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It remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.
Aims
To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.
Method
Randomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment–covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.
Results
IPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = −0.48 to −0.27). Effects could not be ascertained up to 24 months (s.m.d. = −0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27–2.79), reliable improvement (relative risk = 1.38–3.17), deterioration (relative risk = 0.67–0.54) and close-to-symptom-free status (relative risk = 1.41–2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (P > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = −0.33 for PHQ-9 = 5).
Conclusions
Psychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.
Developing integrated mental health services focused on the needs of children and young people is a key policy goal in England. The THRIVE Framework and its implementation programme, i-THRIVE, are widely used in England. This study examines experiences of staff using i-THRIVE, estimates its effectiveness, and assesses how local system working relationships influence programme success.
Methods
This evaluation uses a quasi-experimental design (10 implementation and 10 comparison sites.) Measurements included staff surveys and assessment of ‘THRIVE-like’ features of each site. Additional site-level characteristics were collected from health system reports. The effect of i-THRIVE was evaluated using a four-group propensity-score-weighted difference-in-differences model; the moderating effect of system working relationships was evaluated with a difference-in-difference-in-differences model.
Results
Implementation site staff were more likely to report using THRIVE and more knowledgeable of THRIVE principles than comparison site staff. The mean improvement of fidelity scores among i-THRIVE sites was 16.7, and 8.8 among comparison sites; the weighted model did not find a statistically significant difference. However, results show that strong working relationships in the local system significantly enhance the effectiveness of i-THRIVE. Sites with highly effective working relationships showed a notable improvement in ‘THRIVE-like’ features, with an average increase of 16.41 points (95% confidence interval: 1.69–31.13, P-value: 0.031) over comparison sites. Sites with ineffective working relationships did not benefit from i-THRIVE (−2.76, 95% confidence interval: − 18.25–12.73, P-value: 0.708).
Conclusions
The findings underscore the importance of working relationship effectiveness in the successful adoption and implementation of multi-agency health policies like i-THRIVE.
Environmental impacts of food systems have stimulated research to examine how to create healthy diets that will be more sustainable while meeting nutrient requirements. Increasing compliance with existing food-based dietary guidelines in most jurisdictions could be a first step to improve health and reduce environmental impact. MyPlanetDiet was an all-Ireland 12-week randomised controlled trial designed to inform sustainable healthy dietary guidelines. Healthy adults (n 355) aged 18–64 years with moderate-to-high greenhouse gas emitting (GHGE) diets were recruited from three study sites on the island of Ireland. The aim of this research is to assess the relationship between dietary intakes, diet-related environmental impacts and metabolic health using baseline data collected during the MyPlanetDiet study. Dietary assessments collected using Foodbook24 were used to calculate diet-related GHGE, adherence to healthy eating guidelines (HEG) and healthy eating index (HEI) score. Anthropometrics and metabolic health markers (e.g. lipids, glucose and insulin) were included. Overall HEG adherence was low, with 43 % meeting zero or one HEG food group recommendations. Adherence to 4 + HEG food group targets was associated with 31 % lower diet-related GHGE compared with those with lowest adherence. Higher HEG adherence was associated with lower BMI and waist circumference and higher HEI scores. While our findings suggest HEG adherence is associated with positive health and environmental impacts, substantial behaviour change will be needed to meet existing HEG. Further research is needed to assess response and acceptability to HEG. However, adherence to HEG may be an important first step to reducing the environmental impact of food consumption.
We use experimental methods to evaluate a simplified interbank market. The design is a laboratory adaptation of the analysis of interbank market fragility by Allen and Gale (J Eur Econ Assoc 2:1015–1048), and features symmetric banks who allocate deposit endowments between cash and illiquid assets prior to the incidence of a shock. Following the shock liquidity-deficient banks trade assets for cash. Treatments include variations in the shock type, as well as alterations in the range of permissible asset prices. Consistent with Allen and Gale, we find that while interbank trading substantially increases investment activity, the markets are frequently characterized by price variability and a stochastic distribution of investment outcomes.
What do we in the West owe those who grow our food, sew our clothes and produce our electronics? And what have we always owed one another, but forgotten, avoided, or simply disregarded?
Looking back on nearly a century of colonial war and genocide, in 1990 the poet and philosopher Édouard Glissant appealed directly to his readers, calling them to re-orient their lives in service of the political struggles of their time: 'You must choose your bearing'.
Informed by the prayer camps at Standing Rock, and presenting Glissant alongside Stuart Hall, Emmanuel Levinas, Simone Weil, Enrique Dussel, Gloria Anzaldúa and W. E. B. Du Bois, this book offers an urgent ethics for the present - an ethics of risk, commitment and care that together form a new sense of decolonial responsibility.
