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Treatment for hoarding disorder is typically performed by mental health professionals, potentially limiting access to care in underserved areas.
We aimed to conduct a non-inferiority trial of group peer-facilitated therapy (G-PFT) and group psychologist-led cognitive–behavioural therapy (G-CBT).
We randomised 323 adults with hording disorder 15 weeks of G-PFT or 16 weeks of G-CBT and assessed at baseline, post-treatment and longitudinally (≥3 months post-treatment: mean 14.4 months, range 3–25). Predictors of treatment response were examined.
G-PFT (effect size 1.20) was as effective as G-CBT (effect size 1.21; between-group difference 1.82 points, t = −1.71, d.f. = 245, P = 0.04). More homework completion and ongoing help from family and friends resulted in lower severity scores at longitudinal follow-up (t = 2.79, d.f. = 175, P = 0.006; t = 2.89, d.f. = 175, P = 0.004).
Peer-led groups were as effective as psychologist-led groups, providing a novel treatment avenue for individuals without access to mental health professionals.
Declaration of interest
C.A.M. has received grant funding from the National Institutes of Health (NIH) and travel reimbursement and speakers’ honoraria from the Tourette Association of America (TAA), as well as honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. K.D. receives research support from the NIH and honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. R.S.M. receives research support from the National Institute of Mental Health, National Institute of Aging, the Hillblom Foundation, Janssen Pharmaceuticals (research grant) and the Alzheimer's Association. R.S.M. has also received travel support from the National Institute of Mental Health for Workshop participation. J.Y.T. receives research support from the NIH, Patient-Centered Outcomes Research Institute and the California Tobacco Related Research Program, and honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. All other authors report no conflicts of interest.
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.
Measurements of glacier ice cliff evolution are sparse, but where they do exist, they indicate that such areas of exposed ice contribute a disproportionate amount of melt to the glacier ablation budget. We used Structure from Motion photogrammetry with Multi-View Stereo to derive 3-D point clouds for nine ice cliffs on Khumbu Glacier, Nepal (in November 2015, May 2016 and October 2016). By differencing these clouds, we could quantify the magnitude, seasonality and spatial variability of ice cliff retreat. Mean retreat rates of 0.30–1.49 cm d−1 were observed during the winter interval (November 2015–May 2016) and 0.74–5.18 cm d−1 were observed during the summer (May 2016–October 2016). Four ice cliffs, which all featured supraglacial ponds, persisted over the full study period. In contrast, ice cliffs without a pond or with a steep back-slope degraded over the same period. The rate of thermo-erosional undercutting was over double that of subaerial retreat. Overall, 3-D topographic differencing allowed an improved process-based understanding of cliff evolution and cliff-pond coupling, which will become increasingly important for monitoring and modelling the evolution of thinning debris-covered glaciers.
Selected area electron diffraction patterns are routinely used to determine the effects of irradiation damage in nuclear materials. Using zone axis orientations, the intensities of Bragg beams change from a dynamical to kinematic-like state due to the presence of amorphous domains in the material. Such changes in beam intensities, together with the increased diffuse scattering from the increasing amorphous fraction, present a major obstacle to the determination of cation or anion disorder in the crystalline fraction.
Synthetic pyrochlore samples Y2Ti2-xSnxO7 (x=0.4, 0.8, 1.2, 1.6), Nd2Zr2O7, Nd2Zr1.2Ti0.8O7, and La1.6Y0.4Hf2O7, were irradiated in-situ using the IVEM-TANDEM microscope facility at the Argonne National Laboratory. The critical temperatures for amorphisation have revealed a dramatic increase in tolerance with increasing Sn content for the Y2Ti2-xSnxO7 series. This change has also found to be linear with increasing Sn content. Nd2Zr1.2Ti0.8O7 and La1.6Y0.4Hf2O7 were both found to amorphise, while Nd2Zr2O7 was found to be stable to high doses (2.5×10^15 ions cm-2). The observed results are presented with respect to previously published results for irradiation stability predictions and structural disorder.
