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The SCIMITAR+ trial was commissioned to evaluate the effectiveness of a bespoke smoking cessation intervention for people with severe mental ill health compared with usual services. It is difficult to define what constitutes usual care in smoking cessation services. We aimed to define what this was during the trial. Twenty-two National Health Service healthcare providers participated in a bespoke survey asking about usual care in their area.
All sites offered smoking cessation support; however, service provider and service type varied substantially. In some cases services were not streamlined, meaning that people received smoking cessation counselling from one organisation and smoking cessation medication from another.
To better implement the National Institute for Health and Care Excellence guideline PH48, clearer referral pathways need to be implemented and communicated to patients, staff and carers. People with severe mental ill health need to be able to access services that combine nicotine replacement therapy and behavioural support in a streamlined manner.
Background: Cervical spondylotic myelopathy (CSM) is the leading cause of spinal cord impairment. In a public healthcare system, wait times to see spine specialists and eventually access surgical treatment for CSM can be substantial. The goals of this study were to determine consultation wait times (CWT) and surgical wait times (SWT), and identify predictors of wait time length. Methods: Consecutive patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN) prospective and observational CSM study from March 2015 to July 2017 were included. A data-splitting technique was used to develop and internally validate multivariable models of potential predictors. Results: A CSORN query returned 264 CSM patients for CWT. The median was 46 days. There were 31% mild, 35% moderate, and 33% severe CSM. There was a statistically significant difference in median CWT between moderate and severe groups; 207 patients underwent surgical treatment. Median SWT was 42 days. There was a statistically significant difference in SWT between mild/moderate and severe groups. Short symptom duration, less pain, lower BMI, and lower physical component score of SF-12 were predictive of shorter CWT. Only baseline pain and medication duration were predictive of SWT. Both CWT and SWT were shorter compared to a concurrent cohort of lumbar stenosis patients (p <0.001). Conclusions: Patients with shorter duration (either symptoms or medication) and less neck pain waited less to see a spine specialist in Canada and to undergo surgical treatment. This study highlights some of the obstacles to overcome in expedited care for this patient population.
High-latitude interactions of local-scale processes in the atmosphere-ice-ocean system have effects on the local, Antarctic and global climate. Phenomena including polynyas and leads are examples of such interactions which, when combined, have a significant impact on larger scales. These small-scale features, which are typically parameterized in global models, can be explicitly simulated using high-resolution regional climate system models. As such, the study of these interactions is well suited to a regional model approach and is considered here using the Arctic Regional Climate System Model (ARCSyM). This model has been used for many simulations in the Arctic, and is now implemented for the Antarctic. Observations of such processes in the Antarctic are limited, which makes model validation difficult. However, using the best available observations for an annual cycle, we have determined a suite of model parameterization which allows us to reasonably simulate the Antarctic climate. This work considers a fine-resolution (20 km) simulation in the Cosmonaut Sea region, with the eventual goal of elucidating the mechanisms in the formation and maintenance of the sensible-heat polynya which is a regular occurrence in this area. It was found in an atmosphere-sea-ice simulation that the ocean plays an important role in regulating the sea-ice cover in this region in compensating for the cold atmospheric conditions.
Sea-ice thickness distributions from 12 submarine cruises under the North Pole are used to evaluate and enhance the results of sea-ice model simulations. The sea-ice models include versions with cavitating fluid and elastic-viscous-plastic rheologies, and versions with a single thickness and with multiple (5–27) thicknesses in each gridcell. A greater portion of the interannual variance of observed mean thickness at the Pole is captured by the multiple-thickness models than by the single-thickness models, although even the highest correlations are only about 0.6. After The observed thickness distributions are used to ˚tune" the model to capture the primary mode of the distribution, the largest model-data discrepancies are in the thin-ice tail of the distribution. In a 41 year simulation ending in 1998, the model results show a pronounced decrease of mean ice thickness at the Pole around 1990; the minimum simulated thickness occurs in summer 1998. The decrease coincides with a shift of the Arctic Oscillation to its positive phase. The smallest submarine-derived mean thickness occurs in 1990, but no submarine data were available after 1992. The submarine-derived thicknesses for 1991 and 1992 are only slightly smaller than the 12–case mean.
