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This study aimed to determine whether, following two years of specialized support for first‐episode psychosis, the addition of a new digital intervention (Horyzons) to treatment as usual (TAU) for 18 months was more effective than 18 months of TAU alone. We conducted a single‐blind randomized controlled trial. Participants were people with first‐episode psychosis (N=170), aged 16‐27 years, in clinical remission and nearing discharge from a specialized service. They were randomly assigned (1:1) to receive Horyzons plus TAU (N=86) or TAU alone (N=84) between October 2013 and January 2017. Horyzons is a novel, comprehensive digital platform merging: peer‐to‐peer social networking; theory‐driven and evidence‐informed therapeutic interventions targeting social functioning, vocational recovery and relapse prevention; expert clinician and vocational support; and peer support and moderation. TAU involved transfer to primary or tertiary community mental health services. The primary outcome was social functioning at 18 months as measured by the Personal and Social Performance Scale (PSP). Forty‐seven participants (55.5%) in the Horyzons plus TAU group logged on for at least 6 months, and 40 (47.0%) for at least 9 months. Social functioning remained high and stable in both groups from baseline to 18‐month follow‐up, with no evidence of significant between‐group differences (PSP mean difference: –0.29, 95% CI: –4.20 to 3.63, p=0.77). Participants in the Horyzons group had a 5.5 times greater increase in their odds to find employment or enroll in education compared with those in TAU (odds ratio, OR=5.55, 95% CI: 1.09‐28.23, p=0.04), with evidence of a dose‐response effect. Moreover, participants in TAU were twice as likely to visit emergency services compared to those in the Horyzons group (39% vs. 19%; OR=0.31, 95% CI: 0.11‐0.86, p=0.03, number needed to treat, NNT=5). There was a non‐significant trend for lower hospitalizations due to psychosis in the Horyzons group vs. TAU (13% vs. 27%; OR=0.36, 95% CI: 0.11‐1.08, p=0.07, NNT=7). So, although we did not find a significant effect of Horyzons on social functioning compared with TAU, the intervention was effective in improving vocational or educational attainment, a core component of social recovery, and in reducing usage of hospital emergency services, a key aim of specialized first‐episode psychosis services. Horyzons holds significant promise as an engaging and sustainable intervention to provide effective vocational and relapse prevention support for young people with first‐episode psychosis beyond specialist services.

ABSTRACTI begin by highlighting central texts from Aristotle that demonstrate both an appreciation of the rich coupling of subject and object that has been the subject of much of the most exciting and innovative phenomenological work and a fundamental methodological commitment to answering to the terms of experience. I then turn to Plato’s dramatic portrayals of Socrates’ distinctive practice—the “Socratic method”—first to document the subtlety that Socrates displays in his dialogical embrace of the description of lived experience and then, with him, to see the depths of existential change that are integral to the commitment to this method.

Following widespread use of the Haemophilus influenzae serotype b (Hib) vaccine, H. influenzae serotype a (Hia) has emerged as an important pathogen in children in some regions. We describe the clinical features and molecular epidemiology of invasive Hia disease in children in Utah over an 11-year period.

A 64-year-old man with recently diagnosed prostate adenocarcinoma and Gleason score 4 + 3 = 7 with a mildly elevated prostate-specific antigen of 5.17 μg/L was referred for 18F-DCFPyL PET/CT for primary staging. The scan demonstrated incidental innumerable moderately avid subcutaneous nodules due to adiposis dolorosa (Dercum’s disease), which is a rare adipose tissue disease.

ABSTRACTThe authors reflect on the methodology of using digital tools to learn about the experiences of Indigenous people enrolled from 1980 to 2000 as adult students at Tranby, an Indigenous-controlled post-secondary college. This collaboration between Tranby and the University of Technology Sydney drew on debates in post-colonial studies, oral history and archival studies. The authors found that participants prioritised personal control in all social media communication and engaged most actively in person-to-person communication to take part in this research. Participants were eager to share memories of student experiences but they have preferred to contribute to online publications which focused on activities, rather than on individuals. To support participants’ desire for control over digital communication, the authors slowed the pace of online outcome development to allow flexible and ongoing consent arrangements along with non-custodial approaches to oral, archival, photographic and material collections.

When patients' kidney function deteriorates to chronic kidney disease stage 5, services offer patients a choice for the next phase of their care. Renal replacement therapies may not have survival benefits, and conservative management may have less treatment burden for older patients with associated comorbidities or frailty. Anna E Winterbottom et al discuss the development of a patient decision aid.

