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On November 20, 2021, petroleum fuel contaminated the Red Hill well, which provides water to about 93 000 persons on Oahu, Hawaii. Initial investigations recommended further evaluations of long-term health effects of petroleum exposure in drinking water. We reviewed electronic health records of those potentially exposed to contaminated water to understand prevalence of conditions and symptoms.
Methods
A sample of persons potentially exposed during November 20, 2021-March 18, 2022 who sought care within the military health system through February 24, 2023 was identified. Abstracted records were categorized as worsening preexisting or persistent new for conditions and symptoms.
Results
Of 653 medical charts reviewed, 357 (55%) had worsening preexisting or persistent new conditions or symptoms. Most-documented conditions included worsening preexisting migraine (8%; 50/653) and chronic pain (4%; 26/653), and persistent new migraine (2%; 14/653) and adjustment disorder (2%; 13/653). Most-documented symptoms included worsening preexisting headache (8%; 49/653) and anxiety (6%; 42/653), and persistent new rash (7%; 46/653) and headache (5%; 34/653).
Conclusions
Approximately half of the abstracted medical records demonstrated worsening preexisting or persistent new conditions or symptoms and might benefit from sustained access to physical, mental, and specialized health care support systems. Continued monitoring for long-term health outcomes is recommended.
Bipolar depression remains difficult to treat, and people often experience ongoing residual symptoms, decreased functioning and impaired quality of life. Adjunctive therapies targeting novel pathways can provide wider treatment options and improve clinical outcomes. Garcinia mangostana Linn. (mangosteen) pericarp has serotonogenic, antioxidant anti-inflammatory and neurogenic properties of relevance to the mechanisms of bipolar depression.
Aims
The current 28-week randomised, multisite, double-blind, placebo-controlled trial investigated mangosteen pericarp extract as an adjunct to treatment-as-usual for treatment of bipolar depression.
Method
This trial was prospectively registered on the Australia New Zealand Clinical Trials Registry (no. ACTRN12616000028404). Participants aged 18 years and older with a diagnosis of bipolar I or II and with at least moderate depressive symptoms were eligible for the study. A total of 1016 participants were initially approached or volunteered for the study, of whom 712 did not progress to screening, with an additional 152 screened out. Seventy participants were randomly allocated to mangosteen and 82 to a placebo control. Fifty participants in the mangosteen and 64 participants in the placebo condition completed the treatment period and were analysed.
Results
Results indicated limited support for the primary hypothesis of superior depression symptom reduction following 24 weeks of treatment. Although overall changes in depressive symptoms did not substantially differ between conditions over the course of the trial, we observed significantly greater improvements for the mangosteen condition at 24 weeks, compared with baseline, for mood symptoms, clinical impressions of bipolar severity and social functioning compared with controls. These differences were attenuated at week 28 post-discontinuation assessment.
Conclusions
Adjunctive mangosteen pericarp treatment appeared to have limited efficacy in mood and functional symptoms associated with bipolar disorder, but not with manic symptoms or quality of life, suggesting a novel therapeutic approach that should be verified by replication.
Recent changes to US research funding are having far-reaching consequences that imperil the integrity of science and the provision of care to vulnerable populations. Resisting these changes, the BJPsych Portfolio reaffirms its commitment to publishing mental science and advancing psychiatric knowledge that improves the mental health of one and all.
A modification of the quartimax computation for factor rotation is described in which a hypothesized factor pattern is given to the machine along with the data. The machine uses the pattern to select the subset of variables to which it will attend when rotating in a given plane, in order to find an orthogonal solution which closely fits the hypothesis. The program also provides a measure of the goodness of this fit. The program can utilize pattern matrices that reflect only partial hypotheses as to the nature of the factors, as well as those that specify highly determined simple structure.
This study compares a quartimax rotation of the centroid factor loadings for Thurstone's Primary Mental Abilities Test Battery with factorings of the same correlation matrix by Thurstone (simple structure), Zimmerman (revised simple structure), Holzinger and Harman (bi-factor analysis), and Eysenck (group factor analysis). The quartimax results agree very closely with the solutions of Holzinger and Harman and of Eysenck, and reasonably well with the two simple structure analyses. The principal difference is the general factor provided by the quartimax solution. Reproduction of the factorial structure is sufficiently good to justify its use at least as the first stage of rotation. More extensive trial of the method will be needed with more varied data before it will be possible to decide whether quartimax factors meet psychological requirements sufficiently well without further rotation.
Insects are the most abundant and diverse group of animals on Earth. They are critical to ecosystem function in terrestrial and aquatic systems, yet they are one of the most understudied groups of organisms. Only a small proportion of the more than five million insect species have been assessed by the IUCN Red List. For most of these species, there is not enough evidence to know what is happening to their populations. In fact, for most insect species globally, there is very little data available on where they live, how they live and what environmental conditions they need to persist in the long term. A number of threats affect insect biology and life cycles generally, including climate change, habitat clearing, invasive species, use of broad-spectrum pesticides, and pollution of soil and waterways. These threats should be addressed immediately to prevent further declines in insect populations. To understand insects better, greater investment in research and documentation of the world’s insect diversity is urgently needed.
