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Understanding inequalities in outcomes between demographic groups is a necessary step in addressing them in clinical care. Inequalities in treatment uptake between demographic groups may explain disparities in outcomes in people with first-episode psychosis (FEP).
Aims
To investigate disparities between broad demographic groups in symptomatic improvement in patients with FEP and their relationship to treatment uptake.
Method
We used data from 6813 patients from the 2021–2022 National Clinical Audit of Psychosis data-set. Data were grouped by category type to obtain mean outcomes before adjustment to see whether disparities in outcomes remained after differences in treatment uptake had been accounted for. After matching, the average effect of each demographic variable in terms of outcome change was calculated. Moderator effects on specific treatments were investigated using interaction terms in a regression model.
Results
Observational results showed that patients aged 18–24 years were less likely to improve in outcome, unless adjusted for intervention uptake. Patients classified as Black and Black British were less likely to improve in outcome (moderation effect 0.04, 95% CI 0–0.07) after adjusting for treatment take-up and demographic factors. Regression analysis showed the general positive effect of supported employment interventions in improving outcomes (coefficient −0.13, 95% CI −0.07 to −0.18, P < 0.001), and moderator analysis suggested targeting particular groups for interventions.
Conclusions
Inequalities in treatment uptake and psychotic symptom outcome of FEP by social and demographic factors require monitoring over time. Our analysis provides a framework for monitoring health inequalities across national clinical audits in the UK.
The branch of psychology that studies how physical objects are perceived by subjects is known as psychophysics. A feature of the experimental design is that the experimenter presents objectively measurable objects that are imperfectly perceived by subjects. The responses are stochastic in that a subject might respond differently in otherwise identical situations. These stochastic choices can be compared to the objectively measurable properties. This Element offers a brief introduction to the topic, explains how psychophysics insights are already present in economics, and describes experimental techniques with the goal that they are useful in the design of economics experiments. Noise is a ubiquitous feature of experimental economics and there is a large strand of economics literature that carefully considers the noise. However, the authors view the psychophysics experimental techniques as uniquely suited to helping experimental economists uncover what is hiding in the noise.
This collection profiles understudied figures in the book and print trades of the seventeenth century. With an equal balance between women and men, it intervenes in the history of the trades, emphasising the broad range of material, cultural, and ideological work these people undertook. It offers a biographical introduction to each figure, placing them in their social, professional, and institutional settings. The collection considers varied print trade roles including that of the printer, publisher, paper-maker, and bookseller, as well as several specific trade networks and numerous textual forms. The biographies draw on extensive new archival research, with details of key sources for further study on each figure. Chronologically organised, this Element offers a primer both on numerous individual figures, and on the tribulations and innovations of the print trade in the century of revolution.
Intracerebral abscess is a life-threatening condition for which there are no current, widely accepted neurosurgical management guidelines. The purpose of this study was to investigate Canadian practice patterns for the medical and surgical management of primary, recurrent, and multiple intracerebral abscesses.
Methods:
A self-administered, cross-sectional, electronic survey was distributed to active staff and resident members of the Canadian Neurosurgical Society and Canadian Neurosurgery Research Collaborative. Responses between subgroups were analyzed using the Chi-square test.
Results:
In total, 101 respondents (57.7%) completed the survey. The majority (60.0%) were staff neurosurgeons working in an academic, adult care setting (80%). We identified a consensus that abscesses >2.5 cm in diameter should be considered for surgical intervention. The majority of respondents were in favor of excising an intracerebral abscess over performing aspiration if located superficially in non-eloquent cortex (60.4%), located in the posterior fossa (65.4%), or causing mass effect leading to herniation (75.3%). The majority of respondents were in favor of reoperation for recurrent abscesses if measuring greater than 2.5 cm, associated with progressive neurological deterioration, the index operation was an aspiration and did not include resection of the abscess capsule, and if the recurrence occurred despite prior surgery combined with maximal antibiotic therapy. There was no consensus on the use of topical intraoperative antibiotics.
