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There is a growing need for academic enquiry acknowledging the challenges surrounding successful prescribing for mental health. This book focuses on the act and skills of psychiatric prescribing and its psychosocial context, bringing together differing views on prescribing, assessing the challenges, and identifying useful principles and guidelines together. Covering a multitude of topics including interpreting and handling uncertainty in the clinical evidence, accounting for phases of illness and natural course, collaborating with allied professionals, addressing the meaning of medications, minimising structural barriers to medications; accounting for interactive effects of dietary factors, supplements and alternative remedies, and shared decision-making approaches. Case vignettes and accompanying analysis frame the issues relevant for psychiatric prescribers and offering an approach that strikes a balance between the biological, psychological and social elements of prescribing. For psychiatrists, clinical psychologists and all those involved with the care of patients with mental health conditions.
Isotopes of strontium, oxygen, and carbon were analyzed in human tooth enamel from two Postclassic sites in the central Peten lakes region, Guatemala, to examine patterns of mobility and diet during a time of social unrest. Excavations at both sites, Ixlu and Zacpeten, have revealed evidence for purposeful dismemberment and interment of individuals. This study examines a possible shrine surrounded by rows of skulls at Ixlu, and a mass grave of comingled individuals interred at Zacpeten. The interments coincide with a period of conflict and warfare between two dominant polities, Itza and Kowoj. The 14 sampled individuals at Ixlu were young males, six of whom isotopically match the Maya Mountains of central Belize/southeastern Peten. At Zacpeten, isotopic signatures of adults and children (n = 68) suggested that many were either local or came from other parts of the Maya lowlands, but not the Maya Mountains. In the Late Postclassic, the Zacpeten individuals were exhumed, defiled, and deposited in a mass grave, probably by Kowojs. Although temporally and geographically related, the Ixlu and Zacpeten burials represent two distinct cases of ritual violence that reflect the tumultuous political landscape of the Postclassic period.
Depressive symptoms are highly prevalent in first-episode psychosis (FEP) and worsen clinical outcomes. It is currently difficult to determine which patients will have persistent depressive symptoms based on a clinical assessment. We aimed to determine whether depressive symptoms and post-psychotic depressive episodes can be predicted from baseline clinical data, quality of life, and blood-based biomarkers, and to assess the geographical generalizability of these models.
Methods
Two FEP trials were analyzed: European First-Episode Schizophrenia Trial (EUFEST) (n = 498; 2002–2006) and Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) (n = 404; 2010–2012). Participants included those aged 15–40 years, meeting Diagnostic and Statistical Manual of Mental Disorders IV criteria for schizophrenia spectrum disorders. We developed support vector regressors and classifiers to predict changes in depressive symptoms at 6 and 12 months and depressive episodes within the first 6 months. These models were trained in one sample and externally validated in another for geographical generalizability.
Results
A total of 320 EUFEST and 234 RAISE-ETP participants were included (mean [SD] age: 25.93 [5.60] years, 56.56% male; 23.90 [5.27] years, 73.50% male). Models predicted changes in depressive symptoms at 6 months with balanced accuracy (BAC) of 66.26% (RAISE-ETP) and 75.09% (EUFEST), and at 12 months with BAC of 67.88% (RAISE-ETP) and 77.61% (EUFEST). Depressive episodes were predicted with BAC of 66.67% (RAISE-ETP) and 69.01% (EUFEST), showing fair external predictive performance.
Conclusions
Predictive models using clinical data, quality of life, and biomarkers accurately forecast depressive events in FEP, demonstrating generalization across populations.
The glacial history of northeast Siberia is poorly understood compared with other high-latitude regions. Using 10Be and 26Al exposure dating together with remote sensing, we have investigated the glacial history of a remote, formerly glaciated valley in the Tas-Kystabyt Range of the Chersky Mountains in central northeast Siberia. Based on measurements from moraine boulders and bedrock samples, we find evidence for deglaciation of the valley 45.6 ± 3.4 ka ago, that is during the peak of Marine Isotope Stage 3. Satellite imagery of the range reveals at least two generations of moraines in other nearby valleys, indicating that multiple stages of glaciation took place across the Tas-Kystabyt Range. Based on calculated equilibrium-line altitudes, we speculate that the outer set of moraines is linked to the 45.6 ± 3.4 ka deglaciation event identified by our dating, while the inner generation of moraines is associated with a younger glaciation event, possibly the last glacial maximum (LGM). Thus, our results reaffirm current impressions that the maximum ice extent during the last glacial cycle was reached before the global LGM in northeast Siberia.
Patients with posttraumatic stress disorder (PTSD) exhibit smaller regional brain volumes in commonly reported regions including the amygdala and hippocampus, regions associated with fear and memory processing. In the current study, we have conducted a voxel-based morphometry (VBM) meta-analysis using whole-brain statistical maps with neuroimaging data from the ENIGMA-PGC PTSD working group.
