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Auditory Verbal Hallucinations (AVH) are a hallmark of psychosis, but affect many other clinical populations. Patients’ understanding and self-management of AVH may differ between diagnostic groups, change over time, and influence clinical outcomes.
We aimed to explore patients’ understanding and self-management of AVH in a young adult clinical population.
35 participants reporting frequent AVH were purposively sampled from a youth mental health service, to capture experiences across psychosis and non-psychosis diagnoses. Diary and photo-elicitation methodologies were used – participants were asked to complete diaries documenting experiences of AVH, and to take photographs representing these experiences. In-depth, unstructured interviews were held, using participant-produced materials as a topic guide. Conventional content analysis was conducted, deriving results from the data in the form of themes.
Three themes emerged:
(1) Searching for answers, forming identities – voice-hearers sought to explain their experiences, resulting in the construction of identities for voices, and descriptions of relationships with them. These identities were drawn from participants’ life-stories (e.g., reflecting trauma), and belief-systems (e.g., reflecting supernatural beliefs, or mental illness). Some described this process as active / volitional. Participants described re-defining their own identities in relation to those constructed for AVH (e.g. as diseased, 'chosen', or persecuted), others considered AVH explicitly as aspects of, or changes in, their personality.
(2) Coping strategies and goals – patients’ self-management strategies were diverse, reflecting the diverse negative experiences of AVH. Strategies were related to a smaller number of goals, e.g. distraction, soothing overwhelming emotions, 'reality-checking', and retaining agency.
(3) Outlook – participants formed an overall outlook reflecting their self-efficacy in managing AVH. Resignation and hopelessness in connection with disabling AVH are contrasted with outlooks of “acceptance” or integration, which were described as positive, ideal, or mature.
Trans-diagnostic commonalities in understanding and self-management of AVH are highlighted - answer-seeking and identity-formation processes; a diversity of coping strategies and goals; and striving to accept the symptom. Descriptions of “voices-as-self”, and dysfunctional relationships with AVH, could represent specific features of voice-hearing in personality disorder, whereas certain supernatural/paranormal identities and explanations were clearly delusional. However, no aspect of identity-formation was completely unique to psychosis or non-psychosis diagnostic groups. The identity-formation process, coping strategies, and outlooks can be seen as a framework both for individual therapies and further research.
Electrochemical energy-storage systems such as supercapacitors and lithium-ion batteries require complex intertwined networks that provide fast transport pathways for ions and electrons without interfering with their energy density. Self-assembly of nanomaterials into hierarchical structures offers exciting possibilities to create such pathways. This article summarizes recent research achievements in self-assembled zero-dimensional, one-dimensional, and two-dimensional nanomaterials, ordered pore structure materials, and the interfaces between these. We analyze how self-assembly strategies can create storage architectures that improve device performance toward higher energy densities, longevity, rate capability, and device safety. At the end, the remaining challenges of scalable low-cost manufacturing and future opportunities such as self-healing are discussed.
The earliest claim for domesticated rice in Island Southeast Asia (4960–3565 cal BP) derives from a single grain embedded in a ceramic sherd from Gua Sireh Cave, Borneo. In a first assessment of spikelet-base assemblages within pottery sherds using quantitative microCT analysis, the authors found no additional rice remains within this sherd to support the early date of rice farming; analysis of a more recent Gua Sireh sherd (1990–830 cal BP), however, indicates that 70 per cent of spikelet bases are from domesticated rice. This technique offers a high degree of contextual and temporal resolution for approaching organic-tempered ceramics as well-preserved archaeobotanical assemblages.
We evaluated the safety and feasibility of high-intensity interval training via a novel telemedicine ergometer (MedBIKE™) in children with Fontan physiology.
The MedBIKE™ is a custom telemedicine ergometer, incorporating a video game platform and live feed of patient video/audio, electrocardiography, pulse oximetry, and power output, for remote medical supervision and modulation of work. There were three study phases: (I) exercise workload comparison between the MedBIKE™ and a standard cardiopulmonary exercise ergometer in 10 healthy adults. (II) In-hospital safety, feasibility, and user experience (via questionnaire) assessment of a MedBIKE™ high-intensity interval training protocol in children with Fontan physiology. (III) Eight-week home-based high-intensity interval trial programme in two participants with Fontan physiology.
