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 email@example.com
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.
The literature on late-life anxiety has grown exponentially in the last two decades, and a wide array of research questions are being explored by an ever-growing cadre of clinicians and scientists internationally. In fact, in the last decade, there have been several special journal issues devoted to aspects of anxiety in later life – for example, American Journal of Geriatric Psychiatry (2011, vol. 19, issue 4), Journal of Anxiety Disorders (2013, vol. 27, issue 6), International Psychogeriatrics (2015, vol. 27, issue 7), and Clinical Gerontologist (2017, vol. 40, issue 3). All have made the point that while our understanding of the etiology, diagnosis, assessment, and treatment of such disorders has grown and continues to increase, there are still many areas requiring further research attention. In addition, experimental techniques to study the biological mechanisms underpinning anxiety continue to grow in sophistication and access.
Historically, clinicians and researchers interested in the mental health of older people have focused on depression and dementia and have given little attention to anxiety except as a complication of depression or dementia. Over recent years, however, research into anxiety in older people has increased substantially, leading to both a burgeoning scientific literature and increasing clinical interest in the field.
Anxiety disorders in later life have historically been overshadowed by strong clinical and epidemiological interest in mood disorders and cognitive disorders. This chapter reviews the key scientific literature on the epidemiology of anxiety disorders in older people and putative risk and protective factors.
Although behavioural and psychological interventions are considered first-line treatments for anxiety disorders in older people (National Institute for Health and Care Excellence, 2014), psychotropic medications are also widely prescribed (Hollingworth & Siskind, 2010). Drugs from a range of psychotropic classes have been used to treat anxiety disorders, including benzodiazepines, antidepressants, anticonvulsants, and antipsychotics (Reinhold et al., 2011). While there is clinical trial evidence for the short-term efficacy of drugs from each of these classes, particularly for generalized anxiety disorder (GAD), there is scant evidence for long-term effectiveness. Psychotropic drugs exhibit a wide range of adverse effects, including some that pose particular hazards in later life.
The schizophrenia polygenic risk score (SCZ-PRS) is an emerging tool in psychiatry.
We aimed to evaluate the utility of SCZ-PRS in a young, transdiagnostic, clinical cohort.
SCZ-PRSs were calculated for young people who presented to early-intervention youth mental health clinics, including 158 patients of European ancestry, 113 of whom had longitudinal outcome data. We examined associations between SCZ-PRS and diagnosis, clinical stage and functioning at initial assessment, and new-onset psychotic disorder, clinical stage transition and functional course over time in contact with services.
Compared with a control group, patients had elevated PRSs for schizophrenia, bipolar disorder and depression, but not for any non-psychiatric phenotype (for example cardiovascular disease). Higher SCZ-PRSs were elevated in participants with psychotic, bipolar, depressive, anxiety and other disorders. At initial assessment, overall SCZ-PRSs were associated with psychotic disorder (odds ratio (OR) per s.d. increase in SCZ-PRS was 1.68, 95% CI 1.08–2.59, P = 0.020), but not assignment as clinical stage 2+ (i.e. discrete, persistent or recurrent disorder) (OR = 0.90, 95% CI 0.64–1.26, P = 0.53) or functioning (R = 0.03, P = 0.76). Longitudinally, overall SCZ-PRSs were not significantly associated with new-onset psychotic disorder (OR = 0.84, 95% CI 0.34–2.03, P = 0.69), clinical stage transition (OR = 1.02, 95% CI 0.70–1.48, P = 0.92) or persistent functional impairment (OR = 0.84, 95% CI 0.52–1.38, P = 0.50).
In this preliminary study, SCZ-PRSs were associated with psychotic disorder at initial assessment in a young, transdiagnostic, clinical cohort accessing early-intervention services. Larger clinical studies are needed to further evaluate the clinical utility of SCZ-PRSs, especially among individuals with high SCZ-PRS burden.
