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Specific phobias are common in the community, and much is known from epidemiological surveys about their subtypes and sex ratio.
Aims
To determine the subtypes and sex ratio in a treatment-seeking sample of people with a specific phobia.
Method
Patients with a specific phobia were identified by a retrospective search of clinical case records from patient notes in electronic health records at the South London and Maudsley NHS Foundation Trust (the largest secondary mental healthcare provider in Europe).
Results
We identified 1017 patients over 5 years as having a specific phobia. The adult female to male sex frequency ratio for having any specific phobia was 3.9, with the ratio of specific phobia subtypes ranging from 2.4 (natural environment) to 8.2 (animal). The child female to male ratio of specific phobia subtypes ranged from 0.7 (natural environment) to 1.8 (other subtypes). Phobia of vomiting was the most common specific phobia presenting in both adults (n = 161, 17.8% of all specific phobias) and children (n = 26, 23.4%). In adults with a phobia of vomiting, the female to male ratio was 9.1 compared with 3.4 in all other specific phobias, and 4.2 versus 0.98 for children.
Conclusions
There is a stark contrast between the apparent prevalence of phobia of vomiting in epidemiological surveys and being the most common presentation clinically. A very high female to male ratio in phobia of vomiting and animals in adults seeking treatment is also in contrast to findings in the community. This has implications for clinician training and public education.
This piece explores the parallel development of two fisheries management regimes in mid-twentieth-century Lake Malawi: one imposed by the British colonial government over the lake and the other by Senior Chief Makanjira focused on Mbenji Island. The parallel development of these regimes provides opportunity for close analysis of how fisheries management centred on different knowledge and practices led to distinctive legacies of governance legitimacy and efficacy. Given the increasing recognition that Indigenous knowledge is crucial to the future sustainability of fisheries globally, we contend that it is imperative to recognise the ways in which colonial pasts have embedded knowledge hierarchies and exclusionary decision-making processes within national fisheries governance regimes that continue to obstruct capacities to bring different knowledges, practices, and management approaches together effectively and appropriately.
The evidence-based psychological therapy for obsessive compulsive disorder (OCD) is cognitive behavioural therapy (CBT) delivered by mental health professionals who are trained and regulated by a professional standards authority. In recent years, people with OCD have reported consulting unqualified and unregulated coaches. We aimed to explore the experience of people who sought unregulated coaching for OCD. Using semi-structured interviews, we explored the lived experiences of 13 people with OCD who have undertaken sessions with an unqualified individual (referred to as a ‘coach’). Thematic analysis was conducted. There were four coaches rated negatively and one rated positively. Four over-arching themes were identified in the coaches who were rated negatively: (1) Appealing content, (2) Vulnerability, (3) Cult-like experience, and (4) Complex peer relationships. There were some positive experiences of coaching described, such as positive peer support from others receiving coaching in group chats. Many of the experiences documented by people who received OCD coaching were negative. It was highlighted that unqualified coaches may increase vulnerability of people seeking OCD treatment, due to unprofessional conduct. We suggest that this unprofessional conduct may be investigated by a regulator. We suggest that people seeking OCD treatment seek help from qualified professionals and that clinicians are aware of the potential negative effects such coaches can have on people.
Key learning aims
(1) To understand the potential risks, vulnerabilities and potential positive aspects associated with unregulated coaching for individuals seeking OCD treatment.
(2) To discuss our findings to promote informed decision-making by encouraging individuals with OCD to seek treatment from regulated and qualified mental health professionals.
(3) Increase clinician awareness of the potential harms associated with unqualified coaching and equip them to guide patients towards evidence-based treatment options.
It remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.
Aims
To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.
Method
Randomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment–covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.
Results
IPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = −0.48 to −0.27). Effects could not be ascertained up to 24 months (s.m.d. = −0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27–2.79), reliable improvement (relative risk = 1.38–3.17), deterioration (relative risk = 0.67–0.54) and close-to-symptom-free status (relative risk = 1.41–2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (P > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = −0.33 for PHQ-9 = 5).
Conclusions
Psychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.
