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Rethinking the course of psychotic disorders: modelling long-term symptom trajectories
- Craig Morgan, Paola Dazzan, Julia Lappin, Margaret Heslin, Kim Donoghue, Paul Fearon, Peter B Jones, Robin M Murray, Gillian A Doody, Ulrich Reininghaus
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- Journal:
- Psychological Medicine / Volume 52 / Issue 13 / October 2022
- Published online by Cambridge University Press:
- 04 February 2021, pp. 2641-2650
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Background
The clinical course of psychotic disorders is highly variable. Typically, researchers have captured different course types using broad pre-defined categories. However, whether these adequately capture symptom trajectories of psychotic disorders has not been fully assessed. Using data from AESOP-10, we sought to identify classes of individuals with specific symptom trajectories over a 10-year follow-up using a data-driven approach.
MethodAESOP-10 is a follow-up, at 10 years, of 532 incident cases with a first episode of psychosis initially identified in south-east London and Nottingham, UK. Using extensive information on fluctuations in the presence of psychotic symptoms, we fitted growth mixture models to identify latent trajectory classes that accounted for heterogeneity in the patterns of change in psychotic symptoms over time.
ResultsWe had sufficient data on psychotic symptoms during the follow-up on 326 incident patients. A four-class quadratic growth mixture model identified four trajectories of psychotic symptoms: (1) remitting-improving (58.5%); (2) late decline (5.6%); (3) late improvement (5.4%); (4) persistent (30.6%). A persistent trajectory, compared with remitting-improving, was associated with gender (more men), black Caribbean ethnicity, low baseline education and high disadvantage, low premorbid IQ, a baseline diagnosis of non-affective psychosis and long DUP. Numbers were small, but there were indications that those with a late decline trajectory more closely resembled those with a persistent trajectory.
ConclusionOur current approach to categorising the course of psychotic disorders may misclassify patients. This may confound efforts to elucidate the predictors of long-term course and related biomarkers.
Symptom remission at 12-weeks strongly predicts long-term recovery from the first episode of psychosis
- Paola Dazzan, Julia M. Lappin, Margaret Heslin, Kim Donoghue, Ben Lomas, Uli Reininghaus, Adanna Onyejiaka, Tim Croudace, Peter B. Jones, Robin M. Murray, Paul Fearon, Gillian A. Doody, Craig Morgan
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- Journal:
- Psychological Medicine / Volume 50 / Issue 9 / July 2020
- Published online by Cambridge University Press:
- 25 July 2019, pp. 1452-1462
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Background
To determine the baseline individual characteristics that predicted symptom recovery and functional recovery at 10-years following the first episode of psychosis.
MethodsAESOP-10 is a 10-year follow up of an epidemiological, naturalistic population-based cohort of individuals recruited at the time of their first episode of psychosis in two areas in the UK (South East London and Nottingham). Detailed information on demographic, clinical, and social factors was examined to identify which factors predicted symptom and functional remission and recovery over 10-year follow-up. The study included 557 individuals with a first episode psychosis. The main study outcomes were symptom recovery and functional recovery at 10-year follow-up.
ResultsAt 10 years, 46.2% (n = 140 of 303) of patients achieved symptom recovery and 40.9% (n = 117) achieved functional recovery. The strongest predictor of symptom recovery at 10 years was symptom remission at 12 weeks (adj OR 4.47; CI 2.60–7.67); followed by a diagnosis of depression with psychotic symptoms (adj OR 2.68; CI 1.02–7.05). Symptom remission at 12 weeks was also a strong predictor of functional recovery at 10 years (adj OR 2.75; CI 1.23–6.11), together with being from Nottingham study centre (adj OR 3.23; CI 1.25–8.30) and having a diagnosis of mania (adj OR 8.17; CI 1.61–41.42).
ConclusionsSymptom remission at 12 weeks is an important predictor of both symptom and functional recovery at 10 years, with implications for illness management. The concepts of clinical and functional recovery overlap but should be considered separately.
OP161 Relationship Between Appropriateness And Arthroplasty Recommendation
- Deborah Marshall, Peter Faris, Allyson Jones, Tom Noseworthy, Don Dick, Jane Squire Howden, Linda Woodhouse, Tania Reczek, Eric Bohm, Michael Dunbar, Gillian Hawker
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 34 / Issue S1 / 2018
- Published online by Cambridge University Press:
- 03 January 2019, pp. 58-59
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Introduction:
We examined relationships between measures of total knee arthroplasty (TKA) “appropriateness” constructs and surgeon TKA recommendations in people with knee osteoarthritis (OA). Although TKA is highly effective, fifteen to thirty percent of recipients report dissatisfaction and/or little or no symptom improvement. More appropriate selection of surgical candidates may improve both patient outcomes and healthcare resource use, but no validated appropriateness criteria exist currently in Canada.
Methods:Patients 30 years of age or older with knee OA referred for surgical consultation at two large joint arthroplasty centres in Alberta, Canada were invited to participate. Participants completed a standardized pre-consult questionnaire, which included the following sociodemographics and validated measures of appropriateness constructs for TKA: knee symptoms; non-surgical management; patient readiness for and expectations of TKA; and net patient benefit. Post-consultation, surgeons were asked to confirm knee OA and their recommendation. We used multivariable logistic regression to examine the relationship between measures of appropriateness constructs and receipt of surgeon TKA recommendation.
