression, this study aimed to determine whether polypharmacy (five to nine medicines) in the 3 months following AF diagnosis, is associated with an increased risk of death or ischemic stroke, compared to non‐polypharmacy (one to four medicines). Methods A prospective cohort study using data from the Clinical Practice Research Datalink (2006–2019). Data from 23 629 individuals with AF were analyzed. Cox regression models were adjusted for age, gender, morbidities, obesity, alcohol, smoking, and wealth. In the PSM models, cases and controls with near identical health profiles were selected from the study pool. The risk of death and stroke were presented as hazard ratios (HRs) with 95% confidence intervals (CIs). Results 68.9% ( n = 16 271) of the participants had polypharmacy. PSM showed that polypharmacy was associated with an increased risk of death during follow‐up (HR 1.32; 95% CI: 1.19–1.47, p < .01), but not ischemic stroke (HR 0.84; 95% CI: 0.69–1.02, p = .08). Conclusion Polypharmacy was associated with an increased risk of death during follow‐up, but not ischemic stroke, in individuals with AF. The effects of comorbidity and other confounding factors were reduced by using PSM. This study focused on the overall medication burden; however, further research is needed to identify which specific medications in polypharmacy regimens increase the risk of mortality in AF. These findings could inform prescribing practices in the future.
The snuff movie has been a cinematic spectre that has haunted successive generations of moviegoers. In the 1970s, the idea galvanised the feminist movement, and while most were quick to concede that it was unlikely that a snuff movie existed, the possibility that one might have proved impossible to dispel. Narratives of this kind have imagined the aesthetic of the snuff movie as the resolutely analogue aesthetic of degraded videotape or flickering cine reels. However, in the twenty-first century, the digital shift has not only democratised production, thereby making the likelihood that a snuff movie might exist more probable, but it has also seen the rise of ‘tube sites’ which provide a platform for the dissemination of this kind of material. This chapter will examine the origins of the snuff movie and will explore its evolution from marginal media myth to digital reality. Considering the murder of Jun Lin by the ‘cannibal killer’ Luka Magnotta, shared online as 1 Lunatic 1 Icepick, this video was freely shared to ‘shock sites’ across the world and garnered hundreds of thousands of views raising significant questions about the motivation of those who would choose to access a film of this kind.
This chapter concludes the book Difficult Death, Dying and the Dead in Media and Culture. We reflect upon the overall themes of the book, considering the ways in which the public and private converge when we begin to look at the difficulties of death and dying. The chapter looks towards the ways in which we interact with death, dying and the dead through varied media—exploring the concepts of celebrity, online interactions with mortality, the differences and divides between real and fictional death, and audiences’ connections to death as entertainment and distraction. We identify that the recording or capturing of death and reactions to it creates a stasis, with such stasis and ongoing access and potential to revisit images of death presenting a challenge to the concept of privacy when considering loss. We find that death in media and culture is a matter of context, with a personal relationship of navigation and negotiation for each member of the audience often at the centre of experience.
This chapter introduces the book Difficult Death, Dying and the Dead in Media and Culture. We reflect on the terms ‘difficult death’, ‘dying’ and the ‘dead’ and their potential meanings and we explore some of the challenges of writing about death in mediated form. We consider the difference between media and culture in the context of death studies and draw on a range of scholarship to consider the mediation of death, dying and the dead in culture. We provide a summary of each of the chapters included within the collection, and some suggestions on how you might approach the reading of the book. We argue that the terms ‘difficult death’, ‘dying’ and ‘the dead’ are contingent ones, and, for example, that what constitutes a difficult death will be culturally and socially relative, as well as dependent on a series of individual factors including life experiences and expectations. We suggest that when death is constructed as difficult, it is often so because it occurs at the nexus of myriad forms of social inequality that function as mechanisms of systemic marginalisation in life and in death.
