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In response to advancing clinical practice guidelines regarding concussion management, service members, like athletes, complete a baseline assessment prior to participating in high-risk activities. While several studies have established test stability in athletes, no investigation to date has examined the stability of baseline assessment scores in military cadets. The objective of this study was to assess the test–retest reliability of a baseline concussion test battery in cadets at U.S. Service Academies.
All cadets participating in the Concussion Assessment, Research, and Education (CARE) Consortium investigation completed a standard baseline battery that included memory, balance, symptom, and neurocognitive assessments. Annual baseline testing was completed during the first 3 years of the study. A two-way mixed-model analysis of variance (intraclass correlation coefficent (ICC)3,1) and Kappa statistics were used to assess the stability of the metrics at 1-year and 2-year time intervals.
ICC values for the 1-year test interval ranged from 0.28 to 0.67 and from 0.15 to 0.57 for the 2-year interval. Kappa values ranged from 0.16 to 0.21 for the 1-year interval and from 0.29 to 0.31 for the 2-year test interval. Across all measures, the observed effects were small, ranging from 0.01 to 0.44.
This investigation noted less than optimal reliability for the most common concussion baseline assessments. While none of the assessments met or exceeded the accepted clinical threshold, the effect sizes were relatively small suggesting an overlap in performance from year-to-year. As such, baseline assessments beyond the initial evaluation in cadets are not essential but could aid concussion diagnosis.
This study provides a morphological and phylogenetic characterization of two novel species of the order Haplosporida (Haplosporidium carcini n. sp., and H. cranc n. sp.) infecting the common shore crab Carcinus maenas collected at one location in Swansea Bay, South Wales, UK. Both parasites were observed in the haemolymph, gills and hepatopancreas. The prevalence of clinical infections (i.e. parasites seen directly in fresh haemolymph preparations) was low, at ~1%, whereas subclinical levels, detected by polymerase chain reaction, were slightly higher at ~2%. Although no spores were found in any of the infected crabs examined histologically (n = 334), the morphology of monokaryotic and dikaryotic unicellular stages of the parasites enabled differentiation between the two new species. Phylogenetic analyses of the new species based on the small subunit (SSU) rDNA gene placed H. cranc in a clade of otherwise uncharacterized environmental sequences from marine samples, and H. carcini in a clade with other crustacean-associated lineages.
Although antidepressants are the most commonly used treatment for depressive illness, there is uncertainty if their use is associated with a reduction in suicide rate. Antidepressant prescribing in Northern Ireland has increased over fivefold in the decade 1989–1999. The authors sought to explore whether this increase was associated with a reduction in suicide rate taking into account social and political factors thought also to have an influence on suicide.
Materials and methods
Factors that have been suggested to influence suicide were entered into a linear regression with frequency of suicide and undetermined deaths (referred to as suicide rate) as the dependent variable. The above factors were antidepressant prescribing, unemployment rate, household alcohol expenditure and persons charged with terrorist offences. The rise in younger suicides, in recent decades, suggests this analysis should be carried out separately for younger (less than 30 years) and older (30 years and above) suicides separately. The predictors in the two models are based on aggregate data for the total group.
In the younger group there was no association between antidepressant prescribing and suicide. For the older group increased antidepressant prescribing was associated with a reduction in suicide rate over the 10 years of the study.
Increasing antidepressant prescribing appears to be an effective strategy for reducing suicide. This has been demonstrated in older individuals.
Individuals with personality disorders (especially paranoid personality disorder) tend to be reluctant to engage in treatment. This paper aimed to elucidate the role of personality disorder in predicting engagement with psychological treatment for depression. The Outcomes of Depression International Network (ODIN) involves six urban and three rural study sites throughout Europe at which cases of depression were identified through a two-stage community survey. One patient in seven who was offered psychological treatment for depression had a comorbid diagnosis of personality disorder (most commonly paranoid personality disorder). Forty-five percent of patients who were offered psychological treatment for depression did not complete treatment. The odds of completion were higher for patients with a comorbid diagnosis of personality disorder, especially paranoid, anxious or dependent personality disorder. The relatively low number of cases with some specific personality disorders (e.g. schizoid personality disorder) limited the study's power to reach conclusions about these specific disorders. This study focused on a community-based sample which may lead to apparently lower rates of engagement when compared to studies based on treatment-seeking populations. Episodes of depression in the context of personality disorder may represent a valuable opportunity to engage with patients who might otherwise resist engagement.
Many people with psychosis experience persecutory delusions and report negative schematic beliefs and intrusive mental images which may be maintaining factors for psychotic symptoms.
This study examined the feasibility and acceptability of a new psychological therapy targeting schemas and images (iMAPS therapy).
