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Psychiatric disorders are associated with increased risk of ischaemic heart disease (IHD) and stroke, but it is not known whether the associations or the role of sociodemographic factors have changed over time.
To investigate the association between psychiatric disorders and IHD and stroke, by time period and sociodemographic factors.
We used Scottish population-based records from 1991 to 2015 to create retrospective cohorts with a hospital record for psychiatric disorders of interest (schizophrenia, bipolar disorder or depression) or no record of hospital admission for mental illness. We estimated incidence and relative risks of IHD and stroke in people with versus without psychiatric disorders by calendar year, age, gender and area-based deprivation level.
In all cohorts, incidence of IHD (645 393 events) and stroke (276 073 events) decreased over time, but relative risks decreased for depression only. In 2015, at the mean age at event onset, relative risks were 2- to 2.5-fold higher in people with versus without a psychiatric disorder. Age at incidence of outcome differed by cohort, gender and socioeconomic status. Relative but not absolute risks were generally higher in women than men. Increasing deprivation conveys a greater absolute risk of IHD for people with bipolar disorder or depression.
Despite declines in absolute rates of IHD and stroke, relative risks remain high in those with versus without psychiatric disorders. Cardiovascular disease monitoring and prevention approaches may need to be tailored by psychiatric disorder and cardiovascular outcome, and be targeted, for example, by age and deprivation level.
Background: Recent research has supported the efficacy of schema therapy as a treatment for personality disorders. A group format has been developed (group schema therapy; GST), which has been suggested to improve both the clinical and cost-effectiveness of the treatment. Aims: Efficacy studies of GST need to assess treatment fidelity. The aims of the present study were to improve, describe and evaluate a fidelity measure for GST, the Group Schema Therapy Rating Scale – Revised (GSTRS-R). Method: Following a pilot study on an initial version of the scale (GSTRS), items were revised and guidelines were modified in order to improve the reliability of the scale. Students highly experienced with the scale rated recorded GST therapy sessions using the GSTRS-R in addition to a group cohesion measure, the Harvard Community Health Plan Group Cohesiveness Scale – II (GCS-II). The scores were used to assess internal consistency and inter-rater reliability. Discriminant validity was assessed by comparing the scores on the GSTRS-R with the GCS-II. Results: The GSTRS-R displayed substantial internal consistency and inter-rater reliability, and adequate discriminate validity, evidenced by a weak positive correlation with the GCS-II. Conclusions: Overall, the GSTRS-R is a reliable tool that may be useful for evaluating therapist fidelity to GST model, and assisting GST training and supervision. Initial validity was supported by a weak association with GCS-II, indicating that although associated with cohesiveness, the instrument also assesses factors specific to GST. Limitations are discussed.
Although dendrochronological methods have the potential to provide precise calendar dates, they are virtually absent in Mesoamerican archaeological research. This absence is due to several long-standing, but erroneous, assumptions: that tree rings in this region do not reflect annual growth and environmental variability, that an adequate number of samples do not exist, and that tree-ring measurements cannot be useful without modern trees to link prehispanic chronologies. In this article we present data from the sites of La Quemada and Los Pilarillos, located in the Malpaso Valley, Zacatecas, to demonstrate that suitable archaeologically derived samples of dendrochronologically useful species do exist, that the samples from these sites are measurable and cross-datable, and that the tree rings can yield precise calendar dates using a method that “wiggle-matches” radiocarbon dates on tree-ring sequences. The work demonstrates the potential of these methods to address chronological, and, in the future, climatic questions, which have so far eluded archaeological work in the region.
Paramphistomosis, caused by Calicophoron daubneyi, is an emerging infection of ruminants throughout Western Europe. Despite its prevalence, many questions remain regarding the basic biology of this parasite and how it interacts with its host. Consequently, there is a need to develop methods to study C. daubneyi in vitro to improve our understanding of rumen fluke biology. Towards this, we aimed to identify a suitable protocol for in vitro excystment of C. daubneyi metacercariae. Six methods that have been used to excyst metacercariae from a number of trematode species were tested with C. daubneyi metacercariae. Three of these achieved an average of >50% excystment whilst one method, which included an acid-pepsin treatment, incubation in reducing conditions and an alkaline/bile salt solution to activate the larvae, consistently gave >80% excystment. The latter protocol also showed no detrimental effect on the motility of newly excysted juvenile (NEJ) parasites when observed for up to 24 h in RPMI 1640 medium post-excystment. The successful production of C. daubneyi NEJs in vitro is a significant step forward, and will enable the discovery of infective stage-specific parasite antigens and facilitate drug screening trials, to aid the development of much needed diagnostic and therapeutic options for paramphistomosis.