The Kulshan caldera formed at ∼1.15 Ma on the present-day site of Mt. Baker, Washington State, northwest USA and erupted a compositionally zoned (dacite-rhyolite) magma and a correlative eruptive, the Lake Tapps tephra. This tephra has previously been described, but only from the Puget Lowland of NW Washington. Here an occurrence of a Kulshan caldera correlative tephra is described from the Quaternary Palouse loess at the Washtucna site (WA-3). Site WA-3 is located in east-central Washington, ∼340 km southeast of the Kulshan caldera and ∼300 km east-southeast of the Lake Tapps occurrence in the Puget Lowland. Major- and trace element chemistry and location of the deposit at Washtucna within reversed polarity sediments indicates that it is not correlative with the Mesa Falls, Rockland, Bishop Ash, Lava Creek B or Huckleberry Ridge tephras. Instead the Washtucna deposit is related to the Lake Tapps tephra by fractional crystallisation, but is chemically distinct, a consequence of its eruption from a compositionally zoned magma chamber. The correlation of the Washtucna occurrence to the Kulshan caldera-forming eruption indicates that it had an eruptive volume exceeding 100 km3, and that its tephra could provide a valuable early-Pleistocene chronostratigraphic marker in the Pacific Northwest.
The aims of the present study were to provide nationally representative data on fruit and vegetable consumption in Vietnam, and to assess the accuracy of the reported numbers of ‘standard servings’ consumed. Data analysed were from a multi-stage stratified cluster survey of 14 706 participants (46·5 % males, response proportion 64·1 %) aged 25−64 years in Vietnam. Measurements were made in accordance with the WHO STEPwise approach to surveillance of non-communicable diseases (STEPS) protocols. Approximately 80 % of Vietnamese people reported having less than five servings of fruit and vegetables daily in a typical week. Fruit and vegetable intake reported in ‘standard serving’ sizes was positively correlated with levels of education completed and household income (P<0·001 for trend). The correlations between summary values for each province reflect some known demographic, geographical and climatic characteristics of the country. For example, provinces at higher latitude had higher mean servings of vegetables (r 0·90), and provinces with higher proportions of urban population had higher mean servings of fruit (r 0·40). In conclusion, about eight in ten Vietnamese people aged 25–64 years did not meet WHO recommendations for daily consumption of at least five servings of fruit and vegetables. On the basis of the consistency of the data collected with other estimates and with physical and demographic characteristics of the country, the WHO STEPS instrument has construct validity for measuring fruit and vegetable intake, but with two issues identified. The issues were seasonal variation in reporting and a limitation on the usefulness of the information for associative analyses.
There are presently eight double degenerate systems with well determined orbital parameters, their periods being either a few hours or a few days (Marsh, Dhillon & Duck 1995; Marsh 1995). The masses of the primaries and secondaries lie in the range 0.15… 0.45M⊙.
We calculate two evolutionary scenarios (Sarna, Marks & Smith 1996); the first is Algol-type evolution with two phases of stable mass transfer, and the second involves first a stage of common envelope (CE) evolution followed by a stage of stable mass transfer. In both calculations we assume non-conservative mass transfer by which we mean that the total mass and angular momentum of the system are not conserved. For both scenarios we start our calculations after the first stage of mass transfer has finished. In all calculations the primary is the initially more massive star that filled its Roche lobe and transferred material to the secondary during the first phase of mass transfer, hence the secondary is the star that fills its Roche lobe in our calculations. The system’s orbital period decreases and then increases until the system detaches; we are left with a detached white dwarf/white dwarf binary with an orbital period of the order of hours or of days (see Table 1). There must exist some bifurcation period below which the systems evolve towards orbital periods of the order of hours and above which the systems evolve to periods of the order of several days.
