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Comprehensive cognitive remediation improves cognitive and functional outcomes in people with serious mental illness, but the specific components required for effective programs are uncertain. The most common methods to improve cognition are facilitated computerized cognitive training with coaching and teaching cognitive self-management strategies. We compared these methods by dismantling the Thinking Skills for Work program, a comprehensive, validated cognitive remediation program that incorporates both strategies.
Methods
In a randomized controlled trial we assigned 203 unemployed people with serious mental illness in supported employment programs at two mental health agencies to receive either the full Thinking Skills for Work (TSW) program, which included computerized cognitive training (based on Cogpack software), or the program with cognitive self-management (CSM) but no computer training. Outcomes included employment, cognition, and mental health over 2 years. To benchmark outcomes, we also examined competitive work outcomes in a similar prior trial comparing the TSW program with supported employment only.
Results
The TSW and CSM groups improved significantly on all outcomes, but there were no differences between the groups. Competitive work outcomes for both groups resembled those of the TSW program in a prior trial and were better than the supported employment-only group in that study, suggesting that participants in both groups benefited from cognitive remediation.
Conclusions
Providing facilitated computerized cognitive training improved neither employment nor cognitive outcomes beyond teaching cognitive self-management strategies in people receiving supported employment. Computerized cognitive training may not be necessary for cognitive remediation programs to improve cognitive and functional outcomes.
Current and future surveys rely on machine learning classification to obtain large and complete samples of transients. Many of these algorithms are restricted by training samples that contain a limited number of spectroscopically confirmed events. Here, we present the first real-time application of Active Learning to optimise spectroscopic follow-up with the goal of improving training sets of early type Ia supernovae (SNe Ia) classifiers. Using a photometric classifier for early SN Ia, we apply an Active Learning strategy for follow-up optimisation using the real-time Fink broker processing of the ZTF public stream. We perform follow-up observations at the ANU 2.3m telescope in Australia and obtain 92 spectroscopic classified events that are incorporated in our training set. We show that our follow-up strategy yields a training set that, with 25% less spectra, improves classification metrics when compared to publicly reported spectra. Our strategy selects in average fainter events and, not only supernovae types, but also microlensing events and flaring stars which are usually not incorporated on training sets. Our results confirm the effectiveness of active learning strategies to construct optimal training samples for astronomical classifiers. With the Rubin Observatory LSST soon online, we propose improvements to obtain earlier candidates and optimise follow-up. This work paves the way to the deployment of real-time AL follow-up strategies in the era of large surveys.
The 2019 UK General Election had seismic consequences for British politics. After three years of political turmoil following the 2016 referendum on Britain’s membership of the European Union (EU), the 2019 election marked a victory for the Leave side of the Brexit debate, putting to rest questions of a second referendum and any chance of Parliament blocking the Withdrawal Bill. The United Kingdom left the EU on January 31, 2020. Although there were clear consequences for Britain’s EU membership, there is debate about whether 2019 was a “Brexit election” (Prosser 2020)—even a critical election (Green 2021)—or the continuation of long-term realignments in British politics (Cutts et al. 2020; Jennings and Stoker 2017). By most accounts, Brexit dominated the 2019 election as a political issue, but whether this represents a key moment in a process of realignment of voters in Britain remains to be seen.
Anaemia is characterised by low hemoglobin (Hb) concentration. Despite being a public health concern in Ethiopia, the role of micronutrients and non-nutritional factors as a determinant of Hb concentrations has been inadequately explored. This study focused on the assessment of serum micronutrient and Hb concentrations and a range of non-nutritional factors, to evaluate their associations with the risk of anaemia among the Ethiopian population (n 2046). It also explored the mediation effect of Zn on the relation between se and Hb. Bivariate and multivariate regression analyses were performed to identify the relationship between serum micronutrients concentration, inflammation biomarkers, nutritional status, presence of parasitic infection and socio-demographic factors with Hb concentration (n 2046). Sobel–Goodman test was applied to investigate the mediation of Zn on relations between serum se and Hb. In total, 18·6 % of participants were anaemic, 5·8 % had iron deficiency (ID), 2·6 % had ID anaemia and 0·6 % had tissue ID. Younger age, household head illiteracy and low serum concentrations of ferritin, Co, Cu and folate were associated with anaemia. Serum se had an indirect effect that was mediated by Zn, with a significant effect of se on Zn (P < 0·001) and Zn on Hb (P < 0·001). The findings of this study suggest the need for designing a multi-sectorial intervention to address anaemia based on demographic group.
