Autoethnographic Reflections on Mental Distress and Medication Management: Conceptualising Biomedical and Recovery Models of Mental Health.

This article uses autoethnography to explore the author's lived experiences of mental distress and how she has conceptualised and explained these symptoms to herself using both the biomedical and recovery models of care. Autoethnography is a process of personal reflection that enables connection between the personal and the political. Experiences of mental distress are recounted alongside the decision to reduce medication. This personal experience is then explored in the context of limited evidence base on the effectiveness of reducing medication and the situation in which prescribers often feel reluctant to recommend and support service users in these choices. Shared decision-making in medication management is introduced which is an approach which draws on the models of recovery and co-production challenging traditional biomedical approaches which locate the prescriber as expert. Moreover, the radical service user led model is highlighted, within which, the Hearing Voices Network and Open Dialogue offer alternative approaches which promote co-production and empowerment. The author connects the personal to the political and reflects on her dual identity as an expert-by-experience and social work academic. She details how she has drawn on biomedical explanations to describe her distress yet has been challenged by the recovery model throughout her journey of recovery. She concludes that her own position, in identifying herself as an academic and expert-by-experience is an important step in challenging notions of expertise and approaches to mental health care.

Salient Object Detection Based on Optimization of Feature Computation by Neutrosophic Set Theory.

In recent saliency detection research, too many or too few image features are used in the algorithm, and the processing of saliency map details is not satisfactory, resulting in significant degradation of the salient object detection result. To overcome the above deficiencies and achieve better object detection results, we propose a salient object detection method based on feature optimization by neutrosophic set (NS) theory in this paper. First, prior object knowledge is built using foreground and background models, which include pixel-wise and super-pixel cues. Simultaneously, the feature maps are selected and extracted for feature computation, allowing the object and background features of the image to be separated as much as possible. Second, the salient object is obtained by fusing the features decomposed by the low-rank matrix recovery model with the object prior knowledge. Finally, for salient object detection, we present a novel mathematical description of neutrosophic set theory. To reduce the uncertainty of the obtained saliency map and then obtain good saliency detection results, the new NS theory is proposed. Extensive experiments on five public datasets demonstrate that the results are competitive and superior to previous state-of-the-art methods.

Hope is a Mediator Between Enhancing Attributional Style and Depressive Symptoms in Early Adolescence.

This study added to understanding of the recovery model of depression in adolescents by testing whether hope mediates the link between enhancing attributional style (EAS) and depression using two independent samples. Study 1 used cross-sectional data from 378 students (51% female) in fifth through seventh grade students. Study 2 used data from 546 (50% female) seventh and eighth grade students at two time points: January and May within the same year. Cross-sectional analyses indicated that EAS indirectly predicted depression. Cross-sectional and prospective analyses indicated that stable attributions, in particular, were associated with lower levels of depression through higher levels of hope. Notably, contrary to expectations, global attributions consistently predicted higher levels of depression. Results suggest that hope mediates the association between attributional stability for positive events and reductions in depression over time. The importance of investigating attributional dimensions is emphasized as implications and future research directions are discussed.

Partial and complete dependency among data sets has minimal consequence on estimates from integrated population models.

Integrated population models (IPMs) are widely used to combine disparate data sets in joint analysis to better understand population dynamics and provide guidance for conservation activities. An often-cited assumption of IPMs is independence among component data sets within the combined likelihood. Dependency among data sets should lead to underestimation of variance and bias because individuals contribute data to more than one data set. In practice, studied individuals often occur in multiple data sets in IPMs (i.e., overlap), which is one way for the independence assumption to be violated. Such cases have the potential to dissuade practitioners and limit application of IPMs to solve emerging ecological problems. We assessed precision and bias of demographic rates estimated from IPMs using a complete gradient (0-100%) of overlap among data sets, wide ranges in demographic rates (e.g., survival 0.1-0.8) and sample sizes (100-1,200 individuals) and variable data sources. We compared results from our simulations with those from IPMs constructed using empirical data on tree swallows (Tachycineta bicolor) where data sets either had complete overlap or included different individuals. Contrary to previous investigators, we found no substantive bias or uncertainty in any demographic rate from IPMs derived from data sets with complete overlap. While variability in demographic rates was greater at low sample sizes (i.e., low capture, recapture, and survey probabilities), there were negligible differences in the posterior mean or root mean square error of demographic rates among IPMs with strong dependence vs. complete independence among data sets. Our simulations suggest IPMs can be designed using only capture-recapture data or harvest and capture-recovery data where population estimates are obtained from the same data as survival and productivity data. While we encourage researchers to carefully consider the modeling approach best suited for their data sets, our results suggest that dependence among data sets does not generally compromise IPM estimates. Thus, violation of the independence assumption should not dissuade researchers from the application of IPMs in ecological research.