Precise instrumental calibration is of crucial importance to 21-cm cosmology experiments. The Murchison Widefield Array’s (MWA) Phase II compact configuration offers us opportunities for both redundant calibration and sky-based calibration algorithms; using the two in tandem is a potential approach to mitigate calibration errors caused by inaccurate sky models. The MWA Epoch of Reionization (EoR) experiment targets three patches of the sky (dubbed EoR0, EoR1, and EoR2) with deep observations. Previous work in Li et al. (2018) and (2019) studied the effect of tandem calibration on the EoR0 field and found that it yielded no significant improvement in the power spectrum (PS) over sky-based calibration alone. In this work, we apply similar techniques to the EoR1 field and find a distinct result: the improvements in the PS from tandem calibration are significant. To understand this result, we analyse both the calibration solutions themselves and the effects on the PS over three nights of EoR1 observations. We conclude that the presence of the bright radio galaxy Fornax A in EoR1 degrades the performance of sky-based calibration, which in turn enables redundant calibration to have a larger impact. These results suggest that redundant calibration can indeed mitigate some level of model incompleteness error.
People often create counterfactual alternatives to reality about how things could have been different “if only …” The creation of alternatives has widespread effects in daily mental life: It enables people to explain the past, to prepare for the future, and to experience emotions such as regret and guilt. In this chapter I consider the profound impact of the counterfactual imagination on everyday thought by focusing on its impact on moral judgments such as blame and responsibility. Insights from the study of imagination and morality shed light on the mechanisms underlying the counterfactual imagination: simulation processes that construct an alternative to reality by mutating aspects of the mental representation of reality. The relationship between the imagination and morality is two-way: On the one hand, counterfactuals affect moral judgments because people rely on them to identify causes of an outcome and to probe a person’s intentions and knowledge. On the other hand, moral thoughts affect the imagination because moral norms provide important “fault lines,” “junctures” in the mental representation of reality that affect the accessibility of imagined alternatives. The two-way relationship corroborates the idea that the imagination depends on cognitive processes shared with reasoning.
Introduction: Cases of anaphylaxis in children are often not appropriately managed by caregivers. We aimed to develop and to test the effectiveness of an education tool to help pediatric patients and their families better understand anaphylaxis and its management and to improve current knowledge and treatment guidelines adherence. Methods: The GEAR (Guidelines and Educational programs based on an Anaphylaxis Registry) is an initiative that recruits children with food-induced anaphylaxis who have visited the ED at the Montreal Children's Hospital and at The Children's Clinic located in Montreal, Quebec. The patients and parents, together, were asked to complete six questions related to the triggers, recognition and management of anaphylaxis at the time of presentation to the allergy clinic. Participants were automatically shown a 5-minute animated video addressing the main knowledge gaps related to the causes and management of anaphylaxis. At the end of the video, participants were redirected to same 6 questions to respond again. To test long-term knowledge retention, the questionnaire will be presented again in one year's time. A paired t-test was used to compare the difference between the baseline score and the follow-up score based on percentage of correct answers of the questionnaire. Results: From June to November 2019, 95 pediatric patients with diagnosed food-induced anaphylaxis were recruited. The median patient age was 4.5 years (Interquartile Range (IQR): 1.6–7.4) and half were male (51.6%). The mean questionnaire baseline score was 0.77 (77.0%, standard deviation (sd): 0.16) and the mean questionnaire follow-up score was 0.83 (83.0%, sd: 0.17). There was a significant difference between the follow-up score and baseline score (difference: 0.06, 95% CI: 0.04, 0.09). There were no associations of baseline questionnaire scores and change in scores with age and sex. Conclusion: Our video teaching method was successful in educating patients and their families to better understand anaphylaxis. The next step is to acquire long-term follow up scored to determine retention of knowledge.
In Early Onset Schizophrenia (EOS; onset before the 18th birthday) late brain maturational changes may interact with disease mechanisms leading to a wave of back to front structural changes during adolescence. To further explore this effect we examined the relationship between age of onset and duration of illness on brain morphology in adolescents with EOS.
Subjects and methods
Structural brain magnetic resonance imaging scans were obtained from 40 adolescents with EOS. We used Voxel Based Morphometry and multiple regressions analyses, implemented in SPM, to examine the relationship between gray matter volume with age of onset and illness duration.
Age of onset showed a positive correlation with regional gray matter volume in the right superior parietal lobule (Brodmann Area 7). Duration of illness was inversely related to regional gray matter volume in the left inferior frontal gyrus (BA 11/47).
Parietal gray matter loss may contribute to the onset of schizophrenia while orbitofrontal gray matter loss is associated with illness duration.
