University Lands Advanced Recovery Initative

Hydrocarbon production from West Texas lands held by The University of Texas System has been in decline since the 1960s (fig. 1). Nonetheless, analysis of resources on University lands indicates that of the 7,252 million stock tank barrels (MMSTB) of original oil in place, only 1,679 MMSTB has been recovered since production was established early in this century, and only 150 MMSTB of reserves exist. Unless advanced development practices are applied to University lands fields, some 5,423 MMSTB will therefore remain unrecovered in existing fields. Importantly, 2,140 MMSTB of this resource, nearly one-third of the original oil in place, is mobile oil that can be recovered using standard drilling and completion practices, provided that wellbores and completion intervals are geologically targeted to access this unrecovered resource (fig. 2). The goal of the University Lands Advanced Recovery Initiative is to characterize selected University Lands reservoirs to aid operators in geologically targeting the remaining hydrocarbon resource to stem the decline in University Lands production. This project is funded by The University of Texas (U.T.) System and by matching funds from operators of University Lands fields chosen for site-specific studies. The agreement between the Bureau of Economic Geology and the U.T. System was finalized on July 29, 1996. Three individual site-specific projects have been initiated in the first year of the project: (1) Fuhrman-Mascho Block 10 Unit, a San Andres-Grayburg carbonate and sandstone reservoir in Andrews County operated by Arrow Operating Company, (2) University Waddell Devonian field, a Devonian chert reservoir in Crane County operated by Pennzoil, and (3) North McElroy Grayburg field, a Grayburg carbonate reservoir in Crane and Upton Counties newly acquired by Apache Corporation (fig. 3). Fuhrman-Mascho and University Waddell fields have recovery efficiencies significantly below that of comparable fields within the same geologically based play. McElroy field, although producing at an efficiency above play average, contains an enormous 832 million barrels of unrecovered mobile oil (table 1).Bureau of Economic Geolog

Antidepressants for the prevention of depression following first-episode psychosis (ADEPP): study protocol for a multi-centre, double-blind, randomised controlled trial

Background: Depressive episodes are common after first-episode psychosis (FEP), affecting more than 40% of people, adding to individual burden, poor outcomes, and healthcare costs. If the risks of developing depression were lower, this could have a beneficial effect on morbidity and mortality, as well as improving outcomes. Sertraline is a selective serotonin reuptake inhibitor and a common first-line medication for the treatment of depression in adults. It has been shown to be safe when co-prescribed with antipsychotic medication, and there is evidence that it is an effective treatment for depression in established schizophrenia. We present a protocol for a multi-centre, double-blind, randomised, placebo-controlled clinical trial called ADEPP that aims to investigate the efficacy and cost-effectiveness of sertraline in preventing depression after FEP. Methods: The recruitment target is 452 participants between the ages of 18 and 65 years who are within 12 months of treatment initiation for FEP. Having provided informed consent, participants will be randomised to receive either 50 mg of sertraline daily or matched placebo for 6 months, in addition to treatment as usual. The primary outcome measure will be a comparison of the number of new cases of depression between the treatment and placebo arms over the 6-month intervention phase. Secondary outcomes include suicidal behaviour, anxiety, rates of relapse, functional outcome, quality of life, and resource use. Discussion: The ADEPP trial will test whether the addition of sertraline following FEP is a clinically useful, acceptable, and cost-effective way of improving outcomes following FEP. Trial registration: ISRCTN12682719 registration date 24/11/2020

Ethnic variations in compulsory detention and hospital admission for psychosis across four UK Early Intervention Services

BACKGROUND: Substantial ethnic variations have been found in incidence, pathways to care and outcomes in psychosis. It is unknown whether these remain as marked in the presence of specialist Early Intervention Services (EIS) for psychosis. We present the first UK study exploring ethnic differences in compulsory detention and hospitalization rates for EIS patients. We investigated whether the excess rates of compulsory admission for people from Black groups have persisted following nationwide introduction of EIS. We also explored variations in compulsory admission for other ethnic groups, and differences by gender and diagnosis. METHODS: Four inner-city London EIS teams gathered data from first-presentation psychosis patients between 2004–2009 using the MiData audit tool. Clinical, sociodemographic and pathways to care data were recorded regarding adult patients from eight different ethnic groups at entry to EIS and one year later. RESULTS: Black African EIS service users had odds of being detained and of being hospitalised three times greater than White British patients, even after adjustment for confounders. This was most marked in Black African women (seven to eight times greater odds than White British women). A post-hoc analysis showed that pathways to care and help-seeking behaviour partially explained these differences. CONCLUSION: These findings suggest EIS input in its current form has little impact on higher admission and detention rates in certain Black and minority groups. There is a need to tackle these differences and engage patients earlier, focusing on the needs of men and women from the most persistently affected groups

