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Current discussions of the early Jewish reception of Kantian philosophy are dominated by two major approaches. According to the first, this reception was governed by a universal Enlightenment rationalism that was present in Judaism no less than in Kantian philosophy. According to the second, it was the fact that Kantianism contained a latent Judaic kabbalistic philosophy that made it attractive to Jewish intellectuals. This paper departs from both approaches by showing that when Jewish intellectuals encountered Kantianism they found neither a universal rationality to which Judaism should conform, nor an esoteric Jewish metaphysics to which Kantian philosophy had already conformed, but something else entirely, namely a hostile philosophical religion that sought to reconstruct Judaism in its own image. As a result of the historical context in which this challenge arose, some Jewish intellectuals accepted this reconstruction as a rational reform, while others repudiated it as a Christian-rationalist assault on Jewish law and tradition. Characterized first by the absence of a defensive Jewish Schulmetaphysik that might combat Kantianism on its own grounds, and second by the preparedness of enlightened intellectuals to extort Jewish acceptance of Christian rationalism by withholding citizenship rights, this context made Kantian philosophy into an offer that was difficult for Jewish intellectuals to refuse, or accept.
Behaviour that challenges in people with intellectual disability is associated with higher healthcare, social care and societal costs. Although behavioural therapies are widely used, there is limited evidence regarding the cost and quality-adjusted life-years (QALYs).
We aimed to assess the incremental cost per QALY gained of therapist training in positive behaviour support (PBS) and treatment as usual (TAU) compared with TAU using data from a cluster randomised controlled trial (Clinical Trials.gov registration: NCT01680276).
We conducted a cost-utility analysis (cost per QALY gained) of 23 teams randomised to PBS or TAU, with a total of 246 participants followed up over 36 months. The primary analysis was from a healthcare cost perspective with a secondary analysis from a societal cost perspective.
Over 36 months the intervention resulted in an additional 0.175 QALYs (discounted and adjusted 95% CI −0.068 to 0.418). The total cost of training in and delivery of PBS is £1598 per participant plus an additional cost of healthcare of £399 (discounted and adjusted 95% CI −603 to 1724). From a healthcare cost perspective there is an 85% probability that the intervention is cost-effective compared with TAU at a £30 000 willingness to pay for a QALY threshold.
There was a high probability that training in PBS is cost-effective as the cost of training and delivery of PBS is balanced out by modest improvements in quality of life. However, staff training in PBS is not supported given we found no evidence for clinical effectiveness.
Staff training in positive behaviour support (PBS) is a widespread treatment approach for challenging behaviour in adults with intellectual disability.
To evaluate whether such training is clinically effective in reducing challenging behaviour during routine care (trial registration: NCT01680276).
We carried out a multicentre, cluster randomised controlled trial involving 23 community intellectual disability services in England, randomly allocated to manual-assisted staff training in PBS (n = 11) or treatment as usual (TAU, n = 12). Data were collected from 246 adult participants.
No treatment effects were found for the primary outcome (challenging behaviour over 12 months, adjusted mean difference = −2.14, 95% CI: −8.79, 4.51) or secondary outcomes.
Staff training in PBS, as applied in this study, did not reduce challenging behaviour. Further research should tackle implementation issues and endeavour to identify other interventions that can reduce challenging behaviour.
Major depressive disorder is a common diagnosis associated with a high burden of disease that has proven to be highly heterogeneous and unreliable. Treatments currently available demonstrate limited efficacy and effectiveness. New drug development is urgently required but is likely to be hindered by diagnostic limitations.
Mergers and acquisitions (M&A), leveraged finance and capital markets are important markets for professional advisory firms such as investment banks, financial sector law firms and the ‘Big 4’ consultancies. While market totals are widely published in free sources, finding both sub-totals and lists of deals is more difficult and usually requires access to paid-for sources. In this article Ian Hunter considers the best paid-for and free sources and looks at the caveats in relying on them. In essence, he asks ‘why don't the sources agree?’ and provides a ‘jargon buster’ and a critique of sources in M&A, leveraged finance and capital markets.