There is wide acknowledgement that apathy is an important behavioural syndrome in Alzheimer’s disease and in various neuropsychiatric disorders. In light of recent research and the renewed interest in the correlates and impacts of apathy, and in its treatments, it is important to develop criteria for apathy that will be widely accepted, have clear operational steps, and that will be easily applied in practice and research settings. Meeting these needs is the focus of the task force work reported here.
The task force includes members of the Association Française de Psychiatrie Biologique, the European Psychiatric Association, the European Alzheimer’s Disease Consortium and experts from Europe, Australia and North America. An advanced draft was discussed at the consensus meeting (during the EPA conference in April 7th 2008) and a final agreement reached concerning operational definitions and hierarchy of the criteria.
Apathy is defined as a disorder of motivation that persists over time and should meet the following requirements. Firstly, the core feature of apathy, diminished motivation, must be present for at least four weeks; secondly two of the three dimensions of apathy (reduced goal-directed behaviour, goal-directed cognitive activity, and emotions) must also be present; thirdly there should be identifiable functional impairments attributable to the apathy. Finally, exclusion criteria are specified to exclude symptoms and states that mimic apathy.
The comparative effectiveness of antidepressant medication and cognitive-behaviour therapy for the acute treatment of depression is contentious.
To compare the acute outcomes of antidepressant medication, cognitive-behaviour therapy (CBT), and the combination of the two, in adult, depressed patients.
Sixteen electronic databases together with reference lists were searched for randomised and other clinical trials that compared CBT, antidepressants, or their combination.
In the comparison between CBT and antidepressants, 8 studies met inclusion criteria. Five studies met the inclusion criteria for the second comparison between single therapy and combination therapy. In the antidepressant and CBT comparison, effect sizes favoured CBT over antidepressants with a significant advantage for CBT on some outcome measures. Combined treatment appeared more effective than antidepressants. However, combined treatment did not emerge more effective than CBT.
Antidepressants may not be considered more efficacious than CBT for the acute treatment of depressed patients nor can combination therapy be regarded as more effective than CBT alone.
Women with obesity breastfeed for shorter durations than women of normal-weight body mass index (BMI). There is also evidence to suggest that women with obesity are less likely to initiate breastfeeding. This is important because breastfeeding is associated with a small, but significant, reduced risk of obesity among offspring; which may be particularly important for the offspring of mothers with obesity as these infants are at an increased risk of obesity. Using data prospectively collected during 2015 by medical staff in a large maternity hospital, we aimed to explore the association between maternal obesity status and early breastfeeding outcomes: breastfeeding initiation and exclusive breastfeeding at hospital discharge (approx. day 2 of life). Data were obtained from electronic records for all births in The National Maternity Hospital, Dublin in 2015. We included data from mothers who delivered a healthy, full-term, singleton infant (n = 7449). At the booking visit (approx. 12 weeks’ gestation), maternal height and weight were objectively measured by nursing staff and subsequently used to calculate BMI; other demographic data were recorded at this time. At delivery, epidural use, mode of delivery, and infant sex and weight were recorded. At discharge, mode of feeding was recorded. In SPSS, we explored unadjusted and adjusted associations between obesity status (BMI < 30kg/m2 [n = 964] vs. BMI ≥ 30kg/m2 [n = 6485]) and breastfeeding outcomes (dichotomous: yes/no) using Chi-squared analysis and multivariate logistic regression, respectively. In unadjusted analyses, there was a significant association between obesity status and breastfeeding initiation; 76% of women without obesity initiated breastfeeding compared with 59% of women with obesity (P < 0.001). There was also a significant association between obesity status and exclusive breastfeeding; 69% of women without obesity were exclusively breastfeeding at discharge compared with 37% of women with obesity (P < 0.001). In logistic regression analyses adjusted for maternal age, ethnicity, marital status, smoking status, parity, epidural use and delivery mode, the odds of women with obesity initiating breastfeeding were 51% lower than women without obesity (odds ratio [OR] 0.49, 95% confidence interval [CI] 0.42–0.57; P < 0.001). Similarly, in adjusted analyses, the odds of women with obesity exclusively breastfeeding at hospital discharge were 54% lower than women without obesity (OR 0.44, 95% CI 0.38–0.51; P < 0.001). Research is needed to understand whether the negative association between obesity and breastfeeding is biological or cultural in origin, or both. Interventions to promote and support breastfeeding among women with obesity may improve breastfeeding outcomes.