This well-balanced introduction to enterprise risk management integrates quantitative and qualitative approaches and motivates key mathematical and statistical methods with abundant real-world cases - both successes and failures. Worked examples and end-of-chapter exercises support readers in consolidating what they learn. The mathematical level, which is suitable for graduate and senior undergraduate students in quantitative programs, is pitched to give readers a solid understanding of the concepts and principles involved, without diving too deeply into more complex theory. To reveal the connections between different topics, and their relevance to the real world, the presentation has a coherent narrative flow, from risk governance, through risk identification, risk modelling, and risk mitigation, capped off with holistic topics - regulation, behavioural biases, and crisis management - that influence the whole structure of ERM. The result is a text and reference that is ideal for graduate and senior undergraduate students, risk managers in industry, and anyone preparing for ERM actuarial exams.
In this chapter, we study risks associated with movements of interest rates in financial markets. We begin with a brief discussion of the term structure of interest rates. We then discuss commonly used interest rate sensitive securities. This is followed by the study of different measures of sensitivity to interest rates, including duration and convexity. We consider mitigating interest rate risk through hedging and immunization. Finally, we take a more in-depth look at the drivers of interest rate term structure dynamics.
In this chapter, we present the frequency-severity model, which is implicit in common risk calculations used in practice. In this model, the total loss from a risk, or set of risks, is treated as a random sum of random, identically distributed individual losses. If the frequency and severity random variables are independent, then the mean and variance of the aggregate loss can easily be calculated from the moments of the frequency and severity distributions. However, numerical methods are usually required for other metrics, such as quantiles or expected shortfall. We show how to implement these methods and discuss the limitations of this type of model, arising from the independence assumptions.
In this chapter, we consider qualitative and quantitative aspects of risk related to the development, implementation, and uses of quantitative models in enterprise risk management (ERM). First, we discuss the different ways that model risk arises, including defective models, inappropriate applications, and inadequate or inappropriate interpretation of the results. We consider the lifecycle of a model – from development, through regular updating and revision, to the decommissioning stage. We review quantitative approaches to measuring model and parameter uncertainty, based on a Bayesian framework. Finally, we discuss some aspects of model governance, and some potential methods for mitigating model risk.
In this chapter, we review the different methods available to a firm that wants to transfer risk. First, we consider the traditional route of insurance, or reinsurance. We describe the different types of insurance contracts, and analyse their advantages and disadvantages. We then consider captive insurance companies, which are insurance companies that are owned by the organization that is transferring risk. Next, we discuss securitization of risk, where risk is packaged into investments that are sold off in the capital markets. One of the most interesting examples of securitized insurance risk is the catastrophe bond, or cat bond. We also look at examples of securitization of demographic risk, through pandemic bonds and longevity derivatives.
A taxonomy is a classification system. In this chapter, we present a risk taxonomy, by which we mean that we shall categorize and describe all the major risks that may be faced by a firm or institution. We will describe risks that arise from outside the organization (external risks) and those that come from within the organization (internal risks). External risks are further categorized into economic, political, and environmental categories, while internal risks include operational and strategic risks. Reputational risk may be internally or externally generated. We describe some examples of how risks have arisen in several high-profile cases, showing the intersectionality of the different risk categories – that is, how the different risk types can all be driven by a single risk event.
In this chapter, we discuss the ways that credit risk arises, and how it can be modelled and mitigated. First, we consider the various types of contractual forms for loans and other obligations. We then discuss credit derivatives, which are contracts with payoffs that are contingent on credit events. We consider credit risk models based on the three fundamental components: probability of default, proportionate loss given default, and exposure at default. We consider models of default for individual firms, including the role of credit rating agencies, structural models, which are based on the underlying processes causing default, and reduced form models which are more based on the empirical information, with less emphasis on the underlying story. This is followed by a description of portfolio credit risk models, where the joint credit risk of multiple entities is the modelling objective.
In this chapter, we discuss some of the common psychological or behavioural factors that influence risk analysis and risk management. We give examples of cases where behavioural biases created a risk management failure, and some ways in which the negative impact of biases can be mitigated. Biases are categorized, loosely, as relating to (i) self-deception, (ii) information processing (both forms of cognitive bias), and (iii) social bias, relating to the pressures created by social norms and expectations. We give examples of a range of common behavioural biases in risk management, and we briefly describe some strategies for overcoming the distortions created by behavioural factors in decision-making. Next, we present the foundational concepts of Cumulative Prospect Theory, which provides a mathematical framework for decision making that reflects some universal cognitive biases.
In this chapter, we review some of the risk management implications of the regulation of banks and insurance companies. Banks are largely regulated through local implementation of the Basel II and Basel III Accords. Insurance regulation is more varied, but the development of the Solvency II framework in the European Union has influenced regulation more widely, and so we focus on Solvency II as an example of a modern insurance regulatory system.
In this chapter, we distinguish funding liquidity from market liquidity, and idiosyncratic liquidity from systemic liquidity. We discuss the nature of highly liquid assets, and methods by which a firm might acquire liquid assets to cover short-term cash flow problems, either in normal operations, or in more extreme crises. As liquidity risk is a problem of cash flow management, we explain how cash flow scenario tests can be used to identify and mitigate risks. We describe liquidity adjusted risk measures used in banking. Finally, we describe how firms might create emergency plans for managing extreme and unexpected liquidity shocks.