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Trends in detention under the Mental Health Act 1983 in two major London secondary mental healthcare providers were explored using patient-level data in a historical cohort study between 2007–2008 and 2016–2017. An increase in the number of detention episodes initiated per fiscal year was observed at both sites. The rise was accompanied by an increase in the number of active patients; the proportion of active patients detained per year remained relatively stable. Findings suggest that the rise in the number of detentions reflects the rise of the number of people receiving secondary mental healthcare.
Common mental health problems affect a quarter of the population. Online cognitive–behavioural therapy (CBT) is increasingly used, but the factors modulating response to this treatment modality remain unclear.
This study aims to explore the demographic and clinical predictors of response to one-to-one CBT delivered via the internet.
Real-world clinical outcomes data were collected from 2211 NHS England patients completing a course of CBT delivered by a trained clinician via the internet. Logistic regression analyses were performed using patient and service variables to identify significant predictors of response to treatment.
Multiple patient variables were significantly associated with positive response to treatment including older age, absence of long-term physical comorbidities and lower symptom severity at start of treatment. Service variables associated with positive response to treatment included shorter waiting times for initial assessment and longer treatment durations in terms of the number of sessions.
Knowledge of which patient and service variables are associated with good clinical outcomes can be used to develop personalised treatment programmes, as part of a quality improvement cycle aiming to drive up standards in mental healthcare. This study exemplifies translational research put into practice and deployed at scale in the National Health Service, demonstrating the value of technology-enabled treatment delivery not only in facilitating access to care, but in enabling accelerated data capture for clinical research purposes.
A.C., S.B., V.T., K.I., S.F., A.R., A.H. and A.D.B. are employees or board members of the sponsor. S.R.C. consults for Cambridge Cognition and Shire. Keywords: Anxiety disorders; cognitive behavioural therapies; depressive disorders; individual psychotherapy
Serious mental illness (SMI, including schizophrenia, schizoaffective disorder, and bipolar disorder) is associated with worse general health. However, admissions to general hospitals have received little investigation. We sought to delineate frequencies of and causes for non-psychiatric hospital admissions in SMI and compare with the general population in the same area.
Records of 18 380 individuals with SMI aged ⩾20 years in southeast London were linked to hospitalisation data. Age- and gender-standardised admission ratios (SARs) were calculated by primary discharge diagnoses in the 10th edition of the World Health Organization International Classification of Diseases (ICD-10) codes, referencing geographic catchment data.
Commonest discharge diagnosis categories in the SMI cohort were urinary conditions, digestive conditions, unclassified symptoms, neoplasms, and respiratory conditions. SARs were raised for most major categories, except neoplasms for a significantly lower risk. Hospitalisation risks were specifically higher for poisoning and external causes, injury, endocrine/metabolic conditions, haematological, neurological, dermatological, infectious and non-specific (‘Z-code’) causes. The five commonest specific ICD-10 diagnoses at discharge were ‘chronic renal failure’ (N18), a non-specific code (Z04), ‘dental caries’ (K02), ‘other disorders of the urinary system’ (N39), and ‘pain in throat and chest’ (R07), all of which were higher than expected (SARs ranging 1.57–6.66).
A range of reasons for non-psychiatric hospitalisation in SMI is apparent, with self-harm, self-neglect and/or reduced healthcare access, and medically unexplained symptoms as potential underlying explanations.
We studied neuroinflammation in individuals with late-life, depression, as a risk factor for dementia, using [11C]PK11195 positron emission tomography (PET). Five older participants with major depression and 13 controls underwent PET and multimodal 3T magnetic resonance imaging (MRI), with blood taken to measure C-reactive protein (CRP). We found significantly higher CRP levels in those with late-life depression and raised [11C]PK11195 binding compared with controls in brain regions associated with depression, including subgenual anterior cingulate cortex, and significant hippocampal subfield atrophy in cornu ammonis 1 and subiculum. Our findings suggest neuroinflammation requires further investigation in late-life depression, both as a possible aetiological factor and a potential therapeutic target.
Annual ryegrass has been proposed as a cover crop in the corn–soybean cropping systems of the U.S. Midwest because of its low seed cost, rapid establishment, contribution to soil quality, weed suppressive abilities, and susceptibility to common broad-spectrum herbicides. However, cover crops can reduce the subsequent main crop yield by creating unfavorable germination and emergence conditions, harboring pests, and if not controlled, competing with the main crop. This study, conducted in Illinois, Oregon, and Tennessee, investigated the efficacy of glyphosate for annual ryegrass winter cover crop removal. Glyphosate at 415, 830, and 1,660 g ae/ha was applied to annual ryegrass at late tiller, second node, boot, and early flowering stages. Annual ryegrass control was consistently maximized with the highest glyphosate rate applied at the boot or early flower stage. Annual ryegrass biomass was generally the lowest with the highest rate of glyphosate applied at the earlier stages. Overall, no single application timing at any glyphosate rate provided complete control or biomass reduction of the annual ryegrass cover crop. A sequential herbicide program or a glyphosate plus a graminicide tank-mix probably will be needed for adequate annual ryegrass stand removal.
ABSTRACT
Mountains produce local changes in climate through their control of vegetation and precipitation, but they may also have significant effects on hemispheric climate by setting up long-period waves in the atmosphere and preventing the simple zonal circulation that would sharply limit latitudinal heat transport through the atmosphere. As such, accurate estimates of paleotopography are an important boundary condition in global climate models of past warm periods. Detailed reconstruction of mountain belts, particularly their average elevation and aerial extent, is needed to address issues of high latitude warmth during the last ‘hyperthermal’ in the early Eocene. A variety of techniques based on sedimentology, structural geology, basalt vesicularity, stable isotopes, and paleotemperature estimates from fossil plant assemblages have been devised to reconstruct the elevations of ancient mountain systems. We present a new paleoaltimeter to estimate the difference in relative elevation between intermontane basins and the high elevations of ranges near the tree line. Application of this paleoaltimeter to the Eocene Green River Formation supports recent evidence that the Laramide mountains of the western United States were as high as or higher than the modern Rocky Mountains and suggests that many recent global climate simulations have prescribed elevations that are substantially too low.
INTRODUCTION
The early Eocene was perhaps the warmest period in the past 100 million years. Floral and faunal data suggest that warm conditions extended to much higher latitudes than today both in the oceans and on the continents.
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