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 firstname.lastname@example.org
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.
One of the greatest hopes and expectations that accompanied American colonialism – from its earliest incarnation – was that Atlantic settlers would be able to locate new sources of raw silk, with which to satiate the boundless desire for luxurious fabrics in European markets. However, in spite of the great upheavals and achievements of Atlantic plantation, this ambition would never be fulfilled. By taking the commercial failure of silk seriously and examining numerous experiments across New Spain, New France, British North America and the early United States, Ben Marsh reveals new insights into aspiration, labour, environment, and economy in these societies. Each devised its own dreams and plans of cultivation, framed by the particularities of cultures and landscapes. Writ large, these dreams would unravel one by one: the attempts to introduce silkworms across the Atlantic world ultimately constituted a step too far, marking out the limits of Europeans' seemingly unbounded power.
Patients receiving treatment for opioid-use disorder (OUD) may experience psychological symptoms without meeting full criteria for psychiatric disorders. The impact of these symptoms on treatment outcomes is unclear.
To determine the prevalence of psychological symptoms in a cohort of individuals receiving medication-assisted treatment for OUD and explore their association with patient characteristics and outcomes in treatment.
Data were collected from 2788 participants receiving ongoing treatment for OUD recruited in two Canadian prospective cohort studies. The Maudsley Addiction Profile psychological symptoms subscale was administered to all participants via face-to-face interviews. A subset of participants (n = 666) also received assessment for psychiatric disorders with the Mini International Neuropsychiatric Interview. We used linear regression analysis to explore factors associated with psychological symptom score.
The mean psychological symptom score was 12.6/40 (s.d. = 9.2). Participants with psychiatric comorbidity had higher scores than those without (mean 16.8 v. 8.6, P<0.001) and 31% of those with psychiatric comorbidity reported suicidal ideation. Higher psychological symptom score was associated with female gender (B = 1.59, 95% CI 0.92–2.25, P<0.001), antidepressant prescription (B = 4.35, 95% CI 3.61–5.09, P<0.001), percentage of opioid-positive urine screens (B = 0.02, 95% CI 0.01–0.03, P<0.001), and use of non-opioid substances (B = 1.92, 95% CI 0.89–2.95, P<0.001). Marriage and employment were associated with lower psychological symptoms.
Psychological symptoms are associated with treatment outcomes in this population and the prevalence of suicidal ideation is an area of concern. Our findings highlight the ongoing need to optimise integrated mental health and addictions services for patients with OUD.
The Late Formative period immediately precedes the emergence of Tiwanaku, one of the earliest South American states, yet it is one of the most poorly understood periods in the southern Lake Titicaca Basin (Bolivia). In this article, we refine the ceramic chronology of this period with large sets of dates from eight sites, focusing on temporal inflection points in decorated ceramic styles. These points, estimated here by Bayesian models, index specific moments of change: (1) cal AD 120 (60–170, 95% probability): the first deposition of Kalasasaya red-rimmed and zonally incised styles; (2) cal AD 240 (190–340, 95% probability): a tentative estimate of the final deposition of Kalasasaya zonally incised vessels; (3) cal AD 420 (380–470, 95% probability): the final deposition of Kalasasaya red-rimmed vessels; and (4) cal AD 590 (500–660, 95% probability): the first deposition of Tiwanaku Redwares. These four modeled boundaries anchor an updated Late Formative chronology, which includes the Initial Late Formative phase, a newly identified decorative hiatus between the Middle and Late Formative periods. The models place Qeya and transitional vessels between inflection points 3 and 4 based on regionally consistent stratigraphic sequences. This more precise chronology will enable researchers to explore the trajectories of other contemporary shifts during this crucial period in Lake Titicaca Basin's prehistory.
The underlying philosophy of this new volume aims to facilitate – even expand – dialogue between clinically orientated scientists, theologians and philosophers over questions posed by neurological disorders in relation to emergent ‘spiritual/religious’ outcomes, real or artefact. This chapter specifically engages with Near-Death and Out-of-Body Experiences (ND/OBE), examining how these events might contribute to such dialogue.
