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Introduction Through routine respiratory samples surveillance among COVID-19 patients in the intensive care, three patients with aspergillus were identified in a newly opened general intensive care unit during the second wave of the pandemic. Methodology As no previous cases of aspergillus had occurred since the unit had opened. An urgent multidisciplinary outbreak meeting was held. The possible sources of aspergillus infection were explored. The multidisciplinary approach enabled stakeholders from different skills to discuss possible sources and management strategies. Environmental precipitants like air handling units were considered and the overall clinical practice was reviewed. Settle plates were placed around the unit to identify the source. Reports of recent water leaks were also investigated. Results Growth of aspergillus on a settle plate was identified the potential source above a nurse’s station. This was the site of a historic water leak from the ceiling above, that resolved promptly and was not investigated further. Subsequent investigation above the ceiling tiles found pooling of water and mould due to a slow water leak from a pipe. Conclusion Water leaks in patient areas should be promptly notified to infection prevention. Detailed investigation to ascertain the actual cause of the leak and ensure any remedial work could be carried out swiftly. Outbreak meetings that include diverse people with various expertises (clinical and non-clinical) can enable prompt identification and resolution of contaminated areas to minimise risk to patients and staff. During challenging pandemic periods hospitals must not lose focus on other clusters and outbreaks occurring simultaneously.

With global dementia cases approaching 50 000 000, the importance of early and accurate diagnosis is crucial. Primary care clinicians are often the initial point of contact for people, their family and caregivers when dementia is first suspected. People who suspect they, or their loved one, may have dementia often experience significant fear and distress. Timely and accurate diagnosis, with an honest but compassionate discussion of dementia and its prognosis, may alleviate some distress by reducing time to diagnosis. Timely diagnosis may also enable opportunities to use disease-limiting treatments, reduce unnecessary testing and investigations and provides an opportunity to undertake advance care planning.

Female genital prolapse is a common presentation to general practice. Although frequently asymptomatic, genital prolapse causes some women significant, distressing and debilitating symptoms. Discomfort and feeling a ‘lump or bulge’ in the vagina or ‘something coming down’ is the most commonly reported symptom. Urinary and bowel dysfunction, including frequency and incontinence can occur and dyspareunia, change in body image and psychological symptoms are common. All of these can have detrimental effects on a woman’s wellbeing, quality of life and relationships. Multiple treatment strategies exist for prolapse, including reassurance, pelvic floor muscle training, pessary use and surgery. These can be discussed to facilitate a shared decision about the right management strategy with the patient. This article aims to give an overview of female genital prolapse and its management, and to increase knowledge and confidence for management of the condition in primary care.

Dyspareunia is persistent pain on attempted or successful vaginal penetration. It is under-reported, infrequently asked about by healthcare professionals, and affects quality of life and relationships. Dyspareunia is multifactorial and possesses biopsychosocial components. Pain may be distinct and localised, deep or persistent. Among the symptoms, women describe sensations of aching, throbbing and tearing. Disinterest in sex and relationship problems can result. This article discusses dyspareunia, its common differential diagnoses and aims to improve clinician confidence in assessing and managing dyspareunia in primary care.

Purpose This paper aims to present the critical reflections of three women implementers formerly working in projects that seek to support the mental health and well-being (MHW) of postgraduate researchers (PGRs), which has become a recent focus for UK researchers and policymakers. The paper offers an experience-based perspective on tensions in PGR-MHW project implementation by providing personal accounts of several social dilemmas the authors encountered. From reflecting on experiences, the authors derived recommendations for mitigating such dilemmas when designing and delivering future projects. Design/methodology/approach First, the experiences of dilemmas as female project implementers of PGR-MHW projects were recalled, listed and discussed and identified broad overarching themes. Second, one dilemma for each of the three themes was fleshed out according to the ones that carried meaning for how the role was personally experienced. Third, what the accounts of dilemmas meant for project implementation and outcomes was analyzed. Then the findings to existing literature where similar tensions were identified were linked, including how these could be mitigated. Findings The dilemmas experienced as implementers in PGR-MHW projects fit among three interconnected themes: identity, values, and motivations and relationships. It was showed that, although they may be hard to see, the dilemmas presented in this paper impede project’s success, outcomes for PGRs and implementers’ well-being. Mitigating such dilemmas when designing, funding, implementing and evaluating future projects is not straightforward, and the findings in this article open avenues to tackle this problem. Originality/value Focusing on reflections of female implementers, the paper provides an original perspective on PGR-MHW project evaluation. Using reflective writing as a research tool allowed us to identify overlooked dilemmas in project implementation. Honest and critical accounts of implementers’ experiences revealed important lessons such as different framings of project success, the intersection between the personal and the professional and individual responsibilities in project networks.

