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Little is known internationally about return to prison from in-patient psychiatric services, including: circumstances leading to return, aftercare services and subsequent patient outcomes.
To examine and describe: (a) circumstances leading to return to prison from medium secure services; (b) available aftercare and early outcomes of returned persons; and (c) implications for policy development.
Prospective cohort design with all patients (n = 96) returned to prisons from 33 National Health Service (NHS) medium secure services over a 6-month period in England and Wales. Follow-up was conducted for 1 year post-remittal, across 60 prisons.
Less than 20% of patients with legal entitlement to section 117 aftercare under the Mental Health Act 1983 were receiving care managed/delivered via the care programme approach. Subsequent pathways included: inter-prison transfer (30%), use of the Assessment, Care in Custody and Teamwork process (49%), referral to secure services (21%) and community release (30%). Less than half of community releases were referred to a community mental health team.
Findings suggest that persons returned to prison are a vulnerable group of patients, many of whom require intervention (e.g. enhanced monitoring, admission to a healthcare wing, readmission to secure mental health services) on return to prison in the absence of targeted aftercare services. More robust guidance for discharge and aftercare planning procedures for persons remitted to prison should be developed to ensure that the benefits of in-patient admission are maintained and that individuals’ legal rights to ongoing aftercare are upheld.
The Cognitive Abilities Screening Instrument (CASI) is a screening test of global cognitive function used in research and clinical settings. However, the CASI was developed using face validity and has not been investigated via empirical tests such as factor analyses. Thus, we aimed to develop and test a parsimonious conceptualization of the CASI rooted in cognitive aging literature reflective of crystallized and fluid abilities.
Secondary data analysis implementing confirmatory factor analyses where we tested the proposed two-factor solution, an alternate one-factor solution, and conducted a χ2 difference test to determine which model had a significantly better fit.
Data came from 3,491 men from the Kuakini Honolulu-Asia Aging Study.
The Cognitive Abilities Screening Instrument.
Findings demonstrated that both models fit the data; however, the two-factor model had a significantly better fit than the one-factor model. Criterion validity tests indicated that participant age was negatively associated with both factors and that education was positively associated with both factors. Further tests demonstrated that fluid abilities were significantly and negatively associated with a later-life dementia diagnosis.
We encourage investigators to use the two-factor model of the CASI as it could shed light on underlying cognitive processes, which may be more informative than using a global measure of cognition.
Environmental issues such as climate change are leading to sustainability challenges for the aerospace industry. New materials such as composites allow significant weight reduction, which leads to a lower fuel consumption. However, composites involve complex processes and there is a lack of knowledge on their social and environmental consequences. Through two cases based on real aero-engines components, this paper shows that the weight savings provided by composites reduce significantly the CO2 emissions during flight which compensates the environmental drawbacks from production and recycling.
The purpose of this rejoinder is to emphasize several important areas of future research that were mentioned by one or both commentaries. First, the authors discuss issues related to multi-source assessment, such as the importance of further research on informant bias, and argue that the information gleaned from multiple sources is worth the added assessment burden. Second, they underscore the importance of longitudinal assessment both in capturing the treatment-relevant within-person processes through which personality pathology unfolds, as well as tracking therapeutic progress. They assert that a given measure’s ability to reliably and validly measure change over time should be considered when evaluating its clinical utility. Finally, they emphasize the need for greater attention to clinical utility of dimensional PD assessment measures.
The purpose of this chapter is to review the current state of the dimensional assessment of personality disorder (PD). The first part of the chapter serves as a review of the most well-established and commonly used measures of maladaptive personality traits. Measures that assess the psychosocial impairment associated with personality pathology also are reviewed. Areas of discontinuity among these measures (e.g., theoretical origin, method of scale construction, degree of correspondence with well-known trait dimensions, attention received in the empirical literature, degree of bipolarity of underlying dimensions) are emphasized, and the clinical utility of measures is evaluated. The second part of the chapter focuses on several controversial issues with which the field of dimensional PD assessment now is grappling. These issues include (a) the psychometric distinction of personality traits from personality functioning, (b) the incremental utility of adaptive trait assessment, (c) the question of maladaptive trait bipolarity, (d) facet-level differences versus domain-level similarity across competing PD trait models, and (e) the value of multi-source assessment.
