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Methamphetamine has been consistently associated with positive psychotic symptoms, but little is known about whether the reverse also occurs.
This study determined whether the relationship between methamphetamine use and positive psychotic symptoms is bidirectional over 12 months. The impact of lifetime psychotic disorders and methamphetamine dependence on these relationships was also examined.
A total of 201 regular (at least monthly) primary methamphetamine users were recruited from free needle and syringe programmes in three Australian cities. Data on the frequency of methamphetamine and other drug use (from Timeline Followback inteviews) and the severity of positive psychotic symptoms (using the Brief Psychiatric Rating Scale) in the past 2 weeks were collected in 12 contiguous monthly face-to-face interviews (mean of 9.14/11 (s.d. = 3.16) follow-ups completed). Diagnoses were derived using the Psychiatric Research Interview for DSM-IV Substance and Mental Disorders.
The mean age of participants was 31.71 years (s.d. = 8.19) and 39% (n = 77) were women. At baseline 55% (n = 110) were dependent on methamphetamine and 51% (n = 102) had a lifetime psychotic disorder. Cross-lagged dynamic panel models found a significant bidirectional relationship between psychotic symptoms and methamphetamine use (Comparative Fit Index (CFI) = 0.94, standardised root mean square residual (SRMR) = 0.05, root mean square error of approximation (RMSEA) = 0.05, 95% CI 0.04–0.06). The magnitude of the relationship in each direction was similar, and the presence of methamphetamine dependence or a lifetime psychotic disorder did not have an impact on results.
A dynamic, bidirectional relationship between methamphetamine and psychotic symptoms of similar magnitude in each direction was found over 1 year. This suggests integrated treatments that target methamphetamine, psychotic symptoms and their interrelationship may be of most benefit.
A wave of recent research challenges the role of regime type in international relations. One striking takeaway is that democratic and autocratic leaders can often achieve similar levels of domestic constraint, which in many issue areas results in similar international outcomes—leading many to question traditional views of democracies as distinctive in their international relations. In this review essay, we use recent contributions in the field to build what we call a “malleable constraints” framework, in which all governments have an institutionally defined default level of domestic audience constraint that is generally higher in democracies, but leaders maintain some agency within these institutions and can strategically increase their exposure to or insulation from this constraint. Using this framework, we argue that regime type is still a crucial differentiator in international affairs even if, as recent studies suggest, democratic and autocratic leaders can sometimes be similarly constrained by domestic audiences and thus achieve similar international outcomes. This framework helps reconcile many competing claims in recent scholarship, including the puzzle of why autocracies do not strategically increase domestic audience constraint more often. Just because autocracies can engage audience constraints and democracies can escape them does not mean that they can do so with equal ease, frequency, or risk.
To explore the opinions of the UK consultant body on endoscopic Eustachian tube balloon dilatation in the context of Eustachian tube dysfunction.
A 10-question online survey was distributed to ENT consultants currently practising in the UK (July–September 2018).
A total of 137 ENT consultants responded. Twenty-three per cent reported experience of Eustachian tube balloon dilatation, with a further 10 per cent planning to start performing the procedure. Of those performing the procedure, 16 per cent had more than two years’ experience. Thirty-two per cent were performing zero to five procedures a year. Eustachian tube balloon dilatation was primarily conducted to treat Eustachian tube dysfunction symptoms, as well as retraction pockets, baro-challenge-induced Eustachian tube dysfunction and otitis media with effusion. The most common reason for not undertaking Eustachian tube balloon dilatation was insufficient evidence of efficacy (65 per cent). Seventy-two per cent of consultants thought that creating a national database for audit and monitoring purposes would benefit the specialty.
The majority of UK ENT consultants do not practise Eustachian tube balloon dilatation, citing a lack of high-level evidence to support its use. A national database for auditing and research could facilitate the creation of guidelines.
Human immunodeficiency virus infected patients have a three-fold increased risk of head and neck squamous cell carcinoma. The British HIV Association recommends human immunodeficiency virus testing in all new diagnoses of head and neck squamous cell carcinoma.
This observational study aimed to examine the current routine practice of human immunodeficiency virus testing in patients with newly diagnosed head and neck squamous cell carcinoma, and to address the importance of this test in promoting the early diagnosis and treatment of human immunodeficiency virus.