Organic solar cells (OSCs) as emerging generation solar cells are required to face climate and energy challenges. In this regard, OSCs based on the D18:Y6 active layer with a ratio of 1:1.6 with thermal and solvent annealing as a post-treatment were fabricated. The effect of different thermal annealing with chloroform on the active layer and the cell performance was studied. Optical, morphological and thermal analysis are executed to investigate the effect of thermal with solvent annealing on the D18:Y6 active layer. Photoluminescence (PL), transmission electron microscope (TEM) and atomic force microscope (AFM) reveal that D18:Y6 film treated at 55 °C with chloroform for 5.0 min had the lowest PL intensity, interpenetrating grain networking structures and more smoother surface leads to optimize photo-induced charge transfer and exciton dissociation in the active layer. D18: Y6 blend film annealed at 80 °C with chloroform for 5.0 min exhibits higher roughness of 17.81 nm than 11.60 nm for D18:Y6 blend film treated at 55 °C. As a result, the optimal performance of the fabricated conventional OSCs based on active layer treated at 55 °C with chloroform had short-current density (Jsc), open circuit voltage (Voc), fill factor (FF) and efficiency of 60 mA/cm ² , 0.70V, 39.8% and 16.5%, respectively. This study indicates additional thermal annealing with chloroform as a post-treatment enhances the device performance of OSCs. Graphical abstract Studying the effect of solvent vapor annealing with thermal annealing of D18:Y6 layer as post-treatment on the performance of organic solar cells.
Flying Ad‐Hoc Network (FANET) is a promising ad hoc networking paradigm that can offer new added value services in military and civilian applications. Typically, it incorporates a group of Unmanned Aerial Vehicles (UAVs), known as drones that collaborate and cooperate to accomplish several missions without human intervention. However, UAV communications are prone to various attacks and detecting malicious nodes is essential for efficient FANET operation. Trust management is an effective method that plays a significant role in the prediction and recognition of intrusions in FANETs. Specifically, evaluating node behaviour remains an important issue in this domain. For this purpose, the authors suggest using fuzzy logic, one of the most commonly used methods for trust computation, which classifies nodes based on multiple criteria to handle complex environments. In addition, the Received Signal Strength Indication (RSSI) is an important parameter that can be used in fuzzy logic to evaluate a drone's behaviour. However, in outdoor flying networks, the RSSI can be seriously influenced by the humidity of the air, which can dramatically impact the accuracy of the trust results. FUBA, a fuzzy‐based UAV behaviour analytics is presented for trust management in FANETs. By considering humidity as a new parameter, FUBA can identify insider threats and increase the overall network's trustworthiness under bad weather conditions. It is capable of performing well in outdoor flying networks. The simulation results indicate that the proposed model significantly outperforms FNDN and UNION in terms of the average end‐to‐end delay and the false positive ratio.
For several decades, conflicts within states rather than between them have been the prevalent form of organized political violence worldwide. Most intra-state conflicts since 1945 have originated in insurgencies, not just against incumbent regimes but, more often, against those regimes’ external sponsors, whether imperial governments or dominant regional powers. This Handbook focuses on the former group, on the insurgencies and counter-insurgencies fought out as European overseas empires collapsed. Seeking to identify the causal dynamics and violence processes of such violent decolonization, the Handbook will address the most taxing problems in conflict limitation: how to constrain the actions of insurgents and counter-insurgents in asymmetric ‘guerrilla wars’; how to mitigate the consequences of proxy involvement in intra-state conflicts; and how to protect civilians in war zones where combatant-non-combatant distinctions have broken down. Underlying these questions is a unifying theme—and a core Handbook objective—the need to recognize the cultural practices of insurgent movements and counter-insurgent forces as a prerequisite to comprehending their violence.
Thalassemia represents one of the most common genetic disorders worldwide, characterized by defects in hemoglobin synthesis. The affected individuals suffer from malfunctioning of one or more of the four globin genes, leading to chronic hemolytic anemia, an imbalance in the hemoglobin chain ratio, iron overload, and ineffective erythropoiesis. Despite the challenges posed by this condition, recent years have witnessed significant advancements in diagnosis, therapy, and transfusion support, significantly improving the prognosis for thalassemia patients. This research empirically evaluates the efficacy of models constructed using classification methods and explores the effectiveness of relevant features that are derived using various machine-learning techniques. Five feature selection approaches, namely Chi-Square (χ2), Exploratory Factor Score (EFS), tree-based Recursive Feature Elimination (RFE), gradient-based RFE, and Linear Regression Coefficient, were employed to determine the optimal feature set. Nine classifiers, namely K-Nearest Neighbors (KNN), Decision Trees (DT), Gradient Boosting Classifier (GBC), Linear Regression (LR), AdaBoost, Extreme Gradient Boosting (XGB), Random Forest (RF), Light Gradient Boosting Machine (LGBM), and Support Vector Machine (SVM), were utilized to evaluate the performance. The χ2 method achieved accuracy, registering 91.56% precision, 91.04% recall, and 92.65% f-score when aligned with the LR classifier. Moreover, the results underscore that amalgamating over-sampling with Synthetic Minority Over-sampling Technique (SMOTE), RFE, and 10-fold cross-validation markedly elevates the detection accuracy for αT patients. Notably, the Gradient Boosting Classifier (GBC) achieves 93.46% accuracy, 93.89% recall, and 92.72% F1 score.
