Bad Days Research Articles

Promises and hazards of artificial intelligence

AbstractArtificial intelligence (AI)‐based technologies employing deep‐learning (DL) approaches have proven effective in supporting decisions in many medical specialties, including radiology, cardiology, oncology, dermatology, ophthalmology, and others. For example, AI/DL algorithms have been shown to reduce waiting times, improve medication adherence, customize insulin dosages, and help interpret magnetic resonance images. The number of AI life‐science papers listed in PubMed increased from 596 in 2010 to 12 422 in 2019. The number of papers on the use of AI in the field of ophthalmology also has increased dramatically. Moreover, human cognitive capacity to effectively manage information is often exceeded by the quantity of data generated, and unlike humans, who have bad days and emotions, and who get tired, with subsequent decreases in performance and accuracy, AI works 24/7 without vacations or complaints. AI/DL algorithms have been used to detect diseases based on image analysis, with fundus photos and optical coherence tomography (OCT) scans analysed for retinal diseases, chest radiographs assessed for lung diseases, and skin photos analysed for skin disorders. Retinal photos have also been used to identify risk factors related to cardiovascular disorders, including blood pressure, smoking, and body mass index.One of many challenges in the field of AI is determining what constitutes evidence of impact and benefit for AI medical devices and who should assess the evidence. The majority of AI studies are conducted in experimental conditions and based on preselected data. They might provide inadequate insight into the use of AI applications in heterogeneous, real‐world care settings. One of the potential hazards of the clinical use of algorithms identified was the risk of applying an algorithm trained on a particular demographic group to a population that differs in factors such as ethnicity, age, and sex. Moreover, many studies of algorithms developed with AI have excluded low‐quality images, treating them as ungradable images, and patients with comorbid eye diseases, making them less reflective of real‐world conditions. The future development of ophthalmology depends on better and possibly unlimited access to the medical data stored within electronic health records. However, this access cannot be allowed to compromise of privacy of this very sensitive data. There is a need for effective regulations that will set a balance between individual protection and the common good.A recent report from the National Academy of Medicine highlights some important challenges in the further development of AI applications in health care. The authors advocate the use of openly accessible, standardized, population‐representative data; addressing explicit and implicit biases related to AI; developing and deploying appropriate training and educational programs for health workers to support health‐care AI; and balancing innovation and safety through the use of regulation and legislation to promote trust.

Response to Bill Rowe Review

Bill Rowe wrote a review of my book A Thousand Brains for the American Journal of Psychology. Bill and his colleague Dominic Massaro, both with the University of California, Santa Cruz, asked me to write a commentary on the review. I was happy to do so, and you are reading the result of that request.First, I would like to thank Bill for the effort he put into his review; it is remarkable. He not only covers what is in my book, he also summarizes several of our technical papers, providing a deeper insight into the science discussed in my book and a bridge to those who want to learn more. He even includes figures from some of our papers, although his are improved over the originals. Readers who are not ready for this level of detail can skim over these sections of the review and still get insights from the rest of the review.I feel that the review is genuine in its praise and criticisms. I see not much to gain by commenting on the former or being picky about the latter. Instead, I would like to comment on a few unexpected things that I was happy to see in the review.One theme that Bill brings up is the openness of our research. (I run a research team at a company called Numenta.) For example, we often post recordings of our internal research meetings, including meetings when we fail to make progress or when we openly debate each other. Openness is also why I included personal stories in the book. Science is a messy affair, with its good days and bad days. It doesn't progress linearly, as it is often portrayed. To me, being honest about our struggles lends credibility when we claim to have made progress. I was pleased to see that Bill mentioned this and appreciates it.Another thing I was pleased to see in the review was an emphasis on some of the foundational concepts underlying our brain theory. Our theory is called The Thousand Brains Theory, hence the title of the book. In the book, I emphasize the overarching concepts of the theory, such as how the brain learns by moving, the need for reference frames to store knowledge, and how the brain has thousands of models that work together. I deemphasized several low-level details that are essential to the theory but might be hard for an average reader to understand. Bill saw this as an opportunity and picked up where I left off. For example, he goes into detail about how we model individual neurons and discusses the important topic of sparsity, something that I didn't even mention in the book. His discussion is clear and conveys the importance of these ideas. I am glad he made the effort to describe these things.Finally, I want to mention what Bill didn't cover in his review. The book has three sections. The first describes the progress we have made in reverse engineering the neocortex. The second section is about machine intelligence based on brain theory. And the third section is about the future of humanity from the perspective of intelligence and machine intelligence. Bill Rowe's review covers only the first section. I am not surprised. When I wrote the book, I realized that it was almost as if I was writing three books. The three sections are united by the theme of intelligence, but not everyone who is interested in how the brain works is interested in intelligent machines, and vice versa. From the perspective of a psychologist, the first section is most relevant. But I want to take this opportunity to encourage readers to give all three sections their consideration.Understanding how the brain works will have large consequences for psychology, education, and mental health. However, my team at Numenta is starting to build machines that work on these brain principles, and the impact of these machines on society and our planet will be profound. There are simultaneously concerns about the risk of intelligent machines. These are the topics discussed in the second section. The book's third section is about the far future, and consequently it may appear to be less relevant given all the problems we face today. But I believe it is not too early to consider these issues. Long-term problems require long-term solutions. I will leave it at that.I want to thank Bill Rowe once again for his comprehensive review of A Thousand Brains and the brain theory we have developed. The thought and care he put into it shows his deep interest in the topic and our theories. As a scientist and a writer, that is all I can hope for.

