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Patients with schizophrenia spectrum disorders (SSD) tend to lack insight, which is linked to poor outcomes. The effect size of previous treatments on insight changes in SSD has been small. Metacognitive interventions may improve insight in SSD, although this remains unproved.
We carried out a systematic review and meta-analysis of randomized controlled trials (RCTs) to examine the effects of metacognitive interventions designed for SSD, namely Metacognitive Training (MCT) and Metacognitive Reflection and Insight Therapy (MERIT), on changes in cognitive and clinical insight at post-treatment and at follow-up.
Twelve RCTs, including 10 MCT RCTs (n = 717 participants) and two MERIT trials (n = 90), were selected, totalling N = 807 participants. Regarding cognitive insight six RCTs (n = 443) highlighted a medium effect of MCT on self-reflectiveness at post-treatment, d = 0.46, p < 0.01, and at follow-up, d = 0.30, p < 0.01. There was a small effect of MCT on self-certainty at post-treatment, d = −0.23, p = 0.03, but not at follow-up. MCT was superior to controls on an overall Composite Index of cognitive insight at post-treatment, d = 1.11, p < 0.01, and at follow-up, d = 0.86, p = 0.03, although we found evidence of heterogeneity. Of five MCT trials on clinical insight (n = 244 participants), which could not be meta-analysed, four of them favoured MCT compared v. control. The two MERIT trials reported conflicting results.
Metacognitive interventions, particularly Metacognitive Training, appear to improve insight in patients with SSD, especially cognitive insight shortly after treatment. Further long-term RCTs are needed to establish whether these metacognitive interventions-related insight changes are sustained over a longer time period and result in better outcomes.
Using an ensemble of close- and long-range remote sensing, lake bathymetry and regional meteorological data, we present a detailed assessment of the geometric changes of El Morado Glacier in the Central Andes of Chile and its adjacent proglacial lake between 1932 and 2019. Overall, the results revealed a period of marked glacier down wasting, with a mean geodetic glacier mass balance of −0.39 ± 0.15 m w.e.a−1 observed for the entire glacier between 1955 and 2015 with an area loss of 40% between 1955 and 2019. We estimate an ice elevation change of −1.00 ± 0.17 m a−1 for the glacier tongue between 1932 and 2019. The increase in the ice thinning rates and area loss during the last decade is coincident with the severe drought in this region (2010–present), which our minimal surface mass-balance model is able to reproduce. As a result of the glacier changes observed, the proglacial lake increased in area substantially between 1955 and 2019, with bathymetry data suggesting a water volume of 3.6 million m3 in 2017. This study highlights the need for further monitoring of glacierised areas in the Central Andes. Such efforts would facilitate a better understanding of the downstream impacts of glacier downwasting.
There is a substantial proportion of patients who drop out of treatment before they receive minimally adequate care. They tend to have worse health outcomes than those who complete treatment. Our main goal is to describe the frequency and determinants of dropout from treatment for mental disorders in low-, middle-, and high-income countries.
Respondents from 13 low- or middle-income countries (N = 60 224) and 15 in high-income countries (N = 77 303) were screened for mental and substance use disorders. Cross-tabulations were used to examine the distribution of treatment and dropout rates for those who screened positive. The timing of dropout was examined using Kaplan–Meier curves. Predictors of dropout were examined with survival analysis using a logistic link function.
Dropout rates are high, both in high-income (30%) and low/middle-income (45%) countries. Dropout mostly occurs during the first two visits. It is higher in general medical rather than in specialist settings (nearly 60% v. 20% in lower income settings). It is also higher for mild and moderate than for severe presentations. The lack of financial protection for mental health services is associated with overall increased dropout from care.
Extending financial protection and coverage for mental disorders may reduce dropout. Efficiency can be improved by managing the milder clinical presentations at the entry point to the mental health system, providing adequate training, support and specialist supervision for non-specialists, and streamlining referral to psychiatrists for more severe cases.
This article presents the long-term results in terms of antipsychotic medication maintenance and factors influencing it in a representative sample of patients with schizophrenia recruited in the SOHO study within Spain.
