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.
Treatment guidelines recommend evidence-based psychological therapies for adults with intellectual disabilities with co-occurring anxiety or depression. No previous research has explored the effectiveness of these therapies in mainstream psychological therapy settings or outside specialist settings.
Aims
To evaluate the effectiveness of psychological therapies delivered in routine primary care settings for people with intellectual disability who are experiencing co-occurring depression or anxiety.
Method
This study used linked electronic healthcare records of 2 048 542 adults who received a course of NHS Talking Therapies for anxiety and depression in England between 2012 and 2019 to build a retrospective, observational cohort of individuals with intellectual disability, matched 1:2 with individuals without intellectual disability. Logistic regressions were used to compare metrics of symptom improvement and deterioration used in the national programme, on the basis of depression and anxiety measures collected before and at the last attended therapy session.
Results
The study included 6870 adults with intellectual disability and 2 041 672 adults without intellectual disability. In unadjusted analyses, symptoms improved on average for people with intellectual disability after a course of therapy, but these individuals experienced poorer outcomes compared with those without intellectual disability (reliable improvement 60.2% for people with intellectual disability v. 69.2% for people without intellectual disability, odds ratio 0.66, 95% CI 0.63–0.70; reliable deterioration 10.3% for people with intellectual disability v. 5.7% for those without intellectual disability, odds ratio 1.89, 95% CI 1.75–2.04). After propensity score matching, some differences were attenuated (reliable improvement, adjusted odds ratio 0.97, 95% CI 1.91–1.04), but some outcomes remained poorer for people with intellectual disability (reliable deterioration, adjusted odds ratio 1.28, 95% CI 1.16–1.42).
Conclusions
Evidence-based psychological therapies may be effective for adults with intellectual disability, but their outcomes may be similar to (for improvement and recovery) or poorer than (for deterioration) those for adults without intellectual disability. Future work should investigate the impact of adaptations of therapies for those with intellectual disability to make such interventions more effective and accessible for this population.
Actuaries must model mortality to understand, manage and price risk. Continuous-time methods offer considerable practical benefits to actuaries analysing portfolio mortality experience. This paper discusses six categories of advantage: (i) reflecting the reality of data produced by everyday business practices, (ii) modelling rapid changes in risk, (iii) modelling time- and duration-varying risk, (iv) competing risks, (v) data-quality checking and (vi) management information. Specific examples are given where continuous-time models are more useful in practice than discrete-time models.
We reprise some common statistical models for actuarial mortality analysis using grouped counts. We then discuss the benefits of building mortality models from the most elementary items. This has two facets. First, models are better based on the mortality of individuals, rather than groups. Second, models are better defined in continuous time, rather than over fixed intervals like a year. We show how Poisson-like likelihoods at the “macro” level are built up by product integration of sequences of infinitesimal Bernoulli trials at the “micro” level. Observed data is represented through a stochastic mortality hazard rate, and counting processes provide the natural notation for left-truncated and right-censored actuarial data, individual or age-grouped. Together these explain the “pseudo-Poisson” behaviour of survival model likelihoods.
Recent changes to US research funding are having far-reaching consequences that imperil the integrity of science and the provision of care to vulnerable populations. Resisting these changes, the BJPsych Portfolio reaffirms its commitment to publishing mental science and advancing psychiatric knowledge that improves the mental health of one and all.
Stochastic mortality models are important for a variety of actuarial tasks, from best-estimate forecasting to assessment of risk capital requirements. However, the mortality shock associated with the Covid-19 pandemic of 2020 distorts forecasts by (i) biasing parameter estimates, (ii) biasing starting points, and (iii) inflating variance. Stochastic mortality models therefore require outlier-robust methods for forecasting. Objective methods are required, as outliers are not always obvious on visual inspection. In this paper we look at the robustification of three broad classes of forecast: univariate time indices (such as in the Lee-Carter and APC models); multivariate time indices (such as in the Cairns-Blake-Dowd and newer Tang-Li-Tickle model families); and penalty projections (such as with the 2D P-spline model). In each case we identify outliers using quantitative methods, then co-estimate outlier effects along with other parameters. Doing so removes the bias and distortion to the forecast caused by a mortality shock, while providing a robust starting point for projections. Illustrations are given for various models in common use.
