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The rates of postnatal depression (PND) in British South Asian (BSA) women are higher than the general population. PND is known to cause disability and suffering in women and negative consequences for their infants and their family with huge costs to society. Due to linguistic and cultural barriers, BSA women do not access health care services.
To conduct an exploratory trial to test the feasibility and acceptability of a culturally adapted group Cognitive Behavioural Therapy (CBT) intervention (Positive Health Programme (PHP).
We aimed to determine if depressed BSA women receiving the PHP intervention will show significant improvements in terms of severity of depression, marital support, and social support as compared to the control group.
We used a two-arm pragmatic single-blind randomised controlled design. Women meeting the inclusion criteria were randomised either to the experimental group receiving PHP or treatment as usual (TAU) that is standard care usually provided by the GP.
A total of 615 mothers were screened for participation in the trial, of these 137 were assessed further to determine eligibility. Eighty-three mothers were randomized to receive either PHP (n = 42) or treatment as usual (TAU) (n = 41). Mothers found the intervention to be acceptable and felt an overall positive change in their attitudes, behaviour and confidence level.
The recruitment and retention figures (70%) highlight the ability of the research team to engage with the population. The findings suggest the acceptability of the culturally adapted PHP intervention for British South Asian women with postnatal depression.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The early intervention service (EIS) approach is based on therapeutic interactions, which promote service user recovery from first episode psychosis. Collaborative therapeutic work between the service user and case manager depends on good communication. This can be a challenge for people with psychosis as the process of thought can be disrupted or stimulus misinterpreted leading to communication errors.
The objective is to develop an interactive tool that can assist service user's communication of distress, whilst employing a psychoeducational approach to the use of an informal therapeutic measurement scale; subjective units of distress (SUDs) and early warning signs (EWS). The ApTiC mobile intervention will include ten numerically graded emoticons from low to extreme distress. Each emoticon is associated with specific individualised service user descriptors and linked to an individually agreed action plan and level of response to be offered by a staff member.
The aim of the present study will be to examine the feasibility and acceptability of the ApTic mobile intervention in preparation for a larger randomised controlled trial.
Phase one: qualitative research to inform the development of the complimentary tool and mobile app (qualitative). Phase two: a 12-week rater-blinded randomized control trial of ApTiC compared to routine EIS case management (quantitative).
The qualitative data will be presented.
It is expected that once validated, the SUDs based ApTiC will enhance rapport and understanding thus improving the recovery approach to well-being and hopefully preventing relapse or the involvement of the crisis team or hospital admissions.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
We report the results of Long Baseline Array observations made in 2001 of ten southern sources proposed by Mattox et al. as counterparts to EGRET >100 MeV gamma-ray sources. Source structures are compared with published data where available and possible superluminal motions identified in several cases. The associations are examined in the light of Fermi observations, indicating that the confirmed counterparts tend to have radio properties consistent with other identifications, including flat radio spectral index, high brightness temperature, greater radio variability, and higher core dominance.
We present results from a multiwavelength study of the blazar PKS 1954–388 at radio, UV, X-ray, and gamma-ray energies. A RadioAstron observation at 1.66 GHz in June 2012 resulted in the detection of interferometric fringes on baselines of 6.2 Earth-diameters. This suggests a source frame brightness temperature of greater than 2 × 1012 K, well in excess of both equipartition and inverse Compton limits and implying the existence of Doppler boosting in the core. An 8.4-GHz TANAMI VLBI image, made less than a month after the RadioAstron observations, is consistent with a previously reported superluminal motion for a jet component. Flux density monitoring with the Australia Telescope Compact Array confirms previous evidence for long-term variability that increases with observing frequency. A search for more rapid variability revealed no evidence for significant day-scale flux density variation. The ATCA light-curve reveals a strong radio flare beginning in late 2013, which peaks higher, and earlier, at higher frequencies. Comparison with the Fermi gamma-ray light-curve indicates this followed ~ 9 months after the start of a prolonged gamma-ray high-state—a radio lag comparable to that seen in other blazars. The multiwavelength data are combined to derive a Spectral Energy Distribution, which is fitted by a one-zone synchrotron-self-Compton (SSC) model with the addition of external Compton (EC) emission.
We are undertaking an observational program using the ATCA to monitor the intraday variability (IDV) of a sample of sources at 4.8 and 8.6 GHz. The sources were selected to include the known strong southern IDV sources plus a number of sources whose IDV was recently discovered. The present monitoring program will extend over a full year in order to search for any annual cycle that may be present in the long-term IDV characteristics of these sources. In this paper we discuss the observing strategy and data analysis, and present the first results from our observations.
