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Glaciers in the Russian High Arctic have undergone accelerated mass loss due to atmospheric and oceanic warming in the Barents–Kara Sea region. Most studies have concentrated on the western Barents–Kara sector, despite evidence of accelerating mass loss as far east as Severnaya Zemlya. However, long-term trends in glacier change on Severnaya Zemlya are largely unknown and this record may be complicated by surge-type glaciers. Here, we present a long-term assessment of glacier change (1965–2021) on Severnaya Zemlya and a new inventory of surge-type glaciers using declassified spy-satellite photography (KH-7/9 Hexagon) and optical satellite imagery (ASTER, Sentinel-2A, Landsat-4/5 TM and 8 OLI). Glacier area reduced from 17 053 km2 in 1965 to 16 275 in 2021 (−5%; mean: −18%, max: −100%), with areal shrinkage most pronounced at land-terminating glaciers on southern Severnaya Zemlya, where there is a recent (post-2010s) increase in summer atmospheric temperatures. We find that surging may be more widespread than previously thought, with three glaciers classified confirmed as surge-type, eight as likely to have surged and nine as possible, comprising 11% of Severnaya Zemlya's 190 glaciers (37% by area). Under continued warming, we anticipate accelerated retreat and increased likelihood of surging as basal thermal regimes shift.
The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in improving surrogates’ mental health and patient outcomes.
Part 1 involved obtaining qualitative stakeholder feedback from 5 bereaved surrogates and 10 critical care and mental health clinicians. Stakeholders were provided with the manual and prompted for feedback on its content, format, and language. Feedback was organized and incorporated into the manual, which was then re-circulated until consensus. In Part 2, surrogates of critically ill patients admitted to an intensive care unit (ICU) reporting moderate anxiety or close attachment were enrolled in an open trial of EMPOWER. Surrogates completed six, 15–20 min modules, totaling 1.5–2 h. Surrogates were administered measures of peritraumatic distress, experiential avoidance, prolonged grief, distress tolerance, anxiety, and depression at pre-intervention, post-intervention, and at 1-month and 3-month follow-up assessments.
Part 1 resulted in changes to the EMPOWER manual, including reducing jargon, improving navigability, making EMPOWER applicable for a range of illness scenarios, rearranging the modules, and adding further instructions and psychoeducation. Part 2 findings suggested that EMPOWER is feasible, with 100% of participants completing all modules. The acceptability of EMPOWER appeared strong, with high ratings of effectiveness and helpfulness (M = 8/10). Results showed immediate post-intervention improvements in anxiety (d = −0.41), peritraumatic distress (d = −0.24), and experiential avoidance (d = −0.23). At the 3-month follow-up assessments, surrogates exhibited improvements in prolonged grief symptoms (d = −0.94), depression (d = −0.23), anxiety (d = −0.29), and experiential avoidance (d = −0.30).
Significance of results
Preliminary data suggest that EMPOWER is feasible, acceptable, and associated with notable improvements in psychological symptoms among surrogates. Future research should examine EMPOWER with a larger sample in a randomized controlled trial.
UK clinical guidelines recommend treatment of attention-deficit hyperactivity disorder (ADHD) in adults by suitably qualified clinical teams. However, young people with ADHD attempting the transition from children's to adults’ services experience considerable difficulties in accessing care.
To map the mental health services in the UK for adults who have ADHD and compare the reports of key stakeholders (people with ADHD and their carers, health workers, service commissioners).
A survey about the existence and extent of service provision for adults with ADHD was distributed online and via national organisations (e.g. Royal College of Psychiatrists, the ADHD Foundation). Freedom of information requests were sent to commissioners. Descriptive analysis was used to compare reports from the different stakeholders.
A total of 294 unique services were identified by 2686 respondents. Of these, 44 (15%) were dedicated adult ADHD services and 99 (34%) were generic adult mental health services. Only 12 dedicated services (27%) provided the full range of treatments recommended by the National Institute for Health and Care Excellence. Only half of the dedicated services (55%) and a minority of other services (7%) were reported by all stakeholder groups (P < 0.001, Fisher's exact test).
There is geographical variation in the provision of NHS services for adults with ADHD across the UK, as well as limited availability of treatments in the available services. Differences between stakeholder reports raise questions about equitable access. With increasing numbers of young people with ADHD graduating from children's services, developing evidence-based accessible models of care for adults with ADHD remains an urgent policy and commissioning priority.
