Life Expectancy: Social Work with Centenarians

Although the older population as a whole is increasing faster than any other age group, the most dramatic growth is in the oldest old. Centenarians, those individuals who have survived 100 or more years, have increased ten times in size over the past forty years. This population trajectory is expected to accelerate even more into the next century. Unfomately, social work with the older population rarely includes practice issues related to work with these older adults who have survived well past the average lie expectancy. This article provides a description of the current cohort of centenarians from a biopsychosocial framework and presents an agenda for social work practice, policy and research

Testing the Continuum of Delusional Beliefs: An Experimental Study Using Virtual Reality

A key problem in studying a hypothesized spectrum of severity of delusional ideation is determining that ideas are unfounded. The first objective was to use virtual reality to validate groups of individuals with low, moderate, and high levels of unfounded persecutory ideation. The second objective was to investigate, drawing upon a cognitive model of persecutory delusions, whether clinical and nonclinical paranoia are associated with similar causal factors. Three groups (low paranoia, high nonclinical paranoia, persecutory delusions) of 30 participants were recruited. Levels of paranoia were tested using virtual reality. The groups were compared on assessments of anxiety, worry, interpersonal sensitivity, depression, anomalous perceptual experiences, reasoning, and history of traumatic events. Virtual reality was found to cause no side effects. Persecutory ideation in virtual reality significantly differed across the groups. For the clear majority of the theoretical factors there were dose–response relationships with levels of paranoia. This is consistent with the idea of a spectrum of paranoia in the general population. Persecutory ideation is clearly present outside of clinical groups and there is consistency across the paranoia spectrum in associations with important theoretical variables

Effects of cognitive behaviour therapy for worry on persecutory delusions in patients with psychosis (WIT): a parallel, single-blind, randomised controlled trial with a mediation analysis

BACKGROUND: Worry might be a contributory causal factor in the occurrence of persecutory delusions in patients with psychotic disorders. Therefore we postulated that reducing worry with cognitive behaviour therapy (CBT) would reduce persecutory delusions.METHODS: For our two-arm, assessor-blinded, randomised controlled trial (Worry Intervention Trial [WIT]), we recruited patients aged 18-65 years with persistent persecutory delusions but non-affective psychosis from two centres: the Oxford Health National Health Service (NHS) Foundation Trust (Oxford, UK) and the Southern Health NHS Foundation Trust (Southampton, UK). The key inclusion criteria for participants were a score of at least 3 on the Psychotic Symptoms Rating Scale (PSYRATS) denoting a current persecutory delusion; that the delusion had persisted for at least 3 months; a clinical diagnosis of schizophrenia, schizoaffective disorder, or delusional disorder; and a clinically significant level of worry. We randomly assigned (1:1) eligible patients, using a randomly permuted block procedure with variable block sizes and division by four strata, to either six sessions of worry-reduction CBT intervention done over 8 weeks added to standard care (the CBT-intervention group), or to standard care alone (the control group). The assessors were masked to patient allocations and did their assessments at week 0 (baseline), 8 weeks (end of treatment), and 24 weeks, follow-up. The primary outcomes were worry measured by the Penn State Worry Questionnaire (PSWQ) and delusions measured by the PSYRATS-delusion scale; we did the analyses in the intention-to-treat population, and also did a planned mediation analysis. This trial is registered with the ISRCTN Registry (number ISRCTN23197625) and is closed to new participants.FINDINGS: From Nov 1, 2011, to Sept 9, 2013, we recruited 150 eligible participants and randomly assigned 73 to the CBT intervention group, and 77 to the control group. 143 patients (95%) provided primary outcome follow-up data. Compared with standard care alone, at 8 weeks the CBT intervention significantly reduced worry (mean difference 6·35 [SE 1·56] PSWQ units, 95% CI 3·30-9·40; p&lt;0·001) and persecutory delusions (2·08 [SE 0·73] PSYRATS units, 95% CI 0·64-3·51; p=0·005). The reductions were maintained to 24 weeks follow-up. The mediation analysis suggested that the change in worry accounted for 66% of the change in delusion. No patients died or were admitted to secure units during our study. Six suicide attempts (two in the CBT intervention group, and four in the control group) and two serious violent incidents (one in each group) were noted, but no adverse events were deemed related to the treatments or the assessments.INTERPRETATION: To our knowledge, this is the first large trial focused on persecutory delusions. We have shown that long-standing delusions were significantly reduced by a brief intervention targeted on worry, although the limitations for our study include no determination of the key elements within the intervention. Our results suggest that worry might cause paranoia, and that worry intervention techniques might be a beneficial addition to the standard treatment of psychosis.FUNDING: Efficacy and Mechanism Evaluation programme, which is a UK Medical Research Council and National Institute of Health Research partnership.</p

