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Life relies on mutualistic relationships among species, and on the constant rejuvenation of Earth’s materials. Mutualistic cities would do the same thing, enhancing biodiversity, clean air, better soils, fresh water, and stronger communities. Today, however, cities are far from mutualistic. Currently, more than 4 billion people live in cities, and that number is rising quickly. These conglomerations of humanity consume vast Earth resources, and, worst yet, disgorge astonishing amounts of waste into the atmosphere, water, land and sea around them. Unlike "smart cities" that rely on sophisticated technology to monitor and respond to environmental conditions, and unlike "sustainable cities" that stress reduction and reuse, the concept of a "mutualistic city" emphasizes regenerative cycles and virtuous feedback loops. These cities are the key to our future.
In light of concerning evidence that many young people with mental disorders are not receiving appropriate mental health intervention, school-based mental health screening has been advocated as one way to improve identification of at-risk youth. Despite having much promise, universal screening in schools remains a relatively uncommon practice internationally. Various barriers that deter school psychologists and counsellors from screening have been identified, including lack of resourcing to implement screening, lack of knowledge about the mechanics of how to carry out a screening program, and concern about how to manage the anticipated increased workload generated by following up identified students. In this practice-based paper we discuss a four-stage process that guides school psychologists and counsellors in the establishment of a school-based screening program, with specific reference to overcoming perceived barriers.
Psychiatry has never been without vociferous critics. Anti-psychiatry raised legitimate, albeit irritating, concerns about psychiatric practice. Clinical psychologists in Britain now outnumber psychiatrists, with an enormously expanded clinical remit. Lead psychologists are now as experienced as consultant psychiatrist and vie for leadership. To pretend that all is well in the world of professional mental health practice and relationship is dangerous.
There is growing evidence of an escalation of depression in young people. In light of this, schools are increasingly being confronted with the challenge of how to best manage students with depressive disorders. Such management includes consideration of the academic, behavioural, social and emotional implications of the disorder. This article provides school practitioners and management with a review of what constitutes ‘best practice’ in school management of students with depressive disorders. It adopts the mental health intervention framework of the Institute of Medicine, considering how school-based intervention occurs across the four domains of mental health promotion, prevention, case identification and treatment, as well as maintenance of students with or at-risk of depression. It provides a checklist for practitioners at each stage of the Institute of Medicine intervention spectrum. Moreover, it takes the view that best practice in psychology is always evidence-based practice, although discerning a clear path through the available research is not always obvious.
The ‘16Up’ study conducted at the QIMR Berghofer Medical Research Institute from January 2014 to December 2018 aimed to examine the physical and mental health of young Australian twins aged 16−18 years (N = 876; 371 twin pairs and 18 triplet sets). Measurements included online questionnaires covering physical and mental health as well as information and communication technology (ICT) use, actigraphy, sleep diaries and hair samples to determine cortisol concentrations. Study participants generally rated themselves as being in good physical (79%) and mental (73%) health and reported lower rates of psychological distress and exposure to alcohol, tobacco products or other substances than previously reported for this age group in the Australian population. Daily or near-daily online activity was almost universal among study participants, with no differences noted between males and females in terms of frequency or duration of internet access. Patterns of ICT use in this sample indicated that the respondents were more likely to use online information sources for researching physical health issues than for mental health or substance use issues, and that they generally reported partial levels of satisfaction with the mental health information they found online. This suggests that internet-based mental health resources can be readily accessed by adolescent Australians, and their computer literacy augurs well for future access to online health resources. In combination with other data collected as part of the ongoing Brisbane Longitudinal Twin Study, the 16Up project provides a valuable resource for the longitudinal investigation of genetic and environmental contributions to phenotypic variation in a variety of human traits.
Based on archival material and interviews, the paper argues that the autonomy of Hong Kong's institutions of higher education has varied since 1911, with the colonial state initially exercising tight control and relaxing it especially as the transfer of sovereignty over Hong Kong approached. China has sought to reassert control especially since 2014 in what continues to be contested space.