Methods
T1-weighted structural neuroimaging scans from 36 cohorts (PTSD n = 1309; controls n = 2198) were processed using a standardized VBM pipeline (ENIGMA-VBM tool). We meta-analyzed the resulting statistical maps for voxel-wise differences in gray matter (GM) and white matter (WM) volumes between PTSD patients and controls, performed subgroup analyses considering the trauma exposure of the controls, and examined associations between regional brain volumes and clinical variables including PTSD (CAPS-4/5, PCL-5) and depression severity (BDI-II, PHQ-9).
Results
PTSD patients exhibited smaller GM volumes across the frontal and temporal lobes, and cerebellum, with the most significant effect in the left cerebellum (Hedges’ g = 0.22, pcorrected = .001), and smaller cerebellar WM volume (peak Hedges’ g = 0.14, pcorrected = .008). We observed similar regional differences when comparing patients to trauma-exposed controls, suggesting these structural abnormalities may be specific to PTSD. Regression analyses revealed PTSD severity was negatively associated with GM volumes within the cerebellum (pcorrected = .003), while depression severity was negatively associated with GM volumes within the cerebellum and superior frontal gyrus in patients (pcorrected = .001).
Conclusions
PTSD patients exhibited widespread, regional differences in brain volumes where greater regional deficits appeared to reflect more severe symptoms. Our findings add to the growing literature implicating the cerebellum in PTSD psychopathology.
The silent patent ductus arteriosus is currently considered a benign lesion with some practitioners dismissing these patients from cardiac follow-up. We present a 5-year-old male with no known cardiac history who presented with endarteritis in a silent patent ductus arteriosus and underwent successful antibiotic treatment and transcatheter device occlusion.
This chapter links Haiti’s ambivalent place in the Latinx literary imaginary to deep-seated anxieties about race, nation, and belonging entangled in representations of Haiti since the Haitian Revolution and the formation of the Latinx literary canon. It argues that in last thirty years the historical exclusion of Haitian American literature from the Latinx literary canon has come increasingly under pressure due to shifting terminology, the broad turn toward recuperating legacies of the Haitian revolution across academic disciplines, and the institutionalization of Dominican American Studies in the United States. The chapter concludes with close readings of Julia Alvarez’s memoir A Wedding in Haiti (2012), Félix Morisseau-Leroy’s poem “Tourist,” and Loida Maritza Pérez’s novel Geographies of Home (2000) to illustrate both the possible pitfalls and promising potential of transnational approaches linking the literatures of the Dominican Republic, Haiti, and their diasporas.
Threat sensitivity, an individual difference construct reflecting variation in responsiveness to threats of various types, predicts physiological reactivity to aversive stimuli and shares heritable variance with anxiety disorders in adults. However, no research has been conducted yet with youth to examine the heritability of threat sensitivity or evaluate the role of genetic versus environmental influences in its relations with mental health problems. The current study addressed this gap by evaluating the psychometric properties of a measure of this construct, the 20-item Trait Fear scale (TF-20), and examining its phenotypic and genotypic correlations with different forms of psychopathology in a sample of 346 twin pairs (121 monozygotic), aged 9–14 years. Analyses revealed high internal consistency and test-retest reliability for the TF-20. Evidence was also found for its convergent and discriminant validity in terms of phenotypic and genotypic correlations with measures of fear-related psychopathology. By contrast, the TF-20’s associations with depressive conditions were largely attributable to environmental influences. Extending prior work with adults, current study findings provide support for threat sensitivity as a genetically-influenced liability for phobic fear disorders in youth.
Increased antibiotic use (AU) has been reported globally during the COVID-19 pandemic despite low rates of bacterial co-infection. We assessed changes in AU during the COVID-19 pandemic in Indonesia and the Philippines.
Methods:
We evaluated hospital-wide AU over 36 months in six hospitals, 3 in Indonesia and 3 in the Philippines. Intravenous antibiotics commonly used for respiratory conditions were selected and grouped for analysis. AU rates were calculated as monthly defined daily dose per 1000 patient-days or patient discharges. Median AU rates were compared from the pre-pandemic (March 2018–February 2020) and pandemic periods (March 2020–February 2021) using quantile regression to assess for statistical significance. Changes in AU during the COVID-19 pandemic were analyzed using interrupted time series analysis.
Results:
Significant increases were noted in the median AU rate from the pre-pandemic to pandemic period of all antibiotics combined in 3/6 hospitals (percentage change, Δ, 12.5%–63.6%) and anti-pseudomonal antibiotics in 3/6 hospitals (Δ 51.5%–161.5%). In the interrupted time series analysis, an immediate increase (range: 125.40–1762) in the use of all included antibiotics combined was observed in 3/6 hospitals at the onset of the COVID-19 pandemic. One of these 3 hospitals experienced a statistically significant sustained increase, while another experienced a decrease over time.
Conclusions:
We observed significant increases in facility-wide inpatient AU during the COVID-19 pandemic in our participating hospitals in Indonesia and the Philippines. These findings reinforce the importance of antibiotic stewardship practices to optimize AU, especially during infectious disease pandemics.
