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The number of mental hospital beds per population varies widely across countries, and the reasons for this variation are not fully understood. Given that differences in disease prevalence do not explain variation in inpatient mental health care availability, we examined the relationship between mental hospital beds and national income, education and longevity as measured by the Human Development Index (HDI).
We used an international dataset of social, economic and structural measures to conduct a mixed-effects longitudinal regression of predictors of the number of mental hospital beds per 100 000 in the overall population for 86 countries for years 2005–2015.
Our initial dataset contained 1881 observations consisting of 11 years of potential measurements across 171 countries. After eliminations based on missing data and subsequent imputation, the dataset for the final regression model included 946 observations over 86 countries. The primary predictors of a country's number of mental hospital beds were year, HDI and GINI coefficient, the latter being a measure of income disparity. Holding all other factors constant, the number of beds decreased 8% per year, reflecting the ongoing international trend of deinstitutionalisation. As hypothesised, higher HDI predicted more mental hospital beds. Every 0.1 increase in HDI (0–1.0) was associated with a 126% increase in the number of hospital beds at the sample's mean GINI index score of 38 (0–100). However, a strong interaction between HDI and the GINI coefficient indicated that a high level of income disparity attenuated the positive association between HDI and mental hospital beds. At a GINI index score of 48, every 0.1 increase in HDI was associated with a 71% increase in the number of hospital beds.
As countries reduce the number of hospital beds over time, higher levels of economic disparity are associated with a reduction in the strength of the association between national prosperity and investment in mental hospitals. As power becomes increasingly concentrated, perhaps those with the least are more easily forgotten.
A physical oceanographic, geophysical and marine geological survey of Edward VIII Gulf, Kemp Coast, collected data from conductivity–temperature–depth casts, multi-beam bathymetric swath mapping and 3.5 kHz sub-bottom surveying. Modified circumpolar deep water (mCDW) is observed in Edward VIII Gulf, as well as notable bathymetric features including mega-scale glacial lineations and a 1750 m-deep trough. Sedimentological, geochemical, rock-magnetic and micropalaeontological analysis of two kasten cores document regional palaeoclimate and palaeo-oceanographic conditions over the past 8000 years, with a warm period occurring from c. 8 to 4 ka and a shift to cooler conditions beginning at c. 4 ka and persisting until at least 0.9 ka. Sediment packages > 40 m thick within deep troughs in Edward VIII Gulf present potential targets for higher-resolution Holocene and deglacial climate studies. Despite the presence of mCDW on the shelf, inland bed topography consisting of highland terrain suggests the likelihood of relative stability of this sector of the East Antarctic Ice Sheet.
Effective communication skills are essential for all healthcare professionals. Specialist teaching on communicating with people with intellectual disabilities is often lacking, resulting in poorer healthcare and worse outcomes than in the general population. Working with professionally trained actors with intellectual disabilities, we developed an interprofessional workshop that sought to provide authentic communication skills training to enable healthcare students from various disciplines to communicate effectively with patients of all abilities. In a survey, students reported that they found the workshops rewarding and confidence-building, and that they learnt more about the roles of their interprofessional colleagues.
A 467-cm core (B94/3) from the Alta Babicora basin in the Chihuahuan Desert, northern Mexico (29°N, 108°W), documents lake-level and climate changes over the past ca. 65,000 yr. Chronological control is provided by four accelerator mass spectrometry 14C dates and five U-series dates on diatom silica. The core has been analyzed for magnetic susceptibility, loss-on-ignition, carbonate content, sediment chemistry and mineralogy, and pollen and diatom composition. The basin was occupied by a deep freshwater lake throughout the late Pleistocene which, based on shoreline evidence, was at least 19 m deeper than today. The lake shallowed after ca. 57,000 yr B.P. High variability typified the period between 54,600 and 38,000 yr B.P., probably with periodic desiccation and deflation. A deep-water lake was reestablished after 38,000 yr B.P. and persisted until ca. 29,000 yr B.P. Shallowing occurred through the last glacial maximum, although the lake was still deeper than at present. The Pleistocene–Holocene transition was marked by a distinctive change in the diatom flora. There is no diatom record for much of the Holocene, but other proxies indicate generally dry, stable catchment conditions. The Babicora record is more akin to those from the southwest United States than it is to Central America and northern South America. Wet conditions in the late Pleistocene are attributed to winter rainfall from midlatitudes in contrast to the modern, tropical, summer rainfall regime.
North American studies show bipolar disorder is associated with elevated
rates of problem gambling; however, little is known about rates in the
different presentations of bipolar illness.
To determine the prevalence and distribution of problem gambling in
people with bipolar disorder in the UK.
The Problem Gambling Severity Index was used to measure gambling problems
in 635 participants with bipolar disorder.
