Automated, cryogen-free headspace-trap with gas chromatography-mass spectrometry analysis of ethylene oxide and 2-chloroethanol as residual fumigants in foods.

Ethylene oxide (EtO), although banned for use, is still being detected in foodstuffs that have been fumigated to eradicate pests during storage and transport. Residual levels over the European Union's (EU) maximum residue limit (MRL) pose severe health concerns. Recent detection of EtO and its by-product 2-chloroethanol (2-CE) at alarming levels have led to product recalls throughout the EU. Here, a simple, automated headspace (HS)-trap method for the simultaneous determination of EtO and its derivative 2-CE by gas chromatography-mass spectrometry (GC-MS) at the required MRL of ≤ 0.05 mg/kg has been implemented. Syringe-based HS combined with backflushed trapping technology provided enrichment of multiple extractions from the same sample vial (known as multi-step enrichment or MSE®) to increase sensitivity for EtO and 2-CE analysis by GC-MS using single-ion-monitoring (SIM) mode. Method detection limits (MDLs) of 0.00059 mg/kg and 0.00219 mg/kg for EtO and 2-CE, respectively, were obtained without the need for manual handling, solvent extraction or derivatization methods. Recoveries were shown to average (n = 5) at 98% and 107% for EtO and 2-CE, respectively, and the reproducibility was <10% for both compounds.

Relationships at Work: Integrating the Perspectives of Disability Partners to Enhance a Peer Navigation Intervention.

Objective: The Our Peers-Empowerment and Navigational Support (OP-ENS) community-based participatory research study developed, implemented, and evaluated a peer navigator intervention aimed at improving health and healthcare access among Medicaid beneficiaries with disabilities. Peer navigators are community partners with physical disabilities trained to deliver structured peer support interventions that can address barriers to care. The purpose of this paper is two-fold. First, it explicates the relational work the peer navigators do with peers in delivering the intervention. Second, it illustrates how our community-based participatory approach empowered peer navigators to share their knowledge to refine the intervention. Methods: Clinical coordinator team meeting notes, critical incident documentation reports, peer navigator reflections (n = 20) were analyzed thematically to understand the peer navigators' relational work and intervention refinements. Following Labov's 6-stage approach to personal narratives and a collaborative writing process academic, clinical, and disability partners co-wrote descriptive exemplars to showcase these processes. Findings: Through the manualized OP-ENS intervention process, peer navigators helped peers achieve incremental successes. Peer navigators used their training and personal experiences to engage with peers and forge deep connections and relationships of trust. As a result, peers identified a wide-range of social health concerns, including poverty, social isolation, and racial and disability related discrimination that might otherwise go unaddressed. True to the principles of community-based participatory research, by fostering an equity-focused collaboration and listening to peer navigators, the project team implemented subtle but salient refinements to the intervention. Refinements included an explicit focus on social determinants of health affecting peers' health and wellbeing and supplemental trainings to help peer navigators support peers with significant mental health needs. Conclusion: The peer navigators were intentional and skilled at relationship building, thus complex elements which impact peers' health were addressed. Peer navigators were empowered to communicate their perspectives with the study team, who worked together to strengthen the intervention processes and infrastructure. This atmosphere of trust and collaboration amongst diverse stakeholders was instrumental to OP-ENS' successful implementation. Healthcare systems should consider implementing peer support interventions that are responsive to consumer input to address social determinants of health for persons with disabilities.

Construing journeys to recovery from psychosis: A qualitative analysis of first-person accounts.

PURPOSE: To perform a qualitative analysis of the factors that were construed as salient in facilitating the process of recovery in the narratives of people with psychosis who had their first-person accounts (FPAs) published in an academic journal. METHODS: Computerized textual analysis was undertaken of 156 FPAs written by persons who had experienced psychosis and published in the Schizophrenia Bulletin between 1979 and 2020. Constructs were extracted from the FPAs and coded in terms of Mental health treatment and therapy, Self-management and Multiple factors; recovery processes (Connectedness, Hope, Identity, Meaning and Empowerment), Struggles and Turning points. RESULTS: Psychosis impacted on individuals in profound and diverse ways. This was reflected in the different pathways to recovery included in the FPAs. Underlying the different pathways was the salience of re-engagement in the shared reality of others; development of a cohesive and positive self; empowerment through the use of self-management strategies, and making sense of experience through reconstruing what was meaningful. Personal constructs identified in the FPAs provided insight into both challenges faced and alternative avenues of movement that were perceived as available. CONCLUSIONS: Processes that support individuals re-engaging with the shared reality of others are central to recovery. Supportive relationships and fostering open dialogue were consistent themes across the different pathways that recovery journeys took. Establishing a meaningful lifestyle and recovering a positive sense of identity were a key challenge following psychosis onset. Appreciation of experiences contained in FPAs has the potential to enhance the effectiveness and humanity of mental health care.

Contact with mental health services in the 12-month period before offending in a cohort of forensic order patients.