Results:Of 3,009 patients approached, 2,360 completed the questionnaire and 2,064 (sixty-nine percent) were eligible at surgical consultation (mean age 65.7 years, standard deviation 9.1; fifty-nine percent were women); 1,495 (seventy-two percent) were recommended for TKA. The likelihood of receiving a TKA recommendation was independently associated with: knee symptoms (odds ratio [OR] per unit increase in pain intensity, 1.19 (95% confidence interval [CI]: 1.11–1.27)); prior non-surgical OA management (OR for prior knee injection, 1.53 (95% CI: 1.21–1.94)); readiness for surgery (OR if definitely/probably willing to undergo TKA, 3.03 (95% CI: 1.99–4.59)); and TKA expectations (OR outcome “very important”: ability to perform daily activities, 1.40 (95% CI: 1.04–1.88); straighten the knee/leg 1.42 (95% CI: 1.13–1.80); participate in exercise/sports 0.75 (95% CI: 0.58–0.98)).
Conclusions:In our cohort of patients with confirmed knee OA who consulted a surgeon for TKA, appropriateness constructs were significantly associated with receipt of a TKA recommendation. Research is ongoing to evaluate the predictive validity of these measures for patient-reported outcomes associated with TKA.
Neuropsychological function at first episode in treatment-resistant psychosis: findings from the ÆSOP-10 study
- Eugenia Kravariti, Arsime Demjaha, Jolanta Zanelli, Fowzia Ibrahim, Catherine Wise, James H. MacCabe, Abraham Reichenberg, Izabela Pilecka, Kevin Morgan, Paul Fearon, Craig Morgan, Gillian A. Doody, Kim Donoghue, Peter B. Jones, Anil Şafak Kaçar, Paola Dazzan, Julia Lappin, Robin M. Murray
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- Journal:
- Psychological Medicine / Volume 49 / Issue 12 / September 2019
- Published online by Cambridge University Press:
- 23 October 2018, pp. 2100-2110
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Background
Neuropsychological investigations can help untangle the aetiological and phenomenological heterogeneity of schizophrenia but have scarcely been employed in the context of treatment-resistant (TR) schizophrenia. No population-based study has examined neuropsychological function in the first-episode of TR psychosis.
MethodsWe report baseline neuropsychological findings from a longitudinal, population-based study of first-episode psychosis, which followed up cases from index admission to 10 years. At the 10-year follow up patients were classified as treatment responsive or TR after reconstructing their entire case histories. Of 145 cases with neuropsychological data at baseline, 113 were classified as treatment responsive, and 32 as TR at the 10-year follow-up.
ResultsCompared with 257 community controls, both case groups showed baseline deficits in three composite neuropsychological scores, derived from principal component analysis: verbal intelligence and fluency, visuospatial ability and executive function, and verbal memory and learning (p values⩽0.001). Compared with treatment responders, TR cases showed deficits in verbal intelligence and fluency, both in the extended psychosis sample (t = −2.32; p = 0.022) and in the schizophrenia diagnostic subgroup (t = −2.49; p = 0.017). Similar relative deficits in the TR cases emerged in sub-/sensitivity analyses excluding patients with delayed-onset treatment resistance (p values<0.01–0.001) and those born outside the UK (p values<0.05).
ConclusionsVerbal intelligence and fluency are impaired in patients with TR psychosis compared with those who respond to treatment. This differential is already detectable – at a group level – at the first illness episode, supporting the conceptualisation of TR psychosis as a severe, pathogenically distinct variant, embedded in aberrant neurodevelopmental processes.
Ethnicity and long-term course and outcome of psychotic disorders in a UK sample: The ÆSOP-10 study
- Craig Morgan, Paul Fearon, Julia Lappin, Margaret Heslin, Kim Donoghue, Ben Lomas, Ulrich Reininghaus, Adanna Onyejiaka, Tim Croudace, Peter B. Jones, Robin M. Murray, Gillian A. Doody, Paola Dazzan
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- Journal:
- The British Journal of Psychiatry / Volume 211 / Issue 2 / August 2017
- Published online by Cambridge University Press:
- 02 January 2018, pp. 88-94
- Print publication:
- August 2017
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Background
The incidence of psychotic disorders is elevated in some minority ethnic populations. However, we know little about the outcome of psychoses in these populations.
AimsTo investigate patterns and determinants of long-term course and outcome of psychoses by ethnic group following a first episode.
MethodÆSOP-10 is a 10-year follow-up of an ethnically diverse cohort of 532 individuals with first-episode psychosis identified in the UK. Information was collected, at baseline, on clinical presentation and neurodevelopmental and social factors and, at follow-up, on course and outcome.
ResultsThere was evidence that, compared with White British, Black Caribbean patients experienced worse clinical, social and service use outcomes and Black African patients experienced worse social and service use outcomes. There was evidence that baseline social disadvantage contributed to these disparities.
ConclusionsThese findings suggest ethnic disparities in the incidence of psychoses extend, for some groups, to worse outcomes in multiple domains.
Callous–unemotional traits in adolescents with autism spectrum disorder
- Virginia Carter Leno, Tony Charman, Andrew Pickles, Catherine R. G. Jones, Gillian Baird, Francesca Happé, Emily Simonoff
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- Journal:
- The British Journal of Psychiatry / Volume 207 / Issue 5 / November 2015
- Published online by Cambridge University Press:
- 02 January 2018, pp. 392-399
- Print publication:
- November 2015
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Background
People with callous–unemotional traits and also those with autism spectrum disorder (ASD) display sociocognitive difficulties. However, the frequency and neurocognitive correlates of callous–unemotional traits within individuals with ASD are unknown.
AimsTo determine the prevalence of callous–unemotional traits in individuals with ASD and test their association with behavioural and cognitive measures.
MethodParents of 92 adolescents with ASD completed the Antisocial Processes Screening Device (APSD) for callous–unemotional traits. Adolescents participated in tasks of emotion recognition, theory of mind and cognitive flexibility.
ResultsIn total 51% (n = 47) scored above a cut-off expected to identify the top 6% on the APSD. Of these 17% (n = 8) had concurrent conduct problems. Regression analyses found callous–unemotional traits were associated with specific impairment in fear recognition but not with theory of mind or cognitive flexibility.
