To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
My chapter takes our old friend Southey as a new “context” for Byron: not the well-known target of satiric abuse, but in surprises of sympathy, as an accidental muse for Byron’s voice. This may seem ultra-counterintuitive for the famous butt of brutal, hilarious Byronic ridicule. The debut was English Bards and Scotch Reviewers (begun October 1807, published 1809): hailing the poet of ponderous Epics (CPWI: 230, l. 25), the relentless Ballad-monger, the plodding long-winded Bard (CPWI: 231–3, ll. 86–118). Southey wasn’t the lone star in the abuse. It was a constellation, including Lakers Wordsworth and Coleridge. The irritation of Wordsworth’s poetry was sharpened in the Regency for Byron by Wordsworth himself, his Tory-turn thanked with a patronage post. As for Coleridge, Byron apologized in 1815 for the “pert, petulant, and shallow” satire in English Bards (BLJ 4: 286), and stayed true to the best of the poet. Coleridge would stand by his Lordship in the Byrons’ separation scandal of 1816, with an essay in the April 18 Courier (unsigned, the author was legible to Byron). Rapt by the “pathos and tenderness” of Byron’s “Fare Thee Well” to Lady Byron (privately circulated, quickly pirated), Coleridge defended its “touching and affecting” verses against charges of “affectation” and “hypocrisy.” Byron had helped him financially, supported his playwriting, and persuaded John Murray (his own publisher) to issue a slim volume of Coleridge’s poetry. This came out in May, leading with Christabel, the poem Wordsworth rejected, years ago, for Lyrical Ballads. Byron had read it in manuscript and praised it in an endnote in The Siege of Corinth (1816, 56). After it was roasted in the reviews, he defended it vigorously to Murray and others (BLJ 5: 108). Among them was Thomas Moore (BLJ 5: 150), whom Byron nudged for a favorable notice in the Edinburgh Review. Moore obliged, but hardly with favor (ER 27, September 1816, 58–67). When in 1819 Byron drafted a satirical “Dedication” of Don Juan to Southey, he let Coleridge off with a friendly jest just about his prose: “Explaining metaphysics to the nation – / I wish he would explain his Explanation” (DJ, Dedication, II. 15–16).
To assess the safety of, and subsequent allergy documentation associated with, an antimicrobial stewardship intervention consisting of test-dose challenge procedures prompted by an electronic guideline for hospitalized patients with reported β-lactam allergies.
Retrospective cohort study.
Large healthcare system consisting of 2 academic and 3 community acute-care hospitals between April 2016 and December 2017.
We evaluated β-lactam antibiotic test-dose outcomes, including adverse drug reactions (ADRs), hypersensitivity reactions (HSRs), and electronic health record (EHR) allergy record updates. HSR predictors were examined using a multivariable logistic regression model. Modification of the EHR allergy record after test doses considered relevant allergy entries added, deleted, and/or specified.
We identified 1,046 test-doses: 809 (77%) to cephalosporins, 148 (14%) to penicillins, and 89 (9%) to carbapenems. Overall, 78 patients (7.5%; 95% confidence interval [CI], 5.9%–9.2%) had signs or symptoms of an ADR, and 40 (3.8%; 95% CI, 2.8%–5.2%) had confirmed HSRs. Most HSRs occurred at the second (ie, full-dose) step (68%) and required no treatment beyond drug discontinuation (58%); 3 HSR patients were treated with intramuscular epinephrine. Reported cephalosporin allergy history was associated with an increased odds of HSR (odds ratio [OR], 2.96; 95% CI, 1.34–6.58). Allergies were updated for 474 patients (45%), with records specified (82%), deleted (16%), and added (8%).
This antimicrobial stewardship intervention using β-lactam test-dose procedures was safe. Overall, 3.8% of patients with β-lactam allergy histories had an HSR; cephalosporin allergy histories conferred a 3-fold increased risk. Encouraging EHR documentation might improve this safe, effective, and practical acute-care antibiotic stewardship tool.
The geometry of Berg-Barrett skew reflections (the normal to the specimen surface and the incident and reflected beam vectors are not coplanar) is analyzed with particular reference to (111) silicon. Angular relationships required for obtaining the 78 most intense such reflections are presented on stereographic projections. Skew reflections are utilized to adapt the Berg-Barrett technique of extinction-contrast micrography to the examination of the (111) wafers generally used in integrated circuit technology. Skew reflections are shown to be more suitable for Berg-Barrett micrography than the zero-layer reflections described by Newkirk; in particular, their versatility in providing a means of varying the angle of incidence of the X-ray beam for a specific reflecting plane is demonstrated. A relatively simple experimental arrangement is described for recording skew reflection images. It permits a high resolution X-ray sensitive plate to be placed parallel to the specimen, and their separation to be increased to as much as 5 mm without excessive loss of resolution ; this avoids both image distortion and surface scattering. Furthermore, the specimen area recorded in a single micrograph is 1-3 cm2, which is large enough to eliminate the need for scanning. Exposure times are very short, in the order of 10 min. Micrographs of boron-diffused silicon are presented showing device components delineated by solute strain, strain fields induced in epitaxial silicon films by underlying buried-layer diffusions, and diffusion-induced Lomer-Cottrell dislocations. These micrographs demonstrate the resolution and contrast obtainable over large specimen areas. The capability of the Berg-Barrett technique is discussed in the examination of the near-surface regions directly involved in device fabrication and operation.
