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Bipolar disorder is a chronic mental health condition, which can result in functional impairment despite medication. A large evidence base supports use of psychological therapies and structured care in the treatment of mood disorders, but these are rarely implemented. e-Pathways are digital structures that inform and record patient progress through a healthcare system, although these have not yet been used for bipolar disorder.
To assess the perceived benefits and costs associated with implementing a collaborative NICE-informed e-pathway for bipolar disorder.
Healthcare professionals and people with bipolar disorder attended a workshop to share feedback on e-pathways. Data were collected through questionnaires (n = 26) and transcription of a focus group, analysed qualitatively by a framework analysis.
Patients and healthcare professionals welcomed the development of an e-pathway for bipolar disorder. There were five elements to the framework: quality and delivery of care, patient–clinician collaboration, flexibility and adaptability, impact on staff and impact on healthcare services.
Identification of benefits and costs ensures that future development of e-pathways addresses concerns of healthcare professionals and people with bipolar disorder, which would be essential for successful implementation. Recommendations for this development include making e-pathways less complicated for patients, ensuring sufficient training and ensuring clinicians do not feel their skills become invalidated. Limitations of the study, and directions for future research, are discussed.
The study of prosocial behavior has been an active area of research in social psychology that dates back to the beginnings of the last century. (For a review see Penner et al., 2005,) This large body of literature includes a diverse range of phenomena centering around the origins and tendencies of humans helping other humans, including traits such as empathy. In psychology the term “prosocial behavior” is typically used to indicate a behavior that provides benefit to another person. However, this same term, and all that it implies, has been increasingly applied to nonhuman vertebrate animal behavior and the neural mechanisms regulating these behaviors. It is within this latter context that the term prosocial has been used rather loosely with no clear definitions provided.
High dietary phosphorus (P), particularly soluble salts, may contribute to chronic kidney disease development in cats. The aim of the present study was to assess the safety of P supplied at 1 g/1000 kcal (4184kJ) from a highly soluble P salt in P-rich dry format feline diets. Seventy-five healthy adult cats (n 25/group) were fed either a low P control (1·4 g/1000 kcal [4184kJ]; Ca:P ratio 0·97) or one of two test diets with 4 g/1000 kcal (4184 kJ); Ca:P 1·04 or 5 g/1000 kcal (4184kJ); Ca:P 1·27, both incorporating 1 g/1000 kcal (4184 kJ) sodium tripolyphosphate (STPP) – for a period of 30 weeks in a randomised parallel-group study. Health markers in blood and urine, glomerular filtration rate, renal ultrasound and bone density were assessed at baseline and at regular time points. At the end of the test period, responses following transition to a commercial diet (total P – 2·34 g/1000 kcal [4184kJ], Ca:P 1·3) for a 4-week washout period were also assessed. No adverse effects on general, kidney or bone (skeletal) function and health were observed. P and Ca balance, some serum biochemistry parameters and regulatory hormones were increased in cats fed test diets from week 2 onwards (P ≤ 0·05). Data from the washout period suggest that increased serum creatinine and urea values observed in the two test diet groups were influenced by dietary differences during the test period, and not indicative of changes in renal function. The present data suggest no observed adverse effect level for feline diets containing 1 g P/1000 kcal (4184 kJ) from STPP and total P level of up to 5 g/1000 kcal (4184 kJ) when fed for 30 weeks.
This paper sheds new light on the drivers of civil service reform in US states. We first demonstrate theoretically that divided government is a key trigger of civil service reform, providing nuanced predictions for specific configurations of divided government. We then show empirical evidence for these predictions using data from the second half of the 20th century: states tended to introduce these reforms under divided government, and in particular when legislative chambers (rather than legislature and governor) were divided.
Establishing an evidence base for the clinical management of catatonia is made difficult by the heterogeneous nature of the condition and the limited understanding of its pathophysiology. Benzodiazepines are a mainstay of treatment. The Cochrane review discussed identified only one eligible study (17 participants with catatonia who received either lorazepam or oxazepam), which found no difference on the single outcome measure (a 50% improvement on a visual analogue scale). This commentary discusses the findings in more detail, and considers what constitutes high-quality evidence for the acute treatment of catatonia, why there is such a paucity of randomised controlled trials (RCTs) on the topic and whether RCTs are both feasible and appropriate for the condition.
