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Around a quarter of people suffering from psychotic conditions, like schizophrenia, continue to experience auditory hallucinations despite adequate drug treatment. In addition to medication, some help is also provided by psychological interventions, particularly cognitive behavioural therapy for psychosis (CBTp). AVATAR therapy is based on computer technology which enables each patient to create an avatar of the entity (human or non-human) that they believe is talking to them. The therapist promotes a dialogue between the patient and the avatar in which the avatar progressively comes under the patient's control. These sessions are audio recorded and provided to the patient on an MP3 player for continued use at home. In an initial pilot study, a maximum of 7 sessions lasting 30 minutes resulted in highly significant reductions in the patients’ hallucinations and the associated distress, enhancing the quality of their life (Leff et al., 2013). Our objective is to replicate the findings of this pilot study of the AVATAR therapy. We will carry out a randomised controlled evaluation of computer assisted voice therapy compared to supportive counselling to determine preliminary estimates of both effectiveness and cost-effectiveness. The study aims to recruit 142 people who have suffered from auditory hallucinations for at least 12 months despite taking medication regularly. Participants will complete a number of selfcompleted and interview based measures (on four assessment points: pre-treatment, post treatment, and then at 12 and 24 weeks follow-up) to assess the impact of interventions on outcomes and to explore potential mediators and modifiers of therapy.
UK Biobank is a well-characterised cohort of over 500 000 participants including genetics, environmental data and imaging. An online mental health questionnaire was designed for UK Biobank participants to expand its potential.
Describe the development, implementation and results of this questionnaire.
An expert working group designed the questionnaire, using established measures where possible, and consulting a patient group. Operational criteria were agreed for defining likely disorder and risk states, including lifetime depression, mania/hypomania, generalised anxiety disorder, unusual experiences and self-harm, and current post-traumatic stress and hazardous/harmful alcohol use.
A total of 157 366 completed online questionnaires were available by August 2017. Participants were aged 45–82 (53% were ≥65 years) and 57% women. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status. Lifetime depression was a common finding, with 24% (37 434) of participants meeting criteria and current hazardous/harmful alcohol use criteria were met by 21% (32 602), whereas other criteria were met by less than 8% of the participants. There was extensive comorbidity among the syndromes. Mental disorders were associated with a high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.
The UK Biobank questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed because of selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.
The Very High Frequency (VHF) Data Exchange System (VDES) is a new radio communication system being developed by the international maritime community, with the principal objectives to safeguard existing Automatic Identification System (AIS) core functions and enhance maritime communication applications, based on robust, efficient and secure data transmission with wider bandwidth than the AIS. VDES is also being considered as a potential component of the R-mode concept, where the same signals used for communication are also used for ranging, thus mitigating the impact of disruptions to satellite positioning services. This paper establishes statistical performance bounds on the ranging precision of VDES R-mode, assuming an additive white Gaussian noise propagation channel. Modified Cramér-Rao bounds on the pseudorange estimation error are provided for all waveforms currently proposed for use in terrestrial VDES communications. These are then used to estimate the maximum usable ranges for AIS/VDES R-mode stations. The results show that, under the assumed channel conditions, all of the new VDES waveforms provide better ranging performance than the AIS waveform, with the best performance being achieved using the 100 kHz bandwidth terrestrial VDE waveforms.
Two cost-benefit analysis methods developed from differing economic situations and analytical objectives in the 1960s and 1970s. The Trade Policy Approach of Ian Little and James Mirrlees analyzed international competitiveness of projects producing private goods and physical infrastructure in markets severely distorted by trade protectionism; it was adopted in 1975 by the World Bank; the multilateral regional development banks followed suit. The Public Finance Approach of Arnold Harberger developed from comparative statics analyses of public projects and policies in the United States and was adopted at the US Agency for International Development and in several Latin American countries. The original Trade Policy Approach included social analysis too tedious for everyday application, leading an efficiency-only version to emerge and be popularized by teaching materials from Price Gittinger and colleagues in the World Bank’s Economic Development Institute. It proved the right method for World Bank use until Washington Consensus reforms, the GATT and WTO reduced price distortions, and slowly restored private international financial flows gave private industry access to international private investment capital. Official Development Assistance (ODA) portfolios responded by refocusing on public goods and market failures, leading to decreased utility of the Trade Policy Approach and decreased use of cost-benefit analysis at the World Bank. A 1990s drive in the World Bank to switch from the Trade Policy Approach to the increasingly relevant Public Finance Approach resulted in an internal manual and operational guidelines, but not a book from a distinguished university press, commonly presumed to signal official Bank policy. It is time for that long-overdue book to be published.