The purpose of this study was to compare next-morning responses of resting metabolic rate (RMR) and appetite to pre-sleep consumption of casein protein (CP) in pre and postmenopausal women. The study was a randomized, crossover, double-blind, placebo-controlled trial. Seven sedentary premenopausal (age: 19.9 (SD 1.2) years, BMI: 23.1(SD 2.6) kg/m2) and seven sedentary postmenopausal (age: 56.4 (SD 4.9) years, BMI: 26.3 (SD 3.5) kg/m2) women participated. During visit one, anthropometrics and body composition were measured. Following visit one, subjects consumed either CP (25g) or placebo (PL) ≥2h after their last meal and ≤30min prior to sleep on the night before visits two and three. Visits two and three occurred ≥one week after visit one and were 48h apart. During visits two and three, RMR (VO2), respiratory exchange ratio (RER), and appetite were measured via indirect calorimetry and visual analogue scale, respectively. Anthropometrics and body composition were analyzed by one-way analysis of variance (ANOVA). RMR and measures of appetite were analyzed using a 2x2 (menopause status × CP/PL) repeated measures ANOVA. Significance was accepted at p≤0.05. RMR was significantly lower in postmenopausal compared to premenopausal women under both conditions (p=0.003). When consumed pre-sleep CP did not alter RMR, RER, or appetite compared to PL when assessed next-morning in pre and postmenopausal women. These data contribute to growing evidence that pre-sleep consumption of protein is not harmful to next-morning metabolism or appetite. In addition, these data demonstrate that menopause may not alter next-morning RMR, RER, or appetite after pre-sleep consumption of CP.
This was a metabolic study of bulimia nervosa required to design short-term cognitive-behavioural therapy (CBT) beginning with a brief admission to a psychiatric ward. The treatment produced significant improvements in eating behaviour and results are compared with those of previously published studies. The comparisons do not suggest that brief admission at the onset of therapy might enhance its effectiveness. In other respects, increase in normal meal intake was found to correlate significantly with decrease in hinging. This supports the notion that appropriate food intake at meal times should be an important issue in CBT for bulimia nervosa.
As in many sciences, description is an important component of theory, research, and practical applications in clinical psychology. Despite this, considerable disagreement exists regarding how to describe the diverse manifestations of psychopathology that clinicians and researchers have observed. The disagreements are such that translating research across descriptive psychopathology models can be difficult or impossible, impeding scientific progress. As this chapter reviews, at least four major descriptive psychopathology approaches exist – clinical theory, descriptive psychiatry, quantitative models, and biological models – each of which has unique goals, units of observation, theoretical concepts, and research traditions. Through reviewing these dominant approaches, it is illustrated how diverging language, concepts, and methods can impede communication between scientists and practitioners working within different descriptive approaches. Beyond this, specific emerging descriptive psychopathology models (i.e., HiTOP, RDoC, and transdiagnostic processes) are reviewed, which have primarily developed as a response to descriptive psychiatry’s limitations (e.g., DSM) and may advance clinical psychology. Despite the promise of these emerging descriptive models, each is still primarily rooted in one traditional descriptive approach and retains that approach’s limitations. Thus, the chapter concludes by discussing the need to integrate descriptive psychopathology approaches and the challenges associated with this task.
Little data exists about the methodology of contextualizing version two of the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) in resource-poor settings. This paper describes the contextualisation and pilot testing of the guide in Kilifi, Kenya.
Contextualisation was conducted as a collaboration between the KEMRI-Wellcome Trust Research Programme (KWTRP) and Kilifi County Government's Department of Health (KCGH) between 2016 and 2018. It adapted a mixed-method design and involved a situational analysis, stakeholder engagement, local adaptation and pilot testing of the adapted guide. Qualitative data were analysed using content analysis to identify key facilitators and barriers to the implementation process. Pre- and post-training scores of the adapted guide were compared using the Wilcoxon signed-rank test.