Conclusion:
This survey demonstrated heterogeneity in the medical and surgical management of primary, recurrent, and multiple brain abscesses among Canadian neurosurgery attending staff and residents.1
This article extends Michael L. Radelet’s 1989 study of rare cases in which Whites have been executed for committing capital crimes against Blacks to include an assessment of White executions involving Latinx and Asian victims. The threefold aim is to (1) establish the frequency of such rare cases, and (2) explore the extent to which status characteristics (beyond race, ethnicity or gender) are present for these rare events; and (3) offer social dominance theory as a viable explanation for the patterns found in the data. An analysis of unique data from the Texas Department of Criminal Justice shows that out of 570 executions imposed between April 1982 and July 2020, only six cases led to the execution of Whites for crimes against Blacks (1.1%), sixteen cases for crimes against Hispanics (2.8%), and one case for crimes against an Asian American (0.18%). Beyond the minority status of the victim, two or more status markers were present when Whites were executed for crimes against people of color. The results, which are consistent with expectations drawn from social dominance theory, highlight the differential value placed on minority lives and call into question the legitimacy of the death penalty in the United States.
Metabolites produced by microbial fermentation in the human intestine, especially short-chain fatty acids (SCFAs), are known to play important roles in colonic and systemic health. Our aim here was to advance our understanding of how and why their concentrations and proportions vary between individuals. We have analysed faecal concentrations of microbial fermentation acids from 10 human volunteer studies, involving 163 subjects, conducted at the Rowett Institute, Aberdeen, UK over a 7-year period. In baseline samples, the % butyrate was significantly higher, whilst % iso-butyrate and % iso-valerate were significantly lower, with increasing total SCFA concentration. The decreasing proportions of iso-butyrate and iso-valerate, derived from amino acid fermentation, suggest that fibre intake was mainly responsible for increased SCFA concentrations. We propose that the increase in % butyrate among faecal SCFA is largely driven by a decrease in colonic pH resulting from higher SCFA concentrations. Consistent with this, both total SCFA and % butyrate increased significantly with decreasing pH across five studies for which faecal pH measurements were available. Colonic pH influences butyrate production through altering the stoichiometry of butyrate formation by butyrate-producing species, resulting in increased acetate uptake and butyrate formation, and facilitating increased relative abundance of butyrate-producing species (notably Roseburia and Eubacterium rectale).
Transport contributes around 11% of greenhouse gas emissions and the sector is also vulnerable to climate change. High temperatures can melt roads and distort rail lines while sea-level rise can disrupt coastal transport infrasructure. At the community level, cities and precincts can help mitigate climate change and adapt to changes by promoting active lifestyles with walking and bicyling replacing powered transport for short-distance travel and making cities more compact. Significant cost and health benefits can accrue from reduction of diseases associated with low physical activity and air pollution can also be mitigated. Increased provision and electrification of public transport based on renewable energy can decarbonise these services. The electification of sea and air transport present challenges but significant development work is underway with expected early availability of electrically powered short-haul aircraft. Phase-out of internal combustion engine cars and other vehicles is scheduled in several countries as battery-electric and hydrogen cars, buses and heavy transport vehicles emerge. Governments can help the transition with a range of policy initiatives.
This chapter outlines the case for the global green building movement to embrace integrated ‘climate-smart’ green building design, construction and operation, which optimises new and existing buildings to achieve both mitigation and adaptation goals synergistically and cost-effectively. The climate-smart building agenda is a high priority for this sector because it can help improve the well-being, productivity and health of occupants, and provide other social equity benefits, thus helping, simultaneously, to achieve other UN Sustainable Development Goals. Focus extends to precincts, the building blocks of cities, interfacing Building and Precinct Information Modelling. Overview is provided of leading sustainability assessment and rating tools for design of buildings and precincts. The chapter identifies key stakeholders and decision makers, and how each can best play their part to enable needed changes in this sector to achieve a net zero-carbon resilient future. It examines the role of governments in addressing major market and informational failures and what policies are needed to underpin efforts by all these key actors to achieve decarbonisation of the built environment sector.
Industry is a major contributor to climate change. Many industrial sites, supply chains and customers are vulnerable to climate change and policy and consumer responses to climate change. Profits from industrial production depend on consumer demand, and how products are provided. Powerful forces such as digitalisation, dematerialisation, decentralisation, electrification, efficiency improvement and circular economies influence production and emissions Industrial firms face pressure from regulators, investors and customers. However, there is enormous potential to capture multiple benefits through aggressive, innovative decarbonisation strategies that target growth markets and involve cooperation along supply chains. Economic productivity and business competitiveness improvement can cut business costs and reduce extreme weather risk exposure, whilst positioning manufacturing companies for fast-growing markets in low-carbon resilient products and services. The chapter overviews policies national and subnational government policymakers can consider to support transition to a zero-carbon resilient industrial sector.
