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To determine the baseline individual characteristics that predicted symptom recovery and functional recovery at 10-years following the first episode of psychosis.
AESOP-10 is a 10-year follow up of an epidemiological, naturalistic population-based cohort of individuals recruited at the time of their first episode of psychosis in two areas in the UK (South East London and Nottingham). Detailed information on demographic, clinical, and social factors was examined to identify which factors predicted symptom and functional remission and recovery over 10-year follow-up. The study included 557 individuals with a first episode psychosis. The main study outcomes were symptom recovery and functional recovery at 10-year follow-up.
At 10 years, 46.2% (n = 140 of 303) of patients achieved symptom recovery and 40.9% (n = 117) achieved functional recovery. The strongest predictor of symptom recovery at 10 years was symptom remission at 12 weeks (adj OR 4.47; CI 2.60–7.67); followed by a diagnosis of depression with psychotic symptoms (adj OR 2.68; CI 1.02–7.05). Symptom remission at 12 weeks was also a strong predictor of functional recovery at 10 years (adj OR 2.75; CI 1.23–6.11), together with being from Nottingham study centre (adj OR 3.23; CI 1.25–8.30) and having a diagnosis of mania (adj OR 8.17; CI 1.61–41.42).
Symptom remission at 12 weeks is an important predictor of both symptom and functional recovery at 10 years, with implications for illness management. The concepts of clinical and functional recovery overlap but should be considered separately.
It has long been claimed that “maltreatment begets maltreatment,” that is, a parent's history of maltreatment increases the risk that his or her child will also suffer maltreatment. However, significant methodological concerns have been raised regarding evidence supporting this assertion, with some arguing that the association weakens in samples with higher methodological rigor. In the current study, the intergenerational transmission of maltreatment hypothesis is examined in 142 studies (149 samples; 227,918 dyads) that underwent a methodological quality review, as well as data extraction on a number of potential moderator variables. Results reveal a modest association of intergenerational maltreatment (k = 80; d = 0.45, 95% confidence interval; CI [0.37, 0.54]). Support for the intergenerational transmission of specific maltreatment types was also observed (neglect: k = 13, d = 0.24, 95% CI [0.11, 0.37]; physical abuse: k = 61, d = 0.41, 95% CI [0.33, 0.49]; emotional abuse: k = 18, d = 0.57, 95% CI [0.43, 0.71]; sexual abuse: k = 18, d = 0.39, 95% CI [0.24, 0.55]). Methodological quality only emerged as a significant moderator of the intergenerational transmission of physical abuse, with a weakening of effect sizes as methodological rigor increased. Evidence from this meta-analysis confirms the cycle of maltreatment hypothesis, although effect sizes were modest. Future research should focus on deepening understanding of mechanisms of transmission, as well as identifying protective factors that can effectively break the cycle of maltreatment.
We sought to explore factors associated with depressive symptom severity among older persons (≥60 years of age) and to compare the depressive symptoms commonly experienced by older elderly (≥75 years) with those commonly experienced by younger elderly (<75 years).
Secondary analysis was conducted on data from a nationally representative survey.
Four parishes in Jamaica.
A total of 2,943 older community dwellers participated.
The survey included the Zung Self-rating Depression Scale (ZSDS), the Mini Mental State Examination (MMSE), and items on age, sex, and educational level. Linear regression analysis was used to determine the association between ZSDS score and: age, sex, MMSE score, and educational level. Logistic regression analysis was used to determine, for each ZSDS item, whether particular responses were more associated with older or younger elderly.
Higher ZSDS scores were associated with increasing age (B = 0.13, p < 0.001), lower MMSE score (B = −0.42, p < 0.001), the female sex (B = 3.52, p < 0.001), and lower educational level (B = −1.27, p < 0.001). The ZSDS items that were endorsed significantly more (p < 0.05) by older elderly related to negative evaluations about their functionality and value. Hopelessness was also more prominent among the older elderly. The items that were endorsed significantly more (p < 0.05) by the younger elderly had less of a focus.
