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Motor neuron disease (MND) is a progressive, fatal, neurodegenerative condition that affects motor neurons in the brain and spinal cord, resulting in loss of the ability to move, speak, swallow and breathe. Acceptance and commitment therapy (ACT) is an acceptance-based behavioural therapy that may be particularly beneficial for people living with MND (plwMND). This qualitative study aimed to explore plwMND’s experiences of receiving adapted ACT, tailored to their specific needs, and therapists’ experiences of delivering it.
Method:
Semi-structured qualitative interviews were conducted with plwMND who had received up to eight 1:1 sessions of adapted ACT and therapists who had delivered it within an uncontrolled feasibility study. Interviews explored experiences of ACT and how it could be optimised for plwMND. Interviews were audio recorded, transcribed and analysed using framework analysis.
Results:
Participants were 14 plwMND and 11 therapists. Data were coded into four over-arching themes: (i) an appropriate tool to navigate the disease course; (ii) the value of therapy outweighing the challenges; (iii) relevance to the individual; and (iv) involving others. These themes highlighted that ACT was perceived to be acceptable by plwMND and therapists, and many participants reported or anticipated beneficial outcomes in the future, despite some therapeutic challenges. They also highlighted how individual factors can influence experiences of ACT, and the potential benefit of involving others in therapy.
Conclusions:
Qualitative data supported the acceptability of ACT for plwMND. Future research and clinical practice should address expectations and personal relevance of ACT to optimise its delivery to plwMND.
Key learning aims
(1) To understand the views of people living with motor neuron disease (plwMND) and therapists on acceptance and commitment therapy (ACT) for people living with this condition.
(2) To understand the facilitators of and barriers to ACT for plwMND.
(3) To learn whether ACT that has been tailored to meet the specific needs of plwMND needs to be further adapted to potentially increase its acceptability to this population.
In response to Timothy Darvill's article, ‘Mythical rings?’ (this issue), which argues for an alternative interpretation of Waun Mawn circle and its relationship with Stonehenge, Parker Pearson and colleagues report new evidence from the Welsh site and elaborate on aspects of their original argument. The discovery of a hearth at the centre of the circle, as well as further features around its circumference, reinforces the authors’ original interpretation. The authors explore the evidence for the construction sequence, which was abandoned before the completion of the monument. Contesting Darvill's argument that the Aubrey Holes at Stonehenge originally held posts, the authors reassert their interpretation of this circle of cut features as Bluestone settings.
Many male prisoners have significant mental health problems, including anxiety and depression. High proportions struggle with homelessness and substance misuse.
Aims
This study aims to evaluate whether the Engager intervention improves mental health outcomes following release.
Method
The design is a parallel randomised superiority trial that was conducted in the North West and South West of England (ISRCTN11707331). Men serving a prison sentence of 2 years or less were individually allocated 1:1 to either the intervention (Engager plus usual care) or usual care alone. Engager included psychological and practical support in prison, on release and for 3–5 months in the community. The primary outcome was the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), 6 months after release. Primary analysis compared groups based on intention-to-treat (ITT).
Results
In total, 280 men were randomised out of the 396 who were potentially eligible and agreed to participate; 105 did not meet the mental health inclusion criteria. There was no mean difference in the ITT complete case analysis between groups (92 in each arm) for change in the CORE-OM score (1.1, 95% CI –1.1 to 3.2, P = 0.325) or secondary analyses. There were no consistent clinically significant between-group differences for secondary outcomes. Full delivery was not achieved, with 77% (108/140) receiving community-based contact.
Conclusions
Engager is the first trial of a collaborative care intervention adapted for prison leavers. The intervention was not shown to be effective using standard outcome measures. Further testing of different support strategies for prison with mental health problems is needed.