The SOHO was a prospective, 3-year observational study of the outcomes of schizophrenia treatment in outpatients who initiated therapy or changed to a new antipsychotic performed in 10 European countries with a focus on olanzapine. The Kaplan–Meier method was used to analyse the time to treatment discontinuation and the Cox proportional hazards model to investigate correlates of discontinuation.
Results and conclusions
In total, 1688 patients were included in the analyses. Medication maintenance at 3 years varied with the antipsychotic prescribed, being highest with clozapine (57.6%, 95% CI 39.2–74.5), followed by olanzapine (48.3%, 95% CI 45.1–51.5); and lowest with quetiapine (19.0%, 95% CI 13.0–26.3). Treatment discontinuation was significantly less frequent with olanzapine than with risperidone (p = 0.015), depot typical (p = 0.001), oral typical antipsychotics (p < 0.001) or quetiapine (p < 0.001); but not than with clozapine (p = 0.309). Longer maintenance was also associated with higher social abilities and better cognitive status at baseline; in contrast, a shorter time to discontinuation was associated with the need for mood stabilisers during follow-up. This study emphasises the different value of antipsychotics in day-to-day clinical practice, as some of them were associated with longer medication maintenance periods than others. This study has some limitations because of possible selection and information biases derived from the non-systematic, non-randomised allocation to treatments and the existence of unobserved covariates that may influence the outcome.
We present a detailed overview of the cosmological surveys that we aim to carry out with Phase 1 of the Square Kilometre Array (SKA1) and the science that they will enable. We highlight three main surveys: a medium-deep continuum weak lensing and low-redshift spectroscopic HI galaxy survey over 5 000 deg2; a wide and deep continuum galaxy and HI intensity mapping (IM) survey over 20 000 deg2 from
$z = 0.35$
to 3; and a deep, high-redshift HI IM survey over 100 deg2 from
$z = 3$
to 6. Taken together, these surveys will achieve an array of important scientific goals: measuring the equation of state of dark energy out to
$z \sim 3$
with percent-level precision measurements of the cosmic expansion rate; constraining possible deviations from General Relativity on cosmological scales by measuring the growth rate of structure through multiple independent methods; mapping the structure of the Universe on the largest accessible scales, thus constraining fundamental properties such as isotropy, homogeneity, and non-Gaussianity; and measuring the HI density and bias out to
$z = 6$
. These surveys will also provide highly complementary clustering and weak lensing measurements that have independent systematic uncertainties to those of optical and near-infrared (NIR) surveys like Euclid, LSST, and WFIRST leading to a multitude of synergies that can improve constraints significantly beyond what optical or radio surveys can achieve on their own. This document, the 2018 Red Book, provides reference technical specifications, cosmological parameter forecasts, and an overview of relevant systematic effects for the three key surveys and will be regularly updated by the Cosmology Science Working Group in the run up to start of operations and the Key Science Programme of SKA1.
The aim of this study is to investigate the impact of anatomical changes in prostate cancer patients on the target coverage when using 6 MV beams-VMAT therapy and to propose strategies that allow us to evaluate the dose or correct it by normalization without having to perform a new simulation.
Methods and materials:
Ten patients of high-risk prostate cancer were chosen for the study. All test plans were delivered using the same isocenter and monitor units as the original plan and compared against the original unedited plan. The expansion and contraction of body contours due to size changes was mimicked by increasing and decreasing the body contour with depths of −2, −1·5, …, 1·5, 2 cm, in the anterior, and both lateral directions of the patient. A total of 90 plans were evaluated, 9 for each patient. Dose-volume histogram statistics were extracted from each plan and normalized to prescription dose.
Weight changes resulted in considerable dose modifications to the target and critical structures. Plans were found to be varied with 2·9% ± 0·3% per cm SSD change for VMAT treatment with a correlation index close to one. Therefore, doses variations were linear to the changes of depth. Gamma index evaluation was performed for the 10 renormalized plans. All of them passed criteria of 3%/3 mm in at least 98.2% of points. Eight of them passed criteria in 99% points. Gamma index 4%/4 mm passed 100% points in all patients for the chosen region of interest.
The dosimetry estimation presented in this study shows important data for the radiation oncology staff to justify whether a CT rescan is necessary or not when a patient experiences weight changes during treatment. Based on the results of our study, discrepancies between real dose and planned dose were >5% for 1·7 cm of difference in external contour in the anterior and both lateral directions of the patient.
