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.
Migration of mental health professionals is an important phenomenon influencing mental health services of host and donor countries. Data on medical migration in Europe is very limited, particularly in the field of young doctors and psychiatry. To research this hot topic, the European Federation of Psychiatric Trainees (EFPT) conducted the EFPT Brain Drain Survey.
To identify the impact of previous short-term mobility on international migration and to understand characteristics, patterns and reasons of migration.
In this cross-sectional European multicentre study, data were collected from 2281 psychiatric trainees across 33 countries. All participants answered to the EFPT Brain Drain Survey reporting their attitudes and experiences on migration.
Two-thirds of the trainees had not had a short-mobility experience in their lifetime, but those that went abroad were satisfied with their experiences, reporting that these influenced their attitude towards migration positively. However, the majority of the trainees had not had a migratory experience of more than 1 year. Flows showed that Switzerland and United Kingdom have the greatest number of immigrant trainees, whereas Germany and Greece have the greatest number of trainees leaving. ‘'Pull factors'’ were mostly academic and personal reasons, whereas ‘'push factors'’ were mainly: academic and financial reasons. Trainees that wanted to leave the country were significantly more dissatisfied with their income.
The majority of the trainees has considered leaving the country they currently lived in, but a lower percentage has taken steps towards migration.
Psychiatric training in the European Union is undergoing a process of harmonization of national curricula in order to establish a common postgraduate training framework. The Research Group of the European Federation of Psychiatric Trainees (EFPT) is conducting a multi-national study on psychiatry education of trainees among the European countries in regard to the Union Européenne Des Médecins Spécialistes (UEMS) 2009 competencies framework.
The aims are to raise awareness on these competencies, compile data on trainees‘ experience of their training and assessment methods, opinions on level of confidence, and on relevance of these competencies.
This study surveyed trainees from 15 EFPT countries using a questionnaire developed specifically for this research.
Psychiatric training in Europe differs significantly regarding length, with a training duration ranging from 4 to 8 years. Only 26,7% of the trainees were well acquainted with the UEMS competencies and trainees from only 8 countries declared to have a competency based national training curriculum. These results reveal that trainees have different experiences and opinions on competencies and assessment methods depending on their country of residence.
A limitation of the results may be that our respondents are the EFPT representatives’ and probably have better knowledge on the educational issues.
The combined quantitative and qualitative outlook on national training programmes from the trainees point of view enhances our understanding and perspective of the dynamic processes of psychiatric education in Europe. Data obtained from this research study contributes to the efforts to unify psychiatric training curricula.
There is a shortage of psychiatrists worldwide. Within Europe, psychiatric trainees can move between countries, which increases the problem in some countries and alleviates it in others. However, little is known about the reasons psychiatric trainees move to another country.
Survey of psychiatric trainees in 33 European countries, exploring how frequently psychiatric trainees have migrated or want to migrate, their reasons to stay and leave the country, and the countries where they come from and where they move to. A 61-item self-report questionnaire was developed, covering questions about their demographics, experiences of short-term mobility (from 3 months up to 1 year), experiences of long-term migration (of more than 1 year) and their attitudes towards migration.
A total of 2281 psychiatric trainees in Europe participated in the survey, of which 72.0% have ‘ever’ considered to move to a different country in their future, 53.5% were considering it ‘now’, at the time of the survey, and 13.3% had already moved country. For these immigrant trainees, academic was the main reason they gave to move from their country of origin. For all trainees, the overall main reason for which they would leave was financial (34.4%), especially in those with lower (<500€) incomes (58.1%), whereas in those with higher (>2500€) incomes, personal reasons were paramount (44.5%).
A high number of psychiatric trainees considered moving to another country, and their motivation largely reflects the substantial salary differences. These findings suggest tackling financial conditions and academic opportunities.
Eosinophils are important immune cells that have been implicated in resistance to gastrointestinal nematode (GIN) infections in both naturally and experimentally infected sheep. Proteins of particular importance appear to be IgA-Fc alpha receptor (FcαRI), C-C chemokine receptor type 3 (CCR3), proteoglycan 3 (PRG3, major basic protein 2) and EPX (eosinophil peroxidase). We used known human nucleotide sequences to search the ruminant genomes, followed by translation to protein and sequence alignments to visualize differences between sequences and species. Where a sequence was retrieved for cow, but not for sheep and goat, this was used additionally as a reference sequence. In this review, we show that eosinophil function varies among host species. Consequently, investigations into the mechanisms of ruminant immune responses to GIN should be conducted using the natural host. Specifically, we address differences in protein sequence and structure for eosinophil proteins.
