This study examined the cognitive mechanism underlying acute stress in creative cognition among individuals with high and low trait anxiety. Specifically, cognitive inhibition was assessed using the flanker task during acute stress. Fifty-two participants (26 high trait anxiety, 26 low trait anxiety) (mean age = 18.94 years) underwent stress induction via the Trier Social Stress Test (TSST). They all completed the Alternative Uses Test (AUT) and the Remote Associates Test (RAT) before and after the TSST. Biochemical markers (salivary cortisol and (...) salivary alpha amylase) were recorded at regular intervals. The results showed that cognitive inhibition was influenced by trait anxiety and acute stress. Compared to before experiencing acute stress, there was a lack of cognitive inhibition in low trait anxious individuals and they performed better in AUT (fluency) after acute stress, whereas high trait anxious individuals showed a decreased interference effect and reduced performance in AUT (fluency, flexibility, and originality). In the RAT, there were shorter response times and increased accuracy after acute stress in both high and low trait anxiety groups. Thus, we suggest that cognitive control, which modulates changes in acute stress, influences creative cognition. These findings provide evidence that inhibition control mediates the effect of stress on the creativity of individuals with different trait anxiety. (shrink)

The vestibulo-ocular reflex (VOR) adaptation is an ideal model for investigating how the neurosteroid 17 beta-estradiol (E2) contributes to the modification of behavior by regulating synaptic activities. We hypothesized that E2 impacts VOR adaptation by affecting cerebellar synaptic plasticity at the parallel fiber–Purkinje cell (PF) synapse. To verify this hypothesis, we investigated the acute effect of blocking E2 synthesis on gain increases and decreases in adaptation of the VOR in male rats using an oral dose (2.5 mg/kg) of the aromatase (...) inhibitor letrozole. We also assessed the effect of letrozole on synaptic plasticity at the PF synapse in vitro, using cerebellar slices from male rats. We found that letrozole acutely impaired both gain increases and decreases adaptation of the VOR without altering basal ocular-motor performance. Moreover, letrozole prevented long-term potentiation at the PF synapse (PF-LTP) without affecting long-term depression (PF-LTD). Thus, in male rats neurosteroid E2 has a relevant impact on VOR adaptation and affects exclusively PF-LTP. These findings suggest that E2 might regulate changes in VOR adaptation by acting locally on cerebellar and extra-cerebellar synaptic plasticity sites. (shrink)

Eyal et al have recently argued that researchers should consider conducting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) human challenge studies to hasten vaccine development. We have conducted (J. L.) and overseen (L. D.) human challenge studies and agree that they can be useful in developing anti-infective agents. We also agree that adults can autonomously choose to undergo risks with no prospect of direct benefit to themselves. However, we disagree that SARS-CoV-2 challenge studies are ethically appropriate at this time, for (...) 3 reasons: (1) current scientific knowledge of SARS-CoV-2 infection is insufficient to manage risks; (2) autonomous decision making, while necessary, does not override concerns about risk; and (3) undertaking challenge studies now would imperil confidence in the research enterprise, potentially undermining the global response to the coronavirus disease 2019 (COVID-19) pandemic. (shrink)

Acute aerobic exercise has been shown to improve fine motor skills and alter activation of the motor cortex. The intensity of exercise may influence M1 activation, and further impact whole-body motor skill performance. The aims of the current study were to compare a whole-body motor skill via a piano task following moderate-intensity training and high-intensity interval training, and to determine if M1 activation is linked to any such changes in performance. Nine subjects, aged 18 ± 1 years completed a control, (...) MIT, and HIIT trial followed by administration of a piano performance task. M1 activation was evaluated by measuring oxyhemoglobin and hemoglobin difference changes during post-exercise piano performance using functional near-infrared spectroscopy. The results indicate that piano performance scores were higher after the MIT trial, but not HIIT trial, compared to the control trial. A negative relationship was detected between heart rate during HIIT and post-HIIT piano scores. M1 activation was significantly increased after the HIIT trial. M1 activation was also positively associated with piano performance when exercise trials and all trials were combined. We found that acute moderate-intensity exercise led to an improvement in complex motor skill performance while higher-intensity exercise increased M1 activation. These results demonstrate that moderate-intensity exercise can prime the nervous system for the acquisition of whole-body motor skills, suggesting that similar exercise protocols may be effective in improving the outcomes of other motor tasks performed during regular routines of daily life. In addition, it appears that improvements in motor task performance may be driven by M1 activation. Our findings provide new mechanistic insight into the complex relationship between exercise intensity, M1 activation, and whole-body motor skill performance. (shrink)

