Care giving and receiving for people with complex emotional needs within a crisis resolution/home treatment setting: A qualitative evidence synthesis.

WHAT IS KNOWN ON THE SUBJECT?: The term 'complex emotional needs' (CEN) is used here to describe people with difficulties and needs that are often associated with the diagnostic label of 'personality disorder'. People with CEN might use out of hours services such as emergency departments and Crisis Resolution/Home Treatment (CRHT) teams more often when experiencing a mental health crisis. Very little is understood about the experiences of both those receiving, and those delivering care, for people with CEN within CRHT settings. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: There are differences between priorities for those delivering and those receiving care within CRHT settings. CRHT staff members are likely to focus more upon those aspects of their role relating to risk issues. managing resources, anxieties and the expectations of others. Service users, meanwhile, focus upon the caring relationship, wanting staff to listen to them, and to feel supported and reassured. In the papers reviewed, service users experiencing CEN did not always feel 'listened to' or 'taken seriously' especially in relation to risk issues and decision-making. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Relating the findings to mental health nursing and CEN within the context of CRHT, to better understand the person experiencing a mental health crisis, mental health nurses need to focus more upon the person and when making decisions around their care and must be aware of the potential for power imbalances. Collaborative 'sense-making' in relation to a person's risk behaviours may help. ABSTRACT: Background A growing body of qualitative evidence focusing upon the experiences of care within Crisis Resolution/Home Treatment (CRHT) is emerging; however, a firm evidence base regarding both the giving and receiving of care for those with complex emotional needs (CEN) in this context is yet to be established. Objective A qualitative evidence synthesis was used to develop a comprehensive understanding of how crisis care for people with CEN is experienced by both those giving and receiving care, within the context of CRHT. Method Findings from 19 research papers considering both clinician and service users' experiential accounts of CRHT were synthesised using meta-ethnography. Findings Both the giving and receiving of care within a CRHT context was experienced across four related meta-themes: 'contextual', 'functional', 'relational' and 'decisional'. Discussion Service user accounts focused upon relational aspects, highlighting a significance to their experience of care. Meanwhile, clinicians focused more upon contextual issues linked to the management of organisational anxieties and resources. For those with CEN, a clinician's focus upon risk alone highlighted power differentials in the caring relationship. Conclusions There is a need for nurses to connect with the experience of the person in crisis, ensuring a better balance between contextual issues and relational working.

Anthropomorphism as a contributor to the success of human (Homo sapiens) tool use.

Humans anthropomorphize: as a result of our evolved ultrasociality, we see the world through person-colored glasses. In this review, I suggest that an interesting proportion of the extraordinary tool-using abilities shown by humans results from our mistakenly anthropomorphizing and forming social relationships with objects and devices. I introduce the term machination to describe this error, sketch an outline of the evidence for it, tie it to intrinsic reward for social interaction, and use it to help explain overimitation-itself posited as underpinning human technological complexity-by human children and adults. I also suggest pathways for testing the concept's presence and limits, with an explicit focus on context-specific individual and temporal variation. I posit cognitive pressure from time constraints or opaque mechanisms as a cause for machination, with rapid, subconscious attribution of goals or desires to tools reducing cognitive overload. Machination holds promise for understanding how we create and use combinatorial technology, for clarifying differences with nonhuman animal tool use, and for examining the human fascination with objects. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Geographically targeted chronic infection screening: lessons from a hepatitis B pilot study in the UK.

Chronic hepatitis B (CHB) most commonly occurs following infection in early childhood. Prevalence varies markedly around the globe. Country of birth is therefore a strong predictor of CHB risk in adults. We used country of birth census data to predict CHB risk and carry out geographically targeted screening in East Yorkshire, UK. Despite engaging individuals born in high-prevalence countries with testing, we observed lower than expected prevalence in targeted highest-risk areas, which may indicate barriers to testing for people with undiagnosed CHB. Improved strategies for engagement with high-risk groups will be key for viral hepatitis elimination.

What might COVID-19 have taught us about the delivery of Nurse Education, in a post-COVID-19 world?

For Nurse Education in the UK, pre-existing challenges already included the need to develop curricula to align with new Nursing and Midwifery Council (NMC) educational standards; and increased numbers entering pre-registration Nurse Education programmes in order to address workforce deficits. Further disruption due to COVID-19, forced Nurse Educators overnight to rapidly adopt and to innovatively use current and emerging technologies to maintain engagement with, and to continue delivering education to, students during the pandemic. Although the full extent of these enforced changes is unknown at this time, this paper argues that online delivery is a necessary and inevitable transition, addressing some of these pre-existing challenges, and that the pandemic has hastened this. It is therefore crucial that Nurse Educators lead the way in navigating this period of uncertainty, viewing the pandemic as an opportunity to plan for the future, to establish how online teaching and learning can continue to benefit Nurse Education in a post-COVID-19 world, not just in the UK, but across the globe.

