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Aims: Following the recent passage of the Terminally Ill Adults (End of Life) Bill (2024) through UK Parliament, we set out to understand the views of psychiatrists towards assisted dying and the nature of their education in this area. Methods: We selected 2 previous surveys. Using a pragmatic group, we developed a survey based on previously used questionnaires in this area. We gathered demographic data including religious affiliation, and country of primary medical qualification. We surveyed 44 psychiatrists in total. Results: 27% had experience of undergraduate education on assisted dying euthanasia while 11% postgraduate education. We adapted a survey form to measure attitudes towards euthanasia, giving a score out of 16. 31% scored 0 (with very positive attitudes to euthanasia), 11% scored 16 (very negative), and the median was 2. Participants with negative attitudes to euthanasia had a higher degree of religiosity, were more likely to train outside of the UK, but had similar age distribution to the general population. The second part of the survey looked at euthanasia in psychiatric patients. Only 14% agreed that it should be allowed for psychiatric illnesses, with 27% unsure and 59% opposed. The most acceptable statement (86% agreement) was that psychiatric patients can find themselves in a medically hopeless situation. 75% agreed that psychiatric patients could suffer unbearably. 70% agreed that psychiatric patients may run out of treatment options. Participants opposed to euthanasia also opposed it in psychiatric patients. They were more likely to doubt the above statements, but only one participant disagreed with all statements. Most disagreed with the statement that “a death request can be well-regarded and considered not only as a symptom of illness” (66%). Of participants in favour of euthanasia in general, 42% said they were unsure of legalising euthanasia for psychiatric patients, while 21% were opposed. This group was more uncertain of the statement that “euthanasia assessment can be compatible with psychotherapeutic relationship” (50% disagreed or unsure). Most participants had little education in this area. International Medical Graduates and those self-described as religious were more likely to have negative perceptions of assisted dying in general. While there was agreement that suffering from mental illness could be unbearable, very few supported euthanasia for mental illness alone. Conclusion: There is a notable lack of education on euthanasia at both undergraduate and postgraduate levels which is known to have a strong influence on attitudes to assisted dying. There are aspects in medical ethics and medical law which need to be incorporated into curricula for medical training.

Deliver advanced functionality faster and cheaper by exploiting SQL Server's ever-growing amount of built-in support for modern data formats. Learn about the growing support within SQL Server for operations and data transformations that have previously required third-party software and all the associated licensing and development costs. Benefit through a better understanding of what can be done inside the database engine with no additional costs or development time invested in outside software. Widely used types such as JSON and XML are well-supported by the database engine. The same is true of hierarchical data and even temporal data. Knowledge of these advanced types is crucial to unleashing the full power that's available from your organization's SQL Server database investment. SQL Server Advanced Data Types explores each of the complex data types supplied within SQL Server. Common usage scenarios for each complex data type are discussed, followed by a detailed discussion on how to work with each data type. Each chapter demystifies the complex data and you learn how to use the data types most efficiently. The book offers a practical guide to working with complex data, using real-world examples to demonstrate how each data type can be leveraged. Performance considerations are also discussed, including the implementation of special indexes such as XML indexes and spatial indexes. What You'll Learn: Understand the implementation of basic data types and why using the correct type is so important Work with XML data through the XML data type Construct XML data from relational result sets Store and manipulate JSON data using the JSON data type Model and analyze spatial data for geographic information systems Define hierarchies and query them efficiently through the HierarchyID type.