The study explored experiences of compassion in adults with a diagnosis of Borderline Personality Disorder (BPD) to further the development of the construct of compassion in relation to BPD. Interpretative Phenomenological Analysis was used to develop themes from the narratives of six adults with a diagnosis of BPD. Five themes emerged: Emotional Connection to Suffering, Empathic Understanding, Prioritisation of Needs, A Model of Genuine Compassion and Developing Acceptance and Worth. Participants described the role of compassion in their difficulties, including the adverse impact of experiences of incompassion upon their sense of self. The themes were integrated into a model that highlighted a process of recovery through therapeutic encounters with others in which genuine compassion was modelled. In addition, barriers to compassion and factors facilitating the development of compassion emerged from the analysis and have implications for clinical practice.

Perinatal care providers are likely to encounter adverse events such as intrapartum emergencies, traumatic births, or maternal or fetal deaths. As a result of being directly or indirectly involved in an adverse event, health care providers can be considered second victims. The experience of the second victim phenomenon can lead to significant physical, psychological, and psychosocial sequelae that can negatively impact the provider's personal and professional life for either a short or long duration of time. When health care providers experience an adverse event, they may manifest symptoms of guilt, shame, blame, flashbacks, nightmares, insomnia, isolation, helplessness, and hopelessness, thereby becoming the second victim. Following an adverse event, health care providers who experience second victim phenomenon experience stages of recovery that influence subsequent professional and personal well-being. Persons who experience the second victim phenomenon can incorporate self-care behaviors to assist with recovery. Health care organizations have a responsibility to implement efficacious support programs that promote the provider's recovery and a return to safe and full function in the workplace.

The number of people living with dementia (PLWD) in the UK is projected to increase rapidly. Much of the contact PLWD and their carers have with the health service is through primary care. The primary care team plays an important role helping people to ‘live well with dementia’. ‘Living well with dementia’ will mean something different for everyone; a holistic, person-centred view of the concept is needed. Important aspects this concept include remaining physically/socially active, understanding the diagnosis and being involved in care decisions. Safe prescribing and regular, high-quality reviews are markers of good dementia care and support people to ‘live well’. ‘Living well’ also incorporates avoidance of adverse health outcomes, including hospitalisation, falls and delirium. As dementia prevalence increases, many more people will be living with the condition, or caring for someone with it. Supporting people with dementia and their carers to ‘live well’ needs to be a primary care priority. This article discusses ways to facilitate achievement of better support for patients living with dementia.

IntroductionActigraphy is commonly used to record free living physical activity in both typically and atypically developing children. While the accuracy and reliability of actigraphy have been explored extensively, research regarding young people’s opinion towards these devices is scarce. This review aims to identify and synthesise evidence relating to the acceptability of actigraphic devices in 5–11 year olds.Methods and analysisDatabase searches will be applied to Embase, MEDLINE, PsychInfo and Social Policy and Practice through the OVID interface; and Education Resources Information Center (ERIC), British Education Index and CINAHL through the EBSCO interface from January 2018 until February 2023. Supplementary forward and backward citation and grey literature database searches, including Healthcare Management Information Consortium (HMIC) and PsycEXTRA will be conducted. Qualitative and quantitative studies, excluding review articles and meta-analyses, will be eligible, without date restrictions. Article screening and data extraction will be undertaken by two review authors and disagreements will be deferred to a third reviewer. The primary outcome, actigraphic acceptability, will derive from the narrative synthesis of the main themes identified from included qualitative literature and pooled descriptive statistics relating to acceptability identified from quantitative literature. Subgroup analyses will determine if acceptability changes as a function of the key participant and actigraphic device factors.Ethics and disseminationEthical approval is not required for this systematic review as it uses data from previously published literature. The results will be presented in a manuscript and published in a peer review journal and will be considered alongside a separate stream of codesign research to inform the development of a novel child-worn actigraphic device.PROSPERO registration numberCRD42021232466.

