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There is growing evidence to support the use of the psychedelic drug psilocybin for difficult-to-treat depression. This paper compares the cost-effectiveness of psilocybin-assisted psychotherapy (PAP) with conventional medication, cognitive behavioural therapy (CBT), and the combination of conventional medication and CBT.
Methods:
A decision model simulated patient events (response, remission, and relapse) following treatment. Data on probabilities, costs and quality-adjusted life years (QALYs) were derived from previous studies or from best estimates. Expected healthcare and societal costs and QALYs over a 6-month time period were calculated. Sensitivity analyses were used to address uncertainty in parameter estimates.
Results:
The expected healthcare cost of PAP varied from £6132 to £7652 depending on the price of psilocybin. This compares to £3528 for conventional medication alone, £4250 for CBT alone, and £4197 for their combination. QALYs were highest for psilocybin (0.310), followed by CBT alone (0.283), conventional medication alone (0.278), and their combination (0.287). Psilocybin was shown to be cost-effective compared to the other therapies when the cost of therapist support was reduced by 50% and the psilocybin price was reduced from its initial value to £400 to £800 per person. From a societal perspective, psilocybin had improved cost-effectiveness compared to a healthcare perspective.
Conclusions:
Psilocybin has the potential to be a cost-effective therapy for severe depression. This depends on the level of psychological support that is given to patients receiving psilocybin and the price of the drug itself. Further data on long-term outcomes are required to improve the evidence base.
The development of wearable technology, which enables motion tracking analysis for human movement outside the laboratory, can improve awareness of personal health and performance. This study used a wearable smart sock prototype to track foot–ankle kinematics during gait movement. Multivariable linear regression and two deep learning models, including long short-term memory (LSTM) and convolutional neural networks, were trained to estimate the joint angles in sagittal and frontal planes measured by an optical motion capture system. Participant-specific models were established for ten healthy subjects walking on a treadmill. The prototype was tested at various walking speeds to assess its ability to track movements for multiple speeds and generalize models for estimating joint angles in sagittal and frontal planes. LSTM outperformed other models with lower mean absolute error (MAE), lower root mean squared error, and higher R-squared values. The average MAE score was less than 1.138° and 0.939° in sagittal and frontal planes, respectively, when training models for each speed and 2.15° and 1.14° when trained and evaluated for all speeds. These results indicate wearable smart socks to generalize foot–ankle kinematics over various walking speeds with relatively low error and could consequently be used to measure gait parameters without the need for a lab-constricted motion capture system.
Intentional vehicular assaults on civilians have become more frequent worldwide, with some resulting in mass casualties, injuries, and traumatized witnesses. Health care costs associated with these vehicular assaults usually fall to compensation agencies. There is, however, little guidance around how compensation agencies should respond to mental and physical injury claims arising from large-scale transport incidents.
Methods:
A Delphi review methodology was used to establish expert consensus recommendations on the major components of “no fault” injury claim processes for mental and physical injury.
Results:
Thirty-three international experts participated in a 3-round online survey to rate their agreement on key statements generated from the literature. Consensus was achieved for 45 of 60 (75%) statements, which were synthesized into 36 recommendations falling within the domains of (1) facilitating claims, (2) eligibility rules, (3) payments and benefits for clients, (4) claims management procedures, (5) making and explaining decisions, (6) support and information resources for clients, (7) managing scheme staff and organizational response, (8) clients with special circumstances, and (9) scheme values and integrity.
Conclusions:
The recommendations present an opportunity for agencies to review their existing claims management systems and procedures. They also provide the basis for the development of best practice guidelines, which may be adapted for application to compensation schemes in different contexts worldwide.
What is classical music? This book answers the question in a manner never before attempted, by presenting the history of fifteen parallel traditions, of which Western classical music is just one. Eachmusic is analysed in terms of its modes, scales, and theory; its instruments, forms, and aesthetic goals; its historical development, golden age, and condition today; and the conventions governing its performance. The writers are leading ethnomusicologists, and their approach is based on the belief that music is best understood in the context of the culture which gave rise to it . By including Mande and Uzbek-Tajik music - plus North American jazz - in addition to the better-known styles of the Middle East, the Indian sub-continent, the Far East, and South-East Asia, this book offers challenging new perspectives on the word 'classical'. It shows the extent to which most classical traditions are underpinned by improvisation, and reveals the cognate origins of seemingly unrelated musics; it reflects the multifarious ways in which colonialism, migration, and new technology have affected musical development, and continue to do today. With specialist language kept to a minimum, it's designed to help both students and general readers to appreciate musical traditions which may be unfamiliar to them, and to encounter the reality which lies behind that lazy adjective 'exotic'.
