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Evidence on the impact of the pandemic on healthcare presentations for self-harm has accumulated rapidly. However, existing reviews do not include studies published beyond 2020.
To systematically review evidence on presentations to health services following self-harm during the COVID-19 pandemic.
A comprehensive search of databases (WHO COVID-19 database; Medline; medRxiv; Scopus; PsyRxiv; SocArXiv; bioRxiv; COVID-19 Open Research Dataset, PubMed) was conducted. Studies published from 1 January 2020 to 7 September 2021 were included. Study quality was assessed with a critical appraisal tool.
Fifty-one studies were included: 57% (29/51) were rated as ‘low’ quality, 31% (16/51) as ‘moderate’ and 12% (6/51) as ‘high-moderate’. Most evidence (84%, 43/51) was from high-income countries. A total of 47% (24/51) of studies reported reductions in presentation frequency, including all six rated as high-moderate quality, which reported reductions of 17–56%. Settings treating higher lethality self-harm were overrepresented among studies reporting increased demand. Two of the three higher-quality studies including study observation months from 2021 reported reductions in self-harm presentations. Evidence from 2021 suggests increased numbers of presentations among adolescents, particularly girls.
Sustained reductions in numbers of self-harm presentations were seen into the first half of 2021, although this evidence is based on a relatively small number of higher-quality studies. Evidence from low- and middle-income countries is lacking. Increased numbers of presentations among adolescents, particularly girls, into 2021 is concerning. Findings may reflect changes in thresholds for help-seeking, use of alternative sources of support and variable effects of the pandemic across groups.
To assess the effect of interventions in the physical health monitoring of patients prescribed depot antipsychotic medications. We hypothesised that compliance with monitoring would improve post-intervention. It is well recognised that patients with severe mental illness have a significantly reduced life expectancy. Depot antipsychotic medication increases the risk of cardiovascular disease, metabolic syndrome, stroke and type 2 diabetes. The SIGN guidelines recommend that all patients on antipsychotic medications should have annual physical health monitoring. Baseline data of patients on depot antipsychotic medication in North West (NW) Edinburgh CMHT in 2019 demonstrated that this was not being achieved. We sought to create interventions to improve compliance with physical health monitoring for patients on depot antipsychotic medication.
Baseline data were collected in 2019 for all patients under NW Edinburgh CMHT receiving depot antipsychotic medication (60 patients). The data addressed 9 domains including smoking status, blood monitoring, BMI and physical monitoring.
Following the baseline data collection interventions were put in place to increase compliance with monitoring. These interventions included a physical health questionnaire and training of staff in the CMHT to perform phlebotomy and ECGs.
Following these interventions the data (74 patients) were re-audited in 2020 following the same domains.
After this initial re-audit a physical health monitoring clinic was implemented in order to specifically target this patient population. The data (66 patients) were then re-audited in 2021.
Baseline data identified that domains were reached between 8% (Lipid monitoring) and 51% (glucose monitoring). Following the initial interventions 77% of domains improved in compliance. Between the two periods, notable improvements were observed in the monitoring of Blood Pressure (9% to 37%), ECG (20% to 43%) and lipids (29% to 46%). There was however a decline in all domains between the 2020 and 2021 data, with 66% of domains still having improved compared to 2019 data.
Overall, interventions have improved compliance with monitoring of physical health for patients on depot antipsychotic medications. It is likely that continuing effects of the COVID-19 pandemic contributed to the decline between the 2020 and 2021 data. As a result of this audit a weekly physical health monitoring clinic has been set up and once formally established it is hoped that compliance with physical health monitoring will continue to improve. Limitations include effects of COVID-19 pandemic, inconsistency in documentation and patient non-attendance to the monitoring clinic. We recommend further audit cycles, with additional interventions being implemented as identified.
Most criminological theories are not truly scientific, since they do not yield exact quantitative predictions of criminal career features, such as the prevalence and frequency of offending at different ages. This Element aims to make progress towards more scientific criminological theories. A simple theory is described, based on measures of the probability of reoffending and the frequency of offending. Three offender categories are identified: high risk/high rate, high risk/low rate, and low risk/low rate. It is demonstrated that this theory accurately predicts key criminal career features in three datasets: in England the Offenders Index (national data), the Cambridge Study in Delinquent Development (CSDD) and in America the Pittsburgh Youth Study (PYS). The theory is then extended in the CSDD and PYS by identifying early risk factors that predict the three categories. Criminological theorists are encouraged to replicate and build on our research to develop scientific theories that yield quantitative predictions.