ObjectiveThe study evaluated the feasibility of mindfulness-based cognitive therapy (MBCT) in patients with non-cardiac chest pain by assessing their willingness to participate and adhere to the programme, and for these data to help further refine the content of MBCT for chest pain.Patients and methodsThis prospective 2:1 randomised controlled trial compared the intervention of adapted MBCT as an addition to usual care with just usual care in controls. Among 573 patients who attended the rapid access chest pain clinic over the previous 12 months and were not diagnosed with a cardiac cause but had persistent chest pain were invited. The intervention was a 2-hour, weekly, online guided 8-week MBCT course. Compliance with attendance and the home practice was recorded. Enrolled patients completed the Seattle angina questionnaire (SAQ), Hospital Anxiety and Depression Scale, Cardiac Anxiety Questionnaire, Five-Facet Mindfulness Questionnaire, and Euro Quality of Life–5 Dimensions–5 Level at baseline assessment and after 8-week period.ResultsPersistent chest pain was reported by 114 patients. Of these, 33 (29%) patients with a mean age of 54.2 (±12.2) years and 68% women, consented to the study. Baseline questionnaires revealed mild physical limitation (mean SAQ, 76.8±25), high levels of anxiety (76%) and depression (53%), modest cardiac anxiety (CAQ,1.78±0.61) and mindfulness score (FFMQ, 45.5±7.3). Six patients subsequently withdrew due to bereavement, caring responsibilities and ill health. Of the remaining 27 participants, 18 in the intervention arm attended an average of 5 sessions with 61% attending ≥6 sessions. Although not statistically powered, the study revealed a significant reduction in general anxiety, improved mindfulness and a trend towards improvement in SAQ scores in the intervention arm.ConclusionOne-third of patients with persistent non-cardiac chest pain were willing to participate in mindfulness-based therapy. An improvement in anxiety and mindfulness was detected in this feasibility study. A larger trial is required to demonstrate improvement in chest pain symptoms.

Background In the UK, children with high levels of hyperactivity, impulsivity and inattention referred to clinical services with possible attention-deficit/hyperactivity disorder (ADHD) often wait a long time for specialist diagnostic assessment. Parent training (PT) has the potential to support parents during this difficult period, especially regarding the management of challenging and disruptive behaviours that often accompany ADHD. However, traditional face-to-face PT is costly and difficult to organise in a timely way. We have created a low-cost, easily accessible PT programme delivered via a phone app, Structured E-Parenting Support (STEPS), to address this problem. The overall OPTIMA programme will evaluate the efficacy and cost-effectiveness of STEPS as a way of helping parents manage their children behaviour while on the waitlist. To ensure the timely and efficient evaluation of STEPS in OPTIMA, we have worked with children’s health services to implement a remote strategy for recruitment, screening and assessment of recently referred families. Part of this strategy is incorporated into routine clinical practice and part is OPTIMA specific. Here, we present the protocol for Phase 1 of OPTIMA—a study of the feasibility of this remote strategy, as a basis for a large-scale STEPS randomised controlled trial (RCT). Methods This is a single arm observational feasibility study. Participants will be parents of up to 100 children aged 5-11 years with high levels of hyperactivity/impulsivity, inattention and challenging behaviour who are waiting for assessment in one of five UK child and adolescent mental health or behavioural services. Recruitment, consenting and data collection will occur remotely. The primary outcome will be the rate at which the families, who meet inclusion criteria, agree in principle to take part in a full STEPS RCT. Secondary outcomes include acceptability of remote consenting and online data collection procedures; the feasibility of collecting teacher data remotely within the required timeframe, and technical difficulties with completing online questionnaires. All parents in the study will receive access to STEPS. Discussion Establishing the feasibility of our remote recruitment, consenting and assessment strategy is a pre-requisite for the full trial of OPTIMA. It can also provide a model for future trials conducted remotely.

