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Early intervention in psychosis (EIP) services improve outcomes for young people, but approximately 30% disengage.
Aims
To test whether a new motivational engagement intervention would prolong engagement and whether it was cost-effective.
Method
We conducted a multicentre, single-blind, parallel-group, cluster randomised controlled trial involving 20 EIP teams at five UK National Health Service (NHS) sites. Teams were randomised using permuted blocks stratified by NHS trust. Participants were all young people (aged 14–35 years) presenting with a first episode of psychosis between May 2019 and July 2020 (N = 1027). We compared the novel Early Youth Engagement (EYE-2) intervention plus standardised EIP (sEIP) with sEIP alone. The primary outcome was time to disengagement over 12–26 months. Economic outcomes were mental health costs, societal costs and socio-occupational outcomes over 12 months. Assessors were masked to treatment allocation for primary disengagement and cost-effectiveness outcomes. Analysis followed intention-to-treat principles. The trial was registered at ISRCTN51629746.
Results
Disengagement was low at 15.9% overall in standardised stand-alone services. The adjusted hazard ratio for EYE-2 + sEIP (n = 652) versus sEIP alone (n = 375) was 1.07 (95% CI 0.76–1.49; P = 0.713). The health economic evaluation indicated lower mental healthcare costs linked to reductions in unplanned mental healthcare with no compromise of clinical outcomes, as well as some evidence for lower societal costs and more days in education, training, employment and stable accommodation in the EYE-2 group.
Conclusions
We found no evidence that EYE-2 increased time to disengagement, but there was some evidence for its cost-effectiveness. This is the largest study to date reporting positive engagement, health and cost outcomes in a total EIP population sample. Limitations included high loss to follow-up for secondary outcomes and low completion of societal and socio-occupational data. COVID-19 affected fidelity and implementation. Future engagement research should target engagement to those in greatest need, including in-patients and those with socio-occupational goals.
A range of decision-makers, including policy-makers, NGOs and local communities, have a stake in developing conservation interventions that are to be implemented on the ground. In order to ensure that decision-making is evidence-informed, the science community needs to engage these communities of policy and practice effectively. This chapter brings together work which explores how scientists can work effectively with decision-makers, using global case studies from South America, Australia, New Zealand and elsewhere to identify what works. It identifies 10 key tips for successful engagement : (1) know who you need to talk to, (2) engage early, (3) make it easy to engage, (4) include multiple knowledges, perspectives and worldviews, (5) think hard about power, (6) build trust, (7) good facilitation is key, (8) learn new engagement skills, (9) make use of existing spaces of collaboration, and (10) don't give up. While executing these tips will not guarantee successful engagement in every case, it will improve the chances for mutually beneficial relationships and hence better conservation outcomes.
Grey seals (Halichoerus grypus) of the North-east Atlantic are protected at designated European Marine Sites (Special Areas of Conservation, SACs) typically during their reproductive periods and in the UK at Sites of Special Scientific Interest (SSSI). As a mobile marine species, grey seals spend other parts of their annual life cycle in non-designated habitat. There is limited information on individual grey seal movements in south-west England. Citizen science photo identification (PID) revealed the movements of 477 grey seals at a regional scale (54 haul-outs up to 230 km apart) for over a decade. Reconstructed movements showed considerable individual variability. Four SACs were linked to up to 18 non-designated sites and two SSSIs in Cornwall were linked to a maximum of 41 non-designated sites. Observations support the value of existing SSSIs at both the well-connected West and North Cornwall sites. Thirteen Marine Protected Areas (MPAs) were visited by grey seals from four SACs and two SSSIs in Cornwall. As a mobile species, grey seals could be included in English MPA management plans. The application of functional linkage from SACs and SSSIs, informed by the movements evidenced in this research, could aid management efforts. This analysis reveals grey seal movements occur across a complex network of interconnected designated and non-designated sites that need to be managed holistically for this species for which the UK has a special responsibility.
Foreground contamination is one of the most important limiting factors in detecting the neutral hydrogen in the epoch of reionisation. These foregrounds can be roughly split into galactic and extragalactic foregrounds. In these proceedings we highlight information that can be gleaned from multi-wavelength extragalactic surveys in order to overcome this issue. We discuss how clustering information from the lower-redshift, foreground galaxies, can be used as additional information in accounting for the noise associated with the foregrounds. We then go on to highlight the expected contribution of future optical and near-infrared surveys for detecting the galaxies responsible for ionising the Universe. We suggest that these galaxies can also be used to reduce the systematics in the 21-cm epoch of reionisation signal through cross-correlations if enough common area is surveyed.
To characterize red eye reactions occurring within 24 hours after receipt of units of leukocyte-reduced red blood cells, determine their etiology, and investigate their potential link to transfusion.
Methods.
We conducted a survey of transfusion facilities nationwide to determine the scope and magnitude of the reactions; performed case-control and cohort studies among transfused patients at the facility where most reactions occurred; and performed animal experiments, using cellulose acetate derivatives extracted from leukocyte-reduction filters and filter precursors, to reproduce reactions.
Results.
From January 1, 1997, through January 15, 1998, we identified 159 reactions in 117 patients from 17 states. Reactions were characterized by conjunctival erythema or hemorrhage (in 100% of patients), eye pain (in 62%), photophobia (in 46%), and decreased visual acuity (in 32%). Symptom onset occurred 1-24 hours after initiation of transfusion and resolved within a median of 5 days. Reactions were associated with transfusion sessions that included units of red blood cells filtered with a specific brand of filter, the LeukoNet filter (HemaSure) (odds ratio, 100.4; P< .001). There was a dose-response relationship between the number of LeukoNet-filtered units transfused and the attack rate for reactions, ranging from 0.8% among sessions in which 1 unit was transfused to 27.3% among sessions in which 3 or more units were transfused (P< .001). A similar ocular syndrome was elicited in rabbits injected with cellulose acetate derivatives extracted from unused LeukoNet filters or filter precursors. No reactions were reported after LeukoNet filters were withdrawn from the market.
Conclusions.
This transfusion-associated red eye syndrome was linked to a specific brand of leukocyte-reduction filter and likely resulted from cellulose acetate derivatives leached from the filter membrane.
Lichen-dominated cryptoendolithic communities from the Dry Valleys of Antarctica have been the subject of much research over recent years owing to their potential as analogues of Martian life forms. Their ability to mobilize iron compounds and organize themselves into distinct coloured biotic zones suggests that they may alter the chemistry of their host rock. By conducting a major, minor and trace element study utilizing inductively coupled plasma atomic emission spectroscopy (ICP-AES) and mass spectrometry (ICP-MS) techniques, we have been investigating the relationship between the microbes and the chemistry of the sandstones. Different layers within a suite of sandstones collected from six localities in the Dry Valleys have been analysed to establish if or how the microbes influence or directly affect the chemical composition of the rocks. Background petrographic studies have shown significant differences in mineralogical maturity between rocks colonized by the communities and those that are not, and the chemistry results have shown significant elemental disparity between colonized and uncolonized rocks. By obtaining accurate percentages of the minerals present in each sample the differences in elemental concentrations could be construed to be caused by the differences in mineralogy between samples. The nature and extent of the concentration differences has led to the conclusion that either the cryptoendolith communities are able to alter their host rock by the solubilization and mobilization of elements that are then subsequently removed or that the organisms are simple opportunists that can only successfully colonize rocks that provide the ideal substrate, being mineralogically mature with ample pore space and less concentrated in the elements tested for.
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