We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Among important dimensions related to the use of coercive measures, professionals’ attitude towards coercion is of particular interest. Little is known about how experiences of violence in the workplace might influence these attitudes.
Aims
The present study aimed to investigate potential correlates of attitudes towards coercion, especially experiences of violence in the workplace.
Method
Mental health professionals were contacted through an online survey to assess their attitudes towards coercion using the Staff Attitude to Coercion Scale (SACS). The three subscales of the SACS (critical, pragmatic and positive attitudes) were analysed in a multivariate multiple linear regression, using a set of covariates including experiences of violence in the workplace. We hypothesised that experience of violence in the workplace would correlate with less critical attitudes of staff members towards coercion.
Results
A total of 423 professionals were included in the regression analysis. Age, professional category, feeling of insecurity, having witnessed or used coercion, and the emotional burden associated with coercive measures had a joint significant effect on the three SACS subscales. A feeling of insecurity, but not the experience of violence, was associated with a less critical, more positive appraisal of coercive measures. The emotional burden related to the use of coercion was associated with a more critical attitude.
Conclusions
The present results highlight the importance of considering staff members’ training and well-being regarding their feelings of insecurity when addressing attitudes towards coercion. The experience of patients should be integrated into staff training and coercion reduction programmes.
Important developments in the conceptualisation and classification of negative symptoms have contributed to refining hypotheses on their pathophysiology. The uptake of recent progress is still only partial and the whole field might make a leap forward once relevant studies fully make use of assessment tools based on current conceptualisations.
Personalised prediction of functional outcomes is a promising approach for targeted early intervention in psychiatry. However, generalisability and resource efficiency of such prognostic models represent challenges. In the PRONIA study (German Clinical Trials Register: DRKS00005042), we demonstrate excellent generalisability of prognostic models in individuals at clinical high-risk for psychosis or with recent-onset depression, and substantial contributions of detailed clinical phenotyping, particularly to the prediction of role functioning. These results indicate that it is possible that functioning prediction models based only on clinical data could be effectively applied in diverse healthcare settings, so that neuroimaging data may not be needed at early assessment stages.
Childhood trauma (CT) is associated with an increased risk of mental health disorders; however, it is unknown whether this represents a diagnosis-specific risk factor for specific psychopathology mediated by structural brain changes. Our aim was to explore whether (i) a predictive CT pattern for transdiagnostic psychopathology exists, and whether (ii) CT can differentiate between distinct diagnosis-dependent psychopathology. Furthermore, we aimed to identify the association between CT, psychopathology and brain structure.
Methods
We used multivariate pattern analysis in data from 643 participants of the Personalised Prognostic Tools for Early Psychosis Management study (PRONIA), including healthy controls (HC), recent onset psychosis (ROP), recent onset depression (ROD), and patients clinically at high-risk for psychosis (CHR). Participants completed structured interviews and self-report measures including the Childhood Trauma Questionnaire, SCID diagnostic interview, BDI-II, PANSS, Schizophrenia Proneness Instrument, Structured Interview for Prodromal Symptoms and structural MRI, analyzed by voxel-based morphometry.
Results
(i) Patients and HC could be distinguished by their CT pattern with a reasonable precision [balanced accuracy of 71.2% (sensitivity = 72.1%, specificity = 70.4%, p ≤ 0.001]. (ii) Subdomains ‘emotional neglect’ and ‘emotional abuse’ were most predictive for CHR and ROP, while in ROD ‘physical abuse’ and ‘sexual abuse’ were most important. The CT pattern was significantly associated with the severity of depressive symptoms in ROD, ROP, and CHR, as well as with the PANSS total and negative domain scores in the CHR patients. No associations between group-separating CT patterns and brain structure were found.
Conclusions
These results indicate that CT poses a transdiagnostic risk factor for mental health disorders, possibly related to depressive symptoms. While differences in the quality of CT exposure exist, diagnostic differentiation was not possible suggesting a multi-factorial pathogenesis.
Negative symptoms of schizophrenia have been documented in the literature for over a century. Nevertheless, research has not convincingly produced effective interventions for their treatment. We propose to re-analyse currently published evidence on treatment of negative symptoms, using narrower definitions for symptom dimensions, to better understand what works for whom.
Efforts to harmonize health technology assessment (HTA) processes and methods across Europe are currently intensified. In this context, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach has been proposed as a “common ground” in joint HTAs. However, GRADE has been primarily developed to support authors of clinical guidelines. Therefore, it is unclear whether HTA reports based on GRADE are compatible with the methods currently applied by European HTA organizations.
