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Acts of worship typically involve expressions of fealty: One takes off one’s shoes, bows low, or falls on one’s face. Experiences that naturally prompt such expressions – the sense that one is in the presence of God in an unusual and profound way – raise interesting metaphysical questions about divine presence and absence. Talk of special divine presence poses serious puzzles. In the Jewish scriptures – and in the writings and words of those who treat these scriptures with reverence, whatever their religion – there is much talk of God’s presence and of God’s absence. And yet, God is also affirmed to be everywhere. How can God be everywhere, but also absent from some places, and especially present in others? Metaphysics is a likely place to look for a range of possible answers to this simple but puzzling question.
This chapter covers generalized anxiety disorder, panic disorder, specific phobia, social anxiety disorder, agoraphobia, separation anxiety disorder, and selective mutism. Based on a review using the new criteria for empirically supported treatments, there is strong research support for: (a) exposure therapies for specific phobias, (b) cognitive and behavioral therapies for generalized anxiety disorder, (c) cognitive-behavioral therapy for panic disorder, and (d) cognitive-behavioral therapy for social anxiety disorder. The two primary components of treatment include exposure and addressing cognitive biases. Each of these components is broken down into additional parts. A sidebar also discusses acceptance and commitment therapy.
The psychiatric interview is an important tool in the field of psychiatry, allowing the clinician to connect with the patient and to gather information that will help determine a treatment plan. The skills for this crucial assessment are not necessarily “learned on the job,” but rather should be taught with dedicated time and attention to ensure that interviewers become both confident and effective. Continuous self-reflection is essential for improvement, and is important for both inexperienced trainees and experienced mental health clinicians alike.
Based on a review using the new criteria for empirically supported treatments, this chapter emphasizes exposure with response prevention for obsessive-compulsive disorder, a treatment that has strong research support. Cognitive therapy is also discussed. Credible components of treatment include exposure, behavioral experiments, and cognitive reappraisal. A sidebar also reviews treatments for body dysmorphic disorder, hoarding disorder, trichotillomania, and excoriation.
Two studies were conducted in 2022 and 2023 near Rocky Mount and Clayton, NC, to determine the optimal granular ammonium sulfate (AMS) rate and application timing for pyroxasulfone-coated AMS. In the rate study, AMS rates included 161, 214, 267, 321, 374, 428, and 481 kg ha-1, equivalent to 34, 45, 56, 67, 79, 90, and 101 kg N ha-1, respectively. All rates were coated with pyroxasulfone at 118 g ai ha-1 and top-dressed onto 5- to 7-leaf cotton. In the timing study, pyroxasulfone (118 g ai ha-1) was coated on AMS and top-dressed at 321 kg ha-1 (67 kg N ha-1) onto 5- to 7-leaf, 9- to 11-leaf, and first bloom cotton. In both studies, weed control and cotton tolerance to pyroxasulfone-coated AMS was compared to pyroxasulfone applied postemergence (POST) and postemergence-directed (POST-directed). The check in both studies received non-herbicide-treated AMS (321 kg ha-1). Before treatment applications, all plots (including the check) were maintained weed-free with glyphosate and glufosinate. In both studies, pyroxasulfone applied POST was most injurious (8 to 16%), while pyroxasulfone-coated AMS resulted in ≤ 4% injury. Additionally, no differences in cotton lint yield were observed in both studies. With the exception of the lowest rate of AMS (161 kg ha-1; 79%), all AMS rates coated with pyroxasulfone controlled Palmer amaranth ≥ 83%, comparable to pyroxasulfone applied POST (92%) and POST-directed (89%). In the timing study, the application method did not affect Palmer amaranth control; however, applications made at the mid- and late timings outperformed early applications. These results indicate pyroxasulfone-coated AMS can control Palmer amaranth comparable to pyroxasulfone applied POST and POST-directed, with minimal risk of cotton injury. However, the application timing could warrant additional treatment to achieve adequate late-season weed control.