For a number of years there has been nothing at all unusual about the United Kingdom finding itself in a state of constitutional upheaval; indeed, for some time, this has been the UK constitution’s default setting. This has sometimes been as a result of long-anticipated and carefully planned reforms, such as the enactment, in the late 1990s, of legislation to give domestic effect to the European Convention on Human Rights and to introduce devolved systems of government in Scotland, Wales and Northern Ireland. In contrast, more recent upheaval is attributable to often unexpected reactions to often unexpected events. For example, legislation making substantial changes to the devolution scheme in Scotland – providing, among other things, for the constitutional permanence of the Scottish Parliament and Government – was enacted to implement panicked promises made by UK politicians in the dying days of the Scottish independence referendum campaign, at which point a vote in favour of independence seemed a distinct possibility. And then, needless to say, there is Brexit – about which it is almost impossible to be guilty of hyperbole when describing its constitutional implications, so numerous and potentially far-reaching are they.
Individuals with schizophrenia are at higher risk of physical illnesses, which are a major contributor to their 20-year reduced life expectancy. It is currently unknown what causes the increased risk of physical illness in schizophrenia.
To link genetic data from a clinically ascertained sample of individuals with schizophrenia to anonymised National Health Service (NHS) records. To assess (a) rates of physical illness in those with schizophrenia, and (b) whether physical illness in schizophrenia is associated with genetic liability.
We linked genetic data from a clinically ascertained sample of individuals with schizophrenia (Cardiff Cognition in Schizophrenia participants, n = 896) to anonymised NHS records held in the Secure Anonymised Information Linkage (SAIL) databank. Physical illnesses were defined from the General Practice Database and Patient Episode Database for Wales. Genetic liability for schizophrenia was indexed by (a) rare copy number variants (CNVs), and (b) polygenic risk scores.
Individuals with schizophrenia in SAIL had increased rates of epilepsy (standardised rate ratio (SRR) = 5.34), intellectual disability (SRR = 3.11), type 2 diabetes (SRR = 2.45), congenital disorders (SRR = 1.77), ischaemic heart disease (SRR = 1.57) and smoking (SRR = 1.44) in comparison with the general SAIL population. In those with schizophrenia, carrier status for schizophrenia-associated CNVs and neurodevelopmental disorder-associated CNVs was associated with height (P = 0.015–0.017), with carriers being 7.5–7.7 cm shorter than non-carriers. We did not find evidence that the increased rates of poor physical health outcomes in schizophrenia were associated with genetic liability for the disorder.
This study demonstrates the value of and potential for linking genetic data from clinically ascertained research studies to anonymised health records. The increased risk for physical illness in schizophrenia is not caused by genetic liability for the disorder.
Abnormal processing of social feedback is an important contributor to social dysfunction in depression, however the exact mechanisms remain unclear. One important factor may be the extent to which social processing depends on expectations, in particular whether social feedback confirms or violates expectations.
To answer this question, we studied behavioral and brain responses during the evaluative processing of social feedback in 25 individuals with subthreshold depression (SD) and 25 healthy controls (HCs). Participants completed a Social Judgment Task in which they first indicated expectation about whether a peer would like them or not, and then received peer's feedback indicating acceptance or rejection.
Individuals with SD who reported greater depressive symptoms gave fewer positive expectations. Compared to HCs, individuals with SD showed reduced activation in the medial prefrontal cortex when expecting positive feedback. They also exhibited increased dorsal anterior cingulate cortex after receipt of unexpected social rejection, and reduced ventral striatum activity after receipt of unexpected social acceptance.
The observed alternations are specific to unexpected social feedback processing and highlight an important role of expectancy violation in the brain dysfunction of social feedback perception and evaluation in individuals at risk for depression.
This study investigates children's real time incrementation of language change as it is impacted by community-wide patterns of linguistic variability. The investigation combines apparent time analyses across an age-stratified sample of adult speakers, with real time analyses across a panel of speakers spanning childhood to adolescence. Three variables are analysed: GOOSE-fronting, a socially unmarked change; TH-fronting, a socially stigmatised, rapidly expanding change; and T-glottaling, a socially stigmatised, steadily shifting change. Variables are selected based on their social and generational profiles which present learners with more or less challenging community patterns to extract. Real time analyses confirm that community variance impacts on speakers’ ability to increment change in real time. Findings provide support for the momentum-based model of language change and builds on Labov's (2012:267) theory of the ‘outward orientation’ of children, which views learners as capable of extracting age vectors from generational differences. (Language change, incrementation, real time, GOOSE-fronting, TH-fronting, T-glottaling)*
We derive and analyse an energy to model lipid raft formation on biological membranes involving a coupling between the local mean curvature and the local composition. We apply a perturbation method recently introduced by Fritz, Hobbs and the first author to describe the geometry of the surface as a graph over an undeformed Helfrich energy minimising surface. The result is a surface Cahn–Hilliard functional coupled with a small deformation energy. We show that suitable minimisers of this energy exist and consider a gradient flow with conserved Allen–Cahn dynamics, for which existence and uniqueness results are proven. Finally, numerical simulations show that for the long-time behaviour raft-like structures can emerge and stabilise, and their parameter dependence is further explored.