ObjectiveThe study is an explorative investigation aimed to assess the differences in acute stress response patterns of health workers facing coronavirus disease 2019 (COVID-19) during Italy’s first lockdown.MethodsA cross-sectional investigation using convenience sampling method was conducted in Italy during April 2020. Eight hundred fifty-eight health workers participated in the research filling out self-report measures including Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), Insomnia Severity Index (ISI), and Impact of Event Scale–Revised (IES-R).ResultsModerate/severe depression was found in 28.9% (95% CI, 25.8–32.04), (...) moderate/severe anxiety in 55.4% (95% CI, 51.9–58.8), insomnia in 15% (95% CI, 12.5–17.5), and distress in 52.5% (95% CI, 48.5%–56.6) of participants. The 3% of health workers reported frequent suicidal thoughts. Female sex, working for >15 h/week in a COVID-19 unit, and living apart from family were associated with a significantly higher risk of distress, anxiety, insomnia, depression, and functional impairment. Four profiles were identified on the basis of psychopathological measures: Profile_0 included 44% (N= 270); Profile_1, 25.6% (N= 157); Profile_2, 19.1% (N= 117); and Profile_3, 11.3% (N= 69) of participants. Results showed a significant effect for Profiles X IES-R (η2= 0.079;f= 0.29), indicating that in all profiles, except for Profile_0, avoidance scale is lower than hyperarousal and intrusion symptoms scales of the IES-R. This characteristic could be a probable index of the control exerted by the responders to not fly away from their job.ConclusionThe identification of specific profiles could help psychiatrists and emergency psychologists to build specific interventions in terms of both primary and secondary prevention to face future waves of the COVID-19 outbreak. (shrink)

Acute Myeloid Leukemia is a kind of fatal blood cancer with a high death rate caused by abnormal cells’ rapid growth in the human body. The usual method to detect AML is the manual microscopic examination of the blood sample, which is tedious and time-consuming and requires a skilled medical operator for accurate detection. In this work, we proposed an AlexNet-based classification model to detect Acute Myeloid Leukemia in microscopic blood images and compared its performance with LeNet-5-based model in Precision, (...) Recall, Accuracy, and Quadratic Loss. The experiments are conducted on a dataset of four thousand blood smear samples. The results show that AlexNet was able to identify 88.9% of images correctly with 87.4% precision and 98.58% accuracy, whereas LeNet-5 correctly identified 85.3% of images with 83.6% precision and 96.25% accuracy. (shrink)

BackgroundIn this article, the sources and features of moral distress as experienced by acute psychiatric care nurses are explored.Research designA qualitative design with 16 individual in-depth interviews was chosen. Braun and Clarke’s six analytic phases were used.Ethical considerationsApproval was obtained from the Norwegian Social Science Data Services. Participation was confidential and voluntary.FindingsBased on findings, a somewhat wider definition of moral distress is introduced where nurses experiencing being morally constrained, facing moral dilemmas or moral doubt are included. Coercive administration of medicines, (...) coercion that might be avoided and resistance to the use of coercion are all morally stressful situations. Insufficient resources, mentally poorer patients and quicker discharges lead to superficial treatment. Few staff on evening shifts/weekends make nurses worry when follow-up of the most ill patients, often suicidal, in need of seclusion or with heightened risk of violence, must be done by untrained personnel. Provision of good care when exposed to violence is morally challenging. Feelings of inadequacy, being squeezed between ideals and clinical reality, and failing the patients create moral distress. Moral distress causes bad conscience and feelings of guilt, frustration, anger, sadness, inadequacy, mental tiredness, emotional numbness and being fragmented. Others feel emotionally ‘flat’, cold and empty, and develop high blood pressure and problems sleeping. Even so, some nurses find that moral stress hones their ethical awareness.ConclusionMoral distress in acute psychiatric care may be caused by multiple reasons and cause a variety of reactions. Multifaceted ethical dilemmas, incompatible demands and proximity to patients’ suffering make nurses exposed to moral distress. Moral distress may lead to reduced quality care, which again may lead to bad conscience and cause moral distress. It is particularly problematic if moral distress results in nurses distancing and disconnecting themselves from the patients and their inner selves. (shrink)