AimsInternational medical graduates (IMG) are an important and integral part of the NHS workforce. The 2022 General medical council (GMC) Workforce Report showed that of the doctors who joined the workforce in 2021, half (50%) were IMGs and 39% UK graduates. This report also emphasized the need for better inclusion and support for IMGs in order to enhance future retention.With this conference we aimed to empower IMGs and their educators with tools and knowledge to better recognize and help mitigate the challenges that IMGs endure whilst working in NHS. We discussed about the factors affecting IMG career progression, wellbeing, and ways to overcome them.MethodsIt was a one-day conference targeted to the PAN-London cohort of IMGs and their educators of medical and surgical specialties. The programme included distinguished speakers from all branches of medical fraternity, the GMC and medical indemnity organisations. Five poster submissions were also selected to be presented on the day. The programme started with IMG consultants describing personal challenges and success stories with a focus on long-term NHS equality diversity inclusion plan. This was followed by an invigorating ‘Schwartz round’ wherein attendees were able to engage in open and reflective discussions of shared experiences in transition to the United Kingdom. The latter half of the day included workshops on mitigating differential attainment and medico-legal aspects of clinical practice. The conference was concluded by an informative discussion led by the head of GMC London.ResultsThe conference was well-attended with 94 attendees present on the day. The audience encompassed a varied set of professionals including medical education managers, directors of medical education, educational supervisors and IMG doctors of all grades and specialties across different London trusts. The feedback was overwhelmingly positive with all the respondents in agreement that the learnings from the conference were relevant to their professional needs. The qualitative response from the attendees in summary was that conferences of a similar agenda and focus should be organized in the future as well.ConclusionHistorically, there is clear evidence in literature that IMGs have lower success rates in both job and training progression, in comparison to British medical graduates. By organizing such conferences, the endeavor is to kick start a productive dialogue between IMGs and their educators, to target more favorable and successful overall outcomes, on a long-term basis. We hope that this initiative sets the building blocks for the way of the future.

Aims: We hypothesise that mental health impacts of flooding will be greater in India compared with the UK. Climate change is causing an increase in flooding due to the rising frequency of extreme weather patterns globally. The major impacts of flooding on mental health include displacement, financial hardship, and loss of access to healthcare. These can lead to conditions such as anxiety, depression, and post-traumatic stress disorder (PTSD). Methods: This study was conducted as a comparative analysis. Data was collected by a systematic search of peer-reviewed articles. Standardised tools were used to evaluate psychological outcome and mental health morbidities such as the Generalised Anxiety Disorder scale (GAD-7), Patient Health Questionnaire (PHQ-9), WHO-5 and the PTSD checklist (PCL-6). Data concerning the mental health consequences caused by the floods (specifically regarding anxiety, depression and PTSD), financial impacts and access to mental health services in both countries were extracted. Our findings were then thematically analysed to compare the patterns and disparities. Results: In both countries, the research conducted on the effects of flooding on mental health has identified that the three main mental health morbidities that arose are depression, anxiety and PTSD. India has an average percentage of 43.2% depression, 32.19% anxiety and 36.46% PTSD amongst individuals affected by flooding, while the UK shows equivalent rates of 25.52% depression, 24.2% anxiety and 31.49% PTSD. These results suggest that socioeconomic differences and access to mental health resources play a significant role in post-flood psychological states. In both countries a larger financial impact links to higher rates of psychological stress. Conclusion: Although effects are noted in both the UK and India, the prevalence of mental health conditions arising from flooding affect both the UK and India. However, our findings indicate that the mental health impacts are more severe in India, supporting our hypothesis. In disaster recovery, mental health funding is frequently deprioritised in favour of immediate concerns such as physical health and infrastructure. Stigma surrounding mental health, particularly affecting developing countries, contributes to under-reporting and therefore the accuracy of assessments. To improve outcomes, a public health approach may destigmatise mental health, and enhance social support. Additionally, Psychological First Aid has set international foundations for psychosocial care following distressing events, a framework which supports people whilst respecting culture and abilities.

This study investigates how the use of a Hitman ST300 acoustic sensor can help identify the best forest stands to be used as supply sources for the production of Machine Stress-Rated (MSR) lumber. Using two piezoelectric sensors, the ST300 measures the velocity of a mechanical wave induced in a standing tree. Measurements were made on 333 black spruce (Picea mariana (Mill.) BSP) trees from the North Shore region, Quebec (Canada) selected across a range of locations and along a chronosequence of elapsed time since the last fire (TSF). Logs were cut from a subsample of 39 trees, and sawn into 77 pieces of 38 mm × 89 mm cross-section before undergoing mechanical testing according to ASTM standard D-4761. A linear regression model was developed to predict the static modulus of elasticity of lumber using tree acoustic velocity and stem diameter at 1.3 m above ground level (R2 = 0.41). Results suggest that, at a regional level, 92% of the black spruce trees meet the requirements of MSR grade 1650Fb-1.5E, whilst 64% and 34% meet the 2100Fb-1.8E and 2400Fb-2.0E, respectively. Mature stands with a TSF < 150 years had 11 and 18% more boards in the latter two categories, respectively, and therefore represented the best supply source for MSR lumber.