Moderate to severe gambling problems were four times higher in people
with bipolar disorder than in the general population, and were associated
with type 2 disorder (OR = 1.74, P = 0.036), history of
suicidal ideation or attempt (OR = 3.44, P = 0.02) and
rapid cycling (OR = 2.63, P = 0.008).
Approximately 1 in 10 patients with bipolar disorder may be at moderate
to severe risk of problem gambling, possibly associated with suicidal
behaviour and a rapid cycling course. Elevated rates of gambling problems
in type 2 disorder highlight the probable significance of modest but
unstable mood disturbance in the development and maintenance of such
A randomised controlled trial (RCT) of high-dose v. low-dose fish oil in recent-onset rheumatoid arthritis (RA) demonstrated that the group allocated to high-dose fish oil had increased remission and decreased failure of disease-modifying anti-rheumatic drug (DMARD) therapy. This study examines the relationships between plasma phospholipid levels of the n-3 fatty acids in fish oil, EPA and DHA, and remission and DMARD use in recent-onset RA. EPA and DHA were measured in blood samples from both groups of the RCT. The data were analysed as a single cohort, and Cox proportional hazards models were used to examine relationships between plasma phospholipid (PL) EPA and DHA and various outcome measures. When analysed as a single cohort, plasma PL EPA was related to time to remission, with a one unit increase in EPA (1 % total fatty acids) associated with a 12 % increase in the probability of remission at any time during the study period (hazard ratio (HR)=1·12; 95 % CI 1·02, 1·23; P=0·02). Adjustment for smoking, anti-cyclic citrullinated peptide antibodies and ‘shared epitope’ HLA-DR allele status did not change the HR. Plasma PL EPA, adjusted for the same variables, was negatively related to time to DMARD failure (HR=0·85; 95 % CI 0·72, 0·99; P=0·047). The HR for DHA and time to remission or DMARD failure were similar in magnitude to those for EPA, but not statistically significant. Biomarkers of n-3 status, such as plasma PL EPA, have the potential to predict clinical outcomes relevant to standard drug treatment of RA patients.
Randomised controlled trials (RCT) examining the effects of fish oil supplementation on cardiac outcomes have yielded varying results over time. Although RCT are placed at the top of the evidence hierarchy, this methodology arose in the framework of pharmaceutical development. RCT with pharmaceuticals differ in important ways from RCT involving fish oil interventions. In particular, in pharmaceutical RCT, the test agent is present only in the intervention group and not in the control group, whereas in fish oil RCT, n-3 fats are present in the diet and in the tissues of both groups. Also, early phase studies with pharmaceuticals determine pharmacokinetics and pharmacodynamics to design the dose of the RCT intervention so that it is in a predicted linear dose–response range. None of this happens in fish oil RCT, and there is evidence that both baseline n-3 intake and tissue levels may be sufficiently high in the dose–response range that it is not possible to demonstrate a clinical effect with a RCT. When these issues are considered, it is possible that the changing pattern of fish consumption and fish oil use over time, especially in cardiac patients, can explain the disparity where benefit was observed in the early fish oil trials but not in the more recent trials.
A local population of P. apachus in California was studied to determine population structure and colony survival during the first 3 months of colony development. Only 24.2% of the colonies survived to the end of July. Bird predation on colonies (60.6%) and loss of foundresses (12.1%) were the main causes of colony failure. Bird attacks occurred approximately 2 weeks prior to the emergence of workers and the scrub jay, Aphelocoma coerulescens, was identified as one of the avain predators. All colonies that survived this initial period persisted until observations were discontinued in late July.
Esterases present in the hemolymph of last instar Heliothis zea (Boddie) were separated by polyacrylamide gel electrophoresis. Four systems, all polymorphic, were observed. One system, Est-II, appeared especially suited for the study of some of the important population processes of this species; these include host–plant relations, migration, and the effects of environmental pressures such as pesticides on the species.
Est-II was classified as a carboxylesterase, being sensitive only to organophosphate inhibitors. Dichlorvos at 10−5M completely inhibited Est-II activity.
Populations collected from corn from Tifton, Ga., and in two locations in Illinois, at approximately the same time were very similar genetically when compared on the basis of Est-II allele frequencies. A population collected from leguminous hosts in Tifton, Ga., at the same time as the above three populations was different genetically.
Est-IIc, an allele normally rare or absent in the populations studied, was present at a high frequency in one Urbana population collection. Est-IIc may be useful in studying the long-range dispersal of H. zea.
