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This paper proposes a framework for comprehensive, collaborative, and community-based care (C4) for accessible mental health services in low-resource settings. Because mental health conditions have many causes, this framework includes social, public health, wellness and clinical services. It accommodates integration of stand-alone mental health programs with health and non-health community-based services. It addresses gaps in previous models including lack of community-based psychotherapeutic and social services, difficulty in addressing comorbidity of mental and physical conditions, and how workers interact with respect to referral and coordination of care. The framework is based on task-shifting of services to non-specialized workers. While the framework draws on the World Health Organization’s Mental Health Gap Action Program and other global mental health models, there are important differences. The C4 Framework delineates types of workers based on their skills. Separate workers focus on: basic psychoeducation and information sharing; community-level, evidence-based psychotherapeutic counseling; and primary medical care and more advanced, specialized mental health services for more severe or complex cases. This paper is intended for individuals, organizations and governments interested in implementing mental health services. The primary aim is to provide a framework for the provision of widely accessible mental health care and services.
Tyler Burge first introduced his distinction between epistemic entitlement and epistemic justification in ‘Content Preservation’ in 1993. He has since deployed the distinction in over twenty papers, changing his formulation around 2011. His distinction and its basis, however, is not well understood in the literature. This chapter distinguishes two uses of ‘entitlement’ in Burge and then focuses on the contrast between justification and entitlement, two forms of warrant, where warrants consists in the exercise of a reliable belief-forming competence. Since he draws the distinction in terms of reasons, this chapter brings his account of reasons altogether in one place. The chapter introduces a decision-procedure for classifying warrants as justifications or entitlements. The distinction is not the same as the inferential vs. non-inferential distinction. Inference is distinguished from processing, thinking, reasoning, and critically reasoning. Burge’s new formulation of the distinction was driven by the recognition of non-accessible modular reasons. Three kinds of access are distinguished.
How should we undertand the role of norms – especially epistemic norms – governing assertive speech acts? Mitchell Green (2009) has argued that these norms play the role of handicaps in the technical sense from the animal signals literature. As handicaps, they then play a large role in explaining the reliability – and so the stability (the continued prevalence) – of assertive speech acts. But though norms of assertion conceived of as social norms do indeed play this stabilizing role, these norms are best understood as deterrents and not as handicaps. This paper explains the stability problem for the maintenance of animal signals, and so human communication; the mechanics of the handicap principle; the role of deterrents and punishments as an alternative mechanism; and the role of social norms governing assertion for the case of human communication.
Does epistemic justification aim at truth? The vast majority of epistemologists instinctively answer ‘Yes’; it's the textbook response. Joseph Cruz and John Pollock surprisingly say no. In ‘The Chimerical Appeal of Epistemic Externalism’ they argue that justification bears no interesting connection to truth; justification does not even aim at truth. ‘Truth is not a very interesting part of our best understanding’ of justification (C&P 2004, 137); it has no ‘connection to the truth.’ A ‘truth-aimed … epistemology is not entitled to carry the day’ (C&P 2004, 138, emphasis added).
Pollock and Cruz's argument for this surprising conclusion is of general interest for it is ‘out of step with a very common view on the part of epistemologists, both internalist and externalist alike’ (C&P 2004, 136), as nearly all ‘epistemologists have claimed that truth and falsity play a crucial role in distinguishing between justified and unjustified beliefs [for] believing truths is the ultimate aim of human rational cognition’ (C&P 2004, 125; cf. Audi 1988).
We compared systematic and random survey techniques to estimate breeding population sizes of burrow-nesting petrel species on Marion Island. White-chinned (Procellaria aequinoctialis) and blue (Halobaena caerulea) petrel population sizes were estimated in systematic surveys (which attempt to count every colony) in 2009 and 2012, respectively. In 2015, we counted burrows of white-chinned, blue and great-winged (Pterodroma macroptera) petrels within 52 randomized strip transects (25 m wide, total 144 km). Burrow densities were extrapolated by Geographic Information System-derived habitat attributes (geology, vegetation, slope, elevation, aspect) to generate island-wide burrow estimates. Great-winged petrel burrows were found singly or in small groups at low densities (2 burrows ha−1); white-chinned petrel burrows were in loose clusters at moderate densities (3 burrows ha−1); and blue petrel burrows were in tight clusters at high densities (13 burrows ha−1). The random survey estimated 58% more white-chinned petrels but 42% fewer blue petrels than the systematic surveys. The results suggest that random transects are best suited for species that are widely distributed at low densities, but become increasingly poor for estimating population sizes of species with clustered distributions. Repeated fixed transects provide a robust way to monitor changes in colony density and area, but might fail to detect the formation/disappearance of new colonies.
