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Cognitive–behavioural therapy (CBT) is the treatment of choice for generalised anxiety disorder (GAD), yielding significant improvements in approximately 50% of patients. There is significant room for improvement in the outcomes of treatment, especially in recovery.
We aimed to compare metacognitive therapy (MCT) with the gold standard treatment, CBT, in patients with GAD (clinicaltrials.gov identifier: NCT00426426).
A total of 246 patients with long-term GAD were assessed and 81 were randomised into three conditions: CBT (n = 28), MCT (n = 32) and a wait-list control (n = 21). Assessments were made at pre-treatment, post-treatment and at 2 year follow-up.
Both CBT and MCT were effective treatments, but MCT was more effective (mean difference 9.762, 95% CI 2.679–16.845, P = 0.004) and led to significantly higher recovery rates (65% v. 38%). These differences were maintained at 2 year follow-up.
MCT seems to produce recovery rates that exceed those of CBT. These results demonstrate that the effects of treatment cannot be attributed to non-specific therapy factors.
Declaration of interest
A.W. wrote the treatment protocol in MCT and several books on CBT and MCT, and receives royalties from these. T.D.B. wrote the protocol in CBT and has published several articles and chapters on CBT and receives royalties from these. All other authors declare no competing interests.
VLBI observations of the nucleus of Centaurus A were made in April, 1982 at two frequencies with an array of five Australian radio antennas as part of the Southern Hemisphere VLBI Experiment (SHEVE). Observations were undertaken at 2.29 GHz with all five antennas, while only two were operational at 8.42 GHz. The 2.29 GHz data yielded significant information on the structure of the nuclear jet. At 8.42 GHz a compact unresolved core was detected as well.
Four working groups and three task groups of IAU Commission 5 deal specifically with information handling, technical aspects of collection, archiving, storage and dissemination of data, with designations and classification of astronomical objects, with library services, editorial policies, computer communications, ad hoc methodologies, and with various standards, reference frames etc. Information about Commission 5 working and task groups and their activities may be found in http://nut.inasan.rssi.ru/IAU/.
The Joint European X-Ray Telescope, JET-X, is one of the core instruments of the scientific payload of the USSR SPECTRUM-X astrophysics mission due for launch in 1993. The JET-X instrument concept is described and its scientific performance and capability discussed.
To examine barriers to initiation and continuation of mental health treatment among individuals with common mental disorders.
Data were from the World Health Organization (WHO) World Mental Health (WMH) surveys. Representative household samples were interviewed face to face in 24 countries. Reasons to initiate and continue treatment were examined in a subsample (n = 636 78) and analyzed at different levels of clinical severity.
Among those with a DSM-IV disorder in the past 12 months, low perceived need was the most common reason for not initiating treatment and more common among moderate and mild than severe cases. Women and younger people with disorders were more likely to recognize a need for treatment. A desire to handle the problem on one's own was the most common barrier among respondents with a disorder who perceived a need for treatment (63.8%). Attitudinal barriers were much more important than structural barriers to both initiating and continuing treatment. However, attitudinal barriers dominated for mild-moderate cases and structural barriers for severe cases. Perceived ineffectiveness of treatment was the most commonly reported reason for treatment drop-out (39.3%), followed by negative experiences with treatment providers (26.9% of respondents with severe disorders).
Low perceived need and attitudinal barriers are the major barriers to seeking and staying in treatment among individuals with common mental disorders worldwide. Apart from targeting structural barriers, mainly in countries with poor resources, increasing population mental health literacy is an important endeavor worldwide.
Official suicide statistics for England are based on deaths given suicide verdicts and most cases given an open verdict following a coroner's inquest. Previous research indicates that some deaths given accidental verdicts are considered to be suicides by clinicians. Changes in coroners' use of different verdicts may bias suicide trend estimates. We investigated whether suicide trends may be over- or underestimated when they are based on deaths given suicide and open verdicts.
Possible suicides assessed by 12 English coroners in 1990/91, 1998 and 2005 and assigned open, accident/misadventure or narrative verdicts were rated by three experienced suicide researchers according to the likelihood that they were suicides. Details of all suicide verdicts given by these coroners were also recorded.
In 1990/91, 72.0% of researcher-defined suicides received a suicide verdict from the coroner, this decreased to 65.4% in 2005 (ptrend < 0.01); equivalent figures for combined suicide and open verdicts were 95.4% (1990/91) and 86.7% (2005). Researcher-defined suicides with a verdict of accident/misadventure doubled over that period, from 4.6% to 9.1% (p < 0.01). Narrative verdict cases rose from zero in 1990/91 to 25 in 2005 (4.2% of researcher-defined suicides that year). In 1998 and 2005, 50.0% of the medicine poisoning deaths given accidental/misadventure verdicts were rated as suicide by the researchers.