Among older persons, increasing age was associated with marginally higher levels of depressive symptoms. Female gender, cognitive deficits, preoccupations about value and functionality, and feelings of hopelessness may serve as useful screening parameters.
Background: Identifying depressed patients unlikely to reach remission and those likely to relapse after reaching remission is of great importance, but there are few pre-treatment factors that can help clinicians predict prognosis and together these explain relatively little variance in treatment outcomes. Attentional control has shown promise in studies to date, but has not been investigated prospectively in routine clinical settings with depressed patients. Aims: This study aimed to pilot the use of a brief self-report measure of attentional control in routine care and investigate the associations between attentional control, psychological treatment response and relapse to depression up to 1 year post-treatment. Method: Depressed patients were recruited from two primary care psychological treatment (IAPT) services and completed the Attentional Control Scale (ACS) alongside routine symptom measures at every therapy session. Participants were tracked and followed up for 1 year post-treatment. Results: Baseline ACS scores were associated with remission and residual depressive symptoms post-treatment, and relapse within 12 months of ending treatment, all independent of pre-treatment depressive symptom severity, and the latter also independent of residual symptoms. Conclusion: A self-report measure of attentional control can potentially be used to predict levels of depressive symptoms post-treatment and can contribute to predicting risk of relapse to depression in IAPT services, without affecting rates of therapy completion/drop-out or data completion of standard IAPT measures. However, this pilot study had a small overall sample size and a very small number of observed relapses, so replication in a larger study is needed before firm conclusions can be made.
Neuropsychological investigations can help untangle the aetiological and phenomenological heterogeneity of schizophrenia but have scarcely been employed in the context of treatment-resistant (TR) schizophrenia. No population-based study has examined neuropsychological function in the first-episode of TR psychosis.
We report baseline neuropsychological findings from a longitudinal, population-based study of first-episode psychosis, which followed up cases from index admission to 10 years. At the 10-year follow up patients were classified as treatment responsive or TR after reconstructing their entire case histories. Of 145 cases with neuropsychological data at baseline, 113 were classified as treatment responsive, and 32 as TR at the 10-year follow-up.
Compared with 257 community controls, both case groups showed baseline deficits in three composite neuropsychological scores, derived from principal component analysis: verbal intelligence and fluency, visuospatial ability and executive function, and verbal memory and learning (p values⩽0.001). Compared with treatment responders, TR cases showed deficits in verbal intelligence and fluency, both in the extended psychosis sample (t = −2.32; p = 0.022) and in the schizophrenia diagnostic subgroup (t = −2.49; p = 0.017). Similar relative deficits in the TR cases emerged in sub-/sensitivity analyses excluding patients with delayed-onset treatment resistance (p values<0.01–0.001) and those born outside the UK (p values<0.05).
Verbal intelligence and fluency are impaired in patients with TR psychosis compared with those who respond to treatment. This differential is already detectable – at a group level – at the first illness episode, supporting the conceptualisation of TR psychosis as a severe, pathogenically distinct variant, embedded in aberrant neurodevelopmental processes.
An experiment was carried out to examine the effects of offering beef cattle five silage diets. These were perennial ryegrass silage (PRGS) as the sole forage, tall fescue/perennial ryegrass silage (FGS) as the sole forage, PRGS in a 50:50 ratio on a dry matter (DM) basis with lupin/triticale silage (LTS), lupin/wheat silage (LWS) and pea/oat silage (POS). Each of the five silage diets was supplemented with 4 and 7 kg of concentrates/head/day in a five silages × two concentrate intakes factorial design. A total of 90 cattle were used in the 121-day experiment. The grass silages were of medium digestibility and were well preserved. The legume/cereal silages had high ammonia N, high acetic acid, low lactic acid, low butyric acid and low digestible organic matter concentrations (542, 562 and 502 g/kg DM for LTS, LWS and POS, respectively). Silage treatment did not significantly affect liveweight gain, carcass gain, carcass characteristics, the instrumental assessment of meat quality or fatty acid composition of the M. longissimus dorsi muscle. In view of the low yields of the legume/cereal crops, it is concluded that the inclusion of spring-sown legume/cereal silages in the diets of beef cattle is unlikely to be advantageous.
