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The Kilmaluag Formation on the Isle of Skye, Scotland, provides one of the richest Mesozoic vertebrate fossil assemblages in the UK, and is among the richest globally for Middle Jurassic tetrapods. Since its discovery in 1971, this assemblage has predominantly yielded small-bodied tetrapods, including salamanders, choristoderes, lepidosaurs, turtles, crocodylomorphs, pterosaurs, dinosaurs, non-mammalian cynodonts and mammals, alongside abundant fish and invertebrates. It is protected as a Site of Special Scientific Interest and by Nature Conservancy Order. Unlike contemporaneous localities from England, this assemblage yields associated partial skeletons, providing unprecedented new data. We present a comprehensive updated overview of the Kilmaluag Formation, including its geology and the fossil collections made to date, with evidence of several species occurrences presented here for the first time. We place the vertebrate faunal assemblage in an international context through comparisons with relevant contemporaneous localities from the UK, Europe, Africa, Asia and the US. This wealth of material reveals the Kilmaluag Formation as a vertebrate fossil assemblage of global significance, both in terms of understanding Middle Jurassic faunal composition and the completeness of specimens, with implications for the early evolutionary histories of mammals, squamates and amphibians.
Over the past 15 years, there has been substantial growth in web-based psychological interventions. We summarize evidence regarding the efficacy of web-based self-directed psychological interventions on depressive, anxiety and distress symptoms in people living with a chronic health condition.
We searched Medline, PsycINFO, CINAHL, EMBASE databases and Cochrane Database from 1990 to 1 May 2019. English language papers of randomized controlled trials (usual care or waitlist control) of web-based psychological interventions with a primary or secondary aim to reduce anxiety, depression or distress in adults with a chronic health condition were eligible. Results were assessed using narrative synthases and random-effects meta-analyses.
In total 70 eligible studies across 17 health conditions [most commonly: cancer (k = 20), chronic pain (k = 9), arthritis (k = 6) and multiple sclerosis (k = 5), diabetes (k = 4), fibromyalgia (k = 4)] were identified. Interventions were based on CBT principles in 46 (66%) studies and 42 (60%) included a facilitator. When combining all chronic health conditions, web-based interventions were more efficacious than control conditions in reducing symptoms of depression g = 0.30 (95% CI 0.22–0.39), anxiety g = 0.19 (95% CI 0.12–0.27), and distress g = 0.36 (95% CI 0.23–0.49).
Evidence regarding effectiveness for specific chronic health conditions was inconsistent. While self-guided online psychological interventions may help to reduce symptoms of anxiety, depression and distress in people with chronic health conditions in general, it is unclear if these interventions are effective for specific health conditions. More high-quality evidence is needed before definite conclusions can be made.
The scarcity of Romano-British human remains from north-west England has hindered understanding of burial practice in this region. Here, we report on the excavation of human and non-human animal remains1 and material culture from Dog Hole Cave, Haverbrack. Foetal and neonatal infants had been interred alongside a horse burial and puppies, lambs, calves and piglets in the very latest Iron Age to early Romano-British period, while the mid- to late Roman period is characterised by burials of older individuals with copper-alloy jewellery and beads. This material culture is more characteristic of urban sites, while isotope analysis indicates that the later individuals were largely from the local area. We discuss these results in terms of burial ritual in Cumbria and rural acculturation. Supplementary material is available online (https://doi.org/10.1017/S0068113X20000136), and contains further information about the site and excavations, small finds, zooarchaeology, human osteology, site taphonomy, the palaeoenvironment, isotope methods and analysis, and finds listed in Benson and Bland 1963.
The purpose of this rejoinder is to emphasize several important areas of future research that were mentioned by one or both commentaries. First, the authors discuss issues related to multi-source assessment, such as the importance of further research on informant bias, and argue that the information gleaned from multiple sources is worth the added assessment burden. Second, they underscore the importance of longitudinal assessment both in capturing the treatment-relevant within-person processes through which personality pathology unfolds, as well as tracking therapeutic progress. They assert that a given measure’s ability to reliably and validly measure change over time should be considered when evaluating its clinical utility. Finally, they emphasize the need for greater attention to clinical utility of dimensional PD assessment measures.
