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Psychotic experiences may emerge in more severe cases of common mental disorders (CMD). Previous work identified that 30% of patients treated by mental health services in primary healthcare, specifically the Improving Access to Psychological Therapies (IAPT) programme in England, reported psychotic experiences, began treatment with more severe CMD and were less likely to reach recovery.
To replicate our previous assessment of psychotic experiences in the IAPT programme using a more sensitive threshold and determine its impact on the prevalence of psychotic experience and likelihood of recovery. Additionally, to compare recovery rates between patients with and without psychotic experiences at the end of therapy.
The Community Assessment of Psychic Experiences (CAPE-P15) with a cut-off of 1.30 was used to determine the prevalence of psychotic experiences. Recovery rates were determined using measures collected in the IAPT programme for depression (PHQ-9) and anxiety (GAD-7). Multi-group growth models estimated improvement trajectories.
In total, 2042 patients with CMD completed the CAPE-P15. The mean age was 39.8. The prevalence of psychotic experiences was 18% higher when using a lower threshold. The recovery rate for patients with psychotic experiences was lower (36%) than for those without (64%). Despite sharing similar improvement trajectories, the higher initial severity of CMD among patients with psychotic experiences impeded likelihood of recovery.
As psychotic experiences may be a marker of severity in CMD, the benefits of identifying these in IAPT populations may also apply to patients with milder experiences. Further investigation of the consequential demands on service provision and how this would affect clinical practice is recommended.
Highly anomalous platinum-group element (PGE) concentrations in the podiform chromitites at the Cliff and Harold's Grave localities in the Shetland ophiolite complex have been well documented previously. The focus of this study is alluvial platinum-group minerals (PGM) located in small streams that drain from the PGE-rich chromitites. The placer PGM assemblage at Cliff is dominated by Pt-arsenides (64%) and Pd-antimonides (17%), with less irarsite–hollingworthite (11%) and minor Pd-sulfides, Pt–Pd–Cu and Pt–Fe alloys and laurite. Gold also occurs with the PGM. Alluvial PGM have average sizes of 20 µm × 60 µm, with sperrylite the largest grain identified at 110 µm in diameter, matching the range reported for the primary PGM in the source rocks. The placer assemblage contains more Pt-bearing and less Pd-bearing PGM compared with the rocks. The more resistant sperrylite and irarsite–hollingworthite grains which are often euhedral become more rounded further downstream whereas the less resistant Pd-antimonides which are commonly subhedral may become striated and etched. Less stable phases such as Pt- and Pd-oxides and other Ni-Cu-bearing phases located in the rocks (i.e. Ru-pentlandite, PtCu, Pd–Cu alloy) are absent in the placer assemblage. Also the scarce PGM (PdHg, Rh- and Ir-Sb) and Os in the rocks are absent. At Harold's Grave only three alluvial PGM (laurite, Ir, Os) and Au were recovered reflecting the limited release of IPGM from chromite grains in the rocks. In this cold climate with high rainfall, where erosion dominates over weathering, the PGM appear to have been derived directly from the erosion of the adjacent PGE-rich source rocks and there is little evidence of in situ growth of any newly formed PGM. Only the presence of dendritic pure Au and Pd-, Cu-bearing Au covers on the surface of primary minerals may indicate some local reprecipitation of these metals in the surficial conditions.
To formulate age- and context-specific complementary feeding recommendations (CFR) for infants and young children (IYC) and to compare the potential of filling population-level nutrient gaps using common sets of CFR across age groups.
Linear programming was used to develop CFR using locally available and acceptable foods based on livelihood- and age-group-specific dietary patterns observed through 24 h dietary recalls. Within each livelihood group, the nutrient potential of age-group-specific v. consolidated CFR across the three age groups was tested.
Three food-insecure counties in northern Kenya; namely, settled communities from Isiolo (n 300), pastoralist communities from Marsabit (n 283) and agro-pastoralist communities from Turkana (n 299).
Breast-fed IYC aged 6–23 months (n 882).
Age-specific CFR could achieve adequacy for seven to nine of eleven modelled micronutrients, except among 12–23-month-old children in agro-pastoralist communities. Contribution of Fe, Zn and niacin remained low for most groups, and thiamin, vitamin B6 and folate for some groups. Age-group-consolidated CFR could not reach the same level of nutrient adequacy as age-specific sets among the settled and pastoralist communities.
Context- and age-specific CFR could ensure adequate levels of more modelled nutrients among settled and pastoralist IYC than among agro-pastoralist communities where use of nutrient-dense foods was limited. Adequacy of all eleven modelled micronutrients was not achievable and additional approaches to ensure adequate diets are required. Consolidated messages should be easier to implement as part of a behaviour change strategy; however, they would likely not achieve the same improvements in population-level dietary adequacy as age-specific CFR.
This book presents a wide range of new research on many aspects of naval strategy in the early modern and modern periods. Among the themes covered are the problems of naval manpower, the nature of naval leadership and naval officers, intelligence, naval training and education, and strategic thinking and planning. The book is notable for giving extensive consideration to navies other than those ofBritain, its empire and the United States. It explores a number of fascinating subjects including how financial difficulties frustrated the attempts by Louis XIV's ministers to build a strong navy; how the absence of centralised power in the Dutch Republic had important consequences for Dutch naval power; how Hitler's relationship with his admirals severely affected German naval strategy during the Second World War; and many more besides. The book is a Festschrift in honour of John B. Hattendorf, for more than thirty years Ernest J. King Professor of Maritime History at the US Naval War College and an influential figure in naval affairs worldwide.
