Search

Mental health professionals can help patients understand exceptional and paranormal experiences, integrate them into day-to-day life, and cope with confusion and anxiety that sometimes accompany them. However, a broader clinical perspective and specialized training in clinical parapsychology is needed. In the first part of the paper I argue that psychiatry as currently practiced is limited because it embraces a strictly materialist paradigm, emphasizes treatment over prevention, and relies principally on pharmaceuticals that are often ineffective and/or unsafe. A paradigm shift in psychiatry is taking place that will soon lead to novel concepts of energy and innovations in therapeutic approaches. In the second part of the paper I review the ongoing debate over consciousness, implications of novel understandings of energy for psychiatry, and research findings in physics, neuroscience and parapsychology that are contributing to a postmaterialist paradigm in psychiatry. I comment on an important problem in the philosophy of science called Hempel’s dilemma and argue that future scientific theories of consciousness will probably encounter similar conceptual limits to those faced by current theories. Following Beauregard, Trent and Schwartz (2018) I argue that different categories of theories may be needed to adequately explain the variety of human experiences and I propose an integral paradigm that acknowledges the validity of both conventional scientific explanations and postmaterialist theories of consciousness. Finally, I discuss implications of postmaterialism for research, education and training in psychiatry.

Hyperkalaemia is a common medical emergency in patients admitted to hospital. There is a limited evidence base supporting some of the commonly applied treatment strategies. Although, NICE has recommended the use of sodium zirconium cyclosilicate (SZC) (TA599) and patiromer (TA623) in both acute and chronic hyperkalaemia, there is a limited evidence base for their use in acute hyperkalaemia in the hospital setting, particularly when compared to the present standard of care calcium polystyrene sulfonate (CPS).A retrospective review of the electronic patient record system across our hospital over a 6-month period identified 138 patients who received either SZC (65 patients) or CPS (73 patients) to manage hyperkalaemia, investigating their efficacy and cost effectiveness. Results were analysed using simple descriptive statistics. Based on the results a naïve cost comparison between the two drugs was made.CPS and SZC both effectively reduced plasm potassium concentrations in patients with hyperkalaemia (6.07 and 6.03 mmol/L respectively) by 1.17 mmol/L and 1.24 mmol/L taking a similar amount of time to work (2.97 days vs. 3 days). The principle causes of hyperkalaemia identified were acute kidney injury, medication, and chronic kidney disease. Cost comparison analysis which took into account raw product price and time needed to dispense medications revealed that CPS has slightly better cost effectiveness compared to SZC albeit at a cost of increased staff input.Both CPS and SZC were equally effective at lowering acutely raised potassium concentrations. The cost difference between the two products appears to be small. Claims regarding the benefits of newer agents over older established medications need to be properly explored in randomized trials rather than being based on small scale non-comparative studies.

We show that the equations of motion governing the dynamics of strings in a compact internal space can be written as dispersion relations, with a local speed that depends on the velocity and curvature of the string in the large dimensions. From a $(3+1)$-dimensional perspective these can be viewed as dispersion relations for waves propagating in the string interior and are analogous to those for current-carrying topological defects. This allows us to construct a unified framework with which to study and interpret the internal structure of various field-theoretic and fundamental string species, in a simple physically intuitive coordinate system, without the need for dimensional reduction or approximate effective actions. This, in turn, allows us to identify the precise conditions under which higher-dimensional strings and current-carrying defects are observationally indistinguishable, for macroscopic observers. Our approach naturally incorporates the description of so-called `cosmic springs', whose dynamics are expressed in terms of an effective Finsler geometry, for circular loops, or generalised Finsler geometry, for non-circular configurations. This demonstrates the importance of these novel geometric structures and their utility in modelling complex physical phenomena in cosmology and astrophysics., 79 pages, no tables, no figures. Published version

We determine the Hausdorff dimension of a particle path, $D_{\rm H}$, in the recently proposed `smeared space' model of quantum geometry. The model introduces additional degrees of freedom to describe the quantum state of the background and gives rise to both the generalised uncertainty principle (GUP) and extended uncertainty principle (EUP) without introducing modified commutation relations. We compare our results to previous studies of the Hausdorff dimension in GUP models based on modified commutators and show that the minimum length enters the relevant formulae in a different way. We then determine the Hausdorff dimension of the particle path in smeared momentum space, $\tilde{D}_{\rm H}$, and show that the minimum momentum is dual to the minimum length. For sufficiently coarse grained paths, $D_{\rm H} = \tilde{D}_{\rm H} = 2$, as in canonical quantum mechanics. However, as the resolutions approach the minimum scales, the dimensions of the paths in each representation differ, in contrast to their counterparts in the canonical theory. The GUP-induced corrections increase $D_{\rm H}$ whereas the EUP-induced corrections decrease $\tilde{D}_{\rm H}$, relative to their canonical values, and the extremal case corresponds to $D_{\rm H} = 3$, $\tilde{D}_{\rm H} = 1$. These results show that the GUP and the EUP affect the fractal properties of the particle path in fundamentally different, yet complimentary, ways., Comment: 19 pages, 2 figures, 2 tables. Published version

Foreward to the Bolyai-Gauss-Lobachevsky 2022 special issue, published in ${\it Symmetry}$, in lieu of the 12${}^{\rm th}$ International Conference on Non-Euclidean Geometry, ``BGL-2022''., Comment: 8 pages, 3 figures. Matches version published in the BGL-2022 special issue: https://www.mdpi.com/journal/symmetry/special_issues/BGL_2022