Neuropsychological deficits following brain injury include cognitive impairment, difficulties with emotion, changes in self-identity, impairment in insight, behavioural challenges and personality change. The reviews rehabilitation for neuropsychological problems and includes specific reference to mild traumatic brain injury and traumatic brain injury in children.
The purpose of this chapter is to review the current state of the dimensional assessment of personality disorder (PD). The first part of the chapter serves as a review of the most well-established and commonly used measures of maladaptive personality traits. Measures that assess the psychosocial impairment associated with personality pathology also are reviewed. Areas of discontinuity among these measures (e.g., theoretical origin, method of scale construction, degree of correspondence with well-known trait dimensions, attention received in the empirical literature, degree of bipolarity of underlying dimensions) are emphasized, and the clinical utility of measures is evaluated. The second part of the chapter focuses on several controversial issues with which the field of dimensional PD assessment now is grappling. These issues include (a) the psychometric distinction of personality traits from personality functioning, (b) the incremental utility of adaptive trait assessment, (c) the question of maladaptive trait bipolarity, (d) facet-level differences versus domain-level similarity across competing PD trait models, and (e) the value of multi-source assessment.
Rehabilitation has been defined in many ways, but in the broadest sense is concerned with maximising quality of life after injury or illness.1 More specifically, rehabilitation is about maximising the ability and opportunity of the person with brain injury to participate in those activities of daily living, work, education, leisure and relationships that are valued by that person. Wade discusses the importance of models of illness (and health) and highlights the value of the World Health Organization International Classification of Functioning, Disability and Health (ICF) as a framework for understanding the process of rehabilitation.
Introduction: Prehospital field trauma triage (FTT) standards were reviewed and revised in 2014 based on the recommendations of the Centers for Disease Control and Prevention. The FTT standard allows a hospital bypass and direct transport, within 30 min, to a lead trauma hospital (LTH). Our objectives were to assess the impact of the newly introduced prehospital FTT standard and to describe the emergency department (ED) management and outcomes of patients that had bypassed closer hospitals. Methods: We conducted a 12-month multi-centred health record review of paramedic and ED records following the implementation of the 4 step FTT standard (step 1: vital signs and level of consciousness (physiologic), step 2: anatomical injury, step 3: mechanism and step 4: special considerations) in nine paramedic services across Eastern Ontario. We included adult trauma patients transported as urgent that met FTT standard, regardless of transport time. We developed and piloted a data collection tool and obtained consensus on all definitions. The primary outcome was the rate of appropriate triage to a LTH which was defined as: ISS ≥12, admitted to intensive care unit (ICU), non-orthopedic surgery, or death. We have reported descriptive statistics. Results: 570 patients were included: mean age 48.8, male 68.9%, falls 29.6%, motor vehicle collisions 20.2%, stab wounds 10.5%, transported to a LTH 76.5% (n = 436). 72.2% (n = 315) of patients transported to a LTH had bypassed a closer hospital and 126/306 (41.2%) of those were determined to be an appropriate triage to LTH (9 patients had missing outcomes). ED management included: CT head/cervical spine 69.9%, ultrasound 53.6%, xray 51.6%, intubation 15.0%, sedation 11.1%, tranexamic acid 9.8%, blood transfusion 8.2%, fracture reduction 6.9%, tube thoracostomy 5.9%. Outcomes included: ISS ≥ 12 32.7%, admitted to ICU 15.0%, non-orthopedic surgery 11.1%, death 8.8%. Others included: admission to hospital 57.5%, mean LOS 12.8 days, orthopedic surgery 16.3% and discharged from ED 37.3%. Conclusion: Despite a high number of admissions, the majority of trauma patients bypassed to a LTH were considered over-triaged, with a low number of ED procedures and non-orthopedic surgeries. Continued work is needed to appropriately identify patients requiring transport to a LTH.