ConclusionsAdolescents with ASD show high rates of callous–unemotional traits but, unlike in the general population, these are not strongly associated with conduct problems. The relationship of callous–unemotional traits to impairments in fear recognition suggests similar affective difficulties as in individuals with callous–unemotional traits without ASD.
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. Flowers, Carole Fontaine, David Ford, Mary Ford, Stephanie A. Ford, Jim Forest, William Franke, Robert M. Franklin, Ruth Franzén, Edward H. Friedman, Samuel Frouisou, Lorelei F. Fuchs, Jojo M. Fung, Inger Furseth, Richard R. Gaillardetz, Brandon Gallaher, China Galland, Mark Galli, Ismael García, Tharscisse Gatwa, Jean-Marie Gaudeul, Luis María Gavilanes del Castillo, Pavel L. Gavrilyuk, Volney P. Gay, Metropolitan Athanasios Geevargis, Kondothra M. George, Mary Gerhart, Simon Gikandi, Maurice Gilbert, Michael J. Gillgannon, Verónica Giménez Beliveau, Terryl Givens, Beth Glazier-McDonald, Philip Gleason, Menghun Goh, Brian Golding, Bishop Hilario M. Gomez, Michelle A. Gonzalez, Donald K. Gorrell, Roy Gottfried, Tamara Grdzelidze, Joel B. Green, Niels Henrik Gregersen, Cristina Grenholm, Herbert Griffiths, Eric W. Gritsch, Erich S. Gruen, Christoffer H. Grundmann, Paul H. Gundani, Jon P. Gunnemann, Petre Guran, Vidar L. Haanes, Jeremiah M. Hackett, Getatchew Haile, Douglas John Hall, Nicholas Hammond, Daphne Hampson, Jehu J. Hanciles, Barry Hankins, Jennifer Haraguchi, Stanley S. Harakas, Anthony John Harding, Conrad L. Harkins, J. William Harmless, Marjory Harper, Amir Harrak, Joel F. Harrington, Mark W. Harris, Susan Ashbrook Harvey, Van A. Harvey, R. Chris Hassel, Jione Havea, Daniel Hawk, Diana L. Hayes, Leslie Hayes, Priscilla Hayner, S. Mark Heim, Simo Heininen, Richard P. Heitzenrater, Eila Helander, David Hempton, Scott H. Hendrix, Jan-Olav Henriksen, Gina Hens-Piazza, Carter Heyward, Nicholas J. Higham, David Hilliard, Norman A. Hjelm, Peter C. Hodgson, Arthur Holder, M. Jan Holton, Dwight N. Hopkins, Ronnie Po-chia Hsia, Po-Ho Huang, James Hudnut-Beumler, Jennifer S. Hughes, Leonard M. Hummel, Mary E. Hunt, Laennec Hurbon, Mark Hutchinson, Susan E. Hylen, Mary Beth Ingham, H. Larry Ingle, Dale T. Irvin, Jon Isaak, Paul John Isaak, Ada María Isasi-Díaz, Hans Raun Iversen, Margaret C. Jacob, Arthur James, Maria Jansdotter-Samuelsson, David Jasper, Werner G. Jeanrond, Renée Jeffery, David Lyle Jeffrey, Theodore W. Jennings, David H. Jensen, Robin Margaret Jensen, David Jobling, Dale A. Johnson, Elizabeth A. Johnson, Maxwell E. Johnson, Sarah Johnson, Mark D. Johnston, F. Stanley Jones, James William Jones, John R. Jones, Alissa Jones Nelson, Inge Jonsson, Jan Joosten, Elizabeth Judd, Mulambya Peggy Kabonde, Robert Kaggwa, Sylvester Kahakwa, Isaac Kalimi, Ogbu U. Kalu, Eunice Kamaara, Wayne C. Kannaday, Musimbi Kanyoro, Veli-Matti Kärkkäinen, Frank Kaufmann, Léon Nguapitshi Kayongo, Richard Kearney, Alice A. Keefe, Ralph Keen, Catherine Keller, Anthony J. Kelly, Karen Kennelly, Kathi Lynn Kern, Fergus Kerr, Edward Kessler, George Kilcourse, Heup Young Kim, Kim Sung-Hae, Kim Yong-Bock, Kim Yung Suk, Richard King, Thomas M. King, Robert M. Kingdon, Ross Kinsler, Hans G. Kippenberg, Cheryl A. Kirk-Duggan, Clifton Kirkpatrick, Leonid Kishkovsky, Nadieszda Kizenko, Jeffrey Klaiber, Hans-Josef Klauck, Sidney Knight, Samuel Kobia, Robert Kolb, Karla Ann Koll, Heikki Kotila, Donald Kraybill, Philip D. W. Krey, Yves Krumenacker, Jeffrey Kah-Jin Kuan, Simanga R. Kumalo, Peter Kuzmic, Simon Shui-Man Kwan, Kwok Pui-lan, André LaCocque, Stephen E. Lahey, John Tsz Pang Lai, Emiel Lamberts, Armando Lampe, Craig Lampe, Beverly J. Lanzetta, Eve LaPlante, Lizette Larson-Miller, Ariel Bybee Laughton, Leonard Lawlor, Bentley Layton, Robin A. Leaver, Karen Lebacqz, Archie Chi Chung Lee, Marilyn J. Legge, Hervé LeGrand, D. L. LeMahieu, Raymond Lemieux, Bill J. Leonard, Ellen M. Leonard, Outi Leppä, Jean Lesaulnier, Nantawan Boonprasat Lewis, Henrietta Leyser, Alexei Lidov, Bernard Lightman, Paul Chang-Ha Lim, Carter Lindberg, Mark R. Lindsay, James R. Linville, James C. Livingston, Ann Loades, David Loades, Jean-Claude Loba-Mkole, Lo Lung Kwong, Wati Longchar, Eleazar López, David W. Lotz, Andrew Louth, Robin W. Lovin, William Luis, Frank D. Macchia, Diarmaid N. J. MacCulloch, Kirk R. MacGregor, Marjory A. MacLean, Donald MacLeod, Tomas