Between 1990/91 and 2005, the proportion of researcher-defined suicides given a suicide verdict by coroners decreased, largely due to an increased use of accident/misadventure verdicts, particularly for deaths involving poisoning. Consideration should be given to the inclusion of ‘accidental’ deaths by poisoning with medicines in the statistics available for monitoring suicides rates.
This study aimed to evaluate the sensitivity of transient evoked otoacoustic emission testing as a screening tool for hearing loss in children, after grommet insertion.
A prospective study was conducted of 48 children (91 ears) aged three to 16 years who had undergone grommet insertion for glue ear. At post-operative review, pure tone audiometry was performed followed by transient evoked otoacoustic emission testing. Outcomes for both tests, in each ear, were compared.
The pure tone audiometry threshold was ≤20 dB in 85 ears (93.4 per cent), 25 dB in two ears (2.2 per cent) and ≥30 dB in four ears (4.4 per cent). Transient evoked otoacoustic emissions were detected in 69 ears (75.8 per cent). The sensitivity of transient evoked otoacoustic emission testing for detecting hearing loss was 100 per cent for ≥30 dB loss but only 66.7 per cent for ≥25 dB loss.
Transient evoked otoacoustic emission testing offers a sensitive means of detecting hearing loss of ≥30 dB following grommet insertion in children. However, the use of such testing as a screening tool may miss some cases of mild hearing loss.
Six super α2 titanium aluminide pancakes were produced by rapid omnidirectional compaction of prealloyed Ti-25Al-l0Nb-3V-lMo (at%) [Ti- 14.1Al-19.5Nb-3.2V-2Mo (wt%)] powder. Various solution and aging heat treatments were investigated to yield the best combination of tensile and stress rupture properties. The β transus temperature was found to be about 1,090 °C (1,990 °F). The alloy was heat treated with four different schedules to develop various structure combinations of α2 and β, and followed by a series of microstructural analyses and mechanical property determinations. The highest ultimate tensile strength and yield strength attained at room temperature were 1,174.9 and 977.7 MPa (170.4 and 141.8 ksi), respectively, for a specimen heat treated at 1,140 °C (2,084 °F) for 1 hr and aged at 816 °C (1,500 °F) for 4 hr + air cooling. However, the elongation was less than 2%. Under the same heat treatment condition, the ultimate tensile strength and yield strength measured at 427 °C (800 °F) were 1,139.1 and 711.6 MPa (165.2 and 103.2 ksi), respectively, with an elongation of 6.7%. The alloy also showed good stress rupture resistance. Compared with a similar hot isostatically pressed material, the current alloy shows superior mechanical properties due to a finer microstructure.
We report angle-resolved photoemission data from single crystals of C60 cleaved in UHV. Unlike the other forms of pure carbon, the valence band spectrum of C60 consists of many sharp features that can be essentially accounted for by the quantum chemical calculations describing individual molecules. This suggests that the electronic structure of solid C60 is mainly determined by the bonding interactions within the individual molecules. We also observe remarkable intensity modulations of the photoemission features as a function of photon energy, suggesting strong final state effects. Finally, we address the issue of the band width of the HOMO state of C60. We assert that the width of the photoemission peak of C60 does not reflectthe intrinsic band width.
The near-EF electronic structure and Fermi surface of Bi2212 has been mapped out with ARPES. A key feature of our measured bandstructure is the existence of an extended region of flat CuO2-derived bands at EF. Comparative analysis of this data with that from NdCeCuO and YBCO7 suggests that many of the anomalous (normal) physical properties of Bi2212 and YBCO7 (NdCeCuO) may be related to the existence (absence) of such bands at EF. Superconducting gap anisotropy at least an order of magnitude larger than that of the conventional superconductors has been observed in the a-b plane of Bi2212 in ARPES. For samples with Tc of 88K, the gap size reaches a maximum of approximately 20 meV along the Cu-O bond direction, and a minimum of much smaller or vanishing magnitude 45° away. The experimental data is discussed within the context of various theoretical models. In particular, a detailed comparison with what is expected from a superconductor with a dx2-y2 order parameter is carried out, yielding a consistent picture.
Prior research on whether marriage is equally beneficial to the mental health of men and women is inconsistent due to methodological variation. This study addresses some prior methodological limitations and investigates gender differences in the association of first marriage and being previously married, with subsequent first onset of a range of mental disorders.
