Psychological treatments for early psychosis can be beneficial or harmful, depending on the therapeutic alliance: an instrumental variable analysis

Background. The quality of the therapeutic alliance (TA) has been invoked to explain the equal effectiveness of different psychotherapies, but prior research is correlational, and does not address the possibility that individuals who form good alliances may have good outcomes without therapy. Method. We evaluated the causal effect of TA using instrumental variable (structural equation) modelling on data from a three-arm, randomized controlled trial of 308 people in an acute first or second episode of a non-affective psychosis. The trial compared cognitive behavioural therapy (CBT) over 6 weeks plus routine care (RC) v. supportive counselling (SC) plus RC v. RC alone. We examined the effect of TA, as measured by the client-rated CALPAS, on the primary trial 18-month outcome of symptom severity (PANSS), which was assessed blind to treatment allocation. Results. Both adjunctive CBT and SC improved 18-month outcomes, compared to RC. We showed that, for both psychological treatments, improving TA improves symptomatic outcome. With a good TA, attending more sessions causes a significantly better outcome on PANSS total score [effect size −2.91, 95% confidence interval (CI) −0.90 to −4.91]. With a poor TA, attending more sessions is detrimental (effect size +7.74, 95% CI +1.03 to +14.45). Conclusions. This is the first ever demonstration that TA has a causal effect on symptomatic outcome of a psychological treatment, and that poor TA is actively detrimental. These effects may extend to other therapeutic modalities and disorders

Searching (the) FIRST radio arcs near ACO clusters

Gravitational lensing (GL) of distant radio sources by galaxy clusters should produce radio arc(let)s. We extracted radio sources from the FIRST survey near Abell cluster cores and found their radio position angles to be uniformly distributed with respect to the cluster centres. This result holds even when we restrict the sample to the richest or most centrally condensed clusters, and to sources with high S/N and large axial ratio. Our failure to detect GL with statistical methods may be due to poor cluster centre positions. We did not find convincing candidates for arcs either. Our result agrees with theoretical estimates predicting that surveys much deeper than FIRST are required to detect the effect. This is in apparent conflict with the detection of such an effect claimed by Bagchi & Kapahi (1995).Comment: 6 pages; 8 figures and 1 style file are included; to appear in Proc. "Observational Cosmology with the New Radio Surveys", eds. M. Bremer, N. Jackson & I. Perez-Fournon, Kluwer Acad. Pres

A comparison of surgical outcomes between endoscopic and robotically assisted thyroidectomy: the authors’ initial experience

Background: The gasless, transaxillary endoscopic thyroidectomy (GTET) offers a distinct advantage over the conventional open operation by leaving no visible neck scar, and in an attempt to improve its ergonomics and surgical outcomes, the robotically assisted thyroidectomy (RAT) was introduced. The RAT uses the same endoscopic route as the GTET but with the assistance of the da Vinci S robotic system. Excellent results for RAT have been reported, but it remains unclear whether RAT offers any potential benefits over GTET. Methods: From June to December 2009, 46 patients underwent endoscopic thyroidectomy. Of these patients, 39 had surgery without the robot (GTET) and 7 had surgery with the robot (RAT). Demographics, surgical indications, operative findings, and postoperative outcomes were compared between the two groups. All the patients were followed up for at least 6 months after surgery. Results: Patient demographics, surgical indications, and extent of resection were similar between the two groups. The median total procedure time was significantly longer for RAT (149 min) than for GTET (100 min; p = 0.018), but the contralateral recurrent laryngeal nerve was more likely to identified in RAT (100%) than in GTET (42.9%; p = 0.070). On the average, GTET needed one more surgical assistant than RAT (1 vs. 0; ppublished_or_final_versionSpringer Open Choice, 21 Feb 201

The non-Abelian gauge theory of matrix big bangs

We study at the classical and quantum mechanical level the time-dependent Yang-Mills theory that one obtains via the generalisation of discrete light-cone quantisation to singular homogeneous plane waves. The non-Abelian nature of this theory is known to be important for physics near the singularity, at least as far as the number of degrees of freedom is concerned. We will show that the quartic interaction is always subleading as one approaches the singularity and that close enough to t=0 the evolution is driven by the diverging tachyonic mass term. The evolution towards asymptotically flat space-time also reveals some surprising features.Comment: 29 pages, 8 eps figures, v2: minor changes, references added: v3 small typographical changes