Objectives: The therapeutic use of nutrient-based ‘nutraceuticals’ and plant-based ‘phytoceuticals’ for the treatment of mental disorders is common; however, despite recent research progress, there have not been any updated global clinical guidelines since 2015. To address this, the World Federation of Societies of Biological Psychiatry (WFSBP) and the Canadian Network for Mood and Anxiety Disorders (CANMAT) convened an international taskforce involving 31 leading academics and clinicians from 15 countries, between 2019 and 2021. These guidelines are aimed at providing a definitive evidence-informed approach to assist clinicians in making decisions around the use of such agents for major psychiatric disorders. We also provide detail on safety and tolerability, and clinical advice regarding prescription (e.g. indications, dosage), in addition to consideration for use in specialised populations. Methods: The methodology was based on the WFSBP guidelines development process. Evidence was assessed based on the WFSBP grading of evidence (and was modified to focus on Grade A level evidence–meta-analysis or two or more RCTs–due to the breadth of data available across all nutraceuticals and phytoceuticals across major psychiatric disorders). The taskforce assessed both the ‘level of evidence’ (LoE) (i.e. meta-analyses or RCTs) and the assessment of the direction of the evidence, to determine whether the intervention was ‘Recommended’ (+++), ‘Provisionally Recommended’ (++), ‘Weakly Recommended’ (+), ‘Not Currently Recommended’ (+/−), or ‘Not Recommended’ (−) for a particular condition. Due to the number of clinical trials now available in the field, we firstly examined the data from our two meta-reviews of meta-analyses (nutraceuticals conducted in 2019, and phytoceuticals in 2020). We then performed a search of additional relevant RCTs and reported on both these data as the primary drivers supporting our clinical recommendations. Lower levels of evidence, including isolated RCTs, open label studies, case studies, preclinical research, and interventions with only traditional or anecdotal use, were not assessed. Results: Amongst nutraceuticals with Grade A evidence, positive directionality and varying levels of support (recommended, provisionally recommended, or weakly recommended) was found for adjunctive omega-3 fatty acids (+++), vitamin D (+), adjunctive probiotics (++), adjunctive zinc (++), methylfolate (+), and adjunctive s-adenosyl methionine (SAMe) (+) in the treatment of unipolar depression. Monotherapy omega-3 (+/−), folic acid (−), vitamin C (−), tryptophan (+/−), creatine (+/−), inositol (−), magnesium (−), and n-acetyl cysteine (NAC) (+/−) and SAMe (+/−) were not supported for this use. In bipolar disorder, omega-3 had weak support for bipolar depression (+), while NAC was not currently recommended (+/−). NAC was weakly recommended (+) in the treatment of OCD-related disorders; however, no other nutraceutical had sufficient evidence in any anxiety-related disorder. Vitamin D (+), NAC (++), methylfolate (++) were recommended to varying degrees in the treatment of the negative symptoms in schizophrenia, while omega-3 fatty acids were not, although evidence suggests a role for prevention of transition to psychosis in high-risk youth, with potential pre-existing fatty acid deficiency. Micronutrients (+) and vitamin D (+) were weakly supported in the treatment of ADHD, while omega-3 (+/−) and omega-9 fatty acids (−), acetyl L carnitine (−), and zinc (+/−) were not supported. Phytoceuticals with supporting Grade A evidence and positive directionality included St John’s wort (+++), saffron (++), curcumin (++), and lavender (+) in the treatment of unipolar depression, while rhodiola use was not supported for use in mood disorders. Ashwagandha (++), galphimia (+), and lavender (++) were modestly supported in the treatment of anxiety disorders, while kava (−) and chamomile (+/−) were not recommended for generalised anxiety disorder. Ginkgo was weakly supported in the adjunctive treatment of negative symptoms of schizophrenia (+), but not supported in the treatment of ADHD (+/−). With respect to safety and tolerability, all interventions were deemed to have varying acceptable levels of safety and tolerability for low-risk over-the-counter use in most circumstances. Quality and standardisation of phytoceuticals was also raised by the taskforce as a key limiting issue for firmer confidence in these agents. Finally, the taskforce noted that such use of nutraceuticals or phytoceuticals be primarily recommended (where supportive evidence exists) adjunctively within a standard medical/health professional care model, especially in cases of more severe mental illness. Some meta-analyses reviewed contained data from heterogenous studies involving poor methodology. Isolated RCTs and other data such as open label or case series were not included, and it is recognised that an absence of data does not imply lack of efficacy. Conclusions: Based on the current data and clinician input, a range of nutraceuticals and phytoceuticals were given either a supportive recommendation or a provisional recommendation across a range of various psychiatric disorders. However several had only a weak endorsement for potential use; for a few it was not possible to reach a clear recommendation direction, largely due to mixed study findings; while some other agents showed no obvious therapeutic benefit and were clearly not recommended for use. It is the intention of these guidelines to inform psychiatric/medical, and health professional practice globally.