Over the last 25 years, the harbour porpoise (Phocoena phocoena) has made a significant return to the Southern Bight of the North Sea and the English Channel due to a shift in distribution from northerly regions. Although the ecological drivers of this return are unclear, this species faces multiple threats in the region, including by-catch and habitat degradation. Ferry-based surveys were conducted year-round between November 2011 and June 2014 to assess the influence of environmental parameters upon the spatiotemporal distribution and relative abundance of harbour porpoises in the Southern Bight of the North Sea. A total of 1450 sightings of harbour porpoises were recorded during the 100 round-trip surveys carried out between Dunkirk (France) and Dover (England). Inter-annual and monthly variations in group size were observed, with largest groups recorded in 2014 (mean = 2.02) and in January (mean = 2.32). The relative abundance showed significant seasonal variation, with peaks recorded during winter months. An inter-annual increasing relative abundance was recorded during the study period. There was a seasonally dependent association with environmental variables, particularly depth, seabed roughness and current speed. Finally, predictions suggest large increases of the relative abundance in offshore habitats during winter months and over the study period.
At present, analysis of diet and bladder cancer (BC) is mostly based on the intake of individual foods. The examination of food combinations provides a scope to deal with the complexity and unpredictability of the diet and aims to overcome the limitations of the study of nutrients and foods in isolation. This article aims to demonstrate the usability of supervised data mining methods to extract the food groups related to BC. In order to derive key food groups associated with BC risk, we applied the data mining technique C5.0 with 10-fold cross-validation in the BLadder cancer Epidemiology and Nutritional Determinants study, including data from eighteen case–control and one nested case–cohort study, compromising 8320 BC cases out of 31 551 participants. Dietary data, on the eleven main food groups of the Eurocode 2 Core classification codebook, and relevant non-diet data (i.e. sex, age and smoking status) were available. Primarily, five key food groups were extracted; in order of importance, beverages (non-milk); grains and grain products; vegetables and vegetable products; fats, oils and their products; meats and meat products were associated with BC risk. Since these food groups are corresponded with previously proposed BC-related dietary factors, data mining seems to be a promising technique in the field of nutritional epidemiology and deserves further examination.
There have been conflicting reports on the relationship between thyroid function and mood between studies in subjects on thyroxine and the general population not on thyroxine. We investigated this relationship in a large population study.
We analysed data on serum TSH levels and Hospital Anxiety and Depression Scale (HADS) scores from the HUNT 2 study (age ≥ 40 years). Following a test for interaction, analyses were performed separately in females on thyroxine (n=1,265) and in people not on thyroxine (males n=9,319 and females n=17,694).
More females on thyroxine had high depression and anxiety scores than females not on thyroxine (depression 18.4% vs 13.0%, p< 0.001, anxiety 23.4% vs 18.7% p< 0.001). In those not on thyroxine there was an inverse association between serum TSH and depression score in males (B coefficient = -0.61, 95% CI -0.91 to -0.24, p=0.001) though not in females (B coefficient = -0.07, -0.33 to 0.19), and an inverse association between TSH and anxiety score in both sexes (B coefficient for males = -0.68, 95% CI -1.04 to -0.32, p< 0.001; females -0.37, -0.67 to -0.08, p=0.01). By contrast, in females on thyroxine, TSH was positively associated with both depression (B coefficient = +0.27, 95% CI 0.02 to 0.51, p< 0.05) and anxiety (B coefficient = +0.29, 0.01 to 0.56, p< 0.05).
There is a different relationship between thyroid function and depression and anxiety in females on thyroxine compared to individuals with no thyroid disease.
Dans le cadre du développement de la classification internationale des maladies (CIM-11), les groupes de travail ont développé des propositions avec pour objectif d’améliorer l’utilité clinique de la classification. Ces propositions sont testées via la plateforme internet « Réseau Mondial de Pratique Clinique (RMPC) » permettant de conduire à des études cliniques électroniques dans les langues officielles de l’OMS, dont le français. Cette étude s’intéresse aux catégories diagnostiques des troubles de l’alimentation et des conduites alimentaires (TCA). Des nouveaux diagnostics ont été proposés tels que le trouble d’hyperphagie et le trouble d’évitement et de restriction de l’apport alimentaire.
– évaluer l’impact des changements spécifiques des TCA entre la CIM-10 et la CIM-11 auprès des membres francophones du RMPC ;
– évaluer la validité, l’utilité clinique des nouvelles propositions et l’accord inter-juges des participants.
Étude mixte, internationale, conduite par internet auprès des membres francophones du RMPC.
