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Relapse prevention strategies based on monitoring of early warning signs (EWS) are advocated for the management of psychosis. However, there has been a lack of research exploring how staff, carers and patients make sense of the utility of EWS, or how these are implemented in context.
To develop a multiperspective theory of how EWS are understood and used, which is grounded in the experiences of mental health staff, carers and patients.
Twenty-five focus groups were held across Glasgow and Melbourne (EMPOWER Trial, ISRCTN: 99559262). Participants comprised 88 mental health staff, 21 patients and 40 carers from UK and Australia (total n = 149). Data were analysed using constructivist grounded theory.
All participants appeared to recognise EWS and acknowledged the importance of responding to EWS to support relapse prevention. However, recognition of and acting on EWS were constructed in a context of uncertainty, which appeared linked to risk appraisals that were dependent on distinct stakeholder roles and experiences. Within current relapse management, a process of weighted decision-making (where one factor was seen as more important than others) described how stakeholders weighed up the risks and consequences of relapse alongside the risks and consequences of intervention and help-seeking.
Mental health staff, carers and patients speak about using EWS within a weighted decision-making process, which is acted out in the context of relationships that exist in current relapse management, rather than an objective response to specific signs and symptoms.
Foot and mouth disease (FMD) is a major animal health problem within Southeast Asia (SEA). Although Indonesia and more recently the Philippines have achieved freedom from FMD, the disease remains endemic on continental SEA. Control of FMD within SEA would increase access to markets in more developed economies and reduce lost productivity in smallholder and emerging commercial farmer settings. However, despite many years of vaccination by individual countries, numerous factors have prevented the successful control of FMD within the region, including unregulated ‘informal’ transboundary movement of livestock and their products, difficulties implementing vaccination programmes, emergence of new virus topotypes and lineages, low-level technical capacity and biosecurity at national levels, limited farmer knowledge on FMD disease recognition, failure of timely outbreak reporting and response, and limitations in national and international FMD control programmes. This paper examines the published research of FMD in the SEA region, reviewing the history, virology, epidemiology and control programmes and identifies future opportunities for FMD research aimed at the eventual eradication of FMD from the region.
Recent observations of the radio-frequency flux spectrum of Jupiter in the frequency range 80-10 000 MHz suggest that the synchrotron component is not independent of frequency as has been generally accepted. Rather, the flux decreases at frequencies below 300 MHz and above 3000 MHz. In this paper we show that extensions and variations of the well-known dipolar model for this emission can account for the modified spectrum.
In this paper we model mathematically the propagation of galactic cosmic-rays in the solar cavity and study the effects of changing the physical parameters; in particular the radius of the cavity. We assume spherical symmetry with heliocentric distance r, momentum p and work in terms of F0(r, p) the mean distribution function with respect to momentum; it is related to JT the mean differential intensity w.r.t. energy by JT = p2F0. The boundary is at r = rb beyond which the galactic spectrum prevails; there is free escape of particles incident on rb from within, and the distribution is steady state.
The purpose of this paper is to provide a new expression for < ṗ > the average time-rate-of-change of momentum of cosmic-ray particles propagating in the interplanetary region. The expression derived replaces the previously used adiabatic deceleration formula and it is arrived at by a rearrangement and reinterpretation of the well known equation of transport for cosmic-rays. Thus, although we provide a new expression for < ṗ > we maintain the equation of transport and do not render invalid results for differential intensity and differential current density of cosmic-ray particles obtained by its solution (Jokipii 1971; Gleeson 1972).
This paper is a preliminary account of the calculation of the circularly polarized synchrotron radiation received from a distribution of electricallycharged particles confined to a thin shell in the magnetic field of a dipole. Calculations of the total radiation and the degree of linear polarization have previously been carried out, and these calculations are duplicated in part.
In this paper we study the steady-state interplanetary propagation of solar cosmic-rays by means of analytic solutions of the equation of transport. The cosmic-rays are released monoenergetically from a fixed heliocentric radius and redistribute in energy as they propagate. Previous investigations by Goldstein et al. (1970), Urch and Gleeson (1971,1972), and Parker (1965, 1966), were either not general enough or used numerical solutions which could not deal with strictly monoenergetic initial injection nor maintain accuracy over a wide range of particle energies. We use the analytic solutions of Gleeson and Webb (1973) and show the energy changes, the redistribution in energy (or momentum) and the characteristics of the particle flow or streaming.