Super-resolution far-field ghost imaging via compressive sampling

Much more image details can be resolved by improving the system's imaging resolution and enhancing the resolution beyond the system's Rayleigh diffraction limit is generally called super-resolution. By combining the sparse prior property of images with the ghost imaging method, we demonstrated experimentally that super-resolution imaging can be nonlocally achieved in the far field even without looking at the object. Physical explanation of super-resolution ghost imaging via compressive sampling and its potential applications are also discussed.Comment: 4pages,4figure

A geometric network model of intrinsic grey-matter connectivity of the human brain

Network science provides a general framework for analysing the large-scale brain networks that naturally arise from modern neuroimaging studies, and a key goal in theoretical neuro- science is to understand the extent to which these neural architectures influence the dynamical processes they sustain. To date, brain network modelling has largely been conducted at the macroscale level (i.e. white-matter tracts), despite growing evidence of the role that local grey matter architecture plays in a variety of brain disorders. Here, we present a new model of intrinsic grey matter connectivity of the human connectome. Importantly, the new model incorporates detailed information on cortical geometry to construct ‘shortcuts’ through the thickness of the cortex, thus enabling spatially distant brain regions, as measured along the cortical surface, to communicate. Our study indicates that structures based on human brain surface information differ significantly, both in terms of their topological network characteristics and activity propagation properties, when compared against a variety of alternative geometries and generative algorithms. In particular, this might help explain histological patterns of grey matter connectivity, highlighting that observed connection distances may have arisen to maximise information processing ability, and that such gains are consistent with (and enhanced by) the presence of short-cut connections

Measuring the effect of enhanced cleaning in a UK hospital : a prospective cross-over study

Increasing hospital-acquired infections have generated much attention over the last decade. There is evidence that hygienic cleaning has a role in the control of hospital-acquired infections. This study aimed to evaluate the potential impact of one additional cleaner by using microbiological standards based on aerobic colony counts and the presence of Staphylococcus aureus including meticillin-resistant S. aureus. We introduced an additional cleaner into two matched wards from Monday to Friday, with each ward receiving enhanced cleaning for six months in a cross-over design. Ten hand-touch sites on both wards were screened weekly using standardised methods and patients were monitored for meticillin-resistant S. aureus infection throughout the year-long study. Patient and environmental meticillin-resistant S. aureus isolates were characterised using molecular methods in order to investigate temporal and clonal relationships. Enhanced cleaning was associated with a 32.5% reduction in levels of microbial contamination at handtouch sites when wards received enhanced cleaning (P < 0.0001: 95% CI 20.2%, 42.9%). Near-patient sites (lockers, overbed tables and beds) were more frequently contaminated with meticillin-resistant S. aureus/S. aureus than sites further from the patient (P = 0.065). Genotyping identified indistinguishable strains from both handtouch sites and patients. There was a 26.6% reduction in new meticillin-resistant S. aureus infections on the wards receiving extra cleaning, despite higher meticillin-resistant S. aureus patient-days and bed occupancy rates during enhanced cleaning periods (P = 0.032: 95% CI 7.7%, 92.3%). Adjusting for meticillin-resistant S. aureus patient-days and based upon nine new meticillin-resistant S. aureus infections seen during routine cleaning, we expected 13 new infections during enhanced cleaning periods rather than the four that actually occurred. Clusters of new meticillin-resistant S. aureus infections were identified 2 to 4 weeks after the cleaner left both wards. Enhanced cleaning saved the hospital £30,000 to £70,000.Introducing one extra cleaner produced a measurable effect on the clinical environment, with apparent benefit to patients regarding meticillin-resistant S. aureus infection. Molecular epidemiological methods supported the possibility that patients acquired meticillin-resistant S. aureus from environmental sources. These findings suggest that additional research is warranted to further clarify the environmental, clinical and economic impact of enhanced hygienic cleaning as a component in the control of hospital-acquired infection