Background: Improving Access to Psychological Therapies (IAPT) services address anxiety and depression in primary care, with psychotic disorders typically excluded. Our previous research found 1 in 4 patients report distressing psychotic experiences (PE) alongside common mental disorders, yet little is known about their clinical presentation and impact on recovery. Methods: We used the Community Assessment of Psychic Experiences - Positive Scale (CAPE-P15) to assess the clinical presentation and symptomatic profile of PE within IAPT settings across three National Health Service (NHS) trusts, serving a diverse population in Southern England. We identified different classes based on the reported PE frequencies using latent class analysis. Results: A total of 2,042 IAPT patients completed the CAPE-P15. The mean age was 39.8 (± 15.3) years. We identified five distinct classes of symptom profiles, findings that PE were common, especially self-referential and persecutory ideas. Prevalence and intensity increased across classes, extending to bizarre experiences and perceptual abnormalities in the fifth and least common class. Perceptual abnormalities were a strong indicator of symptom severity, with patients being the least likely to achieve recovery by the end of treatment. Limitations: Data were collected during a service evaluation. Replication of these findings across other IAPT services could prove beneficial. We did not collect information on negative PE. Conclusions: Patients seeking treatment for anxiety and depression in primary care commonly experience a wide range of positive PE. Self-referential and persecutory ideation were prevalent; perceptual abnormalities were infrequent. Providing information about prevalence and tailoring therapy may help reduce patient distress.
Fiscal space is a crucial factor that determines state capacity. Both state capacity and fiscal space, in particular, have played significant roles in facilitating rapid recovery from the pandemic. However, a report by UNESCAP (Nov. 2020) suggests that Small Island Developing States (SIDS, hereafter) with limited fiscal space have been more vulnerable to the negative impacts of the pandemic. SIDS are among the world’s lowest global emitters of greenhouse gases but are also the most vulnerable to natural disasters caused by climate change. These countries are particularly threatened by irreversible effects such as sea-level rise, ocean acidification, coastal erosion, and saltwater intrusion (UNCTAD, 2022). These challenges are existential threats to the 65 million people who call SIDS home, according to IPCC (2019) data. Moreover, limited fiscal space for these countries, already challenged by climate change before the pandemic, to provide resources to compensate for the economic losses caused by the pandemic will make implementing climate change measures even more challenging. This study provides a comparison of SIDS through stringency measures and their economic effects including responses to climate change, pre- and post-Covid-19 fiscal space. Basic statistical tools are employed to reveal if there is a correlation between fiscal space, responses to climate change, and recovery from the pandemic. The study can provide an appropriate framework to understand why some SIDS outperformed others during the pandemic and how these countries can better implement measures against climate change in the post-Covid-19 era.
Children's self-regulation is associated with their concurrent and long-term school achievement. Theorists have argued the importance of child–adult interactions in the development of children's self-regulatory skills. However, empirical findings are mixed and have produced small or modest effect sizes, which could be due to the low ecological validity of the self-regulation measures typically used. In this study, an adult-reported scale, the Child Self-Regulation in Interaction Scale (CSIS), was developed to measure preschoolers' behavioral self-regulation in their daily interactions with adults. The psychometric properties of CSIS were also examined. A total of 1015 children and their mothers from multiple regions in China participated in this study. Factor analysis indicated that a three-factor model (namely Inhibition, Updating, and Shifting) was the best fit for the data. The CSIS also had good internal consistency, test–retest reliability, and convergent and criterion validity. Additionally, the three-factor model showed satisfactory gender and longitudinal measurement invariance. The results suggest that the CSIS is a reliable and valid instrument. Children’s self-regulatory behaviors may vary in different contexts. A context-specific measure of self-regulation may have stronger ecological validity by tapping into context-specific behavioral demands and is thus likely to have greater value and utility.
