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Antipsychotic treatment is known to be associated with secondary sexual dysfunction (SD). Recognition and treatment of this adverse effect has received growing attention. Until now, all antipsychotic agents were thought to potentially cause SD mediated by increased prolactin. Our aim was to observe whether aripiprazole modifies SD in patients with schizophrenia after 3 months of treatment.
Material and Methods:
Multicenter, observational, open-label, prospective, three-month study with single group of aripiprazole treated patients. Sexual activity was assessed using CGI-S and CGI-I for SD; SALSEX scale, validated for Spanish, 3 times after initiating study drug. Patient's clinical status was evaluated by CGI-S and CGI-I for psychotic disorders, and by BPRS Scale.
Result: 42 patients (70% men), 38 completed the study. Incidence of SD at 3 months was null for all patients studied. As period of treatment advanced, the Salsex score decreased, showing a mean overall reduction of –5 points (SD 3.6). Largest reduction was observed in subgroup of patients with SD in baseline visit, who exhibited a mean reduction of –6 points (SD 3.1).
Men with SD in baseline evaluation showed more marked improvement than women at 40 days of treatment (p=0.0447). However, recovery was similar for both groups at 90 days of treatment.
In schizophrenia, SD secondary studies to antipsychotics are important in establishing effectiveness of these agents in chronic treatment. After 3 months of aripiprazole treatment, no SD was observed in patients. Patients who presented SD at study initiation improved over course of 3 months treatment with aripiprazole.
This review aims to understand the scope of the literature regarding mental health-related microaggressions towards people affected by mental health problems.
A scoping review was conducted to explore this question. Four electronic health-oriented databases were searched alongside Google Scholar. As per scoping review principles, the inclusion criteria were developed iteratively. The results of included studies were synthesised using a basic narrative synthesis approach, utilising principles of thematic analysis and thematic synthesis where appropriate.
A total of 1196 records were identified, of which 17 met inclusion criteria. Of these, 12 were peer-reviewed journal articles, three were research degree theses and two were book chapters. Six included empirical studies were qualitative, four were quantitative and two employed a mixed-methods design. Within these, five qualitative studies aimed to describe the nature of mental health microaggressions experienced by people with mental health problems. Themes identified in a thematic synthesis of these five studies included stereotypes about mental illness, invalidating peoples' experience and blaming people with mental illness for their condition. The included publications informed on the perpetration of mental health microaggressions by family, friends, health professionals and social workers. In addition, two studies created scales, which were then used in cross-sectional surveys of the general public and community members to assess characteristics, such as right-wing political views, associated with endorsement of mental health microaggressions. A consensus definition of microaggressions emerged from the included studies: microaggressions are brief, everyday slights, snubs or insults, that may be subtle or ambiguous, but communicate a negative message to a target person based on their membership of a marginalised group, in this case, people affected by mental illness.
The study of mental health microaggressions is an emerging, heterogeneous field, embedded in the wider stigma and discrimination literature. It has been influenced by earlier work on racial microaggressions. Both can be ambiguous and contradictory, which creates difficulty defining the boundaries of the concept, but also underpins the key theoretical basis for the negative impact of microaggressions. Mental illness is a more concealable potential type of identity, so it follows that the reported perpetrators of microaggressions are largely friends, family and professionals. This has implications for intervening to reduce the impact of microaggressions. There are several challenges facing research in this area, and further work is needed to understand the impact of mental health microaggressions on people affected by mental health problems.
What does the rise and election of Donald J. Trump as president mean for the future of conservatism? Republican elites continue to argue about whether Trump is changing the definition of conservatism for better or worse, although many Republicans seem content to let him shape the issues, direction, and brand of the traditional party of conservatism. We examine the ideological characteristics of different groups of Republican voters across three types of ideology: symbolic, operational, and conceptual. We find distinct differences between Republicans who consistently supported Trump and other groups that either supported him in the general election only and those who never supported him. The Never Trump camp stands out as a group that is less symbolically and operationally conservative but also better able to articulate what it means to be a conservative than do Trump’s core supporters, who look very much the opposite. These results suggest a contemporary Republican Party that is far from unified in what it means to be a conservative.