We perform direct numerical simulations of soluble bubbles dissolving in a Taylor–Couette (TC) flow reactor with a radius ratio of $\eta =0.5$ and Reynolds number in the range $0 \leq Re \leq 5000$, which covers the main regimes of this flow configuration, up to fully turbulent Taylor vortex flow. The numerical method is based on a geometric volume-of-fluid framework for incompressible flows coupled with a phase-change solver that ensures mass conservation of the soluble species, whilst boundary conditions on solid walls are enforced through an embedded boundary approach. The numerical framework is validated extensively against single-phase TC flows and competing mass transfer in multicomponent mixtures for an idealised infinite cylinder and for a bubble rising in a quiescent liquid. Our results show that when bubbles in a TC flow are mainly driven by buoyancy, theoretical formulae derived for spherical interfaces on a vertical trajectory still provide the right fundamental relationship between the bubble Reynolds and Sherwood numbers, which reduces to $Sh \propto \sqrt {Pe}$ for large Péclet values. For bubbles mainly transported by TC flows, the dissolution of bubbles depend on the TC Reynolds number and, for the turbulent configurations, we show that the smallest characteristic turbulent scales control mass transfer, in agreement with the small-eddy model of Lamont & Scott (AIChE J., vol. 16, 1970, pp. 513–519). Finally, the interaction between two aligned bubbles is investigated and we show that a significant increase in mass transfer can be obtained when the rotor of the apparatus is operated at larger speeds.
The psychometric rigor of unsupervised, smartphone-based assessments and factors that impact remote protocol engagement is critical to evaluate prior to the use of such methods in clinical contexts. We evaluated the validity of a high-frequency, smartphone-based cognitive assessment protocol, including examining convergence and divergence with standard cognitive tests, and investigating factors that may impact adherence and performance (i.e., time of day and anticipated receipt of feedback vs. no feedback).
Methods:
Cognitively unimpaired participants (N = 120, Mage = 68.8, 68.3% female, 87% White, Meducation = 16.5 years) completed 8 consecutive days of the Mobile Monitoring of Cognitive Change (M2C2), a mobile app-based testing platform, with brief morning, afternoon, and evening sessions. Tasks included measures of working memory, processing speed, and episodic memory. Traditional neuropsychological assessments included measures from the Preclinical Alzheimer’s Cognitive Composite battery.
Results:
Findings showed overall high compliance (89.3%) across M2C2 sessions. Average compliance by time of day ranged from 90.2% for morning sessions, to 77.9% for afternoon sessions, and 84.4% for evening sessions. There was evidence of faster reaction time and among participants who expected to receive performance feedback. We observed excellent convergent and divergent validity in our comparison of M2C2 tasks and traditional neuropsychological assessments.
Conclusions:
This study supports the validity and reliability of self-administered, high-frequency cognitive assessment via smartphones in older adults. Insights into factors affecting adherence, performance, and protocol implementation are discussed.
Psychological therapies can be effective in reducing symptoms of depression and anxiety in people living with dementia (PLWD). However, factors associated with better therapy outcomes in PLWD are currently unknown.
Aims
To investigate whether dementia-specific and non-dementia-specific factors are associated with therapy outcomes in PLWD.
Method
National linked healthcare records were used to identify 1522 PLWD who attended psychological therapy services across England. Associations between various factors and therapy outcomes were explored.
Results
People with frontotemporal dementia were more likely to experience reliable deterioration in depression/anxiety symptoms compared with people with vascular dementia (odds ratio 2.98, 95% CI 1.08–8.22; P = 0.03) or Alzheimer's disease (odds ratio 2.95, 95% CI 1.15–7.55; P = 0.03). Greater depression severity (reliable recovery: odds ratio 0.95, 95% CI 0.92–0.98, P < 0.001; reliable deterioration: odds ratio 1.73, 95% CI 1.04–2.90, P = 0.04), lower work and social functioning (recovery: odds ratio 0.98, 95% CI 0.96–0.99, P = 0.002), psychotropic medication use (recovery: odds ratio 0.67, 95% CI 0.51–0.90, P = 0.01), being of working age (recovery: odds ratio 2.03, 95% CI 1.10–3.73, P = 0.02) and fewer therapy sessions (recovery: odds ratio 1.12, 95% CI 1.09–1.16, P < 0.001) were associated with worse therapy outcomes in PLWD.
