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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.
A significant body of evidence shows that law schools and many elite colleges use large admissions preferences based on race, and other evidence strongly suggests that large preferences can undermine student achievement in law school and undergraduate science majors, thus producing highly counterproductive effects. This article draws on available evidence to examine the use of racial preferences in medical school admissions, and finds strong reasons for concern about the effects and effectiveness of current affirmative action efforts. The author calls for better data and careful investigation of several identified patterns.
Decisions on the use of nature reflect the values and rights of individuals, communities and society at large. The values of nature are expressed through cultural norms, rules and legislation, and they can be elicited using a wide range of tools, including those of economics. None of the approaches to elicit peoples’ values are neutral. Unequal power relations influence valuation and decision-making and are at the core of most environmental conflicts. As actors in sustainability thinking, environmental scientists and practitioners are becoming more aware of their own posture, normative stance, responsibility and relative power in society. Based on a transdisciplinary workshop, our perspective paper provides a normative basis for this new community of scientists and practitioners engaged in the plural valuation of nature.
We draw attention to studies indicating that phasic arousal increases interference effects in tasks necessitating the recruitment of cognitive control. We suggest that arousal-biased competition models such as GANE (glutamate amplifies noradrenergic effects) may be able to explain these findings by taking into account dynamic, within-trial changes in the relative salience of task-relevant and task-irrelevant features. However, testing this hypothesis requires a computational model.
Poor access to improved seeds in West and Central Africa has compromised crop yields and productivity as most farmers source the bulk of their seeds from informal channels. The use of farmer produced seeds has mostly resulted in high seedling mortality thereby presenting challenges to cocoa rehabilitation programmes across the sub region. With the aid of a mobile data collection system (MDCS), the first of its kind to enhance accuracy of survey results in an improved seed supply system through brokerage and linkages among diverse actors, this study assesses Ghanaian farmers’ access to improved hybrid cocoa seeds and provides evidence on the socio-cultural factors that affect field performance of such planting materials. Results show that farmers value a seed brokerage system (SBS), which is facilitated through group bulk purchase, timely acquisition and delivery of seeds. The study also revealed that farm size, land use type and gender have significant effect on survival rate of transplanted hybrid cocoa seedlings over two dry seasons. Regardless of the rehabilitation process, mean survival rate was high (79%) although an 11% (p < 0.000) difference occurred between gender with men recording a higher rate. The majority of farmers prefer cultivating cocoa on forest and fallow lands, implying continues degradation of forest areas. There is therefore an urgent need for a change of mind set, to advocate for land recycling to spare forest areas to thrive.
Crossbreeding in commercial hog operations is widely practiced and has increased substantially in recent years. Perhaps the most important positive feature of crossbreeding is heterosis, i.e., the performance of crossbred progeny is superior to the average performance of the parents. In addition, producers have much wider options in breeding for desired carcass traits and sire and dam characteristics when blending breeds than when making genetic selection within any single breed. The costs to the firm are primarily managerial because of the necessity of buying replacements, frequently rotating boar breed, or maintaining miniherds to produce replacements for the breeding herd. Over the long run there is also a potential cost to the industry of reducing the number of purebred lines from which the crossbreds are derived and thus slowing genetic improvements within breeds.
In the coming decades, the broad outline of Kenyan development is quite likely to duplicate the Mexican experience of industrial and commercial progress for a minority combined with economic stagnation for the majority. While there are obvious differences in culture, history, and geography, there are basic similarities in industrialization strategy, agricultural structure, urban expansion, and population growth rate. A continuation of the current industrial, financial, and agricultural strategies, and an extrapolation of other variables along certain key paths, will almost surely lead Kenya to the same form of dualistic transformation that has gradually engulfed Mexico over the course of three decades. A rather important point which emerges from the following analysis is that only by a significant reduction in the population growth rate can that result be avoided.
An economic transformation is many faceted, involving technological, institutional, and cultural changes as well as significant shifts in the product mix. From an economic standpoint, an essential element of transformation is a significant growth in labor productivity which, in turn, is translated into a rising level of income per capita. This improvement in average product per worker largely involves the transfer of labor from traditional, low productivity sectors into those which spearhead modernization. This facet of economic transformation is referred to as labor force transformation and is generally understood to be a goal of economic development.