Aims: Extreme weather events refer to weather events that are dramatically different from typical patterns. These can be catastrophic, unexpected and pose a risk to the population. This review aims to examine whether sufficient evidence exists to demonstrate a link between extreme weather events and an increase in mental health conditions, specifically PTSD, anxiety, and depression. Methods: We conducted a literature search across multiple electronic databases, including PubMed, Web of Science, Scopus, and PsycINFO, for articles published between January 2000 and January 2025. Keywords include Extreme weather; Mental health; Depression; Anxiety; Post traumatic stress disorder. From this we used four articles reporting quantitative data on the prevalence of mental health conditions in those exposed to extreme weather events. The selection of these four articles is justified based on the relevance to our research question. They provide figures which allow us to compare mental health prevalence before and after extreme weathers took place. Furthermore, they offer a vast array of data, from various populations to weather patterns, enabling us to conduct more thorough research. Results: All four studies reported a rise in PTSD, anxiety, depression following extreme weather events like floods, heatwaves, and wildfires. A meta-analysis of surveys that targeted people who had been affected by floods in the previous 12 months found that the prevalence rates of anxiety (25.2%), depression (26.3%), and PTSD (30.4%) were generally higher in this group than in the overall population. The prevalence of anxiety (5.7%) and PTSD (7.8%) in the overall population was considerably lower than this. In contrast, depression did not experience such a large spike (20.6%). However, a cross-sectional analysis aiming to assess the relationship between flooding and psychological morbidity concluded that those experiencing cumulative and repeated exposure to extreme weather events such as flooding had a significant increased risk of developing depression but did not impact the levels of anxiety or PTSD. Two studies highlighted vulnerable groups including older adults and those with pre-existing mental health conditions are more susceptible to experience deteriorating symptoms. Conclusion: Overall, there is sufficient evidence to highlight the strong association between extreme weather leading to an increase in prevalence of mental health conditions. These findings emphasize the urgent need for mental health support and early intervention strategies for the communities affected.

Few subjects in European welfare history attract as much attention as the nineteenth-century English and Welsh New Poor Law. Its founding statute was considered the single most important piece of social legislation ever enacted, and at the same time, the coming of its institutions – from penny-pinching Boards of Guardians to the dreaded workhouse – has generally been viewed as a catastrophe for ordinary working people. Until now it has been impossible to know how the poor themselves felt about the New Poor Law and its measures, how they negotiated its terms, and how their interactions with the local and national state shifted and changed across the nineteenth century. In Their Own Write exposes this hidden history. Based on an unparalleled collection of first-hand testimony – pauper letters and witness statements interwoven with letters to newspapers and correspondence from poor law officials and advocates – the book reveals lives marked by hardship, deprivation, bureaucratic intransigence, parsimonious officialdom, and sometimes institutional cruelty, while also challenging the dominant view that the poor were powerless and lacked agency in these interactions. The testimonies collected in these pages clearly demonstrate that both the poor and their advocates were adept at navigating the new bureaucracy, holding local and national officials to account, and influencing the outcomes of relief negotiations for themselves and their communities. Fascinating and compelling, the stories presented in In Their Own Write amount to nothing less than a new history of welfare from below.

Drowning is a newly comprehended public health concern in Fiji. Defined as \"the process of experiencing respiratory impairment from submersions or immersion in liquid,\" drowning has been identified as one of Fiji's 5 leading causes of death for those aged 1 to 29 years. The aim of this article was to develop the most parsimonious model that can be used to explain the number of monthly fatal drowning cases in Fiji. Based on a cross-section of 187 drowning incidents from January 2012 to April 2015, this observational study found the number of monthly drownings in Fiji was significantly affected by monthly rainfall ( P = .008, 95% confidence interval = 0.10-0.62) and the number of days comprising public holidays/weekends ( P = .018, 95% confidence interval = 0.06-0.60). Furthermore, the multiple coefficient of determination ( r = .4976) indicated that almost half the variation in drownings was explained by rainfall and public holidays/weekend periods. Inadequate supervision, an inability to identify or carry out safe rescue techniques, and limited water-safety knowledge were identified as common risk factors. To overcome this preventable cause of death, technically guided interventions need to be actively embedded into a range of government policies and community health promotions, disaster management, and education programs.