Pulmonary atresia with intact ventricular septum is a rare congenital cardiac lesion with significant anatomical heterogeneity. Surgical planning of borderline cases remains challenging and is primarily based on echocardiography. The aim was to identify echocardiographic parameters that correlate with surgical outcome and to develop a discriminatory calculator.
Methods:
Retrospective review of all pulmonary atresia with intact ventricular septum cases at a statewide tertiary paediatric cardiac centre was performed between 2004 and 2020. Demographic, clinical, and echocardiographic data were collected. Logistic regression was used to develop a discriminatory tool for prediction of biventricular repair.
Results:
Forty patients were included. Overall mortality was 27.5% (n = 11) and confined to patients managed as univentricular (11 vs 0, p = 0.027). Patients who underwent univentricular palliation were more likely to have an associated coronary artery abnormality (17 vs 3, p = 0.001). Fifteen surviving patients (51.7%) achieved biventricular circulation while 14 (48.3%) required one-and-a-half or univentricular palliation. Nineteen patients (47.5%) underwent percutaneous pulmonary valve perforation. No patients without tricuspid regurgitation achieved biventricular repair. The combination of tricuspid valve/mitral valve annulus dimension ratio and right ventricle/left ventricle length ratio identified biventricular management with a sensitivity of 93% and specificity of 96%. An online calculator has been made available.
Conclusion:
Pulmonary atresia with intact ventricular septum is a challenging condition with significant early and interstage morbidity and mortality risk. Patient outcomes were comparable to internationally reported data. Right ventricle/left ventricle length and tricuspid valve/mitral valve annulus dimension ratios identified a biventricular pathway with a high level of sensitivity and specificity. Absent tricuspid regurgitation was associated with a univentricular outcome.
Compared to single-gene BRAF testing to guide targeted treatment with BRAF/MEK inhibitors for advanced melanoma, multigene panels can identify additional gene mutations with known therapeutic or prognostic relevance. Implementation of multigene panels remains uneven across healthcare systems given an uncertain clinical and economic evidence base. We determined the population-level cost-effectiveness of multigene panels compared to single-gene BRAF testing for advanced melanoma.
Methods
Our population-based retrospective study emulated a hypothetical pragmatic trial comparing multigene panel sequencing to single-gene BRAF testing. We drew on comprehensive patient-level clinical and health administrative data between September 2016 and December 2018 in British Columbia, Canada. To emulate random treatment assignment, we 1:1 matched multigene panel patients to contemporaneous single-gene tested controls using genetic algorithm-based matching. We estimated three-year overall survival and healthcare costs (2021 CAD), and incremental net monetary benefit (INMB) for life years gained (LYG) using inverse probability of censoring weighted linear regression and nonparametric bootstrapping. We also estimated overall survival using Weibull regression and Kaplan–Meier survival analysis.
Results
We matched 147 patients with advanced melanoma receiving multigene panel sequencing to contemporaneous single-gene-tested controls, achieving good balance for all 15 baseline clinical and sociodemographic covariates. After matching, mean incremental costs were CAD19,447 (USD14,217) (95% confidence interval [CI]: −CAD18,517 [−USD13,537], CAD76,006 [USD55,565]; p=0.41) and mean incremental LYG were 0.22 (95% CI: −0.05, 0.49; p=0.12). We found uncertain differences on overall survival using Kaplan–Meier (stratified Log-rank test p=0.11) and Weibull regression (HR: 0.73 [95% CI: 0.51, 1.03]; p=0.07) survival analysis. Cost differences were driven by systemic therapy (∆C: CAD8,665 [USD6,334]; 95% CI: −CAD36,387 [−USD26,600], CAD53,716 [USD39,268]; p=0.71). The INMB at CAD100,000(USD73,104)/LYG was CAD2,646 (USD1,934) (95% CI: −CAD30,044 [−USD21,963], CAD43,416 [USD31,739]; p=0.89), with a 52.8 percent probability of being cost effective.
