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Radiocarbon (14C) results on cremated bone are frequently published in high-ranking journals, but 14C laboratories employ different pretreatment methods as they have divergent perceptions of what sources of contaminants might be present. We found pretreatment protocols to vary significantly between three laboratories (Brussels [RICH], Kiel [KIA], and Groningen [CIO]), which all have a long history of dating cremated bone. We present a case study of 6 sets of replicate dates, to compare laboratory pretreatment protocols, and a further 16 sets of inter-laboratory replicate measurements, which compare specific steps of the conversion and measuring process. The 14C results showed dates to be reproducible between the laboratories and consistent with the expected archaeological chronology. We found that differences in pretreatment, conversion to CO2 and accelerator mass spectrometry (AMS) measurement to have no measurable influence on the majority of obtained results, suggesting that any possible diagenesis was probably restricted to the most soluble ≤5% of each sample, as this proportion of the sample mass was removed under all laboratory protocols.
The majority of self-management interventions are designed with a narrow focus on patient skills and fail to consider their potential as “catalysts” for improving care delivery. A project was undertaken to develop a patient self-management resource to support evidence-based, person-centered care for cancer pain and overcome barriers at the levels of the patient, provider, and health system.
The project used a mixed-method design with concurrent triangulation, including the following: a national online survey of current practice; two systematic reviews of cancer pain needs and education; a desktop review of online patient pain diaries and other related resources; consultation with stakeholders; and interviews with patients regarding acceptability and usefulness of a draft resource.
Findings suggested that an optimal self-management resource should encourage pain reporting, build patients’ sense of control, and support communication with providers and coordination between services. Each of these characteristics was identified as important in overcoming established barriers to cancer pain care. A pain self-management resource was developed to include: (1) a template for setting specific, measureable, achievable, relevant and time-bound goals of care, as well as identifying potential obstacles and ways to overcome these; and (2) a pain management plan detailing exacerbating and alleviating factors, current strategies for management, and contacts for support.
Significance of results
Self-management resources have the potential for addressing barriers not only at the patient level, but also at provider and health system levels. A cluster randomized controlled trial is under way to test effectiveness of the resource designed in this project in combination with pain screening, audit and feedback, and provider education. More research of this kind is needed to understand how interventions at different levels can be optimally combined to overcome barriers and improve care.
Multiple burial in medieval burial grounds are often interpreted as a result of disease, but it is difficult to test such hypotheses, as most acute infectious diseases leave no visible evidence on skeletal material. Scientific dating can potentially associate multiple burials with historically documented epidemics, but the precision required to exclude alternative explanations would normally be attainable only by dendrochronology. Here, we argue that by combining archaeological, osteological and paleodiet research in a Bayesian framework, we can exploit differences in dietary reservoir effects to refine the dates of multiple burials, and potentially date such events to within a range of <20 years. We present new radiocarbon (14C) and stable isotope (δ13C, δ15N) results from a medieval multiple grave at St Alban’s Odense, on the island of Funen in central Denmark. We show the ca. 150-yr spread in 14C ages of the five juveniles is compatible with differences in the amount of fish they consumed. Our chronological model, which combines marine reservoir effect correction with calendar age offsets based on osteological evidence, dates the multiple burial to cal AD 1425–1445 (95% probability), an interval in which two plague epidemics took place in Denmark.
UK Biobank is a well-characterised cohort of over 500 000 participants that offers unique opportunities to investigate multiple diseases and risk factors.
An online mental health questionnaire completed by UK Biobank participants was expected to expand the potential for research into mental disorders.
An expert working group designed the questionnaire, using established measures where possible, and consulting with a patient group regarding acceptability. Case definitions were defined using operational criteria for lifetime depression, mania, anxiety disorder, psychotic-like experiences and self-harm, as well as current post-traumatic stress and alcohol use disorders.
157 366 completed online questionnaires were available by August 2017. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status than the general population across a range of indicators. Thirty-five per cent (55 750) of participants had at least one defined syndrome, of which lifetime depression was the most common at 24% (37 434). There was extensive comorbidity among the syndromes. Mental disorders were associated with high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.
The questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed owing to selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.
Declaration of interest
G.B. received grants from the National Institute for Health Research during the study; and support from Illumina Ltd. and the European Commission outside the submitted work. B.C. received grants from the Scottish Executive Chief Scientist Office and from The Dr Mortimer and Theresa Sackler Foundation during the study. C.S. received grants from the Medical Research Council and Wellcome Trust during the study, and is the Chief Scientist for UK Biobank. M.H. received grants from the Innovative Medicines Initiative via the RADAR-CNS programme and personal fees as an expert witness outside the submitted work.
