Computational models can distinguish the contribution from different mechanisms to familiarity recognition.

Familiarity is the strange feeling of knowing that something has already been seen in our past. Over the past decades, several attempts have been made to model familiarity using artificial neural networks. Recently, two learning algorithms successfully reproduced the functioning of the perirhinal cortex, a key structure involved during familiarity: Hebbian and anti-Hebbian learning. However, performance of these learning rules is very different from one to another thus raising the question of their complementarity. In this work, we designed two distinct computational models that combined Deep Learning and a Hebbian learning rule to reproduce familiarity on natural images, the Hebbian model and the anti-Hebbian model, respectively. We compared the performance of both models during different simulations to highlight the inner functioning of both learning rules. We showed that the anti-Hebbian model fits human behavioral data whereas the Hebbian model fails to fit the data under large training set sizes. Besides, we observed that only our Hebbian model is highly sensitive to homogeneity between images. Taken together, we interpreted these results considering the distinction between absolute and relative familiarity. With our framework, we proposed a novel way to distinguish the contribution of these familiarity mechanisms to the overall feeling of familiarity. By viewing them as complementary, our two models allow us to make new testable predictions that could be of interest to shed light on the familiarity phenomenon.

Ambient heat exposure patterns and emergency department visits and hospitalizations among medicare beneficiaries 2008-2019.

OBJECTIVE: To assess the association between ambient heat and all-cause and cause-specific emergency department (ED) visits and acute hospitalizations among Medicare beneficiaries in the conterminous United States. DESIGN: Retrospective cohort study. SETTING: Conterminous US from 2008 and 2019. PARTICIPANTS: 2% random sample of all Medicare fee-for-service beneficiaries eligible for Parts A, B, and D. MAIN OUTCOME MEASURES: All-cause and cause-specific (cardiovascular, renal, and heat-related) ED visits and unplanned hospitalizations were identified using primary ICD-9 or ICD-10 diagnosis codes. We measured the association between ambient temperature - defined as daily mean temperature percentile of summer (June through September) - and the outcomes. Hazard ratios and their associated 95% confidence intervals were estimated using multivariable Cox proportional hazards regression, adjusting for individual level demographics, comorbidities, healthcare utilization factors and zip-code level social factors. RESULTS: Among 809,636 Medicare beneficiaries (58% female, 81% non-Hispanic White, 24% <65), older beneficiaries (aged ≥65) exposed to >95th percentile temperature had a 64% elevated adjusted risk of heat-related ED visits (HR [95% CI], 1.64 [1.46,1.85]) and a 4% higher risk of all-cause acute hospitalization (1.04 [1.01,1.06]) relative to <25th temperature percentile. Younger beneficiaries (aged <65) showed increased risk of heat-related ED visits (2.69 [2.23,3.23]) and all-cause ED visits (1.03 [1.01,1.05]). The associations with heat related events were stronger in males and individuals dually eligible for Medicare and Medicaid. No significant differences were observed by climatic region. We observed no significant relationship between temperature percentile and risk of CV-related ED visits or renal-related ED visits. CONCLUSIONS: Among Medicare beneficiaries from 2008 to 2019, exposure to daily mean temperature ≥ 95th percentile was associated with increased risk of heat-related ED visits, with stronger associations seen among beneficiaries <65, males, and patients with low socioeconomic position. Further longitudinal studies are needed to understand the impact of heat duration, intensity, and frequency on cause-specific hospitalization outcomes.

Influence of interactive effects on long-term population trajectories in multispecies reintroductions.