The growing prevalence of non-communicable diseases, combined with greater recognition of the effectiveness of lipid lowering agents (LLAs), has fuelled their increasing use in recent years. Similarly, increasing recognition of mental health and, arguably, societal expectations and pressures, has driven appreciable growth in antidepressant prescribing in recent years. Concurrent with this, growing resource pressures enhanced by the continual launch of new premium priced medicines necessitates reforms and initiatives within finite budgets. Scotland has introduced multiple measures in recent years to improve both the quality and efficiency of prescribing. There is a need to document these initiatives and outcomes to provide future direction.
Assessment of the utilization (items dispensed) and expenditure of key LLAs (mainly statins) and SSRIs between 2001 and 2017 in Scotland alongside initiatives.
Multiple interventions have increased international non-proprietary name (INN) prescribing (99% for statins and up to 99.9% for SSRIs). They have also increased preferential prescribing of generic versus patented statins with low costs for generics, reduced inappropriate prescribing of ezetimibe due to effectiveness concerns, and increased the prescribing of higher dose statins (71% in 2015). These measures have resulted in a 50% reduction in LLA expenditure between 2001 and 2015 despite a 412% increase in utilization. Initiatives to reduce the prescribing of escitalopram as lack of evidence demonstrating cost-benefits over generic citalopram, along with high INN prescribing, achieved a 73.7% reduction in SSRI expenditure between 2001 and 2017 despite a 2.34-fold increase in utilisation. Concerns with paroxetine, and more recently citalopram and escitalopram following safety warnings, resulted in a considerable reduction in their use alongside a significant increase in sertraline.
Generic availability coupled with multiple measures has resulted in appreciable shifts in statin and SSRI prescribing behavior and reduced ezetimibe prescribing, resulting in improvements in both the quality and efficiency of prescribing to provide future direction.
As mental healthcare expands to smartphone apps and other technologies that may offer therapeutic interventions without a therapist involved, it is important to assess the impact of non-traditional therapeutic relationships.
To determine if there were any meaningful data regarding the digital therapeutic alliance in smartphone interventions for serious mental illnesses.
A literature search was conducted in four databases (PubMed, PsycINFO, Embase and Web of Science).
There were five studies that discuss the therapeutic alliance when a mobile application intervention is involved in therapy. However, in none of the studies was the digital therapeutic alliance the primary outcome. The studies looked at different mental health conditions, had different duration of technology use and used different methods for assessing the therapeutic alliance.
Assessing and optimising the digital therapeutic alliance holds the potential to make tools such as smartphone apps more effective and improve adherence to their use. However, the heterogeneous nature of the five studies we identified make it challenging to draw conclusions at this time. A measure is required to evaluate the digital therapeutic alliance.
The landmark US Multimodal Treatment of ADHD (MTA) study established the
benefits of individualised medication titration and optimisation
strategies to improve short- to medium-term outcomes in attention-deficit
hyperactivity disorder (ADHD). This individualised medication management
approach was subsequently incorporated into the National Institute for
Health and Care Excellence (NICE) ADHD Clinical Guidelines (NICE CG78).
However, little is known about clinicians' attitudes towards implementing
these medication management strategies for ADHD in routine care.
To examine National Health Service (NHS) healthcare professionals'
consensus on ADHD medication management strategies.
Using the Delphi method, we examined perceptions on the importance and
feasibility of implementing 103 ADHD treatment statements from sources
including the UK NICE ADHD guidelines and US medication management
Certain recommendations for ADHD medication management were judged as
important and feasible to implement, including a stepwise titration of
stimulant medication. Other recommendations were perceived as important
but not feasible to implement in routine practice, such as weekly clinic
follow-up with the family during titration and collection of follow-up
Many of the key guideline recommendations for ADHD medication management
are viewed by clinicians as important and feasible to implement. However,
some recommendations present significant implementation challenges within
the context of routine NHS clinical care in England.