The past decade has witnessed an intensification of research into the use of pottery by hunter-gatherers. Long viewed by Western scholars as a marginal practice among these groups, pottery production is now known to have been widespread among prehistoric hunter-gatherers, many of whom practised no other activities associated with agriculture. In emphasising the centrality of ceramics to these communities, however, we risk marginalising those who did not adopt pottery. Here, the authors critically examine a series of different models proposed for hunter-gatherer pottery innovation and adoption within the context of the aceramic communities who inhabited Britain and Ireland during the fifth millennium cal BC.
Does a leader's ethnicity affect the regional distribution of basic services such as education in Africa? Several influential studies have argued in the affirmative, by using educational attainment levels to show that children who share the ethnicity of the president during their school-aged years have higher attainment than their peers. In this paper we revisit this empirical evidence and show that it rests on problematic assumptions. Some models commonly used to test for favouritism do not take adequate account of educational convergence and once this is properly accounted for the results are found to be unstable. Using Kenya as a test case, we argue that there is no conclusive evidence of ethnic favouritism in primary or secondary education, but rather a process of educational convergence among the country's larger ethnic groups. This evidence matters, as it shapes how we understand the ethnic calculus of politicians.
The global loss of biodiversity is one of the most important challenges facing humanity, and a multi-faceted strategy is needed to address the size and complexity of this problem. This paper draws on scholarship from the philosophy of science and environmental ethics to help address one aspect of this challenge: namely, the question of how to frame biodiversity loss in a compelling manner. The paper shows that the concept of biodiversity, like many scientific concepts, is value-laden in the sense that it tends to support some ethical or social values over others. Specifically, in comparison with other potential concepts, the biodiversity concept is tied more closely to the notion that nature has intrinsic value than to the idea that nature is valuable instrumentally or relationally. Thus, alternative concepts could prove helpful for communicating about biodiversity loss with those who emphasize different value systems. The paper briefly discusses five concepts that illustrate the potential for using different concepts in different contexts. Going forward, conservationists would do well to recognize the values embedded in their language choices and work with social scientists to develop a suite of concepts that can motivate the broadest swath of people to promote conservation.
This paper provides evidence of racial variation in traffic enforcement responses to local government budget stress using data from policing agencies in the state of Missouri from 2001 through 2012. Like previous studies, we find that local budget stress is associated with higher citation rates; we also find an increase in traffic-stop arrest rates. However, we find that these effects are concentrated among White (rather than Black or Latino) drivers. The results are robust to the inclusion of a range of covariates and a variety of model specifications, including a regression discontinuity examining bare budget shortfalls. Considering potential mechanisms, we find that targeting of White drivers is higher where the White-to-Black income ratio is higher, consistent with the targeting of drivers who are better able to pay fines. Further, the relative effect on White drivers is higher in areas with statistical over-policing of Black drivers: when Black drivers are already getting too many fines, police cite White drivers from whom they are presumably more likely to be able to raise the needed extra revenue. These results highlight the relationship between policing-as-taxation and racial inequality in policing outcomes.
CHD remains one of the leading causes of mortality of children in the United States. There is limited research about the experience of parents from the diagnosis of their child with CHD through the death of their child. A prior study has shown that adults with heart failure go through a series of four transitions: 1) learning the diagnosis, 2) reframing the new normal, 3) taking control of the illness, and 4) understanding death is inevitable. In our qualitative study, we performed semi-structured interviews with parents who have a child die of CHD to determine whether the four transitions in adults apply to parents of children with CHD. We found that these four transitions were present in the parents we interviewed and that there were two novel transitions, one that proceeded the first Jones et al transition (“Prenatal diagnosis”) and one that occurred after the final Jones et al transition (“Adjustment after death”). It is our hope that identification of these six transitions will help better support families of children with CHD.