Search

Administration of anti-RhD immunoglobulin (Ig) to decrease maternal alloimmunization (antibody-mediated immune suppression [AMIS]) was a landmark clinical development. However, IgG has potent immune-stimulatory effects in other settings (antibody-mediated immune enhancement [AMIE]). The dominant thinking has been that IgG causes AMIS for antigens on RBCs but AMIE for soluble antigens. However, we have recently reported that IgG against RBC antigens can cause either AMIS or AMIE as a function of an IgG subclass. Recent advances in mechanistic understanding have demonstrated that RBC alloimmunization requires the IFN-a/-ß receptor (IFNAR) and is inhibited by the complement C3 protein. Here, we demonstrate the opposite for AMIE of an RBC alloantigen (IFNAR is not required and C3 enhances). RBC clearance, C3 deposition, and antigen modulation all preceded AMIE, and both CD4+ T cells and marginal zone B cells were required. We detected no significant increase in antigen-specific germinal center B cells, consistent with other studies of RBC alloimmunization that show extrafollicular-like responses. To the best of our knowledge, these findings provide the first evidence of an RBC alloimmunization pathway which is IFNAR independent and C3 dependent, thus further advancing our understanding of RBCs as an immunogen and AMIE as a phenomenon. [ABSTRACT FROM AUTHOR]

Aim: To expand our understanding of suicide by examining reports of this behavior from the Chinese mythical era (commencing circa 1200 BCE) and drawing comparisons with subsequent eras. Method: Four hundred recently published accounts of Chinese myths and folk tales were examined, along with supplementary material. Lists were created including one focused on attempted suicide and another on completed suicide. Comparisons were drawn with the suicide of a later era China and the current west. Results: No evidence was located of suicide resulting from mental disorder. Six accounts of attempted suicide and 13 of completed suicide were located. Triggers included the death of a loved one, the loss of a valued possession, complicated relationships, and the avoidance of guilt and disgrace. These accord with current western behavior. Conclusion: There is at least fair agreement in the triggers of suicide in past eras in China and the current western era. This supports the view that suicide may be, in some instances, a customary response to circumstances. [ABSTRACT FROM AUTHOR]

Objective: Four Medicare Benefits Schedule item numbers for Transcranial Magnetic Stimulation (TMS) treatment of unresponsive MDD were declared in Australia in 2021. They are accompanied by rules/conditions. The aim is to consider these rules/conditions in light of recent research and real-world experience. Conclusions: While evidence supports some listed rules/conditions, others lack clinical justification and deserve to be reconsidered. These include (a) ineligibility of patients who have previously received TMS, (b) a lifetime total limit of 50 treatments, (c) a second/final course being unavailable for 4 months following the completion of the first course, and (d) the second/final course being limited to 15 treatments. [ABSTRACT FROM AUTHOR]

The southern US and northern Mexican Cordillera experienced crustal melting during the Laramide orogeny (c. 80–40 Ma). The metamorphic sources of melt are not exposed at the surface; however, anatectic granites are present throughout the region, providing an opportunity to investigate the metamorphic processes associated with this orogeny. A detailed geochemical and petrochronological analysis of the Pan Tak Granite from the Coyote Mountains core complex in southern Arizona suggests that prograde metamorphism, melting, and melt crystallization occurred here from 62 to 42 Ma. Ti-in-zircon temperatures (T Ti-zr) correlate with changes in zircon rare earth elements (REE) concentrations, and indicate prograde heating, mineral breakdown, and melt generation took place from 62 to 53 Ma. T Ti-zr increases from ~650 to 850 °C during this interval. A prominent gap in zircon ages is observed from 53 to 51 Ma and is interpreted to reflect the timing of peak metamorphism and melting, which caused zircon dissolution. The age gap is an inflection point in several geochemical-temporal trends that suggest crystallization and cooling dominated afterward, from 51 to 42 Ma. Supporting this interpretation is an increase in zircon U/Th and Hf, a decrease in T Ti-zr, increasing zircon (Dy/Yb)n, and textural evidence for coupled dissolution–reprecipitation processes that resulted in zircon (re)crystallization. In addition, whole rock REE, large ion lithophile elements, and major elements suggest that the Pan Tak Granite experienced advanced fractional crystallization during this time. High-silica, muscovite± garnet leucogranite dikes that crosscut two-mica granite represent more evolved residual melt compositions. The Pan Tak Granite was formed by fluid-deficient melting and biotite dehydration melting of meta-igneous protoliths, including Jurassic arc rocks and the Proterozoic Oracle Granite. The most likely causes of melting are interpreted to be a combination of (1) radiogenic heating and relaxation of isotherms associated with crustal thickening under a plateau environment, (2) heat and fluid transfer related to the Laramide continental arc, and (3) shear and viscous heating related to the deformation of the deep lithosphere. The characteristics and petrologic processes that created the Pan Tak Granite are strikingly similar to intrusive suites in the Himalayan leucogranite belt and further support the association between the North American Cordilleran anatectic belt and a major orogenic and thermal event during the Laramide orogeny. [ABSTRACT FROM AUTHOR]