Analisis Tingkat Pencemaran SO2 pada Udara Ambien Akibat Aktivitas Kendaraan Bermotor di Jalan A.H Nasution Kota Kendari

The air condition on our earth is getting worse day by day due to air pollution. Air pollution changes the composition (composition) of the atmosphere, where the amount and concentration of one or more pollutants endangers the health of living things, damages property, and reduces air comfort. The dense use of motorized vehicle activities in Kendari City is one of the factors that affect ambient air quality. This is what can be used as a reference in conducting this research using a field survey method for the number of vehicles and ambient air dampel testing for air quality in Kendari City with Sulfur Dioxide parameters. The results showed that the daily traffic density at the monitoring point on Jalan A.H Nasution, Kendari City, for motor vehicles was 8,046 units/day, cars were 3,237 units/day, and trucks were 213 units/day. Based on the results of laboratory tests, the concentration of SO2 at the measurement point on Jalan A.H Nasution, Kendari City, was 38.5 g/m3 in the morning, 61.7 g/m3 in the afternoon, and 53.5 g/m3 in the afternoon. Based on government regulation Number 22 of 2021 concerning the implementation and management of the environment, the sulfur dioxide concentration on the A.H Nasuton road, Kendari City, between morning, afternoon and evening is still below the quality standard threshold.

Using Autoregulation to Safely Return to Weightlifting During Cancer Treatments

ABSTRACT Masters-level weightlifters diagnosed with cancer can return to training as a part of a successful treatment plan. Many older adults at higher risk for cancer participate in masters weightlifting meets worldwide. Resuming activities enjoyed before diagnosis is part of a return to normalcy for these athletes. This article recommends using autoregulation integrated with periodization principles to account for changes in the body due to surgery, side effects from masters cancer treatments, and age-related declines that affect masters athletes. Surgery, chemotherapy, and radiation therapy require adjusting workouts from prediagnosis levels to insure a safe and successful recovery while athletes experience side effects from treatments. Autoregulation is recommended to help strength and conditioning specialists assist in daily exercise prescriptions for patients with cancer who experience good and bad days during months of treatment cycles. Resistance training is an evidence-based practice for a successful recovery, and existing literature provides a basis for recommendations found in this article to support program development for masters weightlifters returning to advanced resistance training.

The unheard victims: Challenges of identifying experiences of trauma among children with ASD

Trigger warning: Sexual assault. Several years ago, I was providing individual psychotherapy to a kind, intelligent woman in her 40's who was in the process of obtaining an advanced scientific degree in a very competitive university program. She received a diagnosis of autism spectrum disorder (ASD) as an adult and was seeking psychotherapy to improve her social skills in hopes of better maintaining personal relationships in both her personal and professional life. Approximately 3 months into therapy, we were exploring common challenges she faces in maintaining positive relationships with fellow graduate students and work colleagues. She casually described an event from a few years ago, during which she was forced to engage in non‐consensual sex with a male colleague in her workplace bathroom. While she seemed distressed in telling her story, she did not appear to understand the gravity of what she was describing. “I didn't like it,” she stated. “That was a bad day at work.” When asked why she didn't mention this in therapy before (she denied any “traumatic or stressful life experiences” during her intake appointment), she stated, “I've never told anyone. Was I supposed to? I don't really know what's ‘normal’, especially with the opposite sex. It made me uncomfortable, but lots of things make me uncomfortable that everyone just tells me to get over. Did I do something wrong?”