Whether monozygotic (MZ) and dizygotic (DZ) twins differ from each other in a variety of phenotypes is important for genetic twin modeling and for inferences made from twin studies in general. We analyzed whether there were differences in individual, maternal and paternal education between MZ and DZ twins in a large pooled dataset. Information was gathered on individual education for 218,362 adult twins from 27 twin cohorts (53% females; 39% MZ twins), and on maternal and paternal education for 147,315 and 143,056 twins respectively, from 28 twin cohorts (52% females; 38% MZ twins). Together, we had information on individual or parental education from 42 twin cohorts representing 19 countries. The original education classifications were transformed to education years and analyzed using linear regression models. Overall, MZ males had 0.26 (95% CI [0.21, 0.31]) years and MZ females 0.17 (95% CI [0.12, 0.21]) years longer education than DZ twins. The zygosity difference became smaller in more recent birth cohorts for both males and females. Parental education was somewhat longer for fathers of DZ twins in cohorts born in 1990–1999 (0.16 years, 95% CI [0.08, 0.25]) and 2000 or later (0.11 years, 95% CI [0.00, 0.22]), compared with fathers of MZ twins. The results show that the years of both individual and parental education are largely similar in MZ and DZ twins. We suggest that the socio-economic differences between MZ and DZ twins are so small that inferences based upon genetic modeling of twin data are not affected.
This study aimed to demonstrate proof of concept and acceptability of a brief acceptance and commitment therapy (ACT)-based guided self-help intervention for improving quality of life (QoL) and mood for people with muscle disorders (MD). A case-series with an AB design was used to assess changes in primary (QoL) and secondary (depression and anxiety) outcome variables across the period of study. Change in the psychological process targeted by ACT – psychological flexibility – was also investigated, to allow insight into possible treatment mechanisms. Post-intervention, participants also completed a brief free-text evaluation. Relative to pre-intervention scores, four (of seven) participants showed varying degrees of improvement in all primary and secondary outcome variables and were thus considered responders. However, consistent concomitant improvements in psychological flexibility were not apparent. Participants reported a mostly positive experience of the intervention; all appeared to complete the intervention, and no adverse events were reported. Nonetheless, there was evidence that those with compromised concentration or who report good initial QoL and low levels of distress may derive less benefit. Although several methodological weaknesses limit the strength of our conclusions, this ACT-based guided self-help intervention shows encouraging utility for improving QoL and mood in MD.
As all students know, there have been not a few cases in history where the ferment and heat of great events have found striking expression in literature, and may even be said to have given birth to that expression. The examples are fewer in which a distinct movement in thought and letters preceded events, being an undoubted preparation for them. To these belong what is known as “Young Poland,” of which the more precise dates might be said to be 1895–1903. The purpose of this paper is to sketch briefly some of the major features of this period of Polish creative achievement, as yet too little known in the English-speaking world.
Substantial policy, communication and operational gaps exist between mental health services and the police for individuals with enduring mental health needs.
To map and cost pathways through mental health and police services, and to model the cost impact of implementing key policy recommendations.
Within a case-linkage study, we estimated 1-year individual-level healthcare and policing costs. Using decision modelling, we then estimated the potential impact on costs of three recommended service enhancements: street triage, Mental Health Act assessments for all Section 136 detainees and outreach custody link workers.
Under current care, average 1-year mental health and police costs were £10 812 and £4552 per individual respectively (n = 55). The cost per police incident was £522. Models suggested that each service enhancement would alter per incident costs by between −8% and +6%.
Recommended enhancements to care pathways only marginally increase individual-level costs.
A better therapeutic relationship predicts better outcomes. However,
there is no trial-based evidence on how to improve therapeutic
relationships in psychosis.
To test the effectiveness of communication training for psychiatrists on
improving shared understanding and the therapeutic relationship (trial
In a cluster randomised controlled trial in the UK, 21 psychiatrists were
randomised. Ninety-seven (51% of those approached) out-patients with
schizophrenia/schizoaffective disorder were recruited, and 64 (66% of the
sample recruited at baseline) were followed up after 5 months. The
intervention group received four group and one individualised session.
The primary outcome, rated blind, was psychiatrist effort in establishing
shared understanding (self-repair). Secondary outcome was the therapeutic
Psychiatrists receiving the intervention used 44% more self-repair than
the control group (adjusted difference in means 6.4, 95% CI 1.46–11.33,
P<0.011, a large effect) adjusting for baseline
self-repair. Psychiatrists rated the therapeutic relationship more
positively (adjusted difference in means 0.20, 95% CI 0.03–0.37,
P = 0.022, a medium effect), as did patients
(adjusted difference in means 0.21, 95% CI 0.01–0.41, P
= 0.043, a medium effect).
Shared understanding can be successfully targeted in training and
improves relationships in treating psychosis.
As with many islands, Christmas Island in the Indian Ocean has suffered severe biodiversity loss. Its terrestrial lizard fauna comprised five native species, of which four were endemic. These were abundant until at least the late 1970s, but four species declined rapidly thereafter and were last reported in the wild between 2009 and 2013. In response to the decline, a captive breeding programme was established in August 2009. This attempt came too late for the Christmas Island forest skink Emoia nativitatis, whose last known individual died in captivity in 2014, and for the non-endemic coastal skink Emoia atrocostata. However, two captive populations are now established for Lister's gecko Lepidodactylus listeri and the blue-tailed skink Cryptoblepharus egeriae. The conservation future for these two species is challenging: reintroduction will not be possible until the main threats are identified and controlled.