Conclusions
Dementia type was generally not associated with outcomes, whereas clinical factors were consistent with those identified for the general population. Additional support and adaptations may be required to improve therapy outcomes in PLWD, particularly in those who are younger and have more severe depression.
The purpose of this report is to describe the appropriate use of indices relating to crystallinity, such as the ‘crystallinity index’, the ‘Hinckley index’, the ‘Kübler index’, and the ‘Árkai index’. A ‘crystalline’ solid is defined as a solid consisting of atoms, ions or molecules packed together in a periodic arrangement. A ‘crystallinity index’ is purported to be a measure of crystallinity, although there is uncertainty about what this means (see below). This report discusses briefly the nature of order, disorder and crystallinity in phyllosilicates and discusses why the use of a ‘crystallinity index’ should be avoided. If possible, it is suggested that indices be referred to using the name of the author who originally described the parameter, e.g. ‘Hinckley index’ or ‘Kübler index’, or in honor of a researcher who investigated the importance of the parameter extensively, e.g. ‘Árkai index’.
Tang et al. (2022) propose a new class of models for stochastic mortality modelling using Hermite splines. There are four useful features of this class that are worth emphasising. First, for single-sex datasets, this new class of projection models can be fitted as a generalised linear model. Second, these models can automatically extrapolate mortality rates to ages above the maximum age of the data set. Third, simpler sub-variants of the models exist for forecasting when one of the variables lacks a clear drift. Finally, a minor reparameterisation increases the quality of long-range forecasts of period mortality.
The fight against ecological degradation “has become a generalized policy demand of the whole society,” declared Marcelo Javelly Girard, Mexico's Secretary of Urban Development and Ecology. Addressing the Mexican Cabinet and hundreds of dignitaries attending Mexico's Primera Reunión Nacional de Ecología in June of 1984, Javelly Girard thus placed environmental concerns on President Miguel de la Madrid's official policy agenda. Appropriately convened in Mexico City (the world's fifth-most-polluted city by the Mexican government's own reckoning), the congress climaxed two years of effort by the de la Madrid administration to promote public environmental awareness as part of its national development program.
Depression is an important, potentially modifiable dementia risk factor. However, it is not known whether effective treatment of depression through psychological therapies is associated with reduced dementia incidence. The aim of this study was to investigate associations between reduction in depressive symptoms following psychological therapy and the subsequent incidence of dementia.
Methods
National psychological therapy data were linked with hospital records of dementia diagnosis for 119808 people aged 65+. Participants received a course of psychological therapy treatment in Improving Access to Psychological Therapies (IAPT) services between 2012 and 2019. Cox proportional hazards models were run to test associations between improvement in depression following psychological therapy and incidence of dementia diagnosis up to eight years later.
Results
Improvements in depression following treatment were associated with reduced rates of dementia diagnosis up to 8 years later (HR = 0.88, 95% CI 0.83–0.94), after adjustment for key covariates. Strongest effects were observed for vascular dementia (HR = 0.86, 95% CI 0.77–0.97) compared with Alzheimer's disease (HR = 0.91, 95% CI 0.83–1.00).
Conclusions
Reliable improvement in depression across psychological therapy was associated with reduced incidence of future dementia. Results are consistent with at least two possibilities. Firstly, psychological interventions to improve symptoms of depression may have the potential to contribute to dementia risk reduction efforts. Secondly, psychological therapies may be less effective in people with underlying dementia pathology or they may be more likely to drop out of therapy (reverse causality). Tackling the under-representation of older people in psychological therapies and optimizing therapy outcomes is an important goal for future research.