An experiment was carried out to examine the effects of offering beef steers grass silage (GS) as the sole forage, lupins/triticale silage (LTS) as the sole forage, a mixture of LTS and GS at a ratio of 70:30 on a dry matter (DM) basis, vetch/barley silage (VBS) as the sole forage, a mixture of VBS and GS at a ratio of 70:30 on a DM basis, giving a total of five silage diets. Each of the five silage diets was supplemented with 2 and 5 kg of concentrates/head/day in a 5 × 2 factorial design to evaluate the five silages at two levels of concentrate intake and to examine possible interactions between silage type and concentrate intake. A total of 80 beef steers were used in the 122-day experiment. The GS was well preserved while the whole crop cereal/legume silages had high ammonia-nitrogen (N) concentrations, low lactic acid concentrations and low butyric acid concentrations For GS, LTS, LTS/GS, VBS and VBS/GS, respectively, silage DM intakes were 6.5, 7.0, 7.2, 6.1 and 6.6 (s.e.d. 0.55) kg/day and live weight gains were 0.94, 0.72, 0.63, 0.65 and 0.73 (s.e.d. 0.076) kg/day. Silage type did not affect carcass fatness, the colour or tenderness of meat or the fatty acid composition of the intramuscular fat in the longissimus dorsi muscle.
I consider a model in which two states choose how much to arm and whether to attack in successive periods. Arms are useful not only for deterrence or taking territory, but also because they influence the resolution of a set of disputed issues. States can cooperate on the issues by limiting military competition, but only as far as an endogenous “war constraint” allows. Factors determining the tightness of the war constraint imply hypotheses about the international determinants of military effort and thus the costs of anarchy. The strategic logic differs from standard security-dilemma arguments, in which the costs of anarchy are associated with conflict between status quo states that are uncertain about others' territorial revisionism. Here, inefficiency arises because arming to deter lowers a state's value for living with the status quo, which creates a security externality and a feedback loop. The model both synthesizes and revises a range of theoretical arguments about the determinants of interstate cooperation and conflict.
The Committee on Medical Aspects of Food Policy report Nutritional Aspects of Cardiovascular Disease recommended increased dietary intakes of the long chain polyunsaturated fatty acids eicosapentaenoic acid and docosahexaenoic acid to help protect against cardiovascular disease. There is some evidence that a-linolenic acid can be elongated and desaturated by mammalian enzyme systems to produce small amounts of eicosapentaenoic and docosahexaenoic acids. Whole linseeds are rich in a–linolenic acid, and it has been suggested that feeding this oilseed to dairy cows may result in higher levels of the long chain polyunsaturated fatty acids in bovine milk. To examine this hypothesis, the effect of feeding whole ground linseed and xylose treated whole ground linseed on the performance and milk composition of dairy cows was investigated.
Either form of whole linseed reduced dry matter intakes and milk protein concentration. The xylose treated whole linseed increased milk yield, but neither linseed source changed milk fat concentration. Levels of milk a-linolenic acid increased to 1.2 g/100 g fatty acid when whole ground linseed was fed, and to 1.5 g/100 g fatty acid with the xylose treated linseed compared with 0.7 g/100 g fatty acid for cows fed the control diet. The efficiency of incorporation of additional dietary a-linolenic acid into milk fat was estimated to be 1.6 and 3.4% for the whole ground and xylose treated whole ground linseed respectively. Feeding whole ground linseed increased the proportion of a-linolenic acid in milk fat, but there was no evidence of eicosapentaenoic and docosahexaenoic acids in milk fat, suggesting that if any elongation and desaturation of a-linolenic acid occurs in dairy cows, none is transferred to milk.