There was good agreement in oxygen consumption during graded exercise at matched work rates between the cardiopulmonary exercise ergometer and MedBIKE™ (1.1 ± 0.5 L/minute versus 1.1 ± 0.5 L/minute, p = 0.44). Ten youth with Fontan physiology (11.5 ± 1.8 years old) completed a MedBIKE™ high-intensity interval training session with no adverse events. The participants found the MedBIKE™ to be enjoyable and easy to navigate. In two participants, the 8-week home-based protocol was tolerated well with completion of 23/24 (96%) and 24/24 (100%) of sessions, respectively, and no adverse events across the 47 sessions in total.
The MedBIKE™ resulted in similar physiological responses as compared to a cardiopulmonary exercise test ergometer and the high-intensity interval training protocol was safe, feasible, and enjoyable in youth with Fontan physiology. A randomised-controlled trial of a home-based high-intensity interval training exercise intervention using the MedBIKE™ will next be undertaken.
Seabirds are one of the most threatened avian taxa and are hence a high conservation priority. Managing seabirds is challenging, requiring conservation actions at sea (e.g. Marine Protected Areas - MPAs) and on land (e.g. protection of breeding sites). Important Bird and Biodiversity Areas (IBAs) have been successfully used to identify sites of global importance for the conservation of bird populations, including breeding seabirds. The challenge of identifying suitable IBAs for tropical seabirds is exacerbated by high levels of dispersal, aseasonal and asynchronous breeding. The western Indian Ocean supports ~19 million breeding seabirds of 30 species, making it one of the most significant tropical seabird assemblages in the world. Within this is the British Indian Ocean Territory (BIOT), encompassing 55 islands of the Chagos Archipelago, which supports 18 species of breeding seabird and one of the world’s largest no-take MPAs. Between January and March in 1975 and 1996, eight and 45 islands respectively were surveyed for seabirds and the data used to designate 10 islands as IBAs. A further two were proposed following an expedition to 26 islands in February/March 2006. Due to the historic and restricted temporal and spatial nature of these surveys, the current IBA recommendations may not accurately represent the archipelago’s present seabird status and distribution. To update estimates of the BIOT breeding seabird assemblage and reassess the current IBA recommendations, we used seabird census data collected in every month except September from every island, gathered during 2008–2018. The maximum number of breeding seabirds for a nominal year was 281,596 pairs of 18 species, with three species making up 96%: Sooty Tern Onychoprion fuscatus - 70%, Lesser Noddy Anous tenuirostris - 18% and Red-footed Booby Sula sula - 8%. Phenology was a complex species-specific mix of synchronous and asynchronous breeding, as well as seasonal and aseasonal breeding. Nine of the 10 designated IBAs and the two proposed IBAs qualified for IBA status based on breeding seabirds. However, not every IBA qualified each year because Sooty Terns periodically abandoned breeding islands and Tropical Shearwater Puffinus bailloni breeding numbers dropped below IBA qualifying criteria in some years. Further, one survey per year does not always capture the periodic breeding of some tropical seabirds. We propose therefore, that IBAs in BIOT are better designated at the island cluster level rather than by specific island and require two surveys six months apart per year. This work highlights the merits of long-term, systematic, versus incidental surveys for breeding tropical seabirds and the subsequent associated designation of IBAs.
Large, ‘complex’ pre-Neolithic hunter-gatherer communities thrived in southern China and northern Vietnam, contemporaneous with the expansion of farming. Research at Con Co Ngua in Vietnam suggests that such hunter-gatherer populations shared characteristics with early farming communities: high disease loads, pottery, complex mortuary practices and access to stable sources of carbohydrates and protein. The substantive difference was in the use of domesticated plants and animals—effectively representing alternative responses to optimal climatic conditions. The work here suggests that the supposed correlation between farming and a decline in health may need to be reassessed.
Gaia Data Release 2 (DR2; April 25, 2018) provides astrometric and photometric data for more than a billion stars - among them many AGB stars. As part of DR2 the light curves of several hundreds of thousand variable stars, including many long-period variable (LPV) candidates, are made available. The publication of the light curves and LPV-specific attributes in addition to the standard DR2 products offers a unique opportunity to study AGB stars. In this contribution, we present the first results for AGB stars based on the analysis of the Gaia data performed after their release. As an immediate result of the Gaia DR2 LPV database we introduce a new photometric index capable of efficiently distinguishing AGB stars of different masses and chemical properties.