In practice, free trade agreements (FTAs) vastly outnumber customs unions (CUs). Nevertheless, the literature traditionally views CUs as optimal for members because CU members coordinate external tariffs. I show that a dynamic FTA flexibility benefit can help explain the prevalence of FTAs: individual FTA members have the flexibility to form their own future FTAs whereas CU members must jointly engage in future CU formation. I show how the relative prevalence of FTAs versus CUs depends on the structure of market size asymmetry across countries and use these predictions to shed some light on FTA versus CU formation in Europe and South America. Formation dynamique d’accords commerciaux preferentiels : le role de la flexibilite. En pratique, les accords de libre‐echange (ALE) sont plus nombreux que les unions douanieres (UD). Neanmoins, la litterature specialisee percoit traditionnellement que les UD sont optimales pour les membres parce qu’ils peuvent coordonner leurs tarifs externes. On montre qu’une flexibilite dynamique de l’ALE peut aider a expliquer la prevalence des ALE : les membres des ALE ont la flexibilite de former leurs propres ALE dans l’avenir alors que les membres des UD s’engagent conjointement pour la formation des UD futures. On montre comment la prevalence des ALE versus les UD depend de la structure de l’asymetrie de la taille entre les pays, et on utilise ces previsions pour eclairer les choix entre la formation de ALE et de UD en Europe et en Amerique du Sud.

The SuperCam instrument suite provides the Mars 2020 rover, Perseverance, with a number of versatile remote-sensing techniques that can be used at long distance as well as within the robotic-arm workspace. These include laser-induced breakdown spectroscopy (LIBS), remote time-resolved Raman and luminescence spectroscopies, and visible and infrared (VISIR; separately referred to as VIS and IR) reflectance spectroscopy. A remote micro-imager (RMI) provides high-resolution color context imaging, and a microphone can be used as a stand-alone tool for environmental studies or to determine physical properties of rocks and soils from shock waves of laser-produced plasmas. SuperCam is built in three parts: The mast unit (MU), consisting of the laser, telescope, RMI, IR spectrometer, and associated electronics, is described in a companion paper. The on-board calibration targets are described in another companion paper. Here we describe SuperCam's body unit (BU) and testing of the integrated instrument. The BU, mounted inside the rover body, receives light from the MU via a 5.8 m optical fiber. The light is split into three wavelength bands by a demultiplexer, and is routed via fiber bundles to three optical spectrometers, two of which (UV and violet; 245-340 and 385-465 nm) are crossed Czerny-Turner reflection spectrometers, nearly identical to their counterparts on ChemCam. The third is a high-efficiency transmission spectrometer containing an optical intensifier capable of gating exposures to 100 ns or longer, with variable delay times relative to the laser pulse. This spectrometer covers 535-853 nm ( 105 - 7070 cm − 1 Raman shift relative to the 532 nm green laser beam) with 12 cm − 1 full-width at half-maximum peak resolution in the Raman fingerprint region. The BU electronics boards interface with the rover and control the instrument, returning data to the rover. Thermal systems maintain a warm temperature during cruise to Mars to avoid contamination on the optics, and cool the detectors during operations on Mars. Results obtained with the integrated instrument demonstrate its capabilities for LIBS, for which a library of 332 standards was developed. Examples of Raman and VISIR spectroscopy are shown, demonstrating clear mineral identification with both techniques. Luminescence spectra demonstrate the utility of having both spectral and temporal dimensions. Finally, RMI and microphone tests on the rover demonstrate the capabilities of these subsystems as well., Proyecto MINECO Retos de la Sociedad. Ref. ESP2017-87690-C3-1-R

An important stylized fact in the empirical Free Trade Agreement (FTA) literature is that member trade flows gradually increase over time following an FTA. Baier and Bergstrand (2007) suggest two explanations: tariff phase-out and delayed pass-through of tariffs into import prices. We examine these hypotheses using 1989–2016 U.S. import growth and product-level data on the tariff phase-out negotiated under NAFTA and the earlier Canada-U.S. FTA. We do not find evidence supporting either hypothesis. While products receiving tariff cuts do show delayed import growth relative to products with unchanged tariffs, the delay in import growth does not correspond to delays in the timing of tariff cuts. We also show that tariff cuts are fully and immediately passed through to U.S. importers as there are virtually no changes in the prices received by exporters either in the short run or the long run. Rather, we find evidence for an important role played by NAFTA tariff cuts reducing the impact of frictions that, in turn, allow for a spatial expansion of imports across the U.S.

We show that global trade negotiations can prevent global free trade. In a simple model where global tariff negotiations precede sequential Free Trade Agreements (FTAs), we show FTA formation can expand all the way to global free trade in the absence of global tariff negotiations but global free trade never emerges when global tariff negotiations precede FTA formation. This result arises precisely because global tariff negotiations successfully elicit concessions from negotiating countries. Moreover, global tariff negotiations can produce a fragmented world of “gated globalization” where some countries form FTAs that eliminate tariff barriers among themselves while outsiders continue facing higher tariffs.

In recent decades, there has been a dramatic proliferation of preferential trade agreements (PTAs) between countries that, while legal, contradict the non-discrimination principle of the world trade system. This raises various issues, both theoretical and empirical, regarding the evolution of trade policy within the world trade system and the welfare implications for PTA members and non-members. The survey starts with the Kemp-Wan-Ohyama and Panagariya-Krishna analyses in the literature that theoretically show PTAs can always be constructed so that they (weakly) increase the welfare of members and non-members. Considerable attention is then devoted to recent developments on the interaction between PTAs and multilateral trade liberalization, focusing on two key incentives: an “exclusion incentive” of PTA members and a “free riding incentive” of PTA non-members. While the baseline presumption one should have in mind is that these incentives lead PTAs to inhibit the ultimate degree of global trade liberalization, this presumption can be overturned when dynamic considerations are taken into account or when countries can negotiate the degree of multilateral liberalization rather than facing a binary choice over global free trade. Promising areas for pushing this theoretical literature forward include the growing use of quantitative trade models, incorporating rules of origin and global value chains, modeling the issues surrounding “mega-regional” agreements, and modelling the possibility of exit from PTAs. Empirical evidence in the literature is mixed regarding whether PTAs lead to trade diversion or trade creation, whether PTAs have significant adverse effects on non-member terms-of-trade, whether PTAs lead members to lower external tariffs on non-members, and the role of PTAs in facilitating deep integration among members.