UK Biobank is a well-characterised cohort of over 500 000 participants that offers unique opportunities to investigate multiple diseases and risk factors.
An online mental health questionnaire completed by UK Biobank participants was expected to expand the potential for research into mental disorders.
An expert working group designed the questionnaire, using established measures where possible, and consulting with a patient group regarding acceptability. Case definitions were defined using operational criteria for lifetime depression, mania, anxiety disorder, psychotic-like experiences and self-harm, as well as current post-traumatic stress and alcohol use disorders.
157 366 completed online questionnaires were available by August 2017. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status than the general population across a range of indicators. Thirty-five per cent (55 750) of participants had at least one defined syndrome, of which lifetime depression was the most common at 24% (37 434). There was extensive comorbidity among the syndromes. Mental disorders were associated with high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.
The questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed owing to selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.
Declaration of interest
G.B. received grants from the National Institute for Health Research during the study; and support from Illumina Ltd. and the European Commission outside the submitted work. B.C. received grants from the Scottish Executive Chief Scientist Office and from The Dr Mortimer and Theresa Sackler Foundation during the study. C.S. received grants from the Medical Research Council and Wellcome Trust during the study, and is the Chief Scientist for UK Biobank. M.H. received grants from the Innovative Medicines Initiative via the RADAR-CNS programme and personal fees as an expert witness outside the submitted work.
The criminal justice system of eighteenth- and nineteenth-century England has been likened to a corridor of connected rooms or stage sets. At each stage in the judicial process—from detection and apprehension through to trial, sentencing, and punishment—decisions were made that might remove the accused from the system entirely, or propel that person further along the process into a number of possible outcomes. That decision making (including the identity of the decision makers and the criteria upon which their decisions were based) has been the subject of much historical study. Less attention has been given to the individual experiences—the singular journeys—of the accused through this labyrinthine process. This is in large part because of the inherent evidential and methodological difficulties of reconstructing judicial pathways and the wider criminal lives of offenders. As Tim Hitchcock and Robert Shoemaker note, the archives of criminal justice were created to manage the bureaucracy of prosecution and punishment, not to reveal the criminal's navigation of that system. Tracing an individual offender's journey through the judicial process (and that person's life beyond) therefore entails piecing together fragments spread almost randomly across hundreds of thousands of pages.
The utility of biological control for weed management in agroecosystems will
increase with a greater understanding of the relationships between common
weed and granivore species. Giant foxtail is an introduced, summer annual
grass weed that is common throughout the United States and problematic in
numerous crops. Harpalus pensylvanicus (DeGeer)
(Coleoptera: Carabidae) is a common, native, omnivorous carabid beetle with
a range that overlaps giant foxtail. In 2004 and 2005, H.
pensylvanicus was captured from farm fields in Centre County,
PA, and subjected to laboratory feeding trials to test the preference of
giant foxtail and other species on predation by H.
pensylvanicus. Weed species seed preference experiments that
included “Choice” and “No Choice” treatments were conducted using giant
foxtail, common lambsquarters, and velvetleaf. When given a choice amongst
the three weed species, H. pensylvanicus preferred giant
foxtail and common lambsquarters seeds equally compared to velvetleaf seeds.
When given the choice, H. pensylvanicus preferred newly
dispersed giant foxtail seeds over field-aged seeds. Phenology of giant
foxtail seed shed relative to H. pensylvanicus activity
density was also quantified in field experiments in 2005 and 2006. Giant
foxtail seed rain was determined by collecting shed seeds from August
through October using pan traps. Activity density of H.
pensylvanicus was monitored for 72-h periods using pitfall traps
from June to October. Peak activity density of H.
pensylvanicus occurred at the onset of giant foxtail seed shed
in both years; however, giant foxtail seed shed peaked approximately 30 to
50 d after H. pensylvanicus activity density. Future
research should focus on management practices that enhance and support
H. pensylvanicus populations later in the growing season
to maximize suppression of giant foxtail and other weeds that shed palatable
seeds later in the season.