To provide a direct test of common envelope (CE) evolution which can be easily confirmed by observations, we (Sarna et al. 1995) recently modelled the change in the abundance ratio of 12C/13C on the surface of the lower mass star of a binary during the CE phase. The model is based on the fact that it is probable that the dwarf star accretes material during the CE phase. Since, during the CE phase, the dwarf secondary effectively exists within the atmosphere/envelope of the giant or supergiant primary, the accreted material has the abundances/composition of a giant/supergiant star. The 12C/13C ratio is known to decrease from approximately 90 in dwarf stars (in which the 13CO band at 2.3448 microns is barely visible) to approximately 10 in giants (in which the 13CO band at 2.3448 microns is fairly prominent). Hence, by measuring the 12C/13C ratio in post common envelope binaries (PCEBs) and comparing it to our models we would be able not only to confirm the CE theory but also to determine the amount of mass accreted during the CE phase and hence the initial mass of the dwarf component prior to the CE phase. We also propose an evolutionary scenario in which PCEBs with secondary component mass near 1.0 M⊙ start semi-detached evolution almost immediately after the CE phase. The progenitor system is a wide binary consisting of a 3 M⊙ primary with a 1.0 M⊙ secondary star. The primary evolves to fill its Roche lobe when it has a 0.6 M⊙ C–O core, with two shell burning regions. Such a star has a thick convective envelope, mass transfer is dynamically unstable and a common envelope forms. After the CE phase we are left with a close detached binary consisting of the primary’s core (0.6 M⊙) and the secondary (1.0 M⊙) main sequence star. Shortly afterwards the secondary fills its Roche lobe and mass transfer occurs (Sarna, Marks & Smith 1995). The system now evolves as a semi-detached binary (CV), transferring material to the white dwarf which undergoes nova outbursts. Figs. 1 and 2 show the isotopic ratios of 12C/13C and 16O/17O during the semi-detached evolution. In Fig. 1 the secondary did not accrete any material during CE evolution whilst in Fig. 2 the secondary accreted 0.2M⊙ during the CE stage.
Avian diet selection is hypothesized to be sensitive to seasonal changes in breeding status, but few tests exist for frugivorous tropical birds. Frugivorous birds provide an interesting test case because fruits are relatively deficient in minerals critical for reproduction. Here, we quantify annual patterns of fruit availability and diet for two frugivorous hornbill (Bucerotidae) species over a 5.5-y period to test for patterns of diet selection. Data from the lowland tropical rain forest of the Dja Reserve, Cameroon, are used to generate two nutritional indices. One index estimates the nutrient concentration of the diet chosen by Ceratogymna atrata and Bycanistes albotibialis on a monthly basis using 3165 feeding observations combined with fruit pulp sample data. The second index is an estimate of nutrient concentration of a non-selective or neutral diet across the study area based on tree fruiting phenology, vegetation survey and fruit-pulp sample data. Fifty-nine fruit pulp samples representing 40 species were analysed for 16 nutrient categories to contribute to both indices. Pulp samples accounted for approximately 75% of the observed diets. The results support expected patterns of nutrient selection. The two hornbill species selected a diet rich in calcium during the early breeding season (significantly so for B. albotibialis in July and August). Through the brooding and fledging periods, they switched from a calcium-rich diet to one rich in iron and caloric content as well as supplemental protein in the form of invertebrates. Calcium, the calcium to phosphorus ratio and fat concentration were the strongest predictors of breeding success (significant for calcium and Ca:P for B. albotibialis in June). We conclude that hornbills actively select fruit based on nutritional concentration and mineral concentration and that the indices developed here are useful for assessing frugivore diet over time.
The effectiveness and efficiency of 17 housekeepers in terminal cleaning 292 hospital rooms was evaluated through adenosine triphosphate detection. A subgroup of housekeepers was identified who were significantly more effective and efficient than their coworkers. These optimum outliers may be used in performance improvement to optimize environmental cleaning.
To assess the effect of adenosine triphosphate (ATP) device measurement of hospital room cleaning and feedback of pooled results to environmental service workers (EVS) to improve cleaning efficacy.
Nonrandomized controlled trial conducted over 20 months.
Three hospitals of varying size.
EVS workers, randomly selected on the basis of convenience sample of rooms.
Environmental cleanliness composite scores were combined with layered educational interventions and used to provide feedback to EVS workers on specific hospital units. Trends in cleaning efficacy were observed after the interventions.
Cleaning efficacy improved significantly with each intervention (P < .01) and decreased during the washout period.
The ATP detection device combined with educational feedback for EVS workers resulted in significant improvement in cleaning efficacy of the hospital room environment.