We lay groundwork for applying ethnographic methods in philosophy of science. We frame our analysis in terms of two tasks, 1) to identify the benefits of an ethnographic approach in philosophy of science, and 2) to structure an ethnographic approach for philosophical investigation best adapted to provide information relevant to philosophical interests and epistemic values. To this end, we advocate for a purpose-guided form of cognitive ethnography which mediates between the explanatory and normative interests of philosophy of science, while maintaining openness and independence when framing such an investigation in order to achieve robust unbiased results.
It is well documented that the private military and security industry has the capacity to do great gendered harms to both those it encounters and those it employs.1 Significantly, it is also a sector where a variety of human rights-based approaches, instruments and mechanisms have emerged beyond the United Nations Guiding Principles on Business and Human Rights (UNGPs).2 The International Code of Conduct for Private Security Providers (ICoC) addresses gender, and sexual and gender-based violence (SGBV), and explicitly requires private military and security companies (PMSCs) to integrate a gender perspective in their practices.3 Through an examination of publicly available documents and policies required for PMSCs certified as complying with the ICoC, this piece evaluates whether PMSCs do in fact integrate a gender perspective into their human rights policies and grievance procedures (see Table 1).4 Our study of certified PMSCs demonstrates that despite increased attention to the potential for negative gender impacts in the sector, companies have not developed gender-responsive policies and procedures. It can be said, therefore, that gender is not addressed in any meaningful way by PMSCs. More specifically, we conclude that PMSCs have not yet shown the required holistic understanding of gendered impacts and barriers that is required to respect human rights, and that further efforts are needed in the sector.
This study aims to describe the relationships between child-internal and child-external factors and the consonant accuracy of bilingual children. More specifically, the study looks at internal factors: expressive and receptive vocabulary, and external factors: language exposure and language status, of a group of 4-year-old bilingual Arabic–French children. We measured the consonant accuracy of the children by the percentage of correct consonants in a Picture-Naming Task and a Non-Word Repetition Task in each language. The results suggest a significant relationship between vocabulary and consonant accuracy. A cross-language correlation was observed between the expressive vocabulary level of the majority language (French) and the consonant accuracy of the minority language (Arabic). Also, a significant correlation was found between Arabic language exposure and Arabic consonant accuracy. Finally, consonant accuracy was significantly higher in French tasks than in Arabic, despite the individual differences of the children.
It is estimated that a third of people in the United Kingdom with signs of dementia are living without a formal diagnosis. In Wales, the proportion is nearly half. Some explanations for the gap between prevalence of dementia and number of diagnoses include living with a long-term partner/spouse and systemic barriers to diagnosis. This study recruited participants from the Cognitive Function and Ageing Studies-Wales (CFAS-Wales) cohort, randomly selected from people aged over 65 living in two areas of Wales, who met study criteria for a diagnosis of dementia and did not have a record of a formal diagnosis in general practice records. We aimed to understand more about the contexts and circumstances of people who live with and cope with cognitive difficulties without having a formal diagnosis of dementia. We conducted qualitative interviews with six participants and their spouses, and additionally with four family members of three invited people who were unable to take part. Themes were generated using thematic analysis. We present the argument that there is an adaptive response to low service levels and a complex interaction between the expectations of levels of service, perceptions of the legitimacy of cognitive problems and the right to make demands on services. This paper concludes that more could be done to address barriers to diagnosis and treatment services for those living with symptoms of dementia, but that the value placed on diagnosis by some individuals might be lower than anticipated by government policy.
This study assessed the cost-effectiveness of the Centers for Disease Control and Prevention’s (CDC’s) Sodium Reduction in Communities Program (SRCP).
We collected implementation costs and performance measure indicators from SRCP recipients and their partner food service organisations. We estimated the cost per person and per food service organisation reached and the cost per menu item impacted. We estimated the short-term effectiveness of SRCP in reducing sodium consumption and used it as an input in the Prevention Impact Simulation Model to project the long-term impact on medical cost savings and quality-adjusted life-years gained due to a reduction in CVD and estimate the cost-effectiveness of SRCP if sustained through 2025 and 2040.
CDC funded eight recipients as part of the 2016–2021 round of the SRCP to work with food service organisations in eight settings to increase the availability and purchase of lower-sodium food options.
Eight SRCP recipients and twenty of their partners.