In contrast to much of the political economy literature, this article explores acts of refusal that obstruct attempts to impose austerity measures on advanced industrial democracies. It thereby complements a literature that has thus far focused far more upon the (apparently unobstructed) imposition of austerity. In doing so, it uses two typically ‘low-resistance’ countries – Japan and the UK –as least-likely cases and finds that austerity is rarely uncontested. Using fuzzy set Qualitative Comparative Analysis, it highlights the ‘causal recipes’ sufficient for both (1) anti-austerity activity to have a significant impact on austerity proposals and (2) the smooth (unobstructed) imposition of austerity. The politics of austerity is shown to be better understood as an iterative interaction between proposals for austerity and the acts of refusal they encounter. These obstacles to austerity appear more straightforward to activate effectively in Japan’s coordinated model of capitalism, whilst the UK’s liberal market economy tends to generate more innovative forms of dissent that (if they are sufficiently militant) provide an alternative route towards the obstruction of austerity.
Research on attachment transmission has focused on variable-centered analyses, where hypotheses are tested by examining linear associations between variables. The purpose of this study was to apply a relationship-centered approach to data analysis, where adult states of mind, maternal sensitivity, and infant attachment were conceived as being three components of a single, intergenerational relationship. These variables were assessed in 90 adolescent and 99 adult mother–infant dyads when infants were 12 months old. Initial variable-centered analyses replicated the frequently observed associations between these three core attachment variables. Relationship-based, latent class analyses then revealed that the most common pattern among young mother dyads featured maternal unresolved trauma, insensitive interactive behavior, and disorganized infant attachment (61%), whereas the most prevalent adult mother dyad relationship pattern involved maternal autonomy, sensitive maternal behavior, and secure infant attachment (59%). Three less prevalent relationship patterns were also observed. Moderation analyses revealed that the adolescent–adult mother distinction differentiated between secure and disorganized intergenerational relationship patterns, whereas experience of traumatic events distinguished between disorganized and avoidant patterns. Finally, socioeconomic status distinguished between avoidant and secure patterns. Results emphasize the value of a relationship-based approach, adding an angle of understanding to the study of attachment transmission.
Global climate models have pointed to the polar regions as very sensitive
areas in response to climate change. However, these models often do not
contain representations of processes peculiar to the polar regions such as
dynamic sea ice, permafrost, and Arctic stratus clouds. Further, global
models do not have the resolution necessary to model accurately many of the
important processes and feedbacks. Thus, there is a need for regional
climate models of higher resolution. Our such model (ARCSy M) has been
developed by A. Lynch and W. Chapman. This model incorporates the NCAR
Regional Climate Model (RegCM2) with the addition of Flato–Hibler cavitating
fluid sea-ice dynamics and Parkinson–Washington ice thermodynamic
formulation. Recently work has been conducted to couple a mixed-layer ocean
to the atmosphere–ice model, and a three-dimensional (3-D) dynamical ocean
model, in this case the S-Coordinate Primitive Equation Model (SPEM), to the
ice model. Simulations including oceanic circulation will allow
investigations of the feedbacks involved in fresh-water runoff from sea-ice
melt and sea-ice transport. Further, it is shown that the definition of the
mixed-layer depth has significant impact on ice thermodynamics.
Occupancy has been associated with risk for healthcare-associated infections, yet its definition varies widely. Occupancy can be modeled as a function of census, acuity of the patient care unit, staffing ratio, or some combination. This article discusses the appropriate parameterization of these measures and how to interpret their impact.
