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We describe an ultra-wide-bandwidth, low-frequency receiver recently installed on the Parkes radio telescope. The receiver system provides continuous frequency coverage from 704 to 4032 MHz. For much of the band (
), the system temperature is approximately 22 K and the receiver system remains in a linear regime even in the presence of strong mobile phone transmissions. We discuss the scientific and technical aspects of the new receiver, including its astronomical objectives, as well as the feed, receiver, digitiser, and signal processor design. We describe the pipeline routines that form the archive-ready data products and how those data files can be accessed from the archives. The system performance is quantified, including the system noise and linearity, beam shape, antenna efficiency, polarisation calibration, and timing stability.
Depression is considered to have the highest disability burden of all conditions. Although treatment-resistant depression (TRD) is a key contributor to that burden, there is little understanding of the best treatment approaches for it and specifically the effectiveness of available augmentation approaches.
We conducted a systematic review and meta-analysis to search and quantify the evidence of psychological and pharmacological augmentation interventions for TRD.
Participants with TRD (defined as insufficient response to at least two antidepressants) were randomised to at least one augmentation treatment in the trial. Pre-post analysis assessed treatment effectiveness, providing an effect size (ES) independent of comparator interventions.
Of 28 trials, 3 investigated psychological treatments and 25 examined pharmacological interventions. Pre-post analyses demonstrated N-methyl-d-aspartate-targeting drugs to have the highest ES (ES = 1.48, 95% CI 1.25–1.71). Other than aripiprazole (four studies, ES = 1.33, 95% CI 1.23–1.44) and lithium (three studies, ES = 1.00, 95% CI 0.81–1.20), treatments were each investigated in less than three studies. Overall, pharmacological (ES = 1.19, 95% CI 1.08–1.30) and psychological (ES = 1.43, 95% CI 0.50–2.36) therapies yielded higher ESs than pill placebo (ES = 0.78, 95% CI 0.66–0.91) and psychological control (ES = 0.94, 95% CI 0.36–1.52).
Despite being used widely in clinical practice, the evidence for augmentation treatments in TRD is sparse. Although pre-post meta-analyses are limited by the absence of direct comparison, this work finds promising evidence across treatment modalities.
Declaration of interest
In the past 3 years, A.H.Y. received honoraria for speaking from AstraZeneca, Lundbeck, Eli Lilly and Sunovion; honoraria for consulting from Allergan, Livanova and Lundbeck, Sunovion and Janssen; and research grant support from Janssen. In the past 3 years, A.J.C. received honoraria for speaking from AstraZeneca and Lundbeck; honoraria for consulting with Allergan, Janssen, Livanova, Lundbeck and Sandoz; support for conference attendance from Janssen; and research grant support from Lundbeck. B.B. has recently been (soon to be) on the speakers/advisory board for Hexal, Lilly, Lundbeck, Mundipharma, Pfizer, and Servier. No other conflicts of interest.
The new regulatory measures to help protect the health of seamen developed in the 1860s have to be seen in the light of many centuries of concern, and occasionally action, to safeguard their health and fitness. The dangers of seafaring have been recorded since the dawn of history, as witnessed by biblical references and texts from the ancient world. Shipwreck and drowning predominated in early sources but the illness and injury risks to ‘they that go down to the sea in ships’ must have been known from an early date. Maritime law has similarly ancient roots. The Lex Rhodia, which covers topics such as the liability for loss if cargo is thrown overboard in a storm to reduce the risk of the ship foundering, dates from 800 BCE, although only fragments remain. By the early medieval period several codes of law made provision for illness among crewmembers. The ones that most directly affected English ships from this time onwards were the Rules of Oleron.
Oleron is an island off Bordeaux on the Atlantic coast of France. Around 1160 a set of laws were developed there that applied to ships trading in the region. Eleanor of Aquitaine, who was by turns queen of France and of England, is said to have had them modelled on a code used by the kingdom of Jerusalem, which she visited as consort to the King of France during the second crusade.
The reasons for the concerns about unseaworthy seamen in the 1860s were rather diffuse, but they appeared to have their origins in the adverse consequences of illness, drunkenness and debauchery on safety at sea. Some activists also linked the causes of this lack of seaworthiness to the quality of accommodation and food or the lack of medical examinations prior to embarkation. However, with the exception of scurvy as a consequence of adulterated or poor-quality lemon juice, none of these aspects gained sufficient public or political credibility for improvements to be required until much later.