Reintroduced populations are typically considered to progress through establishment, growth, and regulatory phases. However, most reintroduction programs do not monitor intensively enough to test this conceptual model. We studied population indices derived from track activity of 4 threatened species (greater bilby [Macrotis lagotis], burrowing bettong [Bettongia lesueur], greater stick-nest rat [Leporillus conditor], and Shark Bay bandicoot [Perameles bougainville]) over 23 years after multiple reintroductions of each species in arid Australia. We compared population trajectories among species and investigated the effect of time and environmental variables. All species bred immediately after release, and the growth phase lasted 3-16 years, varying markedly among but not within species. The end of the growth phase was characterized by an obvious peak in population density followed by either a catastrophic decline and sustained low density (bettongs), a slow decline to extirpation after 20 years (stick-nest rat), or a slight decline followed by irregular fluctuations (bilby and bandicoot). Minor fluctuations were related to environmental variables, including 12-month cumulative rainfall and lagged summer maximum temperatures. Three of the 4 species did not reach a regulation phase, even after 23 years, possibly due to interspecific competition and trophic cascades triggered by predator removal and multispecies reintroductions. Bilbies and bandicoots exhibited a second growth phase 18 years after reintroduction, likely caused by high rainfall and increased resources following the population crash of overabundant bettongs. Our results suggest that assemblages within multispecies reintroductions demonstrate high variability in population trajectories due to interactive effects. Intensive monitoring to assess population viability may require decades, particularly where multiple species are reintroduced, release sites are confined, and the climate is unpredictable. Intensive monitoring also allows for adaptive management to prevent precipitous population declines. Practitioners should not assume reintroduced species pass through predictable postrelease population phases or that viability is assured after a certain period.

Influencia de los efectos interactivos sobre la trayectoria a largo plazo de las poblaciones en reintroducciones de múltiples especies Resumen Comúnmente se considera que las poblaciones reintroducidas progresan cuando se establecen, crecen y atraviesan fases regulatorias. Sin embargo, casi todos los programas de reintroducción no monitorean lo suficiente para evaluar este modelo conceptual. Estudiamos los índices poblacionales derivados de la actividad de rastreo de cuatro especies amenazadas (Macrotis lagotis, Bettongia lesueur, Leporillus conditor, y Perameles bougainville) más de 23 años después de varias reintroducciones de cada especie en las zonas áridas de Australia. Comparamos las trayectorias poblacionales entre especies e investigamos el efecto del tiempo y las variables ambientales. Todas las especies se reprodujeron inmediatamente después de la liberación, y la fase de crecimiento duró entre 3 y 16 años, con una variación marcada entre, pero no dentro de las especies. El final de la fase de crecimiento se caracterizó por un pico obvio en la densidad poblacional seguido de una declinación catastrófica o una baja densidad sostenida (B. lesueur), una declinación lenta ante la extirpación 20 años después (L. conditor) o una declinación leve seguida de fluctuaciones irregulares (M. lagotis y P. bougainville). Las fluctuaciones menores estuvieron relacionadas con las variables ambientales, incluyendo la precipitación acumulada de 12 meses y el retraso en las temperaturas máximas de verano. Tres de las cuatro especies no llegaron a la fase regulatoria, incluso después de 23 años, posiblemente por la competencia interespecífica y las cascadas tróficas causadas por la eliminación de depredadores y la reintroducción de varias especies. M. lagotis y P. bougainville exhibieron una segunda fase de crecimiento 18 años después de la reintroducción, probablemente causada por la precipitación elevada y el incremento de recursos después de la crisis poblacional por sobreabundancia de B. lesueur. Nuestros resultados sugieren que los conjuntos dentro de la reintroducción de múltiples especies demuestran una gran variabilidad en las trayectorias poblacionales debido a los efectos interactivos. El monitoreo intenso para evaluar la viabilidad poblacional puede llevar varias décadas, particularmente cuando se reintroducen varias especies, en donde los sitios de liberación están confinados y en donde el clima es impredecible. El monitoreo intensivo también permite que el manejo adaptativo prevenga una declinación poblacional precipitada. Quienes practican la conservación no deberían asumir que una especie reintroducida atraviesa fases predecibles después de la liberación o que la viabilidad está asegurada después de cierto periodo.

Depression: why drugs and electricity are not the answer.

The dominant view within mental health services and research suggests that feeling depressed is a kind of medical illness, partially caused by various biological deficits which are somehow corrected by physical interventions. This article critically appraises evidence for the effectiveness and value of antidepressant drugs and electroconvulsive therapy (ECT), the two principle physical treatments recommended for depression. It also describes the negative effects of these interventions and raises concerns about how they impact the brain. We propose an alternative understanding that recognises depression as an emotional and meaningful response to unwanted life events and circumstances. This perspective demands that we address the social conditions that make depression likely and suggests that a combination of politics and common sense needs to guide us in providing help for one another when we are suffering in this way. This alternative view is increasingly endorsed around the world, including by the United Nations, the World Health Organization and service users who have suffered negative consequences of physical treatments that modify brain functions in ways that are not well-understood.