We show that multilateral tariff binding liberalization substantially impacts the nature and extent of Preferential Trade Agreement (PTA) formation. First, it shapes the nature of forces constraining expansion of Free Trade Agreements (FTAs). The constraining force is a free riding incentive of FTA non-members under relatively high bindings but an exclusion incentive of FTA members under relatively low bindings. Second, multilateral tariff binding liberalization shapes the role played by PTAs in the attainment of global free trade. Initially, tariff binding liberalization leads to Custom Union (CU) formation in equilibrium but in a way that undermines the pursuit of global free trade. However, further tariff binding liberalization leads to FTA formation in equilibrium and in a way that facilitates the attainment of global free trade. Our theoretical analysis also has implications regarding recent empirical discussions over the relative merits of FTAs versus CUs.

Current methods in psychiatric assessment and diagnosis are reviewed and critiqued. Problems encountered when evaluating causes and meanings of cognitive, affective, and behavioral symptoms are described. The ambiguous status of “disorder” in psychiatry and problems in the Diagnostic and Statistical Manual are discussed. Criteria used to classify affective, cognitive, and behavioral states as “disorders” vary widely across cultures and there is no consensus definition of what constitutes a “mental disorder.” The goals of the interview and formulation in integrative mental health care are described. Approaches widely used in Western medicine and CAM to assess mental health problems are described and their limitations are pointed out. Most CAM assessment approaches that have been carefully evaluated in Western-style research studies have resulted in findings that are not reproducible, sensitive, or specific. Novel practitioner-centered assessment approaches and emerging technologies will permit future integrative practitioners to capture information that is unattainable using contemporary biomedical assessment approaches. A general methodology is introduced for planning integrative assessment incorporating biomedical and CAM approaches. A methodology is introduced for determining the optimal individualized assessment strategy, that is, the strategy that will most reliably yield accurate and complete information about the causes and meanings of symptoms in a unique patient. Finally, important considerations when making clinical decisions on the type, number, and order of assessment approaches are discussed.

This chapter reviews competing models of consciousness and their implications for theory building in medicine and psychiatry. After millennia of observation, research, and debate, there is still no compelling evidence for any single model of consciousness nor is there agreement on how to define consciousness or what constitutes a rigorous model of consciousness. The strengths and limitations of popular models of consciousness are reviewed. Disparate metaphysical assumptions about the nature of reality and disparate perspectives on valid ways of knowing about reality translate into different schemata for characterizing attributes of body–brain. Some models rest on assumptions about mechanisms that cannot be examined using available empirical means and are thus not falsifiable. The reductionist framework imposed by mainstream science on consciousness research excludes quantum-level processes or other postulated nonclassical phenomena. However, emerging research findings suggest that nonclassical phenomena may play a significant role in consciousness.

This chapter reviews trends that are driving change in mental health care and offers near-term and long-term forecasts. Advances in the basic sciences are gradually transforming Western medicine into a more complete paradigm that is embracing advanced technologies and insights from the world’s great healing traditions. Innovations in assessment and treatment of mental health problems are being shaped by progress in neuroscience, genetics, artificial intelligence, and advanced technologies. Artificial intelligence (AI) software is already changing how physicians work with patients and how patients obtain care for mental health problems. This trend will continue and accelerate as AI applications become pervasive in industrialized countries. Irrespective of whether change is conservative or radical, advances in Western medicine and CAM will inevitably lead to innovations in mental health care resulting in a broader range of treatment choices and improvement in the current model of care delivery. Psychiatry as currently practiced will transition away from pharmacology as the dominant mode of treatment toward increasing reliance on advanced technologies for promoting optimal wellness and for assessing and treating mental illness. Increasing openness to new ways of thinking about mental health among both practitioners and patients is leading to a more integrative model of mental health care that draws evidence from biomedical psychiatry and CAM. In the coming decades, well before the end of the century, there will no longer be a rigid dichotomy between Western medical therapies and CAM modalities, and the terms “biomedicine” and “CAM” will no longer be used. Instead there will be “new medicine” and “old medicine.” Mental health care will evolve into individualized “whole person” care and will address complex biological, psychological, social, cultural, spiritual, and postulated energetic causes and meanings of mental illness. Changes that take place in this century will radically shift the paradigm of psychiatry from an emphasis on treatment of mental illnesses to an emphasis on optimizing emotional, cognitive, and behavioral functioning.