This article builds on Richards’s work to formulate an understanding of the emerging practice of performance-installation, which embraces sound art, DIY electronic music and maker culture. A number of key points are addressed in this formulation: making/unmaking and ‘public making’; the assembling/disassembling of sonic devices and artefacts in the performance space; sound ‘through’ materials and materials at hand; and site and architectural features as material. In addition, readymade actions, illustrated by George Brecht’s The Cabinet, and the relationship between audience and performer are also presented. The article continues by outlining practice undertaken by the authors comprising two UK tours: ‘Sacrificial Floors’, 2018 with Tetsuya Umeda; and ‘Points of Failure’, 2020. Derek Bailey’s idea of ‘instrumental impulse’ is extended to include the concepts of expanded and reduced instruments that encompass ‘instrument as object’ and ‘raw material as instrument’. ‘Instrument’ is also viewed as a distributed mesh-like structure in which collective improvisation may occur. Borrowing from Ingold, ‘wayfaring’ is used to describe improvising with materials found ‘along the way’. Silent actions, uncontrollable instruments, unstable systems, performative failures, reimagined affordance of objects, ‘playing with resource’ and ‘improvising inside electronics’ are all addressed in relation to performance-installation. Finally, the authors explore the idea of ‘virtuosity in listening’, and question sonic autonomy and self-expression in improvisation and how ‘attending to sound’ can be an active part of improvised performance.
Under stress, corals and foraminifera may eject or consume their algal symbionts (“bleach”), which can increase mortality. How bleaching relates to species viability over warming events is of great interest given current global warming. We use size-specific isotope analyses and abundance counts to examine photosymbiosis and population dynamics of planktonic foraminifera across the Paleocene–Eocene thermal maximum (PETM, ~56 Ma), the most severe Cenozoic global warming event. We find variable responses of photosymbiotic associations across localities and species. In the NE Atlantic (DSDP Site 401) PETM, photosymbiotic clades (acarininids and morozovellids) exhibit collapsed size-δ13C gradients indicative of reduced photosymbiosis, as also observed in Central Pacific (ODP Site 1209) and Southern Ocean (ODP Site 690) acarininids. In contrast, we find no significant loss of size-δ13C gradients on the New Jersey shelf (Millville) or in Central Pacific morozovellids. Unlike modern bleaching-induced mass mortality, populations of photosymbiont-bearing planktonic foraminifera increased in relative abundance during the PETM. Multigenerational adaptive responses, including flexibility in photosymbiont associations and excursion taxon evolution, may have allowed some photosymbiotic foraminifera to thrive. We conclude that deconvolving the effects of biology on isotope composition on a site-by-site basis is vital for environmental reconstructions.
The discovery of a dismantled stone circle—close to Stonehenge's bluestone quarries in west Wales—raises the possibility that a 900-year-old legend about Stonehenge being built from an earlier stone circle contains a grain of truth. Radiocarbon and OSL dating of Waun Mawn indicate construction c. 3000 BC, shortly before the initial construction of Stonehenge. The identical diameters of Waun Mawn and the enclosing ditch of Stonehenge, and their orientations on the midsummer solstice sunrise, suggest that at least part of the Waun Mawn circle was brought from west Wales to Salisbury Plain. This interpretation complements recent isotope work that supports a hypothesis of migration of both people and animals from Wales to Stonehenge.
Recent work suggests that antihypertensive medications may be useful as repurposed treatments for mood disorders. Using large-scale linked healthcare data we investigated whether certain classes of antihypertensive, such as angiotensin antagonists (AAs) and calcium channel blockers, were associated with reduced risk of new-onset major depressive disorder (MDD) or bipolar disorder (BD).
Method
Two cohorts of patients treated with antihypertensives were identified from Scottish prescribing (2009–2016) and hospital admission (1981–2016) records. Eligibility for cohort membership was determined by a receipt of a minimum of four prescriptions for antihypertensives within a 12-month window. One treatment cohort (n = 538 730) included patients with no previous history of mood disorder, whereas the other (n = 262 278) included those who did. Both cohorts were matched by age, sex and area deprivation to untreated comparators. Associations between antihypertensive treatment and new-onset MDD or bipolar episodes were investigated using Cox regression.