Radiocarbon dating of closely associated marine mollusk shells and terrestrial material (mammal bones or charred wood) collected from archaeological contexts in northern Atlantic Iberian coastal areas is used to quantify the marine 14C reservoir effect (ΔR) for the coastal waters off the Cantabrian coast of northern Iberia. For the first time, ΔR values were reliably determined for these coastal waters and, also for the first time, a ΔR was calculated for the Late Pleistocene in Atlantic Iberia. Pairs of coeval samples of different carbon reservoirs selected from Upper Paleolithic (Late Pleistocene) and Mesolithic (Early Holocene) contexts yielded ΔR weighted mean values of –117±70 14C yr and –105±21 14C yr, respectively. These values show oceanographic conditions characterized by a reduced offset between atmospheric and surface water 14C contents, suggesting a nonexistent or very weak upwelling and some stratification of the water column. Similar oceanographic conditions have been recorded in other areas of Atlantic Iberia during the Holocene, such as off Andalusian and northwestern Galician coasts. Results not only provide useful information on environmental conditions but also a framework to obtain more precise and reliable absolute chronologies for the Late Pleistocene and Early Holocene in northern Iberia.
We present spectropolarimetric observations of the eclipsing cataclysmic variable 1H1752+08. Modelling of the line intensity and polarisation spectra of 1H1752+08 shows that the magnetic field structure of the white dwarf is off-centre and the mean photospheric field strength is about 7 MG, the lowest measured in a cataclysmic variable (CV). We argue that 1H1752+08 is most probably a low-field AM Herculis system.
We have developed an easy-to-use, mouse-driven program for the interactive fitting of interstellar absorption lines in high-resolution astronomical spectra. The program, Xvoigt, gives values for the column density and velocity dispersion of the absorbing clouds. It runs under the popular X Window system available on most workstations, and offers significant enhancements over existing profile-fitting software. Xvoigt can be an important adjunct to automatic programs for fitting absorption lines in low to moderate signal-to-noise QSO or other spectra, and is ideal for demonstrating the details and difficulties of absorption line analysis.
Serum and erythrocyte (RBC) total folate are indicators of folate status. No nationally representative population data exist for folate forms. We measured the serum folate forms (5-methyltetrahydrofolate (5-methylTHF), unmetabolised folic acid (UMFA), non-methyl folate (sum of tetrahydrofolate (THF), 5-formyltetrahydrofolate (5-formylTHF), 5,10-methenyltetrahydrofolate (5,10-methenylTHF)) and MeFox (5-methylTHF oxidation product)) by HPLC–MS/MS and RBC total folate by microbiologic assay in US population ≥ 1 year (n approximately 7500) participating in the National Health and Nutrition Examination Survey 2011–2. Data analysis for serum total folate was conducted including and excluding MeFox. Concentrations (geometric mean; detection rate) of 5-methylTHF (37·5 nmol/l; 100 %), UMFA (1·21 nmol/l; 99·9 %), MeFox (1·53 nmol/l; 98·8 %), and THF (1·01 nmol/l; 85·2 %) were mostly detectable. 5-FormylTHF (3·6 %) and 5,10-methenylTHF (4·4 %) were rarely detected. The biggest contributor to serum total folate was 5-methylTHF (86·7 %); UMFA (4·0 %), non-methyl folate (4·7 %) and MeFox (4·5 %) contributed smaller amounts. Age was positively related to MeFox, but showed a U-shaped pattern for other folates. We generally noted sex and race/ethnic biomarker differences and weak (Spearman's r< 0·4) but significant (P< 0·05) correlations with physiological and lifestyle variables. Fasting, kidney function, smoking and alcohol intake showed negative associations. BMI and body surface area showed positive associations with MeFox but negative associations with other folates. All biomarkers showed significantly higher concentrations with recent folic acid-containing dietary supplement use. These first-time population data for serum folate forms generally show similar associations with demographic, physiological and lifestyle variables as serum total folate. Patterns observed for MeFox may suggest altered folate metabolism dependent on biological characteristics.
There is growing evidence that Behavioural Activation is an effective treatment for older adults with depression. However, there is a lack of detail given in studies about any adaptations made to interventions or efforts made to remove treatment barriers. Factors such as co-morbid physical health problems, cognitive impairment and problems with social support suggest there may be specific treatment considerations when developing interventions for this group. This article aims to describe adaptations made to a general adult Behavioural Activation manual using literature on treatment factors for older adults as an organizational framework. This information may be of use to mental health workers delivering behavioural interventions to older adults with depression and documents the initial phase of developing a complex intervention.