This study is the first to attempt to isolate a relationship between cognitive activity and equilibration to a Nash Equilibrium. Subjects, while undergoing fMRI scans of brain activity, participated in second price auctions against a single competitor following predetermined strategy that was unknown to the subject. For this auction there is a unique strategy that will maximize the subjects’ earnings, which is also a Nash equilibrium of the associated game theoretic model of the auction. As is the case with all games, the bidding strategies of subjects participating in second price auctions most often do not reflect the equilibrium bidding strategy at first but with experience, typically exhibit a process of equilibration, or convergence toward the equilibrium. This research is focused on the process of convergence.
In the data reported here subjects participated in sixteen auctions, after which all subjects were told the strategy that will maximize their revenues, the theoretical equilibrium. Following that announcement, sixteen more auctions were performed. The question posed by the research concerns the mental activity that might accompany equilibration as it is observed in the bidding behavior. Does brain activation differ between being equilibrated and non-equilibrated in the sense of a bidding strategy? If so, are their differences in the location of activation during and after equilibration? We found significant activation in the frontal pole especially in Brodmann's area 10, the anterior cingulate cortex, the amygdala and the basal forebrain. There was significantly more activation in the basal forebrain and the anterior cingulate cortex during the first sixteen auctions than in the second sixteen. The activity in the amygdala shifted from the right side to the left after the solution was given.
Results of meta-analyses are of interest not only to researchers but often to policy-makers and other decision-makers (e.g., in education and medicine), and visualizations play an important role in communicating data and statistical evidence to the broader public. Therefore, the potential audience of meta-analytic visualizations is broad. However, the most common meta-analytic visualization – the forest plot – uses non-optimal design principles that do not align with data visualization best practices and relies on statistical knowledge and conventions not likely to be familiar to a broad audience. Previously, the Meta-Analytic Rain Cloud (MARC) plot has been shown to be an effective alternative to a forest plot when communicating the results of a small meta-analysis to education practitioners. However, the original MARC plot design was not well-suited for meta-analyses with large numbers of effect sizes as is common across the social sciences. This paper presents an extension of the MARC plot, intended for effective communication of moderate to large meta-analyses (k = 10, 20, 50, 100 studies). We discuss the design principles of the MARC plot, grounded in the data visualization and cognitive science literature. We then present the methods and results of a randomized survey experiment to evaluate the revised MARC plot in comparison to the original MARC plot, the forest plot, and a bar plot. We find that the revised MARC plot is more effective for communicating moderate to large meta-analyses to non-research audiences, offering a 0.30, 0.34, and 1.07 standard deviation improvement in chart users’ scores compared to the original MARC plot, forest plot, and bar plot, respectively.
Vaccines have revolutionised the field of medicine, eradicating and controlling many diseases. Recent pandemic vaccine successes have highlighted the accelerated pace of vaccine development and deployment. Leveraging this momentum, attention has shifted to cancer vaccines and personalised cancer vaccines, aimed at targeting individual tumour-specific abnormalities. The UK, now regarded for its vaccine capabilities, is an ideal nation for pioneering cancer vaccine trials. This article convened experts to share insights and approaches to navigate the challenges of cancer vaccine development with personalised or precision cancer vaccines, as well as fixed vaccines. Emphasising partnership and proactive strategies, this article outlines the ambition to harness national and local system capabilities in the UK; to work in collaboration with potential pharmaceutic partners; and to seize the opportunity to deliver the pace for rapid advances in cancer vaccine technology.
Two studies were conducted in 2022 and 2023 near Rocky Mount and Clayton, NC, to determine the optimal granular ammonium sulfate (AMS) rate and application timing for pyroxasulfone-coated AMS. In the rate study, AMS rates included 161, 214, 267, 321, 374, 428, and 481 kg ha−1, equivalent to 34, 45, 56, 67, 79, 90, and 101 kg N ha−1, respectively. All rates were coated with pyroxasulfone at 118 g ai ha−1 and topdressed onto 5- to 7-leaf cotton. In the timing study, pyroxasulfone (118 g ai ha−1) was coated on AMS and topdressed at 321 kg ha−1 (67 kg N ha−1) onto 5- to 7-leaf, 9- to 11-leaf, and first bloom cotton. In both studies, weed control and cotton tolerance to pyroxasulfone-coated AMS were compared to pyroxasulfone applied POST and POST-directed. The check in both studies received non-herbicide-treated AMS (321 kg ha−1). Before treatment applications, all plots (including the check) were maintained weed-free with glyphosate and glufosinate. In both studies, pyroxasulfone applied POST was most injurious (8% to 16%), while pyroxasulfone-coated AMS resulted in ≤4% injury. Additionally, no differences in cotton lint yield were observed in either study. With the exception of the lowest rate of AMS (161 kg ha−1; 79%), all AMS rates coated with pyroxasulfone controlled Palmer amaranth ≥83%, comparably to pyroxasulfone applied POST (92%) and POST-directed (89%). In the timing study, the application method did not affect Palmer amaranth control; however, applications made at the mid- and late timings outperformed early applications. These results indicate that pyroxasulfone-coated AMS can control Palmer amaranth comparably to pyroxasulfone applied POST and POST-directed, with minimal risk of cotton injury. However, the application timing could warrant additional treatment to achieve adequate late-season weed control.