Results
For patients without a history of mood disorder, antihypertensives were associated with increased risk of new-onset MDD. For AA monotherapy, the hazard ratio (HR) for new-onset MDD was 1.17 (95% CI 1.04–1.31). Beta blockers' association was stronger (HR 2.68; 95% CI 2.45–2.92), possibly indicating pre-existing anxiety. Some classes of antihypertensive were associated with protection against BD, particularly AAs (HR 0.46; 95% CI 0.30–0.70). For patients with a past history of mood disorders, all classes of antihypertensives were associated with increased risk of future episodes of MDD.
Conclusions
There was no evidence that antihypertensive medications prevented new episodes of MDD but AAs may represent a novel treatment avenue for BD.
Poor physical health in severe mental illness (SMI) remains a major issue for clinical practice.
Aims
To use electronic health records of routinely collected clinical data to determine levels of screening for cardiometabolic disease and adverse health outcomes in a large sample (n = 7718) of patients with SMI, predominantly schizophrenia and bipolar disorder.
Method
We linked data from the Glasgow Psychosis Clinical Information System (PsyCIS) to morbidity records, routine blood results and prescribing data.
Results
There was no record of routine blood monitoring during the preceding 2 years for 16.9% of the cohort. However, monitoring was poorer for male patients, younger patients aged 16–44, those with schizophrenia, and for tests of cholesterol, triglyceride and glycosylated haemoglobin. We estimated that 8.0% of participants had diabetes and that lipids levels, and use of lipid-lowering medication, was generally high.
Conclusions
Electronic record linkage identified poor health screening and adverse health outcomes in this vulnerable patient group. This approach can inform the design of future interventions and health policy.
Equitable access to mental healthcare is a priority for many countries. The National Health Service in England uses a weighted capitation formula to ensure that the geographical distribution of resources reflects need.
Aims
To produce a revised formula for estimating local need for secondary mental health, learning disability (intellectual disability) and psychological therapies services for adults in England.
Method
We used demographic records for 43 751 535 adults registered with a primary care practitioner in England linked with service use, ethnicity, physical health diagnoses and type of household, from multiple data-sets. Using linear regression, we estimated the individual cost of care in 2015 as a function of individual- and area-level need and supply variables in 2013 and 2014. We sterilised the effects of the supply variables to obtain individual-need estimates. We aggregated these by general practitioner practice, age and gender to derive weights for the national capitation formula.
Results
Higher costs were associated with: being 30–50 years old, compared with 20–24; being Irish, Black African, Black Caribbean or of mixed ethnicity, compared with White British; having been admitted for specific physical health conditions, including drug poisoning; living alone, in a care home or in a communal environment; and living in areas with a higher percentage of out-of-work benefit recipients and higher prevalence of severe mental illness. Longer distance from a provider was associated with lower cost.
Conclusions
The resulting needs weights were higher in more deprived areas and informed the distribution of some 12% (£9 bn in 2019/20) of the health budget allocated to local organisations for 2019/20 to 2023/24.
Geologists and archaeologists have long known that the bluestones of Stonehenge came from the Preseli Hills of west Wales, 230km away, but only recently have some of their exact geological sources been identified. Two of these quarries—Carn Goedog and Craig Rhos-y-felin—have now been excavated to reveal evidence of megalith quarrying around 3000 BC—the same period as the first stage of the construction of Stonehenge. The authors present evidence for the extraction of the stone pillars and consider how they were transported, including the possibility that they were erected in a temporary monument close to the quarries, before completing their journey to Stonehenge.