For over 120 years, the shell middens of western Scotland and the series of open-air sites on Oronsay have been the focus of debate in European Mesolithic studies. This paper challenges the significance of Oronsay in light of results from the geophysical survey and test-excavation of a new limpet and periwinkle shell midden dated to the late 5th or start of the 4th millennium cal bc at Port Lobh, Colonsay that offers fresh evidence to re-evaluate critically the role of Oronsay and coastal resources in island settlement models ahead of the Mesolithic–Neolithic transition. Test excavations recovered a marine molluscan assemblage dominated by limpet and periwinkle shells together with crab, sea urchin, a fishbone assemblage composed mainly of Gadidae, some identifiable bird and mammal bone, carbonised macroplant remains, and pumice as well as a bipolar lithic assemblage and coarse stone implements. Novel seasonality studies of saithe otolith thin-sections suggest wintertime tidal fishing practices. At least two activity events may be discerned, dating from the late 5th millennium cal bc. The midden could represent a small number of rapidly deposited assemblages or maybe the result of stocastic events within a more extended timeframe. We argue that alternative research questions are needed to advance long-standing debates about seasonal inter-island mobility versus island sedentism that look beyond Oronsay to better understand later Mesolithic occupation patterns and the formation and date of Oronsay middens. We propose alternative methodological strategies to aid identification of contemporaneous sites using geophysical techniques and lithic technological signatures.
Collaborative care can support the treatment of depression in people with long-term conditions, but long-term benefits and costs are unknown.
Aims
To explore the long-term (24-month) effectiveness and cost-effectiveness of collaborative care in people with mental-physical multimorbidity.
Method
A cluster randomised trial compared collaborative care (integrated physical and mental healthcare) with usual care for depression alongside diabetes and/or coronary heart disease. Depression symptoms were measured by the symptom checklist-depression scale (SCL-D13). The economic evaluation was from the perspective of the English National Health Service.
Results
191 participants were allocated to collaborative care and 196 to usual care. At 24 months, the mean SCL-D13 score was 0.27 (95% CI, −0.48 to −0.06) lower in the collaborative care group alongside a gain of 0.14 (95% CI, 0.06-0.21) quality-adjusted life-years (QALYs). The cost per QALY gained was £13 069.
Conclusions
In the long term, collaborative care reduces depression and is potentially cost-effective at internationally accepted willingness-to-pay thresholds.
To investigate relationships between mortality and circulating 25-hydroxyvitamin D (25(OH)D), 25-hydroxycholecalciferol (25(OH)D3) and 25-hydroxyergocalciferol (25(OH)D2).
Design
Case–cohort study within the Melbourne Collaborative Cohort Study (MCCS). We measured 25(OH)D2 and 25(OH)D3 in archived dried blood spots by LC–MS/MS. Cox regression was used to estimate mortality hazard ratios (HR), with adjustment for confounders.
Setting
General community.
Subjects
The MCCS included 29 206 participants, who at recruitment in 1990–1994 were aged 40–69 years, had dried blood spots collected and no history of cancer. For the present study we selected participants who died by 31 December 2007 (n 2410) and a random sample (sub-cohort, n 2996).
Results
The HR per 25 nmol/l increment in concentration of 25(OH)D and 25(OH)D3 were 0·86 (95 % CI 0·78, 0·96; P=0·007) and 0·85 (95 % CI 0·77, 0·95; P=0·003), respectively. Of 5108 participants, sixty-three (1·2 %) had detectable 25(OH)D2; their mean 25(OH)D concentration was 11·9 (95 % CI 7·3, 16·6) nmol/l higher (P<0·001). The HR for detectable 25(OH)D2 was 1·80 (95 % CI 1·09, 2·97; P=0·023); for those with detectable 25(OH)D2, the HR per 25 nmol/l increment in 25(OH)D was 1·06 (95 % CI 0·87, 1·29; P interaction=0·02). HR were similar for participants who reported being in good, very good or excellent health four years after recruitment.