Recovering Uncertainty: Exploring Eating Disorder Recovery in Context.

Attending to the shades of grey in eating disorder recovery may help to illuminate possibilities for navigating recoveries in their full complexity and diversity. There is a need for more complexity and flexibility in understandings of the timelines, processes, endpoints, and versions of eating disorder recoveries. In this article, we explore eating disorder recovery as a dynamic, intercorporeal, and non-linear process. Drawing on interviews with 20 people doing significantly better than they were during a time of acute distress around food and body, we articulate "recoveries" in relation to four themes: Fuzzy Logics of Time, Not Only Recovered, Recovery is Not All Sunshine and Rainbows, and The Life of Recovery. These themes speak to the ways in which participants struggled to articulate the temporalities of their recoveries, situated recovery as one among many events and processes that shaped their being in the world, resisted "too perfect" articulations of recovery journeys/ endpoints, and described preferred versions of and open-ended guidelines for recovery. We argue that eating disorder recoveries are as complicated and messy as lives themselves and are equally entangled in social contexts. We suggest that articulations of recovery be attuned to power dynamics as they operate in dictating which performances of eating disorders and recovery will be honoured as "legitimate" and whose pathways to recovery will be respected.

Experiences and perceptions of people living with schizophrenia in Japan: A qualitative study.

This descriptive study used a qualitative inductive approach to investigate the subjective experiences and perceptions of people with schizophrenia living in the community during times of difficulty and how they coped. We conducted semi-structured interviews with nine community-dwelling people with schizophrenia and used the KJ method developed by Kawakita Jiro to structure the data obtained. We identified 10 symbols with his method: bewilderment at the onset; helplessness and longing for death; solitude linked to death; precarious daily life; relationships at risk; fear of being stigmatized; pillars of emotional support; will to overcome; hope to never give up; and living with the illness. The results suggest that community mental health nurses should provide support so their patients can continue to have pillars of emotional support and the will to overcome difficulties, as well as continue to use their coping methods, even when experiencing many difficulties. It is important that nurses understand and share in their patients' difficult experiences and hopes when providing support toward their recovery.

Recovery Model Implementation for a Medical/Geriatric Psychiatric Unit to Decrease Restraint and Seclusion Episodes: A Quality Improvement Project.

INTRODUCTION: In inpatient behavioral health units, a long-standing behavioral management controversy has been whether to physically restrain or seclude patients. The rate of restraint use at the institution underperformed compared with the national average, which led to the project implementation. AIMS: This quality improvement project's objective was to decrease restraint and seclusion use, improve quality of care, and decrease cost through implementation of recovery model principles. METHOD: Implementation started in October 2019 on a 14-bed inpatient medical/geriatric psychiatric unit with 38 psychiatric RNs at a large academic medical center. The project was a pre-post implementation design with interventions consisting of staff education, RN language observation, and orientation toolkit development. Changes in staff knowledge were measured by Recovery Knowledge Inventory surveys at baseline, 1 week posteducation, and 4 months posteducation. Restraint and seclusion use data were analyzed 3 months preimplementation and 3 months postimplementation. RESULTS: Staff knowledge of the recovery model increased from baseline to 1 week postimplementation in all four survey domains (range = 6% to 9% improvement). While improvements were maintained in two survey domains, two domains of staff knowledge showed slight declines (1% to 2% decline in scores) 4 months postintervention. Restraint use decreased 73.1% and seclusion use decreased 16.3% from pre to postintervention. CONCLUSION: Implementation of recovery model principles can decrease restraint and seclusion episodes, which increases quality and decreases cost to the organization.

Assessing and measuring financial sustainability model of the Spanish HIV HGM BioBank.