Gender differences in one-year outcomes of first-presentation psychosis patients in inner-city UK Early Intervention Services

Aim Men and women have historically been shown to differ in their presentation and outcome of psychotic disorders and thus are likely to have different treatment needs. It is unclear whether Early Intervention Services (EIS) are able to provide equitable care for both men and women presenting for the first time with psychosis. The main aim of this study was to explore gender differences for first‐presentation psychosis patients at the time of their referral to inner‐city EIS and their outcomes 1 year later. Methods Audit data were utilized from 1098 first‐presentation psychosis patients from seven EIS across London, UK, collected via the computerized MiData package. Binary logistic regression was employed to detect potential associations between gender and (i) initial clinical presentation (including duration of untreated psychosis, pathways to care, risk behaviours); and (ii) 1‐year clinical and functional outcomes. Results At entry to EIS, male patients presented with more violent behaviour whereas female patients had more suicide attempts. Following 1 year of EIS care, men still presented as more violent towards others whereas women were more likely to have been admitted to a psychiatric ward. Conclusion Gender differences in clinical outcome, service use and risk behaviours were apparent within the first year of specialist psychosis care. This may be partly due to the different pathways to care taken by men and women and differences in clinical presentation. Greater focus on the specific needs of each gender by EIS in detection and intervention is required to improve equality of outcome

Ethnic variations in pathways into early intervention services for psychosis

BackgroundEthnic variations have previously been identified in the duration of untreated psychosis (DUP) and pathways into psychiatric services. These have not been examined in the context of early intervention services, which may alter these trajectories.AimsTo explore ethnic differences in the nature and duration of pathways into early intervention services.MethodIn a naturalistic cohort study, data were collected for 1024 individuals with psychotic disorders accepted for case management by eight London early intervention services.ResultsDuration of untreated psychosis was prolonged in the White British group compared with most other ethnic groups. White British individuals were more likely to make contact with their general practitioner and less likely to be seen within emergency medical services. All Black patient groups were more likely than their White British counterparts to experience involvement of criminal justice agencies.ConclusionsVariations continue to exist in how and when individuals from different ethnic groups access early intervention services. These may account for disparities in DUP.</jats:sec

Duration of untreated psychosis and clinical outcomes of first episode psychosis: An observational and an instrumental variables analysis.

AIM: Duration of untreated psychosis (DUP) is considered as a key prognostic variable in psychosis. Yet, it is unclear whether a longer DUP causes worse outcomes or whether reported associations have alternative explanations. METHODS: Data from 2 cohorts of patients with first episode psychosis were used (n = 2134). Measures of DUP were assessed at baseline and outcomes at 12 months. Regression models were used to investigate the associations between DUP and outcomes. We also investigated whether any associations were replicated using instrumental variables (IV) analysis to reduce the effect of residual confounding and measurement bias. RESULTS: There were associations between DUP per 1-year increase and positive psychotic symptoms (7.0% in symptom score increase 95% confidence interval (CI) 4.0%, 10.0%, P < .001), worse recovery (risk difference [RD] 0.78, 95%, CI 0.68, 0.83, P < .001) and worse global functioning (0.62 decrease in functioning score 95% CI -1.19, -0.04, P = .035). There was no evidence of an association with negative psychotic symptoms (1.0%, 95%, CI -2.0%, 5.0%, P = .455). The IV analysis showed weaker evidence of associations in the same direction between DUP per 1-year increase and positive psychotic symptoms, recovery and global functioning. However, there was evidence of an inverse association with negative psychotic symptoms (decrease of 15.0% in symptom score 95% CI -26.0%, -3.0%, P = .016). CONCLUSIONS: We have confirmed previous findings of a positive association between positive psychotic symptoms, global functioning and recovery and DUP using regression analysis. IV analysis shows some support for these findings. Future investigation using IV analysis should be repeated in large data sets.The research is supported by the NIHR Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West) at University Hospitals Bristol NHS Foundation Trust