In the autumn of 1997 a butter manufacturer in Northern Ireland was approached by their principal buyer and asked to consider how the store's own brand creamery butter product could be improved in order to compete with the new spreadable butters and spreads arriving in the marketplace. In succeeding months, meetings between groups representing the dairy processing industry, animal production specialists, food scientists and animal feed manufacturers set in motion a major project aimed at managing the transfer of scientific technology into a commercial operation. Each group within the project had their own objectives and the level of risk associated with their involvement varied between the groups. However, it was undoubtedly the interaction between groups that was the most significant factor in the overall success of the project in producing a naturally spreadable creamery butter which has received extremely favourable consumer feedback.
This paper describes the steps that were taken to increase the productivity of a commercial cheese company by genetically altering the milk composition. These steps included validation of the effect of b–lactoglobulin polymorphism on casein production and cheese yield under typical New Zealand pastoral farming conditions, manufacture and ripening of cheese from single variant milks, selection of a suitable company to trial breeding for a single variant, development of a suitable payment scheme to reflect the additional value of the higher casein milk, development of a testing regime to support the payment system and getting buy–in from the company. These steps have all been taken, and the company has pursued the recommended breeding strategy for 3 years, purchased instrumentation and elected to move to the new testing and payment scheme for the current dairy season.
One hundred and thirteen Holstein Friesian heifers (PIN (95) £88 s.d. 11.1) were used in a study to determine the effect of rearing regime, in terms of diet offered and target calving weight, on milk production in high genetic merit heifers. Eighty of the heifers were supplied from 11 commercial farms, the remainder were supplied from the herd at the Agricultural Research Institute of Northern Ireland. The heifers commenced the experiment at 7 weeks of age when they were allocated on the basis of source, live weight and genetic merit to one of four rearing regimes. The target weights at calving were 540 kg (Treatment 1) and 620 kg (treatments 2, 3 and 4). Treatments 1 heifers were offered grass silage-based diets during the winter and grass–based diets during the summer. Treatment 2 heifers were offered the same forage base along with additional concentrate supplementation. Treatment 3 heifers were offered a straw/concentrate diet during the winter and grass-based diets during the summer. Treatment 4 heifers received the same diets as treatment 3, apart from the first summer period when they were housed and offered a straw/concentrate diet. The heifers were mated at 14 months of age and were returned to the 11 farms one month prior to calving. Heifers reared on treatment 1 weighed less had a lower withers height (P<0.001) and were of a lower condition score (P<0.001) before calving than heifers reared on the other treatments. During early lactation (3 months post-calving) heifers reared on treatment 1 lost less weight and condition score than the heifers reared on treatments 2, 3 and 4. Over the winter housing period (mean 140 days) the average milk yield was lower for heifers reared on treatment 1 compared with heifers reared on treatments 2 (P<0.05), 3 (P=0.08) and 4 (P<0.05). Milk protein content was higher in animals reared on treatment 1 compared with treatment 2 (P<0.01), 3 (P<0.05) and 4 (P=0.12). Overall milk fat plus protein yield was lower for heifers reared on treatment 1 compared with treatments 2 (P<0.05), 3 (P=0.06) and 4 (P<0.05).