Infants with coarctation of the aorta may have obstructions at other sites within the left heart which are not always apparent on the initial echocardiogram. The magnitude of the risk of having the additional obstructions is not well described, with few reliable quantitative criterions for identifying patients at the highest risk. We determined the frequency of additional, late appearing, stenotic lesions within the left heart, and the predictive morphologic features on the initial cross-sectional echocardiogram.
We identified all patients with coarctation of the aorta diagnosed by 3 months of age, excluding those with complex cardiac disease or definite additional stenotic lesions at presentation, leaving 101 patients for study. At follow-up, 31 stenotic lesions were diagnosed in 23 patients, 15 of whom had at least 1 intervention. Mitral stenosis was diagnosed in 11 patients, aortic stenosis in 10, subaortic stenosis in 8, and supravalvar aortic stenosis in 2. The probability for freedom from obstructive lesions was 81% at 1 year, 74% at 3 years, and 70% at 5 years. Echocardiographic predictors of mitral stenosis included smaller mitral valvar annuluses, presence of a mean transmitral gradient between 2.5 and 5.0 mmHg, and elongation of the area of intervalvar fibrous continuity. Predictors of aortic stenosis were smaller mitral valvar annuluses, an initial aortic valvar gradient between 15 and 20 mmHg, and obliteration of the commissure between the right and non-coronary leaflets of the aortic valve. Predictors of subaortic stenosis were smaller mitral valvar annuluses and elongation of the area of intervalvar fibrous continuity. Patients with Z-scores for the diameter of the mitral valve of less than −1 were at the highest risk for manifesting obstructive lesions at any level.
Associated stenoses in the left heart are common in the setting of aortic coarctation. When Doppler data is equivocal, features of the cross-sectional echocardiogram can identify the sub-group of infants at increased risk.
Edited by
Alex S. Evers, Washington University School of Medicine, St Louis,Mervyn Maze, University of California, San Francisco,Evan D. Kharasch, Washington University School of Medicine, St Louis
The introduction of mammal predators to islands often results in rapid declines in the number and range of seabirds. On Ascension Island the introduction of cats in 1815 resulted in extirpation of large seabird colonies from the main island, with relict populations of most species persisting only in cat-inaccessible locations. We describe the eradication of feral cats from this large and populated island. The campaign had to minimize risk to humans and maintain domestic animals in a state that prevented them re-establishing a feral population. Feral cat numbers declined rapidly in response to the strategic deployment of poisoning and live trapping, and cats were eradicated from the island within 2 years. During the project 38% of domestic cats were killed accidentally, which caused public consternation; we make recommendations for reducing such problems in future eradications. Since the completion of the eradication campaign cat predation of adult seabirds has ceased and five seabird species have recolonized the mainland in small but increasing numbers. Breeding success of seabirds at Ascension was low compared to that of conspecifics elsewhere, and the roles of food availability, inexperience of parent birds and black rat predation in causing this warrant further investigation. It is likely that the low breeding success will result in the rate of increase in seabird populations being slow.
Recent studies have suggested that untreated coeliac disease is associated with lower total cholesterol than in the general population while the effect of treatment with a gluten-free diet on the cholesterol profile of clinically apparent coeliac disease is not known. We measured the cholesterol profile at diagnosis, and compared this with Health Survey for England figures, and again following 12 months treatment with a gluten-free diet in 100 consecutive adults with coeliac disease attending the Royal Hallamshire Hospital, Sheffield, UK. The mean total cholesterol was 4·84 (sd 1·2) mmol/l in adults (mean age 51 (sd 16) years) newly diagnosed with coeliac disease. At diagnosis of coeliac disease, men had 21 % lower and women had 9 % lower mean total cholesterol in comparison to the general population (difference in age-adjusted mean total cholesterol − 1·09 mmol/l (95 % CI − 0·97, − 1·21); − 0·46 mmol/l (95 % CI − 0·24, − 0·68), respectively). There was no change in mean total cholesterol following treatment. However, there was a small but statistically significant increase of 0·12 mmol/l (95 % CI 0·05, 0·18) in the mean HDL-cholesterol. Total cholesterol was lower at diagnosis in coeliac patients than in the general population and did not increase with 1 year of a gluten-free diet while HDL-cholesterol increased following treatment. Any increase in risk of IHD or stroke in people with coeliac disease is unlikely due to an adverse cholesterol profile either before diagnosis or after treatment with a gluten-free diet.