Excess meat consumption, particularly of red and processed meats, is associated with nutritional and environmental health harms. While only a small portion of the population is vegetarian, surveys suggest many Americans may be reducing their meat consumption. To inform education campaigns, more information is needed about attitudes, perceptions, behaviours and foods eaten in meatless meals.
A web-based survey administered in April 2015 assessed meat reduction behaviours, attitudes, what respondents ate in meatless meals and sociodemographic characteristics.
Nationally representative, web-based survey in the USA.
US adults (n 1112) selected from GfK Knowledgeworks’ 50 000-member online panel. Survey weights were used to assure representativeness.
Two-thirds reported reducing meat consumption in at least one category over three years, with reductions of red and processed meat most frequent. The most common reasons for reduction were cost and health; environment and animal welfare lagged. Non-meat reducers commonly agreed with statements suggesting that meat was healthy and ‘belonged’ in the diet. Vegetables were most often consumed ‘always’ in meatless meals, but cheese/dairy was also common. Reported meat reduction was most common among those aged 45–59 years and among those with lower incomes.
The public and environmental health benefits of reducing meat consumption create a need for campaigns to raise awareness and contribute to motivation for change. These findings provide rich information to guide intervention development, both for the USA and other high-income countries that consume meat in high quantities.
In this editorial, we challenge the current understanding of “Living Well with Dementia.” Such discourse introduces the possibility of not living well with the condition or even of “living badly with dementia.” Numerous words might be relevant here – grief, pain, anguish, depression – but in this editorial we consciously use the word “suffering.” This term is used for two reasons; one, because it captures the attributes of other more limited words, and, two because the language of “suffering” is contentious, making it suitable for debate. We speak of suffering, not to deny the positive aspects of life with dementia or to concentrate just on the negative, but to redress the balance that is disturbed by a relentlessly positive view of living with the condition. Our aim is to promote a more realistic understanding of the dementia experience, one based on actualities and evidence rather than presumption and sentiment.
Britt, Shen, Sinclair, Grossman, and Klieger (2016) draw attention to issues in the psychological literature regarding how we define, assess, select for, and build employee resilience. We offer a handful of recommendations for complementing and expanding on these important issues. Specifically, we propose that research should include more common forms of workplace adversity, versus extreme and rare types of adversity; resilience should be assessed via objective multirater methodology rather than subjective self-report; because context is important when studying resilience, researchers should delineate the purposes of the research; resilience should be treated as a malleable rather than a fixed characteristic; and finally, the field would benefit from qualitative research in addition to quantitative research.
The Medium-l Program of the Michelson Doppler Imager (MDI) instrument on board SOHO provides continuous observations of oscillation modes of angular degree, l, from 0 to ∼ 300. The initial results show that the noise in the Medium-l oscillation power spectrum is substantially lower than in ground-based measurements. This enables us to detect lower amplitude modes and, thus, to extend the range of measured mode frequencies. The MDI observations also reveal the asymmetry of oscillation spectral lines. The line asymmetries agree with the theory of mode excitation by acoustic sources localized in the upper convective boundary layer. The sound-speed profile inferred from the mean frequencies gives evidence for a sharp variation at the edge of the energy-generating core. In a thin layer just beneath the convection zone, helium appears to be less abundant than predicted by theory. Inverting the multiplet frequency splittings from MDI, we detect significant rotational shear in this thin layer.
The opening of the nithan khun bulom genre of texts is usually regarded as a mythic account of Lao history. But the process by which Lao historians themselves began to perceive this was an important nationalist project of the elite during the Royal Lao Government (RLG) period. As early as the 1920s, Lao authors began rewriting the old folktales into a new, modern, scientific account of the past, the ‘birth of the Lao race’. By studying elite writings in the RLG period I show that Lao nationalism was more modernist and autonomous than previously recognised.
Despite the importance of cooking in modern life, public perceptions about what it means to cook are unknown. We aimed to examine perceptions of cooking and their association with cooking confidence, attitudes and behaviours in the USA.
We designed and fielded a nationally representative survey among US adults (n 1112) in April 2015. We used factor analysis to identify perceptions about cooking and multivariate ordered logit and Poisson models to explore associations between those perceptions and cooking confidence, attitudes and behaviours.
Nationally representative web-based survey of US adults.
US adults aged ≥18 years.
