To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
This paper demonstrates how climate scenario analysis can be used for forward-looking assessment of the risks and opportunities for financial institutions, using a case study for a UK defined benefit pension scheme. It uses a top-down modelling tool developed by Ortec Finance in partnership with Cambridge Econometrics to explore the possible impacts of three plausible (not extreme) climate pathways of the scheme’s assets and liabilities. It finds that the funding risks are greater under all three climate pathways than under the climate-uninformed base scenario. In the absence of changes to the investment strategy or recovery plan, the time taken to reach full funding is increased by three to nine years. Given that most models currently used by actuaries do not make explicit adjustments for climate change, these modelled results suggest it is quite likely that pension schemes are systematically underestimating the funding risks they face.
This paper illustrates the potential impacts of climate change on financial markets, focusing on their long-term significance. It uses a top-down modelling tool developed by Ortec Finance in partnership with Cambridge Econometrics that combines climate science with macro-economic and financial effects to examine the possible impacts of three plausible (not extreme) climate pathways. The paper first considers the impact on gross domestic product (GDP), finding that GDP is lower in all three pathways, with the most severe reduction in the Failed Transition Pathway where the Paris Agreement climate targets are not met. The model then translates these GDP impacts into financial market effects. In the Failed Transition Pathway, cumulative global equity returns are approximately 50% lower over the period 2020–2060 than in the climate-uninformed base case. For the other two pathways where the Paris Agreement targets are met, the corresponding figures are 15% and 25% lower returns than in the base case. Results are provided for other asset classes too. These demonstrate that climate change represents a significant market risk, with implications for financial planning, modelling and regulation.
Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.
To examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.
Genome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.
Earlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.
AAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.
The increased morbidity and mortality relating to the poor physical health of patients with severe mental illness has repeatedly been an area identified as requiring improvement. Despite this, no national minimum standard has been published around the minimum level of physical health equipment that should be available within an inpatient psychiatric setting.
The aim of this project was to improve and standardise availability of physical health equipment across the five clinical areas within a medium secure inpatient forensic setting, thus enabling optimal and timely medical care and physical examination of patients to occur.
This project used a combination of audit and quality improvement practices. An audit standard was created and current practice was established within the 5 clinical areas of a Medium Secure Forensic Unit. Improvements were made in a systematic and measured way and two audit cycles were completed.
At baseline, the attainment of audit standard ranged from 14-76%. Clinical areas were sharing equipment and there was an inconsistency as to where and how equipment was being stored. Changes implemented included redistribution and reorganisation of equipment which increased attainment to between 48% - 86%. Following this further equipment was ordered and the equipment was separated into that which was required on a daily basis to conduct physical observations and more specialist specific examination equipment. Re-audit found attainment across the five clinical areas being between 90-100%.
Monitoring of physical health within psychiatric inpatient settings is a key area of patient care, and is frequently identified as requiring improvement. Without access to equipment to monitor and assess physical health, this becomes challenging and potentially poorly completed. By standardizing available equipment and furthermore through practical steps such as separating the equipment required on a daily basis and that used less frequently the retention of equipment improved. This enables delivery of high quality, timely and thorough monitoring and assessment of physical health to be achievable.
There has been an increasing focus in the UK on the support provided to the Armed Forces community, with the publication of the Armed Forces Covenant (2011), the Strategy for our Veterans (2018) and the first ever Office for Veterans’ Affairs (2019). There is also an important body of research – including longitudinal research – focusing on transitions from military to civilian life, much of which is quantitative. At the same time, the UK has witnessed a period of unprecedented welfare reform. However, research focused on veterans’ interactions with the social security system has been largely absent. This article draws on the authors’ experiences of undertaking qualitative longitudinal research (QLR) to address this knowledge gap. We reflect on how QLR was essential in engaging policy makers enabling the research to bridge the two parallel policy worlds of veterans’ support and welfare reform, leading to significant policy and practice impact.