S. Maddela, Inge Mager, Laurenti Magesa, David G. Maillu, Fortunato Mallimaci, Philip Mamalakis, Kä Mana, Ukachukwu Chris Manus, Herbert Robinson Marbury, Reuel Norman Marigza, Jacqueline Mariña, Antti Marjanen, Luiz C. L. Marques, Madipoane Masenya (ngwan'a Mphahlele), Caleb J. D. Maskell, Steve Mason, Thomas Massaro, Fernando Matamoros Ponce, András Máté-Tóth, Odair Pedroso Mateus, Dinis Matsolo, Fumitaka Matsuoka, John D'Arcy May, Yelena Mazour-Matusevich, Theodore Mbazumutima, John S. McClure, Christian McConnell, Lee Martin McDonald, Gary B. McGee, Thomas McGowan, Alister E. McGrath, Richard J. McGregor, John A. McGuckin, Maud Burnett McInerney, Elsie Anne McKee, Mary B. McKinley, James F. McMillan, Ernan McMullin, Kathleen E. McVey, M. Douglas Meeks, Monica Jyotsna Melanchthon, Ilie Melniciuc-Puica, Everett Mendoza, Raymond A. Mentzer, William W. Menzies, Ina Merdjanova, Franziska Metzger, Constant J. Mews, Marvin Meyer, Carol Meyers, Vasile Mihoc, Gunner Bjerg Mikkelsen, Maria Inêz de Castro Millen, Clyde Lee Miller, Bonnie J. Miller-McLemore, Alexander Mirkovic, Paul Misner, Nozomu Miyahira, R. W. L. Moberly, Gerald Moede, Aloo Osotsi Mojola, Sunanda Mongia, Rebeca Montemayor, James Moore, Roger E. Moore, Craig E. Morrison O.Carm, Jeffry H. Morrison, Keith Morrison, Wilson J. Moses, Tefetso Henry Mothibe, Mokgethi Motlhabi, Fulata Moyo, Henry Mugabe, Jesse Ndwiga Kanyua Mugambi, Peggy Mulambya-Kabonde, Robert Bruce Mullin, Pamela Mullins Reaves, Saskia Murk Jansen, Heleen L. Murre-Van den Berg, Augustine Musopole, Isaac M. T. Mwase, Philomena Mwaura, Cecilia Nahnfeldt, Anne Nasimiyu Wasike, Carmiña Navia Velasco, Thulani Ndlazi, Alexander Negrov, James B. Nelson, David G. Newcombe, Carol Newsom, Helen J. Nicholson, George W. E. Nickelsburg, Tatyana Nikolskaya, Damayanthi M. A. Niles, Bertil Nilsson, Nyambura Njoroge, Fidelis Nkomazana, Mary Beth Norton, Christian Nottmeier, Sonene Nyawo, Anthère Nzabatsinda, Edward T. Oakes, Gerald O'Collins, Daniel O'Connell, David W. Odell-Scott, Mercy Amba Oduyoye, Kathleen O'Grady, Oyeronke Olajubu, Thomas O'Loughlin, Dennis T. Olson, J. Steven O'Malley, Cephas N. Omenyo, Muriel Orevillo-Montenegro, César Augusto Ornellas Ramos, Agbonkhianmeghe E. Orobator, Kenan B. Osborne, Carolyn Osiek, Javier Otaola Montagne, Douglas F. Ottati, Anna May Say Pa, Irina Paert, Jerry G. Pankhurst, Aristotle Papanikolaou, Samuele F. Pardini, Stefano Parenti, Peter Paris, Sung Bae Park, Cristián G. Parker, Raquel Pastor, Joseph Pathrapankal, Daniel Patte, W. Brown Patterson, Clive Pearson, Keith F. Pecklers, Nancy Cardoso Pereira, David Horace Perkins, Pheme Perkins, Edward N. Peters, Rebecca Todd Peters, Bishop Yeznik Petrossian, Raymond Pfister, Peter C. Phan, Isabel Apawo Phiri, William S. F. Pickering, Derrick G. Pitard, William Elvis Plata, Zlatko Plese, John Plummer, James Newton Poling, Ronald Popivchak, Andrew Porter, Ute Possekel, James M. Powell, Enos Das Pradhan, Devadasan Premnath, Jaime Adrían Prieto Valladares, Anne Primavesi, Randall Prior, María Alicia Puente Lutteroth, Eduardo Guzmão Quadros, Albert Rabil, Laurent William Ramambason, Apolonio M. Ranche, Vololona Randriamanantena Andriamitandrina, Lawrence R. Rast, Paul L. Redditt, Adele Reinhartz, Rolf Rendtorff, Pål Repstad, James N. Rhodes, John K. Riches, Joerg Rieger, Sharon H. Ringe, Sandra Rios, Tyler Roberts, David M. Robinson, James M. Robinson, Joanne Maguire Robinson, Richard A. H. Robinson, Roy R. Robson, Jack B. Rogers, Maria Roginska, Sidney Rooy, Rev. Garnett Roper, Maria José Fontelas Rosado-Nunes, Andrew C. Ross, Stefan Rossbach, François Rossier, John D. Roth, John K. Roth, Phillip Rothwell, Richard E. Rubenstein, Rosemary Radford Ruether, Markku Ruotsila, John E. Rybolt, Risto Saarinen, John Saillant, Juan Sanchez, Wagner Lopes Sanchez, Hugo N. Santos, Gerhard Sauter, Gloria L. Schaab, Sandra M. Schneiders, Quentin J. Schultze, Fernando F. Segovia, Turid Karlsen Seim, Carsten Selch Jensen, Alan P. F. Sell, Frank C. Senn, Kent Davis Sensenig, Damían Setton, Bal Krishna Sharma, Carolyn J. Sharp, Thomas Sheehan, N. Gerald Shenk, Christian Sheppard, Charles Sherlock, Tabona Shoko, Walter B. Shurden, Marguerite Shuster, B. Mark Sietsema, Batara Sihombing, Neil Silberman, Clodomiro Siller, Samuel Silva-Gotay, Heikki Silvet, John K. Simmons, Hagith Sivan, James C. Skedros, Abraham Smith, Ashley A. Smith, Ted A. Smith, Daud Soesilo, Pia