The transition to a low-carbon economy will increase mineral commodity demands by up to tenfold by 2050. Improving the quality of lives in developing countries will further increase resource demands. Mineral ores are critical for manufacturing low-carbon technologies. The projected increase in demand provides a major business opportunity, in turn providing a driver for the required investment to move to low-carbon mining, processing and recycling. To improve efficiency and reduce the carbon footprint of mining and metals recycling, the industry can take advantage of solar photovoltaics, wind and batteries, and renewable energy power purchase agreements, and reduce flaring, venting and fugitive emissions. Adaptation to cope with extreme weather events is critical to ensure materials can be delivered to low-carbon technology producers. Reducing exposure to climate risks through an integrated adaptation–mitigation approach lessens operational, maintenance and insurance costs. This chapter reviews tools to help the sector simultaneously achieve both climate mitigation and adaptation cost-effectively.
Whiteite-(MnMnMn), Mn2+Mn2+Mn2+2Al2(PO4)4(OH)2⋅8H2O, is a new whiteite-subgroup member of the jahnsite group from the Foote Lithium Company mine, Kings Mountain district, Cleveland County, North Carolina, USA. It was found in small vugs of partially oxidised pegmatite minerals on the East dump of the mine, in association with eosphorite, hureaulite, fairfieldite, mangangordonite, whiteite-(CaMnMn) and jasonsmithite. It occurs as sugary aggregates of blade-like crystals up to 0.1 mm long and as epitaxial overgrowths on whiteite-(CaMnMn). The crystals are colourless to very pale brown, with a vitreous lustre and a white streak. The blades are flattened on {001} and elongated along [010], with poor cleavage on {001}. The calculated density is 2.82 g⋅cm–3. Optically it is biaxial (–) with α = 1.599(2), β = 1.605(2), γ = 1.609(2) (white light); 2V (calc.) = 78.2°, having no observable dispersion or pleochroism, and with orientation X = b. Electron microprobe analyses and structure refinement gave the empirical formula (Mn2+0.59Ca0.38Na0.03)Σ1.00Mn1.00(Mn2+1.04Fe3+0.58Fe2+0.23Zn0.16Mg0.08)Σ2.09Al2.04(PO4)3.89(OH)3.18(H2O)7.26. Whiteite-(MnMnMn) is monoclinic, P2/a, a = 15.024(3) Å, b = 6.9470(14) Å, c = 9.999(2) Å, β = 110.71(3)°, V = 976.2(4) Å3 and Z = 2. The crystal structure was refined using synchrotron single-crystal data to wRobs = 0.057 for 2014 reflections with I > 3σ(I). Site occupancy refinements confirm the ordering of dominant Mn in the X, M1 and M2 sites of the general jahnsite-group formula XM1(M2)2(M3)2(H2O)8(OH)2(PO4)4. A review of published crystallochemical data for jahnsite-group minerals shows a consistent chemical pressure effect in these minerals, manifested as a contraction of the unit-cell parameter, a, as the mean size of the X and M1 site cations increases. This is analogous to negative thermal expansion, but with increasing cation size, rather than heating, inducing octahedral rotations that result in an anisotropic contraction of the unit cell.
Knotweed (Fallopia spp.) is an herbaceous perennial from East Asia that was brought to Europe and North America and, despite control efforts, subsequently spread aggressively on both continents. Data are available on knotweed’s modes of sexual and asexual spread, historical spread, preferred habitat, and ploidy levels. Incomplete information is available on knotweed’s current global geographic distribution and genetic diversity. The chemical composition of knotweed leaves and rhizomes has been partially discovered as related to its ability to inhibit growth and germination of neighboring plant communities via phytochemicals. There is still critical information missing. There are currently no studies detailing knotweed male and female fertility. Specifically, information on pollen viability would be important for further understanding sexual reproduction as a vector of spread in knotweed. This information would help managers determine the potential magnitude of knotweed sexual reproduction and the continued spread of diverse hybrid swarms. The potential range of knotweed and its ability to spread into diverse habitats makes studies on knotweed seed and rhizome cold tolerance of utmost importance, yet to date no such studies have been conducted. There is also a lack of genetic information available on knotweed in the upper Midwest. Detailed genetic information, such as ploidy levels and levels of genetic diversity, would answer many questions about knotweed in Minnesota, including understanding its means of spread, what species are present in what densities, and current levels of hybridization. This literature review summarizes current literature on knotweed to better understand its invasiveness and to highlight necessary future research that would benefit and inform knotweed management in the upper Midwest.