BACKGROUND: The Spanish HIV HGM BioBank is of great relevance for basic and clinical investigation, and for those groups trying to establish large networks focused on investigation on specific clinical problems. The collection of different types of samples from HIV-infected individuals is the beginning of the chain of translational investigation, starting in 2004 a prospective national HIV BioBank that expanded in 2009 a local node (HGM: Hospital Gregorio Marañón) for diverse pathologies and clinical networks, not only in adults but also in paediatric patients, becoming the Spanish HIV HGM BioBank. Our main objective is to find a general criteria and analytical tools to widespread its economic management to assure their sustainability and the future exploitation of the extreme high valuable biomaterial they custody. METHODS: The Spanish HIV HGM BioBank was created with the aim of contributing to advance understanding of different pathologies through the transfer, management, register, processing, cryopreservation and cession of biological material from patients, always for research purposes and under conditions that guarantee its usefulness in current studies and future research that may appear as knowledge evolves. In this study, we have developed a policy for financial control and recovery costs of the Spanish HIV HGM BioBank. RESULTS: Actually, Spanish HIV HGM BioBank guards 413,747 vials of 46,594 samples from 16,210 donors with various prospective longitudinal study type of samples. Interestingly, more than 7907 of these samples are now used in 28 national and international investigation projects and clinical trials. One of the objectives of this study is to develop an economic plan that you get future projects, design of acceptance or rejection keys, have internal investment limits, minimum recovery needs in short/medium term, deviation detection system and a register of capital recovery by period and type of service for the Spanish HIV HGM BioBank. CONCLUSION: Our model can help BioBanks that do not have a costs recovery model to design it, as well as to detect improves and functional revisions to those experienced in this field.

Global analysis of depletion and recovery of seabed biota after bottom trawling disturbance.

Bottom trawling is the most widespread human activity affecting seabed habitats. Here, we collate all available data for experimental and comparative studies of trawling impacts on whole communities of seabed macroinvertebrates on sedimentary habitats and develop widely applicable methods to estimate depletion and recovery rates of biota after trawling. Depletion of biota and trawl penetration into the seabed are highly correlated. Otter trawls caused the least depletion, removing 6% of biota per pass and penetrating the seabed on average down to 2.4 cm, whereas hydraulic dredges caused the most depletion, removing 41% of biota and penetrating the seabed on average 16.1 cm. Median recovery times posttrawling (from 50 to 95% of unimpacted biomass) ranged between 1.9 and 6.4 y. By accounting for the effects of penetration depth, environmental variation, and uncertainty, the models explained much of the variability of depletion and recovery estimates from single studies. Coupled with large-scale, high-resolution maps of trawling frequency and habitat, our estimates of depletion and recovery rates enable the assessment of trawling impacts on unprecedented spatial scales.

Innovation and Its Discontents: Pathways and Barriers in the Diffusion of Assertive Community Treatment.

Policy Points Widespread diffusion of policy innovation is the exception rather than the rule, depending as it does on the convergence of a variety of intellectual, political, economic, and organizational forces. The history of Assertive Community Treatment (ACT) provides a compelling case study of this process while also showing how conditions may shift over time, altering the scenarios for continued program expansion. Diffusion of a program like ACT challenges government to play a nuanced role in which public endorsement and resources are used to strengthen a worthwhile service, but without suppressing flexibility and ongoing experimentation as core program values. Acceptance as a proven form of "evidence-based practice" is a critical element in the validation of ACT and other community mental health interventions that combine clinical and social features in novel ways. However, the use of conventional evidence-based research as a singular gold standard of program value narrows the range of stakeholder input, as well as the evaluation methodologies and forms of data deemed worthy of attention. CONTEXT: Originating at the county level in Wisconsin in the early 1970s, Assertive Community Treatment is one of the most influential mental health programs ever developed. The subject of hundreds of research studies and recipient of enthusiastic backing from private advocacy organizations and government agencies, the program has spread widely across the United States and internationally as a package of resources and management techniques for supporting individuals with severe and chronic mental illness in the community. Today, however, ACT is associated with a rising tide of criticism challenging the program's practices and philosophy while alternative service models are advancing. METHODS: To trace the history of the Assertive Community Treatment movement, a diffusion-of-innovation framework was applied based on relevant concepts from public policy analysis, organizational behavior, implementation science, and other fields. In-depth review of the literature on ACT design, management, and performance also provided insight into the program's creation and subsequent evolution across different settings. FINDINGS: A number of factors have functioned to fuel and to constrain ACT diffusion. The former category includes policy learning through research; the role of policy entrepreneurs; ACT's acceptance as a normative standard; and a thriving international epistemic community. The latter category includes cost concerns, fidelity demands, shifting norms, research contradictions and gaps, and a multifactorial context affecting program adoption. Currently, the program stands at a crossroads, strained by the principle of adherence to a long-standing operational framework, on the one hand, and calls to adjust to an environment of changing demands and opportunities, on the other. CONCLUSIONS: For nearly 50 years, Assertive Community Treatment has been a mainstay of community mental health programming in the United States and other parts of the world. This presence will continue, but not in any static sense. A growing number of hybrid and competing versions of the program are likely to develop to serve specialized clientele groups and to respond to consumer demands and the recovery paradigm in behavioral health care.