The limitations of current treatments in psychiatry are reviewed. As many as one half of individuals being treated for a psychiatric “disorder” fail to respond or respond only partially to psychotropic medications and other conventional Western medical treatments and are labeled “treatment-resistant” or “non-responders.” The role of placebo and nocebo effects in Western medicine and CAM is discussed. Safety, liability, and ethical issues in integrative mental health care are reviewed. Research findings are providing evidence for safety and efficacy of select CAM treatments of depressed mood, anxiety, and other mental health problems, including pharmaceutical-grade natural products, lifestyle modifications, and others. The major categories of CAM modalities used to treat mental health problems and to maintain wellness are introduced. The goals of integrative mental health care are described and safety and ethical issues are reviewed. A methodology for selecting appropriate modalities when planning integrative care is presented, including considerations of treatment precedence and treatment selection when managing moderate versus severe symptoms. Strategies are described for developing a realistic treatment plan that is both acceptable and affordable to the patient. The treatment plan should be reviewed and modified until the most effective realistic combination of Western medical and CAM treatments has been identified and successfully implemented. Methods are developed for refining and optimizing the integrative treatment plan and evaluating compatibility and synergy between two or more modalities. Considerations of ongoing care versus termination are discussed.

Common patterns of comorbidity in mental illness are described and mainstream approaches to managing complex cases with high comorbidity are reviewed. Depressed mood, anxiety, psychosis, bipolar disorder, post-traumatic stress disorder (PTSD), and other serious mental health problems often occur together (i.e., “are comorbid”) with substance abuse and medical problems. Mental health problems are also frequently comorbid with medical disorders in all age groups and may significantly impact the clinical course of medical illness and response to treatment. Complex presentations involving two or more serious mental health problems and comorbid substance abuse or a medical problem are often poorly responsive to pharmaceuticals and other Western medical treatments. Managing complex cases calls for multitiered treatment planning incorporating evidence from a wide range of Western medical and CAM modalities. There is currently no agreement within Western medicine or non-Western systems of medicine on how to manage complex cases with high comorbidity. Complex patients with serious mental health problems and comorbid substance abuse or medical problems respond better and more rapidly when managed by a team of practitioners using a collaborative care model. The methodology developed in previous chapters is expanded to address complex cases with high comorbidity including co-occurring psychiatric disorders, substance abuse and medical problems. Important clinical considerations involved in managing complex patients are reviewed. The goal of parsimony is to identify the simplest care plan that adequately addresses all medical, mental health and substance use problem(s). The uses of the evidence tables and algorithms for planning integrative mental health care involving highly comorbid cases are described. The chapter concludes with a detailed case vignette that includes the rationale for recommendations made during different phases of treatment.

The problem of evidence in medicine is discussed. Criteria are introduced for assigning levels of evidence to CAM modalities. In Western medicine findings from laboratory studies comprise the highest level of evidence for a putative mechanism of action and the relationship between “treatment” and “outcomes.” In contrast, in non-Western systems of medicine “evidence” reflects the values and beliefs of the parent culture. Important differences between quantitative and qualitative evidence are described. Special problems pertaining to literature research on CAM are discussed including how to formulate a question, identifying resources most likely to yield pertinent information on a particular subject, and using methods for optimizing and streamlining literature research. A clearly phrased question is the basis for any literature search. If the question is ambiguous or unfocused important resources will be overlooked, and relevant information will be missed. Valuable web-based resources are identified and practical tips are provided for obtaining current reliable information. Techniques for using prefiltered databases and evidence mapping are reviewed. The concepts of the evidence table and the algorithm are introduced. A methodology is proposed for using these tools when planning integrative mental health care. The accuracy and quality of information put into an algorithm will determine the effectiveness and relevance of clinical solutions generated by it for each unique patient. The optimal integrative care plan for a patient depends on history, symptoms, circumstances, preferences, and financial constraints in the context of locally available health care resources, and the professional judgment and clinical experience of the practitioner. The chapter concludes with a discussion of advances in artificial intelligence (AI) software and AI’s implications for the future of mental health care.

Current research and clinical methodologies in mental health care are reviewed and critiqued. Randomized controlled trials and other quantitative research designs do not adequately address complex synergistic mechanisms involved in many Western medical and CAM interventions. Treatment planning in Western medicine generally overlooks evidence for CAM modalities, and treatment planning in non-Western systems of medicine generally excludes evidence for Western medical approaches. The limitations of evidence-based medicine are discussed. Practice-based evidence is an important concept in personalized medicine that is emerging in response to the limitations of EBM. Novel research methodologies and their potential applications to studies on CAM and integrative modalities are described. Different research questions pertaining to Western medicine, CAM, or integrative medicine call for a variety of research methodologies. The limitations and benefits of different research designs should always guide the choice of study design especially when complex, multilevel interventions are being investigated. Mixed methods research designs that combine quantitative and qualitative research methods may help elucidate complex dynamic interactions between synergistic factors that influence outcomes in response to integrative treatment regimens. Methods for determining outcomes in clinical integrative mental health care are described including measures of cost-effectiveness, cost–utility analysis, and cost–benefit analysis. Finally, recent innovations in expert panels and their implications for more effective, more cost-effective, and more individualized clinical guidelines are discussed.

Circumstances that have led to a crisis in mental health care in the USA and globally are discussed. Limited effectiveness, safety problems, and high costs of many psychotropic medications have resulted in an urgent mandate for safer, more effective, and more affordable treatments of mental illness. The conventional Western model of mental health care delivery is limited in its capacity to alleviate the root causes of mental illness because its theories and methods address only some of the complex causes of symptoms. Trends driving increasing acceptance of complementary and alternative medicine (CAM) by the general public, patients, and health care providers are reviewed. Western medicine is being influenced by increasing openness to non-Western healing traditions and growing demand for more personalized care. In industrialized world regions there is a trend toward eclectic training among mental health care providers many of whom use or recommend CAM modalities in their clinical practice. Individuals who report a mental health problem are significantly more likely to use CAM compared to the general population and individuals with more severe symptoms are more likely to combine Western medical treatments and CAM. Integrative mental health care incorporating validated CAM modalities into mainstream treatment is an emerging paradigm that more adequately addresses the complex causes of mental illness than current mainstream treatments and models of care while resulting in significant potential cost savings. By combining select conventional and CAM treatments on a case-by-case basis integrative mental health care offers more advantages compared to any particular conventional or CAM modality or any single system of medicine.