Variability due to stellar pulsation on the Asymptotic Giant Branch (AGB) has a great potential for applications such as distance measurements, the study the evolution of stars and galaxies, and the estimate of global stellar parameters, as well as to constrain stellar evolutionary models. Given the importance of long-period variables (LPVs) in this sense, and given the lack of recent, updated sets of pulsation models, we computed an extended grid of pulsation models widely covering the space of AGB stellar parameters, including up-to-date opacities and accounting for the chemical evolution associated with third dredge-up events. We present the relevant properties of this grid and discuss the main results it allowed to obtain in terms of the interpretation of the observed properties of LPVs in the Large Magellanic Cloud (LMC).
Research reviews highlight methodological limitations and gaps in the evidence base for the arts in dementia care. In response, we developed a 12-week visual art program and evaluated the impact on people living with dementia through a mixed-methods longitudinal investigation.
One hundred and twenty-five people living with mild to severe dementia were recruited across three research settings in England and Wales (residential care homes, a county hospital, and community venues). Quantitative and qualitative data on quality of life (QoL), communication and perceptions of the program were obtained through interviews and self-reports with participants and their carers. Eight domains of well-being were measured using a standardized observation tool, and data compared to an alternative activity with no art.
Across all sites, scores for the well-being domains of interest, attention, pleasure, self-esteem, negative affect, and sadness were significantly better in the art program than the alternative condition. Proxy-reported QoL significantly improved between baseline and 3-month follow-up, but no improvements in QoL were reported by the participants with dementia. This was contrasted by their qualitative accounts, which described a stimulating experience important for social connectedness, well-being, and inner-strength. Communication deteriorated between baseline and follow-up in the hospital setting, but improved in the residential care setting.
The findings highlight the potential for creative aging within dementia care, the benefits of art activities and the influence of the environment. We encourage dementia care providers and arts and cultural services to work toward embedding art activities within routine care provision.
Analysis of glass beads from the Ingombe Ilede burials provides additional information that supports McIntosh and Fagan's new dating of burials 3 and 8, and that also clarifies the chronology of some of the other burials. Following an unsuccessful attempt to locate the Ingombe Ilede beads in the Livingstone Museum, we analysed beads from a card with samples of Ingombe Ilede beads that had been originally prepared by A.P. du Toit (1965), and later sold to MuseuMAfricA in Johannesburg (Figure 1). The beads were chemically analysed using LA-ICP-MS, as part of a larger project on ancient African glass bead chemistry (Robertshaw et al.2003). All analysed beads from burials 3 and 8 belong to the Khami series produced in India and traded into southern and south-central Africa from the mid fifteenth to mid seventeenth centuries. Some beads of an earlier type were present in other graves, and may have been kept as heirlooms.
Depression and obesity are highly prevalent, and major impacts on public health frequently co-occur. Recently, we reported that having depression moderates the effect of the FTO gene, suggesting its implication in the association between depression and obesity.
To confirm these findings by investigating the FTO polymorphism rs9939609 in new cohorts, and subsequently in a meta-analysis.
The sample consists of 6902 individuals with depression and 6799 controls from three replication cohorts and two original discovery cohorts. Linear regression models were performed to test for association between rs9939609 and body mass index (BMI), and for the interaction between rs9939609 and depression status for an effect on BMI. Fixed and random effects meta-analyses were performed using METASOFT.
In the replication cohorts, we observed a significant interaction between FTO, BMI and depression with fixed effects meta-analysis (β=0.12, P = 2.7 × 10−4) and with the Han/Eskin random effects method (P = 1.4 × 10−7) but not with traditional random effects (β = 0.1, P = 0.35). When combined with the discovery cohorts, random effects meta-analysis also supports the interaction (β = 0.12, P = 0.027) being highly significant based on the Han/Eskin model (P = 6.9 × 10−8). On average, carriers of the risk allele who have depression have a 2.2% higher BMI for each risk allele, over and above the main effect of FTO.
This meta-analysis provides additional support for a significant interaction between FTO, depression and BMI, indicating that depression increases the effect of FTO on BMI. The findings provide a useful starting point in understanding the biological mechanism involved in the association between obesity and depression.
Persistent pain is common and inadequately treated in cancer patients. Behavioral pain interventions are a recommended part of multimodal pain treatments, but they are underused in clinical care due to barriers such as a lack of the resources needed to deliver them in person and difficulties coordinating their use with clinical care. Pain coping skills training (PCST) is an evidence-based behavioral pain intervention traditionally delivered in person. Delivering this training via the web would increase access to it by addressing barriers that currently limit its use. We conducted a patient pilot study of an 8-week web-based PCST program to determine the acceptability of this approach to patients and the program features needed to meet their needs. Focus groups with healthcare providers identified strategies for coordinating the use of web-based PCST in clinical care.