This letter discusses the Continuing Professional Development (CPD) program required by the Medical Councils of Australia and New Zealand for psychiatrists. The letter raises questions and concerns about the program, particularly regarding the inclusion of the CanMEDS framework and the roles it emphasizes. It also questions the process for marking Professional Development Plans, the availability of high-quality peer review, and the requirements for evidence of practice improvement. The letter concludes by acknowledging the importance of CPD for psychiatrists and commending the RANZCP Committee for CPD for their efforts. [Extracted from the article]

On receiver-based teleosemantic theories of representation, the chemical states of the circadian clocks in animal, plant and cyanobacterial cells constitute signals of future states of affairs, often the rising and setting of the sun. This signalling is much more rigid than sophisticated representational systems like human language, but it is not simple on all dimensions. In most organisms the clock regulates many different circadian rhythms. The process of entrainment ensures that the mapping between chemical states of the clock and the daily light-dark cycle is adjusted to deal with seasonal changes. In regulating anticipatory behaviour, the states of the clock look forward both to the time the behaviour is supposed to happen and the later time when the anticipated circumstances are supposed to arise. The case of the circadian clock shows that purely indicative signals can arise in very basic biological systems and brings into sharp relief the trade-offs involved in characterizing representational systems. On receiver-based teleosemantic theories, future-directed signals are not restricted to complex multicellular organisms but are ubiquitous in the biological world. [ABSTRACT FROM AUTHOR]

Objective: To examine reports of Transcranial Magnetic Stimulation (TMS) during pregnancy for evidence of fetal risk.Method: PubMed was used to locate relevant literature for the years 1998-2020 and reference lists were examined for materials not located electronically.Results: Ten reports were located dealing with 67 births over 20 years. Stimulation was applied is all trimesters, at low and high frequency, and as intermittent theta-burst stimulation. No mother or baby experienced a serious event.Conclusions: Certainty awaits large, standardized studies. However, the available reports provide no evidence that TMS to mother during pregnancy has detrimental effects on the fetus. [ABSTRACT FROM AUTHOR]

Objectives: First, to conduct a historical review of the evidence for repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder and determine a clinical algorithm. Second, to identify opportunities for research.Methods: Literature searches were conducted of the MEDLINE database, UpToDate and the Australian National University Library SuperSearch from 1 January 2000 to 30 September 2019. The search terms used were 'transcranial magnetic stimulation', 'major depressive disorder' and 'depression'.Results: There were 24 meta-analyses identified, demonstrating a clear clinical effect. Left high-frequency rTMS had the most evidence. Ideal clinical parameters and study design were explored.Conclusion: Use of rTMS for some patients with depression is justified. Open research questions include the comparative efficacy of right low-frequency and bilateral stimulation, the role of rTMS in medication-naïve patients, and maintenance of effect. [ABSTRACT FROM AUTHOR]

The article discusses the possibility of psychiatrists dishonestly claiming Continuing Professional Development (CPD) credits for webinars they did not attend. The Medical Board of Australia and the Medical Council of New Zealand require satisfactory compliance with a CPD program for practitioner registration, which is administered by the RANZCP. The CPD program has various requirements, including spending time on a Professional Development Plan, Peer Review Group activities, and Self-Guided Learning. Fellows must list their CPD activities and provide substantiating documents, and organizers of Peer Review Groups must verify attendance. The article suggests that the size and complexity of the task make accurate policing of CPD participation impossible, and proposes an honor system as an alternative. [Extracted from the article]

Over the last quarter century, transcranial magnetic stimulation (TMS) has been researched and applied in clinical practice in the treatment of major depressive disorder (MDD). More than 100 placebo-controlled studies and 20 meta-analyses have shown this treatment to be effective in treatment resistant depression (TRD). This revolutionary modality uses electromagnetism to therapeutically impact brain cortex; it causes few side effects. TMS corrects abnormalities in brain connectivity, and such corrections correlate with changes in mood. TMS is complimentary and not a replacement for electroconvulsive therapy (ECT), a comprehensive service will provide both techniques. The efficacy of TMS is expected to increase with new stimulation protocols. Currently used as a second line treatment, TMS is likely to become a first line option. Currently, expertise is limited to those working in particular clinics – there is a need/call for training to be more widely available. [ABSTRACT FROM AUTHOR]

RMT is central to therapeutic TMS. Routine clinical checks may reveal changes and some research has reported changes. It is unclear whether long-term preservation TMS treatment produces accumulative/permanent change in RMT of clinical concern. Our aim was to examine RMT records of participants in preservation TMS for any evidence of possible accumulative/permanent RMT change. The records were accessed of 30 females and 10 males who had received preservation TMS for from 24 to 57 (male) and 60 (female) months. Generalized estimating equations were used to explore trajectories of RMT over time for the overall sample and by age and gender. Some individual records displayed occasional sharp (up or down) spikes, frequently followed by a degree of rectification. The records of the three highest (mean 75.8) and lowest (mean 36.1) RMT scores were free of large variations. There were no significant changes in RMT over time for the total group, or by gender or age. For this group of 40 patients receiving long term TMS, there were no significant changes in the RMT. [ABSTRACT FROM AUTHOR]