The hippocampus plays an important role in psychopathology and treatment outcome. While posterior hippocampus (PH) may be crucial for the learning process that exposure-based treatments require, affect-focused treatments might preferentially engage anterior hippocampus (AH). Previous studies have distinguished the different functions of these hippocampal sub-regions in memory, learning, and emotional processes, but not in treatment outcome. Examining two independent clinical trials, we hypothesized that anterior hippocampal volume would predict outcome of affect-focused treatment outcome [Interpersonal Psychotherapy (IPT); Panic-Focused Psychodynamic Psychotherapy (PFPP)], whereas posterior hippocampal volume would predict exposure-based treatment outcome [Prolonged Exposure (PE); Cognitive Behavioral Therapy (CBT); Applied Relaxation Training (ART)].
Thirty-five patients with posttraumatic stress disorder (PTSD) and 24 with panic disorder (PD) underwent structural magnetic resonance imaging (MRI) before randomization to affect-focused (IPT for PTSD; PFPP for PD) or exposure-based treatments (PE for PTSD; CBT or ART for PD). AH and PH volume were regressed with clinical outcome changes.
Baseline whole hippocampal volume did not predict post-treatment clinical severity scores in any treatment. For affect-focused treatments, but not exposure-based treatments, anterior hippocampal volume predicted clinical improvement. Smaller AH correlated with greater affect-focused treatment improvement. Posterior hippocampal volume did not predict treatment outcome.
This is the first study to explore associations between hippocampal volume sub-regions and treatment outcome in PTSD and PD. Convergent results suggest that affect-focused treatment may influence the clinical outcome through the ‘limbic’ AH, whereas exposure-based treatments do not. These preliminary, theory-congruent, therapeutic findings require replication in a larger clinical trial.
Are people conservative (liberal) because they are Republicans
(Democrats)? Or is it the reverse: people are Republicans
(Democrats) because they are conservatives (liberals)? Though much
has been said about this long-standing question, it is difficult to
test because the concepts are nearly impossible to disentangle in
modern America. Ideology and partisanship are highly correlated,
only growing more so over time. However, the election of President
Trump presents a unique opportunity to disentangle party attachment
from ideological commitment. Using a research design that employs
actual “conservative” and “liberal” policy statements from President
Trump, we find that low-knowledge respondents, strong Republicans,
Trump-approving respondents, and self-described conservatives are
the most likely to behave like party loyalists by accepting the
Trump cue—in either a liberal or conservative direction. These
results suggest that there are a large number of party loyalists in
the United States, that their claims to being a self-defined
conservative are suspect, and that group loyalty is the stronger
motivator of opinion than are any ideological principles.
Two new species of Oreocharis, O. tribracteata and O. rufescens, are described and a key to the species in Vietnam is provided. The new species have distinct features not previously, or rarely, observed in the genus, both showing the partial fusion of the calyx lobes into a tube, and the presence of three bracts in Oreocharis tribracteata.
Coinfection with human immunodeficiency virus (HIV) and viral hepatitis is associated with high morbidity and mortality in the absence of clinical management, making identification of these cases crucial. We examined characteristics of HIV and viral hepatitis coinfections by using surveillance data from 15 US states and two cities. Each jurisdiction used an automated deterministic matching method to link surveillance data for persons with reported acute and chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections, to persons reported with HIV infection. Of the 504 398 persons living with diagnosed HIV infection at the end of 2014, 2.0% were coinfected with HBV and 6.7% were coinfected with HCV. Of the 269 884 persons ever reported with HBV, 5.2% were reported with HIV. Of the 1 093 050 persons ever reported with HCV, 4.3% were reported with HIV. A greater proportion of persons coinfected with HIV and HBV were males and blacks/African Americans, compared with those with HIV monoinfection. Persons who inject drugs represented a greater proportion of those coinfected with HIV and HCV, compared with those with HIV monoinfection. Matching HIV and viral hepatitis surveillance data highlights epidemiological characteristics of persons coinfected and can be used to routinely monitor health status and guide state and national public health interventions.