In the summer of 1952, Ezra Pound told Guy Davenport that ‘the poet looks forward to what’s coming next in the poem’, as though the poem, not the poet, dictated the work. One way of interpreting this Delphic remark is to suppose that Pound meant pending events, whether in the poet’s head or out in the world, would determine the content of the later Cantos. Noel Stock called the late cantos ‘the diary of a mind’; therefore they inevitably comment on current events.
Cannabis is the most commonly used substance among patients in methadone maintenance treatment (MMT) for opioid use disorder. Current treatment programmes neither screen nor manage cannabis use. The recent legalisation of cannabis in Canada incites consideration into how this may affect the current opioid crisis.
Investigate the health status of cannabis users in MMT.
Patients were recruited from addiction clinics in Ontario, Canada. Regression analyses were used to assess the association between adverse health conditions and cannabis use. Further analyses were used to assess sex differences and heaviness of cannabis use.
We included 672 patients (49.9% cannabis users). Cannabis users were more likely to consume alcohol (odds ratio 1.46, 95% CI 1.04–2.06, P = 0.029) and have anxiety disorders (odds ratio 1.75, 95% CI 1.02–3.02, P = 0.043), but were less likely to use heroin (odds ratio 0.45, 95% CI 0.24–0.86, P = 0.016). There was no association between cannabis use and pain (odds ratio 0.98, 95% CI 0.94–1.03, P = 0.463). A significant association was seen between alcohol and cannabis use in women (odds ratio 1.79, 95% CI 1.06–3.02, P = 0.028), and anxiety disorders and cannabis use in men (odds ratio 2.59, 95% CI 1.21–5.53, P = 0.014). Heaviness of cannabis use was not associated with health outcomes.
Our results suggest that cannabis use is common and associated with psychiatric comorbidities and substance use among patients in MMT, advocating for screening of cannabis use in this population.
To establish the reliability of the application of National Health and Safety Network (NHSN) central-line–associated bloodstream infection (CLABSI) criteria within established reporting systems internationally.
Diagnostic-test accuracy systematic review.
We conducted a search of Medline, SCOPUS, the Cochrane Library, CINAHL (EbscoHost), and PubMed (NCBI). Cohort studies were eligible for inclusion if they compared publicly reported CLABSI rates and were conducted by independent and expertly trained reviewers using NHSN/Centers for Disease Control (or equivalent) criteria. Two independent reviewers screened, extracted data, and assessed risk of bias using the QUADAS 2 tool. Sensitivity, specificity, negative and positive predictive values were analyzed.
A systematic search identified 1,259 publications; 9 studies were eligible for inclusion (n = 7,160 central lines). Publicly reported CLABSI rates were more likely to be underestimated (7 studies) than overestimated (2 studies). Specificity ranged from 0.70 (95% confidence interval [CI], 0.58–0.81) to 0.99 (95% CI, 0.99–1.00) and sensitivity ranged from 0.42 (95% CI, 0.15–0.72) to 0.88 (95% CI, 0.77–0.95). Four studies, which included a consecutive series of patients (whole cohort), reported CLABSI incidence between 9.8% and 20.9%, and absolute CLABSI rates were underestimated by 3.3%–4.4%. The risk of bias was low to moderate in most included studies.
Our findings suggest consistent underestimation of true CLABSI incidence within publicly reported rates, weakening the validity and reliability of surveillance measures. Auditing, education, and adequate resource allocation is necessary to ensure that surveillance data are accurate and suitable for benchmarking and quality improvement measures over time.
