Treatment adherence

Angela has been spending a fair bit of time with Sam in recent months. She is a 29-year-old single mother with one child. She studies part-time at the local university and has managed to maintain acceptable grades. She has bipolar disorder that has been well managed with medication, in different combinations at different pOints in her illness. However, over the last month she has intermittently missed doses and is consequently becoming unwell. It is puzzling that she is missing doses because she is very attached to her child and last time she stopped medication her daughter was placed in care. The following information was obtained from her in order to undertake a functional analysis. Financially, Angela was managing well on her supporting parent benefit and the maintenance paid by the father of her child. However, her former partner was sent to jail 3 months ago and the maintenance money he was sending her dried up. As a consequence, she started falling behind in some bills about 8 weeks ago. She has told you that this worries her. On top of this, her daughter started experiencing stomach aches last week and is cranky most of the time. Angela has said that she thinks that her daughter may be lactose intolerant and believes that her local GP did not take her concerns about her daughter\u27s distress seriously enough when she took her to see him 10 days ago. Since becoming involved with Sam, Angela has struggled to keep a routine for her and her daughter and she says she forgets her medication from time to time. Sometimes Angela loses interest in sex and she thinks that her medication might reduce her libido. Angela has never received much help from her family because they don\u27t agree with her diagnosis. He father says that she is just an attention getter and that she puts it on. He says that is why she cut herself when she was a teenager. Her father states that if she just stopped \u27boozing\u27 she wouldn\u27t be so down and need the medication. Angela disagrees, stating that she has been drinking to help her sleep for years and is drinking no more or less now. Nonetheless, Angela has tried to cut down on her alcohol use over the last month and this has interfered with her sleep

Predictors of financial capacity performance in older adults using the Financial Competence Assessment Inventory

Background

Gridded and direct Epoch of Reionisation bispectrum estimates using the Murchison Widefield Array

We apply two methods to estimate the 21~cm bispectrum from data taken within the Epoch of Reionisation (EoR) project of the Murchison Widefield Array (MWA). Using data acquired with the Phase II compact array allows a direct bispectrum estimate to be undertaken on the multiple redundantly-spaced triangles of antenna tiles, as well as an estimate based on data gridded to the $uv$-plane. The direct and gridded bispectrum estimators are applied to 21 hours of high-band (167--197~MHz; $z$=6.2--7.5) data from the 2016 and 2017 observing seasons. Analytic predictions for the bispectrum bias and variance for point source foregrounds are derived. We compare the output of these approaches, the foreground contribution to the signal, and future prospects for measuring the bispectra with redundant and non-redundant arrays. We find that some triangle configurations yield bispectrum estimates that are consistent with the expected noise level after 10 hours, while equilateral configurations are strongly foreground-dominated. Careful choice of triangle configurations may be made to reduce foreground bias that hinders power spectrum estimators, and the 21~cm bispectrum may be accessible in less time than the 21~cm power spectrum for some wave modes, with detections in hundreds of hours.Comment: 19 pages, 10 figures, accepted for publication in PAS

Population genomic diversity and structure in the golden bandicoot: a history of isolation, extirpation, and conservation

Published online: 08 October 2023. OnlinePublUsing genetic information to develop and implement conservation programs is vital for maintaining biodiversity and ecosystem resilience. Evaluation of the genetic variability within and among remnant populations can inform management of both natural and translocated populations to maximise species' adaptive potential, mitigate negative impacts of inbreeding, and subsequently minimise risk of extinction. Here we use reduced representation sequencing to undertake a genetic assessment of the golden bandicoot (Isoodon auratus), a threatened marsupial endemic to Australia. The currently recognised taxon consists of three subspecies distributed among multiple natural and translocated populations. After confirming the genetic distinctiveness of I. auratus from two closely related taxa, I. fusciventer and I. macrourus, we identified four genetic clusters within I. auratus. These clusters exhibited substantial genetic differentiation (pairwise FST values ranging from 0.18 to 0.65, pairwise DXY ranging from 0.1 to 0.168), reflecting long-term isolation of some populations on offshore islands and the influence of genetic drift. Mainland natural populations in the Kimberley region had the highest genetic diversity and the largest contribution to overall allelic and gene diversity compared to both natural and translocated island populations. A population translocated to Guluwuru Island in the Northern Territory had the lowest genetic diversity. Our data suggest that island populations can appear genetically unique due to genetic drift and this needs to be taken into account when considering genetic diversity in conservation efforts to maintain overall genetic diversity of the species. We effectively demonstrate how genomic information can guide practical conservation planning, especially when declining species are represented by multiple isolated populations.Kate Rick, Margaret Byrne, Skye Cameron, Steve J. B. Cooper, Judy Dunlop, Brydie Hill, Cheryl Lohr, Nicola J. Mitchell, Craig Moritz, Kenny J. Travouillon, Brenton von Takach and Kym Ottewel

BMQ

BMQ: Boston Medical Quarterly was published from 1950-1966 by the Boston University School of Medicine and the Massachusetts Memorial Hospitals

Robust statistics towards detection of the 21 cm signal from the Epoch of Reionization