To examine whether national initiatives have led to improvements in the physical health of people with psychosis. Secondary analysis of a national audit of services for people with psychosis. Proportions of patients in ‘good health’ according to seven measures, and one composite measure derived from national standards, were compared between multiple rounds of data collection.
Results
The proportion of patients in overall ‘good health’ under the care of ‘Early Intervention in Psychosis’ teams increased from 2014–2019, particularly for measures of smoking, alcohol and substance use. There was no overall change in the proportion of patients in overall ‘good health’ under the care of ‘Community Mental Health Teams’ from 2011–2017. However, there were improvements in alcohol use, blood glucose and lipid levels.
Clinical implications
There have been modest improvements in the health of people with psychosis over the last nine years. Continuing efforts are required to translate these improvements into reductions in premature mortality.
Engaging communities can increase the speed of translating health and health equity research into practice. Effective engagement requires a shared understanding of the health of a community. This can be challenging without timely and accurate local health data, or ways to provide that data, that are directly applicable to improving community health outcomes. The University of Wisconsin Institute for Clinical and Translational Research formed the Neighborhood Health Partnerships Program (NHP) to overcome this challenge, making sub-county health data available to researchers and community stakeholders while incorporating community voice into data delivery processes. The NHP team used a human-centered design approach to facilitate community engagement. Through co-design, the team created NHP reports and data-to-action tools to maximize accessibility and utility for a diverse set of community stakeholders. Early indicators show that the final co-designed NHP reports and data-to-action tools will be immediately useful in promoting community–academic partnerships and in planning, implementing, and evaluating research and other initiatives in communities. The NHP program demonstrates that an effective co-design strategy can lead to increased usability and adoption of Clinical and Translational Science Award resources, enabling a shared understanding of community health and ultimately leading to the successful translation of research into practice.
In recent years, a variety of efforts have been made in political science to enable, encourage, or require scholars to be more open and explicit about the bases of their empirical claims and, in turn, make those claims more readily evaluable by others. While qualitative scholars have long taken an interest in making their research open, reflexive, and systematic, the recent push for overarching transparency norms and requirements has provoked serious concern within qualitative research communities and raised fundamental questions about the meaning, value, costs, and intellectual relevance of transparency for qualitative inquiry. In this Perspectives Reflection, we crystallize the central findings of a three-year deliberative process—the Qualitative Transparency Deliberations (QTD)—involving hundreds of political scientists in a broad discussion of these issues. Following an overview of the process and the key insights that emerged, we present summaries of the QTD Working Groups’ final reports. Drawing on a series of public, online conversations that unfolded at www.qualtd.net, the reports unpack transparency’s promise, practicalities, risks, and limitations in relation to different qualitative methodologies, forms of evidence, and research contexts. Taken as a whole, these reports—the full versions of which can be found in the Supplementary Materials—offer practical guidance to scholars designing and implementing qualitative research, and to editors, reviewers, and funders seeking to develop criteria of evaluation that are appropriate—as understood by relevant research communities—to the forms of inquiry being assessed. We dedicate this Reflection to the memory of our coauthor and QTD working group leader Kendra Koivu.1
Our recent exploration into the use of biodegradable metals and surface treatments resulting in sufficient strength for skeletal reconstruction applications has led to the need to test these devices’ cytotoxicity. More specifically, our group has developed a resorbable magnesium alloy, Mg–1.2Zn–0.5Ca–0.5Mn, that can be strengthened by heat treatment and coated with a ceramic layer offering time-certain resorption of a medical device. This in vitro study shows that these treatments do not result in cytotoxicity. Both heat-treated (HT) and HT + ceramic-coated (sol–gel) coupons demonstrated more than 70% viability. Thus, these processing steps are likely to be useful in producing biocompatible, resorbable implants that incorporate our Mg–1.2Zn–0.5Ca–0.5Mn alloy.