The 'new normal': relativity of quality of life judgments in individuals with bipolar disorder-a qualitative study.

PURPOSE: Quality of life (QoL) is increasingly a target of interventions for bipolar disorders (BD). While the subjective experience of consumers is often elevated as central to the construct of QoL in BD, limited investigation in this area means subjective QoL remains poorly understood. The present qualitative study seeks to address this by investigating how people with BD appraise the quality of their lives in the context of a QoL self-management intervention. METHODS: Semi-structured interviews were conducted with 43 individuals who had participated in a self-management intervention for improving QoL in BD. Individuals were questioned about experiences of the intervention and perceptions of their QoL. Thematic analysis was used to explore participants' appraisal of their QoL. RESULTS: An overarching theme concerned the intrinsic relativity of subjective QoL: individuals located QoL as relative to self, others and possible futures. Incorporating illness-related reference points for QoL ('given my circumstances…') was associated with perceptions of improved QoL. Deliberately modifying reference points for QoL was perceived as self-compassionate. CONCLUSION: The present study generates novel hypotheses about how individuals with BD make sense of their QoL. Data suggest that individuals located their QoL relative to a variety of reference points, use of which was flexible. In accord with gap theories of QoL, individuals experienced acceptance of illness impacts as improving subjective sense of QoL. Rather than 'settling for' a lower standard of QoL, individuals experienced these changes as adaptive and positive. Findings are discussed in relation to the measurement and amelioration of QoL in BD.

Recovery in Mind: Perspectives from Postgraduate Psychiatric Trainees.

OBJECTIVE: The authors assessed psychiatric trainees' understanding of recovery-oriented care, a therapeutic philosophy with varied meanings but wide purchase in contemporary mental health policy. METHODS: Four cohorts of residents were presented with a clinical vignette as part of a written curricular evaluation and asked what it would mean to engage the patient from a recovery-oriented perspective. Responses were subjected to qualitative analysis, with the analysts examining each cohort independently, then meeting to discuss their findings and build consensus on the most pertinent themes. RESULTS: Nine themes emerged in trainees' understanding of recovery-oriented care: (1) a person is more than his or her illness; (2) hope; (3) an emphasis on patient goals; (4) taking a collaborative approach; (5) an emphasis on level of social function; (6) valuing subjective experience; (7) psychosocial interventions; (8) empowerment of the patient; and (9) persistence of traditional attitudes. CONCLUSIONS: Residents revealed an understanding of recovery that reflected many, but not all, of the guiding principles in the Substance Abuse and Mental Health Services Administration's 2010 working definition. For many of these trainees, recovery-oriented care signified a shift in the traditional power dynamic between physician and patient that allowed patients to take an active role in their own care. Residents also recognized the importance of hope and the complexity of their patients' social identities, though some trainees had difficulty reconciling a collaborative approach with their perceived responsibilities as physicians. If educators wish to incorporate elements of the American Psychiatric Association's Recovery to Practice initiative into their curricula, they would do well to recognize residents' variable receptivity to elements of the model.

[Active compounds from Baoyuan decoction with myocardial protection activities and their potential targets].