BackgroundInterest in internet-based patient reported outcome measure (PROM) collection is increasing. The NHS myHealthE (MHE) web-based monitoring system was developed to address the limitations of paper-based PROM completion. MHE provides a simple and secure way for families accessing Child and Adolescent Mental Health Services to report clinical information and track their child’s progress. This study aimed to assess whether MHE improves the completion of the Strengths and Difficulties Questionnaire (SDQ) compared with paper collection. Secondary objectives were to explore caregiver satisfaction and application acceptability.MethodsA twelve-week single-blinded randomised controlled feasibility pilot trial of MHE was conducted with 196 families accessing neurodevelopmental services in south London to examine whether electronic questionnaires are completed more readily than paper-based questionnaires over a 3-month period. Follow up process evaluation phone calls with a subset (n=8) of caregivers explored system satisfaction and usability.ResultsMHE group assignment was significantly associated with an increased probability of completing an SDQ-P in the study period (adjusted hazard ratio, (HR) 12.1, 95% CI 4.7-31.0; p= ConclusionsMHE holds promise for improving PROM completion rates. Research is needed to refine MHE, evaluate large scale MHE implementation, cost effectiveness and explore factors associated with differences in electronic questionnaire uptake.Key practitioner messagesPatient reported outcome measures (PROMs) are considered an important tool for measuring treatment success and outcomes in healthcare systems.Adherence to routine PROM guidance in Child and Adolescent Mental Health Services (CAMHS) remains low, largely driven by limitations associated with paper-based data collection.Paperless monitoring systems (i.e., digital) as an alternative to traditional outcome measure delivery and collection are growing in healthcare settings.Remote questionnaire completion using the myHealthE (MHE) system is feasible and acceptable to caregivers of children accessing CAMHS in South London, yielding a 60.3 % increase in Strengths and Difficulties questionnaire reporting compared to standard practice.More research is required to understand whether MHE implementation affords similar improvements in remote PROM completion at scale and whether electronic questionnaire uptake is equal for different socio-demographic and clinical populations.

Purpose The US Congress set the original goal that 80 per cent of all tax returns should to be filed electronically for the 2007 tax year. Unfortunately, only 70 per cent of the total returns were electronically filed (e-filed) in 2017. This paper aims to examine the longitudinal progress of total tax returns e-filed by individuals, businesses and “other” categories for the period from 2004 to 2017 and projects a timeline to attain the goal. Design/methodology/approach A comprehensive computation and analysis were performed for the volume, ratios and growth of e-filing for the major types of return. A parallel analysis was performed for the business categories. Applying various time series and exponential smoothing forecasting models, the authors projected major return e-filings for the forecast horizons from 2018 to 2025. Findings First, individual tax returns filed electronically have attained the target goal of 80 per cent since 2012, the extended deadline by Congress, so have corporations and partnerships for Fiscal Year 2017. Second, both the e-file volume and e-file rate for the grand total, individuals and businesses exhibit monotonically increasing trends over the sample period. Third, of the grand e-filings, individual returns constitute the vast majority of 84 per cent, while business e-files are less than 12 per cent. Originality/value This study is a holistic and comprehensive analysis of the adoption of e-filing in the USA. From the longitudinal analysis and the variety of forecasting models applied, the results show that the focus should be on the employment tax e-file as it stands at only 41 per cent for 2017 due to few mandates, while the returns make up 65 per cent of total business returns. The authors projected that the grand total e-filing will attain the Congressional goal of 80 per cent by 2020 along with proposed strategies and recommendations.

This paper reports our experience of developing, implementing, and evaluating myHealthE (MHE); a digital innovation for Child and Adolescents Mental Health Services (CAMHS) which automates the remote collection and reporting of Patient Reported Outcome Measures (PROMs) into National Health Services (NHS) electronic health care records. We describe the logistical and governance issues encountered in developing the MHE interface with patient identifiable information, and the steps taken to overcome these development barriers. We describe the applications architecture and hosting environment to enable it to be operable within the NHS, as well the as the capabilities needed within the technical team to bridge the gap between academic developers and NHS operational teams. We present evidence on the feasibility and acceptability for this system within clinical services and describe the process of iterative development, highlighting additional functions which were incorporated to increase system utility. This article provides a framework with which to plan, develop and implement automated PROM collection from remote devices back to NHS infrastructure. The challenges and solutions described in this paper will be pertinent to other digital health innovation researchers aspiring to deploy interoperable systems within NHS clinical systems.