Recently (Gleeson (1972), Quenby (1973), Gleeson and Webb (1974, 1978)) it has been shown that the mean rate of change of momentum of cosmic rays reckoned for a volume fixed in the solar system is
where G = (1/Up)(∂Up/∂r)si the cosmic-ray density gradient with Up, the differential number density with respect to momentum p at position r. (cf also the integral form of (1) by Jokipii and Parker 1967).
In this paper we give an account of the corrections that must be made to the formula for the emissivity ηf due to a power-law energy distribution of ultrarelativistic charged particles in a uniform magnetic field B0 in directions well away from the field lines when the effects of upper and lower cut-off values E2 and E1 in the energy distribution are not negligible.
This review is concerned mainly with the solar modulation of galactic cosmic rays and the progress that has been made since the Tenth International Conference on Cosmic Rays (Calgary, June 1967), My aim is to set out some of the advances in the basic theories; to indicate why certain disagreements between convection-diffusion theory and observations (noted in Webber’s invited review at Calgary) are to be expected; and to indicate some of the currently emerging areas of interest.
With prevention and treatment of mental disorders a challenge for primary care and increasing capability of electronic medical records (EMRs) to facilitate research in practice, we aim to determine the prevalence and treatment of mental disorders by using routinely collected clinical data contained in EMRs.
We reviewed EMRs of patients randomly sampled from seven general practices, by piloting a study instrument and extracting data on mental disorders and their treatment.
Data were collected on 690 patients (age range 18–95, 52% male, 52% GMS-eligible). A mental disorder (most commonly anxiety/stress, depression and problem alcohol use) was recorded in the clinical records of 139 (20%) during the 2-year study period. While most patients with the common disorders had been prescribed medication (i.e. antidepressants or benzodiazepines), a minority had been referred to other agencies or received psychological interventions. ‘Free text’ consultation notes and ‘prescriptions’ were how most patients with disorders were identified. Diagnostic coding alone would have failed to identify 92% of patients with a disorder.
Although mental disorders are common in general practice, this study suggests their formal diagnosis, disease coding and access to psychological treatments are priorities for future research efforts.
Background: High quality randomized controlled trials (RCT) of psychotherapeutic interventions should ensure that the therapy being tested is what is actually delivered. However, contamination of one therapy into the other, a critical component of treatment adherence, is seldom measured in psychotherapy trials of psychosis. Aims: The aim of the study was to determine whether a purpose-designed measure, the ACE Treatment Integrity Measure (ATIM) could detect therapy contaminations within a controlled trial of cognitive behavioural therapy (CBT) versus Befriending for first-episode psychosis and to compare the ATIM to a more traditional adherence measure, the Cognitive Therapy Scale (CTS). Method: Therapy sessions were audio-recorded and at least one therapy session from 53 of the 62 participants in the RCT was rated by an independent rater using the CTS and ATIM. Results: Ninety-nine therapy sessions were rated. All Befriending sessions and all but three CBT sessions were correctly identified. The ATIM showed that 29 of the 99 (29%) sessions were contaminated by techniques from the other therapy. Within the CBT sessions, 19 of the 51 sessions (37%) were contaminated by one or more Befriending techniques. Of the Befriending sessions, 10 of 48 (21%) were contaminated by ACE techniques. The mean CTS score was higher in the CBT than the Befriending group. Conclusions: The ATIM was able to detect contaminations and revealed more meaningful, fine-grained analysis of what therapy techniques were being delivered and what contaminations occurred. The study highlights the benefit of employing purpose-designed measures that include contamination when assessing treatment adherence.
In recent years there has been increasing interest in functional recovery in the early phase of schizophrenia. Concurrently, new remission criteria have been proposed and several studies have examined their clinical relevance for prediction of functional outcome in first-episode psychosis (FEP). However, the longitudinal interrelationship between full functional recovery (FFR) and symptom remission has not yet been investigated. This study sought to: (1) examine the relationships between FFR and symptom remission in FEP over 7.5 years; (2) test two different models of the interaction between both variables.