In Sri Lanka all public signs are required by law to be in Sinhala, Tamil, and English. This article investigates the multiple, clashing ways that Sri Lankan Tamil speakers (Tamils and Muslims) living in-country and abroad interpret Tamil signage blunders in relation to the position of ethnic minorities in the postwar nation. I incorporate ethnographic interviews to examine how three Tamil speakers made sense of a signboard, displayed in several government buses in Colombo, in which the Tamil portion read “reserved for pregnant dogs” instead of “reserved for pregnant mothers.” I situate their responses in an account of the circulation of Tamil signage errors on Facebook. I argue that Tamil speakers’ disparate interpretations reflect contrasting semiotic ideologies concerning the intentionality of the blunders and the relationship between the posted signboard images and lived sociolinguistic practices (Keane 2003, 2018), which have implications for imagined postwar futures and transnational Tamil political activism.
This essay introduces a collection of six articles that analyze the political economy of language and script in relation to the emergence and contestation of identities and publics in contemporary India, Sri Lanka, Nepal, Bangladesh, and South Asian diasporas. Social media and the virtual forums that they enable have inspired new representational practices and discursive possibilities that are in dialogue with older ways of ordering difference. Rather than making a hard-and-fast distinction between new and old media, this issue draws on the rich visual tapestries of South Asia to examine implicit and explicit debates over codes, scripts, and sign language systems in relation to different forms of print and digital media, from street signs to social media posts. We demonstrate the centrality of visual semiotic systems in processes of political, economic, and sociocultural change in contemporary South Asia.
“Improper linear models” (see Dawes, Am. Psychol. 34:571–582, 1979), such as equal weighting, have garnered interest as alternatives to standard regression models. We analyze the general circumstances under which these models perform well by recasting a class of “improper” linear models as “proper” statistical models with a single predictor. We derive the upper bound on the mean squared error of this estimator and demonstrate that it has less variance than ordinary least squares estimates. We examine common choices of the weighting vector used in the literature, e.g., single variable heuristics and equal weighting, and illustrate their performance in various test cases.
The adipofascial anterolateral thigh (AF-ALT) free flap represents a versatile technique in head and neck reconstructions, with its applications increasingly broadening. The objective was to detail the novel utilization of the AF-ALT flap in orbital and skull base reconstruction, along with salvage laryngectomy onlay in our case series.
Method
We conducted a retrospective analysis at Roswell Park Comprehensive Cancer Center, spanning from July 2019 to June 2023, focusing on patient demographics and reconstructive parameters data.
Results
The AF-ALT flap was successfully employed in eight patients (average age 59, body mass index [BMI] 32.0) to repair various defects. Noteworthy outcomes were observed in skull base reconstructions, with no flap failures or major complications over an average 12-month follow-up. Donor sites typically healed well with minimal interventions.
Conclusion
Our series is the first to report the AF-ALT flap's efficacy in anterior skull base and orbital reconstructions, demonstrating an additional innovation in complex head and neck surgeries.
To investigate functional outcomes in children who survived extracorporeal life support at 12 months follow-up post-discharge.
Background:
Some patients who require extracorporeal life support acquire significant morbidity during their hospitalisation. The Functional Status Scale is a validated tool that allows quantification of paediatric function.
Methods:
A retrospective study that included children placed on extracorporeal life support at a quaternary children’s hospital between March 2020 and October 2021 and had follow-up encounter within 12 months post-discharge.
Results:
Forty-two patients met inclusion criteria: 33% female, 93% veno-arterial extracorporeal membrane oxygenation (VA ECMO), and 12% with single ventricle anatomy. Median age was 1.7 years (interquartile range 10 days–11.9 years). Median hospital stay was 51 days (interquartile range 34–91 days), and median extracorporeal life support duration was 94 hours (interquartile range 56–142 hours). The median Functional Status Scale at discharge was 8.0 (interquartile range 6.3–8.8). The mean change in Functional Status Scale from discharge to follow-up at 9 months (n = 37) was −0.8 [95% confidence interval (CI) −1.3 to −0.4, p < 0.001] and at 12 months (n = 34) was −1 (95% confidence interval −1.5 to −0.4, p < 0.001); the most improvement was in the feeding score. New morbidity (Functional Status Scale increase of ≥3) occurred in 10 children (24%) from admission to discharge. Children with new morbidity were more likely to be younger (p = 0.01), have an underlying genetic syndrome (p = 0.02), and demonstrate evidence of neurologic injury by electroencephalogram or imaging (p = 0.05).
Conclusions:
In survivors of extracorporeal life support, the Functional Status Scale improved from discharge to 12-month follow-up, with the most improvement demonstrated in the feeding score.