The COVID-19 pandemic raised the importance of adaptive capacity and preparedness when engaging historically marginalized populations in research and practice. The Rapid Acceleration of Diagnostics in Underserved Populations’ COVID-19 Equity Evidence Academy Series (RADx-UP EA) is a virtual, national, interactive conference model designed to support and engage community-academic partnerships in a collaborative effort to improve practices that overcome disparities in SARS-CoV-2 testing and testing technologies. The RADx-UP EA promotes information sharing, critical reflection and discussion, and creation of translatable strategies for health equity. Staff and faculty from the RADx-UP Coordination and Data Collection Center developed three EA events with diverse geographic, racial, and ethnic representation of attendees from RADx-UP community-academic project teams: February 2021 (n = 319); November 2021 (n = 242); and September 2022 (n = 254). Each EA event included a data profile; 2-day, virtual event; event summary report; community dissemination product; and an evaluation strategy. Operational and translational delivery processes were iteratively adapted for each EA across one or more of five adaptive capacity domains: assets, knowledge and learning, social organization, flexibility, and innovation. The RADx-UP EA model can be generalized beyond RADx-UP and tailored by community and academic input to respond to local or national health emergencies.
To examine differences in surgical practices between salaried and fee-for-service (FFS) surgeons for two common degenerative spine conditions. Surgeons may offer different treatments for similar conditions on the basis of their compensation mechanism.
Methods:
The study assessed the practices of 63 spine surgeons across eight Canadian provinces (39 FFS surgeons and 24 salaried) who performed surgery for two lumbar conditions: stable spinal stenosis and degenerative spondylolisthesis. The study included a multicenter, ambispective review of consecutive spine surgery patients enrolled in the Canadian Spine Outcomes and Research Network registry between October 2012 and July 2018. The primary outcome was the difference in type of procedures performed between the two groups. Secondary study variables included surgical characteristics, baseline patient factors, and patient-reported outcome.
Results:
For stable spinal stenosis (n = 2234), salaried surgeons performed statistically fewer uninstrumented fusion (p < 0.05) than FFS surgeons. For degenerative spondylolisthesis (n = 1292), salaried surgeons performed significantly more instrumentation plus interbody fusions (p < 0.05). There were no statistical differences in patient-reported outcomes between the two groups.
Conclusions:
Surgeon compensation was associated with different approaches to stable lumbar spinal stenosis and degenerative lumbar spondylolisthesis. Salaried surgeons chose a more conservative approach to spinal stenosis and a more aggressive approach to degenerative spondylolisthesis, which highlights that remuneration is likely a minor determinant in the differences in practice of spinal surgery in Canada. Further research is needed to further elucidate which variables, other than patient demographics and financial incentives, influence surgical decision-making.
Multiple micronutrient deficiencies are widespread in Ethiopia. However, the distribution of Se and Zn deficiency risks has previously shown evidence of spatially dependent variability, warranting the need to explore this aspect for wider micronutrients. Here, blood serum concentrations for Ca, Mg, Co, Cu and Mo were measured (n 3102) on samples from the Ethiopian National Micronutrient Survey. Geostatistical modelling was used to test spatial variation of these micronutrients for women of reproductive age, who represent the largest demographic group surveyed (n 1290). Median serum concentrations were 8·6 mg dl−1 for Ca, 1·9 mg dl−1 for Mg, 0·4 µg l−1 for Co, 98·8 µg dl−1 for Cu and 0·2 µg dl−1 for Mo. The prevalence of Ca, Mg and Co deficiency was 41·6 %, 29·2 % and 15·9 %, respectively; Cu and Mo deficiency prevalence was 7·6 % and 0·3 %, respectively. A higher prevalence of Ca, Cu and Mo deficiency was observed in north western, Co deficiency in central and Mg deficiency in north eastern parts of Ethiopia. Serum Ca, Mg and Mo concentrations show spatial dependencies up to 140–500 km; however, there was no evidence of spatial correlations for serum Co and Cu concentrations. These new data indicate the scale of multiple mineral micronutrient deficiency in Ethiopia and the geographical differences in the prevalence of deficiencies suggesting the need to consider targeted responses during the planning of nutrition intervention programmes.