Søltoft, Choan-Seng (C. S.) Song, Kathryn Spink, Bryan Spinks, Eric O. Springsted, Nicolas Standaert, Brian Stanley, Glen H. Stassen, Karel Steenbrink, Stephen J. Stein, Andrea Sterk, Gregory E. Sterling, Columba Stewart, Jacques Stewart, Robert B. Stewart, Cynthia Stokes Brown, Ken Stone, Anne Stott, Elizabeth Stuart, Monya Stubbs, Marjorie Hewitt Suchocki, David Kwang-sun Suh, Scott W. Sunquist, Keith Suter, Douglas Sweeney, Charles H. Talbert, Shawqi N. Talia, Elsa Tamez, Joseph B. Tamney, Jonathan Y. Tan, Yak-Hwee Tan, Kathryn Tanner, Feiya Tao, Elizabeth S. Tapia, Aquiline Tarimo, Claire Taylor, Mark Lewis Taylor, Bishop Abba Samuel Wolde Tekestebirhan, Eugene TeSelle, M. Thomas Thangaraj, David R. Thomas, Andrew Thornley, Scott Thumma, Marcelo Timotheo da Costa, George E. “Tink” Tinker, Ola Tjørhom, Karen Jo Torjesen, Iain R. Torrance, Fernando Torres-Londoño, Archbishop Demetrios [Trakatellis], Marit Trelstad, Christine Trevett, Phyllis Trible, Johannes Tromp, Paul Turner, Robert G. Tuttle, Archbishop Desmond Tutu, Peter Tyler, Anders Tyrberg, Justin Ukpong, Javier Ulloa, Camillus Umoh, Kristi Upson-Saia, Martina Urban, Monica Uribe, Elochukwu Eugene Uzukwu, Richard Vaggione, Gabriel Vahanian, Paul Valliere, T. J. Van Bavel, Steven Vanderputten, Peter Van der Veer, Huub Van de Sandt, Louis Van Tongeren, Luke A. Veronis, Noel Villalba, Ramón Vinke, Tim Vivian, David Voas, Elena Volkova, Katharina von Kellenbach, Elina Vuola, Timothy Wadkins, Elaine M. Wainwright, Randi Jones Walker, Dewey D. Wallace, Jerry Walls, Michael J. Walsh, Philip Walters, Janet Walton, Jonathan L. Walton, Wang Xiaochao, Patricia A. Ward, David Harrington Watt, Herold D. Weiss, Laurence L. Welborn, Sharon D. Welch, Timothy Wengert, Traci C. West, Merold Westphal, David Wetherell, Barbara Wheeler, Carolinne White, Jean-Paul Wiest, Frans Wijsen, Terry L. Wilder, Felix Wilfred, Rebecca Wilkin, Daniel H. Williams, D. Newell Williams, Michael A. Williams, Vincent L. Wimbush, Gabriele Winkler, Anders Winroth, Lauri Emílio Wirth, James A. Wiseman, Ebba Witt-Brattström, Teofil Wojciechowski, John Wolffe, Kenman L. Wong, Wong Wai Ching, Linda Woodhead, Wendy M. Wright, Rose Wu, Keith E. Yandell, Gale A. Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- The Cambridge Dictionary of Christianity
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- 05 August 2012
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- 20 September 2010, pp xi-xliv
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- By Willem M. Ankum, Ruth Bender Atik, Carolien M. Boomsma, Tom H. Bourne, Larry W. Chamley, Ole B. Christiansen, Fatima Crispi, Feroza Dawood, Pat Doyle, Niek Exalto, Roy G. Farquharson, M. Goddijn, Eduard Gratacos, Mike Greaves, Aisha Hameed, Barbara E. Hepworth-Jones, Kristin Holoch, José A. Horcajadas, Eric R. M. Jauniaux, Jemma Johns, Davor Jurkovic, Anne Kennedy, Emma Kirk, Ruth Bunker Lathi, Nico J. Leschot, Bruce A. Lessey, Nick S. Macklon, Dimitrios Mavrelos, Saskia Middeldorp, Gillian Norrie, Errol R. Norwitz, Thomas Philipp, Anja Pinborg, Siobhan Quenby, Lesley Regan, Dominique Royère, Isaac E. Sasson, Sony Sierra, Mary D. Stephenson, Peter R. Stone, Ai-Wei Tang, Etienne Van den Abbeel, Nicole S. Winkler
- Edited by Roy G. Farquharson, University of Liverpool, Mary D. Stephenson, University of Chicago
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- Early Pregnancy
- Published online:
- 05 October 2010
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- 09 September 2010, pp vii-x
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Neuropsychological functioning in first-episode schizophrenia
- Eugenia Kravariti, Kevin Morgan, Paul Fearon, Jolanta W. Zanelli, Julia M. Lappin, Paola Dazzan, Craig Morgan, Gillian A. Doody, Glynn Harrison, Peter B. Jones, Robin M. Murray, Abraham Reichenberg
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- Journal:
- The British Journal of Psychiatry / Volume 195 / Issue 4 / October 2009
- Published online by Cambridge University Press:
- 02 January 2018, pp. 336-345
- Print publication:
- October 2009
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Background
Identifying neurocognitive subtypes in schizophrenia may help establish neurobiologically meaningful subtypes of the disorder, but is frequently confounded by differences in intellectual function between individuals with schizophrenia and controls.