Clinical Nursing Skills provides students with a strong, industry-focused foundation in nursing across various clinical settings. It includes the essential theory as well as relevant practical examples, which illustrate the skills required to prepare students for the workplace and help them achieve clinical competence. Each chapter is written by leading academics and based on the registered nurse standards for practice. Pedagogical features include learning objectives, reflective questions, clinical tips, full-colour images, in-situ troubleshooting case studies, skills in practice case studies, keys terms and definitions, and research topics for further study. Clinical Nursing Skills is a highly practical and authoritative resource designed to educate the next generation of nurses. The book comes with free access to the VitalSource etext. This enhanced version of Clinical Nursing Skills houses homework assignments, tutorial assistance, guided solutions and additional content in one convenient resource, which you can download to your computer or mobile device.
The New Cambridge Shakespeare appeals to students worldwide for its up-to-date scholarship and emphasis on performance. The series features line-by-line commentaries and textual notes on the plays and poems. Introductions are regularly refreshed with accounts of new critical, stage and screen interpretations. For this second edition of Titus Andronicus Sue Hall-Smith has written a new section on recent scholarship and important contemporary performances of the play. The edition retains the text prepared by Alan Hughes, based on the first quarto and supplemented by crucial additions and stage directions from the Folio. In the introduction, Hughes contradicts the historically popular view that Titus Andronicus is a poor play of dubious authorship. Joining the growing ranks of critics who take the play seriously, Hughes applauds its thematic unity and grim humour, and demonstrates that it is the work of a brilliant stage craftsman, confident in his mastery of space, movement and verse.
The Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND) cohort study of the Canadian Consortium on Neurodegeneration in Aging (CCNA) is a national initiative to catalyze research on dementia, set up to support the research agendas of CCNA teams. This cross-country longitudinal cohort of 2310 deeply phenotyped subjects with various forms of dementia and mild memory loss or concerns, along with cognitively intact elderly subjects, will test hypotheses generated by these teams.
Methods:
The COMPASS-ND protocol, initial grant proposal for funding, fifth semi-annual CCNA Progress Report submitted to the Canadian Institutes of Health Research December 2017, and other documents supplemented by modifications made and lessons learned after implementation were used by the authors to create the description of the study provided here.
Results:
The CCNA COMPASS-ND cohort includes participants from across Canada with various cognitive conditions associated with or at risk of neurodegenerative diseases. They will undergo a wide range of experimental, clinical, imaging, and genetic investigation to specifically address the causes, diagnosis, treatment, and prevention of these conditions in the aging population. Data derived from clinical and cognitive assessments, biospecimens, brain imaging, genetics, and brain donations will be used to test hypotheses generated by CCNA research teams and other Canadian researchers. The study is the most comprehensive and ambitious Canadian study of dementia. Initial data posting occurred in 2018, with the full cohort to be accrued by 2020.
Conclusion:
Availability of data from the COMPASS-ND study will provide a major stimulus for dementia research in Canada in the coming years.
Background: Endovascular thrombectomy (EVT) has shown efficacy in acute ischemic stroke (AIS) patients with infective endocarditis (IE). The possibility to undertake advanced histopathological clot analysis following EVT offers a new avenue to establish the etiological basis of the stroke – which is often labelled “cryptogenic.” In this paper, we present our findings from four consecutive patients with IE who underwent EVT following an AIS at our tertiary referral comprehensive stroke centre. Methods: Comprehensive histopathological analysis of clot retrieved after EVT, including morphology, was undertaken. Results: The consistent observation was the presence of dense paucicellular fibrinoid material mixed/interspersed with clusters of bacterial cocci. This clot morphology may be specific to septic embolus due to IE unlike incidental bacteraemia and could possibly explain the refractoriness of such clots to systemic thrombolysis. Conclusion: Detailed morphological and histopathological analysis of EVT-retrieved clots including Gram staining can assist in etiological classification of the clot. Understanding the composition of the clot may be of clinical value in early diagnostics and mapping treatment planning in IE.