© 2019 The Author(s) Published by Oxford University Press on behalf of the Royal Astronomical Society. We explore methods for robust estimation of the 21 cm signal from the Epoch of Reionization (EoR). A Kernel Density Estimator (KDE) is introduced for measuring the spatial temperature fluctuation power spectrum from the EoR. The KDE estimates the underlying probability distribution function of fluctuations as a function of spatial scale, and contains different systematic biases and errors to the typical approach to estimating the fluctuation power spectrum. Extraction of histograms of visibilities allows moments analysis to be used to discriminate foregrounds from 21 cm signal and thermal noise. We use the information available in the histograms, along with the statistical dis-similarity of foregrounds from two independent observing fields, to robustly separate foregrounds from cosmological signal, while making no assumptions about the Gaussianity of the signal. Using two independent observing fields to robustly discriminate signal from foregrounds is crucial for the analysis presented in this paper. We apply the techniques to 13 h of Murchison Widefield Array EoR data over two observing fields. We compare the output to that obtained with a comparative power spectrum estimation method, and demonstrate the reduced foreground contamination using this approach. Using the second moment obtained directly from the KDE distribution functions yields a factor of 2-3 improvement in power for k < 0.3 h Mpc-1 compared with a matched delay space power estimator, while weighting data by additional statistics does not offer significant improvement beyond that available for thermal noise-only weights

Sensible heat has significantly affected the global hydrological cycle over the historical period

Globally, latent heating associated with a change in precipitation is balanced by changes to atmospheric radiative cooling and sensible heat fluxes. Both components can be altered by climate forcing mechanisms and through climate feedbacks, but the impacts of climate forcing and feedbacks on sensible heat fluxes have received much less attention. Here we show, using a range of climate modelling results, that changes in sensible heat are the dominant contributor to the present global-mean precipitation change since preindustrial time, because the radiative impact of forcings and feedbacks approximately compensate. The model results show a dissimilar influence on sensible heat and precipitation from various drivers of climate change. Due to its strong atmospheric absorption, black carbon is found to influence the sensible heat very differently compared to other aerosols and greenhouse gases. Our results indicate that this is likely caused by differences in the impact on the lower tropospheric stability

A multicentre phase II study of cisplatin and gemcitabine for malignant mesothelioma

Our previous phase II study of cisplatin and gemcitabine in malignant mesothelioma showed a 47.6% (95% CI 26.2–69.0%) response rate with symptom improvement in responding patients. Here we confirm these findings in a multicentre setting, and assess the effect of this treatment on quality of life and pulmonary function. Fifty-three patients with pleural malignant mesothelioma received cisplatin 100 mg m−2 i.v. day 1 and gemcitabine 1000 mg m−2 i.v. days 1, 8, and 15 of a 28 day cycle for a maximum of six cycles. Quality of life and pulmonary function were assessed at each cycle. The best response achieved in 52 assessable patients was: partial response, 17 (33%, 95% CI 20–46%); stable disease, 31 (60%); and progressive disease, four (8%). The median time to disease progression was 6.4 months, median survival from start of treatment 11.2 months, and median survival from diagnosis 17.3 months. Vital capacity and global quality of life remained stable in all patients and improved significantly in responding patients. Major toxicities were haematological, limiting the mean relative dose intensity of gemcitabine to 75%. This schedule of cisplatin and gemcitabine is active in malignant mesothelioma in a multicentre setting. Investigation of alternative scheduling is needed to decrease haematological toxicity and increase the relative dose intensity of gemcitabine whilst maintaining response rate and quality of life

Testing the cognitive-behavioural maintenance models across DSM-5 bulimic-type eating disorder diagnostic groups: A multi-centre study

The original cognitive-behavioural (CB) model of bulimia nervosa, which provided the basis for the widely used CB therapy, proposed that specific dysfunctional cognitions and behaviours maintain the disorder. However, amongst treatment completers, only 40–50 % have a full and lasting response. The enhanced CB model (CB-E), upon which the enhanced version of the CB treatment was based, extended the original approach by including four additional maintenance factors. This study evaluated and compared both CB models in a large clinical treatment seeking sample (N = 679), applying both DSM-IV and DSM-5 criteria for bulimic-type eating disorders. Application of the DSM-5 criteria reduced the number of cases of DSM-IV bulimic-type eating disorders not otherwise specified to 29.6 %. Structural equation modelling analysis indicated that (a) although both models provided a good fit to the data, the CB-E model accounted for a greater proportion of variance in eating-disordered behaviours than the original one, (b) interpersonal problems, clinical perfectionism and low self-esteem were indirectly associated with dietary restraint through over-evaluation of shape and weight, (c) interpersonal problems and mood intolerance were directly linked to binge eating, whereas restraint only indirectly affected binge eating through mood intolerance, suggesting that factors other than restraint may play a more critical role in the maintenance of binge eating. In terms of strength of the associations, differences across DSM-5 bulimic-type eating disorder diagnostic groups were not observed. The results are discussed with reference to theory and research, including neurobiological findings and recent hypotheses