In piezotronics, PN junctions usually possess both piezoelectricity and semiconductor properties. This allows them to be manipulated mechanically by external forces through the coupling between deformation and free carriers. For a conventional non-piezoelectric PN junction, however, the mechanical manipulation seems difficult to achieve. In this paper, we theoretically demonstrate that this problem may be addressed via structural design. A composite beam model consisting of a piezoelectric dielectric layer and two non-piezoelectric PN junction layers is proposed. Then its electromechanical response under three different types of shear loads is examined based on a one-dimensional phenomenological theory. Results show as expected that the electrical behaviors of the junction can be tuned mechanically when the external force is applied on the interface, which provides a new idea for the design of piezotronic devices. Further, the effects of the doping level, thickness ratio, and material combination are also investigated, providing a comprehensive understanding of the proposed composite model.
Objective Increasing numbers of young people attending university has raised concerns about the capacity of student mental health services to support them. We conducted a randomised controlled trial (RCT) to explore whether provision of an 8 week mindfulness course adapted for university students (Mindfulness Skills for Students—MSS), compared with university mental health support as usual (SAU), reduced psychological distress during the examination period. Here, we conduct an economic evaluation of MSS+SAU compared with SAU. Design and setting Economic evaluation conducted alongside a pragmatic, parallel, single-blinded RCT comparing provision of MSS+SAU to SAU. Participants 616 university students randomised. Primary and secondary outcome measures The primary economic evaluation assessed the cost per quality-adjusted life year (QALY) gained from the perspective of the university counselling service. Costs relate to staff time required to deliver counselling service offerings. QALYs were derived from the Clinical Outcomes in Routine Evaluation Dimension 6 Dimension (CORE-6D) preference based tool, which uses responses to six items of the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM; primary clinical outcome measure). Primary follow-up duration was 5 and 7 months for the two recruitment cohorts. Results It was estimated to cost £1584 (2022 prices) to deliver an MSS course to 30 students, £52.82 per student. Both costs (adjusted mean difference: £48, 95% CI £40–£56) and QALYs (adjusted mean difference: 0.014, 95% CI 0.008 to 0.021) were significantly higher in the MSS arm compared with SAU. The incremental cost-effectiveness ratio (ICER) was £3355, with a very high (99.99%) probability of being cost-effective at a willingness-to-pay threshold of £20 000 per QALY. Conclusions MSS leads to significantly improved outcomes at a moderate additional cost. The ICER of £3355 per QALY suggests that MSS is cost-effective when compared with the UK’s National Institute for Health and Care Excellence thresholds of £20 000 per QALY. Trial registration number Australian and New Zealand Clinical Trials Registry, ACTRN12615001160527.
The farmer-producer organisation (FPO) is an umbrella term used to describe modes of farmer collectivisation in India, i.e. co-operatives and companies. While women cultivators play a central role in agriculture, their continued marginalisation is reflected in a lack of engagement in FPO activities and governance structures, with only 3% of existing FPOs being female-led ventures. This paper examines the nature of tensions around social inequities—and how such tensions might be addressed in the collective spaces offered by FPOs—using a gender lens, specifically in balancing conflicting pressures of economic performance versus inclusion and meeting specific members' needs. Using a participatory research approach, a conceptual framework is developed and applied in three FPOs operating at various stages of development. With a specific focus on gender equity and social inclusion, selected cases involved FPOs with > 75% female membership and scheduled caste/tribe participation. Qualitative data on societal needs, based on the expectations and experiences of FPO participants, are then analysed to better understand (1) what might promote FPO participation and (2) how equity and inclusion may be enabled from the ‘bottom-up’. This exploratory study informs the collective action debate with its new and intersectional approach to gender equity and inclusivity. Empirical observations and within-case analyses involving FPOs provide new insights into the functioning of these institutions and nuanced interactions involving their members. Findings suggest that informal micro-producer arrangements or vyavastha , in the FPO pre-registration phase, are well positioned to act as spatial agents for establishing ethical norms as FPOs collectivise and grow. In terms of promoting social objectives and evaluating FPOs operating in different stages, a set of guiding principles are proposed with follow-on implications for policy.