Background: Anger causes significant problems in offenders and to date few interventions have been described in the Caribbean region. Aim: To evaluate a package of CBT-based Anger Management Training provided to offenders in prison in Trinidad. Method: A controlled clinical trial with 85 participants who participated in a 12-week prison-based group anger management programme, of whom 57 (67%: 16 control, 41 intervention) provided pretrial and posttrial outcome data at Times 1 and 2. Results: Intervention and control groups were not directly comparable so outcome was analysed using t-tests. Reductions were noted for state and trait anger and anger expression, with an increase in coping skills for the intervention group. No changes were noted in the control group. The improvements seen on intervention were maintained at 4 month follow-up for a sub-group of participants for whom data were available. Several predictors of outcomes were identified.
Background: Cognitions are starting to receive more prominence as important when examining a number of factors including the topography of challenging behaviour. This study examined the relationships between maternal stress, challenging behaviour (aggressive and self-injurious behaviours) and parental cognitions and specifically whether maternal cognitions mediated the effect of challenging behaviour on parenting stress. Method: 46 mothers of children and young adults with ID completed questionnaires regarding their child's challenging behaviour, maternal cognitions and stress. Results: Significant correlations were found between challenging behaviour and maternal stress. The overall mediation models for aggression and self-injurious behaviour were significant. The Challenging Behaviour Perception Questionnaire: Consequences client subscale was the only independent significant mediator for both behaviours. Conclusions: Cognitions do play an important part in mediating the relationship between challenging behaviour and stress. Further research is needed to examine the similarities and differences between the mediation models for aggression and self-injurious behaviour.
We are conducting a wide-angle Hα survey of the southern sky at CTIO using a robotic CCD camera. The survey consists of 283 fields covering the sky from δ = −90° to δ = +10°, with the same centers as those in the IRAS Sky Survey Atlas. As of July 1, 1998, it was about 45% complete. When all the images are obtained and fully processed, the survey will be made available to the scientific community on the web and on CD-ROM.
We are conducting a robotic wide-angle imaging survey of the southern sky at 656.3 nm wavelength, the Hα emission line of hydrogen. Each image of the survey covers an area of the sky 13° square at an angular resolution of approximately one arcminute, and reaches a sensitivity level of 0.5 Rayleigh (3 × 10−18erg cm−2s−1arcsec−2), corresponding to an emission measure of 1 cm−6pc, and to a brightness temperature for microwave free-free emission of 3 µK at 30 GHz.
While recent studies suggest children can use cross-situational information to learn words, these studies involved minimal referential ambiguity, and the cross-situational evidence overwhelmingly favored a single referent for each word. Here we asked whether 2·5-year-olds could identify a noun's referent when the scene and cross-situational evidence were more ambiguous. Children saw four trials in which a novel word occurred with four novel objects; only one object consistently co-occurred with the word across trials. The frequency of distracter objects varied across conditions. When all distracter referents occurred only once (no-competition), children successfully identified the noun's referent. When a high-probability competitor referent occurred on three trials, children identified the target referent if the competitor was absent on the third trial (short-competition) but not if it was present until the fourth trial (long-competition). This suggests that although 2·5-year-olds’ cross-situational learning scales up to more ambiguous scenes, it is disrupted by high-probability competitor referents.
Background: Interventions for anger represent the largest body of research on the adaptation of cognitive behavioural therapy (CBT) for people with intellectual disabilities. The extent to which the effectiveness of these interventions reflects the behavioural or cognitive components of CBT is uncertain. This arises in part because there are few measures of anger-related cognitions. Method: The Profile of Anger-related Cognitions (PAC) is built around interpersonal scenarios that the participant identifies as personally anger-provoking, and was designed as an extension of the Profile of Anger Coping Skills (PACS). A conversational presentational style is used to approach ratings of anger experienced in those situations and of four relevant cognitive dimensions: attribution of hostile intent, unfairness, victimhood, and helplessness. The PAC, and other measures, including the PACS, was administered to (i) people with ID identified as having problems with anger control (n = 12) and (ii) university students (n = 23); its psychometric properties were investigated and content analyses were conducted of participants’ verbal responses. In a third study, clinicians (n = 6) were surveyed for their impression of using the PAC in the assessment of clients referred for help with anger problems. Results: The PAC had good consistency and test-retest reliability, and the total score on the four cognitive dimensions correlated significantly with anger ratings but not with impersonal measures of anger disposition. The predominant cognitions reported were perceptions of unfairness and helplessness. People with ID and university students were in most respects very similar in both the psychometric analyses and the content analyses of their verbal responses. The PAC had high acceptability both to people with ID and to clinicians. Conclusions: The PAC may be a useful instrument for both clinical and research purposes. Personal relevance and the conversational mode of administration are particular strengths.