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.
Post-traumatic stress disorder (PTSD) is a serious mental disorder that develops in some individuals following exposure to severe psychological stressors. In this chapter, we provide an overview of the conceptual issues, specific methods, and practical considerations in evidence-based assessment of PTSD. First, we outline the conceptual issues and practical components of a comprehensive assessment of PTSD. Second, we provide an overview of the most widely used self-rated and clinician-rated measures of trauma exposure and PTSD, comorbid disorders, and response bias. Third, we discuss cultural considerations in assessing PTSD. Fourth, we offer practical guidelines for conducting a clinically sensitive assessment of PTSD, highlighting some of the unique considerations in engaging trauma survivors in the assessment process and optimizing the information obtained. Last, we briefly summarize conceptual considerations and specific measures for other trauma- and stressor-related disorders.
Low rates of bystander cardiopulmonary resuscitation (CPR) were identified as a shortcoming in the “chain of survival” for out-of-hospital cardiac arrest (OHCA) care in the Korean city of Ansan. This study sought to evaluate the effect of an initiative to increase bystander CPR and quality of out-of-hospital resuscitation on outcome from OHCA. The post-intervention data were used to determine the next quality improvement (QI) target as part of the “Plan-Do-Study-Act” (PDSA) model for QI.
The study hypothesis was that bystander CPR, return of spontaneous circulation (ROSC), and survival to discharge after OHCA would increase in the post-intervention period.
This was a retrospective pre/post study. The data from the pre-intervention period were abstracted from 2008–2011 and the post-intervention period from 2012–2013. The effect of the intervention on the odds of ROSC and survival to hospital discharge was determined using a generalized estimating equation to account for confounders and the effect of clustering within medical centers. The analysis was then used to identify other factors associated with outcomes to determine the next targets for intervention in the chain of survival for cardiac arrest in this community.
Rates of documented bystander CPR increased from 13% in the pre-intervention period to 37% in the post-intervention period. The overall rate of ROSC decreased from 18.4% to 14.3% (risk difference −4.1%; 95% CI, −7.1%–1.0%), whereas survival to hospital discharge increased from 3.9% to 5.0% (risk difference 1.1%; 95% CI, −1.8%–3.8%), and survival with good neurologic outcome increased from 0.8% to 1.6% (risk difference 0.8%; 95% CI, −0.8%–2.4%). In multivariable analyses, there was no association between the intervention and the rate of ROSC or survival to hospital discharge. The designated level of the treating hospital was a significant predictor of both survival and ROSC.
In this case study, there were no observed improvements in outcomes from OHCA after the targeted intervention to improve out-of-hospital CPR. However, utilizing the PDSA model for QI, the designated level of the treating hospital was found to be a significant predictor of survival in the post-period, identifying the next target for intervention.
The Minnesota Center for Twin and Family Research (MCTFR) comprises multiple longitudinal, community-representative investigations of twin and adoptive families that focus on psychological adjustment, personality, cognitive ability and brain function, with a special emphasis on substance use and related psychopathology. The MCTFR includes the Minnesota Twin Registry (MTR), a cohort of twins who have completed assessments in middle and older adulthood; the Minnesota Twin Family Study (MTFS) of twins assessed from childhood and adolescence into middle adulthood; the Enrichment Study (ES) of twins oversampled for high risk for substance-use disorders assessed from childhood into young adulthood; the Adolescent Brain (AdBrain) study, a neuroimaging study of adolescent twins; and the Siblings Interaction and Behavior Study (SIBS), a study of adoptive and nonadoptive families assessed from adolescence into young adulthood. Here we provide a brief overview of key features of these established studies and describe new MCTFR investigations that follow up and expand upon existing studies or recruit and assess new samples, including the MTR Study of Relationships, Personality, and Health (MTR-RPH); the Colorado-Minnesota (COMN) Marijuana Study; the Adolescent Brain Cognitive Development (ABCD) study; the Colorado Online Twins (CoTwins) study and the Children of Twins (CoT) study.
To analyse how the auditory brainstem response changes in patients with sudden sensorineural hearing loss.
Data were collected via retrospective medical chart review.
Forty-three patients were included in this study. The mean latency of auditory brainstem response wave 1 was significantly longer for the affected side than for the unaffected side (p = 0.003). The mean latency of auditory brainstem response wave 1 was significantly shorter, and the mean amplitude of auditory brainstem response wave 1 was significantly larger, in the good response group compared to the poor response group. In forward conditional logistic regression analysis, auditory brainstem response wave 1 latency was an independent predictor of a good response (odds ratio = 34.37, 95 per cent confidence interval = 1.56–757.15, p = 0.025).
In patients with sudden sensorineural hearing loss, the latency of wave 1 of the auditory brainstem response was significantly increased and was related to prognosis.
