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Cognitive therapy for PTSD (CT-PTSD) is an efficacious treatment for children and adolescents with post-traumatic stress disorder (PTSD) following single incident trauma, but there is a lack of evidence relating to this approach for youth with PTSD following exposure to multiple traumatic experiences.
Aims:
To assess the safety, acceptability and feasibility of CT-PTSD for youth following multiple trauma, and obtain a preliminary estimate of its pre–post effect size.
Method:
Nine children and adolescents (aged 8–17 years) with multiple-trauma PTSD were recruited to a case series of CT-PTSD. Participants completed a structured interview and mental health questionnaires at baseline, post-treatment and 6-month follow-up, and measures of treatment credibility, therapeutic alliance, and mechanisms proposed to underpin treatment response. A developmentally adjusted algorithm for diagnosing PTSD was used.
Results:
No safety concerns or adverse effects were recorded. Suicidal ideation reduced following treatment. No participants withdrew from treatment or from the study. CT-PTSD was rated as highly credible. Participants reported strong working alliances with their therapists. Data completion was good at post-treatment (n=8), but modest at 6-month follow-up (n=6). Only two participants met criteria for PTSD (developmentally adjusted algorithm) at post-treatment. A large within-subjects treatment effect was observed post-treatment and at follow up for PTSD severity (using self-report questionnaire measures; ds>1.65) and general functioning (CGAS; ds<1.23). Participants showed reduced anxiety and depression symptoms at post-treatment and follow-up (RCADS-C; ds>.57).
Conclusions:
These findings suggest that CT-PTSD is a safe, acceptable and feasible treatment for children with multiple-trauma PTSD, which warrants further evaluation.
Many male prisoners have significant mental health problems, including anxiety and depression. High proportions struggle with homelessness and substance misuse.
Aims
This study aims to evaluate whether the Engager intervention improves mental health outcomes following release.
Method
The design is a parallel randomised superiority trial that was conducted in the North West and South West of England (ISRCTN11707331). Men serving a prison sentence of 2 years or less were individually allocated 1:1 to either the intervention (Engager plus usual care) or usual care alone. Engager included psychological and practical support in prison, on release and for 3–5 months in the community. The primary outcome was the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), 6 months after release. Primary analysis compared groups based on intention-to-treat (ITT).
Results
In total, 280 men were randomised out of the 396 who were potentially eligible and agreed to participate; 105 did not meet the mental health inclusion criteria. There was no mean difference in the ITT complete case analysis between groups (92 in each arm) for change in the CORE-OM score (1.1, 95% CI –1.1 to 3.2, P = 0.325) or secondary analyses. There were no consistent clinically significant between-group differences for secondary outcomes. Full delivery was not achieved, with 77% (108/140) receiving community-based contact.
Conclusions
Engager is the first trial of a collaborative care intervention adapted for prison leavers. The intervention was not shown to be effective using standard outcome measures. Further testing of different support strategies for prison with mental health problems is needed.
Training plays a central role in the pursuit of conservation goals, and it is vital to know if it is having the desired effect. However, evaluating the difference it makes is notoriously challenging. Here, we present a practitioner's perspective on overcoming these challenges and developing a framework for ongoing evaluation of a conservation training programme. To do this, we first created a theory of change, describing the pathway of change we expect from training delivery to conservation impact. This provided the clarity and structure needed to identify indicators of change in the short, medium and long term. For data collection, we utilized both quantitative and qualitative methods to provide a more complete understanding of the change expected and capture any that might be unexpected. However, the more time that passes since a training event, the more difficult it becomes to attribute results; in response, we shifted predominantly to the use of qualitative methods to understand the long-term results achieved. After 3 years of implementation, this framework has enabled us to measure the difference our training makes to individuals and their work, and to provide evidence for the contribution it makes to achieving conservation impact. We believe that the lessons learnt can be used to improve the evaluation of training activities across the conservation sector and maximize the impact they achieve.
China's coal safety has improved dramatically since 2003. This article will present the official data and conclude that it is almost impossible that the figures conceal a situation where there has not been remarkable improvement. Structural factors including China's level of economic development, changes in the labour market and the economic health of the industry have played an important role, but state commitment and policies have been central at least to the speed and magnitude of the improvement.
We previously reported a putative detection of a radio galaxy at $z=10.15$, selected from the GaLactic and Extragalactic All-sky Murchison Widefield Array (GLEAM) survey. The redshift of this source, GLEAM J0917–0012, was based on three weakly detected molecular emission lines observed with the Atacama Large Millimetre Array (ALMA). In order to confirm this result, we conducted deep spectroscopic follow-up observations with ALMA and the Karl Jansky Very Large Array (VLA). The ALMA observations targeted the same CO lines previously reported in Band 3 (84–115 GHz) and the VLA targeted the CO(4-3) and [CI(1-0)] lines for an independent confirmation in Q-band (41 and 44 GHz). Neither observation detected any emission lines, removing support for our original interpretation. Adding publicly available optical data from the Hyper Suprime-Cam survey, Widefield Infrared Survey Explorer (WISE), and Herschel Space Observatory in the infrared, as well as $<$10 GHz polarisation and 162 MHz inter-planetary scintillation observations, we model the physical and observational characteristics of GLEAM J0917–0012 as a function of redshift. Comparing these predictions and observational relations to the data, we are able to constrain its nature and distance. We argue that if GLEAM J0917–0012 is at $z<3,$ then it has an extremely unusual nature, and that the more likely solution is that the source lies above $z=7$.
