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Psychotic disorders are severe mental health conditions frequently associated with long-term disability, reduced quality of life and premature mortality. Early Intervention in Psychosis (EIP) services aim to provide timely, comprehensive packages of care for people with psychotic disorders. However, it is not clear which components of EIP services contribute most to the improved outcomes they achieve.
Aims
We aimed to identify associations between specific components of EIP care and clinically significant outcomes for individuals treated for early psychosis in England.
Method
This national retrospective cohort study of 14 874 EIP individuals examined associations between 12 components of EIP care and outcomes over a 3-year follow-up period, by linking data from the National Clinical Audit of Psychosis (NCAP) to routine health outcome data held by NHS England. The primary outcome was time to relapse, defined as psychiatric inpatient admission or referral to a crisis resolution (home treatment) team. Secondary outcomes included duration of admissions, detention under the Mental Health Act, emergency department and general hospital attendances and mortality. We conducted multilevel regression analyses incorporating demographic and service-level covariates.
Results
Smaller care coordinator case-loads and the use of clozapine for eligible people were associated with reduced relapse risk. Physical health interventions were associated with reductions in mortality risk. Other components, such as cognitive–behavioural therapy for psychosis (CBTp), showed associations with improvements in secondary outcomes.
Conclusions
Smaller case-loads should be prioritised and protected in EIP service design and delivery. Initiatives to improve the uptake of clozapine should be integrated into EIP care. Other components, such as CBTp and physical health interventions, may have specific benefits for those eligible. These findings highlight impactful components of care and should guide resource allocation to optimise EIP service delivery.
Herbaceous perennials must annually rebuild the aboveground photosynthetic architecture from carbohydrates stored in crowns, rhizomes, and roots. Knowledge of carbohydrate utilization and storage can inform management decisions and improve control outcomes for invasive perennials. We monitored the nonstructural carbohydrates in a population of the hybrid Bohemian knotweed [Polygonum ×bohemicum (J. Chrtek & Chrtková) Zika & Jacobson [cuspidatum × sachalinense]; syn.: Fallopia ×bohemica (Chrtek and Chrtková) J.P. Bailey] and in Japanese knotweed [Polygonum cuspidatum Siebold & Zucc.; syn.: Fallopia japonica (Houtt.) Ronse Decr.]. Carbohydrate storage in crowns followed seasonal patterns typical of perennial herbaceous dicots corresponding to key phenological events. Starch was consistently the highest nonstructural carbohydrate present. Sucrose levels did not show a consistent inverse relationship with starch levels. Lateral distribution of starch in rhizomes and, more broadly, total nonstructural carbohydrates sampled before dormancy break showed higher levels in rhizomes compared with crowns. Total nonstructural carbohydrate levels in crowns reached seasonal lows at an estimated 22.6% of crown dry weight after accumulating 1,453.8 growing degree days (GDD) by the end of June, mainly due to depleted levels of stored starch, with the estimated minimum of 12.3% reached by 1,220.3 GDD accumulated by mid-June. Depletion corresponded to rapid development of vegetative canopy before entering the reproductive phase in August. Maximum starch accumulation in crowns followed complete senescence of aboveground tissues by mid- to late October. Removal of aboveground shoot biomass in late June to early July with removal of vegetation regrowth in early September before senescence would optimize the use of time and labor to deplete carbohydrate reserves. Additionally, foliar-applied systemic herbicide translocation to belowground tissue should be maximized with applications in late August through early fall to optimize downward translocation with assimilate movement to rebuild underground storage reserves. Fall applications should be made before loss of healthy leaf tissue, with the window for control typically ending by late September in Minnesota.
In this chapter we examine music ensemble timing. This process, in which musicians watch and listen to sense each other and so adjust the timing of their motor actions in order to maintain good ensemble synchronisation, may be considered an example of sensorimotor synchronisation. We recount how experimental studies of the act of tapping along to a metronome – one of the simplest forms of sensorimotor synchronisation – led to the development of an internal clock model, in which self-perceived errors in synchrony between a person's taps and the metronome's beats drive phase corrections to the timing of that person's internal clock. We go on to expand this model to account for the maintenance of ensemble timing in string quartet performance. We assume each player has their own internal clock which is undergoing constant adjustment according to perceived synchrony errors between them and each of their three colleagues. Such a model is mathematically linear and describes phase correction between players. We conclude the chapter by noting that a recently developed oscillator model points the way towards a complementary, non-linear perspective on these timing adjustments between players. Both the linear and non-linear models make important contributions to our understanding of the science behind music ensemble timing, an understanding that could one day inform new approaches to rehearsal technique, and even stylistic variation, in music-making.
