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Across disciplines, scholars strive to better understand individuals’ milieus—the people, places, and institutions individuals encounter in their daily lives. In particular, political scientists argue that racial and ethnic context shapes attitudes about candidates, policies, and fellow citizens. Yet, the current standard of measuring milieus is to place survey respondents in a geographic container and then to ascribe all that container's characteristics to the individual's milieu. Using a new dataset of over 2.6 million GPS records from over 400 individuals, we compare conventional static measures of racial and ethnic context to dynamic, precise measures of milieus. We demonstrate how low-level static measures tend to overstate how extreme individuals’ racial and ethnic contexts are and offer suggestions for future researchers.
Objective. To identify clinically useful predictors of adherence to medication among persons with schizophrenia. Method. We evaluated levels of compliance with neuroleptic medication among 32 consecutive admissions with DSM-III-R schizophrenia from a geographically defined catchment area using a compliance interview. We also assessed symptomatology, insight, neurological status and memory. Results. Less than 25% of consecutive admissions reported being fully compliant. Drug attitudes were the best predictor of regular compliance, symptomatology the best predictor of noncompliance, and memory the best predictor of partial compliance with neuroleptic medication. Conclusions. These data emphasise the complexity of factors that influence whether a person adheres to his medication regimen. Furthermore, they suggest that these factors may vary within the same person over time.
National and international research has shown the association between depression and anxiety disorders with the risk of planned and impulsive suicidal behavior. Patients with depression may have severe anxiety or agitation associated with their depression with or without comorbid additional anxiety disorder diagnoses.
1. Evaluate differences between self rated overall suicide risk of inpatients on a treatment resistant depression unit based on presence or absence of comorbid anxiety disorder.
2. Evaluate association of pharmacogenetic testing results with self-ratings of suicide risk.
1. To determine if suicide risk of psychiatric inpatients is higher in patients with depression and comorbid anxiety disorder.
2. To determine utility of pharmacogenetic testing with suicide risk assessment and patterns of use in patients with treatment resistant depression at a large academic medical center.
This is a retrospective records review study of a sample of over 700 inpatients on a treatment resistant depression unit at the Mayo Clinic. Patients overall suicide risk self-assessments will be analyzed for differences in suicide risk assessment controlling for diagnoses, age, and sex. Pharmacogenetic testing results, including serotonin transporter and p450 2D6 testing results, will be analyzed for their association with suicide risk.
Statistical analyses results are pending at time of abstract submission.
At a population level, the interplay between anxiety disorders and depressive symptoms is felt to be key to understanding the progression from suicidal ideation to suicidal behavior. Factors complicating this at an individual patient level along with results of research study will be discussed.
Natural disasters are increasing in frequency and impact; they cause widespread disruption and adversity throughout the world. The Canterbury earthquakes of 2010–2011 were devastating for the people of Christchurch, New Zealand. It is important to understand the impact of this disaster on the mental health of children and adolescents.
To report psychiatric medication use for children and adolescents following the Canterbury earthquakes.
Dispensing data from community pharmacies for the medication classes antidepressants, antipsychotics, anxiolytics, sedatives/hypnotics and methylphenidate are routinely recorded in a national database. Longitudinal data are available for residents of the Canterbury District Health Board (DHB) and nationally. We compared dispensing data for children and adolescents residing in Canterbury DHB with national dispensing data to assess the impact of the Canterbury earthquakes on psychotropic prescribing for children and adolescents.
After longer-term trends and population adjustments are considered, a subtle adverse effect of the Canterbury earthquakes on dispensing of antidepressants was detected. However, the Canterbury earthquakes were not associated with higher dispensing rates for antipsychotics, anxiolytics, sedatives/hypnotics or methylphenidate.
Mental disorders or psychological distress of a sufficient severity to result in treatment of children and adolescents with psychiatric medication were not substantially affected by the Canterbury earthquakes.