Background: Positive effects of acute exercise on cognitive performances in general inspired research that investigated the effects of acute exercise on specific cognitive subdomains. Many existing studies examined beneficial effects of acute exercise on subsequent set shifting performance in healthy adults. Set shifting, a subdomain of executive function, is the ability to switch between different cognitive sets. The results of existing studies are inconsistent. Therefore, a meta-analysis was conducted that pooled available effect sizes. Additionally, moderator analyses were carried out to (...) identify covariates that determine the magnitude of exercise-induced set shifting benefits.Methods: Medline, PsycINFO, and SPORTDiscus were searched for eligible studies. Hedges' g corrected standardized mean difference values were used for analyses. Random-effects weights were applied to pool effects. Potential moderation of the effect of acute exercise on subsequent set shifting performance by exercise intensity, type of exercise, participants' age, and type of control group were examined.Results: Twenty-two studies were included into analysis. All aggregated effect sizes ranged from small to moderate. Overall, a small significant beneficial effect was revealed. Heterogeneity of included effect sizes was moderate and significant. Moderator analyses revealed a larger average effect in older adults than for studies examining younger adults. Light exercise led to larger effects than moderate or vigorous exercise. Studies testing acute exercise against active control groups showed a noticeably smaller average effect than studies that used passive or cognitive engaging control groups. Interestingly, application of resistance or aerobic exercise led to no different average effect sizes. However, none of the tested covariates reached statistical significance.Conclusion: Acute exercise improves subsequent set shifting performance. However, effect sizes are small, making the relevance for everyday life questionable. The results indicate that older adults benefit more from acute exercise than younger adults do. Light intensity exercise seems most effective while the type of exercise does not seem to influence the magnitude of effects. Research designs with active control groups show the smallest average effect, raising concerns about placebo effects.PROSPERO registration number: CRD42019138799. (shrink)

The present study aimed to investigate the effects of acute aerobic exercise on underlying neuronal activities associated with task-switching processes including both mixing and switch costs. A total of 29 healthy young adults (21.4 ±1.2 years) participated in this study. The experiment consisted of an exercise and a rest condition. In the exercise condition, participants completed 30 minutes of walking and/or jogging on a motor driven treadmill sufficient to achieve an intensity of 70% of maximum heartrate (HRmax). In the rest (...) condition, participants rested quietly for 30 minutes. Both conditions were conducted on different days, and the order was counterbalanced across participants. Participants performed the task-switching paradigm (switching between two different tasks), after both exercise and rest conditions respectively. The P3 amplitude was smaller in the non-switch trial than the single trial only in the rest condition, but not in the exercise condition. In other words, more attentional resources were allocated to the non-switch trial requiring greater amounts of working memory following the exercise condition. Mixing and switch effects on the P3 component were influenced by acute aerobic exercise. This result suggests that acute aerobic exercise may serve to facilitate the flexibility of task-set reconfiguration and maintaining the task set in working memory. Furthermore, during the switch trials, the P3 latency was shorter in the exercise condition than in the rest condition. This result is consistent with the findings of previous studies, indicating that cognitive processing speed is increased only during task conditions requiring greater amounts of executive control. Our study clearly indicates that acute aerobic exercise may facilitate cognitive flexibility as well as other executive functions (i.e., inhibitory control and working memory). (shrink)

Violence has been linked to the co-occurrence of cognitive dysfunction and altered activations in several brain regions. Empirical evidence demonstrated the benefits of acute exercise on motor inhibition and error detection and their neuronal processing. However, whether such effects also hold for the population with violent behaviors remains unknown. This study examined the effects of acute aerobic exercise on inhibitory control and error monitoring among violent offenders. Fifteen male violent offenders were counterbalanced into experimental protocols, which comprised a 30-min moderately (...) aerobic exercise [60% heart rate reserve] and a 30-min reading control session. After each session, participants performed an emotional stop signal task while event-related potentials were recorded simultaneously. Results showed insignificant changes in ERPs components [i.e., N2, P3, error-related negativity, and error-positivity amplitudes] and the behavioral performance in go condition, stop accuracy, and post-error adjustments by exercise. However, the current study demonstrated that the acute exercise facilitated stop signal reaction time when compared to the control session regardless of emotional conditions. This is the first research to exhibit the improvements in inhibitory performance by acute exercise for violent offenders. Most importantly, this effect was independent of affective settings, expanding the existing knowledge of the influences of acute exercise on cognition. Our findings implicate the perspective of acute exercise for clinical and correctional practices. (shrink)

Transcranial magnetic stimulation studies have demonstrated increased cortical facilitation and reduced inhibition following aerobic exercise, even when examining motor regions separate to the exercised muscle group. These changes in brain physiology following exercise may create favorable conditions for adaptive plasticity and motor learning. One candidate mechanism behind these benefits is the increase in brain-derived neurotropic factor observed following exercise, which can be quantified from a venous blood draw. The aim of this study was to investigate changes in motor cortex excitability (...) and inhibition of the upper limb, and circulating BDNF, following high-intensity interval training on a stationary bicycle. Nineteen sedentary adults participated in a randomized crossover design study involving a single bout of high-intensity interval cycling for 20 min or seated rest. Venous blood samples were collected, and transcranial magnetic stimulation was used to stimulate the extensor carpi radialis, where motor evoked potentials were recorded pre- and post-condition. Following exercise, there was a significant increase in corticospinal excitability measured at 120% of resting motor threshold and a reduction in short-interval cortical inhibition. There was a non-significant 23.6% increase in BDNF levels. Collectively, these results reflect a net reduction in gamma aminobutyric acid ergic synaptic transmission and increased glutamatergic facilitation, resulting in increased corticospinal excitability. This study supports the notion that acute high-intensity exercise provides a potent stimulus for inducing cortical neuroplasticity, which may support enhanced motor learning. (shrink)

