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No evidence-based therapy for borderline personality disorder (BPD) exhibits a clear superiority. However, BPD is highly heterogeneous, and different patients may specifically benefit from the interventions of a particular treatment.
From a randomized trial comparing a year of dialectical behavior therapy (DBT) to general psychiatric management (GPM) for BPD, long-term (2-year-post) outcome data and patient baseline variables (n = 156) were used to examine individual and combined patient-level moderators of differential treatment response. A two-step bootstrapped and partially cross-validated moderator identification process was employed for 20 baseline variables. For identified moderators, 10-fold bootstrapped cross-validated models estimated response to each therapy, and long-term outcomes were compared for patients randomized to their model-predicted optimal v. non-optimal treatment.
Significant moderators surviving the two-step process included psychiatric symptom severity, BPD impulsivity symptoms (both GPM > DBT), dependent personality traits, childhood emotional abuse, and social adjustment (all DBT > GPM). Patients randomized to their model-predicted optimal treatment had significantly better long-term outcomes (d = 0.36, p = 0.028), especially if the model had a relatively stronger (top 60%) prediction for that patient (d = 0.61, p = 0.004). Among patients with a stronger prediction, this advantage held even when applying a conservative statistical check (d = 0.46, p = 0.043).
Patient characteristics influence the degree to which they respond to two treatments for BPD. Combining information from multiple moderators may help inform providers and patients as to which treatment is the most likely to lead to long-term symptom relief. Further research on personalized medicine in BPD is needed.
The mammal family Tenrecidae (Afrotheria: Afrosoricida) is endemic to Madagascar. Here we present the conservation priorities for the 31 species of tenrec that were assessed or reassessed in 2015–2016 for the IUCN Red List of Threatened Species. Six species (19.4%) were found to be threatened (4 Vulnerable, 2 Endangered) and one species was categorized as Data Deficient. The primary threat to tenrecs is habitat loss, mostly as a result of slash-and-burn agriculture, but some species are also threatened by hunting and incidental capture in fishing traps. In the longer term, climate change is expected to alter tenrec habitats and ranges. However, the lack of data for most tenrecs on population size, ecology and distribution, together with frequent changes in taxonomy (with many cryptic species being discovered based on genetic analyses) and the poorly understood impact of bushmeat hunting on spiny species (Tenrecinae), hinders conservation planning. Priority conservation actions are presented for Madagascar's tenrecs for the first time since 1990 and focus on conserving forest habitat (especially through improved management of protected areas) and filling essential knowledge gaps. Tenrec research, monitoring and conservation should be integrated into broader sustainable development objectives and programmes targeting higher profile species, such as lemurs, if we are to see an improvement in the conservation status of tenrecs in the near future.
Background: The impact of alcohol use disorders (AUD) on psychological treatments for depression or anxiety in primary care psychological treatment services is unknown. Aims: To establish levels of alcohol misuse in an Improving Access to Psychological Therapies (IAPT) service, examine the impact of higher risk drinking on IAPT treatment outcomes and drop-out, and to inform good practice in working with alcohol misuse in IAPT services. Method: 3643 patients completed a brief questionnaire on alcohol use pre-treatment in addition to measures of depression, anxiety and functioning. Symptom and functioning measures were re-administered at all treatment sessions. Results: Severity of alcohol misuse was not associated with treatment outcomes, although those scoring eight or more on the AUDIT-C were more likely to drop out from treatment. Conclusions: IAPT services may be well placed to offer psychological therapies to patients with common mental disorders and comorbid AUD. Patients with AUD can have equivalent treatment outcomes to those without AUD, but some higher risk drinkers may find accessing IAPT treatment more difficult as they are more likely to drop out. Alcohol misuse on its own should not be used as an exclusion criterion from IAPT services. Recommendations are given as to how clinicians can: adjust their assessments to consider the appropriateness of IAPT treatment for patients that misuse alcohol, consider the potential impact of alcohol misuse on treatment, and improve engagement in treatment for higher risk drinkers.
