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The use of transdiagnostic mental health treatments in low resource settings has been proposed as a possible aid in scaling up mental health services. Modular, multi-problem transdiagnostic treatments can be used to treat a range of mental health problems and are designed to handle comorbidity. Two randomized controlled trials have been completed on one treatment – the Common Elements Treatment Approach, or CETA – delivered by lay counsellors in Iraq and Thailand. This paper utilizes data from two clinical trials to explore the delivery of CETA by lay providers, examining fidelity and flexibility of element use. Data were collected at every therapy session. Clients completed a short symptom assessment and providers described the clinical elements delivered during sessions. Analyses included descriptive statistics of delivery including selection and sequencing of treatment elements, and the variance in element dose, clustering at the counsellor level, using multi-level models. Results indicate that lay providers in low resource settings (with supervision) demonstrated fidelity to the recommended CETA elements, order and dose, and occasionally added in elements and flexed dosage based on client presentation (i.e. flexibility). This modular approach did not result in significantly longer treatment duration. Our analysis suggests that lay providers were able to learn decision-making processes of CETA based on client presentation and adjust treatment as needed with supervision. As modular multi-problem transdiagnostic treatments continue to be explored in low resource settings, research should continue to focus on ‘unpacking’ lay counsellor delivery of these interventions, decision-making processes, and the level of supervision required.
The use of hedging with commodity futures markets to reduce the price risk in corn production is examined. Both intra-year and inter-year risk are evaluated with different hedging strategies. Strategies involve no hedge, hedge and hold, controlled hedge placement and hold, and in and out hedging. Both technical and forecasting criteria are used to place hedges in the more active strategies. Substantial risk reduction is possible, often without a reduction in price received. Considerable basis risk diminishes the risk reducing properties of a hedge and hold strategy.
With improvements in early survival following congenital heart surgery, it has become increasingly important to understand longer-term outcomes; however, routine collection of these data is challenging and remains very limited. We describe the development and initial results of a collaborative programme incorporating standardised longitudinal follow-up into usual care at the Children’s Hospital of Philadelphia (CHOP) and University of Michigan (UM).
We included children undergoing benchmark operations of the Society of Thoracic Surgeons. Considerations regarding personnel, patient/parent engagement, funding, regulatory issues, and annual data collection are described, and initial follow-up rates are reported.
The present analysis included 1737 eligible patients undergoing surgery at CHOP from January 2007 to December 2014 and 887 UM patients from January 2010 to December 2014. Overall, follow-up data, of any type, were obtained from 90.8% of patients at CHOP (median follow-up 4.3 years, 92.2% survival) and 98.3% at UM (median follow-up 2.8 years, 92.7% survival), with similar rates across operations and institutions. Most patients lost to follow-up at CHOP had undergone surgery before 2010. Standardised questionnaires assessing burden of disease/quality of life were completed by 80.2% (CHOP) and 78.4% (UM) via phone follow-up. In subsequent pilot testing of an automated e-mail system, 53.4% of eligible patients completed the follow-up questionnaire through this system.
Standardised follow-up data can be obtained on the majority of children undergoing benchmark operations. Ongoing efforts to support automated electronic systems and integration with registry data may reduce resource needs, facilitate expansion across centres, and support multi-centre efforts to understand and improve long-term outcomes in this population.
We review the current status and future prospects of the PLANET collaboration, an international team of astronomers performing high-precision photometric monitoring of microlensing events. Our photometric precision and sampling is characterised and the suitability of the database for variable star studies is discussed. Preliminary results on K-giant stability are presented.
The pre-world war I period decisively structured modern class relations in Europe and the United States. Farmers, the largest population group, greatly influenced the development of capitalism and states. Scholars have demonstrated farmers’ significance in particular areas (e.g., Blackbourn in Germany and Esping-Andersen in Scandinavia), but there has been little comparative analysis. Farmer politics, and thus modern class relations in general, have been inadequately theorized. Most existing work on agrarian classes has also been economistic, neglecting politics. We fill the gaps by analyzing agrarian politics in the United States, France, Denmark, Norway, Sweden, Germany, Austria-Hungary, and Russia.
We present the results of two 2.3 μm near-infrared (NIR) radial velocity (RV) surveys to detect exoplanets around 36 nearby and young M dwarfs. We use the CSHELL spectrograph (R ~ 46,000) at the NASA InfraRed Telescope Facility (IRTF), combined with an isotopic methane absorption gas cell for common optical path relative wavelength calibration. We have developed a sophisticated RV forward modeling code that accounts for fringing and other instrumental artifacts present in the spectra. With a spectral grasp of only 5 nm, we are able to reach long-term radial velocity dispersions of ~20–30 m s−1 on our survey targets.
Mike Kane is a cognitive psychologist who studies the dynamic interaction between attention and memory. Mike has Tourette's Syndrome (TS), a disorder characterized by multiple motor tics and at least one vocal tic. His first professional paper, while still a graduate student in psychology, was an introspective case study of his own experience of TS tics. Whereas the tics that characterize TS have typically been thought to be involuntary, Kane's observations and the work of others have suggested that TS tics tend to be compulsory, perhaps emitted in response to a subjective tactile/kinesthetic/sensory experience. Kane observed in himself, as have others, that tics are preceded by premonitory sensations:
These sensations are not mere precursors to tics; they precipitate tics. … I experience the TS state as one of keen bodily awareness, or a continual consciousness of muscle, joint, and skin sensations. For example when sitting in a chair, I do not lose awareness of the tactile sensation of the seat against my body, nor can I ignore the deeper somatic sensations of what my back and legs feel like.