This study investigated acute effects of real and imagined endurance exercise on sustained attention performance in healthy young adults in order to shed light on the action mechanisms underlying changes in cognitive functioning. The neural similarities between both imagined and physically performed movements reveal that imagery induces transient hypofrontality, whereas real exercise reflects both transient hypofrontality effects and the global release of signaling factors due to muscle contraction and the accompanying sensory feedback. We hypothesized improved cognitive functioning after both interventions (...) with greater improvements for real exercise because it targets both mechanisms. Fifty-three sport science students completed two 25-min sessions of moderate endurance exercise in either a motor imagery modality or an executed bodily activity within the framework of an order-balanced crossover study. Assessments for sustained attention performance were performed before and after each endurance exercise condition. Statistical results showed improvements for both groups over time, which can mostly be explained by retest effects. However, we observed a significant interaction effect between group and time, F = 3.64, p = 0.04, η2 = 0.07, with higher increases in the first session in case physical endurance exercise was performed compared to motor imagery exercise, t = −2.71, p = 0.09, d = 0.75. This might suggest that the release of signaling factors due to muscle contractions with sensory feedback processing is an additional mediating mechanism alongside motor-related transient hypofrontality that improves cognitive performance. (shrink)

Both daily demands as well as training and competition characteristics in sports can result in a psychobiological state of mental fatigue leading to feelings of tiredness, lack of energy, an increased perception of effort, and performance decrements. Moreover, optimal performance will only be achievable if the balance between recovery and stress states is re-established. Consequently, recovery strategies are needed aiming at mental aspects of recovery. The aim of the study was to examine acute effects of potential mental recovery strategies on (...) subjective-psychological and on cognitive performance outcomes after a mentally fatiguing task. A laboratory-based randomized cross-over study with twenty-four students was applied. Participants were run through a powernap intervention, a systematic breathing intervention, a systematic breathing plus mental imagery intervention, and a control condition with one trial a week over four consecutive weeks. Mental fatigue was induced by completion of the 60-min version of the AX-continuous performance test. The Short Recovery and Stress Scale and Visual Analog Scales were assessed to measure effects on perceptual outcomes. Cognitive performance was measured with a reaction time test of the Vienna Test System. During all three recovery interventions and CC portable polysomnography was applied. Results showed a significant increase from pre-AX-CPT to pre-MR on fatigue states and recovery-stress states indicating that the induction of mental fatigue was effective. Moreover, results underlined that analysis yielded no significant differences between recovery interventions and the control condition but they revealed significant time effects for VAS, SRSS items, and cognitive performance. However, it could be derived that the application of a rest break with 20 min of mental recovery strategies appears to enhance recovery on a mainly mental and emotional level and to reduce perceived mental fatigue. (shrink)

Research suggests that sedentary behavior is negatively associated with cognitive outcomes. Interrupting prolonged sitting has been shown to improve cognitive functions, including executive functioning, which is important for academic performance. No research has been conducted on the effect of standing on EF in VET students, who make up a large proportion of the adolescent population and who are known to sit more than other students of this age. In this study, we investigated the acute effects of reducing SB by short (...) time standing on EF in vocational education and training students. In a randomized crossover study, 165 VET students were first taught for 15 min in seated position. After this, they performed while seated the Letter Memory Test for updating, and the Color Shape Test for shifting and inhibition. Students were randomly assigned to a sitting or standing condition. All students were taught again for 15 min and then took the same tests in the condition they were allocated to, respectively, standing or seated. After 1 week, the test procedure was repeated, in which students switched conditions. Mixed model analyses showed no significant effect of sitting or standing on updating, shifting, or inhibition. Also, no significant differences were found for the order of condition on updating, shifting, or inhibition. Our results suggest that 40 min of standing does not significantly influence EF among VET students. (shrink)