Jeankempite, Ca5(AsO4)2(AsO3OH)2(H2O)7, is a new mineral species (IMA2018-090) discovered amongst coatings of arsenate minerals on oxidised copper arsenides from the Mohawk No. 2 mine, Mohawk, Keweenaw County, Michigan, USA. The new mineral occurs as lamellar bundles of colourless to white plates up to 1 mm wide and is visually indistinguishable from guérinite, with which it forms intergrowths. Jeankempite is transparent to translucent with a waxy lustre and white streak, is non-fluorescent under longwave and shortwave ultraviolet illumination, has a Mohs hardness of ~1.5 and brittle tenacity with uneven fracture. Crystals are flattened on {01$\bar{1}$} and exhibit perfect cleavage on {01$\bar{1}$}. Optically, jeankempite is biaxial (+), α = 1.601(2), β = 1.607(2), γ = 1.619(2) (white light); 2Vmeas. = 72(2)° and 2Vcalc. = 71.0°. The empirical formula is (Ca4.97Na0.013Mg0.017)(As3.99S0.01)4O23H16, based on 23 O and 16 H atoms per formula unit. Thermogravimetric analysis indicates that jeankempite undergoes four weight losses totalling 16.82%, close to the expected loss of 16.30%, corresponding to eight H2O. Jeankempite is triclinic, P$\bar{1}$, a = 6.710(6), b = 14.901(14), c = 15.940(15) Å, α = 73.583(12)°, β = 81.984(12)°, γ = 82.754(12)°, V = 1507(2) Å3 and Z = 3. The final structure was refined to R1 = 0.0591 for 2781 reflections with Iobs > 3σI. The crystal structure of jeankempite is built from a network of edge- and vertex-sharing CaO6, CaO7 and AsO4 polyhedra, and we hypothesise that the new mineral has formed due to a topotactic reaction brought on by dehydration of preexisting guérinite.
Lewy body dementia, consisting of both dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), is considerably under-recognised clinically compared with its frequency in autopsy series.
Aims
This study investigated the clinical diagnostic pathways of patients with Lewy body dementia to assess if difficulties in diagnosis may be contributing to these differences.
Method
We reviewed the medical notes of 74 people with DLB and 72 with non-DLB dementia matched for age, gender and cognitive performance, together with 38 people with PDD and 35 with Parkinson's disease, matched for age and gender, from two geographically distinct UK regions.
Results
The cases of individuals with DLB took longer to reach a final diagnosis (1.2 v. 0.6 years, P = 0.017), underwent more scans (1.7 v. 1.2, P = 0.002) and had more alternative prior diagnoses (0.8 v. 0.4, P = 0.002), than the cases of those with non-DLB dementia. Individuals diagnosed in one region of the UK had significantly more core features (2.1 v. 1.5, P = 0.007) than those in the other region, and were less likely to have dopamine transporter imaging (P < 0.001). For patients with PDD, more than 1.4 years prior to receiving a dementia diagnosis: 46% (12 of 26) had documented impaired activities of daily living because of cognitive impairment, 57% (16 of 28) had cognitive impairment in multiple domains, with 38% (6 of 16) having both, and 39% (9 of 23) already receiving anti-dementia drugs.
Conclusions
Our results show the pathway to diagnosis of DLB is longer and more complex than for non-DLB dementia. There were also marked differences between regions in the thresholds clinicians adopt for diagnosing DLB and also in the use of dopamine transporter imaging. For PDD, a diagnosis of dementia was delayed well beyond symptom onset and even treatment.