Participants included 7 adults with bone pain due to multiple myeloma or metastasized breast or prostate cancer and 12 healthcare providers (4 physicians and 8 advanced practice providers) who treat cancer-related bone pain. Patients completed web-based PCST at home and then took part in an in-depth qualitative interview. Providers attended focus groups led by a trained moderator. Qualitative analyses identified themes in the patient and provider data.
Patients reported strongly favorable responses to web-based PCST and described emotional and physical benefits. They offered suggestions for adapting the approach to better fit their needs and to overcome barriers to completion. Focus groups indicated a need to familiarize healthcare providers with PCST and to address concerns about overburdening patients. Providers would recommend the program to patients they felt could benefit. They suggested applying a broad definition of cancer pain and having various types of providers help coordinate program its use with clinical care.
Significance of results:
Web-based PCST was acceptable to patients and providers. Our findings suggest that patients could benefit from this approach, especially if patient and provider barriers are addressed.
Among low‐income homebuyers, a contract for deed (CFD) has been a widely used but risky and informal mechanism for purchasing a home or lot. This article examines a series of major consumer protections adopted by the Texas Legislature from 1995 to 2005 and whether this legislation shaped the behavior of sellers who historically relied on CFDs in Texas colonias. Tracking changes in the use of CFDs between 1990 and 2010, we show that developers responded to the legislative reforms by shifting away from CFDs and into other forms of seller financing. At the same time, developers have adopted a series of workarounds to the legislation (presumably legal), leaving low‐income buyers vulnerable to rapid repossession by the developer. In contrast, the impact of the legislation on low‐income residents selling their homes has been minimal. These consumer‐to‐consumer transactions remain highly informal, with ongoing reliance on the now illegal, unrecorded CFD.
It is widely accepted that binary interactions are responsible for the shaping of planetary nebula. However, these binary interactions and evolutionary channels are poorly understood. Our recent study revealed a newly discovered population of low-luminosity, low-metallicity, likely binaries in the Magellanic Clouds: dusty post-RGB stars. They are likely to have evolved off the RGB via binary interaction. In this paper we present preliminary results of the first radial velocity monitoring of the post-RGB stars in the Small Magellanic Cloud (SMC) and the implications on stellar (binary) evolution. We also investigate their link, if any, to the planetary nebulae systems.
International studies have shown that patients want their spiritual needs attended to at the end of life. The present authors developed a project to investigate people's understanding of spirituality and spiritual care practices in New Zealand (NZ) hospices.
A mixed-methods approach included 52 semistructured interviews and a survey of 642 patients, family members, and staff from 25 (78%) of NZ's hospices. We employed a generic qualitative design and analysis to capture the experiences and understandings of participants' spirituality and spiritual care, while a cross-sectional survey yielded population level information.
Our findings suggest that spirituality is broadly understood and considered important for all three of the populations studied. The patient and family populations had high spiritual needs that included a search for (1) meaning, (2) peace of mind, and (3) a degree of certainty in an uncertain world. The healthcare professionals in the hospices surveyed seldom explicitly met the needs of patients and families. Staff had spiritual needs, but organizational support was sometimes lacking in attending to these needs.
Significance of results:
As a result of our study, which was the first nationwide study in NZ to examine spirituality in hospice care, Hospice New Zealand has developed a spirituality professional development program. Given that spirituality was found to be important to the majority of our participants, it is hoped that the adoption of such an approach will impact on spiritual care for patients and families in NZ hospices.
Recent seeing measurements at the Anglo-Australian Telescope (AAT) point towards the thermal characteristics of the telescope itself, in particular the temperature difference between the mirror and the dome air, as the most important factor degrading the seeing, more so than the temperature difference between the inside and outside air. We present the findings, propose clarifying experiments, and discuss possible remedies. We set the realistic target for the AAT to achieve median seeing of 1·5″ rather than the current 1·8″.
Recent results have shown that Long-Period Variables (LPVs) with periods in the range 100 to 250 days have ages ~ 10 Gyr. We have studied the kinematics of a sample of such variables in the Large Magellanic Cloud (LMC). A comparison with the kinematics of other populations (H I gas, CO molecular clouds, planetary nebulae, CH stars and old clusters) indicates that all populations younger than the old LPVs are dominated by a single common rotating disk, with the kinematics of the old LPVs being the first to indicate the presence in the LMC of a spheroidal population, with little or no rotation and a velocity dispersion ~ 6 times larger than that of the H I gas.