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Despite the importance of routinely assessing the outcomes of everyday practice, few studies have reported outcome metrics for child and adolescent mental health services (CAMHS).
Our aim is to investigate reliable change and recovery rates for treatment as usual, provided by one community CAMHS over two time periods.
We prospectively audited accepted consecutive referrals from November 2017 to January 2018, and April to September 2019. Cases with paired outcomes were identified, and reliable change and recovery rates were calculated.
Baseline outcome data were obtained for 672 (78.2%) and 744 (77.5%) young people in 2018 and 2019, respectively. Of eligible participants, 174 (59.2%) and 155 (45.7%) completed at least one follow-up outcome measure in 2018 and 2019, respectively. Pre- and post-test scores on the Revised Child Anxiety and Depression Scale (RCADS) and Strengths and Difficulties Questionnaire (SDQ) showed a reduction in symptoms. Total RCADS scores showed 21–25% of participants reliably improved, with 44–49% showing reliable improvement on one or more subscale. On the SDQ, 11 (15.5%) and 19 (25.3%) participants reported reliable improvement on at least one subscale in 2018 and 2019, respectively. Reliable recovery rates ranged from 48 to 51% for youth-completed and 40 to 42% for parent-completed RCADS.
Half of young people receiving treatment as usual from CAMHS reliably improved on at least one routine outcome measure subscale, improvement rates comparable with adult psychological therapies services. Our findings indicate that reliable change and recovery on subscale rather than total scores may be a better indication of outcomes.
Antihypertensive drugs (AHTs) are associated with lowered risks of neurodegenerative diseases and stroke. However, the relative risks associated with different AHT classes are unclear. Using an electronic health record network with 34 million eligible patients, we compared rates of these disorders over a 2-year period, in propensity score-matched cohorts of people taking calcium channel blockers (CCBs) compared with those taking other AHT classes. CCBs were associated with a higher incidence of all disorders compared with renin-angiotensin system agents, and a higher incidence of dementia and cerebrovascular disease compared with diuretics. CCBs were associated with a lower incidence of movement disorders and cerebrovascular disease compared with beta-blockers. The data show that AHT classes confer differential risks of neurodegenerative and cerebrovascular diagnoses.
Schizophrenia is a severe mental disorder striking mainly young adults and leading to life-long disability in a substantial portion of the sufferers. On the other hand, substantial knowledge about its etiology and pathogenesis is still lacking. Therefore the European Science Foundation (ESF) sponsored a meeting of a panel of European experts on schizophrenia research to discuss the state of art and future perspectives of key topics in this area. The fields covered genetics, epidemiology, animal models, molecular neuropathology and imaging. This was a first step to establish a network of European groups dedicated to Schizophrenia research. The coming calls of the frame work program will be used to strengthen this network in order to achieve substantial progress in understanding and treating this devastating illness.
We reappraise the psychiatric potential of calcium channel blockers (CCBs). First, voltage-gated calcium channels are risk genes for several disorders. Second, use of CCBs is associated with altered psychiatric risks and outcomes. Third, research shows there is an opportunity for brain-selective CCBs, which are better suited to psychiatric indications.
Around 60 000 people in England live in mental health supported accommodation. There are three main types: residential care, supported housing and floating outreach. Supported housing and floating outreach aim to support service users in moving on to more independent accommodation within 2 years, but there has been little research investigating their effectiveness.
A 30-month prospective cohort study investigating outcomes for users of mental health supported accommodation.
We used random sampling, accounting for relevant geographical variation factors, to recruit 87 services (22 residential care, 35 supported housing and 30 floating outreach) and 619 service users (residential care 159, supported housing 251, floating outreach 209) across England. We contacted services every 3 months to investigate the proportion of service users who successfully moved on to more independent accommodation. Multilevel modelling was used to estimate how much of the outcome and cost variations were due to service type and quality, after accounting for service-user characteristics.
Overall 243/586 participants successfully moved on (residential care 15/146, supported housing 96/244, floating outreach 132/196). This was most likely for floating outreach service users (versus residential care: odds ratio 7.96, 95% CI 2.92–21.69, P < 0.001; versus supported housing: odds ratio 2.74, 95% CI 1.01–7.41, P < 0.001) and was associated with reduced costs of care and two aspects of service quality: promotion of human rights and recovery-based practice.
Most people do not move on from supported accommodation within the expected time frame. Greater focus on human rights and recovery-based practice may increase service effectiveness.
