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Early intervention in psychosis is a complex intervention, usually delivered in a specialist stand-alone setting, which aims to improve outcomes for people with psychosis. Previous studies have been criticised because the control used did not accurately reflect actual practice.
To evaluate the cost-effectiveness of early intervention by estimating the incremental net benefit (INB) of an early-intervention programme, delivered in a real-world setting. INB measures the difference in monetary terms between alternative interventions.
Two contemporaneous incidence-based cohorts presenting with first-episode psychosis, aged 18–65 years, were compared. Costs and outcomes were measured over 1 year. The main outcome was avoidance of a relapse that required admission to hospital or home-based treatment.
From the health sector perspective, the probability that early intervention was cost-effective was 0.77. The INB was €2465 per person (95% CI − €4418 to €9347) when society placed a value of €6000, the cost of an in-patient relapse, on preventing a relapse requiring admission or home care. Following adjustment, the probability that early intervention was cost-effective was 1, and the INB to the health sector was €3105 per person (95% CI −€8453 to €14 663). From a societal perspective, the adjusted probability that early intervention was cost-effective was 1, and the INB was €19 928 per person (95% CI − €2075 to €41 931).
Early intervention has a modest INB from the health sector perspective and a large INB from the societal perspective. The perspective chosen is critical when presenting results of an economic evaluation of a complex intervention.
Irish Journal of Psychological Medicine (IJPM) was recently accepted for indexing on Medline. This reflects the high scientific quality of articles published in the journal and highlights the excellent work by publishers, authors, reviewers and the journal editorial board who have contributed to the journal’s development over many years. IJPM remains committed to further progression through constant innovation and maintaining the excellent standard of publishing to date. We look forward to promoting our aims of improving knowledge and advocating for better mental health services by continuing to highlight key topics of current relevance to mental health.
Reassuming the role of a “regular” faculty member after serving as department chair presents a common set of challenges that often are overlooked and underappreciated in the discipline. To provide former chairs with guideposts for navigating this pivotal moment in their career, we offer a few thoughts on what our experience suggests are the keys to a successful transition. Among the issues to consider are time and space to regroup, mining what you have learned as chair to revamp research and teaching, careful management of your new social status in the department, and envisioning how you can lead without holding a formal position.
In this article, I shall refer to the standard commentaries on Propertius by the name of the editor alone. I include under this heading Shackleton Bailey's Propertiana (CUP, 1954), whose comments on 1. 3 are on pp. 11–14. Another work I mention now, honoris causa, which will be referred to by name of author alone, is M. W. Edwards, ‘Intensification of Meaning in Propertius and Others’ (T.A.P.A. XCII (1961), 128–44). Edwards well illustrates and develops the growing awareness of the extent to which Propertius exploits the possibilities of ambiguity, shifting nuance, and linguistic innovation in the creation of his poetry.
At dead of night, Propertius comes to Cynthia's bedside, apparently after leaving a fairly drunken party. He is first tempted by her beauty to take advantage of her there and then, but decides against such a hasty act, and contents himself with presenting her in her sleep with gifts which he has brought back from the party. The straying beams of the moon interrupt this tender scene and, filtering through the window, they wake Cynthia up. She then delivers an harangue to him, among other things accusing him of unfaithfulness. And so the poem closes. This is one of Propertius' best known poems, but one which, in my opinion, still lacks adequate exposition both in the details of its art and in its general purpose and effect.
In a notice of Knecht's new edition of the Ciris to appear in due course in the Classical Review, I was able to commend the book only in one respect: that it provided copious information on largely neglected recentiores. For the first time all the manuscripts which have ever been considered possibly significant for the text of the Ciris were assembled and fully reported in one place. However, this mass of information was ill-digested: the conclusions drawn from it were vague, or inadequately argued – or simply wrong; and much was left unsaid. But I thought that the results towards which Knecht's work pointed were interesting and that it would be a pity if they remained obscured. Since to clarify them involved more space than a review allowed, I offer the following short paper. Necessarily it will have some of the appearance of a review article; but I shall try to make it as self-contained as possible. Knecht never once ventures a stemma – in my remarks I shall have in mind Goodyear's stemma on p. 99 of the OCT Appendix.
Quality improvement (QI) analytic methodology is rarely encountered in the emergency medicine literature. We sought to comparatively apply QI design and analysis techniques to an existing data set, and discuss these techniques as an alternative to standard research methodology for evaluating a change in a process of care.
We used data from a previously published randomized controlled trial on triage-nurse initiated radiography using the Ottawa ankle rules (OAR). QI analytic tools were applied to the data set from this study and evaluated comparatively against the original standard research methodology.
The original study concluded that triage nurse-initiated radiographs led to a statistically significant decrease in mean emergency department length of stay. Using QI analytic methodology, we applied control charts and interpreted the results using established methods that preserved the time sequence of the data. This analysis found a compelling signal of a positive treatment effect that would have been identified after the enrolment of 58% of the original study sample, and in the 6th month of this 11-month study.