Genetic improvement is constrained by the long-term and cumulate nature of genetic improvement, by the economic rewards for making genetic change and by the variances and covariances among traits of interest. Genetic change is cumulate, so that small annual changes make substantial differences over time. This cumulate nature of genetic improvement dictates the importance of identifying long-term goals driven by robust economic signals and then adhering to them. The economic rewards for genetic improvement will ultimately determine the uptake and therefore the success of any breeding program. In developed countries the value of milk can be divided between the weight of water, fat and protein produced. Water generally has a negative value due the cost of handling, removal and disposal. Fat and protein have varying values depending on the market, but both will always have underlying positive values. Genetic variances and covariances among the aggregate composition traits, water, fat and protein, are such that simultaneous increase in the yield of all three is considerably easier than improvement of just one, or improvement of one while decreasing others. Selection for simultaneous increase of fat and protein percentage will also be successful, but at the price of not increasing fat and protein yield nearly as rapidly as when selecting directly on yield traits. In virtually all developed countries, the optimum selection goal will be for some combination of increased fat and protein yield that may lead to a gradual increase in the protein to fat ratio. Genetic polymorphisms in several protein genes have been associated with yield and with milk processing properties, but are unlikely to play more than a minor role in overall selection. There is some evidence of genetic variation in milk fat composition, but the level of variation and economic incentives for change mean that selection for milk fat composition is not worthwhile. Thus, with the exception of very slow changes in the water to fat to protein yield ratio, genetic improvement does not seem a particularly suitable route for altering milk composition.
Mycobacterium paratuberculosis is the known cause of Johne's disease in cattle and has been implicated as a cause of Crohn's disease in humans. Concern has been expressed that the organism, which is excreted in milk and faeces of infected cattle, may be transmitted via pasteurised milk. This is largely from work that has shown an unacceptable risk of survival of the organism when it is present in raw milk at numbers exceeding 102 cfu/ml. Three possible reasons for this apparent heat resistance were investigated viz. use of a milk heating menstruum, presence of a heat resistant sub–population, and the tendency of the organism to form clumps. Heat resistance studies using a combined acid–fast/viability stain, and a comparison of the relative heat sensitivities of clumped and de-clumped M. paratuberculosis cells provided circumstantial evidence that it is the organism's tendency to form clumps which confers the apparent heat resistance. This work casts doubt on the efficacy of current commercial pasteurisation heat treatments (72°C/15s) for the inactivation of M. paratuberculosis. This would be of concern if a link between M. paratuberculosis and Crohn's disease is eventually established.
Dietary manipulation of milk fat content and/or fatty acid composition is becoming a feasible, and for certain niche–markets, attractive means of boosting the nutritive value and acceptability of milk and its secondary products. However it is not yet possible to indicate equivalent ways of manipulating milk protein content and/or composition. This paper will consider current knowledge on milk protein biosynthesis and the opportunities for nutritional manipulation. Recent infusion studies which have linked changes in mammary amino acid metabolism with changes in milk protein content will be examined in an attempt to elucidate key features of the metabolic regulation of the dairy cow which need to be addressed if the British consumer is to have the choice of higher protein (possibly designer protein) milk products. This review will (in part) utilise data from a joint project at the Rowett Institute and Reading University funded by a consortium comprising government (MAFF, BBSRC and SOAEFD) and agribusiness (MDC, Purina Mills and Hendrix).
A technology transfer project has been set up to demonstrate management techniques to help raise the weighted average annual milk protein concentration to 36 g/kg in a cost effective manner using feeding, breeding and management techniques over a period of five years. A herd of autumn calving Holstein/Friesian cows was selected for the project on the basis of performance records and a number of commercial farms were selected for demonstration and benchmarking purposes. Methods which have been employed to improve milk protein include the use of extended grazing, improvements in silage quality, the use of specifically formulated concentrate supplements and the development of a breeding strategy designed to improve milk protein. Herd performance currently stands at 34.2 g/kg milk protein. Improvements in protein content to date have coincided with improvements in silage quality, the early introduction of grazed grass and the use of a specifically formulated concentrate. To date heifers entering the herd have not improved milk protein content. However, this appears to have been a result of the breeding policy adopted prior to the start of the project. Farmers have been able to develop their own competencies and management skills through project features on the Internet, in press articles, during visits to Greenmount College and through John Thompson and Sons Technical Department.