Anorexia nervosa (AN) is a serious illness leading to substantial morbidity and mortality. The treatment of AN very often is protracted; repeated hospitalizations and lost productivity generate substantial economic costs in the health care system. Therefore, this study aimed to determine the differential cost-effectiveness of out-patient focal psychodynamic psychotherapy (FPT), enhanced cognitive–behavioural therapy (CBT-E), and optimized treatment as usual (TAU-O) in the treatment of adult women with AN.
The analysis was conducted alongside the randomized controlled Anorexia Nervosa Treatment of OutPatients (ANTOP) study. Cost-effectiveness was determined using direct costs per recovery at 22 months post-randomization (n = 156). Unadjusted incremental cost-effectiveness ratios (ICERs) were calculated. To derive cost-effectiveness acceptability curves (CEACs) adjusted net-benefit regressions were applied assuming different values for the maximum willingness to pay (WTP) per additional recovery. Cost–utility and assumptions underlying the base case were investigated in exploratory analyses.
Costs of in-patient treatment and the percentage of patients who required in-patient treatment were considerably lower in both intervention groups. The unadjusted ICERs indicated FPT and CBT-E to be dominant compared with TAU-O. Moreover, FPT was dominant compared with CBT-E. CEACs showed that the probability for cost-effectiveness of FTP compared with TAU-O and CBT-E was ⩾95% if the WTP per recovery was ⩾€9825 and ⩾€24 550, respectively. Comparing CBT-E with TAU-O, the probability of being cost-effective remained <90% for all WTPs. The exploratory analyses showed similar but less pronounced trends.
Depending on the WTP, FPT proved cost-effective in the treatment of adult AN.
This paper describes a preliminary series of observations of the Sun made at a frequency of 80 MHz with the 3 km radioheliograph of the Culgoora Observatory. The instrument records, at one-second intervals, pictures of the solar image in the form of 60 (E-W) × 48 (N-S) points, each separated in angle by half the Rayleigh limit (2’ arc in the zenith). At the time of the present observations the instrument was incomplete in three main respects : (a) the facilities for recording opposite senses of circular polarization were not available; (b) the automatic image compensation for zenith-angle foreshortening was not available—hence the optical disk of the Sun appears elliptical; and (c) the phase and amplitude calibration procedures had not been fully established, resulting in a higher sidelobe level than that specified in the design—the effects are sometimes evident in the pictures as spoke-like brightenings.
The design and construction of the 30 m2 Bicentennial Gamma Ray Telescope at Woomera South Australia is described. This novel instrument is now completed and commissioning is underway. It is designed to observe astronomical sources at energies greater than ∼ 500 GeV by means of atmospheric Cerenkov light. It contains 55 spherical, glass mirrors of focal length 2.66 m arranged in three groups of 10 m2, to focus the light onto three sets of detectors operated in fast co-incidence. The recording electronics includes a rubidium clock to enable pulsars to be studied.
The date of the Late Bronze Age Minoan eruption of the Thera volcano has provoked much debate among archaeologists, not least in a recent issue of Antiquity (‘Bronze Age catastrophe and modern controversy: dating the Santorini eruption’, March 2014). Here, the authors respond to those recent contributions, citing evidence that closes the gap between the conclusions offered by previous typological, stratigraphic and radiometric dating techniques. They reject the need to choose between alternative approaches to the problem and make a case for the synchronisation of eastern Mediterranean and Egyptian chronologies with agreement on a ‘high’ date in the late seventeenth century BC for the Thera eruption.
A number of studies have demonstrated that consuming almonds increases satiety but does not result in weight gain, despite their high energy and lipid content. To understand the mechanism of almond digestion, in the present study, we investigated the bioaccessibility of lipids from masticated almonds during in vitro simulated human digestion, and determined the associated changes in cell-wall composition and cellular microstructure. The influence of processing on lipid release was assessed by using natural raw almonds (NA) and roasted almonds (RA). Masticated samples from four healthy adults (two females, two males) were exposed to a dynamic gastric model of digestion followed by simulated duodenal digestion. Between 7·8 and 11·1 % of the total lipid was released as a result of mastication, with no significant differences between the NA and RA samples. Significant digestion occurred during the in vitro gastric phase (16·4 and 15·9 %) and the in vitro duodenal phase (32·2 and 32·7 %) for the NA and RA samples, respectively. Roasting produced a smaller average particle size distribution post-mastication; however, this was not significant in terms of lipid release. Light microscopy showed major changes that occurred in the distribution of lipid in all cells after the roasting process. Further changes were observed in the surface cells of almond fragments and in fractured cells after exposure to the duodenal environment. Almond cell walls prevented lipid release from intact cells, providing a mechanism for incomplete nutrient absorption in the gut. The composition of almond cell walls was not affected by processing or simulated digestion.
