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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.
Functional impairment is a defining feature of psychotic disorders. A range of factors has been shown to influence functioning, including negative symptoms, cognitive performance and cognitive reserve (CR). However, it is not clear how these variables may affect functioning in first-episode psychosis (FEP) patients. This 2-year follow-up study aimed to explore the possible mediating effects of CR on the relationship between cognitive performance or specific clinical symptoms and functional outcome.
A prospective study of non-affective FEP patients was performed (211 at baseline and 139 at follow-up). CR was entered in a path analysis model as potential mediators between cognitive domains or clinical symptoms and functioning.
At baseline, the relationship between clinical variables or cognitive performance and functioning was not mediated by CR. At follow-up, the effect of attention (p = 0.003) and negative symptoms (p = 0.012) assessed at baseline on functioning was partially mediated by CR (p = 0.032 and 0.016), whereas the relationship between verbal memory (p = 0.057) and functioning was mediated by CR (p = 0.014). Verbal memory and positive and total subscales of PANSS assessed at follow-up were partially mediated by CR and the effect of working memory on functioning was totally mediated by CR.
Our results showed the influence of CR in mediating the relationship between cognitive domains or clinical symptoms and functioning in FEP. In particular, CR partially mediated the relationship between some cognitive domains or clinical symptoms and functioning at follow-up. Therefore, CR could improve our understanding of the long-term functioning of patients with a non-affective FEP.
Evidence suggests the incidence of non-affective psychotic disorders (NAPDs) varies across persons and places, but data from the Global South is scarce. We aimed to estimate the treated incidence of NAPD in Chile, and variance by person, place and time.
We used national register data from Chile including all people, 10–65 years, with the first episode of NAPD (International Classification of Diseases, Tenth Revision: F20–F29) between 1 January 2005 and 29 August 2018. Denominators were estimated from Chilean National Census data. Our main outcome was treated incidence of NAPD and age group, sex, calendar year and regional-level population density, multidimensional poverty and latitude were exposures of interest.
We identified 32 358 NAPD cases [12 136 (39.5%) women; median age-at-first-contact: 24 years (interquartile range 18–39 years)] during 171.1 million person-years [crude incidence: 18.9 per 100 000 person-years; 95% confidence interval (CI) 18.7–19.1]. Multilevel Poisson regression identified a strong age–sex interaction in incidence, with rates peaking in men (57.6 per 100 000 person-years; 95% CI 56.0–59.2) and women (29.5 per 100 000 person-years; 95% CI 28.4–30.7) between 15 and 19 years old. Rates also decreased (non-linearly) over time for women, but not men. We observed a non-linear association with multidimensional poverty and latitude, with the highest rates in the poorest regions and those immediately south of Santiago; no association with regional population density was observed.
Our findings inform the aetiology of NAPDs, replicating typical associations with age, sex and multidimensional poverty in a Global South context. The absence of association with population density suggests this risk may be context-dependent.
In this work, a new method to determine and correct the linear drift for any crystalline orientation in a single-column-resolved high-resolution scanning transmission electron microscopy (HR-STEM) image, which is based on angle measurements in the Fourier space, is presented. This proposal supposes a generalization and the improvement of a previous work that needs the presence of two symmetrical planes in the crystalline orientation to be applicable. Now, a mathematical derivation of the drift effect on two families of asymmetric planes in the reciprocal space is inferred. However, though it was not possible to find an analytical solution for all conditions, a simple formula was derived to calculate the drift effect that is exact for three specific rotation angles. Taking this into account, an iterative algorithm based on successive rotation/drift correction steps is devised to remove drift distortions in HR-STEM images. The procedure has been evaluated using a simulated micrograph of a monoclinic material in an orientation where all the reciprocal lattice vectors are different. The algorithm only needs four iterations to resolve a 15° drift angle in the image.