Subclinical delusional ideas, including persecutory beliefs, in otherwise healthy individuals are heritable symptoms associated with increased risk for psychotic illness, possibly representing an expression of one end of a continuum of psychosis severity. The identification of variation in brain function associated with these symptoms may provide insights about the neurobiology of delusions in clinical psychosis.
A resting-state functional magnetic resonance imaging scan was collected from 131 young adults with a wide range of severity of subclinical delusional beliefs, including persecutory ideas. Because of evidence for a key role of the amygdala in fear and paranoia, resting-state functional connectivity of the amygdala was measured.
Connectivity between the amygdala and early visual cortical areas, including striate cortex (V1), was found to be significantly greater in participants with high (n = 43) v. low (n = 44) numbers of delusional beliefs, particularly in those who showed persistence of those beliefs. Similarly, across the full sample, the number of and distress associated with delusional beliefs were positively correlated with the strength of amygdala-visual cortex connectivity. Moreover, further analyses revealed that these effects were driven by those who endorsed persecutory beliefs.
These findings are consistent with the hypothesis that aberrant assignments of threat to sensory stimuli may lead to the downstream development of delusional ideas. Taken together with prior findings of disrupted sensory-limbic coupling in psychosis, these results suggest that altered amygdala-visual cortex connectivity could represent a marker of psychosis-related pathophysiology across a continuum of symptom severity.
A wide variety of methods are available to assess dietary intake, each one with different strengths and weaknesses. Researchers face multiple challenges when diet and nutrition need to be accurately assessed, particularly in the selection of the most appropriate dietary assessment method for their study. The goal of the current collaborative work is to present a collection of available resources for dietary assessment implementation.
As a follow-up to the 9th International Conference on Diet and Physical Activity Methods held in 2015, developers of dietary assessment toolkits agreed to collaborate in the preparation of the present paper, which provides an overview of each toolkit. The toolkits presented include: the Diet, Anthropometry and Physical Activity Measurement Toolkit (DAPA; UK); the National Cancer Institute’s (NCI) Dietary Assessment Primer (USA); the Nutritools website (UK); the Australasian Child and Adolescent Obesity Research Network (ACAORN) method selector (Australia); and the Danone Dietary Assessment Toolkit (DanoneDAT; France). An at-a-glance summary of features and comparison of the toolkits is provided.
The present review contains general background on dietary assessment, along with a summary of each of the included toolkits, a feature comparison table and direct links to each toolkit, all of which are freely available online.
This overview of dietary assessment toolkits provides comprehensive information to aid users in the selection and implementation of the most appropriate dietary assessment method, or combination of methods, with the goal of collecting the highest-quality dietary data possible.
For this study, we adapted the Montgomery Borgatta Caregiver Burden Scale, used widely in the United States, to the Saudi Arabian context. To produce an Arabic, culturally sensitive version of the scale, we conducted semi-structured interviews with 20 Saudi family caregivers. The Arabic version of the scale was tested, and participants were asked to comment on the appropriateness of items for the construct of “caregiver burden” using the repertory grid technique and laddering procedure – two constructivist methods derived from personal construct theory. From interview findings, we examined the content of the items and the caregiver burden construct itself. Our findings suggest that the use of constructivist methods to refine constructs and quantitative instruments is highly informative. This strategy is feasible even when little is known about the investigated constructs in the target culture and further elucidates our understanding of cross-cultural variations or invariance of different versions of the scale.
In sub-Saharan Africa, there are limited data on burden of non-alcohol substance abuse (NAS) and depressive symptoms (DS), yet potential risk factors such as alcohol and intimate partner violence (IPV) are common and NAS abuse may be the rise. The aim of this study was to measure the burden of DS and NAS abuse, and determine whether alcohol use and IPV are associated with DS and/or NAS abuse. We conducted a cross-sectional study at five sites in four countries: Nigeria (nurses), South Africa (teachers), Tanzania (teachers) and two sites in Uganda (rural and peri-urban residents). Participants were selected by simple random sampling from a sampling frame at each of the study sites. We used a standardized tool to collect data on demographics, alcohol use and NAS use, IPV and DS and calculated prevalence ratios (PR). We enrolled 1415 respondents and of these 34.6% were male. DS occurred among 383 (32.3%) and NAS use among 52 (4.3%). In the multivariable analysis, being female (PR = 1.49, p = 0.008), NAS abuse (PR = 2.06, p = 0.02) and IPV (PR = 2.93, p < 0.001) were significantly associated with DS. Older age [odds ratio (OR) = 0.31, p < 0.001)], female (OR = 0.48, p = 0.036) were protective of NAS but current smokers (OR = 2.98, p < 0.001) and those reporting IPV (OR = 2.16, p = 0.024) were more likely to use NAS. Longitudinal studies should be done to establish temporal relationships with these risk factors to provide basis for interventions.