Conclusions
Total 25(OH)D and 25(OH)D3 concentrations were inversely associated with mortality. The finding that the inverse association for 25(OH)D was restricted to those with no detectable 25(OH)D2 requires confirmation in populations with higher exposure to ergocalciferol.
Marine protected areas (MPAs) are sites in the ocean and coastal sea that are dedicated to the conservation of biodiversity, fisheries, ecosystem services and cultural values. MPAs range from small, highly protected marine reserves through to large, multiple-use marine parks, such as the Great Barrier Reef Marine Park of Queensland, Australia. This chapter identifies the major policy events and phases of MPA development in Australia, and explores the role and effectiveness of MPAs in conserving Australia’s marine environment. The governance of Australian MPAs is complex; the responsibility for their declaration and management is shared between the Australian (Commonwealth), State and Territory Governments. Progress in the declaration and management of MPAs is not uniform across Australia, with some jurisdictions performing better than others. Australia is considered a world leader in the science and implementation of MPAs. However, there are serious weaknesses in the design of MPAs in Commonwealth waters due to the locating of new MPAs where they are least controversial and least costly. Considerable further effort is needed to create an effective national programme for delivering biodiversity conservation in Australia waters. This is particularly important because Australia’s oceans face an unprecedented set of pressures from accelerating climate change and coastal development.
Introduction
Australia is responsible for one of the largest marine jurisdictions in the world, covering an area of more than 13.86 million km2. This domain stretches across about 45° of latitude from the tropical waters of the north to the sub-Antarctic waters of the Southern Ocean, and encompasses seabed, open ocean and shoreline ecosystems, and near-shore marine and estuarine waters. The marine environment is rich in biodiversity. Over 33 000 identified marine species live in Australian waters, including a large number of endemics.
Virtue epistemology standardly divides into two camps: virtue-reliabilism and virtue-responsibilism. This chapter discusses the epistemic warrant in terms of features of reliable belief-forming faculties. By treating epistemic virtue in terms of functions, and functions in terms of history, it sets out to understand functions, virtues, and warrant. The chapter explicates the etiological functions. The etiological account of functions entails an account of normal functioning and normal conditions. On the etiological account, functions arise when an item produces a beneficial effect that in turn enters into a feedback mechanism, where the mechanism explains why the item persists or reoccurs because of the beneficial effect. The chapter identifies three functional norms for any item with an etiological function: function fulfillment, normal functioning, and function fulfillment because functioning normally. Natural selection requires three elements: variation, copying, and beneficial consequences. Trial-and-error learning involves trials, variations in behavior, errors, negative reinforcers and successes, positive reinforcers.
It is uncertain whether antipsychotic long-acting injection (LAI) medication in schizophrenia is associated with better clinical outcomes than oral preparations.
Aims
To examine the impact of prior treatment delivery route on treatment outcomes and whether any differences are moderated by adherence.
Method
Analysis of data from two pragmatic 1-year clinical trials in which patients with schizophrenia were randomised to either an oral first-generation antipsychotic (FGA), or a non-clozapine second-generation antipsychotic (SGA, CUtLASS 1 study), or a non-clozapine SGA or clozapine (CUtLASS 2 study).
Results
Across both trials, 43% (n = 155) of participants were prescribed an FGA-LAI before randomisation. At 1-year follow-up they showed less improvement in quality of life, symptoms and global functioning than those randomised from oral medication. This difference was confined to patients rated as less than consistently adherent pre-randomisation. The relatively poor improvement in the patients prescribed an LAI pre-randomisation was ameliorated if they had been randomised to clozapine rather than another SGA. There was no advantage to being randomly assigned from an LAI at baseline to a non-clozapine oral SGA rather than an oral FGA.