ABSTRACT IMPACT: Recommendations for increasing trainee productivity will be highlighted. OBJECTIVES/GOALS: Using a combination of qualitative (interview) and quantitative (publications tracking) data, we undertook to describe the hurdles and concerns impeding academic accomplishments among T and K awardees at one CTSA hub and to examine whether hurdles at 6 months would predict academic output within one year following completion of the training program. METHODS/STUDY POPULATION: Semi-structured interviews were conducted with 29 trainees (28 TL1 and 8 KL2) 6 months into their training. Interview transcripts were analyzed using Atlas.ti to identify hurdles (factors that had already impeded research progress) and concerns (future challenges anticipated by the trainee). PubMed searches yielded the number of publications within one year of exiting the training program. Frequencies of hurdles and concerns were examined to characterize the factors most likely to impact trainee progress during the first 6 months of their training program. Among 18 trainees who had completed their training, the mean number of publications within one year of exiting the program (identified via verified PubMed searches) was compared across the total number of hurdles reported at 6 months (range = 0 to 3). RESULTS/ANTICIPATED RESULTS: The thematic analysis yielded 19 categories of hurdles and 14 categories of concerns. The top three hurdles were technological challenges (e.g., issues with equipment or data reduction; reported by 63% of trainees), professional competing responsibilities (40%), and navigating collaborations (30%). The top three concerns were future funding (33%), potential as an independent researcher (27%), and institutional context (e.g., departmental structure; 23%). The number of hurdles reported at 6 months significantly predicted number of publications one year post-exit (F (3,14) = 3.14, p < .05). Trainees reporting zero hurdles generated a mean of 8.67 publications; those with 3 hurdles generated a mean of 2.4 publications. DISCUSSION/SIGNIFICANCE OF FINDINGS: Future concerns were completely different from past hurdles, suggesting that the issues impeding research progress are not anticipated. Results suggest trainees would benefit from training related to how to balance competing professional responsibilities and navigate collaborations and that early attention to hurdles may enhance productivity.
The use of global positioning system (GPS) units attached to collars is becoming increasingly common in primate studies (Anderson, pers. comm.; Crofoot et al. 2014; Di Fiore & Link 2013; Dore, pers. comm.; Klegarth et al. 2017; Markham & Altmann 2008; Markham et al. 2013; Sprague et al. 2004; Stark, pers. comm.). By deploying GPS collars, researchers can gain enhanced knowledge of primate group whereabouts and overall ranging and landscape use patterns at a high resolution (Crofoot et al. 2014). The utility of these systems has greatly expanded with the increasing spatial accuracy, reliability, and mechanisms (remote data download and drop-off units) of units that facilitate reasonably low impact on study animals (Klegarth et al. 2017; Matthews et al. 2013). While these collars open up new methodological and analytic possibilities for assessing primate ranging patterns and habitat use, they also present a diverse array of technical, structural, and ethical concerns with doing so (Hebblewhite & Haydon 2010; Todd & Shah 2012)
Wildlife reintroduction projects often face resistance from local residents who see potential conflicts with the species or lack trust or confidence in the agencies and professionals involved in reintroduction. Yet the linkages between trust, confidence, risk perceptions, attitudes towards the species and local support for its reintroduction are not well known. The Dual-Mode Model of Cooperation and Cognitive Hierarchy Model were theoretical frameworks used to shed light on these linkages by exploring the potential roles trust and confidence play as mediators between risk perceptions and attitudes towards, and support for, reintroduced elk in Tennessee (USA). A mail survey of 1005 residents living in the five-county area surrounding the North Cumberland Elk Restoration Zone assessed resident attitudes and risk perceptions towards the reintroduced elk, trust towards the managing wildlife agency and support for continued conservation efforts. A structural equation model revealed that trust and confidence play positive roles in mitigating risk perceptions and improving support for the reintroduction of elk. The findings confirm the roles public trust and confidence play in wildlife reintroductions and should help agencies work towards building local trust and confidence, minimizing risks, improving attitudes and increasing the chances for successful outcomes for the species and people.
Congenital heart disease (CHD) is the most common birth defect for infants born in the United States, with approximately 36,000 affected infants born annually. While mortality rates for children with CHD have significantly declined, there is a growing population of individuals with CHD living into adulthood prompting the need to optimise long-term development and quality of life. For infants with CHD, pre- and post-surgery, there is an increased risk of developmental challenges and feeding difficulties. Feeding challenges carry profound implications for the quality of life for individuals with CHD and their families as they impact short- and long-term neurodevelopment related to growth and nutrition, sensory regulation, and social-emotional bonding with parents and other caregivers. Oral feeding challenges in children with CHD are often the result of medical complications, delayed transition to oral feeding, reduced stamina, oral feeding refusal, developmental delay, and consequences of the overwhelming intensive care unit (ICU) environment. This article aims to characterise the disruptions in feeding development for infants with CHD and describe neurodevelopmental factors that may contribute to short- and long-term oral feeding difficulties.