In spite of evidence to the contrary, constant repetition of the claim that mental illness is the cause of all suicide has even the "experts" believing this message. The aim of this study, using a case study methodology, was to highlight that this faulty belief has prevented the development of holistic and effective suicide prevention policies. As a result, people unnecessarily die by suicide who otherwise may have survived. Policy makers are decades behind with the developments in suicide research. They still believe and follow medical literature that insists suicide is only caused by a mental illness developed through intervening variables, e.g., bereavement, marriage breakup, employment, types of occupation. Decades of government services basing all suicide prevention policies on this unitary cause have failed to reduce the suicide rate. In New Zealand, suicide numbers have reached new records five years in a row since 2015. We need to admit and acknowledge that we do not understand suicide per se, but that we have some understanding of human behaviour and decision-making processes. A New Zealand experience provides prima facie evidence that the public can be protected against suicide through changes in attitudes and adopting a more holistic approach to address suicide. [ABSTRACT FROM AUTHOR]

Objective: To analyse the overseas approval of aducanumab for Alzheimer's disease, in order to derive lessons of potential interest to individuals and groups involved in dementia drug development and regulation in Australia. Conclusions: Opportunities were identified regarding optimising clinical trial design and solidifying regulatory responsibilities. Increased awareness of the attitudes and needs of patients and patient advocacy organisations would likely improve the patient-clinician alliance. Incorporation of these factors into research design has the potential to improve patient satisfaction with outcomes. [ABSTRACT FROM AUTHOR]

Transcranial magnetic stimulation (TMS) is a safe and effective treat- ment of resistant major depressive disorder (MDD). However, MDD is a chronic disorder and relapse is common. The leading method of managing those cases of MDD who respond to TMS, but continue to relapse, is to provide maintenance TMS – short courses of 5 treatments over 2.5 days, repeat at monthly (or greater) intervals. The strategy is to increase the interval between treatment clusters and for patients to be discharged when they have been able to remain well for a couple of months. However, patients and doctors are both frequently apprehensive about increasing the between cluster interval, and patients tend to remain in treatment programs for long periods. We present a protocol and instrument to assist in moving from treatment to discharge, which we have found helpful. [ABSTRACT FROM AUTHOR]

It is widely agreed that the color vision process moves quickly from cone receptors to opponent color cells in the retina and lateral geniculate nucleus. Many workers have proposed the transformation or coding of long, medium, short (LMS) cone responses to r − g, y − b opponent color chromatic responses (unique hues) on the following basis: That L, M, S cones represent Red, Green, and Blue hues, with Yellow represented by (L + M), while r − g and y − b represent the opponent pairs of unique hues. The traditional coding from cones to opponent colors is that L − M gives r − g, while (L + M) − S gives y − b. This convention is open to several criticisms, and a new coding is required. A literature search produced 16 studies of cone responses LMS and 15 studies of spectral (i.e., ygb) opponent color chromatic responses, in terms of response wavelength peaks. Comparative analysis of the two sets of studies shows the means are almost identical (within 3 nm; i.e., L = y, M = g, S = b). Further, the response curves of LMS are very similar shapes to ygb. In sum, each set can directly transform to the other on this proposed coding: (S + L) − M gives r − g, while L − S gives y − b. This coding activates neural operations in the cardinal directions r − g and y − b. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of clustered maintenance transcranial magnetic stimulation (TMS) on irritability occurring in treatment-resistant major depressive disorder (MDD).Method: A naturalistic study of 106 courses that includes pre- and posttreatment assessments of subjective and objective depression and a subjective measure of irritability developed for this study.Results: Forty-six participants (35 females), mean age 43.2 years (14.3), completed 106 courses. There was a significant reduction in irritability and depression scores (p < .001). The change in irritability scores was significantly correlated with the change in depression scores, r = .40, p < .001.Conclusion: TMS has the capacity to reduce the irritability co-occurring with treatment-resistant MDD, known to be responsive to TMS. This increases the possibility of using TMS in the treatment of irritability co-occurring with other disorders or standing alone (should irritability be categorized as a stand-alone disorder). [ABSTRACT FROM AUTHOR]

Objective: To examine the impact (if any) of a course of transcranial magnetic stimulation (TMS) on irritability occurring in association with acute major depressive disorder (MDD). Method: In a naturalistic study, patients with MDD according to DSM-5 criteria were given 20 daily TMS treatments. A visual analogue scale for irritability (VAS-I) was developed. Objective tools included the six-item Hamilton Depression Rating Scale (HAMDS6) and the Clinical Global Impression - Severity (CGI-S). Results: Fifty patients received 53 courses. Forty-seven courses achieved remission on both HAMD6 and CGI-S and six courses did not achieve remission with either. Irritability significantly reduced when MDD remission was achieved but was unchanged when remission was not achieved. Conclusion: TMS reduces irritability occurring in association with MDD when this treatment affects MDD remission, but not when remission is not affected. [ABSTRACT FROM AUTHOR]