Conclusions
There were clinically relevant but uncertain differences in improved survival associated with multigene panel sequencing for advanced melanoma, and the cost-effectiveness of panel-based testing was finely balanced. This real-world evidence generated using randomized trial design principles can support jurisdictions’ deliberations on the reimbursement of precision oncology interventions.
Leveraging blockchain technology in the energy sector holds immense potential, particularly in facilitating decentralised energy systems. However, the legal and regulatory landscapes of several countries, including Malaysia and Australia, pose significant obstacles to its effective implementation. This article examines the specific legal and regulatory hurdles hindering the incorporation of P2P energy trading systems in these two jurisdictions: Malaysia and Australia. Through a comparative analysis, the authors aim to provide valuable insights for policymakers and regulators seeking to develop comprehensive frameworks that encourage blockchain adoption in the energy sector. The article highlights the need to address the under-inclusiveness of laws, legal uncertainty around novel blockchain-based concepts like smart contracts, and the obsolescence of legal frameworks designed for traditional centralised energy systems. By examining Malaysia’s and Australia’s unique challenges, the article seeks to contribute to a broader understanding of the complexities of adapting legal and regulatory frameworks to accommodate this transformative technology.
Consider the class of two parameter marginal logistic (Rasch) models, for a test of m True-False items, where the latent ability is assumed to be bounded. Using results of Karlin and Studen, we show that this class of nonparametric marginal logistic (NML) models is equivalent to the class of marginal logistic models where the latent ability assumes at most (m + 2)/2 values. This equivalence has two implications. First, estimation for the NML model is accomplished by estimating the parameters of a discrete marginal logistic model. Second, consistency for the maximum likelihood estimates of the NML model can be shown (when m is odd) using the results of Kiefer and Wolfowitz. An example is presented which demonstrates the estimation strategy and contrasts the NML model with a normal marginal logistic model.
A local independence latent structure model, which assumes m latent classes, requires a minimum of 2m-1 items for the solution of the 2m2 latent parameters. If one adds 3 items to the test and if one assumes local “dependence” between pairs of items, thereby adding\documentclass[12pt]{minimal}\usepackage{amsmath}\usepackage{wasysym}\usepackage{amsfonts}\usepackage{amssymb}\usepackage{amsbsy}\usepackage{mathrsfs}\usepackage{upgreek}\setlength{\oddsidemargin}{-69pt}\begin{document}$$\left( {\begin{array}{*{20}c} {2m + 2}\\ 2\\ \end{array} } \right)$$\end{document} additional latent parameters, ξij, representing the association between items i and j, then it is possible to obtain estimates for all of the latent parameters: latent class frequencies latent probabilities, and measures of association between pairs of items. The solution consists of (1) forming (m + 1) × (m + 1) matrices of manifest data, which are singular, (2) solving for the ξij in equations that result from the singularity of the data matrices, (3) “correcting” the manifest data by removing the “contamination” due to local dependence, and (4) estimating the remaining latent parameters from the corrected data, using methods outlined in earlier literature.
A stimulus (or stimulus-complex) is pictured as giving rise to a random series of sensory nerve “pulses,” which manifest themselves in contractions of individual muscle fibers. Assuming the expected time-frequency of these pulses to be proportional to the intensity of the stimulus, probability distributions are computed representing the cumulative effect of these pulses on the state of the organism, that is, on its degree of awareness of the stimulus. Preliminary results suggest a modification of the Weber-Fechner formula for intensity discrimination for certain types of stimuli: the psychological scale to be measured by I1/2 instead of log I.
Conjoint choice experiments are used widely in marketing to study consumer preferences amongst alternative products. We develop a class of choice models, belonging to the class of Poisson race models, that describe a ‘random utility’ which lends itself to a process-based description of choice. The models incorporate a dependence structure which captures the relationship between the attributes of the choice alternatives and which appropriately moderates the randomness inherent in the race. The new models are applied to conjoint choice data and are shown to have performance markedly superior to that of independent Poisson race models and of the multinomial logit model.