Mixing describes the process by which solutes evolve from an initial heterogeneous state to uniformity under the stirring action of a fluid flow. Fluid stretching forms thin scalar lamellae that coalesce due to molecular diffusion. Owing to the linearity of the advection–diffusion equation, coalescence can be envisioned as an aggregation process. Here, we demonstrate that in smooth two-dimensional chaotic flows, mixing obeys a correlated aggregation process, where the spatial distribution of the number of lamellae in aggregates is highly correlated with their elongation, and is set by the fractal properties of the advected material lines. We show that the presence of correlations makes mixing less efficient than a completely random aggregation process because lamellae with similar elongations and scalar levels tend to remain isolated from each other. We show that correlated aggregation is uniquely determined by a single exponent that quantifies the effective number of random aggregation events. These findings expand aggregation theories to a larger class of systems, which have relevance to various fundamental and applied mixing problems.
Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent psychiatric condition that frequently originates in early development and is associated with a variety of functional impairments. Despite a large functional neuroimaging literature on ADHD, our understanding of the neural basis of this disorder remains limited, and existing primary studies on the topic include somewhat divergent results.
Objectives
The present meta-analysis aims to advance our understanding of the neural basis of ADHD by identifying the most statistically robust patterns of abnormal neural activation throughout the whole-brain in individuals diagnosed with ADHD compared to age-matched healthy controls.
Methods
We conducted a meta-analysis of task-based functional magnetic resonance imaging (fMRI) activation studies of ADHD. This included, according to PRISMA guidelines, a comprehensive PubMed search and predetermined inclusion criteria as well as two independent coding teams who evaluated studies and included all task-based, whole-brain, fMRI activation studies that compared participants diagnosed with ADHD to age-matched healthy controls. We then performed multilevel kernel density analysis (MKDA) a well-established, whole-brain, voxelwise approach that quantitatively combines existing primary fMRI studies, with ensemble thresholding (p<0.05-0.0001) and multiple comparisons correction.
Results
Participants diagnosed with ADHD (N=1,550), relative to age-matched healthy controls (N=1,340), exhibited statistically significant (p<0.05-0.0001; FWE-corrected) patterns of abnormal activation in multiple brains of the cerebral cortex and basal ganglia across a variety of cognitive control tasks.
Conclusions
This study advances our understanding of the neural basis of ADHD and may aid in the development of new brain-based clinical interventions as well as diagnostic tools and treatment matching protocols for patients with ADHD. Future studies should also investigate the similarities and differences in neural signatures between ADHD and other highly comorbid psychiatric disorders.
Populations of Pasteuria penetrans isolated from root-knot nematodes (Meloidogyne spp.) and cyst nematodes (Heterodera spp.) were tested for their ability to adhere to a limited selection of sheathed and exsheathed animal parasitic nematodes, free living nematodes, including Caenorhabditis elegans wild type and several srf mutants, and plant parasitic nematodes. The attachment of spores of Pasteuria was restricted and no spores were observed adhering to any of the animal parasitic nematodes either with or without their sheath or to any of the free living nematodes including C. elegans and the srf mutants. All spore attachment was restricted to plant parasitic nematodes; however, spores isolated from cyst nematodes showed the ability to adhere to other genera of plant parasitic nematodes which was not the case with spores isolated from root-knot nematodes. The results are discussed in relationship to cuticular heterogeneity.
Despite the Supreme Court’s lack of direct electoral accountability, voters may factor its outputs into their voting decisions because elected representatives can affect the Court’s powers and composition. In this paper, we uncover an ironic predicament that faces candidates running on reforming this institution. Citizens who possess higher levels of diffuse support for the Court are more likely to rank it as an important factor in their voting logic. But because this diffuse support has sorted along partisan lines, candidate messaging about reform may not motivate partisans who have lost support for the Court because they view it as less important than other pressing issues. Thus, although Democrats are sympathetic to reform, Democratic candidates may have weak incentives to promote reform given low levels of diffuse support among their constituents. This dynamic mitigates against the possibility of a public or congressional backlash against the Court, preserving the status quo.
While sociologists have focused on the national adoption of public-sphere women’s rights such as the right to vote in elections or participate fully in economic matters, less work has examined the diffusion of private-sphere women’s rights, rights of women in the home. We address this gap by examining the cross-national adoption of laws that criminalize marital rape. Building on prior research that finds that women’s rights organizations and women’s rights focused treaties, we explore the cross-national determinants of the criminalization of marital rape. Using an event history analysis covering 131 countries from 1979 to 2013, we find support for the global institutionalist framework that contends that socialization into the global system and direct advocacy efforts of global organizations contribute to faster rates of criminalization of marital rape. Further, we suggest that these global institutionalist processes become amplified when they are focused by events that set the agenda for international organizations. Implications for world-society scholarship on the global adoption of women’s rights are further discussed.