Adequacy of Inquiry About, Documentation of, and Treatment of Trauma and Adversities: A Study of Mental Health Professionals in England.

This study aimed to ascertain how often staff in community mental health services (CMHSs) in England ask about adverse experiences in childhood and adulthood, including abuse and neglect, how often those experiences are known about and documented by staff, and how staff respond when such experiences are known about and documented. The files of 400 people using four CMHSs in England were reviewed. Only 13% of clinical records contained documentation of any adverse experiences. One percent showed clear evidence that clients had been asked about adversities. People with psychosis diagnoses were less likely to have adverse experiences documented in their file. Rates of responses to adversities of which staff were aware were high, with 90% of records indicating some appropriate support following disclosure. Future research endeavours are recommended, including on reasons for not routinely asking and on type of training needed. Recommendations are made in relation to policy change, staff training and guidelines to improve routine enquiry about adversities. Ultimately, a move to 'trauma-informed' services, already underway in some areas, is required for all mental health services.

Childhood adversities among students at an English University: A latent class analysis.

University students routinely participate in research, including research on trauma and adversity, but the unique implications of trauma and adversity for educational and developmental outcomes for this group have received less attention. This study surveyed first year undergraduate students at an urban university located in the most ethnically diverse district in England, with the second highest poverty rate. Of 7,110 students, 858 responded; a response rate of 12%. The survey included thirteen questions about adverse events and circumstances before age 18. Four in five students (79%) reported at least one adversity, 51% reported three or more, and 20% reported at least six. Female students reported a higher mean number of adversities than men, but men were significantly more likely to report having been "attacked, stabbed, shot or robbed by threat." Where comparisons were possible, rates were higher than for the general population or for the only other UK university survey. A Latent Class Analysis produced four groupings. Besides the 'No adversity' (36%) and "Intermediate" (46%) classes, there were two "High adversity" groups, differentiated by high (12%) or moderate (6%) adversities related to cohabitation (parental separation, lived with depressed person, lived with alcohol/drug user, and lived with incarcerated person). Higher rates of adversities, and latent class membership, were related to predictions that one would not complete one's degree. Implications and next steps are discussed.

How important are informed consent, informed choice, and patient-doctor relationships, when prescribing antipsychotic medication?

BACKGROUND: Antipsychotic medications (APs) are used for people with psychosis diagnoses and, increasingly for other problems and groups. AIMS: This study examines how APs are prescribed, from the perspective of recipients. METHODS: 757 people, from 30 countries, responded to questions about their experiences with APs, in an online survey. RESULTS: Most (70%) were told nothing about adverse effects. Fewer than 2% recalled being told about the risks of diabetes, suicidality, sexual dysfunction, or reduced life span. None recalled being told about reduced brain volume or withdrawal effects. Only 28% recalled being offered other treatments; with only 14% offered talking therapies. 46% were not told how long to take the APs; and, of those who were told something, 48% were told to take them forever. Most respondents (76%) were not told how APs work. Only 19% were satisfied with the prescribing process, and only 25% reported a good, or very good, relationship with the prescriber. Information, satisfaction with the process, and the prescriber relationship were all positively related to three self-reported outcomes: reduction of problems the drugs were prescribed for, general helpfulness, and quality of life. CONCLUSIONS: Steps need to be taken to ensure people prescribed antipsychotics are fully informed, especially about adverse effects and alternatives.

The impact of adverse childhood experiences and recent life events on anxiety and quality of life in university students.