The regent honeyeater Anthochaera phrygia is a Critically Endangered Australian songbird, with current population estimates of < 300 individuals remaining in the wild. Low nest success is a factor preventing the recovery of the population, and management remedies are needed. However, a lack of data on intervention success raises uncertainty and impedes planning. To identify management priorities under uncertainty, we engaged with conservation practitioners and key stakeholders to develop and evaluate potential nest protection interventions. Four categories of threats were considered: avian predators, mammalian predators, extreme weather events and avian competitors. The interventions with the highest predicted probabilities of nest success under each threat category were, respectively: lethal control of avian predators, the use of tree collars to control arboreal mammalian predators, the provisioning of supplementary food and nesting resources during extreme weather events, and control of the noisy miner Manorina melanocephala, a competitor species. Our analysis shows that by applying a combination of conservation actions alongside improvements in nest detection, it is possible, based on the opinion of experts, to provide a pathway for the recovery of the regent honeyeater.
Alternative proteins provide a better way to feed the world(1) and have great potential to support the United Nations’ sustainable development goals in ending hunger, promoting sustainable energy use, protecting the climate, and promoting good health(2). However, consumers’ acceptance of alternative proteins is much lower than that of conventional meat(3). With the alternative protein market consistently growing since 2021(4), it is essential to summarise and update factors affecting consumer acceptance of alternative proteins to inform relevant organisations such as the government and support industry development. Using a systematic review, this study aimed to understand and compare consumers’ acceptance of five popular alternative proteins (algae, pulses, plant-based alternative proteins, insects, and cultured meat) and identify research trends and essential factors influencing consumption of alternative protein foods. Specifically, the study compared familiarity and external factors in consumer acceptance.
Building upon an existing systematic which included studies published by 2020, five electronic databases were searched. This review followed PRISMA guidelines, covering Western and Eastern countries, and articles published between June 2020 and March 2023. A total of 112 articles from 40 countries were included. Following the innovation-decision process framework, factors between alternative protein types, products, and psychological and external variables are compared, and changes over time are identified.
Italy (n = 15), China (n = 13) and the United Kingdom (n = 12) were the top 3 in publication numbers. Surveys (n = 95) were the most used method in the studies. Insects (n = 41) and cultured meat (n = 21) were the most popular. The findings reveal that consumers show moderate acceptance of alternative proteins, but a relatively higher acceptance of food products made with these proteins. Tastiness emerged as the top concern in alternative protein consumption, highlighting the importance of sensory appeal. Environmental benefits plus health beliefs also played a significant role in consumer acceptance. Interventions to illustrate food safety and quality variables correlated to a higher willingness to consume alternative proteins. Food neophobia and diet showed distinguished value in consumer acceptance level. Participants who had experienced eating insects showed significant differences in food neophobia scores, subjective norms, attitudes, and intentions. Meal composition and trust in the chef increased consumers’ willingness to consume. Many studies focused on developing alternative protein food products and determining their appropriateness for consumption in different contexts. Consuming alternative proteins with family or friends with positive emotions was more acceptable to consumers.
Consumers’ different acceptance levels and critical factors of alternative protein consumption illustrated the essentials of focusing more on consumer categorisation. The fast expansion of the global alternative protein market and accelerated study output call for building a more complete standardised management and information supply system.
Farm advisors provide knowledge and support to farmers, to help them change their on-farm practices or behaviours, with a view to improving the farm’s overall sustainability and competitiveness(1,2). In this way, advisors can be viewed as agents of change(3). In order to fulfil their role as agents of change, advisors must possess sufficient knowledge of human psychology and behavioural science, which is the discipline involved with understanding, predicting and changing behaviour(4,5). Despite this, within advisory education and professional development, it is considered that greater emphasis is given to advisory technical knowledge acquisition, than how to work effectively with others to support learning and change(6). Accordingly, this study aims to implement a behaviour change communication training programme for farm advisors and evaluate its efficacy. As much work within the health and social care field has been undertaken to support health related behaviour change, this study aims to adapt a behaviour change communication training programme originally developed for use within this field to the advisory setting(7,8).
