Nature-inspired spider web shaped UHF RFID reader antenna for IoT and healthcare applications.

This paper proposes a nature-inspired spider web-shaped ultra-high frequency (UHF) radio frequency identification (RFID) reader antenna and battery-free sensor-based system for healthcare applications. This antenna design consists of eight concentric decagons of various sizes and five straight microstrip lines.These lines are connected to the ground using 50 [Formula: see text] resistors from both ends, except for one microstrip line that is reserved for connecting a feeding port. The reader antenna design features fairly strong and uniform electric and magnetic field characteristics. It also exhibits wideband characteristics, covering whole UHF RFID band (860-960 MHz) and providing a tag reading volume of 200 [Formula: see text] 200 [Formula: see text] 20 mm[Formula: see text]. Additionally, it has low gain characteristics, which are necessary for the majority of nearfield applications to prevent the misreading of other tags. Moreover, the current distribution in this design is symmetric throughout the structure, effectively resolving orientation sensitivity issues commonly encountered in low-cost linearly polarized tag antennas. The measurement results show that the reader antenna can read medicine pills tagged using low-cost passive/battery-free RFID tags, tagged expensive jewelry, intervenes solution, and blood bags positioned in various orientations. As a result, the proposed reader antenna-based system is a strong contender for near-field RFID, healthcare, and IoT applications.

International overview of phallometric testing for sexual offending behaviour and sexual risk.

Phallometry is an objective method of assessing male sexual arousal. The main applications in forensic psychiatry concern the evaluation of men charged with or convicted of sexual offences, the evaluation of those with suspected paraphilias not subject to the criminal justice system, risk assessment and measurement of response to sex offender treatment. In some jurisdictions, phallometry is incorporated into legal decisions about release from custody or discharge from secure hospitals. This paper provides a brief overview of the international development of phallometry, considers challenges to its broader adoption and discusses future directions for research and clinical practice.

Psychiatry in the federal correctional system in Canada.

The unique challenges of the correctional healthcare environment are well-documented. Access to community-equivalent care, voluntary informed consent of offenders with mental disorder, violence risk, suicide risk, medication misuse, and clinical seclusion, confinement and segregation are just a few of the challenges faced by correctional psychiatric services. This paper shares experiences for dealing with the ongoing challenges for psychiatrists working in the field. It provides an overview of the current state of mental healthcare in the federal correctional system in Canada, the legislative framework and initiatives aimed at addressing the healthcare needs of federal inmates.

The mental health of doctors during the COVID-19 pandemic.

Doctors experience high levels of work stress even under normal circumstances, but many would be reluctant to disclose mental health difficulties or seek help for them, with stigma an often-cited reason. The coronavirus disease 2019 (COVID-19) crisis places additional pressure on doctors and on the healthcare system in general and research shows that such pressure brings a greater risk of psychological distress for doctors. For this reason, we argue that the authorities and healthcare executives must show strong leadership and support for doctors and their families during the COVID-19 outbreak and call for efforts to reduce mental health stigma in clinical workplaces. This can be facilitated by deliberately adding 'healthcare staff mental health support process' as an ongoing agenda item to high-level management planning meetings.

A 'benign' extrapyramidal side effect masking a life-threatening neuroleptic malignant syndrome.

The neuroleptic malignant syndrome is a rare, life-threatening idiosyncratic reaction to neuroleptic medication. The use of newer antipsychotics combined with its rare incidence has made NMS seem as a complication of the past. Here we report a patient in his early 20s suffering from a psychotic disorder developing a life-threatening neuroleptic malignant syndrome on an inpatient psychiatric ward in Canada without the characteristic overt change in autonomic stability. We review the clinical characteristics to facilitate the early recognition of neuroleptic malignant syndromes and discuss why this condition still is highly relevant for practising physicians.

Terrorism in Pakistan: the psychosocial context and why it matters.

Terrorism is often construed as a well-thought-out, extreme form of violence to perceived injustices. The after effects of terrorism are usually reported without understanding the underlying psychological and social determinants of the terrorist act. Since '9/11' Pakistan has been at the epicentre of both terrorism and the war against it. This special paper helps to explain the psychosocial perspective of terrorism in Pakistan that leads to violent radicalisation. It identifies the terrorist acts in the background of Pakistan's history, current geopolitical and social scenario. The findings may also act as a guide on addressing this core issue.

Forensic psychiatric service provision in Pakistan and its challenges.