Insurance industry practitioners have deep knowledge of their industry, but there is a lack of a simple-to-understand, practical blueprint on applying distributed ledger technology solutions, including blockchain. This paper provides a practical guide for actuaries, risk professionals, insurance companies and their Boards on blockchain, including an education piece to provide an understanding of the technology. Examples of real-world applications and use cases in insurance are provided to illustrate the capability of the technology. The current risks and challenges in adopting the technology are also considered. Finally, a checklist of issues to consider in adopting a blockchain solution for insurance business problems is provided.
Systematic, national surveillance of outbreaks of intestinal infectious disease has been undertaken by Public Health England (PHE) since 1992. Between 1992 and 2002, there were 19 outbreaks linked to raw drinking milk (RDM) or products made using raw milk, involving 229 people; 36 of these were hospitalised. There followed an eleven-year period (2003–2013) where no outbreaks linked to RDM were reported. However, since 2014 seven outbreaks of Escherichia coli O157:H7 (n = 3) or Campylobacter jejuni (n = 4) caused by contaminated RDM were investigated and reported. Between 2014 and 2017, there were 114 cases, five reported hospitalisations and one death. The data presented within this review indicated that the risk of RDM has increased since 2014. Despite the labelling requirements and recommendations that children should not consume RDM, almost a third of outbreak cases were children. In addition, there has been an increase in consumer popularity and in registered RDM producers in the UK. The Food Standards Agency (FSA) continue to provide advice on RDM to consumers and have recently made additional recommendations to enhance existing controls around registration and hygiene of RDM producers.
Epoch of Reionisation (EoR) data analysis requires unprecedented levels of accuracy in radio interferometer pipelines. We have developed an imaging power spectrum analysis to meet these requirements and generate robust 21 cm EoR measurements. In this work, we build a signal path framework to mathematically describe each step in the analysis, from data reduction in the Fast Holographic Deconvolution (FHD) package to power spectrum generation in the εppsilon package. In particular, we focus on the distinguishing characteristics of FHD/εppsilon: highly accurate spectral calibration, extensive data verification products, and end-to-end error propagation. We present our key data analysis products in detail to facilitate understanding of the prominent systematics in image-based power spectrum analyses. As a verification to our analysis, we also highlight a full-pipeline analysis simulation to demonstrate signal preservation and lack of signal loss. This careful treatment ensures that the FHD/εppsilon power spectrum pipeline can reduce radio interferometric data to produce credible 21 cm EoR measurements.
We apply two methods to estimate the 21-cm bispectrum from data taken within the Epoch of Reionisation (EoR) project of the Murchison Widefield Array (MWA). Using data acquired with the Phase II compact array allows a direct bispectrum estimate to be undertaken on the multiple redundantly spaced triangles of antenna tiles, as well as an estimate based on data gridded to the uv-plane. The direct and gridded bispectrum estimators are applied to 21 h of high-band (167–197 MHz; z = 6.2–7.5) data from the 2016 and 2017 observing seasons. Analytic predictions for the bispectrum bias and variance for point-source foregrounds are derived. We compare the output of these approaches, the foreground contribution to the signal, and future prospects for measuring the bispectra with redundant and non-redundant arrays. We find that some triangle configurations yield bispectrum estimates that are consistent with the expected noise level after 10 h, while equilateral configurations are strongly foreground-dominated. Careful choice of triangle configurations may be made to reduce foreground bias that hinders power spectrum estimators, and the 21-cm bispectrum may be accessible in less time than the 21-cm power spectrum for some wave modes, with detections in hundreds of hours.
Advancing Industry 4.0 concepts by mapping the product of the automotive industry on the spectrum of Cyber Physical Systems, we immediately recognise the convoluted processes involved in the design of new generation vehicles. New technologies developed around the communication core (IoT) enable novel interactions with data. Our framework employs previously untapped data from vehicles in the field for intelligent vehicle health management and knowledge integration into design. Firstly, the concept of an inter-disciplinary artefact is introduced to support the dynamic alignment of disparate functions, so that cyber variables change when physical variables change. Secondly, the axiomatic categorisation (AC) framework simulates functional transformations from artefact to artefact, to monitor and control automotive systems rather than components. Herein, an artefact is defined as a triad of the physical and engineered component, the information processing entity, and communication devices at their interface. Variable changes are modelled using AC, in conjunction with the artefacts, to aggregate functional transformations within the conceptual boundary of a physical system of systems.
A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.