The strength of foliations defined by shape preferred orientation of plagioclase in troctolitic cumulates from the Layered Series of the Skaergaard intrusion, and the Rum Eastern Layered Intrusion, increases as the grains become more tabular, due either to the greater propensity of highly non-equant grains to be re-arranged by magmatic currents or tectonic disruption of poorly consolidated mush, or by the effects of a pre-existing shape preferred orientation on final grain shape in fully solidified rocks. The stratigraphic evolution of grain shape, microstructures and fabrics in the lowest 320m of the Skaergaard Layered Series records the progressive inflation of the chamber to its final size. During the earliest stages of solidification, the extent of in situ nucleation and growth on the chamber floor decreased upwards through the stratigraphy, due to the development of a thermally insulating blanket of mush on the floor. An upwards increase in foliation strength as the chamber inflated to its final size was a result of the increasing strength of convection of the bulk magma and an increasing contribution to the floor mush of crystals derived from the walls of the enlarging magma chamber. Plagioclase in the troctolites in the open-system magma chamber of the Rum Eastern Layered Intrusion is generally more equant than that in the Skaergaard intrusion, perhaps related to the slower crystal growth on the margins of the continuously replenished Rum chamber. Significant sub-solidus modification of original igneous microstructures is observed in Rum troctolites from parts of the stratigraphy recording frequent replenishment events.

BACKGROUND: Patient-reported outcome measures (PROMs) are important tools to inform patients, clinicians and policy-makers about clinical need and the effectiveness of any given treatment. Consistent PROM use can promote early symptom detection, help identify unexpected treatment responses and improve therapeutic engagement. Very few studies have examined associations between patient characteristics and PROM data collection.METHODS: We used the electronic mental health records for 28,382 children and young people (aged 4-17 years) accessing Child and Adolescent Mental Health Services (CAMHS) across four South London boroughs between the 1st of January 2008 to the 1st of October 2017. We examined the completion rates of the caregiver Strengths and Difficulties Questionnaire (SDQ), a ubiquitous PROM for CAMHS at baseline and 6-month follow-up.RESULTS AND CONCLUSIONS: SDQs were present for approximately 40% (n = 11,212) of the sample at baseline, and from these, only 8% (n = 928) had a follow-up SDQ. Patterns of unequal PROM collection by sociodemographic factors were identified: males were more likely (aOR 1.07, 95% CI 1.01-1.13), whilst older age (aOR 0.87, 95% CI 0.87-0.88), Black (aOR 0.79 95% CI 0.74-0.84) and Asian ethnicity (aOR 0.75 95% CI 0.66-0.86) relative to White ethnicity, and residence within the most deprived neighbourhood (aOR 0.87 95% CI 0.80-0.94) were less likely to have a record of baseline SDQ. Similar results were found in the sub-group (n = 11,212) with follow-up SDQ collection. Our findings indicate systematic differences in the currently available PROMS data and highlights which groups require increased focus if we are to gain equitable PROM collection. We need to ensure representative PROM collection for all individuals accessing treatment, regardless of ethnic or socioeconomic background; biased data have adverse ramifications for policy and service level decision-making.

There is increasing evidence demonstrating an association between chronic obstructive pulmonary disease (COPD) and cognitive impairment. We present a narrative review of published studies on the subject and a cross-sectional study investigating domain-specific cognitive impairment in people with COPD compared to people with known Alzheimer's dementia, and controls without known COPD or cognitive impairment. The aim of the study was to compare prevalence and pattern of cognitive impairment between the three groups using the Addenbrooke's Cognitive Examination (ACE)-III tool. A total of 89 participants were recruited (44 with COPD, 17 with Alzheimer's and 28 controls). Patients with COPD had significantly lower total ACE-III scores than controls (p, People with COPD are more likely than controls to have cognitive impairment. When compared to people with known Alzheimer's disease, the pattern of impairment and cognitive domains affected are significantly different. http://bit.ly/2VPFxjh

BACKGROUND: Previous research in the UK has suggested that individuals with a diagnosable borderline personality disorder (BPD) have often found contact with adult mental health services unhelpful. In 2003, UK government guidance outlined how services might address this issue. Since this guidance, there has been little research that seeks to understand services users' experiences of services and provide information about how services might improve. AIMS: To explore the experiences of individuals with a diagnosis of BPD in accessing adult mental health services and to better understand which aspects of contact with services can be helpful or unhelpful. METHODS: Nine service users with a diagnosable BPD were recruited through voluntary sector services in England. Semi-structured interviews were used and interview data was analysed using an inductive thematic analysis. RESULTS: Three themes were generated including "The diagnostic process influences how service users feel about BPD", "Non-caring care" and "It's all about the relationship". CONCLUSION: The participants' accounts identify a number of practical points which services could implement to improve the experiences of service users.

