Predictors of change in global psychiatric functioning at an inpatient adolescent psychiatric unit: A decade of experience

BACKGROUND: Psychiatric inpatient treatment for children is sometimes beneficial, but predictors of who benefits, and in what circumstances, are largely unknown. This study aimed to identify personal and environmental factors that influence outcome in an adolescent unit that accepts both emergency and planned admissions. METHODS: Routine standardised intake and outcome measures were analysed for the period 2009–2018. Potential predictors assessed included the Children’s Global Assessment Scale (CGAS), engagement with treatment, behavioural attitudes and peer relationships on the unit. FINDINGS: One hundred and twelve admissions were tracked. Mean age of admission was 16 years, and 71% were female. A total of 61% had higher (better) CGAS scores on discharge than on admission; 34% of inpatients fully engaged with their treatment. Median admission duration was 118 days for males and 196 days for females. Admission lengths were much shorter for ethnic minority patients, but group sizes were small. Longer admissions led to greater improvement. Poor outcomes were associated with failure to engage with treatment and a deterioration in peer relationships. INTERPRETATION: Compliance with treatment and female gender were both significant predictors of positive change during admission. The establishment of good and supportive peer relationships during the admission was also a potent indicator of benefit

Predictors of change in global psychiatric functioning at an inpatient adolescent psychiatric unit: A decade of experience

Background: Psychiatric inpatient treatment for children is sometimes beneficial, but predictors of who benefits, and in what circumstances, are largely unknown. This study aimed to identify personal and environmental factors that influence outcome in an adolescent unit that accepts both emergency and planned admissions. Methods: Routine standardised intake and outcome measures were analysed for the period 2009–2018. Potential predictors assessed included the Children’s Global Assessment Scale (CGAS), engagement with treatment, behavioural attitudes and peer relationships on the unit. Findings: One hundred and twelve admissions were tracked. Mean age of admission was 16 years, and 71% were female. A total of 61% had higher (better) CGAS scores on discharge than on admission; 34% of inpatients fully engaged with their treatment. Median admission duration was 118 days for males and 196 days for females. Admission lengths were much shorter for ethnic minority patients, but group sizes were small. Longer admissions led to greater improvement. Poor outcomes were associated with failure to engage with treatment and a deterioration in peer relationships. Interpretation: Compliance with treatment and female gender were both significant predictors of positive change during admission. The establishment of good and supportive peer relationships during the admission was also a potent indicator of benefit

Conflicting Selection in the Course of Adaptive Diversification: The Interplay between Mutualism and Intraspecific Competition

Adaptive speciation can occur when a population undergoes assortative mating and disruptive selection caused by frequency-dependent intraspecific competition. However, other interactions, such as mutualisms based on trait matching, may generate conflicting selective pressures that constrain species diversification. We used individual-based simulations to explore how different types of mutualism affect adaptive diversification. A magic trait was assumed to simultaneously mediate mate choice, intraspecific competition, and mutualisms. In scenarios of intimate, specialized mu- tualisms, individuals interact with one or few individual mutualistic partners, and diversification is constrained only if the mutualism is obligate. In other scenarios, increasing numbers of different partners per individual limit diversification by generating stabilizing selection. Stabilizing selection emerges from the greater likelihood of trait mismatches for rare, extreme phenotypes than for common intermediate phenotypes. Constraints on diversification imposed by increased numbers of partners decrease if the trait matching degree has smaller positive effects on fitness. These results hold after the relaxation of various assumptions. When trait matching matters, mutualism-generated stabilizing selection would thus often constrain diversification in obligate mutualisms, such as ant-myrmecophyte associations, and in low-intimacy mutualisms, including plant-seed disperser systems. Hence, different processes, such as trait convergence favoring the incorporation of nonrelated species, are needed to explain the higher richness of low-intimacy assemblages—shown here to be up to 1 order of magnitude richer than high-intimacy systems

Outcomes of inpatient psychiatric treatment for adolescents: A multiple perspectives evaluation

Adolescent inpatient psychiatric treatment was evaluated from the multiple perspectives of clinicians, young people and parents using standardised measures and goal-based outcomes (GBOs). The sample included cases (N = 128) discharged from a London adolescent unit between April 2009 and December 2015. Measures were completed at admission and discharge, and change in ratings was analysed to assess treatment outcomes. Ratings of clinicians and young people on the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) were compared. Adolescents demonstrated significant improvement across all measures from admission to discharge. Correlation between clinicians’ and adolescents’ HoNOSCA ratings was weak at admission (r = .25) but stronger at discharge (r = .63). Standardised effect sizes were larger for GBOs (d = 1.73 and 3.16 for adolescent and clinician-rated goals, respectively) compared to all standardised measures (d = 0.31–0.93). Improvement was observed across all measures of functioning and symptoms following inpatient treatment. Clinicians and young people developed better shared understanding of the problems from admission to discharge. GBOs are more sensitive to change compared to standardised measures and may be meaningfully adopted by inpatient units for routine outcome monitoring

A Network Perspective for Community Assembly

Species interactions are responsible for many key mechanisms that govern the dynamics of ecological communities. Variation in the way interactions are organized among species results in different network structures, which translates into a community's ability to resist collapse and change. To better understand the factors involved in dictating ongoing dynamics in a community at a given time, we must unravel how interactions affect the assembly process. Here, we build a novel, integrative conceptual model for understanding how ecological communities assemble that combines ecological networks and island biogeography theory, as well as the principles of niche theory. Through our conceptual model, we show how the rate of species turnover and gene flow within communities will influence the structure of ecological networks. We conduct a preliminary test of our predictions using plant-herbivore networks from differently-aged sites in the Hawaiian archipelago. Our approach will allow future modeling and empirical studies to develop a better understanding of the role of the assembly process in shaping patterns of biodiversity

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Conflicting Selection in the Course of Adaptive Diversification: The Interplay between Mutualism and Intraspecific Competition

Adaptive speciation can occur when a population undergoes assortative mating and disruptive selection caused by frequency-dependent intraspecific competition. However, other interactions, such as mutualisms based on trait matching, may generate conflicting selective pressures that constrain species diversification. We used individual-based simulations to explore how different types of mutualism affect adaptive diversification. A magic trait was assumed to simultaneously mediate mate choice, intraspecific competition, and mutualisms. In scenarios of intimate, specialized mu- tualisms, individuals interact with one or few individual mutualistic partners, and diversification is constrained only if the mutualism is obligate. In other scenarios, increasing numbers of different partners per individual limit diversification by generating stabilizing selection. Stabilizing selection emerges from the greater likelihood of trait mismatches for rare, extreme phenotypes than for common intermediate phenotypes. Constraints on diversification imposed by increased numbers of partners decrease if the trait matching degree has smaller positive effects on fitness. These results hold after the relaxation of various assumptions. When trait matching matters, mutualism-generated stabilizing selection would thus often constrain diversification in obligate mutualisms, such as ant-myrmecophyte associations, and in low-intimacy mutualisms, including plant-seed disperser systems. Hence, different processes, such as trait convergence favoring the incorporation of nonrelated species, are needed to explain the higher richness of low-intimacy assemblages—shown here to be up to 1 order of magnitude richer than high-intimacy systems

Calendar of Bradford-on-Avon settlement examinations and removal orders, 1725-98

SIGLEAvailable from British Library Document Supply Centre- DSC:9319.155(WRS-Pub--46) / BLDSC - British Library Document Supply CentreGBUnited Kingdo