The aim of this project is to improve the training experience of Psychiatry trainees across CNWL. In QI terms, we want to achieve a satisfaction rating of above 7/10 for all themes identified by August 2021.
Method
Collected baseline data on satisfaction and priority ratings on 7 training themes Held discussion groups with trainees for specific themes to generate issues and solutions Developed and provided Quality Improvement training for trainees and trainers, 1:1 support and QI clinics – empowering trainees to develop their own local project and to make changes to issues on the ground Enacted central changes in communication, responsiveness, recognising success.
Reassessed and fedback to the trainees throughout.
Result
Our baseline satisfaction survey was completed in June 2020. Trainees their satisfaction for each theme out of 10 and to rank their priorities for change. Results showed satisfaction was lowest in morale and in safety and highest in education and supervision. Their highest priorities for change were safety, then morale, with induction as the lowest priority.
We repeated the survey in October 2020. This showed improvements in most themes (apart from induction, perhaps due to induction having to be delivered virtually). Satisfaction in key priority areas of morale and safety increased from 4.53 to 6.37, and 5.12 to 6.70 respectively. We also asked what ‘one thing’ would they improve about their training. Key phrases included teaching, on-call, communication and induction.
From this data, and softer feedback from trainees, it is encouraging that we are moving in a positive direction, but we are continuing to make changes.
Conclusion
• Trainees must be central to the work in improving their training
• Using QI methodology helps – developing a structure and breaking down a bigger task helps make a plan
• Feedback is key – but people are busy and receive a lot of emails and requests to fill surveys – catching people ‘in person’ (virtually) was the best way to ensure a lot of responses
• Trainees have loads of great ideas, but they need support, time and resources to be able to develop their projects and changes
• Flexibility is crucial: some topics work better locally, driven by trainees and some require a more coordinated, central role
We hope that developing a structured approach to a large task like improving training will help make changes sustainable, and enables us to share our learning with others.
Dispersal is a key ecological process affecting community dynamics and the maintenance of populations. There is increasing awareness of the need to understand individual dispersal potential to better inform population-level dispersal, allowing more accurate models of the spread of invasive and beneficial insects, aiding crop and pest management strategies. Here, fine-scale movements of Poecilus cupreus, an important agricultural carabid predator, were recorded using a locomotion compensator and key movement characteristics were quantified. Net displacement increased more rapidly than predicted by a simple correlated random walk model with near ballistic behaviour observed. Individuals displayed a latent ability to head on a constant bearing for protracted time periods, despite no clear evidence of a population level global orientation bias. Intermittent bouts of movement and non-movement were observed, with both the frequency and duration of bouts of movement varying at the inter- and intra-individual level. Variation in movement behaviour was observed at both the inter- and intra- individual level. Analysis suggests that individuals have the potential to rapidly disperse over a wider area than predicted by simple movement models parametrised at the population level. This highlights the importance of considering the role of individual variation when analysing movement and attempting to predict dispersal distances.
To determine healthcare-associated infection (HAI) prevalence in 9 hospitals in Jacksonville, Florida; to evaluate the performance of proxy indicators for HAIs; and to refine methodology in preparation for a multistate survey.
Design.
Point prevalence survey.
Patients.
Acute care inpatients of any age.
Methods.
HAIs were defined using National Healthcare Safety Network criteria. In each facility a trained primary team (PT) of infection prevention (IP) staff performed the survey on 1 day, reviewing records and collecting data on a random sample of inpatients. PTs assessed patients with one or more proxy indicators (abnormal white blood cell count, abnormal temperature, or antimicrobial therapy) for the presence of HAIs. An external IP expert team collected data from a subset of patient records reviewed by PTs to assess proxy indicator performance and PT data collection.
Results.