Adverse childhood experiences (ACEs) have been repeatedly associated with a wide range of physical and mental health issues. Research has indicated high levels of anxiety and depression among university students, and a few studies have documented the relationship between ACEs and anxiety in the university student population. This study surveyed first year students at a university located in the most ethnically diverse district in England, with the second highest poverty rate. Eight hundred and fifty-eight responded; a response rate of 12%. The survey included questions about adverse childhood events, recent life stressors, current deprivation, quality of life, positive physical health and positive mental health, and used the Generalized Anxiety Disorder Scale, a standardised measure. Thirty-seven percent of the responding students met the diagnosis for generalised anxiety disorder. In a multivariate multiple regression model, life stressors and childhood adversities were significantly associated with higher levels of anxiety and lower levels of physical and mental health. Only childhood adversities significantly predicted lower levels of quality of life. The findings highlight the importance of considering adverse childhood experiences in enhancing the wellbeing of the student population. Given the demographics of the student population at the University of East London, the high rates of ACEs and anxiety are likely to partially reflect poverty and racism. The implications of the findings for trauma-informed policies and practices in universities are discussed. Supplementary Information: The online version contains supplementary material available at 10.1007/s10734-021-00774-9.

A retrospective case study of the thematic content of psychotic experiences in a first episode psychosis population.

BACKGROUND: Historically, the content of psychotic experiences has tended to be of little importance to biological psychiatry, with hallucinations and delusions being seen as symptoms of mental illness rather than meaningful experiences or responses to life circumstances. AIMS: This study aims to explore the thematic content of psychotic phenomena in a sample of clients with a first episode of psychosis. METHODS: The electronic medical records of 160 services users of two Early Intervention for Psychosis Services were comprehensively reviewed. A thematic analysis was used to explore the thematic content of psychotic symptoms recorded by healthcare professionals. RESULTS: The results illustrate 30 themes and 85 sub-themes. This includes delusional beliefs (e.g. "being harmed, attacked or killed", "being monitored or followed by others", "special powers or abilities") and hallucinations (e.g. "commanding voice", "derogatory/critical voice", "commentary"). CONCLUSIONS: The results illustrate the extensive and varied experience of psychosis within this sample. Based on the findings of this study, it is hoped that future research studies and mental health services will attend to the meaning and content of psychotic experiences.

Exploring the internal and external wildlife gradients created by conservation fences.

Spillover effects are an expansion of conservation benefits beyond protected areas through dispersal of species that reside within. They have been well documented in marine but not terrestrial systems. To understand the effects on wildlife created by conservation fences, we explored the internal and external gradients of activity in mammal, reptile, and bird species at a conservation reserve in arid Australia that is fenced to exclude invasive rabbits (Oryctolagus cuniculus), cats (Felis catus), and foxes (Vulpes vulpes). Two methods were used: counts of animal tracks along transects on sand dunes and captures at pitfall-trapping sites. In both cases, sites were spaced at different distances from the reserve fenceline inside and outside the reserve. We recorded a range of spillover, source-sink, step, and barrier effects that combined to create a zone within and around the reserve with fence-induced species-specific wildlife gradients. Two endemic rodents but none of the 4 mammal species reintroduced to the reserve showed positive spillover effects. Barrier effects, where activity was highest close to the fence, were recorded for the feral cat and native bettong (Bettongia lesueur), species that could not breach the fence. In comparison, some reptiles and native mammal species that could permeate the fence displayed source-sink effects; that is, their activity levels were reduced close to the fence likely due to constant emigration to the side with lower density. Activity of some reptiles was lowest at sites inside the reserve and gradually increased at outside sites with distance from the fence, a gradient likely related to trophic cascades triggered by predator exclusion. Our result shows that fenced reserves can create overlapping layers of species-specific gradients related to each species' ability to permeate the fence and its varying susceptibility to threats. Managers should be aware that these gradients may extend for several kilometers either side of the fence and that not all contained species will increase in abundance. Creating wider conservation benefits may require increased fence permeability and threat reduction outside the fence.