Recent fieldwork and archival sedimentary materials from southern Iraq have revealed new insights into the environment that shaped southern Mesopotamia from the pre-Ubaid (early Holocene) until the early Islamic period. These data have been combined with northern Iraqi speleothem, or stalagmite, data that have revealed relevant palaeoclimate information. The new results are investigated in light of textual sources and satellite remote sensing work. It is evident that areas south of Baghdad, and to the region of Uruk, were already potentially habitable between the eleventh and early eighth millennia B.C., suggesting there were settlements in southern Iraq prior to the Ubaid. Date palms, the earliest recorded for Iraq, are evident before 10,000 B.C., and oak trees are evident south of Baghdad in the early Holocene but disappeared after the mid-sixth millennium B.C. New climate results suggest increased aridity after the end of the fourth millennium B.C. For the third millennium B.C. to first millennium A.D., a negative relationship between grain and date palm cultivation in Nippur is evident, suggesting shifting cultivation emphasising one of these crops at any given time in parts of the city. The Shatt en-Nil was also likely used as a channel for most of Nippur's historical occupation from the third millennium B.C. to the first millennium A.D. In the early to mid-first millennium A.D., around the time of the Sasanian period, a major increase in irrigation is evident in plant remains, likely reflecting large-scale irrigation expansion in the Nippur region. The first millennium B.C. to first millennium A.D. reflects a relatively dry period with periodic increased rainfall. Sedimentary results suggest the Nahrawan, prior to it becoming a well-known canal, formed an ancient branch of the Tigris, while the region just south of Baghdad, around Dalmaj, was near or part of an ancient confluence of the Tigris and Euphrates.
It is a commonplace in the history of science that reputations of scientists play important roles in the stories of scientific knowledge. I argue that to fully understand these roles we should see reputations as produced by communicative acts, consider how reputations become known about, and study the factors influencing such processes. I reapply James Secord's ‘knowledge-in-transit’ approach; in addition to scientific knowledge, I also examine how ‘biographical knowledge’ of individuals is constructed through communications and shaped by communicative contexts. My case study is Carl Sagan, widely discussed – amongst scientists, media professionals and publics – for his skill as a charismatic popularizer, his perceived arrogance, his political activism, and his debated merit as a researcher. By examining how aspects of Sagan's reputation circulated alongside his scientific work – rather than existing as a static context for his scientific work – I show how different forms of knowledge (biographical and scientific) influence each other as they circulate.
This study exploits a new long-run data set of daily bid and offered exchange rates in spot and forward markets from 1919 to the present to analyze carry returns in fixed and floating currency regimes. We first find that outsized carry returns occur exclusively in the floating regime, being zero in the fixed regime. Second, we show that fixed-to-floating regime shifts are associated with negative returns to a carry strategy implemented only on floating currencies, robust to the inclusion of volatility risks. These shifts are typically characterized by global flight-to-safety events that represent bad times for carry traders.
OBJECTIVES/SPECIFIC AIMS: Every year, approximately 800,000 Americans suffer a stroke. Supportive social environments are recognized as an important factor contributing to successful stroke recovery, yet, stroke lesions can affect brain areas important for socioemotional functioning, which could impair a patient’s ability to maintain their social relationships. Specifically, emotion recognition, a fundamental socioemotional skill, is predominantly right-lateralized and may be impacted by right-hemisphere stroke. This research tests for emotion recognition impairments after right-hemisphere stroke and examines whether such deficits are associated with worse reported social support. METHODS/STUDY POPULATION: Twenty right-hemisphere stroke patients (9 female, 11 male) and 23 age-matched healthy control subjects (9 female, 14 male) completed laboratory testing including the Geneva Emotion Recognition Test Short. Subjects additionally completed a measure of self-reported social support using the Older Americans Resources and Services questionnaire. Emotion recognition accuracy was calculated using overall accuracy and valence accuracy (i.e. correctly rating a positive emotion as positive). RESULTS/ANTICIPATED RESULTS: Right-hemisphere stroke patients had lower overall emotion recognition accuracy than controls (patients; M = 37.8%, SD = 18.9%. controls; M = 48.5%, SD = 14.6%, t(41)=2.11, p=.041). Furthermore, patients had significantly lower valence accuracy (patients; M = 84.5%, SD = 10.7%. controls; M = 90.0%, SD = 5.2%, t(41)=2.19, p =.035), indicating that they more often mistook a positive emotion as a negative emotion, and vice-versa. Finally, within the right-hemisphere patient group, overall emotion recognition accuracy was trending to be positively correlated with self-reported social support (rho = 0.397, p =.083), suggesting that poor emotion recognition skills may be associated with worse social outcomes in the real-world. DISCUSSION/SIGNIFICANCE OF IMPACT: Our findings indicate that right-hemisphere stroke is associated with impaired emotion recognition. Future research could investigate whether an emotion recognition training may be beneficial for right-hemisphere stroke patient recovery.