This article reports on an evaluation of the Keeping Children Safe parent education programme run in Central West New South Wales. The programme, conducted since 2004, and continuing today, primarily targets parents of children at risk and other vulnerable and disadvantaged families. The evaluation covers a 13-year period, from the first group held in May 2004 to February 2017. From the beginning, the authors strategically endeavoured to recruit and retain parents from the target group. Findings from the literature indicate that this group is difficult to engage and retain in parent education groups. Parents targeted for the groups in this study were generally not receiving parent education elsewhere. Using mixed methods, the facilitators have continuously evaluated the programme in terms of attendance rates, process and impact. The results of these evaluations show successful recruitment and retention of participants from the target group over the 13 years of the evaluation reporting period and indicate that the programme’s immediate impact on participants has been favourable. The findings complement other programme evaluations focusing on recruitment and retention to programmes in the child protection context and on hard-to-reach clients. The authors also argue the importance of education for parents about child abuse and neglect.
In this note we consider parabolic subroot systems of a complex simple Lie Algebra. We describe root theoretic data of the subroot systems in terms of that of the root system and we give a selection of applications of our results to the study of generalized flag manifolds.
Major depressive disorder (MDD) is a leading cause of disease burden worldwide, with lifetime prevalence in the United States of 17%. Here we present the results of the first prospective, large-scale, patient- and rater-blind, randomized controlled trial evaluating the clinical importance of achieving congruence between combinatorial pharmacogenomic (PGx) testing and medication selection for MDD.
Methods
1,167 outpatients diagnosed with MDD and an inadequate response to ≥1 psychotropic medications were enrolled and randomized 1:1 to a Treatment as Usual (TAU) arm or PGx-guided care arm. Combinatorial PGx testing categorized medications in three groups based on the level of gene-drug interactions: use as directed, use with caution, or use with increased caution and more frequent monitoring. Patient assessments were performed at weeks 0 (baseline), 4, 8, 12 and 24. Patients, site raters, and central raters were blinded in both arms until after week 8. In the guided-care arm, physicians had access to the combinatorial PGx test result to guide medication selection. Primary outcomes utilized the Hamilton Depression Rating Scale (HAM-D17) and included symptom improvement (percent change in HAM-D17 from baseline), response (50% decrease in HAM-D17 from baseline), and remission (HAM-D17<7) at the fully blinded week 8 time point. The durability of patient outcomes was assessed at week 24. Medications were considered congruent with PGx test results if they were in the ‘use as directed’ or ‘use with caution’ report categories while medications in the ‘use with increased caution and more frequent monitoring’ were considered incongruent. Patients who started on incongruent medications were analyzed separately according to whether they changed to congruent medications by week8.
Results
At week 8, symptom improvement for individuals in the guided-care arm was not significantly different than TAU (27.2% versus 24.4%, p=0.11). However, individuals in the guided-care arm were more likely than those in TAU to achieve remission (15% versus 10%; p<0.01) and response (26% versus 20%; p=0.01). Remission rates, response rates, and symptom reductions continued to improve in the guided-treatment arm until the 24week time point. Congruent prescribing increased to 91% in the guided-care arm by week 8. Among patients who were taking one or more incongruent medication at baseline, those who changed to congruent medications by week 8 demonstrated significantly greater symptom improvement (p<0.01), response (p=0.04), and remission rates (p<0.01) compared to those who persisted on incongruent medications.
Conclusions
Combinatorial PGx testing improves short- and long-term response and remission rates for MDD compared to standard of care. In addition, prescribing congruency with PGx-guided medication recommendations is important for achieving symptom improvement, response, and remission for MDD patients.
Funding Acknowledgements: This study was supported by Assurex Health, Inc.
Attendance at overnight school camp is an integral component of the Australian educational landscape. However, some students are reluctant to attend camp, while others refuse to attend at all. School psychologists play an important part in supporting these students and their families, and teachers. While much is published about general school refusal, there is surprisingly little attention given to the specific management of school camp refusal and reluctance. This article summarises the contribution of the related theoretical areas of childhood anxiety, school refusal, and homesickness. It then outlines, through a case study example, a management approach for school psychologists, from presentation of the problem to assessment, through to informed intervention, including a suite of strategies to support the student, parents and teachers, who have duty of care during camps.