At the recipient level, average cost per person reached was $10, and average cost per food service organisation reached was $42 917. At the food service organisation level, median monthly cost per food item impacted by recipe modification or product substitution was $684. Cost-effectiveness analyses showed that, if sustained, the programme is cost saving (i.e. the reduction in medical costs is greater than the implementation costs) in the target population by $1·82 through 2025 and $2·09 through 2040.
By providing evidence of the cost-effectiveness of a real-world sodium reduction initiative, this study can help inform decisions by public health organisations about related CVD prevention interventions.
Rates of prescriptions of antidepressants and suicide are inversely correlated at an epidemiological level. Less attention has been paid to relationships between other drugs used in mental health and suicide rates. Here we tested relationships between prescriptions of anxiolytics and antipsychotics and suicide rates in Scotland.
Suicide rates were inversely correlated with prescriptions of antidepressants and antipsychotics over 14 years (2004–2018), and positively with prescriptions of anxiolytics.
This illustrates the role of medications used in mental health in suicide prevention, and highlights the importance of identifying causal mechanisms that link anxiolytics with suicide.
There is a paucity of knowledge and understanding of medical error in opioid substitution treatment programmes.
To characterise patient safety incidents involving opioid-substitution treatment with methadone or buprenorphine in community-based care to identify the sources and nature of harm, describe and interpret themes and use this qualitative analysis to identify priorities to focus future improvement work.
We undertook a mixed-methods study examining incidents involving opioid substitution treatment with methadone or buprenorphine in community-based care submitted between 2005 and 2015 from the National Reporting and Learning System, a repository of incident reports from England and Wales. We analysed each report using four frameworks to identify incident type, contributory factors, incident outcome and severity of harm. Analysis involved detailed data coding and iterative generation of data summaries using descriptive statistical and thematic analysis.
2,284 reports were identified. We found that most risks of harm came from failure in one of four processes of care delivery: prescribing opiate-substitution (n=151); supervised dispensing errors (n=248); non-supervised dispensing errors (n=318); and monitoring and communication activities (n=1544). Most incidents resulting in harm involved supervised or non-supervised dispensing (n=91/127, 72%). Staff- (e.g. mistakes, not following protocols) and organisation-related (e.g. poor working conditions or poor continuity of care between services) contributory factors were present for over half of incidents.
We have identified four processes of care delivery and associated contributory factors, which represent potential target areas for healthcare systems worldwide to develop interventions to improve the safe delivery of opioid substitution treatment.
To monitor the quality of physical health monitoring of patients prescribed depot antipsychotic medication in the North West Edinburgh Community Mental Health Team (CMHT). We also evaluated the completeness of prescriptions and Mental Health Act (Scotland) (Act) 2003 paperwork where relevant.
Antipsychotic medications are medicines for treating conditions such as Schizophrenia, but some may be associated with an increased risk of Metabolic Syndrome. Moreover, evidence indicates that patients with major mental disorder have a reduced life expectancy in comparison to those without such diagnoses. These two factors illustrate the importance of the physical health of this patient cohort being monitored on a regular basis. This project will evaluate how a local CMHT is performing, with the possibility of enacting service improvements if required.
The records of the 60 patients prescribed depot antipsychotic medication administered by this CMHT were reviewed. A check-list was created consisting of 14 categories analysing the quality of physical health monitoring, as well as compliance with prescription standards and, where relevant, Mental Health Act (Scotland) (Act) 2003 paperwork. We compared patient records against our checklist for the calendar year of 2019. The Scottish Intercollegiate Guidelines Network (SIGN) 131 (Management of Schizophrenia) section 5.2 was used as the gold standard for physical health monitoring against which the data we collected was compared.
We identified a wide range of flaws with the current system and implementation of monitoring, and difficulty in locating the required information. There was no consistent monitoring of physical observations on electronic record, nor an accepted alternative way in which this was documented. Furthermore, blood tests were not consistently obtained either by the service or GP practices in a reproducible manner. This led to discussions within the CMHT regarding creation of a new pathway for the monitoring of this patient cohort using a Quality Improvement model, with the ultimate goal to establish a regular physical health clinic.
There is significant evidence that patients with major mental disorder do not access healthcare as consistently as those without, leading to a disparity in life expectancy. In light of the fact that antipsychotic medications can be associated with Metabolic Syndrome, we have an even greater responsibility to tackle this marked health inequality by appropriately monitoring our patients. This was not done well in this particular CMHT, but this project will lead to improvements in the service and ultimately patient care.
