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The coral reefs of the Pitcairn Islands are in one of the most remote areas of the Pacific Ocean, and yet they are exposed to the impacts of anthropogenic climate change. The Pitcairn Islands Marine Protected Area was designated in 2016 and is one of the largest in the world, but the marine environment around these highly isolated islands remains poorly documented. Evidence collated here indicates that while the Pitcairn Islands' reefs have thus far been relatively sheltered from the effect of warming sea temperatures, there is substantial risk of future coral decalcification due to ocean acidification. The projected acceleration in the rate of sea level rise, and the reefs' exposure to risks from distant ocean swells and cold-water intrusions, add further uncertainty as to whether these islands and their reefs will continue to adapt and persist into the future. Coordinated action within the context of the Pitcairn Islands Marine Protected Area can help enhance the resilience of the reefs in the Pitcairn Islands. Options include management of other human pressures, control of invasive species and active reef interventions. More research, however, is needed in order to better assess what are the most appropriate and feasible options to protect these reefs.
Pain, depression, anxiety, and psychosis are common non-cognitive symptoms of dementia. They are often underdiagnosed and can cause significant distress and carer strain. Numerous standardised assessment tools (SATs) exist and are recommended for the assessment of non-cognitive symptoms of dementia. Anecdotal evidence suggests that SATs are used rarely and inconsistently. This study aims to explore which SATs to detect non-cognitive symptoms of dementia are recommended in local guidelines and used in practice across different organisations. Secondary aims were to identify barriers and facilitators to using these tools.
This service evaluation is cross-sectional in design. A questionnaire was developed and distributed to clinicians working with patients with advanced dementia in any setting, across four geographical locations (Leeds, Bradford, Hull, and Cambridge). Quantitative data were analysed descriptively, and qualitative data from free-text comments were interpreted using thematic analysis.
135 professionals from a range of backgrounds and clinical settings completed the survey. Respondents indicated that SATs for non-cognitive symptoms in dementia were rarely used or recommended. Respondents were unaware of the existence of most SATs listed. 80% respondents felt that SATs were a useful adjunct to a structured clinical assessment. The most recommended tool was the Abbey Pain Scale, with 41 respondents indicating its recommendation by their Trust. Perceived facilitators to using SATs include education and training, reliable IT systems and accessibility. Barriers include lack of time and training.
Numerous SATs are available for use in dementia, but they are rarely recommended in local policy or used in practice. There appears to be a lack of consensus on which, if any, are superior diagnostic tools, and on how or when they should be applied.
The Discrimination and Stigma Scale (DISC) is a patient-reported outcome measure which assesses experiences of discrimination among persons with a mental illness globally.
This study evaluated whether the psychometric properties of a short-form version, DISC-Ultra Short (DISCUS) (11-item), could be replicated in a sample of people with a wide range of mental disorders from 21 sites in 15 countries/territories, across six global regions. The frequency of experienced discrimination was reported. Scaling assumptions (confirmatory factor analysis, inter-item and item-total correlations), reliability (internal consistency) and validity (convergent validity, known groups method) were investigated in each region, and by diagnosis group.
1195 people participated. The most frequently reported experiences of discrimination were being shunned or avoided at work (48.7%) and discrimination in making or keeping friends (47.2%). Confirmatory factor analysis supported a unidimensional model across all six regions and five diagnosis groups. Convergent validity was confirmed in the total sample and within all regions [ Internalised Stigma of Mental Illness (ISMI-10): 0.28–0.67, stopping self: 0.54–0.72, stigma consciousness: −0.32–0.57], as was internal consistency reliability (α = 0.74–0.84). Known groups validity was established in the global sample with levels of experienced discrimination significantly higher for those experiencing higher depression [Patient Health Questionnaire (PHQ)-2: p < 0.001], lower mental wellbeing [Warwick-Edinburgh Well-being Scale (WEMWBS): p < 0.001], higher suicidal ideation [Beck Hopelessness Scale (BHS)-4: p < 0.001] and higher risk of suicidal behaviour [Suicidal Ideation Attributes Scale (SIDAS): p < 0.001].
The DISCUS is a reliable and valid unidimensional measure of experienced discrimination for use in global settings with similar properties to the longer DISC. It offers a brief assessment of experienced discrimination for use in clinical and research settings.
Major depressive disorder (MDD) is a leading cause of morbidity and mortality. Shortfalls in treatment quantity and quality are well-established, but the specific gaps in pharmacotherapy and psychotherapy are poorly understood. This paper analyzes the gap in treatment coverage for MDD and identifies critical bottlenecks.
Seventeen surveys were conducted across 15 countries by the World Health Organization-World Mental Health Surveys Initiative. Of 35 012 respondents, 3341 met DSM-IV criteria for 12-month MDD. The following components of effective treatment coverage were analyzed: (a) any mental health service utilization; (b) adequate pharmacotherapy; (c) adequate psychotherapy; and (d) adequate severity-specific combination of both.