In the Islamic Republic of Pakistan the law relating to people who are mentally ill, until 2001, was set out by the Lunacy Act of 1912, which was inherited from the British colonial occupiers. In 2001 the Mental Health Ordinance 2001 took its place but only for this federal law to be superseded in April 2010 with the 18th constitutional amendment. As part of that amendment, provinces have become responsible for (psychiatric) healthcare, including mental health legislation. Forensic psychiatry is practised in Pakistan but is very much in its infancy; it needs to develop and learn from more experienced countries in Europe and North America. Cultural factors and misconceptions arising from religion can at times contribute to, or create, barriers to the implementation of forensic psychiatric services in Pakistan. This paper reviews the current state of forensic psychiatric services in Pakistan and is intended to open the debate on the challenges ahead.

The AttentionTrip: A game-like tool for measuring the networks of attention.

BACKGROUND: Recognizing that attention is not a unitary system, the Attention Network Test (ANT) and its variants were developed to measure the efficacy of the multiple components of attention. One potential weakness of these tests (ANTs) is that they are unengaging. This poses a problem when particular groups are tested (e.g., young children), when more stable measures of performance are desirable (and can only be achieved in longer testing sessions) and when repeated testing is necessary. NEW METHOD: Here we describe the evolution of a game-like tool, which we call the AttentionTrip©, that is suitable for investigating three isolable attentional networks (alerting, orienting, and executive functions). RESULTS: Utilizing this tool we were able to generate reasonable network scores for alerting, executive control (from both the flanker and Simon effects), endogenous orienting and, after some motivated modifications, exogenous orienting. COMPARISON WITH EXISTING METHOD(S): Split-half reliabilities of the alerting and executive (flanker) network scores were considerably higher than those reported by MacLeod et al. (2010) in their psychometric review of the ANT. Informal observations (e.g., some participants asking if they could keep doing the task when their session was over) suggesting that the AttentionTrip is considerably more engaging than the traditional ANT have been confirmed in a head-to-head comparison (Vallis & Klein, 2016). CONCLUSIONS: The AttentionTrip@ is available now for research purposes. A tablet version, which will have greater clinical utility, is under development.

Preliminary evaluation of a "formulation-driven cognitive behavioral guided self-help (fCBT-GSH)" for crisis and transitional case management clients.

BACKGROUND: Cognitive behavioral therapy (CBT) is found to be effective for common mental disorders and has been delivered in self-help and guided self-help formats. Crisis and transitional case management (TCM) services play a vital role in managing clients in acute mental health crises. It is, therefore, an appropriate setting to try CBT in guided self-help format. METHODS: This was a preliminary evaluation of a formulation-driven cognitive behavioral guided self-help. Thirty-six (36) consenting participants with a diagnosis of nonpsychotic illness, attending crisis and the TCM services in Kingston, Canada, were recruited in this study. They were randomly assigned to the guided self-help plus treatment as usual (TAU) (treatment group) or to TAU alone (control group). The intervention was delivered over 8-12 weeks. Assessments were completed at baseline and 3 months after baseline. The primary outcome was a reduction in general psychopathology, and this was done using Clinical Outcomes in Routine Evaluation - Outcome Measure. The secondary outcomes included a reduction in depression, measured using the Hospital Anxiety and Depression Scale, and reduction in disability, measured using the World Health Organization Disability Assessment Schedule 2.0. FINDINGS: Participants in the treatment group showed statistically significant improvement in overall psychopathology (P<0.005), anxiety and depression (P<0.005), and disability (P<0.005) at the end of the trial compared with TAU group. CONCLUSION: A formulation-driven cognitive behavioral guided self-help was feasible for the crisis and TCM clients and can be effective in improving mental health, when compared with TAU. This is the first report of a trial of guided self-help for clients attending crisis and TCM services.

Severe Cytomegalovirus Gastritis During Natalizumab-Mediated Immunosuppression.

We report a 35-year-old female receiving natalizumab as monotherapy for multiple sclerosis who subsequently developed severe cytomegalovirus gastritis. As cytomegalovirus gastritis has not been previously described during natalizumab treatment, we discuss the biological plausibility of this potential association and avenues for further study.

Canadian Physicians' Attitudes towards Accessing Mental Health Resources.

Despite their rigorous training, studies have shown that physicians experience higher rates of mental illness, substance abuse, and suicide compared to the general population. An online questionnaire was sent to a random sample of physicians across Canada to assess physicians' knowledge of the incidence of mental illness among physicians and their attitudes towards disclosure and treatment in a hypothetical situation where one developed a mental illness. We received 139 responses reflecting mostly primary care physicians and nonsurgical specialists. The majority of respondents underestimated the incidence of mental illness in physicians. The most important factors influencing respondent's will to disclose their illness included career implications, professional integrity, and social stigma. Preference for selecting mental health treatment services, as either outpatients or inpatients, was mostly influenced by quality of care and confidentiality, with lower importance of convenience and social stigma. Results from this study suggest that the attitudes of physicians towards becoming mentally ill are complex and may be affected by the individual's previous diagnosis of mental illness and the presence of a family member with a history of mental illness. Other factors include the individual's medical specialty and level of experience. As mental illness is common among physicians, one must be conscious of these when offering treatment options.