All head and neck cancer multidisciplinary teams in England were questioned on their protocol for human immunodeficiency virus testing in new diagnoses of head and neck squamous cell carcinoma.
Only 1 out of 30 hospitals leading head and neck multidisciplinary teams (3.3 per cent) routinely offered human immunodeficiency virus testing in this high-risk patient group.
This observational study highlights that head and neck specialists are not aware of, and are consequently not complying with, routine human immunodeficiency virus testing as recommended by the British HIV Association guidelines.
All courts perform functions of a broadly constitutional kind. They provide a key mechanism for ensuring compliance with law and the peaceful resolution of disputes between people, according to law. Viewed from this perspective, they are integral to the capacity of a state to carry out its responsibility to establish and maintain internal peace and security.1 In one form or another, courts also are likely to be the forum for the resolution of that most challenging category of legal disputes: enforcing compliance with law by the institutions of the state itself. In each of these respects, courts are central to the rule of law. They may be analysed in terms of separation of powers or representative democracy, as well, where these are features of the constitution of the state.
Genetically informative research designs are becoming increasingly popular as a way to strengthen causal inference with their ability to control for genetic and shared environmental confounding. Co-twin control (CTC) models, a special case of these designs using twin samples, decompose the overall effect of exposure on outcome into a within- and between-twin-pair term. Ideally, the within-twin-pair term would serve as an estimate of the exposure effect controlling for genetic and shared environmental factors, but it is often confounded by factors not shared within a twin-pair. Previous simulation work has shown that if twins are less similar on an unmeasured confounder than they are on an exposure, the within-twin-pair estimate will be a biased estimate of the exposure effect, even more biased than the individual, unpaired estimate. The current study uses simulation and analytical derivations to show that while incorporating a covariate related to the nonshared confounder in CTC models always reduces bias in the within-pair estimate, it will be less biased than the individual estimate only in a narrow set of circumstances. The best case for bias reduction in the within-pair estimate occurs when the within-twin-pair correlation in exposure is less than the correlation in the confounder and the twin-pair correlation in the covariate is high. Additionally, the form of covariate inclusion is compared between adjustment for only one’s own covariate value and adjustment for the deviation of one’s own value from the covariate twin-pair mean. Results show that adjusting for the deviation from the twin-pair mean results in equal or reduced bias.
No standardized surveillance criteria exist for surgical site infection after breast tissue expander (BTE) access. This report provides a framework for defining postaccess BTE infections and identifies contributing factors to infection during the expansion period. Implementing infection prevention guidelines for BTE access may reduce postaccess BTE infections.
Romance has most often been viewed as an escapist mode, comparable to contemporary fantasy and romantic fiction. Northrop Frye characterises romance as ‘secular scripture’, built on universal human desires and archetypal patterns – a genre, one might suppose, with little space for the law. Yet medieval romance is fluid and various: writing in ‘romanz’, the vernacular, only gradually came to have generic associations. Subjects range from classical to historical to legendary, linked most of all by recurring motifs: love, adventure, the supernatural. Often exotic and fantastical, romance is also profoundly concerned with social contexts, and this balance between mimetic and non-mimetic is acutely evident in its engagement with law. Middle English romances reflect a growing ‘legal consciousness’ that shapes ‘values, beliefs and aspirations’ and ‘provid[es] a reserve of knowledge, memory and reflective thought’. Their treatment of legal concepts and processes can be remarkably specific, while the idea of ‘good laws’ also informs their deep structures, founded on notions of order, honour and right. Romances repeatedly dramatise issues of inheritance and outlawry, accusations of felony and treason, trials by combat and ordeal, oaths and contracts, and debates over property and marriage. In Malory’s Morte Darthur, these motifs are woven into a tragic disquisition on the need for social order founded on good laws.
The discovery of a tenth-century AD high-status burial at Prague Castle in 1928 led to multiple identifications in the context of two world wars and the Cold War. Recognised variously as both a Viking and Slavonic warrior according to Nazi and Soviet ideologies, interpretation of the interred individual and associated material culture were also entangled with the story of the burial's excavator, the remains and commemorative monuments of two Czech Unknown Soldiers and the creation of the Czechoslovak state. This epic narrative reflects the circumstances of Czechoslovakia and Central Europe across the twentieth century.