We develop a new theoretical political economy framework called a ‘parallel contest’ that emphasizes the political fight over trade agreement (TA) ratification within countries. TA ratification is inherently uncertain in each country because anti- and pro-trade interests contest each other to influence their own government's ratification decision. As in the terms-of-trade theory of TAs, the TA removes terms-of-trade externalities created by unilateral tariffs. But, a TA also creates new terms-of-trade and local-price externalities in our framework due to endogenous ratification uncertainty combined with the requirement that each country ratify the TA for it to go ahead. Thus, reciprocal TA liberalization fails to eliminate all terms-of-trade externalities.

Conventional wisdom says that tariffs are counter-cyclical. We analyze the relationship between business cycles and applied MFN tariffs using a disaggregated product-level panel dataset covering 72 countries between 2000 and 2011. Strikingly, and counter to conventional wisdom, we find that tariffs are pro-cyclical. Further investigation reveals that this pro-cyclicality is driven by the tariff setting behavior of developing countries; tariffs are acyclical in developed countries. We present evidence that pro-cyclical market power drives the pro-cyclicality of tariffs in developing countries, providing further evidence of the importance of terms of trade motivations in explaining trade policy.

In the presence of multilateral negotiations, are Free Trade Agreements (FTAs) necessary for, or will they prevent, global free trade? I answer this question using a dynamic farsighted model of network formation among asymmetric countries. Ultimately, FTAs prevent global free trade when there are two larger countries and one smaller country but FTAs can be necessary for global free trade when there are two smaller countries and one larger country. The model provides insights into the dynamics of recent real-world negotiations and recent results in the literature on the empirical determinants of trade agreements. (JEL C71, F12, F13)

Governments, especially in developing countries, routinely practice binding overhang (i.e. setting applied tariffs below binding WTO commitments) and frequently move applied tariffs for given products up and down over the business cycle. Moreover, applied tariffs are pro-cyclical in developing countries. We explain this phenomenon using a dynamic theory of lobbying between domestic interest groups. Applied tariffs are pro-cyclical when high-tariff interests (e.g. import-competing industries) capture the government: these groups concede lower tariffs to low-tariff interest groups (e.g. exporting firms or firms using imported intermediate inputs) during recessions because recessions lower the opportunity cost of lobbying and thereby generate a stronger lobbying threat.

When governments impose a quota or tariff on imports, it is well known that the resulting rents and revenues trigger costly rent-seeking and revenue-seeking activities, which are welfare-reducing and may be economically more significant than the efficiency losses resulting from the protectionist-induced resource misallocation. Repeated interaction among firms can eliminate wasteful rent- and revenue-seeking expenditures through cooperation. We show that while aggregate outcomes are equivalent under tariffs and quotas if cooperation arises, the conditions under which cooperation arises differ by policy. This difference arises because a firm must incur additional cost to physically import and distribute the goods associated with additional quota licenses, whereas there is no such cost when it comes to consuming additional tariff revenue. Thus, quotas and tariffs are non-equivalent. We provide a simple sufficient condition under which cooperative elimination of rent-seeking under quotas is easier than cooperative elimination of revenue-seeking under tariffs and therefore a quota is the preferred policy whenever the policy admits cooperation.

Post-traumatic stress disorder (PTSD) may be the most urgent problem the U.S. military is facing today. Pharmacological and psychological interventions reduce the severity of some PTSD symptoms however these conventional approaches have limited efficacy. This issue is compounded by the high rate of co-morbid traumatic brain injury (TBI) and other medical and psychiatric disorders in veterans diagnosed with PTSD and unresolved system-level problems within the Veterans Administration and Department of Defense healthcare services that interfere with adequate and prompt care for veterans and active duty military personnel. This paper is offered as a framework for interdisciplinary dialogue and collaboration between experts in biomedicine and CAM addressing three primary areas of need: resiliency training in high risk military populations, prevention of PTSD following exposure to combat-related trauma, and treatment of established cases of PTSD. The evidence for widely used conventional pharmacological and psychological interventions used in the VA/DOD healthcare systems to treat PTSD is reviewed. Challenges and barriers to adequate assessment and treatment of PTSD in military personnel are discussed. A narrative review of promising CAM modalities used to prevent or treat PTSD emphasizes interventions that are not widely used in VA/DOD clinics and programmes. Interventions reviewed include virtual reality graded exposure therapy (VRGET), brain–computer interface (BCI), EEG biofeedback, cardiac coherence training, EMDR, acupuncture, omega-3 fatty acids and other natural products, lucid dreaming training, and energy therapies. As meditation and mind-body practices are widely offered within VA/DOD programmes and services addressing PTSD the evidence for these modalities is only briefly reviewed. Sources included mainstream medical databases and journals not currently indexed in the mainstream medical databases. Although most interventions discussed are applicable to both civilian and military populations the emphasis is on military personnel. Provisional integrative guidelines are offered with the goal of providing a flexible and open framework when planning interventions aimed at preventing or treating PTSD based on the best available evidence for both conventional and CAM approaches. The paper concludes with recommendations on research and policy within the VA and DOD healthcare systems addressing urgent unmet needs associated with PTSD.