AimsTo examine neuropsychological performance in individuals with epidemiologically based, first-onset schizophrenia and intellectually matched controls.
MethodUsing standard IQ and reading tests, we examined the proportions of 101 people with epidemiologically derived, first-onset schizophrenia/schizoaffective disorder and 317 community controls, falling into three a priori defined intellectual categories: ‘stable good’, ‘deteriorated poor’ and ‘stable poor’. Neuropsychological function was compared between intellectually matched participants with schizophrenia and control subgroups.
ResultsMultiple deficits in executive function, processing speed and verbal memory, but not visual/spatial perception/memory, were detected in all participant groups with schizophrenia compared with controls. The average effect size across the affected domains ranged from small to medium to large in the stable good, deteriorated poor and stable poor subgroups of participants with schizophrenia, respectively.
ConclusionsCompared with intellectually matched controls, people with epidemiologically derived, first-onset schizophrenia/schizoaffective disorder show multiple deficits in executive function, processing speed and verbal memory.
Gender differences in the association between childhood abuse and psychosis
- Helen Fisher, Craig Morgan, Paola Dazzan, Thomas K. Craig, Kevin Morgan, Gerard Hutchinson, Peter B. Jones, Gillian A. Doody, Carmine Pariante, Peter McGuffin, Robin M. Murray, Julian Leff, Paul Fearon
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- Journal:
- The British Journal of Psychiatry / Volume 194 / Issue 4 / April 2009
- Published online by Cambridge University Press:
- 02 January 2018, pp. 319-325
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- April 2009
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Background
Studies demonstrating an association between childhood trauma and psychosis in adulthood have not systematically explored gender differences.
AimsTo investigate gender differences in the prevalence of childhood sexual and physical abuse among people with psychosis in comparison with healthy controls.
MethodThe Childhood Experiences of Care and Abuse Questionnaire was completed to elicit experiences of sexual and physical abuse during childhood in first-episode psychosis cases and population-based controls.
ResultsAmong women, those in the cases group were twice as likely to report either physical or sexual abuse compared with controls following adjustment for all confounders. In particular, the effect of physical abuse in women was stronger and more robust than that for sexual abuse. A similar trend was found for psychotic-like experiences in the female control group. No association was found in men.
ConclusionsReports of severe childhood physical or sexual abuse were associated with psychosis in women but not in men.
Neurological abnormalities and cognitive ability in first-episode psychosis
- Paola Dazzan, Tuhina Lloyd, Kevin D. Morgan, Jolanta Zanelli, Craig Morgan, Ken Orr, Gerard Hutchinson, Paul Fearon, Matthew Allin, Larry Rifkin, Philip K. McGuire, Gillian A. Doody, John Holloway, Julian Leff, Glynn Harrison, Peter B. Jones, Robin M. Murray
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- Journal:
- The British Journal of Psychiatry / Volume 193 / Issue 3 / September 2008
- Published online by Cambridge University Press:
- 02 January 2018, pp. 197-202
- Print publication:
- September 2008
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Background
It remains unclear if the excess of neurological soft signs, or of certain types of neurological soft signs, is common to all psychoses, and whether this excess is simply an epiphenomenon of the lower general cognitive ability present in psychosis.
AimsTo investigate whether an excess of neurological soft signs is independent of diagnosis (schizophrenia v. affective psychosis) and cognitive ability (IQ).
MethodEvaluation of types of neurological soft signs in a prospective cohort of all individuals presenting with psychoses over 2 years (n=310), and in a control group from the general population (n=239).
ResultsPrimary (P<0.001), motor coordination (P<0.001), and motor sequencing (P<0.001) sign scores were significantly higher in people with any psychosis than in the control group. However, only primary and motor coordination scores remained higher when individuals with psychosis and controls were matched for premorbid and current IQ.
ConclusionsHigher rates of primary and motor coordination signs are not associated with lower cognitive ability, and are specific to the presence of psychosis.
Perceptions of disadvantage, ethnicity and psychosis
- Claudia Cooper, Craig Morgan, Majella Byrne, Paola Dazzan, Kevin Morgan, Gerard Hutchinson, Gillian A. Doody, Glynn Harrison, Julian Leff, Peter Jones, Khalida Ismail, Robin Murray, Paul Bebbington, Paul Fearon
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- Journal:
- The British Journal of Psychiatry / Volume 192 / Issue 3 / March 2008
- Published online by Cambridge University Press:
- 02 January 2018, pp. 185-190
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- March 2008
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Background
People from Black ethnic groups (African-Caribbean and Black African) are more prone to develop psychosis in Western countries. This excess might be explained by perceptions of disadvantage.
AimsTo investigate whether the higher incidence of psychosis in Black people is mediated by perceptions of disadvantage.
MethodA population-based incidence and case-control study of first-episode psychosis (Aetiology and Ethnicity in Schizophrenia and Other Psychoses (ÆSOP)). A total of 482 participants answered questions about perceived disadvantage.
ResultsBlack ethnic groups had a higher incidence of psychosis (OR=4.7, 95% CI 3.1–7.2). After controlling for religious affiliation, social class and unemployment, the association of ethnicity with psychosis was attenuated (OR=3.0, 95% CI 1.6–5.4) by perceptions of disadvantage. Participants in the Black non-psychosis group often attributed their disadvantage to racism, whereas Black people in the psychosis group attributed it to their own situation.
