Effective elements of cognitive behaviour therapy for psychosis: results of a novel type of subgroup analysis based on principal stratification

Background. Meta-analyses show that cognitive behaviour therapy for psychosis (CBT-P) improves distressing positive symptoms. However, it is a complex intervention involving a range of techniques. No previous study has assessed the delivery of the different elements of treatment and their effect on outcome. Our aim was to assess the differential effect of type of treatment delivered on the effectiveness of CBT-P, using novel statistical methodology. Method. The Psychological Prevention of Relapse in Psychosis (PRP) trial was a multi-centre randomized controlled trial (RCT) that compared CBT-P with treatment as usual (TAU). Therapy was manualized, and detailed evaluations of therapy delivery and client engagement were made. Follow-up assessments were made at 12 and 24 months. In a planned analysis, we applied principal stratification (involving structural equation modelling with finite mixtures) to estimate intention-to-treat (ITT) effects for subgroups of participants, defined by qualitative and quantitative differences in receipt of therapy, while maintaining the constraints of randomization. Results. Consistent delivery of full therapy, including specific cognitive and behavioural techniques, was associated with clinically and statistically significant increases in months in remission, and decreases in psychotic and affective symptoms. Delivery of partial therapy involving engagement and assessment was not effective. Conclusions. Our analyses suggest that CBT-P is of significant benefit on multiple outcomes to patients able to engage in the full range of therapy procedures. The novel statistical methods illustrated in this report have general application to the evaluation of heterogeneity in the effects of treatment.

Effective communication to improve udder health: can social science help?

Improved udder health requires consistent application of appropriate management practices by those involved in managing dairy herds and the milking process. Designing effective communication requires that we understand why dairy herd managers behave in the way they do and also how the means of communication can be used both to inform and to influence. Social sciences- ranging from economics to anthropology - have been used to shed light on the behaviour of those who manage farm animals. Communication science tells us that influencing behaviour is not simply a question of „getting the message across‟ but of addressing the complex of factors that influence an individual‟s behavioural decisions. A review of recent studies in the animal health literature shows that different social science frameworks and methodologies offer complementary insights into livestock managers‟ behaviour but that the diversity of conceptual and methodological frameworks presents a challenge for animal health practitioners and policy makers who seek to make sense of the findings – and for researchers looking for helpful starting points. Data from a recent study in England illustrate the potential of „home-made‟ conceptual frameworks to help unravel the complexity of farmer behaviour. At the same time, though, the data indicate the difficulties facing those designing communication strategies in a context where farmers believe strongly that they are already doing all they can reasonably be expected to do to minimise animal health risks.

Wave trapping in a two-dimensional sound-soft or sound-hard acoustic waveguide of slowly-varying width

In this paper we derive novel approximations to trapped waves in a two-dimensional acoustic waveguide whose walls vary slowly along the guide, and at which either Dirichlet (sound-soft) or Neumann (sound-hard) conditions are imposed. The guide contains a single smoothly bulging region of arbitrary amplitude, but is otherwise straight, and the modes are trapped within this localised increase in width. Using a similar approach to that in Rienstra (2003), a WKBJ-type expansion yields an approximate expression for the modes which can be present, which display either propagating or evanescent behaviour; matched asymptotic expansions are then used to derive connection formulae which bridge the gap across the cut-off between propagating and evanescent solutions in a tapering waveguide. A uniform expansion is then determined, and it is shown that appropriate zeros of this expansion correspond to trapped mode wavenumbers; the trapped modes themselves are then approximated by the uniform expansion. Numerical results determined via a standard iterative method are then compared to results of the full linear problem calculated using a spectral method, and the two are shown to be in excellent agreement, even when $\epsilon$, the parameter characterising the slow variations of the guide’s walls, is relatively large.