Goodbye and thank you from the editor

When I became editor of The Successful Registrar in June 2006, I wasn't exactly sure what a registrar does. I had fond memories of the registrar at my undergraduate university. He was the guy you went to when you were having a really bad day. He would make you a cup of tea and tell you that you could handle whatever the problem was, and beyond that, you were absolutely awesome in every way. I had some vague idea his job description was broader than making tea and encouraging students, but I never worried much about it.

S445 Severity of Reflux Predicts Number of Days Abnormal on Ambulatory Reflux Testing: Discovery and External Validation Cohort Study

Introduction: Ambulatory reflux monitoring off PPI has become a leading option for the diagnosis of GERD. Even with adoption of the Lyon Consensus, there remains controversy on ambulatory reflux parameters for the prediction of abnormal reflux. The aim of our study was to evaluate if severity of reflux alone predicted the number of days of abnormal acid exposure. Methods: Our discovery cohort included single center data from patients with GERD symptoms despite PPI evaluated by pH testing (“Medical”). The Medical group was compared to an external validation cohort from the clinical RCT trial of TIF 2.0 (“RESPECT”) during parallel time-periods over 10 years. RESPECT patients had symptoms and were being evaluated to undergo TIF 2.0. 48 Hour wireless pH testing was performed at least 7 days off PPI therapy in all subjects. Percent total time pH< 4 was considered abnormal if greater than 6% (Lyon Classification). The probability of having abnormal reflux was measured based on severity and frequency of reflux events. Wilcoxon and Pearson X2 tests were used for comparison of continuous and categorical variables, respectively. Results: Our cohorts included the RESPECT group (n=129, 49% male) compared to Medical group (n=119, 30% male). Frequency of abnormal days on pH monitoring was highly dependent on severity of reflux events with a 91-93% likelihood of both days being abnormal if reflux AET was 12% or greater (Figure). Using 6.0% AET on the worst day, the prediction for the 2nd day to also be abnormal was driven by severity of reflux event (Medical= 78% at a pH of 6.0, 88% at pH of 10, and 91% at pH of 12). This was similar for the validation cohort (RESPECT = 72% at a pH of 6.0, 80% at pH of 10, and 93% at pH of 12) (p-value for non-linear effects < .0001) (Figure). This finding was consistent between the discovery and validation cohorts irrespective of esophagitis status. Conclusion: Severity of reflux (defined by abnormal acid exposure time) is highly predictive of number of days abnormal. Utilizing the severity of reflux on ambulatory testing potentially obviates the need for extended ambulatory monitoring beyond 48 hours. As severity of reflux worsens, the predictive power for number of abnormal days is strengthened (from current Lyon of 6.0% to moderate-severe ranges of 10-12). When using ambulatory reflux testing, increased focus on the severity of reflux has higher predictive power in guiding patient diagnosis.Figure 1.: Severity of Reflux (x-axis) Compared to Proportion Abnormal Reflux Parameters on Day 1 vs Day 2 (y-axis) in Our Cohorts

Daily fluctuations in children’s working memory accuracy and precision: Variability at multiple time scales and links to daily sleep behavior and fluid intelligence

Children often experience better and worse days when performing cognitive tasks. Whether such fluctuations are systematic and how they are linked to fluctuations at faster time scales within days is less clear. To fill these gaps, we probed N = 108 fifth graders on WM tasks twice daily in morning and afternoon sessions, and also assessed nightly sleep behavior, over a period of four weeks using ambulatory assessment. Children systematically fluctuated in their recall of visuospatial and numerical information in WM across multiple time scales. These fluctuations showed consistencies but also discrepancies among each other. Especially, fast variability of memory precision across moments was related to load and fluid intelligence. Daily WM accuracy was positively coupled to sleep quality, but only in a subset of children with larger daily WM fluctuations. We propose that short-term WM fluctuations and their couplings to other time-varying constructs could help to explain long-term cognitive development. • Children show systematic intra-individual working memory (WM) fluctuations. • WM load particularly affected the rapid item-to-item variability of recall precision. • Lower momentary recall variability was linked to higher levels in fluid intelligence. • Nightly sleep quality predicted higher daily WM accuracy, but only in a subset of children. • These dynamics emphasize a nuanced distinction of faster and slower WM variability.