Palmer amaranth is one of the most problematic weeds in the midsouthern United States, and the evolution of resistance to protoporphyrinogen oxidase (PPO) inhibitors in biotypes already resistant to glyphosate and acetolactate synthase (ALS) inhibitors is a major cause of concern to soybean and cotton growers in these states. A late-season weed-escape survey was conducted in the major row crop–producing counties (29 counties) to determine the severity of PPO-inhibitor resistance in Arkansas. A total of 227 Palmer amaranth accessions were sprayed with fomesafen at 395 g ha−1 to identify putative resistant plants. A TaqMan qPCR assay was used to confirm the presence of the ΔG210 codon deletion or the R128G/M (homologous to R98 mutation in common ragweed) target-site resistance mechanisms in the PPX2 gene. Out of the 227 accessions screened, 44 were completely controlled with fomesafen, and 16 had only one or two severely injured plants (≥98% mortality) when compared with the 1986 susceptible check (100% mortality). The remaining 167 accessions were genotypically screened, and 82 (49%) accessions were found to harbor the ΔG210 deletion in the PPX2 gene. The R128G was observed in 47 (28%) out of the 167 accessions screened. The mutation R128M, on the other hand was rare, found in only three accessions. About 13% of the accessions were segregating for both the ΔG210 and R128G mutations. Sixteen percent of the tested accessions had mortality ratings <90% and did not test positive for the ΔG210 or the R128G/M resistance mechanisms, indicating that a novel target or non–target site resistance mechanism is likely. Overall, PPO inhibitor–resistant Palmer amaranth is widespread in Arkansas, and the ΔG210 resistance mechanism is especially dominant in the northeast corridor, while the R128G mutation is more prevalent in counties near Memphis, TN.
Benzobicyclon is the first 4-hydroxyphenylpyruvate dioxygenase-inhibiting herbicide pursued for commercial registration in U.S. rice production. A study was conducted in 2015 and 2016 to evaluate the response of eight rice cultivars to post-flood application timings of benzobicyclon at 494 g ai ha-1 (proposed 2X rate). ‘Caffey’, ‘CL151’, ‘CLXL745’, ‘Jupiter’, ‘LaKast’, ‘Mermentau’, ‘Roy J’, and ‘XL753’ were evaluated in response to applications of benzobicyclon. The highest level of visible injury was observed in LaKast at 7% in 2015. No visible injury was detected among other cultivars either year at 2 weeks after treatment. In 2015 and 2016, no more than a four-day delay to reach 50% heading occurred across all cultivars. Rough rice yield was not affected by any of the post-flood application timings of benzobicyclon. A second study was conducted in 2016 at three locations throughout Arkansas to investigate the tolerance of 19 tropical japonica (inbred and hybrid) and two indica inbred cultivars to a premix containing benzobicyclon at 494 g ai ha-1 and halosulfuron at 72 g ai ha-1 applied 1 week after flooding. The tropical japonica cultivars have excellent crop safety to benzobicyclon while application to the indica cultivars, Rondo and Purple Marker, expressed severe phytotoxicity. Benzobicyclon caused less than a 2 d delay in heading to the japonica cultivars. Rough rice yield of the tropical japonica cultivars was not affected by benzobicyclon while yields of both indica cultivars were negatively affected. Benzobicyclon can safely be applied to drill-seeded tropical japonica inbred and hybrid cultivars in a post-flood application without concerns for crop injury. Benzobicyclon should not be used on indica cultivars as it will cause severe injury, delayed heading, and yield loss.