By the end of the nineteenth century the fitness and capability of seafarers was being viewed in much clearer terms: the nature of their duties was being analysed or surmised and this information was being used to evaluate their risks of ‘unseaworthiness’. The personal attributes being reviewed included competence, based on training and experience, and inherent or acquired capabilities such as vision, hearing or physical fitness. The fundamentals of capability requirements had long been recognised; for instance the ability of seamen to climb masts and set sails and the need for this to be learnt early in life had been used as an example of age-related learning by the physician and philosopher Erasmus Darwin in the eighteenth century. But most of the earlier forms of assessment of skills and abilities were informal and occurred during apprenticeships and training on the job.
From the 1860s merchant seamen, and sometimes officers too, were commonly seen by shipowners and the state as a commodity to be purchased at market rates, with terms of service that were limited to a set period, usually three years in the deep-water trades. Prior to the 1850s, while seamen were still casually employed on merchant ships the state took the view that seafaring manpower should be maintained and developed as a national resource serving both naval and commercial requirements. The state intervened by requiring indentured apprentices to form part of the complement of merchant ships, on a scale dependent on the size of the vessel. In addition these apprenticeships at sea also provided a way for poor law guardians to move pauper youths off their books and into work that was no longer a charge on the poor rate. However, despite the separation of naval and merchant ship manning in the 1850s, whenever there was a war, merchant ships became part of the war effort and targets for enemy action. This was in addition to the creation of a Royal Naval Reserve based on those in the merchant service who could be called up in times of war.
The pattern of casual employment, and the attitudes of shipowners associated with it, often had a negative influence on the provision of a good diet, and decent working and living conditions, as well as on the arrangements for welfare, and for the prevention and treatment of illness and injury.
Prevention of illness and injury in seamen and the management of their illnesses and injuries had developed over the years such that in the early twentieth century it was the province of many different agencies, including several departments of government, individual shipowners, public health authorities and voluntary bodies. But by the 1920s there was an expectation of a co-ordinated and consistent approach and one apparently simple question had become dominant: who is responsible for the health of British seamen? It was a question that was in reality far from simple, and there were a lot of interest groups seeking to keep the issue unresolved or decently out of sight. One parliamentary exchange provides a contemporary insight:
On November 24th (1925) Mr B Smith asked the President of the Board of Trade whether he would arrange for an annual report to be issued regarding the health of merchant seamen, giving a scientific analysis of diseases in the statistics published in the return of shipping casualties to and deaths on vessels registered in the United Kingdom, giving information as to the total number of men serving amongst whom the deaths occurred; and in view of the apparent absence of medical advisers in the department, if he would consider whether the health of seamen was a responsibility which might with advantage be transferred to the Ministry of Health.[…]
Maritime disasters have long captured the public attention; by contrast, disease and injury in merchant seamen have been neglected. This is true both in the maritime industry and among historians. While neglect by British governments, shipowners and by the seamen themselves has been the norm, there have been times when it has been expedient to take action. This has only succeeded where there is a degree of consensus among the different parties in the industry, while the actions taken have been dependent on input from those with expertise in health risks and their management.
This episodic pattern of action has had an effect on the information available to anyone preparing a historical account. There are periods when concern about particular topics leads to a detailed archival record, but long spells when the record is limited or absent. In particular there are no long-term records of patterns of injury, illness or death of the sort available from public health and from military and naval medicine that would enable comparisons to be made between the health of seamen and other groups. Thus this book uses those times and events which are recorded as a series of vignettes from which to build up a picture of maritime health and its developments in the hundred years from 1860.
An anonymous article appeared in the British Medical Journal on 12 January 1867 titled ‘Report on the hygienic condition of the merchantile marine and on the preventable diseases of merchant seamen’. It was the first of four such articles and the tone was set by the first paragraph:
The unsatisfactory condition of that very important section of our community who man the merchant fleets of Great Britain, has now for some months occupied general as well as special attention, and has formed the subject of many leading articles in the principle daily journals. The scarcity of competent sailors, and the consequent rise in wages, threaten to injure seriously the vast commercial interests of this country; and the subject has lately roused to speaking action those who are financially interested in this question.