Methods
We contrasted IQWiG's methods paper and publications by the GRADE Working Group with regard to the following domains: 1) risk of bias (RoB) assessment 2) prerequisites for “greater benefit” (assuming that IQWiG's “greater benefit” corresponds to a GRADE assessment of at least low certainty and a small important effect) and 3) consideration of non-randomized studies (NRS). We present illustrative differences and highlight similarities.
Results
Overall, RoB assessments are very similar under both approaches. However, we identified several important differences. In case of very severe publication bias, IQWiG methods preclude drawing a conclusion, whereas GRADE requires only downgrading the certainty of evidence while still allowing for a conclusion on effect sizes. Secondly, IQWiG generally requires a statistically significant effect for a “greater benefit”, while GRADE does not (statistically non-significant effects would only necessitate downgrading the certainty of results for imprecision). Another difference is that in general, NRS are not included in IQWiG assessments when randomized studies (RS) are available and thus possible. In contrast, preliminary GRADE guidance recommends considering NRS in addition to RS when the RS evidence is of low or very low certainty.
Conclusions
While GRADE and IQWiG's method share some similarities, our exemplary analysis shows that there are some notable differences. Therefore, GRADE should not be used “out of the box” for European HTAs. To foster further discussion, more research (including a comprehensive comparison of methods and an analysis of resources for adaptation) is needed.
Bipolar disorder I (BD-I) is defined by episodes of mania, depression and euthymic states. These episodes are among other symptoms characterized by altered reward processing and negative symptoms (NS), in particular apathy. However, the neural correlates of these deficits are not well understood.
Methods
We first assessed the severity of NS in 25 euthymic BD-I patients compared with 25 healthy controls (HC) and 27 patients with schizophrenia (SZ). Then, we investigated ventral (VS) and dorsal striatal (DS) activation during reward anticipation in a Monetary Incentive Delayed Task and its association with NS.
Results
In BD-I patients NS were clearly present and the severity of apathy was comparable to SZ patients. Apathy scores in the BD-I group but not in the SZ group correlated with sub-syndromal depression scores. At the neural level, we found significant VS and DS activation in BD-I patients and no group differences with HC or SZ patients. In contrast to patients with SZ, apathy did not correlate with striatal activation during reward anticipation. Explorative whole-brain analyses revealed reduced extra-striatal activation in BD-I patients compared with HC and an association between reduced activation of the inferior frontal gyrus and apathy.
Conclusion
This study found that in BD-I patients apathy is present to an extent comparable to SZ, but is more strongly related to sub-syndromal depressive symptoms. The findings support the view of different pathophysiological mechanisms underlying apathy in the two disorders and suggest that extra-striatal dysfunction may contribute to impaired reward processing and apathy in BD-I.
The synergistic combination of two promising engine architectures for future aero engines is presented. The first is the Composite Cycle Engine, which introduces a piston system in the high pressure part of the core engine, to utilise closed volume combustion and high temperature capability due to instationary operation. The second is the Intercooled Recuperated engine that employs recuperators to utilise waste heat from the core engine exhaust and intercooler to improve temperature levels for recuperation and to reduce compression work. Combinations of both architectures are presented and investigated for improvement potential with respect to specific fuel consumption, engine weight and fuel burn against a turbofan. The Composite Cycle alone provides a 15.6% fuel burn reduction against a turbofan. Options for adding intercooler were screened, and a benefit of up to 1.9% fuel burn could be shown for installation in front of a piston system through a significant, efficiency-neutral weight decrease. Waste heat can be utilised by means of classic recuperation to the entire core mass flow before the combustor, or alternatively on the turbine cooling bleed or a piston engine bypass flow that is mixed again with the main flow before the combustor. As further permutation, waste heat can be recovered either after the low pressure turbine – with or without sequential combustion – or between the high pressure and low pressure turbine. Waste heat recovery after the low pressure turbine was found to be not easily feasible or tied to high fuel burn penalties due to unfavourable temperature levels, even when using sequential combustion or intercooling. Feasible temperature levels could be obtained with inter-turbine waste heat recovery but always resulted in at least 0.3% higher fuel burn compared to the non-recuperated baseline under the given assumptions. Consequently, only the application of an intercooler appears to provide a considerable benefit for the examined thermodynamic conditions in the low fidelity analyses of various engine architecture combinations with the specific heat exchanger design. Since the obtained drawbacks of some waste heat utilisation concepts are small, innovative waste heat management concepts coupled with the further extension of the design space and the inclusion of higher fidelity models may achieve a benefit and motivate future investigations.