Articles from a broad search of the literature dating from 1704 are cited and described briefly in order to provide an overview of complementary colors and associated research areas, especially chromatic induction (ie, complementary afterimages) as the principal research area. The literature shows that complementary colors have roles in all aspects of color appearance and color vision. Forty specific roles are described, which can be divided into three general roles of complementary color: color mixture, color constancy (or chromatic adaptation), and color perception (or appearance). [ABSTRACT FROM AUTHOR]

This article examines the short story "Senator Bilbo" by fantasy writer Andy Duncan, in which the author provides a futuristic view of J. R. R. Tolkien's Middle-earth, specifically the hobbits' world of the Shire, in a setting which has become xenophobic and racist, excluding all those who are "other" than hobbits. The chief protagonist of the story, Senator Bilbo, is modelled on the American senator Theodore Bilbo, a mid-twentieth-century southern senator known for his segregationist views and writings on "miscegenation". In the article I investigate how Duncan's character Senator Bilbo mirrors the real Senator Bilbo as he fails to adjust to the Shire's new attitudes to a multicultural Middle-earth— a view Tolkien supported—and how Tolkien's views on "race" were in fact non-racist and, in contrast to many ideologies of his time, advanced in terms of the acceptance of different cultures and ethnicities. In doing so I examine some of Tolkien's views on South Africa and how these ideas influenced his writing; I also explore the ways in which both segregation and apartheid were anathema to his worldview in the 1940s and 1950s, at the time of the writing of The Lord of the Rings. I argue that Duncan's story is meaningful in showing how Bilbo Baggins's descendant can successfully realise that the hobbits of the Shire cannot, for all time, live in an isolated Shire but must, eventually, engage with other peoples. [ABSTRACT FROM AUTHOR]

Objective: Management of peripheral nerve injuries requires physicians to rely on qualitative measures from patient history, electromyography, and physical exam. Determining a successful nerve repair can take months to years for proximal injuries, and the resulting delays in clinical decision‐making can lead to a negative impact on patient outcomes. Early identification of a failed nerve repair could prevent permanent muscle atrophy and loss of function. This study aims to test the feasibility of performing diffusion tensor imaging (DTI) to evaluate injury and recovery following repair of wrist trauma. We hypothesize that DTI provides a noninvasive and reliable assessment of regeneration, which may improve clinical decision‐making and alter the clinical course of surgical interventions. Methods: Clinical and MRI measurements from subjects with traumatic peripheral nerve injury, carpal tunnel syndrome, and healthy control subjects were compared to evaluate the relationship between DTI metrics and injury severity. Results: Fractional anisotropy from DTI was sensitive to differences between damaged and healthy nerves, damaged and compressed nerves, and injured and healthy contralateral nerves. Longitudinal measurements in two injury subjects also related to clinical outcomes. Implications of other diffusion measures are also discussed. Interpretation: DTI is a sensitive tool for wrist nerve injuries and can be utilized for monitoring nerve recovery. Across three subjects with nerve injuries, this study has shown how DTI can detect abnormalities between injured and healthy nerves, measure recovery, and determine if re‐operation was successful. Additional comparisons to carpal tunnel syndrome and healthy nerves show that DTI is sensitive to the degree of impairment. [ABSTRACT FROM AUTHOR]

Objectives:: To characterize suicide in early China, as a means of extending knowledge of this behaviour.Methods:: We examined Romance of the Three Kingdoms, and collated and considered relevant details.Results:: In early China, loss of authority/status, loved ones and fortune were triggers for suicide. The expression of the intention to suicide, either by word or action, was observed and elicited a placating response. Less frequent, but nevertheless clearly recorded, were accounts of suicide completed to satisfy the wishes of others.Conclusions:: The suicide and related behaviour of early China shares many features with late Western societies, but one form (to satisfy the wishes of others) is currently undetected. [ABSTRACT FROM AUTHOR]

The belief that suicide was a sinful act was replaced in the early 19th century by the belief that suicide is always a response to a mental disorder (the mental disorder model of suicide). Jacob[[11]] observed that India had a moderately high suicide rate. In comparison with high income countries, they found India had a larger rate of female suicides, and mental illness was less commonly present. It is known that people with a serious mental disorder complete suicide more often than people without mental disorder suggesting that good treatment is important in suicide prevention (more suicides come from the group without mental disorder, because there are more people in that group). [Extracted from the article]

Objective: The six‐item Hamilton Depression Rating Scale (HAMD6) is a clinician rated measure which lacks a self‐report companion. We explored whether a six‐item client rated visual analogue scale (VAS6) based on the HAMD6, was a consistent and valid measure of depression and useful for clinical practice. Method: Participants were N = 117 participants, 88 (75%) female, with major depressive disorder (MDD) who received transcranial magnetic stimulation (TMS). Pre‐ and post‐treatment a trained clinician completed the HAMD6 and Clinical Global Impression Scale for Severity (CGI‐S), and patients the self‐reported VAS6. Results: VAS6 internal consistency using Cronbach's alpha was 0.87. VAS6‐HAMD6/GGI‐S spearman correlations were moderate‐strong for four items (depressed mood; work/activities; feelings of guilt; anxiety) and the total score and weak for two items (somatic symptoms, retardation). Conclusions: The self‐reported VAS6 was a valid measure of core aspects of depression measured by the HAMD6. It is cost effective (takes relatively little clinician time) and is a useful companion to the clinician reported HAMD6. [ABSTRACT FROM AUTHOR]

