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Psychiatric treatments have specific and non-specific components. The latter has been addressed in an extensive literature on the placebo-effect in pharmacology and on common factors in psychotherapy. In the practice of mental health care, pharmacological, psychotherapeutic and social treatments are combined in complex interventions. This paper aims to review non-specific components across diverse psychiatric treatments and consider implications for practice and research.
We conducted a non-systematic review of non-specific components across psychiatric treatments, their impact on treatment processes and outcomes, and interventions to improve them.
The identified research is heterogeneous, both in design and quality. All non-specific components capture aspects of how clinicians communicate with patients. They are grouped into general verbal communication – focusing on initial contacts, empathy, clarity of communication, and detecting cues about unspoken concerns – non-verbal communication, the framing of treatments and decision-making. The evidence is stronger for the impact of these components on process measures – i.e. therapeutic relationship, treatment satisfaction and adherence than on clinical outcomes – i.e. symptoms and relapse. A small number of trials suggest that brief training courses and simple methods for structuring parts of clinical consultations can improve communication and subsequently clinical outcomes.
Methodologically, rigorous research advancing current understandings of non-specific components may increase effectiveness across different treatments, potentially benefitting large numbers of patients. Brief training for clinicians and structuring clinical communication should be used more widely in practice.
In the past few years, there has been an unprecedented increase in the number of forcibly displaced migrants worldwide, of which a substantial proportion is refugees and asylum seekers. Refugees and asylum seekers may experience high levels of psychological distress, and show high rates of mental health conditions. It is therefore timely and particularly relevant to assess whether current evidence supports the provision of psychosocial interventions for this population. We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) assessing the efficacy and acceptability of psychosocial interventions compared with control conditions (treatment as usual/no treatment, waiting list, psychological placebo) aimed at reducing mental health problems in distressed refugees and asylum seekers.
We used Cochrane procedures for conducting a systematic review and meta-analysis of RCTs. We searched for published and unpublished RCTs assessing the efficacy and acceptability of psychosocial interventions in adults and children asylum seekers and refugees with psychological distress. Post-traumatic stress disorder (PTSD), depressive and anxiety symptoms at post-intervention were the primary outcomes. Secondary outcomes include: PTSD, depressive and anxiety symptoms at follow-up, functioning, quality of life and dropouts due to any reason.
We included 26 studies with 1959 participants. Meta-analysis of RCTs revealed that psychosocial interventions have a clinically significant beneficial effect on PTSD (standardised mean difference [SMD] = −0.71; 95% confidence interval [CI] −1.01 to −0.41; I2 = 83%; 95% CI 78–88; 20 studies, 1370 participants; moderate quality evidence), depression (SMD = −1.02; 95% CI −1.52 to −0.51; I2 = 89%; 95% CI 82–93; 12 studies, 844 participants; moderate quality evidence) and anxiety outcomes (SMD = −1.05; 95% CI −1.55 to −0.56; I2 = 87%; 95% CI 79–92; 11 studies, 815 participants; moderate quality evidence). This beneficial effect was maintained at 1 month or longer follow-up, which is extremely important for populations exposed to ongoing post-migration stressors. For the other secondary outcomes, we identified a non-significant trend in favour of psychosocial interventions. Most evidence supported interventions based on cognitive behavioural therapies with a trauma-focused component. Limitations of this review include the limited number of studies collected, with a relatively low total number of participants, and the limited available data for positive outcomes like functioning and quality of life.
Considering the epidemiological relevance of psychological distress and mental health conditions in refugees and asylum seekers, and in view of the existing data on the effectiveness of psychosocial interventions, these interventions should be routinely made available as part of the health care of distressed refugees and asylum seekers. Evidence-based guidelines and implementation packages should be developed accordingly.