ABSTRACTAlthough therapeutic alliance is a robust predictor of treatment outcomes in child and adolescent psychotherapy, less is known about relational factors, such as youth’s attachment, to mothers and fathers. The current study investigated anxious or avoidant attachment to mothers or fathers as predictors of early formation of the therapeutic alliance in a high-risk sample of depressed and suicidal adolescents. Changes in adolescents’ alliance ratings between the 1st and 4th treatment sessions were examined in a comparative efficacy trial (N = 115) of attachment-based family therapy and family-enhanced nondirective supportive therapy for suicidal and depressed adolescents. Multilevel regression analysis accounted for nested data by therapist and treatment condition. After accounting for significant random effects in our multilevel model associated with therapist to treatment condition, results revealed a significant effect of perceived insecurity to mothers leading to lower levels of therapeutic alliance at Session 4 (β = −0.49, p < .05). The quality of adolescents’ attachments to parents may play an important role in adolescents’ ability to form strong working relationships with a therapist. Findings suggested that adolescents with avoidant attachment styles may be more difficult to engage in treatment and could benefit from specific interventions focused on alliance-building.

Simulation training has been adopted by other industries, particularly aviation, for many years. With patient safety on every agenda, more recently there has been considerable interest and investment in its use for the acute medical specialities. Evidence in palliative medicine, for the use of simulation is mainly limited to advanced communication skills but little is described about its use in developing acute clinical skills. This article describes how in the Yorkshire and Humber Deanery a simulation training day was set up for Palliative Medicine specialty trainees, to assess their knowledge and develop the skills required to deal with acute medical emergencies, as described in the specialty training curriculum for palliative medicine. Scenarios included opioid toxicity, acute left ventricular failure, anaphylaxis, hypoglycaemia and massive haemorrhage. The set up and scenarios are described, along with the mechanisms for delivering feedback. This method of training received positive feedback from trainees and facilitators. The advantages, limitations and potential future role for high-fidelity simulation training for medical trainees and the wider multidisciplinary palliative care team are discussed.

Wrist block has been used to provide pain relief for many procedures on the hand and wrist but its role in arthroscopy of the wrist remains unexplored. Chondrotoxicity has been a concern with the intra-articular infiltration of local anaesthetic. We aimed to evaluate and compare the analgesic effect of portal and wrist joint infiltration with a wrist block on the pain experienced by patients after arthroscopy of the wrist.A prospective, randomised, double-blind trial was designed and patients undergoing arthroscopy of the wrist under general anaesthesia as a day case were recruited for the study. Levo-bupivacaine was used for both techniques. The effects were evaluated using a ten-point visual analogue scale, and the use of analgesic agents was also compared. The primary outcomes for statistical analyses were the mean pain scores and the use of analgesia post-operatively. A total of 34 patients (63% females) were recruited to the portal and joint infiltration group and 32 patients (59% males) to the wrist block group. Mean age was 40.8 years in the first group and 39.7 years in the second group (p > 0.05). Both techniques provided effective pain relief in the first hour and 24 hours post-operatively but wrist block gave better pain scores at bedtime on the day of surgery (p = 0.007) and at 24 hours post-operatively (p = 0.006). Wrist block provides better and more reliable analgesia in patients undergoing arthroscopy of the wrist without exposing patients to the risk of chondrotoxicity.Cite this article: Bone Joint J2015;97-B:1250–6.

We present 12 seasonally resolved δ18O profiles of giant clams (Tridacnasp.) from the Huon Peninsula, Papua New Guinea, spanning discrete periods of time (9–38 years) over the past 60 ka. The interannual anomaly time series of these shells are used to reconstruct interannual variability which can predominantly be attributed in the modern climate to the El Niño–Southern Oscillation (ENSO) in this region. We have found a significant reduction in interannual δ18O variance during the early Holocene, whereas during Marine Isotope Stage 3 there were at least some periods with variance not significantly different to the twentieth century. We show that ENSO variability seen during the late twentieth century is rare but not unprecedented within glacial climates. ENSO events can be seen in fossil Tridacna δ18O recordsENSO was suppressed during the early HoloceneENSO events stronger than today can be seen in MIS3 data

Advanced renal failure has a mortality rate worse than for most cancers with significant symptom burden. Despite this palliative care for this group has been poor. This article summarizes the role that palliative and nephrology teams can play in optimizing end-of-life care.

The short story "Softly the Fall," by Penni Russon is presented.