Escherichia coli O157 is a human pathogen carried asymptomatically by cattle and shed in their faeces. Infection can occur from the consumption of contaminated beef or by direct contact. Large variations of E. coli O157 shedding in cattle exist and vary in the number of cattle positive for E. coli O157 and the amount of bacteria (c.f.u./g faeces) shed by positive animals. To investigate E. coli O157 shedding and super-shedding (>104 c.f.u./g) we used daily sampling over two 8-day periods; in January 2013 (n = 12) and February 2013 (n = 21). Samples were tested by direct faecal culture for enumeration and by immunomagnetic separation to detect lower levels of shedding. We identified three patterns of shedding, similar to previously observed descriptions: intermittent, transient and consistent. The most commonly observed pattern was intermittent shedding and variation in the level of shedding could be large. This extreme variation is demonstrated by a heifer from which E. coli O157 could be not detected one day, was super-shedding E. coli O157 the next and was detected as shedding >100 c.f.u./g the following day. Recto-anal mucosal swab testing did not predict super-shedding in this cohort of heifers. The variable individual patterns of shedding suggest that a common mechanism of infection may not operate within such a herd when considering previously described patterns and the inferred mechanisms. The sporadic and intermittent nature of shedding is a challenge to identifying risk factors and potential intervention strategies.
We undertook a longitudinal study within a cohort of 52 dairy heifers maintained under constant management systems and sampled weekly to investigate a comprehensive range of risk factors which may influence shedding or super-shedding of E. coli O157 (detected by direct faecal culture and immunomagnetic separation). E. coli O157 was detected from 416/933 (44·6%) samples (faeces and recto-anal mucosal swabs) and 32 (3·4%) samples enumerated at >10000 c.f.u./g. Weekly point prevalence ranged from 9·4% to 94·3%. Higher temperature (P < 0·001), rainfall (P = 0·02), relative humidity (P < 0·001), pasture growth (P = 0·013) and body score (P = 0·029) were positively associated with increased shedding. Higher rainfall (P < 0·001), hide contamination (P = 0·002) and increased faecal consistency (P = 0·023) were positively associated with super-shedding. Increased solar exposure had a negative effect on both shedding and super-shedding within bivariate analyses but in the final multivariate model for shedding demonstrated a positive effect (P = 0·017). Results suggest that environmental factors are important in E. coli O157 shedding in cattle.
Two factors that can degrade native plant community composition and structure, and hinder restoration efforts, are invasive species and chronic overbrowsing by ungulates such as white-tailed deer. Beginning in 2007, the effectiveness, costs, and impacts of Japanese barberry control treatments and herbivory on nonnative and native plant communities was examined at eight study areas over 4 to 5 yr. Prescribed burning and mechanical mowing by wood shredder or brush saw were utilized as initial treatments to reduce the aboveground portion of established barberry and were equally effective. Without a follow-up treatment, barberry had recovered to 56 to 81% of pretreatment levels 50 to 62 mo after initial treatment. Follow-up treatments in mid-summer to kill new sprouts included directed heating and foliar herbicide applications. Relative to untreated controls, follow-up treatments lowered barberry cover 50 to 62 mo after initial treatment by at least 72%. Although all follow-up treatments were equally effective, the labor cost of directed heating was four times higher than for herbicide applications. Follow-up treatment type (directed heating vs. herbicide) had minimal impact on species other than barberry. White-tailed deer herbivory had a larger impact on other species than did barberry control treatments. Native grass and fern cover was higher outside of exclosures. Areas inside exclosures had higher cover of Oriental bittersweet and multiflora rose, but not Japanese barberry. Thus, recovery of native communities will require more than simply removing the dominant invasive species where deer densities are high. Excellent reduction of Japanese barberry cover can be achieved using either directed heating or herbicides as follow-up treatments in a two-step process, but other invasive plants may become a problem when barberry is removed if deer populations are low.
The woylie Bettongia penicillata is categorized as Critically Endangered, having declined by c. 90% between 1999 and 2006. The decline continues and the cause is not fully understood. Within a decline diagnosis framework we characterized the nature of the decline and identified potential causes, with a focus on the species’ largest populations, located in south-west Western Australia. We described the spatio-temporal pattern of the decline, and several attributes that are common across sites. We categorized the potential causes of the decline as resources, predators, disease and direct human interference. Based on the available evidence the leading hypothesis is that disease may be making woylies more vulnerable to predation but this remains to be tested. No substantial recoveries have been sustained to date, and one of the three remaining indigenous populations now appears to be extinct. Therefore, verifying the factors causing the decline and those limiting recovery is becoming increasingly urgent. Active adaptive management can be used to test putative agents, such as introduced predators. Insurance populations and ecological monitoring should also be included in an integrated conservation and management strategy for the species.