Accurate (< 10%) distances of Galactic star clusters allow a precise estimation of the physical parameters of any physically associated Planetary Nebula (PN) and also that of its central star (CSPN) and its progenitor. The progenitor’s mass can be related to the PN’s chemical characteristics and, furthermore, provides additional data for the widely used white dwarf (WD) initial-to-final mass relation (IFMR) that is crucial for tracing the development of both carbon and nitrogen in entire galaxies. To date, there is only one PN (PHR1315- 6555) confirmed to be physically associated with a Galactic open cluster (ESO 96 -SC04) that has a turn-off mass ∼2Mʘ. Our deep HST photometry was used for the search of the CSPN of this currently unique PN. In this work, we present our results.
Bede frequently used dating formulas to frame his narrative. In some cases these simply reflect the wording of his sources, whether he states that he is quoting from them or not. More often, however, the types of phrasing he uses reflect conscious construction on his part. Such formulas drew attention to key people and passages in the work and so assisted in the achievement of Bede's authorial intentions in the Historia ecclesiastica. These phrases also imitated and developed previous exemplars from earlier historiography thus enabling Bede to situate and validate his work within the genre.
Four new species of the Aleiodes apicalis (Brullé) species group (Hymenoptera: Braconidae: Rogadinae) from the Neotropical Region are described and illustrated: Aleiodes ambrosiaenew species. from Peru, A. aquilesinew species from Costa Rica, and A. sachambrosiaenew species and A. tapirapenew species from Brazil. We also add new distribution records for Aleiodes molestus Cresson, from Costa Rica. With the addition of the new species, the A. apicalis species group has 11 species from the New World, six of which are recorded from Neotropical Region.
Field experiments were conducted in 1986 and 1987 to evaluate the effect of herbicide incorporation to various depths on common cocklebur control with imazaquin, a tank mix of imazaquin and metribuzin, and a preformulated mixture of chlorimuron and metribuzin in soybeans. Herbicide rates included were two-thirds and the full registered rate. All treatments, except chlorimuron plus metribuzin (50 plus 320 g ai/ha, respectively), controlled more common cocklebur when incorporated to depths of 2.5 to 7.6 cm than when left unincorporated. Also, imazaquin at 90 g ai/ha and the tank mix of imazaquin plus metribuzin at 90 plus 280 g ai/ha, when incorporated, controlled more common cocklebur than higher rates of the same combination when not incorporated. Common cocklebur control was similar with 2.5-, 5.0-, and 7.6-cm soil incorporation depths.
Field experiments were conducted in 1986 and 1987 to evaluate the effect of herbicide rate (two-thirds and maximum labeled rate) and timing of application before soybean planting on common cocklebur control. In 1986, chlorimuron plus metribuzin at 50 plus 320 and 80 plus 480 g ai/ha and imazaquin at 90 g ai/ha applied at planting controlled common cocklebur better than when applied 4 weeks before planting (WBP). Imazaquin at 140 g/ha applied at planting controlled common cocklebur better than when applied 6 WBP. All treatments at two-thirds of the labeled rate applied at planting controlled common cocklebur comparable to the full labeled rate applied 2, 4, or 6 WBP. In 1987, all treatments applied 2 WBP controlled common cocklebur better than when applied 4, 6, or 8 WPB.
The European Innovation Partnership on Active and Healthy Ageing (EIP-AHA) was launched by the European Commission in 2011 to promote innovation in ageing research. This paper explores the experiences of partners delivering frailty interventions within Europe, registering their programmes with the EIP-AHA. Data were collected using an online survey from 21 partners in seven countries. A mixed-method approach was used with inductive thematic analysis of free-text responses to improve data richness. Responses indicated that there was a lack of consistency between EIP-AHA partners in methods of defining, screening and measuring for frailty and pre-frailty. Open responses to survey questions about intervention facilitators, moderators and barriers were coded into two themes: working with stakeholders and project management. We concluded that EIP-AHA partners are providing interventions addressing physical, cognitive and wellbeing elements of frailty. However, there needs to be an increase in the proportion of interventions that consistently apply valid methods of screening and/or measuring frailty and pre-frailty. Most, but not all projects are targeting pre-frail older adults, suggesting an appropriate balance of prevention in a useful ‘intervention window’ but also a growing understanding that frailty at later stages is amenable to intervention. Findings suggest design manipulations to improve outcomes and adherence to interventions, specifically inclusion of a perceived benefit/reward for older adults, e.g. a social aspect or health-care promotion.