The deep subsurface of other planetary bodies is of special interest for robotic and human exploration. The subsurface provides access to planetary interior processes, thus yielding insights into planetary formation and evolution. On Mars, the subsurface might harbour the most habitable conditions. In the context of human exploration, the subsurface can provide refugia for habitation from extreme surface conditions. We describe the fifth Mine Analogue Research (MINAR 5) programme at 1 km depth in the Boulby Mine, UK in collaboration with Spaceward Bound NASA and the Kalam Centre, India, to test instruments and methods for the robotic and human exploration of deep environments on the Moon and Mars. The geological context in Permian evaporites provides an analogue to evaporitic materials on other planetary bodies such as Mars. A wide range of sample acquisition instruments (NASA drills, Small Planetary Impulse Tool (SPLIT) robotic hammer, universal sampling bags), analytical instruments (Raman spectroscopy, Close-Up Imager, Minion DNA sequencing technology, methane stable isotope analysis, biomolecule and metabolic life detection instruments) and environmental monitoring equipment (passive air particle sampler, particle detectors and environmental monitoring equipment) was deployed in an integrated campaign. Investigations included studying the geochemical signatures of chloride and sulphate evaporitic minerals, testing methods for life detection and planetary protection around human-tended operations, and investigations on the radiation environment of the deep subsurface. The MINAR analogue activity occurs in an active mine, showing how the development of space exploration technology can be used to contribute to addressing immediate Earth-based challenges. During the campaign, in collaboration with European Space Agency (ESA), MINAR was used for astronaut familiarization with future exploration tools and techniques. The campaign was used to develop primary and secondary school and primary to secondary transition curriculum materials on-site during the campaign which was focused on a classroom extra vehicular activity simulation.
Among phoneticians, the Vocal Profile Analysis (VPA) is one of the most widely used methods for the componential assessment of voice quality. Whether the ultimate goal of the VPA evaluation is the comparative description of languages or the characterization of an individual speaker, the VPA protocol shows great potential for different research areas of speech communication. However, its use is not without practical difficulties. Despite these, methodological studies aimed at explaining where, when and why issues arise during the perceptual assessment process are rare. In this paper we describe the methodological stages through which three analysts evaluated the voices of 99 Standard Southern British English male speakers, rated their voices using the VPA scheme, discussed inter-rater disagreements, and eventually produced an agreed version of VPA scores. These scores were then used to assess correlations between settings. We show that it is possible to reach a good degree of inter-rater agreement, provided that several calibration and training sessions are conducted. We further conclude that the perceptual assessment of voice quality using the VPA scheme is an essential tool in fields such as forensic phonetics but, foremost, that it can be adapted and modified to a range of research areas, and not necessarily limited to the evaluation of pathological voices in clinical settings.
There is much dialogue in the academy about the role of doctoral studies in relation to employment, career trajectories and graduate outcomes. This project explores the experiences of Doctor of Musical Arts (DMA) graduates and students at the Queensland Conservatorium in Australia to reveal how the programme has impacted upon their professional activities, while also addressing assumptions promulgated through the literature on artistic practice and research education. The paper presents emergent themes and concludes by offering insights into artistic research in music more broadly.
Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.
To evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.
Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit.
A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15–3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98–10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7–15) (OR = 0.96; 95% CI = 0.56–1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26–0.97).
The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.
Declaration of interest
Drs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
In North America, terrestrial records of biodiversity and climate change that span Marine Oxygen Isotope Stage (MIS) 5 are rare. Where found, they provide insight into how the coupling of the ocean–atmosphere system is manifested in biotic and environmental records and how the biosphere responds to climate change. In 2010–2011, construction at Ziegler Reservoir near Snowmass Village, Colorado (USA) revealed a nearly continuous, lacustrine/wetland sedimentary sequence that preserved evidence of past plant communities between ~140 and 55 ka, including all of MIS 5. At an elevation of 2705 m, the Ziegler Reservoir fossil site also contained thousands of well-preserved bones of late Pleistocene megafauna, including mastodons, mammoths, ground sloths, horses, camels, deer, bison, black bear, coyotes, and bighorn sheep. In addition, the site contained more than 26,000 bones from at least 30 species of small animals including salamanders, otters, muskrats, minks, rabbits, beavers, frogs, lizards, snakes, fish, and birds. The combination of macro- and micro-vertebrates, invertebrates, terrestrial and aquatic plant macrofossils, a detailed pollen record, and a robust, directly dated stratigraphic framework shows that high-elevation ecosystems in the Rocky Mountains of Colorado are climatically sensitive and varied dramatically throughout MIS 5.