Theory and existing research suggest that emotion regulation capabilities develop during the formative years. Emotion dysregulation is associated with psychological distress and may contribute towards difficulties such as personality disorder and self-harm. This study aimed to explore the contexts in which individuals' narratives of emotional experience and self-harm developed. Eight participants who cut themselves and were seen by a personality disorder service were recruited. Semi-structured interviews were carried out, and interview transcripts were analysed using a narrative approach. Five temporal themes were generated: 'Seen and not heard', 'A big release … to get rid of all the pain and hurt', 'A vicious circle', 'A different world' and 'Trying to turn my life around'. The findings highlight how early experiences may have led participants to perceive emotions as unacceptable and subsequently suppress emotion in adulthood. Suppression of emotions appeared to be related to appraisals of emotions and to secondary emotional distress. Furthermore, cutting was linked to suppression of emotions as well as negative self-beliefs formed during childhood and reinforced through subsequent experiences. The study emphasizes the need for therapeutic approaches to focus on emotions when working with individuals who self-cut. Furthermore, the findings indicate the need for compassionate and validating health services that may help service users develop more optimistic future narratives.

This narrative review draws upon a broad range of literature, including theory and empirical research, to argue that positive emotions are a useful adjunct to therapy when working with individuals who self-harm. The review highlights how self-harm is often employed as a method of emotion regulation and may be both negatively and positively reinforced. It is suggested that individuals who self-harm have potential difficulty in experiencing positive and negative emotions. The compatibility of an emotion focused approach to therapy for individuals who self-harm is therefore deemed an appropriate one. However, current therapeutic models predominantly focus on unpleasant or negative emotions and largely tend to neglect positive emotions, such as happiness. Broaden and build theory indicates that positive emotions can reduce the effects of negative emotions and aid recovery from intolerable negative emotions that may underpin self-harming behaviours. Therefore, the incorporation of positive emotions into therapy is likely to be helpful. In addition, if cultivated over time, positive emotions can build resilience that may enable individuals to cope better with events that precipitate self-injurious behaviours. The review emphasizes how positive emotions represent a valuable addition to therapeutic work but also highlights that the negatively valenced and painful emotions often experienced by those who self-injure must still be addressed.

This article discusses limitations associated with psychological interventions available in the NHS when working with individuals from BME groups. Also discussed is how clinical psychology trainees can be prepared for working with clients who have backgrounds different to their own.

Theory and existing research suggest that emotion regulation capabilities develop during the formative years. Emotion dysregulation is associated with psychological distress and may contribute towards difficulties such as personality disorder and self-harm. This study aimed to explore the contexts in which individuals' narratives of emotional experience and self-harm developed. Eight participants who cut themselves and were seen by a personality disorder service were recruited. Semi-structured interviews were carried out, and interview transcripts were analysed using a narrative approach. Five temporal themes were generated: 'Seen and not heard', 'A big release … to get rid of all the pain and hurt', 'A vicious circle', 'A different world' and 'Trying to turn my life around'. The findings highlight how early experiences may have led participants to perceive emotions as unacceptable and subsequently suppress emotion in adulthood. Suppression of emotions appeared to be related to appraisals of emotions and to secondary emotional distress. Furthermore, cutting was linked to suppression of emotions as well as negative self-beliefs formed during childhood and reinforced through subsequent experiences. The study emphasizes the need for therapeutic approaches to focus on emotions when working with individuals who self-cut. Furthermore, the findings indicate the need for compassionate and validating health services that may help service users develop more optimistic future narratives.

This narrative review draws upon a broad range of literature, including theory and empirical research, to argue that positive emotions are a useful adjunct to therapy when working with individuals who self-harm. The review highlights how self-harm is often employed as a method of emotion regulation and may be both negatively and positively reinforced. It is suggested that individuals who self-harm have potential difficulty in experiencing positive and negative emotions. The compatibility of an emotion focused approach to therapy for individuals who self-harm is therefore deemed an appropriate one. However, current therapeutic models predominantly focus on unpleasant or negative emotions and largely tend to neglect positive emotions, such as happiness. Broaden and build theory indicates that positive emotions can reduce the effects of negative emotions and aid recovery from intolerable negative emotions that may underpin self-harming behaviours. Therefore, the incorporation of positive emotions into therapy is likely to be helpful. In addition, if cultivated over time, positive emotions can build resilience that may enable individuals to cope better with events that precipitate self-injurious behaviours. The review emphasizes how positive emotions represent a valuable addition to therapeutic work but also highlights that the negatively valenced and painful emotions often experienced by those who self-injure must still be addressed.When working with individuals who self-harm it may be beneficial for practitioners to consider clients' experiences of positive emotions, and how to cultivate these, in addition to targeting the negative emotions which tend to underpin self-harming behaviours.