MDD prevalence was 4.8% (s.e., 0.2). A total of 41.8% (s.e., 1.1) received any mental health services, 23.2% (s.e., 1.5) of which was deemed effective. This 90% gap in effective treatment is due to lack of utilization (58%) and inadequate quality or adherence (32%). Critical bottlenecks are underutilization of psychotherapy (26 percentage-points reduction in coverage), underutilization of psychopharmacology (13-point reduction), inadequate physician monitoring (13-point reduction), and inadequate drug-type (10-point reduction). High-income countries double low-income countries in any mental health service utilization, adequate pharmacotherapy, adequate psychotherapy, and adequate combination of both. Severe cases are more likely than mild-moderate cases to receive either adequate pharmacotherapy or psychotherapy, but less likely to receive an adequate combination.
Decision-makers need to increase the utilization and quality of pharmacotherapy and psychotherapy. Innovations such as telehealth for training and supervision plus non-specialist or community resources to deliver pharmacotherapy and psychotherapy could address these bottlenecks.
Neodymium magnets were independently discovered in 1984 by General Motors and Sumitomo. Today, they are the strongest type of permanent magnets commercially available. They are the most widely used industrial magnets with many applications, including in hard disk drives, cordless tools and magnetic fasteners. We use a vector potential approach, rather than the more usual magnetic potential approach, to derive the three-dimensional (3D) magnetic field for a neodymium magnet, assuming an idealized block geometry and uniform magnetization. For each field or observation point, the 3D solution involves 24 nondimensional quantities, arising from the eight vertex positions of the magnet and the three components of the magnetic field. The only unknown in the model is the value of magnetization, with all other model quantities defined in terms of field position and magnet location. The longitudinal magnetic field component in the direction of magnetization is bounded everywhere, but discontinuous across the magnet faces parallel to the magnetization direction. The transverse magnetic fields are logarithmically unbounded on approaching a vertex of the magnet.
The General Medical Council has introduced a generic professional capabilities framework. It includes the need to develop the professional values, actions and aspirations fundamental to becoming a ‘dedicated doctor’. The history of psychiatry has potential to facilitate this learning, both by an understanding of content and the ability to think historically.
The basic idea motivating this paper is that something can be done intentionally even when it is not done with the intention of doing it. An implication of this idea is that the distinction between doing what one intends and doing something as a foreseen avoidable consequence of doing what one intends cannot be used to exonerate agents for misdeeds.
My immediate purpose here is to illustrate these points and show how they pertain to the morally relevant difference between active and passive euthanasia, and to the exoneration of God for the production of evil. In particular, I shall try to show, first, that the American Medical Association's recent attempt to distinguish between active and passive euthanasia is seriously defective. Second, I shall try to show that a popular version of the so-called Free Will Defense of God for Evil is also seriously defective.
Significant developments in micro-electrical-mechanical systems (MEMS)-based devices have led to the commercialization of windowed gas cells that now enable atomic-resolution scanning transmission electron microscopy (STEM) observation of phenomena occurring during gas-solid interactions at atmospheric pressure. An in situ atmospheric STEM study provides information that is beneficial to correlating the structure-properties relationship of catalytic nanomaterials, particularly under realistic gaseous reaction conditions. In this article, we illustrate the advantages of this tool as applied to our study of two important systems: (1) the CO-induced Pt nanoparticle surface reconstruction at saturation coverage and (2) the ordering and Pt surface enrichment in supported Pt3Co nanoparticles.
The role that vitamin D plays in pulmonary function remains uncertain. Epidemiological studies reported mixed findings for serum 25-hydroxyvitamin D (25(OH)D)–pulmonary function association. We conducted the largest cross-sectional meta-analysis of the 25(OH)D–pulmonary function association to date, based on nine European ancestry (EA) cohorts (n 22 838) and five African ancestry (AA) cohorts (n 4290) in the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium. Data were analysed using linear models by cohort and ancestry. Effect modification by smoking status (current/former/never) was tested. Results were combined using fixed-effects meta-analysis. Mean serum 25(OH)D was 68 (sd 29) nmol/l for EA and 49 (sd 21) nmol/l for AA. For each 1 nmol/l higher 25(OH)D, forced expiratory volume in the 1st second (FEV1) was higher by 1·1 ml in EA (95 % CI 0·9, 1·3; P<0·0001) and 1·8 ml (95 % CI 1·1, 2·5; P<0·0001) in AA (Prace difference=0·06), and forced vital capacity (FVC) was higher by 1·3 ml in EA (95 % CI 1·0, 1·6; P<0·0001) and 1·5 ml (95 % CI 0·8, 2·3; P=0·0001) in AA (Prace difference=0·56). Among EA, the 25(OH)D–FVC association was stronger in smokers: per 1 nmol/l higher 25(OH)D, FVC was higher by 1·7 ml (95 % CI 1·1, 2·3) for current smokers and 1·7 ml (95 % CI 1·2, 2·1) for former smokers, compared with 0·8 ml (95 % CI 0·4, 1·2) for never smokers. In summary, the 25(OH)D associations with FEV1 and FVC were positive in both ancestries. In EA, a stronger association was observed for smokers compared with never smokers, which supports the importance of vitamin D in vulnerable populations.