The study aim was 2-fold (i) to describe and compare the in-season variations of acute: chronic workload ratio (ACWR) coupled, ACWR uncoupled, and exponentially weighted moving average (EWMA) through session-rated perceived exertion (s-RPE), total distance (TD), high-speed running distance (HSRD), and sprint distance across different periods of a professional soccer season (early, mid, and end-season) between starters and non-starters; (ii) to analyze the relationship the aforementioned measures across different periods of the season for starters and non-starters. Twenty elite soccer players (...) (mean ± SD age, 29.4 ± 4.4 y; height, 1.8 ± 0.1 m; and body mass, 74.8 ± 2.3 kg). They were divided into starter and non-starter groups and were evaluated for 20 weeks. ACWR had general changes throughout the season. At the beginning and end of the mid-season, the highest ACWR was observed in three parameters: s-RPE, TD, and HSRD. ACWR and EWMA through sprint distance were higher at the beginning of the early-season than at any other time of the season.The ACWR coupled of s-RPE shows a significant higher value for non-starters than starters (p = 0.015;g = −1.01 [−1.98, −0.09]) and the ACWR coupled of TD shows a significant higher value for starters than non-starters in early-season (p < 0.01;g = 3.01 [1.78, 4.46]) and shows a significant higher value for non-starters than starters in mid-season (p < 0.01;g = −2.52 [−3.83, −1.39]), and end-season (p < 0.01;g = −2.57 [−3.89, −1.43]). While the EWMA of TD shows a significant higher value for starters than non-starters in early-season (p < 0.01;g = 2.25 [1.17, 3.49]) and mid-season (p < 0.01;g = 2.42 [1.31, 3.71]), and shows a significant higher value for non-starters than starters in end-season (p < 0.01;g = −2.23 [−3.47, −1.16]). Additionally, we found some correlations between external and internal load measures during three periods of the in-season. The study’s main finding was that the indexes of ACWR and EWMA were useful to detect differences between period and between playing status with the exception for the sprint variable. In addition, the necessary work for non-starter players’ improvement is not done during training, and these players lose their readiness as the season progresses. Consequently, these players perform poorly during the match. Therefore, coaches and their staff should consider devising new activities to keep non-starter players physically fit. This deficit must be accounted for in training because they compete in fewer matches and have less burden than starters. (shrink)

How do we explain the coincidence of religion and madness in which prophets, founders of religions and great saints often show symptoms of an excitability that is extreme and even pathological? This book attempts to address this phenomenological problem. Richard Saville-Smith argues that 'acute religious experiences' provides a novel category to the study of the non-rational. This book provides an epidemiological approach to a crisis, which is non-veridical and non-reductionist, recognizing a predisposition due to gene variation as a perennial constant, (...) whilst affirming that culture contextualizes experiences. Informed by contemporary psychiatric theory, which is passed through the lens of mad studies, this book proposes the 'sweet-spot' of 'acute religious experiences' which express the phenomenality of madness – but where mad is good. This interdisciplinary study provides a species-wide account of interest to all disciplines that encounter such anomalies in their subjects, from fine art to psychiatry. (shrink)

Two studies employed a dissociative detachment induction technique to examine if experiences of dissociation increased acute shame feelings. Study 1 recruited college participants, while Study 2 enlisted adults attending treatment for childhood sexual abuse. Two hypotheses were explored: (1) more shame would be reported following a dissociative detachment induction than a relaxation induction; and (2) shame would increase when detachment was induced in the relationship context of a close other than when alone. Study 1 (N = 81) effectively induced detachment (...) and participants reported higher shame in this condition compared to the relaxation condition. This effect was maintained when state anxiety was controlled. The relationship context produced no impact on dissociation or shame. Attributions around feeling flawed predominantly linked detachment experiences with subsequent shame feelings. In Study 2 with clinical participants (N = 28), regression analyses showed state shame was predicted by acute detachment after controlling for state anxiety, gender, and trait shame and dissociation. The most common appraisals offered for why detachment led to feelings of shame was being flawed and exposed. Collectively, our findings suggest that increased acute shame results from detachment experiences, making more specific the relationship between shame and dissociation. (shrink)

We propose that hyper‐inflammation (HYPi) is a ‘‘runaway’’ consequence of acute inflammation (ACUi) that arises more easily (and also abates less easily) in those who host a pre‐existing chronic inflammation (CHRi), because (i) most factors involved in generating an ACUi to limit viral proliferation are already present when there is an underlying CHRi, and also because (ii) anti‐inflammatory (AI) mechanisms for the abatement of ACUi (following containment of viral proliferation) are suppressed and desensitized where there is an underlying CHRi, with (...) this causing the ACUi to spiral into a HYPi. Stress, pollution, diet, and gut microbiomes (alterable in weeks through dietary changes) have an intimate and bidirectional cause‐effect relationship with CHRi. We propose that avoidance of CHRi‐promoting foods and adoption of CHRi‐suppressing foods could reduce susceptibility to HYPi, in Covid‐19 and in other viral diseases, such as influenza, which are characterized by episodic and unpredictable HYPi. (shrink)