Tebufenozide (Mimic) kills Lepidoptera larvae that ingest it. Aerial applications of tebufenozide were made against spruce budworm (Choristoneura fumiferana (Clemens)) (Lepidoptera: Tortricidae) in boreal forest in Manitoba, Canada, in 1999 and 2000. In 2000 and 2001, moths in sprayed and unsprayed plots were sampled with light traps; trapping was supplemented by foliage sampling. Relative to unsprayed plots, catches of spruce budworm moths in plots sprayed in 1999 and 2000 were depressed in 2000, but not in 2001. Host tree defoliation was reduced in 2000 by 1999 and 2000 applications; the 2000 application reduced numbers of spruce budworm larvae in 2000 and 2001. Multivariate analysis revealed negative effects of tebufenozide application on two species of non-target moths in 2000 and no negative effects in 2001. Negatively affected species have larvae feeding in the tree canopy at the time of spray application. Higher catches of non-target species in sprayed treatments were observed for three species in 2000 and two species in 2001. We conclude that tebufenozide can depress the numbers of spruce budworm larvae and provide foliage protection during the year of application and the following year, and that negative effects on non-target species are detectable for about 15 months after application.
Chaucer treats the subject of love in many forms and across genres from fabliau to romance, with a unique variety and flexibility. His works draw on classical, continental and English traditions; on courtly and chivalric ideals and practices; and the tropes of Christianity. It is often in the reshaping, adapting and undercutting of material and motifs that the originality of Chaucer’s works lies. In exploring love, Chaucer also probes the psychology of loss and grief, the physiology of love, the paradoxes of fin’ amor, and the ways in which love can open onto the sublime. Chaucer’s treatment of love is intimately connected with questions of gender, in particular, the possibilities of female agency and voice. This essay makes reference to a range of Chaucer’s works, in the context of their sources and analogues, but focuses in particular on his romance narratives, The Book of the Duchess, The Legend of Good Women, The Knight’s Tale and Troilus and Criseyde.
Donald Trump promised to build a wall along the US–Mexico border and to make Mexico pay for it, but this seems to violate the principle of ‘no taxation without representation’ on which the United States was founded. Some democratic theorists propose even more radical principles of inclusion, such as that all those affected by or subject to a decision should have a say in it. But even a more moderate principle, requiring that those who pay must be represented, is sufficient to show that Trump's proposed border wall lacks democratic legitimacy.
Patients with congenital diaphragmatic hernias often have concomitant congenital heart disease (CHD), with small left-sided cardiac structures as a frequent finding. The goal of this study is to evaluate which left-sided heart structures are affected in neonates with congenital diaphragmatic hernias.
Retrospective review of neonates between May 2007 and April 2015 with a diagnosis of a congenital diaphragmatic hernia was performed. Clinical and echocardiographic data were extracted from the electronic medical record and indexed to body surface area and compared to normative values. Univariable regression models assessed for associations between different variables and length of stay.
Data of 52 patients showed decreased mean z scores for the LVIDd (–3.16), LVIDs (–3.05), aortic annulus (–1.68), aortic sinuses (–2.11), transverse arch (–3.11), and sinotubular junction (–1.47) with preservation of the aorta at the diaphragm compared to age-matched normative data with similar body surface areas. Regression analysis showed a percent reduction in length of stay per 1 mm size increase for LVIDd (8%), aortic annulus (27%), aortic sinuses (18%), sinotubular junctions (20%), and transverse arches (25%).
Patients with congenital diaphragmatic hernias have significantly smaller left-sided heart structures compared to age-matched normative data. Aortic preservation at the diaphragm provides evidence for a mass effect aetiology with increased right-to-left shunting at the fetal ductus resulting in decreased size. Additionally, length of stay appears to be prolonged with decreasing size of several of these structures. These data provide quantitative evidence of smaller left-sided heart structures in patients with congenital diaphragmatic hernias.