MENGENAL PADEWASAN : KEYAKINAN, PILIHAN DAN HARAPAN

Padewasan is one of the teachings that comes from the veda smrti; jyotisha. The question of the existence of padewasan for the life of the Hindu community in Bali can certainly be categorized as two interrelated things. The difficulty in separating the life of the Balinese people from the implementation of Padewasan teachings can be seen from how the specifics of these teachings are used in almost every line of life of the Hindu community in Bali; from birth to death. Balinese people fully believe that every election day should be based on careful calculations. Not just any day can be used to carry out certain activities, such as farming, making weapons, to other religious rituals. From this description, of course, it can be seen how “time” for the Balinese has a very important role; valuable. Thus, the first step to getting to know padwasan for Balinese people's life is not only related to understanding it as a hereditary habit. More than that, padwasan seems to talk about the beliefs, choices and hopes of the Balinese Hindu community in living all lines of life. Sacredness in the selection of good or bad days is interpreted as an expectation of the values ​​of goodness, safety, luck and the success of an activity that is being carried out. The following are some of the process of selecting the good and bad days in terms of the teachings of Padewasan, including: Tenung Mitra Satruning Dina, Tenung Jatu Karma and Tenung Pakeraban.

Analysis of the Environmental Quality of Seawater in the Bohai Sea, China

According to the survey data on seawater quality in the Bohai Sea from 2020 to 2021, a single-factor data analysis was carried out on the seawater environmental quality of Liaoning, Hebei, Tianjin, Shandong and the offshore waters. The results show that the seawater quality of the Bohai Sea in 2021 Compared with the more serious pollution in 2020, the main pollutants are active phosphate and inorganic nitrogen. The spatiotemporal distribution characteristics of the eutrophication state index are high at the top of Bohai Bay and low on the outside, high in the southeast and low in the northwest. And through the comparison of water quality data for two years, the organic pollution and eutrophication near Panjin, Dalian, Yingkou and Weifang are getting worse day by day and the content of inorganic nitrogen and active phosphate in some waters in the Bohai Bay has increased. The total amount of materials discharged into the sea is controlled.

Impacts of Climate Change in Bangladesh and its Consequences on Public Health

Climate change can affect many aspects of our lives, for example, health and environment, access to natural resources, safety and security, agriculture and food production. Health issues are the most crucial and burning difficulties for human beings in all of these aspects. The scope of this review considered commonly used methodologies for climate change-induced diseases research and assessment of climate-induced health problems throughout Bangladesh. Surveys, key informant interviews (KII), focus group discussion (FGD), registered hospital visit patient data as well as and other similar methodologies are found popular in this research area. Negligible studies are found that used experimental method including laboratory analysis and registered hospital visit of patient information. Very few experimental studies observed water sample tests and human health-related samples like urine and blood pressure. People living in the coastal part has climate-induced crisis like salinity intrusion, cyclone, storm surge that lead to health problems like diarrhea, cholera, skin diseases, typhoid, chicken pox. While people living in both drought-prone and flood prone areas have health problems like diarrhea, cholera, fever, and skin diseases. People living in the urban and the hilly regions have climate induced crisis of increased temperature and they suffer from vector-borne diseases. Waterborne communicable diseases are the most common climate-induced diseases found in this review. Waterborne non-communicable diseases like hypertension, pre-eclampsia, eclampsia and gynecological problems during pregnancy are common and women suffers a lot. Blood pressure and related cardiovascular diseases, jaundice, and respiratory issues are also getting worse day by day which has strong connection with climate change effects like temperature, rainfall and salinity.

Maybe they had a bad day: how LGBTQ and BIPOC patients react to bias in healthcare and struggle to speak out.