Objective: Hereditary neuropathy with liability to pressure palsies (HNPP) is caused by heterozygous deletion of the peripheral myelin protein 22 (PMP22) gene. Patients with HNPP present multifocal, reversible sensory/motor deficits due to increased susceptibility to mechanical pressure. Additionally, age‐dependent axonal degeneration is reported. We hypothesize that length‐dependent axonal loss can be revealed by MRI, irrespective of the multifocal phenotype in HNPP. Methods: Nerve and muscle MRI data were acquired in the proximal and distal leg of patients with HNPP (n = 10) and matched controls (n = 7). More specifically, nerve magnetization transfer ratios (MTR) were evaluated to assay proximal‐to‐distal gradients in nerve degeneration, while intramuscular fat percentages (Fper) were evaluated to assay muscle fat replacement following denervation. Neurological disabilities were assessed via the Charcot‐Marie‐Tooth neuropathy score (CMTNS) for correlation with MRI. Results: Fper values were elevated in HNPP proximal muscle (9.8 ± 2.2%, P = 0.01) compared to controls (6.9 ± 1.0%). We observed this same elevation of HNPP distal muscles (10.5 ± 2.5%, P < 0.01) relative to controls (6.3 ± 1.1%). Additionally, the amplitude of the proximal‐to‐distal gradient in Fper was more significant in HNPP patients than controls (P < 0.01), suggesting length‐dependent axonal loss. In contrast, nerve MTR values were similar between HNPP subjects (sciatic/tibial nerves = 39.4 ± 2.0/34.2 ± 2.5%) and controls (sciatic/tibial nerves = 37.6 ± 3.8/35.5 ± 1.2%). Proximal muscle Fper values were related to CMTNS (r = 0.69, P = 0.03), while distal muscle Fper and sciatic/tibial nerve MTR values were not related to disability. Interpretation: Despite the multifocal nature of the HNPP phenotype, muscle Fper measurements relate to disability and exhibit a proximal‐to‐distal gradient consistent with length‐dependent axonal loss, suggesting that Fper may be a viable biomarker of disease progression in HNPP. [ABSTRACT FROM AUTHOR]

Background: The predominant, current western view is that all suicide is the result of mental disorder. This view is much too narrow and does not admit extensive information regarding the social, economic, and forensic factors (among many others) which may contribute to completed suicide. A consequence of this narrow view is that prevention strategies mainly focus on the detection and treatment of mental disorder. A preferred approach is to place greater emphasis on public health approaches to suicide prevention. Objective: To develop and suggest a body of information which may be useful in a public health approach to suicide. Conclusion: It is suggested that the following be available to the general public: i) suicide is a fact of life which should be minimised, ii) suicide has many different triggers, iii) most people who take their lives are able to make decisions, and iv) increased public discussion and understanding of suicide is desirable. Five pieces of information that may be useful to those contemplating suicide include: i) don't murder the part of you that wants to live, ii) suicide actions may leave you alive but disabled, iii) suicide hurts other people, iv) suicidal impulses do pass if you hold on, and v) suicide is a waste. [ABSTRACT FROM AUTHOR]

Background. It is popularly believed that all suicide is the result of mental disorder. We have proposed the concept of “predicament suicide" – suggesting that suicide represents escape from intolerable circumstance, and while mental disorder may be one trigger, there are many others, such as social and economic difficulties. Objective. With a view to extending our understanding we explored thinking on this subject by Mao Zedong, one of the most influential figures of the 20th century. Conclusions. Mao strenuously held that suicide is caused by the social environment/society – he was particularly concerned with oppression and institutionalized disadvantage, which he sought to correct via revolution. His belief that “A person's suicide is determined entirely by circumstances" corresponds precisely with the concept of “predicament suicide." [ABSTRACT FROM AUTHOR]

Objective: First, to review the principles and practice of disaster psychiatry, in light of recent global events. Second, to identify opportunities for research. Method: A literature review of the MEDLINE database, UpToDate and the Cochrane Library was conducted. Reference lists were also reviewed. Results: Psychiatrists are well-positioned to contribute to positive outcomes at all stages of the disaster response. These contributions derive from their roles as doctors, mental illness specialists and clinical leaders. Conclusion: A novel framework for the psychiatrist's contributions was proposed. Specific knowledge of disaster psychiatry may be worthwhile, and establishment of a public disaster psychiatry centre is reasonable. Research should further examine the role of tele-psychiatry and pursue a best practice for community and front-line employee psychological preparedness. [ABSTRACT FROM AUTHOR]

Background. Over the last century, the claim has been made that suicide is always, or almost always, the result of mental disorder. Aim. To explore the beliefs of famous English speaking poets regarding the triggers of suicide. Method. Poetry libraries were explored for poetry giving information regarding the attitude of writers to the triggers of suicide. This material was analysed and categorized. Results. Fifteen poems (separate poets) were identified and examined. The triggers of suicide included mental disorder and socioeconomic stressors (acute and chronic). In a minority of cases (four), categorization could not be made. Conclusions. Poets describe the triggers of suicide as including not only mental disorder, but also socioeconomic (acute and chronic) factors. [ABSTRACT FROM AUTHOR]