Bistable systems with stochastic noise: virtues and limits of effective one-dimensional Langevin equations

The understanding of the statistical properties and of the dynamics of multistable systems is gaining more and more importance in a vast variety of scientific fields. This is especially relevant for the investigation of the tipping points of complex systems. Sometimes, in order to understand the time series of given observables exhibiting bimodal distributions, simple one-dimensional Langevin models are fitted to reproduce the observed statistical properties, and used to investing-ate the projected dynamics of the observable. This is of great relevance for studying potential catastrophic changes in the properties of the underlying system or resonant behaviours like those related to stochastic resonance-like mechanisms. In this paper, we propose a framework for encasing this kind of studies, using simple box models of the oceanic circulation and choosing as observable the strength of the thermohaline circulation. We study the statistical properties of the transitions between the two modes of operation of the thermohaline circulation under symmetric boundary forcings and test their agreement with simplified one-dimensional phenomenological theories. We extend our analysis to include stochastic resonance-like amplification processes. We conclude that fitted one-dimensional Langevin models, when closely scrutinised, may result to be more ad-hoc than they seem, lacking robustness and/or well-posedness. They should be treated with care, more as an empiric descriptive tool than as methodology with predictive power.

Intrusions in trauma and psychosis: information processing and phenomenology

Background: Intrusions are common symptoms of both posttraumatic stress disorder (PTSD) and schizophrenia. Steel et al (2005) suggest that an information processing style characterized by weak trait contextual integration renders psychotic individuals vulnerable to intrusive experiences. This ‘contextual integration hypothesis’ was tested in individuals reporting anomalous experiences in the absence of a need-for-care. Methods: Twenty-six low schizotypes and twenty-three individuals reporting anomalous experiences were shown a traumatic film with and without a concurrent visuo-spatial task. Participants rated post-traumatic intrusions for frequency and form, and completed self-report measures of information processing style. It was predicted that, due to their weaker trait contextual integration, the anomalous experiences group would (1) exhibit more intrusions following exposure to the trauma-film; (2) display intrusions characterised by more PTSD qualities and (3) show a greater reduction of intrusions with the concurrent visuo-spatial task. Results: As predicted, the anomalous experiences group reported a lower level of trait contextual integration and more intrusions than the low schizotypes, both immediately after watching the film, and during the following seven days. Their post-traumatic intrusive memories were more PTSD-like (more intrusive, vivid and associated with emotion). The visuo-spatial task had no effect on number of intrusions in either group. Conclusions: These findings provide some support for the proposal that weak trait contextual integration underlies the development of intrusions within both PTSD and psychosis.

Corporate social responsibility in construction and engineering firms: key elements of effective strategy

Through multiple case studies of firms we argue that firms that have developed corporate responsibility strategies, albeit informally at first, do so by making intentional, informed and collective choices about CSR initiatives. More precisely, we point to the importance of considering corporate identity in making these choices and to the process of adaptive coordination, which includes both responding to and influencing the CSR environment. We conclude that CSR strategic landscape are determined more and more by the astute and careful management of a network of cooperative and competitive stakeholder interests which possess both tangible and intangible value to a firm.

Brodifacoum is effective against Norway Rats (Rattus norvegicus) in a tyrosine139cysteine focus of anticoagulant resistance, Westphalia, Germany

BACKGROUND: The single nucleotide polymorphism (SNP), and consequent amino acid exchange from tyrosine to cysteine at location 139 of the vkorc1 gene (i.e. tyrosine139cysteine or Y139C), is the most widespread anticoagulant resistance mutation in Norway rats (Rattus norvegicus Berk.) in Europe. Field trials were conducted to determine incidence of the Y139C SNP at two rat infested farms in Westphalia, Germany, and to estimate the practical efficacy against them of applications, using a pulsed baiting treatment regime, of a proprietary bait (KleratTM) containing 50 ppm brodifacoum. RESULTS: DNA analysis for the Y139C mutation showed that resistant rats were prevalent at the two farms, with an incidence of 80.0% and 78.6% respectively. Applications of brodifacoum bait achieved results of 99.2% and 100.0% control at the two farms, when measured by census baiting, although the treatment was somewhat prolonged at one site due to the abundance of attractive alternative food. CONCLUSION: The study showed that 50 ppm brodifacoum bait is fully effective against the Y139C SNP at the Münsterland focus and is likely to be so elsewhere in Europe where this mutation is found. The pulsed baiting regime reduced to relatively low levels the quantity of bait required to control these two substantial resistant Norway rat infestations. Previous studies had shown much larger quantities of bromadiolone and difenacoum baits used in ineffective treatments against Y139C resistant rats in the Münsterland. These results should be considered when making decisions about the use of anticoagulant against resistant Norway rats and their potential environmental impacts.