A mixed-methods case study under the pragmatic worldview was conducted. Ethical approval was obtained from the Faculty of Medicine, Health and Life Sciences Research Ethics Committee at Queen’s University Belfast. The programme was adapted from the ‘MAP of Health Behaviour Change Learning Programme’ (MAP) created by NHS Education for Scotland(9). Eight farm advisors completed the programme delivered by health psychologists, which involved the completion of a 40-minute online module and a one-day in-person workshop about the principles of person-centred communication and behaviour change techniques. The Brinkerhoff training evaluation model guided the evaluation(10). Quantitative questionnaire data, including perceived knowledge and confidence, was descriptively analysed. Qualitative data including surveys, logs and focus group/interview data was thematically analysed.
Descriptive analysis found advisors scored highly in perceived knowledge (mean: 5.5) and confidence (mean: 5.5) post-training (measured on 6-point Likert scale). Thematic analysis determined three themes: valuable activities, takeaways, and programme evolution. Advisors valued open discussions and role-playing activities. A key takeaway was how to structure conversations about change; firstly, identifying a person’s stage of change, then delivering behaviour change techniques tailored to that stage. Further training on how to support individuals to explore and build motivation towards change was deemed beneficial.
MAP was shown to be an effective training programme with applications in agriculture. This study offers insights for those involved in advisory education. Incorporating behaviour change communication courses into advisory programmes helps advisors develop knowledge surrounding the psychology behind behaviour change and additional competencies in supporting behaviour change at the farm level.
The production and consumption of food has a significant impact on our environment, with 2030% of consumption impact on the environment relating directly to food and drink(1–3). One method of reducing this is to diversify protein intake e.g. reducing meat consumption in favour of more sustainable products. While the use of plant proteins is to be encouraged, on the island of Ireland this still has challenges(4). There is therefore a need to diversify protein intake on the island of Ireland through products which are both sustainable and local.
Using co-creation methods, this study aimed to understand what consumers want as sustainable and local plant-based products. Specifically, the study focused on oat, wheat, barley, rye, and pea. Co-creation puts consumers at the heart of product development, ensuring their ideas are understood from the beginning, thus leading to greater acceptance and potential for product success. Four workshops plus a follow-up workshop (n=38: 21 female, 17 male, age range 22-80 years old) were held across Belfast and Dublin to understand consumers’ wants for a sustainable and local alternative protein product. Workshops discussed factors influencing food purchasing, current sustainability issues, and strategies to shift to a sustainable diet. Key co-creation tasks included drawing a local and sustainable product based on any (or any combination) of the 5 specified ingredients. Discussions were transcribed and initial findings using content analysis are presented.
For products made by participants through co-creation, pea was a popular ingredient, with the top 3 highest rating products based on pea. Products containing oats and wheat were also popular. Product types varied and included main meals (plant-based burgers, pastas etc.), snacks (crackers, crisps etc.), and drinks (milks and meal replacements). While popular in the main workshops, consumers in the follow-up workshop who were tasked with reviewing the products created in the other workshops, largely rejected pea-based products due to taste. The highest rated products were a bolognese product made with pea and barley, porridge oats, and wheat and barley pasta.
These findings corroborate wider research findings that taste is vital in new product development. Basic products based on similar products already on the market ranked high, in line with findings that familiarity is a key driver of acceptance of alternative proteins. Future research should use these findings to gauge the popularity and acceptance of these products at a wider level.
The diets of children in the UK are suboptimal(1), which may influence their immediate and future health and well-being(2). Schools offer convenient and prolonged access to children from diverse backgrounds, thus interventions within this setting have been suggested as a means to promote diet and health outcomes among this population(3). This study explored the effects of Project Daire(4), a school-based food intervention, on children’s diet diversity and diet quality as well as their attitudes towards health behaviours.