The study used a randomised multiple baseline design. Participants with first episode psychosis were randomised using a multiple baseline design with 2–5 assessments. Six sessions of therapy, consisting of a combination of imagery techniques and imagery rescripting techniques, was used. In each session, participants completed a Mental Imagery in Psychosis Questionnaire (MIPQ) and imagery interview. Mood and delusional beliefs (PSYRATS) were also measured at each session.
Five participants with first episode psychosis completed the baseline visits and attended all therapy sessions. One participant declined the final assessment. Results demonstrated significant reductions in negative schematic beliefs, delusions, imagery distress and other measures of schema (YSQ, SMI). Although multiple baseline randomisation strengthens the study, it lacked a control arm and blind assessments.
iMAPS appears a feasible and acceptable treatment for psychosis, and further evaluation is indicated.
Hard-core smokers have been identified as a potential public health challenge. The trans-theoretical model lacks the specificity to identify hard-core smokers. The precaution adoption process model (PAPM) is a stage-based behaviour change model which includes ‘no intent to quit’ as a distinct stage and so may be useful in identifying hard-core smokers.
The aim of this study was to apply the PAPM to a community based sample of smokers to determine whether it provides a useful approach to identifying hard-core smokers.
We surveyed smokers in Australia who were recruited through social media and an online data collection agency.
The sample included 336 current smokers, 11.9% were in Stage 4 of the PAPM – i.e. had decided not to quit. Stage 4 smokers are more resistant to quitting and marked by their similarities to hard-core smokers. This is further amplified when addressing Stage 4 smokers with no previous quit attempt.
Stage 4 smokers with no previous quit attempts are aligned with a hard-core smoker profile with higher levels of nicotine dependence, greater cigarette consumption and low socio-economic status. Further research is required to determine if PAPM is a valid predictive model for identifying hard-core smokers in clinical practice.
Reflecting on present unease about structural biases in the discipline, and aiming to offer a data-rich response to some recent criticisms of this Journal, the Editorial Board has undertaken a study of the representation of female scholars in the Journal of Roman Studies. To that end, we have gathered data on publications, submissions and JRS Editorial Board membership for the past fifteen years, from Volume 95 (2005) through to the present volume, Volume 109 (2019). The data are set out in the final section (VII), following a brief review of the main results. Our goal here is neither to present a definitive analysis, nor to offer a commentary on the underlying causes of the patterns revealed (on which we expect much fruitful discussion elsewhere). Rather, the JRS Editorial Board aims to make key data available both to inform a much wider debate within the profession as a whole and, importantly, to inform this Journal’s policies, procedures and active outreach. The Board is also acutely aware that any analysis of gender bias needs to be framed carefully — both by an awareness that there are other under-represented groups in the discipline (on which our data in their current form would regrettably only offer a most imperfect picture), and by a sensitivity to the limitations of a conception of gender as a simple binary.
With generous support from the National Science Foundation, we have spent the past four years developing an archaeological radiocarbon database for the United States. Here, we highlight the importance of spatial data for open-access, national-scale archaeological databases and the development of paleodemography research. We propose a new method for analyzing radiocarbon time series in the context of paleoclimate models. This method forces us to confront one of the central challenges to realizing the full potential of national-scale databases: the quality of the spatial data accompanying radiocarbon dates. We seek to open a national discussion on the use of spatial data in open-source archaeological databases.
Species distribution models (SDMs) are statistical tools used to develop continuous predictions of species occurrence. ‘Integrated SDMs’ (ISDMs) are an elaboration of this approach with potential advantages that allow for the dual use of opportunistically collected presence-only data and site-occupancy data from planned surveys. These models also account for survey bias and imperfect detection through the use of a hierarchical modelling framework that separately estimates the species–environment response and detection process. This is particularly helpful for conservation applications and predictions for rare species, where data are often limited and prediction errors may have significant management consequences. Despite this potential importance, ISDMs remain largely untested under a variety of scenarios. We performed an exploration of key modelling decisions and assumptions on an ISDM using the endangered Baird’s tapir (Tapirus bairdii) as a test species. We found that site area had the strongest effect on the magnitude of population estimates and underlying intensity surface and was driven by estimates of model intercepts. Selecting a site area that accounted for the individual movements of the species within an average home range led to population estimates that coincided with expert estimates. ISDMs that do not account for the individual movements of species will likely lead to less accurate estimates of species intensity (number of individuals per unit area) and thus overall population estimates. This bias could be severe and highly detrimental to conservation actions if uninformed ISDMs are used to estimate global populations of threatened and data-deficient species, particularly those that lack natural history and movement information. However, the ISDM was consistently the most accurate model compared to other approaches, which demonstrates the importance of this new modelling framework and the ability to combine opportunistic data with systematic survey data. Thus, we recommend researchers use ISDMs with conservative movement information when estimating population sizes of rare and data-deficient species. ISDMs could be improved by using a similar parameterization to spatial capture–recapture models that explicitly incorporate animal movement as a model parameter, which would further remove the need for spatial subsampling prior to implementation.