Adult and juvenile bearded capuchin monkeys handle stone hammers differently during nut-cracking.

Wild bearded capuchin monkeys (Sapajus libidinosus) habitually use stone hammers to crack open palm nuts and seeds on anvils. This activity requires strength, balance, and precise movement of a large stone with respect to the item placed on an anvil. We explored how well young monkeys cope with these challenges by examining their behavior and the behavior of adults while they cracked palm nuts using a stone. Using video records, we compared actions of six juvenile (2-5 years) and six adult (7+ years) wild monkeys during their first 20 strikes with one unfamiliar ellipsoid, quartzite stone (540 g), and the outcomes of these strikes. Compared with adults, juveniles cracked fewer nuts, performed a more diverse set of exploratory actions, and less frequently placed one or both hands on top of the stone on the downward motion. Adults and juveniles displayed similar low frequencies of striking with a slanted trajectory, missing the nut, and losing control over the nut or stone after striking. These findings indicate that young monkeys control the trajectory of a stone adequately but that is not sufficient to crack nuts as effectively as adults do. Compared with juveniles, adults more quickly perceive how to grip the stone efficiently, and they are able to adjust their grip dynamically during the strike. Young monkeys develop expertise in the latter aspects of cracking nuts over the course of several years of regular practice, indicating that perceptual learning about these aspects of percussion occurs slowly. Juvenile and adult humans learning to use stones to crack nuts also master these features of cracking nuts very slowly.

How the emergency department four-hour target affects clinical outcomes for patients diagnosed with a personality disorder.

Emergency departments (EDs) may already be invalidating environments for patients diagnosed with a personality disorder, with negative attitudes from staff perpetuating patients' feelings of dismissal and rejection. Despite a higher prevalence of patients with personality disorder in health services, including EDs, than the general population, there is a lack of literature on how achieving ED targets may affect this patient group. This article expands on Harden's concept of destructive goal pursuit in relation to the four-hour target and uses the literature to illustrate how pressures to meet the target may distort clinical priorities and result in adverse clinical outcomes for patients. It makes recommendations for practice including using short-stay units in which patients can be treated outside of the target wait time and introducing mental health triage in EDs to improve delivery of psychosocial assessments.

Three thousand years of wild capuchin stone tool use.

The human archaeological record changes over time. Finding such change in other animals requires similar evidence, namely, a long-term sequence of material culture. Here, we apply archaeological excavation, dating and analytical techniques to a wild capuchin monkey (Sapajus libidinosus) site in Serra da Capivara National Park, Brazil. We identify monkey stone tools between 2,400 and 3,000 years old and, on the basis of metric and damage patterns, demonstrate that capuchin food processing changed between ~2,400 and 300 years ago, and between ~100 years ago and the present day. We present the first example of long-term tool-use variation outside of the human lineage, and discuss possible mechanisms of extended behavioural change.

Wild sea otter mussel pounding leaves archaeological traces.

Wild sea otters (Enhydra lutris) are the only marine mammals that habitually use stones while foraging, using them to break open hard-shelled foods like marine snails and bivalves. However, the physical effects of this behavior on local environments are unknown. We show that sea otters pounding mussels on tidally emergent rocks leave distinct material traces, which can be recognized using methods from archaeology. We observed sea otters pounding mussels at the Bennett Slough Culverts site, California, USA, over a l0-year period. Sea otters repeatedly used the same rocks as anvils, which resulted in distinctive wear patterns on the rocks and accumulations of broken mussel shells, all fractured in a characteristic way, below them. Our results raise the potential for discovery of similar sea otter pounding sites in areas that no longer have resident sea otter populations.

How bearded capuchin monkeys (Sapajus libidinosus) prepare to use a stone to crack nuts.

Bearded capuchin monkeys crack nuts with naturally varying stone hammers, suggesting they may tune their grips and muscular forces to each stone. If so, they might use discrete actions on a stone before lifting and striking, and they would likely use these actions more frequently when the stone is larger and/or less familiar and/or when first initiating striking. We examined the behavior of (a) four monkeys (all proficient at cracking nuts) with two larger (1 kg) and two smaller (0.5 kg) stones, (b) 12 monkeys with one 1 kg stone, and (c) one monkey during its first 100 strikes with an initially unfamiliar 1 kg stone. Bearded capuchin monkeys used three discrete actions on the stone before striking, all more often with the larger stones than the smaller stones. We infer that the first discrete action (Spin) aided the monkey in determining where to grip the stone, the second (Flip) allowed it to position the stone on the anvil ergonomically before lifting it, and the third (Preparatory Lift) readied the monkey for the strenuous lifting action. The monkey that provided 100 strikes with one initially unfamiliar stone performed fewer Spins in later strikes but performed Flip and Preparatory Lift at consistent rates. The monkeys gripped the stone with both hands along the sides to lift it, but usually moved one or both hands to the top of the stone at the zenith of the lift for the downward strike. The findings highlight two new aspects of the capuchins' nut-cracking: (a) Anticipatory actions with the stone before striking, especially when the stone is larger or unfamiliar, and when initiating striking and (b) shifting grips on the stone during a strike. We invite researchers to investigate if other taxa use anticipatory actions and shift their grips during percussive activity.