The Dietary Approaches to Stop Hypertension (DASH) eating pattern has been shown to reduce blood pressure (BP) in previous clinical trials. In the PREMIER study, an established behavioural intervention, with or without DASH, promoted greater weight loss than an advice-only control group, but effects of the DASH intervention on BP were weaker. In these analyses, PREMIER data were used to evaluate whether change in dairy product or fruit and vegetable (FV) intake during the first six intervention months impacted changes in weight and/or BP. Study participants were classified as having low or high intakes of dairy products (<1·5 v. ≥1·5 servings/d) and FV (<5 v. ≥5 servings/d) at baseline and 6 months. For dairy products, in particular, participants with higher baseline intakes tended to decrease their intakes during the intervention. In these analyses, subjects consuming <1·5 dairy servings/d at baseline whose intake increased during the intervention lost more weight than those whose intake decreased or remained low throughout (10·6 v. 7·0 pounds (4·8 v. 3·2 kg) lost, respectively, P = 0·002). The same was true for FV intake (11·0 v. 5·9 pounds (5·0 v. 2·7 kg) lost, P < 0·001). We also found synergistic effects of dairy products and FV on weight loss and BP reduction. Specifically, subjects who increased their intakes of dairy products and also consumed ≥5 servings of FV/d lost more weight and had greater reductions in BP than other groups; in addition, higher FV intakes had the greatest benefit to BP among those consuming more dairy products. These results provide evidence that the DASH pattern was most beneficial to individuals whose baseline diet was less consistent with DASH.
Evidence suggests that dietary intake of UK children is currently suboptimal. It is therefore imperative to identify effective and sustainable methods of improving dietary habits and knowledge in this population, whilst also promoting the value of healthiness of food products beyond price. Schools are ideally placed to influence children's knowledge and health, and Project Daire, in partnership with schools, food industry partners and stakeholders, aims to improve children's knowledge of, and interest in, food to improve health, wellbeing and educational attainment.
Daire is a randomised-controlled, factorial design trial evaluating two interventions. In total, n = 880 Key Stage (KS) 1 and 2 pupils have been recruited from 18 primary schools in the North West of Northern Ireland and will be randomised to one of four 6-month intervention arms: i) ‘Engage’, ii) ‘Nourish’, iii) ‘Engage’ and ‘Nourish’ and iv) Delayed. ‘Engage’ is an age-appropriate, cross-curricular educational intervention on food, agriculture, science and careers linked to the current curriculum. ‘Nourish’ is an intervention aiming to alter schools’ food environments and increase exposure to local foods. Study outcomes include food knowledge, attitudes, trust, diet, behaviour, health and wellbeing and will be collected at baseline and six months. Qualitative data on teacher/pupil opinions will also be collected. The intervention phase is currently ongoing. We present baseline results from our involvement and food attitudes measure from all participating schools. Results were compared by Key Stage and sex using Pearson Chi-Squared test.
Baseline results from our food involvement and attitudes measure are presented for n = 880 KS1 (n = 454) and KS2 (n = 426) pupils. KS1 pupils were more likely to always or sometimes help with food shopping (89.0%) whilst KS2 pupils were more likely to always or sometimes help with food preparation (69.0%). A higher proportion of KS1 pupils reported liking to try new foods (66.1%) and that it was important that food looked (64.5%), tasted (71.1%) and smelled good (60.6%) compared with KS2 children (P < 0.01). Girls were more likely to always or sometimes help with food shopping (96.2%) and preparation (73%) when compared with boys; whilst a higher proportion of girls reported they liked to try new foods (48.2%) and that it was important that food looked (68%) smelled (50.5%) and tasted (71.8%) good compared with boys (P < 0.01).
Results suggest that involvement in food preparation and shopping, willingness to try new foods and attitudes towards food presentation varied by KS and sex in this cohort.
The rocky shores of the north-east Atlantic have been long studied. Our focus is from Gibraltar to Norway plus the Azores and Iceland. Phylogeographic processes shape biogeographic patterns of biodiversity. Long-term and broadscale studies have shown the responses of biota to past climate fluctuations and more recent anthropogenic climate change. Inter- and intra-specific species interactions along sharp local environmental gradients shape distributions and community structure and hence ecosystem functioning. Shifts in domination by fucoids in shelter to barnacles/mussels in exposure are mediated by grazing by patellid limpets. Further south fucoids become increasingly rare, with species disappearing or restricted to estuarine refuges, caused by greater desiccation and grazing pressure. Mesoscale processes influence bottom-up nutrient forcing and larval supply, hence affecting species abundance and distribution, and can be proximate factors setting range edges (e.g., the English Channel, the Iberian Peninsula). Impacts of invasive non-native species are reviewed. Knowledge gaps such as the work on rockpools and host–parasite dynamics are also outlined.