Shifting prey distributions due to global warming are expected to generate dramatic ecosystem-wide changes in trophic structure within Arctic marine ecosystems. Yet a relatively poor understanding of contemporary Arctic food webs makes it difficult to predict the consequences of such changes for Arctic predators. Doing so requires quantitative approaches that can track contemporary changes in predator diets through time, using accurate, well-defined methods. Here we use fatty acids (FA) to quantify differences in consumer diet using permutational multivariate analysis of variance tests that characterize spatial and temporal changes in consumer FA signatures. Specifically we explore differences in Greenland shark (Somniosus microcephalus) FA to differentiate their potential trophic role between Svalbard, Norway and Cumberland Sound, Canada. Greenland shark FA signatures revealed significant inter-annual differences, probably driven by varying seal and Greenland halibut responses to environmental conditions such as the NAO, bottom temperature, and annual sea-ice extent. Uncommon FA were also found to play an important role in driving spatial and temporal differences in Greenland shark FA profiles. Our statistical approach should facilitate quantification of changing consumer diets across a range of marine ecosystems.
This article summarises new research, together with core features, course
and outcome of schizophrenia with onset in childhood and adolescence, and
investigates its neurobiology and continuity into adult life. It concludes
that, in conformity with other disorders of childhood, adult-based
diagnostic criteria have validity in adolescence. Sadly, the disorder has a
poorer outcome when onset is in youth.
Digital technology has the potential to transform mental healthcare by
connecting patients, services and health data in new ways. Digital online
and mobile applications can offer patients greater access to information and
services and enhance clinical management and early intervention through
access to real-time patient data. However, substantial gaps exist in the
evidence base underlying these technologies. Greater patient and clinician
involvement is needed to evaluate digital technologies and ensure they
target unmet needs, maintain public trust and improve clinical outcomes.
Schizophrenia is one of the most devastating psychiatric disorders to affect children and adolescents. Although extremely rare before the age of 10, the incidence of schizophrenia rises steadily through adolescence to reach its peak in early adult life. The clinical severity, impact on development and poor prognosis of child- and adolescent-onset schizophrenia reinforce the need for early detection, prompt diagnosis and effective treatment.
The current concept of schizophrenia in children and adolescents evolved from a different perspective held during much of the 20th century. Until the early 1970s, the term childhood schizophrenia was applied to children who would now be diagnosed with autism. Kolvin's landmark studies distinguished children with early-onset (autistic) symptoms beginning in the first 2 years of life from children with a relatively ‘late-onset’ psychosis with onset of symptoms after age 6 or 7, which closely resembled adult schizophrenia (Hollis, 2008). Importantly, in ICD-9 (1978) and DSM-III (1980) the separate category of childhood schizophrenia was removed, and the same diagnostic criteria for schizophrenia were applied across the age range. The validity of the diagnosis of schizophrenia in childhood and adolescence is supported by follow-up studies into adulthood that show a high level of diagnostic stability (Hollis, 2000).
This chapter focuses on children and young people who meet ICD- 10 (World Health Organization, 1992) or DSM-5 (American Psychiatric Association, 2013) diagnostic criteria for schizophrenia. I use the term ‘adolescent schizophrenia’ as short-hand to refer to child and adolescent cases with onset up to 17 years of age. I examine evidence for continuities and discontinuities between adolescent schizophrenia and adultonset schizophrenia in terms of aetiology, premorbid features, clinical presentation, course and outcome, and treatment response. My goal is to summarise what is currently known about adolescent schizophrenia and to indicate the extent and limitations of the evidence base for clinical diagnosis, management and treatment.
Incidence and prevalence
Gillberg et al (1986) calculated age-specific prevalences for all psychoses (including schizophrenia, schizophreniform disorder, affective psychosis, atypical psychosis and drug psychoses) using Swedish case-register data on 13- to 18-year-olds with psychotic illnesses. In 41% of cases the diagnosis was schizophrenia. At 13 years of age, the prevalence for all psychoses in the general population was 0.9 per 10 000, showing a steady increase during adolescence, reaching a prevalence of 17.6 per 10 000 at age 18 years.
In the mid-1820s, Charles Darwin was in medical school at the University of Edinburgh. There he met the evolutionist Robert Grant. Grant was interested in zoophytes, organisms that were considered plantlike animals. He and others hoped these organisms might help bridge the gap between the two kingdoms. Darwin accompanied Grant on collecting trips to the Firth of Forth, and it was through this work that he had his first brush with scientific scholarship. Darwin delivered a short report to the Plinian Society, a natural history club, on his observations of the “ova” of Flustra, a seaweed-like aquatic invertebrate.