There are limited data on detection disparities of common mental disorders in minority ethnic women.
Aims
Describe the natural history of common mental disorders in primary care in the maternal period, characterise women with, and explore ethnic disparities in, detected and potentially missed common mental disorders.
Method
Secondary analyses of linked birth cohort and primary care data involving 8991 (39.4% White British) women in Bradford. Common mental disorders were characterised through indications in the electronic medical record. Potentially missed common mental disorders were defined as an elevated General Health Questionnaire (GHQ-28) score during pregnancy with no corresponding common mental disorder markers in the medical record.
Results
Estimated prevalence of pre-birth common mental disorders was 9.5%, rising to 14.0% 3 years postnatally. Up to half of cases were potentially missed. Compared with White British women, minority ethnic women were twice as likely to have potentially missed common mental disorders and half as likely to have a marker of screening for common mental disorders.
Conclusions
Common mental disorder detection disparities exist for minority ethnic women in the maternal period.
From the end of the fifteenth century, the Ming state redirected the entire flow of the Yellow River into the course of the Huai River in order the facilitate the transport of tribute grain. This shifted the major problems of water control from the middle and lower reaches of the Yellow River to the Huaibei region. Huaibei was viewed as ‘a local interest’, as opposed to the ‘general interests’ represented by the central government, and was sacrificed for those general interests. These policies, which were continued under the Qing dynasty, created widespread and frequent flooding in the region, causing short-term famine and destruction and leading to long-term economic decline.
The seventh annual Teaching and Learning Conference (TLC) was held in Philadelphia, Pennsylvania, from February 5 to 7, 2010, with 224 attendees onsite. The theme for the meeting was “Advancing Excellence in Teaching Political Science.” Using the working-group model, the TLC track format encourages in-depth discussion and debate on research dealing with the scholarship of teaching and learning.
This paper analyses the trajectories of handicraft cloth production in three major sub-regions of Jiangsu Province in the late nineteenth and early twentieth centuries. In contrast to traditional focus on the bankruptcy of rural handicrafts in the face of competition from the modern industry, it argues that the fate of handicrafts depended on the specific characteristics of each sub-regional economy. Thus in Song-Tai, handicraft weaving declined as labour was drawn off into modern industry. In Tong-Hai the availability of machine-spun yarn in the market enabled the development of a commercialised handicraft weaving sector. Finally, in Xu-Huai-Hai machine-spun yarn enabled the inhabitants to substitute their own subsistence handicraft production for cloth purchased from elsewhere.
How far were China's prewar economic institutions the product of its particular history and traditions—that is, the product either of the nature of its premodern society or of its later status as a semicolony—and how far can they rather be seen as answers to problems common to the stage of economic development which the country had reached at that time?
The Endangered Madagascar giant jumping rat, Hypogeomys antimena, has suffered a major decline in distribution and is now restricted to two seemingly unconnected sub-populations in the largest remaining fragment of deciduous, seasonally dry forest in Menabe, western Madagascar. In a previous study a rapid decrease in numbers of H. antimena was observed in relatively intact forest, suggesting a factor of population decline additional to habitat loss, and provoking fears of a negative trend occurring across its remaining range. In the current study we conducted extensive line transect surveys to estimate active H. antimena burrow density in 2004 and 2005 as an index of population size, and trapping to estimate mean group size, as a multiplier for population size estimation. Within the surveyed areas we estimated the combined size of the two H. antimena sub-populations in 2005 to be c. 36,000, considerably larger than previously assumed. There was no evidence that active burrow density across the species’ known range changed between 2000 and 2005. H. antimena was not uniformly distributed, with higher densities of active burrows found in forest with the highest canopy in areas furthest from forest edges. These core forest areas are vital for the species’ conservation and the recent declaration that the Menabe forest will receive statutory protection provides hope that H. antimena may be safeguarded. However, given its restricted range and low reproductive output, among other factors, H. antimena remains threatened and requires close future monitoring.
A woman, having already delivered one child, underwent fetal echocardiography during thre subsequent pregnancies. All three showed enlargement and poor function of the right-sided chambers. The first was still-born, the second died as a neonate, while the third pregnancy was terminated. Pathological examination revealed the same findings in each fetus, possibly representing a variation of Uhl's anomaly, or alternatively a hitherto unrecognised cardiomyopathic process.