ConclusionsPerceived disadvantage is partly associated with the excess of psychosis among Black people living in the UK. This may have implications for primary prevention.
Group cognitive-behavioural therapy for schizophrenia: Randomised controlled trial
- Christine Barrowclough, Gillian Haddock, Fiona Lobban, Steve Jones, Ron Siddle, Chris Roberts, Lynsey Gregg
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- Journal:
- The British Journal of Psychiatry / Volume 189 / Issue 6 / December 2006
- Published online by Cambridge University Press:
- 02 January 2018, pp. 527-532
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- December 2006
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Background
The efficacy of cognitive–behavioural therapy for schizophrenia is established, but there is less evidence for a group format.
AimsTo evaluate the effectiveness of group cognitive – behavioural therapy for schizophrenia.
MethodIn all, 113 people with persistent positive symptoms of schizophrenia were assigned to receive group cognitive – behavioural therapy or treatment as usual. The primary outcome was positive symptom improvement on the Positive and Negative Syndrome Scales. Secondary outcome measures included symptoms, functioning, relapses, hopelessness and self-esteem.
ResultsThere were no significant differences between the cognitive-behavioural therapy and treatment as usual on measures of symptoms or functioning or relapse, but group cognitive – behavioural therapy treatment resulted in reductions in feelings of hopelessness and in low self-esteem.
ConclusionsAlthough group cognitive – behavioural therapy may not be the optimum treatment method for reducing hallucinations and delusions, it may have important benefits, including feeling less negative about oneself and less hopeless for the future.
Parental separation, loss and psychosis in different ethnic groups: a case-control study
- CRAIG MORGAN, JAMES KIRKBRIDE, JULIAN LEFF, TOM CRAIG, GERARD HUTCHINSON, KWAME McKENZIE, KEVIN MORGAN, PAOLA DAZZAN, GILLIAN A. DOODY, PETER JONES, ROBIN MURRAY, PAUL FEARON
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- Journal:
- Psychological Medicine / Volume 37 / Issue 4 / April 2007
- Published online by Cambridge University Press:
- 21 November 2006, pp. 495-503
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Background. Numerous studies have reported high rates of psychosis in the Black Caribbean and Black African populations in the UK. However, few studies have investigated the role of specific risk factors in different ethnic groups. We sought to investigate the relationship between long-term separation from, and death of, a parent before the age of 16 and risk of adult psychosis in different ethnic groups.
Method. All patients with a first episode of psychosis who made contact with psychiatric services in defined catchment areas in London and Nottingham, UK and a series of community controls were included in the AESOP (Aetiology and Ethnicity in Schizophrenia and Other Psychoses) study. Data relating to clinical and social variables, including parental separation and loss, were collected from patients and controls.
Results. Separation from, and death of, a parent before the age of 16 were both strongly associated with a two- to threefold increased risk of psychosis. The strength of these associations were similar for White British and Black Caribbean (but not Black African) subjects. Separation from (but not death of) a parent was more common among Black Caribbean controls than White British controls.
Conclusions. Early separation may have a greater impact in the Black Caribbean population, because it is more common, and may contribute to the excess of psychosis in this population.
Childhood trauma and hallucinations in bipolar affective disorder: preliminary investigation
- Paul Hammersley, Anton Dias, Gillian Todd, Kim Bowen-Jones, Bernadette Reilly, Richard P. Bentall
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- Journal:
- The British Journal of Psychiatry / Volume 182 / Issue 6 / June 2003
- Published online by Cambridge University Press:
- 02 January 2018, pp. 543-547
- Print publication:
- June 2003
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Background
Strong evidence exists for an association between childhood trauma, particularly childhood sexual abuse, and hallucinations in schizophrenia. Hallucinations are also well-documented symptoms in people with bipolar affective disorder.
AimsTo investigate the relationship between childhood sexual abuse and other childhood traumas and hallucinations in people with bipolar affective disorder.
MethodA sample of 96 participants was drawn from the Medical Research Council multi-centre trial of cognitive–behavioural therapy for bipolar affective disorder. The trial therapists recorded spontaneous reports of childhood sexual abuse made during the course of therapy. Symptom data were collected by trained research assistants masked to the hypothesis.
ResultsA significant association was found between those reporting general trauma (n=38) and auditory hallucinations. A highly significant association was found between those reporting childhood sexual abuse (n=15) and auditory hallucinations.
ConclusionsThe relationship between childhood sexual abuse and hallucinations in bipolar disorder warrants further investigation.
Electron field emission from Ar+ ion-treated thick-film carbon paste
- Gillian A. M. Reynolds, Lap-Tak Cheng, Robert Bouchard, Paul Moffett, Howard Jones, Linda F. Robinson, S. Ismat Shah, Daniel I. Amey
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- Journal:
- Journal of Materials Research / Volume 17 / Issue 10 / October 2002
- Published online by Cambridge University Press:
- 31 January 2011, pp. 2590-2598
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- October 2002
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Ion bombardment was used to produce electron-emitting microscale features on surfaces of thick films printed with carbon pastes. This technology can potentially enable the development of large-area field emission displays. Systematic investigations using microscopy and electron field emission experiments have demonstrated a close link among paste formulation, ion processing parameters, and the development of surface microstructures. These investigations were also useful in understanding the fundamentals of microstructure formation under ion bombardment and the field emission characteristics of the carbon-based emitters. Several device concepts aimed toward achieving a low-voltage switchable triode were also tested with varying degrees of success. In this paper, we discuss various technological issues related to the materials, processes, and devices.
