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Social anxiety disorder (SAD) is a prevalent chronic condition with a large demand for treatment. This community outpatient study examined the effectiveness of a group intervention version of the established one-to-one cognitive therapy derived from the Clark and Wells model for SAD. Questionnaires were completed pre-treatment and post-treatment for SAD symptoms (Social Phobia Scale, Social Interaction Anxiety Scale), depressive symptoms (BDI-II), self-focused attention, safety behaviours (Social Phobia Weekly Summary Scale and Subtle Avoidance Frequency Examination), and impaired functioning (Work and Social Adjustment Scale). From an initial sample of 159 participants, 101 completed at least seven of the nine weekly group sessions (Mage = 34.1 years, SDage = 10.8 years, 53% female). Significant improvements were demonstrated on all measures. Large effect sizes were found for social anxiety symptoms and safety behaviour use. Self-focused attention, depressive symptoms, and impaired functioning had moderate effect sizes. Effect sizes for anxiety (d = 1.00 and 1.32) and mood measures (d = 0.71) were as high, or in some cases, higher than previous group treatment studies. Results suggest group cognitive therapy for SAD based on the Clark and Wells model is effective in a clinical setting for individuals with moderate/severe and treatment-resistant social anxiety.
High rates of post-traumatic stress disorder (PTSD) are documented within refugee populations. Although research supports effectiveness of trauma-focused cognitive behaviour therapy (TF-CBT) among Western populations, little research exists for its efficacy among refugees living in camps and settlements in developing nations.
To investigate whether a culturally sensitive, group-based TF-CBT programme (EMPOWER) delivered in a Ugandan refugee settlement effectively reduced refugees’ post-traumatic stress symptoms (PTSS), and whether sociodemographic factors, trauma characteristics, or PTSS severity related to programme completion or treatment outcomes.
Method and Results:
Data linkages were conducted on information provided by 174 Congolese refugees living in a Ugandan settlement (mean age = 33.4 years, SD = 11.7; 49% male). Using a quasi-experimental design, participants who initially completed the intervention (n = 43) delivered across nine 90-minute sessions, reported significant reductions in self-reported PTSS with a large effect size. The delayed treatment group (n = 55) also reported significant treatment gains once they received the intervention. Participants who completed the programme reported significantly greater initial PTSS severity than those who dropped out, while no sociodemographic factors, trauma characteristics or PTSS were associated with better treatment outcomes.
A culturally sensitive, group-based TF-CBT programme delivered in a refugee settlement meaningfully reduces refugees’ PTSS severity and is equally effective for all participants, with the highest retention rates found among those in greatest need of treatment. Programmes such as this, with capacity to treat hundreds of people simultaneously, represent highly cost-effective, accessible, disseminable and effective treatment for PTSS among refugees living in humanitarian settings in developing nations.
The Eating Assessment in Toddlers FFQ (EAT FFQ) has been shown to have good reliability and comparative validity for ranking nutrient intakes in young children. With the addition of food items (n 4), we aimed to re-assess the validity of the EAT FFQ and estimate calibration factors in a sub-sample of children (n 97) participating in the Growing Up Milk – Lite (GUMLi) randomised control trial (2015–2017). Participants completed the ninety-nine-item GUMLi EAT FFQ and record-assisted 24-h recalls (24HR) on two occasions. Energy and nutrient intakes were assessed at months 9 and 12 post-randomisation and calibration factors calculated to determine predicted estimates from the GUMLi EAT FFQ. Validity was assessed using Pearson correlation coefficients, weighted kappa (κ) and exact quartile categorisation. Calibration was calculated using linear regression models on 24HR, adjusted for sex and treatment group. Nutrient intakes were significantly correlated between the GUMLi EAT FFQ and 24HR at both time points. Energy-adjusted, de-attenuated Pearson correlations ranged from 0·3 (fibre) to 0·8 (Fe) at 9 months and from 0·3 (Ca) to 0·7 (Fe) at 12 months. Weighted κ for the quartiles ranged from 0·2 (Zn) to 0·6 (Fe) at 9 months and from 0·1 (total fat) to 0·5 (Fe) at 12 months. Exact agreement ranged from 30 to 74 %. Calibration factors predicted up to 56 % of the variation in the 24HR at 9 months and 44 % at 12 months. The GUMLi EAT FFQ remained a useful tool for ranking nutrient intakes with similar estimated validity compared with other FFQ used in children under 2 years.