Geography, Occupations and Social Classes
Andrew R. Holmes, Lecturer in Modern Irish History, Queen's University Belfast,
Eugenio F. Biagini, Professor of Modern and Contemporary History in the University of Cambridge and a Fellow of Sidney Sussex College Cambridge
The Protestants of Ireland are a complex community, made so by social, denominational, political, economic and geographical factors. Since the early seventeenth century, there have been tensions between, on the one hand, Church of Ireland Protestants in the south, the self-styled natural leaders of Ireland with their ties to the land and the state, and, on the other, Presbyterian-dominated Ulster with its tenant farmers, industrial character and often cantankerous disposition. Of course, this simplistic dichotomy obscures social and economic divisions within both communities and the numerically small but dynamic subculture of Protestant churches and sects that have contributed much to the development of the island. Given its often bewildering variety, historians have struggled to describe the complexity of this group.
Confessional State, Enlightenment and Rebellion, 1740–1800
Ireland in the 1740s, according to S. J. Connolly, was an ancien régime society in which religious inequalities were inseparable from social hierarchy and landownership. The dominance of the members of the established episcopal Church of Ireland was predicated on the rights of landed property, not the rights of numbers. The religious allegiance of the Irish population had been determined in the previous century by population movements rather than conversion. Three-quarters to four-fifths of the population were Catholic and though various Protestants were at certain times compelled to make common cause, Irish religious divisions were not simply binary – tensions between Protestants were as important and contributed to the remarkable events of 1798 when Presbyterian rebels in Ulster joined with Catholic insurgents in the south to overthrow in part the political, social and economic ascendancy of episcopal Protestants. The confessional divisions expressed during the Williamite wars had largely subsided by the 1740s. The Age of Reason had cooled somewhat the religious temperature of the previous century, though it was the ‘good behaviour’ of Irish Catholics during the Jacobite risings of 1715 and 1745 that is perhaps more important. The penal laws played their part, but those against Catholic religious practice quickly entered abeyance whereas those concerned with landownership were rigorously enforced.
Leibovich et al. claim that number representations are non-existent early in life and that the associations between number and continuous magnitudes reside in stimulus confounds. We challenge both claims – positing, instead, that number is represented independently of continuous magnitudes already in infancy, but is nonetheless more deeply connected to other magnitudes through adulthood than acknowledged by the “sense of magnitude” theory.
White matter (WM) impairments have been reported in patients with bipolar disorder (BD) and those at high familial risk of developing BD. However, the distribution of these impairments has not been well characterized. Few studies have examined WM integrity in young people early in the course of illness and in individuals at familial risk who have not yet passed the peak age of onset.
WM integrity was examined in 63 BD subjects, 150 high-risk (HR) individuals and 111 participants with no family history of mental illness (CON). All subjects were aged 12 to 30 years.
This young BD group had significantly lower fractional anisotropy within the genu of the corpus callosum (CC) compared with the CON and HR groups. Moreover, the abnormality in the genu of the CC was also present in HR participants with recurrent major depressive disorder (MDD) (n = 16) compared with CON participants.
Our findings provide important validation of interhemispheric abnormalities in BD patients. The novel finding in HR subjects with recurrent MDD – a group at particular risk of future hypo/manic episodes – suggests that this may potentially represent a trait marker for BD, though this will need to be confirmed in longitudinal follow-up studies.