Baoyuan decoction (BYD) is a classical Chinese formula for coronary heart disease with Qi deficiency, blood stasis tonifying Qi and Yang deficiency. However, the chemical material basis and underlying action mechanisms of BYD still lack systemic study. In order to clarify the active compounds and the potential action mechanisms of BYD, the oxygen-glucose deprivation/recovery (OGD/R)-induced H9c2 cells injury models was used to screen the monomeric compounds of BYD with myocardial protection activity. PubChem's BioAssay database was then used to analyze the potential targets of active monomeric compounds, classify the predicted biological targets, and analyze the internal relation between active compounds of BYD and biological targets. The screening results showed that BYD aqueous extract and 17 monomeric compounds could significantly increase the survival rate of OGD/R-induced H9c2 myocardial cells. The results of virtual targets screening study showed that 15 monomeric compounds and the potential mechanisms for myocardial protection were related to oxidative stress pathway, calcium ion pathway, mitochondrial protection, anti-apoptosis, etc. These results verified that BYD had myocardial protection effect, which was obtained by network regulation of multi-components and multi-targets. All these results provide the theoretical basis and references for the clinical usage of BYD in treatment of coronary heart disease.

Optimizing delivery of recovery-oriented online self-management strategies for bipolar disorder: a review.

OBJECTIVES: Self-management is emerging as a viable alternative to difficult-to-access psychosocial treatments for bipolar disorder (BD), and has particular relevance to recovery-related goals around empowerment and personal meaning. This review examines data and theory on BD self-management from a recovery-oriented perspective, with a particular focus on optimizing low-intensity delivery of self-management tools via the web. METHODS: A critical evaluation of various literatures was undertaken. Literatures on recovery, online platforms, and self-management in mental health and BD are reviewed. RESULTS: The literature suggests that the self-management approach aligns with the recovery framework. However, studies have identified a number of potential barriers to the utilization of self-management programs for BD and it has been suggested that utilizing an online environment may be an effective way to surmount many of these barriers. CONCLUSIONS: Online self-management programs for BD are rapidly developing, and in parallel the recovery perspective is becoming the dominant paradigm for mental health services worldwide, so research is urgently required to assess the efficacy and safety of optimization methods such as professional and/or peer support, tailoring and the development of 'online communities'.

Engagement as an Element of Safe Inpatient Psychiatric Environments.

BACKGROUND: The American Psychiatric Nurses Association (APNA) Institute for Safe Environments (ISE) has focused on key elements that affect safety in psychiatric treatment environments; one of these key elements is patient engagement. An ISE workgroup discussed and reviewed the literature on engagement and safety in inpatient psychiatric settings. This article presents what we have learned about the role that engagement plays in inpatient treatment of severely mentally ill individuals and evidence that links nurse-patient engagement to safety. OBJECTIVES: To describe, using supporting literature, the role that nurse-patient engagement plays in creating safe, therapeutic environments for individuals with severe mental illness. DESIGN: (1) Define engagement and describe why it is an important element of safe treatment environments; (2) identify what helps and what hinders patients in their engagement with nurses, and nurses in their engagement with patients; (3) describe how engagement may improve unit safety; and (4) propose recommendations and set future directions for practice, research, and education. CONCLUSION: Engagement may provide the foundation for safe, therapeutic, and recovery-oriented treatment. In the future, APNA's ISE plans to build upon this foundation by developing a clinical model of nurse-patient engagement and safety by drawing together emerging research and practice models.

A new simple local muscle recovery model and its theoretical and experimental validation.

This study was conducted to provide theoretical and experimental validation of a local muscle recovery model. Muscle recovery has been modeled in different empirical and theoretical approaches to determine work-rest allowance for musculoskeletal disorder (MSD) prevention. However, time-related parameters and individual attributes have not been sufficiently considered in conventional approaches. A new muscle recovery model was proposed by integrating time-related task parameters and individual attributes. Theoretically, this muscle recovery model was compared to other theoretical models mathematically. Experimentally, a total of 20 subjects participated in the experimental validation. Hand grip force recovery and shoulder joint strength recovery were measured after a fatiguing operation. The recovery profile was fitted by using the recovery model, and individual recovery rates were calculated as well after fitting. Good fitting values (r(2) > .8) were found for all the subjects. Significant differences in recovery rates were found among different muscle groups (p < .05). The theoretical muscle recovery model was primarily validated by characterization of the recovery process after fatiguing operation. The determined recovery rate may be useful to represent individual recovery attribute.

The recovery model and anorexia nervosa.