We examine the origin of very-large-scale motions (VLSMs) in fully developed turbulent pipe flow at friction Reynolds number,
, using data from a direct numerical simulation. The VLSMs and the packet-like large-scale motions (LSMs) found in this study are very similar to those found in earlier studies. Three-dimensional time-evolving instantaneous fields show that one component of the process leading to the large streamwise length of VLSMs is the concatenation of adjacent streamwise LSMs caused by the continuous elongation of LSMs due to the strain component of the mean shear. Spatial organization patterns of the VLSMs and LSMs and their properties are studied by separating auto-correlation of the streamwise velocity fluctuations into the components of the VLSM and the LSM defined by low-pass/high-pass filtering in the streamwise direction. The structures of the two-point spatial correlations of the streamwise velocity component of the VLSMs and the LSMs in the streamwise-azimuthal plane are characterized by multiple maxima and complex patterns that beg explanation in terms of patterned coherent arrangements of the LSMs. Using proper orthogonal decomposition (POD), it is found that the X-shape correlation pattern of the VLSMs results from the superposition of very long helically inclined structures and streamwise-aligned structures. Further explanation of the patterns in the correlations of the VLSMs and LSMs is provided through the study of synthetically constructed arrangements of simple hairpin packet models of the LSM. Head-to-tail alignment of the model packets along streamwise and helical directions suggested by the eigenvalues of the POD creates a pair of long roll-cells centred above the logarithmic layer, and bracketing the LSMs. These roll-cells are pure kinematic consequences of the induction within the LSM packets, but they may also serve to organize smaller packets.
Chapter 4 argues that the Franklin’s performance serves as the dialectical synthesis of the views on value of the preceding performances, encompassing the wondrous renewal of the Squire, the amoral instrumentalism of the Merchant, and the meta-value of the Clerk. In this way, the Franklin’s performance presents a sober, disenchanted, but nonetheless ultimately affirmative meditation on the creative power of fiction - one that recognizes fiction’s instrumental value but insists that a paradoxically knowing mystification of this instrumentality can be the basis for a practicable ethics for living in a fallen world. To pursue this argument, the chapter performs a close reading of the Squire-Franklin link (taking into account the bearing of manuscript evidence), examines key aspects of the tale’s prologue and narrative, and considers the Franklin’s portrait in respect to the social status of franklins in Chaucer’s day. It concludes that the performance formulates a commitment to literary value that not only transcends the vulnerabilities of the preceding tales, but is also precisely the literary value that someone socially situated like Chaucer is best positioned to create.
Chapter 1 argues that the Clerk’s performance, like Chaucer’s earlier House of Fame, presents an array of different and even contradictory conceptions of literary value in order to give Chaucer’s fiction the distinctive meta-value of standing above any one commitment to literary value, playfully and provocatively assessing competing options, and thereby positioning the implied author as a master of the literary game. For the House of Fame this sort of meta-value serves the purpose of imagining the social identity of customs controller as a legitimate and distinctive locus for poetic composition. In the Clerk’s performance Chaucer imagines the university student as a normative masculine occupation for which meta-axiology is an end in itself, and thereby gives his earlier position a more authoritative and traditional institutional home. To pursue this argument, the chapter considers the House of Fame; select features of the Clerk’s prologue, tale, and epilogue, for the tale focusing on specific wording in light of its Petrarchan source; and the Clerk’s portrait, placing it against the backdrop of what we know about the normative function of the university in Chaucer’s day.
After presenting book’s justification, the introduction articulates its central argument: that the four-tale sequence of Clerk, Merchant, Squire, and Franklin enacts a dynamically unfolding, conflicted meditation on how literary value may be construed in a way that justifies the time, energy, and expense devoted to the writing of fiction - a justification made in respect to other activities pertaining to other values, especially to economic value in the sense of making a living. The introduction then considers the metacritical stakes and implications of this argument along the methodological dimension of the bearing of manuscript evidence on the principles of Chaucer interpretation and the conceptual dimension of the problem literary value. The former consideration reviews the manuscript basis for the book’s claim about the four-tale sequence; the latter consideration indicates theoretical debts (to, e.g., Bruno Latour and Georg Simmel) and introduces several key terms used throughout the book (the most important: literary axiology, axiological person, and axiological logic), explaining the relation of these terms to more traditional ones of Chaucer criticism.
Chapter 2 argues that the positioning of the Merchant’s performance as an answer to the Clerk’s stages a stern critique of the naïve escapism of the poet-student occupation as the Clerk’s performance imagines it. In this view, the Clerk’s meta-value is an attempt to avoid confronting the true nature of value in the sublunary realm: the material desires of flesh-and-blood individuals. According to the Merchant’s performance, all discourse is a self-interested instrument of these desires. Yet the chapter also argues that this grim position is not one voiced by a bitter man far removed from Chaucer, but rather that the tale is told with the very narratorial wit and playfulness most characteristic of Chaucer’s fiction, whether in his first-person voice or otherwise. For this reason, the Merchant’s dialectical negation of the Clerk’s notion of literary value represents at once Chaucer’s skepticism about the value of his own craft and his reveling in his mastery over it. To pursue this argument, the chapter performs a close reading of the Merchant’s Prologue, examines key moments in the Merchant’s Tale, and considers the Merchant’s portrait in its historical context.