Introduction: Emergency Departments (EDs) are frequently the first point of entry to access health services for First Nation (FN) members. In Alberta, FN members visit EDs at almost double the rate of non-FN persons. Furthermore, preliminary evidence demonstrates differences in ED experience for FN members as compared to the general population. The Alberta First Nations Information Governance Centre, Maskwacis Health Services, Yellowhead Tribal Council, Treaty 8 First Nations of Alberta, and Alberta Health Services are working together to research FN members ED experiences and concerns. Methods: This is participatory research guided by a two-eyed seeing approach that acknowledges the equal value of both Western and Indigenous worldviews. FN and non-FN leaders researchers are full partners in the development of the research project. Six sharing circles will be held in February 2018 across Alberta, with Elders, FN patients, FN and non-FN clinicians and FN and non-FN administrators. Sharing circles are similar to focus groups, but emphasize everyone having a turn to speak and demonstrating respect among participants in accordance with FN protocols. Elders will select the questions for discussion based on topics that arose in initial team meetings. Sharing circle discussions will be audio recorded and transcribed. Analysts will include both Western and Indigenous worldview researchers, who will collaboratively interpret findings. Elders will review, discuss, contextualize and expand upon study findings. The research is also guided by FN principles of Ownership, Control, Access, and Possession of FN information. It is through these principles that First Nation research projects can truly be classified as FN lead and driven. Results: Based on initial team meeting discussions, results of sharing circles are expected to provide insights on issues such as: healing, patient-provider communication (verbal and non-verbal), shared decision making, respect for patient preferences, experiences leading to trust or distrust, understandings of wait times and triage, times when multiple (repeat) ED presentations occur, distances travelled for care, choosing specific EDs when seeking care, impacts of stereotypes about FN patients, and racism and reconciliation. Conclusion: Understanding FN ED experience and bringing FN perspectives to Western conceptions of the goals and provision of ED care are important steps toward reconciliation.
Stable isotopes of water (δ18O and δ2H) were measured in the debris-laden ice underlying an Antarctic blue ice moraine, and in adjoining Law Glacier in the central Transantarctic Mountains. Air bubble content and morphology were assessed in shallow ice core samples. Stable isotope measurements plot either on the meteoric waterline or are enriched from it. The data cluster in two groups: the ice underlying the moraine has a δ2H:δ18O slope of 5.35 ± 0.92; ice from adjoining portions of Law Glacier has a slope of 6.69 ± 1.39. This enrichment pattern suggests the moraine's underlying blue ice entrained sediment through refreezing processes acting in an open system. Glaciological conditions favorable to warm-based sediment entrainment occur 30–50 km upstream. Basal melting and refreezing are further evidenced by abundant vapor figures formed from internal melting of the ice crystals. Both the moraine ice and Law Glacier are sufficiently depleted of heavy isotopes that their ice cannot be sourced locally, but instead must be derived from far-field interior regions of the higher polar plateau. Modeled ice flow speeds suggest the ice must be at least 80 ka old, with Law Glacier's ice possibly dating to OIS 5 and moraine ice older still.
Reliable and affordable technology for collecting and managing livestock production process information is being developed. The advances in data measurement, collection and transfer technology enable us to retrieve information from one or more remote sites to be processed and managed centrally. This opens up the opportunity to advance from open loop, prescriptive production to closed loop systems where factors influencing the actual performance of animals are used to modify and improve their production parameters (feed, environment, medication). We strive from producing animals by predicting what is needed using outdated data, to measuring what is actually happening as they grow, processing this information and acting to optimise animal performance by modifying production parameters in real time.
This paper describes commercially available systems that make possible the retrieval, collection, processing and distribution of near real time production information. Various aspects of production management using this technology are discussed, and examples of how it can be applied to monitor water usage, how it relates to pig performance and how energy usage can be influenced, are considered.
Background: Traumatic brain injury (TBI) is a leading cause of disability in Australia. Evidence shows that multidisciplinary rehabilitation and support in the six months following TBI is important for successful independent living and social re-integration. Despite this, access to services and supports during this period is often limited by environmental, socio-economic, geographic and cultural factors. Australian studies on outcomes after brain injury have reported primarily on non-Indigenous people. This study will investigate key sentinel events during the transition from hospital to home after a TBI in the first longitudinal study with Indigenous Australians.
Method: Indigenous Australians admitted to one of three major trauma hospitals in northern Australia with a TBI, and their care givers, will be recruited. Clinical and brain injury risk factor information, along with measures of cognitive function, transition events, mental health and community re-integration will be collected at three time points prior to hospital discharge, and at three and six months post-discharge. Qualitative interviews will also be conducted. Data will be analysed using regression methods for the quantitative component, and situational analysis for the qualitative component. Annual rates of brain injury will be calculated for patients admitted to tertiary hospital facilities in the study region with a diagnosis of TBI.