Membres du RMPC maîtrisant le français (environ 1000 professionnels) et exerçant une activité clinique.
La population cible recevra un email d’invitation. Les participants seront amenés à lire deux vignettes puis à poser des diagnostics et à répondre à des questions complémentaires, en se basant sur la CIM-10 ou la CIM-11 qu’ils auront reçu de façon aléatoire.
Les vignettes représenteront des cas cliniques réels et reflèteront les changements spécifiques entre la CIM-10 et la CIM-11. Elles seront ainsi présentées par pair (8 pairs possibles).
– interparticipants portant sur l’utilisation du système diagnostique (10 ou 11) et l’attribution du diagnostic en fonction des changements spécifiques ;
– intra-participant sur l’évaluation des pairs de vignettes.
Cette étude doit permettre d’évaluer les nouvelles propositions CIM en français, en tenant compte des spécificités culturelles et linguistiques de la francophonie.
Stigma against mental illness and the mentally ill is well known. However, stigma against psychiatrists and mental health professionals is known but not discussed widely. Public attitudes and also those of other professionals affect recruitment into psychiatry and mental health services. The reasons for this discriminatory attitude are many and often not dissimilar to those held against mentally ill individuals. In this Guidance paper we present some of the factors affecting the image of psychiatry and psychiatrists which is perceived by the public at large. We look at the portrayal of psychiatry, psychiatrists in the media and literature which may affect attitudes. We also explore potential causes and explanations and propose some strategies in dealing with negative attitudes. Reduction in negative attitudes will improve recruitment and retention in psychiatry. We recommend that national psychiatric societies and other stakeholders, including patients, their families and carers, have a major and significant role to play in dealing with stigma, discrimination and prejudice against psychiatry and psychiatrists.
L’exercice de la médecine est un compromis permanent entre la vie et la mort, entre puissance médicale et risque d’échec. Un exercice d’autant plus complexe qu’il est soumis aux contraintes d’une organisation institutionnelle mouvante et d’une charge de travail croissante. Par essence, les psychiatres sont exposés à une charge émotionnelle intense dans leurs échanges avec des patients souffrants et traumatisés, d’autant qu’il leur est recommandé de faire preuve d’empathie. Ainsi les médecins présentent un risque important de burn out, avec 49 % d’épuisement émotionnel chez des psychiatres italiens par exemple. Les comorbidités du burn out restent la dépression, le suicide, les addictions. Le risque suicidaire est plus élevé chez les médecins (les hommes médecins sont 1,4 fois plus à risque de commettre un suicide que les hommes non-médecins) et seulement 1/5 déclarent qu’ils iraient chercher de l’aide s’ils souffraient d’une maladie mentale. Etre thérapeute auprès de victimes de traumatismes peut entraîner une souffrance psychologique cumulée se manifestant sous forme de certains symptômes post-traumatiques révélant un traumatisme vicariant ou secondaire. L’usure de compassion, terme parfois utilisé comme synonyme, est pourtant quant à elle conceptualisée comme la somme de deux entités : le trauma vicariant et le burn out. La vulnérabilité à ces modifications cognitives est d’autant plus grande chez les soignants qu’ils présentent une exposition personnelle à des évènements traumatisants importante. L’élaboration d’échelles d’évaluation validées permet de mener des études sur ces différentes dimensions (« usure de compassion », traumatisme vicariant, burn out,…) parfois comprises comme conséquences néfastes de stratégies de coping dépassées. En France, le développement de la prise en soin des victimes de psychotraumatisme, doit conduire à étudier l’impact de celui-ci sur les personnels soignants.
Social contact is one of the most effective strategies for improving inter-group relations and is supported by decades of positive evidence. Several studies specifically support social contact interventions as a way of reducing stigma against people with mental health problems. Despite the effectiveness of this approach, some social groups have few opportunities for social contact in the real world.
Using the England Time to Change anti-stigma campaign as an example, we investigate the feasibility and effectiveness of delivering social contact interventions at the mass population level to reduce stigma and discrimination against people with mental health problems.
To investigate: (i) the feasibility of scaling up social contact interventions to reduce stigma and discrimination against people with mental health problems and (ii) the effectiveness of mass population social contact interventions to: improve intended stigmatising behaviour, increase willingness to disclose mental health problems and to promote engagement in antistigma activities.