MICHAEL CHURCH has spent much of his career in newspapers as a literary and arts editor; since 2010 he has been the music and opera critic of The Independent. From 1992 to 2005 he reported on traditional musics all over the world for the BBC World Service; in 2004, Topic Records released a CD of his Kazakh field recordings and, in 2007, two further CDs of his recordings in Georgia and Chechnya.
Contributors: Michael Church, Scott DeVeaux, Ivan Hewett, David W. Hughes, Jonathan Katz, Roderic Knight, Frank Kouwenhoven, Robert Labaree, Scott Marcus, Terry E. Miller, Dwight F.Reynolds, Neil Sorrell, Will Sumits, Richard Widdess, Ameneh Youssefzadeh
The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.
The Must Farm pile-dwelling site is an extraordinarily well-preserved Late Bronze Age settlement in Cambridgeshire, UK. The authors present the site's contextual setting, from its construction, occupation and subsequent destruction by fire in relatively quick succession. A slow-flowing watercourse beneath the pile-dwellings provided a benign burial environment for preserving the debris of construction, use and collapse, while the catastrophic manner of destruction introduced a definitive timeframe. The scale of its occupation speaks to the site's exceptional nature, enabling the authors to deduce the everyday flow and use of things in a prehistoric domestic setting.
This article introduces the second of two special issues on philosophical approaches to leadership ethics. In this issue, the articles draw on the works of Plato, Niccolò Machiavelli, Michel Foucault, and Jürgen Habermas to explore questions in leadership ethics concerning leaders’ self-knowledge and self-constitution and their responsibilities to their followers. The articles in this issue demonstrate the potential of philosophy to deepen our understanding of leadership and ethics.
This article introduces the first of two special issues on philosophical approaches to leadership ethics. In it, we show some of the ways that philosophy contributes to the study of leadership and leadership ethics. We begin with an overview of how philosophers have treated some of the ethical aspects and challenges of leadership. These include discussions of self-interest, the problem of dirty hands, responsibility, moral luck, power, gender and diversity, and spirituality. The articles in this issue draw on philosophy to explore a variety of ethical questions related to leadership and the relationships that leaders have with followers and others.
Two medium-depth ice cores were retrieved from Berkner Island by a joint project between the Alfred-Wegener-Institut and the British Antarctic Survey in the 1994/95 field season. A 151m deep core from the northern dome (Reinwarthhöhe) of Berkner Island spans 700 years, while a 181 m deep core from the southern dome (Thyssenhöhe) spans approximately 1200 years. Both cores display clear seasonal cycles in electrical conductivity measurements, allowing dating by annual-layer counting and the calculation of accumulation profiles. Stable-isotope measurements (both δ18O and δD), together with the accumulation data, allow us to estimate changes in climate for most of the past millennium: the data show multi-decadal variability around a generally stable long-termmean. In addition, a full suite of major chemistry measurements is available to define the history of aerosol deposition at these sites: again, there is little evidence that the chemistry of the sites has changed over the past six centuries. Finally, we suggest that the southern dome, with an ice thickness of 950 m, is an ideal site from which to gain a climate history of the late stages of the last glacial and the deglaciation for comparison with the records from the deep Antarctic ice cores, and with other intermediate-depth cores such as Taylor Dome and Siple Dome.
In [8], the third author defined a reducibility $\le _w^{\rm{*}}$ that lets us compare the computing power of structures of anycardinality. In [6], the first two authors showed that the ordered field ofreals ${\cal R}$ lies strictly above certain related structures. In the presentpaper, we show that $\left( {{\cal R},exp} \right) \equiv _w^{\rm{*}}{\cal R}$. More generally, for the weak-looking structure ${\cal R}$ℚ consisting of the real numbers withjust the ordering and constants naming the rationals, allo-minimal expansions of ${\cal R}$ℚ are equivalent to ${\cal R}$. Using this, we show that for any analytic functionf, $\left( {{\cal R},f} \right) \equiv _w^{\rm{*}}{\cal R}$. (This is so even if $\left( {{\cal R},f} \right)$ is not o-minimal.)