Risk for emotional and behavioural problems are known to be high among children of depressed mothers, but little is known about the impact of antenatal and postnatal depression on the physical health of the infant. Our one-year prospective follow-up study of 320 mothers and their infants in rural Rawalpindi, Pakistan, shows that infants of antenatally depressed mothers have poorer growth than controls. The relative risk for being underweight (weight-for-age z-score < -2SD) is 4.0 (95%CI 2.1-7.7) at 6 months and 2.6 (95% CI 1.7-4.1) at 12 months, while the risks for stunting (length-for-age z-score < –2SD) is 4.4 (95%CI 1.7-11.4) at 6 months and 2.5 (95% CI 1.6-4.0) at 12 months. Relative risk for ≥5 diarrhoeal episodes per year is 2.4 (95% CI 1.7-3.3). Chronic depression carries a greater risk for poor outcome than episodic depression. The associations remain significant after adjustment for confounders by multivariate analyses. It is concluded that preventive and treatment strategies for maternal depression could benefit not only the mother's well-being but also the infant's physical health and development.
The second year of life is a period of nutritional vulnerability. We aimed to investigate the dietary patterns and nutrient intakes from 1 to 2 years of age during the 12-month follow-up period of the Growing Up Milk – Lite (GUMLi) trial. The GUMLi trial was a multi-centre, double-blinded, randomised controlled trial of 160 healthy 1-year-old children in Auckland, New Zealand and Brisbane, Australia. Dietary intakes were collected at baseline, 3, 6, 9 and 12 months post-randomisation, using a validated FFQ. Dietary patterns were identified using principal component analysis of the frequency of food item consumption per d. The effect of the intervention on dietary patterns and intake of eleven nutrients over the duration of the trial were investigated using random effects mixed models. A total of three dietary patterns were identified at baseline: ‘junk/snack foods’, ‘healthy/guideline foods’ and ‘breast milk/formula’. A significant group difference was observed in ‘breast milk/formula’ dietary pattern z scores at 12 months post-randomisation, where those in the GUMLi group loaded more positively on this pattern, suggesting more frequent consumption of breast milk. No difference was seen in the other two dietary patterns. Significant intervention effects were seen on nutrient intake between the GUMLi (intervention) and cows’ milk (control) groups, with lower protein and vitamin B12, and higher Fe, vitamin D, vitamin C and Zn intake in the GUMLi (intervention) group. The consumption of GUMLi did not affect dietary patterns, however, GUMLi participants had lower protein intake and higher Fe, vitamins D and C and Zn intake at 2 years of age.
Collaborative care can support the treatment of depression in people with long-term conditions, but long-term benefits and costs are unknown.
To explore the long-term (24-month) effectiveness and cost-effectiveness of collaborative care in people with mental-physical multimorbidity.
A cluster randomised trial compared collaborative care (integrated physical and mental healthcare) with usual care for depression alongside diabetes and/or coronary heart disease. Depression symptoms were measured by the symptom checklist-depression scale (SCL-D13). The economic evaluation was from the perspective of the English National Health Service.
191 participants were allocated to collaborative care and 196 to usual care. At 24 months, the mean SCL-D13 score was 0.27 (95% CI, −0.48 to −0.06) lower in the collaborative care group alongside a gain of 0.14 (95% CI, 0.06-0.21) quality-adjusted life-years (QALYs). The cost per QALY gained was £13 069.
In the long term, collaborative care reduces depression and is potentially cost-effective at internationally accepted willingness-to-pay thresholds.
We report the results of Long Baseline Array observations made in 2001 of ten southern sources proposed by Mattox et al. as counterparts to EGRET >100 MeV gamma-ray sources. Source structures are compared with published data where available and possible superluminal motions identified in several cases. The associations are examined in the light of Fermi observations, indicating that the confirmed counterparts tend to have radio properties consistent with other identifications, including flat radio spectral index, high brightness temperature, greater radio variability, and higher core dominance.
