Global mental health as a component of psychiatric residency training.

This study seeks to assess the educational value of an international psychiatry elective using a cross section of psychiatric residents. In 2010, a 10-item semi-structured questionnaire was administered to Mount Sinai psychiatric residents who have participated in the Global Health Residency Track of the Mount Sinai School of Medicine. Authors reviewed the qualitative data and arrived at a consensus regarding trends and deviations regarding residents' experiences of their international field work. Six residents participated in this study. Common themes included exposure to sicker, treatment-naïve patients in resource scarce conditions, enhancement of cross-cultural communications skills, renewed appreciation for psychiatry, empowerment as teachers, and greater awareness of health-care systems. Knowing that an international elective existed would be a significant factor in their choice of residency. Respondents had concerns for the sustainability. Participants felt that the elective was a place to consolidate skills already learned during residency and resulted in increased professional confidence although it did not necessarily alter career paths. International electives can enrich psychiatric residency training in terms of understanding of mental health care systems, cross cultural psychiatry, sharpening diagnostic skills, building professional confidence and communication skills, and reaffirming motivation to practice psychiatry.

Electrode placement in electroconvulsive therapy (ECT): A review of the literature.

Electrode placement in electroconvulsive therapy affects both the efficacy and adverse cognitive effect profile of the treatment. For many years, 2 placements, bitemporal (also referred to as "bifrontotemporal" or simply "bilateral") and right unilateral, were the principal placements in widespread clinical use. More recently, bifrontal placement has joined their ranks as a commonly used placement. In this article, we review the evidence base for the efficacy and safety of each of these electrode placements for the indication of depression, describe another novel placement, and then draw conclusions from this available evidence base, pointing out areas in need of further study.

Assessment of temporal trends in ecosystem health using an holistic indicator.

The Ecosystem Approach to environmental management, with its explicit acknowledgment of the environmental, social and economic elements within ecological systems, is becoming increasingly adopted by managers and policy makers. However, there are few specific prescriptions as to exactly how these different elements should be integrated, or examples where historical changes have been tracked. Here, we assess the potential benefits and challenges of applying an Ecosystem Approach to management using one particular method, the Holistic Ecosystem Health Indicator (HEHI), which integrates data from the ecological, social and interactive dimensions into a single composite index of ecosystem 'health'. We apply it to one of the best-documented catchments in the UK, the Ythan Estuary in Aberdeenshire, Scotland, based on a 50-year time series of data. The evaluation of ecosystem health over time is lacking in previous applications of HEHI, yet is crucial for the assessment of the utility of this approach to ecosystem management. The application of HEHI yielded different insights to those revealed from the traditional application of biophysical approaches for managing the Ythan. Overall, ecological health declined through the 50-year period, although it increased marginally in the last decade, while social and interactive dimensions followed the opposite trend. HEHI indicated a steady increase in ecosystem health overall except for the last decade, when it declined marginally. Our evaluation of the application of ecosystem health for the Ythan revealed major data gaps. For the approach to be used more widely, issues of data availability and the temporal and geographical mismatch between ecological and social research boundaries need to be overcome.