Gig work and other flexible labour practices have been subject to unprecedented levels of attention recently. While this topic has attracted significant interest from employment lawyers, it remains relatively underexplored from other pertinent legal and inter-disciplinary angles. This paper will adopt an alternative perspective on flexible work inspired by Coase's theory of the firm. Focusing on the implications of flexible work for the relative allocation of control, risk and reward within the firm, it will highlight how both task-oriented (gig) and on-demand (casual) work practices typically entail workers assuming most of the positional disadvantages associated with orthodox employment and self-employment, while enjoying none or few of the corresponding advantages. Using a hypothetical contract analysis, it will highlight the structural similarity between flexible work and unsecured financial investments in business firms by reference to key strands of institutional economics and law and finance literature. On this basis, it will enquire as to optimal forms of compensation that rational flexible workers can (counter-factually) be regarded as bargaining for in the absence of impediments to efficient contracting, and as the price for trading off their traditional employment guarantees.
There is an urgent need to find effective methods of supporting individuals to make dietary behaviour changes. Peer-supported interventions (PSI) have been suggested as a cost-effective strategy to support chronic disease self-management. However, the effect of PSI on dietary behaviour is unclear. The present systematic review aimed to assess the effectiveness of PSI for encouraging dietary behaviour change in adults and to consider intervention characteristics linked with effectiveness.
Electronic databases were searched until June 2018 for randomised controlled trials assessing the effectiveness of PSI compared with an alternative intervention and/or control on a dietary related outcome in adults. Following title and abstract screening, two reviewers independently screened full texts and data were extracted by one reviewer and independently checked by another. Results were synthesised narratively.
Randomised controlled trials.
The fifty-four included studies varied in participants, intervention details and results. More PSI reported a positive or mixed effect on diet than no effect. Most interventions used a group model and were lay-led by peer supporters. Several studies did not report intervention intensity, fidelity and peer training and support in detail. Studies reporting positive effects employed more behaviour change techniques (BCT) than studies reporting no effect; however, heterogeneity between studies was considerable.
As evidence was mixed, further interventions need to assess the effect of PSI on dietary behaviour, describe intervention content (theoretical basis, BCT, intensity and peer training/support) and include a detailed process evaluation.
Highly variable climates induce large variability in the supply of forage for livestock and so farmers must manage their livestock systems to reduce the risk of feed gaps (i.e. periods when livestock feed demand exceeds forage supply). However, mixed crop-livestock farmers can utilise a range of feed sources on their farms to help mitigate these risks. This paper reports on the development and application of a simple whole-farm feed-energy balance calculator which is used to evaluate the frequency and magnitude of feed gaps. The calculator matches long-term simulations of variation in forage and metabolisable energy supply from diverse sources against energy demand for different livestock enterprises. Scenarios of increasing the diversity of forage sources in livestock systems is investigated for six locations selected to span Australia’s crop-livestock zone. We found that systems relying on only one feed source were prone to higher risk of feed gaps, and hence, would often have to reduce stocking rates to mitigate these risks or use supplementary feed. At all sites, by adding more feed sources to the farm feedbase the continuity of supply of both fresh and carry-over forage was improved, reducing the frequency and magnitude of feed deficits. However, there were diminishing returns from making the feedbase more complex, with combinations of two to three feed sources typically achieving the maximum benefits in terms of reducing the risk of feed gaps. Higher stocking rates could be maintained while limiting risk when combinations of other feed sources were introduced into the feedbase. For the same level of risk, a feedbase relying on a diversity of forage sources could support stocking rates 1.4 to 3 times higher than if they were using a single pasture source. This suggests that there is significant capacity to mitigate both risk of feed gaps at the same time as increasing ‘safe’ stocking rates through better integration of feed sources on mixed crop-livestock farms across diverse regions and climates.
Identifying genetic relationships between complex traits in emerging adulthood can provide useful etiological insights into risk for psychopathology. College-age individuals are under-represented in genomic analyses thus far, and the majority of work has focused on the clinical disorder or cognitive abilities rather than normal-range behavioral outcomes.