Introduction
Playing music in time – whether to an internally generated pulse or to an external signal such as a click track – is a complex task that relies on a number of cognitive mechanisms including perception, attention, memory, and action. In many musical styles, the desired timing of playing can be quite complex, with intended large-scale or local fluctuations in tempo or purposeful deviations from the beat. Fluctuations in the cognitive mechanisms during performance, as well as changes in neurophysiological factors affecting the muscles such as fatigue and stiffness, may result in additional, unintended variability in an individual musician's timing performance (as also discussed in Chapter 2). Despite this variability, musicians must be able to predict and adjust the temporal progression of their music-making in order to achieve their desired musical expression. When musicians play together in groups, additional challenges are put upon these mechanisms.
This article extends Michael L. Radelet’s 1989 study of rare cases in which Whites have been executed for committing capital crimes against Blacks to include an assessment of White executions involving Latinx and Asian victims. The threefold aim is to (1) establish the frequency of such rare cases, and (2) explore the extent to which status characteristics (beyond race, ethnicity or gender) are present for these rare events; and (3) offer social dominance theory as a viable explanation for the patterns found in the data. An analysis of unique data from the Texas Department of Criminal Justice shows that out of 570 executions imposed between April 1982 and July 2020, only six cases led to the execution of Whites for crimes against Blacks (1.1%), sixteen cases for crimes against Hispanics (2.8%), and one case for crimes against an Asian American (0.18%). Beyond the minority status of the victim, two or more status markers were present when Whites were executed for crimes against people of color. The results, which are consistent with expectations drawn from social dominance theory, highlight the differential value placed on minority lives and call into question the legitimacy of the death penalty in the United States.
This chapter outlines the case for the global green building movement to embrace integrated ‘climate-smart’ green building design, construction and operation, which optimises new and existing buildings to achieve both mitigation and adaptation goals synergistically and cost-effectively. The climate-smart building agenda is a high priority for this sector because it can help improve the well-being, productivity and health of occupants, and provide other social equity benefits, thus helping, simultaneously, to achieve other UN Sustainable Development Goals. Focus extends to precincts, the building blocks of cities, interfacing Building and Precinct Information Modelling. Overview is provided of leading sustainability assessment and rating tools for design of buildings and precincts. The chapter identifies key stakeholders and decision makers, and how each can best play their part to enable needed changes in this sector to achieve a net zero-carbon resilient future. It examines the role of governments in addressing major market and informational failures and what policies are needed to underpin efforts by all these key actors to achieve decarbonisation of the built environment sector.
Radiocarbon (14C) is an isotopic tracer used to address a wide range of scientific research questions. However, contamination by elevated levels of 14C is deleterious to natural-level laboratory workspaces and accelerator mass spectrometer facilities designed to precisely measure small amounts of 14C. The risk of contaminating materials and facilities intended for natural-level 14C with elevated-level 14C-labeled materials has dictated near complete separation of research groups practicing profoundly different measurements. Such separation can hinder transdisciplinary research initiatives, especially in remote and isolated field locations where both natural-level and elevated-level radiocarbon applications may be useful. This paper outlines the successful collaboration between researchers making natural-level 14C measurements and researchers using 14C-labeled materials during a subglacial drilling project in West Antarctica (SALSA 2018–2019). Our strict operating protocol allowed us to successfully carry out 14C labeling experiments within close quarters at our remote field camp without contaminating samples of sediment and water intended for natural level 14C measurements. Here we present our collaborative protocol for maintaining natural level 14C cleanliness as a framework for future transdisciplinary radiocarbon collaborations.
To examine whether national initiatives have led to improvements in the physical health of people with psychosis. Secondary analysis of a national audit of services for people with psychosis. Proportions of patients in ‘good health’ according to seven measures, and one composite measure derived from national standards, were compared between multiple rounds of data collection.