Exploración de los gradientes de vida silvestre internos y externos creados por las vallas de conservación. Resumen Los efectos de derrame son una expansión de los beneficios de conservación más allá de las áreas protegidas a través de la dispersión de especies que residen en su interior. Han sido bien documentados en sistemas marinos, pero no terrestres. Para entender los efectos de las vallas de exclusión sobre la vida silvestre, exploramos los gradientes internos y externos de la actividad de especies de mamíferos, reptiles y aves en una reserva de conservación en la región árida de Australia que está cercada para excluir conejos invasivos (Oryctolagus cuniculus), gatos (Felis catus) y zorros (Vulpes vulpes). Se utilizaron dos métodos: conteo de huellas de animales a lo largo de transectos en dunas de arena y captura con trampas pitfall. En ambos casos, los sitios fueron espaciados a distintas distancias dentro y fuera de la valla de la reserva. Registramos una gama de efectos de derrame, fuente-sumidero, escalón y barrera que se combinaron para crear una zona dentro y alrededor de la reserva con gradientes de vida silvestre inducidos por la valla. Dos roedores endémicos, pero ninguna de 4 especies de mamíferos reintroducidas a la reserva, mostraron efectos de derrame positivos. Los efectos de barrera, donde la actividad era mayor cerca de la valla, fueron registrados para el gato feral y la rata canguro nativa (Bettongia lesueur), especies que no pudieron franquear la valla. En contraste, algunas especies de reptiles y mamíferos nativos que pudieron permear la valla mostraron efectos de fuente-sumidero; esto es, sus niveles de actividad fueron bajos cerca de la valla probablemente debido a la emigración constante hacia el lado con menor densidad. La actividad de algunos reptiles fue menor en los sitios núcleo de la reserva e incrementaron a medida que incrementó la distancia hacia afuera, un gradiente relacionado probablemente con las cascadas tróficas desencadenadas por la exclusión de depredadores. Nuestros resultados muestran que las reservas cercadas pueden crear capas sobrepuestas de gradientes específicos relacionados con la habilidad de cada especie para permear la valla y su susceptibilidad a las amenazas. Los manejadores deber ser conscientes de que esos gradientes pueden extenderse varios kilómetros a ambos lados de la valla y que no todas las especies contenidas aumentarán en abundancia. La creación de beneficios de conservación más amplios puede requerir una mayor permeabilidad de la vallas y la reducción de amenazas fuera de la reserva.

Young Women's Selfhood on Antidepressants: "Not Fully Myself".

The impact of antidepressants on selfhood is well recognized but little is known about what this means for young women who take antidepressants during a key period for identity development. We analyzed interviews with 16 young women to explore the way that antidepressant use might shape selfhood. Thematic analysis was used to identify a range of potential self-related themes in the participants' narratives including a "diagnosed self," "an ill self," "a normal self," "a stigmatized self," "an uncertain self," and a "powerless self." Themes highlighted the complex influence of antidepressants on young women's selfhood. Antidepressants not only offered legitimacy for distress and the opportunity to have a more "normal" self but also left the young women challenged by some of the negative associations with antidepressant use and uncertainty about their identity. Prescribers should be mindful of the impact of antidepressants on young women's developing selfhood.

The Positive and Negative Experiences of 342 Antidepressant Users.

Most efficacy and safety studies about medications adopt a quantitative approach, testing specific hypotheses with restricted samples. This online survey provides additional insights by directly asking people open questions. Thematic analysis was used to explore the responses of 342 antidepressant users to "Is there anything else you would like to tell us about your experience of taking medication". 59 (17.3%) made exclusively positive comments, 146 (42.7%) purely negative comments and 137 (40.0%) offered a mixture of positive and negative. Positive themes included: daily coping, life-changing/saving and stepping stone. Negative themes included: physical adverse effects, emotional and cognitive blunting, and withdrawal effects. Many participants also commented on relationships with prescribers. Collaboration was particularly valued. Negative sub-themes included failings in relation to information (especially about adverse effects and withdrawal), support, and alternatives. Clinicians have a duty to inform potential antidepressant users about positive and adverse effects, including withdrawal effects.

The Views of Non-psychiatric Medical Specialists About People with Schizophrenia and Depression.

This study explored the views of non-psychiatric medical specialists about people with schizophrenia and depression and examined whether specialists' approach to these clients, and their perception of dangerousness and social distance, differed by disorder. Non-psychiatric medical specialists working in community centers in Italy read either a schizophrenia or depression description and then completed a questionnaire on their views about people with that disorder. The schizophrenia-group (N = 114) was more sure than the depression-group (N = 97) that the patients should be approached differently in outpatient specialized clinics like those where the respondents worked; are incapable of caring for their own health; and are kept at distance by others. Perceived dangerousness did not significantly differ between the two groups. These findings highlight the potential effects of attitudes on medical practice and outline the need to educate non-psychiatric medical specialists on stigma as a strategy to reduce health discrepancies, particularly toward people diagnosed with schizophrenia.