The incidence of facial palsy has been rising worldwide, with recent evidence emerging of links to COVID-19 infection. To date, guidance on cost-effective treatments is limited to medication (prednisolone). In terms of physical therapy, neuromuscular retraining (NMR) to restore balanced facial function has been most widely evaluated, but not in terms of cost effectiveness. The added value of telerehabilitation is unknown.
Methods
A multistage technology assessment was conducted, which included the following:
• a national survey of current therapy pathways in the UK and patients’ and clinicians’ views on the benefits and challenges of telerehabilitation;
• a systematic review of clinical effectiveness trials evaluating facial NMR therapy;
• calculation of long-term morbidity costs (national economic burden) based on incidence, patient recovery profiles, health-related quality of life, and national facial palsy treatment costs (valuation of clinical improvements in monetary terms was provided by a national Delphi panel); and
• evaluation of the cost effectiveness of telerehabilitation (remote monitoring wearables) added to current face-to-face NMR delivery.
Results
Nationally, approximately five percent of patients with facial palsy (17% of unresolved cases) are referred for facial NMR. The long-term economic burden associated with unresolved cases is estimated to range from GBP351 (EUR417) to GBP584 (EUR692) million, indicating substantial savings if long-term recovery can be improved. Medical treatment costs are GBP86.34 (EUR102) million per annual cohort, and physical and psychological therapy costs are GBP643,292 (EUR762,561). Economic modeling showed that telerehabilitation was cost effective, producing a health gain and a cost-saving of GBP468 (EUR555) per patient. If scaled to the national level for all patients who do not recover fully, an annual saving of GBP3.075 (EUR3.65) million is possible.
Conclusions
Economic modeling indicates that NMR could improve patient outcomes and reduce costs. The national survey demonstrated that access to NMR therapy services is limited, so introduction of telerehabilitation could improve access for currently underserved populations. Future clinical trials need to incorporate economic evaluations to help inform decision-making.
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.
In most social psychological studies, researchers conduct analyses that treat participants as a random effect. This means that inferential statistics about the effects of manipulated variables address the question whether one can generalize effects from the sample of participants included in the research to other participants that might have been used. In many research domains, experiments actually involve multiple random variables (e.g., stimuli or items to which participants respond, experimental accomplices, interacting partners, groups). If analyses in these studies treat participants as the only random factor, then conclusions cannot be generalized to other stimuli, items, accomplices, partners, or groups. What are required are mixed models that allow multiple random factors. For studies with single experimental manipulations, we consider alternative designs with multiple random factors, analytic models, and power considerations. Additionally, we discuss how random factors that vary between studies, rather than within them, may induce effect size heterogeneity, with implications for power and the conduct of replication studies.
To examine underlying political economy factors that enable or impede the integration of nutrition considerations into food system governance.
Design:
Comparative political economy analysis of data collected through (1) value chain analyses of selected healthy and unhealthy commodities and (2) food system policy analyses, using a theoretical framework focused on power, politics, interests and ideas.
Setting:
Ghana and South Africa.
Participants:
Value chain actors relevant to healthy and unhealthy foods (Ghana n 121; South Africa n 72) and policy stakeholders from government (Health, Agriculture, Trade and Industry, Finance), academia, civil society, development partners, Civil Society Organization (CSO) and private sector (Ghana n 28; South Africa n 48).
