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Despite the critical role families play in the care and recovery journeys of people who experience enduring mental distress, they are often excluded by the mental health services in the care and decision-making process. International trends in mental health services emphasise promoting a partnership approach between service users, families and practitioners within an ethos of recovery.
Objective:
This paper evaluated the acceptability of and initial outcomes from a clinician and peer co-led family information programme.
Methods:
A sequential design was used involving a pre-post survey to assess changes in knowledge, confidence, advocacy, recovery and hope following programme participation and interviews with programme participants. Participants were recruited from mental health services running the information programme. In all, 86 participants completed both pre- and post-surveys, and 15 individuals consented to interviews.
Results:
Survey findings indicated a statistically significant change in family members’ knowledge about mental health issues, recovery attitudes, sense of hope and confidence. In addition, the interviews suggested that the programme had a number of other positive outcomes for family members, including increased communication with members of the mental health team and increased awareness of communication patterns within the family unit. Family members valued the opportunity to share their experiences in a ‘safe’ place, learn from each other and provide mutual support.
Conclusion:
The evaluation highlights the importance of developing information programmes in collaboration with family members as well as the strength of a programme that is jointly facilitated by a family member and clinician.
In this paper, we summarise and critique a network meta-analysis (NMA) of antidepressant efficacy and tolerability for paediatric depression and an accompanying editorial. Although we agree that many of the extant studies are flawed, this meta-analysis showed clear efficacy of fluoxetine in the NMA, and for sertraline and escitalopram in pairwise analyses. Consequently, these papers underestimate the benefits of antidepressants for paediatric depression, and provide support for current practice guideline, which recommends the use of an antidepressant if the patient does not respond to psychotherapy. In these circumstances, fluoxetine should be the first choice, with escitalopram and sertraline as alternatives.
Declaration of interest
D.A.B. receives royalties from Guilford Press, has or will receive royalties from the electronic self-rated version of the C-SSRS from eResearch Technology, Inc., is on the editorial board of UpToDate, and is a reviewer for Healthwise. R.D.G. serves as an expert witness for the US Department of Justice, Pfizer, Wyeth and GSK; and is the founder of Adaptive Testing Technologies. P.W. receives personal fees from Lundbeck and Takeda. B.D. reports a licensing agreement with Lundbeck for a psychosocial treatment manual for depression. No other disclosures were reported.
Every lazy functional programmer knows about the following approach to enumerating the positive rationals: generate a two-dimensional matrix (an infinite list of infinite lists), then traverse its finite diagonals (an infinite list of finite lists).
There is an increased appreciation of the need for horizon scanning: the identification and assessment of issues that could be serious in the future but have currently attracted little attention. However, a process is lacking to identify appropriate responses by policy makers and practitioners. We thus suggest a process and trial its applicability. Twelve environmental conservation organizations assessed each of 15 previously identified horizon scanning issues for their impact upon their organization and the urgency with which they should consider the issue. They also identified triggers that would result in changes in their scoring of the likely urgency and impact of the issues. This process enables organizations to identify priority issues, identify issues they can ignore until there are further developments, benchmark priorities across organizations and identify cross-organizational priorities that warrant further attention, so providing an agenda for collation of evidence, research and policy development. In this trial the review of responses by other organizations resulted in the upgrading of response by a substantial proportion of organizations for eight of the 15 issues examined. We suggest this approach, with the novel components of collaborative assessment and identification of triggers, could be adopted widely, both within conservation organizations and across a wider range of policy issues.
In this chapter we describe three relatively rare, clinically complex syndromes in which the occurrence of α thalassemia provided the clue to understanding the molecular basis of each condition. These conditions exemplify the important interplay between clinical observation and human molecular genetics. Two of these syndromes (ATR-16 [OMIM: 141750] and ATR-X [OMIM: 301040]) in which α thalassemia is associated with multiple developmental abnormalities (including mental retardation, MR) are inherited. The third condition (ATMDS [OMIM: 300448]) is an acquired disorder in which α thalassemia appears for the first time in the context of myelodysplasia.
α THALASSEMIA ASSOCIATED WITH MENTAL RETARDATION AND DEVELOPMENTAL ABNORMALITIES
The rare association of α thalassemia and mental retardation (MR) was recognized more than 25 years ago by Weatherall and colleagues. It was known that α thalassemia arises when there is a defect in the synthesis of the α-globin chains of adult hemoglobin (HbA, α2β2). When these authors encountered three mentally retarded children with α thalassemia and a variety of developmental abnormalities, their interest was stimulated by the unusual nature of the α thalassemia. The children were of northern European origin, where α thalassemia is uncommon, and although one would have expected to find clear signs of this inherited anemia in their parents, it appeared to have arisen de novo in the affected offspring. It was thought that the combination of α thalassemia with MR (ATR), and the associated developmental abnormalities represented a new syndrome and that a common genetic defect might be responsible for the diverse clinical manifestations.
It has lately become commonplace to suspect that most household and family structures in history were much the same. Under the pugnacious influence of the Cambridge Group for the History of Population and Social Structure, historians have grown wary of drawing attention to apparently abnormal household structures, and perhaps weary of reiterating the predominance in northwestern European societies of the simple or nuclear family household. Ireland, however, was not easily squeezed into the Cambridge standard model as generated for preindustrial England. Not only were Irish households before the First World War uncomfortably large, but their bulges appeared in the wrong places. Admittedly these divergences were not great; yet to students following the path of Conrad M. Arensberg and Solon T. Kimball they betokened a more fundamental divergence between the underlying structures of English and Irish families.
Low temperature hydrothermal methods allow for growth of nanowires on novel substrates. We examine the impact of variations in chemical concentration, time, temperature, and seed layer on nanowire (NW) growth and crystallite formation. The majority of growth (NWs and crystallites) was found to occur within the first two hours. Lower Zn(NO3)2 concentrations produced a reduction in the undesired large crystallites, whereas hexamethylene tetramine (HMT) concentration did not largely impact crystallite density or nanowire morphology. Growth temperature appeared to impact NW diameter variation. Nanowires grow only on the ZnO seed layer and crystallites seem to attach preferentially to the bare Kevlar surface.
A method of estimating crop production potential was devised and tested in a number of contrasting solar radiation climates. With increasing levels of solar radiation, total dry matter yields of kale, maize and sugar beet increased, whilst energy conversion efficiency declined in kale and sugar beet but increased in maize. Maximum potential crop yields in almost all environments were achieved with a conversion efficiency of approximately 2 per cent of total radiant energy.
On-farm research in remote areas demands methods that keep down costs and reduce the need for subsequent research and extension inputs and yet that still produce useful and sustainable recommendations. An important part of the process is to identify existing resource user groups and use them, rather than individual farmers, as a starting point for on-farm research. This approach is discussed in the context of farming systems research in the eastern hills of Nepal.
Building natural language spoken dialogue systems requires large amounts of human transcribed and labeled speech utterances to reach useful operational service performances. Furthermore, the design of such complex systems consists of several manual steps. The User Experience (UE) expert analyzes and defines by hand the system core functionalities: the system semantic scope (call-types) and the dialogue manager strategy that will drive the human–machine interaction. This approach is extensive and error-prone since it involves several nontrivial design decisions that can be evaluated only after the actual system deployment. Moreover, scalability is compromised by time, costs, and the high level of UE know-how needed to reach a consistent design. We propose a novel approach for bootstrapping spoken dialogue systems based on the reuse of existing transcribed and labeled data, common reusable dialogue templates, generic language and understanding models, and a consistent design process. We demonstrate that our approach reduces design and development time while providing an effective system without any application-specific data.