Data on campaign contributions of PACs (political action committees) in the US does not contain the PACs' issues of concern. Additionally, while recent US lobbying data details the issues of concern for an interest group, it does not detail the Congressional representatives lobbied by the interest group. Expanding the time-frame of earlier work, I confirm that PACs engaging in lobbying and campaign contributions account for the majority of such political money despite representing a small minority of all PACs. I show how this allows the construction of a novel dataset that decomposes representative-specific contributions across issues as well as issue-specific lobbying expenditures across representatives. This decomposition can qualitatively affect results regarding the relationship between political money and Congressional voting behavior on trade policy.

Current treatments and the dominant model of mental health care do not adequately address the complex challenges of mental illness, which accounts for roughly one-third of adult disability globally. These circumstances call for radical change in the paradigm and practices of mental health care, including improving standards of clinician training, developing new research methods, and re-envisioning current models of mental health care delivery. Because of its dominant position in the US health care marketplace and its commitment to research and innovation, Kaiser Permanente (KP) is strategically positioned to make important contributions that will shape the future of mental health care nationally and globally.This article reviews challenges facing mental health care and proposes an agenda for developing a collaborative care model in primary care settings that incorporates conventional biomedical therapies and complementary and alternative medicine approaches. By moving beyond treatment delivery via telephone and secure video and providing earlier interventions through primary care clinics, KP is shifting the paradigm of mental health care to a collaborative care model focusing on prevention. Recommendations are to expand current practices to include integrative treatment strategies incorporating evidence-based biomedical and complementary and alternative medicine modalities that can be provided to patients using a collaborative care model. Recommendations also are made for an internal research program aimed at investigating the efficacy and cost-effectiveness of promising complementary and alternative medicine and integrative treatments addressing the complex needs of patients with severe psychiatric disorders, many of whom respond poorly to treatments available in KP mental health clinics.

Mental illness accounts for about one-third of adult disability globally, reflecting marked societal and personal suffering, and enormous social and economic costs. On a global level, mental healthcare has failed to adequately address urgent unmet needs of the mentally ill. These circumstances call for change in the paradigm and practices of mental healthcare, including fundamental reforms in education, clinician-training, and research priorities. This White Paper outlines current challenges in mental healthcare, and characterizes the emerging field of Integrative Mental Health (IMH), a critical element in the large-scale changes needed to transform mental healthcare in the 21st century. Strategic recommendations for advancing IMH are outlined including increasing research in key areas, improving clinician training and education, and promoting a public health agenda. The field of IMH adopts the bio-psycho-socio-spiritual model, utilizing evidence-based and evidence-guided treatments from both traditional healing systems and modern scientific practices. IMH incorporates mainstream interventions including the judicious use of psychopharmacology and psychosocial therapies, in addition to evidence-based complementary and alternative (CAM) medicines and therapies, and health-promoting lifestyle changes (i.e. enhancement of dietary, exercise, sleep, work/relaxation patterns). The clinical application of IMH takes into account the range of socio-cultural, economic and spiritual considerations affecting mental healthcare practice in different countries. To meet the challenges facing mental healthcare, the International Network of Integrative Mental Health (INIMH: www.INIMH.org) was established in 2010 (officially launched in October 2012) with the objective of creating an international organization consisting of clinicians, researchers, educators, and public health advocates. INIMH was created to advance a global agenda for research, education and the clinical practice of evidence-based integrative mental healthcare. In authoring this White Paper, the board of INIMH is inviting global dialogue on critical issues surrounding mental health care in the hope of achieving integrated, compassionate, individualized, person-centered mental healthcare.

The HOPE mass spectrometer of the Radiation Belt Storm Probes (RBSP) mission (renamed the Van Allen Probes) is designed to measure the in situ plasma ion and electron fluxes over 4π sr at each RBSP spacecraft within the terrestrial radiation belts. The scientific goal is to understand the underlying physical processes that govern the radiation belt structure and dynamics. Spectral measurements for both ions and electrons are acquired over 1 eV to 50 keV in 36 log-spaced steps at an energy resolution ΔE FWHM/E≈15 %. The dominant ion species (H+, He+, and O+) of the magnetosphere are identified using foil-based time-of-flight (TOF) mass spectrometry with channel electron multiplier (CEM) detectors. Angular measurements are derived using five polar pixels coplanar with the spacecraft spin axis, and up to 16 azimuthal bins are acquired for each polar pixel over time as the spacecraft spins. Ion and electron measurements are acquired on alternate spacecraft spins. HOPE incorporates several new methods to minimize and monitor the background induced by penetrating particles in the harsh environment of the radiation belts. The absolute efficiencies of detection are continuously monitored, enabling precise, quantitative measurements of electron and ion fluxes and ion species abundances throughout the mission. We describe the engineering approaches for plasma measurements in the radiation belts and present summaries of HOPE measurement strategy and performance.

There are important ethnic variations in metabolism, response, and tolerability of psychotropic medications. There has been a dramatic expansion of use of psychotropic medications in children in recent years. This article reviews the literature on the role of race and ethnicity in psychopharmacology as it relates to children and adolescents, examines what is known thus far about complementary and alternative medicine approaches in pediatric psychopharmacology, and presents a method to engage patients and families of varying educational and cultural backgrounds in pharmacotherapeutic treatment.