People who experience marginalization, including Black, Indigenous, People of Color (BIPOC) and Lesbian, Gay, Bisexual, Transgender, Queer, Plus (ie, all other marginalized genders and sexual orientations) people (LGBTQ+) experience discrimination during healthcare interactions, which negatively impacts patient-provider communication and care. Yet, scarce research examines the lived experience of unfair treatment among patients from marginalized groups to guide patient-centered tools that improve healthcare equity. We interviewed 25 BIPOC and/or LGBTQ+ people about their experiences of unfair treatment and discrimination when visiting healthcare providers. Through thematic analysis, we describe participants' immediate reactions and longer-term consequences of those experiences. We identified 4 ways that participants reacted to discrimination in the moment: Fighting, Fleeing, Excusing, and Working Around Bias. Long-term consequences reflect 6 ways they coped: Delaying or Avoiding Care, Changing Healthcare Providers, Self-prescribing, Covering Behaviors, Experiencing Health Complications, and Mistrusting Healthcare Institutions. By describing how patients react to experiences of unfair treatment and discrimination, our findings enhance the understanding of health disparities as patients cope and struggle to speak out.To combat these problems, we identify 3 future directions for informatics interventions that improve provider behavior, support patient advocacy, and address power dynamics in healthcare. BIPOC and LGBTQ+ patients' perspectives on navigating unfair treatment and discrimination in healthcare offers critical insight into their experiences and long-term consequences of those experiences. Understanding the circumstances and consequences of unfair treatment, discrimination, and the impact of bias through this patient-centered lens is crucial to inform informatics technologies that promote health equity.

“IF WE DIDN’T EAT THEM, THEY WOULDN’T EXIST” The Nonidentity Problem’s Implications for Animals (Including Humans)

“IF WE DIDN’T EAT THEM, THEY WOULDN’T EXIST” The Nonidentity Problem’s Implications for Animals (Including Humans)

Communication Lake

Communication Lake

Analyzing The Protagonist Character of Elliot Anderson As Seen In The Film “Black Or White” By Mike Binder

‘Black or White’ described of complains, blames, jealously, selfishness, and understanding about the family love from Elliot Anderson’s character. This research is aimed to know the character of Elliot Anderson as main character by analyzing the evidence from the dialogues and his actions in the film. To know about the character of Elliot Anderson, the writer used the descriptive qualitative method in this paper. The writer employs himself to collect the data by reading script, watching the film and marking them. The writer used the film of Black or White by Mike Binder released in 2014 by Toronto International Film Festival (TIFF). The writer focused on the dialogues of the film, and then followed by analyzing the character through conscientiousness and neuroticism of personality. In this analysis, the writer finds out that final result about the protagonist character of Elliot Anderson. Elliot Anderson is a recently widower and visible wealthy grandfather. The writer found Conscientiousness of Elliot Anderson characteristic is ambitious and neuroticism Elliot is irritable or anger, complaining person, blaming person, selfish, and jealous. It’s all happened when on one particularly bad day, in which he loses his wife, he wishes people would recognize how hard he is trying and how good his heart is and just leaving him alone in his big house with its big swimming pool and his Mexican maid to raise his young granddaughter Eloise. Keyword: Black or White Film, Elliot Anderson, Protagonist Character

Knowledge and Awareness of COVID-19 in Uttar Pradesh: An Exploratory Data Analysis

Corona viruses, commonly called COVID-19, are a large family of viruses that can cause diseases ranging from the common cold to Severe Acute Respiratory Syndrome (SARS). Worldwide Covid-19 is affecting 210 countries and territories around the world and two international conveyances. As of 2 June 2020, there are 6,408,869 confirmed 2,935,368 recovered and 378,317 deaths cases has been reported in world of Coronavirus diseases, India is not untouched from this situation. Currently, it has reported infected 190,535 and 5,394 death cases due to COVID-19 in India. (https://covid19.who.int/region/searo/country/in). The COVID-19 pandemic was first confirmed in the Indian state of Uttar Pradesh on 4 March 2020, with the first positive case in Ghaziabad. As of 1 June 2020, the state has 8361 confirmed cases, resulting in 222 deaths and 5030 recoveries. The situation is getting worst day by day as COVID-19 outbreaks and patients are increasing by every minute and become the most important issue for the whole world and So accessing knowledge and awareness among the people is very important. The present study using the exploratory data analysis we tried to demonstrate the knowledge and awareness of individuals about the COVID-19 pandemic in Uttar Pradesh, the most populous state of India. The findings of the present study can be utilized by the researchers and policy makers to handle this worst situation.

