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Approximately 60 000 people in England have coexisting type 2 diabetes mellitus (T2DM) and severe mental illness (SMI). They are more likely to have poorer health outcomes and require more complex care pathways compared with those with T2DM alone. Despite increasing prevalence, little is known about the healthcare resource use and costs for people with both conditions.
To assess the impact of SMI on healthcare resource use and service costs for adults with T2DM, and explore the predictors of healthcare costs and lifetime costs for people with both conditions.
This was a matched-cohort study using data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics for 1620 people with comorbid SMI and T2DM and 4763 people with T2DM alone. Generalised linear models and the Bang and Tsiatis method were used to explore cost predictors and mean lifetime costs respectively.
There were higher average annual costs for people with T2DM and SMI (£1930 higher) than people with T2DM alone, driven primarily by mental health and non-mental health-related hospital admissions. Key predictors of higher total costs were older age, comorbid hypertension, use of antidepressants, use of first-generation antipsychotics, and increased duration of living with both conditions. Expected lifetime costs were approximately £35 000 per person with both SMI and T2DM. Extrapolating nationally, this would generate total annual costs to the National Health Service of around £250 m per year.
Our estimates of resource use and costs for people with both T2DM and SMI will aid policymakers and commissioners in service planning and resource allocation.
The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.
Our aim was to develop a brief cognitive behavioural therapy (CBT) protocol to augment treatment for social anxiety disorder (SAD). This protocol focused specifically upon fear of positive evaluation (FPE). To our knowledge, this is the first protocol that has been designed to systematically target FPE.
To test the feasibility of a brief (two-session) CBT protocol for FPE and report proof-of-principle data in the form of effect sizes.
Seven patients with a principal diagnosis of SAD were recruited to participate. Following a pre-treatment assessment, patients were randomized to either (a) an immediate CBT condition (n = 3), or (b) a comparable wait-list (WL) period (2 weeks; n = 4). Two WL patients also completed the CBT protocol following the WL period (delayed CBT condition). Patients completed follow-up assessments 1 week after completing the protocol.
A total of five patients completed the brief, FPE-specific CBT protocol (two of the seven patients were wait-listed only and did not complete delayed CBT). All five patients completed the protocol and provided 1-week follow-up data. CBT patients demonstrated large reductions in FPE-related concerns as well as overall social anxiety symptoms, whereas WL patients demonstrated an increase in FPE-related concerns.
Our brief FPE-specific CBT protocol is feasible to use and was associated with large FPE-specific and social anxiety symptom reductions. To our knowledge, this is the first treatment report that has focused on systematic treatment of FPE in patients with SAD. Our protocol warrants further controlled evaluation.
Lewy body dementia, consisting of both dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), is considerably under-recognised clinically compared with its frequency in autopsy series.
This study investigated the clinical diagnostic pathways of patients with Lewy body dementia to assess if difficulties in diagnosis may be contributing to these differences.
We reviewed the medical notes of 74 people with DLB and 72 with non-DLB dementia matched for age, gender and cognitive performance, together with 38 people with PDD and 35 with Parkinson's disease, matched for age and gender, from two geographically distinct UK regions.
The cases of individuals with DLB took longer to reach a final diagnosis (1.2 v. 0.6 years, P = 0.017), underwent more scans (1.7 v. 1.2, P = 0.002) and had more alternative prior diagnoses (0.8 v. 0.4, P = 0.002), than the cases of those with non-DLB dementia. Individuals diagnosed in one region of the UK had significantly more core features (2.1 v. 1.5, P = 0.007) than those in the other region, and were less likely to have dopamine transporter imaging (P < 0.001). For patients with PDD, more than 1.4 years prior to receiving a dementia diagnosis: 46% (12 of 26) had documented impaired activities of daily living because of cognitive impairment, 57% (16 of 28) had cognitive impairment in multiple domains, with 38% (6 of 16) having both, and 39% (9 of 23) already receiving anti-dementia drugs.
Our results show the pathway to diagnosis of DLB is longer and more complex than for non-DLB dementia. There were also marked differences between regions in the thresholds clinicians adopt for diagnosing DLB and also in the use of dopamine transporter imaging. For PDD, a diagnosis of dementia was delayed well beyond symptom onset and even treatment.
A physical oceanographic, geophysical and marine geological survey of Edward VIII Gulf, Kemp Coast, collected data from conductivity–temperature–depth casts, multi-beam bathymetric swath mapping and 3.5 kHz sub-bottom surveying. Modified circumpolar deep water (mCDW) is observed in Edward VIII Gulf, as well as notable bathymetric features including mega-scale glacial lineations and a 1750 m-deep trough. Sedimentological, geochemical, rock-magnetic and micropalaeontological analysis of two kasten cores document regional palaeoclimate and palaeo-oceanographic conditions over the past 8000 years, with a warm period occurring from c. 8 to 4 ka and a shift to cooler conditions beginning at c. 4 ka and persisting until at least 0.9 ka. Sediment packages > 40 m thick within deep troughs in Edward VIII Gulf present potential targets for higher-resolution Holocene and deglacial climate studies. Despite the presence of mCDW on the shelf, inland bed topography consisting of highland terrain suggests the likelihood of relative stability of this sector of the East Antarctic Ice Sheet.