Scavenging in the Anthropocene: Human impact drives vertebrate scavenger species richness at a global scale.

Understanding the distribution of biodiversity across the Earth is one of the most challenging questions in biology. Much research has been directed at explaining the species latitudinal pattern showing that communities are richer in tropical areas; however, despite decades of research, a general consensus has not yet emerged. In addition, global biodiversity patterns are being rapidly altered by human activities. Here, we aim to describe large-scale patterns of species richness and diversity in terrestrial vertebrate scavenger (carrion-consuming) assemblages, which provide key ecosystem functions and services. We used a worldwide dataset comprising 43 sites, where vertebrate scavenger assemblages were identified using 2,485 carcasses monitored between 1991 and 2018. First, we evaluated how scavenger richness (number of species) and diversity (Shannon diversity index) varied among seasons (cold vs. warm, wet vs. dry). Then, we studied the potential effects of human impact and a set of macroecological variables related to climatic conditions on the scavenger assemblages. Vertebrate scavenger richness ranged from species-poor to species rich assemblages (4-30 species). Both scavenger richness and diversity also showed some seasonal variation. However, in general, climatic variables did not drive latitudinal patterns, as scavenger richness and diversity were not affected by temperature or rainfall. Rainfall seasonality slightly increased the number of species in the community, but its effect was weak. Instead, the human impact index included in our study was the main predictor of scavenger richness. Scavenger assemblages in highly human-impacted areas sustained the smallest number of scavenger species, suggesting human activity may be overriding other macroecological processes in shaping scavenger communities. Our results highlight the effect of human impact at a global scale. As species-rich assemblages tend to be more functional, we warn about possible reductions in ecosystem functions and the services provided by scavengers in human-dominated landscapes in the Anthropocene.

Deconstructing compassionate conservation.

Compassionate conservation focuses on 4 tenets: first, do no harm; individuals matter; inclusivity of individual animals; and peaceful coexistence between humans and animals. Recently, compassionate conservation has been promoted as an alternative to conventional conservation philosophy. We believe examples presented by compassionate conservationists are deliberately or arbitrarily chosen to focus on mammals; inherently not compassionate; and offer ineffective conservation solutions. Compassionate conservation arbitrarily focuses on charismatic species, notably large predators and megaherbivores. The philosophy is not compassionate when it leaves invasive predators in the environment to cause harm to vastly more individuals of native species or uses the fear of harm by apex predators to terrorize mesopredators. Hindering the control of exotic species (megafauna, predators) in situ will not improve the conservation condition of the majority of biodiversity. The positions taken by so-called compassionate conservationists on particular species and on conservation actions could be extended to hinder other forms of conservation, including translocations, conservation fencing, and fertility control. Animal welfare is incredibly important to conservation, but ironically compassionate conservation does not offer the best welfare outcomes to animals and is often ineffective in achieving conservation goals. Consequently, compassionate conservation may threaten public and governmental support for conservation because of the limited understanding of conservation problems by the general public.