Cross-sectional household surveys in 15 countries from the WHO World Mental Health survey initiative (n=34493), with structured diagnostic assessment of mental disorders using the Composite International Diagnostic Interview 3.0. Discrete-time survival analyses assessed the interaction of gender and marital status in the association with first onset of mood, anxiety and substance use disorders.
Marriage (versus never married) was associated with reduced risk of first onset of most mental disorders in both genders; but for substance use disorders this reduced risk was stronger among women, and for depression and panic disorder it was confined to men. Being previously married (versus stably married) was associated with increased risk of all disorders in both genders; but for substance use disorders, this increased risk was stronger among women and for depression it was stronger among men.
Marriage was associated with reduced risk of the first onset of most mental disorders in both men and women but there were gender differences in the associations between marital status and onset of depressive and substance use disorders. These differences may be related to gender differences in the experience of multiple role demands within marriage, especially those concerning parenting.
A 10 min education programme was developed which, if effective in changing the behaviour of pregnant women, would eliminate or greatly reduce the risk of congenital toxoplasmosis. It was taught in 26 randomly selected (case) prenatal classes offered to women early in their pregnancy. The remaining 26 (control) classes received routine class material which did not mention toxoplasmosis. A questionnaire was administered to all women prior to this early class (pre-test) and again after the last prenatal class, held just prior to delivery (post-test). Changes in pet, food and personal hygiene behaviour between the pre- and post-test were determined and a score calculated by adding points for change towards those behaviours recommended in the programme and subtracting points for change in the opposite direction. Cat owners in case classes had a significantly higher score in pet hygiene behaviour than those in control classes (P < 0·05). No significant difference was found between the food or personal hygiene scores of women in case and control classes, possibly because of low power. However, although behaviours did not differ on the pre-test, women in case classes had significantly better cooking methods for roast beef and hamburger on the post-test (P < 0·05 and P < 0·01 respectively). It is concluded that this programme is effective and should be offered to all women in order to reduce congenital toxoplasmosis incidence.
The antibiotic resistance patterns of coliforms in faecal specimens from pigs and their human contacts were studied. The ability of the resistant coliforms to transfer their resistance in vitro to antibiotic-sensitive recipients was examined. The results showed that pigs which had received antibiotics carried more multiply-resistant, R-factor bearing coliforms than pigs which had not been given antibiotics. Human contacts of the antibiotic-treated pigs had a higher incidence of antibiotic-resistant coliforms with R-factors than human contacts of pigs which had not been given antibiotics. It is concluded that antibiotic treatment of farm, animals may lead to acquisition of antibiotic resistance by gut coliforms of man.
We have previously described a bloodmeal-induced molecule (lectin-trypsin complex) from the midgut of the tsetse fly, Glossina longipennis, with both lectin and trypsin activities (Osir et al., 1995). In this paper, we report on the isolation of a similar molecule from the midguts of Glossina fuscipes fnscipes and provide direct evidence for its involvement in the development of African trypanosomes. The molecule (native Mr ∼65,700) has two non-covalently linked subunits, Mr ∼28,800 and Mr ∼35,700. The native molecule was found to be capable of inducing differentiation of bloodstream-form trypanosomes into procyclic (midgut forms) in vitro. In the assays, specific antibodies against procyclin were used to monitor the transformation of the bloodstream-form trypanosomes into procyclic forms. This induction was specifically inhibited by D-glucosamine. Cis-aconitate was also capable of inducing the transformation process with the same efficiency as that of the lectin-trypsin complex. While increasing the concentrations of the lectin-trypsin complex (≥100 μg protein/ml) in the incubation assays resulted into higher transformation rates, it also led to high parasite mortality. These results provide evidence for the involvement of the midgut lectin-trypsin complex in the differentiation of bloodstream-form trypanosomes within tsetse midgut.
In 1967 Roger Penrose introduced the notion of twistors and twistor geometry in a seminal paper entitled ‘Twistor Algebra’. Since that time, there has developed a significant literature and research movement in many parts of the world, devoted to understanding the ramifications of his original proposals. The fundamental thesis of the ‘twistor program’ is to replace the usual background space-time, in which most of the phenomena of modern physics is presented, by a new background space of twistors. In particular, the physical phenomena and the equations describing them are to be reinterpreted in this new background space, with the intent of gaining new insight into them. There is some analogy to introducing ‘momentum space’ and using the Fourier transform to transform back and forth from space-time to momentum space. A principal aim of this book is to present a systematic study of the main developments in the applications of twistor geometry to problems arising from theoretical physics.
There are several aspects to the twistor program. First, it has been quite successful in giving new insight into various nonlinear classical field equations which are of interest to the physics community, as well as a new point of view for the much better understood classical linear field theories.