Background Complex PTSD (CPTSD) is a relatively new diagnosis. The objective of the present study was to investigate how trauma characteristics, comorbid psychopathology and cognitive and social factors experienced by children and adolescents with a posttraumatic stress disorder (PTSD) diagnosis following exposure to multiple traumatic events differs between those who meet the criteria for CPTSD and those who do not. Method The present research used baseline data from the DECRYPT trial (BMJ Open, 2021, 11, e047600). Participants ( n = 120) were aged 8–17 years and had exposure to multiple traumas and a PTSD diagnosis. The data collected comprised self‐report and parent/caregiver‐report questionnaires and interviews. Three primary analyses were conducted, comparing number of trauma types, prevalence of sexual trauma and prevalence of intrafamilial abuse between the CPTSD and PTSD‐only groups. A range of comorbid psychopathology and cognitive and social factors were compared between the groups in an exploratory secondary analysis. All analyses were preregistered. Results The CPTSD group ( n = 72, 60%) had a significantly higher frequency of sexual trauma than the PTSD‐only group ( n = 48, 40%). The groups did not significantly differ on number of trauma types or prevalence of intrafamilial abuse. From the secondary analysis, the CPTSD group were found to have significantly higher scores on measures of negative post‐traumatic cognitions, depression and panic. These results were replicated in correlation analyses using a continuous measure of CPTSD symptoms. Conclusions A large proportion of youth exposed to multiple traumatic events met criteria for CPTSD. Sexual trauma appears to be related to CPTSD symptoms. Youth with CPTSD appear to have greater severity of comorbid depression and panic symptoms, as well as more negative post‐traumatic cognitions. Further investigation could focus on the directionality and mechanisms for these associations.
Tobacco use is a major cause of preventable morbidity and mortality globally. Tobacco products, including smokeless tobacco (ST), generally contain tobacco-specific N-nitrosamines (TSNAs), such as N0-nitrosonornicotine (NNN) and 4-(methylnitrosamino)-1-(3-pyridyl)-butanone (NNK), which are potent carcinogens that cause mutations in critical genes in human DNA. This review covers the series of bio-chemical and chemical transformations, related to TSNAs, leading from tobacco cultivation to cancer initiation. A key aim of this review is to provide a greater understanding of TSNAs: their precursors, the microbial and chemical mechanisms that contribute to their formation in ST, their mutagenicity leading to cancer due to ST use, and potential means of lowering TSNA levels in tobacco products. TSNAs are not present in harvested tobacco but can form due to nitrosating agents reacting with tobacco alka-loids present in tobacco during certain types of curing. TSNAs can also form during or following ST production when certain microorganisms perform nitrate metabolism, with dissimilatory nitrate reduc-tases converting nitrate to nitrite that is then released into tobacco and reacts chemically with tobacco alkaloids. When ST usage occurs, TSNAs are absorbed and metabolized to reactive compounds that form DNA adducts leading to mutations in critical target genes, including the RAS oncogenes and the p53 tumor suppressor gene. DNA repair mechanisms remove most adducts induced by carcinogens, thus preventing many but not all mutations. Lastly, because TSNAs and other agents cause cancer, pre-viously documented strategies for lowering their levels in ST products are discussed, including using tobacco with lower nornicotine levels, pasteurization and other means of eliminating microorganisms, omitting fermentation and fire-curing, refrigerating ST products, and including nitrite scavenging chem-icals as ST ingredients.
Molecular tools for modulating transgene expression in Aedes aegypti are few. Here we demonstrate that adjustments to the AePUb promoter length can alter expression levels of two reporter proteins in Ae. aegypti cell culture and in mosquitoes. This provides a simple means for increasing or decreasing expression of a gene of interest and easy translation from cells to whole insects.
We investigate the groups of units of one-relator and special inverse monoids. These are inverse monoids which are defined by presentations, where all the defining relations are of the form $r=1$ . We develop new approaches for finding presentations for the group of units of a special inverse monoid, and apply these methods to give conditions under which the group admits a presentation with the same number of defining relations as the monoid. In particular, our results give sufficient conditions for the group of units of a one-relator inverse monoid to be a one-relator group. When these conditions are satisfied, these results give inverse semigroup theoretic analogues of classical results of Adjan for one-relator monoids, and Makanin for special monoids. In contrast, we show that in general these classical results do not hold for one-relator and special inverse monoids. In particular, we show that there exists a one-relator special inverse monoid whose group of units is not a one-relator group (with respect to any generating set), and we show that there exists a finitely presented special inverse monoid whose group of units is not finitely presented.