The psychosexual therapy service within a Health Psychology service in Derbyshire, NHS, was established in May, 2020 and due to Covid-19 the service offering was virtual and patients attending the service were offered online psychosexual therapy. A service evaluation was carried out to explore and understand patients experiences of online psychosexual therapy and resources, in addition to further inform service development of online therapeutic work beyond Covid. Data was collected between December 2020 – March 2021. Qualitative data collection via phone calls using a semi-structured interview schedule were completed by a Volunteer Assistant Psychologist and a Clinical Psychologist. Data was analysed using Thematic Analysis as outlined by Braun and Clarke (2013).7 participants who had recently been discharged from the NHS Psychosexual Service for a range of psychosexual presentations. There were mixed results on the experience of online therapy, some finding it more accessible and some struggling to open up without face to face contact. An overall positive experience of the relationship with the therapist was experienced, with many reporting the help has taught them how to continue working on their issues outside of therapy. Feedback highlighted individual differences in resource preference. The gap between sessions appeared to suit most patients and facilitated home practice. Four action points were generated in response to the findings. (1) An enquiry is needed into the functioning of online therapy technology. (2) Online therapy could be made an option for individuals even after the restoration of face-to-face therapy (3) Maintain and improve the inclusivity of the service. (4) Resources focusing on active participation and normalising could be continued to be offered. The report shows promising results of online PST to be successful in alleviating patient's distress around psychosexual issues. Further research into online psychosexual therapy would be beneficial to further inform clinical outcomes and practice. No [ABSTRACT FROM AUTHOR]

Background: Tiredness is used in some characterizations of major depressive disorder (MDD). Transcranial magnetic stimulation (TMS) lowers all symptoms of MDD. Objective: To explore whether, 1) a visual analogue scale (VAS) for tiredness is a valid and reliable measure of a feature of MDD, and 2) TMS treatment reduces subjective tiredness occurring in MDD. Method: A naturalistic study of treatment with 10 Hz TMS. Completed pre- and post-treatment: HAMD-6, a visual analogue scale (VAS-6), the Clinical Global Impression - Severity (CGI-S) and a 'VAS-tiredness'. Two groups received TMS. Acute course: N=52 participants suffering acute MDD, received 20 treatment courses (total courses 86). Relapse prevention (RP) course: N=26 participants suffering chronic relapsing MDD received scheduled episodic courses over 3 days; (total courses 266). VAS-tiredness scores were compared with the standardized tool results. Results: There were significant medium to large correlations between pre- and post-treatment VAS-tiredness and the standard depression measures (HAMD-6 .406 to .447, VAS-6 .446 to .525, CGI-S .348 to .407; all p<.001). TMS treatment produced a significant reduction in VAS tiredness in both (Acute course and RP) groups (main effect: F(1,350)=147.3, p<.001, η2=.30). The two groups displayed difference in the pre-treatment VAStiredness with the Acute group having higher scores pre-treatment. Post-treatment tiredness scores were similar. Conclusion: VAS-tiredness is a valid measure of a feature of MDD. VAS-tiredness provides potentially useful information and complements standard mood tools. TMS treatment can reduce tiredness in MDD. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to explore the effects of a four-week course of transcranial magnetic stimulation (TMS) on the following symptoms of major depressive episode (MDE): mood, work activities, health concerns, guilt, anxiety and retardation.Method: Patients underwent 20 daily sessions of 10 Hz TMS (two sets of 10 daily treatments separated by two days of rest). The six-item Hamilton Depression Rating Scale (HAMD-6) was administered before and after treatment. Remission was operationalised as a HAMD-6 score of <4. Descriptive statistics and t-tests were used to compare pre/post scores on HAMD-6 subscales, and logistic regression was used to understand symptoms that predicted remission/non-remission.Results: There were 104 participants (79 female; 76%), with a mean age of 44.6 years (SD=15.7 years). There was a significant improvement in the whole sample and in remitters (n=70) on all subscales. However, those who failed to remit did not achieve significant reductions in 'health concerns' and 'retardation'. There were no difference in age and sex between remitters and non-remitters. Also, there were no significant differences between the remitters and non-remitters on the pretreatment depression symptom profiles. No predictors of response were identified, as expected.Conclusions: TMS has the ability to reduce all listed MDE symptoms. No pretreatment MDE symptom profile was identified which might carry prognostic value. [ABSTRACT FROM AUTHOR]