Discussion: Understanding the experience and events which shape the transition period is critical to determining the services and supports that may enhance transition outcomes, and ensure that such services are culturally appropriate and endorsed by Indigenous families and communities.
There is consensus about the importance of ‘recovery’ in mental health services, but the link between recovery orientation of mental health teams and personal recovery of individuals has been underresearched.
To investigate differences in team leader, clinician and service user perspectives of recovery orientation of community adult mental health teams in England.
In six English mental health National Health Service (NHS) trusts, randomly chosen community adult mental health teams were surveyed. A random sample of ten patients, one team leader and a convenience sample of five clinicians were surveyed from each team. All respondents rated the recovery orientation of their team using parallel versions of the Recovery Self Assessment (RSA). In addition, service users also rated their own personal recovery using the Questionnaire about Processes of Recovery (QPR).
Team leaders (n = 22) rated recovery orientation higher than clinicians (n = 109) or patients (n = 120) (Wald(2) = 7.0, P = 0.03), and both NHS trust and team type influenced RSA ratings. Patient-rated recovery orientation was a predictor of personal recovery (b = 0.58, 95% CI 0.31–0.85, P<0.001). Team leaders and clinicians with experience of mental illness (39%) or supporting a family member or friend with mental illness (76%) did not differ in their RSA ratings from other team leaders or clinicians.
Compared with team leaders, frontline clinicians and service users have less positive views on recovery orientation. Increasing recovery orientation may support personal recovery.
Charcoal is the result of natural and anthropogenic burning events, when biomass is exposed to elevated temperatures under conditions of restricted oxygen. This process produces a range of materials, collectively known as pyrogenic carbon, the most inert fraction of which is known as black carbon (BC). BC degrades extremely slowly and is resistant to diagenetic alteration involving the addition of exogenous carbon, making it a useful target substance for radiocarbon dating particularly of more ancient samples, where contamination issues are critical. We present results of tests using a new method for the quantification and isolation of BC, known as hydropyrolysis (hypy). Results show controlled reductive removal of non-BC organic components in charcoal samples, including lignocellulosic and humic material. The process is reproducible and rapid, making hypy a promising new approach not only for isolation of purified BC for 14C measurement but also in quantification of different labile and resistant sample C fractions.
We present results that validate a new wet oxidation, stepped-combustion procedure for dating “old” charcoal samples. An acid–base–wet oxidation (ABOX) pretreatment procedure has been developed that is used in place of the conventional acid-base-acid (ABA) pretreatment. Combustions and graphitizations are performed in a vacuum line that is insulated from the atmosphere by a second backing vacuum to eliminate the risk of atmospheric leakage into the line at any stage of the procedure. Combustions are performed at 3 temperatures (330 °, 630 ° and 850 °) with a graphite target produced from the CO2 evolved during each combustion step. In this way, the removal of any contamination can be monitored, and a high degree of confidence can be placed on the final age. The pretreatment, combustion, graphitization, and measurement blank for the procedure, based on the analysis of a “radiocarbon-dead” graphite, is 0.5 ± 0.5 μg C (1σ, n=14), equivalent to 0.04 ± 0.02 pMC or an “age” of approximately 60 ka for a 1 mg graphite target. Analyses of a “radiocarbon-dead” natural charcoal after ABOX pretreatment and stepped combustion suggest that the total blank (including contamination not removed by pretreatment) may be higher than for graphite, ranging up to 0.10 ± 0.02 pMC. Additional experiments confirm good agreement with accepted values for the international low-14C “New Kauri” standard (0.16–0.25 pMC). They also confirm excellent reproducibility, with 3 separate dates on different aliquots of a charcoal sample from Ngarrabullgan Cave (Queensland, Australia) ranging from 35.2 to 35.5 ka 14C BP. It is also demonstrated that the ABOX pretreatment, in conjunction with the new vacuum line described here, is able to remove contamination not removed by the conventional ABA pretreatment, suggesting that the technique can be used to produce reliable 14C dates on charcoal up to at least 50 ka.