This study examined a sample of emerging adults 18–22 years of age (N = 5947) to construct an atlas of polygenic risk for 33 traits predicting relevant phenotypic outcomes. Twenty-eight hypotheses were tested based on the previous literature on samples of European ancestry, and the availability of rich assessment data allowed for polygenic predictions across 55 psychological and medical phenotypes.
Polygenic risk for schizophrenia (SZ) in emerging adults predicted anxiety, depression, nicotine use, trauma, and family history of psychological disorders. Polygenic risk for neuroticism predicted anxiety, depression, phobia, panic, neuroticism, and was correlated with polygenic risk for cardiovascular disease.
These results demonstrate the extensive impact of genetic risk for SZ, neuroticism, and major depression on a range of health outcomes in early adulthood. Minimal cross-ancestry replication of these phenomic patterns of polygenic influence underscores the need for more genome-wide association studies of non-European populations.
We performed a spatial-temporal analysis to assess household risk factors for Ebola virus disease (Ebola) in a remote, severely-affected village. We defined a household as a family's shared living space and a case-household as a household with at least one resident who became a suspect, probable, or confirmed Ebola case from 1 August 2014 to 10 October 2014. We used Geographic Information System (GIS) software to calculate inter-household distances, performed space-time cluster analyses, and developed Generalized Estimating Equations (GEE). Village X consisted of 64 households; 42% of households became case-households over the observation period. Two significant space-time clusters occurred among households in the village; temporal effects outweighed spatial effects. GEE demonstrated that the odds of becoming a case-household increased by 4·0% for each additional person per household (P < 0·02) and 2·6% per day (P < 0·07). An increasing number of persons per household, and to a lesser extent, the passage of time after onset of the outbreak were risk factors for household Ebola acquisition, emphasizing the importance of prompt public health interventions that prioritize the most populated households. Using GIS with GEE can reveal complex spatial-temporal risk factors, which can inform prioritization of response activities in future outbreaks.
Recovery is a key goal for individuals, and services’ recovery orientation can facilitate this process. The independent mental health sector is increasingly important in Ireland, particularly in counselling and suicide prevention. We aimed to evaluate Pieta House as a recovery-oriented service through clients’ self-rated recovery; and clients’ and therapists’ evaluation of the service.
Clients completing therapy over a 3-month period were invited to complete the Recovery Assessment Scale (RAS) and the Recovery Self Assessment-Revised (RSA-R). Therapists completed the RSA-R staff version.
Response rate was 36.7% for clients (n=88), 98% for therapists (n=49). Personal recovery was endorsed by 73.8% of clients, with highest agreement for factors ‘Willingness to Ask for Help’ (84.5%), and ‘Reliance on Others’ (82.1%). A smaller number agreed with factors ‘Personal Confidence and Hope’ (61.3%) and ‘No Domination by Symptoms’ (66.6%). Clients’ and therapists’ evaluation of the service showed high levels of agreement with factors of ‘Choice’ (90.9% clients, 100% therapists); ‘Life Goals’ (84.1% clients, 98% therapists) and ‘Individually Tailored Services’ (80.6% clients, 79.6% therapists). Client involvement in service management had the lowest level of agreement (36.4% clients, 30.6% therapists). Clients’ self-rated recovery correlated with their rating of the service (correlation value 0.993, p=0.01).
Clients’ self-rated recovery and the recovery orientation of Pieta House were rated highly, with areas for improvement in service user involvement, peer support and advocacy. The correlation of personal recovery and recovery orientation of the service may merit further study.