We exploit the records of a large Toledan hospital to study the compensation of female labor and the gender wage gap in early modern Castile in the context of nursing—a non-gendered, low-skill occupation in which men and women performed the same clearly defined tasks. We employ a robust methodology to estimate the value of in-kind compensation, and show it to constitute a central part of the labor contract, far exceeding subsistence requirements. Patient admissions records are used to measure nurse productivity, which did not differ across genders. Female compensation varied between 70 percent and 100 percent of male levels, with fluctuations clearly linked to relative labor scarcity. Contrary to common assumptions in the literature, we show that markets played an important role in setting female compensation in early modern Castile. The sources of the gender disparity are, therefore, likely to be found in the broader social and cultural context.
Decisions on the use of nature reflect the values and rights of individuals, communities and society at large. The values of nature are expressed through cultural norms, rules and legislation, and they can be elicited using a wide range of tools, including those of economics. None of the approaches to elicit peoples’ values are neutral. Unequal power relations influence valuation and decision-making and are at the core of most environmental conflicts. As actors in sustainability thinking, environmental scientists and practitioners are becoming more aware of their own posture, normative stance, responsibility and relative power in society. Based on a transdisciplinary workshop, our perspective paper provides a normative basis for this new community of scientists and practitioners engaged in the plural valuation of nature.
Sharing information between different countries is key for developing sustainable solutions to environmental change. Coastal wetlands in the Gulf of Mexico are suffering significant environmental and human-related threats. Working across national boundaries, this research project brings together scientists, specialists and local communities from Cuba and the USA. While important advances have been made in strengthening collaborations, important obstacles remain in terms of international policy constraints, different institutional and academic cultures and technology. Overcoming these limitations is essential to formulating a comprehensive understanding of the challenges that coastal socioecological systems are facing now and into the future.
There are no published estimates of the health state utility values (HSUVs) for a broad range of eating disorders (EDs). HSUVs are used in economic evaluations to determine quality-adjusted life years or as a measure of disorder burden. The main objective of the current study is to present HSUVs for a broad range of EDs based on DSM-5 diagnoses.
We used pooled data of two Health Omnibus Surveys (2015 and 2016) including representative samples of individuals aged 15 + years living in South Australia. HSUVs were derived from the SF-6D (based on the SF-12 health-related quality of life questionnaire) and analysed by ED classification, ED symptoms (frequency of binge-eating or distress associated to binge eating) and weight status. Multiple linear regression models, adjusted for socio-demographics, were used to test the differences of HSUVs across ED groups.
Overall, 18% of the 5609 individuals met criteria for ED threshold and subthreshold. EDs were associated with HSUV decrements, especially if they were severe disorders (compared to non-ED), binge ED: −0.16 (95% CI −0.19 to −0.13), bulimia nervosa: −0.12, (95% CI −0.16 to −0.08). There was an inverse relationship between distress related binge eating and HSUVs. HSUVs were lower among people with overweight/obese compared to those with healthy weight regardless of ED diagnosis.
EDs were significantly associated with lower HSUVs compared to people without such disorders. This study, therefore, provides new insights into the burden of EDs. The derived HSUVs can also be used to populate future economic models.
The last chapter of this volume is somewhat unusual for an edited book in social science research on peace and transitional justice. But, it is one that we thought it was important to include. “Geographies of Truth,” by personnel from the Casa de la Memoria (House of Memory) of Medellin, is a discussion of how individuals from the museum developed key exhibits on the violence in Colombia. This process begins with a great many similarities to social science projects as literature is reviewed, original data are collected, and all the materials are analyzed for their relevance and role in, in this case, museum exhibits. At this stage, scholars would typically then conceive of our understanding and representation of events of the past in fairly conventional, analytical products that are designed to communicate to fellow academics. But those who curate museums like Casa de la Memoria must arrive at a work product in ways that will affect people not just intellectually but also emotionally and physically through the various senses. Such exhibits are also constructed for a much larger audience − the people of the nation − whose experiences are being represented. Thus, the process by which these exhibits are created is both fascinating as both an alternative means of conveying understandings about war and violence, and for the responsibilities the museum personnel have toward society as a whole in representing their truths. There is much we, as peace studies scholars, can gain from understanding their work.