Deconstrucción de la Conservación Compasiva Resumen La conservación compasiva se enfoca en cuatro principios: no causar daño; los individuos importan; la integración de los animales individualmente; y la coexistencia pacífica entre los humanos u los animales. Recientemente, la conservación compasiva ha sido promovida como una alternativa a la filosofía convencional de la conservación. Creemos que los ejemplos presentados por los conservacionistas compasivos han sido elegidos arbitraria o deliberadamente por estar enfocados en los mamíferos; por ser inherentes y no compasivos; y por ofrecer soluciones de conservación poco efectivas. La conservación compasiva se enfoca arbitrariamente en las especies carismáticas, principalmente los grandes depredadores y los megaherbívoros. La filosofía no es compasiva cuando deja que los depredadores invasores dentro del ambiente causen daño a un vasto número de individuos nativos o usa el miedo al daño por superdepredadores para aterrorizar a los mesodepredadores. El entorpecimiento del control de especies exóticas (megafauna, depredadores) in situ no mejorará las condiciones de conservación de la mayoría de la biodiversidad, incluso si los conservacionistas compasivos no dañan a los individuos exóticos. Las posiciones que toman los llamados conservacionistas compasivos sobre especies particulares y sobre las acciones de conservación podrían extenderse para entorpecer otros tipos de conservación, incluyendo las reubicaciones, el encercado para la conservación y el control de la fertilidad. El bienestar animal es increíblemente importante para la conservación e irónicamente, la conservación compasiva no ofrece los mejores resultados de bienestar para los animales y comúnmente es poco efectiva en el logro de los objetivos de conservación. Como consecuencia, la conservación compasiva puede poner en peligro el apoyo público y del gobierno que tiene la conservación debido al entendimiento poco limitado que tiene el público general sobre los problemas de conservación.

Single port component separation: endoscopic external oblique release for complex ventral hernia repair.

BACKGROUND: Component separation (CS) is a technique which mobilizes flaps of innervated, vascularized tissue, enabling closure of large ventral hernia defects using autologous tissue. Disadvantages include extensive tissue dissection when creating these myofascial advancement flaps, with potential consequences of significant post-operative skin and wound complications. This study examines the benefit of a novel, ultra-minimally invasive single port anterior CS technique. METHODS: This was a prospective study of 16 external oblique (EO) releases performed in 9 patients and 4 releases performed in 3 fresh frozen cadavers. All patients presented with recurrent complex ventral hernias, and were administered preoperative Botulinum Toxin A to their lateral oblique muscles to facilitate defect closure. At the time of elective laparoscopic repair, patients underwent single port endoscopic EO release using a single 20-mm incision on each side of the abdomen. Measurements were taken using real-time ultrasound. Postoperatively, patients underwent serial examination and abdominal CT assessment. RESULTS: Single port endoscopic EO release achieved a maximum of 50-mm myofascial advancement per side (measured at the umbilicus). No complications involving wound infection, hematoma, or laxity/bulge have been noted. All patients proceeded to laparoscopic or laparoscopic-open-laparoscopic intraperitoneal mesh repair of their hernia, with no hernia recurrences to date. CONCLUSIONS: Single port endoscopic EO release holds potential as an adjunct in the repair of large ventral hernia defects. It is easy to perform, is safe and efficient, and entails minimal disruption of tissue planes and preserves abdominal wall perforating vessels. It requires only one port-sized incision on each side of the abdomen, thus minimizing potential for complications. Further detailed quantification of advancement gains and morbidity from this technique is warranted, both with and without prior administration of Botulinum Toxin A to facilitate closure.

Preoperative Botulinum toxin A enabling defect closure and laparoscopic repair of complex ventral hernia.

INTRODUCTION: Operative management of complex ventral hernia still remains a significant challenge for surgeons. Closure of large defects in the unprepared abdomen has serious pathophysiological consequences due to chronic contraction and retraction of the lateral abdominal wall muscles. We report outcomes of 56 consecutive patients who had preoperative Botulinum toxin A (BTA) abdominal wall relaxation facilitating closure and repair. METHODS: This was a prospective observational study of 56 patients who underwent ultrasound-guided BTA into the lateral abdominal oblique muscles prior to elective ventral hernia repair between November 2012 and January 2017. Serial non-contrast abdominal CT imaging was performed to evaluate changes in lateral oblique muscle length and thickness. All hernias were repaired laparoscopically, or laparoscopic-open-laparoscopic (LOL) using intraperitoneal onlay mesh. RESULTS: 56 patients received BTA injections at predetermined sites to the lateral oblique muscles, which were well tolerated. Mean patient age was 59.7 years, and mean BMI was 30.9 kg/m2 (range 21.8-54.0). Maximum defect size was 24 × 27 cm. A subset of 18 patients underwent preoperative pneumoperitoneum as an adjunct procedure. A comparison of pre-BTA to post-BTA imaging demonstrated an increase in mean lateral abdominal wall length from 16.1 cm to 20.1 cm per side, a mean gain of 4.0 cm/side (range 1.0-11.7 cm/side) (p < 0.0001). This corresponds to an unstretched mean length gain of 8.0 cm of the lateral abdominal wall. Laparoscopic/LOL primary closure was achieved in all cases, with no clinical evidence of raised intra-abdominal pressures. One patient presented with a new fascial defect 26 months post-operative. CONCLUSION: Preoperative BTA to the lateral abdominal wall muscles is a safe and effective technique for the preparation of patients prior to operative management of complex ventral hernias. BTA temporary flaccid paralysis relaxes, elongates and thins the chronically contracted abdominal musculature. This in turn reduces lateral traction forces facilitating laparoscopic repair and fascial closure of large defects under minimal tension.