The timing of the late Middle Paleolithic and late disappearance of Neanderthals in the Iberian Peninsula are hotly debated subjects in Paleolithic archeology. Several studies suggested a late survival in South and Central Iberia until about 32 ka, but were probably subject to significant age underestimation due to contamination of dating samples, undiagnostic lithic assemblages, and/or lack of stratigraphic integrity. We conducted a radiocarbon and luminescence-dating study backed by detailed sedimentological and micromorphological investigations at the newly discovered rock shelter sequence of Abrigo del Molino (Central Spain). Accumulation of the sediment sequence was rapid. It started with deposition of paleoflood slack-water deposits at around 48 ka and continued until about 41 ka with deposition of colluvial and detrital sediments. These contain two Mousterian levels, which place the latest Neanderthal occupation at around 45 to 41 ka, i.e., between Heinrich Stadials 5 and 4, and probably during a time of climate amelioration. Abrigo del Molino thus provides a detailed and chronologically well-constrained record of Late Neanderthal presence and morphodynamic change in Central Iberia during times of millennial-scale climate changes. The site gives further evidence for an early disappearance of Neanderthals in Central Iberia.
There is accumulating evidence for the role of fronto-striatal and associated circuits in obsessive–compulsive disorder (OCD) but limited and conflicting data on alterations in cortical thickness.
To investigate alterations in cortical thickness and subcortical volume in OCD.
In total, 412 patients with OCD and 368 healthy adults underwent magnetic resonance imaging scans. Between-group analysis of covariance of cortical thickness and subcortical volumes was performed and regression analyses undertaken.
Significantly decreased cortical thickness was found in the OCD group compared with controls in the superior and inferior frontal, precentral, posterior cingulate, middle temporal, inferior parietal and precuneus gyri. There was also a group x age interaction in the parietal cortex, with increased thinning with age in the OCD group relative to controls.
Our findings are partially consistent with earlier work, suggesting that group differences in grey matter volume and cortical thickness could relate to the same underlying pathology of OCD. They partially support a frontostriatal model of OCD, but also suggest that limbic, temporal and parietal regions play a role in the pathophysiology of the disorder. The group x age interaction effects may be the result of altered neuroplasticity.
The main objective was to analyze relationships and predictive patterns between 3x2 classroom goal structures (CGS), and motivational regulations, dimensions of self-concept, and affectivity in the context of secondary education. A sample of 1,347 secondary school students (56.6% young men, 43.4% young women) from 10 different provinces of Spain agreed to participate (M age = 13.43, SD = 1.05). Hierarchical regression analyses indicated the self-approach CGS was the most adaptive within the spectrum of self-determination, followed by the task-approach CGS. The other-approach CGS had an ambivalent influence on motivation. Task-approach and self-approach CGS predicted academic self-concept (p < .01; p < .001, respectively; R2 = .134), and both along with other-approach CGS (negatively) predicted family self-concept (p < .05; p < .001; p < .01, respectively; R2 = .064). Physical self-concept was predicted by the task-approach and other-approach CGS’s (p < .05; p < .001, respectively; R2 = .078). Finally, positive affect was predicted by all three approach-oriented CGS’s (p < .001; R2 = .137), whereas negative affect was predicted by other-approach (positively) and self-approach (negatively) CGS (p < .001; p < .05, respectively; R2 = .028). These results expand the 3x2 achievement goal framework to include environmental factors, and reiterate that teachers should focus on raising levels of self- and task-based goals for students in their classes.
The spatial and orientational distribution in a dilute active suspension of non-Brownian run-and-tumble spherical swimmers confined between two planar hard walls is calculated theoretically. Using a kinetic model based on coupled bulk/surface probability density functions, we demonstrate the existence of a concentration wall boundary layer with thickness scaling with the run length, the absence of polarization throughout the bulk of the channel, and the presence of sharp discontinuities in the bulk orientation distribution in the neighbourhood of orientations parallel to the wall in the near-wall region. Our model is also applied to calculate the swim pressure in the system, which approaches the previously proposed ideal-gas behaviour in wide channels but is found to decrease in narrow channels as a result of confinement. Monte Carlo simulations are also performed for validation and show excellent quantitative agreement with our theoretical predictions.