We extend two known existence results to simply connected manifolds with positive sectional curvature: we show that there exist pairs of simply connected positively-curved manifolds that are tangentially homotopy equivalent but not homeomorphic, and we deduce that an open manifold may admit a pair of non-homeomorphic simply connected and positively-curved souls. Examples of such pairs are given by explicit pairs of Eschenburg spaces. To deduce the second statement from the first, we extend our earlier work on the stable converse soul question and show that it has a positive answer for a class of spaces that includes all Eschenburg spaces.
Study of the composition from diverse sources of the Universe helps to us to understand their evolution. Molecular spectroscopy provides detailed information of the observed objects. We present a small study of the starburst NGC 253 with ALMA at 1mm. We detect the prebiotic molecules NH2CHO, and CNCHO. We obtain the integrated intensity maps and abundances of HNCO, CH3OH, H3O+ and CH3C2H. We propose the use of Artificial Intelligence for big data to find prebiotic molecules in galaxies.
Short-term feeding studies have highlighted a phenomenon in Ca regulation that raises concerns around Ca absorption in dogs that may make an impact on commercial diets near to the maximum recommended level. A recent study to determine responses in dogs fed one of two diets differing in dietary Ca over 40 weeks found no evidence to suggest a concern across a range of biological parameters hypothesised to be affected by Ca. Unforeseen consequences of dietary Ca could have occurred and metabolic profiling was deemed a suitable data-driven approach to identify effects of dietary Ca. The objectives were to compare the fasted plasma metabolome (sampled at 8-week intervals over 40 weeks) of dogs fed one of two diets, near to the minimum and maximum recommended levels of dietary Ca. Comparisons with the control diet were also investigated across the postprandial time course (1–4 h) following acute (1 d) and long-term (24 weeks) feeding of the test diet. Comparing fasted plasma samples at each time point, no significant effect (adjusted P < 0·05) of diet on metabolites was observed. In the postprandial state, only phosphate was consistently different between diets and was explained by additional dietary P to maintain Ca:P. Metabolic profiling analysis supports the view that the dietary Ca upper limit is safe. Additionally, the canine plasma metabolome was characterised, providing insights into the stability of individual profiles across 40 weeks, the response to consumption of a nutritionally complete meal over a 4 h postprandial time course and different kinetic categories of postprandial absorption.
Differences in material conditions are a determinant that explains the little divergence between northwestern and southern Europe. This article approaches the evolution of prices in early modern Toledo (Spain). The price index includes new items such as housing and employs different baskets over time, reflecting changes in consumption patterns. During the city’s golden age, prices grew faster than in London, Paris, or Amsterdam. Wine, urban rent, and food prices experienced a great increase, coinciding with demographic growth and the arrival of the American precious metals. Prices slowed in the first half of the seventeenth century, throughout Castile’s demographic and economic decay.
The Richter Scale measures the magnitude of a seismic occurrence, but it does not feasibly quantify the magnitude of the “disaster” at the point of impact in real humanitarian needs, based on United Nations International Strategy for Disaster Reduction (UNISDR; Geneva, Switzerland) 2009 Disaster Terminology. A Disaster Severity Index (DSI) similar to the Richter Scale and the Mercalli Scale has been formulated; this will quantify needs, holistically and objectively, in the hands of any stakeholders and even across timelines.
An agreed terminology in quantifying “disaster” matters; inconsistency in measuring it by stakeholders posed a challenge globally in formulating legislation and policies responding to it.