Altogether, 209 FEP patients treated at a specialized early psychosis service were assessed at baseline, 8 months, 14 months and 7.5 years to determine their remission of positive and negative symptoms and functional recovery. Multivariate logistic regression and path analysis were employed to test the hypothesized relationships between symptom remission and FFR.
Remission of both positive and negative symptoms at 8-month follow-up predicted functional recovery at 14-month follow-up, but had limited value for the prediction of FFR at 7.5 years. Functional recovery at 14-month follow-up significantly predicted both FFR and remission of negative symptoms at 7.5 years, irrespective of whether remission criteria were simultaneously met. The association remained significant after controlling for baseline prognostic indicators.
These findings provided support for the hypothesis that early functional and vocational recovery plays a pivotal role in preventing the development of chronic negative symptoms and disability. This underlines the need for interventions that specifically address early psychosocial recovery.
We report a case of an arteriovenous malformation within the internal auditory meatus and cerebellopontine angle, and we discuss its imaging appearances and management.
A 50-year-old man presented with a two-year history of vertigo. Magnetic resonance imaging and magnetic resonance angiography demonstrated a lesion consisting of multiple ‘high flow’ vessels within the left internal auditory meatus and cerebellopontine angle. Transarterial embolisation was performed, with obliteration of the arteriovenous malformation.
Arteriovenous malformations of the internal auditory meatus and cerebellopontine angle are exceedingly rare. It is important that a pre-treatment diagnosis is made, as the management of arteriovenous malformation differs from that of other, more common lesions at this site.
Myxosporean parasites are significant parasites of fishes not only for their apparent high diversity but also for their potential impact on fish health and/or marketability. Regardless, our knowledge of most myxosporeans, especially those found in elasmobranch hosts, is superficial. A study of multivalvulidan diversity in a range of elasmobranchs from Queensland, Western Australia and the Northern Territory (Australia) was conducted to address this knowledge gap. Specimens were collected from a total of 3 orders, 9 families and 31 species of elasmobranchs. Myxosporean infections referable to the genus Kudoa were discovered in host muscle and characterized morphologically and genetically. Both small subunit (SSU) and large subunit (LSU) rDNA sequences were used in molecular phylogenetic analyses. Kudoa spp. infected 27 of the 31 species of elasmobranchs examined, representing new records of this parasite genus in 26, of the 27, host species. Kudoids were observed in all 3 orders, and 7 out of the 9 families of elasmobranchs investigated. This paper reports the first 2 multivalvulidan species to be formally described from elasmobranchs, Kudoa hemiscylli n.sp. characterized from Hemiscyllium ocellatum (and 8 other host species) and Kudoa carcharhini n. sp. characterized from Carcharhinus cautus (and 2 other host species). Phylogenetic analyses revealed that kudoids from elasmobranchs form a separate lineage to those of teleosts, but are anchored within the overall kudoid clade.
Little research has focused on delineating the specific predictors of emotional over-involvement (EOI) and critical comments (CC) in the early course of psychosis. The purpose of this study was to investigate the differential relationships of EOI and CC with relevant predictors in relatives of first-episode psychosis (FEP) patients.
Baseline patient-related factors including psychotic symptoms, depression and duration of untreated psychosis (DUP) and carer attributes comprising CC, EOI, burden of care and carers' stress and depression were assessed in a cohort of 63 remitted FEP patients and their relatives. Carers were reassessed at 7 months follow-up.
Baseline analysis showed that EOI was more strongly correlated with family stress compared with CC, whereas CC yielded a stronger association with DUP than EOI. Carers' CC at follow-up was not significantly predicted by either baseline family stress, burden of care or patient-related variables. Conversely, baseline EOI predicted both family stress and burden of care at 7 months follow-up. Finally, family burden of care at follow-up was a function of baseline EOI and patients' depressive symptoms.
This study provides preliminary support to the postulate that EOI and CC may be influenced by separate factors early in the course of psychosis and warrant future research and therapeutic interventions as separate constructs. Implications for family interventions in the early phase of psychosis and the prevention of CC and EOI are discussed.