Our comparative analysis demonstrates some of the potential benefits of QI analytic methodology. We found that had this approach been used in the original study, insights regarding the benefits of nurse-initiated radiography using the OAR would have been achieved earlier, and thus potentially at a lower cost. In situations where the overarching aim is to accelerate implementation of practice improvement to benefit future patients, we believe that increased consideration should be given to the use of QI analytic methodology.
Import substitution industrialization was the postwar development policy of choice in Latin America, and the diagnosis of its weaknesses heavily influenced subsequent policy recommendations. Yet few attempts have been made to test the predominant sectorally based explanation of ISI's failings against alternatives. This article develops a model of direct (clientelistic) linkages between politicians and their supporters and tests it against the standard sectoral model based on indirect linkages. Examining three features of process (economic sector influence, legislative voting, and exchange rate policy) and analyzing the distributional implications of the overall policy in Brazil, this article demonstrates that a clientelist model provides a more complete and coherent account of the empirical record. By demonstrating that variation in linkage type alters the political constraints on policy choice, the analysis also provides new insight into enduring puzzles, including the better performance in East Asia.
The Mental Health Act 2001 has introduced significant changes to the process of admission to hospital for individuals affected by mental health disorders. This study aimed to determine whether a newly designed smartphone application could result in an improvement in service users’ knowledge of their rights compared with the paper booklet.
This was a randomized study conducted in an outpatient and day-hospital in North Dublin. Participants were randomized to receive the information booklet as either a smartphone application or in the paper form. A questionnaire which was scored from 0 to 10 was devised and was completed at baseline and at 1-week follow-up.
A total of 42 individuals completed the baseline and follow-up questionnaire and of these, 53.7% were female and the mean age was 38.2 years (s.d.±13.5). A total of 34.1% had a diagnosis of a psychotic disorder, 29.3% had a depressive disorder and 22% had bipolar-affective disorder. The mean score before the intervention in the total group was 3.5 (s.d.±2.2) and this increased to 5.8 (s.d.±2.2) at follow-up. Participants randomized to the smartphone application improving by a mean of 2.5 (s.d.±2.5), while those randomized to the booklet improving by a mean of 2.3 (s.d.±2.6), which was not statistically significant.
Both forms of the information booklet showed improvement in service users’ knowledge of their legal rights. It is possible that each individual will have preference for either a paper form or a smartphone form and this study suggests that both forms should be offered to each individual service user.
The evolution of integrated pulse profiles from high to low frequencies does not conform exactly to the simple model of a dipole field. Several groups (DavÃ®es et al. 1984, Kuz'min 1986, Shitov, Malofeev, and Izvekova 1988) have suggested large field twisting due to the rotation of the pulsar, which leads to a delay in pulse arrival times for low frequencies whose sources are located in the outer parts of the magnetosphere. We are, therefore, comparing profiles of about 30 pulsars, observed at frequencies from 40 to 1400 MHz. Our preliminary analysis shows that significant delay at low frequencies occurs in many pulsars and we present here some typical examples.
We present the results of mean pulse polarization observations at 1560 MHz of 8 pulsars with high southern latitude, large values of dispersion measure, short period and low flux density. All of these pulsars have strong linear polarization with a mean value of 47% and no previously published polarization data.
PSR B1820–30A is located in the globular cluster NGC 6624 and has the smallest projected distance to the centre of any globular cluster in the sky plane. We observe this millisecond pulsar over more than 25 years and obtain higher-order rotational frequency time derivative measurements through high-precision timing. Modelling these higher-order derivatives as being due to orbital motion, we find that the pulsar is in either a low-eccentricity smaller orbit with a low mass companion or a high-eccentricity larger orbit with a massive companion. The cluster mass properties and the observed properties of other nearby sources indicate that the high-eccentricity solution is more probably. This reveals that the pulsar is orbiting around an intermediate-mass black hole (IMBH) of mass >7500 M⊙ located at the cluster centre. This contribution is based on previous work published in MNRAS 471, 1258 (2017).
We have used LOFAR to perform targeted millisecond pulsar surveys of Fermi γ-ray sources. Operating at a center frequency of 135 MHz, the surveys use a novel semi-coherent dedispersion approach where coherently dedispersed trials at coarsely separated dispersion measures are incoherently dedispersed at finer steps. Three millisecond pulsars have been discovered as part of these surveys. We describe the LOFAR surveys and the properties of the newly discovered pulsars.
PSR B1828–11 is a young pulsar once thought to be undergoing free precession and recently found instead to be switching magnetospheric states in tandem with spin-down changes. Here we show the two extreme states of the mode-changing found for this pulsar and comment briefly on its interpretation.
Multi-decade observing campaigns of the globular clusters 47 Tucanae and M15 have led to an outstanding number of discoveries. Here, we report on the latest results of the long-term observations of the pulsars in these two clusters. For most of the pulsars in 47 Tucanae we have measured, among other things, their higher-order spin period derivatives, which have in turn provided stringent constraints on the physical parameters of the cluster, such as its distance and gravitational potential. For M15, we have studied the relativistic spin precession effect in PSR B2127+11C. We have used full-Stokes observations to model the precession effect, and to constrain the system geometry. We find that the visible beam of the pulsar is swiftly moving away from our line of sight and may very soon become undetectable. On the other hand, we expect to see the opposite emission beam sometime between 2041 and 2053.