This summarises a debate that was raging at the time about what was wrong with merchant shipping, both in terms of its economics and its safety. Public concern had repeatedly been directed at the loss of life at sea and at the conditions suffered by seamen both when at sea and when in the sailortowns of the major ports. Activists, some motivated by concerns about the appalling record of shipwrecks and some about the conditions of labour and the lack of religious underpinning for moral and sober behaviour in the laboring classes, had been campaigning for most of the early part of the nineteenth century, and this had led to parliamentary inquiries, notably on loss of life at sea and on the conditions for emigrants aboard passenger ships.
As the hostilities of the Second World War were drawing to a close, a new conflict arose in a scientific journal that related to the frequency of illness in seamen as compared to other groups of workers. This was perhaps a reflection of the importance attached to this topic during the war, and also shows a move away from the earlier neglect of seamen's health by those in the maritime world to a new concern that any risks to their health might be exaggerated. Exaggeration would bring the dangers of public campaigns for reform – a threat to both government and shipowners – and this could in turn strengthen the hands of seafarers' organisations at a time when the nationalisation of industry and the benefits of a planned economy formed a large part of political debate.
An editorial published in the new British Journal of Industrial Medicine, a journal that was itself a product of the greater use of science to improve practice under wartime conditions, stated that the mortality rate of seamen from all causes of death was double that in the general population, while for tuberculosis it was four times higher. These figures were contested by several of the leading doctors working in the maritime industry, and this inaccuracy was discussed with Sir William Elderton, the deputy government actuary and a former statistical adviser to the Ministry of War Transport, who agreed that they were not supported by the evidence.
The maritime industry differs in many ways from onshore sectors of industry. It was the first truly global enterprise, crossing national boundaries as soon as nations were invented, and encircling the world for the last 500 years. It was the first industry to create and develop many of the methods for the financial management of business risks that are now in widespread use, for instance shared ownership of ships, with profits allocated in proportion to the share owned, and insurance for ships and cargoes as a risk-sharing device. The complex of trade, financial services, logistics and subject expertise that is now a feature of all developed economies originated in port cities. At an early stage the shipping industry gained experience of both the opportunities and abuses that can stem from every aspect of this business complex. Shipping was closely linked with the state throughout the era of European expansion around the world, which was marked, for much of the time, by a British domination of international maritime trade, with the force projected by a powerful navy ready to support it. Skilled crewmembers were seen as common to naval, merchant and fishing activities and in times of war were forcibly impressed for service with the Navy, while merchant ships were taken up from trade in many wars to meet the logistic requirements of the military.
The 1867 Merchant Shipping Act contained a range of provisions aimed at improving the health of seamen, but was only specific about one condition – scurvy. Here was a disease with a known remedy – lemon or other citrus juice – that, if used, was often adulterated and so not fit for purpose. What were the other health problems in seamen that this Act aimed to remedy? This is not easy information to find. It is difficult to relate the disease descriptions then used, especially by non-medical people such as ship captains and British consuls, to present-day terminology.
The most detailed records are those from hospitals treating seamen, notably the Dreadnought, but also others, for instance the British Hospital in Callau (or now more commonly Callao), Peru, which saw seafarers after arduous trans-Pacific and Cape Horn passages. There are a small number of studies based on ships' log-books and rather more covering passengers and especially emigrants, where the maintenance of a log and its presentation at the end of a voyage was a statutory requirement. Contemporary articles in medical journals can give information, while the Ship Captain's Medical Guide, although not a source of quantitative information, gives a perspective on how various diseases were viewed and categorised.
In reviewing such data many aspects must be considered in addition to the contemporary nomenclature of disease.
British seamen and their health have been the subject, or perhaps, given the lack of many identifiable seamen's voices, the object of the preceding chapters. This lack of seamen's voices is significant, as ill health is by its nature personal and those who claim to speak on behalf of seamen will usually be doing it to make a political point rather than fully expressing the hopes and concerns of the individuals directly affected. In parallel those representing business interests will seek to rationalise away any suggestion that cost-cutting is the main reason for any shortcomings in seafarer health provisions and will present them in terms of lack of proof of need, or their impracticability in the maritime environment. Historians writing from the perspectives of labour and social history have written little about merchant seamen and their health risks, but have identified the problems of stereotyping and of individual exploitation in other aspects of work at sea and for health risks in other sectors of employment. They have noted that these can result in the imposition of constraints on seafarers and workers in the supposed interests of safety or to reduce the liability of employers. Such constraints and stereotyping can be real and a significant cause of discrimination, but some of the trends in scholarship in this area also ignore the economic dimension and the long-used axiom that for the maritime sector: ‘Cargo is the mother of wages’.