Conclusions
A switch at randomisation from an LAI to an oral antipsychotic was associated with poorer clinical and functional outcomes at 1-year follow-up compared with switching from one oral antipsychotic to another. This effect appears to be moderated by adherence, and may not extend to switching to clozapine. This has implications for clinical trial design: the drug from which a participant is randomised may have a greater effect than the drug to which they are randomised.
The predatory behaviour of introduced house mice Mus musculus at Gough Island is known to impact on albatross and petrels, resulting in the Tristan Albatross Diomedea dabbenena and Atlantic Petrel Pterodroma incerta being listed as “Critically Endangered” and “Endangered”, respectively. Although predation has been documented for two burrowing petrels and one albatross species, the impact of house mice on other burrowing petrels on Gough Island is unknown. We report burrow occupancy and breeding success of Atlantic Petrels, Soft-plumaged Petrels Pterodroma mollis, Broad-billed Prions Pachyptila vittata, Grey Petrels Procellaria cinerea and Great Shearwaters Puffinus gravis. With the exception of the Great Shearwater, breeding parameters of burrowing petrels at Gough Island were very poor, with low burrow occupancy (range 4–42%) and low breeding success (0–44%) for four species, and high rates of chick mortality in Atlantic Petrel burrows. Breeding success decreased with mass, suggesting that smaller species are hardest hit, and winter-breeding species had lower breeding success than summer breeders. The results indicate that introduced house mice are having a detrimental impact on a wider range of species than previously recorded and are likely to be causing population declines among most burrowing petrels on Gough Island. The very low values of burrow occupancy recorded for Soft-plumaged Petrels and Broad-billed Prions and greatly reduced abundance of burrowing petrels in comparison to earlier decades indicate that Gough Island’s formerly abundant petrel populations are greatly threatened by the impact of predatory house mice which can only be halted by the eradication of this species from the island.
Digital signal processing is one of many valuable tools for suppressing unwanted signals or inter-ference. Building hardware processing engines seems to be the way to best implement some classes of interference suppression but is, unfortunately, expensive and time-consuming, especially if several miti-gation techniques need to be compared. Simulations can be useful, but are not a substitute for real data. CSIRO’s Australia Telescope National Facility has recently commenced a ‘software radio telescope’ project designed to fill the gap between dedicated hardware processors and pure simulation. In this approach, real telescope data are recorded coherently, then processed offline. This paper summarises the current contents of a freely available database of base band recorded data that can be used to experiment with signal processing solutions. It includes data from the following systems: single dish, multi-feed receiver; single dish with reference antenna; and an array of six 22 m antennas with and without a reference antenna. Astronomical sources such as OH masers, pulsars and continuum sources subject to interfering signals were recorded. The interfering signals include signals from the US Global Positioning System (GPS) and its Russian equivalent (GLONASS), television, microwave links, a low-Earth-orbit satellite, various other transmitters, and signals leaking from local telescope systems with fast clocks. The data are available on compact disk, allowing use in general purpose computers or as input to laboratory hardware prototypes.
Episodic memory deficits are a core feature of neurodegenerative disorders. Muscarinic M1 receptors play a critical role in modulating learning and memory and are highly expressed in the hippocampus. We examined the effect of GSK1034702, a potent M1 receptor allosteric agonist, on cognitive function, and in particular episodic memory, in healthy smokers using the nicotine abstinence model of cognitive dysfunction. The study utilized a randomized, double-blind, placebo-controlled, cross-over design in which 20 male nicotine abstained smokers were tested following single doses of placebo, 4 and 8 mg GSK1034702. Compared to the baseline (nicotine on-state), nicotine abstinence showed statistical significance in reducing immediate (p=0.019) and delayed (p=0.02) recall. GSK1034702 (8 mg) significantly attenuated (i.e. improved) immediate recall (p=0.014) but not delayed recall. None of the other cognitive domains was modulated by either nicotine abstinence or GSK1034702. These findings suggest that stimulating M1 receptor mediated neurotransmission in humans with GSK1034702 improves memory encoding potentially by modulating hippocampal function. Hence, selective M1 receptor allosteric agonists may have therapeutic benefits in disorders of impaired learning including Alzheimer's disease.