Lynch's Crater in northeastern Australia provides a long, continuous record of environmental change within the Late Quaternary. Here, we present newly determined radiocarbon ages, using acid-base-acid stepped combustion (ABA-SC) and acid-base-wet oxidation stepped combustion (ABOX-SC) pretreatment strategies. The new results largely confirm the original untreated radiocarbon results for the uppermost 9 m of sediments, (ca. 35 ka BP). Below this depth, results from both pretreatment methods are in stratigraphic agreement and extend the dating of the record from 38 ka BP to about 48 ka BP, although an apparent increased sedimentation rate below 12 m is questionable. The scarcity of “charcoal” in several of the samples raises questions regarding the application of ABOX-SC to lake or swamp sediments, with evidence for contributions from younger, chemically resistant bacterial carbon along with fine “charcoal” in some samples. However, the extent to which this phenomenon is significant to the final age estimate appears to be sample specific, and is probably dependent upon the length of the wet oxidation step in the pretreatment.
An Accelerator Mass Spectrometry system has been developed using the 14UD tandem accelerator at the Australian National University. It has been used for 36Cl measurements on groundwater samples from the Murray Basin in southeastern Australia. Measurements of 14C have also been made on the same groundwaters. The information can be combined with stable isotope ratios and other data to illustrate the occurrence of processes such as radioactive decay and local recharge in different aquifers.
Do women vote for women and men for men? Do visible minorities vote for minority candidates, and white voters for white candidates? And what happens when a minority woman appears on the ballot? This study tests for the presence of gender and ethnic affinity voting in the Toronto mayoral election of 2014, where Olivia Chow was the only woman and only visible minority candidate among the three major contenders. Our analysis, which draws on a survey of eligible Toronto voters, is the first to examine the interactive effects of sex and ethnicity on vote choice in Canada in the context of a non-partisan election and in a non-experimental manner. We find strong evidence of ethnic affinity voting and show that Chow received stronger support from ethnic Chinese voters than from other minority groups. Our results also reveal that gender was related to vote choice but only when connected with race.
A search has been made using the Buckland Park air shower array for evidence of any excess of events from the direction of the recent supernova in the Large Magellanic Cloud. Upper limits resulting from this search and their significance are discussed in this paper.
We report here a search of data recorded by the Buckland Park air shower array from the first year after the supernova and set an upper limit to the proton luminosity of SN1987A of 7.7 × 1040 ergs s−1.
The extreme isotropy of cosmic ray events allows one to put upper limits on any possible non-isotropic contribution to the flux. In particular, one can investigate any excess of events which may be confined to the galactic plane. Such extra events would be expected from galactic ultra-high-energy (UHE) gamma-ray sources. Under the assumption of an isotropic cosmic ray flux, recent Buckland Park data place a 95% confidence level limit on the total southern hemisphere (declination −15° to −55°) flux of UHE gamma-rays at between 0.6 and 6 equivalent Cygnus X-3 sources, depending on assumptions concerning the gamma-ray spectrum.
An analysis has been made of events recorded in one year from the direction of the active galaxy Centaurus A using the Buckland Park UHE gamma-ray telescope. No statistically significant excess was observed over this period. Data collected between 1984 and 1989 show evidence for an excess of events from this direction at shower sizes in the range of 2 × 105 to 5 × 105 particles.
The cosmic ray array at Buckland Park is being developed to extend its useful collecting area at 1016 eV to ∼105m2 so that anisotropy measurements can be made at higher energies than previously possible with that system. A new array is also being designed to assist with this investigation. Design considerations for the new arrays are discussed.
Several extragalactic HI surveys using a λ21 cm 13-beam focal plane array will begin in early 1997 using the Parkes 64 m telescope. These surveys are designed to detect efficiently nearby galaxies that have failed to be identified optically because of low optical surface brightness or high optical extinction. We discuss scientific and technical aspects of the multibeam receiver, including astronomical objectives, feed, receiver and correlator design and data acquisition. A comparison with other telescopes shows that the Parkes multibeam receiver has significant speed advantages for any large-area λ21 cm galaxy survey in the velocity range range 0–14000 km s−1.