The management of glyphosate-resistant Palmer amaranth has been a challenge in southern United States cropping systems. Registration of dicamba-resistant crops will provide an alternative management option to control herbicide-resistant Palmer amaranth populations, particularly those having resistance to herbicide Groups 2, 3, 5, 9, 14, and 27. However, repeated use of sublethal doses of dicamba may lead to rapid evolution of herbicide resistance, especially in Palmer amaranth—a species with a strong tendency to evolve resistance. Therefore, selection experiments with dicamba were conducted on Palmer amaranth using sublethal doses. In the greenhouse, a known susceptible Palmer amaranth population was subjected to sublethal dicamba doses for three generations (P1–P3). Susceptibility of the individuals to dicamba was evaluated, and its susceptibility to 2,4-D was characterized. Based on the greenhouse study, following three generations of dicamba selection, the dose required to cause 50% mortality increased from 111 g ae ha−1 for parental individuals (P0) to 309 g ae ha−1 for the P3. Furthermore, reduced susceptibility of the P3 to 2,4-D was also evident. This research presents the first evidence that recurrent use of sublethal dicamba doses can lead to reduced susceptibility of Palmer amaranth to dicamba as well as 2,4-D. Here, we show that selection from sublethal dicamba doses has an important role in rapid evolution of Palmer amaranth with reduced susceptibility to auxin-type herbicides.
Pachyonychia congenita is a rare keratinising disorder, which typically presents during the first three years of life and usually affects the nails and palmoplantar surfaces. It can involve the larynx and potentially result in life-threatening airway obstruction.
A case report is presented and the findings of a literature review are reported. The review involved a PubMed search using the keywords ‘pachyonychia congenita’ together with ‘larynx’, ‘laryngeal involvement’, ‘laryngeal obstruction’, ‘airway obstruction’, ‘hoarseness’ and/or ‘stridor’.
A five-year-old boy, with confirmed pachyonychia congenita, presented with complications of laryngeal involvement over a four-year period. He required three intubations and a tracheostomy for acute airway obstruction. Treatment with potassium titanyl phosphate laser laryngoscopy stabilised the progression of laryngeal disease.
Patients with pachyonychia congenita and laryngeal involvement can have a varied presentation, ranging from hoarseness to acute airway obstruction. Management can be a challenge, requiring early evaluation, regular surveillance and aggressive treatment. This paper reports our experience in managing and treating the laryngeal complications of a child with pachyonychia congenita.
Vision loss caused by the death of photoreceptors is the leading cause of irreversible blindness in the developed world. Rapid advances in stem cell biology and techniques in cell transplantation have made photoreceptor replacement by transplantation a very plausible therapeutic strategy. These advances include the demonstration of restoration of vision following photoreceptor transplantation and the generation of transplantable populations of donor cells from stem cells. In this review, we present a brief overview of the recent progress in photoreceptor transplantation. We then consider in more detail some of the challenges presented by the degenerating retinal environment that must play host to these transplanted cells, how these may influence transplanted photoreceptor cell integration and survival, and some of the progress in developing strategies to circumnavigate these issues.
A statistically sound procedure for the unambiguous identification of the underlying Bravais lattice of an image of a 2D periodic array of objects is described. Our Bravais lattice detection procedure is independent of which type of microscope has been utilized for the recording of the image data. It is particularly useful for the correction of Scanning Tunneling Microscope (STM) images that suffer from a blunt scanning probe tip artifact, i.e. simultaneously recording multiple mini-tips. The unambiguous detection of the type of translation symmetry presents a first step towards making objective decisions about which plane symmetry a 2D periodic image is best modeled by. Such decisions are important for the application of Crystallographic Image Processing (CIP) techniques to images from Scanning Probe Microscopes (SPMs).