Background: Transcranial Magnetic Stimulation (TMS) is effective in major depressive episodes (MDE). However, MDE may follow a chronic, relapsing course, and some individuals may not satisfactorily respond to a first course of TMS. Objective: To investigate the outcome of second courses of TMS. Method: A naturalistic investigation--we prospectively studied 30 MDE in-patients and routinely collected information, including pre- and post-treatment with Six-item Hamilton Depression Rating Scale (HAMD6), a six-item Visual Analogue Scale (VAS6) and the Clinical Global Impression-Severity (CGI-S). Two categories of patients were considered: i) those who had remitted with a first course, but relapsed, and ii) those who had not remitted with the first course. Results: Thirty individuals received a second TMS course. The mean time to the second course was 27.5 weeks. Based on the HAMD6, 26 (87%) achieved remission after the first course, and 22 (73%) achieved remission after the second course. Furthermore, based on the HAMD6 results, of the four patients who did not achieve remission with a first course, three (75%) did so with a second course. Conclusion: In MDE, a second course of TMS is likely to help those who remitted to a first course and then relapsed, as well as those who did not achieve remission with a first course. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to investigate mammographic density in a sample of Victorian women and explore a possible association between mammographic density and ethnicity.Methods: Categories of mammographic density, using Volpara Density Grade, were reported using two editions of Volpara automated software in a data set of women attending two Victorian sites for mammographic screening. The variables available for analysis were age, self-reported exposure to menopausal hormone therapy (MHT) and ethnicity based on country of birth.Results: Data from 16,943 women were available for analysis. Using the VDG 4th edition, 40% of women were classified in the higher two categories (42% for the 5th edition) and 76.9% of women were in the same VDG category using both systems. In the sample, 87.7% of women were in the age range currently invited for screening in Victoria (50-74 years). Of the total group, 82.5% could be classified on the basis of country of birth. In multivariable logistic regression analyses examining factors associated with higher VDG, age (protective), use of MHT (risk factor) and being born in a country with predominantly Asian ancestry (risk factor) were all statistically significant at P < 0.001 for both editions irrespective of whether the reference category was the lowest two or three VDG categories.Conclusions: Mammographic density as assessed by VDG was positively associated with ever exposure to MHT and inversely associated with age. Being born in a country with predominantly Asian ancestry was associated with higher VDG when controlled for age and MHT exposure. [ABSTRACT FROM AUTHOR]

Background: During the last century suicide has been medicalised. This restrictive view has been challenged, and the wisdom of experts from beyond medicine is being valued. Fictional literature is a source of information regarding the human experience. Objective: To extend our understanding of suicide and suicidal thinking by examining the early-17th Century Spanish novel, "Don Quixote". Method: Various translations were examined for accounts of suicide, suicidal thinking, and associated behaviour. Results: There were no accounts of completed suicide. There was one statement indicating the belief that suicide could be triggered by mental disorder. There were five statements indicating that suicidal thinking could arise in situations of distress. Such distress arose from the actual/ potential loss of a loved person, suffering by another person, and relentless sleep deprivation. There is one account of a person pretending to attempt suicide and achieving a self-inflicted wound, not with the intention to self-murder, but to impact the disposition of another person. Conclusion: The observation that in early-17th Century Spain suicide was acknowledged as means of dealing with distress is consistent with findings from other periods, and the present day. This strengthens the position that suicide can occur in the absence of mental disorder. [ABSTRACT FROM AUTHOR]

Background. In the West, beginning in the early 19th century, the belief was published that suicide was always, or almost always, the result of a mental disorder (a medical problem). This belief became established wisdom when psychological autopsies commenced in mid-20th century. However, should this belief be inaccurate, our suicide prevention strategies, which are currently medically orientated, need to change. Aim. To argue the case that metal disorder is not always, or almost always, the cause of suicide, and that suicide may be triggered by a host of other factors. Method. The scientific basis of psychological autopsies and the practice of medicalization were explored. The opinions of non-medical experts were explored, including philosophers, historians, sociologists, economists and ethicists, among others. Epidemiology of rates in different countries and gender differences were examined for evidence. Conclusion. Suicide is not exclusively a medical problem. While suicide is more common in people who have a mental disorder than people without a mental disorder, mental disorder is not a necessary condition. Thus, open discussions about the nature and causes of suicide are required, with a view to involving experts from a range of fields, and the general community, in developing and funding suitable prevention strategies. [ABSTRACT FROM AUTHOR]

Objectives: National suicide rates fall during times of war. This fits with the notion of the population coming together against a common foe. But, what happens in the case of a war which is not fully supported, which draws the population and families apart? We consider this question by examining the Australian suicide rates during the divisive Vietnam War.Methods: We graphed and examined the Australian suicide figures for 1921-2010.Results: We found clear evidence of a decrease in the suicide rate for World War II (consistent with other studies), but a marked elevation of suicide during the Vietnam War.Conclusions: The elevation of the Australian suicide rate during the Vietnam War is consistent with Durkheim's social integration model - when social integration is lessened, either by individual characteristics or societal characteristics, the risk of suicide rises. [ABSTRACT FROM AUTHOR]

Background: Various TMS protocols have been described, none is appropriate in all circumstances. Objective: To describe the response of a person with acute MDD treated with TMS who was only available for treatment on 3 consecutive days per week. Method: 5 treatment sessions were provided over 3 days – this was provided 4 times, separated by no-treatment periods of 4 days. HAMD6, CSI-S and VAS for depression were completed on the first and last day of each 3-day treatment series. Results: Remarkable improvement; the HAMD6 fell from 12 (severe depression) to 0, the CGI-S fell from 5 (Markedly ill) to 1 (Normal, not mentally ill) and the VAS fell by 98%. There was clear improvement during the last 3 treatment series, as well as during all 3 no-treatment periods. Conclusion: Should these findings be replicated, an additional, useful protocol may be established. [ABSTRACT FROM AUTHOR]