Gut microbes have a substantial influence on systemic immune function and allergic sensitisation. Manipulation of the gut microbiome through prebiotics may provide a potential strategy to influence the immunopathology of asthma. This study investigated the effects of prebiotic Bimuno-galactooligosaccharide (B-GOS) supplementation on hyperpnoea-induced bronchoconstriction (HIB), a surrogate for exercise-induced bronchoconstriction, and airway inflammation. A total of ten adults with asthma and HIB and eight controls without asthma were randomised to receive 5·5 g/d of either B-GOS or placebo for 3 weeks separated by a 2-week washout period. The peak fall in forced expiratory volume in 1 s (FEV1) following eucapnic voluntary hyperpnoea (EVH) defined HIB severity. Markers of airway inflammation were measured at baseline and after EVH. Pulmonary function remained unchanged in the control group. In the HIB group, the peak post-EVH fall in FEV1 at day 0 (−880 (sd 480) ml) was unchanged after placebo, but was attenuated by 40 % (−940 (sd 460) v. −570 (sd 310) ml, P=0·004) after B-GOS. In the HIB group, B-GOS reduced baseline chemokine CC ligand 17 (399 (sd 140) v. 323 (sd 144) pg/ml, P=0·005) and TNF-α (2·68 (sd 0·98) v. 2·18 (sd 0·59) pg/ml, P=0·040) and abolished the EVH-induced 29 % increase in TNF-α. Baseline C-reactive protein was reduced following B-GOS in HIB (2·46 (sd 1·14) v. 1·44 (sd 0·41) mg/l, P=0·015) and control (2·16 (sd 1·02) v. 1·47 (sd 0·33) mg/l, P=0·050) groups. Chemokine CC ligand 11 and fraction of exhaled nitric oxide remained unchanged. B-GOS supplementation attenuated airway hyper-responsiveness with concomitant reductions in markers of airway inflammation associated with HIB.
There is evidence for health benefits from ‘Palaeolithic’ diets; however, there are a few data on the acute effects of rationally designed Palaeolithic-type meals. In the present study, we used Palaeolithic diet principles to construct meals comprising readily available ingredients: fish and a variety of plants, selected to be rich in fibre and phyto-nutrients. We investigated the acute effects of two Palaeolithic-type meals (PAL 1 and PAL 2) and a reference meal based on WHO guidelines (REF), on blood glucose control, gut hormone responses and appetite regulation. Using a randomised cross-over trial design, healthy subjects were given three meals on separate occasions. PAL2 and REF were matched for energy, protein, fat and carbohydrates; PAL1 contained more protein and energy. Plasma glucose, insulin, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide (GIP) and peptide YY (PYY) concentrations were measured over a period of 180 min. Satiation was assessed using electronic visual analogue scale (EVAS) scores. GLP-1 and PYY concentrations were significantly increased across 180 min for both PAL1 (P= 0·001 and P< 0·001) and PAL2 (P= 0·011 and P= 0·003) compared with the REF. Concomitant EVAS scores showed increased satiety. By contrast, GIP concentration was significantly suppressed. Positive incremental AUC over 120 min for glucose and insulin did not differ between the meals. Consumption of meals based on Palaeolithic diet principles resulted in significant increases in incretin and anorectic gut hormones and increased perceived satiety. Surprisingly, this was independent of the energy or protein content of the meal and therefore suggests potential benefits for reduced risk of obesity.
Pill-taking, expectations and therapeutic alliance may account for much of the benefit of medication and placebo treatment for major depressive disorder (MDD).
To examine the effects of medication, placebo and supportive care on treatment outcome, and the relationships of expectations and therapeutic alliance to improvement.
A total of 88 participants were randomised to 8 weeks of treatment with supportive care alone or combined with double-blind treatment with placebo or antidepressant medication. Expectations of medication effectiveness, general treatment effectiveness and therapeutic alliance were measured (trial registration at ClinicalTrials.gov: NCT00200902).
Medication or placebo plus supportive care were not significantly different but had significantly better outcome than supportive care alone. Therapeutic alliance predicted response to medication and placebo; expectations of medication effectiveness at enrolment predicted only placebo response.