Regulatory T Cells Control Effector T Cell Inflammation in Human Prediabetes

A disparate array of plasma/serum markers provides evidence for chronic inflammation in human prediabetes, a condition that is most closely replicated by standard mouse models of obesity and metaflammation. These remain largely nonactionable and contrast with our rich understanding of inflammation in human type 2 diabetes. New data show that inflammatory profiles produced by CD4+ T cells define human prediabetes as a unique inflammatory state. Regulatory T cells (Treg) control mitochondrial function and cytokine production by CD4+ effector T cells (Teff) in prediabetes and type 2 diabetes by supporting T helper (Th)17 or Th1 cytokine production, respectively. These data suggest that Treg control of Teff metabolism regulates inflammation differentially in prediabetes compared with type 2 diabetes. Queries of genes that impact mitochondrial function or pathways leading to transcription of lipid metabolism genes identified the fatty acid importer CD36 as highly expressed in Treg but not Teff from subjects with prediabetes. Pharmacological blockade of CD36 in Treg from subjects with prediabetes decreased Teff production of the Th17 cytokines that differentiate overall prediabetes inflammation. We conclude that Treg control CD4+ T cell cytokine profiles through mechanisms determined, at least in part, by host metabolic status. Furthermore, Treg CD36 uniquely promotes Th17 cytokine production by Teff in prediabetes

Measuring adherence in social recovery therapy with people with first episode psychosis

Background:The SUPEREDEN3 study, a phase II randomized controlled trial, suggests that social recovery therapy (SRT) is useful in improving functional outcomes in people with first episode psychosis. SRT incorporates cognitive behavioural therapy (CBT) techniques with case management and employment support, and therefore has a different emphasis to traditional CBT for psychosis, requiring a new adherence tool.Aims:This paper describes the SRT adherence checklist and content of the therapy delivered in the SUPEREDEN3 trial, outlining the frequency of SRT techniques and proportion of participants who received a full therapy dose. It was hypothesized that behavioural techniques would be used frequently, consistent with the behavioural emphasis of SRT.Method:Research therapists completed an adherence checklist after each therapy session, endorsing elements of SRT present. Data from 1236 therapy sessions were reviewed to determine whether participants received full, partial or no therapy dose.Results:Of the 75 participants randomized to receive SRT, 57.3% received a full dose, 24% a partial dose, and 18.7% received no dose. Behavioural techniques were endorsed in 50.5% of sessions, with cognitive techniques endorsed in 34.9% of sessions.Conclusions:This report describes an adherence checklist which should be used when delivering SRT in both research and clinical practice. As hypothesized, behavioural techniques were a prominent feature of the SRT delivered in SUPEREDEN3, consistent with the behavioural emphasis of the approach. The use of this adherence tool would be considered essential for anyone delivering SRT looking to ensure adherence to the model

Jack Voltaic 3.0 Cyber Research Report

The Jack Voltaic (JV) Cyber Research project is an innovative, bottom-up approach to critical infrastructure resilience that informs our understanding of existing cybersecurity capabilities and identifies gaps. JV 3.0 contributed to a repeatable framework cities and municipalities nationwide can use to prepare. This report on JV 3.0 provides findings and recommendations for the military, federal agencies, and policy makers