Flux density monitoring data at 2.3 and 8.4 GHz is presented for a sample of 33 southern hemisphere GPS sources, drawn from the 2.7 GHz Parkes survey. This monitoring data, together with VLBI monitoring data, shows that a small fraction of these sources, ∼10%, vary. Their variability falls into several categories: sources whose spectral classification is, at best, ephemeral on a timescale of years; sources with a stable GPS classification that vary, but retain their classification; and a small number of sources that exhibit interstellar scintillation, but that maintain a mean GPS spectrum. Existing data on GPS sources with higher frequency peaks, ≥3 GHz, reveals that many such sources vary. However, the majority of these sources possess a GPS spectrum only during outbursts, and hence should perhaps be classified as ephemeral GPS sources. In addition, significant levels of circular polarisation have been found in a number of GPS sources, both amongst the variables and non-variables. Remarkable amongst these is PKS 1519–273, which possesses strong and variable circular polarisation, and which exhibits IDV in all Stokes parameters.
Collaborative care is an effective intervention for depression which includes both organizational and patient-level intervention components. The effect in the UK is unknown, as is whether cluster- or patient-randomization would be the most appropriate design for a Phase III clinical trial.
We undertook a Phase II patient-level randomized controlled trial in primary care, nested within a cluster-randomized trial. Depressed participants were randomized to ‘collaborative care’ – case manager-coordinated medication support and brief psychological treatment, enhanced specialist and GP communication – or a usual care control. The primary outcome was symptoms of depression (PHQ-9).
We recruited 114 participants, 41 to the intervention group, 38 to the patient randomized control group and 35 to the cluster-randomized control group. For the intervention compared to the cluster control the PHQ-9 effect size was 0.63 (95% CI 0.18–1.07). There was evidence of substantial contamination between intervention and patient-randomized control participants with less difference between the intervention group and patient-randomized control group (−2.99, 95% CI −7.56 to 1.58, p=0.186) than between the intervention and cluster-randomized control group (−4.64, 95% CI −7.93 to −1.35, p=0.008). The intra-class correlation coefficient for our primary outcome was 0.06 (95% CI 0.00–0.32).
Collaborative care is a potentially powerful organizational intervention for improving depression treatment in UK primary care, the effect of which is probably partly mediated through the organizational aspects of the intervention. A large Phase III cluster-randomized trial is required to provide the most methodologically accurate test of these initial encouraging findings.
Common mental health problems are highly prevalent in primary care, the UK National Service Framework for mental health demanding that effective and accessible services be made available. Although built upon a strong evidence base, traditional psychological therapies are often limited in terms of their applicability and availability. As a consequence innovative self-help programmes are increasingly being advocated as an alternative means of managing mental health illness within primary care. This study reports the results of a three month evaluation of a self-help service provided by a busy UK urban Primary Care Trust. Levels of utilization, effectiveness and stakeholder acceptability were examined through a combination of quantitative and qualitative data. A total of 662 patients were referred to the self-help clinics over a three month period, 67% of whom attended their first appointment. The mean number of sessions per patient was 2.8 (SD = 2.4), with an average total time of 69.6 min (SD = 48.2). Mean Clinical Outcomes in Routine Evaluation (CORE-OM) scores improved significantly between baseline and three month follow-up (P < 0.001), 39% of patients demonstrating a clinically significant improvement. Both selfhelp therapists and referring general practitioners reported moderate to high satisfaction with the self-help treatment model, with the majority of patients perceiving the intervention to be appropriate to their needs. Data demonstrated that, whilst there was a clear need for a simple self-help service to be based in primary care, the ultimate success of this provision necessitates a well developed infrastructure capable of providing sufficient support and information to ensure that it is flexible and responsive to individual needs.
In February 1997 the Japanese radio astronomy satellite HALCA was launched to provide the space-borne element for the VSOP mission. HALCA provided linear baselines three-times greater than that of ground arrays, thus providing higher resolution and higher AGN brightness temperature measurements and limits. Twenty-five percent of the scientific time of the mission was devoted to the “VSOP survey” of bright, compact, extra-galactic radio sources at 5 GHz. A complete list of 294 survey targets were selected from pre-launch surveys, 91% of which were observed during the satellite's lifetime.
The major goals of the VSOP Survey are statistical in nature: to determine the brightness temperature and approximate structure, to provide a source list for use with future space VLBI missions, and to compare radio properties with other data throughout the electro-magnetic spectrum. All the data collected have now been analysed and is being prepared for the final image Survey paper. In this paper we present details of the mission, and some statistics of the images and brightness temperatures.
Background and objectives: The potential for increased drug administration errors during the transition to the International Colour Coding syringe labelling system has been highlighted. The purpose of this study was to assess the potential effects before their introduction into our department. Methods: Thirty-one anaesthetists, 19 with no previous practical experience of the new labelling system (Group 1), and 12 with previous experience (Group 2), volunteered to induce general anaesthesia for a standardized simulated patient in a designated theatre. They were presented with a scenario designed to suggest the need for a rapid sequence induction and provided with drug syringes labelled with the International Colour Coding system. All drug administrations were recorded. Active error was defined as the injection of the wrong drug. Latent error was defined as the selection of a syringe in error but stopping short of administering the drug. Results: In Group 1 a total of 107 drug injections were recorded of which 1 (0.9%) was an active error and 16 (15%) involved latent errors. Eleven anaesthetists (58%) performed at least one latent error. Group 2 had an error rate of 3%, a 6.9 (1.3–26.7) fold reduction in the rate of error (P = 0.023). Conclusions: Although only one drug was given in active error, latent errors occurred in 15% of drug administrations. The only factor conferring protection against error was prior experience of the new labelling system. The period of transition to the International Colour Coding syringe labelling system represents a time of increased risk of drug administration error.