Examining neurometabolic abnormalities in critical brain areas in schizophrenia and major depressive disorder (MDD) may help guide future pharmacological interventions including glutamate-modulating treatments.
To measure metabolite concentrations within the anterior cingulate cortex (ACC) and thalamus of people with schizophrenia and people with MDD.
Spectra were acquired from 16 volunteers with schizophrenia, 17 with MDD and 18 healthy controls using magnetic resonance spectroscopy on a 7 Tesla scanner.
In the thalamus, there were lower glycine concentrations in the schizophrenia group relative to control (P=0.017) and MDD groups (P=0.012), and higher glutamine concentrations relative to healthy controls (P=0.009). In the thalamus and the ACC, the MDD group had lower myo-inositol concentrations than the control (P=0.014, P=0.009, respectively) and schizophrenia (P=0.004, P=0.002, respectively) groups.
These results support the glutamatergic theory of schizophrenia and indicate a potential glycine deficiency in the thalamus. In addition, reduced myo-inositol concentrations in MDD suggest its involvement in the disorder.
Present and past gas-fuelling of galaxies is expected to depend upon both the properties of the galaxies themselves, as well as their larger-scale environments. In the case of galaxies in groups the environment, i.e the group mass, can be probed by measuring the velocity dispersion of the group members, as done with the GAMA Galaxy Group catalogue (Robotham et al. 2011), probing the halo mass function all the way to small groups. The gas-fuelling rate of normal late-type galaxies can be traced by the SFR under the assumption of a steady state between gas-fuelling and gas-consumption by SF. We present a method to estimate disk opacities from UV/optical photometric characteristics, calibrated using the radiative transfer model of Popescu et al. (2011), applied to UV-Opt-FIR GAMA/H-ATLAS photometry for a subset of GAMA galaxies. We use the method to extract attenuation corrected SFRs for a large sample of late-type GAMA galaxies, which we use in an initial application to constrain the dependency of star formation/gas-fuelling in late-type galaxies on mass of parent DMH, and compactness of galaxy group.
Background: Manualized cognitive-behavioural therapy (MCBT) approaches to treating adolescent anxiety and depression have been shown to be effective in recent years, as have MCBT for adult self-harm (SH). Aims: This paper describes the rationale for, development and pilot evaluation of the efficacy of a novel manualized CBT package for adolescent self-harm (SH). It also addresses the acceptability of this treatment package to therapists and patients. Method: Twenty-five adolescents (aged 12–18 years) presenting to a Community Child and Adolescent Mental Health Service (CAMHS) in Greater London with SH behaviour began the “Cutting Down” programme and 16 (64%) completed the treatment. Outcomes were assessed at baseline, at the end of treatment and at 3 month follow up. Results: Significant reductions in self-harm behaviour, depression symptoms and trait anxiety were reported. There was no change in state anxiety or in levels of parental expressed emotion as perceived by the adolescent. Conclusion: These pilot findings provide preliminary support for the efficacy and acceptability of this time-limited CBT package for adolescents who self-harm.
The business meeting of Division X in the IAU 2009GA took place in three sessions during the day of August 6, 2009. The meeting, being well attended, started with the approval for the meeting agenda. Then the triennium reports were made in the first session by the president of Division X, Ren-Dong Nan, and by the chairs of three working groups: “Historic Radio Astronomy WG” by Wayne Orchiston, “Astrophysically Important Lines WG” by Masatoshi Ohishi, and “Global VLBI WG” by Tasso Tzioumis (proxy chair appointed by Steven Tingay). Afterwards, a dozen reports from observatories and worldwide significant projects have been presented in the second session. Business meeting of “Interference Mitigation WG” was located in the third session.
Since the invention of organic electroluminescent devices, a great deal of effort has been made to improve their performance. Reducing the barrier and optimizing charge injection is crucial for efficient and bright Organic Light Emitting Diodes (OLEDs). We report the performance of OLEDs with ITO/TPD/Alq3/Al structure by inserting LiF both at electrode-organic interfaces and organic-organic interface. We elucidate the mechanism of the LiF buffer layer inserted at different interfaces. The device with LiF as a cathode injection layer shows improved luminescence and steeper IV characteristics.
Simple alkanedithiols exhibit the same molecular conductance whether measured in air, under vacuum or under liquids of different polarity. Here, we show that the presence of water ‘gates’ the conductance of a family of oligothiophene–containing molecular wires, and that the longer the oligothiophene, the larger is the effect; for the longest example studied, the molecular conductance is over two orders of magnitude larger in the presence of water, an unprecedented result suggesting that ambient water is a crucial factor to be taken into account when measuring single molecule conductances (SMC), or in the design of future molecular electronic devices. Theoretical investigation of electron transport through the molecules, using the ab initio non-equilibrium Green's function (SMEAGOL) method, shows that water molecules interact with the thiophene rings, shifting the transport resonances enough to increase greatly the SMC of the longer, more conjugated examples.
Organic light-emitting devices (OLEDs) emitting near-infrared (NIR) light have many potential applications, yet the efficiency of these devices remains very low, typically ˜0.1% or less. Here we report efficiency NIR OLEDs based on two fluorescent donor-acceptor-donor oligomers and a phosphorescent Pt-containing organometallic complex. External quantum efficiencies in the range of 0.5–3.8% with emission peak ranging from 700 to 890 nm have been achieved.