Digital tools are widely used in archaeology for excavation, research, and communication of results. Recently, due in large part to the COVID-19 pandemic, there has been a significant increase in the use of these resources in the classroom. The use of digital games for teaching undergraduate archaeology courses has been explored by a number of educators, but the majority of instructors continue to see this medium as lacking any particular educational merit. To combat this conclusion, in this article, the author explores some of the ways that unmodified digital games can be integrated into undergraduate archaeology courses to inspire critical discussions. She discusses two main types of games—conceptual simulations and realist simulations—to show how these can help students better understand theoretical approaches to archaeological interpretation and to consider the most effective form of archaeological reconstructions for different audiences. The author highlights her own experiences teaching with Assassin's Creed: Origins to show the benefits and challenges of working with this medium, and she includes student responses to the use of digital games in discussions. An example of a student assignment and an example of a project prompt are provided as supplemental materials to further encourage the use of digital games in the classroom.
In this article, I offer a reading of On Liberty II which focuses on the structural features of the argument that Mill presents. Mill's argument, I suggest, is grounded on an appeal to the value of truth, and is divided into three sub-arguments, treating true, false and partially true opinion respectively. In section 1, I consider what constraints the teleological orientation of Mill's argument places on the case he makes, before examining in section 2 what the division of Mill's argument into three exhaustive sub-arguments tells us about the nature of ‘discussion’ as Mill uses the term. I go on, in section 3, to suggest that although On Liberty II does not offer a defence of free speech in the broad sense in which the term is often now used, we should be optimistic about the chances of finding such a defence in On Liberty III.
ABSTRACT IMPACT: A better understanding of the spectrum of problematic opioid use will lead to more targeted treatments. OBJECTIVES/GOALS: It is unclear how to approach treatment of individuals with problematic opioid use who do not clearly meet criteria for opioid use disorder (OUD). We aim to characterize clinical, demographic, and medication use at time of identification of problematic opioid use across the spectrum as well as identify predictors of poor outcomes. METHODS/STUDY POPULATION: A national sample of Veterans coded as having opioid abuse or dependence were previously categorized as (1) high likelihood of OUD, (2) limited aberrant opioid use, and (3) prescribed opioid use with no evidence of aberrant use based on chart review. We will describe how individuals in these three categories differ demographically and clinically. We will then use a trained binary logistic regression model to predict whether individuals with limited aberrant opioid use more closely resemble category (1) or (3). Cox proportional hazards models will be used to predict all-cause mortality, suicide-related mortality, opioid-overdose related mortality, and hospitalization over a three-year period using the three categories as predictors and adjusting for relevant covariates. RESULTS/ANTICIPATED RESULTS: We anticipate that Veterans with a high likelihood of OUD will be more likely to experience homelessness and have more psychiatric comorbidities (especially PTSD). We hypothesize that Veterans with prescribed opioid use and no evidence of misuse will be significantly older, more likely to have disability, medical comorbidities (ie., chronic pain, cancer), more prescriptions for non-opioid analgesics, and be prescribed higher doses of opioids. Using a trained binary logistic regression model, we predict that Veterans with limited aberrant opioid use will more closely resemble Veterans with a high likelihood of OUD. We expect that all categories of problematic opioid use will have a high risk of mortality, with a high likelihood of OUD associated with the greatest risk of premature death. DISCUSSION/SIGNIFICANCE OF FINDINGS: Identifying and better characterizing individuals with limited aberrant opioid use may be an important opportunity to intervene prior to development of severe OUD. Future research will focus on targeting interventions to this population, which may have specific needs that are separate from classic OUD or simple pain-related opioid dependence.
Computerised cognitive behavioural therapy (CCBT) has been made available within the National Health Service (NHS) across Scotland as an alternative treatment for mild to moderate anxiety and depression. However, the provision of CCBT services is still limited in the NHS, possibly affecting delivery of this computer-aided therapy to patients and inhibiting acceptance and uptake of this intervention. This paper reports on the qualitative exploration of patients’ experiences and acceptance of one CCBT programme delivering computer-assisted therapy (Beating the Blues: BTB), examining particularly the point of referral, access to treatment, and support. Thematic analysis was conducted on semi-structured face-to-face and email interviews with 33 patients at different NHS organisations across Scotland. Data analysis generated six key themes which illustrated patients’ experiences relating to referral and access to the treatment, and the challenges they faced: (1) information dissemination; (2) expectations and the impact of waiting for BTB; (3) impact of locations on experience of BTB; (4) preference for home access; (5) desire for better human support; and (6) desire for additional application support features. The findings highlighted that better methods of implementing and delivering such CCBT services together with the design of the technological interventions are vital to the success of these services.