Behaviorally assessing residual consciousness of acutely comatose patients involves a high rate of false-negatives. That is, long-term behavioral assessment shows that 41% of vegetative state patients in fact have residual consciousness. Nonetheless, surrogates need to remove ventilation before the acute-phase passes away if they want to induce medico-legal death due to pragmatic factors, such as financial costs. So, surrogate decision-making regarding behaviorally nonresponsive acutely comatose patients involves a moral dilemma: should we ignore the chance that patients have residual consciousness for (...) the sake of pragmatic factors? This paper examines whether neural methods can resolve the moral dilemma. Neural methods are used to assess residual consciousness of behaviorally nonresponsive postcomatose patients. For instance, by instructing a vegetative state patient to imagine wiggling all of her toes, conscious- ness is ascribed if brain activities are localized in the supplementary motor area. Since the most extensive application of neural methods has been in chronic population, it is unclear whether such methods can resolve the moral dilemma. I argue that neural methods also involve a high rate of false-negatives because current tasks of neural methods are structurally misguided. Given the argument, there is no significant difference between behavioral and neural methods regarding the moral dilemma. (shrink)

Psychiatry and Religious Studies have common interests in extreme and extraordinary states when articulated in the languages of religions. For Religious Studies the problems with the category of religious experience are philosophical and profound; whilst the resurgence of interest in religion by psychiatrists (three meta-analyses in the past five years) has not repaired the damaging legacy of reductionist interpretations. In this paper I adopt an interdisciplinary approach to the religious experience discourse. From psychiatry I apply the new idea of Disruption, (...) which makes its first appearance in the US psychiatric textbook DSM-5 (APA, 2013); and the older Biopsychosocial model (Engel, 1977). From Physiology I apply the language of ‘ictal’ (Adachi, 2002, 2010) to privilege a dynamic idea of time. These concepts involve particular epistemological presuppositions and, as this is an interdisciplinary, rather than a multidisciplinary contribution, these will be critically developed. The approach I propose provides a way of holistically addressing the categories of Mysticism, Possession and Altered States of Consciousness, as acute or extreme categories of experience. I propose that the idea of ‘Disruption’ can act as a pre-interpretive placeholder for a real existential experience which might (or might not) result in a non-pathological diagnosis of religious experience. The outcome depends on the socialisation of interpretation. I hope to show that the idea that there might be alternative interpretations removes the need for a sui generis defence of religious experience. By insisting on a biopsychosocial approach within an ictal framework, a way beyond the linguistic impasse of interpretation is proposed; the essentialism, implicit in the mysticism discourse, is questioned; and the non-medicalisation of Possession confirmed. The limitations of this paper point to the opportunity for further conversations between interested parties, including people with experiences of Disruption. (shrink)

ABSTRACT:Psychedelics, including psilocybin, and other consciousness-altering compounds such as 3,4-methylenedioxymethamphetamine (MDMA), currently are being scientifically investigated for their potential therapeutic uses, with a primary focus on measurable outcomes: for example, alleviation of symptoms or increases in self-reported well-being. Accordingly, much recent discussion about the possible value of these substances has turned on estimates of the magnitude and duration of persisting positive effects in comparison to harms. However, many have described the value of a psychedelic experience with little or no reference (...) to such therapeutic benefits, instead seeming to find the experience valuable in its own right. How can we make sense of such testimony? Could a psychedelic experience be valuable even if there were no persisting beneficial effects? If so, how? Using the concept of psychological richness, combined with insights from the philosophy of aesthetics and the enhancement literature, this essay explores potential sources of value in the acute subjective experience, apart from the value derived from persisting beneficial effects. (shrink)

Acute myocardial infarction (AMI) is a common disease in the Western world and has been the topic of much research. Conducting clinical trials with patients in the acute phase of a myocardial infarction, however, poses an ethical challenge. As patients are often under extreme stress and require urgent medical attention, the process of informed consent is severely constrained. Furthermore, the very procedure of informed consent, which is supposed to protect eligible patients, may be a cause of harm in itself due (...) to the delay in the provision of therapy which it causes. This paper describes how physicians have dealt with the informed consent process in various AMI trials and summarizes the results from empirical studies of the consent process of such trials. Finally, the ethical issues and their implications for future trials involving this particular group of patients are discussed. (shrink)