Although the argument of the Essay on population originated in a family disagreement between Malthus and his father Daniel, who idolized Rousseau, and the Essay itself attacks Condorcet and Godwin, both of whom drew on Rousseau's ideas about human perfectibility, Malthus's project can plausibly be seen as an extension of the social theory set out above all in Rousseau's Discourse on the origin of inequality. Malthus was animated by some of Rousseau's characteristic concerns, and he deployed recognizable versions of some of Rousseau's distinctive arguments, in particular relating to the natural sociability and natural condition of humankind, conjectural history, and political economy, especially with respect to the question of balanced growth. His arguments about ‘decent pride’, furthermore, that were emphasized in later editions of the Essay map neatly onto what has been called ‘uninflamed amour-propre’ in the Rousseau literature. When we treat the social question as a nineteenth-century question, or when we locate its origins in the post-Revolutionary political controversies of the 1790s, we risk losing sight of the way in which what was being discussed were variations on mid-eighteenth-century themes.
To evaluate whole-genome sequencing (WGS) as a molecular typing tool for MRSA outbreak investigation.
Investigation of MRSA colonization/infection in a neonatal intensive care unit (NICU) over 3 years (2014–2017).
Single-center level IV NICU.
NICU infants and healthcare workers (HCWs).
Infants were screened for MRSA using a swab of the anterior nares, axilla, and groin, initially by targeted (ring) screening, and later by universal weekly screening. Clinical cultures were collected as indicated. HCWs were screened once using swabs of the anterior nares. MRSA isolates were typed using WGS with core-genome multilocus sequence typing (cgMLST) analysis and by pulsed-field gel electrophoresis (PFGE). Colonized and infected infants and HCWs were decolonized. Control strategies included reinforcement of hand hygiene, use of contact precautions, cohorting, enhanced environmental cleaning, and remodeling of the NICU.
We identified 64 MRSA-positive infants: 53 (83%) by screening and 11 (17%) by clinical cultures. Of 85 screened HCWs, 5 (6%) were MRSA positive. WGS of MRSA isolates identified 2 large clusters (WGS groups 1 and 2), 1 small cluster (WGS group 3), and 8 unrelated isolates. PFGE failed to distinguish WGS group 2 and 3 isolates. WGS groups 1 and 2 were codistributed over time. HCW MRSA isolates were primarily in WGS group 1. New infant MRSA cases declined after implementation of the control interventions.
We identified 2 contemporaneous MRSA outbreaks alongside sporadic cases in a NICU. WGS was used to determine strain relatedness at a higher resolution than PFGE and was useful in guiding efforts to control MRSA transmission.
Music Criticism in France, 1918–1939: Authority, Advocacy, Legacy examines the aesthetic battles, discursive strategies and cultural stakes that animated and informed French music criticism during the interwar period. Drawing on a rich corpus of critical writings and archival documents, the primary goal of its twelve essays is to uncover some of the public debates that emerged around classical music at this time. As such, it provides significant new insights into the period's musical priorities and values while also highlighting some of the challenges confronting this war-bound generation. The book examines the ways in which influential critics played prominent roles in promoting the careers and defending the reputations of both young and established composers. It considers the efforts that critics took to shape the history of France's musical past. Finally, it questions how critics used their professional and social affiliations as a means of better buttressing their own aesthetic and political agendas.
The interwar period in France is often described as problematic, more famous for the deaths of major figures including Claude Debussy, Gabriel Fauré and Camille Saint-Saëns than the achievements of its living composers. Until fairly recently it has been marginalised, in contrast to the ‘golden’ generation of Debussy and his circle on the one hand and the ‘renewal’ of French musical life with Olivier Messiaen on the other. Yet the ‘Années Folles’ are distinctive in several respects. Having inherited the pre-war musical aesthetics of Debussy and Fauré, but also confronted with the iconoclastic works of a new generation (including Les Six) who used the press to reject the aesthetics of its forebears, interwar French music critics were drawn into an acute battle over conservative and progressive musical trends. Whereas critics including Henri Collet (1885–1951), Paul Landormy (1869–1943) and Henry Prunières (1886–1942) energetically supported the works and aesthetic paradigms of the younger generations, figures such as Émile Vuillermoz (1878–1960), Léon Vallas (1879–1956), Dominique Sordet (1889–1946) and Lucien Rebatet (1903–72) frequently denounced the avant-garde and attempted to influence a musical climate for which they felt a fair measure of dissatisfaction. As a result, the period is characterised by often fraught debates around what it meant to be avant-garde and modern.