Ventenata [Ventenata dubia (Leers) Coss.], an invasive winter annual grass, negatively impacts grassland community composition and function in the Pacific Northwest. Ventenata dubia established in Palouse prairie (PP) and canyon grasslands (CG) of northern Idaho/eastern Washington in the mid-1980s to early 1990s. Understanding and comparing patterns of invasion can elucidate future trends as its range expands. We performed surveys in PP (2012 and 2013) and CG (2018) to assess V. dubia abundance. Specifically, we correlated species richness, Shannon diversity, rank abundance, and indicator species with no, low (<12.5%), and high (>12.5%) V. dubia cover. We used nonmetric multidimensional scaling analysis (NMDS) to visualize species similarities and associations with abiotic variables. In both ecoregions, V. dubia was very common, appearing in nearly 60% of 450 plots. When present, V. dubia cover averaged 26% (±2.3 SE) in PP and 19% (±1.8 SE) in CG. Indigenous plant species richness and diversity were lowest in plots with high V. dubia cover. In CG, this relationship held for nonindigenous species; in PP, nonindigenous plant richness and diversity were higher with high V. dubia cover. Ventenata dubia and other winter annual grasses (Bromus spp., medusahead [Taeniatherum caput-medusae (L.) Nevski]) were moderately associated according to the NMDS analysis. Indicator species analysis showed V. dubia was positively associated with nonindigenous winter annual grasses and negatively associated with indigenous low shrub species. Abiotic factors that explained V. dubia abundance included shallow soils and a south to west aspect. Overall, these findings indicate V. dubia can successfully invade both dry and relatively wet plant communities and is more abundant than other invasive annual grasses. We suggest these findings foreshadow what will happen in sagebrush steppe and Great Plains grasslands, regions where V. dubia recently became established.
OBJECTIVES/GOALS: To evaluate the FAITH! (Fostering African-American Improvement in Total Health) App mHealth lifestyle intervention by using post-intervention feedback obtained from participants in our intervention pilot study. METHODS/STUDY POPULATION: We used qualitative methods (focus groups) to elicit post-intervention feedback. Participants who completed the pilot study were recruited to one of two focus groups. Semi-structured focus groups were conducted to explore participants’ views on the app functionality, utility and satisfaction as well as its impact on healthy lifestyle change. Sessions were audio-recorded, transcribed verbatim and qualitative data were analyzed by systematic text condensation thematic analysis. RESULTS/ANTICIPATED RESULTS: Nine individuals participated (N = 4 and N = 5) in each of the two focus groups. Their mean age was 47.9 years (SD 12.1), 67% were women, and all had at least an education level of some college. Six overarching themes emerged from the data: (1) overall impression, (2) content usefulness (3) formatting, (4) implementation, (5) impact and (6) suggestions for improvement. Underpinning the themes was a high level of agreement that the intervention facilitated healthy behavioral change through cultural tailoring, multimedia education modules and social networking. Among the suggestions for improvement were streamlining of app self-monitoring features, personalization based on individual’s cardiovascular risk and attentiveness to nuanced cultural perspectives. DISCUSSION/SIGNIFICANCE OF IMPACT: This formative evaluation found the FAITH! App mHealth lifestyle intervention had high reported satisfaction and impact on the health-promoting behaviors of African-Americans, thereby improving their overall cardiovascular health. The findings provide further support for the acceptability of mHealth interventions among African-Americans. CONFLICT OF INTEREST DESCRIPTION: None.
Alcohol misuse is common in bipolar disorder and is associated with worse outcomes. A recent study evaluated integrated motivational interviewing and cognitive behavioural therapy for bipolar disorder and alcohol misuse with promising results in terms of the feasibility of delivering the therapy and the acceptability to participants.
Here we present the experiences of the therapists and supervisors from the trial to identify the key challenges in working with this client group and how these might be overcome.
Four therapists and two supervisors participated in a focus group. Topic guides for the group were informed by a summary of challenges and obstacles that each therapist had completed at the end of therapy for each individual client. The audio recording of the focus group was transcribed and data were analysed using thematic analysis.
We identified five themes: addressing alcohol use versus other problems; impact of bipolar disorder on therapy; importance of avoidance and overcoming it; fine balance in relation to shame and normalising use; and ‘talking the talk’ versus ‘walking the walk’.
Findings suggest that clients may be willing to explore motivations for using alcohol even if they are not ready to change their drinking, and they may want help with a range of mental health problems. Emotional and behavioural avoidance may be a key factor in maintaining alcohol use in this client group and therapists should be aware of a possible discrepancy between clients’ intentions to reduce misuse and their actual behaviour.
Worldwide, early intervention services for young people with recent-onset psychosis have been associated with improvements in outcomes, including reductions in hospitalization, symptoms, and improvements in treatment engagement and work/school participation. States have received federal mental health block grant funding to implement team-based, multi-element, evidence-based early intervention services, now called coordinated specialty care (CSC) in the USA. New York State’s CSC program, OnTrackNY, has grown into a 23-site, statewide network, serving over 1800 individuals since its 2013 inception. A state-supported intermediary organization, OnTrackCentral, has overseen the growth of OnTrackNY. OnTrackNY has been committed to quality improvement since its inception. In 2019, OnTrackNY was awarded a regional hub within the National Institute of Mental Health-sponsored Early Psychosis Intervention Network (EPINET). The participation in the national EPINET initiative reframes and expands OnTrackNY’s quality improvement activities. The national EPINET initiative aims to develop a learning healthcare system (LHS); OnTrackNY’s participation will facilitate the development of infrastructure, including a systematic approach to facilitating stakeholder input and enhancing the data and informatics infrastructure to promote quality improvement. Additionally, this infrastructure will support practice-based research to improve care. The investment of the EPINET network to build regional and national LHSs will accelerate innovations to improve quality of care.