Veteran’s Treatment Courts: will More be Necessary Now that the 20-Year War on Terror has Concluded for US Soldiers?

Senator John Kerry noted that September 11th was the worst day that we, as a nation, had ever seen; however, it served to unite us. For the families of the 2,977 victims, it was a day of immeasurable and unimaginable loss. For first responders, it was a living nightmare they willingly chose to return to for days, weeks, and months following the attacks so that the families impacted could have some measure of closure. Many of these experienced subsequent physical and mental health illnesses due to what they were exposed to. For others, it was a call to arms. A call to action and to begin serving something bigger than themselves. It was a call to enlist in the US military. It is reported that immediately following the September 11th attacks, over 180,000 American citizens enlisted in active-duty military with some claiming the events of 9/11 were the driving force behind their decision. The military reported that 1 year after 9/11 there were just over 1.4 million active-duty military personnel in the Army, Navy, Marine Corps, and Air Force combined. Since the beginning of the American military involvement in the Iraq and Afghanistan wars in 2001, it is estimated that approximately 1.9 US military personnel were deployed in 3 million missions lasting at least 30 days. Over 7,000 servicemembers have been killed, in post-9/11 wars, with thousands more sustaining critical life-changing injuries, including loss of limbs, traumatic brain injuries and the invisible injuries of posttraumatic stress disorder. This work consists of a content analysis, specifically focusing on the establishment and ongoing need of Veteran’s Treatment Courts (VTC), a specialty court established in 2008, as a direct response to a growing number of veterans, appearing on court dockets, who were addicted to drugs, alcohol, or suffering from undiagnosed/untreated mental illness due to exposure to traumatic events while on military deployment. Today there are 400 VTC across the country, but more of these courts and significantly more funding and resources are needed to address the invisible wounds and impact of a 20-year war. This article examines the literature in existence related to VTCs, including their missions, strategies, and recidivism success rates. It also examines where these VTCs are in relation to US military installations that experienced deployments, and the resources that are available and accessible to those veterans who agree to enter these diversion programs. Finally, it discusses any noted gaps in where VTCs should be and currently are not as well as the potential for deleterious outcomes for veterans who have honorably served their country and have either fallen through the system’s cracks or live in an underserved area of the country. These are wounded warriors that, absent being exposed to traumatic events in a war zone, may never have entered the criminal justice system.

‘We may have bad days . . . that doesn’t make us killers’: How military veterans perceive contemporary British media representations of military and post-military life

Over the last two decades of long wars in Afghanistan and Iraq, the media’s attention on military veterans in the UK has been characterized by a series of shifts: from a focus on combat operations; to initiatives to support transition to civilian life; and finally to a largely invisible presence of veteran issues in the mediated public sphere. This article presents findings from an online qualitative survey conducted with British veterans in 2020. The authors’ primary focus is on how veterans express their concerns when asked about varied televised representations of military and post-military experience. How did the respondents perceive differences across television genres (drama, news, reality TV), and how did this affect their engagement? How do they see their veteran identity reflected back at them through popular media culture? There is a growing research interest in ‘veteran studies’ from a range of disciplines, but the relationship between veteran identity and perceptions of (post)-military representations remains largely under-researched, at least in the UK context. One concern is that negative or misleading stereotypes of veterans among publics could hinder their successful reintegration into society, but the authors are interested in how veterans make sense of such representations across popular media culture, how they imagine the ‘general public’ audience in their reflections, and the nature of veteran identity they project within the survey responses. This study finds that anxieties about ‘mad, bad or sad’ stereotypical representations of veterans continue, but the diversity within its findings also reaffirms the importance of not treating veterans as a homogeneous group in research.

"My life isn't my life, it's the systems": A qualitative exploration of women's experiences of day-to-day restrictive practices as inpatients.