The aim of the present study was to reach international consensus on the minimum set of outcomes to measure and report in adult traumatic brachial plexus injury care and research. This would facilitate comparison of outcomes from different centres and meta-analysis in research. A list of outcomes was developed from a systematic review ( n = 54) and patient interviews ( n = 12). The outcomes were rated in a three-round online Delphi survey completed by international surgeons, patients and therapists. Two online consensus meetings with patients and clinicians ratified the final core outcome set. A total of 72 people (20 surgeons, 21 patients, 31 therapists) from 19 countries completed all survey rounds. Thirty-eight people from nine countries attended separate patient ( n = 13) and clinician consensus ( n = 25) meetings. Outcomes were included if recommended by more than 85% of contributors. Pain, voluntary movement and carrying out a daily routine are the core outcome domains that should be assessed and reported when treating and researching adults with a traumatic brachial plexus injury. Level of evidence V
Veganism, Archives and Animals: Geographies of a Multispecies World Veganism, Archives and Animals: Geographies of a Multispecies World , by Catherine Oliver. London: Routledge, 2022144 + xiv pp., £38.99 paperback (ISBN: 978-0-367-69278-0); £130.00 hardcover (ISBN: 978-0-367-69277-3): by Catherine Oliver. London: Routledge, 2022 144 + xiv pp., £38.99 paperback (ISBN: 978-0-367-69278-0); £130.00 hardcover (ISBN: 978-0-367-69277-3)
One of the most common distinctions in long-term memory is that between semantic (i.e., general world knowledge) and episodic (i.e., recollection of contextually specific events from one’s past). However, emerging cognitive neuroscience data suggest a surprisingly large overlap between the neural correlates of semantic and episodic memory. Moreover, personal semantic memories (i.e., knowledge about the self and one’s life) have been studied little and do not easily fit into the standard semantic-episodic dichotomy. Here, we used fMRI to record brain activity while 48 participants verified statements concerning general facts, autobiographical facts, repeated events, and unique events. In multivariate analysis, all four types of memory involved activity within a common network bilaterally (e.g., frontal pole, paracingulate gyrus, medial frontal cortex, middle/superior temporal gyrus, precuneus, posterior cingulate, angular gyrus) and some areas of the medial temporal lobe. Yet the four memory types differentially engaged this network, increasing in activity from general to autobiographical facts, from autobiographical facts to repeated events, and from repeated to unique events. Our data are compatible with a component process model, in which declarative memory types rely on different weightings of the same elementary processes, such as perceptual imagery, spatial features, and self-reflection.
Culex mosquitoes pose a significant public health threat as vectors for a variety of diseases including West Nile virus and lymphatic filariasis, and transmit pathogens threatening livestock, companion animals, and endangered birds. Rampant insecticide resistance makes controlling these mosquitoes challenging and necessitates the development of new control strategies. Gene drive technologies have made significant progress in other mosquito species, although similar advances have been lagging in Culex. Here we test a CRISPR-based homing gene drive for Culex quinquefasciatus, and show that the inheritance of two split-gene-drive transgenes, targeting different loci, are biased in the presence of a Cas9-expressing transgene although with modest efficiencies. Our findings extend the list of disease vectors where engineered homing gene drives have been demonstrated to include Culex alongside Anopheles and Aedes, and pave the way for future development of these technologies to control Culex mosquitoes.
Stroke services must detect and manage psychological and neuropsychological problems that occur after stroke, such as cognitive and language impairments, post-stroke apathy, post-stroke emotionalism, depression, anxiety, post-traumatic stress disorder, personality changes and suicidality. Stroke neuropsychology plays a key role in the assessment, understanding and management of these consequences of stroke, as well as contributing to complex case management, staff supervision and training. Where these provisions are absent from the stroke rehabilitation pathway, this significantly limits potential rehabilitation outcomes. To manage the scale of psychological and neuropsychological needs post stroke, clinical guidance recommends the use of a matched care system, in which these needs are triaged and matched with corresponding levels of support. Recent workforce guidelines provide clear professional recommendations for psychological staffing skill mix and threshold requirements for clinical oversight and clinical governance assurances.
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