Psychoses, especially schizophrenia, are often preceded by cognitive deficits and psychosis risk states. Altered metabolic profiles have been found in schizophrenia. However, the associations between metabolic profiles and poorer cognitive performance and psychosis risk in the population remain to be determined.
Detailed molecular profiles were measured for up to 8976 individuals from two general population-based prospective birth cohorts: the Northern Finland Birth Cohort 1986 (NFBC 1986) and the Avon Longitudinal Study of Parents and Children (ALSPAC). A high-throughput nuclear magnetic resonance spectroscopy platform was used to quantify 70 metabolic measures at age 15–16 years in the NFBC 1986 and at ages 15 and 17 years in ALSPAC. Psychosis risk was assessed using the PROD-screen questionnaire at age 15–16 years in the NFBC 1986 or the psychotic-like symptoms assessment at age 17 years in ALSPAC. Cognitive measures included academic performance at age 16 years in both cohorts and general intelligence and executive function in ALSPAC. Logistic regression measured cross-sectional and longitudinal associations between metabolic measures and psychosis risk and cognitive performance, controlling for important covariates.
Seven metabolic measures, primarily fatty acid (FA) measures, showed cross-sectional associations with general cognitive performance, four across both cohorts (low density lipoprotein diameter, monounsaturated FA ratio, omega-3 ratio and docosahexaenoic acid ratio), even after controlling for important mental and physical health covariates. Psychosis risk showed minimal metabolic associations.
FA ratios may be important in marking risk for cognitive deficits in adolescence. Further research is needed to clarify whether these biomarkers could be causal and thereby possible targets for intervention.
Significant developments in micro-electrical-mechanical systems (MEMS)-based devices for use in transmission electron microscopy (TEM) sample holders have recently led to the commercialization of windowed gas cells that now enable the atomic-resolution visualization of phenomena occurring during gas-solid interactions at atmospheric pressure. In situ atmospheric TEM study provides unique information that is beneficial to correlating the structure-properties relationship of catalytic nanomaterials, particularly under realistic gaseous reaction conditions. In this paper, we illustrate the capability of this novel in situ device as applied to our study of two catalyst systems: (1) In situ kinetic growth of free standing Pt nanowires as active catalysts toward oxygen reduction reaction (ORR); (2) In situ observation of facet-dependent oxidation of another promising ORR catalyst, Pt3Co nanoparticles.
Significant developments in micro-electrical-mechanical systems-based devices for use in transmission electron microscopy (TEM) sample holders have recently led to the commercialization of windowed gas cells that now enable the atomic-resolution visualization of phenomena occurring during gas–solid interactions at atmospheric pressure. In situ TEM study under atmospheric pressures provides unique information that is beneficial to correlating the structure–properties relationship of nanomaterials, particularly under real gaseous environments. We here provide a brief introduction of the advanced instrumentation of windowed gas cells and review recent progress of in situ atomic-resolution TEM study under atmospheric pressures, including some application examples of oxidation and reduction processes, dynamic growth of nanomaterials, catalytic reactions, and “operando” TEM.
Regulatory impact analyses (RIAs) weigh the benefits of regulations against the burdens they impose and are invaluable tools for informing decision makers. We offer 10 tips for nonspecialist policymakers and interested stakeholders who will be reading RIAs as consumers.
1. Core problem: Determine whether the RIA identifies the core problem (compelling public need) the regulation is intended to address.
2. Alternatives: Look for an objective, policy-neutral evaluation of the relative merits of reasonable alternatives.
3. Baseline: Check whether the RIA presents a reasonable “counterfactual” against which benefits and costs are measured.
4. Increments: Evaluate whether totals and averages obscure relevant distinctions and trade-offs.
5. Uncertainty: Recognize that all estimates involve uncertainty, and ask what effect key assumptions, data, and models have on those estimates.
6. Transparency: Look for transparency and objectivity of analytical inputs.
7. Benefits: Examine how projected benefits relate to stated objectives.
8. Costs: Understand what costs are included.
9. Distribution: Consider how benefits and costs are distributed.
10. Symmetrical treatment: Ensure that benefits and costs are presented symmetrically.