A few years later, while aboard the Beagle, Darwin’s interest in zoophytes continued. In his account of the voyage, he offered the following reflective description of one of these species, Virgularia patagonica:
Each polypus, though closely united to its brethren, has a distinct mouth, body, and tentacula. Of these polypi, in a large specimen, there must be many thousands; yet we see that they act by one movement; that they have one central axis connected with a system of obscure circulation; and that the ova are produced in an organ distinct from the separate individuals. Well may one be allowed to ask, what is an individual?
Childhood psychiatric disorders may have deleterious consequences through childhood and into adulthood.
To estimate costs and preference-based health-related quality of life outcomes (health utilities) associated with a broad range of childhood psychiatric disorders during the eleventh year of life.
Participants in a whole-population study of extremely preterm children and term-born controls (EPICure) undertook psychiatric assessment using the Development and Well Being Assessment (DAWBA) and the Kaufman–Assessment Battery for Children. Questionnaires completed by parents and teachers described the children's utilisation of health, social and education services during the eleventh year of life. Parents also described their child's health status using the Health Utilities Index Mark 2 and Mark 3 health status classification systems. Descriptive and multiple regression techniques were used to explore the association between psychiatric disorders and economic outcomes.
The study presents detailed costs and health utilities associated with psychiatric disorders for the preterm population, term-born population and pooled study population, following appropriate controls.
The results of this study should be used to inform future economic evaluations of interventions aimed at preventing childhood psychiatric disorders or alleviating their effects. Further research is required that identifies, measures and values the longer-term economic impacts of these disorders in a valid and reliable manner.
All child and adolescent psychiatrists and community paediatricians in the former Trent Region were surveyed about their antipsychotic prescribing practice during 1 year, including monitoring, and whether they would like consensus guidelines on prescribing and monitoring of antipsychotics in children and adolescents.
The majority (88%) of child psychiatrists and 33% of paediatricians had prescribed atypical antipsychotics, most commonly risperidone. Only two psychiatrists had prescribed a typical antipsychotic and no paediatrician had done so. Challenging behaviour in developmental disorders was the most common indication for atypicals. Both child psychiatrists and paediatricians prescribed atypicals for non-psychotic developmental disorders, whereas prescribing for psychosis occurred almost exclusively among psychiatrists. Height, weight and blood pressure were routinely monitored, but waist circumference was rarely measured and there was wide variation in the monitoring of other parameters such as blood glucose, prolactin and extrapyramidal side-effects. Three-quarters of the participants felt there was a need for guidance on prescribing and monitoring atypical antipsychotic therapy.
The greater prescription of antipsychotics by child and adolescent psychiatrists may reflect differences in case-load and training. Routine monitoring of adverse effects is inconsistent among prescribers. The survey highlights the need for training and guidance on prescribing and monitoring of atypical antipsychotic use in children and adolescents.
Adverse effects of maternal substance use during pregnancy on fetal development may increase risk of psychopathology.
To examine whether maternal use of tobacco, cannabis or alcohol during pregnancy increases risk of offspring psychotic symptoms.
A longitudinal study of 6356 adolescents, age 12, who completed a semi-structured interview for psychotic symptoms in the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort.
Frequency of maternal tobacco use during pregnancy was associated with increased risk of suspected or definite psychotic symptoms (adjusted odds ratio 1.20, 95% CI 1.05–1.37, P = 0.007). Maternal alcohol use showed a non-linear association with psychotic symptoms, with this effect almost exclusively in the offspring of women drinking >21 units weekly. Maternal cannabis use was not associated with psychotic symptoms. Results for paternal smoking during pregnancy and maternal smoking post-pregnancy lend some support for a causal effect of tobacco exposure in utero on development of psychotic experiences.
These findings indicate that risk factors for development of non-clinical psychotic experiences may operate during early development. Future studies of how in utero exposure to tobacco affects cerebral development and function may lead to increased understanding of the pathogenesis of psychotic phenomena.