Chapter 3 argues that the division of the four-tale sequence into two fragments has obscured the pivotal function of the Squire’s performance, and especially of the linking passage that accomplishes the positioning of this performance as the dialectical answer to the Merchant’s response to the Clerk. Negating the Merchant’s negation of the Clerk, the Squire’s performance reinstates literary value as the power of the distinctive discourse of romance fiction: the power to provide a restorative vision of a world governed by exactly the kind of ideals that the Merchant’s view understands as mere smokescreens for material desire. Moreover, by associating this kind of literary value with the normative sociocultural practice of a young aristocrat, the Squire’s performance understands literary discourse as also possessing the concrete value of the cultural capital that helps distinguish the elite from the common. The chapter concludes that the Squire’s response to the Merchant nonetheless collapses, not for dramatic reasons (as one trend in criticism has held), but because of a contradiction at the heart of its view of literary value that Chaucer could not overcome.
Literary authors, especially those with other occupations, must come to grips with the question of why they should write at all, when the world urges them to devote their time and energy to other pursuits. They must reach, at the very least, a provisional conclusion regarding the relation between the uncertain value of their literary efforts and the more immediate values of their non-authorial social identities. Geoffrey Chaucer, with his several middle-strata identities, grappled with this question in a remarkably searching, complex manner. In this book, Robert J. Meyer-Lee examines the multiform, dynamic meditation on the relation between literary value and social identity that Chaucer stitched into the heart of The Canterbury Tales. He traces the unfolding of this meditation through what he shows to be the tightly linked performances of Clerk, Merchant, Franklin and Squire, offering the first full-scale reading of this sequence.
Given the range and reach of psychosocial support (PSS) interventions in humanitarian settings, within the continuum of mental health and psychosocial support services, evaluation of their impact is critical. Understanding stakeholders' perspectives on which PSS interventions of unknown effectiveness warrant rigorous evaluation is essential to identify research priorities. This project aimed to facilitate a process with stakeholders to reach consensus on PSS interventions that are of high priority for further research based on existing evidence and stakeholders' opinions.
Interviews with 109 stakeholders working on PSS programming in humanitarian settings served as the foundation for two in-person regional meetings and four webinars. Nominal Group Technique (NGT) was used to develop a priority PSS program list. The top five priorities from each meeting were combined for a final online survey distributed globally.
Seventy participants across six meetings contributed to the prioritization process. Eighty-seven individuals completed the final online survey. ‘Community based PSS’ was the top-ranked research priority, followed by PSS integrated into basic services, providing PSS to caregivers to improve child wellbeing, PSS-focused gender-based violence programming, and classroom-based PSS interventions.
NGT and online surveys were effective methods to engage stakeholders in a priority setting exercise to development a research agenda. Information from this stage of the project will be combined with findings from a concurrent systematic review to form the base of a second phase of work, which will include the development and implementation of a research strategy to strengthen the evidence base for those prioritized interventions.
Online self-reported 24-h dietary recall systems promise increased feasibility of dietary assessment. Comparison against interviewer-led recalls established their convergent validity; however, reliability and criterion-validity information is lacking. The validity of energy intakes (EI) reported using Intake24, an online 24-h recall system, was assessed against concurrent measurement of total energy expenditure (TEE) using doubly labelled water in ninety-eight UK adults (40–65 years). Accuracy and precision of EI were assessed using correlation and Bland–Altman analysis. Test–retest reliability of energy and nutrient intakes was assessed using data from three further UK studies where participants (11–88 years) completed Intake24 at least four times; reliability was assessed using intra-class correlations (ICC). Compared with TEE, participants under-reported EI by 25 % (95 % limits of agreement −73 % to +68 %) in the first recall, 22 % (−61 % to +41 %) for average of first two, and 25 % (−60 % to +28 %) for first three recalls. Correlations between EI and TEE were 0·31 (first), 0·47 (first two) and 0·39 (first three recalls), respectively. ICC for a single recall was 0·35 for EI and ranged from 0·31 for Fe to 0·43 for non-milk extrinsic sugars (NMES). Considering pairs of recalls (first two v. third and fourth recalls), ICC was 0·52 for EI and ranged from 0·37 for fat to 0·63 for NMES. EI reported with Intake24 was moderately correlated with objectively measured TEE and underestimated on average to the same extent as seen with interviewer-led 24-h recalls and estimated weight food diaries. Online 24-h recall systems may offer low-cost, low-burden alternatives for collecting dietary information.