Attempting to stop antipsychotic medication: success, supports, and efforts to cope.

PURPOSE: To explore supports and coping strategies used during attempts to discontinue antipsychotic medication and test for associations with success. METHOD: 144 people who were taking or had taken antipsychotics completed The Experiences of Antipsychotic Medication Survey. Among them, 105 people had made at least one discontinuation attempt and answered a series of questions about their most recent attempt to stop. Content analysis and Chi-square tests of independence were used to categorise the data and explore associations. Success was defined as stopping all AM use irrespective of the duration of the medication-free period or whether relapse occurred, which were explored separately. RESULTS: Among the 105 people who had attempted discontinuation, 61.9% described unwanted withdrawal effects and 27.6% of the group described psychotic or manic relapse during the withdrawal period. Within this group 55% described successfully stopping all AM for varying lengths of time, half reported no current use, and half described having some form of professional, family, friend, and/or service user or peer support for their attempt. Having support was positively associated with success and negatively associated with both current use, and relapse during withdrawal. A range of coping efforts were described, but having coping strategies failed to show significant associations with any of the dependent variables explored. Among those who described successfully stopping, some described returning to AM for short periods when needed, while others reported managing well with alternative methods alone. CONCLUSIONS: Findings cannot be readily generalised due to sampling constraints, but results suggest a wide range of supports and coping strategies may be used when attempting to discontinue antipsychotics. Many people may attempt to discontinue antipsychotics without any support. Those who have support for their attempts may be significantly less likely to relapse during withdrawal and more likely to succeed in their attempt. There is a pressing need for further research in this area.

Assessing the Impact and Effectiveness of Hearing Voices Network Self-Help Groups.

The Hearing Voices Network (HVN) is an influential service-user led organisation that promotes self-help as an important aspect of recovery. This study presents the first systematic assessment of the impact and effectiveness of HVN self-help groups. A customized 45-item questionnaire, the Hearing Voices Groups Survey, was sent to 62 groups affiliated with the English HVN. 101 responses were received. Group attendance was credited with a range of positive emotional, social and clinical outcomes. Aspects that were particularly valued included: opportunities to meet other voice hearers, provision of support that was unavailable elsewhere, and the group being a safe and confidential place to discuss difficult issues. Participants perceived HVN groups to facilitate recovery processes and to be an important resource for helping them cope with their experiences. Mental health professionals can use their expertise to support the successful running of these groups.

"I Believe I Know Better Even than the Psychiatrists What Caused It": Exploring the Development of Causal Beliefs in People Experiencing Psychosis.

This study aimed to describe the causal beliefs of individuals experiencing psychosis, specifically exploring how they are developed and maintained. Individuals with experience of psychosis were recruited from mental health services for in-depth interviews. A thematic analysis was used to analyse transcripts and key themes were identified. Fifteen interviews were conducted. Individuals were engaged in the process of exploring explanations for their experiences and reported sophisticated models of causation. Participants described a change in their beliefs, with the cause of their experiences not immediately clear. Individuals generated their models via external (family, professionals) and internal (evaluative, positive affect) processes and reported differing levels of conviction in relation to their beliefs. Clinicians should take the opportunity to explore the causal beliefs of their service-users, as they are able to provide intelligent and thoughtful explanatory models. In particular, clinicians should be aware of the emotional impact of different aetiological models and their personal role in the development of a client's beliefs.