In this work results are presented regarding carbon composites produced by high energy mechanical milling and consolidated by spark plasma sintering. The involved energy input in such a processing method has been used to develop composite materials and to synthesize effective in-situ reinforcement. In the as milled and sintered composites various dispersions of graphene, graphitic carbon, and diamonds in an amorphous matrix are found. The graphene, graphitic carbon and diamond phases are synthesized primarily during milling. The TEAM-05 microscope has been used for characterization that is complemented with Raman results. The spark plasma sintering method enhances the presence of graphene, graphitic carbon and diamonds.
To develop a self-report questionnaire to measure mental health recovery from the service user viewpoint. Literature searches and scoping exercises indicated that psychological, social and spiritual issues should be included. The resultant provisional scale was completed by 107 service users.
The provisional scale was shortened as a result of factor analysis. The finalised version was highly reliable (Cronbach's alpha 0.911) and valid, correlating significantly with an already established recovery scale. It contained nine recognisable subscales, the first two describing existential and religious well-being. Separate well-being and ill-being factors were also identified.
An inclusive tool for service users' assessment of their own recovery, the Service User Recovery Evaluation (SeRvE) scale, has been validated. This can be used both as a research tool and clinically to monitor interventions. The importance of spiritual care for service users is highlighted.
The mechanical behavior of nanocomposites is critically dependent on their structural composition. In this paper we use Focused Ion Beam (FIB) microscopy to prepare surfaces from a layered polymer nanocomposite for investigation using phase contrast atomic force microscopy (AFM). Phase contrast AFM provides mechanical information on the surface examined and, by combining with the sequential cross-sectioning of FIB, can extend the phase contract AFM into three dimensions.
Flow separation is a source of aerodynamic inefficiency, by using vortex generators flow separation can be controlled. This is of particular benefit to flows around bodies which are susceptible to separated flows, such as bodies in ground effect. Previous studies on the ability of dimples to produce vortices for flow mixing concerned heat transfer applications. Experimental measurements using Laser Doppler Anemometry (LDA) were taken in the wake of the Tyrrell026 aerofoil (Rec = 0·5 × 105) with a dimple array machined in the surface. Results for a dimple array of three rows placed forward of x/c = 0·23 with 1·5D dimple to dimple spacing, showed significant flow recovery in the wake. The velocity deficit of u/Uo,min = −0·1 recovered to u/Uo,min = 0·3 with the dimple array and the size of the wake reduced by 50%; at α = 10°, h/c = 0·313. The positive effect of the dimple array on the wing reduced as the wing was brought closer to the ground.
To determine the anatomic sites and natural history of colonization with gram-negative multidrug-resistant organisms (MDROs).
Prospective, longitudinal cohort study.
Walter Reed Army Medical Center, a 236-bed tertiary care center in Washington, DC.
Deployed subjects (ie, inpatients medically evacuated from Iraq or Afghanistan) or nondeployed subjects admitted to the same hospital.
Consenting patients had 6 anatomic sites cultured every 3 days for 2 weeks and then weekly. Gram-negative organisms resistant to 3 or more classes of antibiotics were considered MDROs. Isolates were genotyped using pulsed-field gel electrophoresis. Clinical data, data on antibiotic use, and clinical culture results were collected.
Of 60 deployed subjects, 14 (23%) were colonized with an MDRO at admission, and 13 (22%) had incident colonization during hospitalization. The groin was the most sensitive anatomic site for detecting MDRO colonization, and all but one subject remained colonized for the duration of their hospitalization. Sixty percent of subjects with incident Acinetobacter colonization and 25% of subjects with incident Klebsiella colonization had strains that were related to those isolated from other subjects. Of 60 nondeployed subjects, 5 (8%) were colonized with an MDRO at admission; all had recent healthcare contact, and 1 nondeployed subject had an isolate related to a strain recovered from a deployed subject.
Colonization with gram-negative MDROs is common among patients with war-related trauma admitted to a military hospital and also occurs among nondeployed patients with recent healthcare contact. The groin is the most sensitive anatomic site for active surveillance, and spontaneous decolonization is rare.