THE MATERIAL AND LITERARY WORLDS of the medieval period remain richly alive in the twenty-first century. Can lived inner experience also speak across the centuries? Julia Boffey describes evocatively ‘the difficulty of writing about individual inner lives without many of the written sources available for more recent periods’; yet, she suggests, ‘the pendulum may be swinging the other way’. Boffey's recent research has extended her seminal work on the fifteenth century to chronicle and life-writing. The Book of Margery Kempe speaks in unique ways to the exploration of inner lives, as well as to Boffey's interests in the intellectual contexts of books. It is a book of feeling, shaped by but also startlingly different from the books Kempe knew. Its powerful affect has surprised, compelled and alienated its readers. ‘Wondirful revelacyons’, the moving of the soul through visionary experience, are the subject of Kempe's narrative. The Book is shaped by the struggle to discern the cause and meaning of such experience, and the challenge to interpret and convey it. Read as an inner life, it is newly animated.
The anxieties and risks of Kempe's book have coloured readers’ perceptions, sometimes evoking unease. When rediscovered in 1934, the Book proved startlingly different from the pamphlet of extracts printed by Wynkyn de Worde (c.1501, STC 14924), reprinted by Henry Pepwell as one of seven mystical treatises in The Cell of Self-Knowledge (1521, STC 20972). Pepwell's characterization of Margery as ‘devout ancress’ was difficult for Hope Emily Allen, one of her first editors, to sustain: ‘[the Book] does give remarkably elevated spiritual passages, but they are interspersed with others highly fanatical’. Allen uses theories of Kempe as neurotic to explain her ‘suggestibility’ and reflection of ‘the highly spiritualised ideals of piety in her world’. Twentiethcentury feminist scholarship, eager to discard the label ‘hysteric’, shifted the focus from interior to exterior, to claim Kempe as proto-feminist, a woman who refused to ‘go spynne and carde [wool] as other women don’ (4330–1).
This article examines issues of island sovereignty and lighthouse administration in maritime Southeast Asia in the context of post-war decolonisation. It does so by demonstrating how lax and complacent colonial governance in British North Borneo led to the construction of a lighthouse on contested island territory. By the late 1940s these islands became the focal point of a regional dispute between the Philippines, North Borneo's colonial government, and the United Kingdom. While lighthouses were, in the colonial mind-set, deemed essential for illuminating the coasts and projecting order onto the seas, the Philippine government sought to renege on colonial-era obligations and wrest a new sense of post-colonial legitimacy.
The legacy of the Turtle Island transfer was therefore significant in recalibrating imperial lighting in the Sulu Sea, as well as giving rise to a Philippine post-colonial authority that was characterised by an acknowledgement of indigenous Suluk maritime heritage. Similarly, it reflected an extension of previous instances of transnational disputes in the region, where the island shoal had been simultaneously claimed and administered by the United States, the United Kingdom and the historical Sulu Sultanate. While the lighthouse remained destroyed, and the seas dimmed, by mid-1948 the Turtle Islands had attained a new post-colonial and transnational status. Utilising a range of archival sources, memoirs and published material, this article sheds light on an under-examined period of Southeast Asian history.
More than 4000 Indigenous Australian students enrol and take up a placement at boarding school each year. While reasons for attending boarding school vary, the impetus for many remote and very remote-dwelling students is restricted secondary educational opportunities in their home communities. A large multi-site study is being undertaken across Queensland to understand the conditions required for these students to be resilient while studying away from home. This paper reports on levels of student satisfaction with Queensland Department of Education's Transition Support Service (TSS) that provide assistance to remote-dwelling Indigenous students in the transition to boarding schools. A survey instrument administered to students included 22 close-ended questions to elicit levels of student satisfaction with TSS. Data were collected electronically using SurveyMonkey™ and analysed in SPSS v24. Descriptive statistics were calculated for variables assessing service support, student perceptions and experiences. A total of 294 primary, secondary and re-engaging students across 21 sites responded. Nearly all primary students (97%) anticipated that TSS would assist their move to boarding school. All secondary students identified that TSS had assisted their transition to boarding school. All re-engaging students agreed that TSS support had increased their capacity to cope when things go wrong. Lower scores related to students’ ability to access TSS when needed. Very high levels of satisfaction with TSS were countered by constraints of distance between TSS and students, and resources available to support the work of TSS. Findings point to the need for equitable provision of transition services in Queensland that emphasise the importance of relationship between service provider and student, and can inform the design of similar transition services across Australia.