Honest signalling theory suggests that humans and chimpanzees can extract socially relevant information relating to personality from the faces of their conspecifics. Humans are also able to extract information from chimpanzees’ faces. Here, we examine whether personality characteristics of chimpanzees, including measures of psychopathy, can be discerned based purely on facial morphology in photographs. Twenty-one chimpanzees were given naïve and expert personality ratings on the Ten Item Personality Inventory (TIPI) and the Chimpanzee Triarchic Model of Psychopathy (CHMP-Tri) before and following behavioural observations. Characteristics relating to openness, conscientiousness, extraversion, and disinhibition could be distinguished from the faces of chimpanzees. Individuals higher on disinhibition have lower scores on conscientiousness and emotional stability and higher scores on extraversion, while those higher on meanness have lower conscientiousness and agreeableness. Facial expressions are linked to personality traits present in the TIPI and CHMP-Tri models: the Relaxed Face and the Grooming Face were displayed more by chimpanzees higher on agreeableness, whereas the Compressed Lips Face was observed more in those individuals higher on boldness, and the Full Open Grin was displayed more by chimpanzees higher on extraversion but lower on emotional stability and conscientiousness. Facial expressions were also found to be associated with particular behavioural contexts, namely the Grooming Face in affiliative contexts and the Relaxed and Relaxed Open Mouth Faces in neutral contexts. Dominant chimpanzees display higher levels of boldness and more Compressed Lips Faces, Relaxed Open Mouth Faces, and Grooming Faces than subordinate individuals. These findings support and extend evidence for an honest signalling system and a personality structure shared between humans and chimpanzees. Future research could further explore how personality is conveyed through the face, perhaps through more than just singular aspects of character, and maybe reflecting what chimpanzees themselves are able to do.
Researchers have intimated that cognitions and emotions can change in the lead up to important events. However, previous research has adopted atemporal cross‐sectional designs, making it challenging to understand how cognitions and emotions unfold in the lead up to a competition. In the current study, we extended previous research by examining the temporal patterns of cognitive appraisals, irrational beliefs, and challenge and threat evaluations in predicting pre‐competitive affective states (hedonic balance and anxiety) in the lead up to an actual competition, among competitive elite Indian golfers ( N = 107). We adopted a within‐subjects repeated‐measures design and collected data in the lead up to an actual golf tournament, at three timepoints; 1 week before (T1), the night before (T2), and an hour prior (T3). Self‐reported measures of cognitive appraisals, irrational beliefs, challenge and threat evaluations, affect, and anxiety were completed. Also, objective golf performance was collected from participants. Crossed‐lagged path analysis did not find a causal effect for irrational beliefs on any of the variables across the three time points. On the other hand, hierarchical multiple regression analysis determined that changes in irrational beliefs predicted changes in cognitive appraisals, threat evaluation, cognitive and somatic anxiety, and the directional interpretation of anxiety. The findings of temporal patterns in the current research indicated that sport psychologists should consider the dynamic nature of antecedent cognitions and affective states in the lead up to competition, and accordingly provide adequate support to the athletes. Further, limitations and future research is discussed with reference to the results.
Suicide and attempted suicide of people receiving care in Adult Mental Health Inpatient Services (AMHIS) leads to significant emotions amongst mental health professionals, characterised by guilt and shame. A sense of responsibility occurs due to hospital being seen as a safe place. However, little is known about what it is like for ‘non-qualified’ staff. This study explored experiences of suicide and attempted suicide on ‘non-qualified’ staff in AMHIS. Semi-structured interviews explored ten staff’s experiences. Participants were recruited online and transcripts were analysed using Reflexive Thematic Analysis. Four themes were identified; ‘Direct personal impact’, ‘Unrealistic expectations’, ‘Attempting to contain the impact’ and ‘Acclimatisation’. Ten sub-themes outlined; responsibility for assessing risk, shame and protective strategies to aid acceptance. The results provide insight into the unique experience of non-qualified staff in AMHIS experiencing suicidal behaviour.
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