There is growing interest in linking vitamin D deficiency with autism spectrum disorders (ASDs). The association between vitamin D deficiency during gestation, a critical period in neurodevelopment, and ASD is not well understood.
Aims
To determine the association between gestational vitamin D status and ASD.
Method
Based on a birth cohort (n=4334), we examined the association between 25-hydroxyvitamin D (25OHD), assessed from both maternal mid-gestation sera and neonatal sera, and ASD (defined by clinical records; n=68 cases).
Results
Individuals in the 25OHD-deficient group at mid-gestation had more than twofold increased risk of ASD (odds ratio (OR)=2.42, 95% confidence interval (CI) 1.09 to 5.07, P=0.03) compared with the sufficient group. The findings persisted in analyses including children of European ethnicity only.
Conclusions
Mid-gestational vitamin D deficiency was associated with an increased risk of ASD. Because gestational vitamin D deficiency is readily preventable with safe, inexpensive and readily available supplementation, this risk factor warrants closer scrutiny.
The problem of active feedback control of fluid flows falls into a class of problems in the area of distributed parameter control. Distributed parameter systems are typically defined by partial differential equations that model the time and spatial evolution of the process. We consider the problem of locating sensors for effective feedback control of a fluid flow problem described by the Navier–Stokes equations. In this setting, the state of the system is the velocity field $\boldsymbol{v}(t,x)$, and hence all feedback laws are a function of this velocity field or, in most practical settings, a function of sensor outputs. In many designs, the feedback control law can be represented as a linear function of the state defined by an integral operator with a kernel function called the functional gain. In this paper we show that these functional gains can be used to determine effective sensor placement in complex flow control applications. The approach is to choose measurements of the state that would provide good quadrature points for the integral operator. We provide a computational validation of this approach by controlling the vortex shedding in a two-dimensional cylinder flow using a pair of fluid actuators on the cylinder surface. This model is linearized about the mean flow and a feedback control is designed by pole placement. Distributed parameter control theory yields the existence and form of the functional gains which are used to locate sensors. In particular, we use the location of the supports of the functional gains to determine two sets of four sensor locations in the wake. One of these measurement sets coincides with large magnitudes of the gain and the other set coincides with small magnitudes. Numerical experiments with a reduced-order model confirm superior performance of the closed-loop (CL) system using the former sensor set. We also show that choosing sensor locations associated with small magnitudes of the functional gains actually destabilizes the CL system.
In the United States alone, ∼14,000 children are hospitalised annually with acute heart failure. The science and art of caring for these patients continues to evolve. The International Pediatric Heart Failure Summit of Johns Hopkins All Children’s Heart Institute was held on February 4 and 5, 2015. The 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children’s Heart Institute was funded through the Andrews/Daicoff Cardiovascular Program Endowment, a philanthropic collaboration between All Children’s Hospital and the Morsani College of Medicine at the University of South Florida (USF). Sponsored by All Children’s Hospital Andrews/Daicoff Cardiovascular Program, the International Pediatric Heart Failure Summit assembled leaders in clinical and scientific disciplines related to paediatric heart failure and created a multi-disciplinary “think-tank”. The purpose of this manuscript is to summarise the lessons from the 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children’s Heart Institute, to describe the “state of the art” of the treatment of paediatric cardiac failure, and to discuss future directions for research in the domain of paediatric cardiac failure.
Scholarly work in the 1990s indicated that the values of civil servants in late colonial Hong Kong were evolving from those of classical bureaucrats to those of more political bureaucrats as the political and social environment changed. Based on in-depth interviews with 58 politicians and senior civil servants carried out between 2009 and 2012, we argue that Hong Kong civil service values have adapted owing in part to external shocks such as regime change and governance reform. Still, traditional civil service values such as fiscal prudence and balancing various community interests continue to be prominent. We illustrate the influence of civil service values in two policymaking cases: small-class teaching and minimum-wage legislation.