The efficiencies of fish passes specifically designed and constructed to facilitate the movement of a limited number of species and life‐stages past structural barriers are likely to decline as site‐specific conditions shift with a changing climate. There is a need to develop realistic fish passage criteria based on understanding swimming capability and behaviour of multiple species in relation to temperature and flow. The influence of temperature and discharge on behaviour and ability of groups of migrating adult river lamprey (Lampetra fluviatilis), a threatened species, to pass a small overshot or undershot weir at night was investigated using a large experimental flume. Lamprey approached the weirs less, and more often maintained station by using the oral disk to attach to structure, under high flows. Oral disk attachment was more commonly observed during tests employing the undershot weir. Upstream movement tended to be in close proximity to the channel walls and floor where, compared to the mid‐channel, velocities were generally lower and velocity vectors more likely to be in a direction other than the bulk flow. Upstream movement was positively related to temperature, and was higher for the overshot weir. Weir passage rate was higher for undershot than overshot weirs, and negatively related to the maximum velocity at the weir. Passage rate was low when maximum velocities at the weir exceeded 1.5 m s−1, although some fish passed at c. 1.7 m s−1. Passage efficiency, the number of weir passes as a percentage of the number of approaches, was also higher for the undershot weir, but was not affected by discharge because lamprey approached less frequently at high flows. This study provides fish passage criteria under realistic conditions for an infrequently studied anguilliform species of conservation concern and provides a methodological perspective by which to improve fishway suitability for a wider range of species subject to changing climate. Copyright © 2010 John Wiley & Sons, Ltd.

Femoral nerve blocks and indeed all peripheral nerve blocks have become a popular, safe and effective method of providing postoperative analgesia. The advantages of a femoral nerve block for lower limb surgery include good postoperative analgesia, a reduction in the need for opioids (thus reducing the associated complications of opioids such as nausea, vomiting, itching and confusion (Allen et al 1998, Wang et al 2002)) and the potential for earlier mobilisation and discharge from the hospital (Wang et al 2002, Ilfeld et al 2008).

The Department of Health (DH) proposes that 75% of elective surgery should be performed as a day case procedure (NHS Plan 2000). To achieve this some modification of the traditional selection criteria may be required and careful thought given to the patient pathway, including the anaesthetic technique. Successful anaesthesia for day case surgery requires a balanced anaesthetic technique and multidisciplinary input which commences at booking, runs through preoperative assessment and continues to a nurse-led discharge. Suitable patients need to be selected (Digner 2007), prepared both physically and psychologically, undergo minimally invasive surgery with a suitable anaesthetic technique encompassing good pain relief and the avoidance of postoperative nausea and vomiting (PONV). Pain and PONV are the most common causes for a patient to require unplanned admission (Junger 2001).

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This article demonstrates the benefits of utilizing the IT Infrastructure Library (ITIL) framework to integrate ZENworks functionality into the help desk or IT service desk. Such benefits include: improved customer satisfaction through expedited incident resolution; automated provisioning of software assets from a policy-driven framework; increased efficiency for help desk agents through remote management tools and complete asset control; enhanced focus and a proactive approach to service provisioning; better managed IT infrastructure and policy-based device configuration; improved usage of IT support resources and increased productivity of business personnel; and more meaningful management information to support decision. Five main areas of IT best practice processes are addressed by ITIL for help desk service support: incident management; problem management; change management; configuration management; and release management. Integrating ZENworks into the help desk processes and workflow provide features such as remote diagnostics, remote control and asset management, among others. The benefits of integrating asset management software with help desk software are centered on increasing agent productivity. ZENworks hardware and software inventory management data that is integrated with Help Desk software streamlines agent flows. This offers benefits such as reduced incident handling and resolution time. Integrating the ZENworks imaging feature, image restoration, allows help desk agents to completely restore a desktop to the desired machine state.

The 3‘,5‘-bis-O-TBDMS derivative of 2‘-deoxyguanosine can be converted to its O⁶-alkyl and O⁶-aryl ethers as well as to N⁶-substituted diaminopurine nucleosides in two simple steps. Also described is a novel, nonaqueous, one-step O⁶-desulfonylation method that leads to deprotection of the carbonyl moiety of 2‘-deoxyguanosine.