The TS state is omnipresent with few exceptions (e.g., during intense concentration or attentional focus, such as in lecturing), but it is not constant in bodily location or intensity.…
If a tic is temporarily stopped, its respective bodily location becomes less ignorable. If all tics are suppressed, virtually all of my joints and muscles begin to demand my attention. The TS state heightens to a stiffening feeling, such that my skin feels like a hardened casing and my joints feel as though they are becoming rigid. […]
Nanoporous carbons (NPC) or carbogenic molecular sieves (CMS) are unique materials that are able to produce shape selectivity for very precise molecular separations, such as that of oxygen from nitrogen on the basis of size. Surprisingly, the structure of NPC is globally amorphous. This seems at first irreconcilable, since regular transport behavior is expected to arise from regular porous solids such as zeolites and other crystalline molecular sieves. With this problem in mind as motivation, in this paper we describe some of the more intriguing aspects of the nanopore formation process. It is argued that at the nanoscale the NPC are both regular and structurally self similar, consisting of curved aromatic nanodomains that arise from the broken symmetry of hexagonal arrays. The symmetry breaking process is a direct result of the dissipation that takes place during pyrolysis leading to small molecules and a defect-laden carbogenic solid. In this context, some preliminary results illustrating how these NPC structures can be used to stabilize cesium for base catalysis and to prepare supported molecular sieve membranes for small molecule separations.
The microstructure of nanoporous, carbogenic molecular sieves (CMS) was studied using high resolution electron microscopy and neutron diffraction. The narrow range of pore sizes observed in these complex materials suggests that although these materials are globally amorphous, the local microstructural features are more organized. Our work, focused on poly(furfuryl alcohol)-derived CMS, is aimed at characterizing the evolution of this microstructure. Microscopy results show that materials synthesized at low temperature have some degree of organization but that the microstructure is featureless and symmetric at longer length scales. This symmetry is broken at higher synthesis temperatures as thermodynamic driving forces lead to further organization of the carbon atoms into more ordered structures but the length scales remain short. Micrographs of high temperature CMS show a high degree of curvature and features reminiscent of fullerene. The connectivity of the carbon atoms in the CMS has been probed using powder neutron diffraction. This data suggests that the atoms in the CMS form ordered structures on the length scale of 15Å which are distinctly different from the structure of graphite. These observed changes in the microstructure directly impact the adsorptive and molecular sieving characteristics of the CMS as illustrated by the marked differences between the diffusivities of oxygen and nitrogen. This property is crucial for the very demanding separation of nitrogen from oxygen in air.
Blair equates the constructs of working memory (WM), executive function, and general fluid intelligence (gF). We argue that there is good reason not to equate these constructs. We view WM and gF as separable but highly related, and suggest that the mechanism behind the relationship is controlled attention – an ability that is dependent on normal functioning of the prefrontal cortex.
The idea that short-term memory is an important component of intelligence is not new. For example, over a century ago, James (1890) wrote, “All the intellectual value for us of a state of mind depends on our after memory of it. Only then is it combined in a system and knowingly made to contribute to a result. Only then does it count for us.” Around the same time, Binet (1905) included a test of short-term memory in a test battery designed to identify learning disabled children in the Paris school system. And more recently, short-term memory has been conceptualized as a fundamental component of human cognition. For example, Miller (1956) famously proposed that the capacity of short-term memory is limited to 7 ± 2 bits of information. Later, Atkinson and Shiffrin (1968) incorporated this idea of a central bottleneck in information processing into their “modal” model of memory.
Nevertheless, the extent to which short-term memory plays an important role in higher-level cognition — intelligence manifested in complex cognitive activities like reasoning and learning — has been a topic of considerable debate in cognitive psychology. Consider, for example, the results of a series of experiments by Baddeley and Hitch (1974). The surprising finding in these experiments was that a secondary task designed to tax short-term memory had little or no effect on a variety of reasoning, comprehension, and memory primary tasks.
Working memory is a system consisting of those long-term memory traces active above threshold, the procedures and skills necessary to achieve and maintain that activation, and limited-capacity, controlled attention. The specific features of our model include:
(2) Domain-specific codes and maintenance (phonological loop and visuospatial sketchpad are two examples but the potential number of such codes is large).
(3) Individual differences in both 1 and 2, but individual differences in capacity for controlled processing are general and possibly the mechanism for general fluid intelligence. Although people can, with practice and expertise, circumvent the abiding limitations of controlled attention in quite specific situations, the limitations reemerge in novel situations and even in the domain of expertise if the situation calls for controlled processing.
(4) Limited-capacity, controlled processing is required for maintaining temporary goals in the face of distraction and interference and for blocking, gating, and/or suppressing distracting events.
(5) The dorsolateral prefrontal cortex (PFC) and associated structures mediate the controlled processing functions of working memory. We also argue that individual differences in controlled processing represent differences in functioning of the PFC.
A number of intellectual influences have served to shape our thinking about working memory (WM) and its evolution as a construct separate from that of short-term memory (STM).
Individuals may differ in the general-attention executive
component or in the subordinate domain-specific “slave”
components of working memory. Tasks requiring sustained memory
representations across attention shifts are reliable, valid indices of
executive abilities. Measures emphasizing specific processing skills
may increase reliability within restricted samples but will not
reflect the attention component responsible for the broad
predictive validity of span tasks.
This article reviews eight published studies that describe clozapine's effects on TD and examines the outcome of 30 patients with TD treated with clozapine for up to 36 months. These data indicate that TD response to clozapine is variable but that approximately 43% of cases, particularly those with dystonic features, improved after clozapine treatment. Methodological limitations of the studies described, however, preclude definitive conclusions, which must await appropriately controlled trials.
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