N.A.M. Rodger is Senior Research Fellow at All Souls College, Oxford.
J. Ross Dancy is Assistant Professor of Military History at Sam Houston State University.
Benjamin Darnell is a D.Phil. candidate at New College, Oxford.
Evan Wilson is Caird Senior Research Fellow at the National Maritime Museum, Greenwich.
Contributors: Tim Benbow, Peter John Brobst, Jaap R. Bruijn, Olivier Chaline, J. Ross Dancy, Benjamin Darnell, James Goldrick, Agustín Guimerá, Paul Kennedy, Keizo Kitagawa, Roger Knight, Andrew D. Lambert, George C. Peden, Carla Rahn Phillips, Werner Rahn, Paul M. Ramsey, Duncan Redford, N.A.M. Rodger, Jakob Seerup, Matthew S. Seligmann, Geoffrey Till, Evan Wilson
We present an analysis of changes of state, pressures and conservation responses over 20 years in the Tanzanian portion of the Coastal Forests of Eastern Africa biodiversity hotspot. Baseline data collected during 1989–1995 are compared with data from a synthesis of recently published papers and reports and new field work carried out across the region during 2010–2014. We show that biodiversity endemism values are largely unchanged, although two new species (amphibian and mammal) have been named and two extremely rare tree species have been relocated. However, forest habitat continues to be lost and degraded, largely as a result of agricultural expansion, charcoal production to supply cities with cooking fuel, logging for timber and cutting of wood for firewood and building poles. Habitat loss is linked to an increase in the number of species threatened over time. The government-managed forest reserve network has expanded slightly but has low effectiveness. Three forest reserves have been upgraded to National Parks and Nature Reserves, which have stricter protection and more effective enforcement. There has also been rapid development of village-owned forest reserves, with more than 140 now existing; although usually small, they are an important addition to the areas being managed for sustainable resource use, and also provide tangible benefits to local people. Human-use pressures remain intense in many areas, and combined with emerging pressures from mining, gas and oil exploration, many endemic species remain threatened with extinction.
The central rock-rat Zyzomys pedunculatus is categorized as Critically Endangered on the IUCN Red List. Over the last 50 years the species had only been recorded from 14 sites within a 600 km2 area of the West MacDonnell National Park and immediate surroundings in the Northern Territory, Australia. The central rock-rat disappeared from monitoring sites in 2002, coincident with the onset of drought conditions and extensive wildfires. With concern growing for the survival of the species, we sought to locate an extant population. During 2009–2012 we surveyed sites throughout the western sector of the West MacDonnell National Park, including sites where rock-rats had previously been recorded. From a total of 55 sites and 5,000 trap nights we located eight central rock-rats from only five sites (overall detection rate = 0.16 rock-rats per 100 trap nights). All sites were on two mountain-top locations, both of which are over 1,250 m altitude. Evidence of reproductive activity was observed at both locations but the subpopulations were relatively localized and no individuals were captured at any of the sites from which the species was known previous to these surveys. Although the rugged mountains may provide the central rock-rat with some refuge from predation and wildfires, more research is needed to understand better the factors suppressing and constraining the species at the population and landscape scales. Immediate management priorities are prescribed burning to limit the extent and severity of wildfires and trialling a baiting programme with 1080 to target feral cats in the mountains.
The aim of this review paper is to consider how the principles of clinical audit could be applied to the development of an audit of nutritional care in hospitals and care homes, based on criteria derived from the Essence of Care: Food and Drink. A literature review identified fifteen key papers that included guidance or standards for nutritional care in hospitals or care homes. These were used to supplement the ten factors suggested by the Essence of Care to develop a set of potential audit criteria covering all aspects of the nutritional care pathway including the identification of risk of malnutrition, implementation of nutritional care plans, referral to healthcare professionals for further nutritional assessment and nutritional support strategies. A series of audit tools have been developed, including an organisational level audit tool, a staff questionnaire, a patients' and residents' records audit tool and a patients' and residents' experiences questionnaire. Further issues to consider in designing a national nutritional audit include the potential role of direct observation of care, the use of trained auditors and the scope for including the results of pre-existing local audits. In conclusion, a national audit would need to encompass a very large number of health and care organisations of widely varying sizes and types and a diverse range of people.
This article examines the role of the market report as a performative technology that does not merely reflect the emerging world of financial capitalism in late nineteenth-century America but actively shapes it. It takes as its case study the financial pages of Town Topics, the preeminent society gossip magazine in the 1880s and 1890s. Although at first sight the financial section seems far removed from the salacious gossip that the main section of the magazine traded in, there are close connections between the two. An analysis of the rhetoric of the financial pages of Town Topics uncovers a mixture of abstraction and personification in their depictions of market activity. In the same way that the society gossip column in effect created the very possibility of “society” as both exclusive and public property, the genre of the financial page helped create the idea of “the market” as both a human-scale drama and an abstraction that was beyond the control of any individual, or even government.