DNA recovery from wild chimpanzee tools.

Most of our knowledge of wild chimpanzee behaviour stems from fewer than 10 long-term field sites. This bias limits studies to a potentially unrepresentative set of communities known to show great behavioural diversity on small geographic scales. Here, we introduce a new genetic approach to bridge the gap between behavioural material evidence in unhabituated chimpanzees and genetic advances in the field of primatology. The use of DNA analyses has revolutionised archaeological and primatological fields, whereby extraction of DNA from non-invasively collected samples allows researchers to reconstruct behaviour without ever directly observing individuals. We used commercially available forensic DNA kits to show that termite-fishing by wild chimpanzees (Pan troglodytes schweinfurthii) leaves behind detectable chimpanzee DNA evidence on tools. We then quantified the recovered DNA, compared the yield to that from faecal samples, and performed an initial assessment of mitochondrial and microsatellite markers to identify individuals. From 49 termite-fishing tools from the Issa Valley research site in western Tanzania, we recovered an average of 52 pg/µl chimpanzee DNA, compared to 376.2 pg/µl in faecal DNA extracts. Mitochondrial DNA haplotypes could be assigned to 41 of 49 tools (84%). Twenty-six tool DNA extracts yielded >25 pg/µl DNA and were selected for microsatellite analyses; genotypes were determined with confidence for 18 tools. These tools were used by a minimum of 11 individuals across the study period and termite mounds. These results demonstrate the utility of bio-molecular techniques and a primate archaeology approach in non-invasive monitoring and behavioural reconstruction of unhabituated primate populations.

Primate archaeology evolves.

Since its inception, archaeology has traditionally focused exclusively on humans and our direct ancestors. However, recent years have seen archaeological techniques applied to material evidence left behind by non-human animals. Here, we review advances made by the most prominent field investigating past non-human tool use: primate archaeology. This field combines survey of wild primate activity areas with ethological observations, excavations and analyses that allow the reconstruction of past primate behaviour. Because the order Primates includes humans, new insights into the behavioural evolution of apes and monkeys also can be used to better interrogate the record of early tool use in our own, hominin, lineage. This work has recently doubled the set of primate lineages with an excavated archaeological record, adding Old World macaques and New World capuchin monkeys to chimpanzees and humans, and it has shown that tool selection and transport, and discrete site formation, are universal among wild stone-tool-using primates. It has also revealed that wild capuchins regularly break stone tools in a way that can make them difficult to distinguish from simple early hominin tools. Ultimately, this research opens up opportunities for the development of a broader animal archaeology, marking the end of archaeology's anthropocentric era.

Technological Response of Wild Macaques (Macaca fascicularis) to Anthropogenic Change.

Anthropogenic disturbances have a detrimental impact on the natural world; the vast expansion of palm oil monocultures is one of the most significant agricultural influences. Primates worldwide consequently have been affected by the loss of their natural ecosystems. Long-tailed macaques (Macaca fascilularis) in Southern Thailand have, however, learned to exploit oil palm nuts using stone tools. Using camera traps, we captured the stone tool behavior of one macaque group in Ao Phang-Nga National Park. Line transects placed throughout an abandoned oil palm plantation confirmed a high abundance of nut cracking sites. Long-tailed macaques previously have been observed using stone tools to harvest shellfish along the coasts of Thailand and Myanmar. The novel nut processing behavior indicates the successful transfer of existing lithic technology to a new food source. Such behavioral plasticity has been suggested to underlie cultural behavior in animals, suggesting that long-tailed macaques have potential to exhibit cultural tendencies. The use of tools to process oil palm nuts across multiple primate species allows direct comparisons between stone tool using nonhuman primates living in anthropogenic environments.

Resource depletion through primate stone technology.

Tool use has allowed humans to become one of the most successful species. However, tool-assisted foraging has also pushed many of our prey species to extinction or endangerment, a technology-driven process thought to be uniquely human. Here, we demonstrate that tool-assisted foraging on shellfish by long-tailed macaques (Macaca fascicularis) in Khao Sam Roi Yot National Park, Thailand, reduces prey size and prey abundance, with more pronounced effects where the macaque population size is larger. We compared availability, sizes and maturation stages of shellfish between two adjacent islands inhabited by different-sized macaque populations and demonstrate potential effects on the prey reproductive biology. We provide evidence that once technological macaques reach a large enough group size, they enter a feedback loop - driving shellfish prey size down with attendant changes in the tool sizes used by the monkeys. If this pattern continues, prey populations could be reduced to a point where tool-assisted foraging is no longer beneficial to the macaques, which in return may lessen or extinguish the remarkable foraging technology employed by these primates.