Results
The proportion of patients in overall ‘good health’ under the care of ‘Early Intervention in Psychosis’ teams increased from 2014–2019, particularly for measures of smoking, alcohol and substance use. There was no overall change in the proportion of patients in overall ‘good health’ under the care of ‘Community Mental Health Teams’ from 2011–2017. However, there were improvements in alcohol use, blood glucose and lipid levels.
Clinical implications
There have been modest improvements in the health of people with psychosis over the last nine years. Continuing efforts are required to translate these improvements into reductions in premature mortality.
Crime, Deviance and Society: An Introduction to Sociological Criminology offers a comprehensive introduction to criminological theory. The book introduces readers to key sociological theories, such as anomie and strain, and examines how traditional approaches have influenced the ways in which crime and deviance are constructed. It provides a nuanced account of contemporary theories and debates, and includes chapters covering feminist criminology, critical masculinities, cultural criminology, green criminology, and postcolonial theory, among others. Case studies in each chapter demonstrate how sociological theories can manifest within and influence the criminal justice system and social policy. Each chapter also features margin definitions and timelines of contributions to key theories, reflection questions and end-of-chapter questions that prompt students reflection. Written by an expert team of academics from Australia, New Zealand and the United Kingdom, Crime, Deviance and Society is a highly engaging and accessible introduction to the field for students of criminology and criminal justice.
Questions have been raised regarding differences in the standards of care that patients receive when they are admitted to or discharged from in-patient units at weekends.
Aims
To compare the quality of care received by patients with anxiety and depressive disorders who were admitted to or discharged from psychiatric hospital at weekends with those admitted or discharged during the ‘working week’.
Method
Retrospective case-note review of 3795 admissions to in-patient psychiatric wards in England. Quality of care received by people with depressive or anxiety disorders was compared using multivariable regression analyses.
Results
In total, 795 (20.9%) patients were admitted at weekends and 157 (4.8%) were discharged at weekends. There were minimal differences in quality of care between those admitted at weekends and those admitted during the week. Patients discharged at weekends were less likely to be given sufficient notification (48 h) in advance of being discharged (OR = 0.55, 95% CI 0.39–0.78), to have a crisis plan in place (OR = 0.65, 95% CI 0.46–0.92) or to be given medication to take home (OR = 0.45, 95% CI 0.30–0.66). They were also less likely to have been assessed using a validated outcome measure (OR = 0.70, 95% CI 0.50–0.97).
Conclusions
There is no evidence of a ‘weekend effect’ for patients admitted to psychiatric hospital at weekends, but the quality of care offered to those who were discharged at weekends was relatively poor, highlighting the need for improvement in this area.
This chapter will explain how modern developments in crime control can be traced back to the original formulae of positivism. Finally, there is a summary of the implications of key elements of positivism for future practices aimed at reducing the risk of crime. After reading this chapter you will be better able to both appreciate and critique the role of positivism as it has impacted the field of criminal justice. This knowledge is key to navigating the complex terrain of policy and practice in the criminal justice domain, from policing to courts and on to correctional practices.
New technological methods, such as rapidly developing molecular approaches, often provide new tools for scientific advances. However, these new tools are often not utilized equally across different research areas, possibly leading to disparities in progress between these areas. Here, we use empirical evidence from the scientific literature to test for potential discrepancies in the use of genetic tools to study parasitic vs non-parasitic organisms across three distinguishable molecular periods, the allozyme, nucleotide and genomics periods. Publications on parasites constitute only a fraction (<5%) of the total research output across all molecular periods and are dominated by medically relevant parasites (especially protists), particularly during the early phase of each period. Our analysis suggests an increasing complexity of topics and research questions being addressed with the development of more sophisticated molecular tools, with the research focus between the periods shifting from predominantly species discovery to broader theory-focused questions. We conclude that both new and older molecular methods offer powerful tools for research on parasites, including their diverse roles in ecosystems and their relevance as human pathogens. While older methods, such as barcoding approaches, will continue to feature in the molecular toolbox of parasitologists for years to come, we encourage parasitologists to be more responsive to new approaches that provide the tools to address broader questions.