Emerging CVD risk factors (e.g. HDL function and central haemodynamics) may account for residual CVD risk experienced by individuals who meet LDL-cholesterol and blood pressure (BP) targets. Recent evidence suggests that these emerging risk factors can be modified by polyphenol-rich interventions such as soya, but additional research is needed. This study was designed to investigate the effects of an isoflavone-containing soya protein isolate (delivering 25 and 50 g/d soya protein) on HDL function (i.e. ex vivo cholesterol efflux), macrovascular function and blood markers of CVD risk. Middle-aged adults (n 20; mean age=51·6 (sem 6·6) years) with moderately elevated brachial BP (mean systolic BP=129 (sem 9) mmHg; mean diastolic BP=82·5 (sem 8·4) mmHg) consumed 0 (control), 25 and 50 g/d soya protein in a randomised cross-over design. Soya and control powders were consumed for 6 weeks each with a 2-week compliance break between treatment periods. Blood samples and vascular function measures were obtained at baseline and following each supplementation period. Supplementation with 50 g/d soya protein significantly reduced brachial diastolic BP (−2·3 mmHg) compared with 25 g/d soya protein (Tukey-adjusted P=0·03) but not the control. Soya supplementation did not improve ex vivo cholesterol efflux, macrovascular function or other blood markers of CVD risk compared with the carbohydrate-matched control. Additional research is needed to clarify whether effects on these CVD risk factors depend on the relative health of participants and/or equol producing capacity.
Victimisation by the police is purported to be widespread in cities in the USA, but there is limited data on police–public encounters from community samples. This is partly due to an absence of measures for assessing police violence exposure from the standpoint of civilians. As such, the demographic distribution and mental health correlates of police victimisation are poorly understood. The aims of this study were to present community-based prevalence estimates of positive policing and police victimisation based on assessment with two novel measures, and to test the hypotheses that (1) exposure to police victimisation would vary across demographic groups and (2) would be associated with depression and psychological distress.
The Survey of Police–Public Encounters study surveyed adults residing in four US cities to examine the prevalence, demographic distribution and psychological correlates of police victimisation. Participants (N = 1615) completed measures of psychological distress (K-6 scale), depression (Patient Health Questionnaire 9) and two newly constructed measures of civilian-reported police–public encounters. Both measures were developed to assess police victimisation based on the WHO domains of violence, which include physical violence (with and without a weapon, assessed separately), sexual violence (inappropriate sexual contact, including public strip searches), psychological violence (e.g., threatening, intimidating, stopping without cause, or using discriminatory slurs) and neglect (police not responding when called or responding too late). The Police Practices Inventory assesses lifetime history of exposure to positive policing and police victimisation, and the Expectations of Police Practices Scale assesses the perceived likelihood of future incidents of police victimisation. Linear regression models were used to test for associations between police–public encounters and psychological distress and depression.
Psychological violence (18.6%) and police neglect (18.8%) were commonly reported in this sample and a substantial minority of respondents also reported more severe forms of violence, specifically physical (6.1%), sexual (2.8%) and physical with a weapon (3.3%). Police victimisation was more frequently reported by racial/ethnic minorities, males, transgender respondents and younger adults. Nearly all forms of victimisation (but not positive policing) were associated with psychological distress and depression in adjusted linear regression models.
Victimisation by police appears to be widespread, inequitably distributed across demographic groups and psychologically impactful. These findings suggest that public health efforts to both reduce the prevalence of police violence and to alleviate its psychological impact may be needed, particularly in disadvantaged urban communities.
Language use is of increasing interest in the study of mental illness. Analytical approaches range from phenomenological and qualitative to formal computational quantitative methods. Practically, the approach may have utility in predicting clinical outcomes. We harnessed a real-world sample (blog entries) from groups with psychosis, strong beliefs, odd beliefs, illness, mental illness and/or social isolation to validate and extend laboratory findings about lexical differences between psychosis and control subjects.