Introduction: Redirecting low acuity patients from emergency departments to primary care walk-in clinics has been identified as a priority by many health authorities. Promoting family physicians for the management of ambulatory patients with urgent health concerns reflects the assumption that primary care facilities can offer high-quality and more affordable ambulatory emergency care. However, no performance assessment framework has been developed for ambulatory emergency care and consequently, quality of care provided in these alternate settings has never been formally compared. Primary objective: To identify structure, process and outcome indicators for ambulatory emergency care. Methods: We will identify and develop quality indicators (QIs) for ambulatory emergency care using a RAND/UCLA Appropriateness Method (RAM) composed of three different steps. First, we will perform a scoping literature review to inventory 1) all previously recommended QIs assessing care provided to ambulatory emergency patients in the ED or the primary care settings; 2) all conditions evaluated with the retrieved QIs; and 3) all outcomes measured by the same QIs. Second, a steering committee composed of the research team and of international experts in performance assessment in emergency and primary care will be presented with the lists of QI-related conditions and outcomes. They will be asked to identify potential outcome indicators for ambulatory emergency care by generating any relevant combinations of one condition and one outcome (e.g. acute asthma exacerbation/re-consultation). Committee members will be given the latitude to use and pair any conditions or outcomes not included in the lists as long as they think the resulting indicators are compatible with the study objectives. Using a structured nominal group approach, they will combine their suggestions and refine the list of potential QIs. This list of potential outcome indicators composed of pairs “condition/outcome” will be merged with the list of already published QIs identified during the literature review. Third, as per the RAM standards, we will assemble an international multidisciplinary panel (n=20) of patients, emergency and primary care providers, researchers and decision makers, after recommendations from international emergency and primary care associations, and from the Canadian Strategy for Patient-Oriented Research (SPOR) Support Units. Through iterative rounds of ratings using both web-based survey tools and videoconferencing, panelists will independently assess all candidate QIs. They will be asked to rate on a nine-level scale to what extent each QI is a relevant and useful measure of ambulatory emergency care quality. From one round to the next, QIs with a median panelist rating score of one to three will be excluded. Those with a median score of seven or more will be automatically included in the final list. QIs with median score of four to six will be retained for future deliberations among the panelists. Rounds of ratings will be conducted until all QIs are classified. Impact: The QIs identified will be used to develop a performance assessment framework for ambulatory emergency care. This will represent an essential step toward testing the assumption that EDs and primary care walk-in clinics provide equivalent care quality to low acuity patients.
We use the TGAS proper motions and parallaxes as well as published and new radial velocities to study the dynamics of nearby moving groups. In particular we try to determine their age using backtracing of the individual members to a common origin. We find that the current data, probably the radial velocities, do not allow to reach a successful conclusion.
We present a model for ice formation in a thin, viscous liquid film driven by a Blasius boundary layer after heating is switched off along part of the flat plate. The flow is assumed to initially be in the Nelson et al. (J. Fluid Mech., vol. 284, 1995, pp. 159–169) steady-state configuration with a constant flux of liquid supplied at the tip of the plate, so that the film thickness grows like
in distance along the plate. Plate cooling is applied downstream of a point,
-distance from the tip of the plate, where
is much larger than the film thickness. The cooling is assumed to be slow enough that the flow is quasi-steady. We present a thorough asymptotic derivation of the governing equations from the incompressible Navier–Stokes equations in each fluid and the corresponding Stefan problem for ice growth. The problem breaks down into two temporal regimes corresponding to the relative size of the temperature difference across the ice, which are analysed in detail asymptotically and numerically. In each regime, two distinct spatial regions arise, an outer region of the length scale of the plate, and an inner region close to
in which the film and air are driven over the growing ice layer. Moreover, in the early time regime, there is an additional intermediate region in which the air–water interface propagates a slope discontinuity downstream due to the sudden onset of the ice at the switch-off point. For each regime, we present ice profiles and growth rates, and show that for large times, the film is predicted to rupture in the outer region when the slope discontinuity becomes sufficiently enhanced.
In typical political experiments, researchers randomize a set of households, precincts, or individuals to treatments all at once, and characteristics of all units are known at the time of randomization. However, in many other experiments, subjects “trickle in” to be randomized to treatment conditions, usually via complete randomization. To take advantage of the rich background data that researchers often have (but underutilize) in these experiments, we develop methods that use continuous covariates to assign treatments sequentially. We build on biased coin and minimization procedures for discrete covariates and demonstrate that our methods outperform complete randomization, producing better covariate balance in simulated data. We then describe how we selected and deployed a sequential blocking method in a clinical trial and demonstrate the advantages of our having done so. Further, we show how that method would have performed in two larger sequential political trials. Finally, we compare causal effect estimates from differences in means, augmented inverse propensity weighted estimators, and randomization test inversion.