PKS 1257—326 is one of three quasars known to show unusually large and rapid, intra-hour intensity variations, as a result of scintillation in the turbulent Galactic interstellar medium. We have measured time delays in the variability pattern arrival times at the VLA and the ATCA, as well as an annual cycle in the time-scale of variability for this source. Results of the two-station time delay observations are presented here. Implications for the scintillation of this source are discussed in the light of these results, together with results from two years of monitoring with the ATCA.
Considerable and reproducible differences were observed in the amount and duration of faecal excretion when in-bred lines of chickens were infected orally with S. enterica serovar Typhimurium at 6 weeks of age after being given a gut flora preparation when newly hatched. Similar but less pronounced results were observed with S. Enteritidis or S. Infantis. Differences in the viable numbers of the inoculated bacteria in caecal contents were detectable within 24 h of inoculation. No major differences were seen in Salmonella-specific serum IgA or IgG titres. Small differences were seen in the numbers of circulating heterophilic cells. Caecal contents taken from the more resistant lines immediately prior to challenge appeared to be no more inhibitory for Salmonella in vivo than contents taken from susceptible lines. The more resistant lines showed a slightly higher rate of intestinal flow, as indicated by the rate of production of faecal droppings, although there was no difference in the rate of emptying of the caeca. In an F1 generation resistance was dominant and not sex-linked. There was no MHC linkage or any association with SAL1, the gene implicated in resistance to systemic salmonellosis in chickens, or NRAMP1.
The in vivo determination of methane (CH4) production requires specialist equipment which is costly to maintain. Whilst the in vitro gas production technique has been demonstrated to show potential to rank diets for their methanongenic potential at maintenance planes of nutrition (Moss and Givens, 1997) no study has investigated this relationship when feedstuffs are fed ad libitum. The objective of this study was to assess the ability of the technique to predict in vivo CH4 production and animal performance from six diets differing in their chemical composition.
Background. Few studies have shown that maladaptive beliefs relate to treatment outcome.
Method. In a randomized controlled study, 87 patients with post-traumatic stress disorder (PTSD) had exposure therapy alone or cognitive restructuring alone, or both combined, or relaxation. Independent blind assessors assessed patients at pre-, mid- and post-treatment and at follow-up; at those times patients rated cognitive, behavioural and emotional aspects of their disorder.
Results. Baseline beliefs about mistrust, helplessness, meaninglessness and unjustness of the world related to baseline PTSD symptoms but did not predict treatment outcome, though improvement in certain beliefs correlated with more symptom improvement. Several ‘key’ beliefs changed after, and none before, symptoms improved. At post-treatment, sense of control and attribution of gains to personal efforts predicted maintenance of gains at follow-up.
Conclusions. Baseline beliefs and improvement in beliefs did not predict outcome. Post-treatment sense of control/internal attribution predicted maintenance of gains at follow-up. How much sense of control is produced by or causes improvement deserves testing.
Intra-day variability (IDV) of active galactic nuclei (AGN) has been detected from gamma-ray energies to radio wavelengths. At high energies, such variability appears to be intrinsic to the sources themselves. However, at radio wavelengths, brightness temperatures as high as 1018 to 1021 K are encountered if the IDV is intrinsic to the source. We discuss here the accumulating evidence showing that, at radio wavelengths where the highest brightness temperatures are encountered, interstellar scintillation (ISS) is the principal mechanism causing IDV. While ISS reduces the implied brightness temperatures, they still remain uncomfortably high.
When planning a mutation to test some hypothesis, one
crucial question is whether the new side chain is compatible
with the existing structure; only if it is compatible can
the interpretation of mutational results be straightforward.
This paper presents a simple way of using the sensitive
geometry of all-atom contacts (including hydrogens) to
answer that question. The interactive MAGE/PROBE system
lets the biologist explore conformational space for the
mutant side chain, with an interactively updated kinemage
display of its all-atom contacts to the original structure.
The Autobondrot function in PROBE systematically explores
that same conformational space, outputting contact scores
at each point, which are then contoured and displayed.
These procedures are applied here in two types of test
cases, with known mutant structures. In ricin A chain,
the ability of a neighboring glutamate to rescue activity
of an active-site mutant is modeled successfully. In T4
lysozyme, six mutations to Leu are analyzed within the
wild-type background structure, and their Autobondrot score
maps correctly predict whether or not their surroundings
must shift significantly in the actual mutant structures;
interactive examination of contacts for the conformations
involved explains which clashes are relieved by the motions.
These programs are easy to use, are available free for
UNIX or Microsoft Windows operating systems, and should
be of significant help in choosing good mutation experiments
or in understanding puzzling results.