The CEOs of Britain's largest companies wield immense power, but we know very little about them. How did they get to the top? Why do they have so much power? Are they really worth that exorbitant salary? Michael Aldous and John Turner provide the answers by telling the story of the British CEO over the past century. From gentleman amateurs to professional managers, entrepreneurs, frauds, and fat cats, they reveal the characters who have made it to the top of the corporate ladder, how they got there, and what their rise tells us about British society. They show how the quality of their leadership influences productivity, innovation, economic development and, ultimately, Britain's place in the world. More recently, issues have arisen regarding high CEO pay, poor performance, and a lack of professionalisation and diversity. Are there lessons from history for those who would seek to reform Britain's flagging corporate economy?
Viscount Victor Spencer was representative of the British social elites deeply entrenched in business at the beginning of the twentieth century. He was amongst the 41 per cent of CEOs who were peers of the realm. Like most of these peers, he did not have a background in the business world or industry. This chapter details why these aristocratic amateurs initially dominated corporate leadership roles but rapidly declined in number as social and political changes reduced the importance of the aristocracy and the economic environment was transformed by the technological and business innovations of the second industrial revolution. They were replaced by professional managers like Thomas Sutherland of the shipping company P&O, founder CEOs such as Thomas Lipton, and family CEOs such as Archibald Coats of the textile business J & P Coats. These CEOs developed extensive business experience as insiders within their companies, which allowed them to innovate the strategy and structure of their companies. Despite their decline, the gentleman amateurs performed no worse than these players.
Across the twentieth century, CEOs became more powerful, and their decisions had a sizeable effect on their company’s performance and the British economy. Some CEOs harnessed technological and organisational innovations which allowed companies to grow and become more efficient, resulting in improvements in national productivity. In contrast, the insularity and lack of dynamism of some CEOs played a significant role in Britain’s economic stagnation. History shows that who gets to the top matters. Based on this, the chapter goes on to argue that those involved in selecting and preparing CEOs need to develop pathways to the top that identify individuals with interpersonal characteristics, values, and vision focused on the long-term stewardship of companies. They need to improve diversity to ensure that a range of cognitive abilities and insights get to the top. Across the century, various corporate governance mechanisms have been used to address the principal–agent problem at the heart of the corporation. The chapter closes by arguing that corporate governance needs to be strengthened through legislation to align CEOs to the long-term interests of company stakeholders.
By the 1970s, Britain’s economic malaise had become chronic. This chapter shows how a group of business outsiders sought to cure the malaise by unleashing market forces. These buccaneers, including Jim Slater, Jimmy Goldsmith, James Hanson, and Gordon White perfected the art of the hostile takeover to shake up poor-quality incumbent management. They believed they were liberating assets and improving the performance of management by focusing their attention on shareholder value. This resulted in high-profile and acrimonious takeover battles. Their critics named them corporate raiders, and incumbents such as Denys Henderson of ICI fought back through accusations of asset stripping and sweating. Although few tangible elements of the buccaneers’ empires survived their fall in the 1990s, they had a profound impact on business strategy, the role of the CEO, and the British economy. They empowered CEOs, their demands for improved corporate leadership were followed, and a growing number of CEOs were sacked for poor performance. Their business model influenced the growing financialisation of companies and Margaret Thatcher’s economic reforms.
Family and founder CEOs had their heyday in the interwar period. They faced a highly volatile economic and geopolitical environment. The chapter shows how they responded to these challenges. CEOs such as Alfred Mond led his family company to become the chemicals giant ICI, and William Lever founded and grew consumer goods company Lever Bros. Skin in the game and roots in social groups outside the mainstream of British society gave many of the families and founders a set of values and a deep commitment to grow their companies. Through investment and innovation, they achieved scale and scope. Their success took some to the heart of government, where they reshaped competition policy. The chapter then goes on to show that families and founders were particularly challenged by succession issues. John Ellerman, the most successful entrepreneur of the era, found his son had little interest in his business empire. The succession trap led to the collapse of many family companies. Others survived by handing power to professional managers such as D’Arcy Cooper, who transformed Lever Bros. Families and founders declined in importance, but through their stewardship corporate giants were built.
In the 1990s, privatisations, globalisation, and the ICT revolution opened up the British economy. This chapter examines how CEOs took advantage of these opportunities. Privatisation of national industries meant CEOs such as George Jefferson of BT now led some of Britain’s largest companies. Jefferson and his successors ensured their pay increased significantly. The average pay of CEOs rose rapidly, becoming a fixture of media debates, making the likes of Cedric Brown of British Gas a cause célébre. British CEOs finally underwent a managerial revolution in terms of education levels and training, but did increased pay correspond with improved corporate performance? In banking, pay rose for the likes of Fred Goodwin of RBS, and James Crosby and Andy Hornby of HBOS. But these CEOs all played leading roles in the collapse of their banks in 2008. The chapter shows how the Cadbury Report sought to rein in CEO excesses, but with limited effect. Governance problems were exacerbated as CEOs got younger and their tenures shorter, further incentivising short-term thinking. Women finally entered the role of CEO with Marjorie Scardino of Pearson and Cynthia Carroll at Anglo American.