Despite policy and practice mandates for patient involvement, people with serious mental illness often feel marginalised in decisions about antipsychotic medication.
To examine stakeholder perspectives of barriers and facilitators to involving people with serious mental illness in antipsychotic prescribing decisions.
Systematic thematic synthesis.
Synthesis of 29 studies identified the following key influences on involvement: patient's capability, desire and expectation for involvement, organisational context, and the consultation setting and processes.
Optimal patient involvement in antipsychotic decisions demands that individual and contextual barriers are addressed. There was divergence in perceived barriers to involvement identified by patients and prescribers. For example, patients felt that lack of time in consultations was a barrier to involvement, something seldom raised by prescribers, who identified organisational barriers. Patients must understand their rights to involvement and the value of their expertise. Organisational initiatives should mandate prescriber responsibility to overcome barriers to involvement.
We present results from a multiwavelength study of the blazar PKS 1954–388 at radio, UV, X-ray, and gamma-ray energies. A RadioAstron observation at 1.66 GHz in June 2012 resulted in the detection of interferometric fringes on baselines of 6.2 Earth-diameters. This suggests a source frame brightness temperature of greater than 2 × 1012 K, well in excess of both equipartition and inverse Compton limits and implying the existence of Doppler boosting in the core. An 8.4-GHz TANAMI VLBI image, made less than a month after the RadioAstron observations, is consistent with a previously reported superluminal motion for a jet component. Flux density monitoring with the Australia Telescope Compact Array confirms previous evidence for long-term variability that increases with observing frequency. A search for more rapid variability revealed no evidence for significant day-scale flux density variation. The ATCA light-curve reveals a strong radio flare beginning in late 2013, which peaks higher, and earlier, at higher frequencies. Comparison with the Fermi gamma-ray light-curve indicates this followed ~ 9 months after the start of a prolonged gamma-ray high-state—a radio lag comparable to that seen in other blazars. The multiwavelength data are combined to derive a Spectral Energy Distribution, which is fitted by a one-zone synchrotron-self-Compton (SSC) model with the addition of external Compton (EC) emission.
Large numbers of small valley glaciers on Svalbard were thicker and more extensive during the Little Ice Age (LIA), demonstrated by prominent ice-cored moraines up to several kilometres beyond present-day margins. The majority of these glaciers have since experienced a long period of strongly negative mass balance during the 20th century and are now largely frozen to their beds, indicating they are likely to have undergone a thermal transition from a polythermal to a cold-based regime. We present evidence for such a switch by reconstructing the former flow dynamics and thermal regime of Tellbreen, a small cold-based valley glacier in central Spitsbergen, based on its basal sequence and glaciological structures. Within the basal sequence, the underlying matrix-supported diamict is interpreted as saturated subglacial traction till which has frozen at the bed, indicating that the thermal switch has resulted in a cessation of subglacial sediment deformation due to freezing of the former deforming layer. This is overlain by debris-poor dispersed facies ice, interpreted to have formed through strain-induced metamorphism of englacial ice. The sequential development of structures includes arcuate fracture traces, interpreted as shear planes formed in a compressive/transpressive stress regime; and fracture traces, interpreted as healed extensional crevasses. The formation of these sediment/ice facies and structures is indicative of dynamic, warm-based flow, most likely during the LIA when the glacier was significantly thicker.
We have completed a Chandra snapshot survey of 54 radio jets that are extended on arcsec scales. These are associated with flat spectrum radio quasars spanning a redshift range z=0.3 to 2.1. X-ray emission is detected from the jet of approximately 60% of the sample objects. We assume minimum energy and apply conditions consistent with the original Felten-Morrison calculations in order to estimate the Lorentz factors and the apparent Doppler factors. This allows estimates of the enthalpy fluxes, which turn out to be comparable to the radiative luminosities.
The Micro-arcsecond Scintillation-Induced Variability (MASIV) Survey and its follow-up observations have provided large datasets of AGN intra-day variability (IDV) at radio wavelengths. These data have shown that IDV arises mainly from scintillation caused by scattering in the ionized interstellar medium (ISM) of our Galaxy, based on correlation with Galactic latitudes and line-of-sight Galactic electron column densities. The sensitivity of interstellar scintillation (ISS) towards source angular sizes has provided a new tool for studying the most compact components of radio-loud AGNs at microarcsecond (μas) scale resolution - much higher than any ground-based radio interferometer. We present here key results from the MASIV Survey and its follow-up observations, and point to relevant papers where these results have been published.