Human resource for mental health in Kilifi is strained with limited infrastructure and outdated legislation. Barriers to implementation included few specialists for referral, unreliable drug supply, difficulty in translating the guide to Kiswahili language, lack of clarity of the roles of KWTRP and KCGH in the implementation process and the unwillingness of the biomedical practitioners to collaborate with traditional health practitioners to enhance referrals to hospital. In the adaptation process, stakeholders recommended the exclusion of child and adolescent mental and behavioural problems, as well as dementia modules from the final version of the guide. Pilot testing of the adapted guide showed a significant improvement in the post-training scores: 66.3% (95% CI 62.4–70.8) v. 76.6% (95% CI 71.6–79.2) (p < 0.001).
The adapted mhGAP-IG version two can be used across coastal Kenya to train primary healthcare providers. However, successful implementation in Kilifi will require a review of new evidence on the burden of disease, improvements in the mental health system and sustained dialogue among stakeholders.
In this chapter, we review the current state of personality disorder (PD) assessment practices. The review includes both traditional measures that are rooted in categorical conceptualizations of PD and dimensional measures that have emerged in response to mounting evidence that has called into question the validity of traditional PD classification approaches. The scope of this chapter includes prominent and promising models and measures of PD. Moreover, our review is focused on omnibus measures that present a relatively “complete” picture of personality pathology rather than measures that focus on the features of only one or a limited set of PDs. Finally, we address two important topics relevant to PD assessment. First, we discuss the cross-cultural PD assessment literature, which is characterized by a relative lack of strong cross-cultural research on the manifestation and measurement of PD. Second, we address the disconnect between research and applied practice of PD assessment.
Explanations for the successes or failures of militaries in both war and peace have traditionally focused on key factors such as technology, leadership, personnel, training, or a combination of all of these. A more recent addition to the list of possible variables contributing to military effectiveness is the concept of organizational culture – the pattern of shared assumptions that an organization learns as it solves problems, that has worked well enough to be considered valid, and that is therefore taught to new members as the correct way to approach those problems. This chapter combines the organizational culture concepts of Edgar Schein with the nine cultural dimensions of the GLOBE research program. The resulting model provides a useful framework to analyze a military’s organizational culture. Perhaps more importantly, the model also provides prescriptive actions leaders can take to align a military’s organizational culture with its mission and environment.
An ongoing challenge in understanding and treating personality disorders (PDs) is a significant heterogeneity in disorder expression, stemming from variability in underlying dynamic processes. These processes are commonly discussed in clinical settings, but are rarely empirically studied due to their personalized, temporal nature. The goal of the current study was to combine intensive longitudinal data collection with person-specific temporal network models to produce individualized symptom-level structures of personality pathology. These structures were then linked to traditional PD diagnoses and stress (to index daily functioning).
Using about 100 daily assessments of internalizing and externalizing domains underlying PDs (i.e. negative affect, detachment, impulsivity, hostility), a temporal network mapping approach (i.e. group iterative multiple model estimation) was used to create person-specific networks of the temporal relations among domains for 91 individuals (62.6% female) with a PD. Network characteristics were then associated with traditional PD symptomatology (controlling for mean domain levels) and with daily variation in clinically-relevant phenomena (i.e. stress).
Features of the person-specific networks predicted paranoid, borderline, narcissistic, and obsessive-PD symptom counts above average levels of the domains, in ways that align with clinical conceptualizations. They also predicted between-person variation in stress across days.
Relations among behavioral domains thought to underlie heterogeneity in PDs were indeed associated with traditional diagnostic constructs and with daily functioning (i.e. stress) in person-specific networks. Findings highlight the importance of leveraging data and models that capture person-specific, dynamic processes, and suggest that person-specific networks may have implications for precision medicine.