The term “seaweed” traditionally includes only macroscopic, multicellular marine red, green, and brown algae. However, each of these groups has microscopic, if not unicellular, representatives. All seaweeds at some stage in their life cycles are unicellular, as spores or gametes and zygotes, and may be temporarily planktonic (Amsler and Searles 1980; Maximova and Sazhin 2010). Some remain small, forming sparse but productive turfs on coral reefs (Hackney et al. 1989) while others, such as the “kelps” of temperate reefs, can form extensive underwater forests (Graham et al. 2007a). Siphonous algae such as Codium, Caulerpa and Bryopsis that form large thalli are, in fact, acellular. The prokaryotic Cyanobacteria have occasionally been acknowledged in “seaweed” floras (e.g. Setchell and Gardner 1919; Littler and Littler 2011a). They are widespread on temperate rocky and sandy shores (Whitton and Potts 1982) and are particularly important in the tropics, where large macroscopic tufts of Oscillatoriaceae and smaller but abundant nitrogen-fixing Nostocaceae are major components of the reef flora (Littler and Littler 2011a, b; Charpy et al. 2012). Benthic diatoms also form large and sometimes abundant tube-dwelling colonies that resemble seaweeds (Lobban 1989). An ancient lineage of (mostly) deep-water green algae, the Palmophyllales, that includes Verdigellas and Palmophyllum, have a palmelloid organization with complex thalli built from an amorphous matrix with a nearly uniform distribution of spherical cells (Womersley 1971; Zechman et al. 2010). On a smaller scale are the colonial filaments of some simple red algae, such as Stylonema (previously Goniotrichum). A “seaweed” is therefore problematic to precisely define: here “seaweed” refers to algae from the red, green, and brown lineages that, at some stage of their life cycle, form multicellular or siphonous macrothalli. In this book we shall consider macroscopic and microscopic marine benthic environments and how seaweeds respond to those environments.
The waters of the oceans are in constant motion. The causes of that motion are many, beginning with the great ocean currents, tidal currents, waves, and other forces, and ranging down to the small-scale circulation patterns caused by local density changes (Vogel 1994; Thurman and Trujillo 2004). Hydrodynamic force is a direct environmental factor, but water motion also affects other factors, including nutrient availability, light penetration, and temperature and salinity changes. The forces embodied in waves are difficult to comprehend, unless one has been dangerously close to them; because of the density of water, a wave or current exerts much more force than do the winds. “Imagine a human foraging for food and searching for a mate in a hurricane and you will have only an inkling of the physical constraints imposed on wave-swept life” (Patterson 1989b, p. 1374). The energy amassed from a great expanse of air–ocean interactions is expended on the shoreline as waves break (Leigh et al. 1987). Equally difficult to visualize are the microscopic layers of water next to seaweed surfaces where the seaweeds’ cells interact with water. Too much water motion imposes drag forces that can rip seaweeds from the rocks, but this also clears patches of “new” space for recruitment. Too little water motion and nutrient concentration gradients form at the seaweed surface which can restrict nutrient uptake, but the same gradients are used by seaweeds to sense how fast the surrounding seawater is moving and thereby cue gamete or spore release.
Studies of seaweed form and function in wave-exposed and wave-protected sites have provided insights into the trade-offs apparent in some species that allow them to maximize resource acquisition in slow flows and minimize drag forces in fast flows. The following texts and reviews provide the necessary background on fluid mechanics: Denny (1988, 1993, 2006); Vogel (1994); Denny and Wethey (2001). “Marine ecomechanics” is an emerging field that uses a “physical framework” to understand the responses of marine organisms on scales from cells to ecosystems (Denny and Helmuth 2009; Denny and Gaylord 2010). We begin this chapter by describing the hydrodynamic environments in which seaweeds grow, and then discuss the mechanisms by which seaweeds can enhance resource acquisition in slow flows and withstand hydrodynamic forces in wave-exposed sites. We finish with a discussion on the effects of wave action and sediments on seaweed communities.
The environment of an organism includes both biotic and abiotic (physiochemical) factors. Communities of marine organisms encompass not only the seaweed communities but also the animal communities, of which the benthic grazers and their predators are most important to seaweed ecology. Thus, the biotic interactions of seaweeds include not only competition with other seaweeds (both within and between species) and with sessile animals but also predator–prey relations at several trophic levels, and facilitation; the mix of such interactions will change as the individual changes with age and environmental history.
Biotic interactions are complex, and their study often requires large-scale and long-term observations and manipulations in the laboratory, as well as in the field. Interactions can be positive (e.g. facilitation, mutualism, and commensalism), negative (e.g. competitive exclusion, consumption) or neutral, where there is no effect of one species on another. Studies on biotic interactions in the marine environment have traditionally focused on competition but more recently facilitation has been recognized as an important way in which biota interact. The minireviews of Olson and Lubchenco (1990), Carpenter (1990), Paine (1990), and Maggs and Cheney (1990) remain useful frameworks, as are the more recent syntheses found within Marine Community Ecology (Bertness et al. 2001) and Marine Ecology (Connell and Gillanders 2007).