Field studies were conducted at Delta Research and Extension Center, Stoneville, MS, in 1996, 1997, and 1998 to assess the effect of tillage systems (conventional tillage and subsoiling) on the environmental fate of imazaquin in a Sharkey clay soil. Imazaquin was applied preemergence at 140 g ai ha−1. Subsoiling in the fall did not affect imazaquin dissipation, total volume of runoff, imazaquin concentration in runoff, or imazaquin concentration in soil, as determined by chemical extraction. A corn root bioassay revealed no differences due to tillage systems in plant-available imazaquin in soil. Imazaquin concentration measured by chemical extraction or bioassay diminished over time, with a half-life ranging from 8 to 25 d. A field bioassay utilizing cotton and corn was conducted in 1997 and 1998 using plots that had received imazaquin the previous year. In 1997, 2 wk after planting, cotton and corn injury ranged from 3 to 15%, whereas no injury was observed in 1998. Injury symptoms declined over time, with no injury 5 wk after planting in either year. Although early-season cotton stunting and slight discoloration of corn was apparent in 1997, imazaquin residues did not affect subsequent vegetative and reproductive growing patterns of cotton or corn. In 1998, corn and cotton height were significantly greater in subsoiled plots compared to conventional tillage.
Field and laboratory studies were conducted at Stoneville, MS, from 1996 to 1998 to determine the influence of subsoiling (SS) and conventional tillage (CT) of a Sharkey clay soil on microbial characteristics and herbicide degradation. Soil samples obtained from imazaquin-treated and nontreated plots from the soybean row and interrow position were analyzed. Because only the row position is actually disturbed by SS, a comparison of row and interrow position on the parameter was conducted. Imazaquin (preemergence, 140 g ai ha−1) had no effect on microbial populations, microbial enzyme activity (fluorescein diacetate [FDA] hydrolysis and triphenyl-tetrazolium chloride [TTC] dehydrogenase), and organic carbon content. Estimates of microbial activity based on FDA hydrolysis and TTC dehydrogenase activity indicated greater activity under CT; however, microbial biomass and organic carbon were not affected by tillage or row position. A laboratory study assessed the degradation of carboxyl- and ring-labeled 2,4-D as influenced by tillage and row position. Soils from CT plots had an initially higher mineralization rate of 14C carboxyl-labeled 2,4-D compared to soils from SS plots; however, no effect of tillage or row position was observed on the cumulative amount of 14CO2 evolved 14 d after treatment (DAT) in 1996 and 18 DAT in 1998. In studies with ring-labeled 2,4-D, a higher 14CO2 evolution was detected in soils obtained from SS plots, regardless of row position, whereas a greater amount of radioactivity was observed in the unextractable fraction from CT soils. Because differences in 2,4-D mineralization between tillage regimes were minimal, adoption of SS as a tillage practice for heavy clay soils in the Mississippi Delta may have a limited effect on microbial characteristics and biodegradation of soil-applied herbicides.
The interaction of Stokes’ edge waves with a developing near-shore ice zone is examined from two points of view. First, the effect of a well-fragmented ice suspension on the classical Stokes’ edge wave is discussed. Secondly, the possibility that ice-cusp formation (and, thereafter, ice mounds or volcanoes) can be initiated by edge waves is examined. Results indicate a negligible effect of a well-fragmented floating ice field on the Stokes’ dispersion equation for typical wave periods, but do indicate that the presence of a standing Stokes’ edge wave may lead to the initiation of ice-field cusps as ice formation occurs in the near-shore zone.