Research is needed that investigates the correlates of emotional intelligence (EI) as a function of sex, especially biological and psychological correlates such as personality, brain activity, cognitions and mood. A large group of healthy males and females were tested for EI, personality, mood, cognitive function, brain activity and heart rate variability. Females were found to have slightly higher EI scores than males while a similar profile of personality was found to predict EI in both sexes. Factors like extraversion, conscientiousness and openness were found to contribute positively to EI in both sexes, meaning a higher level of emotional capacity was associated with a person who is outgoing, dependable, and independent-minded. Cortical under-arousal contributed to low EI in both males and females, consistent with the proposal that somatic markers are needed to guide human behaviour. While frontal asymmetry was associated with low EI in females, the contribution of this finding to overall variance in EI was small (1%) and should be treated with caution. Overall, findings suggest that personality and brain activity factors are correlates of EI that may contribute to individual differences in EI manifest in males and females. © 2008 Elsevier Ltd. All rights reserved.

This study was undertaken using the INTEGRATE Model of brain organization, which is based on a temporal continuum of emotion, thinking and self regulation. In this model, the key organizing principle of self adaption is the motivation to minimize danger and maximize reward. This principle drives brain organization across a temporal continuum spanning milliseconds to seconds, minutes and hours. The INTEGRATE Model comprises three distinct processes across this continuum. Emotion is defined by automatic action tendencies triggered by signals that are significant due to their relevance to minimizing danger-maximizing reward (such as abrupt, high contrast stimuli). Thinking represents cognitive functions and feelings that rely on brain and body feedback emerging from around 200 ms post-stimulus onwards. Self regulation is the modulation of emotion, thinking and feeling over time, according to more abstract adaptions to minimize danger-maximize reward. Here, we examined the impact of dispositional factors, age and genetic variation, on this temporal continuum. Brain Resource methodology provided a standardized platform for acquiring genetic, brain and behavioral data in the same 1000 healthy subjects. Results showed a "paradox" of declining function in the "thinking" time scale over the lifespan (6 to 80+ years), but a corresponding preservation or even increase in automatic functions of "emotion" and "self regulation". This paradox was paralleled by a greater loss of grey matter in cortical association areas (assessed using MRI) over age, but a relative preservation of subcortical grey matter. Genetic polymorphisms associated with both healthy function and susceptibility to disorder (including the BDNFVal(66)Met, COMTVal(158/108)Met, MAOA and DRD4 tandem repeat and 5HTT-LPR polymorphisms) made specific contributions to emotion, thinking and self regulatory functions, which also varied according to age.

In this study, we examined whether the Met allele of the BDNF Val66Met polymorphism is associated with selective disruptions to task-relevant information processing. In 475 non-clinical participants for whom BDNF genotype status was determined we used the 'IntegNeuro' computerized battery of neuropsychological tests to assess cognitive performance, an auditory oddball task to elicit the P300 event-related potential (ERP) and, in smaller subsets of these subjects, high resolution structural MRI imaging to quantify fronto-hippocampal grey matter (n=161), and functional magnetic resonance imaging to assess fronto-hippocampal BOLD activation (n=37). Met/Met (MM) homozygotes had higher verbal recall errors, in the absence of differences in attention, executive function, verbal ability or sensori-motor function. Further, MM homozygotes demonstrated a slowed P300 ERP during the oddball task, with corresponding alterations in hippocampal and lateral prefrontal activation, and a localized reduction in hippocampal grey matter. These results are consistent with a subtle impact of the Met allele on fronto-hippocampal systems involved in selective information processing of stimulus context and memory updating within the normal population. The findings also indicate that heritable endophenotypes such as the P300 have value in elucidating genotype-phenotype relationships.