Two types of mass participation social contact programmes within England's Time to Change campaign were evaluated via self-report questionnaire. Participants at social contact events were asked about the occurrence and quality of contact, attitudes, readiness to discuss mental health, and intended behaviour towards people with mental health problems.
Findings on feasibility and effectiveness of social contact programmes will be presented.
This study suggests that social contact interventions can be used by anti-stigma campaigns to reduce stigma and discrimination against people with mental health problems. Further investigation is needed regarding the maintenance of these changes
Previous research demonstrates various associations between depression, cardiovascular disease (CVD) incidence and mortality. Differences between studies may occur as a result of different methodologies.
This work investigated the impact of using two different methods to measure depression and two different methods of analysis to establish relationships.
The work investigated the association between depression, CVD incidence (CVDI) and mortality from coronary heart disease (MCHD), smoking related conditions (MSRC), and all causes (MALL), in a major population study using depression measured from a validated scale and a depression measure derived by factor analysis, and analyses based on continuous data and grouped data.
Data from the PRIME Study (N=9,798 men) on depression and ten year CVD incidence and mortality were analysed using Cox proportional hazards models.
Using continuous data, no relationships with CVDI were found, but both measures of depression resulted in the emergence of positive associations between depression and mortality (MCHD, MSRC, MALL). Using grouped data, no associations with CVDI or MCVD were found, and associations between the measure derived from factor analysis and MSRC and MALL were also lost. Positive associations were only found between depression measured using validated items, MSRC and MALL.
These data demonstrate a possible association between depression and mortality but detecting this association is dependent on the methodology used. Different findings based on methodology present clear problems for the determination of relationships. The differences here suggest the preferential use of validated scales and suggest against over-reduction via factor analysis and grouping.
Stigma and social exclusion related to mental health are of substantial public health importance for Europe. As part of ROAMER (ROAdmap for MEntal health Research in Europe), we used systematic mapping techniques to describe the current state of research on stigma and social exclusion across Europe. Findings demonstrate growing interest in this field between 2007 and 2012. Most studies were descriptive (60%), focused on adults of working age (60%) and were performed in Northwest Europe—primarily in the UK (32%), Finland (8%), Sweden (8%) and Germany (7%). In terms of mental health characteristics, the largest proportion of studies investigated general mental health (20%), common mental disorders (16%), schizophrenia (16%) or depression (14%). There is a paucity of research looking at mechanisms to reduce stigma and promote social inclusion, or at factors that might promote resilience or protect against stigma/social exclusion across the life course. Evidence is also limited in relation to evaluations of interventions. Increasing incentives for cross-country research collaborations, especially with new EU Member States and collaboration across European professional organizations and disciplines, could improve understanding of the range of underpinning social and cultural factors which promote inclusion or contribute toward lower levels of stigma, especially during times of hardship.
The unprecedented growth, availability and accessibility of sophisticated image analysis algorithms and powerful computational resources led to the idea of developing web-based computational infrastructures that could meet users’ new requirements. On the other hand the gap between the pace of data generation and the capability to extract clinically or scientifically relevant information is rapidly widening.
Integration of the power of sophisticated mathematical models, efficient computational algorithms and advanced hardware infrastructure provides the necessary sensitivity to detect, extract and analyze subtle, dynamic and distributed patterns distinguishing one brain from another, and a diseased brain from a normal brain.
neuGRID is the leading e-Infrastructure where neuroscientists can find core services and resources for brain image analysis. The neuGRID platform makes use of grid services and computing, and was developed with the final aim of overcoming the hurdles that the average scientist meets when trying to set up advanced experiments in computational neuroimaging, thereby empowering a larger base of scientists. Although originally built for neuroscientists working in the field of AD, the infrastructure is designed to be expandable to services from other medical fields (e.g. multiple sclerosis, psychiatric conditions).
“neuGRID for Users” will provide an e-Science environment by further developing and deploying the neuGRID infrastructure to deliver a Virtual Laboratory offering neuroscientists access to a wide range of datasets and algorithm pipelines, access to computational resources, services, and support. Information from this abstract is intended to make aware researchers working with neuroimaging of all possibilities when it comes to resources.