A factorial design cluster randomized controlled trial was conducted. Fifteen primary schools in Northern Ireland were randomized into one of four 6-month intervention arms: Nourish, Engage, Nourish and Engage or Control (Delayed). The Nourish intervention modified the school food environment, provided food-related experiences and increased access to local foods. The Engage intervention included educational activities on nutrition, food and agriculture. Data on food consumption at home, school and/or in total over a 24-hour period were collected using ageappropriate food frequency questionnaires at baseline, with follow-up at 6-months. Diet diversity score (DDS) and diet quality score (DQS) were developed based on adherence to the Eatwell Guide. Additionally, a Health Attitudes and Behaviour measure assessed 10-11 year old children’s attitudes towards importance of various health behaviours at both time points. Linear and logistic regression models were used to examine intervention effects and to account for school clustering.
A total of 445 children aged 6-7 and 458 aged 10-11 years old completed the trial. Results indicated that children aged 10-11 year old who received the Nourish intervention demonstrated higher school DDS (adjusted mean difference=2.79, 95% CI 1.40 – 4.19; p = 0.001) and total DDS (adjusted mean difference=1.55, 95% CI 0.66 – 2.43, p = 0.002) compared to their counterparts who did not. Subgroup analyses revealed that the increases in school DDS among 10-11 year old children in the Nourish group were apparent in both boys and girls (Boys: adjusted mean difference=2.4 95% CI 0.1 – 4.7, p = 0.04; Girls: adjusted mean difference=3.1 95% CI 1.6 – 4.6, p = 0.001). However, the increase in total DDS remained statistically significant only among girls, with an adjusted mean difference of 1.9 (95% CI 1.1-2.7, p<0.001). No statistically significant changes in DQS were detected in either age group. High levels of positive attitudes towards health behaviours were observed at baseline, with no clinically significant effects of either the Nourish or Engage interventions detected during the follow-up period.
The multi-component approach of the Nourish intervention, addressing both food provision and environment, showed promise in promoting diet diversity. Further research is warranted to develop sustainable implementation strategies for Daire, to explore additional intervention components to impact other outcomes, including diet quality, and to evaluate long-term effectiveness.
Executive control over low-level information processing is impaired proximal to psychosis onset with evidence of recovery over the first year of illness. However, previous studies demonstrating diminished perceptual modulation via attention are complicated by simultaneously impaired perceptual responses. The present study examined the early auditory gamma-band response (EAGBR), a marker of early cortical processing that appears preserved in first-episode psychosis (FEP), and its modulation by attention in a longitudinal FEP sample.
Methods
Magnetoencephalography was recorded from 25 FEP and 32 healthy controls (HC) during active and passive listening conditions in an auditory oddball task at baseline and follow-up (4–12 months) sessions. EAGBR inter-trial phase coherence (ITPC) and evoked power were measured from responses to standard tones. Symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS).
Results
There was no group difference in EAGBR power or ITPC. While EAGBR ITPC increased with attention in HC, this modulation was impaired among FEP. Diminished EAGBR modulation in FEP persisted at longitudinal follow-up. However, among FEP, recovery of EAGBR modulation was associated with reduced PANSS negative scores.
Conclusion
FEP exhibit impaired executive control over the flow of information at the earliest stages of sensory processing within auditory cortex. In contrast to previous work, this deficit was observed despite an intact measure of sensory processing, mitigating potential confounds. Recovery of sensory gain modulation over time was associated with reductions in negative symptoms, highlighting a source of potential resiliency against some of the most debilitating and treatment refractory symptoms in early psychosis.
Mental health is deteriorating quickly and significantly globally post-COVID. Though there were already over 1 billion people living with mental disorders pre-pandemic, in the first year of COVID-19 alone, the prevalence of anxiety and depression soared by 25% worldwide. In light of the chronic shortages of mental health provider and resources, along with disruptions of available health services caused by the pandemic and COVID-related restrictions, technology is widely believed to hold the key to addressing rising mental health crises. However, hurdles such as fragmented and often suboptimal patient protection measures substantially undermine technology’s potential to address the global mental health crises effectively, reliably, and at scale. To shed light on these issues, this paper aims to discuss the post-pandemic challenges and opportunities the global community could leverage to improve society’s mental health en masse.