The Chauvet-Pont d'Arc Cave is one of the most important sites for the study of the earliest manifestations and development of prehistoric art at the beginning of the Upper Paleolithic. Different dating techniques have been performed thus far (AMS 14C, U/Th TIMS, 36Cl dating) to model the chronological framework of this decorated cave. The cave yielded several large charcoal fragments, which enabled the opportunity for obtaining multiple dates; thus, a First Radiocarbon Intercomparison Program (FIP) was initiated in 2004 using three charcoal pieces. The FIP demonstrated that those cross-dated samples belonged to a time period associated with the first human occupation. One of the statistical interests of an intercomparison program is to reduce the uncertainty on the sample age; thus, to further assess the accuracy of the chronological framework, the Second Intercomparison Program (SIP) involving 10 international 14C laboratories was carried out on two pieces of charcoal found inside two hearth structures of the Galerie des Mégacéros. Each laboratory used its own pretreatment and AMS facilities. In total, 21 and 22 measurements were performed, respectively, which yielded consistent results averaging ∼32 ka BP. Two strategies have currently been developed to identify statistical outliers and to deal with them; both lead to quasi-identical calibrated combined densities. Finally, the new results were compared with those of the FIP, leading to the important conclusion that five different samples from at least three different hearth structures give really tightened temporal densities, associated with one short human occupation in the Galerie des Mégacéros.
A cloud monitor has been developed for use with cosmic ray air shower fluorescence detectors, the High Resolution Fly's Eye and the Pierre Auger Observatory. This is based on an infrared thermopile device which, unlike previous such monitors, requires no moving chopper and is suitable for unattended operation over long periods of time.
Practical astronomy is usually taught using optical telescopes or, more rarely, radio telescopes. For a similar cost, complementary studies may be made of astrophysical particles through the use of a modestly sized muon detector. Such a detector records the arrival of cosmic ray particles that have traversed the heliosphere and the rate of muon detections reflects the flux of those particles. That flux is controlled by the day to day properties of the heliosphere which is in a state of constant change as the outflowing solar wind is affected by solar activity. As a consequence, a laboratory muon detector, whose count rate depends on the state of the heliosphere, can be an interesting and useful teaching tool that is complementary to optical or radio studies of the Sun.
In this chapter, we describe and explain some of the patterns observed in the behaviour of Earth’s climate system. We explain some of the causes of the climate’s natural variability, setting contemporary climate change in its longer-term context. We describe the various lines of evidence about climate forcing and the feedbacks that determine the responses to perturbations, and the way in which reconstructions of past climates can be used in combination with models and contemporary observations of change.
Human activity is creating a major perturbation to the Earth, directly affecting the composition of the atmosphere, and the nature of the land surface . These direct effects are expected in turn to cause impacts on numerous aspects of the Earth: regional climates , the distribution of ice and vegetation types, and perhaps the circulation of the oceans. Numerous interactions within the Earth system must be understood to enable prediction of the effects of the imposed changes. Models used for prediction are underpinned by a physical understanding of the climate. Aspects of these models are generally tuned to the Earth we experience today, but it is their representation of Earth’s response to change that really interests us.
By observing the Earth, both directly in the present and indirectly in the past, we learn about processes and feedbacks that models need to represent; and we can test whether the real Earth has responded to perturbations with the speed and magnitude that our models display. The ultimate goal is to use such observations to test models quantitatively, and to calibrate some of their less-constrained parameters. This goal cannot be fully realized unless we have knowledge of both the perturbation and the spatial pattern and magnitude of the response. This chapter concentrates on observations of how the Earth’s climate has responded to perturbations in the past.
Fluidic flight controls enable forces and moments for flight vehicle trim and manoeuvre to be produced without use of conventional moving surface controls. This paper introduces a methodology for the design of Circulation Control (CC) and Fluidic Thrust Vectoring (FTV) as fluidic controls for roll and pitch. Work was undertaken as part of the multidisciplinary FLAVIIR project, with the goal of providing full authority fluidic flight controls sufficient for a fully flapless flight of an 80kg class demonstrator aircraft known as DEMON. The design methodology considers drag, mass, volume and pneumatic power requirements as part of the overall design cost function. It is shown that the fundamental flow physics of both CC and FTV are similar, and hence there are strong similarities to the design approach of each. Flight ready CC and FTV hardware has been designed, manufactured and ground tested. The CC system was successfully wind tunnel demonstrated on an 85% scale half model of the DEMON. The design condition of a control ΔCL of 0·1 was achieved with a blowing coefficient of 0·01, giving a useable control gain of 10. The FTV system was static tested using a micro gas turbine source. The control characteristic was ‘N’ shaped, consisting of an initial high gain response in a negative sense (gain = −30) followed by a low gain response in a positive sense (gain = +3) at higher blowing rate. CC and FTV control hardware directly contributes to around 6% to the overall mass of the flight vehicle, however provision of pneumatic power carries a significant mass penalty unless generated as part of an integrated engine bleed system.