We describe the results of two experiments using Linguistic Inquiry and Word Count software to assess word category frequencies. In experiment 1, we compared word use in psychosis and control subjects in the laboratory (23 per group), and related results to subject symptoms. In experiment 2, we examined lexical patterns in blog entries written by people with psychosis and eight comparison groups. In addition to between-group comparisons, we used factor analysis followed by clustering to discern the contributions of strong belief, odd belief and illness identity to lexical patterns.
Consistent with others’ work, we found that first-person pronouns, biological process words and negative emotion words were more frequent in psychosis language. We tested lexical differences between bloggers with psychosis and multiple relevant comparison groups. Clustering analysis revealed that word use frequencies did not group individuals with strong or odd beliefs, but instead grouped individuals with any illness (mental or physical).
Pairing of laboratory and real-world samples reveals that lexical markers previously identified as specific language changes in depression and psychosis are probably markers of illness in general.
Freshwater fishes represent among the most diverse and threatened taxa globally, accounting for more than 25% of total vertebrates (> 30,000 species described), 37% of which are threatened with extinction (Darwall et al., 2008; Chapter 1). The poor conservation status of freshwater biodiversity is directly related to the pressure that these systems experience worldwide (Vörösmarty et al., 2010). Because of their importance to human welfare and development, freshwater ecosystems and biodiversity are subject to higher pressures and threats than are adjacent terrestrial ecosystems (Nel et al., 2007). Water pollution and abstraction coupled with invasive species and habitat modification (e.g. channelling and damming) are the principal threats to the conservation of freshwater biodiversity (Strayer & Dudgeon, 2010; Vörösmarty et al., 2010). These pressures are rapidly growing due to the increase of human population worldwide and the effect of climate change (Dudgeon et al., 2006; Chapter 3).
Although freshwater ecosystems and biodiversity are in urgent need of protection, there has been little emphasis on declaring protected areas for the primary purpose of conserving freshwater biodiversity (although see attempts in South Africa since the early 1970s (Roux & Nel, 2013 for a brief history) or the USA (Moyle & Yoshiyama, 1994)). Instead, uninformed opportunism has reigned, whereby the conservation of freshwater ecosystems has remained peripheral to conservation goals developed for terrestrial ecosystems, unless considered important for terrestrial biodiversity (Nel et al., 2007; Olden et al., 2010). The implementation of conservation is constrained by limited budgets and potential conflicts with other human uses. For this reason, it is unfeasible to protect all the areas that contribute to the persistence of biodiversity (Margules et al., 2002), and adequate planning is required. Conservation planning is a discipline that tries to deal with these issues to inform stakeholders and decision-makers on how to best invest limited resources available for conservation. The development of a conservation plan typically draws on knowledge spanning several scientific disciplines, increasingly also from the social sciences.
To be effective for freshwater conservation in general and fish in particular, protected areas must consider some particularities of freshwater ecosystems from the early planning stages (e.g. when deciding where to implement conservation) to the daily management. Freshwater ecosystems pose some unique challenges to the implementation of effective conservation (Abell, 2002), such as the importance of connectivity at maintaining natural processes and facilitating the propagation of threats (Linke et al., 2011).
It is American iconography. On January 1, 1863, Abraham Lincoln issued the Emancipation Proclamation, a bold presidential war measure indicating a dramatic shift in the rationale for fighting the Civil War and a promise of future freedom for 4 million enslaved Americans. Yet the document marked just a beginning. Only after the spring of 1865, when the North's military victory toppled the South's powerful slaveholding class, were the enslaved guaranteed liberation. Freedom's future was far from certain, however. Long after January 1863, the significance of both the Proclamation and emancipation assumed new meanings. During the ensuing generations, African Americans explored freedom, even while the nation hoped to rebuild itself and the government attempted to reconstruct the South. Events would ultimately demonstrate that, despite the sweeping power of Lincoln's Proclamation, the struggle over freedom and the problem of coercion defined emancipation's wider legacy. Ultimately, as historian Laura F. Edwards observes in her Epilogue to this volume, freedom's journey “was a long one, because slavery's influence was so pervasive.”