Of 851 patients surveyed by PTs, 51 had one or more HAIs (6.0%; 95% confidence interval, 4.5%–7.7%). Surgical site infections (n = 18), urinary tract infections (n = 9), pneumonia (n = 9), and bloodstream infections (n = 8) accounted for 75.8% of 58 HAIs detected by PTs. Staphylococcus aureus was the most common pathogen, causing 9 HAIs (15.5%). Antimicrobial therapy was the most sensitive proxy indicator, identifying 95.5% of patients with HAIs.
Conclusions.
HAI prevalence in this pilot was similar to that reported in the 1970s by the Centers for Disease Control and Prevention's Study on the Efficacy of Nosocomial Infection Control. Antimicrobial therapy was a sensitive screening variable with which to identify those patients at higher risk for infection and reduce data collection burden. Additional work is needed on validation and feasibility to extend this methodology to a national scale.
Knowledge of both population size and genetic diversity is critical for assessing extinction risk but few studies include concurrent estimates of these two components of population biology. We conducted an investigation of population density and size, and genetic variation and past demographic events, of the Endangered grey-headed lemur Eulemur cinereiceps in south-east Madagascar. We estimated lemur density using line-transect surveys and used satellite imagery to calculate forest fragment area in three localities. We collected tissue samples from 53 individuals and used 26 polymorphic microsatellite loci to obtain measures of population structure (divergence and diversity) across these localities. We tested the probability of past bottleneck events using three models. Contrary to expectation, there were no significant differences in population density across localities. Genetic diversity decreased, but not significantly, with decreasing habitat area and population size. We found a higher likelihood of past bottleneck events in the fragmented coastal populations. The low population size and prior decline in diversity in coastal patches are consistent with their isolation, anthropogenic disturbance, and exposure to cyclone activity. The similarities in the estimates of density between continuous and fragmented sites may indicate recent population growth in the fragments but these populations nevertheless remain at risk from reduced levels of genetic variation. These patterns should be confirmed with more extensive sampling across the limited range of E. cinereiceps.
The remains of the first Iron Age chariot burial in Britain outside Yorkshire were discovered during the winter of 2000–1, near the Bronze Age burial mound of Huly Hill, at Newbridge, Edinburgh. Excavated by Headland Archaeology (UK) Ltd with the assistance of the National Museums Scotland, the chariot proved unique beyond just its burial location. The Newbridge chariot was buried intact, a method consistent with the burial practices of Continental Europe rather than Yorkshire, where they were predominantly buried disassembled. Detailed post-excavation analysis revealed a history of repair and reuse, and construction techniques that indicate links with the chariot building traditions of both Yorkshire and Continental Europe. Fifth century bc radiocarbon dates for the burial place it firmly within La Tène A, consistent with its similarities to European examples and indicating that it pre-dates the known Yorkshire examples. This indicates the emergence of a British tradition of chariot construction by this time, familiar with Continental habits and technology but distinctively different in such areas as wheel construction and suspension fittings. Based on the findings, a reconstruction of the chariot was built for display in the National Museums Scotland, providing an opportunity further to understand and confirm the construction techniques observed or hypothesised during excavation.
On the occasion of the 100th issue of English Today, scholars from around the world were invited to send their thoughts. Excerpts from messages received up to September 6th, 2009 are presented here.
One hundred and fifty years ago Edinburgh lost one of her most distinguished citizens of all time, James Hutton, who is universally acclaimed as chief among the founders of modern geology. To-day, Lord Provost Sir John Falconer, to whom the city owes so much in this triumphant Festival year, has fittingly unveiled a tablet in Greyfriars Churchyard to mark the last resting-place of our great scientist. It must not be imagined that the absence of a tombstone during all these years illustrates the proverbial lack of appreciation which a prophet must expect in his own country. During his lifetime Hutton's brilliant associates recognised him at his true worth; and shortly after his death one of them, John Playfair, distinguished mathematician and physicist, erected to his friend a noble monument in the world of letters, entitled Illustrations of the Huttonian Theory, 1802. He also provided the Royal Society of Edinburgh with a Biographical Account of 61 pp. 4to, 1803, which includes many personal details coupled with a comprehensive scientific appreciation.
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