In this round table response, we discuss some of the problems inherent in insisting on specific consent for an activity that needs to happen rapidly as part of a package of care. The Human Tissue Authority consider that specific consent is mandatory to assess which antibiotics are appropriate on the neonatal unit, but this insistence may actually limit the autonomy which consent aims to promote. While genetic testing to determine which child will react adversely to particular antibiotics has been available (...) clinically for several years, the research proposed here is to assess whether improving the speed of testing allows decisions to be made before treatment starts. Insisting on specific consent before this activity can take place is likely to delay appropriate care in some cases. On admission to the neonatal unit, the unwell infant is routinely subjected to a range of investigations and treatments. A person with parental responsibility will usually be asked to provide consent to undertake treatments for children who do not have capacity to give consent themselves.1 For the acutely unwell child, consent will usually be sought for a package of care: the urgent nature of neonatal medicine often requires clinicians to make many decisions without explicit consent. Doctors must always act in a child’s best interests: their decisions need to protect the health and well-being of a child and hold the child’s welfare paramount in accordance with the Children Act and General Medical Council guidelines.1 2 Thus, for example, ventilation might be initiated, sedation provided, antibiotics commenced or diagnostic investigations requested without separate consent conversations or …. (shrink)

This study examined the effects of acute stress on creative problem-solving. Thirty-five male participants underwent stress induction via the Trier Social Stress Test; another 35 male participants...

Genetic testing has historically been performed in the context of chronic disease and cancer diagnostics. The timelines for these tests are typically measured in days or weeks, rather than in minutes. As such, the concept that genetic information might be generated and then used to alter management in the acute setting has, thus far, not been feasible. However, recent advances in genetic technologies have the potential to allow genetic information to be generated significantly quicker. The m.1555A>G genetic variant is present (...) in one in 500 individuals and predisposes to profound hearing loss following the administration of aminoglycoside antibiotics. These antibiotics are used frequently in cases of neonatal sepsis and it is estimated that approximately 180 neonates in the UK are at risk of antibiotic induced hearing loss each year because of this genetic change. Knowledge of this variant in the acute setting would allow clinicians to prescribe alternative antibiotics. The Pharmacogenetics to Avoid Loss of Hearing study will implement a genetic point of care test for the m.1555A>G variant within two major UK based neonatal intensive care units. This represents the first trial of a genetic POCT aimed at altering management in the acute setting. This round table discussion outlines the novel ethical issues faced in the development of this trial and the legal barriers to implementation. We ask five stakeholders to provide their opinions on this trial and their perspectives on the concept of genetic testing in the acute setting.Trial registration numberISRCTN-13704894. (shrink)

This book showcases the best in modern medieval and religious scholarship, deploying spirited and progressive approaches to the study of Christian mysticism and the philosophy of religion. The volume explores excessive forms of desire and eroticism at play within Christian mystical texts and the historiographical, theological, and philosophical problems bound up in the interrogation of extraordinary experiences of the divine. Amy Hollywood examines how feminist and queer studies have changed the history of mysticism and how the study of religion in (...) general has altered our understanding of what is true, what is real, and what it means to research a historical subject. Ideal for novices and experienced scholars alike, this volume models cutting-edge methods for the ethical study of divine embodiment and religious experience in the Middle Ages. It makes a forceful case for thinking about religion as both belief and practice, in which traditions marked by change are passed down through generations, laying the groundwork for their own critique. Through a provocative integration of medieval sources and texts by Derrida, Butler, Asad, and Chakrabarty this book redefines what it means to engage critically with history and those embedded within it. (shrink)

Background: Physical exercises can affect executive function both acutely and chronically, with different mechanisms for each moment. Currently, only a few reviews have elaborated on the premise that different types of exercises have different mechanisms for improving executive function. Therefore, the primary purpose of our systematic review was to analyze the effects of acute and chronic exercises on executive function in children and adolescents.Objective: We identified acute and chronic exercise studies and randomized controlled trials of executive function in children and (...) adolescents that reported overall effect, heterogeneity, and publication bias of acute and chronic exercises on executive function.Methods: We searched for RCTs of exercise interventions in children and adolescents from databases including PubMed, Web of Science, Scopus, The Cochrane Library, CNKI, and Wanfang, from January 1 2009 to December 31 2019. We performed methodological quality evaluations on the included literature using the Physiotherapy Evidence Database Scale and graded evidence with a meta-analysis using Stata 12.0 software.Results: In total, 36 RCTs were included ; the overall results of the meta-analysis indicated that acute exercises significantly improved working memory = −0.72; 95% confidence interval −0.89 to −0.56; p < 0.001), inhibitory control, and cognitive flexibility, whereas chronic exercises significantly improved working memory, inhibitory control, and cognitive flexibility.Conclusion: Acute and chronic exercises can effectively improve the executive function of children and adolescents. The effects on inhibitory control and cognitive flexibility are considered as small effect sizes, while the effects on working memory are considered as moderate effect size. Limited by the quantity and quality of the included studies, the above conclusions need to be verified with more high-quality studies. (shrink)