Analysis of sea almond (Terminalia catappa) cracking sites used by wild Burmese long-tailed macaques (Macaca fascicularis aurea).

Nut-cracking is shared by all non-human primate taxa that are known to habitually use percussive stone tools in the wild: robust capuchins (Sapajus spp.), western chimpanzees (Pan troglodytes verus), and Burmese long-tailed macaques (Macaca fascicularis aurea). Despite opportunistically processing nuts, Burmese long-tailed macaques predominantly use stone tools to process mollusks in coastal environments. Here, we present the first comprehensive survey of sea almond (Terminalia catappa) nut-cracking sites created by macaques. We mapped T. catappa trees and nut-cracking sites that we encountered along the intertidal zone and forest border on the coasts of Piak Nam Yai Island, Thailand. For each nut-cracking site, we measured the physical properties (i.e., size, weight, use-wear) of hammer stones and anvils. We found that T. catappa trees and nut-cracking sites primarily occurred on the western coast facing the open sea, and cracking sites clusters around the trees. We confirmed previous results that nut cracking tools are among the heaviest tools used by long-tailed macaques; however, we found our sample of T. catappa stone tools lighter than a previously collected sea almond sample that, unlike our sample, was collected immediately after use within the intertidal zone. The difference was likely the result of tidal influences on tool-use sites. We also found that tool accumulations above the intertidal region do not resemble those within them, possibly leading to incomplete assessments of macaque stone tools through archaeological techniques that would use these durable sites.

Distance-decay effect in stone tool transport by wild chimpanzees.

Stone tool transport leaves long-lasting behavioural evidence in the landscape. However, it remains unknown how large-scale patterns of stone distribution emerge through undirected, short-term transport behaviours. One of the longest studied groups of stone-tool-using primates are the chimpanzees of the Taï National Park in Ivory Coast, West Africa. Using hammerstones left behind at chimpanzee Panda nut-cracking sites, we tested for a distance-decay effect, in which the weight of material decreases with increasing distance from raw material sources. We found that this effect exists over a range of more than 2 km, despite the fact that observed, short-term tool transport does not appear to involve deliberate movements away from raw material sources. Tools from the millennia-old Noulo site in the Taï forest fit the same pattern. The fact that chimpanzees show both complex short-term behavioural planning, and yet produce a landscape-wide pattern over the long term, raises the question of whether similar processes operate within other stone-tool-using primates, including hominins. Where hominin landscapes have discrete material sources, a distance-decay effect, and increasing use of stone materials away from sources, the Taï chimpanzees provide a relevant analogy for understanding the formation of those landscapes.

Wild monkeys flake stone tools.

Our understanding of the emergence of technology shapes how we view the origins of humanity. Sharp-edged stone flakes, struck from larger cores, are the primary evidence for the earliest stone technology. Here we show that wild bearded capuchin monkeys (Sapajus libidinosus) in Brazil deliberately break stones, unintentionally producing recurrent, conchoidally fractured, sharp-edged flakes and cores that have the characteristics and morphology of intentionally produced hominin tools. The production of archaeologically visible cores and flakes is therefore no longer unique to the human lineage, providing a comparative perspective on the emergence of lithic technology. This discovery adds an additional dimension to interpretations of the human Palaeolithic record, the possible function of early stone tools, and the cognitive requirements for the emergence of stone flaking.

Wild capuchin monkeys adjust stone tools according to changing nut properties.

Animals foraging in their natural environments need to be proficient at recognizing and responding to changes in food targets that affect accessibility or pose a risk. Wild bearded capuchin monkeys (Sapajus libidinosus) use stone tools to access a variety of nut species, including otherwise inaccessible foods. This study tests whether wild capuchins from Serra da Capivara National Park in Brazil adjust their tool selection when processing cashew (Anacardium spp.) nuts. During the ripening process of cashew nuts, the amount of caustic defensive substance in the nut mesocarp decreases. We conducted field experiments to test whether capuchins adapt their stone hammer selection to changing properties of the target nut, using stones of different weights and two maturation stages of cashew nuts. The results show that although fresh nuts are easier to crack, capuchin monkeys used larger stone tools to open them, which may help the monkeys avoid contact with the caustic hazard in fresh nuts. We demonstrate that capuchin monkeys are actively able to distinguish between the maturation stages within one nut species, and to adapt their foraging behaviour accordingly.