Introduction: Acute upper gastrointestinal bleeding is a potentially life-threatening medical emergency that frequently requires red blood cell (RBC) transfusions. However, the optimal hemoglobin thresholds for transfusion is controversial. The objective of this study was to establish the most efficacious transfusion threshold. Methods: A systematic review of the published literature was completed. MEDLINE, Health technology assessment database, Cochrane central register, Cochrane database of systematic reviews, and EMBASE were searched from inception to May 2015 using search terms including “blood transfusions”, “hemoglobin”, and “red blood cell”. Studies were included if they: reported original data, were peer-reviewed, studied adult populations, were randomized controlled clinical trials and primarily focused on clinical efficacy or effectiveness of liberal and restrictive pre-transfusion hemoglobin level thresholds. Quality was assessed using the Cochrane Risk of Bias tool. Data were extracted and meta-analysis was conducted using a random effects model to determine the risk ratio for: all-cause mortality, further bleeding and any adverse events. All steps were completed independently by two reviewers. Results: The literature search identified 4037 unique abstracts. Of these, 156 abstracts proceeded to full text review. 154 articles were excluded during full-text review resulting in 2 articles for final analysis. The total number of participants included was 701. The hemoglobin threshold to transfuse RBC varied between 70-80g/L versus 90-100g/L in restrictive and liberal policies, respectively. Both studies were at low risk of bias. Meta-analysis resulted in a pooled decreased risk of all-cause mortality (RR 0.65, 95% CI 0.44-0.96), re-bleeding (RR 0.63, 95% CI 0.46-0.85) and adverse events (RR 0.83, 95% CI 0.73-0.95) in the restrictive blood transfusion group versus the liberal blood transfusion group. Conclusion: While the evidence is limited, the risk of death is lower and there is no significant harm for a restrictive strategy. In this context, there is a decreased risk of transfusion associated adverse events among those receiving a restrictive strategy and should be considered for its impact on patient safety and health system resources.
The use of underground geological repositories, such as in radioactive waste disposal (RWD) and in carbon capture (widely known as Carbon Capture and Storage; CCS), constitutes a key environmental priority for the 21st century. Based on the identification of key scientific questions relating to the geophysics, geochemistry and geobiology of geodisposal of wastes, this paper describes the possibility of technology transfer from high-technology areas of the space exploration sector, including astrobiology, planetary sciences, astronomy, and also particle and nuclear physics, into geodisposal. Synergies exist between high technology used in the space sector and in the characterization of underground environments such as repositories, because of common objectives with respect to instrument miniaturization, low power requirements, durability under extreme conditions (in temperature and mechanical loads) and operation in remote or otherwise difficult to access environments.
In the present work, the interactions between forsterite-91 with distilled water and forsterite-91 with artificial seawater were studied at two pHs (2.0 and 8.0) using different techniques. A large increase in pH was observed for samples incubated at an initially acidic pH (2.0) due to the dissolution of forsterite-91 in distilled water and artificial seawater. Thus, in acidic hydrothermal vents, an increase in the amount of hydrocarbons and magnetite should be expected due to the release of Fe(II). The pHPZC decreased and the pHIEP increased when forsterite-91 was treated with distilled water and artificial seawater. The ions from the artificial seawater had an effect on zeta potential. Scanning electron microscopy (SEM) images and X-ray diffractograms showed halite in the samples of forsterite-91 mixed with artificial seawater. The presence of halite or adsorption of ions on the surface of forsterite-91 could affect the synthesis of magnetite and hydrocarbons in hydrothermal vents, due to a decrease in the dissolution rates of forsterite-91. The dissolution of forsterite-91 yields low concentrations of Fe(III) and Mn(II) as detected by electron paramagnetic resonance (EPR) spectroscopy. Microanalysis of forsterite-91 showed a higher amount of Mn, with an oxidation that was likely not +II, as Mn in supernatant solutions was only detected by EPR spectroscopy after mixing with artificial seawater at pH 2.0. As Fe(III) and Mn(II) are catalyst constituents of magnetite and manganese oxide, respectively, their presence is important for synthesis in hydrothermal vents. Etch pits were observed only in the forsterite-91 sample mixed with distilled water at pH 8.0. Na, Cl, S, Ca and K were detected in the samples mixed with artificial seawater by SEM–EDS. Si, Mg, Fe and Al were detected in almost all supernatant samples due to forsterite-91 dissolution. Cr was not dissolved in the experiments, thus Cr in the mineral could serve as an effective catalyst for Fischer Tropsch Types (FTT) reactions in hydrothermal vent systems. X-ray diffractograms of the original forsterite-91 also showed peaks arising from zeolites and clinochlore. After the samples were treated with artificial seawater, X-ray diffractograms showed the dissolution of zeolite. Experiments should be performed in the natural environment to verify the potential for zeolites to act as a catalyst in hydrothermal vents.
Over the last 60 years, the resources and the research in the Danish Twin Registry (DTR) have periodically been summarized. Here, we give a short overview of the DTR and a more comprehensive description of new developments in the twenty-first century. First, we outline our experience over the last decade of combining questionnaire and survey data with national demographic, social, and health registers in Statistics Denmark. Second, we describe our most recent data collection effort, which was conducted during the period 2008–2011 and included both in-person assessments of 14,000+ twins born 1931–1969 and sampling of biological material, hereby expanding and consolidating the DTR biobank. Third, two examples of intensively studied twin cohorts are given. The new developments in the DTR in the last decade have facilitated the ongoing research and laid the groundwork for new research directions.