The ideal of trust pervades nursing. This article uses empirical material from acute psychiatry that reveals that it is distrust rather than trust that is prevalent in this field. Our data analyses show how distrust is expressed in the therapeutic environment and in the relationship between nurse and patient. We point out how trust can nonetheless be created in an environment that is characterized by distrust. Both trust and distrust are exposed as `fragile' phenomena that can easily `tip over' towards (...) their opposites. Trust is not something that nurses possess or are given; it is rather something that they earn and have to work hard to achieve. Regarding themselves as potential causes of distrust and active wielders of power can contribute to nurses developing a more realistic view of their practice. Assuming a realistic middle-way perspective can help to manoeuvre between the extremities of excellence and resignation, which in turn can lead to processes that create trust between psychotic patients and nurses. (shrink)

Relationships are central to enacting person‐centred care of the older person with cognitive impairment. A fuller understanding of relationships and the role they play facilitating wellness and preserving personhood is critical if we are to unleash the productive potential of nursing research and person‐centred care. In this article, we target the acute care setting because much of the work about relationships and older people with cognitive impairment has tended to focus on relationships in long‐term care. The acute care setting is (...) characterized by archetypal constraints which differentiate it from long‐term care, in terms of acuity and haste, task‐orientated work patterns and influence from “the rule of medicine,” all of which can privilege particular types of relating. In this article, we drew on existing conceptualizations of relationships from theory and practice by tapping in to the intellectual resources provided by nurse researchers, the philosophy of Martin Buber and ANT scholars. This involved recounting two examples of dyadic and networked relationships which were re‐interpreted using two complementary theoretical approaches to provide deeper and more comprehensive conceptualizations of these relationships. By re‐presenting key tenets from the work of key scholars on the topic relationships, we hope to hasten socialization of these ideas into nursing into the acute care setting. First, by enabling nurses to reflect on how they might work toward cultivating relationships that are more salutogenic and consistent with the preservation of personhood. Second, by stimulating two distinct but related lines of research enquiry which focus on dyadic and networked relationships with the older person with cognitive impairment in the acute care setting. We also hope to reconcile the schism that has emerged in the literature between preferred approaches to care of the older person with cognitive impairment, that is person‐centred care versus relationship‐centred care by arguing that these are complementary rather than mutually exclusive and can be brought together in one theoretical framework acknowledging personhood as relational in essence. (shrink)

SCHOFIELD I, TOLSON D and FLEMING V. Nursing Inquiry 2012; 19: 165–176 [Epub ahead of print]How nurses understand and care for older people with delirium in the acute hospital: a Critical Discourse AnalysisDelirium is a common presentation of deteriorating health in older people. It is potentially deleterious in terms of patient experience and clinical outcomes. Much of what is known about delirium is through positivist research, which forms the evidence base for disease‐based classification systems and clinical guidelines. There is little (...) systematic study of nurses’ day‐to‐day practice of nursing patients with delirium. The aim was to uncover the kinds of knowledge that informs nurses’ care and to explicate the basis of that knowledge. Critical Discourse Analysis is underpinned by the premise that powerful interests within society mediate how social practices are constructed. Links were made between the grammatical and lexical features of nurses’ language about care in interviews and naturalistic settings, and the healthcare context. Care focused on the continuous surveillance of patients with delirium by nurses themselves or vicariously through other patients, and containment. Nurses influenced by major discourses of risk reduction and safety, constructed patients with delirium as risk objects. The philosophy of person‐centred and dignified care advocated in nursing literature and government policy is an emerging discourse, though little evident in the data. The current dominant discourses on safety must give space to discourses of dignity and compassion. (shrink)

Five enrolled nurses (ENs) were interviewed as part of a comprehensive investigation into the narratives of registered nurses, ENs and patients about their experiences in an acute care ward. The ward opened in 1997 and provides patient care for a period of up to three days, during which time a decision has to be made regarding further care elsewhere or a return home. The ENs were interviewed concerning their experience of being in ethically difficult care situations and of acute care (...) work. The method of phenomenological-hermeneutic interpretation inspired by the French philosopher Paul Ricoeur was used. The most prominent feature was the focus on relationships, as expressed in concern for society’s and administrators’ responsibility for health care and the care of older people. Other themes focus on how nurse managers respond to the ENs’ work as well as their relationships with fellow ENs, in both work situations and shared social and sports activities. Their reflections seem to show an expectation of care as expressed in their lived experiences and their desire for a particular level and quality of care for their own family members. A lack of time could lead to a bad conscience over the ‘little bit extra’ being omitted. This lack of time could also lead to tiredness and even burnout, but the system did not allow for more time. (shrink)