Interstellar scintillation (ISS) has been shown to be primarily responsible for the short term intraday variability (IDV) exhibited by extragalactic sources at centimeter wavelengths (e.g. Bignall et al. 2006 and references therein). For a source to scintillate its angular size must be comparable to that of the first Fresnel zone (Narayan 1992) which implies microarcsecond angular sizes for screen distances of tens to hundreds of parsecs. This has the potential to probe within a few light months of the central black hole (Bignall et al. 2006). The aim of the Microarcsecond Scintillation-Induced Variability (MASIV) survey was to provide a catalogue of at least a hundred AGNs that vary on timescales of hours to days to provide the basis of detailed studies of the IDV population drawn from a well-defined sample.
We are undertaking an observational program using the ATCA to monitor the intraday variability (IDV) of a sample of sources at 4.8 and 8.6 GHz. The sources were selected to include the known strong southern IDV sources plus a number of sources whose IDV was recently discovered. The present monitoring program will extend over a full year in order to search for any annual cycle that may be present in the long-term IDV characteristics of these sources. In this paper we discuss the observing strategy and data analysis, and present the first results from our observations.
We have commenced a program to monitor the gravitational lens B1152+199 with the Australia Telescope Compact Array (ATCA) to search for variability of the lensed components with the goal of measuring the lensing time delay. As part of this program we made a 9 hour full-synthesis observation in June 2000 to derive a ‘template’ for model-fitting the shorter, multi-epoch, monitoring observations. We report here on the results of this full-synthesis observation and on three additional epochs of monitoring for time variation.
Flux density monitoring data at 2.3 and 8.4 GHz is presented for a sample of 33 southern hemisphere GPS sources, drawn from the 2.7 GHz Parkes survey. This monitoring data, together with VLBI monitoring data, shows that a small fraction of these sources, ∼10%, vary. Their variability falls into several categories: sources whose spectral classification is, at best, ephemeral on a timescale of years; sources with a stable GPS classification that vary, but retain their classification; and a small number of sources that exhibit interstellar scintillation, but that maintain a mean GPS spectrum. Existing data on GPS sources with higher frequency peaks, ≥3 GHz, reveals that many such sources vary. However, the majority of these sources possess a GPS spectrum only during outbursts, and hence should perhaps be classified as ephemeral GPS sources. In addition, significant levels of circular polarisation have been found in a number of GPS sources, both amongst the variables and non-variables. Remarkable amongst these is PKS 1519–273, which possesses strong and variable circular polarisation, and which exhibits IDV in all Stokes parameters.
The future of centimetre and metre-wave astronomy lies with the Square Kilometre Array (SKA), a telescope under development by a consortium of 17 countries that will be 50 times more sensitive than any existing radio facility. Most of the key science for the SKA will be addressed through large-area imaging of the Universe at frequencies from a few hundred MHz to a few GHz. The Australian SKA Pathfinder (ASKAP) is a technology demonstrator aimed in the mid-frequency range, and achieves instantaneous wide-area imaging through the development and deployment of phased-array feed systems on parabolic reflectors. The large field-of-view makes ASKAP an unprecedented synoptic telescope that will make substantial advances in SKA key science. ASKAP will be located at the Murchison Radio Observatory in inland Western Australia, one of the most radio-quiet locations on the Earth and one of two sites selected by the international community as a potential location for the SKA. In this paper, we outline an ambitious science program for ASKAP, examining key science such as understanding the evolution, formation and population of galaxies including our own, understanding the magnetic Universe, revealing the transient radio sky and searching for gravitational waves.
The discovery that interstellar scintillation (ISS) is suppressed for compact radio sources at z ≳ 2 has enabled ISS surveys to be used as cosmological probes. We discuss briefly the potential and challenges involved in such an undertaking, based on a dual-frequency survey of ISS carried out to determine the origin of this redshift dependence.