Automatic Generation of Efficient Sparse Tensor Format Conversion Routines

This paper shows how to generate code that efficiently converts sparse tensors between disparate storage formats (data layouts) such as CSR, DIA, ELL, and many others. We decompose sparse tensor conversion into three logical phases: coordinate remapping, analysis, and assembly. We then develop a language that precisely describes how different formats group together and order a tensor's nonzeros in memory. This lets a compiler emit code that performs complex remappings of nonzeros when converting between formats. We also develop a query language that can extract statistics about sparse tensors, and we show how to emit efficient analysis code that computes such queries. Finally, we define an abstract interface that captures how data structures for storing a tensor can be efficiently assembled given specific statistics about the tensor. Disparate formats can implement this common interface, thus letting a compiler emit optimized sparse tensor conversion code for arbitrary combinations of many formats without hard-coding for any specific combination. Our evaluation shows that the technique generates sparse tensor conversion routines with performance between 1.00 and 2.01$\times$ that of hand-optimized versions in SPARSKIT and Intel MKL, two popular sparse linear algebra libraries. And by emitting code that avoids materializing temporaries, which both libraries need for many combinations of source and target formats, our technique outperforms those libraries by 1.78 to 4.01$\times$ for CSC/COO to DIA/ELL conversion.Comment: Presented at PLDI 202

Marine heatwaves redistribute pelagic fishing fleets

Marine heatwaves (MHWs) have measurable impacts on marine ecosystems and reliant fisheries and associated communities. However, how MHWs translate to changes in fishing opportunities and the displacement of fishing fleets remains poorly understood. Using fishing vessel tracking data from the automatic identification system (AIS), we developed vessel distribution models for two pelagic fisheries targeting highly migratory species, the U.S. Atlantic longline and Pacific troll fleets, to understand how MHW properties (intensity, size, and duration) influence core fishing grounds and fleet displacement. For both fleets, MHW size had the largest influence on fishing ground area with northern fishing grounds gaining and southern fishing grounds decreasing in area. However, fleet displacement in response to MHWs varied between coasts, as the Atlantic longline fleet displaced farther in southern regions whereas the most northern and southern regions of the Pacific troll fleet shifted farther. Characterizing fishing fleet responses to these anomalous conditions can help identify regional vulnerabilities under future extreme events and aid in supporting climate-readiness and resilience in pelagic fisheries

A qualitative process evaluation of Social Recovery Therapy for enhancement of social recovery after first-episode psychosis (SUPEREDEN3)

Background: Many individuals with first-episode psychosis experience severe and persistent social disability despite receiving specialist early intervention. The SUPEREDEN3 trial assessed whether augmenting early intervention services with social recovery therapy (SRT) would lead to better social recovery. Aims: A qualitative process evaluation was conducted to explore implementation and mechanisms of SRT impact from the perspective of SUPEREDEN3 participants. Method: A subsample of trial participants (n=19) took part in semi-structured interviews, which were transcribed verbatim and analysed thematically. Trial participants were early intervention clients aged 16-35 years with severe and persistent social disability. Both SRT plus early intervention and treatment as usual arm participants were interviewed to facilitate better understanding of the context in which SRT was delivered and aid identification of mechanisms specific to SRT. Results: The six themes identified were used to generate an explanatory model of SRT’s enhancement of social recovery. Participant experiences highlight the importance of the therapist cultivating increased self-understanding and assertively encouraging clients to face feared situations in a way that is perceived as supportive, while managing ongoing symptoms. The sense of achievement generated by reaching targets linked to personally meaningful goals promotes increased self-agency, and generates hope and optimism. Conclusions: The findings suggest potentially important processes through which social recovery was enhanced in this trial, which will be valuable in ensuring the benefits observed can be replicated. Participant accounts provide hope that, with the right support, even clients who have persistent symptoms and the most severe disability can make a good social recovery