One of the most remarkable developments of modern finance was the emergence of a public debt. Governments of different kingdoms – including papal kingdoms – were able to increase their resources due to credit and, more importantly, these governments were able to make payments abroad through bankers who had previously lent the funds. These bankers lent money in order to finance armies or wars, and their loans constituted short-term debt. The development of this system in Castile began at the end of the fifteenth century, when the Catholic kings needed loans in order to conquer the Muslim city of Granada. Scholars have highlighted this event as the origin of Charles V's loans; so, the fiscal and financial system of the Habsburg dynasty had precedents before 1516.
Charles V's fiscal system took its influences from Castile and the Low Countries. The administration was built in a previous period (the Contadurías of Castile) and the reforms of 1523–5 were influenced by the model of Flanders. But, if there is an area in which tradition and innovation went together, it was debt. Castile had several types of debt and credit systems in place dating from the fourteenth and fifteenth centuries, while the Catholic kings continued with a new type of juros with more modern elements. Why did public credit arrive? Traditionally, scholars have always recognized that there was the need to increase expenses to build a new model of army, and this would include a process of authority centralization and fiscal increases. In this paper, we argue about the importance of financial markets in attracting more resources to Castile in the first decades of the sixteenth century. The increase of expenditure was very important, of course; this increase, however, would not have been possible without a new context. Money, credit, merchant networks and, in general, a very good economic situation characterized this context. Moreover, production growth and merchant profits were a reliable source of potential income for the monarchy. We cannot forget that the fiscal system was a way to earn money as well.
A new generation of radio telescopes with unprecedented capabilities for astronomy and fundamental physics will be in operation over the next few years. With high sensitivities and large fields of view, they are ideal for cosmological applications. We discuss their uses for cosmology focusing on the observational technique of HI intensity mapping, in particular at low redshifts (z < 4). This novel observational window promises to bring new insights for cosmology, in particular on ultra-large scales and at a redshift range that can go beyond the dark energy domination epoch. In terms of standard constraints on the dark energy equation of state, telescopes such as Phase I of the SKA should be able to obtain constrains about as well as a future galaxy redshift surveys. Statistical techniques to deal with foregrounds and calibration issues, as well as possible systematics are also discussed.
The reform of the pension system of the Mexican Social Security Institute (IMSS) in 1997, limited the growing fiscal cost of the previous pay-as-you-go scheme. Sixteen years on from its creation, the Retirement Savings System (SAR) has had favourable macroeconomic effects for Mexico, as it has significantly increased financial savings and encouraged the development of local financial markets.
However, the employment and pension coverage has not developed as hoped, due to the high rate of informality in the labour market. In addition, the replacement rates (RR) forecast for old-age pensions from the defined-contribution scheme will be low, due to problems exogenous to the pension system, such as low contribution rates and low contribution densities. The main objective of this study is to develop a macroeconomic and actuarial projection model to simulate the expected coverage and RR for the period 2012–2050, within the framework of a demographic and economic forecast that will allow a detailed diagnosis of the current conditions of the pension system. The results reveal the unpromising scenario that the pension system has and will continue to have in the long term, with limited improvements in coverage rates. The possibility of obtaining adequate pensions will be restricted to those who have socioeconomic conditions with a long employment history, who can thus make contributions to their individual accounts.
Taking into account this baseline projection scenario, we simulate the expected effects of applying a set of proposals with the aim of tackling the main problems, such as the low coverage, low RR, and low level of participation by young people in the system.
We describe an opinion mining system which classifies the polarity of Spanish texts. We propose an NLP approach that undertakes pre-processing, tokenisation and POS tagging of texts to then obtain the syntactic structure of sentences by means of a dependency parser. This structure is then used to address three of the most significant linguistic constructions for the purpose in question: intensification, subordinate adversative clauses and negation. We also propose a semi-automatic domain adaptation method to improve the accuracy of our system in specific application domains, by enriching semantic dictionaries using machine learning methods in order to adapt the semantic orientation of their words to a particular field. Experimental results are promising in both general and specific domains.