Americans conceptualized cooking in three ways: the use of scratch ingredients, convenience foods and not using heat. Respondents who perceived cooking as including convenience foods were less confident in their ability to cook from scratch (OR=0·52, P<0·001) and less likely to enjoy cooking (OR=0·68, P=0·01) than those who did not. Although individuals who perceived cooking as including only scratch ingredients reported cooking dinner (4·31 times/week) and using packaged/boxed products (0·95 times/week) the least frequently, few notable differences in the frequency of cooking meals were observed.
Cooking frequency is similar among US adults regardless of how they perceive cooking, but cooking confidence and enjoyment are lowest among Americans who perceive cooking as including the use of convenience foods. These insights should inform the development of more specific measures of cooking behaviour as well as meaningful and targeted public health messages to encourage healthier cooking.
Paul Wolfson, (deceased) formerly Consultant Rehabilitation Psychiatrist, Oxleas NHS Foundation Trust, Pinewood House, Pinewood Place, Dartford,
Frank Holloway, Emeritus Consultant Psychiatrist, South London and Maudsley NHS Foundation Trust
Those who cannot remember the past are condemned to repeat it.
‘Rehabilitation psychiatry’ is a relatively new term. It combines a word that is quite old – rehabilitation (which initially related to restoring one's title or place in society, and which gained its current meaning only in the early 20th century) – with a word – psychiatry – first coined in the early 19th century (from the Greek ‘healing the mind’). Specific rehabilitation departments were developed in UK mental hospitals only in the 1950s, since when rehabilitation services have flourished, declined and then re-emerged as a core element of mental healthcare, albeit often rebranded under various fashionable rubrics.
This chapter looks at the ‘pre-history’ of psychiatric rehabilitation and its development since the 1950s, when it was first identified as a specialty. The story is inevitably highly selective, given the range of material available. Some important themes, for example the voice of the patient (or service user, or survivor), which was first influential during the 19th century, and the Recovery Movement and its precursors, are discussed in detail elsewhere in this book (see Chapters 6 and 3, respectively). The present chapter draws largely but not exclusively on the evolution of ideas and practice in England: very similar though subtly different stories could be told for France, Germany and the USA (Stone, 1998).
The difficulties of any historical analysis of psychiatry were well described by Berrios & Freeman (1991) in their introduction to 150 Years of British Psychiatry. One problem is ‘presentism’ – seeing the past from a perspective that takes no account of the intellectual, social and cultural context of the times. A further potential pitfall is developing a story of uninterrupted progress (in historical jargon, the Whiggish interpretation of history): in reality, progress in what we would now call psychiatric rehabilitation has ebbed and flowed. Another problem with any attempt at understanding the past, not mentioned by Berrios & Freeman, is that historical sources overwhelmingly represent the experiences of a privileged and literate elite.
Background: Multiple sclerosis (MS) is a lifelong neurological disorder requiring care in a variety of settings. The purpose of this study is to describe preferences of general practitioners (GPs) with regards to providing care for MS patients.Methods: A stratified sample of 900 GPs in the province of Quebec were sent a questionnaire, with 266 returning completed questionnaires. Respondents were surveyed about their preferences using four clinical scenarios describing hypothetical patients experiencing different stages of MS. Respondents were asked whether they would continue managing the patient themselves, formally refer the patient to a specialist, or seek specialist advice.Results: In two scenarios representing stable courses, 40.9% and 61.6% of GPs, respectively, intended to manage the patient themselves. GPs who reported having experience with MS patients were more likely to report an intention to continue management. In one scenario, GPs operating in rural areas were less likely to consider management than those in the Montreal metropolitan area (odds ratio=0.422, 95% confidence interval 0.20-0.90). Conclusions: For MS patients with a stable disease course, an important proportion of GPs appear to be willing to manage long-term care for MS patients.
To examine the association between fast-food consumption, diet quality and body weight in a community sample of working adults.
Cross-sectional and prospective analysis of anthropometric, survey and dietary data from adults recruited to participate in a worksite nutrition intervention. Participants self-reported frequency of fast-food consumption per week. Nutrient intakes and diet quality, using the Healthy Eating Index-2010 (HEI-2010), were computed from dietary recalls collected at baseline and 6 months.
Metropolitan medical complex, Minneapolis, MN, USA.
Two hundred adults, aged 18–60 years.
Cross-sectionally, fast-food consumption was significantly associated with higher daily total energy intake (β=72·5, P=0·005), empty calories (β=0·40, P=0·006) and BMI (β=0·73, P=0·011), and lower HEI-2010 score (β=−1·23, P=0·012), total vegetables (β=−0·14, P=0·004), whole grains (β=−0·39, P=0·005), fibre (β=−0·83, P=0·002), Mg (β=−6·99, P=0·019) and K (β=−57·5, P=0·016). Over 6 months, change in fast-food consumption was not significantly associated with changes in energy intake or BMI, but was significantly inversely associated with total intake of vegetables (β=−0·14, P=0·034).
Frequency of fast-food consumption was significantly associated with higher energy intake and poorer diet quality cross-sectionally. Six-month change in fast-food intake was small, and not significantly associated with overall diet quality or BMI.