Cognitive remediation is a promising pathway for ameliorating cognitive impairment of patients with schizophrenia. Here, we investigate predictors of improvement in problem-solving ability for two different types of cognitive remediation – specific problem-solving training and training of basic cognition. For this purpose we conducted a re-analysis of a randomized controlled trial comparing these two training approaches. The main outcome measure was improvement in problem-solving performance. Correlational analyses were used to assess the contribution of clinical, cognitive and training-related predictors. In the problem-solving training group, impaired pre-training planning ability was associated with stronger improvement. In contrast, in the basic cognition training group antipsychotic medication dose emerged as a negative predictor. These results demonstrate that predictors for successful cognitive remediation depend on the specific intervention. Furthermore, our results suggest that at least in the planning domain patients with impaired performance benefit particularly from a specific intervention. (JINS, 2014, 20, 1–6)
Deficits in executive functioning are closely related to the level of everyday functioning in patients with schizophrenia. However, many existing neuropsychological measures are limited in their ability to predict functional outcome. To contribute towards closing this gap, we developed a computer-based test of planning ability (“Plan-a-Day”) that requires participants to create daily activity schedules in a simulated work setting. Eighty patients diagnosed with schizophrenia were tested with Plan-a-Day and a battery of cognitive ability tests. Plan-a-Day showed satisfactory psychometric properties in terms of consistency, reliability, and construct validity. Compared to other neuropsychological tests used in this study, it also demonstrated incremental validity with regard to the Global Assessment of Functioning. The Plan-a-Day approach, therefore, seems to represent a valid alternative for measuring planning ability in patients with executive function deficits, occupying a middle ground between traditional neuropsychological tests and real-life assessments. (JINS, 2011, 17, 327–335)
The perceptions of resource users towards any conservation policy can be a major determinant of its success. While co-management policy can enhance the management of fisheries, to date there have been few reports concerning how engagement in co-management regimes may affect fishers' perceptions. This paper assesses the determinants of fishers' environmental perceptions within a co-management regime in Chile. Group meetings and structured questionnaires showed fishers' environmental perceptions were composed of four domains of concern, termed ‘water pollution’, ‘stock conservation’, ‘conservation/profit trade-offs’ and ‘charismatic species’. Fishers' dependence on diving and/or the length of time fishers had engaged with the policy affected their perceptions of each of these domains. Perceptions of the ‘water pollution’ domain were related to length of time fishers had participated in co-management, probably because fishers gained an increased understanding of the market and its need for unpolluted produce. Attitudes towards ‘conservation/profit trade-offs’ tended to become linked to an increasingly conservation-oriented ethic with increasing time of engagement with the policy. Given that the length of time fishers engaged with co-management differentially affected fishers' perceptions of environmental domains of concern, public officials and funding agencies should be careful not to judge co-management prematurely. It takes time to educate participants and overcome distrust. Through co-management processes in Chile, fishers' environmental awareness increased, and sustainable behaviours may consequently increase in the future.
The East Asian countries of China, Japan and Korea (Republic of Korea, ROK) are unique in the modern world in that they continue (to varying degrees) to use a non-phonetic script. This is a reflection of their past, when they shared a common heritage in the form of shared use of Classical Chinese.
Until about 100 years ago, Classical Chinese was the language of the educated in these countries (and also in Vietnam), although the respective forms of the vernacular were used for everyday and literary purposes. However, the situation altered significantly in the first half of the twentieth century due to changes in language policy. The most dramatic differences are that Vietnam changed to the Roman alphabet in 1910 (Tuttle 1996, p. 691), and the Democratic People's Republic of Korea (DPRK) abolished the use of Chinese characters altogether in 1949 (King 1996, p. 219); there were various minor changes too.
As a result of more than a millennium of language contact, plus centuries of language modernisation using Chinese loan translations, China, Japan and Korea (as well as Vietnam) now have a large body of cognate vocabulary that is based on Chinese morphemes (for an example, see the section ‘Policy regarding foreign words’ below).
Any discussion of future developments of these East Asian languages needs to take into consideration two points:
the degree to which there are shared elements in the vocabulary (and their written representation) of the three languages, and to what degree this is magnified or diminished by national language/script policy;
the problems that non-phonetic writing systems cause for computer input (these issues are of varying magnitude, depending on the language).
The previously developed method to prepare highly dispersed metals in SiO2 by sol-gel processing of metal complexes containing alkoxysilyl-substituted ligands was extended to the preparation (i) of bimetallic particles in SiO2 and (ii) of highly dispersed metals in TiO2.