Results:
Nutrition was a stated policy priority in both countries; however, policy responsibility was located within the health sector, with limited integration of nutrition into food system sectors (including Agriculture, Trade and Industry). Contributing factors included a conceptions of policy responsibilities for nutrition and food systems, dominant ideas and narratives regarding the economic role of the food industry and the purpose of food system policy, the influence of large food industry actors, and limited institutional structures for cross-sectoral engagement and coordination.
Conclusions:
Integrating nutrition into multi-sectoral food policy to achieve multiple food system policy goals will require strategic action across jurisdictions and regional levels. Opportunities included increasing investment in healthy traditional foods, strengthening urban/rural linkages and informal food systems, and strengthening institutional structures for policy coherence and coordination related to nutrition.
This study investigates practicing clinician and staff perspectives on potential protocol modifications for the “Nasal Irrigation, Oral Antibiotics, and Subgroup Targeting for Effective Management of Acute Sinusitis” (NOSES) study, a pragmatic randomized controlled trial aiming at improving acute rhinosinusitis management. Focus groups with clinicians and staff at the pretrial stage recommended expanding participant age inclusion criteria, incorporating patients with COVID-19, and shortening the supportive care phase. Participants also discussed patient engagement and recruitment strategies. These practical insights contribute to optimizing the NOSES trial design and underscore the value of qualitative inquiries and healthcare stakeholder engagement in informing clinical trial design.
An experiment was conducted in 2022 and 2023 near Rocky Mount and Clayton, NC, to evaluate residual herbicide-coated fertilizer for cotton tolerance and Palmer amaranth control. Treatments included acetochlor, atrazine, dimethenamid-P, diuron, flumioxazin, fluometuron, fluridone, fomesafen, linuron, metribuzin, pendimethalin, pyroxasulfone, pyroxasulfone + carfentrazone, S-metolachlor, and sulfentrazone. Each herbicide was individually coated on granular ammonium sulfate (AMS) and top-dressed at 321 kg ha−1 (67 kg N ha−1) onto 5- to 7-leaf cotton. The check plots received the equivalent rate of nonherbicide-treated AMS. Before top-dress, all plots (including the check) were treated with glyphosate and glufosinate to control previously emerged weeds. All herbicides except metribuzin resulted in transient cotton injury. Cotton response to metribuzin varied by year and location. In 2022, metribuzin caused 11% to 39% and 8% to 17% injury at the Clayton and Rocky Mount locations, respectively. In 2023, metribuzin caused 13% to 32% injury at Clayton and 73% to 84% injury at Rocky Mount. Pyroxasulfone (91%), pyroxasulfone + carfentrazone (89%), fomesafen (87%), fluridone (86%), flumioxazin (86%), and atrazine (85%) controlled Palmer amaranth ≥85%. Pendimethalin and fluometuron were the least effective treatments, resulting in 58% and 62% control, respectively. As anticipated, early season metribuzin injury translated into yield loss; plots treated with metribuzin yielded 640 kg ha−1 and were comparable to yields after linuron (790 kg ha−1) was used. These findings suggest that with the exception of metribuzin, residual herbicides coated onto AMS may be suitable and effective in cotton production, providing growers with additional modes of action for late-season control of multiple herbicide–resistant Palmer amaranth.
The Brazil Nut tree (Bertholletia excelsa, Lecythidaceae) is a species of considerable historical, economic and ecological importance in South America. Radiocarbon dating indicates some individuals can live from hundreds to more than 1000 years, which means they have the potential to reconstruct deep time growth patterns and their relationship to anthropogenic management or climate change from pre-colonial to present times. However, age estimates vary considerably amongst trees dated with different methods (i.e. tree-ring analysis, radiocarbon-dating, and repeated diameter measurements). Here we analyze living Brazil Nut trees growing in four distinct regions across the Brazilian Amazon using two dating methods: tree-ring counting and radiocarbon dating. Our results show that the congruence between the two methods varies amongst regions, and the highest congruence is found at the site of Tefé, Amazonas. This region features archaeological sites with anthropogenic Terra Preta soils, and is known for its long-term human forest management. This management likely enhanced light and nutrient availability, which possibly enabled the trees to grow at higher rates and form annual rings. Our findings highlight the need for better understanding of the growth of Brazil Nut trees for ecological research, but also the potential of dendrochronology for exploring climate change and human-forest interactions in the Amazon Basin.