A proportion of ex-military personnel who develop mental health and social problems end up in the Criminal Justice System. A government review called for better understanding of pathways to offending among ex-military personnel to improve services and reduce reoffending. We utilised data linkage with criminal records to examine the patterns of offending among military personnel after they leave service and the associated risk (including mental health and alcohol problems) and socio-economic protective factors.
Questionnaire data from a cohort study of 13 856 randomly selected UK military personnel were linked with national criminal records to examine changes in the rates of offending after leaving service.
All types of offending increased after leaving service, with violent offending being the most prevalent. Offending was predicted by mental health and alcohol problems: probable PTSD, symptoms of common mental disorder and aggressive behaviour (verbal, property and threatened or actual physical aggression). Reduced risk of offending was associated with post-service socio-economic factors: absence of debt, stable housing and relationship satisfaction. These factors were associated with a reduced risk of offending in the presence of mental health risk factors.
Ex-military personnel are more likely to commit violent offences after leaving service than other offence-types. Mental health and alcohol problems are associated with increased risk of post-service offending, and socio-economic stability is associated with reduced risk of offending among military veterans with these problems. Efforts to reduce post-service offending should encompass management of socio-economic risk factors as well as mental health.
Childhood abuse is a risk factor for poorer illness course in bipolar disorder, but the reasons why are unclear. Trait-like features such as affective instability and impulsivity could be part of the explanation. We aimed to examine whether childhood abuse was associated with clinical features of bipolar disorder, and whether associations were mediated by affective instability or impulsivity.
We analysed data from 923 people with bipolar I disorder recruited by the Bipolar Disorder Research Network. Adjusted associations between childhood abuse, affective instability and impulsivity and eight clinical variables were analysed. A path analysis examined the direct and indirect links between childhood abuse and clinical features with affective instability and impulsivity as mediators.
Affective instability significantly mediated the association between childhood abuse and earlier age of onset [effect estimate (θ)/standard error (SE): 2.49], number of depressive (θ/SE: 2.08) and manic episodes/illness year (θ/SE: 1.32), anxiety disorders (θ/SE: 1.98) and rapid cycling (θ/SE: 2.25). Impulsivity significantly mediated the association between childhood abuse and manic episodes/illness year (θ/SE: 1.79), anxiety disorders (θ/SE: 1.59), rapid cycling (θ/SE: 1.809), suicidal behaviour (θ/SE: 2.12) and substance misuse (θ/SE: 3.09). Measures of path analysis fit indicated an excellent fit to the data.
Affective instability and impulsivity are likely part of the mechanism of why childhood abuse increases risk of poorer clinical course in bipolar disorder, with each showing some selectivity in pathways. They are potential novel targets for intervention to improve outcome in bipolar disorder.
OBJECTIVES/SPECIFIC AIMS: To translate a behavioral theory–informed, evidence-based, face-to-face health education program into an mHealth lifestyle intervention for African-Americans (AAs). METHODS/STUDY POPULATION: This mixed methods study consisted of 4 phases, using an iterative development process to intervention design with the AA community. In Phase 1, we held focus groups with AA community members and church partners (n=23) to gain insight regarding the needs and preferences of potential app end users. In Phase 2, the interdisciplinary research team synthesized input from Phase 1 for preliminary app design and content development. Phase 3 consisted of a sequential 3-meeting series with the church partners (n=13) for iterative app prototyping (assessment, cultural tailoring, final review). Phase 4 was a single group pilot study among AA church congregants (n=50) to assess app acceptability, usability, and satisfaction. RESULTS/ANTICIPATED RESULTS: Phase 1 focus groups indicated preferences for general and health related apps: multifunctional; high-quality graphics/visuals; evidence-based, yet simple health information; and social networking capability. Phase 2 integrated these preferences into the preliminary app prototype. Feedback from Phase 3 was used to refine the FAITH! App prototype for pilot testing. Phase 4 pilot testing indicated high acceptability, usability, and satisfaction of the FAITH! App. DISCUSSION/SIGNIFICANCE OF IMPACT: This study illustrates the process of using formative and CBPR approaches to design a culturally relevant, mHealth lifestyle intervention to address CV health disparities within the AA community. Given the positive perceptions of the app, our study supports the use of an iterative development process by others interested in implementing an mHealth lifestyle intervention for racial/ethnic minority communities.