Key learning aims
(1) To understand the service models and methods of implementing and delivering one CCBT programme (BTB) in routine care;
(2) To learn about user experiences of accessing and using BTB; and
(3) To learn about the implications and factors that might have influenced uptake and understand the implications.
Social anxiety disorder (SAD) is a prevalent chronic condition with a large demand for treatment. This community outpatient study examined the effectiveness of a group intervention version of the established one-to-one cognitive therapy derived from the Clark and Wells model for SAD. Questionnaires were completed pre-treatment and post-treatment for SAD symptoms (Social Phobia Scale, Social Interaction Anxiety Scale), depressive symptoms (BDI-II), self-focused attention, safety behaviours (Social Phobia Weekly Summary Scale and Subtle Avoidance Frequency Examination), and impaired functioning (Work and Social Adjustment Scale). From an initial sample of 159 participants, 101 completed at least seven of the nine weekly group sessions (Mage = 34.1 years, SDage = 10.8 years, 53% female). Significant improvements were demonstrated on all measures. Large effect sizes were found for social anxiety symptoms and safety behaviour use. Self-focused attention, depressive symptoms, and impaired functioning had moderate effect sizes. Effect sizes for anxiety (d = 1.00 and 1.32) and mood measures (d = 0.71) were as high, or in some cases, higher than previous group treatment studies. Results suggest group cognitive therapy for SAD based on the Clark and Wells model is effective in a clinical setting for individuals with moderate/severe and treatment-resistant social anxiety.
Decadence is traditionally regarded as having little importance or presence in the American literary context. This chapter sets out to prove otherwise. It employs reception-focused, materialist and book history methodologies to demonstrate the many and various ways in which Decadence manifested itself in America as well as identifying fruitful under-examined areas for further research. It argues that Americans were, in many respects, greater consumers of aestheticism and Decadence than they were producers, especially in the 1890s, but that this consumption was creative and productive, paving the way for a late flowering of Decadent production in the 1920s. The chapter covers the role of American writers Edgar Allan Poe and Walt Whitman as formative influences in the development of European Decadence; Wilde’s importance to the enthusiasm in America for aestheticism and decadence in the 1880s; the circulation of decadent literature, art and design in American popular and avant-garde print culture; key critics and producers of Decadence of the era; and the relationship of decadence to the development of modernism.
The Cognition Battery of the National Institute of Health (NIH) Toolbox for Assessment of Neurological and Behavioural Function is a computerised neuropsychological battery recommended for clinical practice, neurological research and clinical trials. We investigated the utility of the NIH Toolbox Cognition Battery (NIHTB-CB) for people with concussion.
In this small qualitative study, semi-structured interviews were conducted with five adults with concussion who were participating in a larger study using the NIHTB-CB. Three clinician participants and two cultural advisors familiar with the tool were also interviewed. Interview transcripts were analysed using a general thematic approach and qualitative description.
Participants described both positive and negative experiences with the NIHTB-CB and using qualitative description, their experiences were organised into three broad themes: (1) using technology for cognitive testing made sense, (2) there were some cultural relevance questions and (3) cognitive testing after concussion could have challenges. They were positive about the computerised format and range of domains assessed for the concussion context but identified the contextual relevance of some content as having potential to impact on performances.
This was a small study examining the experiences of a select group of participants, but nevertheless does suggest a need for future research validating the NIHTB-CB for use in different cultural and clinical contexts.
Close double neutron stars (DNSs) have been observed as Galactic radio pulsars, while their mergers have been detected as gamma-ray bursts and gravitational wave sources. They are believed to have experienced at least one common envelope episode (CEE) during their evolution prior to DNS formation. In the last decades, there have been numerous efforts to understand the details of the common envelope (CE) phase, but its computational modelling remains challenging. We present and discuss the properties of the donor and the binary at the onset of the Roche lobe overflow (RLOF) leading to these CEEs as predicted by rapid binary population synthesis models. These properties can be used as initial conditions for detailed simulations of the CE phase. There are three distinctive populations, classified by the evolutionary stage of the donor at the moment of the onset of the RLOF: giant donors with fully convective envelopes, cool donors with partially convective envelopes, and hot donors with radiative envelopes. We also estimate that, for standard assumptions, tides would not circularise a large fraction of these systems by the onset of RLOF. This makes the study and understanding of eccentric mass-transferring systems relevant for DNS populations.