There has been limited research examining the details of mental health service contact in the pre-offending period. A retrospective case-note study of the complete cohort of people found not criminally responsible or permanently unfit for trial in Queensland, Australia, was conducted. An electronic clinical database search for seven treatment event types in the 12-months pre-offence was conducted. Of the 123 eligible patients, half were recorded as having experienced at least one treatment event. There was a statistically significant increase in the number of patients experiencing a treatment-related event per month over this 12-month pre-offence period (increase of ∼1.4 patients per month, p < .001). The findings highlight the need for appropriate weight to be placed on both longitudinal and recent factors when undertaking routine clinical review or mental health assessment, or considering changes to a patient's diagnosis and treatment plan. Screening in custody and early intervention are also indicated to ensure appropriate treatment.

Interviewing persons with mental illness charged with murder or attempted murder: a retrospective review of police interviews.

Individuals with a mental illness may be particularly vulnerable during police interviews. Assessing fitness for police interview is vital for ensuring procedural fairness. This article reports the findings of a retrospective review of 31 police interviews of mentally ill persons charged with murder (n = 18) or attempted murder (n = 13) who appeared before the Queensland Mental Health Court. Police interviews were conducted for all murder and 50% of attempted murder cases. Possible or overt mental illness symptoms were present in all interviews. Symptoms of mental illness were pervasive in 36.7% of interviews, intermittent in 43.3% of interviews and seldom in 20% of interviews. Support persons were present for 9.7% of interviews, and legal representation was not present for any interview. These findings highlight the need to enhance access to support persons during interviews. Intersectoral collaboration between mental health services, forensic medical officers, police, public guardians and the legal sector is needed.

Drug driven psychoses and legal responsibility or insanity in six Western Pacific nations.

Prompted by four questions, forensic mental health clinicians from Russia, China, Japan, Hong Kong, Australia and New Zealand provided information on both the legislative basis and current practice concerning the relationship between legal insanity, intoxication and drug induced psychosis in their six Pacific Rim Countries which account for nearly 20% of the world's population. Details of the survey for each contributing nation are provided. While there are significant variations in practice that have been shaped by regional legal, clinical and cultural influences there is considerable similarity in the legislation underpinning how these issues are considered. Consequently there remain similar challenges for each nation. In none of the legislative bases was the issue of drug induced psychosis specifically addressed. The authors conclude that evolving pharmaco-neuropsychiatric knowledge, societal values and patterns of substance misuse require nations to consider developments in scientific and clinical knowledge to support their interpretations of the relationship between altered mental states as a result of substance use and the legal construct of insanity.

Review of psychiatric services to mentally disordered offenders around the Pacific Rim.

This article was commissioned to collate and review forensic psychiatric services provided in a number of key Pacific Rim locations in the hope that it will assist in future dialogue about service development. The Board of the Pacific Rim College of Psychiatrists identified experts in forensic psychiatry from Australia, Canada, China, Hong Kong, Japan, Russia, Singapore, Taiwan, and the US. Each contributor provided an account of issues in their jurisdiction, including mental health services to mentally disordered offenders in prison, competence or fitness to stand trial, legal insanity as a defense at trial, diminished responsibility, and special forensic services available, including forensic hospitals and community forensic mental health services. Responses have been collated and are presented topic by topic and country by country within the body of this review. The availability of mental health screening and psychiatric in-reach or forensic liaison services within prisons differed considerably between countries, as did provisioning of community forensic mental health and rehabilitation services. Diversion of mentally disordered offenders to forensic, state, or hybrid hospitals was common. Legal constructs of criminal responsibility (insanity defense) and fitness to stand trial ("disability") are almost universally recognized, although variably used. Disparities between unmet needs and resourcing available were common themes. The legislative differences between contributing countries with respect to the mental health law and criminal law relating to mentally disordered offenders are relatively subtle. The major differences lie in operationalizing and resourcing forensic services.

New media simulation stories in nursing education: a quasi-experimental study exploring learning outcomes.

New media simulation stories are short multimedia presentations that combine simulation, digital technology, and story branching to depict a variety of healthcare-related scenarios. The purpose of this study was to explore whether learning outcomes were enhanced if students viewed the results of both correct and incorrect nursing actions demonstrated through new media simulation stories. A convenience sample of 109 undergraduate nursing students in a family-centered maternity course participated in the study. Study findings suggests that students who viewed both correct and incorrect depictions of maternity nursing actions scored better on tests than did those students who viewed only correct nursing actions.

Structured risk assessment in community forensic mental health practice.

OBJECTIVE: This paper will examine the use of the Historical Clinical Risk Management-20 (HCR-20) by Australian community forensic mental health services (CFMHS) and explore some key issues involved in the application of Structured Professional Judgment (SPJ) risk assessment tools in clinical practice. METHOD: We used a survey of the use of the HCR-20 by 10 Australian CFMHSs. RESULTS: During the 12-month survey period, the number of assessments conducted ranged from 6 to 186 (median 55). Differences in service models impacted on who was seen, whether reassessments were undertaken, and involvement of generalist mental health staff. Most services employed quality assurance processes and accessed qualified trainers. CONCLUSION: The use of SPJ tools acknowledges the role of professional judgment while also providing a structure to ensure that relevant evidence-based factors are taken into account. The survey highlighted service model variation as well as the importance of training and quality assurance processes required to ensure that comprehensive violence risk assessments are completed in a valid and reliable fashion.