Attitudes of Canadian psychiatry residents if mentally ill: awareness, barriers to disclosure, and help-seeking preferences.

BACKGROUND: The medical culture is defined by mental illness stigma, non-disclosure, and avoidance of professional treatment. Little research has explored attitudes and help-seeking behaviors of psychiatry trainees if they were to become mentally ill. METHOD: Psychiatry residents (n = 106) from training centres across Ontario, Canada completed a postal survey on their attitudes, barriers to disclosure, and help-seeking preferences in the context of hypothetically becoming mentally ill. RESULTS: Thirty-three percent of respondents reported personal history of mental illness and the frequency of mental illness by year of training did not significantly differ. The most popular first contact for disclosure of mental illness was family and friends (n = 61, 57.5%). Frequent barriers to disclosure included career implications (n = 39, 36.8%), stigma (n = 11, 10.4%), and professional standing (n = 15, 14.2%). Personal history of mental illness was the only factor associated with in-patient treatment choice, with those with history opting for more formal advice versus informal advice. CONCLUSIONS: At the level of residency training, psychiatrists are reporting barriers to disclosure and help-seeking if they were to experience mental illness. A majority of psychiatry residents would only disclose to informal supports. Those with a history of mental illness would prefer formal treatment services over informal services.

Forensic psychiatry in Pakistan.

This article reviews existing forensic psychiatric services in Pakistan highlighting the role played by the judicial and the medical fraternity in managing the legal and forensic issues of the population of patients with mental illnesses. Until 2001, all legal and forensic issues were dealt with the mental health legislation of 1912, the Lunacy Act of 1912. This was inherited from the British rulers in the Sub-Continent at the time. The Mental Health Ordinance of 2001 could not sustain following the 18th constitutional amendment in 2010, whereby psychiatric healthcare was devolved to the provinces from the previous federal authority. The article also highlights the difficulties and the barriers in implementation of the forensic psychiatric services in Pakistan at various levels within the healthcare system. This article also delves into the current framework of training in forensic psychiatry for postgraduates as well as the assessments and management schedules for the mentally ill offenders at tertiary care institutions in Pakistan.

Frequency of metabolic syndrome in psychiatric patients, is this the time to develop a standardized protocol to reduce the morbidity from an acute care psychiatry unit.

OBJECTIVE: To determine the frequency of Metabolic Syndrome among psychiatric patients and to look for the correlation between the two medical conditions. METHODS: The cross-sectional study was conducted from February to April 2013 at the acute care psychiatry in-patient unit at Kingston General Hospital, Ontario, Canada, and comprised adult patients of both genders diagnosed under the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. For Metabolic Syndrome, definitions outlined by the International Diabetes Federation were used. The patients were divided into two groups on the basis of presence or absence of the Syndrome and were compared for clinical and demographic characteristics. SPSS 22 was used for statistical analysis. RESULTS: Of the 50 patients in the study, 24(48%) were found to have Metabolic Syndrome. Besides, 40 (80%) patients were taking atypical antipsychotics regardless of the diagnosis; 20(83%) among those with the Syndrome, and 20(77%) among those without it. CONCLUSIONS: Patients at high risk of developing metabolic syndrome need to be identified early so that an individualised care plan can be formulated. Identifying the variables to make a management plan is vital.

Terrorism in Pakistan: a behavioral sciences perspective.

This article reviews the behavioral science perspectives of terrorism in Pakistan. It can be argued that Pakistan has gained worldwide attention for "terrorism" and its role in the "war against terrorism". The region is well placed geopolitically for economic successes but has been plagued by terrorism in various shapes and forms. A behavioral sciences perspective of terrorism is an attempt to explain it in this part of the world as a complex interplay of historical, geopolitical, anthropological and psychosocial factors and forces. Drawing from theories by Western scholars to explain the behavioral and cognitive underpinnings of a terrorist mind, the authors highlight the peculiarities of similar operatives at individual and group levels. Thorny issues related to the ethical and human right dimensions of the topic are visited from the unique perspective of a society challenged by schisms and divergence of opinions at individual, family, and community levels. The authors have attempted to minimize the political descriptions, although this cannot be avoided entirely, because of the nature of terrorism.

Clozapine reinitiation following a "red result" secondary to chemotherapy.