OBJECTIVE: Treatments in anorexia nervosa (AN) have not been wholly effective and, accordingly, practices need to be reviewed. The recovery model is an approach to treatment that has become a guiding principle for mental health policy worldwide that might provide promise for AN treatment. The model has received much attention in recent years; however, there is a dearth of literature exploring how useful this model is for AN. The aim of the current article was to consider the relevance of this model in AN. METHODS: This article provides a summary of the recovery model and reviews the literature to establish whether it is compatible with AN. The possible utility of the approach in AN is explored and suggestions are made as to how the model might be implemented in treatment. RESULTS: Qualitative studies examining the patient's perspective of AN support the recovery model. Many evidenced-based treatments currently used in AN have elements that are consistent with a recovery model approach. Treatments that are most consistent with recovery approaches have been effective for those with chronic AN. CONCLUSION: It is proposed that the model might offer a way in which to add to current practice and might have particular relevance for those with chronic AN. Future research is required to better understand how the model can best be utilised in AN.

Implementation of the Recovery Model and Its Outcomes in Patients with Severe Mental Disorder.

BACKGROUND: The recovery model assumes that the patient can experience personal growth even while maintaining symptoms of a mental disorder. In order to achieve this recovery, the practices of professionals must also change. However, in our setting, there are limited data on the implementation of practices based on the recovery model and their effect on personal recovery. OBJECTIVE: To describe the association between professionals' practices and patients' personal recovery. METHODS: An observational and cross-sectional study in which the Recovery Self-Assessment (RSA) was used to assess the degree of implementation of the different practices and the Recovery Assessment Scale (RAS) was used to assess the personal recovery of 307 patients with severe mental disorders. RESULTS: Patients attended by professionals who followed the recovery model obtained a greater personal recovery (p < 0.001, d = 1.10). The dimension associated with greater recovery was that of working toward life goals. The least implemented dimensions had to do with offering treatment options and patient participation in decision-making. This study was conducted in accordance with STROBE (STrengthening the Reporting of OBservational studies in Epidemiology). CONCLUSIONS: Although this is a cross-sectional study that does not allow us to establish causal relationships, it shows that the model with which mental health professionals work is associated with patients' chances of recovery. We therefore consider that it is important to foster the implementation of practices based on the recovery model within mental health care.

A dynamic spatiotemporal model for fall warning and protection.

Early detection of falls is important for reducing fall injuries. However, existing fall detection strategies mostly focus on reducing impact injuries rather than avoiding falls. This study proposed the concept of identifying "Imbalance Point" to warn the body imbalance, allowing sufficient time to recover balance. And if falling cannot be avoided, an impact sign is released by detecting the "Fall Point" prior to the impact. To achieve this goal, motion prediction model and balance recovery model are integrated into a spatiotemporal framework to analyze dynamic and kinematic features of body motion. Eight healthy young volunteers participated in three sets of experiment: Normal trial, Recovery trial and Fall trial. The body motion in the trials was recorded using Microsoft Azure Kinect. The results show that the developed algorithm for Fall Point detection achieved 100% sensitivity and 98.6% specificity, along with an average lead time of 297 ms. Moreover, Imbalance Point was successfully detected in all Fall trials, and the average time interval between Imbalance Point and Fall Point was 315 ms, longer than reported step reaction time for elderly (approximately 270 ms). The experiment results demonstrate that the developed algorithm have great potential for fall warning and protection in the elderly.

Research on resilience assessment method of train control on-board system.

To address the problem of difficult performance assessment of train control on-board system after recovery from failures, we have proposed a resilience assessment methodology that uses reliability as an indicator of system resilience. Since the system failures are time-dependent, we adopted the Discrete Time Bayesian Network method to obtain the system's reliability before and after failure. Subsequently, we used an exponential recovery model to quantify the system's performance curve during the recovery phase, and finally utilized the resilient triangle area method to quantify its resilience size. Analyzing the CTCS3-300T train control on-board system, we found that the resilience of the system with cold standby redundancy design and hot standby redundancy design were 89.44 % and 87.34 %, respectively, indicating a slight decrease in system performance after recovery from failures compared to pre-failure levels. At that time, it was necessary to adjust operational plans based on actual conditions to avoid greater impact on the railway network. This paper realizes performance resilience of train control on-board system after failure recovery, which can be applied to similar systems and provide theoretical references for realizing intelligent maintenance of the high-speed train.