WHAT IS KNOWN ON THE SUBJECT?: Sometimes someone needs to be in hospital because they are struggling with their mental health and need some extra support but being in hospital can also be a difficult experience. There are a lot of restrictions in place in hospital, like locked doors, rules to follow and not much choice about what happens to you. Other research has found that these restrictions can feel difficult and stressful for people and so more research is needed about this. We wanted to know what being in hospital felt like for women in particular. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We interviewed women who were in hospital because of their mental health about what it was like for them in hospital. The women told us that they felt powerless while they were in hospital. They sometimes felt like they were being punished and this could affect their mood and could lead to them hurting themselves. They also said that they were not always listened to by staff, and they found it difficult being away from their family and friends while they were in hospital. The women also told us that being in hospital could sometimes help them to feel safe. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Women should be looked after in hospital in a way that helps them to feel in control of what happens to them. They should be supported to be able to go outside the hospital on leave, to keep in touch with their family and friends, and they should be listened to by staff. A project called "safewards" has suggested some ways for helping to make hospital wards safer. They have suggested that everyone should be clear about what the rules are when they go into hospital and ways that staff could communicate more clearly with the people they are working with. Our research supports using these techniques. ABSTRACT: Introduction Inpatient care often involves restrictive interventions such as seclusion and restraint and restrictive practices that limit the person's freedom, rights and daily activities. Restrictive practice has not been the explicit focus in previous research; however, it often appears as an important theme, with participants identifying it can have a detrimental effect on their well-being. More research specifically on this topic in an inpatient setting is, therefore, needed. Women might be particularly vulnerable to adverse effects of restrictive practices compared to men as women generally occupy less powerful positions in society and more often experience abuse. Aims The study aimed to explore women's experiences of routine restrictive practices in mental health inpatient settings. Methods Twenty-two women who were currently inpatients on mental health wards were interviewed about their experiences of restrictive practices in hospital. Interviews were analysed using thematic analysis. Results An overarching theme emerged of powerlessness. Four key sub-themes were also identified: restrictions perceived as punitive, having no voice, impact of restrictions on relationships and restrictions providing safety and support. Discussion Although restrictive practices were found to provide the women with a sense of safety, they were also found to impact upon the women's well-being, leading to increases in self-harm and over-reliance on restrictions. Implications for practice This research highlights the importance of gender-informed inpatient services for women that foster independence, empowerment and allow women to have their voices heard. Safewards interventions such as clear mutual expectations and soft words could contribute to mitigating the impact of restrictive practices.

Evaluation of Gastroesophageal Reflux Disease in Children on the Autism Spectrum: A Study Evaluating the Tolerance and Utility of the BRAVO Wireless pH Monitoring.

Children on the autism spectrum disorder (ASD) may express pain or discomfort through stereotypic or self-injurious behaviors. Gastroesophageal reflux disease (GERD) may be challenging to diagnose in a child who is non-verbal or has impaired communication skills, diagnostic testing for GERD may be the only way to establish the diagnosis. We report our experience using the BRAVO wireless pH monitoring device for the evaluation of GERD in this patient population. Tolerance and feasibility as well as pH parameters and symptom correlation of the BRAVO pH were evaluated retrospectively in ASD children and compared it to a large cohort of non-ASD children. Only patients with studies lasting &gt;24 hours were included. A total of 172 patients were included, 27 of those were diagnosed with autism (median age 11 years, 17 male). We found no difference in age and weight between both groups but there was a male predominance in the autism group ( P = 0.007). We found no difference in the ability to complete at least 24 hours of study duration between both groups (24/27 or 89% in ASD vs 133/145 or 92% non-ASD patients, P = 0.632). We also found no difference in the median reflux index on the worst day ( P = 0.27) or the average of both days ( P = 0.75), BRAVO pH parameters and the proportion of abnormal studies between ASD and non-ASD children. When evaluating the overall symptom correlation with GER episodes, we did not find a difference between both groups, but we did find a higher symptom correlation for GER symptom during supine position in ASD children. Study was performed for behavioral indication in 11 ASD children, all had normal esophageal mucosa but 4 of those had an abnormal BRAVO pH study. No significant side effects were reported during the study, only 2 patients (1 non-ASD and 1 ASD) complained of self-limited chest pain. BRAVO wireless pH is well tolerated and feasible in evaluating GER and behavioral symptoms in ASD children and provides a reasonable alternative to standard trans-nasal pH monitoring.