We describe a case of a patient whose clozapine was discontinued after a "red result" following R-CHOP (rituximab with cyclophosphamide, hydroxydaunorubicin, Oncovin, and prednisolone) chemotherapy for large B-cell lymphoma. In some cases, manufacturers grant permission, on compassionate grounds, for clozapine to be continued or reinitiated following assessment by their consultant hematologist. Other than a recent case report, there is not much literature surrounding this medical issue. However, since the two leading causes of mortality in schizophrenia are cancer and cardiac disease, this is not an uncommon occurrence. Clinicians are reluctant to prescribe clozapine in view of its side-effect profile, despite its proven efficacy for managing treatment-resistant schizophrenia. The alternative is to prescribe two antipsychotics to manage symptoms. This approach may be associated with increased side effects, and evidence for actual benefits is scant. The consequences were disastrous in this case, as the individual not only relapsed following clozapine discontinuation, but the therapy for this treatable form of lymphoma had to be delayed. He was eventually admitted to an inpatient unit after having been stable for 15 years. We managed to stabilize him with olanzapine and aripiprazole which enabled the heme-oncology group to resume R-CHOP therapy with filgrastim (granulocyte colony-stimulating factor). Even so, he continued to exhibit severe psychotic symptoms, with religious delusions and auditory hallucinations. We therefore applied for permission to rechallenge him on clozapine. Permission was granted when protocol conditions were met, and reinitiation went without any adverse events. The patient's symptoms showed improvement within a few weeks, and the other antipsychotics were discontinued once clozapine was titrated up to 300 mg. The decision to reinitiate clozapine following a red result is not to be taken lightly, but needs to be considered in terms of the risks versus benefits. More literature surrounding this issue would be of great benefit to clinicians, patients, and their families.

Treatment of anxiety disorders and comorbid alcohol abuse with buspirone in a patient with antidepressant-induced platelet dysfunction: a case report.

The risk of abnormal bleeding with serotonin reuptake inhibitors has been known, but there is insufficient evidence base to guide pharmacological treatment of anxiety in patients with underlying haematological conditions. The following case report is about a 50-year-old female with generalized anxiety disorder, social phobia, obsessive compulsive disorder, and alcohol abuse where pharmacological treatment of anxiety symptoms has been difficult as it would lead to bruising due to the patient's underlying qualitative platelet dysfunction. Treatment with venlafaxine, citalopram, escitalopram, and clomipramine resulted in improvement and anxiety symptoms, as well as reduction in alcohol use, but pharmacological treatment has to be discontinued because of bruising and hematomas. In view of an active substance use disorder, benzodiazepines were avoided as a treatment option. The patient's anxiety symptoms and comorbid alcohol abuse responded well to pharmacological treatment with buspirone which gradually titrated up to a dose of 30 mg BID. Patient was followed for around a six-month period while she was on buspirone before being discharged to family doctor's care. Buspirone is unlikely to have a significant effect on platelet serotonin transponder and could be an effective alternative for pharmacological treatment of anxiety in patients with a bleeding diathesis.

A postal survey of doctors' attitudes to becoming mentally ill.

A postal survey of 3512 doctors in Birmingham was carried out to assess attitudes to becoming mentally ill. The response rate for the questionnaire was 70% (2462 questionnaires). In total, 1807 (73.4%) doctors would choose to disclose a mental illness to family and friends rather than to a professional. Career implications were cited by 800 (32.5%) respondents as the most frequent reason for failure to disclose. For outpatient treatment, 51.1% would seek formal professional advice. For inpatient treatment, 41.0% would choose a local private facility, with only 21.1% choosing a local NHS facility. Of respondents 12.4% indicated that they had experienced a mental illness. Stigma to mental health is prevalent among doctors. At present there are no clear guidelines for doctors to follow for mental healthcare. Confidential referral pathways to specialist psychiatric care for doctors and continuous education on the vulnerability of doctors to mental illness early on in medical training is crucial.

The impact of VA and Navy Hospital Collaboration on medical school education.

OBJECTIVE: The U.S. Department of Veterans Affairs (VA) is the largest single provider of medical education in the United States and is often the preferred training site for medical students and residents. However, changing priorities of patients and the marketplace are forcing medical schools and the VA to consider new ways of practicing medicine and relating to each other. This article reviews the value of that relationship. METHODS: The authors describe a VA and Department of Defense sharing agreement and the development of a federal medical center as well as the involvement of a local medical college and the impact on education. RESULTS: The federal medical center will provide more clinical services to veterans, active duty service members, and their beneficiaries. Trainees see a variety of young adults of both genders and are exposed to behaviors and pathology not commonly seen in typical general adult inpatient VA psychiatric units. CONCLUSION: The federal facility will provide accessible, high quality health care for active duty and veteran patients. It benefits trainees by enriching their training experience and allowing students and residents to receive a comprehensive clinical experience by caring for diversified patients with a wide range of pathology.