A quantitative, mathematical calculation which uses the median score percentage of 100% as a baseline, indicating the ability to cope within the local capacity, was used. Seventeen indicators were selected based on the UNISDR 2009 disaster definition of vulnerability and exposure and holistic approach as a pre-condition. The severity of the disaster is defined as the level of unmet needs. Thirty natural disasters were tested, retrospectively, and non-parametric tests were used to test the correlation of the DSI score against the indicators.
The findings showed that 20 out of 30 natural disasters tested fulfilled the inability to cope, within local capacity in disaster terminology. Non-parametric tests showed that there was a correlation between the 30 DSI scored and the indicators.
By computing a median fit percentage score of 100% as the ability to cope, and the correlation of the 17 indicators, in this DSI Scale, 20 natural disasters fitted into the disaster definition. This DSI will enable humanitarian stakeholders to measure and compare the severity of the disaster objectively, as well as enable future response to be based on needs.
YewYY, Castro DelgadoR, HeslopDJ, Arcos GonzálezP. The Yew Disaster Severity Index: A New Tool in Disaster Metrics. Prehosp Disaster Med. 2019;34(1):8–19.
To assess trends of mortality attributable to child and maternal undernutrition (CMU), overweight/obesity and dietary risks of non-communicable diseases (NCD) in sub-Saharan Africa (SSA) using data from the Global Burden of Disease (GBD) Study 2015.
For each risk factor, a systematic review of data was used to compute the exposure level and the effect size. A Bayesian hierarchical meta-regression analysis was used to estimate the exposure level of the risk factors by age, sex, geography and year. The burden of all-cause mortality attributable to CMU, fourteen dietary risk factors (eight diets, five nutrients and fibre intake) and overweight/obesity was estimated.
All age groups and both sexes.
In 2015, CMU, overweight/obesity and dietary risks of NCD accounted for 826204 (95 % uncertainty interval (UI) 737346, 923789), 266768 (95 % UI 189051, 353096) and 558578 (95 % UI 453433, 680197) deaths, respectively, representing 10·3 % (95 % UI 9·1, 11·6 %), 3·3 % (95 % UI 2·4, 4·4 %) and 7·0 % (95 % UI 5·8, 8·3 %) of all-cause mortality. While the age-standardized proportion of all-cause mortality accounted for by CMU decreased by 55·2 % between 1990 and 2015 in SSA, it increased by 63·3 and 17·2 % for overweight/obesity and dietary risks of NCD, respectively.
The increasing burden of diet- and obesity-related diseases and the reduction of mortality attributable to CMU indicate that SSA is undergoing a rapid nutritional transition. To tackle the impact in SSA, interventions and international development agendas should also target dietary risks associated with NCD and overweight/obesity.
To summarize ways that networks of community-based organizations (CBO), in partnership with public health departments, contribute to community recovery from disaster.
The study was conducted using an online survey administered one and 2 years after Hurricane Sandy to the partnership networks of 369 CBO and the New York Department of Health and Mental Hygiene. The survey assessed the structure and durability of networks, how they were influenced by storm damage, and whether more connected networks were associated with better recovery outcomes.
During response and recovery, CBOs provide an array of critical public health services often outside their usual scope. New CBO partnerships were formed to support recovery, particularly in severely impacted areas. CBOs that were more connected to other CBOs and were part of a long-term recovery committee reported greater impacts on the community; however, a partnership with the local health department was not associated with recovery impacts.
CBO partners are flexible in their scope of services, and CBO partnerships often emerge in areas with the greatest storm damage, and subsequently the greatest community needs. National policies will advance if they account for the dynamic and emergent nature of these partnerships and their contributions, and clarify the role of government partners. (Disaster Med Public Health Preparedness. 2018;12:635–643)
We present a critical reanalysis of the black-hole binary coalescences detected during LIGO’s first observing run under different Bayesian prior assumptions. We summarize the main findings of Vitale et al. (2017) and show additional marginalized posterior distributions for some of the binaries’ intrinsic parameters.
These findings were presented at IAU Symposium 338, held on October 16-19, 2017 in Baton Rouge, LA, USA.