Rethinking American Emancipation: Legacies of Slavery and the Quest for Black Freedom contains nine essays that reconsider the origins, impact, and meaning of the end of slavery. It relies on several generations of rich scholarship about emancipation that has documented how the Civil War became a violent struggle to end the world's largest and most powerful system of slavery. The destruction of slavery has become a central element in our understanding of how the cataclysmic Civil War helped to remake American society. During the war years, both Abraham Lincoln and Frederick Douglass framed slavery's death as the catalyst for a national “rebirth.” “This revolutionary – regenerative – conception of the war,” writes historian David Blight, “launched black freedom and future equality on its marvelous, but always endangered, career in American history and memory.”
Collectively, the essays in this volume constitute a complex portrait of emancipation and its aftermath, thereby demonstrating new ways of considering the sources of slavery's demise. Was emancipation accomplished by political and military policies from above, or by self-emancipation from below? How important were slaves’ actions versus those of Congress, the president, and military authorities? Even after slavery formally ended in 1865 with the Thirteenth Amendment, freedom's boundaries remained fluid and contested.
On January 1, 1863, Abraham Lincoln announced the Emancipation Proclamation, an event that soon became a bold statement of presidential power, a dramatic shift in the rationale for fighting the Civil War, and a promise of future freedom for four million enslaved Americans. But the document marked only a beginning; freedom's future was anything but certain. Thereafter, the significance of both the Proclamation and of emancipation assumed new and diverse meanings, as African Americans explored freedom and the nation attempted to rebuild itself. Despite the sweeping power of Lincoln's Proclamation, struggle, rather than freedom, defined emancipation's broader legacy. The nine essays in this volume unpack the long history and varied meanings of the emancipation of American slaves. Together, the contributions argue that 1863 did not mark an end point or a mission accomplished in black freedom; rather, it initiated the beginning of an ongoing, contested process.
Identifying and applying the optimum fertilizer nitrogen (N) rate is a permanent challenge for farmers. Prediction of fertilizer N requirement, based on crop chlorophyll measurements (CMs), relies on a strong relationship between fertilizer N supply and leaf chlorophyll concentration at a given crop growth stage. A methodological approach is described, aiming to develop an algorithm that uses CM inputs to derive the economically optimum fertilizer N rate for top-dressing, without using a reference plot for data normalization. The method was tested on maize (Zea mays L. cvar Jabali) at experimental and farmer sites in the central (‘Bajío’) region of Mexico over 3 years (2010–12). Increasing fertilizer N supply at planting significantly influenced chlorophyll concentration at the seventh unfolded maize leaf stage (GS 17 on the Zadoks scale). Maize grain yields increased with increasing total fertilizer N supply and fitted quadratic models, which allowed economically optimum fertilizer N rates (Nopt) to be calculated. The Nopt ranged from 160 to 300 kg N/ha and corresponding grain yields ranged from 7·7 to 14 t/ha. Grouped data analysis (sites–years) confirmed a highly significant relationship between the Nopt and the chlorophyll concentration at GS 17, which could be described by a linear model: Nopt = 513·3–0·58 × CM. This model predicted the top-dressing Nopt within a fertilizer N management regime adapted to local maize cropping systems and led to similar grain yields across test sites compared with the same parameters calculated based on grain yield response trials. The current approach is variety-specific, so development of so-called correction factors accounting for variety-related differences in chlorophyll concentration is described. The results demonstrated the feasibility of the proposed algorithms to support decision-making on the optimum fertilizer N rate to apply in maize production systems with one top-dressing application.