From 1994–2007 Ceredigion County Council and a network of shore-based, volunteer observers monitored levels of boat traffic and the occurrence of bottlenose dolphins Tursiops truncatus at seven sites on the coast of Cardigan Bay, Wales. We report high rates of site use and site occupancy by this species during the summer: at Mwnt for example, dolphins were recorded in >80% of 2 hours' observation periods; and at New Quay Harbour dolphins were present in >30% of all 15-minute intervals. At Mwnt and Aberporth there was a significant annual trend for increasing sighting rates; at Ynys Lochtyn a positive trend was only marginally non-significant; at New Quay Bird's Rock the trend was ambiguous but appeared stable over the seven most recent years. Although trends in site use may not reflect population trends in the wider region, these data were consistent with recent abundance estimates that indicate that the number of bottlenose dolphins using Cardigan Bay is stable or slightly increasing. Average group size at our study sites was small (<3 animals), which contrasts with observations of larger schools of the same population elsewhere in their range. The predominant behaviour in coastal Cardigan Bay is demersal foraging, often by solitary animals in shallow near-shore habitats. There was evidence that boat traffic suppressed site use by dolphins at New Quay Harbour, the busiest monitoring site: sighting rates fell when high numbers of boats were present and sighting rates were higher in 2007 than in previous years, when boat use was reduced due to poor weather during the main tourist season. This study demonstrates that networks of volunteer observers can provide a cost-effective, non-invasive means of gathering data on marine mammals for the purposes of coastal zone management.
Symptoms of attention-deficit hyperactivity disorder (ADHD) are known to
persist into adulthood in the majority of cases.
To determine the prevalence of methylphenidate, dexamfetamine and
atomoxetine prescribing and treatment discontinuation in adolescents and
A descriptive cohort study using the UK General Practice Research
Database included patients aged 15–21 years from 1999 to 2006 with a
prescription for a study drug.
Prevalence of prescribing averaged across all ages increased 6.23-fold
over the study period. Overall, prevalence decreased with age: in 2006,
prevalence in males dropped 95% from 12.77 per 1000 in 15-year-olds to
0.64 per 1000 in 21-year-olds. A longitudinal analysis of a cohort of 44
patients aged 15 years in 1999 demonstrated that no patient received
treatment after the age of 21 years.
The prevalence of prescribing by general practitioners to patients with
ADHD drops significantly from age 15 to age 21 years. The fall in
prescribing is greater than the reported age-related decrease in
symptoms, raising the possibility that treatment is prematurely
discontinued in some young adults in whom symptoms persist.
Non-clinical psychotic symptoms appear common in children, but it is possible that a proportion of reported symptoms result from misinterpretation. There is a well-established association between pre-morbid low IQ score and schizophrenia. Psychosis-like symptoms in children may also be a risk factor for psychotic disorder but their relationship with IQ is unclear.
To investigate the prevalence, nature and frequency of psychosis-like symptoms in 12-year-old children and study their relationship with IQ.
Longitudinal study using the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort. A total of 6455 children completed screening questions for 12 psychotic symptoms followed by a semi-structured clinical assessment. IQ was assessed at 8 years of age using the Wechsler Intelligence Scale for Children (3rd UK edition).
The 6-month period prevalence for one or more symptoms was 13.7% (95% CI 12.8–14.5). After adjustment for confounding variables, there was a non-linear association between IQ score and psychosis-like symptoms, such that only those with below average IQ score had an increased risk of reporting such symptoms.
Non-clinical psychotic symptoms occur in a significant proportion of 12-year-olds. Symptoms are associated with low IQ and also less strongly with a high IQ score. The pattern of association with IQ differs from that observed in schizophrenia.
steels & belpaeme (s&b) describe the role of genetic evolution in linguistic category sharing among a population of agents. we consider their methodology and conclude that, although it is plausible that genetic evolution is sufficient for such tasks, there is a bias in the presented work for such a conclusion to be reached. we suggest ways to eliminate this bias and make the model more convincingly relevant to the cognitive sciences.
An increased rate of premorbid impairment has been reported in both child- and adolescent-onset schizophrenic and affective psychoses.
To examine the evidence for a specific association between premorbid impairment and child- and adolescent-onset schizophrenia, and whether specific continuities exist between premorbid impairments and psychotic symptom dimensions.
Retrospective case note study of 110 first-episode child- and adolescent-onset psychoses (age 10–17 years). DSM–III–R diagnoses derived from the OPCRIT algorithm showed 61 with schizophrenia (mean age 14.1 years) and 49 with other non-schizophrenic psychoses (mean age 14.7 years).
Premorbid social impairment was more common in early-onset schizophrenia than in other early-onset psychoses (OR 1.9, P=0.03). Overall, impaired premorbid development, enuresis and incontinence during psychosis were specifically associated with the negative psychotic symptom dimension.
Premorbid social impairments are more marked in child- and adolescent-onset schizophrenia than in other psychoses. There appears to be developmental continuity from premorbid impairment to negative symptoms.