Matrix‐assisted laser desorption/ionization (MALDI) time‐of‐flight mass spectrometry (TOFMS) can be used for rapid detection of bacteria proteins in a crude mixture. It can potentially be used as a tool for bacterial identification based on the mass spectral patterns or the appearance of some characteristic mass peaks. However, there are many experimental parameters that can potentially have a strong effect on the observed mass spectra. The objective of this work is to address the mass spectral reproducibility issue. Several experimental parameters that may affect the MALDI spectra are systematically investigated. Results of spectral comparison from two laboratories with different operators and instrumentation are presented. It is demonstrated that minor variations in the sample/matrix preparation procedures for MALDI and in the experimental conditions used for bacterial protein extraction can result in a significant change in the observed spectra, though a number of peaks are conserved in the spectra obtained under different experimental conditions from the same bacterial sample. These conserved peaks may potentially be used as the biomarkers for bacterial identification. It is stressed that this type of investigation on spectral reproducibility should be carried out for different bacterial species in order to identify the mass spectral peaks that are consistently detected regardless of operator and nominal variations in sample preparation approach. © 1998 John Wiley & Sons, Ltd.

The role of national libraries has been discussed widely over the past three decades and a number of core functions have been identified. Most national libraries have been developed with a primary aim of acting as the steward of the national archive. Traditionally there has been a strong bias towards the humanities and social sciences, with services to the scientific and industrial communities delegated to specific institutions separate from the national library. The British Library is unique in dividing its resources approximately equally between humanities and social sciences and science and technology. The units making up its Science, Technology and Industry division (which include the Document Supply Centre, the Science Reference and Information Service and the National Bibliographic Service) provide a wide range of services which are targeted specifically at the scientific and commercial sectors. Electronic publishing, as it develops, will affect the role of national libraries in collection development, document supply and information services.

The social implications the impact of the new technology in the office could bring about if critical thought is not given to current methods of secretarial training are quite frightening. The implications of change in terms of the extent office jobs will be affected by the new technology are outlined in the report 'Office Technology' published by the Royal Society of Arts, but the possible future career structure in secretarial work requires further elaboration for the full impact of the urgent necessity for a changed emphasis in the curricula to be more clearly apparent. An awareness of how future career patterns are likely to evolve and how the present structure of secretarial training equates with future commercial needs will enable teachers to identify areas of the secretarial curriculum that require a different emphasis. Whilst a changed secretarial curriculum is perhaps a long-term prospect, flexible teaching techniques can be implemented immediately and can go a long way to helping the evolution of the secretarial curriculum to suit changing career patterns and social changes. This paper has been written in the spirit that it might invite conscious thought about current training practices and how they might evolve to the benefit of both individuals and the business organisation.The dominant theme throughout the Royal Society of Arts Report 'Office Technology' is related to a broader-based curriculum related to the inter-dependence of every aspect of the office environment. Whilst the curricula implications mentioned in the report covered a diverse area of training in schools, colleges of further education and higher education, the aspects relative to the secretarial curriculum fell in two categories: (1.)Schools and Colleges - the implications for clerical and secretarial courses. (2.)Higher Education - the implications for administrative and managerial staff. The recommendations in the second category get to the heart of word processing communication systems, for they centre around people-related problems. It is unfortunate that the recommendations for the in-service training of teachers to cope with change were mentioned in the same section as was lack of specialised packages for educational use. This could be reflected in a bias towards the mechanical aspects of word processing in schools and colleges. The mechanical approach to word processing is already being reinforced by some of the examination boards who propose introducing examinations on word processing techniques. Examination pressures for evidence of practical ability in word processing directs attention to the mechanical aspects of the new technology and can become far removed from the reality of people-related problems in the business environment. Over-emphasis on the mechanical aspects of word processing could prove disastrous if attention is not also placed on the broader issues. The philosophical and social issues concerning word processing represent an important aspect of in-service training that would enable teachers to approach the technological challenge with caution. Knowledge of these issues would encourage teachers to think critically of the future implications of any action they might take.

The field of home health care is the focus of much attention as alternatives to institutionalization are sought. As a result, many types of organizations are now providing home care, health or otherwise, without the guidance of national standards similar to those found in accreditation models for care in an institutional setting. So that stakeholders in New Brunswick can be assured of the quality of the service it provides, the Extra-Mural Hospital has embarked upon the development of a review process which will, to some extent, follow established accreditation models.

Arsonists seen for psychiatric assessment were compared to property offenders and to violent offenders on a number of clinical measures. It was found that arsonists were a mixture of the two groups but the majority aligned with property offenders in personality, diagnosis, criminal and violence history, family background, alcohol and drug use as well as in sexual behaviour. Significantly 18% of arsonists were mentally retarded.The act of arson was examined in detail using reliable ratings. While there was no obvious motive in two-fifths of the cases, revenge with underlying anger was most frequently a recognized motive for arson. The provocateur for the act of arson was not always readily identifiable and in over half the cases more than one person or an institution was the stimulus for the fire. Direct ions for future study were discussed.