Microbial detachment from biofilms
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- By Gillian F. Moore, Environmental Microbiology Research Group, Exeter University, Exeter, UK, Braden C. Dunsmore, Environmental Microbiology Research Group, Exeter University, Exeter, UK, Steven M. Jones, Environmental Microbiology Research Group, Exeter University, Exeter, UK, Christopher W. Smejkal, Environmental Microbiology Research Group, Exeter University, Exeter, UK, Jana Jass, Department of Microbiology, Umeå University, Umeå, Sweden, Paul Stoodley, Center for Biofilm Engineering, Montana State University, Bozeman, MT, USA, Hilary M. Lappin-Scott, Environmental Microbiology Research Group, Exeter University, Exeter, UK
- Edited by David G. Allison, University of Manchester, P. Gilbert, University of Manchester, H. M. Lappin-Scott, University of Exeter, M. Wilson
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- Community Structure and Co-operation in Biofilms
- Published online:
- 03 June 2010
- Print publication:
- 23 October 2000, pp 107-128
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Summary
INTRODUCTION
This chapter reviews the broad area of biofilm detachment, the mechanisms of detachment and the methods used to study this important process. Two case studies are included: the first of these focuses on the control of clinical biofilms; the second case study examines detachment in the water industry.
Biofilms are dynamic structures found in a wide variety of both natural and man-made environments. Their formation has been well studied; for example, Characklis (1990) described eight different stages of biofilm accumulation (Table 1 and Fig. 1). There has been much research into the initial attachment of micro-organisms to surfaces, including the effect of electrostatic interactions and electrochemical forces (Bos et al., 1999). The physiological changes that attaching cells undergo have also been examined; for example, the production of surface appendages such as fimbriae (Austin et al., 1998). In contrast to the work undertaken on attachment, detachment has received little attention although many researchers regard it as a crucial stage of biofilm development (Stewart, 1993; Allison et al., 1999).
Bryers (1988) classified the detachment process into four separate groups: abrasion, grazing, erosion and sloughing. Detachment from the biofilm can be directly caused by the collision or rubbing together of surfaces on which the biofilm has developed, leading to abrasive detachment. Larger organisms feeding on the biofilm can indirectly cause detachment through grazing. Erosion and sloughing refer to physical or chemical processes, which indirectly affect the biofilm structure, leading to detachment. Erosion refers to the continual removal of cells or small groups of cells from the biofilm, whereas sloughing is the loss of discrete amounts of biofilm.
The food refuse of an affluent urban household in the late fourteenth century: faunal and botanical remains from the Palazzo Vitelleschi, Tarquinia (Viterbo)
- Gillian Clark, Lorenzo Costantini, Angelo Finetti, John Giorgi, Andrew Jones, David Reese, Sheila Sutherland, David Whitehouse
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- Journal:
- Papers of the British School at Rome / Volume 57 / November 1989
- Published online by Cambridge University Press:
- 09 August 2013, pp. 200-321
- Print publication:
- November 1989
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3.6 Animal Bone Remains
- Gillian Jones
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- Journal:
- Proceedings of the Prehistoric Society / Volume 55 / Issue S2 / 1989
- Published online by Cambridge University Press:
- 12 March 2021, pp. 85-89
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- 1989
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The Collfryn Hillslope Enclosure, Llansantffraid Deuddwr, Powys: Excavations 1980–1982
- William Britnell, Jenny Britnell, Timothy C. Darvill, Stephen Greep, Elizabeth Healey, Hilary Howard, Gillian Jones, Glynis Jones, Helen C. M. Keeley, Annie Milles, Graham C. Morgan, Elaine L. Morris, Mansel G. Spratling, Janet Webster, Peter V. Webster
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- Journal:
- Proceedings of the Prehistoric Society / Volume 55 / Issue 1 / 1989
- Published online by Cambridge University Press:
- 12 June 2014, pp. 89-134
- Print publication:
- 1989
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The report on partial rescue excavations of the Collfryn enclosure between 1980–82 presents a summary of the first large-scale investigation of one of the numerous semi-defensive cropmark and earthwork enclosure sites in the upper Severn valley in mid-Wales. Earlier prehistoric activity of an ephemeral nature is represented by a scattering of Mesolithic and Late Neolithic or early Bronze Age flintwork, and by a pit containing sherds of several different Beaker vessels. The first enclosed settlement, constructed in about the 3rd century bc probably consisted of three widely-spaced concentric ditches, associated with banks of simple dump construction, having a single gated entranceway on the downhill side. It covered an area of about 2.5 ha and appears to have been of a relatively high social status, and appropriate in size for a single extended-family group. This was subsequently reduced in about the 1st century bc to a double-ditched enclosure, by the recutting of the original inner ditch and the cutting of a new ditch immediately outside it. The habitation area between the 3rd and 1st centuries bc probably focused on timber buildings in the central enclosure of about 0.4 ha, whose gradually evolving pattern appears to have comprised between 3–4 roundhouses and 4–5 four-posters at any one time. Little excavation was undertaken between the outer ditches of the first phase settlement, but these are assumed to have been used as stock enclosures. A mixed farming economy is suggested by cattle, sheep/goat and pig remains, and remains of glume wheats, barley and oats. Industries included small-scale iron and bronze-working. The Iron Age settlement was essentially aceramic, although there are significant quantities of a coarse, oxidized ceramic probably representing salt traded from production centres in the Cheshire Plain. The entranceway was remodelled in about the late 1st or early 2nd, century AD by means of a timber-lined passage linked to a new gate on the line of the inner bank. There is equivocal evidence of continued occupation within the inner enclosure continuing until at least the mid-4th century AD, possibly at a comparatively low social level, associated with domestic structures of uncertain form sited on earlier roundhouse platforms, and including some four-posters and possible six-posters. Drainage ditches were dug across parts of the site during the Medieval and post-Medieval periods, which were associated with various structures, including a corn-drying kiln inserted into the inner enclosure bank in the 15th century.