Seabirds are declining globally and are one of the most threatened groups of birds. To halt or reverse this decline they need protection both on land and at sea, requiring site-based conservation initiatives based on seabird abundance and diversity. The Important Bird and Biodiversity Area (IBA) programme is a method of identifying the most important places for birds based on globally agreed standardised criteria and thresholds. However, while great strides have been made identifying terrestrial sites, at-sea identification is lacking. The Chagos Archipelago, central Indian Ocean, supports four terrestrial IBAs (tIBAs) and two proposed marine IBAs (mIBAs). The mIBAs are seaward extensions to breeding colonies based on outdated information and, other types of mIBA have not been explored. Here, we review the proposed seaward extension mIBAs using up-to-date seabird status and distribution information and, use global positioning system (GPS) tracking from Red-footed Booby Sula sula – one of the most widely distributed breeding seabirds on the archipelago – to identify any pelagic mIBAs. We demonstrate that due to overlapping boundaries of seaward extension to breeding colony and pelagic areas of importance there is a single mIBA in the central Indian Ocean that lays entirely within the Chagos Archipelago Marine Protected Area (MPA). Covering 62,379 km2 it constitutes ~10% of the MPA and if designated, would become the 11th largest mIBA in the world and 4th largest in the Indian Ocean. Our research strengthens the evidence of the benefits of large-scale MPAs for the protection of marine predators and provides a scientific foundation stone for marine biodiversity hotspot research in the central Indian Ocean.
The COVID-19 pandemic requires that actuaries track short-term mortality fluctuations in the portfolios they manage. This demands methods that not only operate over much shorter time periods than a year but that also deal with reporting delays. In this paper, we consider a semi-parametric approach for tracking portfolio mortality levels in continuous time. We identify both seasonal patterns and mortality shocks, thus providing a comparison benchmark for the impact of COVID-19 in terms of a portfolio’s own past experience. A parametric model is presented to allow for the average impact of seasonal variation and also reporting delays. We find that an estimate of mortality reporting delays can be made from a single extract of experience data. This can be used to forecast unreported deaths and improve estimates of recent mortality levels. Results are given for annuity portfolios in France, the UK and the USA.
The COVID-19 pandemic creates a challenge for actuaries analysing experience data that include mortality shocks. Without sufficient local flexibility in the time dimension, any analysis based on the most recent data will be biased by the temporarily higher mortality. Also, depending on where the shocks sit in the exposure period, any attempt to identify mortality trends will be distorted. We present a methodology for analysing portfolio mortality data that offer local flexibility in the time dimension. The approach permits the identification of seasonal variation, mortality shocks and occurred-but-not reported deaths (OBNR). The methodology also allows actuaries to measure portfolio-specific mortality improvements. Finally, the method assists actuaries in determining a representative mortality level for long-term applications like reserving and pricing, even in the presence of mortality shocks. Results are given for a mature annuity portfolio in the UK, which suggest that the Bayesian information criterion is better for actuarial model selection in this application than Akaike’s information criterion.
Health and social care workers (HSCWs) are at risk of experiencing adverse mental health outcomes (e.g. higher levels of anxiety and depression) because of the COVID-19 pandemic. This can have a detrimental effect on quality of care, the national response to the pandemic and its aftermath.
Aims
A longitudinal design provided follow-up evidence on the mental health (changes in prevalence of disease over time) of NHS staff working at a remote health board in Scotland during the COVID-19 pandemic, and investigated the determinants of mental health outcomes over time.
Method
A two-wave longitudinal study was conducted from July to September 2020. Participants self-reported levels of depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7) and mental well-being (Warwick-Edinburgh Mental Well-being Scale) at baseline and 1.5 months later.
Results
The analytic sample of 169 participants, working in community (43%) and hospital (44%) settings, reported substantial levels of depression and anxiety, and low mental well-being at baseline (depression, 30.8%; anxiety, 20.1%; well-being, 31.9%). Although mental health remained mostly constant over time, the proportion of participants meeting the threshold for anxiety increased to 27.2% at follow-up. Multivariable modelling indicated that working with, and disruption because of, COVID-19 were associated with adverse mental health changes over time.