Towards effective water reuse: drivers, challenges and strategies shaping the organisational management of reclaimed water in Jordan

Treated wastewater or reclaimed water is gaining recognition as a valuable water resource around the world. To assess why, where and how water reuse takes place in Jordan, semi-structured interviews were conducted with representatives of 29 key organisations in 2008. The analysis reveals that water scarcity is a key driver for water reuse. However, despite such recognition, reuse was described positively by only a small proportion of the interviewees (n = 6). Negative and neutral perceptions regarding reuse dominated and the research found that this was related to two underlying challenges: (i) the requirement for more intensive management when using reclaimed water compared with freshwater and (ii) concern over societal acceptance of water reuse. These factors were found to be associated with the risks posed to humans and their environments, combined with negative emotional and cultural responses to human waste and its applications. Numerous strategies are identified that are employed by organisations to overcome these challenges. Wastewater treatment, regulation, monitoring, the mixing of treated effluent with freshwater and limited public discussion of water reuse are all employed to achieve maximum use of reclaimed water. Each strategy presents benefits of sort, but some may paradoxically also inhibit optimal use of reclaimed water. Careful modifications to the existing strategies of Jordanian agencies, such as more open discussion of reuse, could lead to greater social, economic and environmental gains.

Use of soft heterocyclic N‑donor ligands to separate actinides and lanthanides

The removal of the most long-lived radiotoxic elements from used nuclear fuel, minor actinides, is foreseen as an essential step toward increasing the public acceptance of nuclear energy as a key component of a low-carbon energy future. Once removed from the remaining used fuel, these elements can be used as fuel in their own right in fast reactors or converted into shorter-lived or stable elements by transmutation prior to geological disposal. The SANEX process is proposed to carry out this selective separation by solvent extraction. Recent efforts to develop reagents capable of separating the radioactive minor actinides from lanthanides as part of a future strategy for the management and reprocessing of used nuclear fuel are reviewed. The current strategies for the reprocessing of PUREX raffinate are summarized, and some guiding principles for the design of actinide-selective reagents are defined. The development and testing of different classes of solvent extraction reagent are then summarized, covering some of the earliest ligand designs right through to the current reagents of choice, bis(1,2,4-triazine) ligands. Finally, we summarize research aimed at developing a fundamental understanding of the underlying reasons for the excellent extraction capabilities and high actinide/lanthanide selectivities shown by this class of ligands and our recent efforts to immobilize these reagents onto solid phases.

Simple and effective technical procedures for the packing and application of nanospray PicoFrit HPLC columns for proteomic analyses

A simple procedure was developed for packing PicoFrit HPLC columns with chromatographic stationary phase using a reservoir fabricated from standard laboratory HPLC fittings. Packed columns were mounted onto a stainless steel ultra-low volume precolumn filter assembly containing a 0.5-mu m pore size steel frit. This format provided a conduit for the application of the nanospray voltage and protected the column from obstruction by sample material. The system was characterised and operational performance assessed by analysis of a range of peptide standards (n = 9).

Driving service agility: a longitudinal case in Yell

Organizations require effective service management in order to meet business service levels and reduce costs in the operation of information systems. There is a growing body of knowledge that describes the rationale and the outcome of these experiences. These cases indicate that the capabilities and processes of the organization are important factors in achieving success. Our review of the literature considers both the hard and soft factors such as service processes and trust in service partners. These factors are explored through a longitudinal case study designed to provide insights into how the environment sets the parameters for service management. The selected case analyses the organization changes to its service management approaches during a period of several years. Results are discussed from both practitioner and theoretical viewpoints with proposals for further research.