Objective To review selected complementary and alternative medicine (CAM) treatments for major depressive disorder (MDD). Participants Authors of this report were invited participants in the American Psychiatric Association's Task Force on Complementary and Alternative Medicine. Evidence The group reviewed the literature on individual CAM treatments for MDD, methodological considerations, and future directions for CAM in psychiatry. Individual CAM treatments were reviewed with regard to efficacy in MDD, as well as risks and benefits. Literature searches included MEDLINE and PsycINFO reviews and manual reference searches; electronic searches were limited to English-language publications from 1965 to January 2010 (but manual searches were not restricted by language). Treatments were selected for this review on the basis of (1) published randomized controlled trials in MDD and (2) widespread use with important clinical safety or public health significance relevant to psychiatric practice. An action plan is presented based on needs pertaining to CAM and psychiatry. Consensus process Consensus was reached by group conferences. Written iterations were drafted and sent out among group members prior to discussion, resolution of any differences of interpretation of evidence, and final approval. Conclusions A review of randomized controlled trials for commonly used CAM treatments such as omega-3 fatty acids, St John's wort (Hypericum), folate, S-adenosyl-L-methionine (SAMe), acupuncture, light therapy, exercise, and mindfulness psychotherapies revealed promising results. More rigorous and larger studies are recommended. Each CAM treatment must be evaluated separately in adequately powered controlled trials. At this time, several CAM treatments appear promising and deserve further study. The greatest risk of pursuing a CAM therapy is the possible delay of other well-established treatments. Clinical, research, and educational initiatives designed to focus on CAM in psychiatry are clearly warranted due to the widespread use of CAM therapies.

The causes of mental illness remain obscure in spite of rapid progress in the neurosciences. This is due in part to the fact that contemporary biomedical psychiatry rests on philosophically and scientifically ambiguous ground. In Western medicine paradigms, theories from physics, chemistry, and biology form the basis of an explanatory model of illness, including mental illness. Symptoms are conceptualized as subjective descriptions of effects caused by factors characterized in empirical terms. Conventional biomedicine asserts that all causes of illness, and by extension, mechanisms of action underlying legitimate treatment approaches, rest on biological processes that can be described in the reductionist language of Western science. However, in contemporary Western psychiatry, there is no single adequate explanatory model of the causes of mental illness. What remains are competing psychodynamic, genetic, endocrinologic, and neurobiological models of symptom formation reflecting disparate ideological positions and diverse clinical training backgrounds of mental health professionals. There is no unifying theory in psychiatry because no single explanatory model has been confirmed as more valid than any other. I hypothesize in this article that the synthesis of ideas and clinical approaches from Western biomedicine and non-Western systems of medicine based on understandings of human consciousness, the neurosciences, complexity theory, and quantum field theory, will lead to rapid evolution of conventional Western biomedical psychiatry toward truly integrative mental healthcare. The result will be the emergence of an integrative mental healthcare model that will more adequately address the disparate causes, conditions, and meanings of symptoms combining multimodal approaches from Western biomedicine and non-Western systems of medicine.

Casual observation reveals a striking phenomenon of Preferential Trade Agreements (PTAs): while Customs Unions (CUs) are only intra-regional, Free Trade Agreements (FTAs) are inter and intra-regional. Using a farsighted dynamic model, we endogenize the equilibrium path of PTAs among two close countries and one far country. Rising transport costs mitigate the cost of discrimination faced by the far country as a CU non-member and diminish the value of preferential access as a CU member. Thus, sufficiently large transport costs imply that an FTA is the only type of PTA that can induce the far country's participation in PTA formation. Unlike CU formation, FTA formation can induce participation because FTAs provide a flexibility benefit: an FTA member can form further PTAs with non-members but a CU member must do so jointly with all existing members. Hence, in equilibrium, CUs are intra-regional while FTAs are intra- and inter-regional.

Objective To determine if the available data support the use of omega-3 essential fatty acids (EFA) for clinical use in the prevention and/or treatment of psychiatric disorders. Participants The authors of this article were invited participants in the Omega-3 Fatty Acids Subcommittee, assembled by the Committee on Research on Psychiatric Treatments of the American Psychiatric Association (APA). Evidence Published literature and data presented at scientific meetings were reviewed. Specific disorders reviewed included major depressive disorder, bipolar disorder, schizophrenia, dementia, borderline personality disorder and impulsivity, and attention-deficit/hyperactivity disorder. Meta-analyses were conducted in major depressive and bipolar disorders and schizophrenia, as sufficient data were available to conduct such analyses in these areas of interest. Consensus process The subcommittee prepared the manuscript, which was reviewed and approved by the following APA committees: the Committee on Research on Psychiatric Treatments, the Council on Research, and the Joint Reference Committee. Conclusions The preponderance of epidemiologic and tissue compositional studies supports a protective effect of omega-3 EFA intake, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), in mood disorders. Meta-analyses of randomized controlled trials demonstrate a statistically significant benefit in unipolar and bipolar depression (p = .02). The results were highly heterogeneous, indicating that it is important to examine the characteristics of each individual study to note the differences in design and execution. There is less evidence of benefit in schizophrenia. EPA and DHA appear to have negligible risks and some potential benefit in major depressive disorder and bipolar disorder, but results remain inconclusive in most areas of interest in psychiatry. Treatment recommendations and directions for future research are described. Health benefits of omega-3 EFA may be especially important in patients with psychiatric disorders, due to high prevalence rates of smoking and obesity and the metabolic side effects of some psychotropic medications.