Pill treatment yielded better outcome than supportive care alone. Medication expectations uniquely predicted placebo treatment outcome and were formed by time of enrolment, suggesting that they were shaped by prior experiences outside the clinical trial.
Dietary pattern (DP) analysis allows examination of the combined effects of nutrients and foods on the markers of CVD. Very few studies have examined these relationships during adolescence or young adulthood. Traditional CVD risk biomarkers were analysed in 12–15-year-olds (n 487; Young Hearts (YH)1) and again in the same individuals at 20–25 years of age (n 487; YH3). Based on 7 d diet histories, in the present study, DP analysis was performed using a posteriori principal component analysis for the YH3 cohort and the a priori Mediterranean Diet Score (MDS) was calculated for both YH1 and YH3 cohorts. In the a posteriori DP analysis, YH3 participants adhering most closely to the ‘healthy’ DP were found to have lower pulse wave velocity (PWV) and homocysteine concentrations, the ‘sweet tooth’ DP were found to have increased LDL concentrations, systolic blood pressure, and diastolic blood pressure and decreased HDL concentrations, the ‘drinker/social’ DP were found to have lower LDL and homocysteine concentrations, but exhibited a trend towards a higher TAG concentration, and finally the ‘Western’ DP were found to have elevated homocysteine and HDL concentrations. In the a priori dietary score analysis, YH3 participants adhering most closely to the Mediterranean diet were found to exhibit a trend towards a lower PWV. MDS did not track between YH1 and YH3, and nor was there a longitudinal relationship between the change in the MDS and the change in CVD risk biomarkers. In conclusion, cross-sectional analysis revealed that some associations between DP and CVD risk biomarkers were already evident in the young adult population, namely the association between the healthy DP (and the MDS) and PWV; however, no longitudinal associations were observed between these relatively short time periods.
This essay argues that today's dominant understanding of secularization—as an epochal transition from a society based on religious belief to one based on autonomous human reason—first appeared in philosophical histories at the beginning of the nineteenth century and was then anachronistically applied to early modern Europe. Apart from the earlier and persisting canon-law use of the term to refer to a species of exclaustration, prior to 1800 the standard lexicographical meaning of “secularization” was determined by its use in public law and diplomacy to name the civil conversion of ecclesiastical property and jurisdiction. Prior to the same point the most important use of the adjective “secular” was in political jurisprudence as a synonym for temporal, civil, and political, to name a religious–political settlement from which rival theologies had been excluded as the condition of its negotiation. But this usage was domain-specific, was quite compatible with religious devotion, and had nothing to do with the putatively secular character of the spheres of philosophy or the natural sciences, thence “society”. Far from seeing a shift from religious belief to autonomous rationality, early modernity in fact witnessed a significant intensification of religious belief and practice under the impact of rival confessional movements. It also emerges that the nineteenth century was characterized not by the supersession of confessional religions—or their conversion into rational religion or moral philosophy—but by their remarkable persistence and adaptation to new circumstances. In light of this, the essay argues that the variant philosophical-historical conceptions of secularization—as the epochal supersession of religious belief by human rationality—should not be understood as theories of a putative process but as “combat concepts”. These were internal to an array of rival cultural-political factions that first emerged in early nineteenth-century Protestant Germany and that continue to do battle today.
Is Google a substitute for using known, authoritative websites for cases, legislation and other official information? Ian Hunter writes about the test searches that he carried out on Google and discusses the results he noted. In this exercise, consideration is given to whether the websites retrieved are authoritative and also attention is paid to Google's ranking of results.
There is a perception in the legal information profession that levels of information literacy among law students and trainee solicitors are lower than they should be. In this article Ian Hunter considers if this starts at sixth form level and discusses the Google generation stereotype. Training sessions given to sixth-form students by the author are described and the students' levels of information literacy are considered against various information literacy standards. The suitability of these standards for sixth form students is assessed and suggestions for future information literacy training at school, HE and trainee solicitor level are discussed.