OBJECTIVES/SPECIFIC AIMS: Background: The importance of engaging community in research and fostering community-academic research partnerships is increasingly acknowledged by Clinical and Translational Science Award (CTSA) institutes. However, forming and maintaining such collaborations is often hampered by numerous challenges. It is critical to investigate the barriers to effective community-academic partnerships and to develop novel approaches to overcome these barriers. Objective: To explore community and academic perspectives of the challenges faced by community-academic research partnerships and potential solutions to these identified challenges. METHODS/STUDY POPULATION: Methods: In an effort to explore creative approaches to address these issues, the Community Engagement Program at the Michigan Institute for Clinical & Health Research (MICHR), the CTSA site that serves Michigan, hosted a retreat to elicit the input of community members and academics from across the state. There was a mix of participants ranging from those with established community-academic partnerships to others who were new to community-engaged research and in early stages of forming partnerships. At the retreat, attendees were randomly divided into groups and asked to answer the specific question, “What are your barriers to partnering in research?” After each group identified a set of barriers and reported their findings to the entire room, attendees were asked to work again in their small groups to discuss potential solutions to these barriers. Ideas for solutions were also shared with the entire room. As part of the process of brainstorming about these questions, attendees were asked to document their ideas --- for both barriers and solutions --- on post-it notes which were then grouped by category. Artifacts from the retreat were saved digitally and transcripts made from these records. The findings were then analyzed to identify common themes. RESULTS/ANTICIPATED RESULTS: Results: Eighty-six participants attended the retreat from across the state of Michigan. Forty-three represented community organizations that focus on addressing a wide array of social determinants of health issues. The remaining forty-three participants represented various academic institutions. The most frequently mentioned challenges to community-academic partnerships were related to communication and relationship building. To overcome barriers in these areas, participants noted that it is critical to collaboratively and explicitly identify shared goals, values and norms in the early stages of partnership development. This was closely linked to the need for additional funding to help foster and strengthen relationships by allowing partners to spend time together to both work and socialize informally, preferably in face-to-face settings. These were deemed crucial for building trust and common ground. In addition, more equitable funding and role distribution --- including shared leadership and governance of research projects between community and academia--- that recognizes and supports the true costs of involvement in research for community members was viewed as important. Other frequently noted issues on the part of community members were the need for greater respect for community partners and for more training opportunities to build capacity within communities to participate in research. Participants from academic institutions emphasized that the current requirements and timeline for promotion in academia make it harder for them to participate in community-engaged research, especially as early career researchers. They maintained that wider recognition of the value of community-engaged research is necessary and that this requires the support of home departments. Finally, participants underscored the importance of building infrastructure to better connect potential partners from the community and academia by making it easier to identify common interests and reciprocal strengths. DISCUSSION/SIGNIFICANCE OF IMPACT: Conclusion: The problems faced by community-academic partnerships may be alleviated by working with community and academic members to identify potential solutions. Further work is needed to systematically examine barriers and the efficacy of solutions to enhance community-academic partnerships. Acknowledgements: We thank all attendees of the MICHR Community Engagement retreat for their participation in this activity that explored barriers to effective community-academic partnerships. Their honest and frank feedback was essential to broaching sensitive topics related to partnership development, and to identify realistic and practical solutions. We also thank all members of the planning committee and our colleagues in the Community Engagement Program for their work on bringing together community and academic members for this retreat. This project was supported by grant number UL1TR002240 from the National Center for Advancing Translational Sciences (NCATS).