Promoting clinical competence using social media.

A critical task for nursing students is learning to synthesize knowledge and disseminate it to their patients in an understandable format, often in the form of posters or pamphlets for a lay audience. With the Internet becoming the place of choice for information for the lay audience and the use of social media almost universal among undergraduate nursing students, the authors discuss a knowledge synthesis activity that allows students to use familiar tools to create a 3- to 5-minute video in lay terms and the use of YouTube to display the videos.

Forensic mental health orders: orders without borders.

OBJECTIVE: Persons subject to forensic mental health orders imposed by the courts form a small but politically salient group. Their management provides a number of challenges for mental health services and for governments throughout Australia. Although their overall management has been enhanced by recent developments in forensic services, there is a lack of consistent cross-border agreements between states and territories. This paper will discuss how this situation is not conducive to effective risk management and is a denial of patients' legitimate demands for freedom of movement. A proposal for the adoption of appropriate principles to improve the current state of affairs is outlined. CONCLUSION: Legislative reform is required to ensure the safe and ethical management of mentally disordered offenders subject to forensic mental health orders in Australia.

Predictors of cannabis use in men with and without psychosis.

BACKGROUND: Factors associated with cannabis use among people with psychosis are not well understood. AIMS: To examine whether people with psychosis and age-matched controls modified cannabis use in response to recent experiences. METHOD: This study predicted 4 weeks of cannabis use prospectively, using expectancies derived from recent occasions of use. RESULTS: People with psychosis used cannabis less frequently than controls, but had more cannabis-related problems. More negative cannabis expectancies resulted in less frequent cannabis use over Follow-up. The psychosis group was more likely to moderate cannabis use after negative effects than controls. CONCLUSIONS: Results offer optimism about abilities of people with psychosis to moderate cannabis use in the short term.

Cannabis use and misuse prevalence among people with psychosis.

BACKGROUND: Increasing attention has been given by researchers to cannabis use in individuals with psychosis. As psychoses are relatively low-prevalence disorders, research has been mostly been restricted to small-scale studies of treatment samples. The reported prevalence estimates obtained from these studies vary widely. AIMS: To provide prevalence estimates based on larger samples and to examine sources of variability in prevalence estimates across studies. METHOD: Data from 53 studies of treatment samples and 5 epidemiological studies were analysed. RESULTS: Based on treatment sample data, prevalence estimates were calculated for current use (23.0%), current misuse (11.3%), 12-month use (29.2%), 12-month misuse (18.8%), lifetime use (42.1%) and lifetime misuse (22.5%). Epidemiological studies consistently reported higher cannabis use and misuse prevalence in people with psychosis. CONCLUSIONS: The factor most consistently associated with increased odds of cannabis prevalence was specificity of diagnosis. Factors such as consumption patterns and study design merit further consideration.

Reasons for cannabis use in men with and without psychosis.

Psychoses are relatively low prevalence disorders that have a disproportionately negative impact on individuals and society. Cannabis use is one factor that can exacerbate the negative consequences associated with psychotic disorders. Relatively few studies have examined the effects or reasons for using cannabis self-reported by individuals with psychosis. The present study is the first known to compare directly such factors in individuals with and without psychosis, within a single study. At baseline and follow-up participants with psychosis most commonly reported using cannabis for positive mood alteration (36% and 42%), coping with negative affect (27% and 29%) and for social activity reasons (38% and 29%). The control group most commonly reported using cannabis for relaxation (34% and 43%) and social activity reasons (49% and 51%). Participants with psychosis were less likely to report relaxation as the most important effect after use (27%) or expect it at follow-up (49%) compared to the control group (53% and 70%). In both groups, addiction and positive affect enhancement were the composite variable scores correlated most consistently with concurrent amount and frequency of use.

Being stoned: a review of self-reported cannabis effects.

Although there has been considerable research into the adverse effects of cannabis, less attention has been directed toward subjective effects that may be associated with ongoing cannabis use. Examination of self-reported cannabis effects is an important issue in understanding the widespread use of cannabis. While reviews have identified euphoria as a primary factor in maintaining cannabis use, relaxation is the effect reported most commonly in naturalistic studies of cannabis users, irrespective of the method used. Self-reported effects in 12 naturalistic and 18 laboratory studies were compared. Regardless of methodology there was considerable variation in the effects experienced. Variation has been reported in terms of opposite effects being experienced by different individuals, variation of effects by individuals within a single occasion and between occasions of use. Factors that might explain this variation are outlined. Limitations of the available literature and suggested directions for future research are discussed. [Green B, Kavanagh D, Young R. Being stoned: a review of self-reported cannabis effects.