Governments around the world are now beginning to seriously consider the use of measures of subjective wellbeing (SWB) – ratings of thoughts and feelings about life – for monitoring progress and for informing and appraising public policy. The mental state account of wellbeing upon which SWB measures are based can provide useful additional information about who is doing well and badly in life when compared to that provided by the objective list and preference satisfaction accounts. It may be particularly useful when deciding how best to allocate scarce resources, where it is desirable to express the benefits of intervention in a single metric that can be compared to the costs of intervention. There are three main concepts of SWB in the literature – evaluation (life satisfaction), experience (momentary mood) and eudemonia (purpose) – and policy-makers should seek to measure all three, at least for the purposes of monitoring progress. There are some major challenges to the use of SWB measures. Two related and well-rehearsed issues are the effects of expectations and adaptation on ratings. The degree to which we should allow wellbeing to vary according to expectations and adaptation are vexing moral problems but information on SWB can highlight what difference allowing for these considerations would have in practice (e.g. in informing prioiritisation decisions), which can then be fed into the normative debate. There are also questions about precisely what attention should be drawn to in SWB questions and how to capture the ratings of those least inclined to take part in surveys, but these can be addressed through more widespread use of SWB. We also provide some concrete recommendations about precisely what questions should be asked in large-scale surveys, and these recommendations have been taken up by the Office of National Statistics in the UK and are being looked at closely by the OECD.
Many government interventions seek to reduce the risk of death. The value of preventing a fatality (VPF) is the monetary amount associated with each statistical death that an intervention can be expected to prevent. The VPF has been estimated using a preference-based approach, either by observing market behaviour (revealed preferences) or by asking hypothetical questions that seek to replicate the market (stated preferences). The VPF has been shown to differ across and within these methods. In theory, the VPF should vary according to factors such as baseline and background risk, but, in practice, the estimates vary more by theoretically irrelevant factors, such as the starting point in stated preference studies. This variation makes it difficult to choose one unique VPF. The theoretically irrelevant factors also affect the estimates of the monetary value of a statistical life year and the value of a quality-adjusted life year. In light of such problems, it may be fruitful to focus more research efforts on generating the VPF using an approach based on the subjective well-being associated with different states of the world.
We study the effect of interactions between objects floating at fluid interfaces, for the case in which the objects are primarily supported by surface tension. We give conditions on the density and size of these objects for equilibrium to be possible and show that two objects that float when well-separated may sink as the separation between them is decreased. Finally, we examine the equilbrium of a raft of strips floating at an interface, and find that rafts of sufficiently low density may have infinite spatial extent, but that above a critical raft density, all rafts sink if they are sufficiently large. We compare our numerical and asymptotic results with some simple table-top experiments, and find good quantitative agreement.
 The title of the lecture can be reformulated as a question. It reads: How does Hegel present the philosophy of the Greeks within the horizon of his own philosophy? We can answer this question by taking a historiographical look at Hegel's philosophy from a present-day standpoint, and in so doing investigate the relation in which Hegel for his part represents Greek philosophy historiographically. This way of proceeding yields a historiographical investigation into historiographical connections. Such a project has its own justification and usefulness.
However, something else is at stake, in play [auf dem Spiel]. With the name “the Greeks” we are thinking of the commencement of philosophy; with the name “Hegel,” of its completion. Hegel himself understands his philosophy according to this determination.
In the title “Hegel and the Greeks,” the whole of philosophy in its history addresses itself to us, and does so now, at a time when the disintegration of philosophy is becoming manifest; for philosophy is migrating into logistics, psychology, and sociology. These independent areas of research secure for themselves their increasing validity and influence at many levels as devices and instruments for the success of the political-economic world, that is to say, of what is, in an essential sense, the technological world.
But the incessant disintegration of philosophy, determined from afar, is not after all the end of thinking, but rather something else, yet something that has withdrawn from public ascertainability.
The Clyde Estuary is recovering from gross pollution. In the early 1970s high densities of a small number of species of intertidal invertebrates tolerant of organic enrichment and low oxygen levels provided rich feeding for large numbers of dunlin, redshank, lapwing, oystercatcher and curlew. Winter numbers of the first three species have now declined considerably. The declines cannot be attributed to national changes in wader numbers and are not due to changes in breeding habitats or lack of reproductive success in particular regions, since each species wintering on the Clyde Estuary breeds in a different area. The most likely explanation of the decline, which is most pronounced in the species highly dependent on Corophium volutator, is either that reduced organic pollution has reduced the densities of the main prey, or that higher oxygen levels over the mudflats have allowed fish, particularly flounders, to enter the estuary and compete with the waders for the available prey. Although there is evidence of some birds having moved to other wintering areas, the fate of most birds is unknown.
As part of a program to study surge-type glaciers, a radar-depth survey, using a frequency of 620 MHz, has been made of Trapridge Glacier, Yukon Territory. Soundings were taken at 26 locations on the glacier surface and a maximum ice thickness of 143 m was measured. A rapid change in surface slope in the lower ablation region marks the boundary between active and stagnant ice and is suggestive of an “ice dam” or the water “collection zone” postulated by Robin and Weertman for surging glaciers.