This article undertakes the first systematic examination of Frank’s (1979, 1981, 1987, 1990, 2007b, 2008) claim that Old Norse influence is discernible in the language of Beowulf. It tests this hypothesis first by scrutinizing each of the alleged Nordicisms in Beowulf, then by discussing various theoretical considerations bearing on its plausibility. We demonstrate that the syntactic, morphological, lexical, and semantic peculiarities that Frank would explain as manifestations of Old Norse influence are more economically and holistically explained as consequences of archaic composition. We then demonstrate that advances in the study of Anglo-Scandinavian language contact provide strong reasons to doubt that Old Norse could have influenced Beowulf in the manner that Frank has proposed. We conclude that Beowulf is entirely devoid of Old Norse influence and that it was probably composed ca. 700, long before the onset of the Viking Age.
We report on an initial long-term study of dissolved inorganic and organic carbon (DIC) from Sabino Creek, located in Sabino Canyon, Pima County, Arizona. The purpose of this study was to monitor changes in dissolved radiocarbon (14C) with time and to understand the processes contributing to these variations. Our results span the period 2009–2016 and show a mixing trend between dissolved inorganic and organic carbon modern end-members with an older component. This study provides preliminary information for more detailed research on recycling of organic components in this stream system.
Intended to test broad hypotheses and arrive at unifying conclusions, meta-analysis is the process of extracting, assembling, and analyzing large quantities of data from multiple publications to increase statistical power and uncover explanatory patterns. This paper describes the ways in which meta-analysis has been applied to support claims and counter-claims regarding two topics widely debated in agricultural research, namely organic agriculture (OA) and conservation agriculture (CA). We describe the origins of debate for each topic and assess prominent meta-analyses considering data-selection criteria, research question framing, and the interpretation and extrapolation of meta-analytical results. Meta-analyses of OA and CA are also examined in the context of the political economy of development-oriented agricultural research. Does size matter? We suggest that it does, although somewhat ironically. While meta-analysis aims to pool all relevant studies and generate comprehensive databases from which broad insights can be drawn, our case studies suggest that the organization of many meta-analyses may affect the generalizability and usefulness of research results. The politicized nature of debates over OA and CA also appear to affect the divergent ways in which meta-analytical results may be interpreted and extrapolated in struggles over the legitimacy of both practices. Rather than resolving scientific contestation, these factors appear to contribute to the ongoing debate. Meta-analysis is nonetheless becoming increasingly popular with agricultural researchers attracted by the power for the statistical inference offered by large datasets. This paper consequently offers three suggestions for how scientists and readers of scientific literature can more carefully evaluate meta-analyses. First, the ways in which papers and data are collected should be critically assessed. Second, the justification of research questions, framing of farming systems, and the scales at which research results are extrapolated and discussed should be carefully evaluated. Third, when applied to strongly politicized topics situated in an arena of scientific debate, as is the case with OA and CA, more conservative interpretations of meta-analytical results that recognize the socially and politically embedded nature of agricultural research is are needed.
The present study evaluates the use of multiple correspondence analysis (MCA), a type of exploratory factor analysis designed to reduce the dimensionality of large categorical data sets, in identifying behaviours associated with measures of overweight/obesity in Vanuatu, a rapidly modernizing Pacific Island country.
Starting with seventy-three true/false questions regarding a variety of behaviours, MCA identified twelve most significantly associated with modernization status and transformed the aggregate binary responses of participants to these twelve questions into a linear scale. Using this scale, individuals were separated into three modernization groups (tertiles) among which measures of body fat were compared and OR for overweight/obesity were computed.
Ni-Vanuatu adults (n 810) aged 20–85 years.
Among individuals in the tertile characterized by positive responses to most of or all the twelve modernization questions, weight and measures of body fat and the likelihood that measures of body fat were above the US 75th percentile were significantly greater compared with individuals in the tertiles characterized by mostly or partly negative responses.
The study indicates that MCA can be used to identify individuals or groups at risk for overweight/obesity, based on answers to simply-put questions. MCA therefore may be useful in areas where obtaining detailed information about modernization status is constrained by time, money or manpower.