This paper combines a study of the rock debris and δD/δ18O isotopic characteristics of basal ice sequences in three representative glaciers in South Georgia and concludes that the debris and ice has been entrained mainly by basal freezing. The size distribution of the rock debris is typical of crushing and abrasion, and reflects transport at the ice–rock interface. The δD/δ18O relationships show that clear ice associated with the debris has accreted through freezing. The white bubbly glacier ice has δD/δ18O relationships typical of precipitation which demonstrates an altitudinal effect between glaciers.
On 19 and 20 August 1984, an ice-marginal lake drained through a subglacial tunnel beneath the ede of the Greenland ice sheet, discharging about 22.3 × 106 m3 of water in less than 19 h. The event, which may occur annually, modified ice-margin dynamics at the lake site and along a 3 km stretch of ice margin 11 km down-stream.
Spatial variations in the debris-bearing basal ice layer exposed at the ice-sheet margin in West Greenland reflect the geography of basal melting and ice flow around large obstacles close to the margin. This paper demonstrates the character of the basal ice layer, which comprises fine material incorporated in an interior, subglacial environment and coarser material entrained in an ice-marginal environment. We develop an empirical model of ice flow close to a lobate margin of the ice sheet in which ice convergence and divergence, and limited subglacial melting affect the character and distribution of the basal ice at the margin. There is a tendency for the convergence and divergence to thicken the basal layer in lobate areas and to thin it in inter-lobate areas. Under certain circumstances, basal melting may remove much of the layer from beneath the snouts of larger lobes, thus causing the basal layer to be thickest in an intermediate location.
Despite the extensive network of moisture-sensitive tree-ring chronologies in western North America, relatively few are long enough to document climatic variability before and during the Medieval Climate Anomaly (MCA) ca. AD 800-1300. We developed a 2300-yr tree-ring chronology extending to 323 BC utilizing live and remnant Douglas-fir (Pseudotsuga menziesii) from the Tavaputs Plateau in northeastern Utah. A resulting regression model accounts for 70% of the variance of precipitation for the AD 1918–2005 calibration period. Extreme wet and dry periods without modern analogues were identified in the reconstruction. The MCA is marked by several prolonged droughts, especially prominent in the mid AD 1100s and late 1200s, and a lack of wet or dry single-year extremes. The frequency of extended droughts is not markedly different, however, than before or after the MCA. A drought in the early AD 500s surpasses in magnitude any other drought during the last 1800 yr. A set of four long high-resolution records suggests this drought decreased in severity toward the south in the western United States. The spatial pattern is consistent with the western dipole of moisture anomaly driven by El Niño and is also similar to the spatial footprint of the AD 1930s "Dust Bowl" drought.
Heavily tuberculated glyptosaur osteoderms were collected in an active limestone quarry in northern Berkeley County, South Carolina. The osteoderms are part of a highly diverse late Paleocene vertebrate assemblage that consists of marine, terrestrial, fluvial, and/or brackish water taxa, including chondrichthyan and osteichthyan fish, turtles (chelonioid, trionychid, pelomedusid, emydid), crocodilians, palaeopheid snakes, and a mammal. Calcareous nannofossils indicate that the fossiliferous deposit accumulated within subzone NP9a of the Thanetian Stage (late Paleocene, upper part of Clarkforkian North American Land Mammal Age [NALMA]) and is therefore temporally equivalent to the Chicora Member of the Williamsburg Formation. The composition of the paleofauna indicates that the fossiliferous deposit accumulated in a marginal marine setting that was influenced by fluvial processes (estuarine or deltaic).
The discovery of South Carolina osteoderms is significant because they expand the late Paleocene geographic range of glyptosaurines eastward from the US midcontinent to the Atlantic Coastal Plain and provide one of the few North American records of these lizards inhabiting coastal habitats. This discovery also brings to light a possibility that post-Paleocene expansion of this group into Europe occurred via northeastward migration along the Atlantic coast of North America.