Conclusions
HSCWs working in a remote area with low COVID-19 prevalence reported substantial levels of anxiety and depression, similar to those working in areas with high COVID-19 prevalence. Efforts to support HSCW mental health must remain a priority, and should minimise the adverse effects of working with, and disruption caused by, the COVID-19 pandemic.
Parametric mortality models permit detailed analysis of risk factors for actuarial work. However, finite data volumes lead to uncertainty over parameter estimates, which in turn gives rise to mis-estimation risk of financial liabilities. Mis-estimation risk can be assessed on a run-off basis by valuing the liabilities with alternative parameter vectors consistent with the covariance matrix. This run-off approach is especially suitable for tasks like pricing portfolio transactions, such as bulk annuities, longevity swaps or reinsurance treaties. However, a run-off approach does not fully meet the requirements of regulatory regimes that view capital requirements through the prism of a finite horizon, such as Solvency II’s one-year approach. This paper presents a methodology for viewing mis-estimation risk over a fixed time frame, and results are given for a specimen portfolio. As expected, we find that time-limited mis-estimation capital requirements increase as the horizon is lengthened or the discount rate is reduced. However, we find that much of the so-called mis-estimation risk in a one-year value-at-risk assessment can actually be driven by idiosyncratic variation, rather than parameter uncertainty. This counter-intuitive result stems from trying to view a long-term risk through a short-term window. As a result, value-at-risk mis-estimation reserves are strongly correlated with idiosyncratic risk. We also find that parsimonious models tend to produce lower mis-estimation risk than less-parsimonious ones.
This study aimed to investigate general factors associated with prognosis regardless of the type of treatment received, for adults with depression in primary care.
Methods
We searched Medline, Embase, PsycINFO and Cochrane Central (inception to 12/01/2020) for RCTs that included the most commonly used comprehensive measure of depressive and anxiety disorder symptoms and diagnoses, in primary care depression RCTs (the Revised Clinical Interview Schedule: CIS-R). Two-stage random-effects meta-analyses were conducted.
Results
Twelve (n = 6024) of thirteen eligible studies (n = 6175) provided individual patient data. There was a 31% (95%CI: 25 to 37) difference in depressive symptoms at 3–4 months per standard deviation increase in baseline depressive symptoms. Four additional factors: the duration of anxiety; duration of depression; comorbid panic disorder; and a history of antidepressant treatment were also independently associated with poorer prognosis. There was evidence that the difference in prognosis when these factors were combined could be of clinical importance. Adding these variables improved the amount of variance explained in 3–4 month depressive symptoms from 16% using depressive symptom severity alone to 27%. Risk of bias (assessed with QUIPS) was low in all studies and quality (assessed with GRADE) was high. Sensitivity analyses did not alter our conclusions.
Conclusions
When adults seek treatment for depression clinicians should routinely assess for the duration of anxiety, duration of depression, comorbid panic disorder, and a history of antidepressant treatment alongside depressive symptom severity. This could provide clinicians and patients with useful and desired information to elucidate prognosis and aid the clinical management of depression.
Emerging from the warehouse of knowledge about terrestrial ecosystem functioning and the application of the systems ecology paradigm, exemplified by the power of simulation modeling, tremendous strides have been made linking the interactions of the land, atmosphere, and water locally to globally. Through integration of ecosystem, atmospheric, soil, and more recently social science interactions, plausible scenarios and even reasonable predictions are now possible about the outcomes of human activities. The applications of that knowledge to the effects of changing climates, human-caused nitrogen enrichment of ecosystems, and altered UV-B radiation represent challenges addressed in this chapter. The primary linkages addressed are through the C, N, S, and H2O cycles, and UV-B radiation. Carbon dioxide exchanges between land and the atmosphere, N additions and losses to and from lands and waters, early studies of SO2 in grassland ecosystem, and the effects of UV-B radiation on ecosystems have been mainstays of research described in this chapter. This research knowledge has been used in international and national climate assessments, for example the IPCC, US National Climate Assessment, and Paris Climate Accord. Likewise, the knowledge has been used to develop concepts and technologies related to sustainable agriculture, C sequestration, and food security.