OBJECTIVES/SPECIFIC AIMS: (1) Assess if the total duration of EEG suppression during a protocolized exposure to general anesthesia predicts cognitive performance in multiple cognitive domains immediately following emergence from anesthesia. (2) Assess if the total duration of EEG suppression in the same individuals predicts the rate of cognitive recovery in a three-hour period following emergence from anesthesia. METHODS/STUDY POPULATION: This was a non-specified substudy of NCT01911195, a multicenter investigation taking place at the University of Michigan, University of Pennsylvania, and Washington University in St. Louis. 30 healthy volunteers aged 20-40 years were recruited to receive general anesthesia. Participants in the anesthesia arm were anesthetized for three hours at isoflurane levels compatible with surgery (1.3 MAC). Multichannel sensor nets were used for EEG acquisition during the anesthetic exposure. EEG suppression was detected through automated voltage-thresholded classification of 2-second signal epochs, with concordance assessed across sensors. Following return of responsiveness to verbal commands, participants completed up to three hours of serial cognitive tests assessing executive function, reaction time, cognitive throughput, and working memory. Non-linear mixed effects models will be used to estimate the initial cognitive deficit and the rate of cognitive recovery following anesthetic exposure; these measures of cognitive function will be assessed in relation to total duration of suppression during anesthesia. RESULTS/ANTICIPATED RESULTS: Participants displayed wide variability in the total amount of suppression during anesthesia, with a median of 31.2 minutes and range from 0 minutes to 115.2 minutes. Initial analyses suggest that greater duration of burst suppression had a weak relationship with participants’ initial cognitive deficits upon return of responsiveness from anesthesia. Model generation of rate of recovery following anesthetic exposure is pending, but we anticipate this will also have a weak relationship with burst suppression. DISCUSSION/SIGNIFICANCE OF IMPACT: In healthy adults receiving a standardized exposure to anesthesia without surgery, burst suppression appears to be a poor predictor of post-anesthesia cognitive task performance. This suggests that burst suppression may have limited utility as a predictive marker of post-operative cognitive functioning, particularly in young adults without significant illness.
To determine whether nut intake is associated with the prevalence of metabolic syndrome in US adolescents.
A cross-sectional analysis of data from the National Health and Nutrition Examination Survey (NHANES) years 2003–2012. Anthropometric measurements, blood tests, 24 h diet recalls and demographic data were retrieved for participating adolescents. Metabolic syndrome was defined according to paediatric-modified Adult Treatment Panel III criteria. The exposure was defined as a nut intake ≥5 g/d.
Individuals aged 12–19 years (n 2805).
Nut consumption was associated with lower odds for metabolic syndrome (crude OR=0·25; 95 % CI 0·11, 0·55; P≤0·001). This effect was independent of age, sex, race/ethnicity and family income:poverty ratio (adjusted OR=0·27; 95 % CI 0·12, 0·61; P=0·002), and was stable after controlling for nutritional covariates including intake of sugar and total energy consumption (OR=0·36; 95 % CI 0·16, 0·81; P=0·014).
Nut consumption of ≥5 g/d is independently associated with lower odds for metabolic syndrome in US adolescents.
Food insecurity is reported in approximately 28 % of individuals with diabetes in the USA and is associated with poor glycaemic and lipid control. The present study aimed to understand the direct and indirect pathways through which food insecurity impacts glycaemic control in individuals with diabetes.
Adults (n 615) with type 2 diabetes completed validated questionnaires after recruitment from two primary care clinics. Structural equation modelling was used to investigate mechanisms through which food insecurity influences diabetes self-care behaviours and glycaemic control, including investigation into possible direct and indirect effects of perceived stress and social support.
The final model showed that higher food insecurity was directly significantly related to increased stress (r=0·14, P<0·001) and increased glycosylated Hb (r=0·66, P=0·03). Higher stress was significantly related to poorer self-care (r=−0·54, P<0·001) and lower social support (r=−0·41, P<0·001). There was no significant direct association between food insecurity and self-care, or between perceived stress and glycaemic control.
Food insecurity had both a direct effect on glycaemic control and an indirect effect on self-care through stress. The indirect pathway suggests that efforts to address stress may influence the ability of individuals to perform diabetes self-care behaviours. The direct effect on glycaemic control suggests that pathways independent of self-care behaviours may also be necessary to improve diabetes outcomes. Results from the study suggest a multipronged approach is necessary to address food insecurity in individuals with diabetes.