Introduction The health effects for children with incarcerated parents, and methods to improve children's experience of the justice system, are under-researched areas. While some work has been done to illuminate these concerns, practical implementation of a “child-friendly prison” has been slow. Aims A Health Directorate-funded project examining children's interactions with the Australian Capital Territory (ACT) justice system was conducted in 2013, which made a number of recommendations. The current study sought to examine the ongoing impacts of parental incarceration for children in the ACT and follow up on the recommendations. Methods Semi-structured interviews were conducted with seven key stakeholders with a relationship to the research area. The interviews were summarised, and a thematic analysis was carried out to identify relevant ideas. Results from recent Detainee Health and Welfare Surveys were used to estimate the number of children affected. Results The findings from the interviews concluded that little action was taken in response to the original report, that children's rights and agency were compromised, that the prison lacked accessibility, that consistent and individualised information should be provided to affected children, and that a previously operational homework program should be reinstated. Model facilities were identified. Conclusion Three broadly-applicable recommendations were made in response to the data from the surveys: increasing accessibility of public transport, the establishment of a child liaison officer at prisons, and maintaining extended family visits. [ABSTRACT FROM AUTHOR]

Major factors to be considered when designing lighting for paintings include colour discrimination, colour diversity, clarity and the balance of cool–warm (bluish-yellowish) lighting. This paper concerns the last factor and presents two radiometric and one colorimetric methods of predicting cool–warm balanced illuminants. For a high correlated colour temperature, the spectral power distributions of Planckian and daylight-simulating illuminants are high in short wavelengths and low in long wavelengths and, therefore, appear bluish. The reverse is true for low correlated colour temperature illuminants, which appear yellowish. The balanced spectral power distribution occurs at 5000 K. MacAdam’s complementary powers function is psychophysical and represents the power of wavelengths across the visible spectrum required to neutralize (convert to white) their complementaries. Again the balanced power occurs for illuminants of 5000 K. Hence, a correlated colour temperature in the 4500–5500 K range is recommended for cool–warm balanced illuminants. This recommendation is supported by results of four recent experimental studies. [ABSTRACT FROM AUTHOR]

Objective: To examine the presentations of suicide and related behaviour in the novels of Dostoyevsky, with a view to understanding suicide in mid-19th Century Russia, and to use this as a point of reference when reading 21st Century western academic suicide literature. Methods: The data collected from Dostoyevsky's three most prominent novels, Crime and Punishment, The Idiot and The Brothers Karamazov were examined for the text events, 1) completed suicide, 2) suicide attempts, 3) suicidal thoughts, and 4) other mentions of suicide. Findings were compared with current orthodox Western medical literature. Results: In Dostoyevsky's Russia suicide occurred not infrequently and the methods were hanging, shooting and drowning. The triggers were predominantly social factors (in contrast to the current time when the triggers are reported to be predominantly mental disorders). Attempted suicide appears to have been less common than suicide, and limited to occasions when others thwarted deadly actions (in contrast to the current time in which overdose and cutting are frequently encountered). Suicidal thoughts were common among the healthy population (which is in agreement with some current findings). Conclusions: Dostoyevsky's novels suggest that in mid-19th Century Russia, suicide was not uncommon and the main methods were similar to those of the current time. The triggers were depicted as mainly social/economic factors (rather than mental disorder). Attempted suicide has changed much. Suicidal thoughts appear common in both time periods, and frequently appears in the absence of mental disorder. [ABSTRACT FROM AUTHOR]

Objective: We aimed to explore aspects of the removal of hanging points from correctional facilities.Conclusion: An argument can be made that individuals have a right to die/suicide. The United Nations holds that except for freedom of movement, prisoners have the same rights as non-prisoners. The rights of the individual and the duty of many custodial institutions are in conflict. This introduces a conundrum; when all hanging points are removed from correctional facilities, prisoners without mental disorder, but with a sustained wish to die, will not be able to achieve that end, while non-prisoners will be well able to do so. [ABSTRACT FROM AUTHOR]

Background . For the last 200 years Western medicine has insisted that all suicide is triggered by mental disorder. Aim. To locate ancient reports of suicide in which the triggers (non - mental disorder) are clearly stated, and to discover whether these triggers still have that role today. Method . We selected cases in which the triggers were compatible with those considered by Plato to constitute acceptable reasons for suicide: Loss of a lover, Loss of a child, Loss of choic e of spouse (forced marriage), Loss of liberty (and revenge), Shame – own actions, Shame – actions of others, Shame – loss in battle, Guilt, and Physical pain. Ancient and current cases were sought. Findings. In all categories we identified at least one an cient and two recent cases. Conclusion. We demonstrated that millennia ago, and at the present time, various non - mental disorder events had and have the capacity to trigger suicide. If we are to prevent suicide, our culture must discourage this response an d strongly recommend other response options, to those who suffer such experiences. [ABSTRACT FROM AUTHOR]